Luting of Inlays, Onlays, and Overlays With Preheated Restorative Composite Resin Does Not Prevent Seating Accuracy

CLINICAL RESEARCH
Luting of inlays, onlays, and overlays

with preheated restorative composite
resin does not prevent seating
accuracy
Pascal Magne, DMD, PhD, PD
The Don & Sybil Harrington Professor of Esthetic Dentistry, Division of Restorative Sciences,
Herman Ostrow School of Dentistry, University of Southern California, Los Angeles,
California, USA
Mehrdad Razaghy, DDS

Student, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles,
California, USA
Marco Aurelio Carvalho, DDS, MS, PhD

%FQBSUNFOUPG1SPTUIPEPOUJDTBOE1FSJPEPOUPMPHZ 6OJWFSTJUZPG$BNQJOBT 1JSBDJDBCB #SB[JM
Luciana Mara Soares, DDS, MS

1SJWBUF1SBDUJDF $BNQJOBT #SB[JM
Correspondence to: Dr Luciana Mara Soares

3VB(FSNBOP$BTFMMBUUP 4BOUB(FOFCSB** $BNQJOBT 41 #SB[JM
5FM
&NBJMTPBSFTMVNBSB!HNBJMDPN
318
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
70-6.&t/6.#&3tAUTUMN 2018
MAGNE ET AL
Abstract N POMBZT

EFFQFSBGUFSBJSCPSOF
particle abrasion (Step 1) (P

Purpose: To evaluate in vitro the verti- Except for cement-luted inlays, the try-in
cal seating of computer-assisted de- QPTJUJPO N
XBTSFDPWFSFEGPMMPX-
sign/computer-assisted manufacturing JOHVOQPMZNFSJ[FEMVUJOH 4UFQ
"GUFS
(CAD/CAM) composite resin inlays, on- QPMZNFSJ[BUJPO 4UFQ
POMBZT BOE
lays, and overlays luted with two differ- PWFSMBZT TFBUFE UP N EFFQFS
FOUDPNQPTJUFSFTJOT UIBOEVSJOHUSZJO CBTFMJOF
VTJOH;
Materials and methods: Sixty plastic ty- (P
BOE UP N EFFQFS
podont molars were prepared for medi- using RelyX (P
*OMBZT MVUFE
VNTJ[FE.0%JOMBZT BOBUPNJDPOMBZT with RelyX seated higher than during try-
BOEnBUPWFSMBZT O
NNUIJDLBU JO CBTFMJOF
FYBDUMZ N BGUFS 4UFQ
the central groove with similar morphol- 2 (P
BOE N BGUFS 4UFQ
PHZ $FSFD CJPHFOFSJD DPQZ
3FTUPS- (P
-VUJOHXJUI;TVTUBJOFE
ations were milled using Lava Ultimate the seating of inlays with no statistical
CMPDLT BOEJODMVEFETUBOEBSEJ[FEIFN- difference when compared to baseline
ispherical occlusal concavity for seating (P

measurements with an electromechan- Conclusion: Airborne-particle abrasion
JD TZTUFN GPSDF/
3FTUPSBUJPOT significantly deepens the seating of
were luted either with preheated com- CAD/CAM composite resin restorations,
QPTJUF SFTJO 'JMUFL ;
PS EVBMDVSF CVUUIFQSFTFODFPGVOQPMZNFSJ[FESFT
SFTJO DFNFOU 3FMZ9 6MUJNBUF
4FBUJOH torative composite resin luting agent
of restorations was first evaluated at perfectly compensates for this discrep-
USZJO CBTFMJOF
4FBUJOH XBT SFFWBMV- BODZ 'PMMPXJOH QPMZNFSJ[BUJPO POMBZT
ated after airborne-particle abrasion and overlays seat deeper compared
(Step 1), after seating with luting agent UP JOMBZT FTQFDJBMMZ XIFO VTJOH 3FMZ9
4UFQ
BOE BGUFS MJHIU QPMZNFSJ[BUJPO The latter, however, resulted in a slightly
4UFQ
5IF'SJFENBOUFTUGPMMPXFECZ IJHIFSTFBUJOHPGJOMBZT
the Wilcoxon post hoc test were used to Clinical significance: With the least
compare the seating among steps, and variation compared to baseline seating
UIF ,SVTLBM8BMMJT UFTU GPMMPXFE CZ UIF (try-in), restorative composite resin used
Mann-Whitney post hoc test were used as luting agent resulted in the seating of
to compare the seating between luting CAD/CAM inlays, onlays, and overlays
agents at P closer to baseline when compared to
Results: Seating differences varied sig- EVBMDVSFSFTJODFNFOU
nificantly from baseline (P
"MM
SFTUPSBUJPOT TFBUFE N JOMBZT
UP (Int J Esthet Dent 2018;13:318–332)
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70-6.&t/6.#&3tAUTUMN 2018
CLINICAL RESEARCH
Introduction DPNQPTJUF SFTJO3-6 These authors all

