Protecting dental implants – even when asleep
UncategorisedPosted by: Dental Design 24th October 2023
Some of your patients may be putting their oral health at risk without realising the destruction they’re causing. When someone presents with parafunctional habits, the approach to treatment may need to change – certainly when providing dental implants.
Patient’s may not recognise that bruxism, or teeth grinding, is what is causing migraines, neck and jaw ache, and poor sleep. It’s important to open their eyes to the damage it deals to their oral health, and the risks that it poses to an implant. After all, you’d be frustrated if something you did in your sleep so heavily impacted the time and money invested into over a year of treatment time.[i]
Making considerations
Bruxism is a common parafunctional habit, defined as a repetitive jaw-muscle activity characterised by the clenching or grinding of teeth.[ii] The attrition can cause severe damage to teeth, depending on the intensity of the condition, creating a worn-down appearance and broken structures, in turn increasing sensitivity and the risk of tooth loss.[iii] Patients can exercise the habit whilst asleep or awake, but the nightly action is prevalent in up to 13% of the population. [iv]
The occlusal forces brought on by bruxism are detrimental to newly placed implants, potentially fracturing the implant, loosening or fracturing the screw, or damaging the crown.[v] This has established bruxism as a widely known risk factor for implant patients, alongside the likes of smoking and diabetes.[vi]
It’s important to stress the emphasis on ‘risk’ – bruxism doesn’t immediately condemn implant failure to patients with the habit. One study, conducted over a five-year period, found that the failure rate in patients with a bruxism habit was 42.9%.v This is a steep increase on the 5-10% in another study, which focused on a generalised population over twice the time span.[vii] There is potential for prevention, and professionals should consider additional methods that could maximise success and create a long-lasting solution, to maximise patient satisfaction, and reduce the risk of failure.
Direct action
To prolong the success of a dental implant, a clinician would have to first, or simultaneously, address the effects of the parafunctional habit. If it’s occurring in sleep, patients lack direct control over it. For some, the most important post-treatment management option provided by a dental-professional is an occlusal splint, [viii]which patients may more commonly recognise as a night guard. There are, however, other approaches to protecting patients from their own parafunctional habits.
Bruxism could potentially manifest as an unhealthy coping mechanism that temporarily relieves stress, whilst negatively impacting a patient’s overall health.[ix] One solution, which is far easier said than done, could be reducing the effects or sources of stress within a patient’s life. This could be achieved through regular physical activity or listening to music,[x], [xi] but this may not be enough for some of the larger issues in a patient’s life. Bruxism may prevail, even following stress-management therapy, for example.
An effective treatment of the symptoms, favoured by some, is the injection of botulinum toxin, or Botox, into muscles associated with chewing. Its properties temporarily inhibit muscle contraction, directly addressing the physiological factors of bruxism. Using it in the temporal and masseter muscles has been found to reduce occlusal force by between 20-40%,[xii] an impactful release of the stress upon an implant. Patients must understand the risks of Botox though, including potential muscle paralysis,xii and that it is only temporary, requiring future injections over time.
Oral appliances
Bruxism in sleep is nearly impossible to put a permanent end to. As such, both clinicians and patients should opt for a simple and effective management method. For those unsuited to or unwilling to use Botox, and still struggling with stress, an oral appliance could be a worthy solution. [xiii]
The nightly use of an occlusal splint allows the forces exerted during sleep to be optimally distributed and redirected.[xiv] This reduces the stress at the bone-implant connection, in turn creating more optimal conditions for successful osseointegration.[xv] The level of pressure upon an implant relies upon a multitude of factors: the direction of the functional loads, the quality of the bone support, and the resilient properties of the implant and alveolar bone, to name a few.xv When the night guard distributes the force evenly, or entirely away from the implant, it can maximise the long term success.
Night guards are widely recommended for implant patients with bruxism habits, and they can successfully operate as a consistent solution for mechanical issues, for partially and completely edentulous patients.[xvi],[xvii]
To ensure your patients have an effective solution at hand, to provide comprehensive protection to a fresh implant, consider recommending the SOVA Night Guard – the only over-the-counter dental guard proven to be as effective as a clinician made prosthesis.xiii It can be moulded up to 20 times for a perfect fit (even with braces), with a thin and low profile that is more protective than thicker night guards.
The risk bruxism poses to dental implant survival requires clinicians to take alternative approaches either before or immediately after treatment, and the assurance provided by a night guard could certainly help patients sleep a bit easier.
