Prosthodontic Rehabilitation Of Hypophosphatasia With 13-Year Implant Follow-Up

Introduction: This case presents a 13-year follow-up of a patient with odontohypophosphatasia (odonto-HPP), the most prevalent form of hypophosphatasia (HPP), who underwent prosthodontics rehabilitation using dental implants. Odonto-HPP is a rare metabolic disorder caused by ALPL gene mutations that result in cementum dysplasia and premature tooth loss. This case highlights the feasibility and clinical value of implant rehabilitation in odonto-HPP. Case description: A 33-year-old female with odonto-HPP, carrying an ALPL mutation, c.346G>A, experienced premature loss of both deciduous and permanent teeth. Notably, no skeletal abnormalities were detected. Despite receiving early non-surgical treatment, she had lost 19 permanent teeth by age 32. Genetic testing confirmed a familial mutation, and histological analysis revealed hypomineralized cementum. In her 20s, she received 7 implants (Osstem, South Korea) along with guided bone regeneration, which remained stable over 13 years without bone resorption radiographically. Throughout follow-up, her good oral hygiene was maintained, and the implants remained functional stably. Discussion: The case underscores a novel treatment approach for odonto-HPP. Despite the cementum abnormalities, implant therapy provided long-term functional restoration. Histopathological and genetic findings supported the diagnosis and rationalized the treatment strategy, illustrating that dental implants can overcome the limitations imposed by compromised cementum in odonto-HPP patients. Conclusion/clinical significance: Implant rehabilitation appears to be a promising solution for odonto-HPP patients, offering functional outcomes and improved life quality. Further studies are needed to validate these findings and expand their application to HPP cases.