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Jurado CA, Mekled S, Abuhammoud S, Azpiazu-Flores FX, Vegh D, Wang T, Morton D. Fracture resistance of partial and complete coverage veneers and ceramic crowns for maxillary central incisors. J Prosthet Dent 2024; 132:420.e1-420.e6. [PMID: 38729791 DOI: 10.1016/j.prosdent.2024.04.020] [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: 02/12/2024] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/12/2024]
Abstract
STATEMENT OF PROBLEM Minimally invasive treatments have gained popularity in recent years. However, research comparing the fracture resistance of lithium disilicate partial coverage veneer restorations with that of ceramic crowns is lacking. PURPOSE The purpose of this in vitro study was to evaluate and compare the fracture resistance of lithium disilicate restorations fabricated for preparations of various designs. The designs included veneer preparations with finish lines in the upper, middle, and lower third of the facial surface and ceramic crown preparations with margins in the lower third of the facial surface. All restorations were designed and fabricated using a chairside digital workflow. MATERIAL AND METHODS Four maxillary right central incisor typodont teeth were prepared for partial coverage veneer preparation with the margin in the upper middle third of the facial surface (PU1/3); partial coverage veneer preparation with margin in lower middle third of the facial surface (PL1/3); complete coverage veneer preparation (CV) with margin in the cervical region; and ceramic crown (CC) preparation. Each preparation was scanned, and 15 casts were 3D printed from each scan. A total of 60 lithium disilicate restorations were fabricated (n=15 per group) using a chairside computer-aided design and computer-aided manufacturing (CAD-CAM) system (Primescan and MCXL). The different restorations were cemented to the 3D printed testing dies with a photopolymerizable resin cement. The specimens were artificially aged with 10 000 thermal cycles between 5 and 55 °C with a dwell time of 30 seconds and were loaded to failure using a universal testing machine. The maximum load to fracture was analyzed using a 1-way ANOVA and post hoc Tukey honestly significant difference (HSD) test (α=.05). Additionally, the fracture patterns of the specimens were evaluated with a stereomicroscope for descriptive purposes. RESULTS The mean fracture resistance of the chairside CAD-CAM lithium disilicate veneers and ceramic crowns was statistically different depending on the design of the restoration (P<.05). Group CC demonstrated the highest fracture resistance values (1440.66 N), followed by CV (929.8 N) and PU1/3 (756.13 N). The lowest value was for PL1/3 (532.4 N). CONCLUSIONS The fracture resistance measured for the maxillary central incisor partial coverage veneers with margins in the middle third of the facial surface appear capable of resisting average occlusal forces. However, these veneers demonstrated lower fracture resistance values when compared with complete coverage veneers. Further, lithium disilicate crowns demonstrated higher fracture resistance than veneers, irrespective of their design.
