Restorative Dentistry

Cleaning and polishing efficacy of abrasive-bristie brushesand a prophylaxis paste on resin composite material in vitroPatrick R. Schmidlin, Dr med dentVBeatrice Sener^/Felix Lutz, Prof Dr med med dent,

Objective: This study evaluated the cleaning and polishing effect of a prophylaxis paste (Cleanic), two dif-ferently shaped abrasive-brist le brushes (Occlubrush normal cup and Occiubrush minipoint), and a nylon-bristle brush (Prophy brush) on a fine (Tetric Ceram) and a coarse hybrid resin composite (TetricCondense) under standardized conditions. Method and materials: A total ot 48 round specimens with adiameter of 17.2 mm (232.32 mm^) of a fine and a coarse hybrid resin composite were readied and tijtedon scanning electron microscopic mounts After a standardized polishing procedure, the mean surfaceroughness values were evaluated using five horizontal and five vertical measurements over an area ot 1 x3 mm. The gloss of each specimen was assessed with a s pect rop h oto meter. Both hybnd resin compositegroups were treated with one of the following instruments: a nylon-bristle brush (n = 8), a normai-cup abra-sive-bristle brush, or a minipoint abrasive-bristle brush. The medium used was either water (control) or aprophylaxis paste. Surface roughness and gloss were measured after instrumentation times of 15, 30, 60,90, and 120 seconds. For the evaluation of cleaning ability, another 48 total round specimens of tine andcoarse hybrid resin composite were covered with a thin layer of black dispersion color and air dried tor 24hours. Specimens were treated with a nylon-bristle brush or an abrasive-bristle brush in combination withwater or prophylaxis paste for 15, 30, 60, 90, and 120 seconds. At the beginning and after every treatmentinterval, the specimens were scanned, the images were digitized, and the percentage of cleaned surfacewas measured planimetrically. Results: The abrasive-bristle brush, used in combination with water, pro-duced the best outcomes for cleaning ability, surface roughness, and gloss on resin composite restora-tions. Conclusion: There is no positive cumulative effect when an abrasive-bristle brush, with its cleaningand polishing effect, is used in conjunction with a prophylaxis paste. Abrasive-bristle brushes used withplain water are highly suitable for cleaning and polishing resin composite surfaces. (Quintessence Int2002:33:691-699)

Key words: abrasive-bristle brush, cleaning ability, gloss, prophylaxis paste, surface roughness,tooth-colored restoration

CLINICAL RELEVANCE: Recently established qualityguidelines for restorative dentistry in Switzerland have re-vealed the need for professional maintenance of tooth-colored restorations. An abrasive-bristle brush used withwater alone is highly suitable for cleaning and polishingresin composite surfaces. The addition of prophylaxispaste offers no extra benefit.

'Clinical and Research Assistant, Clinic ot Preventive Dentistry, Perio-dortology, and Cariology, Zurich University, Dental Sctiool, Zurich,Switzerland.

^hiet Laboratory Assistant, Oral Care Research Laboratory, Clinic otPreventive Dentistry, Periodontology, and Cariology, Zurich University,Dental School, Zurich, Switjerland.

'Pratessor and Chairman, Clinic of Preventive Dentistry, Periodontology,and Cariolcgy, Zurich University, Dental School, Zurich, Switzerland,

Heprint requests: Dr R R. Schmidlin, Zuijch University, Dental School,Plattenstrasse t 1 , CH-et]3S Zurich, Switzerland. E-mail: schmidli@amk,ijnizh.ch

The desire to use resin composites as restorative mate-rials in posterior teeth is based on esthetic concerns.

The term tooth-colored restoration is therefore self-defining. The establishment or the reestahlishment ofsecondary oral health has not only the preservation ofdental hard structures and the restitution of tooth formand function as major aims hut also the imperceptive-ness of restorations at normal talking distance as a goal,fn Switzerland, long-term quality warranties of 8 yearsfor direct restorations and 10 years for indirect restora-tions have been established; the guidelines institute highdemands concerning the quality of restorations.' ^

These goals may he difficult to achieve, however.The main problems that present are changes in thecolor of the material as well as superficial and mar-ginal discoloration.^ Therefore, a successful care con-cept has not only to discern and to avoid new cariesand attachment loss arising from periodontal diseasebut also to preset^e the quality of the restoration in aspecific and prophylactic way.

