Custom made subperiosteal implant in jaws of β-Thalassemia major patient

Objectives: β-Thalassemia is an inherited genetic disorder characterized by a quantitative reduction of β–chains of globin. Patients with this disease suffer skeletal deformity, particularly in skull and maxilla stemming from marrow erythroid hyperplasia and expand to medullary cavities ending with attenuation of the cortical structures. The displacement of the dentition by the marrow expansion results in malocclusion, leading to difficulties in mastication, swallowing, and speech. The aim of this report is to introduce the first case in the literature of β-Thalassemia major patient treated with custom-made subperiosteal implant to restore occlusion and mastication function.
Methods: A 35-year old patient was referred to our department in 2015. He was treated by blood transfusions on a monthly basis. His maxilla and gingiva exhibited excessive growth. The panoramic X-Rays and CT Scanning revealed both large bone marrow space and thin cortices in jaws. A custom-made subperiosteal dental implant was fabricated by DENTAL IMPLANT AB™ utilizing the CT-Scan model with extension (wings) to both zygomatic buttresses. Medical evaluations, including chest radiography, complete blood tests were performed. The preoperative hemoglobin level of 9.5 g/dL was deemed sufficient by the hematologist to allow surgical procedure. The treatment plan involved full teeth extraction, 10mm segmental osteotomy of the maxilla and insertion of prefabricated subperiosteal dental implant in both jaws.
Results: The patient healed after GA was with no complications, his postoperative hemoglobin level was 9.1 g/dL, and encountered no compromised medical situations. The oral mucosa also healed without any complication.
Conclusions: We present here the first β-Thalassemia major patient undergoing a successful insertion of custom-made dental implant in both jaws to restore his occlusion and mastication function. Preoperative consultation and preparation must be conducted in coordination with the concerned hematologists and anesthesiologist.