Direct composite for an extremely large diastema cosure

145 Rating(s).


Posted on By Ibrahim Abdelmunim In Composite Resin

Direct approach has proven its supremacy in esthetic dentistry with great longevity , low cost relatively , less visits and only clinician dependent .
Our dilemma here is to close this large diastema without over widening of centrals, as a compromise , we can solve this by space distribution + increase height ,

before and after
Ibrahim Abdel-monem May 17 · Edited · PSD

Patient presented to clinic, complaining of bad, anachronistic Anterior filling that debonds at intervals and he glues it back himself !!, he finally sought a professional replacement. On examination , we found that ,nonintegrated ,color changed composite
RD placement .


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11 Comments

In an age of Invisalign, clear aligners and rapid orthodontic movement PAOO etc. it seems a shame to distort tooth proportions to "close spaces" IMHO.


Reply

i think ortho will distort teeth more and more .other than invisalin ,ortho will cause post ortho enamel demineralization , one year time , lower ortho with extraction , high relapse , permanent palatal fixation for life !!!! and high cost relatively.
Morever , patient already came with bad restoration


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Simple orthodontic case. This is not the solution in my view for an anterior diastema. If the patient does not want tooth movement. Let them live with the diastema


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so compare life long large diastema which consider an aesthetic problem with my management ?


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You did well considering the spacing limitations. Just a different perspective. Remember as well that a composite resin solution does not last a lifetime? It is prone to leakage, staining, chipping and wear and will require multiple times in their lifetime to redo the composite at additional cost. thanks for sharing Dr. Salama


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I think we are not fair enough regarding composite , composite resin is a supreme material just if we do it with the right way ,
If we do a highly polished ,monolithic , voidlessly composite ,it will last for years flawless.
Best regards


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Cuspids are in Class 1 and there is minimal overjet. How would you close the diastema orthodontically while keeping the Class 1 cuspid?
I think ortho can help achieving better space distribution before bonding but is not the way to close this diastema by itself.


Reply

Hi Ibrahim;
The correct solution is the one that results in all of the rules of esthetic dentistry being followed. Your case does not follow the rules of size of the centrals and the rules of proportionality

In this case, the centrals look to be 10x10 or a height to width ratio of 1:1 instead of 75-80%.
Therefore restorative dentistry alone is not the solution to the problem.

Of course you CAN do direct bonding and you have performed it well. The case just does not conform to the rules that we have to live by to have a successful esthetic outcome.
Regards,
gerald


Reply

U r right ,but u will always meet limitations in your work
Patient limitation
Cost limitation
Time limitation
As u said ,interdisplinary work combining minor Ortho correction plus composite . Is the optimum one .
But think again :
Braces on for months in upper and lower teeth + cost + patient desire
All these justify my management
I love simplicity and rules are not a religion , we put rules and we can modify them depending on benefits.
Thank u


Reply

Hi Ibrahim;
Dental XP is about the unrelenting pursuit of excellence. It is also about the contrarian approach to moving the guidelines so that new standards of excellence are constantly evolving.

Rules are standards so that we can measure our progress. The best of the best tell the rest of us what qualifies as excellence. Each of us then decides whether it is in our best interest or our patient's best interest to pursue excellence.
Regards,
gerald


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Ibrahim, I first lectured about the technique of closing diastemata via the technique you illustrated in 1960 and later included it in my first and second editions of Esthetics in Dentistry. However, the I introduced the concept of restorative treatment of diastema by saying that for most cases of diastema, the best treatment is by orthodontics despite the fact that many patients want an instant solution. You are correct when you list the patient concerns such as a financial limitation but I do think it is essential to give the patient the choice of treatments and especially letting them know the esthetic life of orthodontics versus restorative solutions which will most likely need to be repeated.


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