]MINISTERUL SNTII AL REPUBLICII MOLDOVA UNIVERSITATEA DE STAT DE MEDICIN I FARMACIE NICOLAE TESTEMIANU

MINISTERUL SNTII AL REPUBLICII MOLDOVA UNIVERSITATEA DE STAT DE MEDICIN I FARMACIE NICOLAE TESTEMIANU Facultatea Stomatologie Catedra stomatologie ortopedic, chirurgie OMF i implantologie oral

Alexandru POSTOLACHI

Alexandru POSTOLACHI

RESTAURAREA ARHITECTONICII SUPRAFEELOR OCLU ALE ALE DINILOR LATERALI

!Re"#$andare $e%#d&"'(

RESTAURAREA ARHITECTONICII SUPRAFEELOR OCLU ALE ALE DINILOR LATERALI

!Re"#$andare $e%#d&"'(

CHIINU )*+)

CHIINU Cen%rul Ed&%#r&al,P#l&-ra.&" Medicina )*+)

CZU 616.314-089.23(076.5) P 87 Aprobat de Consi i! "etodi# Centra U$"% Nicolae Testemianu, pro#es-&erba nr. 4 din 12. 02. 2012 Au%#r/ Alexandru Postolachi dr. 'n (edi#in)* #on+eren,iar !ni&ersitar* Catedra sto(ato o-ie ortopedi#)* #.ir!r-ie /"% 0i i(p anto o-ie Re"en0en1&/ V. Burlacu 0e+ Catedr) sto(ato o-ie terape!ti#) %P"* dr. (ed.* pro+esor !ni&ersitar* U$"% Nicolae Testemianu P. Gnatiuc 1 dire#tor a C ini#ii $to(ato o-i#e a U$"% Nicolae Testemitanu, dr. (ed.* #on+eren,iar !ni&ersitar* Catedra sto(ato o-ie terape!ti#) Reda"%#r/ Lidia Cssa Ma"2e%are "#$3u%er&0a%'/ Maria Matei
DESCRIEREA CIP A CAMEREI NAIONALE A CRII P#4%#la"2&5 Alexandru 7esta!rarea ar.ite#toni#ii s!pra+e,e or o# !8a e a e din,i or atera i9 (7e#o(andare (etodi#)) : A e;andr! Posto a#.i9 Uni&. de $tat de "edi#in) 0i %ar(a#ie Nicolae Testemianu, %a#. $to(ato o-ie* Catedra sto(atoo-ie ortopedi#)* #.ir!r-ie /"% 0i i(p anto o-ie ora ). 1 C..9 Medicina, 2012. 1 57 p. 3ib io-r.9 p. 55-57 (54 tit). 1 50 e;. 2$34 978-9975-113-33-5. 616.314-089.23(076.5) P 87.

INTRODUCERE
U ti(a -enera,ie de (ateria e #o(po8ite resta!rati&e 0i siste(e ade8i&e a! dat do&ad) de o (are e+i#a#itate # ini#)* resta!r<nd di+erite &ariet),i de e8i!ni a e ,es!t!ri or d!re dentare. C! a=!tor! or a de&enit posibi ) resta!rarea #o(p et) a (or+o o-iei 0i +!n#,iei din,i or e8a,i pe o !n-) perioad) de ti(p. A#este (ateria e restabi es# #ara#teristi#i e esteti#e a e ,es!t!ri or d!re e8ate* #are apar s!b in+ !en,a di+eritor +a#tori etio o-i#i. >atorit) propriet),i or sa e !ni#e* !ti i8area or este #onsiderat) drept a ternati&) a (etodei tradi,iona e de trata(ent proteti#* d!p) #!( a +ost de(onstrat a 'n#ep!t! ani or 90 ai se#o ! !i tre#!t de #)tre ". ?i#.(an (1993). >ar* +iind a#!( !ne e dintre #e e (ai pop!are tip!ri de (ateria e resta!rati&e* para e pot pro&o#a 0i di&erse di+i#! t),i 'n resta!rarea din,i or atera i* da#) n! s!nt !ti i8ate d!p) (enirea or. (@o++e A.* 2002B CDEFGFHI A. J.* 2005B KLMENOI J. P. 0i a .* 2006). Con+or( date or !i Q. 2. 7o-o8.niRo& 0i a . (2002)* (! te obt!ra,ii s!nt adesea ne#a itati&e* +apt #on+ir(at prin e;a(en! # ini# 'n 49*9S din #a8!ri 0i radio-ra+i# 'n 79*8S din #a8!ri. Qrad! de #ontra#,ie a #o(po8ite or po i(eri8abi e a e -enera,ii or anterioare se (a=orea8) 'n dependen,) de #re0terea s!pra+e,ei de obt!ra,ie* #are de (! te ori se so dea8) #! +or(area (i#ro+is!ri or 0i de8&o tarea #arii or se#!ndare* pre#!( 0i #! +ra#t!rarea obt!ra,ii or 0i de8&o tarea a tor #o(p i#a,ii* 'n spe#ia (i-rarea dinti or. Tn a#e a0i ti(p* A. 3 o.ina (2012) a #onstatat #) re#onstr!#,ia tridi(ensiona ) a din,i or atera i #! e8i!ni e odonta e #oronare este o sit!a,ie tipi# # ini#) 'nt< nit) 'n pra#ti#a sto(ato o-i#). Ast+e * de&ine di+i#i de a (oti&a pa#ient! !i ne#esitatea restabi irii (or+o o-iei #oronare a din,i or atera i prin (etode indire#te ortopedi#e* #!( ar +i in aU-!ri #era(i#e sa! #o(po8ite. >a#) ()s!ri e !ti e n! s!nt e+e#t!ate a ti(p* apar #o(p i#a,ii (or+o o-i#e 0i +!n#,iona e9 (i-r)ri dento-a &eo are* ins!+i#ien,a s!praso i#it)rii (!0#.i or (asti#atori* (odi+i#)ri a e s!pra+e,e or o# !8a e din #a!8a de+or(arii ar#ade or dentare. 7esta!rarea dentar) #! dere- )ri par,ia e sa! tota e (or+o o-i#e* #ara#teristi#e pentr! -r!p! dat de din,i* pre8int) di+i#! t),i se(ni+i#ati&e. Tn iterat!ra (odern) 0tiin,i+i#) n! s!nt e&iden,iate s!+i#ient prob e(e e (ode )rii s!pra+e,e or o# !8a e a e din,i or atera i prin (etoda dire#t) 0i 'n pra#ti#) deseori s!nt ap i#ate int!iti&* dar (etode e prop!se di+er) prin i(p e(entarea # ini#) 'n s#op! re8o &arii prob e(ei respe#ti&e 0i a #onse#!ti&it),ii ei. >in a#este p!n#te de &edere* '0i (en,in a#t!-

2$34 978-9975-113-33-5

5 C6P Medicina, 2012 5 A.Posto a#.i* 2012

a itatea sa i(a-inea (or+o-ene8ei dinti or. 3a8<nd!-se pe !n 0ir de ipote8e* teorii 0i re8! tate a e an!(itor #er#et)ri 'n do(eni! (or+o-ene8ei din,i or 'n +i o-ene8) 0i onto-ene8)* V.". Vo(ia0.&i i 0i a ,ii (2004* 2006) prop!n !ti i8area (or+o o-iei #anin! !i #a o an!(it) !nitate de ()s!r) pentr! a da dinte !i o propor,iona itate* #a !n 'ntre- 0i p)r,ia #o(ponent a #ara#teristi#i or anato(i#e. Ap i#<nd di&erse a -orit(e 'n #onstr!#,ia (or+o o-iei #anin! !i* p!te( ob,ine di&erse &ariet),i #o(p e;e de +or(e de din,i orientate a pri(a +is!r) (#entra )). Uti i8<nd a#este teorii* A. W. WetRinRin (2001* 2002) a prop!s (etoda a##eptat) #! den!(irea de **3a8e e esteti#e a e (or+o-ene8ei **#are se a;ea8) pe e-i e +!nda(enta e a e bioni#ii 1 0tiin,) #are se o#!p) #! st!di! e-it),i or de ba8) 0i a prin#ipii or obie#te or or-ani#e 0i neor-ani#e 'n nat!r). A!tor! a e aborat !n a -orit( de #onstr!ire a !n!i siste( de #oordonate a e p!n#te or anato(i#e 0i inii or #e +or(ea8) #oroana dinte !i #a obie#t 'n propor,ii e de Xse#,i!ne de a!rX* #are per(ite pra#ti# dentist! !i (! t (ai pre#is s) restabi ieas#) (or+o o-ia anato(i#) a din,i or 'n ar#ada dentar) 0i per(ite asi-!rarea #ore#t) a raport! !i o# !8a 'ntre (a;i are. Tn po+ida +apt! !i #) 'n iterat!ra de spe#ia itate s!nt e !#idate aspe#te e re e&ante a e (ode )rii (resta!rarii) s!pra+e,e or o# !8a e a e din,i or atera i* r)(<n a#t!a e prob e(e e (ode )rii prin (etoda dire#t) din #a!8a (or+o o-iei or #o(p e;e* spe#i+i#! topo-ra+i# 'n #a&itatea ora ) 0i di+i#! tatea de a##es instr!(enta . Ana i8a re8! tate or e;a(en! !i # ini#* date or o# !8io-ra(e or 0i e&a !area date or bio(etri#e a e para(etri or* 'n ba8a (ode e or de dia-nosti# ob,in!te de a pa#ien,i 'n &<rst) de 18124 ani #! din,ii inta#,i 'n o# !8ie orto-nat)* a per(is s) stabi i( o serie de #ara#teristi#i str!#t!rae a e re ie+! !i o# !8a a din,i or atera i. Tn spe#ia * a#est !#r! este &aabi pentr! pri(ii (o ari ai (a;i are or s!perior 0i in+erior #are tind s) aib) re ie+!ri !ni#e* indi&id!a e de o# !8ie* #e e &a per(ite s) +or(e8e !n #onta#t opti( o# !8a #! din,ii anta-oni0ti. A&<nd 'n &edere #) #anin! este o X#.eie de ba8)X a siste(! !i sto(ato-nat* iar pre(o arii 1 -r!p! +!n#,iona orientat prin (or+o o-ia sa !ne0te e e(ente e #ara#teristi#e at<t (o ari or* #<t 0i #anini or* treb!ie s) se ia 'n #onsiderare #ara#teristi#i e or (or+o-anato(i#e 'n resta!r)ri e re ie+! !i s!pra+e,e or o# !8a e.

UNELE PARTICULARITI ANATOMICE ALE STRUCTURII DINILOR LATERALI

Premolarii superiori i inferiori

$!pra+a,a o# !8a ) a pre(o ari or s!periori este pre8entat) de pante e #!spi8i or &estib! ari 0i ora i. %or(at) din pante e #!spi8i or* #reasta on-it!dina ) se 'ndreapt) #)tre 0an,! inter#!spidian* i(itat din a(be e p)r,i de #reste e (ar-ina e* !nde pot +i (i#i #!spi8i s!p i(entari dintre #are* d!p) #!( (en,ionea8) !nii a!tori* #e dista se 'nt< ne0te (ai rar de#<t #e (e8ia . Tn opinia noastr)* a#e0ti #!spi8i pot +i #onsidera,i #a se(ne de (o ari8are a din,i or* iar* pe de a t) parte* dat +iind +apt! #) a#este se#toare a e s!pra+e,ei o# !8a e pre8int) 8one e de #onta#te o# !8a e #! anta-oni0tii* ei 'nt)res# #reste e (ar-ina e #ontra a#,i!nii +or,ei (asti#atorii !i". #$.

a b %i". #. 7e ie+! o# !8a a pre(o ari or s!periori.

%i". &. 7e ie+! o# !8a a dinte !i. 34.

>e a #!spid! &estib! ar a pri(! !i pre(o ar in+erior* pe s!pra+a,a o# !8a ) se 'ntinde #reasta de s(a , #are 'ntretaie +is!ra #e de i(itea8) a(bii #!spi8i +or(<nd do!) +osete9 (e8ia ) 0i dista ). >atorit) a#estei #reste* s!pra+a,a o# !8a ) a #oroanei n! este #on#a&). Uneori a#east) #reast) se 'ntrer!pe 0i #e e do!) +osete se !nes# 'ntr-!n 0an, !i". &$.

Va pre(o ar! doi 'n+erior #!spid! ora prin +is!ra in-!a ) este di&i8at 'n do!) p)r,i 1 (e8ia ) 0i dista ) (se(n! (o ari8)rii). >in a#est (oti&* #oroana !i este (ai (are de#<t a pri(! !i pre(o ar* iar +oseta dista ) 1 (ai e;pri(at). Tn) ,i(ea p)r,ii (e8ia e a #!spid! !i ora poate +i e-a ) #! #ea a #!spid! !i &estib! ar !i". '$.

Molarul doi superior

A+ar) de parti#! arit),i e de str!#t!r) #!nos#!te a e s!pra+e,ei (asti#atorii* pre8int) interes 0i #reasta ob i#) de s(a , #are este (ai p!,in e;pri(at) de#<t a pri(! (o ar 0i 'ntotdea!na interse#t) +is!ra #entra ) !i". )$.

%i".'. 7e ie+! o# !8a a din,i or 44* 45.

%i". ). 7e ie+! o# !8a a dinte !i 17.

Primul molar superior

$t!di! s!pra+e,ei o# !8a e a e&iden,iat &ariabi itatea ()ri(ii #!spi8i or 0i 'n spe#ia a #e !i pa atina dista . >a#) &o( !ni printr-o inie i(a-inar) #ei trei #!spi8i prin#ipa i 1 doi &estib! ari #! #e pa atina (e8ia * &o( ob,ine !n tri!n-.i #! &<r+! orientat spre ora . C!spi8ii s!nt separa,i prin +is!ri #! !n #ara#ter &ariabi a desen! !i. >esen! tipi# a +is!rii (e8ia e 0i dista e #oresp!nde aran=)rii ob i#e a iterei YZ[ #! +is!ra trans&ersa ) &ariabi ). Un p!n#t de reper anato(i#-Y#.eie[* i(portant 'n resta!rarea reie+! !i o# !8a * 'n opinia noastr)* este &a ! de s(a , 1 Y#reasta ob i#)[ #are '(parte #oroana 'n do!) p)r,i. >!p) #!( s-a (en,ionat* Y#reasta ob i#)[ este +or(at) prin #ontopirea #reste or tri!n-.i! are dista e a e #!spi8i or &estib! ar-dista #! #e (e8ia -paatina . Tns) a#est +eno(en o# !8a #onst) 'n +apt! #) 8ona #restei de ba8) on-it!dina ) a #!spid! !i &estib! ar-dista se !ne0te #! %i". (. 7e ie+! o# !8a a #ea a #!spid! !i pa atina -(e8ia * ase()n)dinte !i 26. toare #! Y#easorni#! de nisip[ !i". ($.

Primul molar inferior

$-a #onstatat #) ()ri(ea 0i sit!area #e or #in#i #!spi8i (trei &estib! ari 0i doi in-!a i) se a+ ) 'n #ore are #! re ie+! +is!ri or #are a! +or(a se(n! !i Y\[. $e deosebes# +is!ri de #ate-orii e 2* 22* 222. %is!ri e de #ate-oria 2-a s!nt #e e inter#!spidiene 0i #e e (ai ad<n#i. %is!ri e de #ate-oria a 22-a s!nt (ai s!per+e#ia e 0i separ) obii #!spi8i or* iar #e e de #ate-oria a 222-a separ) #!spi8ii s!p i(entari. >e (en,ionat #) +is!ri e de #ate-oria 2 pot a #)t!i desene de di+erite +or(e* (ai +re#&ent 'nt< nite s!nt #e e 'n +or() de Y\[* Y][* Y^[. 1) >esen! Y\[ se +or(ea8) prin interse#,ia +is!ri or (e8iodista e 0i &estib! o- in-!a e #! #rearea !nei +osete sa! a !n!i #onta#t inter#!spidian !i". *$. 7e8! tate e st!di! !i e+e#t!at as!pra !n!i (ode a! de(onstrat #) a pre8en,a a#est!i desen #!spi8ii &estib! ari (e8ia 0i dista s!nt apro;i(ati& de o ()ri(e* iar #e disto-dista este sit!at (ai aproape de +is!ra #entra ). 2) >esen! Y][ se +or(ea8) prin interse#,ia +is!ri or (e8ia e 0i dista e #! #rearea +osetei anterioare #entra e* de a #are porne0te +is!ra 0i se pre !n-e0te p<n) a p!n#t! interse#,iei +is!ri or dista e #on#o(itent 0i in-!a e 1 +oseta #entra ) dista ). A( #onstatat #) a#est desen se +or-

(ea8) at!n#i* #<nd pe #!spid! in-!a (e8ia este bine e;pri(at) #reasta de s(a ,* #are se !ne0te #! #!spid! &estib! ar-dista printr-o +is!r) s#!rt)* se 'nt< ne0te #e (ai +re#&ent. Va !nirea prin inii a #!spi8i or &estib! ar-(e8ia * &estib! ar dista #! #e in-!a -(e8ia prin #reasta de s(a ,* se ob,ine !n tri!n-.i ase()n)tor #! #e a pri(! !i (o ar s!perior 'n #are o at!r) tre#e a +e prin #reasta Yob i#)[de s(a ,. A#est tip de desen asi-!r) !n #onta#t o# !8a opti(a 0i stabi 'ntre pri(ii (o ari !i". +$.

