ПРИЛОЗИ, Одд. мед. науки, XXXV 2, 2014 МАНУ CONTRIBUTIONS. Sec. Med. Sci., XXXV 2, 2014 MASA
DOI: 10.2478/prilozi-2014-0022 ISSN 1857 9345 UDC: 616.314.21 007 02
THE INFLUENCE OF ETIOLOGICAL FACTORS IN THE OCCURENCE OF DIASTEMA MEDIANA
Biljana Kapusevska, Nikola Dereban, Efka Zabokova Bilbilova, Mirjana Popovska
Faculty of Dentistry, St. Panteleimon P.H.O. Dental Clinical Centre, Department of Prosthodontics, Ss. Cyril and Methodius University, Skopje, R. Macedonia
Corresponding Author: Biljana Kapusevska, MD, PhD, Faculty of Dentistry, University St. Cyril and Methodius, Majka Tereza PO BOX 17, Skopje 1000, R. Macedonia Tel: ++ 389 (02) 3 11 56 47 Fax: ++ 389 (02) 3 11 56 47 Url: http://www.stomfak.ukim.edu.mk/; E mail: [email protected]
Abstract Even from the distant past the aesthetic perception in an individual was diminished by the presence of gap between the central incisors. This condition is found under the term "dents du bonheur" or "lucky teeth" and is encountered even among world famous figures including Brigitte Bardot, Eliah Wood, Madonna, Zac Efron, Amy Winehouse and Elton John. The teeth gaps are still considered main reasons for dissatisfaction of the dental patients and reasons for the requirement of aesthetic treatment. The purpose of this study is to exhibit the influence of the etiological factors in the occurrence of dia stema mediana classified according to the dominance of their occurrence expressed in percentage values. Materials of this investigation were 100 patients with diastema mediana from the following factors: inheritance, disproportion in the dental arches, inborn or acquired missing teeth, harmful oral habits, high insertion of the labial frenulum as well as mesiodens. After the diagnosis and evaluation of the etiological factor for diastema mediana was performed, a decision regarding the course of treatment was made in direction of the removal of the etiological factor at an early age and orthodontic treatment. The end of the orthodontic treatment in a group of the patients was the beginning of prosthodontic reconstruction. From our clinical investigation we came to the realization that in 49 patients (49%) the hereditary influence was a dominant factor, next followed disproportions and discrepancies in the dental arch in 14 (14%), inborn or acquired missing teeth in 11 patients (11%), harmful oral habits in 10 (10%), high frenulum insertion in 4 (4%), and pathological objects between central incisors, mesiodens, iatrogenic factors and periodontal disease, in 3 of the clinical cases (3%) each. We concluded that the occurrence of diastema mediana is multi causal. The dominant place is occupied by the hereditary factors. With regard to the mutual relationship between the multitudes of factors in the occurrence of diastema mediana, the diagnosis should be made conciliary and the clinical treatment should be interdisciplinary including a prosthodontist, orthodontist and oral surgeon.
Key words: diastema mediana, etiological factors, real diastema mediana, physiological diastema mediana.
