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Treatment Sequence in Patients with Orthodontics and Missing Teeth Requiring Dental Implants

temporary anchorage device for orthodontics-KazemiA common dental question is what is the proper sequence of the treatment for patients who need orthodontics and dental implant replacement of their missing teeth. Such treatments can be quite complex and hence the most important requirement in such circumstances is a close collaboration between the orthodontist, oral surgeon, and restorative dentist and a unified vision for the overall treatment. Each team member should evaluate the clinical findings, the diagnostic information, and patient needs and then collaborate with the other members to design a treatment plan that will achieve the desired goals.

The restorative dentist should first evaluate the occlusion and aesthetic needs this may be achieved by digital or conventional simulation on models or mock-up directly in the mouth. This information is then communicated with the orthodontist and the oral surgeon to assist them in their respective treatment plans. The orthodontic treatments and dental implant replacement of the missing teeth must be done based on the restorative and cosmetic requirements planned by the restorative dentist. The orthodontist and the oral surgeon should also collaborate regarding the adequacy of spaces and the alignment of the adjacent roots where dental implants are planned.

Upon completion of the orthodontic treatment, the restorative dentist provides temporary restorations (often a removable type) replacing the missing teeth. The oral surgeon then evaluates the sites for proper space, bone, and gum tissue and completes a 3-D digital work up to precisely position the dental implants. Following proper healing, the implants are restored by the restorative dentist. Finally, the orthodontist will consider retainer options and long-term stabilization of the bite.

No dental implants should ever be done until the teeth alignment have been completed orthodontically, and the restorative dentist has communicated the restoration treatment plan.

This careful sequencing and team-approach collaboration will assure a result with proper aesthetics, bite, and longevity of the overall treatment.

Dr. H. Ryan Kazemi is a Board-Certified Oral and Maxillofacial Surgeon in Bethesda, MD