Closing Diastemas with a Direct Technique Approach

Diastema closure is one of the most demanded treatments in aesthetic dentistry. Ideally, orthodontic treatment must be accomplished to give proper space relationships and good occlusion but in some cases this is not possible and we need the help of the restorative treatment. Diagnostic, patient approval and a recipe to obtain good results is mandatory. We are going to show the case step by step to teach a protocol that can make you have success in this type of treatments.

Fig.1

Patient smile displays unsatisfactory aesthetics in a 28 year old female patient, she asks for a solution with minimally invasive dentistry.

Fig.2

Intra and extraoral pictures are taken to make a DSD protocol to show the patient what we can achieve and to guide us during treatment phases.

Fig.3

Image with open mouth allow us to see incisal edges of anterior teeth tough as wear of the teeth.

Fig.4

A lateral view allow us to determine the space we need to close in the diastema between 12 and 11, necessary to check occlusion.

Fig.5

Frontal image take with Flexipalette form A is the one that we are going to use to make de digital analysis in the DSD protocol.

Fig.6

Digital Smile Design is made to see what we can do during our treatment and is a great tool to guide us to during the dental plan.

Fig.7

We transfer the digital analysis to the cast model to make the wax up as much reliable with the real situation and the treatment plan that we proposed.

Fig.8

Wax up is made to show the patient possible final result and to guide us during stratification process.

Fig.9

The bleaching protocol is made with carbide peroxide 16% following Style Italiano protocol with White Dental Beauty.

Fig.10

When we obtain the color desired by the patient we proceed to the restorative phase.

Fig.11

Isolation with rubber dam is made to obtain a dry field to work, perforations can be made with the template.

Fig.12

It is important to have the space well defined to make good diastema closure.

Fig.13

Using Style Italiano burs set Direct Style we eliminate old composite without eliminating too much enamel.

Fig.14

Cleaning the teeth with glycine powder allows us to have better adhesion.

Fig.15

Glycine is less aggressive to dentin compared to other powders.

Fig.16

Three steps bonding agent is used to obtain adhesion in this case. Etching with 37% orthophosphoric acid.

Fig.17

Priming.

Fig.18

Bonding.

Fig.19

Using LM-Arte Fissura instrument allow us to mark the silicon key to see where to extend the first composite layer.

Fig.20

Enamel layer is applied.

Fig.21

After removing the silicone key we eliminate excess of composite in the distal part with an aluminum oxide disc taking care not to disturb the anatomy that we made in the wax up.

Fig.22

To maintain the matrix (in this case posterior matrix of the Garrison Dental system, Slick Bands) we use a product to polymerize that is the gingival barrier.

Fig.23

Stratification process is done following composite recipes and taking care of the thickness of the enamel.

Fig.24

We go tooth by tooth.

Fig.25

Drawing with a pencil allows us to know the anatomy that we need to reproduce.

Fig.26

Final result shows us a natural result that makes patient happy.

Fig.27

By following the steps a predictable and good result can be achieve and give our patients the desired smile they want.

Conclusions

Recipes in dentistry allow us to have good result in our treatments, the best way to have desired objectives is follow step by step procedures taken into account

Bibliography

1. Devoto W, Saracinelli M., Manauta J.Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth.
Eur. J. Esthet Dent 2010; 5: 102-124
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. Coachman, C., Calamita, M. Digital Smile Design: A Tool for Treatment Planning and Communication in Esthetic Dentistry. QDT 2012.
4. Manauta J, Salat A. Layers, An atlas of composite resin stratification.Quintessence Books, 2012
5. Chaiyabutr Y, Kois JC. The Effects of Tooth Preparation Cleansing Protocols on the Bond Strength of Self-adhesive Resin Luting Cement to Contaminated Dentin.Operative Dentistry. 2008;33-5, 556-563.

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