Esthetic Rehabilitation of Bilateral Diastemas with Direct Resin Composite After Orthodontic Treatment: A Case Report

Year 2025, Volume: 9 Issue: 3, 195 - 199, 31.12.2025

Elif Nur Kaya , Bengü Doğu Kaya , Pınar Yılmaz Atalı , Bilge Tarçın

https://doi.org/10.29228/erd.114

Abstract

Diastema between the maxillary anterior teeth is a frequent esthetic concern for many patients. Orthodontic, prosthetic and restorative treatment options are avaliable for closure of diastemas. In this case report, esthetic rehabilitation of anterior diastemas that could not be closed with orthodontic treatment was aimed with a minimally invasive approach using direct composite resin. A 22-year-old healthy female patient applied to the Restorative Dentistry Clinic with esthetic concerns following orthodontic treatment. Clinical and radiographic examination revealed caries on the mesial surfaces of teeth #12 and #21 and bilateral diastema between the upper central and lateral incisors. The decision was to close the diastemas using direct resin composite restorations. Following shade selection with button technique, initial photographs were taken, and the teeth were isolated with rubber-dam (Nictone, Mexico). Carious lesions on teeth #12 and #21 were removed using a 6-bladed tungsten carbide bur (Frank Dental, Germany). Enamel surfaces were etched with 35% orthophosphoric acid (Ultra Etch, Ultradent, USA) for 30 seconds and universal adhesive (G-Premio Bond, GC, Japan) was used according to manufacturer's instructions. A simply-shade supra-nanohybrid composite (Estelite Asteria A1B, Tokuyama, Japan) in the selected shade was applied to the teeth (#11, #12, #21, #22) using the layering technique. All polimerization steps were performed using the Valo Cordless (Ultradent, USA) light curing device (standart mode /1000 mW/cm2). Finishing and polishing were completed using discs (OptiDisc, Kerr, Switzerland) and two-stage polishing systems (Diacomp Plus Twist, Eve, Germany). The patient was recalled for a 6-mounth follow-up and scored according to FDI criteria.

Keywords

Bilateral diastema , minimally invasive , resin composite restoration , simply-shade

Ortodontik Tedavi Sonrası Bilateral Diastemaların Direkt Rezin Kompozit ile Estetik Rehabilitasyonu: Vaka Sunumu

Abstract

Üst çenede anterior dişler arasındaki diastema, hastalar arasında yaygın bir estetik kaygıdır. Diastemaların kapatılması için ortodontik, protetik ve restoratif tedavi uygulamaları seçenekler arasında yer alır. Bu vaka sunumunda ortodontik tedavi sonrası restoratif tedaviye ihtiyaç duyulan ön bölgedeki diastemaların direkt rezin kompozit kullanılarak minimal-invaziv yaklaşım ile estetik rehabilitasyonu amaçlanmıştır. 22 yaşında sağlıklı kadın hasta ortodontik tedavisi sonrasında estetik kaygılar nedeniyle Restoratif Diş Tedavisi Kliniğine başvurdu. Yapılan klinik ve radyografik muayenede #12 ve #21 numaralı dişlerin mezial yüzeylerinde çürük ve üst santral- lateral dişler arasında bilateral diastema tespit edildi. Diastemaların direkt kompozit rezin restorasyonlar ile kapatılmasına karar veridi. Buton tekniği ile renk seçimi yapıldıktan sonra başlangıç fotoğrafları alınarak dişler rubber-dam (Nictone, Meksika) ile izole edildi ve 6 bıçaklı tungsten karbid frez (Frank Dental, Almanya) kullanılarak çürükler (#12, #21) temizlendi. Mine yüzeyleri %35 ortofosforik asit (Ultra Etch, Ultradent, ABD) ile 30 saniye pürüzlendirildi ve üniversal adeziv ajan (G- Premio Bond, GC, Japonya) üretici talimatlarına göre uygulanarak 20 saniye boyunca polimerize edildi. Seçilen renkteki simply-shade supra nanohibrit kompozit (Estelite Asteria A1B, Tokuyama, Japonya) tabakalama tekniği ile dişlere (#11, #12, #21, #22) uygulandı. Tüm polimerizasyon işlemleri için Valo Cordless (Ultradent, ABD) ışıklı polimerizasyon cihazı standart modda (1000 mW/cm2) kullanıldı. Diskler (OptiDisc, Kerr, İsviçre) ve elmas emdirilmiş çift aşamalı polisaj sistemleri (Diacomp Plus Twist, Eve, Almanya) kullanılarak bitim ve polisaj işlemleri tamamlandı. Hasta 6. ay kontrolüne çağırılarak FDI kriterlerine göre skorlandı.

