Treatment Considerations for Congenitally Missing Lateral Incisors

BracesDiscover OrthodonticsInvisalign March 4, 2020

Did you know, up to 20% of the population is missing one or more adult teeth because it never developed? Most of the time these are the wisdom teeth or third molars, but approximately 1% of the population has a different tooth missing. Sometimes, the adult lateral incisor—the teeth on either side of your two front teeth—is one of these congenitally missing teeth. It is one of the most common dental anomalies that orthodontists see.  

The cause of congenitally missing teeth is normally genetic.  A person with a missing tooth is likely to have a parent, grandparent, sibling, cousin, or aunt/uncle also missing the same tooth or other teeth. People with one missing adult lateral incisor are also often seen to have a missing or malformed opposing lateral incisor, as well as one or more impacted canine teeth.  

The development of all teeth is a complex genetic process so any problem with a missing tooth is normally caused by an interruption in genetic signal during the tooth bud formation. This is also a common problem in people with genetic conditions.

Issues Caused By Missing Lateral Incisors

Having a congenitally missing lateral incisor can impact people in many different ways:

Missing a tooth can affect the self-esteem and social well-being of patients, especially if that tooth is in the front of the mouth such as it can impact the aesthetics of the smile.

Missing even one tooth can cause one’s whole bite to become misaligned. Over time this can cause problems with uneven tooth wear.

Treatment Options for Lateral Incisors

Treatment plans are based on various factors including the bite, the condition of the bite, the amount of crowding, as well as finances. There are a number of different treatment options for people with missing lateral incisors:

1. Replace the missing tooth with an implant

Benefits

  • This will allow for a symmetrical smile because teeth on each side are made to look the same size and colour.  
  • Implants are normally a durable and lasting solution and don’t need to be changed.

Disadvantages

  • Implants can be expensive.
  • Implants can only be placed once growth is complete therefore temporary solutions are needed to hold the space, and for aesthetic purposes until the child is old enough.
  • If space is not even or big enough, orthodontics are needed to optimize the space prior to placing the implant.
  • Implants can fail over time if not maintained properly or rejected by the body. However, this is a rare occurrence.

2. Preserve the baby tooth and have it “bonded” or “built-up”

Benefits

  • Bonding is less expensive than getting an implant in the short term.
  • This option still allows for people to proceed with an implant later in life.

Disadvantages

  • There is no way to predict how long this baby tooth will last.
  • Bonding, especially front teeth, can be prone to chipping, therefore, requiring possible maintenance overtime.

3.  Close the space with orthodontics

Benefits

  • There is no further cost after orthodontics for restorations, veneers or crowns. 

Disadvantages

  • Closing the space may not be possible depending on the bite.  
  • Surrounding teeth may need reshaping to make them look symmetrical.
  • This could result in uneven midlines, meaning the upper centerline doesn’t line up with the bottom centerline or with the middle of the face. 

Next Steps

If you are concerned because you or your child have a congenitally missing lateral tooth or any other missing teeth, the best approach is to have an orthodontist have a look! Be sure to contact Walt Orthodontics and set up your free consultation to learn more about your unique options.

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