masters of esthetic dentistry

PROFILE

Dr. Cherilyn G. Sheets

Current Occupation Private Practice, Newport Beach, California

Executive Director, Newport Coast Oral Facial Institute, Newport Beach, California

Education University of Southern California, School of Dentistry, DDS

Academic Affiliations Clinical Professor, Department of Restorative Dentistry, University of Southern California

Associate Clinical Professor, Department of Orthopaedics, University of California School of Medicine, lrvine

Professional Memberships Fellow, Pierre Fauchard Academy of Dentistry

Fellow, American College of Dentists

Fellow, International College of Dentists

Fellow, Academy of General Dentistry

Fellow, Academy of Dentistry International

Offices Past President, American Academy of Esthetic Dentistry

Past President, American Academy of Women Dentists 1997 to Present, Editorial Board, Journal of Esthetic and Restorative Dentistry 1998 to Present, Editorial Board, Journal of the American Dental Association

Publications "Pathways to the Pulp" Chapter on Bleaching

Contributions to Dentistry Patent on F'eriometer, with James C. Earthman, PhD, University of California, lrvine

Founder of two nonprofit organizations: The Children's Dental Center and Newport Coast Oral Facial Institute

Masters of Esthetic Dentistry

THE CLINICAL MICROSCOPE IN AN ESTHETIC RESTORATIVE PRACTICE

Cherilyn G. Sheets, DDS Jacinthe M. Paquette, DDS Katsuhiro Hatate, RDT

ere is much interest in the sci- T" entific and clinical community about the use of the surgical microscope in dentistry. The increasing interest in magnification is evi- denced by the introduction of surgical microscopes into dental school curricula throughout the nation. What makes clinical magnification so intriguing is that the need for optimal visibility is one of the most common challenges shared by all disciplines of dentistry. The dual advantages of increased illumination and magnification provided by the surgical microscope make the delivery of dental care easier. The chief benefits a restorative dentist will immediately appreciate are a broader range of visual accessibility, more favorable ergonomics, and improved quality of end results.

Until recently, magnification as used by the dental clinician has been in the form of eyeglass- mounted oculars with or without illumination accessories.'" Many dentists have introduced another tool into their operatory setting, the fiberoptic, head-mounted lighting system. However, the use of

both the oculars and the light source can become awkward, with a cord running from the head- mounted lighting platform to the light generator, decreasing maneuverability. Additionally, the increasing weight of the system can lead to upper body discomfort and mus- cle fatigue.h In contrast, the clinical microscope allows the operator to perform in an upright position under clear illumination, leading to a direct reduction in musculo- skeletal

Baumann realized the necessity for integrating the surgical microscope into dental practice over 20 years

from his otorhinolaryngology practice, he discovered that the structures of the oral cavity can be illuminated and visualized much more clearly, and that even simple caries preven- tion is enhanced by its use. Given the technologic advances apparent in optical machinery, the clinical microscopes currently available supersede the ability of those described by Baumann and provide greater levels of magnification accompanied by a broader field of view.

Borrowing the microscope

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Former publications have eluci- dated the benefits of the clinical microscope in specialty fields including endodontics, periodon- tics, oral surgery, and prosthodon-

Association of Endodontists elected to require that all endodontic post- graduate students display profi- ciency in using the microscope before receiving their certification.* The growing use of microscope- assisted dentistry has also become apparent in the periodontic field. Microsurgical techniques and instrumentation, coupled with the surgical microscope, empower the periodontal surgeon to operate with increased precision and reduced surgical trauma.’.’

In 1998, the American

The benefits of the clinical microscope extend beyond the specialty fields of dentistry. Practitioners in general practice seek to reap the benefits of the microscope as do specialists, enhancing both the stan- dard of care and the level of treatment. With the additional video packages and co-observer oculars available for many of the current microscopes, dental assistants can view the procedures as never before possible and prepare materials more efficiently and knowledgeably, furthering the efficiency of dental procedures.

