Maxillary midline diastemas: a look at the causes.

BACKGROUND: Maxillary midline diastemas are a common esthetic problem that dentists must treat. Many innovative therapies have been used, varying from restorative procedures to surgery (frenectomies) and orthodontics. At times, these procedures have been performed by the dentist without full appreciation of the factors contributing to the diastemas. CASE DESCRIPTION: Before the practitioner can determine the optimal treatment, he or she must consider the contributing factors. These include normal growth and development, tooth-size discrepancies, excessive incisor vertical overlap of different causes, mesiodistal and labiolingual incisor angulation, generalized spacing and pathological conditions. A carefully developed differential diagnosis allows the practitioner to choose the most effective orthodontic and/or restorative treatment. CLINICAL IMPLICATIONS: The differential diagnosis leads to a treatment approach that most effectively addresses the patient's problem. By treating the cause of the diastema, rather than just the space, the dentist enhances both the patient's dental function and appearance.