Diastemas: Closing Spaces Between Teeth

The cause

A diastema is space between teeth, that is, adjacent teeth that do not touch. There are a number of reasons why spaces may exist between teeth. The two most common are an arch length discrepancy (teeth are too narrow for the arch that supports them), or because there are congenitally missing teeth. The remaining teeth then either shift or merely don’t touch the next available tooth. The spaces between the teeth can be just a fraction of a millimeter wide or so wide that a straw can easily fit between the teeth.

The missing teeth can often do cause a cosmetic problem. In the present culture of the Western world, spaces or gaps between teeth are not regarded as being desirable or attractive.

Treatment Options

There are several options available to treat a diastema. Most of these options work well whether the spaces are large or small or whether there are several spaces or just on space between two teeth.

Orthodontics can be used to move the teeth into a more pleasing alignment. This could be done with a retainer or fixed bands and wires. Clear Invisalign orthodontics aligners are often used to close these spaces. The advantage is that complex restorations are usually unnecessary and you have to worry about the restoration chipping or breaking after years of service. The disadvantage of orthodontics to close a diastema is the time needed to move teeth, which can range from months to 18 months.

The other option is to have the teeth restored with bonding. The bonding can be done with either resin or with porcelain. The resin will be less expensive and work well to close small diastemas. The porcelain takes an additional visit, is more expensive, and is more appropriate for larger cases in which a more significant appearance modification is needed. This would include changing the color of the teeth, the length of several teeth, or the alignment of several teeth. As a rule of thumb for small spaces, a bonded resin will work well; for larger spaces, orthodontics and porcelain must be considered. Porcelain and resin both can be made to exactly match your existing tooth.

Each situation must be individually examined and evaluated before treatment. Often, we will require sturdy model impressions to be made so we can make measurements of the tooth length, width, and amount of separation between teeth. Using this method, we can show you how you can look through the use of a diagnostic “wax up” showing the new shape of the teeth.

An important point to remember is that if you also want a whiter appearing smile, we should complete the whitening process before the bonding process. Teeth can be whitened, but dental materials such as porcelains and resins cannot be whitened. The restorations are placed to match your tooth color at the time they are placed, so whitening has to come first.

Afterwards

After the teeth are moved orthodontically or reshaped with porcelain or resin, your appearance will change! Not only that, but also your teeth will feel different to you. Your lips will be supported differently. Air will be deflected from your teeth in a different fashion. Depending on the amount of change, you may even need to make slight adjustments to your speech. The good news is that all the adjustments take only several hours to a few days to make. Very quickly, additions and changes become natural for you and you don’t even notice that they were done, except that people will compliment you on how lucky you are to have been born with such beautiful teeth.