Introduction sometimes even 5 mm in width. It is almost DIastema mediana is a visually detectable always credited with unpleasant personal appea gap or space, more than 1mm in width, between rance and sometimes depending on the size can upper first permanent central incisors which con cause speech impediments [2]. tinues to exist throughout the entire adult life [1]. From the beginning of time people have The distance between the central incisors noticed the prominent spaces in their dentiti in diastema mediana varies from 1–4 mm and ons. In France, the teeth on either side of a 170 Biljana Kapusevska, et al . space or gap are called "dents du bonheur" or diastema. The diagnosis of true diastema can "lucky teeth ". In Macedonia a girl who has not be considered until the eruption of the perma diastema mediana is believed to marry a rich nent canines. The appearance of diastema me husband. In Greece it is a sign of wealth and diana is a normal stage of the early develop prosperity. Yet diastema mediana is still consi ment of the dental arch. It is a good prognostic dered as one of the main reasons for dissatis sign that there is sufficient room in the dental faction of dental patients [3]. arch for the placement of the permanent teeth. Diastema mediana is present in a large The transitory diastema may continue to persist number of celebrities such as Arnold Schwar until the period of 9–11 years in the time of zenegger, Brigitte Bardot, Chris Martin, Eddie mixed dentition (Fig. 1). After the eruption of Murphy, Eliah Wood, Jack Black, LeAnn Rimes, the permanent incisors, they are separated by Madonna, Seal, Zac Efron, Amy Winehouse the bony elements of the midline suture. Mid and Elton John [4]. line diastema may be considered normal for The interdental diastema "always creates many children during the eruption of the perma an unpleasant appearance and interferes with nent maxillary central incisors. When the inci speech depending on its width". A study by sors first erupt, they may be separated by bone Kerosuo (1995) reports that people with signi and the crowns incline distally because of crow ficant anterior crowding or midline diastema ding of the roots. With the eruption of lateral were very frequently considered less intelligent, incisors and permanent canines, midline diastema beautiful and sexually attractive and were per reduces or even closes (ugly duckling stage). ceived to be of a lower social status in compari This stage was named by Broadband, and the refore it is also known as a Broadband phenol son to the same individuals when they had excel menon. The possibility of space closure without lent occlusion [5]. Rosenstiel and Rashid (2002), treatment is inversely proportionate to diastema in an Internet study concerning the opinion of size. The transitory diastema mediana is gra lay people about anterior teeth aesthetics, showed dually shrunken and closed during the eruption of that conditions such as diastema and midline the maxillary lateral incisors and canines. The deviation received the worst ratings. The correc medially guided eruptive path of the maxillary tion of diastema mediana, a seemingly simple lateral incisors and canines creates medial pres anomaly, can be a challenge for the general prac sure and normal closure of the diastema for titioner, the orthodontist or the prostodontist [6]. correct placement of the teeth in the dental arch. • Physiological midline diastema When treating patients with diastema mediana The diastema that appears as a normal we should consider the dental and not the chro development of the dental arch is called midline nological age of the patient [7].
7 years 9 years 14 years
Fig. 1 – "Ugly duckling stage" The influence of etiological factors in the occurence of diastema mediana 171
• Real midline diastema diastema mediana. A heavy band of tissue with We define the real midline diastema as a broad, fan like base is attached to the palatal the distance between the central incisors without interdental papillae and produces the blanching periodontal or periapical changes in the area of of the papilla. The high frenulum insertion was the frontal teeth in the presence of all perma additionally diagnosed with RTG as a presence nent erupted frontal teeth in the dental arch [8]. of interdental bony notch of the alveolar ridge and represents one of the early signs for wide and Purpose fibrous frenulum attachment. This is why an Of this study is to exhibit the influence of RTG was often required before making a defi the etiological factors in the occurrence of dia nitive diagnosis of high frenulum insertion after stema mediana classified according to the domi the clinical examination. The wrongfully deter nance of their occurrence expressed in percen mined high frenulum insertion as a reason behind tage values. diastema