Abordagem estética e conservadora para fechamento de múltiplos diastemas: relato de caso / Aesthetic and conservative approach to multiple diastema closure: case report / Enfoque estético y conservador para el cierre de múltiples diastemas: relato de caso

Introdução:Na odontologia moderna, a estética vem ocupando um espaço cada vez mais expressivo, e o desejo por dentes mais brancos, a insatisfação com o alinhamento dos dentes e com a anatomia dentária, têm sido os motivos mais relevantes de procura dos pacientes nos consultórios odontológicos.Objetivo:O presente artigo tem como objetivo descrever, através de relato de caso clínico, uma abordagem terapêutica estética e conservadora para fechamento de múltiplos diastemas anterossuperiores com a utilização de facetas de resina composta.Relato de caso:Paciente do sexo masculino, 21 anos de idade, procurou atendimento queixando-se de insatisfação estética pelos diastemas apresentados. Por meio de um planejamento digital das facetas em resina, com mockup e modelo impresso em 3D, as restaurações foram feitas respeitando anatomia, forma, opacidade e cores dos dentes naturais do paciente. O resultado dos procedimentos adotados foi satisfatório, demonstrando que a técnica empregada foi eficaz, sendo capaz de devolver um sorriso estético e biológico ao paciente. A odontologia contemporânea tem ofertado cada vez mais materiais com capacidade de devolver estética e função em dentes de forma minimamente invasivas, além de passar total confiabilidade em tratamentos a longo prazo, agradando o paciente desde a apresentação digital do planejamento traçado pelo cirurgião dentista com previsibilidade dos resultados, até o momento final do tratamento.Conclusões:O recontorno estético com resina composta representa uma opção funcional e de baixo custo para o tratamento de pacientes que apresentam diastemas múltiplos, principalmente em pacientes jovens pela preservação daestrutura dentária e possibilidade de reparo, sendo considerado um procedimento reversível, rápido e de baixo custo (AU).

Introduction:Aesthetics have been occupying an increasingly significant role in modern dentistry, and the desire for whiter teeth, dissatisfaction with tooth alignment, and dental anatomy concerns have been the most relevant reasons for patients seeking dental care. Objective:This article aims to describe an aesthetic and conservative therapeutic approach for closing multiple anterior upper diastemas using composite resin veneers in a clinical case report. Case report:A 21-year-old male patient sought treatment, expressing dissatisfaction with the diastemas he had. The restorations were performed using digital planning of the resin veneers with a mockup and a 3D-printed model, while respecting the patient's natural tooth anatomy, shape, opacity, and colors. The results of the adopted procedures were satisfactory, demonstrating effectiveness of the employed technique in restoring an aesthetic and biologically harmonious smile to the patient. Contemporary dentistry has been offering increasingly more materials capable of providing aesthetics and function to teeth through minimally invasive approaches. This not only ensures long-term treatment reliability, but also pleases the patient with a digital presentation of the treatment plan outlined by the dentist, predicting the results up to the final stages of the treatment. Conclusions:Aesthetic contouring using composite resin presents a functional and cost-effective option for treating patients with multiple diastemas, especially among young patients due to its preservation of dental structure, repair potential, and being considered a reversible, fast, and low-cost procedure (AU).

Introducción: En la odontología moderna, la estética viene ocupando un espacio cada vez más destacado, y las ganas de tener dientes más blancos, la insatisfacción con el alineamiento de los dientes, y la anatomía dental son las razonesmás relevantes por las cuales los pacientes acuden a las consultas odontológicas. Objetivo:El presente artículo tiene como objetivo describir, a través de un relato de caso clínico, un abordaje terapéutico estético y conservador para el cierre de múltiples diastemas anterosuperiores mediante el uso de carillas de resina compuesta. Informe de caso:Paciente del sexo masculino, 21 años de edad, buscó atendimiento quejándose de insatisfacción estética debido a los diastemas presentados. A través de una planificación digital de las carillas en resina, con un mockup y un modelo impreso en 3D, las restauraciones fueron ejecutadas, respetándose la anatomía, forma, opacidad y colores de los dientes naturales del paciente. El resultado de los procedimientos adoptados fue satisfactorio y demostró que la técnica utilizada fue eficaz, siendo capaz de restituir una sonrisa estética y funcional al paciente. La odontología contemporánea viene ofreciendo cada vez más materiales con la capacidad de devolver estética y función a los dientes de maneras mínimamente invasivas, además de brindar total confiabilidad en tratamientos a largo plazo, satisfaciendo al paciente desde la presentación digital del plan trazado por el cirujano dentista con la previsibilidad de los resultados, hasta el momento final del tratamiento. Conclusiones:El recontorneado estético con resina compuesta representa una opción funcional y de bajo costo para el tratamiento de pacientes con múltiples diastemas, especialmente en pacientes jóvenes, debido a la preservación de la estructura dental y la posibilidad de reparación. Se considera, de este modo, que se trata de un procedimiento reversible, rápido y económico (AU).

