A clinical case by our Community member Dr Omar Hasbini
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.
While widely recognized as a minimally invasive approach in both aesthetic and restorative dentistry, diastema closure with direct composites presented significant technical hurdles, often limiting optimal outcomes to skilled and experienced practitioners. Common technical difficulties faced by clinicians lead to a spectrum of undesirable results, including unaesthetic restorations and cervical overhangs. Seeking to simplify diastema closure for broader implementation in everyday dentistry, Dr. Jordi Manauta and the Style Italiano Group have introduced the “Front Wing Technique”. The latter involves freehand sculpting of a buccal wing followed by subsequent filling of the buccal gap.
This technique allows for a simultaneous management of white and pink aesthetics. In fact, it allows an anatomical filling of the diastemas following an adequate newly formed emergence profile which paves the road for gingival creeping. To achieve such success, a precise gingival retraction achieved with retraction clamps is mandatory, keeping in the back of the minds the location of the future contact point.
It is true that a well-executed shaping technique is essential, but without the right color strategy, optimal diastema closure cannot be achieved. To effectively camouflage the underlying anatomical features during shape modification, the use of a specific “body mass” is highly recommended. This material should possess a balanced translucency, neither excessively opaque nor overly transparent.
A female patient presented to the clinic complaining about her smile as she wanted to close the diastema between tooth 22 and tooth 23.
A close-up picture was taken to see the considerable diastema between the concerned teeth, which constitutes a great challenge.
Shade selection was done before rehydration at the beginning of the appointment using the button technique. For diastema closure, body shade composites are of preference. In this case, the CompoSite Si 3 body shade composite from White Dental Beauty was selected.
The Sanctuary dental dam was placed from the right first premolar to the left one. B4 retraction clamps Hygienic were used to push down the gingiva and the rubber dam, and to build an anatomical emergence profile.
This retraction is insured both buccally and palatally.
Ortho phosphoric acid etching was extended to half of the buccal surface and applied for 60 seconds since no preparation was made on the enamel and a 30 seconds etching on the aprismatic enamel layer isn’t sufficient.
A layer of a universal bonding Tetric N-bond (Ivoclar Vivadent) was applied for 20 seconds followed by another layer of bonding applied for the same amount of time. This was followed by 40 seconds of light curing.
Two free hand buccal wings were created using the CompoSite Si 3 body composite.
The LM Arte Applica instrument (LM, powered by Styleitaliano) was used to adapt the composite in the gingival region and the LM Anterior Solo anterior (LM, powered by Styleitaliano) was used in order to provide a more regular surface.
The main focus was to create an excellent emergence profile and contour exploiting this technique correctly.
In fact, it is clear now that the location of the future contact point is approximately established, in a way to pave the path for a future gingival creeping.
Notice that the space between both wings should be roughly of the same thickness of the brown instrument LM Arte Applica.
Two sectional matrices in place with a wooden wedge. The palatal side of the lateral was filled first using the Snow Plow technique, where a flowable composite (SI MP Multiplo) is injected palatally followed by a layer of packable composite of the same selected shade.
Notice that the flowable composite flash buccally which is a sign of a good compaction marking the creation of a good marginal seal.
Removal of the first matrix followed by the use of the same technique at the level of the canine.
A close-up image of the situation after 40 seconds of final curing using the Curing Pen E from Eighteeth.
An expected difference in shade between the teeth and the restorations can be observed in addition to the presence of a black triangle between the two teeth.
Extra-oral view of the situation immediately post-op, the restorations can be easily detected with a noticeable black triangle in between.
The same close-up picture after 72 hours, the clinician can appreciate the composite blending perfectly with the surrounding tooth structures.
Note that the creeping of the gingiva, which has filled the black triangle observed directly post op, highlights the correct emergence profile provided by the restorations in addition to the accurate placement of the contact point.
Extra-oral comparison between both situations, immediately post-op and 72 hours later:
-Post-op, after closure of the diastema, with the presence of dehydrated teeth and a black triangle.
-72 hours post-op, after rehydration and gingival creeping.
Note that the gingiva might still have the potential to close the entire gap if given the appropriate time.
The case before and after.
By bypassing the palatal index and addressing restorations from the buccal side, the “Front Wing Technique” successfully achieves optimal emergence profile and contact points without introducing unnecessary complexity to the procedure.
This technique demonstrates remarkable ease of adoption and implementation, effectively simplifying a perceived challenge and facilitating the achievement of desirable outcomes.
Success is granted when focusing on three pillars during this technique, the shape, the shade and most importantly the biology (emergence profile).
In the clinical setting, prioritizing techniques that consistently deliver predictable results is paramount. The “Front Wing Technique” stands out in this regard, making it a valuable addition for managing common clinical scenarios.
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