ABSTRACT
Introduction:
The space between two central incisors is called diastema. It is aesthetically very unpleasant to the patients. Besides, this it may be a sign of underlying pathology. So proper research about diastema is necessary. This study has been carried out in Dr. R. Ahmed Dental College and Hospital as no such study has been conducted in Eastern India so far.
Materials and Methods:
1000 samples were taken randomly (500 males and 500 females) from the OPD of Dr. R. Ahmed Dental College and Hospital to calculate prevalence of diastema, its male female variation, location and etiological distribution. Clinical and radiological examination has been done. Data were calculated and statistically analyzed.
Results:
The Prevalence of midline diastema was found to be 5.9%. Prevalence in males is 4.4% and in females is 7.4%. It is present bi-dentally in 49.15%, in maxilla 38.98% and mandible 11.86%. The various etiologies are habits (28.81%), dentoalveolar disproportion (23.72%), high frenal attachments (18.64%), missing laterals (11.86%), microdontia (11.86%), supernumerary tooth (5.08%), etc. There was no statistically significant gender variation among etiologies.
Conclusions:
Females are having more diastema than males. It is more common in bi dentally. Habit is the most common causes of midline diastema.
KEYWORDS: Dento-alveolar disproportion, high labial frenum, mesiodens, midline diastema, oral habits, peg laterals
INTRODUCTION
Facial balance and midline coordination are two important factors in esthetic treatments, especially in Orthodontics. In Greek, the meaning of diastema is interval. The space between the two central incisors is called midline diastema.[1] It may be both in upper and lower arch. According to Proffitt, the prevalence of midline diastema in adolescents was 6%.[2] It is more in the maxilla than in the mandible.[3] It is seen more in Africans than Caucasians.[4] It may be associated with generalised spacing.[5] The treatment of midline diastema is an important goal in Orthodontics as it is related to both midline and facial proportion. Also, there may be an underlying pathology behind diastema. For proper treatment, knowing the proper aetiology is also necessary. There are so many factors that cause midline diastema, like high frenal attachments, tooth material arch length discrepancy, presence of mesiodens, missing laterals, oral habits, etc.[6,7,8]
MATERIALS AND METHOD
The study was conducted after receiving ethical approval from the institutional ethical committee (EC/NEW/INST/2023/3191). A sample of 1000 patients (age group 15–34 years) visiting the OPD of R. Ahmed Dental College and Hospital, Kolkata, were randomly taken. Among them, 500 were males, and 500 were females. Any past relevant medical and dental history were taken. Intra oral examination was done using a mouth mirror and probe to find out diastema in maxilla and mandible on dental chair using chair light source. The spacing between the two central incisors was measured using a vernier calliper. Measurement was done at the incisal area. Space more than 0.5 mm was considered midline diastema. OPG was done in positive cases to find out any underlying pathology, like the presence of mesiodens or frenal knotch to confirm any anodontia, etc.
Inclusion criteria:
The inclusion criteria were:
The patient should be in permanent dentition.
Should not undergo any orthodontic or orthopedic treatment and orthognathic surgery previously.
Age group: 15–34 years.
Exclusion criteria:
The exclusion criteria were:
Mixed dentition stage.
Presence of any grossly decayed teeth or any periodontal disease.
Presence of any gross facial deformity.
Data was recorded and analysed statistically.
RESULTS AND ANALYSIS
The data was recorded in a specific format in an Excel sheet. Statistical analysis was done in computer statistical software IBM SSPSS version 27. A Chi square (X2) test was done. A P value less than 0.05 was considered as statistically significant.
Their mean age was 20.85, with a standard deviation of ±3.9 and a median of 21.
Table 1 shows that the prevalence of midline diastema was 5.9%. The prevalence of midline diastema among males was 4.4% and among females was 7.4% with a P value of 0.44 (<0.5). So, the prevalence of midline diastema was statistically higher in females than in males.
Table 1.
