Help! Spacing, Pegs, Slight TMJ but Good Bite...can I Obtain a Perfect Smile?

Hi,need advice on closing up spacing but I would like to keep the gap in between my two front teeth. I was told by an ortho a year ago that my bite was good & I don't need braces. The problem is my Cosmetic Dentist stated(I agree)that with the spacing I have now if we were to use veneers only it would create huge teeth & an unnatural looking smile. Please advise, I want a normal smile & would like to obtain it by end of year. I'm 25 & would love to finally be comfortable showing my teeth. Thanx!

Doctor Answers 6

Yes, you can have a Beautiful Smile

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You're 25? I would not have quessed from your teeth, which make you appear younger.
Your dentist was wrong about you ending up with very large teeth. They must  not very familiar with Cosmetic Densistry and are not comfortable giving you the smile that you desire.
From a true cosmetic dentist's standpoint, from what I can see in your photo, you would be a perfect veneer candidate and get a smile with properly proportioned teeth. I would advise you to carefully reconsider leaving the space in the middle.
My consult technique is to show you with some temporary bonding, chairside, what you would look like with the space closed.  Most patients like it a lot.  I could not guarantee that your teeth dont shift in the future, leaving spaces elsewhere, that you dont like.  
I would also show you chairside, and take a photo of how we make the teeth to proper, harmoneous proportions.  The 2 front teeth become slightly smaller, while the side, peg laterals become normal size laterals with veneers.  Most times we include the cuspids, and even one tooth back on either side, if changing shade of your teerth.  If your existing shade is fine for you, the case may even only require 4 veneers.  All the work done chairside is for you and I to decide together what looks best. and then once we agree, a treatment plan goes out to my lab who creates your smile in wax. We both get to look at it, to see if we like the result, because that is very close to what your final smile will look like
Once the patient and I are both in agreement, and "love" the new look, we proceed.
The first thing I do is address your TMJ. If  there are bite issues, the veneers will fail. The bite is addressed and adjusted and treated first, so that  the case will SUCCEED.

Englewood Dentist

Smile design and TMJ

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Cosmetic dentistry can help you. 

Space closure can be accomplished while maintaining good tooth sizes and proportions with either porcelain veneers or direct resin veneers. The trick is to include enough teeth, eight or ten in your case, so the tooth enlargement can be shared..Porcelain will last longer than resin.

You present two challenges:

First, the right and left sides are not the same.  the lack of symmetry must be addressed to have a beautiful outcome. 

the second challenge is that you describe "slight TMJ."  Bite problems lead to TMJ issues. 

without knowing what your TMJ issue is, I  would caution you to sort that out before you make any changes to your teeth. 

Finally, I would not rule out orthodontics to correct your bite and eliminate the TMJ issues.

Good luck

Gary Lederman, DMD
Long Island Dentist

A Perfect Smile

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In situations such as yours, the best answer is in a wax up of what the final results could look like.  This is usually done by a lab and transferred to your mouth in a plastic temporary smile design.  This will give both you and the designing dentist an accurate depiction of what can be done cosmetically with porcelain crowns.  If this turns out to be acceptable, the temporary crowns can be duplicated in porcelain and there will be no surprises.

A perfect smile is a personal idea, and the design has to match your idea of what is perfect.


Jerome R. Baruffi, DDS
Seattle Dentist

Undersized Laterals and Spacing

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This looks like a FUN CASE for the right cosmetic dentist. It's a perfect case for DIRECT RESIN BONDING. The nice thing here is the dentist could do a quick diagnostic mock-up with the composite directly in your mouth and you could see how everything might fit into place. Without having to re-shape or cut the teeth and sending the case to a dental lab direct resins veneers are the most conservative approach. To make the bonding material emerge from the gum in the right place for the teeth to look natural you might need a little reshaping of the gums with a laser. 

Ted Murray, DDS
Dubuque Dentist

You should be able to achieve your goals.

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Looking at your tooth arrangement, I would say that it is possible to close your spaces and keep normal proportions.  What I would recommend as a preview is that you have study models made of your teeth and have the dental lab create a pre-treatment wax-up of the final result.  This is a wax pattern of what your teeth could look like when the veneers are completed.  I think that you could even close the space between the two front teeth if you wanted to, and it would still look natural.  This gives you a chance to see what it will look like before doing anything irreversible to your teeth.

Another way to preview the final result is with cosmetic imaging.  This is done digitally on a computer with a digital photo of your teeth.  There are companies that will do this for you.  Some dentists own the software to do this, but it was more popular a number of years ago.

Good luck.

Martin Frankel, DDS
Toronto Dentist

Works like magic! closing big spaces between front teeth

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It is possible to close your anterior spaces and not make the teeth look too large. The process would involve veneering your lateral incisors ( the teeth on either side of your two front teeth that in your case are peg shaped) and also veneering the cuspids ( your "eye" teeth), and veneering the upper first bicuspids on both sides ( these are the teeth immediately behind your "eye" teeth.) The dentist will direct the dental lab to add extra porcelain to the front side of the bicuspids which will make them a tiny bit wider than they were originally. Because the lab has added extra porcelain on the front of the bicuspids, the dentist will need to reduce the back side of the  cuspids (eye teeth) to make room for the extra porcelain. ( are you still following me?) The dentist will also direct the lab to add some extra porcelain to the front of the cuspids so that these teeth can be the correct size since the dentist needed to remove a little of the back side of these teeth and it made them a bit too narrow.. This procedure is in effect reducing the size of the space behind your peg lateral teeth. Now when the veneers are placed on the peg lateral teeth they will not  appear too wide because the space was gradually reduced and shared between the other teeth that received veneers. This is a bit difficult to explain but I hope you can get the idea that it is possible and a good dental lab-dentist team can make it happen.

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.