Relation between bruxism and dental implants

OBJECTIVE: The aim of this study was to gather information and discuss the predictability of implant-supported prostheses in patients with bruxism by performing a literature review. METHODS: In order to select the studies included in this review, a detailed search was performed in PubMed and Medline databases, using the following key words: bruxism, dental implants, implant supported prosthesis, and dental restoration failure. Items that were included are: case reports, randomized controlled trials, in vitro studies, literature and systematic reviews, with or without meta-analysis, of the last 20 years that addressed the theme. Articles without abstracts, animal studies, articles in languages other than English and articles from journals unrelated to the dental field were excluded. RESULTS: after analysis according to inclusion and exclusion criteria, 28 articles were selected from a total of 54. It is known from the array of scientific articles which have assessed, either through retrospective, prospective or experimental studies, that the biomechanical and biological impact of bruxism on implant-supported prostheses is small, and that the literature has contributed little to exemplify the prosthetic limits of safety for the specialist from a clinical point of view. CONCLUSION: Although there is still no general consensus on this matter, most of the literature review articles do provide clinical guidelines that contribute to implant supported prostheses longevity and stability in patients with bruxism.OBJETIVO: Realizar uma revisão sistemática, a fim de reunir informações e discutir a previsibilidade de próteses sobre implantes em pacientes com bruxismo. MÉTODOS: Para a identificação dos estudos dessa revisão, foi realizada uma estratégia de busca detalhada e avançada nos bancos de dados PubMed e Medline. Foram utilizados como descritores: bruxismo, implantes dentários, prótese implantossuportada e falha da restauração dentárial; bruxism, dental implants, implant-supported prosthesis e dental restoration failure. Os critérios de inclusão foram: artigos clínicos, estudos controlados aleatórios, estudos in vitro, revisões de literatura e revisões sistemáticas com e sem meta-análise dos últimos 20 anos que abordassem o tema proposto. Os critérios de exclusão foram: artigos sem resumo, estudos em animais, artigos cujo idioma não fosse o inglês e artigos de periódicos que não pertencessem à área odontológica. RESULTADOS: De um total de 54 artigos, após uma análise segundo o critério de inclusão e exclusão, foram selecionados 28 artigos. É sabido que a quantidade de artigos científicos que avaliaram, seja através de estudos retrospectivos, prospectivos ou experimentais, o impacto biológico e biomecânico do bruxismo em próteses sobre implantes é pequena e pouco tem contribuído para melhor exemplificação e discernimento dos limites protéticos de segurança para o especialista sob um ponto de vista clínico. CONCLUSÃO: Portanto, ainda não há um consenso geral acerca desse assunto, porém, a maioria dos artigos de revisão de literatura fornecem guias de orientação clínica, os quais auxiliam na longevidade e estabilidade de próteses sobre implantes em pacientes com bruxismo

Terapéutica alternativa asociada al bruxismo: revisión de literatura

The aim of this study was to review the literature in order to discuss the main and the most effective therapeutic activities to control the nocturnal bruxism. To identify the studies included in this review, it was conducted a detailed and advanced search strategy in the PubMed and Medline databases. It was used as KEY WORDS: bruxism, therapeutics and drug therapy. Inclusion criteria were: case reports, randomized controlled trials, in vitro studies, literature reviews and systematic reviews with or without meta-analysis of the past 10 years that addressed the theme. Exclusion criteria were: articles without abstract, animal studies, articles whose first language was not English and articles from journals that do not belong to the dentario field. From a total of 83 articles, after an analysis according to the inclusion and exclusion criteria, 33 articles were selected. Despite the fact that there is a small number of prospective clinical studies with high degree of reliability and most studies that evaluated the alternative treatments effectiveness are isolated case reports, the current literature shows that the use of botulinum toxin has been shown to be effective in the control of nocturnal bruxism. On the other hand, important aspects such as transitory effect, safe dosage and application technique are still little discussed, then, further studies are needed to have these doubts clarified.El objetivo del presente estudio fue realizar una revisión de literatura actualizada, con la finalidad de discutir las principales y más eficaces actividades terapéuticas en el control del bruxismo nocturno. Para la identificación de los estudios, fue realizada una estrategia de búsqueda detallada y avanzada en los bancos de datos: PubMed y Medline. Fueron utilizados como PALABRAS CLAVE: bruxism, therapeutics y drug therapy. Los criterios de inclusión fueron: artículos clínicos, estudios controlados aleatorios, estudios in vitro, revisiones de literatura y revisiones sistemáticas con y sin meta-análisis de los últimos 10 años, que aborden el tema propuesto. Los criterios de exclusión fueron: artículos sin resumen, estudios en animales, artículos cuyo idioma no sea el inglés y artículos de revistas que no pertenecen al área odontológica. De un total de 83 artículos, después de un análisis según el criterio de inclusión y exclusión, fueron seleccionados 33 artículos. A pesar de la pequeña cantidad de estudios clínicos prospectivos con alto grado de confiabilidad y que la mayoría de los estudios que evaluaron la eficacia de tratamientos alternativos fueron reportes de casos clínicos aislados, la literatura muestra que la utilización de la toxina botulínica se mostró eficaz para el control del bruxismo nocturno. Por otro lado, aspectos importantes como el efecto transitorio, dosis segura y técnica de aplicación aún son poco estudiados, de esa manera más investigaciones son necesarias para que esas dudas sean esclarecidas

