If you have an implant, crown, bridge, veneer or filling in your mouth, clear aligner treatment is still possible in most cases; however, the type of restoration changes the plan. Natural teeth can be moved with clear aligners, whereas an implant is fused to the bone and does not move, and ceramic crowns and porcelain surfaces can make it harder for attachments to hold. For this reason, in these situations the treatment sequence, the design of the aligners and when the restorations will be renewed are planned in advance. This information is general; the decision for you is made after an examination.
This page explains which restorations do not cause problems with clear aligners, which need care, and in what order orthodontics and cosmetic dental treatment proceed. For a shorter summary of the topic, you can also look at our article can you have clear aligners with crowned, filled and implant teeth.
Can you have clear aligners with an implant in your mouth?
Yes, in most cases you can. Because an implant is a titanium root fused to the jawbone, it does not move with orthodontic force. That is, clear aligners cannot shift the implant; the aligner only moves the natural teeth around it. Although this may look like a limitation, it can be useful in planning: the implant can be used as a fixed point, and the other teeth are arranged around it.
The points to watch are as follows:
- Because the tooth arrangement in the implant area cannot be changed afterward, the final position of the teeth should be planned before the implant is placed.
- The crown on the implant does not adapt to new tooth movement at its contact points with neighboring teeth; after movement, the contact may be disrupted and the restoration may need to be renewed.
- Gum and bone health around the implant must be protected; hygiene is important while the aligners are in.
If you are planning an implant because of a missing tooth and space needs to be opened first, the details of this topic are on the page clear aligners with missing teeth. For general information about the implant itself, you can read the article what is implant treatment.
How does each restoration behave with clear aligners?
Because the material of each restoration and its connection to the tooth are different, its situation in clear aligner treatment is different too. The table below shows the general framework; the definitive evaluation is made at the examination.
| Restoration | Does it move with clear aligners? | Point to note | What is usually done? |
|---|---|---|---|
| Implant | No, it is fused to the bone | Neighboring teeth are arranged around it; contact points may change | Orthodontics is planned first, and the implant is placed according to the right position |
| Single-tooth crown | The natural tooth underneath moves | Attachment retention and the crown margin | The aligner can also be used over a crowned tooth; the attachment location is chosen by the doctor |
| Bridge | Connected teeth move as a single piece | The bridge abutments cannot be moved one by one | The bridge is planned as a block or renewed after treatment |
| Veneer (laminate porcelain) | The tooth underneath moves | Attachment retention on the porcelain surface and surface integrity | It is usually renewed or checked after orthodontics is finished |
| Filling | The tooth moves | The margin of an old filling, overhang or leakage | Checked before treatment; renewed if necessary |
| Temporary crown | Can be used with the aligner but may be weak | Aligner force and the risk of breaking off when removing the aligner | The timing of the permanent restoration is planned with the doctor |
Can an attachment hold on a crowned tooth?
Attachments are small, tooth-colored bumps bonded to the tooth that help the aligner move the tooth. On natural enamel, attachment retention is usually good. On porcelain, zirconia or ceramic surfaces, the surface is different, so bonding requires special preparation and lower retention than on a natural tooth may be seen. In these cases, the doctor may consider placing the attachment not on the crown but on a neighboring natural tooth, choosing a different shape, or designing the aligner so that it provides additional retention.
When an attachment is removed, a mark or a change in shine may remain on the crown surface. For this reason, placing the attachment on the crown and cleaning it afterward should be discussed in advance. You can read what an attachment is and why it is used in the article what are Invisalign attachments.
Can you have clear aligners with a bridge?
Because several teeth are connected to one another in a bridge, these teeth behave as a single piece. Clear aligners cannot move the connected teeth under a bridge separately. On the other hand, the natural teeth outside the bridge can be moved with the aligners. The orthodontist may plan the bridge as a single unit of movement or may recommend that the bridge be removed and renewed after treatment. The bone support of the bridge is also important; if there is gum disease or bone loss, this needs to be evaluated before orthodontics.
