Failure in Implant Rehabilitation in a Patient With Severe Congenital Neutropenia (Kostmann Syndrome)

Abstract

Introduction .- Kostmann syndrome is an autosomal recessive disorderthat precipitates severe congenital neutropenia (SCN). One of the most characteristic oral manifestations of this syndrome is severe periodontal disease with extensive bone loss in the primary dentition. This bone loss often extends into the permanent dentition leading to premature partial or total edentulism. Objective.- This paper will review, discuss, and document the indications of implant placement as well as the dental and medical management of periimplant infective complications in a patient with Kostmann syndrome. Case report.- The dental management of patients with SCN has been poorly described in the literature thus far. In this paper we report a case of dental implant failure in a 24 years old patient diagnosed with Kostmann syndrome. This patient underwent implant supported rehabilitation with 8 upper maxilla and 4 mandible dental implants and returned to the Hospital 5 months post-operatively with an implant related submandibular abscess ultimately requiring removal of the mandibular implants despite extended IV antibiotics therapy. Discussion.- There is currently no available data to guide the use of dental implants in patients affected from Kostmann disease. We believe the most likely cause of infective oral complications in this patient population occurs during the surgical stages of implant placement as this genetic immunodeficiency likely allows for increased ability of opportunistic oral microflora to colonize the implant surface as well as the oral soft and hard tissues.