Braces with missing teeth — closing or opening spaces before implants

Key facts

• Missing teeth let neighbours tip and opposing teeth over-erupt
• Spaces can be closed or opened for a replacement
• TADs give precise anchorage when teeth are missing
• Implant timing is coordinated with orthodontics
• Retainers hold the space until the final restoration

How missing teeth affect the bite

When a tooth is missing, the teeth beside it tend to drift and tip into the gap, and the tooth in the opposite jaw may over-erupt because it has nothing to bite against. Over time this can change the bite, create food traps and make the gap too narrow or angled for a natural-looking replacement. Commonly missing teeth include upper lateral incisors and lower second premolars, which are often absent from birth, as well as molars lost after decay or failed root canal treatment. Bone at the missing tooth site can also shrink, which affects later implant planning. Orthodontic assessment considers both the teeth and the bone.

Closing the space versus opening it

There are two broad strategies. Space closure moves neighbouring teeth into the gap so no replacement is needed — for example, moving a canine into the position of a missing lateral incisor and reshaping it, or bringing molars forward to close a premolar space. Space opening or redistribution aligns the teeth and creates a gap of the right size and root angle for an implant, bridge or bonded restoration. The choice depends on the bite, the amount of crowding or spacing, the shape and colour of the teeth, facial profile, gum line, bone volume, age and personal preference. Each option has trade-offs that Dr. Pacha explains.

TADs for anchorage

Moving teeth into or away from a gap requires anchorage — something stable to push or pull against. When teeth are missing, there may be fewer teeth to anchor with, and conventional mechanics can move the wrong teeth. Temporary anchorage devices (TADs), small titanium mini-screws placed in the bone under local anaesthetic, provide a fixed anchor so that specific teeth can be moved precisely, for example protracting molars forward to close a space without pulling the front teeth back. TADs can also be used to upright tipped molars or intrude over-erupted teeth to recreate space for a replacement. They are removed once that phase is complete.

Coordinating with the implant dentist

When an implant is planned, orthodontics and implant treatment must be sequenced carefully. The orthodontist aligns the teeth and creates the correct space at crown and root level, confirmed on X-rays or CBCT so that neighbouring roots are not in the way. The implant dentist assesses the bone and gum and decides whether grafting is needed. In young patients, implants are usually delayed until jaw growth is complete, and a temporary tooth — on a removable retainer or bonded to adjacent teeth — fills the gap meanwhile. A retainer holds the space until the final restoration is fitted. Clear communication between both clinicians avoids having to redo work later.

Planning your treatment at Manhal

At Manhal Medical Center in Dubai, consultant orthodontist Dr. Moaiyad Pacha examines your teeth, bite and the missing tooth sites, takes a digital scan and X-rays, and uses CBCT where root position or bone needs precise assessment. He explains whether closing or opening the space is more suitable, whether TADs are needed, and how the orthodontic phase fits with any implant, bridge or restorative work, in a written plan covering duration, retention and itemised fees. Treatment options include aligners or fixed braces. Dr. Pacha holds a clinical PhD from Queen Mary University of London and RCS orthodontic qualifications; contact the clinic for his Dubai dates.

It is never too late to straighten teeth. Adult orthodontics often works alongside implants, veneers or gum treatment, and discreet appliances fit professional life.

Prepared by the Manhal Medical Center editorial team · Updated: 2026-10-18 · Treating specialist: Dr. Moaiyad Pacha

This page is general information and does not replace a consultation. Suitability, risks and results vary between patients.