Midline diastema closure using a lithium disilicate glass ceramic fragment: increased long-term color stability"

ABSTRACT: Nowadays, maxillary midline diastema (MMD) can be treated with different multidisciplinary approaches. When restorative dentistry is needed, glass-matrix ceramic materials is one of the best choices, since they present good optical behavior and high survival rates in the anterior dentition. To obtain an adequate interphase, and color integration are one of the main restorative goals, and for that purpose, specific finishing and polishing procedures must be employed to avoid staining and ensure the restoration's color stability. In the case report presented in this article, a single lithium disilicate ceramic fragment was performed to close a MMD produced by the shape alteration of one of the maxillary central incisors. Also, the finishing and polishing procedure is discussed.

Longitudinal evaluation of diastema closure in patients submitted to labial frenectomy in different phases of the mixed dentition: A historical cohort.

BACKGROUND: There is a controversy in the literature concerning the indications for frenectomy to treat interincisal diastema. Aims and Objectives: The aim of this study was to evaluate the spontaneous closure of the interincisal diastema in patients submitted to upper labial frenectomy (ULF) during the mixed dentition. MATERIALS AND METHODS: Records from patients treated between 2009 and 2014 in the course of Pediatric Dentistry Surgery at Fundecto-USP were evaluated to select those that were submitted to ULF during the mixed dentition using the Chelotti technique. Initial clinic characteristics and radiographic data related to the abnormal upper labial frenum were collected. The patients were called for a return visit to evaluate the diastema closure. The prevalence of children with diastema reduction after the frenectomy was determined by descriptive analysis. Logistic regression was used to evaluate the association between exposure factors and diastema reduction. Results: From 449 eligible records, 53 were selected and 25 were in a return visit. It was not possible to find association between the exposure factors and diastema closure. CONCLUSION: There is no relation between the time of surgery intervention and diastema closure. However, the intervention during the mixed dentition led to a partial diastema reduction in 80% of the cases.

Finite element stress analysis of composite resin veneers for diastema closure.

The fracture of restorations used for diastema closure is a clinical concern. The objective of this study was to perform a finite element-based comparative analysis of functional stress patterns in composite resin veneer restorations used for diastema closure to determine the influence of factors such as the preparation design, proximal extension, loading level, and vector of stress (loading angle). Three-dimensional finite element stress analysis was performed on a maxillary central incisor model to examine the stress distribution resulting from a nanofilled composite veneer restoration with 4 different extensions of unsupported composite (0.5, 1.0, 1.5, or 2.0 mm) and 2 different preparation designs (partial or full) under 3 loads (50, 150, or 250 N) and 3 loading angles (60°, 90°, or 125°). The maximum stress was found to be concentrated on the full-preparation design with a 0.5-mm mesial extension under a 250-N load and 60° loading angle. The minimum stress was found with the partial-preparation design with a 0.5-mm mesial extension under a 50-N load and 90° loading angle. Based on the results of the present study, a partial-preparation design is preferred when nanofilled composite resins are used for diastema closure.

Longevity of direct diastema closure and recontouring restorations with resin composites in maxillary anterior teeth: A 4-year clinical evaluation.

OBJECTIVES: To evaluate the clinical performance of resin composite restorations and to investigate causes of failure. MATERIALS AND METHODS: The longevity of 216 restorations in 53 patients (mean age, 33.3 years) was retrospectively evaluated according to Fédération Dentaire Internationale (FDI) criteria. Dental history and photographic data were used to evaluate diastema closure (n = 199) and recontouring (n = 19) restorations comprising microhybrid (Essentia Universal, GC Corp.), nanohybrid (Ceram.x One, Dentsply Sirona), and nanofilled (Estelite Asteria, Tokuyama Dental) composites. Data were analyzed with the Kaplan-Meier log-rank test, Cox regression analysis, Pearson chi-square test. p < 0.05 was considered statistically significant. The overall survival rate was 90.3 % and the mean survival duration was 46.2 months during the for 4 - year study period. The annual failure rate was 0.9 % - 3.4 %. Mean survival durations for diastema closure and recontouring restorations were 46.2 and 45.9 months, respectively (p = 0.328). Mean survival durations for Essentia Universal, Estelite Asteria, and Ceram.x One were 46.1, 46.7, and 45.7 months, respectively (p = 0.677). If we include failed restorations that were repaired and remained functional, the overall survival rate was 100 %. CONCLUSION: Longevity was similar among composites and restoration types. The long-term clinical performance of monochromatic anterior composite restorations was robust. Composite repair may be suitable for diastema closure and recontouring restorations. CLINICAL SIGNIFICANCE: There is a lack of long-term clinical evidence regarding the performance of direct anterior composite restorations. Monochromatic direct composite restorations may meet both the esthetic and functional expectations with even simpler restorative techniques. This 4 - year follow-up study evaluated the clinical performance of monochromatic anterior diastema closure and recontouring restorations with three different composite materials. The longevity of the restorations and the reasons for failure were investigated.

