Management of Midline Diastema: Presented By:-Sudha Roll No. 72

MANAGEMENT OF
MIDLINE DIASTEMA
Presented by:-
Sudha
Roll no. 72
CONTENTS,,
ETIOLOGY
DIAGNOSIS
INTRODUCTIO
N
CONCLUSION
MANAGEMEN
T
REFERENCES
ACTIVE
REMOVA TREATME RETENTI
L OF NT ON
CAUSE
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INTRODUCTION

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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.
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ETIOLOGY

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Main etiological factors are:-
TRANSIENT MALOCCLUSION
PROCLINATION
TOOTH MATERIAL-ARCH
LENGTH DESCREPENCY
MIDLINE PATHOLOGY
UNERUPTEC MESIODENS
IATROGENIC
ABNORMAL FRENAL
ATTACHMENT

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TRANSIENT
MALOCCLUSION
A midline spacing can occur during the
mixed dentition period associated with
the eruption of permanent canines .this
stage is called ugly duckling stage

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Ugly duckling stages

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Tooth material-arch length
descrepancy
A disparity in which the arch length exceeds
the tooth material can result in midline
diastema.
This includes conditions such as:-
missing teeth
microdontia
macrognathia
extraction ith resultant drifting of
adjacent teeth
Peg laterals and missing laterals can lead to
midline diastema

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Abnormal frenal attachment
The presence of thick and fleshy labial
frenum can give rise to midline
diastema.
This kind of frenal attachment prevents
the two central incisors from
approximating each other due to fibrous
connective tissue interposed between
them.

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Pressure habits
Habits such as thumb sucking ,tongue
thrusting also predispose to midline
diastema. These patient generally
present with proclination and
generalised anterior spacing.

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Midline pathology
Spacing in the midline can be caused by
soft tissue and hard tissue pathologies
such as cyst,tumour and odontomes.
Presence of an unerupted mesiodens
between the roots of the two central
incisor also predispode to midline
diastema.

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iatrogenic causes
Midline diastema can occur when certain
theraputic procedures are
undertaken.appearence of midline diastema is
an important prognostic signs.
During rapid maxillary expansion and it
indicates the opening of intermaxillary suture
with rapid expansion at the rate of 0.5 mm to 1
mm/day 1 mm or more of expansion is obtained
in two to three weeks.
A space is created at the midpalatal suture
which is filled initially by tissue fluid and
hemorrhage

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And the expansion is highly unstable .
This diastema closes as a result of
trans-septal fiber traction.

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RACIAL PREDISPODITON
The presence of midline spacing also
has a racial and familial backgrounds.
The negroid race shows the greatest
incidence of midline diastema.

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SLOW PALATAL EXPANSION
Approximately 0.5 mm per week is the

maximum rate at which the tissue of mid
palatal suture can adapt if a jackscrew
device attached to the teeth is activated
at the rate of 1 quarter turn of screw
every other day .
The ratio of dental to skeletal expansion
isabout 1 to 1 .tissue damage and the
hemorhage at the suture us minimised and
the large midline diastema never appeares
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DIAGNOSIS

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The proper history and clinical examination
should be done .
Measure the mesiodistal width of the teeth
which will help in determining the tooth
material arch length discrepancies.
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.
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Check for any pernicious oral habit.
Periapical radiograph- presence of
nothing in interdental bone is a
diagnostic of a thick and fleshy frenum.
Midline radiographs will help in
diagnosting midline pathology
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MANAGEMENT

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MANAGEMENT OF MIDLINE DIASTEMA
CAN BE DONE IN THREE PHASES:-
ACTIVE
TREATMENT
REMOVAL
OF CAUSE
RETENTION

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removal of cause
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.
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Active treatment
Removal Fixed appliance

appliances

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Removable appliance
Simple removable appliances are-
finger springs
labial bows
finger spring can be given to the
two central incisors
Split labial bow made up of 0.7 mm hard
stainless steel wire
in reciprocal tooth movement
the forces applied to teeth which is equal
and opposite as a resultant each unit to a
normal occlusion
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Hawleys appliance
A simple hawleys appliance incorporating
two springs distal to the central incisor
can close small diastemas in 3-6
months.the finger spring is made up of
0.5 or 0.6 mm diameter wire.

