Discussion : Implant therapy for a patient (2)|palmerah.implantgigi.com

Discussion

The vast majority of published articles regarding OI type I revolve around fractures of the long bones and treatment strategies. An extensive literature search for manuscripts detailing the implant therapy for patients diagnosed with OI produced a marginal amount of literature (Table 3). Our case posits that oral restoration is attainable without implant failure for OI type I patients. In OI type I, the collagen produced is of normal quality but in reduced quantities [14]. As a result, OI type I is considered the mildest form of OI with the majority of fractures occurring in childhood and adolescence as the bones continue to grow. Since the collagen is of normal quality, successful osseointegration of implants can be attained with proper planning. To account for poor bone strength, Marx et al. proposed using implants as a “tent-pole” for bone graft to be placed around to consolidate and maintain the graft’s volume [15].

The same factors that must be considered when placing implants in any patient are also pertinent to OI patients. However, extra emphasis should be placed on bone quantity and bone quality. In placing implants for our patient, we ensured that all fixtures attained a final torque value greater than 35 Ncm. Traditional endosseous implants require a bone healing period post-extraction of 3 months for the mandible and 6 months for the maxilla before the implant can be loaded [16]. Innovation in implant technology allows for immediate implant loading following extraction due to design changes that provide a stronger mechanical connection to the surrounding tissue [17]. While these innovations have made implant delivery much more time-effective, primary stability can be challenging in patients with diminished bone quantity and quality. Bone graft augmentation can be utilized to ensure the osseointegration of the implant and has been utilized to achieve positive results in some OI cases [18,19,20,21,22]. However, some cases found successful osseointegration without the usage of bone grafts, including some of the implants placed in our patient [23, 24]. While we were able to successfully deliver implants using synthetic grafting material or no grafting material, other literature utilized autogenous bone from either the ascending ramus [21] or iliac crest [18,19,20, 22]. In determining the success rate of dental implants, there is a great deal of variability due in part to the varying degrees of bone quality and quantity in the OI subtypes, patient compliance to treatment plans and dental care, and a multitude of other factors typically involved in implant therapy. One retrospective and prospective study cites strong success rates in implant delivery for OI patients with a survival rate between 93 and 100% [25]. Our patient is now 4 years post-placement of his first implant procedure and has been functioning without any issues. The diagnosis of OI type I should not be a contraindication of implant therapy as our case, and others [18,19,20,21,22,23,24,25], have shown. This case differs from other cases in utilizing synthetic grafts to aid in stability and providing another case to illustrate the advancements in implant delivery for patients with bone abnormalities.

Conclusion

In conclusion, this case shows that implant therapy for patients with OI type I is a viable treatment option with appropriate planning, surgical skill, and routine care. Advancements in the fields of implants, prosthetics, and bone grafting will continue to make implants an increasingly practical treatment option for patients with OI. However, dental practitioners should always take great precaution in ensuring that bone quality and quantity is appropriate to ensure primary stability and successful osseointegration.

Abbreviations

OI:: Osteogenesis imperfecta