The importance of central sensitization management in prosthodontic clinical practice: Two case reports of phantom bite syndrome

Abstract

Patients: Two female patients aged 55 and 65 presented with persistent occlusal discomfort diagnosed as phantom bite syndrome (PBS) despite multiple prosthetic interventions. Neither had significant psychiatric comorbidity. Both underwent psychosomatic evaluation after non-pharmacological approaches proved insufficient. Pharmacotherapy included low-dose amitriptyline at 10–35 mg/day with aripiprazole augmentation at 1 mg/day in Case 1, and low-dose aripiprazole monotherapy at 1 mg/day in Case 2 after amitriptyline intolerance. Both patients showed marked improvement on the Oral Discomfort/Dysesthesia Rating Scale misalignment subscale, achieved stable occlusion without excessive adjustments, and reported no severe adverse effects during 27–33 months of follow-up.

Discussion: These cases show that pharmacotherapy targeting central hypersensitivity can facilitate successful prosthetic rehabilitation, even in patients without major psychiatric comorbidity. Continued medication during definitive prosthetic procedures helped prevent relapse, highlighting the value of integrated psychopharmacological and prosthodontic management. Clear communication, reframing the condition as hypersensitivity, and shared decision-making further improved adherence and long-term stability.

Conclusions: Maintaining pharmacotherapy throughout prosthetic treatment stabilized PBS symptoms, reduced relapse risk, and improved acceptance of definitive restorations. Recognition of possible central nervous system involvement, even without overt psychiatric comorbidity, broadens therapeutic options and supports better outcomes. Future studies should expand clinical case data, refine medication strategies, define optimal treatment timing, and strengthen interdisciplinary collaboration in PBS management.