Maxillary Midline Diastema Research Articles

Mind the Gap Familial Maxillary Midline Diastema and High Labial Frenum Attachment

In day today life clinicians can come across various dental malocclusions in human beings. Maxillary midline diastema is one among those and when this condition occurs it causes aesthetic impairment requiring orthodontic treatment in order to close the existing ugly looking gap between two central incisors. However, before performing this treatment, it is essential to rule out the underlying etiologic factors as this clinical entity is caused by various causative factors. In the present article, occurrence of maxillary midline diastema and high labial frenum attachment both in mother and daughter indicating genetic relation associated with it is shown

The role of the maxillary labial frenectomy in closure of the midline diastema: A review and management recommendations

A maxillary midline diastema is often seen in childhood as part of physiological development, but those persisting after the establishment of the permanent dentition may be a functional and aesthetic concern for which patients seek treatment. The association between an enlarged maxillary labial frenum and a maxillary midline diastema is commonly reported in the literature. However, the aetiologic role of an enlarged frenum is likely to represent only a proportion of diastema cases, and many diastemas exist without the presence of an abnormal frenum. This article provides an overview of the maxillary labial frenectomy and its role in closure of the midline diastema, providing management recommendations for practitioners. CPD/Clinical Relevance: The association between an enlarged maxillary labial frenum and a midline diastema and the management options is useful clinical information

Conventional Frenectomy: 2 Case Reports

The frenum is a fold of mucous membrane that attaches the lip and the cheek to the alveolar mucosa, the gingiva and the underlying periosteum. An aberrant frenum may results in gingival recession, decreased range of lip movement and involvement of interdental papilla causing a diastema leading to compromised esthetic and functional needs of the patient and they may also interfere with oral hygiene. Maxillary midline diastema is a common esthetic problem of patients which adversely affects body image and self-esteem, especially in adults. Often, patients are more conscious about the spaces between front teeth and seek treatment for the same. One of the commonest reason for midline diastema is aberrant frenum. The muscle pull of the aberrant frenum pushes the central incisors away from each other. Before correcting the space, removal of the cause is of utmost importance. Therefore, frenectomy is performed before proceeding with the space closure treatment. Frenectomy is thus defined as complete elimination of the frenum and its attachment. This article consists of two case reports on classis or conventional frenectomy.

Clinical application of sectional feldspathic porcelain veneers in maxillary midline diastema closure

The presence of midline diastema is a common complaint of patients that may affect dentofacial esthetics. This article summarized the etiology of maxillary midline diastema, and introduced the clinical application of sectional feldspathic porcelain veneers in maxillary midline diastema closure, including indication selection as well as clinical procedure. It aimed to provide an alternative solution on clinical treatment of maxillary midline diastema.

Smile Attractiveness and Treatment Needs of Maxillary Midline Diastema with Various Widths: Perception among Laypersons, Dental Students, and Dentists in Malaysia.

Smile attractiveness and the need for treatment of maxillary midline diastema with various widths are perceived differently between dentally trained and nondentally trained individuals of different sociodemographic backgrounds. This study aims to evaluate how laypersons, dental students, and dentists in Malaysia differ in their perceptions on smile attractiveness and treatment needs of maxillary midline diastema. A smiling photograph with well-aligned maxillary central incisors with proportionate width-to-height ratio and healthy gingival tissues was selected and digitally manipulated to create maxillary midline diastema with 0.5, 2.0, and 4.0 mm widths. The smile attractiveness and the perceived need for treatment of varying widths of maxillary midline diastemas were rated by laypersons, dental students, and dentists using the Likert scale via a single set of self-administered questionnaires. The impact of sociodemographic variables on aesthetic perception of different gap widths was tested using univariate analysis followed by a multiple linear regression model. A total of 158 laypersons, 118 dental students, and 138 dentists participated in this study. Both laypersons and dentists showed significantly higher mean aesthetic scores for 0.5 mm maxillary midline diastema, lower mean aesthetic scores, and hence higher mean treatment needs scores for 4.0 mm maxillary midline diastema as compared with dental students (p < 0.05). In general, female respondents perceived a gap width of up to 2.0 mm as aesthetically pleasing. Higher educational group and the Malay ethnicity had tolerance threshold of 0.5 mm gap width. The older group considered 4.0 mm gap width as aesthetically unpleasing. In conclusion, both laypersons and dentists accepted a 0.5 mm maxillary midline diastema as an attractive smile but considered 4.0 mm maxillary midline diastema as unpleasing smile which required treatment. Perceptions of laypersons and dentists were significantly different from dental students. Educational level, gender, ethnicity, and age were significantly associated with smile attractiveness of maxillary midline diastema at different investigated widths.

