A diastema is that visible space between two teeth, often between the two upper central incisors. Some patients see it as a signature trait, others as a complex. The question of closing or keeping it is not strictly medical. It is personal.
Here’s how I approach the issue at Dental Swiss Clinics in Montreux, with the available clinical options and the criteria guiding the decision.
My fundamental clinical position
A diastema is not a defect to be systematically corrected. It is a normal anatomical variation, often linked to multiple factors: the presence of an hypertrophic labial frenum, a size discrepancy between teeth, a particularity of the bone arch, or simply family genetics.
In my practice, I observe that a significant portion of my patients who consult me for a diastema suffer psychologically from it. This suffering is real and legitimate. But it is not universal. Other patients embrace their diastema and consider it a trait of their identity.
When a patient comes to see me, my first job is to listen. What is the request? What is the expectation? Does closing it correspond to a real personal desire or to external pressure? These questions are as important as the clinical examination.
Clinical examination first
Before discussing options, a complete examination is necessary.
Check for the presence and shape of the labial frenum
An hypertrophic labial frenum attached in a low position can be a cause of diastema, and a factor of recurrence after treatment. When it is present and abnormally inserted, its management must be integrated into the treatment plan. A frenectomy may sometimes be proposed, often in addition to orthodontic treatment. Its necessity is evaluated on a case-by-case basis.
Assess the periodontal situation
Active periodontal disease can create or worsen a diastema. Uncontrolled inflammation must be treated before any aesthetic project. Closing a space on unstable gums makes no clinical sense.
Analyze the overall occlusion
An isolated diastema is treated differently from a diastema in a broader malposition context. A complete orthodontic evaluation helps determine if the problem is simple or if other corrections are useful.
Evaluate the condition of adjacent teeth
If the teeth concerned are healthy, the preferred solution is conservative. If they are already affected by significant or visibly unsightly restorations, the strategy changes.
My priority option: orthodontics
In the vast majority of cases where the patient wants to close their diastema, my priority proposal is orthodontic treatment. The reason is simple: it is the most conservative option. No dental preparation, no restorations to maintain over time, a stable result if retention is well managed.
Modern aligners make this approach accessible and discreet. The treatment lasts several months, but the result is durable and respects natural teeth as much as possible.
When an hypertrophic labial frenum is present, a frenectomy can be planned as a complement, to limit the risk of recurrence.
Alternatives when orthodontics are not suitable
If the teeth are already affected, unsightly, or require overall aesthetic improvement, the approach changes. Two options then present themselves.
Direct composite restoration
For small diastemas (less than 1.5 mm) on otherwise healthy teeth, a direct composite can close the space in one session, without preparation. It is quick and economical, but composite dulls over time and requires periodic touch-ups.
Ceramic veneers
When diastema closure is part of a global aesthetic project (smile enhancement, correction of tooth shape, harmonization of shade), ceramic veneers are the reference option. Manufactured in the clinic using a fully digital workflow, they combine space closure with overall aesthetic improvement.
The choice between orthodontics, composite, or veneers does not depend on a fashion preference. It depends on the clinical situation, the overall aesthetic demand, and the patient’s constraints.
When I advise against closing
Certain situations lead me to advise against closure, at least temporarily.
Unstabilized periodontal situation
Active gingival inflammation, uncontrolled periodontal disease, must be treated before any aesthetic project. An aesthetic treatment placed on fragile foundations will fail.
Undecided or reflective patient
If a patient comes only to discuss options without having made a clear decision, my role is to inform them and let them reflect. I do not propose treatment to a patient who has not yet measured their commitment. Taking time for the decision is part of the care.
Unrealistic expectations
A patient who expects an impossible transformation must be guided towards other avenues, or towards an acceptance of their situation. Engaging in a treatment destined to disappoint is not in their best interest.
What if the patient wants to keep their diastema?
This is a perfectly legitimate position. A diastema can be an identity signature, a character trait, a family memory. There is no clinical obligation to close it.
I never suggest closing a diastema to a patient who has not requested it. A dental examination should not become an unsolicited aesthetic consultation.
A decision that remains with the patient
The diastema belongs to the person who has it. My role is to inform, examine, and explain the options and their consequences. The final choice rests with the patient.
This position is not neutrality. It is respect for a principle: aesthetic decisions are not strictly medical. They involve the person, their image, their relationship with themselves. They must be made consciously, without pressure from the practitioner.
Frequently Asked Questions
Can a diastema close on its own?
Not in adulthood. In children with mixed dentition, a temporary diastema may close with the eruption of adjacent teeth. In adults, spontaneous closure practically does not occur.
Is frenectomy systematic?
No. It is considered only when the labial frenum is hypertrophic, inserted in a low position, and considered a causal or recurrence factor. Evaluation is done on a case-by-case basis.
How long does aligner treatment take to close a diastema?
It depends on the size of the diastema and the overall situation. A simple case can be treated in a few months. A more complex case requires more time. A consultation evaluation provides an accurate estimate.
Does direct composite last as long as a veneer?
No. Direct composite is an effective short-to-medium-term solution, but it dulls over time and requires touch-ups. Ceramic veneers offer superior longevity and aesthetic stability.
Can we try before deciding?
Yes, in some cases. A digital mock-up allows visualizing the result before any treatment. An in-mouth mock-up is possible when the planned treatment adds volume, which is often the case for diastema closure.
For an evaluation of your situation, contact Dental Swiss Clinics in Montreux, Monday to Friday from 8 AM to 8 PM.