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Carlos Fernández Villares

Interproximal resto tools: make your diastema predictable

19456 Views - May 2017

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Closing diastemas with a direct technique might seem quite unpredictable; composite resins allow a very conservative treatment that provides us with very natural results, and without removing natural sound tissues. Actual composite resins allow us to mimic natural teeth even when they have been previously bleached. In this clinical case we are going to show some tips and tricks to use anterior matrix and how to get the best out of this kind of treatment.



Img. 1 - Initial situation of the patient. 50 old year woman comes asking for an esthetic and conservative result

Img. 2 - In the first appointment we shoot videos, extraoral, intraoral photos and take impressions for the study cast

Img. 3 - Photographs allow us to obtain a lot of information that normally we don't see during a quick examination of the patient

Img. 4 - We like to take photographs from different angles to obtain as much information as possible.

Img. 5 - All of this information is a great tool to communicate with the patient

Img. 6 - After a DSD analysis we proceed to make the mock-up

Img. 7 - We show the mock-up to the patient, as it is the best way to communicaticating the final result in a realistic manner

Img. 8 - Here are some tips to make your mock-up a piece of cake!

Img. 9 - After having seen the mock-up, the patient accepts the treatment plan

Img. 10 - We start with our bleaching protocol (White Dental Beauty)

Img. 11 - After the result is appropriate for the patient we go through the restorative phase

Img. 12 - TIP: We wait at least 2 o 3 weeks after the whitening to start the adhesive procedures

Img. 13 - We think isolation is the only way to manage these cases

Img. 14 - Having the field isolated allows us a better vision and have no influence of the saliva

Img. 15 - We simply eliminate the aprismatic enamel with a soflex disc

Img. 16 - We then clean the surface with glycine powder

Img. 17 - Until everything is really clean

Img. 18 - Now we proceed with the etching phase

Img. 19 - Going far away in the enamel

Img. 20 - And wash it thoroughly

Img. 21 - We need to be sure that everything is clean and then dry (MDP PHOTO)

Img. 22 - In this case we use a universal adhesive (MDP PHOTO)

Img. 23 - We polymerize the adhesive 10 sec from different directions

Img. 24 - And we start with the palatal enamel

Img. 25 - With the help of the applica instrument (LM Arte)

Img. 26 - After removing the index

Img. 27 - We use a posterir matrix (Polydentia) to imitate the emergence profile

Img. 28 - My Custom Rings Kit by Style Italiano (Polydentia) contains everything you might want to use for interproximal modelling.

Img. 29 - TIP: Liquid dam is a great tool to mantain the matrix in place.

Img. 30 - After removing the matrix, the proximal wall is made.

Img. 31 - We apply the mass and smoothen it with a brush

Img. 32 - Thanks to the Misura instrument, we respect the 0,5 mm for the thickness of enamel

Img. 33 - And we finish with the appropiate enamel

Img. 34 - First we finish one tooth

Img. 35 - We remove the excess material with the Eccesso (LMArte) spatula

Img. 36 - And we continue with the next tooth

Img. 37 - Repeating the same procedure

Img. 38 - Then we go through the finishing and polishing procedures

Img. 39 - Discs and burs are used

Img. 40 - Immediate result after removing the rubber dam

Img. 41 - We need to wait for the healing of the soft tissues and rehydration of the teeth and their restorations.

Img. 42 - Final lateral smile, one week after

Img. 43 - From the other side

Img. 44 - Frontal photo

Img. 45 - Polarized photos allow us to check the color of the restoration

Img. 46 - Different views

Img. 47 - From all the angles

Img. 48

Img. 49 - And final smile

Img. 50 - The whole procedure took us

Img. 51 - 1 hour and 46 min

Conclusions

Composite resins used with a direct technique is the most conservative option to solve esthetic problems in a very good way. Additionally, a whole set of tools have been brought to the market to make it even easier. This article has shown how these cases can become predictable and easily manageable.
 

Bibliography

  1. 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-Vanini L. Mangani F. Klimovskaia O. Conservative Restoration of Anterior Teeth. Acme, 2005
  2. Baratieri LN., Araujo Jr E.M. Monteiro Jr S. Composite Restorations in Anterior Teeth: Fundamentals and Possibilities. Quintessence Books
  3. Dietschi D. Layering concepts in anterior composite Restorations. J. Adhes Dent 2001; 3: 71-80
  4. http://www.styleitaliano.org/closing-diastemas

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