Adult Orthodontics with Crowns, Implants or Missing Teeth
Orthodontic treatment as an adult often starts with a more complicated dental picture than it does in childhood or the teenage years.
By the time someone considers straightening their teeth or improving their bite, they may already have crowns, large fillings, bridges or dental implants. There may also be spaces left by missing teeth or plans for restorative treatment in the future.
None of these automatically rule out orthodontic treatment. They do, however, affect what can be moved, how treatment should be planned and, in some cases, which treatment needs to happen first.
For adults, orthodontics can therefore become part of a wider dental plan rather than simply a way of making the teeth straighter.
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When existing dental work changes the plan
Orthodontic treatment moves natural teeth gradually through the bone. When crowns, implants, bridges or missing teeth are already part of the picture, the plan needs to account for how each of those will behave during treatment.
Some restorations can move with the natural tooth underneath them. Others cannot move at all. A missing tooth creates a different question again: should the space be kept, adjusted or closed?
That is why the first decision is not always whether to choose braces or clear aligners. Before that, it is important to understand what is already present, what can be changed and what the final result needs to achieve.
Once that wider picture is clear, each type of existing dental work can be considered in context.
Read more about orthodontic treatment at Yass Valley Dental.
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Orthodontic treatment with crowns
Having a crown does not usually prevent a tooth from being moved orthodontically.
A crown sits over a natural tooth and root, so movement may still be possible provided the tooth and surrounding tissues are healthy. The main difference is that the restoration needs to be taken into account during treatment planning.
For example, bonding a bracket or clear-aligner attachment to a ceramic surface may require a different approach from bonding directly to natural enamel. The condition of the tooth underneath the crown also matters before movement begins.
Timing can matter too. If a crown is already due for replacement and the position of that tooth is expected to change, it may make more sense to complete the orthodontic movement first and plan the new restoration afterwards.
The same question of timing becomes even more important with dental implants.
Read about the orthodontic treatments available at Yass Valley Dental.
Dental implants need a different approach
Unlike a natural tooth, a dental implant cannot be moved orthodontically once it has integrated with the jawbone.
The natural teeth around it can still be repositioned, but the implant itself stays where it is. That means an existing implant becomes one of the fixed points the orthodontic plan has to work around.
The situation is different if an implant is planned but has not yet been placed.
If neighbouring teeth need to be straightened, tilted teeth need to be repositioned or the space for the future implant needs to be changed, it may be better to complete those movements first. The implant can then be planned around the final tooth positions rather than the other way around.
When an implant is planned, we need to think about where the surrounding teeth should ultimately sit before the implant goes in. In some cases, moving those teeth first gives us a much better foundation for the restorative treatment that follows.
Dr Daniel Yang, Principal Dentist, Yass Valley Dental
A similar principle applies when the tooth is missing but has not yet been replaced.
A missing tooth does not always need to be replaced first
When a tooth is missing, it can seem logical to fill the gap straight away. From an orthodontic perspective, however, the space itself may be useful.
In some cases, orthodontic treatment is used to create or maintain the right amount of room for a future implant or bridge. In others, moving the surrounding teeth may allow the space to be reduced or closed instead.
The right approach depends on where the tooth is missing, the position of the neighbouring teeth, the bite and what is planned for the final restoration.
Working this out before the space is restored can prevent a situation where an implant or bridge is placed first and later restricts the tooth movement that would otherwise have been useful.
Existing bridges also need to be considered
Bridges create another type of limitation because they connect two or more teeth together.
Those teeth cannot always be moved independently while the bridge remains unchanged, so its position and design need to be considered before orthodontic treatment begins.
Sometimes treatment can be planned around an existing bridge. In other situations, the bridge may eventually need to be modified or replaced once the teeth are in their new positions.
The important part is knowing this from the beginning, so the orthodontic and restorative stages are working towards the same final result.
Once the existing dental work has been accounted for, the next question is which type of orthodontic treatment is best suited to the movements required.
Braces or Invisalign when you already have dental work
Crowns, implants or missing teeth do not automatically mean that fixed braces are better than clear aligners, or vice versa.
The choice still depends mainly on the type of tooth movement required, the bite and how complex the case is.
Fixed braces can provide continuous control over the teeth and may be useful when more complex movements are needed.
Invisalign for adults and other clear-aligner systems can also be suitable in many cases, including for patients who already have restorative dental work. Because the aligners are removable, they may appeal to adults who want a less noticeable option and easier access for brushing and flossing.
Existing dental work still affects how treatment is planned. Attachments may need to be bonded differently to crowned teeth, and implants remain fixed while the natural teeth around them are moved.
