Immediate Dentin Sealing: a Fundamental Procedure for Indirect Bonded Restorations

Immediate Dentin Sealing: A Fundamental Procedure for Indirect Bonded Restorations

PASCAL MAGNE, DMD, PH D*

ABSTRACT The purpose of this article is to review evidence-based principles that could help optimize dentin bonding for indirect composite and porcelain restorations. More than 30 articles were reviewed, most of them addressing the specific situation of dentin bonding for indirect restorations. It appears that the combined results of this data plus clinical experience suggest the need for a revi- sion in the dentin bonding procedure. Immediate application and polymerization of the dentin bonding agent to the freshly cut dentin, prior to impression taking, is recommended. This new application procedure, the so-called immediate dentin sealing (IDS), appears to achieve improved bond strength, fewer gap formations, decreased bacterial leakage, and reduced dentin sensitivity. The use of filled adhesive resins (low elastic modulus liner) facilitates the clinical and technical aspects of IDS. This rational approach to adhesion also has a positive influence on tooth structure preservation, patient comfort, and long-term survival of indirect bonded restorations.

CLINICAL SIGNIFICANCE Tooth preparation for indirect bonded restorations (eg, composite/ceramic inlays, onlays, and veneers) can generate significant dentin exposures. It is recommended to seal these freshly cut dentin surfaces with a dentin bonding agent (DBA) immediately following tooth preparation, before taking impression. A three-step total-etch DBA with a filled adhesive resin is recommended for this specific purpose. The major advantages, as well as the technical challenges of this procedure, are presented in detail. (J Esthet Restor Dent 17:144–155, 2005)

DENTINOENAMEL JUNCTION AS leagues in the 1980s,1 the principle can be regarded as a perfect fibril A MODEL FOR DENTIN BONDING of which is to create an interphase reinforced bond.4,5 It is composed OPTIMIZATION or interdiffusion layer, also called of a moderately mineralized inter- Whenever a substantial accessible the hybrid layer,2 by the interpene- face between two highly mineral- area of dentin has been exposed tration of monomers into the hard ized tissues (enamel and dentin). during tooth preparation for indi- tissues. This approach was land- Parallel-oriented coarse collagen rect bonded restorations, local mark because once the infiltrating bundles form massive consolida- application of a dentin bonding resin is polymerized, it can generate tions that can divert and blunt agent (DBA) is recommended. The a “structural” bond somewhat sim- enamel cracks through consider- principles for dentin bonding are ilar to the interphase formed at the able plastic deformation. There are well established today based on the dentinoenamel junction (DEJ).3 startling similarities between the work of Nakabayashi and col- Studies have shown that the DEJ DEJ and the current principles of

*Tenured associate professor, director of Esthetic Dentistry, Division of Primary Oral Health Care, University of Southern California School of Dentistry, Los Angeles, CA, USA

