With both practical and aesthetic implications, maxillary midline diastema (MMD) is a quite frequent dental malocclusion that is defined by a gap between the maxillary central incisors. The direct assessment of diastema has shown a wide range of incidence values — from 1.6 to 25.4 in adults, and indeed advanced in young individuals.1-3 Only when the frenum separates the teeth is it deemed problematic; nonetheless, the frenum problem is typically resolved by natural forces closing the gap. It was found that superior labial frenum is one among the major factors that contributes to the midline diastema formation according to the research done in orthodontics.4

Disparities in the size of the jaw or teeth, incorrect labial frenal attachments, parafunctional habits, loss of teeth, periodontitis, deep bites, and maxillary midline diseases like supernumerary teeth are some of the reasons that have been proposed as causes of MMD. Additionally, diastema from tongue piercings has been reported.5

An M-spring, a specialist orthodontic appliance, was created to treat this commonly seen tooth problem. This specific orthodontic device has three circular loops arranged in a certain manner: two on each side and one in the centre. It is shaped like an M. When M-springs are manufactured using a durable kind of orthodontic wire which is simple to toggle and activate, they gradually generate moderate, and constant force to close the diastema.6

The M-spring's ability to provide effective treatment in a shorter amount of time is one of its primary appealing qualities. The gap can be closed by the teeth moving gently together which is due to the use of precise forces. Furthermore, compared to conventional approaches, this methodology is favoured due to its simplicity (using less inventory) and shorter treatment duration.7 Orthodontists rely on the accuracy of M-spring along with its adaptability while treating a case of MMD. It is frequently utilized for functional and/or aesthetic purposes because of its clever design and ease of closing areas, particularly those with cosmetic difficulties.8 In this case study, an adult patient's midline diastema was effectively and quickly closed within four months by utilizing M-spring in conjunction with frenectomy.

A female patient with an age of 37 years reported with chief complaint of spacing in the upper front teeth. Upon clinical examination, intra-orally class one molar relationship on the left side and end-on molar relation on right side on class1 skeletal base with proclined upper and lower incisors, normal overjet and deep overbite is seen. A midline diastema of 4–5 mm was observed, accompanied by a papilla-penetrating frenum. When examined extra orally lips were found to be competent. Patient had mild convex profile, acute naso-labial angle, mesocephalic profile presentation.

PRE TREATMENT OPG AND LATERAL             

PRE TREATMENT PHOTOGRAPHS

TREATMENT PLANNING: Post Oral prophylaxis, etching of the teeth was done utilizing 37% phosphoric acid. Transbond composite resin was used to bond the McLaughlin Bennett Trevisi (MBT) 0.22 slot brackets. The MBT bracket positioning gauge assisted in precise bracket placement, guided by the MBT chart. LED light cure was utilized to cure the brackets for a duration of 20 seconds. Case was planned to manage through non-extraction therapeutic approach. To enable lower arch bonding, the bite was elevated using a blue bite. Additionally, frenectomy was planned to eliminate the aberrant frenal attachment and facilitate diastema closure using an M spring.

TREATMENT PROGRESS: The initial alignment stage of treatment was carried out using a series of nickel-titanium wires, progressively advancing to a 0.019 × 0.025 stainless steel (SS) wire. Upper arch consolidation was done from central incisor to molar, and similar treatment was done in the opposite quadrant as well. On reaching the higher rectangular stainless-steel wire, Frenectomy was done followed by Midline diastema closure which was done using “M” spring made up of 0.0178 0.025 TMA wire. Upper and lower incisors proclination was reduced, and molar class 1 molar relation was achieved on both sides, and overbite also reduced into normal range, and diastema closure along with parallel roots also achieved.

Frenectomy after alignment

M spring placement after frenectomy (after 3 weeks of frenectomy m spring has been placed)

POST TREATMENT PHOTOGRAPHS

POST TREATMENT RADIOGRAPHS

COMPARISON OF PRE AND POST TREATMENT CEPHALOMETRIC VALUES

BIOMECHANICS: The spring is designed to apply a controlled tipping force to the crowns of the central incisors, moving them towards the midline and closing the diastema

ACTIVATION: During activation, the active arm of the spring is carefully bent inward, ensuring it sits securely in the bracket slot. This precise positioning helps controlled and accurate tooth movement during the treatment. The M-spring mechanics are based on Begg's philosophy, which emphasizes using lighter forces and round archwires to tip teeth, minimizing potential damage to tooth structure or investing structures. Incorporating a rectangular wire in the M spring helps minimize the risk of relapse by facilitating tooth movement bodily and towards mesially.

Many patients consider undergoing orthodontic therapy due to their compromised aesthetics. Several factors effect an aesthetic smile and one among them was the maxillary midline diastema. Midline diastema may be caused due to several factors. At times this diastema needs to be corrected orthodontically. The novel M-spring orthodontic appliance aids in the closure of the gap between the incisors within a short duration of time, effectively as well as efficiently thereby reducing the time of orthodontic therapy.

1. Brunelle JA, Bhat M, Lipton JA. Prevalence and distribution of selected occlusal characteristics in the US population, 1988–1991. Journal of Dental Research. 1996 Feb;75(2_suppl):706-13.
2. Richardson ER, Malhotra SK, Henry M, Little RG, Coleman HT. Biracial study of the maxillary midline diastema. The Angle Orthodontist. 1973 Oct 1;43(4):438-43.
3. Steigman S, Weissberg Y. Spaced dentition: an epidemiologic study. The Angle Orthodontist. 1985 Apr 1;55(2):167-76.
4. Tadros S, Ben-Dov T, Cathain EO, Anglin C, April MM. Association between superior labial frenum and maxillary midline diastema-a systematic review. Int J Pediatr Otorhinolaryngol. 2022 May 1;156(111063):10-16.
5. Edwards JG. The diastema, the frenum, the frenectomy: a clinical study. American journal of orthodontics. 1977 May 1;71(5):489-508.
6. Kumar N, Daigavane P. Midline diastema closure using an M spring in a young adult: a case report. Cureus. 2022 Oct 27;14(10).
7. Koora K, Muthu MS, Rathna PV. Spontaneous closure of midline diastema following frenectomy. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2007 Jan 1;25(1):23-6.
8. Suresh P, Muthukrishnan K, Ramassamy E, Shivashankarappa PG. ‘M’mechanics for midline diastema correction in mixed dentition. BMJ Case Reports CP. 2023 Sep 1;16(9):e256179.