Region Jnkpings ln Odontologiska Institutionen
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Dental implants in a patient with Down's syndrome

Bergendal B*, Nilsson P, Olson L
 

Aim

The aim was to present a case report of treatment with implant-supported fixed prostheses in a patient with Down's syndrome and oligodontia.

Materials and methods

The patient was a 28-year-old man with Down's syndrome and agenesis of 17 permanent teeth, third molars excluded. He had been treated during his childhood and adolescence at a clinic for paediatric dentistry and co-operated very well with dental treatment. His primary teeth were severely worn and the occlusal dimension was low. There was also a tendency for mandibular prognatism. Root resorption of several of his primary teeth was evident when his parents requested oral habilitation. He had received a composite retained onlay fixed partial denture in the right upper jaw to replace the lateral incisor at the age of 21. At the age of 27 a removable onlay partial denture was made which the patient was unable to adapt to. A treatment plan was therefore established by a multidisciplinary team of specialists in orthodontics, paediatric dentistry, prosthodontics, oral surgery, and dentomaxillofacial radiology. A computed tomographic (CT) scan of the jaws was made before treatment. The primary teeth were extracted under general anaesthesia and dental implants installed in the upper and lower jaw in the same session: three in the upper right jaw, two in the upper left jaw, and four in the frontal part of the lower jaw. The abutment connection was made under intravenous sedation in co-operation with specialists in oral surgery and prosthodontics. At the next appointment 7 days later it was discovered that one abutment had fallen out of the mouth and two abutments were loose, probably because of extensive tongue movements. Acrylic splints were therefore used to make a rigid connection between the abutments while the permanent metal-ceramic fixed partial dentures were being fabricated. Otherwise, prosthodontic treatment was performed without complications.

Results

The different phases of treatment were adapted to the patient's level of co-operation and successfully carried out. The patient is satisfied from a functional as well as a psychosocial point of view.

Conclusion

Extensive prosthodontic treatment including treatment with dental implants can be performed in patients with Down's syndrome if due consideration is taken to the patient's level of co-operation. Uncontrolled tongue movements in patients with Down's syndrome should be given special clinical attention in oral habilitation. Further follow-up is necessary before any recommendations on maintenance care and overall function can be made.

Uppdaterad: 2013-04-03
Anna Thofelt, Avdelningen för odontologisk radiologi Jönköping, Folktandvården