mediana and its subsequent removal may lead to the appearance of gummy smile Materials and methods • Teeth arch discrepancies In this study we have selected as material The discrepancies between the length of 100 patients from our everyday clinical practice the dental arch and the mesio dental arch of the who were dissatisfied with the current appe teeth was diagnosed when the mesio distal width arance of their dentition because of the pre of the upper central incisors was lower than the sence of diastema mediana. Each of the pati average of 30–32 mm or when there was an ents underwent a clinical evaluation and identi inborn or acquired condition of missing teeth. fication of the etiological factor responsible for the occurrence of diastema medana. The clini • Harmful oral habits cal findings were put in an individual evalua Tongue thrusting is clinicly diagnosed with tion chart made for each of the patients. Each the help of Lindhe – Andersоn examination of the etiological factors was evaluated accor technique, in which the patient is given instruc ding to a specific diagnostic criteria and proto tions to swallow and the clinician simultaneo col of assessment. usly with the fingers stretches the patients’ lips. If the habit is present, the therapist notices for Hereditary factors • ward thrust and pressure from the tongue. Thumb Midline spacing between the central inci sucking was diagnosed by the maceration on the sors has a racial and family background. The skin of the thumb together with anamnestic data. hereditary influence was determined in patients who had other family members with midline • Periapical changes diastema. The periapical changes were diagnosed with a periapical RTG from the central incisors. • Mesiodens and supplementary teeth Mesiodens was diagnosed through pano • Periodontal disease ramic and periapical RTG. Sometimes, when The periodontal pockets were diagnosed the findings were ambiguous we had to use an by a special probe "Flexible Plastic", Universal occlusal RTG. Explorer, manufactured by Vivacare − Vi vadent. • Abnormally high frenulum insertion To confirm the presence of high labial • Iatrogenic factors frenulum insertion, a simple test of ischemia Iatrogenic factors were confirmed by the was performed, in which the localization of simultaneous therapy protocol that was prescri alveolar insertion was determined while simul bed to the patients. taneously performing alternative pressure appli The patients were later professionally trea cation by lifting and stretching the upper lip in ted in accordance with the etiological cause. A a downward and outward direction. If this acti prosthodontic reconstruction was done in the vity caused blanching and tension of the pre clinical cases involving teeth dental arch dis viously mentioned structures, we consider the crepancies, inborn or acquired missing teeth. Dia high frenulum insertion as the main cause for stema mediana caused by mesiodens or high 172 Biljana Kapusevska, et al . frenulum insertion was surgically treated. All ning of the treatment of diastema mediana de of these patients, regardless of the concerning pends on the etiological agent that caused it. The etiological factor, were orthodonticly treated for correction of harmful habits and removal of the correct placement of the teeth in the dental arch, present mesiodens should begin before the ortho removal of harmful oral habits and accompli dontic treatment. The removal of the high fre shment of ideal interarch relationship. nulum insertion can start during the orthodontic The treatment of diastema mediana is treatment. Atypical or missing lateral incisors and always interdisciplinary and in accordance with teeth dental arch discrepancies should be resol the etiological factor that caused it. The begin ved after the orthodontic treatment (Table 1).
Table 1
Treatment plan for diastema mediana
Etiological factor Timing of treatment Treatment
Start before continuing orthodontic Tongue thrust Tongue rake (fixed or removable) treatment proper
Start before continuing orthodontic Thumb sucking Thumb rake (fixed or removable) treatment proper
High frenal During treatment Frenectomy with or without gingivoplasty attachment
After orthodontic treatment or Peg shaped lateral Composite built up crowns sometimes before
Tooth material After orthodontic treatment Veneers (porcelain/composite crowns) deficiency
Supernumerary Before orthodontic treatment Extraction teeth Missing lateral After orthodontic treatment Implants crown/bridges incisor
