Amicri Ekfelill. DDS.

PhD
Deparlmenl nf Prosthetic Denlistry
Medical anrf Denial Health Center
Halntstad, Sweden

changes of Masticatory
Movement Characteristics
After Prosthodontic
Rehabilitation of
Individuals With Extensive
Tooth Wear

Stig Karlsson, DOS, PhD

Department of Prosthetic Dentistry
Faculty of Odontology
Coteborg University
Gteborg, Sweden

The masticatory cycles ot 11 men (mean age 51.5 years] with extensive tooth
wear were investigated before and after rehabilitation with fixed partial
dentures. Parameters such as the toolh wear index (1^) and masticatory
mandibular movement were recorded. Before treatment, the patients were
also given a questionnaire related to possible background tactofs of
importance to tooth wear. At baseline a mean score of 48,6 (range 0 to 100)
for the tooth wear index (1^) was found. The clinical recall examination 3
years atter prosthodontic rehabilitation displayed obvious wear of restorative
material for two patients, and, in another patient, one of the fixed partial
dentures had to be remade because of fracture of abutment teeth. Following
rehabilitation, the duration of the masticatory mandibular opening movement
increased and mandibular movement velocity decreased. The mandibular
closing angle, near to occlusal contact, became steeper after prosthodontic
treatment, indicating a changed mandibular movement pattern,

intj Prosthodont 1998;9:539-546.

eeth in function will be affected by incisai

and/or occlusal wear. Tooth wear is related to
factors responsible for the changes in tooth substances,' and the multifactorial character of the occlusal wear phenomenon is widely accepted on
the basis of a number of studies,-"*
The mechanical effect depends on a variety of
factors such as the type of contact between the
teeth, the development of forces and load when
the teeth make contact, the time in relationship to
tooth contacts, and the presence of abrasives in the
oral cavity,''
Studies on ancient skulls have demonstrated
the effect of the tooth wear process on the dentoalveolar and craniofacial morphology; with a
gradual loss of occlusal and proximal tooth substance, a shortening and widening of the dental
arch is seen, and space for erupting and migrating

Reprint requests: Dr Anders Eiifeidt, Department of Prosliielic

DcntiHry, Medical and Dentil Heaith Center, 5-301 3.5
H^ilmslad, Sweden.

Volume % Number 6, 1996

539

teeth is created. To maintain vertical dimension

and face height, a compensatory eruption occurs,
and there is a gradual transition from a normal incisal horizontal overlap to an edge-to-edge relatinnship that results from a lingual inclination of
anterior teeth together with an anterior rotation of
the mandible,^"^
The mandibular movement pattern in the natural dentition related to canine guidance described by D'Amico" is reported to faciiitate and
mediate a vertical chewing pattern and to prevent
tooth wear. However, group function as described
by Beyron" necessitates progressive wear for functional harmony.
While Beyron^ demonstrated progressive occlusal
wear in dentitions with group function, Johansson et
aP found no correlation between the distribution of
occlusal wear and the type of lateral gliding schetne,
canine guidance, or group function in a young adult
Saudi population. However, there was a strong correlation between contacts in the protrusive movement and incisai or occlusal tooth wear.

lournal ol Prostliodontic

Masticatory Movement Atter Prosthodortic lieiiabilitation

One of the individuals was not rehabilit^iied because of economic reasons and one had moved
from the area and could not participate in the second examination. Gonsequently, nine patients
were finally included.
Most of the patients were rehabilitated in 1991.
Three years later, in 1994, the same patients were
reexamined by one of the authors.
Patients were restored using a fixed partial denture and/or single crowns. Some of the units had a
gold occlusal contact area to allow a gold-to-gold
contact, while other restorations had a porcelain-toporcelain occlusal contact (Table 1). Most of the
subjects were rehabilitated both in the maxillae and
mandible with an increased vertical dimension of
occlusion (VDOl. The new VDO was established
and tested using fixed provisional restorations prior
to the final rehabilitation. An increase of vertical dimension of occlusion is possible without complete
arch rehabilitation. By placement of an anterior device to increase the vertical dimension of occlusion, the lateral segments are allowed to extrude."
In this way it is possibie to restore parts of an occlusal table and still achieve occlusal stability.