The restorative dental procedures currently encountered are much more involved than procedures encountered just a decade

Accompanying this increasing com- plexity in restorative practices, many new materials and methods have been developed to advance both the longevity and esthetic quality of restorative procedures. However, these new technologies cannot be maximized unless the clinician can clearly visualize the operating field.Is

REVIEW OF IMPORTANT FEATURES FOUND IN A CLINICAL MICROSCOPE

The ideal restorative clinical microscope may have many variations, but there are several essential features that are needed: stable fixation, sufficient arm length to com- fortably extend the distance from fixation to operating field, easy maneuverability, good arm balance to negate drift, elimination of microtremors, inclinable oculars, excellent optics, multiple magnifications, fine focus, coaxial illumination, light-curing shields, and the ability to add attachments.

Stable Mounting The stability of the microscope is an important feature that helps prevent micromovement of the scope, causing disruptive movement of the operator’s visual image during use. Microscopes can be mounted in several ways. They can be secured on a floor stand, ceiling mounted, or wall mounted. The decision is determined by operatory dimen- sions and layout for maximized use of space and optimized ergometrics,

location of the most rigid fixation source, and operator preference.

The authors prefer to mount the microscope on the ceiling. Heavy bracing supports can be hidden in the ceiling to provide stability for the scope. Additionally, the microscope should be ideally mounted in a position that is to the left of the patient for the right-handed operator and approximately at the patient’s hip area. This position not only allows for sufficient maneuverability of the microscope in multiple planes, it also allows easy storage during times of nonuse. Wall mountings should be used only when the walls are extremely stable and free from any movement. Floor mounting allows the ability to move the microscope from one operatory to another. However, in practice, currently designed microscopes are infre- quently moved, owing to instrument weight and the bulky nature of the floor stand.

Several features of the microscope should be examined in more detail. it is critical for a restorative dentist to have inclinable binoculars, to allow ease in viewing many areas of the mouth (Figure 1) This increased adjustability not only allows more flexibility in the vertical dimension, it also permits multiple axis locations of the microscope body while maintaining comfortable binocular-eye posi- tions. Additionally, an adjustable interocular distance permits cor-

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Figure 1 . A, Clinician in working position demonstrating ideal ergometric positioning with use of inclinable binoculars. B , Inclinable binoculars prouide a wide range of maneuverability for ideal positioning.

rect, stereoscopic vision throughout the visual field (Figure 2). Improper interocular distance causes double vision through the microscope. Each eyepiece also should allow for individual focus adjustment to accommodate the wide array of personal visual abilities.

with unlimited flexibility for optimized visual acuity to address all clinical situations (Figure 3 ) .

The clinical microscope should con- tain fine focal adjustments. As the level of magnification fluctuates, the ability to fine-focus the visual field

The microscope also must provide multiple magnification settings. The microscope illustrated in this article has a six-step magnification system, with the lowest setting, 0.33, allot- ting a 2.2 times magnification, and a setting of 3 affording 21 times magnification. The settings that are commonly used during tooth preparation are 0.8 ( 5 . 6 ~ ) for bulk tooth reduction and 1.25 ( 8 . 7 5 ~ ) to 2 (14x) for final finishing of the tooth preparation. These variable magnification levels provide the clinician

becomes paramount in maintaining a clear view of the operating field. Another beneficial attachment for restorative applications is the light- curing filter. This provides uncom- promised faculty in handling light-sensitive materials under microscope-assisted vision during adhe-

Figure 2. Adjustable intraocular distance permits correct alignment of eyepieces to individual needs.

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video leads for monitors or recording devices, and printers for Polaroid photographs. These varied options often eliminate the need for other less flexible and antiquated methods of detailing clinical procedures (Figure 4). For the clinical professional educator, "operator's view" can now be transmitted live with ease during any clinical demonstration.

CLINICAL POSITIONING

Figure 3. Multiple magnification set- rings are available at tbe turn of a knob.

A proper seating position is key to effective ergonomics with the clini-

sive and bonding procedures. With the orange filter in position, the operator can work on light-sensitive materials with full visibility from the coaxial illumination and magnification while not inadvertently curing the photosensitive materials. The filter allows the dentist to view the field with adequate light on light- sensitive composite materials without the frustration of premature curing. With such shielding of unwanted light, the benefits of illumination and magnification can be experienced during the entire placement process of composite filling materials and during the luting process of porcelain-bonded restorations.

