Introduction: “Doctor, I was born with missing teeth — what’s the fix?”

A common question in Jeddah orthodontic clinics: someone discovers they have congenitally missing teeth — not extracted, not lost to trauma — the permanent tooth simply never formed. Most often this involves the lateral incisors next to the front teeth.

At Joele Clinics, Dr. Saeed Anjari, Specialist in Orthodontics and Dentofacial Orthopedics, together with Dr. Ammar Al Jazaery, Orthodontic Consultant, explain that there are usually two main paths — and the right one depends on bite, smile aesthetics, and the size of the teeth you already have.

Video: Dr. Saeed Anjari and Dr. Ammar Al Jazaery explain both options

Source: short video on congenitally missing teeth with Dr. Saeed Anjari and Dr. Ammar Al Jazaery — Joele Clinics, Jeddah.

• Congenitally missing teeth are often the lateral incisors.
• Option one: open space with braces, then place implants — often excellent aesthetically.
• Option two: if the canines are small/suitable, close the space with orthodontics — and avoid an artificial tooth in the mouth.
• Dr. Saeed personally favors whatever gives the patient the best natural long-term smile.
• Dr. Ammar stresses: the choice depends on occlusion, aesthetics, function, tooth sizes, and the size of the gap.

Interactive diagram: see the difference between the two plans

1. Left: open the space and restore the missing tooth with an implant/crown.
2. Right: close the gap with braces so the canine moves beside the central — a continuous natural smile without an implant.

Not every case fits one recipe. Diagnosis chooses the path.

What does “congenitally missing teeth” mean?

Clinically this is often called hypodontia: one or more permanent teeth never formed in the bone, so they never erupt on schedule. A baby tooth may stay for years, or a visible gap appears.

Most common smile sites:

• Upper lateral incisors
• Sometimes premolars or other teeth depending on genetics

The issue isn’t “just a gap.” It affects occlusion, tipping of neighbors, and how the smile fits the face.

Option ①: open the space — then implant

Orthodontics redistributes teeth and opens a precise space for a future implant or restoration. After the site is stable, an implant and crown match the shade and shape of neighboring teeth.

When it fits:

• Bite and tooth sizes need a full tooth in the natural lateral position.
• Closing the space would harm canine–incisor aesthetics.
• Facial/smile analysis favors a restored lateral over canine substitution.

Aesthetic results can be excellent — with coordinated planning between orthodontics and implant dentistry.

Option ②: close the space with braces (no implant)

In selected cases — especially when canines are small and well shaped — orthodontics can close the gap: the canine moves closer to the central, creating a continuous smile without a gap and without an implant.

Dr. Saeed’s key point: the goal isn’t “to place something.” The goal is the best natural outcome for that patient. Avoiding an artificial tooth can be kinder aesthetically and psychologically long-term when anatomy allows.

How do we choose between opening and closing?

As Dr. Ammar Al Jazaery notes, the decision is not preference alone. It depends on:

• Occlusion and jaw relationship
• Smile and facial aesthetics
• Function (chewing, speech, comfort)
• Existing tooth sizes and gap width
• Age, bone, and gum health

That’s why assessment often involves orthodontics — and sometimes implants/cosmetics — before any plan starts.

What to expect at Joele Clinics

1. Consultation with Dr. Saeed Anjari (with Dr. Ammar when needed).
2. Imaging and smile/occlusion measurements.
3. Clear presentation of both paths: open + implant, or orthodontic closure.
4. Braces or aligners according to diagnosis.
5. If opening space: later implant coordination once the site is ready.
6. Retention after orthodontics to protect the result.

Key takeaways

Congenitally missing teeth — especially laterals — have two evidence-based paths: open space and implant, or close the gap with braces. The prettiest plan isn’t always an implant, and the smartest plan isn’t always closure. Watch the video and diagram, then book an assessment with Dr. Saeed Anjari at Joele Clinics in Jeddah.