Transitioning from injectable resin composite restorations to resin composite CAD/CAM veneers: A clinical report.

OBJECTIVE: To describe a shift from injectable resin composite technique to composite resin computer-aided design and computer-aided manufacturing (CAD/CAM) veneers in addressing esthetic concerns associated with diastemas between anterior lower teeth in a clinical case. CLINICAL CONSIDERATIONS: Among several techniques proposed for direct resin composite restoration, the "Injectable resin composite technique" has gained popularity for its time-efficiency, reduced technique sensitivity, and diminished reliance on clinician skills. However, challenges such as staining and the need for frequent polishing follow-ups may prompt the consideration of more stable alternatives such as indirect veneer restorations. While ceramic veneers offer superior mechanical and optical properties, resin ceramic veneers, especially those milled from CAD/CAM resin ceramic blocks, offer advantages such as rapid, cost-effective production, simplified intra-oral repairs, less susceptibility to fracture, superior stress absorption, and requires minimal tooth preparation, making them an appealing option for many patients. Moreover, a fully-digital approach not only streamlines the process but also saves time and labor while ensuring the delivery of high-quality restorations to patients. CONCLUSION: In addressing a patient's dissatisfaction with constant polishing of direct resin composite restorations, a shift to resin composite CAD/CAM veneers was implemented. Utilizing a fully-digital approach with CAD/CAM resin ceramic restorations successfully restored both esthetics and function. CLINICAL SIGNIFICANCE: While the injectable resin composite technique achieves immediate esthetic results, its low color stability necessitates frequent polishing sessions. The replacement of direct resin composite restorations with CAD/CAM resin composite veneers becomes a viable option for patients seeking more stable restorations that require fewer follow-ups. This transition addresses both esthetic concerns and the need for enduring solutions in restorative dentistry.

Facetas em resina composta com fechamento de diastemas para harmonização do sorriso: relato de caso / Composite resin veneers with diastema closure for smile harmonization: A case report / Facetas de resina compuesta con cierre de diastemas para harmonización de la sonrisa: Informe de caso

Introdução:A estética do sorriso é um aspecto valorizado pela sociedade atual, o que demanda que os profissionais de odontologia estejam atualizados sobre materiais dentários e novas técnicas para alcançar resultados estéticos restauradores de alta qualidade. A resina composta é frequentemente utilizada para simplificar a reabilitação oral, pois oferece facetas dentárias que combinam excelente estética e durabilidade. Objetivo:Este artigo tem como objetivo relatar um caso clínico de reabilitação estética utilizando facetas em resina composta com fechamento de diastemas.Relato de caso:Uma paciente do sexo feminino, com 24 anos de idade, procurou a clínica escola de odontologia com insatisfação em relação à estética do seu sorriso. A pacienteapresentava diastemas, restauração defeituosa e desproporção no tamanho dos dentes anteriores. O tratamento consistiu em um clareamento caseiro prévio, seguido pela confecção de facetas diretas em resina composta para fechamento dos diastemas e correção da desproporção dentária. Foram utilizados um Jig Estético e o software Digital Smile Design (DSD)para o planejamento, além de um mock-up em resina bisacrílica. Após a confecção das facetas, foi obtido um resultado estético final satisfatório. O caso incluiu um total de oito facetas,dos dentes 14 ao 24. Conclusão:O tratamento utilizando restaurações em resina composta proporcionou à paciente uma reabilitação estética, funcional e biológica (AU).

