Cosmetic Treatment for Large or Multiple Diastemas
No-prep, direct composite veneers enable conservative, highly esthetic outcomes
Sandra Hulac, DDS
Diastema closures are commonly performed procedures in cosmetic dentistry. Although small maxillary midline diastemas are seemingly now in fashion, they still bother many of our patients. Orthodontic treatment to close diastemas or to correctly position the teeth prior to any restorative treatment is, of course, often the best solution in these situations, but many patients are reluctant to invest the additional money and time. Treating these cases indirectly with porcelain veneers is another option; however, without pre-restorative orthodontics, the biologic burden placed on the teeth through the invasive preparations needed to achieve correct alignment may be high. For patients with large or multiple diastemas who do not wish to undergo any additional orthodontic treatment at the time, no-preparation direct composite veneers are a very attractive alternative. Being solely additive, they also enable patients to pursue alternative treatment options in the future, including orthodontics.
Although diastemas can be easily remedied with direct composite restorations, difficulties can arise when treating larger and/or multiple diastemas with direct composite. These tend to occur in patients whose teeth are correctly sized but positioned with incorrect or flared axial inclinations. In these cases, if the only focus of restoration is space closure, the esthetic results can be poor with undesirable proportions regarding the width and length of the teeth and an even more flared appearance. One way to properly address these cases is with a full composite veneering approach, which allows the practitioner to adjust the placement of the proximal line angles, the width-to-height ratio, and the placement of the gingival zeniths. However, it should be emphasized that in order to achieve correct esthetic proportions, in most cases, the central and lateral incisors and sometimes even the cuspids have to be treated.
The squarish appearance of restored teeth can be overcome by adding length and by moving the proximal line angles mesially to create smaller zones of light reflection. In addition, highlighting vertical texture in the final shaping and polishing process can also be helpful because this creates small deflective areas that make teeth appear slimmer. Incorrect axial inclinations can be corrected by shifting the gingival zeniths as well as through correct proximal line angle placement. Oftentimes, this requires the placement of more composite in the middle and cervical areas of teeth to create correct heights of contour. Care should be taken to not create too much cervical convexity because this will make the teeth appear shorter. This article presents three diastema closure cases involving no-prep direct composite veneers that highlight these optical principles.
About the Author
Sandra Hulac, DDS
Hong Kong, China