Midline Diastema Research Articles

A case report on the management of mandibular midline diastema by using laser as a treatment modality

A frenum is a fold of mucous membrane that connects the labial mucosa (lips) to the gingiva or that connects the tongue to the floor of the mouth and hence providing support to the lips and the tongue. The normal frenal attachment is at the level of mucogingival junction (mucosal) and hence maintaining a balance between the interproximal contacts of the anterior teeth of either maxilla or mandible. But if this frenal attachment is high or in other words if there is a an aberrant frenum, then this type of frenal attachment either results in spacing between the anterior teeth or in some cases can lead to the loss of gingival embrasure resulting in the creation of black triangle between the anterior teeth. Present case report is on a 38 years old female whose chief complaint was spacing between the mandibular central incisors and upon intraoral examination, it was noted that there was an aberrant frenum which has also resulted in loss of gingival embrasure between the mandibular anterior teeth and hence this aberrant frenum was treated by a process called frenectomy by using a thermal treatment modality called as Laser. Upon follow up after 1 week, there was a reduction in spacing between mandibular central incisors.

Prevalence of Malocclusion among School aged Children and Adolescents in Kabul, Afghanistan

One of the major public health concerns is the prevalence of malocclusion among school-aged children. Malaligned teeth and incorrect jaw posture are referred to as malocclusion, and they can cause a number of functional and cosmetic problems. The aim of this study was to investigate the prevalence of malocclusion in school-aged children and adolescents in Kabul, Afghanistan. This descriptive cross-sectional study was conducted at the Faculty of Dentistry, Kabul University of Medical Sciences “Abu Ali Ibn Sina” (KUMS). The data were collected from High schools in Kabul, Afghanistan during 2019 and 2020. A sample of 479 children and adolescents, 236 females (49.3%) and 243 males (50.7%) 8-18 years old (mean age 14.16±2.8) were randomly selected from four high schools of different districts of Kabul city. We used the angle classification for sagittal plane malocclusion; open bite and deep bite for vertical plane malocclusions; cross bites for transverse plane malocclusion; midline diastema, spacing and crowding show the tooth material and arch length discrepancies. This study demonstrated that only 41 (8.6%) of subjects had normal occlusion while 92.4% of subjects had different types of malocclusions. Class I malocclusion was found in 275 subjects ( (57.4%, class II Division 1 in 63 subjects (13.1%), Class II Division 2 in 64 subjects (13.4%), Class III malocclusion in 36 subjects (7.5%), moreover, crowding in 183 (38.2%), spacing in 79 (16.5%), midline diastema in 54 (11.3%), crossbite in 77 subjects (16.1%), open bite in 23 subjects (4.8%) and deep overbite in 44 subjects (9.2%) were found. According to Angle’s classification of malocclusion class I malocclusion was the most prevalent malocclusion and class III was the least prevalent malocclusion in school-aged children and adolescents in Kabul city.

Correction of midline diastema and severe gingival recession with periodontal surgery and orthodontic treatment: A case report with 20 years of follow-up

Correction of midline diastema and severe gingival recession with periodontal surgery and orthodontic treatment: A case report with 20 years of follow-up

To bond or not to bond: considerations for choosing the appropriate treatment for closing a midline diastema

In the realm of dental aesthetics, the decision between employing a resin composite material bonded to the dental hard tissues, or orthodontics to address a midline diastema and enhance smile aesthetics, can be complex and multifaceted. This article delves into the critical considerations and decision-making processes guiding dental practitioners through how to decide when orthodontic movement, while a more costly and complex treatment option, might provide optimum aesthetics. By exploring the aetiology of midline diastemas, and the pivotal role of the central incisor in smile aesthetics the author aims to equip clinicians with a comprehensive framework. CPD/Clinical Relevance: This article shows how to assess suitable treatment modalities for closing midline diastemas in adult patients.

A Comprehensive Management of Midline Diastema- A Review of Literature

A Comprehensive Management of Midline Diastema- A Review of Literature

Midline Diastema Correction using M Spring

One among the most common malocclusions encountered during our clinical practice i s m i d l i n e d i a s t e m a and it is associated with high chance of relapse as well. This article illustrates a case report in which clinical utilization of M-spring resulted in a faster and efficient midline diastema closure in 6 weeks duration.

MULTIDISCIPLINARY PERIODONTIA-ORTHODONTIA APPROACH IN A CASE OF MIDLINE DIASTEMA WITH LABIAL FRENECTOMY USING ELECTROSURGERY

Introduction: Periodontal tissue condition plays an important role as an adjunctive in the success of orthodontic therapy. One of prominent esthetic problem is midline diastema case, which was caused by high and aberrant frenulum attachment. This clinical case aims to report the frenectomy procedures with electrosurgery through multidiscipline perio- orthodontic approach to close the midline diastema. Case: : A female 19 years old patient was referred from orthodontic clinic with chief complaint there was a gap between her central insisif in upper jaw. The frenulum showed the Blanch test positive and there was no clinical attachment loss. Case Treatment: Frenectomy with electrosurgery was done to eliminate the aberrant frenulum attachment. This procedure followed with fixed orthodontic therapy to close the midline diastema and prevent any relapse. Discussions: Frenectomy can be achieved with electrosurgery which has many advantages such as coagulation, a better visualization, blood-less area, bacterimial risk reduction, an uneventful healing process, less post operative discomforts, and minimal scar tissue formation. Fixed orthodontic appliance was bonded to close the gap between central incisors. The intraoral examination showed that there was no any relaps in midline after one year follow up debonding of fixed orthodontic. Conclusion and Suggestions: a functional and esthetic outcome can be achieved through multidiscipline perio-orthodontic approach. The combination of frenectomy and orthodontic therapy showed an optimal result to close the midline diastema. Conclusion and Suggestions: a functional and esthetic outcome can be achieved through multidiscipline perio-orthodontic approach. The combination of frenectomy and orthodontic therapy showed an optimal result to close the midline diastema.

Ankyloglossia-Related Speech Articulation Correction in Orthodontics: A Case Report

The ability of the tongue to protrude and elevate is the most crucial characteristic for activities like eating, speaking, nursing, and the development of dental arches. When the lingual frenum is short and tight, it can hinder the movement of the tongue, leading to malalignment of anterior teeth and Speech Articulation. This article discusses a case report of a 20-year-old male patient with a chief complaint of speech difficulty, maxillary anterior teeth spacing, and mandibular anterior teeth crowding. There was lingual frenum attachment suggestive of mild ankyloglossia. Patient underwent a lingual frenectomy pro- cedure under local anaesthesia which resulted in speech correction and relief of lower anterior crowding. Maxillary anterior spacing and midline diastema was corrected with orthodontic mechanotherapy and labial frenectomy, re- spectively. In cases where the frenulum anomaly is severe enough to result in both mechanical and functional limitations, surgery to reduce the frenulum (frenulectomy) is recommended. In consequence, it is fair to state that the chief complaint of inappropriate speech of the patient need to be resolved by an interdisciplinary approach.

Management of Ankyloglossia Using Conventional Surgical Technique: A Case Series

Periodontal plastic surgery is a more conservative and precise technique practised to create more functional and aesthetic results for the treatment of mucogingival problems. The presence of an aberrant frenum is one of the aetiological factors associated with the persistence of a midline diastema. Inadequate dental plaque removal, poor oral hygiene, bifid tongue, impaired speech, and mucogingival problems like recession and black triangles need more attention. Ankyloglossia, or tongue-tie, is a congenital anomaly with an abnormally short lingual frenulum. The aberrant frenum can be treated with surgical removal of the frenum using either frenectomy or frenotomy procedures. In the present case series, frenectomy was performed using a conventional scalpel technique for the treatment of tongue tie.

Management of midline diastema using the direct composite resin technique - A case report

Diastema or space between the anterior teeth is a common aesthetic complaint of patients. Direct composite resins in midline diastema cases allow dentists to have complete control in formation of natural smiles. This case report describes midline diastema closure with esthetic composite layering technique. A 25-year-old male patient reported to the clinic, with a complaint of spacing in the upper front tooth region of the jaw. The direct aesthetic composite laminate veneer was considered as the treatment of choice for the build-up of both maxillary central incisors as a more conservative, inexpensive, aesthetic, and quicker option. A2 & A3 shades were selected; prepared tooth surface was etched for 15 seconds using 37% phosphoric acid, rinsed with water for 20 seconds, and air dried with slight air pressure. Bonding agent was applied (Adper single Bond, 3M ESPE, USA) and cured for 20 seconds using (Vivadent Blue phase) curing light. The labial surface of the restoration was flattened using red banded knife-edge tip diamond bur. The natural look of the restored teeth was achieved after finishing and polishing. At six-month and one-year recalls the general outlook of the maxillary anterior teeth was considered natural and aesthetical. Clinically, both restorations have no fractures and also the restoration margins on both maxillary central incisors demonstrated no discolorations. By taking this into consideration and according to the positive results, an experienced dentist with proper case selection, using an appropriate technique and modern materials, can perform highly aesthetic and durable direct composite resin restorations that can satisfy patients as under the conditions of the case presented.

Management of frenectomy anterior upper arch before orthodontic treatment

Abnormal labial frenum may affect gingival health and cause periodontal disease. Abnormalities of the frenum also cause diastema of central incisors and irritation of the periodontal tissues, interfering with the teeth cleaning process, movement of orthodontic tools, and the proper fit of the denture and affecting the aesthetics. This case report shows that frenectomy is an alternative treatment due to abnormal labial frenum, in this case, caused by central diastema on maxillary incisors teeth. A-19 years old female patient came with chief complaints of midline diastema that affect her smile. She wants to get orthodontic treatment after the frenectomy management. The frenum was clinically high and elongated to the palatal side. Scaling and root planing were done at the first appointment, continued with frenectomy using a conventional technique (classical frenectomy) a week after the control. The treatment result showed that the frenectomy attachment was repaired and can continue the orthodontic treatment.

Orthodontic management of midline diastema caused by mesiodens: A case series

Supernumerary teeth are teeth in excess of the normal number, found in both primary and permanent dentition. Mesiodens are the most common form of supernumerary teeth, usually found in the maxillary anterior region, in between the permanent central incisors. It may lead to complications such as malocclusion, unesthetic appearance, food lodgment, and cyst formation. Early diagnosis and immediate intervention are advised to avoid orthodontic and pathological complications. The case series here discusses three different cases for presence of supernumerary teeth leading to development of midline diastema. Extraction of the supernumerary teeth followed by fixed orthodontic treatment was performed to correct the malocclusion and improve the facial esthetics.

Prevalence of Maxillary and Mandibular Frenal Attachment and Its Association with Age, Gender, and Oral Hygiene Status in Nepalese Population Seeking Dental Treatment.

Frenum attachments are folds of mucous membrane that connect the lips to the alveolar mucosa and underlying periosteum. Aberrant positioning of the maxillary and mandibular labial frenum can lead to various clinical issues, including mucogingival problems and midline diastema. The objective of this study was to assess the prevalence of maxillary and mandibular frenal attachments and their association with age, gender, and oral hygiene status in the Nepalese population seeking dental treatment. This descriptive cross-sectional study was conducted over a period of 6 months, from February 2023 to August 2023, among patients visiting the Department of Periodontology and Oral Implantology, aged 6 years and above, after obtaining official permission from the Institutional Review Committee (IRC-KUSMS Approval No. 8/23). The study collected data on morphological variations of frenal attachment and various periodontal parameters such as Oral Hygiene Index-Simplified (OHI-S), pocket depth, recession, and midline diastema in both arches. Descriptive statistics, including frequency and percentage, were used to analyze the data. The χ2-test was employed to determine the correlation between gender and types of frenulum attachment, while analysis of variance was used to assess the association of frenal attachments with oral hygiene status. Among 380 patients, the prevalence of frenal attachment was as follows: gingival 248 (65.30%), mucosal 71 (18.70%), papillary 42 (11.10%), and papillary penetrating 19 (5.00%) in the maxilla, and mucosal 225 (59.20%) and gingival 155 (40.78%) in mandible. Among the different morphological variations of frenal attachments, normal frenum was the most common, accounting for 231 cases (60.80%), followed by frenum with a nodule, with 101 cases (26.60%). The study found significant associations between frenal attachment and gender, as well as oral hygiene status. The prevalence of frenal attachments in this study was comparable to findings from previous research.

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

Evaluation of Association Between High Frenal Attachment and Severity of Midline Diastema

Introduction: A "midline diastema" arises when there is a space of more than 0.5 millimeters between the proximal surfaces of two consecutive teeth. There is usually open space between the two central incisors. Depending on its width, a midline diastema can make speaking difficult and look unsightly. Genetic factors, large tongues, improper tongue positioning during rest or function, microdontia or hypodontia of upper lateral incisors, extra teeth between upper central incisors, particularly mesiodens, aberrant frenal attachment, periodontal disease, and extra teeth are some of the multifactorial causes of midline diastema. The aim of this study is to assess the association between high frenal attachment and the severity of midline diastema. Materials and method: The study involved 126 patients. We assessed the frequency of high frenal attachment and midline diastema in these patients. The Chi square test was used to examine the data in the SPSS Software. Results and discussion: The current study has arrived at a positive correlation between the frenal attachment type and the severity of the midline diastema space. Midline diastema might be transitory or result from pathogenic, developmental, or iatrogenic reasons. Treatment options for diastema vary, and each one calls for an accurate etiology diagnosis and prompt action appropriate to that etiology. A correct diagnosis needs radiographic and clinical examination, medical and dental history, and perhaps tooth size assessment. Conclusion: Within the limitations of the study, it can be concluded that there is a positive correlation between the frenal attachment type and the severity of midline diastema space. It was also observed that the most common frenal attachment type was papillary type and the space more commonly was 2-3 mm in length.

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

Case report: A-short period management of female adolescent with Papilary Penetrating (PP) frenulum attachment

Background: A space between the anterior teeth and midline diastema is really important for aesthetic concerns in adolescents. Midline diastema may be related to high frenal attachment. Frenectomy is a treatment option for high frenal attachment. The entire removal of the frenum may be followed by orthodontic treatment. Case Presentation: A female 16-year-old patient complained of feeling embarrassed because of a gap in her front teeth. A frenectomy with orthodontic treatment is used to correct midline diastema. A frenectomy procedure uses conventional technique. The Straight Wire Technique (SWT) technique for orthodontic treatment. Midline diastema is complete correction at the 3rd control. Conclusion: Frenectomy before orthodontic treatment, followed by a medium-anchored Straight Wire Technique (SWT) with an elastromic chain or power chain, can be an alternative technique with a short duration.

Step-by-step practical procedures to close midline diastema with a vacuum-formed retainer

Step-by-step practical procedures to close midline diastema with a vacuum-formed retainer

Rehabilitation of the patient with ceramic laminate veneers having midline diastema and rotated maxillary central incisors associated with highly attached maxillary labial frenum- A case report

IPS Emax is a lithium disilicate glass ceramic that has excellent translucency, longetivity, durability and strength for all restorations. It is a unique system that fulfills all of your patient demands for minimally invasive dentistry. It is a choice for single anterior/posterior crowns, as it truly mimics the light refraction and natural translucency necessary for outstanding esthetic appearance. Maxillary midline diastema with associated rotation of maxillary incisors presents a very challenging situation for dentist to meet the esthetic requirements. The presence of highly attached labial frenum in such patients adds to the complexity of the outcome of the treatment. Labial frenectomy done with the Laser presents a very quick and early satisfactory healing with no postoperative patient discomfort. Presenting a one such case report of rehabilitation of maxillary midline diastema with the IPS Emax ceramic laminate veneers.

Frenectomy with Classical Technique

Objective: A 16-year-old man came to RSGMP Airlangga University with a complaint of a midline diastema in the maxilla which interfered with his appearance when smiling. After examination, it was found that there was an abnormal attachment of the superior labial frenulum so a frenectomy was needed. Methods: Anesthetize the operating area with a local anesthetic. The lips are retracted upwards. The frenulum is clamped using a hemostat until released. Irrigate the surgical area with saline. Perform suturing of the operating area with the interrupted technique using silk thread size 4 – 0. Result: one week post frenectomy shows redness, and slight edema in the mucobuccal fold region 11 21. One month post frenectomy it appears that wound healing is good, there is no pull from the frenulum. Conclusion: Frenectomy with the classical technique can correct the abnormal attachment of the frenulum