Implants and Aligners: Sequencing Orthodontics Around Implant Treatment

Many adult aligner patients either already have implants or will need one. Because implants behave very differently from natural teeth, the order of treatment matters. Getting the sequence right avoids a well-integrated implant ending up in the wrong place.

An osseointegrated implant is fused directly to bone with no periodontal ligament, so orthodontic forces won't move it. Treat it like a fixed point. Aligners can be designed to fit passively over an existing implant crown, or relieved around it, while the surrounding teeth are moved.

When a patient needs both, moving the teeth first is usually preferred. Orthodontics can:

• Open or redistribute space so the implant site has the right mesiodistal width
• Upright tipped neighboring teeth so roots are parallel and don't crowd the site
• Align the adjacent teeth so the final crown matches the arch form
• Improve the vertical position of neighbors for better gingival harmony

Once the site is ready, the implant can be placed in the ideal position. A retainer or a fixed splint then holds the space until the implant is restored.

A pontic — a tooth-colored shell built into the aligner over the space — keeps the smile looking complete during treatment, which matters to patients missing a front tooth. Mention it at case submission so it's included in the plan.

Because an implant won't move, it can serve as an anchor for moving other teeth. This can be useful when natural anchorage is limited, but the implant crown's shape and the intended movements must be planned together.

Implants placed before growth is complete can end up positioned too high relative to neighboring teeth, because natural teeth keep erupting as the face grows while the implant does not. For adolescents missing a tooth, orthodontics can prepare the space, and the space is maintained until growth has finished and the implant can be placed.

• Agree on the target site width and root positions with the implant surgeon before approving the plan.
• Confirm on a scan or radiograph that roots adjacent to the site are parallel before implant placement.
• Retain the result until the definitive crown is placed.

Infinity Aligner certified providers can request pontics and implant-aware staging when submitting a case.