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.

'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.

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

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.

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.

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.

A Suggested Technique to Restore a Stable and Tight Contact Point in Diastema Closure

This article presents a case report on diastema closure in anterior teeth with direct resin composite restoration. This suggested approach has been found to be efficient with regards to esthetics, marginal adaptation, and the quality of proximal contacts in diastema closure. These advantages are presented in this report.

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.

Stability of maxillary interincisor diastema closure after extraction orthodontic treatment

OBJECTIVES

To evaluate the stability of maxillary interincisor diastema closure and the relationship between space relapse and interincisor diastema width, overjet, overbite, angulations between adjacent maxillary anterior teeth and presence of intermaxillary osseous cleft after orthodontic treatment with extractions.

MATERIALS AND METHODS

Twenty-four individuals with a maxillary interincisor diastema pretreatment, treated with maxillary first premolar extractions were evaluated. Dental casts and panoramic radiographs taken at pretreatment (T1), posttreatment (T2), and posttreatment follow-up (T3) were assessed. Periapical radiographs at T1 and T2 were also evaluated. Diastema relapse was assumed when T3-T2 interincisor space change was greater than zero. Diastema relapse was considered clinically significant when it was at least 0.50 mm. Data were analyzed using repeated-measures analysis of variance followed by post hoc Tukey tests or Friedman followed by Wilcoxon tests. T-test or Mann-Whitney U-test, Pearson correlation coefficient, and multiple linear regression analyses were also performed.

RESULTS

No statistically significant relapse of maxillary interincisor diastemas was found. The percentage of clinically significant relapse of the maxillary interincisor diastemas was 27.78%. Specifically, for the interincisor midline diastema, it was 8.33%.

CONCLUSIONS

Maxillary interincisor diastema closure showed no statistically significant relapse after orthodontic treatment with premolar extractions. Clinically significant stability for maxillary interincisor diastema closure was 72.22% and, specifically, for interincisor midline diastema closure, it was 91.67%.

Occlusal and Esthetic Enhancement: A Noninvasive Approach to an Old Dilemma

This article describes an indirect composite restoration technique for diastema closure and tooth lengthening with a noninvasive approach using regularly available materials such as silicone, composite resin, and an adhesive system. The procedure resulted in occlusal and functional improvement, with diastema closure, protrusive guide adjustment, and an increase in central incisor length. The procedure provided an adequate proportion of the central incisors with an esthetically natural appearance. It also resulted in simple, fast, and accurate manufacturing with a noninvasive esthetic indirect rehabilitation compared with more invasive preparation of ceramic veneers.

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.

Ultrathin Monolithic Zirconia Veneers: Reality or Future? Report of a Clinical Case and One-year Follow-up

Yttria-stabilized polycrystalline zirconia ceramics have greatly advanced over the past few years. High-translucent zirconia is a newly introduced ceramic that affords high strength and esthetics and that has significantly increased the clinical indications of monolithic zirconia restorations. Thus, the purpose of this case report was to evaluate the performance of ultrathin monolithic zirconia veneers adhesively luted to enamel surfaces after minimally invasive preparations; in addition, we aimed at presenting a clinical protocol for zirconia surface treatment in order to promote bonding effectiveness to resin cement. This type of restoration presented very acceptable esthetic results and decreased the risk of fracturing the veneer during try-in and clinical use. The results were still satisfactory after one-year follow-up. However, randomized, prospective, controlled clinical trials are required to determine the long-term clinical durability of this treatment.

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.

Tooth movement with elastic separators before ceramic veneer treatment: Rearranging asymmetric diastemas by managing the horizontal distance

The treatment of diastemas should be conservative to preserve tooth structure, and porcelain veneers provide an esthetic solution with minimal tooth preparation. However, asymmetric diastemas can be difficult to treat and may require redistribution of spaces. Additionally, extensive proximal restorations may negatively impact periodontal health. Minor tooth movement with elastic separators can be used to redistribute the interdental spaces and provide space for the interdental papilla. The aim of this paper was to present a clinical treatment involving the movement of peg-shaped maxillary lateral incisors with elastic separators to rearrange the spaces of asymmetric diastemas, thereby managing the horizontal distance during rehabilitation of the smile with minimally invasive ceramic veneers.

