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Title Best to Delay Implant Treatment in Pediatric Patients Until Skeletal Maturity Is Complete
Clinical Question For pediatric patients with hypodontia, what stage of development is the best to place implants when indicated for treatment?
Clinical Bottom Line For pediatric patients with hypodontia, it is ideal to place implants at skeletal maturity when indicated for treatment. This is supported by two systematic reviews comprised of case reports and case studies. No randomized clinical trials have been performed due to the ethics involving RCTs and pediatric patients. Despite the lack of RCTs, the systematic reviews seemed valid and the information is applicable to pediatric patients in a dental office.
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) 18181934Bergendal/200815 StudiesSystematic review of non-randomized trials
Key resultsBergendal concluded that it is best to place implants once “dental and skeletal development has ceased or is almost complete.” In developing children, there is continuous growth of the maxilla and mandible and the teeth around the implant are still erupting, causing an early-placed implant to become infraocccluded. Infraocclusion affects vertical bone height causing future problems. Bergendal indicated that it is best to delay implant treatment as long as possible.
#2) 23727735Mishra/201346 StudiesSystematic review of non-randomized trials
Key resultsMishra concluded that the most successful implantation occurs after skeletal growth has completed or, in general, past the age of 15 for females and 18 for males. This is indicated because there is a risk that, as the bone of the mandible or maxilla continues to grow, implant prostheses may become infraoccluded. Mishra determined that implant location, number of missing teeth, and the sex of the patient are also important in determining timing for implant placement.
Evidence Search ("dental implants"[MeSH Terms] OR ("dental"[All Fields] AND "implants"[All Fields]) OR "dental implants"[All Fields] OR ("dental"[All Fields] AND "implant"[All Fields]) OR "dental implant"[All Fields]) AND ("child"[MeSH Terms] OR "child"[All Fields] OR "children"[All Fields]) AND ("anodontia"[MeSH Terms] OR "anodontia"[All Fields] OR "hypodontia"[All Fields])
Comments on
The Evidence
Validity: These systematic reviews are not composed of randomized controlled trials, as that is unethical in pediatric patients. In both reviews, there was a comprehensive search. No meta-analysis was performed. In addition, the authors of both reviews included only articles written in English. However, neither review assessed the studies included for potential bias or quality. Perspective: I believe these systematic reviews captured current guidelines on placing implants in children. The exact timing of placing an implant in a pediatric patient depends on numerous factors such as severity of hypodontia, age, amount of bone, whether the deciduous tooth has exfoliated, and skeletal maturity. Neither specific developmental stage nor specific age can be recommended for every pediatric patient, except to say, if possible it is best to wait until skeletal maturity.
Applicability Seemingly there are a variety of opinions on this topic, but the overall evidence suggests waiting for skeletal maturity. The case is also affected by the patient’s severity of hypodontia (hypodontia to anodontia). In general, the recommendation would be to assess the skeletal growth (by comparing cephalometric radiographs taken 6 months apart) and wait for skeletal growth to be complete, if this is possible in the particular patient. Implants should only be placed in children when the benefits outweigh the negatives. Other treatment options include removable partial prosthetics, which were discussed in these reviews.
Specialty/Discipline (Oral Surgery) (Pediatric Dentistry)
Keywords Hypodontia; Pediatric; Implants; Deciduous teeth
ID# 3170
Date of submission: 04/13/2017spacer
E-mail foxkc@livemail.uthscsa.edu
Author Kirsten Fox
Co-author(s) e-mail
Faculty mentor/Co-author Issa Sasa, BDS, MS
Faculty mentor/Co-author e-mail Sasa@uthscsa.edu
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