Am I A Candidate For Invisalign? I Have A Missing Tooth and a Dental Flipper.

Hi Polkadots,

This is a very interesting question and consequently has an interesting answer:

First, I wish we had x-ray of this impacted tooth.  There has to be a reason why this tooth never came down! Is it blocked by other teeth surrounding it? Is it side-ways, is it fused to bone (ankylosed).  The best case scenario is that your tooth never erupted because the teeth to the sides of it were tilted into that space never letting it erupt due to delay in you losing your baby tooth there!  Very likely this is your situation and that’s a great thing so read on…

If the tooth is ankylosed (fused) or sideways, minor surgical treatment will be needed to move it down or extract it and create room for a future implant.  If this tooth is not coming down simply because of blockage by other surrounding erupted teeth, invisalign or braces can do the trick!

First of all there is something called passive eruption meaning if teeth are not stopped by anything, they will passively erupt.  In this case, I would certainly do invisalign and I would place smart force attachments and/or facial and lingual VRA attachment to insure bodily movements of the teeth next to impacted tooth so the roots can move out of the way as well as top of the teeth.  If the tooth is completely impacted under the gum, I would use a little laser to remove soft tissue (gum) from the top of the impacted tooth.  All of a sudden after few invisalign aligners pushing surrounding teeth out of the way, magic happens and the impacted  tooth start showing up on its own moving down into the aligner.  What’s even more amazing?  We can create a full pontic space into the invisalign aligner so from the first day you wear your aligners, that missing tooth is replaced with a fake tooth inside the aligner and you no longer need the annoying flipper! – We will hollow out the area where canine is coming out to avoid any interference without affecting esthetics of the pontic tooth.  Furthermore, once we see the tip of the canine show up either surgically or via passive eruption, I would attach a special button and tie invisible elastic chain to the back of the aligner which you can pull and hook onto this button to let it come down faster!  (We do it for our patients and it’s so easy for them to comply)

If this tooth is not fused to bone and is not sitting in the bone horizontally, we can do any types of orthodontics either invisalign or braces to pull it down.  Consequently if the impacted tooth has to be extracted, I would still go for invisalign and bodily move surrounding teeth out of the way using methods explained above to make room for future implant.  You can still have a full pontic (fake tooth) inside all of the aligners during entire treatment time so you will never walk around with a missing tooth and you can forget about the flipper.  

Furthermore, I would design the fake impacted canine on computer model to be the mirror image of your other erupted canine so that when it erupts, it will fit into the aligner space due to nearly perfect shape and let the aligner guide it into perfect final position… It’s possible you will need what is  called refinement aligners to fine tune final results from a new impression or digital scan but if we can get an impacted tooth out, refinement is no big deal and will be a piece of cake.

So can we treat impacted teeth with invisalign?  The answer is if you can treat it with braces, then you can also treat it with invisalign!  

Best wishes and we will be here for you if you and your doctor have any questions.

***Online Answers should NEVER be substituted for a complete clinical exam and following advice of your treating doctors based on proper and full diagnosis and treatment planning.   There is no way anyone can properly diagnose and treatment plan a patient online without an in office exam.  We have patients coming from other states and countries and we have redesigned their treatment plans to facilitate fewer visits.

If the tooth is congenitally absent, closure of the space or opening the space for a replacement tooth can be achieved with Invisalign in combination with the rest of your treatment. However, if the missing tooth is unerupted and is in the jaw, treatment is best to be done by fixed braces in order to align the unerupted tooth. Well, what is certain is that Invisalign cannot bring down your missing tooth. Your particular options for treatment will be affected by this tooth and whatever reason there is for why it never came down in the first place. Sort that out first and then you can revisit the idea of Invisalign.

I agree with Clark Jones; if you have the canine then use metal braces and get it pulled down.Invisalign will not be able to close the gap effectively so you will need fixed braces.The other option is to replace the missing if indeed missing tooth with a dental implant.

You did not mention if you have spaces for the canine to erupt.However,the way you describe it looks that braces will work the best in your case.

If you are lucky enough to have the impacted cuspid still up there unerupted I would make every effort to get it brought down where it belongs with whatever method  is the best way to do it.  To me that would be braces hands down, no question about it.  Now if the appearance is an issue, we can do something cosmetic such and ceramic upper front  braces to be less visible.  I use the Damon System and the new Damon Clear Braces are some of the best looking we have ever had for adults.  You can look them up on the web.  

Most important is getting your own cuspid brought in where it belongs. I would also recommend a special 3D type x-ray called a cone beam CT scan to find out exactly where the cuspid is located and then have a consult with the oral surgeon your orthodontist  works with.  Talk to both of them and if they think the prospects for recovering the cuspid are good that is your very best option.  Incidentallly, they will straighten out all the other little irregularities in the teeth while they are bringing in the cuspid so you should end up with a perfect set of teeth, all there and totally straight.

Invislaign is not designed to help bring teeth into the arch.  Invisalign orthodontics works by engaging the coronal portion of erupted teeth and applying a force to reposition the them.  In your case traditional orthodontics is going to be necessary to bring your unerupted canine into the right position.  Consult with an orthodontist and oral surgeon to get the best long term result.   

Unfortunately as other dentists have mentioned invisalign is not intended or designed to bring impacted teeth down, your only option would be to have traditional braces done.   Good luck

it gets complicated treating impacted teeth without braces, it all depends on your clinical records. one option is to use a mini implant to bring the impacted tooth down, (just to reduce your treatment time in braces) assuming you have enough room for the impacted tooth. followed by limited braces then invisalign if possible.  Another option would be the use of lingual braces which is as good as traditional braces.

Applying the force necessary to bring an impacted canine tooth into the mouth is beyond the capability of Invisalign.  This tooth movement requires fixed braces. Most canine impactions can be successfully corrected with braces, and those few that cannot might require extraction followed by replacement with a dental implant.

Invisalign is generally not designed to solve problems that include unerupted teeth.  This is usually best done with traditional braces and can be very successful if done correctly.  First,  find out what is possible by having your dentist take xrays and then have him coordinate a consult with an orthodontic specialist that he recommends to find out all your options.  Sometimes teeth can not be brought down depending on position and sometimes the impacted tooth may be in the way of other teeth moving to correct a bite problem.  Good Luck!