elm ato Oy Direct Composite Resin Restorations of the Anterior Single Tooth: Clinical Implications and Practical Applications Nitzan Bichacho, DMD Vice President of the European ‘Academy of Esthetic Dentistry Private Practice Limited to Prosthodontics Director of Aesthetic Dentistry Department of Prosthodontics Goldschleger School of Dental Medicine Tel Aviv University Tel Avio, Israel he introduction of rein- forced Bis-GMA resin as 4 composite resin restor- ative material coupled with the acid-etching technique! greatly improved the esthetics and longevity of direct anterior restorations. Initially, these prod- ucts used large ceramic particles for filler. Subsequent formula- tions have included various glasses and submicron silica par- ticles, either alone or in a mix, to enhance the physical properties. However, before this decade, clinical results were disappoint. ing; leakage, wear, microscopic and gross fracture, and color change problems were common.”* ‘The conversion to the available 796 Compendium » August 1996 Abstract Moder technology has continued to improve composite resins to the point where they are commonly used in restorative dentistry. In spite of some drawbacks, such as polymerization shrinkage, incom- plete conversion and cross-linking, and undesirable water sorption, the expected time of service of these restorations is extended continu. ‘ously due to physical and chemical improvements. The improved han- dling and excellent optical properties of the latest generation of com- osite resins can provide the appearance of natural dentition. Sophisti- cated effects can be obtained through the use of direct intraoral applications of stratification techniques. This article discusses com- ‘mon indications for direct restoration of anterior teeth and their treat- ‘ment in order to be biocompatible with the adjacent hard and soft tis- sues and to meet the requirements of form, function, and phonetics. | ain PERDUE TEER CERES SESE WATE ‘bonds of Bis-GMA restorative res- tion." Microorganisms that accu- ins for direct intraoral use has mulate at margin defects may also been shown to be in the 50% to cause recurrent caries." Micro- 70% range.® Improved physical leakage leading to secondary car- Properties, such as surface hard- ies has been reported as the pre- ness, correlated directly with the dominant reason for replacement degree of cure of the resin matrix of composite resin restorations. Polymerization shrinkage and Good margin qualities are ob- thermal expansion/contraction of tained with enamel-bonded? and ‘composite resins counteract mar- _ dentin-bonded™ composite res- ginal bonding. ins, However, some of the charac- Because the main purpose of a _teristics inherent to composite res- dental restoration is to restore the ins may destroy good bonding tooth’s form and function, the in- and good margin adaptation dur- ability to provide a tight seal may ing polymerization." Also, if the cause a catastrophic failure as a composite resin is bonded to the result of colonization of microor- cavity walls, internal stresses are ganisms at the margin’s gap? built up around the margins. The Toxins produced by these micro- magnitude of these stresses de- organisms and their metabolic _ pends on a variety of factors. products may penetrate toward The filler/resin ratio, the the pulp, causing pulpal inflamma- modulus of elasticity, the free-sur- Vol. 17, No. & ite RESPL Fae Fees a SRge STEERS EGE TERS S co VoFigure 1A—Unesthetlc, old, and defec- tive restoration ofthe lft maxillary cen- tral inclsor. face /bonded-surface ratio, and the type and speed of the poly- merization reaction all influence the stress level." However, some of the initial stresses may be re- lieved as a result of water uptake of the composite resin and the subsequent increase in water vol- ume. Adequate radiopacity of resto- ration material is of primary im- portance for radiographic diagno- sis of caries, as are voids, marginal contours, and overhangs that may Jead to detrimental periodontal ef- fects.>+® The American Dental As- sociation described two categories of direct-filling composite resins in specification No. 27." More elaborate rankings are based on the specific filler-size distribution and amount of incorporated filler "® as well as on filler com- Position.