COSTS INVOLVED IN PROVIDING PROSTHODONTIC CARE
by
[Lyndon Erhart]
Acknowledgement
I would take this opportunity to thank my research supervisor, family and friends for their
support and guidance without which this research would not have been possible.
Experiment 4 1
Experiment 4 2
DECLARATION
I, [Lyndon Erhart], declare that the contents of this dissertation/thesis represent my own unaided
work, and that the dissertation/thesis has not previously been submitted for academic
examination towards any qualification. Furthermore, it represents my own opinions and not
necessarily those of the University.
Signed __________________ Date _________________
Experiment 4 3
CHAPTER 1: INTRODUCTION
1.1 Background
This thesis is based on Experiment #4 which will evaluate the costs involved in providing
prosthodontic care. The dental prosthesis is to replace part of a tooth or one or several teeth that
were lost for some reason. There are three types of dental prosthesis according to how they are
fixed in the mouth such as Fixed Prosthodontics, Removable Prosthesis and Dental Implant.
Dental implant treatments are expensive compared with the placement of dentures or
bridges, but they worth it in the long term. A dental implant may last up to 40 years, compared
with dentures and bridges, which have a shorter retention time. The cost of dental implants is an
important factor, but it as an investment for the long term. It is recommended that patients must
think of it as a stable and reliable way to restore the confidence or the ability to enjoy a good
meal solution, and of course, to bring back your beautiful smile. A crown is a type of restoration
techniques of dentistry which completely encircles and caps a dental or tooth implants. This type
of crowns are often required when huge cavity threaten the ongoing tooth health. It is bonded
typically to the tooth by employing the dental cement. These types of crowns are often made
from a planet of materials which is primarily indirectly fabricated. These crowns are often
employed for improving the appearance or strength of teeth. Whereas, inarguably it is useful to
the materials, procedure, and dental health can be comparatively expensive. Basically, a dental
implant is a titanium or zirconium cylinder threaded or smooth, it is inserted into the bone
replacing lost tooth root. These cylinders have a surface treatment to allow integration (bonding
of the implant to the bone). This procedure is simple and painless and is performed under local
anesthetic (Overview of Prosthodontics Prices, 2013).
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The market for dental industry is very broad, covering both equipment like equipment
and smaller products. However, one of the segments more is important within the implants, with
demand growing so progressive, representing today nearly 20% of the total market.
1.2 Research Significance
In recent years, public opinions on affordability of dental care have become a topic of
interest. Policy attention has been given to this issue, especially within the context of working
poverty. It has been argued that a significant minority of the adult population is likely to
experience financial barriers in accessing dental care, especially among those who do not have
any form of dental insurance. Due to eligibility, low insurance coverage rate and lack of dental
care facility accessibility, the issue of dental care and costs still remain a problem for the low-
income population. Against this background, a large part of the public health literature argues
that significant reductions can be made in both individual and government level spending on
dental health care if health care professionals increased their efforts in educating themselves as
well as their patients on preventive dental health care methods.
1.3 Hypothesis
The fees levied by dentists for treatment are proportionate to the laboratories and
materials costs.
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CHAPTER 2: LITERATURE REVIEW
2.1 Introduction
The prosthesis can be combined with metal and porcelain and porcelain Zirconia
designed and created by modern automated equipment and computer (CAD / CAM 3D). As we
know, the cost of preventing dental diseases typically is far less than the cost of curing. Effective
tooth brushing decreases the likelihood of periodontal (gum) disease. Dental plaque is a
tenacious material on the tooth surfaces composed of a mucoid matrix, bacteria, and other debris.
It has been identified as the cause not only for the majority of inflammatory lesions of
periodontal tissue but also most dental caries. When properly used, tooth brushing is a
therapeutic tool, but that when it involves too much pressure, or is otherwise done improperly, it
can become a weapon that may destroy both tooth surfaces and the gingi (Warpeha, 2011).
There are various advantages of dental prosthetics such as it is least aggressive
technology, so this kind of dental services for patients offer more often. But many patients know
about the existence and restoration of dental implants, and insist on them. Many people look at
the cost of implants and prosthetics, and prosthetic teeth are selected. And some patients are
interested in a range of indicators, which also includes chronic diseases. The important thing is
that in prosthetics, dental interventions in the dentition, made much smaller, so the appearance of
complications is greatly reduced. Dental restoration can be applied in all cases (Gift et.al, 1981).
