Prosthodontics Original Article

LAYERS TO A BEAUTIFUL SMILE: COMPOSITE

RESIN STRATIFICATION
1
AYESHA ASLAM
2
BILAL AHMED
3
AZAD ALI AZAD
4
NIDA OVAIS
5
MALEEHA NAYYER
ABSTRACT
A beautiful smile with better dental aesthetics has always been the patient’s prime expectation.
Like all other fields, the field of cosmetic and restorative dentistry has evolved over time. Worldwide
research has been aimed at crafting solutions to provide the patient with minimally invasive, cost
effective and yet aesthetic restorations. A number of different stratification techniques for composites
have been advocated. A vast majority of clinicians still utilize monochromatic techniques when aes-
thetically restoring teeth with composites whereas some believe in the use of a polychromatic approach
with multiple shades, tints and opaque to create life-like restorations. Unless the clinician is well
acquainted with all the available options, choosing the appropriate layering technique and necessary
materials can become very tricky and challenging. This paper aims to provide a review of the various
composite stratification techniques described in literature and to acquaint the reader with the basic
concept working behind these techniques.
Key Words: Direct veneers, Composite resins, cosmetic dentistry.

INTRODUCTION solutions to provide the patient with minimally invasive,

cost effective and yet aesthetic restorations.3 Owing to
One of the major concerns of patients seeking
the advancements in dental materials and restorative
dental treatment is aesthetics.1 An enhanced smile
skills, a smile can now be improved cosmetically with
with better dental aesthetics and long-lasting effects
the help of both direct and indirect procedures.4
has always been the patient’s prime expectation.2 Like
all other fields, the field of dentistry has evolved over Every new dental material is developed with the
time. Worldwide research has been aimed at crafting aim to optimize aesthetics and to make the restorative
procedure minimally invasive.5 From the discovery
1
Ayesha Aslam, PG Resident (MS Prosthodontics Program), De- of enamel etching by Bunaocore in 1955 and the Bis
partment of Prosthodontics, Army Medical College, National Uni- -GMA resin by Bowen in 1961,6 Resin composites have
versity of Science & Technology (NUST) Islamabad.
Email: [email protected] improved tremendously over time, especially in the last
2
Bilal Ahmed, Associate Professor, Department of Prosthodontics two decades.7 With their improved aesthetics, color
/ AFID Army Medical College, National University of Science &
Technology (NUST) Islamabad stability and clinical longevity as well as affordable
Email: [email protected] cost and preservation of tooth structure compared to
3
Azad Ali Azad, Professor, Department of Prosthodontics / AFID porcelains, composites can now be considered the pre-
Army Medical College, National University of Science & Technol-
ogy (NUST) Islamabad Email: [email protected] ferred treatment modality for the restoration of both
4
Nida Ovais, PG Resident (MS Prosthodontics Program), Depart- anterior and posterior teeth.8,9 Many of the deficits
ment of Prosthodontics, Army Medical College, National Univer-
sity of Science & Technology (NUST) Islamabad
pertaining to the aesthetics or function of teeth can
Email: [email protected] simply be restored by the use of direct composites,
5
Maleeha Nayyer, PG Resident (MS Prosthodontics Program), either as restorations or as veneers.10
Department of Prosthodontics, Army Medical College, National
University of Science & Technology (NUST) Islamabad. Along with enhancing the material properties,
Emaiil: [email protected]
Correspondence: Dr. Bilal Ahmed, Associate Professor, Depart- efforts have also been made by the clinicians in im-
ment of Prosthodontics, Army Medical College, Abid Majeed proving the application technique of composites, so
Road. Rawalpindi Cantt. Cell: 92321-600-8263
Email: [email protected] as to achieve a better color matching between the
Received for Publication: October 24, 2015 composite and the natural tooth tissue.11 Advent of
Revised: June 16, 2016 stratification or the layering techniques has hence
Accepted: June 20, 2016

Pakistan Oral & Dental Journal Vol 36, No. 2 (April-June 2016) 335
 Layers to a beautiful smile

Fig 4: Buccolingual approach for tooth restoration

via Natural Layering Concept13

Fig 1: Dual shade technique - Identifying the

different shades of enamel(b) and dentin(a)

