The presence of multiple diastemata in anterior teeth is one of the challanges of clinical estheitcs dentistry. There are multiple options for the treatment of diastema, but not all diastemata can be treated using one single approach. Proper case selection and diagnosis are crucial for success of the treatment. In this article multiple diastemata closure was performed using a direct, multi-shade composite resin layering technique.
This 23-year-old female patient was not satisfied with her existing smile because of multiple diastemata. She refused orthodontic treatment because of long duration and financial constraint, so, after discussing treatment options she preferred an alternative, cost-effective treatment with direct composite resin as a minimally-invasive approach.
Retracted view show multiple diastema between anterior teeth with composite restoration on 21 and 22 .
After simulating the suitable proportions of width and height between teeth, it became clear that a good length-width ratio would be achieved by gingivectomy before proceeding to the restorations.
After gingivectomy and increase in length of anterior teeth.
Rubber dam is placed for isolation, and floss ligatures were used to retract the papillae laterally and enable better management of the emergence profile. If the papillae are not well retracted the result is the presence of an interdental black triangle.
Only tooth 22 required preparation. A 2-3 mm fine bevel preparation using a diamond bur and afterwards the finishing of the preparation with coarse and medium abrasive discs were done on tooth 21.
Enamel etching for 30 seconds, and 15 seconds for dentin. The etchant was then rinsed for 60 seconds.
Multiple coats of bonding agent are applied, and after 20 seconds air is blown using oil-free syringe to let the solvent evaporate. Light curing is carried out for and extended time of 60 seconds to ensure perfect polymerization.
Building the proximal walls by using metallic sectional matrices with WE Filtek Z350 XT (3M) composite shade.
This is an important step during work. If we control the outer shape, it’s easier to control layering of the inside dentin shade. Also finishing and polishing steps are made easier.
Finishing started by correction of the angle lines with a fine needle diamond bur.
Correction of the buccal contour following the three thirds of the labial surface with a fine long taper diamond bur.
Labial view of upper anterior region after diastema closure and shape correction.
To create the vertical macro texture and V-shape grooves we can use a finishing carbide bur.
After having created the texture details we should soften the surface of the composite resin with a rubber Eve twist polisher.
After initial finishing and polishing. The patient rescheduled for a second visit for minor modifications and repairs according to patient wishes and for a more detailed finishing and polishing.
On the second appointment, restorations were polished using 3 and 1 micron diamond paste (Micerium) with Shiny G (Micerium), and a natural goat-hair brush used at 1,000 rpm with no water and at 10,000 rpm with abundant irrigation.
1-μm aluminum oxide paste (Shiny F, Micerium) paste was used with a soft felt disk. is used with a to achieve a very high gloss used at 1,000 rpm with no water and at 10,000 rpm with abundant water.
After final finishing and polishing. Two-week follow up side view.
Final result at 2-weeks check up appointment.
Before and after.
We should always consider simple treatment approach if it gave the same aethetic result compared to other alternative treatment options, especially in cases of diastema closure.
1.Manauta J, Salat A. Layers, An atlas of composite resin stratification. Chapter 10 Surface and polishing Quintessence Books, 2012
2.Monteiro P. The step by step in finishing and polishing: anterior direct composite restorations.https://www.styleitaliano.org/the-step-by-step-in-finishing-and-polishing-part-i/
3.Mangani F, Cerutti A, Putignano A , Bollero R, Madini L. Clinical approach to anterior adhesive restorations using resin composite veneers, Eur. J. Esthet. Dent. Off. J. Eur. Acad. Esthet. Dent. 2 (2007) 188–209.
4.Villarroel M, Fahl N, De Sousa AM, De Oliveira OB Jr. Direct esthetic restorations based on translucency and opacity of composite resins. J Esthet Restor Dent 2011;23(2):73-87.