Tardive Dyskinesia considerations

[JMN]

We recently did a stint for an implant into a Pt. with Tardive Dyskinesia. (https://en.wikipedia.org/wiki/Tardive_dyskinesia)
Has anybody dealt with a patient suffering this before? I'm not even sure how the O.S. is going to be able to place the implant, guess he's got some way to block the neuromotor pathway to prevent the involontary movments? Dunno.

Should there be any extra considerations made for this? We've been told that the bite will have to be hand articulated as she cannot give and basically doesn't have a stable reproducible bite. We were just thinking to keep the crown just barely out of occlusion in every way we can maniplulate the relationship. Overdoing the usual motion amount checks on bennet movement and arc of closure paths, etc.

Any ideas?

 

[JMN]

No ideas?

 

[JMN]

/s chirping....

 

[doug]

okay, I'll jump in. I don't care whether the doc has a problem keeping the patient stable. Thankful that he's using a surgical guide. We did a full rehab on a twenty-something you man who is autistic and doesn't sit still. The doc was a saint in getting good impressions. His bite is class III. when we were done he had an occlusion that appeared similar to a Mortar & Pestle relationship. Kind of slid all around with no perceptible interferences. He's managed to fracture five crowns. We remake them and move on. it's an Annuity.

 

[JMN]

Thanks for wading in. This one looks tricky. I was expecting something like this, but that pretty much confirms it.
Did you do anything as far as creating a force breaker to prevent overloading on the implant? Is there even such a method? It's #7.

 

[doug]

We never let laterals load even in natural teeth. They can group with centrals & cuspids and then we take them out of function, if possible. Using my own mouth as an example, I cannot get my laterals to function at all. If I take models of my mouth I can make them work perfectly in group with the others. Evidently, I can go places in my sleep that I can't during the day.

 

[JMN]

Know what you mean, I'll wake up some mornings with 5 or 12 bugging me from sleep bruxing, but can't figure out how they get any load at all while I'm awake.