Multidisciplinary Treatment of a Median Diastema in a Patient with Tongue-Tie and Tongue Thrusting : A clinical report

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Chompunuch Tiyawongmana
Charlermpol Leevailoj


Objective: This case report describes the treatment of a female patient with a median diastema, caused by tongue-tie and a tongue thrusting habit, using a sequence of multidisciplinary treatments to achieve an esthetic outcome.

Materials and procedures: A treatment plan was developed to first perform a frenectomy at the lower lingual frenum to correct the tongue-tie and utilize a removable orthodontic appliance with tongue cribs to train the patient’s swallowing habit. An asymmetrical gingival line was visible when the patient smiled. To evaluate the desired gingival level and the proportions of the restorations to be made based on the recurring esthetic dental (RED) proportion, a diagnostic wax-up model was fabricated. Esthetic crown lengthening was performed to correct the gingival line. Home whitening was prescribed for 2 weeks, with an additional 2-week waiting period to ensure tooth color stability. Final restoration was obtained by placing ceramic veneers on the maxillary anterior teeth.

Conclusions: This multidisciplinary treatment approach achieved excellent esthetic results; after veneer cementation, the patient exhibited greater confidence with her new smile.

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Tiyawongmana C, Leevailoj C. Multidisciplinary Treatment of a Median Diastema in a Patient with Tongue-Tie and Tongue Thrusting : A clinical report. M Dent J [Internet]. 2017 Jan. 16 [cited 2024 Jun. 18];37(1):89-101. Available from:
Review articles


