Introduction

The presence of diastema between the maxillary central incisors in adults is often considered as an aesthetic or malocclusion problem (Ferguson & Rix, 1983). Midline diastema is a dento-alveolar disorder that causes special concerns to patients (Gkantidis, Kolokitha, & Topouzelis, 2008). It is also known as open teeth or gapped teeth (Gkantidis et al., 2008; Omotosa & Kadir, 2010). It is the spacing in the anterior midline region measuring more than 0.5mm between the proximal surfaces of central incisors (Keene, 1963).

Nainar et al . define true midline diastema to be one without periodontal or periapical factors and with the presence of all anterior teeth in the arch (Abdulateef, Ali, & Othman, 2014; Keene, 1963) whereas, Attia defines it as spaces of varying magnitude between the crowns of fully erupted incisors (Carruitero, Castillo, Garib, & Janson, 2020).

Maxillary midline diastema is aesthetic problem appearing in children and affecting adults and adolescents irrespective of gender and ethnicity (Abdulateef et al., 2014; Carruitero et al., 2020).

Midline diastema is caused by many etiological factors like the disproportion between teeth sizes and dental arch length, abnormal labial frenum attachment between central incisors (Edwards, 1977; O'Mahony, Millett, Barry, McIntyre, & Cronin, 2011). Also, congenitally missing or extracted incisors or canine impaction, peg lateral incisors can also be minor causes.

This study aims in finding the prevalence of midline diastema and its etiology among patients reporting to our institution.

Materials and Methods

The study was conducted in the department of orthodontics of our institution. A total of 305 patients attending the department of orthodontics from June 2019 to March 2020 were screened. 68 patients were diagnosed with midline diastema and were assessed for etiology. Intraoral photographs of the patients were collected from the digital archives of the Dental Information Archive System of the institution and assessed for etiology. The distribution among male and female patients was assessed and evaluated. The most common cause of midline diastema namely high frenal attachment, generalised spacing and periodontal disease were assessed. The data obtained were subjected to statistical analysis using SPSS software version 25. Descriptive analysis and chi-square tests were performed and graphs were tabulated.

Results and Discussion

The mean age of the patient was 23±5.25 years.

Prevalence of midline diastema

Out of 305 patients, 68 patients had midline diastema, which is about 22.3% which included both males and females. Table 1 and Figure 1 shows the prevalence of midline diastema.

Etiology of midline diastema

Among the patients diagnosed with midline diastema, the etiology was found to be high frenal attachment in 52%, generalised spacing in 36% and periodontal disease in 12% of the cases. Table 2 and Figure 2 shows the different etiologies of midline diastema prevalent among the population.

Gender predilection

It was found that male distribution was predominant with 73% of cases whereas females were only about 27%.

Table 3 and Figure 3 shows the gender distribution of the study population.

Association between etiology and gender

Among the given population, high frenal attachment was found among 25 males and 11 females, generalised spacing among 20 males and 5 females, periodontal disease among 5 males and 2 females. Table 4 and Figure 4 shows the association between etiology of midline diastema and gender among the study population.

In Figure 1, X axis corresponds to the prevalence of midline diastema and Y axis corresponds to the number of patients. The colour red denotes patients without midline diastema and the colour purple denotes patients with midline diastema. Midline diastema was found in 68 patients. In table 2, The etiology of midline diastema was found to be High frenal attachment in 36 patients, Generalised spacing in 25 patients and Periodontal disease in 7 patients. The prevalence of midline diastema was found to be 22.3% in Table 1.

In Figure 2, X axis corresponds to the etiology of midline diastema and Y axis corresponds to the number of patients. The colour pink denotes high frenal attachment, colour yellow denotes generalised spacing and colour orange denotes periodontal disease. High frenal attachment was found among 36 patients, generalised spacing among 25 patients and periodontal disease among 7 patients. In Table 2, The etiology of midline diastema was found to be High frenal attachment in 36 patients, Generalised spacing in 25 patients and Periodontal disease in 7 patients.

In Figure 3, X axis corresponds to the gender and Y axis corresponds to the number of patients. The colour blue denotes males and colour green denotes females. There was a higher male distribution (50 cases) than females (18 patients). It shows a male distribution in 50 patients and female distribution in 18 patients in Table 3.

In Figure 4, X axis corresponds to the etiology of midline diastema and Y axis corresponds to the gender of the patients. The colour blue denotes male population and green denotes female population. All the etiologies were more prevalent in males than females. However, this is statistically not significant (Pearson chi-square test; P-value = 0.520 - not significant). In Table 4, P-value obtained >0.05. It shows an insignificant association between the two parameters. (p-value = 0.520)

In the present study it was found that, among the given population, prevalence of midline diastema was found to be 22% and the major etiological factor was high frenal attachment with a percentage of 52%. This was similar to a study that showed prevalence of midline diastema to be 23%, but the major causative factor was generalised spacing [39%] (Abdulateef et al., 2014; Carruitero et al., 2020). A study reported that black children exhibit a higher prevalence [19%] of midline diastema than white children (AlSadhan & Al-Jobair, 2017; Edwards, 1977). In another study, the prevalence of midline diastema was recorded to be 7.3% and shows a higher frequency among females (AlSadhan & Al-Jobair, 2017; Edwards, 1977; Elfadel & Abuaffan, 2016). A similar study shows the prevalence of midline diastema to be 6.8% (Shenoy & Attokaran, 2016). A study done in Kenya shows that 35% of the population showed midline diastema. Another study, states that the primary factors contributing to maxillary diastema appear to be degree of spacing or crowding in most cases and that the frenal attachment making a minor contribution (Popovich & Thompson, 1979). Considerable research has been conducted in the field of orthodontics (Felicita, 2017; Jain, 2014; Rubika, Felicita, & Sivambiga, 2015) with relevance to the current population under study (Krishnan, 2015; Samantha, Sundari, Chandrasekhar, Sivamurty, & Dinesh, 2017; Sivamurthy & Sundari, 2016).

An attempt was made in this study to identify the prevalence of midline diastema (Felicita, 2017; Kumar, Sundari, Venkatesan, & Chandrasekar, 2011) and its etiological factors among the population (Kamisetty, 2015; Vikram, Prabhakar, Kumar, Karthikeyan, & Saravanan, 2017; Viswanath, Ramamurthy, Dinesh, & Srinivas, 2015). Further studies with a larger population is advised (Dinesh, 2013; Felicita, 2018; Felicita, Shanthasundari, & Chandrasekar, 2012).

Conclusion

This study shows the prevalence of midline diastema to be 22.3%. The most common cause of midline diastema was found to be high frenal attachment, being present in 52% of the patients.

Conflict of Interest

The authors declare that there is no conflict of interest for this study.

Funding Support

The authors declare that there is no funding support for this study.