Diastema closure with direct composite restoration-Case report

Maxillary midline diastema is a frequently occurring malocclusion found to be a common aesthetic complaint of patients. It occurs due to of multifactorial etiology such as labial frenum, microdontia, and oral habits such as thumb sucking, Tongue thrusting, or Dental malformations. Proper technique and materials for successful treatment are grounded on time and the patient's physical, psychological, and economical conditions. The use of Direct composite resin restoration in diastema closure permits the dentist and patients to gain complete control of the above-mentioned and recreation of an aesthetic natural smile. The case report describes a case of midline diastema closure using direct composite resin restoration. The patient was recalled for follow-up for 1 year. No discoloration, sensitivity, line of demarcation, or fracture lines were seen. Therefore, midline diastema closure using direct composite resin restoration is considered highly aesthetic, and durable and could fulfill the aesthetic need of the patient in the present case.

Effectiveness, longevity, and color stability of in-office bleaching (6% H2O2 gel/Violet LED) and diastema closure with direct composite: 3-year follow-up

To reduce bleaching side effects, the use of low concentrations of Hydrogen Peroxide (HP) agents associated with hybrid light (violet LED/Diode Laser) has gained interest. Case report: The aim of this report is to describe a case of a 16-year-old patient that presented a complaint related to the color of his teeth and a maxillary midline diastema. In-office bleaching with 6% HP associated with hybrid light (violet LED/Diode Laser) was performed. The bleaching gel was applied once on the teeth and light-activated for 1 minute (15 times) followed by 1min intervals (15 times) with a total bleaching time of 30 minutes. After the bleaching procedure, the teeth were polished and the desensitizer was applied for 4 minutes. Two bleaching sessions were performed at a 1-week interval. The diastema was closed with direct resin composite restorations without any tooth preparation. The conventional 3-step bonding agent was used and A1 dentin shade and B1 enamel shade were used followed by polishing discs. At 3-year recall, discoloration and fractures were not found on the the teeth or restorations and patient was completely satisfied. Conclusion: the conservative and safe option of bleaching with a low-concentrated HP gel associated with violet LED light is an interesting option for young patients and presents longevity over time.

Maxillary midline diastema closure with sectional feldspathic porcelain veneers: A case series followed 1 to 4 years.

To evaluate clinical outcome of maxillary midline diastema closure using sectional feldspathic porcelain veneers up to 4 years. Five female patients with stable maxillary midline diastema were included in the current study and restored with minimal invasive sectional feldspathic porcelain veneers under dental microscope. Esthetic, functional, as well as biologic properties of sectional veneers were evaluated according to the World Dental Federation (FDI) criteria after 1 to 4 years' follow-up. Based on FDI criteria, all five cases were evaluated as clinically excellent to satisfactory during a mean observation period of 26.4months. Slight to moderate cervical marginal staining was observed in two cases after 3 to 4 years' follow-up. Slight white line or ditching of labial surface margin was found in most cases, but it is not easy to be noticed with saliva covering the margins. Sectional feldspathic porcelain veneers presented satisfying clinical outcome with potential long-term esthetic risk for maxillary midline diastema closure. 1. Sectional feldspathic porcelain veneers presented satisfying short to medium term clinical performance when applied to close maxillary midline diastema. 2. The exposure of labial surface margin may increase a long-term potential esthetic risk.

Management of midline diastema in an orthodontic retreatment case: A novel technique

The purpose of this article was to describe the closure of a maxillary midline diastema that had reopened after breakage of retainers and presenting with a notable amount of root resorption. Treatment was done by placing Begg brackets and elastics on the lingual aspect of upper anterior teeth, and completed in a period of 1 month.

Midline Diastema Closure Using an M Spring in a Young Adult: A Case Report

The malocclusion known as maxillary midline diastema frequently occurs. For the management of diastema, a variety of therapy approaches are recommended. This article gives a case report of a female patient, age 24, who underwent treatment for a 4-mm maxillary midline diastema following the extraction of an additional tooth between her upper central incisors. The orthodontic treatment index was minimal (grade 2). The maxillary central incisors were fitted with bonded McLaughlin-Bennett-Trevisi (MBT) 0.018" brackets. A rectangular archwire was used after the circular archwire to ligate and activate the M spring. The diastema was successfully closed after a total of four months of treatment. This approach is effective and efficient and uses minimal inventory. This shortens the length of the orthodontic treatment and conserves valuable chairside time.

