Updated: December 2018
Being aware, and being worried about, a gap between your two front teeth is quite common and will affect about five percent of the population. There are quite a lot of differences between various racial groups.
A midline gap is also known as a midline diastema. A midline diastema is defined as a gap of more than 0.5 millimeters between your two front teeth. This gap is generally all the way from the gum line to the tip of the teeth. There are cases where the teeth are meeting proper properly at the biting surface, but near the gum line there is a gap – but this is not classified as a midline diastema.
At some point, everyone during the developmental stage of teeth eruption will have a midline diastema. This usually occurs in the early or preteen years of teeth eruption and teeth development. A gap of two millimeters or less at this stage will usually close up when the permanent upper canine teeth start to come through and start to push the front incisors back towards the midline, hence the midline diastema will be eliminated over time. In some patients, this midline diastema doesn’t fully close and it will remain throughout the adult life.
There is another common scenario also, where someone does not have a midline diastema but one starts to appear later on in their adult life. For these cases, it is important to identify the reason why a midline diastema has appeared or seems to be increasing in size. The most common reason is that the front teeth are starting or have moved slightly forward or have inclined forward. When the two front teeth or the front teeth incline forward, this will create a natural gap between the two front teeth. Gaps will also occur on all the front teeth as well.
In these cases, it is important to identify the reason why a midline gap has appeared because if you treat the midline gap and cover this gap, it could get bigger if the underlying cause is not identified and addressed. Probably the two most common reasons of why a midline gap is increasing are gum disease and bad habits. If you have noticed that your gap between your two front teeth is increasing, the most likely cause will be underlying gum disease. It is important to have the extent of the gum disease diagnosed properly so that treatment can be started. If treatment is not started, the midline gap will get larger but more importantly you could end up losing your front teeth due to the gum disease.
There are a number of treatment options for treating midline diastema. It is important to add that a midline diastema is almost always on the upper teeth and not very often in the lower teeth. Even if there is a midline diastema in the lower teeth, it is usually not much of a worry for a patient because the lower lid usually hides the gap; and therefore the patient is usually not conscious of it. The quickest and easiest way to address a gap between your two front teeth, is simply just to accept the gap as it is. It can also be that in some cultures, a middling gap is actually desirable and there are certain cultures and races where they even try to make a gap between the two front teeth even larger than what it actually is. So one of the options in a scenario where you have a midline gap, is simply just to accept the gap as it is.
Have a look at the section on ‘Having cosmetic dental treatment close carried out’. Often, the reason for having a midline gap filled in is because somebody else has mentioned something and now you feel conscious about it. So before you even decide to have anything done, it is important to be clear in your own mind why you want to have the gap closed and if it’s the right choice that you are making.
A dental retainer can be used to keep the gap as it is but also to prevent it from getting bigger. If you feel that the gap is not an issue for you at the moment, but you don’t want the gap to get bigger, this is the best and easiest way to make sure that the gap does not get bigger. A dental retainer is a bit like a clear gum shield, which is obviously much thinner than a normal gum shield and it is worn just at night in order to make sure that your front midline gap does not get any bigger. It’s very easy to have a retainer made as your dentist will simply take an impression of your teeth and send it to an orthodontics dental laboratory for about a week or two later. You can then go back to your dentist who will simply give you the retainer to use at night. The advantage of this method is that it is non-invasive, relatively cheap and simple and doesn’t involve active treatment.
Dental bonding can be used to close a midline diastema. Dental bonding is a way of using an aesthetic dental filling material which can be added on to the existing enamel of your teeth in order to close the midline diastema. Enamel has a property which allows it to be conditioned using an acid gel and bonding agent, which allows a tooth coloured filling material to bond onto the tooth. It can be done, without the need for any drilling whatsoever. However, in some cases, it is usually necessary to slightly roughen the surface of the enamel where the new tooth coloured filling material will be bonded in order to close the midline diastema. This roughening is easily carried out without an injection and it is quite quick and painless.
In other cases, it is usually necessary to grind or take back some of the enamel, before using a tooth coloured filling in order to close the midline gap up. The tooth filling material used is called dental composite. There are many different subtypes of dental composites, such as hybrid composites, micro filled composites, composites with glass ioniser inside them, and these are just a few examples of the vast number of dental composites that are available to the dentist.
My view is that it is not the exact type of composite that will determine how good the final result will look, but the actual skill of the individual dentist in using the material in order to get the best aesthetic result. In this regard, it is important to be confident in your dentist’s abilities to carry out this type of aesthetic dental treatment. The advantages of dental bonding in order to close a midline diastema are that it is minimally invasive and can be carried out in one visit.
