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1
IMPLANTS IN BRUXISM
DEPARTMENT OF PROSTHODONTICS
Dr. Sreeram.v.vijayPost-Graduate Trainee
2 Contents
Introduction Consequences Of Overload Of Dental Implants Causes Of Overload Of Implants Bruxism Occlusal Considerations For Implant Prostheses Occlusal Material For The Suprastructure In Implant Prostheses Management Of Bruxism Conclusion
3 Introduction
What Is An Implant ? “A prosthetic device made of alloplastic biomaterial, surgically implanted
into the oral tissues beneath the mucosa, and/ or within the bone to provide retention and support for a fixed or removable prosthesis”.
GPT - 8
Osseointegration The apparent direct attachment or connection of osseous tissue to an inert,
alloplastic material without intervening connective tissue.
GPT - 8
4
OVERLOAD
BIOLOGICAL BIOMECHANICAL
Consequences of overload of dental implants
5 Biological complications
Early failures
Late failures
Insufficient osseointegration Pathological bone loss after complete osseointegration
Clinical Management of Implant Prostheses in Patients with Bruxism Osamu Komiyama,Frank Lobbezoo International Journal of Biomaterials ,Volume 2012
6 Biomechanical complications
Screw loosening
Implant fracture
Uncemented restoration
7 Component fracture
Porcelain fracture
Prosthesis fracture
8 Causes of overload of implants Poor bone density/quality
Inadequate number of implants
Large occlusal table
Steep cusp inclinationOcclusal consideration in implant therapy, Kim Y, Oh T-J, Misch CE ; Clin. Oral Impl. Res. 16, 2005 / 26–35
9 Excessive premature contacts >180 µm in monkey studies >100 µm in human
Overextended cantilever >15 mm in the mandible >10–12 mm in the maxilla
Parafunctional habits/Heavy bite force
Bruxism Clenching
Occlusal consideration in implant therapy, Kim Y, Oh T-J, Misch CE ; Clin. Oral Impl. Res. 16, 2005 / 26–35
10 What Is Bruxism ?
Bruxism is a movement disorder of the masticatory system that is expressed, among others, by tooth grinding and clenching, during sleep as well as during wakefulness.
11Bruxism - Diagnosis
Lavigne et al. proposed sleep bruxism research diagnostic criteria (SB-RDC)
A history of frequent tooth grinding occurring at least 3 nights per week for the preceding 6 months, as confirmed by a sleep partner
Clinical presence of tooth wear
Masseter muscle hypertrophy
Report of jaw muscle fatigue or tenderness in the morning
12
Bruxism has also been suggested to cause excessive (occlusal) load of dental implants and their suprastructures
Bruxism is often considered as contraindication for implant treatment.
Researchers use bruxism as an exclusion criterion for the selection of their participants in clinical studies concerning treatment modalities with dental implants
Bruxism – Contraindication for implants ?
13
In a study of 379 patients who had used implant prostheses for many years, occlusal wear had no statistically significant impact on vertical peri-implant bone loss
Occlusal wear was closely related to bruxism, and thus bruxism did not seem to be a risk factor for the examined variables
Bruxism – Insignificant in implant therapy !
