Implant Patient with Bruxism: What Steps Need to Be Taken to Ensure Success?

Dr. B asks:

I have a patient with a history of bruxism (clenching specifically) that is considering implant surgery to replace/repair a number of lost or damaged teeth. Due to the bruxism this patient has required far longer than usual to heal after general dental work, particularly root canal treatments. While he has a custom guard that reduces the impact, I am concerned that continual clenching will impair the implant’s ability to ‘settle’ and could in fact cause them to fail.

As I have only limited knowledge of implant procedures, I want to know if bruxism is an issue with implants or if there are ways to overcome the impact of clenching until the implant post has been able to fully heal?

Due to the cost of implants, as you can appreciate, I am unwilling to advise this patient to consider implants if there is a sufficient risk of failure. I look forward to hearing some comments.

5 Comments on Implant Patient with Bruxism: What Steps Need to Be Taken to Ensure Success?

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Ezio Costa

3/22/2011

In patients with bruxism, there is a possibility very effective to protect the delicate initial phase of implants integration: the use of the botulinum toxin (TBA). The TBA, in the masseter muscle, reduces the force for about 4-6 months.

Jim

3/22/2011

If you are not sure which way to go with this consult a prosthodontist because increasing the vertical dimension if you are going that route will be tricky. But a simple single implant with flat occlusion, so there are no lateral forces has been successful in the several times I have restored them. The occlusal table should also be narrow and the patient told that. If the crown is a molar and the same size as a natural tooth the porcelain will fracture off if the coping is not wide and high enough to support the porcelain and again the lateral forces on the implant should be minimized, so smaller occlusal surface area especially in B-L direction. Hope that helps a little. Also use an experienced lab, or you will have problems with the porcelain.

Pankaj Narkhede, DDS; MDS

3/22/2011

Please use maximum available bone keeping in mind the basic principles of required bone width around the body. After sufficient healing period you may use composite crowns for progressive healing. That way you will understand the occlusion and also let the bone heal according to the load factor. As the natural teeth has PDL and they move - The implant crowns come in contact only when the patient clenches hard. Occlusal guard is advised. Please mount the case on a Denar to study well and then plan the treatment. Also follow comments made by Jim Pankaj Narkhede, DDS;MDS prosthodontics & surgery

Dr. Peter, Croatia

3/22/2011

Dear dr. B. I need more information to give to you better advice. In which region you want to put implants, does your patient have one or more teeth distal from implants? If has, are they in good condition. What is with TMJ? Did you make a functionally analysis? Has your patient clicking in TMJ(during opening or closing mouth)? Today there are a lot of patients who has bruxism, who grind or who clench teeth. I had and still have a lot of patients in therapy with same or similar problems and there is a procedure what to do. It's step by step therapy. Don't hurry. In first step you must prepare conditions for next step.

alan

3/22/2011

Carl Mish presented a webinar on occlusal forces. The forces exerted on implant restoration exceed the forces exerted on teeth for the same amout of pressure. This information is as fundamental to dental implant success as bone quality and surface aera. If you can catch this presentation at an imlpant meeting you will have an appriciation of forces exerted on implant restorations. Work with the surgeon to plan the number of implants required for treatment of this patient. You will want to inform the patient of their cost before you get started. Good luck you are right to be concerned about a patient who bruxes.