13 Year Old Missing Lateral Incisors - Close Space or Open for Implants?

My son is missing both lateral incisors. One ortho says to close space and shape teeth because even if implants are placed once growth has stopiped, teeth still natural move as we age and implants would remain still. The other ortho says to open the space and place implants once he stops growing around 23-25 year old, until them use a bridge to fill in the space of the missing teeth. He is already very self conscious regarding his smile and want to make the right decison. Any one have advise?

Doctor Answers 5

Close space vs implants

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If you are looking at long term solutions, either option will work.  If you are looking for long term aesthetic solutions, I would go with the implants.  This will give your son 1.) more teeth to function with, 2.) a more natural smile, and 3.) more confidence in that his teeth and mouth will appear normal when compared to his peers.  Trying to make canines look like laterals is very difficult.

Portland Dentist

Close Lateral Incisor Space or Open for Implants?

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Aesthetically opening the space for Implants is the best option, not that there won't also be aesthetic challenges for your son. As laterals they are highly visible up front during smiling, and creating aesthetically pleasing "gum" gingival anatomy around the Implants is going to be a little difficult. That being said, i still believe the Implant option would be better than trying to "lateralize" the canine teeth. 

Implants have been improved significantly over the years and now we have options for thin implants in the anterior lateral zones, that give great final results. As pointed out, proper Ortho is essential to align the roots of the Centrals and Canines, and bone quality at the lateral sites will have to be assessed with some scans. 

Would love to see the pictures as your son's case progresses. 

Paul Newitt, BSc, DMD
Vancouver Dentist

Dental Implants For Missing Lateral Incisors

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Without question, the wisest choice aesthetically  would be to orthodontically open the spaces to make sufficient room for dental implants.   I have seen too many cases where canines are moved into the positions of the congenitally missing lateral incisors  and this is an aesthetic disaster most of the time!  For an orthodontist this can be difficult to do and time consuming, but it is the best option.  Find an orthodontist that enjoys the challenge of this case and have them create the spaces.  When the braces are ready to come off retainers will be made to hold the spaces intact until your son is old enough for the implants.  Around age 18 he can have a 3D CT scan taken of the areas that are to receive the implants.  If the bone is sufficient at that time procede with the implants.  If not, he may have to wait a couple more years. Good luck.

Open the Spaces

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As a cosmetic-oriented dentist, in my opinion it is virtually impossible to make canine teeth appear like natural-looking lateral incisors.  That being said, I would highly recommend that you follow the advice of the second orthodontist and have the lateral sites spaced out properly being sure that the roots of teeth on either side of the sites are positioned so as to not converge into the site and infringing on space necessary for implant placement.To hold the spaces until your son is of age for implants use a zirconia framework resin bonded retainer on each side.

Good Luck!!

Gary Nack, DDS
Philadelphia Dentist

Missing Laterals Incisors

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I would recommend placing implants as an ideal esthetic outcome.  The cases that close the space and reshape the canines to look like lateral incisors do not look as good in my opinion.  Often the facial profile will look flat and the bite will not function as well.  Maintaining the bone width and proper spacing  for future implants can be a challenge though. He may be a candidate to place the implants as early as 18 years old depending on how quickly he matures.  

It is true that teeth do move as they have a natural ligament surrounding them while a dental implant fuses to bone and will not move. Dental implants are stronger than your natural teeth. 

A good orthodontist should be able to have a stable bite and promote longterm stabilization to keep teeth from moving.  Having orthodontics is a lifelong commitment to wearing retainers if you want the teeth to not move at all.  Good luck!








Sarah Roberts, DMD
Atlanta Dentist

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.