Docstoc

Minimally Invasive Cosmetic Dentistry

Document Sample
Minimally Invasive Cosmetic Dentistry Powered By Docstoc
					          AestheticDentistry




        Tif Qureshi




        Minimally Invasive Cosmetic
        Dentistry: Alignment, Bleaching
        and Bonding (ABB)
         Abstract: This article will outline how combining existing techniques in a new and unique manner can potentially redefine the traditional
         approach to smile design planning and execution. Alignment, tooth whitening and edge bonding with new highly polishable nano-
         hybrid composites can make cosmetic dentistry far simpler and less invasive. Patients’ perceptions of their end smile result can change
         dramatically if they are allowed to see their teeth improve gradually.
         Clinical Relevance: This technique will highlight a choice of pathways available in cosmetic dentistry making it much less invasive for the
         patient and less risky for dentists.
         Dent Update 2011; 38: 586–592


        The United Kingdom has seen a large                Gingival aesthetics                               increases as the dentition progresses away
        increase in the demand and provision of                                                              from the midline;5
                                                                       Gingival aesthetics particularly
        cosmetic dentistry over the last 10 years.                                                            Symmetrically reducing contact points
                                                           relates to gum health. Unhealthy and
                    Smile Design Principles                                                                  from the incisors to the canines often
                                                           inflamed gums may be generally considered
        have provided a format for dentists and                                                              following a 50–40–30 rule6 of tooth length in
                                                           unaesthetic. Too much gum display is also
        orthodontists to create what has been                                                                proportion to contact point length;
                                                           sometimes considered unaesthetic, even if
        widely accepted as an aesthetic target to                                                             Harmonious but gently medial tipping of
                                                           the gums are healthy and pink.
        achieve in the treatments of their patients.                                                         the axial inclinations of the anterior teeth;7
                    Smile design theory can be                                                                Width of the buccal corridor. It is generally
        broken down into four components:1                 Microaesthetics                                   considered more aesthetic for the teeth
         Facial aesthetics;                                                                                 behind the canines to be visible in a wide
                                                                       Microaesthetics relates to specific
         Gingival aesthetics;                                                                               smile.8
                                                           anatomical details that characterize teeth,
         Microaesthetics; and                                                                                            These elements have traditionally
                                                           such as surface contour and texture, incisal
         Macroaesthetics.                                                                                   been important when assessing patients
                                                           translucency, halo effect.
                                                                                                             requesting cosmetic dentistry. Many patients
                                                                                                             currently experiencing cosmetic dentistry
        Facial aesthetics                                                                                    may be shown their teeth improving with
                     Facial aesthetics forms the frame     Macroaesthetics                                   imaging software or through wax mock-ups.
        of the smile with the lips and surrounding                      The macroaesthetic requirements      While these tools can be useful for conveying
        soft tissues, which vary from patient to           for smile design theory may be considered         the possibilities, there is also an argument
        patient and can change depending on                to encapsulate several requirements to            that they set up an ‘ideal image’ in a patient’s
        various positions of speech and when               achieve what is arguably a correct aesthetic      mind to the point where alternative options
        smiling or laughing.                               smile.                                            are not fully considered or previewed. As a
                                                                        These include:                       result, many patients requesting cosmetic
                                                            Position and direction of the facial midline    dentistry often ended up with multiple veneer
                                                           related to the central incisor teeth;2–4          preparations.
          Tif Qureshi, BDS, President Elect of the          Incisal embrasures, which are the pattern                    However, with ABB the
          British Academy of Cosmetic Dentistry,           of edges of the maxillary teeth against the       progressive nature of the treatment allows
          General Practitioner, Dental Elegance,           darker background. The size and volume            the patients to visualize the appearance of
          Sidcup, Kent DA15 8PT, UK.                       of the incisal embrasures between teeth           their teeth improving and see their own teeth
         586 DentalUpdate                                                                                                                 November 2011


pg586-592 Minimally Invasive Cosmetic Dentistry.indd 586                                                                                               08/12/2011 12:01
                                                                                                                                AestheticDentistry




         looking more attractive. They can then decide
         at any point whether they are satisfied.
                      While textbook, full-mouth,
         non-compromise orthodontics should
         always be offered, practically speaking,
         patients may be put off by the time, cost
         and perceived discomfort involved and
         instead choose veneers. Combined ABB,
         while sometimes being a compromise on the
                                                                                                             Figure 2. Before smile view.
         ideal, could potentially offer patients who
         were considering irreversible, potentially
         destructive dentistry a real practical
         alternative.                                      Figure 1. Before full facial
                      The case described will highlight
         this.