*' Filler content and size have been shown to directly de- termine the physical and me- chanical properties of composite resin materials. Among these Properties, Young’s modulus, surface hardness, and intrinsic surface roughness” should have been the most clinically relevant for the materials’ mechanical per- formance. However, despite the different laboratory tests and results, it seems that there isa small correla- tion between mechanical proper- ties and the. clinical performance of composite resins. Modern, advanced technology continues to develop improved composite resins. As a result, the Vol. 17, No.8 Figure 1B—Tooth preparation: because the exposed dentin was deep, a light- ‘ured, glass ionomer liner was used, and «a chamfer finish line Increased the adhe- sive surface. use of new composite resins has become common in restorative dentistry. Although considered the best esthetic direct-restorative material,” drawbacks still exist, including excessive polymeriza- tion shrinkage, incomplete con- version and cross-linking, and un- desirable water sorption. ‘The present restorative materi- als are not panaceas; rather, the latest generation of composite resin materials and adhesive sys- tems provide promising physical and chemical characteristics. The improved handling and excellent ‘optical properties enable the clini- cian to replicate the appearance of natural dentition so that the resto- ration is indistinguishable from the adjacent natural dentition. Sophisticated effects can be ob- tained because the variety of col- ors and opacities available permit directintraoral application of strati- fication techniques, similar to the indirect fabrication techniques used by the dental technician. The freehand bonding tech- nique facilitates complete control of each restorative step in the chairside reconstruction of the de- fective dentition** Using incre- mental techniques, a restoration ‘can be sculpted to the desired mor- phology and color, controlling the esthetic result from initial shade se- lection to the final polishing, Because direct composite resin restorations are especially appli- cable within the anterior denti- tion, this article concerns the com- mon indications and their treat- Ished and polished tothe desired shape, luster, and texture. ment when directly restoring defi- cient, damaged, or compromised anterior teeth. Case 1—Replacing Exist- ing Defective Restorations Because the early composi resin systems lasted for a very lim- ited time, the most common indica- tion of failure is the replacement of old, defective composite resin res- torations. The reasons for failure ‘may vary from secondary caries and fractures to margin or com- plete staining or color change and wear that led to an unacceptable, unnatural-looking restoration, ‘The patient in Figure 1A pre- sented with an old Class 4 com- posite resin restoration of the left maxillary central incisor, exhibit- ing stained margins, a monochro- matic “shine through” appear- ance, and an artificial uniformity of the surface texture, When the restoration was re- moved, a deep dentin area was ex- posed (Figure 1B). Vitrebond™, a resin-reinforced glass ionomer liner, was chosen to cover it, al- though a fourth- or fifth-genera- tion dentin adhesive system could have served just as well. ‘A chamfer was formed to in- crease the enamel-adhesive sur- face and to provide a sufficient bulk of material at the margins. After conditioning the prepared enamel with acid etching and bonding, hybrid composite resins of different shades and opacities * 3M Dental Products St.Paul, MN S544 Heraeus Kulzer, vine, CA 92618 ‘August 1996 Compendium 797Figure 24—A trauma fracture ofthe left ‘maxtllary central incisor, originally buc- «ally inclined. Figure 2D—Dentinike shades are placed ‘buccally. The surface texture is rough- ‘ened before polymerization, (Charisma®®) were incrementally laced, light cured, finished, and polished to the desired shape, color, transtucency, and surface texture (Figure 1C). Case 2—Restoring Trau- matized Fractured Teeth As shown in Figure 2A, frag- ment fracture of anterior teeth is one of the most common dental traumas. Restoring this Class 4 restoration fulfills an esthetic re- quirement but is also simply like bandaging a wound. A freehand composite resin build-up tech- rique was also used in this case to restore the missing dental tissues (Figures 2B through 2F). After chamfer preparation of the mar- gins, the tooth was conditioned using an adhesive system (Opti- bond" FL9. Because two optically different components, dentin and enamel, were tobe restored, different com- osite resin shades were selected. A dentinlike hybrid composite (Enamel plus-HFO*) representing & Kerr Corporation, Orange, CA 92667 “ Mficeram, Avegno, aly 798 Compendium w August 1996 Figure 28—After chamfer preparation {and conditioning ofthe prepared dentin and enamel, an Increment of a dentin. like shade hybrid composite resin Is Palatally placed and light cured. Figure 2£—Complete stratification after placement of the enamellixe shades in ‘the labial plane, the opaque core, saturated in chroma, rich in hue, and fluores- cent, was used to build up most of the palatal wall of the restoration (Figure 2). ‘The incisal part of the palatal aspect was then incrementally added with an enamel shade (Enamel-plus HFO), which is translucent, transparent, and opalescent (Figure 2C). After creating the palatal base, dentin increments were placed and light cured buccally to replace the dentin tissue (Figure 2D). The surface of this layer was rough- ened before curing using a dental explorer (Figure 2D) for scattering, the light rays after penetrating through the external enamellike layer, composed of transparent ‘enamel shades (Figure 2B). Finish- ing and polishing procedures were followed using gradually decreasing grit diamondst, Sof- Lex" aluminum oxide polishing discs, a low-speed, flame-shaped, green corundum stone, a polish- * Dentatus USA LTD®, New York, NY 10016 * Coamedent®, Chicago, I 60640 Figure 2C—A consecutive layer of enamelke shade Is inclally placed and light cured while stil inthe palatal plane of the restoration. Figure 2F—The complete, invisible res: toration blends into the surrounding, tooth structure. ing paste (Enamelize™), and a FlexiBuff™ buffing disc A natural-appearing restora- tion was completed when the con- vex areas (transitional lines, incisal edge, and labial lobes) of the restoration were highly pol- ished with Sof-Lex™ superfine discs (Figure 2F). Case 3—Recontouring Disproportionate Teeth Missing teeth replaced by mi- grating adjacent teeth aze usually treated orthodontically before ei- ther implant rehabilitation or fixed (or adhesive) prostho- dontics. However, when the pa- tient refuses the treatment plan, and/or when an immediate es. thetic solution is required, com- posite resin bonding for augmen- tation of the involved teeth is rec- ‘ommended. Because no macromechanical prepreparation is executed, the treatment is reversible, enabling removal of the restoration from the teeth and a return to their original form and shape.® The goals of treatment are to Vol. 17, No. 8 wean eh — agen DRA ee hoogs a0 vwFigure 3A—Unnatural api disproportionate front maxillary teeth as a result of the congenitally missing Fett central incisor. Figure 48—Removal of the defective ‘composite resin restoration reveals a thin and dark buccal plate of the tooth a 2 4, Figure 4E—Luminex* clear plastic post inserted Into the uncured Hybrid com- posite resin. improve the proportions of the treated teeth, to establish proper contact with opposing and adja- cent teeth, to match color between the restoration and the unpre- pared tooth structure, to avoid trauma to the soft tissues, and to ‘maximize the longevity of the res- toration by using proper tech- niques and materials. ‘The patient presented with a congenitally missing maxillary left central incisor and mesial shifting of the right central incisor and left Vol. 17, No. & Figure 38—Six years postoperative ap- pearance of bonded teeth. A freehand Stratification technique of microfiled ‘composite resin had been applied. Note the color and texture stability, Oh Figure 4c—e- spite the suc- essful endodon- tic and surgical treatments, the tooth is stil Jeopardized by the fragile, thin- walled root “(endodonties by THeling, DMD, ‘and R Huber, DMD, surgical treatment by Y Lustman, DMD, Jerusa rae). Figure 4fRemoval of the post exhibits, thickened root walls and a narrower Intracomposite canal. lateral incisor (Figure 3A). A free- hand stratification technique was used to create even shape and width by bonding multishaded microfilled composite resins (Durafill®) to the right central in- cisor buccally, and to the left lat eral incisor distally and incisally. ‘At 6 years posttreatment (Fig- ure 3B), the left canine was short- ened, recontoured, and slightly leached to achieve