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Tretment of etiologic factor
s.no. Etiologic factor Timing of treatment treatment
1. Tongue thrust Start before continuing Tongue rake(fixed or

orthodontic treatment removable)
proper
2 Thumb sucking Start before continuing Tongue rake(fixed or
orthodontic treatment removable)
proper
3 High frenal attachment During treatment Frenectomy with or without
gingivoplasty
4 Peg shaped lateral After orthodontic Composite build up crowns
treatment or sometimes
before
5 Tooth material deficiency After orthodontic Vneers(porcelain/composite
treatment crowns)
6 supernumerary Before starting extract

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Missing lateral incisor After(copyright
orthodontic Implants crown/bridges29
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fixed appliance
Fixed appliances incorporating springs
or elastics bring about the most rapid
correction of midline diastema.
Elastic thread or elastic chain can be
used between the two central incisors
for the same purpose.
An alternative is to strech a closed coil
spring between the two central incisor.

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M shaped springs incorporating three
helices can be inserted into the two
central incisor brackets.
The springs are activated by closing the
helices

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ESSIX APPLIANCE
Presuming that the incisal spacing is not
due to forces induced by occlusion,the
essix tooth movement is unique
biomechanical system involving the use
of a removable appliance that is thin
,durable and particularly invisible.
Additionaly tooth movement is possible in
all plane of spaces.

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Technique
Section a canine to canine-essix appliance is
fabricated from 1 mm essix type C+ plastic.in
the diastema space
Place one half of the appliance on each side of
midline andextend each section 2-3 mm on to
the gingive
Place elastic attachment taps in the distal of
each section .
Attach a clear thin walled rubber band to taps
and strech it tightly across the diastema space
to create in a force about 150 gm to move
bodily

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The canine ,lateral incisor and central incisor or
each side of diastemas.
the patient wears the appliance full time with
the exception of cleaning and eating and
replaces the elastics everyday
The diastema space should be closed within 4-5
weeks .at that time the midline will be closed
but one half of that space will be distal to the
canines and the teeth can move back into it.
this redistributed space should be
filled with small composite thickness on the
mesial of the first bicuspid or distal of the
canine.

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RETENTION
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

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Hawleys retainer
They are the retainer that are bonded on
lingual aspect.stainless steel or blue elgiloy
wire is adapted lingually to follow the
anterior curvature the ends are curved
over the canines where it is bonded
Various prefabricated retainers are
available that can be bonded to the teeth
Minimal patient discomfort due to reduced
bulk
It is acceptable to most of the patient as
it is relatively inconspicious.
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fixed retainer
Indication for fixed retainer is a situation
where teeth must be permanently bonded
together to maintain the closure of a space
between them.
This encountered most commonly when
diastema between the maxillary central
incisior has been closed.
the best retainer for this purpose is a
bonded section of flexible wire.
The wire should be cntoured so that it lies
near the cingulum to keep it out of
occlusion

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An alternative of it ia a solid wire
configured to avoid the tooth contact to
fluctuate flossing which can incorporate
stops to prevent deepening of bite..

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ROLE OF COSMETIC
RESTORATION
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.

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PROSTHESIS OR CROWN
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.

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CONCLUSION
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.

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REFERENCES
Contemporary orthodontics-4th edition-
by:-William R Proffit,Henry W.Fields,David
M.Sarver
Orthodontics current principle techniques-
4th edition-by:-Thomas M. Graber,Robert
L. Vanarsdall,Katherine W.L.
Orthodontics The Art and Science-4th
edition by:-S.I.Bhalaji
Textbook of Orthodontics-2nd edition-by:-
Gurkeerat singh
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THANK YOU

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Management of Midline Diastema: Presented By:-Sudha Roll No. 72

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MANAGEMENT OF

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Approximately 0.5 mm per week is the

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Removal Fixed appliance

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1. Tongue thrust Start before continuing Tongue rake(fixed or

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midline diastema is considered as easy

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THUS THE TREATMENT OF MIDLINE

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