Dr. O. asks:
I have an 8 year old edentulous male patient who is recovering from cancer. He is medically complex but at the present time is stable. Within the next few years I would like to place some dental implants to support overdentures. I am assuming that as facial growth continues, the position of the implants will change. Where are the best sites to place implants in the maxilla and mandible? I am planning 2 in the mandible in #27/26 and #23/22 areas and in 4 in the maxilla in #3, 6/7, 10/11 and 14 sites. Will the overdenture retard facial growth? Should the overdenture be replaced at time intervals to accommodate normal facial growth? I have not been able to find much guidance in the literature. Any ideas?
Dr. Cronin, at U of Texas H.C. Dental School in San Antonio, I believe, is head of Prosthodontics and restores kids with congenitally missing teeth. He will place implants in the mandibular anterior at 8-9 years because the midline suture fuses at an early age and he doesn’t see much submergence with growth. These cases can be very complicated and treatment time can extend over decades. I strongly recommend seeking his advice.
DONt try to guess where and how deep…. , I have done two or three of similar characteristics and after lots of considerations we went with mini dental implants (arrows) just to give te overdentures good stability and after many years I was able to place final implants and do a final restoration. the disadvantage of not having any teeth is that you wont get normal growing stimulus to the maxillary bones so yes you will have growing dissorders…. that is one of the reasons for doing this as a temporary restoration and after the MDIs are easier to remove or in some cases you can include them in the final plan.
IMHO,This case should be conducted simultanously by prosthodontist and orthodontist.
Make OPG and CM.TC -if it possible.
1 option-Two permanent implants in maxilla,and two in mandible-in cuspid areas
2 option-temporary implants in maxilla and mandible.
No compressive overdenture for jaws growing possibility.
How it make? With using orthodontisc screws like in removable orthodontics braces.
Obviously we will have to changed denture,how often,it depend of age end growing level.
Very long treatment,but can be /I hope -will be/ very satisfacious.
Best regards ,and forgive me my english
Kris
When the jaws growth wil be progress,osteointegrated implants will be reincluded.
IMHO,temporary implants is the better solution .
Kris
Here is a CRAZY notion. (Please don’t jump down my throat! I’m insane!!) Maybe a good prosthedontist could work with an ortho lab to construct some kind of overdenture to include expansion screws, like a Schwartz with sagittals or a 3-way to both accomodate and encourage growth?
Yup. Certifiable!
Insane??
Mike…..nobody tould You it will be easy…….
Belive me it is possible….
Thanks for certificate;-))))))
Kris
What was the nature of the boy’s cancer and what treatment did he undergo?
May I ask what type of cancer did this young child have, and what medicines have been and are being perscribed? This could be an issue as well not only with ongoing rx therapy but that prior to treatment. Is the patient immunocompromised? Bisphosphonates? Liver or kidney concerns? I am sure the family is thankful for your keen interest in helping this young patient dentally. Bill
I have a 10 year old, post-radiation treatment patient who is edentulous. I have been reading the literature and I plan to place 4 implants in the mandibular anterior region between the mental foramina. I will then make an overdenture. Is there anywhere else that I can place implants in the maxilla so I can retain an overdenture? I know that the mandibular symphysis area should be dimensionally stable but the rest of the mouth will keep growing. How often will I have to replace the maxillary overdenture? I am planning on assembling a team with an oral surgeon and orthodontist to plan this out. Has anybody placed implants on a patient this young? Any thoughts?
Dear Anon,
I do not mean to quench the fires of your enthusiasm, but if you are asking these questions, perhaps you aren’t the person to treat this case.
Where was the radiotherapy field and what dose?
Why is the patient edentulous? Due to the radiotherapy? Do you or your “Team” feel competent to treat the complications that may arise in placing implants into an irradiated jaw?
Why have an orthodontist in your team if the patient is edentulous?
Why removable prosthetics and not fixed? Is your overdenture to be implant supported or soft-tissue supported?
Perhaps this is one to pass to a hospital-based team or to a centre of excellence – I do not feel this is one for general practice (no disrespect whatsoever to general practitioners – we just all need to know when to refer).
Kind Regards,
Bill Schaeffer
A lot of questions have been raised and all of them are very legitimate. This is definately a case for a clinician with a lot of experience in radiotherapy, treatment of irriadiated bone ( how many weeks and doseage?), type of cancer, understanding of bone growth in males thru 18-19?, all meds, blood work, consultation with oncologist and pedicatrician/any other medical doctors. This would be a great case to refer to somebody like Carl or Craig Misch, speak with Bob Cronin at UTHSCSA ( a mentor and very good friend of mine), and go slow. Mini implants may be a good idea for period of time. However, realize that anything that is rigid is going to restrict Maxillary and Mandibular growth plates. Speak with academic institutions first. There are just too many issues at hand and this is a 10 year old child with a lot of life ahead. What would you do if he was your little guy?
Sir, I admire your judgement. A fixed partial denture supported by mini-implants, and of course for temporary usage, would be a very good idea. They can be replaced by standard implants after the puberty. However, one problem remains to be solved and that is the shortage of both soft and hard tissues at the area.In a 10 year old child, some parts of the anterior mandible (e.g. symphyseal area),are still cartilaginous and have not been replaced by bone yet.