Direct composite restorations: extended use in anterior and posterior situations.
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Composite Resins↗
Biomedical subjects
H J Staehle
Publications and source records attributed to H J Staehle.
[Ill due to amalgam? 10 rules for managing the symptomatic patient].
Over the past two decades, mercury released by amalgam fillings has been held responsible for a number of mental and somatic health complaints. However, a systematic relation between increased mercury levels and the severity of the reported symptoms has never been demonstrated in any of the present well-controlled multidisciplinary studies. These studies, however, have found a high prevalence of mental disorders, especially somatization syndromes, among patients with self-diagnosed "amalgam illness". Additionally, our own studies indicate that amalgam anxiety is often merely one aspect of a general environmental anxiety. Overall, the present findings suggest a psychological etiology for amalgam-related complaints. Our psychosomatic model of "amalgam illness" integrates external factors, individual predispositions and specific processes of perception, awareness, evaluation and attribution. Practical management strategies for primary care physicians can be derived from this model.
Dental Amalgam↗
Adverse health effects related to mercury exposure from dental amalgam fillings: toxicological or psychological causes?
BACKGROUND: Possible adverse health effects due to mercury released by amalgam fillings have been discussed in several studies of patients who attribute various symptoms to the effects of amalgam fillings. No systematic relation of specific symptoms to increased mercury levels could be established in any of these studies. Thus, a psychosomatic aetiology of the complaints should be considered and psychological factors contributing to their aetiology should be identified. METHODS: A screening questionnaire was used to identify subjects who were convinced that their health had already been affected seriously by their amalgam fillings (N = 40). These amalgam sensitive subjects were compared to amalgam non-sensitive subjects (N = 43). All participants were subjected to dental, general health, toxicological and psychological examinations. RESULTS: The two groups did not differ with respect to the number of amalgam fillings, amalgam surfaces or mercury levels assessed in blood, urine or saliva. However, amalgam sensitive subjects had significantly higher symptom scores both in a screening instrument for medically unexplained somatic symptoms (SOMS) and in the SCL-90-R Somatization scale. Additionally, more subjects from this group (50% versus 4.7%) had severe somatization syndromes. With respect to psychological risk factors, amalgam sensitive subjects had a self-concept of being weak and unable to tolerate stress, more cognitions of environmental threat, and increased habitual anxiety. These psychological factors were significantly correlated with the number and intensity of the reported somatic symptoms. CONCLUSIONS: While our results do not support an organic explanation of the reported symptoms, they are well in accord with the notion of a psychological aetiology of the reported symptoms and complaints. The findings suggest that self-diagnosed 'amalgam illness' is a label for a general tendency toward somatization.
Adult↗
Reproducibility of peri-implant probing using a force-controlled probe.
The aim of the present study was to evaluate the reproducibility of probing depth (PD) and vertical attachment level (PAL-V) measurements at endosseous implants. Twenty partially edentulous patients who had received 44 Frialit-2 and 30 Astra implants between 1994 and 1996 were examined. At all teeth and implants, clinical parameters (GI, PlI, PD, PAL-V) were measured at 6 sites using the flexible plastic version of the universal explorer TPS probe. At the implants and at teeth that were in similar locations compared to the implants, PD and PAL-V measurements were repeated. For each of the 20 probes that had been used for clinical examination of the 20 patients, the probing force was assessed using a precision balance. As a measure of intraexaminer reproducibility, the following standard deviations of single PD and PAL-V measurements were calculated: Frialit-2: 0.71/0.74 mm; Astra: 0.72/0.75 mm; tooth: 0.59/0.57 mm (PD/PAL-V). Stepwise multiple regression analysis revealed implant/tooth position and GI to influence PD and PAL-V measurement error (P<0.001). At anterior teeth, a lower variability was observed than at posterior teeth (P<0.001). PD and PAL-V measurement error were higher at implants than at teeth and influenced by patients. The respective models explained 13% and 17% of the variability of the dependent variable (PD/PAL-V), respectively. Intraexaminer variability of PD and PAL-V measurements at implants tended to be higher than at teeth. Multivariate analysis of variance revealed probe and probe holder to statistically significantly (P<0.001) influence probing force. However, the differences in probing force between the various probe heads were very small. They reached a maximum of 0.054 N between probe 3 and 14 and may be looked upon as clinically irrelevant.
