Dental Implant Treatment in Bruxers: A Case Report and Literature Review
This case report presents a literature review and a case report of a full-mouth implant rehabilitation for a 65-year-old woman with a history of Bruxism. The patient’s oral condition showed dentition with severe occlusal wear, extensive dental work, and missing teeth replaced with bridges and implants. The existing dental work was failing due to recurrent caries and the mechanical failure of long-span bridges. The unique aspect of the treatment presented in this report is the management of existing osseointegrated implants of different systems with different platform designs, which adds to the treatment’s complexity. The existing implants were incorporated into the planned treatment, and other implants were added to support maxillary zirconia and mandibular hybrid full-arch prostheses. After 2 years of function, extensive wear was evident on the milled acrylic, even though an occlusal guard was used. New acrylic teeth were processed using the same milled titanium bar of the mandibular hybrid prosthesis, and the occlusal surfaces of the acrylic teeth were protected with gold onlays. The patient is seen regularly for maintenance every 6 months with no further complications. Careful evaluation, planning, and treatment execution are paramount in managing patients with a history of bruxism. Patients should be prepared and informed about possible mechanical failure and seen regularly for maintenance.
Preoperative panoramic X ray.
Digital scan of the maxillary implants superimposed with diagnostic wax-up.
Phase 1 treatment (surgical and prosthetics). (a) Immediate loading of implant #6 and immediate provisionalization of maxillary arch after sinus augmentation and implants #4, 6. (b) Clinical presentation of the maxillary full-arch acrylic provisionalization.
Phase 2 treatment with zirconia fixed dental prosthesis. (a) Maxillary implants after retrieval of maxillary provisional. (b) Implant-level impression transferred into model for digital scanning. (c) Verification jig to confirm passive fit of the zirconia full-arch prosthesis. (d) Beta try-in with full-arch acrylic prosthesis. (e) Monolithic zirconia full-arch prosthesis milled on the model. (f) Monolithic zirconia full-arch prosthesis on the patient’s implant. (g) Monolithic zirconia full-arch prosthesis on occlusion. (h) Postoperative panoramic X ray of the maxillary arch. (i) Patient smile view with maxillary zirconia restoration.
Worn mandibular teeth due to bruxism and deeper overbite.
Phase 3 treatment of the mandibular arch. (a) Digital impression of the maxillary arch. (b) Digital impression of the mandibular arch. (c) Digital interocclusal record in maximum intercuspation. (d) Virtual plan for mandibular implants using stackable guides.
Immediate mandibular implants placed after teeth extractions and vertical bone reduction.
Immediate load mandibular implant-supported acrylic prosthesis.
Postoperative panoramic X ray.
Phase 4 treatment of mandibular fully milled hybrid prosthesis. (a) Mandibular implants completely healed. (b) Implant-level impression transferred into the model for digital scanning. (c) Mandibular fully milled titanium bar and acrylic hybrid. (d) Mandibular fully milled titanium bar and acrylic hybrid torqued into the implants. (e) Postoperative panoramic X ray. (f) Frontal view of the maxillary zirconia full arch and mandibular hybrid on occlusion.
Severely worn mandibular hybrid prosthesis.
Mandibular hybrid redone. (a) Acrylic teeth processed using the same titanium bar with occlusal reduction on the posterior teeth (b) Gold onlays bonded on the posterior teeth. (c) Newly processed hybrid with gold onlays on occlusion.
Postoperative panoramic X ray.
Contributor Notes