Midline diastema is a gap or space between the maxillary or mandibular incisors caused due to malocclusion. The condition is common in young children and is also known as the ugly duckling stage. Midline diastema is a self-correcting condition; therefore, it is not a reason to worry. However, children's midline diastema of more than 2.7 mm needs orthodontic treatment, and the situation can be managed clinically. The orthodontic procedure for midline diastema usually starts after the eruption of permanent canines. Still, the dentist may start treatment early in some instances due to the large midline space.
The common causes of midline diastema include:
- Hereditary.
- Racial.
- Microdontia.
- Macrognathia.
- Spacing between the teeth.
- Congenitally missing tooth.
- Tooth extraction.
- Increased overjet and overbite.
- Tongue thrusting.
- Thumb sucking.
- Midline cystic lesion.
- Peg laterals.
- Physiological spacing between the deciduous tooth.
- Ectopic tooth eruption.
- Palatal eruption of lateral incisors.
- Retained deciduous teeth.
- Iatrogenic cause - rapid palate expansion.
- Abnormal labial frenum.
- Transient malocclusion or ugly duckling stage.
- Initial diagnosis involves proper case history and clinical examination of the person or child.
- A Blanch test is done to diagnose the fleshy labial frenum. In this test, the upper lip is pulled outward to check the presence of a fleshy and thick frenum by blanching the tissues in the incisive papilla region, palatal to the central incisors.
- Tooth material arch-length discrepancy, which is the primary cause of midline diastema, is also determined through model analysis.
- Radiographical X-rays also show notching in the interdental alveolar bone. This confirms the presence of a thick fleshy frenum. Midline radiographs are, therefore, essential tools for diagnosing midline diastema.
Treatment of midline diastema is done in three stages:
- Removal of Causes - This is essential before starting any procedure to prevent treatment failure. These may include surgical removal of the fleshy and thick frenum, extraction of supernumerary or ectopic teeth, and removal of cystic lesions. Etiological factors and their treatment include:
- Supernumerary Tooth - Tooth extraction.
- Missing Later Incisors - Crowns and Bridges.
- Thumb Sucking - Removal or fixed appliances with tongue rake.
- Thumb Thrust - Removal or fixed orthodontic appliances with tongue rake.
- Microdontia or Peg Laterals - Composite build-ups over crowns.
- Abnormal Frenum Attachment - Frenectomy.
2. Active Treatment - The doctor can treat Midline diastema with fixed or removable orthodontic appliances.
- Fixed Appliances - Attach buccal tube or brackets, band maxillary central incisors, and Pin and tube appliances.
- Removable Orthodontic Appliances - The orthodontist uses finger springs with a labial bow and finger springs.
3. Retention - Midline diastema is not easy to retain; therefore, removing etiological factors is essential to a successful treatment plan. Some orthodontic surgeons use retainers for long-term retention, such as Hawley’s retainer and banded retainers.