When a dental professional is planning for an effective treatment resolution, it’s important to consider how the issue came about in the first place, and what that means for the potential future of a restoration.
Those that suffer with bruxism, the involuntary and subconscious performance of teeth grinding, may see this issue come up often when seeking effective care. The constant presence of masticatory forces may be of detrimental effect to posterior occlusal restorations, and these may be needed because of the initial damage caused by bruxism.
One study found that the maximum bite force during bruxism events was as high as 1,100N, which was greater than the largest voluntary bite force.[i] Whilst this pressure is not present for an extensive period of time, it is especially noteworthy to understand the risks it presents if the action is recurring, and the appropriate considerations that must be made when planning a posterior occlusal restoration. After all, whilst cessation is preferred, it may not always be immediately achievable.
Solutions for the posterior dentition
Bruxism presents the potential for occlusal trauma and breakdown of the periodontal tissue.[ii] When the surface of the posterior teeth is worn away, a clinician must be able to suggest a restorative solution that can adequately replace the once-present tooth structure.
The options are endless. Resin composites are a versatile material that the literature has crowned the first choice for restoring posterior teeth, thanks to its capabilities within a minimally invasive workflow.[iii] However, clinicians may have doubts around the aesthetics and durability of some direct composite solutions;[iv] the latter is unequivocally important in the bruxism patient. Choosing the correct resin composite for a case is fundamental.
On the other hand, ceramic reconstructions hold some popularity due to their aesthetic advantages, and zirconia ceramics have seen an increase in use thanks to their stability and toughness.[v] Full crowns, as you will know, fall at the invasive hurdle, with studies saying it can demand a removal of up to 75.6% tooth structure.[vi]
Another option that may be suitable for some patients, dependent on the extent of the attrition, could be an occlusal veneer. Whilst materials vary greatly, restorations as thin as 0.3mm could be used in areas subject to masticatory stress, whilst retaining aesthetics and allowing for a conservative tooth preparation.v However, they are technically demanding, and alignment can prove difficult.[vii]
Each solution has its own merits, and this is not necessarily an exhaustive list. The unique treatment needs presented to clinicians – based on factors such as the level of damage and wear that is present, the presence of bruxism habits, and a patient’s aesthetic preferences – may all change the choice of material and overall approach that is used.
Planning for future restorations
When a bruxism patient requires a restoration in the posterior, a clinician must consider the potential for future damage to the dentition.
The cessation of bruxism is obviously ideal, and wouldn’t require such foresight. The interruption of parafunctional habits may be possible through occlusal adjustments and oral rehabilitation; the elimination of causative factors such as smoking, alcohol and coffee; or even the management of psychological factors through psychotherapy, relaxation, or yoga.[viii] However, this is unique between each individual patient, and may not be a simple fix. Instead, clinicians should approach an initial restoration with the need for eventual repairs in mind.
Considering this, additive techniques are preferable, and more invasive restorative techniques such as ceramic crowns, whilst not totally ruled out, should not be considered the first clinical option for a posterior restoration.iv Resin composites show immense promise here. A majority of clinical failures of composites allow for minimally invasive repairs that are shown to extend the clinical durability of the solution in posterior teeth.iv
Meeting today’s demands
Function and the potential for repair are imperative considerations from a clinical point of view, but there are other factors to consider. Patient expectations around dental restorations are slowly changing in front of our eyes, and the social media generation is putting more emphasis on aesthetic solutions. When bruxism puts an extraordinary level of stress on a posterior restoration, some patients may feel they have to compromise and settle for a solution that trades appearance for improved function – but this doesn’t have to be the case.
A solution like the award-winning* Filtek One Bulk Fill Restorative (from Solventum, formerly 3M Health Care), is designed to combine aesthetic brilliance, clinical simplicity, and most importantly excellent wear resistance in the posterior dentition. The innovative use of AFM and AUDMA monomers also help reduce shrinkage and stress within the restoration.[ix] The Filtek One Bulk Fill Restorative is designed especially for posterior restorations, and is an effective choice for a wide variety of treatment indications.
The bruxism patient will likely need a posterior restoration within their lifetime, and potentially multiple if the habit continues to damage the dentition. Choosing the right solution for each case, whilst considering modern treatment demands and the prospect of future repairs, is essential for every treatment workflow.
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*Dental Advisor Research Award 2024 winner, https://www.dentaladvisorawards.com/products/3m-tm-filtek-tm-one-bulk-fill-restorative
About Solventum
At Solventum, we enable better, smarter, safer healthcare to improve lives. As a new company with a long legacy of creating breakthrough solutions for our customers’ toughest challenges, we pioneer game-changing innovations at the intersection of health, material and data science that change patients’ lives for the better while enabling healthcare professionals to perform at their best. Because people, and their wellbeing, are at the heart of every scientific advancement we pursue. We partner closely with the brightest minds in healthcare to ensure that every solution we create melds the latest technology with compassion and empathy. Because at Solventum, we never stop solving for you.
[i] Lantada, A. D., Bris, C. G., Morgado, P. L., & Maudes, J. S. (2012). Novel system for bite-force sensing and monitoring based on magnetic near field communication. Sensors, 12(9), 11544-11558.
[ii] Murali, R. V., Rangarajan, P., & Mounissamy, A. (2015). Bruxism: Conceptual discussion and review. Journal of pharmacy & bioallied sciences, 7(Suppl 1), S265.
[iii] Pizzolotto, L., & Moraes, R. R. (2022). Resin Composites in Posterior Teeth: Clinical Performance and Direct Restorative Techniques. Dentistry Journal, 10(12), 222.
[iv] Egbert, J. S., Johnson, A. C., Tantbirojn, D., & Versluis, A. (2015). Fracture strength of ultrathin occlusal veneer restorations made from CAD/CAM composite or hybrid ceramic materials. Oral Science International, 12(2), 53-58.
[v] Hmaidouch, R., & Weigl, P. (2013). Tooth wear against ceramic crowns in posterior region: a systematic literature review. International journal of oral science, 5(4), 183-190.
[vi] Wang, B., Fan, J., Wang, L., Xu, B., Wang, L., & Chai, L. (2022). Onlays/partial crowns versus full crowns in restoring posterior teeth: a systematic review and meta-analysis. Head & Face Medicine, 18(1), 1-17.
[vii] Abd Elmonam, A. E., Hamza, T. A., & Abd-El Aziz, M. H. (2017). A comparative study on the effect of different preparation designs and type of materials on the marginal fit of occlusal veneer.
[viii] Murali, R. V., Rangarajan, P., & Mounissamy, A. (2015). Bruxism: Conceptual discussion and review. Journal of pharmacy & bioallied sciences, 7(Suppl 1), S265.
[ix] Elshazly TM, Bourauel C, Sherief DI, El-Korashy DI. Evaluation of Two Resin Composites Having Different Matrix Compositions. Dent J (Basel). 2020 Jul 17;8(3):76. doi: 10.3390/dj8030076. PMID: 32709056; PMCID: PMC7559380.