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Fig 1 Different brushes (left to rignt) Nylon-bristie brush.Oooiubrush normai cup {Hawe Neos), and Occlubrush minipoint(Hawe Neos)

Ferrari et al"̂ demonstrated the importance of peri-odic maintenance of restorations in a 5-year clinicalstudy. Sixty esthetic Class III, Class IV, and Class Vrestorations were placed and reexamined every 6months, using Ryge and Snyder's criteria for marginalintegrity, anatomic form, and color stability.̂ Patients inthe trial periodically received conservative restorationpolishing and professional toothcleaning. Despite thisintensive maintenance care, after 5 years, only 50% ofthe evaluated restorahons received an Alpha score forcolor stability. Fifteen percent of all restorations requiredreplacement for other reasons. These results demon-strate the needs and problems of maintenance care.

Baillod et al̂ also examined 60 Class III and ClassIV restorations clinically, after placement and after 3,6, and 12 months. They evaluated marginal adaptationwith a scanning electron tnicroscope, using the replicatechnique. All restorations were rated Alpha or Bravo.Tbe percentage of "continuous margins" was about9O''/o initially and increased to 95% at 12 montbs. Tbiscan be explained by tbe repeated refinishing of mar-ginal imperfections at all recall intervals.

Contouring, finishing, and polisbing procedures im-mediately after the placement of tooth-colored adhe-sive restorations are a prerequisite to achieving a highinitial restoration quality, including smooth surfaces tominimize accumulation of plaque. Freshly cured com-posites have a physically, chemically, and estbeticallyinferior, resin-rich surface layer, in which polymeriza-tion is inhibited by oxygen. Ideally, a filler-rich,enamel-like, polished, and glossy surface must beacbicved in combination witb a perfect marginal adap-tation. In addition, repolishing within a few days orweeks after placement of the restoration optimizes theinitial restoration quality.

The long-term quality is ensured by consistent pro-fessional maintenance care.'' To tbis end, many instru-ments are at tbe disposal of dentists and dental by-gienists. Tbese instruments are used in refinishingand polishing; elimination of excess material, de-tached flashes, and marginal imperfections; and re-moval of marginal and superficial discoloration.However, within the realm of professional dental hy-giene procedures, gentle, nondestructive instrumentsare indicated.**

The use of prophylaxis pastes in combination withrubber cups, nylon-bristle brushes, or abrasive-bristlebrusbes is accepted, although controversial. Self-regu-lating abrasive propbylaxis pastes witb tbe abrasivemedium perlite consistently yield low relative dentinand enamel abrasion values, good cleaning ability, andgood surface roughness scores.^'" They thus seem tobe suitable for tbe removal of bard and smooth de-posits from bard dental structures," as well as forrestoration maintenance.'^

Clinical experience suggests that stain can be re-moved more efficiently from dentin and enamel sur-faces wben an abrasive-bristle brusb is combined witha prophylaxis paste. This hypothesis should be testedwitb regard to tbe maintenance of resin compositerestorations. Tberefore, it was the aim of this study toevaluate tbe effect of two differently sbaped abrasive-bristle brusbes and a nylon-bristle btiisb in combina-lion witb a propbylaxis paste or water alone onstained composites. In tbis research, cleaning abilityand final surface quality, ie, surface roughness (Ra)and gloss, were assessed. Additionally, the aim was toprovide general practitioners with guidelines for theselection of adequate cleaning and polishing instru-ments for stain removal and optimization of restora-hon surface quality.

METHOD AND MATERIALS

The appearance of the brushes (Hawe Neos) is similarto that of currently available prophylaxis brushes. Thebrushes are available in the form of cups and mini-points (Fig 1). To prevent confusion with prophylaxisbrushes, the metallic parts are gold plated. The bristlesare made of a special, rather rigid polycarbonate fiber,which is impregnated with silicon carbide particles.

Cleanic (Hawe Neos) is a prophylaxis paste com-bining a good cleaning ability witb a simultaneous pol-ishing, ie, morphologic smoothing of the surfaces,causing minima] abrasion. This paste contains perlite,a natural glass with a sheetlike geometry of particles(Fig 2). The average grit size of these abrasives is 40pm and decreases during instrumentation as the parti-cles become rounded.

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Tbese materials can be used to polisb ceramics,resin composites, and "compomers" as well as to pol-ish the teeth during a dental prophylaxis.

