Manrina Rhode shares the best options for treating midline diastemas and whether it is always the best option for the patient.
Today I’m going to talk to you about midline diastemas. First of all, let’s talk about whether to treat or not to treat.
So many of our patients come in wanting to have a smile makeover. They feel like their midline diastema is a part of their personality, and they choose not to treat it as a part of their smile makeover.
My advice to you guys is to take that with a grain of salt. I’ve had so many experiences in my 22 years as a cosmetic dentist and the 14,000 porcelain veneers that I had done where about 80% of patients start out saying that they would like to keep their midline diastema, and within that, about 80% end up then closing their midline diastema once they’re in treatment.
Exploring the options
What I do is I say to them, ‘Do you want to keep some of your midline diastema, or do you want to keep all of it?’ Quite often they will agree to close it slightly, but keep it there.
So, you create your wax-up keeping that in mind, closing the midline diastema slightly. Then your patient will come in for their preparation appointment, and you’ll put their new smile on for them in temporaries. When they come for that appointment, they’ll come for a review of the temporaries, for artistic re-contouring the next day.
And then you can say, ‘How do you feel? Do you love your new smile?’ and they’ll say they love it.
You can ask them if they are still happy with their midline diastema, and I would explore that with them. And there’s a few different ways that you can explore that…
Quite often, I’ll take a photo, pop it up in Photoshop, and close the diastema for them, just to show them what their options are. And then they can see an option of both photos with the diastema and without their diastema.
If you’re not that good with using Photoshop, it’s something you can also do in the mouth. If you just take a flowable composite, you don’t want to use etch or bond, but literally just take composite and pop it on your temporaries and close the diastema so you’ve got a photo of them with the diastema open and closed.
Instead of using flowable composite, you could use a traditional composite so it’s easier to pop it on and then flick it off if you want to take it off as well. So pop that composite on, take a photo of that so you can put those images side by side. You might want to put a little smear of Vaseline underneath that composite before you add it to your temporaries too, so that it doesn’t bond too well, and it’s then impossible to take off.
Having the conversation
That’s a conversation you can have. You can Whatsapp those pictures to the patient, so they can send them to their partner or whoever else might be making decisions with them, so they can be sure whether the diastema is something that they want to close or not.
To go through numbers again, about 80% of them don’t want to close it. And then once they’re in temporaries and you show them it closed, I’d say about 80% of them then go ahead and actually close it. So it’s a conversation worth having!
I’ve got a terrible story about a midline diastema that I will share with you. I had a very successful musician come in, and we went through a journey with orthodontics, and then finished off with porcelain veneers where we closed his midline diastema. And at the end of this reasonably long journey at the last appointment, I said: ‘Oh, you know, they say that midline diastema is linked with creativity, but I’m glad that it wasn’t linked with yours, so there were no repercussions to to us closing it for you.’
And he said, ‘Actually, I’ve not been able to make music for the last year!’ That was a moment where we had to explore options and see whether he felt that he’d like to have his diastema back, and he chose not to have it back at that time. I have seen that he’s making great music since. So, it wasn’t a long-term thing! But it definitely made my heart stop for a moment.
Closing midline diastemas
There are other options for closing midline diastemas – it’s not always porcelain veneers. When you’re closing a diastema, typically, it means preparing the teeth you’re removed from the distal of the central so that you could make the mesial wider, and then you’d have to remove from the distal of the laterals and make the mesial wider so that you could move all the teeth forward.
Depending on the proportions of the teeth and whether there was space to make them wider, typically essential incisors should be at a one to 0.8 ratio of height to width. So, if they’re not within that ratio, if they’re perhaps a bit narrower than that, then there’s space to close the diastema with your restoration.
And then do you want to close it with a restoration? Is it a porcelain veneer, or is it maybe composite bonding that you just want to pop in the middle there to close it. This is very easy to mock up for the patient, by just getting some composite chairside, popping it in and closing the diastema.
Or is it maybe an orthodontic option? Even with Invisalign now, you can close diastemas, so it could be fixed or a removable appliance to get a really great result. So, lots of things to think about.
Catch up with previous Aesthetic Dentistry Expert columns:
- World Kindness Day: why is kindness a key skill for clinicians?
- Sober October: exploring alcohol and oral health
- Why is overall health important in aesthetic dentistry?
- How to manage tooth staining
- Can aesthetic dentistry be more environmentally friendly?
Follow Dentistry.co.uk on Instagram to keep up with all the latest dental news and trends.
Visit Manrina’s website here: www.drmrlondon.co.uk.