BHSFFEUIBUUIFUIJDLOFTTPGUIFSFTUPS-
The use of computer-assisted design/ ation can be compensated for by ex-
computer-assisted manufacturing (CAD/ UFOEFE QPMZNFSJ[BUJPO UJNFT PG VQ UP
CAM) posterior bonded restorations has TQFSTVSGBDF*OBEEJUJPO EVBMDVSF
CFFO TUFBEJMZ HSPXJOH 5IFTF SFTUPS- cements still require efficient light curing
ations are classically delivered with an UPSFBDIUIFJSPQUJNBMDPOWFSTJPOSBUF7,8
adhesive protocol, including dual-cure Another potential advantage of re-
DFNFOU 6QEBUFE BQQSPBDIFT OPX JO- storative composite resins used as a
clude the use of immediate dentin seal- luting agent is their resistance to wear,
JOH *%4
BOEBSFMJHIUQPMZNFSJ[FE XJUI which proved to be superior to meth-
only composite resins used as a luting acrylate or phosphate-based resin ce-
BHFOU 0NJUUJOH EVBMDVSF SFTJO DF- NFOUT9,10 Using light-curing restorative
NFOUTJTOPUBOFXJEFB*OBOUFSJPSUFFUI materials for luting tooth-colored inlay,
Friedman1 demonstrated the success onlays or overlays should therefore no
for over 15 years of porcelain veneers MPOHFSCFDPOTJEFSFEIB[BSEPVT11
bonded with a microhybrid restorative Despite the aforementioned, clini-
DPNQPTJUF SFTJO *O #FTFL FU BM2 cians are still concerned about the pos-
may have been the first to propose the sibility of incomplete restoration seating
use of a restorative composite resin as due to the viscosity of the restorative ma-
BMVUJOHBHFOUGPSDFSBNJDJOMBZT5IFTF UFSJBM)FODF QSFIFBUJOHUIFDPNQPTJUF
authors demonstrated that, with respect resin through ultrasonic devices12 or a
UPQPMZNFSJ[BUJPOSBUF UIFSFXFSFOPBE- small composite heater13 has been pro-
vantages of dual-curing resin compared posed to increase the flow and facilitate
UPMJHIUDVSJOHPOMZ*OBEEJUJPO UIFPWFS- UIF TFBUJOH PG UIF SFTUPSBUJPO *O BEEJ-
all handling of the light-curing compos- tion, preheating proved to have posi-
ite resin was judged to be easier than UJWFFGGFDUTPONBSHJOBMBEBQUBUJPO14,15
UIBUPGUIFEVBMDVSFNBUFSJBM5IFTBNF $PNQPTJUFSFTJOTXJMMQPMZNFSJ[FCFUUFS
conclusions were drawn by Krämer and XIFO IFBUFE16-18 however, this might
'SBOLFOCFSHFS 3 who added that less not happen during a luting procedure
luting composite overhangs were found because of the rapid cooling of the ma-
XJUI UIF TPMFMZ MJHIUQPMZNFSJ[FE DPN- UFSJBM CFGPSF JU JT MJHIU QPMZNFSJ[FE13,14
posite resin because the clinician has The same syringe of material can be
more time for excess removal prior to preheated up to 20 times without affect-
QPMZNFSJ[BUJPO ing the mechanical properties or poly-
Remaining concerns about the depth NFSJ[BUJPOSBUF19,20
PGQPMZNFSJ[BUJPOPGUIFMVUJOHBHFOUBOE Some authors, however, have claimed
JUTFGGFDUPOUIFQFSGPSNBODFPGUIJDLPO- UIBU CPUI UIF TISJOLBHF BOE UIF mMN
lays and overlays have been resolved UIJDLOFTTPGEJSFDUSFTUPSBUJWFDPNQPTJUF
by several studies showing that even resins were higher than those of veneer
UIJDL SFTUPSBUJPOT EFNPOTUSBUF BQQSP- cements and flowable composite resins,
priate mechanical performance when XIFUIFS QSFIFBUFE PS OPU21 Although
EFMJWFSFEXJUIBTPMFMZMJHIUQPMZNFSJ[FE restorative composite resins might not
320
70-6.&t/6.#&3tAUTUMN 2018
MAGNE ET AL

a b c
Inlay Anatomical onlay Flat overlay
Groups INcr INcem ONcr ONcem OVcr OVcem
Preheated Dual-cure Preheated Dual-cure Preheated Dual-cure

Luting
restorative resin restorative resin restorative resin
agent
composite resin cement composite resin cement composite resin cement
Fig 1 1SFQBSBUJPOEFTJHOT JONN

BOEFYQFSJNFOUBMHSPVQT(a)*OMBZ(b)"OBUPNJDPOMBZ(c) Overlay
nBUQSFQBSBUJPO

QSFTFOUUIFMPXFTUmMNUIJDLOFTT UIFSFJT Materials and methods

TUJMMBMBDLPGEBUBUPQSPWFUIBUUIJTXPVME
QSFDMVEF UIF TFBUJOH PG UIF SFTUPSBUJPO Tooth preparation
&TQFDJBMMZ LOPXJOH UIBU UIF mUUJOH TVS-
face of composite resin inlays or onlays "TUBOEBSEJ[FEJOMBZ .0%
QSFQBSBUJPO
needs to be air abraded with aluminum with an isthmus width of 4 mm, pulpal
oxide before bonding,22-25 this might floor depth of 3 mm, and proximal box
create the additional clearance space forms was applied to 20 mandibular first
GPS UIF MVUJOH BHFOU *O BEEJUJPO PG JN- molar typodont teeth (Columbia Dento-
portance is that different parameters of form) by using chamfer round-ended
BJSBCSBTJPOTVDIBTHSJUTJ[F EJTUBODF EJBNPOECVST #SBTTFMFS
'JHB
4JNJ-
pressure, and time of abrasion could af- larly, 20 additional teeth were prepared
GFDUUIJTTQBDF5IFSFGPSF UIFPCKFDUJWF with identical isthmus width and pulpal
of this study was to evaluate in vitro the floor depth measurements as those of
vertical seating of CAD/CAM composite the inlay, but with an extra 2-mm reduc-
resin inlays, onlays, and overlays luted UJPO PG DVTQT " TIPVMEFS XBT DSFBUFE
XJUIUXPEJGGFSFOUDPNQPTJUFSFTJOT5IF that was to be connected to the proximal
null hypothesis was that restorations box forms, to receive anatomic onlay res-
would seat similarly, independent of the UPSBUJPOT 'JHC
"nBUPWFSMBZQSFQBSB
type of luting agent (restorative mater- tion with an occlusal reduction of 3 mm
ial vs dual-cure cement) or preparation and flattened cusps was performed on
JOMBZWTPOMBZWTPWFSMBZ
UIF UIJSE HSPVQ PG UFFUI 5XP TNBMM
321
70-6.&t/6.#&3tAUTUMN 2018
CLINICAL RESEARCH
Fig 2 #BTFESBXJOHVTFEUPHVJEFUIFQSFDJTFQPTJUJPOPGUIFTQFDJNFOUPJOJUJBUFUIFWFSUJDBMTFBUJOHUFTU
proximal box forms were developed DPQZ NPEF 4VCTFRVFOUMZ EJHJUBM JN-
BT BO BOUJSPUBUJPOBM GFBUVSF 'JHD
"MM pression scanning of each prepared
preparations presented soft internal an- tooth was performed, aided with a con-
HMFTBOESPVOEFEUSBOTJUJPOBMTVSGBDFT trast powder (Cerec Optispray, Sirona),
All typodont teeth were sectioned at and restorations were designed using
the root base 3 mm below the artificial UIF $FSFD TPGUXBSF "MM SFTUPSBUJPOT
cementoenamel junction (CEJ), and the were milled in nanofilled composite
sectioned surfaces were accurately flat- resin (Lava Ultimate A2, 3M ESPE), and
tened and smoothened with sandpaper carefully adjusted to the preparations
UPNBYJNJ[FTUBCJMJUZ4VCTFRVFOUMZ UXP VOEFS PQUJDBM NJDSPTDPQZ -FJDB .;
box forms of 1-mm depth were created -FJDB.JDSPTZTUFNT
"DFOUSBMJ[FE
in the center of the buccal and lingual hemispherical occlusal concavity (load
root surfaces to guide the positioning of fossa) of 1-mm depth was created by
the specimens during all the measure- VTJOHBSPVOEEJBNPOECVS #SBTTFMFS