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Affiliation(s)
- Carlos A Jurado
- Associate Professor and Director, Operative Dentistry Division, The University of Tennessee Health Science Center, Memphis, Tenn
| | - Salwa Mekled
- Clinical Associate Professor, Restorative Dentistry Department, Temple University Kornberg School of Dentistry, Philadelphia, Pa
| | - Salahaldeen Abuhammoud
- Associate Professor, Department of Prosthodontics, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa
| | | | - Daniel Vegh
- Assistant Professor, Department of Prosthodontics, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Ting Wang
- Prosthodontic Resident, Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, Ind
| | - Dean Morton
- Professor, Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, Ind; and Director, Center for Implant, Esthetic and Innovative Dentistry, Indiana University School of Dentistry, Indianapolis, Ind
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Jurado CA, Davila CE, Davila A, Hernandez AI, Odagiri Y, Afrashtehfar KI, Lee D. Influence of occlusal thickness on the fracture resistance of chairside milled lithium disilicate posterior full-coverage single-unit prostheses containing virgilite: A comparative in vitro study. J Prosthodont 2024. [PMID: 38790151 DOI: 10.1111/jopr.13870] [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: 10/04/2023] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
PURPOSE To evaluate the fracture resistance of chairside computer-aided design and computer-aided manufacturing (CAD-CAM) lithium disilicate mandibular posterior crowns with virgilite of different occlusal thicknesses and compare them to traditional lithium disilicate crowns. MATERIALS AND METHODS Seventy-five chairside CAD-CAM crowns were fabricated for mandibular right first molars, 60 from novel lithium disilicate with virgilite (CEREC Tessera, Dentsply Sirona), and 15 from traditional lithium disilicate (e.max CAD, Ivoclar Vivadent). These crowns were distributed across five groups based on occlusal thickness and material: Group 1 featured CEREC Tessera crowns with 0.8 mm thickness, Group 2 had 1.0 mm thickness, Group 3 had 1.2 mm thickness, Group 4 with 1.5 mm thickness, and Group 5 included e.max CAD crowns with 1.0 mm thickness. These crowns were luted onto 3D-printed resin dies using Multilink Automix resin cement (Ivoclar Vivadent). Subsequently, they underwent cyclic loading (2,000,000 cycles at 1 Hz with a 275 N force) and loading until fracture. Scanning electron microscopy (SEM) assessed the fractured specimens. Statistical analysis involved one-way ANOVA and the Kruskal-Wallis Test (α = 0.05). RESULTS Fracture resistance varied significantly (<0.001) across mandibular molar crowns fabricated from chairside CAD-CAM lithium disilicate containing virgilite, particularly between crowns with 0.8 mm and those with 1.2 and 1.5 mm occlusal thickness. However, no significant differences were found when comparing crowns with 1, 1.2, and 1.5 mm thicknesses. CEREC Tessera crowns with 1.5 mm thickness exhibited the highest resistance (2119 N/mm2), followed by those with 1.2 mm (1982 N/mm2), 1.0 mm (1763 N/mm2), and 0.8 mm (1144 N/mm2) thickness, whereas e.max CAD crowns with 1.0 mm occlusal thickness displayed the lowest resistance (814 N/mm2). CONCLUSIONS The relationship between thickness and fracture resistance in the virgilite lithium disilicate full-coverage crowns was directly proportional, indicating that increased thickness corresponded to higher fracture resistance. No significant differences were noted among crowns with thicknesses ranging from 1 to 1.5 mm. This novel ceramic exhibited superior fracture resistance compared to traditional lithium disilicate.
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Affiliation(s)
- Carlos A Jurado
- Operative Dentistry Division, Department of General Dentistry, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Christian Edgar Davila
- Division of Prosthodontics, Department of Restorative Dental Sciences, University of Florida College of Dentistry, Gainesville, Florida, USA
- Division of Prosthodontics, Department of Restorative Sciences, School of Dentistry, University of Alabama, Birmingham, Alabama, USA
| | - Alexandra Davila
- Division of Prosthodontics, Department of Restorative Dental Sciences, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - Alfredo I Hernandez
- A.T. Still University Arizona School of Dentistry and Oral Health, Mesa, Arizona, USA
| | - Yukari Odagiri
- Department of Operative Dentistry, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Kelvin I Afrashtehfar
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, Faculty of Medicine, University of Bern, Bern, Switzerland
- Clinical Sciences Department, College of Dentistry, Ajman University, Ajman City, UAE
- Consultant Private Practice Limited to Prosthodontics and Pre-Prosthetic Surgery, Abu Dhabi, UAE
- Consultant Private Practice Limited to Prosthodontics, Esthetic and Implant Dentistry, Dubai, UAE
- Division of Periodontology, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, Aachen, Germany
| | - Damian Lee
- Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
