GP3d - Pediatric Dental Implants for Oral Rehabilitation After Maxillary and Mandibular Tumor Resection

Abstract: Statement of the Problem: Oral rehabilitation following maxillary or mandibular tumor resection in pediatric patients presents significant functional, esthetic, and psychosocial challenges. These patients frequently experience impaired mastication, disruption of the occlusal plane, and facial asymmetry, in addition to difficulty with compliance when using removable prostheses. While dental implants are a well-established modality for restoring oral function in adults, their application in pediatric patients has been limited due to concerns regarding craniofacial growth and long-term implant positioning. As a result, there is limited evidence evaluating the safety and efficacy of dental implants in the pediatric population. This study aims to assess clinical outcomes associated with dental implant placement in pediatric patients undergoing oral rehabilitation following jaw tumor resection.

Materials and Methods: A retrospective chart review was conducted at a single tertiary children's hospital, including pediatric patients who underwent maxillary or mandibular tumor resection between August 2009 and August 2019. Inclusion criteria were patients under 18 years of age at the time of resection who subsequently underwent placement of dental implants for oral rehabilitation. All implants were placed using preoperative virtual planning and surgical guides in collaboration with a maxillofacial prosthodontist to optimize implant positioning and facilitate future prosthetic restoration. Data collected included patient demographics, type of resection, reconstructive technique, number of implants placed, timing of implant placement, and follow-up duration.

Method of Data Analysis: Descriptive statistical analysis was performed. Continuous variables were summarized as means, and categorical variables were reported as frequencies. The study included a sample size of 7 patients with a total of 23 implants. The study period spanned 10 years, with an average follow-up duration of 4.6 years. Outcomes assessed included implant osseointegration, complications, and completion of prosthetic restoration. Due to the small sample size, no inferential statistical testing was performed.

Results: Seven pediatric patients underwent placement of 23 dental implants. One patient underwent hemimaxillectomy and 6 underwent hemimandibulectomy. Reconstruction was performed using vascularized or non-vascularized bone grafts, most commonly free fibula flaps (n = 3). The mean age at tumor resection and reconstruction was 10.7 years, and the mean age at implant placement was 13.3 years. The most common number of implants placed per patient was 4 (n = 4), followed by 3 (n = 2), and 1 (n = 1).

There were no implant-related complications, including infection, hardware failure, or revision. All 23 implants demonstrated successful osseointegration as confirmed by clinical examination and imaging at most recent follow-up. Five of the 7 patients had completed prosthetic restoration, while 2 remained in the process of staged rehabilitation. Functional improvements included restoration of mastication and maintenance of occlusal alignment. Esthetic and psychosocial outcomes were noted to improve based on subjective clinical assessment.

Conclusions: Dental implant placement in pediatric patients following tumor resection appears to be a safe and effective option for oral rehabilitation, demonstrating high rates of osseointegration and no observed complications in this cohort. Despite concerns related to ongoing craniofacial growth, the use of surgical guides allows for accurate implant placement and facilitates future prosthetic modifications, particularly with screw-retained restorations. Although additional procedures may be required as patients grow, the functional and psychosocial benefits of early implant-based rehabilitation are significant. Further research with larger sample sizes and longer follow-up is needed to better define long-term outcomes. Dental implants should be considered a viable option in the multidisciplinary management of pediatric patients undergoing jaw reconstruction.


References:

1. Shahzad F. Pediatric Mandible Reconstruction: Controversies and Considerations. Plast Reconstr Surg Glob Open. 2020;8(12):e3285. doi:10.1097/GOX.0000000000003285.

2. Bohner L, Hanisch M, Kleinheinz J, Jung S. Dental implants in growing patients: a systematic review. Br J Oral Maxillofac Surg. 2019;57(5):397-406. doi:10.1016/j.bjoms.2019.04.011