Dental implant therapy has revolutionized dentistry and the way we treat patients today. There is continued research discussing the TIMING of implant placement and how it relates to the young, growing patient and the implications of continued facial growth.
The human dentition and supporting structures must be viewed as dynamic entities, which change in response to age, facial growth, dental eruption, tooth wear, and recession throughout life. Osseointegrated dental implants behave like ankylosed teeth (teeth that are fused to the jaw bone) that do not move. This poses a significant problem in the growing, young growing patients, if implants are placed too early. When facial growth occurs, the teeth erupt to stay in contact as the upper and lower jaw elongates. If implants are placed too early in a young growing patient, there will be a discrepancy between the bone and gum tissues of the implant crown compared to the natural erupting teeth. As a result, the gum tissue and crown around the implant will appear shorter, causing an unaesthetic and unfavorable result (figure 1). For these reasons, it is important to determine that the patient has completed growth before placing implants. So, how do you determine when facial growth is complete?
In the past, a hand -wrist film was used to assess the completion of growth. However, this method is thought to not be specific enough in assessing facial growth. A more specific method to evaluate the completion of facial growth is by superimposing sequential cephalometric radiographs taken 6 months to 1 year apart.1 A cephalometric x-ray, which is also sometimes referred to simply as a Ceph, is a diagnostic radiograph used primarily for orthodontic treatment planning to visualize key anatomical structures. If these radiographs are superimposed and there are no changes in vertical facial height, this indicates that most of the facial growth has been completed. Typically, the age that implants can be placed is approximately 17 years of age for females and 21-22 years for males, however sequential cephalometric radiographs should be compared for verification.2 It has been our experience that the above ages of 17 for females and 21-22 for males is still too early and the cephalometric radiographs must be taken and compared, to rule out further growth.
By understanding the interactions between the human dentition and its continued state of growth in the young patient, one can properly plan and place dental implants. Our next article will discuss the management of congenitally (at birth) missing front teeth and how dental implants can be orchestrated to replace the missing teeth.
- Kokich VG: Orthodontic-restorative management of the adolescent patient, in McNamara JA JR (ed): Orthodontics and Dentofacial Orthopedics. Ann Arbor, MI, Needham Press, 2001, pp 425-52
- Fudalej P: Determining the cessation of facial growth to facilitate implant placement. Master’s Thesis. University of Washington, Department of Orthodontics. Seattle, WA 1998