Is it possible to close the 46 gap with orthodontics, avoiding implants?

Hello! It's very common for neighboring teeth to shift into the space after the extraction of the lower right molar (46). This can lead to the lengthening of the opposing tooth, a shift in the midline, and, over time, asymmetry/a "distorted" sensation in the jaw's bite.

Can it be corrected with braces?

• Most likely, yes. Dental (non-skeletal) misalignments and malocclusions can usually be corrected with orthodontic treatment.
• Treatment options:

1. Closing the space: The back teeth (47, 48, if present) can be brought forward to close the 46 space. Temporary anchor screws (mini-screws) are often used. The process can take 12–24 months.
2. Re-opening the space and implant/bridge: Orthodontics realign the teeth, the 46 area is optimally opened, and an implant is placed once growth is complete. If there is bone loss, a graft may be necessary. For girls, implants can generally be planned after the age of 17–18, but imaging confirms the end of growth.

How much can a "jaw misalignment" be corrected?

• If the misalignment is a functional/dental misalignment caused by unilateral spacing and misalignment of the teeth, braces often significantly correct it.
• If true skeletal asymmetry (curvature of the lower jaw) is present, braces alone may not be sufficient; orthodontics + Oral and Maxillofacial Surgery and orthognathic surgery may be necessary. Examination and radiographs are essential for this diagnosis.

What tests are required?

• Clinical examination and photographs - Panoramic X-ray (OPG)
• Lateral cephalometric x-ray; if necessary, 3D imaging - Details such as the lengthening of the 16th in the contralateral jaw, the inclination of the 47th, and the status of the 48th are evaluated.

My personal recommendation for you - Consult an orthodontist. Depending on the situation, a plan will be developed in conjunction with Prosthodontics and Oral and Maxillofacial Surgery.

• Treatment duration, the need for miniscrews, and whether "gap closure" or "space creation" is more appropriate will be determined by X-rays.
• The sooner you start, the easier it is to prevent further tooth shifting and additional joint/jaw problems.

A few quick questions for you:

• Do you experience difficulty chewing, pain/clicking/sounds in the jaw joint, or morning locking?
• Do you notice a shift in your upper-lower midline?
• Do you feel like the upper 16 teeth in the opposite jaw are hanging loose?
• Is your wisdom tooth (48) erupting, or is it still in your mouth?

It doesn't seem like an emergency, but as asymmetry can progress, schedule an orthodontic appointment without delay.

I am not a doctor, and this is not a medical diagnosis.

What you've described (discomfort while chewing on the extracted 46th incisor side, occasional clicking/pain, midline shift, and decay on the 16th incisor) is consistent with the tipping of adjacent teeth into the space after unilateral extraction and the supereruption of the upper 16th incisor. In this case, dental shifts can often be corrected with orthodontic treatment.

Answer: Can it be corrected with braces?

• Probably yes. Midline shift, tipped molars, and malocclusion can be corrected with orthodontics.
• Treatment generally involves:
• Straightening the 47th incisor and advancing it into the 46th space (closing the space), and - "lifting" the upper 16th incisor with orthodontic intrusion, if necessary.
• Miniscrews (temporary anchors) are used when necessary. The duration is approximately 12–24 months.
• Alternative: The space is re-opened to the ideal width, and the teeth are aligned; If growth is complete, an implant is planned in the 46-mm region. It is suitable for most people at age 18, but the doctor will confirm with imaging.

Situation of the 16-mm: Decay must be addressed urgently. The depth is determined first with an examination and x-ray; a filling, root canal treatment, and a crown may be considered if necessary.

If the 16-mm is drooping and contacting the opposing teeth prematurely, orthodontic intrusion or occlusal adjustment after orthodontics is planned. This loss of time can lead to increased sagging and joint complaints.

For the jaw joint (clicking/pain) - It is usually caused by malocclusion and unilateral chewing; most patients experience relief once the alignment is corrected.

During this period:

Avoid wide yawning/mouth straining movements and choose soft, chewable foods.

If pain occurs, a short-term warm compress may be helpful.

If teeth clenching/grinding is present, night guards may be considered.

