There is general agreement that excessive stress to the bone-implant interface may result in implant overload and failure. Early failure of the implant due to excessive loading occurs shortly after uncovering the implant. Excess load on a final restoration after successful implant integration can result in physical failure of the implant structure. Many clinicians believe that overload of dental implants is a risk factor for vertical peri-implant bone loss and/or may be detrimental for the suprastructure in implant prostheses. It has been documented that occlusal parafunction, such as, bruxism (tooth grinding and clenching) affects the outcome of implant prostheses, but there is no evidence for a causal relation between the failures and overload of dental implants. In spite of this lack of evidence, often metal restorations are preferred instead of porcelain for patients in whom bruxism is presumed on the basis of tooth wear. The purpose of this paper is to discuss the importance of the occlusal scheme used in implant restorations for implant longevity and to suggest a clinical approach and occlusal materials for implant prostheses in order to prevent complications related to bruxism. 1. Introduction The most important factor in implant longevity as a factor for clinically successful implant treatment is the formation of a direct interface between the implant and the bone, without intervening soft tissue, a process called “osseointegration”. Osseointegrated dental implants represent an advance in modern odontology, which has become a great option for the rehabilitation of missing single teeth in partially or totally edentulous patients. Despite the very high success rates [1], complications associated with implant treatment may occur. Early loading failure may affect 2% to 6% of implants, and as many as 15% of restorations fail as a result of this problem [2, 3]. Excess load on a final restoration after successful implant integration can result in failure of the implant itself [4]. Therefore, it is important to clarify the risk factors for failure of implant prostheses in order to further improve the good success rate. The consequences of overload of dental implants can be divided into two groups: biological and biomechanical complications [5]. Biological complications can be divided into early failures and late failures [6]. In case of early failures, osseointegration was insufficient: the implant is lost before the first prosthetic loading. Late biological failures are characterized by pathological bone loss after full osseointegration was obtained at
References
[1]
R. Adell, B. Eriksson, U. Lekholm, P. I. Br？nemark, and T. Jemt, “Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws,” The International Journal of Oral & Maxillofacial Implants, vol. 5, no. 4, pp. 347–359, 1990.
[2]
C. E. Misch, “Density of bone: effect on treatment plans, surgical approach, healing, and progressive boen loading,” The International Journal of Oral Implantology, vol. 6, no. 2, pp. 23–31, 1990.
[3]
T. Jernt, B. Lindén, and U. Lekholm, “Failures and complications in 127 consecutively placed fixed partial prostheses supported by Br？nemark implants: from prosthetic treatment to first annual checkup,” The International Journal of Oral & Maxillofacial Implants, vol. 7, no. 1, pp. 40–44, 1992.
[4]
C. E. Misch, “The effect of bruxism on treatment planning for dental implants,” Dentistry Today, vol. 21, no. 9, pp. 76–81, 2002.
[5]
F. Lobbezoo, J. E. I. G. Brouwers, M. S. Cune, and M. Naeije, “Dental implants in patients with bruxing habits,” Journal of Oral Rehabilitation, vol. 33, no. 2, pp. 152–159, 2006.
[6]
M. S. Tonetti and J. Schmid, “Pathogenesis of implant failures,” Periodontology 2000, vol. 4, pp. 127–138, 1994.
[7]
T. Albrektsson, G. Zarb, and A. R. Eriksson, “The long-term efficacy of currently used dental implants: a review and proposed criteria of success,” The International Journal of Oral & Maxillofacial Implants, vol. 1, no. 1, pp. 11–25, 1986.
[8]
J. B. Brunski, “In vivo bone response to biomechanical loading at the bone/dental-implant interface,” Advances in Dental Research, vol. 13, pp. 99–119, 1999.
[9]
S. J. Hoshaw, J. B. Brunski, and G. V. B. Cochran, “Mechanical overloading of Branemark implants affects interfacial bone modeling and remodeling,” Journal of Oral Surgery, vol. 9, pp. 345–360, 1994.
