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Hofsteenge JW, Carvalho MA, Botenga ELF, Cune MS, Özcan M, Magne P, Gresnigt MMM. Effect of preparation design on fracture strength of compromised molars restored with direct composite resin restorations: An in vitro and finite element analysis study. J Prosthet Dent 2024; 131:1150-1158. [PMID: 38670907 DOI: 10.1016/j.prosdent.2024.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
STATEMENT OF PROBLEM More data are needed on the influence of preparation design on the fracture strength, failure type, repairability, and polymerization-induced cracks of molar teeth restored with direct composite resin restorations. PURPOSE This in vitro and finite element analysis study investigated the effect of different preparation designs on fracture strength, failure type, repairability, tooth deformation, and the formation of polymerization-induced cracks of compromised molars restored with direct composite resin restorations. MATERIAL AND METHODS Human molars (n=64) were randomly assigned to 4 different preparation designs: undermined inlay (UI), extended inlay (EI), restricted overlay (RO), and extended overlay (EO). The teeth were restored using direct composite resin and subjected to artificial thermomechanical aging in a mastication simulator, followed by load-to-failure testing. Three-dimensional (3D) finite element analysis was conducted to assess tooth deformation. Polymerization-induced cracks were evaluated using optical microscopy and transillumination. The fracture strength data were analyzed using a Kruskal-Wallis test, while the failure mode, repairability, and polymerization cracks were analyzed using the Fisher exact test (α=.05). RESULTS All specimens withstood thermomechanical aging, and no statistically significant difference in fracture strength was observed among the 4 preparation designs (P>.05). The finite element analysis showed differences in tooth deformation, but no correlation was observed with in vitro fracture resistance. The RO and EO groups presented significantly more destructive failures compared with the UI and EI groups (P<.01). The RO group had significantly fewer repairable failures than the UI and EI groups (P=.024). A correlation was found between higher frequencies of repairability and higher tooth deformation. A significant correlation between the increase in microfractures and preparation design was observed (P<.01), with the UI group exhibiting a higher increase in microfracture size compared with the EO group (P<.05). CONCLUSIONS No influence of preparation design on the fracture strength of compromised molars restored with direct composite resin restorations was evident in this study, but the failure mode of cusp coverage restorations was more destructive and often less repairable. The finite element analysis showed more tooth deformation in inlay preparations, with lower stresses within the root, leading to more reparable fractures. Since cusp coverage direct composite resin restorations fractured in a more destructive manner, this study suggests that even a tooth with undermined cusps should be restored without cusp coverage.
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Affiliation(s)
- Jelte W Hofsteenge
- Postgraduate student, Department of Restorative Dentistry, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Marco Aurelio Carvalho
- Associate Professor, School of Dentistry, Evangelical University of Goias (UniEVANGÉLICA), Anapolis, Brazil
| | - Elenoor L F Botenga
- Graduate student, Department of Restorative Dentistry, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marco S Cune
- Professor, Department of Restorative Dentistry, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mutlu Özcan
- Professor, Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Pascal Magne
- Director, Center for Education and Research in Biomimetic Restorative Dentistry (CER BRD), Beverly Hills, Calif
| | - Marco M M Gresnigt
- Associate Professor, Department of Restorative Dentistry, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Néma V, Kunsági-Máté S, Őri Z, Kiss T, Szabó P, Szalma J, Fráter M, Lempel E. Relation between internal adaptation and degree of conversion of short-fiber reinforced resin composites applied in bulk or layered technique in deep MOD cavities. Dent Mater 2024; 40:581-592. [PMID: 38368136 DOI: 10.1016/j.dental.2024.02.013] [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: 10/01/2023] [Revised: 01/08/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE The purpose was to evaluate the degree of conversion (DC), internal adaptation (IA) and closed porosity (CP) of short-fiber reinforced resin composites (SFRC) associated with layered or bulk restorative procedures in deep MOD cavities. METHODS Eighty third molars with standardized MOD cavities (5-mm-depth, 2.5-mm-width) were randomly divided into four groups and restored as follows: 1) bulk SFRC; 2) layered SFRC; 3) flowable bulk-fill resin-based composites (RBC); 4) layered conventional RBC. After one-month wet storage the samples were subjected to micro-computed tomography measurements and scanning electron microscopy to assess the IA and CP. Micro-Raman spectroscopy was used to determine the DC in different depths. Data were subjected to ANOVA and Tukey's post-hoc test, multivariate analysis and partial eta-squared statistics (p < 0.05). Pearson correlation coefficient was determined to assess the relationship among the parameters of interest. RESULTS Gap/total interface volume ratio ranged between 0.22-0.47%. RBCs applied in bulk revealed significantly lower gap volume (p < 0.001) and CP (p < 0.05). Each group showed complete detachment on the pulpal and partial on the lateral walls, except for group3. While the highest DC% was achieved by the conventional RBC (87.2%), followed by the flowable bulk-fill (81.2%), SFRC provided the best bottom to top DC ratio (bulk: 96.4%, layered: 98.7%). The effect of factors studied (RBC type, filling technique) on IA and DC was significant (p < 0.001). SIGNIFICANCE Bulk placement of RBCs exhibited lower interfacial gap volume and achieved satisfactory DC without significant correlation between these parameters. Incremental insertion of SFRC had no advantage over bulk placement in terms of IA and DC.