The use of direct composite resin to close maxillary midline diastema complementary to orthodontic treatment

ABSTRACT: The maxillary midline diastema is a common esthetic problem in patients. Assess and diagnose may be challenging due to the many factors that influences the alteration of tooth eruption process and tooth shape. Due to the various advantages and the reversibility of treatments, composite resins are today a suitable aesthetic and functional option, even so, its management and technique require a trained and experienced clinician in order to obtain an optimal outcome. The following report, is a clinical case of a 21-year old female with a main complaint of a maxillary midline diastema produced by the alteration in tooth shape and size of both upper central incisors, which was closed and corrected with direct composite resins.

Mind the gap: A novel technique for space closure - a case report.

Patients presenting with severe hypodontia can be challenging to manage. They often present with significant spaces within the dental arches and the lack of permanent teeth can make anchorage control difficult. This case report demonstrates a novel technique for diastema closure in a 14-year-old with severe hypodontia. The technique allows maintenance of root parallelism during space closure in cases with reduced anchorage support. The treatment plan was agreed on a multidisciplinary hypodontia clinic and involved an upper sectional fixed orthodontic appliance to close a 7-mm midline diastema aiding subsequent partial denture provision. Treatment commenced by bonding upper primary canines and central incisors. However, attempting space closure on a 0.019 × 0.025-inch stainless-steel working archwire resulted in tipping of the incisor crowns. Two brackets were therefore placed on the labial surface of each central incisor (one incisal and one gingival). Subsequently two stainless steel working archwires and elastomeric chain were used for diastema closure. This four-bracket system provided superior control allowing space closure by bodily tooth movement. Excellent root parallelism was achieved with this innovative technique.

Diastema closures: A novel technique to ensure dental proportion.

OBJECTIVE: To describe a novel technique that helps the clinician on promoting a midline diastema closure with appropriate width proportions based on previous wax up, avoiding excesses of the resin material on the gingival area, which could lead to possible inflammation. MATERIALS AND METHODS: Two different silicone indexes were made over a wax up to perform a diastema closure. RESULTS: The use of a silicone index made with putty polyvinyl siloxane (PVS) material and another index made with putty and light PVS materials performed over a modified wax up, helped on achieving esthetically pleasant diastema closure with appropriate proportional widths, respecting the gingival tissue. CONCLUSIONS: The use of a novel silicone index technique allowed for ensuring the same width for both upper central incisors in a midline diastema closure, improving gingival tissue's health. CLINICAL SIGNIFICANCE: The main difficulties regarding diastema closure are related to reaching an appropriate width proportion of the central incisors and avoiding a ledge at the gingival aspect of the contact area, which could become a plaque and food trap. This article describes, step-by-step, how to avoid such diastema closure issues, ensuring the width proportions of the upper central incisors.

Comparison of two different composite resins used for tooth reshaping and diastema closure in a 4-year follow-up.

AIMS: This aim of this study is to evaluate and to compare the clinical performances of two nanohybrid composite resin systems used for diastema closure and tooth reshaping at 4 years. SUBJECTS AND METHODS: Twenty-three patients with midline or multidiastema problem were enrolled in this study. Nanohybrid resin composite systems to be used on each patient were randomly selected. Thirty seven teeth of 10 patients were restored with Filtek-Z550 (3M/ESPE) in combination with Adper™ Single Bond 2 (3M/ESPE) etch and rinse adhesive in Group 1 whereas 39 teeth of 13 patients were restored with Charisma-Diamond (Heraeus Kulzer) in combination with Gluma2 Bond (Heraeus Kulzer) etch and rinse adhesive in Group 2, by two operators. Esthetic, functional, and biological properties of the restorations were evaluated at baseline, 1, 2, 3, and 4 years using foreign direct investment criteria by two independent examiners. STATISTICAL ANALYSIS USED: The data were evaluated using Fisher's Chi-Square (P = 0.05). RESULTS: Fifty-eight restorations (19 patients) with a mean service time of 43.4 months were evaluated (recall rate 82.6%). One Filtek-Z550 and two Charisma-Diamond restorations were repaired due to partial fracture (Score 4). Survival rates of Group 1 and Group 2 were 96.3% and 93.5%, respectively (Kaplan-Meier) (P > 0.05). Qualitative deteriorations were observed within each group according to baseline regarding surface luster, surface/marginal staining, marginal adaptation, patient's view, and periodontal response (P < 0.05). However, there were no significant differences between two restorative materials for any of the criteria assessed (P > 0.05). CONCLUSIONS: Both nanohybrid composite resin systems revealed esthetically, functionally, and biologically acceptable clinical performance when used for diastema closure and tooth reshaping at 4 years.

