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Diastema closure using direct bonding restorations combined with orthodontic treatment: a case report.

Hwang SK, Ha JH, Jin MU, Kim SK, Kim YK - Restor Dent Endod (2012)

Bottom Line: However, a comprehensive approach combining two or more treatment modalities may be needed to improve esthetics.This case report describes the management of a patient with multiple diastemas, a peg-shaped lateral incisor and midline deviation in the maxillary anterior area.Direct resin bonding along with orthodontic movement of teeth allows space closure and midline correction, consequently, creating a better esthetic result.

View Article: PubMed Central - PubMed

Affiliation: Department of Conservative Dentistry, Kyungpook National University School of Dentistry, Daegu, Korea.

ABSTRACT
Closure of interdental spaces using proximal build-ups with resin composite is considered to be practical and conservative. However, a comprehensive approach combining two or more treatment modalities may be needed to improve esthetics. This case report describes the management of a patient with multiple diastemas, a peg-shaped lateral incisor and midline deviation in the maxillary anterior area. Direct resin bonding along with orthodontic movement of teeth allows space closure and midline correction, consequently, creating a better esthetic result.

No MeSH data available.


Related in: MedlinePlus

Midline correction and re-distribution of interdental spaces after minor tooth movement. Through the movement of both central incisors to the left, midline was corrected and interdental spaces were re-distributed.
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Related In: Results  -  Collection

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Figure 5: Midline correction and re-distribution of interdental spaces after minor tooth movement. Through the movement of both central incisors to the left, midline was corrected and interdental spaces were re-distributed.

Mentions: After six weeks of orthodontic treatment, the teeth were in proper positions. All brackets and wires were removed (Figure 5). An irreversible hydrocolloid impression of maxillary arch was taken and wax-up was performed again. A silicone index (Exafine Putty Type, GC Corp.) was obtained from the cast to guide the application of the first lingual composite layer. For direct resin bonding procedure of the left central incisor, tooth surfaces were cleaned with a slurry of fine pumice. Although the space of 1.5 mm or less can be successfully restored using a relatively translucent enamel shade, a mock-up with different shades/opacities of resin composites was done to accurately match not just single shade, but also the adjacent tooth structure.9 A superfine diamond bur was used to roughen the proximal enamel surfaces for optimal adhesion, extending from the facial line angle to the lingual line angle.10 With cotton rolls in place to isolate the operating field, a gingival retraction cord of size 00 was tucked in the gingival crevice to displace the tissue of interproximal gingival papilla. The adjacent tooth was separated by Teflon tape (P.T.F.E. thread seal tape, Chungku Industrial Co., Seoul, Korea). The enamel was etched with 32% phosphoric acid (Uni-Etch, BISCO Inc., Schaumburg, IL, USA) for 30 seconds. After rinsing and drying, bonding agent (One-Step, BISCO Inc.) was applied according to manufacturer's instructions and cured for 10 seconds using a LED curing unit (Sholuz, IV Tech., Seoul, Korea). A microhybrid resin composite, GRADIA DIRECT (GC Corp.) was used for the composite build-ups due to its good handling property and shade matching. The composite was placed and polymerized using a layering technique to simulate natural tooth color and translucency. Each layer was light-cured for 40 seconds each from facial and lingual directions. Once the putty index was placed, the first lingual composite layer of shade NT was applied. In order to avoid translucent 'shine through' effect, a small amount of an opaque dentin shade of resin (shade AO2) was added. The facial and incisal contours were then established by using A2, A1 and NT shade of resin composites in turn. Care was taken to achieve the desired proximal contour, especially in the gingival embrasure area. After closing the space between the left central incisor and the left lateral incisor, finishing and polishing of the restoration took place with Super Snap Discs (SHOFU Inc., Kyoto, Japan) in the sequence recommended by manufacturer (Figure 6). The other spaces were closed with the same technique as described previously and the incisal edge of the right lateral incisor was modified according to the shape of the left lateral incisor. After the restorative procedures, the final irreversible hydrocolloid impression of maxillary arch was taken to make a clear aligner which was used for retention of the both incisors from rotational or labial movement.11 The following check-ups of the patient were done for 3 months. As shown in Figure 6, it was possible to obtain an optimal esthetic result with a combination of restoration and minor tooth movement. Although the patient was satisfied with the appearance, a better result would be obtained if the gingival level of the central incisors had been corrected through a periodontal approach.


