Diastema Closure PDF

Six Steps
to COnsider
When Closing
Diastemas
Many clinicians are faced with the

challenge of how to close a diastema
esthetically, and without the presence
of black triangles. Dr. Marcos Vargas,
a professor at the University of Iowa
College of Dentistry, believes freehand
direct resins composites provide an
esthetic and conservative approach
for closing diastemas and should be a
part of the armamentarium for every
cosmetic dentist.
This article summarizes the technique

demonstrated by the author, published
in Volume 26, No. 3, Fall 2010 issue of the
Journal of Cosmetic Dentistry.
Proper treatment options should always be carefully
analyzed and presented to the patient in detail before

The presence of black
moving forward with any treatment plan. The following
triangles around the
approach may be an option and is best used for closing
teeth can make it
a diastema with non-slumping and non-sticking
difficult for practitioners
materials.
to close anterior
The case here describes the treatment plan performed on
diastemas.
a 27-year-old female concerned with the space between
her front teeth. She agreed to the following treatment
after all options were investigated and presented to her.
Here are the six steps to consider when using this approach:
Step 1: Shade and Opacity Selection

1.
Tooth shade should be obtained by comparing the center
middle-third of the tooth against the middle of the shade tab
(Fig 1). An enamel-like opacity material is usually selected when
closing diastemas up to 2 mm. Larger diastemas may require
layering of a dentin-like opacity material to prevent show-
through, followed by an enamel-like opacity material.
Figure 1: The appropriate shade of direct composite is selected.
Step 2: Isolation 2.
Rubber dam isolation with ligatures is recommended. The rubber dam keeps the operatory field
dry and free of contaminants. The ligatures help the rubber dam push the gingiva apically, to allow
access to the proximal gingival areas for ideal contouring and polishing of the restorations.
Step 3: Tooth Preparation
3.
Although, tooth preparation is not required when clos-
ing a diastema there may be situations where the teeth
are slightly misaligned (Fig 2) and a minor recontour-
ing may be necessary when the teeth are positioned fa-
cially. On the other hand, no preparation is necessary
when the teeth are lingually positioned. Roughening
of the enamel is recommended only when self-etch
Figure 2: The enamel surface of Figure 3: The enamel surface of teeth
adhesives are to be used. Following tooth preparation,
the teeth is minimally prepared for #8 and #9 is etched.
the enamel surface of both teeth is etched for at least composite placement.
30 seconds (Fig 3), after which the adhesive bonding
agent is placed and cured (Fig 4).
Step 4: Material Selection

4.
Composite resin materials for this technique must demonstrate handling char-
Figure 4: An adhesive bonding agent
acteristics that enable placement without slumping or sticking to placement
is applied to the preparations and
instruments. Few commercially available resin composites (e.g., Estelite Sigma,
light-cured.
Tokuyama [Tokyo, Japan]; Filtek Supreme Ultra, 3M ESPE [St. Paul, MN]; Prem-
ise, Kerr [Orange, CA]; Renamel Microfill, Cosmedent [Chicago, IL]) demonstrate
the handling characteristics for this particular diastema closure technique.
Step 5: Material Placement

5.
A small increment of the appropriately shaded
composite resin that corresponds to the facial
half of each diastema is placed over the mesio-
facial aspect of each tooth. These increments are
placed simultaneously and contoured to ensure
optimal contour and identical width for both Figure 5: Two increments of nano- Figure 6: An IPC instrument is used
central incisors (Fig 5). Attention should be composite resin are applied to to adapt the resin to the proper
given to blending the increments over the facial the diastema simultaneously and contour.
surface. contoured to optimal proportion on
Using a thin-bladed interproximal carver (IPC) the mesial aspect.
instrument, contour the increments to match
each others profile and ensure adequate gingival
embrasure and emergence profile (Fig 6).
A metal matrix is sometimes utilized to produce
a small separation between the two increments.
A small brush is used to smooth the composite
resin surface and approximate the increments
(Fig 7). Light-cure the increments (Fig 8).
Figure 7: A small brush is used to Figure 8: These increments of

