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

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.

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.

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!!