./0. ,. K__L`aFNHHbc DaNd efg (F_E) aDhI 37

./0. -. K__L`aFNHHbc DaNd e\g (jL`E) aDhI 37

Molarul trei superior i inferior

4!()r! #!spi8i or este &ariabi * +apt #e in+ !en,ea8) 0i re ie+! o# !8a . A#easta se e;p i#) prin +eno(en! de red!#ere a din,i or (en,iona,i. 7e8! tate e in&esti-a,ii or #e se re+er) a parti#! arit),i e de str!#t!r) a e s!pra+e,ei o# !8a e a din,i or atera i 'n o# !8ia orto-nati#) a! stat a ba8a e abor)rii !nei &ariante noi a te.ni#ii de resta!rare a a#estei str!#t!ri. 6sen,a &ariantei date #onst) 'n (ode area #!spi8i or 0i ar.ite#t!rii o# !8a e prin (etoda Yp i#! !i[ (Certi+i#at de ino&ator nr. 4448 din 31.07.2006* e iberat de U$"% Y4i#o ae ieste(i,an![)* #<nd re#onstr!irea are o# prin restabi irea #onse#!ti&) a #!spi8i or op!0i. Tn s#op! reai8)rii a#estei te.ni#i noi* este ne#esar de a !a 'n #onsiderare !r()toaree do!) sit!a,ii # ini#e9 a) e8area s!pra+e,ei o# !8a e #! p)strarea !n!i sa! (ai (! tor #!spi8iB b) e8area tota ) a re ie+! !i o# !8a . 7ea i8area te.ni#ii e aborate pre&ede respe#tarea etape or #onse#!ti&e de resta!rare 'n +!n#,ie de sit!a,ii e # ini#e indi#ate. 7esta!rarea s!pra+e,ei o# !8a e a p)strarea !n!i sa! (ai (! tor #!spi8i s-a e+e#t!at !ti i8<nd!-se #o(po8ite e +otopo i(eri8abi e (i#ro.ibride 0i #ondensabi e9 Y%i teR P 60[* Y%i teR Z 250[* YPoint 4[. METODA DE RESTAURARE DIRECT A MOLARILOR 6PE SECTOARE7 Prob e(a resta!r)rii dire#te a (or+o o-iei #oronare 'n e8i!ni e 'ntinse #arioase a e din,i or atera i 0i-a p)strat a#t!a itatea p<n) 'n pre8ent. Una dintre #e e (ai #o(p i#ate etape 'n te.ni#a de obt!rare a #a&it),i or de # . 22 3 a#R este #rearea p!n#te or de #onta#t #! adaptarea

%i". *. >esen! o# !8a Y\[ (p !s) a dinte !i 36.

%i". +. >esen! o# !8a Y][ a dinte !i 36.

3) >esen! Y^[ se +or(ea8) prin interse#,ia +is!ri or (e8ia e 0i in-!a e #! #rearea +osetei #entra e anterioare* iar prin !nirea +is!rii &estib! are 0i dista e se #reea8) +oseta #entra ) dista ). 2n&esti-a,ii e a! ar)tat #) pentr! a #rea !n #onta#t o# !8a opti( a (ode area re ie+! !i o# !8a a pri(! !i (o ar in+erior este ne#esar de a se ,ine #ont 0i de &arietatea desen! !i o# !8a . A0adar* #e e trei &ariante de topo-ra+ie a #restei ob i#e se a+ ) 'ntr-o dependen,) rer#ipro#) #! tip! desen! !i o# !8a a pri(! !i (o ar in+erior* +apt #e asi-!r) 'n +ie#are #a8 re a,ii intero# !8a e opti(e.

Molarul doi inferior

6ste #!nos#!t #) (o ar! doi in+erior in# !de !n n!()r (are de +or(e a e s!pra+e,ei o# !8a e. >a#) 'n #a&itatea b!#a ) s!nt to,i #in#i #!spi8i* (ai +re#&ent este s!p!s red!#erii #!spid! dista 0i +or(a #oroanei este ase()n)toare !n!i drept!n-.i. %is!ri e s!pra+e,ei o# !8a e pe #ea (ai +re#&ent 'nt< nit) #oroan) #! patr! #!spi8i +or(ea8) desen! Y\[ sa! Y^[. Pentr! #oroana #! trei #!spi8i este #ara#teristi# desen! Y][ !i". ,, -$.

(ar-ina ) opti() 'n 8ona #o et! !i* deoare#e ! ti(a se #onsider) Y8on) de ris#[ 'n resta!r)ri e dire#te. A#easta* 'n pri(! r<nd* se re+er) a te.ni#a de +or(are a p!n#t! !i de #onta#t. >atorit) parti#! arit),i or de str!#t!r) anato(i#) a s!pra+e,e or o# !8a e* d!p) +or(area #a&it),ii 0i ad(inistrarea #o(po8it! !i* !r(ea8) #ondensarea (ateria ! !i* #are este di+i#i ) din #a!8a absen,ei s!port! !i de spri=in a instr!(ent! !i din partea op!s) a p!n#t! !i de #onta#t. >in a#est (oti&* p!n#t! de #onta#t n! poate +i #ont!rat 0i (ode at 'n #on#ordan,) #! parti#! arit),ie indi&id!a e a e #e or doi din,i &e#ini. / a t) parti#! aritate de obt!rare a #a&it),i or de # . 22 3 a#R #onst) 'n a#eea #)* datorit) te.ni#ii ane&oioase de #ondensare a (ateria ! !i obt!rator* n! se asi-!r) !n #onta#t #o(pa#t #! ,es!t!ri e dentare (ar-ina e a e #a&it),ii. "i#roper(eabi itatea ! terioar) 'n a#east) 8on) se #onsider) !na dintre #a!8e e prin#ipae a e #ariei se#!ndare* .ipersensibi it),ii ,es!t!ri or dentare a a#,i!nea di+eritor e;#itan,i* desprinderea obt!ra,iei (resta!ta,iei) 0i a tor #o(p i#a,ii.

# d %i". #1 a, 2, c ,d $. 6;e(p e de restabi ire in#ore#t) a s!pra+e,ei o# !8iona e a (o ari or d!p) (etoda dire#t) (a *b) 0i (etoda atera ) (#* d).

A#este obie#ti&e a! stat a ba8a e abor)rii (etodei de obt!rare #! #rearea p!n#t! !i de #onta#t +!n#,iona #a itati&. Tn prea abi * pe (ode! -+anto() a! +ost (ode ate sit!a,ii e # ini#e #! #rearea #a&ita,i or "/* >/* "/>* pe #are s-a! st!diat (ai (! te &ariante de asi-!rare a #ondens)rii (ateria ! !i de obt!rare* restabi irea pere,i or pro;i(a i #! #rearea p!n#te or de #onta#t 0i (ode area s!pra+e,ei o# !8a e. Tn a0a (od* 'n e8i!ni e #oronare 'ntinse 'n s!pra+a,) 0i pro+!n8i(e* #<nd #a&itatea este e;tins) p<n) a ori+i#ii e #ana e or radi#! are* #e #o(p i#) !ti i8area (ateria e or #o(po8ite #! po i(eri8are dire#,ionat)* a +ost e aborat) (etoda de resta!rare Ype se#toare[ (Certi+i#at de ino&ator nr. 4441 din 30.06.2006* e iberat de U$"% Y4i#o ae ieste(i,an![). Tn ase(enea sit!a,ii # ini#e* noi a( +o osit #o(binarea #o(po8it! !i + !id Y7e&o !tion[ (kerr) #! #e de '(pa#.etare Y%i teR P-60[ (3" 6$P6). Prin#ipi! Yse#toria [ pre&ede di&i8area s!pra+e,ei o# !8a e 'n se#toare prin #rearea pere,i or &erti#a i 'n dire#,ie &estib! o-ora )* 'n +!n#,ie de sit!a,ia # ini#). Tn pre8en,a #a&it),i or "/ sa! >/* se &a (ode a !n perete &erti#a * di&i8<nd ast+e #a&itatea preparat) de pe s!pra+a,a o# !8a ) 'n do!) Yse#,ii[* iar 'n pre8en,a #a&it),ii "/> 1 doi pere,i &erti#a i sit!a,i a ni&e ! #!spi8i or in-!a i* #are '(part s!pra+a,a o# !8a ) 'n trei Yse#,ii[ !i". ##$. W. 4. / eso&a 0i #oat. (2006) re(ar#) #) date e statisti#e (ani+est) despre !ti i8area prioritar) 'n pre8ent a (etodei de p o(bare #! #o(po8ite 0i #on#o(itent despre !n n!()r (are de re8! tate nesatis+)#)toare. >!p) #!( #o(!ni#) 6.W. 3oro&sRii (2001)* #er#etarea e+e#t!at) de e a de(onstrat #) peste 3 ani d!p) p o(barea din,i or #ota #o(p i#a,ii or s!b +or() de p! pite 0i periodontite a #onstr!it 52*6S. Con+or( date or #er#et)tori or A. 2. 4i#o ae& 0i V. ".lepo&a (1999)* peste 2 ani d!p) tratarea din,i or* a+e#ta,i de #arie* prin (etoda p o(b)rii ##a 70S de p o(be e;a(inate* indi+erent de (ateria ! +o osit* n! #oresp!ndea! #erin,e or # ini#e ne#esare (adia#en,a (ar-ina ) #a itati&)* restabi irea +or(ei anato(i#e 0i p!n#t! !i de #onta#t interdentar* ipsa #ariei re#idi&e). Tn 44*5S din #a8!ri ipsea p!n#t! de #ontro interdentar* s-a (ar#at pre8en,a (ar-inii at<rnate a p o(bei 'n re-i!nea dentar) 'n !r(a !ti i8)rii in#ore#te a (atri#ei sa! a restabi irii pro;i(a e a s!pra+e,ei +)r) +o osirea ei. Una dintre #e e (ai #o(p i#ate etape a e p o(b)rii #a&it),i or de # asa a 22-a este #rearea p!n#te or de #onta#t 0i adaptarea (ar-ina ) b!n) a (ateria ! !i a perete e #a&it),ii #arioase* deoare#e re-i!nea dat) este pri&it) #a !na de ris# (a=or pentr! tip! dire#t de resta!rare.

10

11

%i". ##. 6tape e # ini#e de resta!rare dire#t) a dinte !i 46 prin (etoda Ype se#toare[.

Tn opinia !i $. >e iperi 0i #oa!t. (2005)* resta!rarea din,i or ne&ita i #! str!#t!r) s )bit) repre8int) !na dintre #e e (ai #o(p i#ate prob e(e pentr! (edi#! -sto(ato o- . Tn e-)t!r) #! a#est +apt* r)(<ne a#t!a ) #)!tarea 'n #ontin!are a #)i or #e ar asi-!ra inte-rarea (ateria !!i de resta!rare 'n tota (ente a p)r,ii #oronare a dinte !i. Para e #! a#easta* 'n #a8 de distr!-ere a s!pra+e,ei o# !8iona e* apar di+i#! t),i 'n rea i8area #ondens)rii #a itati&e a (ateria ! !i de p o(bare* +apt #e este !na dintre #ondi,ii e prin#ipa e #are asi-!r) n! doar '(b!n)t),irea ad-e8iei #)tre ,es!t!ri e dinte !i* dar 0i ob,inera resta!r)rii o(o-ene d!p) densitate. Tndep inirea a#estei #ondi,ii #ontrib!ie a #ontrap!nerea str!#t!rii #o(binate Y resta!rare-dinte m sar#ini or +!n#,iona e pe #are e s!port) din,ii atera i.

>!p) (ode area pere,i or &erti#a i* a +ost insta at siste(! de (atri#e* apoi pe p an0e! 0i pere,ii #a&it),ii s-a ap i#at #o(po8it + !id sa! #o(po(er* pentr! i#.idarea (i#ropori or de pe p an0e!* +or(area strat! !i Yadapti&[ 0i a +or(ei o&a e a #a&it),ii. Tn #ontin!are* s-a (ode at perete e pro;i(a -dista 0i p!n#t! de #onta#t #on+or( (etodei Ys+erei prepo i(eri8ate[ sa! #! a=!tor! !n!i #o(posit de '(pa#.etare* de e;e(p ! Y%i teR P-60[. Ast+e se (ode ea8) 0i perete e pro;i(a -(e8ia * iar* 'n +ina * 0i #a&itatea #entra ). >!p) (ode area pe strat!ri a #a&it),ii #entra e* se restabi e0te s!pra+a,a o# !8a ) tota ) #on+or( (etodei Yp i#! !i[ #on#o(itent #! e&iden,a desen! !i o# !8a . A0adar* a#east) &ariant) de resta!rare* 'n pre8en,a #a&it),i or "/>* are !r()toare e a&anta=e9 (ode area pere,i or &erti#a i #ond!#e a (a=orarea s!pra+e,ei de #onta#t a (ateria ! !i #o(po8it #! pere,ii #a&it),iiB 'n #a&itatea #! (! ,i pere,i se red!#e re8e ien,a (ateria ! !i #o(po8it* adi#) Ys#!r-erea !i 'n dire#,ia pere,i or de=a antrena,i* #are #o(pensea8) tensi!nea )!ntri#)[B i !(inarea transdenta ) red!#e intensitatea !(inii d!p) str)baterea ei de #)tre ,es!t!ri e dentare* 0i* #a !r(are* are o# Yso+t-start[* a0a-n!(it! Ystart (oa e[ sa! po i(eri8area #e per(ite (i#0orarea #ontra#,iei 0i tensi!nii )!ntri#e 'n resta!ra,ieB per(ite e+e#t!area #ore#t) a po i(eri8)rii diri=ate a #o(po8it! !i. >!p) #!( s-a (en,ionat* #rearea #a&it),i or s+eri#e (! t (ai p!,in in+ !en,ea8) stabi itatea dinte !i a s!praso i#itarea (asti#atorie de stres* di(in!<nd -rad! de #on#entrare a tensi!ni or )!ntri#e 'n dinte a !tii8area +re8e or s+eri#e. Tn #adr! (ode )rii #! (ateria resta!rati& a Yse#,ii or[ separate* e ne#esar s) +or()( #ont!r!ri e )!ntri#e ase()n)toare s+erei* #e* d!p) p)rerea noastr)* asi-!r) resta!ra,iei 0i dinte !i o bio(e#ani#) opti() a presi!ni e (asti#atorii. 89HNICA DE RESTAURARE DIRECT A RELIEFULUI OCLU AL :L DINILOR LATERALI

Etapele de modelare a suprafeei ocluzale a primului molar superior

Tn #adr! (ode )rii #ore#te a ar.ite#t!rii #o(p i#ate a s!pra+e,ei o# !8a e a (o ari or* 'n spe#ia prin (etoda dire#t)* este i(portant de a

12

13

+o osi #riterii obie#ti&e s!p i(entare (+oto-ra+ii* s#.e(e* (ode e de st!di! din s!per-.ips* (! a=e). 6tape e de (ode are a s!pra+e,ei o# !8a e s!nt !r()toare e9 +; 2ni,ia * se deter(in) re a,ii e o# !8a e inter(a;i are* -rad! de e8are a s!pra+e,ei o# !8a e 0i se apre#iea8) parti#! aritatea Y#restei ob i#e[ pe dinte e op!s. ); 6&a !area pre i(inar) a #onta#te or o# !8a e restante #! .<rtie de arti#! a,ie Y3an-.[ 0i s#.i,area #ont!r! !i &iitoarei resta!ra,ii. <; Apre#ierea #! orii &iitoarei resta!ra,ii. =; "ode area #!spi8i or &estib! ar-(e8ia 0i &estib! ar-dista !i". #& a, 2, c$. >; "ode area #!spid! !i (e8ia pa atina 0i a #restei ob i#e !i". #& d, e$. ?; "ode area pante or ora e a e #!spid! !i &estib! ar-(e8ia 0i #rearea +is!rii (e8ia e 0i +osetei #entra e anterioare !i".#&. !$. @; "ode area #!spid! !i dista pa atina #! #rearea +is!rii dista e* #are &aria8) d!p) ad<n#i(e 0i !n-i(e 0i poate 'ntret)ia toat) s!pra+a,a o# !8a ) !i".#& ", h$.
333333333333333333 45ac6 cor7ul se a!l6 su2 in!luena !orelor externe, atunci se s7une c6 el este n stare de tonicitate.