2.2 Cost of Dental Implants
In our modern world, there are many cutting-edge and proven method of correction and
restoration of dental problems. In traditional dental prosthetics market, dental services took a
strong position as effectively fighting for health, comfort and aesthetics. According to modern
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dentists, best technology is the one that is chosen individually for each patient, despite the
diversity in the field of dentistry. In any case report should be the principle of maximum reduced
dental treatment. Needless prosthetic patient should not bear the moral or any other costs, and
they should be kept to a minimum. To put it another way, this should not be overstated value.
Prosthesis prices are important trend in modern dentistry, which helps to recover completely
destroyed and missing teeth. For tooth prosthesis itself, it is not a cosmetic function, and
provides shape and stability of the bite and protects existing teeth from further damage. In
prosthetics, it uses sophisticated biomechanical design.
According to Meng (2005) a dental prosthesis is an artificial piece standing as a
replacement for a portion of our teeth that have been damaged or that have suffered loss. It is
very common to lose teeth due to bites, diseases, etc. The goal of a dental prosthesis is not only
aesthetic. It's back to normal life of a person rebuilding a damaged part and as a result, cannot
function properly. The mouth serves several important functions among which eating (chewing
food) and communicate (speak). If the teeth do not fit properly, we will have problems in
performing these functions.
The first cost to the patient faces is to install the implant. In general, the placement of
dental implants is costly because it is extremely expensive acquisition and replacement of all the
tools and materials to place (motors, micromotors, surgical kit, etc) as well as the elements and
materials used before and during the surgery (strawberries, surgical guides, grafting materials,
etc). A second cost is discovered or when the second surgery is done. This involves connecting
the implant to the oral cavity. This second intervention is a critical part between implant is good
or very good aesthetically. Those who know more soft tissue engineering are the periodontists. A
significant added value as mentioned training is professional, and his success depends on their
Experiment 4 7
knowledge of diagnosis and treatment. A third cost to patients, rehabilitation is faced.
Rehabilitation consists of two stages, the preparation of the tooth itself. The impression for
which special attachments and is needed. This tooth or crown can be made of different materials
and that will depend largely on the cost of this stage. Another item that influences the cost is the
system used for bonding between the crown and the implant (Glantz et.al, 1993).
The main problem today is not the cost of materials used in each practice, as it did many
years ago. To understand the issue, the professional must recognize that whenever a patient pays
for a treatment to the dentist, a part is intended to cover the costs for this provision, and the other
part corresponds to professional fees (i.e. the actual gain of the dentist). It is important to
understand that that these costs are classified as direct (inputs used in each practice) or indirect
(include investments to equip the office, monthly expenses, wages, services, taxes, etc.). It is
important to note that several decades ago; indirect costs were not so relevant, because those
dentists also performed a significant initial investment, so there was no need to renew the
equipment as often as today. Technological changes were much slower and those dental chairs
were not as sophisticated, besides the manufactured virtually for life (as with cars). On the other
hand, the rare time dentists working with paraprofessionals and charges taxes and service were
much lower (Bagewitz et.al, 2007).
The emergence of new technology requires long-term investments to avoid being
outdated and obsolete. Moreover, current techniques increasingly require teamwork and support
staff. The same bio-security measures adopted today are essential, which are very difficult to
implement without suitable support staff. All these changes are accentuated year after year; they
have completely changed the scenario in which the dentist has to perform. In short, if the indirect
cost means an expense of $7,700 per month (obviously highly variable value) and the dentist
Experiment 4 8
works with patient 160 hours per month, collect about $48 per hour just to cover these expenses.
Of course, we then have to add the cost of dental materials for each practice, which certainly are
not low. Therefore, when talking about the high cost of having dentistry, it will be directly
related to the time that will require treatment. The more complex the treatment, the more
impaired is the oral health of a patient; the more expensive it will be mainly prosthetic treatments
that require many hours of clinical and laboratory (Karlsson et.al, 1995).