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Jurado CA, Afrashtehfar KI, Robles M, Alaqeely RS, Alsayed HD, Lindquist TJ, Alhotan A. Effect of preparation design and endodontic access on fracture resistance of zirconia overlays in mandibular molars: An in vitro study. J Prosthodont 2024. [PMID: 38734932 DOI: 10.1111/jopr.13865] [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: 04/15/2023] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
PURPOSE To evaluate the fracture resistance of zirconia overlays, considering various preparation designs and the presence of endodontic access. MATERIALS AND METHODS Ninety translucent zirconia (5Y-PSZ) overlay restorations were divided into six groups (n = 15/group) based on different preparation designs, with and without endodontic access: chamfer margin 4 mm above the gingival level without (group 1) and with endodontic access (group 2); margin 2 mm above the gingival level without (group 3) and with endodontic access (group 4); overlay with no chamfer margin without (group 5) and with endodontic access (group 6). Restorations were bonded to mandibular first molar resin dies, and the groups with endodontic access were sealed with flowable resin composite. All restorations underwent 100,000 cycles of thermal cycling between 5°C and 55°C, followed by loading until fracture. Maximum load and fracture resistance were recorded. ANOVA with Tukey post-hoc tests were used for statistical comparison (α < 0.05). RESULTS Fracture resistance significantly varied among overlay designs with and without endodontic access (p < 0.001), except for the no-margin overlays (groups 5 and 6). Overlays with a 2 mm margin above the gingival margin with endodontic access (group 4) exhibited significantly higher fracture resistance compared to both the 4-mm supragingival (group 2) and no-margin (group 6) designs, even when compared to their respective intact groups (groups 1 and 5). There were no significant differences between the no-margin and 4-mm supragingival overlays. CONCLUSION The more extensive zirconia overlay for mandibular molars is the first choice since the 2 mm margin above the gingival level design withstood considerable loads even after undergoing endodontic access. A no-margin overlay is preferred over the 4-mm supragingival design as it preserves more tooth structure and there was no outcome difference, irrespective of endodontic access. Caution is warranted in interpreting these findings due to the in vitro nature of the study.
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Affiliation(s)
- Carlos A Jurado
- Operative Dentistry Division, Department of General Dentistry, University of Tennessee Health Science Center College of Dentistry, Memphis, Tennessee, USA
| | - Kelvin I Afrashtehfar
- Department of Reconstructive Dentistry and Gerodontology (RekGero), School of Dental Medicine, University of Bern, Bern, Switzerland
- Evidence-Based Practice Unit (EBPU), Clinical Sciences Department, College of Dentistry, Ajman University, Ajman City, UAE
- Prosthodontics Private Practice, Dental Clinics, Abu Dhabi, UAE
- Artificial Intelligence Research Center (AIRC), Ajman University, Dubai, UAE
| | - Manuel Robles
- Department of Restorative Dentistry, Universidad del Valle De Mexico, Hermosillo, Sonora, Mexico
| | - Razan S Alaqeely
- Department of Periodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Hussain D Alsayed
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saudi University, Riyadh, Saudi Arabia
| | - Terry J Lindquist
- Department of Prosthodontics, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa, USA
| | - Abdulaziz Alhotan
- Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Jurado CA, Alresayes S, Rojas-Rueda S, Alqahtani A, Tsujimoto A, Fischer NG, Afrashtehfar KI. Ceramic versus Composite Resin Polishing Systems on the Surface Roughness of Milled Leucite-Reinforced Ceramics. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1048. [PMID: 37374252 DOI: 10.3390/medicina59061048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023]
Abstract
Background and Objective: This study aimed to compare the surface finish of milled leucite-reinforced ceramics polished with ceramic and composite polishing systems based on the manufacturers' recommendations. Materials and Methods: Sixty subtractive computer-aided manufactured (s-CAM) leucite-reinforced glass-ceramic specimens (IPS-Empress-CAD) were assigned into six groups: no polishing, a ceramic polishing kit, and four composite kit groups. The roughness average (Ra) was evaluated in microns using a profilometer, and scanning electron micrographs were obtained for qualitative analysis. A Tukey HSD posthoc test (α = 0.05) was used to determine significant intergroup differences. Results: After surface evaluation of the ceramics, the Ra values of the polishing systems ranked OptraFine (0.41 ± 0.26) < Enhance (1.60 ± 0.54) < Shofu (2.14 ± 0.44) < Astropol (4.05 ± 0.72) < DiaComp (5.66 ± 0.62) < No Polishing (5.66 ± 0.74). Discussion: Composite polishing systems did not provide as smooth surfaces as the ceramic polishing kit for CAD-CAM leucite-reinforced ceramics. Thus, using ceramic polishing systems, polishing leucite ceramics is recommended, whereas composite polishing systems should not be considered as an alternative for use in minimally invasive dentistry.
