Do you experience gaps between your teeth? This separation between your teeth is a frequent dental phenomenon known as a 'Diastema’. Additionally, these spaces between teeth can sometimes serve as a potential indicator of underlying dental concerns. Furthermore, the gap between an individual's teeth can widen significantly over time. Surprisingly, a gap can even seemingly emerge out of nowhere, particularly as a person's bite naturally shifts with age. While some individuals may embrace the unique character it adds to their smile, others may prefer a more traditional appearance.

Overview

Diastema, originating from the Greek word for "interval," refers to an increased gap or space between two or more neighbouring teeth in the same dental arch.¹ The occurrence of diastema is more prevalent among certain ethnic groups. Spacing between teeth can either be localised or generalised. If gaps are present between almost all teeth, it’s called generalised spacing. Localised spacing is found commonly between the two incisors (front teeth), which is called midline diastema. Its occurrence is more prevalent in the upper teeth compared to the lower teeth. Typically, the individual will notice the gap first, while brushing or flossing.

Causes of gaps between teeth

The development of gaps in teeth involves multiple factors. While some causative factors are well-established, others lack complete understanding. Identifying the potential causes is crucial as the treatment approach for diastema depends on accurately diagnosing the underlying factors and addressing them accordingly. 

 The presence of gaps in children is a typical aspect of healthy development during primary dentition (baby teeth). While their jaws grow larger, the teeth remain the same size. Temporary spacing may occur in the transitional phase where both milk teeth and adult teeth coexist in the mouth (mixed dentition). It naturally resolves in the majority of cases as baby teeth shed and larger adult teeth come in.¹

However, in the set of permanent teeth, gaps can result from:²

• Discrepancies between the size of the jaws and the size of the teeth
• Missing teeth, 
• Microdontia (small Teeth), 
• Large labial frenum, 
• Habitual behaviours like excessive thumb sucking, tongue thrusting
• Severe periodontitis

Genetics play a role in determining the size of your teeth and jawbone, leading to the possibility of diastema running in families.

Diagnosis and treatment planning

Clinical assessment is usually sufficient to diagnose the gaps between teeth. Clinical assessment begins by identifying the patient's chief complaint and reviewing their medical history and dental history. A thorough examination of the dentofacial soft and hard tissue structures is essential. Along with clinical assessment, diagnostic aids such as study models are also used.

Radiographic examinations include orthopantomogram (shows the upper and lower jaws with all the teeth including the unerupted ones), lateral cephalogram (shows the profile view of the skull and soft tissues), advanced imaging techniques like three-dimensional computed tomography and three-dimensional computed photography are needed for identifying the underlying cause, any added malocclusion and reaching an accurate diagnosis and treatment planning. The timing of treatment is too important to achieve acceptable outcomes.¹

Cosmetic treatment

Orthodontic braces

Mostly for adult patients, contemporary fixed orthodontic rehabilitation is the treatment of choice. It’s an extensive and long-term procedure. The duration of treatment involved can vary based on several factors, including the size and number of gaps between teeth, the patient's age, the condition of their gums, the severity of the case, the density of the jawbone, any prior dental procedures, and adherence to orthodontic care instructions.

There are different types of orthodontic braces. They are as follows:

• Traditional metallic braces
• Ceramic braces
• Clear aligners

Traditional metallic braces

Metallic braces are the most commonly used mode of orthodontic treatment for correcting gaps between teeth. They are cost-effective and have shorter treatment duration when compared to other braces. Brackets, wires, and elastic chains to gradually move teeth into their correct positions and close the gaps. Metal brackets are adhered to the teeth and connected by a wire. The wire is periodically tightened to exert pressure on the teeth, guiding them into alignment.

Elastic chains placed over the brackets are particularly effective in closing gaps between teeth within a relatively short time frame. They are often employed as a final step in orthodontic treatment, following the resolution of other dental alignment issues. 

Lingual braces

Lingual braces are placed on the backside of the teeth, making them virtually invisible from the front, offering excellent esthetics. Each bracket for lingual braces must be custom-fitted to the tooth. They are higher in cost compared to traditional metal braces. Additionally, wearing lingual braces may require a slightly longer treatment duration as they may not exert the same force to move teeth as effectively. Some individuals may have a speech difficulty (temporary lisp), which typically improves with practice. They also experience tongue discomfort.³

Ceramic braces

Ceramic braces function similarly to metal braces, but instead of metal brackets, they have translucent ceramic brackets that blend in with the teeth. While clear braces provide a more discreet look, they tend to be more costly and less durable when compared to traditional metal braces.