• Treatment planning guard. The surgical obstructions for contact bet The treatment of diastema mediana is done ween the central incisors should be removed in three stages: removal of etiological factors, from the beginning of the orthodontic treatment. active treatment and retention. The mesiodens and the excess teeth are removed The first phase of treatment consists of before orthodontic treatment. For diastema due to removal of the etiological factor responsible for imperfect fusion at midline excision of included diastema mediana. The tongue thrust is remo interdental tissue between the incisors, a flap is ved by educating the patient about this harmful raised interdentally and a fissure inserted gently habit, exercises for correct placement of the ton into the cleft.With the bur, the included tissue is gue during swallowing, with the tip of the ton removed and flap situated. In clinical cases with gue placed on the palate behind the central inci high frenulum insertion, a frenelectomy should sors, prescription ofa vestibular plate and later be the main course of action. The pathological with the use of a tongue guard. The habit of periapical changes in the frontal region should thumb sucking should be removed with the be removed in the first stage of the treatment. assistance of the parent and the simultaneous The second stage of treatment involves prescription of a vestibular plate and thumb active orthodontic treatment and therefore it is The influence of etiological factors in the occurence of diastema mediana 173 known as the active phase. The orthodontic treatment in this phase is done with mobile and fixed orthodontic appliances. Orthodontic elastic for treatment of diastema mediana is the easiest to manage. The elastic loop is stretched bet ween the two central incisors. For the closure of the diastema between teeth with smaller crowns or lower teeth we incorporate ortho dontic elastics with an internal diameter of 1/8" (3.2 mm), and for upper incisors with more prominent crowns we use size 3/16" (4.6 mm) elastics. Simple removable appliances are fin ger springs and labial bows. A finger spring can be given to the two central incisors. A simple Hawleys appliance incorporating two springs Fig. 2 –Fig. Closure 2 Closure of diastema of diastema mediana mediana with withactive active plates, distal to the central incisor can close small Invisalign, Ecligner and Essix diastemas in 3–6 months. The finger spring is made of 0.5 or 0.6 mm diameter wire. A split labial bow made of 0.7 mm hard stainless steel wire applies force to the teeth in reciprocal tooth movement which is equal and opposite and as a result each unit comes to a normal occlusion (Fig. 2). Fixed appliances incorporating springs Fig. 3 Activation of М spring Fig. 3 – Activation of M spring or elastics bring about the most rapid correction of midline diastema. M shaped springs incur porating three helices can be inserted into the two central incisor brackets. The springs are activated by closing the helices (Fig. 3). A section of a canine to canine essix appliance is fabricated from 1 mm essix type C+ plastic in the diastema space. We placed one half of the appliance on each side of midline and extended The third phase of treatment is retention. Most orthodontists recomend long term reten tion using suitable retainers since midline dia stema is considered as easy to treat but difficult to retain. Prolonged retention is indicated in a lingual bonded retainer. Various prefabricated retainers are available that can be bonded to the teeth. There is minimal patient discomfort due to reduced bulk. It is acceptable to most patient Fig. 4 – Retention with metal wires as it is relatively inconspicious. Maybe the best retainer for this purpose is a bonded section of Results flexible wire. The wire should be contoured so The results were statistically processed as that it lies near the cingulum to keep it out of each diagnosed etiological factor for diastema occlusion (Fig. 4). The presence of a peg sha mediana was presented as a ratio from the total ped lateral, or teeth with other anomalies of number of patients diagnosed with diastema shape and size, requires prosthetic rehabilita mediana and expressed in percentage. tion. Missing teeth should be replaced with a The results from our investigation placed fixed or removable prosthesis. in Table 2 show that in 49 patients (49%) the 174 Biljana Kapusevska, et al . etiological factor for diastema mediana was cal factor was the harmful oral habits, 4 (4%) the hereditary factor, in 14 patients (14%) of of the patients were diagnosed high frenulum patients the reason behind diastema mediana insertions. The clinical cases of diastema me was the disproportion and discrepancy in the diana involving pathological objects between dental arch, 11 (11%) of the patients posses central incisors, mesiodens, iatrogenic factors sed diastema mediana because of the inborn or and periodontal disease consisted of 3 (3%) acquired missing teeth, 10 (10%) of the cli from the total number of observed patients nical cases thediagnosed responsible etiologi each.
