pediatric implants

8/8/2019 Pediatric Implants

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Dental Implants inPediatric Patients

Dr. Chris Kirkup

Dr. Dan Bower


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Indications Hereditary Anhidrotic Ectodermal Dysplasia

(HAED)

Alveolar Clefts

Trauma

Tumor Resection


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Contraindications

Childs inability to perform oral hygiene

Presence of adjacent primary teeth

Inadequate quantity or quality of bone

Unrealistic parental expectations


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Mandibular Growth Patterns

Anteroposterior Growth: Mandible lengthens by posterior-superior growth of the

condyle and posterior growth of the ramus

Body of mandible increases in length by resorption onanterior aspect of the ramus and deposition on the

posterior

Posterior width of mandible increases by virtue of Vconfiguration ; symphyseal suture ceases growth prior

to eruption of primary teeth


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Mandibular Growth Patterns

Rotational Growth Condyle grows vertically, or vertically and forward, so

that vertical growth of ramus exceeds that of

symphyseal area, causing a rolling downward andforward

In patterns of excessive rotation requiring considerable

dental compensation to maintain occlusion, implantscould ultimately be deficient in height or be oriented at

improper inclination


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Mandibular Growth


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Maxillary Growth Pattern

Growth of surrounding tissues translates the maxilla

downward and forward, opening space at the posterior and

superior suture attachments for bone addition

As the maxilla translates downward and forward, its

anterior surface tends to resorb

Remodeling of the palatal vault produces movement in the

same direction as maxillary translation. Bone is removed

from the floor of the nose and added to the roof of the

mouth. As the vault moves downward, the same process

widens it.


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Maxillary Growth


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Pediatric Patient Classification

Group 1: Missing a single permanent tooth Ideally, placement should be delayed until completion

of alveolar development and eruption of all permanent

teeth

Implants placed early in alveolar growth may become

submerged, requiring a longer prosthesis andcompromising implant success


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Group 2: Oligodontia (as in HAED) Alveolar process demonstrates abnormal growth, and

incidence of submerged implant is low

Placement should begin as soon as patient understands

treatment and can perform maintenance


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Group 3:Acquired anadontia due to tumorresection or trauma reconstructed with bone

graft No concerns regarding alveolar growth

Implants placed as soon as appropriate from

psychosocial standpoint


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Case Study #1

15 year old male, placement #13. 35 months later implant demonstrates ankylosis.

Crown was later lengthened by addition of porcelain.


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Case Study #2

16 year old male, placement of congenitally missing #20,#29. Implants 56 months

later with no evidence of further alveolar bone growth


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Clinical Findings Following

Placement

Maxillary and mandibular growth may alter initialimplant position

Implants behave like ankylosed teeth and may

become buried, exposed or lost

Implants may alter growth patterns of the jaws

Morphology and path of eruption of tooth germs

may also be altered


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References Westwood, RM, Ducan, JM. Implants in adolescents: A literature review and

case reports. Int J Oral Maxillofac Implants 1996;11:750-755.

Perrott DH, Sharma AB, Vargervik K. Endosseous implants for pediatric

patients. Oral and Maxillofac Surg Clin North Am 1994;6:79-88.

Brugnolo E, Mazzocco C, Cordioli G, Majzoub Z. Clinical and radiographic

findings following placement of single-tooth implants in young patients-casereports. Int J Perio Rest Dent 1996;16:5421-433.

Cronin RJ, Oesterle LJ, Ranly DM. Mandibular implants and the growing

patient. Int J Oral Maxillofac Implants 1994;9:55-62.

Kearns G, Perrott DH, Sharma A, Kaban LB, Vargervik K. Placement ofendosseous implants in grafted alveolar clefts. Cleft Palate and Craniofacial J

1997;14:520-525

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