Prevalence of midline diastema and its gender variatin
| Number/percent | Diastema present | Without diastema | Total | P | |
|---|---|---|---|---|---|
| Male | n | 22 | 478 | 500 | 0.044 |
| % | 4.4% | 95.6% | 100% | ||
| Female | n | 37 | 463 | 500 | |
| % | 7.4% | 92.6% | 100% | ||
| Total | n | 59 | 941 | 1000 | |
| % | 5.9% | 94.1% | 100% |
Table 2 showed that midline diastema was more common in the maxilla than the mandible. In maxilla it was 38.98%, in mandible it was 11.86% and in both the cases it was 49.15%.
Table 2.
Location-wise distribution of midline diastema
| Variable | No | % |
|---|---|---|
| Maxilla | 23 | 38.98% |
| Mandible | 7 | 11.86% |
| Both | 29 | 49.15% |
| Total | 59 | 100% |
Table 3 showed different etiological distributions of midline diastema. It was found that the various causes of diastema was high labial frenum (18.18% males, 18.91% females), missing laterals (13.63% males, 10.81% females), dentoalveolar disproportion (22.72% males, 24.32% females), habits (27.27% males, 29.72% females), microdontia (9.09% males, 13.51% females), supernumerary tooth (9.09% males, 2.7% females). There was no statistically significant difference among males and females as the P value is more than 0.05 in each case.
Table 3.
Etiological distribution of midline diastema
| Variable | Male | Female | Total | P | |||
|---|---|---|---|---|---|---|---|
|
|
|
|
|||||
| No | % | No | % | No | % | ||
| High labial frenum | 4 | 18.18% | 7 | 18.91% | 11 | 18.64% | 0.94 |
| Missing laterals | 3 | 13.63% | 4 | 10.81% | 7 | 11.86% | 0.74 |
| Dentoalveolar disproportion | 5 | 22.72% | 9 | 24.32% | 14 | 23.72% | 0.88 |
| Habits | 6 | 27.27% | 11 | 29.72% | 17 | 28.81% | 0.84 |
| Microdontia | 2 | 9.09% | 5 | 13.51% | 7 | 11.86% | 0.61 |
| Supernumerary tooth | 2 | 9.09% | 1 | 2.7% | 3 | 5.08% | 0.28 |
| Total | 22 | 100% | 37 | 100% | 59 | 100% | |
DISCUSSION
The aim of this study was to detect prevalence of midline diastema, its gender wise distribution, its location wise distribution and etiological distribution.
1000 samples were taken randomly from OPD of Dr. R. Ahmed Dental College and Hospital. From them 500 were males and 500 were females. Clinical and radiological examination was done. The data was tabulated and calculated statistically.
The prevalence was found to be 5.9% of them; 4.4% were males, and 7.4% were females. It was also found that the prevalence of midline diastema is higher in females than in males, with a P value of 0.04% (<0.05).
In Jammu Kashmir, it was found to be 23% by Phulari et al., which is greater than this study.[3] A study by Kaimenyi et al. in Kurdistan found the prevalence was 23.2%, which was also greater than this study.[1] In Madras (Shashua et al.), it was 1.6%, which was less compared to this study.[5] A study by Edwards et al. in Mumbai had a prevalence of 16.9%, which was also more than our study.[6]
It was found that it was mostly seen in bidentally (49.15%), followed by the maxilla (38.98%), and the mandible (11.86%). But Hasan HS et al.[4] found it was more in the maxilla (97%), which was not similar to this study.
The midline diastema was mostly due to habits (28.81%), followed by dentoalveolar disproportion (23.72%), high frenal attachments (18.91%), missing laterals (11.86%), microdontia (11.86%), supernumerary tooth (5.08%). There was no significant different among male and females, as in each cases P value is more than 0.05.
So regarding treatment planning, first it should be established whether there is Bolton’s discrepancy or not. If there is no Bolton’s discrepancy orthodontic space closure can be done, otherwise esthetic consideration has to be followed. If there is any missing tooth, it’s better to go for prosthetic rehabilitation.
High frenal attachment should be surgically incised to prevent relapse. As it is the third most common cause, more advanced surgical techniques should be developed.
CONCLUSION
To conclude it can be said that midline diastema is very common in eastern Indian population. Females are having more diastema than males. It is mostly seen bi-dentally. There are various causes also. But the most common cause is habits. There is no gender variation among aetiologies. As the prevalence is very high, more accurate and better treatment plan should be developed.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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