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.

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.

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.

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.

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.

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.

Longevity of direct diastema closure and recontouring restorations with resin composites in maxillary anterior teeth: A 4-year clinical evaluation.

OBJECTIVES: To evaluate the clinical performance of resin composite restorations and to investigate causes of failure. MATERIALS AND METHODS: The longevity of 216 restorations in 53 patients (mean age, 33.3 years) was retrospectively evaluated according to Fédération Dentaire Internationale (FDI) criteria. Dental history and photographic data were used to evaluate diastema closure (n = 199) and recontouring (n = 19) restorations comprising microhybrid (Essentia Universal, GC Corp.), nanohybrid (Ceram.x One, Dentsply Sirona), and nanofilled (Estelite Asteria, Tokuyama Dental) composites. Data were analyzed with the Kaplan-Meier log-rank test, Cox regression analysis, Pearson chi-square test. p < 0.05 was considered statistically significant. The overall survival rate was 90.3 % and the mean survival duration was 46.2 months during the for 4 - year study period. The annual failure rate was 0.9 % - 3.4 %. Mean survival durations for diastema closure and recontouring restorations were 46.2 and 45.9 months, respectively (p = 0.328). Mean survival durations for Essentia Universal, Estelite Asteria, and Ceram.x One were 46.1, 46.7, and 45.7 months, respectively (p = 0.677). If we include failed restorations that were repaired and remained functional, the overall survival rate was 100 %. CONCLUSION: Longevity was similar among composites and restoration types. The long-term clinical performance of monochromatic anterior composite restorations was robust. Composite repair may be suitable for diastema closure and recontouring restorations. CLINICAL SIGNIFICANCE: There is a lack of long-term clinical evidence regarding the performance of direct anterior composite restorations. Monochromatic direct composite restorations may meet both the esthetic and functional expectations with even simpler restorative techniques. This 4 - year follow-up study evaluated the clinical performance of monochromatic anterior diastema closure and recontouring restorations with three different composite materials. The longevity of the restorations and the reasons for failure were investigated.

Finite element stress analysis of composite resin veneers for diastema closure.

The fracture of restorations used for diastema closure is a clinical concern. The objective of this study was to perform a finite element-based comparative analysis of functional stress patterns in composite resin veneer restorations used for diastema closure to determine the influence of factors such as the preparation design, proximal extension, loading level, and vector of stress (loading angle). Three-dimensional finite element stress analysis was performed on a maxillary central incisor model to examine the stress distribution resulting from a nanofilled composite veneer restoration with 4 different extensions of unsupported composite (0.5, 1.0, 1.5, or 2.0 mm) and 2 different preparation designs (partial or full) under 3 loads (50, 150, or 250 N) and 3 loading angles (60°, 90°, or 125°). The maximum stress was found to be concentrated on the full-preparation design with a 0.5-mm mesial extension under a 250-N load and 60° loading angle. The minimum stress was found with the partial-preparation design with a 0.5-mm mesial extension under a 50-N load and 90° loading angle. Based on the results of the present study, a partial-preparation design is preferred when nanofilled composite resins are used for diastema closure.

Effect of maxillary median diastema on the esthetics of a smile.

INTRODUCTION: With the increasing demand for facial esthetics, patients' expectations regarding dental treatment have increased. The treatment of maxillary median diastemas (MMDs) stands out as one of the most noticeable esthetic alterations performed on patients. The objectives of the present article were to evaluate the effects of MMD and its restorations on the esthetics of a smile and to determine the differences in esthetic perceptions among 3 different groups of patients: orthodontists, prosthodontists, and laypeople. METHODS: Printed photographic images were randomly arranged in an album that contained the original photograph of the smile, 8 photographs with digitally created diastemas (0.5 mm, 1.0 mm, 1.5 mm, 2.0 mm, 2.5 mm, 3.0 mm, 4.0 mm, and 5.0 mm), and 8 with simulated restorations of these spaces. Each evaluator assigned scores to the images using a 100-mm visual analogue scale. RESULTS: Orthodontists, prosthodontists, and laypeople presented similar perceptions regarding the levels of attractiveness of the original smiles and those of smiles involving restorations of diastemas with widths of 0.5 mm and 1.0 mm. The ratings assigned to the smiles with diastemas differed significantly from those of the corresponding restored smile with the same magnitude of diastema. CONCLUSIONS: The prosthetic space closure of diastemas is better than leaving the space untreated. Restorations of MMD up to 1 mm perform similar to orthodontic closure. Larger MMDs are ideally treated with orthodontics because the restorative treatment is more invasive, leading to incremental damage to the dental tissues.

