International Journal of Dental and Health Sciences Review Article Volume 03,Issue 02 DENTAL IMPLANTS IN PEDIATRIC DENTISTRY: A REVIEW V Krishnapriya1,Mayuri Ganesh2,Divya Gaur3,Sneha Mary Mathew4,Shilpa G5 1.Professor and Head ,Department of Pedodontics and Preventive Dentistry,Army College of Dental Sciences 2.Post graduate student,Department of Pedodontics and Preventive Dentistry,Army college of Dental Sciences 3.Post graduate student,Department of Pedodontics and Preventive Dentistry,Army college of Dental Sciences 4.Post graduate student,Department of Periodontics and Oral implantology,Army college of Dental Sciences 5.Reader,Department of Pedodontics and Preventive Dentistry,Army college of Dental Sciences ABSTRACT: Pediatric dental patients are most often seen visiting dentists for tooth loss due to trauma. Congenitally missing teeth are also encountered in children from time to time. Diseases such as Ectodermal dysplasia or oligodontia may lead to partial anodontia, leading to a great psychological impact in children apart from the loss of function. Removable appliance therapy is the treatment option most commonly followed in such cases, however, these appliances are seen to have their own disadvantages. Therefore, a more concrete treatment option needs to be developed in future and hence this review article throws light upon the possibility of use of dental implants in Pediatric population. Keywords: Children, Dental implants, Pediatricdentistry ,Ectodermal Dysplasia ,Oligodontia INTRODUCTION: Dental implant is defined as a alveolar ridge resorption, and prosthetic device made up of alloplastic complications of the periodontium .[3] material(s) implanted into the oral tissue under the mucosal or periosteal layer, Shaw reported that the dramatic and on or within the bone to provide changes in growth and development retention and support for a fixed or occurring in infancy and early childhood removable prosthesis”.[1] were not conducive to the maintenance of implants.[4] According to Dietschl and Children and adolescents are seen to Schatz'' and Mackie and Quayle, manifest anodontia, congenitally missing implants in children younger than 16 to teeth as well as teeth loss due to 18 years must not be placed since trauma.[2] In these cases, the degree of adjacent alveolar growth will render hypodontia can bring about them infraoccluded.[5],[6] psychological stress in the child and proper oral rehabilitation of the child is Bergendal et al stated that implants required before skeletal and dental placement must be delayed upto the maturation. Here, removable prosthesis point when growth is almost complete, is often the treatment of choice. except for rare cases of total aplasia, as [7] However, it may lead to increase in ectodermal dysplasia. progression rate of caries, residual *Corresponding Author Address: Dr Mayuri Ganesh Email: [email protected] Ganesh M.et al, Int J Dent Health Sci 2016; 3(2):405-414 The use of implants in adolescents is In partially edentulous cases, long-term uncommon because the dental surgeon success of dental implants has been is concerned about maxillary and responsible for other clinicians to mandibular “growth spurts”. If he broaden the use of implants to follows the indications and ideal timing adolescents in whom teeth are missing of placement of implants, predicting due to trauma or agenesis.. Anodontia their success will not be a problem for either primary or acquired occasionally him.. If the implant placement protocol creates the opportunity for the use of in adolescents is followed, they can be dental implants.[3] used more routinely. Therefore, the aim of this review is to throw light upon the In the absence of maxillary teeth, the use of dental implants in children, maxilla will remain underdeveloped both adolescents and young adults to discuss sagittally and vertically as the alveolar its role in oral rehabilitation of children ridges will not develop. In contrast, the with partial or complete anadontia and mandibular growth is not dependent on also to bring out the role of dental the presence of teeth. Therefore, implants in some special cases where disproportionate relationship between dental implant placement might be the two jaws will tend to occur in the treatment of choice in the near future. presence of hypodontia or anodontia resulting in class III development as REVIEW OF LITERATURE growth occurs throughout the normal growth period. Furthermore, A thorough review of available articles physiological and psychological factors published from 1968 to 2013, obtained increase the pressure to start early from the PubMed database, was done treatment.