Dr. Abrams asks us:
I am planning on placing two dental implants to
replace the lower right first and second molars in a patient with a long history of bruxism.
The history bruxism has resulted in a completely
flat occlusal plane, i.e. the curve of Monson is flat. Would a screw-retained or cement -retained superstructure be better?
I am aware that an occlusal nightguard is imperative. Any advice would be appreciated.
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I have done a signigicant number of implants on patients with bruxism. Your main concern is fracture of components including abutment screws and even implants. I would suggest you use an implant witha minimum diameter of 4.1 mm–4.8mm, and use cement retained prosthetics.
A wide diameter implant with a deep thread profile would be best. Progressively load the implants PRIOR to definitive restoration to increase mineralization and bone to implant contact. Finally, a plane of occusion that matches his habitual bite.
40 yr old lady, heavy bruxism, missing #19 due to vertical root fracture/endo/posts extraction and loss of #18 {unknown cause}wants #19 implant. I advised her that her level of bruxism is heavy and contraindicates an implant for #19. What is your opinion. This lady wants reimbursement for the “failed endo” #19 done in ’97 and extracted in 2007. {Abscessed and vert. root fracture} with the history of 2 broken files left. Is this request reasonable and fair? jim hales, dds thurs. 19 Nov 09
Dear Jim, I would tell this lady nicely that tires, shoes, tooth brushes and root canal treatment does not last forever. I would also refer her to Eugene McCoy’s web page http://www.toothcrunch.com. This will educate her about bruxing. Keep your money and refer her to some deserving doc that has irritated you in the past. Remember “People In Hell Want Icewater”. She has unrealistic expectations. If you go to the hospital emergency room and die——Your family gets a bill and it has to be paid! We dentist have to change this and take a lesson from our medical buddies.
Jim, don’t wanna sound like a jerk but the patient is in dream world if she wants money back for tx done in 97. If you search around, you can find an article about endo done in most infection controlled environment lasting for about 14- 15 years. (I know endo guys say they last forever) Tell the patient to try, I mean, try to get realistic at least a bit more.
I did not recieved any update information about Dental Implants and Bruxism. Is it contraindicated? is it a complication?
are any diferences in diffrent type of patient or different situations?
1- Implant facing natural dentition (One side or in both sides)?
2 – Implant facing Implants(One side or in both sides)?
Fixed Implant facing Implant supported overdenture?
3- If we fabricate Nigthguard for patients thenafter. what should be done on each above case? how & what should be nigthguard charactersitic of each case? PLEASE SHEAR YOU KNOWLEDGE AND EXPERIENCSES?
Thanks a lot
Jalil Sadr , DMD, MSD, FICD