Treatment Example: Gap Closure with Aligners Instead of Implant

This treatment example shows gap closure with aligners instead of an implant.

Anonymized presentation of a real treatment professionally published by our practice.

The Initial Situation

A 48-year-old patient came to us with an upper left molar (tooth 26) that could no longer be saved. The situation was more complex than a simple gap: additionally, the front teeth in both the upper and lower jaws protruded too far forward and were somewhat crowded, the bite did not close properly in the front region (anterior open bite), and the upper jaw was too narrow in the lateral areas.

The standard recommendation for this gap would have been an implant. However, because the patient still had a wisdom tooth in the upper jaw that could move forward, she specifically requested orthodontic gap closure — as part of treatment with clear aligners.

The Treatment Planning

At the outset, the dentition was digitally captured with an intraoral scanner and the aligner therapy was planned on the computer. To create space in the lower jaw for correcting the protruding front teeth, one lower incisor was extracted. In the area of the missing tooth 26, the typical bone loss after tooth extraction was already visible – precisely here, new bone was intended to form through the movement of the patient’s own teeth.

For stable anchorage of tooth movement, skeletal anchorage in the palate was planned. Because of the high and unevenly distributed force requirements, not just two but a total of three small mini-implants were placed (a particularly stable, triple-supported construction). The associated appliance – the mesial slider – was digitally designed and fabricated precisely in the laboratory.

The Procedure in a Single Session

Mini-implants and mesial slider were placed in a single appointment. After local anesthesia, the prefabricated appliance was precisely positioned using a custom-fitted positioning guide and attached to the molars; then the mini-implants were placed. For the patient, this meant: no conventional impressions, no bands, no separate separation of teeth – a significant gain in comfort compared to earlier procedures.

The actual tooth movement was accomplished by fine tension springs on the appliance, while the clear aligners guided the remaining correction. Appliance and aligners were coordinated so they could work in parallel.

The Result

As with any bodily tooth movement in adulthood, the process required patience. After approximately two years, the gap in the area of tooth 26 was completely closed – the patient’s own tooth row had replaced the missing tooth. In the final phase, the appliance was incorporated into the final fine-tuning of the bite. After a total of approximately two and a half years, treatment was successfully completed: a closed, functional tooth row of the patient’s own teeth – without an implant.

Why We Show This Case

Combined treatments involving skeletal anchorage and aligner therapy require specialized expertise and are often delegated to fixed braces by many practices or not offered at all. Our practice owner Dr. Julia Steinmaier has published scientific work on precisely this technique together with university experts (you can find the professional article in our Publicationssection). For you, this means: Even challenging initial situations can in many cases be resolved with modern, gentle methods.

Every case is individual – whether your situation is suitable for such a treatment approach is something we would be happy to discuss in a personal consultation.

Frequently Asked Questions About Gap Closure with Aligners

Can a tooth gap be closed without an implant?

In many cases, yes. Instead of filling the gap with an implant or bridge, the existing teeth can be moved orthodontically so that the gap closes naturally. Whether this is possible depends on the gap size, bite position, and the condition of the adjacent teeth.

For whom is orthodontic gap closure suitable?

It is often suitable when misaligned teeth need to be corrected anyway. Prerequisites are healthy adjacent teeth as well as appropriate space and bone conditions.

How long does gap closure with aligners take?

The duration depends on the size and location of the gap and is usually in the range of several months to about one and a half years. We determine the exact timeframe after digital treatment planning.

Is the result stable – do I have to wear a retainer?

Yes, stabilization is important after gap closure to prevent the teeth from moving back. A retainer is used for this purpose. With consistent retention, the result remains permanently stable.

Gap closure or implant – which is better?

There is no universal answer. Orthodontic gap closure avoids a surgical procedure and preserves the body’s own tissue; an implant may be more sensible if gap closure would worsen the bite. We will discuss together which solution is appropriate.