“he Intemational Journal of Poidantics & Restorative Dr 92012 BY QUINTESSENCE PUBLISHING CO, INC, PRINTING OF THIS DOCUMENT IS RESTRICTED TOPERSONAL USEONLY, NO PART Muty BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM TME PUBLISHER.Clinical Performance of Porcelain Laminate Veneers: Outcomes of the Aesthetic Pre-evaluative Temporary (APT) Technique | Galip Gurel, DDS, MSD*/Susana Morimoto, DDS, MSD, PhD** Marcelo A. Calamita, DDS, MSD, PhO*** ‘Christian Coachman, DDS, CDT***/Newton Sesma, DDS, MSD, PhD**** ‘This article evaluates the long-term clinical performance of porcelain laminate ‘veneers bonded! to teeth prepared with the use of an aakditive mock-up andl aesthetic pre-evaluative temporary (APT) technique over a t2.year period. Saty-six patients mere restored with 580 porcelain laminate veneers. The wehnique, used for diagnosis, esthetic design, tooth preparation, and provisional restoration fabrication, was based on the APT protacol. The influence of several factors on the durabily of veneers was analyzed according ta pre-and postoperative parameters. With utilization of the APT restaration, over 2% ‘of tooth preparations ware confined tothe dental enamel. Over 12 years, 42 wminate veneers fale, but whan the preparatins were limited to the enamel, ‘he fale rate resulting kom debonding and mieroiaakage dacreased to O% Porcelain laminate veneers presented 2 successiul clinical performance in terms ‘f marginal claptation, discoloration, gingival recession, secandary caries, postoperative sensitivy, and satisfaction with restoration shade at the end of 12 years The APT technique faciliated diegnos’s, communication, ord preparation, providing prediciabilty or the restorative treatment. Limiting the preparation depth ta the enamel surface significantly inemases the performance of porcelain laminate veneers. int J Peviodonties Restorative Dent 2012:32:625-635) “*ictng Profossox, New York University Collage of Dentistry, New York, New York, USA: ising Profoezor, University of Marea, Mareilo, France; Private Practice, isartul, Tukey. ‘Professor of Graduation Program, Schaal af Dentsry, lirspucrs University, S89 Paulo, raz sw*Pavate Practice, Se Paule, Bri ‘wvenasinant Profezcar, Department f Prosthodontics, Schaol of Dentistry, University of SSe Paula, io Paula, Braz. Conespardonce to: Ds Galip Gust, Tesllye Cad Bayer apto . 63, PO 34365, Nisontas lnarbul, Tukey, fax: 0090 212 231 2713; emai: lersistiperantinecom, Porcelain laminate veneers (PL¥s) area minimally invasive! esthetic restorative option with a high rave ‘of long-term success." Ta achieve the best results with these restora- tions, it is necessary to understand the essential factors involved and applya clinical protocol that guaran- tees reliability with regard to esthet- ies and longevity. Several clinical factors may al- ter the success rates of Pls, such as treatment planning, types of preparations, enamel preservation, tooth vitality, presence of compos- ite resin restorations, selection of ‘appropriate ceramics and compas- ite resin cements, finishing, polishe ing. and control and maintenance ‘over time, Failure to address these factors can resultin fractures, micro leakage, and debonding.**"> ‘Adhesive cementation is a eri cal factor for the long-term success of PWS Nevertheless, 2 stable ‘and lasting bond does not depend ‘exclusively on the composite resin cement but on an understanding of the bond interface and, conse- quently, on the correct choice of the three factors involved Volume 32, Number 6, 2012 92012 BY QUINTESSENCE PUBLISHING CO, INC, PRINTING OF THIS DOCUMENT IS RESTRICTED TOPERSONAL USEONLY, INO PART MitY BE REPRODUCED OR TRANSMITTED IN ANY FORA WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER,826 ‘The first factor at the bond in- ‘terface is the dental subsvate, For many years, cementation was con sidered a secondary factor for the success of indirect restorations. However, at present, the application of adhesive systems hes allowed many concepts to be changed, per- ‘ticularly tooth preparation. Porce- Iain veneers essentially depend on ‘the band to dental structures." In the case of veneers, the prepa- rations can be confined to only the ‘enamel, with