Treatment planning for a tongue thruster

[Brett Hansen CDT]

One of my docs called me today about a patient she is treating. This patient is a 58 year old female who is mentally challenged. She lost 8 and 9 due to the thrusting of her tongue which she is unable to control. These missing teeth were replaced with a flipper which she lost as well. Implants were placed in 8 and 9 about a year ago. They are ready to be restored now. The doctor would like to know if there were anything we could do differently in the design of these restorations to inhibit the tongue thrusting behavior or strengthen the restoration so that this behavior doesn't jeopardize the longevity of the crowns/implants. She wants all porcelain abutments and crowns, but is willing to use different materials if it will help in this case. Would splinting the units help? Since there is no Periodontal Ligament, I was thinking that the tongue thrusting wouldn't be an issue for any type of restoration we did, but I haven't come across this type of situation before. I would appreciate any thoughts you all have. Thanks!

 

[TheLabGuy]

Splinting would help. I know with little kids, they have an orthotic appliance that has little wires that stick out, makes the tongue/brain train itself to stay away from this area. I wonder if you could create something like this when you make a PFM, where you create a hemostat holder but leave it instead of cutting it off. Sure, you don't want to make it so sharp it cuts the tongue, but something blunt that sticks out might help. Just an idea.

 

[Marcusthegladiator CDT]

Broken glass bonded to the lingual.

 

[Brett Hansen CDT]

Sounds like a winner Marcus! I was also thinking of implanting a small taser into the crown with the prongs on the lingual.

Rob, I think your idea was what the doc was thinking of. Am I wrong to think that the implants will stand up to the tongue thrusting better than her natural teeth did?

 

[2thm8kr]

Sounds like a winner Marcus! I was also thinking of implanting a small taser into the crown with the prongs on the lingual.

Rob, I think your idea was what the doc was thinking of. Am I wrong to think that the implants will stand up to the tongue thrusting better than her natural teeth did?

Axial forces are what implants survive. Lateral forces are what can cause failure. Splint those units to help share the load, and cross your fingers.

 

[Marcusthegladiator CDT]

Sounds like a winner Marcus! I was also thinking of implanting a small taser into the crown with the prongs on the lingual.

Rob, I think your idea was what the doc was thinking of. Am I wrong to think that the implants will stand up to the tongue thrusting better than her natural teeth did?

You could always cut the toungue out.

 

[lcmlabforum]

I find it hard to believe there was no occlusal or periodontal component that led
to the loss of those teeth . . .
LCM

 

[Brett Hansen CDT]

The doctor says she had a lot of bone loss around 8 and 9. I understood that the cause of this was the protrusive tongue thrusting over the years.

 

[TheLabGuy]

My solution:

 

[Brett Hansen CDT]

Thanks Rob....that is now burned into my brain.....nightmares to follow

 

[Marcusthegladiator CDT]

Cant see the pic...

 

[Doris A]

Cant see the pic...

You don't want to...

 

[rkm rdt]

I think Rob is planning a threesome.

 

[aidihra]

Lol! That pic is disturbing.

How about making an ortho appliance with a wire preventing the tongue from touching those teeth? I'm not an Ortho guy, but just trying to think of a possible solution for you.

 

[zero_zero]

My solution:

Photoshop...lol...

 

[rkm rdt]

Photoshop...lol...

You mean that's not LabGuy?

 

[2thm8kr]

You mean that's not LabGuy?

The rumor amongst the ladies is he can lick his eyebrows.

 

[TheLabGuy]

The rumor amongst the ladies is he can lick his eyebrows.

...and part my hair