Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

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

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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