Treatment options for a 15 year old with unrestorable tooth?

18 has been the ballpark age

Never at this age. Jaws are still growing. The implants will act like an ankylosed tooth, will be infra occlusion.

Never at this age. Even at 18 years of age it can be still too early. Two cephalometric radiographs one year apart starting at the age of 18 will determine whether growth is still be taking place or not.

You can place an implant in a 15 year old patient safely. Alternatively you can do a conventional bridge.

As has been pointed out, 15 is too young to place an implant. To do so will be a long term disaster. I think in males, 24 years old is about the earliest you should implant BUT it is an individual circumstance consideration. An orthodontic opinion as to when the growth has stopped would help guide you further on this. So you real question should be - how do I manage the situation for another 10 years (approximately). This depends on the clinical situation. Ideally you would find a way to keep the existing tooth in place to maintain space and bone. Even in the worst cases, this can be managed with temporary endo treatment (if required), resin build ups (with or without posts and/or pins), extrusion of tooth orthodontically to get better access to margins, tooth division, etc. If you find this too hard then perhaps consider a referral to a prosthodontist (at least for the short term). While I understand many dentists are reluctant to refer, specialists are trained to do the hard stuff. So it is wise to utilise their expertise if needed. However if the tooth must be extracted, then you could consider maintaining space with a temporary fixed appliance (eg Maryland type device) or if the previous orthodontist is still supervising post treatment stability, he/she might be able to stabilise with a a retaining wire or similar. In such a case you would have to hope the bone will be retained - so grafting into the extraction site would be prudent to do to give the best chance and of course delicate removal of the tooth carried out with minimal bone trauma. Perhaps most importantly, discuss all options with the patient and parents and fully explain the good and bad points of all treatments.

There are reports in the literature that jaw growth has stabilized enough by age 13 to have implants placed......there is no hard and fast rule that it shouldn’t be placed in a 15 year old.....if there is much confusion you should take it on a case by case basis and decide.

To substantiate my previous comments you may like to read the following literature (there is more extensive literature available on the internet from peer reviewed journals that have reported similar instances). Hope this helps! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357921/ https://www.ncbi.nlm.nih.gov/pubmed/12861881

A single screw retainer with screw opened and clasped onto the 2nd molar via an Adams or other clasp, clasp the lower 1st premolars each side, have the patient turn the screw one quarter turn every three nights...the 2nd molar will contact the 2nd premolar in 6-9 months. You will develop the extraction site bone by osteoblast activity furthermore. And you just might allow the wisdom tooth room to erupt...show an OPG? The image in the link below shows 2 sagittal screws, you just need one , but it needs to be fully opened at construction, the action of turning the screw will then close the screw mesially and bring the 7 forward. Easiest thing you'll ever do :) Device acts a good retainer afterwards, especially if you add a close fit labial bow

http://excelorthodontics.com/wp-content/uploads/2015/11/type-304-lg.jpg Sorry, forgot to include the link in my earlier message....picture shows 2 screws, you need just one, but the screw needs to be fully open as against - as per the picture- fully closed. Insert the small rod into the little holes in the barrel of the screw will start to close the screw bit by bit....

If you ever want to see new bone growth, mesialize a 2nd molar into a 1st molar space and be frankly stunned:) At any age too

2 years ago I placed 1 implant to 16 years old boy in 46 region/ He finished his orthodontic treatment and he and his mother didnt want to damage 45 ad 47 teeth with prostodontic construction. I am watching him. Everething Ok

You know it’s funny why ask the question if you are going to ignore biology and growth and place it anyway for the fast buck, kicking the future complications down the road. It’s pretty straight forward extract graft and make a simple space maintainer. Kids grow it’s life don’t listen to the early placement posts, just anecdotal. Seems like you are trying to get permission to ignore the rules and will do what you want anyway.

Kids grow.

It's nuts to think implant when everyone should know that it's ortho ( and I'm not even suggesting brackets and closing coil) which should be employed, and my retainer based sagittal is spot on for doing the job. Then again, guess there are not too many on this web site even remotely familiar with functionals

While certain dire cases may undoubtedly call for implants in children, I hardly think that this case is dire enough to justify violating nature's own rules. Implants in children before growth is complete is asking for problems down the road, because of the impredictability. It would have been nice if you had included at least an x-ray, so we can see if that first molar might, just might, be a candidate for a hemisection (a.ka. premolarisation). That said, Dr. Joe Nolan's is by far the most sensible approach to this case from a long-term perspective.