Introduction:Smile aesthetics is an aspect valued by today's society, which demands that dental professionals are up to date on dental materials and new techniques to achieve high-quality restorative aesthetic results. Composite resin is often used to simplify oral rehabilitation, as it offers dental veneers which combine excellent aesthetics and durability. Objective:This article aims to report a clinical case of aesthetic rehabilitation using composite resin veneers with diastema closure. Case report:A24-year-old female patient came to the dental school clinic with dissatisfaction regarding the aesthetics of her smile. The patient had diastemas, defective restoration and disproportionate anterior teeth size. The treatment consisted of prior at-home tooth bleaching, followed by creating direct composite resin veneers to close the diastemas and correct tooth disproportion. An Aesthetic Jig and the Digital Smile Design (DSD) software program were used for planning, in addition to a mock-up in bisacrylic resin. After treatment, a satisfactory final aesthetic result was obtained. The case included a total of eight veneers, from teeth 14 to 24. Conclusion:Treatment using composite resin restorations provided the patient with aesthetic, functional and biological rehabilitation (AU).

Introducción: La estética de la sonrisa es un aspecto valorado por la sociedad actual, hecho que demanda de los profesionales de odontología actualización constante sobre los materiales dentarios y nuevas técnicas para alcanzar resultados estéticos restauradores de altacualidad. La resina compuesta es frecuentemente utilizada para simplificar la rehabilitación oral, pues ofrece facetas dentarias que combinan excelente estética y durabilidad.Objetivo: Este artículo tiene como objetivo relatar un caso clínico de rehabilitación estética a partir de la utilización de facetas en resina compuesta con cierre de diastemas. Informe de caso: Una paciente, del sexo femenino, con 24 años de edad, buscó la clínica-escuela de odontología insatisfecha con la estética de su sonrisa. La paciente presentaba diastemas, restauración dentaria defectuosa y desproporción en el tamaño de los dientes anteriores. El tratamiento consistió en un blanqueamiento casero previo, seguido por la confección de facetas directas de resina compuesta para cierre de los diastemas y corrección de la desproporción dentaria. Fueron utilizados un Jig Estético y el software Digital Smile Design(DSD) para el planeamiento, además de un mock-upen resina bisacrílica. Tras la confección de las facetas, fue obtenido un resultado estético final satisfactorio. El caso incluyó un total de ocho facetas, de los dientes 14 al 24.Conclusión: El tratamiento a partir de restauraciones en resina compuesta proporcionó a la paciente una rehabilitación estética, funcional y biológica (AU).

'M' mechanics for midline diastema correction in mixed dentition.

Maxillary midline diastema is a self-correcting anomaly which in few conditions may get retained in adolescence stage due to various aetiological factors and correction of which is usually done at permanent dentition stage. The persistence of midline diastema can be predicted in mixed dentition period and necessary management could be provided at the mixed dentition period. This case report is on a novel technique using 'M' spring to correct the midline diastema in mixed dentition period.

Direct vs indirect restorations for diastema closure: determining the suitable approach.

Determining the appropriate technique for diastema closure is challenging, and the decision must be evidence based. The objective of these case reports is to describe different approaches to diastema closure using direct and indirect techniques, focusing on the characteristics of the patient and clinical requirements to guide treatment. In the first case, a 16-year-old patient had multiple diastemas in the maxillary anterior dentition. The clinical evaluation revealed microdontia of the lateral incisors and malpositioned teeth. The treatment included tooth whitening and placement of composite resin veneers using a direct technique. In the second case, a 54-year-old patient displayed a disharmonious and esthetically compromised smile due to small teeth, color changes, multiple diastemas, incisal wear, and severe dentogingival disproportion. Based on the patient's expectations, the patient's age, and the presence of a "black triangle" interdental space, a multidisciplinary restorative treatment was proposed, including gingivoplasty, tooth whitening, and placement of ceramic laminate veneers using an indirect technique. Both approaches achieved successful esthetic rehabilitation and diastema closure with minimal intervention. The choice of procedure and restorative material, as well as the need for tooth preparation, varied based on the clinical requirements, patient expectations, and financial constraints. Careful treatment planning avoided lengthy and inefficient procedures.

