ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Predicting Growth Patterns In Younger Individuals Is Important For Timing Implant Placement
Clinical Question In young patients seeking dental implant therapy, do growth patterns and/or amount of growth left to be completed influence when implants should be placed?
Clinical Bottom Line Patient growth is an important consideration in the timing of implant placement. Craniofacial growth steadily decreases after puberty, but it is not until after the average age of 20 (second decade of life) that the amount of growth may become clinically insignificant. Furthermore, it is around this time that a patient’s growth pattern should be assessed if implants are being considered.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 17448387Fudalej/2007142 males and 159 females treated in the Orthodontics department at the University of Washington. Evaluated radiographically by pretreatment, end of treatment, and 10-year post-treatment lateral cephalograms. Retrospective, cross-sectional
Key resultsThough it appears to decrease steadily, facial skeletal growth continues well after adolescence. It isn’t until after the second decade of life that it slows to a clinically insignificant amount. Roughly 60-70% of the increase in anterior facial height occurs in the lower third of the face. Male and female facial growth differs significantly during adolescence and this difference diminishes greatly after 20 years of age. Despite the overall greater facial growth noted in males, females showed a faster eruption rate of the maxillary central incisors.
Evidence Search ("Dental Implants, Single-Tooth"[Mesh] AND "Maxillofacial Development"[Mesh]) AND "Age Factors"[Mesh] AND ("humans"[MeSH Terms] AND English[lang])
Comments on
The Evidence
While this type of study is not considered the highest on the hierarchy of evidence, the study was relatively well controlled and constructed. The authors discuss several limitations. Most notable is the fact that the specific patterns of facial growth were not considered during the sample selection process. That being said, the decision of when to place implants in a growing individual may be affected by whether the patient has a more significant vertical growth pattern versus horizontal growth pattern. While the study looks at mean data, it does not provide clinical guidance as to how an individual patient may fare, i.e., some may complete growth earlier or later than average.
Applicability With the advent and increasing use of implant therapy in individuals with oligodontia, this article has increasing relevance. It is critical to avoid placing implants too early in growing individuals, and this study aids in timing this placement.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Orthodontics) (Periodontics) (Prosthodontics)
Keywords Dental Implants, Growth and Development, Age Factors, Maxillofacial Development, Adolescent
ID# 2159
Date of submission: 10/07/2011spacer
E-mail grodin@livemail.uthscsa.edu
Author Evan Grodin, DMD
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Thomas Oates, DMD, PhD
Faculty mentor/Co-author e-mail OATES@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Carson Lackey and Zeki Wathiq (San Antonio, Texas) on 11/30/2017
A PubMed search on the importance for timing implant placement by taking growth pattern into consideration was performed in November 2017. A more recent publication was found--a systematic review by Prithviraj in 2012 (PMID: 22984963)--as well as another article of higher level evidence--a systematic review by Heij in 2006 (PMID: 17190296). Both studies report on the importance of postponing implant placement until growth is complete, around 20 years of age, rather than immediate replacement of missing teeth when the growth rate is still high. Growth patterns should be observed around this age, as significant growth can still occur and create serious risk for implants.
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