smooth the composite. composite are light-cured.
5. continued
Place a matrix against one of the central incisors
and layer the lingual half of the diastema
between the tooth and the matrix. Push this
increment facially, close the matrix against the
tooth, and pull it through toward the facial to
ensure proper lingual contour (Fig 9). If excess
composite remains in the gingival embrasure,
remove it prior to light-curing.
Light-cure the direct resin buildup and repeat last
bullet point above for the other central incisor.
Figure 9: After the matrix is placed, the composite is layered against the
matrix lingually and pulled through toward the facial.
Step 6: Finishing and Polishing

6.
Using a #12 blade, remove any excess material
gingivally to the contact point. Sof-Lex disks
(3M ESPE) and a coarse polishing cup were used
to contour the facial surface of the restorations
(Fig 10). Create surface characteristics with a
Figure 10: The facial surface is Figure 11: Surface characteristics are
diamond bur, without water irrigation (Fig 11). finished using a finishing disk. created with a diamond bur, without
Proximal polishing was achieved by sequentially water irrigation.
using polishing strips (Epitex strips, GC America;
Alsip, IL). Polishing cups (HiLuster, Kerr) were
used to create the restorations final luster and
surface anatomy (Fig 12). In this case, the
patient was scheduled a week later to evaluate
her satisfaction, gingival healing, and marginal
adaptation.
Figure 12: The use of polishing cups contributes to the creation of the
restorations final luster and surface anatomy.
Conclusion.
Conclusion
One of the biggest challenges practitioners face in
esthetic dentistry is the presence of black triangles
around the teeth when closing anterior diastemas.1
However, this difficulty can be effectively managed.
While the success of a restorative treatment in anteri-
or teeth depends on the esthetic integration between
soft and hard tissues, direct restorative techniques de-
scribed here can be applied to avoid black triangles
for an optimal result. (Fig 13).2
Resources
1. De Araujo EM Jr., Fortkamp S, Baratierri LN. Closure of diastema

and gingival recontouring using direct adhesive restorations: a
case report. J Esthet Restor Dent. 2009;21(4):229-40.
Figure 13: Postoperative view after the diastema between teeth #8 and #9 was
2. Lacy AM. Application of composite resin for single-appointment closed with direct composite resin.
anterior and posterior diastema closure. Pract Periodont Aes-
thet Dent. 1998;10(3):279-86.
The American Academy of Cosmetic Dentistry (AACD) is dedicated to advancing excellence
in the art and science of cosmetic dentistry and encouraging the highest standards of ethical
conduct and responsible patient care. The AACD fulfills its mission by: offering superior
educational opportunities; promoting and supporting a respected Accreditation credential;
serving as a user-friendly and inviting forum for the creative exchange of knowledge and ideas;
and providing accurate and useful information to the public and the profession.
For more information or to join AACD, visit www.AACD.com

Diastema Closure PDF

Uploaded by

Copyright:

Available Formats

Diastema Closure PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Diastema Closure PDF

Uploaded by

Copyright:

Available Formats

What are the 6 steps to consider when closing diastemas?

What materials should be used for closing diastemas?

Six Steps

Many clinicians are faced with the

This article summarizes the technique

analyzed and presented to the patient in detail before

her front teeth. She agreed to the following treatment

after all options were investigated and presented to her.

Step 1: Shade and Opacity Selection

Figure 1: The appropriate shade of direct composite is selected.

Step 4: Material Selection

Step 5: Material Placement

Figure 7: A small brush is used to Figure 8: These increments of

Step 6: Finishing and Polishing

1. De Araujo EM Jr., Fortkamp S, Baratierri LN. Closure of diastema

The American Academy of Cosmetic Dentistry (AACD) is dedicated to advancing excellence

educational opportunities; promoting and supporting a respected Accreditation credential;

For more information or to join AACD, visit www.AACD.com

You might also like