Surfaces Of Molars Research Articles

Ideal placement of an implant considering the positional relationship to an opposing tooth in the first molar region: a three-dimensional finite element analysis

BackgroundExcessive loading from the occlusion is known as a major pathological factor in implant failure. The force applied to the implant varies depending on the positional relationship to an opposing tooth in clinical cases. However, no studies have clarified the relationship between the discrepancy and mechanical complications.Materials and methodsThe study enrolled patients whose mandibular first molar was missing and was opposed by a natural maxillary first molar. The horizontal and vertical distance between the residual ridge and the occlusal surface of the maxillary first molar were measured from computerized tomograms. Subsequently, four finite element models were constructed in combinations of horizontal and vertical discrepancies. Additionally, the effect of inclined implantation and angled abutments were examined in a large clearance model. Maximum von Mises stress values generated in abutments under 90° or 60° loading vectors were compared with a three-dimensional finite element method.ResultsData from 123 subjects (39 males and 84 females, average age 55.2 ± 11.4 (SD) years) were collected for the analyses. Under all conditions, the stress on the load side (the buccal side) was concentrated on the platform, and the stress on the opposite side (the lingual side) was concentrated on the top of the abutment tube inserted into the implant. In comparison to 90° loading vectors, the maximum von Mises stresses of each model were 1.20 to 2.67 times under 60° loading vectors. For inclined implantation, the maximum stress was 8.4% less at a 90° load and 9.7% less at a 60° load compared with vertical implantation. With angled abutments, the maximum stress was 15.7% less at a 90° load and 30.0% less at a 60° load compared with vertical implantation.ConclusionIn cases of progressive alveolar resorption with a large clearance between the implant and the opposing teeth, a higher stress concentration was observed at the joint between the implant and the abutment. Our findings also showed that stress concentration around this area can be reduced by the use of inclined implantation and angled abutments under the condition of a horizontal offset between the implant and opposing teeth.

Comparative Evaluation of Microleakage of Amalgam, High Viscosity and Resin-Modified Glass Ionomers as Restorative Materials in Primary Molars

<p><strong>Background and Objective:</strong> One of the major requisites of an ideal restorative material is excellent marginal seal. Microleakage has been identified as a significant clinical problem with filling materials. The objective of the study was to evaluate and compare the degree of microleakage of amalgam, high viscosity glass ionomer and resin-modified glass ionomer in primary molars.<br /><strong>Methods:</strong> A total of 99 human non-carious primary molars that were liable to exfoliate within the next six months were selected. Standardized Class I cavities were prepared on occlusal surfaces of molars and randomly filled with either Amalgam (Aristaloy 21), High Viscosity Glass Ionomer (Ketac Molar) or ResinModified Glass Ionomer (GC Fuji II LC). The teeth were divided into nine groups (n=11 each) on the basis of filling material used and time of restored tooth extraction viz. one week, six weeks and twelve weeks. After immersion in a 2% methylene blue dye solution for 24 hours, the teeth were sectioned buccolingually in an occluso-apical direction through the middle of the restoration. The specimens were then examined under <br />stereomicroscope at 30X magnification. Statistical analyses were performed with ANOVA and Tukey’s test <br />at 5% level of significance.<br /><strong>Results:</strong> Amalgam restorations had significantly less microleakage as compared to the high-viscosity glass ionomer and resin-modified glass ionomer restorations. High-viscosity glass ionomer restorations were superior in resisting microleakage than resin-modified glass ionomers. The restorative materials used can be arranged in their sealing ability from least to severe microleakage as: Amalgam <High-viscosity glass ionomer <Resin-modified glass ionomer.<br /><strong>Conclusion: </strong>Amalgam restorations showed less microleakage as compared to high-viscosity and resinmodified glass ionomer restorations. Amalgam may preferably be used as a restorative material of choice <br />for primary molars.</p>

Comparison of different diagnostic techniques in detecting smooth surface caries in primary molars using the histological gold standard: An in vitro study.

