I Am Missing my Upper Left Lateral. Please Suggest Options for Correcting my Uneven Midline? (photo)

Question

My upper L lateral was pulled in order to "save" my upper L canine which grew right above it (ectopic eruption). It took 8+ years of braces to move the canine down and into the lateral's space. I've noticed that my upper lip and nose seem to have shifted with my teeth, and one side of my face looks flatter. It's not too noticeable when I'm smiling/posing for photos, but I'm very self-conscious when I speak. What options do I have, and how long would they take? More details in my photo captions.

Scott Young, DDS · Answer

I would typically advise  you to seek an orthodontic consult first, but considering that you spent eight years in braces in the past this would not be realistic.  I think that you would have a dramatic improvement with a combination of porcelain crowns, veneers, and perhaps a dental implant for the missing lateral incisor.  This would help improve a host of issues:

	1.  Midline could be improved

	2. The slanting of your smile (Canting) from left to right could be made much less noticeable.  

	3.  Symmetry could be added to your smile by adding an implant and making both lateral incisors the same size and shape.  

	This is not an easy case and requires a cosmetic dentist with a great deal of experience treating difficult cases.  Look for a dentist that has training from a reputable cosmetic institute such as The Las Vegas Institute For Advanced Dental Studies.  Also, look at before and after pictures of cases that they have treated to make sure like the results that they can offer you.  The lab technician that the treating dentist uses is also crucial for the success in this case.  Your smile can be amazing in the right hands.  Choose wisely!  Good luck.

Gerry Curatola, DDS · Answer

Based on your photos, I believe you are an excellent candidate for Invisalign at this stage. The missing lateral and canine moved into the lateral incisor position can present some aesthetic challenges but they are correctable. My aesthetic concern from your photos is the "canting" of your midline (appears on a diagonal) which exacerbates the lack of balance in your smile. I would advise having diagnostic records taken for Invisalign first and then some cosmetic bonding or veneers after treatment completion for the tooth contour changes that should be made to provide symmetry in your smile.

Robert Penning, DMD · Answer

Hi

	When studies were done on how much people noticed midlines being off centre, most dentists and orthodontists didn't even see the problem in smile photos unless it was more than 1.5mm from the centre of your face. Likewise, when upper and lower midlines didn't match. In your photos, the tipping is more noticeable that the midline.

	Reshaping the incisal edges to follow the contour of the lower lip when you smile will improve the appearance from a social distance. Some bonding on the shorter side will improve the symmetry from a social distance. Beyond that, the tipping would require bonding or veneers from what I can see. Hope this helps.

Jay Neuhaus, DDS · Answer

You have a very complex situation. Do NOT expect to get a good answer on this forum. You need a consultation with a very experienced Cosmetic Dentist who can take X-rays and then advise you on orthodontics and/or Porcelain Veneers/Crowns.

Paul Newitt, BSc, DMD, AFAAID - Account Suspended · Answer

There a couple things you have mentioned that suggest you have already put a lot of effort into getting your teeth to where they are presently. The Orthodontics is always the first option for aligning the teeth and it seems you have made use of that option. You also mentioned that the canine had been shaped to appear more like a lateral once the braces were off. That is often what we do in cases where a canine is in the lateral position and is part of the aesthetic solution when doing smile design. 

	Although you don't have a picture of a wide smile. showing your gums, your gums will be an important factor in any treatment plan for aesthetic correction of your smile. This again, is something that needs to be discussed with a dentist with experience in smile design techniques. 

	You can certainly consult with a dentist experienced in advanced smile design and get a few options. The pictures do help but more diagnostics would be required to provide sound options.

	Often in cases where we have a midline cant, midline shift, canine in the lateral position, diastemas (spaces between teeth), and cant in the smile, we can use crowns and veneers to shape the teeth and position the teeth more aesthetically. "Lateralizing" the canine, as you have mentioned, is part of that process. The teeth behind that canine also have to be shaped to match the teeth on the right side of your mouth to even out your smile bilaterally. 

	As far as the flatness to one side of your face Vs. the other, i think you may be dealing more with a bony situation there. The bone over the canine teeth is more prominent than over a natural lateral incisor. This doesn't show in your pictures so it hard to say exactly what is going on. In some cases "flatness" can be corrected with dermal fillers but this would have to be discussed between your dentist and physician providing such services.

I Am Missing my Upper Left Lateral. Please Suggest Options for Correcting my Uneven Midline? (photo)

Answers (5)

Answer: Missing Lateral and Uneven Teeth & Midline

Answer: Missing Lateral and Uneven Teeth & Midline

Answer: Options for Correcting Uneven Midline

Answer: Options for Correcting Uneven Midline

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I Am Missing my Upper Left Lateral. Please Suggest Options for Correcting my Uneven Midline? (photo)

Answers (5)

Answer: Missing Lateral and Uneven Teeth & Midline

Answer: Missing Lateral and Uneven Teeth & Midline

Answer: Options for Correcting Uneven Midline

Answer: Options for Correcting Uneven Midline

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Recommended reading

Everything you need to know about Smile Makeover

Our mission is to create a world where every investment in modern beauty is Worth It.