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Gr
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[
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[
2
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A
s
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[
3
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.
Ad
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[
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[
5
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.
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8
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6
C
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'
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(
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1731
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r
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m
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ex
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r
esto
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[
6
]
.
Su
cc
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tag
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tu
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[
7
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,
[
8
]
.
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[
9
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[
1
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r
o
p
r
iate
an
g
u
latio
n
,
a
n
d
ca
r
ef
u
l
r
ed
u
ctio
n
to
en
s
u
r
e
p
r
o
p
e
r
f
it
an
d
f
u
n
ctio
n
.
C
o
n
s
eq
u
e
n
tly
,
m
an
y
d
e
n
tal
s
tu
d
en
ts
s
tr
u
g
g
l
e
with
th
is
s
tag
e
d
u
e
to
th
e
h
i
g
h
lev
el
o
f
m
an
u
al
d
ex
ter
ity
,
c
o
n
ce
n
tr
atio
n
,
a
n
d
p
r
o
ce
d
u
r
al
ac
c
u
r
ac
y
r
eq
u
i
r
e
d
[
1
1
]
.
T
h
ese
ch
allen
g
es
h
i
g
h
lig
h
t
th
e
n
ee
d
f
o
r
en
h
an
ce
d
tr
ain
in
g
m
eth
o
d
s
,
s
u
ch
as si
m
u
la
tio
n
-
b
ased
lea
r
n
in
g
o
r
d
ig
ital g
u
id
an
ce
s
y
s
tem
s
,
to
im
p
r
o
v
e
s
tu
d
en
t
co
m
p
eten
ce
a
n
d
co
n
f
id
en
ce
in
p
er
f
o
r
m
in
g
b
r
id
g
ewo
r
k
d
en
tu
r
e
p
r
o
ce
d
u
r
es.
I
n
th
is
co
n
tex
t,
th
e
co
m
p
eten
c
y
s
tan
d
ar
d
s
f
o
r
I
n
d
o
n
esian
d
e
n
tis
ts
s
tip
u
late
th
at
s
tu
d
en
ts
m
u
s
t
b
e
ab
le
to
m
aster
an
d
p
er
f
o
r
m
b
r
id
g
e
d
en
tu
r
e
tr
ea
tm
e
n
t
as
an
in
teg
r
al
p
ar
t
o
f
t
h
e
r
eq
u
ir
ed
c
o
m
p
eten
cies
[
1
2
]
.
Nev
er
th
eless
,
f
ield
p
r
ac
tices
i
n
d
icate
th
at
th
er
e
ar
e
s
till
d
if
f
icu
lties
in
im
p
lem
en
tin
g
th
is
p
r
ac
tice
[
1
3
]
,
[
1
4
]
.
A
n
u
m
b
er
o
f
d
e
n
tis
ts
,
esp
ec
ial
ly
co
-
ass
is
tan
t
s
tu
d
en
ts
,
s
till
e
n
co
u
n
ter
c
h
allen
g
es
r
an
g
in
g
f
r
o
m
a
lack
o
f
clin
ical
ex
p
er
ien
ce
to
am
b
ig
u
ity
r
eg
a
r
d
in
g
co
r
r
ec
t te
ch
n
i
q
u
es a
n
d
t
h
e
co
m
p
lex
ity
o
f
d
e
n
tal
an
ato
m
y
[
1
5
]
.
T
h
e
n
o
v
elty
o
f
th
is
r
esear
ch
lies
in
s
ev
er
al
asp
ec
ts
th
at
co
n
tr
ib
u
te
to
a
n
ew
u
n
d
e
r
s
tan
d
i
n
g
o
f
t
h
e
ch
allen
g
es
f
ac
ed
b
y
d
e
n
tal
s
tu
d
en
ts
,
p
ar
ticu
lar
ly
co
-
ass
is
tan
t
s
tu
d
en
ts
,
in
th
e
co
n
tex
t
o
f
to
o
th
p
r
ep
ar
atio
n
f
o
r
th
e
f
ab
r
icatio
n
o
f
f
ix
ed
d
en
tal
b
r
id
g
es
in
I
n
d
o
n
esia.
T
h
e
s
tu
d
y
f
o
c
u
s
es
o
n
th
e
d
if
f
icu
lties
en
co
u
n
ter
ed
b
y
d
en
tal
s
tu
d
en
ts
,
esp
ec
ially
co
-
ass
is
ta
n
t
s
tu
d
en
ts
,
in
to
o
th
p
r
ep
ar
atio
n
f
o
r
th
e
f
a
b
r
icatio
n
o
f
f
ix
ed
d
en
tal
b
r
id
g
es.
W
h
ile
liter
atu
r
e
o
n
p
r
o
s
th
o
d
o
n
tics
is
av
ailab
le
g
lo
b
al
ly
,
th
is
r
ese
ar
ch
ex
p
l
o
r
es
th
e
s
p
ec
if
ic
co
n
tex
t
in
I
n
d
o
n
esia,
en
r
ich
in
g
t
h
e
u
n
d
er
s
tan
d
in
g
o
f
th
e
ch
allen
g
es
f
ac
ed
b
y
d
en
tal
s
tu
d
en
ts
in
th
is
co
u
n
tr
y
.
T
h
is
r
esear
ch
is
co
n
d
u
cte
d
with
t
h
e
aim
o
f
o
b
tain
in
g
th
e
s
eq
u
e
n
ce
o
f
d
if
f
icu
l
ties
in
to
o
th
p
r
e
p
ar
atio
n
f
r
o
m
t
h
e
m
o
s
t
d
if
f
icu
lt t
o
th
e
ea
s
iest
.
T
h
e
id
en
tific
atio
n
o
f
d
if
f
ic
u
lties
in
to
o
th
p
r
ep
a
r
atio
n
in
th
e
f
ield
o
f
d
en
tal
p
r
o
s
th
o
d
o
n
tics
h
o
ld
s
s
ig
n
if
ican
t
im
p
o
r
tan
ce
,
as
it
allo
ws
d
en
tal
f
ac
u
lties
to
f
o
c
u
s
o
n
an
d
m
o
d
if
y
tr
ain
in
g
in
s
tag
es
co
n
s
id
er
ed
ch
allen
g
in
g
b
y
s
tu
d
en
ts
.
T
h
u
s
,
th
is
ca
n
en
h
an
ce
lear
n
in
g
ef
f
ec
tiv
en
ess
b
y
p
r
o
v
id
in
g
s
p
ec
ial
atten
tio
n
to
ar
ea
s
n
ee
d
in
g
m
o
r
e
f
o
c
u
s
,
im
p
r
o
v
e
t
h
e
p
r
o
f
ess
io
n
al
q
u
ality
o
f
s
tu
d
en
ts
b
y
aid
i
n
g
th
e
m
in
o
v
er
c
o
m
in
g
clin
ical
p
r
ac
tice
o
b
s
tacle
s
,
m
in
im
ize
clin
ical
er
r
o
r
r
is
k
s
b
y
e
n
h
a
n
cin
g
s
tu
d
en
ts
'
clin
ical
p
r
ep
ar
ed
n
ess
,
an
d
en
h
a
n
ce
s
tu
d
en
t
s
atis
f
ac
tio
n
b
y
p
r
o
v
id
in
g
tailo
r
ed
tr
ain
in
g
to
th
eir
n
ee
d
s
,
u
lt
im
ately
aid
in
g
th
em
in
ac
h
iev
in
g
s
u
cc
ess
in
th
eir
d
en
tal
ca
r
ee
r
s
.
