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Resistance of core materials against torsional forces on differently

conditioned titanium posts


Ismail Akışlı, DMD,a Mutlu Özcan, DMD,b and Ibrahim Nergiz, DMDc
University of Hamburg, Dental School, Hamburg, Germany; and University of Groningen,
Groningen, The Netherlands
Statement of problem. The separation of core materials from titanium posts, which have a low modulus of
elasticity, has been identified as a problem in restorative dentistry.
Purpose. This study evaluated the resistance to torsional forces of various core materials adapted to differently
conditioned titanium posts.
Material and methods. Seven hundrd and twenty specimens were tested consisting of: 6 core materials and
5 surface conditioning techniques for 2 kinds of opaquers with 10 specimens in each group (6 ⫻ 5 ⫻ 2 ⫻
10⫽600) plus 6 core materials and 2 opaquers were tested and considered as control groups on nonconditioned
titanium posts, each group containing 10 specimens (6 ⫻ 2 ⫻ 10⫽120). The custom-made pure titanium posts
were conditioned with the following products: Silicoater Classical, Silicoater MD, Rocatec, Kevloc, and Siloc
surface-conditioning systems. Subsequently, 6 core materials with different compositions (Durafill, Adaptic,
Coradent, Ti-Core, Hytac Aplitip, and Photac-Fil Aplitip) were applied to titanium posts that were previously
coated with 2 types of light-polymerized opaquers, either Artglass or Dentacolor. Sixty air-abraded titanium posts
(250 ␮m, 30 seconds) were used as controls for each core material. Following thermocycling (5°-55°C, 30
seconds, 5000 cycles), maximum torsional forces were determined with an electronic torque movement key. Data
were statistically analyzed by 1-way analysis of variance followed by 2-way analysis of variance (P⬍.05).
Results. Significantly higher mean torsional forces were observed with respect to Siloc (20.4 Newton decimeter
[dNm]), Silicoater Classical (18.6 dNm), Silicoater MD (18.2 dNm), and Rocatec (17.0 dNm) systems com-
pared with the mean for the untreated control group (14.6 dNm) (P⬍.001). The Kevloc system (10.4 dNm)
demonstrated no significant difference compared with the control group (P⬎.001). The Kevloc system in
combination with the Artglass opaquer and Photac-Fil Aplitip (0.00 dNm) core material showed no resistance
against torsional forces. Significant differences were observed between hybrid core materials and microfilled
composite, compomer, or resin-modified glass ionomer core materials (P⬍.001).
Conclusion. Within the limitations of this study, the resistance to torsional forces for the core materials on
titanium posts increased with the use of chemical surface-conditioning techniques and varied in accordance with
the opaquer type. Type of core material also significantly influenced the resistance after thermocycling.
(J Prosthet Dent 2002;88:367-74.)

CLINICAL IMPLICATIONS
In this study, microfilled composite and resin-modified glass ionomer core materials offered poor
resistance to torsional forces. Surface-conditioning systems based on silica coating/silanization
or silica coating/acrylization can be recommended for composite cores used with titanium posts.

T he long-term clinical performance of prefabricated


posts and cores depends on a number of factors,1,2 and
cal design and structural properties, are made from pure
titanium or titanium alloys, in addition to the traditional
retention of the core material is one of the most signif- stainless steel posts. Titanium is biocompatible, al-
icant of these.3-7 A great number of screw or threaded though its relatively low modulus of elasticity compared
prefabricated post systems are commercially available. with most stainless steels is viewed as a major disadvan-
These systems, which vary according to their geometri- tage.8,9
Experimental and clinical reports provide evidence of
Presented at 27th Annual Meeting of the American Association for significant differences in the survival of posts.10-13 Re-
Dental Research, Minneapolis, Minn., March 1998. duced chair time and ease of manipulation of prefabri-
a
Research Assistant, Department of Operative Dentistry and Peri- cated posts, as compared with cast posts and cores, make
odontology, University of Hamburg. the procedure appealing to practitioners. Silver amal-
b
Assistant Professor, Department of Dentistry and Oral Hygiene,
University of Groningen.
gam, composite, and resin-reinforced glass ionomer re-
c
Instructor, Department of Operative Dentistry and Periodontology, storative materials have been suggested as core materials
University of Hamburg. for use with prefabricated posts.14-22 Core reconstruc-

