CLINICAL ARTICLE

Restoring Congenitally Missing Maxillary Lateral Incisors

Using Zirconia-Based Resin Bonded Prostheses
ANTIGONI STYLIANOU, DDS, MS*, PERNG-RU LIU, DMD, MS, DDS, SANDRA J ONEAL, DMD, MS,
MILTON E ESSIG, DMD

ABSTRACT
Objective: This clinical report describes an alternative treatment modality for the replacement of congenitally missing
maxillary lateral incisors in a 17-year-old patient.
Clinical Considerations: Zirconia-based resin-bonded fixed partial dentures (RBFPDs) were selected as a viable and
conservative treatment option in a young individual with highly aesthetic expectations. Fabrication of all-ceramic
RBFPDs followed specific preparation design and features to accommodate two retainers. The zirconia frameworks
with bilateral wings were digitally designed and then milled by a computer-aided design and computer-aided
manufacturing (CAD/CAM)-controlled milling machine. Zirconia surface was treated with a two-step chairside
tribochemical silica-coating/silane coupling surface treatment protocol, and adhesive resin luting cement was used to
achieve micromechanical and chemical bonding. Completion of the treatment resulted in a functional and aesthetic
successful outcome and a 17-month follow-up presented uneventful.
Conclusion: Contemporary adhesive techniques involving resin-bonded zirconia-based prostheses can be utilized
successfully and predictably in young patients with single missing teeth when implant therapy is currently not a
treatment of choice and a less invasive approach is desired.

CLINICAL SIGNIFICANCE
The zirconia-based resin-bonded prosthesis constitutes a viable and conservative treatment modality for the
replacement of missing teeth either congenitally or from another etiology in young patients in which implant therapy
and a fixed partial denture are currently contraindicated.
(J Esthet
(J Esthet Restor
Restor Dent
Dent 28:8^17,2015)
:, 2016)

INTRODUCTION bilateral agenesis of maxillary lateral incisors is more

Congenitally missing teeth, especially in the anterior
maxillary region, continue to present a restorative
challenge in clinical dentistry with respect to treatment
planning and rehabilitation. Approximately 20% of
congenitally missing teeth are maxillary lateral incisors,
with prevalence varying between 1 to 2% in the
population.1 Regarding the distribution of the agenesis
of the permanent lateral incisor, it has been found that
common than a unilateral one.2 Current treatment
modalities with dierent therapeutic approaches for
missing maxillary lateral incisors involve canine
substitution,3 tooth-supported restorations4 with
conventional full coverage or resin-bonded xed dental
prosthesis, and the implant supported restoration.35
Another alternative option has been the
autotransplantation of premolars to the maxillary
incisor sites by the time that the roots of premolars

*Prosthodontist, Former Prosthodontics Resident, Department of Restorative Sciences, Graduate Prosthodontics, University of Alabama at Birmingham School of
Dentistry, Birmingham, AL, USA

Professor and Chair, Department of Restorative Sciences, Graduate Prosthodontics, University of Alabama at Birmingham School of Dentistry, Birmingham, AL, USA

Professor Emeritus, Department of Restorative Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA

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have been developed at two-thirds to three-fourths of
the nal root length.6 Despite the biologic approach of
this technique, it can be considered surgically technique
sensitive with age limitation requirements and possible
needed additional orthodontic treatment.7 In the
majority of the cases, adjunctive orthodontic treatment
is required before nal restorative and implant therapy
for redistribution or establishment of properly and
adequately aligned space.
