Treating a patient who has bruxism and clenching and there is no restorative space

Rehabilitation of a Patient with Bruxism and Clenching

Treating a patient who has bruxism and clenching and there is no restorative space

by Carlos Castro, DDS, FACP, Board Certified Prosthodontist | Georgia Prosthodontics

Joan was referred to us with a history of multiple fractures, bruxism, clenching, short clinical crowns, and a severe lack of restorative space.  The patient’s aesthetics was compromised, and that was affecting her overall health.

The referring general dentist assessed Joan, but due to the severity of her tooth wear, she trusted us to seek a prosthetic solution. Previously to visiting us, the only alternative she was offered was having endodontic therapy.

Before Patient with Bruxism and Clenching

Treatment Suggested

Generally, we proceed by planning a multi-stage workflow that is beneficial for both the patient and us.

  1. Endodontic assessment and vitality tests
  2. Diagnostic wax-up to evaluate space and options to restore canine guidance
  3. Laboratory processed provisionals following wax-up at an increased Vertical Dimension for a Dahl appliance.
  4. Crown lengthening
  5. Healing and re-evaluation6. Definitive restorations using Lithium disilicate ceramics. A short clinical crown adjacent to a canine was splinted to reduce decementation risks
Patient´s case with Bruxism and Clenching (Before)
Pressed lithium disilicate crowns (Emax) fabricated by Prostho Dental lab

What was challenging about this case?

The main challenges were the lack of space for restorative material, the short clinical crowns, and high esthetic demands. Additionally, being the most conservative and avoiding endodontic therapies provided a biological goal.

It was remarkably important in the process to have the patient adapt to a new occlusal scheme with canine guidance at an increased Vertical Dimension.

The purpose of the Dahl appliance is to provide a combination of intrusion and extrusion resulting in a gain on restorative space.

Georgia Prosthodontics patient treated for Bruxism and Clenching

At Georgia Prosthodontics, this is a condition that we have treated on numerous occasions with a high rate of success, and we knew that the recommended path for Joan was quite different from what she has been told in the past.

Choosing the right path is as important as selecting the appropriate materials that will ensure a successful process.

Fortunately, the treatment for her bruxism and clenching went excellent, and Joan recovered her oral health along with her confidence. Two years have passed since we first met Joan, and she still trusts our professionals to take care of her oral health.

During our patient’s treatment, we dealt with a fracture in one of her teeth due to constant bruxism and clenching; the only solution was to remove it. In the surgery, we grafted a DPTFE cytoplast TXT200 membrane and after 4 weeks the membrane was removed. Then, after 12 weeks, the crown was placed on the tooth.

Tooth fracture in a patient with bruxism and clenching
cytoplast TXT200 membrane

Do you have a patient in a similar situation or that is experiencing a complex case?

We are specialized in complex cases as Joan’s case, if there is a case that you would like to work collaboratively on, please submit the enclosed referral form, and we will contact you at the earliest convenience.

We receive complex case referrals regularly and thrive on seeing your patients recover successfully.

For additional information, please visit our website

Study Club In Prosthodontics
New Findings & Best Practices for Cosmetic & Restorative Dentistry

Do you want another opinion on a complex case? Or to meet and share ideas?

There are many ways we can help each other by working together on complex cases and by sharing knowledge and experience.
With your reputation for quality dental care and our experience with restorative treatments, we can work together on advanced cases and both benefit!
If you’d like to meet to discuss a difficult procedure or talk on the phone about how we can help each other, please call or email our office with specific days and times when you are available to talk or meet.

Registration for future events visit us at STUDY CLUB

The Reconstructive Dentistry Team

Georgia Prosthodontics is focused on Implant, Cosmetic, and Reconstructive Dentistry. Drs. Carlos Castro & Norberto Delgado have the training and private practice experience that makes treatments of complex cases more successful, including patients:

• With severely worn/damaged teeth, missing all teeth, or with ill-fitting dentures can receive a full arch of natural-looking teeth to restore function & esthetics.

Congenital defects, a chronic condition, or traumatic injury can receive oral prostheses, which may be a combination of dental implants, crowns, bridges, or veneers.

• Patients with difficult anterior cases in the esthetic zone can receive single or multiple dental implants to replace missing teeth, or veneers or crowns to improve the appearance of their smile.

In addition, they have a private dental laboratory called Prostho Dental Lab. An in-house, experienced, and certified dental technician creates each custom restoration for referred patients from the best materials using the latest technology. To send an implant case to our dental lab, please visit:

Carlos Castro DDS Georgia Prosthodontics
Dr. Carlos Castro is the only Board Certified Prosthodontist cross trained in Dental Implant Surgery

Online Referral Form

Dear Doctor:

We appreciate your confidence in us. To refer one of your patients to a Prosthodontist you can either download our referral form or fill it out online and send it directly to us.

We look forward to hearing from you!