Orthodontics and implantology are two essential aspects of modern dentistry. The former corrects the existing dentition, adjusting a malocclusion to return function and aesthetics, whereas a dental implant achieves the same goal in an edentulous space.
However, in select cases it may be fruitful to consider both clinical modalities in a singular, cohesive approach. Dental professionals who are considering such treatments must balance the benefits and the challenges facing the use of both workflows.
Just as an orthodontic appliance and implant restoration could be part of the same treatment plan to create a functional and minimally invasive result, multiple clinicians may need to work together to deliver success. Each dental professional involved should have an understanding of the current literature linking both fields, and be confident that the pairing is best for an individual patient’s needs.
Changes in density
With appropriate case selection, adjunctive orthodontic treatment can be considered alongside conventional implant placement in order to maximise aesthetic and functional results.[i].
Successful dental implant placement relies upon adequate space and favourable hard and soft tissues health. In some cases, edentulism will induce malalignment in the surrounding dentition, which must be rectified before an implant is placed.[ii]
However, orthodontic treatment is associated with changes in bone density.ii If improperly managed, this may compromise the treatment site for future implant surgery. Failure to provide adjunctive support, such as hard tissue augmentation, for example, could lead to a greater risk of implant failure.
The level of bone resorption observed in the literature is not insignificant. Some level of root resorption is expected in most orthodontic treatments, with 1-2mm thought to be a normal side effect.[iii] A study into resorption around the maxilla anterior teeth when moved through orthodontic treatment found that the bone density around teeth reduced by 24.3±9.5% during just 7 months of treatment.[iv] Bone density was seen to increase in only two of 144 samples. In general, bone density actually developed on the tension side of the tooth (opposite to the tooth movement) whilst decreasing on the compressed side, exemplifying that density is affected by the direction in which teeth are moved.iv
Clinicians must consider how bone density changes will favour the success of the placed implant; a 2019 studyii of 255 implants amongst a orthodontically-treated and control group found that success was only compromised when a restoration was placed in the maxilla following orthodontic treatment, meaning the approach could be more viable in mandibular-based cases.
Extrusion
If the defective tooth is still in place, a different orthodontic approach may be useful. Orthodontic extrusion is recognised to improve the quality of local bone and gingivae prior to implant placement in select cases, especially in the anterior maxillary zone.[v] Slow extrusion with close monitoring can encourage the mineralisation of new trabecular bone, making it a more favourable site for an implant.iii Immediate placement is recommended to reduce subsequent bone resorption in this situation.i
With either approach, orthodontic treatment could be paired with surgical tissue augmentation at the treatment site to facilitate a successful, aesthetic outcome. Clinicians should develop their skills before taking on such cases.
Augmentation
Alveolar ridge augmentation techniques are generally more effective at restoring the width of the site rather than the vertical height – the latter can be quite reliably developed through extrusion in the right cases.i Simultaneous implant placement with guided bone regeneration is a widely accepted, though complex, technique in modern dentistry. Soft tissue augmentation may also be required to optimise the aesthetic result.[vi]
The General Dental Council’s ‘Standards for the Dental Team’ calls for clinicians to find out about the current evidence and best practices that affect their care, and take part in activities that develop their knowledge and skills.[vii] For clinicians looking to implement the discussed approaches with confidence, this includes courses that cover surgical skills, implant placement, and hard and soft tissue management.
The Postgraduate Diploma in Advanced Techniques in Implant Dentistry from One to One Implant Education provides clinical confidence in complex implant procedures. Delegates delve into the use of hard and soft tissue augmentation, and refine workflows that help deal with common anatomical defects faced in everyday implant dentistry. The course is led by Dr Fazeela Khan-Osborne and Dr Nikolas Vourakis, two eminent and experienced clinicians who provide unique, evidence-backed insights into complex protocols.
Orthodontics and implantology are not worlds away, but together can lead to particularly interesting treatment outcomes in select cases. Clinicians should seek out opportunities to develop their skills and be encouraged work collaboratively to find the best approach in each case.
To reserve your place or to find out more, please visit
https://121implanteducation.co.uk or call 020 7486 0000.
Author bio: Dr Fazeela Bio
Dr Fazeela Khan-Osborne is the founding clinician of the FACE dental implant multi-disciplinary team for the One To One Dental Clinic based on Harley Street, London. She has always had a passion and special interest in implant dentistry, particularly in surgical and restorative full arch rehabilitation of the maxilla. She has been involved in developing treatment modalities for peri-implantitis within clinical practice.
Dr Khan-Osborne is also the Founding Course Lead for the One To One Education Programme, now in its 20th year. As a former Lead Tutor on the Diploma in Implant Dentistry course at the Royal College of Surgeons (England), she lectures worldwide on implant dentistry and is an active full member of the Association of Dental Implantology, the British Academy of Aesthetic Dentistry and the International Congress of Oral Implantologists.
[i] Borzabadi-Farahani, A., & Zadeh, H. H. (2015). Adjunctive orthodontic applications in dental implantology. Journal of Oral Implantology, 41(4), 501-508.
[ii] Chang, L. C., & Tsai, I. M. (2019). Comparison of early implant failure rates between subjects with and without orthodontic treatment before dental implantation. Journal of Oral Implantology, 45(1), 29-34.
[iii] Haworth, J., & Sandy, J. (2024). Contemporary theories of orthodontic tooth movement. Orthodontic Update, 17(2), 56-62.
[iv] Chang, H. W., Huang, H. L., Yu, J. H., Hsu, J. T., Li, Y. F., & Wu, Y. F. (2012). Effects of orthodontic tooth movement on alveolar bone density. Clinical oral investigations, 16, 679-688.
[v] Cavalcante, A. D. M., Medeiros, R. C. T., Lima, D. L. F., & Santos, S. E. (2021). Interrelationship Between Orthodontics and Implantology in Anterior Aesthetic Rehabilitation: A Case Report. Journal of Dentistry Indonesia, 28(2), 112-117.
[vi] Izzetti, R., Cinquini, C., Alfonsi, F., Nisi, M., Covelli, M., Garcia Mira, B., … & Barone, A. (2024). Horizontal Bone Augmentation with Simultaneous Implant Placement in the Aesthetic Region: A Case Report and Review of the Current Evidence. Medicina, 60(11), 1786.
[vii] General Dental Council, (2019). Standards for the Detnal Team. (Online) Available at: https://standards.gdc-uk.org/Assets/pdf/Standards%20for%20the%20Dental%20Team.pdf [Accessed January 2025]
