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Considerations In Bruxist Patients

Functional loading of implants has been shown to potentially enhance osseointegration (Duyck and Vandamme, 2014). However, it is generally accepted that occlusal loads must significantly exceed normal physiological limits before they can compromise the integrity of the surrounding tissues (Lang and Lindhe, 2015).

 

Potential Consequences of Overloading Implants:

  • Early Biological Failure: Excessive lateral forces can cause micromovement of the implant, leading to insufficient osseointegration and early implant failure.
  • Late Biological Failure: Even after successful osseointegration, pathological bone loss can occur if inflammation is present and excessive forces persist.
  • Mechanical and Technical Failures: Overload can result in the failure of both the implant and its superstructure.

While occlusal parafunctions like bruxism are known to affect implant prostheses, the direct causal relationship between implant failure and overload remains inconclusive (Manfredini et al., 2011). Although the effect of bruxism on implant survival and osseointegration is still not fully understood (Chrcanovic et al., 2015a), evidence suggests that bruxism may increase the risk of implant failure and the likelihood of mechanical and technical complications (Chrcanovic et al., 2017). Specifically, retrospective studies have reported higher implant failure rates in patients with bruxism (13%) compared to those without parafunctional habits (4.6%) (Chrcanovic et al., 2016c).

 

Strategies to Reduce Implant Complications in Bruxism Patients:

  • Monitor and manage parafunctional habits.
  • Use occlusal splints to protect the implant.
  • Reduce cantilevers and narrow the occlusal table.
  • Decrease cuspal inclines.
  • Increase the number of implants and contact points.
  • Implement progressive loading, particularly in patients with poor bone quality.
  • Prefer metal restorations over porcelain for molar teeth.
  • Consider using acrylic teeth for extensive restorations (Manfredini et al., 2011; Sheridan et al., 2016).

These strategies aim to mitigate the risks associated with bruxism and enhance the long-term success of implant-supported restorations.

 

We would like to acknowledge Dr. Manraj Kalsi for his insights and contributions to this page