Management of an unusual midline diastema with a fixed appliance: a case report

This is the case of a 12 year old, male child who reported with a 9mm midline diastema due to two mesiodens. The diastema was unusual as the central incisors were displaced unequally from the midline. Tooth 21 and 22 were displaced more distally from the midline leaving inadequate space for eruption of tooth 23. The challenge in this case was to close this unequal diastema. Thus the conventional fixed appliance which relies on reciprocal anchorage could not be used to close the diastema. Hence the fixed appliance was modified by using a Nance palatal arch with a labial wire extension to close this unequal diastema. The presentation discusses this unusual presentation of diastema and the modified fixed appliance used to treat the case. Clinical Relevance: This case report explains the biomechanics during midline diastema closure where the space is unequally distributed across the midline.