Treatment options for a 15 year old with unrestorable tooth?

I have a 15-year old male that has presented with a fracture at the furcation of tooth #19 (man. left first molar), making it unrestorable. I have presented 2 treatment options, orthodontically relocate #18 into the position of #19, and #17 into #18’s position when it erupts, or bone graft and place an implant. Is 15 too young for an implant in this position? At what age would it be best? Patient and parents would rather not go through orthodontics again, which he finished last year. If I have to wait, I would extract, bone graft and place a fixed space maintainer. Thank you in advance for the replies.

21 thoughts on: Treatment options for a 15 year old with unrestorable tooth?

  1. Saleh Muhammad says:

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

    • george l sinnis dds says:

      Thank you for your reply. I understand that things may change and that the implant may be out of perfect alignment when growth is completed, but since he is 15 I was thinking, hoping, that if that is the case, since its a molar, i can compensate with an updated custom abutment and new crown at the time. Esthetics wouldnt be of prime importance as if there would be if it were an anterior tooth. I guess Im assuming because of his age, there wouldnt be large changes in the implant position because of bone growth. Am I wrong?

  2. Dr Shalash says:

    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.

  3. Ajay Kashi, DDS, PhD says:

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

  4. Dale Gerke - BDS, BScDent(Hons), PhD, MDS, FRACDS, MRACDS (Pros) says:

    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.

    • george l sinnis dds says:

      thank you for your thorough reply. the tooth is unrestorable at this point. theres a significant RL at the furcation and needs to be extracted and the site bone grafted asap. my other concern is that we will lose bone height if I have to wait till hes 24 and another, more complicated bone grafting procedure will be needed. im trying to weigh that against the possibility that the implant will be out of alignment. if its a few mm and i can compensate with a custom abutment and new crown, id rather do that than to subject him to a bone block grafting procedure in the future.

  5. Ajay Kashi, DDS, PhD says:

    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.

  6. Dr Joe Nolan says:

    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

    • george l sinnis dds says:

      there is bone loss at the site.. should I graft, wait 3-4 months then begin the movement with the appliance?

  7. Dr Joe Nolan says:

    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

  8. Alex Davydov says:

    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

  9. CRS says:

    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.

    • george l sinnis dds says:

      seems like youre wrong and Im not seeking permission from anyone here. just asking questions to educate myself, since both sides are adamant about their opinions. my preference is to orthodontically move #18 into place. if the patient’s parents continue to insist on an implant after Ive thoroughly explained the possible consequences, ill be armed with the info i need to determine if i want to continue seeing the patient. make sense?

  10. Dr Joe Nolan says:

    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

  11. Matt Helm DDS says:

    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.

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