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									2                                                                                                                                                        INSIDE DENTISTRY—APRIL 2009

                                                                                           “The ideal material for inserting porcelain laminate
                                                                                               veneers would be a composite resin material
                                                                                                    with a high filler concentration...”

Porcelain Laminate Veneer Insertion
Using a Heated Composite Technique
Gregg A. Helvey, DDS

Porcelain laminate veneers are                  placement, and the materials to be used       rounded by a resin matrix and contain a          POLYMERIZATION BEHAVIOR
used routinely in cosmetic dentistry. The       for bonding.7-13                              photoinitiator; the basic difference is that     OF COMPOSITE RESINS
public usually refers to this mode of treat-        Initially, porcelain laminate veneers     they vary in the amount and configuration        Composite resins shrink when polymer-
ment simply as “veneers.” Their popu-           were placed with restorative composite        of the filler particles (volume percentage).     ized and the amount of shrinkage is pro-
larity has increased because of television      resin. The same material used for anteri-     The difference in filler amounts accounts        portional to the filler type, shape, and
makeover programs, commercials, and             or restorations was used to insert veneers    for varying rates of flow or viscosity. For      volume of that material. 17-20 Shrink-
magazine advertisements. Porcelain lam-         because it was the only material availa-      example, the low viscosity of a flowable         age, in the form of bulk reduction, oc-
inate veneers have so increased in their        ble. A significant number of restorations     composite is achieved by decreasing the          curs during the polymerization process
attractiveness that the general public is       would fracture at the time of placement       filler concentration, which in turn, in-         as a result of the monomer molecules
demanding this type of instant make-            because the composite was thick and had       creases the amount of resin and polymer-         packing closer together, forming a poly-
over. Further, dental laboratories are com-     little flow. In pressing the veneer into      ization shrinkage.15 On the other hand,          mer network.20-23 In short, the higher
peting in marketing their abilities as to       place, clinicians sometimes used exces-       increasing the percentage of filler particles    the filler content of a composite resin,
how thin they can make their porcelain          sive force, resulting in cracks or complete   increases the viscosity, thereby decreasing      the less shrinkage occurs.24 Mechanical
laminate veneers. Plus, certain manufac-        fractures. Manufacturers recognized these     the flow and polymerization shrinkage.           properties and the wear resistance of a
turers and laboratories advocate prepless       problems and developed entire lines of            The ideal material for inserting porce-      composite resin are predisposed by the
laminate veneer techniques.                     composite resin luting materials solely       lain laminate veneers would be a com-            filler content.25,26 The filler volume of
    Porcelain laminate veneers were first       for the placement of porcelain laminate       posite resin material with a high filler         a composite resin has an effect on the
introduced by Charles Pincus1 in the 1930s      veneers and posterior porcelain restora-      concentration for strength, low polymer-         elastic modulus and volumetric shrink-
and used to change the appearance of            tions. The various luting materials differ    ization shrinkage, high modulus of elas-         age and is a key component in the devel-
movie actors’ teeth. Unfortunately, denture     in color, flowability, film thickness, and    ticity, and a high flowability that allows       opment of polymerization contraction
adhesive was the only means of attaching        volume percentage of filler material. To      the ceramic restoration to be easily placed.     stress.27 According to Hooke’s Law (vol-
the veneers to the teeth, and they came         keep the viscosity at a lower level, both     This ideal luting material would have to         umetric shrinkage x elastic modulus =
off in a short period of time. It was not       the size and amount of the filler particles   allow the full seating of the restoration,       stress), the greater the polymerization
until after Buonocore2,3 introduced the         are smaller than in restorative composite     without the excessive pressure that can          shrinkage and the higher the elastic mod-
concept of acid-etching enamel as a means       resins. The physical properties of these      result in a fracture to the restoration. The     ulus of a composite resin, the larger the
of mechanical retention that composite          materials can lead to post-insertion sit-     material would have low solubility, as well      contraction stress.