Table 2
Graduation table of the etiological factors for diastema mediana in percentage
Etiological factor Graduation in percentage
Hereditary factors 49 patients (49%)
Disproportion and discrepancy in the dental arch 14 patients (14%)
Inborn or acquired missing teeth 11 patients (11%)
Harmful oral habits 10 patients (10%)
High frenulum insertion 4 patients (4%)
Pathological objects between central incisors 3 patients (3%)
Mesiodens 3 patients (3%)
Iatrogenic factors 3 patients (3%)
Periodontal disease 3 patients (3%)
Discussion The presence of diastema mediana is From the results of our investigation we particularly noticeable in the population of Nige had the opportunity to compose a graduation ria. This means that the hereditary factors are chart for the frequency of the etiological factors involved in the pathogenesis of diastema medi for the occurrence of diastema mediana. First ana. The diastema mediana shows an autosome on the graduation chart with the largest percen dominant pattern of inheritance [10]. tage of patients were the ones with family pre The term mesiodens refers to a supple disposition or the hereditary factor with almost mentary atypical tooth placed in the midline of half of our patients or 49% of all diagnosed the maxilla between the two central incisors. patients. We determined that the following fre The presence of an unerupted or impacted me quent etiological factor in our population is the siodens between is a predisposition for occu disproportion in the dental arch with 14% of all rance of midline diastema. The mesiodens in clinical cases. A prominent place as etiological most cases is an impacted tooth with conical factor is held by the the inborn or acquired mis shape and one root, most frequently placed in sing teeth in 11% of the patients. The harmful inverted position. It appears more often in the oral habits and high frenulum insertion also maxilla, but in rare instances could appear in shouldn’t be neglected as etiological factors. the mandible. It can be solitary, multiple, unila The etiology of diastema mediana is mul teral and bilateral [11]. ticausal and it is developed as a result of the The maxillary midline diastema is often interaction of the mutual influence from the complicated by the high insertion of the labial combination of multitude of factors [9]. frenulum. The band of strong fibrous tissue of The influence of etiological factors in the occurence of diastema mediana 175 the frenulum is situated between the central inci that derives from oral habits such as thumb sors into the notch in the alveolar bone [12]. sucking, lip biting or tongue thrusting together The discrepancy in which the length of with the incompetent closure of the lip seal the dental arch exceeds the collective width of which is a cause for proclination of the teeth, the teeth from the patient may be responsible and occurrence of midline diastema along with for the occurrence of diasteme mediana. Such generalized spacing. Thumb sucking is a harm conditions could be extractions of permanent ful habit that is characterized by placing the teeth, inborn missing teeth, microdontia, macro thumb or other fingers in various depths in the gnathia and atypically peg shaped lateral inci mouth. Tongue thrusting is a condition in which sors [13]. If the lateral incisors are small, aty during the act of swallowing, the tongue esta pical or absent, the extra space can allow the blishes contact with any teeth anterior in rela incisor teeth to move apart and create a dia tion to the first molars [18]. stema. Microdontia refers to teeth that appear The pathological conditions of the bony smaller in size compared to normal. In this case and soft tissue in the midline in the dental arch the jaw size is normal but the size of the teeth such as cysts, tumors, and odontoms, may alter is small, which produces diastema between the the eruptive path of the central incisors and phy teeth. The congenital absence or extraction of sically displace the incisors laterally, creating any other teeth in the dental arch with appe space between them and diastema mediana [19]. arance of excess space is a sufficient reason for Rapid maxillary expansion may represent the rest of the teeth to move toward the empty a reason for occurrence of diastema mediana space and facilitate the occurance of diastema because of the opening of the intermaxillary mediana [14]. Orthodontic malocclusions such suture. With rapid maxillary expansion, the as incisor rotation and II class Angle interarch dental arch is widened at a rate of 0.5 to 1 mm relationship are also a cause for diastema medi daily or 1 cm expansion obtained in 2 to 3 weeks. ana [15]. The ectopic maxillary canines can be The space created at the mid palatal suture which a factor for diastema mediana. In case of wrong is filled initially by tissue fluids and hemor positioning of the maxillary canines the pres rhage, and this is why the expansion is highly sure needed for closure of physiological dia unstable. The opening of the mid palatal suture stema mediana in the mixed dentition is absent. is fan shaped or triangular with maximum ope The absence of the canines from their appro ning at the incisor region which gradually di priate place in the dental arch facilitates the minishes toward the posterior part of the palate. distalization of the central incisors creating a As a result of this process, incisor separation space between them [16]. Microdontia refers to and a midline diastema are formed. Slow ma the teeth, which are smaller than the average xillary expansion with active plates can not be and it is often accompanied by spacing of the a cause for occurrence of midline diastema due teeth and occurance of diastema mediana, beca to opening of the intermaxillary suture. The use the teeth are smaller in size while the jaw is active plates produce expansion at maximum with normal size. Microdontia is specific for rate of 0.5 mm per week. With this speed, the conditions such as Down’s syndrome and ecto tissue of the mid palatal suture is adapted to the dermal dysplasia. Macrognathia is a growth de gradual activation at the rate of 1 quarter turn velopment anomaly that is characterized with of the jackscrew that activated every week. The abnormally large jaw. In this anomaly the size tissue damage with the slow expansion is re of the teeth is average, but the length of the duced to minimal and that is why there is never dental arch is increased. The occurrence of this an occurrence of diastema mediana. According anomaly is specific for the skeletal abnormal to Moyers the imperfect fusion of the palatinal lities and hormone disturbances such as acro extensions in the middle of the premaxilla is a megaly [17]. common reason for the occurrence of diastema The prolonged harmful habits may alter mediana. The normal physiological palatal su the balance of forces between the lips, cheeks ture on RTG is represented as slight divergence and tongue and become a cause for unwanted between the central incisors in the middle of dentofacial alterations. The external pressure the alveolar ridge in the shape of the letter V. 176 Biljana Kapusevska, et al .
