Thursday, September 15, 2011

Diastema Closure Steps to Success

Patients present for Diastema Closures all the time in our practice. This is one of the most challenging cases to be done correctly in dentist office. Lumineers is hot due to their direct marketing. The case below would have been a disaster if a dentist wuld have allowed the patient to dictate the treatment. Although patients have demands we are the professionals and must guide them to what is possible or not. Here are the steps we go through.

1) Discuss patient's expectations
2) Discuss Shade Change
3) Discuss Monetary Restrictions
4) Discuss Orthodontics
Step 1: Intraoral Photos
Not only are they important for you and your lab technician to see the case, but more importantly for the patient. This allows them to now OWN their problem and see where they are. This usually leads to more case closing.

Smile and Profile

Notice the deviation of her chin that is masked by her diastema

Intraoral Photos

Now that we have our case we see the challenges.
1)Diastema is large so doing two veneers is out of the question
Options 4-8-10. We never do 6 . That is a whole other discussion
2)Lack of papilla so long contact will be present. Papilla is not present because no bone peak is present. 
Tissue is the Issue but Bone sets the TONE
3)Flared Incisors and and edge to edge. This shows is that NO prep is not possible. Minimal Prep Maybe

We then go ahead take good diagnostic impressions, Bite registration and Kois facial Analyzer Registration to make sure that final waxup is straight.

Here are the models and Waxup.

Duplicate of Waxup

Recommended preparation to make teeth proportional. Moving everything MeDially

Diagnostic Waxup

Preparation Guide. In this technique a Clear Stent is placed. Teeth are prepped through the Windows. The Waxup is then transferred to the mouth and a 0.3mm reduction bur is used. This prevent haphazard preparation and allows Minimally Invasive Dentistry to be performed

Day of Prepartion. All the Work is transfered to the patients mouth.

Adequate preparation done. Prep polished and Polyether Impression taken.

Trial Smile done.
We don't like to make the temporaries So SPECTACULAR as patients then get too comfortable and do NOT return

Temporaries after Diode Laser Recontouring of gingiva

Notice Change in shade

Now is when we hit a speed bump. this is what the case came back looking like. In Diastema Cases make sure that your lab understands that no papilla is presents and to close the gingival embrasue completely.

After ditching the dies they lost sight of the embrasure so finished it to normal size. We resent to reaply porcelain.

Day Of insertion

2 week post op

2 week post op


All in all with 4 veneers we were able to get away with closing the diastema and not making her teeth look bulky. 
Enjoy! As always comments are welcomed.


  1. Beautiful work !!!

    Jonathan, I just read your comment in DT about your philosophy regarding where dental implant education stands in dental education.

    What would you think that atraumatic extraction as a stepping stone to implant dentistry ?

    Please see:

  2. This case shows very nicely how pictures can help the Lab to do a better job.
    On the solid stone model the Diastema looked closed, but it was obvious once in the mouth that these veneers needed to have porcelain added.
    To communicate this to the Lab in minute detail you could write 100 words or just send a picture and the Lab will see immediately how and where to add.
    Important to note that the prep was wrapped around and this allowed to make a more natural emergence profile.