Cosmetic Dentistry: Using Invisalign® to close the space between two front teeth.

There are several different methods a dentist can use to close in a gap between two teeth (a "diastema"). One of these involves the use of orthodontic treatment.

Having dental braces may not appeal to some people but that may be because they don't realize how much they've changed. Nowadays there are a number of different techniques and options that can make having orthodontic treatment much less noticeable.

One of the most popular is Invisalign®. This technique involves wearing clear plastic aligners that are both removable and relatively invisible. The digital makeovers on this page show two cases where this system might be used to close the space between two front teeth.

Digital smile makeover #1: A simulation for Condoleezza Rice.

Dental history and concerns:

1) Dr. Rice's smile is well known. It's most prominent feature is the diastema (gap) that lies between her two center teeth.

a) From a dental-health standpoint, having a space like hers is a non-issue. Neither leaving it nor closing it would be expected to have any impact on the long-term outlook for the health of her teeth.

b) From a standpoint of cosmetic appearance, some people might feel that having a diastema detracts from the beauty of their smile. This would be a personal preference, and no doubt one that Dr. Rice has already weighed. Having said that, in our "after" picture we've illustrated how her smile would look if the space were closed.

2) When considering possible treatment options for this case, it's important to note that, overall, the color and shape of her teeth is already quite pleasing and doesn't really need any improvement.

Cosmetic dentistry solutions:

1) Making a decision to close the space using orthodontic treatment. - As mentioned previously, there are a couple of different techniques that a dentist might use to close a diastema. With this case (other than braces) it seems that either porcelain veneers or dental bonding could be used.

Both of these methods, however, seem to approach the problem from the wrong side. If the teeth already have a nice color and shape (something that bonding and veneers are often used to improve), why not treat the real underlying problem and just straighten the teeth?

Placing veneers or bonding will involve long-term maintenance issues, both planned and unplanned. This includes making repairs and, especially for relatively younger patients, the need to replace their existing work with new restorations later on in life.

Considering this disadvantage, the comparatively minor inconvenience of needing to wear a retainer after having braces may seem the more attractive option.

2) Invisalign® treatment. - It seems likely that Invisalign® could be used to make the changes we've shown in our "after" picture. Possibly even Invisalign Express®. Compared to traditional braces, here are some of the advantages that this technique offers.

1. Invisalign® tooth aligners are clear. When they are worn, it's relatively hard for others to detect them.
2. The aligners can be removed (like when eating or cleaning your teeth). This makes having braces easier to tolerate. They can also be taken out for especially important functions, which might be an attractive feature for Dr. Rice.

Of course, we only have a picture to evaluate. This method does have limitations in regard to the types of cases that it can be used to treat. (Here are some diagrams showing how dentists use Invisalign®.) Only her dentist could determine if this would be an appropriate approach for closing her tooth gap.

Digital dental makeover #2: Another case where closing a tooth gap using braces may make the most sense.

This second digital makeover is actually one we show on another page as an example of closing tooth gaps using dental bonding. This technique can be a good option for closing relatively narrow spaces between teeth.

However, and similar to the case above, the biggest cosmetic concerns with this smile are directly related to tooth alignment. Using braces to actually correct this problem, rather than just masking it by placing bonding, seems the better approach.

Dental history and concerns:

1) Here are the things we notice when we look at this case's "before" picture.

1. There's a space (diastema) between the center two teeth.
2. The biting edges of the center teeth are notched.
3. The alignment of the teeth needs improvement.

Cosmetic dentistry solutions:

1) Making a decision to close the diastema using braces. - Once again, with this case it's not that the teeth are so bad (although they're not as nice as Dr. Rice's), it's mostly just their alignment that needs correcting.

The minor tooth notching on the front teeth could be filled in by placing dental bonding (or possibly just trimmed off using a dental drill).

The remainder of the attention that this smile needs, including closing the gap, could all be accomplished by the orthodontic treatment, possibly even Invisalign®.

2) If the patient wants whiter teeth ... - In the case that the patient decides that they would like their teeth to be whiter, it is possible for Invisalign® aligners to be used as bleaching trays. Using them as a substitute for custom trays isn't ideal. But, in many cases, they can produce satisfactory results. All whitening treatments should be terminated some weeks before any dental bonding is placed.