Conventional Frenectomy With Topical Ozonated Oil Application.

The frenum is a mucous membrane fold that connects the lip and cheek to the gingiva, periosteum, and alveolar mucosa. When the frena are linked too closely to the gingival border, there may be issues with plaque removal, and the overall gingiva may be affected. In addition, the maxillary frenum may provide aesthetic difficulties or interfere with the aesthetic outcome in cases of midline diastema, which may result in a recurrence after treatment. A labial frenectomy, a frequently performed surgical operation in the specialty of dentistry, is used to address such an abnormal frenum. This article describes a case study of a maxillary labial frenectomy using a traditional scalpel approach and topical application of ozonated olive oil.

Management of Aberrant Frenum by Z-plasty Procedure: A Case Report.

During or after the orthodontic closure, persistent diastemas are frequently the result of a high frenum attachment. A labial frenectomy is a complete removal of the frenum attachment, which typically attaches to the space between the upper two anterior teeth and the centre of the upper lip. It might be required if there is space between the teeth due to a frenulum positioned too high on the gums. Many surgical technique modifications, including Miller's technique, Z-plasty, and V-Y-plasty, have been established since the conventional classical frenectomy procedure was initially presented to cope with the difficulties associated with an aberrant labial frenum. This case report demonstrates that a Z-plasty approach was used to remove the 21-year-old female patient's high papillary-type labial frenum attachment and how orthodontic treatment led to the closure of the midline diastema. For several reasons, the frenectomy procedure with Z-plasty proved to be reliable and yielded outstanding aesthetic outcomes for the removal of the aberrant labial frenum connection. Understanding Z-plasty will enable primary intention-based tissue healing, reduce the risk of tissue contractures, shorten the patient's recovery, and enhance the patient's aesthetic outcomes.

Use of surgical grafting as a part of multidisciplinary treatment for a patient treated with fixed orthodontic therapy to improve treatment outcomes.

Key Clinical Abstract: Multidisciplinary treatment options can help provide good clinical outcomes if these are appropriately sequenced and carried out correctly. This case exemplifies interdisciplinary involvement to ensure the patient received an improved esthetic outcome. Abstract: The presence of anterior diastemas may compromise the esthetics of a patient's smile, causing mental, and social trauma in many patients. After careful evaluation Periodontal, surgical, and prosthodontic treatments are sometimes required to ensure successful treatment outcomes using a multidisciplinary staged treatment approach. These approaches must be carefully planned to ensure timely treatment progress. Surgical intervention must be planned at the right point in treatment to ensure adequate healing before placement of esthetic restorations.

Correlation of the Stature with Arch and Chord Dimensions in Young Subjects using Carrea's Index- An Anthropometric Study.

Background: Forensic identifications have utilized the height or stature of an individual in their field. Teeth and dentition can act as reliable tools to estimate the stature in cases where the only skull is presented as evidence. The Carrea's index assesses the stature in a subject from the lower anterior teeth dimensions. Aim: The present study was aimed to judge the reliability of Carrea's index in Indian subjects. Materials and Methods: From 80 subjects who were undergraduate students, plaster models were made and each was assessed individually making 160 hemiarches. These hemiarches were divided based on the teeth alignment into normal, diastema, and crowded forms. This was followed by measurement with a vernier caliper into chord and arch. Results: In both genders, the difference seen was statistically significant between dental arch types concerning various alignments with 95.23% and 83.75% success for males and females in normal dentition and 92.30% and 85.71% in crowded dentition. Also, a significant difference was seen for the type of arch with P ≤ 0.001 and 0.003, respectively. Lesser success was seen for spacing in both the genders and arches. Conclusion: The present study concludes that Carrea's index is a dependable and efficient tool for estimating height in subjects having arches with crowded and normal dentition which is functional for both the gender on the left and right side of the dental arches. However, in hemiarches with diastema, this method is not reliable.

Management of Midline Diastema in a Young Adult With Minimal-Thickness Porcelain Laminate Veneers.

Treating healthy but unaesthetic teeth has been a major challenge for a dental practitioner. Maxillary midline diastemas are one such aberration in the smile zone. Although a diastema can be transient in the developing dentition, the management of the diastema in adulthood requires a detailed examination and appropriate care for a successful outcome. Majority of specialty dentists prefer conservative or minimally invasive treatments, such as porcelain laminate veneer (PLV) restorations over full-ceramic crowns for anterior teeth, where esthetics can be extremely concerning. Minimal-thickness laminate veneers provide a satisfactory outcome while preserving the dental structure as a whole. Thus, this clinical report describes a conservative approach of minimal preparation utilizing a restoration to accomplish both esthetic and functional rehabilitation.

