Sleep bruxism: challenges and restorative solutions

Semidirect Resin Composite Veneers in a Patient with Bruxism

This case report details the esthetic rehabilitation of a 32-year-old male patient suffering from sleep bruxism, primarily manifesting as a fracture and significant loss of tooth structure in the anterior maxillary central incisors. To address these concerns, the patient underwent a restorative treatment involving the application of semidirect resin composite veneers on the maxillary incisors and direct resin composite restoration on the incisal regions of the maxillary canines. This approach not only restored the functional integrity of the teeth but also significantly enhanced the patient's esthetic appearance.

Effects on Sleep Bruxism Activity of Three Different Oral Appliances: One Year Longitudinal Cohort Study

BACKGROUND

Different oral appliances (OAs) have been proposed to control sleep bruxism (SB) detrimental effects on the stomatognathic system.

OBJECTIVE

The aim of the study was to evaluate the effect of different OAs on SB activity and masticatory muscle activity (sMMA) measured by EMG.

METHODS

This longitudinal cohort study was conducted on 51 patients (21 M, 30 F, mean age 26,5 ± 3,5) suffering from SB diagnosed with a validated portable EMG-ECG holter and wearing different OAs: occlusal splints, functional appliance with metallic bites and clear aligners followed after 1 week, 1 month, 3 months, 6 months and 12 months from delivery. A control group of 16 non-treated SB patients (6 M, 10 F mean age 27,1 ± 1,4) was used as a reference. A multiple regression analysis was performed to estimate the differences between groups. The level of significance was set as P value <0,05.

RESULTS

Occlusal splint reduced sleep bruxism index after 1 week, 3, 6 and 12 months from delivery while functional appliance only after 12 months. Occlusal splints reduced general phasic contractions only in the first week and sleep bruxism-related phasic contractions at 1 week, 3 and 6 months after delivery with no significant reductions after 12 months. Patients wearing clear aligners showed a reduction in general tonic contractions after 6 and 12 months.

CONCLUSION

Resin and metal bites can reduce sleep bruxism index, while resin bites can reduce sleep bruxism-related phasic contractions. Clear aligners do not influence sleep bruxism index but can reduce tonic contractions.

Sleep Bruxism in Children: A Narrative Review

Sleep bruxism, characterized by involuntary grinding or clenching of the teeth and/or by bracing or thrusting of the mandible during sleep, is common in children. Sleep bruxism occurs while the patient is asleep. As such, diagnosis can be difficult as the affected child is usually unaware of the tooth grinding sounds. This article aims to familiarize physicians with the diagnosis and management of sleep bruxism in children. A search was conducted in May 2023 in PubMed Clinical Queries using the key terms "Bruxism" OR "Teeth grinding" AND "sleep". The search strategy included all observational studies, clinical trials, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. According to the International classification of sleep disorders, the minimum criteria for the diagnosis of sleep bruxism are (1) the presence of frequent or regular (at least three nights per week for at least three months) tooth grinding sounds during sleep and (2) at least one or more of the following (a) abnormal tooth wear; (b) transient morning jaw muscle fatigue or pain; (c) temporary headache; or (d) jaw locking on awaking. According to the International Consensus on the assessment of bruxism, "possible" sleep bruxism can be diagnosed based on self-report or report from family members of tooth-grinding sounds during sleep; "probable" sleep bruxism based on self-report or report from family members of tooth-grinding sounds during sleep plus clinical findings suggestive of bruxism (e.g., abnormal tooth wear, hypertrophy and/or tenderness of masseter muscles, or tongue/lip indentation); and "definite" sleep bruxism based on the history and clinical findings and confirmation by polysomnography, preferably combined with video and audio recording. Although polysomnography is the gold standard for the diagnosis of sleep bruxism, because of the high cost, lengthy time involvement, and the need for high levels of technical competence, polysomnography is not available for use in most clinical settings. On the other hand, since sleep bruxism occurs while the patient is asleep, diagnosis can be difficult as the affected child is usually unaware of the tooth grinding sounds. In clinical practice, the diagnosis of sleep bruxism is often based on the history (e.g., reports of grinding noises during sleep) and clinical findings (e.g., tooth wear, hypertrophy and/or tenderness of masseter muscles). In childhood, sleep-bruxism is typically self-limited and does not require specific treatment. Causative or triggering factors should be eliminated if possible. The importance of sleep hygiene cannot be over-emphasized. Bedtime should be relaxed and enjoyable. Mental stimulation and physical activity should be limited before going to bed. For adults with frequent and severe sleep bruxism who do not respond to the above measures, oral devices can be considered to protect teeth from further damage during bruxism episodes. As the orofacial structures are still developing in the pediatric age group, the benefits and risks of using oral devices should be taken into consideration. Pharmacotherapy is not a favorable option and is rarely used in children. Current evidence on the effective interventions for the management of sleep bruxism in children is inconclusive. There is insufficient evidence to make recommendations for specific treatment at this time.