Fu
r
th
er
m
o
r
e,
th
is
r
esear
ch
is
d
escr
ib
ed
as
a
p
ilo
t
s
tu
d
y
,
in
d
icat
in
g
th
at
it
m
ay
b
e
a
p
r
elim
in
ar
y
s
tep
in
f
u
r
th
er
in
v
esti
g
atio
n
o
n
th
is
to
p
ic.
C
o
n
s
eq
u
en
tly
,
th
e
s
tu
d
y
p
av
es
th
e
wa
y
f
o
r
f
u
r
t
h
er
r
esear
ch
th
at
ca
n
ex
p
lo
r
e
m
o
r
e
in
-
d
ep
th
asp
ec
ts
o
r
ad
d
itio
n
al
v
ar
iab
les
th
at
m
ay
in
f
lu
e
n
ce
th
e
p
e
r
ce
p
tio
n
s
an
d
d
if
f
icu
lties
o
f
d
en
tal
s
tu
d
en
ts
.
2.
M
E
T
H
O
D
T
h
e
r
esear
ch
d
esig
n
a
p
p
lied
in
th
is
s
tu
d
y
is
d
escr
ip
tiv
e
o
b
s
er
v
atio
n
al
u
s
in
g
a
cr
o
s
s
-
s
ec
tio
n
al
m
eth
o
d
.
T
h
e
aim
o
f
th
is
r
esear
ch
is
to
d
etail
th
e
p
e
r
ce
p
tio
n
s
o
f
clin
ical
s
tu
d
en
ts
at
th
e
Facu
lty
o
f
D
en
tis
tr
y
,
Un
iv
er
s
itas
T
r
is
ak
ti,
r
eg
ar
d
in
g
th
e
d
if
f
ic
u
l
ties
th
ey
ex
p
er
ien
ce
in
ca
r
r
y
in
g
o
u
t
b
r
i
d
g
ewo
r
k
d
en
tu
r
e
to
o
t
h
p
r
o
ce
d
u
r
es.
T
h
e
p
o
p
u
latio
n
in
th
is
s
tu
d
y
co
n
s
is
ts
o
f
clin
ical
s
tu
d
en
ts
f
r
o
m
th
e
Facu
lty
o
f
Den
tis
tr
y
,
Un
iv
er
s
itas
T
r
is
ak
ti.
A
q
u
esti
o
n
n
air
e
was
u
s
ed
as
th
e
d
ata
co
llectio
n
to
o
l
an
d
d
is
tr
ib
u
ted
in
Sep
tem
b
er
-
Octo
b
e
r
2
0
2
3
.
R
esp
o
n
d
en
ts
in
clu
d
ed
clin
ical
s
tu
d
e
n
ts
f
r
o
m
th
e
co
h
o
r
ts
o
f
2
0
2
1
-
2
0
2
3
b
ased
o
n
th
ei
r
en
tr
y
y
ea
r
i
n
to
clin
ical
in
ter
n
s
h
ip
,
to
talin
g
1
5
5
r
esp
o
n
d
e
n
ts
.
Sam
p
lin
g
was
co
n
d
u
cte
d
u
s
in
g
p
u
r
p
o
s
iv
e
co
n
s
ec
u
tiv
e
s
am
p
lin
g
(
to
tal
p
o
p
u
latio
n
s
am
p
lin
g
)
,
with
in
clu
s
io
n
cr
it
er
ia
in
v
o
lv
in
g
ac
tiv
e
clin
ical
s
tu
d
en
ts
wh
o
h
av
e
m
et
th
e
r
e
q
u
ir
em
en
ts
o
f
f
ix
e
d
d
en
tal
p
r
o
s
th
o
d
o
n
tics
an
d
ar
e
willin
g
to
p
r
o
v
id
e
in
f
o
r
m
ed
co
n
s
en
t
an
d
co
m
p
lete
th
e
q
u
esti
o
n
n
air
e.
Me
an
wh
ile,
ex
clu
s
io
n
cr
iter
ia
lim
ited
p
a
r
ticip
atio
n
to
clin
ical
s
tu
d
en
ts
w
h
o
h
a
v
e
n
o
t
m
et
th
e
r
eq
u
i
r
em
en
ts
o
f
f
ix
ed
d
en
tal
p
r
o
s
th
o
d
o
n
tics
o
r
ar
e
o
n
lea
v
e
,
as we
ll a
s
th
o
s
e
wh
o
h
av
e
g
r
ad
u
ated
f
r
o
m
d
en
tal
ed
u
ca
tio
n
[
1
6
]
.
I
n
th
is
s
tu
d
y
,
we
c
o
n
d
u
cted
v
a
lid
ity
an
d
r
eliab
ilit
y
ca
lc
u
latio
n
s
to
en
s
u
r
e
th
e
r
eliab
ilit
y
an
d
v
alid
ity
o
f
th
e
q
u
esti
o
n
n
air
e
u
s
ed
to
m
ea
s
u
r
e
th
e
p
r
ep
a
r
atio
n
o
f
d
en
tal
b
r
id
g
es.
T
o
m
e
asu
r
e
th
e
q
u
esti
o
n
n
air
e'
s
r
eliab
ilit
y
,
we
o
p
ted
f
o
r
th
e
R
asch
m
o
d
el
an
aly
s
is
m
eth
o
d
.
Af
ter
an
aly
zin
g
th
e
r
esu
lts
f
r
o
m
5
0
r
esp
o
n
d
en
ts
wh
o
co
m
p
leted
th
e
q
u
esti
o
n
n
air
e,
we
o
b
tai
n
ed
a
C
r
o
n
b
ac
h
'
s
alp
h
a
v
alu
e
o
f
0
.
7
5
(
>0
.
7
0
)
,
in
d
icatin
g
ac
ce
p
tab
le
in
ter
n
al
co
n
s
i
s
ten
cy
r
eliab
ilit
y
.
T
h
is
s
u
g
g
ests
th
at
th
e
item
s
in
o
u
r
q
u
esti
o
n
n
air
e
a
r
e
r
eliab
ly
m
e
asu
r
in
g
th
e
in
ten
d
e
d
co
n
s
tr
u
cts.
T
h
er
ef
o
r
e,
we
ca
n
h
av
e
co
n
f
id
en
ce
in
th
e
co
n
s
is
ten
cy
o
f
r
esp
o
n
s
es
o
b
tain
ed
f
r
o
m
p
ar
ticip
a
n
ts
.
T
o
en
s
u
r
e
co
n
te
n
t
v
alid
ity
o
f
t
h
e
r
esear
ch
i
n
s
tr
u
m
en
t,
th
e
q
u
esti
o
n
n
air
e
was
r
e
v
iewe
d
b
y
th
r
e
e
f
ac
u
lty
m
e
m
b
er
s
wh
o
s
p
ec
ialize
in
p
r
o
s
th
o
d
o
n
tics
.
T
h
is
ap
p
r
o
ac
h
allo
we
d
u
s
to
r
ef
in
e
an
d
v
alid
ate
th
e
q
u
es
tio
n
n
air
e,
en
s
u
r
in
g
its
ap
p
r
o
p
r
iaten
ess
an
d
e
f
f
ec
ti
v
en
ess
f
o
r
m
ea
s
u
r
in
g
th
e
i
n
ten
d
ed
co
n
s
tr
u
cts.
To
an
aly
ze
th
e
c
o
m
p
lex
ity
in
v
o
lv
ed
in
ab
u
tm
en
t
to
o
th
p
r
e
p
ar
atio
n
f
o
r
f
ix
ed
b
r
id
g
ewo
r
k
,
th
is
s
tu
d
y
u
tili
ze
d
a
r
ig
o
r
o
u
s
d
ata
an
aly
s
is
ap
p
r
o
ac
h
.