NFOUQSPDFEVSFT 'JH
on all the restorations, to precisely per-
form the vertical seating measurement
Design and manufacturing QSPDFEVSF MPBEUJQQPTJUJPOJOH

of the restorations The 60 teeth were divided into six

groups according to preparation design
All specimens were restored using the BOE MVUJOH BHFOU O
'JH
5IF
$FSFD 4JSPOB
$"%$". TZTUFN composition and properties of the luting
One unprepared tooth was scanned to materials used in the study are shown in
generate a master for the biogeneric 5BCMF
322
70-6.&t/6.#&3tAUTUMN 2018
MAGNE ET AL
Table 1 Material application, brand name, manufacturer, and composition of the materials used for lut-
ing in the study
Application Preheated restora- Dual-cure self- Total-etch adhe- Universal adhe-

tive composite adhesive universal sive system sive system
resin for restor- resin cement for
ation luting restoration luting
Brand name 'JMUFL; RelyX Ultimate Optibond FL (Ad- Scotchbond Uni-

IFTJWF#PUUMF
versal Primer and
Adhesive
Manufacturer 3M ESPE, St Paul, 3M ESPE, Seefeld, Kerr, Orange, USA 3M ESPE, Seefeld,
USA Germany Germany
Composition #JT(."BOE Base paste: Adhesive: MDP phosphate

TEG-DMA methacrylate 2-hydroxyethyl NPOPNFSEJNFUI-
Inorganic matrix: monomers con- NFUIBDSZMBUF BDSZMBUFSFTJOT
[JSDPOJBTJMJDB taining (or not) 3-trimetho- )&."7JUSFCPOE
(71%) phosphoric acid xysilylpropyl DPQPMZNFSmMMFS
HSPVQTTJMBOBUFE NFUIBDSZMBUF FUIBOPMXBUFS
mMMFST 2-hydroxy-1,3- JOJUJBUPSTTJMBOF
initiator compo- propanediyl
OFOUTTUBCJMJ[FST CJTNFUIBDSZMBUF
rheological addi- BMLBMJnVPSPTJMJ-
tives cates (n/a)
Catalyst paste:
methacrylate
NPOPNFSTBMLB-
MJOF CBTJD
mMMFST
TJMBOBUFEmMMFST
initiator compo-
OFOUTTUBCJMJ[FST
QJHNFOUTSIFP-
logical additives
Flexural 300 98 n/a n/a

strength (MPa)
Mean particle o 13 n/a

size (μm)
Filler content 85 o 48 o

(% wt)
5&(%." USJFUIZMFOFHMZDPMEJNFUIBDSZMBUF
CJT(." CJTQIFOPM"HMZDJEZMNFUIBDSZMBUF
.%1 NFUIBDSZMPZMPYZEFDZMEJIZ-
ESPHFOQIPTQIBUF
)&." IZESPYZFUIZMNFUIBDSZMBUF

OB/PUBWBJMBCMF
323
70-6.&t/6.#&3tAUTUMN 2018
CLINICAL RESEARCH
a b c
Fig 3 -VUJOH GPS QSFIFBUFE SFTUPSBUJWF DPNQPTJUF SFTJO TUFQCZTUFQ QSPDFEVSF HSPVQT BOE

(a) 4JMBOFBQQMJDBUJPO(b)"EIFTJWFDPBUJOH(c)4FBUJOHXJUI'JMUFL;
Vertical seating test At baseline (dry try-in)

Restorations were initially seated without
All specimens were placed on a flat any surface treatments or luting agent
stainless steel base and the contour of (Fig 2), and the vertical axial positioning
their root base was drawn on the sur- was recorded as a baseline measurement
face with a pencil to guide and repeat A[FSPQPTJUJPO

the precise position of the specimen at
FBDIWFSUJDBMNFBTVSFNFOUVOEFSUBLFO After airborne-particle abrasion (Step 1)
'JH
5IFTQFDJNFOTXFSFUIFOHSBE- The inner surfaces of all the restorations
ually subjected to a maximum 30 N of XFSF BJS BCSBEFE VTJOH N TJMJDB
load (Acumen III, MTS Systems), axially modified aluminum oxide (Rocatec, 3M
applied by a spherical stainless steel tip ESPE) for 10 s at a distance of 10 mm
NNDVSWBUVSFSBEJVT
UPUIFDFOUFS XJUI B QSFTTVSF PG CBST "EEJUJPOBM
of the occlusal surface of the restor- cleaning was performed by immersion
BUJPO"UPUBMPGUISFFBYJBMNFBTVSFNFOU in distilled water using an ultrasonic bath
values were recorded for each step of GPS NJO 5IF TQFDJNFOT XFSF UIFO
the vertical seating test (baseline, after BJSESJFE/FYU UIFZXFSFQSFDJTFMZQPT-
airborne-particle abrasion, after seating itioned on the stainless steel base for the
with luting agent, and after light polymer- second step of the vertical seating test,
J[BUJPO
*OPSEFSUPNBYJNJ[FBDDVSBDZ following the same parameters as pre-
the root base of the tooth and the surface WJPVTMZFTUBCMJTIFE5IFBYJBMNFBTVSF-
of the stainless steel base were cleaned NFOUWBMVFTXFSFSFDPSEFEBDDPSEJOHMZ
out after each measurement to remove
BOZQPTTJCMFNJDSPJOUFSGFSFODFT
324
70-6.&t/6.#&3tAUTUMN 2018
MAGNE ET AL
a b c
Fig 4 -VUJOHGPSEVBMDVSFSFTJODFNFOU TUFQCZTUFQQSPDFEVSF HSPVQT BOE

