Many patients who have been living with a missing tooth for some time wonder whether it’s too late to do something about it. For some, the changes are already noticeable: neighboring teeth have tilted inward, the opposing tooth has drifted into the empty space, and the bite no longer feels quite right. The good news is that dental implants can still be a highly effective solution even after shifting has occurred.
In this article, we’ll discuss what happens to your mouth when a tooth doesn’t get replaced, how implants address the situation even after shifting has occurred, and what the treatment looks like depending on how much movement has taken place.
Why Teeth Shift in the First Place
Your teeth aren’t locked rigidly into your jaw. They’re held in place by a network of ligaments, surrounding bone, and the pressure that neighboring and opposing teeth apply to one another.
When one tooth is removed, the balance shifts. The teeth on either side of the gap begin to tilt inward because there’s nothing pushing back against them. The tooth on the opposing jaw, which used to have something to bite against, starts to over-erupt, meaning it slowly grows downward or upward into the empty space.
This process doesn’t happen overnight, but it is gradual and consistent. Some minor movement can begin within weeks of losing a tooth, while more noticeable structural changes tend to develop over several months. By the one-year mark, the shifting is often clearly visible on an X-ray. The longer the gap remains unfilled, the more the surrounding teeth compensate, and the more complex any future treatment becomes.
Can an Implant Still Be Placed After Shifting Has Occurred?
The answer is yes, but it depends on how much movement has taken place.
Dental implants are still one of the most effective solutions for replacing a missing tooth even after significant shifting, but the implant itself cannot simply be dropped into a space that has changed shape. If the adjacent teeth have tilted into the gap, there may not be enough room for a properly sized implant and crown. If the opposing tooth has over-erupted significantly, it may collide with the crown before the surrounding teeth even come together, creating an uneven bite that puts harmful pressure on the implant.
This is why the first step is always a thorough evaluation, not just of the gap, but of the teeth around it. Dr. Delwyn Dick, DDS, at Kootenai Dental Group in Coeur d’Alene, ID, has been placing dental implants for over 25 years and understands that no two cases are alike. For this reason, a careful, personalized assessment is always the starting point before any treatment plan is put together.
What Gets Evaluated Before an Implant Is Placed
Before implant placement, several things need to be assessed to give the implant the best possible chance of long-term success.
- Bone density and volume are among the most important factors. When a tooth is lost, the jawbone that used to support its root begins to shrink, a process called resorption. Studies suggest that up to 25% of jawbone density can be lost within the first year after tooth loss. If the bone has deteriorated significantly, a bone graft will be needed before the implant can be placed. A cone beam CT scan, which produces a three-dimensional image of the jaw, gives our team of experts at Kootenai Dental Group an accurate picture of what is available to work with.
- Available space is equally important. If the neighboring teeth have drifted too far into the gap, there may not be enough room for an implant and crown of the right size. If the gap has closed too much due to shifting, orthodontic treatment to move those teeth back into position is typically required before implant placement.
- The position of the opposing tooth also matters. If the tooth has over-erupted into the space, it needs to be addressed before a crown is placed on the implant. Depending on the degree of movement, this might involve orthodontic correction or reshaping the tooth to create enough room for the crown to fit properly.
- Overall bite alignment: Placing an implant without first correcting the bite can lead to uneven forces on the implant over time, which shortens its lifespan and can cause the crown or implant to fail prematurely.
When Orthodontic Treatment Is Needed
Orthodontic treatment before implant placement is typically recommended when:
- The gap has closed too much to fit a properly sized implant.
- The neighboring teeth have tilted so far that their roots are now angled into the space where the implant needs to go, or
- The opposing tooth has shifted far enough that it would interfere with the crown once it’s placed.
Depending on how much movement needs to be corrected, the orthodontic phase can take several months. Once the teeth are in their corrected positions, the implant placement can proceed with proper spacing and angulation, giving it the strongest possible foundation from the start.
When Is Bone Grafting Needed?
If the jawbone has deteriorated significantly since the tooth was lost, bone grafting is often a necessary step before the implant can be placed. A bone graft involves adding bone material to the area where volume has been lost, which your body naturally integrates over time to form new, stable bone. The graft material can come from the patient’s own body, a donor source, or a synthetic substitute.
Healing after a bone graft typically takes three to six months before the site is ready for implant placement. Research shows that implants placed into well-healed grafted bone achieve success rates comparable to those placed in natural bone, consistently above 95 percent, so while the graft adds time to the process, the outcomes speak for themselves.
What the Treatment Timeline Looks Like
Implant treatment after tooth shifting does take longer than a routine implant, but the timeline varies depending on what needs to be corrected.
If shifting has been minimal and bone density is adequate, the process from the initial consultation to the final crown can take roughly four to eight months. If orthodontic correction is required, that phase adds six to eighteen months before implant placement begins.
If a bone graft is needed, that adds another three to six months of healing. In cases where both orthodontics and bone grafting are necessary, the total treatment time can range from fifteen months to over two years.
Understanding the timeline from the start helps patients plan ahead and go into treatment with realistic expectations. Every phase serves a purpose, and giving each one the time it needs is what makes the difference between an implant that lasts and one that doesn’t.
What Happens if the Gap Is Left Untreated?
For patients who are on the fence about moving forward, it helps to understand what continued waiting actually means for their oral health.
The shifting that has already happened won’t stop on its own. Adjacent teeth will keep tilting, the opposing tooth will keep drifting further out of position, and the bone beneath the gap will continue to shrink. A bone graft that might be relatively simple today could become a much more involved procedure a year or two from now, and in some cases, the bone loss eventually reaches a point where it can’t be adequately rebuilt at all.
As the bite shifts, certain teeth end up carrying more force than they were designed to handle and wear down faster as a result. The joint in your jaw can come under strain from a bite that’s no longer properly balanced. And as more teeth drift out of position, keeping them clean becomes harder, which raises the risk of decay and gum disease in teeth that would otherwise have been perfectly healthy.
Replacing the missing tooth addresses far more than the gap itself. The longer the treatment is delayed, the more the surrounding teeth, bone, and bite are affected, and the higher the cost and complexity of fixing it.
Bottom Line
Dental implants placed after tooth shifting can achieve equally strong outcomes as any other implant case, provided the treatment plan is thorough, and each phase is allowed the time it needs to heal properly.
A well-integrated implant with a properly fitted crown restores full chewing function, looks natural alongside the surrounding teeth, and prevents further bone loss at the implant site.
Teeth that have already shifted don’t disqualify anyone from getting an implant. They simply mean there are a few extra steps involved, and each of those steps is there to make sure the implant settles in correctly, functions the way it should, and stays that way for the long term.
If you have a missing tooth and have noticed changes in your bite or the surrounding teeth, the best thing you can do is to come in and see Dr. Delwyn Dick, DDS, at Kootenai Dental Group in Coeur d’Alene, ID. Our team of experts will take the time to evaluate your specific situation, walk you through your options, and put together a treatment plan that ensures you the best outcome.
Take the first step toward restoring your smile and dental health! To schedule your free consultation, call 208-762-8750 today!