When missing upper lateral incisors, there are two options for their replacement. The first is referred to as cuspid substitution; this is done when the eye tooth or cuspid is placed in the position of the lateral incisor. The cuspid is then modified in size and shape to mimic the lateral incisor. The other option is to replace the lateral incisor with some form of prosthesis. This form can either be a bridge or a single tooth implant. There are advantages and disadvantages to both of these options.
When providing the cuspid substitution, there can be problems in both shade and tooth shape. Often a veneer (or porcelain covering), is used to mask the discrepancies. There is also the problem of the root configuration for a cuspid. The root is often more prominent. The advantages of cuspid substitution, is a natural tooth is replacing the lateral incisor. This eliminates the problem of gingival architecture, bone heights changing during later growth periods and development, and possible implant show through in the bone and gums.
When providing prosthetic replacement, either with an implant or a bridge, one needs to look at a different set of problems. The first is the necessity to place an implant with a crown, at a cost of approximately $5000 to $6000. An additional problem is implant show through at the gum level. A third problem is an alteration in gingival and bone height later in the person’s development. This has created an interesting problem reading timing for implant placement. It was once believed the best placement time was ages 17 or 18. This has been altered to later in the early 20s. It has always been my advice that once the space is created and the root positions are appropriate. The patient should place a semi-permanent replacement. This in the form of a Maryland bridge, a false tooth bonded in place with metal tie wings to the proximal teeth. This should provide a reasonable aesthetic result that will address the patients need until thet decide to proceed with an implant.