Afeasuremeni of surface roughness and gioss

A total of 48 round specimens, with a diameter of 172inin (232.32 mm-), were made of a fine hybrid resincotnposite (Tetric Ceram, Vivadent) and a coarse hy-brid resin composite (Tetric Condense, Vivadent).They were fixed on scanning electron microscopicmounts (PPK). All specimens were then groundsmooth with a rotating sandpaper device (Pedemax-2,Struers) and waterproof silicon carbide papers(Struers). Minimal pressure was applied for 15 sec-onds each with 1,200 and 2.400 grit papers and for1 minute with 4,000 grit paper.

After this standardized polishing procedure, themean surface roughness values were evaluated withfive horizontal and five vertical measurements takenover an area of 1 x 3 mm (Talysurf 50, Rank TaylorHobson). In addition, tbe gloss of each specimen wasdetermined with a spectrophotomeler (Minolta CM508d), as described in standard speciflcation 5033 ofthe International Standardization Organization (gloss:sphere geometry D/8°, specular component included,and specular component excluded).

After evaluation of aO basehne data, the specimensof both hybrid resin composite groups were treatedwith one of the following instruments: a nylon-bristlebrush (Prophy brush, Hawe Neos), an abrasive-bristlebrush with a normal cup (Occlubrush normal cup,Hawe Neos) and a minipoint abrasive-bristle brush(Occlubrush minipoint, Hawe Neos). The instrumentswere operated at 3,600 rpm in a slow contra angle-handpiece (120 IS Micro Mega) used with a standard-ized force of 2 N, ensured by the use of an 8,600-digi-tal multimeter specifications control device (KontronElectronic). The media used were either water (con-trol) (n = 8) or a prophylaxis paste (Cleanic, HaweNeos) (n = 8). Every 15 seconds, specimens wererinsed for 15 seconds with distilled water, and a freshportion of prophylaxis paste was apphed.

Surface roughness and gloss measurements weretaken after instrumentation times of 15, 30, 60, 90,and 120 seconds. In addition, impressions were madeafter every treatment interval in a low-viscositypolyvinyl siloxane (President light body, Cohene), andreplicas were made {Stycast 1266, ICI). These replicaswere analyzed under a scanning electron microscope(Amray 1810) at a magnification of x500.

The measured mean surface roughness values at allintervals and treatment steps were statistically ana-lyzed with the unpaired t test, performed with a com-puter program (Stat View TM II).

Fig 2 Perlite showing sheetlike geometry of particles. The gritsize of these abrasives decreases during inslrumentaticn, andparticles become rounded. (Original magnification X200.1

Assessmerit of cleaning abilit

For the evaluation of cleaning ability, another 48 totalround specimens of fine and coarse hybrid resin com-posite were fixed on scanning electron microscopicmounts. The specimens were mecbanically smoothedfor 15 seconds with 1,200-grit silicon carbide paper asdescribed earlier. All specimens were then coveredwith a thin layer of black dispersion color (Exponitblack 380. Bosshard), and air dried for 24 bours. Thisindustrial color suitably simulates staining in vitro, be-cause it consists of biack ferric oxide (Fe^O;) particlesvarying in size from 30 to 50 pm in a matrix ofpolyvinyl acetate. Furthermore, this dispersion colorhas excellent wetting properties, has a low water sorp-tion potential, is not water soluble after drying, andalso resists large changes in pH values.

Eight specimens each were treated with either anylon-bristle brush or abrasive-bristle brushes (Occlu-brush), in combination witb water or a propbylaxispaste (Cleanic) for 15, 30, 60, 90, and 120 seconds.The brushes were operated at 3,600 rpm with a stan-dardized force of 2 N. At the beginning and after everytreatment interval, the specimens were scanned(Hewlett Packard C1750A), the images were digitized,and the percentage of cleaned surface was measuredplanimetrically. Unpaired t tests were used to comparethe groups statistically.

RESULTS

Surface roughness and gloss

On both hybrid resin composites, independent on thetype of brush used, the prophylaxis paste produced a

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Fig 3 Increase in average surfaoeroughness (Ra] and ohange in gioss vai-ues atter an instrumentation ot 120 sec-onds on the fine hybrid resin composite(Tetric Ceram].

Fig 4 increase in average surfaceroughness (Ra] and change in gioss vai-ues after an inslrumentaticn of 120 sec-onds on the coarse hybrid lesin compos-ite (Tet'ic Condense].

significantly greater increase in mean surface rough-ness (P = .001) than did water (Figs 3 and 4).

The initiai gioss after standard polishing with 4,000-grit silicon carbide paper indicated that the fine hybridresin composite had superior polishing ability. Onboth composite materials, all instruments produced ahigher gloss when used with water rather than in com-bination with the prophylaxis paste.