margins in the enamel and litle dentin exposure, or mini- mally in the enamel, with large amounts of dentin exposure and ‘composite resin. Mechanical inter- locking with enamel is more stable than the bend to dentin,’ which has @ less homogenous nature, creates humidity, and may have areas of sclerosis. Tooth prepara- ‘ion should preferably not remave healthy tooth stuctures unneces- sarily, This will guarantee a larger quantity of remaining enamel’? and greater strength of the tooth, since flexion of the tooth may be related ‘to fractures and debonding. Teeth with color alteration may demand 2 little more depth for the tooth preparation. Teeth with abrasion ‘or erosion and those in older pa- ‘tients may have a thinner layer of enamel since they have lost some ‘of their original volume, and there- fore create conditions under which ‘the preservation of enamel is more complicated S22 ‘The second factor is the ce ramic to be selected. Ceramics that undergo.a lang vitreous phase, and can therefore be acid etched and silanized, have the best adhesive behavior and consequently allow more conservative preparations and better esthetics because of ‘heir translucency. The third factor is the resin adhesive cementation, which is interposed between and inter dependent on the other two fac- ‘ors. Clinical follow-ups comparing selfetch and totaletch adhesive systems in PLVS showed 2 simi- lar behavior over 2 period of $ ‘years, but a phosphoric acid agent was applied to the enamel in all samples.!? Tooth preparation is an im. portant step because it ties to consider obtaining an adequate ‘thickness of ceramic and tooth structure wear Basically, there are ‘wo different approaches te tooth preparation fer veneers: (7) the tra- ditional approach, which is based ‘on the existing tooth structure, and (2)a more recent and sophisticated mechod guided by the final volume of the restoration. This approach uses wax- and mock-ups?" This paper provides clinical datz on the zesthetic pre-evalustive ‘temporary (APT) technique," which ‘takes the final volume of the resto- ration into consideration. Use of the ‘APT technique, step by step, may guide che clinician from the time ‘of diagnosis, communication, and preparation through the final result, making the treatment predictable. This study retrospectively evalu- ated the long-term clinical perfor mance of PLVs bonded to teeth prepared using the APT technique over @ period of 12 years. “he Intemational Joursl of Poiadantics & Restorative Dany 92012 BY QUINTESSENCE PUBLISHING CO, INC, PRINTING OF THIS DOCUMENT IS RESTRICTED TOPERSONAL USEONLY, INO PART MitY BE REPRODUCED OR TRANSMITTED IN ANY FORA WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER,Method and materials. Between May 1997 and May 2009, 580 PLVs were cemented. The sample consisted of 64 patients (09 men, 47 women), and the ve- neers were cemented in the maxilla (299 anterior teeth, 115 posterior moet ution of PLVs according tolecation No. of PLYS % 299 722 15 278 2 vas 4a 265 Distribution of PLVs according to the restoration and ‘cementation material No. of PLYS % PLV material IPS! 201 aur esi 320 552 IPS Esthetic 16 2 Creation a3 74 | cementation material aMOpal am 298 Varilink I 305. 526 Bisco Choice “ 24 Variolink Veneer mA Herculite 40. a6 Lu = porcain iam veneer teeth) and mandible (122 anterior teath, 44 posterior toesh) [Table 1). Veneers were fabricated using both a pressed ceramic technique {IPS Empress |, ll, and Esthetic, hvoclsr Vivadent) and = refractory die technique (feldspathic porce- lain; Creation, Jensen Industries). The following products were used ‘2s cementation materials for PIMs: Variolink It {lvoclar Vivadent), 3M ‘Opal (3M ESPE), Herculite (Heraeus Kulzer), Variolink Weneer (Ivoclar Vivadent), and Bisco Choice (Bisco Dental} (Table 2). Volume 32, Number 6, 2012 92012 BY QUINTESSENCE PUBLISHING CO, INC, PRINTING OF THIS DOCUMENT IS RESTRICTED TOPERSONAL USEONLY, INO PART MitY BE REPRODUCED OR TRANSMITTED IN ANY FORA WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER,828 ‘The preparations were per formed according to the APT! protocol. In this technique, after 2 three-dimensicnal smile design anslysis, the dentist creates an im= medizte