This document discusses implants in patients with bruxism. It defines implants and osseointegration. Bruxism can overload implants and cause biological and biomechanical complications like bone loss, screw loosening, and fracture. Bruxism is diagnosed through tooth wear, muscle hypertrophy, and jaw pain/fatigue. While some research shows bruxism does not affect implants, occlusal considerations are important for implant prostheses given their rigid fixation. Management of bruxism includes night guards and pharmacological therapies to reduce forces. More research is still needed on the effects of bruxism on dental implants.

1. IMPLANTS IN BRUXISM
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DEPARTMENT OF PROSTHODONTICS
Dr. Sreeram.v.vijay
Post-Graduate Trainee

2. Contents
 Introduction
 Consequences Of Overload Of Dental Implants
 Causes Of Overload Of Implants
 Bruxism
 Occlusal Considerations For Implant Prostheses
 Occlusal Material For The Suprastructure In Implant Prostheses
 Management Of Bruxism
 Conclusion
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3. Introduction
What Is An Implant ?
 “A prosthetic device made of alloplastic biomaterial, surgically implanted
into the oral tissues beneath the mucosa, and/ or within the bone to provide
retention and support for a fixed or removable prosthesis”.
GPT - 8
Osseointegration
 The apparent direct attachment or connection of osseous tissue to an inert,
alloplastic material without intervening connective tissue.
GPT - 8
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4. 4
OVERLOAD
BIOLOGICAL BIOMECHANICAL
Consequences of overload of dental implants

5. Biological complications5
Early failures Late failures
Insufficient osseointegration Pathological bone loss after
complete osseointegration
Clinical Management of Implant Prostheses in Patients with Bruxism
Osamu Komiyama,Frank Lobbezoo International Journal of
Biomaterials ,Volume 2012

6. Biomechanical complications
 Screw loosening
 Implant fracture
 Uncemented restoration
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7.  Component fracture
 Porcelain fracture
 Prosthesis fracture
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8. Causes of overload of implants
 Poor bone density/quality
 Inadequate number of implants
 Large occlusal table
 Steep cusp inclination
8
Occlusal consideration in implant therapy,
Kim Y, Oh T-J, Misch CE ; Clin. Oral Impl.
Res. 16, 2005 / 26–35

9.  Excessive premature contacts
 >180 µm in monkey studies
 >100 µm in human
 Overextended cantilever
 >15 mm in the mandible
 >10–12 mm in the maxilla
 Parafunctional habits/Heavy bite force
 Bruxism
 Clenching
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Occlusal consideration in implant therapy,
Kim Y, Oh T-J, Misch CE ; Clin. Oral Impl.
Res. 16, 2005 / 26–35

10. What Is Bruxism ?
 Bruxism is a movement disorder of the masticatory system that is
expressed, among others, by tooth grinding and clenching, during
sleep as well as during wakefulness.
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11. Bruxism - Diagnosis
Lavigne et al. proposed sleep bruxism research diagnostic criteria
(SB-RDC)
 A history of frequent tooth grinding occurring at least 3 nights per
week for the preceding 6 months, as confirmed by a sleep partner
 Clinical presence of tooth wear
 Masseter muscle hypertrophy
 Report of jaw muscle fatigue or tenderness in the morning
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12.  Bruxism has also been suggested to cause excessive (occlusal) load
of dental implants and their suprastructures
 Bruxism is often considered as contraindication for implant
treatment.
 Researchers use bruxism as an exclusion criterion for the selection
of their participants in clinical studies concerning treatment
modalities with dental implants
12 Bruxism – Contraindication for implants ?

13.  In a study of 379 patients who had used implant prostheses for many
years, occlusal wear had no statistically significant impact on
vertical peri-implant bone loss
 Occlusal wear was closely related to bruxism, and thus bruxism did
not seem to be a risk factor for the examined variables
13 Bruxism – Insignificant in implant therapy !

14. Occlusal considerations for implant prostheses
 Natural tooth is attached through periodontal ligaments and osseointegrated
implant has a rigid bone contact
 A natural tooth can be intruded about 28 to100 μm by a light force (20 N)
compared to only 2 to 5 μm for an osseointegrated implant
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Clinical Management of Implant Prostheses in Patients with Bruxism Osamu
Komiyama,Frank Lobbezoo International Journal of Biomaterials ,Volume
2012

15.  Occlusal perception level is higher for implant prostheses than for natural
teeth
 Occlusal scheme for an implant prosthesis should be designed to decrease
cuspal interferences, centralize forces along the long axis, and minimize
lateral forces
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Clinical Management of Implant Prostheses in Patients with Bruxism Osamu
Komiyama,Frank Lobbezoo International Journal of Biomaterials ,Volume 2012

16. Clinical trials regarding the influence of bruxism on
implant prostheses are limited16
Clinical Management of Implant Prostheses in Patients with Bruxism Osamu
Komiyama,Frank Lobbezoo International Journal of Biomaterials ,Volume 2012