For general information about bridges, you can look at the article what is a dental bridge, and for cleaning under a bridge, the guide to floss for under bridges.
Orthodontics first, or cosmetic treatment first?
The general approach is to complete orthodontic treatment before cosmetic restorations such as permanent crowns, veneers or crowns on implants. This is because, as the teeth move, their shapes, contact points and margin boundaries change. A newly made crown can become ill-fitting because of a tooth that shifts during treatment and may need to be renewed. Once the teeth are in the position they should be, if the crowns are made with the right impression and contacts, both the aesthetic and the functional result are more predictable.
Temporary solutions may be needed during treatment. For example, a temporary restoration can be made for a crown that has broken or been lost, but its compatibility with the aligner is evaluated separately by the doctor. In situations that require tooth extraction, orthodontic movement can also come first and then the implant plan; this timing differs from person to person.
How does the aligner adapt to the shape and manufacture of a restoration?
The aligner is produced from a digital impression of the teeth. All restorations in the mouth appear in this impression, and the aligner is designed according to their surface shape. For this reason, if old fillings and crowns have a fracture, overhang or roughness, it is important to correct them before the impression is taken, because the aligner follows the shape in the impression exactly. If a restoration is changed after the impression is taken, the aligners may need to be renewed to fit the new shape. That is why seeing restoration problems before the impression protects the flow of treatment.
The digital impression taken with the iTero scanner used at the clinic and the planning in the ClinCheck software make it possible to take the condition of the restorations into account as well. For general information about the technology, you can look at our technology page.
What happens if a restoration problem comes up during orthodontics?
During treatment, a filling may fall out, a temporary crown may come off or a crown may loosen. In such a case, instead of continuing to wear the aligner, you need to let your clinic know, because an exposed tooth can change the fit of the aligner and the treatment plan must be updated. For general information on a crown falling off, you can look at the article crowned tooth falling off. An attachment coming off is a separate issue, and whether it can be bonded again on a crowned tooth depends on the doctor's evaluation.
Is tooth reshaping (IPR) done on teeth with restorations?
In clear aligner treatment, a very small amount of enamel can be removed from tooth surfaces to create space (IPR). On surfaces with crowns, veneers or bridges, this procedure is generally not done or is planned very carefully, because there is a boundary between the porcelain surface and the natural tooth. If needed, the space is obtained from natural teeth without restorations or by other methods. This decision depends on the doctor's evaluation.
Restorations and the retainer after treatment is finished
When orthodontics is completed, the teeth must be held in their new positions; a retainer is used for this. In mouths with crowns, bridges or implants, the retainer design is made according to these restorations. If a fixed wire retainer is to be placed, the surfaces of the restorations are also evaluated. You can find information on the retention period and its duration on the page retainer after clear aligners; the article protecting teeth after orthodontics with a retainer can also help with the general discussion on duration.
What information should you prepare before clear aligners if you have restorations?
- Which of your teeth have crowns, implants, bridges, veneers or large fillings, and when they were done
- Your old X-rays and the notes of the doctor who made the restorations, if any
- Cosmetic or implant procedures you are planning
- Additional conditions such as teeth grinding or gum disease
Sharing this information at the examination makes it easier for the orthodontist and doctors from other specialties to manage the treatment within the same plan. You can see the preparations for the initial evaluation on the page orthodontic consultation question list; general information on whether clear aligners suit you is on the page who are clear aligners for.
How are patients with restorations evaluated at our clinic?
The Invisalign system is used at Funda Sarıkaya Oral and Dental Health Polyclinic. At the first examination, Funda Pekyılmaz Sarıkaya, specialist orthodontist (Uzm. Dt.), evaluates the existing implants, crowns and fillings in the mouth together with clinical and imaging findings; when needed, the cosmetic dental treatment or implant plan is arranged according to the orthodontic sequence. The clinic is located at Park Oran Ofis in Oran, Çankaya, and is open Monday–Saturday, 09:00–20:00. For appointments and questions, you can get in touch by phone at 0312 911 60 36 or via WhatsApp. Fee information is given in writing after the examination and planning.