A gap between teeth, medically termed a diastema, is a common orthodontic concern. This spacing can occur anywhere in the mouth, but it is most frequently observed between the upper front teeth. For individuals seeking a uniform smile, correcting this spacing is often the first step toward treatment. Braces are a highly effective method for closing dental gaps, regardless of their size or location. This traditional orthodontic approach uses a precise system of gentle, continuous pressure to physically move teeth together.
How Braces Mechanically Close Dental Gaps
Braces work by harnessing a complex biological process known as bone remodeling to shift teeth through the jawbone. The fixed appliance system, consisting of brackets bonded to the teeth and an archwire running through them, applies a steady force. This constant pressure triggers activity in the periodontal ligament, the tissue connecting the tooth root to the surrounding alveolar bone.
The pressure exerted on one side of a tooth stimulates specialized cells called osteoclasts to dissolve the bone, creating space for the tooth to move. Simultaneously, on the opposite side, osteoblasts begin to deposit new bone tissue. This coordinated cycle of bone resorption and deposition allows the tooth to safely migrate across the jawbone and into the gap.
The archwire dictates the direction and degree of movement, often made of nickel-titanium or stainless steel. As the teeth move, the gaps close, and the surrounding bone structure rebuilds to support the teeth in their final position. This process is gradual, requiring adjustments every few weeks to maintain the necessary light force for controlled movement.
Other Treatment Options for Diastema
While traditional braces are effective for all types of spacing, several other options exist for patients seeking alternatives, particularly for smaller gaps.
Clear Aligners
Clear aligners, such as transparent plastic trays, offer a less noticeable orthodontic solution. These aligners apply staged pressure to the teeth, working on the same principle of bone remodeling as braces, but they are removable. Aligners are best suited for minor to moderate spacing issues and require strict adherence to wearing them for 20 to 22 hours per day.
Restorative Procedures
For purely cosmetic fixes that do not involve moving the teeth, two common restorative procedures are dental bonding and veneers.
Dental bonding involves applying a tooth-colored composite resin to the surface of the tooth, which is then shaped and hardened to widen the tooth and instantly fill the gap. Bonding is less expensive and can often be completed in a single visit.
Veneers are thin, custom-made shells of porcelain or composite material bonded to the front surface of the teeth to mask the space. Veneers are more durable, stain-resistant, and offer a long-lasting aesthetic change.
Frenectomy
If the spacing is caused by an oversized piece of tissue connecting the upper lip to the gum, known as a large labial frenum, a minor surgical procedure called a frenectomy may be necessary. This procedure reduces the size of the frenum, allowing the teeth to be moved together. A frenectomy is almost always performed in conjunction with orthodontic treatment to ensure the gap remains closed.
Addressing Underlying Causes and Retention
For long-term success, identifying and addressing the underlying cause of the diastema is important to prevent the gap from reappearing. Spacing often results from several factors:
- Genetic factors, such as a mismatch between tooth size and jaw size, or congenitally missing teeth.
- Oral habits like tongue thrusting, where the tongue pushes against the front teeth during swallowing.
- Advanced periodontal disease, which can cause bone loss and tooth shifting.
Retention After Treatment
Because teeth have a natural tendency to revert to their original positions, the retention phase immediately following treatment is necessary. Once the gap is closed, the surrounding bone needs time to fully solidify around the new tooth placement. Retainers are used to hold the teeth in their corrected position, allowing the bone and soft tissues time to adapt.
Retention protocols typically involve either a fixed or a removable appliance. A fixed retainer consists of a thin wire bonded permanently to the back surfaces of the teeth, offering constant support and preventing relapse. Removable retainers, such as clear plastic trays or the traditional Hawley appliance, are worn for a prescribed period, usually full-time initially and then only at night. For diastema closure, the fixed retainer is often the preferred choice to ensure the gap remains closed.