A diastema is a space or gap between two teeth, most commonly observed between the upper front teeth (midline diastema). This spacing can occur for various reasons, including a mismatch between the size of the jawbone and the teeth, or an oversized piece of gum tissue that prevents the teeth from coming together. While some individuals embrace the gap as a distinctive feature, many others seek correction for aesthetic concerns or to improve functional aspects of their bite. The choice of treatment depends heavily on the size of the gap and the underlying cause.
Non-Orthodontic Cosmetic Solutions
For smaller gaps, particularly those under 2 millimeters, the quickest and least invasive solutions involve altering the shape and surface of the teeth rather than moving them. These cosmetic procedures effectively close the space by widening the teeth on either side of the gap. These methods are typically completed in one or two dental visits and offer immediate aesthetic improvement.
Dental bonding uses a tooth-colored composite resin material. The dentist applies this resin directly to the tooth surface, molding and sculpting it to fill the gap and reshape the tooth before hardening it with a specialized curing light. This process is highly conservative because it often requires minimal to no removal of the natural tooth structure, making it a reversible option in many cases. The longevity of dental bonding generally ranges from three to ten years, as the material can be more prone to staining and chipping than natural enamel or porcelain.
Porcelain veneers offer a durable and stain-resistant alternative for closing a diastema, especially if teeth have issues with color or minor shape irregularities. A veneer is a thin, custom-made shell of porcelain that is bonded to the front surface of the tooth. To prepare the tooth, a small amount of enamel is usually removed, which makes this procedure irreversible. Porcelain mimics the light-reflecting properties of natural tooth enamel, providing an aesthetic and long-lasting result with high survival probability.
Comprehensive Orthodontic Treatment
When a diastema is large, or when the spacing is combined with other alignment issues, comprehensive orthodontic treatment is often the most effective way to achieve a stable and functional result. This approach physically moves the teeth through the bone structure, which is a biological process that permanently repositions the teeth. Orthodontic treatment addresses the root of the spacing issue by aligning the entire dental arch, not just cosmetically masking the gap.
Traditional braces utilize metal or ceramic brackets bonded to the teeth, with an archwire threaded through them to apply continuous, controlled forces. This fixed appliance system is highly effective for closing gaps of any size and for managing complex tooth movements. Patients typically visit the orthodontist every four to six weeks for adjustments; treatment duration can range from 18 to 24 months.
Clear aligners, such as those made from transparent plastic trays, provide a less visible option for closing a diastema. A series of custom-made aligners are worn sequentially, each designed to make slight, incremental movements to the teeth. Clear aligners are most appropriate for mild to moderate spacing issues and require the patient to wear them for 20 to 22 hours per day. While treatment time for simple diastema closure can be as short as six to nine months, the overall process involves careful planning and monitoring of tooth movement.
Following the completion of any active orthodontic treatment, a retention phase is always necessary. This involves wearing a retainer, either fixed or removable, to prevent the teeth from shifting back to their original position, which is a common risk with diastema cases.
Correcting Soft Tissue Causes
In some cases, the gap between the upper front teeth is primarily caused by an anatomical factor known as an oversized or low-attaching labial frenum. The labial frenum is a fold of tissue that connects the inside of the upper lip to the gum tissue between the two central incisors. If this band of tissue is thick or extends too far down, it can physically prevent the teeth from meeting, contributing to the formation of the diastema.
The surgical procedure to address this soft tissue issue is called a frenectomy, which involves the complete removal or modification of the frenum. This procedure is performed by a dentist or oral surgeon, often using a scalpel or a laser, and typically requires only local anesthesia. A frenectomy eliminates the physical barrier and the pulling force of the tissue, which is necessary to ensure the gap does not reopen after it has been closed.
Although the frenectomy removes the cause, the procedure itself does not close the gap; it only prepares the area for movement. For this reason, a frenectomy is often performed in conjunction with or just before orthodontic treatment begins. The orthodontic appliance, such as braces or aligners, can then move the teeth together into the newly cleared space for a successful and lasting result.