Missing #5 tooth for over 10 years, gap closed, assymetry in the face; what should I do?

Hi there, thank you for your question. I see that you have a concerned with the shifting of your teeth and facial asymmetry. This normally could be easily corrected with orthodontic treatment. I would suggest you visit an orthodontist to see your options about opening the space and having the teeth aligned. Opening the space will allow for a placement of a dental implant and thus correcting your facial asymmetry. Good luck!

Your arch actually looks pretty symmetrical and your Orthodontics looks to have been done very well. I want to tell you that most human beings are not symmetrical from right to left. You can take a photograph of someone and cut it right down the middle, duplicate the left side and invert the photograph reattach to the left piece: you can do the same thing with the right side and then have the original and it looks like 3 different people. We all have a little bit of asymmetry. I guess you could be evaluated for no prep veneers (mock up with some removable composite resin first)  to see if some additional porcelain can be added to the right side to see if it would prop out nasal labial fold. That seems a little aggressive and your situation since the arch appears to be well formed. You could talk to a cosmetic surgeon about placing some filler, Juvederm, in that part of your face to maybe fill in. This, however, is a temporary treatment that last up to a year only.

Your first and most desirable option is to indeed recreate the space orthodontically, if possible.  Given the time period there is a possibility the adjacent teeth have moved also and it may be more difficult to treat but if possible it is far and away your best option.  After the orthodontics an implant can be placed.  It may also require some bone grafting.  This would greatly improve your smile and stabilize your bite.  As for the nasolabial fold prominence a simple and effective solution could be using some filler (Juvaderm) to fill in the crease and thus improve the symmetry.