Single shade everyday

An excellent strategy to integrate in the Front Wing workflow is the pre-operative mock-up. This strategy is useful in many ways, four to be precise:
It’s the exact buccal thickness you need, and it gives precious feedback about how hard the procedure will be.
It is the best possible color try, as it is physical, with the true color of the actual material you’ll use to restore.
The patient can give us immediate feedback about the project and accept it. Early training on the shape. With a little rehearsal, logically, a better performance is to be expected. Well, think of the pre-op mock-up as your rehearsal, associated with some happy side effects.
After acceptance, at the time one begins the actual treatment, this is some sort of a confidence boost, and really helps to perform an excellent treatment.
Regardless of the type of diastema, the shape and space discrepancies, any problem is solved with a front wing and the backfill.
It’s extremely versatile, leaves little chance for mistakes, and plenty of room for intra-op correction.

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Fig.1
This patient wanted to close the space and optimize the shape of the lateral, which was too small.

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Fig.2
A quick mock-up was done, firstly to meet patient expectations before starting, second to double check the color in the real situation.

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Fig.3
With the rubber dam alone, the cervical area is not accessible.

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Fig.4
Retraction done with a B4 clamp to have access to the cervical area, both buccally and proximally.

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Fig.5
The matrix is rotated and placed on the neighboring tooth while etching is carried out. We’ll use the same matrix later on.

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Fig.6
Aspect of the etched surface.

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Fig.7
Aspect of the front wing rising from the cervical area without creating overhangs. A2B mass from 3M Filtek Utlimate was used because of its very stable handling.

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Fig.8
Palatal aspect of the front wing and the defect it creates.

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Fig.9
Buccal view of the void behind the front wing.

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Fig.10
The matrix perfectly fits from the cervical to the incisal.

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Fig.11
Application of the flowable composite.

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Fig.12
This kind of material is better handled with a thin instrument rather than its syringe.

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Fig.13
Body shade paste composite is placed in the palatal void before the flowable is cured.

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Fig.14
Packing should continue until excess keeps flowing from the buccal side.

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Fig.15
Aspect after polymerization and matrix removal. The contour is almost perfect.

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Fig.16
First stage of the finishing is the metal finishing strip. Pass it through the contact point in its non-cutting area and work up to the cervical.

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Fig.17
After the finishing strip you can use a disc as well before removing the clamp.

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Fig.18
Spiral wheel with water during at least 30 seconds.

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Fig.19
Felt wheel with paste for the final finishing.

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Fig.20
Aspect immediately after rubber dam removal.

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Fig.21
Aspect after 2 months with good integration and perfect tissue healing.

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Fig.22
Wedge insertion
A wedge can be very helpful to firmly hold the matrices in a chosen position, or as an aid to create a strong contact. Not in all cases a wedge is required. When reproducing a proximal surface with matrices, the priority is to keep the matrix intact so we can take advantage of its shape.

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Fig.23
When restoring a wide diastema, the matrix is very likely to lack cervical support, and hence be crushed. In such cases the most successful strategy is to back-fill the palatal void without inserting a wedge. The resulting contact point will be enough.

Conclusions

– Wax-up is of little use in diastema and shape cases.
– Most diastema cases are managed with a single body shade, except when incisal edge is highly characterized or when the cervical is highly opaque.
– A metallic finishing strip is one of the most fundamental tools for this kind of restorations.
– The front wing technique is easy, fast, predictable and applicable to diastema, shape modifications, direct and semi-direct veneers and class IV.

Bibliography

1- Vargas M, A step-by-step approach to a diastema closure, a dualpurpose technique that manages black triangles. Volume 26, No. 3, Fall 2010. Journal of Cosmetic Dentistry.
2- 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
3- De Araujo EM Jr., Fortkamp S, Baratierri LN. Closure of diastema and gingival recontouring using direct adhesive restorations: a case report. J Esthet Restor Dent. 2009;21(4):229-40.
4- Lacy AM. Application of composite resin for single- appointment anterior and posterior diastema closure. Pract Periodont Aesthet Dent. 1998;10(3):279-86
5- Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Books, 2012
6- Leclaire CC, Blank LW, Hargrave JW, Pelleu GB Jr. Use of a twostage composite resin fill to reduce microleakage below the cementoenamel junction. Oper Dent 1988 Winter;13(1):20-3

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