Braces with existing dental work

Crowns

Brackets can be bonded to porcelain, but the bond is weaker than to enamel and needs surface preparation and a different adhesive. Expect the occasional debond on a crowned tooth. A crown also has a shape decided by its previous position, so once the tooth is moved the crown may no longer look or fit ideally — worth knowing before, not after. Where a crown is old and due for replacement anyway, doing that after orthodontics is usually the right order.

Implants

An implant is fused to bone and does not move. That makes it a fixed point the plan works around — occasionally a useful one, since it can serve as anchorage. It also means the position an implant was placed in constrains what the rest of the arch can do. Where an implant is planned but not yet placed, orthodontics goes first: the space is opened and the roots either side are uprighted to receive it, which is one of the most common reasons a general dentist refers an adult here.

Veneers

Bonding to veneer porcelain is possible with care. The larger issue is that veneers were shaped to disguise the tooth positions you had, so straightening those teeth may reveal that the veneers no longer suit. Patients who have veneered front teeth to camouflage crowding are often better served by orthodontics first and new veneers afterwards — sometimes with less aggressive preparation than the originals required.

Fillings, bridges and root-treated teeth

• Large fillings reduce the enamel available for bonding; position may shift slightly to find a bondable surface.
• Bridges splint the teeth they join, so those teeth move as a unit or not at all. Sectioning a bridge is sometimes part of the plan.
• Root-treated teeth move normally. They may be slightly more prone to root resorption, so progress is monitored with that in mind.

Sequencing

The general rule is orthodontics first, definitive restorative work second, because it is easier to build a crown to a corrected position than to move a tooth already built. We coordinate with your general dentist before starting so the order is agreed rather than discovered.