Maxillary Midline Diastema Research Articles

A multidisciplinary approach to the management of a maxillary midline diastema: A clinical report

A maxillary midline diastema (MMD) is a common complaint of dental patients. An MMD can be closed with treatment from different disciplines, including operative dentistry and orthodontics. A comprehensive smile analysis is also a necessity before beginning treatment. This article highlights the closure of a 3-mm MMD by using a combination of orthodontics and direct composite resin restorations.

An unexpected behavior of a patient after a diastema closure treatment

Bir diastema kapatma işlemi sonrasında hastanın beklenmeyen davranışı Estetik görünümden uzak dişlerin çözümünü bulmak ve estetik restorasyonlar yapmak yeni materyaller ve teknikler sayesinde artık çok kolaylaşmıştır. Hastaların en büyük estetik şikayetlerinden biri maksilla orta hat diasteması’dır. Labial frenulumdan konjenital sebeplere kadar pek çok farklı nedenlerden dolayı orta hat diasteması oluşabilir. Orta hat diastema tedavi tekniklerinden biri dişlerin kompozit materyali ile restore edilmesidir. Wax-up model üzerinde silikon anahtar hazırlanarak kompozit materyalle yapılmış diastema kapatma yöntemi pratik, basit, öngörülebilir ve uygun fiyatlı bir minimal invaziv tekniktir. Bu olgu sunumunda; restoratif diş hekimliğinde yaygın bir tedavi şekli olan diastema kapatma işleminin hastanın model üzerinde onayladığı ve bitim sonrasında da beğendiği restorasyonları daha sonrasında yaşadığı kararsızlık sebebiyle 2 gün içinde söktürtmesi anlatılmaktadır. 24 yaşındaki bayan hasta üst ön dişleri arasındaki ~4mm genişliğindeki diastema şikâyeti ile kliniğimize başvurmuştur. Planlanan tedavi hakkında gerekli bilgilendirmeler yapıldıktan sonra hastamız restorasyonları onayladığına dair onam formunu imzalamış ve tedavilere başlanmış ve nanohibrit kompozit materyal ile restorasyonlar tamamlanmıştır. Sonuç olarak, kararsız hastalarda invaziv bir işleme başlamadan önce, hastanın yeni yapılan restorasyonlara alışma süresi de göz önünde bulundurularak, başlangıç tedavisi olarak kompozit lamina veneerleri tercih etmek çok daha yerinde bir tedavi yöntemi olacaktır.

Conservative and esthetic closure of maxillary midline diastema without creating “black triangle” using direct resin composite

Conservative and esthetic closure of maxillary midline diastema without creating “black triangle” using direct resin composite

Treatment of Maxillary Midline Diastema Using Removable Clear Trays and Elastics: A Case Report

Maksilladaki orta hat diastemasi tedavi gerektiren yaygin bir estetik problemdir. Bu olgu sunumunda minor ust orta hat diastemasinin hareketli seffaf plak ve elastikler kullanilarak tedavi edilme sureci anlatilmaktadir. Ust santral kesici disleri arasindaki kucuk diastemadan sikayetci 20 yasindaki kadin hasta simetrik bir yuze ve yeterli dudak kapanisina sahipti. Agiz ici muayenesinde sinif 1 dissel iliski, normal overjet ve overbite iliskisi goruldu. Diastemanin kapatilmasi amaciyla hastadan alinan olcu uzerinde, orta hattan 2 parcaya ayrilmis ve kaninler bolgesinde elastik kullanilmasi amaciyla birer adet cikintisi olan seffaf plak hazirlandi. Iki ayin sonunda diastema tamamen kapatildi ve retansiyon amaciyla ust 3-3 lingual retainer yerlestirildi. Estetik problem giderildi. Seffaf apareyler estetiktir ve maksiller orta hat diastemasinin kapatilmasinda basariyla kullanilabilir