                                                           also made aware of the need for permanent
         Case example                                      retention and the potential for relapse if this
                      The patient, a 27-year-old female,   was not maintained.
         requested an improved smile. Her main
         complaint was that her front teeth were
         protruded and she had a large diastema.           Patient selection criteria
                                                                                                             Figure 3. Side profile view.
         She complained that she couldn’t smile with                     Case selection for the Inman
         confidence. She was considering veneers to        Aligner is critical. Only certain types of
         perform an instant smile make-over and had        movement are possible and some patients
         attended another practice where a digital         will still need conventional orthodontic
         simulation of her corrected smile had been        treatment or indirect restorations.
         given. She was considering heavy tooth                          Certain criteria were met before
         preparations just to achieve this proposed        her treatment was carried out:
         result.                                            Her case should require movement of
                      On examination, several              incisor and/or canine teeth only;
         aesthetic problems existed. Her front teeth        Root formation of the teeth to be moved
         were protruding but occlusal space existed        was complete;                                     Figure 4. Close front view.
         to retract these and this would close the          Crowding or spacing was to be 3 mm.
         diastema. The teeth were also clearly             Arch evaluation would be performed to
         different lengths meaning that, even when         determine the amount of space required
         the teeth retracted, they would still have an     (see next section);
         irregular outline. The teeth were also shade       The patient’s posterior teeth were well
         A2–A3 (Figures 1–4).                              positioned to facilitate retentive clasps,
                      All options were presented in        with a reasonably well-aligned arch form
         detail. The patient was shown side and            to facilitate the path of insertion of the
         occlusal photographs of her teeth and it was      appliance;
         clear that a large amount of tooth structure       She had good periodontal health. Cases
         would need to be removed if veneers were          should be stable or preferably free from
         to be used without orthodontics. The patient      periodontal disease;
         had previously seen a specialist orthodontist      Compliance: The patient agreed to wear
         and considered fixed and clear braces but         the aligner for about 20 hours a day and to
         refused both options, based on the lack of        be responsible for good appliance and oral
         removability of fixed and the time quoted for     hygiene;                                          Figure 5. An Inman Aligner.
         clear aligners.                                    Compliance: The patient accepted the
                      The patient wanted a removable       need for some measured inter-proximal
         solution and something that would work            reduction (IPR) to be carried out if necessary.   performed before any aligner case is
         quickly. She understood that the Inman                                                              attempted. This is to ensure that the case is
         Aligner (Figure 5) could only treat the                                                             suitable and, if not, what additional space
         anterior region. She was made aware that          Model evaluation/arch analysis                    creation techniques will be needed to allow
         a small space mesial to her upper right           with Spacewize                                    the Inman Aligner to work. The amount of
         premolar would not close totally. She was                      Arch analysis should be              crowding or spacing present is calculated9
         November 2011                                                                                                                      DentalUpdate 587


pg586-592 Minimally Invasive Cosmetic Dentistry.indd 587                                                                                                08/12/2011 12:01
          AestheticDentistry




