Minimally invasive management of lower midline diastema: A case report and literature review

RATIONALE: Midline diastema is an unpleasant condition that affects a patient's smile and causes significant aesthetic concerns. Treating diastema and achieving the desired aesthetics, function, and harmony can be challenging without invasive treatment. This case report demonstrates a minimally invasive approach to closing a lower midline diastema. PATIENT CONCERNS: A 38-year-old female patient presented to the dental clinic at King Khalid University with the primary complaint of a "large space in the lower front tooth region." Her medical history indicated no significant health concerns. DIAGNOSES: The patient was diagnosed with localized periodontitis, stage III, grade B. She presented with a Miller class III gingival recession at the lower central incisors, an aberrant frenum, a decreased width of keratinized gingiva, and a midline diastema of 6 mm. INTERVENTIONS: A free gingival graft is used to increase the width of the keratinized gingiva, followed by the placement of a zirconia resin-bonded bridge to close the space. OUTCOMES: The treatment yielded a satisfactory outcome, as evidenced by an increase in the width of keratinized gingiva from 1 mm at baseline to 5 mm at 4 months and a gain of 1 to 2 mm in clinical attachment level. Two months following surgery, complete closure of a 6-mm lower midline diastema was successfully achieved using a zirconia resin-bonded bridge. LESSONS: The use of a free gingival graft effectively increases the width of the keratinized gingiva. A resin-bonded bridge offers satisfactory aesthetics and functionality, providing a conservative treatment that makes it a favorable option for closing lower midline diastema compared with more invasive and time-consuming procedures, such as bone grafting or orthodontic treatment.