cosmetic dentistry_ beauty & science International

14 I I clinical technique _ diastema closure cosmeticdentistry 3_2011 _Step-by-step procedure for the indirect mock-up technique 1. Take an alginate impression of the patient’s diastema during the initial visit. The impres- sion needs only to be of the anterior quadrant containing the diastema and a quadrant tray may be used if desired. 2. Immediately pour the alginate impression using fast set VPS material (Aquasil Ultra XLV, DENTSPLY),takingcaretoavoidbubbles(Fig.4). 3. Measure width and length of central incisors andthediastemaspaceontheVPSmodel.Typ- ically, central incisors should be mirror images of each other, with similar width. 4. Trim the gingival tissue contour with a #12 scalpel blade to prevent formation of a black triangle in the gingival embrasure area (Fig. 5). 5. Place and contour a sculptable composite resin on one central incisor with a Gold Micro- fil instrument or IPC instrument, and smooth the surface with a #3 synthetic sable brush. The contour of the placed resin should pro- duce the desired facial and proximal con- tours and extend lingually to just beyond the contact. It should not extend over the lin- gual marginal ridge. Light-cure the restora- tion (Fig. 6). 6. Continue the composite build-up on the oppo- site central incisor. Attach the resin material to the tooth and while maintaining a hold on the celluloidstripwithafingertiponthefacialside, pullthestripfromthefacialtowardsthelingual topushtheresinmaterialthroughtheproximal to form a smooth contour adapted properly in the gingival area of the tooth (Fig. 7). Use a #3 brush to shape the material to the desired con- tour proximally and to form contact with the adjacent tooth. Use a brush to refine the facial andgingivalembrasures,andlight-cure(Fig.8). 7. Remove the polymerised resin restorations and transfer the butterfly-shaped indirect mock-up to the patient’s mouth (Fig. 9). 8. The mock-up allows the patient to evaluate the aesthetic outcome of the proposed treat- ment (Figs. 10 & 11). _Step-by-step procedure for the direct build-up of composite resin 1. Isolate the operative field with a retractor (OptraGate, Ivoclar Vivadent) and place re- Fig. 8_Smoothening of the surface with a #3 synthetic sable brush. Fig. 9_Careful removal of the butterfly-shaped indirect mock-up from the VPS model. Fig. 10_Pre-op view of patient’s smile. Fig. 11_Placement of indirect mock-up into the patient’s mouth to evaluate the outcome of the proposed treatment. Fig. 9Fig. 8 Fig. 11Fig. 10