Closing a Large Maxillary Median Diastema using Bapat Power Arm.

AIM: The aim of this study is to present a case of large maxillary median diastema closed by bodily movement of central incisors using Bapat power arm (BPA). MATERIALS AND METHODS: After extraction of mesiodens, a power chain with a force of 120 gm was applied to BPA ligated to preadjusted edgewise brackets bonded to maxillary central incisors to move them over round steel wire for closure of resultant diastema. Bonded retainer was placed after the closure of median diastema. RESULTS: The median diastema was completely closed in 5 months period with almost bodily movement of incisors, which was confirmed by periapical X-ray. CONCLUSION: Bapat power arm was efficient in closing diastema without any discomfort or injury and was well accepted by the patient. HOW TO CITE THIS ARTICLE: Bapat SM, Singh C, Bandejiya P. Closing a Large Maxillary Median Diastema using Bapat Power Arm. Int J Clin Pediatr Dent 2017;10(2):201-204.

Conservative and esthetic closure of maxillary midline diastema without creating "black triangle" using direct resin composite

Anterior diastemas are common esthetic problems. One of the challenges in clinical esthetic dentistry is closing anterior diastemas without creating “black triangles” between the teeth. The success of a restorative treatment in anterior teeth depends on the esthetic integration between soft tissues and hard tissues. This report describes the successfully accomplished diastema closure case by producing the emergence profile with natural contours at the gingival-tooth interface and then generating of gingival recontouring process.

Rehabilitación estética con carillas de disilicato de litio / Esthetic rehabilitation with lithium disilicate veneers

Debido a sus resultados estéticos y a la máxima conservación de la estructura dentaria, las carillas de disilicato de litio se encuentran indicadas para el tratamiento estético de los dientes anteriores que tengan anomalía en la forma, tamaño y color. El objetivo de este caso es demostrar los pasos en la rehabilitación utilizando carillas de disilicato de litio. El paciente presenta diastemas desde los dientes 15 a 25, se realizo el examen clínico general y oral, se obtuvieron los modelos de estudio, se realizo el encerado diagnóstico en base al DSD y se confeccionó el Mock up con silicona de adición; el laboratorio fabrico las carillas en disilicato de litio y se cementaron con técnica adhesiva. Las carillas permitieron un tratamiento rehabilitador conservador, funcional y estético de nuestro paciente

Because the aesthetic results and preservation of tooth structure, lithium disilicate veneers are indicated for the aesthetic treatment of anterior teeth with abnormal shape, size and color. The aim of this report was to demonstrate the steps in oral rehabilitation using lithium disilicate veneers. The patient had teeth diastemas from 15 to 25; general and oral clinical examination was performed, and study models were obtained. waxed diagnosis was made based on the DSD and Mockup was drawn with addition silicone; the laboratory fabricate veneers lithium disilicate were cemented by adhesive technique. Veneers allowed a conservative, functional and aesthetic rehabilitation treatment of our patient

Diastema closure using direct bonding restorations combined with orthodontic treatment: a case report.

Closure of interdental spaces using proximal build-ups with resin composite is considered to be practical and conservative. However, a comprehensive approach combining two or more treatment modalities may be needed to improve esthetics. This case report describes the management of a patient with multiple diastemas, a peg-shaped lateral incisor and midline deviation in the maxillary anterior area. Direct resin bonding along with orthodontic movement of teeth allows space closure and midline correction, consequently, creating a better esthetic result.

Diastema closure using direct bonding restorations combined with orthodontic treatment: a case report

Closure of interdental spaces using proximal build-ups with resin composite is considered to be practical and conservative. However, a comprehensive approach combining two or more treatment modalities may be needed to improve esthetics. This case report describes the management of a patient with multiple diastemas, a peg-shaped lateral incisor and midline deviation in the maxillary anterior area. Direct resin bonding along with orthodontic movement of teeth allows space closure and midline correction, consequently, creating a better esthetic result.

Diastema closure with direct composite: architectural gingival contouring / 대한치과보존학회지

One of the most challenging task in closing anterior diastema is avoiding "black triangle" between the teeth. This paper reports a case that the closure of diastema in anterior teeth could be successfully accomplished using direct adhesive restorations and gingival recontouring. The traditional technique using Mylar strip was modified to increase the emergence profile with natural contours at the gingival-tooth interface. Mylar strip was extended out of the sulcus by approximately 1 mm high from the gingival margin, and a small cotton pellet was used to provide the emergence contour. This modified approach is acceptable for the clinical situation.