Management of midline diastema using a new surgical technique

Aim The aim of this study was to evaluate spontaneous closure of the interincisive diastema in a group of patients, using a new surgical technique for the treatment of upper lip frenulum hypertrophy. Study design A triangular flap was lifted, rotated and sutured across the midline. A primary intention healing and positioning of the flap allowed minimal tissue contractures. Materials and methods 65 patients aged between 8-11 years, presenting with a wide upper labial frenum inserted in the palatine papilla and with a diastema of 4.5 mm or more, were divided into three groups: A) 33 patients underwent an upper labial frenoplasty using the new triangular flap technique, with no other treatment. B) 22 patients received orthodontic treatment for the closure of their diastema; C) 10 patients, whose parents refused both surgery and orthodontic treatment, were used as a control group. Results None of the patients in group A presented with complications after surgery. In 32 patients spontaneous closure of the midline incisor diastema was obtained without any orthodontic treatment. In all patients in group B, closure of the diastema was obtained, but retention had to be applied to avoid relapse. Eruption of lateral incisors was observed in only two patients in the control group C within one year, and both were in ectopic position (buccally), while in the other groups lateral incisors erupted correctly. Discussion There are many advantages in using the triangular flap technique. It avoids orthodontic treatment of the diastema, which can be closed within 2-4 months, but oral hygiene is difficult because of the large frenum and the presence of brackets.Therefore, this new surgical approach allows a reduced healing time while preventing tissue contractions. Conclusions The triangular flap is a safe, easy, reliable and well accepted procedure that provides positive aesthetic results and allows spontaneous closure of the diastema.