mock-up with composite resin, which will provide critical guidelines, such as the position and length of the maxillary incisors, for the technician to execute the diagnostic wacup. The waxcup is then transferred to the mouth us- ing a silicone index, whichis tested estheticelly and functionally. Once approved by the restorative team and the patient, the APT restaration is used as a precise guideline to prepare the tooth structure based fon the planned final tooth con tours. The tooth structure will une ergo only the minimal necessary preparation or even no preparation in certain areas using depth cutter burs through the APT restoration according to the pre-established goals. The previous silicone index is also used to check the prepara tion depths (Figs 1 to 11) Photographs, radiographs, and individual clinical forms were used te follow up with patients A sys- tematic recall was carried out at 1, 6 and 12 years. Pre- and postop- erative parameters were evaluat- Figs ta to 1¢ The patient exhibited a canted smile line. ed. All veneers were made by one dentist and rated by three examin- fers. Rules were established fer the clinical examination and rating two dentists made independent evaluations, and the characteristic with the lowest rating determined the category. Descriptive statistics were used in this swudy. Results A total of SEO PLVs were cemented in 66 patients, who were followed fora period of 12years. Patientsand teeth were evaluated according to “he Intemational Joursl of Poiadantics & Restorative Dany 92012 BY QUINTESSENCE PUBLISHING CO, INC, PRINTING OF THIS DOCUMENT IS RESTRICTED TOPERSONAL USEONLY, INO PART MitY BE REPRODUCED OR TRANSMITTED IN ANY FORA WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER,oy design wesc Figs2ato2e Anew smi Canting ws comassaet Fige Je and 36 A use up nse appiec preoperative parameters: bruxism filings (16.2%), and vital teeth surface (80.5%), dentin exposure/ 19.1%), abrasion (50.5%), presence (99.7%) (Table 3) enamel margin (14.7%), or den ‘of discoloration (61.2%), crowding The preparation design was tin exposure/dentin margin (4.8%) (18.5%), diastema (10.9%), caries’ classified as being in the enamel (Table 4). Volume 32, Number &, 2012 92012 BY QUINTESSENCE PUBLISHING CO, INC, PRINTING OF THIS DOCUMENT IS RESTRICTED TOPERSONAL USEONLY, NO PART Muty BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM TME PUBLISHER.830 on Fig 4 Fecal tooth preparation wae: rough the A ° of the APT resto Fig 5 Propsretion depthe make wth s Fig 6 Fig? Alterthe preperation depths we pation fralited us comple, the APT restoration wre sk Note thatthe comp Fige 109 ard 108 Provisional mstorations in plsce, 7 jon Journal of Pe B Restorative Derry 92012 BY QUINTESSENCE PUBLISHING CO, INC, PRINTING OF THIS DOCUMENT IS RESTRICTED TOPERSONAL USEONLY, NO PART Muty BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM TME PUBLISHER.631 Figs Mate Ite The Ps were bonded andthe final smile design Wat achieved, which mimicked the meecupand APT restortian. Preoperative parameters Cariesfilings vital teeth Volume 32, Number 6, 2012 92012 BY QUINTESSENCE PUBLISHING CO, INC, PRINTING OF THIS DOCUMENT IS RESTRICTED TOPERSONAL USEONLY, INO PART MitY BE REPRODUCED OR TRANSMITTED IN ANY FORA WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER,832 Distribution of PLVs according to preparation design No. Pov = porcelain eninate veneer Postoperative parameters ana- lyzed included crown lengthening (no change, 46.5%; apical, 7.6%; and coronal, 45.9%) and presence ‘oF gingival recession {no reces- sion, 85.7%; physiologic recession, 14.3%). In the eveluation obtained of PLVs % 270 65 “4 76 268 59 497 857 ce 143 a9 947 3 53 @ oo 546 oan 4 59 oo by the pationt and dentist, the col- ‘or match of the veneers was estab- lished as being very good (94.7%), good (5.3%), or unacceptable (0.0%), With regard to marginal ad- aptation, the PLVs were classified as very good (94.1%), good (5.9%). ‘or unacceptable (0.0%). Problems observed in the PLVs were also evaluated with regard to fractures chipping. debonding, micrclesk- age, secondary caries, sensitivity, and postoperative roat canal treat- ment {Table 5} “he Intemational Joursl of Poiadantics & Restorative Dany 92012 BY QUINTESSENCE PUBLISHING CO, INC, PRINTING OF THIS DOCUMENT IS RESTRICTED TOPERSONAL USEONLY, INO PART MitY BE REPRODUCED OR TRANSMITTED IN ANY FORA WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER,Forty-two PLVs (7.2%) were re- corded as being failures or unsuc- cessful within the sample due to fracture/chipping (3.4%), debond- ing (2.0%), microleakage (1.2%). secondary caries (0.2%), sensitivity 10.2%), and postoperative root ca- nal treatment (0.2%) (Table 4} Discussion Variations among materials, opera: tors, and patients can contribute to clinical éailures.