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Favoreto MW, Carneiro TDS, Ñaupari-Villasante R, Cordeiro DC, Cochinski GD, Machado do Nascimento TVP, Matos TDP, Bandeca MC, Reis A, Loguercio AD. Clinical performance of preheating thermoviscous composite resin for non-carious cervical lesions restoration: A 24-month randomized clinical trial. J Dent 2024; 144:104930. [PMID: 38471581 DOI: 10.1016/j.jdent.2024.104930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/17/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES This 24-month, double-blind, split-mouth randomized clinical trial aimed to compare the retention rates of a preheated thermoviscous composite resin (PHT) compared to a non-heated composite resin (NHT) in non-carious cervical lesions (NCCLs). METHODS A total of 120 restorations were restored on NCCLs using a preheated (VisCalor bulk, Voco GmbH) and a non-heated (Admira Fusion, Voco GmbH) composite resins with 60 restorations per group. A universal adhesive in the selective enamel conditioning was applied. In the PHT group, composite was heated at 68 °C for using a bench heater. In the NHT group, no heating was employed. Both restorative materials were dispensed into caps and inserted into the NCCLs. The restorations were evaluated at baseline, 6, 12, 18, and after 24 months of clinical service using the FDI criteria. Statistical analysis was performed with Kaplan-Meier estimation analysis for retention/fracture rate and Chi-square test for the other FDI parameters (α=0.05). RESULTS After 24 months 108 restorations were assessed. Seven restorations were lost (two for PHT group and five for NHT group), and the retention rates (95 % confidence interval [CI]) were 96.7 % (81.5-99.9) for PHT group and 90.8 % (81.1-96.0) for NHT group, with no statistical differences between them (p > 0.05). The hazard ratio (95 % CI) was 0.52 (0.27 to 1.01), with no significant difference within groups. In terms of all other FDI parameters that were assessed, all restorations were deemed clinically acceptable. CONCLUSIONS Both composites showed high rates of retention rates after 24 months. CLINICAL SIGNIFICANCE The clinical performance of the new preheated thermoviscous was found to be as good as the non-heated composite after 24-month of clinical evaluation in non-carious cervical lesions. REGISTRATION OF CLINICAL TRIALS RBR-6d6gxxz.
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Affiliation(s)
- Michael Willian Favoreto
- Department of Restorative Dentistry, School of Dentistry, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil; School of Dentistry, Tuiuti University, Curitiba, Paraná, Brazil
| | - Taynara de Souza Carneiro
- Department of Restorative Dentistry, School of Dentistry, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil; Department of Stomatology, IDIBO research group, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Romina Ñaupari-Villasante
- Department of Restorative Dentistry, School of Dentistry, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | - Deisy Cristina Cordeiro
- Department of Restorative Dentistry, School of Dentistry, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | - Gabriel David Cochinski
- Department of Restorative Dentistry, School of Dentistry, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | | | | | - Matheus Coelho Bandeca
- Department of Restorative Dentistry, School of Dentistry, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | - Alessandra Reis
- Department of Restorative Dentistry, School of Dentistry, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil.
| | - Alessandro D Loguercio
- Department of Restorative Dentistry, School of Dentistry, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil.
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Branco NTT, Diniz IMA, Abreu LG, Sales ALB, Kimura ACRS, de Almeida Queiroz Ferreira L, de Magalhães CS, Zeola LF. Noncarious cervical lesions in the aging population analyzed through digital scanning: occlusal risk factors, dimensions, and morphology. Clin Oral Investig 2023; 27:6177-6186. [PMID: 37638975 DOI: 10.1007/s00784-023-05234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES To evaluate noncarious cervical lesions (NCCL) in older adults by analyzing each lesion's morphology, dimension, and occlusal risk factors using intraoral scanning and clinical evaluation. MATERIALS AND METHODS Individuals over 60 treated at the School of Dentistry in Minas Gerais, Brazil, were invited to participate in this cross-sectional study. We clinically evaluated 1245 teeth for the presence of NCCL and dentin hypersensitivity (DH) in 53 individuals. Three-dimensional models were obtained using Omnicam, and occlusal risk factors were evaluated through the presence of wear facets, intense occlusal contacts, and interferences. The 3Shape 3DViewer software was used to classify NCCL morphology and to measure their height. NCCL depth, width, and area measurements were determined using ImageJ. Descriptive analyses were performed. The Kolmogorov-Smirnov test showed that quantitative data exhibited non-normal distribution. For bivariate analyses of quantitative data, the Mann-Whitney test was employed. The results were reported with mean, standard deviation, median, minimum, and maximum. For bivariate analyses of categorical data, the Pearson chi-square test was used. The results were reported with frequencies (counts) and percentages. A regression model evaluating the association between occlusal risk factors and the absence/presence of NCCL was built. RESULTS Most participants were female (58.5%), with