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?]

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.

Minimally Invasive Dentistry: A Conservative Approach to Smile Makeover

The concept of minimally invasive dentistry is based on preserving tooth structure, especially enamel. A conservative method to treat discolored teeth that have diastemas is a freehand additive technique using composite resin. While selecting the correct shade of resin can be challenging, newer composite resin formulations are being developed with optical properties that enable the material to more effectively blend into the dentition. This case report describes the use of conservative approaches and materials to treat discolored, unevenly spaced teeth and restore harmony and balance to a patient's smile.

Premium protocol for planning a periodontal-restorative approach: Conservative, predictable, and reproducible

Planning oral rehabilitation that involves an interdisciplinary approach is challenging, especially when it includes changes in the morphologic aspects of teeth and the architecture of gingival tissues. Patients commonly complain about the esthetics of maxillary anterior teeth, especially when diastemata are present. A guideline known as the golden proportion can be used to establish adequate width distribution of anterior teeth. Tooth proportion is also affected by incisogingival tooth length, hence gingival contouring should be evaluated as well. In these situations, the width-to-height ratio of 0.75:0.78 in the maxillary anterior teeth could be used to obtain wax-ups and a surgical guide, resulting in a more predictable esthetic outcome. Therefore, this clinical report describes a protocol for the planning of a periodontal-restorative approach with two wax-ups and a surgical guide using the golden proportion width-to-height ratio of 0.75:0.78 for the treatment of maxillary anterior teeth with diastemata using minimum thickness lithium disilicate veneers.

European College of Orthodontics: Commission of Affiliation and Titularisation

Date of birth: 8 May 2000; sex: female. A.

PRETREATMENT RECORDS

9 years 9months; 4/2010.

DIAGNOSIS

Angle Class I. II with ectopic 13, 23; mesial tipping of the roots of 12-22 and space opening at 12-22. Lack of space in 13 and 23 areas. Early loss of 53-63 due to undermining resorption and mesial migration of deciduous molars and first molars. Lower anterior crowding. Deep bite.

TREATMENT PLAN

Distalization of the upper molars and premolars. Space opening for alignment of 13-23; Appliances and devices: cervical headgear; lip bumper; multibracket appliance. B.

POST-TREATMENT RECORDS

11/2013; 13 years 5months.

DURATION OF ACTIVE TREATMENT

42 months (brackets: 24 months). A Cl. I relationship with canine guidance has been achieved. The overjet measures 2mm, and the overbite 1mm. The second molars are not fully erupted. The upper incisors are slightly protruded. The profile is well-balanced.

RETENTION

2/2013. Bonded 3-3 retainer in the upper and lower jaws, splint retainers for nighttime use. C.

POST-RETENTION RECORDS

(1 year minimum): 6/2015; 15 years 1month. The result is stable. The overbite has increased to 2mm. Inclination of upper incisors has decreased by 2°. All wisdom teeth are planned for extraction. As long as the patient is willing to keep her retainers. The splint aligners are already worn irregularly.

Conservative Management of Macrodontia in the Mixed Dentition Stage--A Case Report

Macrodontia is a rare dental abnormality, which can cause cosmetic concerns. Various management techniques for this condition have been documented in the literature. This case describes the initial management of macrodontia in the mixed dentition stage with the use of a minimally invasive approach to treatment. CPD/Clinical Relevance: The importance of early referral of dental abnormities is highlighted. Short- and long-term treatment options for macrodontia are described, including the impact such anomalies can have on the developing dentition.

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.

Surgically Assisted Orthodontics: Use of Piezocision in a Case of Oligodontia to Accelerate the Rate of Tooth Movement

Conventionally the use of surgical assisted tooth movement is to hasten orthodontic tooth movement. In this article, a case of 13 year-old male with oligodontia has been described in whom piezocision has been used to improve bone turnover and remodeling in long standing edentulous spaces which have less medullary bone and more cortical bone.