Fig 5: Polychromatic Technique: Color chart for

selection of composite shades46

Fig 2: Vanini’s Anatomic Stratification: The five

color dimensions30

Fig 6: Style Italiano - Restoring tooth with two

shades only51
broadened the spectrum of composites efficiency in
recreating the anterior aesthetics.12 Initially, efforts
were made to imitate the layering techniques used for
porcelain restorations.13 This resulted in complicated
procedures, rendering the use of composites somewhat
technique-sensitive.14 Subsequent simpler layering
techniques were introduced based on the concept of
reproducing enamel and dentin layers as found in a
natural tooth.15 To achieve cosmetic results that are
Fig 3: Tristimulus L*a*b*color measurements both aesthetic and predictable, composite layering

Pakistan Oral & Dental Journal Vol 36, No. 2 (April-June 2016) 336
 Layers to a beautiful smile

techniques must be easy, effective, and repeatable.16 A translucency, as required for restoring the incisal edges
common consensus today exists that in order to achieve of anterior teeth, while in a thicker section, this nano-
indiscernible aesthetic composite restorations, a ‘bio- hybrid absorbs light, perfectly mimicking the darker,
mimetic’ incremental layering technique is mandatory, saturated appearance of the natural chromatic dentin.28
employing a number of different shades of enamel-like
and dentin-like materials (depending on the patient’s Dual Shade Layering Technique
requirement).17,18 Dual-shade technique employs two different shades
of resin composites for the restoration of lost tooth
DISCUSSION
structure (Fig 1). It is usually recommended for begin-
A number of different stratification techniques for ners who are unfamiliar with the concept of composite
composites have been advocated in the literature.19 layering.19 A darker, more opaque shade is selected to
A vast majority of clinicians still utilize monochro- recreate the lost dentin, followed by the use of a more
matic techniques when aesthetically restoring teeth translucent composite shade to build up the enamel.20
with composites20 while some believe in the use of a It is, however, the clinician’s skill that enables the
polychromatic approach with multiple shades, tints selection of appropriate composite shades to emulate
and opaque to create life-like restorations.21 Unless the natural tooth layers in both form and color.29
the clinician is well acquainted with all the available
options, choosing the appropriate layering technique Vanini’s Stratification Technique
and necessary materials can become very tricky and Lorenzo Vanini introduced the concept of anatomic
challenging.22 stratification. This technique of stratification is based on
All the composite layering techniques that have the restoration of the lost enamel and dentin tissues to
been published so far are at least theoretically based their proper location and thickness, guided by the five
on the concept of reproducing the histological layers color dimensions of teeth.30 The five color dimensions
as found in a natural tooth.23 Different techniques that include ( Fig. 2): Chromaticity – high chroma for dentin,
have been proposed in literature include Monochromatic Value – strictly associated with enamel and decreases
Technique, Dual-shade Layering Technique, Vanini’s with age, Intensives – like white areas in enamel owing
Stratification Technique, Natural Layering Concept, to defects in mineralization, Opalescent – confined
Histological Layering Technique, Polychromatic Lay- to the incisal third only and responsible for creating
ering Approach, Incremental Monolayering and Style the halo effect of enamel, Characterizations – include
Italiano. mamelons and bands for dentin and margins, stains
and cracks for enamel.19,30-32
Monochromatic Technique
Prior to any clinical intervention, a chromatic
The most common and widely practiced technique chart is created based on the patient’s tooth color di-
for anterior composites is the monochromatic tech- mensions.31,33 Restorations are constructed by initially
nique.19 As the name implies, it involves the use of only building up the lingual/palatal enamel and then the
one composite shade to replace the lost tooth structure, interproximal walls using the same composite shade.30
whether only enamel or both enamel and dentin. Most of Depending on the size of the preparation, one or more
the time, employing a monochromatic technique does not high chromaticity shades are then selected to restore
yield optimal aesthetic results20, since the complicated the opaque dentin, paying special attention to “chro-
color and optical properties existing in a natural tooth matic desaturation” from the gingival to the incisal
cannot be reproduced by any single composite shade.24 third. Any characterizations, intensives or opalescents
This leaves the patient highly discontented with the must be incorporated at this stage. Finally, the labial
final restorative outcome.25 or buccal enamel layer of a higher translucency is laid
down trailed by the finishing and polishing procedures.19
However, recent advancements in the creation
of enhanced restorative materials have led to the Natural Layering Concept
development of a newer “light-cured nano-hybrid
composite” (Nuance™, Philips Oral Healthcare, www. Natural layering concept, proposed by Didier Diet-
philipsoralhealthcare.com) that allows the reproduction schi, involves the use of two separate composite masses
of the natural aesthetics using only a single shade of to restore the tooth anatomy.34 The concept is based
the composite for the whole of the restoration.26 This on the employment of natural tooth as a model and
nanohybrid composite contains “multi-faceted fillers” identification of the optical properties of true dentin
that both reflect and refract light, replicating the ex- and enamel.35 It utilizes the “tristimulus L*a*b* color
act optical properties of the natural tooth and hence measurements and contrast ratio”, where L* is the
eradicating the requirement for any polychromatic lightness or value, a* is hue over the green-red axis
approach.27 When used in a thin section, it exhibits and b* is the hue over the blue-yellow axis (Fig 3).36