This in vitro study evaluated the caries status of the smooth surfaces of primary molars using the DIAGNOdent pen, Vistacam iX, and Bitewing radiography as compared to histologic assessment. 68 primary molars were selected, and their mesial or distal caries status were determined using DIAGNOdent pen, Bitewing radiography, and Vistacam iX. To achieve reference standards, the teeth were sectioned and directly assessed by a stereomicroscope. The Mc Nemar test was used to compare the sensitivity, specificity, and accuracy of the methods. The spearman rank correlation coefficient (r) was also determined to compare the extent of caries with histology. The statistical significance level was set at α = 0.05. Regarding D1 as a cut-off point for histological assessments, sensitivity, specificity, and accuracy of DIAGNOdent pen were 82 %, 75 %, and 80 % while the values were 63 %, 100 % and 62 % for bitewing radiography and 56 %, 100 % and 59 % for Vistacam iX. Regarding D3 as a cut-off point for histological analysis; Sensitivity, specificity, and accuracy rates of DIAGNOdent pen were 71 %, 86 % and 80 % while these values were 71 %, 73 % and 72 % for bitewing radiography and 50 %, 78 % and 67 % for Vistacam iX. In conclusion, the DIAGNOdent pen shows the highest performance and accuracy to detect smooth surface caries both at D1 and D3 among the three methods. Although VistaCam iX and bitewing radiography showed better performance at D3 compared to D1, their performances were lower than the DIAGNOdent pen.

Forming temperature of ethylene vinyl acetate sheets for fabrication of vacuum-formed mouthguards.

The appropriate heating temperature for the fabrication of mouthguards using ethylene vinyl acetate sheets is reported to be 80-120°C. However, the measurement side of the heating temperature has not been determined. The aim of this study was to investigate the influence of the measurement side of the heating temperature when fabricating mouthguards. Mouthguard sheets of 3.8mm ethylene vinyl acetate were vacuum-formed on working models until the sheet was heated to 120°C. The sheet temperature was measured at the upper side and the lower side. The thickness of the mouthguard was measured at the labial surface of the central incisor, and the buccal and occlusal surfaces of the first molar. The fit of the mouthguard was examined at the central incisor and the first molar by measuring the distance between the mouthguard and the cervical margin of the working model. Differences in the thickness and fit of the mouthguards were analyzed by two-way analysis of variance. Mouthguard thickness varied among the measured regions of the central incisors and first molars (P<.01). The thicknesses at the labial surface of the central incisor and buccal surface of the first molar were larger when the sheet temperature measured at the lower side was 120°C compared to when the sheet temperature measured at the upper side was 120°C (P<.01). The fit of the mouthguard was better when the sheet temperature measured at the lower side was 120°C (P<.05). The sheet temperature should be measured at the lower side of the sheet and it should be 120°C for fabricating mouthguards.

Longitudinal assessment on the impact of caries status of nearby surfaces on caries progression on the mesial surface of first molars.

The mesial surface of the first permanent molar is the most caries-susceptible proximal surface of the permanent dentition in children under the age of 12. The aim of this study was to determine the association between caries progression on the mesial surface of the first permanent molar (T6M) and caries on the distal surface of the primary second molar (t5D)and the occlusal surface of the first permanent molar (T6O). Children (between 5 and 13years old; N=565) that had participated in a 4-year longitudinal caries study that at baseline had at least one T6 fully erupted with a t5 in proximal contact, with no restoration or sealant on T6O and t5D, and adequate bitewing radiographs were included. Clinical data using the International Caries Detection and Assessment System (ICDAS) and radiographs were used to determine the caries status of T6M, T6O, and t5D. Baseline caries presence on t5D and T6O were highly significantly associated with follow-up caries presence on T6M (P<.001). The adjusted odds ratios corresponding to t5D and T6O were 3.94 (95% CI: [1.78, 8.71]) and 3.26 (95% CI: [1.46, 7.31]), respectively. These findings highlight the need for prevention and management of caries on T6O and t5D.

