Unlike the Cheshire Cat, your smile does not float in the air by itself. When people see your smile, they are seeing it in the context of your face. Any successful cosmetic dentistry procedure can’t just consider your smile. It has to incorporate your smile fully into the appearance of your face, or else you will likely be unhappy with the results. 

One of the most important ways that your smile’s appearance should integrate with your facial appearance is in the midline. The midline of your smile should match the midline of your face. If it doesn’t, we describe it as a canted midline. 

Many people have naturally canted midlines. Others get it as a result of cosmetic dentistry that fails to factor in the facial features. Fortunately, most people have multiple options for treating a canted midline. 

Causes of a Canted Midline

The best treatment for your canted midline depends on the cause of your canted midline. There are five common causes of a canted midline:

  • Misaligned jaw
  • Misaligned teeth
  • Uneven gum growth or recession
  • Orofacial trauma
  • Poor cosmetic dentistry

Finding the cause of your canted midline helps us recommend the right solution. 

business woman smiling while reviewing data on her iPadMisaligned Jaw

We consider the normal jaw alignment as being the upper and lower jaws aligned horizontally, with a slight overbite . However, if the upper jaw is so far ahead of the lower jaw that the lower teeth hit the back of the upper teeth or the upper gums, this is considered a serious overbite that requires treatment. Your jaw might also be misaligned horizontally, causing the midline of the lower jaw to be off-kilter from the upper jaw and the rest of the face. 

Over time, the upper teeth might drift to match the lower teeth, causing the upper midline to be off as well. 

Misaligned Teeth

Sometimes your jaws are aligned but your teeth are not. This can occur if you have lost one or more teeth, allowing the other teeth to drift. Teeth coming in unevenly might also cause a misalignment between the teeth and your facial midline. Crowding can also cause your midline to drift, as some teeth move aside or rotate to make room for others. 

Uneven Gum Line

Your gums provide an important framework for your smile. If the frame is uneven, it’s hard for your smile to look straight, as the gums help define the apparent size and shape of your teeth. An uneven gum line might develop as you grow, or it might be due to gum recession caused by gum disease or other factors. For example, people who put chewing tobacco in one place might experience receding gums unevenly, which makes their smile look uneven. 

Orofacial Trauma

Trauma to the face or mouth can cause developmental problems that lead to an uneven smile and canted midline. If a baby tooth gets knocked out early, it can cause the adult teeth to come in off-kilter. Or an injury to your lips might cause a change in the facial midline. Jaw trauma can cause jaw misalignment. 

Not all trauma is sudden. Worn-down teeth are subject to a slow trauma, and this can also cause your smile to get off-balance, especially if you experience uneven jaw wear related to TMJ

Poor Cosmetic Dentistry

A comprehensive cosmetic dentistry procedure like a smile makeover or porcelain veneers gives a cosmetic dentist full control over your smile, including the midline. A dentist who doesn’t take proper care in designing and executing the case can create a canted midline. 

It doesn’t have to be comprehensive cosmetic dentistry, either, to mess up the midline. Many inexperienced dentists create a canted midline when doing something as simple as closing a gap in your smile (diastema). 

Treating a Canted Midline

There are many approaches to treating a canted midline. These might include:

  • Jaw surgery
  • Orthodontics
  • Gum recontouring
  • Porcelain Veneers

Each is suited to treating different types of canted midline. 

man smilingJaw Surgery

Jaw surgery is only necessary in the most extreme cases of a canted midline. It’s risky, painful, requires a long recovery, and costs a lot. Few people will choose jaw surgery when other options exist that have even a reasonable chance of getting good results. 

Jaw surgery is good for jaws that develop a misalignment, either naturally or because of trauma. 


Fortunately, orthodontic treatments like Invisalign can handle most circumstances of a canted midline. Orthodontics works by moving the teeth, which lets them adjust the midline. Even when the jaws might be slightly misaligned, it is possible to get a properly aligned midline with orthodontics. 

Orthodontics can be used for canted midlines caused by teeth misalignment, orofacial trauma, poor cosmetic dentistry, and even sometimes jaw misalignment. 

Gum Recontouring

Gum recontouring reshapes your gums to create a gum line that provides a better frame for your smile. 

Although gum recontouring works best when an uneven gum line is to blame for your canted midline, it often plays a supporting role in other approaches. 

Porcelain Veneers

Porcelain veneers are facades of advanced ceramic that fit on the front of your natural teeth. This gives them a new visible surface, and in the process it’s possible to reshape and shift your teeth. 

Porcelain veneers work best for canted midlines caused by teeth misalignment, poor cosmetic dentistry, and orofacial trauma. The benefit of veneers is that they let you correct other complaints you might have about your smile at the same time. You can whiten your teeth and reshape them while correcting your canted midline. 

Correct Your Canted Midline in Anchorage

If you are unhappy because the midline of your smile doesn’t match the rest of your face, Excellence in Dentistry can help. Please call (907) 349-0022 or use our online form today to request an appointment with an Anchorage cosmetic dentist to talk about the options best suited for your smile.