Peg Lateral Teeth and Braces: My Honest Experience

If you've been told you have a peg tooth - or peg lateral teeth - and you're considering braces, this is the honest account I wish I'd been able to find when I started my own journey. I had a peg lateral incisor (the small tooth next to your front teeth) as part of a wider congenital issue where three of my teeth simply never developed. No adult teeth ever formed in the gum. The plan was always to use braces to move everything into position, then add a veneer over the peg tooth to make it look like a normal lateral incisor. That was the plan, anyway.

What actually happened was a lot more complicated. Here's everything.

 

What is a peg lateral tooth? 

A peg lateral is a smaller than normal version of a lateral incisor - the teeth either side of your two front teeth. Instead of a full-sized tooth, you get a tiny, narrow, pointed one that looks a bit out of place. It's a genetic anomaly, and it's actually fairly common in people who have other congenitally missing teeth. My dentist wasn't surprised by it at all. 

For me, the peg tooth was overlapping one of my front teeth when I first went for a consultation. It wasn't sitting where it should be and it was a noticeably odd shape. The plan was to move it into the correct position using braces, then build it up with a veneer so it would look like a proper lateral incisor.

My peg lateral tooth before braces, during treatment and after treatment - it's the small tooth to the right of my front teeth in the first two images, and voila - gone in the final smile!

How braces work with peg lateral teeth

Moving my peg tooth with braces was more involved than straightening a normal tooth. Because it's sitting in the wrong position to begin with, it needs a lot of repositioning throughout the treatment - not just a simple nudge in one direction. They wanted to place it in the middle of the gap, rather than to one side.

Throughout my 28 months in braces with photos month by month, my peg tooth was one of the teeth that needed the most attention at appointments. Elastics were added and changed repeatedly to pull it into the right position. At one point multiple elastics were attached to the peg tooth and the teeth either side, all working to pull it into the middle of the gap created for the veneer. It would move, then drift back. Move, then drift again. My orthodontist repositioned it more times than I can count.

By my 12th appointment, the peg tooth had wandered from the middle of the gap all the way back to sit next to my front tooth. So we started again. This happened more than once. It was one of the more frustrating parts of an already long process.

Why my peg tooth couldn't be saved

When my top brace was finally removed after 28 months, my peg tooth was wobbly. Really wobbly. Like it might fall out at any moment.

I was referred to the dentist who took an x-ray and discovered the reason - the tooth had internal resorption. Essentially the body had started breaking down the tooth from the inside out, absorbing its minerals. It was eating itself.

The likely cause? The peg tooth was already an abnormal tooth - small, not a normal structure, not as robust as a regular tooth. All that movement throughout the brace journey - being pulled, repositioned, pulled again, over and over for more than two years - was probably just too much for it. A normal tooth might have coped. This one couldn't.

It had to come out!

My top brace removed. Not a happy experience really as so many gaps, and my journey wasn't over. The peg tooth is visible beside my front tooth, with a gap left ready for restorative treatment.  After trying to keep in the middle, it ended up positioned next to front tooth with an idea of cosmetic bonding to build it up before we discovered it was wobbly and needed to be extracted.  Arg!

What happens at a tooth extraction

I'll be honest - after everything I'd been through with the braces, I wasn't particularly nervous about the extraction itself. But the timing of mine was a complete disaster, entirely of my own making.

The appointment was originally booked for 9am. Ben was working from home in the morning and doing both school and nursery runs first thing, so I could recover in peace. Then the dentist called that morning to rearrange because the dentist wasn't in. I pushed back - I had four consecutive appointments booked, plus an orthodontist appointment the same week, and rearranging would knock everything back. They squeezed me in at 2pm instead.

Which was 30 minutes before the afternoon school run!

The extraction itself was straightforward. Two injections into the gum, and within seconds my lip felt like it was ballooning (it wasn't). I couldn't feel anything when the tooth was pulled. It was quick and simple - honestly one of the least dramatic parts of the whole three-year process.  Perhaps because it wasn't a proper adult sized tooth, and was already wobbly, it came out really easily.  There's not much to write home about regarding the extraction, it was really stragihtforward for the peg tooth.

Immediately after, the dentist built up a temporary composite in my clear Essix retainer to cover the gap. It wasn't a false tooth as such, just some filling material shaped and cured to fill the space. Not perfect, but fine as a temporary fix.

Now the veneer wasn't an option, I'd have to consider a bridge or implant on this side too!  But first, to let it heal.

What happened next (the chaotic bit) 

I got home and the wound was bleeding heavily into the retainer. I took it out to rinse it and the temporary composite fell straight out and down the plughole!

I stood there staring at the plughole going no, no, no.

It was now 2.45pm and I had to leave to get my daughter from school. I stuffed a tiny piece of cotton wool into the gap in the retainer and headed out the door, numb from my lips up to my eye and halfway across my nose, praying nobody would try to talk to me.

Of course a teaching assistant made a beeline for me straight away. I couldn't even lift my lip to smile properly. I mumbled something, grabbed Bella and got home as fast as I could to remove the cotton wool before it bonded to the wound.

Then off to nursery for my son, retainer back in, blood still dripping from the fresh extraction site and filling up the plastic. All the nursery staff were lined up when I walked in - they always give you a full rundown of the day - and I stood there in front of all of them with what I can only assume were visibly red teeth from the blood.

The lesson: never, ever schedule a visible tooth extraction before the school run.  I tried not to!

Luckily I didn't have to walk around with gaps on show before my eventual bridges were fitted - a clear Essix retainer had two composite teeth built in to hide the gaps - phew!

Life after the peg tooth extraction

Once the tooth was out I was left with two gaps either side of my front teeth. I'd never had lateral incisors on either side - those were two out of the three teeth that simply never developed as adult teeth in my gums - and now even the peg tooth that had been filling one of those spaces was gone.

I had to wait months for the gum and bone to heal and to have the bottom bace off before having permanent false teeth fitted. In the meantime I had a false tooth added to my Essix retainer and eventually had a temporary denture made so I could eat in public without embarrassment - something I'd been avoiding for months. I also tried a metal Hawley retainer during this time, which you can read about in my Hawley vs Essix retainer comparison.

The final solution was two fixed bridges, one on each side. Four of my natural teeth were filed down to act as anchors, with a false tooth in the middle of each bridge. Six false teeth in a row across the front of my mouth. It cost over £3,000 just for the bridges and the whole process took three years from first consultation , wearing braces and to finished result. 

Would I do it again? Yes. But if you're heading into braces with a peg tooth, go in knowing it's one of the more unpredictable teeth to work with. It might behave. It might not. Mine very much did not. 

My full braces journey 

If you want to read the whole story from consultation to retainer, I've written my full adult braces story with photos over on the Healthy Vix website, including the emotional side of having visible gaps at the front of your mouth for months on end!