2.3 Considerations about Dental Implants
Melton (2000) revealed in the article that a dental prosthesis can be created from different
materials, among which the resins, metal, porcelain, glass or carbon fiber. Depending on the
material from which it is made will be priced or another and a different resistance. The results
can be both aesthetic and functional level. When more implants are installed in a lower surgery is
cost, because the disposable elements used for the installation of an implant or a number is the
same and the time of installation of one or more does not vary significantly. To minimize the
cost and techniques have been developed that simplify surgery implants but are just as safe in the
final result. Another solution that has reduced costs in our clinic has been Implants One Body.
This type of implant is done without flap and reduces the three stages to one or two. For all these
reasons we decided to give free consultations to see each particular case and reach the exact
diagnosis and p each patient budget.
When we compare Prosthodontic care with other dental treatments, it is not expensive. In
concordance with its quality and complexity (which is related to bone loss) may have higher
rates. Implant logy involves 20 to 30 visits or more and obligatorily, six months of treatment.
Depending on the qualification and the importance of professional that will place the implants
Experiment 4 9
and prostheses draw up the may have some variation. In this case the higher capitalization
greater security. The life of prosthodontic care depends on the history of each patient. People,
who did not care about teeth and does not intend to change their hygiene habits, have a negative
prognosis. People who smoke also have a guarded prognosis and who take some medications
that interfere with the normal functioning of bone physiology. Without doubt, the way to avoid
the high cost is the sophisticated in complex dentistry, it is tipping decidedly in preventive
dentistry and regular consultation. The periodic consultation is the best tool to detect oral disease
in incipient form, whose treatment is of low complexity (Bassi et.al, 2013).
In Kingdom of Bahrain, the segment of dental implants is more significant, whose
purchasing power and health coverage allow patients to access and more easily afford dental
care. However, Kingdom of Bahrain is an emerging market whose growth in 2007 was 35%,
result of deregulation of dental services. The study conducted by the Ministry of Health has
resulted in increased private dental practices resorted to by the emerging middle and upper
classes, as well as the many foreigners working in the country. The profile of patient seeks not
only improved health but an aesthetic progress, often using prostheses. In 2011, the sales of fixed
implants, crowns and bridges in Kingdom of Bahrain are expected to reach 120 million and $125
million in 2013.
The key to ensuring prosthodontic care is the recognition of the true costs of modern
dentistry. This is essential for any activity. It should start by knowing the costs of each practice.
Giroux (2007) believes that an ideal way to resolve these issues is to develop professional
categories. This is recognized in each dental category, according to their background, and
according to its path. Since, dentists of lower categories charge lower costs faced, they can
ensure coverage of oral care, and to all affiliates. This is a correct solution, as it would solve
Experiment 4 10
most of the problems of the public. There is no doubt that the ideal solution would be that all
treatments have full coverage by companies (including prostheses and implants), it is a serious
error that can lead to failure (Leles et.al, 2004).
The recruitment of professionals in dentistry is authorized by the system of remuneration
for services by professional time, which may not be less than 35,000 Dirham on the
understanding that the contractor must provide all required inputs.
2.4 Crowns, Bridges and Implants
The type of material used and the cost of the implant are also important in the
composition of the total price. If there are some small differences, it is important to consider that
sometimes two implants will support three teeth in the prosthesis, sometimes three implants will
be placed for a prosthesis of five elements, excluding over dentures, where three or four
maintains implant complete denture. Furthermore, in the safest cases where after extraction of a
root implant is placed, there is the possibility of more sophisticated prosthetic solutions with
screws, metal ceramics and special aesthetics. In these circumstances the prosthesis ends
reaching higher values than surgery and good visible results much more noticeable. For the
customer, it is important to take the budget in full and from there they should make personal
assessment.
Bagewitz (2007) declare that patients who have lost a tooth are increasingly interested in
undergoing a particular type of intervention, such as the imposition of porcelain veneers. The
plastic surgeries are becoming more popular among Bahrain consumers, which can make a big
source of income for providers of dental materials. It is estimated that it given the increase in
living standards in Kingdom of Bahrain, there is a boom in demand for these professionals’
Experiment 4 11
dentists and dental products. Products include dental repair and restoration, predicts that the
crowns and bridges grow more rapidly, followed by the implant, in large part by the high cost of
the last.