D/iicromorphology

The scanning electron microscopic views of both com-posite materials after standard polishing clarified the dif-ference concerning filier dimensions. In the coarse hy-brid resin composite {Fig 5), the coarse filler particles areclearly visible, whereas the fine hybrid resin composite(Fig 6) shows a smooth, even, although porotjs, stirface.

On the fine hybrid resin composite, all instrumentsin combination witb water produced a stnooth surfaceafter a 15-second instrumentation (Fig 7). This corre-

lated witb the modest increase in surface roughtiessvalues and did not differ significantly from the un-treated and polished surfaces at baseline. In contrast,all specimens treated witb tbe prophylaxis pastesbowed clear surface alterations. Only the normai cupof the abrasive-bristie brush (Occlubrush) producedno scratches (Fig 8).

On the coarse hybrid resin composite, the tested in-struments showed different results. With water alone,the Occiubrush normal cup produced a visiblysmuotber surface than was present at baseline (Fig 9).The nylon-bristle brush led to an apparent reductionof the filler particle size, whereas the minipoint pro-duced no surface alterations. Tbe micromorphologicappearance correlated with the measured Ra values.In combination with prophylaxis paste, a clear rough-ening effect was seen. The minipoint abrasive-bristiebrush produced the visibly smootbest surface, whereastbe normal cup as well as tbe nylon-bristle brusb re-suited in a coarse micromorpbology (Fig 10).

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Fig 5 Scanning electron microscopic observation o) the coarsehybrid resin composite atter standard polishing with 4.000-grrt sili-con carbide paper. (Original magnification x500.)

Fig 6 Scanning electron microscopic observation oí the fine hy-brid resm composite atter standard polishing with 4.000-grit sili-con carbide paper. (Original magnification x500.)

Fig 7 Smooth surface on the fine hybrid resrn composite after15-second instrumentation with an abrasive-bristle brush(Occiubrush normal cup) and water. (Original magnificalionX5(X).]

Fig 8 Fine hybrid resin composite treated with an abrasive-bris-(le brush in combination with prophyla>;is paste (Cleanic).(Original magniticalion x500.)

Fig 9 Coarse hybrid resm composite treated with the abrasive-bristle b/ush and water. (Original magnification x500.)

Fig 10 Coarse micromorphology on the coarse hybrid resincomposile after 15-second instrumentation with the abrasive-bris-tle brush rn combination with prophylaxis paste (Cleanic).(Original magnification X5OO )

QUI h lessen ce International 695

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Fig 12 Cleaning ability on the coarse hy-brid resin composite, measured as a per-centage of cleaned surlace (%CS), ie, ttiearea cleaned of dispersion color.

deaning abiiity

As expected, the cleaning ability of the nylon-hristlebrush without prophylaxis paste was poorest on bothcomposite materials and did not exceed the 15%marii, even after 2 minutes of instrumentation (Figs 11and 12).

The ahrasive-bristle brushes with plain watershowed better cleaning effects, particularly within the60-second instrumentation bracket. This resulted in asteeper and exponential increase in measurable clean-ing. In contrast, the Ra values pertaining to the combi-nations of prophylaxis paste with the normal-cupabrasive-bristle brush and prophylaxis paste with thenylon-bristle brush resuited in sigmoid curves over thesame time interval. Thus, the paste had a lower final

cleaning effect. After the 2-minute interval, hoth typesof abrasive-bristle brushes showed a nearly 100%cleaning effect with water. The same was achievedwith the prophylaxis paste irt combination either withthe nylon-bristle hrush or the normal-cup abrasive-bristle brush.

The minipoint abrasive-bristle brush, when com-bined witb the prophylaxis paste, showed a reducedcleaning ability. This instrument showed a clearly bet-ter cleaning ability with water alone.

Qualitative examination of the scanned specimensalso clarified the better cleaning ability of the abrasive-bristle brushes when combined with water [Fig 13)rather than prophylaxis paste (Figl4). The nylon-bris-tle brush exhihited almost no cleaning effect on thecolored resin composite surfaces.

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Fig 13 Planimetrie evaluation ot cleaning ability alter 15seconds when the abrasive-bristle brush was used in oom-bination with water.

Fig 14 Planimetrie evaluation of cleaning ability after 15seconds when the abrasive-bristle brush was used in oom-bination with a prophylaxis paste

DISCUSSION

A high quality immediately after tbe completion of arestoration does not, in itself, guarantee high longevity.However, it improves the chances of remaining com-pliant with professional standards during tbe qualitywarranty period, despite a progressive loss of quality.Periodic recalls are undoubtedly important for themaintenance and the restitution of periodontai health.