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dentin-resin hybridization. Both hybridization, the most important 2. Precuring of the DBA leads to can be considered complex inter- of which are related to problems improved bond strength. In most phases (fibril reinforced) and not of (1) dentin contamination and studies on DBA bond strength, simple interfaces. Consequently, (2) susceptibility of the hybrid layer the infiltrating resin and adhesive the clinical performance of to collapse until it is polymerized. layer are usually polymerized present-day DBA has significantly These essential elements when con- first (precuring), before compos- improved, allowing adhesive sidered within the frame of indirect ite increments are placed, which restorations to be placed with a bonded restorations, especially appears to generate improved highly predictable level of clinical BPRs, lead to the conclusion that bond strength when compared success. Simulation of the DEJ by dentin could be sealed immediately with samples in which DBA and dentin hybridization has proved after tooth preparation, the so-called the overlaying composite are to set a new reference for the opti- immediate dentin sealing (IDS),9 cured together.13,14 These results mization of dentin bonding proce- prior to impression taking. There can be explained by the collapse dures and opens a wide window are at least four rational motives of the uncured dentin-resin of opportunities to the biomimetic and several other practical and hybrid layer caused by pressure and conservative restoration of technical reasons supporting IDS. during composite placement or teeth using bonded porcelain as seating of the restoration.15–17 an enamel/DEJ substitute.6 1. Freshly cut dentin is the ideal sub- The hybrid layer may be weak- strate for dentin bonding. Most ened superficially as a conse- EVIDENCE-BASED CLINICAL studies on DBA bond strength use quence of the lower resin content APPLICATION OF DBA FOR freshly prepared dentin. However, of the compacted collagen fibers. INDIRECT BONDED RESTORATION in daily practice, teeth have to be This hypothesis is supported by The clinical significance of success- temporarily protected for the the fact that structural defects ful dentin bonding is particularly patient’s functional and esthetic and an intrinsic weakness of the strong in the case of indirect bonded needs. In 1996 and 1997, Paul hybrid layer have been shown to porcelain restorations (BPRs) such as and colleagues raised the concern be associated with handling con- inlays, onlays, and veneers because that dentin contamination owing ditions of the DBA.18 Precuring the final strength of the tooth- to provisionalization can reduce the DBA is fully compatible with restoration complex is highly depen- the potential for dentin bond- the direct application of compos- dant on adhesive procedures. Long- ing.10–12 Their research demon- ite restorations; however, it raises term clinical trials by Dumfahrt strated that significant reductions several issues when applied dur- and by Friedman showed that in bond strength can occur when ing the luting of indirect bonded porcelain veneers partially bonded simulating dentin contamination restorations. Cured DBA thick- to dentin have an increased risk of with various provisional cements nesses can vary significantly failure.7,8 Recent advances in the compared with freshly cut dentin. according to surface geometry, on knowledge database for DBA appli- They did not simulate additional average 60 to 80 µm on a smooth cation suggest that these failures contamination sources such as convex surface and up to 200 to can likely be prevented by changing saliva and bacterial leakage, 300 µm on concave structures the application procedure of the which will be discussed later. In such as marginal chamfers.16,19 DBA. In fact, there are basic prin- practice, freshly cut dentin is As a result, applying and curing ciples to be respected during the present only at the time of tooth the DBA immediately before the clinical procedure of dentin-resin preparation (before impression). insertion of an indirect compos-

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ite or porcelain restoration could ter withstand long-term exposure This idea proves even more use- interfere with the complete seat- to thermal and functional loads ful when using bonded porcelain ing of the restoration. Practically compared with the same adhe- restoration (eg, veneers) given speaking, it is therefore recom- sive being applied and cured the specific difficulty to obtain mended that the adhesive resin together with the restoration. sealed and stable provisionals. be kept uncured before the An in vivo study confirmed the restoration is fully seated. This, 3. Immediate dentin sealing allows ability of different primers to in turn, generates at least two stress-free dentin bond develop- prevent sensitivity and bacterial significant problems: (1) while ment. Dentin bond strength penetration when preparing for the restoration is being inserted, develops progressively over porcelain veneers.28 the outwardly directed flow of time, probably owing to the dentinal fluid dilutes the bonding completion of the copolymeri- Practical and Clinical Facts agent and blocks microporosities zation process involving the Supporting IDS into which the resin otherwise different monomers. Reis and The following practical and clinical would have penetrated20,21; and colleagues showed significant facts account for the use of IDS: (2) the pressure of the luting increases in bond strength over composite during the seating of a period of 1 week.26 In directly • Patient comfort. Patients experi- the veneer can create a collapse placed adhesive restorations, ence improved comfort during of demineralized dentin (collagen the weaker early dentin bonding provisionalization, limited need fibers) and subsequently affect is immediately challenged by the for anesthesia during definitive the adhesive interface cohesive- overlaying composite shrinkage insertion of the restorations, ness.15–17 It has been proposed and subsequent occlusal forces. and reduction of postoperative that the adhesive layer be On the other hand, when using sensitivity.19,28 thinned to less than 40 µm to IDS and indirect bonded restora- • Maximum tooth structure preser- allow for precuring (before the tions, because of the delayed vation. When used on full-crown insertion of the restoration); placement of the restoration coverage preparations and com- however, because methacrylate (intrinsic to indirect techniques) bined with glass ionomer or resins show an inhibition layer and postponed occlusal loading, modified-resin cements, IDS can up to 40 µm when they are light the dentin bond can develop result in significantly increased cured,22 excessive thinning can without stress, resulting in retention, exceeding the cohesive prevent the curing of light-acti- significantly improved restora- strength of the tooth.29 IDS can vated DBAs. All the aforemen- tion adaptation.27 therefore constitute a useful tool tioned issues can be resolved if for improving retention when eventual dentin exposures are 4. Immediate dentin sealing pro- dealing with short clinical crowns sealed immediately, the DBA tects dentin against bacterial and excessively tapered prepara- being applied and cured directly leakage and sensitivity during tions. Provided that optimal after the completion of tooth provisionalization. Based on the adhesion is achieved also at the preparations, before the final fact that provisional restorations inner restoration surface (eg, impression itself, which has been may permit microleakage of bac- porcelain etching and silaniza- confirmed to generate superior teria and subsequently dentin tion, as in the case of inlays, bond strength23,24 and fewer gap sensitivity, in 1992 Pashley and onlays, and veneers), traditional formations.16,25 The resulting colleagues proposed sealing principles of tooth preparation interphase could potentially bet- dentin in crown preparations.19 can be omitted and significantly

