Bruxism and Implant Restorations
Based on clinical experience, probably every dentist would group bruxers into a high-risk category for technical and mechanical complications and failures once the implant restorations are delivered.
The mechanical overload of the implant restorations can cause significant mechanical/technical complications. These would be fracture of the restorative material, fracture of the framework, loosening of the restoration, loosening or fracture of the screw. According to case reports even implant fractures seem to occur more frequently in bruxers. Although there is still no proof for the suggestion that bruxism may cause an overload of dental implants and of their suprastructures, a careful approach is nevertheless recommended. The loss of the periodontal ligament (PDL) once the tooth is extracted is the major difference between how teeth and how implants react to the overloading during bruxism. The osseointegration of the implants allows for almost no axial mobility during overloading of the masticatory surfaces of the restorations. As a consequence some changes need to be consider in the treatment plan in order for the final restoration to became a healthy part of the stomatognathic system and for its longevity.
Besides the recommendation to control the forces applied by bruxism itself, these guidelines concern also the occlusion design. The specific occlusal guidelines that need a different approach from the usual tooth supported restorations concern will be discussed in this presentation. The differences between tooth supported and implant restorations will be explored and through a series of clinical cases the differences in the occlusal design will be discussed.