                                                           incisal contacts, with a small amount of IPR
                                                           needed to upright the teeth. The Inman
                                                           Aligner was made on this model. Anterior
                                                           and canine guidance would be protected
                                                           and potentially improved.
                                                                         On the first appointment, the
                                                           Aligner was fitted and the patient shown
                                                           how to insert and remove it. Instructions for
                                                           use and oral hygiene were given. The patient       Figure 7. Before retracted view.
                                                           was asked to wear the aligner for 18–20
                                                           hours a day, removing the Aligner every few
         Figure 6. Spacewize™ result.
                                                           hours to eat. As intermittent forces are less
                                                           likely to cause root resorption, it is important
                                                           for patients to remove their braces for a few
                                                           hours a day.10–12 The palatal component of
         by measuring the sum of the mesial-distal
                                                           the Inman Aligner was removed at this stage
         widths of the teeth to be moved. This
                                                           to improve comfort and to ease speech.
         distance is called the ‘Required Space’ or
                                                           It would be needed later but currently,
         ‘The Teeth’. If canines and incisors are to be                                                       Figure 8. Inman Aligner in position.
                                                           because the main movement was retraction,
         moved, this distance will be measured from
                                                           it could be removed. Two composite anchors
         the distal surface of one canine to the distal
                                                           were placed on the upper central incisors
         surface of the other.
                                                           about 4 mm from the gingival margins.
                      Using a jeweller’s chain or a
                                                           These were placed to ensure the labial bow
         polishing strip, the ideal arch form is then
                                                           stayed in the incisal third to ensure good
         measured from the distal of each canine
                                                           efficiency.
         and letting it align with the most ideal
                                                                         The patient returned 3 weeks
         arch form after orthodontics. Critically, the
                                                           later and movement was already evident.
         curve needs to run through the suggested
                                                           The Aligner was checked to ensure that
         position of the contact points and not                                                               Figure 9. Inman Aligner after 10 weeks.
                                                           the bow was still tensioned and seating
         the incisal edges. This is described as the
                                                           correctly.
         ‘Available Space’ or ‘The Curve’.
                                                                         The patient returned again after
                      Now it is possible to perform
                                                           another 3 weeks and the contacts were
         this task more quickly and accurately with                                                           than 0.1 mm per contact was carried out
                                                           starting to close. The palatal bow of the
         software such as Spacewize™. Just one                                                                over six contacts.
                                                           Aligner was re-inserted to help control the
         simple occlusal photograph is required,                                                                           Studies by El-Mangoury et al13
                                                           final movement. Approximately 0.1 mm
         taken at the chairside.                                                                              and Radlanski14 have shown that there is no
                                                           per contact of IPR was carried out from the
                      One tooth needs to be                                                                   increased risk of caries after IPR provided
                                                           mesial of the upper left canine to the mesial
         measured for calibration. A curve can be                                                             surfaces are smoothed correctly.
                                                           of the upper right canine at this stage to
         set up digitally and this is normally easier                                                                      Studies by Heins et al15 and Tal16
                                                           allow a little more retraction. This was carried
         when observing the patient’s aesthetic                                                               have shown that there is no increased risk of
                                                           out using a 0.1 mm Vision-flex diamond strip.
         requirements and occlusion directly; a                                                               periodontal disease despite the decreased
         result for the amount of crowding can be                                                             interproximal space. Indeed, they showed it
         produced immediately (Figure 6).                  Simultaneous whitening                             to be beneficial to periodontal health.
                      It was clear from this digital                    The patient returned after a                       Three weeks later the patient
         calculation that, even with the large amount      further 2 weeks. Her teeth were found to be        returned. Her teeth had moved fully to the
         of space present, some inter-proximal             aligning well and the midline diastema was         position determined by the Inman Aligner.
         reduction (IPR) would need to be carried out      closing. At this point impressions were taken      Her teeth had also whitened from A2/A3
         once the spaces closed and a good incisal         for home whitening. Instructions were given        to B1 shade. At this point she commented
         position was achieved                             and close-fitting sealed trays were provided       that she felt her teeth were more aesthetic
                                                           to the patient. She would whiten her teeth         and that she was very pleased with the
                                                           with Day White ACP™ (7.5% hydrogen                 outcome. The only problem now was the
         Treatment                                         peroxide) (supplied by Discus Dental, Philips      irregular incisal edge outline. This outline
                     Impressions were taken and the        Oral Healthcare, Guildford) for 35 minutes a       was due to differential toothwear which
         Aligner was constructed on a Kesling model        day during times when the Inman Aligner            may become more apparent when teeth
         set up in wax according to the Spacewize™         was out. A small amount of IPR was carried         reach alignment. This was confirmed by
         prescription. It was clear that there was         out with hand strips on the tight contacts         measuring the lengths of the teeth. Rather
         space to retract the teeth and regain anterior    from the mesial of canine to canine. No more       than resort to porcelain veneers, it was clear

         588 DentalUpdate                                                                                                                    November 2011


pg586-592 Minimally Invasive Cosmetic Dentistry.indd 588                                                                                                08/12/2011 12:01
          AestheticDentistry




                                                                                                              Figure 12. Venus Diamond dentine OL and B1
         Figure 10. Close view after retraction.           Figure 11. Preps-roughened edges.                  placed.




