Advice on Bruxism patient

[finnster68]

Hi All

Just received a call from a client in regards to a bruxism patient. Client wants me to meet with him and the patient to discuss some ideas in a couple of days.

Issue seems to be the patient has a full upper over a part COCR and is an extremely heavy bruxer

F/- is less than 2 years old and has had multiple midline fractures as well as the teeth have been ground down to nothing. Client says the denture looks like a 10 year old denture already.

Just wondering what advice/plan i could go into the surgery armed with.

My initial thoughts are we could possible do a COCR palate for the denture to give some extra strength, however not sure how we stop the patient grinding the teeth down to stumps again.

Any thoughts would be greatly appreciated.

Cheers

Tony

[DDDental]

First thing that I can come up with is that lower rpd needs to be remade. Metal palate on upper will help palate area but not saddle-teeth part. I assume , lower one is bilateral free end. Check with your account what type of teeth were used. Give us a little more information after meeting.

[Kreyer]

Originally Posted by finnster68

Hi All

Just received a call from a client in regards to a bruxism patient. Client wants me to meet with him and the patient to discuss some ideas in a couple of days.

Issue seems to be the patient has a full upper over a part COCR and is an extremely heavy bruxer

F/- is less than 2 years old and has had multiple midline fractures as well as the teeth have been ground down to nothing. Client says the denture looks like a 10 year old denture already.

Just wondering what advice/plan i could go into the surgery armed with.

My initial thoughts are we could possible do a COCR palate for the denture to give some extra strength, however not sure how we stop the patient grinding the teeth down to stumps again.

Any thoughts would be greatly appreciated.

Cheers

Tony

Hello Tony,

Your first thought is right on to make a cast cr-co palate,. The problem with a bruxer is at what position do you restore them at. According to literature it is always best to restore at true centric relation and create a functional occlusal scheme from this position of the condyle to glenoid fossa. To treatment plan this I would duplicate the existing denture and convert the duplicate into a maxillary reprograming prosthesis. After duplicating the maxillary set-up a central bearing device for an intra-oral tracing on the maxillae and mandible. Remount to apex of tracing which is centric relation then with new established VDO/CR add occlusal contacts and anterior lingual ramp if necessary to create centric reference points for stops and ramp for disclusion if necessary. If you make all heavy contacts in anterior ramp this will help seat condyles if repositioning is needed.

After patient is comfortable and can function with new CR/VDO then start with your new maxillary complete denture with cast cr-co palate and mandibular RPD. To prevent wear and breakage of teeth I would do a Functionally Generated Path posterior occlusion. This can be done direct or indirect but should always be verified intra-orally. The FGP posteriors occlusal surface can be cast in gold or even cured in composite and then processed into denture. A less expensive route is to use a composite tooth for this procedure as well. I do like gold though for extreme cases.

It is difficult to go into every detail step but if you want more info I would be happy to provide.

Cheers to you!

Robert