What should you do now? - Consult an orthodontist: Panoramic X-ray, cephalometric analysis, and, if necessary, 3D imaging will clarify the plan (closing the gap or creating space for an implant).

• General Dentistry or Restorative Dentistry: Immediate treatment of the upper 16th tooth.
• Oral and Maxillofacial Surgery, if necessary: Implant plan or evaluation of impacted 48th tooth.

Quick questions (help clarify the plan):

• Do you feel your lower right 47th tooth is tilted sideways (food buildup/difficulty cleaning)?
• Does your upper right 16th tooth feel "longer," causing premature contact?
• Do you experience nighttime teeth clenching/grinding or morning jaw fatigue?
• Is the lower right 48th tooth still in the mouth or impacted?

Emergency warning signs: If you experience locking or opening of your mouth, severe and increasing pain/swelling in your joint, or a throbbing in your tooth that wakes you up at night, consult a dentist immediately.

Summary: Your description indicates dental asymmetry, which can likely be corrected with braces. Have the cavity at your 16th incision treated without delay and proceed to an orthodontic evaluation without delay.

I am not a doctor, and this is not a medical diagnosis.

The details were very helpful, thank you. Based on your description, the situation looks like this:

• There is tipping of the 47th molar and its displacement into the 46th molar.
• There is no sagging in the 16th molar (advantage).
• There is nighttime bruxism and jaw fatigue.
• The wisdom tooth is not impacted in the lower right (it has erupted).

In this case, correction with braces is highly likely:

• Goal: Straighten and move the 47th molar forward (including the 48th molar if necessary) and correct the bite. Miniscrews (temporary anchors) are often used. The duration is approximately 12–24 months.
• Alternative: Orthodontically widen the space to the ideal width and plan an implant in the 46th molar. This is possible in most people at age 18; imaging confirms growth. If the 48th molar (lower right wisdom tooth) has erupted, two common planning options are available:
• Retract the 48th molar and move the 47th molar forward more comfortably, or - Retract both the 47th and 48th molars to close the gap. This decision is determined by panoramic x-rays, cephalometry, and the need for space/anchorage.

Laminate veneers (front two teeth):

• Orthodontics can be performed with existing laminates. However, bonding brackets to porcelain surfaces requires a special protocol and sometimes carries a risk of breakage.
• Clear aligner treatment may be more comfortable in terms of protecting the veneer surfaces. For those with bruxism, aligners provide some protection.
• Discuss the question of "braces or aligners" with your dentist.

For bruxism and jaw joint complaints:

• Plan a night guard (occlusal splint) with your Prosthodontist or Oral and Maxillofacial Surgery. A traditional splint may not be suitable when there are fixed braces; be sure to consider it before and after braces. If an aligner is used, it provides partial protection during treatment. Daily recommendations: Avoid large yawns/mouth-straining movements, reduce hard/sticky foods, limit caffeine and energy drinks, especially in the evening, and engage in warm compresses and gentle jaw exercises (opening and closing within a painless range, controlled side-to-side movements). Stress management (sleep hygiene, relaxation techniques) can alleviate bruxism.

Steps to be taken now (recommendations):

1. General Dentistry or Restorative Dentistry: Have the cavity at 16 treated without delay.
2. Orthodontics: Detailed plan for erecting 47, closing the 46 space, etc., using panoramic x-rays and cephalometry. This will clarify whether miniscrews and 48 need to be extracted.
3. Prosthetic Dentistry: Night guard plan for bruxism and evaluation of the compatibility of your laminate veneers with orthodontics.

Quick follow-up questions:

• Is the lower right 48 full and easy to clean, or does food frequently accumulate behind it?
• Do you wake up with pain in your temples/head in the morning?

Emergency alerts: If you experience significant limitation/locking of your mouth opening, rapidly increasing pain and swelling in the joint, or a throbbing in your teeth that wakes you up at night, consult your dentist immediately.

Summary: Your misalignment is likely dental and can be corrected with orthodontics. The presence of a veneer does not preclude treatment; it may influence the method chosen. Be sure to schedule a night guard for bruxism and address the decay in the 16th denture immediately.