(a) Application of
VOJWFSTBMCPOEJOHBHFOU(b)*OKFDUJPOPGSFTJODFNFOU(c)4FBUJOHPGJOMBZ
After seating with luting agents (Step 2) Adhesive (3M ESPE) to the inner surface
The bonding surfaces of the restorations of the restorations for 20 s, followed by
for groups 1, 3, and 5 were subsequently SVCCJOHBOEBJSUIJOOJOHGPST 'JHB

treated according to the following luting 2) Application of the resin cement into
protocol for preheated restorative com- UIFDBWJUZQSFQBSBUJPO 'JHC

4FBU-
posite resin: 1) Application of silane (Si- ing of the restorations onto the prepar-
lane, Ultradent) for 20 s and heat drying BUJPOT XJUI UIF SFTJO DFNFOU 'JHD

BU ¡$ GPS ø NJO %* $PMUFOF
The specimens were then loaded in
'JHB

"QQMJDBUJPOPGBEIFTJWFSFT- UIFTBNFXBZBTQSFWJPVTMZEFTDSJCFE
in (Optibond FL, bottle 2, Kerr), without Testing was then performed, and axial
QPMZNFSJ[BUJPO 'JHC

4FBUJOH PG NFBTVSFNFOUWBMVFTSFDPSEFE
the restorations onto the preparations
with the restorative composite resin (Fil- After light polymerization (Step 3)
UFL;
QSFIFBUFEGPSøNJOBU¡$ Each surface of the restorations was ulti-
in a heating device (Calset, AdDent) NBUFMZMJHIUQPMZNFSJ[FEGPST 7"-0
'JHD
"GUFS UIF SFNPWBM PG DPNQPT- curing light, Ultradent) while the speci-
ite resin excesses, the specimens were mens were maintained under 30 N of
placed on the stainless steel device to QSFTTVSF5IFTQFDJNFOTXFSFSFNPWFE
perform the second step of the test, fol- from the device and all margins covered
lowing the same parameters previously XJUI BO BJSCMPDLJOH CBSSJFS ,: +FMMZ
FTUBCMJTIFE.FBOXIJMF UIFTVSGBDFTPG Personal Products Company) for an
all the restorations for groups 2, 4, and 6, BEEJUJPOBMTQFSTVSGBDFQPMZNFSJ[B-
luted with dual-cure resin cement (RelyX UJPO DZDMF 5IF TQFDJNFOT XFSF BHBJO
Ultimate), were treated according to the placed in the same position on the flat
NBOVGBDUVSFSTJOTUSVDUJPOT
"QQMJDB- surface to perform the third step of the
tion of Scotchbond Universal Primer and WFSUJDBMTFBUJOHUFTU
325
70-6.&t/6.#&3tAUTUMN 2018
CLINICAL RESEARCH
Statistical analysis compare the seating among the differ-

ent steps for each preparation design
Statistical analysis was performed with BOEMVUJOHBHFOU
SPSS (version 23) statistical software
*#.$PSQPSBUJPO
'JSTU UPFWBMVBUFUIF
difference in seating after airborne-par- Results
ticle abrasion (Step 1) for each type of
preparation (inlay, onlay, and overlay), The measured mean vertical displace-
UIF OPOQBSBNFUSJD ,SVTLBM8BMMJT UFTU ments and standard deviations of the
with P XBTVTFE GPMMPXFECZUIF seated restorations are presented in Ta-
.BOO8IJUOFZ 6 QPTU IPD UFTU 5IFO CMF 5IF WFSUJDBM EJTQMBDFNFOUT BGUFS
during the seating with the luting agent airborne-particle abrasion (Step 1) are
4UFQ
BOE BGUFS MJHIU QPMZNFSJ[BUJPO presented in Figure 5, according to the
(Step 3), the Mann-Whitney U test was QSFQBSBUJPOEFTJHO O
5IF.BOO
used to compare two-by-two the means Whitney U test revealed the presence
obtained according to the luting agent of significant differences in the seating
QSFIFBUFE'JMUFL;SFTUPSBUJWFDPN- of inlays compared to onlays (P

posite resin, and RelyX Ultimate dual- and overlays (P
BOEOPEJGGFS-
cure resin cement) within each type of ence was found between onlays and
QSFQBSBUJPO JOMBZ POMBZ BOEPWFSMBZ
overlays (P

The Friedman test, followed by the During the seating with unpolymer-
8JMDPYPO QPTU IPD UFTU XJUI #POGFSSPOJ J[FEMVUJOHBHFOU 4UFQ
BDDPSEJOHUP
correction (P
XBT VTFE UP the Wilcoxon post hoc test, the baseline
-1
7FSUJDBMNFBTVSFNFOUT N
-2
-3
-4
-5
a
Fig 5 Vertical measurement
means and standard deviation
-6
(n = 20) after airborne-particle
b b
abrasion (Step 1) for each type
-7 PG QSFQBSBUJPO ,SVTLBM8BMMJT UFTU
Inlay Onlay Overlay followed by Mann-Whitney U post
hoc test (P

326
70-6.&t/6.#&3tAUTUMN 2018
MAGNE ET AL
Table 2 Vertical measurement data during Steps 1, 2, and 3
Step 1: Verti- Step 2: Vertical Step 3: Vertical

cal measure- measurements measurements
Groups ments in μm in μm with unpo- P value in μm after luting P value
after air abra- lymerized luting agent polymeriza-
sion (SD) agent (SD) tion (SD)
INcr (1)

Aa
Aab

Ab 0 0
INcem (2)

#D
#D
ONcr (3)

Aa
Ac

#C 0
ONcem (4)

Aa
#C
OVcr (5)

Aab
Ab

#C
OVcem (6)

