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Dentistry Journal dentistry journal Case Report Minimally Invasive Diastema Restoration with Prefabricated Sectional Veneers Claudio Novelli 1 and Andrea Scribante 1,2,* 1 Private Practice, DENS Centro Medico Lombardo, 20124 Milan, Italy; [email protected] 2 Unit of Orthodontics and Pediatric Dentistry, Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy * Correspondence: [email protected] Received: 28 March 2020; Accepted: 19 June 2020; Published: 24 June 2020 Abstract: This case report presents a new technique for sectional veneer fabrication and diastema restoration with a prefabricated composite veneer. For the purpose of diastema restoration, a prefabricated sectional veneer provides the same benefits of a traditional ceramic sectional veneer (highly esthetic restoration with no need for tooth preparation) but involves a less technically demanding and time-consuming clinical procedure and a less delicate restoration with a reduced risk of accidental breakage and post-bonding crack formation. The technique presented in this case report bridges the gap between a direct and indirect technique for diastema restoration and introduces a new treatment option to close anterior spacing with a highly esthetic sectional veneer in a predictable and timely manner. Keywords: diastema; restoration; sectional veneer; ceramic veneer; composite veneer; prefabricated veneer 1. Introduction Thanks to the combination of excellent esthetic outcomes and no sacrifices related to healthy tooth structure, orthodontic treatment is frequently advocated to close anterior diastemas [1–3]. However, when a Bolton discrepancy is detected, orthodontic treatment alone cannot establish proximal contacts with proper vertical and horizontal overlaps and restorative treatment is indicated to close the residual spaces [4–6]. Several treatment options are available for minimally invasive diastema restoration, including the recently introduced injectable composite resin technique, composite template technique and the prefabricated veneer technique [7–10]. However, direct composite restoration and indirect ceramic veneers are still the most popular minimally invasive treatment options to close the anterior spacing and restore the natural appearance of the smile. Direct composites can produce a very lifelike diastema restoration in a convenient single appointment with no need for tooth preparation. However, the technique requires advanced sculpting and finishing skills to achieve an optimally polished restoration with ideal anatomic form and no residual black triangle in the gingival embrasure [11–13]. Because of these limitations, some dentists prefer to depend on laboratory-fabricated ceramic veneers, especially for large diastemas that are more challenging to close with a direct technique. Ceramic veneers can produce a diastema restoration with exquisite esthetics and excellent longevity, but the technique requires a technically demanding and time-consuming clinical procedure, not to mention the sacrifice of a healthy tooth structure to allow space for the restorative material. Sometimes, a noninvasive veneer preparation is possible where the buccal surface remains intact, but the margin of the veneer still requires tooth reduction, especially in the interproximal area where the margin has to be moved lingually and sub-gingivally in order to produce effective space management and soft tissue contouring [14,15]. Ultimately, either direct composites or indirect ceramic veneers can serve very well for the purpose of diastema restoration; however, both techniques have Dent. J. 2020, 8, 60; doi:10.3390/dj8020060 www.mdpi.com/journal/dentistry Dent. J. 2019, 7, x FOR PEER REVIEW 2 of 12 directDent. J. 2020composite, 8, 60 s or indirect ceramic veneers can serve very well for the purpose of diastema2 of 12 restoration; however, both techniques have intrinsic limitations for dentists who are looking for a minimally invasive and simple technique to close anterior spacings. This paper presents an intrinsicDent. limitationsJ. 