Implants · patient case with 2 questions
Implant treatment planning
Patient: Male, 38 years old
Chief complaint: “I'm missing some teeth and I'd like replacements.”
History: Ectodermal dysplasia. Skeletal growth complete. Otherwise healthy, non-smoker.
Findings: Hypodontia with several edentulous spaces. Adequate bone volume on CBCT. A single edentulous space between two natural teeth measures 7 mm mesiodistally. Peri-implant inflammation is present around an implant placed elsewhere three years ago.
Question 1
Which bacteria predominate in peri-implantitis?
Show answer and explanation
Correct answer: B. Gram-negative anaerobes
- A. Gram-positive facultative rods such as Actinomyces species belong to early plaque maturation and root-surface caries.
- B. CORRECT. The peri-implantitis microbiota closely resembles that of chronic periodontitis — predominantly GRAM-NEGATIVE ANAEROBES including Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia and Fusobacterium species. This is the practical basis for treating implant patients' remaining natural teeth first: untreated periodontal pockets act as a reservoir that seeds the implant surface.
- C. Gram-positive aerobic cocci such as Streptococcus sanguinis dominate EARLY supragingival plaque and healthy peri-implant sulci. They are where colonisation starts, not where disease ends up.
- D. Obligate aerobes cannot survive in the anaerobic environment of a deep peri-implant pocket.
Note: The key management distinction: peri-implant MUCOSITIS is inflammation confined to soft tissue and is REVERSIBLE with debridement and hygiene. Peri-implantITIS involves progressive BONE loss and is not reliably reversible — which makes early detection and regular probing essential.
Question 2
What is the best treatment option to address this adult patient's hypodontia?
Show answer and explanation
Correct answer: B. Implant-supported prostheses
- A. Fixed partial dentures require sound abutments on both sides of each space, which extensive hypodontia rarely provides, and they demand destructive preparation of the few teeth present.
- B. CORRECT. He is 38 with COMPLETED SKELETAL GROWTH and adequate bone volume. That changes the answer entirely from what it would be in a child. Implant-supported prostheses preserve alveolar bone through functional loading, avoid preparing sound teeth, and deliver far better function and comfort than a removable prosthesis in a patient who will need a prosthesis for another forty or fifty years.
- C. Doing nothing leaves the functional, aesthetic and psychosocial problem unaddressed, and the edentulous ridges continue to resorb.
- D. Conventional removable prostheses remain the fallback where bone volume is inadequate or cost is prohibitive, and they are the correct answer in a GROWING patient — but they are second-best here.
Note: Ectodermal dysplasia patients often have reduced ridge volume and may need grafting. Aim to preserve every existing tooth as an overdenture abutment during the growth years so that bone remains for implants later.