resin restoratives had retentiveness. By        uations, such as solubility, color change,    as high compressive and tensile strengths.           Another factor is the degree of con-
1982, Simonsen and Calamia 4 discov-            and flexural strength.14                      The proportional limit would be high             version or the amount of free radical
ered composite resin’s ability to bond to           This article discusses a method and the   and have excellent adhesion to porcelain         monomers in the resin matrix that bond
porcelain if the ceramic was treated with       advantages of thermal conditioning a re-      as well as tooth structure.                      together, forming a polymer network.
hydrofluoric acid. In 1983, using a refrac-     storative composite resin or commercial           The question is: Which available ma-         The greater the number of monomer-
tory model technique, Calamia5 described        luting cement that can be used for place-     terial is the closest to ideal? There are many   to-polymer formations that occur, the
a technique for fabrication and placement       ment of porcelain laminate veneers.           commercial luting cements for porcelain          higher the degree of conversion a com-
of porcelain laminate veneers. Around                                                         laminate veneers. Manufacturers provide          posite is said to have. There is a correla-
the same time, Horn6 described a tech-          LUTING CEMENTS                                ample advertising of their commercial pro-       tion between the degree of conversion and
nique of porcelain laminate veneer fab-         AND COMPOSITE                                 ducts. For unsuspecting clinicians, these        shrinkage.23,28 Shrinkage manifests as
rication using platinum foil. Since that        RESIN RESTORATIVES                            advertisements can sway their choices in         stress.20 This stress can have adverse ef-
time there have been numerous articles          Composite resin restoratives and luting       selecting products. For the more discrim-        fects on the composite resin material
describing tooth preparation protocols,         cements share the same component parts.       inate clinician, the literature is filled with   (internal crack formation), 29 the sur-
techniques for fabrication, methods for         Each is made up of filler particles sur-      countless studies on different luting ce-        rounding tooth structure (flexure or de-
                                                                                              ments. But a relatively small number of          formation),30-32 and/or failure of the
                                                                                              properly conducted clinical trials have          adhesive layer interface between the tooth
                                                                                              been reported, so clinicians must formu-         and the composite material (gap forma-
                                 Gregg A. Helvey, DDS                                         late their decisions from various sources.16     tion).33 Factors that effect these mani-
                                 Adjunct Associate Professor                                  There are numerous laboratory studies            festations include: the flexibility of the
                                 Virginia Commonwealth University School of Dentistry         available that show the differences of luting    surrounding tooth structure, the bond
                                 Richmond, Virginia                                           cements in regard to compressive strengths,      strength of the adhesive interface layer,
                                                                                              diametral tensile strength, tooth structure      and the temperature of the composite
                                 Private Practice                                             adhesion, film thickness, flowability, trans-    resin during the polymerization stage.
                                 Middleburg, Virginia                                         lucency, and other physical factors of these         Interestingly, the temperature of the
                                                                                              materials. Does the improvement of these         composite resin at the point of insertion
                                                                                              physical factors proportionally improve          has been the subject of discussion in the
                                                                                              the clinical success of the material?            literature.34-37 As previously mentioned,
INSIDE DENTISTRY—APRIL 2009                                                                                                                                                                             3

Figure 1 Each composite resin was placed
between two glass slabs at room temperature.

Figure 2 The glass slabs were placed in an oven   Figure 3 Tetric EvoCeram A-2 exhibited a flow       Figure 4 Prodigy B-1 exhibited a flow rate per-    Figure 5 Venus B-1 exhibited a flow rate per-
at 150.3°F for 4 minutes.                         rate percentage increase of 108%, calculated by     centage increase of 85%; 14 mm diameter after 4    centage increase of 76%; 17 mm diameter after 4
                                                  measuring the diameter of the sample after 4 min-   minutes at room temperature (top) and 26 mm        minutes at room temperature (top) and 30 mm
                                                  utes at room temperature (12 mm, top) and again     diameter after 4 minutes at 150.3°F (bottom).      diameter after 4 minutes at 150.3°F (bottom).
