Use of endosseous implants in a 3-year-old child with ectodermal dysplasia: case report and 5-year follow up

Resident: J. Hencler
Date: 03/05/2010

Article title:
Use of endosseous implants in a 3-year-old child with ectodermal dysplasia: case report and 5-year follow up

Author(s): Albert D. Guckes, DDS, MSD George R. McCarthy, DDS Jaime Brahim, DDS, MS
Journal: Pediatric Dentistry-19: 4, 1997
Major topic: Ectodermal dysplasia
Type of Article: Case Report

Main Purpose:
Present a case report of implant placement in a 3yo w/ ectodermal dysplasia, subsequent prostho tx, and 5 yr follow-up.

Background:
Ectodermal dysplasia represents a grp of inherited disorders characterized by defects in tissue that are derived from ectoderm.

Case:
3 yo white male dx w/ Christ-Siemens-Touraine ectodermal dysplasia. 4 mandibular and 2 maxillary implants were placed (stage 1 complete). Max/Mand bone augmentation with hydroxyapatite (HA) was completed. Clinical exam was consistent w/ dx of hypohidrotic ecto dysplasia. 2 max tooth buds observed. Implants healed normal, child scheduled for stage 2 uncovering of implants and placement of mand healing abutments. Maxillary right implant was removed due to mobility. Max left implant was covered b/c it alone could not contribute to prosthesis support. Max conventional complete denture and mand over-denture were fabricated and adjusted/remade over 5 yrs as needed to accommodate eruption of 2 max teeth and overall growth.

Follow-up:
Mand implants in function 4 yrs. Relative position w/in ant mand unchanged as growth occurs in the rami and condyles. Some resorption of HA noted radiographically after 5 yrs. Relative position of unloaded single max implant has not moved w/ the downward and forward growth of the maxilla but is positioned in close proximity to the nasal floor. This implant will require close monitoring, as the ultimate position is uncertain.

Key points in the article discussion:
This case confirms that implants placed int the ant mand wil move w/ the mand as growth occurs in the condyles and rami. Mand rotation that occurs w/ growth has not caused problems relative to implant angulation and prosthetic occl plane. The change in implant position of the max implant as the mand grows downward is not unexpected and may be a significant complication and may require removal. While the magnitude of the change in position of the max implant may not be typical, it provides a cautionary note regaeding implant placement in the growing maxilla. The most important issue raised by this case is if and when tx of a young child w/ implants is indicated and prudent. There is little research identifying any physiologic benefits of placing implants in children. The theoretical possibility exists that significant edentulism in a growing child adversely affects craniofacial growth. While the lit supports the concept that craniofacial devel is adversely affects in ecto dyplasia children, the exact mechanism by which the growth is affected is unclear. The most obvious effect of ecto dyplasia is lack of alveolar bone in areas of anodontia. At present there is no evidence from clinical trials to indicate that implant placement in young children has a positive effect on craniofacial growth and devel.

Summary of conclusions:
This case provides a good opportunity to follow the consequences of placing oral implants in a very young patient. Psychological benefits may be associated w/ using implant to support an oral prosthesis in the mandible of a teenage child with many missing teeth. However, clinical research has not demonstrated compelling reasons to place implants in pre-teenage children.

Assessment of article:
Very interesting article. Implant placement in the growing child will require multi-specialty extensive tx planning. I feel that ultimately it should be the parent’s decision once they are fully informed of prognosis and tx requirements including ongoing maintenance to accommodate for future growth.