Do you have peg laterals?
Undersized lateral incisors leave gaps and asymmetry that braces alone cannot fix, because orthodontics moves teeth but cannot change their size. Send us a photo and we will tell you what it would actually take.
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- A written cost from us, before you commit to anything.
- No obligation. Many patients take weeks to decide. That is normal.
What this case cost
$335/month
144 payments at 9.99% APR, on approved credit.
Total: $28,000 for ten porcelain veneers on the upper arch and whitening.
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Treatment Plan by Dr. Mehdizadeh
- Comprehensive smile analysis with facial proportion assessment
- Digital smile design to preview new tooth proportions before preparation
- 10 upper porcelain veneers with customized width and shape
- Proportional redesign of all visible teeth to establish harmony
- Natural color gradation and surface characterization by master ceramist
Why Invisalign Could Not Fix Small Lateral Incisors
She had completed Invisalign treatment hoping that straightening her teeth would resolve her smile concerns. The aligners did their job and her teeth were well aligned, but something still looked off and she could not pinpoint what it was. The problem was the shape of her teeth, not their position. Her lateral incisors, teeth number seven and ten, were genetically smaller than normal. This relatively common condition, called peg laterals or microdontia, affects approximately 2% of the population, and orthodontic movement cannot change tooth size or shape.
“Orthodontics moves teeth. It cannot change their shape.”
Why Small Lateral Incisors Disrupt Smile Harmony
The lateral incisors sit immediately adjacent to the front teeth, the central incisors. In a harmonious smile, the lateral incisors should be approximately 75–80% the width of the centrals. Normal central incisors measure 8.5–9.5mm in width; the laterals should measure approximately 6.5–7.5mm. When they fall significantly below this ratio, as with genetically small laterals that may measure only 4–5mm, the entire smile appears unbalanced: the central incisors look too large and the canines too prominent. Even though every tooth may be healthy and properly positioned, the proportional relationship falls out of balance.
This disruption becomes more apparent during a broad smile. People sense that something is wrong without being able to say what, even though the teeth are healthy and straight.
Patient Goals
Create proportional harmony across the smile. Address genetically small lateral incisors that Invisalign could not correct. Achieve natural beauty through proper shape and proportion rather than uniform whiteness.
How Facially-Driven Veneer Design Works
The solution required more than making the lateral incisors larger. Had we changed only teeth seven and ten, they would have looked out of place against the unchanged teeth around them, so Dr. Mehdizadeh redesigned the proportions across all the visible upper teeth as one whole.
This is what cosmetic dentists call facially-driven design. Rather than focusing on teeth in isolation, the process begins with the face—analyzing how the lips frame the smile, how much tooth shows at rest and in full animation, and how the smile relates to facial features and overall appearance. We design the teeth to complement the face, not to exist independently of it.
How We Redesigned the Proportions
We placed ten porcelain veneers on the upper teeth, not because all ten teeth had a problem, but because balancing the smile meant adjusting every visible proportion. The small laterals received the largest change in width, from approximately 4.5mm to the proper 6.5–7mm range. We refined the central incisors to balance the new laterals, and shaped the canines and premolars to flow naturally from the front teeth, widening the smile corridor.
We addressed the color at the same time. Her shade had yellowed slightly over time, and the new veneers give her a brighter but natural tone rather than the opaque white that announces dental work. Our ceramist layered the porcelain to create natural color gradation from the gum line to the incisal edge, with surface texture matched to natural tooth anatomy.
- Lateral incisors increased from approximately 4.5mm to 6.5–7mm proper proportional width
- Central incisors refined for improved balance with new lateral dimensions
- All ten teeth shaped to create unified proportional flow across the smile
- Natural color gradation from gum line to incisal edge
- Surface texture and translucency matched to natural tooth anatomy
The Result After 5 Weeks of Treatment
The color is brighter and the shapes look natural. We designed this smile for her facial features, lip dynamics and personal aesthetic rather than applying a generic one, and the result looks as if she was born with these teeth.
“The goal is not perfect teeth—it is teeth perfect for your face.”
The Five-Week Veneer Process
From consultation to final placement, treatment took five weeks. The first appointments involved detailed facial analysis and digital planning, allowing the patient to preview her new smile before any work began. The preview let her confirm the design before we committed to irreversible preparation.
