Interproximal resto tools: make your diastema predictable

15 May 2017 - 48317

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 tissue. 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.

Fig. 1

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

Fig. 2

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

Fig. 3

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

Fig. 4

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

Fig. 5

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

Fig. 6

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

Fig. 7

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

Fig. 8

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

Fig. 9

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

Fig. 10

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

Fig. 11

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

Fig. 12

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

Fig. 13

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

Fig. 14

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

Fig. 15

We simply eliminate the aprismatic enamel with a Sof-lex disc.

Fig. 16

We then clean the surface with glycine powder.

Fig. 17

Until everything is really clean.

Fig. 18

Now we proceed with the etching phase.

Fig. 19

Going far away in the enamel.

Fig. 20

And wash it thoroughly.

Fig. 21

We need to be sure that everything is clean and then dry (MDP picture)

Fig. 22

In this case we use a universal adhesive (MDP picture).

Fig. 23

We cure the adhesive 10 sec from different directions.

Fig. 24

And we start with the palatal enamel.

Fig. 25

With the help of the Applica instrument (LM Arte).

Fig. 26

After removing the index.

Fig. 27

We use a posterior matrix (Polydentia) to imitate the emergence profile

Fig. 28

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

Fig. 29

TIP: Liquid dam is a great tool to maintain the matrix in place.

Fig. 30

After removing the matrix, the proximal wall is made.

Fig. 31

We apply the mass and smoothen it with a brush.

Fig. 32

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

Fig. 33

And we finish with the appropriate enamel.

Fig. 34

First we finish one tooth.

Fig. 35

We remove the excess material with the Eccesso (LM Arte) spatula.

Fig. 36

And we continue with the next tooth.

Fig. 37

Repeating the same procedure.

Fig. 38

Then we go through the finishing and polishing procedures.

Fig. 39

Discs and burs are used.

Fig. 40

Immediate result after removing the rubber dam.

Fig. 41

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

Fig. 42

Final lateral smile, one week after.

Fig. 43

From the other side.

Fig. 44

Frontal photo.

Fig. 45

Polarized photos allow us to check the color of the restoration.

Fig. 46

Different views.

Fig. 47

From all the angles

Fig. 48
Fig. 49

And final smile.

Fig. 50

The whole procedure took us…

Fig. 51

 1 hour and 46 minutes.

 

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

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
Baratieri LN., Araujo Jr E.M. Monteiro Jr S. Composite Restorations in Anterior Teeth: Fundamentals and Possibilities. Quintessence Books
Dietschi D. Layering concepts in anterior composite Restorations. J. Adhes Dent 2001; 3: 71-80
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