Diastema closure using direct bonding restorations combined with orthodontic treatment: a case report.

Hwang SK, Ha JH, Jin MU, Kim SK, Kim YK - Restor Dent Endod (2012)

Midline correction and re-distribution of interdental spaces after minor tooth movement. Through the movement of both central incisors to the left, midline was corrected and interdental spaces were re-distributed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3569402&req=5

Figure 5: Midline correction and re-distribution of interdental spaces after minor tooth movement. Through the movement of both central incisors to the left, midline was corrected and interdental spaces were re-distributed.
Mentions: After six weeks of orthodontic treatment, the teeth were in proper positions. All brackets and wires were removed (Figure 5). An irreversible hydrocolloid impression of maxillary arch was taken and wax-up was performed again. A silicone index (Exafine Putty Type, GC Corp.) was obtained from the cast to guide the application of the first lingual composite layer. For direct resin bonding procedure of the left central incisor, tooth surfaces were cleaned with a slurry of fine pumice. Although the space of 1.5 mm or less can be successfully restored using a relatively translucent enamel shade, a mock-up with different shades/opacities of resin composites was done to accurately match not just single shade, but also the adjacent tooth structure.9 A superfine diamond bur was used to roughen the proximal enamel surfaces for optimal adhesion, extending from the facial line angle to the lingual line angle.10 With cotton rolls in place to isolate the operating field, a gingival retraction cord of size 00 was tucked in the gingival crevice to displace the tissue of interproximal gingival papilla. The adjacent tooth was separated by Teflon tape (P.T.F.E. thread seal tape, Chungku Industrial Co., Seoul, Korea). The enamel was etched with 32% phosphoric acid (Uni-Etch, BISCO Inc., Schaumburg, IL, USA) for 30 seconds. After rinsing and drying, bonding agent (One-Step, BISCO Inc.) was applied according to manufacturer's instructions and cured for 10 seconds using a LED curing unit (Sholuz, IV Tech., Seoul, Korea). A microhybrid resin composite, GRADIA DIRECT (GC Corp.) was used for the composite build-ups due to its good handling property and shade matching. The composite was placed and polymerized using a layering technique to simulate natural tooth color and translucency. Each layer was light-cured for 40 seconds each from facial and lingual directions. Once the putty index was placed, the first lingual composite layer of shade NT was applied. In order to avoid translucent 'shine through' effect, a small amount of an opaque dentin shade of resin (shade AO2) was added. The facial and incisal contours were then established by using A2, A1 and NT shade of resin composites in turn. Care was taken to achieve the desired proximal contour, especially in the gingival embrasure area. After closing the space between the left central incisor and the left lateral incisor, finishing and polishing of the restoration took place with Super Snap Discs (SHOFU Inc., Kyoto, Japan) in the sequence recommended by manufacturer (Figure 6). The other spaces were closed with the same technique as described previously and the incisal edge of the right lateral incisor was modified according to the shape of the left lateral incisor. After the restorative procedures, the final irreversible hydrocolloid impression of maxillary arch was taken to make a clear aligner which was used for retention of the both incisors from rotational or labial movement.11 The following check-ups of the patient were done for 3 months. As shown in Figure 6, it was possible to obtain an optimal esthetic result with a combination of restoration and minor tooth movement. Although the patient was satisfied with the appearance, a better result would be obtained if the gingival level of the central incisors had been corrected through a periodontal approach.

Bottom Line: However, a comprehensive approach combining two or more treatment modalities may be needed to improve esthetics.This case report describes the management of a patient with multiple diastemas, a peg-shaped lateral incisor and midline deviation in the maxillary anterior area.Direct resin bonding along with orthodontic movement of teeth allows space closure and midline correction, consequently, creating a better esthetic result.

View Article: PubMed Central - PubMed

Affiliation: Department of Conservative Dentistry, Kyungpook National University School of Dentistry, Daegu, Korea.

ABSTRACT
Closure of interdental spaces using proximal build-ups with resin composite is considered to be practical and conservative. However, a comprehensive approach combining two or more treatment modalities may be needed to improve esthetics. This case report describes the management of a patient with multiple diastemas, a peg-shaped lateral incisor and midline deviation in the maxillary anterior area. Direct resin bonding along with orthodontic movement of teeth allows space closure and midline correction, consequently, creating a better esthetic result.

No MeSH data available.


Related in: MedlinePlus