[10]
F. Isidor, “Loss of osseointegration caused by occlusal load of oral implants: a clinical and radiographic study in monkeys,” Clinical Oral Implants Research, vol. 7, no. 4, pp. 143–152, 1996.
[11]
F. Isidor, “Histological evaluation of peri-implant bone at implants subjected to occlusal overload or plaque accumulation,” Clinical Oral Implants Research, vol. 8, no. 1, pp. 1–9, 1997.
[12]
T. Berglundh, L. Persson, and B. Klinge, “A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years,” Journal of Clinical Periodontology, vol. 29, no. 3, pp. 197–212, 2002.
[13]
C. G？thberg, T. Bergendal, and T. Magnusson, “Complications after treatment with implant-supported fixed prostheses: a retrospective study,” International Journal of Prosthodontics, vol. 16, no. 2, pp. 201–217, 2003.
[14]
AASM, International Classification of Sleep Disorders, American Academy of Sleep Medicine, Westchester, NY, USA, 2nd edition, 2005.
[15]
J. P. Okeson, Orofacial Pain. Guidelines for Assessment, Diagnosis, and Management, Quintessence Publishing, Chicago, Ill, USA, 1996.
[16]
G. J. Lavigne, N. Huynh, T. Kato et al., “Genesis of sleep bruxism: motor and autonomic-cardiac interactions,” Archives of Oral Biology, vol. 52, no. 4, pp. 381–384, 2007.
[17]
F. Lobbezoo and M. Naeije, “Bruxism is mainly regulated centrally, not peripherally,” Journal of Oral Rehabilitation, vol. 28, no. 12, pp. 1085–1091, 2001.
[18]
U. Br？gger, S. Aeschlimann, W. Bürgin, C. H. F. H？mmerle, and N. P. Lang, “Biological and technical complications and failures with fixed partial dentures (FPD) on implants and teeth after four to five years of function,” Clinical Oral Implants Research, vol. 12, no. 1, pp. 26–34, 2001.
[19]
E. Engel, G. Gomez-Roman, and D. Axmann-Krcmar, “Effect of occlusal wear on bone loss and periotest value of dental implants,” International Journal of Prosthodontics, vol. 14, no. 5, pp. 444–450, 2001.
[20]
T. D. Taylor, J. Wiens, and A. Carr, “Evidence-based considerations for removable prosthodontic and dental implant occlusion: a literature review,” Journal of Prosthetic Dentistry, vol. 94, no. 6, pp. 555–560, 2005.
[21]
T. Haraldson, G. E. Carlsson, and B. Ingervall, “Functional state, bite force and postural muscle activity in patients with osseointegrated oral implant bridges,” Acta Odontologica Scandinavica, vol. 37, no. 4, pp. 195–206, 1979.
[22]
T. Miyata, Y. Kobayashi, H. Araki, Y. Motomura, and K. Shin, “The influence of controlled occlusal overload on peri-implant tissue: a histologic study in monkeys,” International Journal of Oral and Maxillofacial Implants, vol. 13, no. 5, pp. 677–683, 1998.
[23]
T. Miyata, Y. Kobayashi, H. Araki, T. Ohto, and K. Shin, “The influence of controlled occlusal overload on peri-implant tissue. Part 3: a histologic study in monkeys,” International Journal of Oral and Maxillofacial Implants, vol. 15, no. 3, pp. 425–431, 2000.
[24]
T. Miyata, Y. Kobayashi, H. Araki, T. Ohto, and K. Shin, “The influence of controlled occlusal overload on peri-implant tissue. Part 4: a histologic study in monkeys,” International Journal of Oral and Maxillofacial Implants, vol. 17, no. 3, pp. 384–390, 2002.
[25]
L. J. Heitz-Mayfield, B. Schmid, C. Weigel et al., “Does excessive occlusal load affect osseointegration? An experimental study in the dog,” Clinical Oral Implants Research, vol. 15, no. 3, pp. 259–268, 2004.
