PMC:2871132 / 192347-199416 JSONTXT

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Clinical Studies on Use of Endosseous Implants\nThe literature contains several anecdotal reports of the use of dental implants in growing patients, many with anodontia or oligodontia, often associated with ED, or from trauma [295,296,308,320–324]. The lack of relevant long-term clinical studies has not prevented clinicians from using implant-assisted prostheses in children; dental implants in children were described in dental literature as a successfull adjunt to oral rehabilitation [308,314,320,325,326]; and implant success rates were reported as 87% in preadolescents (ages 7–11), 90% in adolescents (ages 12–17), and 97% in adults (older than 17) [318]. The studies have demonstrated that implants may have high success rates in the edentulous child [307], and implants placed in girls after 15 and in boys after 18 years of age have a better prognosis than in younger children [297,302]. Stable implant conditions were reported after an observation period of 4 to 5.5 years in children with ED [308,320,325,327].\nAlcan et al. [328] reported on 6-year follow-up of a child with ectodermal dysplasia who was treated with implants surgery very early. In edentulous patients, the 10-year survival rates of such implants were 82% and 94% for the maxilla and mandible, respectively [307]. The mandibular endosseous implant was placed in a 4-year-old patient with hypohidrotic ectodermal dysplasia and oligodontia. It was reported that (i) the congenital anomaly does not appear to retard healing and the osseointegration remains after six years and three months of loading, (ii) mandibular and maxillary skeletal growth and development was normal, (iii), however, because of lack of alveolar growth, in time, patient’s vertical growth pattern changed to low angle. This could be corrected by changing the vertical heights of the abutment and prosthesis. As a result, in ectodermal dysplasias cases with anadontia, early implant placement and fixed prosthesis could be a good multidisciplinary treatment option for poor cooperative child. Balshi et al. [329] claimed the advantages of implants (Ti Brånemark implants, and zygomatic implants as well) due to biomechanical and esthetic uniqueness associated with implant-related prosthodontic orofacial rehabilitation for ED patients. A similar clinical opinion can be found from Becktor et al. [330], who used the endosseous implants in the oral rehabilitation of adolescent patients with HED and reported it should be considered a viable treatment option. The clinical report of a 18-year-old patient with hypohidrotic ED treated with a maxillary implant overdenture and a mandibular hybrid prosthesis supported by osseointegrated implants have presented significant improvements in oral function and psychosocial activities at the one-year follow-up [331]. Patients with oligodontia may benefit from the use of dental implants in the mandibualr anterior region, with restoration of function and improvement in psychosocial development, without waiting for the completion of growth to initiate treatment [7]. In older ED patients, for whom growth has stabilized, osseointegrated implants can be used as an alternative treatment to support, stabilize, and retain the prosthesis [308,314].\nFailures in dental implant treatment can be classified as early or late depending on certain complications. Late failures are usually attributed to peri-implantitis and/or occlusal overload. However, the hypothesis that occlusal overload causes peri-implant bone loss is still being debated [332–335], and scientific evidence for such a relationship has not been fully established [336]. In several studies [337–339], marginal bone defects similar to periodontal lesions found around teeth were created around the peri-implant tissues experimentally, through plaque accumulation promoted by various methods [7]. Although an increasing number of reports have presented the successful regenerative treatment of peri-implantitis defects [7,340–342], histologic evidence of re-osseointegration in humans is lacking. Persson et al. [343] demonstrated only a dense connective tissue capsule formation in the peri-implantitis defects next to commercially pure titanium surfacesin a dog study. However, the same authors recently demonstrated substantial re-osseointegration next to a sandblasted/acid-etched surface in another dos study [343,344]. Also, rapid biologic host recovery of the sandblasted/acid-etched surface was shown, with early radiographic signs of loss of osseointegration [316].\nBecktor et al. [330] pointed out that opinions vary as to whether it is advisable to place endosseous implants in growing patients, since there is a lack of scientific knowledge concerning the fate of these implants and associated prosthetic rehabilitation. Bone volume in young patients may not be sufficient for placing the implants in ideal positions to support the prosthesis. Also unknown is what happens psychologically to these patients when no treatment or various temporary solutions are provided. It was postulated that implants in the alveolus of a young, growing maxilla may become significantly buried in bone and their apical portions exposed as the nasal floor and maxillary sinuses remodel. The effect of remodeling in the presented subject can be seen on the maxillary superimposition. Björk et al. [284] showed an average nasal floor remodeling of 4.6 mm in boys aged four to 20 years. The inferior repositioning related to surface remodeling in the present patient was 3.8 mm. Because the continuous lengthening of the maxilla occurred posterior to the implants, the implants moved in harmony with the sagittal displacement and growth of the maxilla. No transverse enlargement could be registered in the tuberosity region of models from age nine to 20 years. By not rigidly connecting the right and left implants, interference at the midline growth suture could possibly be avoided [307].\nBergendal et al. [345] reported that dental implant placement has been a rarely used treatment modality in Swedish children less than 16 years old in the last 20 years. The failure rate in children treated because of tooth agenesis was only slightly higher than that reported for adult individuals, where in young children with ED and anadontia in the mandible, implants seemed to present special challenges, and the failure rate was very high. The small jaw size and preoperative conditions were thought to be the main risk factors.\nThe fact that the imp does not follow the normal growth of the maxilla or mandible in the three planes of space and behaves like an ankylosed tooth has been demonstrated in some clinical studies [296,300,301]. Additionally, Rossi and Andreasen [346], analyzed the unfavorable clinical and radiographic findings of a single-tooth replacement in a 10 year child and reported 9 mm discrepancy between the implant collar and the CEJ of the adjacent teeth in 25 years of age; additionally they have stated that there was no significant bone loss at the implant site during a 10 year observation."}

