|Year : 2020 | Volume
| Issue : 3 | Page : 57-59
Dental implants in children
Binoy Mathews Nedumgottil1, Sajina Sam2, Sajith Abraham1
1 College of Dentistry, King Faisal University, Al Ahsa, KSA
2 Department of Pedodontics & Preventive Dentistry, Mahe Institute of Dental Sciences & Hospital, Mahe, Union Territory of Puducherry, India
|Date of Submission||14-Sep-2020|
|Date of Acceptance||15-Sep-2020|
|Date of Web Publication||28-Sep-2020|
Prof. Binoy Mathews Nedumgottil
College of Dentistry, King Faisal University, P.O Box: 400, Al-Hofuf, Al-Hassa.
Source of Support: None, Conflict of Interest: None
Dental implant placement is one of the possible modes of rehabilitation in pediatric patients, with conditions such as congenital partial anodontia and traumatic tooth loss. Systematic planning of treatment is required to achieve optimum esthetic and functional outcomes. Growth assessment accompanied with alveolar bone evaluation is mandatory at the planning of implant treatment. For greater outcomes of implant treatments, all the surgical and orthodontic procedures should be well initiated about a year prior to the planned implant placement. In children, greater the physiologic harmony that can be created within the dentition, alveolar bone and skeletal growth changes, higher are the chances of successful implant placement. To determine the optimal individual time point of implant insertion, the status of skeletal growth, the degree of hypodontia, and extension of related psychological stress should be taken into account in addition to the status of the existing dentition and dental compliance of a pediatric patient.
Keywords: Anodontia, dental implant, pediatric patient, skeletal growth
|How to cite this article:|
Nedumgottil BM, Sam S, Abraham S. Dental implants in children. Int J Oral Care Res 2020;8:57-9
| Introduction|| |
In pediatric dental patients, conditions such as congenital partial anodontia and traumatic tooth loss often require oral rehabilitation even before the occurrence of skeletal and dental maturation. Removable partial denture (RPD) is the most common treatment of choice, with certain complications such as high dental caries risk, periodontal complications, and increased chances of residual alveolar bone resorption. Dental implants in children are one of the new treatment modalities with two primary concerns: (i) in a growing child, presence of implants during several years of facial growth may result in the danger of implants getting embedded, relocated, or displaced related to the rate of potential jaw growth and (ii) the second area of concern is the effect of prosthesis on jaw growth.
| Scope of Dental Implants in Children|| |
In children and adolescents, the amount of research on treatment planning, success rate, and execution of implant placement is still in its infancy. Scope of implants in a growing child depends on the balance between the benefits and concerns for their premature use. Studies showing long-term success rate of dental implants in partially edentulous cases has promoted the clinicians to broaden its application in adolescents with missing teeth due to trauma or agenesis. Anodontia either primary or acquired occasionally creates the opportunity for the use of dental implants. In the case of congenital partial anodontia with minimum alveolar bone, placement of dental implant controls and directs the load mechanism on bone and thereby retards alveolar bone resorption. In adolescent age group, the use of dental implants differs significantly from adults with a wide variety of changes occurring in the dentition and jaws. Undesirable conditions such as periodic prosthesis remodeling to compensate growth changes and inadequate bone volume in children recommends to avoid placing implants in children younger than 16–18 years of age or until growth and skeletal development is completed or nearly completed except for severe cases of anodontia.
| Dental Implant Placement in a Normal Growing Child|| |
Maxillary anterior quadrant
Absence of maxillary teeth may result in underdeveloped maxilla both sagittally and vertically, with impaired development of alveolar ridge. Among the multiple factors that might cause a halt in implant positioning in anterior maxillary area, the most relevant to be referred is high and divergent inherent growth potential in anterior, posterior, and vertical dimensions that result in overall developmental increase. Moreover, a need for esthetically pleasing restoration, existence of mid-palatal joint, implant placement causing no growth cessation or uncoordinated width growth are the other contributing factors that determine the long term success. Therefore, placing implant should be delayed in anterior maxilla up to the age of 15 in girls and 17 in boys. Premature placement results in repetitive need to lengthen the transmucosal implant-to-prosthesis ratios and the potential load magnification. Evaluation of skeletal age, preparing consent form, and probable prescription of implant in future should be considered during the treatment planning process itself.
