A, Peg-shaped lateral incisors. B, Lateral incisors restored with resin composite laminate veneers. 

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... in the tooth formation process during initiation or proliferation of the tooth bud cause hypodontia. 1 The congenital absence of 1 or more teeth without systemic disorders is generally considered an inherited dominant condition with varying expression. 1 Aberrations in tooth morphology resulting from late disturbances during the differentiation process most commonly result in size variations. 1-5 Peg-shaped or mesiodistally deficient maxillary lateral incisors demon- strate variation in the expression of the trait, although the gene(s) causing hypodontia are not known. 1-5 A peg lateral is defined as ‘‘an undersized, tapered, maxillary lateral incisor’’ 6 that may be associated with other dental anomalies, such as canine transposition and overretained deciduous teeth. Individuals with malformed lateral incisors often display a diastema in the midline region caused by the distal movement of the central incisor. 7 Due to their reduced size, the malformed lateral incisors may also allow the formation of other diastemata in the anterior region. These patients may exhibit otherwise normal dentitions unless other congenital etiologic factors or habits are present. Prevalence of peg-shaped maxillary lateral incisors has been reported to be higher than the prevalence of other developmental malformations of teeth. In a study by Backman and Wahlin, 8 the incidence of peg-shaped incisors was found to be 0.8% in 739 children. In another study, it was found to be 0.4%. 9 The occurrence of hypodontia together with the development of malformations of permanent teeth was found to be 4%. 10 Several previous reports have described the association between the presence of peg-shaped maxillary lateral incisors and other developmental anomalies, 3,5,11,12 with one study 3 showing increased occurrence on the left side of the maxilla. In the restoration of peg lateral incisors, there are many factors to be considered that depend on the patient’s expectations and the expertise of the clini- cian. 13,14 The type of treatment should be selected based on functional and esthetic requirements, need for extractions, the position of the canines, and the potential for coordinating restorative and orthodontic treatment. 15 Treatment options vary but include the following: (1) extraction of the peg-shaped tooth and orthodontic movement of the canine into the space of the lateral incisor; the canines can then be recontoured to resemble lateral incisors; (2) extraction and replace- ment with a single-tooth implant-supported restoration or a fixed partial denture (FPD); or (3) direct or indirect restoration of the peg lateral incisors to develop normal tooth morphology. All of these treatment approaches may produce acceptable results. Treatment options include procedures such as porcelain laminate veneers, metal-ceramic restorations, and all-ceramic crowns, as well as minimally invasive procedures such as direct resin composite bonding. 13 Porcelain laminate veneers have high abrasion resistance and color stability. 16 Also, the properties of porcelain laminate veneer such as color, form, surface, individual characterization through internal and external staining, and the fact that these restorations can be further color- corrected during cementation with special cement colors, make them an attractive treatment option. 16 However, porcelain laminate veneers are relatively expensive. 16 A conservative veneer technique is the application of the resin composite without tooth reduction. Resin composite veneers can be altered and repolished in situ, and this feature is very useful when subtle changes to the emergence angles are desirable. Also, resin composite veneers are not as expensive as porcelain laminate veneers. 16 This clinical report describes a simple direct technique for restoring the esthetic appearance of peg-shaped lateral incisors, with good short-term results in 4 patients. Four patients with peg-shaped lateral incisors were referred to the Dicle University Faculty of Dentistry, Department of Prosthodontics (Figs. 1, 2, 3, and 4, A ). On examination, all 4 patients had good periodontal health and a stable intercuspal position, normal vertical and horizontal overlap, and canine-protected guidance. The peg-shaped lateral incisors were restored with direct resin composite laminate veneers using the following technique (Figs. 1, 2, 3, and 4, B ). First, retraction cords (Stay-put, Medium; Roeko, Langenau, Germany) were used to minimize crevicular fluid flow. It has been suggested that acid etching prior to application of the self-etching primer produces higher bond strength to enamel than self-etching priming only. 17 Therefore, prior to