J Korean Acad Conserv Dent.  2011 Nov;36(6):515-520. 10.5395/JKACD.2011.36.6.515.

Diastema closure with direct composite: architectural gingival contouring

• Kim YH
• Cho YB

• KMID: 2176609
• DOI: http://doi.org/10.5395/JKACD.2011.36.6.515

Abstract

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.

Keyword

Black triangle; Contact point; Diastema closure; Emergence profile; Gingival contouring

MeSH Terms

Adhesives
Diastema
Polyethylene Terephthalates
Tooth
Adhesives
Polyethylene Terephthalates

Figure

• 

  Figure 1 Preoperative intraoral photographs. (a) Frontal view, (b) Occlusal view.

• 

  Figure 2 The length was obtained from the ratio, comparing values of radiograph and the cast.

• 

  Figure 3 The dental cast was waxed up to establish the shape of the restoration.

• 

  Figure 4 (a) Isolation with a retraction cord, (b) The strip was fully seated and a small cotton pellet was placed, (c) After removal, leaving the space.

• 

  Figure 5 (a) After resin build up to the contact point, (b) Completion of resin build-up of #11, (c) Completion of resin build-up of #21.

• 

  Figure 6 (a) Preoperative photograph, (b) Postoperative photograph, (c) Follow-up after 3 months.

• 

  Figure 7 (a) Preoperative periapical radiograph, (b) Postoperative periapical radiograph.

Reference

1. Blatz MB, Hürzeler MB, Strub JR. Reconstruction of the lost interproximal papilla-presentation of surgical and nonsurgical approaches. Int J Periodontics Restorative Dent. 1999. 19:395–406.

2. Helvey GA. Closing diastemas and creating artificial gingiva with polymer ceramics. Compend Contin Educ Dent. 2002. 23:983–998.

3. Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol. 1992. 63:995–996.

4. Kurth JR, Kokich VG. Open gingival embrasure after orthodontic treatment in adults: prevalence and etiology. Am J Orthod Dentofacial Orthop. 2001. 120:116–123.

5. Wu YJ, Tu YK, Huang SM, Chan CP. The influence of the distance from the contact point to the crest of bone on the presence of the interproximal dental papilla. Chang Gung Med J. 2003. 26:822–828.

6. Cho HS, Jang HS, Kim DK, Park JC, Kim HJ, Choi SH, Kim CK, Kim BO. The effects of interproximal distance between roots on the existence of interdental papillae according to the distance from the contact point to the alveolar crest. J Periodontol. 2006. 77:1651–1657.

7. Martegani P, Silvestri M, Mascarello F, Scipioni T, Ghezzi C, Rota C, Cattaneo V. Morphometric study of the interproximal unit in the esthetic region to correlate anatomic variables affecting the aspect of soft tissue embrasure space. J Periodontol. 2007. 78:2260–2265.

8. Chang LC. Assessment of parameters affecting the presence of the central papilla using a non-invasive radiographic method. J Periodontol. 2008. 79:603–609.

9. Willhite C. Diastema closure with freehand composite: controlling emergence contour. Quintessence Int. 2005. 36:138–140.

10. De Araujo EM Jr, Fortkamp S, Baratieri LN. Closure of diastema and gingival recontouring using direct adhesive restorations: a case report. J Esthet Restor Dent. 2009. 21:229–240.

11. Lee DW, Kim CK, Park KH, Cho KS, Moon IS. Non-invasive method to measure the length of soft tissue from the top of the papilla to the crestal bone. J Periodontol. 2005. 76:1311–1314.