WEBINAR BY PROF. DR. SVEN RINKE

Enhance your knowledge and skills in the field of all-ceramic restorations! We invite you to watch the recording of the recent webinar titled "Cementation of All-Ceramic Restorations" by the esteemed Professor Dr. Sven Rinke.

Whether you currently incorporate all-ceramic restorations in your daily practice or aspire to offer them, this webinar recording is a valuable resource that you shouldn't miss. Professor Dr. Rinke, an expert in the field, delves into the key aspects of implementing an all-ceramic treatment concept that guarantees predictable long-term success and superior aesthetic outcomes while utilizing a limited number of materials and straightforward treatment strategies.

During the webinar, two types of cementation techniques are showcased: self-adhesive cement (PANAVIA SA Cement Universal, Kuraray Noritake Dental Inc.) and adhesive composite material (PANAVIA V5, Kuraray Noritake Dental Inc.). Professor Dr. Rinke provides a comprehensive step-by-step concept that offers easy-to-follow instructions, which you can readily incorporate into your daily routine.

The webinar recording covers a wide range of important topics, including:

• An update on material-specific recommendations for preparing all-ceramic restorations, ensuring you stay up-to-date with the latest advancements.
• Established procedures and materials for adhesive cementation of glass-ceramic and zirconia restorations, enabling you to implement best practices in your clinical work.
• A discussion on the relevance of conventional cementation and its viability in today's dental landscape.
• Valuable tips and strategies for avoiding failures and flaws in all-ceramic restorations, ultimately improving your treatment outcomes.

Don't miss out on this chance to elevate your skills and expand your expertise in all-ceramic restorations. We are confident that the knowledge shared in this webinar recording will have a positive impact on your daily practice and help you achieve superior outcomes.

Watch now at your own convenience!

DR. SVEN RINKE

Sven Rinke’s vast experience and expertise in the field of Prosthodontics and Implantology has seen him taking on a wide range of roles in universities, private practice, and the dental industry.

In 1992, he joined the School of Dentistry Department of Prosthodontics, Georg-August-University, Göttingen, and later worked as Senior Lecturer for Material Sciences and Prosthetic Dentistry before taking on the role of Associate Professor. Sven has also been a Visiting Assistant Professor at the Harvard School of Dental Medicine’s Department of Restorative Dentistry.

Since 1996 Sven has run a private practice specializing in prosthodontics and implantology as well as being a scientific consultant for Degussa Dental. He was Head of Clinical Research at Degussa Dental GmbH where, from 2002, he headed up the Foundation of EC EviDent Consulting (Clinical research and scientific transfer management).

Other achievements include membership of the Assigned Board Specialist of Oral Implantology and Assigned Board Specialist of Periodontics plus a MSc in Oral Implantology and another in Periodontology.

Since 2013, Sven has worked in the Venia Legendi for Dentistry, Georg-August-University, Göttingen, Germany, and the university’s Department of Prosthodontics.

He has also won numerous awards, recognising his extensive expertise in Prosthodontics and Implantology.

LabLine magazine is an English language publication catering to the field of lab-side dentistry. It provides comprehensive coverage of the latest techniques and trends in dental laboratory technology and materials, showcasing them via sophisticated, challenging and aesthetic clinical cases done by some of the most known experts in Europe. With its expertly curated content, LabLine serves as an invaluable resource for dental professionals seeking to enhance their knowledge and stay at the forefront of the industry.

In the SPRING edition of LabLine you can find a wonderful AESTHETIC CASE by Mikel Villar Gonzales and DT Pilar Ballesteros Galan. The patient, a 21-year-old female had a hypoplasia defect on her permanent teeth, 1.1 and 1.2., presumably due to trauma on her deciduous anterior teeth. Click the image below and check out how the case was done!

Shortly before KATANA™ Zirconia ML was launched at the IDS in Cologne ten years ago, I had the pleasure to be invited to Japan. We visited the KATANA™ Zirconia production facilities and learned from Kazunobu Yamada and Takuro Nagura how the new material worked. So far, all dental zirconia I had used was white and quite opaque.

