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To bond or not to bond: considerations for choosing the appropriate treatment for closing a midline diastema Elaine Halley Aesthetic Update 2025 1:2, 82-88.
In the realm of dental aesthetics, the decision between employing a resin composite material bonded to the dental hard tissues, or orthodontics to address a midline diastema and enhance smile aesthetics, can be complex and multifaceted. This article delves into the critical considerations and decision-making processes guiding dental practitioners through how to decide when orthodontic movement, while a more costly and complex treatment option, might provide optimum aesthetics. By exploring the aetiology of midline diastemas, and the pivotal role of the central incisor in smile aesthetics the author aims to equip clinicians with a comprehensive framework.
CPD/Clinical Relevance: This article shows how to assess suitable treatment modalities for closing midline diastemas in adult patients.
Article
The presence of a midline diastema in the maxilla, a space between the maxillary central incisors, is a common dental anomaly that can arise for various reasons. This condition, while sometimes considered a characteristic or personality trait, can also be a significant aesthetic concern for many individuals.
The prevalence of maxillary midline diastema varies across different populations and age groups. In the UK, the prevalence has been reported as 3.4%, and globally it has been reported in different populations ranging from 1.6% in certain populations to over 50% in younger age groups and certain ethnic groups.1,2
The decision to close a diastema is largely influenced by the patient's perception of beauty and cultural trends. Famous personalities, such as Madonna, Eddie Murphy, and model, Lara Stone, have been celebrated for their distinctive smiles, which feature a midline diastema. Their visibility has played a role in shifting perceptions, illustrating that beauty is diverse and that a diastema can indeed contribute to a person's charisma and identity.3 While aesthetic concerns are the primary motivation, closing a diastema can also have functional benefits, such as improving occlusion and preventing abnormal tooth wear. Additionally, addressing the diastema may help in managing underlying pathological conditions, such as abnormal frenum attachments or periodontal issues, thereby preventing further dental complications.4
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