* Therefore, clinical research and studies are important to evaluate the performance of restorative materials and to deter- jine the factors strongly rolzted to feilures since certain intraoral con- ditions cannot be reproduced in laboratory.” Studies have used modified United States Public Health Service (USPHS) or Ryge criteria???” * or preparation design Secondary caries Sensitivity Postoperative root canal 2 variation of the USPHS system {modified California Dental Asso- ciation [CDAV/Ryge criteria)!" to perform postoperative evaluations. However, there are many other ‘ac- tors that can be studied.” Thus, some clinical studieshave adopted ‘other parameters directed more to- ward evaluation of the veneers. 58!" Based on the guidelines described in the literature and on questions atising in daily clinical practice, pre- and postoperative parameters were established in this study in an effort to cover the clinical factors that influence the performance of porcelain veneers in the simplest, most clinical, and direct manner. Longitudinal porcelain veneers have shown ex cellent results in a period of $ to 12 years, with success rates rang- ing between 85% and 98%"! In the longest followup with 3,500 porcelain veneers over 15 years, evaluations of Frequency distribution of failures according to the authors found a failure rate of only 7%%, two-thirds of which were fractures (223%) or leakage and debonding (11%).’ These data, with reference ta the high rate of success, are in agreement with the results obtained in this retrespec- tive swudy. In this study, a low failure rate (7.2%) was computed during the evaluation period. Fracture’ chipping (8.4%) and debonding (20%) contributed greatly to this value, although clinically, in many instances, the parts could either be repaired or recemanted. Some problems that occur during the first year are generally related to adhesive failure during cementation and appear to oc cur most frequently in the first & months. Afterward, problems de- cline or stabilize at low rates.’ Bond feilures may have an influence ‘on marginal staining, gaps. and Volume 32, Number 6, 2012 92012 BY QUINTESSENCE PUBLISHING CO, INC, PRINTING OF THIS DOCUMENT IS RESTRICTED TOPERSONAL USEONLY, INO PART MitY BE REPRODUCED OR TRANSMITTED IN ANY FORA WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER,634 fractures of the ceramic since in- complete impregnation or polym- erization of the adhesivefcement may accelerate the process of hy- drolysis in the short term." Over time, these failures may be more related to fatigue at the bond ine ‘terface or crack propagation within ‘the ceramic, resulting from either masticatory forces, dissolution of ‘the resin matrix in the oral medi- um, or the development of gaps due to hydrolysis of the bonds beween the components of the ceramic 8952" There was 2 low rate of soc- ‘ondary caries (0.2%) in this study. The location of the PLWs enabled coral hygiene procedures 10 be per- formed more easily. Consequently, the occurrence of complications, such as secondary caries and peri- odontal disease, has not been reported in many studies’? but could become a significant factor according to the patient's hygiene.” ‘The least commen problems associated with PLVs are marginal discoloration and loss of color sta bility because all margins ere in areas in which hygiene is easy 10 maintain, the porcelain is often eas- ily finished and polished, and its glazed surface ismostly impervious to emtrinsie stzining.”