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THE JOURNAL OF PROSTHETIC DENTISTRY AKIŞLI, ÖZCAN, AND NERGIZ

tions made from silver amalgam offer high compressive together with the air-abrasion pressure results in embed-
strength and ease of manipulation,17 but composites can ding of silica particles on the metal surface, rendering
be prepared immediately after placement and impressed the metal surface chemically more reactive to resin
for restoration with a complete crown.16,22 With dentin through silane. The particular advantages of the process
bonding agents, composites also offer the advantage of are the speed and accuracy of coating and the ability to
bonding to tooth structure. Another material used for visually evaluate the adhesive layer so that thermal stress-
core reconstruction is resin-reinforced glass ionomer. ing of the framework is avoided. In these aforemen-
The advantages of this material are fluoride release to the tioned procedures, by increasing the roughness of the
adjacent tooth structure and rapid setting. However, metal surface, the air abrasion contributes to the forma-
glass ionomers including resin-reinforced materials are tion of a mechanical bond. As a result of silanization, the
inherently brittle, are vulnerable to moisture,23 and lack metal surface is provided with a layer of double
the strength required to withstand occlusal loading un- bonds.40,42,43
der simulated occlusal forces.24 To improve bond strengths of the Silicoater tech-
Most in vitro studies have been performed to evaluate nique, new bonding systems were introduced. The Kev-
the posts and cores subjected to tensile,25,26 compres- loc system works with acrylization and Siloc with both
sive,26,27 and shear forces,28-30 as well as trauma31 and silica-coating and acrylization principles.
fatigue tests.32 Clinically, however, posts are also sub- Kevloc, introduced in 1995, is a relatively new sys-
jected to torsional or rotational forces produced by func- tem, which offers a combination of mechanical and
tional tooth contacts.33-37 chemical bonding, presenting promising results in resin
Advances in adhesive dentistry have resulted in the veneer-alloy bonding, inlays, onlays, implant-supported
recent introduction of modern surface treatment meth- restorations, and removable prostheses. The tempera-
ods. These new systems involve conditioning the sub- ture needed for the activation of the bonding layers is
strate to produce bifunctional molecules that adhere to generated by contact heat transfer and heat radiation in
the metal surface through silane by means of a polymer- the activation chamber of the Kevloc apparatus. The
izable double bond. Such molecules react with the bonding layers in this system consist of a fused layer of
methacrylate groups contained in the monomers of the the rigid acrylonitrile and a layer of the water-resistant,
applied opaque/composite in a radical polymerization highly cross-linked urethane resin. Both layers are rein-
process. The manufacturers of most of the new surface- forced by the direct acrylizing network and have the
conditioning systems require that airborne particle abra- capability of sustaining the loading forces.40,42-45
sion of the metal be performed before bonding, to The Siloc system involves air-particle abrasion fol-
achieve high bond strengths. Among these systems, Sili- lowed by the application of Siloc-Pre silane, which is
coater Classical was introduced in 1984 as a system of dried at room temperature first and then placed in the
molecular bond between resins and the surface of dental Siloc apparatus. Because of the application of both Siloc-
alloys. The procedure produces an intermediate layer Pre silane and Siloc-Bond bonding agent, the working
containing silicium oxide (SiOx) to allow bonding of the principle of the system is called silica coating and acryl-
resin through silane bonding. The technique consists of ization.40
air abrasion followed by heating SiOx with a flame in a Thermocycling relaxes stresses within the composites
specially designed apparatus that burns chrome, produc- produced by polymerization shrinkage. In general, the
ing a silica layer on the surface.38-41 surface treatment studies conducted have used different
Silicoater MD is the new version of the Silicoater thermocycling times, and the common consensus was
Classical system and uses the same principle. The differ- that thermocycling decreased the bond strength as it
ence between the 2 techniques is the method of coating weakened the resin structure.46-48
the metal surface. The surface is coated with SiOx in a Although comparative studies exist showing the ad-
liquid form in the Silicoater MD apparatus, in which vantages of various types of surface-conditioning meth-
firing takes place at highly controlled temperatures. This ods on both base and noble alloys,49-53 limited informa-
system has the advantage of avoiding flame adjustment tion is available with regard to the use of these
problems, eliminating the human factor.39,40,42 techniques on titanium substrate.54,55 Therefore the aim
The Rocatec conditioning procedure presents a kind of this study was to evaluate the effect of current surface-
of resin-metal bonding procedure based on silica coat- conditioning methods and opaquers on the resistance of
ing and silanization. The principle is tribochemical ap- various core materials against torsional forces on tita-
plication of a silica layer by means of air abrasion, which nium posts after thermocycling.
takes place in the Rocatector Delta unit with Rocatec
Pre and Rocatec Plus abrasives followed by silane appli-
MATERIAL AND METHODS
cation. The Rocatec Plus particles hit the alloy surface
with a theoretically calculated speed of 200 m/s, pro- Seven hundred twenty custom-made pure titanium
ducing spot heating up to 1000°C. This spot heating posts, each 3 mm wide and 15 mm long, were prepared

