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Ask UsOcclusal Splint Therapy: An Option for Unsuccessful Dental Implant Treatment?
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Sara, a dental implant patient, asks:
I have been an unsuccessful dental implant patient for two years. I have 2 regular screw-type implants in my lower right posterior molars. I have had 4 sets of crowns. My bite eventually becoming unstable each time. The first 3 sets were made by my general dentist, and the last set by a prosthodontist. Even the last set was in occlusion for only a month then my bite slipped again and I could only chew on the implant side.
I have had a hard acrylic night guard for two months and this has helped some, but my bite is becoming more open on the non-implant side again. What should I do? My prosthodontist is frustrated too. He recommends occlusal splint therapy to stabilize the jaw muscle with a hard acrylic appliance. Would this help?
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7 Responses to “ Occlusal Splint Therapy: An Option for Unsuccessful Dental Implant Treatment? ”
THE 5Ps always apply. Obviously the overall functionality of the dentition was overlooked initially and subsequently. Proper CR and CO are important in all cases. In this case, targeted Botox® treatment should have been used/needs to be used to be able to determine proper CR and CO, and lessen hard and soft tissue imbalances. A full gnathologic work-up should have been performed/ needs to be performed to determine para-functional from functional generated pathways. Comprehensive Orthordontic/Prosthetic treatment will most likely be required. Splint therapy is in and by itself a one way street to nowhere. Splint therapy in conjunction with Botox® with a definitive oral rehabilitation plan is plausible.
In English- the way your teeth meet is not in harmony with the way your jaws want to close. Many people have this problem, some before and some after treatment. Botox use in occlusal problems is not a common method and this may be something the previous dentist has had good results with, but most do not use this and suggesting this to your dentist may suprise him/her.
If the problems have only been since the implant crowns then they are interfering with the jaw movement and positioning. You need to have a good record taken of how the jaws ‘like to close’ before the teeth get in the way ( this is CR- centric relation ) so that the implant crowns dont prevent the other teeth interlocking ( this is CO-centric occlusion). If you have a clicking jaw or had a click which has now disappeared you may have a displaced disc. That is the part that sits between the bones and lets them slide over each other. Splint therapy would be the normal treatment course for this.
It may be worth your time, money & effort to look for a neuromuscular-trained dentist. They are trained & equipped to analyze the difference, as Dr. Aneiros says, between where your teeth want to meet and where your jaw (muscles) what to close. And, I would add, where those muscles want to relax. The Botox is sometimes used to help locate the relaxed position, but is complicated to use as a diagnostic-it lasts for months.
The Dr. that mentioned the benefits of occlusal therapy is absolutely correct. Once her musculature is supple and stabilized, then the teeth can be brought into their proper occlusion, without the muscles working against them. This is the basic premise of Peter Dawson’s seminars. It is relatively easy to obtain from any doctor proficient in his teachings. She can be predictably treated as long as she has no other permanent TM joint dysfunction that is also contributing to the occlusal instability. This just may be a slam dunk!!
Find a dentist who knows how to use a leaf guage.
John, is that like the leaf guage I use to measure my car engine clearances? I REALLY don’t need more materials & equipment to research….
On rereading the initial question, I mostly wonder what is happening with Sara’s TM joint. It sounds as if one side may be collapsing (since the expansion is unlikely) thus leaving her with an open bite somewhere.
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