a mean age of 66. The frequency of NCCL was 28.27%, corresponding to 352 teeth. Of these, 68.18% exhibited saucer morphology and 31.82% wedge-shaped morphology. The frequency of DH was 13.92% in teeth with NCCL. Saucer NCCL exhibited significantly greater height (p = 0.02), while wedge-shaped lesions showed greater depth (p < 0.001). Also, teeth with NCCL had a higher proportion of wear facets (66.8%; p < 0.001), intense occlusal contacts (39.8%; p = 0.008), and occlusal interferences (21.9%; p = 0.05). The regression model showed that teeth with wear facets were 1.50 times more likely to exhibit NCCL than teeth without wear facets (p < 0.001). Teeth with intense occlusal contact were 1.22 times more likely to exhibit NCCL than teeth without intense occlusal contact (p = 0.031). CONCLUSIONS NCCL is a common dental condition in the older adults evaluated in this study. Wedge-shaped NCCL exhibited greater depth, while saucer NCCL had more expressive height. Occlusal risk factors may represent a crucial mechanism for the occurrence of NCCL in this population. CLINICAL RELEVANCE Understanding the mechanisms involved in developing NCCL is helpful in diagnostic and preventive practices. The study showed the importance of dental occlusion and characteristics of different NCCL morphologies that help the clinician in decision-making.
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Affiliation(s)
- Natália Teixeira Tavares Branco
- Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Ivana Márcia Alves Diniz
- Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas Guimarães Abreu
- Department of Child and Adolescent Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Anna Luiza Bicalho Sales
- Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Anna Carolina Rye Sato Kimura
- Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luiza de Almeida Queiroz Ferreira
- Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Cláudia Silami de Magalhães
- Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lívia Favaro Zeola
- Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Stănuşi A, Stănuşi AŞ, Gîngu O, Mercuţ V, Osiac E. Stereomicroscopic Aspects of Non-Carious Cervical Lesions. Diagnostics (Basel) 2023; 13:2590. [PMID: 37568952 PMCID: PMC10417311 DOI: 10.3390/diagnostics13152590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Non-carious cervical lesions (NCCLs) represent a form of tooth wear, characterized by the irreversible loss of dental hard tissues at the enamel-cement junction, without the involvement of caries and dental trauma. The aim of this study was to highlight the morphological elements of NCCLs via their stereomicroscopic examination and to confirm the role of this examination in the diagnosis of early lesions. In addition, the association between the morphological aspects identified during the stereomicroscopic examination of NCCLs and their etiological factors was determined. For this study, extracted teeth with NCCLs were examined with a stereomicroscope. The morphological aspects of NCCLs were evaluated at magnifications up to 75×. In wedge-shaped NCCLs, the stereomicroscopic examination allowed the identification and measurement of scratches, furrows and cracks. In saucer-shaped NCCLs, the stereomicroscopic examination highlighted the smooth appearance of the walls. The presented study highlighted the role of stereomicroscopic examination in the assessment of NCCL morphology and in their early diagnosis. The study confirmed, in particular, the role of occlusal overloads and tooth brushing in determining the morphology of NCCLs.
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Affiliation(s)
- Andreea Stănuşi
- Department of Prosthetic Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | - Oana Gîngu
- Department of Engineering and Management of Technological Systems, Faculty of Mechanics, University of Craiova, 200585 Craiova, Romania;
| | - Veronica Mercuţ
- Department of Prosthetic Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Eugen Osiac
- Department of Biophysics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
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Stănuşi A, Iacov-Crăițoiu MM, Scrieciu M, Mitruț I, Firulescu BC, Boțilă MR, Vlăduțu DE, Stănuşi AŞ, Mercuț V, Osiac E. Morphological and Optical Coherence Tomography Aspects of Non-Carious Cervical Lesions. J Pers Med 2023; 13:jpm13050772. [PMID: 37240942 DOI: 10.3390/jpm13050772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
Non-carious cervical lesions (NCCLs) are considered the irreversible losses of dental hard tissues at the cemento-enamel junction, in the absence of acute trauma and dental caries. The aim of this study was to highlight the presence of NCCLs in cervical areas based on specific macroscopic aspects in order to establish their clinical form, size and location and to confirm the role of optical coherence tomography (OCT) examination in the early diagnosis of these lesions. For this study, 52 extracted teeth were used, which did not have endodontic treatments, fillings or carious lesions in the cervical area. All teeth were examined macroscopically and OCT was used to evaluate the degree of occlusal wear, the presence and clinical form of NCCLs. Most NCCLs were identified on the buccal surfaces of the premolars. The most frequently encountered clinical form was the wedge-shaped form, with a radicular location. NCCLs present most frequently in the wedge-shaped form. Teeth that presented several NCCLs were identified. The OCT examination is an adjunct method to evaluate the clinical forms of NCCL.