Pakistan Oral & Dental Journal Vol 36, No. 2 (April-June 2016) 337
 Layers to a beautiful smile

Dietschi suggested the selection of a composite material the optical properties of both the natural tooth and the
to replicate dentin that should have a single hue, a sin- available materials.29,47-48
gle opacity but a large chroma (beyond the usual four
Polychromatic approach is favored by the fact that
Chroma levels of the VITA system).34,37 He described
our natural dentition is also polychromatic, with a
three different types of enamel as young, adult and
variable thickness and hence, a varying chroma and
old.38 This characterization is based on the changes in
translucency of dentin and enamel in different parts
value L* and the contrast ratio in relation to the age
of the tooth.21 For this reason, this techniques suggests
of the tooth, with the enamel becoming yellower, less
the selection of a single dentine shade with a chroma
opalescent and more translucent with the advancing
preferably one shade higher than the natural tooth.26
age.34,37-40 The technique involves the placement of
For replacing enamel, a combination of chromatic and
lingual enamel layer, followed by the use of a high
achromatic shades must be used. Chromatic enamel
chromatic shade to build up the dentin and a last layer
shades are preferred in the gingival third where a more
of translucent enamel to complete the restoration (Fig
saturated color and a higher opacity can be perceived
4).41-42 In cases where special optical effects are seen
while in the incisal third, achromatic shades with
in the tooth such as areas of hypocalcification or areas
higher translucency are utilized so that the underlying
with high opalescence, special tints or effect materials
mamelons may be visible.26,48 For a medium-sized class
may be used to mimic the natural tooth.34,41
IV direct composite restoration or a direct composite
Histological Layering Technique veneers, Fahl suggested the use of the following dif-
ferent shades of composite46:
Another stratification technique by the name
of Histological Layering Technique (HLT) has been i A dentin shade with large chroma and small value
proposed by Jeff T. Blank. The technique is based on ii A shade for body enamel, opposite to that of dentin,
the concept of replacing the lost tooth layers with a with less chroma and more value
composite material that closely resembles the natural
tissues in both color and opacity.23 If only the enamel iii A translucent effect shade for enamel to create
layer needs to be restored, then a single enamel shade effects in the incisal third
of composite is selected and used. However, with larger iv A “milky white semi-translucent effect enamel”
and deeper preparations, two different shades are used shade with a high opacity to build up contours and
for restoration of the dentin and enamel respectively.43 halo effect
HLT has been advocated as requiring “minimal artis-
tic skills” such that even inexperienced clinicians can v A “value effect enamel” shade that forms the outer
achieve excellent cosmetic results within minutes.44 most final layer of the restoration

In case of direct composite veneers, HLT’s princi- vi Opaquers to be used in combination with the enamel
ple of replacing only the lost tissue layer faces a slight and dentin shades in cases where a strong discol-
variation. In most of the cases, direct composite veneers oration of the underlying tooth needs concealment.
are minimally invasive or at times require no signifi- A color chart may prove helpful in the selection
cant tooth modifications at all.4 Hence, no tooth layer of various composite shades for restoration buildup
is literally being restored. However, in such a case, the (Fig 5). Polychromatic technique, though somewhat
operator must create both the chromatic dentin layer technique-sensitive and time consuming, can work
incorporating the contours and mamelons as well as wonders in emulating natural dentition and satisfying
the translucent enamel layer with the replication of the patient’s cosmetic anticipations.45
the natural halo effect at the incisal edge.23 The result
would be a life-like restoration with optimum aesthetics. Incremental Monolayering

