This document discusses the management of midline diastemas through direct composite restoration. It defines a midline diastema as a space greater than 0.5mm between the two central incisors. Common causes include normal development, tooth material deficiency, extracted teeth, habits, and artificial/iatrogenic factors. Diagnosis involves examination, measuring diastema width, and radiographs. Management through direct composite involves selecting shade/opacity, isolation, a mockup impression, optional tooth preparation, material placement in increments with curing, and finishing/polishing. Indications are fractured/malformed teeth and esthetics, while contraindications include poor oral hygiene and habits. Other treatment options depend on the
7. EXTRACTED TEETH
This also result in tooth material arch
discrepancy which causes drifting of the
adjacent tooth leading to the formation
of diastema.
MISSING LATERAL
11. RACIAL
PREDISPOSITION
The presence of midline spacing also has a racial and famililal background.
The negroid race shows the greatest incidence of midline diastema
12. DIAGNOSIS
Ÿ Proper history and clinical examination should be done.
• Measure the MD width which will help in determining the tooth material-arch
length discrepancies.
• Check for any pernicious oral habits.
• Midline radiographs: For the diagnosis of any midline pathology.
14. STEPS FOR CLOSING
MIDLINE DIASTEMA BY
COMPOSITE RESTORATION
2.ISOLATION
4.TOOTH PREPARATION
5.MATERIAL SELECTION
6.MATERIAL PLACEMENT
7.FINISHING AND POLISHING
1.SHADE & OPACITY SELECTION
3. MOCKUP IMPRESSION
15. 1.SHADE & OPACITY
SELECTION
• Tooth shade should be optained by
comparing the center middle-third of the
tooth.
• An enamel like opacity material is usually
selected when closing diastema.
2.ISOLATION
• Rubber dam isolation is recommended.
• The rubber dam keeps the operatory
field dry & free of contamination.
16. 3.MOCKUP
IMPRESSION
In order to close the diastema both central incisors would have been
widened.
For which a diagnostic wax-up can be made then take a putty impression to
record the palatal surfaces & incisal edges of the diagnostic wax up.
Then check the fit of putty stent intraorally. Make cuts through the stent to
allow insertion of the matrices.
Then transfer the putty stent intraorally and carefully tuck the matrices into
the gingival sulcus.
Apply the composite resin for palatal and incisal edge then light cured it.
The shell can be created either one at a time or together.
18. 4.TOOTH
PREPARATION
• Although, tooth preparation is not
required when closing diastema but
there may be situations where the
teeth are slightly misaligned & a
minor recontouring may be
necessary when teeth are positioned
facially.
5.MATERIAL
SELECTION
• Select the proper
shade of composite for
the midline diastema
closure.
19. 6.MATERIAL
PLACEMENT
• Apply the enamel etchent on the prepared tooth
surface
• Leave it for 30 seconds then rinse it.
• After which apply the adhesive bonding agent is
placed and cured.
• Then apply the composite in increments then cured it
with light cure unit.
ENAMEL
ETCHING
BONDING AGENT AND CURING
INCREMENTAL
PLACEMENT OF
COMPOSITE
20. 7.FINISHING AND POLISHING
• Remove any excess material with the help of composite finishing burs/
composite finishing strips or soflex disk
21.
22. INDICATIONS
Fractured tooth
Anatomically malformed tooth
Diastema closure
Tooth discoloration
Esthetics
CONTRA
INDICATIONS
Very dark staining
Mandibular teeth
Multiple large defective restoration
Poor oral hygiene
Parafunctional habits
23. OTHER TREATMENT
OPTIONS
CAUSES MANAGEMENT
TUMB SUCKING TONGUE RAKE (REMOVABLE OR FIXED)
HIGH FRENAL ATTACHMENT FRENECTOMY WITH OR WITHOUT
GINGIVOPLASTY
MISSING LATERAL INCISOR IMPLANTS CROWN/ BRIDGES
SUPERNUMERARY EXTRACTION
TOOTH MATERIAL DEFICIENCY VNEERS (PORCELAIN/COMPOSITE
CROWNS)
PEG SHAPED LATERAL COMPOSITE BUILDUP CROWNS
TONGUE THRUST TONGUE RAKE (REMOVABLE OR FIXED)