A difference in the vertical position of one tooth compared to its neighbors is a common dental concern. This issue, technically known as vertical tooth misalignment, disrupts the uniform biting surface. Misalignment can manifest as supra-eruption (a tooth extending too far beyond the normal plane) or infra-occlusion (a tooth failing to fully reach that plane). Understanding the underlying reason for this vertical shift is the first step toward finding an appropriate solution.
Causes Stemming from Early Development
Vertical tooth discrepancies often originate in the processes of jaw and tooth formation during childhood and adolescence. Genetic factors play a significant role, predetermining the size of the teeth relative to the jawbones. This difference can lead to crowding, which forces teeth to erupt along an abnormal path, pushing them higher or lower than adjacent teeth.
The natural process of shedding primary (baby) teeth and the subsequent eruption of permanent teeth can also be disrupted. If a primary tooth is retained for too long, it can block the permanent successor, causing it to erupt in a skewed position or fail to erupt fully. Conversely, premature loss of a primary tooth can lead to adjacent teeth drifting and impacting the vertical space available for the permanent tooth.
Skeletal issues, involving the growth and development of the upper and lower jaws, are another structural cause. An uneven growth pattern between the maxilla (upper jaw) and the mandible (lower jaw) can result in a misaligned bite (malocclusion), where certain teeth contact prematurely or not at all. These developmental issues program the teeth into an incorrect vertical relationship from the start, requiring specialized correction.
Height Changes Due to Missing or Damaged Teeth
Vertical misalignments are often acquired later in life due to environmental or behavioral factors that disrupt the established bite. The most frequent cause for a tooth appearing “higher” is supra-eruption, or over-eruption. This occurs when a tooth loses its opposing partner in the opposite jaw, typically due to an unreplaced extraction or loss.
Without the regular biting force to keep it in check, the tooth naturally continues its slow, physiological movement out of the bone and into the empty space. This lack of resistance causes the tooth to rise beyond the normal biting plane, sometimes by as much as 2 millimeters or more. Over-erupted teeth can create difficulties in chewing, interfere with jaw joint function, and complicate future restorative work.
Chronic habits, such as bruxism (teeth grinding and clenching), can also create height discrepancies through uneven wear. While grinding generally wears teeth down, it often does so unequally, causing some teeth to appear shorter and making an untouched tooth seem relatively higher.
Poorly placed or old dental restorations, such as a filling or crown that is slightly too tall, can immediately disrupt the bite plane. This high spot concentrates excessive pressure on that single tooth. This can cause pain, jaw issues, and eventually lead to damage in the surrounding teeth.
Options for Correcting Tooth Height Discrepancies
Correcting a tooth height discrepancy requires identifying the source of the problem. Orthodontic treatment is a common solution, utilizing braces or clear aligners to gently move the misaligned tooth vertically. This process, known as intrusion, pushes a supra-erupted tooth back into alignment with the rest of the biting surface.
For minor height differences, a dentist may perform selective grinding, also called enameloplasty or coronoplasty. This procedure involves carefully reshaping the tooth surface by removing a small amount of enamel to bring it back into harmony with the opposing teeth. This is a conservative, non-invasive approach often used for slightly high spots.
Restorative dentistry offers solutions for teeth that are too short or have suffered wear or fracture:
- Dental bonding uses a tooth-colored resin to build up a tooth.
- Porcelain veneers can be placed over the existing tooth to establish a new, uniform height.
- Crowns can be placed over the existing tooth to establish a new, uniform height.
In cases where the misalignment is severe or involves significant skeletal issues, surgical intervention may be necessary to reposition the jawbones and provide a stable foundation.