Closing Spaces

This patient presented wanting a brighter smile that didn't have the spaces between her teeth.

Asymmetries in the gingival contours complicated the multiple spaces. The shade of this patient's teeth was also a factor, but shape will always trump shade. The treatment plan included bleaching and 8 maxillary and 4 mandibular indirect porcelain restorations.

A silicone putty matrix (Siltech by Ivoclar) was made from the diagnostic wax-up.

A diode laser was used to raise the gingival contour on the right central incisor and cut the facial frenum. The rule of thumb I use as to whether or not to perform a frenectomy is, if pulling the lip away with my fingers I can see movement of the papillae, then do the frenectomy.

Using a silicone matrix putty as a guide to form the minimal facial reduction. Cut dry so you can clearly see the margin, this will not create excessive heat if you use light pressure and a sharp bur. To prepare conservatively, one needs a steady hand, good stable instrumentation, loops with great lighting and an attitude that dentistry is not sold by the pound. Less is best.

Conservative preparations predominately in enamel. To develop proper draw to place the final indirect restorations, keep close attention to the interproximal transition from the facial surface to the lingual margin. The lingual margin must be far enough lingually and gingivally to allow for placement by the ceramist of the porcelain to create a natural and cleanable contour.

Planning for the option of a future graft, stop the preparation at the tooth's original CEJ or the level of the adjacent teeth.

Even though the teeth are wide, tapering the line angles toward the gingival (most apparent on the mesial of the right lateral incisor), reflects light to give the tooth a narrower appearance. Incisal translucencies also break-up the mass of a wide surface along with significant surface texturing.

Symmetry was created by developing gingival harmony and allowing the facial and buccal surfaces to flow from tooth to tooth. The maxillary gingival embrasures where closed successfully without creating a shape that was too square. As the tissue matures around the restorations, the papillae with form an even more intimate adaptation to the teeth. The gingival embrasures on the mandibular arch were not completely closed because it would have made the teeth too wide in the gingival areas. The margin along the mandibular right central incisor will be grafted with a soft tissue graft. The margin of the veneer stops at the tooth's original CEJ so this procedure can be accomplished.

It is always interesting to see how much more sophisticated an individual looks when the spacing between multiple teeth are closed. The final result is proportional to the overall face and within the dental arch. The teeth tend to have a squarer form when closing gingival embrasures or diastemata and tapering the line angles of the individual teeth toward the gingival areas keeps the appearance most natural.