Quantitative tooth wear analysis of index teeth compared to complete dentition

ObjectivesRecent software advancements have facilitated quantification of erosive tooth wear progression using intraoral scans. This paper investigated if wear on commonly affected surfaces (central incisors and first molars) was representative of wear on the full arch. MethodsBimaxillary digital intraoral scans (True Definition, 3 M, USA) of patients (n = 30) from the monitoring arm of the Radboud Tooth Wear Project, were taken at baseline and at 3 years (+/-10months). The occlusal/incisal surface of each tooth (excluding 3rd molars) was analysed for volume change and volume change per mm of analysed surface area in WearCompare (www.leedsdigitaldentistry.com/Wearcompare) following previously published protocols. Data were normal, descriptives and multi-level linear regression analysis was performed in Stata v15.1 taking patient level and surface type data into account. ResultsData from 556 surfaces in 29 patients were included in analysis. Per patient, mean volume loss (95 % CI) was -0.91mm3(-1.28,-0.53) on all surfaces, -1.85mm3(-2.83,-0.86) on index surfaces, -2.53mm3(-3.91,-1.15) on molar surfaces and -0.83 mm3(-1.34,-0.31) on upper central incisal surfaces. Statistical differences were observed between analysing all surfaces and index teeth(p = 0.002) in addition to molar surfaces(p < 0.0001). Mean volume loss per mm2 of surface analysed was -0.024 mm3 (-0.031,-0.017), -0.028mm3 (-0.041,-0.014), -0.030mm3 (-0.046,-0.013) and -0.025mm3 (-0.041,-0.010) for all surfaces, index surfaces, first molar surfaces and central incisor surfaces respectively with no statistical differences between groups. ConclusionsWear on upper central incisors was not statistically different to full arch wear analysis. If the surface area is standardised, wear on both index surfaces are statistically similar to wear on the full arch. Clinical SignificanceThese results suggest that analysing rates of wear on index teeth can be a resource-saving substitute for analysing rates of wear on the entire dentition, provided the surface area is standardised. If whole surfaces are analysed, the molar surfaces will show greater rates of wear.

Micro-computed tomography analysis of the relationship between root canal number and root concavity in maxillary first and second molars in a Japanese population.

The aim of this study was to investigate root canal configurations in maxillary first and second molars from a Japanese population, as well as the relationship between the root canal number and root concavity depth, using micro-computed tomography. Maxillary first (N = 74) and second (N = 70) molars from a Japanese population were used. Virtual horizontal sections were created, and the number of root canals and the degree of root concavity were measured. Mesiobuccal (MB) roots were categorized into Group 1 (with a single root canal) or Group 2 (with two or more root canals). The relationship between the root canal number and root concavity depth was evaluated using the Mann-Whitney U test. Approximately 51% and 35% of the MB roots in the three-rooted maxillary first and second molars, respectively, had two or more root canals. The depths of the root concavities in maxillary first molars differed significantly between Groups 1 and 2 at the mesial and distal sides of the MB root, in the section 2mm apical to the furcation area (p < 0.05). A significant relationship between the number of root canals and the depth of root concavity in the MB root of the maxillary first molars was observed. Close clinical monitoring is needed during the removal of calculus and cleaning of the root surfaces of maxillary first molars: specifically, excessive removal of cementum and dentin should be avoided, particularly when the molar has already undergone root canal treatment.

Qualitative anatomical restoration of the contact point of teeth – prevention of localized forms of periodontal diseases

Relevance. The restoration of a high-quality anatomical and functional contact point of teeth plays an important role in preventing the development of localized forms of periodontal disease.Purpose. Development of recommendations for qualitative anatomical restoration of the contact point of teeth for the prevention of localized forms of periodontal diseases.Materials and methods. In our study, which consisted of pre-clinical and clinical stages, were analyzed 50 CT scan of the chewing group teeth calculated the ratio of approximal surfaces of molars and premolars to the width of their crowns and computer simulations of the results of restoration of contact point. We also conducted a comparative analysis of wedges of different material with different cross-sectional shapes. At the clinical stage, the restoration of the contact point of teeth in patients according to our recommendations was carried out.Results. On the basis of the data obtained during the study, a formula for calculating the height and size of the restored contact point was compiled. Recommendations for anatomical restoration of the contact point are formulated.Conclusion. The application of the recommendations developed by us allows anatomically qualitatively restore the contact point and prevent the development of localized periodontal diseases.

Glyburide inhibits the bone resorption induced by traumatic occlusion in rats.