368 VOLUME 88 NUMBER 4


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Table I. Characteristics of surface-conditioning methods assessed

Trade name Abbreviation Conditioning principle Manufacturer

Silicoater Classical SC Silica coating/silanization Heraeus-Kulzer GmbH, Wehrheim, Germany


Silicoater MD SMD Silica coating/silanization Heraeus-Kulzer GmbH
Rocatec RC Silica coating/silanization ESPE AG, Seefeld, Germany
Kevloc KV Acrylization Heraeus-Kulzer GmbH
Siloc SL Silica coating/silanization Heraeus-Kulzer GmbH

Table II. Types of core materials and opaquers

Trade name Abbreviation Core/opaquer type Polymerization Manufacturer

Durafill DL Microfilled Light polymerized Heraeus-Kulzer GmbH


Adaptic AD Hybrid Chemically polymerized Johnson & Johnson, Skillman, N.J.
Coradent CD Hybrid Chemically polymerized Vivadent, Schaan, Liechtenstein
Ti-Core TC Hybrid Chemically polymerized EDS, Hackensack, N.J.
Hytac Aplitip HA Compomer Light polymerized ESPE AG
Photac-Fil Aplitip PF Glass ionomer Light polymerized ESPE AG
Dentacolor Dent Methacrylate Light polymerized Heraeus-Kulzer GmbH
Artglass Art Bismethacrylate Light polymerized Heraeus-Kulzer GmbH

according to DIN 17850-Ti4/3.70651.56 Ten speci- layer of a mixture of Silicoup A and B (Heraeus-Kulzer
mens per group for 5 surface-conditioning techniques, 2 GmbH) was applied.
opaquers, and 6 post core materials were assessed (6 ⫻ 5 The Silicoater MD system worked in manner similar
⫻ 10 ⫻ 2⫽600). Tables I and II summarize the charac- to the Silicoater Classical system. The difference be-
teristics of surface-conditioning methods, types, and po- tween the 2 techniques was the coating process for the
lymerization procedures for the core materials and metal surface. In Silicoater MD, SiOx was applied in a
opaquers. Specimens were divided into groups accord- liquid form in a special apparatus in which firing took
ing to core material, opaquer, and surface-conditioning place at highly controlled temperatures. With this appa-
method. Sixty titanium posts (10 groups of 6 core ma- ratus, flame adjustment problems and human factor
terials and 2 nonconditioned opaquers), air-abraded were eliminated.
with 250-␮m grains of aluminum oxide for 30 seconds Rocatec was based on tribochemical application of a
each, were used as controls. The surface roughness of
silica layer by means of airborne particle abrasion. First,
the control specimens, which was initially approximately
the specimens were conditioned by air abrasion with
equal to 2 ␮m, was measured to be approximately equal
110-␮m aluminum oxide grains at a pressure of
to 13 ␮m after air abrasion (Pruefgerät Type 402; Mi-
0.25 MPa with Rocatec Pre abrasive by means of the
tutoyo, Kawasaki, Japan).
Rocatector Delta device. The specimens were then air-
Surface-conditioning methods abraded with Rocatec Plus abrasive, which was 110-␮m
aluminum oxide grains modified with silicic acid, at
Titanium posts were conditioned and underwent si-
0.25 MPa at a distance of 1 cm from the metal surface
lanization chemically according to the manufacturers’
for 13 s/cm2. The surfaces were then coated with silane
recommendations.
(ESPE-Sil; ESPE AG) to render them chemically more
With the Silicoater Classical method, the posts were
reactive to the resin.
air-abraded with 250-␮m grains of aluminum oxide for
30 seconds at 4 bar. The surfaces were then coated with The Kevloc system offers a combination of mechani-
Siliclean solution (Heraeus-Kulzer GmbH). After being cal and chemical bonding. In this system the specimens
washed, the surfaces were air-dried for 2 minutes at were air-abraded with fresh 110-␮m grains of aluminum
room temperature. This technique consisted of heating oxide at 0.2 MPa. The air-abraded surfaces were cleaned
SiOx with a flame (Siliflam, Heraeus-Kulzer GmbH) in a with a brush, and the loose particles were removed. Kev-
specially designed Silicoater apparatus at temperatures loc-Primer was applied with a clean brush and dried at
higher than 250°C. The flame was adjusted to provide room temperature for 2 minutes. Kevloc Bond was then
sufficient SiOx molecular deposition on the metal sur- applied with a brush. After it was dry, the specimens
face. Siliflam was applied for 5 minutes (air/propane were placed in the chamber of the Kevloc AC apparatus,
20:1; air, approximately 130 L/h; propane, 6.5 L/h). where the activation of the bonding layers was generated
After the specimen was dried for 4 minutes in air, a silane by contact heat transfer and heat radiation for 8 minutes.

