Application of orthodontic elastics for the treatment of midline diastemas

Patients with a midline diastema smaller than 2 mm are often treated with orthodontic elastics applied on composite resin esthetic buttons bonded to incisors or incorporated in clear removable trays. However, these methods of applying elastics for diastema closure have shortcomings, including the additional clinical steps of etching the facial tooth surface and bonding for composite resin buttons; occlusal derangement and dependence on patient compliance for trays; and compromised esthetics for both treatment approaches. This article presents an alternative technique that overcomes the limitations of those methods by applying orthodontic elastics directly on the central incisors without the use of esthetic buttons or removable trays. The technique can lead to tipping of the incisors and therefore is restricted to treatment of diastemas up to 2 mm. The technique is straightforward to perform with readily available materials and can be performed by a general dentist. Once the desired space closure is achieved, the corrected position of the incisors can be retained with a resin-bonded splint to counter labial tipping movement and aid in root alignment. In some cases, esthetic restorations such as laminate veneers are indicated to close the redistributed interdental spaces, and the contact areas of the restorations could serve as a form of retention.