More and more dental patients are concerned about their appearance, particularly their smile. This has led to an increased demand for aesthetic dentistry procedures that are minimally invasive. One common issue that dental professionals encounter is the presence of a gap between teeth, known as a diastema.
There are different treatment options available for diastema closure, including keeping the gap as is, using orthodontic treatment to move the teeth and close the gap, placing porcelain veneers or crowns, or using restorative materials to close the gap after addressing any underlying issues.
The choice of treatment depends on factors such as the specific case, patient preferences, and the expertise of the dental professional. Your dentist or orthodontist must consider various factors that contributed to the development of the diastema, including:
- Normal growth and development
- Differences in tooth sizes
- Excessive overlap of the front teeth
- The angulation of the teeth
- Spacing between teeth, and
- Any underlying dental conditions.
To make an accurate diagnosis and choose the most effective treatment, your dentist will have to examine your teeth using X-rays and perform a clinical evaluation. They may also evaluate the size of your teeth to better understand the cause of the diastema.
How common are diastemas?
Midline diastema, or a space between adjacent teeth, is a normal or developmental occurrence that affects 98% of 6 year olds, due to factors such as tooth position, eruption path, jaw size, and facial musculature.
Over time, natural forces, including tooth eruption, migration, and muscle development, contribute to the closure of midline dental spaces, reducing the incidence of diastemas to 49% by the age of 11 years, and 7% by the age of 18 years.
Decades ago, dentists recommended that adults who still had a gap between their front teeth to opt for frenectomy, which involves removing or modifying the frenum to enhance the natural forces influencing closure of the midline dental space.
However, dental professionals nowadays tend to address the midline dental space without the need for frenectomy in most cases. Though orthodontic treatment options also have certain limitations such as time and cost constraints.
Today, gaps between front teeth can be successfully treated using various options, including composite resin restorations, dental crowns, and porcelain laminate veneers.
But before closing the diastema through any technique, it’s important to understand the cause of the gap, in order to plan the right treatment accordingly. Restoring the tooth with composite resin is the least invasive, economical, and aesthetic option that can be done in a single visit as compared to the alternative treatment options.
Causes of Diastemas
Although diastemas are a natural occurrence, there are various contributing factors:
- Genetic: Some individuals may have a natural predisposition to develop midline spacing between their teeth due to their racial or familial background.
- Physiological: It is common for children to have midline diastemas during the eruption of their permanent upper front teeth (central incisors). Initially, the teeth may be separated by bone, and the crowns may tilt backward due to crowding of the roots. However, as the lateral incisors and canines erupt, the midline diastema typically reduces or closes.
- Supernumerary Teeth: The presence of extra teeth (supernumerary teeth) can affect the normal development of the dental arch and occlusion. Patients with supernumerary teeth may experience delayed or failed eruption of permanent teeth, and certain types of supernumeraries can cause displacement of the permanent incisors, including midline diastema.
- Abnormal Frenum: In some cases, a thick band of fibrous tissue called the labial frenum can insert into the notch in the upper jawbone, resulting in a midline diastema. This abnormal frenum can be identified through a simple blanching test where pressure is applied intermittently to observe tissue attachment.
- Tooth Material-Arch Length Discrepancy: Conditions such as missing teeth, unusually small teeth (microdontia), peg-shaped lateral incisors, or a larger jaw (macrognathia) can create extra space in the dental arch. This additional space can cause the front teeth to move apart and result in a diastema.
- Habits: Certain habits like thumb sucking or tongue thrusting can lead to teeth protrusion, which can contribute to midline diastema and generalized spacing between the teeth.
- Midline Pathology: Pathological conditions affecting the soft tissue or hard tissue in the midline area, such as cysts, tumors, or odontomes, can cause midline diastema.
- Iatrogenic: In some cases, orthodontic treatments like rapid maxillary expansion (a procedure to widen the upper jaw) can inadvertently lead to midline diastema due to the opening of the intermaxillary suture.
- Imperfect Fusion: According to Moyers, imperfect fusion at the midline of the premaxilla (the front part of the upper jaw) is a common cause of maxillary midline diastema. Radiographically, this fusion is typically seen as a V-shaped structure.
These various factors can contribute to the development of diastemas, and understanding the underlying cause is essential in determining the most appropriate treatment approach.
Should I seek treatment for diastema?
The treatment for a diastema depends on its underlying cause. In some cases, no treatment is necessary, especially if the gap is a normal part of a child’s growth and is expected to close naturally once the permanent canines erupt. Typically, a childhood diastema that is 2mm wide or less has a higher chance of closing on its own.