application of the self-etching primer, the buccal, incisal third of lingual surfaces, incisal, mesial, and distal surfaces of the lateral teeth were conditioned with 35% phosphoric acid gel (3M Scotchbond; 3M ESPE, St. Paul, Minn) for 30 seconds. Care was taken to completely rinse the etchant gel for 30 seconds, and then the tooth was air dried. Teeth were conditioned and primed with a self-etching adhesive (Clearfil SE Bond, Primer; Kuraray Co Ltd, Tokyo, Japan) for 20 seconds. Enamel margins were then covered with a bonding agent (Clearfil SE Bond; Kuraray Co Ltd) and polymerized for 10 seconds with a polymerizing unit (Polofil Lux, Halogen light; VOCO, Cuxhaven, Germany). The restorations were formed using a hybrid resin composite (Clearfil AP-X; Kuraray Co Ltd), which was placed using an incremental technique. Particular attention was given to the contouring of the apical finish line of the restorations. The resin composite restorations were polymerized for at least 2 minutes with the polymerization unit (Polofil Lux; VOCO). The maxillary right lateral incisor of the patient in Figure 1 and maxillary central incisors of the patient in Figure 4 were also treated with direct resin composite laminate veneers. The restorations was then contoured and polished with polishing discs (Sof-Lex; 3M ESPE). At the completion of placement, the importance of rig- orous and effective oral hygiene was re-emphasized, and the patients were recalled at 3-month intervals. If the patient’s oral hygiene had deteriorated during the follow-up period with a build-up of plaque and associated marginal inflammation, then the patient was given further oral hygiene instruction in an attempt to overcome the problems. If there was unsightly staining, the affected areas were contoured and polished with the polishing discs. In the event that the restorations were chipped but the resultant appearance was acceptable to the patient, the surface was refinished using the previously described technique. Redness or bleeding on probing were not observed. The esthetic defect in patients with peg lateral incisors consists of both the malformed teeth and the presence of diastema between teeth. The treatment includes 2 primary objectives: to restore or replace the hypoplastic dental crowns and to close the diastema. If the patient does not smoke or drink dark-colored liquids that can al- ter the color of the teeth, esthetic bonding with resin composite may be the most conservative approach for several reasons: sound tooth structure will not be re- moved, the procedure may not require administration of local anesthetic, the procedure may be accomplished in 1 appointment, and the treatment is relatively inex- pensive. Walls 14 et al used resin composite laminate veneers for masking discoloration or hypoplasia of the anterior teeth of 68 patients. The technique produced an acceptable improvement in the esthetics and function of patients over a 2-year period. Results of this clinical study showed that the gingival status of patients’ teeth improved significantly between the initial assessment visit and placement of the veneers. However, the veneer restorations showed a deleterious effect on the gingival health of the patients who were unable to maintain good oral hygiene. Also, it was found that the gingival score was sometimes associated with a discontinuity of the gingival margin of the veneer; however, there was no correlation between marginal discontinuity and gingival status for the sample as a whole. 14 The treatment plan for the patients described con- sisted of retaining the peg-shaped right maxillary lateral incisor and restoring the natural tooth form with bonded composite. This conservative option was chosen because it preserved tooth structure. Resin composite restorations exhibit excellent physical properties, marginal integrity, and esthetics. 18,19 Moreover, in compari- son to all-ceramic restorations, resin composite does not have the potential for catastrophic brittle fracture, nor does it cause abrasive wear of the opposing denti- tion. 18-20 Other advantages of this type of treatment are the lower cost compared to an indirect technique, and the reversible nature of this procedure, which allows for other treatment approaches in the future. A signifi- cant advantage of resin composite restorations over other restorative materials is that repair may be possible intraorally without the risk of modifying esthetics or mechanical performance. 18 This clinical report describes the treatment of 4 patients with peg-shaped lateral incisors that were restored with resin composite laminate veneers. These simple procedures may be a cost-effective treatment alternative to restore the esthetics of these teeth and may prove particularly useful in growing patients before more definitive restorations can be ...