For more details, please visit Oraldent.co.uk/bruxism or
call 01480 862080
Bio – Julia Svec
Julia Svec is the Product Development Manager for Billion Dollar Smile Cosmetics Ltd. She has spent the last ten years working in collaboration with dentists, laboratories and manufacturers in North America, Europe and Asia researching and developing effective and safe non-peroxide teeth-whitening products for professional and home use.
[i] Funato, A., Yamada, M., & Ogawa, T. (2013). Success rate, healing time, and implant stability of photofunctionalized dental implants. Int J Oral Maxillofac Implants, 28(5), 1261-1271.
[ii] Lobbezoo, F., Ahlberg, J., Glaros, A. G., Kato, T., Koyano, K., Lavigne, G. J., … & Winocur, E. (2013). Bruxism defined and graded: an international consensus. Journal of oral rehabilitation, 40(1), 2-4.
[iii] NHS, (2022). Teeth grinding (bruxism). NHS. (Online) Available at: https://www.nhs.uk/conditions/teeth-grinding/ [Accessed 11th July 2023]
[iv] Beddis, H., Pemberton, M., & Davies, S. (2018). Sleep bruxism: an overview for clinicians. British dental journal, 225(6), 497-501.
[v] Chitumalla, R., Kumari, K. H., Mohapatra, A., Parihar, A. S., Anand, K. S., & Katragadda, P. (2018). Assessment of survival rate of dental implants in patients with bruxism: a 5-year retrospective study. Contemporary clinical dentistry, 9(Suppl 2), S278.
[vi] Kate, M. A., Palaskar, S., & Kapoor, P. (2016). Implant failure: A dentist’s nightmare. Journal of Dental Implants, 6(2), 51.
[vii] Raikar, S., Talukdar, P., Kumari, S., Panda, S. K., Oommen, V. M., & Prasad, A. (2017). Factors affecting the survival rate of dental implants: A retrospective study. Journal of International Society of Preventive & Community Dentistry, 7(6), 351.
[viii] Gayathri, S. K. (2021). Parafunction and Dental Implants. International Journal of Prosthodontic Rehabilitation, 2(1), 17-20.
[ix] Vlăduțu, D., Popescu, S. M., Mercuț, R., Ionescu, M., Scrieciu, M., Glodeanu, A. D., … & Mercuț, V. (2022). Associations between bruxism, stress, and manifestations of temporomandibular disorder in young students. International Journal of Environmental Research and Public Health, 19(9), 5415.
[x] Hamer, M., Endrighi, R., & Poole, L. (2012). Physical activity, stress reduction, and mood: insight into immunological mechanisms. Psychoneuroimmunology: Methods and protocols, 89-102.
[xi] Linnemann, A., Ditzen, B., Strahler, J., Doerr, J. M., & Nater, U. M. (2015). Music listening as a means of stress reduction in daily life. Psychoneuroendocrinology, 60, 82-90.
[xii] Kwon, K. H., Shin, K. S., Yeon, S. H., & Kwon, D. G. (2019). Application of botulinum toxin in maxillofacial field: Part III. Ancillary treatment for maxillofacial surgery and summary. Maxillofacial Plastic and Reconstructive Surgery, 41, 1-9.
[xiii] Gerstner, G., Yao, W., Siripurapu, K., Aljanabi, H., Decker, A., Ludkin, D., … & Tewksbury, C. (2020). Over‐the‐counter bite splints: A randomized controlled trial of compliance and efficacy. Clinical and experimental dental research, 6(6), 626-641.
[xiv] Komiyama, O., Lobbezoo, F., De Laat, A., Iida, T., Kitagawa, T., Murakami, H., … & Kawara, M. (2012). Clinical management of implant prostheses in patients with bruxism. International journal of biomaterials, 2012.
[xv] Chrcanovic, B. R., Albrektsson, T., & Wennerberg, A. (2015). Bruxism and dental implants: A meta-analysis. Implant dentistry, 24(5), 505-516.
[xvi] Gowd, M. S., Shankar, T., Ranjan, R., & Singh, A. (2017). Prosthetic consideration in implant-supported prosthesis: A review of literature. Journal of International Society of Preventive & Community Dentistry, 7(Suppl 1), S1.
[xvii] Maló, P., de Araújo Nobre, M., Petersson, U., & Wigren, S. (2006). A pilot study of complete edentulous rehabilitation with immediate function using a new implant design: case series. Clinical implant dentistry and related research, 8(4), 223-232.
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