Closing diastemata with composite resin is considered one of the big challenges, mainly because of dealing with the cervical part of the diastema (the emergence profile) which may sometimes lead to overhangs or improper contours that may cause food stagnation and inflammation. Using the Front Wing technique developed by Jordi Manauta makes the whole procedure very easy for the very reasons mentioned in his article:
– Skipping the wax-up (NOT to be confused with not doing a project) closing diastema just one visit .
– Giving the user the chance of building and selecting the emergency profile and contour of one or multiple diastemata
– The chance of working with single shade or multi shade approach
– Tight contacts are easier to get
– Ideal cervical fit
– Aesthetics of the restoration
Fig.1
20 years old young lady came to the clinic complaining of her midline diastema. The patient said she want to close the diastema and to enhance the shape of upper anterior segment.
Fig.2
Retracted view shows a midline diastema with genesis of upper lateral incisors. Implants were placed in the canine area after extraction of the deciduous canines.
Her permanent natural canines, right next to the central incisors, were small in size which made it easier to modify in shape, yet, note the inclination of the natural canines.
Fig.3
A simple design was enough find the proper dimensions for both centrals and laterals. We decided to close the diastema symmetrically between centrals, and to change the inclination of canines by adding composite in the selected red areas to appear as laterals.
Fig.4
Shade was selected with a composite button try before rubber dam isolation to keep teeth hydrated and prevent faulty shade selection due to dehydration.
Fig.5
A cross-polarised picture was taken with the MDP Smilelite to ensure color matching.
Fig.6
Rubber dam isolation is mandatory for the whole procedure. Rubber dam inversion and extra retraction are required for diastema closure.
Fig.7
B4 clamps are used to achieve maximum retraction to expose the mesial cervical part to guarantee a perfect emergence profile.
Fig.8
A coarse grit disc is used to clean the mesial surface, and to remove the debris for better bonding.
Fig.9
Enamel etching for 30 seconds with safe margin over-extension is highly advised for diastema closure. Water rinsing for 60 seconds to remove all the remnant of etching gel.
Fig.10
Frosty white appearance after enamel etching.
Fig.11
Multiple coats of universal adhesive were rubbed on the surface 20 seconds and air-blown for 5 seconds to remove the solvent. Light curing for 60 seconds to ensure complete polymerization.
Fig.12
The first step of Front Wing technique is creating the buccal wings (red arrows) freehand as precisely as possible. Multiple layers can be added. SI2 Composite WDB was used in this case.
Fig.13
After building the from wings, it is time to focus on the sealing of the restorations and on the achievement of a tight contact, by placing two sectional matrix with a wedge.
Fig.14
Matrices in place, it is time to fill the palatal void. Note the adaptation of the matrix fitting in the sulcus.
Fig.15
A small drop of flowable composite resin is placed and left uncured. This helps the wettability of the following composite increment.
Fig.16
A composite increment is placed to fill the palatal part and condensed until excess material stops flowing from the buccal.
Fig.17
Both palatal cavities are perfectly sealed. Always check that the matrices still lay on the cervical.
Fig.18
A layer of enamel is added before final polymerization.
Fig.19
After the centrals are complete, it is time to shape the canines as we mentioned before.
Fig.20
Finishing procedures remove the excess and surface irregularities while correcting the buccal contour.
Fig.21
To correct the angle lines, after having drawn them with a pencil, a yellow coded diamond needle bur is used.
Fig.22
After shape is complete , polishing is done with rubber wheels.
Fig.23
Immediately after restoration and rubber dam removal.
Fig.24
At two-week follow-up.
Fig.25
Surface texture.
Fig.26
Surface texture.
Conclusions
With the Front Wing technique we can simplify direct diastema closure and obtain immediate, single-visit results. Moreover, skipping the wax-up is cost-saving and freehand modeling is much easier and more precise than methods involving a palatal silicone index.
Bibliography
1. Fahl N Jr. Achieving ultimate anterior esthetics with a new microhybrid composite. Compend Contin Educ Dent Suppl. 2000;(26):4-13; quiz 26.
2. 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.
3. Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. Eur J Esthet Dent 2008; 3(1):14-29.