Body Nasopalatine Duct Cyst Modified

This article aim to introduce the study process and outcome of Maxillary Midline Diastema formation after Nasopalatine Duct Cyst (NPDC); which is the most common non-neoplastic, non-odontogenic maxillary cyst. In this report we present a 24-year old male student recently experienced the formation of a maxillary midline diastema. The maxillary central incisors exhibited less than 1 mm of buccolingual mobility and less than 2 mm of attachment loss. Panoramic and periapical radiographs showed a radiolucent lesion located in the premaxilla, between the maxillary central incisors. A cone-beam computed tomography (CBCT) scan suggested that the radiolucent lesion was confluent with the incisive canal. A presumptive diagnosis was Nasopalatine Duct Cyst (NPDC) and the cyst was surgically excised via palatal approach. Surgical enucleation is usually the treatment of choice, although marsupialization also has been used for larger lesions. On the basis of the clinical, radiographic, and histopathologic features, the diagnosis of NPDC was confirmed. The spontaneous appearance of an MMD in an adult patient should suggest the possibility of pathology. The differential diagnosis should include periodontal attachment loss and expansile lesions, most notably the nasopalatine duct cyst. The review is to show the relationship between Maxillary Midline Diastema and Nasopalatine Duct Cyst.

Discrete gingival enlargement resulting from artificially created maxillary midline diastema

A case of discrete gingival enlargement as a long-term consequence of artificially created midline diastema by a dental quack in an otherwise healthy 33-year-old female was reported. The patient and her husband were bothered by the gingival enlargement and requested treatment. The patient was unconcerned about the associated discolored tooth. The lesion was diagnosed as fibrous epulis and was treated by surgical excision after which the patient was referred to the restorative dentist for endodontic treatment. To conclude, discrete gingival enlargement occurring as a long-term consequence of artificially created midline diastema by a dental quack should be considered as fibrous epulis until proven otherwise.

Relationship between Perception of Maxillary Midline Diastema and Personality Profiles

ABSTRACT Aims The aim of this study was to investigate the relationship between personality profiles and perception of maxillary midline diastema (MMD) among laypeople. Materials and methods Hundred total of 200 laypeople (100 females and 100 males, mean age = 28.8 ± 5.5 years) were recruited in this cross-sectional study. They were asked to rate the attractiveness of two digital photographs of ideal smile with 1 and 2 mm MMD on a visual analog scale (VAS) from 0 to 10. Participants' personality and psychological profiles were assessed via neuroticism.extraversion.openness five-factor inventory. The statistically significant levels were set at p ≤ 0.05. Results The mean VAS scores were 5.7 (± 2.1) and 4.3 (± 2.0) for 1 and 2 mm MMD respectively. The participants rated the attractiveness of 1 mm diastema better than the attractiveness of 2 mm diastema (p < 0.001). Females showed no difference in rating diastema attractiveness in comparison with males (p > 0.05). Participants (from both genders) with higher neuroticism scores rated 1 and 2 mm diastemas as less attractive than those with lower neuroticism scores (p ≤ 0.001). Conclusion Psychological profiles (high neuroticism) might be associated with negative perceptions of attractiveness of MMD. How to cite this article Al Nazeh AA. Relationship between Perception of Maxillary Midline Diastema and Personality Profiles. World J Dent 2016;7(2):59-63.

Revisiting the Factors Underlying Maxillary Midline Diastema.

Aim. The aim of this study is to analyze the etiological factors underlying the presence of maxillary midline diastema in a sample of orthodontic patients. Materials and Methods. One hundred patients who fulfill the inclusion criteria were selected from 1355 patients seeking orthodontic treatment. The pretreatment orthodontic records were analyzed. The width of the maxillary midline diastema was measured clinically with a digital caliper at two levels: the mesioincisal angles of the central incisors and five millimeters from the incisal edge. The two measurements were averaged, and patients with diastema of more than 0.5 millimeter in width were enrolled. Results. Diastema is a multifactorial clinical finding with more than one underlying etiological cause. The interrelationship between the familial pattern of midline diastema and the microdontia, macroglossia, labial frenum, and alveolar cleft conforms was clear. The effect of a mesiodens and the upper lateral incisor whether bilaterally missing, unerupted, or peg shaped was minimal. Conclusion. Etiological factors underlying maxillary midline diastema are interconnected. Using a checklist as a guide during handling maxillary midline diastema is important in the different stages of treatment.

