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. Al l righi.s reservedCopyright C^ Munksgaard l^

Endod ontics &Dental TraumatologiSSN 0109-2502

m p la n t s in c h i ld r e n : a c a s e r e p o r tC a s e r e p o

in children: a case report.Dent Traum atol 1993; 9: 124-126. Munksgaard, 1993.- A post-crowned, root-filled tooth in a 13-year-oldin palatal fracture of the

In this instance the root was retained in order topreservefor an implant

I . C . H e m , A . A . Q u a y ieUniversity Dental Hospital, Manchestet. EnslamKey woids; dental ttauma; partial detitute; detitimplant.lain C Mackie, Department o(Oral Health andDevelopment, University Dental Hospital ot Manster. Higher Cambridge Street, Manchester, M l 56 F H , England.Accepted October tO. t992

healthy 13-year-old boy was referred tothe Uni-ty of Manchester Den tal H ospital by his dentistthemanagement of a post crowned upper lefthad been traumatised.theupper left central incisor tooth. Thisby root canal therapy and placement

a post crown. Two weeks before referral to thehe had again fallen and knockedt thepost crown. In addition he had fractureda palatal

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i m p i a n t s i n c i i i i

3. Occlusal view showing the implant in place.

The close fitting labiaU|);il,iKil ^

On examination of the root of the upper left cen-

referral, he was too young for an implant becait is generally recommencled that implants shonot be placed below the age of 16 years, when fagrowth is almost complete. Removal of the rand space closure using fixed applianee therapy considered but the patient would not contemporthodontic treatment. Partial dentures and bridwere discussed with the family.However, the patient and parents were keenimplant therapy, and, therefore it was decided

Fig. 5. .'interior \'iew showing the labial-paiatal veneer in posafter the implant has been placed.

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M a c k l e & Q u a y l eretain the root in position to preserve alveolar boneby preventing the atrophy which inevitably followsloss of teeth. A partial over-denture was fitted tosatisfy aesthetics.When the patient was 16 years of age the root wasremoved atraumatically under local anaesthesia. Aperiotome was used to sever the periodontal liga-ment around the root fragment which was subse-quently renioved by means of a reamer engaged inthe root canal {1). This technique preserves alveolarbone. A Tubingen Frialit implant was placed in thesocket using the standard technique (2) {Fig. 3). Aclose-fitting, well-retained labial-palatal veneer wasfitted (Figs. 4, 5) to protect the implant from anyforces during the healing and osseointegration of theimplant (3).Six months after the implant had been placed apost crown was constructed and fitted. T he T ubing -en Frialit implant has a preformed post hole, thesurface of the implant was prepared and an im-pression taken using a silicone based elastomericimpression material. The post and crown was fittedat the next visit. In addition the composite restora-tion on the upper right central incisor tooth wasreplaced. The patient was reviewed one year laterand everything was found to be satisfactory (Fig.6), with clinical signs of osseointegration andhealthy peri-implant gingivae.D i s c u s s i o nIt is usually recommended that implants are placedin patients who are 16 years of age and over. Im-

plants heal by osseointegration, which is simiankylosis and if they a re placed before 16 yeage they can become infraoccluded as the albone on each side of the implant continues to The retention of the root preserved the alvbone facilitating the placement of the implanlater date. If the root had been removed follthe traumatic episode resorption of alveolarin the socket area may have occurred resultinsufficient bone to support an implant whepatient had reached 16 years of age.

The alternative treatment options for this 13old patient would have been removal of thefollowed by either closure of the space and a on the permanent lateral incisor or maintenanthe space followed by a bridge. Instead, he noa simple, functioning, implant-borne crown.

R e f e r e n c e s1 QiiAYLE AA, Atr aum atic remo val of teeth and roments in dental implantology. Int J Oral Maxillofac

1990; 5: 293-296.2. QUA YLE AA, CAWO OD JI , SMITH GA, ELDRIDGE DJ

ELL RA. The immediate or delayed replacement oby permuco^a! intvaosseous implants: the Tubingen system. Part 2: Surgical and restorative techniq ues.J 1989; 166: 403 -410 .3. McCoRD JF, SMITH G A, QUAYLE AA. An aesthetic ary restoration for the partially edentulous immediaimplantation patient. Int J Prosthet (in press).

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