Polychromatic Layering Approach Incremental monolayering has been described as

a simplified technique for achieving optimal aesthetic
Newton Fahl Jr. strongly recommends the use of results related to the development of a new hybrid
a polychromatic approach for creating stratified com- composite that resembles the natural tooth in terms
posite restorations. It is an advanced clinical technique of the optical parameters (Clearfil Majesty Esthetic,
that utilizes a number of different composite shades to Kuraray America, Inc.). To create imperceptible aes-
build up the lost or affected tooth substrate.45 With this thetic restorations, in each case, a “low-shrinkage flow
technique, the clinician is able to control the color as well able” composite is first placed on the tooth surface as a
as the form of the final restoration, thereby achieving liner. This is followed by the placement of the hybrid
highly aesthetic and effective results.46,47 In order to composite by monolayering of only one shade of the
master this stratification technique, the clinician must material.49
be well-versed with the material characteristics and

Pakistan Oral & Dental Journal Vol 36, No. 2 (April-June 2016) 338
 Layers to a beautiful smile

A relatively newer nanohybrid material, Herculite® Rehabilitation of Anterior Teeth with Laminate Composite
Veneers. Case Reports in Dentistry Volume 2014; 1-9.
Ultra™ (Kerr) has also been proposed for the incre-
mental monolayering. The material is said to possess 5 Korkut B, Yanıkoğlu F, Günday M. Direct Composite Laminate
Veneers: Three Case Reports. J Dent Res Dent Clin Dent Pros-
good handling properties, especially sculpability and pect 2013; 7(2): 105-11.
an excellent “chameleon effect” to mimic the natural
6 Dima R. Esthetics and Biocompatibility of Ceramic versus
aesthetics.50 Composite Dental Laminates. TMJ 2011; 61(1-2): 102-06.
Style Italiano 7 Gresnigt MMM, Kalk W, Ozcan M. Randomized Controlled
Split-Mouth Clinical Trial of Direct Laminate Veneers with Two
A latest introduction to the field of aesthetic and Micro-Hybrid Resin Composites. Journal of Dentistry 2012; 40:
restorative dentistry is a relatively easy yet highly aes- 766-75.
thetic technique famous by the name of Style Italiano. 8 Macedo G, Raj V, Ritter AV. Longevity of Anterior Composite
Style italiano is basically a group of famous Italian Restorations. J Esthet Restor Dent 2006; 18: 310-11.
dentists who are the ambassadors of this restorative 9 Hickel R, Manhart J. Longevity of Restorations in Posterior
technique. The concept, actually originated by Dr Wal- Teeth and Reasons for Failure. J Adhes. Dent. 2001; 3: 45-64.
ter Devoto and Prof Angelo Putignano, aims to equip 10 Dietschi D. Free-Hand Bonding: The Ultimate Treatment
clinicians with the knowledge and skill necessary to Modality to Enhance Smiles in Young Patients. International
Dentistry – African edition 2013; 3(4): 4-12.
create aesthetic composite restorations that are “feasi-
ble, teachable and repeatable”.51 The technique utilizes 11 Fellipe LA et al. Using Opaquers under Direct Composite Resin
Veneers: An Illustrated Review of the Technique. J Esthet Restor
special color recipes for producing layered restorations Dent 2003; 15: 327-37.
with only two masses of 3M™ ESPE™ Filtek™ Supreme
12 Beddis HP, Nixon PJ. Layering Composites for Ultimate Aes-
XTE Universal Composites.52,53 This makes Style Ital- thetics in Direct Restorations. Dent Update. 2012 Nov; 39(9):
iano essentially a variation of the dual-shade layering 630-2, 634-36.
