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.
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.
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.
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).
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).
It is imperative to clean the tooth from any bacterial biofilm to avoid any poor adhesion.
An immediate silicon index was created and divided in half exactly in the center of the centrals.
The index was created by means of a red coded bur to deepen the index to the desired depth.
The index was on place on the centrals, and make sure they are both cut equally in half and deepened well.
Only roughening is required to remove the aprismatic enamel and then etching of the enamel surface (no preparation with bur).
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).
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.
First step, the palatal shell was created using an enamel shade (A1) according to the shade selection.
After, further reinforcing of the palatal shell with more composite (dentin shade between the layers). It is now ready to be wedged.
After creating an emergence profile by creating and reinforcing the palatal shell, a wedge and bands were applied to continue the work.
The layering stage was done. Now it is ready to be finished and polished.
Finished and polished composite surfaces.
The lateral was also closed, but with the free hand technique.
Ready for finishing.
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).
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.
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