Gap between teeth. Causes of appearance and treatment methods.
Gap between teeth
, dentists call it diastema, can appear anywhere in the dentition and at any age.
However, patients are usually worried about the gap between the front teeth
, since many consider this feature unaesthetic.
It’s really better to show the diastema to the dentist, but not because of its external unattractiveness (many even consider it the highlight of a smile), but because this gap can expand over time and lead to objective inconvenience. the diastema between a child’s baby teeth
false because it can disappear when the teeth are replaced with permanent ones. Dentists consider the gaps between permanent teeth to be true, and they recommend paying close attention to them.
Background - total dental prosthetics
Doctors at the Family Dentistry performed very complex work on dental prosthetics with ceramic crowns, some of which were installed on dental implants (read more about this work here). Total prosthetics was performed - all 28 of the patient’s teeth were restored with ceramics. At the same time, the bite, facial proportions, length and inclination of the teeth were changed. Which, accordingly, required adaptation of the patient’s neuromuscular system to new conditions. The temporomandibular joints, the muscles of the lips and tongue, and the muscles that move the lower jaw and neck had to accept the new teeth and adjust to working with them. Usually such adaptation occurs without problems within a short period of time. But in some cases, muscle tone and a certain activity inherent in the muscles before prosthetics remain after prosthetics and spoil the achieved result.
Compare the situation before and after prosthetics using the most modern Astra Tech dental implants and the most modern E.max restorative ceramics:
The excellent results of prosthetics are obvious. But almost immediately after dental prosthetics, the attending physician Tsukor S.V. I noticed a trend - the lower front teeth have moved slightly apart. At the same time, the position of the remaining teeth remained stable.
How to prevent a gap in a child: prevention of diastemas
Diastema rarely occurs due to external causes, so it is difficult to prevent its occurrence. But in any case, it is important to follow the rules in order to notice violations in the early stages:
- regularly visit a doctor, both a dentist and an orthodontist;
- wean the child from thumb sucking and other objects;
- Eat well, including in your diet the required amount of foods with calcium, magnesium, fluorine, phosphorus, vitamins D, A, C.
The earlier the diagnosis is made, the easier it is to solve the problem. In adulthood, prevention consists of visiting a doctor in a timely manner and wearing braces, if required. It is also important to immediately restore lost elements of the dentition using implants or “bridges.”
Observation after dental prosthetics
The doctors took the situation under observation and met with the patient a few months after the completion of dental prosthetics. It was clear that the movement of the teeth continued. The result got worse. The lower front teeth have moved further apart and shifted. Aesthetics were lost, gaps appeared between the teeth, where tartar immediately began to form, and the gums became inflamed.
Type of teeth during observation:
Ultimately, we saw this picture - gaps between the teeth:
At Family Dentistry, we work with complex cases and provide support to patients throughout their lives and beyond.
We began to understand the reasons for the possible movement of teeth. Most dentists believe that they work with immobile teeth. But some very good specialists know that the teeth and bones of the skull are not motionless. And only a few good dentists know that teeth are immobile and know how to work with it.
Why does thorotoanomaly occur?
Most often, the tooth is forced to take a pathological position due to lack of space in the jawbone due to macrodentia (large teeth in relation to the bone) or an excessively narrow jaw. In this case, it tends to turn around so as to take up as little space as possible, and the minimum will be achieved when turning at an angle of 45°. But pathology arises not only due to the primary lack of free space.
- The crown can rotate in the socket due to constant pressure exerted on it from the side or below, either by a supernumerary tooth, or by complete “neighbors” that erupt not entirely physiologically - for example, with a delay.
- Quite often, erupting permanent teeth unfold due to the persistence of the milk teeth that precede them. If during the period when baby teeth fall out, the “old” one is in no hurry to fall out, then the “new” molar will have to bypass the obstacle, deviating to the side or turning around the vertical. Pathology can be avoided by timely removal of worn-out milk teeth.
- Sometimes the cause of non-physiological tooth eruption is a dental follicle that is incorrectly formed during pregnancy or in early infancy.
- Often a permanent tooth rotates as a result of a mechanical injury received by a child at the stage of changing the primary bite to a permanent one.
Participation of a speech therapist in dental treatment
Considering the situation from all sides, the doctors paid attention to the position of the woman’s tongue. The fact is that normally, the pressure of the tongue from inside the mouth should be directed to a certain point on the palate. With the loss of teeth, their wear, malocclusion, and for a number of other reasons, the tongue begins to put pressure not on the palate, but on the teeth from the inside. The tongue is a powerful muscle that can develop pressure up to 500 g. This pressure is enough to force the teeth apart. Normally, the pressure of the tongue is partially or completely balanced by the muscles of the lips. Myodynamic balance occurs at rest and during function (eating, swallowing, speaking, etc.). With muscular balance, the teeth stand exactly for years and no deformations occur. If the deformity progresses, it means that the pressure of one muscle dominates, causing the teeth to shift. In this case it was language.