The appearance of the individual chewing pattern and the masticatory cycle has been said by
many authors to be associated with the state of occlusion and influenced by prosthodonlic reconstruction.'""^- The basic form of the masticatory
cycle, however, seems not to be influenced by
prosthodontic rehabilitation.'^
The chewing pattern in individuals with extensive tooth wear has been discussed by Russell,'''
who reported that a ruminating form of masticatory
activity occurs more frequently for patients with
generalized wear.
Aspects of the restorative procedures for patients
with extensive occlusal tooth wear has also been
given.-*''^ Oral restorative treatment can be semiirreversible or irreversible. The semi-irreversible alternatives include resin composite restorations, removable partial dentures, and overdentures.
Irreversible methods include a variety of fixed
restorations. Other problems, such as increase of the
vertical dimension of occlusion and the retention of
cast restorations, are encountered when restoring
extensively worn dentitions'' that are a consequence
of the reduced height of abutment teeth.
However, there are no detailed reports as to
whether comprehensive occlusal rehabilitation will
alter the chewing pattern and decrease occlusal wear
in individuals with extensively worn dentitions.
The purpose of this investigation was to study the
masticatory pattern of individuals with diagnosed
extensive tooth wear and wear of restorative materials, before and after prosthodontic rehabilitation.

Recording Mandibular Movements

The characteristics of masticatory mandibular movement were recorded at two separate sessions: before
rehabilitation and approximately 3 years following
completion of the prosthodontic treatment.
Oral motor function (expressed in terms of
mandibular movement dimension and velocity)
was monitored by a reference system attached to
the subjects using an optoelectronic method
(Selspot, Partille, Sweden) that allowed for freedom
of head movement (Figs 1 and 2). While seated upright in a dental chair chewing standardized pieces
of chewing gum, duplicate recordings of 12-second
masticatory sequences were performed for each patient. This three-dimensional analysis system, based
on light-emitting diodes (LEDs), has been described
in detail in previous reports.'^'''
For computer analysis, a single masticatory cycle
was divided into three separate phases: mandibular
opening (OP), mandibular closing (CP), and occlusal
level phase (OLP). Recordings of two masticatory sequences for 12 seconds each were performed both
before and after rehabilitation. In total, approximately 70 cycles were analyzed for each patient.
The OLP was defined as any position in which
the mandible was located from maximum intercuspation to a level 0.5 mm inferior to maximum intercuspation. The OP and CP phases start and end
at this position.

Material and Methods

The study group consisted of 11 men (mean age
51.5 years, range 37 to 67 years) referred to the
Department of Prosthetic Dentistry, Gteborg
University, Gteborg, Sweden, for treatment necessitated by extensive tooth wear both on natural
teeth and existing restorations.
A clinical examination was carried oui and complemented with radiographs and models. Before
treatment, patients were given a questionnaire related to possible background factors of importance
for tooth wear, including dietary, environmental,
working, and parafunctional factors, signs and
symptoms of functional disturbances of the masticatory system, and recurrent headache.
All patients were examined and tieatment was
planned by one of the authors. The prosthodontic rehabilitation was performed either at the Department
of Prosthetic Dentistry, Gteborg University, the
Prosthodontic Department of the Public Health
Service, Gteborg, or by the referring dentist.

Tiie inlemationailournalof Prosliiodortics

540

Volume 9, Number 6.1996

Maslicjtory Movement Aflc^r Pro;llio(iuntit lehalil nation

Measurement LEDs

Fig 1 Components of the Selspot movement

analysis system. LCU = light-emitting diode
control unit; C = camera; CIM = camera interlace module; PC AT = computer; Pr = printer;
PL = plotter.

Table 1
Patient
number
1
2
3
4
5
6
7
8
9
10"

Fig 2 Reference system consisting of three

LEDs attached to a test person.

Type of Prosthodontic Rehabilitation at the Follow-up Examination

rMandible

Maxillae
Type
FP,
se,
FP,
se,
FP,
FP,
FP,
FP,
FP,
se,
FP,
se,

Teetti

MC
MC
MC
MC
MC
MC
MC
MC
MC
MC
MC
MC

4-6(15-13)
7-11 (12-23]
2-5(17-14]
6-10(13-22]
2-5(17-14]
6-11 (13-23]
12-14(24-26]
3-15(16-27]
4-6(15-13)
7-11 (12-23)
12-14(24-26)
6-11 (13-23)

se. Me
FP, Me
se. Me

6-10(13-23)
11-15(23-27)
4-12(15-25)

se, MC

3-14(16-26]

Type

Teeth

FP, Me

21-19(34-36)

se. Me

29-27 (45-43)

FP, Me
FP, Me

30-28(46-44)
22-19(33-36)

FP, MC
29-27 (45-43)
s e , MC
26-23 (42-32)
FP, MC
22-18 (33-37)
FP, MC
31-27 (47-f3)
FP, MC
21-18(34-37)
Removable partial denture
se, Me
FP, Me
se. Gold
se. Me

27-22 (43-33)
30-20 (46-35]
31,19,18(47,36,37)
30-19 (46-36]

Patient number 10 was retiabililated but did no(partic:ipate in Ihe foKow-upesamination.

