When an adult tooth never forms, the upper lateral incisor is one of the teeth most often involved, but it is not the most common. A large 2004 meta-analysis by Polder and colleagues in Community Dentistry and Oral Epidemiology ranked the lower second premolar first, the upper lateral incisor second and the upper second premolar third. The upper lateral incisor is simply the one people notice, because it sits right beside the two front teeth.
A close relative of the missing lateral is the peg lateral: a lateral incisor that does form, but small and tapered. Both can be managed, and the best choice for a child usually depends on timing as much as on the tooth itself.
A missing tooth bud means the tooth will not arrive late
A congenitally missing tooth is one whose bud never developed. That is different from a tooth that is slow to erupt, stuck under the gum, or lost to decay or injury. An X-ray shows the difference. If the bud is not there, waiting will not change anything, and planning can begin.
Parents often first notice something is different when a baby lateral incisor stays in place well after the neighbouring adult teeth have come through, or when a gap appears beside a front tooth. Your dentist or OHT may also spot it on a routine X-ray at a check-up.
Peg laterals and missing laterals are linked
A 2013 meta-analysis in the American Journal of Orthodontics and Dentofacial Orthopedics (Hua and colleagues) estimated that about 1.8 per cent of people have peg-shaped upper lateral incisors, with higher rates in women and in studies of Asian populations. The same review found that when one lateral incisor was peg-shaped, the lateral on the other side was missing in about 55 per cent of cases. In other words, the two conditions often appear together in one mouth.
Missing teeth can also run in families. A review in the British Dental Journal (Cobourne, 2007) described familial hypodontia as a complex trait, shaped by genes, environment and the timing of development rather than a single cause. If a parent or sibling has a missing or peg-shaped lateral, it is worth mentioning at your child's next visit.
A peg lateral is a healthy tooth. It works normally, and the main concerns are how it looks and the spaces that can form around a small tooth.
Two directions for a missing lateral
Once enough adult teeth are through to judge the bite, the plan usually heads one of two ways. A 2023 paper in the British Dental Journal (Dolan and colleagues) on hypodontia treatment planning describes the same central question: open the space or close it.
Closing the space
Braces or aligners move the canine forward into the lateral incisor's position. The canine is then reshaped, often with tooth-coloured bonding and some gentle contouring, so it looks more like a lateral incisor. The tooth behind it takes the canine's place. This avoids an artificial tooth altogether, but it only suits some bites, and the size, shape and colour of the canine affect how natural the result looks.
Opening or holding the space
Braces or aligners create a gap of the right size, and a replacement tooth goes in later, usually a resin-bonded bridge or an implant. The Dolan paper notes that the space between the neighbouring roots needs to be wide enough for an implant, so the orthodontic phase is planned with the final replacement in mind.
Which way suits a child depends on the bite, the crowding, the size of the other teeth and the face as it grows. At Lumi, our dentists provide orthodontic treatment with fixed braces and clear aligners. More complex cases may be referred to a registered orthodontist, and planning often involves more than one clinician.
Implants come last
An implant is fixed in the bone and does not move as the jaw grows, while natural teeth keep shifting slowly. If it is placed too young, the implant crown can end up looking short or out of line with the teeth beside it. Dolan and colleagues note that bridges are unlikely to be possible until the late teens, and implants possibly later still.
That leaves a gap of several years for many children, and it has to be held open. Options include:
- a removable retainer with a false tooth attached, which holds the space and fills the gap at the same time
- a resin-bonded bridge, where a false tooth is attached to the back of a neighbouring tooth with a thin wing, with little or no drilling of that tooth
Retainers need to be worn as instructed. If they are not, the teeth can drift and some of the orthodontic work may need to be repeated before the final tooth goes in.
When the time comes, our guides to the parts of a dental implant and how an implant bonds with the jawbone explain the process. Because the space is often held for years, our article on getting an implant long after a tooth is lost is also relevant.
A peg lateral can often be built up
If the peg tooth is in a good position and the bite is fine, braces may not be needed. The tooth can be built out to a normal shape with composite bonding, which needs little or no removal of tooth structure. A porcelain veneer or crown is another option once the tooth and gum have matured. Bonding placed early may need touching up as the gum line settles in the late teens.
Where the peg tooth sits within a larger spacing problem, orthodontic treatment may come first to put the right amount of space around it, so the built-up tooth ends up the right width. Our articles on tooth contouring and reshaping and gaps between the front teeth cover related situations.
| Situation | Common approach | When |
|---|---|---|
| Lateral missing, bite suits closure | Orthodontics moves the canine forward; canine reshaped | Once enough adult teeth are through |
| Lateral missing, space kept | Orthodontics sets the space; retainer with tooth or bonded bridge; implant later if chosen | Temporary tooth first; implant after growth |
| Peg lateral, bite otherwise fine | Composite bonding, later veneer or crown if wanted | Often reviewed in the late teens |
What parents ask us
Should treatment start as soon as the missing tooth is found?
Not necessarily. Often the first step is simply to monitor growth and the eruption of the other adult teeth, and to plan the timing of any orthodontic treatment so the space does not have to be held for longer than needed.
Will the gap close by itself?
It may partly close as neighbouring teeth drift, but rarely in a controlled way. Drifting can make later treatment harder, which is one reason to keep an eye on it.
Does a peg lateral need treatment at all?
No, if it does not bother your child and the bite is fine. Many families leave it until the late teens and then decide whether to build it up.
If a dentist has mentioned a missing or peg-shaped lateral incisor, the team at Lumi Dental in Melrose Park can assess your child's teeth and bite and talk through the timing with you. See our current deals or read more about family dental care at Lumi. This article is general information and does not replace an individual dental assessment.