Sobredentaduras mandibulares inmediatas: revisión de literatura

Conventional complete denture even though well confectioned, could present deficiencies in the retention, stability and support, in addition uncomfortable and retention of food below it. The overdentures have been considered an alternative to resolve problems and negative experiences with the conventional dentures, thus also can be an alternative to the complex treatments (surgical/prosthetic) with implant-supported prosthesis. In the attempt to reduce the healing time for the confection of the dentures showed higher rates of success to the implants when immediate mandibular overdentures were used in the rehabilitation of edentulous patients. The aim of this paper was to discuss by means of a Literature review, the viability of the use of mandibular implant-supported overdentures. The immediate mandibular overdentures have been showed like a reproducible method, predictable and confidence to provide an efficient function to the total edentulous patients.Las Prótesis totales convencionales aún cuando bien confeccionadas, pueden presentar deficiencias en la retención, estabilidad y soporte, además de la incomodidad y acumulo de alimentos. Las sobredentaduras sobre implantes fueron consideradas una alternativa para solucionar problemas y experiencias negativas con las prótesis convencionales, así también pueden ser una alternativa a los tratamientos complejos (quirúrgico/protésico) con prótesis fijas soportadas por implantes. Buscando reducir el período de cicatrización para la confección de las prótesis, las investigaciones mostraron altos índices de éxito para los tratamientos con sobredentaduras mandibulares inmediatas sobre implantes, que fueron utilizadas en la rehabilitación de pacientes edéntulos. Este trabajo tiene como objetivo abordar, por medio de una revisión de literatura, la viabilidad de la utilización de sobredentaduras mandibulares implanto retenidas. Los implantes de carga inmediata que retienen una sobredentadura mandibular que ha mostrado ser un método reproducible, previsible y de confianza para restablecer una eficiente función masticatoria a los pacientes totalmente edéntulos

Photoelastic Analysis of Biomechanical Behavior of Single and Multiple Fixed Partial Prostheses With Different Prosthetic Connections

The aim of this study was to evaluate the stress distribution on external hexagon, internal hexagon, and Morse taper implant in single and 3-unit implant-supported fixed partial prostheses (FPPs) using photoelasticity. Six models were fabricated with the photoelastic resin PL-2: 3 models for the 3-unit implant-supported FPP with implants of 4.0 x 10.0 mm in the region of the second premolar and molar including 1 model for each type of implant connection, and 3 models for the single prosthesis for each implant type. The prostheses fabrication was standardized. A circular polariscope was used, and axial and oblique (45 degrees) loads of 100 N were applied in a universal testing machine. The results were photographed and analyzed qualitatively. The internal hexagon implant exhibited better stress distribution and lower intensity of fringes followed by the external hexagon and Morse taper implants for the models with the 3-unit prostheses. For the single implants, the Morse taper implant presented better stress distribution, followed by the internal and external hexagon implants. The oblique loading increased the number of photoelastic fringes in all models. It was concluded that the internal hexagon implant exhibited better biomechanical behavior for the 3-unit implant-supported FPP, whereas the Morse taper implant was more favorable for the single implant-supported prosthesis. The oblique loading increased the stress in all models.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Evaluation of temporomandibular joint noise in partially edentulous patients.

