Braces are fixed orthodontic appliances used to gradually move existing teeth into better alignment. Partial dentures are removable appliances designed to replace missing teeth, often secured by clasps around the remaining natural teeth. Patients needing both solutions often ask if they can undergo treatment simultaneously. The answer is generally yes, but this combined approach is highly specialized and requires meticulous planning by a collaborative dental team.
Feasibility of Simultaneous Treatment
The feasibility of simultaneous treatment depends on the specific mechanics of the case and the condition of the existing partial denture. A primary consideration is the health and number of the remaining teeth. These teeth must be stable enough to withstand the forces of both orthodontic movement and the support from the partial denture; compromised teeth may not be suitable anchor points.
Feasibility is also influenced by the type of partial denture worn. A cast metal framework partial denture, designed to fit precisely around existing teeth, often presents a significant challenge. If the supporting teeth need to be moved, the partial must usually be redesigned or replaced because the rigid metal structure impedes tooth movement. Less rigid, acrylic-only partial dentures tend to be more accommodating for minor tooth shifts.
A major technical hurdle is achieving proper orthodontic anchorage. Orthodontists must ensure that the teeth supporting the partial are not relied upon for anchorage, or that the applied force does not destabilize the denture’s fit. The overall space needed for tooth movement determines whether the existing partial can be maintained or if it will immediately obstruct the treatment plan.
Adjusting Partial Dentures During Orthodontic Care
If orthodontic treatment proceeds, the partial denture requires ongoing management throughout the active phase of tooth movement. As teeth shift, the dental arch changes shape, causing the original partial denture to quickly lose its precise fit and retention. This necessitates frequent adjustments, relining, or temporary replacement of the prosthetic.
The restorative dentist and orthodontist must coordinate closely to modify the partial denture and avoid interference with the brackets and wires. If a specific tooth is being moved, the corresponding clasp on the partial denture must be adjusted or removed entirely to allow for the shift. When the partial replaces a highly visible front tooth, the denture may be temporarily modified to include a prosthetic tooth attached to the orthodontic archwire, ensuring continuous aesthetics.
An all-acrylic partial denture may require several relines, where material is added to the base to re-establish a secure fit against changing gum and tooth contours. This management is continuous because the partial must still function for eating and speaking while the underlying dental structure changes. Neglecting these adjustments can lead to tissue irritation or unintentionally impede planned tooth movement.
Treatment Sequencing and Long-Term Restoration Options
When simultaneous treatment is too complex or mechanically impossible, the preferred approach is a sequential treatment plan, prioritizing orthodontics first. The primary goal is to align the remaining teeth into the most optimal position for a successful long-term restoration. Orthodontic movement creates ideal spacing or up-rights tilted teeth, which improves the prognosis for the final appliance.
Once the teeth reach their final, stable position and the braces are removed, the definitive partial denture or alternative restoration can be fabricated. This sequencing ensures that the final prosthetic device (such as a new removable partial denture, fixed bridge, or dental implant) is placed on a perfectly aligned foundation. The precision of the final fit is significantly enhanced when the supporting teeth are correctly positioned.
Orthodontic treatment often helps reduce the size or complexity of the final partial denture, sometimes making it possible to use a fixed restoration like an implant instead. Correcting the alignment first provides a more stable bite, improved aesthetics, and a final restoration designed to last over a longer period. This phased approach avoids the compromise of fitting a static prosthetic into a dynamic, moving environment.