Midline Diastema Research Articles

Misusing Elastics for Midline Diastema Closure - Disaster and Treatment Via a Case Report in Vietnam

Midline diastema has been a popular aesthetic problem for children. Several treatment options are available, however, the use of elastic bands without other appliances for closing the diastema still remains a pressing issue in Vietnam, which could be done by the patient’s parents either themselves or under the dental practitioners’ suggestion. Objective: To report a specific case about the extensive extrusion regarding upper central incisors in a pediatric patient due to misusing the elastic band, in which management was complex due to an unfavorable situation for splinting. Case Report: Single rubber band usage for orthodontic movement in closing diastema has been an unresolved disaster in Vietnam, leading to the need for early diagnosis and immediate intervention when facing the complications. Conclusion: Significant information dissemination is paramount for long-term improvement in the oral health of pediatric patients in Vietnam and around the world.

Comparison of pleasant and unpleasant smile characteristics in the perception of the laypeople in an Iranian population

This study aimed to compare the characteristics of pleasant and unpleasant smiles from the perception of laypeople. Two-hundred posed smile photographs were obtained from adult participants with no anomaly, restoration, or severe crowding and spacing in anterior teeth. Photographs were shown to 26 judges to give each photograph a score for attractiveness. Upper and lower quartiles for the most and least rated smiles were determined, and variables including gingival display, smile arc, midline deviation, buccal corridor, smile width, tooth rotation or malposition, diastema, upper and lower vermilion show, and tooth form were measured. Independent-sample t test and Pearson chi-square analysis were used to determine the differences between the pleasant and unpleasant groups for quantitative and qualitative variables, respectively. The linear regression model revealed variables with the most significant impact on the mean score. All quantitative and qualitative variables except tooth form significantly differed between pleasant and unpleasant smile groups (P<0.05). The consonant smile arc was associated with an increase of 12.59% in mean scores compared with the inconsonant smile arc. Each tooth reported with malposition was correlated with a decrease of 9.37% in the scores. In the same way, each 1-mm increase in midline diastema and occlusal cant coincided with a drop of 8.73% and 3.59% in scores, respectively. The results of this study suggested that smile arc, tooth malposition, midline diastema, and occlusal plane canting had the most impact on smile esthetics and should be given priority by orthodontists in the treatment plan of choice.

Management of Papilla Penetrating Frenum Using Z-plasty Technique - A Case Report

Frenectomy is a surgical procedure that is commonly used to address issues related to the frenulum which can affect speech and can cause midline diastema which looks unesthetic. Z-plasty is a modification of the standard frenectomy procedure to reposition the frenulum and improve outcomes. This article provides an overview of frenectomy by using Z-plasty, including the procedure in detail, potential risks and complications, and a discussion of its clinical applications and outcomes.&#x0D; &#x0D; Keywords- Aberrant frenum, Frenectomy, Z-plasty&#x0D; Source of support- Nil&#x0D; Conflict of interest- None declared&#x0D; Ethical clearance- Approved by Intuitional Ethical Committee

Surgical Excision of an Inverted-Y Frenum

Frenula of the oral cavity consist of the labial, buccal, or lingual frenum. They are folds of mucous membrane enclosing connective tissue. Clinically, an abnormal/aberrant frenum can pull the gingival margins causing recession, plaque accumulation, pocket formation, or midline diastema. Furthermore, in edentulous ridges, high frenal attachment can interfere with the denture margins affecting its stability. Frenotomy and frenectomy are common surgical approaches for such conditions. This case report highlights the frenectomy of inverted-Y frenula with a wide base as a means of preprosthetic surgery.

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.

FRENECTOMY: BREAKING THE BARRIER

One of the causes of midline diastema is an abnormal labial frenulum. This case report showcases the successful and efficient surgical management of an aberrant maxillary labial frenulum in a 17-year-old patient. The follow-up evaluation revealed optimal healing. The midline diastema was further closed using fixed appliance. The patient showed successful closure of the midline diastema within a time period of four months

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.