While crowns costs decrease rapidly, since it can produce locally at competitive prices,
manufacturing still accounts for dental implants a high cost for the product which is imported,
which in turn entails that even more expensive and their prices cannot be met by most Kingdom
of Bahrain consumers. Still, the Asian market has a huge potential for this sector due to high
population, the increase in per capita income and rising middle class resident in these countries
(Conrad et.al, 1987).
2.5 Dental Market of Kingdom of Bahrain
Kingdom of Bahrain‘s dental market is divided into three areas, depending on the
economic power of the region. Given the size of Kingdom of Bahrain, the areas of greatest
commercial interest are often very distant from each other, making it impossible for a
distribution company to cover the entire surface of the country. Chinese companies distribute
their products in Kingdom of Bahrain through their own contacts or through large distributors.
Instead, foreign companies settled in the country must rely on other solutions such as joint
ventures with local firms. Local distributors contact several companies from different regions,
specialized in the distribution within the medical and hospitable equipment industry, even more
specifically dental instruments. They are companies that specialize in medical or even dental
equipment. Generally, more and more institutions are opening offices in other major cities of
Kingdom of Bahrain (Bassi et.al, 2013).
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Today, depending on type, brand and origin of the implants, the value is between 200 and
400 dollars. These values are generic, but they represent real situations. The oscillations also
occur depending on the professional level. It is important to remember the factors that represent
the costs of the surgical phase of implant placement. Since, the prosthetic phase depend on the
different alternatives, it is more difficult to make comparisons. Whoever knows the costs of
implants, cost of preparing surgery and the materials and instruments required for placement of
them can understand that prices cannot go lower, because if this happens, would probably
indicate that the use of an implant inferior or performing surgeries outside the minimum
standards required of aseptic, antiseptic and sterilization, which poses a risk to the patient and,
for the success of the implant itself (Locker et.al, 2011).
Like most products for hospital equipment, promotion of dental implants dentists are
directly aimed at professionals, i.e. as they are the decision makers at the time of purchase of the
product or even promote it among their patients. In Kingdom of Bahrain, it is especially
important to have local contacts to deal directly the dental hospital or clinics. In this respect, the
dental implants must penetrate in some cities of Bahrain. In addition, there are numerous fairs
and conferences by a dental association that serve as a platform to reach the specialists.
CHAPTER 3: RESERCH METHODOLOGY
The methodology for this research is based on Secondary Research. The research method
adopted and applied in the proposed study is the secondary research and this will also include the
application of qualitative research method. In my opinion the method of qualitative research is
more appropriate method than the quantitative method in such kind of research studies. In my
opinion qualitative method is better research method than the quantitative method in this kind of
Experiment 4 13
research study. Many different kinds of libraries, journals and articles were reviewed in order to
gain extensive insight about the proposed study. Some of the databases include Google scholar,
sage publications and other relevant websites. For the purpose of identifying eligible studies, a
free text search is performed by using MEDLINE, CINHAL plus, and Pub Med electronic
databases and various other journals such as Journal of dentistry, and Journal of prostheses. The
overall searching for this study utilized various keywords such as implant, dental laboratories,
prosthodontics in dentistry, Cost of Dental Implants, Dental Market of Kingdom of Bahrain etc.
Researcher is completely conscious of the ethical consequences implied in the future
research. Obligation for all processes and ethical consequences associated with the research
remained with the primary researchers. Study was carried on in such a way that the reliability of
the research project will be preserved and negative impacts which may reduce the prospective for
succeeding studies will be avoided. Some of data was not accessible so information about that
was retrieved through some insider information. However, it was important for the study and it
could not be avoided.
Ethical Considerations
I am fully aware of the ethical issues that were related to this research study. I take
responsibility of all the procedures followed and the ethical issues that prevail in carrying out
this research study. The research study was carried out in a way that the veracity of the research
is maintained and the effects that tend to be negative would diminish the future research
potential. This research topic was chosen based on the best scientific judgment and the
assessment of the possible benefits to the respondents also the society. The research study is
based on an intellectual issue.
