Diastema is an abnormal position of the Central incisors, characterized by the presence of a free gap between them. The interdental gap in diastema can reach values from 1 to 10 mm (average 2-6 mm). The Biggest gap between teeth is up to 1 cm. 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 can also occur in the lower dentition. Diastema is often combined with other anomalies in the position, size and shape of the teeth and therefore requires a comprehensive approach to solving the problem from the therapeutic and surgical dentistry, orthodontics and orthopedics.
Causes of diastema
Analysis of clinical observations shows that the most common cause of the formation of diastema is heredity: in families with a genetic predisposition of about 50% of relatives have this defect of dentition.
A significant role in the appearance of the diastema is given to the anomalies of bridles, such as tongue-tie, low attachment of the frenulum of the upper lip, thick upper lip frenulum, etc. in addition, the diastema can occur in the presence of a supernumerary impacted teeth, partial or multiple edentulous, late eruption of permanent teeth, tumors of the jaws, cleft of the alveolar process.
Various bad habits (prolonged sucking nipples, biting pens, pencils and other objects, the habit of gnawing seeds, etc.) can cause not only diastema, but also the rotation of the Central incisors along the vertical axis.
Classification of diastema
First of all, there are false and true diastema. False diastema is characteristic for the period of change of temporary bite to permanent. This is a normal, natural condition for children. Usually, by the end of the change of teeth, the diastema closes itself. But if there is still a big gap between front teeth of the baby it’s time to contact a dentist. True diastema is observed in a constant bite and does not disappear without special dental care.
According to another classification, there are three types of diastema:
with a lateral slope of the crowns of the Central incisors; while the roots of the teeth are located correctly;
with lateral body displacement of Central incisors;
with medial deviation of crowns and lateral deviation of the roots of Central incisors.
For all types of diastema, the normal position of the cutter crowns (without turning on the axis), the rotation of the cutter crowns on the axis in the vestibular or oral direction can take place.
Symptoms of diastema
All forms of diastema are a defect of the dentition, expressed to some extent. However, some owners of diastema tend to consider it not an aesthetic disadvantage, but rather a certain “highlight” of appearance and do not see the need for dental care.
However, the interdental big gap between teeth is rarely relatively narrow and parallel. Much more often due to the deviation of the Central incisors, it has a triangular shape with a top facing the gum or the cutting edge of the teeth. In addition, diastema between teeth is often accompanied by a powerful frenulum of the upper lip.
Diagnosis of diastema
The presence of the patient’s diastema is detected during a visual examination of the oral cavity. However, to clarify the causes and type of diastema requires a number of additional diagnostic procedures: determination of bite, sighting radiography, taking casts, manufacture and study of diagnostic models of the jaws.
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 of diastema
Depending on the etiology and type of diastema treatment can be carried out using therapeutic, orthopedic, orthodontic, surgical methods, as well as their combination. Elimination of diastema by cosmetic restoration involves closing the interdental gap with the help of composite (straight) veneers made of light-curing composite directly in the dentist’s office in one visit.
Orthopedic method of elimination of the diastema is based on the use of the closure of the interdental gap porcelain veneers or fixed prosthesis (metal-ceramic, all-ceramic crowns).
If the causative factors of the diastema are anomalies in the shape and attachment of the frenulum, surgical treatment is carried out – plastic frenulum of the lips or tongue. In some cases, required the removal of impacted and dystopic teeth and subsequent orthodontic correction. Orthodontic method is the elimination of the diastema is the movement of the position of the cutters with the help of removable devices (vestibular plates) or fixed appliances (braces).
Prognosis and prevention of diastema
The variety of clinical forms of diastema dictates the need for an individual treatment plan in each case, a clear justification of the criteria for choosing the best methods and the sequence of treatment stages. This approach allows to achieve the optimal aesthetic results of the treatment of diastema, elimination of sound communication defects and psychological complexes.
The basic rules of prevention of diastema are reduced to the exclusion of harmful oral habits, elimination of concomitant maxillofacial anomalies, regular monitoring at the dentist.