Key points in brief
- A small lateral incisor, the tooth next to the front tooth, is narrower than usual and sometimes peg-shaped. It can usually be widened with composite, a veneer or a crown, if there is room for this between the front tooth and the canine.
- The dentist suggests the method that is gentlest on the tooth and still gives it a good shape. This is often bonding, which means building up the tooth with tooth-coloured composite, usually without any grinding.
- The choice depends on the space available, the tooth's proportions next to the front tooth and the canine, its colour, and the condition of the enamel and the gum. Before you decide, ask for a mock-up, which means the new shape of the tooth recreated in a temporary material, without any grinding.
- When only one lateral incisor is small, widening that tooth alone is sometimes enough. Whether to widen one or both is easier to decide once you have seen the mock-up.
What causes a small lateral incisor
A small lateral incisor has been that size since it came through. It has not become narrower from brushing or with age. The lateral incisor is the tooth between the central incisor, one of the two front teeth, and the canine. In some people it develops smaller than usual. It may be narrower and shorter, and sometimes it narrows towards the biting edge so that it looks like a peg. Dentists call this microdontia, meaning a tooth that is smaller than usual. A lateral incisor that narrows like a peg is often called a peg lateral.
A small lateral incisor may be on one side or on both. When one lateral incisor is missing altogether, the one on the other side is often small and peg-shaped. That is why, before planning, the dentist checks on an X-ray whether both lateral incisors are present and how the canines are positioned. If there is no lateral incisor at all, the gap can be filled, for example, with a resin-bonded (Maryland) bridge, which is bonded to the tooth next to it.
A small lateral incisor is not a disease and does not, in itself, need treatment. It is usually widened because it affects how the smile looks or leaves gaps between the teeth. A narrow lateral incisor changes the proportions of the whole smile - next to it, the central incisors may look larger, even though they are entirely typical in size. If the shape of your central incisors also bothers you, the dentist plans those first, because they set the centre of the smile.
How to compare your lateral incisor with the central incisor in a photo
- Take a photo of your smile from straight in front, in daylight, with the phone held at the level of your mouth.
- Compare the width of the lateral incisor with the central incisor next to it and with the lateral incisor on the other side.
- Check whether there are gaps next to the small lateral incisor, and make a note of when you first noticed them. A gap that has appeared recently may have a different cause from a small tooth.
- Bring the photos to your consultation, including older ones in which you are smiling.
A phone photo distorts proportions, so it will not replace a measurement at the clinic. It does, however, help you tell the dentist what bothers you: the width of the tooth, its length or the gaps next to it.
Bonding, a veneer or a crown: how they differ for a small lateral incisor
Each of the three methods can widen a small lateral incisor. They differ in the shape and width they can achieve, in how they behave at the gum and in how easily the tooth can be repaired later.
| Method | Shape and width | At the gum and when repairing |
|---|---|---|
| Bonding (composite applied directly to the tooth) | builds up the sides and the biting edge of the lateral incisor, usually with no grinding or only minimal grinding; needs healthy enamel and a colour close to the neighbouring teeth | at the gum, the composite is smoothed so that floss passes through easily; a small chip or loss of shine can usually be put right directly on the tooth |
| Ceramic veneer | changes the shape to a greater extent, and the colour as well; needs enough enamel to bond to and usually a little grinding | keeps its colour and shine well; if it chips, a new veneer is often needed |
| Crown | covers the tooth all the way round, so it removes the most tooth; suited to a tooth with large fillings, with little of its own tissue left (for example after root canal treatment) or badly discoloured | the gum next to a crown bleeds slightly more often than next to a healthy tooth surface |
With lateral incisor bonding, the dentist usually builds up the sides of the tooth and its biting edge, because that is where a small lateral incisor differs most from the typical shape. The procedure itself is the same as central incisor bonding. It is often completed in a single visit, and when no grinding is needed, it can usually be done without a local anaesthetic.
A veneer - composite or ceramic - usually covers the whole front surface of the tooth. Ceramic veneers are also called porcelain veneers. When deciding between porcelain and composite veneers, what matters most is how long they last, how they are repaired and how much enamel has to be removed. A ceramic veneer and a crown are made by a dental technician in a laboratory, so at least two visits are usually needed.
