Orthodontic Treatment With Crowns
A crowned tooth responds to orthodontic pressure much like a tooth with a simple filling, since the movement occurs at the root and bone level rather than at the visible surface of the tooth. We do take extra care when placing brackets or attachments on crowned teeth, since the material and shape of a crown can differ slightly from natural enamel. This is something we account for during treatment planning rather than something that prevents treatment altogether.
Orthodontic Treatment With Missing Teeth
Missing teeth do not rule out orthodontic treatment. In many cases, treatment is specifically recommended to help close or manage the space left by a missing tooth, or to properly align the remaining teeth around a planned implant or bridge. If you are missing one or more teeth, we will evaluate whether orthodontic treatment should happen before or after any restorative work, and coordinate directly with your dentist to sequence your care appropriately.
Why Gum Health Comes First
Orthodontic treatment relies on healthy bone and gum tissue to support tooth movement. Active periodontal disease weakens this support, which can make orthodontic movement unpredictable or, in more advanced cases, unsafe until the condition is addressed. This is why a periodontal evaluation is part of every adult consultation, not an optional add-on.
What Happens If Gum Disease Is Present
If we identify signs of active gum disease during your evaluation, we will coordinate with your dentist or refer you to a periodontist for treatment before proceeding with orthodontic care. In many cases, once periodontal health is stabilized, orthodontic treatment can move forward as planned. In some situations, we may recommend ongoing periodontal maintenance alongside orthodontic treatment to protect your gum health throughout the process.
Working With Your Existing Dental Team
Adult treatment often involves closer coordination with your general dentist, periodontist, or restorative dentist than treatment for a younger patient, simply because adult patients are more likely to have existing dental work or periodontal history to account for. We view this coordination as a standard part of adult treatment planning, and we communicate directly with your other providers to ensure your treatment plan fits within your overall dental health.
What We Evaluate at Your Consultation
- Digital x-rays to assess bone support around each tooth
- A full periodontal review of gum health
- The condition and position of any crowns, bridges, or implants
- Whether any missing teeth should be addressed before, during, or after orthodontic treatment
Orthodontic Treatment and Dental Implants
Dental implants function differently from natural teeth because they are fused directly to the bone and do not respond to orthodontic pressure the way a natural tooth does. This means any orthodontic movement involving nearby teeth typically needs to happen before an implant is placed, or the treatment plan needs to be designed carefully around an existing implant. If you are considering both an implant and orthodontic treatment, we will coordinate closely with your dentist to determine the correct sequence.
When a Periodontist Should Be Involved First
If your evaluation reveals signs of moderate to advanced gum disease, we will typically recommend a periodontal evaluation before beginning orthodontic treatment. In many cases, this involves a deep cleaning or other periodontal therapy to stabilize the gum and bone tissue. Once your periodontist confirms your gums are healthy and stable, orthodontic treatment can generally proceed as planned, sometimes with periodic periodontal maintenance continuing alongside your orthodontic appointments.
Bone Support and Orthodontic Safety
Bone loss associated with gum disease can affect how safely and predictably teeth respond to orthodontic pressure. This is why we prioritize a full periodontal and radiographic evaluation before recommending treatment for any adult patient with a history of gum disease. In cases with significant bone loss, we may recommend a more conservative treatment plan or lighter forces to protect the long-term health of the affected teeth.
What to Bring to Your Consultation
If you have crowns, implants, missing teeth, or a history of gum disease, it is helpful to bring any recent x-rays or notes from your general dentist or periodontist to your consultation. This allows us to build the most accurate picture of your dental history from the start and reduces the chance of delays once treatment begins.
A Personalized Plan for Your Dental History
No two adult patients arrive at a consultation with the same dental history, and treatment planning reflects that. Whether you have one crown or several, a missing tooth you have lived with for years, or a periodontal condition that needs to be managed, we will build a plan around your specific situation rather than applying a one-size-fits-all approach.
If you have been told in the past that your dental history makes orthodontic treatment impossible, we would encourage a second opinion. Advances in orthodontic planning mean that many cases once considered too complex can now be treated safely and predictably with the right approach.
Learn more about our adult orthodontic treatment options, or schedule your free consultation today.
MacKenzie Orthodontics provides adult orthodontic treatment, including braces and clear aligners, at three locations in Saint John, Quispamsis, and St. Stephen, New Brunswick, also serving patients from St. George, St. Andrews, and Northern Maine. Over 10,000 patients have been treated to date, including more than 6,000 with clear aligners. Book a free consultation to discuss treatment options.
About the Author
Dr. Liliya MacKenzie is an orthodontist and the founder of MacKenzie Orthodontics, with locations in Saint John, Quispamsis, and St. Stephen, New Brunswick. She has practiced orthodontics since 2009, holds a DMD from McGill University, and completed her specialty training at the University of Rochester. She has treated over 10,000 patients, including more than 6,000 with clear aligners, and over half of her patients are adults.