Cosmetic Procedure »» Diastema Closure

A diastema is a space between front teeth. Diastemas are closed by orthodontics or restoration. A highly successful technique is addition of composite. A space which is too large and closed with composite results in teeth that are esthetically too wide and orthodontics is recommended. Space closure requires placement of composite two adjacent teeth. Placement of composite onto one tooth can be done it proper tooth dimensions allow it. Anesthetic is not required unless dentin or root structure is involved. Diamond burs prepare tooth structure creating a rough surface for improved bond strength and to produce bevels that show through tooth color at restoration cavosurface areas. Cross section of enamel rods improves enamel bond strength.

The back of the mouth is a dark area because it receives no light. Composite must block out darkness or a restoration appears dark. Placement of opaque material to the lingual covered with translucent material to the facial achieves a natural looking restoration that is not influenced by this darkness. Blending composite color to tooth color is further achieved by proper composite selection, placement and preparation design. Restoring small diastemas or restoration of teeth that have a large buccal lingual dimension do not require placement of lingual opaque composite.

Bonding to enamel provides strength to hold composite onto tooth structure and minimize microleakage. Removal of caries often creates areas of mechanical locking that aids retention. Strength of enamel bonding is increased by beveling across enamel rods. A longer bevel or chamfer preparation creates more surface area for strength and provides a long gradual show through of tooth color for better color transition. A translucent outer layer of composite provides a chameleon effect picking up and showing through surrounding color.

Gingival control eliminates a black triangle in the papillae area. Placement of composite subgingival is achieved by placement of a matrix that reflects gum tissue to allow bonding and composite placement.

Tooth structure is prepared, a plastic matrix placed, etching and bonding completed on one tooth. A lingual wall of composite placed trying to achieve ideal interproximal contours and light cured. Dimensions are made exact or too large. Cured composite is difficult to add to when the oxygen inhibited layer is lost but it is easily removed.

Wrapping a matrix is avoided because it produces a straight contour and eliminates the oxygen inhibited layer. A contoured matrix or hand shaping produces convex interproximal areas. A layer of translucent composite is placed across the facial aspect, shaped with hand instruments and light cured.

Final shaping and polishing is achieved with burs, sandpaper disks, rubber wheels, points, cups, and polishing pastes. Mesial distal dimension is measured on the restored tooth and compared to the distal mesial dimension of the adjacent tooth and space. Adjustments are made to the restored tooth with burs or sandpaper disks.

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Case 2:

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