Multidisciplinary treatment with a customized lingual appliance for an adult patient with severe Class III malocclusion and multiple missing teeth.

A 24-year-old man presented with a severe skeletal class III malocclusion, associated with an anterior and posterior crossbite in the left side, upper and lower lip eversion, skeletal asymmetry, midline discrepancy, diastemas in the maxillary and mandibular dental arches, and agenesis of maxillary lateral incisors and canines with retained deciduous teeth. Treatment was performed with the use of the Win Lingual System. When the 0.016 × 0.022-inch NiTi archiwire was applied, the deciduous teeth were extracted and replaced with temporary crowns connected to the appliance. After the aligning, leveling, and diastema closure phases, a modified Le Fort II osteotomy, a mandibular setback with a bilateral sagittal split osteotomy and a genioplasty were performed. Implants were placed in the canine site through a flapless guided surgery, and cantilevered temporary bridges were delivered. Final prosthetic rehabilitation included veneers for the central incisors and zirconia-ceramic cantilevered bridges for the canine and lateral incisors. After 36 months of active treatment, the patient showed an Angle Class I molar and canine relationship and an ideal overbite and overjet. His profile had improved, lips were competent, and gingival levels were acceptable. The lateral radiograph and cephalometric analysis showed a good balance of the skeletal pattern, a good profile of the soft tissue, and proper inclinations of the maxillary and mandibular incisors in relation to maxilla and mandible. After 2 years of follow-up, the patient had a pleasant smile and no relapse, or joint or muscular pain.

Management of the Maxillary Diastema by Various Dental Specialties.

PURPOSE: There is considerable controversy in the literature concerning the indications for frenectomy for treating a maxillary diastema and for timing of the procedure. The purpose of this study was to survey pediatric dentists, orthodontists, and oral and maxillofacial surgeons on their opinion of this matter to develop a consensus. MATERIALS AND METHODS: An anonymous 7-item electronic questionnaire was sent to members of the American Academy of Pediatric Dentists, the American Association of Orthodontists, and the American Association of Oral and Maxillofacial Surgeons asking about the etiology of the maxillary diastema, its diagnosis, and treatment. RESULTS: Although there was no agreement among the oral and maxillofacial surgeons for the timing of frenectomy and when the diastema should be closed, the pediatric dentists and orthodontists generally agreed that frenectomy should not be performed before the permanent canines are erupted and that the operation should follow orthodontic closure of the space. CONCLUSION: Although there was no complete consensus among the 3 groups, a logical treatment approach for the maxillary diastema is proposed.

A multidisciplinary approach to the management of a maxillary midline diastema: A clinical report.

A maxillary midline diastema (MMD) is a common complaint of dental patients. An MMD can be closed with treatment from different disciplines, including operative dentistry and orthodontics. A comprehensive smile analysis is also a necessity before beginning treatment. This article highlights the closure of a 3-mm MMD by using a combination of orthodontics and direct composite resin restorations.

Torturous path of an elastic gap band: Interdisciplinary approach to orthodontic treatment for a young patient who lost both maxillary central incisors after do-it-yourself treatment.