Effect of maxillary anterior supernumerary tooth extraction on the underlying malocclusion.

INTRODUCTION: Orthodontic discrepancies are a common finding in patients with supernumerary teeth (ST). The presence of a ST can cause a number of orthodontic discrepancies, such as delayed eruption or retention of adjacent teeth, crowding, spacing, abnormal root formation and so on. The aim of the present study was to assess the effect of extraction of an anterior supernumerary tooth on the underlying orthodontic discrepancies without additional treatment for a 6-month period. METHODS: This was a prospective, longitudinal, observational, study. It included 40 individuals with orthodontic malocclusions due to maxillary anterior supernumeraries. We examined the changes in the crowding and excessive space in the anterior and posterior segments on cast models. RESULTS: In the group that presented with crowding, a statistically significant decrease of 0.95 ± 0.17 mm (P < 0.001) was found between T0 and T1. Of the participants, three exhibited full self-correction. The excessive space at T0 (3.06 mm) decreased by 1.78 ± 0.19 mm to T1 (1.28 mm) in the anterior segment. Seven patients showed full self-correction of the diastemas after the 6-month observation period. CONCLUSION: The results imply that orthodontic treatment can be postponed for at least 6 months after the extraction of the supernumerary tooth as potential self-correction can be expected. This natural alleviation of the malocclusions may make the orthodontic treatment simpler, shorten the treatment time and decrease overall appliance wear time.

Integration of Digital and Analog Workflow to Achieve Predictable Esthetics: A Novel Approach.

The use of digital smile designing simplifies the restoration of esthetics. In this article, a case of diastema and incisal notching in anterior teeth was rehabilitated with porcelain laminate veneers using combination of digital and analog workflow.

Maxillary midline diastema closure with sectional feldspathic porcelain veneers: A case series followed 1 to 4 years.

OBJECTIVE: To evaluate clinical outcome of maxillary midline diastema closure using sectional feldspathic porcelain veneers up to 4 years. MATERIALS AND METHODS: Five female patients with stable maxillary midline diastema were included in the current study and restored with minimal invasive sectional feldspathic porcelain veneers under dental microscope. Esthetic, functional, as well as biologic properties of sectional veneers were evaluated according to the World Dental Federation (FDI) criteria after 1 to 4 years' follow-up. RESULTS: Based on FDI criteria, all five cases were evaluated as clinically excellent to satisfactory during a mean observation period of 26.4 months. Slight to moderate cervical marginal staining was observed in two cases after 3 to 4 years' follow-up. Slight white line or ditching of labial surface margin was found in most cases, but it is not easy to be noticed with saliva covering the margins. CONCLUSIONS: Sectional feldspathic porcelain veneers presented satisfying clinical outcome with potential long-term esthetic risk for maxillary midline diastema closure. CLINICAL SIGNIFICANCE: 1. Sectional feldspathic porcelain veneers presented satisfying short to medium term clinical performance when applied to close maxillary midline diastema. 2. The exposure of labial surface margin may increase a long-term potential esthetic risk.

Periodontal structures in horses with pituitary pars intermedia dysfunction: A histological evaluation.

Introduction: Pituitary pars intermedia dysfunction (PPID) and dental disorders are of major concern in horses older than 15 years. Although PPID in geriatric horses and dental disorders in all age groups are well described, a connection between this endocrine disease and pathological changes in equine dental structures has not yet been investigated. In humans, periodontitis is considered to be a complication of systemic diseases like diabetes mellitus type 2, obesity and various conditions leading to an impaired immune response. In PPID, cross links to insulin and immune dysregulations are proven. The aim of this study was to compare histological findings of the gingiva and the sub gingival periodontal ligament of PPID affected horses with control horses. Methods: In a case-control morphometric descriptive study, 145 dental locations of 10 PPID affected horses (27.3 ± 2.06 years) were compared with 147 dental locations of 10 controls (21.4 ± 4.12 years). Histological parameters were leukocyte infiltration, keratinization of gingival epithelium, blood vessel supply of the periodontium and structure of cementum. Results: The distribution and localization of gingival leukocyte infiltrations (LI) in PPID affected horses was more often multifocal to coalescing (p = 0.002) and reached into deeper parts of the periodontium, sometimes down to the sub gingival periodontal ligament (PDL). Aged animals of both groups showed higher prevalence (PPID: OR 1.66; controls: OR 1.15) for severe leukocyte infiltration in the PDL. PPID was not significantly associated with increased LI. The cementum bordering the soft tissue in interdental locations showed four times more irregularities in PPID affected horses than in controls which predisposes for interdental food impaction and periodontal diseases. Discussion: In summary, multifocal to coalescing leukocytes and irregular cementum are seen more often in PPID than in controls - however our findings mainly reflect an association of older age with periodontal disease.