Adult↗
Reliability of assessing interproximal bone loss by digital radiography: intrabony defects.
AIM: The aim of the present study was to assess the reproducibility and validity of linear measurements of interproximal bone loss in intrabony defects on digitized radiographic images after application of different filters and magnifications. METHODS: Immediately before surgery 50 radiographs of 50 periodontally diseased teeth exhibiting interproximal intrabony defects were obtained by a standardized technique in 50 patients. Intrasurgically the distances from the cementoenamel-junction (CEJ) to the alveolar crest (AC) and from the CEJ to the deepest extension of the bony defect (BD) were assessed. All radiographs were digitized by a flatbed scanner (resolution: 600x1200 dpi). Using the FRIACOM-soft ware, the linear distances CEJ to AC and CEJ to BD were measured at 50 intrabony defects on digitized but unchanged radiographic images and also after use of 2 different basic image processing modes (filters: enhancement of grey level differences, spreading of grey values) with 7-fold and 14-fold magnification by 2 different examiners. RESULTS: Repeated measures MANOVA revealed reproducibility of the measurement of the distance CEJ to AC to be significantly influenced by examiner (p=0.027) and filter in combination with the height of 2 wall component of the intrabony defect (p=0.066). For the distance CEJ to BD filters had significant influence on reproducibility in correlation with vertical angulation difference (p=0.001). On the average in this study radiographic measurements tended to overestimate the amount of bone loss as assessed by intrasurgical measurements (CEJ-AC: 0.74-1.91 mm; CEJ-DB: -0.04-0.77 mm). Validity of measurement of the distance CEJ-AC was shown to be significantly influenced by the depth of the intrabony defect (p<0.003). Validity of the distance CEJ-BD was significantly influenced by intrasurgically assessed bone loss (p=0.029), horizontal angulation (p=0.066). Filters influenced the validity only in combination with examiner (p<0.001). CONCLUSIONS: In this study, the chosen digital manipulations (filters: spreading, structure) of radiographic images failed to result in statistically significantly more reproducible or valid measurements of interproximal bone loss within intrabony defects when compared to the digitized but unchanged images. All radiographic assessments on the digitized images except for use of enhancement of grey level differences (structure) came close to the intrasurgical gold standard.
Adult↗
Computer-based intraoral image analysis of the clinical plaque removing capacity of 3 manual toothbrushes.
BACKGROUND: (I) Introducing an intraoral camera system with a special positioner to allow computer-based analysis of reproducible images on lingual tooth surfaces and (II) comparing plaque removal by three manual toothbrushes with different brushhead designs (convex, multilevel and flat trimmed) on lingual mandibular tooth surfaces. METHOD: In a clinical single-blind, crossover, 24-h plaque-regrowth study on 25 subjects, a computer-based index (PPI) was used to evaluate pre- and postbrushing plaque on lingual surfaces of mandibular premolars and molars. Subjects brushed their teeth under standardized conditions at three visits, each time with a different, randomly assigned toothbrush. RESULTS: The intraoral camera system allowed a reproducible and relatively convenient access to the lingual surfaces of the mandibular teeth and provided an increase in objectivity. Overall, each brush achieved statistically significant plaque removal, however, none reached clinical relevance. The multilevel brush was superior at specific sites, but failed to show statistically significant superiority in terms of overall plaque reduction. Without regard of the toothbrush used, the right handed subjects were less efficient in removing plaque from the right side compared to the left. CONCLUSIONS: The method is able to detect even small differences in plaque reduction. None of the different brushhead designs was able to compensate an insufficient brushing techniques.
Adult↗
A clinical study to compare the efficacy of 2 electric toothbrushes in plaque removal.