The successful outcome of single-tooth implant
restorations, as reported in various studies,8,9 has rendered
this treatment alternative a predictable option for the
replacement of missing teeth including maxillary lateral
incisors.10 Implant restorative treatment is commonly
perceived as the most conservative approach, since it does
not involve any modication or utilization of the adjacent
teeth. However, endosseous implant placement in
growing patients is indicated until after the completion of
craniofacial/skeletal growth unless severely partial or
complete edentulism require an earlier intervention.11
Several studies have suggested the continuation of
craniofacial growth on average until the age 17 and 21 for
females and males, correspondingly.5,12 The impact of
facial growth on implant timing and position can be
explained by the amount of implant submergence and
displacement which in turn depends on the patients
skeletal and dental age and growth pattern as well as the
maxillary or mandibular positional placement.13 Taking
into consideration that chronologic age is not sucient in
estimating growth, due to the signicant variability within
one gender, other methods such as superimposing
tracings of serial cephalometric radiographs taken at least
6 months apart, and analysis of a radiograph of the wrist
of the least used hand must be considered before any
implant treatment attempt in young individuals.14
Regarding tooth-supported restorations, resin-bonded
xed dental prostheses (RBFDPs) constitute a relatively
minimal invasive approach and can serve either as a
denitive or interim prosthesis until implant
rehabilitation is permitted. Since its development in
1973, RBFDP has undergone signicant alterations in
design, materials, and tooth preparation.15 From the
early technique of direct macromechanical bonding
using a Rochette bridge,16 a perforated gold casting, to
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the Maryland bridge,17 a non-perforated, nonprecious
metal alloy framework with micromechanical retention
by electrolytic etching, these advancements have led to
the evolvement of resin cements, ber-reinforced resin,
and ceramic materials. In regards to the ber-reinforced
composite as an alternative to metal retainers, the
adhesion, reparability, and aesthetics are improved;7
however, the composite material is subject to wear and
discoloration through time when compared to ceramic.
Nonetheless, the retentive capabilities of previous
RBFDPs could frequently result in the loss of additional
tooth structure, beyond the enamel boundaries, in
order to achieve mechanical resistance for the
prevention of debonding. With the introduction of
all-ceramic RBFDPs in the early to mid-1990s, superior
and more predictable bonding to the tooth structure
could be obtained along with an enhanced aesthetic
appearance18 that also addressed the main problem of
gray coloration of teeth abutments of the traditional
resin-bonded metal restorations.4
Specic criteria in respect to the position and mobility
of adjacent teeth as well as the anterior teeth
relationship must be fullled to ensure a predictable
restorative outcome. Ideal patient conditions are stable
and upright abutment teeth with translucency in the
incisal third and moderate thickness, with minimal
anterior vertical overlap without signs and symptoms of
occlusal parafunction.10 In essence, when the teeth
abutments have dierent grades of mobility, they will
move in dierent vectors resulting in debonding of the
least mobile retainer and thus, failure of the overall
prosthetic restoration.10 The interincisal angle between
maxillary and mandibular incisors denes the upright
position of the teeth and the type of forces at the bond
interface. Particularly, with a larger interincisal angle
and thus, a more upright position of the incisors, a
more shear type force can be generated at the bond
interface. This will be 40% more tolerated by the loaded
objects than a tensile type of force.4,19 In cases where
deep vertical overlap exist between the anterior teeth,
an inadequate surface for bonding will increase stress
on the bond interface thereby rendering the RBFDP
treatment less favorable.19 In addition to a thorough
preprosthetic evaluation, a precise preparation of the
abutment teeth coupled with patient follow-up on a
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FIGURE 1. Smile view at initial evaluation.
regular basis are required for a successful long-term
prognosis.20
The following clinical and laboratory patient
presentation describes the implementation of a
minimally invasive prosthetic approach for the
restoration of missing maxillary lateral incisors in a
young patient utilizing contemporary adhesive
techniques and two-retainer zirconia frameworks.
CASE REPORT
Comprehensive Evaluation and Treatment Planning
A 17-year-old male with unremarkable medical history
was referred to Graduate Prosthodontics, Department
of Restorative Sciences of University of Alabama at
Birmingham (UAB) School of Dentistry for
comprehensive evaluation and treatment of congenitally
missing maxillary lateral incisors. The patient presented
with an Essix retainer, following the completion of
orthodontic therapy, approximately 1 year ago, for the
maintenance of spaces of the maxillary lateral incisors
and as temporary replacements of the teeth. According
to the patient, the current removable prosthesis had a
negative psychological impact on his social life, aecting
his desire to eat in front of his classmates. Therefore,
the patient requested a xed prosthetic replacement of
the missing teeth.
Extraoral ndings and facial analysis appeared normal
with no facial asymmetry and with mild increase of
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FIGURE 2. Pretreatment frontal view (minimal anterior
vertical overlap).
lower vertical height and a slightly concave prole.