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more conservative tooth structure The knowledge database about Therefore, either the mechanical removal is enabled (Figure 1).30 dual-cure resins is limited, and, characteristics or esthetic proper- • Systematic use of light-activated therefore, they should not be the ties might be compromised. DBA. When applying IDS, owing first choice as a luting material. • Separate conditioning of enamel to the direct and immediate cur- The formulation of dual-cure and dentin. As IDS is performed ing mode, light-activated DBAs materials is known to represent primarily on exposed dentin sur- can be used. Without IDS, the a balance between high levels of faces, the operator can focus on use of dual-cure DBA to ensure polymerization in all aspects of the “wet bonding” to dentin (in complete curing through the the restoration and color instabil- cases of total etching), whereas restoration might be required. ity owing to amine degradation.31 enamel conditioning can be per-

Figure 1. A, Clinical situation after the placement of four bonded porcelain restorations (veneer type) on the four vital maxil- lary incisors, rehabilitating not only esthetics but also function and mechanical integrity of anterior teeth. B, Preoperative situation: severe case of localized erosion and wear with marked and multiple dentin exposures. Such a case is definitely not a contraindication for a conservative approach with bonded porcelain restorations (facial veneer type IIIB according to Magne P, Belser U. Evolution of indications for anterior bonded porcelain restorations. In: Magne P, Belser U, eds. Bonded porcelain restorations in the anterior dentition—a biomimetic approach. Chicago: Quintessence Publishing Co., 2002:129–176), provided that dentin exposures are sealed immediately after tooth preparation. C, Clinical view just prior to final impression. Note the immediately sealed facial dentin surfaces (smooth texture of sealed dentin on all four incisors), a key element in the long-term success of indirect bonded restorations. Palatal surfaces were left intact and unprepared. D, The 1-year follow-up radiographs show a perfectly stable situation.

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formed separately at the stage of porcelain thickness.9 In other axial tion (see Figure 2D and E) to avoid final restoration placement (see locations, confined and superficial saliva contamination. Following step-by-step procedure below). dentin exposure gives only a limited rinsing, excess water must be space for the restorative materials, removed. One should be cautious PRACTICAL CONSIDERATIONS including the bonding agent. The as both excessive drying and exces- Dentin Identification application and curing of the DBA sive wetting can cause an inferior The first technical step for the would significantly reduce the space bond owing to demineralized colla- application of IDS is the identifica- left for the ceramic buildup. Con- gen collapse and nanoleakage/water tion of exposed dentin surfaces. A sidering that a low ratio of ceramic treeing, respectively.36 Accordingly, simple but efficient method is to to luting agent thickness can nega- air drying should be avoided. Excess proceed to a short etching (2–3 s) tively influence the stress distribu- moisture removal can be achieved and thorough drying of the pre- tion within the porcelain,32,33 IDS by use of suction drying (negative pared surfaces. Dentin can be easily is not indicated for very superficial air pressure) (see Figure 2F and G) recognized because of its glossy dentin exposures. On the other without applying positive pressure aspect, whereas enamel is frosty. It hand, deeper preparation surfaces to demineralized dentin. goes without saying that after this (ie, in the presence of Class IV or V initial etch, the dentin surface must defects or in the case of inlay/onlay/ The next steps can include the be reprepared (eg, a slight roughen- overlay preparations) can be easily application of either the primer ing with a diamond bur) to expose treated with IDS before impression (three-step systems) or the self- a fresh layer of dentin and re-etched taking because sufficient space is priming resin (two-step systems). before the application of the DBA. left for the restorative material to Practically, the separate primer maintain a reasonable ratio of application should be favored (see Preparation Depth thicknesses between the ceramic Figure 2H–J), not only because of As mentioned earlier, DBA thick- and the luting agent. the superior subsequent bond but nesses can reach several hundred also because it allows a more accu- micrometers when applied to con- Adhesive Technique rate placement of the adhesive cave areas.19 When using IDS, the The technique described focuses on resin. In fact, the application of a additional adhesive layer can some- the use of the total-etch technique priming agent or self-priming resin times negatively affect the thickness (also called “etch and rinse”), often requires a slight brushing of the future restoration. This is which can include either three-step motion, which frequently results particularly evident in the case of (separated primer and resin) or in the spread of resin above the porcelain veneers and in the pres- two-step (self-priming resin) dentin exposed dentin limits. There are no ence of gingival margins in dentin adhesives. Although there is a ten- consequences when using a separate (Figure 2). When margins terminate dency to simplify bonding proce- primer as the latter does not create in dentin, a marked chamfer dures, recent data confirm that any detectable thickness or layer. (0.7–0.8 mm) is recommended to conventional three-step total-etch Following the suction of the excess provide adequate margin definition adhesives still perform most favor- solvent (see Figure 2J), the adhesive and enough space for the adhesive ably and are most reliable in the resin can be placed accurately (eg, and overlaying restoration (see Fig- long term.34,35 with a periodontal probe, as in the ure 2A–C). A shallow chamfer case of veneer preparation margins; would cause the adhesive resin to Etching of the freshly cut dentin see Figure 2K–N). On the other pull over the margin and compro- (with H3PO4 for 5–15 s) must hand, the use of self-priming resins mise both margin definition and immediately follow tooth prepara- generates excesses and may pull

