An adhesive partial
technique
for small
anterior
fixed
San Francisco,
Calif.
dentures
J. Ben Stolpa, D.D.S.* School of Dentistry, University
of California,
D
ental composite resins have opened new possibilities for esthetic prostheses. Such techniques are available for anterior restorations and tooth replacements without mechanical retention. The desirability of an adhesive restoration material is unquestionable, and past decades have seen reports of progress.1s ’ True adhesion of resin to tooth structure is still in question. The molecular forces exerted between two surfaces, such as Van der Waal’s, hydrogen, or polar forces, which are necessary in true adhesion, may exist in dental adhesives.3 Mechanical bonding on a microscopic scale has been demonstrated and accepted.*-? The current position on adhesion of the Council on Materials and Devices of the American Dental Association is that no data have yet been offered which unequivocally prove that a dental material adheres to tooth structure in a clinical setting.i, ’ The term ‘Ladhesive restorative material” could be accepted realizing its relative imprecision. It is thus used in this report. The retentive effect of the new adhesive restorative materials is primarily achieved by creating microscopic undercuts or irregularities in enamel prisms. These microscopic irregularities are produced by etching the surface of the enamel with an acid, generally 50 per cent phosphoric acid. The enamel rod dissolves in preference to the rod sheath and interrod substance, although the reverse also occurs.5, ’ The surface of the enamel must be clean and free of moisture.. ?, I” When the adhesive material is then applied, it will extend into the irregularities and undercuts with great precision. Fingers of resin of up to 50 p, exactly mirroring the etched enamel surface, have been reported in microscopy studies.” The enamel surface, available for the adhesive material, is increased as are the interlocking irregularities. Several currently available restorative systems claim adhesive qualities. Some of the proposed uses for adhesive materials include fracture repair, periodontal splints, restorations, crown cementation, space maintenance, temporary fixed partial dentures, densensitization, and orthodontic brackets.11-13 This report describes a technique for making a fixed partial denture of inter*Assistant Professor, Department of Oral Diagnosis. 513
514
J. l’rosthet. Dent. November, 1973
Stolpa
Fig. 1. The contoured wax. Fig. 2. The adapted
acrylic
resin teeth are held in place on the model with
foil reinforced
with
acrylic
hard baseplate
resin forms a matrix.
mediate length. There are advantages and disadvantages to conventional fixed or removable partial dentures. The dentist’s professional judgment must be exercised to optimize the treatment of his patients. In some patients with missing teeth, conventional appliances are either impossible or are too much of a compromise. Costs may be prohibitive. The patient may not be capable of accepting a large palatal or lingual appliance. The improvements in adhesive dental restorative materials offer possible alternatives; one may be the treatment of choice, not a less desirable option. TECHNIQUE The replacement of two maxillary central incisors will serve to describe the technique. (1) At the first visit, fabricate maxillary and mandibular working and study casts. (2) Select the shade, shape, and size of acrylic resin artificial tooth (or teeth) to approxrmately fit the space. Minor adjustments can be made during the fabrication of the fixed partial denture. (3) On the working model, contour and adjust the artificial teeth to fit the space mesiodistally, labiolingually, and gingivally. Also adjust the artificial teeth to avoid incisal edge-to-edge contact in eccentric movements (Fig. 1 1. Hand-held cast articulation will suffice. (4) Place the contoured artificial teeth on the cast in the desired position, and fix them in place by dripping hard baseplate wax on the lingual surfaces of the plastic teeth and the adjacent stone teeth. The wax should be of adequate thickness to resist displacement of the teeth when handling the cast. At this time, final adjustments to the teeth can be made. (5 i Burnish tinfoil (or aluminum foil) on the labial surfaces of the denture teeth and adjacent stone teeth. The foil should be burnished carefully, avoiding puncture
Fig. 3. Typical resin teeth.