The Family Dental Clinic employs a neuromuscular therapist with a primary specialty of speech therapist, T. B. Tsukor. She knows everything about the work of the tongue, lips and facial muscles. It was she who was approached by an orthopedic doctor in order to solve the issue of tongue dysfunction and help the patient.
After analyzing the situation, the speech therapist came to the conclusion that the tongue is really to blame for the fact that the teeth are moving apart and the gaps between the teeth are increasing. The tongue pressed from the inside incorrectly - not on the front of the palate, but on the lower teeth. This situation with the incorrect position of the tongue had happened before and arose as a result of the patient’s difficult situation associated with the absence of many teeth and bite deformation. The bite was corrected, but the tongue muscles continued to work in a dysfunctional mode. The doctors were faced with the task of dealing with the dysfunction in order to stabilize the situation. An examination by our special and very rare speech therapist-neuromuscular therapist revealed weakness of the patient’s lower lip. This became an additional factor in aggravating the deformity, since the lip did not provide the necessary resistance.
Speech therapist's appointment:
The speech therapist, having conducted an examination and identified the causes of the incident, passed on the information to the treating prosthetist. The speech therapist offered the patient a set of exercises to normalize the position of the tongue and strengthen the lips. The complex included exercises for the lips, for the tongue, for developing a directed air stream, and for producing sounds. The patient performed this complex at home with periodic control conversations with a speech therapist via Skype. Skype checks made it possible for the patient not to come to the clinic and saved her time and effort. Classes with a speech therapist via Skype are a valuable opportunity that Dial-Dent provides to its clients. The patient performed the exercises exactly as prescribed. This is very important to achieve results. The teeth stopped moving apart, and the situation stabilized. But the initial result was already lost, and doctors had to decide how to return the lower teeth to their previous positions.
Features of diagnosing dental anomalies
The diagnosis is made even if the tooth is rotated only a few degrees around its axis. Cases of turning at an angle of up to 45° are classified as minor, and all others are classified as significant. The maximum rotation angle of the dental crown is 180°.
To diagnose and develop a pathology correction program, the patient may be prescribed:
- X-ray of the problem area;
- orthopantomogram, which allows assessing the quality of tissue;
- anthropometric analysis, during which, using specially prepared models of the patient’s jaws, the parameters of the components of his dental system are determined and their relationship is analyzed.
Diagnostics makes it possible to identify the cause of tortocclusion and develop a treatment program that corresponds to the degree of its severity and the condition of the dental tissues. When the teeth are rotated by 10–20°, they resort to straightening the teeth with braces, a trainer or a plate. When the angle is 20–40°, special orthodontic devices based on a spring arch and elastic rings are used. In even more complex cases, orthodontic treatment is combined with surgical treatment.
Teeth straightening with aligners
Re-prosthetics in this situation would be very expensive, since it would be necessary to replace 4 ceramic crowns on the lower front teeth. This method is quick but expensive and does not truly move the roots. By replacing the crowns, we seem to mask the situation. In the end, a different decision was made!
Using the most modern computer developments from the 3DSmile company, we have produced special mouth guards for the lower jaw. Mouth guards for straightening and moving teeth according to a given program. The mouthguards are hard. Each aligner is programmed with minimal tooth movement. Each mouthguard must be worn for 2 weeks. Analysis using special software showed that in order to set the teeth back, remove the gaps between them and return the teeth to the correct position, eight aligners are needed, which must be worn sequentially one after another.
Type of mouthguard on teeth:
The trays on the teeth are almost invisible. They must be worn 23 hours a day. But for meals and in emergency situations, the mouth guard can be removed. This creates additional convenience for the patient.
Alignment with aligners returned the original treatment result!
View of teeth at the beginning of treatment with aligners and after treatment with 3DSmile aligners:
Types of diastemas
There are many types of diastemas. They are mainly classified according to the following features:
- False or true. False diastema occurs in children and is considered a type of normal. It disappears on its own after changing the bite. The teeth are not harmed. True diastema is permanent and requires treatment.
- Symmetry. There is a symmetrical cleft, in which the incisors have the same shift relative to each other, and an asymmetrical one, when one of the front teeth occupies the correct position, and the second is shifted. The latter is the most dangerous, because it disrupts the correctness of the dentition.
- Direction of the vertical axis of the incisors. It can be lateral, when the roots are parallel and the crowns diverge, corpus, if the tooth moves along with the root, and medial, when the incisors grow to the side or rotate around their axis.
False and small symmetrical diastemas are practically safe. The first will disappear on its own, the second is just a cosmetic defect. If the position of the tooth root is disturbed or the gap between the incisors is too large, it is better to consider treatment options.