Abnormally opened maxillary suture in the re 11. Robert E. Moyers, D.D.S. Ph.D Handbook of ortho gion of the alveolar ridge between the central dontics, School of Dentistry, University of Michigan. incisors is shaped in the form of the letter W Chicago, 1958. 12. Ѓоргова Ј., Кануркова. Л., Џипунова Б., Тошеска and could be a reason for occurance of dia Спасова Н. Ортодонтска морфолошка анализа и stema mediana. This suture is wider than 2 mm дијагностика. Алфа принт, Скопје, 2012. and is often accompanied with a high frenulum 13. Huang WJ, Creath CJ. The midline diastema: A re insertion [20]. view of its etiology and treatment. Pediatric Dent The loss of periodontal support of the 1995; 17: 171–9. central incisors with bony pockets causes an 14. Reitan K. Clinical and histologic observations on occurrence of midline diastema at a larger part tooth movement during and after orthodontic treat ment. Am J Orthod. 1967; 53: 721–45. of the adult population. The maxillary central 15. Зужелова М. Ортодонција за стручни забни тех incisors are with increased mobility due to the ничари. ,,Цетис принт“. Скопје, 2014. loss of bone tissue and apical migration of the 16. Деребан Н. Естетско згрижување кај пациенти со gingival insertion and with tendency to move diastema mediana. Стоматолошки симпозиум – divergently increasing the mutual distance [21]. ,,Естетска реставрација од конзервативен и про тетички аспект“. Струмица, 2014. Conclusion 17. Campbell PM, Moore JW, Matthews JL. Orthodon tically corrected midline diastemas. A histologic study We concluded that the factors for dia and surgical procedure. Am J Orthodont. 1975; 67: stema mediana are multicausal, ranging from 139–58. genetic inheritance to mesiodens, supplemen 18. Edwards JG. A clinical study: the diastema, the fre tary teeth, abnormal frenulum, teeth arch dis num, the frenectomy. Oral Health. 1977; 67: 51–62. crepancies, harmful oral habits, pathological 19. Edwards JG. A Long term prospective evaluation of objects in the frontal teeth region and iatroge the circumferential Supracrestal fiberotomy in alle nic causes as well as periodontal disease. The viating orthodontic relapse. Am J Orthod Dentofacial Orthop. 1988; 93: 380–7. dominant place is occupied by the hereditary 20. Littlewood SJ, Millette DT. Orthodontic retention: A factors. With regard of the mutual relationship systemic review. J Orthodont. 2006; 33: 205–12. between the causal factors, the treatment of 21. Melrose C, Millett DT. Toward a perspective on diastema mediana should be interdisciplinary, orthodontic retention? Am J Orthod Dentofacial involving orthodontist, oral surgeon and pros Ortho. p 1998; 113: 507–14. thodontist.
