Big Diastemas Composite Restorations

Big diastema are always difficult to treat, we need a good diagnosis to know if the result is gonna be acceptable or not. Treating them with porcelain veneers without orthodontic therapy is something really tricky cause there will be a lot of ceramic without support and is better to go is this situations with composite resin.

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Fig.1
Young man comes to the office to improve the esthetic of the diastema.

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Fig.2
He is a periodontal patient that refuses orthodontic treatment and only wants a fast solution.

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Fig.3
So we propose him a conservative treatment of a non preparing restoration with composite resin.

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Fig.4
3M Filtek Ultimate/Supreme XTE is selected for this case due to the opacity of the body shade for the big diastema.

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Fig.5
A mock up with protempt 4 A2 allow us to check if the esthetic is the appropriate for the patient.

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Fig.6
Gingivectomy is made to improve the gingival margins.MDP Photo IPhone 6S.

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Fig.7
Flapless surgery. MDP Photo IPhone 6S.

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Fig.8
Now we are ready for restorations.

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Fig.9
Isolation is mandatory.

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Fig.10
Is important to take care of details. When we want to control adhesive in the cervical region sometimes is good to use the tip of a flowable composite to aspirate the excess of the bonding agent to avoid problems in that area.

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Fig.11
After using a small shell of body composite por palatal layer…

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Fig.12
…we use a Polydentia matrix fix with my custom resin liquid to make the shape of the interproximal area.

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Fig.13
Now we can go easy to build up with the body shade the final restoration.

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Fig.14
We polish the interproximal area with a oscillating tip (EVA system).

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Fig.15
Review.

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Fig.16
Final result.

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Fig.17
Final result 7 months later.

Conclusions

Composite materials are a great option to restore big diastema when the space is big and the possibility of orthodontic treatment is not a choice for patients desire. The right choose of the opacity is one of the goals for this technique due to the black background that we need to mask and in the other side the correct shade to match the natural teeth. A correct adhesion technique and the simple stratification will be chose every time that we can. Posterior matrix are a helping tool that can allow us to guide our restoration process.

Bibliography

1. Closing Diastemas
2. Fahl N Jr. Achieving ultimate anterior esthetics with a new microhybrid composite. Compend Contin Educ Dent Suppl. 2000;(26):4-13; quiz 26.
3. Manauta J, Salat A. Layers, An atlas of composite resin stratification.Quintessence Books, 2012
4. Diastema closure a single shade opacity aesthetic approach

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