Maxillary posterior quadrant
Diversity in anteroposterior and vertical growth, three times increased transverse growth than anteriors due to growth at mid palatal suture, rotational development, mesial and rotational displacement of molars, resorption activity of nasal base, deposition of alveolar bone and increased masticatory load on the implant are few factors that delay the implant placement in posterior maxilla as that of anterior maxilla.,
Mandibular anterior quadrant
Mandibular anterior due to its fewer growth variables provides favorable dental space for an osseointegrated implant placement before growth completion and skeletal maturation. Endosseous implant placement in a 5-year-old child has shown positive treatment results, with closure of symphyseal suture early in the first 2 years of life along with the continuance of growth with bone deposition, resorption in labial and lingual surface, respectively. In anterior mandible, the prognosis of the treatment mainly depends on the selection of ideal prosthesis supported by dental implants. Considering the growth changes in a young child, the prosthesis should be of retrievable design favoring repeated modification with an average increase of 5–6 mm of dental height as well as anteroposterior growth.
Mandibular posterior quadrant
Multiple treatment concern in implant positioning on the mandibular posterior area is mainly due to the dynamic three-dimensional growth and developmental changes such as active appositional growth at the alveolar border (upward and outward on an expanding arc) with resorption in lingual area, increase in transverse dimension (expanding V pattern), growth in the anterior-posterior, and vertical direction coupled with rotational growth of condyle. Remodeling process represented by apposition and resorption in the mandible as well as independency of mandibular growth on the presence of teeth advocates to postpone the placement of osseointegrated implants until skeletal completion in the late growing period.
| Dental Implants in Children with Ectodermal Dysplasia|| |
Anodontia is rare genetic disorder characterized by the congenital absence of all primary or permanent teeth. Congenital anodontia of the mandible is mostly found as a common feature of ectodermal dysplasia of hypohydrotic type. Restoring function and esthetics in a young child with anodontia, hypodontia, and oligodontia often presents treatment challenges for the clinician particularly, during the years of active growth. Considerable vertical, anteroposterior, and dental changes can be expected with growth, more in a partially anodontic patient than a totally anodontic patient. Few successful treatment options suggested by several case reports in treating anodontic mandible are removable denture around the age of 3 years till the completion of lateral growth, implant supported overdenture in the canine region from the age of 3–6 years after the closure of median suture. Studies indicates early intervention of anodontia/severe oligodontia with implant supported prosthesis in mandible with periodic follow-up and avoidance of implants in maxilla.
In children with hypodontia, the complicated decision-making depends on factors such as number of teeth absent, sex of the patient, location and the length of edentulous area, need for conservation of bone with the use of dental implant, orthodontic treatments required, psychological factors, and potential skeletal/dental growth changes. Studies recommend implant placement to be planned after assuming growth cessation using serial cephalometric tracings (no evident skeletal change for 1 year) as there are no reliable indicators. It is mandatory to keep the parents well informed and aware of growth completion schedule for any further corrective surgery or prosthesis placement.
| Implant and Other Functionalities|| |
Numerous studies substantiated the use of dental implant as a valuable tool for anchorage in orthodontic treatments and also in distraction osteogenesis due to its resistance on employing force, especially in cases with inadequate dental anchorage. Use of implant was found to be satisfactory in children who had undergone bone removal in maxillary and mandibular tumoral areas and also in long-term bone restoration in palatal cleft. Treatment modalities addressing dental problems associated with congenital conditions such as ectodermal dysplasia, Williams–Beuren syndrome, dental agenesis, and hemifacial microsomia are often found to be well benefitted by the advent of using implants in dentistry.
| Conclusion|| |
Published reports on the use of dental implants in young patients are very limited; long-term clinical studies are necessary for sound conclusions. If the goal of treatment planning favors implant placement before skeletal maturation, parents are to be well informed about the benefits and possible complications. However, more emphasis should be given on planning of prosthesis and the follow up phase. The treatment outcome can only be justified when the anticipated positive effects are greater than the drawbacks of the procedure.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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