W
e
em
p
lo
y
ed
th
e
non
-
p
a
r
am
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
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I
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t J Pu
b
lic
Hea
lth
Sci
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Vo
l.
14
,
No
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4
,
Dec
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er
20
25
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[
1
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ab
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1
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r
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k
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t
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1
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n
k
2
2
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n
k
3
3
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n
k
4
4
R
a
n
k
5
5
R
a
n
k
6
6
R
a
n
k
7
(
e
a
s
i
e
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t
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7
3.
RE
SU
L
T
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B
ased
o
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th
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co
llectio
n
o
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a
n
k
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g
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lts
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s
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g
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Frie
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m
an
test
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d
d
escr
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tag
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u
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ep
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o
r
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k
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ated
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k
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n
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2
8
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0
3
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,
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1
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n
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t
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h
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t
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m
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k
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3
7
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.
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2
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R
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k
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f
d
if
f
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lty
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r
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m
h
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r
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t f
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ts
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ased
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m
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r
an
k
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r
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p
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r
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t
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t
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(
F
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d
m
a
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t
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me
a
n
r
a
n
k
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A
l
i
g
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e
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p
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p
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6
T
h
e
Frie
d
m
an
'
s
AN
OVA
te
s
t d
o
es
n
o
t
r
eq
u
ir
e
a
n
o
r
m
ality
test
b
ec
au
s
e
it is
a
n
o
n
-
p
ar
am
etr
ic
test
th
at
d
o
es
n
o
t
r
ely
o
n
s
p
ec
if
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d
is
tr
ib
u
tio
n
ass
u
m
p
tio
n
s
,
s
u
ch
as
t
h
e
n
o
r
m
al
d
is
tr
ib
u
tio
n
.
No
n
-
p
ar
am
etr
ic
m
eth
o
d
s
lik
e
th
e
Frie
d
m
a
n
test
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e
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ased
o
n
r
an
k
s
o
f
d
ata
r
at
h
er
th
a
n
t
h
eir
o
r
i
g
in
al
v
alu
es,
m
ak
in
g
th
em
m
o
r
e
r
o
b
u
s
t to
v
io
latio
n
s
o
f
n
o
r
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ality
ass
u
m
p
tio
n
s
.
T
h
is
tes
t
is
o
f
ten
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p
l
o
y
ed
wh
e
n
d
ata
is
m
ea
s
u
r
e
d
o
n
an
o
r
d
i
n
al
s
ca
le
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
C
lin
ica
l d
en
ta
l stu
d
en
ts
'
p
erce
p
tio
n
s
o
f d
iffi
cu
lties
in
fixed
p
r
o
s
th
o
d
o
n
tics
…
(
A
d
itya
P
r
a
t
a
ma
S
a
r
w
o
n
o
)
1733
[
1
8
]
.
T
h
e
r
esu
lts
o
f
t
h
e
Frie
d
m
an
s
tatis
tical
test
in
d
icate
d
a
test
s
tati
s
tic
C
h
i
-
s
q
u
ar
e
v
alu
e
is
1
4
8
.
3
8
5
.
T
h
is
v
alu
e
d
ep
icts
h
o
w
m
u
c
h
d
if
f
e
r
en
ce
e
x
is
ts
b
etwe
en
th
e
r
an
k
s
o
f
th
e
c
o
m
p
ar
ed
g
r
o
u
p
s
.
T
h
e
lar
g
er
t
h
e
C
h
i
-
s
q
u
ar
e
v
alu
e,
th
e
m
o
r
e
s
ig
n
if
ican
t
th
e
d
if
f
e
r
en
ce
b
etwe
en
th
e
s
tag
es
o
f
th
e
p
r
e
p
ar
atio
n
g
r
o
u
p
s
.
T
h
e
o
b
tain
ed
d
e
g
r
ee
s
o
f
f
r
ee
d
o
m
(
d
f
)
ar
e
6
,
co
r
r
esp
o
n
d
in
g
to
th
e
n
u
m
b
er
o
f
s
tag
es
(
k
)
ass
ess
ed
in
th
is
s
tu
d
y
m
in
u
s
o
n
e
(
k
-
1
)
.
T
h
e
s
ig
n
if
ican
ce
v
alu
e,
r
ep
r
esen
ted
b
y
Asy
m
p
.
Sig
.
is
0
.
0
0
0
(
<
0
.
0
5
)
,
in
d
icatin
g
th
at
th
e
p
-
v
a
lu
e
o
f
t
h
is
s
tatis
tical
test
is
ze
r
o
,
b
el
o
w
0
.
0
5
.
T
h
is
p
-
v
al
u
e
in
d
icate
s
th
at
th
er
e
i
s
co
n
s
is
ten
cy
in
h
o
w
d
en
tal
s
tu
d
en
ts
ass
ess
th
e
d
if
f
icu
lty
o
f
v
ar
io
u
s
s
tag
es
in
th
e
ev
alu
ati
on
p
r
o
ce
s
s
.
Alth
o
u
g
h
ea
ch
s
tu
d
e
n
t
m
ay
h
av
e
d
if
f
er
en
t
o
p
in
i
o
n
s
,
th
e
Frie
d
m
an
test
r
esu
lts
in
d
icate
th
at
th
er
e
is
a
g
e
n
er
al
s
im
ilar
i
ty
in
t
h
eir
p
er
ce
p
tio
n
s
o
f
th
e
d
if
f
icu
lty
le
v
els
o
f
ce
r
tain
s
tag
es
.
4.
DIS
CU
SS
I
O
N
T
h
is
s
tu
d
y
aim
s
to
g
ain
a
d
ee
p
er
u
n
d
e
r
s
tan
d
in
g
o
f
h
o
w
d
en
tal
clin
ic
s
tu
d
en
ts
at
th
e
Facu
lty
o
f
Den
tis
tr
y
,
Un
iv
er
s
itas
T
r
is
ak
ti
,
p
er
ce
i
v
e
th
e
d
if
f
icu
lties
in
t
h
e
p
r
o
ce
s
s
o
f
p
r
ep
a
r
in
g
b
r
i
d
g
e
wo
r
k
d
en
tu
r
es.
T
h
e
f
o
cu
s
o
f
th
is
r
esear
ch
is
n
o
t
o
n
ly
o
n
ass
ess
in
g
d
if
f
icu
lties
b
u
t
also
o
n
d
eter
m
in
in
g
th
e
o
r
d
er
o
f
s
tag
es
co
n
s
id
er
ed
m
o
s
t
d
if
f
icu
lt
to
ea
s
iest
b
y
al
l
r
esp
o
n
d
en
ts
,
in
v
o
lv
in
g
a
to
tal
o
f
1
5
5
r
esp
o
n
d
en
ts
.
T
h
is
is
to
p
r
o
v
id
e
a
m
o
r
e
co
m
p
r
eh
e
n
s
iv
e
o
v
er
v
iew
o
f
th
e
d
y
n
am
ics
o
f
d
if
f
icu
lty
p
er
ce
p
tio
n
in
th
e
s
tag
es
o
f
b
r
id
g
ewo
r
k
d
en
tu
r
e
to
o
t
h
p
r
ep
ar
atio
n
f
o
r
all
co
h
o
r
ts
f
r
o
m
2
0
2
1
to
2
0
2
3
.
