Dental Implants in

Pediatric Patients
Dr. Chris Kirkup
Dr. Dan Bower
 Indications
• Hereditary Anhidrotic Ectodermal Dysplasia
(HAED)

• Alveolar Clefts

• Trauma

• Tumor Resection
 Contraindications
• Child’s inability to perform oral hygiene

• Presence of adjacent primary teeth

• Inadequate quantity or quality of bone

• Unrealistic parental expectations

 Mandibular Growth Patterns
• Anteroposterior Growth:
– Mandible lengthens by posterior-superior growth of the
condyle and posterior growth of the ramus
– Body of mandible increases in length by resorption on
anterior aspect of the ramus and deposition on the
posterior
– Posterior width of mandible increases by virtue of V
configuration ; symphyseal suture ceases growth prior
to eruption of primary teeth
 Mandibular Growth Patterns
• Rotational Growth
– Condyle grows vertically, or vertically and forward, so
that vertical growth of ramus exceeds that of
symphyseal area, causing a “rolling” downward and
forward
– In patterns of excessive rotation requiring considerable
dental compensation to maintain occlusion, implants
could ultimately be deficient in height or be oriented at
improper inclination
Mandibular Growth
 Maxillary Growth Pattern
• Growth of surrounding tissues translates the maxilla
downward and forward, opening space at the posterior and
superior suture attachments for bone addition
• As the maxilla translates downward and forward, its
anterior surface tends to resorb
• Remodeling of the palatal vault produces movement in the
same direction as maxillary translation. Bone is removed
from the floor of the nose and added to the roof of the
mouth. As the vault moves downward, the same process
widens it.
Maxillary Growth
 Pediatric Patient Classification
• Group 1: Missing a single permanent tooth
– Ideally, placement should be delayed until completion
of alveolar development and eruption of all permanent
teeth

– Implants placed early in alveolar growth may become

submerged, requiring a longer prosthesis and
compromising implant success
 Pediatric Patient Classification
• Group 2: Oligodontia (as in HAED)
– Alveolar process demonstrates abnormal growth, and
incidence of submerged implant is low

– Placement should begin as soon as patient understands

treatment and can perform maintenance
 Pediatric Patient Classification
• Group 3:Acquired anadontia due to tumor
resection or trauma reconstructed with bone
graft
– No concerns regarding alveolar growth
– Implants placed as soon as appropriate from
psychosocial standpoint
 Case Study #1

15 year old male, placement #13. 35 months later implant demonstrates ankylosis.
Crown was later lengthened by addition of porcelain.
 Case Study #2

16 year old male, placement of congenitally missing #20,#29. Implants 56 months

later with no evidence of further alveolar bone growth
 Clinical Findings Following
Placement
• Maxillary and mandibular growth may alter initial
implant position
• Implants behave like ankylosed teeth and may
become buried, exposed or lost

• Implants may alter growth patterns of the jaws

• Morphology and path of eruption of tooth germs

may also be altered
 Recommendations
• Implants should be placed after growth. Predicting
growth is almost impossible

• Implants may become displaced or malpositioned

and may require removal and replacement

• When possible, placement should be delayed until

age 15 for females and 18 for males
 References
• Westwood, RM, Ducan, JM. Implants in adolescents: A literature review and
case reports. Int J Oral Maxillofac Implants 1996;11:750-755.
• Perrott DH, Sharma AB, Vargervik K. Endosseous implants for pediatric
patients. Oral and Maxillofac Surg Clin North Am 1994;6:79-88.
• Brugnolo E, Mazzocco C, Cordioli G, Majzoub Z. Clinical and radiographic
findings following placement of single-tooth implants in young patients-case
reports. Int J Perio Rest Dent 1996;16:5421-433.
• Cronin RJ, Oesterle LJ, Ranly DM. Mandibular implants and the growing
patient. Int J Oral Maxillofac Implants 1994;9:55-62.
• Kearns G, Perrott DH, Sharma A, Kaban LB, Vargervik K. Placement of
endosseous implants in grafted alveolar clefts. Cleft Palate and Craniofacial J
1997;14:520-525