A clinical case by our Community member Dr. Gianmarco Terry
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.
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.
Fig.2
Lateral view of the upper lateral incisors splinted with resin.
Fig.3
The resin splint was removed in order to initiate the closure of the diastema (Right side).
Fig.4
The resin splint was removed in order to initiate the closure of the diastema (Left side).
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).
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).
Fig.7
Absolute isolation from first premolar to first premolar with rubber dam and W2 clamps (Right Side).
Fig.8
Absolute isolation from first premolar to first premolar with rubber dam and W2 clamps (Left Side).
Fig.9
Maximum retraction with B4 clamp, to guarantee the sealing of the emergence profile with the front wing technique (Right Side).
Fig.10
Maximum retraction with B4 clamp, to guarantee the sealing of the emergence profile with the front wing technique (Left Side).
Fig.11
Photo overlay in order to show the maximum gingival retraction achieved with absolute isolation and B4 clamp (Right Side).
Fig.12
Photo overlay in order to show the maximum gingival retraction achieved with absolute isolation and B4 clamp (Left Side).
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.
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).
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.
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).
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).
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).
Fig.19
After finishing, we polish with rubber spirals (same process on both sides).
Fig.20
After finishing, we polish with rubber spirals (Same process on both sides).
Fig.21
Final high gloss with the Lucida system, disposable felt star and extreme polishing paste (same process on both sides).
Fig.22
Follow up after 20 days (Right Side).
Fig.23
Follow up after 20 days (Left Side).
Fig.24
Photo overlay in order to show the before and after of the clinical case (Right Side).
Fig.25
Photo overlay in order to show the before and after of the clinical case (Left Side).
Fig.26
Surface texture.
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
- Manauta J, Salat A, Devoto W, Putignano A. Layers 2 2022.
- Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. Eur J Esthet Dent 2008; 3(1):14-29.
- 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