Class III
cavity
preparations
are prepared
on the mesial surfaces of the acrylic
Fig. 4. Composite
resin has been placed to a slight excess into the Class III
Fig. 5. Class III
cavity
preparations
Fig. 6. The pontic seated in the matrix
have been prepared
cavity
preparations.
in the distal surfaces.
and placed on the stone model.
or tear into the interproximal depressions and carrying 1 to 2 mm. of foil around the incisal edges of the teeth (Fig. 2). (6) Paint autopolymerizing resin,* about 2 to 4 mm. thick, on the labial foil, providing support for the foil matrix. Paint a thin layer of autopolymerizing resin around the incisal edges of the teeth. Do not extend the acrylic resin too far gingivally past the necks of the teeth, as this would lock in the artificial teeth. (7) After the resin has polymerized, the entire matrix is removed by gentle prying labially and incisally. (8) Remove the artificial teeth from the baseplate wax, holding them in place on the cast. Form undercuts on the mesial surfaces of the artificial teeth, as for a Class III cavity preparation (Fig. 3). Minimize the reduction of labial surfaces to preserve the anatomy of the artificial teeth. Additionally, slight, shallow crosshatching and roughening of the mesial and lingual surfaces will increase the area available for the composite resin attachment. (9) Thoroughly clean the wax from the denture teeth by scraping and wiping with a suitable agent such as alcohol. Avoid touching the surfaces that will be covered by the composite resin. *Dura-Lay,
Reliance
Dental
Manufacturing
Company,
Chicago,
111.
516
Stoljxi
.I. l’rostbet. Lhll. November. 1975
Fig. 7. The rubber dam exposes the teeth on either side of the abutments. resin to the abutment teeth and Class III
Fig. 8. Apply a fresh mix of composite arations of the pontic.
cavity
prcp-
(IO) Place the denture teeth in the respective depressions in the matrix. Gently wipe and hand vibrate freshly mixed composite resin (slightly more than needed) into the cavity preparations and on the mesial surfaces of the two teeth (Fig. 4). After the material has polymerized, contour and shape the two-unit pontic. ( 11) Prepare typical Class III cavities in the distal surfaces of the artificial teeth (Fig. 5). Again, shallow crosshatching and roughening of the surfaces involved will improve retention. (12) Thoroughly clean the pontic, replace it in the matrix, and return it to the model (Fig. 6). (13) At the second appointment, polish the abutment teeth with pumice, and place a rubber dam. exposing the teeth from premolar to premolar. (14) With a medium disc or diamond, roughen the mesial surfaces of the lateral incisors. Also, slightly crosshatch the enamel with a No. f/2 round bur (Fig. 7) (15) Acid etch the lingual and mesial surfaces of the abutment teeth which are to be covered with the composite resin, and rinse them thoroughly, according to the directions of the manufacturer. Dry the teeth completely. Chloroform or another drying agent may be used. (16 1 Try the foil matrix with the denture teeth in place to confirm the fit and assure that there are no interferences with the rubber dam. i 17) Mix a large amount of composite resin. Place it in the distal Class III preparations of the pontic as it is lying in the matrix. Also, coat the mesial surfaces combination over the paof the lateral incisors (Fig. 8) Place the matrix-pontic tient’s own teeth (Fig. 9). (18) Hold the matrix in place for about five minutes: then, not disturbing it. leave it for another 10 to 15 minutes to allow the composite resin to polymerize. from the prosthesis by carefully prying it away. If (19) Remove the matrix necessary, additional composite material may be added at this time. (20) With discs. pointed diamonds, and finishing stones, trim and shape the contact areas and surfaces. The rubber dam will have prevented any excess resin from extruding gingivally (Fig. 10).
Volume 34 Number 5
Adhesive
Fig. 9. The matrix
is held firmly
technique
for
fixed
partial
dentures
517
in place for at least five minutes.
Fig. 10. There is no incisal interference
in the edge-to-edge
position.
