The laterals, which are the teeth on either side of the front two teeth in your mouth, are sometimes missing and sometimes misshapen. Most often, they are narrower than what would be expected, leaving spaces on one or both sides of the teeth. Except for wisdom teeth, and an occasional lower bicuspid, the laterals (teeth numbers 7 and 10 in the dentist world), are the most common teeth with shape problems.
When one or more laterals are missing in a young person, orthodontists may treat the problem with a couple of different approaches. They may leave the spaces open, allowing the restorative dentist to replace the tooth/teeth with implant crowns or permanent bridges when the child is done maturing; until that time, a removable appliance – like a retainer or “flipper” – may be used to help with a more normal appearance. Another alternative is moving the canines or “eye teeth” into the space. Unfortunately, since the canines have a different size and shape than the laterals, it becomes a challenge for the operative dentist to make it look “normal” and achieve correct proportions.
If the laterals are present in the mouth but are narrow or even pointed, it is advisable for the orthodontist to allow enough room on either side of the tooth for bonding or a veneer or crown. In this manner, the teeth can be placed in an idealized position for the restorative dentist to make the laterals look completely normal. As an aside, but an important one, there are often tissue complications associated with a missing or misshapen tooth. Fortunately, with the use of a diode laser, excess tissue covering up the top or sides of the lateral or space can be easily removed (like lifting up or opening a window shade), resulting in a more normal “architecture.” This approach, otherwise known as gum contouring, is a key element.
So whether a lateral incisor is missing or misshapen, there are lots of considerations in restoring the space. The options in treatment, from orthodontics to restorative dentistry to gum and tissue (periodontal) conditions, are varied and require study and discussion before embarking on definitive care. Thankfully, today’s advancements in cosmetic dentistry allow for successful treatment of the situation, resulting in beautiful teeth and smiles!