Treating missing teeth is a central part of being a dentist. Whether they go missing because of tooth decay, or they were never there in the first place, missing teeth are a great disruptor of oral health. But what if I told you braces could not only help treat your missing teeth but could help replace them altogether?
You can and you should get braces if you have one or multiple missing teeth. When a tooth goes missing, the neighboring teeth drift and tilt into the gap, making it harder to treat with a dental implant. Braces can correct this drifting while also taking care of crooked or misaligned teeth.
Braces can help a lot with your crooked teeth and the way your teeth fit together, which is very important prior to getting other dental work done, like implants, crowns, veneers, bridges, etc.
While all patients are different, we often see the same types of cases in our orthodontic practice, and in this article, I’m going to describe multiple scenarios – hopefully, you’ll fit into one of them.
What causes teeth to go missing?
If you’re reading this and have a missing tooth, chances are you lost it because of extensive tooth decay. That’s the number one reason teeth get extracted, but it’s not the only reason. Let’s explore the main causes of missing teeth and see if you’re part of the majority or the minority:
- Missing teeth due to decay. Cavities cause tooth decay over time, as they get bigger and attack the tooth’s structure. Once a cavity gets into the toot’s nerve chamber, it will cause infection. You’ll need a root canal, but if the infection is too extensive, your tooth will need to be extracted.
- Missing teeth due to trauma. While unfortunate, trauma to the front or back teeth will damage the teeth and the bone, to the point where your teeth need replacing. This often happens to the incisors, especially if the patient has an overbite (top teeth are too far forward).
- Missing teeth due to periodontitis. Periodontal disease can be very sneaky and cause damage to the underlying teeth structures until there’s no longer any healthier bone or gingival attachment. Teeth with periodontitis will become extremely loose and need to be extracted.
- Congenitally missing teeth. Sometimes teeth are missing because they were never there in the first place. Congenitally missing teeth are a genetic condition that often affects the maxillary lateral incisors and the second premolars. They’re more common than you might think, but braces are a great way to treat them.
- Impacted teeth. Technically, impacted teeth aren’t missing, but the deciduous teeth that are sitting on top of them might go missing since they’re not supposed to stay on the arch for more than a few years. Impacted teeth are teeth that are stuck deep inside the bone, and braces are the only way to slowly pull them on the arch.
Now that you’ve learned why teeth go missing, let me explain how braces work in every single one of these scenarios.
Can you get braces if A front tooth is missing?
Missing front teeth can be a huge blow to anyone’s self-esteem, especially if they’re suddenly extracted or lost through an accident.
If you’re missing a top central incisor, you can and should get braces prior to replacing that front incisor if your other teeth are crooked or misaligned. The same goes for missing bottom incisors, especially when you lose them because of periodontitis.
The rule of thumb is: if you need braces for any reason (misaligned, crooked teeth, gaps, malocclusions, asymmetries), it’s best to get braces first and deal with the missing tooth later.
But don’t freak out! If you have an unsightly gap from a missing tooth, it doesn’t mean that we can’t hide it during treatment. What we do is glue a fake tooth to the archwire (or fill in a fake tooth in the aligner tray, if you’re wearing aligners), so that you can enjoy a normal look while wearing braces.
The fake tooth will stay on the braces while we work on either maintaining, opening, or closing the space.
Missing front tooth: when do we keep the gap open?
If you’re missing a central incisor, a lateral incisor, or a canine and you’re an adult, most dentists will advise you to get an implant.
The great news is that if the gap needs to be bigger or smaller, and if the neighboring teeth need to be straighter, we can work together with your dentist and oral surgeon to calibrate that gap to the precise width they need.
You’ll be getting an implant with braces still on – read more on implants and braces here – and you’ll get a permanent crown right after your braces come off. Not only will you have a beautiful straight smile, but you’ll also have your missing teeth replaced and good as new. What a relief!
Missing front tooth: when do we close the gap?
There are a few situations in which we prefer to close the gap and replace the missing front tooth with its neighboring teeth, while also keeping symmetry and balance.
For example, if you have a congenitally missing lateral incisor and you’re young, the most recent recommendation is to close that gap by pulling the canine forward into the gap and then reshaping it to look like an incisor. This is called canine substitution and we do it all the time in our practices.
