Reanatomization of anterior teeth with composite resin : case report

Dental diastema is a space or absence of contact between two consecutive teeth, which may represent an aesthetic embarrassment for the patient when smiling. For the aesthetic resolution of diastema some factors should be evaluated as, age of the patient, dental structure conservation, reversibility of treatment, cost and longevity. For closing diastema, for a long time, the clinical alternatives were the use of orthodontics and fixed prostheses. Currently, with composite resins, it is possible to reproduce natural characteristics of the teeth with a direct, reversible restorative technique, without the wear of healthy dental structure, with affordable cost, able to provide satisfactory aesthetic results. The aim of this study is to report a case of a patient diagnosed with inter incisor diastema and to present a literature review. Patient, male, 70 years old, was attended at oral clinic of Ingá University Center Uningá, Research, Society and Development, v. 9, n. 12, e32891210962, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i12.10962 2 complaining about the aesthetics of his smile. Clinically, was observed the presence of a diastema between upper incisor, fracture of incisal edge of central incisors and poor dental positioning. A reverse planning of the case was carried out through diagnostic waxing. With aid of a silicone guide, the diastema was closed through reanatomizations in composite resin. After the proposed treatment, was possible to obtain a satisfactory aesthetic in the patient's smile. The closure of diastema, with the use of composite resins was able to provide a better contour to the teeth, closing the spaces present, resulting in an aesthetic and pleasant smile.


Introduction
The current society is composed with a large number of people who value and seek for body and facial aesthetics. They seek an appearance within the standards of beauty adopted in the environment in which they live, seeking their own acceptance and that of other individuals. They take into account the beauty of a perfect smile searching for healthy, harmonic teeth, with clear and uniform coloration, so that this smile can provide you with greater acceptance of yourself and by the society (Lamenha, et al., 2007).
There are several conditions that affect the oral cavity that can cause a smile in disharmony, among them are diastema, which is a space or absence of contact between two consecutive teeth. These spaces can occur in all teeth, in jaw and mandible. However, it is more often observed between anterior teeth of the jaw, which may represent an aesthetic constraint for the patient when smiling (Lamenha, et al., 2007). The correction of diastema can be performed through orthodontic treatment and restorative treatment, performing direct or indirect restorations (Schwarz, et al., 2013). Sometimes, orthodontic treatment only does Development, v. 9, n. 12, e32891210962, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i12.10962 4 not present the desired result, and then aesthetic restorative treatment is performed (Sabri, 1999;Kokich & Kinzer, 2005).
Nowadays, the treatment with composite resin has been widely used for presenting several advantages, the one that stands out most is the aesthetic result, because with this material is possible to recreate a natural appearance close to that of dental structures, restoring morphological function and restoring natural aesthetic characteristics of teeth (Schwarz, et al., 2013).
This way, the present study aims to report a successful clinical case conducted in an oral undergraduate clinic of a patient who dissatisfied with his smile due to the presence of a diastema, agreed with the performance of reanatomizations with direct composite resin for the aesthetic reestablishment of the upper anterior teeth.

Case Report
A 70-year-old male patient was attended at oral clinic of the Ingá University Center -UNINGÁ, Maringá unit, complaining about his smile. After clinical examination, was possible to observe a change in the angulation of central incisors, in addition to the presence of a diastema between upper incisors and fracture of the incisal edges of the central incisors, resulting in a disharmonious and aesthetically unsatisfactory smile (Figure 1 A and B). After the initial consultation, study models were made, where was found that the cause of the diastema was the low insertion of the patient's lip brake, which was causing an inclination of the central incisors (Figure 1 C). Was explained to patient that the treatment could be done through a frenectomy and orthodontic alignment, but the patient refused due to age. Was offered to patient the reanatomization of anterior teeth, through ceramic laminates or composite resins, the pros and cons of each technique were presented and the patient, finally, opted for reanatomization, by the direct technique with composite resin. probe on the area that should receive the resin composed by the palatine face. On the guide with this marking, a thin layer of composite resin was applied for enamel in color A3, referring to the palatine enamel, the silicone guide with the composite resin were adapted to the teeth with the aid of a spatula and with this set in position the photoactivation was made.
The silicone guide was removed and the palatine enamel was reproduced, thus facilitating the subsequent application of composite resin.
The composite resin referring to dentin in the color OA3,5 was applied, distributing it to close the diastema and giving a new shape to the tooth. The composite resin was carefully inserted with a thin and long spatula and smoothed with the help of a flat-tipped mink hair brush (Tigre,308,Brazil). To assist in reproduction of the proximal face and to obtain a contact area, a polyester strip was positioned in the inter proximal space and after the insertion of composite resin, it was processed. After applying the dentin resin, a last and only layer of enamel resin was applied and adapted with the brush over entire vestibular face. After the reatomization in composite resin, water soluble gel (KY, Johnson & Johnson) was applied on the restoration and a new photopolymerization was made. The finishing of the restorations was carried out, with the removal of excess material with scalpel lamina number 12 (Advantive, Curitiba, Paraná, Brazil) adjustment of proximal faces with sandpaper strips (Microdont, São Paulo, SP, Brazil) and occlusal adjustment (Figure 2-B).