Jawale Bhushan, Rodrigues Lishoy, Chaudhary Amit, Desai Niranjan, Badavannavar Anand, Hattarki Rohan

ABSTRACT

Background: Maxillary midline diastema is one of the most frequently encountered esthetic problems in mixed and permanent dentition. Several causes have been attributed to the midline diastema, including developmental, pathologic or iatrogenic. It can also be seen as a transient malocclusion in which case any intervention is contraindicated. A wide range of possible treatments like restorative procedures, composite build up, surgeries (frenectomies) can be done, based on etiology. Thus, correct diagnosis of etiology and specific early intervention plays a major role in deciding the treatment plan. Case report: This case report evaluates the management of Class I malocclusion with spaced anterior dentition in a 31 year old female patient with presence of peg shaped lateral incisors and maxillary midline diastema. She showed spacing in the upper anterior region and mild crowding in the lower anterior region. The upper arch spacing can be attributed to presence of a thick band of fibrous tissue between the upper central incisors and also due to the presence of small lateral incisors. The case was treated with routine fixed orthodontic therapy and frenectomy was performed at the end of the treatment just before closure of midline diastema space to prevent scar tissue formation. After orthodontic treatment, the patient was referred to an aesthetic dentist for maxillary lateral incisors build-up with composite. Conclusion: Maxillary anterior arch spaces were closed down and mandibular anterior arch crowding was unraveled. Spaces were maintained deliberately distal to the upper lateral incisors for esthetic composite build-up after orthodontic treatment. The dental changes and treatment results were demonstrated. This case report illustrates the interdisciplinary collaboration of an Orthodontist, Periodontist and Endodontist for treatment of such a case. With proper case selection, planning and good patient cooperation, we could obtain significant results.