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INTERNATIONAL JOURNAL
OF CURRENT RESEARCH
International Journal of Current Research
Vol. 10, Issue, 06, pp.70190-70193, June, 2018

ISSN: 0975-833X
RESEARCH ARTICLE

SINGLE APPOINTMENT AESTHETIC SPACE CLOSURE OF MAXILLARY ANTERIORS:

ONE YEAR FOLLOW-UP
1,*Dr. Kanodia Aalisha, 2 Dr. Kalita Chandana and 3Dr. Bhuyan A.C.
1Post
Graduate Student, Regional Dental College, Guwahati, Assam, India
2Reader,Department of Conservative Dentistry and Endodontics, Regional Dental College,
Guwahati, Assam, India
3Principal and Head of the Department, Department of Conservative Dentistry & Endodontics,

Regional Dental College, Guwahati, Assam, India

ARTICLE INFO ABSTRACT

Article History: Introduction: Maxillary anterior spacing is a common aesthetic complaint of patients, which has a
th
Received 13 March, 2018 multifactorial aetiology. Many therapies ranging from orthodontic intervention to full coverage
Received in revised form porcelain crowns, laminate veneers, composite build-ups
build ups are available. The use of proximally applied
20h April, 2018 composite resin is a quick, inexpensive and conservative approach to this difficult problem. It allows
Accepted 30th May, 2018 the dentist and patient complete control in formation of a natural smile. Aim: Closure of maxillary
Published online 28th June, 2018 anterior spacing in single appointment. Method: In this case report maxillary anterior spacing was
closed with
wit direct composite resin restoration in one appointment without any laboratory preparation.
Key words: Result: Complete aesthetic closure of the spaces. At six-month
month and one
one-year recalls, restorations had
Aesthetics, Composite Build-Up, no fractures and margins demonstrated no discoloration. Conclusion:
sion: Composite resin augmentation
Midline Diastema, Maxillary Anterior serves as an excellent treatment option for anterior spacing for patients unwilling to undergo
Spacing. orthodontic treatment or in whom previous orthodontic treatment has not produced an acceptable
result.
*Corresponding author

Copyright © 2018, Kanodia Aalisha et al. This is an open access article distributed under the Creative Commons Attribution
ribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is properly cited.

Citation: Dr. Kanodia Aalisha, Dr. Kalita Chandana and Dr. Bhuyan A.C. 2018. “Single
Single appointment aesthetic space closure of maxillary anteriors: one
year follow-up”, International Journal of Current Research,
Research 10, (06), 70190-70193.

However, this approach requires radical reduction of healthy

INTRODUCTION individual teeth. The use of laminate veneers has also been
considered (Banker et al., 1982
1982). Although it is a less invasive
Cosmetics and aesthetics are current trends of our society
societ that procedure than crowning, veneering requires unnecessary
also involve the dental profession, especially the restorative coverage of the entire facial surfaces of the involved teeth,
dentistry (Ardu, 2006). Maxillary anterior spacing is a with the attendant problems of colour, contour
contour, harmony, and
common aesthetic complaint of patients (KooraKoora et al., 2007). soft tissue compatibility at the gingival margin. Although each
Keene described midline diastema as anterior midline spacing of these procedures may have definite indications and
greater than 0.5 mm between the proximal surfaces of adjacent advantages in certain patients, all have significant
teeth (Keene, 1963).. The midline diastema has a multifactorial shortcomings that compromise their effectiveness in treatment
aetiology. In addition to the labial frenulum, microdontia, of anterior
or interdental spacing. The use of proximally applied
mesiodens, peg-shaped
shaped lateral incisors, lateral incisor agenesis, composite resin is often a quick, more practical and
cysts in the midline region, habits such as finger sucking, conservative approach to this difficult problem (Goldstein,
tongue thrusting, and/or lip sucking, dental malformations, 1976; Banker, 1982).
genetics, maxillary incisor proclination,
proclination dental-skeletal
discrepancies, and imperfect coalescence of the interdental Case report 1: A 20-year-old old male patient reported to the
septum should be considered factors that can cause diastema Departmentt of Conservative Dentistry and Endodontics,
(Weber, 1972). Orthodontic space closure is often the Regional Dental College, Guwahati, with the chief complaint
treatment of choice, particularly for young patients. of spacing in the upper front teeth region. Patient’s medical
Prosthodontic treatment with full-coverage coverage porcelain history did not reveal any systemic diseases and intraintra-oral
restorations can also provide an aesthetic and functional result examination revealed presence of multiple spacing between
(Goldstein, 1976). maxillary anterior teeth with anterior proclination and a deep
70191 Kanodia Aalisha et al. Single appointment aesthetic space closure of maxillary anteriors: one year follow-up

bite. No dental caries were observed in both clinical and clinical and radiological examination. Patient preferred a quick
radiological examination. Patient was unwilling for the treatment option due to personal aesthetic concern and hence
orthodontic treatment and hence was referred to the department was referred to the department for conservative management.
for conservative management. As a more conservative, Again in this case as well, direct aesthetic composite resin
economical, aesthetic, and quicker option, direct aesthetic build-up for the closure of anterior spacing in a single
composite build-ups for the anterior teeth in a single appointment was considered. The procedure followed was
appointment were considered. exactly the same as in Case 2.

