ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Bruxism Is a Risk Factor for Implant Complications That May Ultimately Lead to Implant Failure
Clinical Question In a patient receiving implants, is bruxism a significant contributor to implant failure?
Clinical Bottom Line Patients with bruxism and treatment planned for implants should be informed that bruxism is a risk factor for potential implant complications, and should require proper diagnosis of bruxism type, options for self monitoring, appliances to prevent further wear and any referral necessary should be discussed.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 25726844Zhou/20167 studies: total 445 participants included Systematic review and meta analysis
Key resultsData from these papers were divided into two groups: number of prostheses (group A) and number of patients (group B). Group A total pooled OR (odds ratio) for bruxers versus nonbruxers in all subgroups was 4.72 (95% CI: 2.66-8.36, p = .07). Group B total pooled OR of bruxers versus nonbruxers for all subgroups was 3.83 (95% CI: 2.12-6.94, p = .22). Comparing bruxers and nonbruxers, bruxers had a higher prostheses failure rate. Although not the sole factor, it suggests bruxism is a contributing factor for causing dental implant complications that play a role in dental implant failure.
#2) 23151302Manfredini/201421 studies: 14 biological complications, 7 mechanical complicationsSystematic review
Key resultsBruxism is unlikely to be a risk factor for biological complications, but some studies suggest it may be a risk factor for mechanical complications. Of the final 21 papers included in this review, 14 papers concerned biological complications, which accounted for 3,447 implants, and 7 papers concerned mechanical complications, which accounted for 2,590 implants.
Evidence Search “bruxism AND implant failure” in PubMed Clinical Queries
Comments on
The Evidence
Validity: Zhou/2016 used an electronic systematic literature search in MEDLINE and EmBase in November 2013 with no time and language restrictions. MeSH terms included words such as “teeth grinding” and “bruxomania” to expand search results. Quality of selected studies used the Newcastle-Ottawa Scale (NOS) tool, specifically assessing risk of bias of cohort studies. From 218 initial citations identified, duplicated, obviously irrelevant, and one non-cohort study, were excluded, ending with a total of 7 studies. These studies were published in the last 10 years, which will relate to recent research on bruxism. Manfredini/2014 used a systematic search in the National Library of Medicine’s Medline Database for English literature dealing with bruxism and dental implants. Studies were focused on clinical studies on humans, assessing the role of bruxism as a risk factor for both biological and mechanical implant complications. From 30 papers after initial exclusion for irrelevance, a PICO-formatted assessment of the papers was conducted. Perspective: Since it is becoming increasingly clear bruxism itself is multifactorial and that it is only one risk factor for implant complications, many of the studies don’t account for differences in patient medical history and conditions that may also play a role. Some studies also did not indicate the implant size and diameter, which is important to know because improper treatment planning of implants itself can cause problems. Bruxism is also an umbrella term for “teeth grinding” conditions, so future studies should note what type of bruxism the patient of interest has - whether it is, for example, wakeful or nocturnal bruxism - since this may make a difference. Finally, it may be helpful to assess and note the severity of the level of bruxism present in patients, which is an obvious metric to determine the level of load the patient places on implants.
Applicability Patients with bruxism should be informed that it is a risk factor for implant complications, which can lead to problems and can possibly lead to implant failure. Patients should be given an extensive exam and seek treatment if bruxism is noted. Along with correct diagnoses, treatment planning in bruxing patients is important. Increasing the number of implants will help to distribute load, and longer implants with an increased implant-bone surface area could reduce complications in bruxing patients. It will be important to have the patient monitor and take necessary actions to reduce bruxism such as self monitoring during the day and wearing a night guard at night.
Specialty/Discipline (General Dentistry) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords dental implant, bruxism
ID# 3294
Date of submission: 11/20/2017spacer
E-mail yangc3@uthscsa.edu
Author Chris Yang
Co-author(s) Dr. Azarnoush
Co-author(s) e-mail azarnoush@uthscsa.edu
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
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