direct composite restoration diastema closure styleitaliano style italiano DMG

Diastema managing: closing gaps with direct restorations

The patient, a 50 y.o. woman, came to the office complaining about the aesthetic appearance of her smile. She didn’t like the gaps in between her teeth, and the misalignment of the two central incisors. She was asking for a non-invasive and non-expansive treatment, with a natural outcome. Thanks to modern technologies, direct composite restorations can be the perfect solution for cases like this one. We can reach high levels of aesthetic, keeping a natural not fake appearance without preparing teeth and with a low economical cost. Nevertheless, unlike porcelain, composite can be modified to correct shape and color if needed.

direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.1

Looking at the picture with the patient, we tried to understand all the problems she was complaining about.

direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.2

She wanted to fill the midline diastema, to correct the misalignment of the central incisors and to have smoother and more regular surfaces on the other frontal teeth.
She asked to avoid a fake-looking appearance, with an unnatural white color and precise, regular shape. She wanted nobody to realize that teeth were artificially restored.

rubber dam isolation direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.3

Rubber dam isolation is mandatory for every adhesive procedure.

silicon index direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.4

Wax up was made on the model to create a silicon key. After the adhesive steps with DMG LuxaBond Universal, the first palatal layer was restored with EL from Ecosite Element layer set on tooth 1.1 under the guide of the silicon key.

silicon index direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.5

The same procedure was performed on the other incisor, paying attention to the position and orientation of the midline.

Unica matrix direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.6

A special kind of anterior matrices (Unica – Polydentia) was placed and settled with V-shaped plastic wedges (MyWedge – Polydentia).

direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.7

New contours of the two central incisors were established using an enamel composite (DMG Ecosite Elements Layer EL).

direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.8

No mamelons were needed in this case. Putting strong translucencies in the incised edges would have been unnatural in the mouth of this patient. Just to give some natural imperfection to the central incisors we decided, together with the patient, to put some white stains (DMG Ecosite Elements Highlight W) and to keep small differences in shape and dimension.

Stains applied with LM Fissura instrument direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.9

The stains were applied with a thin instrument (Fissura – LM).

direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.10

To Avoid too much translucency a more opaque composite was layered to combine with the enamel already used (DMG Ecosite Elements Pure A2).

direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.11

In order to homogenize the chromatic appearance, the same mass (DMG Ecosite Elements Pure A2) was used from 13. to 2.3.

Transition angles and lines were modified to give a new way of light reflection. All the restorations were covered by a thin layer of high value enamel (DMG Ecosite Elements Layer EL).

direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.12

After removing the rubber dam, a thin pencil was used to highlight the transition lines in order to perform the primary contouring.

direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.13

At the end of the first appointment we need to check the occlusion and all the possible movements. Then we need to allow the patient to perfectly clean her teeth. Then we can skip a little bit the polishing steps: We should always be humble and think that a mistake is always possible. Now we can’t check the aesthetic outcome because of the dehydration caused by the rubber dam. It’s possible that in the next appointment we realized something needs to be corrected. So we should wait the control appointment: if we need to correct we will do it, otherwise we will complete the polishing procedures.

direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.14

Two weeks control: the patient is very happy about the natural looking result. We can perform the final polishing.

direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.15

Four months control.

direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.16

Pre-op and 4 moths control.

direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.17

Pre-op smile.

direct composite restoration diastema closure styleitaliano style italiano DMG

Fig.18

4 months control smile.

Conclusions

Performing direct restorations on aesthetic areas has become easier and easier thanks to new materials. Styleitaliano philosophy is based on simplifying the procedures, removing all the complications, aiming for a reliable workflow. Now everyone can reach high results in the daily practice, with conservative techniques, reducing the costs and in a quick way. These new kind of composite are incredibly easy to handle, very mimetic and almost don’t need to be polished.

Bibliography

1- Manauta J, Salat A. Layers, An atlas of composite resin stratification. Chapter 5. Quintessence Books, 2012.

2- Tirlet G, Chabouis HF, Attal JP. Infiltration, a new therapy for masking enamel white spots: a 19-month follow-up case series. Eur J Esthet Dent. 2013 Summer; 8(2): 180-90.

3- Meyer-Lueckel H, Chatzidakis A, Naumann M, Dörfer CE, Paris S. Influence of application time on penetration of an infiltrant into natural enamel caries. J Dent. 2011 ; 39(7):465-9.

4- Manauta J, Salat A, Putignano A, Devoto W, Paolone G, Hardan LS. Stratification in anterior teeth using one dentine shade and a predefined thickness of enamel: A new concept in composite layering – Part II. Odontostomatol Trop 2014; 37(47): 5-13