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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 8  |  Issue : 2  |  Page : 123-125

Masticatory overload due to areca nut chewing on dental implants


1 Department of Prosthodontics, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
2 Department of Oral and Maxillofacial Surgery, S. B. Patil Dental College, Bidar, Karnataka, India
3 Department of Prosthodontics, Peoples College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India

Date of Web Publication13-Sep-2019

Correspondence Address:
Dr. Ramesh Chowdhary
Department of Prosthodontics, Rajarajeswari Dental College and Hospital, Bengaluru - 560 074, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjhs.sjhs_31_19

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  Abstract 


The habitual chewing of areca nut causes severe wear of incisal and occlusal surfaces of the tooth. However, in implant-supported occlusion, the effect of areca nut chewing is not documented in the literature. This study presents a case of areca nut chewing habit, which causes occlusal overload in the patient with implant-supported prosthesis. Areca nut chewing should be strictly avoided by implant patients, as it causes marginal bone loss due to overload and may lead to failure of prosthesis.

Keywords: Areca nut, dental implants, implant-supported prosthesis, mastication, osseointegration, overload


How to cite this article:
Chowdhary R, Sangolikar DK, Mishra SK. Masticatory overload due to areca nut chewing on dental implants. Saudi J Health Sci 2019;8:123-5

How to cite this URL:
Chowdhary R, Sangolikar DK, Mishra SK. Masticatory overload due to areca nut chewing on dental implants. Saudi J Health Sci [serial online] 2019 [cited 2019 Nov 18];8:123-5. Available from: http://www.saudijhealthsci.org/text.asp?2019/8/2/123/264947




  Introduction Top


Osseointegration, a direct interface between the bone and implant without any intervening soft tissue, is an important factor for the success and longevity of implants.[1] Bone withstands functional load up to a certain extent without any pain or breakthrough with the ability of the calcified tissue which undergoes remodeling in response to function.[2] Implant to bone interface is usually maintained by a continuous remodeling process of replacing the fatigued bone in an implant-supported prosthesis.[3]

One of the main causes for bone loss surrounding the implant prosthesis is occlusal overload, which may lead to failure of implant and implant-supported prosthesis, due to loss of osseointegration.[4] Studies have shown that there was loss of osseointegration in cases of successfully integrated implants due to occlusal overload.[5],[6],[7]

Areca nut chewing habit has been associated with oral diseases, which includes periodontal disease, oral submucous fibrosis, and oral cancer. The habitual chewing of areca nut causes severe wear of incisal and occlusal surfaces of the tooth. However, in implant-supported occlusion, the effect of areca nut chewing is not documented in the literature. This case report presents a case of areca nut chewing habit, leading to loss of osseointegration of dental implants.


  Case Report Top


A 47-year-old male patient with completely edentulous maxillary and mandibular arches (except 38) was rehabilitated with implant-supported prosthesis at Branemark Osseointegration Center, Bengaluru, Karnataka, India. The patient gave a history of loss of his natural teeth mainly because of gradual reduction in the height of the teeth, due to beetle nut chewing habit for 20 years. The patient was treated with four endosseous Mark III Branemark (Nobel Biocare, USA) implants and restored with hybrid prosthesis in maxillary and mandibular arches [Figure 1]. The patient was advised for discontinuation of the beetle nut chewing habit and called for routine checkups at regular intervals, but he did not follow and not visited the center for the last 3 years. He visited the center after 3 years with a complaint of slight movement with the mandibular prosthesis. On clinical examination, there was no mobility of the maxillary prosthesis observed, but mandibular right side of the implant area showed slight movement. On thorough clinical examination, it was observed that there was a fracture of abutment screw in the mandibular right premolar region implant. Radiograph confirmed the fracture of abutment screw [Figure 2]. The radiograph also revealed horizontal bone loss in relation to implants placed at angulation in the mandible. Further clinical examination revealed that mandibular implant threads exposed in oral cavity with plaque accumulation, and there was no inflammation of the soft tissue around the implants; all the implants showed no signs of mobility. The orthopantomograph confirmed that horizontal bone loss was generalized in all the implants supporting the mandibular and maxillary prosthesis [Figure 3]. It was planned to remove the mandibular prosthesis and retrieve the abutment screw and replace with a new abutment screw and check the occlusion, in order to find out the reason for bone loss.
Figure 1: Patient wearing implant-supported hybrid prosthesis

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Figure 2: Fractured part of the abutment screw in the mandibular right quadrant implant

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Figure 3: Orthopantomograph showing generalized bone loss around implants

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The amount of bone loss found in this case indicated an overload of the implants. The patient was questioned about his food habits and occupation, to find the reason for bone loss. The patient revealed that he had ignored the instructions given and chews 12–15 areca nuts every day with his implant-supported prosthesis. As the implants showed no mobility, it was decided to continue with the same prosthesis, and thus, the fractured abutment screw was retrieved and prosthesis was tightened back with the new screw. The patient was explained about the disadvantages of the overload caused due to crushing of areca nuts and was instructed to avoid this habit for long-term success of his implant-supported prosthesis.


