*4.2.2. Frenectomies*

structures, and excessive horizontal and/or vertical trespass [24]. It should be remembered that the diastema of racial and genetic etiologies are considered normal and the treatment will

Patients' perception of the need for treatment for anterosuperior diastemas is influenced by the epoch and culture in which they live [29]. There is also a great contribution of the media to the opinion of people. In the 1960s, Gardiner [20] referred to a famous movie actor who presented a medium diastema and suggested, between the lines, that this feature, when smooth, may be well accepted for those individuals with a rather pleasant facial appearance. However, this cannot be considered for the majority of the population. The author's opinion

It was demonstrated [30] that when patients self-evaluate, they perceive a greater need for orthodontic treatment, when the problem is located in the anterior region, compromising

In the majority of cases, the central interincisive diastemas in the mixed dentition period are a temporary physiological feature of the "ugly duckling phase" [12, 13], which will be closed gradually with the eruption of the permanent lateral incisors and then with the eruption of the permanent canines. However, orthodontic interception is indicated in exceptional cases, where the diastema is preventing normal eruption of permanent teeth, stimulating the appearance or maintenance of deleterious habits, or compromising the child's self-esteem [16].

There are several approaches used in the treatment of anterosuperior diastema, which vary according to the present etiologic factor [2, 16, 17]. The success of such treatment will depend

The orthodontic approach can be performed with the following objective: close the diastema or redistribute the spaces for a posterior reanatomization of the anterior teeth. Orthodontic treatment also has the function of treating, if present, any other associated occlusal problem and helping in the elimination of parafunctional habits. In cases where there is discrepancy of dental size, orthodontic treatment alone is not able to offer the best results. Therefore, these diastemas must be closed by means of composites, facets, or prosthetic crowns. However, for a better esthetic result of these restorations, orthodontic movement is indicated to redistribute

Proffit, in the new volume of his book [32], divides the protocol of treatment of anteroposterior diastema according to two basic groups: (1) incisors with diastema and vestibular inclination and (2) diastema in the upper midline. In the first group, the diastema is usually caused by deleterious habit, which must be removed before the space closes, which can only

aesthetics, as is the case of the anterosuperior diastema and anteroinferior crowding.

be dispensable, unless the patient considers the diastema an esthetic problem [24].

was retracted through the following statement:

100 Current Approaches in Orthodontics

**4.1. Treatment of diastemas in the mixed dentition**

**4.2. Treatment of diastemas in permanent dentition**

on the elimination of these factors [17].

the spaces before the cosmetic procedure [31].

*4.2.1. Orthodontic treatment*

Labial frenulum is considered abnormal when it is enlarged and/or inserted near the gingival margin [15]. Some authors [16, 33] recommend frenectomy to be performed after orthodontic closure of space, since diastema closure and interdental papilla compression may act as a stimulus to promote atrophy of the fibrous tissue interposed between the incisors.
