Occlusal considerations in maintaining health of implants and their restorations

Dental implants are a regular feature in daily clinical practice and there is a need to undertake routine assessment and maintenance of implants and their restorations on par with that provided for natural teeth. Occlusal checks form an important part of the maintenance regime for preserving the integrity of implants, their restorations, and health of the peri-implant tissues. Implant restorations are subjected to the full characteristics and magnitude of occlusal forces, including those associated with parafunction. Compared with the periodontal ligament around teeth, the biophysical response to occlusal forces of osseointegration is different through the more rigid link of implant to bone and reduced proprioception. Risks attributable to occlusal forces primarily affect implant restorations and they are elevated in the presence of bruxism. The occlusal guidelines recommended by the literature are aimed at reducing these risks and regular assessment and maintenance of the occlusion is essential. A four-step sequence is presented to ensure that the annual occlusal checks include the patient's input and evaluation of restoration integrity, occlusal scheme, additional protection, and spatial changes.

Dental Implant Treatment in Bruxers: A Case Report and Literature Review

This case report presents a literature review and a case report of a full-mouth implant rehabilitation for a 65-year-old woman with a history of Bruxism. The patient's oral condition showed dentition with severe occlusal wear, extensive dental work, and missing teeth replaced with bridges and implants. The existing dental work was failing due to recurrent caries and the mechanical failure of long-span bridges. The unique aspect of the treatment presented in this report is the management of existing osseointegrated implants of different systems with different platform designs, which adds to the treatment's complexity. The existing implants were incorporated into the planned treatment, and other implants were added to support maxillary zirconia and mandibular hybrid full-arch prostheses. After 2 years of function, extensive wear was evident on the milled acrylic, even though an occlusal guard was used. New acrylic teeth were processed using the same milled titanium bar of the mandibular hybrid prosthesis, and the occlusal surfaces of the acrylic teeth were protected with gold onlays. The patient is seen regularly for maintenance every 6 months with no further complications. Careful evaluation, planning, and treatment execution are paramount in managing patients with a history of bruxism. Patients should be prepared and informed about possible mechanical failure and seen regularly for maintenance.

Clinical and cone beam computed tomography outcomes of maxillary anterior implant restorations after immediate implant placement with interim restorations: A 1- to 14-year retrospective analysis

STATEMENT OF PROBLEM: Achieving and maintaining optimal tissue health and esthetics when immediately placing maxillary anterior implants with interim restorations has been challenging and the clinical outcomes heterogenous.

PURPOSE

The purpose of this retrospective study was to evaluate the clinical outcomes of immediate placement of maxillary anterior implants with interim restorations and compare the tomographic and clinical results before and after implant placement in participants followed for 1 to 14 years.

MATERIAL AND METHODS

Twenty participants receiving 25 postextraction single implants in the anterior maxilla were studied. Clinical parameters included pink esthetic score (PES) and white esthetic score (WES), peri-implant phenotype, implant probing, plaque index, and cone beam computed tomography (CBCT) to compare initial and at least 1 year after crown placement (postoperative). For qualitative variables, a descriptive analysis was carried out. The PES and WES results were analyzed by using nonparametric statistics, the median (ME) and the interquartile range (IQR) were used as summary measures, and the Wilcoxon sum of signs test was used to compare the total scores between the intervention area and the contralateral tooth. To compare pre- and postoperative data points, the paired t test was used (α=.05).

RESULTS

Mean ±standard deviation (SD) time of follow-up was 7.6 ±4.2 years. Twenty participants with a mean ±SD age of 62.4 ±11.0 years old received 25 implants. Mean ±SD initial torque value at implant placement was 38.6 ±9.63 Ncm. Bone height at the top of the alveolar ridge (BH) and bone width at the middle of the alveolar ridge (BW2) showed a statistically significant decrease between the initial and subsequent CBCT measurements (both P<.001). Likewise, the bone width at the alveolar crest (BW1) showed a statistically significant decrease between the initial and post-CBCT measurements (P=.006). Facial bone integrity (FBI) revealed a statistically significant increase between the initial and postoperative time periods (P<.001). The PES index showed a median of 9.0 IQR (8-10), statistically lower than the contralateral tooth (P=.032). No significant differences were found for the WES index or for FBI, regardless of the peri-implant phenotype.

