What are the trade-offs between braces or dental implants to close a gap left by a missing tooth?
I'm a 30 year old lady. I have a gap due to a missing tooth which I want to close up. I've been recommended Invisalign braces and/or a dental implant to close the gap. What are the trade-offs between using braces, or getting a dental implant to close the gap? Will my teeth get worse if I don't close the gap?
Dear Miss Chew,
Thank you for your question! Generally speaking, having a good, well aligned and balanced bite with your OWN NATURAL SOUND TEETH, is going to be better than trying to achieve the same with dental implants, or any other man-made prosthesis.
However, there are instances whereby dental implants are indicated as part of an overall orthodontic treatment plan. Dental implants maybe suggested in situations where gaps are too large to be predictably closed with braces.
There is no cookie cutter approach to answering your question so every case has to be assessed on its unique merits and the risk and benefits discussed.
Its hard to describe absolute " trade-offs" between braces and dental implants, because there is no perfect option that would work for everyone.
Braces can take up to 2-3 years for some cases, and dental implants sometimes only 3 months. So there might be a benefit in terms of time. if you choose implants.
Theres no surgery involved in braces, but if you consider dental implants, surgery is required.
Braces moves all your natural teeth into its most favourable bite position, whereas a dental implant just replaces one single tooth.
If you dont close the gap, the neighbouring teeth might collapse into the space and the imbalance in your bite may get worse, resulting in some teeth being subjected to more stress than others. This will in turn result in uneven wear and tear of your teeth over time.
If time is not a factor, i would strongly suggest that you consider braces, to move all of your teeth to its most ideal bite and aesthetic position, if it means you can avoid getting a dental implant.
I hope my answer helps!
Dr Gerald Tan
Dear Low Chew,
Closing the gap using braces/Invisalign means that you will not have an artificial tooth replacement to contend with in the future. However, depending on the location of the missing tooth (front tooth/back tooth) and also the symmetry of your smile, and how you bite, this may not always be the best solution.
For example, if you were missing an upper front tooth (the central incisor), closing the gap with braces will cause a severe asymmetry in your smile which is unattractive.
Alternatively, if you are missing a back tooth (a premolar, or a molar), then closing the space by substituting the adjacent tooth for the missing one with orthodontics can be a workable solution. The effect of substitution on your bite should be considered as moving teeth a big distance away from the current position may cause an opposing tooth to lose functional contact.
If a large tooth (such as a molar) needs to be moved a significant distance without affecting the movement of your other teeth, additional anchorage must be included. This may be mini implant screws (TADs) or even headgear. This makes orthodontic treatment potentially more cumbersome. Tooth movement normally proceeds at about 1mm a month, so this means that space closure can take quite some time to complete. Moving a very large tooth is difficult to control with a removable brace system (such as Invisalign) and you should be prepared to have refinements done with fixed braces.
Choosing an implant is potentially quicker since the implant surgery and crown can be completed within 3-6 months. If the missing tooth site is very deficient in bone or gum, then additional grafting to restore the tissue volume will increase your treatment complexity and duration. This may be more critical if the missing tooth is in the aesthetic zone at the front of the mouth.
If you have an implant placed and then later on decide to get braces, the implant CANNOT be moved and the braces will have to be planned around the current implant position. This may lead to a compromised result if you are not planning to remove the implant.
Since you are young, I would prefer to avoid implants where possible since ALL dental prostheses are NOT PERMANENT. Dental implants also behave differently to natural teeth in terms of how the implant appearance will change especially in the aesthetic zone. You should be aware of the need for future prosthesis/implant replacements on average every 10-15 years. This is comparable with hip or knee replacements. This means that should you get an implant prosthesis now, you would be looking at 4-6 replacements over the course of your lifespan.
Leaving the space untreated and unrestored (not filled in with an artificial tooth) tends to cause drifting of the remaining teeth into the space and overloading of adjacent teeth which have to compensate for the missing tooth.