Diastema closure and midline deviation correction
Multiple diastemas in the frontal region affect the self-esteem of many patients and represent one of the most important problems in the clinic of aesthetic dentistry. The described clinical case demonstrates that in such situations the inclinations and the position of the midline are often influenced; this confirms once again: a universal method of treatment for such clinical cases does not exist. Despite the large number of possible treatment options, the path to success is the correct diagnosis and the selection of an appropriate clinical case. In this article, a direct composite restoration was chosen to close the diastems and correct the position of the midline.
This 20-year-old patient was unhappy with her smile due to the presence of multiple diastemas. She refused orthodontic treatment because of its duration, as well as for financial reasons. So, during the discussion of treatment options, the patient opted for direct restoration as a cost-effective and minimally invasive approach.
The complexity of this clinical case lies in the presence of a displacement of the midline to the left in addition to the uneven gaps between the teeth.
For a preliminary assessment of the proportions and available space, the Digital Smile Design technology was used. Also, the use of DSD made it possible to design a correction of the position of the midline and evaluate on which side to close the diastems to center the new midline.
Analysis and selection of the shade should be carried out before the cofferdam is applied, while the surface of the teeth is completely moistened; otherwise there is a great risk of making a mistake with the shade, choosing a lighter than necessary.
Using the MDP SmileLite polarizing filter, an image was obtained in polarized light in order to make sure that the hue was selected correctly.
The teeth were isolated with a cofferdam; the papillae were removed by floss ligatures to improve visibility and access to the operative field in order to prevent errors in the modeling of the cervical areas. The teeth were cleaned with pumice (without fluoride), their surface was lightly sanded with a coarse-grained disc in order to remove the outer layer of pristine enamel for better adhesion.
Neighboring teeth were protected with Teflon tape before 30 second etching of enamel. This was followed by a 60-second flushing of the etching agent in order to completely eliminate the acid.
After the etching procedure, the enamel should look chalky white.
After applying the adhesive, it is important to inflate it carefully so that the solvent evaporates. A long exposure time (with caution to avoid overheating of the teeth) ensures maximum transition of monomers to polymers and better adhesion.
I made a silicone key to place the palatine composite frame (E White Dental Beauty CompoSite system).
Restoring approximate surfaces is not difficult using sectional matrices. The SI2 shade from the White Dental Beauty CompoSite set was used. Controlling the external framework of the restoration is a key point in minimizing the final correction of the shape and ensuring a predictable layer-by-layer application of material.
As you can see, the layering of the SI2 shade is not difficult if the restoration framework is done carefully.
After that, SI1 dentin shade and the final layer of enamel shade were used, as well as a little blue dye between the mamellons to create a better relief.
I had to adjust the contact point to prevent the appearance of a black triangle, which would ruin the whole look of a smile.
Finishing the restoration is crucial to get a great result. First of all, I corrected the angles using a fine-grained diamond bur and the vestibular contour using a fine-grained conical long diamond bur.
Then he polished the surface of the composite with a rubber polisher.
The next step was polished with pastes (Shiny G): first at a speed of 1000 rpm without water cooling and then at a speed of 10000 rpm with water cooling.
To achieve an ideal mirror surface, polishing was also carried out using a soft filt and paste (based on alumina, particle size 1 micron): first at a speed of 1000 rpm without water cooling; then at a speed of 10,000 rpm with water cooling.
Even in difficult cases, do not neglect the simplest treatment option, especially if it satisfies the desires and interests of the patient.