Once the most suitable orthodontic approach is clear, the next question is how it should fit with any restorative treatment that is already planned or may be needed later.
Read also: Why Teeth Shift After Braces? Adult Orthodontics After Previous Braces.
Planning orthodontic and restorative treatment together
When both orthodontic and restorative treatment are needed, the sequence can have a significant effect on the final result.
Moving the teeth first can sometimes create better conditions for the treatment that follows. Orthodontics may be used to:
- create or improve the space for a dental implant
- reposition the teeth beside a missing tooth
- improve the bite before new crowns or other restorations are made
- redistribute uneven spaces before restorative treatment
There are also situations where the opposite is true. Decay, gum disease or a failing restoration may need attention before any orthodontic movement begins.
Rather than treating one problem at a time without considering what comes next, it is often more useful to decide on the final goal first and then plan the order of treatment around it.
Before that plan can move forward, the condition of the teeth and supporting tissues also needs to be assessed.
Healthy teeth and gums come first
Whatever type of orthodontic treatment is being considered, the teeth and supporting tissues need to be healthy enough for movement.
For adults who have had dental treatment over many years, this may mean checking not only the teeth themselves but also the gums, bone and condition of existing restorations.
Active gum disease, untreated decay or problems around a crown or bridge may need to be addressed before braces or aligners are started.
This is why an orthodontic assessment in an adult is about more than deciding whether the teeth could look straighter. It needs to establish whether the mouth is healthy enough for the planned movement and how orthodontics fits with any treatment that may be needed later.
Planning orthodontic treatment at Yass Valley Dental
For adults, orthodontic treatment is often only one part of a wider dental plan. There may already be crowns or implants to work around, missing teeth to replace, or restorative treatment that needs to happen before or after the teeth are moved.
At Yass Valley Dental, those different parts of treatment can be considered together from the beginning. The practices are equipped for digital scanning, 3D imaging, in-house milling and 3D printing, giving the team the information and tools needed to assess the teeth and bite properly and plan the different stages of treatment.
Learn more about the technology used at Yass Valley Dental.
Dr Daniel Yang provides orthodontic care at Yass Valley Dental, including Invisalign, and also has extensive clinical experience in dental implants and restorative treatment. For adults with more complex dental histories, that means the plan does not have to focus on one issue at a time. Orthodontic treatment can be considered alongside existing crowns or implants, missing teeth and any restorative work that may be needed later.
Meet Dr Daniel Yang and the Yass Valley Dental team.
This makes it easier to work out the right order of treatment from the start, whether that means moving teeth before an implant is placed, working around existing restorations, or coordinating orthodontic and restorative treatment over several stages.
If you are considering orthodontic treatment as an adult, visit our team in Yass or Murrumbateman to talk through your options and how treatment could fit with any crowns, implants or other dental work you may already have.
Frequently asked questions about adult orthodontics and existing dental work
Can I have braces if I already have crowns?
In many cases, having crowns does not prevent orthodontic treatment. A crowned tooth still has a natural root and can usually be moved if the tooth and surrounding tissues are healthy.
The crown itself still needs to be considered during treatment planning, particularly when brackets or other orthodontic attachments are placed.
Can Invisalign move a dental implant?
A dental implant itself cannot be moved with Invisalign or other orthodontic treatment once it has integrated with the jawbone.
The natural teeth around the implant can still be repositioned, so treatment may still be possible, but the implant has to remain a fixed point within the plan.
Should orthodontic treatment happen before a dental implant?
In some cases, it makes sense to complete the orthodontic treatment first.
If neighbouring teeth need to be repositioned or the space for the future implant needs to be adjusted, moving those teeth before the implant is placed can make the final restoration easier to plan.
Can braces close the space left by a missing tooth?
Sometimes the space left by a missing tooth can be reduced or closed with orthodontic treatment.
In other cases, the better approach may be to create or maintain the right amount of space for a future implant or bridge. The decision depends on the location of the missing tooth, the position of the neighbouring teeth and the overall bite.
Can I have orthodontic treatment if I already have a bridge?
It may still be possible to have orthodontic treatment if you already have a bridge, but the bridge can affect how the connected teeth are able to move.
Its position and design need to be considered from the beginning so the orthodontic plan can work around it or account for any restorative changes that may be needed later.
Are braces or Invisalign better if I already have dental work?
There is no single answer that applies to everyone with crowns, implants or missing teeth.
The choice between fixed braces and Invisalign depends on the type of movement required, the complexity of the bite and how the existing dental work fits into the overall treatment plan.
