Did braces leave you with gaps that never closed?
Orthodontics moves teeth but cannot change how wide they are, so an arch with undersized lateral incisors keeps its spacing however well the teeth are aligned. The width has to be added to the teeth themselves. Send us a photo of your smile and we will tell you what is left to do and what it would cost.
- A call within two hours during office hours.
- 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
$275/month
144 payments at 9.99% APR, on approved credit.
Total: $23,000 for whitening, one implant, one implant crown and three porcelain veneers.
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Treatment Plan by Dr. Mehdizadeh
- Assessment of the residual spacing, the peg-shaped lateral incisors and the edentulous site at tooth eight.
- Whitening of the upper and lower dentition, with the shade allowed to stabilize.
- One implant placed at tooth eight.
- Two months of osseointegration.
- One implant crown at tooth eight.
- Three porcelain veneers, at teeth seven, nine and ten.
The Patient's Journey
This patient had completed orthodontic treatment at another office, and by the measure orthodontics uses the treatment had worked. Every tooth was where it should be. He still had visible spaces across the front of his upper arch, and he was still missing tooth eight, one of the two central incisors.
What he wanted was the missing tooth replaced. He was also dissatisfied with the spacing around his lateral incisors, which had not closed and which he had assumed the braces would deal with.
Understanding the Challenge
Orthodontics moves teeth but does not change their dimensions. His lateral incisors were peg laterals, a developmental variation in which the tooth forms narrower and more conical than normal, tapering toward the biting edge instead of presenting a full width.
An arch containing two undersized teeth has more space in it than teeth to fill, and that surplus has to go somewhere. Orthodontics can gather it into one location or distribute it evenly between the teeth, but it cannot remove it, because the deficiency is in the width of the teeth rather than in their arrangement. Closing the spaces by moving teeth together would simply have crowded the arch and put the midline in the wrong place.
The missing central incisor complicated the arithmetic. Tooth eight sits immediately beside the midline, and a restoration there governs how the entire anterior segment reads. We could not set its width independently of the veneers on either side of it, since the four restorations together had to account for the surplus space the peg laterals had left.
Replace the missing central incisor with an implant rather than a bridge. Widen the peg laterals in ceramic rather than moving teeth into the space. Distribute the residual spacing across four restorations. Whiten first, then match. Complete treatment within four months.
How We Approached Treatment
We whitened the upper and lower teeth first and let the shade stabilize before recording anything. Ceramic does not respond to peroxide, so the natural teeth have to reach their final color before our laboratory makes the restorations that must match them.
Dr. Mehdizadeh placed an implant at tooth eight and left it for two months to osseointegrate. He chose an implant over a bridge because the teeth beside the space were sound: a conventional bridge would have meant preparing both of them for crowns, which on a young adult means removing healthy structure from two teeth in order to replace a third.
We then designed the four anterior restorations as one set: an implant crown at tooth eight and porcelain veneers at seven, nine and ten. Designing them together is what resolves the spacing, because we divide the surplus width deliberately across four units rather than leaving it concentrated wherever the orthodontics finished. The veneers widen the peg laterals to normal proportions, the central incisors match each other across the midline, and the spaces close without moving a single tooth.
The Result After Four Months
The missing tooth is replaced, the peg laterals are full-width, and there are no residual spaces across the upper anterior segment. The overall color is lighter than he arrived with because we whitened the natural teeth before matching the ceramics to them.
His orthodontic result was not wasted: the teeth were in the correct positions when he arrived, and that is what allowed four restorations to finish the case rather than a full arch of them.
Frequently Asked Questions About Peg Laterals and Front Tooth Implants
What are peg laterals?
A developmental variation in which the lateral incisors form narrower and more conical than normal, tapering toward the biting edge instead of presenting a full width. The teeth are healthy; they are simply undersized.
Why did braces not close the gaps?
Orthodontics moves teeth but does not change their dimensions. An arch containing two undersized teeth has more space in it than teeth to fill, and moving teeth can gather or distribute that surplus but cannot remove it.
Could the spaces have been closed by moving the teeth together?
Only by crowding the arch and displacing the midline. The deficiency is in the width of the teeth rather than in their arrangement, so the correct place to add width is the teeth themselves.
Why an implant rather than a bridge for the missing tooth?
The teeth on either side of the space were sound. A conventional bridge would have meant preparing both for crowns, which means removing healthy structure from two teeth in order to replace a third.
Why were four restorations designed together?
Because the widths depend on one another. We divide the surplus space left by the peg laterals deliberately across the four units, and the two central incisors have to match across the midline. Designing them separately leaves the spacing wherever it happens to fall.
Why was whitening done before the restorations?
Ceramic does not lighten. The natural teeth have to reach their final color, and the shade has to stabilize afterwards, before our laboratory makes restorations that must match them.
How long does an implant take before the crown is fitted?
In this case we allowed two months of osseointegration. The interval depends on bone quality and on the stability achieved at placement, and we assess it rather than assume it.
Will the veneers on the peg laterals look bulky?
Widening an undersized tooth adds ceramic where the tooth is deficient rather than over its full surface, so a peg lateral usually needs less preparation than a normal-sized tooth would. The finished width follows the proportions of the arch, not the original tooth.
Is orthodontic treatment wasted if restorations are still needed afterwards?
No. The orthodontics had already corrected the positions here, which is what allowed four restorations to finish this case instead of a full arch of them. Restorative treatment corrects width and shape efficiently and position expensively, so we sequence the two rather than substitute one for the other.
How much does this kind of treatment cost?
This case was $23,000, covering whitening, one implant, one implant crown and three porcelain veneers. $275/month: 144 payments at 9.99% APR, on approved credit.
