Bruxism and dental implant failures: a multilevel mixed effects parametric survival analysis approach

J Oral Rehabil. 2016 Nov;43(11):813-823. doi: 10.1111/joor.12431. Epub 2016 Sep 9.


Recent studies have suggested that the insertion of dental implants in patients being diagnosed with bruxism negatively affected the implant failure rates. The aim of the present study was to investigate the association between the bruxism and the risk of dental implant failure. This retrospective study is based on 2670 patients who received 10 096 implants at one specialist clinic. Implant- and patient-related data were collected. Descriptive statistics were used to describe the patients and implants. Multilevel mixed effects parametric survival analysis was used to test the association between bruxism and risk of implant failure adjusting for several potential confounders. Criteria from a recent international consensus (Lobbezoo et al., J Oral Rehabil, 40, 2013, 2) and from the International Classification of Sleep Disorders (International classification of sleep disorders, revised: diagnostic and coding manual, American Academy of Sleep Medicine, Chicago, 2014) were used to define and diagnose the condition. The number of implants with information available for all variables totalled 3549, placed in 994 patients, with 179 implants reported as failures. The implant failure rates were 13·0% (24/185) for bruxers and 4·6% (155/3364) for non-bruxers (P < 0·001). The statistical model showed that bruxism was a statistically significantly risk factor to implant failure (HR 3·396; 95% CI 1·314, 8·777; P = 0·012), as well as implant length, implant diameter, implant surface, bone quantity D in relation to quantity A, bone quality 4 in relation to quality 1 (Lekholm and Zarb classification), smoking and the intake of proton pump inhibitors. It is suggested that the bruxism may be associated with an increased risk of dental implant failure.

Keywords: bruxism; dental implant; implant failure; multilevel mixed effects parametric survival analysis.

MeSH terms

  • Adult
  • Bone Density
  • Bruxism / complications*
  • Bruxism / physiopathology
  • Bruxism / surgery
  • Dental Implantation* / adverse effects
  • Dental Implants*
  • Dental Prosthesis, Implant-Supported
  • Dental Restoration Failure / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Smoking / adverse effects*
  • Treatment Failure


  • Dental Implants