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Treatment For Peg Shaped Tooth

 

Introduction

Having a perfect body and perfect smile is everybody’s dream. When peg-shaped tooth, commonly lateral incisors erupt in the mouth, it can be a disappointment to the patient that their teeth are not perfect or too small in comparison to the rest of the anterior teeth. With the globalization era and sophisticated technologies, everything seems possible. It is not a problem anymore especially for adolescents who always notice if their teeth are different to others and that do not conform to the ideal of a beautiful smile.

A peg shaped tooth (or commonly called peg lateral) (Picture 1) is defined as ‘an undersized, tapered, maxillary lateral incisor’ (Glossary of prosthodontic terms, 1990) that may be associated with other dental anomalies, such as canine transposition and over retained deciduous teeth. The peg shaped upper lateral incisor presents relatively commonly, in more than half of the cases the condition is bilateral. The tooth or teeth are usually healthy and functional.


Picture 1 : Peg shaped 22 (left lateral incisor)

What are the treatment options?

The aim of treatment should be to give the lateral a normal looking crown structure that appears unremarkable. Usually, sufficient space exists between the central and canine to allow restoration.

Occasionally, the canine will have drifted mesially, close to the lateral’s distal wall and orthodontics will be needed to create room. Restoration can be indirect or direct. As is so often the case, neither approach is definitive and each brings distinct advantages and disadvantages.

Treatment options for Peg Shaped Tooth include:

 
Treatment Options
Explanation
1
No treatment,
patient not concerned
In the case whereby patient satisfied with the existing tooth function and aesthetic.
2
Orthodontic treatment first to align the teeth in the arch Realignment or repositioning the tooth/teeth to the expected original/acquired position to facilitate better Prostheses placement later.
3
Direct composite bonding/build-up onto peg laterals/tooth This is a direct placement of tooth coloured restoration to alter the shape and length of the peg-shaped tooth, so that it will match the contra lateral side.
4
Indirect composite placement Fabrication of tooth coloured restoration extraorally/in the lab in order to get better visualization and adaptation in altering the tooth. The restoration then will be bonded to the peg-shaped tooth intraorally.
5
Veneer (Composite / Porcelain) A composite or porcelain coating bonded to the labial surface of a cosmetically imperfect tooth morphology.
6
Bonded crowns A dental crown is a tooth-shaped “cap” that is placed over and cover the tooth to restore its shape and size, strength, and improve its appearance.
7
Crown lengthening surgery to get better gingival heights then direct bonding A surgical procedure performed by a periodontist to expose a greater amount of tooth structure for the purpose of subsequently restoring the tooth prosthetically. Often indicated in the case of short clinical crown in order to gain prosthesis retention later.
8
Extractions and implant placement In cases of poor prognosis/outcome of the tooth (eg : carious or small tooth), it would be better to extract the tooth and replace with implant supported crown or bridge.  
9
Combinations of treatment in different sequences Combinations of treatment options (eg: crown lengthening,direct composite bonding followed with crown)

Direct composite build-up onto peg shaped lateral

Picture 2: Before composite build – up
Picture 3 : After composite build – up

Porcelain veneer

Picture 4 : Before veneers 12 & 22 preparation
(Source : blog:julieqillisdds.com) 
Picture 5 : After veneers 12 & 22 cemented
(Source : blog:julieqillisdds.com)

References

  1. Rohit Kulshrestha (2016). Interdisciplinary approach in the treatment of Peg Lateral Incisors. Journal of Orthodontics And Endodontics. 2:1
  2. Linda Greenwall  (2010). Treatment options for  Peg-shaped laterals using direct composite bonding. International Dentistry SA. Vol. 12, No 1

 

Last Reviewed : 08 June 2017
Writer : Dr. Norziana bt. Ibrahim
Accreditor : Dr. Roshima bt. Mohd Sharif