Diastema Closure utilizing Greater Curve

At the left is a standard shaped tofflemire band.
At the right is the "Greater Curve" tofflemire band.

	Click on photos to enlarge.
	Introduction: 17 year old female. Due to her age I waned to do something reversible. This case was done with Filtek Supreme. I like this composite because I'm not seeing bubbles within the composite. I just hate to fill in little voids after a restoration has been finished out.
	Straight on
	Left view
	Right view
	Mesial 1/3 of #8 lightly roughened with a coarse diamond. Greater Curve in place. Matrix is subgingival and exposing subgingival enamel.
	Sequence: Etch, unfilled resin, Artiste Flow A1 and Filtek Supreme Ultra A1 Body. The unfilled resin wets the surface and allows the flowable to knife edge against the matrix and tooth. The Filtek Supreme is pushed into the unfilled resin flowable mixture. All composite cured at one time.
	Composite after band removed. I desire to have excess composite to shape. Gives me ample composite to shape so 1) I can control the emergence contour, (2) get the midline parallel to the long axis of the face, and 3) adjust so 8 & 9 will have the same width.
	#8 completed
	Before I bond #9 I quickly place unbonded composite on the mesial of #9 to see if I have the width and midline correct. Takes seconds to do. This way you know it will look right.
	I placed a Greater Curve around #9 and marked the contact point with an explorer and remove.
	Contact cut away with a small football finishing carbide.
	Matrix placed. Teflon tape placed. (Teflon tape optional. I place it when I can do it quickly.) Sequence of composite placement the same as for #8.
	For tooth #10 the space was too large for the Greater Curve to traverse. To get the matrix to warp further, a slot was cut at the distal, and the retainer was rotated into the tooth. Rotating the matrix makes the mesial portion of the band flare more toward the distal of #9. Triad Gel used to lock the rotated retainer in place. I also cured the flowable while holding base of matrix against the adjacent tooth with an explorer. I then placed the Filtek Supreme to complete the closure.
	Straight on view after Diastema Closure. (I rounded the mesial corner of #8 before the patient was excused. Forgot to take another photo.)
	Right side
	Left side. Also bonded mesial # 12.
	Conclusion: Over time one would expect the gingiva to recede as the patient matures. Should the expected recession occur, the case will still remain aesthetic because I was able to bond to subgingival enamel. (To expose more enamel a gingival lift would require osseous recontouring as well. Patient and parents declined the ginginval lift.)

Greater Curve Diastema Closure 2nd Case

When doing diastema closures with direct composites there are four keys to long term and esthetic success:

Isolation of the entire surface to be bonded will produce fine results.
Bonding to the available subgingival enamel works best. Since most diastema closures are done on young people, subgingival enamel is usually present. When beginning subgingivally, the emergence profile of the composite will look very natural.
Roughen the enamel surface to be bonded. I use a medium course diamond very lightly. I want to see the scratches.
Bond and taper the composite to the proximal 1/3 of the tooth. This provides a lot of surface area for strength and will provide a much more esthetically appearing result because the composite is transitioning over a large surface of enamel.

Before	Composite will be placed mesial and distal #10 and mesial #11.
	Prior to placing the band, a portion of the band was trimmed.
	The trimmed Greater Curve tofflemire band is placed around tooth #10 and held with a standard tofflemire retainer. Prior to placing the band, the mesial 1/3 of the enamel was roughened. There is total isolation of the tooth. Subgingival enamel is available for bonding, since gingiva is removed from the operative field. The flare of the Greater Curve allows access to the mesial surface.
	A Brasseler's flame shaped composite finishing bur is used to taper the leading edge of the Greater Curve where it lies against the distal surface of tooth #9. This was the part of the band that was trimmed as seen in the photo above. The transition of metal to enamel is seamless. When done properly the transition is imperceptible with the point of an explorer.
	Here is the sequence of the composite placement: Etch. Unfilled resin painted on and blown thin. Flowable composite is placed at the very base and worked side to side with an explorer. It blends with the unfilled resin that was placed prior. This assures a void free knife edge of composite. Kerr's Point 4 A1 enamel is layered on top with no concern that it blends with the flowable composite. Now you cure and only now. This produces a homogeneous strong block of composite with no voids. I am not worried about polymerizing shrinkage. We are bonding to 100% enamel. Don't worry about protecting the distal surface of #9. The bond is easily broken with the blade of a spatula. You could place the teflon tape around the distal of #9 if desired.
After	As seen in this photo a composite was placed mesial and distal of #10 and mesial of #11. When bonding to the proximal 1/3 you can use an enamel shade for the entire diastema closure. No opaque layer of composite is necessary.
After	Here is the Lingual view. You have to look closely to see the transition.
	All total, there were 8 proximal surfaces bonded for this case. Note the bands all come out in one piece which indicates that no ledging occurred as the composite transitioned from the band surface onto the adjacent tooth surface. This was made possible by using the flame shaped composite finishing bur.
Numbers 6, 7, 8, 9, 10, & 11 were all bonded interproximally.	Before After
	Another case.
	Before After Three months later.

The Greater Curve tofflemire bands have simplified diastema closures.

Our goal is to provide a system that improves the quality of your restorative dentistry while making it easier and faster to perform.

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