Facial Growth: How Should This Effect the Dental Implant Treatment Plan?

Good question... at what age should a patient recieve a dental implant because of an accident or a congenitally missing tooth? In the case of Acromegally,tumours,etc facial changes will take place continulously... so we cannot blaim ourselves if there are esthetic changes Normally in a healthy adult, once the facial bone are fully formed, I see no reason why there should be drastic changes....except for periodontal reasons.

Continued growth is a concern and is not limited to pituitary abnormality; the anterior maxilla may continue a downward or rotational movement for many years beyond the accepted implantation age. The obvious consequence is an implant restoration left behind or appearing to be intruded. If lucky, the gingival architecture may still appear normal and the solution is retrieval and modification of the existing crown; re-making the crown is also a realistic possibility if the crown coping will be inadequate for the additional porcelain. If the soft tissue is distorted by the asymmetric growth (teeth versus implant) of the bone, then simply modifying the crown will not resurrect the esthetic result. Soft tissue augmentation may be necessary, but one faces the difficult task of grafting over an implant; be prepared to re-enter a provisional restoration phase. Clearly it is not the norm that growth will continue, nor should we consider it exceptional. It is a possibility and should be discussed at the treatment planning stage when considering placement in young patients. Perhaps comparison of the potential patient with the facial or dental characteristics of older siblings and/or biologic parents should be considered. Those patients with class II occlusion and lack of anterior coupling are at risk for this growth pattern. The issue is not blame for unforetold esthetic deterioration, but rather a greater understanding of the physical processes that influence our efforts. If we discuss the possibilities before treatment, it may be classified as a potential complication; after the fact it may sound like an excuse.