Fro
m
th
e
r
esu
lts
o
f
r
a
n
k
in
g
th
e
s
ev
en
s
tag
es
o
f
b
r
id
g
ewo
r
k
d
en
tu
r
e
t
o
o
th
p
r
ep
a
r
atio
n
f
o
r
all
co
-
ass
co
h
o
r
ts
,
s
tar
tin
g
f
r
o
m
th
e
s
tag
e
co
n
s
id
er
ed
th
e
m
o
s
t
d
if
f
icu
l
t
in
th
e
f
ir
s
t
r
an
k
,
n
am
ely
"
p
r
o
x
im
al
r
e
d
u
ctio
n
,
"
f
o
llo
wed
b
y
"
ce
r
v
ical
p
r
e
p
ar
a
tio
n
"
in
th
e
s
ec
o
n
d
r
an
k
,
"
lin
g
u
al
r
ed
u
ctio
n
"
in
th
e
th
ir
d
r
an
k
,
"
in
c
is
al/o
cc
lu
s
al
r
ed
u
ctio
n
"
in
th
e
f
o
u
r
th
r
a
n
k
,
"
b
u
cc
al
r
e
d
u
ctio
n
"
in
th
e
f
if
th
r
an
k
,
"
alig
n
m
e
n
t
o
f
p
r
e
p
ar
atio
n
b
etwe
en
two
ab
u
tm
en
t te
eth
"
in
th
e
s
ix
th
r
a
n
k
,
an
d
f
in
ally
,
th
e
s
tag
e
co
n
s
id
er
ed
th
e
ea
s
iest
is
"
f
in
is
h
in
g
."
T
h
e
m
o
s
t
d
if
f
icu
lt
s
tag
e,
n
am
ely
p
r
o
x
i
m
al
r
e
d
u
ctio
n
,
p
r
ese
n
ts
a
m
ajo
r
ch
allen
g
e
b
ec
a
u
s
e
it
r
eq
u
ir
es
h
ig
h
ly
tech
n
ical
s
k
ills
.
Stu
d
e
n
ts
n
ee
d
e
x
tr
ao
r
d
in
ar
y
p
r
ec
is
io
n
b
ec
a
u
s
e
th
ey
m
u
s
t
esti
m
ate
th
e
am
o
u
n
t
o
f
s
p
ac
e
r
eq
u
ir
ed
to
b
e
ad
eq
u
ate
an
d
h
a
v
e
f
r
ee
co
n
tact
with
th
e
p
r
o
x
i
m
al
walls
o
f
a
d
jace
n
t
te
eth
,
co
n
s
id
er
in
g
t
h
e
lim
ited
s
p
ac
e
in
th
e
p
r
o
x
im
al
ar
ea
,
a
n
d
en
s
u
r
e
p
r
ec
is
e
r
ed
u
ctio
n
wit
h
o
u
t
d
am
a
g
in
g
a
d
jace
n
t
teeth
.
T
h
is
d
if
f
icu
lty
ca
n
b
e
in
f
lu
en
ce
d
b
y
n
atu
r
al
v
a
r
i
atio
n
s
am
o
n
g
p
atien
ts
,
s
u
ch
as
d
if
f
er
en
t
to
o
th
s
h
ap
es
a
n
d
p
o
s
itio
n
s
,
c
r
ea
tin
g
d
y
n
am
ic
c
h
allen
g
es a
t th
is
s
tag
e
[
1
9
]
,
[
2
0
]
.
T
h
e
n
ex
t
s
tag
e,
ce
r
v
ical
f
in
is
h
p
r
ep
a
r
atio
n
in
t
h
e
f
o
r
m
o
f
a
ch
am
f
er
,
a
d
d
s
co
m
p
lex
ity
b
y
r
eq
u
ir
i
n
g
ca
r
ef
u
l
cu
ttin
g
o
f
th
e
to
o
th
'
s
ce
r
v
ical
ed
g
e
to
ac
h
iev
e
p
r
ec
is
e
r
esu
lts
.
Dif
f
icu
lty
ar
is
es
b
ec
au
s
e
s
tu
d
en
ts
m
u
s
t
ca
r
ef
u
lly
c
o
n
s
id
er
t
h
e
ex
ten
t
o
f
ce
r
v
ical
f
in
is
h
f
o
r
m
e
d
with
o
u
t
ex
ce
s
s
o
r
d
ef
icien
c
y
o
f
p
r
ep
ar
atio
n
[
2
1
]
.
T
h
is
r
eq
u
ir
es
a
d
ee
p
u
n
d
er
s
tan
d
in
g
o
f
ce
r
v
ical
f
in
is
h
s
h
ap
es
,
s
u
c
h
as
s
u
p
r
ag
in
g
iv
al,
eq
u
ig
in
g
i
v
al,
an
d
s
u
b
g
in
g
iv
al
,
th
at
m
atch
t
h
e
p
la
n
n
ed
b
r
id
g
e
wo
r
k
d
en
tu
r
e
d
esig
n
,
m
atu
r
e
t
ec
h
n
ical
o
p
er
ato
r
s
k
ills
,
an
d
p
r
o
p
er
b
u
r
s
elec
tio
n
f
o
r
ch
am
f
e
r
cr
ea
tio
n
[
2
2
]
.
F
u
r
th
er
m
o
r
e,
th
e
p
r
e
p
ar
atio
n
o
f
th
e
ce
r
v
ical
f
in
is
h
lin
e
is
also
a
s
ig
n
if
ican
t
r
eq
u
ir
em
e
n
t
to
o
b
tain
a
g
o
o
d
im
p
r
ess
io
n
u
s
in
g
p
o
l
y
v
in
y
l
s
ilo
x
an
e,
th
er
eb
y
f
ac
ilit
atin
g
d
e
n
tal
lab
o
r
ato
r
y
tech
n
ician
s
in
cr
ea
tin
g
a
p
r
ec
i
s
e
f
in
is
h
lin
e
a
n
d
well
-
f
itted
d
en
tal
b
r
id
g
es
[
2
3
]
.
L
in
g
u
al
r
ed
u
ctio
n
b
ec
o
m
es
th
e
n
ex
t
ch
allen
g
i
n
g
s
tag
e.
D
if
f
icu
lty
ar
is
es
f
r
o
m
lim
ited
ac
ce
s
s
an
d
v
is
ib
ilit
y
in
th
e
lin
g
u
al
ar
ea
,
cr
ea
tin
g
a
d
d
itio
n
al
c
h
allen
g
es
in
m
ain
tain
in
g
s
tr
u
ctu
r
al
in
teg
r
ity
an
d
to
o
t
h
alig
n
m
en
t.
Mo
r
eo
v
er
,
th
e
d
if
f
icu
lty
in
th
is
s
tag
e
i
s
f
u
r
th
er
ex
ac
er
b
ated
b
y
th
e
to
n
g
u
e'
s
p
r
o
x
im
ity
to
th
e
lin
g
u
al
wall,
s
o
th
e
o
p
er
ato
r
m
u
s
t
en
s
u
r
e
th
at
th
e
b
u
r
d
o
es
n
o
t
in
ju
r
e
th
e
to
n
g
u
e,
esp
ec
ially
if
th
e
p
atien
t's
to
n
g
u
e
is
lar
g
e
an
d
h
y
p
e
r
ac
tiv
e
[
2
4
]
.
Me
an
wh
ile,
o
cc
lu
s
al
r
ed
u
ctio
n
r
eq
u
i
r
es
a
ca
r
ef
u
l
a
p
p
r
o
ac
h
to
ac
h
iev
e
th
e
r
i
g
h
t
b
alan
ce
b
etwe
en
ad
eq
u
ate
r
ed
u
ctio
n
f
o
r
th
e
d
en
tu
r
e
an
d
p
r
eser
v
atio
n
o
f
th
e
ex
is
tin
g
to
o
th
tis
s
u
e
'
s
h
ea
lth
.