Keywords

Bilateral diastema , minimal invaziv , rezin kompozit restorasyon , simply-shade

Thanks

Bu vaka Marmara-Trakya Üniversitesi Diş Hekimliği Fakülteleri ve Edirne Diş Hekimleri Odası iş birliği ile 12-13 Ekim 2024 tarihinde düzenlenmiş olan 1. Ulusal Öğrenci Sempozyumunda sunulmuştur.

References

• Azzaldeen A, Muhamad A-H. Diastema closure with direct composite: architectural gingival contouring. Journal of Advanced Medical and Dental Sciences Research. 2015;3(1):134-9.
• Bagıs B, Bagıs H. Porselen laminate veneerlerin klinik Uygulama asamaları: Klinik bir olgu sunumu. Ankara Universitesi Dis Hekimligi Fakültesi Dergisi. 2006;33(1):49-57.
• Chu F, Siu A, Newsome P, Wei S. Management of median diastema. General dentistry. 2001;49(3):282-7; quiz 8.
• Demirci M, Tuncer S, Öztaş E, Tekçe N, Uysal Ö. A 4-year clinical evaluation of direct composite build-ups for space closure after orthodontic treatment. Clinical oral investigations. 2015;19:2187-99.
• Dorland WAN. Dorland's illustrated medical dictionary: Wb Saunders; 1925.
• Frese C, Schiller P, Staehle HJ, Wolff D. Recontouring teeth and closing diastemas with direct composite buildups: a 5-year follow-up. Journal of dentistry. 2013;41(11):979-85.
• Jordan RE. Esthetic composite bonding: techniques and materials. (No Title). 1993.
• Khashayar G, Dozic A, Kleverlaan C, Feilzer A, Roeters J. The influence of varying layer thicknesses on the color predictability of two different composite layering concepts. Dental Materials. 2014;30(5):493-8.
• Kim Y-H, Cho Y-B. Diastema closure with direct composite: architectural gingival contouring. Journal of Korean Academy of Conservative Dentistry. 2011;36(6):515-20.
• Kokich VO, Kokich VG, Kiyak HA. Perceptions of dental professionals and laypersons to altered dental esthetics: asymmetric and symmetric situations. American Journal of Orthodontics and Dentofacial Orthopedics. 2006;130(2):141-51.
• Korkut B, Tarçın B, Atalı PY, Özcan M. Introduction of a New Classification for Resin Composites with Enhanced Color Adjustment Potential. Current Oral Health Reports. 2023;10(4):223-32.
• Lenhard M. Closing diastemas with resin composite restorations. European Journal of Esthetic Dentistry. 2008;3(3).
• Magne P, Belser UC. Porcelain versus composite inlays/onlays: effects of mechanical loads on stress distribution, adhesion, and crown flexure. International Journal of Periodontics & Restorative Dentistry. 2003;23(6).
• Mooney JB, Barrancos PJ. Operatoria Dental: Ed. Médica Panamericana; 2006.
• Nedeljkovic I, De Munck J, Vanloy A, Declerck D, Lambrechts P, Peumans M, et al. Secondary caries: prevalence, characteristics, and approach. Clinical oral investigations. 2020;24:683-91.
• Nuvvula S, Ega S, Mallineni SK, Almulhim B, Alassaf A, Alghamdi SA, et al. Etiological factors of the midline diastema in children: a systematic review. International Journal of General Medicine. 2021:2397-405.
• Oquendo A, Brea L, David S. Diastema: correction of excessive spaces in the esthetic zone. Dental Clinics. 2011;55(2):265-81.
• Prabhu R, Bhaskaran S, Prabhu KG, Eswaran M, Phanikrishna G, Deepthi B. Clinical evaluation of direct composite restoration done for midline diastema closure–long-term study. Journal of Pharmacy and Bioallied Sciences. 2015;7(Suppl 2):S559-S62.
• Rossato DM, Saade EG, Saad JRC, de Toledo Porto-Neto S. Coroas estéticas anteriores em cerâmica metal-free: relato de caso clínico. RSBO Revista Sul-Brasileira de Odontologia. 2010;7(4):494-8.
• Signore A, Kaitsas V, Tonoli A, Angiero F, Silvestrini-Biavati A, Benedicenti S. Sectional porcelain veneers for a maxillary midline diastema closure: a case report. Quintessence International. 2013;44(3).
• Staehle HJ. Minimally invasive restorative treatment. Journal of adhesive dentistry. 1999;1(3).
• Stappert CF, Ozden U, Gerds T, Strub JR. Longevity and failure load of ceramic veneers with different preparation designs after exposure to masticatory simulation. The Journal of prosthetic dentistry. 2005;94(2):132-9.
• Wolff D, Kraus T, Schach C, Pritsch M, Mente J, Staehle HJ, et al. Recontouring teeth and closing diastemas with direct composite buildups: a clinical evaluation of survival and quality parameters. Journal of dentistry. 2010;38(12):1001-9.