I am not a doctor, and this is not a medical diagnosis.

Thanks for the information. The description "My mouth is full of sores and my gums are very sore" suggests several causes, including stress/abrasion, aphthous stomatitis, viral (herpes/HSV and gingivostomatitis), fungal (candidiasis, especially if antibiotics have been used recently), or acute gingival infection (e.g., necrotizing gingivitis). Because it's common and painful, it's best to take this period seriously.

Preliminary assessment and what you can do - Get a general dentistry exam this week, and if possible, a periodontology evaluation. For widespread lesions, they will diagnose and plan the appropriate treatment (professional cleaning, topical/medication treatments).

• Home support:
• Rinse with warm salt-baking soda water (half a teaspoon of salt + half a teaspoon of baking soda in 1 glass of water), 4–6 times a day. - Chlorhexidine mouthwash (0.12%) twice daily for 7–10 days (use temporarily; may cause discoloration/taste changes).
• Canker sores: Orobase ointment containing triamcinolone acetonide (ask your pharmacist) applied to the lesion 2–3 times daily; if unavailable, hyaluronic acid gel or benzydamine spray/solution may provide relief.
• Paracetamol or ibuprofen can be used for short periods if appropriate for pain.
• Reduce irritation: Avoid very hot/hot/acidic foods and drinks, chips/nuts, alcoholic mouthwash, and toothpastes containing SLS; clean gently with a soft brush.
• If recurring, request blood tests from your family doctor for iron, B12, and folate deficiencies (Complete Blood Count, ferritin, B12, folate).

When should you see your doctor more urgently? - High fever, fatigue, sore throat, blisters/cracks on the lips, significant swollen lymph nodes,

• Severe gum pain, easy bleeding, foul odor, and gray-white plaques (suggesting necrotizing gingivitis),
• Inability to drink or eat, or persistent sores lasting more than two weeks, consult your dentist or family physician/dermatologist immediately. If HSV (cold sores) is suspected, antiviral treatment within the first 72 hours (if deemed appropriate by your dentist) will be significantly beneficial.

Your orthodontic plan - Do not start braces/treatment until oral sores and gum sensitivity have subsided; symptoms may worsen during this period. Aligners may be more comfortable for your veneers and bruxism. Plan a night guard for bruxism with your orthodontist.

Your most likely scenario is an aphthous lesion + gingival tenderness triggered by stress and occlusion/irritation. However, because they are common, HSV, Candida, or acute gingival infection should be excluded through examination.

A few quick questions to clarify the diagnosis:

• Are there high fevers, sore throats, and general malaise?
• Do the sores appear with widespread redness in the lip, gum, and gum area, or do they appear as a white, "milk curd"-like coating that can be wiped away?
• Do your gums bleed easily, and is there a distinct foul odor?
• Do these sores recur frequently? Do they last longer than two weeks?
• Do the sores also accompany genital sores, eye redness/light sensitivity, or painful skin blisters?

If the pain and bleeding increase, you become unable to drink fluids, or a fever develops, seek medical attention immediately.

I am not a doctor, and this is not a medical diagnosis.

You're right; let me summarize, specifically regarding your teeth.

Situation Summary: After the extraction of the right lower 46, the 47 tipped and shifted into the space; there is a midline shift.

The upper right 16 is decayed, but there is no sagging/early contact.

There is nighttime teeth grinding.

The lower right 48 has erupted and is well-cleaned.

Can it be corrected?

Yes, this situation can most likely be corrected with orthodontics.

Two main treatment options: 1) Closing the space - The 47 is straightened and brought forward into the 46 space; if necessary, the 48 is brought forward as well.

Temporary anchorage screws (mini-screws) are usually required.

Pros: An implant may not be necessary; the bite and midline are corrected; TMJ symptoms generally decrease.

Cons: It may take longer (approximately 12–24 months); sensitivity may occur during movement.

2. Creating space for the implant - The teeth are aligned, the ideal space is created in the 46 area; and once growth is confirmed, the implant is placed. - Pros: Orthodontic treatment may be shorter (approximately 6–12 months); establishing posterior relationships may be easier.

