Strategies for rehabilitation management with implants in patients with down syndrome: a scoping review

Down Syndrome (DS), caused by an extra chromosome 21, has a prevalence of 24.7 per 10,000 live births in Chile, the highest in Latin America. Individuals with DS commonly present orofacial and dental anomalies, complicating oral health management. Many depend on removable prostheses, which represent challenges in hygiene, handling, and adaptation. Dental implants are a promising alternative, offering improved stability and functionality. However, successful rehabilitation requires addressing specific anatomical, physiological, and behavioral considerations. This scoping review compiles evidence-based strategies to guide implant treatment in this population.

Registered on the Open Science Framework (https://osf.io/bstwk/), this review followed the PRISMA-ScR protocol, addressing the question: "Which are the management strategies and survival rates of dental implants in patients with Down Syndrome?" Searches were conducted in Pubmed/MEDLINE, Scopus, Science Direct, Web of Science, and Ebsco databases.

Of 92 studies identified, 7 met inclusion criteria, encompassing 179 implants in DS patients. Anesthesia type varied based on patient cooperation and procedure complexity: general anesthesia for uncooperative patients, local anesthesia for compliant individuals, and sedation for intermediate cases. Delayed loading (3-12 months) yielded better outcomes than immediate loading. Overdentures with locator or bar systems were effective and easier to maintain, while screw-retained fixed prostheses provided stability but required strict hygiene adherence. Clinical success rates varied, with higher success in simple cases and higher failure rates in studies involving multiple implants.

Dental implants, combined with structured behavioral management, improve oral rehabilitation outcomes in DS patients. While sedation or general anesthesia may be required, associated risks must be carefully managed. Delayed implant loading is recommended to minimize osseointegration failures. An interdisciplinary approach, including material selection, caregiver education, and long-term maintenance, is essential for successful, individualized outcomes.