Bone Graft Augmentation and Dental Implant Treatment in a Patient With Osteogenesis Imperfecta: Review of the Literature With a Case Report

Bone Graft Augmentation and Dental Implant Treatment in a Patient With Osteogenesis Imperfecta: Review of the Literature With a Case Report
December 2003
Lee, Cameron Y. S. DMD, MD*; Ertel, Steven K. DDS
Implant Dentistry: Volume 12(4) December 2003 pp 291-295
Lippincott Williams & Wilkins
*Private Practice, Aiea, Hawaii.
ÇƒÜPrivate Practice, Aiea, Hawaii.
Reprint requests and correspondence to:
Cameron Y. S. Lee, DMD, MD
98-1247 Kaahumanu Street
Suite 314
Aiea, Hawaii 96701
Telephone:1-808-484-2288
Fax: 808-484-1181
E-mail: CLee555294@aol.com
Abstract TOP
This case report with a review of the literature describes a patient with osteogenesis imperfecta who was treated with dental implants. To our knowledge, only one case report has been published in the English dental literature describing implant treatment in the osteogenesis imperfecta patient. The uncertainty in treatment confronted by all clinicians is the density of bone, which is essential for implant survival.
Rehabilitation of the oral cavity to restore function and aesthetic appearance in the patient with osteogenesis imperfecta (OI) can prove to be very challenging. Associated with this collagen synthesis abnormality is the condition of dentinogenesis imperfecta (DI), which is a condition that affects the normal development of dentin. The goal of management of teeth affected by DI is to protect the teeth from attrition and fracture. In many instances, the teeth are treated by full-coverage restorations because the teeth are prone to fracture, which eventually could result in tooth loss. The restoring dentist is then faced with the challenge of replacing the missing teeth with either a removable or a fixed-type of prostheses.
We recently had the opportunity to manage a patient with OI. Many of the teeth covered with porcelain-fused-to-metal restorations had fractured. This resulted in the extraction of the abutment teeth. Treatment options were discussed with the patient who elected to replace the missing teeth with implant-supported ceramometal restorations. Because we had no experience in managing the implant patient with OI, a literature search was performed. After reviewing the world dental and medical literature in English, to our surprise, there has only been one published case report of a patient with OI treated with dental implants. Most of the published clinical articles have focused on long bone fractures and current treatment strategies.
We, therefore, would like to report on our clinical experiences and review the literature about this abnormal connective tissue disorder associated with dental implant treatment.
Osteogenesis imperfecta, also known as brittle bone disease, is an uncommon heritable disturbance in bone formation characterized by bone fragility. 1 This is the result of abnormal type I collagen synthesis. 1,2 The incidence is estimated at 1 in 20,000 to 1 in 60,000 live births. 2,3 The prevalence is estimated at between 20,000 to 50,000 people in the United States. 2,3 Males and females are equally affected. The disturbance in collagen formation is believed to be the result of genetic mutations in the protein responsible for the assembly and maintenance of bone and connective tissues. This results in poor bone quality and quantity that leads to bone fractures resulting from deficiencies of osteoblasts, osteoid, and periosteal bone formation. 4,5
Depending on the severity of the disease, affected individuals have spinal deformities, a triangular face, fractures of the lower extremity and pelvis, blue sclera, hearing loss, joint hyperextensibility, and metabolic abnormalities such as elevated body temperature. 1-5
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