  Discussion Top


Osseointegrated implant lacks periodontal receptors and has decreased load-sharing ability and adaptation to occlusal force. Mechanoperception is significantly reduced in dental implants and they are more susceptible to occlusal overload.[8] Mechanical overload causes damage of the involved tissues and induce marginal bone resorption which may lead to total loss of integration. Failure of osseointegration mainly depends on the intensity and duration of the load and the levels of stress and strain concentration.[9] The study had shown the correlation between overload and bone breakdown, thus eventually leading to implant failure. It has been determined that cortical bone is the least resistant to shear stress, which is seriously increased by bending overload.[10]

The overload from the parafunctional habits seemed to be the most probable cause of implant loss and marginal bone loss after loading. The patient's habit of areca nut crushing dramatically increased the occlusal load and stress and strain on the marginal bone surrounding the osseointegrated implants causing abutment screw loosening and fracture. Mechanical complications such as implant fracture, loosening and fracture of the abutment screw, and prosthesis fracture are documented as clinical consequences of occlusal overloading.[11]

Other possible factors are overextended cantilever (>15 mm) in the mandible and maxilla (>10–12 mm). It has been shown that occlusal overload may cause marginal bone loss, but in the absence of plaque-related infection, the marginal soft tissues remain unaffected, which was also seen in the present case.[12] Areca nut chewing is one of the most common chewing habits in India and leads to increased occlusal load. Approximately nine times greater occlusal force is required to illicit a tactile perception around implants.[13] Control of the applied load in the form of chewing habit and other parafunctional habits is the important factor for the long-term stability of the peri-implant tissues and prevention of biomechanical complications. Total loss of osseointegration appears possible with an already osseointegrated dental implants, when the applied force exceeds the biologically adaptable limit, but this has been very rarely documented. Hence, this case report is a rare representation of the occlusal overload on dental implants in clinical situation.

The clinical significance of the article is that a thorough history of areca nut chewing should be taken before implant placement, and if such habits are present, it should be strictly avoided by implant patients as it causes marginal bone loss due to overload and may lead to failure of prosthesis.[14],[15]

From this case report, it is clear that occlusal overload causes marginal bone loss, which was continues in nature, due to continuous habit of areca nut chewing by the patient. Healthy nature of the gingiva surrounding the implants could be due the machined surface of the implants, which even after exposed in the oral cavity did not accumulate plaque because of smooth nature of the implant surface, thus preventing gingival inflammation around the implant, which could have resulted in peri-implantitis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Alghamdi HS. Methods to improve osseointegration of dental implants in low quality (Type-IV) bone: An overview. J Funct Biomater 2018;9. pii: E7.  Back to cited text no. 1
    
2.
Smeets R, Stadlinger B, Schwarz F, Beck-Broichsitter B, Jung O, Precht C, et al. Impact of dental implant surface modifications on osseointegration. Biomed Res Int 2016;2016:6285620.  Back to cited text no. 2
    
3.
Hoshow SJ Brunski JB, Cochran GV. Mechanical loading of branemarl implants affects interfacial bone modeling and remodeling. Int J Oral Maxillofac Implants 1994;9:345-60.  Back to cited text no. 3
    
4.
Kate MA, Palaskar S, Kapoor P. Implant failure: A dentist's nightmare. J Dent Implant 2016;6:51-6.  Back to cited text no. 4
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5.
Razmara F, Kazemian M. Etiology, complications, key systemic and environmental risk factors in dental implant failure. Int J Contemp Dent Med Rev 2015;81:1-6.  Back to cited text no. 5
    
6.
Prashanti E, Sajjan S, Reddy JM. Failures in implants. Indian J Dent Res 2011;22:446-53.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Berglundh T, Abrahamsson I, Lindhe J. Bone reactions to longstanding functional load at implants: An experimental study in dogs. J Clin Periodontol 2005;32:925-32.  Back to cited text no. 7
    
8.
Mishra SK, Chowdhary R, Chrcanovic BR, Brånemark PI. Osseoperception in dental implants: A systematic review. J Prosthodont 2016;25:185-95.  Back to cited text no. 8
    
9.
Duyck J, Rønold HJ, Van Oosterwyck H, Naert I, Vander Sloten J, Ellingsen JE. The influence of static and dynamic loading on marginal bone reactions around osseointegrated implants: An animal experimental study. Clin Oral Implants Res 2001;12:207-18.  Back to cited text no. 9
    
10.
Oh TJ, Yoon J, Misch CE, Wang HL. The causes of early implant bone loss: Myth or science? J Periodontol 2002;73:322-33.  Back to cited text no. 10
    
11.
Goodacre CJ, Bernal G, Rungcharassaeng K, Kan JY. Clinical complications with implants and implant prostheses. J Prosthet Dent 2003;90:121-32.  Back to cited text no. 11
    
12.
Fu JH, Hsu YT, Wang HL. Identifying occlusal overload and how to deal with it to avoid marginal bone loss around implants. Eur J Oral Implantol 2012;5 Suppl: S91-103.  Back to cited text no. 12
    
13.
Hämmerle CH, Wagner D, Brägger U, Lussi A, Karayiannis A, Joss A, et al. Threshold of tactile sensitivity perceived with dental endosseous implants and natural teeth. Clin Oral Implants Res 1995;6:83-90.  Back to cited text no. 13
    
14.
Oh SL, Shiau HJ, Reynolds MA. Survival of dental implants at sites after implant failure: A systematic review. J Prosthet Dent 2019. pii: S0022-3913 (18) 30849-7.  Back to cited text no. 14
    
15.
Brune A, Stiesch M, Eisenburger M, Greuling A. The effect of different occlusal contact situations on peri-implant bone stress – A contact finite element analysis of indirect axial loading. Mater Sci Eng C Mater Biol Appl 2019;99:367-73.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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