Associations among the occurrence or types of maxillary canine impaction, labial frenum attachment types, lateral incisor anomalies, and midline diastema in patients with and without impaction: A case-control study.

INTRODUCTION: We tested whether the labial frenum attachment types may affect the occurrence or type of maxillary canine impaction. METHODS: This case-control study was performed on 96 subjects (48 with maxillary canine impaction [20.50±4.99 years, 32 females], 48 controls [21.94±3.79, 31 females]). Types of canine impaction (buccal/palatal, bilateral/unilateral, left/right), types of upper lip middle frenums (mucosal, gingival, papillary), the anatomy of lateral incisors (impacted, peg shaped, small, normal), and the midline diastema were evaluated clinically and radiographically. Associations were examined using multiple binary logistic regression, 3-way repeated-measures ANCOVA, and Fisher tests (α=0.05, ß=0.2). RESULTS: The numbers of mucosal, gingival, and papillary frenums in the case group were '29, 14, and 5', respectively; in the control group, they were '25, 21, and 2' (Fisher, P=0.248). The numbers of mucosal, gingival, and papillary frenums were respectively '25, 11, and 1' in the palatally impacted canine subgroup; they were '4, 3, and 4' in the buccally impacted subgroup (Fisher, P=0.010). Abnormal laterals were present in 12 cases and 4 controls; normal laterals were observed in 36 cases and 44 controls (Fisher, P=0.053). Abnormal laterals were seen in 10 cases with palatally impacted canines and 2 cases with buccally impacted canines; normal laterals existed in 27 cases with palatally impacted canines and 9 cases with buccally impacted canines (Fisher, P=0.705). Lateral anatomy was not associated with frenum attachment (Fisher, P=0.827). Greater midline diastemas were seen in cases with maxillary canine impaction, papillary frenums, and abnormal laterals (ANCOVA, P≤0.016). CONCLUSIONS: Buccal type of canine impaction is positively associated with papillary labial frenums. Canine impaction is 3.6 folds more prevalent in cases with lateral abnormality. Midline diastema is positively and independently associated with canine impaction, papillary frenums, and abnormal laterals.

Dental management of a pediatric patient with progressive familial intrahepatic cholestasis having dental anomalies: a case report and brief review of the literature.

BACKGROUND: Progressive familial intrahepatic cholestasis is a heterogeneous group of disorders, leading to intrahepatic cholestasis, with the possibility of chronic liver failure and biliary cirrhosis. Oligodontia is either the manifestation of a specific syndrome or is non-syndromic. To the best of our knowledge, this is the first case report of type 3 progressive familial intrahepatic cholestasis and concurrent oligodontia, craniosynostosis, dens in dente, taurodontism, and delayed permanent dentition in the medical and dental literature. CASE PRESENTATION: We present the dental and medical histories and comprehensive dental management of a girl with type 3 progressive familial intrahepatic cholestasis and several dental anomalies, who was referred to a dental clinic due to severe dental caries and pain. CONCLUSION: Our findings suggest that PFIC with manifestations as oligodontia, craniosynostosis, dens in dente, taurodontism, and delayed permanent dentition, might indicate an unknown syndrome; otherwise, the craniofacial anomalies are the manifestations of an independent disease coinciding with PFIC. Moreover, our case is a good example of the importance of timely medical and dental care in confining further health-related complications. The patient was able to ingest without any pain or discomfort after receiving proper dental management.

Should midline diastema in mixed dentition be an aesthetic concern?

