Congenitally Missing Teeth

Some of us will have 32 teeth develop during our lifetime. This has been considered a normal complement of teeth. More often than not, however, we do not develop a full set of 32 teeth. It is quite common for people to be missing one or more of the third molars (wisdom teeth). And as the jaw sizes of modern human beings have decreased in size, it is not unusual that there is no room for the proper placement of the third molars in a mouth, and they must be extracted.

Not as common, but not at all unusual, is a condition in which certain permanent front teeth never develop. When permanent teeth don’t develop, they are considered to be congenitally missing. The term for this condition is congenitally missing teeth. When this happens, it is frequently one or both of the upper lateral incisors, which are smaller teeth on either side of the two top front teeth. Less often, the permanent eyeteeth (canines) or premolars don’t develop.

The problem that results from congenitally missing teeth involves the space where the tooth (teeth) should have been. The teeth nearest the space shift into different positions to fill the gap, often resulting in a crowded smile—when in fact, some teeth are missing!

The problems resulting from missing permanent teeth can be reduced or eliminated with early detection and a plan for future treatment. The usual treatment involves orthodontics to move the permanent teeth into better position or keep the permanent teeth in the correct location. Because we treat missing lateral incisors so often, the treatment routine is well established. The best aesthetics, the most natural look, will be achieved by leaving the adjacent permanent central incisors and canine teeth in their customary places.

When there are missing lateral incisors, it is likely that we will recommend moving the eyeteeth (canines) into their positions. This will keep the bone in the missing tooth space at the proper level. We will then recommend moving the eyeteeth back into their proper positions. This may sound like extra treatment, but it is needed to keep the bone at the proper height for future tooth replacement treatment.

The sequence of treatment is orthodontics as early as necessary to maintain the space. The further the teeth have shifted from this original position, the more orthodontic treatment will be necessary. Then, while the child and mouth are growing, a removable replacement tooth is made. This appliance is worn until the teeth are ready to receive the implant or bridge, after age 18 or so when the mouth and dental structures are more mature.

When the permanent teeth further back in the mouth are missing, it is common for baby teeth to be retained in these spaces. Sometimes the baby teeth can last for years, but they do not have the root structure to remain stable over a lifetime. Because the retained baby teeth are meant for a small mouth, they do not have the right size, shape, or function as the permanent teeth. When lost, they can be replaced with implants or a bridge. Your own particular situation will determine the best course of treatment.