Have you been told your gap cannot be closed properly?
For spacing caused by undersized lateral incisors, dentists frequently quote veneers on the two front teeth, which closes the visible gap and leaves the laterals looking small. Correcting the proportions requires establishing how long each tooth should be before deciding how wide it can become. Send us a photo of your smile and we will tell you what a complete correction would involve.
- 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
$311/month
144 payments at 9.99% APR, on approved credit.
Total: $26,000 for the design, whitening of the lower teeth, the gum lifting and its healing period, the provisional phase and twelve porcelain veneers.
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Treatment Plan by Dr. Mehdizadeh
- Diagnosis of undersized lateral incisors, the resulting spacing and the central diastema.
- Smile design establishing the finished length and width of every upper tooth.
- Whitening of the lower natural teeth, with the shade allowed to stabilize.
- Gum lifting to provide the additional length the laterals and centrals required.
- Provisional restorations, revised in the mouth against the design.
- Twelve porcelain veneers in e.max across the upper arch.
The Patient's Journey
This patient was self-conscious about his smile and had consulted several dentists beforehand, none of whom offered a plan he considered acceptable.
His visible complaint was spacing, including a distinct gap between the two central incisors, but the cause lay elsewhere.
Understanding the Challenge
His lateral incisors were peg laterals, a developmental variation in which the tooth forms narrower and more conical than normal instead of developing a full width. Two undersized teeth leave an arch containing more space than teeth to occupy it, and that surplus space redistributes itself. In his case the central incisors had drifted apart into the territory a full-width lateral would have occupied, which produced the diastema he had come in about.
The obvious proposal is veneers on the central incisors, closing the visible gap. It also leaves the laterals conspicuously undersized, and it widens two teeth that were already the widest in the arch, so the proportions deteriorate rather than improve.
Correcting the proportions properly runs into a geometric constraint. A tooth has a characteristic ratio of width to length, and widening a short tooth without lengthening it produces a square tooth that looks wrong for reasons most people cannot articulate but register immediately. We could not simply make the laterals wider; they had to become longer first.
The additional length was not available from the teeth, which had already fully erupted, so it had to come from the tissue above them, which is the only other place in the mouth that can supply length.
Establish the finished proportions of every upper tooth before any treatment began. Obtain the additional length surgically rather than compromising the widths. Widen the laterals proportionally rather than approximately. Close the central diastema by redistributing width, not by enlarging two teeth. Leave the lower teeth unrestored.
How We Approached Treatment
The design came first, and it specified the finished length and width of all twelve upper restorations. Designing before any intervention is what made the remainder of the treatment measurable, because we calculate the amount of tissue repositioning from the finished proportions rather than estimating it in advance of knowing them.
We whitened the lower teeth and let the shade stabilize, but did not restore them. The twelve upper veneers had to match the natural teeth below them, and natural teeth have to reach their final color before anything can match them.
Dr. Mehdizadeh then performed the gum lifting, which provided the additional length the design required at the laterals and the centrals. Lengthening the laterals permitted a proportional increase in their width, and lengthening the centrals let us widen them enough to eliminate the diastema without making them disproportionate. We redistributed the width across the arch instead of concentrating it on the two teeth that already had the most of it.
We placed provisional restorations and revised them in the mouth against the design. Our master ceramist then reproduced the approved shapes as twelve porcelain veneers in e.max, designing and making all of them in our own laboratory.
The Result After Ten Weeks
The spacing and the diastema are gone, and the lateral incisors are proportionate to the teeth surrounding them rather than conspicuously narrow. Six appointments across ten weeks covered the design, the whitening of the lower teeth, the gum lifting and its healing period, the provisional phase and the final cementation of all twelve restorations.
Only the upper teeth carry restorations. The lower teeth are his own, whitened rather than covered with ceramic, and natural teeth gradually accumulate stain again while porcelain retains its color. Maintaining the match between the arches is therefore a matter of hygiene and occasional re-whitening rather than something concluded at cementation.
Frequently Asked Questions About Peg Laterals, Gum Lifting and Diastema Closure
What are peg laterals?
A developmental variation in which the lateral incisors form narrower and more conical than normal instead of developing a full width. The teeth are healthy and simply undersized, and the consequence is an arch containing more space than teeth to occupy it.
Why did the gap between my front teeth appear?
Because the surplus space left by undersized laterals redistributes itself. In this case the central incisors drifted apart into the territory a full-width lateral would have occupied, which produced the visible diastema.
Why not simply put veneers on the two front teeth?
That closes the visible gap and leaves the laterals conspicuously undersized. It also widens the two teeth that were already the widest in the arch, so the proportions deteriorate even though the gap disappears.
Why did the teeth have to be lengthened before being widened?
A tooth has a characteristic ratio of width to length. Widening a short tooth without lengthening it produces a square tooth, which looks wrong for reasons most people register immediately without being able to articulate. The tooth had to gain length first.
Where does the additional length come from?
From repositioning the gum line, since the teeth had already fully erupted. Gum lifting exposes more of the existing tooth, which provides the length the design requires without altering the teeth themselves.
Is a gum lift cosmetic or functional here?
Neither description is quite right. It was a proportional requirement. Without the additional length we could not widen the laterals proportionally, so the gum lifting is what made the restorative correction possible rather than an aesthetic addition to it.
Why was the smile designed before anything was done?
Because we calculate the amount of tissue repositioning from the finished proportions. Designing afterwards means estimating how much length to obtain before knowing how much length the restorations need.
Why were the lower teeth whitened rather than restored?
They did not require restoration. Whitening brought them to a color we could match the upper veneers to, which is considerably more conservative than covering sound teeth in order to control their shade.
Will my upper and lower teeth stay matched?
The porcelain retains its color. The natural lower teeth gradually accumulate stain again, so hygiene and occasional re-whitening maintain the match; it does not end at cementation.
How much does this kind of treatment cost?
This case was $26,000, covering the design, whitening of the lower teeth, the gum lifting and its healing period, the provisional phase and twelve porcelain veneers. $311/month: 144 payments at 9.99% APR, on approved credit.
