Masking the fact that a smile has a missing front tooth.

This digital makeover starts with the same "before" picture as this case. But with this simulation, the changes will be made without the benefit of orthodontic treatment. While an approach involving orthodontic work can give a better end result, some people are hesitant to commit to that type of treatment plan.

With our example here, with this limitation, the goal isn't to correct the underlying problem (replacement of a missing tooth) but instead to try to create an illusion where its absence isn't so easily noticed. (A similar approach is taken with this case.)

Case issues and concerns:

  • This smile is missing an upper front tooth. It should be positioned between the teeth labeled #'s 1 and 2. Its size and shape should be similar to the tooth labeled #4.
  • The biting edges of several of the upper teeth have worn.
  • On a whole, this smile seems to slope off to this person's right side.
  • There's a real likelihood that the missing tooth is impacted (present and embedded in the jaw). And ideal treatment would involve guiding it into place orthodontically.

    Since that approach will not be taken with this makeover, the tooth should be monitored periodically with dental x-rays so to evaluate both it and its surrounding tissues for possible pathological changes.
  • This smile has a missing a lateral incisor.
    This smile has a missing a lateral incisor. This smile has a missing a lateral incisor.
  • The right eyetooth has been transformed into a lateral incisor.
    The right eyetooth has been transformed into a lateral incisor. The right eyetooth has been transformed into a lateral incisor.
 

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Treatment solutions:

If having braces isn't an option that this patient will consider, creating a normal-looking smile becomes much more difficult. There are, however, some steps that can be taken toward this goal.

Step #1: Perform "gum sculpting." -

The height of the gum line on teeth #'s 1 and 2 is lower than that found on the teeth on the left side. Gum sculpting (a minor surgical procedure) could be used to reposition the gum line on these teeth. Doing so would go a long way toward providing a sense of symmetry for this smile.

Step #2: Adjust the biting edges of selected teeth. -

The biting edge of tooth number 3, and possibly teeth numbers 4 and 5 too, should be straightened. This can probably be accomplished just by trimming these teeth slightly with a dental drill.

Step #3: A crown for tooth # 2. -

Create a dental crown for the tooth marked # 2 that establishes its biting edge in line with # 3. Ideally, teeth #'s 2 and 3 should be mirror images of each other. The crown placed on tooth # 2 will create this effect.

Step #4: A crown for tooth # 1. -

Create a dental crown for the tooth marked # 1 but make its biting edge straighter and less pointed than the tooth was originally. In a nutshell, the idea here is to transform the shape of this tooth from an eyetooth (which it is) to a lateral incisor (like tooth #4). Doing so will improve the left-right harmony of this person's smile.

That's pretty much all that can be done. Clearly an orthodontic approach to this case offers a better cosmetic outcome, at least on close inspection. But for those who will not consider it, this second method may offer a look that's good enough.

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