Lucky gap
Featured Products Promotional FeaturesPosted by: Dental Design 6th December 2024
In different cultures, a midline diastema, or gap between the central incisors, can be a sign of good luck, of fertility, or a mark of beauty, amongst other things. Chaucer’s cheeky Wife of Bath’s gap symbolises her bawdiness, as she gamely pursues her sixth husband. Before his cosmetic treatment, David Letterman used his gappy grin to add a hint of Alfred E. Newman innocence after delivering a comedic barb. Lea Seydoux’s gap gives her beauty an unconventional edge. In some African countries, the gap is such an attractive feature that some even have a diastema created through cosmetic dentistry.
Gaps between the front teeth can form during the eruption of maxillary anterior teeth. In most cases, they correct themselves after the eruption of the permanent maxillary canines. However, a diastema can have a number of causes, such as supernumerary teeth, congenital absence of permanent teeth, poor oral habits, tooth reduction due to erosion or movement due to periodontal disease, high frenal attachment,[i] habits such as thumb-sucking, and dental-skeletal discrepancies[ii] among many others.
Orthodontic treatment
Many people embrace their diastema, while there are a variety of procedures to choose from should a patient decide to pursue treatment to remove it. Orthodontic management of a diastema can be very effective, and can treat many problems associated with a diastema that affect occlusion. Treatment can involve a bracketed orthodontic arch appliance, or, in certain cases, a sectional arch wire technique may be useful.[iii] Clear aligners have also increasingly been used in the successful orthodontic treatment of a number of conditions affecting tooth position, including diastema.[iv]
Orthodontic treatment should consider alignment of the midline where possible for the best aesthetic outcome, and permanent retention is required in most cases, as the diastema can recur after even the best managed treatment. A lingual bonded fixed retainer is recommended in several studies for retention therapy.[v] Any orthodontic treatment requires time and commitment from patients, and may require periodic tolerance of some discomfort to work properly.[vi]
Veneers
Veneers can be a great solution for treating an unwanted diastema once any occlusal, oral hygiene or other problems leading to erosion or tooth movement have been addressed.
The long-term survivability of indirect veneers is generally very good. Minimal prep porcelain veneers have been used for many years, and have long been considered a predictable, durable and aesthetic option for restorative treatment. The disadvantages of porcelain include the higher cost compared to composites, as well as comparatively poor polishability. Its thinness and translucency can make it less appropriate for masking heavy discoloration. The etching required on the inner surface of porcelain can also cause micro-cracks which can decrease the flexural strength of the porcelain and eventually fracture the veneer. However, with the right cementing material and techniques, porcelain veneers average 95% survival after 7 years, and can achieve survival rates as high as 91% after 20 years.[vii]
The clinical survival rate of no-prep indirect composite laminate veneers is around 91.3%, or 7 years – lower than the average lifespan of porcelain veneers. However, composite veneers are currently preferred to porcelain alternatives by many practitioners. As well as being generally more affordable, they require less clinical intervention than porcelain alternatives, and can be a more conservative treatment for a diastema, as well as masking tooth discolorations, and restoring fractured and misshapen teeth. [viii]
Direct composite veneers have gained an important role in dental clinical applications following recently developed materials and techniques in adhesive and restorative dentistry. Direct restorations can be applied on prepared tooth surfaces or even without any preparation, in a single visit.[ix] The treatment of a diastema can increasingly be undertaken by the application of direct composite resin with highly aesthetic and durable results. This has been done successfully using wax-up restoration and building a silicon matrix. Some clinicians have achieved positive, natural-looking restorations by building up layers on the surfaces of central incisors one by one. However, restorations without a guide such as silicon matrix are not easy to perform, and successful application depends on the individual dentist’s ability and confidence.[x]
Brilliant aesthetics, long-term results
Offering patients the best possible solution for aesthetics as well as durability is the aim in any restorative procedure. Whether used for veneers, inlays, onlays or crowns in the anterior as well as posterior region, BRILLIANT Crios (CAD/CAM solution) from COLTENE is the ultimate reinforced composite bloc for permanent restoration. BRILLIANT Crios has high flexural strength, supporting permanent restorations, and with 13 shades and two translucencies, it blends in perfectly with natural teeth.
The definition of a beautiful smile can vary according to convention, geography, culture, the patient’s own aesthetic ideals and preferences, or according to the variable standards in vogue at the time. If any treatment is required, the clinician and patient both should have absolute confidence that it offers them a safe, aesthetic, durable and cost-effective solution.
Email info.uk@coltene.com or call 0800 254 5115
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Author: Nicolas Coomber COLTENE National Account & Marketing Manager
[i] Kumar A, Shetty RM, Dixit U, Mallikarjun K, Kohli A. Orthodontic Management of Midline Diastema in Mixed Dentition. Int J Clin Pediatr Dent. 2011 Jan-Apr;4(1):59-63. doi: 10.5005/jp-journals-10005-1083. Epub 2011 Apr 15. PMID: 27616861; PMCID: PMC4999640.
[ii] Korkut B, Yanikoglu F, Tagtekin D. Direct Midline Diastema Closure with Composite Layering Technique: A One-Year Follow-Up. Case Rep Dent. 2016;2016:6810984. doi: 10.1155/2016/6810984. Epub 2016 Jan 6. PMID: 26881147; PMCID: PMC4736806.
[iii] Kumar A, Shetty RM, Dixit U, Mallikarjun K, Kohli A. Orthodontic Management of Midline Diastema in Mixed Dentition. Int J Clin Pediatr Dent. 2011 Jan-Apr;4(1):59-63. doi: 10.5005/jp-journals-10005-1083. Epub 2011 Apr 15. PMID: 27616861; PMCID: PMC4999640.
[iv] Yokoi Y, Arai A, Kawamura J, Uozumi T, Usui Y, Okafuji N. Effects of Attachment of Plastic Aligner in Closing of Diastema of Maxillary Dentition by Finite Element Method. J Healthc Eng. 2019 Mar 3;2019:1075097. doi: 10.1155/2019/1075097. PMID: 30944717; PMCID: PMC6421825.
[v] Kumar A, Shetty RM, Dixit U, Mallikarjun K, Kohli A. Orthodontic Management of Midline Diastema in Mixed Dentition. Int J Clin Pediatr Dent. 2011 Jan-Apr;4(1):59-63. doi: 10.5005/jp-journals-10005-1083. Epub 2011 Apr 15. PMID: 27616861; PMCID: PMC4999640.
[vi] Hussain AS, Al Toubity MJ, Elias WY. Methodologies in Orthodontic Pain Management: A Review. Open Dent J. 2017 Aug 31;11:492-497. doi: 10.2174/1874210601711010492. PMID: 28979577; PMCID: PMC5611706.
[vii] Alothman Y, Bamasoud MS. The Success of Dental Veneers According To Preparation Design and Material Type. Open Access Maced J Med Sci. 2018 Dec 14;6(12):2402-2408. doi: 10.3889/oamjms.2018.353. PMID: 30607201; PMCID: PMC6311473.
[viii] Fahl N Jr,, Ritter AV. Composite veneers: The direct-indirect technique revisited. J Esthet Restor Dent. 2021 Jan;33(1):7-19. doi: 10.1111/jerd.12696. Epub 2020 Dec 18. PMID: 33336852.
[ix] Korkut B. Smile makeover with direct composite veneers: A two-year follow-up report. J Dent Res Dent Clin Dent Prospects. 2018 Spring;12(2):146-151. doi: 10.15171/joddd.2018.023. Epub 2018 Jun 20. PMID: 30087767; PMCID: PMC6076883.
[x] Korkut B, Yanikoglu F, Tagtekin D. Direct Midline Diastema Closure with Composite Layering Technique: A One-Year Follow-Up. Case Rep Dent. 2016;2016:6810984. doi: 10.1155/2016/6810984. Epub 2016 Jan 6. PMID: 26881147; PMCID: PMC4736806.
