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Correction of tremors and diastema

We tell you how to restore the aesthetics of your smile and close gaps
We use the most effective devices and advanced bite correction techniques
Treatment time — from 8 months

Tremas – are gaps between teeth that are often the reason for orthodontist visits. Tremas can be between any teeth, single or multiple. Spaces between teeth significantly compromise aesthetics, especially when located in the smile area. The gaps between the upper central incisors are called differently – diastema.

In addition to aesthetic problems, tremors lead to a malocclusion, risk of periodontal disease, and tooth loss. When teeth are not in close contact with each other, the chewing load is not redistributed between them. Teeth take on a tremendous load that they are not equipped to handle.

Why do tremors appear?

  1. The size of the teeth is smaller than the size of the jaw
    The amount of space in the dentition (and the risk of developing crowding or, conversely, treme) depends on the size of the teeth and the size of the jaw. An excess of space is needed to form a treme, which is created by micrognathia (teeth smaller than normal) or macrognathia (jaw larger than normal).

  2. Lack of any teeth
    When a tooth is missing (after extraction or in case of adentia), the space in the tooth row is vacated – other teeth are shifted towards the missing one and lose tight contact with each other.

  3. Disorder of tongue function
    The position of the teeth is also affected by the mifunctional equilibrium – if the function is disturbed, the tongue can «push» the teeth, leading to the formation of protrusion (forward tilt) and three.

  4. Genetic predisposition
    In addition to tooth size, other features are genetically passed on from parents. For example, a short and massive frenulum of the upper lip with a low attachment between the central incisors leads to the formation of diastema.

  5. Periodontal Disease
    In inflammatory periodontal disease, even normal physiologic stress is perceived as extreme – teeth become more mobile, tilt and turn. This can lead to a variety of orthodontic problems, including the formation of tremors.

  6. Age-related changes
    As we age, bone tissue throughout the body weakens, including the teeth. bone tissue decreases in volume and becomes more porous. As a consequence, the teeth shift, lean forward and form fissures.

In which case, gaps between teeth – is the norm?"

The formation of tremors in childhood (at the age of 4-6 years) – is the norm. Physiological trems at this age – is a sign of proper growth of the child and development of the dento-alveolar system. The appearance of tremors at this age is associated with active jaw growth, which is necessary for the beginning of the eruption of permanent teeth. The spaces between milk teeth – this is the necessary place for large permanent teeth. The lack of physiological thirds at 4-6 years of age leads to the development of crowding and other pathologies in the permanent bite.

How do tremors affect aesthetics?

For the orthodontist, the aesthetics of the smile are as important as a correct bite. Every year, there are many studies conducted in the scientific community evaluating various smile parameters. But what about tremors? Here is an interesting example

The study evaluates the perception of smile aesthetics in lateral incisor adentia by different groups of people (dentists, orthodontists, orthodontic patients, and the general public)

The study evaluates the perception of smile aesthetics in lateral incisor adentia.

Four groups of people were asked to evaluate 12 modeled smile variants in the absence of lateral upper incisors. Figures B and D are the most interesting for us. In Figure B, we see uniform tremors in the aesthetically important area resulting from the absence of both lateral incisors. In picture D, only one lateral incisor is missing, there is an inclination of the teeth, tremors and a shift of the midline.

Pay attention to the results – of all 12 variants of simulated smiles, all 4 groups of people recognized the variants with tremors (B and D) as the least aesthetic.

Perceptions of dental professionals and laypeople to altered dental esthetics in cases with congenitally missing maxillary lateral incisors. Prog Orthod. 2013 Oct 1;14:34. doi: 10.1186/2196-1042-14-34. PMID: 24325825; PMCID: PMC4384961.

How does diastema affect aesthetics?

If we are not talking about multiple tremors, but only about the diastema between the central incisors, then this is a more complicated question. Therefore, the data differs slightly in different studies.

In one study* diastema up to 2 mm with no tilt or offset from the facial centerline did not impair smile aesthetics, in another* – a smile with a diastema of 1 mm or more was negatively evaluated by most people.

*Kokich VO, Kokich VG, Kiyak HA. Perceptions of dental professionals and laypersons to altered dental esthetics: asymmetric and symmetric situations. Am J Orthod Dentofacial Orthop. 2006 Aug;130(2):141-51. doi: 10.1016/j.ajodo.2006.04.017. PMID: 16905057. *Chaves PRB, Karam AM, Machado AW. Does the presence of maxillary midline diastema influence the perception of dentofacial esthetics in video analysis? Angle Orthod. 2021 Jan 1;91(1):54-60. doi: 10.2319/032020-200.1. PMID: 33289783; PMCID: PMC8032285.

Trem Diagnostics

Despite its seeming simplicity, closing thirds and diastemas – is a complex orthodontic task. To solve it correctly, the orthodontist performs a diagnosis – analyzes scans, CT scans of the skull and photographs of the teeth and face.

To determine the treatment tactics, it is important to know:

  1. Tooth sizes

  2. Closure of teeth in the lateral part

  3. Incisor overlap (open bite, direct overlap, deep, etc.)

  4. The slopes of the teeth in the bone tissue (protrusion, retrusion)

  5. The volume of bone tissue around the teeth

The treatment of three

Depending on your clinical situation, treatment can take several paths:

  1. Orthodontic treatment
    If it is not necessary and desirable to change the shape and color of teeth, but in addition to trims, the orthodontist has other orthodontic tasks (e.g. correction of distal bite). Closure of gaps can be performed in various ways – depending on the initial task and the desired result, chains, springs, elastics, miniscrews for additional support and many other orthodontic tools can be used for closure.

  2. Dental restorations with gap closure
    In the absence of bite pathology and the need to change the color and shape of the teeth (e.g., microdentistry or erasability), it is advisable to close three teeth with restorations. An orthopedic dentist will help you with this, and will install veneers or crowns of the desired color, size and shape. When planning, digital modeling of the result and temporary fitting of constructions– together with the doctor, you will choose the shape and color suitable for you, and you can even try on your new smile.

  3. Orthodontic treatment with subsequent restoration of teeth
    In order to achieve the most beautiful result and gentle preparation of teeth for veneers, in some cases it is necessary to change their inclination, redistribute the gaps between teeth and solve other orthodontic problems (tooth rotation, inclination, bite, etc.). In such cases, orthodontic treatment with braces or eliners is performed first, followed by aesthetic restorations.

In addition to worsening the aesthetics of the smile, the presence of gaps leads to the development of periodontal problems (e.g. loosening of teeth and formation of recessions) and the formation of an incorrect bite. Timely closure of gaps and creation of tight contacts between teeth – the key to a beautiful smile and healthy teeth.

Physician's Review

The presence of cusps or diastemas is not such a common pathology in my practice, more often I have to work with crowding (lack of space in the tooth row), but this pathology also requires close attention, because even small gaps can lead to the fact that the teeth separately perceive the load and thus overloaded. Therefore, it is never too late to start orthodontic treatment; in my practice, the oldest adult patient was about 70 years old, and we were just solving the issue of closing gaps on the lower jaw due to age-related bone changes in order to preserve her own teeth.

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Updated 17.01.2024