[26]
D. Lundgren, L. Laurell, H. Falk, and T. Bergendal, “Occlusal force pattern during mastication in dentitions with mandibular fixed partial dentures supported on osseointegrated implants,” The Journal of Prosthetic Dentistry, vol. 58, no. 2, pp. 197–203, 1987.
[27]
H. Falk, “On occlusal forces in dentitions with implant-supported fixed cantilever prostheses,” Swedish Dental Journal. Supplement, vol. 69, pp. 1–40, 1990.
[28]
M. Abarca, D. van Steenberghe, C. Malevez, and R. Jacobs, “The neurophysiology of osseointegrated oral implants: a clinically underestimated aspect,” Journal of Oral Rehabilitation, vol. 33, no. 3, pp. 161–169, 2006.
[29]
G. E. Carlsson, “Dental occlusion: modern concepts and their application in implant prosthodontics,” Odontology, vol. 97, no. 1, pp. 8–17, 2009.
[30]
M. R. Wood and S. G. Vermilyea, “A review of selected dental literature on evidence-based treatment planning for dental implants: report of the Committee on Research in Fixed Prosthodontics of the Academy of Fixed Prosthodontics,” Journal of Prosthetic Dentistry, vol. 92, no. 5, pp. 447–462, 2004.
[31]
M. Trulsson, “Sensory and motor function of teeth and dental implants: a basis for osseoperception,” Clinical and Experimental Pharmacology and Physiology, vol. 32, no. 1-2, pp. 119–122, 2005.
[32]
S. Lundqvist and T. Haraldson, “Occlusal perception of thickness in patients with bridges on osseointegrated oral implants,” Scandinavian Journal of Dental Research, vol. 92, no. 1, pp. 88–95, 1984.
[33]
N. Enkling, C. Nicolay, K. H. Utz, P. J？hren, G. Wahl, and R. Mericske-Stern, “Tactile sensibility of single-tooth implants and natural teeth,” Clinical Oral Implants Research, vol. 18, no. 2, pp. 231–236, 2007.
[34]
G. J. Lavigne, P. H. Rompré, and J. Y. Montplaisir, “Sleep bruxism: validity of clinical research diagnostic criteria in a controlled polysomnographic study,” Journal of Dental Research, vol. 75, no. 1, pp. 546–552, 1996.
[35]
G. J. Lavigne, P. H. Rompré, J. Y. Montplaisir, and F. Lobbezoo, “Motor activity in sleep bruxism with concomitant jaw muscle pain: a retrospective pilot study,” European Journal of Oral Sciences, vol. 105, no. 1, pp. 92–95, 1997.
[36]
F. Lobbezoo and G. J. Lavigne, “Do bruxism and temporomandibular disorders have a cause-and-effect relationship?” Journal of Orofacial Pain, vol. 11, no. 1, pp. 15–23, 1997.
[37]
M. T. John, H. Frank, F. Lobbezoo, M. Drangsholt, and K. E. Dette, “No association between incisal tooth wear and temporomandibular disorders,” Journal of Prosthetic Dentistry, vol. 87, no. 2, pp. 197–203, 2002.
[38]
G. J. Lavigne, T. Kato, A. Kolta, and B. J. Sessle, “Neurobiological mechanisms involved in sleep bruxism,” Critical Reviews in Oral Biology and Medicine, vol. 14, no. 1, pp. 30–46, 2003.
[39]
C. Hirsch, M. T. John, F. Lobbezoo, J. M. Setz, and H. G. Schaller, “Incisal tooth wear and self-reported temporomandibular disorder pain in children and adolescents,” International Journal of Prosthodontics, vol. 17, no. 2, pp. 151–156, 2004.
[40]
F. Lobbezoo, J. van der Zaag, C. M. Visscher, and M. Naeije, “Oral kinesiology: a new postgraduate programme in the Netherlands,” Journal of Oral Rehabilitation, vol. 31, no. 3, pp. 192–198, 2004.
[41]
D. Manfredini and F. Lobbezoo, “Relationship between bruxism and temporomandibular disorders: a systematic review of literature from 1998 to 2008,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, vol. 109, no. 6, pp. e26–e50, 2010.
