Very often we are asked to solve aesthetic problems related to the presence of diastema, especially in young patients at the end of an orthodontic treatment. In the case of this young girl, the frontal teeth are very small compared to the width of the arches. There is also agenesis of the second molars.
In this case, a wax-up was performed from which it was evident the impossibility of complete closure of the diastema between the central incisors, otherwise an excessive imbalance between height and width would have resulted in an even greater aesthetic problem.
A rigid silicone key (A) is obtained from the wax-up. This helps us to determine the position of the incisal edge and the mesial and distal limits of each tooth (C, D, E, F). To obtain a good result, the proximal walls should emerge from the inside of the gingival sulcus. Personally, I prefer to complete the restoration, connecting the incisal part with the cervical one, with the help of the metal matrix.
To obtain a good result, the proximal walls should emerge from the inside of the gingival sulcus. This result can be achieved by connecting the incisal portion (realized by the template reference) to the cervical one, with the help of the metal matrix.
It can be seen how the composite supports the gingival tissue (blue arrows) and how in this way it is possible to create a papilla (blue arrow) where there wasn’t one before (red arrow).
The composite that supports the gum has been polymerized in contact with the metal matrix, so there is no inhibition by oxygen and the surface is smooth. For this reason, the intrasulcular portion of the restoration does not require finishing and polishing.
The young patient can now smile with ease. I would like to emphasize that this intervention is completely reversible and does not affect any future treatment options.