%i". #&. 6tape e de (ode are a s!pra+e,ei o# !8a e a dite !i 26 #! e8area tota ) a re ie+! !i o# !8a (s#.e(a).

A#este etape asi-!r) re+a#erea #onse#!ti&) a ar.ite#t!rii o# !8a e d!p) (etoda Yp i#! !i[ (Certi+i#at de ino&ator nr. 4448 din 31.07.2006* e iberat de U$"% Y4i#o ae ieste(i,an![) pre8entate prin #a8 # ini# !i". #' a, 2, c, d$.

a a b #

# d %i". #'. 6tape e # ini#e de resta!rare dire#t) a dinte !i 26. Ca&itate preparat) 'n dinte e 26 1 (a)B (ode area #restei Yob i#e[ 1 (b)B (ode area #!spi8i or 1 (#)B dinte e 26 resta!rat 1 (d).

14

15

Etapele de restaurare a suprafeei ocluzale lezate total a coroanei primului molar inferior cu arietatea tipuluil desenului arhitectonic
>!p) #!( s-a atras aten,ia anterior* re ie+! o# !8a a pri(! !i (oar in+erior pre8int) o ar.ite#t!r) &ariat) 0i siste(ati8at) 'n trei tip!ri de desen9 Y\[* Y][* Y^[. >in a#este #onsiderente* pre8int) interes te.ni#a de restabi ire a re ie+! !i o# !8a a a#est!i dinte* ,in<nd #ont de tip! desen! !i ar.ite#toni#* #are* 'n opinia noastr)* asi-!r) +!n#,iona itatea o# !8a ) opti(). A0adar* 'nainte de a 'n#epe (ode area s!pra+e,ei o# !8a e* este ne#esar de a !a 'n #onsiderare n! n!(ai absen,a re ie+! !i a#estei str!#t!ri* dar 0i +ost! tip a desen! !i ar.ite#toni#* #are se deter(in) d!p) dinte e de pe .e(iar#ada op!s). Tn #a8 de e8are sa! 'n ipsa a#est!i dinte* tip! de desen o# !8a &a +i stabi it de #)tre (edi# 'n ba8) parti#! arit),i or de o# !8ie 0i a str!#t!rii s!pra+e,ei o# !8a e a (o ar! !i anta-onist. Va a#east) etap)* e ne#esar de a deter(ina o#! de proie#tare a #onta#t! !i o# !8a a #!spid! !i pa atina (e8ia a a#est!i dinte pe s!pra+a,a o# !8a ) a pri(! !i (o ar in+erior. Tn ase(enea sit!a,ie # ini#)* noi re#o(and)( e+e#t!area re#onstr!irii s!pra+e,ei o# !8a e #! desen! Y\[* #a #e (ai si(p !. Con+or( nor(ei* a#est desen se #ara#teri8ea8) prin pre8en,a !nei +osete #entra e #! #are &ine 'n #onta#t 'n o# !8ia #entri#) #!spid! (e8ia in-!a a anta-onist! !i s!perior* +or(<nd #onta#t o# !8a +!n#,iona .Tn #a8! 'n #are dinte e de pe .e(iar#ada dentar) op!s) este pre8ent 0i pe s!pra+a,a o# !8a ) se deter(in) tip! de desen Y][ sa! Y^[* se ,ine #ont de +apt! #) pentr! ase(enea desene este #ara#teristi#) pre8en,a +osetei #entra e anterioare 0i dista e. Prin !r(are* o#! #onta#t! !i o# !8a #reat de #!spid! (e8ia in-!a poate ser&i #a p!n#t de reper a restabi irea opti() a s!pra+e,ei o# !8a e e8ate a pri(! !i (o ar in+erior. A#easta &a per(ite #rearea #onta#te or o# !8a e inter#!spidiene 0i a re a,ii or intero# !8a e (ai pre#ise* pre#!( 0i a e-erea p an! !i indi&id!a de trata(ent resta!rati&. Prin !r(are* 'n +!n#,ie de &arietatea desen! !i* &o( !a 'n #onsiderare parti#! arit),i e (ode )rii. Va bio(etria (ode e or de dia-nosti#* a +e stabi i( pre8en,a sa! ipsa (i-r)ri or dentare 0i a #ara#ter! !i de a#operire a din,i or in+eriori de #ei s!periori 'n 8ona +ronta ). U terior* se &or e+e#t!a !r(atoare e etape de (ode are #! restabi area tip! !i de desen o# !8a d!p) (etoda Yp i#! !i[9

+. $t!di! re a,ii or intero# !8a e* a re ie+! !i o# !8a 0i deter(inarea tip! !i de desen a pri(i or (o ari in+eriori. ); Apre#ierea #! orii resta!ra,iei &iitoare. <; Constr!irea e e(ente or de spri=in a #oroanei #! por,i!ni separate de (ateria resta!rati& #! trans+or(area de+e#t! !i 'n de+e#t! "/> ((e8io-o# !8io-dista ). =. irans+or(area de+e#t! !i "/> 'n de+e#t! "/ ((e8io-o# !8a ) #! #rearea #onta#t! !i pro;i(a dista . 2nsta area (atri#ei se#toria e 0i a pene or interdentare #! #rearea #onta#t! !i pro;i(a dista . P!n#te e de #onta#t a e din,i or atera i s!nt sit!ate (ai aproape de s!pra+e,e e &estib! are* iar s!pra+e,e e pro;i(a e* in-!a e s!nt orientate spre ora . Pentr! #rearea #ore#t) a p!n#t! !i de #onta#t* e ne#esar #a pene e s) +ie insta ate din partea &estib! ar). Tn pro#es! !ti i8)rii siste(e or de (atri#e #are per(it restabi rea a(be or #onta#te pro;i(a e* de+e#t! "/> se trans+or() dire#t 'n de+e#t! / (siste(! de (atri#e io++ e(aier* "a;i(at* et#.). >. irans+or(area de+e#t! !i "/ 'n de+e#t! / (o# !8a ). 2nsta area (atri#ei se#,iona e* a penei interdentare 0i #rearea #onta#t! !i pro;i(a (e8ia . ?. Va a#east) etap)* indi+erent de tip! desen! !i o# !8a * noi* 'n ba8a prin#ipii or de +or(are a #oroane or din,i or din (od! ! -odonto(er prop!s de V. ". Vo(ia0.&i i (2004)* 'n#epea( (ode area #! #!spid! &estib! ar dista #are o#!p) o po8i,ie #entra ) din partea &estib! ar)* stabi irea pre i(inar) a 'n) ,i(ii #oroanei d!p) dinte e de pe .e(iar#ada op!s) !i".#($. Tn ipsa dinte !i de pe .e(iar#ada op!s)* restabi irea 'n) ,i(ii #oronare 0i a #!spi8i or se e+e#t!ea8) #on+or( di(ensi!ni or respe#ti&e (edii. %or(area i(itei (e8ia e a s!pra+e,ei &estib! are a a#est!i #!spid se e+e#t!ea8) a distan,a 'n (edie de 5 (( de a !n-.i! (e8ia a #oroanei #! o 'n# inare spre ora * )s<nd o# pentr! (ode area #!spid! !i (e8ia &estib! ar. Vi(ita dista ) a #!spid! !i se #reea8) a distan,a de #ir#a 4 ((* )s<nd 2 (( pentr! #!spid! dista * #e #oresp!nde di(ensi!ni or (edii (e8io-dista e a e #oroanei dinte !i. Prin !r(are* #on#o(itent se restabi es# i(ite e #e or trei #!spi8i 0i do!) +is!ri* dintre #are +is!ra &estib! ar)-(e8ia ) este (ai e;tins) 0i (ai pron!n,at) de#<t #ea dista )-&estib! ar).

16

17

%i". #(. 6tape e de (ode are a s!pra+e,ei o# !8a e a dinte !i #! e8area tota ) a re ie+! !i o# !8a 0i #rearea desen! !i Y][ #on+or( (etodei Yp i#! !i[d!p) A. Posto a#.i (s#.e(a).

separat de +is!r). >!p) a#easta* #onse#!ti&* #! por,i!ni separate de (ateria resta!rati&* se (ode ea8) #!spi8ii &estib! ar 0i in-!a -(e8ia . Tn #a8! 'n #are se deter(in) desen! Y][* (ode area 'n#epe #! #!spid! in-!a -(e8ia * #are se !ne0te #! #reasta sa on-it!dina ) bine e;pri(at) #! o +is!r) s#!rt) din 8ona #entra ) a #oroanei #! #!spid! &estib! o-dista * di&i8ind s!pra+a,a o# !8a ) 'n do!) p)r,i. U terior* #! por,i!ni sepa rate de (ateria resta!rati& se #reea8) #!spid! in-!a -dista . Tn #ontin!are* se (ode ea8) #!spid! &estib! ar-(e8ia . $e ,ine #ont de +apt! #) #!spid! in-!a -(e8ia este p!,in (ai 'na t 0i (ai (are de#<t #e in-!a -dista 0i a +e (ai 'na t 0i (ai as#!,it de#<t #e &estib! ar-(e8ia . Un-.i! * +or(at de pante e #!spi8i or de &i8a&i* este aproape drept. Va (ode area pantei (e8ia e* #on+or( obser&a,ii or noastre* #a p!n#t de reper s!p i(entar poate ser&i inia i(a-inar) trasat) pe (ar-inea pantei spre &i<r+! #!spid! !i in-!a a pre(o ar! !i doi. A. "ode area #!spid! !i dista este etapa +ina ) de (ode are a s!pra+e,ei o# !8a e a pri(! !i (o ar in+erior pentr! toate tip!ri e de desene ar.ite#toni#e. B; >eter(inarea #ara#ter! !i #onta#t! !i restabi it #! din,ii-anta-oni0ti* topo-ra+ia #ontra#te or o# !8iona e #! a=!tor! .<rtiei Y3a!0#.[ 0i #ori=area or 'n o# !8ia #entra ) 0i +!n#,iona ). +*; Pre !#rarea de +inisare a resta!r)rii.

@. Tn +!n#,ie de tip! desen! !i* se e+e#t!ea8) (ode area ar.ite#t!rii re ie+! !i o# !8a . Va rea i8area desen! !i Y\[* 'n#epe( (ode area #! #!spid! in-!a (e8ia . A#est #!spid se resta!rea8) (ai 'na t 0i (ai as#!,it de#<t ! ti(! #!spid dista . Vi(ita (e8ia ) a #!spid! !i 'n #a!8)* +is!ra in-!a ) se +or(ea8) a ni&e ! +is!rii (e8ia e-&estib! are #! #rearea +osetei #entra e sa! a p!n#t! !i de #onta#t inter#!spidian 'n 8ona #entra ) a #oroanei. Tn #ontin!are* #! por,i!ni de (ateria resta!rati& se e+e#t!ea8) #onse#!ti& (ode area #!spid! !i (e8ia -&estib! ar. "ode area a#est!i #!spid* #a #e (ai (are* se rea i8ea8) d!p) p!n#te e de reper anato(i#e s!p i(entare 1 #!spi8ii &estib! ar-dista 0i in-!a -(e8ia . Vo#! de !nire a pante or #!spi8i or se separ) prin #reasta (e8ia ) trans&ersa ) 0i se 'n-!stea8) spre +oseta (e8ia ) #entra ). >a#) se deter(in) desen! Y^[* (ode area 'n#epe #! #!spid! in-!a -dista * 'n a0a (od* #a #reasta on-it!dina ) a a#est!i #!spid s) tra&erse8e por,i!nea #entra ) a #oroanei 'n dire#,ia #!spid! !i &estib! o(e8ia * !nde 'ntre e 0i #!spid! in-!a -dista se &a +or(a #onta#t! ne-

Etapele de restaurare a suprafeei ocluzale lezate total a molarului doi inferior

Tn #adr! (ode )rii s!pra+e,ei o# !8a e e8ate tota a a#est!i dinte* #on+or( (etodei de (ode are a Yp i#! !i[* se re#o(and) respe#tarea #onse#!ti&it),ii !r()toare or etape9 1) (ode area #!spid! !i &estib! ar(e8ia sa! a #e !i in-!a -dista B 2) (ode area #!spid! !i in-!a -dista sa! a #e !i &estib! ar-(e8ia B 3) (ode area #!spid! !i in-!a -(e8ia sa! a #e !i &estib! ar-dista B 4) (ode area #!spid! !i &estib! ar-dista sa! a #e !i in-!a -(e8ia . RE UMAT "etode e de (ode are a ar.ite#toni#ii o# !8a e a din,i or atera i prop!se* #! e&iden,a desen! !i o# !8a indi&id!a d!p) (etoda Yp i#!!i[ 0i a de+e#te or "/> pe Yse#,ii[* (a=orea8) e;a#titatea restabi irii topo-ra+i#e a #onta#te or intero# !8a e* i(portante a asi-!rarea e#.i i-

18

19

br! !i o# !8a . A#este (etode te.ni#e pot +i !ti i8ate #! s!##es 'n trata(ent! sto(ato o-i# terape!ti# sa! ortopedi#.

!"!#"O$%&F"E 1. nLNGFHI o. JIdFIHpb dMqMHFr I_pDILsHNc jdNhLMtb ONEEpIHNOLMHFr jNLNEpMc O hN_NObG aDhIG : uMHpodp. 1 v 1. 1 2012. 1 w. 50156. 2. uMLFjMdF w.* nIdxOMLL u.* yNcIHI y. JNEEpIHNOLMHFM HMOFpILsHbG aDhNO E jNtNzs` jdrtbG dMEpIOdI{Fc E FEjNLsaNOIHFMt _NtjNaFpI* DEFLMHHN|N ONLN_HItF. yLFHF}ME_Fc ELD}Ic : @. Ad.es. >ent. 1 2005* v 7. 1 P. 1651171. 3. utFpdFMH_N w. J.* ~OIHNO . .* ydI`q_FH o. ~.* NIdHF{_Ir C. C. dI_pF}ME_NM dD_NONxEpON jN tNxMLFdNOIHF` aDhNO : C.9 ~a-ON eK JPC C g. 1 2001. 1 240 E. 4. ~NM A. DhNOdI}MhHbM aItMp_F. M_p jNLFtMdFaI{FNHHHNc DEIx_F _NtjNaFpHbG tIpMdFILNO : PNONM O EpNtIpNLN|FF.1 2002. 1 (101) v 5. 1 w. 25126. 5. NtFIqOFLF . C.* o`jNOI . . fDxNMEpOMHHNM tNxMLFdNOIHFM F dMEpIOdI{Fr aDhNO : C.9 ~ax-ON eCMxF{FHE_Ir _HF|Ig. 1 2004. 1 252 E. 6. NtFIqOFLF .* N|IxIMO u. dNEpdIHEpOMHHNM NdFMHpFdNOIHFM EpNtIpNLN|NO jdF dM_NHEpdD_{FF aDhNO C uMHpodp. 1 v 4. 1 2006. 1 w. 32140. 7. D{_Ir ~. y.* PNOI_ P. J. pIjb dIhNpb E NpNjNLFtMdItF O EpMpF}ME_Nc EpNtIpNLN|FF : wNOdMtMHHIr EpNtIpNLN|Fr. 1 2004* v 3. 1 w. 4111. 8. CDEFGFHI A. J. yLFHF_N-LIhNdIpNdHNM FEELMxNOIHFM IdtFdNOIHFr jdF jLNthFdNOIHFF xMM_pNO dMDzM|N _dIr F N__L`aFNHHNc jNOMdGHNEpF aDhNO : oOpNdM. xFE. _IHx. tMx. HID_ :: 1 C.9 1 2005. 9. PNOF_NO J. K__L`aFr O dMEpIOdI{FF aDhNO : uMHpodp* 20011 v 4.1 w. 35140. 10. PF_NLIMO o. ~.* MjNO . C. dI_pF}ME_Ir pMdIjMOpF}ME_Ir EpNtIpNLN|Fr : wh9. wIH_p-MpMdhDd|E_Fc FHEpFpDp EpNtIpNLN|FF* 2001. 1 390 E. 11. KLMENOI J. P.* yLMjFLFH A. w.* N|IpHMO J. . F xd. nFNtMGIHF_I pOMdxbG p_IHMc aDhI jdF aItMzMHFF jNLNEpF pFjI CKu _MdNtMdHbtF O_LIx_ItF FLF jdrtbtF _NtjNaFpHbtF dMEpIOdI{FrtF : wpNtIpNLN|Fr. 1 2006 1 v 1. 1 w. 14117.