Factors associated with preschool children's sleep bruxism

OBJECTIVE

To evaluate the prevalence of sleep bruxism, related factors, and quality of life of preschool children and their families.

METHOD

The sample was 475 children between 4 and 5 years old enrolled in schools in the city of Bauru-Brazil. Parents/legal guardians answered two questionnaires, one to assess the presence of bruxism and related factors and another that was the validated Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). Intraoral clinical examination was performed by two trained examiners (Kappa = 0.82) within the school environment. The data were analyzed using statistics and the Mann-Whitney, Kruskal-Wallis, and Spearman correlation coefficient. The significance level was p < 0.05.

RESULTS

The prevalence of sleep bruxism was 47.4%. The highest prevalence was related to Class I canines and marked overjet, oral habits, such as nail biting, lip biting, chewing gum, and mouth breathing. Children with agitated sleep, reports of headache, and those considered aggressive, anxious, and/or shy were also more related.Conclusion: In the studied sample, sleep bruxism prevalence was high and related to important oral and general factors. Data also indicated SB as the main factor that interfered in the OHRQoL of children and their families.

Apical periodontitis after intense bruxism

BACKGROUND

Bruxism is known to cause masticatory muscle pain, temporomandibular joint pain, headaches, mechanical tooth wear, prosthodontic complications and cracked teeth. Less known to the practitioner, and described only experimentally in literature, is that bruxism can also damage the pulp. To our knowledge, this is the first known clinical case of a patient developing apical periodontitis due to bruxism.

CASE PRESENTATION

This article presents the case and successful treatment of a 28-year-old healthy male patient with apical periodontitis on teeth 36 and 46 requiring root canal treatment after an intense phase of bruxism. Due to an unclear diagnosis, treatment had been delayed.

CONCLUSIONS

Incomprehensible tooth pain can be the result of bruxism. Practitioners need to be informed that intense bruxism can possibly lead to apical periodontitis. It is important, therefore, that a thorough anamnesis is collected and taken into account during diagnostics.

A 3D Finite Element Analysis Model of Single Implant-Supported Prosthesis under Dynamic Impact Loading for Evaluation of Stress in the Crown, Abutment and Cortical Bone Using Different Rehabilitation Materials

In the literature, many researchers investigated static loading effects on an implant. However, dynamic loading under impact loading has not been investigated formally using numerical methods. This study aims to evaluate, with 3D finite element analysis (3D FEA), the stress transferred (maximum peak and variation in time) from a dynamic impact force applied to a single implant-supported prosthesis made from different materials. A 3D implant-supported prosthesis model was created on a digital model of a mandible section using CAD and reverse engineering. By setting different mechanical properties, six implant-supported prostheses made from different materials were simulated: metal (MET), metal-ceramic (MCER), metal-composite (MCOM), carbon fiber-composite (FCOM), PEEK-composite (PKCOM), and carbon fiber-ceramic (FCCER). Three-dimensional FEA was conducted to simulate the collision of 8.62 g implant-supported prosthesis models with a rigid plate at a speed of 1 m/s after a displacement of 0.01 mm. The stress peak transferred to the crown, titanium abutment, and cortical bone, and the stress variation in time, were assessed.

