CASE · Cosmetic dentistry
Peg Laterals and a Missing Lateral Incisor: Braces First, Then Ceramic Restorations (Case Study)
Small (peg-shaped) lateral incisors and congenitally missing teeth are hard to fix with ceramics alone. In this case, a woman in her late teens had four problems in her front teeth at once, so we used braces first to create exactly the right space, then restored six front tooth positions with ceramics. Every tooth kept its nerve.
Case at a glance
- Concern: Front teeth of uneven size and alignment (woman in her late teens)
- Diagnosis: A peg lateral on the right, a retained baby tooth, an impacted upper right canine, and a congenitally missing upper left lateral incisor; the two central incisors were larger than their neighbors
- Treatment: (1) braces to create space for ceramics, (2) gum contouring, (3) temporary teeth to test the design, (4) ceramic restorations for six front tooth positions, with a bridge for the missing tooth
- Temporary phase: usually 1 week to 1 month
- Nerves: all teeth kept vital
What are peg laterals, retained baby teeth, impacted and missing teeth?
- Peg lateral: a lateral incisor that grows smaller than normal, often leaving gaps and an unbalanced smile
- Retained baby tooth: a baby tooth that never fell out because the adult tooth is missing or impacted; it is smaller and has a shorter root
- Impacted tooth: a tooth that stays in the bone or gum; here, the upper right canine
- Congenitally missing tooth: an adult tooth that never formed; here, the upper left lateral incisor
On the left, the canine had drifted into the missing lateral’s place, and the premolar behind it had rotated to fill the space. Because each problem affected the others, the plan had to look at the whole arch.
Why braces before ceramics?
The goal of orthodontics here was not just straight teeth but space that fits the future restorations exactly. We created room around the peg lateral and baby tooth for the thickness of ceramic, kept a tooth-shaped temporary in the missing position during braces, and corrected the rotated premolar.
What mattered most in the ceramic design?
- Slightly narrow the two large central incisors to balance proportions
- Reinforce the peg lateral and baby tooth with composite cores
- Contour the gums to even out heights
- Use a bridge for the missing lateral, designed symmetrically with the opposite side
- Keep every tooth vital by limiting reduction to what is necessary
Why use temporary teeth first?
Before the final ceramics, patients usually wear temporaries for one week to one month. This lets us check shape, size and color on the actual face and adjust anything before the final restorations, which are hard to change once bonded.
What did the result look like?
Symmetry, tooth proportions and the gum line came together, and treatment was completed with all nerves preserved. For a young patient who will use these teeth for decades, keeping the teeth vital matters for long-term health.
Can international patients do this kind of treatment?
Treatment that starts with braces takes longer and needs regular visits. If you live abroad, ask us about splitting the work, for example braces at home and the ceramic phase in Seoul. Ceramic fees depend on the type and number of restorations and are quoted after an examination.
Frequently asked questions
Can a peg lateral be fixed with a veneer alone?
Sometimes, if the gaps are small and the bite is fine. When missing or impacted teeth are also involved, braces are often needed as well.
Can a retained baby tooth be kept under a ceramic restoration?
It depends on the root. Baby teeth have short roots and may not last, so we check the X-ray before deciding.
Implant or bridge for a missing lateral incisor?
It depends on age, bone and the neighboring teeth. This patient chose a bridge designed to mirror the other side.
Can the nerves be kept?
In this case every tooth stayed vital. We plan reduction tooth by tooth and keep it to what is necessary.
This case was treated at our clinic. The article was medically reviewed by Dr. Sunmin Kim, our lead dentist and a board-certified orthodontist.
About the reviewer
Dr. Sunmin Kim is the lead dentist at Ceramic Dental Clinic in Gangnam, Seoul, a board-certified orthodontist (Ministry of Health and Welfare, Korea) with a PhD from Tokyo Medical and Dental University. Our clinic is registered with the Ministry of Health and Welfare to treat international patients.
Important information
This is a real case. Results, treatment time and the number of visits vary from person to person.
How much tooth structure is removed for veneers or crowns depends on the case. Some cases can be no-prep or minimal-prep (case by case, decided after diagnosis), others need more. After bonding, sensitivity, chipping, debonding or gum changes can occur, so regular check-ups are needed.
Photos show teeth only and are published with the patient’s consent. Fees are as of October 2026.
Questions about your own teeth?
Send us photos of your teeth for a preliminary opinion. A final plan and quote are given after an in-person examination.
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