My 17 year old son was congenitally missing a top tooth (the one right next to the front tooth). With braces a nice space was created. The braces are now off and a retainer with a tooth is used to keep the space open. Unfortunately the retainer was lost. One week later impressions were made to replace the retainer and tooth. The tooth on the new retainer is about 1 mm smaller than it was and looks terrible (looks like a primary tooth). How can the spaced that closed so quickly be opened?
Room for a Dental Implant?
Doctor Answers 6
A Fixed-Temporary Solution to Correct Spacing from Missing Teeth
Bichon 71, I would strongly recommend your son go back to the orthodontist and have that 1mm space regained by either a spring action appliance or resuming the original orthodontic work. One millimeter of space is critical in when working in the esthetic zone. Once that space is regined, I would recommend your son waiting until he is 23-25 until an implant is placed. The reason for waiting is that the pre-maxilla or front part of the upper jaw continues to grow until a male reaches that age. During ths waitng period and if all else is stable from an orthodontic perspective, I would recommend an acid etched bridge, commonly known as a "Maryland Bridge" to hold the space. A Maryland Bridge is bonded between the existing teeth and often times the these untouched teeth do not have to be prepared or drilled down. A Maryland Bridge can easily be de-bonded when the time comes for the implant to be placed. Our office never uses Maryland Bridges as a final restoration. We do use these bridges as a temporary solution when a fixed or non-removable prostheitcs have to be removed for subsequent treatment.
Room for Implants
It is best to consider using orthodontics (brackets) again to regain the millimeters of space that were lost. Afterwards, it is vital that your son wear the retainer religiously to maintain the space. In your son's case, his teeth may very likely be moving until he is around 22 years old. Therefore, make sure he wears the retainer until this age and then, at this time, he can consider having an implant placed. The ideal time for implant placement is after 25 years of age.
Amount of space for dental implant
It is best to wait until he has completed his growth. For males, this can be at least 18 or 19 however some may have a growth spurt up to age 20-21. The minimum space necessary for placement of a dental implant is 6 mm.
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Maintain space until done growing
Implants are not a good idea until he is done growing, so get the space opened again, then maintain it, likely until age 23-25. Teeth move quickly when retainers are not worn, moreso the closer to taking braces off (they move less quickly 10years after braces compared to a week after having them removed). It may be as simple as a spring loaded retainer.
Room for Dental Implant
Ask the dentist that did the braces and the original retainer to try to re-open the space as originally done. Should not be too difficult if the retainer was only lost for a week or 2.
How can I open space ?
A removable appl can be inserted or after the ortho a doctor usually takes impressions and a retainer could be placed. If your putting an implant in you need room between the roots and the crown portion and a radiograph will tell you if enough room is their. Good Luck
Kevin Coughlin DMD, MAGD, MBA CEO Baystate Dental PC
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