Sleep-Disordered Breathing and Its Potential Impact on Restorative Dentistry: A 14-Year Case Study.

Understanding the effects sleep-disordered breathing can have on dentitions may be critical to the long-term success of restorative treatment. In the current case, a patient presented with a large diastema that was successfully closed using porcelain veneers only to have an unexpected unesthetic consequence occur years later. The case demonstrates that if the clinical focus is solely on reparatory modalities or clinical management, without recognition of possible airway issues, unintended restorative consequences may surface in the future. Studying and understanding the origin of the signs and symptoms of sleep-disordered breathing can be crucial for the prevention of future problems and optimization of a patient's overall health.

Gingival Conditioning with Provisional Composite Veneer Prior to Final Dental Restoration: Three-year Follow-up.

This manuscript reports a three-year follow-up of a case of gingival conditioning with a provisional composite veneer prior to diastema closure and tooth recontouring with direct composites. This conservative treatment resulted in a natural and harmonious smile.

Maxillary midline diastema closure with sectional feldspathic porcelain veneers: A case series followed 1 to 4 years.

OBJECTIVE: To evaluate clinical outcome of maxillary midline diastema closure using sectional feldspathic porcelain veneers up to 4 years. MATERIALS AND METHODS: Five female patients with stable maxillary midline diastema were included in the current study and restored with minimal invasive sectional feldspathic porcelain veneers under dental microscope. Esthetic, functional, as well as biologic properties of sectional veneers were evaluated according to the World Dental Federation (FDI) criteria after 1 to 4 years' follow-up. RESULTS: Based on FDI criteria, all five cases were evaluated as clinically excellent to satisfactory during a mean observation period of 26.4 months. Slight to moderate cervical marginal staining was observed in two cases after 3 to 4 years' follow-up. Slight white line or ditching of labial surface margin was found in most cases, but it is not easy to be noticed with saliva covering the margins. CONCLUSIONS: Sectional feldspathic porcelain veneers presented satisfying clinical outcome with potential long-term esthetic risk for maxillary midline diastema closure. CLINICAL SIGNIFICANCE: 1. Sectional feldspathic porcelain veneers presented satisfying short to medium term clinical performance when applied to close maxillary midline diastema. 2. The exposure of labial surface margin may increase a long-term potential esthetic risk.

Should midline diastema in mixed dentition be an aesthetic concern?

BACKGROUND: Mixed dentition determines an important period of occlusion development in childhood. OBJECTIVE: This study aimed to evaluate the aesthetic impact of the midline diastema cut-off point in mixed dentition. DESIGN: A cross-sectional study was performed with 257 children aged 8-10 years in late mixed dentition, with midline diastema of 1-5 mm and normal maxillary overjet. Orthodontic Aesthetic Subjective Impact Score determined the aesthetic impact of the midline diastema. Four quartiles of diastema measurements and impact scores were considered as cut-off points. Receiver Operating Characteristic curves were constructed, and the distances representing the distances to the ideal point were calculated. The Yuden index determined the efficiency of measuring the diastema to assess the aesthetic impact. The Kruskal-Wallis test compared the groups of participants classified according to the diastema cut-off by the sample quartile regarding the impact score. The analyses were performed with a significance level of 5%. RESULTS: There was no significant difference between the four groups of measurement quartiles of the diastema regarding the aesthetic impact (P > .05). CONCLUSIONS: The perception of dental aesthetics in mixed dentition children was not affected by the midline diastema, regardless of the cut-off point.

Two-year retrospective evaluation of monoshade universal composites in direct veneer and diastema closure restorations.

