Dental Implants

The replacement of missing teeth by implantation of a titanium anchor with a laboratory fabricated restoration (crown or cap) has become very common in today's modern dental practice. Having found a material that the body would not reject and that would allow itself to be integrated into the bony crypt that surrounds it has taken implant dentistry from a questionable practice to a highly successful approach to restoring function and esthetics when necessary. The process involves surgically placing the titanium anchor into the bone where the missing tooth once thrived. A prescribed number of months (6-12mos) is required for the bone to integrate or "grow" through openings in the anchor to secure the anchor to the jaw bone. Then the anchor is surgically uncovered and a top piece is fastened to it. A fabricated crown restoration is then attached to the anchor surface extension piece. People who have had implants, especially single tooth implants, state that they feel very much like a natural tooth.  

Concerns:

1. One must maintain excellent oral hygiene to maintain the healthy tissues surrounding the implant. Build up of plaque and tartar can jeopardize the success of an implant. This can be an issue in some individuals with CdLS. 
2. Alveolar bone bone original tooth was surrounded by base bone of the upper or lower jaw both bones must have some substance and thickness to support the placement of the anchor for the implant. If the bone where the tooth was extracted is very thin or flat, there might not be enough bone to support an implant. Bone Density is a major concern and tests can be run to evaluate this.
3. Absolute contraindications to implant rehabilitation include recent heart attack or stroke, heart valve, prosthesis surgery, immunosuppression, bleeding issues, active treatment of cancer, drug abuse, psychiatric illness, as well as intravenous bisphosphonate use for osteoporosis. Most of these are not an issue in CdLS.
4. Risks of general anesthesia and concerns of post operative recovery are also to be taken into consideration.

Therefore, would implants be appropriate for our patients with CdLS? One would have to assess the oral hygiene and the ability of the patient and family to maintain a healthy mouth. If one could feel comfortable that the implant could be maintained with healthy gums surrounding it, then an implant could be considered. Adequate bone, bone density and room for proper placement of the anchor must be considered. A dentist who has adequate experience with placing implants would be able to determine if the patient was a good candidate for an implant. Always discuss with your dentist if he or she is well trained in implants and if they have a special oral surgeon or periodontist who performs the surgical aspect in placing the titanium anchors.
 An implant could be a challenge in a compromised oral environment where maintenance of a healthy hard and soft tissue area is so important. The other question regarding the fear of losing more teeth should be discussed with her dentist. I will presume that the concerns of loss of the teeth would be related to the periodontal condition around those teeth. Gum disease and subsequent supportive bone loss are common in mature patients with CdLS. Perhaps a consultation with a periodontist, or gum specialist, would be helpful. If the loss of the other teeth was due to dental decay, then dietary issues and hygiene issues must be addressed.



DM 9-30-2011