In order to evaluate the presence of TMD (temporomandibular disorder), dissatisfaction related to the use of removable partial dentures (RPD) and the effect of the treatment on temporomandibular joint noises, 13 female patients with Kennedy class I and II mandibular arch were selected. Another 13 young, asymptomatic, dentate patients, also female, were used as reference. After four years, 38.4% were found to have a moderate or severe degree of TMD. Over the four years, the degree of TMD increased in 46.15% of the patients, was not affected in 20.07%, while in 15.38% it decreased or the patients remained free from signs and symptoms. About 30% of the patients at the second year and 46% after the fourth year, had complaints regarding retention and stability. It was concluded that there is no relationship between TMD and the condition of partially edentulous Kennedy class I and II, but patient dissatisfaction increased after the second year and temporomandibular joint noise was reduced significantly with the replacement of the teeth

Influence of ridge type on mandibular distal extension removable partial denture.

The aim of this study was to use photoelastic models to analyze the distribution of stress caused by the incidence of loads on a mandibular distal extension removable partial denture, both on the abutment teeth and on differently shaped residual ridges: distal ascending, descending-ascending, horizontal and distal descending. The best type of retainer and location of the rest on the last abutment tooth were determined for the different types of ridge. Four models were made from photoelastic resin (PL-1 for the teeth and PL-2 for the alveolar ridge), one for each kind of ridge. For each model, 4 removable partial dentures (RPD) were made (16 RPD altogether): T-bar retainer and distal rest, T-bar retainer and mesial rest, circumferential retainer and distal rest, and circumferential retainer and mesial rest. The models were placed on a circular polariscope and a 100 N axial load (point load) was applied to premolars and molars of the RPD. The formation of photoelastic bands was photographed for qualitative analysis. Results showed that the horizontal ridge had better distribution of stress, while the distal descending ridge had greater concentration of stress. The circumferential retainer had greater areas of stress for all types of ridges except the horizontal ridge, where there was no influence related to retainer type. The distribution of stress was similar among the different types of ridges when the rest was mesial or distal to the last abutment tooth, except for the distal descending ridge, where there was greater concentration of stress when the rest was located distally to the last abutment tooth. Thus, it may be concluded that (1) the situation was least favorable for the distal descending ridge and most favorable for the horizontal ridge, (2) the T-bar retainer had more favorable stress distribution, except when the ridge was horizontal, in which case there was no influence in relation to the type of retainer, (3) the location of the rest showed similar behavior in all except the distal descending ridge

Photoelastic analysis of the influence of residual ridge inclination in conjugated class i mandibular prostheses with different attachment systems

Objectives: The aim of this study was to evaluate the stress distribution in mandibular free-end removable partial dentures (RPD) associated with FPD in the abutment teeth considering different inclinations of the residual ridge: (1) horizontal and (2) distal descending ridges and two designs of free-end RPD with different attachment systems were tested: (1) clasp and (2) system ERA. Methods. Axial loads (100 N) were applied on the teeth of the RPD. The images were recorded and the stress distribution was evaluated through photoelastic fringes. Results. In general, the distal descending ridge presented more photoelastic fringes in the region of the roots of the abutment teeth while the horizontal ridge exhibited higher compression in the base of the prosthesis. In the horizontal ridge, the denture with clasp presented more favourable stress distribution than the denture with the system ERA. In the distal descending ridge, the denture with the system ERA relieved the region of the abutment teeth and overloaded the residual ridge. Conclusion: The horizontal ridge presented more favourable performance; the dentures with clasp exhibited better performance for both ridges evaluated; the denture with the system ERA presented better results in the distal descending ridge. © 2013 Informa Healthcare

Prevalence of removable partial dentures users treated at the Aracatuba Dental School - UNESP

Objectives: The aim of this study was to evaluate the frequency of removable partial dentures (RPD) at the Aracatuba Dental School.Methods: The study was conducted by analysing 412 clinical history of patients attended at the RPD clinics in the period from 2000 to 2007.Results: 412 charts were analysed: 148 (35.9%) men and 264 (64.1%) women. The mean age was 53.8 years (men) and 52.4 years (women). A total of 556 dentures were made; of these, 233 (41.90%) were maxillary and 323 (58.09%) were mandibular dentures. The most frequent Kennedy classification found was Class III (maxilla) and Class I (mandible). In the maxilla, 55% (126) of the major connectors were of the anterior-posterior palatal bar, while in the mandible, 64% (202) were the lingual bar. As regards the claps, 401 were circumferential and 318 were bar claps.Conclusion: The mean age of the patients was 52.9 years with higher prevalence of female patients; the most frequent Kennedy's classification was Class I in mandible and Class III in maxilla; the most common major connector was anterior-posterior palatal bar for maxilla and lingual bar for mandible; the circumferential clasps were the most common retainer used in both jaws