Dif
f
icu
lty
at
th
is
s
tag
e
ca
n
b
e
in
f
lu
en
ce
d
b
y
t
h
e
u
n
ev
en
ce
r
v
ic
o
-
o
cc
lu
s
al
lev
el
b
etwe
en
teeth
an
d
v
ar
y
in
g
o
c
clu
s
al
p
lan
e
am
o
n
g
p
atien
ts
;
th
er
ef
o
r
e
,
th
e
o
p
e
r
ato
r
n
ee
d
s
t
o
b
e
ca
r
ef
u
l
f
o
r
u
n
n
ec
ess
ar
y
r
em
o
v
al
o
r
ex
ce
s
s
o
f
to
o
th
s
tr
u
ctu
r
e
an
d
to
p
r
ev
en
t
p
u
lp
d
am
ag
e
[
2
5
]
.
T
h
e
o
cc
lu
s
al
p
lan
e
is
a
p
lan
e
p
ar
allel
to
th
e
lin
e
co
n
n
ec
tin
g
th
e
o
cc
lu
s
al
p
ea
k
s
b
etwe
en
teeth
,
s
o
it
is
cr
u
cial
f
o
r
ch
ewin
g
f
u
n
ctio
n
an
d
ae
s
th
etics
in
b
r
id
g
ewo
r
k
,
d
en
tu
r
e
r
esto
r
atio
n
p
lan
n
in
g
[
2
6
]
.
B
u
cc
al
r
ed
u
ctio
n
,
wh
ile
n
o
t
to
o
d
if
f
ic
u
lt,
h
as
its
o
w
n
ch
allen
g
es.
Stu
d
en
ts
ar
e
f
ac
ed
with
th
e
ch
allen
g
e
o
f
en
s
u
r
in
g
p
r
ec
is
e
b
u
cc
al
p
r
e
p
ar
atio
n
with
o
u
t
s
ac
r
if
icin
g
s
tr
u
ctu
r
al
in
teg
r
it
y
.
T
h
is
d
if
f
icu
lt
y
m
ay
b
e
r
elate
d
to
lim
ited
ac
ce
s
s
to
th
e
b
u
cc
al
ar
ea
b
ec
au
s
e
it
is
a
d
ir
ec
t
ar
ea
f
ac
in
g
th
e
ch
ee
k
m
u
c
o
s
a,
an
d
if
th
e
o
p
er
ato
r
is
n
o
t
ca
r
ef
u
l,
it m
ay
p
o
ten
tially
in
ju
r
e
th
e
ch
ee
k
m
u
co
s
a,
esp
ec
iall
y
if
th
e
p
atien
t
h
as th
ick
an
d
c
h
u
b
b
y
ch
ee
k
s
[
2
7
]
.
Ad
d
itio
n
ally
,
s
tu
d
en
ts
s
till
f
in
d
it
d
if
f
icu
lt
t
o
p
r
ep
ar
e
th
e
b
u
cc
al
d
u
e
to
th
e
two
r
e
d
u
c
ed
b
u
cc
al
ar
ea
s
,
o
cc
lu
s
al
two
-
th
ir
d
s
an
d
ce
r
v
ical
o
n
e
-
t
h
ir
d
ar
ea
s
,
an
d
s
tu
d
en
ts
o
f
ten
m
ak
e
m
is
tak
es
in
d
eter
m
i
n
in
g
th
ese
two
ar
ea
s
,
r
esu
ltin
g
in
s
h
o
r
t c
e
r
v
ico
-
o
cc
l
u
s
al
teeth
an
d
b
ec
o
m
in
g
n
o
n
-
r
eten
tiv
e
[
1
7
]
.
Dete
r
m
in
in
g
th
e
alig
n
m
en
t
b
e
twee
n
two
ab
u
tm
en
t
teeth
is
a
s
tag
e
th
at
r
eq
u
ir
es
h
ig
h
p
r
ec
i
s
io
n
an
d
a
d
ee
p
u
n
d
e
r
s
tan
d
in
g
o
f
to
o
th
a
lig
n
m
en
t.
Dif
f
icu
lty
ar
is
es
f
r
o
m
v
ar
iatio
n
s
in
th
e
wid
t
h
o
f
a
b
u
tm
en
t
teeth
a
n
d
d
if
f
er
en
ce
s
in
to
o
th
an
ato
m
y
am
o
n
g
p
atien
ts
[
2
8
]
.
Stu
d
en
ts
n
ee
d
to
en
s
u
r
e
th
at
th
e
d
e
n
tu
r
e
ca
n
b
e
ac
cu
r
ately
p
o
s
itio
n
ed
,
wh
ich
ca
n
b
e
ch
all
en
g
in
g
,
esp
ec
ially
wh
en
f
ac
i
n
g
ca
s
es
with
u
n
u
s
u
al
alig
n
m
e
n
ts
,
b
ec
au
s
e
s
tu
d
en
ts
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
4
,
Dec
em
b
er
20
25
:
1
7
3
0
-
1
7
3
7
1734
ar
e
ex
p
ec
ted
to
id
en
tify
ab
u
tm
en
t
to
o
th
alig
n
m
en
t
to
f
ac
ilit
ate
th
e
in
s
er
tio
n
d
ir
ec
tio
n
o
f
th
e
b
r
id
g
ewo
r
k
d
en
tu
r
e
[
2
9
]
.
Fin
ally
,
th
e
ea
s
y
s
tag
e,
"f
in
is
h
in
g
,
"
in
v
o
lv
es
f
in
al
d
etailin
g
to
ac
h
iev
e
s
m
o
o
th
a
n
d
ae
s
th
etic
r
esu
lts
.
Dif
f
icu
lty
ar
is
es
i
n
ac
h
iev
in
g
th
e
d
esire
d
s
m
o
o
th
n
ess
an
d
m
ain
tain
in
g
s
tr
u
ctu
r
al
in
teg
r
ity
,
esp
ec
ially
wh
en
f
ac
ed
with
lim
ited
ac
ce
s
s
in
ce
r
tain
ar
ea
s
an
d
th
e
ab
ilit
y
to
e
n
s
u
r
e
co
n
s
is
ten
cy
in
f
in
is
h
in
g
r
esu
lts
[
3
0
]
.
T
h
e
d
if
f
icu
lties
f
ac
ed
b
y
d
en
ta
l
clin
ic
s
tu
d
en
ts
at
th
e
Facu
lty
o
f
Den
tis
tr
y
,
Un
iv
er
s
itas
T
r
is
ak
ti,
in
ea
ch
s
tag
e
o
f
b
r
id
g
ewo
r
k
d
en
tu
r
e
t
o
o
th
p
r
ep
ar
atio
n
r
ef
lect
th
e
co
m
p
lex
ity
o
f
to
o
th
a
n
ato
m
y
,
p
a
tien
t
v
ar
iatio
n
s
,
a
n
d
h
ig
h
tech
n
ical
s
k
ill
d
em
a
n
d
s
.
