Download `M` Mechanics for the Management of Maxillary Midline Diastema

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10.5005/jp-journals-10021-1163
CASE REPORT
‘M’ Mechanics for the Management of Maxillary Midline Diastema
‘M’ Mechanics for the Management of
Maxillary Midline Diastema
1
Anand Pramod Sondankar, 2Nitin Gulve, 3Sheetal Patani
ABSTRACT
Maxillary midline diastema is commonly occurring malocclusion. Variety of treatment modalities are suggested for the management of
diastema. This article presents a case report in which 14-year-old female patient was treated for the maxillary midline diastema of size 3 mm
after extraction of supernumerary tooth between upper central incisors. The index of orthodontic treatment was mild (Grade 2). MBT 0.022''
brackets were bonded on the maxillary central incisors. M spring was fabricated, activated and ligated initially with round archwire followed
by rectangular archwire. Successful closure of diastema was seen with total treatment duration of 4 months. This method is efficient,
effective, require less inventory. This saves precious chairside time of orthodontics and reduces treatment duration as well.
Keywords: Malocclusion, Diastema, Archwire, Bonding, Brackets.
How to cite this article: Sondankar AP, Gulve N, Patani S. ‘M’ Mechanics for the Management of Maxillary Midline Diastema. J Ind Orthod
Soc 2013;47(4):229-231.
INTRODUCTION
Maxillary midline diastema (MMD) is a relatively common
dental malocclusion characterized by a space between the
maxillary central incisors, with functional and esthetic
consequences. Based on the linear measurement of a diastema,
a wide range of prevalence values has been reported—from 1.6
to 25.4% in adult populations, and even higher in younger
groups.1-3 The literature strongly supports racial differences in
the distribution of the trait, with blacks demonstrating
consistently higher prevalence values than whites, Asians or
Hispanics.2,6
Numerous etiologies have been proposed for MMD,
including tooth size or jaw size discrepancies, aberrant labial
frenum attachments, parafunctional habits, tooth loss,
periodontal disease, deep bites, and maxillary midline
pathologies, such as supernumerary tooth.4-8 There have been
reports of self-inflicted pathological cases of diastema caused
by tongue piercing.4
The treatment include identification and removal of etiologic
factor followed by various modalities, such as orthodontic tooth
movement, restorative procedures with esthetic composite,
1
Postgraduate Student,
2,3
Professor and PG Guide
1-3
Department of Orthodontics and Dentofacial Orthopedics, MGV’S
KBH Dental College, Nashik, Maharashtra, India
Corresponding Author: Anand Pramod Sondankar, Postgraduate
Student Department of Orthodontics and Dentofacial Orthopedics,
MGV’S KBH Dental College, Nashik, Maharashtra, India, e-mail:
[email protected]
Received on: 5/12/12
Accepted after Revision: 14/5/13
prosthetic management of space with porcelain jacket crowns,
laminates.
MATERIALS AND METHODS
This article presents a case report in which the midline diastema
was managed with simple M shaped sectional archwire
mechanics.
A 16-year-old female patient presented with supernumerary
tooth between the upper central incisors (Figs 1 and 2). After
extraction of the supernumerary tooth maxillary midline
diastema of size 3 mm was evident.
Treatment Objective
Patient was reluctant for complete orthodontic treatment and
severity of malocclusion according to IOTN was mild
(Grade 2). So management of midline diastema only was the
prime focus.
Method
Diagnostic records were made. The treatment was initiated by
bonding two preadjusted edgewise brackets 0.022" × 0.028"
MBT prescription on the labial surfaces of upper central
incisors. The M coil spring was fabricated initially with 0.016”
round Australian orthodontic premium grade wire as shown in
the Figure 3.
M spring was designed with 3 round loops of diameter 3 to
4 mm, one at the center and two at the periphery. Care was
taken so that it should not interfere the labial sulcus and other
soft tissues. The spring was activated as shown in Figures 4A
and B. After activating spring, it was ligated to the brackets.
The Figure 4B shows the direction of forces generated. Round
The Journal of Indian Orthodontic Society, October-December 2013;47(4):229-231
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Anand Pramod Sondankar et al
Fig. 1: Pretreatment intraoral photographs with mesiodens
Fig. 2: Pretreatment OPG
Fig. 3: M spring with 0.016'' round Australian orthodontic premium
grade archwire
Table 1: Torque expression
Archwire
RESULTS
0.016" × 0.22" SS
0.019 × 0.025" SS
Upper incisor to NA
(angle in degrees)
24
22
Upper incisor to NA
(linear distance)
5 mm
4.5 mm
Upper incisor to SN
(angle in degrees)
103
101
archwire allowed free tipping of the incisors and the space
was closed.
The roots of the maxillary incisors were divergent at the
end of tipping. To upright the roots the spring was refabricated with the same design with 0.016" × 0.022" stainless
steel rectangular archwire for the better torque control and
root parallelism.The activation was done as shown
previously.
After the uprighting of the roots 0.019" × 0.025"
segmented stainless steel archwire was tightly ligated for a
month to assist for the better torque control (Table 1).
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Clinically closure of diastema was evident. The overjet and overbite were average. The periapical radiograph shows almost upright
roots with good contact point at the incisal two-third (Fig. 5).
DISCUSSION
The mechanics combined Beggs philosophy of tipping of the
teeth with lighter forces with the round archwire followed by
use of preadjusted edgewise mechanics for root uprighting and
torque control with rectangular archwire.
The light wire technique enables teeth to be moved by being
simply tipped. It does not cause pain, does not damage tooth
roots or tooth investing tissues while preadjusted edgewise
brackets with rectangular wires controls the torque and root
uprighting.9,10
The time required for closure of diastema with tipping was
about 2 months. The 0.016" × 0.022" stainless steel wire and
0.019" × 0.025" stainless steel wire were ligated, each for
1 month. Total treatment duration was 4 months. The mechanics
JIOS
‘M’ Mechanics for the Management of Maxillary Midline Diastema
Figs 4A and B: M spring: (A) activated, (B) forces generated after
engagement in brackets
Fig. 5: Periapical radiograph with near parallel roots
Fig. 6: Postretention stability after 2 and half years
is definitely time saving as compared to treatment solely with
either light wire technique; which may need different auxiliaries
for control of root position; or preadjusted edgewise technique
where friction is encountered, both of which may increase total
treatment time.
Treatment Progress
The case was debonded after uprighting of the roots of both the
central incisors. The fixed retainer was bonded on the lingual
aspect of the two incisors. The patient was referred to
prosthodontist for reshaping of incisal edge of right central
incisor for better esthetics. The Figure 6 shows 2 and half years
postretention stability.
CONCLUSION
This is a novel way of treating the case of maxillary midline
diastema. It requires minimum inventory and less chairside
time. Treatment duration is also reduced and the results are
stable.
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