However, routine cleaning procedures with conven-tional hand citrettes and sealers, as well as sonic or ul-trasonic deiices. cannot be performed during periodicrecalls without risking damage to the restorations.'^"''An in vitro investigation on the effect of metal and plas-tic curettes* on the restorative interface of laboratory-made ceramic restorations revealed tbe importance ofcareful and gentle instrumentation during recall treat-ments, Attenhon must tberefore be paid to the instru-mentation during professional dental hygiene proce-dures and during cleaning and polishing of restorations.

In essence, prophylaxis pastes are able to cleanrestorative materials as well as enamel and dentin.Among these pastes, the self-regulating abrasive perlitehas proven to be very efficient and yet gentle to dentalhard structures. The main objective of cleaning is fastand efflcient stain removal. At tbe same time, destruc-live abrasion on tooth and restoration surfaces andthe resulting surface roughness should be minimized.Cleanic propbylaxis paste, based on perlite, fulfillsthese objectives very well.

Paste carriers also play an important role. Nylon-bristle brusbes and rubber cups are the most com-monly used application instruments. The rubber cup isto be preferred clinically because it is friendlier to thegingiva. The development of abrasive-bristle brushes

bas complemented tbe spectrum of clinically availableinstruments to finisb resin-based restorations. Tbeyfilled a critical gap for tbe polisbing of tbese materials.Tbese instruments proved to be useful, even for tbe re-moval of stain.

It migbt be considered advantageous to combineabrasive-bristle brusbes and a propbylaxis paste to co-ordinate tbeir benefits. No objective comparative stud-ies combining surface treatment and cleaning abilityseem to bave been published previously. The presentin vitro investigation aimed to compare, under stan-dardized conditions, abrasive-bristle brusbes whh anylon-bristle brush when used witb water or in combi-nation with a propbylaxis paste on two bybrid resincomposites of different filler size.

Surprisingly, tbe clinically postulated bigh effi-ciency of the combination of an abrasive-bristle brusbwitb a propbylaxis paste was not confirmed. For bothhybrid resin composites, a highly significant differ-ence was found in the induced surface roughness val-ues of the water and the prophylaxis paste groups.These surface roughness values were micromorpho-logically corroborated by tbe scanning electron mi-croscopic investigation.

Tbe propbylaxis paste bad no additional positive ef-fect on gloss. Hatber, tbe use of propbylaxis paste re-sulted in lower gloss values tban were found after thestandard polishing procedure. On tbe fine hybrid resincomposite, Tetric Ceram, a high subjectively and ob-jectively measured gloss was found after standard pol-ishing; this could be maintained when water was usedin combination with any of the brushes. On the coarsehybrid resin composite, Tetric Condense, the abrasive-bristle brusbes even improved the gloss when usedwith water.

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Cleaning efficiency showed similar tendencies.During the first minute of treatment, the abrasive-bris-tle brushes with water produced better cleaning thandid the same brushes with the prophylaxis paste.Subjective niicromorphologic investigations confirmedthese results. The following are possible explanationsfor these results: (1) With abrasive-bristle brushes, theclearance of the prophylaxis paste is high, ie, the pastesplatters away almost immediately and is thereforebarely effective; or (2) tbe paste has a lubricating ef-fect, tbus reducing the cleaning efticiency of the abra-sive-bristle brusb.

On composite surfaces, tbe additional use of a pro-phylaxis paste did not enhance the cleaning ability ofabrasive-bristle brusbes. No superior surface qualitiesin rougbness, morpbology, or gloss were found. Thesubjective Impression of clinicians, that the combina-tion of a prophylaxis paste with abrasive-bristlebrushes may be advantageous, was not confirmed inthis study. The working hypothesis was that the com-bination of abrasive-bristle brushes, with their clean-ing and polishing effects, and a prophylaxis paste mayhave a positive cumulative eftect. The clinical impres-sions of "practice suitability" probably developed be-cause the stiffer abrasive bristles of the abrasive-bristlebrusb produce a bighcr pressure than the relativelysofter nylon bristles. Tberefore, tbis combination ofpressure and prophylaxis paste may give a false, sub-jective impression of an improved effect.

It is clear that, for maintenance care of resin com-posite restorations, the use of an abrasive-bristle brushwith water alone is preferred to the combination withprophylaxis paste.

