Implants in Young Patient: Will This Prevent Full Growth of Maxilla?

Usually,people will tell you NOT to place implants in someone so young for a variety of reasons. First is that the implants are "ankylosed" and the growing premaxilla will develop over it. There was an article in JPerio that showed that that was not the case, but I still wouldn't do it because...according to the literature, there is a lower success rate with implants placed in males under the age of 18. The reasoning was multifactoral (patient compliance, growing, hormones, etc), but there it was nonetheless. A safe bet is to wait until he is older and send him to get a wrist film to see about the growth plates. I would inform the parents of the need for grafting etc.

You should look at the literature about placing implants in the esthetic zone of growing patients before doing this case. Do a Google search on "adolescents dental implants growth" or look up Rossi and Andreasen, Int. J. Perio & Rest Dentistry 2003;23:113-119. You don't even have to read the article, just look at the photos to know that placing implants in the esthetic zone of a growing adolescent is not a particularly good idea. These authors cite other papers that come to the same conclusion. It sounds like this patient needs some kind of long term temporary treatment, like a bonded bridge. Maybe even consider mini-implants that are destined to be replaced when he stops growing. But the last treatment to be contemplated is placing "definitive" implants and restorations at age 14. The worst case (and very likely) scenario is that the implants that you place will integrate beautifully, then submerge relative to the rest of the alveolus and adjacent teeth. If the patient has a high smile line, he could be permanently disfigured.

Do not place definitive implants in a 14 year old male. Period.

My son has a similar situation to Dr. M's patient. We will not have implants placed until age 18; however, I am wondering about the life-span of implants. The teeth were lost as a result of an accident, so for insurance purposes, I need to know if in a normal life expectancy of age 73, should we expect to have to replace these implants. Thanks to anyone who can volunteer insight.

Dr. M, do you have experience? "I am concerned that if the boy continues to grow..."should have put the brakes on any thoughts about placing any implants. I do not think there is any real validity in the literature. Without that, you are totally defenseless in court. Wait. Bill

Like everyone else I wouldn't place implants in a 14 year old, but I would graft the sockets with bioss or something similar.

I have reimplanted avulsed teeth after accidents provided the roots weren't damaged.Root Canal and tooth disinfection was performed first and of course splinting .I was amazed when at the success rate considering the contaminated condition of the teeth, the trauma, and disinfection isn't sterilization.I don't recall a failure. So attendings should evaluate the teeth for reimplantation before extraction at least for ridge preservation sake.And give bridgework back to the patient or parent to have the family dentist evaluate if, part of it can be used again. I reimplanted an upper central incisor in a 14 year old I was doing ortho on.I told the parent that,a) the tooth over time will undergo resorbtion,b)the rest of the teeth will move with the growing bone,but the reimplant won't,even with the wires. As the patient matured a veneer was placed to correct b).As the resorption loosened the tooth a Maryland bridge was used to support the reimplant.The occlusion should be relieved to prevent premature loss of the resorbed tooth's crown.The resorption process in most cases includes the gutta percha. This preserved the alveolar bone until the implant was placed. Bill Pace DDS

To Dr. pace: Very good advice. I had a similar 16 year old who had a failed RCT on a central incisor and at the time I was planning a bone expansion. I emailed some pics to a well known dentist who promptly and well advised me at the time to refer out . Growth issues, anterior esthetics and parent financial concerns all ended up with placement of a Maryland bridge. The periodontist had taken out the tooth without my knowledge. i was trying to hold on to it for the sake of the bone but it was extracted due to a midroot fracture. No graft, no info to the parent. Now we have a nice maryland bridge with little bone, so when its time for an implant, things are going to be decidedly different. It was evident that what was best for the patient did not occur because of lack of communication from the specialist to me. So communication works and I now have a periodontist that communicates with me and what is going on and what I think is best for my patient as her general dentist. Bill

wow, I dont see any problems with placing dental implants for a 14 y old.The smile line is well established and facial muscles and pre maxilla is fully developed.The alveolus doesnt grow down if the opposing dentition is stable. Two implants at lateral incisors and then cantilever bridge(lat incisor and central)on each side would solve the problem even if there is hypothetical growth disfiguring the patient. Nothing in literature that supports contraindication of placing and restoring implants in 14 y old patients. Clue is Research done with governance.

No implant should be placed before its time and even 18 years old male might well be too young. Placing it now may turn out to be a disaster.

If delaying implants causes subsequent bone loss to the extent that the option for dental implants is lost, due to the increased mobidity and cost (financial and time) of bone grafting later, should not consideration be given to following the patient and placing the implants as late as possible, but prior to this "point of no implant option"? There is risk in everything and there are factors such as gender, max v. mandible, amount of bone, anatomy of smile, insurance issues (may have no coverage later). . . I think this issue has no pat answer and should be approached on a case by case basis with the patient/guardian being informed of the risks and benefits associated with each treatment option and allowed to make an informed decision.

Dear Dr M: My advise : 1.not to make a bridge in this age espicillay in the maxilla. 2.from my clinical experience in making implant in adolesence, in boys, the implant became submerged about 10 mm or more, having bone loss in the crestal labial bone with probing depth 12 mmm. No problem happened in girls at the same age. 3. I agree with the suggetion of making transitional implants like 4 separate midi implant untill the age of growth cessation. Then the case can be evaluated for new implant insertion or bone graft before implant insertion .Best regards

The problem with inserting a dental implant into the alveolar process of a young person does not only lay within the confines of the probability of vertical growth inhibition but there are also problems with the shortage of the soft and hard tissues due to incomplete skeletal growth and development. The implant rehabilitation at the narrow, partially edentulous ridge often needs a stepwise improvement of both soft and hard tissue. Although both soft and hard tissue management is of equal importance in the full plan of reconstruction, bone graft at the deficient ridge should be considered prior to soft tissue management which necessitates a very serious decision making. The autogenous bone graft can provide the needed bone volume but it is very hard to find a donor site in a very young adolescent. The mandibular symphysis is not a reliable bone graft source in these cases, so, to serve as a dependable implant supporting tissue, the surgeon should think of one of the extraoral sites. In a young child, the iliac crest may still be cartilaginous rather than bony and harvesting a rib bears the danger of a pneumothorax and the resulting morbidity. The ridge width at the anterior maxilla substantially provides the need for the implant placement. However, the insufficiency in the ridge height could still be considered. Ridge splitting technique may widen the deficient area, and osteodistractors are potentially able in making new bone grow in the bone gap through the distraction osteogenesis process and help us to level the under-grown implant containing segment with the other parts of the alveolar process. A bidirectional floating distraction device has been advocated but, the long-term stability still needs to be confirmed.

Place in mini implants and restore with an acrylic bridge. The implants will maintain the integrity of the bone and prevent excessive resorption. When skeletal maturity is reached, replace it with conventional implants or rebuild the bridge to accomodate the growth changes. Minis can usually be unscrewed. However, if the growth changes have not significantly altered the relative position of the mini implants and cost is a factor, I would just rebuild the bridge for aesthetics.

Dr.N First of all I thank you for the posted comments. I have a 10 yo girl lost 7,8,9 in a bike accident (mom can not find teeth for re-implant). I understand the wisdom of not placing implants until pt’s growth has stop. I would like your thoughts of placing mini implants at 7,8,9 (but not restore)just for the sake of preserve bone then replace them with regular implants later when she gets older. Pt will still wear flippers for the next few years. thanks

Make a Maryland Bridge and place implants about age 16 to 18 yrs. This is still uncharted water.