The prevalence of congenitally missing laterals (second from the front top teeth are missing) is relatively common and is reported to occur in 2% of the population. They are the third most common missing tooth after third molars and mandibular second premolars, and account for 20% of all congenitally missing teeth.
Why it happens
Disturbances during the early stages of tooth development are thought to be the reason why one or more teeth are absent, and it is thought to be an inherited pattern.
There are two main options for treatment, the first of which is to close the space and move the canine (eye tooth) in to the gap created by the missing tooth, and to then significantly reshape it. This depends on the bite and available space, and is better for teeth that are crowded, and with a well balanced facial profile. The size difference between the teeth also needs to be carefully analysed so that the shift is not apparent, and the gum lines need to be carefully considered. Another issue is that the canines are usually naturally darker and may need to be whitened or have veneers placed. Closing the space is not appropriate for all situations.
The second option is to open the space so that an implant or bridge can be placed at a later date. This is best where there is no bite issue, there is good spacing of the top teeth, and unfavourable shaping of the canines and adjacent teeth.
There are important factors and considerations that create a favourable smile, one of which are the widths of the top front teeth. Treatment is a team approach, taking into account the bite, the size and shape of the adjacent teeth, and the age of the patient, as well as the shape of the face and gums.
There must be sufficient bone, and the area typically needs some more bone added if there is a deficiency. Implants are placed when the patient's facial growth ceases, so this can not occur for girls until the ages of around 17, and around 21 for boys, although waiting longer is safer.
Assessment is necessary with a general dentist so that the complex treatment can be overseen and planned with specialists as required.