My Two Front Teeth Are Not in the Middle and I Dont Have a Canine Tooth, Can I Do Anything

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.

Doctor Answers 8

Instant orthodontics.

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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.

Toronto Dentist

Quick Fix

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I have an easy answer for you.  In looking at your smile, I don't see that the 2 front teeth are in the wrong place. In fact, when a patient loses a primary cuspid, and doesn't have the permanent one, the orthodontist evaluates the space available, and moves the teeth to close the space.
1. Just from looking, it appears to be a very nice orthodontic result.

2. HOWEVER, I do see the problem that you do not like.  The problem is that the right and left sides of the smile do not match. In the cuspid area, you have a natural left cuspid, which has a special shape.  On the right, the bicuspid was moved into the space, and is a smaller tooth.  That's why the shapes do not match. There is not symmetry in the front 6 teeth.

3. Good news....when there is only a shape problem, 1 beautiful veneer can be placed over the right bicuspid, changing its shape to match the other cuspid!  This can also be done in bonding....but only by a very skilled cosmetic dentist, who can create a shape match and color match to your other teeth.
I hope I led you in a new direction to rethink what it is you do not like. In my office, I would perform a test with temporary bonding, shaped on the right bicuspid . Chair side, we would discuss, and take photos, to confirm my hunch that would vastly improve your smile line, and create something you liked very much. 

Paula S. Gould, DDS
Englewood Dentist

My Two Front Teeth Are Not in the Middle and I Dont Have a Canine Tooth, Can I Do Anything

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Anytime a patient loses any one of the front six teeth it really complicates treatment.  It loos like your orthodontist did a nice job, almost closing the space where the cuspid once was.  To get your upper midline to match your lower midline, the resulting space would end up being larger.  That in itself would certainly be more objectionable to you I'm sure.
Do you know the actor Tom Cruise?  Did you notice how much his midline was off?  About 4mm whereas yours is only off about 1mm.  Or did you know that the actor Cary Grant only had one upper incisor and his midline was way off as well.  The reason that the midline is not very important is that as long as the teeth are straight up and down, upper compared to lower teeth, it is rarely noticeable to others.  My suggestion is that it is not a critical thing that would be worth going through more orthodontics, moving the teeth around again, then needing a implant or a dental bridge.
Saying all that, in my professional opinion the best way to solve the resulting issues you're having would be with going to a cosmetic dentist and getting porcelain veneers, probably a minimum of eight upper veneers to make things look the best they can.

Norman Huefner, DDS
Laguna Niguel Dentist


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Although you have many choices, I feel veneers are the best choice.  You could have that canine made to look like a lateral incisor and the bicuspid made into a canine.

Dental Midline Shift and Mismatch

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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.

Clark L. Jones, DDS, MSD
Phoenix Orthodontist

ReTreat the Case

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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.

Gary Nack, DDS
Philadelphia Dentist

Replacing a missing tooth with an implant

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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

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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

J. Willis Baker, DDS
Wichita 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.