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
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.