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.

[Incisor repositioning: a new approach in orthodontics]

Lower incisors axis has a "key" position in different cephalometric analysis. However, several critics are directed towards the cephalometric profile and cephalometric landmarks (point, line and angle). The published norms and the cephalometric standards recommended for the optimal positioning of incisors could only be used as general clinical guidelines. Incisor repositioning to achieve optimal facial aesthetics requires taking into consideration the hard and soft tissues of the face, the profile, the muscular dynamics as well as the facial growth. In this work, we propose a new approach of incisor repositioning taking into account the variability of periodontal, functional and aesthetic factors.

Esthetic rehabilitation with laminated ceramic veneers reinforced by lithium disilicate

Because of their predictable results and conservation of tooth structure, ceramic veneers are indicated for the esthetic treatment of anterior teeth with anomalous positions or appearance. The objective of this case report is to highlight the steps in dental rehabilitation using ceramic veneers reinforced by lithium disilicate. In this case the patient had diastemas between the mandibular incisors. After preliminary procedures, diagnostic models, waxing, and mock-up were completed, an impression was made with addition silicone, and the veneers were fabricated and cemented with light-cure cement. As a result, the esthetics and function expected by the patient were achieved. The use of ceramic veneers enabled a conservative and esthetically successful rehabilitation treatment.

Bone stress and strain modification in diastema closure: 3D analysis using finite element method

The aim of this study was to analyse the stress and strain distribution in the alveolar bone between two central incisors in the process of diastema closure with a constant force. A 3-dimensional computer modeling based on finite element techniques was used for this purpose. A model of an anterior segment of the mandible containing cortical bone, spongy bone, gingivae, PDL and two central incisors with a bracket in the labial surface of each tooth were designed. The von Mises stress and strain was evaluated in alveolar bone along a path of nodes defined in a cresto-apical direction in the midline between two teeth. It was observed that stress and strain of alveolar bone increased in midline with a constant force to close the diastema regardless of the type of movement in gradual steps of diastema closure, however the stress was higher in the tipping movement than the bodily so it can be suggested that a protocol of force system modification should be introduced to compensate for the stress and strain changes caused by the reduced distance to avoid the unwanted stress alteration during the diastema closure.

Esthetic Smile Design: Limited Orthodontic Therapy to Position Teeth for Minimally Invasive Veneer Preparation

The standards of dentistry are being elevated, with a greater emphasis being placed on esthetics along with functionality. Minimally invasive dentistry has become an essential component in creating restorations that are functional and have increased longevity. In the case discussed in this article, the patient underwent 9 months of orthodontic therapy to correct her improper overbite and overjet, and the spacing of her dentition so the teeth could be positioned for future minimally invasive restorations. Orthodontic therapy was paramount in positioning the teeth so that the future restorations would have ideal axial inclinations and be as minimally invasive as possible.

Contemporary options for restoration of anterior teeth with composite

The present article gives an overview of modern adhesive restoration in the anterior area, in view of the fact that modern dental therapy should be as minimally invasive as possible. Illustrated with multiple cases, the article shows possible prospective fields of indication.

Using functional analysis to determine if esthetically driven treatment requires comprehensive care for long-term success

This article reviews the case of a male patient with esthetic concerns about a large diastema between teeth Nos. 8 and 9. Through functional analysis, the clinician determined that the patient had a mild temporomandibular disorder, as well as a constriction in his anterior envelope of function. These issues will affect the prognosis of treatment if only orthodontics is used to close the diastema. The clinician determined that implementing a systematic treatment planning approach was critical in achieving a successful outcome, which was accomplished with a combination of orthodontics, occlusal deprogramming, and complex prosthodontics restorations.