OBJECTIVES: To compare the cleaning efficacy of a powered toothbrush with 3-dimensional brush head action (Braun Oral-B 3D Plaque Remover D15) and a high-speed "microtation" brush with an additional "microbrush-clip" (Rowenta Dentasonic MH921S). MATERIAL AND METHODS: 82 healthy subjects took part in the study. After a familiarization period of 8 days, the subjects abstained from all oral hygiene procedures for 48 h. After plaque was scored, the subjects brushed their teeth under supervision with the two brushes according to a split-mouth design. Immediately after brushing, subjects completed a questionnaire and plaque was scored again. RESULTS: The overall plaque scores were found to be significantly reduced from 3.05+/-0.60 to 1.96+/-0.63 by the D15 and from 3.02+/-0.58 to 2.24+/-0.64 by the Dentasonic (p<0.05). The proximal surface plaque scores were reduced from 3.20+/-0.63 to 2.17+/-0.69 by the D15 and from 3.17+/-0.60 to 2.44+/-0.69 by the Dentasonic. The relative plaque reduction was overall 36.6+/-12.2% for the D15 compared to 26.1+/-13.5% for the Dentasonic and at proximal surfaces, 33.1+/-12.3% and 23.2+/-13.0%, respectively. 75% of the subjects stated that they would prefer to keep the D15. CONCLUSIONS: Both brushes were able to remove a significant amount of plaque, but the D15 was significantly more effective compared to the Dentasonic. The additional "microbrush-clip" for the proximal embrasures failed to improve plaque removal from these tooth surfaces, compared to the D15 alone.
Adult↗
Radiographic defect depth and width for prognosis and description of periodontal healing of infrabony defects.
BACKGROUND: The aims of the present study were to evaluate 1) defect depth and width as a prognostic factor and 2) change in defect width as a describing parameter of periodontal healing in infrabony defects treated by regenerative therapy after 6 and 24 months. METHODS: In 24 patients with advanced periodontitis, 39 infrabony defects were treated by guided tissue regeneration (GTR) using expanded polytetrafluoroethylene (ePTFE) (n = 7) or bioabsorbable barriers (n = 32). Clinical parameters were assessed and 39 standardized radiographs (in triplicate) were taken before and 6 and 24 months after surgery. Using a computer-assisted analysis, the depth, width, and angle of the bony defects were measured. RESULTS: Statistically significant vertical clinical attachment gains (CAL-V: 3.15 +/- 1.63 mm to 3.31 +/- 1.65 mm; P<0.001) and bony fill (1.30 +/- 2.53 mm; P<0.01 to 1.54 +/- 2.70 mm; P<0.005) were observed 6 and 24 months postsurgically. In a multilevel regression analysis CAL-V gain was predicted by baseline CAL-V (P <0.0001), actual smoking (P <0.05), and age (P <0.1). Bony fill could be predicted by baseline height of the infrabony component (P<0.0001), gingival index at baseline (P<0.05), and actual smoking (P <0.01). In narrow (<26 degrees) and deep (> or = 3 mm) infrabony defects bony fill was more pronounced than in wide and shallow defects (P <0.05). CONCLUSIONS: Improvement achieved by guided tissue regeneration in infrabony defects can be maintained up to 24 months after surgery. Narrow and deep infrabony defects respond radiographically and to some extent clinically more favorably to GTR therapy than wide and shallow defects. However, depth of the infrabony component was a stronger prognostic parameter than defect angle. Actual smoking impairs the results of GTR therapy in infrabony defects.
Adult↗
Combined mechanical and antibiotic periodontal therapy in a case of Papillon-Lefèvre syndrome.
BACKGROUND: Papillon Lefèvre syndrome (PLS) is a rare entity and, as such, it is almost impossible to evaluate an effective therapy in a randomized controlled study. The amount of success reported after therapy for prepubertal periodontitis (PP) in PLS is highly variable from case to case. The goal of this case report is to evaluate the effects of a combined mechanical and antibiotic periodontal therapy regimen in the management of PLS. METHODS: A male patient was diagnosed as suffering from PP associated with PLS at the age of 7 years. He showed hyperkeratosis of the palms and soles, as well as advanced periodontal disease already affecting permanent teeth with maximal probing depth and vertical attachment loss of 12 mm and 11 mm, respectively. Subgingival debridement was performed with simultaneous administration of oral 250 mg amoxicillin 3 times daily and 250 mg metronidazole twice daily for one week. Clinical parameters were assessed and subgingival plaque was collected from all teeth prior to therapy and 7 and 26 months after treatment. Selective cultures for A. actinomycetemcomitans were incubated for each individual tooth and DNA probe analysis was performed for various periodontal pathogens. RESULTS: Prior to combined mechanical and antibiotic treatment, all teeth but one harbored Actinobacillus actinomycetemcomitans subgingivally. However, at 7 and 26 months after therapy A. actinomycetemcomitans could be detected neither by culture nor by DNA probes. Clinical parameters improved markedly and teeth erupting after therapy did not exhibit attachment loss of more than 1.5 mm during the observation period. CONCLUSIONS: Eradication (suppression beneath detection levels) of A. actinomycetemcomitans seems to play a significant role in the successful treatment of localized prepubertal periodontitis in PLS.
