Orthodontics is all about transforming smiles by bringing the teeth and jaws into proper alignment. But what happens when one or more of your teeth are missing?
Whether you lost teeth in an accident, to tooth decay, or they just never came in, you can still straighten your teeth and boost your smile with braces or clear aligners—or at least you can in the majority of cases. In this guide, we’ll outline several important considerations when straightening your smile with missing teeth.
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Why Might Someone Be Missing Teeth?
Losing adult teeth is often treated as taboo, which leads to a lot of secrecy and misconceptions regarding missing teeth. It is important that you understand that having one or more missing teeth isn’t a personal failing, and you deserve a beautiful smile just as much as anyone else.
So, what are some common reasons an adult might be missing teeth?
- Trauma: Teeth are often lost due to mouth-related injuries. This is especially common in those who play contact sports.
- Decay: When teeth become too decayed to restore, they are removed. Decay can happen due to poor dental hygiene or be a result of genetics.
- MIA: Sometimes, the adult tooth just wasn’t there to begin with. While not incredibly common, there are still many adults who are missing teeth because they never came in.
- Periodontitis: Also known as gum disease, when this condition develops, the teeth can become loose and fall out.
Does Tooth Loss Complicate Orthodontic Treatment?
Having a missing tooth means considering more factors while planning treatment. However, on its own, it doesn’t make the process excessively complex.
With that said, there are other oral health concerns that often accompany tooth loss that can make orthodontic treatment more difficult. Most notable are gum and bone loss and continuing decay of the teeth. In most cases, your orthodontist will be able to formulate a plan with your general dentist to address these problems and prepare you for treatment.
Which Comes First: Braces or the False Tooth?
This sounds like the chicken and the egg question, but it has a much more concrete answer: both can come first, and which order is correct depends on your unique needs.
When Braces or Aligners Come First
If your tooth or teeth have been missing for a while, your other teeth have likely shifted to start to close the gap left behind. While this might be imperceptible to you, it means there could be insufficient room left behind to place a false tooth. In this case, it’s likely best to start with braces or aligners to open up that space and straighten your other teeth.
When Braces or Aligners Come Second
If too many teeth are missing, orthodontic appliances may not be able to get enough leverage to function. In this case, depending on your gum and bone health, it might be best to get dental implants or temporary anchorage devices (TADs) first, creating a point of contact for your braces or aligners.
Which Is Better When Missing Teeth: Braces or Clear Aligners?
In the majority of cases, when a patient is missing teeth, aligners will be the better choice. There are a few reasons for this.
- Easier Hygiene: For someone with tooth loss due to poor hygiene, improving and maintaining a good brushing and flossing routine is essential to reversing damage and stopping future tooth loss. This is much easier with removable aligners than fixed-in-place braces.
- Dual Treatments: Many people seeking a smile makeover don’t want to stop at straight teeth; they also want them whiter and brighter. With aligners, you can complete teeth-whitening treatment at the same time.
- Temporary Falsies: If you want to disguise the missing tooth while in treatment, custom aligners can get the job done. A composite material will be placed in the right spot of each aligner, mimicking the appearance of a natural tooth.
- Bone Retention: Aligners generally see less bone loss than braces when worn correctly. This means keeping them in for at least 22 hours a day.
Yet, clear aligners are not universally better. If you struggle with maintaining a routine, a removable appliance is not right for you. Additionally, you might require certain tooth movements that only braces can perform. In this case, braces treatment may be best.
What About Online Aligners Like SmileDirectClub?
Orthodontic treatment is expensive, and if you are facing additional costs related to your missing teeth, you might be tempted to save money wherever you can. In many cases, mail-order aligners like Byte and SmileDirectClub are a solid choice for orthodontic treatment without breaking the bank.
But are they suited to correcting tooth alignment when there are missing teeth involved?
In general, no. Aligning the teeth when some are missing often requires additional appliances, such as anchorage devices, and the ability to attach the aligners to them. While Invisalign and braces offer this functionality, at-home clear aligners don’t.
This doesn’t mean it isn’t worth trying. Most at-home aligner services will refund your startup costs if their dental team decides you aren’t a candidate for treatment. If you want to see if mail-order treatment could work for you, look for companies with good refund policies (like Byte) and see what their experts say.
What Should I Expect After Getting My Braces Off?
This will depend on your needs. Like all orthodontic patients, you will go into the retention phase of treatment. This means wearing a retainer to hold the teeth in their new positions. Your retainer may be removable or fixed in place, depending on your situation.
You may also want to get some cosmetic treatments done at this time. This can include tooth whitening, veneers, and even new and better fillings and crowns.