Aesthetic Management of Anterior Midline Diastema

This case report describes a treatment using lithium disilicate in rehabilitating maxillary anterior with midline spacing. This conservative treatment requires fewer clinical sessions along with detailed clinical protocol, precise indications, and laboratory procedures. The result concludes that ceramic veneers not only restore harmony and proportion in a patient’s smile but also prove to be an excellent treatment for an anterior aesthetic zone.&#x0D; Today, with the influence of social media or social technologies, the concern about facial aesthetics and the demand for cosmetic procedures grows rapidly.[1] Hence, the requirement for aesthetic dental treatments and the creation of beautiful smiles has increased for the re-establishment of oral health and function.[2] The presence of anterior spacing or diastema is one of the factors that affect the smile of an individual. This has become the most common aesthetic complaint of patients.[3] According to Keene (1963), a midline diastema is an anterior midline separation between the proximal surfaces of consecutive teeth that is greater than 0.5 mm.[4] There was also a report that states the maxilla has a higher occurrence of midline diastema than the mandible.[5] According to Oquendo et al., the objectives of treating diastemata are to achieve a stable and effective occlusion as well as a tooth form that is harmonious with the surrounding teeth, arch, and facial form. The result needs to be balanced and appealing to the patient.[6]&#x0D; The options to correct midline diastema range from composite resins to ceramics. Time restrictions, the desire for fast aesthetic results, or the perception of the social stigma connected with their age and wearing braces are some of the reasons why patients may choose not to have orthodontics to close diastemas.[7]&#x0D; Due to the preservation of dental structures, reduced price compared to ceramics, reversibility, and straightforward process, the composite resin was once the preferred choice for diastema closure.[8] However, it was shown that secondary caries, loss of repair, pigment impregnation, fracture, marginal flaws, and a high level of colour instability all contribute to their high failure rate.[9]&#x0D; For patients looking for long-lasting therapy and with high aesthetic standards, ceramics have become the material of choice. Although zirconia has greater mechanical strength, lithium disilicate has greater translucency, making the two materials the most popular. Porcelain laminate veneers introduced by Charles Pincus in 1938 are a thin shell of ceramic and these can be bonded to the facial surface of anterior teeth using bonding agents and dual-cure cements.[10] Buonocore in 1955 introduced the acid etch technique. Bowen in 1958 introduced silica resin direct filling material. Furthermore, with the introduction of improved bonding agents in the 1980s when coupled with the silanization of veneers, the results of porcelain laminate veneers have become more predictable.[11] Considering the little dental preparation and outstanding aesthetic result, this surgery is therefore quite conservative. These materials acquire enamel's strength when they are adhered to it, becoming just as durable as the native tooth structure.[12] According to Peumans et al. (2004), survival rates have ranged from 92% at 5 years to 64% at 10 years. The importance of adequate case selection and procedure is stressed by the extremely high survival rates of carefully implanted PLVs (porcelain laminate veneer) of over 90% after 9 years (Strassler &amp; Nathanson, 1989; Dunne &amp; Millar, 1993).[13] This article reports a case of aesthetic rehabilitation of anterior diastema closure using lithium disilicate porcelain veneers.

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.

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.

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.

Immediate dentoskeletal and periodontal effects of miniscrew-assisted rapid palatal expansion: Comparison between young vs middle-aged adults

This study aimed to compare the dentoskeletal and periodontal changes after miniscrew-assisted rapid palatal expansion (MARPE) in patients aged 18-29 and 30-45 years. The sample comprised 28 subjects with transverse maxillary discrepancy successfully treated with MARPE. The young adult (YA) group comprised 14 subjects (mean age, 22.8 years; 3 male, 11 female). The middle adult (MA) group comprised 14 subjects (mean age, 36.8 years; 6 male, 8 female). All patients were treated with a 4-miniscrew MARPE expander. The activation protocol was one quarter turn twice a day until the midline diastema opening, followed by one quarter turn a day until overcorrection. Cone-beam computed tomography (CBCT) scans taken before and immediately after the expansion was analyzed using OnDemand3D Dental software. Using CBCT coronal images, transversal dentoskeletal and periodontal variables were measured in the preexpansion and postexpansion. Intergroup comparisons of expansion changes were performed using t and Mann-Whitney tests (P<0.05). Groups were compatible at preexpansion for most CBCT measurements. A success rate of midpalatal suture opening of 100% and 81% was observed for YA and MA groups, respectively. No intergroup differences were found for the maxillary and dental arch widths increases. The buccal tip of anchorage teeth was observed similarly in both groups. The buccal bone thickness of posterior teeth decreased, and the palatal bone thickness increased after expansion with no difference between groups. After MARPE, the MA group showed similar dentoskeletal and periodontal changes compared to the YA group.

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.