1. Gass JR, Valiathan M, Tiwari HK, Hans MG, Elston RC. Familial correlations and heritability of maxillary midline diastema. Am J Orthod Dentofacial Orthop. 2003;123(1):35-9.
2. Bernabe E, Flores-Mir C. Influence of anterior occlusal characteristics on self-perceived dental appearance in young adults. Angle Orthod. 2007;77(5):831-6.
3. Kerosuo H, Hausen H, Laine T, Shaw WC. The influence of incisal malocclusion on the social attractiveness of young adults in Finland. Eur J Orthod. 1995;17(6):505-12.
4. Gkantidis N, Kolokitha OE, Topouzelis N. Management of maxillary midline diastema with emphasis on etiology. J Clin Pediatr Dent. 2008;32(4):265-72.
5. Kumar S, Gandhi S, Valiathan A. Perception of smile esthetics among Indian dental professionals and laypersons. Indian J Dent Res. 2012;23(2):295.
6. Nainar SM, Gnanasundaram N. Incidence and etiology of midline diastema in a population in south India (Madras). Angle Orthod. 1989;59(4):277-82.
7. Segal LM, Stephenson R, Dawes M, Feldman P. Prevalence, diagnosis, and treatment of ankyloglossia: methodologic review. Can Fam Physician. 2007;53(6):1027-33.
8. Ballard JL, Auer CE, Khoury JC. Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics. 2002;110(5):e63.
9. Chu MW, Bloom DC. Posterior ankyloglossia: a case report. Int J Pediatr Otorhinolaryngol. 2009;73(6):881-3.
10. Northcutt ME. The lingual frenum. J Clin Orthod. 2009;43(9):557-65; quiz 81.
11. Hanson ML, Barnard LW, Case JL. Tongue-thrust in preschool children. Am J Orthod. 1969;56(1):60-9.
12. Peng CL, Jost-Brinkmann PG, Yoshida N, Chou HH, Lin CT. Comparison of tongue functions between mature and tongue-thrust swallowing--an ultrasound investigation. Am J Orthod Dentofacial Orthop. 2004;125(5):562-70.
13. Cheng CF, Peng CL, Chiou HY, Tsai CY. Dentofacial morphology and tongue function during swallowing. Am J Orthod Dentofacial Orthop. 2002;122(5):491-9.
14. Ward DH. Proportional smile design using the recurring esthetic dental (red) proportion. Dent Clin North Am. 2001;45(1):143-54.
15. Ward DH. A study of dentists' preferred maxillary anterior tooth width proportions: comparing the recurring esthetic dental proportion to other mathematical and naturally occurring proportions. J Esthet Restor Dent. 2007;19(6):324-37; discussion 38-9.
16. Kellum GD. Orofacial Myology: Beyond Tongue Thrust In Michelle Ferketic and Kirsten Gardner (Eds.) ed. Rockville, MD: American Speech-Language-Hearing Association.; 1994.
17. Zante SM. Orofacial Myology: Beyond Tongue Thrust. In Michelle Ferketic and Kirsten Gardner (Eds.) ed. Rockville, MD: American Speech-Language-Hearing Association.; 1994.
18. Tuverson DL. Anterior interocclusal relations. Part I. Am J Orthod. 1980;78(4):361-70.
19. Tuverson DL. Anterior interocclusal relations. Part II. Am J Orthod. 1980;78(4):371-93.
20. Campbell A, Kindelan J. Maxillary midline diastema: a case report involving a combined orthodontic/maxillofacial approach. J Orthod. 2006;33(1):22-7.
21. Huang WJ, Creath CJ. The midline diastema: a review of its etiology and treatment. Pediatr Dent. 1995;17(3):171-9.
22. Russell KA, Folwarczna MA. Mesiodens--diagnosis and management of a common supernumerary tooth. J Can Dent Assoc. 2003;69(6):362-6.
23. Kotlow LA. Ankyloglossia (tongue-tie): a diagnostic and treatment quandary. Quintessence Int. 1999;30(4):259-62.
24. Kupietzky A, Botzer E. Ankyloglossia in the infant and young child: clinical suggestions for diagnosis and management. Pediatr Dent. 2005;27(1):40-6.
25. Manfro AR, Manfro R, Bortoluzzi MC. Surgical treatment of ankyloglossia in babies--case report. Int J Oral Maxillofac Surg. 2010;39(11):1130-2.
26. Alexander S, Sudha P. Genioglossis muscle electrical activity and associated arch dimensional changes in simple tongue thrust swallow pattern. J Clin Pediatr Dent. 1997;21(3):213-22.
27. Cayley AS, Tindall AP, Sampson WJ, Butcher AR. Electropalatographic and cephalometric assessment of myofunctional therapy in open-bite subjects. Aust Orthod J. 2000;16(1):23-33.
28. Huang GJ, Justus R, Kennedy DB, Kokich VG. Stability of anterior openbite treated with crib therapy. Angle Orthod. 1990;60(1):17-24; discussion 5-6.
29. Mack MR. Perspective of facial esthetics in dental treatment planning. J Prosthet Dent. 1996;75(2):169-76.
30. Pradeep K, Patil N, Sood T, Akula U, Gedela R. Full mouth rehabilitation of severe fluorozed teeth with an interdisciplinary approach (6 handed dentistry). J Clin Diagn Res. 2013;7(10):2387-9.
31. Fletcher P. Biologic rationale of esthetic crown lengthening using innovative proportion gauges. Int J Periodontics Restorative Dent. 2011;31(5):523-32.
32. Kois JC. New paradigms for anterior tooth preparation. Rationale and technique. Oral Health. 1998;88(4):19-22, 5-7, 9-30.
33. Pontoriero R, Carnevale G. Surgical crown lengthening: a 12-month clinical wound healing study. J Periodontol. 2001;72(7):841-8.
34. Rezende M, Loguercio AD, Kossatz S, Reis A. Predictive factors on the efficacy and risk/intensity of tooth sensitivity of dental bleaching: A multi regression and logistic analysis. J Dent. 2016;45:1-6.
35. Meijering AC, Creugers NH, Roeters FJ, Mulder J. Survival of three types of veneer restorations in a clinical trial: a 2.5-year interim evaluation. J Dent. 1998;26(7):563-8.
36. Denry I, Kelly JR. Emerging ceramic-based materials for dentistry. J Dent Res. 2014;93(12):1235-42.
37. Christensen GJ. The all-ceramic restoration dilemma: where are we? J Am Dent Assoc. 2011;142(6):668-71.
38. Wang F, Takahashi H, Iwasaki N. Translucency of dental ceramics with different thicknesses. J Prosthet Dent. 2013;110(1):14-20.
39. Yang Y, Yu J, Gao J, Guo J, Li L, Zhao Y, et al. Clinical outcomes of different types of tooth-supported bilayer lithium disilicate all-ceramic restorations after functioning up to 5 years: A retrospective study. J Dent. 2016;51:56-61.
40. Fradeani M, Redemagni M, Corrado M. Porcelain laminate veneers: 6- to 12-year clinical evaluation-a retrospective study. Int J Periodontics Restorative Dent. 2005;25(1):9-17.