Smile analysis showed a low-to-medium smile line, an
incisal line following the lower lip line and evenly
distributed right and left buccal corridors. (Figure 1) In
addition, dental analysis of width/length ratio (85%) of
maxillary central incisors was found to be within the
normal esthetic range. Oral screening was negative, and
temporomandibular disorder screening was found to be
positive for teeth clenching and bilateral reciprocal
clicking without subjective symptoms. All components
were within the patients adaptive capacity. Intraoral
ndings (Figure 2) included edentulous lateral incisor
areas with mild deciency in orofacial dimension,
absence of carious lesions, minimal anterior vertical
overlap, normal and healthy surrounding soft tissue,
and good general periodontal condition. The patient
presented with a tendency for a Class III Skeletal
relationship and with a bilateral Class I molar
relationship. The central incisors and canines adjacent
to the missing lateral incisors appeared immobile with
an upright position and proper alignment in the arch as
well as adequate thickness of the enamel surface for
bonding. Radiographic evaluation showed an absence
caries and adequate mesiodistal width for future
implant placement in the maxillary lateral incisor areas.
Diagnostic study casts were fabricated and mounted on
a semi-adjustable articulator following facebow transfer
and interocclusal records. Intercoronal space analysis of
the established orthodontic space for the maxillary
lateral incisors was measured at 6.4 mm and 6.2 mm,
respectively, thus satisfying the requirements for an
aesthetic prosthetic replacement. A diagnostic wax-up
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FIGURE 3. Diagnostic wax-up for missing maxillary lateral
incisors.
was made to obtain a three-dimensional representation
of the anticipated functional and aesthetic treatment
outcome (Figure 3).
The main goal of the nal treatment was to provide a
xed restorative solution for the missing lateral incisors
that could preserve the properly established mesiodistal
space for future implant treatment with the least
amount of tooth structure removal. Based upon all the
diagnostic ndings, zirconia-made resin-bonded FDPs
utilizing two retainers were proposed as a denitive
xed-prosthetic treatment plan. The rationale of the
use of two retainers instead of cantilever prosthesis is
based on the absence of dierential mobility between
the retainers and the existing occlusal scheme.
Clinical Treatment Procedures
The nal preparation of teeth abutments which
included the maxillary central incisors and canines
followed a three-step procedure. The occlusal
evaluation revealed that this patient has no vertical
overjet, therefore, the preparation objectives are to
reduce minimal amount of tooth structure for
structural durability of the prosthesis and to maintain a
normal anatomical contour at the palatal surface. The
utilization of two retainers is justied by the absence of
dierential mobility between the teeth abutments as
well as by the relatively short clinical crowns of the
canines that did not allow for sucient bondable
surface for cantilever prosthesis. After successful local
anesthesia of the teeth (two carpules of carbocaine 3%
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FIGURE 4. Lingual preparation design (supragingival chamfer
margin, interproximal retentive groove, cingulum ledge).
with epinephrine 1:100.000), the palatal surfaces were
reduced axially by 0.6 mm with the marginal nish line
being 1 mm distant from the incisal edge and gingival
tissue, respectively, using a round-end taper diamond
bur (Brasseler, USA # 850-016), maintaining the axial
preparation into the enamel. The supragingival margin
was created as a 0.5 mm light chamfer nish line in the
enamel. Then, interproximal retentive grooves were
prepared parallel to the planned path of insertion with
the use of a round-end taper diamond bur (Brasseler,
USA #850-012) at 1 mm depth and with length that
varied from 2.5 mm for the central incisors and 3.5 mm
for the canines. The preparation design was completed
with a horizontal central groove in the form of a
cingulum ledge at the height of the lingual fossa
extending from the vertical groove to 1 mm from the
corresponding proximal surface. To provide a smooth
transition within the preparation design for better stress
distribution of the zirconia-based restoration, all sharp
line angles were rounded with a round-end taper
diamond bur (Figure 4).
Prior to the nal impression, a maxillary alginate
impression was made and a study cast of the tooth
preparations was fabricated and surveyed to verify if the
proper path of insertion was obtained. For the nal
impression, a double-cord retraction technique was
applied and a vinyl polysiloxane (VPS) medium body
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FIGURE 5. Bis-acryl provisional RBFPDs.