For the clinician who wishes to document procedures, audiovisual attachments provide an ideal setup for through-the-scope documenta- tion. Many options are available, including a 35-mm camera attachment, digital camera attachments,

cal microscope. When preparing to work on a patient, the dentist's position in the doctor's chair must be such that the thighs are parallel to the floor, and the body is seated in the rearmost position on the chair. Arm supports on the chair impart ideal arm stabilization to minimize tremors and fatigue. These supports must be positioned

to support the forearm of the operator at a level that approximates the patient's mouth. The operator's back should be well supported by the chair as well, with several adjustments to the back support, ensuring ideal positioning (Figure 5) . Once properly seated, the opera tor then places the microscope at a height that maintains ideal seating and allows comfortable viewing through the oculars without any excess strain. The interocular positioning is established to provide a single, stereoscopic visual field.

The patient is placed in a fully reclined chair position. Throughout procedures, the patient's head is slightly adjusted to improve operator visibility of different areas of the mouth and for focus. Additionally, during restorative procedures, the patient's chair may be moved slightly to change the focal distance

Figure 4. Port attachments allow for varied docttmentation options, swh as 35-mm photography, digital photograpby, OT

video recording.

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from direct to reflected vision. The most common ways to bring an area into focus include chair movement, patient head movement, and mirror movements. The least used method is microscope movement after initial ergonomic positioning (Figure 6).

MICROSCOPIC VIEWS OF A SIMPLE ESTHETIC PROCEDURE

The bonded porcelain veneer restoration has dramatically impacted the daily practice of dentistry. The conservative and mini- mally invasive nature of the preparation, coupled with the ability to provide excellent esthetics, has made the porcelain veneer a well- accepted restorative option. The underlying basis for the long-term success of these restorations is a properly designed substructure- the tooth preparation. The following example of microscope-assisted restorative dentistry demonstrates the use of the clinical microscope in the preparation, impression, provi- sionalization, try-in, and final luting procedures.

The patient presented with two maxillary central incisors that were in need of restoration, owing to increasing incisal edge translucency and subsequent chipping of the incisal edges (Figure 7). The patient was educated as to her parafunc- tional activities that had potentially caused the defects to develop, and all treatment options were dis- cussed. She chose the conservative and esthetic advantages of porce-

lain veneers and understood the need to wear a protective occlusal splint after restoration of the two anterior teeth.

Magnification and focus to 8.75 times created a visual field limited to the two maxillary central incisors to be prepared. The handpiece head was positioned so that it was directed from a lingual approach, providing an unobstructed operating view for the clinician. Incisal depth reduction grooves were made, and the incisal edge was reduced (Figure 8). The microscope was adjusted slightly toward the operator. The patient’s head could be slightly tilted downward to provide a more gingival visual field, or minor losses of focus could be corrected with the fine focus knob for refined clarity of the image. Depth reduction was then accomplished with the depth reduction bur, in a

biplane fashion, to compensate for the curved labial surface of central incisors (Figure 9). Depth-reduction grooves were extended across the entire labial surface and provided a guide for the preliminary 0.3 to 0.5 mm of enamel reduction. A bullet-shaped diamond bur was used to remove the labial enamel, following the guide of the depth- reduction grooves (Figure 10).

The patient chair was moved closer to the microscope, to allow focusing into a mirror placed against the incisal edges of the mandibular incisors. It is often helpful for the patient and for the operator if the patient has the assistance of an intraoral bite block to provide sufficient interarch distance and stabilization of the mandibular jaw to prevent micromovements. At this stage, the operator’s choice and space requirements determine the

Figure 5. Proper clinician positioning is easily achieved with appropriate back and arm support.

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Figure 6 . A, Microadjustments in patient chair position can be accomplished by clinician or assistant. B, Adjustment o f mirrors allows additional flexibility in focus.

type of mirror used. Traditional mouth mirrors come in various sizes. Occlusal and buccal photo-

graphic mirrors are helpful in many situations, and endodontic mirrors provide micro-sized reflective sur-

faces (Figure 1 1 ) . Mirror placement may be intra- or extraoral, depend- ing on the area being viewed.

Figure 7. A, Right lateral, B, central, and C, left lateral views of maxillary incisors of patient desiring porcelain veneer restorations of both central incisors.

