Exclude the case if it is on Bisphosphonate, otherwise dental implants can be placed safely and osseointegartion can be acheived....

Best,

Check for the type of OI. Most patient with OI type 1 can be managed with routine dental implants. Another concern would be that of bisphosphonate therapy (either oral or parenteral). In any case patients with an optimal CTX level (C-terminal telopeptide) can still undergo dental implants without any complication. We have a case report coming up in this regard.

The implant will take but the strong anchorage of the implant will be questionable since the formed bone is weak.

You don't mention the age of the patient or whether these would be single tooth implants or for implant supported dentures. Implants can ceratinly be placed in patients with OI, but would recommend waiting if patient is still in the mixed dentition and growing. I agree with the previous concern regarding bisphosphonates.

Not much in the literature other than case reports and even those are small in number. Ultimately you start to consider the disease itself, what category/classification is this patient? What is the severity of the dental disease? How have they healed following previous dental surgery? There are many questions that should be addressed to consider the potential for this patient to experience successful intervention and then there must be consideration of the alternatives...will removable prostheses be acceptable (unlikely)? Will removable prostheses lead to rapid bone loss (residual ridge resorption... likely)? Bisphosphonate usage might be a question but the benefit of serum CTX is of questionable value considering that the normal range is so large thereby making "safe" levels a bit of a dream. Implant literature seems to show bisphosphonates to be of little risk to implants which is probably secondary to the controlled surgery in comparison to tooth extraction which is less controlled, less gentle.

It lso depends on the OI type.

If the patient is OI type I then implants may be considered ( Use of biphosphonates may be an issue though)

If patient is type III and IV, I would refrain as too few studies exist to support the use of these devices in these patients

I have a good experience in a female patient with tipe IIIB OI that was treated with 7 implants in mandible and maxilla. She was treated for years with bisphosphonates for 6 months every year and lately with denosumab. The procedure was performed after 6 months of the last shot. The case is under review in "quintessence international"

The half-life of most bisphosphonates is somewhere in the 8 to 12 year range. Discontinuing for six months might make you feel good but it probably doesn't make any difference. I think I mentioned previously that the literature is primarily case or technical reports.

The problem with that type of article is that it does not provide scientific information. With the study number of one all you can learn is how that one patient's treatment worked out. That one patient may have been the luckiest or the unluckiest person on the planet, we don't know. That person may have been the healthiest person you've ever met or the least healthy person you've ever met, we don't know.

I'm including below comments that I send to authors when they submit case or technical reports to the international Journal of oral maxillofacial implants. In some situations they may be presenting something that has never been described previously, in that case we consider their article for submission. If somebody is presenting something that has been published in this specific journal previously it won't be considered for publication again, the next logical step is to publish a series of patient treatments, known as "case series". In the evidence-based hierarchy that is level four evidence. If that's the best we have we consider it carefully comparing it to what we already know, reading it to make sure that it makes scientific sense and then we make a decision as to whether or not we want to use that technology on our own patient, a patient that we have taken the responsibility to treat. Would we feel better if everything had a randomized controlled clinical trial, or better yet a meta-analysis of randomized controlled clinical trials with consistent evidence? Of course we would. The reality is that in the field of intervention care (surgery on the medical side and almost everything that we do in dentistry is intervention of care) it is very hard to perform randomized controlled clinical trials. The first problem is that the trials are generally underpowered (too few subjects enrolled) and the second problem is that many of these studies do not last long enough for the anticipated complications that have previously been described in the literature to appear. So in the world of implant dentistry if your concern is long-term survival of implants in a certain patient group even if you perform an RCT the value of that RCT is going to be exceedingly limited if the study duration is only one year… One year is not the same as long-term.

Regarding case reports: The authors are cautioned that this style of article needs to avoid over representation of the events observed in the article. Case reports must present novel information. If the authors provide a literature search that describes publication of similar case reports then there is no reason to repeat a similar case report. Realistically the existence of previous case reports on a specific topic identified the need for critical scientific research on that topic to either validate or invalidate the method that is being described. Repeated documentation of case reports fails to advance the scientific knowledge. Case reports are not scientific studies. As such a case report should not be written as if it were a scientific study. Case reports should be clear and concise. Every case report should have a clear, descriptive title, an unstructured abstract, a concise, highly focused introduction and a description of the individual patient treatment or technical notes. Case report should be written in 3 to 5 double spaced typewritten pages and the author should strive to include no more than five illustrations.Case reports do not demand structured abstracts and case reports do not have materials and methods, discussions or conclusions. A short, focused introduction is valuable. If the case report describes a novel approach to manage a specific disease or condition the introduction may include a highly focused systematic review of that specific disease. Following the introduction the author should provide the specific case report or technical report/note. This should be descriptive in nature.Since the case report describes the treatment of one, or very few, patient(s) the favorable response in management of this patient cannot be generalized to a broader patient population. This is the reason that a case report will not provide conclusions and it is also the reason that a case report should avoid the inclusion of a discussion.

We have performed a dental implant in a 27 female patients with OI type III, and there was no osteointegration....

We most often consider the most severe type of osteogenesis imperfecta to be type II. It's unlikely that we would have the opportunity to treat a type two patient because there is a low likelihood that they would survive to adulthood. Type III is a serious disease. Look at the description of type III:

Type III

Bones fracture easily. Fractures often present at birth, and x-rays may reveal healed fractures that occurred before birth.

Short stature.

Sclera have a blue, purple, or gray tint.

Loose joints and poor muscle development in arms and legs.

Barrel-shaped rib cage.

Triangular face.

Spinal curvature.

Respiratory problems possible.

Bone deformity, often severe.

Brittle teeth possible.

Hearing loss possible.

Collagen improperly formed.

Treating a patient with this severity of the disease was probably heroic.

I think the most of the descriptions of treated patients with this disease probably are looking at type I. Even then it's not a totally benign process but it probably is within the realm of possibility of treatment. Let's look at the description of type I:

Type I

Most common and mildest type of OI.

Bones fracture easily. Most fractures occur before puberty.

Normal or near-normal stature.

Loose joints and muscle weakness.

Sclera (whites of the eyes) usually have a blue, purple, or gray tint.

Triangular face.

Tendency toward spinal curvature.

Bone deformity absent or minimal.

Brittle teeth possible.

Hearing loss possible, often beginning in early 20s or 30s.

Collagen structure is normal, but the amount is less than normal.

This comparison of types of osteogenesis imperfecta probably does clarify the disease process for us. If were going to consider treating patients with this disease we have to be treating those patients who have minimal or absent bone deformities and have normal collagen.

I think we all have to realize that sometimes in our effort to provide treatment for patients we have to consider when that treatment might simply have so poor of a prognosis as to not justify the intervention. I think this is probably what happened in the treatment of the 27-year-old described above. Of course I'm only going from history and there's always some level of severity variability but in many instances we have to be aware that there comes a point where treatment prognosis is poor enough that it is not worth putting the patient through the effort.

This is probably a discussion for the medical ethicist.

By the way, I think we have to be careful about getting to enamored with the serum CTX test. The values are highly variable in patients who exhibit no signs of bone disorders. If you have pre- treatment serum CTX levels and you are able to compare these with post treatment serum CTX levels then you will have an idea is to what his happened with these markers but if you all you have is post-treatment and if the levels of pretreatment levels are highly variable you really don't gain much from posttreatment serum CTX levels.