I read with interest an article in our recent journal about how various dental specialties treat maxillary diastemas in children. (J Oral Maxillofac Surg 76:709-715, 2018) According to this article pediatric dentists and orthodontists generally agreed that frenectomy should not be performed before the permanent canines are erupted and that the operation should follow orthodontic closure of the space. I could not disagree more. I have seen this treatment sequence carried out for 30 years and I often get to see these patients in their 20s and 30s where there diastema has relapsed or they are having gingival problems between the central incisors. It is simple to understand and simple to manage. I have successfully treated many of these patients on referral by their general dentists who understand the logic of my method.

The maxillary midline diastema, a space between the upper front teeth, is typically caused by a thickened band of tissue under the upper lip that is abnormally attaching through to the palatal aspect rather than inserting in the more normal position on the front side of the upper jaw. The diastema and abnormal frenum attachment are easily seen in the pediatric patient as a thickened tissue band extending between the upper front teeth holding the primary/baby teeth apart. I recommend treatment at about age 5 or 6. I find it best to treat it before the primary teeth are lost, but at a time where the permanent teeth are close to coming into the arch.

This is not a simple snipping or cutting of the muscle attachment under the lip. That will not resolve the problem. It is important to excise the fibrous attachment between the central incisors as well (frenuloplasty and fiberotomoy). In most cases, we have found that the primary central incisors will drift into a more normal position and permanent central incisors will erupt into a completely normal position. Without the procedure, the adult incisors come in with the same diastema space.

It is a no-brainer to me that you would take care of this as a preventative treatment even if it requires a surgical procedure. I have had several of my dental colleagues, dental assistants, and even orthodontist’s assistants come to me for this procedure for their childrens’ care and with consistently good results. There is no question that I would recommend this for a child with a maxillary midline diastema.