FP = Fixed partial dentjre; SC = single cmwn; MC = metal ceramic; Gold = all gold crow/n. Tooth njmBers are expressed in the Universal nuniLjerirg system, and FDI notation is indicated in parentheses.

angle relative to the sagittal plane at which the

mandible approached and left the intercuspal position.
Student's f test (two-tailed] was used for examination of the significance of differences between
registrations.

The following variables were quantitatively analyzed: (V the total cycle duration (TCD) and the
subdivided phases OP, CP, and OLP; (2) the mean
and maximum velocity in the OP and CP phases;
(3) the mean three-dimensional mandibular spatial
displacement in the OP and CP phases; and (4) the

Volume 9, Number 6, 1996

541

The Internat ion I Journal of Prosthodontic

Maticalor>'

erl Atei Prosthodontit Reh,il)ilitatic

Fig 3b Patient 10 alter rehabilitation with metal ceramic

crowns in the maxillae and mandible (courtesy ot Dr Annika
Torbjorner.

Fig 3a Patient 10 displays a maximum score (82.5) for tbe

individual tootb wear index (1^). He had previously been subjeot to frequent vomiting beoause of food allergy.

Table 2 Patient Distribution and Number, Age, and Value of the Individual Tooth
Wear Index and Number ot Remaining Teeth at the First Examination
Patient
number
1
2
3
4
5
6
7
8
9
10
11
Mean

Age

1^
score

53
45
67
45
48
52
56

45.7
50 4
139
19.1
57.8

37
63
57
44
51.5

52.1
43.0
82.5
65,7
48.6

66.1
38.2

Number of
remaining
teeth
21
24
23
23
19
18
22
28
23
28
23

Veneered crowns in the maxillae

Veneered crowns in tbe maxillae and mandible
The questionnaire was not filied in because of
ianguage difficulties.
Did not participate in tbe second examination
Did nol participate in the second examination

22.9

Diagnostic Criteria of Wear

where Gp, G,, G,, G3 are the number of teeth with

scores of zero, one, two, and three, respectively.
The constants 10, 30, and 100 were chosen to reflect the difference in incisa! or occlusal breakdown between teeth with scores 1, 2, and 3, respectively, and to increase the discriminating
power of the index 1^. The range of tbe index was
Oto 100.

The degree of incisai or occiusai wear was evaluated by one of the authors for each single tooth in
accordance with the following criteria; 0 = no
wear or negligible wear of enamel; 1= obvious
wear of enamel or wear through the enamel to the
dentin in single spots; 2 = wear of the dentin up to
one third of the crown height; and i = wear of the
dentin more than one third of the crown height, or
excessive wear of tooth restorative material or dental materials of the fixed restorations (more than
one third of the crown height).^'^
Based on the scores of incisai or occlusal wear for
each tooth of a patient, an individual tooth wear
index (1^) was made. The purpose of this index was
to obtain one single value for the degree of incisai
and occlusal wear as presented by Ekfeldt et al.'^

Results
The number of patients, age, wear index (l^ at
baseline, and number of remaining teeth are presented in Table 2.
Wear

All the individuals showed a high baseline I,

index score (mean 48.6) before rehabilitation.
Patient 10 had a maximum score of 82 5 (Figs 3a
and 3b).