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Affiliation(s)
- Viktória Néma
- Department of Operative and Esthetic Dentistry, Faculty of Dentistry, University of Szeged, Tisza Lajos Blvd 64-66, 6720 Szeged, Hungary
| | - Sándor Kunsági-Máté
- Department of Organic and Pharmacological Chemistry, University of Pécs Medical School, Faculty of Pharmacy, Honvéd street 1, 7624 Pécs, Hungary; János Szentágothai Research Center, University of Pécs, Ifjúság Street 12, 7624 Pécs, Hungary
| | - Zsuzsanna Őri
- Department of Nutritional Sciences and Dietetics, University of Pécs, Faculty of Health Sciences, Vörösmarty Street 4, 7621 Pécs, Hungary; Department of Physical Chemistry and Materials Science, University of Pécs, Faculty of Sciences, Ifjúság Street 6, 7624 Pécs, Hungary
| | - Tamás Kiss
- Department of Pharmacology and Pharmacotherapy, University of Pécs Medical School, Szigeti Street 12, 7624 Pécs, Hungary
| | - Péter Szabó
- János Szentágothai Research Center, University of Pécs, Ifjúság Street 12, 7624 Pécs, Hungary
| | - József Szalma
- Department of Oral and Maxillofacial Surgery, University of Pécs Medical School, Tüzér Street 1, 7623 Pécs, Hungary
| | - Márk Fráter
- Department of Operative and Esthetic Dentistry, Faculty of Dentistry, University of Szeged, Tisza Lajos Blvd 64-66, 6720 Szeged, Hungary
| | - Edina Lempel
- Department of Restorative Dentistry and Periodontology, University of Pécs Medical School, Tüzér Street 1, 7623 Pécs, Hungary.
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Szczesio-Wlodarczyk A, Garoushi S, Vallittu P, Bociong K, Lassila L. Polymerization shrinkage stress of contemporary dental composites: Comparison of two measurement methods. Dent Mater J 2024; 43:155-163. [PMID: 38296513 DOI: 10.4012/dmj.2023-192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The aim of this study was to compare two testing methodologies employed for assessing the polymerization shrinkage stress of dental resin composites. Ten commercial resin composites were investigated (EverX Posterior & Flow; G-ænial Anterior, Posterior, A'CHORD & Universal Injectable; Filtek One Bulk Fill & Universal Restorative; SDR flow+ and Aura Bulk Fill). Photoelastic and contraction forces measurement methods were performed. The slope of the linear trendline and C-factor of specimens were calculated. The shrinkage stress values (range between: 6.4-13.4 MPa) obtained by the photoelastic method were higher for all resin composites than the values obtained by contraction forces measurements (range between 1.2-4.8 MPa). However, there was a strong linear correlation between these methods (r=0.8). The use of both investigated methods revealed important information about the shrinkage behavior of the restorative resin composites.