Invisalign

Closing small gaps between teeth can often be achieved using clear plastic aligners. However, if the gap is substantial, aligners may not effectively bring the teeth together to the desired extent, necessitating the use of braces. If the gaps in teeth are accompanied by other malocclusions, then aligners are not advised.

Composite bonding

A tooth-coloured composite resin material is applied to the teeth to close single or multiple small gaps. Then, the composite is unshaped and polished on the tooth to give a natural appearance. The patient is given oral hygiene instructions and recalled for checkup after 6 months. In the follow-up, marginal leakage, discolourations, fractures, and debonding will be checked. These restorations are functional, stable, aesthetically pleasing, cost-effective, and achieved in less chair time. They can also be easily repaired in the event of fractures.⁴

Porcelain veneers

Porcelain veneers are individualised ceramic shells that permanently bond to the surfaces of your front teeth. It's a conservative, long-lasting solution and the finished surface is very similar to the natural tooth. Porcelain veneers are durable, resist staining and are comfortable to wear with no irritation to gums. However, they are expensive and may lead to increased tooth sensitivity since the tooth structure is altered to fit the veneer.⁵

Dental bridge and implants 

The gap between teeth due to a missing tooth can be corrected by replacing it with a dental bridge. Two healthy teeth on either side of the gap are altered to serve as anchors for the new tooth to be replaced in the gap. Likewise, a dental implant is also used to replace a missing tooth and close the gap, without the need to alter the neighbouring teeth. 

Treatments for the underlying cause

Frenectomy

When a patient’s labial frenum tissue is excessively thick, a surgical procedure frenectomy may be considered to release the tissue band. It aims to minimise the risk of orthodontic relapse, particularly concerning median diastema. There are differences in opinions regarding the diagnosis, indications, and timing of frenectomy. The timing should be agreed between the orthodontist and surgeon.

Periodontal treatment 

In case of mild periodontal disease, dental cleaning procedures like scaling and root planing are recommended. In the case of moderate to advanced periodontal disease, flap surgery is done in which the gums are incised and retracted temporarily to expose the tooth roots. They are then thoroughly cleaned and the gums are sutured back in their original place. A bone graft is used during this procedure for bone regeneration in case of bone loss.

Summary

Fixing gaps between teeth involves various treatment options ranging from orthodontic braces to cosmetic procedures like composite bonding or porcelain veneers. The choice of treatment depends on factors such as the severity of the gaps, the age of the patient, patient preference, and underlying dental issues. It's essential to consult with a dentist to determine the most suitable approach for closing the gaps and achieving desired results.

FAQs

Can a gap between the front teeth be closed?

• If patients want to have a diastema closed for cosmetic reasons, treatment options are chosen depending on the cause and severity of the gaps. It includes orthodontic intervention, restorative treatment like porcelain veneers and composite bonding or prosthodontic dental bridges and implants.

Are gaps between teeth common in children?

• Gaps between teeth are common in children. It's usually not a matter of concern since these gaps gradually disappear as adult teeth erupt. If there are several gaps between a child’s teeth even after all of the adult teeth have come through, then they have to go for a dental check-up.

How long do braces take to fix the gap in teeth? 

The time taken to fix gaps between teeth by braces depends on the size of the gap and the type of braces chosen. It might take anywhere between 6 months to 2 years to fix gaps. The gaps gradually close throughout treatment.

Which is the better option for filling gaps in teeth, braces or restorative procedures?

• Veneers and composite bonding are suitable for closing just one or two small gaps between teeth. If several teeth are over-spaced and these gaps are larger, then braces may be a better option.

Can gaps between teeth be prevented?

While the genetic predisposition of gaps between teeth cannot be prevented there are certain ways in which we can minimise the risk of developing large gaps. Maintaining a good oral hygiene routine reduces gum disease risk, preventing gum recession and gaps. Regular dental check-ups aid in the early detection and management of dental issues like gum disease and tooth decay and potentially prevent gap formation. By early orthodontic evaluation, issues like gaps between teeth can be prevented from worsening. Discouraging bad oral habits like thumb sucking in children will prevent unnecessary pressure on teeth. Using mouthguards during sports minimises trauma-induced tooth loss and subsequent gaps.