OBJECTIVES: The aim of this retrospective evaluation was to assess the short-term outcome of two monoshade universal resin composites with high chameleon effect in anterior direct veneer and diastema closure restorations, and to investigate the possible reasons for failure. MATERIAL AND METHODS: Patients subjected to veneer and diastema closure restorations with two monoshade universal resin composites (Essentia Universal Shade; EU, GC Corp., and Omnichroma; OC, Tokuyama) operated between January 2018 and March 2019 were selected for the present retrospective evaluation. A total of 159 composite restorations (78 veneers and 81 diastema closure restorations) performed by a single operator in 44 patients (mean age: 33.6) were included in the study. Two blinded and calibrated examiners performed 1- and 2-year assessments of the restorations with respect to FDI criteria, using medical/clinical history and dental photography records. Data were analyzed using Pearson Chi-square with Continuity Correction, Fisher's Exact tests, and Cox regression (a < 0.05). RESULTS: The cumulative overall survival rates of EU and OC restorations were 94.6% (97.3% for the first year) and 88.6% (95.3% for the first year), respectively, with no significant difference from each other (p = 0.316). The cumulative overall survival rates of direct veneer and diastema closure restoration types were 90.2% (95.1% for the first year) and 92.4% (97.4% for the first year), respectively, with no significant difference (p = 0.559). The reasons for failure were evaluated as fracture of the restoration, failure in esthetic anatomical form, and color mismatch. All the failed direct veneer restorations were due to fractures (FDI score of 5.4), whereas 5 of 6 failed diastema closure restorations were due to color mismatch (FDI score of 3.4). Regarding the composite materials, there were no significant differences between the success rates of the restoration types (p = 0.442 for EU, p = 1.000 for OC). With respect to the restoration types, there were also no significant differences between the success rates of the resin-based composites (p = 1.000 for direct veneer restorations and p = 0.228 for the diastema closure restorations). In addition, no significant difference was observed between male and female patients regarding the acceptable and unacceptable scores (p = 1.000). CONCLUSIONS: The 2-year clinical performance of the two monoshade universal composites in anterior veneer and diastema closure restorations were both considered successful and similar. Despite the lack of shade selection, both monoshade universal composites presented a successful color match. However, the diastema closure restorations might be more prone to color mismatch compared to the veneers over time, while veneer restorations presented more fractures than the diastema closure restorations. CLINICAL SIGNIFICANCE: Monoshade universal composites presented successful short-term clinical outcomes regarding both function and esthetics in anterior direct veneer and diastema closure restorations.

Maxillary Midline Diastemas in West African Smiles.

The maxillary midline diastema (MMD) has experienced a renaissance in popular culture over the last 10 years. Current literature states that MMDs should be eliminated where possible or be reduced to 1 mm or less in width. This literature review explores the evidence for this in a West African population. A systematic search of the literature (Medline and Google Scholar) followed by a hand search was carried out to identify all papers evaluating perceptions of MMDs. In all, 209 papers were identified in the literature search, 8 of which met the inclusion criteria. The review revealed that midline diastemas are desirable in this specific population with a width of 2 to 4 mm deemed as attractive. As many as 95% of participants found the MMD beautiful, and as many as 95% would consider having one created artificially. The literature does not support the position that MMDs larger than 1 mm should always be treated to be perceived as attractive in this population. MMDs are accepted as attractive and should be considered a key feature in smile design for this population.

Digital technology for fluid resin injection to close anterior diastema after orthodontic treatment.

Anterior diastema and tooth defects are common clinical issues in restorative dentistry and are often restored by veneers or crowns based on the results of digital smile design and wax-up. Traditional direct resin restoration for closing a diastema is relatively minimally invasive but is time consuming and laborious, and shape control depends on experience. Digital technology can be used to design and transfer the shape of aesthetic restoration more accurately and quickly; thus, it could close anterior diastema and restore defects easily. According to the workflow, this technical process integrates virtual design and practical wax-up, transfers the designed restoration shape by templates, and injects through the preset channel after the template is in place. This clinical technique simplifies the clinical operation and saves clinical time, which can effectively improve the predictability and accuracy of the restoration and reduce technical sensitivity. This digital workflow provides a new technology for closing diastema quickly and effectively.

Advances in diastema closure and tooth shape change using direct composite restorations: the Front Wing Technique.

