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 Table of Contents  
Year : 2019  |  Volume : 53  |  Issue : 1  |  Page : 90-91

Correction of relapsed midline diastema

Prof., Department of Orthodontics, Mahatma Gandhi College of Dental Sciences, Jaipur, Rajasthan, India

Date of Submission22-Oct-2017
Date of Acceptance13-Mar-2018
Date of Web Publication04-Feb-2019

Correspondence Address:
Dr. Abhishek Kshetrapal
Department of Orthodontics, Mahatma Gandhi College of Dental Sciences, Sitapura Institutional Area, Jaipur, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jios.jios_225_17

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Relapse of the midline diastema is one of the most common postorthodontic complaints. Although numerous methods have been cited in literature, we propose an easy, time-saving, cost-effective, and reliable method for its correction using an elastomeric ring separator.

Keywords: Correction of midline diastema, midline diastema, relapse

How to cite this article:
Kshetrapal A. Correction of relapsed midline diastema. J Indian Orthod Soc 2019;53:90-1

How to cite this URL:
Kshetrapal A. Correction of relapsed midline diastema. J Indian Orthod Soc [serial online] 2019 [cited 2019 Apr 26];53:90-1. Available from: http://www.jios.in/text.asp?2019/53/1/90/251548

  Introduction Top

Midline diastema, though a common problem,[1] is extremely annoying to most people, especially when it reappears in patients who have completed their orthodontic treatment.[1]

In general, the most popular form of retention for midline diastema cases is indefinite fixed retention.[2] Sometimes, there are breakages in fixed or removable retention which goes unnoticed by the patient. The patient only realizes after there is a visible opening of the midline space.

There are many options available for correction, namely, removable appliance, fixed appliance, elastics, composite build-up, veneers, and brass wire.[3],[4]

Here, we suggest a fast and effective way of closure of the relapsed diastema [Figure 1]a with the use of elastomeric ring separator for diastemas 1–1.5 mm wide.
Figure 1: (a) Pre-treatment, (b) Separator placed, (c) Post-treatment, (d) Fixed retainer in place

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  Procedure Top

The patient is examined to measure the amount of diastema space. This method is ideal to close diastemas up to 1.5 mm. Check the effect of digital pressure on the two central incisors by pushing them toward each other, by applying pressure on the distal surfaces of both the incisors. If this shows some reduction in space, then an elastomeric ring separator can be used to close the space.

A proper separator placing plier is selected; it should have maximum beak separation more than 18 mm (as the average mesiodistal dimension of maxillary central incisor is 8.5–9 mm).

Then, an elastic ring separator is taken and prestretched 2–3 times to reduce the amount of force generated. Then, it is threaded in the distal embrasures of both the central incisors [Figure 1]b. Within minutes, closure of the midline space is seen. Next, the palatal surfaces of the incisors are etched and a fixed retainer is bonded. The flexibility of the elastic separator allows the operator to apply and contour the composite properly to the palatal surface. After bonding, the separator is removed using an explorer. The whole procedure can be completed in 15–20 min [Figure 1]c and [Figure 1]d.

  Discussion Top

Many different techniques have been used for correction of relapsed midline diastemas. One such single sitting space closure technique using brass wire[3] has been suggested in literature. However, use of brass wire makes the procedure more traumatic[5] with chances of gingival lacerations; moreover, the threading and tightening of brass wire is often uncomfortable to the patients.[5] Correction using elastomeric ring separators followed by stabilization with fixed retainer is a reliable, easy, time-saving procedure, especially for relapsed diastema space up to 1.5 mm.

  Conclusion Top

The main advantage here is the short procedure, time saving, and cost-effectiveness.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Shashua D, Artun J. Relapse after orthodontic correction of maxillary median diastema: A follow-up evaluation of consecutive cases. Angle Orthod 1999;69:257-63.  Back to cited text no. 1
Proffit WR, Fields HW, Sarver DM. Retention, in Contemporary Orthodontics. 5th ed. St. Louis: Elsevier; 2013. p. 754.  Back to cited text no. 2
Tanaka OM, Clabaugh R 3rd, Sotiropoulos GG. Management of a relapsed midline diastema in one visit. J Clin Orthod 2012;46:570-1.  Back to cited text no. 3
Kamath MK, Arun AV. Midline diastema. Int J Orthod Rehabil 2016;7:101-4.  Back to cited text no. 4
  [Full text]  
Sandhu GP, Kanase A, Naik CR, Pupneja P, Sudan S. Separation effect and perception of pain and discomfort from three types of orthodontic separators. J Ind Orthod Soc 2013;47:6-9.  Back to cited text no. 5


  [Figure 1]


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