[42]
A. Johansson, A. K. Johansson, R. Omar, and G. E. Carlsson, “Rehabilitation of the worn dentition,” Journal of Oral Rehabilitation, vol. 35, no. 7, pp. 548–566, 2008.
[43]
F. Lobbezoo, J. van der Zaag, and M. Naeije, “Bruxism: its multiple causes and its effects on dental implants—an updated review,” Journal of Oral Rehabilitation, vol. 33, no. 4, pp. 293–300, 2006.
[44]
R. Skalak, “Biomechanical considerations in osseointegrated prostheses,” The Journal of Prosthetic Dentistry, vol. 49, no. 6, pp. 843–848, 1983.
[45]
J. A. Hobkirk and K. J. Psarros, “The influence of occlusal surface material on peak masticatory forces using osseointegrated implant-supported prostheses,” The International Journal of Oral & Maxillofacial Implants, vol. 7, no. 3, pp. 345–352, 1992.
[46]
I. Naert, M. Quirynen, D. van Steenberghe, and P. Darius, “A six-year prosthodontic study of 509 consecutively inserted implants for the treatment of partial edentulism,” The Journal of Prosthetic Dentistry, vol. 67, no. 2, pp. 236–245, 1992.
[47]
B. Carlson and G. E. Carlsson, “Prosthodontic complications in osseointegrated dental implant treatment,” The International Journal of Oral & Maxillofacial Implants, vol. 9, no. 1, pp. 90–94, 1994.
[48]
T. Jemt and J. Johansson, “Implant treatment in the edentulous maxillae: a 15-year follow-up study on 76 consecutive patients provided with fixed prostheses,” Clinical Implant Dentistry and Related Research, vol. 8, no. 2, pp. 61–69, 2006.
[49]
J. S. Feine and G. E. Carlsson, Eds., Implant over Dentures: The Standard of Care for Edentulous Patients, Quintessence, Chicago, Ill, USA, 2003.
[50]
M. Gahlert, D. Burtscher, I. Grunert, H. Kniha, and E. Steinhauser, “Failure analysis of fractured dental zirconia implants,” Clinical Oral Implants Research, vol. 23, pp. 287–293, 2011.
[51]
B. Al-Amleh, K. Lyons, and M. Swain, “Clinical trials in zirconia: a systematic review,” Journal of Oral Rehabilitation, vol. 37, no. 8, pp. 641–652, 2010.
[52]
M. Karl, F. Graef, and M. Wichmann, “Strain development of implant-supported fixed prostheses copy milled from zirconia ceramic,” International Journal of Prosthodontics, vol. 24, pp. 479–481, 2011.
[53]
J. Abduo, K. Lyons, N. Waddell, V. Bennani, and M. Swain, “A comparison of fit of CNC-milled titanium and zirconia frameworks to implants,” Clinical Implant Dentistry and Related Research. In press.
[54]
M. L. Perel, “Parafunctional habits, nightguards, and root form implants,” Implant Dentistry, vol. 3, no. 4, pp. 261–263, 1994.
[55]
T. Tosun, C. Karabuda, and C. Cuhadaroglu, “Evaluation of sleep bruxism by polysomnographic analysis in patients with dental implants,” International Journal of Oral and Maxillofacial Implants, vol. 18, no. 2, pp. 286–292, 2003.
[56]
J. van der Zaag, F. Lobbezoo, P. G. G. L. van der Avoort, D. J. Wicks, H. L. Hamburger, and M. Naeije, “Effects of pergolide on severe sleep bruxism in a patient experiencing oral implant failure,” Journal of Oral Rehabilitation, vol. 34, no. 5, pp. 317–322, 2007.
[57]
F. Lobbezoo, J. van der Zaag, M. K. A. van Selms, H. L. Hamburger, and M. Naeije, “Principles for the management of bruxism,” Journal of Oral Rehabilitation, vol. 35, no. 7, pp. 509–523, 2008.
