How should the prosthesis material be in patients with clenching teeth?

th the development of technology and artificial intelligence, we live in a time when time is flowing rapidly, we are trying to fulfill our responsibilities at this pace and catch up with life. In this process, people have started to turn to yoga meditation, psychological counseling and healthy nutrition to keep their motivation high and to protect their energy and health. This picture reveals that people today are overburdened with stress and are trying to develop their own methods to cope.

Teeth are our organs that we take as our spiritual anchor. In fact, this is the reason why the expression “grit your teeth” is often used among the people. We can clench our teeth when we are dealing with a stressful, sensitive job. When our stress level increases, it starts to affect our sleep. Just as we have bad dreams during these periods, we start clenching our teeth. And bruxism, which is a habit, is mostly seen in people in this way.

What are the effects/consequences of teeth clenching?

When we clench our teeth, the load on our teeth is many times more than the normal chewing force. Since all our dental tissues are formed according to chewing forces, not according to this force, we encounter different problems as a result of clenching. The most important of these problems are the development of the chewing muscles and the angular/square shape of the face, the wear of the teeth, the formation of cracks and fractures, and the progression of gum problems.

Although our teeth wear against these forces, our dentures do not. If there is a tooth against our prostheses (veneers), it will wear that tooth more or fractures may occur in the porcelain.

Our standard prosthesis materials consist of 2 parts. To ensure aesthetics, the entire surface visible from the outside is porcelain. However, since porcelain is not strong enough, there is a material such as metal or zirconia in its infrastructure and this infrastructure gives strength to porcelain.

What are the developments in prosthetic (crown, bridge, veneer) materials?

While metal-supported porcelains were often made in the past, zirconia, which is a healthier and more aesthetic material for the gums, has started to be used in many cases with the development of zirconia. Many studies have been carried out to improve both the durable and aesthetic structure of zirconia. With the development of computer-aided technology, CAD/CAM systems emerged.

Today, zirconia is produced with completely digital systems in untouched scraper devices with high aesthetics and strength. In this way, the need for porcelain structure has decreased considerably.

In addition, porcelain materials have also been developed and strengthened separately and can be used alone. The material we call E-max is produced by the production of reinforced porcelain close to perfection by machines with digital systems.

Which material should individuals with clenched teeth prefer in dental treatments?

In prostheses produced in the form of substructure and porcelain, fractures called chipping occur in porcelain during tooth clenching. This is of course not a situation we want. Especially in patients with clenched teeth, we prefer to use one-piece materials thanks to digital CAD/CAM systems. Because in patients with clenched teeth, fractures occur from this combination as a result of the prostheses being exposed to a force higher than the holding force of 2 materials.

While the use of specially produced one-piece (monolithic) zirconia in the posterior regions provides sufficient strength, emax crowns (veneers) that provide maximum aesthetic effectiveness in the anterior region can be preferred. Optionally, one-piece (monolithic) zirconia or emax crowns can also be used in the whole mouth.

While one-piece (monolithic) material is the most ideal for patients with clenching teeth, the choice of zirconia or full ceramic emax crowns (veneers) should be decided according to the person’s clenching force. For this reason, the knowledge and experience of the examining physician is very valuable in patients with clenching teeth.

What should individuals with clenching teeth pay attention to after dental treatments?

The use of a night protective plate (night plate, splint) is the gold standard in all treatments performed in patients with clenching teeth. Because especially at night, the amount of force is very, very high. Thanks to the aligner, the forces coming to the teeth will be distributed and some of the force will be absorbed by the aligner. Thus, excessive force transfer to the teeth is prevented. Again, thanks to the night plaque, the clenching efficiency will decrease as the length of the muscles will increase slightly.

Teeth clenching botox is also a good option that can be applied in appropriate patients in the treatment of bruxism. By normalizing the contraction strength of the muscles, it is aimed to erase the habit of clenching teeth from muscle memory. Even if this does not happen, it is a good supportive treatment that relieves the pain of the person and prevents the muscles from overdeveloping and bulging.

Again, in order to reduce the effect of teeth clenching, it is recommended to relax the chewing muscles with facial yoga, facial massage, and to strengthen the back and neck muscles with yoga and pilates to provide muscle strength balance. It helps to reduce the pain caused by muscle fatigue as a result of teeth clenching.

Smile to life…

Dt. İrem Sena Divanlıoğlu