PEG LATERALS

Peg laterals are small cone shaped teeth next to the maxillary central incisors.  Teeth adjacent to peg laterals often shift into the space left by inadequate peg lateral dimension.  Space analysis prior to restoration is critical for success.  Shape of interproximal contours of adjacent teeth determines where contacts can be placed and what shape embrasures will form.  Orthodontics, esthetic recontouring, or restoration of adjacent teeth might be required to achieve ideal esthetic results.

Composite restoration restores a peg lateral to normal shape, color and position.  The procedure is easy and successful.  No tooth reduction or anesthetic is required.  A diamond bur roughens the enamel surface for increased bond strength.  Acid is placed on enamel for 15 to 30 seconds.  Acidity is neutralized so only 10 microns of enamel is removed.  Inorganic structure dissolves quicker than organic structure and a porous, honeycomb surface is created.  Resin bonding agent flows into the honeycomb to create "micromechanical retention".  Composite is placed and cured building the tooth incrementally.  When contacts to adjacent teeth are being formed, a matrix is placed and composite added.  An opaque lingual wall of composite is used if darkness from the back of the mouth is going to influence composite color.

Final shaping and polishing is achieved with burs, sandpaper disks, rubber wheels, points, cups, and polishing pastes. Mesial distal dimension is measured on the restored tooth and compared to the distal mesial dimension of the adjacent tooth and space.  Adjustments are made to the restored tooth with burs or sandpaper disks. 

A popular alternative technique is to fit a plastic crown form to fit over a peg lateral.  The form is filler with composite and pressed over the tooth.  Excess composite is removed and the form light cured.  The crown form is removed.  The technique make it difficult to avoid excess at the gingival interproximal areas and to produce tight contacts.