20

21

12. NE_DE .* LIEFxN . F xd. JLFrHFM Ix|MaFOHNc EFEpMtb F tMpNxF_F HIHMEMHFr tIpMdFILI HI _dIMOD` jdNHF{IMtNEps _NtjNaFpHbG dMEpIOdI{Fc : @. Ad.es. >ent. 1 2004 1 v 6. 1 . 2271232. 13. NEpNLI_F o. JIdFIHp pMGHF_F tNxMLFdNOIHFr jdrtbt tMpNxNt N__L`aFNHHNc jNOMdGHNEpF hN_NObG aDhNO. IEps 2 : uMHpodp. 1 20071 v 1. 1 w. 73 179. 14. NEpNLI_F o. JIdFIHp pMGHF_F tNxMLFdNOIHFr jdrtbt tMpNxNt N__L`aFNHHNc jNOMdGHNEpF hN_NObG aDhNO. IEps 22 : uMHpodp. 1 20071 v 2. 1 w. 69178. 15. IxLFHE_Fc w. J. JFxb jdrtNc dMEpIOdI{FF aDhNO : uMHpodp 1 2004. 1 v 1.1 w. 33140. 16. IxLFHE_Fc w. J. MEpIOdI{FNHHbM _NHEpdD_{FF jMdMxHM|N F hN_NON|N aDhNO : uMHpodp. 1 1996.1 v 4. 1 w. 22129. 17. IxLFHE_Fc w. J. MEpIOdI{Fr hN_NObG aDhNO9 EpdIpM|Fr F jdFH{Fjb : uMHpodp. 1 1999.1 v 4. 1 w. 30 1 40. 18. IxLFHE_Fc w. J. MEpIOdI{Fr hN_NObG aDhNO9 _NHEpdD_{FF F _LIEEb : uMHpodp. 1 2000.1 v 1. 1 w. 31140. 19. N|NHF_NO . ~.* N|FHNO J. o.* oEpIqFHI P. n.* MdhI_NO o. w.* yNH`GNOI w. . MEpIOdI{Fr pOMdxbG p_IHMc aDhNO O_LIx_ItF : 1 C.9 ~a-ON eCMxF{FHE_Ir _HF|Ig. 12002. 1150 E. 20. wILNOI o. J.* MGI}MO J. C. KENhMHHNEpF EpMpF}ME_Nc dMEpIOdI{FF O EpNtIpNLN|FF9 dI_pF}ME_NM dD_NONxEpON : 1 wh.9 ~axON eMLNOM_g. 1 2004. 1 160 E. 21. OM nLDH_. ox|MaFOHbM EFEpMtb. KhaNd F EdIOHMHFM : uMHpodp. 1 2003* v 2. 1 w. 5111. 22. OM nLDH_. ox|MaFOHbM EFEpMtb. KhaNd F EdIOHMHFM : uMHpodp. 1 2003* v 3. 1 w. 25130. 23. 3!r a#! W.* 3!r a#! W.* $trat! W.* Carta ean! An-e a* %!ior W.* A bot $&et ana. $iste(e ade8i&e de ! ti() -enera,ie. "edi#ina sto(atoo-i#) nr.1* &o .1. 6di,ie #onsa#rat) #e !i de-a ^222- ea Con-res 4a,iona a A$7". C.i0in)!* 2006* p. 81182. 24. %is#er ?. JbEN_N_I}MEpOMHHNM ONEEpIHNOLMHFM hN_NObG aDhNO E FEjNLsaNOIHFMt ietri# Cera( : PNONM O EpNtIpNLN|FF. 1 2000* v 9. 1 w. 14117. 25. @o++e A. M_pFOHNEps jNLFtMdFaI{FHHNc DEIx_F _NtjNaFpHbG tIpMdFILNO : PNONM O EpNtIpNLN|FF. 1 2002. 1 v 5. 1 w. 25126.

26. Vee&ai o= $. C.* Co#.ran ". A.* "atis 3. A.* "oore 3. k.* P att @. A. "i#ro eaRa-e o+ Posterior Pa#Rab e 7esin Co(posites ?it. and ?it.o!t % oab e Viners : /perati&e >entistrU. 1 2005. 1 (26)* v 3. 1 w. 2171320. 27. ?i#.(an ". IEqFdMHFM jN_IaIHFc _ jdNOMxMHF` pMdIjMOpF}ME_N|N LM}MHFr _I_ ILspMdHIpFOb NdpNjMxF}ME_NtD OtMqIpMLsEpOD. : yOFHpEEMH{Fr. 1 1993. 1 v 4. 1 w. 416.

22

23

MINISTRD OF HEALTH OF THE REPUBLIC OF MOLDOVA STATE UNIVERSITD OF MEDICINE AND PHARMACD EN&"#lae Te4%e$&%anuE

De3ar%$en% #. Pr#4%2e%&" Den%&4%rF5 Oral and Max&ll#.a"&al Sur-erF and I$3lan%#l#-F

ALEGANDER POSTOLACHI

ARCHITECTONICS OF THE OCCLUSAL SURFACES OF LATERAL TEETH AND THEIR RESTORATION !Me%2#d&"al re"#$$enda%&#n4(

C2&4&nau )*+)

24

25

In%r#du"%&#n Vatest -eneration o+ #o(posite restorati&e +i in- (ateria s and ad.esi&e sUste(s are #onstant U #on+ir( t.eir .i-. # ini#a e++e#ti&eness in anU area and t.e # asses o+ de+e#ts o+ .ard denta tiss!e. ?it. t.eir .e p* it be#a(e possib e to #o(p ete U restore and (aintain on--ter( +or(* +!n#tion and aest.eti# #.ara#teristi#s o+ t.e teet. .a&e been ost d!e to destr!#tion o+ .ard tiss!e +a#tors o+ di++erent etio o-ies. >!e to its !ni!e properties* s!#. (ateria s are #onsidered as an a ternati&e to traditiona prost.eti# (et.od o+ treat(ent* at .i#. pointed ba#R in t.e ear U 90s o+ ast #ent!rU* ". ?i#.(an (1993). 3!t* bein- no one o+ t.e (ost pop! ar tUpes o+ restorati&e (ateria s* a (ost dai U a##o!nts +a#es &ario!s di++i#! ties in restorin- da(a-ed or poor U t.e sea ed side o+ t.e teet.. /+ten !sed it. (ateria s not intended +or !se it. ar-e esions and areas o+ .ard tiss!e o+ teet. e;perien#in- #onsiderab e #.ein- press!re. 2t s.o! d be re#o-ni8ed t.at t.is is o+ten done on U a Xre(o&a X o+ t.e de+e#t (@o++e A. 2002B CDEFGFHI A. J. 2005B KLMENOI J. P. 0i a . 2006). A##ordin- to t.e Q. 2. 7o-o8.niRo& et a . (2002)* s!#. sea s are a readU in t.e ear U period are de+e#ti&e* as e&iden#ed bU # ini#a e;a(ination - in 49.9S o+ #ases* and in ^-raUs - to 79.78S. i.e de-ree o+ po U(eri8ation s.rinRa-e o+ #o(posites o+ pre&io!s -enerations in#reases it. t.e s!are +i in-* .i#. o+ten eads to (i#rodribb in-s* t.e de&e op(ent o+ se#ondarU #aries* +i in-s and ot o(! to de&e op ot.er #o(p i#ations* in parti#! ar t.e (i-ration o+ teet.. At t.e sa(e ti(e A. 3 o.ina (2012) notes* t.at t.e t.reedi(ensiona re#onstr!#tion o+ #a&ities in posterior teet. - t.is is a tUpi#a # ini#a sit!ation* .i#. o##!rs e&erU daU in denta pra#ti#e. And it is di++i#! t to (oti&ate t.e patient to restore posterior indire#t ort.opedi# #onstr!#tions* s!#. as #era(i# or #o(posite in aUs. As a res! t* o&er ti(e* de&e oped (orp.o o-i#a and +!n#tiona disorders9 dentoa &eo ar e on-ation* !nder oad #.ein(!s# es* #.an-e t.e o## !sa s!r+a#e. 2n t.e +!t!re* t.e restoration o+ teet. it. in#o(p ete U reprod!#ed or #o(p ete U absent t.eir #.ara#teristi# (orp.o o-U is &erU di++i#! t. 2n t.e s#ienti+i# iterat!re ins!++i#ient U i !(inated iss!es o+ (ode in- o+ t.e o## !sa s!r+a#e o+ posterior teet. and t.e dire#t (et.od in pra#ti#e is o+ten done int!iti&e U* and t.e proposed (et.ods di++er in t.eir # ini#a approa#. to t.e prob e( and its #onsisten#U. %ro( t.ese positions are sti &a id

#on#epts o+ (orp.o-enesis o+ teet.. 3!i din- on a series o+ .Upot.eses* t.eories and resear#. +indin-s on t.e +or(ation o+ teet. in t.e p.U o-enesis and onto-enesis V. ". Vo(ias.&i i Mt a . (2004* 2006) propose t.at #anine* as a !nit to -i&e t.e proportiona itU toot. as a .o e and its parts. Usin- &ario!s a -orit.(s !sin- t.e #anine +or(* as a !nit or !nits o+ e e(ents* Uo! #an -et (! tip e and #o(p e; &ariations o+ s.apes o+ teet.* oriented -roo&e 2 order. A on- it. t.ese t.eories A. W. Wet#.inRin (2001* 2002) proposed a te#.ni!e* #a ed Xaest.eti# basis o+ (orp.o-enesis*X.i#. re ies on t.e basi# as o+ bioni#s - t.e s#ien#e dea in- it. t.e st!dU o+ basi# as and prin#ip es o+ i&in- and inani(ate ob=e#ts in nat!re. A!t.or de&e oped an a -orit.( +or #onstr!#tin- a sUste( o+ #oordinates o+ anato(i#a points and ines o+ +i in- +or(s in t.e proportions o+ t.e X-o den se#tionX* a oin- t.e pra#ti#a dentist (ore a##!rate U re#reate t.e str!#t!re o+ t.e #onstr!#tion o+ t.e teet. o+ a dentition and o## !sa re ations.ip to ens!re t.e #orre#t !pper and oer =as. >espite t.e idea o+ s.apin- t.e teet. re(ain re e&ant aspe#ts o+ (ode in- (restoration) o+ t.e o## !sa s!r+a#e o+ posterior teet. d!e to t.eir #o(p e; (orp.o o-U o+ t.e str!#t!res* parti#! ar U t.ose in t.e ora #a&itU and t.e #o(p e;itU o+ t.e too a##ess. Ana Usis o+ t.e res! ts o+ # ini#a e;a(ination* t.e data obtained bU o## !sio-ra( and e&a !ation o+ bio(etri# dia-nosti# (ode s obtained +ro( st!dents a-ed 18-24 Uears it. inta#t toot. ros and t.e o## !sa s!r+a#e in ort.o-nat.i# bite it possib e to estab is. a n!(ber o+ str!#t!ra +eat!res o+ t.e o## !sa re ie+ posteriors. 2n parti#!ar t.is app ies to +irst (o ars o+ t.e !pper and oer =a* .i#. tend to .a&e !ni!e* indi&id!a o## !sa re ie+* a oin- t.e( to en-a-e in opti(a #onta#t it. t.e str!#t!ra e e(ents o+ teet. anta-onists. Qi&en t.at t.e t!sR is t.e XReUX e e(ent in t.e .!(an dentition and pre(o ars - a +!n#tiona -oriented -ro!p o+ teet.* .i#. in its str!#t!re #o(bines e e(ents #.ara#teristi# o+ bot. t.e (o ars and #anines (!st taRe into a##o!nt t.eir anato(i#a +eat!res in t.e restoration o+ o## !sa re ie+. S#$e ana%#$&"al .ea%ure4 #. %2e 4%ru"%ure 3#4%er&#r %ee%2; Pre$#lar4 u33er and l#Her IaH; Co((on in t.e anato(U o+ t.e pre(o ars is t.e presen#e o+ o## !sa s!r+a#es it. to Rnobs - t.e &estib! ar and in-!a . i.e !pper pre(o ars are ar-er oer* and t.e +irst abo&e and are (ore &ariab e and #on&e; &estib! ar #!sps. /ra b!(p t.e( s i-.t U s(a er. 2n t.e

26

27

oer pre(o ar &estib! ar ora t!ber# es abo&e and #rons .a&e a s ope o+ ora side as opposed to t.e top. /ra papi a is !s!a U s(a er in si8e at +irst* b!t in t.e atter .as a (ost t.e sa(e a(o!nt. i.e ar-est - t.e +irst top* t.e s(a est - t.e +irst botto(. i.eU di++er in s.ape and #rons. At t.e top - it is + attened in t.e (esio-dista dire#tion and .as a #ross-se#tiona s.ape o+ an o&a * .i e t.e oer se#tion o+ t.is #ir#! ar (%i-. 1).

o!r opinion* on t.e one .and* t.ese b!(ps are a si-n o+ (o arisation teet.* on t.e ot.er .and* t.e o#ation o+ t.e (edia t!ber# e is an additiona area o+ o## !sa #onta#t it. t.e toot.-anta-onist* and it #an be ass!(ed t.at s!#. additiona topo-rap.U .i o#Rs pro(otes (ar-ina rid-es !nder t.e in+ !en#e o+ o## !sa oads* and a so in#reases t.e area o+ t.e o## !sa s!r+a#e o+ t.e toot. #ron.

a b %i-. 1. Pre(o ars o+ t.e !pper =a - (a)B X7et!rnX a si-n o+ t.e #!r&at!re o+ t.e +irst pre(o ar #rons o+ t.e !pper =a. Qenera &ie o+ t.e toot. 14 - (b). $i-n o+ t.e an- e at t.e #ron o+ t.e oer pre(o ars is deter(ined* and at t.e top - is not e;pressed (be#a!se in so(e #ases* t.e ro!nded dista an- e o+ t.e #ron* and in ot.ers - (esia ). Westib! ar s!r+a#e o+ t.e +irst !pper #anine is &erU si(i ar to t.e ot.er side o+ t.e dentition. i.is si(i aritU is e;p ained bU t.e presen#e o+ Xre&erseX +eat!re #ron #!r&at!re opposite t.e #!r&at!re o+ a t.e ot.er bits o+ t.is .a + o+ t.e dentition. 2+ t.e #!r&at!re #ron re+ e#ts t.e #.ein- +!n#tion (.ere t.e +ood is -rad!a U (o&ed o!t o+ t.e anterior (o!t. to posterior)* t.e Xret!rnX to t.e #!r&at!re re+ e#ts t.e pattern o+ t.e ti(e de aU in t.e #anine +ood +or .er #r!s. in t.e se#ond p.ase o+ (asti#ation. i.is si(i aritU pre(o ar teet. it. res! ts in t.e possibi itU o+ a =oint operation bU #r!s.in- t.e +ood. /## !sa s!r+a#e o+ !pper pre(o ar is represented bU s opes o+ &estib! ar and ora t!ber# es. 6d!#ated pit#.ed on-it!dina rid-es are dire#ted to intrat!ber +!rro* bo!nded on to sides e;pressed (ar-ina rid-es* .ere t.ere (aU be additiona inter(ediate t!ber# es* o+ .i#. t.e dista is ess #o((on t.an (esia . 2n

%i-. 2. /## !sa pattern o+ toot. 34. %ro( t.e &estib! ar #!sp o+ t.e +irst oer pre(o ar on t.e #.ein- s!r+a#es o+ ena(e bead is p! ed* .i#. #rosses t.e -roo&e separatin- t.e to .i o#Rs* and di&ides it into to pits9 t.e (esia and dista . i.ro!-. t.is ro er s!r+a#e is not #on#a&e #ron. $o(eti(es .e stops and t.en t.e to .o es (er-e into a #o((on .orses.oe-+!rro (%i-. 2).