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Affiliation(s)
| | - Sufyan Garoushi
- Department of Biomaterials Science and Turku Clinical Biomaterials Center-TCBC, Institute of Dentistry, University of Turku
| | - Pekka Vallittu
- Department of Biomaterials Science and Turku Clinical Biomaterials Center-TCBC, Institute of Dentistry, University of Turku
- Wellbeing Services County of South-West Finland
| | - Kinga Bociong
- Department of General Dentistry, Medical University of Lodz
| | - Lippo Lassila
- Department of Biomaterials Science and Turku Clinical Biomaterials Center-TCBC, Institute of Dentistry, University of Turku
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ElAziz RHA, ElAziz SAA, ElAziz PMA, Frater M, Vallittu PK, Lassila L, Garoushi S. Clinical evaluation of posterior flowable short fiber-reinforced composite restorations without proximal surface coverage. Odontology 2024:10.1007/s10266-024-00905-5. [PMID: 38393515 DOI: 10.1007/s10266-024-00905-5] [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: 09/29/2023] [Accepted: 01/11/2024] [Indexed: 02/25/2024]
Abstract
The purpose of this clinical trail was to assess the clinical behavior of posterior composite restorations supported by a substantial foundation of flowable short fiber-reinforced composite SFRC (everX Flow, GC, Japan) used without proximal surface coverage with particulate filler resin composite (PFC). Seventy patients (20 males, 50 females; mean age: 30 ± 10 years) were randomly enrolled in this trial. Patients received direct restorations of either SFRC covered only on the occlusal surface (1-2 mm) by conventional PFC composite (G-ænial Posterior, GC), or plain conventional PFC composite without fiber-reinforcement, in Class II cavities in premolar and molar vital teeth. One operator made all restorations using one-step, self-etch bonding agent (G-ænial Bond, GC) according to manufacturers' recommendations. Two blinded trained operators evaluated the restorations at baseline, at 6, 12 and 18 months using modified USPHS criteria. Results indicated that, in both groups and at different follow-up intervals, according to evaluated criteria, restorations were rated mostly with best score (Alpha) (p > 0.05). For the marginal integrity after 6 months, a single case in the intervention [increased to 3 (8.8%) after 18 months] and 3 (9.7%) cases of the control group [increased to 4 (12.9%) after 18 months] had Bravo score but with no significant difference (p > 0.05). For color match measured after 6 and 18 months, three (8.8%) cases had Bravo score in the intervention group. The use of flowable SFRC composite without any PFC surface coverage proximally in Class II restorations demonstrated satisfactory clinical outcome throughout the 18-month follow-up.
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Affiliation(s)
- Rawda H Abd ElAziz
- Conservative Dentistry Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Sherifa A Abd ElAziz
- Conservative Dentistry Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Possy M Abd ElAziz
- Conservative Dentistry Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Mark Frater
- Department of Operative and Esthetic Dentistry, Faculty of Dentistry, University of Szeged, Szeged, Hungary
| | - Pekka K Vallittu
- Department of Biomaterials Science and Turku Clinical Biomaterials Center-TCBC, Institute of Dentistry, University of Turku, Itäinen Pitkäkatu 4B, 20520, Turku, Finland
- Wellbeing Services County of South-West Finland, Turku, Finland
| | - Lippo Lassila
- Department of Biomaterials Science and Turku Clinical Biomaterials Center-TCBC, Institute of Dentistry, University of Turku, Itäinen Pitkäkatu 4B, 20520, Turku, Finland
| | - Sufyan Garoushi
- Department of Biomaterials Science and Turku Clinical Biomaterials Center-TCBC, Institute of Dentistry, University of Turku, Itäinen Pitkäkatu 4B, 20520, Turku, Finland.