-t- 3QXG2 H- 100XG3

Go + Gi -I- G2 + G3

The Iniernalional Journai of Prosthodortics

542

Volume 9, Numtier 6. 199

ilury MVfincnt After fmstiiodoriLic RdlJbiiilJtiun

Table 3

Distribution of Some ot the Answers to the Questionnaire |n = 10]

At
present

Question
1. Do you spend much time in dusty or poiiuted environments?
2. Do you experience frequent acid rgurgitation or vomiting''
3. Do you sufter from gastric catarrh oi digestive problems?
4. Do you often clench or grind your teeth?
5. Do you suffer from headaches?
6. Do you suffer from pain in your jaws and/or neok?
7. Do you suffer from buzzing in your ears?
8. Do you oonsider your teeth to be extensively worn?
9. How long time have you considere your teeth to be worn?
less than 4 years
4-10 years
more than 10 years

2
1
3
5
3
4
3
9

Previousiy
but not at
at present
2
2
1
0
2
1
1

6
7
6
5
5
5
6
1

3
5
2

Table 4 Measurements ot the Masticatory Cycle Before and 3 Years After

Prosthodontic Rehabiiitation
Before
Tofai cycie duration ms)
ivlandibular opening (ms)
Mandibular ciosing (ms)
Occlusai phase (ms)
Mean veiocity opening (mm/s)
Mean velocity ciosing (mm/s)
Max, velocity opening (mm/s)
Ma, velocity ciosing (mm/s)
Angle opening (degrees)
Angle oiosing (degrees)
Ampiitude (mm)

Atter

Difference

Mean

SD

Mean

SD

P)

743
230
304
210
102
85
182
161
58
64
20

153
28
68
134
31
23
57
52
7
13
5

805
300
332
173
78
70
132
138
60
54
16

93
73
54
49
28
19
66
46
6
13
5

ns
.05
ns
ns
.05
ns
.05
ns
ns
,01

ns

ns = not Significant.

abutment tooth. Two other patients (5 and 9) showed

obvious wear of both the gold and the porcelain
restorative materials. Some small fractures of the
porcelain were present in patienl 5. Only minor wear
facets were observed for the remaining patients.

Questionnaire
In the questionnaire, awareness of bruxism was reported by five individuals (Table 3). "Digestive
problems" and "frequent acid rgurgitation or
vomiting" were also relatively frequent (positive responses to questions relating to "lime spent in
dusly or polluted environments" were also frequently mentioned). Symptoms such as headache
and facial pain were common.
It is notable that seven individuals had been
aware of their worn teeth for more than 4 years. All
the individuals considered that they were in need
of restorative treatment for their worn dentitions.

Masticatory Cycte Duration

After rehabilitation, a significantly (P< ,05) longer
OP duration was recorded. No significant change
of the total cycle duration was observed (Table 4).
Velocity of Masticatory Cycte Components
A significant decrease of maximum {P < .05) and
mean velocity (P < .05) were recorded for the OP
after rehabilitation (Table 4).

Clinical Recall Examination

At recall, the nine patients (1 lo 9) rehabilitated with
prosthodontic restorations (see Table 1 ) were all satisfied with the esthetics and function of the restorations. However, one of ihe fixed partial dentures of
patient 4 was removed because of the fracture of an

Voiume 9, Number &, 1996

Angle at Closing Near to the Intercuspal Position

A significantly more narrow closing angle (P< .01)
was recorded after rehabilitation (Table 4).

543

The Internjtional lournal of frcsthodontics

Masticalory Movenienl Aiter Pmsiliodontit Rehabilitsliun

must be renewed at certain interval-, iherefore,

after a rehabilitation it is recommended that patients be provided an occlusal splint to be worn as
frequently as possible and that a schedule be
arranged for regular recall visits to diagnose further
development and effect early repairs. This is emphasized by the continuous occlusal wear of the
restorative material observed at the follow-up examination (patients 5 and 9).

Discussion
When extensively worn leeth are to be restored,
the etiologic factors involved must be thoroughly
considered, A mechanical action on the tooth is
generally the basic factor, but erosive factors also
contribute to the reduction in hardness of the
enamel, making the tooth more susceptible to
wear,''' Salivary factors, such as buffer capacity
and the pH of the saliva, must also be considered.
The mechanical effect depends on various factors,
including the type of contact between the teeth,
the development of forces when the teeth are in
contact, the time in relation to tooth contacts, and
the presence of abrasive factors in the oral cavity.
Similarly, gastrointestinal disturbances related to
alcoholism and diet (ie, acidic substances related
to bulimia) have also been found to be associated
witb tooth wear,''
Thus, many factors contribute to tooth
^^gg,,18,20,21 35 displayed by the answers to the
questionnaire. Awareness of bruxism and gastrointestinal disturbances such as "frequent acid rgurgitation or vomiting" were relatively often reported. The subject that displayed an almost
maximum individual tooth wear index (l^ score
(82,5) had previously been exposed to frequent
vomiting because of food allergy.
Sexual dimorphism, in which more tooth wear is
more present in males than in females in the
Western population is well documented in other
studies-'^'^; therefore the present study group
comprised males only. Bulimia is a disease that affects more female patients, therefore with bulimic
patients more women than men present with dental erosion.
Prosthodontic management of a severely worn
dentition can be very complicated and time consuming. Identification and possible elimination of
causative factors before prosthodontic rehabilitation is desirable. Incisai and/or occlusal tooth wear
seems to have intermittent active and inactive periods,'"-^^ Therefore, when recording anamnestic
data it is important to consider the time factor in
relation to the development of wear,^ In the present study, 70% of the subjects had been aware of
their worn teeth for more than 4 years.
Heavy bruxers should be informed that restoring
their teeth will not lead to cessation of bruxism.
Diurnal bruxism will not only lead to direct wear
of the incisai and occlusal surfaces of the restorations but most probably also cause material fatigue,'' Patients must accept that their restorations
will also be subjected to wear and tbat prosthodontic rehabilitation is an intermediate means that

