Crown Lengthening and Veneers for Peg Laterals

The Patient's Journey

This patient presented with spaces between his upper front teeth that would not close. His gum line also sat low, which made the visible portion of each tooth shorter than it should have been. The two problems were connected, and treating either one in isolation would have made the other more obvious rather than less.

The spacing was caused by peg lateral incisors, which are lateral incisors that developed narrower and more tapered than normal and are sometimes almost conical in form. Because each lateral incisor was undersized, the dental arch contained measurably less tooth material than the available space required. That surplus appeared as gaps distributed between the anterior teeth rather than concentrated in one place. This is a dimensional problem rather than a positional one. That is why it does not resolve on its own and why moving the teeth closer together relocates the spaces without eliminating them.

Understanding the Challenge

Tooth proportion is a ratio of width to length, and a porcelain restoration can only alter one of those two dimensions. Adding width to a tooth that is already short produces a square result. Adding enough width to close a diastema produces a tooth wider than it is tall, which most observers register as dental work immediately.

The length of a visible tooth is set by the gingival margin above it. That margin, not the porcelain, determines how much vertical dimension the design has to work with. Correcting the spacing without first addressing the gingival position would have required distributing the additional width across teeth with insufficient vertical dimension to carry it. The gingival position therefore had to be established surgically before any tooth was prepared for a restoration.

How Dr. Mehdizadeh Approached Treatment

A facially-driven smile design was drawn first, establishing where the gum margins and the incisal edges needed to sit. Guided crown lengthening was then carried out to the positions that design specified, rather than estimated during surgery. That distinction is the reason the gingival result matched the plan.

Crown lengthening removes excess gingival tissue and recontours the alveolar bone beneath it. This differs from a gingivectomy, which removes soft tissue only and tends to allow the tissue to migrate back toward its original position because the underlying bone level is unchanged. Recontouring the underlying alveolar bone, rather than the soft tissue alone, is what makes the new gingival position stable over time.

Six weeks of healing followed, because gingival margins continue to settle for several weeks after surgery, and porcelain bonded to a margin still in motion will show a visible line at its edge if the tissue recedes. Provisional restorations were then placed so the proposed length, width, incisal edge position and shade could be assessed intra-orally and revised before final fabrication. Twenty porcelain veneers, ten upper and ten lower, were delivered once those revisions had been agreed and transferred to the laboratory.

The Result After Ten Weeks

The gum line is even, at a height that gives the anterior teeth their proper vertical dimension, and it no longer dominates the smile. The spacing is closed, and because the teeth were lengthened before they were widened, the closure was achieved with restorations that hold a natural width-to-length ratio rather than square ones.

The shade is brighter without being uniform or flat. The additional width was distributed across several teeth rather than concentrated on the two undersized laterals. This prevents the oversized front teeth that characterise a poorly planned diastema closure. The finished result is symmetrical and unremarkable, which was the stated objective.