Patient was made aware of the anticipated changes in tooth DISCUSSION

contour that will occur as a result of composite resin addition,
also the shortcomings of this procedure were explained. Before Direct resin-based composite build-up was used to correct
isolation, shade selection was considered, after which all maxillary anterior spacing in all these above mentioned cases.
maxillary anteriors along with the first premolars were isolated This is a biomimetic, functional, and biologically prudent
with rubber dam. To prevent hindrance to access to treatment option for closing diastemas with clinically
subgingival areas the rubber dam sheet was pulled upwards promising survival rates, especially in cases wherein minimally
and fixed. The proximal surfaces that extend from the facial invasive or non-invasive procedures on healthy teeth are
line angle to the lingual line angle were lightly roughened with indicated (Wolff et al., 2010). It has a survival rate nearly 85%
a coarse straight fissure diamond instrument. 37% phosphoric after 5 years, with the majority of restorations reaching
acid (ETCH, d-tech) was applied on the prepared enamel to be excellent or good quality (Frese et al., 2013) which is similar
restored for 15 seconds, rinsed for 20 seconds, and dried with to the survival rate exhibited by laminate veneers (above 90%
air slightly. Then a single bottle bonding agent (Single Bond in 10 years) (Layton et al., 2007). Most composite materials
Universal Adhesive, 3M ESPE) was applied and light cured for possess less fractural toughness, shear and compressive
20 seconds. Composite resin (Filtek Z250 XT, 3M ESPE) was strength and are not ideally suited for ultra-high stress areas for
then carefully placed in increments and light cured on each eg; presence of unmanaged parafunctional forces such as
proximal surface. The last layer was carefully placed and bruxism, Class III end-to-end occlusal schemes, or noxious
contoured using a matrix strip. oral habits such as nail biting (Hemmings et al., 2000). But
despite these, there are numerous advantages offered by them
Finishing and polishing was achieved with composite finishing which are the following: (1) tooth shape, colour, and position
white stones (Shofu Composite Finishing Kit) and polishing can be corrected in one treatment session (2) non-invasive or
discs (3M ESPE Soflex Contouring Polishing Discs). Finishing minimally invasive technique (3) the technique is reversible (4)
and polishing strips (3M ESPE Soflex Strip) were used for in case of minor failure, the restoration can be repaired (5) in
completing the proximal contours. All teeth were sequentially case of major failure, other treatment options (laminate
treated after one another to the desired contour. Patient was veneers, crowns) can be applied and (6) cost-effective
cautioned not to bite hard food or objects because of the technique, requiring little or no laboratory work (Wolff et al.,
potential for fracture of the composite resin additions. Patient 2010).
was informed that the restoration might need eventual
replacement because of staining, wear, or discoloration. Patient In these case reports, direct composite resin restorations were
was recalled for follow-ups. planned as the treatment method due to aesthetical demands of
the patient having restricted time and money, and non-
Case report 2: A 25-year-old female patient reported to the willingness for an orthodontic treatment. All the three cases
Department of Conservative Dentistry and Endodontics, were done in single appointment each. The direct composite
Regional Dental College, Guwahati, with the chief complaint resin restorations can be placed in a single visit, often do not
of spacing in the upper middle teeth region. Patient’s medical require preliminary models or wax-ups, and do not involve
history did not reveal any systemic diseases and intra-oral laboratory fees that escalate costs (Korkut et al., 2016). As
examination revealed presence of anterior midline diastema rubber dam isolation is a “gold standard” approach for
with anterior maxillary proclination. No dental caries were restorative procedures, some authors recommend it should be
observed in both clinical and radiological examination. Patient used whenever possible (Cajazeira, 2014). Whereas according
was unwilling for the orthodontic treatment and hence was to Heymann et al. a rubber dam is not recommended for this
referred to the department for conservative management. procedure because it obscures the interproximal papilla and
Again in this case as well, direct aesthetic composite resin limits access to subgingival regions. The proximal surfaces
build up for the closure of midine diastema was considered. should be isolated with appropriate-sized retraction cord,
The procedure followed was exactly the same as in Case 1, which holds the gingival tissue away from the tooth and
except that for proper access, isolation was done using cotton prevents seepage and contamination by crevicular fluids
rolls and a size 00 retraction cord (Ultrapak #00, Ultradent (Heymann, 1985). In the first case, teeth were isolated with
Products) on the central incisors was used as teeth involved rubber dam as multiple teeth were involved, whereas in the
were less, and isolation could be achieved successfully with other two cases use of retraction cord and cotton rolls was
this. found to be more appropriate. Proximal surfaces of teeth were
roughened as it creates more surface area for bonding and
Case report 3: A 23-year-old female patient reported to the removes the outer few microns of fluoride-rich enamel, which
Department of Conservative Dentistry and Endodontics, may be resistant to acid etching. This treatment of the enamel
Regional Dental College, Guwahati, with the chief complaint significantly improves the retention of the composite addition
of spacing in the upper front teeth region. Patient’s medical (Aker, 1939). Addition of composite resin to previously
history did not reveal any systemic diseases and intra-oral untreated healthy enamel allows the composite resin to be
examination revealed presence of maxillary anterior spacing bonded only to the enamel surface of the tooth, and due to the
involving the incisors. No dental caries were observed in both low configuration factor of the restorations no relevant stress
70192 International Journal of Current Research, Vol. 10, Issue, 06, pp.70190-70193, June, 2018

