Aesthetic Management of Anterior Midline Diastema
Authors: Khaidem Monalee Devi  , Abhinav Giri  
Published: May 2023

This case report describes a treatment using lithium disilicate in rehabilitating maxillary anterior with midline spacing. This conservative treatment requires fewer clinical sessions along with detailed clinical protocol, precise indications, and laboratory procedures. The result concludes that ceramic veneers not only restore harmony and proportion in a patient’s smile but also prove to be an excellent treatment for an anterior aesthetic zone.

Today, with the influence of social media or social technologies, the concern about facial aesthetics and the demand for cosmetic procedures grows rapidly.[1] Hence, the requirement for aesthetic dental treatments and the creation of beautiful smiles has increased for the re-establishment of oral health and function.[2] The presence of anterior spacing or diastema is one of the factors that affect the smile of an individual. This has become the most common aesthetic complaint of patients.[3] According to Keene (1963), a midline diastema is an anterior midline separation between the proximal surfaces of consecutive teeth that is greater than 0.5 mm.[4] There was also a report that states the maxilla has a higher occurrence of midline diastema than the mandible.[5] According to Oquendo et al., the objectives of treating diastemata are to achieve a stable and effective occlusion as well as a tooth form that is harmonious with the surrounding teeth, arch, and facial form. The result needs to be balanced and appealing to the patient.[6]

The options to correct midline diastema range from composite resins to ceramics. Time restrictions, the desire for fast aesthetic results, or the perception of the social stigma connected with their age and wearing braces are some of the reasons why patients may choose not to have orthodontics to close diastemas.[7]

Due to the preservation of dental structures, reduced price compared to ceramics, reversibility, and straightforward process, the composite resin was once the preferred choice for diastema closure.[8] However, it was shown that secondary caries, loss of repair, pigment impregnation, fracture, marginal flaws, and a high level of colour instability all contribute to their high failure rate.[9]

For patients looking for long-lasting therapy and with high aesthetic standards, ceramics have become the material of choice. Although zirconia has greater mechanical strength, lithium disilicate has greater translucency, making the two materials the most popular. Porcelain laminate veneers introduced by Charles Pincus in 1938 are a thin shell of ceramic and these can be bonded to the facial surface of anterior teeth using bonding agents and dual-cure cements.[10] Buonocore in 1955 introduced the acid etch technique. Bowen in 1958 introduced silica resin direct filling material. Furthermore, with the introduction of improved bonding agents in the 1980s when coupled with the silanization of veneers, the results of porcelain laminate veneers have become more predictable.[11] Considering the little dental preparation and outstanding aesthetic result, this surgery is therefore quite conservative. These materials acquire enamel's strength when they are adhered to it, becoming just as durable as the native tooth structure.[12] According to Peumans et al. (2004), survival rates have ranged from 92% at 5 years to 64% at 10 years. The importance of adequate case selection and procedure is stressed by the extremely high survival rates of carefully implanted PLVs (porcelain laminate veneer) of over 90% after 9 years (Strassler & Nathanson, 1989; Dunne & Millar, 1993).[13] This article reports a case of aesthetic rehabilitation of anterior diastema closure using lithium disilicate porcelain veneers.