Treatment of diastema (gap between teeth)

What is Diastema?

Diastema is a misalignment of the front teeth where a gap of 1 to 5 mm forms between their lateral surfaces on the upper or lower jaw. Usually, this defect does not affect proper speech or chewing, but in some cases, it causes significant aesthetic difficulties and psychological discomfort.

Causes of Diastema

Diastema is an anomaly characterised by a gap between the central incisors. The width of this gap in the upper and lower jaws can range from 1 to 5 mm. The incidence of diastema among all dental anomalies is between 7% and 19%. Although this condition does not interfere with normal chewing, it can affect speech clarity (causing lisps or whistling sounds when pronouncing consonants), which creates some discomfort. Moreover, diastema can destabilize the dental arch and contribute to the development of periodontal diseases.

Main causes of the gap between teeth include:

• Short and thick upper lip frenulum
• Wide palatine suture
• Significant thickening of the bone tissue in the median interalveolar septum
• Presence of retained teeth (teeth that have not fully erupted), supernumerary teeth near the central incisors
• Missing lateral teeth (one or two)
• Late removal of primary teeth
• Partial adentia (absence of some or all teeth)
• Mismatch in the size of teeth and jaws
• Hereditary predisposition

Diastema can appear in both baby and permanent teeth.

Types and Characteristics of Diastema

Diastema, or gap between teeth, can vary depending on shape, location, and pathology of surrounding tissues or root areas. Main types include:

• False Diastema - a temporary gap between the front primary incisors during jaw growth. This gap is normal due to the smaller size of baby teeth and usually disappears with the eruption of permanent teeth. However, sometimes it persists, so regular preventive check-ups are important for timely detection and correction.
• True Diastema - a permanent gap between the front teeth remaining after full bite formation. If untreated, it can cause aesthetic problems, speech impairments, and psychological distress. True diastema may also lead to serious dental complications.
• Symmetrical Diastema - a gap between the front teeth that is equal on both sides of the midline of the jaw.
• Asymmetrical Diastema - one tooth is correctly positioned, while the other is shifted to the side, often creating a triangular-shaped gap.
• Physiological Diastema - a gap appearing naturally during jaw growth.
• Pathological Diastema - develops due to gum disease or bone tissue atrophy, causing a gap between front teeth in an already formed bite.
• Lateral Crown Deviation - crowns of teeth shift sideways while roots remain correctly positioned. Often caused by supernumerary teeth or harmful habits, it can lead to aesthetic and functional defects, and faster enamel wear.
• Corpus Lateral Displacement - displacement of both crowns and roots, often due to congenital adentia, improper frenulum attachment, or thickening of the palatine suture.
• Medial Tilt of Central Incisors - a complex form where teeth shift relative to each other with simultaneous vertical rotation.

Each type is treated differently, and only a dentist can assess the severity and prescribe the most effective treatment.

Methods of Treating Diastema

Diastema diagnosis involves a visual examination where the doctor assesses the attachment of the upper lip frenulum, tongue, palate shape, dental arches, their occlusion, tooth size and shape, alveolar bone position, and available space.

For more precise evaluation, X-rays are typically done to determine the position of central incisors, roots, crowns, width and density of the interalveolar septum, and presence of supernumerary teeth. Additional exams like panoramic X-rays, dental impressions, or 3D modeling may be needed. Untreated diastema can lead not only to aesthetic defects but also speech difficulties and increased risk of caries.

Treatment Options

Surgical Treatment

The type of surgery depends on the cause and type of diastema and aims to improve the dental system. Surgery often shortens orthodontic treatment duration (2 to 4 years) and stimulates self-correction of the gap. Surgical options include:

• Frenulum release with scalpel or laser
• Upper lip frenulum plastic surgery
• Removal of supernumerary teeth
• Excision of connective palatine tissue
• Grid compactosteotomy

Treatment cost depends on clinical complexity, necessary exams, and surgery volume.

Orthodontic Treatment

Modern orthodontic techniques close the gap using crowns, veneers, aligners, plates, or braces to create a beautiful smile. Ceramic or composite microprosthetics restore the proper shape of front teeth.

Correct orthodontic treatment includes a multi-step process: individual material selection, color and shape matching, tooth preparation, making plaster molds, lab production, and final fitting.

Therapeutic Treatment

This approach closes the gap with artistic restoration. A special filling material is applied to the tooth surface, hardened, and restores the tooth’s proper anatomical shape. All procedures are done in one session.