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over the margin (into the gingival provisional restoration). Given the ing procedures could easily destroy sulcus), requiring additional correc- potential exposure of the cured the hybrid layer and reexpose the tions with a bur, again exposing adhesive to the oral fluids as well as dentin because of the reduced thick- dentin at the margin. the water sorption mechanism,37 it ness and stiffness of the adhesive is recommended to keep the provi- (related to the absence of filler). Following a first curing (regular sionalization period reduced to a Surfaces sealed with an unfilled DBA mode 20 s; see Figure 2O and P), a maximum of 2 weeks. should therefore be cleansed gently layer of glycerin jelly (air block) is with a soft brush and pumice only. applied to the adhesive and slightly Adhesive Resins: Final Restoration In deeper preparations (eg, in poste- beyond. Additional curing (regular Placement rior teeth), unfilled DBA covered by mode 10 s) of the DBA through a Among the most reliable contempo- a thin layer of flowable composite layer of glycerin jelly is recom- rary systems, OptiBond FL (Kerr, can also be used to achieve IDS. mended (see Figure 2Q) to poly- Orange, CA, USA) is particularly Under no circumstances should the merize the oxygen inhibition layer indicated for the application of IDS flowable resin replace the use of the and prevent interaction of the because of its ability to form a con- unfilled resin because of the insuffi- dentin adhesive with the impression sistent and uniform layer (about cient penetration of such resin at material (especially polyethers). 80 µm when placed over a slightly the top of the hybrid layer as well Accurate placement of the adhesive convex dentin surface) and its as numerous tubules obstructed by resin is usually confirmed by the cohesiveness with the final luting filler particles.39 removal of the deflection cord as composite.16 Especially in the case the latter should not adhere to the of posterior bonded restorations, Universal Approach margin (see Figure 2R and S). OptiBond FL allows both dentin The above-described technique is hybridization and the formation applicable to both anterior and Caution with Provisionalization of a low elastic modulus liner posterior bonded restorations. A Sealed dentin surfaces have the (stress absorber) with significantly typical situation of adhesive onlay potential to bond to resin-based improved adaptation to dentin.27,38 preparation following amalgam provisional materials and cements. Just prior to the luting procedures removal is described in Figure 3, As a result, retrieval and removal of (when placing the final restoration), following the same protocol. As in provisional restorations can prove it is recommended to roughen the anterior teeth, etching should always extremely difficult. Tooth prepara- existing adhesive resin using a extend slightly over enamel to tions must be rigorously isolated coarse diamond bur at low speed or ensure the conditioning of the entire with a separating medium (eg, a by microsandblasting. The entire dentin surface (see Figure 3C). In thick layer of petroleum jelly) dur- tooth preparation surface can then posterior teeth, given the greater ing fabrication of the provisional be conditioned as it would be done average size, depth, and more restoration. It is strongly suggested in the absence of dentin exposure: favorable configuration of most to avoid resin-based provisional H3PO4 etch (30 s), rinse, dry, and preparations, use of either two-step cements but to provide mechanical coat with adhesive resin. This time, or three-step DBAs is equally pos- retention and stabilization instead no precuring of the adhesive is indi- sible (see Figure 3D–F). The clini- (eg, locking the restoration through cated because it would prevent the cian, however, should keep in mind additions of liquid resin in palatal complete insertion of the restoration. that the use of self-priming resins embrasures; splinting multiple Unfilled DBA can also be used to generates more excess resin (owing restorations can also significantly seal dentin; however, one must keep to the brushing motion), which may enhance the primary stability of the in mind that cleaning and roughen- pull over the margin and require