CONCLUSIONS

Immediate implant placement in the maxillary anterior sextant was found to be a predictable procedure with good esthetic results when the protocol described was used. Labial bone loss is inevitable after tooth extraction but can be compensated for by filling the space with a xenograft material. Long-term gingival tissue integrity was maintained, regardless of phenotype, in periodontally healthy participants.

Does Bruxism Affect Marginal Bone Level around Single Tooth Implants in the Posterior Mandible?

Background

Parafunctional forces are a potential risk factor for implant-related complications. This study aimed to evaluate the possible relationship of bruxism with implant-related complications and marginal bone loss (MBL).

Methods

In this prospective cohort study, patients were divided into two groups with and without bruxism, and received single-tooth implants in the posterior mandible. Patients in the bruxer group were requested to use a customized fabricated night guard. Bone quality was also assessed based on CBCT scans. The MBL, crown detachment, and porcelain fracture were evaluated, and clinical assessments were made at the 12-month follow-up.

Results

Seventy patients were studied in two groups (n = 35 in each group). None of the implants in any of the two groups showed pain, sensitivity, suppuration, exudation, clinically detectable mobility, or peri-implant radiolucency. No significant difference was observed between the two groups in the mean MBL at the 12-month follow-up (p =  0.60). Regarding bone quality, there was no significant difference in the mean MBL among different types of bone qualities (p = 0.66). There were no significant differences regarding crown detachment and porcelain fracture between the two groups either (p =  0.32 and p =  0.30, respectively).

Conclusion

According to the results of this study, dental implant treatment according to the suggested protocol in bruxers yielded promising outcomes.

Retrospective clinical study of tooth-supported single crowns: A multifactor analysis

The purpose of the study was to investigate the influence of multiple factors on the survival of tooth‐supported single crowns and assess the biological and technical complications. This retrospective study included patients rehabilitated with single crowns with a minimum follow‐up time of 6 months after delivery. The cumulative survival rate was calculated over the maximum period of follow‐up time and reported in a life‐table survival analysis. Univariate and multivariate Cox regression was used to evaluate the associations between clinical covariates and crown failure. The included cohort group consisted of 1037 single crowns delivered in 401 patients and followed for a mean of 134.8 ± 80.2 months. Cumulative survival rate was 89.9% and 80.9% after 5 and 10 years and 70.5% and 61.8% after 15 and 20 years, respectively. The main reasons for single crown failure were loss of retention, tooth loss, and fracture. Anterior placement, non‐vital abutments, and bruxism significantly influenced the survival of single crowns. The survival of single crowns was not influenced by patient's age and sex, location of the crowns in relation to the jaws, type of tooth, presence of post and core, and type of crown material, treatment providers, or smoking. Anterior placement, non‐vital abutments, and bruxism are factors suggested to increase the risk of single crown failure and the prevalence of technical and biological complications.

Prevalence and predictors of bruxism in two university clinic patient populations with dental implants: A cross-sectional analysis

OBJECTIVE

To analyze the prevalence, predictors, and prosthetic complications of bruxing patients with dental implants in two tertiary clinics in Istanbul, Turkey.

METHODS

Patients with at least one dental implant and with a fixed prosthesis were examined for the evidence of probable bruxism. Factors that could be related to bruxism were analyzed in relation to patient-specific variables. Technical and mechanical complications were investigated.

RESULTS

A total of 1688 patients were analyzed. The overall rate of probable bruxism was 19.72%. Besides self-reported bruxism (p < 0.022), antidepressant use (p < 0.002), frequent headaches (p < 0.014), and observation of linea alba (p < 0.028) were the predictors for probable bruxism. Technical and mechanical complications were frequent in the probable bruxers (p < 0.05).

CONCLUSION

Overall prevalence of bruxism was 19.72%, and bruxism was associated with general and gender-specific predictors.

Clinical outcomes of botulinum toxin type A injections in the management of primary bruxism in adults: A systematic review

STATEMENT OF PROBLEM

Botulinum toxin has been used for various therapeutic and esthetic purposes for nearly 4 decades and has shown positive outcomes in patients with bruxism. However, the effectiveness of botulinum toxin injections as an alternative to traditional therapies in the management of primary bruxism is still unclear.

PURPOSE

The purpose of this systematic review was to analyze the clinical outcomes of the use of botulinum toxin type A injections in the management of primary bruxism in adults.