[Study on the correlation between the mandibular masticatory muscle movement and sleep tooth wear]

OBJECTIVE

To investigate the correlation between the clinical diagnostic criteria of sleep bruxism and the frequency of mandibular movements during sleep.

METHODS

Video polysomnography was used to record 20 healthy adults with at least one of the following clinical symptoms and signs: 1) report of frequent tooth grinding; 2) tooth wear and dentin exposure with at least three occlusal surfaces; 3) masticatory muscle symptoms in the morning; 4) masseter muscle hypertrophy. The rhythmic masticatory muscle activity (RMMA) and isolated tonic activity were scored to compare the correlations with clinical symptoms and signs. Finally, the incidence of temporomandibular disorders (TMD) was investigated in patients with isolated tonic and RMMA subjects.

RESULTS

Among the 20 subjects, RMMA events were observed (5.8±3.1) times·h⁻¹ and isolated tonic episodes were observed (2.1±0.9) times·h⁻¹. The frequency of RMMA events was significantly greater in the patients with acoustic molars than in those without (P<0.05). Similarly, the frequency of RMMA events was significantly greater in the patients with tooth attrition than in those without (P<0.05). However, no difference was observed between the occurrence of RMMA and the symptoms of masticatory muscles or masseter hypertrophy in the morning. The incidence of TMD was significantly higher in the patients with RMMA than in the isolated tonic patients.

CONCLUSIONS

The clinical symptoms and signs often used to diagnose sleep bruxism are different clinical and physiological mandibular movements during sleep. RMMA during sleep can reflect the occurrence of tooth attrition and the high risk of TMD.

Associations between sleep bruxism and (peri-)implant complications: lessons learned from a clinical study

Objective

To report and discuss the lessons learned from the conduct of a clinical study on the associations between sleep bruxism and (peri-)implant complications, the protocol of which has been pre-published.

Materials and methods

A single-center, double-blind, prospective cohort study with a 2 year follow-up was performed in the Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. Eleven adult participants were included, where an inclusion of 98 was planned. Sleep bruxism was assessed by multiple single-channel electromyographic (EMG) recordings. Main outcomes were biological and technical complications. Results of the study are presented alongside with comments on encountered difficulties.

Results

Insufficient participant recruitment and failed EMG recordings were encountered. The small sample size did not allow answering the study’s main aim, and was mainly attributed to the study’s protocol complexity. EMG recording failures were attributed to insufficient quality of the EMG signal and detachments of the electrode.

Discussion

The lessons learned from the conduct of this study can be used to design successful future clinical studies.

Conclusions

Adequate participant recruitment, effective EMG recordings, and a careful selection of predictor variables are important ingredients for the successful conduct of a longitudinal clinical study on the association between sleep bruxism and (peri-)implant complications.

Comparison between conventional and computerised methods in the assessment of an occlusal scheme

PURPOSE

In the definition of an occlusal scheme, clinicians should choose between conventional and computerised methods based on a careful appraise of the advantages and limitations. This study aims to assess the correlation between the two approaches in a clinical setting.

METHODS

Twenty-four patients were included to compare different methods of occlusal contacts assessment on the posterior surfaces of flat mandibular appliances. In supine position, they were asked to clench with maximum strength, in the maximum intercuspation position with a 24 μm articulating paper positioned between the teeth and the appliance surface. An extra-oral photograph of the marks was taken (total N = 2082). They were visually classified based on a pre-defined scale (ie, conventional assessment) and with ImageJ analysis software (ie, photographic software assessment). Additionally, a computerised occlusal analysis was performed (ie, computerised assessment). Correlation analysis of the data achieved with conventional, photographic and computerised assessments was performed.

RESULTS

Correlation between conventional and computerised assessments was weak (r = .265), whilst it was moderate between conventional and photographic assessments (r = .633), as well as between photographic and computerised assessments (r = .476).

CONCLUSIONS

This investigation showed a weak-to-moderate correlation between different methods (ie, conventional, photographic and computerised) to assess occlusal marks. None of the three can actually be considered the standard of reference, but based on their specific features, it can bet suggested that the conventional method may be enough for most clinical purposes, unless otherwise proven.