Bruxism And Posterior Restorations: Choosing The Right Solutions For Long-Lasting Dental Health

When dental professionals design effective treatment plans for patients, it's crucial to analyse the root cause of the dental issues they face. This is especially true for those affected by bruxism, the involuntary grinding of teeth that can lead to significant oral health problems, particularly concerning posterior restorations.

The Challenges Of Bruxism

Bruxism can create excessive masticatory forces that jeopardise posterior occlusal restorations. For patients seeking treatment, the constant strain may result in the very damage that necessitates these restorations in the first place.

A notable study revealed that the maximum bite force during bruxism episodes can reach as high as 1,100N, surpassing even the strongest voluntary bite force1. Although these forces may not be exerted for long periods, the risks associated with recurring bruxism are significant, warranting careful consideration during restoration planning.

Solutions for Posterior Dentition

Bruxism poses various threats, including occlusal trauma and periodontal tissue breakdown2. When the surface of posterior teeth is eroded, it is vital for clinicians to suggest effective restorative solutions that can replace the lost tooth structure. The options are diverse:

  1. Resin Composites: Often hailed as the first choice for posterior tooth restorations, resin composites offer versatility and a minimally invasive approach3. However, some clinicians express concerns regarding the aesthetics and durability of direct composite solutions – paramount for bruxism patients. Selecting the right resin composite is crucial for achieving long-lasting outcomes.
  2. Ceramic Reconstructions: These restorations are favoured for their aesthetic appeal. Zirconia ceramics have gained popularity due to their strength and durability4. However, full crowns can be invasive, requiring the removal of up to 75.6% of the original tooth structure5.
  3. Occlusal Veneers: In cases of less severe attrition, occlusal veneers may be a viable solution. These thin restorations (as little as 0.3mm) can withstand masticatory stress while maintaining aesthetics and facilitating conservative tooth preparation6. However, they demand high technical skill and can present fitting challenges7.
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Each treatment option has its advantages, and the choice of material should be tailored to the unique needs of the patient, considering factors such as the extent of damage, bruxism severity, and aesthetic preferences.

Planning For Future Restorations

For patients with bruxism, it is essential for clinicians to account for the potential for future dental damage. While stopping bruxism would eliminate the need for careful planning, this goal may not be immediately attainable. Strategies for managing bruxism may include8:

  • Occlusal adjustments and oral rehabilitation.
  • Elimination of contributing factors (such as smoking, alcohol, and caffeine).
  • Psychological interventions (including relaxation techniques and psychotherapy).

Given the individual nature of every patient’s condition, a straightforward solution may not be available. Therefore, clinicians should approach initial restorations with the foresight of potential future repairs in mind.

Additive techniques are generally preferred over more invasive options, such as ceramic crowns, which should not be the first line of treatment for posterior restorations5. Resin composites, known for their capacity for minimally invasive repairs, show promise in enhancing the longevity of posterior restorations.

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Meeting Modern Demands

While functionality and repairability are critical from a clinical perspective, patient expectations are evolving. With the rise of social media, many patients prioritise aesthetic results in their dental restorations. Bruxism often places undue stress on posterior restorations, leading some patients to believe they must compromise on appearance for functionality. This doesn't have to be the case.

The award-winning 3M™ Filtek™ One Bulk Fill Restorative is designed to bridge the gap between aesthetics and durability in posterior restorations. This innovative solution combines aesthetic brilliance, clinical simplicity, and exceptional wear resistance, making it suitable for various treatment indications. The use of AFM and AUDMA monomers reduces shrinkage and stress within the restoration, enhancing overall performance.

Bruxism patients are likely to require several posterior restorations throughout their lives, particularly if their grinding habits persist. Therefore, selecting the appropriate solution for each case while balancing modern treatment demands and the possibility of future repairs is vital for successful outcomes8.

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About The Author

3M Health Care is now Solventum.

Case Courtesy by Dr. Marco Maiolino.

  1. 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
  2. Murali, R. V., Rangarajan, P., & Mounissamy, A. (2015). Bruxism: Conceptual discussion and review. Journal of pharmacy & bioallied sciences, 7(Suppl 1), S265
  3. Pizzolotto, L., & Moraes, R. R. (2022). Resin Composites in Posterior Teeth: Clinical Performance and Direct Restorative Techniques. Dentistry Journal, 10(12), 222
  4. 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
  5. 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
  6. 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
  7. 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
  8. Murali, R. V., Rangarajan, P., & Mounissamy, A. (2015). Bruxism: Conceptual discussion and review. Journal of pharmacy & bioallied sciences, 7(Suppl 1), S265
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