The presence of a diastema or diastemata between teeth is a common feature found in the anterior dentition. Many forms of therapy can be used for diastema closure. A carefully developed diagnosis and advanced planning allows the most appropriate treatment to be determined for each individual case to address the patient’s needs. Clinical considerations, advantages, disadvantages, and alternative treatment modalities for diastema closure are discussed in this article and a clinical case is presented to illustrate the application of these techniques.
The presence of a space, or diastema, between anterior teeth is a common feature of adult dentitions. The spaces usually distort a pleasing smile by concentrating the observer’s attention not on the overall dental composition, but on the diastema. However, not every diastema should be viewed by the practitioner as needing correction. The patient’s needs, demands, and expectations must be considered in the process of treatment planning to ensure satisfaction with the treatment outcomes.
Many forms of therapy can be used for diastema closure. A carefully developed diagnosis, which includes a determination of the causal elements, and advanced treatment planning, allows the most appropriate treatment to be selected for each case. Explaining the various treatment options to the patient, and documenting their understanding of the options, is critical in gaining the patient’s consent and cooperation in achieving a result that will be judged successful.
Orthodontic correction often results in a sensible esthetic improvement and is well accepted by patients. However, orthodontics alone often may not be able to correct the problems associated with excessive space. In many cases, postorthodontic restorative and periodontal procedures are also necessary.
In the past decade, there has been a remarkable upswing in interdisciplinary collaboration between restorative dentists, orthodontists, and periodontists in smile enhancement. As the interactions within the pseudospecialty that has become known as cosmetic dentistry have increased, dentists have become more sensitive to the standards that should guide them in striving to create a more pleasing smile for their patients.
The specific goals of treating diastemata are: creating a tooth form in harmony with adjacent teeth, arch, and facial form; maintaining an environment for excellent gingival health; and attainment of a stable and functional occlusion. The final result should be one that is harmonious and pleasing to the patient. These goals can be met and clinical success achieved by applying contemporary principles of smile design and following an appropriate sequence of treatment.
Cause
Numerous factors contribute to proper tooth and arch interrelationships. These may include the relative height, width, orientation, and the number of teeth as well as the size and shape of the dental arches. An imbalance in size and shape of the teeth and dental arches may limit the ability of the teeth to fit together properly. This may result in the formation of a single or multiple diastemata. It is important to understand the origins of the problem. The significance of any single factor may vary among patients, thus each patient must be evaluated thoroughly before the initiation of any treatment. The causes must always be considered, as they lead to more individualized and effective therapies.
Factors that may be involved in the cause of congenital or acquired diastemata include the following:
- •
Transition between deciduous and permanent dentition in the normal development of the dentition
- •
Hereditary or ethnic features
- •
Enlarged labial frenae
- •
Regular deleterious behavior (parafunction)
- •
Unbalanced muscular function
- •
Physical obstacles
- •
Defects in the intermaxillary suture
- •
Accentuated overbite
- •
Dentoalveolar discrepancies
- •
Pathologies (eg, partial agenesis, supernumerary teeth, cysts in the anterior region, impeded eruption, palatal cleft)
- •
Iatrogenic
- •
Orthodontic mechanics (eg, rapid maxillary expansion, distal movements)
- •
Anomalies in the shape, size, and number of teeth
- •
Physiologic or pathologic dental migration
- •
Tongue and lip habits
- •
Tooth loss.
Dentoalveolar discrepancies may be listed among the most common causes of anterior diastemata in adults. Dentoalveolar discrepancies usually result from disharmonies between the size of the dental arch and the width of the teeth or from the presence of bone defects that cause diastemata.
Stay updated, free dental videos. Join our Telegram channel
VIDEdental - Online dental courses