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Figure 8. The initial depth cuts for a porcelain veneer preparation using a 1 -mm-thick, bullet-shaped, diamond bur. Three initial cuts are made to ensure even incisal reduction. All microscope views are oriented as seen from a 12 o’clock operator position.

A mirror places the visual object at a greater distance from the operator. Moving the patient’s chair closer to the microscope negates the increased effective visual distance. Additionally, the operator can choose to focus into the mirror at

a distance that is remote from the working field. This provides the handpiece with an unobstructed work environment without sacrific- ing visual control and minimizes the potential buildup of debris onto the mirror surface.

Figure 9. Biplane reduction between the incisal plane and the ceruical plane of the labial surface of the tooth ensures even reduction across the curvature of the tooth.

From an incisal view, the current incisal-labial portion of the preparation was visualized. With a lingual handpiece approach for increased visibility, the bur was placed in a position to create an incisal offset (Figure 12); an alter- native position to create this offset is a vertical approach. Once the incisal offsets were completed, the patient chair was repositioned toward the floor, and a direct labial view of the maxillary central incisors was established. The final step was to use a 12-fluted carbide finishing bur only on the margins to provide a sharp marginal edge free of any bur roughness (Figure 13). The bur was not used on the body of the preparation. Any marginal discrepancies could be evalu- ated at higher magnifications and removed with the finishing bur (Figure 14).

If the proximal margins are placed close to the contact point but do not extend through the contact area, it is sometimes helpful to pass a fine’ finishing strip through the interproximal area (Figure 15). This assures the operator that any plaque, preparation debris, or roughness is removed prior to the making of impressions. Addition- ally, it assists the laboratory techni- cian at the time of die fabrication during the die separation process with a more distinct finish of margin to adjacent teeth.

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Figure 10. The depth reduction cuts are connected with the two-grit diamond bur. A, Attention to the biplane curvature of the preparation is again followed with this bur. B, Magnification allows greater control and accuracy in marginal placement.

The Impression With the aid of magnification, the retraction cord soaked in hemosta- tic solution was gently and atrau- matically placed in the gingival sulcus. When the cord was removed, the preparation was dried and re- examined prior to placement of the impression material to confirm that the preparation was clean and dry. As the impression material was

extruded from the fine tip of the syringe, the operator could actually watch the impression material flow into the sulcus. A dry airflow could be used to maximize the adaptation of the light-bodied polyvinylsiloxane impression material (Figure 16).

At this stage, after the impression is removed, the operator can immediately evaluate the marginal accuracy,

inspect for bubbles or inclusions, and assess the thoroughness of set of the material. If there are any problems noted, the impression can easily be retaken while the patient is still in the chair and anesthetized. The authors have noted that with higher magnifications, impression defects that could have caused even- tual problems in restoration fabrication are easily located and eliminated.

Figure 1 1. A, Numerous mirror choices allow varied approaches to achieve optimal visibility. B, A large occlusal view mirror is an effective way to obtain a broad view of the preparation field through the microscope. The patient chair must be adjusted toward the microscope to refocus the field of vision.

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Figure 12. The incisal offset o f the preparation before final refinement for sharp and distinct margin detail.

The prepared teeth were then cleaned in preparation for spot bonding of laboratory-processed, custom-made acrylic provisional restorations (Figure 17).

Laboratory Fabrication Proper shade selection must take into consideration a number of fac- tors: the shade of the prepared tooth, the shade of the surrounding teeth, the patient desires, and the

porcelain materials being used. It is recommended that the shade of the underlying tooth be assessed at a time subsequent to the preparation appointment to allow for rehydra- tion of the tooth surface. This assess- ment assists laboratory technologists with information regarding irregularities in color continuity that may require special masking procedures. Photographs that accurately reflect the clinical situation are a vital tool to help the laboratory technologist. The fabrication of the porcelain veneers was accomplished with the assistance of stone models, epoxy models, and refractory dies. Die trimming procedures were achieved with the use of the laboratory micro-

Figure 13. A, Sharp transition of lingual offset to facial aspect o f preparation, noted on inspection in various planes. B, A more idealized, rounded transition created by elimination of sharp area. C, The finishing process begins with the use of the 12- fluted carbide bur at the marginal area only. D, The 12-fluted carbide bur is used to create a smooth margin finish for idealized porcelain adaptation.

