Dra. Cléo Salustiano In this article
SummaryWhat peg laterals, microdontia and dental agenesis areTreatments: bonding, veneers, braces, implant or prosthesisFAQRead nextPeg Lateral Teeth, Small Teeth and Missing Teeth: Causes and Treatment
Quick summary of this article+
A peg lateral is a smaller, cone-shaped tooth, usually the upper lateral incisor, and is a form of microdontia, the term for teeth smaller than expected. It often comes with dental agenesis, when a permanent tooth never forms, so the assessment includes imaging when needed. A peg lateral is usually harmonized with additive bonding or a composite veneer, sometimes after braces. For a missing tooth, options are closing the space with braces, an implant after growth or a prosthesis. The choice depends on each case. In Mooca, Dr. Cléo Salustiano (CRO-SP 170844) sees patients every day, from 8 a.m. to 10 p.m.
A peg lateral is a tooth that is smaller than normal and cone-shaped, narrower at the tip. The most common case is the upper lateral incisor, the tooth next to the two front teeth. It is a developmental variation, often inherited, not a disease: the tooth is usually healthy but may leave gaps in the smile or look different from its neighbors. In most cases its shape can be harmonized with bonding, a veneer or a thin composite veneer, sometimes combined with braces, after an assessment.
In the office, people often say they have always hidden their smile because of "a little tooth" or "a pointy tooth" and did not know it had a name. It is also common to find, in the same exam, that a tooth never developed, which is called dental agenesis or a congenitally missing tooth. The two often go together and change the plan.
Dr. Cléo Salustiano (CRO-SP 170844), a dentist in Mooca, explains what peg laterals, microdontia and missing teeth are, how the assessment is done and which treatment options exist for each case, with the advantages and limits of each one.
This article comes from Dr. Cléo Salustiano's dental office in Mooca, São Paulo (care in English, Portuguese and Spanish). See the composite veneers page to learn how the treatment is done here and book your assessment.
Topic overview: our guide to composite veneers covers who they suit, the step-by-step process, lifespan, aftercare and composite vs porcelain.
What peg laterals, microdontia and dental agenesis are
Microdontia is the technical term for teeth that are smaller than expected. It can be localized, affecting one or a few teeth, which is the most common form, or generalized, when all teeth are small. Sometimes teeth are a normal size but look small because the jaw is large and there are gaps between them. A peg lateral is a form of localized microdontia: besides being smaller, it has a tapered tip. In rare cases, generalized microdontia may be linked to general health conditions, which are assessed together with a physician.
Dental agenesis means a permanent tooth does not form and therefore never comes in. It has a strong hereditary component and often appears in more than one family member. The teeth most often missing are wisdom teeth, second premolars and upper lateral incisors. When the lateral does not form, the baby tooth may stay in the mouth for many years or the canine may move into its space.
Peg laterals and agenesis are related: it is common to have a peg lateral on one side and a missing lateral on the other, or other eruption changes, such as a canine that comes in late or stays impacted. That is why the dentist examines the mouth and, when needed, requests a panoramic X-ray or another imaging exam to check that all teeth are present and in position.
A pointy tooth is not always a peg lateral. Naturally sharper canines, uneven wear or a rotated tooth can give the same impression. In some cases a small contour adjustment is enough; in others, material needs to be added. The correct diagnosis defines the path and avoids unnecessary treatment.
| Situation | Possible options | Note |
|---|---|---|
| Single peg lateral, no large gaps | Additive bonding or composite veneer | Little or no reduction in many cases |
| Small teeth with gaps between them | Bonding or veneers, sometimes after braces | Plan how the space is distributed |
| Pointy tooth | Cosmetic contouring or added resin | Depends on natural shape, wear or peg lateral |
| Missing upper lateral incisor | Close the space with braces, implant after growth or prosthesis | Choice depends on bite, age and space |
| Missing premolar with a firm baby tooth | Keep and monitor the baby tooth | Plan replacement if it is eventually lost |
Treatments: bonding, veneers, braces, implant or prosthesis
Peg lateral or small tooth: the most common option is adding composite resin to give the tooth a shape and size in proportion to its neighbors. Since a small tooth has extra space around it, this is often done with little or no enamel reduction, using an additive technique. It may be direct cosmetic bonding, a composite veneer or a thin composite veneer and, in some plans, a porcelain veneer or crown. When several teeth or gaps are involved, the case is planned as a whole, as explained in gap between teeth: bonding, veneers or braces and in composite veneers.
Sometimes braces come first. When gaps are poorly distributed, the tooth is rotated or the bite needs correction, orthodontic treatment repositions the teeth and leaves the right amount of space before the peg lateral is built up with resin. This combined plan usually gives a more proportional result. See also braces and aligners.
Agenesis: there are basically three paths, chosen after an assessment. Closing the space with braces, moving the canine into the lateral's place and reshaping it with contouring and resin. Keeping or opening the space with braces and, after growth is complete, placing a dental implant, with a temporary prosthesis until then. Or a prosthesis such as a bonded bridge or a fixed bridge. When a premolar is missing and the baby tooth is firm and healthy, it can be kept and monitored for a long time.
Each option has limits: resin can stain and wear over time and needs maintenance, and no technique gives the same result for everyone. In children and teenagers, additive bonding can be done to improve appearance, leaving definitive solutions for after growth. This content is for information only and does not replace an exam. Consult a dentist before deciding. In Mooca, Dr. Cléo Salustiano sees patients every day, from 8 a.m. to 10 p.m., including Sundays and holidays, with assessments for composite veneers.
What is a peg lateral?
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It is a tooth smaller than normal and cone-shaped, narrower at the tip. Most often it is the upper lateral incisor. It is a developmental variation, often inherited, and the tooth is usually healthy. The concern is usually cosmetic, because of gaps or the size difference.
Can a peg lateral be fixed?
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Yes. The most common approach is adding resin to give a proportional shape and size, often with little or no reduction. Composite veneers, a porcelain veneer or a crown may also be used. When gaps are poorly distributed, braces may come first. The choice is made after an assessment.
What is dental agenesis?
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It is when a permanent tooth does not form and never comes in. It has a strong hereditary component. The teeth most often missing are wisdom teeth, second premolars and upper lateral incisors. The diagnosis is confirmed with a clinical and imaging exam, which the dentist requests when needed.
Missing lateral incisor: implant, braces or bridge?
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It depends on the bite, age, available space and the shape of the canine. The options are closing the space with braces and reshaping the canine, keeping the space for an implant after growth is complete, or a prosthesis such as a bonded bridge. Planning is individual.
What is microdontia?
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It is the technical term for teeth smaller than expected. It can affect one or a few teeth, which is more common, or all teeth. A peg lateral is a type of localized microdontia. In rare cases, the generalized form may be linked to health conditions that are assessed with a physician.
Does a veneer on a small tooth damage it?
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On small teeth, resin is usually added on top of the enamel with little or no reduction, which preserves tooth structure. Still, the technique and any reduction depend on each case. The article on whether composite veneers damage teeth explains this in detail.
Where can I have a peg lateral or small teeth assessed in Mooca?
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In Mooca, Dr. Cléo Salustiano (CRO-SP 170844) sees patients at Rua Hipódromo, 1141, near Bresser-Mooca station, Monday to Sunday, from 8 a.m. to 10 p.m., including holidays, with assessments for composite veneers. Appointments via WhatsApp (11) 97409-7834, in Portuguese, English or Spanish.
