This document discusses the management of midline diastemas through direct composite restoration. It defines a midline diastema as a space greater than 0.5mm between the two central incisors. Common causes include normal development, tooth material deficiency, extracted teeth, habits, and artificial/iatrogenic factors. Diagnosis involves examination, measuring diastema width, and radiographs. Management through direct composite involves selecting shade/opacity, isolation, a mockup impression, optional tooth preparation, material placement in increments with curing, and finishing/polishing. Indications are fractured/malformed teeth and esthetics, while contraindications include poor oral hygiene and habits. Other treatment options depend on the

1. MANAGEMENT OF MID
LINE DIASTEMA BY
DIRECT COMPOSITE
RESTORATION
BY: SAglow007
OPERATIVE DENTISTRY

2. CONTENTS
§ DEFINITION
• CAUSES
• DIAGNOSIS
• MANAGEMENT

3. DEFINITION
• Midline diastema refers to anterior midline spacing which is
greater than 0.5mm,between the two central incisors.

4. CAUSES OF MIDLINE
DIASTEMA
NORMAL
DEVELOPING
DENTITION
TOOTH
MATERIAL
DEFICIENCY
PHYSICAL
RESTRAIN
HABITS ARTIFICAL
CAUSES
RACIAL
PREDISPOSITION
PHYSIOLOGIC
MEDIAN
DIASTEMA/
UGLY
DUCKLING
STAGE
• MICRODONTIA
A.MACROGNATHIA
B.MISSING
LATERAL
C.PEG LATERAL
D.EXTRACTED
TOOTH
A.RETAINED DECIDUOUS
B.MESIODENSE
C.MIDLINE PATHOLOGY
D.ABNORMAL LABIAL
FRENUM
A.THUMB SUKING
B.TONGUE THRUSTING
C.FRENUM THRUSTING
A.RAPID MAXILLAY
EXPANSION
B.PLACEMENT OF BRACES

5. NORMAL DEVELOPING
DENTITION
PHYSIOLOGIC MEDIAN
DIASTEMA/UGLY DUCKLING
STAGE

6. TOOTH MATERIAL
DEFICIENCY
MACROGNATHIA
MICRODONTIA

7. EXTRACTED TEETH
 This also result in tooth material arch
discrepancy which causes drifting of the
adjacent tooth leading to the formation
of diastema.
MISSING LATERAL

8. PHYSICAL
RESTRAIN
RETAINED DECIDUOUS
TEETH
MESIODENSE
ABNORMAL LABIAL FRENUM
MIDLINE PATHOLOGY

9. HABITS
TONGUE THRUSTING
•FRENUM
THRUSTING
THUMB SUCKING

10. ARTIFICIAL/IATROGENIC
CAUSES
RAPID
MAXILLARY
EXPANSION

11. RACIAL
PREDISPOSITION
The presence of midline spacing also has a racial and famililal background.
 The negroid race shows the greatest incidence of midline diastema

12. DIAGNOSIS
Ÿ Proper history and clinical examination should be done.
• Measure the MD width which will help in determining the tooth material-arch
length discrepancies.
• Check for any pernicious oral habits.
• Midline radiographs: For the diagnosis of any midline pathology.

13. MANAGEMENT OF MIDLINE
DIASTEMA BY DIRECT
COMPOSITE RESTORATION
BEFORE AFTER

14. STEPS FOR CLOSING
MIDLINE DIASTEMA BY
COMPOSITE RESTORATION
2.ISOLATION
4.TOOTH PREPARATION
5.MATERIAL SELECTION
6.MATERIAL PLACEMENT
7.FINISHING AND POLISHING
1.SHADE & OPACITY SELECTION
3. MOCKUP IMPRESSION

15. 1.SHADE & OPACITY
SELECTION
• Tooth shade should be optained by
comparing the center middle-third of the
tooth.
• An enamel like opacity material is usually
selected when closing diastema.
2.ISOLATION
• Rubber dam isolation is recommended.
• The rubber dam keeps the operatory
field dry & free of contamination.

16. 3.MOCKUP
IMPRESSION
 In order to close the diastema both central incisors would have been
widened.
 For which a diagnostic wax-up can be made then take a putty impression to
record the palatal surfaces & incisal edges of the diagnostic wax up.
 Then check the fit of putty stent intraorally. Make cuts through the stent to
allow insertion of the matrices.
 Then transfer the putty stent intraorally and carefully tuck the matrices into
the gingival sulcus.
 Apply the composite resin for palatal and incisal edge then light cured it.
 The shell can be created either one at a time or together.

17. DIAGNOSTIC
WAXUP
PUTTY IMPRESSION OF
DIAGNOSTIC WAXUP

18. 4.TOOTH
PREPARATION
• Although, tooth preparation is not
required when closing diastema but
there may be situations where the
teeth are slightly misaligned & a
minor recontouring may be
necessary when teeth are positioned
facially.
5.MATERIAL
SELECTION
• Select the proper
shade of composite for
the midline diastema
closure.

19. 6.MATERIAL
PLACEMENT
• Apply the enamel etchent on the prepared tooth
surface
• Leave it for 30 seconds then rinse it.
• After which apply the adhesive bonding agent is
placed and cured.
• Then apply the composite in increments then cured it
with light cure unit.
ENAMEL
ETCHING
BONDING AGENT AND CURING
INCREMENTAL
PLACEMENT OF
COMPOSITE

20. 7.FINISHING AND POLISHING
• Remove any excess material with the help of composite finishing burs/
composite finishing strips or soflex disk

22. INDICATIONS
Fractured tooth
Anatomically malformed tooth
Diastema closure
Tooth discoloration
Esthetics
CONTRA
INDICATIONS
Very dark staining
Mandibular teeth
Multiple large defective restoration
Poor oral hygiene
Parafunctional habits

23. OTHER TREATMENT
OPTIONS
CAUSES MANAGEMENT
TUMB SUCKING TONGUE RAKE (REMOVABLE OR FIXED)
HIGH FRENAL ATTACHMENT FRENECTOMY WITH OR WITHOUT
GINGIVOPLASTY
MISSING LATERAL INCISOR IMPLANTS CROWN/ BRIDGES
SUPERNUMERARY EXTRACTION
TOOTH MATERIAL DEFICIENCY VNEERS (PORCELAIN/COMPOSITE
CROWNS)
PEG SHAPED LATERAL COMPOSITE BUILDUP CROWNS
TONGUE THRUST TONGUE RAKE (REMOVABLE OR FIXED)