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Figure 14. A, This 2 1 -times magnification view illustrates the types of marginal irregularities that can be easily detected and corrected with the use of the microscope, as indicated by this explorer tip. B, View at 2 1 -times magnification following the correction of the marginal defect with the 12-fluted carbide bur.

scope at 20 times magnification for enhanced marginal accuracy.

The laboratory technologists fabri- cated an epoxy master cast following the multidie technique to incor- porate the refractory dies. As part of this multidie master cast, remov- able refractory dies replace the epoxy dies for fabrication of the two porcelain veneers.'"" The porcelain veneers were then taken to completion on these refractory dies, and fine adjustments to the functional occlusion were achieved. After all finishing and adjustments were completed with the veneer still affixed to the refractory material, the refractory die material was removed from the delicate porcelain veneer (Figure 18). The porcelain margins were examined under the laboratory microscope, and final finishing and refitting of the porcelain margins was accomplished.

The use of the laboratory microscope for these detailed adjustments combined with the creation of distinct, crisp margin detail at the time

of preparation greatly enhances the marginal integrity of the porcelain restorations. Careful refitting of the veneers on to their dies and solid casts during the laboratory phase is a tremendous advantage because it minimizes clinical adjustment time.

Preliminary Try-In O n the patient's subsequent appointment, the veneers were ready for try-in. At this appointment, macroscopic and micro-

scopic evaluations were required for thorough restoration evaluation. Macroscopic evaluations included the overall esthetic impact of the restorations; the color, as determined by the placement of a try-in material; the comparison of overall length with the provisional restoration, to compare phonetic appropriateness; the contour; the contacts; and the surface texture. The patient's approval of esthetics was received at this time (Figure 19).

Figure 15. An interproximal polishing strip can be used to slightly accentuate the interproximal contact for easier laboratory die fabrication procedures.

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Figure 16. A, The polyvinylsiloxane material is injected into the sulcular area. B, Magnification ( I 4 ~ ) of the impression ensures proper inspection for an idealized impression.

Figure 17. A, The final preparations, after impressions, cleaned and ready for spot bonding of the provisional restorations. B, Provisionalized maxillary central incisors. Provisionals act as an esthetic template for final restorations.

Figure 2 8. A, Close-up view of individual refractory dies prior to porcelain applica- tion. 8, Refractory dies seated in master epoxy cast. C, Completed porcelain veneers still affixed to refractory dies.

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Figure 19. Once the dentist and technologist are pleased with the results, the final evaluation and approval rests with the patient.

I t is critical to always have patient approval prior to final luting procedures. The patient needs to have psychologically committed to the restorations at this time in the process. The microscopic areas of evaluation chiefly involve marginal adaptation at the try-in, bonding, and finishing stages of delivery (Figure 20).

The Delivery The provisional restorations were removed, cleaned, and examined under magnification for any residual bonding agent. Etchant was applied in an even layer on the first tooth preparation to be bonded. The etched preparation was then dried and examined for any areas of dentin exposure (Figure 21).

If dentin is found to be exposed, and a wet bonding technique is desired, the tooth is rehydrated for a minute with water and blotted dry with a

Figure 20. Magnifications of 10 to 20 times provide excellent visual confirmation of marginal fit.

clean cotton pellet. With the light- blocking filter in place on the lighting source, preventing premature curing, the dentin-enamel bonding agent is applied. This provides a unique opportunity during any bonding procedure to have direct viewing with adequate illumination without fear of prematurely curing the light-sensitive materials. Prior to curing, an ultra-thin metallic strip is placed into the interproximal areas.

The light-blocking feature of such a strip prevents curing of excess material onto adjacent tooth surfaces.

After silanation, the veneer was treated with the selected manufac- turer’s luting resin and filled composite luting material. With gentle finger pressure in a labial and incisal direction, the excess material smoothly flowed ou t of the marginal areas. This excess was incre-

Figure 2 1 . Etchant was started on all enamel margins and spread over the entire surface for complete etching.

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mentally removed with a resin- moistened brush leaving a small bead at the marginal interface, and thorough curing was achieved over the entire labial and lingual surfaces (Figure 22).