14Occlusal considerations for implant prostheses
Natural tooth is attached through periodontal ligaments and osseointegrated implant has a rigid bone contact
A natural tooth can be intruded about 28 to100 μm by a light force (20 N) compared to only 2 to 5 μm for an osseointegrated implant
Clinical Management of Implant Prostheses in Patients with Bruxism Osamu Komiyama,Frank Lobbezoo International Journal of Biomaterials ,Volume 2012
15
Occlusal perception level is higher for implant prostheses than for natural teeth
Occlusal scheme for an implant prosthesis should be designed to decrease cuspal interferences, centralize forces along the long axis, and minimize lateral forces
Clinical Management of Implant Prostheses in Patients with Bruxism Osamu Komiyama,Frank Lobbezoo International Journal of Biomaterials ,Volume 2012
16 Clinical trials regarding the influence of bruxism on
implant prostheses are limited
Clinical Management of Implant Prostheses in Patients with Bruxism Osamu Komiyama,Frank Lobbezoo International Journal of Biomaterials ,Volume 2012
17 Authors’ views on the same
Taylor et al The damaging effects of bruxism are created through lateral friction between the occlusal surfaces of maxilla and mandible
Miyata et al The relationship between occlusal overload and peri-implant tissue and suggested that peri-implant bone resorption occurred under occlusal overload
18
Heitz-Mayfield et al A period of 8 months of excessive occlusal load on titanium implants did not result in loss of osseointegration or marginal bone loss when compared with nonloaded implants in animal study
19Occlusal material for the suprastructure in implant prostheses
Materials Advantages Disadvantages
Acrylic resin Shock absorbing material No wear resistance
Metal ceramic Withstand maximum occlusal forces
Chipping or a fracture of ceramic portion
Ceramic Superior esthetics and wear resistance
Maximum forces transmitted to the implant – bone interface
Zirconia Long lasting and good esthetics
Cause friction against the root of the tooth as well as other teeth
Clinical Management of Implant Prostheses in Patients with Bruxism Osamu Komiyama,Frank Lobbezoo International Journal of Biomaterials ,Volume 2012
20
Management of bruxismNight Guard And Pharmacological Approach For Bruxism
Night Guard
CONSEQUENCES OF NOCTURNAL PARAFUNCTIONAL HABITS MAY BE PREVENTED BY ACRYLIC RESIN NIGHT GUARDS
21
22
23 A night guard should promote even occlusal contacts around the arch in
centric-related occlusion
The consequences or intensity of the bruxism habit may be directly observed
Night guard is hollowed out at the implant sites so no occlusal force is transmitted to the implant prostheses
A soft material may also be placed around the crowns for stress relief and to decrease the impact force on the crowns
24 Pharmacological Approach
Low doses of the dopamine D1/D2 receptor agonist pergolide finally resulted in a substantial and lasting reduction in the bruxism
The use of acetylcholine-inhibiting formulations such as botulinum toxin
Benzodiazepam–type drugs and muscle relaxants have been prescribed by clinicians in an attempt to reduce nocturnal bruxism
Dopaminergic medication also appears to demonstrate potential utility in reducing nocturnal bruxism
[Guideline] Kato T, Thie NM, Montplaisir JY, Lavigne GJ. Bruxism and orofacial movements during sleep.Dent Clin North Am. 2001 Oct. 45(4):657-84
25 Conclusion
The lack of well-designed clinical trials regarding the consequence of bruxism on implant prostheses poses a serious problem.
At present, expert opinion and cautionary approaches are still considered the best available sources for suggesting good practice indicators.
There is an urgent need for those actively engaged in clinical research centers and university research institutes to provide evidence on whether the subjective feeling of clinicians regarding the approach of bruxism in implant patients is correct or not.
26References
T. D. Taylor, J. Wiens, and A. Carr, “Evidence-based considerations for removable prosthodontic and dental implant occlusion: a literature review,” Journal of Prosthetic Dentistry, vol. 94, no. 6, pp. 555–560, 2005
T. Haraldson, G. E. Carlsson, and B. Ingervall, “Functional state, bite force and postural muscle activity in patients with osseointegrated oral implant bridges,” ActaOdontologica Scandinavica, vol. 37, no. 4, pp. 195–206, 1979
J. van der Zaag, F. Lobbezoo, P. G. G. L. van der Avoort, D. J. Wicks, H. L. Hamburger, and M. Naeije, “Effects of pergolide on severe sleep bruxism in a patient experiencing oral implant failure,” Journal of Oral Rehabilitation, vol. 34, no. 5, pp. 317– 322, 2007
27 Occlusal consideration in implant therapy, Kim Y, Oh T-J, Misch CE ; Clin. Oral Impl. Res. 16,
2005 / 26–35
Effects Of Pergolide On Severe Sleep Bruxism In A Patient Experiencing Oral Implant Failure, Jac. Van Der Zaag, Frank Lobbezoo, J Oral Rehabil. 2007;34(5):317-322.
Bruxism: Its Multiple Causes And Its Effects On Dental Implants – An Updated Review* F. Lobbezoo, J. Van Der Zaag & M. NAEIJE, Journal Of Oral Rehabilitation 2006 33; 293–300
[Guideline] Kato T, Thie NM, Montplaisir JY, Lavigne GJ. Bruxism and orofacial movements during sleep.Dent Clin North Am. 2001 Oct. 45(4):657-84
Does bruxism contribute to dental implant failure? Zhou Y, Gao J, Luo L, Wang Y. A systematic review and meta-analysis. Clinical Implant Dentistry and Related Research 2015
Management of Abutment Screw Loosening: Review of Literature and Report of a Case Vinod Krishnan, C. Tony Thomas & Ipe Sabu Volume 14 Number 3 J Indian Prosthodont Soc (2014) 14:208-214
28
THANK YOU