BACKGROUND: Mixed dentition determines an important period of occlusion development in childhood. OBJECTIVE: This study aimed to evaluate the aesthetic impact of the midline diastema cut-off point in mixed dentition. DESIGN: A cross-sectional study was performed with 257 children aged 8-10 years in late mixed dentition, with midline diastema of 1-5 mm and normal maxillary overjet. Orthodontic Aesthetic Subjective Impact Score determined the aesthetic impact of the midline diastema. Four quartiles of diastema measurements and impact scores were considered as cut-off points. Receiver Operating Characteristic curves were constructed, and the distances representing the distances to the ideal point were calculated. The Yuden index determined the efficiency of measuring the diastema to assess the aesthetic impact. The Kruskal-Wallis test compared the groups of participants classified according to the diastema cut-off by the sample quartile regarding the impact score. The analyses were performed with a significance level of 5%. RESULTS: There was no significant difference between the four groups of measurement quartiles of the diastema regarding the aesthetic impact (P > .05). CONCLUSIONS: The perception of dental aesthetics in mixed dentition children was not affected by the midline diastema, regardless of the cut-off point.

Treatment of a Mandibular Diastemal Fracture Using Locking Compression Plate and Cerclage Wire in a Mare.

This report describes the combination of two surgical fracture repair techniques and the postoperative management of a mandibular diastemal fracture in a two-year-old mare. The mare was referred to a veterinary hospital with a laceration over the body of the right mandible. Radiographic assessment revealed two mesial fracture lines involving the second premolar tooth and a ventrally displaced bone fragment. The mare was treated under general anesthesia and the fracture was corrected using open reduction and plate fixation. A 3.5 mm narrow 15-hole locking compression plate with seven locking screws were used in a bridge form. Cerclage wire was also used to anchor the incisor teeth to the second and third premolar teeth. The cerclage wire and incisor teeth were covered with polymethylmethacrylate to prevent implant failure and avoid injury to the oral mucosa. Implants were removed 55 days after surgery and the mare was discharged from hospital five days later. The mare returned for cerclage wire removal after 90 days and was allowed to resume exercise thereafter. The combination of two surgical techniques, proper implant choice and appropriate postoperative management, including use of pelleted feed, contributed to successful bone healing and return to function.

Maxillary Midline Diastemas in West African Smiles.

The maxillary midline diastema (MMD) has experienced a renaissance in popular culture over the last 10 years. Current literature states that MMDs should be eliminated where possible or be reduced to 1 mm or less in width. This literature review explores the evidence for this in a West African population. A systematic search of the literature (Medline and Google Scholar) followed by a hand search was carried out to identify all papers evaluating perceptions of MMDs. In all, 209 papers were identified in the literature search, 8 of which met the inclusion criteria. The review revealed that midline diastemas are desirable in this specific population with a width of 2 to 4 mm deemed as attractive. As many as 95% of participants found the MMD beautiful, and as many as 95% would consider having one created artificially. The literature does not support the position that MMDs larger than 1 mm should always be treated to be perceived as attractive in this population. MMDs are accepted as attractive and should be considered a key feature in smile design for this population.

Two-year retrospective evaluation of monoshade universal composites in direct veneer and diastema closure restorations.

