Diastema Flashcards
When ae gaps normal?
Broadbents ugly duckling (upper central incisors)
Primate spaces btw upper c and b and lower c and d’s
What are the causes of diastemas?
Teeth too small
Or
Teeth normal size but more availible arch space
These are polygenically inherited and result in generalised spacing
Supernumery teeth (mesiodens)
Impactions (odontomes, cysts, tumours, mucosal barriers, crowding)
Missing teeth (agenesis, extractions)
Low frenum (could be victim of the gap, but check whether fibres run through the gap onto the palate, check the blacncing of tissues between teeth onto palate when pulled on)
Iatrogenic (arch expansion), however, tends to be transitory and closes by itself. No treatment required.
Whqt is broadbenta ugly duckling stage
Gap in btwn upper central incisors as a result of canine eruption path agaisnt laterals
What can cause proclined incisors?
Soft tissue habits
Parafunction
Why should diastemas be treated?
1) aesttics
2) speech- whistles
3) periodontql concerns ( food packing and stagnation) leads t o gingivitis and so n
4) prosthetic rehabilitation (can either be close or opened to put a prosthtic replacement)
How should the ugly duckling stage be managed?
Need to differrentiate between ugly duckling stage (distal flare of latal incisors as permanent canines erupt. They upright as canines erupt agaisnt distal portion of laterals)
This does not warrant treatment. If centrals are uprited, can result in damage to developing follicles underneath.
How should diastemas be diagnos?
Radiographs (need to differentiate beteen ugly duckling stqage, also to ensure that there is no pathology going on).
How should a diastema be managed if it due to small teeth and a wi jaw?
1) no treatment
2) close the spaces and deband patient
( howev, relapse tends to occcur) hence retainers need to be worn for a lifetime
3) multiple diastemas difficult to close with removable appliances, use fixed apiances.
4) relocate spaces into other parts of the arch fir purposes of prosthetic replacement
5) if incisor proclination, reduce the overjet
How to manage diastemas if its due to a frenum?
Clical tests to confirm:
No other causes
Take rqdiograph to check the shape of the dental bone (notching at crest of intdental bone)
Frenectomy
When should a frenectomy be carried out?
Many diastemas can close spontaneously
Frenectomy must be cqrried out prior to eruption of upper canines (usually at about 11 years of age)
What are the steps involved in a frenectomy?
1) anaesthetic
2) incise betweeen incisors on either side of the central incisors
3) complete bilateral labial incisions
4) incision carried to incisive papilla
5) transverse incison before papilla (links the two longitudinal cuts together and needs to be very careful)
6) excised tissue
7) evert lip, extend incisions,
8) grasp with forceps and excise
9) suture and coe pack
Bone removal is unneccasry
What applainces should be used post frenectomy?
1) removable, finger springs, however, only tipping motion hence doomed to failure as therre is nothing to keep the teeth from going back to the way they were before. The upper incisors need a slight distal angulation for this procedure to work
2) fixed, elastic for traction (this is if youre starting incisors that are angulated well to begin with) (neve use a circumferential elastic)
Why shdould we neve use a circumferential elastic to close the gap beteen two central incisors?
You end up extracting the teeth as the band works its way apically and gets lost under the gums as the teeth are concially shaped. Teeth end up getting lost.
