Back to simple: Diastema closure with simple customized metal matrix

A clinical case by our Community member Dr Hung Bui

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

Diastema is a common clinical concern in dentistry; this condition causes the patient to be cautious when interacting with others. The patient always desires to address this condition as soon as possible, so direct restoration with composite is the optimum option.
Nowadays, there are many matrix systems to do diastema closure, but in some cases, there aren’t enough systems to do it, so how can a dentist do diastema closure? In this article, a basic way for creating a customized matrix that the clinician may use in a variety of circumstances will be shown. It is manufactured quickly and easily. However, only in some simple circumstances, this strategy is recommended.

style italiano styleitaliano Initial situation

Fig.1
The initial situation. The patient came to the clinic with the desire to repair teeth 11-21 that were filled with composite 2 years ago. The patient told that she had a large gap between teeth 11 and 21 before, and was then filled with composite, but now the filling is no longer aesthetic, so she wants to do it again. In addition, the patient also wants to fill the gaps between tooth number 12-13-22-23.

style italiano styleitaliano isolation

Fig.2
The first step is isolating the teeth with the rubber dam, this is a very important step to have a clean environment, free from contaminants, and with a clear vision. When done correctly, the gum will be pulled down and revealed the boundary of the old composite filling. In this case, the patient wants to fill the 6 front teeth, so the rubber dam will be used to expose the first premolar tooth on both sides of the upper jaw.

style italiano styleitaliano removal of the old composite

Fig.3
Use the bur to clean the old composite fillings. Note at this step, when the old composite filling was removed, a special attention should be done to not grind too much into the teeth tissue.

style italiano styleitaliano remnant composite checked

Fig.4
The remnant composite can be checked again by blowing the surface dry.

style italiano styleitaliano sandblasting

Fig.5
Use an AquaCare sandblaster with 29-micron Al2O3 sand to clean and create a rough surface on enamel. When using a sandblaster, the invasion of teeth enamel will be minimized while ensuring the durability of the filling.

style italiano styleitaliano etching enamel surface

Fig.6
Etching enamel surface with H3 PO4 acid for 30s and then washing for 60s to ensure complete removal of the etching gel.

style italiano styleitaliano blowing after etching and rinsing

Fig.7
Blow dry the enamel surface after etching, the frosty white appearance is a good indicator of enough etching.

style italiano styleitaliano bonding and matrix placement

Fig.8
The surface was bonded using a universal adhesive (Scotchbond Universal Adhesive, 3M ESPE). Keeping the matrix in place helps to avoid accidental contamination of the adjacent teeth during the adhesive procedure.

style italiano styleitaliano 3m relyx universal
style italiano styleitaliano 3m relyx universal
style italiano styleitaliano customized matrix

Fig.9
In this case, a customized matrix is created from a traditional matrix band. A curve at the tip was cut, so that this part of the matrix can hug the cervical part of the tooth in the labial-lingual direction. Then, the top of the matrix is warped to create the emergence profile wanted. Finally, a hole was drilled in the bottom part of the matrix so that the clinician can attach the 2 customized matrices together with the flow composite.

style italiano styleitaliano customized matrices in place

Fig.10
2 customized matrices attached together by composite seen from the side.

style italiano styleitaliano closure of the diastema

Fig.11
A1 shade from the Filtek Z250 (3M ESPE) was used to fill all of the space. First, 2 emergence profiles were created in one-third of the cervical part of 2 central incisors.

style italiano styleitaliano 3m
style italiano styleitaliano 3m
style italiano styleitaliano closure of the diastema

Fig.12
Then, orange wedges (Garrison) were used to fix the matrices at the gingival triangle and continue filling the entire diastema area. The composite was applied by using LM Arte Applica (LM Arte kit, powered by Styleitaliano) to build the proximal wall, while making sure the contact between the composite and the matrix is nicely curved. If this contact area is too sharp, it is very difficult to make the right transition lines.

style italiano styleitaliano lm arte anterior instrument
style italiano styleitaliano lm arte anterior instrument
style italiano styleitaliano after filling the entire diastema area

Fig.13
After filling the entire diastema area between 2 central incisors.

style italiano styleitaliano closure of the diastema

Fig.14
The same procedure for the remaining teeth was repeated. In tooth 12, since the diastema area is small and the patient wanted the tooth 12 to have a better shape, only the mesial part of the tooth 12 was filled.

style italiano styleitaliano closure of the diastema

Fig.15
Perform the same procedure with teeth 13-22-23.

style italiano styleitaliano closure of the diastema was done

Fig.16
After removing all the matrices, the finishing and polishing step was crucial.

style italiano styleitaliano finishing procedure with 3M Sof-lex

Fig.17
The Sof-lex extra-thin contouring and polishing discs (3M ESPE) were used to remove the excess composite and create the transition lines.

style italiano styleitaliano 3m sof lex discs and diamond spirals polishing
style italiano styleitaliano 3m sof lex discs and diamond spirals polishing
style italiano styleitaliano polishing procedure

Fig.18
Firstly, the polishing was done with a blue rubber polisher.

style italiano styleitaliano Polishing procedure

Fig.19
Then, the polishing wheel was used to make the surface glossy.

style italiano styleitaliano composites polished

Fig.20
The surfaces of the composites after polishing.

style italiano styleitaliano Immediate final result

Fig.21
Immediate final result with dehydration which makes the teeth look whiter than natural. Shade selection should be performed at the beginning of any restorative procedure. Complete rehydration of the enamel can take between 24 and 48 hours.

style italiano styleitaliano 7 days follow-up

Fig.22
7 days after, the teeth look more natural and the gingiva is healthy.

style italiano styleitaliano 7 days follow-up

Fig.23
Patient’s new smile after 7 days.

style italiano styleitaliano 7 days follow-up

Fig.24
Another side view of the new smile.

style italiano styleitaliano 7 days follow-up

Fig.25
Another side view of the new smile.

Conclusions

Diastema closure is a technique that is widely applied in clinical practice, with the development of dental instruments, the performance of diastema closure is no longer difficult.
The customized matrix is one of the options that can be used in simple cases, it also helps dentists to perform diastema closure cases accurately and with high efficiency. Besides, the customized matrix can also be flexible in creating the desired emergence profile in some cases. As a result, whenever a clinical instance of diastema was encountered, the proper matrix must be selected for that scenario.

Bibliography

  1. De Araujo EM, Fortkamp S, Baratieri LN. Closure of Diastema and Gingival Recontouring Using Direct Adhesive Restorations: A Case Report. J Esthet Rest Dent 2009; 21:229-240.
  2. Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. Eur J Esthet Dent 2008; 3(1):14-29.
  3. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Chapter 5. Quintessence Books, 2012.
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style italiano styleitaliano Essential Dentistry kit online on demand course

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