Ortho and implants, one plan.

The problem this solves

Orthodontics opens space. Implants and restorations then go into it. Run sequentially by separate providers, the restorative plan starts with a gap that already exists and has to make the best of it.

But the restoration has a correct width. Golden-proportion arguments aside, there is a dimension that looks right for that patient, that tooth, that smile — and the orthodontics is perfectly capable of producing it if somebody says what it is before the aligners are made.

So the sequence runs from the end backwards. The final restoration is designed first, its width is measured, and that measurement becomes the orthodontic target.

What we need from you

• Intraoral scans and the bite
• CBCT where implants are involved, covering the planned sites with the adjacent roots visible
• Full photographic series, including a smile at rest and in animation — the restorative design is partly an aesthetic decision and cannot be made from casts
• The restorative intent: implants, resin-bonded bridges, or a combination, and any sites you have already ruled out
• Periodontal status and bone volume at the planned sites

How it runs

1. The restorative design first

Before any tooth movement is planned, we design the intended final restorations and establish their widths, positions and emergence. This is the specification everything else is built to.

2. Root positions, not just crown positions

Opening a space at crown level while the roots converge below it produces a gap that looks correct and will not accept a fixture. Implant sites need root divergence planned deliberately, with the fixture diameter and the safety margins in mind from the start.

3. The orthodontic plan, built to those numbers

Staging, anchorage and space distribution all follow from the target widths. Where the required movement is not achievable, that surfaces now — while the restorative design can still be adjusted — rather than at the end.

4. Implant planning into the planned anatomy

Fixture positions are planned against where the roots will be, not where they are today.

What leaves the lab

• The restorative design with target widths, dimensioned
• The orthodontic setup staged to achieve them, including root positions at the implant sites
• Implant positions planned into the post-orthodontic anatomy
• The surgical guide, when the time comes
• A sequence with the decision points marked, so everyone involved knows what has to be true before the next stage starts

Where these go wrong

• Space opened to a round number rather than to the restoration
• Crowns diverged, roots not, so the site will not take a fixture
• The restorative plan made after the orthodontics finished, inheriting whatever it produced
• Retention not planned across the interim period, so the space closes while everyone waits for bone

Timeline

Five working days for the combined plan. It is longer than either part alone because the whole value is in the two being resolved against each other before either starts.