It is entirely possible to receive orthodontic treatment even if you have a missing tooth. While the presence of a gap complicates planning, it rarely prevents treatment, as the orthodontist incorporates the empty space directly into the overall strategy for alignment. Braces ensure the remaining teeth are positioned correctly, improving bite function and overall oral health. The missing tooth becomes a focal point for a customized treatment plan designed to either close the gap or prepare it for a prosthetic replacement.
Initial Consultation and Feasibility
The first step is a comprehensive initial consultation to determine the treatment’s feasibility and goals. This assessment starts by determining the cause of the missing tooth—whether lost due to trauma, disease, or congenital absence—as this influences the long-term prognosis. A detailed examination includes advanced diagnostic imaging, such as panoramic X-rays or 3D cone-beam computed tomography (CBCT) scans.
These images check the health of the surrounding gum tissue and the bone density in the area of the missing tooth. Sufficient bone support is necessary because the bone must be strong enough to handle the gentle, continuous force applied by the braces. If bone or gum health is compromised, treatment may be postponed until those underlying issues are addressed by a general dentist or periodontist. The orthodontist may also consult with a restorative dentist or oral surgeon during planning to coordinate the final outcome.
Managing the Missing Tooth Space During Treatment
The orthodontist formulates a plan using one of two primary strategies for managing the empty space: closure or maintenance. The decision depends on factors like the location of the missing tooth, the patient’s bite relationship, and aesthetic goals. Both strategies use the mechanics of braces to achieve a precise, predetermined result.
One strategy is space closure, which uses braces to pull the adjacent teeth into the gap, eliminating the space entirely. This approach is often considered if the missing tooth is non-visible (such as a back molar or premolar) or if the patient’s bite allows for movement without compromising function. The mechanism involves bodily movement, shifting the entire tooth, or mesial drifting, guiding back teeth forward to fill the void. Closing the space eliminates the need for a prosthetic replacement.
The second strategy is space maintenance or creation, which prepares the site for a future artificial tooth replacement. The orthodontist uses braces to move the surrounding teeth until the gap is perfectly sized and positioned for the eventual restoration. This is particularly important when planning for a dental implant, as the roots of the adjacent teeth must be moved into a parallel position. If the roots are angled toward each other, there will not be enough bone to place the titanium implant post. During treatment, a temporary cosmetic appliance, often called a “flipper” or a prosthetic tooth attached to the wire, is used to hide the empty space.
Restorative Options After Braces
If the treatment plan involved maintaining the space, the final phase begins after the braces are removed, focusing on the permanent replacement of the missing tooth. The precise alignment achieved by the braces maximizes the success of these restorative options. The most common and durable choice is a dental implant, which involves surgically placing a titanium screw into the jawbone to act as an artificial root. This option preserves the bone and functions like a natural tooth, but it requires the patient to have sufficient bone density.
A fixed bridge is another common option, where a prosthetic tooth is suspended in the gap and anchored by crowns placed on the adjacent natural teeth. While a bridge provides a stable, non-removable solution, it requires modifying the neighboring healthy teeth to accommodate the crowns. The most economical option is a removable partial denture, which is a replacement tooth set on a plastic or metal base that the patient can remove for cleaning. The orthodontic work ensures that the alignment is ideal, regardless of the final restorative option chosen.