Missing Lateral Incisors Orthodontics UK

Why are lateral incisors sometimes missing?

Upper lateral incisors are the second most commonly missing permanent teeth after lower second premolars and wisdom teeth. The condition is classified as hypodontia — congenital absence of one or more permanent teeth — and affects approximately two per cent of the UK population for lateral incisors specifically. The cause is primarily genetic, and the condition frequently runs in families. In some individuals the lateral incisor tooth bud is completely absent; in others it forms but develops into a small, peg-shaped or cone-shaped tooth — known as a peg lateral — rather than a normal-sized incisor. A peg lateral is considered a partial expression of the same underlying developmental variation. Both true absence and peg laterals present the same fundamental question: how should the resulting space or cosmetically inadequate tooth be managed?

The two main treatment pathways

There are two primary orthodontic treatment strategies for missing or peg lateral incisors, and they lead to quite different outcomes. The first is space opening — using orthodontics to create or maintain a space of the correct size where the missing lateral should be, then filling that space with either a dental implant (after jaw growth is complete) or a tooth-supported bridge. This approach preserves the natural role of each tooth: the canine stays as a canine, and the gap is filled with a restoration that looks and functions like a lateral incisor. The second is canine substitution — closing the space orthodontically so that the canine moves forward to occupy the position of the missing lateral incisor. The canine then replaces the lateral, and the first premolar moves forward to replace the canine. This approach avoids implants or bridges but requires careful reshaping and sometimes veneering of the canine to make it look more like a lateral incisor.

Pros and cons of space opening for implant or bridge

Space opening preserves the natural tooth positions and, when completed with a well-made implant crown, produces results that are aesthetically excellent and functionally very close to a natural tooth. Implant crowns are independent of adjacent teeth and do not require grinding down healthy teeth. However, the approach has significant limitations. Implants cannot be placed until jaw growth is complete, usually around eighteen years of age for females and slightly later for males — meaning younger patients must manage a temporary restoration during the waiting period. Implants are also expensive (typically £2,000 to £3,500 per implant in the UK), entirely private, and require sufficient bone volume at the site, which may need augmentation. A tooth-supported bridge is an alternative to an implant but requires preparation of the adjacent teeth and will eventually need replacement. Overall costs for the space opening pathway are higher over a lifetime.

Pros and cons of canine substitution

Canine substitution avoids the need for an implant or bridge and can produce excellent results when the case is well selected and the canine is carefully reshaped. The approach is simpler, cheaper in the short term, and avoids the wait for skeletal maturity before final restoration. However, canines are naturally larger, more yellowed, and differently shaped than lateral incisors, so achieving a convincing aesthetic result requires cosmetic reshaping — enameloplasty — and often composite bonding or a veneer on the canine tooth to alter its shape and colour. The bite must also be carefully managed, since canines play a specific guidance role in the bite and moving them to the lateral position changes how the bite functions. For some patients the aesthetic result is entirely satisfactory; for others the canine tip and colour difference remain noticeable despite reshaping. The canine substitution option tends to work better when the canine is narrow and not excessively yellow.

The multidisciplinary team

Deciding between these two pathways requires input from at least two — and often three — dental specialists working together. The orthodontist manages tooth positioning and space. The restorative dentist plans and places the final restoration — a bridge, veneer, or composite build-up. An implant surgeon is required if an implant is chosen. This team should ideally meet or communicate before treatment begins so that the orthodontic space is the right size and shape for the planned restoration. Poor communication between treating clinicians is a frequent cause of suboptimal results — for example, orthodontic spaces that are too narrow or incorrectly shaped to receive a well-proportioned implant crown. Ask whether your orthodontist works with or refers to restorative and implant colleagues who are familiar with the management of missing laterals.

NHS vs private, timing, and costs overview

NHS orthodontic treatment is available to eligible under-18 patients and can include space opening or space closure for missing laterals as part of an overall treatment plan. However, the NHS does not fund implants or private restorative work, meaning that even patients who receive NHS orthodontics will face private costs for the final restoration. The implant and final crown typically cost between £2,500 and £4,000 per tooth at UK private dental practices. Bridge work starts from around £800 to £1,500 per unit. Canine substitution with composite reshaping is the most cost-effective final outcome. The total treatment journey — from orthodontics to final restoration — commonly spans five to ten years when implants are chosen, since treatment often begins in the early teens and implants cannot be placed until growth is complete at eighteen or later.

Useful related pages

This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist.