Case report a 23yearold female was referred to our department for orthodontic consultation. Midline diastema has multifactorial etiology such as labial frenulum, microdontia, mesiodens, pegshaped lateral incisors, agenesis, cysts, habits such as finger. Lingual orthodontic treatment to correct a midline diastema. Assess and diagnose may be challenging due to the many factors that influences the. The authors present five cases of mmds in adults to. The maxillary labial fraenum a controversy of oral.
Orthodontic treatment of midline diastema related to. The aim of this paper is to underscore the main etiological factors for the presence of a maxillary midline diastema and to illustrate the clinical and laboratory examinations required to recognize these factors. However, a comprehensive approach combining two or more treatment modalities may be needed to improve esthetics. In the majority of studies the predominant opinion is that the upper midline. Resin bonded fixed partial denture is a conservative approach to the replacement of missing teeth. Midline diastema, which occurs as spacing between the upper central incisors, is a common occurrence seen in the pediatric population. Habbit should be eliminated using fixes or removal habit breakers a diastema due to ugly duckling stage no treatment required b diastema due to imperfect fusion at midline excision of included interdental tissue between the incisors. Resin retained fixed bridges are indicated in short span edentulous case. Orthodontic treatment of a midline diastema related to.
Esthetic management of diastema closure using metal. Midline diastema treatment composite sorabh kumar bansal. Diastema closure using direct bonding restorations combined. In france, the teeth on either side of a space or gap are called dents du bonheur or lucky teeth. Midline diastema or spacing in anterior teeth is a common condition that can present itself anytime to the dental office. From the beginning of time people have noticed, and perhaps passed judgment on, people with prominent spaces in their dentitions. Gerardo duran1, francisca vivar1, jose tisi 1, ismael henriquez abstract the maxillary midline diastema is a common esthetic problem in patients. Priority will be given to letters less than 500 words long. An mmd of greater than 2 millimeters in the mixed dentition is. Midline diastema and crowding correction with invisalign. Pdf maxillary midline diastema aetiology and orthodontic. Midline diastema can be treated by various treatment options like composites, veneers and orthodontic treatment, in this case due to the excess space between the central incisors, composites and veneers were not the ideal treatment options. European journal of paediatric dentistry 32001 1 management of midline diastema using a new surgical technique i.
A midline diastema usually is part of normal dental development during the mixed dentition. Long term retention was provided by fixed lingual retainers. Aapd policy on management of the frenulum in pediatric. Midline diastema and crowding correction with invisalign lite. This type of fibrous attachment can prevent the two maxillary central incisors from approximating each other. The labial frenum is found at the mid line inside the upper lip, and it is a flap of mucosa and connective tissue that holds the upper lip close to the teeth. Relapse is a major factor to be considered in the treatment of midline diastema. Treatment modality, timing and retention protocol depends on the aetiology of the diastema. Midline diastema closure with partial laminate veneers. She had a wellbalanced face, but her chief complaint was impaired esthetics due to a midline diastema in the maxillary arch. This case report describe orthodontic approach towards correction of midline diastema.
Diastema closure in anterior teeth using a posterior matrix. Treatment options for the significant dental midline diastema. In this case it was used as a temporary or provisional treatment until the patient goes for permanent treatment. Orthodontic treatment of midline diastema related to abnormal. Case report direct midline diastema closure with composite.
Keene described midline diastema as anterior midline spacing greater than 0. Surgical removal of the maxillary midline frenulum also is related to presence or prevention of midline diastema formation, prevention of post orthodontic relapse, esthetics, and psychological considerations. Aug 12, 2017 treatment options for midline diastema ruling out etiology and correct diagnosis is imperative to attain aesthetic results but to maintain the stability of the results attain as the chances of opening of the spaces post treatment is higher in case of midline diastema. Prevalence of midline diastema in children deepa j. Therefore, priority needs to be given to diagnosing the aetiology before making any treatment decisions. The space can occur either as a transient malocclusion or created by developmental, pathological or iatrogenic factors. Midline diastema kamath m k, arun a v int j orthod rehabil. Differential diagnosis and combined treatment of maxillary. Midline diastema closure with directbonding restorations. Orthodontic management of midline diastema in mixed. Longterm use of retainers or the use of permanent bonded lingual retainers have been encouraged, especially in cases with large diastema. Pdf treating a maxillary midline diastema in adult patients.
Management of maxillary midline diastema with emphasis on. Midline diastemas require proper diagnosis and timing for better care of patients. Resin retained bridge a treatment modality for diastema. Laserassisted multidisciplinary approach for closure and. Introduction a space between adjacent teeth is called a diastema. The preop retracted view revealed excellent tissue health and an ideal color. Midline diastema, dental spacing, etiology, treatment, relapse. Here, i shall explain midline diastema,its asthetic impacts and treatment. High attachment of labial frenum fold of the mucous membrane connecting the lip to upper jaw. Midline diastema causes and treatment options omilights. Midline diastema can be physiological, dentoalveolar, due to a missing tooth, due to peg lateral, midline supernumerary teeth, proclination of the upper labial segment, prominent frenum or due. Orthodontic treatment of a midline diastema the first step in interception treatment was to proper inform the patient and his parents the need of discontinuing the thumbsucking habit in order to reestablish the normal dental development.
Send your letters to the editor, british dental journal, 64 wimpole street, london, w1g 8ys. It has been reported that maxilla has a higher prevalence of midline diastema than mandible. Management of midline diastema linkedin slideshare. The prevalence of midline diastema is high in children and it decreases with age. Midline diastema case due to lingually displaced lateral incisor fig.
Jun 29, 2017 treatment modality, timing and retention protocol depends on the aetiology of the diastema. Apr 19, 2012 iatrogenic causes midline diastema can occur when certain theraputic procedures are undertaken. Feb 16, 2011 c abnormal labial frenum the presence of a thick and fleshy labial frenum can cause a midline diastema. Maxillary anterior spacing or diastema is a common aesthetic complaint of patients. A maxillary midline diastema mmd often is a primary concern of patients during a dental consultation. Apr 01, 2006 a 21yearold patient presented to the office with a small, 2mm midline diastema. Creating a waxup restoration previously to simulate the diastema closure and building a silicon matrix to guide final composite resin restoration are. A properly placed midline contributes to the desirable effect of balance and harmony of the dental composition. In adults, the prevalence of upper midline diastema is considered to range between 1.
James29 used a sample of 10 girls 1222 years old with medial diastema. So a modified resin bonded fixed partial denture was used. A 21yearold patient presented to the office with a small, 2mm midline diastema. Home about us subject areas contacts advanced search help. Although diastema doesnt have any adverse effects on ones health, most patients prefer to have it corrected for aesthetic purposes. Meticulous diagnosis and elimination of the etiology is the key to gaining a stable result.
Balk j stom, vol 16, 2012 the maxillary labial fraenum 143 midline diastema. Treatment objective the treatment objectives were to align the arches. Maxillary midline diastema is a common esthetic problem in mixed and permanent dentition. Many innovative therapies are available from restorative procedures such as composite buildup. Ideal treatment for a midline diastema is orthodontic or composite or veneers. Many treatment option were used such as orthodontic treatment, resinbased composite restorations, and veneers or crowns. Diastema closure using direct bonding restorations. Diastema closure using direct bonding restorations combined with orthodontic treatment. Policy on the management of the frenulum in pediatric dental. A multidisciplinary approach to the management of a maxillary midline diastema. Background a maxillary midline diastema mmd often is a primary concern of patients during a dental consultation.
Management of midline diastema using a new surgical technique i. Midline diastema has a multifactorial etiology suchas labialfrenulum,microdontia,mesiodens,pegshapedlateralincisors,agenesis,cysts,habits suchas ngersucking,tongue thrusting, or lip sucking, dental malformations, genetics, proclinations, dentalskeletal discrepancies, and imperfect coalescence. Management of midline diastema using a new surgical technique. It involves the installation of braces on the upper and lower teeth to pull the teeth together and close the space. The use of direct composite resin to close maxillary. Management of midline diastema using a new surgical. Case report when the midline diastema is not characteristic. Although an mmd can be transient owing to the developing dentition and, thus, requires no active treatment, management of mmds in the permanent dentition requires a detailed examination and appropriate care. The midline diastema has a multifactorial etiology. The maxillary labial fraenum a controversy of oral surgeons. Midline diastema is a well defined multifactorial clinical entity with several treatment options available for correction. Irrespective of the treatment alternative selected, permanent retention of stable results should be considered as a treatment objective. In wider diastemas this retention should be permanent.
The most recommended method for closing a diastema is orthodontic treatment. Creating a waxup restoration previously to simulate the diastema closure and building a silicon matrix to guide final composite resin restoration are a common method for this kind of cases 8, 22. Large spaces or other associated dental anomalies may require combination of treatment with braces followed by restorative treatment. During rapid maxillary expansion and it indicates the opening of intermaxillary suture with rapid expansion at the rate of 0. Combined treatment with orthodontic, restorative and oral surgery techniques may be advocated when, for example, tooth size discrepancies exist or supernumerary teeth are present. Another common cause of diastema is a high attached labial frenum. Aim the aim of this study was to evaluate spontaneous closure of the interincisive diastema in a group of patients, using a new surgical technique for the treatment of upper lip frenulum hypertrophy. A year after frenectomy, a reduction was noted in 8 cases. Midline diastema is common dental anomaly having multiple causes and various orthodontic and surgical options for management. However, several factors can cause a diastema that may require intervention. Lindsey1 conducted a study, the results of which showed that about twothirds of children in whom only central incisors had erupted exhibited an mmd. Creath, dmd, ms t he continuing presence of a diastema between the maxillary central incisors in adults often is considered an esthetic or malocclusion problem. Many innovative therapies are available from restorative procedures such as composite buildup to surgery frenectomies and orthodontics is available. In these cases retention planning plays an important role for the long term stability of the achieved goals.
The power chain is stretched from the mesial wing of one lateral incisor bracket through the brackets of the centrals to the mesial wing of the other lateral. A maxillary midline diastema associated with an enlarged frenum closed by orthodontic treatment involving a sectional arch wire and a power chain elastic. Treating a maxillary midline diastema in adult patients. It was reported that maxilla has a higher prevalence of midline diastema than mandible. Nov 17, 2017 midline diastema treatment composite sorabh kumar bansal. Pdf treating a maxillary midline diastema in adult. In this case report, oneyear recall of a midline diastema closure treatment by using direct composite resins was assessed. This article aims to determine and evaluate the aetiology and possible treatment options of midline diastema. He assumed that frenectomy leads to a reduction of the diastema. Midline diastema is a space between the central incisors. By the time researchers rejected this statement and proved that. Closing a diastema or a gap is an esthetically challenge for many clinicians.
Jan 06, 2016 in this case report, oneyear recall of a midline diastema closure treatment by using direct composite resins was assessed. Treatment options for the significant dental midline diastema michael r. Surgical removal of the mesiodens was then performed, and after 2 months the diastema had. This case report highlights an esthetic closing of a gap spacing between maxillay canine and lateral incisor teeth using metal ceramic crowns to. Habbit should be eliminated using fixes or removal habit breakers a diastema due to ugly duckling stage no treatment required b diastema due to imperfect fusion at midlineexcision of included interdental tissue between the incisors. If this tissue is short and too tight, it can result in the diastema. Direct midline diastema closure with composite layering. Management of midline diastema orthodontics dentistry. Midline diastema is defined as anterior midline spacing greater than 0.
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