Aggregatibacter actinomycetemcomitans↗
Gliding capacity of different dental flosses.
BACKGROUND: One of the major concerns with the use of dental floss is the passage of the proximal contact, which might be influenced by the material characteristics of the floss. The aim of this study was to compare the gliding capacities of different flosses with major differences in structure and experimental behavior in vivo. METHODS: In a clinical, single-blind, crossover study of 27 subjects, the forces necessary for passing all 14 proximal contacts between the first premolars were measured using 2 polytetrafluoroethylene (PTFE)-based flosses, 2 nylon-based flosses, and 1 nylon-based tape. The flosses were fixed in a special holder with strain gauges, which allowed registration of the maximum forces at insertion into and removal from the interdental area. RESULTS: In most contacts, the PTFE flosses needed less force compared to the nylon flosses. The range between the flosses was higher in the mandible compared to the maxilla and increased from the mesially located contacts to the more distally located contacts. The nylon tape required higher forces at insertion for all maxillary contacts. All other flosses proved to be equivalent at these contacts. CONCLUSIONS: PTFE flosses are superior to nylon flosses in terms of passing stronger proximal contacts in both directions. Due to gliding differences between different types of floss, the selection of a floss has the potential of compensating intra- and interindividual variation in contact strengths.
Adult↗
Influence of rubber-dam on the reconstruction of proximal contacts with adhesive tooth-colored restorations.
PURPOSE: To clinically measure the influence of rubber-dam on the proximal contact strength after its reconstruction with tooth-colored restorations. MATERIALS AND METHODS: The frictional forces during the removal of a metal strip from the proximal contact area were taken as measure for the proximal contact strengths of 46 restorations (35 ceramic inlays, 11 direct composite restorations). The teeth were separated with a rubber-dam and wedged thoroughly during the complete reconstruction procedure according to the multiple wedging technique. The proximal contact strengths were measured immediately before and immediately after removing the rubber-dam. RESULTS: The contact strengths were statistically significantly lower immediately after the removal of the rubber-dam (1.07+/-0.82N) compared to the situation with the rubber-dam (1.99+/-1.21N). The amount of the reduction after removing the rubber-dam was statistically significantly higher between the second premolar and the first molar (1.45+/-1.06N) compared to the contacts between the canines and the first premolar (0.32+/-0.44N) and the first and second premolar (0.59+/-0.77N). No influence of the restorative material, the use and localization of retainers, localization of the restoration, or number of teeth under the rubber-dam was detectable. CONCLUSION: Rubber-dam is recommended for adhesive restorations as it is helpful for achieving good adhesion between the tooth and restorative materials. Nevertheless, the application of rubber-dam seems to be a factor which complicates the reconstruction of adequate proximal contacts.
Analysis of Variance↗
Nanoleakage at the composite-dentin interface: a review.
The term "nanoleakage" was introduced to describe a specific type of leakage within the dentin margins of restorations. Nanoleakage appears as a consequence of the acid etching procedure allowing the penetration of oral and pulpal liquids such as acids into porosities within or adjacent to the hybrid layer. Nanoleakage is independent from microleakage. The amount of penetration depends on the type of bonding agent and on different parameters of the application technique (e.g. etching time, dentin moisture). Nanoleakage is much less extensive than microleakage and has probably no short-term clinical relevance. The long-term stability of the adhesive bond between dentin and restorative material, however, might be adversely affected. Nevertheless, based on the knowledge to date, acid etching prior to dentin bonding should be performed.
Acid Etching, Dental↗
Effect of intrapulpal pressure simulation in vitro on shear bond strengths and hybrid layer formation.