I was immediately impressed by the complexity of the production procedure including all the measures taken by Kuraray Noritake Dental to provide for an extremely high material and blank quality. The blanks appeared to have an extremely homogeneous multi-layered structure and a high density responsible for stable edges and smooth surfaces. What we were told in the manufacturing plant was confirmed by Kazunobu Yamada, who shared his experience and showed us several full-contour cases. I was pleasantly surprised by the fact that he was able to produce impressive outcomes without adding any colour. Moreover, Kazunobu Yamada was obviously able to polish the surface of his restorations within seconds. The perfectly smooth surface would allow us avoid the use of glaze, which usually wears off very quickly, leaving a potentially rough surface that may harm the antagonist.

Based on what I had learned in Japan, I went back to Italy and started experimenting with the amazing new material. While Kazunobu Yamada had identified KATANA™ Zirconia ML as the solution for monolithic restorations in the posterior area, I started using it in every region of the mouth – with different design concepts from full-contour to micro-cutback with micro-layering in the vestibular area. The occlusal contact area was always held in plain, polished zirconia.

Fig. 1. Early example of anterior restorations made of KATANA™ Zirconia ML individualized with CERABIEN™ ZR using the new micro-layering technique.

Fig. 2. Possible cutback design.

During the testing period, I learned a lot about the new zirconia, which was so different from earlier generations. The most important insight was that that the processing conditions have a huge impact on the final outcome. Kuraray Noritake Dental provided valuable support e.g. in the form of sintering protocols and processing and finishing recommendations. This helped me develop my own workflow and concept based on a full-contour design in the posterior and different micro-cutback options with micro-layering in the anterior region. For me, this is a perfect combination of the new type of zirconia (KATANA) and the traditional porcelain material (CERABIEN™ ZR Luster Porcelain and Internal Stain).

In May 2013, at a meeting of the Noritake Study Club in Florence, Italy, I presented the new approach for the first time. Many colleagues were enthusiastic about it and started adopting it. While further developments like more translucent (cubic) material variants and a new generation multi-layered zirconia with a flexural strength and translucency gradient increased the application options and aesthetic potential, micro-layering became a truly popular approach used by dental technicians all over the world. In 2016, it was recognized as a relevat workflow during a closed meeting of the European Academy of Aesthetic Dentistry.

Fig. 3. Perfectly polished palatal zirconia surfaces of anterior restorations.

Fig. 4. More recent case showing a patient who received restorations made of KATANA™ Zirconia STML …

Fig. 5. … finished with CERABIEN™ ZR Internal Stains and a micro-layer of CERABIEN™ Luster Porcelain LT1.

But what is the major reason for the success of the concept and of multi-layered zirconia with KATANA™ Zirconia ML as the pioneer? In my opinion, it should not be implemented for greater simplicity or economic reasons, as one might assume at first thought. The time saved in the layering procedure should be spent on other tasks such as surface texturing and a fine-tuning of the processing procedure. The real benefit is that KATANA™ Zirconia ML and its successors allow for better solutions adapted to the patient’s needs. First of all, they enable us to save natural tooth structure, as the required wall thickness is reduced. They also offer mechanical advantages, as chipping is avoided, and the occlusal contact area remains smooth over time. In my dental laboratory, we changed our workflows completely and – preferring a more conservative approach whenever indicated for the case on hand – we often abandon full layering.

KATANA™ Zirconia can be considered as a great contribution to the digital workflow in the dental laboratory and office, which increases the efficiency of prosthodontic procedures. With the KATANA™ Zirconia Multi-Layered series, it is easy to hold our promise of delivering the best possible quality and aesthetics. The reason is that the materials support us in an ideal way, delivering the perfect combination of tradition and innovation.

Case by Michal Jaczewski

This patient came to the clinic to improve the aesthetics of her smile. After an aesthetic and functional analysis, it was decided to align and restore the teeth using a minimally invasive protocol with flowable composite.

