Closing Diastemas with a Direct Technique Approach

21 Mar 2016 - 48440

Diastema closure is one of the most demanded treatments in aesthetic dentistry. Ideally, orthodontic treatment must be accomplished to give proper space relationships and good occlusion but in some cases this is not possible and we need the help of the restorative treatment. Diagnostic, patient approval and a recipe to obtain good results is mandatory. We are going to show the case step by step to teach a protocol that can make you have success in this type of treatments

Fig. 1

Patient smile displays unsatisfactory aesthetics in a 28 year old female patient, she asks for a solution with minimally invasive dentistry

Fig. 2

Intra and extraoral pictures are taken to make a DSD protocol to show the patient what we can achieve and to guide us during treatment phases

Fig. 3

Image with open mouth allow us to see incisal edges of anterior teeth tough as wear of the teeth

Fig. 4

A lateral view allow us to determine the space we need to close in the diastema between 12 and 11, necessary to check occlusion

Fig. 5

Frontal image take with Flexipalette form A is the one that we are going to use to make de digital analysis in the DSD protocol

Fig. 6

Digital Smile Design is made to see what we can do during our treatment and is a great tool to guide us to during the dental plan

Fig. 7

we transfer the digital analysis to the cast model to make the wax up as much reliable with the real situation and the treatment plan that we proposed

Fig. 8

Wax up is made to show the patient possible final result and to guide us during stratification process

Fig. 9

bleaching protocol is made with carbide peroxide 16% following Style Italiano protocol with Dental Beauty

Fig. 10

When we obtain desired color (patient desired) we proceed to the restorative phase

Fig. 11

Isolation with rubber dam is made to obtain a dry field to work, perforations can be made with the template

Fig. 12

It is important to have the space well defined to make good diastema closure

Fig. 13

Using Style Italiano burs set Direct Style we eliminate old composite without eliminating too much enamel

Fig. 14

Cleaning the teeth with glycine powder allows us to have better adhesion

Fig. 15

Glycine is less aggressive to dentin compared to other powders

Fig. 16

Three steps bonding agent is used to obtain adhesion in this case. Etching…

Fig. 17

…priming…

Fig. 18

…bonding…

Fig. 19

Using LM-Arte Fissura instrument allow us to mark the silicon key to see where to extend the first composite layer

Fig. 20

enamel layer is applied

Fig. 21

after removing the silicon key we eliminate excess of composite in the distal part with an aluminum oxide disc taking care not to disturb the anatomy that we made in the wax up

Fig. 22

To maintain the matrix (in this case posterior matrix of the Garrison Dental system, Slick Bands) we use a product to polymerize that is the gingival barrier

Fig. 23

Stratification process is done following composite recipes and taking care of the thickness of the enamel

Fig. 24

We go tooth by tooth

Fig. 25

Drawing with a pencil allows us to know the anatomy that we need to reproduce

Fig. 26

Final result shows us a natural result that makes patient happy

Fig. 27

By following the steps a predictable and good result can be achieve and give our patients the desired smile they want.

 

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