What can be done if you have a normal bite but there are spaces only between your upper front teeth? This article explains why you may have such spaces and what you can do about them.

The Problem
If you have spaces between the upper teeth because they are too narrow, you may have what is called a tooth size discrepancy (officially known as a Bolton discrepancy). Some patients even have misshaped laterals that look like pegs, aptly referred to as “pegged laterals.” The problem is that if the upper teeth are narrow relative to the lower ones, you cannot close all the spaces orthodontically without changing the size of the upper teeth, the lower teeth, or the bite.

Just closing the spaces between the front teeth may change your bite
A side effect of closing spaces between the upper front teeth is that they also move backward. If your upper front teeth currently rest against the lower front teeth, they can’t just be moved backwards without disrupting the bite. (This is a common problem with direct-to-consumer aligners.) The front teeth can be moved sideways to close the spaces, but not backward. Moving them sideways, however, merely re-distributes the space but doesn’t close it. Here are four possible solutions to address your spaces.

1. Scoot the back teeth forward
One way to close spaces between the front teeth without moving them backwards is to move all the back teeth forward (or leave them forward if you begin treatment with an overbite.) Moving all the back teeth forward is difficult to achieve, however, and may leave them in an unstable position. Leaving the back bite “off” just a little in this manner is not usually a problem.

2. Make the bottom teeth narrower
If the top teeth are too narrow, another fix is to make the lower teeth narrower to match them. This is accomplished using smooth diamond disks during a procedure known as interproximal reduction. Creating space in the lower arch allows the lower teeth to move backward the same amount as the upper teeth which then makes full space closure in the upper possible.

3. Make the top teeth wider
If the top teeth are smaller than the lowers, another option is to make the top ones bigger. This can be done with buildups, veneers, or crowns. Closing spaces in the upper using cosmetic dental procedures may actually be faster and more stable than using braces. If your dentist feels your laterals will be too wide if they are the only ones widened, your orthodontist can use braces or aligners to spread out the space equally among all four front teeth.

4. Leave space behind the laterals
If you are OK leaving some space, but just don’t want it right in front, your orthodontist can move all four of your front together and leave the extra space on the sides behind the laterals. This would require some orthodontic treatment and then permanent retainers afterward so the spaces don’t reopen. The advantage of this approach is that is requires less orthodontic treatment and eliminates the need to change the shape of any of the other teeth.

Spaces due to narrow upper teeth is a common problem in orthodontics. Luckily, there are solutions. As with most orthodontic issues, “one size does not fit all,” so schedule a consultation with your local orthodontist to discuss the best approach for you.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa. Dr. Jorgensen's 29 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor select treatment plans for readers. The opinions expressed here are protected by copyright laws and can only be used with the author's written permission.