         Figure 13. Venus Diamond incisal clear enamel.    Figure 14. Basic polish.                           Figure 15. High polish.




         that simple incisal edge bonding could            application of Incisal CL clear was layered over
         improve the outline and final aesthetics.         the facial surface and incisal edge to build and
         Flowable composite was used to mock up            enhance the outer aesthetic layer. This was
         a potential outline for the patient and she       repeated on each tooth from canine to canine.
         was pleased with the set up. The patient was                    The initial contouring was carried
         then provided with a clear Essix retainer to      out with a medium then fine roughness
         maintain the position and to wear full time       soflex disc. A rubber Pogo stick from Dentsply
         (Figures 7–9).                                    (Weybridge, UK) was then used, polishing           Figure 16. Before occlusal view.
                                                           vertically to hide the join. Enamelise diamond
                                                           polishing paste and Flexibuff discs were then
         Incisal edge bonding
                                                           used to heighten the polish. A high level of
                      One week later the patient
                                                           chameleon-like blending is possible with
         returned for edge bonding on the front six
                                                           materials such as this. Large bevels are not
         teeth. No local anaesthesia was required. No
                                                           required as much as with previous materials
         bevels were cut. A nano-hybrid material was
                                                           because of the better opacity of the dentine
         chosen for strength in thin sections and ease
                                                           material.
         of colour blending. Venus Diamond (Heraeus
                                                                         The occlusion was checked, then
         Kulzer, Newbury, Berks, UK) was chosen for                                                           Figure 17. After ABB-retainer in place (12 weeks).
                                                           lateral and canine guidance checked to ensure
         this case.
                                                           positive deflection, but also to ensure that the
                      The front six teeth were dried,
                                                           guidance was not too steep (Figures 10–15).
         the teeth lightly roughened to improve bond
         strength and the incisal thirds were etched                                                          correct seating.
         with phosphoric acid. Optibond FL (Kerr,          Retention                                                      In the mouth the teeth were
         Peterborough, Cambs) was used as a bonding                      At this point an impression was      isolated and the palatal surfaces of the teeth
         agent. The composite was built incrementally      taken for a permanent wire retainer to be          roughened slightly using a diamond bur
         to replace and enhance the short-incisal edge     fitted in a week. The previous Essix retainer      to ensure the composite used to bond the
         outline to a more aesthetic position. This can    was cut back so that the incisal edges poked       retainer was exposed to subsurface enamel.21
         be made easier by ordering a wax-up and           through to allow fit and temporary stability.      The teeth were etched with phosphoric acid
         creating a silicone stent that is placed in the   The patient was instructed to continue             for 15 seconds, washed, Optibond Solo was
         mouth so that the composite can be built into     wearing the retainer full time.                    used as the bonding resin, cured, then the jig
         it to make placement easier.                                    One week later a retainer was        was reseated and flowable composite used to
                      This case was carried out free       fitted.17–20 This was made using a technique       bond the wire on each tooth from canine to
         hand. Shade OL dentine was used initially to      where a multistrand stainless steel wire is        canine. The jig was cut free from the wire, the
         replace the missing dentine layer. Shade B1       pre-bent by a technician on the finished           occlusion was checked and residual resin was
         was used to build the core outline, then a thin   model. An acrylic jig is then made to allow        removed using interdental brushes and the

         590 DentalUpdate                                                                                                                     November 2011


pg586-592 Minimally Invasive Cosmetic Dentistry.indd 590                                                                                                   08/12/2011 12:01
                                                                                                                               AestheticDentistry




                                                                                                            imaging at a previous consultation, desired
                                                                                                            a result that classically fitted into traditional
                                                                                                            smile design rules.
                                                                                                                         Because of the speed and
                                                                                                            removability of the Inman Aligner, she
                                                                                                            was prepared to have this done first. As
                                                                                                            her treatment progressed, her perceptions
                                                                                                            changed dramatically. She started to
                                                                                                            appreciate her own smile improving and
                                                                                                            those rules became less important (Figures
         Figure 18. Side smile view before.                Figure 19. Side smile view after ABB.            18–24).


                                                                                                            Conclusion
                                                                                                                          The concept of progressive smile
                                                                                                            design vs computer imaging carried out in a
                                                                                                            single first consultation can create a dramatic
                                                                                                            contrast in pathways of potential treatment.
                                                                                                                          A more minimally invasive
                                                                                                            outcome is possible if alignment and
                                                                                                            whitening techniques are carried out before
         Figure 20. Before smile view.                     Figure 21. After alignment, whitening.           any tooth preparation is even considered,
                                                                                                            because patients’ own perceptions of what
                                                                                                            they find aesthetic and what suits them can
                                                                                                            change if they are allowed to see their teeth
                                                                                                            transform progressively. Now that new nano-
                                                                                                            hybrid composite materials are available,
                                                                                                            edge bonding has become simpler and more
                                                                                                            predictable to place for a natural aesthetic
                                                                                                            result.


