By: Dr. Elizabeth Eggert
How did this start?
Elena came to Eggert Family Dentistry at the age of 15 as a referral from our orthodontic colleague, Dr. DeVoe. Dr. DeVoe wanted Dr. Elizabeth Eggert to evaluate restorative options for Elena because she is congenitally missing (was born without) one of her lateral front teeth and her lateral incisor on the other size is undersized. Dr. DeVoe anticipated that Elena would want a solution for her smile after her braces were removed.
A congenitally missing tooth is one of the most common dental developmental abnormalities. In fact, roughly 20% of adults have at least one tooth that never developed. Why is that number so high? Well, we’ve all heard of that person who didn’t develop all, if any, wisdom teeth. If you take wisdom teeth out of the picture, the percentage of adults with congenitally missing teeth drops to only 5%. Other permanent teeth we often see missing are second premolars, upper lateral incisors, and lower central incisors.
A wisdom tooth that never develops would typically be thought of as a good thing – one less tooth to remove! However, being a person with a missing front tooth can be quite a different story. Teenage years are difficult enough without having to worry about your smile. With the emotional roller coaster of being a teen, we need to give our children any excuse to smile and no reason not to!
What was recommended?
Dr. Elizabeth had some options for Elena for replacing her missing tooth. One option was to use a “flipper,” which is a removable partial denture that contains one or more artificial teeth. A flipper is often made from denture acrylic and can blend in well with your smile. The flipper is custom made using an impression or digital scan of your mouth. Flippers can be uncomfortable to wear and they do come in and out of the mouth, which can be inconvenient.
To replace missing teeth, you can also consider a bridge. A traditional bridge uses the neighboring teeth as anchors to “fill in the gap.” Since Elena was still growing and developing, a traditional bridge wasn’t Dr. Elizabeth’s first choice. A more conservative option for Elena’s age was to consider a composite bonded bridge, which still stays fixed in the mouth like a traditional bridge, but is much more conservative for neighboring teeth and can more easily be altered with growth, if needed.
Another common method to replace missing teeth is to use a dental implant. With a dental implant, a small post, usually made of titanium, is placed into the jaw bone and serves as a substitute for the root of the tooth. Then, through a series of attachments, a tooth is added to the implant. Again, because of Elena’s age, a dental implant wasn’t indicated…yet, anyway.
Dr. Elizabeth discussed pros and cons with Elena and her mom of these options and emphasized that something would have to be done to last through Elena’s teenage and early adulthood, even though a dental implant may be the best long-term approach.
What did Elena want?
For the undersized lateral on her right side, composite bonding was done to change the shape and size of the tooth. A porcelain veneer could have been done, but with Elena’s age, the composite material can more easily be changed, if needed, for future growth and development. As an adult, Elena could choose to convert her composite bonding to a porcelain veneer for ideal color match. After much discussion, Elena and her mom decided that for her missing tooth on her left side, Elena would use a flipper during the day and an orthodontic retainer at night.
Then what happened?
Throughout Elena’s high school career, she found it was inconvenient for her to wear her flipper and she also didn’t wear her retainer much so her teeth moved somewhat. In thinking of her life after high school, Elena wanted to review her options. Elena and her dad came to consult with Dr. Elizabeth she told Dr. Elizabeth, “I am interested in a bridge now.” Once again, Dr. Elizabeth reviewed Elena’s options in regards to how the most conservative approach would still be preferred. Dr. Elizabeth recommended that Elena complete a composite bonded bridge. Dr. Elizabeth would be able to artistically create a “fake” tooth and attach it her surrounding teeth. This choice is good for the esthetics and will buy Elena some time until she is older and can make some alternate decisions, if needed.
What does she think?
When asked how Elena felt about getting the procedures done, she said “I was looking forward to my tooth looking like a normal sized tooth.” She also said that her mom had a bridge done and so she was not worried about it. “I like it a lot and it looks good. It doesn’t feel weird to my bite. It does not feel weird when I chew or eat.” She is really happy to have her palate free! She would recommend that anyone needing the same or similar treatment done go for it. She says, “I like it! It’s nice to have a normal smile where all my teeth are a normal size.”
Congratulations on your amazing results Elena and thank you for putting your trust in us! We are delighted to help you move into your college years!
