Cosmetic Treatment for Large or Multiple Diastemas

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.

Sandra Hulac, DDS
Private Practice
Hong Kong, China