Content uploaded by Abu-Hussein Muhamad
Author content
All content in this area was uploaded by Abu-Hussein Muhamad on May 05, 2019
Content may be subject to copyright.
Content uploaded by Abu-Hussein Muhamad
Author content
All content in this area was uploaded by Abu-Hussein Muhamad on Mar 08, 2019
Content may be subject to copyright.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 18, Issue 3 Ser. 5 (March. 2019), PP 30-33
www.iosrjournals.org
DOI: 10.9790/0853-1803053033 www.iosrjournals.org 30 | Page
Closing Diastemas with Resin Composite Restorations; a Case
Report
Mai Abdulgani*, Azzaldeen Abdulgani, Abu-Hussein Muhamad
Corresponding Author: Mai Abdulgani
Abstract:Maxillary anterior spacing is a common aesthetic complaint of patients. Midline diastema has a
multifactorial etiology such as labial frenulum, microdontia, mesiodens, peg-shaped lateral incisors, agenesis,
cysts, habits such as finger sucking, tongue thrusting, or lip sucking, dental malformations, genetics,
proclinations, dental-skeletal discrepancies, and imperfect coalescence of interdental septum. Appropriate
technique and material for effective treatment are based on time, physical, psychological, and economical
limitations. Direct composite resins in diastema cases allow dentist and patient complete control of these
limitations and formation of natural smile. This case report describes direct aesthetic midline diastema closure
with direct composite technique.
Keywords: Diastema closure, Direct resin bonding, Midline diastema,
---------------------------------------------------------------------------------------------------------------------------------------
Date of Submission: 25-02-2019 Date of acceptance:11-03-2019
---------------------------------------------------------------------------------------------------------------------------------------
I. Introduction
The midline diastema is a space between the maxillary central incisors.[1] The incidence of diastemas
varies greatly with age and race.The space can be a normal growth characteristic during the primary and mixed
dentition and generally is closed by the time the maxillary canines erupt.[1,2,3] In adults, the most common
factors in the development of diastemas are tooth-size discrepancies and excessive vertical overlap of the
incisors.[4] Other less frequent, but important, contributing factors are Incisor mesiodistal angulations,
generalized spacing, labiolingual incisor inclination, frenums and pathological conditions.[2,3,5]
Maxillary midline diastemas are considered as esthetic problems by majority of the patients and thus
are an esthetic liability just like crowding or protrusion of incisors. A study evaluating the influence of incisal
malocclusion on social attractiveness of young adults in Finland found that patients with a broad midline
diastema were perceived as being less socially successful and of lower intelligence.[4,5] Diastemas can be
treated in a multitude of ways including orthodontic closure, restorative therapy, surgical correction or
multidisciplinary approach depending upon the particular case and the etiology of diastema.[1,3] A carefully
developed differential diagnoses allows the practitioner to choose the most effective treatment plan. Diastemas
based on tooth-size discrepancy are most amenable to restorative solutions.[4] The restorative closure of
diastemas can be achieved by using any of the techniques mentioned; direct composite veneers, indirect
composite veneers, porcelain laminate veneers, all ceramic crowns, metal ceramic crowns and composite
crowns.[4,5]
Figure 1: Preoperative view of a patient who presented with a diastema between teeth #8 and #9.
The increased patient demand for minimally invasive aesthetic procedures and the improved physical
properties of current composite materials has resulted in the extensive utilization of direct bonding of composite
resin to anterior teeth.]6]Contemporary composite materials can be handled throughout the restorative process to
achieve the desired morphology and color of the final restoration.[7] Direct resin build up can be a worthy
choice to treat diastemas based on tooth-size discrepancy.[4,5] However, direct placement of composites for
veneering is a laborious process particularly for multiple teeth. Simpler techniques using matrix have been
advocated to make the procedure less technique sensitive. Use of matrix in placing composite simplifies the
chair side treatment procedure. [8,9]This paper proposes a new simplified direct composite veneering using a
modified matrix to achieve diastema closure and desirable esthetics in single visit.
Closing diastemas with resin composite restorations ; A Case Report
DOI: 10.9790/0853-1803053033 www.iosrjournals.org 31 | Page
Case Presentation:
A 19-year-old male patient reported with a complaint of spacing in the anterior teeth region. His history
reveals that he had the spacing from the time of permanent dentition and he had problem with smiling because
of the same. Patient medical history was noncontributory. It was the first dental visit Patient wanted an esthetic
correction for the closure of the multiple spaces because it restrained him from his self-confidence. On
examination there was gap in between his social six from canine to canine in the maxillary arch. (Fig: 1,2)
Overjet was more than 3mm.
