Presented by:

Dr. Hitesh Chopra

Consultant Cosmetic Surgeon and
Endodontist

INTRODUCT
ION
ETIOLOGY
DIAGNOSIS
MANAGEME
NT
CONCLUSIO
N
REFERENCE
S
REMOV
AL OF
CAUSE
ACTIVE
TREAT
MENT
RETENT
ION


INTRODUCTION
The term midline diastema refers to any
spacing or gaps existing in midline of the dental
arch.
It is generally used in reference to maxillary
arch,even tough midline spacing is present in
the mandibular arch.
Maxillary midline diastema are one of the most
common problems encountered.
It has been defined as a space greater than 0.5
mm between proximal surfaces of adjacent
teeth
It is easy to treat but difficult to retain.

ETIOLOGY
Main etiological factors are:-
TRANSIENT
MALOCCLUSION
TOOTH MATERIAL-ARCH
LENGTH DESCREPENCY
ABNORMAL FRENAL
ATTACHMENT
PRESSURE HABITS
MIDLINE PATHOLOGY
IATROGENIC
RACIAL PREDISPOSITION
DIAGNOSIS
1. The proper history and clinical examination should
be done .

2. Measure the mesiodistal width of the teeth
which will help in determining the tooth material
arch length discrepancies.

3. BLANCH TEST- lift the upper lip and pull in
outward and look for blanching of the soft tissue
lingual to and between two central incisors.
presence of blanch
indicates high frenal
attachment as cause of
midline diastema.
4. Check for any oral habit.

5. Periapical radiograph- presence of nothing in
interdental bone is a diagnostic of a thick and
fleshy frenum.
MANAGEMENT
RETENTION
REMOVAL
OF CAUSE
TREATMENT
First phase involves the removal of etiology.
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. a flap is raised
interdentally and fissure inserted gently into
the cleft.with the bur the included tissue are
removed and flap situated.
12
Esthetic
Rehabilitation
ACTIVE Tx
Removal
appliances
PASSIVE Tx
Fixed
appliance
Most orthodontist recomends long term
retention using suitable retainers since

midline diastema is considered as easy to
treat but difficult to retain
Prolonged retention is indicated in lingual bonded
retainer
Esthetic composite resins generally used to
close midline diastema specially in adult
patients.

it requires a gradual composite build up on the
mesial surface and stripping of distal surface
of central incisors and lateral incisors in order
to achieve a natural shape and size of the
teeth.
Presence of peg shaped lateral or teeth with
other anomalies of shape and size require
prosthetic rehabilitation.
missing teeth should be replaced
with fixed or removable prosthesis.
THUS THE TREATMENT OF MIDLINE
DIASTEMA WILL IMPROVE THE ESTHETICS
OF THE PERSON
IT WILL HELP IN NORMAL ALIGNMENT OF
TEETH WHICH WILL CONTRIBUTE TO THE
ORAL HEALTH BUT ALSO GOES A LONG
WAY IN THE OVERALL WELL BEING AND
PERSONALITY OF AN INDIVIDUAL.
Contemporary orthodontics-4
th
edition-by:-
William R Proffit,Henry W.Fields,David
M.Sarver
Orthodontics current principle techniques-4
th

edition-by:-Thomas M. Graber,Robert L.
Vanarsdall,Katherine W.L.
Orthodontics The Art and Science-4
th
edition
by:-S.I.Bhalaji
Textbook of Orthodontics-2
nd
edition-by:-
Gurkeerat singh


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