%i-. 3. /## !sa pattern o+ toot. 35.

28

29

i.e se#ond oer pre(o ar - in-!a t!ber# e is di&ided into (esia and dista in-!a -roo&e (a +eat!re (o arisation). >!e to t.is* .is #ron is ar-er t.an t.e +irst* and t.e dista +o&ea (ore prono!n#ed. "esia in-!a t!ber# e (aU be a .ei-.t appro;i(ate U e!a to t.e .ei-.t o+ t.e &estib! ar #!sp (%i-. 3). F&r4% $#lar #. %2e u33er IaH %irst (o ar o+ t.e !pper =a toot. is t.e (ost stab e and ess prone to t.e rest o+ t.e !pper (o ars red!#tion. %ro( +irst to t.ird (o ar is #.ara#teri8ed bU red!#ed (esio-dista #ron di(ensions (Xt.e e++e#t o+ #o(pression bits). 2n t.e nor(a +or( o+ t.e o## !sa #ron # ose to t.e dia(ond or s!are and ed!#ated its +o!r t!ber# es* it. t.e ar-est dia-ona o+ t.e &estib! ar-(esia ed-e to t.e dista U-pa atine. Vatera i8ation o+ t.e (ain +eat!res o+ t.e #!r&at!re is (ost prono!n#ed +eat!re #ron. Westib! ar s!r+a#e o+ t.e #ron is si(i ar to t.e to #onne#ted s!r+a#es o+ pre(o ars. i.e a&era-e #ron .ei-.ts se#ond pre(o ar and +irst (o ar o+ t.e !pper =a are t.e sa(e* and a##ordin- to $. >(itrienRo (2001) ere - 8.0 ((. ?it. t.e destr!#tion o+ .i s on one side and t.e opposin- denta ar#.* t.ese di(ensions #an ser&e as a -!ide +or (ode in- t.e .ei-.t o+ t.e #ron. Westib! ar t!ber# es ((esia and dista )* a#!te ora and (esia ar-er and (ore dista . Cron s.ape is deter(ined bU t.e de-ree o+ de&e op(ent o+ t!ber# es* espe#ia U t.e dista pa atine* .ose &a !e &aries (arRed U. As t.is (o!nd t.e (ost &ariab e in si8e and s!b=e#ted to red!#tion* t.e t.ird (o ars its e;pression is red!#ed. 2+ Uo! #onne#t an i(a-inarU ine beteen t.e tops o+ t.e t.ree (a=or b!(ps - bot. &estib! ar and (esia pa ata * t.en a +i-!re o+ a trian- e it. t.e ape; +a#in- t.e ora side. 2n addition* ea#. obe .as t.e s.ape o+ a +o!r-sided pUra(id. /+ t!ber# es* t.e ar-est a(o!nt in (esia pa ata . ?.en &ieed +ro( t.e #ron to t.e &estib! ar side o+ it is &isib e beteen t.e to &estib! ar b!(ps d!e to its .ei-.t. 4e;t to .i( is* to &arUin- de-rees o+ se&eritU* an additiona b!(p b!(p Carabe i. Westib! ar dista * (esia pa ata t!ber# es and t!ber# e Carabe i are on t.e sa(e ine. /n t.e ed-e #rest toot. #ron .ad (eetin-s (ore b!(ps - (esia and dista . i.e b!(ps are separated bU -roo&es* t.e nat!re o+ t.e re ie+ o+ .i#. &aries. "esia -roo&e + os into t.e #enter o+ t.e #ron to t.e #entra s! #!s or pit. i.e tUpi#a pattern o+ (esia and dista -roo&es #orresponds to sRe t.e o#ation o+ t.e etter XZX and t.e trans&erse -roo&e r!nnin- a on- t.e dia-ona o+

t.e -reatest* #an be e;pressed in di++erent aUs - +ro( bare U noti#eab e to e;tre(e s.ort (%i-. 4).

%i-. 4. /## !sa pattern o+ toot. 26. /ne o+ t.e XReUX b!i din- b o#Rs* .i#. #an be de+ined anato(i#a and(arR +or proper #onstr!#tion o+ t.e o## !sa s!r+a#e o+ t.e #ron (o ar* in o!r opinion* is t.e trans&erse ena(e rid-e (Xob i!e #o(bX)* t.e se&eritU o+ .i#. is indi&id!a and is s.aped iRe a +i-!re o+ X.o!r- assX. X/b i!e #o(bX #onne#ts (esia U-pa ata and &estib! ar dista obe* and di&ides t.e #ron o+ t.e toot. into to .a &es. /n t.e #.ein- s!r+a#e o+ t.e #ron s opes b!(ps are arran-ed so t.at one on-it!dina rid-e #rest* as it ere Xed-edX beteen t.e to nei-.bors* .i#.* in o!r opinion* in#reases t.e area o+ t.e o## !sa s!r+a#e and pro&ides e;tra stren-t. !nder t.e in+ !en#e o+ s!#. #.einpress!re. ?it. bio(etri#s* dia-nosti# (ode s* e .a&e estab is.ed t.at t.e idt. o+ t.e Xob i!e s#a opX on t.e a&era-e o+ 3-4 ((* and in t.e #entra part is narroed to t.e top o+ t.e rid-e. Zei-.t Xob i!e s#a opX depends on t.e o## !sa re ations.ip beteen t.e dista and &estib! ar ((idd e) and dista (posterior) t!ber# e* t.eir .ei-.t and dept. o+ t.e #entra +o&ea (o ar anta-onist. T2e 4e"#nd $#lar #. %2e u33er IaH $i(i ar in +or( to t.e +irst !pper (o ar (esia U it. a de#rease in t.e si8e o+ t.e dista -#ron (%i-. 5). $i-ns o+ atera i8ation deter(ined. WarU t.e intensitU and n!(ber o+ t!ber# es #.eins!r+a#e. i.e (ost &ariab e in si8e and pa ata t!ber# es* espe#ia U dista

30

31

!nder-oin- red!#tion. ?it. its #o(p ete red!#tion o+ t.e #ron s.ape is ro!nded-trian-! ar.

22-nd and 222-t. order. %!rros o+ 2-st order 1 beteen t!ber (deepest). %!rros 22-order - ess deep t.an t.e 2-t. order* di&ide s#a ops it.in t.e (o!nd and +!rro 222-t. order* separated bU (ore b!(ps #ron. At t.e sa(e -roo&e 2-t. order ((esia * dista * &estib! ar and in-!a ) #an -enerate patterns o+ di++erent s.apes* t.e (ost #o((on patterns o+ t.ree tUpes o+ -roo&es in t.e +or( o+ X\X (p !s si-n)* e]g or X^X9 1) Xp !s e\g - patternX +or(ed bU t.e interse#tion o+ (esia U and dista -&estib! ar- in-!a -roo&es to +or( a #entra pit or #o((on point o+ #onta#t beteen t.e b!(ps. 2n a st!dU o+ dia-nosti# (ode s* e +o!nd t.at it. t.is tUpe o+ pattern on t.e (esia and dista &estib! ar t!ber# e appro;i(ate U t.e sa(e si8e as dista or posterior obe is o#ated # oser to t.e #entra s! #!s (%i-. 6).

%i-. 5. /## !sa pattern o+ toot. 17. %or t.reet!bered possib e +or(s and t.e (ost rare option .en b!(ps in one ro* t.e #ron is narro* + attened and ob i!e U #rossin- t.e ar#.. Vo#ation o+ additiona #!sps on t.e bo!ndarU rid-es (o ars preser&ed. Carabe i t!ber# e is rare. X/b i!e #o(bX is e;pressed ess t.an t.e +irst (o ar* and in a (ost a #ases* #rosses t.e #entra s! #!s. %irst (o ar o+ t.e (andib e in t.e o## !sion rate* t.e +irst (o ar #rons o+ t.e oer =a to +or( # ose to re#tan-! ar or penta-ona * dependinon t.e n!(ber and s.ape o+ t!ber# es on t.e #.ein- s!r+a#e it. a predo(inan#e o+ (esia U-dista si8e o+ t.e .ei-.t o+ t.e #ron. Westib! ar s!r+a#e o+ t.e #ron in re ie+ at t.e e;pense o+ -roo&es* &arUin- in dept. and en-t.* and #on&e;* it. a s ope at t.e ed-e o+ t.e #.eins!r+a#e ora side and ora side is #on&e;* b!t ess t.an t.e &estib! ar. iUpi#a is t.e presen#e o+ +i&e posterior t!ber# es - to o+ t.e t.ree &estib! ar and in-!a * o+ .i#. t.e ar-est and (ost .i-. is t.e &estib! ar (esia obe and east prono!n#ed dista . i.e si8e and re ati&e position o+ #!sps #orre ate it. t.e re ie+ -roo&es t.at are eit.er #ross or so(e.at rese(b e t.e etter XZX. A(on- t.e( are t.e +!rros o+ 2-*

%i-. 6. /## !sa pattern X\X (p !s) o+ t.e toot. 46. 2) X] - patternX +or(ed bU t.e interse#tion o+ t.e (esia and abia +!rros* it. t.e +or(ation o+ t.e anterior #entra +o&ea* +ro( .i#. ori-inates -roo&e and -oes to t.e point o+ interse#tion o+ t.e dista and in-!a -roo&es - t.e rear #entra +o&ea. A##ordin- to o!r obser&ations o+ s!#. a pattern is +or(ed .en* at t.e (esia in-!a t!ber# e is !ite prono!n#ed ena(e bead* .i#. is #onne#ted t.ro!-. a s.ort -roo&e in t.e dista &estib! ar t!ber# e (%i-. 7).

32

33

%i-. 8. /## !sa pattern X\X (p !s) o+ t.e toot. 37. %i-. 7. /## !sa pattern X]X (]) o+ t.e toot. 36. 3) X^ - patternX +or(ed bU t.e interse#tion o+ t.e (esia and in-!a -roo&es to +or( t.e +ront o+ t.e #entra +o&ea* and .en Uo! #onne#t t.e &estib! ar and dista -roo&es - t.e rear #entra +o&ea. 3eteen t.e &estib! ar and in-!a (esia dista t!ber# e t.ere is a dire#t* !ndi&ided -roo&e #onta#t. $. W. >(itrienRo et a . (2001) s!--est t.at t.e patterns o+ -roo&es options are dire#t U re ated to t.e (ost dista part o+ t.e &ariab e bits* in# !din- &estib! ar dista t!ber# e* dista or posterior t!ber# e and dista in-!a t!ber# e. i.ere+ore* e be ie&e t.at +or opti(a o## !sa re ations.ip* #onsider t.e indi&id!a tUpe o+ pattern in t.e si(! ation. i.e se#ond (o ar o+ t.e (andib e se#ond oer (o ar is s i-.t U in+erior in (a-nit!de to t.e +irst. Cron .as a ri-.t #!boid s.ape. C.ein- s!r+a#e .as a distin#t #ross-s.aped -roo&e separatint.e +o!r #!sp9 to &estib! ar and to speaRin-. iUpi#a U* t.e tops are ro!nded .i o#Rs o+ &estib! ar and in-!a pointed. i.e &estib! ar s!r+a#e (ore #on&e; t.an t.e in-!a * b!t bot. o+ t.ese s!r+a#es are !s!a U + atter t.an t.e +irst. (esia #!sps (assi&e dista (%i-. 8*9).

%i-. 9. /## !sa pattern X^X (^) o+ t.e toot. 37. T2e %2&rd $#lar #. %2e u33er and l#Her IaH; i.ird (o ars are t.e (ost &ariab e in si8e and str!#t!re. 2n t.e nor(a o## !sion o+ t!ber# es rat.er &ariab e and ran-es +ro( t.e !pper 1 to 8 or (ore (!s!a U 3-5)* at t.e botto( +ro( 1 to 6. i.e #ron o+ t.e oer s(a er t.an t.e rest o+ t.e oer (o ars* b!t not as red!#ed as t.e !pper #ron* and !s!a U Reeps t.e #!boid s.ape. Zis #.eins!r+a#e* in #ontrast to t.e !pper* o+ten ass!(es a spe#i+i# +or a Xs.a o +o ds.X 7ed!#tion o+ t.e top s.os in t.e absen#e o+ Xob i!e s#a opX and in addition is #.ara#teri8ed bU red!#tion o+ t.e &estib! ar and t.e pa ata dista t!ber# es* e;pressed in &arUin- de-rees. i.e res! ts o+

34

35

st!dies on t.e anato(i#a +eat!res o+ t.e atera teet. ere t.e basis +or de&e opin- an a -orit.( +or t.e restoration o+ o## !sa re ie+* parti#! ar U in t.e +irst and se#ond (o ars. i.e essen#e o+ t.e de&e oped (et.od ies in t.e +a#t t.at t.e restoration o+ t.e teet. is #arried o!t taRin- into a##o!nt t.e indi&id!a #.ara#teristi#s o+ t.e ar#.ite#toni#s o+ t.e o## !sa s!r+a#e to be deter(ined be+ore treat(ent. i.e &erU sa(e si(! ation is #arried o!t bU !s on t.e proposed prin#ip e o+ Xen&e opeX Certi+i#at de ino&ator 4r. 4448 din 31.07.2006* e iberat de U$"% Y4i#o ae ieste(i,an![) .en re#onstr!#tion is #arried o!t it. s!##essi&e #ron restoration o+ opposed b!(ps. 2t is proposed to #onsider to # ini#a sit!ations9 a) t.e destr!#tion o+ o## !sa posterior teet. .i e (aintainin- t.e .ei-.t o+ .i o#Rs* and b) t.e tota destr!#tion o+ t.e o## !sa s!r+a#e o+ posterior teet.. 7estorations are !sed i-.t-#!rin(i#ro-.Ubrid #o(posites* +or e;a(p e* X%i teR P 60X* X%i teR Z 250X and X%i teR + oX (3" 6$P6) and ot.ers* in #o(p ian#e it. instr!#tions +or !se. SECTION METHOD OF RESTORATION OF MOLARS C!rrent U* (i#ro-.Ubrid #o(posites are t.e (ain +i in(ateria s +or restorin- posterior teet. it. pro;i(a esions and : or o## !sa s!r+a#e. i.is is ar-e U d!e to t.e +a#t t.at (odern te#.no o-U # oser to t.e p.Usi#a properties o+ t.e #o(posites and aest.eti# #.ara#teristi#s o+ .ard tiss!es o+ teet.. 3!t .ate&er t.e s!##esses re(ains &a id .et.er t.e dire#t red!#tion o+ e;tensi&e .ard tiss!e esions o+ t.e atera teet. d!e to #aries and its #o(p i#ations* as o+ten .en t.e need arises in t.e +or(ation o+ #a&ities s!#. as "/> ((esia U-o## !si&e-dista ). W. 4. / eso&a et a . (2006) point o!t t.at statisti#s s.o a pre+erentia !se o+ t.e (et.od #!rrent U +i in#o(posites and t.e presen#e in t.is ar-e n!(ber o+ poor res! ts. A##ordin- to 6. 3oro&sRU (2001) #ond!#ted t.eir st!dU s.oed t.at 3 Uears a+ter stoppin- teet.* t.e per#enta-e o+ #o(p i#ations in t.e +or( o+ p! pitis and periodontitis as 52.6S. A##ordin- to A. 2. 4iRo ae&* V. ". isepo& (1999) 2 Uears a+ter treat(ent o+ teet. de#aUed bU +i inabo!t 70S o+ s!r&eUed sea s* re-ard ess o+ t.e (ateria did not (eet t.e ne#essarU # ini#a re!ire(ents (!a itU o+ +it* t.e restoration o+ anato(i#a and interdenta #onta#t point* t.e a#R o+ Xre#!rrent #ariesX). 2n 44.5S o+ #ases o+ (issin- interdenta #onta#t point and noted t.e presen#e o+ o&er.an-in- ed-es o+ +i in-s in aro!nd t.e -in-i&a area

d!e to i(proper !se o+ a (atri; or pro;i(a s!r+a#e restoration as #arried o!t it.o!t !sin- it. /ne o+ t.e (ost di++i#! t sta-es .en +i in- t.e #a&ities o+ # ass 22 is to estab is. points o+ #onta#t and a -ood (ar-ina adaptation o+ t.e (ateria to aro!nd t.e -in-i&a a #a&itU* as t.is area is #onsidered X.i-. risR areaX +or t.e dire#t +or( o+ restoration. "i#rodribb in- at t.e Xrestoration-toot.*X is #onsidered t.e (ain #a!se o+ se#ondarU #aries* toot. sensiti&itU to sti(! i a+ter treat(ent* destr!#tion* restoration and de&e op(ent o+ ot.er #o(p i#ations. ?it. t.e in#rease in area restoration* in#reases t.e risR o+ eaRa-e d!e to (anU reasons (%i-. 10 a* b* #* d).

