Missing teeth rarely prevent someone from getting braces. The treatment plan must be customized to address the missing tooth alongside existing alignment issues. The orthodontist must decide whether to close the space by moving other teeth into it or to maintain the space for a future prosthetic replacement. This decision depends on factors like the location of the missing tooth, the condition of the surrounding bone, and the patient’s overall bite.
Orthodontic Goals When a Tooth is Missing
The orthodontist’s goal with a missing tooth is to create a functional and aesthetically pleasing final result. The first option is to close the space, moving adjacent teeth into the gap. This approach is considered when the missing tooth is not functionally critical, such as a back premolar, or when the patient has existing crowding. For example, a larger canine tooth may be moved into the position of a smaller, congenitally missing lateral incisor, requiring the canine to be reshaped to look like the tooth it is replacing.
The second option is to preserve the space, preparing the site for a future prosthetic replacement. This path is chosen when the missing tooth is in a highly visible or functionally important area, like a front incisor, where closing the space would compromise the bite or facial profile. Keeping the space open is also guided by the condition of the jawbone, as a future dental implant requires adequate bone structure for support.
Mechanics of Space Management During Braces
Managing the space created by a missing tooth requires specific mechanical techniques to ensure the desired outcome is achieved without unwanted movement. If the treatment plan involves preserving the space, the orthodontist uses braces to precisely align the roots of the adjacent teeth. This alignment creates a parallel space of the correct width to accommodate a dental implant or a bridge abutment.
Patients often worry about having a visible gap, but temporary tooth replacements are commonly used to maintain aesthetics. A temporary prosthetic tooth, known as a pontic, can be attached directly to the archwire of the braces to fill the space. In cases using clear aligners, a temporary tooth can be built directly into the plastic tray, providing a seamless cosmetic solution. Specialized orthodontic devices, such as temporary anchorage devices (TADs), are employed to provide a fixed anchor point, preventing other teeth from drifting.
Preparing for the Final Restoration
The orthodontic treatment acts as a precise preparatory phase for the final restoration. Braces ensure that the roots of the teeth bordering the gap are upright and parallel, which is a requirement for successful placement of a dental implant. Without this root positioning, the restorative dentist or oral surgeon would struggle to place the implant post or design a stable bridge. Orthodontics also corrects the bite relationship so the final prosthetic tooth will meet the opposing teeth in a functional manner.
This phase requires an interdisciplinary approach, with the orthodontist collaborating with a general dentist, prosthodontist, or oral surgeon. The final restoration options include a dental implant or a fixed bridge. The dental implant offers a standalone solution that does not impact the surrounding teeth, but it necessitates adequate jawbone volume. A fixed bridge is an alternative that can be placed quickly but requires the anchoring teeth to be slightly reshaped to support the restoration.