                                                  after 4 minutes at 150.3°F (25 mm, bottom).

Figure 6 Point 4 T-2 exhibited a flow rate per-   Figure 7 Gradia A-2 exhibited a flow rate per-      Figure 8 8 Filtek Supreme A-1 exhibited a flow     Figure 9 Clearfil Majesty Flow exhibited an
centage increase of 74%; 15 mm diameter after 4   centage increase of 41%; 17 mm diameter after 4     rate percentage increase of 40%; 15 mm diameter    increased flow of 5 mm after 4 minutes at
minutes at room temperature (top) and 26 mm       minutes at room temperature (top) and 24 mm         after 4 minutes at room temperature (top) and 21   150.3°F.
diameter after 4 minutes at 150.3°F (bottom).     diameter after 4 minutes at 150.3°F (bottom).       mm diameter after 4 minutes at 150.3°F (bottom).

the amount of monomer conversion to               elevation in temperature increases mon-             increase in conversion rates was also
a polymer network of a composite resin            omer mobility, which results in addition-           found in the study by Prasanna et al.45
when photoactivated is less than 100%.            al polymerization and lessened composite            Using the manufacturer’s required amount
In fact, it can vary from 50% to 75%.38           viscosity.34,35,41,42 Trujillo et al43 found        of light exposure to the composite resin,
The problem with incomplete polymer-              that an increase in the temperature of              they not only found an increase in the
ization is the effect of unreacted mon-           composite resin could significantly in-             conversion rates, but also an increase in
omer on the physical and mechanical               fluence resin polymerization. These in-             residual stress in the bulk of the materi-
properties of the composite resin. Un-            creased conversion rates could lead to              al.45 This increase in residual stress can
reacted monomers act as plasticizers,             improved properties of composite restor-            lead to reduced resistance to wear, result-
reducing the mechanical strength and              ative materials.43 Daronch et al44 found            ing in surface cracks.
increasing swelling of the composite res-         similar results in their study, which show-             On the other hand, Daronch et al37             Figure 10 The restorations are etched with a
in.39,40 Monomer conversion is effected           ed an increase in conversion rates that             found the duration of light exposure               10% hydrofluoric acid for the appropriate condi-
by the temperature, which in turn affects         were attributed to pre-warming com-                 could be reduced by 50% to 75% with                tioning time.
the composite resin properties.34-36 An           posites before photopolymerization. An              preheated composite, which yielded the
4                                                                                                                                                            INSIDE DENTISTRY—APRIL 2009

same or significantly higher conversion        tested and found to have an increased flow         ceramic surface. Water, alcohol, acetone,       Bond® FL, Kerr Corp). The elevated
(P = .001) than with a control (22°C,          of 5 mm after heating (Figure 9).                  acetic acid, and other by-products, if not      temperature of the ceramic surface will
20 sec). They concluded that preheat-                                                             completely removed by air-drying, may           increase the flow of the adhesive resin
ing a composite before photoactivation         RAISING THE                                        remain hydrogen-bonded to the hydrox-           into microporosities and any surface flaws
provided greater conversion, requiring         TEMPERATURE OF SILANE                              yl-rich silica fillers of the composite sub-    present. The surface flaws on a ceramic
reduced light exposure than with room-         The literature cites several studies on the        strate and decrease the number of bond          surface may increase the potential of crack
temperature composite. They also found         effectiveness of the use of silane appli-          sites available for reacting with silane,       propagation.65 Unseen microscopic flaws
that the reduced light exposure of heat-       cation to ceramic surfaces creating high-          thus compromising the final degree of           can develop at the laboratory, during the
ed composite lowered the contraction           er bond strengths of composite resins to           siloxane bond formation.55-58,63 There-         try-in phase, or during conditioning steps.
