What are the trade-offs between braces or dental implants to close a gap left by a missing tooth?

Doctor's Answer

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.

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