I am missing my lateral incisors and my canines grew in their place (leaving me with a gap and a baby tooth) .I do not have enough room for implants without moving my teeth. I went for an invisalign consultation and she recommended I go with traditional orthodontics. Should I move my front four together, have the canines shaped into laterals, and get two canine implants? Or do I have these five removed and get all implants? Money isn't a problem, i'm on a time contraint for my wedding in '14
Implants Vs Moving Teeth? (photo)
Doctor Answers (7)
Congenitally Missing Lateral Incisors...to treat with orthodontics, implants, etc.???
First, I would have the deciduous (baby) canines removed and implants placed in the canine areas. The implants would then have crowns placed on them that will have the shape of canines.
Then to "move" the four front teeth that have spaces, place porcelain veneers. This is sometimes called "instant orthodontics." It will make the four front teeth look normal with the porcelain veneers on the central incisors and on the canines that are in the lateral incisor position look like lateral incisors.
If you look at the web reference link below you will see a case where I made the canines look like lateral incisors and first bicuspid teeth look like canines. The patient was missing lateral incisors and you can see how nice the end result with this kind of treatment looks utilizing porcelain veneers.
Do not remove all 5 teeth.
DO NOT REMOVE ALL 5 TEETH!!! You would NEVER want to do that! Without seeing models or x-rays, I would tell you to get traditional orthodontics, and have the spaces opened up so you could place 2 implants where your laterals should be (of course, removing your baby tooth in the process). You would rather leave your natural canines alone, instead of trying to make them into something they are not. For best aesthetic results, and the most natural looking smile possible, get the orthodontics done, place the implants in the lateral spaces, and place some nice all porcelain crowns. And since it’s for your wedding, make sure you do some bleaching a couple months before you place the permanent crowns so you can have a nice, bright smile.
The traditional orthodontic route (vs invisalign) is most certainly the best way to go. You have flexibility on having the canines reshaped at the lateral sites (a little faster) or moving them into their ideal canine position. Sometimes reshaping the canine to look like a lateral can be difficult or lead to other issues as a lot of tooth structure needs to be removed (read: you may need a root canal and will definitely need at least veneers or a crown to make them really resemble lateral incisors) So timing wise this may make sense but may offer some issues with increasing the cost/invasiveness of the procedures. As most have stated, getting the canines into their true position and placing implants at the lateral sites and replacing the primary (baby) teeth with implants is your best ultimate option.
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Implants for Missing Lateral Incisors
As mentioned previously there are several options for you. Also taking care of the situation the "quick" way is not the best option. From your photos it appears that you have an overbite in addition to the missing laterals. You may have a narrow upper acrch as well, but this is difficult to say from the photos. The best option for you id tradtional ortho to get your arches level and aligned. Move the canines to the proper position, then place implants in the lateral region. This is a treatment that should last you decades. If you feel you need veneers for esthetics after ortho that is up to you, but remember that Veneers have a limited lifespan and will need to be redone on a regular basis. The other options mentioned are viable, but ultimatley it is up to you to decide what is best for you as long as you have been prperly informed of all risks and benfits of all options
How to replace missing laterals
Best option is not always the fastest option or the most aesthetic. You cannot move teeth too fast , teeth will get loose.
- Fast option: upper arch 14 veneers/crowns . This allows correction of bite and smile make over. Makes canines look like laterals, and first bicuspids( tooth behind the canines) into canines.
- longest and most conservative option : orthodontic. move the canine bck to canine position, place two implants in lateral position.
- Best option: move canine to canine position, centrals closer together to leave room for laterals. Place implant on laterals and then 8 veneers, 2 crowns ( on implants) to get a smile make over.
Good luck and happy wedding
Invisalign, Orthodontist, Prosthodontist, lateral incisor, implants
You are actually fortunate that the canines grew into the lateral position. When lateral incisors are missing, many times the bone in the area is insufficient for implant placement and then multiple surgeries are required.
Bringing the canines to the lateral position and them moving them back to their proper position allows us to have excellent quality and quantity of bone in the area. However, you have to move fast. It does take time to move the teeth, and conventional orthodontics (braces) will give you much more control over the movement of the canine roots within the bone. This can be done with invisalign, yet the immediate control traditional braces give you are an advantage. I would stick with that.
Prior to beginning the orthodontic treatment, however, you should see the most trained person in the restoration of this very visible and challenging procedure, the Prosthodontist. A Prosthodontist receives three more years of additional training in handling cases such as your, and some even perform their own implant surgery, giving you the most control over the procedure. The Prosthodontist is the expert in cosmetic, restorative, and implant dentistry. Let the Prosthodontist, who will be placing the final crowns on the implants and possibly the necessary veneers communicate with the Orthodontist and determine the optimal position of the canines. Even of the implants are to be placed by an oral surgeon or a periodontist, the exact position is dictated by the work up of the Prosthodontist.
You have a high smile line and you show all of your teeth and gums, if your case is not planned perfectly from the end result back, you will end up with an uneven gum-line and potentially a very problematic result. Ask the Prosthodontist to see photos of prior work like your and make sure that you like the work.
Excellent results always start with proper planning and small steps. Take the time, find a person with whom you are comfortable and go for it.
Best of luck.
Implants vs Moving Teeth
Ideally, you should have traditional ortho to move the canines into their correct positions, move your 2 Centrals together, then place implants where the laterals should be. Then, if you still need more cosmetic improvement, you could have Porcelain Veneers placed on the centrals, canines and first bicuspids on both sides (6 Veneers) at the same time that the crowns are made for the 2 implants (laterals). Have a consultation with an orthodontist and explain your time constraints to make sure there is enough time to move the canines.
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.