Figure 2: The enamel surface of the teeth is minimally prepared for composite placement, Maxillary anterior
teeth were isolated with rubber damand the central incisors were retracted with retraction cord.
The patient was explained about the reason for his diastema being tooth material arch length
discrepancy (Bolton’s discrepancy). Various treatment modalities were explained to ;the patient such as
1. Fixed orthodontic therapy
2. Ceramic veneering
3. Composite veneering
4. Full coverage restorations (crown)
5. Direct composite build up
Closure of midline diastema and overall smile build up using a customized matrix technique.The teeth
were restored with a nano-hybrid composite, Tetric N Ceram by a three step etch rinse and bond technique.
Etching was done for 20 seconds with N-Etch , a phosphoric acid gel for enamel etching and dentin
conditioning (fig.3). Bonding was done by Tetric N-Bond , a light-curing, single-component bonding agent
for enamel and dentin bonding used in combination with the total-etch technique.
In the process of resin build up after etching and bonding, a light-curing, radiopaque nano-hybrid
restorative composite was applied on the tooth surfaces and then the transparent custom matrix was placed.
The curing was done with a light emitting diode (LED) curing through the transparent matrix for 60 seconds for
each tooth (fig.4). After the curing was complete the matrix was removed and the extra flash was removed with
fine-grit flame shaped diamonds and finishing carbide burs. The final finishing of the restorations was done by
fine composite finishing( fig.5) . The final restorations resulted in the diastema closure and as well as overall
aesthetic improvement of the patient, both meeting the patient’s expectations (fig.6).
Figure 3: The enamel surface of teeth #8 and #9 is etched.
Figure 4: Two increments of composite resin are applied to the diastema simultaneously and contoured to
optimal proportion on the mesial aspect.
Closing diastemas with resin composite restorations ; A Case Report
DOI: 10.9790/0853-1803053033 www.iosrjournals.org 32 | Page
Figure 5: The facial surface is finished using a finishing disk
II. Discussion
Diastema closure with direct resin is a recommended procedure, which is frequently accomplished in
clinic. However, in cases where there is a wide space between the teeth, the simple closure may not offer a
natural and pleasant solution to the patient.[4,5,7] The remodeling with composite resin can solve the problem
of tooth architecture, but because of an unwanted black triangle between the teeth, such remodeling may not
solve the problem of gingival architecture.[1,2,8,9]
The modern composite restorative materials are remarkable with their improved physical and esthetic
properties, if manipulated properly they can be used to create good quality esthetic restorations with sufficient
wear resistance providing satisfactory years of service. [8,9,10]They are conservative esthetic options of
restorative dentistry since minimal or no tooth preparation as compared to ceramics[4,5]. Direct resin veneering
can be done by hand sculpting or free hand bonding, but that is a cumbersome process, requiring a lot of effort,
time and often it is not possible to veneer multiple teeth in the same appointment. [1,2,3]To simplify composite
placement –a customized matrix for individual patients can be made which is less technique sensitive and
provides greater opportunity and freedom to deliver optimized aesthetic goals. [11]The only limitation to the
customized matrix technique can be the need for wax up of the models and then the accurate fabrication of the
matrix. However, keeping in view the benefits of using a customized anatomical matrix for direct resin
veneering this extra effort is worth. The advantage of using a laboratory-fabricated template is, of course, the
freedom from having to sculpt perfect dental anatomy.[12] In the present case report the fabrication of the
customised matrix helped to achieve optimal aesthetics in a single visit.[13]
Figure 6: Postoperative view after the diastema between teeth #8 and #9 was closed with direct composite
resin.
Direct composite restoration is the simplest among all procedures for diastema closure. Direct
composite resins in diastema closure cases allow dentist and patient complete control in formation of natural
smile.[4,8] In terms of aesthetic dentistry, these restorations offer numerous advantages that other possible
treatment options such as ceramic veneers and orthodontic treatment do not have. They are kinder to the
opposing dentition compared to ceramic materials[9]. Recent aesthetic composite resin materials have similar
physical and mechanical properties to that of the natural tooth and possess an appearance like natural dentin and
enamel.[4,5]
The presence of a midline diastema or spaces in between anterior teeth can be a major esthetic concern
for patients. There are various treatment options available for diastema closure in adults like orthodontic
movement, restorative and prosthodontic treatment. Amongst these, the use of direct resin restorations seems to
be conservative and more practical [13,14]. In this case report patient's esthetic expectations were successfully
met through conservative direct composite resin restorations.
