A diastema, a gap between teeth, is a space that can appear anywhere in the mouth, though it is most frequently observed between the two upper front teeth. It is common in both children and adults. While some individuals embrace their diastema, many seek solutions to close these spaces for aesthetic reasons or to improve oral health. Understanding the factors contributing to these gaps helps determine the most suitable closure method.
Causes of Gaps Between Teeth
Gaps between teeth arise from various factors, with genetic predisposition often playing a role. A genetic predisposition means if parents or grandparents had spaced teeth, the trait is likely passed down. Discrepancies between jaw and tooth size are another common cause; large jaws with small teeth naturally form spaces. Missing teeth, especially underdeveloped or absent lateral incisors, also create gaps as remaining teeth may not adequately fill the dental arch.
Oral habits also contribute to diastema. Thumb sucking or tongue thrusting, where the tongue pushes against front teeth during swallowing, can exert pressure that gradually moves teeth apart. An oversized labial frenum, the band of tissue connecting the upper lip to the gums above the front teeth, can prevent teeth from coming together, leading to a gap. Advanced gum disease (periodontitis) can also damage supporting bone and tissues, causing teeth to shift and create spaces.
Orthodontic Approaches
Orthodontic treatments close gaps by physically moving teeth into alignment. Traditional braces, with metal or ceramic brackets bonded to teeth and connected by wires, exert continuous pressure to shift teeth into desired positions. Wires are adjusted periodically by an orthodontist to guide movement. Treatment duration varies, typically 18 to 24 months, depending on case complexity. After active treatment, retainers stabilize teeth in their new positions, preventing shifting back.
Clear aligners, such as Invisalign, offer a discreet alternative to traditional braces. These custom-made, transparent plastic trays are worn over teeth and changed every one to two weeks, with each new aligner incrementally moving teeth closer to desired alignment. Clear aligners are removable for eating, brushing, and flossing, an advantage for oral hygiene. Treatment duration with clear aligners ranges from 9 to 18 months, depending on individual needs and gap extent. Both traditional braces and clear aligners effectively close gaps of various sizes and address other bite alignment issues.
Cosmetic and Restorative Treatments
Cosmetic and restorative treatments close gaps by altering tooth appearance or structure. Dental bonding involves applying tooth-colored composite resin directly to the tooth surface to fill the gap. The resin is sculpted to match natural tooth shape and hardened with a special light, often completed in a single visit. Bonding is suitable for smaller gaps, offering a quick, cost-effective aesthetic improvement. Results typically last up to five years or longer with proper care.
Porcelain veneers provide a durable, long-lasting cosmetic solution. These thin, custom-made ceramic shells are bonded to the front surface of teeth. To prepare a tooth for a veneer, a small amount of enamel may be removed for proper fit and natural appearance. Veneers effectively close larger gaps and improve tooth shape, size, and color, offering a significant smile transformation that can last a decade or more. While veneers offer excellent aesthetic outcomes, they are a permanent alteration to tooth structure compared to bonding.
Dental crowns can close gaps in specific situations, especially when a tooth is damaged, eroded, or needs significant restoration beyond just gap closure. A crown is a tooth-shaped cap that fully covers a tooth’s visible portion, restoring its size, shape, and strength. By increasing the crowned tooth’s width, it can help eliminate spaces. This option is typically considered for both restorative and cosmetic correction, not solely for gap closure in otherwise healthy teeth.
Surgical Solutions
Surgical interventions address underlying causes of gaps, particularly when soft tissue contributes. A frenectomy is a minor surgical procedure to remove or reshape an oversized labial frenum—the band of tissue connecting the upper lip to the gums between the two front teeth. If this frenum is too large or extends too far down, it can prevent the front teeth from naturally coming together, leading to a midline diastema. The procedure typically takes under 30 minutes and can be performed using a scalpel or laser, often under local anesthesia.
In children, a frenectomy performed before adult front teeth fully erupt may allow teeth to come in without a gap. For adults or children whose adult teeth have already emerged with a gap, a frenectomy is often combined with orthodontic treatment (braces or aligners) to actively close the space. Frenum removal helps eliminate tension contributing to the gap and improves orthodontic result stability, preventing teeth from shifting back after treatment. If a gap is due to a missing tooth, surgical considerations like bone grafting may precede dental implant placement, which replaces the missing tooth and helps close the space.