Research Article Revisiting the Factors Underlying Maxillary Midline Diastema Abdullah M. Zakria Jaija, 1 Amr Ragab El-Beialy, 2,3 and Yehya A. Mostafa 2,3 1 Private Practice, P.O. Box 376385, Riyadh 11335, Saudi Arabia 2 Department of Orthodontics and Dentofacial Orthopedics, Faculty of Oral and Dental Medicine, Cairo University, 11 El-Saraya Street, Manial, Cairo 12511, Egypt 3 MOrth Programs at Cairo University and Future University, Cairo, Egypt Correspondence should be addressed to Amr Ragab El-Beialy; amr.elbeialy@dentistry.cu.edu.eg Received 5 December 2015; Accepted 17 March 2016 Academic Editor: William Maloney Copyright © 2016 Abdullah M. Zakria Jaija et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aim. Te aim of this study is to analyze the etiological factors underlying the presence of maxillary midline diastema in a sample of orthodontic patients. Materials and Methods. One hundred patients who fulfll the inclusion criteria were selected from 1355 patients seeking orthodontic treatment. Te pretreatment orthodontic records were analyzed. Te width of the maxillary midline diastema was measured clinically with a digital caliper at two levels: the mesioincisal angles of the central incisors and fve millimeters from the incisal edge. Te two measurements were averaged, and patients with diastema of more than 0.5 millimeter in width were enrolled. Results. Diastema is a multifactorial clinical fnding with more than one underlying etiological cause. Te interrelationship between the familial pattern of midline diastema and the microdontia, macroglossia, labial frenum, and alveolar clef conforms was clear. Te efect of a mesiodens and the upper lateral incisor whether bilaterally missing, unerupted, or peg shaped was minimal. Conclusion. Etiological factors underlying maxillary midline diastema are interconnected. Using a checklist as a guide during handling maxillary midline diastema is important in the diferent stages of treatment. 1. Introduction Te presence of a midline diastema represents an esthetic and psychological impairment and distress for patients seeking orthodontic treatment [1]. Maxillary midline diastema is a clinical sign, which has a multitude of underlying etiological factors that might be interdependent or independent. Many etiological factors for maxillary midline diastema have been reported in the literature [2]. Among them are the physiological (developmental) self-limiting diastema, famil- ial background, mesiodens [3–5], abnormal labial frenum [6–8], missing or undersized lateral incisor, thumb sucking, mouth breathing, tongue thrust, ankylosed central incisor, fared or rotated central incisors, anodontia, macroglossia [9, 10], dentoalveolar disproportion, generalized spacing [11], localized spacing, closed bite, facial type, ethnic and familial characteristics [12, 13], interpremaxillary suture and transsep- tal fbers [14], midline pathology, midline submucosal alve- olar clef [15], tongue piercing [16], gingival recession, and pathological tooth migration [17]. Te aim of this survey is to investigate the correlation between the diferent etiological factors underlying maxillary midline diastema and highlight their clinical implications. 2. Materials and Methods Tis survey was performed on patients undergoing orthodontic treatment at three orthodontic graduate programs. Te pretreatment records of 1355 patients were examined, to collect 100 patients fulflling the inclusion criterion (presence of maxillary midline diastema >0.5 mm) within an age range of 13–30 years. Te pretreatment records included history, intra- and extraoral examination, and panoramic and periapical radiographs of the maxillary incisor region. Te width of the maxillary midline diastema was measured clinically with a digital caliper at two levels: the mesioincisal angles of the central incisors and fve millimeters from the incisal edge. Te two measurements were averaged, and patients with diastema of more than 0.5 millimeter in Hindawi Publishing Corporation Scientifica Volume 2016, Article ID 5607594, 5 pages http://dx.doi.org/10.1155/2016/5607594