Spacing between the maxillary anterior teeth is a common concern for young patients and their parents. Patients often consider a diastema to be an annoying but minor problem; they might consult their general dentists for help, or try to address the issue themselves by applying elastic "gap bands." Moreover, parents, without any informed consent, sometimes accept this erroneous method as an easy and inexpensive treatment approach. A 9-year-old boy had severe acute periodontitis involving the maxillary central incisors caused by the placement of an elastic band and its apical migration. Despite periodontal and surgical interventions, the maxillary central incisors were finally extracted, and the patient started orthodontic treatment. The orthodontic treatment plan included maxillary lateral incisor substitution to replace the lost central incisors and mesialization of the maxillary posterior dentition. An interdisciplinary approach with excellent cooperation among the orthodontist, general dentist, and other dental specialists obtained an esthetically pleasing and optimized functional result. Treating the diastema between the anterior teeth with elastic gap bands and without fixed orthodontic appliances should be avoided. Patients should seek proper orthodontic advice for even small-scale orthodontic problems to prevent catastrophic outcomes, as exhibited in this case report.

Interdental papilla formation after diastema closure.

Due to improvements in esthetic dentistry, the number of patients seeking to obtain a more harmonious smile has increased. A 40-year-old woman was referred for treatment because she was dissatisfied with the effect that diastemas and a conoid tooth had on her smile. Her maxillary anterior teeth were relatively short, resulting in a compromised esthetic relationship between height and width. Orthodontic treatment for better distribution of her teeth was recommended to the patient, but she refused, wanting faster and less expensive treatment. After diagnostic and waxed-up study casts were obtained, composite resin esthetic mock-ups were made to confirm that sufficient space was left for formation of the interdental papilla. After the patient approved the mock-ups, her anterior teeth were submitted to bleaching, definitive restoration, and additional occlusal adjustments. At the 1-year follow-up, the patient exhibited a harmonious, esthetic smile without black spaces or periodontal inflammation.

Concept of Minimally Invasive Indirect Veneers.

Minimally invasive indirect veneers (MIIV) are ultrathin porcelain veneers that can be cemented onto labial surfaces after no or minimal tooth preparation. The benefits of no or minimal veneer preparation are conservation of tooth structure, absence of postoperative sensitivity, bonding to enamel, minimal flexural stresses, no need for provisionals and improved patient acceptance. However, no or minimal preparation veneers should be considered only after thorough functional and aesthetic evaluation. The article presented here illustrates a case of diastema closure using MIIV, to highlight the importance of treatment planning for achieving good results.

[A diastema in patients with a disability; what to do?] / Een diasteem bij mensen met een beperking; wat nu?

People with a disability also sometimes lose a (front) tooth. Their closest relatives in particular are concerned that the person they love appears to be 'ordinary, natural and well-cared for' and often consider a diastema to be unacceptable. At the same time, they do not want to expose these patients to a painful, taxing treatment for purely aesthetic reasons. Fibre re-enforced adhesive bridges offer a very good alternative in such cases.

Two-Year Follow-up of Multidisciplinary Treatment Using Digital Smile Design as a Planning Tool for Esthetic Restorations on Maxillary Midline Diastema.

One of the challenges posed by diastema closure treatment in the presence of tooth size discrepancy is to achieve adequate distribution of the spaces between the teeth. The use of the Digital Smile Design can assist the clinician in visualizing and measuring dentogingival discrepancies with maximum predictability. The present clinical case describes an approach to space distribution with assistance of the digital tool, allowing adequate restorative procedures. The protocol used was shown to be efficient, achieving the esthetics desired by the patient both during and after multidisciplinary treatment, as well as having adequate stability.

Interdisciplinary Management of Patient with Advanced Periodontal Disease.

This case report describes the interdisciplinary management of an adult patient with advanced periodontal disease. Treatment involved orthodontic and periodontal management. Good esthetic results and dental relationships were achieved by the treatment.

Dilemmas in Treatment of Recurrent Recalcitrant Dental Anterior Open Bite.

An anterior open bite is one of the most difficult occlusal abnormalities to treat. Quite often this aberration entails dental component and/or skeletal component. The skeletal open bite will require intrusion of the posterior sextants with the assistance of bite blocks, temporary anchorage devices, high pull headgear, and as a last resort - orthognathic surgery. The orthodontic treatment should be augmented with the orofacial myofunctional therapy. In this article, the author describes 3 different variations of treatment of the dental anterior open bite, first on acrylic models, and then on the actual patients. Consideration should be given to patients with a 'short upper lip," and in this case, surgical correction should be entertained.