Correcting A Gappy Smile

Correcting A Gappy Smile

When a tooth is lost, simply leaving a gap isn’t the answer, advises Dr Krina Patel.

Few of us will retain all of our teeth for our whole lives, however well we look after them.

At some point, whether in our teen years or later life, there is a reasonable chance that one or two may be damaged through an accident, or perhaps lost due to poor oral health care finally catching up with us.

Especially if the tooth is not a visible one, it may be tempting to just leave a gap but this is inadvisable, for reasons we will discuss. However, where the gap in the teeth is visible, we will almost certainly want to do something about it.


Before we move on to where a tooth is missing, it is worth mentioning another kind of ‘gappy smile’. This is one known as a diastema and is where there is a gap between the top two front teeth. Whilst this look has its fans, it is generally unwise as it may cause other teeth to also become crooked if the gap is left. At the Confidental Clinic in Greenwich, we can correct a diastema, either through using one of our cosmetic dental braces, or sometimes, through the use of dental veneers.

Missing teeth

Before we look at the potential solution to replacing a missing tooth, patients should consider the risks if one is not replaced, whether it is a visible or less visible at the rear of the mouth. When a tooth is lost, the supporting bone structure will start to degrade and be reabsorbed by the body. As it does this, it causes a certain amount of facial shape change. Especially where more than one consecutive tooth is missing, this can cause aesthetic issues such as sunken cheeks, causing you to look older than you are.

Another real risk is that, when a tooth is lost, it creates a vacant space. Over time, it is likely that the adjacent teeth will encroach into this space, possible followed by others moving into theirs. The ‘domino effect’ of this is that you could potentially end up with crooked teeth.

The solutions

There are, essentially three replacement solutions for a missing tooth; dentures, bridges and dental implants.


Dentures have sometimes had a bad rap, being an object of fun in cartoons, for example. The truth is that, for some people, they do prove to be unstable and prevent them eating certain foods. They can, however, be ideal for some patients, for example those where undergoing treatment may be inadvisable due to a medical condition. Some nervous dental patients may also opt for this method as it can be much less invasive than other techniques. The modern cosmetic dentures that we provide at our Greenwich practice are of the highest quality and we are happy to discuss the pros and cons with you.

Dental bridges

If you are looking for something that offers more strength and stability than dentures, a bridge is a well established solution. This is a replacement tooth, or teeth, that is held in position by attaching dental crowns to the teeth either side of the gap. Whilst this procedure does offer more strength and stability than dentures for most patients, it is worth remembering that the treatment does involve the preparation of the teeth either side of the gap. Where these are healthy teeth, some patients, understandably, are reluctant to have this done.

Which brings us onto the final, and in our opinion, the best, method of tooth replacement that is currently available.

Dental implants

A dental implant is widely considered to be the ‘gold standard’ of tooth replacement methods. Unlike the previous procedures, dental implants not only replace the missing tooth, but also its roots. This is important as it helps to prevent bone loss in the jaw and means that it is as close to a natural tooth as is currently possible. Although some patients may think of an implant as being the actual tooth part that they see once the procedure is complete, it is actually the small screw like object that is made of titanium and which is placed into the jawbone. This bonds with the bone, providing an extremely strong foundation which provides for much of the strength of this procedure.

Once the titanium implant is safely bonded, we will attach an abutment, and, finally, add the crown which will be the visible part of the procedure. Once the treatment is complete, your new dental implant will both look and feel natural and can last you for at least twenty years, with good care.

Ultimately, the choice of tooth replacement method is down to the patient, where practical. We are more than happy to discuss the pros and cons of each procedure with you, and would recommend an initial consultation where we can explain each in turn, and you can ask questions of our dental team.

We are pleased also, to be able to provide intravenous sedation for patients whose anxiety may prevent them considering a more invasive procedure, such as implant placement. This is a safe and effective way of helping patients to be fully relaxed during a procedure. This helps both patient and dentist ensure that the procedure is performed as quickly, accurately and comfortably as possible.

If you would like to discuss any tooth replacement method with us, or are unhappy with your gappy smile and not sure what to do about it, why not make an initial appointment at our Greenwich dental practice, by calling us on 020 8858 1422. Our team look forward to welcoming you!

Dr Krina Patel is a dentist at the Confidental Clinic (GDC 192609).