Essay IV: Ongoing alveolar growth, continuous tooth eruption, and implants.

It is common knowledge that dental implants should not be inserted in adolescents, before completion of skeletal growth, because they behave as ankylosed teeth and remain in a fixed position while the surrounding bone and teeth are still developing, with consequential worsening esthetic damage. However, there is growing evidence that this phenomenon may continue throughout life in a large number of adult patients, although with a great variability in onset, progression, and extent. Infraocclusion and interproximal contact loss are the more common complications, and the majority of clinically significant cases are located in the anterior maxilla. The esthetic impact is mostly minimal, but in some cases the patient's smile may be severely compromised. Therefore, adult patients need to be informed when dental implants are considered to replace anterior missing teeth.