The Internalional Journal of Prosthodontii

The adaptability of the stomatognathic system to

alteration in the VDO and the stability of a therapeutically induced increase in the VDO is well
g
Table 2 presents the scores for the 1^ of study
participants. The 1^ can be explained as the ratio
between the weighted sum of all teeth with some
degree of incisai or occlusal wear and the total
number of existing teeth for the individual.^^
The index describes excessive wear of enamel,
dentin, and restorative material, but does not discriminate incisai and occlusal wear of restorative
materials of degrees 0, 1, and 2, This limits the
possibility of ranking slight to modrale wear in individuals with occlusal restorations. This was observed in the restorations of patients 3 and 4,
where obvious wear of the restorations was present
but not to the degree of score 3, For this reason the
lA was not used at the clinical recall examination.
Individual values for total incisai and occlusal
tooth wear have been considered to be a problem
in epidemiological studies, Pollman et al^"* calculated the average tooth wear for each person using
the Parma Index, but found it unsuitable for statistical purposes. Other methods have been used, including the calculation of the highest score of
tooth wear in each of seven arch segments or the
mean score of wear for the Incisai, canine, premolar, and molar regions,^''^^^
Numerous studies have described observations of
mandibular movements and duration of the masticatory cycle.'^'"^'^'''^^ There are also studies describing mandibular movement characteristics before and after prosthodontic rehabilitation.'^'^^'^ To
the authors' knowledge, there is only one published
study discussing masticatory movement characteristics before and after rehabilitation of subjects with
extensively worn dentitions.'"" In that study it was
reported that a ruminating form of masticatory activity occurs more frequently for patients with generalized wear, Tbe report also stated two hypotheses for the apparent existence of a ruminating
activity: (1) the activity is "inherent and peculiar to
the individuals concerned and tbe dentition has become worn as a result such that the form of occlusal surface has become related to function"; or

544

Volume?, Number 6, 1996

Masticatory Movement Aipr Proiliodontic Reliji:iiiitation

2) "the masticatory cycle has adapted to the altered

form of the occlusal surface." After rehabilitation no
clear suggestion could be drawn, as the masticatory
form altered in some patients and not in others.
This study found a significantly more narrow closing angle (P < ,011 of the masticatory cycle after rehabilitation compared to that of the baseline. This indicates that the masticatory cycle converted from a
ruminating form to one that was sharper. The maintenance of a distinct occlusion after rehabilitation will,
naturally, influence this parameter. A prosthodontic
occlusal stabilization has been shown to reduce the
irregular masticatory movements and disturbed
rhythm seen in persons with malocclusion.^^
Generalized wear in modem man is rare,^" and it
is unlikely to believe that the envelope of the masticatory movements, except for a few instances, is a
cause for general tooth wear.
In addition to a steeper closing angle, a significant decrease in the maximum and mean velocity
(P < .05) of the opening phase (OP), combined
with a significantly longer duration of the OP (P <
.05) were found. No significant change of the total
cycle duration was observed. In other studies an
increased mean velocity of the opening phase has
been recorded after rehabilitation. In these studies,
however, edentulous patients were rehabilitated
with implant-supported fixed prostheses or overdentures generating a stabilization of the functional
capacity.''-^
The authors' results indicate that mandibular
movement characteristics will partly change after a
rehabilitation of an extensively worn dentition. The
clinical importance of this for the longevity of dental restorations is unclear, however, and further
studies are necessary to elucidate possible influences of this pattern on the wear process.

