Spacing In Permanent Dentition: Etiology,Epidemiology,Treatment Modality And Post-treatment Measures

-Introduction: There are many treatment courses and choices that can be used in the treatment of spacing in the dental arches,but the problem that we face when we deal with these conditions is the possibility of having a high tendency for the cases to be subjected on the long run to relapse,to occlusion distortion,or even unwanted dental esthetic results which due to the lack of complete and comprehensive understanding and the proper knowledge of how the treating orthodontist should be approaching those cases and to select the most appropriate treatment modality to not only resolve the inter-dental spacing,but also to avoid future relapse.Regardless of the inter-dental spacing types,they will always involve different etiological factors that are related to the inter-dental spacing.In our study which we are preforming on five selected patients,we will present diverse clinical cases that have been diagnosed with different etiological origins that have played different parts in the creating of inter-dental spacing in their permanent dentitions,which in some of our selected cases have progressively deviated from the normal dental occlusion and proceeded to continue to deviate to a more unfavorable inter-dental spacing due to the different etiological reasons that led to the inter-dental spacing.It should be mentioned that permanent dentition with inter-dental spaces is considered to be of normal type of dental occlusion,which can be commonly found in almost one third of the population’s dental arches.We should also state that the most suitable and appropriate time for starting the treatment is usually at the permanent dentition period.Treatment of Dental Spacing is performed mainly for esthetic and psychological purposes.-Material and Methods : Five adult patients which have reported to have inter-dental spacing that have occurred naturally and without any iatrogenic intervention.those patient were selected for this study from the xxx,xxx.The five cases that were selected were reported that all of them were complaining from undesirable Inter-Dental Spaces.After a complete and thorough diagnosis was performed on the five selected cases,we have discovered that the main etiological cause,or causes,that lead to the creation of the inter-dental spacing for each patient,and according to our findings,a proper treatment plan was established and discussed with the five selected cases.One case have been diagnosed with having Pseudo-macroglossia;which happened because of the change in the tongue’s anatomical position in relation to the surrounding anatomy in the oral cavity.This new tongue position was due to a skeletal class III malocclusion relationship that have occurred as a result of the patient reporting to have a previous medical history of Tonsillitis.This have eventually resulted in what is known as Pseudo-macroglossia.The treatment plan was to make sure to remove the cause for the Pseudo-macroglossia,and then to correct the class III malocclusion with the combination with tongue repositioning exercises to be instructed for the patient.The second case was reported to be diagnosed with having a Midline Diastema;this condition have happened due to the presence of two small maxillary lateral incisor teeth on each side of the maxillary arch in comparison to the average size of maxillary lateral incisor teeth.This variation in size for the maxillary lateral incisor teeth as a result have led to the migration of the maxillary central incisor teeth distally toward the empty spaces.This migration by the maxillary central incisor teeth have led to the creation of Midline Diastema.The treatment of choice was to use an invisible aligner appliance technology to close the dental spaces.The third selected case was reported to have been suffering from inter-dental spacing due to missing upper maxillary canine(Maxillary Canine Agenesis),which have been reported in many studies to be a very rare case.The creation of a space in the area where the missing canine should be so then it would be filled later in the future by a dental prosthodontic appliance was selected as the treatment of choice for the third case.The fourth case was reported to be diagnosed with having midline diastima.The midline diastema on further examination was confirmed to have happened due to the presence of a supernumerary tooth between the two upper central incisor teeth.The supernumerary tooth was first extracted by the oral surgery department prior to the commencing of the treatment.After the extraction was done,we proceeded to close the inter-dental spaces by using fixed orthodontic appliance and power-chain.And lastly,one case was reported to be diagnosed with inter-dental spacing in the early permanent dentition stage;the treatment involved teeth aligning followed by dental space closure by a successional use of power-chains.-Result : The inter-dental spaces previously present in the five selected cases were totally closed and an optimum dental occlusion and an optimum inter-dental contact between the teeth was accomplished within a period of 11 months to one year and halve for all the selected five cases.-Conclusion : Inter-dental spacing in the permanent dentition is mainly considered as an esthetic dental problem,and the aim for the treatment diagnosis and the treatment modality should be directed mainly toward the treating of the etiological factors that have caused the inter-dental spaces.The treatment should tackle the causative agent for the inter-dental spaces prior,during or at the end of the treatment course.The stage where we should tackle the etiological factor that caused the inter-dental spacing is dependant and varies between the cases,and it also depends on the causative agent for the inter-dental spacing.