Alterations of papilla dimensions after orthodontic closure of the maxillary midline diastema: a retrospective longitudinal study.

PurposeThe aim of this study was to evaluate alterations of papilla dimensions after orthodontic closure of the diastema between maxillary central incisors.MethodsSixty patients who had a visible diastema between maxillary central incisors that had been closed by orthodontic approximation were selected for this study. Various papilla dimensions were assessed on clinical photographs and study models before the orthodontic treatment and at the follow-up examination after closure of the diastema. Influences of the variables assessed before orthodontic treatment on the alterations of papilla height (PH) and papilla base thickness (PBT) were evaluated by univariate regression analysis. To analyze potential influences of the 3-dimensional papilla dimensions before orthodontic treatment on the alterations of PH and PBT, a multiple regression model was formulated including the 3-dimensional papilla dimensions as predictor variables.ResultsOn average, PH decreased by 0.80 mm and PBT increased after orthodontic closure of the diastema (P<0.01). Univariate regression analysis revealed that the PH (P=0.002) and PBT (P=0.047) before orthodontic treatment influenced the alteration of PH. With respect to the alteration of PBT, the diastema width (P=0.045) and PBT (P=0.000) were found to be influential factors. PBT before the orthodontic treatment significantly influenced the alteration of PBT in the multiple regression model.ConclusionsPH decreased but PBT increased after orthodontic closure of the diastema. The papilla dimensions before orthodontic treatment influenced the alterations of PH and PBT after closure of the diastema. The PBT increased more when the diastema width before the orthodontic treatment was larger.

Direct Midline Diastema Closure with Composite Layering Technique: A One-Year Follow-Up.

Objective. Maxillary anterior spacing is a common aesthetic complaint of patients. Midline diastema has a multifactorial etiology such as labial frenulum, microdontia, mesiodens, peg-shaped lateral incisors, agenesis, cysts, habits such as finger sucking, tongue thrusting, or lip sucking, dental malformations, genetics, proclinations, dental-skeletal discrepancies, and imperfect coalescence of interdental septum. Appropriate technique and material for effective treatment are based on time, physical, psychological, and economical limitations. Direct composite resins in diastema cases allow dentist and patient complete control of these limitations and formation of natural smile. Clinical Considerations. In this case report a maxillary midline diastema was closed with direct composite resin restorations in one appointment without any preparation. One bottle total etch adhesive was used and translucent/opaque composite resin shades were layered on mesial surfaces of the teeth that were isolated with rubber dam and Teflon bands. Finishing and polishing procedures were achieved by using polishing discs. Patient was informed for recalls for every 6 months. Conclusions. At one-year recall no sensitivities, discolorations, or fractures were detected on teeth and restorations. Direct composite resins seemed to be highly aesthetic and durable restorations that can satisfy patients as under the conditions of case presented.

Closure of a maxillary midline diastema using a modified omega loop

A maxillary midline diastema is important from a clinical management standpoint by virtue of its presence, as well as the esthetic concerns it causes to the patient. While seen in many children as a part of normal development in the mixed dentition (only to disappear as the growth progresses), it may persist in situations associated with some or the other etiological factors. These could be tooth size-shape discrepancy, midline cysts, missing lateral incisors, habits (thumb sucking, tongue thrusting, etc.), familial tendencies, abnormal labial frenum, etc., Treatment planning should seek to manage not only the diastemata in question but also the cause behind it. Possible therapeutic approaches include orthodontic treatment, restorative dentistry, surgery, and its various combinations. This article describes a modified form of loop mechanics used to close diastemata.