Р е з им е REFERENCES ВЛИЈАНИЕ НА ЕТИОЛОШКИТЕ 1. Gurkeerat Singh. Textbook of orthodontics. 2nd edi ФАКТОРИ ВРЗ ПОЈАВАТА tion. Jaypee, 2007. НА DIASTEMA MEDIANA 2. TD, Fоster. A Textbook of Orthodontics, 3rd edition, Blackwell Science, Oxford, 1990. Билјана Капушевска, Никола Деребан, 3. Samir E, Bishara. Textbook of Orthodontics, New Ефка Жабокова Билбилова, Мирјана Поповска Delhi, 2007. 4. http://en.wikipedia.org/wiki/Diastema. Стоматолошки клинички центар 5. WR, Profitt. Contemporary Orthodontics. 4th edition, „Св Пантелејмон“, Стоматолошки факултет, Mosby Inc., St. Louis, MO, USA. Универзитет „Св. Кирил и Методиј“, Скопје, 6. Shobha Tandon. Textbook of Pedodontics, 2nd edi Р. Македонија tion. Paras Medical Publisher, Hyderabad, India. 2008. 7. Thomas M. Graber, Robert L. Vanarsdall, Katherine th W.L. Orthodontics Current Principle techniques, 4 Уште од далечното минато перцепцијата edition, Mosby Inc. St. Louis 2005. 8. SI, Bhalaji. Orthodontics the Art and Science, 4 th за естетска привлечност кај една индивидуа edition. Nizamabad, India. 2012. била намалена поради присуство на растојание 9. Management of Midline Diastema, presented by меѓу двата централни инцизиви. Оваа појава се Sudha Roll no. 72. сретнува под терминот dents du bonheur или 10. Midline Diastema, presented by Dr. Manish Kumar, т.н. среќни заби, а се сретнува и кај светски Bapuji Dental College & Hospital, Davangere. познатите личности, меѓу кои Брижит Бардо, The influence of etiological factors in the occurence of diastema mediana 177
Елија Вуд, Мадона, Зак Ефрон, Ејми Вајнхаус и Од испитуваните пациенти, дојдовме до Елтон Џон. Денес дијастемите се едни од глав сознание дека кај 49 пациенти (49%) генетската ните причини за незадоволство кај стоматолош наследност беше доминантен фактор, а потоа следуваа диспропорции и неусогласености во ките пациенти и потреба од нивно естетско денталните лаци кај 14 пациенти (14%), вроден згрижување. или стекнат недостаток на заби кај 11 пациенти Целта на трудот е да се прикаже влија (11%), штетни орални навики кај 10 (10%), нието нa етиолошките фактори врз појавата на висока инсерција на лабијален френулум кај diastema mediana, класифирајќи ги според доми четворица (4%), а со по тројца (3 %) од случаите нантноста во појавувањето изразена во проценти. беа застапени патолошки промени во фронтот, Материјал во иследувањето ни претста mesiodens, јатрогени фактори и присутна паро вуваа 100 пациенти со diastema mediana причи донтална болест. нета од следниве фактори: наследност, неусо Од испитувањето заклучивме дека поја гласеност во денталните лаци, вроден или стек вата на diastema mediana е од мултифакторија нат недостаток на заби, штетни орални навики, лен карактер, при што доминантно место за висока инсерција на лабијален френулум, како и земаат генетските фактори. Имајќи предвид на мезиоденс. По поставување дијагноза и евалуа заемното дејство на многуте фактори во наста ција на етиолошкиот фактор за настанувањето нувањето на diastemа mediana, дијагнозата треба на diastema mediana, беше донесен терапискиот да биде донесена конзилијарно, а клиничкото пристап во смисла на отстранување на етио згрижување да биде мултидисциплинарно, вклу лошкиот причинител уште од најрана возраст и чувајќи ортодонт, протетичар и орален хирург. продолжување со ортодонтски третман. Заврше токот на ортодонтската терапија честопати е Клучни зборови: diastema mediana, етиолошки фак почеток на протетичката. тори, вистинска дијастема, физиолошка дијастемa.