         Figure 22. After incisal edge bonding.            Figure 23. Profile view after ABB at 12 weeks.   Acknowledgements
                                                                                                                        The author thanks Donal Inman
                                                                                                            CDT Inman Orthodontic Laboratory, Coral
                                                                                                            Springs Florida and Nimrodental Ortho Lab,
                                                                                                            Paddington, London.
                                                           the flexibility of the archwire allows for
                                                           physiological tooth movement and reduces
                                                           the risk of bond fracture through occlusal       References
                                                           forces. Periodontal ligament stability is also   1.   Morley J, Eubank J. Macroesthetic
                                                           achieved with this technique (Figures 16 and          elements of smile design. J Am Dent
                                                           17)                                                   Assoc 2001; 132: 39–44.
                                                                                                            2.   Miller EL, Bodden WR, Jamison HC. A
                                                                                                                 study of the relationship of the dental
                                                           Discussion                                            midline to the facial median line.
                                                                        This patient previously had              J Prosthet Dent 1979; 41: 657–660.
                                                           been put off by traditional orthodontics.        3.   Beyer JW, Lindauer SJ. Evaluation of
                                                           Ultimately, she knew she could have                   dental midline position. Semin Orthod
         Figure 24. After full face.
                                                           achieved a more ideal orthodontic result              1998; 4: 146–152.
                                                           with fixed brackets, but the patient was         4.   Latta GH. The midline and its relation to
                                                           adamant that she did not want to go down              anatomic landmarks in the edentulous
         patient was shown how to clean interdentally.     this route. Instead, she had considered               patient. J Prosthet Dent 1988; 59: 681–
                     At the same appointment, the          porcelain veneers, which would have                   683.
         composite was re-polished and contoured           involved far greater tooth reduction and the     5.   American Academy of Cosmetic
         to ensure that the edges were relatively          associated biological risk. She had looked            Dentistry. Accreditation Examination
         symmetrical and the patient was happy.            at the results of other veneer cases and,             Criteria. 21: Is there a Progressive Increase
         Advantages of this method are that                because she had been shown computer                   in the Size of the Incisal Embrasures?
         November 2011                                                                                                                 DentalUpdate 591


pg586-592 Minimally Invasive Cosmetic Dentistry.indd 591                                                                                                 08/12/2011 12:01
          AestheticDentistry




             Madison, Wis: American Academy of             11. Linge BO, Linge L. Apical root                    interproximal distance of roots and the
             Cosmetic Dentistry, 1999.                         resorption in upper anterior teeth:               prevalence on intrabony pockets.
         6. Morley J. A multidisciplinary approach             Eur J Orthod 1983; 5(3): 173–183;                 J Periodont 1984; 55(10): 604–607.
             to complex aesthetics restoration with            doi:10.1093/ejo/5.3.173.                    17.   Reprinted: Case CS. Principles of
             diagnostic planning. Prac Perio Aesth         12. Kumasako-Haga T, Kanoo T, Hayashi                 retention in orthodontia. Am J Orthod
             Dent 2000; 12: 575–577.                           H. Effect of 8-hour intermittent                  Dentofacial Orthop 2003;124(4): 352–
         7. Lombardi RE. The principles of                     orthodontic force on osteoclasts                  361.
             visual perception and their clinical              and root resorption. Am J Orthod            18.   Little RM, Reidel RA, Artun J. An
             application to denture esthetics.                 Dentofacial Orthop 2009; 135: 278.                evaluation of changes in mandibular
             J Prosthet Dent 1973; 29: 358–382.                e1–278.e8.                                        anterior alignment from 10 to 20 years
         8. Morley J, Eubank J. Advanced Smile             13. El-Mangoury NH, Moussa M, Mostafa Y,              post retention. Am J Orthod Dentofacial
             Design. Course presented at 141st                 Girgis A. In vivo remineralization after          Orthop 1988; 93: 423–428.
             Annual Session of the American                    air-rotor stripping. J Clin Orthod 1991;    19.   Blake M, Bibby K. Retention and
             Dental Association, Chicago: Oct 17,              25(2): 75–78.                                     relapse: a review of the literature. Am J
             2000.                                         14. Radlanski R. Morphology of                        Orthod Dentofacial Orthop 1998; 114:
         9. Hancher P. Orthodontics for esthetic               interdentally stripped enamel one year            299–306.
             dentistry Part 1. J Cosmetic Dent 2005;           after treatment. J Clin Orthod 1991;        20.   Becker A, Goultschin J. The multistrand
             20: 80–92.                                        23(11): 748–750.                                  retainer and splint. Am J Orthod 1984;
         10. Kameyama T, Matsumoto Y, Warita H,            15. Heins PJ, Thomas RG, Newton JW. The               85: 470–474.
             Soma K. Inactivated Periods of Constant           relationship of interradicular width        21.   Hadad R, Hobson RS, McCabe JF. Micro-
             Orthodontic Forces Related to Desirable           and bone loss. J Periodont 1988; 59(2):           tensile bond strength to surface and
             Tooth Movement in Rats. Tokyo Medical             73–79.                                            subsurface enamel. Dent Mater 2006;
             and Dental University, Japan, 2003.           16. Tal H. Relationship between the                   22(9): 870–874. Epub 2006 Jan 24.