Composite veneers that changed the shape of front teeth were still serving well after 6 years in people with a normal bite and without heavy clenching or grinding of the teeth. Ceramic works well for a peg-shaped lateral incisor: after 5 years, more than 9 in 10 tooth-sparing ceramic restorations were still in use. Some, however, came loose or the ceramic chipped, and a few had to be made again straight after fitting.
It is not known which of the three methods lasts longest specifically for a small lateral incisor. That is why the dentist starts with the one that needs the least grinding and still achieves the intended shape. Veneers and composite bonding are often used to change the shape of small and peg-shaped teeth.
What the dentist assesses before suggesting widening
First, the dentist checks whether there is room next to the lateral incisor for a wider tooth. When there are gaps beside it, widening the tooth may close them. If there is too little room, widening the tooth alone will not give good proportions, and the dentist discusses a different plan with you. With a very wide gap, a lateral incisor that filled it completely could look unnatural. In that case it is often better to leave part of the gap or to spread the added material over the neighbouring teeth as well.
Next, the dentist assesses the proportions. A lateral incisor is usually narrower than the central incisor, but there is no single proportion that suits everyone. In one study, a very narrow lateral incisor was liked least both by orthodontists and by people with no dental training. The second group rated the other widths similarly. So the dentist matches the width to your face, to the central incisor and to the canine, rather than to a textbook formula.
The dentist also checks:
- the height of the gum line above the lateral incisor compared with the other side, because a difference at the gum is noticed sooner than a difference in width;
- the health of your gums, because bleeding gums make it harder to bond the composite;
- the colour of your teeth, because composite and ceramic are matched to the neighbouring teeth. Neither composite nor ceramic can be whitened later, so if you would like lighter teeth, they are whitened before the widening;
- your bite, meaning how the lower teeth meet the upper teeth when you close your mouth, because composite placed where the teeth meet firmly chips more easily;
- habits such as clenching or grinding your teeth at night, which increase the pressure on the biting edge of the tooth.
Finally, the dentist asks what you are hoping for. Whether building up the tooth with composite will be enough, or a veneer would be better, depends on this.
When planning treatment at our practice in Wola, Warsaw, we pay particular attention to whether floss can pass easily between the lateral incisor and the neighbouring teeth after widening. Over time, a tooth that looks good but traps food near the gum encourages gum inflammation and decay at the composite margin, the place where the composite meets the tooth.
How a mock-up helps you judge the proportions
A mock-up, also called a trial restoration, shows the new shape of the lateral incisor in your mouth before anything is done permanently. The dentist or a dental technician designs the shape on a model of your teeth or on a computer. The dentist then transfers it onto the teeth in a temporary material, without any grinding. Once you have seen it, the mock-up is removed without leaving a trace. The whole process, from the photos to the trial in your mouth, resembles broader smile design, except that it involves fewer teeth.
During the trial, you judge in the mirror and in photos whether the lateral incisor looks too wide next to the central incisor and whether it resembles the lateral incisor on the other side. Also check how it looks when you smile and when you speak. Photograph your smile from several angles and look at the photos calmly at home, because it is hard to judge a new shape in a few minutes at the clinic. If something bothers you, the dentist adjusts the design.
The final shape of the tooth is made to the same plan as the mock-up, so it is close to it, although not identical. The mock-up itself usually reproduces the planned shape well - least accurately at the biting edge of the tooth.
How long a widened lateral incisor lasts and how to look after it
It is not possible to predict how many years a widened lateral incisor will last. When composite was used to close gaps and reshape front teeth, nothing needed repairing within 4 years in roughly 9 cases out of 10. The faults that did appear could be corrected without replacing the whole restoration.
At a check-up, the dentist looks at the composite margin near the gum, checks for chips and polishes the surface if needed. If you clench or grind your teeth, the dentist may suggest a night guard, which reduces the pressure on the edges of the teeth.
