Bruxism and Implants: Recognizing the Hidden Enemy
Written by Dr. Agatha Bis
Implant dentistry is celebrated for its predictability and high success rates, often reported at 95 percent or higher over long-term follow-ups. Yet there is a hidden enemy that undermines this success and challenges the very foundation of osseointegration: bruxism.
Bruxism is not just a nuisance. It is a destructive, repetitive muscle activity that introduces non-physiological loads to a system that lacks the protective feedback of the periodontal ligament. Unlike natural teeth, implants are ankylosed in bone without the cushioning or sensory input that signals the central nervous system to stop clenching or grinding. As a result, implants are exposed to prolonged, uncontrolled forces that they are not engineered to withstand.
Diagnostic Imperatives
Clinicians must recognize that bruxism is a clinical paradox: implants thrive in equilibrium, but parafunction disrupts that balance. Identifying early signs is essential:
Tooth and prosthetic wear such as flattened canines or loss of porcelain glaze.
Component complications like recurrent screw loosening or fractures.
Muscle and soft tissue signs including hypertrophic masseters or tongue scalloping.
Radiographic hallmarks such as angular wedge-shaped bone defects that mimic but are distinct from peri-implantitis.
Failing to distinguish mechanical overload from infection-driven bone loss leads to ineffective treatment. While peri-implantitis presents with inflamed tissues, bleeding, and suppuration, occlusal overload often manifests in otherwise healthy soft tissues but shows mechanical failure.
Clinical Implications
Survival rates from the literature do not apply universally. A patient with unmanaged bruxism is in a different risk category entirely. Longitudinal studies have shown a progressive decline in implant survival for bruxers, dropping to 72 percent at 5 years compared to 95 percent in the general population. The risk multiplies when bruxism is combined with other systemic or behavioral factors such as smoking or diabetes.
The take-home message is clear: recognize bruxism early, document it, and treat it as a major risk factor. Implant dentistry without bruxism management is incomplete care.
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