(21) Check f o r incisal interferences in centric occlusion and in protrusive and lateral movements. Remove any interference. (22) Explain to the patient the precautions to be taken with and limitations of an intermediate fixed partial denture of this type. Caution against heavy incising is indicated, as this is strictly an esthetic replacement. The device is to be cleaned in the same manner as any fixed partial denture, and it should be evaluated periodically for replacement and repair. PATIENT
HISTORIES
Patient No. I. A 15-year-old high school student presented with missing maxillary central incisors, avulsed several months previously in a bicycle accident. The lateral incisors were unaffected and had no restorations. The occlusion was normal. The patient’s age and financial considerations precluded a standard fixed prosthesis. A temporary fixed partial denture with acrylic resin artificial teeth and an adhesive composite material bonded to the lateral incisors was fabricated. The prosthesis was observed periodically for eight months, at which time it was still serving satisfactorily. right Patient No. 2. A 20-year-old university student presented with a maxillary central incisor fractured apically to the crest of the alveolus. It had been restored with a dowel and core crown. The root was extracted. The left central maxillary incisor was missing. The dentition was otherwise normal, though the maxillary lateral incisors were crazed and slightly chipped. The patient preferred not to have either a conventional fixed or a removable partial denture. After discussion, a temporary fixed partial denture was fabricated with acrylic resin teeth and a composite resin adhesive material. The result was observed periodically for four months. DISCUSSION There are situations when the relative contraindications to the placement of traditionally preferable prostheses are sufficient to warrant alternative solutions. The technique of replacing two missing adjacent anterior teeth with a two-unit pontic is an alternative. Indications are the patient’s inability or unwillingness to
518
Stolpa
.J. l’rosthet. Dtwt. November. 1975
accept a conventional fixed partial denture or a removable prosthesis, continued exposure to potentially traumatic episodes, age, financial barriers, lack of time for repeat visits of long duration, and a desire to conserve tooth structure on the adjacent virgin teeth. The prime advantage of a fixed partial denture of this type is its esthetic contribution to the patient’s appearance when no other alternative exists. The main disadvantage is its lack of strength and function. If a break does occur, the strength of the bonds is such that the break can occur within the resin itself as well as at the interfaces with the tooth structure. I1 In either case, the damage is reparable with a minimum of difficulty. In the case of Patient No. 1, a soft-drink bottle was slammed into her fixed partial denture two weeks after initial placement. The device broke, shearing the composite material at the junction of the pontic with the two lateral incisors. Composite resin remained on both the lateral incisors and the pontic surfaces. The fixed partial denture was replaced by cleaning the surfaces involved, placing fresh composite resin on them, then placing the pontic back in its former position. The sheared surfaces bvere used as guides to replacement. Excess material was trimmed as before. SUMMARY
A technique for the fabrication of a resin anterior fixed partial denture of mediate length has been described. This type of device offers an inexpensive, treatment for selected patients with two adjacent missing anterior teeth. The nique allows the postponement of a definitive treatment to a more favorable The total treatment can be completed in two relatively short appointments.
interquick techtime.
References 1. Wickwise, N. .4., and Rentz, D.: Enamel Pretreatment: A Critical Variable in Direct Bonding Systems, Am. J. Orthod. 64: 499-512, 1973. 2. Buonocore, M. G.: A Simple Method of Increasing the Adhesion of Acrylic Filling Materials to Enamel Surfaces, J. Dent. Res. 34: 849-853, 1955. 3. Retief, D. H.: Effect of Conditioning the Enamel Surface With Phosphoric Acid, J. Dent. Res. 52: 333-341, 1973. 4. Retief, D. H., Dreyer, C. J., and Gavron, G.: The Direct Bonding of Orthodontic Attachments to Teeth by Means of an Epoxy Resin Adhesive, Am. J. Orthod. 58: 21-40, 1970. 5. Sheykholeslam, Z., and Buonocore, M. G.: Bonding of Resins to Phosphoric Acid Etched Enamel Surfaces of Permanent and Deciduous Teeth, J. Dent. Res. 51: 1572-1576, 1972. 6. Poole, D. F. G., and Johnson, N.: The Effect of Different Demineralizing Agents on Human Enamel Surfaces. Studies by Scanning Electron Microscopy, Arch. Oral Biol. 12: 1621-1634, 1967. 7. Lee, B. D., Phillips, R. W., and Swartz, M. L.: The Influence of Phosphoric Acid Etching on Retention of Acrylic Polymer for Dental Restorations, J. Am. Dent. Assoc. 82: 13811386, 1971. 8. Council on Dental Materials and Devices: Claims Related to Adhesion or to Adhesive Restorative Materials, J. Am. Dent. Assoc. 88: 393-394, 1974. 9. Swanson, I,. T., and Beck, J. F.: Faetors Affecting Bonding to Human Enamel With Special Reference to a Plastic Adhesive, J. Am. Dent. Assoc. 6I: 581-586, 1960. 10. Restodent: Incisal Edge Dental Restorative, Technical Bulletin No. 9090-1, South El Monte, Calif., Oct. 1, 1973, Lee Pharmaceuticals.
