My son is 15 and is missing both of his permanent first premolar teeth. My question is...do I pull the baby teeth and move the back teeth forward with braces, keeping the third molars/wisdom teeth or should I leave the teeth in their natural position and fill the spaces with implants. I'm not sure which route would be best.
Missing Permanent Teeth - Best Option?
Doctor Answers 3
Keep baby teeth or close space depends a lot on facial profile and crowding .
If the baby teeth are in good shape and there is no crowding or other major bite issues keeping the baby teeth often works very well. They may last up into the patient's forties or fifties and some times even longer. Implants are great if the teeth are gone and we have no other options but every year that you can wait before you have to replace the baby teeth lets the implant technology mature and get better. Also every year that you wait is another year that the implant doesn't have to last on the other end. Closing the spaces can be a very good treatment plan in some cases but the overall plan for the facial appearance and profile is the most important factor in making that decision.
Tricky situation - See an orthodontist
As a rule of thumb, when we have missing premolars and baby teeth are still in their place, as long as the baby teeth are in healthy and remain at the same level as the adjacent permanent teeth, it is best to leave them there. They will eventually fall out (10, 20, 30 years?) and can be replaced with implants. But if they baby teeth start to become lower than the adjacent teeth it gets trickier.
Pulling the baby teeth and bring things forward is an OK idea if there is significant crowding or misalignment of the front teeth. If there is not, it is really tough and time consuming closing that space and maintaining a good bite.
Best thing to do is consult with an orthodontist who specializes in these situations.
Proper teeth arch form is important
As a general rule, a full set of teeth is best. If teeth are missing, then instead of closing spaces and moving forward, the spaces should be filled with either a bridge or implant. It is common to have orthodontists close spaces, but that doesn't mean that is the best treatment.
Every case is different, and sometimes choices are limited. It it were my child, I would try to maintain the locations for future implants when he is done growing.
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