Bruxism: sleep and awake parafunctional activity
Bruxism is a parafunctional activity characterised by clenching or grinding of the teeth, predominantly during sleep (sleep bruxism) or while awake (awake bruxism). The two forms have different electromyographic profiles and require partially different management approaches.
The effect on dental structure is cumulative over time. Teeth subject to excessive occlusal forces for years undergo progressive structural loss that, once a critical threshold is exceeded, can no longer be recovered with conservative approaches. Early diagnosis is the key determinant of reversibility.
Not every patient with bruxism develops clinically significant wear. Severity depends on the intensity of forces generated, the resistance of hard dental tissues, and whether protective devices are in place. Some patients with documented bruxism show minimal wear at 50; others present severe structural loss at 35. The distinction is not primarily one of diagnosis but of quantification.
When an occlusal device is not enough
An occlusal device (bite plane, splint) is the primary tool for managing bruxism. It protects teeth from grinding forces, reduces articular loading, and in some patients contributes to reducing parafunctional activity. It does not eliminate bruxism, but limits its structural consequences.
In patients where wear has already produced significant occlusal, incisal, or vestibular structural loss, the device alone is insufficient: form, function, and in many cases aesthetics must be restored. The choice of restoration type, and its sequencing relative to bruxism stabilisation, is a clinical decision requiring case-by-case assessment.
Adhesive restoration in the bruxism patient
Patients with bruxism can be treated with ceramic overlays and onlays, but specific conditions must be met.
The bruxism must first be stabilised, or at least documented in its intensity. A restoration placed in an unstable occlusal system is exposed to the same loads that produced the original wear. Second, ceramic material choice must account for the forces involved: in patients with intense parafunctional activity, feldspathic ceramic, the biomimetically optimal material for anterior restorations, may need to be replaced by higher-fracture-resistance ceramics in posterior areas.
Third, the patient must understand that a nocturnal occlusal device remains necessary after restoration, permanently. The restoration recovers the lost structure; the device protects the restoration from the same force that destroyed the original structure.
The correct clinical sequence
Studio Calesini applies a structured phased sequence in patients with bruxism-related wear. The first phase involves bruxism diagnosis (clinical history, occlusal analysis, where indicated a bruxism checker or polysomnography), wear assessment (severity, distribution, residual structure), and prescription of an occlusal device. The second phase, after a period of stabilisation, involves clinical reassessment and, if indicated, restoration planning. The third phase is the restoration itself, executed in the occlusal scheme re-established with the device and designed to coexist with residual parafunctional activity.
In many patients, before proceeding to definitive restorations, a composite mock-up or full-arch provisional in resin is fabricated. This allows verification of the restored vertical dimension, aesthetics, and the patient's functional tolerance before committing to definitive restorations.