To examine whether glyburide inhibits bone destruction caused by traumatic occlusion in a rat occlusal trauma model. Excessive mechanical stress, such as traumatic occlusion, induces expression of IL-1β and may be involved in bone resorption. NLRP3 inflammasomes have been linked to IL-1β expression, but it is currently unclear whether glyburide, the inhibiter of NLRP3 inflammasome, suppresses occlusal trauma in rats. Male SD rats aged 7weeks were used. In the trauma group, the occlusal surface of the maxillary first right molar was raised by attaching a metal wire to apply occlusal trauma to the mandibular first right molar. In the trauma+glyburide group, the NLRP3 inhibitor glyburide was administered orally every 24hours from 1day before induction of occlusal trauma. Rats were euthanized after 5 or 10days, and the maxillary first molars were harvested with the adjacent tissues for histopathological investigation. Immunohistochemical expression of IL-1β, NLRP3, and RANKL was also assessed. On day 5, bone resorption was significantly greater in the trauma group compared with the control group or the trauma+glyburide group, and there were significantly higher numbers of osteoclasts and cells positive for IL-1β, NLRP3, and RANKL in the trauma group. In this study, glyburide inhibits bone resorption by traumatic occlusion in rats. It suggests that the NLRP3/IL-1β pathway might be associated with bone resorption induced by traumatic occlusion.

Comparison between visual and laser-fluorescence diagnosis of occlusal surfaces of first permanent molars. Literature review and clinical cases

Comparison between visual and laser-fluorescence diagnosis of occlusal surfaces of first permanent molars. Literature review and clinical cases

What is on the menu today? Creating a microwear reference collection through a controlled-food trial to study feeding management systems of ancient agropastoral societies

The study of ancient herd-feeding systems is essential to investigate livestock management and the interactions of humans with domestic animals and past environments. This topic for historic periods has recently been investigated through dental microwear analyses. This approach, however, must be used with caution, as it is based on comparisons of established microwear patterns of modern wild animals. Here we present an experimental reference collection of dental microwear for domestic sheep (Ovis aries), created by a controlled-food trial to fill this methodological gap. Fifty sheep were split into five groups of ten, fed with four different types of vegetation potentially used by agropastoral societies (alfalfa, ray-grass, forage, and barley), and administrated following different techniques of processing (wet, dried and fresh). After being fed with a specific and controlled diet, the animals were slaughtered and the microwear patterns on the enamel surface of the lower molars were analysed via standard light stereomicroscopy. The differences found in our experiment between the different diets and processed plants have allowed us to characterize each dietary group and feeding management system. This information is extremely important to correctly interpret the archaeological record.

Appropriate fabrication method for vacuum-formed mouthguards using polyolefin sheets.

The appropriate heating conditions for polyolefin sheets have not yet been determined and polyolefin sheets are usually formed in the same manner as ethylene vinyl acetate sheets. The aim of this study was to examine the appropriate heating conditions for polyolefin sheets when fabricating vacuum-formed mouthguards. Mouthguard sheets of 3.0 mm polyolefin were vacuum formed on working models at three heating temperatures: 90°C, 105°C, and 120°C. The thickness of the mouthguard was measured at the labial surface of the central incisor, and the buccal and occlusal surfaces of the first molar. The fit of the mouthguard was examined at the central incisor and the first molar by measuring the distance between the mouthguard and the cervical margin of the working model. Differences in the thickness and fit of the mouthguards according to the heating conditions and the measured regions were analyzed by two-way analysis of variance. Mouthguard thickness varied among the measured regions of the central incisors and first molars (P < .01). The smallest thickness was found at the labial surface of the central incisor in mouthguards fabricated at 90°C (P < .01). The smallest thickness was found at the buccal and occlusal surface of the first molar in mouthguards fabricated at 120°C (P < .01). The worst fit was obtained with the heating temperature of 90°C (P < .01). The appropriate heating temperature for polyolefin sheets was 105°C to maintain mouthguard thickness and to obtain proper fit.

Greater caries-free survival of first permanent molars: Findings from a 7-year follow-up evaluation of a community-based oral health preventive program.

The occlusal surface of the first permanent molar is the most frequently affected site by dental caries. To assess the caries-free survival of first permanent molars in children participating in a community-based oral health preventive program. This was a retrospective study conducted on 426 children under 12years of age, beneficiaries of a preventive program from 2009 to 2015, in El Cedro, Colombia. The program offered oral health care education, supervised brushing and mouth washing, and application of topical fluoride. By using parametric survival models for interval-censored data, primary and secondary caries-free survival of any first permanent molar was estimated and analyzed. Before program implementation, dental caries lesions presented at an average age, adjusted by age of eruption, of 8.3years for primary caries lesion and 9.3years for secondary caries lesion. After 7years of the program, the estimated average age for presenting primary dental caries lesion was delayed by 4.6years and by 5.3years for secondary caries. The implementation of the oral health program led to improved caries-free survival of first permanent molars.

