A multidisciplinary approach to the management of a maxillary midline diastema: A clinical report

Abstract

Anterior maxillary spacing has been shown to be one of the most negative influences on self-perceived dental appearance, and a maxillary midline diastema (MMD) is commonly cited by patients as a primary concern during dental consultations. MMD has been defined as a space greater than 0.5 mm between the mesial surfaces of the 2 maxillary central incisors. An MMD greater than 2 mm in the mixed dentition is unlikely to spontaneously close. African Americans are more than twice as likely to have an MMD than whites or Hispanics. In esthetic situations, without a comprehensive smile analysis and proper planning, overtreatment and undesirable effects can occur. Tooth size especially has been emphasized as the primary element of an esthetic smile design. One method of establishing tooth size is tooth biometry as described by Chu. He reported that maxillary anterior tooth widths average 8.5 mm for central incisors, 6.5 mm for lateral incisors, and 7.5 mm for canines and that 80% of the patient population falls within ±0.5 mm of these values. Other important elements of smile analysis include the dental midline, tooth morphology, axial inclinations, and the soft tissue components of gingival health, levels, and harmony. The direct bonding technique is a straightforward, conservative method for diastema closure. However, artistic skills, a knowledge of tooth morphology, and the appropriate selection and use of composite resin materials are essential for success. According to Spear and Kokich, “some existing dentitions simply cannot be restored to a more pleasing appearance without the assistance of several different dental disciplines.” Therefore, complex esthetic dilemmas may require more than one dental discipline, for example, operative dentistry and orthodontics, to establish a functional, maintainable, and pleasant smile. This article illustrates a clinical situation in which an MMD was addressed by first completing a comprehensive smile analysis, followed by closure using limited orthodontics and direct composite resin restorations.