Ehlers-Danlos Syndrome: Treatment Plan for Dental Implants?

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Dr. P. asks:

I have a patient with Ehlers-Danlos Syndrome who I would like to restore with single and multiple implant restorations. I cannot find any guidance for treatment planning in the peer-reviewed literature. Has anyone had any experiences with treating patients with this disorder with dental implants? Were you able to find any references? What precautions or extra measures did you take?

Editor´s Note: Ehlers-Danlos Syndrome is a connective tissue disorder which is genetic (autosomal dominant) and is characterized by hyper-extensibility of the skin, hypermobility of the joints, cardiovascular defects (most frequently mitral valve prolapse), tissue fragility, etc.

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4 Responses to “ Ehlers-Danlos Syndrome: Treatment Plan for Dental Implants? ”

• GWK, DMD, MMSc February 20th, 2007

  
  

  The syndrome has somewhat heterogeneous population of patients who all suffer from defective collagen synthesis. Some do have poor soft tissue wound healing as a result. Your best guide, in addition to getting as much info from related fields, for example from orthopedic or general surgical literature, will be to get a detailed history of your particular patient. This will allow you to evaluate the specific risks better by locating your patient’s situation in the full range of the possible risks.
  The E-D National Foundation might be a good resource.

• dcarlton February 20th, 2007

  
  

  If the quality of the clinical attachment in the rest of the mouth is stable, there is a reasonable chance for clinical success. If there is progressive attachment loss in the absence of any clinical pathology then the probability of long term implant success is diminished. In some cases, implant placement is conceivably indicated for the short term to minimize ridge loss and provide stability for prosthetics. The subjective clinical evaluation is most important for these cases.

• Bonnie Heintskill, MS, CCC/SLP February 21st, 2007

  
  

  Regarding Ehlers-Danlos Syndrome patient, there are 6 different types of EDS.

  Look for the following articles:
  Dentin Dysplasia, Hedge, M & Hedge ND, Edodontology, Vol 6, 2004

  EDSers have a difficult time getting adequate numbing for procedures.

  Oral Manifestations of Ehlers-Danlos Syndrome
  • Yves Létourneau, DMD •
  • Rénald Pérusse, DMD, MD •
  • Hélène Buithieu, DMD, MSD •
  J Can Dent Assoc 2001; 67:330-4

  PAIN & EDS

  Nov. 1997, Vol. XII, Number 4 of “Loose Connections”, the official
  communication link of the EDNF reprinted by permission of Elsevier Science,
  Inc. Journal of Pain & Symptom Management,Vol.14,No.2,pp.88-93 Copyright
  1997 by the Cancer Pain Relief Committee”. “Chronic Pain is a Manifestation
  of the Ehlers-Danlos Syndrome”.
  by SRCurry LPT/RNc

  The United Kingdom EDS group has great articles too. As well as the Canadian Ehlers Danlos Association.

  there is also a high incidence of Arnold Chiari Malformation which impacts how long a person can sit in a dental chair, how much pressure can be used on their jaw, and many EDSers have TMJ due to dislocations/subluxations of the joint.

  Chronic Pain is a Manifestation of the Ehlers–Danlos Syndrome
  Anubha Sacheti, Judy Szemere, Bruce Bernstein, Triantafyllos Tafas, Neil Schechter, Petros Tsipouras “Reprinted by permission of Elsevier Science, Inc. Journal of Pain and Symptom Management, Vol. 14, No. 2, pp. 88–93. Copyright 1997 by the U.S. Cancer Pain Relief Committee.”

  Also, any articles by Beighton, MD or Grahame, MD, Claire Francomano, MD; or Nazli McDonnell, MD

• Dr Pedro Peña March 12th, 2007

  
  

  Thank you all for your comments. My patient is 13 years old and she almost has all her roots resorbed so we are planning dental implants in the near future. No other symthoms are visible. His father came to me asking implant treatment when his dougther will loose her teeth.
  We will try to keep her teeth as long as we can so she will reach the apropriate age (18).
  Thanks again for the information.
  Dr. Pedro Peña.
  Madrid. Spain.

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Wed August 20 2008

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