You look after a widened lateral incisor in the same way as your other teeth, with one addition: clean the space next to the gum every day with floss or a small interdental brush. The gum next to fillings and crowns that reach it bleeds slightly more often than next to healthy tooth surfaces. The difference is greatest with crowns. Do not bite your nails or pens, and do not bite through thread with your teeth, because composite on the biting edge of the tooth chips most easily.
Coffee, tea, red wine and cigarettes can stain the composite margin faster than enamel. If a dark line appears there, show it to your dentist at a check-up. Polishing or replacing a thin layer is then usually enough.
What to do before deciding to widen your lateral incisor
Bring photos of your smile to the consultation and say what bothers you. Ask for a mock-up and judge the lateral incisor in it together with the central incisor and the canine, because the dentist matches the shape of the lateral incisor to the teeth beside it. Decide on the method together with your dentist only once the new shape looks right next to the neighbouring teeth.
Consult your case with an expert and get your treatment plan
Frequently asked questions
Can a small lateral incisor be widened without grinding?
A small lateral incisor can often be widened without grinding. If the tooth has healthy enamel and the widening consists of adding material, the composite is applied to enamel prepared with a liquid and an adhesive, without drilling. Sometimes the dentist smooths the surface very slightly, so that the composite bonds better and does not form a step at the gum. A ceramic veneer usually needs a little grinding, and a crown much more.
Will a widened lateral incisor stand out from the neighbouring teeth?
Well-matched composite is usually hard to tell apart from enamel, especially when it has a high shine. The dentist chooses the shade in daylight and often combines several shades, because the biting edge of the tooth is more translucent than its middle. Over time, composite may lose its shine and may darken at the margin with the tooth faster than enamel does.
Do both lateral incisors need widening if only one is small?
Widening both lateral incisors is not always necessary. The dentist is more likely to suggest it when the other lateral incisor is also slightly narrower. Other people usually start to notice a difference in width between the lateral incisors only when it reaches a few millimetres. A difference at the gum or at the biting edge of the tooth is noticed sooner. You look at your teeth close up, so decide once you have seen the mock-up in both versions.
Does a peg-shaped tooth need a crown?
A peg-shaped tooth usually does not need a crown. Most often it has healthy enamel and lacks width and sometimes length. Both can be added with composite or a thin veneer. A crown requires the tooth to be ground down all the way round, so the dentist is more likely to suggest one when the tooth has large fillings, little of its own tissue left, or is so discoloured that a thin layer of material will not hide it.
What is the tooth like in the first days after widening with composite?
You can see the new shape straight away, but the colour is best judged the next day, because a tooth that has dried out during the procedure is temporarily lighter. For a few days your tongue usually feels the new edge, and some sounds may come out slightly differently until you get used to it. If the composite gets in the way when you bite, or floss catches near the gum, tell your dentist. Excess composite is usually smoothed away during a short visit.
When does composite on a lateral incisor need polishing or repair?
Composite is usually polished at check-ups once a year or more often, because the first signs of lost shine can be visible after as little as a year. Small chips and a stained composite margin are corrected when they appear, often in a single visit. It is not possible to say in advance after how many years a larger repair will be needed, because this depends on your habits and your bite.
Read more:
- Veneers and Composite Bonding in Warsaw
- Central incisor bonding — what does the procedure on the front teeth look like?
- Porcelain vs composite veneers — which to choose? A comprehensive comparison
- Smile design step by step — how does smile design work?
- Veneers or crowns — when to choose which restoration
Content and liability disclaimer
This article is informational and educational in nature and does not constitute medical advice, a diagnosis or a therapeutic recommendation — it does not replace a consultation with a specialist. If you are experiencing symptoms, have doubts or are facing a decision about treatment, consult a dentist. The methods described and the data cited are general in nature. The results of scientific studies relate to populations, not to an individual patient. The course and outcome of therapy depend on the individual clinical situation and may vary between patients. No information contained in this article constitutes a guarantee of result. The content has been prepared with due care, based on publicly available medical knowledge and the scientific publications indicated in the Sources section. We do not advise taking or refraining from any health-related action solely on the basis of the content of this article, without prior consultation with a doctor.
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