Braces with missing teeth

Permanent tooth extraction for orthodontic treatment

The use of extractions in orthodontic treatment has been a controversial topic for over a century. The debate about whether extractions are used too frequently in correcting malocclusion, or misaligned teeth, goes back to the early 1900s when some scientists believed that all 32 teeth could fit in the jaw with an ideal occlusion.

This assumption was based on the belief that bone would form around the teeth in their new position, according to Wolff’s law.

Wolff’s law is a principle in biology that states that bone in a healthy person or animal will adapt to the loads under which it is placed. This means that bone will become stronger and denser when it is subjected to physical stress, such as weight-bearing exercise, and weaker and less dense when it is not subjected to physical stress, such as when a limb is immobilized in a cast

However, there are some other scientists who held a contrary opinion, arguing that extractions were necessary to relieve crowding and aid stability of treatment. According to these scientists, tooth extraction is necessary in orthodontics to achieve stable results.

Today, there is a renewed debate about extractions, with some dental professionals believing that expansion of the jaws and retraining of posture can obviate the need for extractions and produce stable results.

However, these claims are largely unsubstantiated. If teeth are genuinely crowded, arch alignment can be achieved by:

• Enlargement of the archform
• Reduction in tooth size, or
• Reduction in tooth number

The arch can be widened by moving teeth towards the cheek and the lip. However, it is uncertain whether the new position of the teeth will remain stable over time and whether bone will grow to support the movement of teeth through the hard outer layer of the bone.

Is tooth extraction for braces necessary?

Several factors should be considered when determining whether tooth extraction is necessary for braces. These factors include:

• The patient’s medical history
• Attitude towards treatment
• Oral hygiene
• Caries rate
• The quality of teeth

Patients with heart problems may need to have teeth removed if the risks associated with orthodontic treatment are high.

Teeth that are heavily restored or have cavities may need to be removed instead of healthy teeth. Teeth that are abnormal in size or shape may also need to be removed if they could cause problems in the future.

If a tooth is difficult to align or if it compromises the long-term prognosis of the tooth, it may need to be removed. However, the decision to extract teeth should be carefully considered, as it can cause an excess amount of space, which could prolong orthodontic treatment.

Getting braces with missing teeth in the back

In a survey, it was found that the first premolars were most commonly extracted, followed by second premolars, while incisors were rarely extracted. Premolars are often extracted for both anterior and posterior crowding, and the choice between first or second premolars depends on the degree of crowding, anchorage requirements, overjet, and overbite.

This implies that missing permanent teeth in the back is not a major orthodontic concern if you’re planning on getting braces.

Braces with missing front teeth

Incisors and canines are rarely extracted in orthodontic treatment because they play important roles in the bite and functional occlusion.

Incisors help to guide the lower jaw during movements, and canines act as ideal abutment teeth because of their long root length and resistance to periodontal problems.

Additionally, the upper labial segment is particularly at risk from trauma, especially in cases with large overjets, so it is important to consider the long-term prognosis of incisors before extraction.

However, in cases where incisors or canines are grossly displaced from the arch form or ectopic, or have poor long-term prognosis due to non-vitality or abnormal form, they may be considered for extraction as part of the orthodontic treatment plan.

Braces with missing front teeth vs. back teeth

Braces can be more challenging if there are missing front teeth. Generally, when there are missing teeth, the orthodontist must carefully plan the movement of the remaining teeth to fill the gaps left by the missing teeth.

If the gaps are too large, the orthodontist may need to use special appliances, such as a temporary bridge or partial denture, to create the necessary space for the remaining teeth to move into proper alignment.

The orthodontist will also need to consider the position of the adjacent teeth and how they will affect the movement of the teeth.

If the missing teeth are located towards the back of the mouth, the braces may not be affected as much.

Overall, missing teeth can make orthodontic treatment more complicated, but a skilled orthodontist can still achieve excellent results with careful planning and management.

Challenges for Getting Braces with Missing Permanent Teeth

While getting braces with missing permanent teeth is possible, it can pose some challenges:

Prolonged orthodontic treatment

If the missing tooth is in the front, the orthodontist may have to use a combination of braces and other dental appliances to move the other teeth into the right position. This process may take longer than usual, and the treatment may be more complex.

When a tooth is missing, the surrounding teeth can shift into the space left behind, causing crowding or spacing issues. In order to address this, the orthodontist may need to create extra space by expanding the arch, which can prolong the treatment time.

Additionally, the missing tooth may need to be replaced with a dental implant or other restorative treatment, which may need to be done before or after the braces are removed.

Shifting of other teeth

If the missing tooth is at the back, it may cause the adjacent teeth to shift towards the space, leading to problems with the bite and alignment. Additionally, it can cause the surrounding teeth to become overcrowded, making it difficult to achieve proper alignment with braces.

The orthodontist may need to use special techniques or appliances, such as a temporary partial denture or a space maintainer, to prevent the surrounding teeth from shifting and maintain the proper alignment.

Moreover, treatment may also take longer than usual, as the orthodontist needs to take into account the missing tooth and its impact on the surrounding teeth.

Benefits of getting braces with missing permanent teeth

Getting braces when you have missing permanent teeth can be beneficial in several ways:

Close gaps permanently

Braces can help close the gap or prevent teeth from shifting towards the gap. This helps to maintain the correct alignment of your teeth and improve your bite.

When a permanent tooth is missing, the surrounding teeth may shift or move towards the gap, resulting in spacing or crowding issues. This can cause aesthetic concerns and may also affect your bite, making it difficult to chew and speak properly.

Braces can help to gradually move the surrounding teeth towards the gap left by the missing tooth, closing the space and restoring a more even and aesthetically pleasing smile. This can also help to improve your bite, making it easier to chew and speak. In some cases, braces may also create enough space to allow for a dental implant or bridge to be placed to replace the missing tooth.

That said, the success of closing gaps with braces depends on various factors, such as the size and location of the gap, the age of the patient, and the overall health of the surrounding teeth and gums. Therefore, it’s important to consult with an orthodontist to determine if braces are a suitable option for your specific case.

Provide support for remaining teeth

Braces can also provide support for your remaining teeth, which will in turn prevent further problems in the future.

When a permanent tooth is missing, the adjacent teeth may shift and move into the empty space, causing misalignment and bite problems. This can put additional pressure on the remaining teeth, leading to wear, fracture, or even tooth loss over time.

By getting braces, an orthodontist can use wires and brackets to gently move the teeth into the correct position and close the gaps left by the missing teeth. This helps to distribute the forces of chewing and biting evenly among all the teeth, reducing the risk of damage or wear.

In addition, by aligning the teeth properly, braces can also improve the stability of the remaining teeth and provide better support for the surrounding bone and gum tissue.

Final thoughts

In conclusion, getting braces with missing permanent teeth is not a major problem, and can even be beneficial in some cases. It can help to maintain a healthy and functional bite, reduce the risk of dental problems, and improve the appearance of your smile.

However, it is important to discuss your options with an orthodontist and consider the potential challenges before making a decision. With proper treatment and care, you can still achieve a healthy, beautiful smile.