* Supragingi- val preparations also had a positive effect on the survival rate of porce- lain veneers In this study, margin al adaptation was considered good for very good (100%), and there ‘was minimal microleskage (1.25), probably because the preparations were situated at the gingival level, which facilitated impressions and leaning of the margins. These fac- ‘tors may also have added to the low rate of gingival recession. No gingival recession was observed in 85.7% of Pls. The degree of satisfaction with restoration shade is corelated with the patient and dentist, and in this study, no restoration was consid ered unacceptable (100% good/ very good) after the study period ‘with regard to color match. No oth- er material is as capable of repro- ducing the beauty and naturalness ‘of a tooth as porcelain The esther ics of these materials is related to color, translucency, luminosity, and metamerism, im which part of the color comes from the adjacent tis- sues, remaining dental structure, neighboring teeth, coping, and the cementing agent. Several clinical factors may in- ‘terfere with the success of restora- ‘tions. However, variations in cavity Preparation may explain many of ‘these differences,” Traditional ap- proaches to veneer preparation can lead t0 major dentin exposure since the recommended prepara ‘ton thickness values are ‘requently close to the average measurements ‘of enamel thickness.” Enamel preservation can still be achieved with bonded porcelain veneer restorations/22821 al. ‘though some studies"! have found no differences in the success rates ‘of veneers with dentin exposure and those completely confined to enamel, others?#5 have empha- sized that there is an increased risk of filure when veneers are bond- ed to large amounts of exposed dentin er on an existing filling. Nevertheless, more conservative preparations undoubtedly help to preserve tooth vitality and reduce postoperative sensivity.” In addition to compressive strength, the flexural strength of ‘the tooth/porcelain set may be af- fected. Deeper preparation into dentin, a substrate that has a much lower modulus of elasticity than porcelain, provides a less rigid base for restoration placement than enamel, This approach has resuked in much higher fracture rates than other enamel-supported restora ‘fons. The residual dentin thickness after preparation may therefore in fluence the life expectancy of the restoration.” ‘The APT technique is based on the “additive mockup" de- Sign, which takes into consideration ‘the final volume of the restora- ‘ton and has allowed a greater number of dental preparations to be completely confined to the enamel (80.5%), whereas without the guide, the dentist resors to freehand preparation, invariably exposing dentin." The best way ‘to avoid unnecessary overprepara~ ‘on is to prepare the tooth in ace cordance with the APT restoration. In this study, low incidences of sensitivity (0.2%) and postopera- ‘ive reot canal therapy (0.2%) were ob:zined. This was because the approaches used preserved the enamel, promoted a superior bond ‘to the dentin, lowered postcemen- ‘ation sensitivity, improved support for the ceramic restoration, and re- duced endodontic intervention.*2” “he Intemational Joursl of Poiadantics & Restorative Dany 92012 BY QUINTESSENCE PUBLISHING CO, INC, PRINTING OF THIS DOCUMENT IS RESTRICTED TOPERSONAL USEONLY, INO PART MitY BE REPRODUCED OR TRANSMITTED IN ANY FORA WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER,Clinical follow-up of the porce- lain veneers has been carried out for long periods with the purpose ‘of obtaining more reliable data on the longevity of the ceramic/silane/ resin cementadhesiveftooth i ‘terface, and the esthetic. biologi and functional results have been considered encouraging.’ Etched porcelain veneers offer 3 predict able and safe treatment modality ‘hat preserves a maximum amount ‘of sound tooth structure! and have proven to be one of the most suc- cessful creatment modalities that modern dentistry has to offer* Conclusions Within the limits of this investi- gation, it may be conduded that PLVs present a successful clinical performance in terms af marginal adaptation, discoleration, ging val recession, secondary caries, postoperative sensitivity, and sat- isfaction with restoration shade af- ter 12 years of function. The APT technique facilitated diagnosis, communication, and preparation, providing predictability for the re- storative treatment. With the use ‘of APT restorations, over 80% of ‘tooth preparations were confined to the dental enamel, significantly increasing the clinical long-term performance of PLS. References 1. Diatschi 0, Sprafico R.Auosize Meta: Free Restorations: Cent Concept: for she Esthetic Trstmant of Posterior “Teeth. Cheage: Quintessence, 1997. 