INITIAL SITUATION

Fig. 1. The patient had worn teeth, visible abrasion, erosion and crowding in the lower arch.

Fig. 2. Situation after orthodontic treatment, full arch ready to restore.

Fig. 3. A silicon mould is used for the Flowable Injection Technique to restore the teeth with flowable composite. The silicone injection mould had injection channels prepared and was placed to check for proper fit.

Fig. 4. For this case it was decided to use CLEARFIL MAJESTY™ ES Flow Low in shade XW.

Fig. 5. Teflon tape was used, in order to separate the teeth.

Fig. 6. The restoration is completely additive; the teeth are not prepared at all. Total etching of the enamel is the best pre-treatment in this situation. K-Etchant Syringe (35% phosphoric acid) was applied for 10 seconds.

Fig. 7. A surgical suction tip was used in order to carefully remove the phosphoric acid gel and protect the isolations on the teeth. Followed by rinsing off completely with water in the usual manner.

Fig. 8. Each tooth was gently air dried for 10 seconds. CLEARFIL™ Universal Bond Quick was applied with a rubbing motion without additional waiting time. Followed by drying of the entire bonding treated surfaces by blowing mild air for more than 5 seconds until the bonding no longer moves.

Fig. 9. Light curing of each bonded tooth for 10 sec.

Fig. 10. The silicon mould is used to inject CLEARFIL MAJESTY™ ES Flow Low (optimal flowability, and properties for a case like this).

Fig. 11. Using the protocol „Treat one, skip one” several teeth are restored simultaneously.

Fig. 12. Situation directly after first round of injections.

Fig. 13. Situation after restoring all teeth, before polishing.

Fig. 14. To create a natural gloss the following polishing protocol was used: 1.) Sof-Lex™* discs, 2.) CLEARFIL™ Twist DIA for Composite polishing wheels, 3.) diamond paste and finally zinc oxide paste.

*Not a brand name of Kuraray Noritake Dental.

Fig. 15. High-shine results after polishing.

FINAL SITUATION

Fig. 16. Final restoration, immediately after treatment.

Fig. 17. Final restoration after 2 days.

Dentist:

MICHAL JACZEWSKI

Michał Jaczewski graduated from Wroclaw Medical University in 2006 and today runs his private practice in the city of Legnica, Poland. He specializes in minimally invasive dentistry and digital dentistry and is the founder of the Biofunctional School of Occlusion. Here he lectures and runs workshops with focus on full comprehensive patient treatments.

Interview with Yoshihisa Yamada
General Manager, Technology Division of Kuraray Noritake Dental Inc.

KATANA™ Zirconia ML was introduced ten years ago, at the IDS 2013 in Cologne, as the dental industry’s first zirconia product with a multi-layered colour structure. Since that event, KATANA™ Zirconia ML blanks have become very popular. Continued development efforts have led to the current line-up of multi-layered materials, KATANA™ Zirconia UTML, STML and HTML PLUS, and our latest product – KATANA™ Zirconia YML. Our new technology with colour, translucency and strength gradation is found in KATANA™ Zirconia YML.

Photo credits to MDT Giuliano Moustakis.

How important was the invention of the Kuraray Noritake Dental’s original multi-layered technology for the dental market?

Our impression is that the material has had a significant impact on the dental market. Being the first zirconia material with a multi-layered colour structure, KATANA™ Zirconia ML was our first product of its class to offer the properties needed for the efficient production of full-contour zirconia restorations with a natural look. Before its introduction, the “full-contour zirconia” concept had not been widely accepted due to the aesthetic properties of the zirconia materials available so far: Many of them lacked the desired level of translucency, while others needed to be treated with dyeing liquids or stains in a complex procedure to obtain a natural shade appearance. With the launch of multi-layered zirconia blanks, which successfully added natural colour gradation to the structure, aesthetic full-contour zirconia restorations started to become popular among dental technicians worldwide. The high potential of the technology was confirmed at the IDS 2013 show, when we saw not only end-users, but also engineers from competing companies come to look at this product.

