August 15, 2018

Q: How long would it take to open a gap between my canine and central incisors? (missing lateral incisors)

Now, I also have baby pre-molars that are adjacent to my canines. I wanted to know how long it would take to open a gap between my canines and central incisors in order to place an implant that would replace my lateral incisors? Also, would transplantation of my canines be possible? Or would it be better to get a veneer or crown to shape my canine like a lateral incisor and then extract my pre-molars and replace them with implants that look like a canines?

Dr. Huefner’s answer:
Based on the photo you sent, you have very little space, and as such it would be difficult (but not impossible) to orthodontically open the space large enough to place a dental implant.  Not only is the small space a problem, but the canine teeth (the ones you want to move backwards) have the longest roots, and as such are more difficult to move.  There is another problem as well, is that even if the space were opened you would most likely have to have bone augmentation (grafting) to have enough bone to place the implants into.
I do not believe tooth transplantation is possible to correct your problem.
I agree with the concept of porcelain veneers, as this is a very predictable way of correcting your problem.  Braces and implants, even if they could be done would take many years.  Porcelain veneer treatment can be completed in less than a month.
I refer you to the web link below, that shows a great example of spacing and missing lateral incisors treated with porcelain veneers.

Web reference:

Congenitally missing teeth treated with very esthetic EMax all-porcelain bridges

all porcelain EMax bridges and two EMax porcelain veneers

Photo above: Teri was congenitally missing both of her upper lateral incisor teeth. For years she had two bonded bridges and six porcelain veneers, but she didn’t like many things about them, especially the color, shape and thickness of the teeth. Photo below: Dr. Huefner replaced her old dentistry with two all-porcelain EMax bridges and two EMax porcelain veneers. Teri got to choose the color, and chose the BL2 shade from the tooth shade guide.

Teri was congenitally missing teeth, both of her upper lateral incisors.  Embarrassed to walk around with two front teeth missing, her parents took her to the family dentist who placed two bonded bridges and six porcelain veneers.   Now having no missing teeth showing Teri was relatively happy with her appearance during high school and early twenties.  But when she graduated from college and entered the work force, she started rethinking how she felt about her two bridges.  She realized they just didn’t look as good as she hoped that they would be.  She liked her old dentist and thought he did the best that he could for her, but couldn’t help but feel that in this day and age, cosmetic dentistry probably offers new technology that could give her a much more attractive looking smile.  It was time for Teri to see a cosmetic dentist to discuss her alternatives.

After hearing Teri’s story, Dr. Huefner asked her specifically what didn’t she like about her old dentistry?  Teri said she wanted whiter teeth, that the bridges were too thick, that there was brown staining between each of her teeth and the edges of her teeth were shorter on her left side compared with her right side.

EMax all porcelain bridges

Upper photo: Notice how Teri’s right central and lateral incisors are shorter that the teeth on her left. Ideally the teeth should be symmetrical, the same length and the edges of the incisors follow the curve of Teri’s lower lip when she smiles. Lower photo: By Dr. Huefner making Teri’s bridges the proper length she had a much more attractive and natural looking smile.

Dr. Huefner was happy to tell Teri that there was an alternative available today that he thought would give her a much more attractive smile.  Rather than do bonded bridges for two teeth replacements, and then porcelain veneers for six teeth, or porcelain fused to metal bridges, Dr. Huefner advised using a new type of all-ceramic bridges called EMax along with two porcelain veneers also fabricated out of the EMax material on her bicuspid (side) teeth.  By doing this she wouldn’t have that unattractive staining line between each of her teethand they wouldn’t be bulky and thick like her present dentistry was.  Also, Dr. Huefner would make the edges of the teeth even and symmetrical in length and follow the curve of her lower lip in a natural way.  But one thing that really excited Teri, Dr. Huefner said that she could actually choose the color of her new dentistry, so she could get the white colored teeth that she had always wanted.  She chose shade BL2 from the Dr. Huefner’s tooth shade guide.

Teri was excited to hear Dr. Huefner’s recommendations and began her treatment almost immediately.  Her entire treatment, EMax bridges and veneers went smoothly and just as Dr. Huefner had planned.  Teri’s new smile makeover with two all porcelain EMax bridges and two EMax porcelain veneers was completed in just under a month’s time.  As you can see from the photos, Teri got a terrific result and her new smile looks much more attractive by using a better design and all porcelain EMax material rather than traditional porcelain fused to metal bridges that dentists have been using for the past three quarters of a century.

For patients not able or willing to have dental implants to treat their congenitally missing teeth, EMax all porcelain bridges should be given much considerations based on its many advantages and superior esthetics.

Dr. Norman Huefner, Laguna Niguel cosmetic dentist serving Orange County and surrounding cities of Rancho Santa Margarita, Mission Viejo, Irvine and Newport Beach

Lance’s Congenitally Missing Tooth and Disheveled Smile Becomes Handsome and Normal Looking with Porcelain Veneers Mission Viejo

old porcelain veneers and congenitally missing tooth

Lance had a congenitally missing front tooth and his dentist placed six porcelain veneers placed back in the 1980s. Over the years his gums receeded and he chipped one veneer. Lance decided to replace the six old porcelain veneers with new ones that were stronger, lighter and more natural in color and had better shaped teeth to hide the fact that one tooth was missing.

Lance from Mission Viejo, was congenitally missing his upper left lateral incisor.  In the late 1980, when porcelain veneers were first introduced into dentistry, Lance had several porcelain veneers placed by his dentist.  At the time it was a huge improvement.

After over twenty years had passed Lance experienced some gum recession around his veneers and then one day he hit his mouth while working with some equipment and one of his porcelain veneers chipped.  Lance realized it was finally time to have his porcelain veneers redone. But Lance’s first question was will they better than the first set he had a few years after porcelain veneers were first introduced to dentistry? One challenge to Lance’s treatment is that he had only had six porcelain veneers and all his other visible teeth were very dark.  If he wanted the color of his teeth to be consistent when he smiled he would best served by doing eight or possibly ten porcelain veneers.  But Lance was adamant that he only wanted to have the six old porcelain veneers replaced, and not have porcelain veneers placed on his dark side teeth.  Lance also asked us to know how different and improved the new design of his smile would look?

porcelain veneers mission viejo

Lance's masculine and natural looking smile with six new porcelain veneers by Dr. Huefner. Lance was extremely pleased with the end results of his new cosmetic dentistry.

The answers to Lance’s questions were encouraging. First, huge improvements in both the porcelain materials and bonding techniques have been made over the past two decades.  Second, using some advanced cosmetic techniques to mask the congenitally missing tooth and give the allusion that all teeth were present (called lateralizing the cuspid and cuspidizing the bicuspid) he would have a vastly improved smile that would look like he had the normal compliment of teeth.

improved results of missing tooth and porcelain veneers

Lance was pleased with how his new cosmetic dentistry masked the problem of his missing tooth, and the final results were an absolutely normal looking smile.

Lance proceeded with his porcelain veneer treatment, Lance was very pleased with the end result. He got a natural looking smile that was greatly improved compared to his original dentistry. We also used a stronger porcelain called “Empress pressed ceramic”.  Beginning to end, Lance’s new smile was completed in just two visits that were fourteen days apart.

Please feel free to comment or ask questions about porcelain veneers or smile makeovers when there are congenitally missing teeth.

Dr. Norman Huefner, Orange County Cosmetic Dentistry and Porcelain Veneers. Serving the surrounding cities of San Clemente, Laguna Niguel, Irvine, Newport Beach, Mission Viejo, Coto de Caza, Rancho Santa Margarita and Lake Forest, CA.
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