ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Implants Should Not Be Placed In Children Or Adolescents Until Jaw Growth Has Ceased
Clinical Question In children with missing teeth, does placing implants versus restoring with removable prostheses, cause alveolar ridge growth abnormality?
Clinical Bottom Line Placing implants in developing alveolar bone may cause the implant to act as an ankylosed tooth, failing to erupt, while adjacent teeth erupt into occlusion. (See Comments on the CAT below)
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) 10442937Kearns/19976 children and adolescents with hereditary ectodermal dysplasiaCase Series
Key resultsA total of 41 implants (19 maxillary, 22 mandibular) were placed. The average follow-up after implant placement was 7.8 years (range, 6-11 years), and the average time since restoration was 6 years (range, 5-10 years). Forty implants successfully integrated and have been restored. There was no evidence that implant placement or prosthetic rehabilitation resulted in restriction of transverse or sagittal growth. One mandibular implant, placed in a partially dentate 5-year-old, became submerged because of adjacent alveolar development and required placement of a longer abutment. Four maxillary implants placed in a partially dentate 7-year-old also became submerged and required prosthetic revision and the placement of longer abutments.
#2) 17172960Ersoy/20066 male farm pigs (n = 1 control)Lab animal
Key resultsThe natural temporary #1 molar teeth and implant-supported prosthetic structure were elevated in the same direction. However, elevation of the natural teeth was more significant due to the effect of the eruption and bone growth. In the control animal, which had no implant, the distance between the tubercle peak of the #1 molar tooth and the foramen mental was in the same order (1–2) with that of the experimental specimens.
Evidence Search "Alveolar Process/growth and development"[Mesh] AND ("Dental Implantation"[Mesh] OR "Dental Implants"[Mesh])
Comments on
The Evidence
In the Kearns article, the strength of evidence was mild. The groups were not similar at the start: 2/6 subjects had already been treated before the start of the study, 1/6 subject had a different type of ED than the others, 2/6 subjects were totally edentulous whereas the others were partially edentulous, the age of implant placement varied significantly, and the implant type varied. They did have a completion rate >80% and compliance was adequate. The study was not double-blind. The followup was adequate with a mean of 7.8 years after implant placement, and 6 years after restoration. In the Ersoy article, the strength of evidence was moderate. The pig groups were very similar at the start and there was a 100% completion rate. The study did not have sufficient follow up to determine long-term effects of implants on alveolar bone growth. We don’t know if the study was double-blind.
Applicability These studies are very applicable to us because we often see children with missing teeth, and we constantly strive to find the most appropriate treatment for them. This subject offers little support for clinical trials due to the fact that we cannot place implants in children since this may not be ethical treatment. The clinical trial performed in pigs does offer us some insight into what happens when implants are placed in growing bone, however, the application of this study to humans is questionable. The study of children with ectodermal dysplasia demonstrates that placing implants in children may result in ‘ankylosed’ implants, though implants may still be indicated for these patients.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Pediatric Dentistry) (Periodontics) (Prosthodontics)
Keywords Dental implants, dental implantation, growth and development, alveolar process
ID# 721
Date of submission: 09/21/2010spacer
E-mail clcorrigan@gmail.com
Author Caroline Corrigan
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author S. Thomas Deahl, II, DMD, PhD
Faculty mentor/Co-author e-mail deahl@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 Khealynn Harris (Pleasant Grove, UT) on 10/04/2012
In October of 2012 I reviewed the current literature of Implant placement in children and after reviewing a Case Report conducted in Sweden over 20 yrs and a Systematic Review on the topic, it is still believed that placing implants in children younger than 18 increases implant failure risk, due to craniofacial growth, small jaw size, and preoperative conditions, supporting the conclusions of this CAT.
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