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THE JOURNAL OF PROSTHETIC DENTISTRY AKIŞLI, ÖZCAN, AND NERGIZ

Fig. 1. Hexagonal metal matrix with holes 6 mm in diameter and 15 mm in length.

The specimens were cooled at room temperature for 5 cording to the manufacturers’ instructions. Whereas
minutes. chemically polymerized core materials were polymerized
With the Siloc technique, the surfaces were air- (Optilux 401; Demetron Research, Danbury, Conn.) in
abraded with 250-␮m grains of aluminum oxide and one increment, the light-polymerized cores were placed
dried with water- and oil-free air at 0.3 MPa. The acti- in the metal matrix in 2 increments to ensure that the
vated surfaces were then coated with Siloc-Pre silane lower portion was also polymerized. The light output of
with a brush and dried at room temperature for 2 min- the polymerizing unit was initially tested to be
utes. Later, the specimens were placed in the Siloc ap- 630 mW/cm2 with the Cure Rite instrument (model
paratus. Finally, they were cooled at room temperature 8000; EFOS Inc, Williamsville, N.Y.). The irradiation
for 4 minutes and the activated surfaces were coated distance between the exit window and the resin surface
with Siloc-Bond and dried in the air for 5 minutes. was maintained at 10 mm to obtain adequate polymer-
ization.
Opaquer application The specimens were then subjected to 5000 ther-
After the titanium posts were conditioned, opaquers mocycles at a temperature ranging from 5°C to 55°C
were painted on the titanium posts and light-polymer- and a dwelling time of 30 seconds.57 An electronic
ized accordingly. rotational torque device (Wear Werk; Hermann
The powder and liquid components of the Denta- Werner, Wuppertal, Germany) was connected to a
color opaquer were mixed (1:1) to produce a thin con- compression test machine (Zwick 1445; Zwick
sistency, stirring for at least 30 seconds to achieve a GmbH, Ulm, Germany) for the measurement of max-
homogeneous distribution of the pigments. A thin layer imal torsional forces. The direction of the torsional
(shade No. 123) was applied with a brush and light- forces was clockwise (Fig. 2). Failure was established
polymerized for 90 seconds in the Dentacolor XS unit at the point at which the specimen could not with-
(Heraeus-Kulzer GmbH). Second and third thin layers stand an increase in load.
were separately applied and polymerized until complete The means of each group were analyzed by analysis of
masking of the metal was achieved. variance (ANOVA) (StatView 5.0; SAS Institute Inc,
The components of the Artglass opaquer were mixed Cary, N.C.). If a significant difference was established,
on a mixing pad. A thin layer (shade No. OA3) of the 2-way ANOVA was used to determine the probability
opaquer was painted on the alloy surface with a short- values, with a significance level at P⬍.05.
bristle brush. As the first layer did not mask the metal
sufficiently, further layering was performed. Each layer
was light-polymerized for 90 seconds in the Dentacolor
RESULTS
XS unit. Tables III and IV display the mean values obtained,
To produce the specimens in a standardized form, a together with the SDs associated with surface-condi-
hexagonal metal matrix with 6-mm-diameter holes was tioning techniques and core materials for the Denta-
used (Fig. 1). Subsequently, 6 core materials were ho- color and Artglass opaquers. The 2-way ANOVA re-
mogeneously placed within the matrix and cured ac- vealed significant differences (P⬍.0001) between

370 VOLUME 88 NUMBER 4


AKIŞLI, ÖZCAN, AND NERGIZ THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 2. Schematic diagram of electronic rotational torque device connected to compression test machine.

