Monolithic Zirconia as Permanent Solution for Bruxism (Two years follow up)

The management of patients with severe worn dentition due to bruxism often necessitates an esthetic and functional approach. It is often challenging for the dentist, the dental technician


CASE REPORT
This case report describes a 54-year-old woman with aesthetic complaints and compromised masticatory function.Prior to treatment, a detailed dental, medical and social history was obtained from the patient.She started to notice that her teeth were "getting short" many years ago.
However, she chooses to leave the problem unattended.Clinically, the patient's facial appearance showed signs of a collapsed occlusal vertical dimension.The clinical examination showed that tooth wear was generalized, but most teeth could be maintained in both jaws.In addition to complaints from sleep partners, signs of teeth grinding include masticatory pain, headaches, tooth sensitivity and tooth wear, as well as tender or hypertrophied masticatory muscles and joints were noticed.(Figure 1) In the radiographic examination, the root to crown ratio of the teeth was more than two, and there was no alveolar bone resorption.
Bruxism management started with cognitive behavioral therapies (CBT) in order to teach patients how to manage emotional problems and to modify their praxis (6).The occlusal splint was also used to protect teeth from the deleterious effects of bruxism (Figure 2).(Figure 6) The mechanical properties and, more importantly, the slow crack growth (SCG) resistance, which rules long-term durability, were thoroughly studied for zirconia ceramics, which are interesting in comparison to lithium-disilicate glass ceramics.(9) The patient was also given an occlusal splint with nocturnal wear to protect the restoration against bruxism.Definitive restorations were evaluated and adjusted for optimal contacts, contours, and esthetics.We opted for a semi-adaptable articulator for recording the occlusal reports in Centric Relation.
And then the crowns were sealed with glass ionomer cement.After prosthetic management, the patient was instructed about individual oral hygiene care.
After insertion of the prosthesis, the patient reported no muscular or dental discomfort.
She was also placed in a maintenance recall program.Follow-up treatments were done to evaluate the patient's comfort, arch form, and potential occlusal vertical dimension problems.The patient was recalled twice for postoperative examinations during the two-year follow-up period.In the controls, it was seen that marginal adaptation of the prostheses was appropriate, and there were no signs of gingival inflammation, recession, or cosmetic fracture.(Figure 7) Bruxism can be defined as a diurnal or nocturnal parafunctional activity including repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible.Bruxism can be defined as a diurnal or nocturnal parafunctional activity including repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible Bruxism can be defined as a wakeful or sleep parafunctional activity including repetitive jaw muscle contraction characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible (1).The management of patients with severe worn dentition due to bruxism often necessitates an esthetic and functional rehabilitation of a full dentition.It is often challenging for the dentist, the dental technician, and the patient because of the loss of occlusal vertical dimension, loss of tooth structure, uneven wear of teeth creating an uneven plane of occlusion, and para-functional habits (2).Bruxism has a considerable negative impact on teeth and increases odds of failure for ceramic restorations, especially fracture and chipping failures (3

Figure 1 :
Figure 1: Initial oral situationimproper occlusal plane orientation caused by abraded upper and lower teeth

Figure 2 :
Figure 2: The occlusal splint must be hard and equilibrated on the articulator in centric relation

Figure 3 :
Figure 3: Digital smile design and virtual wax up creation

Figure 4 :Figure 5 :
Figure 4: mock up placement after recontouring the interfering tooth structure.Occlusal adjustment and veneering were done to keep the mock up as long as we can for diagnostic and aesthetic purposes

Figure 6 :
Figure 6: Intra oral image showing cemented upper and lower zirconia crown

Figure 7 :
Figure 7: Intra oral image after 24 months of follow up showing good marginal adaptation with no signs of gingival inflammation, recession, or cosmetic fracture