There are several ways to close unsightly gaps depending on the cause of the space, its size, its location, and the condition of adjacent teeth. Both cost and your personal needs will play a significant role in your choice of treatment. Options to correct gaps include :

• Repositioning teeth with orthodontics.

  When teeth are attractive and healthy, repositioning is the deal treatment, as it involves no loss of enamel. Some alternatives, such as ull crowns, require sacrificing healthy tooth structure for cosmetic correction.

• Restoring teeth through bonding, veneers, or crowns.

  Patients frequently prefer immediate results. In such cases, bonding or laminating with porcelain may be the answer. In other cases, a combination of therapies offers the best results.

• Removal of teeth, followed by replacement with a bridge or implant.

  Removal is used only as a last resort.

Orthodontics is a long-lasting, conservative approach to closing unsightly spaces between teeth. New techniques that are almost invisible have removed some of the stigma of having braces; however, orthodontics does take longer than most of the other options. Orthodontics may be the best option if you:

In the long run, orthodontics is the best solution for most people. Even if full crowns eventually will be needed, teeth should be aligned properly first. And although orthodontic treatment requires regular adjustments and the most time of the alternatives - usually taking 6 months to 2 years to complete - it has the advantage of leaving the natural teeth intact and close to a permanent solution (although in most cases, retainers must be worn to keep teeth from shifting back to their original positions).

In recent years, bonding has proved to be highly effective treatment for closing spaces between the teeth. Bonding may be the best option if you:

• Want immediate result
• Desire a less expensive and less invasive option than veneers or crowns
• Have other esthetic problems that could be solved by bonding
• Prefer a procedure that is reversible

Bonding can be used successfully on both upper and lower teeth. However, bonded teeth are more likely to chip, crack, and stain than are natural teeth, particularly the lower front teeth, which are more susceptible to forces from chewing. This also means that some repairs to the bonding are considered normal maintenance during its life expectancy. If you have bonded teeth, a professional cleaning three to four times a year is a must. Even then, the bonding may need to be replaced or repaired in 5 to 8 years.

Porcelain veneers provide a more esthetic option compared with bonding. Porcelain veneers may be the best option if you:

Although bonding is the quickest way to close spaces between the teeth, laminating with porcelain is also an option. Although veneers take at least two appointments and typically cost much more than bonding, a major advantage is the proportional accuracy that they provide. This technique is especially effective when spaces are not uniform. Another reason to choose porcelain veneers is that they will not stain nearly as much as bonded restorations.

Although crowns can provide beautiful results-filling gaps and lightening tooth color just like bonding-they typically are not the treatment of choice for spaces between the teeth because their placement requires considerable reduction of natural tooth structure. However, in cases where teeth are badly damaged, these finely sculptured lookalikes are often ideal.

In most cases, gaps between teeth are better addressed using less invasive procedures such as orthodontics or bonding. However, there are some circumstances in which crowns offer the best solution. Crowns may be the best option if you:

Crowns are a more time-consuming and costly option than bonding or veneers. Crowns are not as likely to chip as veneers and bonding; however, replacement still may be required within 5 to 15 years.

Orthodontics	Bonding	Porcelain Veneers	Crowns
Treatment Time
6-24 mo for most patients	1office visit; 1-2 hours per tooth	2 office visits; 1-4 hours each (more time needed for office visits, more extensive treatment)	2 office visits; 1-4 hours each for up to 4 teeth (more time needed for more extensive treatment)
Maintenance
Brush and floss daily. Have a professional cleaning 3-4 times per year. Wear retainers at night indefinitely, at least a few nights per week. Use a water-powered device daily for thorough cleaning.	Have a professional cleaning 3-4 times per year. Avoid biting down with front teeth, especially on hard foods. Brush and floss daily. See dentist for polishing or repair as necessary.	Have a professional cleaning 3-4 times per year. Take special care when biting into or chewing hard foods. Use your back teeth to avoid placing torque on the veneer.	Avoid biting down on hard and ice. Get yearly fluoride treatments. Brush and floss daily.
Results
Spaces between teeth are closed.	Most spaces can be filled in to look natural.	A polished, natural-appearing result that effectively closes spaces	The best method to improve tooth shapes to fill spaces
Treatment Longevity
Generally permanent if retainer is worn at least a few nights per week	5-8 years, with professional refinishing once every few years.	5-12 years if special care is taken	5-15 years (directly related to fractures, problems with tissues, and decay)
Advantages
Closes space between teeth Permanent results for most people if retainers are worn No tooth reduction required May be the least expensive option	Little or no tooth reduction required. No anesthetic required. Reversible procedure. Less expensive than veneers or crowns. Color change is possible.	Easier to obtain proportionate closure of spaces. Less chipping and staining than bonding. Less loss of color or luster. Less tooth reduction required than crowning. Last longer than bonding. Gum tissue tolerates porcelain well. Color change is possible.	Can be shaped to esthetically fill gaps. Teeth can be lightened to any shade. Some realignment or straightening of teeth is possible. Should last about twice as long as bonding. Gum tissue tolerates porcelain well. Color change is possible
Disadvantages
Time-consuming Teeth may return to original position if retainers are nor worn. Thorough cleanings are more difficult during treatment.	Can chip or stain more easily than veneers or crowns. Has a limited esthetic life. Treatment may involve extra teeth to obtain proportionate space closing. Teeth may appear and feel thicker.	More expensive than bonding Difficult to repair if the veneer cracks or chip Irreversible if much enamel is removed May not be best choice in difficult bite situations	Can fracture. Requires an anesthetic. Tooth form is altered (most of the tooth enamel is removed). May need to be replaced after 5-15 years. More expensive than bonding.

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