The presence of a fake tooth does not automatically disqualify an individual from receiving orthodontic treatment. Modern orthodontics has developed specialized techniques to manage teeth that have been restored with prosthetic materials. A “fake tooth” can refer to several types of dental work, including crowns, bridges, veneers, and dental implants, and each requires a different approach. While treatment is generally possible, it demands careful and coordinated planning between the orthodontist and the restorative dentist to ensure a successful outcome. This interdisciplinary strategy is the foundation for moving natural teeth effectively while protecting or utilizing existing restorations.
Understanding Tooth Movement Limitations
Orthodontic tooth movement relies on a natural biological process unique to natural teeth. Each natural tooth is suspended within its socket by the periodontal ligament, a fibrous connective tissue. When a consistent force is applied by braces, the ligament signals the body to initiate a remodeling of the surrounding alveolar bone. This remodeling involves two types of specialized cells: osteoclasts, which break down bone tissue in the direction of movement, and osteoblasts, which rebuild new bone on the opposite side to stabilize the tooth in its new position. This cycle of bone resorption and deposition allows teeth to shift gradually and predictably into alignment.
Prosthetic teeth, however, operate under different rules depending on their foundation. A crown or veneer that covers a natural tooth retains the underlying root and its periodontal ligament, meaning the tooth can still be moved, albeit with a few precautions. In contrast, a dental implant is surgically fused directly to the jawbone through osseointegration, which completely eliminates the periodontal ligament. This direct bone-to-metal connection means that an implant is rigid and incapable of being moved by orthodontic forces, fundamentally altering the treatment plan.
Orthodontic Strategy with Dental Implants
The presence of a dental implant requires the orthodontist to shift their strategy to using a fixed object as an anchor. Because an implant is osseointegrated, it provides absolute anchorage, meaning it will not move when orthodontic forces are applied to adjacent teeth. This characteristic is advantageous, especially in complex cases where maximum movement of surrounding teeth is desired without reciprocal movement.
The orthodontist may intentionally use the implant as a rigid support structure to move other teeth into place. This concept is similar to using temporary anchorage devices (TADs), which are mini-implants temporarily placed into the bone to provide an immovable anchorage point. If a full-sized dental implant is already in place, it serves this function naturally.
The timing of implant placement is a crucial consideration, as it is often recommended to wait until after orthodontic treatment is complete to place the final implant. If an implant is present before braces, the orthodontist must carefully plan the trajectory of movement for surrounding teeth to ensure they do not collide with the implant root during shifting. If a bracket needs to be bonded to a porcelain or ceramic implant crown, special primers and adhesives are necessary to ensure secure adherence to the non-enamel surface without causing damage. This specialized bonding technique must also account for careful removal later to avoid chipping the prosthetic surface.
Managing Crowns, Bridges, and Veneers During Treatment
Crowns, bridges, and veneers typically do not prevent orthodontic treatment, but they introduce specific management concerns that influence the treatment sequence. A single crown or veneer placed on a natural tooth root can move along with the tooth because the underlying periodontal ligament remains active. Special adhesives are required to bond orthodontic brackets to the prosthetic material, as standard bonding agents will not adhere reliably to porcelain or ceramic surfaces.
Bridges present a greater challenge because they are multiple prosthetic teeth fused together, anchored by crowns on the teeth on either side. Since the bridge is a single, rigid unit, the natural teeth supporting it cannot be moved independently. The bridge must be treated as a single block, and movement in that area will be severely limited.
In many cases involving restorations, the final prosthetic work is strategically delayed until orthodontic treatment is finished. Once natural teeth have moved into their final positions, existing crowns or bridges may no longer fit correctly and could require replacement. Waiting allows the restorative dentist to fabricate new restorations that perfectly complement the newly aligned teeth and bite, ensuring the best long-term aesthetic and functional result.