stress more than the control.                  ceramic surfaces.49-52 Silane improves             fore, the heat treatment of silane accom-       Magne has presented a case scenario where
                                               the wettability and adds to the covalent           plishes several things: It drives the silane/   prebonding cracks existed in a porcelain
INCREASING THE                                 bond formation between ceramic and res-            silica surface condensation reaction toward     veneer and remained invisible after 5
FLOW RATE WITH                                 in composite.51 It provides a bi-functional        completion; it promotes silane/silica for-      years.62 He attributed the phenomenon
TEMPERATURE ELEVATION                          attachment to both the resin and the ce-           mation; and it advances the evaporation         to the efficient sealing of the flaw by the
In their study, Blalock et al46 found that     ramic.52 The adhesive bond of composite            of water and solvents.58                        adhesive resin. Only the heated ceramic
preheating composite resin did yield high-     resin to enamel is purely mechanical and                                                           condition could have increased the flow-
er flow rates for some composite resins.       is solely dependent on the quality of the          Technique Sequence                              ability of the adhesive resin and aided in
They also found that there was no corre-       etch pattern created by phosphoric acid.           After the provisional restorations are re-      the ceramic flaw repair.
lation between the composite resin clas-       However, the adhesive bond of compos-              moved, clean the prepared teeth careful-           After the adhesive resin application
sification, filler content or shape, and       ite resin to a ceramic surface is not only         ly, using 50-µm aluminum oxide with             (Figure 14), apply a composite resin to the
film thickness.                                generated through mechanical means (hy-            light pressure. Wet the veneers with wa-        bonding surface of the porcelain veneers
    To simplify the effect of increasing the   drofluoric acid conditioning53,54), but            ter and try them in for verification of fit     (Figure 15). Then, arrange the “loaded”
flow of the composite, the authors placed      also by chemical means through the use             and patient approval. After the try-in,         veneers in the wells in the order of place-
several commercially available compos-         of the silane coupling agent.55                    clean the bonding surfaces of the res-          ment, cover them, and allow them to reach
ite resins between two glass slabs at room         Several studies have shown that warm-          torations with phosphoric acid for 5 sec-       the desired insertion temperature.37
temperature (Figure 1). The weight of          air drying of the silane improves the ad-          onds to remove salivary proteins that can
the top glass slab was a constant pressure     hesive–ceramic bond.51,56,57 After the             interfere with the ceramic etching with         CONDITIONING THE
applied to each sample. After 4 minutes,       silane is applied to the ceramic surface,          hydrofluoric acid (Figure 10). Rinse the        TEETH AND INSERTING
the amount of flow was noted by meas-          heat treatment causes a condensing ef-             restorations with water and dry them.           THE RESTORATIONS
uring the diameter of the sample. To-          fect of the coupling silane molecules on           Then, etch the internal surfaces with a         Isolate the prepared teeth, etch them
gether, the glass slabs were then placed       the ceramic surface.58,59 The heat treat-          10% hydrofluoric acid for the appropri-         with phosphoric acid, rinse them with
into an oven at 150.3°F for 4 minutes          ment can be accomplished through sev-              ate conditioning time. Each type of por-        water, and then suction them dry (no
(Figure 2). Then, the flow rate or the         eral methods. Magne described placing              celain has a specific etching time, which       air-water syringe used). Using a three-
amount that the composite resin spread         the silanated ceramic restoration in a dry         should be recognized and followed by            step bonding system (OptiBond FL),
out was noted by measuring the diame-          furnace at 100°C for 1 minute or using             the clinician to prevent improper condi-        apply the primer to the teeth and suction
ter. A percentage increase was then cal-       the warm air from a hair dryer for 2 mi-           tioning. After the acid is rinsed off, place    them dry. Then, apply the adhesive resin.
culated for each sample. The elevation in      nutes. 60 Improved microtensile bond               the restorations into a distilled water ul-     Thinning the resin with the air-water
temperature did affect some composite          strengths have been reported using a dry-          trasonic bath for 4 minutes.62 This bath        syringe is not necessary.