%i-. 10. 6;a(p es o+ i(proper restoration o## !sa s!r+a#e o+ (o ars it. t.e dire#t (et.od (a* b) and t.e aboratorU (et.od (#* d).

36

37

A##ordin- to $. >e iperi et a . (2005) restoration de&ita teet. t.at .a&e eaRened t.e str!#t!re* is one o+ t.e (ost di++i#! t prob e(s +or t.e dentist. 2n t.is re-ard* !estions #ontin!e to be re e&ant to +ind aUs to +!rt.er ens!re t.e inte-ration o+ t.e restorati&e (ateria in t.e inte-ritU o+ t.e #orona part o+ t.e toot.. 2n addition* it. #onsiderab e destr!#tion o+ t.e o## !sa s!r+a#e* di++i#! ties arise in t.e i(p e(entation o+ !a itU #ondensin- t.e +i in- (ateria * .i#. is one o+ t.e (ain #onditions .i#. ens!re not on U i(pro&e t.e ad.esion to t.e toot.* b!t a so to obtain a !ni+or( densitU o+ restoration. 2(p e(entation o+ t.is #ondition #ontrib!tes to t.e str!#t!re o+ t.e #o(bined opposition Xrestoration-toot.X to t.e in#reased +!n#tiona oads e;perien#ed bU t.e atera teet.. Attention is dran to t.e +a#t t.at de&ita teet. are not so #a ed XdeadX teet.* be#a!se t.eU are asso#iated it. periodonta and denta i+e i depend on t.e inte-ritU o+ t.e periodonti!(. i.ere+ore* ade!ate endodonti# treat(ent o+ teet. d!e to #aries or #o(p i#ated re-treat(ent ear ier de&ita teet. it. poor U sea ed root #ana s is t.e (ain indi#ation +or t.e preser&ation o+ t.e toot. to restore its ost anato(i#a and +!n#tiona &a !e in t.e str!#t!re o+ denta sUste( and t.e bodU as a .o e. Qi&en t.at t.e &ast and deep #a&ities o+ # ass 22 on 3 aRe it. s!btota or tota esion o+ o## !sa ("/* >/* "/>)* a #o((on te#.ni!e in&o &es #ondensin- t.e +i in(ateria di++i#! ties be#a!se o+ its spread in a dire#tions* t.e #a&itU !nder t.e press!re o+ t.e too * e as in&ited to address t.is p.eno(enon bU separatin- t.e (ain #.a(ber into to separate* to in#rease t.e opport!nities to e;er#ise opti(!( #ondensation o+ t.e (ateria . i.is prin#ip e o+ separation is #a ed Xse#tiona X (sp. on ra#. o++er v 4441 U$"% X4. ieste(itan!X - 6.12.06). X$e#tiona X prin#ip e restoration (o ars s.o t.e presen#e o+ deep #a&ities in t.e teet. a si-ni+i#ant disr!ption o+ t.e o## !sa and pro;i(a s!r+a#es - (esia Uo## !sa ("/)* dista -o## !sa (>/) or (esia U-o## !si&e-dista de+e#ts ("/>) (%i-. 11 a* b* #* d).

%i-. 11. C ini#a sta-es (a* b* #* d). 7estoration o+ t.e toot. 46. X$e#tiona X (et.od. A+ter preparin- t.e #a&itU it. dia(ond b!rs* sp.eri#a * .en it tooR t.e +or( o+ near-ro!nd* insta in- a #o++erda( (r!bber da()* 3ondin- o+ ena(e and dentin bondin- as #arried o!t paU(ent o+ trainin- and o (od! !s X+ oab eX #o(posite X7e&o !tionX (kerr) in t.e prepared toot. #a&itU. 2ts !se is asso#iated it. a &ie to (a;i(i8in- t.e sea ino+ (i#ro pores and irre-! arities on t.e botto( o+ t.e #a&itU and on t.e ed-e o+ t.e de+e#t on t.e pro;i(a s!r+a#e to #reate a spe#ia adaptation aUer. Vi-.t-#!rin- is #arried o!t at an an- e to t.e toot. #a&itU* t.at is* +ro( t.e s!r+a#e to .i#. atta#.(ent i be t.e ar-est portion o+ t.e #o(posite. $trati+ied i-.t po U(eri8ation a&oid de+or(ations t.at ead to t.e e(er-en#e o+ #.!nRin- #o(posite aUers. i.ere+ore* it. indi&id!a portions o+ t.e #o(posite (i#ro.Ubrid e%i teR Z 250g (3" 6$P6)

38

39

is si(! ated* !s!a U one or to (dependin- on t.e area a++e#ted)* &erti#a a s rea#.in- a .ei-.t o+ ena(e -dentin border and t.e idt. o+ t.e #o(ponents o+ 1.5-2.0 ((. i.en* it. t.e dista pro;i(a side o+ t.e toot. (atri; sUste( is insta ed. At t.e botto( o+ t.e #a&itU o+ t.e toot. and on its peri(eter is (ade X+ oab eX #o(posite and t.e #a&itU is +or(ed bU a ro!nded +or(. Vater si(! ated dista pro;i(a a and restored t.e #onta#t point. A so (ode ed and t.e (esia pro;i(a a and t.e #onta#t point. i.e proposed a -orit.( #an arti+i#ia U red!#e t.e tota area a++e#ted toot. #ron. 2n addition it be#o(es (!#. (ore #on&enient to #ondense t.e insertion portion o+ t.e #o(posite too to #reate #onta#t points and +or( t.e bo!ndarU rid-es. A+ter t.e restoration o+ t.e pro;i(a a * separate portions o+ t.e #o(posite +i ed t.e #entra part o+ t.e toot. #a&itU. i.e ne;t i(portant step in t.e restoration ies in t.e (ode in- o+ t!ber# es on t.e Xprin#ip e o+ t.e en&e ope.X Corre#tion o+ o## !sa #onta#ts is #arried o!t in stati# and +!n#tiona o## !sion !nder #ontro o## !sio-ra((. i.e proposed a -orit.( +or 7estoration o+ (o ars it. #orona de+e#ts s!#. "/> .as #ertain ad&anta-es o&er traditiona (et.ods o+ dire#t red!#tion o+ s!#. teet.. i.eU are as +o os9 $i(! ation o+ t.e &erti#a a s in#reases t.e area o+ ad.esion o+ t.e #o(posite it. t.e #a&itU a s o+ t.e toot.B i.e s(a si8e o+ t.e #a&ities de#reased Uie din- o+ t.e (ateria * t.at is* its X+ oX toard t.e asso#iated a * .i#. #o(pensates +or t.e +or(ation o+ interna stresses in t.e restoration B $trati+ied #o(posite stU in- a os Uo! to proper U #ond!#t dire#ted po U(eri8ation. iransdenta - are red!#es t.e intensitU o+ i-.t e(itted a+ter passin- t.ro!-. t.e toot. tiss!e and t.e res! t is eso+tstartg - poU(eri8ationX* .i#. red!#es t.e po U(eri8ation s.rinRa-e and interna 4stress o+ restorationB 4 8! the 2od9 is under the in!luence o! external !orces, then :e sa9 that the 2od9 is under stress. C ini#a a -orit.( +or restoration o+ t.e a++e#ted toot. to t.e presen#e o+ #a&ities s!#. as "/* >/ - or "/> pro&ides !a itU re.abi itation o+ pro;i(a a and interdenta #onta#t pointsB 2t is Rnon t.at t.e +or(ation o+ sp.eri#a #a&ities east &ioates t.e stabi itU o+ t.e toot. as a .o e to stress+! #.ein- oads. Zen#e* t.e +or(ation o+ sp.eri#a #a&ities and restoration +or (ode in-

indi&id!a #a&ities* si(i ar in s.ape to ro!nd* i pro&ide t.e opti(a bio(e#.ani#s o+ t.e restoration and t.e toot. !nder t.e in+ !en#e o+ +!n#tiona oad. TECHNOLOJD OF RESTORATION OCCLUSAL SURFASE POSTERIOR TEETH S%a-e4 #. %2e #""lu4al 4ur.a"e $#del&n.&r4% u33er $#lar 1) i.e st!dU o+ intero## !sa re ations.ips* topo-rap.U and str!#t!ra +eat!res o+ Xob i!e #rest.X 3e+ore be-innin- t.e restoration* +or a (ore detai ed st!dU o+ t.e re ations.ip beteen o## !sa toot. ros* and in parti#! ar beteen t.e toot. it. t.e o## !sa s!r+a#e o+ t.e da(a-ed and anta-onists* it is ad&isab e to obtain prints and (aRe a dia-nosis o+ .i-.-stren-t. -Ups!( (ode to pre&ent possib e abrasion o+ o## !sa re ie+ o+ indi&id!a parts in t.e pro#ess o+ earnin- (ode s. 2n dia-nosti# (ode s deter(ine t.e indi&id!a #.ara#teristi#s o+ ort.o-nat.i# bite* intero## !sa re ations.ips in t.e atera and anterior teet.* t.e oer t.e de-ree o+ o&er ap o+ t.e !pper +ront teet.* as e as t.e topo-rap.U o+ t.e o## !sa #onta#ts. Parti#! ar attention is paid to st!dU t.e str!#t!re o+ t.e o## !sa re ie+ and Xob i!e #rest.X 2n t.e absen#e o+ prod!#tion o+ dia-nosti# (ode s* t.e abo&e #riteria* it is ad&isab e to deter(ine in t.e (o!t.* !sin- an additiona di-ita p.oto-rap.U* or b!##a #a(#order. iopo-rap.U o+ t.e o## !sa #onta#ts deter(ined !sin- arti#! atinpaper e3a!s#.g* as e as t.e presen#e or absen#e o+ &erti#a (i-ration o+ t.e teet.. ?.en t.e tota destr!#tion o+ t.e o## !sa s!r+a#e to deter(ine t.e pro=e#tion o+ t.e dista &estib! ar ((idd e)* t.e +irst oer (oar t!ber# e in re ation to t.e da(a-ed s!r+a#e o+ t.e toot.anta-onist. ?it. t.e .e p o+ +!n#tiona tests s.o! d e;a(ine t.e de-ree o## !ssion t.e no(ination o+ t.e (andib e in t.e sa-itta and trans&ersa p ane as a re+eren#e a spe#i+i# re ations.ip beteen t.e dept. o+ o&erappin- teet. in t.e anterior* posterior t!ber# es .ei-.t and o## !sa #!r&es. i.e (ore prono!n#ed +ronta o&er ap o+ t.e teet.* t.e (ore prono!n#ed t.e .ei-.t o+ t.e atera t!ber# es o+ t.e teet. and t.e (ore s.arp U prono!n#ed o## !sa #!r&es. 2+ Uo! +ind no +!n#tiona o## !sa #onta#ts be+ore treat(ent s.o! d be t.eir e i(ination bU se e#ti&e tried inB

40

41

2) >eter(ination o+ #o or restoration !sin- a s#a e o+ #o ors o+ t.e #o(posite (ateria B 3) 2+ t.ere is a de+e#t o+ t.e toot.* .i#. does not +it into anU o+ t.e # asses o+ 3 aRe* e +o oed t.e prin#ip e o+ t.e proposed $. W. 7ad insRi( (1996*1999*2000)* t.e essen#e o+ .i#. ies in t.e #onstr!#tion o+ s!pportin- parts in bat#.es #ron restorati&e (ateria * #a ed X brands. X >!e to t.e #onstr!#tion o+ XbrandsX* e a so #onsistent U trans ate anU de+e#t in t.e #ron o+ t.e de+e#t (odes - (esio-dista o## !si&e. X"arRsX are t.ere+ore t.e &estib! ar and ora s!r+a#es o+ atera teet.. i.en t.e de+e#t o+ t.e "/U* t.e #ron -oes to t.e de+e#t "/ - (esio-o## !sa * pro;i(a to t.e #onstr!#tion o+ t.e dista #onta#t as a +ree #entra spa#e* b anR +i in- (ateria * i-.t #!rin- i-.t is easier to pass* t.at pro&ides t.e best #!re pro;i(a parts o+ t.e restoration. %!rt.er r!ns (edia point o+ #onta#t it. t.e trans+er o+ a de+e#t in / - /## !sa (%i-. 14)B

%i-. 14. $ta-es o+ si(! ation o+ t.e o## !sa s!r+a#e o+ toot. 26* it. t.e tota destr!#tion o+ t.e .ei-.t o+ .i o#Rs (+i-!re)9 a) si(! ation o+ (esia and dista &estib! ar #!sps #) si(! ation o+ (esia pa ata #!sp and t.e +or(ation o+ Xob i!e s#a opX* d) si(! ation o+ (esia and dista #!sps and additiona +or(ation o+ trian-! ar pits. 4) $i(! ation o+ t.e &estib! ar #!sp (esia to t.e pre i(inarU deter(ination o+ its .ei-.t on t.e toot. it. a denta ar#. inter part* or re U on t.e .ei-.t o+ t.e #ron o+ se#ond pre(o ar on t.e orRinside. 2n t.e absen#e o+ a stored .ei-.t o+ b!(ps on bot. sides* t.e restoration is #arried o!t on t.e (ean &a !es o+ .ei-.t. $in#e t.e &estib! ar s!r+a#e o+ t.e (esia #!sp (ore #on&e; t.an t.e dista * its +or( t.e to separate portions o+ t.e (ateria . A+ter t.e +irst aUer* e en&isa-e a on-it!dina rid-e and its s opes on t.e o## !sa s!r+a#e* and t.en (ain U #o(p ete si(! ation o+ t.e &estib! ar s!r+a#e o+ t.e prot!beran#e. "ode in- is #arried o!t taRin- into a##o!nt t.e t.ree (ain ines +or t.e proper spatia orientation in t.e #onstr!#tion o+ t!ber# es* as s!--ested bU A. W. Wet#.inRin (2002)9 1) t.e ine #onne#tin- t.e tops

42

43

o+ t.e &estib! ar t!ber# es* a ine o+ t.e #entra s! #!s o## !sa s!r+a#e and t.e ine #onne#tin- t.e tops o+ ora t!ber# esB 5) $i(! ation o+ &estib! ar dista t!ber# e and t.e +or(ation o+ t.e &estib! ar s! #!s trans ated it on t.e o## !sa s!r+a#e to t.e #enter o+ t.e #ron. 2ts dept. and e;tent &aries ide UB 6) $i(! ation o+ (esia pa ata #!sp and ena(e #ross-ro er Xob i!e #rest.X A separate portion o+ t.e (ateria +or( t.e pa ata s!r+a#e o+ t.e t!ber# e and o!t ine its +!t!re top so t.at it as in ine it. t.e dista tip o+ t.e &estib! ar rea#tion. "esia rid-e -rad!a U trans ate into +air U distin#t (edia ed-e rid-e and dista - #onne#ts to t.e #entra part o+ t.e #.ein- s!r+a#e it. on-it!dina rid-e #rest &estib! ar dista t!ber# e. i.!s* t.e dista s!r+a#e o+ t.e +or(ed Xs#a op ed-eX t.at separates t.e #ron o## !sa s!r+a#e into to !ne!a .a &es. 4e;t* si(! ate t.e tip o+ t.e t!ber# e to t.e #enter o+ t.e #.ein- s!r+a#e o+ t.e #rest o+ a on-it!dina rid-e* (esia and dista ra(p. At t.e =!n#tion it. t.e #rest o+ a on-it!dina rid-e (esia &estib! ar #!sp +or(s t.e #entra s! #!s. i.e dista s ope o+ t.e (o!nd +or(ed bU a trans&erse +!rro* .i#. #oin#ides it. t.e ine o+ -reatest dia-ona +ro( &estib!ar-(esia end to dista -pa ata * is #onne#ted to t.e (edia &estib! ar ra(p dista t!ber# e. ?it. a si-ni+i#ant destr!#tion o+ t.e in-!a s!r+a#e o+ t.e #ron* Carabe i t!ber# e restored a separate portion o+ t.e (ateria B 7) $i(! ation o+ an additiona (esia #!sp and t.e +or(ation o+ t.e #entra +ront (trian-! ar) .o esB 8) $i(! ation o+ t.e oest o+ t.e dista pa ata t!ber# e* additiona dista t!ber# e and +or(in- t.e rear #enter (trian-! ar) .o es it. a dista -pa ata -roo&esB 9) >eter(ine t.e # osin- o+ t.e restored toot. it. teet.anta-onists* t.e topo-rap.U o+ t.e o## !sa #onta#ts it. arti#! atinpaper e3a!s#.g* t.eir #orre#tion in t.e #entra and +!n#tiona o## !sionB 10) %inis.in- t.e restoration (%i-. 15).

