CONSIDERATIONS WITH MISSING PERMANENT TEETH

It is not uncommon for people to be missing permanent teeth. Typical causes are an earlier trauma or agenesis (lack of development) and most often there is no identifiable cause. The most commonly missing teeth are the 3rd molars (wisdom teeth). These seldom cause an issue for orthodontic treatment if they are missing. The next most commonly missing teeth are the lower second bicuspids followed by the upper lateral incisors and upper second bicuspids. These may impact orthodontic treatment and involve collaboration with a number of dental specialties for their management.

 

With missing permanent teeth, there are typically two different options to consider. One option involves “closing the space(s)”, while another option is replacing the missing tooth (teeth).

Which option is right for you is based on a number of factors and your orthodontist will explain the options available to you. 

Typical considerations to be aware of are:

  • There will be fees in addition to the orthodontic fee for the consultation and management by the additional dental specialists and general dentist, payable directly to them.

  • The most common members of the team include the following:

    • General Dentist: Typically determines the restorative plan and manages appropriate referrals. They will likely be involved in the actual final restoration, but not always.

    • Periodontist: Typically involved in bone grafting, soft tissue augmentation, and implant placement.

    • Oral and Maxillofacial Surgeon: Typically involved in bone grafting and implant placement. Also commonly involved in wisdom teeth extractions and orthognathic (jaw) surgery.

    • Prosthodontist: Typically involved in more advanced or esthetically sensitive cases where implant placement or fixed restorative treatment is required beyond the expertise of the general dentist.

  • There will be an increased amount of correspondence involved with your treatment and close collaboration to achieve an optimal treatment result. Expect more appointments and a slightly longer orthodontic treatment time to be required.

  • In many instances, advanced imaging modalities may have to be employed to position adjacent teeth for optimal restorative considerations.

  • The use of retainers is of paramount importance with missing teeth as typically there is a period of time between the end of orthodontic treatment and tooth replacement. The teeth have been positioned just right and any tooth movement due to poor retainer compliance can compromise the final result and result in additional fees and another round of braces at your expense.

  • The retainers will typically require modification by the general dentist/specialist performing the restorative procedures. It is important you bring your retainers to every appointment with every specialist or general dentist.

  • Orthodontic retainers are only a temporary appliance (12-24 months), so there will likely be additional treatment by your general dentist to maintain positioning of the teeth over a longer period of time.

  • It is important that you find out about your options, timing and scope of treatment, and potential future costs of all treatment prior to commencing orthodontic treatment.