A clinical case by our Community member Dr. Zuhair Arif
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.
In the modern world, one’s smile plays a major role in their aesthetics, and the presence of a diastema may affect confidence, and thus lead to intervention. Dental diastemata are quite common and are more frequently found between anterior teeth. The most common reasons for diastema are occlusal factors, hypertrophic labial frenulum, dento-alveolar discrepancies, periodontal disease, or iatrogenic factors. There are several therapeutic approaches for closure of diastemata, but the use of composite resins allows, in fact, a minimally invasive, affordable treatment that is also predictable over time. This article shows a step wise approach to diastema closure resorting to the Front Wing Technique proposed by Jordi P Manauta.
The patient, a 22 years old male with good periodontal health having no contraindication to any dental treatment, came to my office after hearing from a friend that he could receive a treatment that would fill the space between his front teeth. He had been self conscious about the space in his front teeth for many years and, despite regular dental appointments, this was the first time he had heard that he could improve his smile in any way. After being offered treatment options of orthodontics, veneers, and direct composite restoration, the patient chose a singlesession direct composite restoration.
Shade selection is done by Realistic Try-In method, a trial performance before the real act. The principle is to rehearse with the actual material(s) before the real restoration is done.
Shade of the patient was selected using a personalized guide, and the selected color was validated by constructing both teeth in same position and thickness and then taking a polarized photograph. Color match was excellent so decided to proceed with it.
Teeth were polished before the procedure and isolated with the rubber dam as mandatory for long term survival of composite restorations. After isolation and inversion is done, the next job is to get as much retraction as possible to create the emergence profile and for that purpose B4 clamps are used.
Etching of enamel surface is done with 37% phosphoric acid for 30 seconds, while frequently activating the etching gel with a microbrush.
After washing and drying the enamel surface looks white and frosty.
Two to three coats of adhesive were applied with a microbrush and rubbed for 20 seconds for better penetration, and then air blown for 5 seconds. Curing was carried out for 60 seconds.
The first step of the Front Wing technique is just to create buccal wings accurately, as close as possible to the final shape. If we think that shape is not good, we have chance to add or remove material to get perfect mirroring contours. Ignoring the value of this step can be disaster.
After getting the perfect shape, the next step is to place two pre-contoured matrices so that we can achieve a tight proximal contact.
As you can see in the picture (source: Front Wing Technique article by Jordi P Manauta, styleitaliano.org), after building the front wings and applying the matrix, the next step is to build palatal surface. In order to do so, one should first put a drop of flowable composite (left uncured) near the proximal margin, and then fill the palatal surface with packable composite and condense it until all excess material stops flowing from the buccal. Keep in mind once the first palatal surface is built, its matrix is removed before build the second one to get a perfect seal.
After closing the gap, finishing and polishing procedures can be done.
Close up image showing the added surface texture.
Final result, immediately after finishing and polishing and rubber dam removal.
The Front wing technique is an amazing strategy to close diastemata in a single session. It is incredibly precise, cost-effective and easily executed if compared to other techniques such as wax-up based ones, and palatal index. Believe me, try it once and you will fall in love with the Front Wing Technique.
1. Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. Eur J Esthet Dent 2008; 3(1):14-29.
2. Manauta J. The Front Wing Technique. 2017 styleitaliano.org
3. Lacy AM. Application of composite resin for single- appointement anterior and posterior diastema closure. Prac Periodont Aesthet Dent.1998;10(3):279-86