Implant and occlusion

May 24, 2011

By Barbara Catalano, RDH

I hope by now that all dental team members who are involved in the treatment of dental implant patients understand the most common reasons for post integrated restored implant failure — traumatic occlusal forces (traumatic occlusion or bruxism).

The very nature of the dental implant with its titanium bone interface does not have the periodontium to act as a shock absorber. Therefore, care must be taken into consideration when assessing both the patient planning to have dental implants and the post restored patient. The most common indicator of bruxism is worn occlusal surfaces.

Some things to think about when examining the natural teeth: Are the pointy cusp tips worn off the canines and first bicuspids? Is the occlusal wear unilateral or bilateral? Bruxism in lateral excursion is very commonly manifested as unilateral occlusal wear. Is there root exposure? Root exposure is not always due to recession; often it is the result of super-eruption due to advanced occlusal wear. Are there larger embrasures in the absence of significant bone loss due to periodontal disease? Larger embrasures can be due to super-eruption. Is there a history of fractured teeth, especially the maxillary first bicuspid? You should also evaluate the tooth opposing the implant or proposed site of the implant. Are there wear facets on the tooth or the restoration? Does the patient have functional habits, such as the seamstress who breaks thread with her teeth, a nail biter, or a weightlifter that clenches?

It is important to have articulating paper ready when the doctor does the exam. An occlusal guard that fits properly is the best tool for preventing problems associated with bruxism. At every recall appointment, patient compliance should be evaluated and every attempt should be made to help a patient be compliant. I always ask patients, “Now be honest, have you been wearing your occlusal guard?” If they say yes, I ask, “Every night?” If the answer is no, it is uncomfortable. I bring this to the doctor’s attention in case an adjustment to the appliance is required. If the patient answers, “I fall asleep with it in, but then I take it out,” I tell the person to keep trying. On average, I find it takes approximately one month for most patients to become accustomed to sleeping with an appliance in their mouth. Patients who have had orthodontic treatment often are more compliant. Finally, the importance of using the occlusal guard should be reiterated at every recall appointment.

I strongly recommend that patients sign a consent form that informs them of the damaging effects of traumatic occlusion, and includes a patient compliance agreement. After all, if the doctor has invested all the hard work and the patient has invested time and money, it is wise to protect that investment from something that can damage it. We know an ounce of prevention is worth a pound of care.