• Cons: Surgery and cost; long-term implant maintenance is required.

The option regarding 48-48 can be moved forward, making 47-48 easier, or 47-48 and 48-48 can be moved forward together. The decision is determined by site analysis, anchorage requirements, and panoramic/cephalometric measurements.

Laminate veneers - Treatment can be done with brackets, but there's a risk of porcelain chipping; special bonding is required.

• Clear aligners may be a good alternative and provide partial protection against bruxism.

Bruxism - Plan a night guard with Prosthetic Dentistry. The type may change during braces; if an aligner is preferred, a separate plate may often be unnecessary.

Priority steps 1) Restorative Dentistry: Have the decay at 16-48 treated without delay. 2) Periodontics/General Dentistry: Do not begin orthodontics until gum sensitivity and mouth sores have resolved.

3. Orthodontics: Clarify the plan with panoramic x-rays and cephalometry; discuss whether space closure or implant placement will be necessary, whether mini-screws or 48-tooth extractions will be necessary.

4. A good retention plan (fixed retainer + night plate) is essential at the end of treatment.

Is your priority to avoid implants or achieve results more quickly? We can narrow down the options together accordingly.

If you experience sudden worsening symptoms, jaw locking, or severe pain, consult a dentist without delay.

I am not a doctor, and this is not a medical diagnosis.

I understand; you want to avoid implants. In this case, the most appropriate approach is to close the space with orthodontics (molar protraction/advancing).

Possible plan for your case - Preliminary preparation:

• Have the decay in the upper right 16th molar treated immediately.
• Do not begin orthodontics until gum sensitivity and mouth sores have subsided.
• Orthodontic treatment:
• Straighten the lower right 47th molar and move it forward into the space of the 46th molar. In most cases, a temporary anchor screw (mini-screw/TAD; in the "buccal shelf" area) is required.
• Two options for the 48th molar (lower right wisdom tooth):

1. Pull out the 48th molar and move the 47th molar forward alone: Generally faster and more predictable.
2. Move both the 47th and 48th molars forward together: Implants are not required, but the time and difficulty increase.

• Alignment and midline correction in the upper arch; intrusion may not generally be necessary because the 16th molar does not prolapse. Duration:

• Often 12–24 months. If 47 and 48 are brought forward together, it can extend to 18–30 months. Using a retainer may shorten the time.

• Braces or clear aligners?

• For such significant molar movements, treatment with fixed brackets and retainers is more effective.

• Clear aligners can also be used; however, a retainer and strong elastics are usually required, and the time may be longer. Because your front teeth have laminates, a hybrid approach (brackets in the back, porcelain-specific bonding for the tray/brackets in the front) may be discussed.

• Bruxism and joints:

• Your symptoms are monitored throughout the treatment; jaw exercises and pain management are added if necessary.

• It is very important to plan for a fixed retainer and night guard (occlusal splint) at the end of treatment.

• Be aware of possible side effects/risks:

• Sensitivity during movement, small risk of root resorption, anchorage loss, recession in areas prone to gingival recession, and temporary posterior bite imbalance. All of these can be managed with proper planning and monitoring.

Key questions to ask your dentist at your first appointment: Will you use mini-screws to bring the 47th anterior forward? Is a "buccal shelf" TAD suitable?

Would it be more appropriate to move the 48th anterior forward or to bring the 47th and 48th anterior forward together?

How many mm of space will be closed, and what is the estimated timeframe?

What will the bracket bonding/hybrid plan look like with my veneers?

What type of retention/night plate do you recommend for bruxism during and after treatment?

Next steps: 1) Restorative Dentistry: Have the cavity at the 16th anterior repaired immediately. 2) Periodontics/General Dentistry: Have the gum and mouth sores heal. 3) Orthodontics: Detailed planning with panoramic and cephalometric radiographs; clarify options with the goal of complete space closure instead of implants.

With this approach, you have a high chance of avoiding implants. Scheduling an orthodontic visit promptly also prevents the existing misalignment from worsening.

I am not a real doctor and this is not a medical diagnosis.