Diastema Closure: A Step by Step for a Successful Outcome

A clinical case by our Community member Dr Burak Yüksel

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.

The rubber dam has become an essential component of modern adhesive dentistry,  as it provides  moisture control, improves access and visibility, and enhances time and treatment efficiency. Using a rubber dam in the case of diastema closures not only serves to isolate the area of work, but also helps in retracting the gingiva and make the subgingival region visible. In cases like this, seemingly healthy gingiva can be deceptive, and cleaning the subgingival area may be necessary. The following clinical case depicts the use of an aesthetic restorative material to close a diastema in the anterior region.

style italiano styleitaliano diastema initial situation

Fig.1
Pre-operative photograph was taken to analyze the diastema placement.

style italiano styleitaliano Shade selection

Fig.2
The color selection was done using the button technique, after which the tooth surface was cleaned with a prophylaxis paste, and then proceeded to the rubber dam isolation stage.

style italiano styleitaliano rubber dam isolation

Fig.3
After retracting the gingiva with a rubber dam, the calculus became visible in the subgingival area, and could be cleaned without any bleeding. Thus, allowing the restoration to be done in the same session.

styleitaliano style italiano Calculus removal

Fig.4
The calculus was removed using a scaler, hence preparing the subgingival area for restoration.

styleitaliano style italiano Etching and bonding

Fig.5
Selective enamel etching was done with 37% phosphoric acid. Adjacent teeth were protected using a teflon strip.

styleitaliano style italiano After etching

Fig.6
The picture was taken to see the appearance of the tooth after etching. Next, bonding agent was applied with Dentsply Sirona Prime and Bond Universal.

styleitaliano style italiano Composite placement

Fig.7
Dentsply Sirona ceram.x Duo D2 and E2 composites were used. The enamel composite (ceram.x duo E2) was used on the top layer due to its high polishability. LM Arte Applica (LM, powered by Styleitaliano) was used for precise detailing, especially in the embrasure areas. 3M Sof-Lex discs were used for the finishing process especially for contouring. Eve Twist was used for polishing.

styleitaliano style italiano final situation diastema closure

Fig.8
Final situation.

Conclusions

In anterior resin composite restorations, the use of a rubber dam is a crucial factor for ensuring the longevity of the restoration and bond strength of the restoration.

Bibliography

  1. Falacho, RI, Melo, EA, Marques, JA, Ramos, JC, Guerra, F, Blatz, MB. Clinical in-situ evaluation of the effect of rubber dam isolation on bond strength to enamel. J Esthet Restor Dent. 2023; 35(1): 48-55. doi:10.1111/jerd.12979.
  2. Keys, W., & Carson, S. J. (2017). Rubber dam may increase the survival time of dental restorations. Evidence-Based Dentistry, 18(1), 19-20. DOI: 10.1038/sj.ebd.6401221.
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