Making a patient smile with diastema closure. A minimally invasive approach

A clinical case by our Community member Dr. Hung Bui

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.

Many patients with a diastema feel like it affects the aesthetics of their smile. Luckily, contemporary composite materials and instruments make diastemata quite easy to fix with a direct restoration technique. And besides, this technique is the most preservative for tooth structure. The purpose of this article is to show the procedure to close the diastema with a simple approach.

middle diastema between central incisors style italiano styleitaliano

Fig.1
The patient wanted to close the middle diastema because she wanted to improve the aesthetics of her smile. She wished for a short treatment that would preserve her enamel the most, so a direct composite technique was chosen in this case.

rubber dam isolation of diastema style italiano styleitaliano

Fig.2
The rubber dam was placed to isolate the teeth from saliva. It is also very useful as it retracts the papillae, thus improving access to the cervical area of the teeth.

roughening of enamel before composite restoration style italiano styleitaliano

Fig.3
Using a fine grit bur to prepare a very thin layer on the surface of teeth 11 and 21.

sandblasting with aquacare style italiano styleitaliano

Fig.4
Sandblasting the surface with 29µm Aluminium Oxide (AquaCare). The purpose of this step is cleaning and improving the bond strength.

etching of proximal area style italiano styleitaliano

Fig.5
Etching the enamel surface with H3PO4 37% for 20 seconds. After that, rinsing the surface for 40 seconds, the tooth was dried completely. The etched area is slightly wider than the working area to get the best bond strength quality, and the transition between composite and tooth surface.

bonding proximal surface for composite restorations style italiano styleitaliano

Fig.6
Bonding with Single Bond Universal (3M). You should lay the adhesive at least two times, then blow it with air until it doesn’t move on the surface anymore.

silicone index created onto waxed up model style italiano styleitaliano

Fig.7
Wax-up and silicone index were made using Honigum putty (DMG).

silicone index try in style italiano styleitaliano

Fig.8
The silicone index was used to create the palatal shells. In this case, due to the small dimensions of the diastema, Dentin A2 shade from the Tetric N-Ceram (Ivoclar Vivadent) was used to fill all of the space.

layering of palatal composite style italiano styleitaliano

Fig.9
The palatal shells are completed.

modeling proximal anatomy to close diastema style italiano styleitaliano

Fig.10
The composite was applied by using LM Arte Modella (LM Arte kit, powered by Styleitaliano) to build the proximal wall, while making sure the contact between composite and the matrix is nicely curved. If this contact area is too sharp, it is very difficult to make the right transition lines.

nice curve of the proximal tooth wall closing diastema style italiano styleitaliano

Fig.11
The result after light curing.

composite incisor restorations before finishing styleitaliano style italiano

Fig.12
Doing the same procedure with tooth 21. And this is the result after removing the matrix and the shim.

pre-finished composite proximal restorations style italiano styleitaliano

Fig.13
Using Sof-lex extra-thin contouring and polishing discs (3M) to remove the excess composite and create the transition lines.

rubber polisher for composite restorations style italiano styleitaliano

Fig.14
The first, polishing with a red rubber polisher.

polishing wheel for composite style italiano styleitaliano

Fig.15
Then Komet polishing wheel was used, first the 94028M polishing wheel to smoothen the surface.

white polishing wheel to achieve composite gloss style italiano styleitaliano

Fig.16
Then the 94028F polishing wheel was used to make the surface glossy.

finished and polished composite restorations style italiano styleitaliano

Fig.17
The final result after polishing.

surface aspect of composite restorations style italiano styleitaliano

Fig.18
Final situation before removal of the rubber dam.

teeth after diastema closure style italiano styleitaliano

Fig.19
The final result after removing the rubber dam.

smile after diastema composite restoration style italiano styleitaliano

Fig.20
The transformed smile after proper composite handling, finishing, and polishing protocols.

Conclusions

With the direct composite technique above, diastema closure is no longer a difficult procedure in clinical, everyday work. This is a method to help preserve the tooth structure in a fast and comfortable way for the patient.

Bibliography

1. De Araujo EM, Fortkamp S, Baratieri LN. Closure of Diastema and Gingival Recontouring Using Direct Adhesive Restorations: A Case Report. J Esthet Rest Dent 2009; 21:229-240.
2. Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. Eur J Esthet Dent 2008; 3(1):14-29.
3. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Chapter 5. Quintessence Books, 2012.

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