Experiment 4 14
CHAPTER 4: FINDINGS AND ANALYSIS
The secondary research shows that dental implants are devices that are used to replace
one or more teeth have been ruined or lost. Dental implants are placed into the jawbone or
mandible and imitate the roots of the teeth that they will replace. The dental implant is made of
titanium, a metal which is 100% accepted by the human body. A study of 60 million consumers
has shown that prosthodontic care is very expensive worldwide. It is little reimbursed by health
insurance; such care can indeed be subjected to excessive pricing practices and even
unacceptable abuses. The survey shows that especially for a passage to the dentist (even after
repayments complementary health), the rest of patients remains high. This may well lead many
people to abandon this type of care, care of the rest being for the body 'main reason for seeking
care which claims to be facing almost a third of consumers. Indeed, patients pay an average of
290 Euros for such services, with variations depending on their geographical location, often
more than 400 Euros in Paris. Although, complementary health can intervene, it is very difficult
to have a precise estimate of the level of care overall load. Another example for a metal-ceramic
crown cost over 600 Euros (Wallace et.al, 2012).
In addition, the placement of an implant which is around 2000 Euros is again very little
support. Thus, prosthetic care in 2012 accounted for five billion Euros of expenditure, only a
billion was reimbursed by health insurance. The survey claims that less expensive techniques
exist but they are little practiced by dentists (Lynch e.al, 2005). This drift concern is particularly
applicable to inlay-core, partial reconstructions of teeth affixed under crown. Implemented by
dental technicians, prices are set freely and vary between 150 and 300 Euros for a return of
122.55 Euros. Unions denounce the abuses of these reconstructions free rate, especially for the
Health Insurance as both techniques are equivalent in terms of quality of care.
Experiment 4 15
While, some people believe that dental care is expensive which is not reimbursed by
health insurance; they are often subject to even unacceptable drift and excessive pricing practices
which can lead to forgo care. The most common are the dental treatment of decay, the decay of a
tooth, the tooth extraction, and the scaling. Expenses are reimbursed at 70% based on
conventional rates. They vary according to the patient if the patient has more or less than 13
years. Some dentists apply higher fees. The practitioner must inform patients about tariffs in
detail. In this case, the repayment of the health insurance fund is effected on the basis of the
conventional rate. The excess fees are not supported. Overruns can be supported by the mutual or
complementary insurance. The teeth whitening and placement of facets are not covered by the
health insurance, but may be partially reimbursed by the mutual or health insurance (Taylor et.al,
1984).
There is no rejection position itself to dental implants that are made of titanium, and the
metal is 100% acceptable by the human body. What can happen in the smallest of cases is that a
dental implant does not integrate with sufficient force so that the patient can chew. Today, the art
of placement of dental implants has a success rate in 98% of cases. In the few cases in which the
dental implant is not properly integrated, a solution arises; the implant can be replaced by
another. It should be noted that the dental implant treatment is for a lifetime. The study,
development and manipulation of dental implants have a very high cost and professional conduct
dealing with dental implants treatments have received high academic preparation. All this must
be taken into account when paying an implant (Bhatti et.al, 2007).
In most of cases, the total price is paid by the patient for treatment, anesthesia, disposable
surgery, dental implants, dentures, metal ceramic crown, professional fees, for each tooth to be
replaced is $8900. There are special cases where a removable prosthesis for various parts, then
Experiment 4 16
this multiplication can take another value is placed, but this will evaluate the professional
depending on what best for the patient. It is possible in almost all cases, to increase the height
and width of the bone of the gums with external application of bone. This has an additional cost
but worth the effort as it allows implant placement in discounted that this technique would be
impossible without bones. The procedure to be performed is divided into two parts, the first is
the surgical phase which consists of the placement of the dental implant and the second is the
prosthetic phase, where a metal ceramic crown is connected to the implant is constructed (Van
der Wijk et.al, 1998).
In general, all adults can be candidates for dental implants. All teeth and molars of the
mouth can be replaced by dental implants. People with good general health, dental implants can
be placed successfully without risk of failure. It is possible to pay for dental implant treatment by
cash, check, debit or credit card. Generally once approved dental implant treatment should I pay
50%, and at the completion of the remaining 50%. The initial consultation to determine tailor the
treatment plan dental implants is free. One must make an appointment and attend.
Moreover, the dentists are allowed to charge more than the minimum rates published
under the terms of each office amount. In general, implants are placed in the gum for about three
months for this to heal and the implant in the jaw correctly before placing a crown on it.
