Diastema

What is the diastema?

"Diastema" is an exquisitely medical term that indicates the presence of a large and conspicuous space between two contiguous teeth. Typical of the upper incisors, the diastema appears as a large black hole between the teeth, which depending on taste and severity gives sweetness and sympathy to the smile, or worsens its aesthetics.

Only rarely does the diastema reflect a pathological condition: most of the time, it is "simply" an aesthetic disturbance of a magnitude comparable to that of a crooked tooth or a chipped tooth. Despite what has been stated, in fact, the diastema constitutes an aesthetic problem that is not a small one: to restore the "harmony to the smile subtracted from this"black hole", the only possible solutions are to be found in corrective orthodontic treatments or in restorative interventions with specific prostheses.
So let's see what causes the diastema, what pathological repercussions it can induce and how it can be treated.

Causes

Before proceeding with any intervention to close the diastema, it is important to research the cause that generated it.
It is thought possible that the diastema occurs in the presence of an unequal relationship between the size of the teeth and the jaw. In these cases we are faced with the opposite problem of dental crowding: when the length of the dental arch is excessive and the teeth are too small, the latter cannot occupy all the available space. For this reason, one or more spaces are created between contiguous teeth, which take the name of diastemas.

Another hypothetical cause of diastema is to be found in the length and thickness of the gingival frenulum, the thin flap of tissue that connects the lips with the alveolar mucosa. When the gingival frenulum is very pronounced and has a very low attachment, its insertion fibrous can hinder the tendency to spontaneous approach of the teeth (incisors).
In young children, it seems that the bad habit of thumb sucking may somehow contribute to the formation of diastemas in the milk teeth.

Curiosity
The presence of the diastema in the deciduous (or milk) teeth can be considered a physiological event: in fact, the "void" between two deciduous teeth must be interpreted as a reserve of space for the eruption of permanent teeth (after the fall of the teeth from milk).

The list of possible risk factors for the formation of diastema is not complete. In fact, both the presence of follicular or radicular dental cysts, and the lack / poor development of the lateral incisors seem to somehow prevent or hinder the teeth from remaining adherent to each other.

Related ailments

Although the diastema generally reflects a purely aesthetic disorder, its presence in a permanent dentition can constitute, in some circumstances, a potential periodontal damage in the incisive area. The absence of a contact surface between two neighboring teeth predisposes to the risk of trauma on the interdental papilla (caused by the mechanical action of food) and to the onset of developmental gingivitis.

Treatment

It is not certain that all diastemas must be closed by means of a corrective dental intervention: apart from the aesthetic discomfort, in fact, many of these do not create any pathological damage to the teeth.
It is therefore up to the dentist to decide how to proceed in the face of a diastema.
It is true, however, that the presence of a hole between the teeth does not fall within the common canons of beauty: this is precisely the reason that drives many people to request dental intervention even in the absence of pathological complications.
The options are:

1. Keeping the diastema as it is: an appropriate choice when the groove between the two incisors does not reflect a morbid condition and does not create discomfort for the patient.
2. Orthodontic treatment to align the teeth: this first-line intervention to close the diastema consists in the application of a fixed or mobile device on the teeth. The results, unfortunately, are not immediate: the diastema can close after 6 months-2 years . Orthodontic surgery is more suitable for young patients.
3. "Filling" treatment with ceramic / porcelain veneers: this intervention amplifies the size of the teeth, making them visibly larger. The ceramic veneers are thin sheets that are literally glued to the external surface of the teeth: they are indicated in the treatment of broken, chipped, dichromic teeth (eg yellow teeth or with spots that cannot be removed by scaling) and for the correction of diastemas. Precisely, in this last case, the aesthetic veneers are made to adhere to the surface of two teeth divided by a diastema: increasing the surface, these teeth are perfectly aligned, in order to fill the sulcus. This option is suitable for diastemas that exceed the millimeter in width.
4. Covering / replacing the tooth with artificial crowns (capsules): when the teeth that delimit a diastema are carious, affected by pulpitis and do not belong to a very young person, the most appropriate remedy is the treatment of the infection (filling or devitalization) followed by a Tooth encapsulation with ceramic or zirconium artificial crowns.
5. Dental implants: rather drastic intervention strategies for the closure of a diastema. Dental implants can only be performed in adults, especially in the presence of carious or deeply infected teeth.
6. Frenectomy: reserved for cases of diastema dependent on structural anomalies of the gingival frenulum. The procedure consists of cutting the frenulum, followed by its repositioning in the correct position. When frenectomy is performed on a child, the diastema tends to spontaneously close again; otherwise, in the adult, the intervention must be supported by the application of a device.