Modern-day dental patients consider front tooth gaps to be unsightly. Fortunately, this issue can be addressed through orthodontics and other disciplines in dentistry. Your preference for cost, treatment timeframe, degree of tooth preservation and other factors will determine the most suitable form of treatment. This article provides a general overview of these factors as they relate to procedures offered under the orthodontic, cosmetic, and prosthodontic specialties in dentistry.
Causes of Tooth Gaps
A diastema has many causes. It can be caused by teeth that are too small in proportion to the jaw bone, allowing space to be created. It can also be caused by missing teeth or severely undersized teeth that allow the adjacent teeth to spread out and leave open spaces between the other teeth. Usually, this is the cause of a gap between front teeth, or a midline diastema.
Another cause is a labial frenum that is oversized. This little piece of tissue is normally located from just inside the upper lip to area above the two front teeth. When the tissue does not stop there and grows past into the area between the two front teeth, a space is created.
Patients who suck their thumbs can also have a diastema, since this habit often pulls the front teeth forward, creating a gap between them. People with tongue thrust, who push their tongue forward against their teeth when they swallow are also susceptible. Even gum disease can cause spaces to open up between the teeth. Because gum disease loosens the teeth and causes supporting bone loss, patients suffering from this might find that space between the teeth opens up as a result of the movement of the teeth.
Children often present with spaces between the teeth. For most children, a diastema is a temporary condition that happens as they lose their milk teeth and wait for their permanent teeth to grow out into the right positions
Orthodontic Treatment with Braces
Braces are a very common choice for correction of gaps between the front teeth. Metal brackets are cemented on the tooth’s surface and an arch-wire is used to initiate deliberate movement of the teeth. Conventional braces are bonded to the facial surface of the tooth while lingual braces can be hidden away behind the teeth. In either case, there is a time period of adjustment before the patient gets used to the orthodontic appliance itself – eating, speaking, and oral hygiene can all be impacted.
The introduction of clear aligners like Invisalign has dramatically altered patient perceptions of orthodontic treatment and has made hygiene much easier. Braces are the ideal form of treatment when only modest investment ($3000-$7000) is desired. The trade-off is that you must wear them between two to three years (on average), followed up by the use of retainers. The type of brackets used (ceramic or metal), the securing mechanism of the archwire, and the placement configuration of the brackets all factor into the cost.
The severity of the case at hand is also a major contributor. In that regard, the total cost of treatment may far exceed the standalone cost of the orthodontic appliance. Additional expenses that may be incurred during the course of treatment include wisdom tooth extraction, impacted tooth exposure and dental implant/crown placement (in the case of missing teeth). It is critically important that you understand the full extent of any smile imperfections so you can choose a treatment within your budgetary and time constraints. A consultation with a competent orthodontist will establish proper expectations for treatment.
Enhancement with Cosmetic Dentistry
Cosmetic dentistry offers a number of options at different price points to correct an anterior tooth gap:
• Tooth bonding – White composite material is applied to the existing tooth structures to hide the gap. The material can be color-matched to the existing tooth and can be polished to a natural shine. This procedure is inexpensive and can last for several years with good care.
• Porcelain veneers – Veneers are porcelain shells that are bonded to the teeth to correct imperfections. They are more durable (life expectancy of upwards of 15 years) than composite veneers and stain-resistant. The preparation process is more intricate and considerably more healthy tooth structure needs to be removed. Veneers are costly and often exceed $1,000/tooth. To correct a front tooth gap, at least two veneers should be placed so color changes in the adjacent teeth do not enhance the contrast between the restorations and natural teeth.
• Dental Crowns – Crowns are similar to veneers but encase the entire tooth structure. They should be reserved for teeth that have succumbed to decay or significant trauma as the requisite degree of tooth alteration is high. For the front teeth, all-ceramic crowns are most ideal. These average approximately $1,400 per tooth.
• Dental Bridge – A dental bridge can be used to replace a missing front tooth, effectively closing a gap. A bridge is anchored in place by the adjacent teeth, which are outfitted with crowns. This is the least conservative cosmetic option and costs upwards of $4500.
Frenectomy – This procedure may be indicated to remove excess labial frenum tissue that may have caused your front tooth gap.
Assessing Your Options
Deciding upon the best course of treatment can only be done after thorough consultations with an orthodontist, cosmetic dentist and any other specialists that may be implicated in treatment. Rank the most important elements in your treatment experience and see where each of the above treatment options falls. Only then can you make a sound decision.
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Huang WJ, Creath CJ. The midline diastema: a review of its etiology and treatment. Pediatr Dent. 1995; 17(3):171-179. http://www.aapd.org/assets/1/25/Huang-17-03.pdf. Accessed February 4, 2018.
Viswambaran CM, Londhe MGSM, Kumar MV. Conservative and esthetic management of diastema closure using porcelain laminate veneers. Med J Armed Forces India. 2015; 71(2):581-585. doi: 10.1016/j.mjafi.2014.08.014.