However, if the diastema is caused by factors such as extra teeth or abnormalities in the soft tissue of the mouth, surgical removal of the extra teeth or correction of the soft tissue may be required.
Additionally, orthodontic treatment, such as braces, may be used to close the gap between the teeth.
It is also important to address any oral habits, like thumb sucking or tongue thrusting, before closing the gap to ensure successful treatment.
Choosing the right treatment for diastema
When it comes to achieving natural-looking diastema closure, your dentist or orthodontist will follow certain guidelines, including consideration of the anatomical characteristics of the teeth, such as the position and width of each lobe, and the proportionate dimensions of the teeth.
The objective is to create a harmonious and balanced appearance while ensuring proper occlusion (bite) and avoiding any negative impact on the surrounding tissues.
1. Orthodontic treatment for large gaps
The size of the diastema can vary, and it may affect the choice of treatment. For larger gaps, orthodontic treatment like braces or Invisalign may be recommended to gradually move teeth.
Orthodontic treatment for diastema begins with a comprehensive evaluation by an orthodontist. The treatment plan aims to address the underlying causes of diastema by properly aligning the teeth and improving overall bite and occlusion. It provides a long-lasting and stable solution, as the results are achieved through controlled tooth movement.
However, orthodontic treatment can be time-consuming, typically taking months or even years to complete. It also requires regular maintenance and follow-up visits, all of which make it very expensive.
2. Direct composite resin bonding
If the teeth are already properly aligned, no preparation of the tooth structure is needed. In such cases, direct composite resin bonding can be an ideal solution. Composite resin is a durable material that closely mimics natural tooth structure and can be polished to achieve a seamless appearance.
Direct bonding offers immediate results and can significantly improve the appearance of diastema in just one dental visit. The resin material used is color-matched to blend seamlessly with the natural teeth, providing a natural-looking result. It is a relatively non-invasive and reversible procedure, as the bonding material can be removed or replaced if necessary.
However, it’s important to note that bonding may not be as long-lasting as other treatment options, and the material may be prone to staining or chipping over time.
3. Dental Crowns
Dental crowns, also known as dental caps, are custom-made restorations that cover the entire tooth surface. They are typically made of materials like porcelain, ceramic, or metal alloys. Crowns can be used to reshape and close the gap between teeth by covering the natural teeth entirely.
The process of getting dental crowns usually involves multiple dental visits. During the initial visit, the dentist prepares the teeth by removing a portion of the enamel to make space for the crown. An impression of the prepared teeth is taken and sent to a dental laboratory, where the crown is fabricated. Temporary crowns may be placed while waiting for the permanent ones. In a subsequent visit, the permanent crowns are cemented onto the teeth.
Dental crowns can provide excellent aesthetics, as they can be customized in terms of shape, size, and color to match the surrounding teeth. They are highly durable and can withstand biting forces. However, the preparation of natural teeth for crowns is irreversible, meaning that a significant portion of the tooth structure is removed to accommodate the crown.
4. Dental Veneers
Veneers are thin shells, usually made of porcelain or composite resin that are bonded to the front surface of the teeth. They are primarily used to improve the appearance of teeth by addressing issues such as gaps, discoloration, and minor misalignment.
Getting dental veneers also involves several dental visits. Initially, the dentist prepares the teeth by removing a small amount of enamel from the front surface. An impression of the prepared teeth is taken, and the veneers are fabricated in a dental laboratory. Temporary veneers may be placed while waiting for the permanent ones. In a subsequent visit, the permanent veneers are bonded to the teeth using dental cement.
Dental veneers provide natural-looking aesthetics and can be customized to achieve the desired shape, size, and color. Compared to crowns, veneers require less tooth preparation, preserving more of the natural tooth structure. However, it’s important to note that veneers are not as strong as crowns and may be more prone to chipping or fracture.
Final thoughts
In terms of cost, dental crowns and veneers are generally more expensive than dental bonding. The costs may vary depending on factors such as the type of material used, the number of teeth treated, and the location of the dental practice. Though orthodontic treatment is the most expensive and time consuming treatment option, but also with the greatest durability.
It’s essential to consult with a dentist to determine the most suitable treatment option for your specific case. They will consider factors such as the size of the gsp, specific cause of the diastema, the condition of your teeth, your oral health, and your aesthetic goals to recommend the most appropriate treatment option for you.