17. Authors’ views on the same
 Taylor et al
The damaging effects of bruxism are created through lateral
friction between the occlusal surfaces of maxilla and mandible
 Miyata et al
The relationship between occlusal overload and peri-implant
tissue and suggested that peri-implant bone resorption occurred under
occlusal overload
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18.  Heitz-Mayfield et al
A period of 8 months of excessive occlusal load on titanium
implants did not result in loss of osseointegration or marginal bone loss
when compared with nonloaded implants in animal study
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19. Occlusal material for the suprastructure in
implant prostheses19
Materials Advantages Disadvantages
Acrylic resin Shock absorbing material No wear resistance
Metal ceramic Withstand maximum
occlusal forces
Chipping or a fracture of
ceramic portion
Ceramic Superior esthetics and wear
resistance
Maximum forces transmitted
to the implant – bone
interface
Zirconia Long lasting and good
esthetics
Cause friction against the
root of the tooth as well as
other teeth
Clinical Management of Implant Prostheses in Patients with Bruxism Osamu
Komiyama,Frank Lobbezoo International Journal of Biomaterials ,Volume 2012

20. Management of bruxism
Night Guard And Pharmacological Approach For Bruxism
Night Guard
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CONSEQUENCES OF NOCTURNAL
PARAFUNCTIONAL HABITS MAY
BE PREVENTED BY ACRYLIC
RESIN NIGHT GUARDS

21. 21

22. 22

23.  A night guard should promote even occlusal contacts around the arch in
centric-related occlusion
 The consequences or intensity of the bruxism habit may be directly
observed
 Night guard is hollowed out at the implant sites so no occlusal force is
transmitted to the implant prostheses
 A soft material may also be placed around the crowns for stress relief and
to decrease the impact force on the crowns
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24. Pharmacological Approach
 Low doses of the dopamine D1/D2 receptor agonist pergolide
finally resulted in a substantial and lasting reduction in the bruxism
 The use of acetylcholine-inhibiting formulations such as botulinum
toxin
 Benzodiazepam–type drugs and muscle relaxants have been
prescribed by clinicians in an attempt to reduce nocturnal bruxism
 Dopaminergic medication also appears to demonstrate potential
utility in reducing nocturnal bruxism
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[Guideline] Kato T, Thie NM, Montplaisir JY, Lavigne GJ. Bruxism
and orofacial movements during sleep.Dent Clin North Am. 2001
Oct. 45(4):657-84

25. Conclusion25
The lack of well-designed clinical trials regarding the
consequence of bruxism on implant prostheses poses a serious
problem.
At present, expert opinion and cautionary approaches are still
considered the best available sources for suggesting good
practice indicators.
There is an urgent need for those actively engaged in clinical
research centers and university research institutes to provide
evidence on whether the subjective feeling of clinicians
regarding the approach of bruxism in implant patients is correct
or not.

26. References
 T. D. Taylor, J. Wiens, and A. Carr, “Evidence-based considerations for removable
prosthodontic and dental implant occlusion: a literature review,” Journal of Prosthetic
Dentistry, vol. 94, no. 6, pp. 555–560, 2005
 T. Haraldson, G. E. Carlsson, and B. Ingervall, “Functional state, bite force and
postural muscle activity in patients with osseointegrated oral implant bridges,”
ActaOdontologica Scandinavica, vol. 37, no. 4, pp. 195–206, 1979
 J. van der Zaag, F. Lobbezoo, P. G. G. L. van der Avoort, D. J. Wicks, H. L.
Hamburger, and M. Naeije, “Effects of pergolide on severe sleep bruxism in a patient
experiencing oral implant failure,” Journal of Oral Rehabilitation, vol. 34, no. 5, pp.
317– 322, 2007
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27.  Occlusal consideration in implant therapy, Kim Y, Oh T-J, Misch CE ; Clin. Oral Impl. Res.
16, 2005 / 26–35
 Effects Of Pergolide On Severe Sleep Bruxism In A Patient Experiencing Oral Implant
Failure, Jac. Van Der Zaag, Frank Lobbezoo, J Oral Rehabil. 2007;34(5):317-322.
 Bruxism: Its Multiple Causes And Its Effects On Dental Implants – An Updated Review* F.
Lobbezoo, J. Van Der Zaag & M. NAEIJE, Journal Of Oral Rehabilitation 2006 33; 293–
300
 [Guideline] Kato T, Thie NM, Montplaisir JY, Lavigne GJ. Bruxism and orofacial
movements during sleep.Dent Clin North Am. 2001 Oct. 45(4):657-84
 Does bruxism contribute to dental implant failure? Zhou Y, Gao J, Luo L, Wang Y. A
systematic review and meta-analysis. Clinical Implant Dentistry and Related Research 2015
 Management of Abutment Screw Loosening: Review of Literature and Report of a Case
Vinod Krishnan, C. Tony Thomas & Ipe Sabu Volume 14 Number 3 J Indian Prosthodont
Soc (2014) 14:208-214
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28. THANK YOU
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