Microscopic Finishing With magnification of 10 to 14 times, atraumatic removal of excess

resin was simplified. The use of sharp knives allowed an accurate and gentle removal of the residual resin without damaging the tooth surface or the veneer (Figure 23). No rotary instruments were used to prevent accidental abrasion of the highly polished porcelain surface and the tooth interface. Rubber polishing burs, fine finishing strips,

and polishing pastes were used to achieve the final finish and surface gloss (Figure 24).

The use of magnification even during simple restorative procedures places great control in the hands of the dental practitioner and the dental technologist. More accurate tooth preparations, detailed impres-

Figure 23. Carbide cutting hand instruments are used to carefully remove the excess luting material under 2 1 times magnification.

Figure 22. A, The veneer was applied with gentle finger pressure from a labial and incisal direction, and excess material was delicately removed with a resin-moistened brush. B, An extra-thin Mylar strip was placed to separate and protect adjacent teeth from the curing materials and to facilitate finishing.

Figure 24. A, Porcelain veneers immediately after placement. B, Smile view of patient with completed porcelain veneers.

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sions, precise dental technology products, accurate evaluation and fitting of the final restorations on the patient, and the ultimate luting and finishing procedures are all enhanced with the benefits of the clinical microscope. Enhanced magnification and illumination in an ergonomically friendly environment will enhance dental results for gen- erations of patients to come.

REFERENCES 1. Caplan SA. Magnification in dentistry.

J Esther Dent 1990; 2:17-21.

2. Fiolek D. Magnification. J Can Dent Assoc 1992; S8:3S 1.

3. Friedman MJ. Landesman HM. Micro- scope-assisted precision (MAP) dentistry, a challenge for new knowledge. J Calif Dent Assoc 1998; 26:900-905.

4. Millar BJ. Focus on loupes. Br Dent J 1998; 185:504-508.

5. Shanelec DA. Optical principles of loupes. j Calif Dent Assoc 1992; 20:25-32.

11. Sheets CC. The periodontal-restorative interface: enhancement through magnification. Pract Periodont Aesthet Dent 1999; 1 ]:A-H.

12. Strassler HE, Syme SE. Serio F. Kaim JM. Enhanced visualization during dental practice using magnification systems. Com- pend Cont Educ Dent 1998; 10:600-602.

13. Tibbets LS, Shanelec DA. Periodontal microsurgery. Dent Clin North Am 1998; 42:339-359.

14. Whitehead SA, Wilson NH. Restorative decision-making behaviour with magnification. Quintessence Int 1992; 23:667471.

6. Sheets CC, Paquerte JIM. Practical applications of the clinical microscope in a restorative dental practice. Compend Cont Educ Dent 2000; 21:1084-1092.

15. Rubenstein R. The anatomy of the surgical operating microscope and operating posi- tions. Dent Clin North Am 1997; 41:3 19413.

DISCLOSURE AND ACKNOWLEDGMENTS

The authors have no financial interest in any of the companies or products mentioned in this article.

7. Friedman M, Mora AF. Schmidt R. Micro- scope-assisted precision dentistry. Corn- pend Cont Educ Dent 1999; 20:723-736.

16. Paquene IM, Taniguchi T. White SN. Dimensional accuracy of an epoxy resin die material using two setting methods. 1

The authors acknowledge Ario Barzin, research assistant, Newport Coast Oral Facial Institute, and Katsuhiro Hatate, RDT, dental technologist.

8.

9.

10.

Michaelides PL. Use of the operating microscope in dentistry. J Calif Dent Assoc: 1996; 24:45-SO.

Baumann RR. How may the dentist bene- fit from the operating microscope? Quin- tessence Int 1977; 517-18.

Khayat BC. The use of magnification in endodontic therapy: the operating microscope. Pract Periodont Aesthet Dent 1998; 10: 137-144.

Prosthet Dent 2 6 0 ; 83:3011305.

17. Sheets CC, Taniguchi T. A multidie technique for the fabrication of porcelain lami- nate veneers. J Prosthet Dent 1993; 70:291-295.

Reprint requests: Cherilyn G . Sheets. DDS. Sheets and Paquette Dental Practice, The Newport Coast Oral Facial Institute. 360 Son Miguel Drive, Suite 204, Newport Beach, CA 92660; e-mail: [email protected] 8 2001 BC Decker lnc

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