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Maxillary midline diastema is a common aesthetic complaint of patients. Treating the midline diastema is a matter of concern for practitioners, as many different aetiologies are reported to be associated with it. The appearance of midline diastema as part of the normal dental development makes it difficult for practitioners to decide whether to intervene or not at an early stage. The aim of this article is to review the possible aetiology and management options which will help the clinician to diagnose, intercept and to take effective action to correct the midline diastema. The available data shows that an early intervention is desirable in cases with large diastemas. Treatment modality, timing and retention protocol depends on the aetiology of the diastema. Therefore, priority needs to be given to diagnosing the aetiology before making any treatment decisions. Clinical Relevance: This article aims to determine and evaluate the aetiology and possible treatment options of midline diastema.

A 34-year-old female attended the orthodontic department and was concerned with a midline diastema in the lower arch. The diagnosis made was pathological migration owing to the habitual placement of her tongue stud on the incisal edges of her mandibular central incisors, forcing them apart. This article describes the causes of pathological migration, and other possible complications due to oral piercings.

It is not always easy to discover the aetiology of malocclusion: only in about 5% of cases is a cause clearly identifiable. In this article, the various genetic, environmental and physical factors that may contribute to malocclusion are discussed.