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A B C

D E F

G H I

Figure 2. A, Immediate dentin sealing is particularly challenging when dealing with dentin margins in veneer preparations for anterior teeth (red rectangle shows the schematic cross-sectional view of gingival dentin margins in images C, E, G, I, J, L–N, and P–S). B, Clinical situation during preparation of eroded teeth. Existing restorations, as well as severe initial erosion and wear, led to the realization of a shoulder facial preparation. C, A marked gingival chamfer always facilitates the application of the dentin bonding agent. Immediate dentin bonding would not be possible in the presence of a traditional light chamfer because the adhesive layer tends to pull over the margin, creating a feather-edge finish line and insufficient margin definition. D and E, Immediately following tooth preparation, uncontaminated dentin surfaces are etched for 5 to 15 seconds (depending on the adhesive system used). It is recommended to extend etching 1 to 2 mm over the remaining enamel to ensure further adhesion of eventual excess resin. F and G, Following abundant rinsing, excess water is suctioned. Direct contact between dentin and the suction tip must be avoided. H and I, The priming agent (hydrophilic monomer, eg, bottle 1 in OptiBond FL) is applied to dentin with a gentle brushing motion for at least 20 seconds. Several applications of fresh primer are recommended.

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J K L

M N O

P Q R S

Figure 2 continued. J, The dentin surface is suctioned again to eliminate the solvent (eg, alcohol in the case of OptiBond FL primer) from the priming solution. K, The adhesive (eg, bottle 2 in OptiBond FL) is applied with precision using a drop of resin on the tip of a periodontal probe. Direct contact between dentin and the tip of the probe should be avoided. The probe is used to help spread the adhesive to the edges of the exposed dentin. L, The adhesive is left to diffuse along the chamfer. The tip of the probe should not approach the margin more than 0.5 mm to avoid pulling of the resin (red rectangle shows a magnified view of gingival dentin margins seen in image M). M, Because of surface tension phenomenon, the adhesive spreads onto the primed dentin surface but is arrested at the sharp edge of the margin. N, Owing to the original deep chamfer, the definition of the margin is not affected by the presence of the adhesive layer. O and P, The adhesive can be cured, first for 20 seconds. Q, A thick layer of glycerin jelly is applied to the sealed surface and beyond, and another 10 seconds of light curing is applied to polymerize the air-inhibited layer of the resin. Glycerin can be removed easily by rinsing. R, In the presence of clean margins, the deflection cord should be removed easily. Excess resin is usually detected at this stage because of adhesion between the tooth and the cord. S, The impression is carried out, preferably with a one-step, double-mix technique: low-viscosity material injected onto the preparation (blue) and more heavy material from the tray (purple).

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ABC

DEF

Figure 3. A, Schematic cross-sectional view of the posterior tooth following amalgam/decay removal and simulating partial cusp coverage (red rectangle shows the magnified view used for images B–K). B, Immediate dentin sealing can be carried out independently of the occlusal enamel margin configuration, and retentive areas can be ignored initially. The application of the dentin bonding agent should always start by freshly cutting the exposed dentin surface. C, The freshly cut dentin surface is etched for 5 to 15 seconds (depending on the adhesive system used). It is recommended to extend etching 1 to 2 mm over the remaining enamel. D, Following abundant rinsing, excess water is suctioned. E, In cavities with enamel margins only, a two- step dentin bonding agent can be used (eg, OptiBond Solo). F, The adhesive is cured for 20 seconds.

