Missing lateral incisors, and a Maryland bridge that keeps breaking

My daughter is 23 years old, and her lateral incisors never erupted. Her dentist recommended braces and left enough space for a Maryland bridge to replace the missing teeth. But since getting the Maryland bridge, the wings on it keep breaking. Each time they break, the dentist cements them on, but this is annoying. My daughter is job searching because she was laid off from work. Now she doesn’t have dental insurance. I’ll help her as much as I can, but I don’t have unlimited funds. We spoke with one dentist who recommends bone grafting and dental implants. Is that better than repeating braces or getting Invisalign to move her teeth closer together and filing down her canines to match the length of the teeth in front? – Thanks. Stephanie from Oregon

Stephanie,

If your daughter’s Maryland bridge keeps breaking, it was probably poorly designed. Although braces or Invisalign are great for aligning teeth, we don’t recommend moving canine teeth in place of her incisors. Moving canine teeth with orthodontics isn’t a solution for replacing incisors.

Canine teeth

• Shape – They are thick and protrude in the front. Moving them to an unnatural position detracts from your smile.
• Function – Canine teeth protect back teeth from lateral stress. If you move them forward, their purpose is lost.

We included patient photos from mynewsmile.com, a cosmetic dentistry website. The photos are an example of a patient whose lateral incisors didn’t erupt. Her dentist used braces to move her canine teeth into the position of the lateral incisors. Although the dentist shaved her canine teeth, her smile doesn’t look normal.

Replacing Missing Incisors

In the above case, many skilled cosmetic dentists would use orthodontics—Invisalign or braces—to move canine teeth back to their original position and use another treatment to replace the missing teeth. Two options for replacing teeth are dental implants or a dental flipper.

Dental implants – Although your budget is limited, dental implants are the best solution. An implant dentist or oral surgeon places artificial tooth roots in the jawbone. After a healing period, replacement teeth, or crowns, are attached to the top. Implants look and function like natural teeth.

Flipper partial – A cosmetic dentist can offer your daughter a well-made flipper partial that looks natural. A flipper includes a plastic plate and replacement teeth. It fits on the palate, and wire clips snap onto back teeth to secure it. Although a flipper is the most affordable option, it isn’t ideal. Some people say that the flipper is uncomfortable and challenging to eat with. Over time, your daughter’s jawbone will continue to shrink.

Dental bridge – Although some dentists might recommend a dental bridge, it requires grinding down your daughter’s healthy teeth to anchor the bridge. Many advanced cosmetic dentists, including Dr. LeSage, preserve healthy teeth and avoid grinding down teeth for crowns.

Schedule an appointment with an advanced cosmetic dentist to examine your daughter’s teeth and the area of the missing incisors. Expect the dentist to recommend dental implants as the first treatment option. If you qualify for financing and affordable payments, implants will be the best long-term solution. But if a dental flipper is the only thing you can afford now, encourage your daughter to think about saving for implants after finding employment and having sufficient income. Implants will be better for her long-term oral health.

Beverly Hills cosmetic dentist, Brian LeSage, DDS, FAGD, FAACD, sponsors this post.