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Clinical Studies on Use of Endosseous Implants\nThe literature contains several anecdotal reports of the use of dental implants in growing patients, many with anodontia or oligodontia, often associated with ED, or from trauma [295,296,308,320–324]. The lack of relevant long-term clinical studies has not prevented clinicians from using implant-assisted prostheses in children; dental implants in children were described in dental literature as a successfull adjunt to oral rehabilitation [308,314,320,325,326]; and implant success rates were reported as 87% in preadolescents (ages 7–11), 90% in adolescents (ages 12–17), and 97% in adults (older than 17) [318]. The studies have demonstrated that implants may have high success rates in the edentulous child [307], and implants placed in girls after 15 and in boys after 18 years of age have a better prognosis than in younger children [297,302]. Stable implant conditions were reported after an observation period of 4 to 5.5 years in children with ED [308,320,325,327].\nAlcan et al. [328] reported on 6-year follow-up of a child with ectodermal dysplasia who was treated with implants surgery very early. In edentulous patients, the 10-year survival rates of such implants were 82% and 94% for the maxilla and mandible, respectively [307]. The mandibular endosseous implant was placed in a 4-year-old patient with hypohidrotic ectodermal dysplasia and oligodontia. It was reported that (i) the congenital anomaly does not appear to retard healing and the osseointegration remains after six years and three months of loading, (ii) mandibular and maxillary skeletal growth and development was normal, (iii), however, because of lack of alveolar growth, in time, patient’s vertical growth pattern changed to low angle. This could be corrected by changing the vertical heights of the abutment and prosthesis. As a result, in ectodermal dysplasias cases with anadontia, early implant placement and fixed prosthesis could be a good multidisciplinary treatment option for poor cooperative child. Balshi et al. [329] claimed the advantages of implants (Ti Brånemark implants, and zygomatic implants as well) due to biomechanical and esthetic uniqueness associated with implant-related prosthodontic orofacial rehabilitation for ED patients. A similar clinical opinion can be found from Becktor et al. [330], who used the endosseous implants in the oral rehabilitation of adolescent patients with HED and reported it should be considered a viable treatment option. The clinical report of a 18-year-old patient with hypohidrotic ED treated with a maxillary implant overdenture and a mandibular hybrid prosthesis supported by osseointegrated implants have presented significant improvements in oral function and psychosocial activities at the one-year follow-up [331]. Patients with oligodontia may benefit from the use of dental implants in the mandibualr anterior region, with restoration of function and improvement in psychosocial development, without waiting for the completion of growth to initiate treatment [7]. In older ED patients, for whom growth has stabilized, osseointegrated implants can be used as an alternative treatment to support, stabilize, and retain the prosthesis [308,314].\nFailures in dental implant treatment can be classified as early or late depending on certain complications. Late failures are usually attributed to peri-implantitis and/or occlusal overload. However, the hypothesis that occlusal overload causes peri-implant bone loss is still being debated [332–335], and scientific evidence for such a relationship has not been fully established [336]. In several studies [337–339], marginal bone defects similar to periodontal lesions found around teeth were created around the peri-implant tissues experimentally, through plaque accumulation promoted by various methods [7]. Although an increasing number of reports have presented the successful regenerative treatment of peri-implantitis defects [7,340–342], histologic evidence of re-osseointegration in humans is lacking. Persson et al. [343] demonstrated only a dense connective tissue capsule formation in the peri-implantitis defects next to commercially pure titanium surfacesin a dog study. However, the same authors recently demonstrated substantial re-osseointegration next to a sandblasted/acid-etched surface in another dos study [343,344]. Also, rapid biologic host recovery of the sandblasted/acid-etched surface was shown, with early radiographic signs of loss of osseointegration [316].\nBecktor et al. [330] pointed out that opinions vary as to whether it is advisable to place endosseous implants in growing patients, since there is a lack of scientific knowledge concerning the fate of these implants and associated prosthetic rehabilitation. Bone volume in young patients may not be sufficient for placing the implants in ideal positions to support the prosthesis. Also unknown is what happens psychologically to these patients when no treatment or various temporary solutions are provided. It was postulated that implants in the alveolus of a young, growing maxilla may become significantly buried in bone and their apical portions exposed as the nasal floor and maxillary sinuses remodel. The effect of remodeling in the presented subject can be seen on the maxillary superimposition. Björk et al. [284] showed an average nasal floor remodeling of 4.6 mm in boys aged four to 20 years. The inferior repositioning related to surface remodeling in the present patient was 3.8 mm. Because the continuous lengthening of the maxilla occurred posterior to the implants, the implants moved in harmony with the sagittal displacement and growth of the maxilla. No transverse enlargement could be registered in the tuberosity region of models from age nine to 20 years. By not rigidly connecting the right and left implants, interference at the midline growth suture could possibly be avoided [307].\nBergendal et al. [345] reported that dental implant placement has been a rarely used treatment modality in Swedish children less than 16 years old in the last 20 years. The failure rate in children treated because of tooth agenesis was only slightly higher than that reported for adult individuals, where in young children with ED and anadontia in the mandible, implants seemed to present special challenges, and the failure rate was very high. The small jaw size and preoperative conditions were thought to be the main risk factors.\nThe fact that the imp does not follow the normal growth of the maxilla or mandible in the three planes of space and behaves like an ankylosed tooth has been demonstrated in some clinical studies [296,300,301]. Additionally, Rossi and Andreasen [346], analyzed the unfavorable clinical and radiographic findings of a single-tooth replacement in a 10 year child and reported 9 mm discrepancy between the implant collar and the CEJ of the adjacent teeth in 25 years of age; additionally they have stated that there was no significant bone loss at the implant site during a 10 year observation."}