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.
The dental morphology usually determines the shape and the volume of the interdental space, which must be filled by a dense connective tissue covered by oral epithelium to achieve pleasant esthetics. When resin composite restorations are placed to solve esthetic problems, the restorative procedure must be designed to allow the formation of healthy interdental papilla.
This article describes a new modification in matrixing system to achieve biological, functional, and esthetic result in the anterior region.
A 25-year-old female wanted to close the space between the anterior teeth to improve the esthetic of her smile.
A preoperative intraoral image was taken to better frame the treatment plan of the case.
A Digital Smile Design (DSD) was used as a guide in all the steps. By doing so, the Golden Proportion (proportion of 1.618:1.0:0.618) used to determine an adequate distribution of the spaces between teeth.
To better control the gingival margin, a split dam technique was used.
No preparation of the tooth surface is needed other than passing a coarse disc over the enamel to only remove the aprismatic layer, and to provide a clean substrate for the adhesive procedure.
The enamel surface was treated with 37% orthophosphoric acid for 20 seconds, followed by rinsing thoroughly with water.
Chalky white appearance of the enamel surface after etching.
A universal bonding agent was applied all over the etched enamel.
Multiple coats of universal bonding agent were applied with air thinning between layers, then curing for 20 seconds.
This diagram describes the first step of diastema closure, which involves creating a palatal shell. According to measurements from DSD, the palatal shell is built to achieve the correct space closure based on the golden proportion, and in relation to the midline of the face.
The thin palatal shell was built with the enamel shade (0.5-1mm), freehand using transparent strips.
The palatal shell is carefully created to close the diastema gap, following specific measurements from the DSD approach. It is designed to harmonize with the palatal surface of the teeth, adhere to the golden proportion, and maintain facial symmetry. Ultimately, enhancing both dental esthetics and function.
According to the results of various studies, it was observed that when the distance from the contact point to the crest of the bone was 5 mm or less, the papilla was present almost 100% of the time. When the distance extended to 6 mm, the papilla was present 56% of the time, and at a distance of 7 mm or more, the papilla was present 27% of the time or less.
A distance from the contact point to the bone crest of less than 5 mm can be maintained by modifying the sectional matrix into a ‘J’ shape. This shape enables to create a contact area more cervically and achieve a correct emergence profile, with the gingival part of the sectional matrix curved within 3-5 mm in length, inserted into the gingival sulcus to push the papilla between the teeth, forming a triangular shape of the papilla, while the incisal part is burnished to be straight, thus avoiding a large incisal embrasure.
This diagram describes the placement of the modified sectional matrix and the change in papilla shape from a flat to a triangular form.
This diagram illustrates the post-composite restoration, tooth, and papilla shapes, as well as the dimensions of the incisal and cervical embrasures, with an absence of any cervical black triangles.
Immediately after building the proximal wall by modifying the sectional matrix and achieving the correct position for the contact point.
Lateral view of proximal wall.
The incisal halo is created by applying a very thin layer of dentin shade to the incisal edge.
Lateral view of the outer frame and the inner dentin.
Transparent enamel placed between mamelons and incisal edge.
Immediately following the comprehensive finishing and polishing procedure.
Extraoral postoperative view after one month.
Intraoral postoperative view after one month.
Extraoral postoperative view after 26 months.
Intraoral postoperative view after 26 months.
The emergence profile should be identified and respected when restorations are placed to obtain diastema closure because healthy periodontal tissues and acceptable esthetics depend on it.
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