a more favor- able esthetic result by odon- toplasty. Figure 44—An endodontic abscess of the right maxillary central incisor. Figure 4D—The large pulp chamber and, ‘very thin dental structures should'be re- Inforced. Case 4—Reinforcement of Compromised Teeth Endodontically treated teeth ‘ight exhibit flared canals as a re- sult of young patients, pulpal pa- thologies, carious lesions, or inad- equate endodontic manipulation. The thin walls of the root in these circumstances might lead to frac- ture of the entire restored tooth complex. Bonding a composite resin to the internal surface of the fragile ‘oot will increase the thickness of the root. This could lead to an in- crease in strength of the dento- restorative complex*™* and pre- vent the dark color of the post from shining through the thin root wall and the overlying gingivae. ‘The post placement in the canal does not strengthen the root © but provides retention and resis- tance to possible displacement of the core material during func- tion Case 4 presents a compromised right maxillary central incisor of 12-year-old female. After endo- ‘August 1996 Compendium 799Figure 4H—The metal post is masked with the opaque composite cement. Scotchbond™ Multi-Purpose Plus Dental Adhesive System*, a light- cured hybrid composite resin (Re- storative Z100") was syringed us- dontic and surgical treatments of ing a Centrix L-R®S syringe and the endodontic abscess (Figures condensed. A Luminex® clear 4A through 4D), the extremely plastic post* was inserted (Figure wide canal and thin root walls 4B) and the composite resin was jeopardized the prognosis of the light cured. compromised tooth. After condi- __The depth of cure using tioning the canal walls with the Centric, kelion CT 0618 Another #%§e! Remake! TR-BITE Impression Trays Specifically designed to simplify crown & bridge impression procedures. "igi, high composite plastic construction large handles wide occlusal plane availible in eight styles Special Introductory Offers Availible 1-800-342-5337 Direct Dental Service ‘See us at Chicago Midwinter Show. Booth #1935. Circle 44 on Reader Service Card 800 Compendium w August 1996 ‘ae Figure 41—The complete intraradicular, Intra- and extracoronal restoration is functional and esthetically acceptable. light-transmitting post exceeds 11 mm. Removal of the Lu- minex® post revealed a narrower- formed canal within the polymer- ized composite resin (Figure 4F). A passive parallel-sided Clas- sic™ Stainless Steel Post* was bonded in the canal with Opalt composite cement (Figure 4G) and masked coronally (Figure 411). A freehand stratification technique ‘was performed to reconstruct the missing palatal and incisal frag- ‘ments of the tooth. A combination of a hybrid composite resin (Restorative Z100) veneered with a microfilled composite resin (Silux Plus™) ‘was used to achieve an acceptable appearance of the treated tooth (Figure 41), Discussion Restorations of the anterior teeth must be biocompatible with the adjacent hard and soft tissues, and meet the requirements of form, function, and phonetics. The result must also satisfy the patient’s expectations. Inadequate techniques contribute to plaque accumulation, caries, and may lead to periodontal breakdown. To achieve the optimal esthetic and functional result, excellence in dentistry demands keen obser- vation, patience, and meticulous application of the relevant tech- niques and materials. Although restorations involv- ing a single tooth are less exten- sive than those involving all ante- rior teeth simultaneously,* single- tooth restorations usually require Vol. 17, No. 8 BRRR PoE BRHpgoouse Vol.a well-developed skill and an ar- tistic sense. When an isolated tooth is treated, success, in terms of how closely the restoration achieves a harmonized, natural- appearing dentition, will be greatly determined by the similar- ity of the restored tooth to its neighboring natural teeth Characteristics such as devel- opmental grooves, shape of the incisal embrasures, prominences, plane areas, etc, determine the overall contours and shape. The ‘optical properties of dentin and enamel should be considered in- dividually when restoring the missing tooth fragment with the correspondent composite resin ‘materials. Meticulous execution of the re- storative phase of the treatment plan, correctly designed contours ‘ofthe restorations, and the appro- priate manipulation