Composite Resin Diastema Closure
A 41-year-old female presented in good health with no contraindications to dental treatment. She had a chief complaint of "old fillings to close my gap." A complete oral examination revealed no significant problems or pathosis, other than her unsightly old single resin restoration wedged between teeth Nos. 8 and 9. There was no contact in which to floss, and there was a large overhang against a blunted papilla.
We discussed several options, including orthodontics, veneers, and direct resin. We both preferred the option of direct resin.
When this case was done more than a decade ago, I selected Filtek Z250 (3M) for its handling, color stability, and initial polishability. Since this case was completed, 3M has developed newer composites with nanotechnology. If I were to do this case today, I would use Filtek Supreme Ultra (3M).
The biggest challenge in this case was achieving complete diastema closure without creating an open gingival embrasure (dark triangle) or leaving an overhang. The only way to achieve an acceptable result was to begin the restorations subgingivally, while maintaining an acceptable biologic width, as described by Maynard and Wilson.1
The accompanying images show how the restorations were begun approximately 1 mm subgingivally and supported with a modifi ed toffl emire matrix. The teeth were restored individually; I placed and cured 1 tooth before moving on to the other. Note how the gingiva responded to well placed restorations in spite of my aggressive fi nishing at the gingival margins. Also, contrast the position, shape, and blunted health of the preoperative papilla with that of the - month and 11-year healthy, stable, and properly pointed postoperative papilla.
The conventional hybrid composite resin polished well at the 1-month postoperative appointment and maintained a reasonable polish for more than a decade.
In the end, both the patient and I were quite satisfi ed, and the long-term success speaks for itself.
Reference: 1. Maynard JG Jr, Wilson RD. Physiologic dimensions of the periodontium significant to the restorative dentist. J Periodontol. 1979;50(4):170-174.