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Affiliation(s)
- Andreea Stănuşi
- Department of Prosthetic Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | - Monica Scrieciu
- Department of Prosthetic Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ioana Mitruț
- Department of Prosthetic Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | | | | | | | - Veronica Mercuț
- Department of Prosthetic Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Eugen Osiac
- Department of Biophysics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Goodacre CJ, Eugene Roberts W, Munoz CA. Noncarious cervical lesions: Morphology and progression, prevalence, etiology, pathophysiology, and clinical guidelines for restoration. J Prosthodont 2023; 32:e1-e18. [PMID: 35920595 DOI: 10.1111/jopr.13585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To synthesize the literature regarding noncarious cervical lesions (NCCLs) and propose clinical guidelines when lesion restoration is indicated. MATERIAL AND METHODS A PubMed search was performed related to NCCL morphology, progression, prevalence, etiology, pathophysiology, and restoration. RESULTS NCCLs form as either rounded (saucerlike) depressions with smooth, featureless surfaces that progress mainly in height or as V-shaped indentations that increase in both height and depth. Prevalence ranges from less than 10% to over 90% and increases with age. Common locations are the facial surfaces of maxillary premolars. They have a multifactorial etiology due to personal habits such as excessive horizontal toothbrushing and consumption of acidic foods and drinks. Occlusal factors have been identified as contributing to the prevalence of NCCLs in some studies, whereas other studies indicate there is no relationship. The concept of abfraction has been proposed whereby mechanical stress from occlusal loading plays a role in the development and progression of NCCLs with publications supporting the concept and others indicating it lacks the required clinical documentation. Regardless of the development mechanism, demineralization occurs and they are one of the most common demineralization diseases in the body. Treatment should be managed conservatively through preventive intervention with restorative treatment delayed until it becomes necessary due to factors such as lesion progression, impact on patient's quality of life, sensitivity, poor esthetics, and food collection may necessitate restoration. Composite resins are commonly used to restore NCCLs although other materials such as glass ionomer and resin-modified glass ionomer are also used. Sclerotic dentin does not etch like normal dentin and therefore it has been recommended to texture the dentin surface with a fine rotary diamond instrument to improve restoration retention. Some clinicians use mechanical retention to increase retention. Beveling of enamel is used to increase the bonding area and retention as well as enhance the esthetic result by gradually creating a color change between the restoration and tooth. Both multistep and single-step adhesives have been used. Dentin etching should be increased to 30 seconds due to the sclerotic dentin with the adhesive agent applied using a light scrubbing motion for 20 seconds but without excessive force that induces substantial bending of a disposable applicator. Both flowable and sculptable composite resins have been successfully used with some clinicians applying and polymerizing a layer of flowable composite resin and then adding an external layer of sculptable composite resin to provide enhanced resistance to wear. When caries is present, silver diamine fluoride has been used to arrest the caries rather than restore the lesion. CONCLUSIONS Noncarious cervical lesions (NCCLs) form as smooth saucerlike depressions or as V-shaped notches. Prevalence values as high as 90% and as low as 10% have been reported due to habits such as excessive toothbrushing and an acidic diet. Occlusal factors have been proposed as contributing to their presence but it remains controversial. Publications have both supported and challenged the concept of abfraction. They are one of the most common demineralization diseases in the body. Conservative treatment through prevention is recommended with restorative treatment delayed as long as possible. When treatment is needed, composite resins are commonly used with proposed restorative guidelines including texturing the sclerotic dentin, beveling the enamel, potential use of mechanical retention, 30 seconds of acid etching, and use of either multistep or single-step adhesives in conjunction with a light scrubbing motion for 20 seconds without excessive force placed on disposable applicators.