However, there are some procedures that provide a dental crown can be placed on the implant
immediately so that the patient will have artificial teeth during the healing period. Once the
implant is properly and firmly attached to the jaw, permanent crowns which are screwed or
cemented are placed. There are different materials used for crowns and their prices vary
depending on these (Nuttall et.al, 2011).
Experiment 4 17
Like other dental procedures, dental implants require patients to have enough jaw bone
for the procedure to succeed. If it is determined that the patient's jaw is narrow, this would have
to undergo a bone graft before having dental implants, which means another fee be added on the
invoice. The bone graft is a process in which a piece of bone is removed in a different part of the
body and grafted into the jaw.
The rate for providing prosthodontic care depends on various factors in Kingdom of
Bahrain. Other factors also determine the cost of dental implants, such as the initial dental exam,
dental anesthetics price and the cost of radiographs taken. A final advice would always
recommend consulting several specialists to evaluate patient’s case and obtain prices for each of
them. Although each day society in Bahrain is more interested in the health and dental aesthetics,
price of implants are still very high as most are foreigners or need advanced technology for
treatments, so that they are not used as frequently as veneers that easily manufactured in China,
offer much more affordable prices (McGivney et.al, 2000).
The cost of an implant and other components covered corona are presumed around 50-
70% of the process, assuming all other labor. The products imported into Kingdom of Bahrain
cost a minimum of U.S. $250, to which other expense are added such as the transport costs,
dealer margins and tariffs, which reaches at least 33% in costs by raising the price a little as 750
U.S. dollars. Therefore, it is true that the best sellers are foreign companies that offer delivery of
prosthodontic care in the Kingdom of Bahrain, most of the time these foreign companies have
dental implants facilities in Bahrain, and in other countries (Carlsson et.al, 2006).
In certain policies that cover treatment, a waiting period is required before the insured to
benefit from such coverage. Much dental insurance impose a minimum period of 12 months
subscription to the policy prior to dental implants done, no further covering the entire treatment.
Experiment 4 18
If patients are looking for insurance to cover nee performing implants, it is likely to cost much to
find one that will allow. There are certain policies with a maximum annual cap on spending for
conducting any type of dental treatment including dental implants. So if patient get a high
number of treatments that are kind and exceeds this maximum, further treatment must incur
payment charge. It is very common that although policies do not cover the completion of the
procedure, the costs for treatment, be priced below the usual cost without the availability of
dental insurance policy (Walton et.al, 1995).
The placement of a dental implant as well as the realization of artificial tooth ceramic
costs about1800 Euros in Kingdom of Bahrain. Indeed, the cost of this operation is less than cost
of placing a dental prosthesis. We can admit that dental reconstructions are relatively expensive.
Even if we compare the cost of implantology operations over the past 15 years, we can see that
the price of these has dropped markedly. In Kingdom of Bahrain, the purchasing power of
consumers is not the most important factor in choosing dental or has surgery to implant
rehabilitation. Bahraini consumer is guided by the motivation, for the sake of the welfare and the
aesthetic importance given in this country. In Bahrain, the cost of placing a dental implant is not
covered by social security. Some mutual partially reimburse these surgical operations. But
normally it is the patient himself who is forced to pay this implant technique and expenses. The
minimum price of a dental implant in the Bahrain market remains too high (McLaughlin et.al,
2002).
Experiment 4 19
CHAPTER 5: CONCLUSION
In the case of implants and dentures, the people in Bahrain tend to give preference to high
quality prosthodontic care regardless of the price factor. Physicians in Kingdom of Bahrain have
an established reputation, Bahraini dental implants are successful as they are recognized as high
quality and its geographical proximity reduces transportation costs. Many consider that
prosthodontic care results are excellent.
The loss of a tooth can engender a great imbalance in the functioning of the jaw. The only
problem with these dental implants is that they require an investment of money greater than a
conventional removable denture or bridge fine. They also require an investment of time as it can
take 3-9 months after treatment is started until it ends. Despite of these disadvantages, the
Bahraini are considering dental implants as the best option in case of loss of a tooth. The
revolution in restorative dentistry, which began three decades ago, has provided in recent years
major advances in the field of materials and the techniques intervention, which allow restorations
whose final appearance is akin to the original tooth structure. Cosmetic dentistry has become the
most active area of specialty. Bahraini no longer only ask that dental restorations work well but
consider it as natural teeth regardless of cost factors.
Experiment 4 20
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