OBJECTIVES: The aim of this retrospective evaluation was to assess the short-term outcome of two monoshade universal resin composites with high chameleon effect in anterior direct veneer and diastema closure restorations, and to investigate the possible reasons for failure. MATERIAL AND METHODS: Patients subjected to veneer and diastema closure restorations with two monoshade universal resin composites (Essentia Universal Shade; EU, GC Corp., and Omnichroma; OC, Tokuyama) operated between January 2018 and March 2019 were selected for the present retrospective evaluation. A total of 159 composite restorations (78 veneers and 81 diastema closure restorations) performed by a single operator in 44 patients (mean age: 33.6) were included in the study. Two blinded and calibrated examiners performed 1- and 2-year assessments of the restorations with respect to FDI criteria, using medical/clinical history and dental photography records. Data were analyzed using Pearson Chi-square with Continuity Correction, Fisher's Exact tests, and Cox regression (a < 0.05). RESULTS: The cumulative overall survival rates of EU and OC restorations were 94.6% (97.3% for the first year) and 88.6% (95.3% for the first year), respectively, with no significant difference from each other (p = 0.316). The cumulative overall survival rates of direct veneer and diastema closure restoration types were 90.2% (95.1% for the first year) and 92.4% (97.4% for the first year), respectively, with no significant difference (p = 0.559). The reasons for failure were evaluated as fracture of the restoration, failure in esthetic anatomical form, and color mismatch. All the failed direct veneer restorations were due to fractures (FDI score of 5.4), whereas 5 of 6 failed diastema closure restorations were due to color mismatch (FDI score of 3.4). Regarding the composite materials, there were no significant differences between the success rates of the restoration types (p = 0.442 for EU, p = 1.000 for OC). With respect to the restoration types, there were also no significant differences between the success rates of the resin-based composites (p = 1.000 for direct veneer restorations and p = 0.228 for the diastema closure restorations). In addition, no significant difference was observed between male and female patients regarding the acceptable and unacceptable scores (p = 1.000). CONCLUSIONS: The 2-year clinical performance of the two monoshade universal composites in anterior veneer and diastema closure restorations were both considered successful and similar. Despite the lack of shade selection, both monoshade universal composites presented a successful color match. However, the diastema closure restorations might be more prone to color mismatch compared to the veneers over time, while veneer restorations presented more fractures than the diastema closure restorations. CLINICAL SIGNIFICANCE: Monoshade universal composites presented successful short-term clinical outcomes regarding both function and esthetics in anterior direct veneer and diastema closure restorations.

What is a superior labial frenulum? An anatomical and histological study.

Anatomy of the superior labial frenulum (SLF), at first glance, seems to be well established. However, existing studies on the SLF lack description of the incisivus labii superioris (ILS), which cannot be ignored when discussing the SLF. We believe that thorough understanding of the SLF necessitates the anatomical knowledge of the ILS. This study aimed to elucidate the anatomical relationship between the orbicularis oris (OO), ILS, and SLF. A total of 20 formalin fixed human cadaveric specimens were used for gross anatomical and/or histological observation. For histological observation, all specimens were stained with Masson-trichrome. The SLF was a mucosal fold between the gingival mucosa and alveolar mucosa with connective tissue deep to it. The connective tissue attached to the alveolar bone in the junction between the right and left ILS. Skeletal muscle fibers other than orbicularis oris was found in one specimen, which were considered the ILS. During a frenulectomy, removal of the connective tissue bundle is required to prevent recurrence of the high SLF insertion.

Anterior Aesthetic Rehabilitation for Midline Diastema Closure With Veneers: A Case Report.

The value of having excellent teeth has increased in today's culture, even from a merely cosmetic perspective. There are several ways to address issues that arise in the area of high aesthetic sensitivity. Every modality has its benefits and drawbacks. One of the most aesthetically pleasing restorations is porcelain laminate veneers (PLVs). It has been demonstrated that the use of PLVs to address functional and/or aesthetic issues is a viable treatment option, particularly in the anterior aesthetic zone. As long as suitable procedures and guidelines are followed, these restorations are conservative and long-lasting. A patient with an anterior diastema is the main focus of this case study. This case report is essential for expanding dental knowledge, training dental practitioners, proving the effectiveness of treatments, and directing treatment choices for instances that are comparable to it. PLVs were used on the patient to close the diastema in the anterior maxillary arch and achieve a good cosmetic outcome.

Morphological variations of the labial frenum, type of attachment and presence of diastemas: integrative review / Variações morfológicas do freio labial, tipo de inserção e presença de diastemas: revisão integrativa

ABSTRACT Objective: The aim of the present literature review was to compile data on the frequency of morphological and attachment types of the upper and lower labial frenum in different populations and investigate the association between the attachment level of the upper labial frenum and the occurrence of diastemas. Methods: Searches were conducted between May and June 2021 in the Medline (via Ovid), Google Scholar and CAPES databases. Thirty-eight studies that evaluated frenum morphology, frenum morphology and attachment or frenum morphology, attachment and the occurrence of diastemas were selected for the extraction of data. Results: Based on the data compiled in this review, the most common morphological and attachment types were labial frenum normale and mucosal attachment. The papillary and papilla penetrating types of attachment were more associated with the occurrence of diastemas. Conclusion: Longitudinal studies are needed to investigate this correlation in children and adults.

