Restorations

Restoring teeth involved with bruxism is challenging. Restorations will commonly be needed to repair chips, breaks, attrition, fractures in the tooth or root, and abfractions. The severity of tooth wear depends on the restoration and the material chosen for best results. Usually anterior restorations main purpose is to restore the lost enamel, by bulking up the teeth that have been shortened and flattened from grinding. In the posterior teeth crowns are commonly needed for chips, breaks and fractures.

Crowns

Gold

Gold is the strongest material available and the material of choice for patients suffering from bruxism. It is less likely to break and can withstand the force of bruxism better than any other material. Gold wears similiar to enamel and it does not cause excessive wear to opposing teeth. Gold is an excellent choice for posterior teeth.

Porcelain-fused-to-metal

This material is used in areas where aesthetics is a concern. It is known to be durable and lasting, although the ceramic surface can be abrasive to the opposing teeth.

Zirconia

Zirconia has substantial strength characteristics as well.

Solid zirconia or “monolithic zirconia” has the greatest strength in this classification of material for bruxism. It has a natural translucency and is recommended for posterior teeth. It also causes minimal wear on opposing teeth.

Layered zirconia is more suitable for anterior teeth since it’s more translucent and opalescent. It has good strength with great aesthetics.

Implants

Natural teeth are the best option in the mouth, however, many times natural teeth fail due to grinding. Implants are not meant to withstand the force of stress from the overload of bruxism.

In some cases, untreated bruxism with an implant may increase the failure rate or can be a contraindication for placement. The success of a dental implant depends on the process of osseointegration. This bond allows the implant to stay securely within the bone, like a natural tooth. Bruxism can interfere with osseointegration by moving the implant back and forth and not allowing the bone-to-implant connection to completely heal and increase dental implant failure.

Bruxism can also cause late implant complications, due to the excessive force on the implant. Forces are considered by magnitude, duration, direction, type, and magnification. The consistency of any of these forces can create crestal bone loss, fractures of implant components such as restoration and the implant itself.⁵⁹

Use of a wider implant decreases the strain on the implant and dissipates stress to the bone. The larger the diameter of an implant the stronger it is, since it provides more of a surface area. Greater surface area designs such as a titanium alloy with an external hex design can be advantageous. Natural teeth have the periodontal membrane where the implant does not. This membrane helps the teeth withstand stress better, although still significantly less than a natural tooth.

If an implant is placed and bruxism is a habit, using a night guard can relieve the implant area allowing the natural teeth to take the brunt, thus prolonging the life of the implant.⁶⁰

Dentures

Edentulous is a lack of teeth, when teeth are extracted for dentures (partial and full) there is a[l1] bone resorption process that happens. When teeth are extracted residual ridge resorption happens with the rate of resorption the fastest in the first six months and then gradually after that. This can affect the success of dentures. The jaw becomes “disuse atrophy” where the teeth are no longer present to stimulate bone.

The pattern of resorption of the mandible is downward and outward to become wider, while the maxilla resorbs upwards and inwards to become smaller. This resorption can change the alveolar ridge affecting denture stability and retention. ⁶¹With already permanent loss of the jaw bone just from the lack of teeth and then adding dentures to the mix can increase resorption faster. Dentures alone, do not stimulate the bone to stay healthy, in fact it puts pressure on the bone to gradually resorb at a faster rate than if there was a dentition.

Dentures and Bruxism

• There is an adjustment period with dentures as the muscles will need time to acclimate since the jaw may not align properly without teeth to promote bruxism

• Dentures increase bone resorption and the change in gum ridge shape can cause ill fitting dentures to promote bruxism

• When chewing with dentures the forces are not evenly spread across the dentures, like they are with natural teeth but rather concentrated pressure points to accelerate localized resorption and causing ill fitting dentures to promote bruxism⁶²

Typically dentures need to be replaced about every 5-10 years if they need replaced sooner that could be a sign of bruxism.

Evaluating dentures for wear should be part of the dental appointment.

Ways to tell if patients are bruxing with dentures:

• Wear and tear on the denture

• Chipped, broken and cracked dentures

• Changes in fit: they become loose, uncomfortable and/or pressure spots on the gums

• Needing more frequent adjustments, relining, repairs or replacements

• Ill fitting dentures

Treatment:

• Night guard if wearing dentures at night

• Gum guard when not wearing dentures at night

• Myofunctional therapy