T
h
ese
ch
allen
g
es
p
r
o
v
id
e
a
d
ee
p
u
n
d
er
s
tan
d
i
n
g
o
f
cr
itica
l
asp
ec
ts
in
p
r
o
s
th
o
d
o
n
tics
ed
u
ca
tio
n
,
h
i
g
h
lig
h
tin
g
t
h
e
n
ee
d
f
o
r
th
e
d
ev
elo
p
m
en
t o
f
teac
h
in
g
s
tr
ateg
ie
s
th
at
f
o
cu
s
m
o
r
e
o
n
co
m
p
lex
clin
ical
an
d
tech
n
ical
asp
ec
ts
[
3
1
]
,
[
3
2
]
.
Dif
f
icu
lties
th
at
ar
is
e
in
ea
ch
s
tag
e
also
n
ee
d
to
b
e
co
n
s
id
er
ed
alo
n
g
s
id
e
s
ev
e
r
al
in
f
lu
e
n
cin
g
f
ac
to
r
s
.
I
n
tr
in
s
ic
f
ac
to
r
s
,
o
r
ig
in
atin
g
f
r
o
m
th
e
s
tu
d
en
ts
th
em
s
elv
es,
s
u
ch
as
h
a
n
d
-
e
y
e
co
o
r
d
i
n
atio
n
,
s
eq
u
e
n
tial
an
d
s
p
atial
r
ea
s
o
n
in
g
,
in
clu
d
in
g
th
eir
p
r
ec
is
io
n
tech
n
ical
s
k
ills
,
an
d
lev
el
o
f
ex
p
e
r
ien
ce
in
p
e
r
f
o
r
m
in
g
b
r
id
g
ewo
r
k
,
d
en
tu
r
e
to
o
th
p
r
ep
ar
atio
n
s
tag
es
[
3
3
]
.
T
h
ey
n
ee
d
to
u
n
d
er
s
ta
n
d
th
at
th
ese
s
k
ill
s
ar
e
n
o
t
ju
s
t
tech
n
ical
b
u
t
also
th
e
co
r
e
o
f
h
ig
h
-
q
u
al
ity
d
en
tal
p
r
ac
tice.
T
h
r
o
u
g
h
g
o
o
d
clin
ica
l
ex
p
er
ien
ce
a
n
d
co
n
tin
u
o
u
s
p
r
ac
tice,
co
-
ass
is
tan
t
s
tu
d
en
ts
ca
n
im
p
r
o
v
e
th
eir
h
an
d
-
ey
e
co
o
r
d
i
n
atio
n
an
d
s
eq
u
e
n
tial
an
d
s
p
atial
r
ea
s
o
n
in
g
s
k
ills
,
wh
ich
in
tu
r
n
will
co
n
tr
ib
u
te
to
th
eir
s
u
cc
ess
in
p
r
o
v
id
in
g
h
ig
h
-
q
u
ali
ty
b
r
id
g
ewo
r
k
d
e
n
tu
r
e
d
en
tal
ca
r
e
to
p
ati
en
ts
.
Han
d
-
ey
e
co
o
r
d
in
atio
n
s
k
ills
allo
w
o
p
e
r
ato
r
s
to
co
o
r
d
in
a
te
th
eir
h
a
n
d
m
o
v
e
m
en
ts
with
a
th
r
ee
-
d
im
en
s
io
n
al
v
is
u
aliza
tio
n
o
f
t
h
e
wo
r
k
ar
ea
.
I
n
th
e
c
o
n
tex
t
o
f
to
o
th
p
r
ep
a
r
atio
n
,
h
a
n
d
-
e
y
e
co
o
r
d
in
atio
n
allo
ws
o
p
er
at
o
r
s
to
m
an
ip
u
late
in
s
tr
u
m
en
ts
with
h
ig
h
p
r
ec
is
io
n
,
cu
ttin
g
a
n
d
r
ed
u
ci
n
g
to
o
th
s
u
b
s
tan
ce
ac
cu
r
ately
ac
co
r
d
in
g
to
th
e
tr
ea
tm
en
t
p
la
n
.
W
ith
o
u
t
g
o
o
d
h
an
d
-
ey
e
co
o
r
d
in
atio
n
,
th
e
r
is
k
o
f
er
r
o
r
s
in
to
o
th
p
r
ep
a
r
atio
n
in
cr
ea
s
es,
wh
ich
ca
n
r
esu
lt
i
n
u
n
s
atis
f
ac
to
r
y
o
u
tco
m
es
an
d
ev
en
d
am
a
g
e
to
h
ea
lth
y
to
o
th
s
tr
u
ctu
r
e.
Den
tal
s
tu
d
en
ts
n
ee
d
to
co
n
tin
u
o
u
s
ly
tr
ain
an
d
d
ev
elo
p
th
ese
h
a
n
d
-
e
y
e
co
o
r
d
in
atio
n
s
k
ills
d
u
r
in
g
t
h
eir
ed
u
ca
tio
n
,
b
o
th
th
r
o
u
g
h
clin
ical
p
r
ac
tice
an
d
s
im
u
latio
n
,
to
im
p
r
o
v
e
th
eir
ab
ilit
y
to
ca
r
r
y
o
u
t
to
o
th
p
r
e
p
ar
atio
n
p
r
o
ce
d
u
r
es
ac
cu
r
ately
[
3
4
]
,
[
3
5
]
.
Seq
u
en
tial
r
ea
s
o
n
in
g
is
also
a
n
im
p
o
r
ta
n
t
asp
ec
t
in
b
r
id
g
ewo
r
k
d
e
n
tu
r
e
to
o
th
p
r
ep
ar
atio
n
.
Seq
u
en
tial
r
ea
s
o
n
in
g
a
b
i
liti
es
en
ab
le
d
e
n
tis
ts
to
p
lan
an
d
ex
e
cu
te
a
s
er
ies
o
f
to
o
th
p
r
ep
ar
atio
n
s
tep
s
lo
g
ically
an
d
s
eq
u
en
tially
.
I
n
th
is
co
n
tex
t,
d
en
tal
s
tu
d
en
ts
n
ee
d
to
b
e
ab
le
to
u
n
d
er
s
tan
d
th
e
s
tag
es
r
eq
u
ir
ed
in
th
e
to
o
th
p
r
ep
ar
atio
n
p
r
o
ce
s
s
,
d
eter
m
in
e
th
e
co
r
r
ec
t
s
eq
u
en
ce
t
o
ca
r
r
y
o
u
t
th
ese
s
tep
s
,
an
d
ad
ju
s
t
th
e
tr
ea
tm
en
t
p
lan
b
ased
o
n
s
p
ec
if
ic
p
atien
t
co
n
d
itio
n
s
.
W
ith
o
u
t
g
o
o
d
s
eq
u
en
tial
r
ea
s
o
n
in
g
,
d
en
tis
ts
m
ay
h
av
e
d
if
f
icu
lty
o
r
g
an
izin
g
th
e
to
o
th
p
r
ep
a
r
atio
n
p
r
o
ce
s
s
ef
f
icien
tly
,
wh
ich
ca
n
r
esu
lt
in
d
elay
s
in
tr
ea
tm
en
t
co
m
p
l
etio
n
an
d
ev
en
er
r
o
r
s
in
th
e
to
o
th
p
r
e
p
ar
atio
n
p
r
o
ce
s
s
[
3
6
]
.
Sp
atial
r
ea
s
o
n
in
g
p
la
y
s
a
cr
it
ical
r
o
le
in
to
o
th
p
r
ep
ar
atio
n
f
o
r
b
r
id
g
ew
o
r
k
an
d
d
en
tu
r
es,
en
ab
lin
g
d
en
tis
ts
to
v
is
u
alize
th
e
th
r
ee
-
d
im
en
s
io
n
al
an
ato
m
y
o
f
teeth
an
d
ac
cu
r
ately
ass
ess
th
e
s
p
a
ce
r
eq
u
ir
ed
f
o
r
th
e
p
o
n
tic
an
d
co
n
n
ec
to
r
s
.