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Affiliation(s)
- Charles J Goodacre
- Advanced Education Program in Implant Dentistry, Loma Linda University School of Dentistry, Loma Linda, California
| | - W Eugene Roberts
- Adjunct Professor Mechanical Engineering, Indiana University & Purdue University, Indianapolis, Indiana
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Werneck RD, Queiroz DA, Freitas MIM, Rio DLD, Turssi CP. Association of Non-carious Cervical Lesions with Oral Hygiene Aspects and Occlusal Force. J Contemp Dent Pract 2023; 24:71-79. [PMID: 37272137 DOI: 10.5005/jp-journals-10024-3457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM The purpose of this case-control (CT) study was to investigate the association between the presence of non-carious cervical lesions (NCCLs) with occlusal force and other potential risk factors. MATERIALS AND METHODS Thirty-nine participants with NCCLs [cases (CS)] and 39 with no NCCLs [control (CT)] attending the dental clinic of the Faculdades Integradas São Pedro (FAESA), located in Brazil, were enrolled in this study. Information was collected through anamnesis, clinical examination, and a questionnaire addressing aspects related to tooth brushing, dentifrice, and mouthwash use. In clinical examination, patients were submitted to four measurements of occlusal force in the maxillary first premolars and maxillary first molars, using a strain gauge sensor of medium intensity, the Flexiforce (Tekscan, South Boston, Massachusetts, United States of America). The sensor was calibrated for the unit of measurement in Newtons (N). Data were analyzed using a student's t-test and multiple logistic regression, e with a significance level of 5%. RESULTS There was no statistically significant difference between the case and CT groups regarding the bite force in the four measured regions. Logistic regression identified sex as a factor significantly associated with NCCLs (p = 0.020). The odds ratio showed the female sex had more chance (OR = 6.082; CI = 1.332-27.765) of having NCCLs. CONCLUSION It is concluded that females presented a higher risk factor for NCCLs than men. In contrast, there was no association of occlusal force, as well as aspects related to brushing and deleterious habits. CLINICAL SIGNIFICANCE Females have a higher risk factor for non-carious lesions than men.
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Affiliation(s)
- Rafael Dario Werneck
- Department of Prosthodontics, College of Dentistry, FAESA - Centro Universitário, Vitória, Espírito Santo, Brazil, Orcid: https://orcid.org/0000-0002-4862-1354
| | - Daher Antonio Queiroz
- Department of Restorative Dentistry and Prosthodontics, The University of Texas Health Science Center at Houston (UT Health); School of Dentistry, Houston, Texas, United States of America, Orcid: https://orcid.org/0000-0002-1477-8599
| | - Mariana Itaborai Moreira Freitas
- Department of Prosthodontics and Periodontology, University of Campinas - Piracicaba Dental School, Piracicaba, Sao Paulo, Brazil, Phone: +55 19 2106-5211, e-mail: , Orcid: https://orcid.org/0000-0001-7729-8536
| | - Diana Leyva Del Rio
- Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio, United States of America, Orcid: https://orcid.org/0000-0001-7584-4302
| | - Cecilia Pedroso Turssi
- Division of Cariology and Restorative Dentistry, Sao Leopoldo Mandic Institute and Dental Research Center, Campinas, Sao Paulo, Brazil, Orcid: https://orcid.org/0000-0002-0078-9895
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Kaida K, Kubo S, Egoshi T, Taira Y. Eight-year clinical evaluation of two types of resin composite in non-carious cervical lesions. Clin Oral Investig 2022; 26:6327-6337. [PMID: 35751704 DOI: 10.1007/s00784-022-04587-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/10/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In this clinical study, the 8-year clinical performances of a flowable resin composite was compared with that of a conventional resin composite. MATERIALS AND METHODS Ninety non-carious cervical lesions (NCCLs) in 19 participants were involved in this trial. NCCLs were restored with a flowable composite (Clearfil Flow FX: FX, Kuraray Noritake, Japan) or a conventional resin composite (Clearfil AP-X: AP) in conjunction with a one-step self-etch adhesive (Clearfil S3 Bond). Each participant had both types of resin composite restorations that were randomly allocated. The restorations were evaluated at baseline and annually up to 8 years using modified USPHS criteria. The data were statistically analyzed using the Fisher's exact test, Kaplan-Meier method, and a multivariate Cox-regression with frailty models (p < 0.05). RESULTS The 8-year participant recall rate was 95%. One hundred percent retention was recorded for AP, whereas four out of 46 restorations were lost for FX during the 8 years. The incidence of marginal staining increased over time regardless of the type of resin composite, showing 48% for AP and 57% for FX after 8 years. Wear of the resin composite occurred only for the flowable material and there was a significant difference between the types of resin composite (p = 0.024). Overall survival rates at 8 years for AP and FX were 98% and 82% respectively (p = 0.110). CONCLUSIONS The flowable resin composite presented lower wear resistance and showed a lower survival rate compared with the conventional composite after eight years of clinical service. CLINICAL RELEVANCE Flowable resin composites may show greater wear after long-term clinical service. TRIAL REGISTRATION NUMBER UMIN000028745, Date of registration: August 19, 2017.
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Affiliation(s)
- Kei Kaida
- Division of Cariology and Restorative Dentistry, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8588, Japan
| | - Shisei Kubo
- Division of Cariology and Restorative Dentistry, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8588, Japan.
| | - Takafumi Egoshi
- Division of Cariology and Restorative Dentistry, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8588, Japan
| | - Yohsuke Taira
- Division of Cariology and Restorative Dentistry, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8588, Japan
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