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Elawsya ME, Montaser MA, El-Wassefy NAM, Zaghloul NM. Two-year clinical performance of dual- and light-cure bulk-fill resin composites in Class ӀӀ restorations: a randomized clinical trial. Clin Oral Investig 2024; 28:138. [PMID: 38321228 PMCID: PMC10847201 DOI: 10.1007/s00784-024-05538-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE This study aimed to compare the clinical performance of dual- and light-cure bulk-fill resin composites (BFRCs) in Class ӀӀ restorations after 2 years. MATERIALS AND METHODS A double-blinded, prospective, randomized clinical trial (RCT) was conducted following the CONSORT (Consolidated Standard of Reporting Trials) guidelines. Forty patients were enrolled in the study. Each patient received three compound Class ӀӀ restorations. One dual-cure (Fill-Up; Coltene Waledent AG) and two light-cure (QuiXfil; Dentsply, and Tetric N-Ceram Bulk Fill; Ivoclar Vivadent) BFRCs were used for 120 Class ӀӀ restorations. A universal adhesive (ONE COAT 7 UNIVERSAL; Coltene Waledent AG) was used with all restorations. Restorations were clinically evaluated after 1 week (baseline), 6 months, 12 months, 18 months, and finally after 24 months using the FDI World Dental Federation (FDI) criteria. The Kruskal-Wallis test was used for comparison between BFRCs groups at baseline and at each recall period, and the Wilcoxon signed-rank test was used for comparing different follow-up times of each BFRC to baseline. The level of significance was set at p < 0.05. RESULTS All BFRCs restorations showed only minor changes and revealed no statistically significant differences between their clinical performance for all evaluated parameters at all recall periods; also, there was no statistically significant difference between all recall periods and baseline for all evaluated parameters. CONCLUSION The two-year clinical performance of dual-cure BFRC was comparable to light-cure BFRCs in Class ӀӀ restorations. CLINICAL RELEVANCE Dual- and light-cure BFRCs showed excellent clinical performance in Class ӀӀ restorations after a 2-year clinical follow-up.
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Affiliation(s)
- Mohamed Elshirbeny Elawsya
- Department of Conservative Dentistry, Faculty of Dentistry, Mansoura University, Algomhoria Street, P.O. Box 35516, Mansoura, Aldakhlia, Egypt.
| | - Marmar Ahmed Montaser
- Department of Conservative Dentistry, Faculty of Dentistry, Mansoura University, Algomhoria Street, P.O. Box 35516, Mansoura, Aldakhlia, Egypt
| | - Noha Abdel-Mawla El-Wassefy
- Department of Dental Biomaterials, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
- Department of Dental Biomaterials, Faculty of Dentistry, Mansoura National University, Mansoura, Egypt
| | - Nadia Mohamed Zaghloul
- Department of Conservative Dentistry, Faculty of Dentistry, Mansoura University, Algomhoria Street, P.O. Box 35516, Mansoura, Aldakhlia, Egypt
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Fráter M, Grosz J, Jakab A, Braunitzer G, Tarjányi T, Gulyás G, Bali K, Villa-Machado PA, Garoushi S, Forster A. Evaluation of microhardness of short fiber-reinforced composites inside the root canal after different light curing methods - An in vitro study. J Mech Behav Biomed Mater 2024; 150:106324. [PMID: 38113823 DOI: 10.1016/j.jmbbm.2023.106324] [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: 10/29/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Short fiber-reinforced composite (SFRC) materials make it possible to reinforce root canal treated teeth with individualized, directly layered intraradicular posts (the Bioblock technique). The question arises, however, as to whether the photopolymerization of the material is sufficient deep within the root canal space and if it can be improved through different light-conducting options. Our study aimed to investigate the hardness of intraradicular SFRC material applied using the Bioblock technique and cured with various illumination methods, as measured through nanoindentation. MATERIALS AND METHODS For this investigation, thirty plastic artificial teeth that had undergone root canal treatment were selected. These teeth were randomly divided into six study groups (Group 1-6; each group consisting of 5 teeth). The restoration procedures involved the use of SFRC or conventional composite materials, placed 6 mm apically from the root canal orifice. In Group 1 and 2, a conventional composite was used, whereas in Group 3-6, SFRC was employed for interradicular reinforcement (with a layered technique in Group 3 and 4 and a bulk-fill technique in Group 5 and 6). A modified light source was utilized for photopolymerization in Group 2, 4, and 6, whereas in Group 3 and 5, the polymerization light was directed through a prefabricated glass fiber posts. The control group (Group 1) utilized conventional composite material with a standard light-curing method. Following embedding and sectioning, the hardness of the composite materials was measured at 2 mm intervals within the root canal (1st, 2nd, 3rd measurements, in the coronal to apical direction). RESULTS During the 1st measurement, light curing conducted through the glass fiber posts (Group 3 and 5) led to markedly higher hardness levels compared to the groups restored with conventional composite (control group with p = 0.002, p = 0.001, and Group 2 with p = 0.043, p = 0.034, respectively). In the 2nd measurement, only Group 5 demonstrated significantly greater hardness in comparison to the control group (p = 0.003) and Group 2 (p = 0.015). However, in the 3rd measurement, no statistically significant differences were observed among the groups. CONCLUSION light curing through the glass fiber post provides outstanding hardness for the SFRC material in the apical layer in the root canal.