Closing a diastema with a direct composite restoration still represents a real challenge for clinicians, mainly due to the need to create a correct contact point and emergence profile at the cervical level. The present article describes a novel anterior direct composite restoration technique for closing diastemata and changing tooth shape. The proposed technique, called the Front Wing Technique (FWT), does away with the use of the traditional wax-up and silicone index-based procedures. To date, there has been no effective way to transfer the anatomy modeled in the wax to the interproximal cervical area of anterior restorations every time these areas need to be corrected or restored. Therefore, the FWT provides a new approach to freehand model the emergence profile without gap formation. The cases in this article demonstrate the closure of maxillary and mandibular incisal diastemata, with the rationale behind each clinical step of the FWT described. This technique should be considered an alternative approach for the direct composite restoration of anterior teeth, saving chair time and cost.

Multidisciplinary approach for the closure of multiple diastemata with composite resin.

Morphologic anterior tooth alterations and diastemata between the anterior teeth are often considered a major esthetic problem. In most cases, the treatment of these conditions involves a multidisciplinary approach. Orthodontic treatment together with direct composite resin veneers are a viable option to close diastemata and alter tooth shape. The extent and etiology of the diastemata must be considered and properly evaluated for the treatment. The present article is a case report of a patient with multiple diastemata in the maxillary anterior teeth, dental crowding, and peg-shaped lateral incisors corrected with orthodontic treatment and direct composite resin veneers. Digital planning was the tool used to decide the tooth proportions before orthodontic treatment and to guide the diagnostic wax-up. An etch-and-rinse adhesive system was applied after etching. A polychromatic layering technique under rubber dam isolation was used for the composite resin veneer construction. Finishing and polishing procedures were achieved using polishing discs and abrasive materials. Direct composite resin is an alternative that allows predictability, esthetics, and the possibility of adjustments, resulting in patient satisfaction.

Labial frenectomy: current clinical practice of orthodontists in the United Kingdom.

OBJECTIVES: To obtain views of orthodontists in the United Kingdom on frenectomy in terms of its indications and timing and a recommended retention regimen after correction of median diastema. MATERIALS AND METHODS: A 14-item online questionnaire was sent to orthodontic specialists for completion. The questionnaire covered demographics and orthodontists' experience and views on frenectomy. RESULTS: Three hundred and fifty-three orthodontists with various background and experience responded to the survey. Three-quarters of respondents routinely performed a blanche test to aid diagnosis of the abnormal frenum; however, only 15% carried out radiographic investigation. Three-quarters of the orthodontists would consider frenectomy as a part of orthodontic treatment, and variation existed among the clinicians in terms of its timing. Frenectomy without orthodontic treatment was not preferred. There was much variation in the retention regimen after diastema closure regardless of frenectomy. CONCLUSIONS: Complete consensus among the orthodontists was not obtained; however, some agreement was found regarding the development of a logical diagnosis and treatment approach. High-quality studies are required to produce national protocols or UK guidelines.

Pathological tooth migration-spontaneous correction of diastema after surgical periodontal therapy: a case report.

A common consequence of moderate to extreme periodontitis is pathologic migration. This denotes tooth movement when the periodontal disease interjects the equilibrium among the elements that preserve physiological tooth position. The balancing factors can migrate the teeth in any direction. The etiology of pathological migration tends to be multifactorial, thus achieving early diagnosis is imperative, which will ultimately lead to the prompt removal of the etiological factors while avoiding severe bone destruction. In this case maxillary central incisors had diastema due to pathological migration with mobility grade I in maxillary left central incisor. Many cases of moderate to severe pathological migration need a suitable, interdisciplinary approach. Nevertheless, since it is possible to detect mild cases of Pathological tooth migration (PTM) at an early stage, spontaneous correction of migrated teeth can be accomplished by periodontal therapy alone. Regardless of the treatment selected, maintenance of stable results should be considered as an aim of treatment.

Safety and efficacy of maxillary labial frenectomy in children: A retrospective comparative cohort study.

