Simplified Diastema Closure

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.

styleitaliano style italiano initial situation

Fig.1
A 25-year-old female wanted to close the space between the anterior teeth to improve the esthetic of her smile.

styleitaliano style italiano preoperative intraoral image

Fig.2
A preoperative intraoral image was taken to better frame the treatment plan of the case.

styleitaliano style italiano Digital Smile Design

Fig.3
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.

styleitaliano style italiano isolation

Fig.4
To better control the gingival margin, a split dam technique was used.

styleitaliano style italiano removal of the aprismatic enamel layer

Fig.5
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.

styleitaliano style italiano etching

Fig.6
The enamel surface was treated with 37% orthophosphoric acid for 20 seconds, followed by rinsing thoroughly with water.

styleitaliano style italiano chalky white appearance of the enamel

Fig.7
Chalky white appearance of the enamel surface after etching.

styleitaliano style italiano bonding placement over the etched enamel

Fig.8
A universal bonding agent was applied all over the etched enamel.

styleitaliano style italiano bonding placement over the etched enamel

Fig.9
Multiple coats of universal bonding agent were applied with air thinning between layers, then curing for 20 seconds.

styleitaliano style italiano the first step of diastema closure

Fig.10
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.

styleitaliano style italiano palatal shell placement

Fig.11
The thin palatal shell was built with the enamel shade (0.5-1mm), freehand using transparent strips.

styleitaliano style italiano importance of palatal shell

Fig.12
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.

styleitaliano style italiano the presence of papilla according to distance from the contact point to the crest of the bone

Fig.13
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.

styleitaliano style italiano maintenance of the distance from the contact point to the bone crest of less than 5 mm

Fig.14
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.

styleitaliano style italiano the placement of the sectional matrix

Fig.15
This diagram describes the placement of the modified sectional matrix and the change in papilla shape from a flat to a triangular form.

styleitaliano style italiano shapes after the insertion of the modified matrix

Fig.16
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.

styleitaliano style italiano proximal wall creation

Fig.17
Immediately after building the proximal wall by modifying the sectional matrix and achieving the correct position for the contact point.

styleitaliano style italiano lateral view of proximal wall

Fig.18
Lateral view of proximal wall.

styleitaliano style italiano dentin shade placement

Fig.19
The incisal halo is created by applying a very thin layer of dentin shade to the incisal edge.

styleitaliano style italiano dentin placement and mamelons creation

Fig.20
Layering of a dentin shade is made easier when your working framework is accurate and can be accomplished efficiently with the LM Solo Anterior Instrument (LM, powered by Styleitaliano).
Shaping the mamelons can be done using the LM Fissura Instrument (LM, powered by Styleitaliano).

style italiano styleitaliano lm arte anterior instrument
style italiano styleitaliano lm arte anterior instrument
styleitaliano style italiano lateral view

Fig.21
Lateral view of the outer frame and the inner dentin.

styleitaliano style italiano enamel placement

Fig.22
Transparent enamel placed between mamelons and incisal edge.

styleitaliano style italiano final enamel shade

Fig.23
The final enamel shade was carefully applied using the LM Solo Anterior Instrument (LM, powered by Styleitaliano) and smoothed using a dental brush.

LM arte solo banner style italiano styleitaliano
LM arte solo banner style italiano styleitaliano
styleitaliano style italiano immediately following the comprehensive finishing and polishing procedure

Fig.24
Immediately following the comprehensive finishing and polishing procedure.

styleitaliano style italiano extraoral postoperative view after one month

Fig.25
Extraoral postoperative view after one month.

styleitaliano style italiano intraoral postoperative view after one month

Fig.26
Intraoral postoperative view after one month.

styleitaliano style italiano surface texture

Fig.27
Surface texture.

styleitaliano style italiano extraoral postoperative view after 26 months

Fig.28
Extraoral postoperative view after 26 months.

styleitaliano style italiano intraoral postoperative view after 26 months

Fig.29
Intraoral postoperative view after 26 months.

Conclusions

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.

Bibliography

  1. De Araujo Jr EM, Fortkamp S, Baratieri LN. Closure of diastema and gingival recontouring using direct adhesive restorations: a case report. Journal of Esthetic and Restorative Dentistry. 2009 Aug;21(4):229-40.
  2. Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. Journal of periodontology. 1992 Dec;63(12):995-6.
  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 Mar 1;5(1):102-24.
  4. Gönülol N, Yılmaz F. The effects of finishing and polishing techniques on surface roughness and color stability of nanocomposites. Journal of dentistry. 2012 Dec 1;40:e64-70.
  5. Şen N, Işler S. Multidisciplinary management of a severe maxillary midline diastema: a clinical report. Journal of Prosthodontics. 2019 Mar;28(3):239-43.
  6. Furuse AY, Franco EJ, Mondelli J. Esthetic and functional restoration for an anterior open occlusal relationship with multiple diastemata: a multidisciplinary approach. The Journal of prosthetic dentistry. 2008 Feb 1;99(2):91-4.
style italiano styleitaliano Essential Dentistry kit online on demand course
style italiano styleitaliano Essential Dentistry kit online on demand course

RELATED CASES

styleitaliano style italiano smile proximal composite restoration technique cavity design polishing proximal walls

Proximal composite restoration from cavity design to polishing

How to create stunning direct posterior composites, from cavity design to polishing, with exceptional proximal composite restoration technique.
styleitaliano style italiano proximal caries cover image snowplow technique direct posterior restoration bulk composite Kerr SimpliShade Bulk Fill composite restoration

Bulk flow for Snowplow