Braces for the second time. Need opinions!

[LizamasLlama]

Basically I was born with one of my lateral incisors missing, and one of them being a peg tooth. I got braces at a young age and the orthodontist closed up the gap on one side of my face (wtf was she thinking?) I am now 16 years old and am left with a lopsided messed up bite. I just got braces on again and my ortho is suggesting to move the top teeth to align with the bottom, but won't that just cause more problems? I want to get my peg incisor extracted and close that gap. Is that the best option? I can't afford implants. As you can see in the pictures I have an open bite and my face is completely slanted...Please help!

[LizamasLlama]

Edit: here are the pictures.

http://i40.tinypic.com/2u8fkbd.jpg
http://i40.tinypic.com/141ml3t.jpg

[Chicken]

Hi
My daughter had a small incisor like yours and she had it capped. It looks really good. It's a possible solution for when you get your braces off.

[Ciara]

I am also missing a lateral incisor (right one) and my ortho as a child moved my canine into the gap. He pulled a bottom premolar to balance the number of teeth. My present orth suggested moving everything and reopening the gap (she did say it would be very difficult) and put in an implant. I decided against this and instead she will reshape my canine when finished to more resemble an incisor. It means that it will not be perfect but will be better. (I have an asymmetrical midline as a result of everything shifting slightly to the right which has become skeletal. I'd need surgery to fix it - decided against this too.)

For your other lateral incisor, have you considered getting a crown or some other kind of cosmetic work done? They can be very realistic these days and far cheaper than an implant.

[LizamasLlama]

I am open to any and all opinions...I am just honestly really confused about this whole thing.

As you can see in the picture my whole face looks pushed to the right, with what my ortho is suggesting (bands to move my uppers aligned with bottom) will this even out or will it remain with the pushed to the right look?

[Kipepeo]

I agree with Ciara. Realign the midlines, reshape the canine into a lateral, crown the peg lateral.

[katsface]

Would it be possible to open up the space where the missing lateral would be and put a bridge in? Then at some point you could save up for an implant if you wanted. I think putting a crown on the peg lateral is a good idea too.

[jem]

Hi LL,

I agree with katsface.

Your lateral incisor is not that small and I think it looks ok. But it could easily be increased in size by bonding or a crown if you wanted.

On the other side, I would strongly recommend that you open the space where the other lateral should be. That will enable you to get your midline straightened out and should give you the regular and symmetrical arch which would be best for your bite and overall dental health long term. It would also give you the best looking outcome. As katsface says, you could find some temporary way of filling the new gap pending getting an implant. At 16, would you be too young for an implant anyway?

I am a little surprised that this issue has not been decided on before you got your braces put on again. You really need to get your desired outcome agreed with your ortho before your treatment goes much further.

You already have very nice teeth and clearly have the potential for them to be fantastic when you are finished. Well done for taking such a mature approach to all this.

Jem

[oldfart]

Armchair Orthodontists Unite!!!

[bmueller]

I think the ideal is to have the midline of the upper teeth match with the midline of your face. For years the midline of my bottom teeth did not match with the midline of my face but it was not very noticable.

Having the top teeth off knocks off the symmetry of your face and just seems weird. Sounds like you have a lot of other issues contributing... missing teeth, small teeth....

Did your ortho line up options to fix these things and possible consequences before you started treatment?

I think the best scenario is to have the ortho line up the top teeth so the midline is correct, then do something cosmetic to fill in the gaps, whether it's reshaping a canine or a temporary bridge or fake tooth until you can afford a more permanant solution (implant). Have you looked into the price of an implant and/or possible payment plans? If you're going to spend some money now to do a temporay fix, it might be worth waiting and saving up the money for the permanent solution.

Armchair othodontists unite! I think everyone on this blog loves these kinds of questions/posts.

[LizamasLlama]

I get my bands on the 15th to begin shifting my uppers back to the center. How aesthetic would the option of shaving canine/crown or veneer on other come out?