Replacing a missing lateral incisor tooth

[DDavid]

My 18 year old daughter is missing a lateral incisor tooth. The orthodontist made room for a new tooth. We have 2 proposals (1) a maryland bridge and in 10 years an implant (2) right away an implant. One dentist saying it is too soon for an implant. The other one proposed to take images of the mouth and see if an implant is immediately possible.

 

[MattKW]

It is generally assumed that by 18yo the face (esp the upper jaw) had ceased growing. The risk is that placing implants at an earlier age may allow the bone to overgrow the implant, so that the fake tooth starts to be left behind as the growing bone moves the real teeth downwards. The attached 2019 article 1 reviews this concept in patients <18yo, and shows cases of implants as early as 10yo. If you look at the parts I've highlighted, the successful studies (<10% failure rate with a long follow-up?) with young children involve small number of patients.
The second study article 2 shows that studies suggest that facial growth usually stops at 18yo, but in some people may continue afterwards, and there was no absolutely reliable way of determine when facial growth stops.
My daughter also missed growing her upper lateral incisors, and I forced her to wait till she was 21yo before implant placement. She is now 35yo without complications. Maybe I could've had them placed at 18? Maybe her growth might've continued after 21yo, and she was just lucky? Maybe as a female she really did stop growing younger than if she had been male? There are no absolute certainties.
So, 18 is an acceptable age with usually minor risk. However, if you can wait a few years, then your risk lessens - just don't ask me for risk percentages!
Placing Marylands bridges is a nice way of delaying the implant, but I see very few cases where Marylands can be successfully applied, and cases where they have caused more harm than good.
If your daughter is badgering you, then I think 18yo in a female is quite acceptable; to wait until 28yo is definitely overkill.

 

[DDavid]

It is generally assumed that by 18yo the face (esp the upper jaw) had ceased growing. The risk is that placing implants at an earlier age may allow the bone to overgrow the implant, so that the fake tooth starts to be left behind as the growing bone moves the real teeth downwards. The attached 2019 article 1 reviews this concept in patients <18yo, and shows cases of implants as early as 10yo. If you look at the parts I've highlighted, the successful studies (<10% failure rate with a long follow-up?) with young children involve small number of patients.
The second study article 2 shows that studies suggest that facial growth usually stops at 18yo, but in some people may continue afterwards, and there was no absolutely reliable way of determine when facial growth stops.
My daughter also missed growing her upper lateral incisors, and I forced her to wait till she was 21yo before implant placement. She is now 35yo without complications. Maybe I could've had them placed at 18? Maybe her growth might've continued after 21yo, and she was just lucky? Maybe as a female she really did stop growing younger than if she had been male? There are no absolute certainties.
So, 18 is an acceptable age with usually minor risk. However, if you can wait a few years, then your risk lessens - just don't ask me for risk percentages!
Placing Marylands bridges is a nice way of delaying the implant, but I see very few cases where Marylands can be successfully applied, and cases where they have caused more harm than good.
If your daughter is badgering you, then I think 18yo in a female is quite acceptable; to wait until 28yo is definitely overkill.

Thank you so much. Much appreciated. This is very helpful.

 

[MattKW]

Glad to help. Those 3 extra years I made her wait made me age 10 years! She still loves me.