2 Chen JH, Shi OX Wang M, Zrao SJ, Wang H. Clinical evaluation of S38 te. facyclnestained toh red with por cela laminae vencess | Gent 2008: ne. 2. Goel G. Prdicble, precie, and ee ppevtable tooth preperation Sr porcesan laminate veneers. Prost Proced Aerhot Dione 2003;15:17=.28 4. Goel G. Porcelain inate veneer: Minimal tomh preparation by dosgr. Dent Cin Nonh Am 2007 51:619-43 5. Granal-Ruia MM, Fene-font A, Labaig Rueds €, Marines Gorzilez sh, Ramin Redriguar Jl, Salita MF AA clinical engin sucdy 222 porcelain Ise rote venaers, Period of surly ‘ram 3 10 ‘Vt years. Mad Oral Patol Oral Cir Bucal 210 1S0831—0537_ 4 Land MF, Hope CD. Survival rates of al-ceramis rynems aifer by circa in ‘ication ancl fabricator maths. J Ewd Bas Dans Pract 2010,1037-38, 2, Faedman MU. A TS.year review of por cola vanges Fale clinicians ob servations, Compend Contn Eve Dent SHB TRASO30 8 Dumiahet H, Scier H, Posen Larix rate verwers. A retrospective evelution afc 1 tm 10 years of sence: Par IK Cineal results. int J Prostbodent 2000; w3s18 9, Aeitides GA, Dini BL Fueyear dine cal performance of porcslan laminate ventas Quintessence Int 2002133: 15189, 10, Seales Ri, Etwmad S. Longewern sate Viva! of porcelais larinata veneers using tno preperation designs: ravespec- hoe such. lot J Proshodont 2004:17: 323-328, 11, Pageant M, Redamagni M, Conado M. Poralain laminate venwerk: & to 12 year clinical evaluation—A retraspectice Study Int.) Peredontis Restorate Dent 200825917. 12, ykor A, Oral EFiveyaar clinical evakine tor of 300 teeth restored with porcelain laminate verses using totaberch ond 2 moded setetch adhesive system, (Sper Oem 2009;35:516-828. 13, Catert HS, Dinadar M, Ostink 8. The et fect of verius preparation designe on the survival of poteaien laminae ve ers J Aches Dens 2008-11:805. 14. Ssdowsky SU a overview af treatment Considerations far extetic weatoratons: ‘Aareview ofthe iterate. Prenat Dent 2006; Feast. 15. Pleripi M, Adksornnaki: M. Compressive fracture resistance of porcelain lrinates bonded t2 enamal ar dertin with four adhesive systems. J Prostmosert 2007; sea 16, Calria JR. Colamia €8, Porcelain loi rte veneers: Reesons for 25 yam of success, Dent Clin North Am ZOQ7:St: 399-47 17. uarocore MS. A simple method of increasing the adhasion of acyic ling rmateralato ename! aufeces J Dent Res sops.a8 389-353, Bonen RL. Properties of & sliea-oin- forced poly for dental restorations. JJ Am Dent Assoc 1953:56:57-68, 19, Fusayama T, Makara M, Kurosaki N, wala Mi Nor-pressure aaheson of & ew adhesive restoratve sesin. J Dent es 1979581556130, 20, Mogae F Magre M, Use af adative wan pare dogettvaaral mockaus fe eraen- al preiervaten wh porcelan laeneate ora, Eur | Esthet Dew 200857018 21, Magne F, Beer UC. Novel porcelain laminate peperation appeaacr even by dagnoste moceup. I Ester Restor Dent 2008,76:7-14 22, Ryga G. Cinical evra, ic Bent 1980; 3047358, 23, Jokotad A, Bayne §, Blunck U, Tyas M. ‘Wisen N. Quality of dental restorations. FOI Commisten Project 2.95, it Dnt J 2001/81:119-188. 2. adison ©, Fleming JP, Morquis PM. The efiect of themnagiing ov the srength of poral laminate weneerIPLM ‘asa, Dant Mater 2003 19-291-297. 25, Rouiat JF Hesdar, Clinieal, in: oulot JF, Fineier §. Bonded Ceraerc inlays. Che cage: Bkintessence, 1997 33-86. 26, Shaft Ek, Freceran MJ, Pesca vo eer autem, part | J Esthet Restor (ane 06; 18 54-57, 27. Edalbol 0, Sorensen Jk Tooth stuct.re removal associated with warns prepara tion sigs fox anterior teth, J Prasthet Dent 2002187 503-503, Volume 32, Number 6, 2012 92012 BY QUINTESSENCE PUBLISHING CO, INC, PRINTING OF THIS DOCUMENT IS RESTRICTED TOPERSONAL USEONLY, INO PART MitY BE REPRODUCED OR TRANSMITTED IN ANY FORA WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER,