Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

January 11, 2016

Maryland bridges keep coming off. Is there another solution?

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Dr. Hall,
I have a question about my daughter’s teeth… The two lateral incisors did not come in. The dentist put on braces and left a place to use a Maryland bridge. The wings are both broke and she has had them cemented several times. She is 21 now and has no dental insurance. Her dentist said that she could have implants but she will have to have a bone graft.. Would it be better for her to go back and have braces applied again to the top teeth only to pull them all close together and file them down… Then again I’m wondering about the price?
– Alaina from West Virginia

Alaina,
So your daughter is missing her two lateral incisors.

I would absolutely not bring the teeth together to close the space and then file down the canine teeth. I had a patient who had that done and later came to me as an adult to ask me to help make it look normal and there was no way to make the result of that look normal. The canines are thick, fat teeth that stick out in the front and that simply doesn’t work. Furthermore, the canines perform an important function in protecting the back teeth against sideways stresses and if you move them to the front, they can’t do that.

Here is a photo first showing the two missing laterals, which is probably the way your daughter looks now:
missing lateral incisors
And here is a photo showing what a smile looks like with the canines moved into the position of the lateral incisors:
missing lateral incisors after orthodonticsShaving the canines and even bonding to them or doing porcelain veneers would not look normal. Yes, it looks better than missing teeth, but as a cosmetic dentist, if a patient comes to me looking like this and wants the ideal solution, I would have them put in braces to move the canines back to their normal position and then use one of several methods to replace the lateral incisors.

The dental implants would be the best solution, no question. If there is money to do that, that’s what I would recommend.

However, the second best in my opinion would be a simple flipper partial. I had an office manager for my dental practice that used a flipper partial the entire time she worked for me. You would never know, meeting her, that her lateral incisors were not real. It’s a simple plastic plate with the twoflipper partial replacing lateral incisors teeth attached. It fits up on the palate and there are two wire clips, one on each side, that snap over the back teeth to hold it in. The cost should be pretty reasonable – maybe a couple hundred dollars, more or less. Here’s a photo of what that appliance would look like.

This isn’t the ideal solution. Some people have difficulty eating with these flipper partials and they have to remove them to eat. And over time, the jawbone shrinks where the missing teeth were. For a few hundred dollars more, you could get a more elaborate partial.

She could also get conventional porcelain bridges replacing these teeth, but that would require grinding down the healthy central incisors and canines. I would rather see her do the flipper and save up her money for implants later.

This monkeying with Maryland bridges, I would not do that. Not only do the wings of a Maryland bridge make the central incisors look darker, you can have problems with them staying in. I suspect that your daughter’s Maryland bridges were poorly designed, for all the trouble she has had with them. But even with a good design, they can be some trouble. I would prefer the flipper partial.

 

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

September 18, 2015

What to do about congenitally missing lateral incisors

Filed under: Cosmetic dentistry mistakes — Tags: , — mesasmiles @ 11:57 am

 

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Hello Dr. Hall,
I have an 18-year-old daughter who is missing the tooth next to her front tooth. She had a baby tooth there when she was little but there was never an adult tooth. The dentist told me the tooth next to that tooth would just shift into place. Well it kind of did but there is a gap and she does not like it. She doesn’t want to smile or take pictures. I took her to a dentist recently and they said she would need braces to shift the spot over and then add an implant, she does not want braces. Do you have any other ideas that we could do?
– Sandy from Maryland
 

Sandy,
Well, you got bad advice on two levels. No only did the tooth not shift the way your dentist said it would, but even if it had, the result would have looked funny.

This would have been pretty simple had it been addressed when the baby tooth came out. Your daughter could have had a temporary flipper partial replacing the one missing lateral incisor, and it would have looked okay and would have served until you were ready for a permanent tooth replacement.

Anyway, the second dentist is right. Not just from an esthetic standpoint, but also from a functional standpoint, the canine tooth should be moved back to where it belongs and an implant placed. The canine tooth is a key tooth and one of its functions is to protect the back teeth from sideways stresses. It has a very long root and it is a thick tooth, and in a normal bite it absorbs the sideways stresses when you chew. This is called canine-protected occlusion. If that tooth is out of place, your daughter could develop costly complications later in life.

And then there are the esthetic issues. Because of its size and shape, it is very difficult to make the smile look normal when you have this canine tooth in the place of the lateral incisor. The lateral incisor is a delicate tooth and thin. There is no way to make the canine that thin so it looks like a lateral without destroying the tooth.

There are ways to move front teeth without conventional braces, and maybe she would be okay with one of those methods. There is Invisalign, that can move the teeth with clear plastic aligners so that no one will know she has braces on. Is that what her objection is–she doesn’t want to be seen with braces? If your dentist hasn’t suggested this, just search for an Invisalign dentist near you. Or there is Six-Month Smiles, a technique for moving just front teeth quickly. That might work for her.

Her smile is so important for her social relationships, especially at her age. I would encourage her to get this done.

Dr. Hall

Here’s an example of what it looks likemissing lateral incisors to have the canine teeth where the lateral incisors should be. And this isn’t something that you can fix easily with bonding or porcelain veneers. A canine tooth is too bulky to be able to make it look like a lateral incisor. And Sandy’s daughter would look worse than this because she’s missing the lateral incisor on only one side.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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