PURPOSE: To test the hypothesis that simulation of an intrapulpal pressure during the application of dentin bonding systems influences hybrid layer formation in vitro. MATERIALS AND METHODS: 180 teeth and three different bonding agents were used for shear bond strength measurements and for confocal laser scanning microscopy studies on the dentin-composite interface. The bonding agents (30 teeth each material) were applied without (90 teeth, Group A) and with intrapulpal pressure simulation of 34 cm H20 with water (90 teeth, Group B). 45 specimens from each group were sheared in a testing machine, and 45 teeth from each group were used for CLSM studies after labeling the primer components of the bonding agents with a fluorescent dye. RESULTS: After simulation of pulpal pressure the bond strengths decreased significantly in all groups (Syntac [without/with]: 16.0 +/- 4.5/8.0 +/- 3.7, P= 0.001; Gluma: 13.3 +/- 4.6/8.4 +/- 4.4, P= 0.008; Prime & Bond NT: 14.8 +/- 5.8/8.7 +/- 5.7, P= 0.007; n = 15 each; U-tests). There were no significant differences between the hybrid layer thickness without/with simulation of pulpal pressure (Syntac: 3.6 +/- 0.6/4.1 + 1.2, P= 0.35; Gluma: 3.5 +/- 0.6/3.7 + 0.9, P= 0.49; Prime & Bond NT: 3.5 +/- 0.9/3.8 + 0.8, P= 0.44; n = 15 each; U-tests). In the case of simulation of an intrapulpal pressure, CLSM examination revealed a distinctly shallower penetration of the adhesives into dentin compared to the samples treated without intrapulpal pressure.
Acid Etching, Dental↗
Comparison of the safety and efficacy of an oscillating/rotating battery-powered toothbrush and a standard manual toothbrush.
PURPOSE: To compare the cleaning efficacy of a battery-powered toothbrush with an oscillating/rotating action (Dr. Best Powerclean) and a standard flat-trimmed manual toothbrush (Elmex super 39) in a single-blind, cross-over clinical study. MATERIALS AND METHODS: 78 healthy subjects took part in the study. Subjects were asked to abstain from all oral hygiene procedures for 48 hours, after which hard and soft oral tissues were examined. Plaque was then scored using the Turesky modification of the Quigley-Hein Index, and subjects were instructed to brush their teeth for a total time of 1 minute with either one or the other brush, according to a predetermined randomization schedule. Immediately after brushing, plaque was scored again and hard and soft tissues were re-examined. All plaque scoring was carried out by the same investigator who was blind with respect to the brushes used. Subjects were instructed to continue with their usual oral care routine throughout the study period. They were scheduled to return after 12-14 days, having again abstained from all oral hygiene for 48 hours prior to the visit, in order to repeat the evaluation sequence but brushing with the alternative brush. Prior to analysis of the results, data from the two phases of the study were combined. RESULTS: Both toothbrushes were found to be safe as used in the study. Using the non-parametric Wilcoxon test for paired samples, whole mouth plaque scores were found to be reduced significantly from 2.04 +/- 0.60 to 1.57 +/- 0.51 by the Powerclean toothbrush (P < 0.001), and from 1.99 +/- 0.65 to 1.27 +/- 0.52 by the manual toothbrush (P < 0.001). At approximal surfaces, the plaque scores were also significantly reduced from 2.14 +/- 0.0.59 to 1.69 +/- 0.50 for the Powerclean (P < 0.001), and from 2.08 +/- 0.64 to 1.40 +/- 0.57 for the manual toothbrush (P < 0.001). A comparison of the two brushes revealed that the manual toothbrush removed significantly more plaque than the Powerclean, both for the whole mouth and approximal surfaces (P < 0.001). The Powerclean reduced whole mouth plaque by 23.2 +/- 11.5% compared to 37.8 +/- 14.0% for the manual toothbrush and approximal plaque by 20.9 +/- 10.6% and 34.9 +/- 14.0%, respectively. It is concluded that the Dr. Best Powerclean toothbrush is not as effective as a standard flat-trimmed manual toothbrush.
Adolescent↗
The nanoleakage phenomenon: influence of different dentin bonding agents, thermocycling and etching time.
"Nanoleakage" takes place within the hybrid layer zone of the dentin-composite interface in spaces not occupied by polymerized resin. The purpose of this study was to quantify the amount of nanoleakage in specimens treated with one of six different bonding agents. For one agent, different etching times were used, and for two agents results after thermocycling were obtained. Standardized class V cavities were prepared in 165 extracted human molars with cervical margins located in dentin. After placement of the composite using bonding agents, the teeth were stored in a 1% rhodamin-B-isothiocyanate solution for 24 h at 20 degrees C, embedded in methacrylate, and sectioned parallel to the long axis of the tooth. A confocal laser scanning microscope was used to visualize a layer 10 microm below the prepared surface of the section. The lengths of the penetrated pathways were measured, representing the amount of nanoleakage. In all materials tested, penetration pathways appeared within the hybrid layer in absence of gap formation. Penetration lengths of the tested materials were in a range from 69 +/- 24 microm to 469 +/- 333 microm. Thermocycling had no statistically significant influence, and etching for 15 s resulted in statistically significantly shorter penetration compared to longer etching.