RBFPD = zirconia-based resin-bonded fixed partial dentures.
tray material (Aquasil Ultra Monophase, Dentsply
Caulk, Milford, DE, USA) in combination with extra
light body wash material (Aquasil Ultra XLV, Dentsply
Caulk, Milford, DE, USA) was used with a full-arch
stock impression tray. An alginate impression of the
opposing arch was made, and a VPS (Regisil 2X VPS
Bite Registration Material, Dentsply International, York,
PA, USA) interocclusal record in maximum
intercuspation was taken. Provisional restorations were
fabricated intraorally using the matrix of the duplicate
cast from the diagnostic wax-up. Dual-cure Bis-acryl
material (Integrity, Dentsply Caulk, Milford, DE, USA)
in the shade of A1 selected from the VITA classical
shade guide (Vident, Brea, CA, USA) was injected into
the matrix, positioned over the prepared teeth to create
initial adaption and form of the provisional prostheses.
Following contouring, nishing, and polishing, the
bonding of the composite resin wings to the palatal
surfaces of the retainers was achieved with a spot-etch
and bonding technique and application of owable
composite resin (Filtek Supreme Ultra Flowable
Restorative, 3M ESPE, USA) (Figure 5).
The master cast was fabricated from low-expansion die
stone (Silky Rock, Whip Mix Corporation, Louisville,
KY, USA) and mounted according to the facebow
transfer record. The opposing cast was then mounted
based on the interocclusal record in maximum
intercuspation. Ovate pontic areas were transferred
onto the nal cast as previously molded and created
with the patients removable provisional device. The
mounted nal cast was forwarded to the dental
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FIGURE 6. Digital dental cast and zirconia-based RBFPD
framework design. RBFPD = zirconia-based resin-bonded fixed
partial dentures.
FIGURE 7. Zirconia framework on the master cast.
laboratory for scanning, CAD modeling and fabrication
of the nal restoration. Additionally, detail shade
mapping coupled with digital photographs of reference
shade tabs were sent to the dental ceramist to achieve
the aesthetic implementation of the nal work. The
RBFDP framework with bilateral wings was digitally
designed, and the nal virtual model was evaluated in a
computerized form before milling (Figure 6). A solid
blank of zirconium (Lava Blanks Crown, 3M ESPE, St.
Paul, MN, USA) was milled by a CAD/CAM-controlled
milling machine to fabricate the zirconia framework.
The nal framework was positioned on the master cast
to verify accurate seating before application of
feldspathic porcelain. (Figure 7) Feldspathic porcelain
veneers were red onto the zirconia frameworks with
the selected tooth shade and white calcication areas as
found in the adjacent natural teeth. Upon completion of
the nal restorations, a precise t of the zirconia FDPs
was conrmed on the master cast (Figure 8).
The denitive zirconia-based RBFDPs (Figure 9) were
tried intraorally, and precise adaptation of the wings and
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FIGURE 8. Definitive zirconia-based RBFPDs on the master
cast, frontal view. RBFPD = zirconia-based resin-bonded fixed
partial dentures.
pontic areas, proper marginal t and interproximal con-
tacts as well as esthetic integration of shade and texture
with adjacent teeth was veried and approved by the
patient and his family. The lateral incisors were made as
symmetrical as possible and with a slight morphologic
variation for a more natural appearance and individual-
ity. Before nal cementation, an elastic retractor
(OptraGate, Ivoclar Vivadent, Schaan, Lichtenstein) was
placed to isolate lips and cheeks from the treatment
eld. A two-step chairside tribochemical silica-coating/
silane coupling system (CoJet Sand, 3M ESPE, St. Paul,
MN, USA) method was applied to the zirconia bonding
surfaces following the manufacturers instructions. This
surface modication was created rst with airborne-
particle abrasion of 30 m aluminum oxide under pres-
sure of 2.8 bars for 15 seconds at a distance of 5 to
10 mm from the zirconia surface while protecting the
veneering ceramic. Second, a silane-coupling agent
(ESPE Sil, 3M ESPE, St. Paul, MN, USA) with zirconia
primer was applied on silica-coated surfaces for 60
seconds and allowed to dry for 20 seconds. Likewise,
palatal tooth preparations were rst cleaned with
pumice, rinsed, and etched with low-viscosity 34% phos-
phoric acid (Scotchbond Universal Etchant, 3M ESPE,
St. Paul, MN, USA) for 30 seconds on the enamel axial
surfaces and for 15 seconds on the area of the inter-
proximal retentive grooves that involved amount of
dentin. Etched surfaces were then rinsed and adequately
dried to allow application of the bonding agent
(Scotchbond Universal Adhesive, 3M ESPE, St. Paul,
MN, USA) in a thin layer. For nal cementation, adhe-
sive resin cement (Rely-X Ultimate Adhesive Resin
Cement, 3M ESPE, St. Paul, MN, USA) in the shade of
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FIGURE 9. Definitive zirconia-based RBFPDs.
