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Ortodoncia y Resina
Ortodoncia y Resina
a
Assistant Professor, Department of Restorative Sciences, Dental College of Georgia at Augusta University, Augusta, Ga.
b
Instructor, Department of General Dentistry, Dental College of Georgia at Augusta University, Augusta, Ga.
c
Assistant Professor, Department of General Dentistry, Dental College of Georgia at Augusta University, Augusta, Ga.
d
Assistant Professor, Department of Restorative Sciences, Dental College of Georgia at Augusta University, Augusta, Ga.
Figure 1. Preoperative view. Note 3-mm maxillary midline diastema. Figure 2. Preoperative smile view illustrating correct axial angulation but
disharmonic shape of maxillary anterior teeth.
Figure 3. Composite resin trial restorations. Placing composite resin Figure 4. Limited orthodontic treatment at placement of appliance.
restorations without orthodontics would lead to excessively wide
maxillary central incisors and black triangle.
Figure 6. Space created after orthodontic treatment. A, Between right maxillary central and lateral incisor. B, Between left maxillary central and lateral incisor.
Figure 7. Polyvinyl siloxane matrix seated and followed by application of Figure 8. After application of final increment of microfilled composite
lingual layer of A1 body microhybrid composite resin to form lingual resin layer and before finishing and polishing.
shell.
composite resin technique, with no preparation of the teeth placed to restore the interproximal walls and contact area. A
needed.15 The teeth were cleaned with a slurry of pumice final 1-mm A1 enamel microfilled composite resin layer was
(Pumice Preppies; Whip Mix Corp), followed by acid etching applied to the facial surface.
with 37% phosphoric acid (Uni-Etch w/BAC; Bisco) for 30 Both of the restorations were assessed as this was the
seconds. A 1-step adhesive system (OptiBond Solo Plus; optimal time to modify the restorations if needed (Fig. 8).
Kerr Corp) was used. With the aid of a Mylar strip (Matrix The finishing process was initiated with coarse and
Strips; Crosstex), the mesiolingual layer of the maxillary medium-coarse disks (Sof-Lex Contouring and Polishing
right canine was developed by using A1 body microhybrid Discs; 3M ESPE), by following the natural contours of the
composite resin (Renamel Microhybrid; Cosmedent Inc), teeth. Fine and extra-fine diamond rotary instruments
followed by the application of a mixture of gray and violet (8888.31.012 FG Fine Flame Diamond, DET6EF FG Extra-
color intensifiers (Renamel Creative Color; Cosmedent Inc) fine Needle Diamond; Brasseler USA) were used for
in the incisal third. texture and microanatomy. Finishing strips (EPITEX; GC
A final facial increment of A1 enamel microfilled com- America) were used interproximally to eliminate flash and
posite resin (Renamel Microfill; Cosmedent Inc) was obtain smooth line angles, and silicone polishing points
sculpted to optimal contours. These steps were repeated to (Enhance Finishing Points; Dentsply Sirona) were used on
restore the mesial aspect of the lateral incisors and left the lingual surface after occlusal adjustment. The final
canine. A polyvinyl siloxane (PVS; Reprosil Putty; Dentsply esthetic evaluation of shade and texture of the restoration
Sirona) lingual matrix was fabricated to restore the central was done 15 days postoperatively (Fig. 9).
incisors from a new diagnostic waxing created after the or-
thodontics. After completing the bonding protocol, the DISCUSSION
lingual PVS matrix was seated, followed by application of
the lingual layer of A1 body microhybrid composite resin to All treatment options for diastema closure should be
form a lingual shell (Fig. 7). After light-polymerizing, the considered and presented to the patient. This patient
PVS matrix was removed, and a polyester film strip was was previously aware of indirect restorations as the only
SUMMARY
In esthetic dilemmas such as diastema closure, a
comprehensive smile analysis is essential prior to treat-
ment. When maximal tooth conservation is required,
direct composite resin restorations, with their combined
benefits of esthetics, minimal invasiveness, and longevity
are the favored treatment option.19 Together with or-
thodontics, direct composite resins offered this patient a
cost-effective, conservative resolution of her MMD.
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Figure 9. Patient’s smile 15 days postoperatively.
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The presence of a diastema is one of the causes of Corresponding author:
deficient or absent interdental papillae.17 While periodontal Dr Courtney S. Babb
Department of General Dentistry
surgery is an option for creating a papilla,9 for this patient, Dental College of Georgia at Augusta University
the interdental gingiva between the central incisors was 1120 15th St, GC-3090
“squeezed” together with movement of the teeth, physically Augusta, GA 30912
Email: cbabb@augusta.edu
displacing the tissue coronally to create a papilla,18 as
another benefit of the orthodontic treatment. After Copyright © 2017 by the Editorial Council for The Journal of Prosthetic Dentistry.