Childhood

Аннотация

Premature permanent tooth loss in patients presents with various challenges, affecting facial aesthetics, chewing function, speech development, and mental health [12]. Unlike adults, children and adolescents continue skeletal and alveolar maturation, which can make implant-based rehabilitation particularly challenging. Delayed dental implantation is thus often recommended to wait for skeletal maturity. The aim of the current review is to provide an overview of the known causes of premature permanent tooth loss and to elucidate the main clinical, biological, and developmental factors that must be considered when discussing the indication for postponed implant placement in patients. Keywords:delayed implantation, dental implants, pediatric dentistry, premature tooth loss, alveolar bone development 1.Introduction Patients who encounter early permanent tooth loss face many complications that impact their speech development, mental health, chewing ability, and facial appearance [12]. Children and teenagers continue to develop their bone structures, unlike adults, which might make implant- based rehabilitation more difficult. It is therefore frequently advised to postpone dental implantation until skeletal maturity. The current study aims to clarify the primary clinical, biological, and developmental elements that must be taken into account when addressing the reason for postponed implant placement in young patients, as well as to give an overview of the known etiology of premature permanent tooth loss. 2.The Causes of Early Permanent Tooth Loss Premature permanent tooth loss may have a systemic, hereditary, or local cause. Avulsion and severe luxation are two of the most frequent causes of traumatic dental injuries [7, 9, 12]. Premature tooth loss can also be caused by dental caries and structural enamel flaws, particularly in individuals with poor enamel quality [8, 15]. Although they are often less common in children, periodontal disorders may contribute to more intense symptoms [2]. Dental abnormalities and premature tooth loss can result from a number of systemic and genetic diseases. CODAS syndrome [1], DiGeorge syndrome [3], hyperimmunoglobulinemia E syndrome [4], Axenfeld-Rieger malformation [6], Coffin-Siris syndrome [15], and hypophosphatasia [18, 22–24] are some of these. Additionally, because amelogenesis imperfecta impairs enamel formation, humans are more prone to caries and tooth failure [10]. Given the wide range of causes, a thorough medical and dental assessment is required to guarantee a specific diagnosis and an appropriate course of treatment. 3.Clinical Aspects of Delayed Implantation 3.1 When Implants Should Be Placed A pivotal foundation in the long-term success of dental implantology is the timing of implant placement. To avoid issues like infraocclusion, which can be brought on by continuous vertical alveolar growth, dental implant placement is frequently delayed until the end of craniofacial growth [20]. Cervical vertebral maturation or radiographic examination of the hand and wrist is often utilized to estimate skeletal maturation. Early implant placement may create functional and aesthetic disparities that call for intricate corrective actions. 3.Maintaining Space After early tooth loss, it is crucial to retain edentulous space. To stop neighboring teeth from tipping and mesial drifting, orthodontic space maintainers, such as band-and-loop appliances and removable or permanent orthodontic appliances, are used [5, 13, 14]. If left untreated, the loss of maxillary primary molars, particularly the first molars, has been shown to have a tendency to cause permanent canines to migrate mesially,which results in the reduction of available space [5]. Our clinical experience indicates that in pediatric patients with delayed implantation, the use of space maintainers can significantly reduce the need for further orthodontic interventions. For implant stability and osseointegration, alveolar bones are essential. Alveolar ridge resorption is frequently associated with premature tooth loss, which may have an impact on implant placement. In these situations, achieving apt bone thickness and body may demand ridge preservation or bone augmentation procedures. 4. The Biological Aspects 4.1 Growth of Alveolar Bones Alveolar bone height and width can be reduced as a result of early tooth loss interfering with this maturation process [24]. Bone resorption may be decreased and implant placement conditions evolved by early space maintenance and ridge preservation techniques. 4.2 The importance of soft tissues Functional and aesthetic results can be vastly impacted by the soft tissue quality surrounding the implant placement site. Peri-implant health may be compromised by inadequate soft tissue or keratinized gingival tissue. Soft tissue augmentation techniques might be appropriate in these situations. 4.3 Osseointegration in individuals undergoing growth Although osseointegration is generally anticipated, i