Simplified Diastema Closure using One Shade

This young patient wanted to close the gap between her front two teeth before moving abroad. The patient wanted something quick and easy, and more affordable than orthodontics. After all the viable options were given, the patient chose composite bonding.

styleitaliano style italiano intraoral picture showing large central diastema

Fig.1
A retracted view of the diastema between the two upper central incisors. A chair-side direct mock-up was done to assess the shade, and to build the palatal aspects in order to make a silicone index. The patient was happy with the result and shade.

styleitaliano style italiano rubber dam isolation before composite restoration

Fig.2
Teeth were isolated using a rubber dam. As you can see, despite the good inversion of the rubber dam, the upper centrals needed further retraction.

styleitaliano style italiano floss and composite retraction of rubber dam on central incisors

Fig.3
A couple of floss ties were used to displace the papilla and retract all the tooth surface needed enabling us to achieve a better emergence profile.
TIP: bond some resin tags disto-gingivally to help keep the floss ties distal and apical throughout the treatment.

styleitaliano style italiano aquacare sandblasting dental surface for optimum adhesion

Fig.4
Air-abrasion of the tooth surface using Aquacare (29µm aluminium oxide particles) was carried out to remove any residual plaque deposits or stains.

styleitaliano style italiano enamel etching with acid

Fig.5
Enamel etching using 37% phosphoric acid for 30 seconds, followed by a 60 second rinse. This is very important to ensure that all the etchant has been washed off the tooth surface.

style italiano styleitaliano 3m
style italiano styleitaliano 3m
styleitaliano style italiano closure of diastema with composite using sectional matrix

Fig.6
After drying the teeth, Scotchbond Universal (3M) was used as a bonding agent. It was rubbed onto the tooth surfaces and left for 30-60 seconds to air dry. Once the bond was cured, the silicone index was used to build up the palatal aspect of the teeth.
Then two sectional matrix bands were placed mesially. Using two matrices is meant to prevent overbuilding or over-extending one of the restorations thus affecting the proportions and overall aesthetic outcome. Once the first tooth had been restored, the sectional band used to build that tooth was removed, while the other one was kept in place. Leaving a single matrix before building the second restoration helps ensure a tight contact between the two restorations. In this case 3M Filtek B1 Universal composite was used for the restorations.

style italiano styleitaliano 3m relyx universal
style italiano styleitaliano 3m relyx universal
styleitaliano style italiano glycerine gel on composite before curing

Fig.7
Once the restorations were complete, a final cure under glycerine was carried out.

styleitaliano style italiano curing light for composite

Fig.8
This is very important as curing under glycerine prevents oxygen from inhibiting the outer layer of composite from completely being cured. An incompletely-cured composite layer can be stained and make the restorations discolor very quickly.

styleitaliano style italiano soflex disc defining shape of composite restoration

Fig.9
A Soflex disc (3M) was used to remove excess composite and to better define the final shape.

styleitaliano style italiano rose bur creating texture of composite restorations

Fig.10
A clean rose-head bur (on a slow hand piece) was then used to add secondary anatomy.

styleitaliano style italiano perso bur for composite finishing

Fig.11
The 831 (perio bur) is also a great bur to use for added secondary and or tertiary anatomy (the perikymata).

styleitaliano style italiano rubber wheel polishing composite diastema closure

Fig.12
A two rubber wheel finishing protocol was used. Here we used ASAP steps 1 and 2 to polish. However, the spiral are also very good for this step.

styleitaliano style italiano fine high polish rubber wheel

Fig.13
The ASAP step 2 is used to give the restorations a beautiful shine and lustre.

styleitaliano style italiano polished composite diastema closure

Fig.14
The restorations after polishing.

styleitaliano style italiano diastema closed with composite direct restorations

Fig.15
Immediate post-op. It is important to warn the patient beforehand that the restorations could appear slightly darker than the teeth immediately after the procedure because of dehydration that occurs under rubber dam isolation. This is also why it is critical to take the shade before starting any treatment!

styleitaliano style italiano smile after diastema closure with direct composite

Fig.16
Immediate post op smile. As well as telling the patient that the slight discoloration will improve, in this case we also advised that the slight gap between the gum will be filled up by the papilla.

styleitaliano style italiano restorations for diastema closure after rehydration

Fig.17
One month recall. You can see that the composite has integrated very well with the natural dentition and the papilla has filled the small gap.

styleitaliano style italiano smile after direct no prep diastema closure

Fig.18

Conclusions

Composite materials are a great alternative treatment modality when it comes to restoring a diastema where the patient has refused or cannot afford orthodontics.
Universal composites such as the 3M filtek universal are fantastic materials that can mask the opacity and provide a natural blend with the natural tooth shade. This can simplify the work process both for the clinician and assistant whilst remaining predictable. The use of the Polydentia posterior matrices or now the UNICA matrix can be invaluable tools to help make the process easier and predictable ever time.

style italiano styleitaliano 3m filtek universal
style italiano styleitaliano 3m filtek universal
style italiano styleitaliano polydentia matrix
style italiano styleitaliano polydentia matrix

Bibliography

1. Monteiro P. The step by step in finishing and polishing: anterior direct composite restorations on styleitaliano.org – 2017
2. Fahl N Jr. Achieving ultimate anterior esthetics with a new microhybrid composite. Compend Contin Educ Dent Suppl. 2000;(26):4-13; quiz 26.
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. Manauta J, Salat A. Layers, An atlas of composite resin stratification.Quintessence Books, 2012
5. C. F. Villares Diastema closure a single shade opacity aesthetic approach on styleitaliano.org – 2019
6. 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.

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Ready, steady, mock-up, go!

The mock-up is an essential tool for so many purposes when it comes to esthetic treatments. In this article, Dr Pavolucci shows how to use it to restore a multiple diastema.