MATERIAL AND METHODS

Databases such as PubMed, Web of Science, Scopus, LILIACS, Cochrane Library, and Open Grey Literature were searched without language or date restrictions until October 6, 2019. Using Mendeley Desktop software to organize the references, 2 independent researchers selected the published clinical studies (Study type) on the improvement of symptoms (Outcome) in human adults with primary bruxism (Participants/Population) who received botulinum toxin type A injections (Intervention), placebo injections, saline injections, no injections, or other treatments (Comparator(s)/Control) for the management of bruxism.

RESULTS

A total of 601 references were initially obtained from the 6 databases. Six randomized clinical trials and 4 case series were selected and critically appraised according to the Fowkes and Fulton guidelines. Heterogeneity among the studies did not allow for a meta-analysis. All studies supported the efficacy and safety of botulinum toxin injections in reducing the symptoms of primary bruxism.

CONCLUSIONS

Botulinum toxin type A injections are effective in the treatment of the symptoms of primary bruxism in adults. Randomized clinical trials are still needed to establish a protocol for using botulinum toxin as an alternative to traditional therapies in the management of primary bruxism.

Recording of bruxism events in sleeping humans at home with a smart instrumented splint

Objective: The aim of this paper is to report quantitative and qualitative characteristics of bruxism events recorded in sleeping humans with a new smart ambulatory system specifically designed to measure dental clenching and grinding forces. The device is wireless and rechargeable, which enables its use over extended periods.Methods: Thirty recordings were obtained from volunteer subjects who wore the device at home during 10 consecutive nights (Clinicaltrials.gov N° NCT03363204).Results: The recordings showed that the system was able to successfully monitor bruxism during 10 consecutive nights, allowing a quantitative (number, duration, intensity, distribution during the night), as well as a qualitative characterization of the bruxism events (clenching vs. grinding).Discussion: This system could offer new perspectives in the field of bruxism, either as a research tool for clinical studies or as a medical device for the ambulatory home-based monitoring of bruxism.

Tardive Dyskinesia, Oral Parafunction, and Implant-Supported Rehabilitation

Oral movement disorders may lead to prosthesis and implant failure due to excessive loading. We report on an edentulous patient suffering from drug-induced tardive dyskinesia (TD) and oral parafunction (OP) rehabilitated with implant-supported screw-retained prostheses. The frequency and intensity of the movements were high, and no pharmacological intervention was possible. Moreover, the patient refused night-time splint therapy. A series of implant and prosthetic failures were experienced. Implant failures were all in the maxilla and stopped when a rigid titanium structure was placed to connect implants. Ad hoc designed studies are desirable to elucidate the mutual influence between oral movement disorders and implant-supported rehabilitation.

Sleep bruxism: challenges and restorative solutions

Bruxism is a parafunctional activity related to clenching or grinding the teeth and tooth wear can be a consequence of sleep bruxism (SB). Management of severe tooth wear due to SB is a challenging situation because of the common reduced amount of remaining dental structure and loss of vertical dimension of occlusion. Rationale for the planning of oral rehabilitation of patients with SB presenting severe tooth wear should rely on evidence-based approaches; however, few studies have discussed properties of dental materials for SB rehabilitation and how to cosmetically manage severe tooth wear. This review aimed to provide an overview into bruxism cosmetic rehabilitation and how this can be implemented with good outcomes for the patient.

A random fatigue of mechanize titanium abutment studied with Markoff chain and stochastic finite element formulation

To measure fatigue in dental implants and in its components, it is necessary to use a probabilistic analysis since the randomness in the output depends on a number of parameters (such as fatigue properties of titanium and applied loads, unknown beforehand as they depend on mastication habits). The purpose is to apply a probabilistic approximation in order to predict fatigue life, taking into account the randomness of variables. More accuracy on the results has been obtained by taking into account different load blocks with different amplitudes, as happens with bite forces during the day and allowing us to know how effects have different type of bruxism on the piece analysed.

Bruxism is unlikely to cause damage to the periodontium: findings from a systematic literature assessment

BACKGROUND

This paper systematically reviews the MEDLINE and SCOPUS literature to answer the following question: Is there any evidence that bruxism may cause periodontal damage per se?

METHODS

Clinical studies on humans, assessing the potential relationship between bruxism and periodontal lesions (i.e., decreased attachment level, bone loss, tooth mobility/migration, altered periodontal perception) were eligible. Methodologic shortcomings were identified by the adoption of the Critical Appraisal Skills Program quality assessment, mainly concerning the internal validity of findings according to an unspecific bruxism diagnosis.