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Affiliation(s)
- Carlos A Jurado
- Department of Prosthodontics, University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA 52242, USA
| | - Saad Alresayes
- Department of Prosthetic Dental Sciences, King Saud University College of Dentistry, Riyadh 11545, Saudi Arabia
| | - Silvia Rojas-Rueda
- School of Dentistry, Pontifical Xaverian University, Bogota 110231, Colombia
| | - Ali Alqahtani
- Department of Periodontics and Community Dentistry, King Khalid University College of Dentistry, Abha 62529, Saudi Arabia
| | - Akimasa Tsujimoto
- Department of Operative Dentistry, Aichi Gakuin University School of Dentistry, Nagoya 646-8650, Japan
| | - Nicholas G Fischer
- Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kelvin I Afrashtehfar
- Evidence-Based Practice Unit, Clinical Sciences Department, Ajman University College of Dentistry, Ajman City P.O. Box 346, United Arab Emirates
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland
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Ellakany P, Aly NM, Alghamdi MM, Alameer ST, Alshehri T, Akhtar S, Madi M. Effect of Different Scaling Methods on the Surface Topography of Different CAD/CAM Ceramic Compositions. MATERIALS (BASEL, SWITZERLAND) 2023; 16:2974. [PMID: 37109810 PMCID: PMC10143924 DOI: 10.3390/ma16082974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/25/2023] [Accepted: 04/03/2023] [Indexed: 06/19/2023]
Abstract
This study evaluated the effect of ultrasonic and manual scaling using different scaler materials on the surface topography of computer-aided designing and computer-aided manufacturing (CAD/CAM) ceramic compositions. After scaling with manual and ultrasonic scalers, the surface properties of four classes of CAD/CAM ceramic discs: lithium disilicate (IPE), leucite-reinforced (IPS), advanced lithium disilicate (CT), and zirconia-reinforced lithium silicate (CD) of 1.5 mm thickness were evaluated. Surface roughness was measured before and after treatment, and scanning electron microscopy was used to evaluate the surface topography following the performed scaling procedures. Two-way ANOVA was conducted to assess the association of the ceramic material and scaling method with the surface roughness. There was a significant difference in the surface roughness between the ceramic materials subjected to different scaling methods (p < 0.001). Post-hoc analyses revealed significant differences between all groups except for IPE and IPS where no significant differences were detected between them. CD showed the highest surface roughness values, while CT showed the lowest surface roughness values for the control specimens and after exposure to different scaling methods. Moreover, the specimens subjected to ultrasonic scaling displayed the highest roughness values, while the least surface roughness was noted with the plastic scaling method.