Volume 34 Number 5
Adhesive
for fixed
technique
partial
dentures
519
11. Rensch, J. A.: Direct Cementation of Orthodontic Brackets, Am. J. Orthod. 63: 156-160, 1973. 12. Buonocore, M. G., and Davila, J.: Restoration of Fractured Anterior Teeth With Ultraviolet Light Polymerized Bonding Materials: A New Technique, J. Am. Dent. Assoc. 86: 1349-1354, 1973. 13. Miura, F., Nakagawa, K., and Ishikazi, A.: Direct Bonding System in General Dentistry, J. Am. Dent. Assoc. 88: 360-366, 1974. 3820 PARK BLVD.,NO. 22 PALO ALTO,CALIF. 94306
ARTICLES TO APPEAR IN FUTURE ISSUES Open-cast
technique
Oscar N. Guerra,
Phonetic
for metal
M.S.P.H.,
molds
D.D.S.,
considerations
used in constructing
facial
prostheses
and Ken Canada
of chromium
alloy
palates
for complete
dentures
Carl A. Hansen, D.D.S.
Posterior
accessory
Carl W. Haveman,
The effect dontics
of tissue
C. M. Heartwell,
A practical restoration William
foramina
D.DS.,
of the human
mandible
and Hey1 G. Tebo, M.A., D.D.S.
resiliency
on occlusion
in complete
W. L. Kydd,
prostho-
Jr., D.D.S.
technique
for the fabrication
of a direct
pattern
E. Jacoby, Jr., D.D.S.
Bone-titanium
denture
implant D.D.S.,
response
and C. H. Daly,
to mechanical Ph.D.
stress
for a post-core
technique
for small
anterior
fixed
San Francisco,
Calif.
dentures
J. Ben Stolpa, D.D.S.* School of Dentistry, University
of California,
D
ental composite resins have opened new possibilities for esthetic prostheses. Such techniques are available for anterior restorations and tooth replacements without mechanical retention. The desirability of an adhesive restoration material is unquestionable, and past decades have seen reports of progress.1s ’ True adhesion of resin to tooth structure is still in question. The molecular forces exerted between two surfaces, such as Van der Waal’s, hydrogen, or polar forces, which are necessary in true adhesion, may exist in dental adhesives.3 Mechanical bonding on a microscopic scale has been demonstrated and accepted.*-? The current position on adhesion of the Council on Materials and Devices of the American Dental Association is that no data have yet been offered which unequivocally prove that a dental material adheres to tooth structure in a clinical setting.i, ’ The term ‘Ladhesive restorative material” could be accepted realizing its relative imprecision. It is thus used in this report. The retentive effect of the new adhesive restorative materials is primarily achieved by creating microscopic undercuts or irregularities in enamel prisms. These microscopic irregularities are produced by etching the surface of the enamel with an acid, generally 50 per cent phosphoric acid. The enamel rod dissolves in preference to the rod sheath and interrod substance, although the reverse also occurs.5, ’ The surface of the enamel must be clean and free of moisture.. ?, I” When the adhesive material is then applied, it will extend into the irregularities and undercuts with great precision. Fingers of resin of up to 50 p, exactly mirroring the etched enamel surface, have been reported in microscopy studies.” The enamel surface, available for the adhesive material, is increased as are the interlocking irregularities. Several currently available restorative systems claim adhesive qualities. Some of the proposed uses for adhesive materials include fracture repair, periodontal splints, restorations, crown cementation, space maintenance, temporary fixed partial dentures, densensitization, and orthodontic brackets.11-13 This report describes a technique for making a fixed partial denture of inter*Assistant Professor, Department of Oral Diagnosis. 513
514
J. l’rosthet. Dent. November, 1973
Stolpa
Fig. 1. The contoured wax. Fig. 2. The adapted
acrylic
resin teeth are held in place on the model with
foil reinforced
with
acrylic
hard baseplate
resin forms a matrix.
