Extremely large diastemas

Tips and tricks - Community - Direct anteriors
20 Sep 2016

Clinical cases with a large diastema always represent an issue in any dentist’s daily practice. The main question is: how can we create a truly good tooth-to-tooth proportion? Not of less worry and difficulty is how to position the material between the central incisors – because there is a very large gingival papilla. In this article I will try to answer these questions with the example of a clinical case.

Fig. 1

Img. 1 – Initial situation

Fig. 2

Img. 2 – Before treatment, was made a plaster model of the jaws, which were rehearsed future work, and a wax-up. On the base of waxed models were made of silicone indices of the palatal surface of the teeth.

Fig. 3

Img. 3 – Note the very large diastema

Fig. 4

Img. 4 – Initial situation

Fig. 5

Img. 5 – Initial situation

Fig. 6

Img. 6 – side view

Fig. 7

Img. 7 – very large gingival papilla

Fig. 8

Img. 8 – a small abrasion of the cutters

Fig. 9

Img. 9 – When planning such clinical cases, which means envisioning the shape of the future teeth, it is important to understand what makes proportions harmonious, hence the need to increase not only the width of the teeth, but also their height. In most clinical cases, the dentist can increase the height of a tooth towards the cutting edge. However, in order to protect the edges against overloads, in such cases it is also necessary to increase the height of the canines.
In order to create this form, it is necessary to get the material is actually under the gum between the teeth. So how can we do that?

Fig. 10

Img. 10 – The selection of shade

Fig. 11

Img. 11 – The first stage of treatment. Isolation is one of the two central incisors

Fig. 12

Img. 12 – Without preparation – sandblasting of the mesial surface of enamel, application of etching and adhesive preparation.

Fig. 13

Img. 13 – Then use a Mylar matrix with a rounded shape, a small portion of the composite was added on the lateral surface of the tooth with a small compression to the gum.

Fig. 14

Img. 14

Fig. 15

Img. 15 – The same procedure was carried out on the other central incisor.

Fig. 16

Img. 16 – As a result, with a little effort, the parts of the restoration that were more challenging to mold were created. In addition, these composite add-ins allow to keep the floss at the neck of the tooth after positioning the rubber dam.

Fig. 17

Img. 17 – The second phase of treatment – teeth preparation.

Fig. 18

Img. 18 – During this procedure, it is desirable to control the amount of removed tissue on the silicone index, based on the wax-up.

Fig. 19

Img. 19 – Isolation

Fig. 20

Img. 20 – Sandblasting

Fig. 21

Img. 21 – Dynamic etching using UltraEtch

Fig. 22

Img. 22 – Dynamic etching using UltraEtch

Fig. 23

Img. 23 – Bonding by OptiBond FL

Fig. 24

Img. 24 – Bonding by OptiBond FL

Fig. 25

Img. 25 – Applying of composite Ceram-X Duo E2 as palatal enamel layer on the silicone key.

Fig. 26

Img. 26 – The procedure is performed on the four incisors.

Fig. 27

Img. 27 – Slit-like space between the palatal enamel layer and a tooth is filled with a small amount of flowable composite shade OA3.

Fig. 28

Img. 28 – This allows you to fill this space without the formation of air pores.

Fig. 29

Img. 29 – The introduction of the mass of the composite Ceram-X DUO D2 to simulate dentin.

Fig. 30

Img. 30 – Simulation of the dentinal body and mamelons

Fig. 31
 

Conclusions

Conclusions

Restoration of large diastemas in the direct method using composite material has great potential. To make an indirect ceramic restoration is much more difficult in such situations. However, this technique can only be used with strict observance of all stages. Finishing is very important

Bibliography

References

Atlas of tooth shape, Shigeo Karaoke