Why oral health first?
Orthodontic treatment moves the teeth within the bone with controlled forces. For this movement to happen in a healthy way, the teeth, gums and surrounding bone need to be as healthy as possible. Because brackets or clear aligners can make cleaning somewhat harder during treatment, dealing with existing problems at the start makes the treatment process more predictable in most cases. At the first orthodontic examination, your orthodontist looks not only at how the teeth are aligned but also at your general oral health.
Decayed teeth
Decay noticed before treatment is usually treated first. There are several reasons for this:
- The surfaces on which brackets or attachments will be bonded need to be sound.
- Because clear aligners fit tightly around the teeth, untreated decay can progress under the aligner.
- Placing a filling during treatment may require removing some of the appliance or remaking the aligners.
To reduce the risk of decay while wearing aligners, paying attention to your eating and drinking routine is important; see what to eat and drink with clear aligners. For information on how decay is noticed, see our article on the signs of tooth decay.
Tartar and gum health
Tartar forms when bacterial plaque hardens and can set the stage for gum inflammation. Moving teeth in a mouth with gum inflammation or advanced gum disease can cause further damage to the supporting tissues. For this reason:
- Tartar is usually cleaned before treatment.
- If there is gum disease, it is brought under control first; if necessary, an assessment by a periodontist is requested.
- Areas with gum recession are taken into account when planning treatment. See gum recession.
Once gum health has been achieved, regular check-ups and cleaning remain important throughout treatment. For people using clear aligners, our article on oral hygiene tips may help.
Teeth needing root canal treatment
Teeth that have had root canal treatment in the past can usually be moved orthodontically as long as they are healthy. However, if there are signs such as inflammation at the root tip, pain or swelling, this may need to be dealt with first. X-rays taken before orthodontics can also help reveal some problems that cause no symptoms. For information on sensitivity in root-canal-treated teeth, see this article.
Missing teeth, implants and prostheses
The gap left by a missing tooth directly affects the orthodontic plan. Your orthodontist assesses whether it is more suitable to close the gap or to keep it at a suitable width for a future implant or bridge. Because an implant usually cannot be moved, the order of orthodontics and the implant is planned carefully. Our implants and orthodontics page and the article on clear aligner and implant planning may give you an idea. Existing crowns, bridges or large fillings are also assessed with regard to bonding brackets or attachments.
How is the order of treatment generally planned?
Every patient's situation is different and the order is set by your orthodontist's assessment. A general framework might be:
- Examination and records: Intraoral examination, X-rays, photographs and impressions or a digital scan.
- Urgent and painful conditions: If there is pain, swelling or inflammation, these are dealt with first.
- Gums and tartar: Cleaning and, if needed, gum treatment.
- Decay and root canal treatment: Teeth needing fillings and root canal treatment.
- Orthodontic treatment: Once oral health is suitable, bracket or aligner treatment begins.
- Complementary procedures: Implants, crowns or cosmetic treatments are in most cases planned for the end of orthodontic treatment or afterwards.
In some cases these steps may run in parallel or the order may change. For example, it may be planned to use an implant as orthodontic anchorage (support). On our treatment process page you can find the stages of clear aligner treatment in detail.
Frequently asked questions
Can I use clear aligners if I have fillings?
Sound fillings are usually no obstacle to clear aligner use. If a new filling is needed, the timing should be discussed with your orthodontist so that it does not affect the fit of the aligners.
Is tartar cleaning required before orthodontics?
If there is tartar, cleaning it before treatment is recommended in most cases for the sake of gum health. Your orthodontist assesses whether it is necessary at the examination.
Can a root-canal-treated tooth be moved?
Healthy, healed root-canal-treated teeth can usually be moved. If there is a problem at the root tip, this is assessed first.
For my missing tooth, should the implant or orthodontics come first?
In most cases the tooth positions are corrected with orthodontic treatment first and the implant is placed afterwards. However, the order varies from person to person and is decided by the clinicians' joint assessment.
For questions, you can call 0312 911 60 36 or use the form on the contact page.
This page is for general information only; diagnosis and the treatment plan are determined by an examination and your orthodontist's assessment.
