Children who experience severe early tooth loss face serious clinical challenges that impact their oral health, facial development, and psychological well-being. Although prompt prosthetic intervention is crucial, there is a dearth of regional data regarding long-term results as well as the practices, attitudes, and knowledge of Middle Eastern clinicians handling these cases. The purpose of this study was to fill in these gaps. A cross-sectional, mixed-methods design was used. To assess the results of fixed and removable prosthetic appliances, a retrospective clinical audit of 368 patient records (aged 2–12 years) from various centres was carried out between 2015 and 2026. Second, 412 dental professionals in the Middle East completed an anonymous online Knowledge, Attitudes, and Practices (KAP) survey, yielding a 75% response rate. Descriptive and inferential statistics, such as logistic regression and chi-square tests, were used to analyse quantitative data. Removable partial dentures had the highest rate (42.6%) and required the most adjustments, according to the audit, which found an overall complication rate of 35.9%. Ectodermal dysplasia was associated with reduced discontinuation and improved compliance. Specialists' knowledge based on their own reporting varied from average to excellent, however knowledge of general dentists was significantly deficient, especially in the area of syndromic cases and growth considerations. Issues about the development of alveolar bone as well as irregular parental compliance were noted even though the attitude towards prosthetic care was generally positive. Different patterns of practice were displayed and the higher knowledge scores of the practitioners were associated with their working with dental technicians. Problems with prosthetics occur quite often, especially when removable appliances are used. Clinicians' knowledge, attitudes, and practices are not the same, which highlights the necessity of professional education with focused objectives and standardized regional guidelines. Achieving better permanent results for the children with severe early tooth loss in the Middle East involves solving the issue of compliance and incorporating care from different disciplines.