The long-term effect of sparkling flavored water on human tooth enamel determined by gravimetric analysis: a preliminary evaluation

Objective: The aim of this study was to assess the in vitro effect of flavored waters on human tooth enamel using a gravimetric method. Lingual surfaces of lower molars were used to obtain enamel specimens. Material and Methods: Enamel (n=3) was washed and dried, immersed in 6 flavors of locally available of flavored sparkling water and assessed using gravimetric analysis, periodically for up to 9 days. Additionally, pH measurements of the flavored waters were recorded. Results: All the tested flavored waters showed pH values below that of critical pH. Paired t-tests demonstrated significant reductions in the mean group mass for all enamel specimens from as early as day 1 after immersion in flavored water, compared to baseline measurements. Further reductions in mean mass continued up to day 9 of immersion. Conclusion: Flavored waters are potentially erosive to human enamel specimens with the erosive effect being cumulative over time.KeywordspH; Enamel; dental erosion.

Dose-response Evaluation of Propolis Dental Varnish in Children: A Randomized Control Study.

Early childhood caries is a sugar-dependent disease with multifactorial modulating factors affecting deciduous dentition. It is defined as the presence of at least one decayed tooth, absence of a tooth due to caries or the existence of a temporary restoration in a tooth in a child between zero and 71 months of age. No BRP varnish was found in intellectual property banks, therefore it was registered and deposited with patent number BR1020160190142. The objective of this study was to evaluate the dose-response concentration of alcoholic extract of Brazilian red propolis (BRP), in the form of dental varnish, against Streptococcus mutans (S. mutans) in children. Twenty-four children, aged between 36 and 71 months, of both genders and without caries, were selected to participate in this pilot study and grouped randomly into four groups to receive different concentrations of BRP varnish (1%, 2.5%, 5% and 10%). The varnish was applied to the surface of all second deciduous molars. The antimicrobial activity was observed in saliva, which was collected in two phases: before applying the BRP varnish and after use. There was microbiological reduction of S. mutans in the oral cavity of the children in all the tested concentrations. The highest percentage reduction of S. mutans was observed at the concentration of 2.5% (P = 0.0443). The BRP extract in the form of dental varnish has antimicrobial activity against S. mutans and constitutes a possible alternative in the prevention of dental caries.

The effect of impacted third molars on second molar external root resorption, a cross-sectional cone beam computed tomography study.

Third molars have the highest prevalence of impaction in teeth and can cause pathological damage on the adjacent second molars. This study aims to evaluate the effects of factors related to impacted third molars on external root resorption (ERR) in adjacent second molars using cone-beam computed tomography (CBCT). In CBCTs, the effect of impacted third molars on the root surface of adjacent second molars was investigated. Inclusion criteria for subjects were being older than 16 and younger than 55, presence of at least one impacted third molar and adjacent second molar. Exclusion criteria were pathology, a follicle gap greater than 5 mm, crowned second molar, severe decay, an artifact on a radiologic image, and previous surgery on the second or third molars. The investigations were made based on age range, gender, tooth inclination, Pell-Gregory classification, retention type, contact area, root formation, pericoronal width, and tooth absence on the same quadrant for potential risk factors. The collected data were statistically analyzed with R software. The Chi-Square test was used to find out any significant difference. Logistic regression analyses were done for potential risk factors for ERR. A total of 437 impacted third molars and adjacent second molars were investigated using CBCT. Of these, 381 met the inclusion criteria. Mesioangular and horizontal inclination, Pell-Gregory Class B-C, contact area, and retention type were found the statistically potential risk factors for ERR. The impacted third molar with horizontal or mesioangular position, and osseous retention, with Pell and Gregory Class B and C, are more likely to cause external root resorption in adjacent second molars.

Effect of dental bleaching on the microhardness and surface roughness of sealed composite resins.