Den
tis
ts
r
ely
o
n
s
p
atial
r
ea
s
o
n
in
g
to
a
lig
n
an
d
f
it
th
e
p
r
e
p
ar
ed
teeth
,
m
an
ag
e
u
n
d
er
c
u
ts
,
p
r
ed
ict
in
ter
f
e
r
en
ce
s
,
an
d
cr
e
ate
a
clea
r
p
ath
o
f
in
s
er
tio
n
f
o
r
o
p
tim
al
s
ea
tin
g
o
f
th
e
b
r
id
g
ewo
r
k
d
en
tu
r
e.
B
y
v
is
u
alizin
g
to
o
th
s
tr
u
ct
u
r
e
an
d
esti
m
atin
g
s
p
ac
e,
s
p
atial
r
ea
s
o
n
in
g
en
h
an
ce
s
th
e
p
r
ec
is
io
n
an
d
ac
cu
r
ac
y
o
f
to
o
t
h
p
r
ep
ar
atio
n
,
en
s
u
r
in
g
p
r
o
p
er
f
it,
alig
n
m
en
t,
an
d
r
eten
tio
n
o
f
th
e
b
r
id
g
ewo
r
k
d
en
tu
r
es.
Ad
d
itio
n
ally
,
s
p
atial
r
ea
s
o
n
in
g
aid
s
in
t
h
e
an
ticip
a
tio
n
o
f
p
o
ten
tial
in
ter
f
e
r
en
ce
s
an
d
f
ac
ilit
ates
th
e
cr
ea
tio
n
o
f
p
ar
allel
walls
to
o
p
tim
ize
r
eten
tio
n
an
d
s
tab
ilit
y
,
u
ltima
tely
co
n
tr
ib
u
tin
g
t
o
th
e
s
u
cc
ess
f
u
l
f
ab
r
ic
atio
n
an
d
p
lace
m
en
t
o
f
b
r
id
g
ewo
r
k
d
e
n
tu
r
es
[
3
4
]
,
[
3
7
]
.
Dif
f
icu
lties
ca
n
also
ar
is
e
f
r
o
m
ex
tr
in
s
ic
f
ac
to
r
s
,
n
am
ely
th
e
co
m
p
lex
ity
o
f
w
o
r
k
in
f
lu
en
ce
d
b
y
th
e
lo
ca
tio
n
an
d
p
o
s
itio
n
o
f
teeth
t
h
at
m
ay
n
o
t b
e
ad
v
an
tag
e
o
u
s
,
o
r
th
e
co
n
d
itio
n
s
ar
o
u
n
d
th
e
te
eth
to
b
e
p
r
ep
ar
e
d
,
s
u
ch
as a
to
n
g
u
e
th
at
is
t
o
o
la
r
g
e
an
d
th
e
in
n
er
p
ar
t
o
f
th
e
ch
ee
k
th
at
is
to
o
th
ick
.
T
h
ese
ex
t
r
in
s
ic
f
ac
to
r
s
c
r
ea
te
v
ar
iatio
n
s
in
th
e
le
v
el
o
f
d
if
f
i
cu
lty
am
o
n
g
d
e
n
tal
clin
ic
s
tu
d
en
ts
,
as
ea
ch
s
tu
d
en
t
h
as
d
if
f
e
r
en
t
ex
p
e
r
ien
ce
s
in
p
r
ep
ar
in
g
v
ar
io
u
s
ar
ea
s
o
f
teeth
,
s
u
ch
as
u
p
p
er
r
eg
io
n
s
,
lo
wer
r
eg
io
n
s
,
r
ig
h
t
s
id
e,
lef
t
s
id
e,
p
o
s
ter
io
r
teeth
,
o
r
an
ter
io
r
teeth
.
T
h
is
p
r
o
v
id
es
a
n
o
v
er
v
iew
th
at
ea
ch
s
tag
e
o
f
to
o
th
p
r
ep
a
r
atio
n
f
o
r
b
r
id
g
e
d
en
tu
r
e
f
a
b
r
icatio
n
m
ay
h
a
v
e
v
ar
y
in
g
lev
els
o
f
d
i
f
f
icu
lty
d
e
p
en
d
i
n
g
o
n
th
e
ex
p
er
ien
ce
an
d
p
o
s
itio
n
o
f
t
h
e
d
e
n
tal
wo
r
k
a
r
ea
f
ac
e
d
b
y
d
e
n
tal
clin
ic
s
tu
d
en
ts
,
s
o
lin
e
o
f
v
is
i
o
n
o
n
p
o
s
tu
r
e,
m
u
s
c
le
ac
tiv
ity
,
an
d
s
itti
n
g
b
alan
ce
is
v
er
y
h
elp
f
u
l
in
ca
r
r
y
in
g
o
u
t to
o
th
p
r
ep
ar
atio
n
[
3
8
]
.
Ho
wev
er
,
it
is
im
p
o
r
tan
t
t
o
n
o
te
th
at
th
e
wea
k
n
ess
o
f
t
h
is
s
tu
d
y
m
ay
lie
i
n
th
e
lack
o
f
m
o
r
e
d
etailed
in
clu
s
io
n
r
eg
ar
d
in
g
in
tr
in
s
ic
a
n
d
ex
tr
in
s
ic
f
ac
to
r
s
th
at
af
f
ec
t
th
e
d
if
f
icu
lty
at
ea
ch
s
tag
e
o
f
b
r
id
g
ewo
r
k
d
en
t
u
r
e
to
o
th
p
r
ep
a
r
atio
n
.
T
h
e
r
esear
c
h
er
s
m
ay
n
o
t
d
ee
p
ly
in
cl
u
d
e
ce
r
tain
v
ar
iab
les,
s
u
ch
as
m
o
r
e
s
p
ec
if
ic
tech
n
ical
s
k
ills
,
d
etailed
clin
ical
ex
p
e
r
ie
n
ce
lev
els,
o
r
o
th
er
in
tr
in
s
ic
f
a
cto
r
s
th
at
m
a
y
af
f
ec
t
th
e
r
esear
ch
r
esu
lts
.
T
h
e
lack
o
f
d
etail
in
in
clu
d
in
g
th
ese
v
a
r
iab
les
co
u
ld
b
e
a
lim
itatio
n
,
as
th
er
e
m
ay
b
e
s
p
ec
if
ic
f
ac
to
r
s
th
at
ar
e
n
o
t
f
u
lly
id
en
tifie
d
.
T
h
er
e
f
o
r
e,
f
u
tu
r
e
r
e
s
ea
r
ch
ca
n
ex
p
lo
r
e
in
tr
i
n
s
ic
an
d
ex
tr
in
s
ic
f
ac
to
r
s
in
m
o
r
e
d
eta
il
to
p
r
o
v
id
e
a
m
o
r
e
co
m
p
r
eh
e
n
s
iv
e
an
d
i
n
-
d
e
p
th
u
n
d
er
s
tan
d
in
g
o
f
t
h
e
d
if
f
icu
ltie
s
f
ac
ed
b
y
d
en
tal
clin
ic
s
tu
d
en
ts
d
u
r
in
g
th
e
s
tag
es
o
f
b
r
id
g
ewo
r
k
d
en
tu
r
e
to
o
th
p
r
ep
ar
atio
n
.