mediate length. There are advantages and disadvantages to conventional fixed or removable partial dentures. The dentist’s professional judgment must be exercised to optimize the treatment of his patients. In some patients with missing teeth, conventional appliances are either impossible or are too much of a compromise. Costs may be prohibitive. The patient may not be capable of accepting a large palatal or lingual appliance. The improvements in adhesive dental restorative materials offer possible alternatives; one may be the treatment of choice, not a less desirable option. TECHNIQUE The replacement of two maxillary central incisors will serve to describe the technique. (1) At the first visit, fabricate maxillary and mandibular working and study casts. (2) Select the shade, shape, and size of acrylic resin artificial tooth (or teeth) to approxrmately fit the space. Minor adjustments can be made during the fabrication of the fixed partial denture. (3) On the working model, contour and adjust the artificial teeth to fit the space mesiodistally, labiolingually, and gingivally. Also adjust the artificial teeth to avoid incisal edge-to-edge contact in eccentric movements (Fig. 1 1. Hand-held cast articulation will suffice. (4) Place the contoured artificial teeth on the cast in the desired position, and fix them in place by dripping hard baseplate wax on the lingual surfaces of the plastic teeth and the adjacent stone teeth. The wax should be of adequate thickness to resist displacement of the teeth when handling the cast. At this time, final adjustments to the teeth can be made. (5 i Burnish tinfoil (or aluminum foil) on the labial surfaces of the denture teeth and adjacent stone teeth. The foil should be burnished carefully, avoiding puncture
Fig. 3. Typical resin teeth.
Class III
cavity
preparations
are prepared
on the mesial surfaces of the acrylic
Fig. 4. Composite
resin has been placed to a slight excess into the Class III
Fig. 5. Class III
cavity
preparations
Fig. 6. The pontic seated in the matrix
have been prepared
cavity
preparations.
in the distal surfaces.
and placed on the stone model.
or tear into the interproximal depressions and carrying 1 to 2 mm. of foil around the incisal edges of the teeth (Fig. 2). (6) Paint autopolymerizing resin,* about 2 to 4 mm. thick, on the labial foil, providing support for the foil matrix. Paint a thin layer of autopolymerizing resin around the incisal edges of the teeth. Do not extend the acrylic resin too far gingivally past the necks of the teeth, as this would lock in the artificial teeth. (7) After the resin has polymerized, the entire matrix is removed by gentle prying labially and incisally. (8) Remove the artificial teeth from the baseplate wax, holding them in place on the cast. Form undercuts on the mesial surfaces of the artificial teeth, as for a Class III cavity preparation (Fig. 3). Minimize the reduction of labial surfaces to preserve the anatomy of the artificial teeth. Additionally, slight, shallow crosshatching and roughening of the mesial and lingual surfaces will increase the area available for the composite resin attachment. (9) Thoroughly clean the wax from the denture teeth by scraping and wiping with a suitable agent such as alcohol. Avoid touching the surfaces that will be covered by the composite resin. *Dura-Lay,
Reliance
Dental
Manufacturing
Company,
Chicago,
111.
516
Stoljxi
.I. l’rostbet. Lhll. November. 1975
Fig. 7. The rubber dam exposes the teeth on either side of the abutments. resin to the abutment teeth and Class III
Fig. 8. Apply a fresh mix of composite arations of the pontic.
