Multiple Diastema Closure in the frontal area

A clinical case by our Community member Dr. Riccardo Galetti

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.

This young patient came seeking for the closure of the spaces between teeth 13-12-11-21-22-23, which presence was due to a discrepancy of the dental-alveolar mesio-distal space (Altered Bolton Index).

styleitaliano style italiano multiple diastemas

Fig.1
Spaces were distributed quite evenly on both sides between canines, laterals and central incisors.

styleitaliano style italiano isolation with rubber dam and ligatures for diastema restorations

Fig.2
After providing proper isolation, ligatures were done on all the teeth to expose the cervical area and retract the soft tissues.

styleitaliano style italiano left and right view of multiple diastemas

Fig.3
Lateral views showing the distribution of the diastemas between all frontal teeth.

styleitaliano style italiano sandblasting of dental surface

Fig.4
Sandblasting with 30-micron aluminum oxide particles to roughen the teeth surfaces prior to the adhesion procedure.

styleitaliano style italiano etching enamel in the proximal areas

Fig.5
Enamel etching procedure of the proximal and bonding areas that need to be restored.

styleitaliano style italiano etched proximal enamel for direct composite bonding

Fig.6
Etched enamel surfaces.

styleitaliano style italiano bonded enamel surfaces before restoration

Fig.7
After applying of a universal adhesive to the dental surfaces.

styleitaliano style italiano closed central diastema

Fig.8
Closure of the central diastema between with a single shade mass of Body A2 composite. A posterior matrix was placed vertically to build up the proximal walls of the two teeth.

styleitaliano style italiano diastemas between incisors close with composite

Fig.9
Closure of the diastemas between teeth 12-11 and 22-21 was managed in the same way, again with a single shade mass of Body A2 composite.

styleitaliano style italiano left and right view of closed diastemas

Fig.10
Side views of the teeth showing the closed diastemas.

styleitaliano style italiano immediately after diastema closure

Fig.11
Immediate post-op after removing the rubber dam.

styleitaliano style italiano coronal migration of papillae after diastema closure with direct composite

Fig.12
Two week check-up. As we can see, the papilla migrated coronally, guided by the new emergence profiles of the teeth.

styleitaliano style italiano smile after multiple diastema closure

Fig.13
Smile of the patient at the end of the treatment, 2 weeks post-op.

Conclusions

Many patients just don’t think about how easy and fast is to completely change the look of a smile like this. Diastemas are not a big deal to treat, but their closure can give amazing results. A single visit treatment with just one shade, and freehand is enough to obtain a result that is smile-changing.

Bibliography

1. Korkut B, Türkmen C. Longevity of direct diastema closure and recontouring restorations with resin composites in maxillary anterior teeth: A 4-year clinical evaluation. J Esthet Restor Dent. 2021 Jun;33(4):590-604. doi: 10.1111/jerd.12697. Epub 2020 Dec 23. PMID: 33354867.
2. Goyal A, Nikhil V, Singh R. Diastema Closure in Anterior Teeth Using a Posterior Matrix. Case Rep Dent. 2016;2016:2538526. doi: 10.1155/2016/2538526. Epub 2016 Oct 13. PMID: 27818804; PMCID: PMC5081967.
3. Demirci M, Tuncer S, Öztaş E, Tekçe N, Uysal Ö. A 4-year clinical evaluation of direct composite build-ups for space closure after orthodontic treatment. Clin Oral Investig. 2015 Dec;19(9):2187-99. doi: 10.1007/s00784-015-1458-8. Epub 2015 Mar 24. PMID: 25802222.
4. Prabhu R, Bhaskaran S, Geetha Prabhu KR, Eswaran MA, Phanikrishna G, Deepthi B. Clinical evaluation of direct composite restoration done for midline diastema closure – long-term study. J Pharm Bioallied Sci. 2015 Aug;7(Suppl 2):S559-62. doi: 10.4103/0975-7406.163539. PMID: 26538917; PMCID: PMC4606659.
3. Brianezzi LFF, Brondino BM, Chaves GC, Ishikiriama SK, Furuse AY. Interdental papilla formation after diastema closure. Gen Dent. 2017 Nov-Dec;65(6):e13-e16. PMID: 29099376.

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