resins more than others. The following         ing temperature less than 100°C (212°F)            will remove the ceramic residue of sodi-           Starting with the central incisors, pick
list shows the percentage increase for sev-    but greater than room temperature.56,61            um, potassium, aluminum, and remin-             up each veneer with a college pliers in-
eral different composite resin products.       High-temperature air-drying (50°C to               eralized salts53,64 (Figure 11).Then, dry       strument (Figure 16), placing each veneer
                                               100°C) has been proven to increase ceram-          the porcelain veneers, and apply two coats      on the appropriate tooth. Because the
    • Tetric EvoCeram® A-2 (Ivoclar Vi-        ic–composite bond strength in luting               of silane to the bonding surface. Next,         composite luting material is warm (in-
      vadent, Inc, Amherst, NY; Figure 3):     ceramic restorations.62 Silane solutions           place the veneers in the preheated (155°F)      creasing both the conversion rate and
      108%                                     contain water and solvents that, when              veneer warming tray (Figure 12 and Fig-         flow of the resin66), light finger and thumb
    • Prodigy™ B-1 (Kerr Corp, Orange, CA;     present, decrease the condensation poly-           ure 13), then cover and warm for 2 minutes      pressure is all that is necessary to place
      Figure 4): 85%                           merization reaction that chemically bonds          (CalSet™ veneer warming tray, AdDent            the restoration in the correct position.
    • Venus™ B-1 (Heraeus Kulzer, Inc,         the silane to the ceramic. Evaporation of          Inc, Danbury, CT).                              Even though there is a reduction in tem-
      Armonk, NY; Figure 5): 76%               water and solvents contributes to the bond             After the silane heat treatment is com-     perature after restoration placement and
    • Point 4™ T-2 (Kerr Corp; Figure 6):      strength of the composite resin to the             pleted, apply a filled adhesive resin (Opti-    before photoactivation, benefits still may
    • Gradia® A-2 (GC America Inc, Alsip,
      IL; Figure 7): 41%
    • Filtek™ Supreme A-1 (3M ESPE, St.
      Paul, MN; Figure 8): 40%

    Preheating some composite resins that
demonstrate a significant increase in flow
rate should allow them to be used as luting
agents. The choice of the type of luting
agent and its filler loading becomes more
important when the marginal gap distance
between the restoration and the tooth
structures increases.47 Torii et al48 found
that cements with a higher filler content
had an increased wear resistance and work-
ed remarkably better in wider gaps.
    One flowable composite (Clearfil Maj-      Figure 11 The bath will remove the ceramic         Figure 12 The CalSet veneer warming tray is     Figure 13 The porcelain veneers are placed in
esty™ Flow, Kuraray America, Inc, New          residue of sodium, potassium, aluminum, and rem-   preheated to 155°F.                             the warming tray, covered, for 2 minutes.
York, NY) that has an extremely high           ineralized salts.
filler content of 81% by weight was also
INSIDE DENTISTRY—APRIL 2009                                                                                                                                                                                5

Figure 14 Adhesive resin is applied to the      Figure 15 Composite resin is loaded into the        Figure 16 Each veneer is picked up with a col-      Figure 17 The index fingers are placed on the
bonding surfaces of the porcelain veneers.      porcelain veneers.                                  lege pliers instrument.                             incisal edges while the thumbs are placed on the
                                                                                                                                                        labial surfaces to fully seat the restorations.

be seen in comparison with room-tem-                Calif S Dent Assoc. 1938;14:125-129.            17. Filho HN, Nagem HD, Francisconi PAS, et         29. Davidson CL, van Zeghbroeck L, Feilzer AJ.
perature composites.39,45                        2. Buonocore MG. A simple method of in-                al. Volumetric polymerization shrinkage of          Destructive stresses in adhesive luting
    Moving in a distal direction, insert the        creasing the adhesion of acrylic filling ma-        contemporary composite resins. Journal of           cements. J Dent Res. 1991;70(5):880-882.