of the restor- ative materials and tools will re- sult in the re-creation of damaged dental tissues. References |. Buonocore MG: A simple method of Increasing the adhesion of acrylic ll ‘ng materials to enamel surfaces 1 Dent Res 34:849-853, 1955 2 AmeyeC, Lambrechts R, Vanherle G: Conventional and mucrofilled com- posite resins. part 1. color stability land marginal adaptation, J Prosthet Dent 46:623-690, 981 3. Leinfelder KF: Composite resin in posterior teeth. Dent Clin North Ams 25:957-364, 1981 4. Lemfelder KF, Sleder TB, Sockwell CC, et al Clinical evaluation of com- ‘ponte resins as anterior and posterior ‘restorative materials J Prosthet Dent 8407-416, 1975. 5. Loys K, Lambrechts P, Vanherle G, tak Material development and clin. ‘al performance of composite resins. [Prosthet Dent 48:564-672, 1962. 6 "Craig RG: Restorative Deal Matric. St Louis, CV Mosby Co, p 137, 1985 7. Van Kerckhoven H, Lambrechta P, Van Beylen M, etal: Unreacted meth. acrylate groups on the surfaces of composite resins. j Dent Res 61:791- 735, 1982. 8. Ferracane JL: Correlation between hardness and degree of conversion during the sting reaction of unfilled dental restorative resins. Dent Mater Vol. 17, No. 8 10. u. a 4 8. 16, uv. 18. ws, a. 41.11, 1985, ‘Brannstrom M, Nyborg H.: The pree- ence of bacteria in cavities filled with silicate cement and composte resin materials. Swed Dent J 64:149-155, sr. Brannstrom M, Nyborg H: Cavity treatment with a microbicidal fuo- ride Solution: growth of bacteria and effect on the pulp. J Prosthet Dent 30:308-310, 1973, Brannstrom M: Infection benesth ‘composite resin restorations: cant be Avoided? Oper Dent 12:158-163, 1987, Brannstrom M, Nordenvall K:Bacte- tal penetration, pulps reaction and the inner surface of concise enamel bond. Composite fillings in etched and unetched cavities. Dent Res 73- 10,1978. Bergenholtz G, Cox CF, Loesche W, al: Bacterial leakage around dental restorations: its effec on the dental pulp. J Oral Pethol 11:439-450, 1982, Goldberg, Tanzer Munster E, et al: (Cross-sectional clinical evaluation of recurrent caries, restoration of mar- inal integrity, and oral hygiene sta- tus. J Am Dent Assoe 1025635-641, 1981 Macinnis WA, Iamail A, Brogan H: Placement and replacement of resto- ‘ations in a miltary population. J Can Dent Assoc 57:227-230, 191, Quist V, Qvist J; Mjor IA: Placement and longevity of tooth-colored rest zations in Denmark. Act Odontol ‘Scand $8:302311, 1950. ‘Kanca J: Dental adhesive and the al- bond system. ] Esthet Dent 34):129- 132, 1951, : Manabe A, Itoh K, Wakumoto S: The ‘optimum combination of dentin bonding system. Dent Mater 7148- 159, 191, Nakabayashi N, Nakamura M, ‘Yasuda N: Hybrid layer a a dents bonding mechanism J Esthet Dent 3(G)133-138, 1991, (Crim GA: Microleakage of thee den- tinal bonding systems. a 6-month evaluation. Quintessence Int 22387- 388, 1991. CChaistensen GJ: Bonding resin to den- tin fact or fantasy? J Am Dent Aseoe 122Q)71, 1991, ‘Kanca J Resin bonding to wet sub- strate. 1. Bonding to dentin. Quites- Sence Int 23:39-41, 1992. Kanca J: Improving bond strength through acid etching of dentin and bonding to wet dentin surfaces. J Am Dent Assoc 123:35-43, 1992, Swift FJ, Perdigno J, Heymann HO: Bonding to enamel and dentin a brief history and state of the art, 1995. Quintzsence Int 26(2}95-107, 195, Heymann HO, Bayne SC: Current 2%. 31 7. ‘concepts in dentin bonding: focusing fon dentinal adhesion factors J Am Dat Assoc 124:27-36, 1953, Leanfelder KF: Curent developments {m dentin bonding systems: major progress found in today’s products, Am Dent Assoc 2440-2, 1993, Erickson RL. Mechanusm and clinical implications of bond formation for {hwo dentin bonding agents, Am j Dent 2117-123, 1988 Finger WI, Inoue M, Asmussen E: Ef. fect of wettability of adhesive resins ‘on bonding to dentin. Am J Dent 735- 38,1994. ‘Nakabayashi N, Kojima K, Masuhara : The promotion of adhesion by the infiltration of monomers into tooth substrates J Biome Mater Res 16265- 773, 1982. Fissore B, Nicholls], YuodelisR: Load fatigue of teeth restored by a dentin bonding agent and a posterior com posite resin. J Prosthet Dent 6:60.85, 1991 Feilzer AJ, De Gee AJ, Davidson CL: ‘Curing contraction of composites and Blaseionomer coments. J Prosthet ent $9:297-300, 1988, Davidson CL, De Gee A), Feilzer Af ‘The competition between the com- _poste-dentin bond strength and the polymerization