We prepared the teeth conservatively, preserving healthy enamel while creating space for the 0.3–0.5mm porcelain shells. Temporary veneers let her live with her new proportions for approximately two weeks, so we could make any refinements before final fabrication. When we bonded the final veneers, they matched the design she had approved.
Frequently Asked Questions About Veneers for Small Lateral Incisors
Why couldn’t Invisalign fix small lateral incisors?
Invisalign and other orthodontic treatments move teeth into better positions, but they cannot change the size or shape of the teeth themselves. If lateral incisors are genetically smaller than normal (a condition called peg laterals or microdontia), orthodontics will simply give you well-positioned small teeth. The proportional imbalance remains unchanged. Only restorative dentistry, typically with porcelain veneers, can address issues of tooth size and shape.
What are peg laterals or microdontia?
Peg laterals refer to lateral incisors that developed smaller than normal, often appearing pointed or peg-shaped. Microdontia is the broader term for teeth that are smaller than typical proportions. Both conditions are genetic and affect approximately 2% of the population. They disrupt smile aesthetics by breaking the proportional balance between teeth: the centrals look too large, the canines too prominent, even when all teeth are otherwise healthy and well-positioned.
Why did all ten upper teeth need porcelain veneers?
Changing the size of the lateral incisors alone would create a new imbalance, with the laterals looking out of place against unchanged surrounding teeth. True harmony requires adjusting proportions across all visible teeth in the smile zone. Each tooth must relate properly to its neighbors following established dental proportion guidelines (approximately 75–80% width ratios). This comprehensive approach ensures the smile looks natural and cohesive rather than obviously restored in selected areas.
What does facially-driven smile design mean?
Facially-driven design starts with analyzing the patient’s face rather than the teeth in isolation. The process assesses how lips frame the smile, how facial features relate to dental proportions, and what tooth characteristics will complement overall appearance. We design the teeth to look natural on your face rather than following generic idealized shapes. This approach produces results that appear effortless rather than artificial.
How long do porcelain veneers last?
High-quality porcelain veneers typically last 15–20 years or longer with proper care. Unlike composite bonding, porcelain resists staining and maintains its appearance over time. Longevity depends on material quality, precision of placement, and patient maintenance including professional cleanings every 6 months and avoiding habits like nail biting or ice chewing. The veneers will eventually need replacement, and future restorations can follow the same proportional design.
How much do 10 porcelain veneers cost in Beverly Hills?
This case was $28,000, covering ten porcelain veneers on the upper arch and whitening. $335/month: 144 payments at 9.99% APR, on approved credit.
How long does the porcelain veneer process take?
This case took 5 weeks from initial consultation to final bonding. The process typically requires 3–4 appointments: facial analysis and digital planning, tooth preparation with temporary veneer placement, an optional try-in appointment, and final bonding of the porcelain veneers. Our ceramist spends most of the elapsed time in the dental laboratory, hand-layering each veneer to achieve natural color gradation and surface texture.
Can dental bonding fix small lateral incisors instead of veneers?
Composite bonding can increase the size of peg laterals at lower upfront cost, but the material has significant limitations for this application. Bonding stains over time, chips more easily than porcelain, and typically needs replacement every 3–7 years. For cases that require treating 10 teeth simultaneously with precise proportional relationships, porcelain veneers deliver far more predictable, longer-lasting, and aesthetically superior results because the ceramist can control color, translucency, and surface texture with greater precision.
Is the digital smile preview accurate to the final result?
The digital smile design provides a close approximation of the final result and is essential for aligning patient expectations with clinical outcomes. The preview confirms proportions, tooth display, and overall aesthetic direction before any irreversible preparation. The temporary veneers placed after preparation provide an even more accurate preview, so you can live with the new proportions for approximately two weeks and ask for refinements before our laboratory makes the final porcelain.
Will peg laterals affect my bite after veneers are placed?
Properly designed veneers account for occlusal (bite) relationships during the planning phase. The digital design and diagnostic wax-up let us verify that the new proportions will function harmoniously with the opposing teeth. The temporary veneers serve as a functional trial period: we identify and resolve any bite issues before our laboratory makes the final porcelain. Most patients report that their bite feels natural within days of final placement.