[8] using the terms Dental implants, ectodermal dysplasia, children, According to World Health Organization oligodontia, anodontia. Articles –young people between the age of 10 published in languages other than years and 19 years are termed English were excluded. adolescents.[9] However, in adolescents the use of implants differs significantly SCOPE OF DENTAL IMPLANTS IN from adults. Because a variety of PEDIATRIC DENTISTRY changes occur in the dentition and jaws of the adolescent, special importance Implant popularity as a treatment has to be given to the growth of the modality in adults is tremendous. In case child. of adults the amount of research being carried out is extensive, however, the IMPLANTS IN GROWING BONE treatment planning and execution of implant placement in children and Placement of implants in children and adolescents is still in its infancy. adolescents has always been controversial. Few researchers advocate 406 Ganesh M.et al, Int J Dent Health Sci 2016; 3(2):405-414 their use in this group of patients and a become deeply buried within the few others strictly contraindicate their mandibular alveolar process.[15] usage. INDICATIONS AND Bjork[10],[11] conducted one of the CONTRAINDICATIONS OF PLACING pioneering studies concerning growth DENTAL IMPLANTS IN PEDIATRIC patterns of the dental arches and DENTAL PATIENTS replicating the implant insertion . For longitudinal cephalometric studies,he Indications for use of implants in implanted 0.5 mm × 1.5 mm. tantalum adolescents pins in the jaws of growing children as stable landmarks. Although most pins dysplasia (1988 National Institute of were stable, pins affected by growth Health Consensus Development were not. The pins were also displaced Conference on Dental Implants at by orthodontic tooth movement. Nearly Bethesda) [2] all the pins placed in the resorptive areas like the anterior mandibular ramus, were lost and had to be replaced. In addition, in patients with cleft of the alveolus and pins placed in areas of appositional bone palate.[16] growth gradually became embedded. and adolescents having Oesterle et al,[12] and Brahim[13] anodontia, partial anodontia, compared dental implants to ankylosed congenitally missing teeth, teeth lost as primary teeth. With lack of alveolar a result of trauma. [13] growth and dental eruption, an osseointegrated implant behaves much Contra-indications for the use of dental like an ankylosed primary tooth. These implants authors proposed that implants placed in -pubertal age group.[16] the posterior maxilla in children may become buried to the point that the apical portion may become exposed as spurt.[16] the nasal and antral floor remodel. Odman et al,[14] recommended that ate mesiodistal space.[17] implants should not be placed posterior to the canines during active growth. In INDICATORS OF COMPLETION OF children with strong rotational pattern, GROWTH posterior teeth undergo continued Completion of growth in an individual is eruption, along with continued alveolar not estimated by chronological age bone growth to maintain the occlusal alone. Studying tracings of serial plane, possibly causing implants to cephalometric radiographs taken at least 6 months apart by superimposing is 407 Ganesh M.et al, Int J Dent Health Sci 2016; 3(2):405-414 probably the most reliable method, adolescents preferably should be though it requires a lot of time and postponed until the end of the irradiation and may unnecessarily delay craniofacial/skeletal growth. [19] implant insertion. Waiting for implant [12] insertion until no growth change is seen Oesterle et al., observed that implants over a period of 1 year is ideal. [18] placed before the cessation of growth especially in the maxilla are Skeletal growth status can be accurately unpredictable in their behaviour and appraised by comparing a conventional hence should be used with a great deal hand and wrist radiograph against a of caution. He suggested that implants standardized atlas of hand and the wrist placed during the pubertal period have a bone development. After maximum greater likelihood of success but still less growth velocity is completed, capping of than the post-pubertal or post-growth the middle phalanges of the third finger implant. Cronin et al.[16] observed that if (MP3cap) usually occurs and it is an implants are placed during active indication of deceleration in the pubertal growth, they may be displaced or growth spurt.On completion of pubertal malpositioned by continued growth and growth spurt,impant placement can be may require removal and replacement. considered although some risks still Implants placed after age 15 for girls and exist. Adult level of skeletal growth is age 18 for boys have the most attained when epiphysis of the radius predictable prognosis. Implants placed fuses and forms a bony union with the before these ages may not be diaphysis. This is the considered