21 years old missing 14 adult teeth and still have baby teeth. Implants? All at once or over time? (photos)

My orthodontist made a makeshift tooth for a missing space where an adult tooth didn't come in, but am worried about needing a bone graft later on. What I have now is working but I am concerned about long term since baby teeth aren't meant to last and am not sure what to do. Would implants be best in one go, instead of as my teeth fall out or possibly veneers on the adult teeth I do have with implants? Also my teeth/ mouth is small would I need them custom? I'm lost and any input is appreciated!

Doctor Answers 3

Baby teeth

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Thank you for your question regarding baby teeth that have not fallen out. I see you are undergoing orthodontics. This is a very good time for your dental implant specialist to team up with your orthodontist and develop an implant treatment plan for you. Baby teeth are much smaller than natural teeth and you will have spacing issues as you get older with the baby teeth. The orthodontist treatment can create the ideal spacing for your natural teeth and the baby teeth can then be removed and have implants placed. This will allow for you to have the correct size of crown dimension delivered. I would suggest you visit with your specialist to discuss these ideas with him/her. Thank you for submitting your photos and question. Best of luck!

Comprehensive Treatment

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The good news: you're missing all of your wisdom teeth that would more than likely need to be removed anyway. My very first concern would be the condition of your TMJ. Just looking at the photos you have provided, I am concerned that you may have a TMJ problem. The narrowness of your upper dental arch, your deep bite and the angulation of your upper and lower front teeth point towards a probable TMJ problem. If this is not corrected, you will potentially have headaches, neck aches, back and shoulder pain, ringing or buzzing in the ears, clicking or popping of your TMJ, facial pain, depression, sleep problems, etc. I would also be concerned about your airway. The position and angle of your teeth and narrowness of your dental arches indicate a probable airway issue. 

I am a big believer that every effort should be made to put teeth in their proper place. In other words, don't try to make a canine a lateral incisor or a lateral incisor a central incisor, etc. Also, your natural teeth are far better than any replacement we can give you and dental implants are the next best alternative. 

So...you would benefit greatly by an exam with a dentist who understands the effect of moving teeth to facial harmony, TMJ function and airway health. The doctor should understand arch development and have a working knowledge of implant systems.

Your case is multi disciplined and complicated. It can be staged so that not everything has to be done all at once (to save on costs) but requires a clear vision of what is required from an orthopedic, orthodontic, oral surgical, TMJ/airway and restorative perspective.

Good luck!

Orthodontics, dental implants, treatment options

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It appears there are several complex decisions with regard to orthodontics, missing teeth, presence of primary teeth, bone grafting needs, implants and restorative needs. The first step is a collaborative discussion among your restorative dentist, oral surgeon, and the orthdontist to evaluate all your diagnostic information, condition, and treatment options. Treatment options are based on your bite, aesthetic requirements, space, bone condition, and location of the missing teeth. Treatments may require staging for several reasons while in some circumstances they can be done at same time. 

H. Ryan Kazemi, DMD
Bethesda Oral & Maxillofacial Surgeon
5.0 out of 5 stars 5 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.