Dental Problems

Maxillary Midline Diastemas

TeethMaxillary midline diastemas are one of the common complaints encountered. It has been defined as a space greater than 0.5 mm between the proximal surfaces of adjacent teeth. The incidence of diastema varies both culturally, racially and with age. In this article, there is a brief discussion on the maxillary midline diastemas. Let us examine them.

Etiology and treatment plan of midline diastemas

  1. Normal developing dentition (Ugly Duckling Stage):

    • Resolves by itself with the eruption of the permanent canines.
    • Spontaneous closure seems to occur with less frequency in the generalized spacing and initial diastema of more than 3 mm.
  2. Familial incidence:

    • Appliance therapy.
  3. Parafunctional habits

    includes the following:

    • a. Flaccid lips and a poor muscle tone
    • b. Tongue thrust (simple) may cause anterior open bite and diastema.
    • c. Thumb or digit sucking over a prolonged period.
    • i. Correction of the habits has been known to spontaneously correct the diastema within limits.
    • ii. In cases of excessive diastema, correction of the diastema can be simultaneously carried out with the habit breaking appliance.
  4. Tooth size discrepancies:

    • a. Excessive anterior vertical overlap
    • b. Excessive vertical maxillary alveolar growth. Retrognathic mandible or a prognathic mandible.
    • First intrusion of the maxillary incisors, followed by retraction of the incisors to close the diastema.
    • If however cephalogram indicates an excessively long lower face or a class II growth trend, functional therapy may be the treatment of choice.
  5. Frenum attachments:

    Generally advocated that the diastema should be closed as far as possible before going in for frenectomy. The reason cited is that should the surgery be performed before, the surgical scar tissue maintains the diastema.

  6. Mesio-distal angulation of teeth:

    The correction of the crown angulation (tipping) will close the diastema.

  7. Tooth anomalies (supernumerary tooth, peg shaped, absence of laterals):

    • Supernumerary:

      Removal of the supernumerary followed by a closure of the diastema is done.

    • Peg shaped laterals:

      The diastema can be corrected orthodontically followed by esthetic restoration of the peg shaped laterals.

    • Absence of laterals:

      • i. The space for the missing laterals, if detected early, may initially be maintained and at later date replaced with fixed prosthesis.
      • ii. Another option is to orthodontically move the canines into the space of the missing laterals, followed by a careful recountouring of the cuspid and the first bicuspid (if required) to stimulate the lateral and cuspid respectively.
  8. Pathological (Juvenile periodontitis):

    • Systemic phase (if required) followed by appliance therapy.

Appliance therapy for the correction of diastema:

The correction of diastema can be carried out by various fixed or removable appliances. The principle applied here is of reciprocal anchorage (in fixed). The types of movement are either bodily or more commonly by tipping.

Removable appliances:

  • a. An active plate can be utilized for this purpose. The plate incorporated palatal finger springs passing between the central and lateral, such that the loop is opposite to the direction of movement. A modified cantilever spring may be used to the same effect.
  • b. A split labial bow is a modification which can be utilized to close the diastema. It may be accompanied by the disadvantage that space may be created between the laterals.
  • c. In cases where there is an increased overjet accompanying the diastema, a Hawleys plate with an active labial low can be used to retract the incisors and thus close the space.

Inherent in the use of removable appliances is the drawback that only tipping movements can be achieved. For optium angulation of the teeth, a further corrections is required.

Fixed appliances:

  • a. A stainless steel band with a bracket or more commonly a bracket may be banded to the tooth and elastics utilized to bring the centrals towards each other. Tubes may be welded and an arch wire used, so that the teeth may slide. In this case, more control can be achieved over movement.
  • b. For a more esthetic treatment, a lingual button may be bonded and an elastic applied. Even these may bring about only a tipping movement, and not true bodily movement.
  • c. For the purpose of bodily movement of the teeth, it is suggested that an Edgewise bracket with a simple looped partial arch wire made from a rectangular wire be tied under the tension into both brackets.

Retention:

In order to prevent a relapse, a long term retention is required in these cases. A small multistranded wire may be used lingually and held in place by means of composite.

The above article discusses briefly about the

maxillary midline diastemas

.

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