Replacing dental work used to close a tooth gap.

This virtual smile makeover involves a case where the person originally had a large gap between their center two teeth (a "diastema"). Then, some years ago dental work was placed to close in this space.

Now, at this point in time, this person is no longer happy with the way their smile looks.

Case issues and concerns:

a) The main underlying problem with this smile has to do with the fact that it's missing two upper teeth, the permanent lateral incisors.

  • These are the smallish front teeth normally positioned between the central incisors and the eyeteeth.
  • This person reported that their laterals were missing congenitally (meaning due to genetic factors they never existed).

b) Right now, this person has a fixed 4-unit dental bridge. It splints together their eyeteeth and central incisors (4 teeth in total).

  • One would expect that when this bridge was originally placed, the tissue between the center teeth was fuller and completely filled in the space underneath the bridge. Since then, for whatever reason, it has receded and a space has formed.
  • There might be some question why a dental bridge was placed initially rather than individual crowns.

    One would have to assume that the treating dentist thought that this extra inter-tooth stability was required because the center teeth would need to be very large to close in the gap. A size that the roots of these individual teeth would not be able to adequately support on their own.

Dense fibrous gum tissue.

The presence of dense tissue can prevent teeth from coming together.

c) Two factors that have influenced the width and location of the tooth gap are:

  • The missing lateral incisors. Since the space normally occupied by 6 teeth is instead filled by only 4, the presence of a gap (or gaps) somewhere would be anticipated.
  • The gum tissue between the center teeth (a "frenum") appears to be quite pronounced.

    When this tissue is especially dense (fibrous), it acts as a barrier that keeps the center teeth from coming together fully. (We've highlighted the general outline of this tissue in our picture.)

  • A previous attempt at closing a large diastema.
    A previous attempt at closing a large diastema. A previous attempt at closing a large diastema.
  • The diastema has been closed by placing a new dental bridge.
    The diastema has been closed by placing a new dental bridge. The diastema has been closed by placing a new dental bridge.
 

Photo submitted by website visitor.

[How to view other cases.]

Treatment solutions:

A) Just making an improvement -

If this person's only complaint is the space underneath their bridge where the tissue has receded, there can be a fairly simple solution. It should be possible to "plump up" the size of this tissue by performing a gum tissue graft.

This minor surgical procedure is used to increase gum tissue volume in a specific region. The grafting material might be tissue taken from another site in the patient's mouth. Or the insertion of some type of preprocessed or synthetic material.

If this solution is chosen, it would be important for the person to discuss with their dentist:

  • How predictable (in terms of appearance) the outcome of the procedure can be expected to be. (Will it unquestionably fill in the gap fully?)
  • How long will the results last? (Will the tissue continue to recede over time?)

B) Full resolution of the problem -

Our "after" picture shows the type of result that should be possible if the existing dental bridge is replaced and two additional teeth are crowned.

a) Gum work:

Before making the new dental bridge, a periodontist (gum specialist) should be consulted.

There is a history of changes taking place with the tissue in this area (hence the gap that formed between the existing bridge and gums). It's likely that trimming away this fibrous tissue would help to create a more stable gum contour.

b) Remaking the bridge:

The dentist who created the original dental work used the standard techniques that are normally used with this type of situation.

  • To close the gap, the center teeth are made wider.
  • Each eyetooth is given a shape that's more like the missing lateral incisors (flatter front side, less pointed). Making these changes helps to give this smile a more customary (familiar) appearance despite the fact that there are missing teeth.

For our virtual makeover, we've simulated these same types of changes with the following differences.

  • Our simulation gives the center two incisors a more customary outline shape.
  • Even though the original bridge did make changes with the eyeteeth, they're still too convex and bulbous.

    Our makeover shows how making their front surface flatter and their biting edges straighter helps to make them look even more like lateral incisors, which is what is needed to give this smile a more normal appearance.

c) Completing the makeover:

One of the problems with the original dental work was that it only addressed the 4 center teeth. There was no attempt to blend different aspects of the smile together.

Placing crowns on the first bicuspids (the teeth behind the bridge), and making these teeth look fuller and more pointed (more like eyeteeth), would help to give this smile a more harmonious and completed look. (As illustrated in our "after" picture above.)


The same makeover case after orthodontic treatment.

If the treatment plan for this makeover involves orthodontic treatment, the size of the teeth can be more normal sized.

Criticisms of our virtual makeover.

Oversized teeth.

There's no question that using the treatment plan outlined above results in a smile that has very large center teeth. That's due to the need to increase their width to fill in the space of the missing lateral incisors.

Orthodontic treatment.

As a treatment alternative, orthodontic work (braces) could be used to bring the center two teeth together, and create space for replacement lateral incisors.

Doing so would result in a full set of teeth, each more "normal" in size. (Our second simulation of this case gives a rough idea of the type of results that this approach might give.)

The trade off would be a longer treatment time and greater expense. More importantly, the patient must decide which treatment method gives the look they are ultimately seeking.

 

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Input from site visitors.

Frenum surgery

How involved is the gum surgery you mention on this page? I have the same thing and my dentist says it should be trimmed.

It's minor surgery.

The actual procedure is simple enough. The area is numbed up with anesthetic (pretty much the same way as for a routine filling or extraction). The tissue is excised and sutures placed.

Depending on how large the wound is, you may have some swelling or have to take care not to disrupt the area for a day or two when eating and such.

Lots of general dentists likely offer this service. If not, then a periodontist or oral surgeon could do the procedure.


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