Diastema closure made easy with simple protocols

A clinical case by our Community member Dr Muhammed Bahadeen

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.

Patients frequently complain about their maxillary anterior spacing. Midline diastema has a multifactorial etiology. Time, physical, psychological, and financial constraints dictate the most appropriate technique and material for effective treatment. In diastema cases, direct composite resins give the dentist and patient entire control over these limits and the development of a natural smile. This case focuses on a diastema closure made easy with simple protocols.

style italiano styleitaliano Initial situation

Fig.1
Chief complaint of this patient was diastema between two centrals and left lateral and central. In this case, the reason of diastema was the small centrals and lateral.

style italiano styleitaliano Measurement of the space between centrals

Fig.2
After deciding to close the diastema, a measurement of the space was taken and it was 3mm between centrals. Thus, an equal division of the space between the centrals was made: each one receiving 1.5mm of composite restoration.

style italiano styleitaliano Shade selection

Fig.3
Two shades including enamel and dentin were selected since a large diastema was presented. Further, restoring this kind of diastema with only an enamel shade will be impossible (because a thickness of 1.5mm of enamel was not presented anywhere on the centrals).

style italiano styleitaliano Closure of the diastema

Fig.4
After shade selection, the diastema was closed with the selected shade to give the patient a rough idea on the final result (no etching and bonding is required in this stage).

style italiano styleitaliano Cleaning before diastema closure

Fig.5
It is imperative to clean the tooth from any bacterial biofilm to avoid any poor adhesion.

style italiano styleitaliano Silicon index

Fig.6
An immediate silicon index was created and divided in half exactly in the center of the centrals.

style italiano styleitaliano silicon index

Fig.7
The index was created by means of a red coded bur to deepen the index to the desired depth.

style italiano styleitaliano Index in place

Fig.8
The index was on place on the centrals, and make sure they are both cut equally in half and deepened well.

style italiano styleitaliano Roughening of the enamel surface

Fig.9
Only roughening is required to remove the aprismatic enamel and then etching of the enamel surface (no preparation with bur).

style italiano styleitaliano Etched surface

Fig.10
After etching, a reference point with a pencil was made in order to not bond the composite on a wider area (bonding on unetched enamel will lead to shrinkage and staining at the interface).

style italiano styleitaliano Adhesive application

Fig.11
After applying the adhesive, a sight of the etched enamel was lost, but the reference points help to avoid the clinical mistake of applying composite on unetched enamel.

style italiano styleitaliano diastema closure

Fig.12
First step, the palatal shell was created using an enamel shade (A1) according to the shade selection.

style italiano styleitaliano diastema closure

Fig.13
After, further reinforcing of the palatal shell with more composite (dentin shade between the layers). It is now ready to be wedged.

style italiano styleitaliano diastema closure

Fig.14
After creating an emergence profile by creating and reinforcing the palatal shell, a wedge and bands were applied to continue the work.

style italiano styleitaliano finishing

Fig.15
The layering stage was done. Now it is ready to be finished and polished.

style italiano styleitaliano Finishing and polishing

Fig.16
Finished and polished composite surfaces.

style italiano styleitaliano Diastema closure between the central and the lateral

Fig.17
The lateral was also closed, but with the free hand technique.

style italiano styleitaliano finishing

Fig.18
Ready for finishing.

style italiano styleitaliano final situation

Fig.19
Final result: all the requirements are met (the left lateral seems a little short since with the respect to the patient’s occlusion, the lateral could not be lengthen due to a premature contact of the lateral incisor tip and lower canine and lateral).

Conclusions

The difficulties concerning diastema closure are linked to reaching a suitable width proportion of the central incisors and avoiding a ledge at the gingival level of the contact area, which might become a trap for plaque and food. This article describes a case of diastema closure made easy when the clinician followed a right protocol.

Bibliography

  1. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Publishing Co; 2012.
  2. Riquieri H. Dental anatomy and morphology. USA: Quintessence Publishing; 2019.
  3. 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(1):102-24.
  4. Hardan L, Bourgi R, Kharouf N, Mancino D, Zarow M, Jakubowicz N, Haikel Y, Cuevas-Suárez CE. Bond strength of universal adhesives to dentin: A systematic review and meta-analysis. Polymers. 2021;13(5):814.
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