3. The duration of the masticatory mandibular

opening movement increased after rehabilitation.
4. Mandibular movement velocity decreased after
rehabilitation.
5. The mandibular closing angle became steeper
after prosthodontic treatment, indicating a
changed mandibular movement pattern.
Acknowledgments
The authors are grateful to Dr Hans tHansson, Dr Christer
Henninj;sson, Dr Annika Torbjorner, and Dr Margareta Persson
at the Prostliodonlic Department, Pubiic Health Service,
Gteborg. A pecial thanks to Mrs Agneta Erneman for processitig the data.
This study was supported by grants from Praktikertjanst AB
and Sigge Persson & Alice Nybergs foundation.

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Conclusions
Male patients with extensive tooth wear were investigated before and after an oral rehabilitation
with fixed partial dentures. Parameters such as a
tooth wear index and masticatory mandibuiar
movements were recorded. From the results the
following conclusions could be made:
1. A mean score 48.6 (range 0 to 1001 for the
tooth wear index was found before rehabilitation.
2, The answers to the questionnaire displayed a
number of factors such as: "digestive problems," bruxism, and "time spent in dusty or
polluted environment," that could have contributed to incisai and occlusal tooth wear.

9, Number 6, 1996

545

16.

Kailsson S, Carlssor CE. Recording of masticatory mandibular

movements and velocity by an optoelectronic method, int |
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Karlsson S, Jeml T. Adaptive changes of masticatory movement characteristics after rehaiiilitation with osseointegrated
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implants 1991;5:259-263.

The Inlcrnationai Journsi ol Prosthodontics

Masticatory Movemeni After Prosthodontic Reh.ibiMtarion

18.

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Ekfeldt A, Hugoson A, Bergendal T, Helkimo M, An individual toolh wear index and an anaiysis of factors correlated to
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Wright KHR. The abrasive wear resistance of human denial

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Carlsson GE, Johansson A, Lundqvist S, Occiusai wearA

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Smilh BGN, Knight JKK. A comparison ol pattern oi looth

wear with aeliological factors, Br Dent J 1984;1S7:1 6-1 9,
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Dahl BL. The face height in adult dentate humans. A discussion of physiological and prosthodontic principles illustrated
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Pollman L, Berger F, Pollman B. Age and dental abrasion,

Gerodontics 1987:3:94-96.

28

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Liler.ilure Abilraci

Antibacterial activity of three dental liners

This study investigated the antibacterial effectiveness of three dental liners over tirne,
Vitrebond (3M, St. Paul, MN], Dycal (LD Caulk, Dentsply Int, Millord, DE], and Life (KerrSybron, Romulus, Ml] were used. Cylindrical samples were prepared from each material
using standard, round, presterilized glass tubes, A control was prepared trom an inert material. Two freshly isolated S. mutans strains, trom in vivo canous loci, and one laboratory
S mi/a/is Strain were used Samples of the test matenals were aged before inhibition.
S. muians was seeded on MSB agar plates and samples were allowed to remain in contact
with the seeded agar tor a predetermined time. The antibacterial etfecl was assessed
ttircugh the surtace area of the inhibition zcne and the type ot antibacterial effect, Vitrebond
had an immediate antibacterial effect thai was evident after a contad time of only 1 minute.
Its inhibitory effect was also evident after contact limes of 5 minutes, 1S minutes, 1 hour,
and 24 hours. Dycal had greater inhibitory action than Life. Vitrebond's greater antibacterial
etfect may De attributed to the low pH levels while setting and to fluo ride-el easing properties. Although the antibacterial activity of Vitrebond on S. mi//aiis decreased after 7 days, it
was still evident. The almost immediate antibacterial action may provide an immediate inhibitory barrier to prevent residual bacteria trapped inside the dentinal tubuli and the smear
layer from reaching the pulp.
II I, Cooper Y, Ben-Amar A, Weiss E, JProsi/iocin995;4.17B-182. Reterences: 21. Heprints:
liana Eli, Department of Operative Oentistry, The Maurice 3rd GaOriela Godschleger School ot Dental
tiedicine, Tel Aviv University, Tel Aviv, 6997B, \srae\.Auguslo L H RoOriguss. DOS, Advanced
Educavon Program in Prosthodoritics. New York University Coitege at Dentistry, New Yorii, New York

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