2019, 7, x FOR for PEER dentists REVIEW who are looking for a minimally invasive and simple technique2 of 12 to alternative technique for diastema restoration with a prefabricated composite sectional veneer. close anterior spacings. This paper presents an alternative technique for diastema restoration with Prefabricateddirect composite composites or indirect veneers ceramic are veneer pre-shaped,s can serve pre- polishedvery well composite for the purpose laminates of diastema available in a prefabricated composite sectional veneer. differentrestorat shapesion; however and sizes, both for techniques direct bonding have intrinsic to the deservinglimitations toothfor dentist withs whoa complementary are looking for shade a - Prefabricatedminimally invasive composite and simple veneers technique are pre-shaped, to close anterior pre-polished spacings. composite This paper laminates presents available an matched composite resin [16–18]. This technique is indicated to treat a large variety of esthetic in dialternativefferent shapes technique and for sizes diastema for direct restoration bonding with a to prefabricated the deserving compo toothsite sectional with a veneer. complementary problems and to produce a veneer with a proper size, accurate anatomy and highly polished surface shade-matchedPrefabricated composite composite resin veneers [16–18]. are This pre technique-shaped, pre is-polished indicated composite to treat alaminates large variety available of estheticin in a single appointment with a reduced number of clinical steps. One of the main innovations problemsdifferent and shapes to produce and sizes a veneer for direct with bonding a proper to size, the accuratedeserving anatomy tooth with and a complementary highly polished shade surface- in introduced by the prefabricated composite veneer technique is the possibility to customize the veneer a singlematched appointment composite with resin a reduced [16–18]. number This technique of clinical is steps.indicated One to of treat the main a large innovations variety of introduced esthetic by chairside using conventional composite instruments. In the case presented in this report, the the prefabricatedproblems and compositeto produce veneera veneer technique with a proper is the size, possibility accurate anatomy to customize and highly the veneer polished chairside surface using prefabricatedin a single composite appointment veneer with was a reduced customized number chairside of clinical with steps. a diamond One of theseparating main innovatio disc tons fit the conventional composite instruments. In the case presented in this report, the prefabricated composite size ofintroduced the diastema by the to prefabricated be closed. Then, composite a sectional veneer veneertechnique is readyis the possibility for bonding to customize to the spaced the veneer dentition veneer was customized chairside with a diamond separating disc to fit the size of the diastema to be and closechairsides the usingdiastema conventional in a single composite appointment instruments. with no In sacrifice the case of presentedhealthy tooth in this structure. report, the closed. Then, a sectional veneer is ready for bonding to the spaced dentition and closes the diastema in Thisprefabricated technique composite bridges veneer the wasgap customizedbetween achairside direct wandith aan diamond indirect separating technique disc forto fit diastema the a single appointment with no sacrifice of healthy tooth structure. restorationsize of theand diastema introduces to be aclosed. new Then,treatment a sectional option veneer to close is ready anterior for bonding spacing to the with spaced a highly dentition esthetic Thisand close techniques the diastema bridges in the a single gap between appointment a direct with and no ansacrifice indirect of healthy technique tooth for structure. diastema restoration sectional veneer in a predictable and timely manner. and introducesThis technique a new treatment bridges optionthe gap to between close anterior a direct spacing and an with indirect a highly technique esthetic for sectional diastema veneer in a predictablerestoration and and introduces timely manner. a new treatment option to close anterior spacing with a highly esthetic 2. Casesectional Presentation veneer in a predictable and timely manner. 2. CaseThe Presentation patient was a 27-year-old lady referred by her orthodontist for restorative treatment of 2. Case Presentation multipleThe anterior patient wasmaxillary a 27-year-old diastemas lady (Figure referred 1). The by unit her orthodontistinternal review for board restorative approved treatment the case of The patient was a 27-year-old lady referred by her orthodontist for restorative treatment of reportmultiple (2019 anterior-0923) maxillary on 23 September diastemas 2019. (Figure Clinical1). The and unit radiologic internal reviewal examination board approved showed thehealthy case multiple anterior maxillary diastemas (Figure 1). The unit internal review board approved the case incisorsreport (2019-0923) with no previous on 23 Septemberrestorations 2019. and no Clinical signs of and periodontal radiological disease examination (Figure 2). showed Measurements healthy from reportthe study (2019 models-0923) on revealed 23 September a significant 2019. Clinical Bolton and discrepancy radiological and examination a 1.9 mm showed diastema healthy between incisorsincisors with with no previousno previous
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