Aa
#C
'PS4UFQ VQQFSDBTFTVQFSTDSJQUMFUUFSJOEJDBUFTEJGGFSFODFCFUXFFOQSFQBSBUJPOEFTJHOT JOMBZ POMBZ PWFSMBZ

,SVTLBM8BMMJTGPM-
MPXFECZ.BOO8IJUOFZ6QPTUIPDUFTU O

'PS4UFQTBOE VQQFSDBTFTVQFSTDSJQUMFUUFSJOEJDBUFTEJGGFSFODFCFUXFFOMVUJOHBHFOUGPSBHJWFOQSFQBSBUJPOEFTJHO DPMVNO

,SVTLBM8BMMJTGPMMPXFECZUXPCZUXP.BOO8IJUOFZ6QPTUIPDUFTU O

-PXFSDBTFTVQFSTDSJQUMFUUFSJOEJDBUFTEJGGFSFODFCFUXFFOUIFTUFQT SPX
GPSBHJWFOQSFQBSBUJPOEFTJHOBOEMVUJOHBHFOU'SJFE-
NBOUFTUGPMMPXFECZ8JMDPYPOQPTUIPDUFTUXJUI#POGFSSPOJDPSSFDUJPO
try-in position was recovered for all res- hand, inlays luted with RelyX Ultimate
torations (P
XJUI NFBOT WBSZ- (INcem) seated close to their unpo-
JOH GSPN UP N 07DS BOE 0/DS MZNFSJ[FE TUBHF P
BU N
SFTQFDUJWFMZ
FYDFQUGPS*/DFN N higher compared to the baseline try-in
above the baseline try-in, P
5IF (P
3FTVMUTPGUIFWFSUJDBMTFBU-
Mann-Whitney U test presented no differ- JOHUFTUBGUFSQPMZNFSJ[BUJPO 4UFQ
BSF
ence between the luting agents for onlays QSFTFOUFEJO5BCMFBOE'JHVSF
(P
BOEPWFSMBZT P
BT
JTQSFTFOUFEJO5BCMFBOE'JHVSF
"GUFSQPMZNFSJ[BUJPO 4UFQ
UIF8JM- Discussion
coxon post hoc test showed that onlays
0/DS
BOEPWFSMBZT 07DS
TFBUFE The use of preheated restorative com-
UP N EFFQFS UIBO CBTFMJOF XIFO posite resin (instead of resin cement)
VTJOH 'JMUFL ; QSFIFBUFE DPNQPT- as a luting agent for inlays, onlays, and
ite resin (P
BOEUPN overlays was investigated, especially
deeper when using RelyX Ultimate dual- JO WJFX PG UIF SJTL PG JODPNQMFUF SFTUPS-
cure composite resin cement (OVcem ation seating due to the viscosity of the
< TFF 5BCMF> BOE 0/DFN <> DPNQPTJUF 5IF OVMM IZQPUIFTJT DBO CF
respectively) (P
0O UIF PUIFS rejected because all restorations seated
327
70-6.&t/6.#&3tAUTUMN 2018
CLINICAL RESEARCH
15
b
10
a
a a
a
0
-5
INcr INcem ONcr ONcem OVcr OVcem
Fig 6 7FSUJDBMNFBTVSFNFOUNFBOTBOETUBOEBSEEFWJBUJPOEVSJOHSFTUPSBUJPOTFBUJOHXJUIVOQPMZNFSJ[FE
MVUJOHBHFOU 4UFQ
%JGGFSFOUCBSDPMPSTSFQSFTFOUEJGGFSFOUQSFQBSBUJPOUZQFT */GPSJOMBZ 0/GPSPOMBZ
BOE07GPSPWFSMBZ
8JUIJOFBDIQSFQBSBUJPOUZQF ADSTUBOETGPSQSFIFBUFEDPNQPTJUFSFTJO BOEADFN
GPSEVBMDVSFDPNQPTJUFSFTJODFNFOU8JUIJOFBDIQSFQBSBUJPOUZQF EJGGFSFOUMFUUFSTSFQSFTFOUTUBUJTUJDBMMZ
TJHOJmDBOUEJGGFSFODFTBDDPSEJOHUPUIFUXPCZUXP.BOO8IJUOFZ6UFTU
15
b
10
a
-5
b b
-10
INcr INcem ONcr ONcem OVcr OVcem
Fig 7 7FSUJDBM NFBTVSFNFOU NFBOT BOE TUBOEBSE EFWJBUJPO BGUFS MVUJOH BHFOU QPMZNFSJ[BUJPO 4UFQ

%JGGFSFOUCBSDPMPSTSFQSFTFOUEJGGFSFOUQSFQBSBUJPOUZQFT */GPSJOMBZ 0/GPSPOMBZ BOE07GPSPWFSMBZ

8JUIJOFBDIQSFQBSBUJPOUZQF ADSTUBOETGPSQSFIFBUFEDPNQPTJUFSFTJO BOEADFNGPSEVBMDVSFDPNQPTJUF
SFTJODFNFOU8JUIJOFBDIQSFQBSBUJPOUZQF EJGGFSFOUMFUUFSTSFQSFTFOUTUBUJTUJDBMMZTJHOJmDBOUEJGGFSFODFT
BDDPSEJOHUPUIFUXPCZUXP.BOO8IJUOFZ6UFTU
328
70-6.&t/6.#&3tAUTUMN 2018
MAGNE ET AL
closer to baseline with the restorative Once inserted with the luting com-
material when compared to the dual- posite resin, the seating of all the res-
cure cement, in addition to the fact that UPSBUJPOT SFUVSOFE UP XJUIJO N PG UIF
the onlays and overlays seated deeper CBTFMJOFQPTJUJPO ESZUSZJO
5IJTJTUPCF
UIBOUIFJOMBZT FYQFDUFEEVFUPUIFmMNUIJDLOFTTPGUIF
Typodont plastic teeth were chosen DPNQPTJUF SFTJO 5IF JOMBZT DFNFOUFE
because of their availability but also be- XJUI3FMZ96MUJNBUF XIJDIXFSFN
cause tooth preparations, restorations, higher than baseline, were an excep-
and positioning in the measuring device UJPO "T QFS UIF NBOVGBDUVSFST JOTUSVD-
DPVMECFTUBOEBSEJ[FE UIVTMJNJUJOHUIF UJPOT GPS VTF UIF QBSUJDMF TJ[F %ø