remaining veneers. A cotton roll can be             terial to enamel surfaces. J Res Dent. 1955;        Applied Oral Science. 2007;15(5):448-452.       30. Jensen ME, Chan DCN. Polymerization
used to wipe away the gross excess before           34:849-853.                                     18. Fleming GJ, Khan S, Afzal O, et al.                 shrinkage and microleakage. In: Vanherle
starting light polymerization. Beginning         3. Buonocore MG. Principles of adhesive reten-         Investigation of polymerisation shrinkage           G, Smith DC, eds. Posterior Composite
with the central incisors, place the index          tion and adhesive restorative materials. J          strain, associated cuspal movement and              Resin Dental Restorative Dental Materials.
fingers on the incisal edges while placing          Am Dent Assoc. 1963;67:382-391.                     microleakage of MOD cavities restored               Utrecht, The Netherlands: Peter Szulc
the thumbs on the labial surfaces (Figure        4. Simonsen R.J, Calamia JR. Tensile bond              incrementally with resin-based composite            Publishing Co; 1985:243-262.
17). Exert light pressure to expel the re-          strengths of etched porcelain [abstract].           using an LED light curing unit. J Dent.         31. Sullivan AH, Boyer DB, Lakes RS. Poly-
maining excess composite luting material,           J Dent Res. 1983;62(Spec Iss):1099.                 2007;35(2):97-103.                                  merization shrinkage of composite resins:
and fully seat the restorations. The den-        5. Calamia JR. Etched porcelain facial ve-         19. Cattani-Lorente M, Godin C, Bouillaguet S,          comparison with tooth deformation. J Prosthet
tal assistant can position the light source         neers: a new treatment modality based on            et al. Linear polymerization shrinkage of           Dent. 1994;71(1):7-12.
between the clinician’s thumbs and acti-            scientific and clinical evidence. N Y J Dent.       new restorative composite resins. Eur Cell      32. Meredith N, Setchell DJ. In vitro measure-
vate the light for 5 seconds. The hands             1983;53(6):255-259.                                 Mater. 2003;5(Suppl 1):40-41.                       ment of cuspal strain and displacement in
of the clinician shield the other veneers        6. Horn HR. A new lamination, porcelain bond-      20. Giachetti L, Scaminaci Russo D, Bambi C,            composite restored teeth. J Dent. 1997;
from any light exposure. Next, the clini-           ed to enamel. N Y State Dent J. 1983;               et al. A review of polymerization shrinkage         25(3-4):331-337.
cian moves to the lateral incisors and              49(6):401-403.                                      stress: current techniques for posterior        33. Davidson CL, de Gee AJ, Feilzer A. The com-
repeats the same procedure. Carry out            7. Calamia JR, Simonsen RJ. Effect of cou-             direct resin restorations. J Contemp Dent           petition between the composite-dentin
this procedure until all the restorations           pling agents on bond strength of etched             Pract. 2006;7(4):79-88.                             bond strength and the polymerization con-
are secured in place. Using two light               porcelain [abstract]. J Dent Res. 1984;63       21. Loshaek S, Fox TG. Cross-linked polymers:           traction stress. J Dent Res. 1984;63(12):
sources, complete the light polymeriza-             (Spec Iss):79.                                      factors influencing the efficiency of cross-        1396-1399.
tion of each restoration. Then, clean the        8. Calamia JR. Etched porcelain veneers: the           linking in copolymers of methyl methacry-                  ,
                                                                                                                                                        34. Bajaj P Gupta DC, Babu GN. The tempera-
margins of excess composite material                current state of the art. Quintessence Int.         late and glycol methacrylates. J Am Chem.           ture dependence of monomer reactivity
using hand instruments such as scalers              1985;16(1):5-12.                                    1953;75:3544-355.                                   ratios in the copolymerization of styrene
and 12-b surgical blades.                        9. Quinn F, Mc Connell RJ, Byrne D. Porcelain                    ,
                                                                                                    22. Patel MP Braden M, Davy KW. Polymer-                with vinyl methyldiacetoxysilane. Eur Polym
                                                    laminates: a review. Br Dent J. 1986;161(2):        ization shrinkage of methacrylate esters.           J. 1977;13:623-624.