cavity
prcp-
(IO) Place the denture teeth in the respective depressions in the matrix. Gently wipe and hand vibrate freshly mixed composite resin (slightly more than needed) into the cavity preparations and on the mesial surfaces of the two teeth (Fig. 4). After the material has polymerized, contour and shape the two-unit pontic. ( 11) Prepare typical Class III cavities in the distal surfaces of the artificial teeth (Fig. 5). Again, shallow crosshatching and roughening of the surfaces involved will improve retention. (12) Thoroughly clean the pontic, replace it in the matrix, and return it to the model (Fig. 6). (13) At the second appointment, polish the abutment teeth with pumice, and place a rubber dam. exposing the teeth from premolar to premolar. (14) With a medium disc or diamond, roughen the mesial surfaces of the lateral incisors. Also, slightly crosshatch the enamel with a No. f/2 round bur (Fig. 7) (15) Acid etch the lingual and mesial surfaces of the abutment teeth which are to be covered with the composite resin, and rinse them thoroughly, according to the directions of the manufacturer. Dry the teeth completely. Chloroform or another drying agent may be used. (16 1 Try the foil matrix with the denture teeth in place to confirm the fit and assure that there are no interferences with the rubber dam. i 17) Mix a large amount of composite resin. Place it in the distal Class III preparations of the pontic as it is lying in the matrix. Also, coat the mesial surfaces combination over the paof the lateral incisors (Fig. 8) Place the matrix-pontic tient’s own teeth (Fig. 9). (18) Hold the matrix in place for about five minutes: then, not disturbing it. leave it for another 10 to 15 minutes to allow the composite resin to polymerize. from the prosthesis by carefully prying it away. If (19) Remove the matrix necessary, additional composite material may be added at this time. (20) With discs. pointed diamonds, and finishing stones, trim and shape the contact areas and surfaces. The rubber dam will have prevented any excess resin from extruding gingivally (Fig. 10).
Volume 34 Number 5
Adhesive
Fig. 9. The matrix
is held firmly
technique
for
fixed
partial
dentures
517
in place for at least five minutes.
Fig. 10. There is no incisal interference
in the edge-to-edge
position.
(21) Check f o r incisal interferences in centric occlusion and in protrusive and lateral movements. Remove any interference. (22) Explain to the patient the precautions to be taken with and limitations of an intermediate fixed partial denture of this type. Caution against heavy incising is indicated, as this is strictly an esthetic replacement. The device is to be cleaned in the same manner as any fixed partial denture, and it should be evaluated periodically for replacement and repair. PATIENT
HISTORIES
Patient No. I. A 15-year-old high school student presented with missing maxillary central incisors, avulsed several months previously in a bicycle accident. The lateral incisors were unaffected and had no restorations. The occlusion was normal. The patient’s age and financial considerations precluded a standard fixed prosthesis. A temporary fixed partial denture with acrylic resin artificial teeth and an adhesive composite material bonded to the lateral incisors was fabricated. The prosthesis was observed periodically for eight months, at which time it was still serving satisfactorily. right Patient No. 2. A 20-year-old university student presented with a maxillary central incisor fractured apically to the crest of the alveolus. It had been restored with a dowel and core crown. The root was extracted. The left central maxillary incisor was missing. The dentition was otherwise normal, though the maxillary lateral incisors were crazed and slightly chipped. The patient preferred not to have either a conventional fixed or a removable partial denture. After discussion, a temporary fixed partial denture was fabricated with acrylic resin teeth and a composite resin adhesive material. The result was observed periodically for four months. DISCUSSION There are situations when the relative contraindications to the placement of traditionally preferable prostheses are sufficient to warrant alternative solutions. The technique of replacing two missing adjacent anterior teeth with a two-unit pontic is an alternative. Indications are the patient’s inability or unwillingness to
518
Stolpa
.J. l’rosthet. Dtwt. November. 1975
accept a conventional fixed partial denture or a removable prosthesis, continued exposure to potentially traumatic episodes, age, financial barriers, lack of time for repeat visits of long duration, and a desire to conserve tooth structure on the adjacent virgin teeth. The prime advantage of a fixed partial denture of this type is its esthetic contribution to the patient’s appearance when no other alternative exists. The main disadvantage is its lack of strength and function. If a break does occur, the strength of the bonds is such that the break can occur within the resin itself as well as at the interfaces with the tooth structure. I1 In either case, the damage is reparable with a minimum of difficulty. In the case of Patient No. 1, a soft-drink bottle was slammed into her fixed partial denture two weeks after initial placement. The device broke, shearing the composite material at the junction of the pontic with the two lateral incisors. Composite resin remained on both the lateral incisors and the pontic surfaces. The fixed partial denture was replaced by cleaning the surfaces involved, placing fresh composite resin on them, then placing the pontic back in its former position. The sheared surfaces bvere used as guides to replacement. Excess material was trimmed as before. SUMMARY
A technique for the fabrication of a resin anterior fixed partial denture of mediate length has been described. This type of device offers an inexpensive, treatment for selected patients with two adjacent missing anterior teeth. The nique allows the postponement of a definitive treatment to a more favorable The total treatment can be completed in two relatively short appointments.
interquick techtime.
