NON-INVASIVE ESTHETIC REHABILITATION OF ANTERIOR DIASTEMA WITH DIRECT COMPOSITE RESTORATION (REHABILITASI ESTETIKA NON-INVASIVE DIASTEMA ANTERIOR DENGAN RESTORASI KOMPOSIT DIREK)

Diastema is a gap between adjacent teeth that occur physiologically from the teeth eruption. However, diastema between the maxillary central incisors in an adult can be an aesthetic problem and sometimes impair speech. Diastema treatment with low or enlarged superior labial frenulum includes frenectomy, orthodontic treatment, veneers, crown, and bridge or resin-based composite direct restorations. This case report will discuss the rehabilitation of diastema in an aesthetic zone of maxillary central incisors due to low frenulum attachment. It was done by a minimally invasive approach using direct composite restoration, completed within several hours after the study model was analyzed


INTRODUCTION
The gap between adjacent teeth is known as a diastema.Diastema locations mostly occur between the upper central incisors.The incidence varies according to age development, mostly 98% at the 6-year-old, 49% at 11, and about 7% at 12-18 years old. 1 The teeth with diastema are a normal condition at the development, caused by the position of maxillary canine eruption with maxillary lateral incisor.Missing teeth is a physiological cause of diastema. 2Several conditions such hyperactive tongue, hypotonic perioral muscles, discrepancy between tooth size, dental arch length, abnormal frenulum, and ectopic tooth eruption lead to esthetic problems in adults.They sometimes slightly effect of speech. 1,3 the eruption stage, the proximal labial that extends proximally will obliterate the eruption of the central     Maxillary and mandibular study models were made to analyze the intra-oral condition.The contact relationship of the upper and lower anterior teeth showed a large overbite and overjet (Fig. 3-4).
The upper central incisors teeth were found to have a small mesiodistal width concerning cervicoincisal dimension.
As proximal contact in final restorations reference points, we used the ideal distance between the incisal edge and the gingival papilla and required 4mm or less from the interdental crest bone. 9     Meanwhile, in small and medium diastemas, the gap between the teeth can be filled using a direct composite restoration.
When there are spaces between teeth appropriate to tooth size discrepancy, or small teeth, orthodontic treatment is contraindicated.It will be advisable to take restoration or prosthetic crown therapy.For a better esthetic result, orthodontic treatment before the restorative procedure may reduce the gap between the teeth. 12other rehabilitation option for diastema closure is subapical and interdental osteotomy procedures.It's because the main factor for diastema relapse is not only the frenulum and soft tissue.This composite type has a composition of BIS-GMA, BIS-EMA, UDMA and a small amount TEGDMA, 20 nm nano silica filler.
The composite is not clustered and easily bonded zirconia/silica nanoclusters to form groups, where the group consists of zirconia/silica particles with a size of 5-20 nm.The combination of nanoparticles with nanoclusters will reduce the amount of interstitial space between filler particles so as to improve physical properties and better polishing results.
Color is a property of light, an object reflects only certain wavelengths, and the rest of the entire wavelength is absorbed by the object. 11In dentistry, color greatly determines the success of treatment, especially in terms of aesthetics.4] The color selection, in incisors.The ideal treatment to eliminate the etiology of the lower superior labial frenulum is frenectomy.It follows orthodontic treatment.Other alternatives include veneers, crowns, bridges, or resinbased direct composite restorations 2,4-8 .Treatment for diastema cases depends on etiology and the distance between the teeth.Resin-based direct composite restoration is a minimal and conservative treatment that can be performed to close the diastema in terms of aesthetics with economical costs and fewer visits to other treatment options. 6-8Patient success and satisfaction in diastema closure rehabilitation with resin-based composite resin restorations depends on several factors, including communication with the patient and analysis of the study model.CASE REPORTS A 21-year-old woman came to RSGM Unjani complaining of a gap between her upper front teeth due to low frenulum.No caries or complaints of pain.The patient demands esthetic treatment.Based on the patient's medical and dental history, clinical examination; Low labial frenulum at maxilla, 11 and 21; caries (-), vitality (+), percussion (-), palpation (-), mobility (-), bite test (-), discoloration (-).Periodontal tissue within normal limits, with no recession or bleeding on probing.Diagnosis: diastema 11 | | 21.The treatment plan was to reach the aesthetic and economic demands.Closing the gap with composite resin increases the incisors' mesiodistal dimension proportionally.And without damaging tooth structure.Smile analysis.At the first visit, extra-oral and intra-oral photos were taken before treatment as a reference and comparison of treatment results (Figure 1,2).Upon the analysis, a gap between teeth 11-21 with the upper buccal frenulum separating the two teeth.

Figure 12
Figure 12 Extra oral photo.

Figure 13 .
Figure 13.three months after treatment this case, was carried out with the patient, single shade A2.After applying the composite on the second visit, the patient was satisfied with the final result because the diastema tooth had closed.Overall, the suitability of the composite color with the teeth and the anatomical shape of the teeth was satisfactory.Still, the gingival embrasure was slightly exposed at the median cervical line.The translucent line on the distal part of the restoration seemed to be shadowed when viewed closely, which was then informed to the patient.Composites with several shade options should be used to get maximum color form of smoothing and rounding the incisor angle can improve aesthetics, prevent tooth structure, and prevent gingival irritation.In this case, the email roughing does not remove the email layer.The gap in the embrasure may be due to the application of a retracted cord.This condition disappears when the control is carried out.Composite changes color with time, and leakage around the margins can occur.Touch-ups to composite are usually required every 7 to 10 years.The wax-up illustrated how the individual restorations would appear dimensionally and whether an occlusal/ functional scheme could be worked out that would provide proper force management for the longevity of the restorations.The wax-up would serve as the prototype design for the direct fabrication of the provisional restorations so that laboratory approximations could be adjusted and verified in vivo. 15Before starting the composite application with the PVC matrix on the palate, an enamel cleaning procedure was performed to improve etching adhesion and bonding.The teeth were restored one by one by layering technique that can also be used in the silicon matrix technique In addition, several things must be considered in creating a smile (smile design) for each individual.This process includes midline, the incisal distance of teeth, zenith point, healthy gingiva, and interdental embrasure, the axial position of central incisors, interdental contacts, dimensions, and character.Teeth. 16-18The vertical size of the upper central incisors is 1,618 times longer than the horizontal size 18,19 The dimension starts with the central incisor being the largest and then each subsequent tooth posterior to it looking one sixteenth smaller.Case analysis of the study model can estimate the outcome of direct restoration. 14This technique includes a dental diagnostic procedure planned restoration waxed on a working model to determine the procedures required to achieve the desired clinical outcome.It will accommodate for the calculation of space available and how to manipulate it, and also help to evaluate the results and can be used as a communication tool between dentist and patient.The mock-up made on the working model is a pattern for making PVC matrix which will serve as a guide during the restoration process. 20CONCLUSION A minimally invasive approach managed a 2 mm diastema between the maxillary central incisors; direct composite