Case Report When the Midline Diastema Is Not Characteristic of the (Ugly Duckling) Stage Orlando Motohiro Tanaka, 1 Alessandro Yuske Kusano Morino, 2 Oscar Fernando Machuca, 3 and Neblyssa Ágatha Schneider 3 1 Graduate Dentistry Program, Orthodontics, School of Health and Biosciences, Pontif´ ıcia Universidade Cat´ olica do Paran´ a, Rua Imaculada Conceic ¸˜ ao 1155, 80215-901 Curitiba, PR, Brazil 2 Undergraduation Dentistry Course, Pontifcia Universidade Cat´ olica do Paran´ a, 80215-901 Curitiba, PR, Brazil 3 Graduate Dentistry Program, Orthodontics, Pontifcia Universidade Cat´ olica do Paran´ a, 80215-901 Curitiba, PR, Brazil Correspondence should be addressed to Orlando Motohiro Tanaka; tanakaom@gmail.com Received 25 April 2015; Accepted 15 July 2015 Academic Editor: Carla Evans Copyright © 2015 Orlando Motohiro Tanaka 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. Tis case report presents the interceptive orthodontic treatment of a 9-year, 5-month-old boy with class I malocclusion, a 9.0-mm maxillary midline diastema, and deviation from the midline. Te treatment goals were to decrease the magnitude of the diastema and to simulate the characteristics of the “ugly duckling” stage. Braces were placed on the frst molars and the maxillary central incisors. Te biomechanics of the anchors on the frst molars elicited substantial mesial movement of the lef central incisor to match the midline. A fat wire segment was bonded onto the palatal surface of the central incisors for retention. 1. Introduction A midline diastema is typically part of normal dental devel- opment during the period of mixed dentition [1]. However, several factors can cause a diastema that may require an intervention. Enlarged labial frena have been blamed for the majority of persistent diastemas, but the etiologic role of this structure is now understood to infuence only a small proportion of cases. Other etiologies associated with diastema include oral habits, muscular imbalances, physical impediments, abnormal max- illary arch structure, and various dental anomalies [2]. Supernumerary teeth, which occur in both the primary and permanent dentitions, cause a variety of pathological disturbances [3], the most common of which is midline dias- tema. In the periods of mixed and early permanent dentitions, median diastemas can be transient or created by develop- mental, pathological, or iatrogenic factors and are a major aesthetic concern for patients and/or their parents [4]. Te presence of a diastema between the teeth is a common feature of the anterior dentition that remains until the com- pletion of the permanent dentition [1]. Carefully developed diagnoses and advanced planning enable the identifcation of the most appropriate treatment to address the needs of each individual patient [5]. Tere has been much debate regarding the ideal time to initiate orthodontic treatment, and from the orthodontist’s perspective, only maxillary midline diastemas and congeni- tally missing teeth should be treated in later stages [6]. An efective diastema treatment requires the correct di- agnosis of its etiology and an intervention that is relevant to that specifc etiology, including medical and dental histories, radiographic and clinical examinations, and possibly tooth- size evaluations [2]. Te needs for treatment are primarily attributed to aesthetic and psychological rather than functional reasons. Although it is ofen the case, treatment plans should not be selected empirically but should rather be based on adequate scientifc documentation. Te ideal treatment should deal not only with the diastema but also with the cause of the diastema. Irrespective of the selected treatment, the permanent reten- tion of stable results should be considered to be a treatment objective [7]. Hindawi Publishing Corporation Case Reports in Dentistry Volume 2015, Article ID 924743, 5 pages http://dx.doi.org/10.1155/2015/924743