Incidence of Maxillary Midline Diastema in Iraqi Students in Baghdad City

Maxillary midline diastema is one of important numerical anomalies of teeth which character as an open space between the maxillary central incisors so that many studies have been carried out in different countries of the world to find the prevalence of maxillary midline diastema. The purpose of this study was to determine the prevalence of the maxillary midline diastema and assess the gender difference in a selective sample of college and institute Iraqi student age (18-22) year in Baghdad city.&#x0D; A total sample of (1460) students distributed into (680) males and (780) females. The statistical analysis shows the incidence of maxillary midline diastema is (55) cases in the total sample with percent (3.8%) which is in males (3.4%) and (4.1%) in female. So it is found in females more than in males, the maxillary Midline Diastema.

Prevalence of artificially created maxillary midline diastema and its complications in a selected nigerian population.

Maxillary midline diastema (MMD) is generally regarded as a symbol of beauty in Nigeria. The desperation to look beautiful has caused many individuals to seek the creation of artificial midline diastema and that comes often with undesirable side effects. To determine the prevalence of artificially created maxillary midline diastema (MMD) and its complications in a selected Nigerian population. A cross-sectional study using a semi-structured questionnaire as the instrument for data collection was done among patients attending a private clinic in Owerri the capital of Imo state in Nigeria over a period of 18 months. The data were retrieved from the questionnaires and analyzed using the SPSS version 20. There were 141 respondents comprising 58(41.1%) males and 83(58.9%) females, giving a male to female ratio of 1:1.4. The prevalence of artificially created MMD was 34.0% with increased frequency in: the 21-30 years age group; among the females and in respondents with tertiary level of education. Majority of the respondents (69.5%) desire MMD and 20.8% of those without it wanted it created through cosmetic dentistry. Twenty of the 48 respondents with artificial MMD had it done to enhance personal beauty and aesthetics. The commonest complication was tooth sensitivity (44.8%), followed by toothache (41.4%). The prevalence of artificially created MMD was 34.0% in this study; and it is commoner in females and younger age group .The commonest complication was tooth sensitivity. Enhancement of personal beauty and aesthetic was the major reason for having it done.

Maxillary Midline diastema closure after replacement of primary teeth with implant prosthesis

Key Clinical MessageThis case shows an excellent esthetic treatment outcome using implant-retained crowns replacing maxillary laterals and canines in hypodontia patient with unusual incidence of spontaneous diastema closure after the placement of implants. To our knowledge, this is the first case report showing maxillary midline diastema closure after implant placement.

When the Midline Diastema Is Not Characteristic of the "Ugly Duckling" Stage.

This case report presents the interceptive orthodontic treatment of a 9-year, 5-month-old boy with class I malocclusion, a 9.0-mm maxillary midline diastema, and deviation from the midline. The treatment goals were to decrease the magnitude of the diastema and to simulate the characteristics of the “ugly duckling” stage. Braces were placed on the first molars and the maxillary central incisors. The biomechanics of the anchors on the first molars elicited substantial mesial movement of the left central incisor to match the midline. A flat wire segment was bonded onto the palatal surface of the central incisors for retention.

The prevalence and etiology of maxillary midline diastema among orthodontic patients attending Shorsh Dental Clinic in Sulaimani City

Objectives: The purposes of this study were to determine the prevalence of MMD among Shorish dental clinic`s patients seeking orthodontic treatment and to find the factors associated with this anomaly. Materials and Methods: During 6 months, 507 patients with age (13 – 40) years old attending Shorish Dental Clinic, seeking orthodontic treatment were screened to find the prevalence and etiology of MMD. Result: The MMD was present in 110 patients (21.7%). The frequency of MMD was the same in males and females. It is highest in the young age group and lowest in the older age group (29% vs. 4%). Conclusion: The most frequent factor among the observed etiological factors was oral unhealthy habit which was found in 40% of MMD patients and 8.7% of all cases.