%i-. 15. C ini#a e;a(p e o+ restoration o+ t.e o## !sa s!r+a#e o+ toot. 26* .i e (aintainin- a .ei-.t o+ t!ber# es9 a) +or(ed #a&ities and iso ation o+ t.e #o++erda(* and b) si(! ation o+ Xob i!e s#a opXB #) si(! ation o+ t.e o## !sa s!r+a#e o+ t.e (esia &estib! ar #!spB d) si(! ation o+ t.e o## !sa s!r+a#e o+ t.e dista pa ata t!ber# e. T2e 4%e34 #. $#del&n- %2e "r#Hn #. .&r4% l#Her $#lar H&%2 &%4 .ull de4%ru"%&#n5 %aK&n- &n%# a""#un% %2e %F3e #. #""lu4al 3a%%ern; 1) i.e st!dU o+ intero## !sa re ations.ips* topo-rap.U and deter(ination o+ t.e tUpe o+ pattern on t.e +irst oer (o ars. 3e+ore be-innin- t.e restoration* it is ne#essarU to e;a(ine t.e re ations.ip beteen o## !sa toot. ros* and in parti#! ar* beteen t.e +irst (o ars on t.e side o+ t.e a++e#ted toot. (see abo&e). ?.en s.attered* irrationa restored o## !sa s!r+a#e o+ t.e toot. o+ a sU((etri# or no* Uo! (!st

44

45

deter(ine .ere t.e pro=e#tion o+ o## !sa #onta#t (esia pa ata #!sp o+ t.e !pper (o ar anta-onist. 2n s!#. #ases* e re#o((end re#onstr!#tion o+ t.e o## !sa s!r+a#e o+ teet. Xp !s e\g patternX as t.e (ost si(p e. 4or(a U* t.e Xp !s e\g patternX is #.ara#teri8ed bU t.e presen#e o+ a #entra pit* .i#. in t.e position o+ #entra o## !sion* (esia pa ata t!ber# e o+ t.e !pper +irst (o ar o## !sa #onta#t +or(. 2+ Xe]g patternX and Xe^g patternX* #.ara#teri8ed bU t.e presen#e o+ (esia and dista o+ t.e #entra +ossa. "esia pa ata t!ber# e +or(s +or t.ese tUpes o+ o## !sa #onta#t pattern in t.e dista re-ion o+ t.e #entra +ossa. %ro( t.is it +o os t.at t.e o#ation o+ o## !sa #onta#ts +or(ed bU (esia pa ata t!ber# e (aU ser&e as a -!ide +or opti(a re#o&erU o+ da(a-ed posterior s!r+a#e o+ t.e +irst oer (o ar* .i#. #o! d be !p to its destr!#tion. i.is i .e p in e&erU # ini#a #ase o+ t.e indi&id!a p an o+ re.abi itation and to #reate (ore a##!rate +iss!re-pap! ose o## !sa re ations.ip beteen t.e teet.-anta-onists. ?.en bio(etri#s (ode s a so deter(ined t.e presen#e or absen#e o+ (i-ration o+ t.e teet. and oer teet. o&er ap t.e nat!re o+ t.e !pper +ronta area. i.!s* dependin- on t.e tUpe o+ pattern* e i #onsider in parti#! ar t.e (ode in- o+ t.e ar#.ite#toni#s o+ t.e o## !sa s!r+a#e (%i-. 16)B 2) >eter(ine t.e #o or o+ t.e +!t!re restoration o+ t.e !se o+ t.e s#a e o+ #o ors W2iA B 3) Constr!#tion o+ s!pportin- parts in bat#.es #ron restorati&e (ateria and t.e trans+er o+ a de+e#t in t.e de+e#t-"/> ((esio-dista o## !sion)B 4) irans+er to a de+e#t - "/ ((esio-o## !sa ). se#tiona (atri; and ed-e* it. t.e #onstr!#tion o+ t.e pro;i(a dista #onta#t. Conta#t points on t.e atera teet. are # oser to t.e abia s!r+a#e* and t.e in-!a s!r+a#e o+ t.e pro;i(a dep oUed in t.e ora side. %or t.e #orre#t #onstr!#tion o+ t.e ed-e point o+ #onta#t s.o! d be insta ed it. t.e in-!a sideB 5) irans+er to a de+e#t - / (o## !sion). 2nsta ation o+ se#tiona (atri; and ed-e* it. t.e #onstr!#tion o+ t.e pro;i(a (esia #onta#tB 6) At t.is sta-e* #arried o!t pre-deter(ination t.e .ei-.t o+ t.e #ron to sU((etri#a U positioned toot.* re-ard ess o+ t.e tUpe o+ pattern. iaRin- t.e prin#ip es o+ +or(ation o+ t.e #rons o+ t.e teet. (od! es t.at rese(b e t.e s.ape o+ t.e #anines* e be-in it. t.e (ode in- o+ &estib! ar dista t!ber# e* .i#. o##!pies a #entra position in t.e &estib! ar part o+ t.e (o ar. 2n t.e absen#e o+ a stored .ei-.t o+

b!(ps on bot. sides. i.e +or(ation o+ t.e (esia s!r+a#e o+ t.e &estib! ar #!sp bo!ndarU s.o! d be at a distan#e o+ abo!t 5 (( +ro( t.e (esia an- e o+ t.e #ron it. a s ope in t.e in-!a side* ea&in- spa#e to (ode t.e (esia &estib! ar rea#tionB 7) >ependin- on t.e tUpe o+ pattern* t.e Xp !s e\g patternX pro#eed to t.e (ode in- o+ t.e dista in-!a #!sp. i.is (o!nd is restored .i-.er and s.arper t.an t.e dista (posterior). "esia border o+ t.e #!sp ( in-!a -roo&e) is +or(ed at t.e e&e o+ t.e &estib! ar s! #!s (esia to t.e +or(ation in t.e #entra part o+ t.e #ron o+ one o+ t.e #entra pit* or a -enera point o+ #onta#t beteen t.e b!(ps. %!rt.er bat#.es o+ t.e (ateria #onsistent U per+or( (ode in- o+ &estib! ar (esia #!sp. Zis si(! ation o+ .o a (assi&e spend on a readU e;istin- additiona anato(i#a and(arRs - &estib! ar and dista (esia in-!a t!ber# e. 3eteen t.e (esia &estib! ar and in-!a (esia t!ber# e* o+ten is an additiona t!ber# eB ?.en Xe^g patternX is #arried o!t (ode in- o+ t.e dista in-!a #!sp so t.at t.e on-it!dina rid-e o+ t.e rea#tion as #rossindia-ona U t.e #enter o+ t.e #ron* in t.e dire#tion o+ t.e (esio&estib! ar #!sp* +or(in- a strai-.t ine* not separated bU -roo&e #onta#t. i.en #onsistent U per+or( (ode in- o+ &estib! ar and in-!a (esia t!be.

46

47

%i-. 16. $ta-es o+ si(! ation o+ t.e o## !sa s!r+a#e o+ toot. 46 at t.e tota destr!#tion o+ t.e o## !sa s!r+a#e it. t.e +or(ation o+ Xe]g patternX (pattern). 2+ Xe]g patternX a (ode in- (esia in-!a #!sp* .ose prono!n#ed on-it!dina rid-es #onne#ted bU a s.ort +!rro in t.e #enter o+ t.e #ron* it. t.e &estib! ar dista t!ber# e* di&idin- t.e o## !sa s!r+a#e into to parts. i.en .o d #onsistent U to b!i d separate portions o+ t.e (ateria - o+ t.e dista in-!a and &estib! ar (esia #!sp. A+ter t.at* per+or( (ode in- o+ (esia in-!a #!sp. "esia in-!a t!ber# e is s i-.t U .i-.er and ar-er t.an t.e dista in-!a * as e as .i-.er and

s.arper t.an t.e (edia &estib! ar. i.e an- e +or(ed bU t.e s opes o+ .i o#Rs* +a#in- ea#. ot.er* # ose to dire#t. ?.en (ode in- t.e (esia in-!a #!sp* additiona -!idan#e +or t.e proper +or(ation o+ its #oppertri&ia bo!ndarU* in o!r obser&ation (aU be an i(a-inarU ine dran +ro( t.e top o+ t.e se#ond pre(o ar in-!a #!sp (esia to t.e #entra +ossa o+ t.e oer +irst (o ar. $i(! ation o+ an additiona (esia t!ber# e on t.e (ar-ina rid-eB 8) "ode in- o+ t.e dista t!ber# e is t.e +inis.in- step in t.e si(! ation o## !sia s!r+a#e o+ t.e +irst oer (o ar +or a t.ree (a=or tUpes o+ pattern. 9) >eter(ine t.e # osin- o+ t.e restored toot. it. teet.anta-onists* t.e topo-rap.U o+ t.e o## !sa #onta#ts it. arti#! atinpaper e3a!s#.g* t.eir #orre#tion in t.e #entra and +!n#tiona o## !sion. 10) %inis.in- o+ t.e restoration. $!#. an a -orit.( (ode in- t.e o## !sa s!r+a#e o+ (o ars* in o!r opinion* a os not on U t.e ri-.t to re#o&er t.e ost anato(i#a re ie+* b!t a so desi-ned to per+or( po U(eri8ation* !sin- t.e dia-ona position o+ t.e +iber. ?.en Uo! sa&e a (partia or +! ) t.e .ei-.t o+ .i o#Rs o+ t.e +irst oer (o ar toot. #ron #aries de+e#t #an be des#ribed as t.e "/> - de+e#ts or "/ - or /> - a de+e#t t.at needs to be #on&erted into / - de+e#t. A+ter preparation and iso ation o+ operati&e +ie d +ro( t.e ater* i+ not eno!-. spa#e beteen t.e teet. +or t.e insta ation and restoration o+ #e (atri; #onta#t point* Uo! (!st +irst (aRe t.e preparation o+ separation (Xed-in-X) it. t.e !se o+ ooden ed-es* .i#. #an absorb (oist!re and in#rease in &o !(e. 2n t.e +!t!re* t.e basi# prin#ip es and se!en#e (ode in- is #arried o!t bU t.e sa(e r! es as stated abo&e* -i&en t.e n!(ber o+ s!r&i&in- t!ber# es and pattern o+ t.e o## !sa s!r+a#e #.ara#teristi# o+ t.e toot.. S%a-e4 #. $#del&n- 4e"#nd l#Her $#lar "r#Hn4 %2e "#$3le%e de, 4%ru"%&#n #. &%4; 3asi# prin#ip es and se!en#e (ode in- is #arried o!t bU t.e sa(e r! es as (entioned abo&e* taRin- into a##o!nt t.e tUpi#a pattern o+ t.e o## !sa s!r+a#e o+ t.e toot. +or t.is9 1) $i(! ation o+ t.e dista in-!a #!sp* 2) "ode in- o+ t.e (edia &estib! ar #!sp* 3) "ode in- o+ (esia in-!a #!sp* and 4) (ode in- o+ &estib! ar dista t!ber# e. i.e anato(i#a s.ape o+ t.e +irst (o ars o+ t.e !pper and oer =as in t.eir str!#t!re is one o+ t.e (ost #o(p e; in t.e denta sUste(

48

49

and no (atter .at (et.od i be t.e restoration o+ t.e de+e#t o+ t.e toot. #ron* t.e ReU is to si(! ate t.e re ie+ o+ t.e o## !sa s!r+a#e. %or ea#. str!#t!ra !nit is t.e nat!re o+ its +!n#tiona ro e* and +eat!res o+ t.eir anato(i#a and (orp.o o-i#a str!#t!re deter(ine t.e o#ation o+ o## !sa #onta#ts* o## !sa restraint .ei-.t. ?it. s!#. +ine di++erentiation si-ni+i#ant U in#reased t.e orRin- area o+ t.e #.ein- s!r+a#es o+ teet.* t.!s ens!rin- opti(!( per+or(an#e o+ t.eir +!n#tion. i.ere+ore* t.e presented (ode is based on t.e sta-es o+ t.e -ro!nd anato(i#a str!#t!re o+ t.e #orona part o+ t.e pre(o ars and (o ars o+ t.e !pper and oer =a. Qi&en t.is* o! d be (!#. easier to p an a se!en#e o+ a#tions +or t.e restoration o+ #o(posite (ateria s and i pro&ide an opport!nitU to e;# !de a n!(ber o+ possib e errors (ade in deter(inin- t.e se!en#e o+ restorin- o## !sa re ie+. 2t is pro&ed t.at it is a aUs and in a #ases* ea#. +or#e (!st be e&e ed bU anot.er +or#e* e!a to it in (a-nit!de and opposite in dire#tion at ea#. point in desi-ns. i.is is tr!e +or a desi-ns +o!nd in nat!re* re-ard ess o+ t.eir si8e and #o(p e;itU. 2+ t.is #ondition is not +! +i ed or #.an-ed +or anU reason* it is t.e ba an#e beteen a e e(ents o+ t.e str!#t!re !nder oad and da(a-e o&er ti(e. i.e (an is a part o+ nat!re* and denta sUste( is a #o(p e; o+ interre ated and intera#tin- str!#t!ra e e(ents to ens!re nor(a +!n#tion o+ a .ar(onio!s .o e bio(e#.ani#a str!#t!re. Considerin- t.e +!n#tion o+ denta sUste( in ter(s o+ t.e abo&e* #an be seen in t.e e -Rnon +a#t t.at t.e #.ein- press!re* trans(itted t.ro!-. t.e teet. on t.e oer =a* deter(ines t.e o#ation o+ bars #an#e o!s bone in a #ertain dire#tion* respe#ti&e U* t.e &a !es o+ o#a stresses* t.e so-#a ed tra=e#tories. iaRen to-et.er* t.e ine tra=e#tories o+ #o idin- oads #reate a str!#t!re rese(b in- a sRe eton* and re+ e#t t.e +!n#tiona a#ti&itU o+ t.e oer =a. %ro( t.e point o+ &ie o+ resistan#e* t.e oer =a is treated as a bodU o+ e!a stren-t.. 2t be#o(es # ear t.at it. re-ard to Xstr!#t!ra X +eat!res o+ dentition is t.e (ost stab e o## !sion is obser&ed in #onta#t it. t.e (o!nds o+ denta +iss!res anta-onists in t.e #entra o## !sion* in .i#. de&e op t.e .i-.est &a !es o+ +or#e and t.ere+ore t.e (ost +re!ent U !sed in t.e #.ein- +!n#tion. As noted bU W. 4o&iRo& (2001)* s!#. a re ation beteen (o!nds and rid-es o+ t.e bo!ndarU iRe a Xbri#R a X* a prin#ip e .i#. is t.at t.e top ro o+ bri#Rs* ea#. p a#ed so t.at ea#. one o&er aps t.e =oint beteen t.e bri#Rs o+ t.e oer ro* .i#. is opti(a +or e&en distrib!tion o+ o## !sa oads and ens!re e++e#ti&e

