Implantoprosthetic therapy in bruxing patients

Abstract

Bruksizam je multifaktorijalna bolest koja zahvaća oko 10% svjetske populacije. Karakteriziran je noćnim škripanjem i stiskanjem zubima, iako postoji i dnevna varijanta te bolesti. Prije je bruksizam svrstavan u kontraindikaciju za implantoprotetsku terapiju budući da su žvačne sile u oboljelih 4-7 puta veće nego kod zdrave populacije što može dovesti do preopterećenja dentalnih implantata. Danas se bruksistima pristupa s povećanim oprezom. Bitno je uspostaviti protetski vođenu ugradnju dentalnih implantata nakon pažljive analize okluzije i postojećeg stanja u pacijenta. Da bi se komplikacije minimizirale, preporučuje se korištenje implantata većeg promjera i duljine, kao i veći broj dentalnih implantata. Protetski radovi najčešće su metalkeramički, a u neestetskom dijelu često se koriste metalne krunice. Radovi su povezani zbog bolje distribucije sila i prijenosa opterećenja. Izbjegavaju se privjesci, a nužno je nošenje tvrde, rigidne udlage kao zaštite tijekom noći. Komplikacije su poglavito mehaničke prirode i to: pucanje obložnog sloja keramike („chipping“), otpuštanje vijka, lom nadogradnje i lom implantata kao završni neuspjeh. Pravovremenim educiranjem pacijenta o mogućim, neželjenim komplikacijama, kao i redovitim kontrolama kojima se neke situacije mogu predvidjeti, uvelike se smanjuje neuspjeh.Bruxism is a multifactorial disease that affects about 10% of the world's population. It is characterized by night grinding and cletching of teeth, although there is also a daily variant of this disease. Earlier bruxism was classified as a contraindication for implantoprosthetic therapy because the chewing forces in bruxers are 4-7 times higher than in the healthy population, which could lead to an overload of dental implants. Today, we approach bruxing patients with increased caution. It is important to establish a prosthetic led placement of dental implants after careful analysis of occlusion and existing condition in the patient. In order to minimize complications, it is recommended to use larger diameter and length implants as well as a larger number of dental implants. Prosthetic procedures are usually metalceramics, whrereas in the non-aesthetic parts metal crowns are often used. Splinted superstructures are related to better power distribution and load transfer. It is not recommended to use cantilevers and it is necessary to wear a hard, rigid splint as a protection over night. The complications are mainly of mechanical nature: ceramic chipping, screw loosening, screw fracture and implant fracture. Well-timed patien's education about possible undesirable complications, as well as regular controls, which help foresee some situations, reduce failure in a large amount