B
y
in
clu
d
in
g
m
o
r
e
d
etailed
v
ar
iab
les,
f
u
tu
r
e
r
esear
ch
ca
n
p
r
o
v
id
e
d
ee
p
er
i
n
s
ig
h
ts
in
to
t
h
e
co
m
p
l
ex
ity
o
f
f
ac
to
r
s
af
f
ec
tin
g
d
e
n
ta
l
clin
ic
s
tu
d
en
ts
'
d
if
f
icu
lties
.
T
h
u
s
,
f
u
t
u
r
e
r
esear
ch
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
C
lin
ica
l d
en
ta
l stu
d
en
ts
'
p
erce
p
tio
n
s
o
f d
iffi
cu
lties
in
fixed
p
r
o
s
th
o
d
o
n
tics
…
(
A
d
itya
P
r
a
t
a
ma
S
a
r
w
o
n
o
)
1735
is
ex
p
ec
ted
to
r
e
f
in
e
m
et
h
o
d
o
lo
g
ies
to
in
clu
d
e
m
o
r
e
v
ar
iab
l
es
an
d
p
r
o
v
id
e
a
r
ich
er
u
n
d
er
s
tan
d
in
g
o
f
s
p
ec
if
i
c
asp
ec
ts
of
th
e
b
r
id
g
ewo
r
k
d
en
t
u
r
e
to
o
th
p
r
e
p
ar
atio
n
p
r
o
ce
s
s
.
5.
CO
NCLU
SI
O
N
T
h
is
r
esear
ch
aim
s
to
r
an
k
th
e
d
if
f
icu
lty
o
f
ea
ch
s
tag
e
in
a
b
u
tm
en
t
to
o
th
p
r
ep
a
r
atio
n
u
s
in
g
s
tu
d
en
t
ev
alu
atio
n
s
,
id
en
t
if
y
in
g
wh
ich
s
tag
es
p
o
s
e
th
e
g
r
ea
test
ch
all
en
g
es.
I
t
f
o
cu
s
es
o
n
u
n
d
er
s
tan
d
in
g
th
e
ch
allen
g
es
f
ac
ed
b
y
d
en
tal
s
tu
d
e
n
ts
in
I
n
d
o
n
esia
d
u
r
in
g
t
h
e
to
o
th
p
r
e
p
a
r
atio
n
p
r
o
ce
s
s
f
o
r
f
i
x
ed
d
en
tal
b
r
id
g
es.
T
h
e
s
tu
d
y
p
r
o
v
id
es
a
co
m
p
r
e
h
en
s
iv
e
a
n
aly
s
is
o
f
th
e
m
o
s
t
d
if
f
icu
lt
s
t
ag
es,
f
r
o
m
o
cc
lu
s
al
r
ed
u
ctio
n
to
f
in
al
f
i
n
is
h
in
g
.
T
h
e
s
tu
d
y
h
ig
h
lig
h
ts
th
at
f
r
o
m
2
0
2
1
to
2
0
2
3
,
i
)
p
r
o
x
im
al
r
ed
u
ctio
n
was
th
e
m
o
s
t
ch
allen
g
in
g
s
tag
e
f
o
r
all
s
tu
d
en
ts
,
f
o
llo
wed
b
y
ii
)
ce
r
v
i
ca
l
p
r
ep
a
r
atio
n
,
iii
)
lin
g
u
al
r
ed
u
ctio
n
,
iv
)
o
cc
lu
s
al
r
e
d
u
ctio
n
,
v
)
b
u
cc
al
r
ed
u
ctio
n
,
vi
)
alig
n
m
en
t
o
f
p
r
ep
ar
atio
n
b
etwe
en
two
ab
u
tm
en
t
teeth
,
an
d
v
ii
)
f
in
is
h
in
g
.
Pro
x
im
al
r
ed
u
ctio
n
is
p
ar
ticu
lar
ly
d
if
f
icu
lt
d
u
e
to
th
e
n
ee
d
f
o
r
h
i
g
h
tech
n
ical
s
k
ills
an
d
p
r
ec
is
io
n
,
r
eq
u
ir
in
g
ac
cu
r
ate
s
p
ac
e
esti
m
atio
n
an
d
ca
r
ef
u
l
r
ed
u
ctio
n
with
o
u
t
d
am
a
g
in
g
a
d
jace
n
t
teeth
.
T
h
is
d
if
f
icu
lty
is
co
m
p
o
u
n
d
ed
b
y
n
at
u
r
al
v
ar
iat
io
n
s
in
t
o
o
th
s
h
ap
es
an
d
p
o
s
itio
n
s
am
o
n
g
p
atien
ts
.
T
h
e
f
in
d
i
n
g
s
o
f
f
er
d
ee
p
er
in
s
ig
h
ts
in
to
clin
ical
ch
allen
g
es
an
d
p
r
o
m
is
e
s
ig
n
if
ican
t
im
p
ac
ts
o
n
d
en
tal
cu
r
r
ic
u
lu
m
d
ev
el
o
p
m
en
t
an
d
teac
h
i
n
g
m
eth
o
d
s
.
W
ith
a
b
etter
u
n
d
er
s
tan
d
in
g
o
f
th
e
d
if
f
icu
lties
in
ea
ch
s
tag
e
o
f
to
o
th
p
r
ep
a
r
atio
n
,
m
o
r
e
ef
f
ec
tiv
e
s
o
lu
tio
n
s
ca
n
b
e
p
r
o
v
i
d
ed
f
o
r
d
en
tal
ed
u
ca
tio
n
an
d
tr
ain
in
g
in
I
n
d
o
n
esia.
ACK
NO
WL
E
DG
E
M
E
NT
T
h
e
au
th
o
r
s
wo
u
ld
lik
e
to
th
a
n
k
th
e
Dep
ar
tm
e
n
t
o
f
Pro
s
th
o
d
o
n
tics
,
Facu
lty
o
f
De
n
tis
tr
y
,
Un
iv
er
s
itas
T
r
is
ak
ti,
f
o
r
th
eir
tech
n
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s
u
p
p
o
r
t.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
Au
th
o
r
s
s
tate
n
o
f
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n
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in
g
in
v
o
lv
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.
AUTHO
R
CO
NT
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B
UT
I
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NS ST
A
T
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M
E
N
T
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h
is
jo
u
r
n
al
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s
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th
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C
o
n
tr
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u
to
r
R
o
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T
ax
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m
y
(
C
R
ed
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ize
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al
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th
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h
ip
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tes,
an
d
f
ac
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co
llab
o
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atio
n
.
Na
m
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Aut
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Vi
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Kh
air
u
n
n
is
a
Feb
ian
ti
✓
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✓
C
:
C
o
n
c
e
p
t
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a
l
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z
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t
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M
:
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Au
th
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E
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is
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as
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tain
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eth
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r
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f
r
o
m
th
e
eth
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co
m
m
is
s
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f
th
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Facu
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f
Den
tis
tr
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Un
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itas
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r
is
ak
ti,
with
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u
m
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er
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2
9
/S1
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PK/F
KG/8
/2
0
2
3
.
DATA AV
AI
L
AB
I
L
I
T
Y
Data
av
ailab
ilit
y
is
n
o
t
ap
p
lica
b
le
to
th
is
p
ap
er
as n
o
n
ew
d
at
a
wer
e
cr
ea
te
d
o
r
an
aly
ze
d
in
t
h
is
s
tu
d
y
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
4
,
Dec
em
b
er
20
25
:
1
7
3
0
-
1
7
3
7
1736
RE
F
E
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1
1
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J.
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.
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,
2020.
[
1
3
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C
.
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.
S
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[
1
4
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[
1
5
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D
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C
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