4-layer colour structure of KATANA™ multi-layered discs.

Photo credits to MDT Daniele Rondoni.

What changes were driven forward by the introduction of KATANA™ Zirconia ML?

After the introduction of KATANA™ Zirconia ML, many companies started developing multi-layered zirconia discs, creating a new dental product category with an added technical and clinical value. We are convinced that the invention of Kuraray Noritake Dental has played a major role in the shift from zirconia exclusively used as a framework material to alternative approaches including full-contour zirconia restorations. If only monochromatic zirconia discs had been available, we imagine that an increased number of dental technicians would have embraced the concept of using liquid colourants to achieve a natural appearance of full-contour crowns and bridges. That would have prevented monolithic zirconia restorations from becoming as popular as they are today.

How did the KATANA™ Zirconia ML technology evolve over the past ten years?

Based on our unique core technology developed for inventing KATANA™ Zirconia ML, we have been continuing making efforts to create even better products. One of Kuraray Noritake Dental’s great strengths is its ability to develop all the raw materials for its zirconia products inhouse. This makes it possible for us to adjust the boundaries between the layers as inconspicuously as possible, even when discs consist of multiple layers. This enabled us to provide multi-layered discs with the required strength and aesthetic qualities, and with a stable, predictable shrinkage rate. In the past ten years, we have focused on adding new materials with different levels of translucency and strength to offer a portfolio that meets the demands of virtually every dental technician, practitioner and patient.

For example, the advent of KATANA™ Zirconia STML, which has even better aesthetic qualities than KATANA™ Zirconia ML, has made it possible to use it all by itself to create highly aesthetic restorations, with no need to characterize or individualize the restorations. Of course, if you use KATANA™ Zirconia Multi-Layered discs and treat the restorations with a surface staining agent, such as CERABIEN™ ZR FC Paste Stain, you can create even more aesthetic restorations in a shorter time.

What are the benefits of Kuraray Noritake Dental’s multi-layered technology, as compared with other manufacturer’s solutions?

KATANA™ Zirconia multi-layered discs offer the advantage of delivering the proper colour even when they are sintered at high speed. There are two reasons for this. First, we developed unique raw materials with suitable characteristics for high-speed firing. This allows the creation of restorations with the same strength, stability, and aesthetics to be achieved after both short- and long-time firing. The second reason is that we possess the technical know-how concerning excellent shading that Noritake Dental Supply, one of Kuraray Noritake Dental’s predecessors, cultivated during its many years spent developing ceramic materials. Noritake Co., Ltd., parent company of Noritake Dental Supply, is a long-established ceramic manufacturer that is famous for its tableware and other outstanding products. It is this background that allows us to properly control pigment coloration using our inorganic pigment know-how and to provide unique firing schedules. These two strengths enable us to bring unique advantages to our products. That is, they remain stable and retain appropriate colouration even under rapid firing schedules.

CERABIEN™ ZR FC Paste Stain being applied to KATANA™ Zirconia restoration.

Photo credits to MDT Roberto Rossi.

How did you manage to shorten the sintering times so significantly, resulting in your speedy sintering with uniform protocols?

When shorter sintering times became possible, Kuraray Noritake Dental recommended that KATANA™ Zirconia ML be sintered for seven hours. After that, when a new furnace claiming being capable of short-time firing was launched, we used it to fire KATANA™ Zirconia ML on a trial basis. We found, happily, that our zirconia material was uniquely compatible with rapid firing. This was the beginning of our full-fledged study of short-time firing of our zirconia material. You could say that we began investigating short-time firing almost by accident. Then, while developing KATANA™ Zirconia STML and KATANA™ Zirconia UTML, successors of KATANA™ Zirconia ML, we focused on incorporating short-time firing into their features and made various adjustments, finally achieving the optimal combination of factors for the successful short-time firing of zirconia.

