The vertical growth of the maxilla exceeds all other dimensions of growth in this region;
therefore, premature implant placement can result in the repetitive need to lengthen the
transmucosal implant connection resulting in poor implant-to-prosthesis ratio and the
potential for load magnification.
--Premature placement of an implant near the midline can create a mesiodistal spatial
disharmony secondary-to-median sutural growth, which accelerates at puberty.
--The placement of implants in the anterior maxillary region before age 15 in female patients
and age 17-25 in male patients should be attempted only to achieve unique treatment
planning goals and with particular emphasis on the determination of skeletal age, informed
consent and the possibility of future implant replacement.
Posterior maxilla6, 9
Large number of variations exist in the amount and direction of both sagittal and vertical
growth, and the unpredictability of the growth pattern adds to the difficulty of deciding when
it is safe to insert implants in that area.. Since the vertical growth occurs by apposition on the
alveolar aspect and resorption on the nasal or maxillary sinus area, an implant placed early
could be submerged oclusally and penetrate the sinus or nasal cavity. In partial edentulism,
implant infraocclusion may lead to long term esthetic problems for the implant and
periodontal damage around the adjacent teeth. So, implant placement can be recommended
only after the cessation of growth. Placement of osseointegrated dental implants in the
maxillary posterior quadrant is best delayed until age 15 in females and age 17(17-25) in
males. Particular care must be exercised when placing implants before skeletal maturity
because of the appositional and resorptive pattern of the posterior maxilla. However, implant
insertion can be considered in an anodontic child under well planned conditions.
Anterior mandible6, 9
After considering various aspects of growth, anterior mandibular region represents the best
site for implant insertion before growth completion. The mandibular symphysis region causes
least problems while implant placement as the mandibular symphysis suture closure occurs
during first two years of life. Recommendations have been made to begin treatment in
children with ectodermal dysplasia as early as three years of age, creating improvement in
facial appearance leading to demonstrable emotional, psychological, phonetic and functional
Posterior mandible6, 9
In case of posterior mandible, large amounts of transverse, vertical, sagittal growth occur.
Due to rotational growth of mandible, significant changes occur in both alveolus and lower
border, leading to progressive infraocclusion of the implant, and harms the adjacent teeth. So
implant in this region should not be placed until skeletal growth is completedGuidelines of implant placement in ED patients as prescribed by National
Foundation of Ectodermal Dysplasias:
The following age-wise...