Correction of Relapsed Midline Diastema

Abstract

Midline diastema is one of the most common malocclusion seen in orthodontics. It may reappear after orthodontic treatment if retention protocol is not followed properly. Many treatment approaches have been cited in the literature for this and we propose an effective, time-saving, and reliable method for the correction of relapsed midline diastema using vacuum-formed retainer with elastomeric elastics.

Introduction

Midline diastema is the most common problem where patients seek orthodontic treatment. ¹ Although the treatment of this malocclusion is comparatively easy, relapse changes are extremely high if retention protocols are not followed. Almost all cases of midline diastema require fixed lingual permanent retainer. Because of the negligence of patients following the retention protocol and the breakage of the fixed or removable retainers, relapse may be encountered. There are many options for the correction of midline diastema, such as veneers, laminates, composites, removable appliances, and fixed appliances. The chances of relapse after orthodontic treatment have changed the trend of clinicians to use restorative means to treat both aesthetic and functional problems. ² In this article, an effective method of relapsed midline diastema closure using vacuum-formed retainer and elastomeric elastics that have a space of 1 mm is suggested.

Procedure

The patient complained of space appearing between her front 2 teeth once her orthodontic treatment was completed after 6 months (Figure 1). When the patient was clinically examined 1 mm midline diastema was present between 2 central incisors in the maxillary arch. The impression was made of the maxillary arch and a vacuum-formed retainer was fabricated for the closure of relapsed midline diastema. The vacuum-formed retainer was sliced in between 2 maxillary central incisors, and holes were created on the retainer with respect to the maxillary right and left canine for the mechanical retention of composites. Composite buttons were placed on the maxillary right and the left canine and intraoral elastics were engaged to the composites on the labial aspect (Figure 2).

Figure 1.

Relapsed Midline Diastema

Figure 2.

Vacuum-Formed Retainer with Elastomeric for the Correction of Midline Diastema

Discussion

Many different techniques have been used for the correction of relapsed midline diastemas such as single sitting space closure technique using brass wire, ³ elastomeric elastics, ⁴ and composites for the correction of relapsed midline diastema, which has been reviewed in the literature. In the present technique, vacuum-formed retainer was used for retention as well as to close the relapsed midline diastema with elastomeric elastics (Figure 3). Pre- and posttreatment intra oral periapical radiograph (IOPA) taken (Figure 4).

Figure 3.

Closure of Midline Diastema

Figure 4.

Pre- and Posttreatment IOPA