Gaps or diastemas are a very common complaint for new patients and are often found between the upper central teeth. They can reopen quickly without proper treatment and can lead to repeated orthodontic treatments. We've outlined a few important considerations that help us reliably keep them closed:
1: Reducing interferences:
When upper spacing with lower crowding (like in this case) we have two options. Make the upper teeth bigger (with veneers, esthetic buildups, or crowns) or reduce the size of the lower teeth (tooth resizing also called inter proximal reduction or extractions). In this case we opted to reduce the size of the lower teeth with tooth resizing where indicated below.
2. Root Angulation
After resizing the lower teeth and closing the upper gap, it is important to pay attention to the upper root angulation (as shown below). The final root angulation should show the roots with roughly the same angle (if they were straight to start). We don't want to see the root tips spread out. This would make the teeth more likely to spread out again in the future.
3. Keeping It Closed
Even after removing interferences, keeping gaps closed can be a challenge. This could be due to thick gum tissue between the teeth or even bone anatomy. To give us some extra insurance, we cement a braided wire between the upper teeth and make a clear retainer over it.
4. After Treatment
To achieve reliable gap closure after treatment, make sure you keep wearing your clear retainer and let us know ASAP if your fixed retainer ever comes loose. In some cases we will refer patients out for a tie removal (frenectomy) to make gap closures even more secure.