DPOGPVOEJOH WBSJBCMFT " MPBE PG / JTBCPVUNGPS3FMZ96MUJNBUFDPN-
was applied consistently through the QBSFEUPUPNGPS'JMUFL;
accurate electromechanic system in the As most of the preparation is formed by
exact same location at each step of the the vertical walls in inlays, it is expected
QSPDFEVSF5IJT/WBMVFXBTDIPTFO that the seating would be more affected
after simulating the luting pressure in a CZUIFMBSHFSmMMFSTJ[FPG3FMZ96MUJNBUF
QJMPUUFTU5IF.54"DVNFOTZTUFNQSP- Apart from this surprising finding about
vided highly precise load and motion inlays, no statistically significant differ-
DPOUSPM 5IF BDUVBUPS JODMVEFT B IJHI ence was found between the cement
resolution digital encoder to ensure ac- and the restorative material for onlays
curate control and measurement of the BOEPWFSMBZT QSPWJOHUIBUUIFmMNUIJDL-
WFSUJDBMSFTUPSBUJPOQPTJUJPO5ISFFDPO- ness might not have an influence on the
TFDVUJWF NFBTVSFNFOUT XFSF UBLFO UP TFBUJOH )FODF BMUIPVHI SFTUPSBUJWF
confirm the exact vertical positioning, composite resins might not present the
XJUIBDPOTJTUFOUWBSJBUJPOPGN MPXFTUmMNUIJDLOFTT 21 this did not pre-
Airborne-particle abrasion is neces- vent the appropriate seating of the res-
sary to enhance resin-to-resin bond- UPSBUJPOJOUIFQSFTFOUTUVEZ
ing of both laboratory and CAD/CAM Prior to light curing, the viscosity af-
DPNQPTJUF SFTJO SFTUPSBUJPOT22-25 This fects the application and manipulation
potentially creates an additional gap in PG UIF DPNQPTJUF SFTJO 5IF WJTDPT-
UIF UPPUI QSFQBSBUJPO 5IF QSFTFOU EBUB ity of restorative composite resins var-
confirms this fact because air abrasion ies significantly between brands, even
with Rocatec sand (3M ESPE) resulted in though they might be included in the
significantly deeper seating into the tooth TBNF DMBTT26 In addition, as tempera-
UPN
*UHPFTXJUIPVUTBZJOH ture increases, the viscosity of the com-
UIBUTQFDJBMDBSFOFFETUPCFUBLFOXIFO QPTJUF SFTJO EFDSFBTFT )PXFWFS FBDI
subjecting the restoration to sandblast- material responded differently, with a
ing, so as to preserve marginal adapta- EFDSFBTF SBOHJOH GSPN UP 27
tion (such as protecting the margins with Hence, many composite resins are not
a finger pressed onto the occlusal surface suitable for luting because their viscos-
PGUIFSFTUPSBUJPO
/PUFUIBUUIFFGGFDUPG JUZJTOPUPQUJNJ[FE FWFOBGUFSQSFIFBU-
sandblasting was slightly stronger in on- JOH28'JMUFL;SFTUPSBUJWFDPNQPTJUF
MBZTBOEPWFSMBZTDPNQBSFEUPJOMBZT resin was selected for luting purposes
329
70-6.&t/6.#&3tAUTUMN 2018
CLINICAL RESEARCH
JOUIJTTUVEZEVFUPJUTPQUJNJ[FEWJTDPT- UPSFTJODFNFOU5IFTFSFTVMUT QFSUBJO-

JUZ26 ing to the positional changes of onlays/
In order to understand the effects of overlays) are also in accordance with
QPMZNFSJ[BUJPOTISJOLBHFPOSFTUPSBUJPO UIF QSFTFOU BVUIPST FYQFSJFODF XIFO
seating, it needs to be borne in mind that EFMJWFSJOH TVDI SFTUPSBUJPOT 8IFO PD-
DPNQPTJUF SFTJOT EP OPU TISJOL UPXBSE clusion is perfectly preadjusted during
the light but rather toward the surfaces try-in, the positional change (deeper
UPXIJDIUIFZBSFCPOEFE29 Therefore, seating) during adhesive delivery will
UIFNBJOEJSFDUJPOPGTISJOLBHFWFDUPST PGUFO SFTVMU JO UIF XFBLFOJOH PS MPTT PG
JT BGGFDUFE CZ UIF UZQF PG QSFQBSBUJPO PDDMVTBMDPOUBDUT
As expected, the seating of all the in- The present results are clearly in favor
lays remained very similar after light of the use of preheated restorative ma-
QPMZNFSJ[BUJPO WBSJBUJPOT PG MFTT UIBO terials as a luting agent for inlays, on-
N
5IJT DBO CF FYQMBJOFE CZ UIF MBZT BOEPWFSMBZT*OBEEJUJPO UIFSFBSF
NBJO WFDUPST PG TISJOLBHF CVDDBM BOE clear, practical advantages to using pre-
lingual) being perpendicular to the long heated composite resin over traditional
BYJT PG UIF UPPUI "T FYQMBJOFE CZ -VU[ resin cements11 such as ease of excess
et al,30JONFEJVNTJ[FEBEIFTJWF.0% removal because of the firm consisten-
DPNQPTJUF JOMBZT UIF QPMZNFSJ[BUJPO DZBOEVOMJNJUFEXPSLJOHUJNFVOUJMMJHIU
contraction of the composite resin ce- QPMZNFSJ[BUJPO
ment is non-destructively compensated
for by an inward flexing of each cavity
XBMMPGBQQSPYJNBUFMZN5IFTJUVB- Conclusions
UJPOJTEJGGFSFOUXJUIPOMBZTBOEPWFSMBZT
*O UIPTF QSFQBSBUJPOT UIF TISJOLBHF The use of preheated restorative com-
vectors are along the axis of the tooth, posite resin as a luting agent for inlays,
hence they pull the restoration against onlays, and overlays can be recom-
UIFQSFQBSBUJPO6OMJLFJOMBZT UIPTFSFT- NFOEFE$MJOJDJBOTDPODFSOTSFHBSEJOH
torations demonstrated significant posi- incomplete restoration seating due to the
tional changes (deeper seating) after viscosity of the composite are not justi-
QPMZNFSJ[BUJPO 5IF DIBOHF XBT FWFO mFE BDDPSEJOHUPUIFQSFTFOUmOEJOHT
MBSHFSXJUIUIFEVBMDVSFDFNFOU UP Airborne-particle abrasion significantly
N
DPNQBSFEUPUIFSFTUPSBUJWFNB- deepens the seating of CAD/CAM com-
UFSJBM UP N
5IFTF mHVSFT mU posite resin restorations, but the pres-
XJUIUIFMJOFBSTISJOLBHFWBMVFTPG'JMUFL FODF PG UIF VOQPMZNFSJ[FE SFTUPSBUJWF
; JG POF DPOTJEFST B MVUJOH HBQ PG composite resin luting agent perfectly
NXJUIPGMJOFBSTISJOLBHF31 DPNQFOTBUFTGPSUIJTEJTDSFQBODZ8JUI
The difference between luting agents the least variation compared to baseline
JT BMTP DPOTJTUFOU XJUI mOEJOHT CZ #FS- seating (try-in), the restorative compos-
tolotto et al32 that showed significantly ite resin resulted in a more predictable
MFTT MJOFBS TISJOLBHF BOE QPMZNFSJ[B- seating of the CAD/CAM inlays, onlays,
tion forces when restorative materials and overlays when compared to the du-
were used as a luting agent compared BMDVSFSFTJODFNFOU
330
70-6.&t/6.#&3tAUTUMN 2018
MAGNE ET AL
"DLOPXMFEHNFOUT 4ZTUFNT #FOTIFJN (FSNBOZ

