engleski

CAD/CAM occlusal splint fabrication after implant prosthetic treatment in patients with bruxism

Background: Bruxism and muscular temporomandibular dysfunctions (TMD) are common in patients and are considered as a contraindication for implant prosthetic treatment. The reason for this is a high percentage of implant failure, as well as biological and technical failures on implant-retained prosthetic restorations. The standard treatment in patients diagnosed with bruxism and muscular TMD includes fabrication of an occlusal splint, which should be made of a suitable material with a precise fit and allow precise occlusal contacts. Aim of the study: The purpose of this paper is to present two clinical cases indicating benefits of CAD/CAM occlusal splint fabrication immediately after implant prosthetic treatment, as an everyday procedure for the purpose of extending implant life and reducing the possibility of biological and mechanical failures of implant-retained prosthetic restorations. Materials and methods: Bruxism and muscular TMD were diagnosed in the two patients by means of clinical functional analysis before the implant treatment. Implant-retained prosthetic restorations were made and fabrication of an occlusal splint was initiated. Impressions of the upper and lower jaw were taken for fabrication of dental stone casts. Interarch relationships were registered using the face bow and centric registration, and eccentric registrations were taken for articulator individualization. The occlusal splint was fabricated by means of the Ceramill CAD/CAM system (AG, Germany). The casts were first scanned in the Map scanner in the real interarch relationships, and they were transferred in the Mind software to the individualized virtual articulator. The occlusal splint was designed in the M-Splint software, first its shape, and then its occlusal surfaces, by creating static and dynamic occlusal contacts. The final design of the splint was milled from the Splintec PMMA material in the Motion 2 milling machine. The fabricated CAD/CAM splint was checked in the articulator and handed in to the patient, together with its fit and occlusal contacts checking. Results: In relation to the fabrication of occlusal splints by means of standard procedures of flasking and polymerization, occlusal splints from transparent PMMA material can be fabricated without contractions using the CAD/CAM system. This enables their excellent retention and stabilization, as well as precise planning and occlusal contacts fabrication. One to two occlusal contacts per a pair of antagonists were established in static occlusion, while contacts according to the concept of canine guided occlusion were established in dynamic occlusion. Four years after the fabrication of implant-retained prosthetic restorations, the two patients had no radioopaque bone loss around the implant, nor biological and technical deficiencies on implant-retained prosthetic restorations. Conclusions and clinical implications: Beside planning of the position of dental implant placement and correct surgical and prosthetic methods in fabrication of implant-retained prosthetic restorations, it is important for patients diagnosed with bruxism or muscular TMD to receive a precise occlusal splint immediately after the implant- prosthetic treatment is finished, in order to prolong the life expectancy of the implant and reduce the possibility of occurrence of biological and technical failures.

Occlusal splint, bruxism, implant prosthetic

nije evidentirano