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.

Management of dental caries guided by the ICDAS-LAA: a 28-month follow-up.

Dental caries is a significant oral health issue and public health concern. Currently conceptualized as a dynamic and multifactorial process, caries is a continuum of disease stages, during which tooth damage may be reversed or controlled, depending on lesion progression. The International Caries Detection and Assessment System, when used in conjunction with the Lesion Activity Assessment (ICDAS-LAA), reflects the dynamic caries process and allows the classification of cavitated lesions according to their severity and progression, which is essential to selecting the appropriate treatment. This case report describes the diagnosis and treatment of a patient who had caries in the past and in whom old lesions remained untreated. The ICDAS-LAA was used to assess caries accurately and guide treatment decisions. The patient maintained a dietary journal for 2 weeks to help establish her risk of developing caries. Treatment involved a minimally invasive dentistry approach, which consisted of remineralization via fluoride applications, placement of a composite resin restoration, microabrasion, and periodic maintenance. During the 28-month follow-up period, rigorous control of caries risk factors was achieved, and the results were satisfactory, demonstrating the effectiveness of the ICDAS-LAA in diagnosing and managing carious lesions.