I had one bottom molar extracted about 15 years ago. The molar and the wisdom tooth behind that missing molar have since moved towards the front. I was suggested either to open this gap using braces and put an implant in the place of the missing molar, or to use only braces and push the two teeth behind the gap towards the front in a way to fill the gap. What should I choose? Are there any dangers if I choose the 2nd option, and which ones?
Replacing a Missing Molar
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Replacing missing molar
Both are treatment options, however orthodontic movement of the third and second molar in a bodily fashion is difficult and very unpredictable. It is easier to tilt them up than actually moving them forward.
Usually, i recommend to extract the third molar, upright the second molar with orthodontics, and them replace the first molar with an implant. this is a very stable and long term solution which offers the most predictable outcome.
Closing the space of a lost first molar
If you are missing your lower 1st molar and are trying to close the space i can think of a few option.
1. use ortho to close the space but moving a 2nd molar to fill a 1st molar position takes a lot of time and can be difficult. that is a big space to fill and you may get a bony defect next to your lower premolar
2. use ortho to upright the 2nd molar and place an implant. this is a good option but you are paying for ortho and implant dentistry.
3. Depending on the size of the space you could crown the 2nd molar and make the crown larger than normal to fill the space. you would really only have the cost of the crown and maybe a filling on the premolar to help fill the gap as well. if the teeth are virgin teeth with no restorations then this may not be the option for you
4. you could do nothing and realize the tipping of the 2nd molar could continue to get worse and cause a gum issue. this could be minimized with a night guard to keep the teeth in place
Replacing a First Molar with a Dental Implant
All of these are viable options for replacement. Moving the two teeh forward with orthodontics is difficult and does not a very predictable outcome. Even if the space has closed somewhat, a smaller size tooth can be placed on the dental ipant. IF the tooth behind the space has "tilted" into the space, then the best reatment would be to uprightit then place a dental implant. Thismay require removal of the wisdom tooth, but this is usually of no consequence since it is ususally not a functional tooth., bone gradfting may need to be performed as well if you have lost bone in the area of hte missing tooth
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Moving Molars Orhtodontically Can Be Tough!
The best and most predictable result would be to upright the second molar and place a dental implant in place of the first molar. Attempting to move the 2nd and 3rd molars forward can be done, but is time consuming and difficult to accomplish. By placing the implant you will maintain good bone in that area and can have a crown placed that will give you a nice stabilized occlusion. Good luck
Replacing a Missing Molar
The most predictable solution for your case would be extraction of third molar, upright the second molar with orthodontics and then place a dental implant to be restored with a fixed crown. If the time commitment for orthodontic movement and implant placement are a concern, you could consider extracting third molar and fabricating a three unit bridge to replace the missing molar. If the second molar has not drifted to far forward, it could be uprighted in the preparation design for the bridge and this treatment could be completed in 2 -4 weeks.
Molars don't move very well
Molars can be tipped up, or uprighted, but to move a molar from one position to another is not easy to do and takes a long time. Temporary implants help, but the process is not very predictable and can be expensive due to all the time involved. Removing the wisdom tooth and uprighting the second molar to then place an implant is the best choice if possible. Since the tooth has been missing for as long as it has, placing an implant there may take some extra treatment such as a bone graft.
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