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.
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.
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.
Using a fine grit bur to prepare a very thin layer on the surface of teeth 11 and 21.
Sandblasting the surface with 29µm Aluminium Oxide (AquaCare). The purpose of this step is cleaning and improving the bond strength.
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.
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.
The palatal shells are completed.
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.
The result after light curing.
Doing the same procedure with tooth 21. And this is the result after removing the matrix and the shim.
The first, polishing with a red rubber polisher.
Then Komet polishing wheel was used, first the 94028M polishing wheel to smoothen the surface.
Then the 94028F polishing wheel was used to make the surface glossy.
The final result after polishing.
Final situation before removal of the rubber dam.
The final result after removing the rubber dam.
The transformed smile after proper composite handling, finishing, and polishing protocols.
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.
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.