The reason we want to avoid dental implants for young patients in the front teeth is that, over time, teeth shift but the implant doesn’t. This means that decades later the front implant will look shorter than the natural teeth.
Another situation in which we don’t close the gap is tooth impaction. Either the canines or the incisors may actually be present inside the bone but placed either diagonally or horizontally, which blocks their path of eruption. By using braces and gentle forces, we can help these teeth slowly emerge on the arch and fill in their gaps.
Can you get braces if a back tooth is missing?
Molars often need to be extracted because of tooth decay. This is because they’re the oldest teeth inside the mouth, and therefore the most likely to get cavities – the first molar erupts at only 6 years old!
When a molar goes missing, a few things happen to the extraction site within months:
- The neighboring teeth drift into the gap;
- The neighboring molar tilts into the gap;
- The opposing molar drops into the extraction site.
The natural tendency of teeth is to drift into gaps and follow the path of least resistance, and this drifting can take place in just under a year. This causes an unstable bite in that area, and your dentist won’t be too happy to see that your teeth have shifted where an implant was supposed to go.
Luckily, braces can fix this issue. I’m often contacted by dentists who want an extraction site reopened and tilted molars corrected with braces.
Missing molar: when do we close the gap?
Some patients come to me when they’re missing a molar because they’ve heard or read that the gap can be closed with braces. And while that’s true sometimes, it doesn’t work in all cases.
We close gaps resulting from missing molars by pulling the second molar forward into the gap. This is called molar protraction. If you also have your wisdom tooth, we pull it too and the result is even more stable. But it’s not an easy thing to do.
In order to close a molar extraction site, we need to move teeth over 9-10mm, which is a long way for teeth to travel through bone. This movement can cause root resorption in molars. Here’s an example of what that looks like:
We can close molar gaps in young patients with healthy bone and recent extraction sites. Adult patients can benefit from molar protraction too, but the treatment can be very slow since the bone is often narrow inside the gap.
Another situation in which we choose to close the molar gap rather than keep it open is when the patient needs extractions for orthodontic purposes. Instead of extracting healthy premolars, we make use of the space we already have.
Missing molar: when do we keep the gap open?
If your bite is good and your teeth aren’t too crowded, I recommend keeping the molar gap open and preparing that extraction site for a future dental implant. Your dentist’s requirements usually dictate when to place the implant and how wide we want the gap to be.
It’s best to get implants if you have multiple missing teeth, or even get implant-supported bridges if they’re necessary. In these complex rehabilitation cases, braces work by correcting the bite, adjusting tilted teeth, and reopening gaps that are too narrow for dental crowns.
Braces will basically restore your dentition to where it was before you lost all your teeth. I strongly suggest you invest in braces if they’re recommended to you by your dentist and oral surgeon, even if your teeth are seemingly straight.
Alternatives to braces when your teeth are missing
If you have missing teeth, it doesn’t necessarily mean you need braces. If you address your issues right after losing your teeth, your bite is good and your teeth are reasonably straight, you won’t need braces.
Here are all the alternatives to braces that your dentist can use to restore your missing teeth:
- Dental Implants. These days, dental implants are the norm. A dental implant will replace the structure and function of your missing tooth without affecting any other teeth. Dental implants can support a single crown, or two dental implants can support a bridge.
- Dental Bridges. Your dentist can suggest implant-supported dental bridges or tooth-supported dental bridges. The latter requires your teeth to be filed so that your dentist can fit crowns on them.
- Partial Dentures. Partial dentures are removable fake teeth meant to replace one tooth or group of teeth missing from your arch. While they’re cheap and effective, they’re not very stable or comfortable.
- Flipper teeth. A flipper tooth is similar to a partial denture, but it’s usually limited to just one tooth. It’s made of plastic, and while it restores your teeth cosmetically, it’s not strong enough to last you long-term.
Missing teeth are a common dental problem, but the solutions are highly individual. If you need braces, closing or opening gaps is a decision that ultimately belongs to your orthodontist and dentist.
Based on your teeth, bite, bone health, and age, your orthodontist can decide what’s possible, present you with the alternatives and you can choose a course of treatment together.
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