MAXILLARY MIDLINE DIASTEMAS: A LOOK AT THE CAUSES
LARRY J. OESTERLE, D.D.S., M.S.; WILLIAM CRAIG SHELLHART, D.D.S., M.S.
lowest incidence in A B S T R A C T or spacing, or dipeople of Chinese astemas, are a descent (1.7 perBackground. Maxillary midline diastemas are a comcommonesthetic cent).3 mon esthetic problem that dentists must treat. Many innovative complaint of paIn a study of therapies have been used, varying from restorative procedures to tients. Although a 5,307 patients, surgery (frenectomies) and orthodontics. At times, these procefew entertainment Richardson and dures have been performed by the dentist without full appreciacelebrities have colleagues4 found tionof the factors contributing to the diastemas. used a midline the incidence of Case Description. Before the practitioner can demaxillary diastema termine the optimal treatment, he or she must consider the conmaxillary midline as a successful diastemas to be tributing factors. These include normal growth and development, trademark, many higher in blacks tooth-size discrepancies, excessive incisorvertical overlap of difpeople find it esthan in whites and ferent causes, mesiodistal and labiolingual incisor angulation, thetically displeashigher in boys than generalized spacing and pathological conditions. A carefully deing. In fact, a rein girls of the same veloped differential diagnosis allows the practitioner to choose cent study race at age 14 the most effective orthodontic and/orrestorative treatment. involving European Clinical Implications. The differential diagnosis years. They found adults found that the incidence to be leads to a treatment approach that most effectively addresses the patients with a 26 percent in black patient’s problem. By treating the cause of the diastema, rather broad midline diboys, 19 percent in than just the space, the dentist enhances both thepatient’s denastema were perblack girls, 17 pertal function and appearance. ceived as being less cent in white boys socially successful and of lower intelligence.1 In and 12 percent in white girls. Keene’s study of that study, maxillary anterior spacing was equal 183 white male Navy recruits found that 8 perto crowding and even more of an esthetic liability cent of them had diastemas greater than 0.5milthan excessive overjet or protruding incisors. limeters.5 The esthetic importance of maxillary anterior Another study of nearly 10,000 patients in South spacing varies both culturally and racially as well India, however, found an incidence of only 1.6 peras with the incidence of diastemas within a given cent.6 It is clear that the incidence of midline dipopulation. The incidence of diastemas variesastemas varies greatly with the population and age greatly with age and race. In 5-year-olds, the incigroup studied, but diastemas are a significant maldence has been reported to be as high as 97 perocclusion factor in some population groups. cent,2 with the incidence decreasing with age. A Maxillary midline diastemas generally have study from Great Britain reported a higher incibeen studied bylumping them into one large dence of maxillary midline diastemas in blacks group, with little consideration given to the con(5.5 percent) than in whites (3.4 percent), and the tributing factors. However, not all maxillary midJADA, Vol. 130, January 1999 Copyright ©1998-2001 American Dental Association. All rights reserved. 85
determine changes in theincidence of maxillary midline diastemas. Eighty-three percent of the patients with a diastema at 9 years of age had no diastema at 16 years of age, without having undergone any treatment. In the approximately 10 percent of the sample with persistent diastemas, generalized spacing or an initial midline diastema larger than 3 mm was present. As the above studies found, the great majority of diastemas...