         Abstracts
         CAn FISSURe SeAlAnTS DelIveR A                    chemistry and dental material science           especially for your patient. The curing
         ‘DoUble-whAMMy’?                                  involved, but concludes that the sealants       ability of three curing lights was tested on
         In situ evaluation of the remineralizing          containing ACP and/or fluoride were             a 2mm thick sample of composite resin.
         capacity of pit and fissure sealants              able to promote in situ remineralization        Full polymerization was achieved if the tip
         containing amorphous calcium phosphate            of artificially induced carious lesions         of the most powerful light was held 15mm
         and/or fluoride. Silva KG, Pedrini D, Delbem      on smooth enamel surfaces. This in situ         from the material, whereas the weakest
         ACB, Ferriera L and Cannon M. Acta Odont          methodology was able to distinguish the         light had to be only 6mm away. If the light
         Scand 2010; 68: 11–18.                            effect of fluoride and calcium-phosphate        is held at a greater distance than these
                                                           releasing materials using different analyses    then full depth curing – that is at the top
         Fissure sealants are a powerful weapon in         and may be applied in tests of new              and the bottom of the restoration - may
         prevention programmes, but some people            formulations of dental materials.               not occur.
         still express concern on the possibility                        An interesting paper, from both                The resultant restoration may
         of inadvertently sealing over an active           a dental material science and a clinical        therefore depend on three factors. First,
         carious lesion. [Clinically the technique of      dentistry perspective.                          the output of the curing light, which varies
         the preventive resin restoration, whereby                                                         with different models and which should be
         a suspicious fissure was investigated             IS TheRe A lIGhT MeTeR In yoUR                  tested regularly using an appropriate light
         with a bur before applying the sealant,           PRACTICe?                                       meter. Second, the distance the curing tip
         has now been termed the destructive               Curing efficiency of three different curing     is held from the surface of the restoration,
         resin restoration and has largely been            lights at different distances for a hybrid      ensuring that the distance remains
         abandoned in teaching centres.] This              composite. Zhu S and Platt JA. Am J Dent        constant throughout the procedure.
         paper reports early work with a new form          2009; 22: 381–386.                              Thirdly, although this is not mentioned in
         of fissure sealant that contains amorphous                                                        this research paper, is the training given to
         calcium phosphate (ACP). Three different          Research papers, especially those reporting     the dental nurse responsible for holding
         commercial sealants containing a mixture          a laboratory based study, often appear          the curing light. This paper may be a useful
         of ACP and fluoride were tested to                boring and irrelevant to the busy general       reference during a staff training session, to
         compare the remineralization of artificially      practitioner faced with a pile of journals      show how apparently esoteric academic
         induced carious lesions in ten volunteer          to read after a busy day in practice. The       research is actually very relevant to
         patients who wore acrylic palatal devices         American Journal of Dentistry always            everyday clinical practice. Evidence based
         for the five days of the double-blind             includes a paragraph entitled ‘Clinical         dentistry in a different form?
         experiment.                                       Significance’ and for this particular piece                                    Peter Carrotte
                      The paper describes the              of research it really is quite significant,                                          Glasgow

         592 DentalUpdate                                                                                                                 November 2011


pg586-592 Minimally Invasive Cosmetic Dentistry.indd 592                                                                                              08/12/2011 12:01

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:18
posted:4/18/2012
language:English
pages:6