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Replacing Maxillary Second Molars in Patient with Bruxism?

posted in Treatment Planning & Complications, advice

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Dr. P. asks:
I have a Type I diabetic patient who has lost one of his legs due to vascular compromises from the diabetes. He also has a severe bruxing problem and has lost several teeth due to fracture. We have done a fair number of root canals and crowns on him.

We recently had to extract a maxillary second molar because either the root canal failed or the root fractured. It had a gold crown. The root canal had been retreated once by an endodontist and the tooth also had experienced several periodontal abscesses. Now the contralateral maxillary second molar has abscessed after root canal treatment and a crown. I am concerned about him fracturing more premolars and molars. Would it be a good or bad idea to replace his maxillary second molars with wide platform implants to help support is bite?

4 Responses to “ Replacing Maxillary Second Molars in Patient with Bruxism? ”

• jw October 14th, 2008

  
  

  There are many issues to this case. First, I would ensure that your patient had a bruxing guard. Bruxing is not great for implant success. Two, it sounds as if you patient has compliance issues with his diabetes, not good for implant success. Third, the bone in the posterior maxilla is poor, again, not good for success. Fourth, what are you trying to gain? An occlusal stop so the mandibular teeth don’t supererupt? cost/benefit is low. Greater occlusal area for mastication? Most of the mastication is done first molar forward. If he is missing other teeth, I might start there. SOMEONE will do this case, but the chances of success given the givens is not great. You might want to save yourself the grief and expense.

• doctorberg October 14th, 2008

  
  

  I would say that in such a case: stay away… implats are not magic and if there is blood sugar issues a the point of loosing limbs, it is certainly not a good candidate. JW is pretty close to what I think, so take the hint and dont go there.

• dr ACatic October 15th, 2008

  
  

  Is there a maxillary third molar present? If so, do the FPD and a relaxation occlusal splint therapy.
  If there is no third molar, just do the relaxation occlusal splint therapy.
  Definitely stay away from implants in this case.

• R. Hughes October 16th, 2008

  
  

  Dear Dr. P, I do not recommend implant treatment with implants for this patient to replace a second molar, considering all to conditions you listed. Make him a nice bruxing appliance and call it a day!

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