Dr. Mayank Khandelwal
Orthodontist
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am 20 years old and have had braces for nearly two years. My left lateral is a peg lateral, and since the beginning of my braces journey, my orthodontist has told me that we are making space next to the peg lateral to build it out with composite bonding. Today I got my braces off and went to get a temporary crown. Later down the line, when we spoke to the prosthodontist, she said I would get a crown on that tooth. She said she had to file down my peg a little for the temporary crown to fit. She did file it down for what felt like an eternity, and I felt so anxious about it. I did not see how much she filed because she fitted the temporary crown on top right after. She said, though, that she had to file down very little. I hope that is true, and when I felt it with my tongue, it felt a little slimmer but not too much. The temporary crown looks awful and disgusting. I have cried so much since I got home. I feel like I have done something irreversible and am stuck with this crown for the rest of my life. This temporary one looks awful, leaving me with little hope for the permanent one. The temporary tooth is not even close to the color of my other teeth, and it is yellow. The shape is all off and much broader than my other teeth. It looks visibly fake. I know it is only temporary, but I have to walk around like this for two weeks, and I feel insecure. Earlier I thought that I might tighten all the teeth together and leave the peg as it is since having a fake tooth felt, I do not know, weird and like a lot of anxiety for some reason. I have not communicated this to my orthodontist. She said the result would be very nice since the prosthetic teeth they make are good. Is this reversible? Can I take this temporary crown off, get braces on my upper teeth again, and push my natural teeth together? I do not care how long it takes or what it costs me. I want my natural teeth. Is it possible even now that she filed down my peg lateral? Thank you.
Hello,
Welcome to icliniq.com.
I read your query and understand your concern. Sorry to hear about the rough experience and mental stress you had to go through and are currently facing due to unexpected and poor esthetics regarding peg lateral incisor management. Peg laterals are the lateral incisors with a different shape than the other side laterals or teeth (if it is on both sides). They are usually pointed and conical in shape, unlike the central incisors, which are flattish at the edge. Orthodontically speaking, the management of peg laterals is decided before starting the treatment. If there is more spacing in the arch and the plan is to close all the spaces, in such case, we can go for a composite build-up before the treatment procedure, and accordingly, the rest of the spaces are managed. If there is more crowding in the arch, we should create some space for the peg lateral restoration, which is later managed after finishing orthodontics. In which category was your situation when the treatment was initiated? Were you asked to undergo a root canal procedure before putting the temporary crown or just a bit of filing, followed by an impression for measurement and placement of the temporary crown? Temporary crowns are given to check the fit and condition of the tooth if you have any issues with the crown, pain, or other discomforts. Once you are fine with temporary crowns, a permanent one is placed. But the main point here is it is done after root canal treatment. If you have not undergone any root canal treatment for this peg lateral, you are safe, and the situation is completely manageable. You can always remove the temporary crown and get a composite build-up on the tooth. If root canal treatment is done, it is advised to have a crown on it as the tooth becomes weak after root canal treatment. Being in an esthetic zone, it is completely unacceptable to have a poor-looking crown being put. The situation is still under control if you have not undergone a root canal and do not wish to get a composite build-up. You can surely get the braces again and push all the teeth back to cover up all the spaces that are present. It is still possible. Re-doing orthodontic treatment even after the root canal is also possible. The only concern will be peg laterals are smaller in width. And with some extent of filing done on it, it would look smaller. But you can relax and reduce your stress. The situation can still be managed. I would like to have certain details, as asked in the response, to have a better assessment, along with a few photos to see the situation exactly. Please answer the related questions asked in response to your query. Please share the teeth photos from frontal and side views to enable me to judge the situation of peg lateral, and I shall be able to assist you better. Feel free to reach out for further queries or clarifications. Thank you.
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