This patient had several operations for keratocyst enucleation.
He has osseous defects in maxilla and mandible which will cause diffuculty for conventional prosthesis.
Scientific literature has shown that KCOT recurrence rate depends on the type of surgery carried out. For instance, simple cystic enucleation carries the highest rate of recurrence wheras radical resection the lowest.
The benefits of implant treatment should thus be weighed compared to the risk of recurrence and need for additional surgery.
Furthermore, to my knowledge of the literature, there has not been any studies pertaining to the risk of early and late implant failure in patients with Gorlin-Goltz syndrome.
I would surmise that the early implant failure rate be somewhat similar to the one found in healthy patients considering that (to my knowledge) PTCH1 (candidate gene implicated in Gorlin-Goltz syndrome) is not implicated in bone metabolism regulation.
Whatever option is chosen for this patient, I would highly recommend regular and thourough follow-ups, in order to intercept recurring keratokysts and detect possible basal cell carcinomas that unfortunately also accompany this syndrome.
I worry about cyst recurrence on an implant site. This time dental implant will have to removed with a bone defect.
This is why clinical and radiographical follow-ups are so important in my opinion. If you chose to put implants in a KCOT-free zone and the implants osseointegrate, then close follow-up will allow you to act quickly in presence of a new KCOT before it compromises the osseointegrated implants.
In this end, it's all a matter of weighing the risks for the patient.
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