Dental bonding however does have some drawbacks or disadvantages. Firstly, it can be difficult to get an exact match of the dental bonding composite material to the shade of your natural enamel. Everyone has their own unique colour of their natural tooth enamel and there are only a limited number of shades of a particular dental material available. Sometimes, it becomes impossible to provide an exact colour match. Another disadvantage of using composite to close a midline diastema, is that the dental composite material will discolour over a period of time as the variation can be huge. It can discolour in a short period of time of a few months if you are a heavy smoker, or drink a lot of tea and coffee, it can last for many years if you don’t have any habits that discolour your teeth, and you look after them by a good cleaning regime.
Composite material can also be weak or fragile in thin sections, so you have to be careful in not biting anything hard on the two front teeth once the midline diastema has been closed using dental composite bonding material. If a little bit does chip away, the advantage is that you can simply go back to your dentist who will just repair the chip and it is not necessary to replace all of the work again.
Another possible disadvantage of a dental bonding composite in order to close a midline diastema is that there will always be disjunction of your natural tooth and the composite material which has just been placed. Although there are particular ways to hide or camouflage disjunction, such as using a long bevel, the junction cannot always be totally hidden and again this depends on the individual skill and experience of the dentist.
However in summary, dental bonding using an aesthetic dental composite material, can be an extremely effective and expedient way to get rid of midline diastema. This method is only suitable where the gap is no more than two to three millimeters, because otherwise the two front teeth will look too big in relation to the remaining teeth and therefore it won’t look natural even though the gap will have been filled in.
Dental veneers can be used to close midline diastema. Broadly speaking, dental veneers can be made out of a composite material or they can be laboratory fabricated using dental porcelain. The general advantages of using them to close a middling gap, is that it is relatively quick to use- in only two visits, and the result is almost instantaneous. The disadvantage is that some removal of your existing healthy enamel will be required in order to place the veneers over the tooth to close the midline diastema.
Dental veneers also do not last a lifetime and will require replacement every 10 to 15 years. In addition, dental veneers can shape or break off or discolour around the margins. This is a problem, because then the dental veneer will need replacing. If your midline diastema is large, it sometimes will not be a good idea just to place the veneers on your two front teeth only, but to get all the proportions correct then it may be necessary to use 4, 6 or even 8 veneers in total. The reason for this is that if the gap is quite large, just placing two veneers at the front will make your two front teeth really big and you risk being called Bugs Bunny when people see you with your new veneers; which have closed the gap, but in the process your teeth now look too big.
When dental veneers first came out, it was a massive breakthrough in cosmetic dentistry, as it was considered non or minimally invasive compared to the traditional treatment of having your teeth capped or crowned. Certainly, dental veneers were far more preferable then full jacket crowns.
Before the advent of dental veneers, a midline gap could realistically only be closed by placing crowns on your front teeth. Also, adult dental orthodontics and the new type of dental bonding techniques were not generally available. So the only option was to provide dental crowns for your front teeth in order to close the midline gap. Sometimes, it is even necessary to carry out an elective root canal treatment and use crowns in order to realign and close the gap between your two front teeth. Although at the time it was an accepted method of treatment, now we know that it is very destructive in the long term and not a very satisfactory aesthetic method to close midline diastema.
Dental veneers can be made out of composite or porcelain. Although the vast majority of dental veneers are made out of porcelain comma a composite material can also be used. A composite material has the advantage that the dentist will bond composite as a veneer over the enamel of your front teeth and this can be carried out in one visit. It is cheaper in terms of cost and it can be done in one visit only for. There are problems however, a composite veneer will not last as long as a porcelain veneer; and also composite Valley veneer will discolour far more easier than a porcelain veneer.
Porcelain veneers can be used to close midline diastema by bonding porcelain veneers onto your two front teeth in order to close up the midline diastema. The results can be quite astounding, and no one can even tell that you have had treatment done on your two front teeth or that you even ever had a gap between your two front teeth. Dental veneers however, are not minimally invasive in most cases because the porcelain used, although it is very thin, it still has a certain thickness which must be taken into account when placing the veneer over your own natural teeth.
If say the porcelain veneer is 0.5 millimeters thick, a corresponding amount of 0.45 millimeters must be removed from your natural tooth. A natural front tooth will have about 2.5 or two millimeters of enamel thickness. By removing that 0.5 millimeters, you are effectively removing a quarter of the thickness of the enamel that was always present on your front teeth. Removing a quarter of your natural enamel can be done without an injection as enamel has no nerves.
The problem arises when a dental veneer requires to be replaced after a certain number of years either due to discoloration, or general wear and tear, or chipping. This procedure involves removing the old veneer, but then also totally removing the bonding substance used to bond the porcelain veneer onto the underlined enamel. It is not easy for a dentist to differentiate between the dental bond and the natural enamel, and so another layer of thickness of enamel may be removed compared to the initial tooth preparation. So if before this was done when you originally had the treatment carried out, the enamel thickness was two millimeters, and after the veneer preparation has been carried out it was reduced to 1.5 millimeters, when the veneer is replaced, you could have another 0.5 millimeters of enamel taken off. The new dental veneer preparation is now only one millimeter compared to the original two millimeters. This means you have now removed half of the all natural protective tooth enamel.