References 1. Wickwise, N. .4., and Rentz, D.: Enamel Pretreatment: A Critical Variable in Direct Bonding Systems, Am. J. Orthod. 64: 499-512, 1973. 2. Buonocore, M. G.: A Simple Method of Increasing the Adhesion of Acrylic Filling Materials to Enamel Surfaces, J. Dent. Res. 34: 849-853, 1955. 3. Retief, D. H.: Effect of Conditioning the Enamel Surface With Phosphoric Acid, J. Dent. Res. 52: 333-341, 1973. 4. Retief, D. H., Dreyer, C. J., and Gavron, G.: The Direct Bonding of Orthodontic Attachments to Teeth by Means of an Epoxy Resin Adhesive, Am. J. Orthod. 58: 21-40, 1970. 5. Sheykholeslam, Z., and Buonocore, M. G.: Bonding of Resins to Phosphoric Acid Etched Enamel Surfaces of Permanent and Deciduous Teeth, J. Dent. Res. 51: 1572-1576, 1972. 6. Poole, D. F. G., and Johnson, N.: The Effect of Different Demineralizing Agents on Human Enamel Surfaces. Studies by Scanning Electron Microscopy, Arch. Oral Biol. 12: 1621-1634, 1967. 7. Lee, B. D., Phillips, R. W., and Swartz, M. L.: The Influence of Phosphoric Acid Etching on Retention of Acrylic Polymer for Dental Restorations, J. Am. Dent. Assoc. 82: 13811386, 1971. 8. Council on Dental Materials and Devices: Claims Related to Adhesion or to Adhesive Restorative Materials, J. Am. Dent. Assoc. 88: 393-394, 1974. 9. Swanson, I,. T., and Beck, J. F.: Faetors Affecting Bonding to Human Enamel With Special Reference to a Plastic Adhesive, J. Am. Dent. Assoc. 6I: 581-586, 1960. 10. Restodent: Incisal Edge Dental Restorative, Technical Bulletin No. 9090-1, South El Monte, Calif., Oct. 1, 1973, Lee Pharmaceuticals.
Volume 34 Number 5
Adhesive
for fixed
technique
partial
dentures
519
11. Rensch, J. A.: Direct Cementation of Orthodontic Brackets, Am. J. Orthod. 63: 156-160, 1973. 12. Buonocore, M. G., and Davila, J.: Restoration of Fractured Anterior Teeth With Ultraviolet Light Polymerized Bonding Materials: A New Technique, J. Am. Dent. Assoc. 86: 1349-1354, 1973. 13. Miura, F., Nakagawa, K., and Ishikazi, A.: Direct Bonding System in General Dentistry, J. Am. Dent. Assoc. 88: 360-366, 1974. 3820 PARK BLVD.,NO. 22 PALO ALTO,CALIF. 94306
ARTICLES TO APPEAR IN FUTURE ISSUES Open-cast
technique
Oscar N. Guerra,
Phonetic
for metal
M.S.P.H.,
molds
D.D.S.,
considerations
used in constructing
facial
prostheses
and Ken Canada
of chromium
alloy
palates
for complete
dentures
Carl A. Hansen, D.D.S.
Posterior
accessory
Carl W. Haveman,
The effect dontics
of tissue
C. M. Heartwell,
A practical restoration William
foramina
D.DS.,
of the human
mandible
and Hey1 G. Tebo, M.A., D.D.S.
resiliency
on occlusion
in complete
W. L. Kydd,
prostho-
Jr., D.D.S.
technique
for the fabrication
of a direct
pattern
E. Jacoby, Jr., D.D.S.
Bone-titanium
denture
implant D.D.S.,
response
and C. H. Daly,
to mechanical Ph.D.
stress
for a post-core
