If a tooth is missing in the upper jaw, the gap can be closed by deliberately shifting the neighboring teeth instead of using an implant. This article shows how a mesial slider combined with aligners achieves this in the posterior region.
Skeletally anchored mesial slider combined with aligners for space closure in the posterior region.
Closing a Gap Without an Implant – When Your Own Teeth Can Close the Space
When a molar is missing or cannot be saved, the question arises how to address the resulting gap long-term. The most familiar options are an implant or a bridge – both fill the gap with artificial tooth replacement. However, there is a third option that is mentioned less often because it requires specialized orthodontic expertise: orthodontic space closure. With this approach, the gap is not filled; instead, your own teeth are moved in a controlled manner until the space is closed.12
The Decisive Advantage: The Teeth “Bring Their Bone Along”
When a tooth is missing for an extended period, the jawbone in that area recedes. What makes space closure special: when a natural tooth is moved into the gap, new bone forms in the area of movement – the bone essentially moves along with the tooth.34 This can even compensate for bone loss that has already occurred, without any foreign material in the jaw. With an implant or bridge, this does not happen.5
A second, often underestimated effect: if a wisdom tooth is present, it can also migrate forward after the front molars have moved, and thus find its place in the dental arch.
Why Space Closure Places Such High Demands
Teeth cannot be moved in isolation – every force also acts back on the teeth that serve as anchorage. To move a molar forward in a targeted and bodily manner requires an exceptionally stable anchor point. Traditionally, elastics between the upper and lower jaws were used for this purpose. These have two disadvantages: their success depends heavily on how reliably they are worn – and they undesirably pull the lower teeth backward.
The Modern Solution: Skeletal Anchorage on the Palate
Rather than relying on neighboring teeth or elastics, modern orthodontics uses a fixed anchor point in the bone: small temporary mini-implants placed in the anterior palate.6 A specialized appliance called a mesial slider is attached to these.78 It provides stable support and guides the tooth bodily in a controlled manner into the correct position. Thanks to digital planning and prefabricated laboratory appliances, mini-implants and mesial sliders can be placed in a single appointment – without traditional impressions, without bands, without separating the teeth.
How this technique can be used in a particularly challenging case with multiple simultaneous malocclusions is shown in our article on complex cases with aligners and skeletal anchorage.
Can This Also Be Done with Invisalign or Clear Aligners?
Clear aligners are popular because they are nearly invisible, removable, and hygienic – and because the risk of decalcification spots is lower than with fixed braces.9 An honest assessment is important, though: bodily advancement of a molar over a long distance is not reliably achievable with aligners alone.101112 That is precisely why the combination is so effective13 – the skeletally anchored appliance takes care of the demanding tooth movement, while the aligners harmoniously guide the remaining correction. This makes it possible to resolve cases that would otherwise require fixed braces.
Is gap closure right for me?
Whether gap closure, an implant, or a bridge is the right choice depends on many individual factors: the position and size of the gap, the condition of the adjacent teeth, a possibly present wisdom tooth, the shape of the jaw, and your personal goals. There is no universally “best” solution. In suitable cases, however, orthodontic gap closure is a particularly conservative option because it does not require artificial tooth replacement and builds up natural bone. The starting point is always a precise, today mostly digital diagnostic workup. In our orthodontic practice in Cologne, we plan such treatments on the computer and discuss openly with you which approaches are realistic and sensible in your situation.
What this treatment approach looks like in practice is shown in our treatment example: gap closure with aligners instead of an implant.
The complete scientific article can be found as a PDF at the top of this page.
Sources
- Robertsson, S., & Mohlin, B. (2000). The congenitally missing upper lateral incisor. A retrospective study of orthodontic space closure versus restorative treatment. European Journal of Orthodontics, 22(6), 697–710. https://doi.org/10.1093/ejo/22.6.697
- Rosa, M., Lucchi, P., Ferrari, S., Zachrisson, B. U., & Caprioglio, A. (2016). Congenitally missing maxillary lateral incisors: Long-term periodontal and functional evaluation after orthodontic space closure with first premolar intrusion and canine extrusion. American Journal of Orthodontics and Dentofacial Orthopedics, 149(3), 339–348. https://doi.org/10.1016/j.ajodo.2015.08.016
- 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. https://doi.org/10.1093/ejo/cjr029
- Re, S., Cardaropoli, D., Corrente, G., & Abundo, R. (2001). Bodily tooth movement through the maxillary sinus with implant anchorage for single tooth replacement. Clinical Orthodontics and Research, 4(3), 177–181. https://doi.org/10.1034/j.1600-0544.2001.040308.x
- Zitzmann, N. U., Arnold, D., Ball, J., Brusco, D., Triaca, A., & Verna, C. (2015). Treatment strategies for infraoccluded dental implants. The Journal of Prosthetic Dentistry, 113(3), 169–174. https://doi.org/10.1016/j.prosdent.2014.08.012
- Zuger, J., Pandis, N., Wallkamm, B., Grossen, J., & Katsaros, C. (2014). Success rate of paramedian palatal implants in adolescent and adult orthodontic patients: A retrospective cohort study. European Journal of Orthodontics, 36(1), 22–25. https://doi.org/10.1093/ejo/cjt003
- Wilmes, B., Nienkemper, M., Nanda, R., Lubberink, G., & Drescher, D. (2013). Palatally anchored maxillary molar mesialization using the mesialslider. Journal of Clinical Orthodontics, 47(3), 172–179.
- 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. https://doi.org/10.1016/j.ajodo.2019.01.011
- Buschang, P. H., Chastain, D., Keylor, C. L., Crosby, D., & Julien, K. C. (2019). Incidence of white spot lesions among patients treated with clear aligners and traditional braces. The Angle Orthodontist, 89(3), 359–364. https://doi.org/10.2319/073118-553.1
- Papadimitriou, A., Mousoulea, S., Gkantidis, N., & Kloukos, D. (2018). Clinical effectiveness of Invisalign orthodontic treatment: A systematic review. Progress in Orthodontics, 19(1), 37. https://doi.org/10.1186/s40510-018-0235-z
- Papageorgiou, S. N., Koletsi, D., Iliadi, A., Peltomäki, T., & Eliades, T. (2020). Treatment outcome with orthodontic aligners and fixed appliances: A systematic review with meta-analyses. European Journal of Orthodontics, 42(3), 331–343. https://doi.org/10.1093/ejo/cjz094
- Simon, M., Keilig, L., Schwarze, J., Jung, B. A., & Bourauel, C. (2014). Forces and moments generated by removable thermoplastic aligners: Incisor torque, premolar derotation, and molar distalization. American Journal of Orthodontics and Dentofacial Orthopedics, 145(6), 728–736. https://doi.org/10.1016/j.ajodo.2014.03.015
- Wilmes, B., Schwarze, J., Vasudavan, S., & Drescher, D. (2021). Maxillary space closure using aligners and palatal mini-implants in patients with congenitally missing lateral incisors. Journal of Clinical Orthodontics, 55(1), 20–33.
Your orthodontist in Cologne!
Schedule your no-obligation consultation at JUST KFO – Dr. Steinmaier & Kollegen in Cologne.