BACKGROUND: Maxillary frenectomy in children is a common procedure, but concerns about scar tissue affecting diastema closure prevent many clinicians from treating prior to orthodontics. OBJECTIVES: To determine if maxillary frenectomy is safe and if diastema size is affected by early treatment. MATERIALS AND METHODS: Paediatric patients with hypertrophic maxillary frena were treated under local anaesthesia with diode laser and CO2 laser. Diastema width was compared by calibrating and digitally measuring initial and postoperative intraoral photographs. RESULTS: In total, 109 patients were included: 95 patients with primary dentition (39% male; mean age 1.9 years±1.5 years) and 14 with mixed dentition (43% male; mean age 8.1±1.3 years) with a mean follow-up of 18.0±13.2 months. No adverse outcomes were noted other than minor pain and swelling. In the primary dentition, a decrease in diastema width was observed in 94.7% with a mean closure of -1.4±1.0mm (range +0.7 to -5.1mm). In the mixed dentition, a decrease in diastema width was observed in 92.9% with a mean closure of -1.8±0.8mm (range 0 to -3.5mm). 74.5% of patients in the primary dentition and 75% of patients in the mixed dentition with preoperative diastema>2mm improved to<2mm width postoperatively. CONCLUSIONS: Frenectomy is associated with cosmetic and oral hygiene benefits and when performed properly, does not impede diastema closure and may aid closure. Technique and case selection are critical to successful outcomes. IRB ethics approval was obtained from Solutions IRB protocol #2018/12/8, and this investigation was self-funded.

Composite resin CAD-CAM restorations for a midline diastema closure: A clinical report.

A diastema between the maxillary central incisors affects an esthetic smile and has been treated in various ways. Precise diagnosis is essential to guide the choice of the most appropriate treatment. This clinical report describes closing a maxillary midline diastema with a computer-aided design and computer-aided manufacturing (CAD-CAM) composite resin.

Esthetic impact of maxillary midline diastema and mandibular crowding in children in the mixed dentition.

INTRODUCTION: This study aimed to investigate the esthetic impact of mandibular crowding and maxillary midline diastema in children in the mixed dentition. METHODS: The sample for this cross-sectional study comprised 785 children, aged 8-10 years, in the late mixed dentition. Mandibular crowding and maxillary midline diastema were evaluated clinically with the Dental Aesthetic Index. Mandibular crowding and maxillary midline diastema were evaluated to determine tooth size-arch length discrepancies. The sample was stratified as group 1, children without maxillary midline diastema or mandibular crowding (n = 177); group 2, children with maxillary midline diastema (n = 256); group 3, children with mandibular crowding (n = 208); and group 4, children with maxillary midline diastema and mandibular crowding (n = 144). The subjective esthetic impact was evaluated using the Orthodontic Aesthetic Subjective Impact Score. Descriptive and exploratory analyses of the data were performed. A generalized linear model was applied, adjusted for the possible confounding variables (age, gender, and race) with a significance level of 5% because the Orthodontic Aesthetic Subjective Impact Score did not meet the assumptions of analysis of variance. RESULTS: Children in groups 2 and 3 showed greater esthetic concern than group 1 (P <0.05). Children in groups 2 and 3 did not show a significant difference with children in group 4 (P >0.05). CONCLUSIONS: Children with mixed dentition with mandibular crowding or maxillary median diastema reported significantly more esthetic concern than children without these conditions.

An interdisciplinary approach to management of diastemas: A novel classification and a case report.

Diastema between the teeth negatively affects the patients' smile, psychology and daily activities by creating a disharmony in the patients' face. The development of diastema has been attributed to several factors such as labial frenulum, microdontia, mesiodens, peg-shaped lateral incisors, agenesis, cysts, habits such as finger sucking, tongue thrusting, or lip sucking, dental malformations, genetics, proclinations, dental-skeletal discrepancies, and imperfect coalescence of interdental septum. Patients often present with complex problems that require a multidisciplinary treatment approach which includes determination of the aetiological factors, soft tissue morphology, occlusion, patient demands and aesthetic consideration to achieve satisfactory outcomes. Lack of current literature on classification of diastemas and multi-disciplinary approach of management led to the proposal of a new classification the ATAC (Anatomic and Therapeutic Classification) for management of the diastema. This case report highlights the use of the proposed classification for management of diastemas, requiring a perio-restorative intervention using a Chu's proportion gauge to achieve ideal aesthetics.