Beyond the Numbers: Evidence-Based Precaution in Bruxism Management
Written by Dr. Agatha Bis
Bruxism and occlusal overload are not fringe topics. They are central to long-term implant success, supported by a growing body of high-level evidence. Systematic reviews and meta-analyses consistently show that patients with bruxism have two to five times the odds of implant failure compared to non-bruxers.
One meta-analysis reported an odds ratio of 4.68, highlighting nearly five times higher risk for mechanical issues and implant loss. Another study revealed a failure rate of 13 percent in bruxers compared to just 4.6 percent in non-bruxers. These are not abstract figures. They reflect what we see chairside when screw loosening progresses to fractures, when porcelain chips evolve into catastrophic failures, and when bone resorption accelerates due to forces that exceed physiologic thresholds.
Why Precaution Is Non-Negotiable
The absence of a periodontal ligament in implants creates a biomechanical environment where overload is silent but relentless. Clinicians cannot rely on patient feedback to detect excessive force. Instead, proactive measures must be standard of care:
Occlusal engineering: narrowing occlusal tables, flattening cusps, eliminating cantilevers, and ensuring passive fit.
Appliance therapy: prescribing protective guards or customized orthotics tailored to whether the bruxism is nocturnal or awake.
Patient communication: integrating risk discussion into informed consent and reinforcing the need for strict recall protocols.
The Principle of Evidence-Based Precaution
Until dentistry has reliable, standardized tools to quantify occlusal force in the clinical setting, we must practice with the assumption that unmanaged bruxism equals future complications.
The cascade of failure is predictable: screw loosening, porcelain chipping, screw fracture, and eventually implant body fracture. Each stage offers an opportunity for early intervention if the clinician is vigilant. A “wait and see” approach is not defensible when high-level evidence already shows the risks.
Dentistry must adopt a proactive stance. Managing bruxism is not optional; it is essential to protect the patient’s investment and the clinician’s credibility.
Take the Next Step in Protecting Your Patients and Your Practice
The evidence is clear: unmanaged bruxism is one of the leading hidden threats to implant success. Do not leave it to chance.
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