What's the Best Way to Improve my Slightly Gappy Upper Smile? I'm Missing L Canine Tooth. (photo)

L upper canine tooth grew out high above gum line -> dentist pulled it out.. Thus, leaving me w/ spaces b/t the 2 front teeth & spaces b/t the front teeth & lateral incisors; arched R side but dented L side; shifted to L side. Would like to fix the front gap & even out the edges of the incisors for a more tight even smile. Bonding? Invisalign? Have a big smile, just cant say it's a big, beautiful one. Would luv a smile makeover for 30th bday!

Doctor Answers 6


Yours appears to be a slam dunk.  I have done many cases like yours in my office with porcelain veneers.  As long as the bone support is good, veneers will do two things at once.  They can correct the shading of your teeth, and eliminate the white streaking, giving you a lifelike beautiful natural shade.  The other thing that veneers do very well are correct spacing problems, and change the shapes of your existing teeth into teeth with proper contours and no spaces!
A skilled cosmetic dentist, together with a good lab as a partner, will make a mock wax smile from a model of your teeth.  You get to look at what the results will be, assuring you that your "problem teeth and spacing now look like what you've always wanted.  If you prefer a more squarish look, or more rounded edges, these can be specified to your dentist and you should get a "mock up " that you love.  
Then you get to wear your new smile in the temporaries, where you will test the length and position of the new teeth.  If all is well, and the bite and lengths as well as the esthetics are beautiful, your new veneers are made very similar to the temps, and inserted in a few weeks time.
My one warning...this is only a case for a skilled cosmetic dentist.  Interview a few. See photos of real patients and their work...full faces too.  If everyone's teeth look alike, not the right place. If they cannot show you a case with spacing similar to your own that they have done, wrong place.  The right place is the office where you feel comfortable, things are explained, you see photos of their own patients with problems similar to yours, and good results. 

Englewood Dentist
5.0 out of 5 stars 2 reviews

Dental Implant and Orthodontics for a missing Canine

Unfortunately, the extraction of your canine tooth probably was not the ideal treatment.  Ideally orthodontics should have been performed to create space for your canine and the canine then brought into the arch.  The canine is probably the most important tooth in the arch to create proper form.  From your photo your midline appears to be off form the lack of symmetry.  The ideal treatemtn at this time would be orthodontics to move your teeth to recreate the need space for a canine and tehn have a dental implant placed to replac the missing canine.  This will require a multispecialty approach and a significant amount of time, but you will ultimately be very happy with the results

Brian Dorfman, MD, DMD
Phoenix Oral & Maxillofacial Surgeon
4.7 out of 5 stars 13 reviews

Consult an Orthodontist

In my opinion this is a "team effort" case.  I believe that ideally you should see an orthodontist to correct the cant of your smile, align your teeth and re-establish a space for a canine implant restoration. Generally, first premolars do not function well in the canine postion as they were not designed to withstand the chewing forces that a canine is designed for. You will also need to see a periodontist before the braces come off to evaluate the implant site and guide the orthodontist to provide an adequate site for implant placement. Finally your general dentist will follow you through the entire procedure and provide the final implant crown.  I do not think you should commit to any "cosmetic" dentistry until after your orthodontic treatment is completed as you may find you are totally thrilled with your smile afterwards.  If not, then you can consider whitening, cosmetic recontouring or veneers depending on your concerns.

Best of Luck!!

Gary Nack, DDS
Philadelphia Dentist

How to improve a Gappy Upper Smile

As you correctly pointed out, you have the gaps as a result of your upper left canine extraction. That is also the reason your midline has shifted to the left, but even more important, your teeth are "canted" to the left as well. That means they are slanted slightly off from the vertical. Orthodontics can help improve some of the spacing and canting issues, but it cannot address the fact that you are missing a canine on one side only. A smile looks beautiful when it is symmetrical (right and left sides match eachother). If you do proceed with orthodontics, you might still want to consider porcelain veneers afterwards in order to regain the symmetry. If that's the case, then you might be able to achieve the big beautiful smile that you are looking for with porcelain veneers alone (without orthodontics) in the hands of a well-trained cosmetic dentist who might also have to go some laser gum contouring. Today, porcelain veneers can be made quite thin with minimal tooth preparation. The key is to use an experienced cosmetic dentist who also uses a very high quality ceramic laboratory. Thus, don't be shopping around for price. Rather, shop for quality. HAPPY 30th!

Jay Neuhaus, DDS
New York Dentist

Gap solution

your teeth seem to be in good shape so i feel you would benefit the most from orthodontics. It is not what people want to hear but to prep and alter enamel that is in good shape is not recommended. the incisal plane discrepancies and spacing issues make doing bonding a very difficult and unreliable outcome unless the dds is very skilled. porcelain restorations to alter the spacing issues would be esthetically better but you are irreversibly changing the teeth which brings me back to the ortho solution.

I recommend braces/invisalign to fix spaces with your smile

I would recommend seeing a cosmetic dentist in conjunction with an orthodontist.  Besides spacing, your smile is canted/off to the left and everything is angled as well.  The best approach is to see where your own natural teeth can be moved first and then finish with bonding/veneers as needed.  You are young, try to put your natural teeth where they should be and then determine how to make it perfect after that.  This should all be discussed and determined prior to doing anything though - make sure the end goal is determined and work back from there!  Good Luck

Frank Orlando, DDS
New York Dentist
5.0 out of 5 stars 1 review

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.