Enhancing the esthetics of face by management of midline diastema: A Case Report

Maxillary midline diastema is a common esthetic problem in mixed and permanent dentition. The space can occur either as a transient malocclusion or created by developmental, pathological or iatrogenic factors. Along with midline diastema, anteriors can have generalised spacing, particularly in the maxillary arch. These can be managed by surgical, orthodontic, restorative and prosthodontic procedures, or by a combination of procedures to meet the patient’s aesthetic and functional needs while also improving the patient’s psycholog

Management of maxillary midline diastema caused by aberrant frenum attachment: A case report

Background: Midline diastema in the maxillary is very common aesthetics problem in mixed and early permanent dentition, one of which etiology is aberrant frenum attachment. High frenum attachment might interfere with aesthetics, plaque control, and create mucogingival deformities, therefore compromising orthodontic result and causing recurrence. Several treatments for maxillary midline diastema are available, one of which is labial frenectomy. Objective: To present a case report of frenectomy as a mean of eliminating maxillary midline diastema. Case: This is a case report of a 25 years old female patient with high frenum attachment causing maxillary midline diastema. Patient was treated with frenectomy afterward. Frenectomy is a complete removal of frenum, including the attachment to the underlying bone. Following the treatment, midline diastema closure was showed in 4 months following frenectomy. Conclusions: Frenectomy is a potential alternative for treatment of maxillary midline diastema.

Management of maxillary midline diastema caused by aberrant frenum attachment: A case report

Management of maxillary midline diastema caused by aberrant frenum attachment: A case report

Partial Laminate Veneers for a Maxillary Midline Diastema Closure: A Case Report

Background: A variety of approaches can be employed to close diastemas using conservative and non-conservative restorative techniques such as composite restorations, laminate veneers, and crowning if there is no indication for orthodontic treatment. Objectives: This paper aimed to discuss the mechanical properties of sectional laminate veneers, the preparation, and the ceramic material used for their manufacturing. Material and methods: A case of a maxillary midline diastema closure using feldspathic partial laminate veneers with an ultra-conservative preparation is described. Results: Feldspathic sectional laminate veneers achieve an esthetically pleasant diastema closure. The ultra-conservative preparation and adequate polishing technique preserve dental and gingival tissues. Conclusion: It can be concluded that sectional partial veneers are an esthetic option with low mechanical properties that must be carefully indicated.

Frequency of Midline Diastema in patients reported To OPD of Bacha Khan Medical College Mardan

Background: A space between adjacent central incisor teeth is termed "diastema or diastemata". Midline diastema in mixed dentition is a great center of concern for parents as well as their children, therefore, determining the time of closure of midline diastema is essential for clinical practice in Orthodontic and the study was aimed to determine the frequency of midline diastema in both maxillary and mandibular arches in patients. Material and Method: The current study was carried out at Bacha Khan Medical College Mardan, Khyber Pukhtoon Khwa to determine the frequency of midline diastema in both maxillary and mandibular arches in patients for which a total of 200 responders have examined 100 responders were males while 100 were female. Results: The frequency of Midline diastema was 12%, out of 200 hundred in which Maxillary midline diastema was 5% and Mandibular midline diastema was 5.5% and both the arches were found to be 1.5% in females. Conclusion: The finding of the current study is that the population of Khyber Pukhtunkhwa has several Midline diastemata affecting their esthetic. A similar study to find out the etiology of Midline diastema is suggested which requires a large sample size. Keywords: Midline diastema, Frequency, Orthodontic

Relationship between Maxillary Midline Diastema Width and Labial Frenum Attachment in a Sample of Nigerian Adolescents

Background: The maxillary midline diastema is a space between both upper central incisors which is more than 0.5 mm in width, and there are varying factors attributed to its occurrence. Aim: The purpose of this study was to determine the relationship between maxillary midline diastema width and labial frenum attachment among secondary school students in a Nigerian rural community. The study also assessed the prevalence of maxillary midline diastema and the distribution of labial frenal morphology. Materials and Methods: A cross-sectional study was conducted among 200 adolescents in Southwestern Nigeria. Participants were selected using a three-stage stratified sampling technique, and structured questionnaires were employed. Intraoral examination was done to assess the presence of maxillary midline diastema, classify the morphology of the upper labial frenum and measure the width of the maxillary midline diastema. Results: The participants were aged between 10 and 17 years (mean age, 12.69 ± 2.1 standard deviation). The prevalence of maxillary midline diastema was 31.5% among participants with gingival attachment being the most prevalent frenal morphology. Participants with papillary frenal attachments had statistically significant wider maxillary midline diastema than those with gingival frenal attachments (P &lt; 0.05). Conclusions: Among Nigerian adolescents, there was an association between the type of labial frenal attachment and width of maxillary midline diastema.