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Affiliation(s)
- Márk Fráter
- Department of Operative and Esthetic Dentistry, Faculty of Dentistry, University of Szeged, Szeged, Hungary.
| | - János Grosz
- Urban Regeneration Institute, Budapest, Hungary
| | - András Jakab
- Department of Operative and Esthetic Dentistry, Faculty of Dentistry, University of Szeged, Szeged, Hungary
| | | | - Tamás Tarjányi
- SEMILAB Semiconductor Physics Laboratory Co. Ltd., Budapest, Hungary; Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Gábor Gulyás
- SEMILAB Semiconductor Physics Laboratory Co. Ltd., Budapest, Hungary
| | - Krisztián Bali
- SEMILAB Semiconductor Physics Laboratory Co. Ltd., Budapest, Hungary
| | | | - Sufyan Garoushi
- Department of Biomaterials Science, Turku Clinical Biomaterials Center -TCBC, Institute of Dentistry, University of Turku, Turku, Finland
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Garoushi S, Akbaşak-Sungur AÖ, Erkut S, Vallittu PK, Uctasli S, Lassila L. Evaluation of fracture behavior in short fiber-reinforced direct and indirect overlay restorations. Clin Oral Investig 2023; 27:5449-5458. [PMID: 37477724 PMCID: PMC10492695 DOI: 10.1007/s00784-023-05164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES The aim was to assess how incorporating a short-fiber composite (SFC) core would affect the fracture behavior of direct and indirect overlays. Furthermore, to examine the relationship between the thickness ratio of SFC core to particulate-filled composite (PFC) veneering and the fracture-behavior of bilayered-structured restorations. MATERIALS AND METHODS A total of 120 molars were used to create MOD cavities, with palatal cusps removed. Four different groups of direct overlays were then made (n = 15/group), all of which featured a SFC core (everX Flow) with varying thicknesses (0, 1, 4, and 5 mm), as well as a surface layer of PFC (G-aenial Posterior), with the overall thickness of the bilayered-structured restoration set at 5 mm. Additionally, four groups of CAD/CAM restorations were created (Cerasmart 270 and Initial LiSi Block), with or without 2 mm of SFC core reinforcement. Following the fabrication of these restorations, cyclic fatigue aging was carried out for a total of 500,000 cycles, with an applied maximum load (Fmax) of 150 N. Subsequently, each restoration underwent quasi-static loading until fracture. The fracture mode was subsequently evaluated using optical microscopy and SEM. RESULTS There were no statistically significant differences (p > 0.05) observed in the fracture resistance of indirect overlays reinforced with a 2-mm SFC core compared to those made solely from restorative materials. Direct overlays constructed using plain SFC or with a 4-mm layer thickness of SFC core exhibited significantly higher fracture resistance values (2674 ± 465 and 2537 ± 561 N) (p < 0.05) when compared to all other groups tested, according to the statistical analysis ANOVA. CONCLUSIONS The most effective method for restoring large MOD cavities was found to be direct restoration using SFC either alone or as a bulk core in combination with PFC composite. CLINICAL RELEVANCE The use of SFC as bulk reinforcing base will significantly improve the loading performance of directly layered restorations.
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Affiliation(s)
- S Garoushi
- Department of Biomaterials Science and Turku Clinical Biomaterial Center -TCBC, Institute of Dentistry, University of Turku, Turku, Finland.
| | - A Ö Akbaşak-Sungur
- Department of Prosthetic Dentistry, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - S Erkut
- Department of Prosthetic Dentistry, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - P K Vallittu
- Department of Biomaterials Science and Turku Clinical Biomaterial Center -TCBC, Institute of Dentistry, University of Turku, Turku, Finland
- Wellbeing Services County of Southwest Finland, Turku, Finland
| | - S Uctasli
- Department of Prosthodontics, Faculty of Dentistry, University of Ankara, Ankara, Turkey
| | - L Lassila
- Department of Biomaterials Science and Turku Clinical Biomaterial Center -TCBC, Institute of Dentistry, University of Turku, Turku, Finland
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