Direct bonded composite resin restorations may be preferable in clinical cases wherein conservative,
esthetic correction of the appearance of anterior teeth is indicated. [4,5]The advantages of this technique far
outweigh those of other techniques. However sometimes, for better esthetic results, an interdisciplinary
approach is often required. In this case, the use of conservative direct resin bonding provided the symmetrical
and harmonious arrangement of the teeth.
Closing diastemas with resin composite restorations ; A Case Report
DOI: 10.9790/0853-1803053033 www.iosrjournals.org 33 | Page
III. Conclusion
Direct composite veneer provides good esthetic result at the lesser cost and time due to absence of
laboratory procedure and completion of work in single appointments. This minimally invasive technique is a
better option in treatment of dental flurosis, peg laterals and midline diastema compared to full crown.
References
[1]. Murchison DF, Roeters J, Vargas MA, Chan DCN. Direct Anterior Restorations. In: Summitt JB, Robbins JW, Hilton TJ, Schwartz
RS, editors. Fundamentals of Operative Dentistry: A Contemporary Approach. 3rd ed. Chicago: Quintessence; 2006. pp. 274–279.
[2]. Kim YH, Cho YB. Diastema closure with direct composite: architectural gingival contouring. J Korean Acad Conserv Dent.
2011;36:515–520.
[3]. Lenhard M. Closing diastemas with resin composite restorations. Eur J Esthet Dent. 2008;3:258–268.
[4]. Azzaldeen A, Muhamad AH. Diastema Closure with Direct Composite: Architectural Gingival Contouring. J Adv Med Dent Scie
Res 2014;3(1):1-6.
[5]. Abdulgani Azzaldeen1,Watted Nezar2,Abu-Hussein Muhamad3 DIRECT BONDING IN DIASTEMA CLOSURE HIGH DRAMA,
IMMEDIATE RESOLUTION: A CASE REPORT.Ijdhs2014.1(4);430-435
[6]. Dlugokinski MD, Frazier KB, Goldstein RE: Restorative treatment of Diastema. In: Esthetic in Dentistry (Vol.2).RE Goldstein, VB
Hoywood (Eds.); 2nd Edn.; BC Decker Inc. London, 2002;703-732.
[7]. Muhamad Abu-Hussein , Nezar Watted2, Azzaldeen Abdulgani ; An Interdisciplinary Approach for Improved Esthetic Results in
the Anterior Maxilla Diastema. Journal of Dental and Medical Sciences2015,14, 12 ,96-101. DOI: 10.9790/0853-1412896101
[8]. B. Korkut, F. Yanıkoğlu, M. Günday. Direct Composite Laminate Veneers: Three Case Reports. JODDD, 7(2), 2013.
[9]. Sabnis, G K Vasunni, P Mahale, GT Kamble. Esthetic Conservative Management of Interdental spaces using Direct Composite
Resin Restorations- A Case Report. IOSR Journal of Dental and Medical Science. 13(6); 2014: 109-112.
[10]. Jha S AS, Karale R,Santhosh L, Kapadia A Novel Approach for the Closure ofMultiple Diastema: A Clinical Technique. J Oper
Dent Endod. 2017;2(2):84-7.
[11]. Muhamad Abu-Hussein ,Nezar Watted ,Azzaldeen Abdulgani; PORCELAIN LAMINATES- CURRENT STATE OF THE ART:
A CLINICAL REVIEW. Int J Dent Health Sci 2015; 2(2):788-795
[12]. Prabhu R, Bhaskaran S, Prabhu KG, Eswaran M, Phanikrishna G, Deepthi B. Clinical evaluation of direct composite restoration
done for midline diastema closure–long-term study. Journal of pharmacy & bioallied sciences. 2015;7(Suppl 2):S559.
[13]. Shuman IE, Goldstein MB. Anterior aesthetics using direct composite with a custom matrix guide. Dent Today. 2008;27:126-131.
[14]. Lal SM, Jagadish S. Direct composite veneering technique producing a smile design with a customised matrix. J Conserv Dent
2006;9:87-92
Mai Abdulgani. “ Closing Diastemas With Resin Composite Restorations ; A Case Report.”
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), vol. 18, no. 3, 2019, pp 30-33.
