A diastema is a gap between teeth that is wider than 0.5 millimeter. Diastemas and generalized spacing between the teeth are the result of mismatch in tooth and jaw size, which can be aesthetically unacceptable to the patients. There are many causes for such aesthetic problem: Missing or undersized teeth, Oversized labial frenum, and others.
Closure of diastemas and spaces can be accomplished by orthodontic movement or by restorations. Orthodontic treatment is indicated for more severe changes to the normal position of teeth. The patient must fully appreciate that orthodontics is the ideal treatment for moving teeth. However, any orthodontic movement is unlikely to be stable over long periods of time and some degree of retention, using either a removable appliance for night-time wear or a fixed wire retainer, is inevitable.
Other treatment options for diastema closure are by restorative approaches (i.e., Direct composite veneers, indirect composite veneers, porcelain laminate veneers, and all ceramic crowns). Such restorative interventions can be a useful solution to such aesthetic problem, but the crucial assessment is the width of the teeth. Naturally narrow teeth will accept an increase in width, but broader ones may appear to be too wide after any change. Thus, digital smile design, diagnostic wax-up, and composite ‘mock-up’ will assist in the preoperative assessment. This can provide the patient with a realistic opportunity to see the proposed changes to the shape of teeth.
The case presented below is for a 23-year-old male patient with a midline diastema of ≈ 3 mm in width. Direct composite veneering protocol was selected as a suitable treatment option after the DSD design. My preferred procedure to apply such protocol is to complete and shape one tooth at a time before starting with the contralateral one for excellent distribution of the interproximal space between the two centrals evenly.
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