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cosmetic dentistry_ beauty & science International

Direct composite resin bonding may lack the permanency of indirect veneers and full- coveragerestorations.However,conservationof sound tooth structure, less treatment time, ease of repair and the low cost of the treatment com- pared with other treatment modalities are very distinct advantages of direct bonding. Visualisation of the final result is an important factor in the patient’s acceptance of the treat- ment of diastema closures. Prior to direct resin bonding, several diagnostic steps and commu- nication tools are available to present the anti- cipated treatment outcome to the patient. The simplest method of assessing the final outcome of a diastema closure is by means of using photo- imaging techniques of before and after images of the space closure (Fig. 2). Patients can then ap- preciate the outcome by looking at the modified image. However, photo imaging may pose a chal- lenge to the clinician to reproduce exactly the modified after-image clinically or the final resto- ration will result in patient disappointment. A diagnostic wax-up on a study model is a commonly used method to assess the treatment outcome and present it to the patient (Fig. 3). The technique is easy to use and helpful in eval- uating the anticipated shape and anatomy of the tooth. Disadvantages of diagnostic wax-ups are lack of relevance of waxing technique to thecompositeapplicationtechnique,inabilityto matchcoloursanddifficultyonthepatient’sside to relate it to the clinical outcome on his/her teeth. An innovative indirect mock-up technique with composite resin on a vinyl-polysiloxane (VPS) model allows the clinician to practice the diastemaclosurecase,andassessthefinalshape and colour of the restoration. The indirect mock- up can then easily be placed on the patient’s teeth to present the anticipated outcome with- out taking too much clinical time. This indirect mock-up also allows the patient to truly appre- ciate the final outcome on his/her actual teeth. Theprocedureinvolvesanalginateimpressionof the patient’s teeth poured with a VPS material, upon which composite mock-ups of the anti- cipated restorations are done. These mock-up shells are then transferred to the patient’s mouth for evaluation. Fig. 4_Fast setting VPS material is poured into the alginate impression. Fig. 5_Gingival contour is trimmed with a #12 blade to prevent formation of a black triangle in the gingival embrasure area. Fig. 6_Application of composite material with an IPC instrument. Fig. 7_Pull-through technique with a celluloid strip from facial towards lingual. I 13 clinical technique _ diastema closure I cosmeticdentistry 3_2011 Fig. 7Fig. 6 Fig. 5Fig. 4