Spaces between teeth can occur in many ways. A patient may have genetically spaced teeth, genetically missing teeth, or teeth extracted. 

Spaces between teeth can also occur from habits such as tongue thrust, pencil chewing and thumb sucking etc.

Teeth can also drift in patients who have suffered periodontal disease/ gum disease. 

The most common space between teeth is the midline upper diastema such as in the artist Madonna. 

Some ethnic minorities will have a higher percentage of teeth spaces.

Most patience have an acceptable smile with space between their teeth, but some patients may want the spaces closed. 

Some dentists will add fillings between the teeth to close the spaces, but we do not agree with that as the fillings can add unnecessary widths to the teeth, can stain chip or even fall off. Fillings added to teeth can also cause gum disease. 

Our advice to close spaces is to use Invisalign aligners. 

The most convenient orthodontic system is Invisalign, in that it is removable clear and really easy to clean. With no pain or food trapping, then why would anyone want fixed braces?

This young male patient had already had braces as a child but over time and without his retainer his teeth stared to drift forwards. There may have been a history of tongue thrust as well. 

From the picture you can see some tartar has built up between the teeth which is quite common when there are spaces present. The patient was a trainee lawyer and did not want to wear fixed braces so we agreed on Invisalign orthodontic treatment.

The Invisalign treatment consisted of 25 pairs of aligners each pair being changed every two weeks and the patient being reviewed at the clinic every 6-8 weeks.

We added attachments to some of the teeth to aid in retention of the aligners. 

The patient was however, not very good at attending and so we probably saw him every three months. 

As you can see from the photographs the patient was nearly finished and his attachments are still on. We achieved space closure, the attachments  were removed and the patient was given three pairs of Invisalign retainers. 

Treatment time was extended due to the patient’s poor attendance. 

As you can see a dramatic difference has been achieved with removable Invisalign aligners and very few appointments with the patient. 

Invisalign allows us to plan treatment around a patient who cannot attend very regularly and in a few cases we have seen patients only once in a year treatment, but with a successful result. 

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Invisalign is a removable orthodontic system made up of a series of clear aligners that you normally change every 2 weeks.

Unlike normal orthodontics which have fixed brackets and wires, Invisalign allows you to remove the aligner to clean your teeth.

Because there are no brackets fixed to your teeth or archwires, Invisalign allows you to floss your teeth as well.

Flossing is very difficult with fixed orthodontics because the wire gets in the way. So normally you have to use interdental brushes under the wire and around the brackets.

One downside is that some patients tend to drink fizzy, sugary drinks constantly with the aligners in; this can cause a build-up of sugars inside the aligner and can cause tooth decay. We recommend avoiding fizzy drinks for all orthodontic systems.

We recommend a fluoride mouth rinse used once a day before going to bed.

With all orthodontic systems, sometimes we need to make spaces with interproximal stripping. This is where a disc or small bur is used to open a space between 2 teeth contacts. The contact between the 2 teeth is opened up.

The space is normally 0.3 to 0 .4 millimetres wide and will normally close with the aligner system.

Sometimes however the space is created too early, i.e when the teeth are heavily crowded or rotated then that can cause uneven spacing between teeth; these spaces do not close very well.

In reality this happens very rarely but can ruin patient’s expectations.

We advise interproximal stripping is done on teeth that are relatively straight or later in the treatment when they are not as crowded.

We also advise stripping should be done with a thin narrow disc and not with a drill or dental bur.

The last problem with orthodontics is poor oral hygiene as this can cause a problem with any orthodontic system especially fixed but less so with Invisalign.

In conclusion, Invisalign being a removable orthodontic system rarely can ruin teeth.

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