Missing teeth and hypodontia
Opening space for a missing tooth and preparing the teeth before an implant or prosthesis.
Does this sound familiar
Patients most often come for this with these words:
One or more of my teeth are congenitally missing
My lateral incisors are small or missing
After an extraction the neighbouring teeth have tipped into the gap
I have been told there is not enough space for an implant
Gaps have remained between my teeth
Sometimes teeth are congenitally missing (hypodontia) or the space stays empty after an extraction. If a tooth is missing from the smile or its shape is not attractive, the smile will never be fully harmonious. The neighbouring teeth tip into the empty space and the opposing tooth over-erupts. That is why in such cases the orthodontic phase is part of a larger plan.
What the orthodontist does
- Opens space of the right size for the missing tooth
- Straightens tipped neighbouring teeth and makes their roots parallel
- Adjusts the bite before restoration
- In some cases closes the space and replaces the tooth with a neighbouring one
- Distributes space around small teeth for aesthetic restoration
Opening or closing the space
| Opening the space | Closing the space | |
|---|---|---|
| What is done | The space is prepared for an implant or prosthesis | Neighbouring teeth are moved and the space is closed |
| Advantage | The natural arrangement of the teeth is restored | No artificial tooth is needed |
| What to consider | The implant is placed after growth is complete | The shape of the neighbouring tooth may need aesthetic change |
| Who it suits | If the bite and profile allow it | With crowding or certain bite types |
We make the decision together with the prosthodontist and implant specialist, according to the bite, profile, smile and the condition of the gums.
Teamwork
- Diagnosis and an overall plan with all specialists
- Orthodontic phase: the space is opened or closed
- A temporary tooth: an aesthetic solution during treatment if the gap is visible
- The implant or prosthesis phase
- The general dentist and prosthodontist complete aesthetics and function
- Retention
In one patient with missing lateral incisors we first restored the space they needed and then set the position of the teeth correctly. After the orthodontic phase the general dentist and prosthodontist completed the aesthetics and function.
In children
Hypodontia is often found in childhood, when the bud of a permanent tooth is not seen on an X-ray. In this case the baby tooth can be kept as long as possible or the space can be managed in a planned way. Early diagnosis increases the options. See: when should a child first see an orthodontist.
In adults
In adults the teeth have often been tipping into the gap for years. Space has to be opened for the implant, root parallelism restored and the condition of the gums and bone taken into account. More: orthodontics for adults.
What the science says
- Systematic review (2016): laypeople are sensitive to the size and symmetry of the front teeth and to gaps between them.
- Systematic review (2010): the condition of the gums and bone must be considered when moving teeth.
Why lateral incisors need special attention
Congenitally missing or very small lateral incisors are among the most common forms of hypodontia. Because they are at the front of the smile, every millimetre shows. When opening space I plan the size of the teeth, the shape of the neighbouring teeth, the gum line and the smile arc together, so that the implant or restoration placed later looks natural.
Diagnosis
- Panoramic X-ray: which teeth are missing and which buds are present
- Measurements on models: how much space is needed
- Smile photographs: tooth size and shape
- An overall plan with the prosthodontist and implant specialist
Frequently asked questions
Can the implant be placed before orthodontic treatment?
Usually the orthodontic phase comes first so that the implant is placed in the right position. An implant does not move, so its position cannot be changed later.
Will the gap be visible during treatment?
For front teeth we offer a temporary aesthetic solution so that the gap does not show.
When is an implant placed in a child?
After jaw growth is complete. Until then we protect the space.
What do you do with small lateral incisors?
In the orthodontic phase we distribute the right amount of space around them, then a general dentist or prosthodontist restores their shape.
Is there a solution without an implant?
Yes. Options include closing the space, a bonded bridge or a prosthesis. The choice depends on the bite, age and wishes.
Read more
Scientific sources
The information in this article is based on the following peer-reviewed scientific articles and systematic reviews.
- Parrini, S., Rossini, G., Castroflorio, T., Fortini, A., Deregibus, A., & Debernardi, C. (2016). Laypeople's perceptions of frontal smile esthetics: A systematic review. American Journal of Orthodontics and Dentofacial Orthopedics, 150(5), 740-750. [PMID: 27871700] | [DOI: 10.1016/j.ajodo.2016.06.022]
- Joss-Vassalli, I., Grebenstein, C., Topouzelis, N., Sculean, A., & Katsaros, C. (2010). Orthodontic therapy and gingival recession: a systematic review. Orthodontics & Craniofacial Research, 13(3), 127-141. [PMID: 20618715] | [DOI: 10.1111/j.1601-6343.2010.01491.x]