However, the biggest treatment to anticipate after your braces come off or you are done with your aligners is the one that replaces your missing tooth or teeth. For this, you have a few options:
This is your longest-lasting tooth replacement option. With this, a tooth root is surgically placed into and fused with the jawbone. At first, only the root can be placed, making your retainer routine extra important. Once the root has firmed into place within the jawbone, the false tooth can be added.
Dental implants can replace a single tooth or multiple missing teeth. They mimic the look and feel of natural teeth and can last decades, even a lifetime, before replacement is needed.
With a fixed bridge, a dental structure is created that closes the gap between one or more missing teeth. It consists of the supporting structures that are attached to healthy teeth and the bridge, which contains the false teeth.
Getting a fixed bridge is faster than getting a dental implant since there is no healing period, but it still requires multiple trips to your cosmetic dentist. Once in place, a bridge looks and functions like natural teeth. There is no need to remove it for cleaning. Expect to need to replace your bridge about once every ten years.
Finally, there is the option of getting partial dentures. This is a removable appliance that can replace multiple teeth or a single tooth, depending on your needs. They get close to matching the look of natural teeth, but fall a bit short.
More problematic for most is that they do not replicate the function of natural teeth. They are not as durable, and with excessive chewing, they can slip out of place and cause embarrassment.
Additionally, dentures can require frequent replacement. On top of misplacing them, they can lose their shape with time. If you lose or gain weight, this can also impact how they fit, forcing you to get new dentures made.
Ultimately, for most patients invested enough in their teeth to get braces or aligners, implants or bridges will be the ideal solutions.
When Are Braces or Aligners Not an Option?
For the vast majority of people missing teeth, braces and aligners can be used. Sometimes, a little preparation is needed first, but usually, you can go straight into orthodontic treatment.
However, there are cases where braces and aligners just won’t work.
Unhealthy or Too Few Teeth
For your teeth to move, your orthodontic appliance needs to be able to leverage force and apply that to your teeth. If your remaining teeth are too unhealthy to stand up to the pressure, treatment won’t work. Additionally, if you have lost too many teeth, there may not be a way to effectively attach or place the appliance.
In most cases, even if you have gum disease, you can get braces or aligners after treating your periodontitis. Rarely, the gums will have receded so much that placing pressure on the teeth to move them is too risky.
Finally, some people with missing teeth also suffer from bone loss in their jaws. Luckily, there are ways to help build up the bone again, but they may not be right for everyone. If your jawbone is too weak, braces and appliances may exert more force than they can handle.
If you have lost one or more teeth and are also worried about your tooth and jaw alignment, both braces and aligners remain options for you—assuming your gum and bone health is strong. With the right approach, orthodontic care can set the stage for healthier teeth overall and a smile you can be proud of.
Frequently Asked Questions
How can a general dentist help support orthodontics with missing teeth?
Your general dentist will be an essential partner during your teeth straightening journey. In addition to maintaining the health of your teeth and gums to prevent additional tooth loss, they offer the standard cleanings and preventative measures that promote oral health and ensure better results.
Can getting implants hurt the results I get from braces or aligners?
It is possible that the addition of a dental implant could throw off your tooth alignment after treatment. However, if your surgeon is qualified, this should not be an issue.
Can I get aligners if I have a tooth or teeth that are decaying?
No, any teeth that have clear signs of decay need to be repaired or removed before you start trying to straighten your teeth. If not, the decaying tooth or teeth will likely crumble under the force of orthodontic treatment.
Can missing teeth cause poor alignment?
Yes. When there is a tooth missing, it allows other teeth to shift, migrating in the gum and jaw to fill in the empty space.
Can orthodontic treatment be part of a larger smile makeover?
Yes, in fact, it is quite common to pair teeth straightening with cosmetic dental treatments, such as whitening and veneers.
What happens if a mail-order aligner company says I am not a good fit for treatment?
At-home aligner systems are only meant to address mild to moderate cosmetic issues with tooth alignment. If a company says you are not a candidate for their system, it means you have problems too complex for them to correct. However, this doesn’t mean you cannot get treatment with in-office braces or aligners.
Can I reverse bone loss?
Not naturally, though you can halt bone loss through the right steps. Replacing lost bone requires a bone graft, which must be done by an experienced surgeon.
Will my insurance help me pay for treatment?
This depends on your policy. However, if you work with an orthodontist, they should be able to verify your coverage and help you maximize your benefits.
Can orthodontic treatment cause tooth loss?
There are some people online who have reported having teeth fall out after starting orthodontic treatment. In most cases, this seems to be a result of entering treatment without healing the gums first or from attempts to straighten teeth without supervision of any sort. Be sure to clear any form of orthodontic treatment with medical professionals first.