1: Median diastema

1 Median diastema

Summary

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?

image

Fig. 1.1 Anterior occlusion at presentation.

History

Complaint

Brian’s mother noticed the gap between his upper front teeth and the irregularity of his lower front teeth. She is anxious about his appearance and is keen for treatment to be provided.

History of complaint

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.

Medical history

Brian is fit and well.

Dental history

Brian attends his general dental practitioner every 6 months but has not required any treatment.

Family history

Brian’s father had an upper midline space that was closed with a fixed appliance.

Examination

Extraoral examination

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.

Intraoral examination

Soft tissues are healthy and the dentition is caries-free. The intraoral views are shown in Figures 1.1 and 1.2.

image

Fig. 1.2 Lower occlusal view (note image erupted but not shown).

image What do you observe?

Low-lying maxillary labial frenum.
The following teeth are clearly visible: image
(note image present but image erupting into image).
Mild lower labial segment crowding with distolabial rotations of image; slight spacing distal of image.
Upper median diastema with the crowns of image flared distally.
Class III incisor relationship.
Crossbites image.

image What is the aetiology of the image rotations?

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.

image What are the possible causes of the upper median diastema?

These are listed in Table 1.1.

Table 1.1 Causes of an upper median diastema

Causes Comments
Developmental Due to pressure of image on image roots (formerly referred to as ‘ugly duckling’ stage); tends to resolve by the time image erupt
Dentoalveolar disproportion Small teeth in a large arch
Absent or peg-shaped 2’s  
Supernumerary tooth/teeth in midline  
Proclination of image 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 image is seen in radiograph
Pathological Cyst/tumour
  Juvenile periodontitis

image Is the dental and occlusal development normal?

Dental development is normal. Eruption dates of the primary and permanent dentition are given in Table 1.2.

Table 1.2 Eruption dates for primary and permanent teeth

image

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 image may indicate inherent crowding. Also, there is no lower primate (anthropoid) space between the primary canines and first primary molars.

Spacing between the upper permanent central incisors (flared distally/>

Related posts:

  1. 27: Facial swelling and dental abscess
  2. 39: Gingival bleeding and enlargement
  3. 3: Absent upper lateral incisors
  4. 6: Palatal canines
  5. 30: The fractured permanent incisor root
  6. 38: Dentinogenesis imperfecta

Stay updated, free dental videos. Join our Telegram channel
Tags:
Jan 2, 2015 | Posted by in Orthodontics | Comments Off on 1: Median diastema

VIDEdental - Online dental courses
Get VIDEdental app for watching clinical videos