A clinical case by our Community member Dr. Mohammed Shaga
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.
Multiple diastemas in between the anterior teeth affect the self confidence of many patients, and constitute one of the challenges in clinical aesthetic dentistry. Although many treatments and materials are available for closing diastemas, proper case selection and diagnosis are key to achieving success. In this article a 3D digital wax up and a direct composite approach were chosen to restore the case.
Fig.1
The midline position and the inclination of the lateral incisors of this 24-year-old female patient were the main problems. The patient complained about her multiple diastemas, yetshe wouldn’t undergo an orthodontic treatment because of a badly-ended one she had 5 years earlier, so she refused to repeat the experiment. After discussing treatment options, she chose a direct approach to fix her smile.
Fig.2
Picture of the intra-oral pre-operative situation.
Fig.3
Digital Smile Design was used to preview the proportions and the space available. The DSD was also used to make a project to correct the midline and evaluate on which side to close the diastemas to center the new midline and used as guide for 3D design.
Fig.4
3D wax up design model displaying the expert design of my case. My patient doesn’t have to wait for the final product to see the results up close and in-person. With 3D wax up design you can fabricate physical, beautiful wax-ups for patient presentation in a matter of hours.
Fig.5
Superimposition of the teeth and the virtual 3D digital diagnostic waxing of maxillary anterior teeth.
Advantages of the new 3D digital diagnostic waxing:
– Requires less labor and eliminates mistakes and reworks.
– Cuts turnaround time from 2-3 days to a few hours.
– Lowers material and machine costs.
– Allows the lab to safely ship aesthetically pleasing 3D printed educational models directly to dentists.
Fig.6
3D printing has significantly simplified the diagnostic wax-up workflow. After the model is printed in a 3D printer (Anycubic 3D) a silicone guide is fabricated to allow for the direct restoration with composite resin.
Fig.7
Rubber dam isolation is ideal in cases of diastema closure because not only it provides absolute isolation, but it retracts the gingiva, allowing access for the creation of an ideal profile.
Fig.8
After cutting of the silicone index, the palatal composite shells can be placed reproducing the 3D-printed model.
Fig.9
After the surfaces were roughened and stains removed, enamel was etched using 37% phosphoric acid.
Fig.10
Palatal shell restored with W2 enamel shade from the Zenit composite kit (President Dental).
Fig.11
Building the proximal walls is easy with metallic sectional matrices. The A1 shade from the Zenit composite kit was used. The outer frame of our restoration is very important for the layering technique.
Fig.12
As you can see, layering of the A1 shade from Zenit composite kit is easy with an accurate framework.
Fig.13
Some Inb shade in the incisal area, between the mamelons for translucency and better characterization.
Fig.14
After the incisors are complete, it is time to shape the canines.
Fig.15
To better control the gingival margin, a split dam was used. Building up the outer frame of our restoration is a crucial step to make layering a predictable step and to minimize final shape corrections.
Fig.16
This view is very important when shaping canines.
Fig.17
After shape is complete, finishing and polishing can be done.
Fig.18
One week later, at check-up.
Fig.19
The patient is satisfied with the result.
Fig.20
Detail of the finished, rehydrated resotrations.
Conclusions
Using a 3D diagnostic wax-up for dental restorations can help ensure accuracy and provide optimal end results for your patient. A 3D wax-up can show any potential problems ahead of time, as well as give the patient a vision of how the final restoration will look before you start work.
Bibliography
1. Abrera-Crum L, D’Affronte LC, Platia CL, Yimer LK. Challenges in the workflow of a digital diagnostic wax-up: a case report. Gen Dent. 2020 Sep-Oct;68(5):56-60.
2. Sampaio CS, Puppin-Rontani J, Tonolli G, Atria PJ. Workflow of digitally guided direct composite resin restorations using open source software and 3D printing: a clinical technique. Quintessence Int. 2020 Oct 28:2-8. doi: 10.3290/j.qi.a45426. Online ahead of print.
3. 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.
4. Devoto W, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth.
5. Gönülol N, Yilmaz F. J. The effects of finishing and polishing techniques on surface roughness and color stability of nanocomposites. Dent. 2012 Dec;40 Suppl 2:e64-70