contraction stress. ‘Dent Res 6:1396-1399, 1984, Feilzer Al, De Gee AJ, Davidson CL: Increased wall-to-wall curing con- traction in thin bonded resin layers. Dent Res 6848-50, 1989. ‘Bassiouny MA, Chapman MK: Etfct of radiopaque filler on visible ight cured composite resin properties. [Dent Res 62219, 1983. Abstract. ‘Omer OE, Wilson NHE, Watts DC: ‘Radiopacty of posterior composites. [Dent 14178179, 1986. Stanford CM, Fan PL, Schoenfeld CR, et al: Radiopacity of posterior com> ‘Poste resins J Dent Res 65797, 1986, Abstract, Stantord CM, Fan PL, Schoenfeld Qi, et al Radiopaciy of ight-cured posterior composite resins J Am Dent ‘Assoc 115722-725 1987, “American Dental Association Counc! ‘on Dental Materials. Specification No. 27 for diect filling materials. Am Dent Aes 941191, 1977. Latz F, Philips RW: A'claswication and evaluation of composite resin systems. J Prosthet Dent Sb480-48, 1983 Leinfelder KF: Composite resins Dent Clin North Ary 2959-571, 1985. Hosoda H, Yamada T, Inokoshi S: SEM and elemental analysis of com- posite resins. J Prosthet Dent 64:669- 676, 1950. LLY, Swartz ML, Phillips RW, et az ‘August 1996 m Compendium 801TST TEST TE GT EE fect of filler content and size on properties of composites. Dent Res 64:1396-1401, 1985, 48, BraemM, Finger W, VanDoren VE, et al: Mechanical properties and filler fraction of dental composites. Dent Mater 5346349, 1969. 44 Chung KH: The relationship between ‘composition and properties of poste- ‘ior resin composites. J Dent Res (6852-856, 199. 48, Bram M, Lambtechts P, Ven Doren, ‘VE, etal: The impact of composite structure on its elastic response. [Dent Res 6548-653, 1986. 45. Cenig RG: Restorative Dental Materials, ed 8. St Louis, Mosby Co, pp 65-112, 1255-292, 1999. 47. Willems G, Lambrecht P, Braem M, et al: The surface roughness of ‘enamelto-enamel contact areas com pared with the intrinsic roughness of ental resin composites. J Dent Res 70:1299-135, 1991. 48. Roulet JF, Seewaldt A, Noack Mi: Margin quality of class I and TV ‘composite in vitro, Dent Mater7173- 1385, 1991. 49, Erickson RL, Glasspoole ES: Bonding 51 to tooth structure: « comparison of slass-ionomer and composite resin systems. J Esthet Dent 6227-244, 1994, ‘Magne P, Holz J: Stratication of ‘composite restorations: systematic and durable replication of natural es- thetcs Pact Periadontic Aesthet Dent (161-70, 196, Fahl N: Predictable esthetic recon- struction of fractured anterior teeth ‘with composite resins: case report. ‘Pract Periodontics Aasthet Dex (117 31,1986. Bichacho N: The centripetal build-up for composite resin posterioc estos tions. Pract Periodontics Aether Dent 6G)17-24, 198. ‘Bichacho N: Cervical contouring con- cepts: enhencing the dentogingival ‘complex. Pract Pelodontics Aesthet Dent 8(95241-256, 1996, Hansen EK, Aamusen E:Tn vivo frac. tures of endodontically treated, pos- terior tooth restored with enamel- bonded resin. Endod Dent Traumatol 6218-225, 1950. Morin D, DeLong R, Douglas W: Cusp reinforcement by the acidetch technique. J Dent Res 63:1075-1078, ——— large handles ‘wide occlusal plane availible in eight styles Special Introductory Offers Availible 1-800-342-5337 Direct Dental Service ‘See us at Chicago Miiwinter Show. Booth #1935, Get it right the first time. TRI-BITE Impression Trays ‘Specifically designed to simplify crown & bridge impression rigid, high composite plastic construction Circe 44 on Reader Service Card 802 Compendium m August 1996 6. a 1984, ‘McCullock A, Smith B In viteo stud Jes of cusp reinforcement with ache- sive restorative material Br Dent J 161-450-452, 1986. ‘Nathanson D, Dias KRHIC, Ashayeri NN: The significance of retention in ppost and core restorations. Pract Penodontcs Aesthet Dent 5(3):82-89, 1953. ‘Trope M, Maltz DO, Tronstad L: Re- slotance fo fracture of restored endo- ontcally treated teeth. Endod Dent “Traumatol 1108-1, 1985, study of endodontcally treated teeth. [Prosthet Dent 51780, 1984. Caputo AA, Standlee JP: Biomechanice fn Clinical Dentistry. Chicago, Quin- tessence Publishing Co, pp 185-203, 1987 Sokol Dj: Bective use of current core land post concepts. J Prosthet Dent 52:231-234, 1984, LL: Depth of composite polymer ization within slmulated root canals using light-transmitting posts. Oper ‘Dent 19:165-168, 1994. Bichacho N: The winning combina- ton, Fenestra 40,1986, > Vol. 17, No. 8 1 OOFGHOREUROMON mm RED sso TU ETON AD mial MEPOPHE SOR eOSa> Al &