Post-orthodontic diastema closure using the Front Wing Technique

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.

When we finish some orthodontic treatments, the challenge to overcome is the Bolton discrepancy, which is the difference in the length of the mesiodistal width of the teeth with respect to the length of the alveolar arch. It is precisely in these cases when at the end of the treatment a residual gap that cannot be closed with orthodontic movements. Diastema closure represents a challenge for some dentists and because they do not have the appropriate protocols or use more complex procedures such as wax-ups (generally done by a technician) or some celluloid bands that make the procedure more complicated without leaving it finished and perfect sealed or even with cervical steps that prevent proper hygiene, causing gingival inflammation. This article proposes to close post-orthodontic residual gaps with the front wing technique created by Dr. Jordi Manauta and the Styleitaliano group, this being a great option due to its simplicity and minimal invasion. This case shows the diastema closure process with this technique.

style italiano styleitaliano smile after orthodontic treatment with splinted laterals

Fig.1
A 27 year old female patient who completed orthodontic treatment with residual diastemata in the distal upper lateral incisors and splinted with resin in order to maintain the spaces and the final position of the lateral incisors. After reviewing the treatment options, we chose the most conservative treatment without tooth preparation.

style italiano styleitaliano splinted upper laterals after orthodontic treatment

Fig.2
Lateral view of the upper lateral incisors splinted with resin.

style italiano styleitaliano upper right lateral after splint removal

Fig.3
The resin splint was removed in order to initiate the closure of the diastema (Right side).

style italiano styleitaliano upper left lateral after splint removal

Fig.4
The resin splint was removed in order to initiate the closure of the diastema (Left side).

style italiano styleitaliano design of upper right lateral diastema closure

Fig.5
A simple digital design was made in order to close the diastema and change the shape of the tooth in a harmonious way with composite layers (Right Side).

style italiano styleitaliano design of upper left lateral diastema closure

Fig.6
A simple digital design was made in order to close the diastema and change the shape of the tooth in a harmonious way with composite layers (Left Side).

style italiano styleitaliano isolation of operative field before diastema closure

Fig.7
Absolute isolation from first premolar to first premolar with rubber dam and W2 clamps (Right Side).

style italiano styleitaliano isolation of operative field before diastema closure

Fig.8
Absolute isolation from first premolar to first premolar with rubber dam and W2 clamps (Left Side).

style italiano styleitaliano retraction of rubber dam with B4 clamp

Fig.9
Maximum retraction with B4 clamp, to guarantee the sealing of the emergence profile with the front wing technique (Right Side).

styleitaliano style italiano retraction of rubber dam with B4 clamp

Fig.10
Maximum retraction with B4 clamp, to guarantee the sealing of the emergence profile with the front wing technique (Left Side).

style italiano styleitaliano photomontage showing maximum rubber dam retraction

Fig.11
Photo overlay in order to show the maximum gingival retraction achieved with absolute isolation and B4 clamp (Right Side).

style italiano styleitaliano photomontage showing maximum rubber dam retraction

Fig.12
Photo overlay in order to show the maximum gingival retraction achieved with absolute isolation and B4 clamp (Left Side).

style italiano styleitaliano front wing technique illustration from layers 2

Fig.13
In this picture you can see how the front wing should be built by freehand on the vestibular side, sealing from the emergence profile of the tooth. Picture of Front Wing Technique from Layers 2 book by Manauta J, Salat A, Devoto W, Putignano A. 2022.

style italiano styleitaliano sectional matrix after front wing buildup

Fig.14
After Universal Adhesive, Light curing for 20 seconds per area to ensure complete polymerization. Layering of composite in single BL (Body) shade to create the buccal wing freehand, and closing the diastema with the Solo Anterior instrument (Same process on both sides).

style italiano styleitaliano front wing step 2 illustration from layers 2

Fig.15
In this drawing, it can be seen that after building the front wing freehand on the vestibular side, a sectional matrix must be placed in order to build and seal the palatal side. Picture of Front Wing Technique from Layers 2 book by Manauta J, Salat A, Devoto W, Putignano A. 2022.

style italiano styleitaliano wedge securing the matrix

Fig.16
After Build the composite front wing, the sectional matrix and wedge must be placed in order to build and seal the palatal side (Same process on both sides).

style italiano styleitaliano palatal view after front wing build up

Fig.17
This step is performed by placing a little fluid resin at the palatal junction of the frontal wing with the sectional matrix and condensing solid composite on top so that one consistency pushes the other and causes a perfect sealing of the palatal side of the frontal wing, completing the closure of the diastema on the palatal side (Same process on both sides).

style italiano styleitaliano pencil highlight of line angles

Fig.18
After closing the diastema with composite, the sectional matrix is removed, the next step is finishing and polishing, removing excesses and irregularities with low speed and without irrigation, in order to be able to see every detail of the finish. transition angles and emergence profiles are corrected with the help of a graphite pencil, fine diamond burs and flexible sanding disc (Same process on both sides).

style italiano styleitaliano rubber twist wheel for composite polishing

Fig.19
After finishing, we polish with rubber spirals (same process on both sides).

style italiano styleitaliano rubber twist wheel for composite polishing

Fig.20
After finishing, we polish with rubber spirals (Same process on both sides).

style italiano styleitaliano lucida star felt and paste polishing composite restorations

Fig.21
Final high gloss with the Lucida system, disposable felt star and extreme polishing paste (same process on both sides).

style italiano styleitaliano diashine lucida
style italiano styleitaliano diashine lucida
style italiano styleitaliano upper right lateral after direct composite diastema closure

Fig.22
Follow up after 20 days (Right Side).

style italiano styleitaliano upper left lateral after direct composite diastema closure

Fig.23
Follow up after 20 days (Left Side).

style italiano styleitaliano extent of right lateral direct composite diastema closure

Fig.24
Photo overlay in order to show the before and after of the clinical case (Right Side).

style italiano styleitaliano extent of left lateral direct composite diastema closure

Fig.25
Photo overlay in order to show the before and after of the clinical case (Left Side).

style italiano styleitaliano surface texture of direct composite restoration

Fig.26
Surface texture.

style italiano styleitaliano smile after direct composite diastema closure

Fig.27
Follow up after 20 days

Conclusions

The front wing technique is an excellent option for the diastema closure treatment without tooth preparation. This particular case of a young patient with Bolton’s discrepancy and finished orthodontic treatment. The closure of the interdental space with orthodontic movements was not indicated to solve the problem.

Front wing is a very good and simplified option for the management of these type of discrepancies with direct composite and without wax-up and the silicone key as part of the treatment plan. This technique allows to improve the shape of the tooth with a great control of the emergence profile and management of gingival tissues quickly, since it is done freehand on the buccal front, with non-invasive, purely additive, we can impressive change patient smile.. The aesthetic result is predictable and of high quality giving the patient a definitive solution.

Bibliography

  1. Manauta J, Salat A, Devoto W, Putignano A. Layers 2 2022.
  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. Devoto W, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth. Eur. J. Esthet Dent 2010; 5: 102-124
style italiano styleitaliano Essential Dentistry kit online on demand course
style italiano styleitaliano Essential Dentistry kit online on demand course

RELATED CASES

Espresso Posterior: A 5-year follow-up in multiple restorations

In this case multiple posterior teeth were treated in a single visit using the StyleItaliano Espresso Posterior technique alongside a single mass of P composite