RESUMO Objetivo: O objetivo dessa revisão de literatura é compilar dados referentes a frequência de tipos morfológicos e de inserção do freio labial superior ou inferior, em diferentes populações, além de avaliar a relação entre o nível de inserção do freio labial superior e a ocorrência de diastemas. Métodos: Foram consultadas as bases de dados Medline (via Ovid), o Google acadêmico e o portal periódicos CAPES. A pesquisa foi realizada no período compreendido entre os meses de maio e junho de 2021. Foram selecionados para a extração de dados 35 estudos, que avaliação a morfologia do freio ou morfologia e inserção ou morfologia, inserção e presença de diastemas. Resultados: A partir dos dados compilados por essa revisão, foi possível estabelecer que os tipos morfológicos e de inserção mais comuns foram freio labial simples e inserção em mucosa. Com relação ao tipo de inserção e a ocorrência de diastemas, os tipos papilar e papilar penetrante foram os mais associados à sua ocorrência. Conclusão: Há necessidade de estudos longitudinais que avaliem essa correlação em crianças e populações adultas.

Ortodontia minimamente invasiva auxiliando a reabilitação estética dos incisivos superiores ­ relato de caso / Minimally invasive orthodontics can help aesthetic rehabilitation of the upper anterior teeth ­ a case report

Resumo Esse artigo descreve o tratamento de um diastema na região anterior da maxila utilizando uma abordagem multidisciplinar. Paciente do gênero feminino, 38 anos, procurou atendimento odontológico na Clínica Faculdade de Odontologia da Universidade Nove de Julho, com queixa estética devido ao diastema da linha média maxilar. Após exame clínico e tratamento periodontal, verificou-se a necessidade de alinhamento e nivelamento dos dentes anteriores. O excesso de papila gengival entre 11 e 21 foi submetido à exérese, e um aparelho ortodôntico fixo foi instalado em 12, 11, 21 e 22. Após três semanas, quando os dentes estavam posicionados em condições mais favoráveis, uma contenção Hawley foi adaptada para pequenas correções no sentido vestíbulo-lingual. Para a restauração dos dentes, foi feito um molde diagnóstico e enceramento para permitir a construção de uma matriz de silicone. Um compósito nano-híbrido e um micro-híbrido foram escolhidos e colocados seguindo a matriz de silicone ajustada ao lado palatino dos dentes. Após os procedimentos de acabamento e polimento, o resultado estético foi muito satisfatório tanto para o paciente quanto para a equipe odontológica. A relevância clínica desse caso indica que é possível treinar alunos de Graduação para alcançar o sucesso no tratamento de diastemas adversos da linha média em um curto período de tempo, com planejamento e interação entre diferentes especialidades odontológicas. (AU)

Abstract This manuscript described the treatment of anterior maxillary diastema using a multidisciplinary approach. A female patient, 38 years old, looked for dental treatment at the University Nove de Julho Dental School Clinic with an esthetic complaint due to maxillary midline diastema. After clinical examination and periodontal treatment, the necessity of alignment and leveling of the anterior teeth was verified. Excess of gingival papilla between 11 and 21 underwent exeresis and an orthodontic fixed appliance was installed in 12, 11, 21, and 22. After three weeks, when the teeth were positioned in a more favorable condition, a Hawley retainer was adapted for small corrections in buccolingual direction. For teeth restoration, a diagnostic cast and wax-up was made to allow the construction of a silicone matrix. A nanohybrid and a microhybrid composite were chosen and placed following the silicone matrix adjusted to the palatal side of the teeth. After finishing and polishing procedures, the esthetic result was very satisfactory for both the patient and the dental staff. The clinical relevance of this case indicates that it is possible to train undergraduate students to achieve success treating adverse midline diastema in a short period of time throw planning and interaction among different dental specialties (AU)

Midline Diastema Closure Using an M Spring in a Young Adult: A Case Report.

The malocclusion known as maxillary midline diastema frequently occurs. For the management of diastema, a variety of therapy approaches are recommended. This article gives a case report of a female patient, age 24, who underwent treatment for a 4-mm maxillary midline diastema following the extraction of an additional tooth between her upper central incisors. The orthodontic treatment index was minimal (grade 2). The maxillary central incisors were fitted with bonded McLaughlin-Bennett-Trevisi (MBT) 0.018" brackets. A rectangular archwire was used after the circular archwire to ligate and activate the M spring. The diastema was successfully closed after a total of four months of treatment. This approach is effective and efficient and uses minimal inventory. This shortens the length of the orthodontic treatment and conserves valuable chairside time.