Diastema – Gap between anterior teeth

The gap between the front teeth, or diastema as it is called, is a controversial issue in smile aesthetics.

Many people consider it part of their style and wouldn’t change it for the world.

Lately, we see a lot of fashion editorials with models showing their diastemas.

The truth is that beautiful people, beautifully styled with good lighting and beautiful clothes can make even the biggest diastemas look good.

However, since most of us are not as good looking or well styled as models, we tend to focus on small imperfections that bother us and often look for an aesthetic solution.

Teeth gaps are one of the most common reasons why patients come to our clinic, proving that people often see them as a problem and want to have them closed.

Why are there gaps between the front teeth? The most common reasons are:

• Mismatch between small teeth and large jaws
• Labial frenum
• Genetics
• Congenital missing teeth
• Thumb sucking
• Incorrect swallowing reflex
• Periodontal disease
• Combination of the above

Depending on the cause, the size of the gap and its treatment may be different.

Let’s look at some examples of cases treated at our clinic to understand the options available.

When one or more teeth are missing congenitally, meaning they were never developed, then the gaps between the teeth are usually big.

The female patient in the picture is having gaps due to congenitally missing lateral incisors.

A simple way to treat a case like that, is by changing the shape of the existing teeth in order to resemble the ideal composition.

In this case the central incisors were altered in shape with porcelain veneers in order to close the existing gap, while the canines where made to look like the missing laterals.

The first premolars were left untreated since their labial side, resembled the shape of canines.

In other cases when teeth are missing congenitally, gaps are left between teeth, while the existing teeth are moving to the  empty space.

Another way to treat a case like that, is with orthodontics in order to move the teeth to their right place, resulting in a space big enough to fill with a new tooth.

In the case of the picture dental implants where used in the position of the missing lateral incisors after orthodontic treatment.

When teeth have gaps between them because of periodontitis, then it is necessary before the esthetic improvement of a case to treat the disease first.

In periodontitis often the teeth are moving labially too, so deciding to treat them esthetically involves orthodontic treatment too.

In the case of the picture, teeth had gaps between them due to periodontitis , but changing the existing prosthesis with a new one without orthodontics, resulted in fixing the esthetic problems.

Treatment of diastemas

As dentists, we can successfully correct a diastema, but we have to study each case carefully to find the right way. We often need to make a diagnostic wax-up of the patient’s mouth in order to determine the best possible treatment.

Gaps between teeth are usually treated by applying some type of restorative material to the teeth adjacent to the gap. The treatment is only successful if the restorative material is applied symmetrically to both teeth.

The picture shows a case where we used composite resin to close the gap in only one appointment,

while the following case, we used porcelain veneers.

The choice of restorative material depends largely on the patient.

As dentists, will explain the advantages and disadvantages of each material and the patient will make a decision based on the cost and time required to complete the treatment.

Orthodontics can also be an excellent treatment, but many patients do not choose a treatment plan that includes orthodontics because it requires time and the use of braces.

Orthodontics may be the most appropriate treatment for diastema closure if:

• The gaps between the teeth are large and the adjacent teeth have shifted in places that do not allow for aesthetic dentistry.
• The teeth are already wide and the application of restorative material may lead to an unaesthetic result.
• Teeth not only have gaps, they also have a labial inclination.

When discussing gap closure with your dentist, remember to ask if he/she has treated such cases before and ask for pictures of the results.

If you are very concerned about the aesthetics of your smile, ask your dentist for a mock-up of the final result. This can easily be made on a model of your case and will give you a better understanding of the final result. It will also make you feel more comfortable and give you the opportunity to discuss any concerns you may have and any changes that may be needed to achieve the best possible result.

What do you think? Do you have a gap between your teeth? Do you like it? Have you ever thought about improving it with cosmetic dentistry?