technique. It proclaims the use of only one shade to 13 Dietschi D. Clinical Application of the Natural Layering Concept.
recreate dentin and one to restore enamel (Fig 6).54 Oral Health Journal Aug 2007.
The Style Italiano concept asserts that aesthetics of a 14 Devoto W, Saracinelli M, Manauta J. Composite in Everyday
restoration are not dependent merely on the number of Practice: How to Choose the Right Material and Simplify Ap-
shades, but also on the morphology and thickness of the plication Techniques in the Anterior Teeth. Int J Esthet Dent
2010; 5(1): 102-24.
composite layers.53 A 0.5 mm thickness of the enamel
layer has been considered as the ideal value to achieve 15 Halley E. Direct Composite Veneers – An Aesthetic Alternative.
Private Dentistry February 2012; xx.
optimum aesthetics in the anterior restorations.54
16 Hugo B. Esthetics with Resin Composite: Basics and Tech-
CONCLUSION niques. London: Quintessence Publishing Co Ltd, 2009. ISBN
978–1–85097–183–2.
Achieving aesthetic durable composite restorations, 17 Ardu S, Krejci I. Biomimetic Direct Composite Stratification
especially in the smile frame, is highly satisfying not Technique for the Restoration of Anterior Teeth. Quintessence
only for the patient but for the clinician as well.20 Com- Int. 2006 Mar; 37(3): 167-74.
posite restorative techniques have evolved over time 18 Magne P et al. Evaluation of an anatomic dual-laminate com-
and now offer infinite possibilities to restore teeth, posite resin shade guide. J Dent 2013; 4(1s): e80-e86.
both in function and aesthetics. Composites, with the 19 Manauta J, Salat A. Layers: An Atlas of Composite Resin
advancements in layering techniques, offer the most Stratification. London: Quintessence Publishing Co Ltd, 2013.
ISBN 978–8–87492–173–7.
conservative, cost effective and aesthetic solutions for
cosmetic restoration of teeth. It is, however, the clini- 20 Mackenzie L, Parmar D, Shortall ACC, Burke FJT. Direct
Anterior Composites: A Practical Guide. Dent Update 2013;
cian’s professional and ethical obligation to master the 40: 2-16.
art and science of dental aesthetics, equipping himself
21 LeSage B, Milnar F, Wohlberg J. Achieving the epitome of
with the latest successful techniques and materials so as composite art: creating natural tooth esthetics, texture, and
to provide his patients with state-of-the-art treatment anatomy using appropriate preparation and layering techniques.
modalities. International Dentistry SA; 11(3): 34-48.
22 Vargas M. Clinical Techniques: Monochromatic vs Polychro-
REFERENCES matic Layering: How to Select the Appropriate Technique. ADA
Professional Product Review. Fall/October 2011; 6(4): 16-17.
1 AlJehani YA, Baskaradoss JK, Geevarghese A, AlShehry MA.
Current Trends in Aesthetic Dentistry. Health 2014; 6: 1941-49. 23 Blank JT. Histological Layering Technique for Composites.
Dent Today 2012 Aug; 31(8): 96-99.
2 Dietschi D. Bio-Aesthetics: Giving a New Face to Smile En-
hancements. Cosmetic Dentistry 2013; 4: 6-12. 24 Terry DA. Color Matching with Composite Resin: A Synchronized
Shade Comparison. Pract Proced Aesthetic Dent 2003; 15(7):
3 Colon P, Lussi A. Minimal Intervention Dentistry: Part 5.
515-21.
Ultra-Conservative Approach to the Treatment of Erosive and
Abrasive Lesions. BDJ 2014; 216(8): 463-68. 25 Belch Eva A. Reconstruction of Fractured Permanent Incisors
in School Children Using Composite Resin Buildup (Review).
4 Dino Re, Augusti G, Amato M, Riva G, August D. Esthetic
J of IMAB 2008; 14(2): 93-96.

