Before starting, the mesial walls of the central incisors must be clean from the debris that usually builds up in this area, plaque, tartar and stains. At this point we will take an accurate alginate impression so the laboratory can develop a wax-up.
This wax-up is extremely important, not only as an aid in the working stage, but it gives us a preview of the restoration closure, where the shape is of extreme importance and it can easily become a beautiful restoration which integrates with the remaining teeth or a grotesque incongruent shape, thus the wax-up is mandatory.
Once the field is isolated, the silicone key impressed from the wax-up is carefully adapted with the rubber dam in place, assuring that the silicone fits perfectly with no pressure at all.
Given the fact that we are working with two adjacent surfaces, the acid etching is made over the enamel, without protection. Enamel etching for 15 seconds and the complete removal of the acid gel is done, with plenty of water and air, paying attention on achieving a complete dry field.
Primer and bonding stages are carried out, carefully and respecting the times the manufacturer indicates. One step we always indicate for success in adhesive dentistry is the complete polymerization of the bonding, regardless the kind or type, a 1:00 minute polymerization has proven to be a highly reliable step to do.
This step is mandatory to obtain a beautiful emergence profile, we call it “modeling with matrices”. That means, that when placing the matrices and the wedges, we must pay a lot of attention on the matrix selection, applying the right wedge and most of all the final shape the matrices have after the placement, if it is not perfect, is convenient to repeat this stage.
With a dentin mass, the cervical area is filled up, very carefully and assuring that no voids are left, taking advantage of the ideal shape that the matrices will have, acting as containers. Polymerization of the dentin for at least 20 seconds.
Once matrices are removed, the silicone key is placed again and the palatal walls are constructed. Note that in this step a very delicate modeling is necessary in order to not glue both restorations.
After the removal of the silicone stent, the proximal walls are built with a high value enamel with the help of an anterior matrix as in the previous step, but now placed more incisally. It is possible to do it one at a time.
Filling the cavity with small increments of denting, always leaving space for a 0,5 mm enamel layer and placing the opalescent (super transparent effect) in the incisal edge.
Placement of the final enamel layer. Is very important to give a smooth surface in order to reduce at maximum the finishing and polishing stage, which in this area is very difficult.
The diastema already polished, shows an optimal integration, especially in the opalescent area in the incisal edge.
The case before the procedure.
The case photographed from another angle, shows that the composite behaves very well with different light direction.