just over 3 years ago i had my right canine tooth taken out because it had become flat in my gum and it wasn't in the right position to come out. I had my braces taken off today after 3 years and four months and can see that my top teeth are going slightly to the right and feel that my two front teeth doesnt look like they're in the right position. I feel that my othordontics lady does not do a very good job and would like to go to another place. Please help me.
My Two Front Teeth Are Not in the Middle and I Dont Have a Canine Tooth, Can I Do Anything
Doctor Answers (5)
This is a difficult case to manage at this point there are 3 options: 1) go back into braces open up the space for right canine and replace with implant supported restoration. This could take up to 3 years to accomplish but offers good results that are long lasting. 2) accept the current tooth position but try to reshape the teeth with some aesthetic bonding based an a functional aesthetic wax-up This option will be quick but is limited on the amount of change in the smile. 3) use porcelain veneers to camouflage the tooth shape and position making the tooth currently in the right canine position look like a canine and correct the midline position of the front teeth. Because of the amount of change needed to get ideal aesthetics this option will require aggressive reduction of some of your front teeth. The veneers are quick to do but will need multiple replacements over you're lifetime. You need to find a cosmetic dentist and review these options. Maybe doing nothing is best. Find someone you trust and talk things over with you're doc. Hope this helps.
Dental Midline Shift and Mismatch
In looking at the facial photos you included I do not think the midline is very far off the center of the face, probably 2 mm. or less. Most people will never notice a midline discrepancy up to 2 mm. and it only becomes really noticable at about 4 mm. (kokich) When the decision was made to extract the cuspid it must have been in a pretty bad position or most orthodontists would certainly have tried to save it. I would give it some time to see if you get used to the appearance and try to leave it alone. You just got your braces off today and you are not at all used to what the teeth look like even if they were perfect. I would certainly not go back into 3 years of ortho to open up space and put in an implant. From what I could see in the front, the result looked resonably good for a situation where the cuspid had to be taken out for whatever reason. Give it some time.
ReTreat the Case
Your case is a difficult one but you do have choices. In my opinion, the most conservative way to treat this is to see another orthodontist to re-open your canine space, then place an implant. This will also allow for straightening of your upper anterior teeth and alignment of your midline. Any other choice will involve removal of tooth structure (probably significant removal to reverse the canting) and future replacements of the restorative work throughout your lifetime every 10-15 years or so. Be sure to employ a team approach to your treatment, involving your general dentist, the orthodontist and a oral surgeon/periodontist to obtain the best result. I hope this helps to answer your question.
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Replacing a missing tooth with an implant
Do your research and find an experienced cosmetic dentist who can: 1) offer a non-ortho solution with cosmetic dentistry or 2) refer you to another orthodontist who can open up the canine space for possible implant. In case #2, you would want to ask your cosmetic dentist to also refer you to a periodontist or an oral surgeon to explore your options for a single tooth implant to replace the missing canine. You might also consider whitening all your teeth prior to having any work done so you can have your new restorations match the whiter tooth shade.
How to give the illusion of straight teeth with restorations
Orthodontics on a case like yours is a challenge due to the spaces that have to be corrected. The cant that you have is noticeable but not terrible. If you want things to be perfect then i feel that some veneers will be in your future to fix the spacing issues. they will be able to fix the spacing and "leaning" of the front teeth. This is an aggressive option but will give good results and be predictable with the right lab and dental cosmetic team. Going back into ortho is another option but getting the perfect angulation of the teeth will take time and the space from the missing canine could be a cause of concern in the future
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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