#.ein-. 2n addition* t.e (orp.o o-i#a str!#t!re o+ t.e posterior t!ber# es is a so o+ -reat i(portan#e to per+or( t.is +!n#tion denta sUste(. An ea#. t!ber# e #.ein- s!r+a#es o+ t.e s.ape o+ a !adran-! ar pUra(id .ose base is in t.e +or( o+ non-re-! ar !adran- e and is o#ated inside t.e toot. #ron* and t.e trian-! ar +a#es +or(ed bU +o!r ribs. /ne o+ t.e( is o#ated on t.e o## !sa s!r+a#e o+ t.e #ron in ter(s o+ #.ein- e++i#ien#U is (ost i(portant* be#a!se at a distan#e o+ 1-2 (( +ro( t.e ape; o+ t!ber# es on t.e( are o## !sa #onta#t points* .i#. are t.e +ood #.opper* and t.e +a#es o+ t.e pUra(id pro&ide stabi itU d!rin- t.e +!n#tion . 2t #an be ass!(ed t.at t.is +or( o+ t!ber# es pro&ides not on U a +!n#tion o+ #r!s.in- and #.ein- +ood* b!t a so a os Uo! to e&en U distrib!te t.e o## !sa press!re on t.e ed-es o+ t.e b!(ps to t.e botto( o+ t.e pUra(id* .i#. is t.e e&e o+ t.e e!ator* pre&ent o&er oadin- o+ s!pportinperiodonta tiss!es a on- t.e on- a;is o+ t.e toot.. i.is ass!(ption is #on+ir(ed bU st!dies* .i#. s.oed t.at t.e oad on t.e toot. &o ta-e is distrib!ted a on- t.e on-it!dina a;is or tan-entia U - to t.e #onta#t points beteen teet. - anta-onists. %!n#tiona #.ara#teristi#s o+ oad distrib!tion (!st be taRen into a##o!nt bU (ode in- t.e #.eins!r+a#e o+ t.e t!ber# es* as o## !sa #onta#ts d!rin- (asti#ation are not si-ni+i#ant U di++erent +ro( t.ose o+ sa oin-* t.e (ost +re!ent U o##!r d!rin- t.e s idin- (otions in di++erent dire#tions and it. di++erent startin- points* t.!s +or(in- o## !sa area d!rin- #.ein- and ens!rin- opti(!( per+or(an#e o+ t.e +!n#tions. i.e o#ation and n!(ber o+ o## !sa #onta#ts* as e as t.e dire#tion o+ app i#ation +or#es d!rin- # os!re o+ t.e teet.* a++e#t t.e a#ti&itU o+ t.e (!s# es t.at raise t.e oer =a. Wio ations ead to o## !sion o+ t.e o## !sa p ane de+or(ation* #.an-e in t.e oad on t.e e e(ents o+ t.e te(poro(andib! ar =oints #ontrib!tin- to t.e de&e op(ent o+ #.roni# (itRrotra&(U and re+ e;i&e U red!#in- t.e a#ti&itU o+ (asti#atorU (!s# es. /n U in t.e traditiona * +ree o+ &io ations # osin- dentition* re#orded its .i-.est a#ti&itU. 2t as a so +o!nd t.at t.e atera teet. it. a s(a distan#e beteen t.e &estib! ar and in-!a t!ber# es are ess +a&orab e #onditions +or t.e nor(a trans&ersa o## !sion it. taRininto a##o!nt t.e topo-rap.U and o#ation o+ t.e anta-onists o+ t.e a;is o+ t.e toot.. %ro( t.is it +o os t.at .en a si-ni+i#ant destr!#tion o+ t.e toot. #ron* ost .en t.e (ain anato(i#a and(arRs o+ t.e o## !sa s!r+a#e o+ t.e toot. is not t.e sa(e it. preser&ed (orp.o o-U*

50

51

t.e si(! ation s.o! d be based on t.e si8e o+ t.e toot.. i.is is ne#essarU +or (ore a##!rate re#onstr!#tion o+ t.e toot. #ron .ei-.t* and proper insta ation o+ a set o+ teet.* t.!s pre&entin- its destr!#tion !nder t.e in+ !en#e o+ o## !sa oadin- in di++erent p anes. i.e proposed &ersion o+ t.e (ode in- te#.ni!es o+ o## !sa s!r+a#es o+ (o ars is based on t.e anato(i#a +eat!res o+ t.eir str!#t!re* .i#. e be ie&e are so(e -!ide ines in t.e restoration and #o(p e(ents t.e e -Rnon (et.ods. %or e;a(p e* $. W. 7ad insRU (1999) proposes to restore t.e o## !sa s!r+a#e o+ t.e separate portions o+ restorati&e (ateria indi&id!a toot. b!(ps t.at +or( t.e bo!ndaries o+ t.eir spe#i+i# desi-n #.ara#teristi# o+ t.e +iss!res o+ t.e toot.. A##ordin- to W. 4o&iRo& (2001)* s.o! d +o#!s on t.e top o+ t.e sa&ed and t.e (ain #!sps +or(in- t.e #.ein- s!r+a#es o+ #ond!#t a+ter t.e po U(eri8ation o+ t.e restorati&e (ateria it. spe#ia dia(ond b!rs o+ di++erent -rit on t.e sta-e o+ +inis.in- t.e restoration o+ A. W. $a o&* W. ". 7e.a#.e& (2004) +or e;a(p e de(onstrate t.e # ini#a re#o&erU o+ t.e +irst oer (o ars and re#o((end rep!b i#s +irst b!##a #!sps bearin- and t.en speaRin- -!ides* and eaRened #!sps red!#ed to 2 (( in .ei-.t and +!rt.er b o#R t.e #o(posite. Co(p ian#e it. a p.ases o+ restoration it. a +i in- (ateria * t.e dire#t (et.od* and si(! ation o+ t.e o## !sa s!r+a#e is a #o(p e; tasR and e&en (ore #o! d be .ard it.o!t t.e !se o+ r!bber da( or a spe#ia a!;i iarU too s +or (a;i(!( iso ation o+ toot. to be restored +ro( #onta(ination it. sa i&a* et#. /n t.e ot.er .and* t.e ar-er t.e area o+ destr!#tion o+ t.e o## !sa s!r+a#e* t.e (ore di++i#! t to a#.ie&e positi&e res! ts it.o!t a spe#i+i# treat(ent a -orit.( si(! ation* .i#. o! d be on t.e one .and is easU to !nderstand and (e(ori8e* b!t on t.e ot.er .and o! d be a X+ e;ib e too X in t.e .ands o+ a dentist .o o! d be a so easi U adapted to &ario!s # ini#a sit!ations* b!t does not #.an-e in essen#e. 2n t.is #ase it is ob i-atorU o+ o## !sa #onta#ts and p annin- #ir#!its restoration. kno ed-e o+ t.e topo-rap.U and anato(U o+ t.e o## !sa s!r+a#e o+ posterior teet. i be -!ided in t.e #orre#t ar#.ite#t!re and +eat!res o+ re#o&erin- t.e #ron o+ t.e toot.* as t.e irrationa +i in-* as e as prost.eti#s* .i#. &io ates t.e (a;i(!( inter#asp #onta#t* (aU #ontrib!te to str!#t!ra #.an-es in t.e periodonta tiss!es and #a!se #.roni# &io ation o+ t.e a#ti&itU o+ (asti#atorU (!s# es and ead to dUs+!n#tion o+ t.e te(poro-(andib! ar =oints (pain* # i#Rin-* #r!n#.in-* et#.). i.!s* .en si(! atin- o## !sa re ie+ o+ posterior teet. s.o! d be

-!ided bU t.eir indi&id!a ar#.ite#t!re and in parti#! ar t.e patterns o+ re ie+. io a#.ie&e t.is -oa e !se (et.od +or si(! atin- t.e o## !sa s!r+a#e o+ posterior teet. on an Xen&e opeX* .i#. pro&ides t.e (ost a##!rate reprod!#tion o+ o## !sa re ie+.

SUMMARD i.e res! ts o+ o!r #o(p e; in&esti-ations ser&ed as a basis in t.e pre(ier e aboration i(pro&ed prin#ip es and (et.ods o+ restoration o+ t.e atera teet. o## !sa s!r+a#e (orp.o o-U bU !sin- #onte(porarU #o(posites. i.e proposed (et.ods o+ atera teet. o## !sa ar#.ite#t!re (ode in- preser&in- t.e indi&id!a o## !sa pi#t!re a##ordin- to t.e men&e ope[ prin#ip e and esions "/> mse#tiona [ prin#ip e in#reases t.e e;a#tness o+ intero## !sa #onta#ts topo-rap.i# restoration* t.ese bein- i(portant +or ens!rin- t.e o## !sa e!i ibri!(.

B&Ll&#-ra.&a
28. nLNGFHI o. JIdFIHpb dMqMHFr I_pDILsHNc jdNhLMtb ONEEpIHNOLMHFr jNLNEpMc O hN_NObG aDhIG : uMHpodp. 1 v 1. 1 2012. 1 E. 50 1 56. 29. uMLFjMdF w.* nIdxOMLL u.* yNcIHI y. JNEEpIHNOLMHFM HMOFpILsHbG aDhNO E jNtNzs` jdrtbG dMEpIOdI{Fc E FEjNLsaNOIHFMt _NtjNaFpI* DEFLMHHN|N ONLN_HItF. yLFHF}ME_Fc ELD}Ic : @. Ad.es. >ent. - 2005* v 7. - d. 165 - 171.

52

53

30. utFpdFMH_N w. J.* ~OIHNO . .* ydI`q_FH o. ~.* NIdHF{_Ir C. C. dI_pF}ME_NM dD_NONxEpON jN tNxMLFdNOIHF` aDhNO : - C.9 ~a-ON eK JPC C g. - 2001. 1 240 E. 31. ~NM A. DhNOdI}MhHbM aItMp_F. M_p jNLFtMdFaI{FNHHNc DEIx_F _NtjNaFpHbG tIpMdFILNO : PNONM O EpNtIpNLN|FF. - 2002. - (101) v 5. - E. 25 - 26. 32. NtFIqOFLF . C.* o`jNOI . . fDxNMEpOMHHNM tNxMLFdNOIHFM F dMEpIOdI{Fr aDhNO : C.9 ~ax-ON eCMxF{FHE_Ir _HF|Ig. 2004. - 252 E. 33. NtFIqOFLF .* N|IxIMO u. dNEpdIHEpOMHHNM NdFMHpFdNOIHFM EpNtIpNLN|NO jdF dM_NHEpdD_{FF aDhNO C uMHpodp. - v 4. 2006. - E. 32 - 40. 34. D{_Ir ~. y.* PNOI_ P. J. pIjb dIhNpb E NpNjNLFtMdItF O EpMpF}ME_Nc EpNtIpNLN|FF : wNOdMtMHHIr EpNtIpNLN|Fr. - 2004* v 3. - E. 4 - 11. 35. CDEFGFHI A. J. yLFHF_N-LIhNdIpNdHNM FEELMxNOIHFM IdtFdNOIHFr jdF jLNthFdNOIHFF xMM_pNO dMDzM|N _dIr F N__L`aFNHHNc jNOMdGHNEpF aDhNO : oOpNdM. xFE. _IHx. tMx. HID_ :: - C.9 - 2005. 36. PNOF_NO J. K__L`aFr O dMEpIOdI{FF aDhNO : uMHpodp* 2001* v 4.- E. 35 - 40. 37. PF_NLIMO o. ~.* MjNO . C. dI_pF}ME_Ir pMdIjMOpF}ME_Ir EpNtIpNLN|Fr : - wh9. wIH_p-MpMdhDd|E_Fc FHEpFpDp EpNtIpNLN|FF* 2001. - 390 E. 38. KLMENOI J. P.* yLMjFLFH A. w.* N|IpHMO J. . F xd. nFNtMGIHF_I pOMdxbG p_IHMc aDhI jdF aItMzMHFF jNLNEpF pFjI CKu _MdNtMdHbtF O_LIx_ItF FLF jdrtbtF _NtjNaFpHbtF dMEpIOdI{FrtF : wpNtIpNLN|Fr. - 2006* v 1. - E. 14 - 17. 39. NE_DE .* LIEFxN . F xd. JLFrHFM Ix|MaFOHNc EFEpMtb F tMpNxF_F HIHMEMHFr tIpMdFILI HI _dIMOD` jdNHF{IMtNEps _NtjNaFpHbG dMEpIOdI{Fc : @. Ad.es. >ent. - 2004* v 6. - d. 227 232. 40. NEpNLI_F o. JIdFIHp pMGHF_F tNxMLFdNOIHFr jdrtbt tMpNxNt N__L`aFNHHNc jNOMdGHNEpF hN_NObG aDhNO. IEps 2 : uMHpodp. - 2007* v 1. - E. - 73 -79. 41. NEpNLI_F o. JIdFIHp pMGHF_F tNxMLFdNOIHFr jdrtbt tMpNxNt N__L`aFNHHNc jNOMdGHNEpF hN_NObG aDhNO. IEps 22 : uMHpodp. - 2007* v 2. - E. 69 - 78.

42. IxLFHE_Fc w. J. JFxb jdrtNc dMEpIOdI{FF aDhNO : uMHpIdp - 2004. - v 1 E. 33 - 40. 43. IxLFHE_Fc w. J. MEpIOdI{FNHHbM _NHEpdD_{FF jMdMxHM|N F hN_NON|N aDhNO : uMHpodp. - 1996.- v 4. - E. 22 - 29. 44. IxLFHE_Fc w. J. MEpIOdI{Fr hN_NObG aDhNO9 EpdIpM|Fr F jdFH{Fjb : uMHpodp. - 1999.- v 4. - E. 30 - 40. 45. IxLFHE_Fc w. J. MEpIOdI{Fr hN_NObG aDhNO9 _NHEpdD_{FF F _LIEEb : uMHpodp. - 2000.- v 1. - E. 31 - 40. 46. N|NHF_NO . ~.* N|FHNO J. o.* oEpIqFHI P. n.* MdhI_NO o. w.* yNH`GNOI w. . MEpIOdI{Fr pOMdxbG p_IHMc aDhNO O_LIx_ItF : - C.9 ~a-ON eCMxF{FHE_Ir _HF|Ig. - 2002. - 150 E. 47. wILNOI o. J.* MGI}MO J. C. KENhMHHNEpF EpMpF}ME_Nc dMEpIOdI{FF O EpNtIpNLN|FF9 dI_pF}ME_NM dD_NONxEpON : - wh.9 ~axON eMLNOM_g. - 2004. - 160 E. 48. OM nLDH_. ox|MaFOHbM EFEpMtb. KhaNd F EdIOHMHFM : uMHpIdp. - 2003* v 2. - E. 5 - 11. 49. OM nLDH_. ox|MaFOHbM EFEpMtb. KhaNd F EdIOHMHFM : uMHpIdp. - 2003* v 3. - E. 25 - 30. 50. 3!r a#! W.* 3!r a#! W.* $trat! W.* Carta ean! An-e a* %!ior W.* A bot $&et ana. $iste(e ade8i&e de ! ti() -enera,ie. "edi#ina sto(atoo-i#) nr.1* &o .1. 6di,ie #onsa#rat) #e !i de-a ^222- ea Con-res 4a,iona a A$7". C.i0in)!* 2006* p. 81-82. 51. %is#er ?. JbEN_N_I}MEpOMHHNM ONEEpIHNOLMHFM hN_NObG aDhNO E FEjNLsaNOIHFMt ietri# Cera( : PNONM O EpNtIpNLN|FF. 2000* v 9. - E. 14 - 17. 52. @o++e A. M_pFOHNEps jNLFtMdFaI{FHHNc DEIx_F _NtjNaFpHbG tIpMdFILNO : PNONM O EpNtIpNLN|FF. - 2002. - v 5. - E. 25 26. 53. Vee&ai o= $. C.* Co#.ran ". A.* "atis 3. A.* "oore 3. k.* P att @. A. "i#ro eaRa-e o+ Posterior Pa#Rab e 7esin Co(posites ?it. and ?it.o!t % oab e Viners : /perati&e >entistrU. - 2005. - (26)* v 3. - d. 217 - 320. 54. ?i#.(an ". IEqFdMHFM jN_IaIHFc _ jdNOMxMHF` pMdIjMOpF}ME_N|N LM}MHFr _I_ ILspMdHIpFOb NdpNjMxF}ME_NtD OtMqIpMLsEpOD. : yOFHpEEMH{Fr. - 1993. - v 4. - E. 4 - 6.

54

55