Table III. Significant differences between torque forces (in dNm) within combinations of core materials and surface-
conditioning techniques with Dentacolor used for each combination

Core material

Surface treatment DL AD CD TC HA PF

Control 12.5 (1.8)* 16.1 (1.1)* 15.1 (1.0) 12.2 (0.8)* 4.8 (1.9)* 7.0 (5.0)
SC 13.9 (3.0)* 20.8 (4.3) 21.1 (3.6) 19.6 (4.5) 16.5 (1.8) 19.5 (3.9)
SMD 14.4 (2.6)* 22.2 (2.9) 19.1 (3.4) 19.7 (3.7) 16.2 (2.1) 17.5 (3.9)
RC 15.6 (2.8) 21.5 (3.2) 18.5 (4.6) 19.5 (2.9) 6.5 (4.3)* 20.0 (1.4)
KV 11.1 (2.8)* 16.2 (1.5)* 12.3 (2.5) 12.9 (1.4)* 10.2 (3.2)* 0.0 (0)
SL 14.4 (3.4)* 23.9 (3.4) 22.2 (3.0) 22.6 (2.9) 21.0 (1.7) 18.7 (3.1)
*Indicates no significant differences in the same column between surface treatment/core material in comparison to control group, as determined by 2-way ANOVA
(P ⬎ .05).

Table IV. Significant differences between torque forces (in dNm) within combinations of core materials and surface-
conditioning techniques with Artglass used for each combination

Core material
Surface
treatment DL AD CD TC HA PF

Control 12.5 (1.8)* 16.1 (1.1)* 15.1 (1.0)* 12.2 (0.8)* 4.8 (1.9) 7.0 (5.0)*
SC 9.0 (3.1) 12.5 (3.2) 13.2 (3.6)* 11.0 (3.4)* 17.0 (1.1) 8.9 (3.2)*
SMD 7.1 (1.3) 6.7 (1.3) 11.1 (2.2) 6.2 (2.0) 12.9 (2.3) 0.5 (1.5)
RC 7.7 (1.7) 13.8 (3.5)* 12.6 (3.7) 7.6 (2.0) 16.2 (1.5) 5.6 (3.9)*
KV 8.9 (2.4) 8.2 (1.7) 10.4 (1.3) 8.5 (2.4) 9.7 (2.4) 0.0 (0)
SL 13.4 (2.6)* 9.0 (1.5) 13.5 (1.6)* 4.5 (0.7) 19.3 (1.6) 4.4 (3.5)*
*Indicates no significant differences in the same column between surface treatment/core material in comparison to control group, as determined by 2-way ANOVA
(P ⬎ .05).

groups dependent on the combinations of surface-con- Hytac Aplitip (19.0 dNm). The Kevloc system in combi-
ditioning techniques and opaquers and the interaction nation with Artglass opaquer and Photac-Fil Aplitip core
with core materials (Tables V and VI). material (0.00 dNm), however, showed no resistance
Significant differences (P⬍.0001) were observed be- against torsional forces.
tween hybrid and microfilled composite, compomer, or Significantly higher torsional forces with respect to
resin-modified glass ionomer core materials. The highest Siloc (20.4 dNm), Silicoater Classical (18.6 dNm), Sili-
torque values were obtained with Siloc-Dentacolor- coater MD (18.2 dNm), and Rocatec (17.0 dNm) sys-
Adaptic (23.9 dNm). The most profound and significant tems were observed compared with the untreated con-
improvements were observed with Siloc–Dentacolor– trol group (14.6 dNm) (P⬍.0001).