RESULTS

The six included articles covered a high variability of topics, without multiple papers on the same argument. Findings showed that the only effect of bruxism on periodontal structures was an increase in periodontal sensation, whereas a relationship with periodontal lesions was absent. Based on the analysis of Hill criteria, the validity of causation conclusions was limited, mainly owing to the absence of a longitudinal evaluation of the temporal relationship and dose-response effects between bruxism and periodontal lesions.

CONCLUSIONS

Despite the scarce quantity and quality of the literature that prevents sound conclusions on the causal link between bruxism and the periodontal problems assessed in this review, it seems reasonable to suggest that bruxism cannot cause periodontal damage per se. It is also important to emphasize, however, that because of methodologic problems, particularly regarding sleep bruxism assessment, more high-quality studies (e.g., randomized controlled trials) are needed to further clarify this issue.

Jaw clenching effects in relation to two extreme occlusal features: patterns of diagnoses in a TMD patient population

OBJECTIVE

The aim of this investigation was to compare the pattern of temporomandibular disorder (TMD) diagnoses in clenching patients with different occlusal features, the null hypothesis being that no between-group differences exist.

MATERIALS AND METHODS

Two groups of subjects receiving a jaw clenching diagnosis and having large overjet or anterior open bite (Group A; N=45, 75.5% females, mean age: 38.1 +/- 15.9 years) or normal occlusion (Group B; N=69, 71% females, mean age: 34.6 +/- 13.8 years) were recruited among a TMD patient population and were given Research Diagnostic Criteria for TMD (RDC/TMD) axis I diagnoses, namely, group I muscle disorders, group II disc displacements, and group III arthralgia/osteoarthritis/osteoarthrosis.

MAJOR FINDINGS

The distribution of RDC/TMD single and combined group diagnoses was significantly different between the two groups (P<0.05), with Group A subjects showing a higher prevalence of multiple diagnoses (60% versus 43.3%), as well as a higher prevalence of combined RDC/TMD axis I group II and III diagnoses (37.8% versus 20.2%). All TMD signs and symptoms were more frequent in the patients with large overjet or anterior open bite with respect to the patients with normal occlusion.

CONCLUSION

In a TMD patient population, jaw clenching may have different consequences in subjects with large overjet or anterior open bite with respect to subjects featuring normal occlusion.

Prevalence of sleep bruxism in children: a systematic review of the literature

The aim of the present investigation was to perform a systematic review of the literature dealing with the issue of sleep bruxism prevalence in children at the general population level. Quality assessment of the reviewed papers was performed to identify flaws in the external and internal validity. Cut-off criteria for an acceptable external validity were established to select studies for the discussion of prevalence data. A total of 22 publications were included in the review, most of which had methodological problems limiting their external validity. Prevalence data extraction was performed only on eight papers that were consistent as for the sampling strategy and showed only minor external validity problems, but they had some common internal validity flaws related with the definition of sleep bruxism measures. All the selected papers based sleep bruxism diagnosis on proxy reports by the parents, and no epidemiological data were available from studies adopting other diagnostic strategies (e.g. polysomnography or electromyography). The reported prevalence was highly variable between the studies (3·5-40·6%), with a commonly described decrease with age and no gender differences. A very high variability in sleep bruxism prevalence in children was found, due to the different age groups under investigation and the different frequencies of self-reported sleep bruxism. This prevented from supporting any reliable estimates of the prevalence of sleep bruxism in children.

Occlusion for implant-supported fixed dental prostheses in partially edentulous patients: a literature review and current concepts

Implant treatment has become the treatment of choice to replace missing teeth in partially edentulous areas. Dental implants present different biological and biomechanical characteristics than natural teeth. Occlusion is considered to be one of the most important factors contributing to implant success. Most literature on implant occlusal concepts is based on expert opinion, anecdotal experiences, in vitro and animal studies, and only limited clinical research. Furthermore, scientific literature regarding implant occlusion, particularly in implant-supported fixed dental prostheses remains controversial. In this study, the current status of implant occlusion was reviewed and discussed. Further randomized clinical research to investigate the correlation between implant occlusion, the implant success rate, and its risk factors is warranted to determine best clinical practices.