Just a quick and dirty case presentation.
Anatomic Bioclear Matrix.
A new patient came to me last week for a consultation about “bonding” a space between her teeth.
She had been to a another dentist who had closed the space with “bonding.” It fell out three months later. She went back to have it done again. That time it fell out a week later. She was interested in ONLY closing the space. Of course, I looked around, and could easily treatment plan a BUNCH of stuff. There was evidence of wear secondary to parafunction (and possibly acid reflux), including significant attrition and “dentin pools.” There were also other restorations that were fairly rough. She needs a comprehensive approach. But, over the years I’ve learned to address the chief complaint and THEN have the “comprehensive discussion.”
Bioclear Interproximator. These are silicone wedges used for diastema closure. You stretch them to make them thin and pass under the cured flowable composite increment (see photo #6 below).
She wanted to know if I could close the space with bonding and have it stay (not fall off). Sure I can!
This case is nothing special, but it’s WAY better than where she started. Definitely not a “brag” case. But good enough.
Unfortunately, I forgot to take a true “before” photo. I got excited about stripping the remaining old composite on #7 and #8 and got started. Then I remembered to take the “before” picture. So, part way through the stripping, I took a “before” shot.
Photo #1: This is my “before” shot, though I had already removed most of the composite on #7. At the gingival aspect, there was a horizontal “shelf” of composite laid across the papilla… the antithesis of emergence profile.
I didn’t have time to take photos of every step. But, here’s what I got!
Photo #2: Most of the composite has been removed, but not all of it. Note I’m using an Optragate for isolation and access. Wonderful tool for anterior cases.
Photo #3: All the old composite has been removed. It would look better than when she came in, if I stopped here!
Photo #4: Composite has been added to the distal of #8. I used a Bioclear matrix and then finishing disks. No prepping of enamel was done.
Photo #5: I placed teflon tape on #8 when I etched and applied bonding agent to #7. Then I placed the Bioclear matrix and squirted some flowable composite at the cervical aspect of the matrix. I used a finger to tilt the matrix towards #8 and light-cured.
Photo #6: The purpose of the flowable increment at the cervical aspect is to create the start of a good emergence profile and to create an anchor point for the wedge. The Bioclear kit includes silicone wedges (“Interproximators”) that are anatomically contoured (triangular). You can see the wedge placed here. After I placed the wedge, I removed the teflon tape.
Photo #7: Here is the final result. No prepping. Single shade of Filtek Supreme Ultra composite. We went a bit on the light side, as the patient expressed she was going to whiten her teeth a bit more. A significant advantage of the Bioclear matrix is the nice emergence profile they create.
The patient was very happy with the result! Hopefully, she’ll be back for more comprehensive treatment.
Bioclear Matrix.
The advantage of the contoured Bioclear matrix should be obvious. Using a traditional mylar strip will create an unnatural straight emergence profile with a small proximal contact towards the incisal. The Bioclear matrix creates a natural emergence profile that supports the gingival papilla while also making a broad proximal contact.
Bioclear offers hands-on courses, but I would recommend at least watching their technique video for diastema closure. The system works VERY well. It’s not cheap, but the time saved and the superior results make the purchase worthwhile. Of course, you have to charge a fee commensurate with your time and expertise.
Check out Bioclear’s website here.
Update August 2018: A more recent case of a midline diastema with Bioclear matrices.
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This approach is really splendid. But you have mentioned that Bioclear Matrices is not cheap. How much it will cost?
Excellent work. Thank you for posting the pictures. This is not something that I offer and my practice at this time but have had a lot of interest in it lately. Thank you for the article.
Nice result. I am exploring this option myself. I appreciate your insight.
Great Blog