additional corrections with a bur. ite as luting agent. Following final merization of the DBA to the This appears more critical in the polymerization of the inhibition freshly cut dentin, prior to impres- case of proximal dentin margins as layer (see Figure 3I), enamel mar- sion taking, is recommended. The excess resin into the gingival sulcus gins are usually reprepared just IDS appears to achieve improved might involve repreparation, reex- prior to final impression to remove bond strength, fewer gap forma- posing dentin at the margin, and excess adhesive resin and provide tions, decreased bacterial leakage, the subsequent use of the DBA dur- ideal taper (see Figure 3J and K). and reduced dentin sensitivity. The ing restoration insertion. use of a filled DBA or the combined CONCLUSIONS use of an unfilled DBA and a flow- IDS can be immediately followed Significant evidence from the litera- able composite liner facilitates the by the placement of a base of com- ture as well as clinical experience clinical and technical aspects of posite (see Figure 3G and H) to indicate the need for a revised appli- IDS. This concept should stimulate block eventual undercuts and/or to cation procedure for dentin bonding both researchers and clinicians in build up excessively deep cavities when placing indirect bonded the study and development of new to maintain reasonable restoration restorations such as composite/ protocols for the rationalization of thickness, facilitating the subse- ceramic inlays, onlays, and veneers. adhesive techniques and materials quent use of a light-cured compos- Immediate application and poly- leading to maximum tooth struc-

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GH I

Figure 3 continued. G–I, All eventual dentin undercuts (or deep dentin areas) can be blocked (or built up) with light curing composite, subsequently cured for 20 seconds, air blocked with glycerin jelly, and cured again for 10 seconds. J and K, Enamel margins are finally reprepared to remove the excess adhesive resin and provide an ideal taper for indirect restorations; this is the last step prior to final impressions. Not blocking the undercuts would have required the removal of much more tooth sub- stance (red dotted line in image J). W/CPR = with composite resin.

ture preservation, improved patient to Dr. Nikolaos Perakis (prostho- 2. Nakabayashi N, Nakamura M, Yasuda N. Hybrid layer as a dentin-bonding mecha- comfort, and long-term survival of dontist, private practice, Bologna, nism. J Esthet Dent 1991; 3:133–138. indirect bonded restorations. Italy) for help during the clinical 3. Lin CP, Douglas WH. Structure-property procedures illustrated and to Profes- relations and crack resistance at the bovine DISCLOSURE AND dentin-enamel junction. J Dent Res 1994; sor Urs Belser (Chair, Department 73:1072–1078. ACKNOWLEDGMENTS of Prosthodontics, University of 4. Lin CP, Douglas WH, Erlandsen SL. Scan- The author does not have any finan- Geneva, School of Dental Medicine) ning electron microscopy of type I collagen cial interest in the companies whose for significant support in the devel- at the dentin-enamel junction of human teeth. J Histochem Cytochem 1993; materials are discussed in this article. opment of all concepts presented 41:381–388.

here. “In his heart, a man plans his 5. Magne P, Belser U. Understanding the The author wishes to express his course, but the Lord determines his intact tooth and the biomimetic principle. gratitude to Dr. Richard Kahn (Phillip In: Magne P, Belser U, eds. Bonded steps” (The Bible, Proverbs 16:9). porcelain restorations in the anterior Maurer Tennis professor of clinical dentition—a biomimetic approach. Chicago: Quintessence Publishing Co., REFERENCES dentistry, Division of Primary 2002:23–55. Oral Health Care, USC School of 1. Nakabayashi N, Kojima K, Masuhara E. The promotion of adhesion by the infiltra- 6. Magne P, Douglas WH. Rationalization of Dentistry) for helpful discussions as tion of monomers into tooth substrates. esthetic restorative dentistry based on bio- well as a review of the English draft, J Biomed Mater Res 1982; 16:265–273. mimetics. J Esthet Dent 1999; 11:5–15.

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7. Dumfahrt H. Porcelain laminate veneers. 19. Pashley EL, Comer RW, Simpson MD, nal volume and length. Int J Periodontics A retrospective evaluation after 1 to 10 Horner JA, Pashley DH, Caughman WF. Restorative Dent 2000; 20:440–457. years of service: part II—clinical results. Dentin permeability: sealing the dentin in Int J Prosthodont 2000; 13:9–18. crown preparations. Oper Dent 1992; 31. Darr AH, Jacobsen PH. Conversion of 17:13–20. dual cure luting cements. J Oral Rehabil 8. Friedman MJ. A 15-year review of porce- 1995; 22:43–47. lain veneer failure—a clinician’s observa- 20. Paul SJ, Scharer P. Factors in dentin bond- tions. Compend Contin Educ Dent 1998; ing. Part II: a review of the morphology 32. Magne P, Kwon KR, Belser UC, Hodges 19:625–628. and physiology of human dentin. J Esthet JS, Douglas WH. Crack propensity of Dent 1993; 5:51–54. porcelain laminate veneers: a simulated 9. Magne P, Belser U. Immediate dentin operatory evaluation. J Prosthet Dent bonding. 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