Maxillary (upper) midline diastema: prevalence, etiology, and aesthetic perception in patients attending a dental teaching clinic in Basrah

Background. Midline diastema, a gap between the maxillary central incisors, is common feature of anterior dentition during development but, if it persistent into adulthood, it is considered an anomaly with aesthetic implications. Objective. This study aimed to determine the prevalence, gender differences, and etiological factors of maxillary midline diastema among patients attending the teaching clinic at the College of Dentistry, University of Basrah. Methods. A cross-sectional study was conducted on 592 patients (246 males and 346 females) aged 10-35 years (mean age 22.08 ± 6.68 years). Clinical and radiographic examinations were performed. Patients with a history of orthodontic or prosthodontic treatment of the anterior teeth, or those with periodontal disease, were excluded. Results. Midline diastema was diagnosed in 90 patients (15.2%). The prevalence was significantly higher in males (18.3%) than in females (13%), with a threshold (p = 0.05). The most frequent etiological factor was generalized spacing (24.4%), followed by hereditary predisposition (23.3%). High frenum insertion and peg-shaped or small lateral incisors each accounted for 15.6% of cases, while canine impaction or malposition accounted for 11.1%. Rotated, impacted, or missing central incisors represented 6.7% of cases, oral habits 3.3%, and mesiodens 1.1%. Regarding patient perception, 56.7% considered the diastema an aesthetic problem, while 43.3% were satisfied with their appearance (p < 0.0001). More than half (54.4%) expressed willingness to undergo treatment, compared with 45.6% who did not (p < 0.0001). Conclusion. Midline diastema is a multifactorial condition requiring thorough clinical and radiographic assessment and, in some cases, involving a multidisciplinary approach. In this study, its prevalence was 15.2%, higher in males than in females. Generalized spacing and genetic factors were the most common etiologies, while mesiodens was rare. More than half of the affected patients perceived diastema as an aesthetic problem and expressed a desire for treatment.