Performing esthetic and affordable diastema closures with composite restoratives
By David J. Clark, DDS
Flowable restoratives are still relatively new to the dental materials world. Given that it often takes the dental community a decade or two to embrace a material, many dental professionals are of the opinion that the jury is still out on flowables. My personal observation is that flowables are either overutilized or underutilized, depending on the clinician. However, I believe that by finding the proper balance between flowable and paste composites, clinicians can make these materials an invaluable part of their repertoire.
The recent availability of an anatomic diastema closure matrix (Bioclear Matrix Systems) makes it possible to achieve porcelain-like contours with composite materials, allowing dentists to offer an alternative treatment to patients who wish to avoid the expense of porcelain. But with this new capability, it is extremely important that dentists select the proper flowable material. For maximum success, a flowable should:
- Be strong enough to avoid wear and fracture.
- Achieve and maintain a high level of polish to compete with porcelain.
- Provide strong esthetics, and match the corresponding shades of paste composite.
Fig. 1: The patient’s peg laterals presented a restorative challengeA rubber dam was placed in order to provide interproximal gingival retraction. An aluminum chloride astringent was placed underneath the dam and burnished into the sulci to control crevicular fluids. The centrals and canines were restored first in order to build out the areas surrounding the very small peg laterals, which were left for last. For each procedure, Bioclear DC203 diastema closure matrices were placed inciso-gingivally to the point where the gingival aprons on the matrices were near the depth of the sulcus (Fig. 2). The rubber dam provided sufficient lateral pressure in this step to seal the gingival margins. Alternately, dentists may use gentle approximating devices, such as an Interproximator (Bioclear). A traditional wooden or plastic wedge should not be used in this wedging step in order to avoid deforming the precurved matrix.