Midline space

Sometime teeth do not end up with any contact between them, when this happens between op front teeth it is called midline diastema.

We are talking about the cases where such space is not created by decay or tooth loss. The cause for this space is general what is called a freenum (pronounced “free – num”, or frenulum (fren-u-lum).

This is a fold of tissue that connects the gum to the lip and sometimes contains muscle tissue. If it is unusually large it may connect through to the gum tissue between the teeth and extend to the front portion of the roof of your mouth, or palate. Sometimes, the frenum attachment extends lower than usual and contributes to a separation of the front teeth, and may contribute to keeping them apart.


If any teeth alignment is anticipated with orthodontic treatment, then the frenum is better removed, because it might cause the space to re-appear. Removal of the frenum is called a “frenectomy.”

Other causes for spacing between front teeth:

1- deep bite (excessive overlap of upper and lower front teeth).

2- tongue thrust (from an involuntary tongue habit).

3- habits, loike tongue or finger sucking.

4- supernumerary, extra tooth that might develop in the midline and does not erupt.

The orthodontist can then direct the proper treatment to close the space between the front teeth and decide whether it can be closed by simple movement requiring no more than a retainer, or whether more complex movement is necessary requiring braces. The orthodontist will also decide upon the timing of the frenectomy and whether additional retention will be necessary, such as use of a removable retainer or fixed retainer to stop the teeth from moving apart again.

It is generally better to close the space between the front teeth before removing the frenum, because prior removal can result in scar tissue that can prevent space closure. It is also not a good idea to have surgery before the teeth are moved, because it can leave a “black” triangular hole if too much tissue is taken away; it is also difficult to gauge how much tissue to remove before the teeth are moved into correct position.


Frenectomy is generally an uneventful, small and limited surgical procedure. It is easily accomplished in the right hands, carried out by a periodontist (gum specialist), oral surgeon, or dentist with surgical training. It is performed by locally anesthetizing (numbing) the area and then dissecting out or undermining the frenum tissue, leaving a very small wound, which is usually completely closed with a few stitches. This can either be accomplished with a small scalpel or with a special dental laser, which “paints away” the unwanted tissue leaving only a small wound with minimal discomfort. In either case healing is usually rapid and uneventful and usually complete in a week or so. Any discomfort should be manageable with no more than non-steroidal anti-inflammatory pain killing medication like aspirin or ibuprofen and antibacterial saltwater mouth-rinses.

If orthodontic treatment is not recommended or not considered an option, the gap can be closed by cosmetic restorative work, like direct veneers, porcelain veneers or crowns.


Space between top front teeth can be managed, either by orthodontics, surgery, or restorative work. If the cause is a frenum, it must be removed.

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