By Dr Kailesh Solanki
One of my patients' most commonly asked questions is what is the best way to close a gap between your teeth? This depends on different factors and is different for each individual. Factors affecting the type of treatment that would be suitable are:
Cosmetic bonding or composite veneers
If the gap between the two teeth is very small, closing the gap with composite bonding provides a quick solution to the problem. Bonding provides a minimally invasive solution to closing the gap. However, the drawbacks with bonding are that it does not last very long and will eventually need to be redone. Boning material is also susceptible to staining and may show up after some time.
Porcelain veneers
Veneers are commonly used to close a gap between two front teeth (diastema), but if the gap is too large, the veneers used to the close the gap will be disproportionately wide compared to the rest of the natural teeth. This could leave the smile looking unnatural, whereas one of the aims of cosmetic dentistry is to create a beautiful and natural look. Veneers offer a more robust solution than composite bonding; however, the teeth need to be prepared, which means that healthy tooth structure must be removed to allow the veneers to be fitted over the front surfaces of the teeth.
Orthodontics/braces/Invisalign
The most conservative and minimally invasive way to close a small gap is orthodontic treatment, either using conventional fixed braces, or invisible braces such as the Invisalign system. There are many different types of braces available, such as lingual braces, the Inman aligner, Damon braces etc. They all serve one purpose: to apply pressure to the teeth to encourage them to move closer together to close the gap. The main drawback to this method is that it takes time and you could be undergoing treatment for many months, versus veneers or bonding where the solution is instantaneous.
Gaps due to missing teeth
If the gap is due to a missing tooth, veneers or orthodontic treatment would be inappropriate. The missing tooth needs to be replaced, both for aesthetic and functional reasons – a restoration would prevent the teeth on either side of the gap from “shifting” towards the gap. Solutions to replace a gap due to missing teeth could be a partial denture, a dental bridge or a dental implant.
Partial denture
This is a false tooth that is mounted on a plate and sits in your mouth to fill the gap. The main drawback to dentures is that they can come loose, which can be embarrassing, as well as making chewing tough foods and eating more difficult.
Dental bridge
A fixed bridge relies on the structure of the neighbouring teeth adjacent to the gap to act as anchors for crowns to "bridge" the gap. This requires the reduction of healthy tooth tissue. The bridge is only as strong as the supporting teeth, and if one of the supporting teeth were to be damaged in the future or undergo decay, the integrity and strength of the bridge would also be lost.
Dental implants
A dental implant is a replacement for the root portion of your tooth and it provides a long-term solution for the replacement of a missing tooth that does not rely on the adjacent teeth. The treatment is usually carried out in two stages, with the implant first placed into a hole drilled into the jawbone and then left to heal for a period of up to six months. The second stage involves placing a crown or bridge on the implant once it has fully integrated with the bone.
There are many different ways in which dentistry can be used to close a gap between teeth, but the most important part of the process is the initial assessment of the patient, what defines the “gap” and what the patient’s requirements are.