RBFPDs = zirconia-based resin-bonded fixed partial dentures.
A1 was applied to both the zirconia treated and tooth
adhered surfaces, and each surface light-cured for 40
seconds. Cement excess was thoroughly removed and
cleaned with microbrushes before light-curing and with
the use of a No.12 surgical scalpel blade (Integra Miltex,
York, PA) following polymerization. After nal seating,
the occlusion was evaluated and adjusted in maximum
intercuspation, protrusive and laterotrusive movements
with ZR (Komet USA, Rock Hill, South Carolina, USA)
diamond rotary instruments. This resulted in minimal
contact of the pontics during excursions. Adjusted areas
were then polished with ZR ash polishers. Instructions
in proper oral hygiene around and beneath the restora-
tions were given to the patient. Also, the patient was
encouraged to return at 6-month recall intervals for
evaluation and maintenance purposes. In the 3-week
follow-up, no mechanical or biological complications
were found, and the functional and aesthetic outcomes
were consistent with the treatment plan. The patients
satisfaction with the current xed prosthesis was
reected in a signicantly increased condence level in
school and enhanced social interactions. The 17-month
follow-up of the patient and the restorative treatment
can be seen in Figures 1012.
DISCUSSION
Current conservative adhesive approaches on single
tooth replacement are derived from the major advances
in modern ceramic systems and enhanced bonding
techniques. The Yttria partially stabilized tetragonal
zirconia polycrystalline (Y-TZP) particle has enhanced
mechanical properties and superior resistance to
fracture compared to other conventional dental
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FIGURE 10. Intraoral view of definitive restorations.
FIGURE 12. Final zirconia-based RBFPDs, smile view.
RBFPDs = zirconia-based resin-bonded fixed partial dentures.
ceramics.21 In particular, densely sintered zirconia has
the highest exural strength, approximately 1000 MPa,
compared to all dental ceramics, thus rendering it
suitable for conventional as well as resin-bonded FDPs.
With the elastic modulus of zirconia to be recorded at
210 GPa,22 compared to that of 12% Au-Ag-Pd alloy (86
GPa), RBFDP zirconia frameworks can be fabricated
with a reduced thickness to assure adequate rigidity and
allow for a more conservative tooth preparation.23
However, signicant disadvantages occur with
machined ceramics and their use in the fabrication of
RBFDPs due to their relatively smooth and
non-adhesive intaglio surface.24 Combined with its
acid-resistance to conventional etchants, the large
crystalline phase of the zirconia becomes less adaptable
to the bonding technique.21
Both mechanical and chemical bonds are interrelated
and essential for a viable outcome and longevity of the
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FIGURE 11. Lingual view of bonded zirconia-based RBFPDs.
RBFPDs = zirconia-based resin-bonded fixed partial dentures.
RBFDPs. With the modied zirconia surface
characterized by abundant and intricate
microporosities, higher penetration of resin cement and
mechanical interlocking for micromechanical retention
is feasible.24 Basically, surface alterations of oxide-based
ceramics are attainable either through abrasive
techniques, such as airborne particle abrasion or
additive surface treatment like sintering, and
modication techniques, such as tribochemical silicon
dioxide (silica) coating, silanization, with
MPD-containing primers, plasma spraying, and
selective inltration etching.25 Several studies have
shown the eectiveness of mechano-chemical retentive
systems such as the tribochemical coating system on
bonding zirconia ceramics to composite substrates.2630
Tribochemical silica coating is a combined surface
treatment that forms a silica layer with the eect of
airborne particle abrasion with silica-coated alumina
particles.25 As a result, the microroughness on the
zirconia surface through the abrasive action of
silica-modied alumina particles, coupled with the
silane coupling agent applied between the sandblasted
surface, and the cement matrix can serve for the
micromechanical and chemical bond as required for the
RBFDPs.26,31 The combined mechanical and chemical
pretreatment has been clinically highly recommended
to bond zirconia.29 A recent meta-analysis on bonding
eectiveness to zirconia ceramics found both
tribochemical silica coating and ceramic coating
capable to achieve a more aging-resistance bond
between composite cement and zirconia surface than
any other surface conditioning method that did not
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include mechanical pretreatment.32 Alternatively, a
recent and promising technique of zirconia surface