CONCLUSION                                          61-65.                                              Biomaterials. 1987;8(1):53-60.                  35. Bausch JR, de Lange D, Davidson CL. The
Elevating the temperature of composite          10. Calamia JR. Clinical evaluation of etched       23. Venhoven BA, de Gee AJ, Davidson CL.                influence of temperature on some physical
resin has been shown to improve the flow            porcelain veneers. Am J Dent. 1989;2(1):            Polymerization contraction and conversion           properties of dental composites. J Oral
characteristics of composite resin, increase        9-15.                                               of light-curing bisGMA-based methacrylate           Rehabil. 1981;8(4):309-317.
the degree of monomer-to-polymer con-           11. Strassler HE, Nathanson D. Clinical evalua-         resin. Biomaterials. 1993;14(11):871-875.       36. Lovell LG, Lu H, Elliott JE, et al. The effect
version, and reduce the amount of poly-             tion of etched porcelain veneers over a         24. Munksgaard EC, Hansen EK, Kato H. Wall-             of cure rate on the mechanical properties
merization contraction stress by reducing           period of 18 to 42 months. J Esthet Dent.           to-wall polymerization contraction of com-          of dental resins. Dent Mater. 2001;17(6):
the light exposure time. All of these ben-          1989;1(1):21-28.                                    posite resins versus filler content. Scand J        504-511.
efits have been made available through          12. Friedman MJ. A 15-year review of porcelain          Dent Res. 1987;95(6):526-531.                   37. Daronch M, Rueggeberg FA, De Goes MF.
the use of a unit for warming composite             veneer failure—a clinician’s observations.      25. Chung KH, Greener EH. Correlation be-               Monomer conversion of pre-heated com-
resin material. A veneer warming tray has           Compend Contin Educ Dent. 1998;19(6):               tween degree of conversion, filler concen-          posite. J Dent Res. 2005;84(7):663-667.
been manufactured that can be used in               625-638.                                            tration and mechanical proper ties of           38. Cook WD, Beech DR, Tyas MJ. Resin-based
conjunction with this unit to warm pre-         13. Barghi N, Overton JD. Preserving principles         posterior resins. J Oral Rehabil. 1990;17(5):       restorative materials—a review. Aust Dent
loaded porcelain veneer restorations using          of successful porcelain veneers. Contem-            487-494.                                            J. 1984;29(5):291-295.
tested composite resins. The same effects           porary Esthetics. 2007;11(1):48-51.             26. Condon JR, Ferracane JL. In vitro wear of       39. Nie J, Linden LA, Rabek JF, et al. A reap-
that are seen for composite restorative         14. Pace LL, Hummel SK, Marker VA, et al.               composite with varied cure, filler level, and       praisal of the photopolymerization kinetics
materials now can be achieved for com-              Comparison of flexural strength of five             filler treatment. J Dent Res. 1997;76(7):           of triethyleneglycol dimethacrylate initiated
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laminate veneers.                                   16(1):18-24.                                    27. Condon JR, Ferracane JL. Assessing the              for dental purposes. Acta Polymer. 1998;
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ACKNOWLEDGMENT                                      posites. Compend Contin Educ Dent. 2004;            merization stress. J Am Dent Assoc. 2000;       40. Lovell LG, Newman SM, Bowman CN. The
Special thanks to Ruth Egli for her edi-            25(5):371-378.                                      131(4):497-503.                                     effects of light intensity, temperature, and
torial contribution.                            16. Donovan TE. The selection of contempo-          28. Silikas N, Eliades G, Watts DC. Light inten-        comonomer composition on the polymer-
                                                    rary restorative materials: anecdote vs. evi-       sity effects on resin-composite degree of           ization behavior of dimethacrylate dental
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6                                                                                                             INSIDE DENTISTRY—APRIL 2009

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