smile with central diastema

Freehand Diastema Closure

This patient was unhappy about the diastema present between his central incisors and wanted an improvement. Whitening was presented as an option, but patient was happy with the color of his teeth.

diastema between central incisors

Fig.1

Pre-operative condition.

rubber dam isolation with diastema

Fig.2

Rubber dam isolation is ideal in cases of diastema closure because not only it provides absolute isolation, but it retract the gingiva, allowing access for the creation of an ideal emergence profile.

air abrasion of proximal area

Fig.3

Air-abrasion with aluminum oxide particles allows to obtain a clean surface, which is a pre-requisite for good adhesion.

etching with orthophosphoric acid

Fig.4

Etching of the enamel with orthophosphoric acid.

bonding on enamel with brush

Fig.5

A Universal adhesive is applied, the solvent is evaporated and light cured for 10 seconds (1,000mw/cm2).

freehand modeling for diastema closure

Fig.6

The diastema is closed with three increments. The first tooth build up is shaped with one increment. This increment wraps around the proximal surface and fills half of the diastema. A thin bladed instrument is used to smooth and blend the increment on the buccal.

thin spatula to model composite resin

Fig.7

The thin bladed instrument is used to push the resin composite inter-proximally and palatally.

compobrush to smooth composite surface

Fig.8

A flat brush is used to smooth the surface, which facilitates contouring and polishing later on. This increment is polymerized 20 seconds from the facial, and 20 seconds from the palatal aspect.

teflon tape on central incisor

Fig.9

Teflon tape is applied to the increment to prevent adhesion while building up the proximal on tooth 21.

spatula for composite modeling

Fig.10

The second portion of the diastema closure is done in two increments. The first increment, the facial increment is placed and it is only building the facial half. Proper contour and smoothness is achieved with an instrument and a brush. This increment also crates the proximal contact.

rough composite restorations on central incisors

Fig.11

Facial increment after polymerization and the polytetrafluoroethylene film tape removed.

mylar strip between central incisors

Fig.12

A mylar strip is placed to help contouring the second increment on tooth 21, the palatal increment.

packing composite in palatal incisor

Fig.13

A small amount of composite resin is placed in the palatal aspect and pushed into place with an instrument.

pulling mylar transparent matrix

Fig.14

The matrix is slightly pulled facially and the matrix closed, and the increment polymerized for 20 seconds.

finished but rough and opaque composite restoration

Fig.15

Restorations are built on both central incisors so we could proceed to finishing and polishing.

pop on solfe disc for composite finishing

Fig.16

Contouring and polishing with diamond burs and aluminum oxide discs is obtained.

texturing of the composite surface with diamond bur

Fig.17

Surface characterization is performed using a fine diamond.

finishing strip to polish composite

Fig.18

Interproximal finishing is achieved by finishing strips.

silicone cup with diamond paste

Fig.19

Final gloss is obtained with diamond impregnated rubber cups.

final picture of diastema closed with direct composite restorations

Fig.20

Final result of direct composite diastema closure.

final smile after diastema restoration

Fig.21

Smile of final result with the diastema closed.

Conclusions

The use of direct resin composite restorations allow for
1) minimally invasive dentistry by preserving enamel
2) highly esthetic restorations that satisfy even the more demanding patient

Bibliography

1. Fahl N. Step-by-Step Approaches for Anterior Direct Restorative Challenge. Journal of Cosmetic Dentistry 26(4), 42-55. 2011.

2. Paolone G. Direct composite restorations in anterior teeth. Managing symmetry in central incisors. The Int J of Esthet Dent. 9(1) 12-25, 2014.

3. Vargas M. A step-by-step approach to a diastema closure – a dual-purpose technique that manages black triangles. International Dentistry 1(3) 60-61, 2011.