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Original Research

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Management of maxillary midline diastema with emphasis on etiology

  • Nikolaos Gkantidis1,*,
  • Olga-Elpis Kolokitha1
  • Nikolaos Topouzelis1

1Department of Orthodontics, School of Dentistry, University of Athens, Greece

DOI: 10.17796/jcpd.32.4.j087t33221771387 Vol.32,Issue 4,July 2008 pp.265-272

Published: 01 July 2008

*Corresponding Author(s): Nikolaos Gkantidis E-mail: ntopouz@dent.auth.gr

Abstract

The importance of the presence of a maxillary midline diastema resides in its position and the concern it causes to patients. This specific diastema has been attributed to genetic and environmental factors, even though it is often a normal feature of growth, especially in primary and mixed dentition.

The need for treatment is mainly attributed to esthetic and psychological reasons, rather than functional ones. Although it is often the case, treatment plans should not be selected empirically but rather should be based on adequate scientific documentation. Possible therapeutic approaches include orthodontics, restorative dentistry, surgery and various combinations of the above. The ideal treatment should seek to manage not only the diastema in question but also the cause behind it. Irrespective of the treatment alternative selected, permanent retention of stable results should be considered as a treatment objective.

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. Furthermore, alternative treatment options are discussed depending on the etiology of the problem.

Keywords

maxillary midline diastema, dental spacing, etiology, treatment, relapse

Cite and Share

Nikolaos Gkantidis,Olga-Elpis Kolokitha,Nikolaos Topouzelis. Management of maxillary midline diastema with emphasis on etiology. Journal of Clinical Pediatric Dentistry. 2008. 32(4);265-272.

References

1. Oesterle LJ, Shellhart WC. Maxillary midline diastemas: a look at the causes. J Am Dent Assoc, 130: 85–94, 1999.

2. Proffit W, Fields H. Contemporary Orthodontics. 3rd ed. Mosby, St. Louis, 77, 87, 170, 429–30, 463–65, 2000.

3. Gardiner JH. Midline spaces. Dent Pract Dent Rec 17: 287–298, 1967.

4. Bishara SE. Management of diastemas in orthodontics. Am J Orthod, 61: 55–63, 1972.

5. Richardson ER, Malhotra S∫, Henry M, Little RG, Coleman H. Biracial study of the maxillary midline diastema. Angle Orthod, 43: 438–443, 1973.

6. Huang WJ, Creath CJ. The midline diastema: a review of its etiology and treatment. Pediatr Dent, 17: 171–179, 1995.

7. Popovich F, Thompson GW, Main PA. The maxillary interincisal diastema and its relationship to the superior labial frenum and inter-maxillary suture. Angle Orthod, 47: 265–271, 1977a.

8. Weyman J. The incidence of median diastema during the eruption of the permanent teeth. Dent Pract Dent Rec, 17: 276–278, 1967.

9. Lavelle CL. The distribution of diastemas in different human population samples. Scand J Dent Res, 78: 530–534, 1970.

10. McVay TJ, Latta GH Jr. Incidence of the maxillary midline diastemas in adults. J Prosthet Dent, 52: 809–811, 1984.

11. Steigman S, Weissberg Y. Spaced dentition. An epidemiologic study. Angle Orthod, 55: 167–176, 1985.

12. Nainar SM, Gnanasundaram N. Incidence and etiology of midline diastema in a population in south India (Madras). Angle Orthod, 59: 277–282, 1989.

13. Brunelle JA, Bhat M, Lipton JA. Prevalence and distribution of selected occlusal characteristics in the US population, 1988–1991. J Dent Res, 75: 706–713, 1996.

14. Baum AT. The midline diastema. J Oral Med, 21: 30–39, 1966.

15. Becker A. The median diastema. Dent Clin North Am, 22: 685–710, 1978.

16. Schmitt E, Gillenwater JY, Kelly TE. An autosomal dominant syndrome of radial hypoplasia, triphalangeal thumbs, hypospadias, and maxillary diastema. Am J Med Genet, 13: 63–69, 1982.

17. Shashua D, Artun J. Relapse after orthodontic correction of maxillary median diastema: a follow-up evaluation of consecutive cases. Angle Orthod, 69: 257–263, 1999.

18. Gass JR, Valiathan M, Tiwari HK, Hans MG, Elston RC. Familial cor-relations and heritability of maxillary midline diastema. Am J Orthod Dentofac Orthop, 123: 35–39, 2003.

19. Moyers R. Handbook of Orthodontics. 4th ed. Year Book Medical Pub-lishers, Chicago, USA, 348–360, 1988.

20. Stubley R. The influence of transseptal fibers on incisor position and diastema formation. Am J Orthod, 70: 645–662, 1976.