GPS QSP-
WJEJOHNBUFSJBMTGPSUIJTTUVEZ"MTP 3FZFT
The authors wish to express their grati- Enciso, PhD (Associate Professor of Clin-
tude to 3M ESPE (St Paul, MN, USA), Kerr ical Dentistry, Herman Ostrow School of
(Orange, CA, USA), Ultradent (South Dentistry, University of Southern Cali-
Jordan, UT, USA), Patterson Dental (Los fornia), for guidance with the statistical
Angeles, CA, USA), and Sirona Dental BOBMZTJTQSFTFOUFEJOUIJTTUVEZ
References
'SJFENBO.+$VSSFOUTUBUF )BTFHBXB&" #PZFS%# DPOWFSTJPOBOEQPMZNFSJ[B-
PGUIFBSUQPSDFMBJOWFOFFST $IBO%$)BSEFOJOHPGEVBM UJPOTISJOLBHF%FOU.BUFS
Curr Opin Cosmet Dent cured cements under com- o
o QPTJUFSFTJOJOMBZT+1SPTUIFU 'SØFT4BMHBEP/3 4JMWB-.
#FTFL. .ÚSNBOO8) %FOUo Kawano Y, Francci C, Reis
1FSTJ$ -VU['5IFDVSJOH %BSS") +BDPCTFO1) " -PHVFSDJP"%$PNQPT-
of composites under Cerec Conversion of dual cure lut- ite pre-heating: effects on
JOMBZT<JO(FSNBO>4DI- JOHDFNFOUT+0SBM3FIBCJM marginal adaptation, degree
XFJ[.POBUTTDIS;BIONFE o of conversion and mechani-
o 4V[VLJ4 -FJOGFMEFS,' DBMQSPQFSUJFT%FOU.BUFS
,SÊNFS/ 'SBOLFOCFSHFS 4IJOLBJ,8FBSSFTJTUBODF o
3$MJOJDBMQFSGPSNBODFPG PGSFTJODFNFOUT"N+%FOU %BSPODI. 3VFHHFCFSH'"
bonded leucite-reinforced o %F(PFT.'.POPNFSDPO-
glass ceramic inlays and %VBSUF4+S 4BSUPSJ/ 4BEBO version of pre-heated com-
POMBZTBGUFSFJHIUZFBST%FOU " 1IBSL+)"EIFTJWFSFTJO QPTJUF+%FOU3FT
.BUFSo cements for bonding esthetic o
4DIVMUF"( 7ÚDLMFS" SFTUPSBUJPOTBSFWJFX2%+ %BSPODI. 3VFHHFCFSH'"
3FJOIBSEU3-POHFWJUZPG o %F(PFT.' (JVEJDJ31PMZ-
ceramic inlays and onlays %JFUTDIJ% 4QSFBmDP3 NFSJ[BUJPOLJOFUJDTPGQSF
luted with a solely light-cur- Current clinical concepts IFBUFEDPNQPTJUF+%FOU
JOHDPNQPTJUFSFTJO+%FOU for adhesive cementation of 3FTo
o tooth-colored posterior res- -VDFZ4 -ZODI$% 3BZ
(SFHPS- #PVJMMBHVFU4 UPSBUJPOT1SBDU1FSJPEPOUJDT /+ #VSLF'. )BOOJHBO"
Onisor I, Ardu S, Krejci I, "FTUIFU%FOUo Effect of pre-heating on the
3PDDB(5.JDSPIBSEOFTT 3PVMFU+' -ÚTDIF(. viscosity and microhardness
of light- and dual-polymer- /PBDL.*OMBZTBOEPOMBZT PGBSFTJODPNQPTJUF+0SBM
J[BCMFMVUJOHSFTJOTQPMZNFS- Curr Opin Cosmet Dent 3FIBCJMo
J[FEUISPVHINNUIJDL o %BSPODI. 3VFHHFCFSH'"
FOEPDSPXOT+1SPTUIFU%FOU %BSPODI. 3VFHHFCFSH'" .PTT-&GGFDUPGSFQFBUFE
o .PTT- EF(PFT.'$MJOJ- and extending heating on
(PMECFSH+ (àUI+' .BHOF cally relevant issues related DPOWFSTJPOPGDPNQPTJUFT
1"DDFMFSBUFE'BUJHVF UPQSFIFBUJOHDPNQPTJUFT ""%3"CTUSBDU
3FTJTUBODFPG5IJDL$"% J Esthet Restor Dent %"NBSJP. 1BDJPOJ4
CAM Composite Resin o $BQPHSFDP. (BUUP3 #BMEJ
0WFSMBZT#POEFEXJUI -PICBVFS6 ;JOFMJT4 3BIJP- .&GGFDUPGSFQFBUFEQSF-
-JHIUBOE%VBMQPMZNFSJ[JOH UJT$ 1FUTDIFMU" &MJBEFT( heating cycles on flexural
-VUJOH3FTJOT+"EIFT%FOU The effect of resin composite TUSFOHUIPGSFTJODPNQPTJUFT
o pre-heating on monomer 0QFS%FOUo
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$ÈDFSFT& FUBM7PMVNFUSJD . #PSUPMPUUP5 "SEV4 ,SFKDJ %PVHMBT8)%PEFOUBM
TISJOLBHFBOEmMNUIJDLOFTT *&WBMVBUJPOPGUIF&GGFDU DPNQPTJUFTBMXBZTTISJOL
of cementation materials of Different Surface Treat- toward the light? J Dent Res
for veneers: An in vitro 3D ments on Luting CAD/CAM o
microcomputed tomography Composite Resin Overlay -VU[' ,SFKDJ* #BSCBLPX'
BOBMZTJT+1SPTUIFU%FOU XPSLQJFDFT+"EIFT%FOU 2VBMJUZBOEEVSBCJMJUZPGNBS-
o o ginal adaptation in bonded
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$WJULP& 1JSFT+"5SFBUNFOU $.3IFPMPHJDBMDIBSBDUFSJ- .BUFSo
of composite surfaces for [BUJPOPGDPNQPTJUFTVTJOH 'PHMFNBO&" ,FMMZ.5
JOEJSFDUCPOEJOH%FOU.BUFS a vertical oscillation rheom- (SVCCT85-BTFSJOUFSGFSP-
o FUFS%FOU.BUFS metric method for measuring
4UPLFT"/ 5BZ8. 1FSFJSB o MJOFBSQPMZNFSJ[BUJPOTISJOL-
#14IFBSCPOEPGSFTJO "M"IEBM, 4JMJLBT/ 8BUUT age in light cured dental
cement to post-cured hybrid %$3IFPMPHJDBMQSPQFSUJFT SFTUPSBUJWFT%FOU.BUFS
DPNQPTJUFT%FOU.BUFS of resin composites accord- o
o ing to variations in composi- #PSUPMPUUP5 (VJMMBSNF%
-BUUB." #BSLNFJFS88 UJPOBOEUFNQFSBUVSF%FOU Gutemberg D, Veuthey JL,
#POETUSFOHUIPGBSFTJO .BUFSo ,SFKDJ*$PNQPTJUFSFTJOWT
cement to a cured compos- #MBMPDL+4 )PMNFT3( resin cement for luting of
JUFJOMBZNBUFSJBM+1SPTUIFU 3VFHHFCFSH'"&GGFDUPG indirect restorations: com-
%FOUo temperature on unpolymer- parison of solubility and
J[FEDPNQPTJUFSFTJOmMN TISJOLBHFCFIBWJPS%FOU
UIJDLOFTT+1SPTUIFU%FOU .BUFSo
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70-6.&t/6.#&3tAUTUMN 2018

