Drg sania dara afiati, Sp.

KG

D IA S TEM A

Apa itu diastem a?

A diastema is a space between two

adjacent teeth in the same arch.

A space greater than 0,5 mm
between the proximal surfaces of
adjecent teeth

M idline diastem a
Midline diastema refers to anterior

midline spacing between the two

central incisors

Causes of diastema
Normal/
developmenta
l

1. Physiologic
median
diastema /
ugly
duckling
stage
2. Ethnic and
familial
3. Imperfect
fusion of
midline of
premaxilla

Tooth material
deficiency

1. Microdontia
2. Macrognathi
a
3. Missing
lateral
4. Extracted
tooth

Physical
Impediment

1. Retained
deciduous
2. Mesioden
s
3. Abnormal
labial
frenum
4. Midline
pathology
5. Deep bite

habits

1. Thumb
sucking
2. Tongue
thrustin
g
3. Frenum
thrustin
g

Artificial
causes

Rapid
maxillary
expansion

N O RM AL D EVELO PIN G D EN TITIO N

Physiologic m edian diastem a/

ugly duckling stage
Described by Broadbent ugly duckling stage children

tend to look ugly during this phase of develompent

Self correcting malocclusion in the maxillary incisor region

between ages 7 12 years of age

As the permanent canines erupt they displace the roots of

the lateral incisor mesially

Often mistaken as an orthodontic problem

Ethnic and fam ilial

Negroid group

Im perfect fusion at the m idline

Midline diastema occurs due to

imperfect fusion at the midline of the

premaxilla
A V-shaped or W shaped osseous
septum may be associated with this
condition

Tooth m aterialdefi
ciency

M icrodontia
The teeth that appear smaller in size
The jaw size is normal, but the size of the

teeth is small
3 jenis :
True generalized all theeth smaller than

normal, well formed

Relative generalized normal/ slightly smaller,
present in jaws that are larger than normal
hereditary factors (inherent the jaw size from
one parent and teeth size from other parent.
Focal / localized Affects axillary latral incisor
and 3rd molar

True generalized
microdontia

Peg lateral
shaped
Forms cone-shaped crown
Taper incisally
Root is frequently shorter than
usual

M acrognathia
A developmental anomaly

characterized by an abnormal large

jaw.
The size of the tooth is normal but
because of the increase in size of jaw,
it result in diastema

M issing lateral& extracted tooth

Due to the missing lateral / agenese

& extracted tooth, there wil be tooth

material-arch discrepancy as a result
there will be drifting of adjacent
teeth

Physicalim pedim ent

Retained
deciduous teeth
This causes ectopic
eruption of tooth and
formation of median
diastema

M esiodens
Presence of an unerupted
mesiodens between the
two central incisors

Abnorm allabialfrenum
test confirm high frenal
attachment
Lift the upper lip and pull in upward and
outward direction.
Presence of blanching in the papilla
indicates abnormal frenal attachment
Blanch

M idline pathology
Pathology such as cysts or

acromeglia
Periodontal disease that can lead to
lack of support and splaying of teeth

H abits

Thum b sucking
A placement of the thumb or one or

more fingers in various depths into

the mouth
Cause severe proclination of the
maxillary anterior teeth along with
formation of diastema

Tongue thrusting
A condition in which the tongue

makes contact with any teeth

anterior to the molars during
swallowing
Causes proclination of anterior teeth
along with diastema and open bite

Frenum thrusting
If the maxillary incisors are slightly

spaced apart, the child may lock his

labial frenum between these teeth
and permit it to remain in this
position for several hours

Artifi
cialcauses/iatrogenic
causes

Rapid m axillary expansion

Orthodontic treatment to expand the maxillary arch 0,5

-1 mm/day
A space is created at the mid palatal suture filled

initially by tissue fluids and hemorrhage

As the result there is incisor separation and a midline

diastema is formed
This diastema closes as a result of the trans-septal

fibretraction

H ow to diagnose??
Anamnesa :
Is there any bad habit??
Past dental history?

Rapid maxillary expansion?

Extraction?

H ow to diagnose??
Oral examination :
Inspection : microdontia, macroghnatia, missing

teeth, deciduous teeth

Periodontal problem?
Palpation cyst
Blanch test high frenum
Radiograph :
Unerupted mesiodens
Cyst
Missing tooth due to extraction / agenese
Periodontitis