Braces and Missing Teeth

It can be difficult to fit orthodontic braces when there are teeth missing, says Dr. Menachem Roth of Carvalho and Roth Orthodontics, which has three offices in Massachusetts. But what to do in this case depends on what type of tooth is missing, and the reason it’s not there. Treatment can be complicated but there are ways to work around the problem.

There are two reasons adult teeth can be missing: The first is a congenital absence where the tooth has not developed at all. The second could be due to a tooth that was removed because of decay, or a fracture, when it is broken. When your orthodontist discovers that a tooth is missing, the decision needs to be made as to how the space will be managed.

Sometimes people just have a baby tooth and no adult tooth is underneath, and they do not know it. Oftentimes they come in when the patient is aged eight, nine, 10 or 11,  and we take an x-ray and find that the tooth is missing. Obviously if they had a tooth extracted or broke a tooth in an accident they will know it’s missing. But if it congenitally missing, many patients do now know until they come to us.

Congenitally Missing Teeth

If a baby tooth is present and the root is of that baby tooth is healthy, then the orthodontist and your dentist together may decide to leave the baby tooth in place long-term. Nobody knows how long a baby tooth is going to last. It may fall out at any time during your life, requiring a replacement tooth, such as a dental implant or a bridge.

If a baby tooth is not present or if the root of the baby tooth is damaged and therefore is nonviable, there are two treatment options: The first is to maintain the site for a replacement tooth, such as a dental implant or bridge. And second, in some cases, depending on the type of malocclusion, the space can be closed and the bite set up with that tooth missing. However, closing the space in that case can often be time-consuming. For that reason, that specific decision will need to be made based on other factors of the case.

Missing Extracted Teeth

The same principles apply: We either open the space or close the space, depending on the other factors of the case. The most commonly missing teeth, besides third molars, would be upper lateral incisors or lower second pre-molars. If patients choose to do dental implants as a replacement therapy, oftentimes these are not done until growth is complete.

Your orthodontist can make you a retainer with a replacement tooth in place to wear during the period between finishing the braces and when the time is right for an implant to be placed.

*Disclaimer: The information on this website is not intended to substitute for the medical expertise and advice of your healthcare provider. We encourage you to discuss any decisions about treatment or care with an appropriate healthcare provider.

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