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Ask UsImplants in 16 Year Old Undergoing Orthodontic Treatment?
« Proximators: Useful for Atraumatically Extracting Teeth? | Lower Molar: Surgical Extraction and Implant Placement at Same Time? »
Patty, the aunt of a prospective dental implant patient, asks:
My niece is 16 years old and is undergoing orthodontic treatment. She has congenitally missing laterals and the orthodontist and dentist are suggesting that she have her wisdom teeth removed and the 2 lateral implants all at the same time to avoid more than one sedation and surgery. I understand that part. My question is about her age. Shouldn’t she wait until after age 18? Will the orthodontic treatment also be a factor here? She is a very petite person and I am wondering if age would allow her bone structure to grow further for the implant placement. Please let me. Thank you.
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15 Responses to “ Implants in 16 Year Old Undergoing Orthodontic Treatment? ”
Wait at least the age of 18-20 years. Implants placed in children will be stuck in then bone, but the adjecent bone will continue to grow. The astetic result will not be ok.
She should wait until after her menses cycle stabilizes and she is past her maximum bone groweth spurt ( Both happen around the same time) anything earlier and her skeletal structure will change but her imlants will be stuck where they are placed. Also in terms of orthodonticsand missing laterals. The most esthetics results will be acheived when the canines are placed into the lateral space and held there to hold bone and then based on timing of the orthodontics , move the canines into the correct position, which will leave maximum bone for implant placement. she will end up with best results and most esthetic outcome with unfortunately two sedations.
I would wait untill her bone structure is pretty much set (that is not at a specific age), it can be checked with a hand x-ray and then i would place the implants. In the time between now and then i would ask the orthodontist to move the canines back and forward to gain as much bone as possible and the place them n final position before the surgery hence best possible cosmetic result.
cheers
Dear Patty,
I couldn’t agree more with what Dr. Berg just said!
Good Luck
If you do not mind, I should like to post another question related to this area. I have heard and have been governed by the previous comments for years, but I have always had one question in the back of my mind.
If continued bone growth is a concern, why is it that maxillary retainers are made and then they are never changed as a patient gets older?
Dear Patty:
Go ahead for implant placement at the same sedation. In this age is not expected to have more growth in the vertical or horizontal direction. As Rand said” why the retainer are made and they never changed?” I have a clinical experience for cases in this age with no any adverse complications for 5 years. Because waiting more, loosing bone more. Hope this will help. Best regards
I would suggest that you delay the wisdom teeth surgery, as it is not urgent at this time, most kids get their wisdom teeth removed at about 18 years of age. By that time there would be no question of further bone development, especially for females. I have performed implant surgery, and the prosthetic phase for many young adults and over the last 20 years or so, there has been no problem for implants placed at this stage as growth.
The extraction of the third molars and the placement of the lateral incisor implants have nothing to do with each other and they should be handled as separate procedures.
The maxillary lateral incisor implants absolutely should NOT be done until she is at least 18 and 20 could be better. The use of wrist films is only a very rough guide, and they do not necessarily coincide with the growth of the maxilla. The wrist bones are endochondral, while the bones of the skull (maxilla) are intramembranous in origin. Their growth periods do not necessarily coincide. Placing implants in too young a patient will result in them being too apical and palatal as the patient’s skull matures and ages. This will be a considerable esthetic concern especially if there is an average or high smile line.
It probably is not imperative to do the extractions on the 16 year old girl right now. If it is desired to do both procedures at the same time, waiting a few years to extract the third molars is probably fine.
Guideline in UK is not to remove wisdom teeth unless they are doing some harm. The third molars in most 16 year olds are deep and their surgery difficult and so increased risk of complications. Much better to wait until they erupt further and then remove them if necessary. Some orthodontists recommend such surgery to prevent late lower incisor crowding but research shows no such association .
I feel doing both surgeries together has no benefit. Sedation should be safe and surgery more tolerable in a more grown up person.
