Do I Need Orthodontics Before Getting Dental Implants?

Sam asks:

I am congenitally missing tooth #7 and have struggled with several Maryland bridges over the past 15-20 years. I am seriously considering a dental implant and have had several consultations each offering different strategies and advice. One dentist informed me that I only have 4 mm of available space to place the implant, where 7 mm is the desired minimum. He has recommended orthodontics. Another dentist advised a bone graft to place the implant because the bone isn't of the desired thickness.

I would prefer to avoid orthodontics, and if the bone graft method is just as successful, this is what I am leaning towards. Can you please comment on my situation? Any advice or input is appreciated.

Answered by: Dr. Ken Ross

Lighthouse Point, FL

Hi Sam,

Actually the option of orthodontics (to create more space between the teeth) & bone grafting (to create more bone) are two completely different solutions to two different problems.

In my opinion orthodontics to create adequate space is always the best option if recommended. If there is only 4mm of space between the teeth you will definitely need orthodontics to create the adequate space for a congenitally missing lateral incisor.

The thinnest implant sufficient for this site is 3.3mm wide. You need to have a minimum of 1 mm on each side of the implant (to the adjacent tooth). This means that 3.3m + 1mm + 1mm = 5.3mm minimum! We generally round this up to 6mm minimum. If there is 4mm present you should pursue orthodontics to adequately create space.

If there is not enough bone and bone grafting has been recommended, you will still need this grafting following orthodontics. You need the same 6mm width for a 3.3mm wide implant. No bone grafting procedure will take the place of orthodontics as grafting can’t create interdental space, only augment the bone width.

Have the orthodontist or oral surgeon/periodontist get a CT scan so that they can visualize the space in 3D and give you an immediate precise answer to this question!