Cosmetic Case Study: Tooth Size Discrepancy

One of my patients has been in braces for almost a year.  If you look carefully at her smile it can be seen that one upper central incisor is wider than the other (almost 1 mm).  Not good, when you’re working for the perfect smile.

The first consideration is when to correct this condition. The orthodontist wants to do something now so that he can provide her with the best occlusion (bite) that he can while giving her the most pleasing smile. For this case, now is the time, approximately half way through her treatment which is expected to be 1 year.

Veneers or Bonding?

The next consideration is how to do it. One way is to do dental veneers. For me this is a very scary way to go because this alters the teeth and you are pretty much stuck with the outcome although the braces are far from complete. After two phone conversations with the orthodontist and a sharing of photos and notes, a combination of bonding to build up parts of the small tooth along with interproximal reduction (removing a small amount of tooth structure, usually 0.2mm) from between the teeth is the best bet. Tooth structure can be removed from both sides of the teeth to give the final look that can be matched.

Measuring with a Boley Gauge

Measurements have been taken with a Boley gauge (essentially a ruler that can measure the width and height of the tooth). This helps with gauging the amount of reduction. It all comes down to having a good eye to get the two teeth to look symmetrical. Symmetry is the key to an esthetic smile. There is also a pleasing proportion between all of the teeth along with the lengths of the teeth. This follows the “Golden Ratio” which was first discovered by the Greeks. This proportion is found in nature and is a good guideline when evaluating teeth and smiles.

Oddly enough, I had a 16 year old male come in the following day. He has a space between his front teeth and a somewhat cockeyed alignment of the 2 front teeth. To see if he would like a new look, I placed some bonding material on the teeth to let him see what it would look like with these minor refinements, skipping braces. It was quite an astounding difference with the subtle changes. I did notice that one tooth looked slightly wider than the other when widening just one tooth for him. When we actually do the case I will pay attention to the widths of the teeth to get them spot on.

I like to make smiles look better.  If you would like a better smile, but have always considered that you have to live with the one you have, let me take a look.  The fix might be easier than you think.