Rubber dam isolation--key to success in diastema closure technique with direct composite resin

The use of direct composite resin for diastema closure has technique advantages, including that the restorative procedure can be carried out in one appointment at a reasonable cost and without the removal of sound tooth structure. The use of a rubber dam for closing diastemas with composite resin is of paramount importance as it prevents moisture contamination and ensures increased gingival retraction compared to other techniques. This provides better access to the cervical area of the tooth, facilitating proper placement of resin to recreate the natural anatomical contours and contact point. Thus, there is a more natural adaptation of the restoration to the gingival tissue, avoiding a space between the papilla and the restored tooth. To illustrate the advantages of this technique, two diastema closure cases are presented using direct composite resin with rubber dam isolation.

Simultaneous Single Tooth Intrusion and Diastema Closure: A Simplified Approach

Re-treatment of relapse with a full bonded appliance following an extensive course of fixed mechanotherapy is psychologically unacceptable and time-consuming for the patient. This article presents a simple removable appliance, which intrudes an extruded maxillary incisor with simultaneous closure of a diastema in an effective and fast way, reducing the need for re-treatment with fixed mechanotherapy.

Biomechanical considerations in mandibular incisor extraction cases

Mandibular incisor extraction can be regarded as a valuable treatment option in certain malocclusions to obtain excellence in orthodontic results in terms of function, aesthetics and stability. This treatment alternative is indicated in clinical situations like mild to moderate class III malocclusion, mild anterior mandibular tooth size excess, periodontally compromised teeth, ectopic eruption of mandibular incisor and minimal openbite tendencies. Unlike in premolar extraction cases, space closure in mandibular incisor extraction cases is unique in which the extraction space will be in the middle of the arch. The end result of space closure in these cases should be well aligned, upright, anterior teeth with parallel roots and the goal can be achieved with the bodily tooth movement through proper application of biomechanics. The purpose of this article is to explain the biomechanics of space closure in mandibular incisor extraction cases.

Distalization controlled with the use of lip-bumper and mini-screw as anchorage: a new approach

An increasingly number of patients with Angle Class II has been seeking orthodontic clinics to have their malocclusion treated. Herein, it is presented a new method of promote distal movements in maxillary molars with a combination of limp-bumper (LB) and mini screw. This technique was proven to be fast, practical and with low-cost, thus favoring both the professional and the patient.

Closure of large midline diastema by a "HIV-Spring"

Midline diastema is a common orthodontic problem in mixed dentition caused by various factors like genetic, supernumery teeth, abnormal frenum attachment, habits and microdontia etc. Large diastemas need closure for the eruption of adjacent teeth. I present here a newly designed customized self active HIV-Spring (Hari Inverted 'V' Spring) for closing a large diastema with minimum orthodontic materials and less activation visits. The spring can be modfied for the three dimensional movement of central incisors.

Invisible Cost Effective Mechanics for Anterior Space Closure

The shifting paradigm towards invisible orthodontic treatment and also awareness in patients has allured their focus towards the most esthetic treatment approach. Also the lingual treatment is proved successful and is very well accepted by the patients. The problem that persist is its high expenses, which is not affordable by all patients. This article is a effort to treat a simple Class I malocclusion with anterior spacing using a simple, esthetic, Cost effective approach with acceptable results when esthetics plays a priority role.

An Interdisciplinary Approach in Rehabilitation of an Adult Mutilated Dentition with Multiple Missing Permanent Teeth--A Case Report

Adult orthodontics has been an area of increasing focus in recent times. Comprehensive treatment of adults is more challenging due to a myriad of problems that coexist in an adult that makes treatment planning more challenging. A large number of individuals seek dental care because of aesthetic reasons, that is, the desire to look more attractive by improving their smiles. The role an attractive smile plays on a person's self-image and confidence cannot be overemphasized. Evaluating and treating patients for the purpose of smile design often involves a multi-discipline approach. Achieving an ideal smile may require orthodontics, orthognathic surgery, periodontal therapy, including soft tissue repositioning and bone re-contouring, cosmetic dentistry, and plastic surgery. This aesthetic approach to patient care produces the best dental and dental-facial beauty. This paper describes a case report in which an orthodontist, an endodontist, and a prosthodontist worked as a team to improve the patients smile and confidence.