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Affiliation(s)
- Passent Ellakany
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 32210, Saudi Arabia
| | - Nourhan M. Aly
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria 21527, Egypt
| | - Maram M. Alghamdi
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 32210, Saudi Arabia
| | - Shahad T. Alameer
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 32210, Saudi Arabia
| | - Turki Alshehri
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 32210, Saudi Arabia
| | - Sultan Akhtar
- Department of Biophysics, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Marwa Madi
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 32210, Saudi Arabia
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Ellakany P, Madi M, Aly NM, Alshehri T, Alameer ST, Al-Harbi FA. Influences of Different CAD/CAM Ceramic Compositions and Thicknesses on the Mechanical Properties of Ceramic Restorations: An In Vitro Study. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16020646. [PMID: 36676383 PMCID: PMC9865408 DOI: 10.3390/ma16020646] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/24/2022] [Accepted: 12/26/2022] [Indexed: 05/14/2023]
Abstract
The aim of this study was to assess the influences of different CAD/CAM ceramic compositions and thicknesses on the surface roughness and hardness of ceramic restorations. Four different ceramics were used in the current study: lithium disilicate (LD), leucite reinforced (LE), advanced lithium disilicate (ALD), and zirconia-reinforced lithium silicate (ZLS). Each group included 30 specimens subdivided into three different ceramic thicknesses (0.5, 1 and 1.5 mm thicknesses). The microhardness was measured for all the specimens using a microhardness testing machine, while the surface roughness was measured using a non-contact optical profilometer at three intervals (before toothbrushing and after toothbrushing, with and without toothpaste). Three-way and two-way ANOVA were used to determine the factors influencing the surface roughness and microhardness. There was a significant difference in the surface roughness between the studied groups for all the thicknesses. The findings showed that ALD had the lowest surface roughness, while ZLS showed the highest surface roughness. Moreover, ALD, followed by ZLS, had the highest hardness, while LD and LE had the lowest hardness values. Regarding the thicknesses, both the 0.5 and 1 mm ceramic thicknesses showed a significantly lower surface roughness than the 1.5 mm thickness, while the 1.5 mm thickness showed a significantly higher microhardness than the 0.5 mm thickness. The surface roughness and hardness were significantly affected by the ceramic composition and type of filler. It is recommended to use 1.5 mm-thick ceramic materials for the fabrication of definitive full-coverage ceramic restorations, while veneers require 0.5 mm-thick materials. ALD is a promising CAD/CAM material that can be used for the fabrication of restorations with a proper strength in both anterior and posterior regions.
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Affiliation(s)
- Passent Ellakany
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 32210, Saudi Arabia
- Correspondence: ; Tel.: +966-547812107
| | - Marwa Madi
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 32210, Saudi Arabia
| | - Nourhan M. Aly
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria 21527, Egypt
| | - Turki Alshehri
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 32210, Saudi Arabia
| | - Shahad T. Alameer
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 32210, Saudi Arabia
| | - Fahad A. Al-Harbi
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 32210, Saudi Arabia
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Alshabib A, Jurado CA, Tsujimoto A. Short fiber-reinforced resin-based composites (SFRCs); Current status and future perspectives. Dent Mater J 2022; 41:647-654. [PMID: 35858793 DOI: 10.4012/dmj.2022-080] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
One technique for placing of resin-based composite for large posterior cavities is the use of short fiber-reinforced resin-based composite (SFRC) to replace dentin in a biomimetic approach. As endurance under mastication cycles is a significant consideration in the clinical success of resin-based composite posterior restorations, the use of SFRC as a base material may prevent restorative fracture due to the fibers' effectiveness in stopping cracks. This review article specifies the characteristics of SFRC and describes the major underlying mechanisms of short fiber reinforcement for resin-based composite. Insights are further taken from laboratory studies used to define the short fiber-related properties of resin-based composite and the performance of currently available materials, focusing on aspects that are relevant to the reinforcement of resin-based composite. Finally, future standpoints on the development of SFRCs with nano fibers and different resin monomers, and their role in digital dentistry, are discussed.
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Affiliation(s)
- Abdulrahman Alshabib
- Department of Restorative Dentistry, King Saud University College of Dentistry.,Engr. Abdullah Bugshan Research Chair for Dental & Oral Rehabilitation, King Saud University
| | - Carlos A Jurado
- Texas Tech University Health Sciences Center El Paso Woody L. Hunt School of Dental Medicine
| | - Akimasa Tsujimoto
- Department of Operative Dentistry, University of Iowa College of Dentistry.,Department of General Dentistry, Creighton University School of Dentistry
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