Braces and clear aligners are getting more popular with adults, which means we often need to work around other dental work that they received over the years: composite fillings, dental implants, veneers, crowns, etc.
Fillings are the most common dental procedure that patients of all ages get done prior to braces. Fillings on front teeth, especially large ones, do pose some risk when it comes to bonding braces on them, but the bond is most often strong enough to withstand the gentle orthodontic forces.
In my practice, both as a dentist for over a decade and as an orthodontist, I got to see how my restorative work withstood the test of time. Front fillings are exceptionally strong these days, even large ones in case of fractured or chipped incisors.
In this article, you’ll learn about the chemical bond between enamel, fillings, and braces. You’ll also discover when front fillings need changing, and anything else you might need to consider. Let’s dive in!
Can you get braces on front teeth if they have large fillings?
If you’re looking to get braces but are worried that your restored front teeth might suffer, rest assured, you’ll be fine.
People get composite restorations on their front teeth because of cavities, and those fillings are usually small, but even if you have a large composite filling as a result of a chipped incisor, it’s still safe to put braces on.
Braces apply light forces on teeth over long periods of time. The fillings you have on your front teeth need to be strong enough to handle biting, chewing, and clenching of your teeth, so if they can withstand that kind of pressure, braces should make no exception. The gentle orthodontic forces we apply with braces are no comparison to the strength of your own jaw muscles.
So what makes dental fillings so strong? The secret is in the ‘glue’. The composite resin doesn’t adhere to the enamel itself but rather to the bonding particles inside it.
The enamel first gets etched with an acid, which creates microscopic holes in its structure. Next, we apply a bonding agent which fills up those tiny holes, creating a strong mesh. Finally, we add the composite paste which is the filling itself. The atoms within the bonding mesh unite with the atoms inside the composite resin, creating a powerful bond.
This is also the same process through which braces adhere to your teeth because the braces ‘glue’ is also a composite resin.
If you have a large filling on your front tooth, your bracket will most likely:
- Bond to some of the enamel, through the process we described above;
- Bond to some of the filling, which is basically a composite-to-composite bond.
Dental fillings are built up in layers, so you can imagine your braces as another layer of composite on top of your resin fillings because that’s technically what the braces glue does – add another layer.
what if the filling comes off?
Now you know how your front fillings get to be so strong and durable, but what happens if a dental filling comes off your front tooth while wearing braces?
While braces come off relatively easily (either accidentally through eating hard foods, or intentionally, when taking braces off), we can’t say the same is true about dental fillings.
There are only three scenarios that would cause your front dental fillings to come off:
- moisture while bonding, in which case your filling will not last long;
- tooth decay underneath an old filling;
- large fillings and strong forces applied to them – either trauma or moving very crooked teeth.
If your filling comes off, your dentist will either fix your tooth with a new filling or put a crown or veneer on it if the damage is too extensive. If you need a crown during orthodontic treatment, you’ll most likely get a temporary plastic crown until the treatment is over.
Soon after your dental work is done, a new bracket will be glued to your brand-new filling or crown. So don’t worry, everything will be fine, even in a worst-case scenario.
what if you have lots of dental fillings?
Some patients are worried that, because they have multiple fillings on their teeth, they won’t be able to get braces. That’s not true at all, we can definitely work around teeth with any type of dental work.
Fillings on front teeth may affect where brackets get bonded because we may no longer have the same natural contour of the tooth, but, again, that’s easily fixable.
What kind of braces work best if you have dental fillings?
The good news is that you can get any type of braces you prefer if you have fillings, even large ones on your front teeth. Clear aligners may work better for large fillings, but they may not be as precise, and they also have a bonded component called an ‘attachment’.
Clear aligner attachments are small rectangle composites bonded on your teeth’ surface to help the aligners work more efficiently and in the right direction. You can bond attachments on top of dental fillings, although it would be best to grip on some of the enamel too.
Both metal and ceramic braces can bond to dental fillings with no issue at all, and since they take up more than one-third of the tooth’s surface, they bond to both the enamel and the resin, which is ideal.
The only situation I’d be worried about is when the bracket bonds ONLY to the composite, in case the filling covers most of the tooth. But if you have such a large filling, you should switch to a crown anyway.
Do you need to change your fillings after braces?
If you’ve recently invested your hard-earned money in lots of fillings, you may be wondering whether you need to change those fillings after orthodontic treatment.
The answer is: it depends. Most of the time, fillings on your front teeth don’t need to be changed entirely, but they do need to be adjusted to your new bite and dental alignment.
Your front fillings will be adjusted if:
- You’ve had crowding in the front and the contact between your fillings and teeth have changed;
- Your tooth moved vertically and now the filling is too long/short.
After taking braces off, orthodontists often like to reshape the incisor edges, so they may reshape the edges of the fillings as well. If some teeth don’t look good or have odd shapes, your orthodontist or dentist may also bond those teeth for aesthetic purposes.
Also, consider if you might need or want to whiten your teeth. Tooth whitening procedures only work on the enamel, and they don’t have any effect on your old fillings, so you will need to change your front fillings to a lighter color.
Lastly, how old are your fillings? Composite resin tends to contract over time, and even if everything looks fine, those cracks allow food and saliva to get inside and cause cavities. Aim to replace your old fillings every 5 to 7 years.
As you’ve learned, bonding braces on top of composite fillings is no problem at all. While those fillings can withstand all the pulling and pushing that happens with braces, they may need changing eventually. It’s useful to plan ahead and budget for new fillings and dental work at the end of orthodontic treatment.