Restoring teeth involved with bruxism is challenging. Restorations will commonly be needed to repair chips, breaks, attrition, fractures in the tooth or root, and abfractions. The severity of tooth wear depends on the restoration and the material chosen for best results. Usually anterior restorations main purpose is to restore the lost enamel, by bulking up the teeth that have been shortened and flattened from grinding. In the posterior teeth crowns are commonly needed for chips, breaks and fractures.
Gold is the strongest material available and the material of choice for patients suffering from bruxism. It is less likely to break and can withstand the force of bruxism better than any other material. Gold wears similar to enamel and it does not cause excessive wear to opposing teeth. Gold is an excellent choice for posterior teeth.
This material is used in areas where aesthetics is a concern. It is known to be durable and lasting, although the ceramic surface can be abrasive to the opposing teeth.
Zirconia has substantial strength characteristics as well.
Solid zirconia or “monolithic zirconia” has the greatest strength in this classification of material for bruxism. It has a natural translucency and is recommended for posterior teeth. It also causes minimal wear on opposing teeth.
Layered zirconia is more suitable for anterior teeth since it’s more translucent and opalescent. It has good strength with great aesthetics.
Natural teeth are the best option in the mouth; however, many times natural teeth fail due to grinding. Implants are not meant to withstand the force of stress from the overload of bruxism.
In some cases, untreated bruxism with an implant may increase the failure rate or can be a contraindication for placement. The success of a dental implant depends on the process of osseointegration. This bond allows the implant to stay securely within the bone, like a natural tooth. Bruxism can interfere with osseointegration by moving the implant back and forth and not allowing the bone-to-implant connection to completely heal and increase dental implant failure.
Bruxism can also cause late implant complications, due to the excessive force on the implant. Forces are considered by magnitude, duration, direction, type, and magnification. The consistency of any of these forces can create crestal bone loss, fractures of implant components such as restoration and the implant itself.58
Use of a wider implant decreases the strain on the implant and dissipates stress to the bone. The larger the diameter of an implant the stronger it is, since it provides more of a surface area. Greater surface area designs such as a titanium alloy with an external hex design can be advantageous. Natural teeth have the periodontal membrane where the implant does not. This membrane helps the teeth withstand stress better, although still significantly less than a natural tooth.
If an implant is placed and bruxism is a habit, using a night guard can relieve the implant area allowing the natural teeth to take the brunt, thus prolonging the life of the implant.59