Diastema is a visible interdental gap separating the central incisors of the upper (less often – lower) dentition. Pathology is not only an aesthetic disadvantage, but also contributes to speech disorders, the emergence of communicative and psychological difficulties. Clarification of the causes and accompanying anomalies is carried out with the help of dental examination, intraoral radiography, orthopantomography, the study of diagnostic models of the jaws. Treatment can be carried out by therapeutic (aesthetic restoration), orthopedic (crowns, veneers), surgical (plastic frenulum of the upper lip or tongue), orthodontic (vestibular plates, braces) methods.
Meaning
Diastema is an abnormal position of the central incisors, characterized by the presence of a free gap between them. The interdental gap can reach a value from 1 to 10 mm (on average 2-6 mm). Diastema is one of the most frequent dental deformities, which occurs in about 8-20% of the population. In most cases, the interdental gap is located between the upper incisors, but it can also occur in the lower dentition. Disease is often combined with other anomalies of the position, size and shape of teeth and therefore requires a comprehensive approach to solving the problem from the side of therapeutic and surgical dentistry, orthodontics and orthopedics.
Causes
Analysis of clinical observations shows that the most common cause of the formation is heredity: in families with a genetic predisposition, about 50% of relatives have this defect of dentition.
A significant role in the appearance of diastema is assigned to the anomalies of the frenulum, such as a short frenulum of the tongue, low attachment of the frenulum of the upper lip, massive frenulum of the upper lip, etc. In addition, diastema can occur in the presence of overcomplicated retinated teeth, microdentia, partial or multiple adentia, late eruption of permanent teeth, jaw tumors (odontoma), cleft of the alveolar process.
Various bad habits (prolonged nipple sucking, biting pens, pencils and other objects, onychophagia, the habit of gnawing seeds, etc.) can cause not only diastema, but also the rotation of the central incisors along the vertical axis.
Classification
First of all, there are false and true diastema. False diastema is characteristic of the period of changing the temporary bite to a permanent one. This is a normal, natural condition for children. Usually, by the end of the tooth change, the diastema closes on its own. True diastema is observed in a constant bite and does not disappear without special dental care.
Taking into account the location of the interdental gap relative to the mid-sagittal plane, the diastema can be symmetrical and asymmetric. With a symmetrical type of diastema, both central incisors are displaced laterally by the same distance; with an asymmetric one, one incisor is located normally, and the other is significantly displaced in the lateral position.
According to another classification, there are three types of diastema:
- with a lateral inclination of the crowns of the central incisors; at the same time, the roots of the teeth are located correctly;
- with lateral body displacement of the central incisors;
- with medial deviation of the crowns and lateral deviation of the roots of the central incisors.
With all types of diastema, there may be a normal position of the incisor crowns (without rotation along the axis), rotation of the incisor crowns along the axis in the vestibular or oral direction.
Symptoms
All forms of diastema are a defect of the dentition, expressed to one degree or another. However, some owners of diastema tend to consider it not an aesthetic flaw, but rather a kind of “highlight” of appearance and do not see the need for dental care.
However, the interdental gap between the central incisors is rarely relatively narrow and parallel. Much more often, due to the deviation of the central incisors, it has a triangular shape with a vertex facing the gum or the cutting edge of the teeth. In addition, diastema is often accompanied by a powerful frenulum of the upper lip, the fibers of which are attached to the crest of the alveolar process and are woven into the incisor papilla, as well as dental anomalies (tremors, microdentia, adentia, rotation of the incisors along the axis), malocclusion (distal, mesial, open, deep, cross). Therefore, many people with diastema experience psychological and physical discomfort, are embarrassed by their appearance and smile. The presence of diastema favors the development of periodontitis in the area of the frontal teeth.
Diastema can be accompanied by a violation of sound reproduction (mechanical dyslalia) – whistling, lisp, which in turn creates difficulties in speech communication, limits the choice of the field of professional activity and requires the help of not only a dentist, but also a speech therapist.
Diagnostics
The presence of diastema in the patient is detected during a visual examination of the oral cavity. Nevertheless, to clarify the causes and type of diastema, a number of additional diagnostic procedures are required: bite detection, targeted radiography, orthopantomography, taking casts, manufacturing and studying diagnostic models of jaws. When analyzing the data, the position, shape, inclination of the incisors and roots are taken into account; the condition of the bridles; the size of the interdental gap and the symmetry of the diastema; the nature of the bite, the presence of retinated teeth, etc.
The problem of choosing the optimal method of eliminating diastema should be solved collectively, with the involvement of various specialists: dentists, therapists, surgeons, orthodontists, orthopedists.
Treatment
Depending on the etiology and type of diastema, treatment can be carried out using therapeutic, orthopedic, orthodontic, surgical methods, as well as their combinations. The elimination of diastema by the method of cosmetic restoration involves closing the interdental gap with the help of composite (straight) veneers made of light-cured composite directly in the dentist’s office in one visit.
The orthopedic method of eliminating diastema is based on the use of ceramic veneers or fixed prostheses (artificial metalacrylic, metal-ceramic, all-ceramic crowns) to close the interdental gap.
If the causative factors of diastema are anomalies of the shape and attachment of the bridles, surgical treatment is performed – plastic surgery of the frenulum of the lips or tongue. In some cases, removal of retinated and dystopian teeth, inter-root compactosteotomy with subsequent orthodontic correction is required. The orthodontic method of eliminating diastema consists in moving the position of the incisors using removable devices (vestibular plates) or non-removable equipment (braces).
Prognosis and prevention
The variety of clinical forms of diastema dictates the need to draw up an individual treatment plan in each case, a clear justification of the criteria for choosing optimal methods and the sequence of treatment stages. This approach allows to achieve optimal aesthetic results of treatment of diastema, elimination of disadvantages of sound reproduction and psychological complexes.
The basic rules for the prevention of diastema are reduced to the exclusion of harmful oral habits, the elimination of concomitant maxillofacial anomalies, regular follow-up at the dentist.
Literature
- Bagga S., Bhat K. M., Bhat G. S., Thomas B. S. Esthetic management of the upper labial frenum: a novel frenectomy technique // Quintessence International. — 2006; 37 (10): 819-823.link
- Attia Y. Midline diastemas: closure and stability // Angle Orthod. — 1993; 63 (3): 209-212.link
- Bhattacharya P., Raju P. S., Bajpai A. Prognosis v/s etiology: midline papilla reconstruction after closure of median diastema // Ann Essences Dent. — 2011; 3 (1): 37-40.
- Bednarz W., Bednarz B. Zabieg frenulektomii częścią periodontologiczno-ortodontycznego leczenia diastemy prawdziwej // Mag Stomatol. — 2014; 24: 20-26.
- Díaz-Pizán M. E., Lagravère M. O., Villena R. Midline diastema and frenum morphology in the primary dentition // J Dent Child (Chic). — 2006; 73 (1): 11-14.link
- Hussaina U., Ali Ayubb A., Farhanc M.. Etiology and treatment of midline diastema: A review of literature // POJ. — 2013: 5 (1): 27-33.