Residents' journal review

Residents' journal review

Midline diastema and its aetiology--a review.

Maxillary midline diastema is a common aesthetic complaint of patients. Treating the midline diastema is a matter of concern for practitioners, as many different aetiologies are reported to be associated with it. The appearance of midline diastema as part of the normal dental development makes it difficult for practitioners to decide whether to intervene or not at an early stage. The aim of this article is to review the possible aetiology and management options which will help the clinician to diagnose, intercept and to take effective action to correct the midline diastema. The available data shows that an early intervention is desirable in cases with large diastemas. Treatment modality, timing and retention protocol depends on the aetiology of the diastema. Therefore, priority needs to be given to diagnosing the aetiology before making any treatment decisions. Clinical Relevance: This article aims to determine and evaluate the aetiology and possible treatment options of midline diastema.

Does the maxillary midline diastema close after frenectomy

To analyze the closure, persistence or reopening of the maxillary midline diastema after frenectomy in patients with and without subsequent orthodontic treatment. All patients undergoing frenectomy with a CO2 laser were included in this retrospective study during the period of September 2002 to June 2011. Age and sex, the dimension of the diastema, eruption status of the maxillary canines, and the presence of an orthodontic treatment were recorded at the day of frenectomy and during follow-up. Of the 59 patients fulfilling the inclusion criteria, 31 (52.5%) had an active orthodontic therapy, while 27 (45.8%) had a frenectomy without orthodontic treatment. For one patient, information concerning orthodontic treatment was not available. In the first follow-up (2 to 12 weeks), only four diastemas closed after frenectomy and orthodontic treatment, and none after frenectomy alone. In the second follow-up (4 to 19 months), statistically significantly (P = .002) more diastemas (n = 20) closed with frenectomy and orthodontic treatment than with frenectomy alone (n = 3). At the long-term (21 to 121 months) follow-up, only four patients had a persisting diastema, and in three patients orthodontic treatment was ongoing. Closure of the maxillary midline diastema with a prominent frenum is more predictable with frenectomy and concomitant orthodontic treatment than with frenectomy alone. This study demonstrates the importance of an interdisciplinary approach to treat maxillary midline diastemas, ideally including general practitioners, oral surgeons, periodontists, and orthodontists.

A survey of orthodontists' perspectives on the timing of treatment: A pilot study.

Objectives:This study aimed to outline orthodontists’ perspectives at what stage they would initiate orthodontic treatment and also sought to assess the relationship between orthodontists’ views and their genders, types of practice, and experience levels.Materials and Methods:A questionnaire was sent electronically to 165 practicing orthodontists at different regions in Saudi Arabia. The orthodontists were asked to consider at what stage they would initiate orthodontic treatment for a child with one of 29 different types of occlusal deviations, functional problems, and temporomandibular disorders (TMDs) listed in the questionnaire as their main orthodontic problem. Frequency distributions of all the variables were derived, and comparisons were made using the Chi-square tests.Results:Fifty-two electronically completed questionnaires were returned (31.5% response rate). The majority of the respondents were males (63.5%). The majority of respondents (90%) reported that they would treat most of the occlusal deviations in the mixed dentition stage. Anterior cross-bite was the most frequent indication for treatment during the early mixed dentition stage (73.7%). Conditions rated as best treated during the late mixed, or the permanent dentition stages were; overjet > 6 mm with interdental spacing, maxillary midline diastema >2 mm and deep bite >5 mm without palatal impingement. The majority of respondents (86.6%) preferred to treat most of the functional problems in the deciduous or early mixed dentition stage. Orthodontists with more than 15 years of experience preferred to treat patients with TMDs, whereas those with <15 years of experience opted to refer such patients to TMD specialists.Conclusions:The findings of the present study suggest that orthodontists should consider many factors, such as the risks, benefits, duration, and costs of early and late intervention, when deciding the best timing to begin orthodontic treatment.