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Table V. Results of 2-way ANOVA for Dentacolor

Source of variation df Sum of squares Mean square F value P value

Surface conditioning (A) 5 4641.079689 928.215918 112.54 ⬍.0001


Core material (B) 5 1776.213409 355.242682 43.07 ⬍.0001
A⫻B 25 4715.052881 188.602115 22.87 ⬍.0001
Error 324 2672.27652 8.24777
Total 359 13804.62240

Table VI. Results of 2-way ANOVA for Artglass

Source of variation df Sum of squares Mean square F value P value

Surface conditioning (A) 5 6784.054378 1356.810876 207.75 ⬍.0001


Core material (B) 5 2397.833771 479.566754 73.43 ⬍.0001
A⫻B 25 2206.338247 88.253530 13.51 ⬍.0001
Error 324 2116.00767 6.53089
Total 359 13504.23407

The mean torque force achieved for the group with groups may be attributed to either the nonuniform dis-
the application of the Kevloc system (10.4 dNm) was tribution of heat transfer or the lack of silane application.
significantly lower than that attained for groups pro- In a study by Vojvodic et al,44 this difference was attrib-
vided with other surface-conditioning methods uted to differences in bonding layer thickness, opaque
(P⬍.001). Improvements in torque forces were not sig- viscosity, or opaque liquid proportion. The common
nificantly different for Dentacolor–Durafill, –Adaptic, finding of several studies was that the bonding results
–Ti-Core, and –Hytac Aplitip core materials compared decreased after artificial aging of specimens treated with
with their control group (P⬎.001). Kevloc.47,48,50-54,58 The individual mechanism produc-
In the Artglass–Photac Fil group, none of the surface- ing this result needs to be further clarified.
conditioning techniques improved the torque forces. The type of composite and surface-conditioning
technique is especially important because the type and
DISCUSSION composition of current composites differ widely. Of the
To withstand functional loads, the bond between the core materials used, the type of core material also signif-
core material and the post should be strong and durable. icantly influenced the resistance after thermocycling. In
Recently, the technology for bonding of resin to dental this study, 3 hybrid composites, 1 microfilled resin, 1
alloys has significantly improved. Various commercial compomer, and 1 resin-modified glass ionomer were
surface-conditioning techniques are available that claim investigated, with results revealing that resin-modified
to provide a durable bond between the resin and a metal glass ionomer core materials were especially affected by
substrate. the type of conditioning method. One explanation for
In this study the ranking of surface-conditioning the nonresistance of Photac-Fil Aplitip to Kevloc-
methods with regard to resistance of core materials after treated titanium posts might be the low resin content of
thermocycling was more favorable with Siloc, Silicoater this core material. The disadvantages of composite cores
Classical, Silicoater MD, and Rocatec and least favorable include microleakage and problems with dimensional
for the Kevloc system. The advantages of extraoral sur- stability that may affect marginal adaptation of castings.4
face conditioning have been reported38,43-45 and are in The results of this study indicated that hybrid compos-
accordance with the results of this study. The surface- ites resisted torsional forces more effectively even after
conditioning techniques tested in this study substan- thermocycling. This result may be due to the resin ma-
tially increased the attachment of the core materials trix or to particle size and filler composition.
tested in comparison to the unconditioned control The results varied in accordance with surface-condi-
groups. tioning methods and the type of the opaquer for the
In the Kevloc-treated groups with either the Denta- core materials. When Dentacolor was used as an
color or Artglass opaquer, however, no resistance to opaquer, significantly higher bond strengths were ob-
torsion was obtained with Photac-Fil Aplitip, which is a tained compared with Artglass opaquer. Dentacolor and
resin-modified glass ionomer. The working principle of Artglass opaquers vary in composition: the former is a
Kevloc is acrylization, whereas the other systems are methacrylate provided in a powder-liquid system,
based on silica coating/silanization or silica coating/ whereas the latter is a bismethacrylate provided in paste
acrylization. The results obtained in Kevloc-treated form. It is likely that bond strengths produced by

372 VOLUME 88 NUMBER 4


AKIŞLI, ÖZCAN, AND NERGIZ THE JOURNAL OF PROSTHETIC DENTISTRY

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UNIVERSITAIR DOCENT
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UNIVERSITY OF GRONINGEN
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ORAL HEALTH INSTITUTE
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81:1-6. FAX: ⫹31-50-363-2696
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