Acid Etching, Dental↗
Factors influencing proximal dental contact strengths.
The aim of this study was to systematically measure proximal contact strength in complete natural dentitions of 30 adults (25.3 +/- 3.0 years of age), and to analyze its relationship to tooth type, tooth location, chewing effort and time of day variation. The contact strengths were measured dynamically during removal of a calibrated 0.05-mm-thick metal strip between the proximal contacts of adjacent teeth. Proximal contact strengths were lower in the maxilla (2.51 +/- 1.36 N) compared to the mandible (4.26 +/- 1.88 N). Within the jaws, the lowest proximal contact strength was measured between canine and first premolar (2.91 +/- 1.79 N) and the highest between second premolar and first molar (3.73 +/- 1.95 N). Chewing increased the proximal contact strength within the maxilla (before: 2.51 +/- 1.36 N, after: 3.02 +/- 1.45 N) but it remained unchanged in the mandible (before: 4.26 +/- 1.88 N, after: 4.22 +/- 1.85 N). The proximal contact strength increased significantly from morning (3.39 +/- 1.86 N) to noon (3.61 +/- 1.77 N), and then decreased in the afternoon (3.43 +/- 1.60 N). It was concluded that proximal contact strength can be significantly influenced by location, tooth type, chewing and time of day variation. Based on the differences in distribution due to the effect of chewing and time of day, it is speculated that proximal contact strength is a physiological entity of multifactorial origin.
Adult↗
Digital radiography of interproximal bone loss; validity of different filters.
The aim of the present study was to compare linear measurements of interproximal bone loss on digitized radiographic images after application of different filters to the gold standard of intrasurgical measurements. Immediately before surgery, 50 radiographs of 50 periodontally-diseased teeth exhibiting interproximal bone loss, were obtained by a standardized technique in 33 patients. Intrasurgically, the distances from the cementoenamel junction (CEJ) to the alveolar crest (AC) and from the CEJ to the deepest extension of the bony defect (BD) were assessed. All radiographs were digitized with a flatbed scanner (resolution: 600x1200 dpi). Using the FRIACOM-soft-ware, the linear distances CEJ to AC and CEJ to BD were measured at 50 interproximal lesions from the digitized but unchanged radiographic images and also after use of 7 different basic image-processing modes (enhancement of contrast [dynamics], inversion, high-pass, enhancement of gray-level differences, mean value, histogram correction, spreading of grey values) with 11-fold magnification. Neither the measurement of the distance CEJ to AC on the unchanged images nor assessments with any of the filters revealed significant differences from the gold standard. Multivariate analysis of variance showed the respective filter (p=0.009), intrasurgical and radiographic assessments (p<0.0001), to statistically significantly, influence the difference between intrasurgical and radiographic measurements of the distance CEJ to BD. The underestimation of the intra-surgically assessed distance CEJ to BD by radiographic measurements ranged from 0.3+/-2.0 to 0.8+/-1.9 mm. The filter "mean value" underestimated interproximal bone loss statistically significantly more than the digitized but unchanged radiograph (p=0.05). In this study, basic digital manipulations (filters) of radiographic images failed to result in statistically significantly more valid measurements of interproximal bone loss when compared to the unchanged but digitized images. All radiographic assessments on the digitized images except for use of one filter (mean value) came close to the intrasurgical gold standard.
Adult↗
Minimally invasive restorative treatment.
Minimally invasive restorative treatment implements need-, damage-, and risk-balanced dental care while ensuring that the ends and means are reconciled. Using examples from initial treatment of carious lesions, maintenance and correction of existing restorations, treatment of traumatic damage, and direct color and form correction of teeth, a preventively offensive and restoratively defensive treatment concept is presented. Such a concept demands of the dentist greater diagnostic efforts and more highly differentiated employment of invasive treatment methods. Demands on the patients are greater as well: they must be willing to comply with regular post-treatment examinations. In return, one receives the option of minimizing the sacrifice of maintainable hard tooth structures and avoiding extensive, large-scale dental procedures.
Composite Resins↗