Pakistan Oral & Dental Journal Vol 36, No. 2 (April-June 2016) 339
 Layers to a beautiful smile

26 Fahl N Jr. Single-Shaded Direct Anterior Composite Resto- 41 Dietschi D. Clinical Application of Natural Layering Concept.
rations: A Simplified Technique for Enhanced Results. Com- Clinical Education DentSply Caulk 2008.
pendium of Continuing Education in Dentistry 2012, 33 (2):
150-54. 42 Dietschi D. Learning and Applying the Natural Layering Con-
cept. Cosmetic Dent 2009; 3(2): 111-14.
27 https://www.philipsoralhealthcare.com/en_us/about/press-re-
lease-nuance.php 43 Blank JT. Direct composite veneers in minutes, not hours: a
simplified technique and material. Dent Today. 2007; 26: 72,
28 Blank JT. The Magic Bullet of Composites? Dental Economics 74-75.
September 2011. 101(9): 931-35.
44 Blank JT. Esthetic Anterior Composite Restorations. Penwell
29 Fahl N Jr. Mastering composite artistry to create anterior Publication Supplement 2011 Sep http://www.ineedce.com/
masterpieces - part 1. J Cosmetic Dent 2010; 26(3): 56-68. courses/2193/PDF/1108cei_dentsply_Restorations.pdf
30 Vanini L. Conservative Composite Restorations that Mimic 45 Fahl N Jr. A Polychromatic Composite Layering Approach for
Nature – A Step-by-Step Anatomical Stratification Technique. Solving a Complex Class IV/ Direct Veneer/ Diastema Combi-
J Cosmetic Dent 2010; 26(3): 80-98. nation: Part II. Pract Proced Aesthet Dent 2007; 19(1): A-F.
31 Vanini L. Mangani F. Determination and Communication of 46 Fahl N Jr. A Polychromatic Composite Layering Approach for
Color using the Five Color Dimensions of Teeth. Pract Proced Solving a Complex Class IV/ Direct Veneer/ Diastema Combi-
Asthet Dent 2001; 13(1): 19-26. nation: Part I. Pract Proced Aesthet Dent 2006; 18(10): A-G.
32 Vanini L. Theunissen J. Development of Esthetics in the An- 47 Griffin JD. Use of Digital Photography to Improve Composite
terior Region: Contemporary Composite Applications. Journ Resin Selection and Placement. . Pract Proced Aesthet Dent
Dent Symposia. 2002; Fall: 2-10. 2008; 20(6): 359-64.
33 Vanini L. Light and Color in Anterior Composite Restorations. 48 Fahl N Jr. Mastering composite artistry to create anterior
Pract Periodontics Asthet Dent 1996 Sep; 8(7): 673-82. masterpieces - part 2. J Cosmetic Dent 2011; 26(4): 42-55.
34 Dietschi D. Optimizing Aesthetics and Facilitating Clinical 49 Cohen RG. Direct Composites for Optimal Restorative Aesthetics.
Application of Free-Hand Bonding Using the ‘Natural Layering Dentaltown.com Inc. March 2008; pp 58-68.
Concept’. BDJ 2008; 204(4): 181-85.
50 Lowe RA. Self-Adhering Flow able Composites: Simplifying the
35 Dietschi D. Layering Concepts in Anterior Composite Resto- Placement of Exquisite Direct Resin Restorations. Kerr News
rations. J Adhesive Dent. 2001; 3: 71-80. January 2014; pp 2-4.
36 Ishikawa-Nagai S et al. Clinical Evaluation of Perceptibility 51 Style Italiano [Internet]: Feasible, teachable and repeatable:
of Color Differences between Natural Teeth and All-Ceramic the Style italiano recipe for a daily success dentistry. Available
Crowns. J Dent 2009; 37s: e57-e63. from http://www.styleitaliano.org/perchestyleitaliano/#sthash.
yl6QrT3v.dpuf
37 Dietschi D. Current Status and Future Perspectives for the Use
of Composite Resins in the Smile Frame. Cosmetic Dent 2011 52 AGT Communications Network [Internet]: Style Italiano new
Fall; 27(3): 112-27. restoration technique. Available from http://www.agt-agency.
com/news/archive/8585/
38 Dietschi D, Ardu S, Krejci I. A new shading concept based on
natural tooth color applied to direct composite restorations. 53 Vliet FV. Style Italiano: the Art of Simplicity. Espertise Mag-
Quintessence Int 2006; 37: 91-102. azine Oct 2012; 22: 4-7.
39 Dietschi D, Ardu S, Krejci I. Exploring the layering concepts for 54 Manauta J et al. Stratification in anterior teeth using one den-
anterior teeth. In Roulet J F, Degrange M (Eds). Adhesion - the tine shade and a predefined thickness of enamel: a new concept
silent revolution in dentistry. pp 235-251. Berlin: Quintessence in composite layering-Part I. Odontostomatol Trop. 2014 Jun;
Publishing, 2000. 37(146): 5-16.
40 Villarroel et al. Direct Esthetic Restorations Based on Translu-
cency and Opacity of Composite Resins. J Esthet Restor Dent
2011; 23(2): 73-88.

CONTRIBUTIONS BY AUTHORS
1 Ayesha Aslam: Main author.
2 Bilal Ahmed: Helped in writing article and revision.
3 Azad Ali Azad: Supervised.
4 Nida Ovais: Helped in data collection and discussion.
5 Maleeha Nayyer: Helped in data collection and proof reading.

Pakistan Oral & Dental Journal Vol 36, No. 2 (April-June 2016) 340