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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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Pediatric Patient Classification
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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Pediatric Patient Classification
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