These findings confirm those described by Bose andOtt," who investigated the effect of 29 prophylaxispastes on surfaces of a microfilled and a hybrid resincomposite. Roughness values recorded on polishedcomposite surfaces (Ra values before treatment: 0.07to 0.17 Jim) ranged from 0.11 to 0.46 jim. On the otherhand, 21 pastes also polished rough surfaces (Ra val-ues before treatment: 0.96 to 1.11 ym) to an Ra valueof 0.4 ± 0.1 pm witbin 15 seconds.

In addition, various other finishing and polishingsystems and techniques have been described."*''Finishing diamonds have been shown to producerough, trough-like surfaces compared to carbide burs.'^Neitber should be used as finisbing and polishing in-struments, but they are suitable as instruments for ini-tial shaping of fhe restoration. ̂ ^ For polishing, other in-struments, such as pohshing disks, cups, and intraoralcomposite polishers yield better results when surfaceroughness is evaluated.^" In addition, polishing pastesalso significantly decrease Ka values.^' Nevertheless,the surface characteristics are also material dependentfollowing polishing with these instruments. Filler con-

tent, particle size, and the ability of the polishing sys-tem to abrade the filler may also contribute to the ob-served changes in surface characteristics.

Only limited data in the literature are available ontbe gloss obtained after polishing.̂ ^ For example, con-trast gloss was measured in one study using a lightscattering method.^' As observed in the present study,there was an inverse relationship between surfacerougbness and gloss, which was probably the result ofan increase in diffuse reflection from a rougher surface.

With regard to the various bristle brusbes used inprofessional cleaning and polishing, the following rec-ommendations can be given:

1. For cleaning and polishing of dental hard tissue,nylon-bristle brushes in combination with a pro-phylaxis paste, particularly the perllte-basedCleanic, are indicated, because of the high cleaningability, the low abrasivity, and fbe comparably lowsurface rougbness that is induced.

2. Near the gingiva, softer, tissue-friendly rubber cupsmaybe preferred.

3. On resin composite surfaces, the combination ofabrasive-bristle brushes and water is to be preferred.

CONCLUSION

The results of this comparative in vitro study disclosedno additional positive effect when abrasive-bristlebrushes were combined with a prophylaxis paste.There was evidence, however, that abrasive-bristlebrusbes used witb water alone are very efficient instru-ments for cleaning and polisbing resin composite sur-faces. The use of abrasive-bristle brushes provides veryfavorable results in the maintenance of tooth-coloredrestorations.

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2. SSO Schweizerische Zahnärzte-Gesellschaft: Qualitäts-standards in der Restaurativen Zahntnedizin. In: Qual-itätleitlinien in der Zahtimedizin. Zurich: Eigenverlag SSO,2000:75-103.

3. Van Meerbeek B, Peumans M, Gladys S, Braem M,Lambrechts P, Vanherle G. Three-year clinical effectivenessof four total-etch dentinal adbesive systems in cervical le-sions. Quintessence Int 1996:27:775-784.

4. Ferrari M, Bertelli E, Finger W. A 5-ycar report on anenamei-dentinai bonding agent and microfilled resin system.Quintessence Int 1993;24:735-741.

5. Ryge G, Snyder M. Evaluating the clinical quality of restora-tions. ¡ Am Dent Assoc 1973;87:369-377.

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6. Baillod R, Krejei I, Lutz F. Adhesive anterior tooth restora-tions with the use of dentin bonding with and without acavity liner. Sehweiz Monatsehr Zahnmed 1994;104:290-296.

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9. Lutz F, Sener B, Imfeid T, et al. Self-adjusting abrasiveness:A new technology for prophylaxis pastes. Quintessenee Int1993;24:53-65,

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13. Arcoria C|, Vitasek BA. Ferracane JL. Microleakage of eom.posite resin restorations following thermocyeling and instru-mentation. Gen Dent 1990:38:129-131.

14. Lee SY. Lai YL, Morgaño SM. Effects of ultrasonic scalingand periodontal curettage on surface roughness of porce-lain, f Prosthet Dent i995;73:227-232.

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17. Hoelscher DC, Neme AM, Pink FE, et al. The effect of threefinishing systetns on four esthetic restorative materials. OperDent 1993:23:36-42

18. Jung M. Surface roughness and cutting efficiency of com-posite finishing instruments. Oper Dent 1997:22:98-104.

19. Berastegui E, Canalda C, Brau E, et al. Surface roughness offinished composite resins. ] Prosthet Dent 1992:68:742-749.

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