Esthetic impact of maxillary midline diastema and mandibular crowding in children in the mixed dentition

This study aimed to investigate the esthetic impact of mandibular crowding and maxillary midline diastema in children in the mixed dentition. The sample for this cross-sectional study comprised 785 children, aged 8-10years, in the late mixed dentition. Mandibular crowding and maxillary midline diastema were evaluated clinically with the Dental Aesthetic Index. Mandibular crowding and maxillary midline diastema were evaluated to determine tooth size-arch length discrepancies. The sample was stratified as group 1, children without maxillary midline diastema or mandibular crowding (n=177); group 2, children with maxillary midline diastema (n=256); group 3, children with mandibular crowding (n=208); and group 4, children with maxillary midline diastema and mandibular crowding (n=144). The subjective esthetic impact was evaluated using the Orthodontic Aesthetic Subjective Impact Score. Descriptive and exploratory analyses of the data were performed. A generalized linear model was applied, adjusted for the possible confounding variables (age, gender, and race) with a significance level of 5% because the Orthodontic Aesthetic Subjective Impact Score did not meet the assumptions of analysis of variance. Children in groups 2 and 3 showed greater esthetic concern than group 1 (P<0.05). Children in groups 2 and 3 did not show a significant difference with children in group 4 (P>0.05). Children with mixed dentition with mandibular crowding or maxillary median diastema reported significantly more esthetic concern than children without these conditions.

Significance Of Various Etiological Factors As An Indicator For The Persistence Of Median Diastema

Maxillary midline diastemas are a common esthetic problem that dentists must treat. This study was performed to quantify the width of median diastema and level of bone crest and to determine the type of inter-maxillary suture, familial prevalence, spacing in upper anterior region, axial inclination of upper centeral incisors, and low frenal attachment as the most contributing factors associated with median diastema. A standardized periapical radiographs using a paralleling technique with a film holder were taken to the (99) maxillary and/or mandibular centeral incisors with median diastema and to the (85) maxillary incisors with no diastema as a control group in adults with age range from 18-25 years old. Diastema width between 0.5-1 mm has a higher percent while diastema above 2 mm has a least percent. There is a non-significant difference in the level of alveolar crest of central incisor in both control and diastema groups. Type I intermaxillary suture type was the most common in control group while type II and III were the most common in diastema. There is a relationship between spacing and type of intermaxillary suture which can use as an indicator for the persistence of diastema from childhood in addition to familial history while frenum may has no effective role in developing median diastema. Axial inclination of central incisors is one of important factors that should be taken in consideration during treatment of median diastema

Maxillary midline diastema among a group of Egyptian adult populations (prevalence and etiology)

Purpose This study was performed to identify the prevalence and etiological factors of maxillary midline diastema among a sample of adult patients undergoing orthodontic treatment in orthodontic private clinics in Qaloubya, Fayoum, and Giza governorates. Patients and methods Three hundred seventy-five patients (199 females and 176 males) were included in this study. The full records (intraoral photographies and radiographs) of all patients were examined and surveyed for the presence or absence of maxillary midline diastema and the possible etiological factors. Results 17.3% of the studied patients showed maxillary midline diastema, while 82.7% of them did not show diastema. There was no significant difference between the prevalence of midline diastema in different sexes (P = 0.079). The most common etiological factors were 38.5% congenitally missed laterals, 33.8% highly attached frenum, 20.0% generalized spaces, and 26.2% had flared incisors. Conclusion Prevalence of midline diastema in the studied patients was 17.3%, while 82.7% of patients did not have diastema.

FREQUENCY OF MALOCCLUSION IN GOVERNMENT HIGH SCHOOL GOING CHILDREN AGED 13-17 IN PESHAWAR

Objective: &#x0D; To determine the frequency of malocclusion in Govt. high school children of District Peshawar.&#x0D; Materials and Methods:&#x0D; About eight hundred and fifty school children of both genders were randomly selected through random cluster sampling, from Government High Schools of District Peshawar. The study participants were examined in their school staff rooms using wooden spatulas, disposable gloves, millimeter ruler, and torchlight. Angle’s classification was used for recording various traits of malocclusion besides overbite, overjet, maxillary midline diastema, crowding, open bite, and crossbite. A special proforma was used for recording the data. Data were analyzed using SPSS-20 while Chi-square test was applied for association.&#x0D; Results:&#x0D; A total of 850 subjects were included in the study, of which there were 600 (70%) males, and 250 (30%) were females. The mean age of the participants was 15 + 1.37 years. The overall frequency of malocclusion was 73.1%. Angle’s class I malocclusion had the highest frequency of 372 (43.8%) followed by normal occlusion 229 (26.9%), class II division 1 as 88(10.4%), class II division 2 as 59(6.9%), class III as 64(7.5%). Angle’s Class I malocclusion (43.8%) and crowding (37.9%) was more frequently found followed by normal occlusion (26.9%) among the school going children of the Peshawar, Pakistan.&#x0D; Conclusion:&#x0D; Angle’s Class I malocclusion and crowding were more frequently found, followed by normal occlusion among the school going children of the Peshawar, Pakistan.