Table of contents
This treatment example shows gap closure with aligners instead of an implant.
Anonymized presentation of an actual treatment professionally published by our practice. Every case is different: the treatment path, duration, and outcome of this individual case cannot be generalized to other patients.
The Initial Situation
A 48-year-old female 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: in addition, the front teeth in both upper and lower jaw protruded too far and were slightly crowded, the bite did not close properly in the front area (anterior open bite), and the upper jaw was too narrow in the lateral area. An overview of all treatment options is provided on our page Orthodontics for Adults in Cologne.
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.
Specialist in orthodontics. Owner of JUST KFO in Cologne, sought-after speaker and author who regularly appears in professional publications and media.
Full profile →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 the tooth movement, skeletal anchorage in the palate was planned. Because the teeth were to be moved unilaterally over a large distance, not two but three mini-implants were placed: two measuring 2 × 9 mm next to the midpalatal suture and a third measuring 2 × 7 mm further back. The appliance is thus supported at three points. The corresponding appliance – the mesial slider – was digitally designed and fabricated to a precise fit 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 positioned precisely using a custom-fit positioning jig and attached to the molars; the mini-implants were then placed. For the patient, this meant: no conventional impressions, no metal bands, and therefore no separating elastics between the teeth that would otherwise press for several days before bands are fitted.
The actual tooth movement was achieved by nickel-titanium coil springs with a force of 200 grams. On the affected side, the clear aligners initially extended only to tooth 25. This allowed the appliance and aligners to work simultaneously, without the aligners having to be adjusted with each movement of the molar.
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.
What this treatment requires from patients
Closing a gap takes longer than placement of an implant, because the molar must move through the bone together with its root. For our patient, the gap was closed after two years; the entire treatment took two and a half years.
The area around the mini-implants on the palate must be cleaned thoroughly every day. In our patient, the palatal mucosa became superficially inflamed there at times. The mini-implants remained stable; with better hygiene and a disinfecting gel, the inflammation was treated. We will show you how to clean the site when the appliance is placed.
Why We Show This Case
Such combined treatments using skeletal anchorage and aligner therapy require precise digital planning and experience with both techniques. We treated this case in our practice; the mini-implants were placed at the University Hospital Düsseldorf. Our practice owner Dr. Julia Steinmaier (then Funke) published this case together with Prof. Dr. Benedict Wilmes and Prof. Dr. Dieter Drescher (University Hospital Düsseldorf) as well as Dr. Werner Schupp and Dr. Julia Haubrich (Umfassende Dentofaziale Orthodontie und Kieferorthopädie, 2021). You can find the professional article in our Professional Publications section. For you, this means: Even with multiple misalignments at once, closing a gap with your own teeth may be an option.
When multiple misalignments occur together, additional stable anchorage on the palate helps – as shown in our treatment example: Complex correction in adults with aligners and mini-anchorage.
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.
Sources, studies & further reading
- Schupp, W., Funke, J., & Haubrich, J. (2020). Der digitale Workflow in der In-Office-Alignertherapie. Informationen aus Orthodontie & Kieferorthopädie, 52(4), 289–300. doi:10.1055/a-1241-9967
- Wilmes, B., Funke, J., Schupp, W., Haubrich, J., & Drescher, D. (2021). Mesialslider & Aligner für den Lückenschluss im Seitenzahngebiet. Umfassende Dentofaziale Orthodontie und Kieferorthopädie (UOO), 3–4/2021, 44–50.
- Lindskog-Stokland, B., Hansen, K., Ekestubbe, A., & Wennström, J. L. (2013). Orthodontic tooth movement into edentulous ridge areas – a case series. European Journal of Orthodontics, 35(3), 277–285. doi:10.1093/ejo/cjr029
- Wilmes, B., Vasudavan, S., & Drescher, D. (2019). Maxillary molar mesialization with the use of palatal mini-implants for direct anchorage in an adolescent patient. American Journal of Orthodontics and Dentofacial Orthopedics, 155(5), 725–732. doi:10.1016/j.ajodo.2019.01.011
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?
That depends primarily on the distance the teeth need to travel. If a molar needs to move forward by an entire tooth width, as in our example, it can take up to two years until the gap is closed; smaller gaps close faster. We will tell you the timeframe for your situation after the digital planning.
Is the result stable – do I have to wear a retainer?
Yes, stabilization is important after closing the gap to prevent the teeth from shifting back. A retainer is used for this purpose. It holds the teeth in their new position as long as it is worn. We will discuss how long and in what form at the end of treatment. Retainers are typically a private expense. For children and adolescents with statutory health insurance coverage, the insurance may cover retention for up to two years after active treatment. A fixed retainer on the lower front teeth may also be covered by statutory health insurance in cases of severe crowding (KIG E3/E4).
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.
Does health insurance cover gap closure with aligners?
Aligners are not covered by statutory health insurance; they are always a private expense. For adults, statutory health insurance only contributes to orthodontic treatment in exceptional cases, with severe jaw anomalies requiring combined jaw surgery. Private insurance and supplemental insurance reimburse part of the cost depending on the policy; we assist you with reimbursement documents. You will receive written information on what your treatment costs before treatment begins – an overview of reference values can be found under Costs & Insurance. If desired, you can pay in installments for up to 18 months interest-free directly through our practice.
Reviewed by Dr. med. dent. Julia Steinmaier, specialist in orthodontics · Last reviewed on June 27, 2026
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