OMF surgeon
Just few comments from a periodontist with lots of experience of placing implants in young adults. The chronological age of the patient has very little impact. The key points are as follows: are all the adult teeth fully erupted and the roots (including apex) fully formed? is the dentition stable, meaning is orthodontics complete and the bite stable/occlusion set and normal gingival contours/architecture ( no altered passive eruption). The intercuspid space (k-9 to k-9) is fairly well established at an early age. Growth in young adults generally continues in the posterior and mandible and in a A/P direction. The anterior maxilla is fairly stable. Add to this info, such as the onset of menses, stable shoe size, (hand films are not very accurate) and smile line, etc. Then you can discuss with each patient the benefits/risks. Waiting has some negative issues, such as space maintenance. Even retatiners can sometimes allow teeth or more importantly, the angle of the roots to change, therefore, making placement of implants difficult due to root proximity. I have had more than one patient/parent become very sadden by the fact that there child must go back into ortho to correct space/root proximity issues. Understand that we talking about only the anterior maxilla in patients with all adult teeth and stable occlusions, not an adolescent in a mixed dentition stage. Bottom line: each case is different and needs to be carefully evalauted. Impants can be placed in 15 year olds if the right conditions are present.
I agree completely with Dr. Massoud’s post of 2/6/08.
Regarding the comments of Dr M, the chronological age has a lot to do with the maxilla and implant placement. The fact that the intercanine distance might be the same in a 15 year old as in the same person as a 30 year old, has nothing to do with the LOCATION of the block of bone containing those teeth. As he stated, the smile line can be adversely affected and that needs to be discussed with the patient, and the implants can be placed if all the right conditions are present. Unfortunately, we cannot travel into the future to make a treatment plan, and no one will know if all the right conditions are present for a particular patient until many years pass and and you find out whether or not you guessed correctly (since the onset of menses, stable shoe size, and hand films are not very accurate). Having a teenager wait for implant placement is a much smaller problem than having the implant be in the wrong place with the concomitant esthetic, and possible functional problems for the rest of his/her life.
(Periodontist & Prosthodontist)
I have to take exception with Dr. Massouds statement. The position of the British Government does not correspond to that of the American powers that be. It may well be that we in the states define harm or the potential to do future harm differently AS an OMFS who has practiced for over thirty years I can categorically state that the removal of wisdom teeth in younger patients (e.g. 16 years old) is not more difficult once you learn the technique. In fact, the incidence of complications are lower. The are far ferwer complications with roots getting involved with nerves , since the roots are usually not fully formed ,also I see fewer localized socket reactions. As for more anesthesia complications. With todays modern meds. that is just rubish. I would challange Dr. Masaud to site studies and statistics. In the U.S. Competent omfs perform these procedures every day with excellent results. I do agree that two surgical procedures would not be a problem.
I agree with Osurg entirely. Two weeks ago I removed my 17 year old daughter’s lower wisdom teeth using local aneasthetic only. I decided to go in early as the OPG showed that her teeth were large, were impacting mesially and at this stage the roots were only beginning to form. On exposure it was also found that the little mongrels were also lingually inclined. Anyway, the point is that to removed these teeth only required a little bit of crestal bone renoval and then sectioning of the crowns which were then flicked out. Left for another 2-3 years this would have been a far more invsaive and risky procedure. As it was she had minimal swelling and no pain (using my standard antibiotic/ pain management drug routine). I firmly believe that all youngster should have a screening OPG about 16 years of age specifically for this reason.
I’m not sure if Dr. Kitzis agrees or disagrees with my comments, so I wanted to re-clarify my thoughts. The age of a patient should never soley influence your treatment plan. Why is it ok to place an implant in a 18 or 20 year old, but not a 17 year old? Is 17.5 years ok? How about an 80 year old patient? Are they to old and lack the healing ability for successful intergration? I have placed dental implants in patients as young as 15 and as old as 85 (in fact they had there first implant at 80 and returned at 85 for another!)As I stated before, each case must be evaluated for function, esthetics and comfort and if all are in alignement, then you will have a succesful case. I do appreciate other point of views and comments as we can all learn form each others experiences.
My daughter is 14. She is missing her 2 lower middle permantent teeth (they are still baby teeth) The dentist says when her braces are removed he will make a retainer with fake teeth. I want her to have implants when her bones stop growing because this is what he has suggested. How do I know when this has happened and is there harm in doing it before her bones have stopped growing. My spousal support stops at the age of 18 and I doubt the father will help with payment if implants are done after this age.
Thank you
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