This report, prepared by the student at the College of Dentistry, Hassan Atheed , in the third phase discusses scientific topics, but it maybe did not be 100% complete. Diastema, which means interval in Greek, is a gap or space between two or more consecutive teeth. It occurs more frequently in the median plane of the maxillary arch between the two central incisors and hence called the median, central or midline diastema.[1,2]Maxillary midline diastemas are an aesthetic concern for many patients and their parents. The diastema seen in many children as part of normal development in the mixed dentition, disappears naturally in most cases as dental development proceeds.It may however persist either because of its width or other associated factors. If it is to be closed satisfactorily by orthodontics an understanding of the aetiology is essential. حسن عضيد

1. Hassan Atheed Habeeb
3rd Stage
Supervised By
Dr.Yasir Alnakib
Diastema Closure
Operative Report
University of Al-Ameed
College of Dentistry

2. Introduction
Diastema, which means interval in Greek, is a gap or space between two or more consecutive
teeth. It occurs more frequently in the median plane of the maxillary arch between the two
central incisors and hence called the median, central or midline diastema.[1,2]Maxillary midline
diastemas are an aesthetic concern for many patients and their parents. The diastema seen in
many children as part of normal development in the mixed dentition, disappears naturally in
most cases as dental development proceeds.It may however persist either because of its width
or other associated factors. If it is to be closed satisfactorily by orthodontics an understanding of
the aetiology is essential.
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.
CAUSES OF MIDLINE DIASTEMA
1) Transient Malocclusion A midline spacing can occur during the mixed dentition period associated
with the eruption of permanent canines.
2) Tooth material arch length discrepancy: Conditions such as missing teeth.
3) Unerupted Mesiodens: between the two central incisors also predispose to midline diastema.
4) Abnormal frenal attachment.
5) Proclination result of habits such as thumb sucking or tongue thrusting.
6) Midline Pathology: Soft tissue and hard tissue pathologies such as cysts,tumors.
7) latrogenic cause: Midline diastema can occur when certain therapeutic procedures such as rapid
maxillary expansion are undertaken.
8) Racial predisposition.
9) Ectopic maxillary canines.
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3. Treatment of diastemas in permanent dentition
There are several approaches used in the treatment of anterosuperior diastema,
which vary according to the present etiologic factor ،The success of such treatment
will depend on the elimination of these factors.
1) Orthodontic treatment
The orthodontic approach can be performed with the following objective: close the
diastema or redistribute the spaces for a posterior reanatomization of the anterior
teeth. Orthodontic treatment also has the function of treating, if present, any other
associated occlusal problem and helping in the elimination of parafunctional habits.
In cases where there is discrepancy of dental size, orthodontic treatment alone is
not able to offer the best results. Therefore, these diastemas must be closed by
means of composites, facets, or prosthetic crowns. However, for a better esthetic
result of these restorations, orthodontic movement is indicated to redistribute the
spaces before the cosmetic procedure.
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4. 2) Frenectomies
Labial frenulum is considered abnormal when it is enlarged and/or inserted near
the gingival margin . Some authors recommend frenectomy to be performed after
orthodontic closure of space, since diastema closure and interdental papilla
compression may act as a stimulus to promote atrophy of the fibrous tissue
interposed between the incisors.
3) Restorative treatment
Peck and Peck stated that teeth are, by nature, perfect structures. However, a tooth
with altered anatomy can often form a malocclusion. For the authors, the
orthodontist should increase their understanding of the limitations of orthodontic
therapy, and know the value of procedures to change dental forms. Only in this way
can treatment success be achieved.
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Befor After

5. spaces between teeth due to discrepancy of tooth size, where there are small
teeth, orthodontic correction is contraindicated, and recommend the restoration
of these teeth with composites ،orthodontic treatment may be an auxiliary tool to
redistribute the spaces between the teeth before the restorative procedure. This
allows the dentition in the anterior teeth to be performed according to the golden
ratio, obtaining a better esthetic result.
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6. 4) Other types of treatments
Bell argued for the immediate closure of diastema by subapical and interdental
osteotomy, justifying that there is a great unpredictability of diastole orthodontic
closure stability and that this approach is difficult and takes a long time. In addition,
the author believes that the alveolar bone is the major factor responsible for the
difficulty in the orthodontic movement of the teeth and for the final stability, as
opposed to the majority of authors who consider the labial frenulum and adjacent
soft tissues as the main factor for relapse.
Refrances
• IOSR Journal of Dental and Medical Sciences (Maxillary Midline Diastema –
Aetiology And Orthodontic Treatment- Clinical Review ) ( 116-130)
• Stability of Diastemas Closure after Orthodontic Treatment By Marcos Jimmy
Honores Submitted: April 9th 2018 Reviewed: November 11th 2018
Published: April 10th 2019
• The study published by American Academy of Cosmetic Dentistry entitled
(Six Steps to Consider When Closing Diastemas)
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