Diastema closure with freehand composite: controlling emergence contour.

Abstract

VOLUME 36 • NUMBER 2 • FEBRUARY 2005 138 One of the most ideal uses of freehand composite restorations is for closing diastemas (Fig 1a). The ability to add material to teeth without any reduction of tooth structure is a significant advantage, especially for elective treatment. Handling composite freehand requires practice and may be considered a disadvantage to some, but with effective technique, an ideal result is possible (Fig 1b). For complete success of any diastema closure, many criteria must be met, including: (1) Increased emergence profile with natural contours at the gingiva–tooth interface; (2) a completely closed gingival embrasure (with no “black triangle”) must be achieved; and (3) the subgingival margin should be smooth so floss will not catch or shred. Unlike traditional operative procedures, such as a Class II or Class III composite restoration, closing a diastema requires the emergence profile to be increased, sometimes significantly. The traditional technique of forming proximal surfaces with composite using a mylar strip and a wedge may achieve one or two of the aforementioned goals but never all three. This article will describe a technique the author has found to be predictable in achieving these three important criteria. It is generally unnecessary to prepare the teeth with a bur when closing diastemas. Because the proximal surface rounds into the facial surface, a natural “bevel” exists for shade blending and retention on the facial and lingual sides. Also, there is no need for a prepared finish line with freehand composite restorations, as the composite margin can be thinned to “infinity.” This allows the proximal aspect, where the composite begins its new emergence profile, to be restored without tooth reduction. Avoiding the use of a bur at or below the gingiva helps prevent hemorrhage, which is an additional advantage. The first step in closing diastemas is to pumice the teeth well and to place 000 retraction cord (Ultrapak Retraction Cord, Ultradent) along the side of the tooth to be widened. This cord is black, making it easier to identify the base of the sulcus and providing a reference or limit for the composite placement. A mylar strip, about 1-inch long and cut lengthwise to about one-third its normal width, should then be placed in a particular fashion. The narrowed strip should be tested by fully seating it into the sulcus to ensure that it is just wide enough to extend out of the sulcus by approximately 1 mm. If it is still too wide, cut it as needed to create the proper width, as this plays an important role in the success of the technique. If the gingival tissue is very rigid, it may be helpful to place a small cotton pellet between the tooth and the mylar strip, gently packed into the sulcus (Fig 2). After 5 to 10 minutes, the tissue will have a reduced capacity to relapse, so the space will remain open longer. This provides some additional working time for etching and composite placement. The narrow mylar strip is then set aside and a full-width mylar strip is used during etching to protect the adjacent tooth. Next, the tooth surface is acid etched. Unprepped enamel should be etched for approximately 60 seconds. To prevent the gingiva from pushing the etching gel out of the sulcus a small instrument may be used to hold the mylar strip to keep the space open for the etching procedure (Fig 3). After thoroughly rinsing the etching gel off the tooth surface, adhesive should be placed per the manufacturer’s recommendations. One word of caution if a self-etching primer is to be used: unprepped enamel is not reliably etched by most self-etching products. If using one of these products, etch the Diastema closure with freehand composite: Controlling emergence contour

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@article{Willhite2005DiastemaCW, title={Diastema closure with freehand composite: controlling emergence contour.}, author={Corky Willhite}, journal={Quintessence international}, year={2005}, volume={36 2}, pages={138-40} }