Figure 1. A-C – Pre-operative photographs showing maxillary spacing between anterior teeth. D- Isolation of teeth using rubber
dam. E- Proximal surfaces lightly roughened with a coarse straight fissure diamond instrument. F- White frosty appearance of
etched enamel. G-H- Post-operative photographs after bonding and composite resin build up on the proximal surfaces
I- One year follow-up photograph

Figure 2. A- Pre-operative photograph showing midline diastema. B- Isolation with cotton rolls and retraction cord
C- Post-operative photograph after space closure using composite resin

Figure 3. A- Pre-operative photograph with spacing in between central incisors and lateral incisors
B- Closure of spacing in between central incisors. C- Closure of spacing between ipsilateral central and later incisor
D- Photograph on one year follow-up
70193 Kanodia Aalisha et al. Single appointment aesthetic space closure of maxillary anteriors: one year follow-up

will arise during polymerization shrinkage, making the Frese C, Schiller P, Staehle HJ, Wolff D. 2013. Recontouring
microleakage less probable (Lenhard, 2008). At six-month and teeth and closing diastemas with direct composite buildups:
one-year recalls, restorations had no fractures and margins a 5-year follow-up. Journal of Dentistry. Nov
demonstrated no discoloration. Although further long term 1;41(11):979-85.
follow-ups are required, restoration problems such as marginal Goldstein RE. 1976. Esthetics in Dentistry. Philadelphia,.
leakage, discolorations, fractures, and debonding for composite Hemmings KW, Darbar UR, Vaughan S. 2000. Tooth wear
resins generally appear within 6 months after the treatment. treated with direct composite restorations at an increased
vertical dimension: results at 30 months. Journal of
Conclusion Prosthetic Dentistry. Mar 1;83(3):287-93.
Heymann HO, Hershey HG. 1985. Use of composite resin for
Hence, by using an appropriate technique and modern restorative and orthodontic correction of anterior
materials, one can perform highly aesthetic and durable direct interdental spacing. The Journal of Prosthetic Dentistry.
composite resin restorations for anterior space closure in a Jun 1;53(6):766-71.
single appointment without any laboratory procedure that can Keene HJ. 1963. Distribution of diastemas in the dentition of
satisfy patients as under the conditions of the cases presented. man. American Journal of Physical Anthropology. Dec
This method is comparatively inexpensive. Composite resin 1;21(4):437-41.
augmentation provides an excellent treatment alternative for Koora K, Muthu MS, Rathna PV. 2007. Spontaneous closure
patients who are unwilling to undergo orthodontic treatment or of midline diastema following frenectomy. Journal of
in whom previous orthodontic treatment has not produced an Indian Society of Pedodontics and Preventive Dentistry.
acceptable result. Jan 1;25(1):23.
Korkut B, Yanikoglu F, Tagtekin D. 2016. Direct midline
REFERENCES diastema closure with composite layering technique: a one-
year follow-up. Case reports in dentistry. 2016.
Aker DA, Aker JR, Sorensen SE. 1979. Effect of methods of Layton D, Walton T. 2007. An up to 16-year prospective study
tooth enamel preparation on the retentive strength of acid- of 304 porcelain veneers. International Journal of
etch composite resins. Journal of the American Dental Prosthodontics. Jul 1;20(4):389.
Association (1939). Aug;99(2):185-9. Lenhard M. 2008. Closing diastemas with resin composite
Ardu S, Krejci I. 2006. Biomimetic direct composite restorations. European Journal of Esthetic Dentistry. Sep
stratification technique for the restoration of anterior teeth. 1;3(3).
Quintessence international. Mar 1;37(3). Weber, Quoted in: Orthodontic Principles and Practice, edited
Banker CA, Berlocher WC, Mueller BH. 1982. Alternative by: T.M. Graber, W.B. Saunders Company, 3rd edition,
methods for the management of persistent maxillary central 1972.
diastema. General Dentistry.30(2):136-9. Wolff D, Kraus T, Schach C, Pritsch M, Mente J, Staehle HJ,
Cajazeira MR, De TS, Maia LC. 2014. Influence of the Ding P. 2010. Recontouring teeth and closing diastemas
operatory field isolation technique on tooth-colored direct with direct composite buildups: a clinical evaluation of
dental restorations. American journal of dentistry. survival and quality parameters. Journal of Dentistry. Dec
Jun;27(3):155-9. 1;38(12):1001-9.

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