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Ask UsBruxism: Suggestions for Affordable Treatment?
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Dr. B. asks:
I have a patient in his late thirties who has an edentulous maxilla and near full complement of mandibular teeth. He is a severe night time bruxer and has a gag reflex. I fear if I place dental implants and make a u- shaped overdenture his bruxing will destroy the implants. I have considered custom abutments with attachments – ERA or Locators – but this is very expensive. I would appreciate it if anyone has some helpful suggestions to assist my patient. Thanks.
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6 Responses to “ Bruxism: Suggestions for Affordable Treatment? ”
Why not instruct him to remove the overdenture / appliance at night; no teeth, no bruxism or provide him with an appropriate occlusal guard.
When we do this type of case with mini implants, we just take an impression of the arch with implants, place analogs in the impression and pour, then construct a “suck-down” heavy vinyl mouthguard material and trim it in a u-shape so it covers only the six implants. Works great, almost free if you do it yourself, and patients love it (even non-bruxers)
A tissue supported/implant retained upper denture is probably the best option (AKA implant overdenture) with 2-4 implants. This way it can be removed at night. A soft custom athletic guard can be worn over the mandibular teeth if trauma to the maxillary anterior ridge becomes a problem. An implant supported/retained upper FPD (hybrid) is probably not a good option b/c the bruxism may create biomechanical and prosthetic failure issues.
Also if you have adequate retention on 3-4 maxillary implants I have seen successful cases where some of the palate can be removed from the overdenture combined with metal reinforcement.
Bruxing is a complication of structural, insufficient nasal & intra-oral space limitations leading to functional breathing deficiencies and neuro-muscular Mandibular response.
What to do?
Consider using implants to anchor orthopedic appliances and orthopedically develop (dimensional increase) of maxillary structure, than followed by sufficient neuro-muscular vertical dimension when completing the bite relation.
I prefer the idea about the guard attached to the implants. Get anterior stops!
Dr. Gelb - I wasn’t aware that the source of bruxing had been discovered. Can you point me to some literature supporting your assertion?
Thanks,
Jason
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