Bruxers and RPDs

[JMN]

Got a situation with a super duper severe bruxer which I'll outline, but overall I'm wondering what materials, steps, or methods have been found that were most beneficial to the longevity of the prosthetic.

Pt presents with the most severe bruxism I've ever seen. Prescription medication has exacerbated what was a prior issue, it now happens day/night awake/asleep.
Constantly, unless talking or eating. Pt has de-cemented a crown!!

Current RPD is TCS over cast frame, has a saddle at/for 3-4 with cast clasps on palatal of 2 & 5 and TCS clasps on buccal of 2 & 5. That entire saddle has been broken off 2x and both buccal TCS clasps have been replaced with wrought wire after failing.

Just wondering if a fully flexible RPD, having some give, would provide a more robust solution or staying with a cast frame is considered best practice. I'm being asked for advice from the DDS for the next go-round coming earlly next year.

My thoughts are mixed:
With cast framework again and a PMMA base that it can be easily repaired as often as it is broken.

A fully Flexible RPD would be harder to destroy, but any repair would be much more likely to fail rapidly unless I sent it somewhere else to get reshot at that area. And with the diatorics, the teeth may fail sooner than if on a cast frame.

Any observations, thoughts, known studies, even just wild conjecture which is all I'm doing, would be very welcome. Really don't want to be married to this one again.

 

[Doris A]

How about a cast partial with metal occusals and just have facings on the buccal. They can't bite metal in two.

 

[CoolHandLuke]

How about a cast partial with metal occusals and just have facings on the buccal. They can't bite metal in two.

no but you can sure destroy the rest of the mouth.

how badly did you want to convert this patient to implants lol

 

[JMN]

How about a cast partial with metal occusals and just have facings on the buccal. They can't bite metal in two.

I'll offer that idea. I know nothing about the situation on the lower, so it may be an option esp if they have metal occ crowns down there.

 

[Chalky]

I would also think that a flexible material would irritate underlying tissue if 'rubbing' occurs during extreme clenching and bruxing. A flexible material may cause more issues, id go metal and maybe ask the cast lab to make a little thicker than usual given the circumstances of the case. Metal occlusion may also be a good long term option, with full metal backings across anterior teeth to prevent fracture also.

 

[JMN]

I would also think that a flexible material would irritate underlying tissue if 'rubbing' occurs during extreme clenching and bruxing. A flexible material may cause more issues, id go metal and maybe ask the cast lab to make a little thicker than usual given the circumstances of the case. Metal occlusion may also be a good long term option, with full metal backings across anterior teeth to prevent fracture also.

That palatal plating is an awesome idea. Thank you!

 

[Jason D]

are the patients natural anteriors present?

 

[JMN]

are the patients natural anteriors present?

2 is natural, 5-10 are natural, 11-15 are on a free end saddle.
Lower is primarily natural.

 

[Cleo]

I would try an acetal base. I have been using them and they are awesome,. Tooth supported but flexible enough to engage undercuts and rigid enough for stability. I make them with very short clasps so there is nothing to break off

 

[Jason D]

2 is natural, 5-10 are natural, 11-15 are on a free end saddle.
Lower is primarily natural.

get them to try an NTI to control the parafunction

 

[Jason D]

deal with the bad habit and everything that goes with it...if you can get that under control then the choice of partial becomes a different conversation

 

[CoolHandLuke]

I would try an acetal base. I have been using them and they are awesome,. Tooth supported but flexible enough to engage undercuts and rigid enough for stability. I make them with very short clasps so there is nothing to break off

what do you use to bond ?

 

[AGV]

Bruxist are my nightmare. They break all my PFM, FCZ,...The only stuff that supports the bite is, surprisingly, e-max crowns, but no way for bridges. I have even thought to bond e-max crowns to a NP implant frame for Bridges. I have also tought to use acetal covered with composite for that C&B pat. What do you think will last for Bridges?

 

[denturist-student]

Has this patient tried a night guard?

 

[Juko]

Sometimes the best option is to do nothing.

 

[JMN]

get them to try an NTI to control the parafunction

Has this patient tried a night guard?

Pt claims to wear a night guard. Pt's spouse says it doesn't happen, basically ever.

 

[cmeistercdt]

Ahhh....Non-Compliance and Cognitive Dissonance. Goes together like peas and carrots

Sent from my SAMSUNG-SM-G920A using Tapatalk

 

[denturist-student]

maybe after he pays for a few partial dentures he will start using his bite guard.

 

[JMN]

maybe after he pays for a few partial dentures he will start using his bite guard.

It's easier to blame than comply and prove you were wrong for way too many people. Same with us all.

 

[JMN]

I would try an acetal base. I have been using them and they are awesome,. Tooth supported but flexible enough to engage undercuts and rigid enough for stability. I make them with very short clasps so there is nothing to break off

Didn't mean to ignore you. The TCS clasps that were replaced had to be replaced from tearing as the saddle of which the were a part was destroyed by ripping it from the cast frame mesh.