Solving a diastema dilemma – Tom Songhurst
Featured Products Promotional FeaturesPosted by: Dental Design 4th September 2018
Dr Thomas Songhurst (BChD) qualified from Leeds University in 1998 and spent five years working in NHS and private practice as an Associate before becoming Principal of Grassington Dental Care in May 2003. He has focused on providing private only treatments in the last five years, and has a keen interest in aesthetic dentistry.
Patient presentation
The patient had been attending the practice for all check-ups and treatment since 2003. Now 19 years old, she had become concerned about the aesthetic appearance of her midline diastema (which was affecting her psychologically) and was keen to explore possible corrective treatment options.
She was referred to a specialist orthodontist for a consultation, but they expressed concerns about retention of the treatment. They felt that without permanent retention her teeth were likely to drift apart again in the future. I had reservations about the patient receiving orthodontic retention, as there is evidence to suggest that the presence of retainers bonded to all anterior teeth could increase plaque accumulation and gingivitis.[i]Likewise, I was concerned that the patient’s oral health would be compromised – not because of her oral hygiene, which is fantastic, but because fixed retainers can make it more difficult to clean between interproximal spaces.
Pre treament
Treatment plan
Ultimately, however, it was down to the patient, but she actually decided independently that she didn’t want to proceed with orthodontic treatment. The main reason being that she didn’t want to commit to a costly, long-term treatment that had a risk of relapse or dental disease, and she wanted a simpler solution. After discussing alternative options that included veneers, crowns and composite bonding, the patient opted for composite build-up to close the gap between the central incisors. This was the preferred treatment pathway, as it builds on the natural tooth in a minimally invasive way without causing any damage to its integrity. During the planning stage, the patient expressed that she wanted to retain some of the diastema for ‘character’. I too felt that filling right to the contact points would have coronally made the teeth appear unnaturally large and wide, so it was agreed that the space wouldn’t be fully closed.
After informing the patient that possible staining might occur over time and that the restoration would need replacing further down the line, the consent forms were signed and a pre-treatment photograph was taken.
Treatment protocol
For the composite build-up I used BRILLIANT EverGlow® shade A1/B1 from COLTENE along with matrix strips to contour, which was applied using the free-hand technique. I chose COLTENE’s next generation universal composite as it doesn’t require warming before use – which to me is quite important – and it’s got a great viscosity. Some of the composites are quite firm, especially when they’re cold, and you have to warm them up in order to manipulate. BRILLIANT EverGlow® on the other hand works superbly, even when it’s cold. Plus, because the material offers a low stickiness to the instrument, it is incredibly easy to use. To finish I used an all-surface access polisher, which together with the exceptional polishing properties of the composite helped to achieve a nice, aesthetic result.
I then provided her with a removable retainer to wear at night, partly because her UR1 had drifted distally slightly, but also because she had erupting wisdom teeth. Now, there are conflicting arguments on whether third molars can cause crowding, but at least if her 8s do cause any problems there’s already a solution in place to minimise any potential movement. She was advised to wear every night and advised that any relapse in use would likely result in needing a new retainer.
Critical appraisal
Looking at the post-treatment photograph you can’t tell that the patient has undergone restorative therapy, which is the outcome I was hoping for so I am very happy with the end result. The patient is also pleased and has a much more confident smile now that the diastema is gone. I wouldn’t change a thing about the treatment.
Post treatment
To find out more visit www.coltene.com, email info.uk@coltene.com
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[i]Rody Jr WJ, Elmaraghy S. McNeight AM, Chamberlain CA. Antal D. Dolce C. Wheeler TT. McGorray SP. Shaddox LM. Effects of different orthodontic retention protocols on the periodontal health of mandibular incisors. Orthodontics and Craniofacial research. 2016; 19 (4): 198-208. Accessed online May 2018 at https://doi.org/10.1111/ocr.12129.
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