Perception of smile esthetics by patients reporting for orthodontic treatment

Objective: The main objective of this study was to evaluate smile esthetics in terms of midline diastema, smile arc and gingival display during smile by patients reporting for orthodontic treatment. Study design: A cross-sectional study. Setting: Out Patient Door, Orthodontic Department Liaquat University of Medical and Health Sciences, Jamshoro Sindh. Duration: The study was conducted within 06 months after the approval of synopsis i-e from Dec 2020, to May 2021. Sample size: Out measures were 1) midline diastema, 2) Gingival Display during smile, 3) smile arc. Sample size calculation was done by using “Openepi” software with 5% margin of error and 95 % confident value, Mean 0.95, Sample size was n= 126. Sample technique: Non-Probability consecutive sampling technique. Data collection method: After approval of this study from Ethical Review Committee of LUMHS study was conducted at Orthodontic Department, Institute of Dentistry, Liaquat University of Medical and Health Sciences Jamshoro. There were total of 126 participants in this study, Data was collected showing three different front smiling photographs with various degrees of; Gingival Show During Smile i-e A= 0mm B =0.5mm C=1.5mm D=2mm E=2.5mm Smile Arc i-e A. Convex/Curved B. Plan/Straight C. Inverted/Reverse.

Orthodontic Management of Midline Diastema and Anterior Spaced Dentition: A Case Report

Orthodontic Management of Midline Diastema and Anterior Spaced Dentition: A Case Report

Esthetic Management of Maxillary Anterior Teeth in a Patient with Midline Diastema Having Deep Bite Using Palatal Loop Connector: A Case Report

Esthetic Management of Maxillary Anterior Teeth in a Patient with Midline Diastema Having Deep Bite Using Palatal Loop Connector: A Case Report

Associations among the occurrence or types of maxillary canine impaction, labial frenum attachment types, lateral incisor anomalies, and midline diastema in patients with and without impaction: A case-control study

We tested whether the labial frenum attachment types may affect the occurrence or type of maxillary canine impaction. This case-control study was performed on 96 subjects (48 with maxillary canine impaction [20.50±4.99 years, 32 females], 48 controls [21.94±3.79, 31 females]). Types of canine impaction (buccal/palatal, bilateral/unilateral, left/right), types of upper lip middle frenums (mucosal, gingival, papillary), the anatomy of lateral incisors (impacted, peg shaped, small, normal), and the midline diastema were evaluated clinically and radiographically. Associations were examined using multiple binary logistic regression, 3-way repeated-measures ANCOVA, and Fisher tests (α=0.05, β=0.2). The numbers of mucosal, gingival, and papillary frenums in the case group were '29, 14, and 5', respectively; in the control group, they were '25, 21, and 2' (Fisher, P=0.248). The numbers of mucosal, gingival, and papillary frenums were respectively '25, 11, and 1' in the palatally impacted canine subgroup; they were '4, 3, and 4' in the buccally impacted subgroup (Fisher, P=0.010). Abnormal laterals were present in 12 cases and 4 controls; normal laterals were observed in 36 cases and 44 controls (Fisher, P=0.053). Abnormal laterals were seen in 10 cases with palatally impacted canines and 2 cases with buccally impacted canines; normal laterals existed in 27 cases with palatally impacted canines and 9 cases with buccally impacted canines (Fisher, P=0.705). Lateral anatomy was not associated with frenum attachment (Fisher, P=0.827). Greater midline diastemas were seen in cases with maxillary canine impaction, papillary frenums, and abnormal laterals (ANCOVA, P≤0.016). Buccal type of canine impaction is positively associated with papillary labial frenums. Canine impaction is 3.6 folds more prevalent in cases with lateral abnormality. Midline diastema is positively and independently associated with canine impaction, papillary frenums, and abnormal laterals.

A CASE SERIES OF NONSYNDROMIC DOUBLE MESIODENS IN MIXED DENTITION

Mesiodens is a commonly found supernumerary tooth present in the midline of maxilla. Mesiodens can be paired, single, erupted, unerupted, and sometimes impacted. Numerous issues are brought on by these mesiodens, including cyst development, root resorption, midline diastema, displacement, and rotation. In the present case, mesiodens is found bilaterally in the anterior maxilla and both mesiodens are prophylactically extracted to prevent its adverse effects on permanent dentition

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.

Early removal of supernumeraries to close a midline diastema: a case report

A midline diastema is a part of normal dental development, which, in the mixed dentition, is termed the ‘ugly duckling’ stage. Supernumerary teeth, however, can also be a cause, with the most common type being a mesiodens. Supernumeraries can cause other complications including delayed or failure of eruption of a permanent tooth, displacement of crowns, crowding, root resorption and cyst formation. Treatment options for supernumeraries include immediate or delayed removal or active monitoring. This article advocates for early diagnosis and treatment to reduce the need for future complex treatment. CPD/Clinical Relevance: This case emphasizes the importance for clinicians to accurately and carefully diagnose the cause of a midline diastema and the presence of supernumerary teeth early in development. Prompt orthodontic referral can reduce the need for later complex surgical and orthodontic treatment.