Luting of Inlays, Onlays, and Overlays With Preheated Restorative Composite Resin Does Not Prevent Seating Accuracy

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Luting of Inlays, Onlays, and Overlays With Preheated Restorative Composite Resin Does Not Prevent Seating Accuracy

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CLINICAL RESEARCH

Luting of inlays, onlays, and overlays

Mehrdad Razaghy, DDS

Marco Aurelio Carvalho, DDS, MS, PhD

Luciana Mara Soares, DDS, MS

Correspondence to: Dr Luciana Mara Soares

Abstract N POMBZT

Introduction DPNQPTJUF SFTJO3-6 These authors all

Inlay Anatomical onlay Flat overlay

Groups INcr INcem ONcr ONcem OVcr OVcem

Preheated Dual-cure Preheated Dual-cure Preheated Dual-cure

Fig 1 1SFQBSBUJPOEFTJHOT JONN

QSFTFOUUIFMPXFTUmMNUIJDLOFTT UIFSFJT Materials and methods

of the restorations The 60 teeth were divided into six

Application Preheated restora- Dual-cure self- Total-etch adhe- Universal adhe-

Brand name 'JMUFL; RelyX Ultimate Optibond FL (Ad- Scotchbond Uni-

Composition #JT(."BOE Base paste: Adhesive: MDP phosphate

Flexural 300 98 n/a n/a

Mean particle o 13  n/a

Filler content 85 o 48 o

Vertical seating test At baseline (dry try-in)

Fig 4 -VUJOHGPSEVBMDVSFSFTJODFNFOU TUFQCZTUFQQSPDFEVSF HSPVQT  BOE

Statistical analysis compare the seating among the differ-

Table 2 Vertical measurement data during Steps 1, 2, and 3

Step 1: Verti- Step 2: Vertical Step 3: Vertical

INcr (1)  

INcem (2)  

ONcr (3)  

ONcem (4)  

OVcr (5)  

OVcem (6)  

'PS4UFQ VQQFSDBTFTVQFSTDSJQUMFUUFSJOEJDBUFTEJGGFSFODFCFUXFFOQSFQBSBUJPOEFTJHOT JOMBZ POMBZ PWFSMBZ

INcr INcem ONcr ONcem OVcr OVcem

JOUIJTTUVEZEVFUPJUTPQUJNJ[FEWJTDPT- UPSFTJODFNFOU5IFTFSFTVMUT QFSUBJO-

"DLOPXMFEHNFOUT 4ZTUFNT #FOTIFJN (FSNBOZ

4BNQBJP$4 #BSCPTB+. ,BTTPUBLJT&. 4UBWSJEBLJT 7FSTMVJT" 5BOUCJSPKO%

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Abstract N POMBZT

Introduction DPNQPTJUF SFTJO3-6 These authors all

Brand name 'JMUFL; RelyX Ultimate Optibond FL (Ad- Scotchbond Uni-

Composition #JT(."BOE Base paste: Adhesive: MDP phosphate

Mean particle o 13 n/a

Filler content 85 o 48 o

Fig 4 -VUJOHGPSEVBMDVSFSFTJODFNFOU TUFQCZTUFQQSPDFEVSF HSPVQT BOE

INcr (1)

INcem (2)

ONcr (3)

ONcem (4)

OVcr (5)

OVcem (6)

'PS4UFQ VQQFSDBTFTVQFSTDSJQUMFUUFSJOEJDBUFTEJGGFSFODFCFUXFFOQSFQBSBUJPOEFTJHOT JOMBZ POMBZ PWFSMBZ

JOUIJTTUVEZEVFUPJUTPQUJNJ[FEWJTDPT- UPSFTJODFNFOU5IFTFSFTVMUT QFSUBJO-

4BNQBJP$4 #BSCPTB+. ,BTTPUBLJT&. 4UBWSJEBLJT 7FSTMVJT" 5BOUCJSPKO%