21. Popovich F, Thompson GW. Maxillary diastema: indications for treat-ment. Am J Orthod, 75: 399–404, 1979.

22. Rahilly G, Crocker C. Pathological migration: an unusual cause of mid-line diastema. Dent Update, 30: 547–549, 2003.

23. Cirelli JA, Cirelli CC, Holzhausen M, Martins LP, Brandao CH. Com-bined periodontal, orthodontic, and restorative treatment of pathologic migration of anterior teeth: a case report. Int J Periodontics Restorative Dent, 26: 501–506, 2006.

24. Ferguson MW, Rix C. Pathogenesis of abnormal midline spacing of human central incisors. A histological study of the involvement of the labial frenum. Br Dent J, 154: 212–218, 1983.

25. Edwards JG. The diastema, the frenum, the frenectomy: a clinical study. Am J Orthod, 71: 489–508, 1977.

26. Edwards JG. Soft-tissue surgery to alleviate orthodontic relapse. Dent Clin North Am, 37: 205–225, 1993.

27. Lindsey D. The upper mid-line space and its relation to the labial frenum in children and in adults. A statistical evaluation. Br Dent J, 143: 327–332, 1977.

28. Konstantinidis A. Periodontology. Vol. 1. ∫Konstantinidis A, Thessaloniki, 77, 2003.

29. Popovich F, Thompson GW, Main PA. Persisting maxillary diastema: differential diagnosis and treatment. Dent J, 43: 330–333, 1977b.

30. Sullivan TC, Turpin DL, Artun J. A postretention study of patients pre-senting with maxillary median diastema. Angle Orthod, 66: 131–138, 1996.

31. Kraut R, Payne J. Osteotomy of intermaxillary suture for closure of median diastema. J Am Dent Assoc, 107: 760–761, 1983.

32. Proffit W, Fields H. Contemporary Orthodontics. 2nd ed. Mosby-Year Book, St. Louis; 128-129, 486, 1993.

33. Angle EH. Treatment of malocclusion of the teeth, 7th ed. S.S. White dental manufacturing. Co, Philadelphia; 167, 1907.

34. Sicher H. Oral Anatomy. 2nd ed. CV Mosby Company, St. Louis; 73–75, 1952.

35. Dewel BF. The labial frenum, midline diastema, and palatine papilla: a clinical analysis. Dent Clin North Am, 175–184, 1966.

36. Diaz-Pizan ME, Lagravere MO, Villena R. Midline diastema and frenum morphology in the primary dentition. J Dent Child, 73: 11–14, 2006.

37. Adams CP. The relation of spacing of the upper central incisors to abnor-mal labial frenum and other features of the dento-facial complex. Dent Pract Dent Rec, 74: 72–86, 1954.

38. Campbell PM, Moore JW, Matthews JL. Orthodontically corrected mid-line diastemas. A histologic study and surgical procedure. Am J Orthod, 67: 139–158, 1975.

39. Henry SW, Levin MP, Tsaknis PJ. Histologic features of the superior labial frenum. J Periodontol, 47: 25–28, 1976.

40. Scott JH, Symons NB. Introduction to dental anatomy. 7th ed. Churchill Livingstone, Edinburgh; 264, 1974.

41. Tait CW. The median frenum of the upper lip and its influence on the spacing of the upper central incisor teeth. Dent Cosmos, 76: 991–992, 1924.

42. Ceremelo PJ. The superior labial frenum and the midline diastema and their relation to growth and development of the oral structures. Am J Orthod, 39: 120–139, 1953.

43. Bergstrom K, Jensen R, Martensson B. The effect of superior labial frenectomy in cases with midline diastema. Am J Orthod, 63: 633–638, 1973.

44. Miller PD Jr. The frenectomy combined with a laterally positioned pedi-cle graft. Functional and esthetic considerations. J Periodontol, 56: 102–106, 1985.

45. Zachrisson BU. Orthodontics and periodontics In: Lindhe J, 3rd ed. Clinical periodontology and implant dentistry. Munksgaard, Copen-hagen, 741–793, 1997.

46. Finn SB. Clinical Pedodontics. WB Saunders, Philadelphia; 416–418, 1971.

47. Miller WB, McLendon WJ, Hines FB 3rd. Two treatment approaches for missing or peg-shaped maxillary lateral incisors: a case study on iden-tical twins. Am J Orthod Dentofac Orthop, 92: 249–256, 1987.

48. Thordarson A, Zachrisson BU, Mjor IA. Remodelling of canines to the shape of lateral incisors by grinding: a long-term clinical and radi-ographic evaluation. Am J Orthod Dentofac Orthop, 100: 123–132, 1991.

49. Millar BJ, Taylor NG. Lateral thinking: the management of missing maxillary lateral incisors. Br Dent J, 179: 99–106, 1995.

50. Kokich VO Jr, Kinzer GA. Managing congenitally missing lateral incisors. Part I: Canine substitution. J Esthet Restor Dent, 17: 5–10, 2005.

51. Kinzer GA, Kokich VO Jr. Managing congenitally missing lateral incisors. Part II: tooth-supported restorations. J Esthet Restor Dent, 17: 76–84, 2005a.

52. Kinzer GA, Kokich VO Jr Managing congenitally missing lateral incisors. Part III: single-tooth implants. J Esthet Restor Dent, 17: 202–210, 2005b.

53. Mason C, Rule DC. Midline supernumeraries: a family affair. Dent Update, 22: 34–35, 1995.

54. Tyrologou S, Koch G, Kurol J. Location, complications and treatment of mesiodentes—a retrospective study in children. Swed Dent J, 29: 1–9, 2005.

55. Tay F, Pang A, Yuen S. Unerupted maxillary anterior supernumerary teeth: report of 204 cases. J Dent Child, 51: 289–294, 1984.

56. Mucedero M, Ballanti F, De Toffol L. Supernumerary teeth and mental retardation: the importance of early surgical intervention. Eur J Paedi-atr Dent, 7: 45–49, 2006.

57. Fernandez Montenegro P, Valmaseda Castellon E, Berini Aytes L, Gay Escoda C. Retrospective study of 145 supernumerary teeth. Med Oral Patol Oral Cir Bucal, 11: E339–344, 2006.

58. Ooshima T, Ishida R, Mishima K, Sobue S. The prevalence of develop-mental anomalies of teeth and their association with tooth size in the primary and permanent dentitions of 1650 Japanese children. Int J Pae-diatr Dent, 6: 87–94, 1996.

59. Kokich VG, Spear FM. Guidelines for managing the orthodontic-restorative patient. Semin Orthod, 3: 3–201, 1997.

60. Proffit WR. Equilibrium theory revisited: Factors influencing position of the teeth. Angle Orthod, 48: 175–186, 1978.

61. Zachrisson BU. Use of self-ligating brackets, superelastic wires, expan-sion/proclination, and permanent retention—a word of caution. World J Orthod, 7: 198–206, 2006.

62. Mulligan TF. Diastema closure and long-term stability. J Clin Orthod, 37: 560–574, 2003.

63. Lang G, Alfter G, Goz G, Lang GH. Retention and stability—taking various treatment parameters into account. J Orofac Orthop, 63: 26–41, 2002.

64. Karaman AI, Polat O, Buyukyilmaz T. A practical method of fabricating a lingual retainer. Am J Orthod Dentofac Orthop, 124: 327–330, 2003.

65. Kokich VO, Kokich VG, Kiyak HA. Perceptions of dental professionals and laypersons to altered dental esthetics: asymmetric and symmetric situations. Am J Orthod Dentofac Orthop, 130: 141–151, 2006.

66. Bernabe E, Flores-Mir C. Influence of anterior occlusal characteristics on self-perceived dental appearance in young adults. Angle Orthod, 77: 831–836, 2007.

67. Campbell A, Kindelan J. Maxillary midline diastema: a case report involving a combined orthodontic/maxillofacial approach. J Orthod, 33: 22–27, 2006.

68. Redlich M, Galun EA, Zilberman Y. Orthodontic-prosthetic treatment to replace maxillary incisors exfoliated because of improper use of ortho-dontic elastics: a case report. Quintessence Int, 28: 241–244, 1997.

69. Nazarian A. Closing the gap with minimal preparation veneers. Dent Today, 25: 70–71, 2006.

70. Willhite C. Diastema closure with freehand composite: controlling emergence contour. Quintessence Int, 36: 138–140, 2005.

71. Peumans M, Van Meerbeek B, Lambrechts P, Vanherle G. The 5-year clinical performance of direct composite additions to correct tooth form and position. I. Esthetic qualities. Clin Oral Investig, 1: 12–18, 1997.

72. Beasley WK, Maskeroni AJ, Moon MG, Keating GV, Maxwell AW. The orthodontic and restorative treatment of a large diastema: a case report. Gen Dent, 52: 37–41, 2004.

73. Almog D, Sanchez Marin C, Proskin HM, Cohen MJ, Kyrkanides S, Malmstrom H. The effect of esthetic consultation methods on accep-tance of diastema-closure treatment plan: a pilot study. J Am Dent Assoc, 135: 875–881, 2004.

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