Missing Lateral incisors

Some people never develop certain teeth (the teeth are congenitally missing). This is an issue of genetics and has nothing to do with external factors (amount of milk that the person drank as a child, lack of vitamins, etc.). The patient below was congentially missing her permanent upper lateral incisors (the teeth second from the middle). In the pictures below, what you are seeing as the tooth second from the middle on her right side is the primary lateral incisor, with the permanent canine erupting to the inside of the primary lateral.

Together with her parents, we decided to have the canines replace the missing laterals. This required reshaping the canines in three different areas (keeping in mind that unless the canines will be crowned (have caps laced on them), they can only be reshaped to the extent that the integrity of the tooth is not compromised. Even when crowning the canines to change their shape, there are limitations - the canine roots are larger than those of the laterals):

  1. They must be made more narrow, since the laterals are more narrow than the canines.
  2. They must be made thinner where they contact the lower teeth. Otherwise their increased thickness relative to the laterals will cause the roots of these teeth to be more prominent and they will stick out from the lower teeth.
  3. The tips must be flattened. The canines have pointed tips, whereas the laterals have flat edges.

In addition to the reshaping issues above, other factors need to be considered, such as the gum levels on the canines relative to the adjacent teeth, the color of the canines (they tend to be darker or have a more orange hue than the incisors), the size and tip of the roots of the canines, the size of the canine crowns, the patient's jaw pattern, cost issues (for restoring the missing teeth with implants/bridges), treatment time factors, midline positioning (especially if missing a single lateral), etc. when deciding on replacing the laterals with the canines vs. restoring the missing laterals.

For this patient, the lower left second premolar was impacted and this tooth had to be exposed so that I could bring it up into place.



Total treatment time was 2 years 4 months.

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