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Closing Black Triangles Following Invisilign Therapy

189 Rating(s).

Posted on 10.10.2018 08:32 PM By Gerald Benjamin In Anterior/Esthetic

It has been my experience that black triangles frequently appear near the completion of Invisilign Therapy in the mandibular arch. Patients are frequently thrilled by the results of having undergone Invisilign Therapy but are quite dismayed by the appearance of large black triangles (spaces in the gingival 2/3 between teeth.There are two ways to eliminate the large spaces: place porcelain veneers which requires significant amounts of tooth structure to be removed or perform direct resin bonding with no removal of tooth structure.The vast majority of my patients select the direct resin bonded approach to preserve as much natural tooth structure as possible. These cases are quite labor intensive and require the dentist to close the spaces in three dimensions so that there are no ledges in the restorations. A small Mylar strip is used and small pieces of a Cosmedent's Renamel MICROFILL are added to the tooth to insure the complete elimination of the space.

Midline view of spaces

Right view of spaces

Left view of spaces

The elimination of black triangles using direct bonded resin

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12 Comments

Maurice Salama says on 10.11.2018 08:38 AM

Benjamin; Impressive and very labor intensive....skill intensive as well. How does this hold up over time. How does staining or calculus buildup effect these direct restorations. regards Maurice

Gerald Benjamin says on 10.11.2018 01:39 PM

Hi Maurice; This is long term treatment with no staining expected. That is why a use a microfill so that I can obtain a high, sustainable polish. Because the space was filled in 3 dimensions, the lingual surface is highly polished as well. I have taken care of this patient for 35 years and I know with a high degree of certainty that calculus will not be an issue. Regards, Gerald

Barry Rimmer says on 10.11.2018 01:37 PM

You might consider bio clear matrix as simple to use and great resultshttps://optident.co.uk/optident_resources/bioclear-matrix/

Gerald Benjamin says on 10.11.2018 01:43 PM

No!!!!!! I know how to do this. In the same vein, I love taking a 10 unit veneer impression rather than scanning the case...Call me old. Gerald

ashok gowda says on 10.11.2018 09:42 AM

Great job Dr. Gerald.

Ronald Goldstein says on 10.11.2018 08:23 PM

Beautiful result, Gerald. I have done many of these type diastema closures and no doubt the lower anteriors are the most difficult to do as well as to maintain. I tell my patients they will need to alter their dietary habits of stain producing foods as well as more frequent prophy appointments which our hygienists should avoid the Prophy Jet. The fact that you obtained a very high polish on the lingual surfaces is so important for longeivity of the restorations.

Gerald Benjamin says on 10.11.2018 08:50 PM

Dr. Goldstein;
As always, your kind words are always appreciated. All students live for complements from their mentors. ( I have many of your books from the 80s and 90s)
Regards,
gerald

Gary Finkleman says on 10.12.2018 12:00 AM

Nice work! A connective tissue graft prior to bonding would yield an even better long term result.

Gerald Benjamin says on 10.12.2018 06:22 AM

Thanks Gary! The patient hated the spaces and was not going to be persuaded to wait for the graft to heal. I planned on mentioning this on the next recall in a few months.

Bernardo Mira Correa says on 10.14.2018 10:57 AM

Hi Gerald! thank you for sharing this so interesting case with us!
Could you show us a post op X-ray control?
It would be very interesting to be able to see how you managed de composite restorations' cervical adaptation.
Thank you so much! :)

Gerald Benjamin says on 10.14.2018 07:22 PM

Hi Bernardo;
The next time the patient is in.
Regards,
gerald

Jeffrey Sims says on 02.26.2019 09:44 PM

Nice Gerald! I have done many of these myself but for me, Bioclear Matrixes work better in my hands. I like the emergence profile the preformed matrixes give. Not a perfect system but pretty good. I love and use composite very often as you do. Always look forward to your posts.