1 Median diastema
Brian is almost 8 years of age. He presents with a gap between his upper front teeth and crooked lower front teeth (Fig. 1.1). What are the causes of these problems and what treatment would you recommend?
Brian’s primary front teeth had a pleasing appearance with a small midline space in the upper arch; the lower primary front teeth were not spaced. There is no history of trauma. The permanent incisors erupted in their present positions.
Brian has a Class I skeletal pattern with average FMPA and no facial asymmetry. Lips are competent with the lower lip resting at the incisal third of the upper central incisors. There are no temporomandibular joint signs or symptoms.
Incisor rotations are usually a manifestation of inherent crowding in the arch, which is genetic in origin. The lack of primary lower incisor spacing reported by the child’s mother is predictive of likely crowding of the permanent successors. Incisor rotations may also result from ectopic position of the tooth germs or from the presence of a supernumerary tooth.
|Developmental||Due to pressure of on roots (formerly referred to as ‘ugly duckling’ stage); tends to resolve by the time erupt|
|Dentoalveolar disproportion||Small teeth in a large arch|
|Absent or peg-shaped 2’s|
|Supernumerary tooth/teeth in midline|
|Proclination of||May be due to digit sucking habit|
|Prominent labial frenum||Implicated where there is blanching of the incisive papilla on stretching the frenum and notching between is seen in radiograph|
It is common for some crowding to be present as the lower incisors erupt, which usually manifests itself as slight lingual placement and/or rotation of the teeth, but the slight distal tilt and rotations of may indicate inherent crowding. Also, there is no lower primate (anthropoid) space between the primary canines and first primary molars.