Dear Colleagues,

We hope this message finds you enjoying the winter, safe, healthy and prosperous! We are excited to share this winter newsletter with you about some information our office and a few recent cases and a few clinical pearls to help you in your practice.

Our office is staffed by 2 Board Certified Prosthodontists- Dr. Avinash Bidra and Dr. Xiao Chun Li who are committed to excellence and offer only the highest quality of dental treatment. Dr. Bidra also serves as Director of the Prosthodontics Residency Program at UConn Dental School in Farmington, CT. Our office is located right in the center of Glastonbury and we serve patients who travel from various parts of Connecticut and across the country.

As specialists, we are not only committed to helping patients with advanced dental needs, but also committed to helping other dentists who need help serving their own patients. Whether you are looking to just get some guidance on difficult cases that you want to complete on your own, or stuck halfway or need help referring patients with complex situations such as occlusal plane issues, vertical dimension challenges, multiple failing teeth, restorative space issues, or bone grafting failures or implant misangulation or implant failures, we are here to help! As an educator for 15 years, Dr. Bidra loves to teach!

We will offer complimentary consultation for your patients and refer them back to you for their maintenance after treatment is complete. We are out of network with all dental insurances but will offer your patients a very fair and reasonable price for their treatment. Our office is certified for IV sedation and we will provide a safe and comfortable “one stop” experience for their dental treatment. Please check out the cases of the month and please visit our website at for additional such cases. Thank you for your time and look forward to working with you!

This patient with severe Bruxism was referred to Dr Bidra by his general dentist. On clinical assessment, patient demonstrated severe collapse of his vertical dimension of occlusion. The remaining teeth were deemed non-restorable and has poor prognosis. After a comprehensive assessment of bruxism habits, facial esthetics, vertical dimension, teeth display, available bone, a decision was made to increase vertical dimension in a systematic way and removal of all existing teeth and 6 implants in each jaw to support a full arch fixed zirconia prosthesis. In the Full mouth extractions and double jaw All on 4 treatment was completed with immediate loading following the Teeth in a Day protocol. In the mandible only 5 implants were placed due to the bone quality. However, no bone grafting was done which was a significant advantage to the patient and the patient eventually received Monolithic zirconia bridges. An occlusal guard and Botox injection into the masseters was included as part of the overall treatment. Total time in treatment was 7 months and patient was ecstatic with the result!

This patient was referred to Dr. Li by her general dentist. The patient had a history of missing multiple posterior teeth severe generalized bruxism, resulting in generalized wear with compensatory eruption, compromised smile esthetics, altered occlusal plane, and loss of VDO. Through conservative preparations adhering to prosthodontic principles, a majority of the teeth were successfully preserved without any need for endodontic treatment. Vertical dimension of occlusion was increased and a full mouth diagnostic waxup was performed to confirm and then a combination of implant and natural teeth supported zirconia crowns were employed to restore the occlusion, function and esthetics. Total time in treatment was 8 months.

Over-treat patients with Bruxism!

As you know Bruxism is a frustrating condition for our patients and for clinicians. According to the NIH, bruxism is caused by several factors including:

• Psychosocial factors: Stress, mood, distress, nervousness, and “feeling blue.”
• Genetics
• Consuming significant alcohol or caffeine
• Smoking

Antipsychotic medications used to treat depression, seizures, attention deficit hyperactivity disorder (ADHD) and many more conditions

Basically, this is a condition originating within the CNS and manifesting its effects in the dentition, muscles of mastication and the TMJ.

The scientific literature is very conclusive that patients who suffer Bruxism have no real cure, and they have a significant increase in prosthodontics complications. The complications include increased implant failure, increased screw loosening, screw fractures, restoration fractures, prosthesis fractures and much more. Only symptomatic treatment is available for Bruxism ranging from use of a simple occlusal guard, monolithic restorations (such as zirconia or gold) and use of Botulinum toxin injections.

In our practice, we manage Bruxism patients by going to an “over-drive” mode in treatment. This includes placement of more implants than usually necessary for full arch (eg: use of 5 or 6 implants for full arch instead of the usual 4 implants to provide a certain reserve should any implants fail), additional preparation of bone to allow a thicker prosthesis, additional preparation of natural teeth to allow for thicker monolithic restorations, provision of an occlusal guard even with the slightest suspicion of bruxism. We also inject Botulinum Toxin injections (“Botox”) into the masseter muscles, which has shown scientifically to significantly reduce the symptoms of Bruxism.

Good luck on your next “Bruxist” patient (if that is even a word)!

References:

1. Bruxism and Causes- National Institutes of Health. https://www.nidcr.nih.gov/health-info/bruxism#causes
2. Häggman-Henrikson B, Ali D, Aljamal M, Chrcanovic BR. Bruxism and dental implants: A systematic review and meta-analysis. J Oral Rehabil. 2024 Jan;51(1):202-217.
3. Taşdemir E, Doğan ŞE, Gülsen EA, Şeker Ç. Can Occlusal Splint or Botulinum Toxin A Therapy Reduce Masseter Muscle Thickness in Patients With Bruxism? J Oral Maxillofac Surg. 2025 Dec;83(12):1453-1460.
    

We offer complimentary consultations and will refer patients back to you for maintenance after treatment is complete.