conditioning through the application of a low-fusing
porcelain glaze on the intaglio surface of Y-TZP has
been introduced in an attempt to create an etchable
hydrouoric acid layer.33,34
With regard to the number of retainers of an all-ceramic
RBFDP, there are strict criteria for the cantilevered
prosthesis in respect to the patients existing occlusal
scheme and the amount of vertical space. In other words,
favorable factors for the more conservative cantilevered
prosthesis are a mutually protected occlusion including
canine or group function as well as minimal anterior
vertical overlap of the teeth.35 In a recent study of Sasse
and colleagues,36 the 5-year survival rate for the
CAD/CAM single retainer zirconia-ceramic RBFDPs in
the anterior region was found to be 100% and signicantly
greater than the survival rate results of similar studies that
used glass-inltrated alumina ceramic.37 On the other
hand, the uneven distribution of forces during
mastication directed to the cantilever RBFDP prosthesis
can cause multiple bending and torqueing forces; thus,
increasing the risk for debonding, fracture of the
connector or even fracture or loss of the abutment
tooth.38 In the event of an overload of the pontic of the
cantilever RBFDPs, abutment tooth rotation can occur
thereby compromising the long-term prognosis of the
prosthesis.39 An in vitro study of Rosentritt and
colleagues40 revealed a signicantly higher fracture
resistance to thermocycling and mechanical loading for
the two-retainer RBFDPs when compared to the
cantilever RBFDPs. In considering the use of a cantilever
design, the rationale is based on the dierential mobility
that might exist between the two abutments and
potentially lead to the debonding of one retainer and its
increased susceptibility to caries.41,42 Therefore, it can be
assumed that when there is no signicant dierence in
the mobility of the two retainers, a three-unit RBFDP can
be proposed and utilized predictably.
Furthermore, tooth preparation design and subsequent
RBFDP framework design are fundamental for the
mechanical retention and strength of the prosthesis. An
increased frequency of adhesive debonding has been
recorded for non-retentive prepared RBFDP retainers,
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which underlies the importance of the preparation
relative to the survival of the restoration.39,40 It has been
demonstrated that both the framework thickness and
retainer preparation design aect framework
deformation with dierent mechanisms.43 The thickness
of the retainer is determined by the available
interocclusal space and the lingual enamel thickness. A
recent in vitro study23 found that a combination of
zirconia framework thickness of as low as 0.5 mm with
a retentive retainer preparation resulted in a
signicantly lower magnitude of principal strain.
Moreover, with the preparation of proximal grooves as
part of the retainer design, both the bonding surface
area and mechanical interlock are increased, leading to
enhanced retention of RBFDPs.44 Likewise, this
preparation feature can provide resistance to dislodging
forces and reinforce the framework design through the
increase of the framework rigidity. Also, it serves for
aesthetic purposes as it compensates for the absence of
proximal wraparound. Aside from that, a
well-developed or prepared cingulum rest can improve
the resistance form of the framework23 and facilitate
accurate seating of the RBFDP.45
CONCLUSIONS
When treatment planning for replacement of missing
maxillary lateral incisors, aesthetic expectations, and
potential ongoing growth of the patient as well as the
interdisciplinary management must be thoroughly
considered and evaluated in the denitive restorative
treatment. In regards to the most suitable combination
of surface treatment and adhesive cementation system
for zirconia-based RBFDPs, there is currently not a
standardized protocol suggesting a more sucient
bonding eect. With further advances in adhesive
clinical dentistry, alternative tooth preparation designs
must be developed to accommodate the new minimally
invasive restorative treatments.
DISCLOSURE
The authors do not have any nancial interest in the
companies whose materials are included in this article.
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 MAXILLARY LATERAL INCISORS RESTORATION Stylianou et al
MAXILLARY LATERAL INCISORS RESTORATION
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Reprint requests: Antigoni Stylianou, University of Alabama at
Birmingham School of Dentistry, Birmingham, AL, USA. Tel:
205-223-5271; 205-934-6898; Fax: 205-975-4747; email: astylian@uab.edu
DOIRestorative
Journal of Esthetic and 10.1111/jerd.12179
Dentistry Vol
2015
28 Wiley
 No 1Periodicals, Inc.
 8^17  2016 17