Choosing the best treatment plan for growing patients remains a challenging task even for an experienced dentist. Numerous general, local and individual considerations have an impact on the final treatment outcome. Therefore, a comprehensive understanding of etiologic and pathogenic, anatomic and developmental, surgical and prosthetic, patient- and parent-centered factors must be considered to obtain predictable and long-term results. This article presents an overview of dental implant placement in growing patients and recommendations related to the most common clinical situations in children and adolescents.
Abstract
Introduction
Over the last decades, implant placement and subsequent implant-supported prosthetic rehabilitation has become a standard of care for adults. This approach has proven its reliability, safety and benefit for patients, as described in ITI Consensus Conferences (Chen & Buser, 2009; Dawson et al. 2022; Gallucci et al. 2018). However, implant survival and success rates in growing individuals are lower than in adults (De Angelis et al. 2017). Nowadays, there are not enough longitudinal clinical trials that evaluate the clinical, functional and esthetic outcomes, the patient's satisfaction, and the quality of life in children and adolescents. Therefore, implant placement in growing patients is still debatable in terms of treatment options, ideal age, number and position of implants to achieve safe and predictable long-term results.
Missing teeth are less frequent in growing patients compared to adults. According to the Global Burden of Disease 2017, tooth loss in adults is most frequently caused by untreated caries and periodontal diseases, whereas in children it is due to dental trauma, congenital disorders, especially ectodermal dysplasia, and post-operative conditions after tumor removal (Huang & Driscoll, 2014; Roth 2018). Different etiology and pathogenesis determine a lower frequency of long-standing chronic inflammation and alteration of oral microbiota in growing patients. Nevertheless, in children the conventional prosthesis is a preferable treatment option until growth has ceased, although sometimes this does not fully satisfy the patient (Bohner et al. 2019).
Plans to restore missing teeth in children and adolescents is based on the patient’s general characteristics (developmental phase and systemic condition), local aspects (maxillary and mandibular growing patterns and the amount and position of absent teeth) and on individual considerations (willingness of the patient and parents to cooperate with the dentist and economic factors). Therefore, this article aims to highlight current and relevant scientific information about treatment modalities and implant placement in growing patients and to provide practical recommendations related to the most common clinical situations.