It is possible to use dental braces when implants are present, but the implant itself cannot be moved by orthodontic forces. A dental implant is a titanium post surgically placed into the jawbone to replace a missing tooth root, acting as a stable base for a prosthetic crown. Braces apply continuous force to shift the position of natural teeth. The implant is permanently fixed, which changes the entire approach to orthodontic treatment planning.
The Fundamental Difference Between Teeth and Implants
The ability of natural teeth to shift relies on the periodontal ligament (PDL), a fibrous tissue surrounding the tooth root. This ligament acts as a shock absorber and connects the tooth to the surrounding alveolar bone. When orthodontic force is applied, the PDL experiences areas of compression and tension.
The body responds to these stresses by initiating bone remodeling. On the compression side, specialized cells called osteoclasts break down the bone, creating space for movement. On the tension side, osteoblasts build new bone to stabilize the tooth in its new position. This cycle of bone resorption and apposition allows the tooth to glide through the jawbone.
In sharp contrast, a dental implant achieves stability through osseointegration, a process where the titanium post fuses directly with the jawbone. There is no periodontal ligament surrounding the implant to allow for movement. Once this fusion is complete, the implant becomes a fixed fixture that cannot be repositioned by braces. Attempting to move an osseointegrated implant would likely result in damage to the surrounding bone rather than a change in position.
Utilizing Implants During Orthodontic Treatment
The immobility of a dental implant is not a limitation in orthodontics; its stability can be used as a significant advantage. Because the implant is a fixed reference point, it provides an unmoving base from which to apply force to other teeth. Orthodontists refer to this fixed point as an anchor, allowing them to achieve complex movements difficult to manage using only natural teeth for resistance.
The implant acts as a stable unit to push or pull surrounding natural teeth into alignment without the anchor itself moving. This stability prevents unwanted reciprocal movement, where a tooth used as an anchor might move slightly in the opposite direction of the intended movement. For instance, an implant can be used to retract a whole arch of teeth backward, a movement that often requires maximum anchorage.
A smaller, temporary version of this concept is the Temporary Anchorage Device (TAD), also known as an orthodontic mini-implant. These are small titanium alloy screws, typically 1 to 2 millimeters wide, placed temporarily into the jawbone to act as short-term anchors. Unlike permanent implants, TADs rely on mechanical engagement rather than full osseointegration, making them easy to remove once the desired tooth movement is complete. Both permanent implants and temporary mini-implants allow the orthodontist to apply precise forces in vertical, transverse, and sagittal planes.
Treatment Sequencing and Collaboration
When a patient requires both orthodontic treatment and an implant to replace a missing tooth, the timing of the procedures requires detailed planning. In most cases, the orthodontist recommends completing the tooth alignment first, before the implant is placed. Braces move the surrounding natural teeth into their final positions, creating the correct amount of space for the replacement tooth.
After the teeth are properly aligned, the implant is placed precisely into the newly created space, ensuring it is positioned for the most aesthetically pleasing and functional outcome. If an implant is placed too early, its fixed position could hinder the orthodontist’s ability to achieve the best alignment for the surrounding natural teeth. For patients who already have an implant, the treatment plan focuses entirely on shifting the natural teeth around the existing fixed structure.
Achieving a successful outcome requires close collaboration between the orthodontist and the implant specialist, such as an oral surgeon or periodontist. This team approach ensures the implant is either placed in the exact location required for the final alignment or that the orthodontic treatment works seamlessly around an existing fixed post. Coordinated planning minimizes complications and ensures the final result is both stable and aesthetically pleasing.