ObjectivesThe aim of this in vitro study was to evaluate the microhardness and surface roughness of composite resins before and after tooth bleaching procedures.Materials and MethodsSixty specimens were prepared of each composite resin (Filtek Supreme XT and Opallis), and BisCover LV surface sealant was applied to half of the specimens. Thirty enamel samples were obtained from the buccal and lingual surfaces of human molars for use as the control group. The surface roughness and microhardness were measured before and after bleaching procedures with 35% hydrogen peroxide or 16% carbamide (n = 10). Data were analyzed using 1-way analysis of variance and the Fisher test (α = 0.05).ResultsNeither hydrogen peroxide nor carbamide peroxide treatment significantly altered the hardness of the composite resins, regardless of surface sealant application; however, both treatments significantly decreased the hardness of the tooth samples (p < 0.05). The bleaching did not cause any change in surface roughness, with the exception of the unsealed Opallis composite resin and dental enamel, both of which displayed an increase in surface roughness after bleaching with carbamide peroxide (p < 0.05).ConclusionsThe microhardness and surface roughness of enamel and Opallis composite resin were influenced by bleaching procedures.

Root Topographic Study on Molars with Furcation Involvements in Taiwanese Adults: A Risk Analysis of Furcation Entrance Dimension and Root Trunk Length

The present study was to investigate the Topography of Root Trunk type (RTT) and Furcation Entrance Dimension (FED) on extracted molars affected with advanced periodontitis and furcation involvement (FI). A total 169 extracted maxillary and mandibular molars (165 patients) affected with severely advanced periodontal destruction. The RTT was categorized as A, B, C, and the FED was clarified into subclass -1, -2, and -3, respectively. Results showed that the prevalence of mandibular second molars with RTT-C and FED-1 occurs higher; (33.0%), and the relationship between RTT and FED is significance (p&lt;0.005). In addition, the relationship between RTT-C and FED-1 also shows a statistical significance (p&lt;0.01) on the buccal surface (41.5%) of the mandibular second molar.

Comparison of the Effect of Modified Ward’s and Triangular Flap Design on Periodontium of the Second Molar after Surgical Removal of Mandibular Impacted Third Molar

Background and Objectives: Impacted lower third molar is found in 90% of the general population. Impacted lower third molar surgery may result in complication like pain, swelling, trismus and periodontal health on the distal surface of the adjacent second molar. The aim of this study was to evaluate the effect of flap design on the pain, swelling, trismus, and periodontal health status adjacent to second molar after lower third molar surgery. Materials and Methods: Sixty patients, with an age range of 18-25 years, participated in the present study. They were divided in two groups, each group comprised of 30 patients. In group one triangular flap was used and in group two modified Ward’s flap was used. Post-operatively pain, swelling, trismus was measured on 1st day, 3rd day, and 7th day and periodontal status at 15th days, 1st month, 3rd month and 6th month. Results: No statistically significant differences were found in comparing of pain, swelling, trismus and periodontal status for the between both type of flap design used. Conclusion: It was concluded that the design of mucoperiosteal flap used in surgical removal of impacted mandibular third molar have no effect on the degree of pain, swelling, trismus and periodontal health of adjacent second molar.

Restorative Direct Management of Cavitated Proximal Carious Lesions of Permanent Molars using Elastic Separators in Children and Adolescents

Purpose: The purpose of this study was to assess the longevity of direct amalgam and composite restorations placed on the mesial surface of permanent molars after separation with elastic separators. Design: One hundred and seventy seven (177) restorations placed on the mesial surfaces of first and second permanent molars in 140 patients aged 10-25 years-old (median age 12.2 years) were followed for a period of 1 to 12 years (median time 4.3 years). Eighty four (84) amalgam and 93 composite resin restorations were placed randomly on carious lesions that were detected by bite-wing x-rays at the dentino-enamel junction and verified as cavitated after tooth separation. Restorations were evaluated clinically according to the modified Ryge criteria. Flexible parametric proportional-hazards and proportional-odds models for censored survival data was used to analyze the data, with application to prognostic modelling and estimation of treatment effects at 95% CI. Results: Of the 177 restorations, 13 (7.2%) failed in a median time to failure of 8.8 years. There was no statistically significant difference on the cumulative median time to failures between amalgam and composite while statistically significant difference was found between patients that were using fluoride mouthrinse or not (p<0.048) and if there was bleeding detected at the interproximal area of the restoration or not (p<0.001). Conclusions: Restorative management of cavitated proximal carious surfaces of permanent teeth with amalgam or composite resin, using elastic separators, seems to be a very good and promising alternative technique in the context of the minimal invasive dentistry in children and adolescents.