What are the benefits of Kuraray Noritake Dental’s second-generation multi-layered technology, as compared with other manufacturer’s solutions?

One advantage of KATANA™ Zirconia YML is that it can be applied to treat a wider range of cases without complex limitations on position within the disc. The reason: it delivers this high level of aesthetics while still maintaining great strength. This advantage of being appropriate for a wider range of cases also simplifies inventory management. In addition, users benefit from our expertise in developing raw materials and reproducing colour with ceramics. This expertise enabled us to develop a zirconia product in which each layer has a different level of translucency, while great strength and admirable aesthetics are maintained throughout the whole blank.

The sintering recommendation is only a guideline; some adjustments may be required depending on each individual furnace. If the furnace cannot be set according to the 54- or 90-minute sintering schedule, speed sintering cannot be used.

* The restorations may be removed at 800°C or less depending on the circumstances.
** For the sintering schedule of KATANA™ Zirconia HT, please refer to the Handy Chart in product packaging.

Is it really possible to address every case using only KATANA™ Zirconia YML?

For every case that can be treated either with KATANA™ Zirconia STML, KATANA™ Zirconia UTML, or KATANA™ Zirconia HTML PLUS, KATANA™ Zirconia YML is also an option. Hence, it is possible to use only KATANA™ Zirconia YML for all your zirconia cases – which is probably one of the reasons for its great popularity. It features both great strength and excellent aesthetics, and – being so versatile – it helps simplify inventory management. Of course, Kuraray Noritake Dental’s other multi-layered materials feature outstanding properties as well. Depending on the features you need, it would also be an option to select from these products - KATANA™ Zirconia STML, KATANA™ Zirconia UTML, or KATANA™ Zirconia HTML PLUS – to realize your ideal restorations.

KATANA™ Zirconia YML, finished with CERABIEN™ ZR.

Photo credits to MDT Giuliano Moustakis.

Why is the KATANA™ brand in general so popular among dental technicians around the world?

We think that dental technicians choose KATANA™ because they find that they can create highly aesthetic restorations using simple, straightforward steps.

Is there any further development potential in multi-layered technology?

On the basis of our technical know-how, there is always room for improvement. That is why we never stop innovating and listening to the voice of our customers. Developing what supports them in improving their outcomes while providing for more predictable, less stressful procedures is our ultimate goal. Right now, we expect to develop products with even greater strength, increased translucency, and outstanding aesthetics that will have a natural look resembling real teeth, even when the material used is full-contour zirconia.

Dentist:

YOSHIHISA YAMADA

Est-il possible de réduire le nombre de ciments différents qu'on utilise dans un cabinet dentaire ? Dans la plupart des cas, c'est possible. Kuraray Noritake Dental Inc. est convaincue qu'un ou deux systèmes de collage résine sont normalement suffisants pour couvrir chaque indication et chaque besoin de collage général. Les produits sélectionnés peuvent varier en fonction des préférences personnelles et traitements spécifiques visés.

La société propose donc trois ciments de résine supérieurs qui permettent de répondre aux besoins et souhaits de chaque dentiste et chaque patient. L'un de ces produits est destiné à ceux qui veulent s'en tenir à l'essentiel tout en bénéficiant des multiples avantages qu'offrent les ciments de résine par rapport aux ciments conventionnels. Un autre est conçu pour ceux qui exigent une force d'adhésion et une esthétique maximales. Enfin, le troisième système est photo-polymérisable et a été développé en tant que solution spécialisée pour le collage des facettes.

Afin de faciliter la prise de décision, cet article fournit des informations détaillées sur chacun de ces trois systèmes et leurs points forts spécifiques.

Collage pour tous les jours
Il est possible de coller simplement et efficacement en réduisant le nombre d'étapes de travail et de composants et en résolvant les problèmes existants. Le ciment de résine auto-adhésif à double polymérisation PANAVIA™ SA Cement Universal a été conçu à cette fin. Le problème de l'élimination de l'excédent de ciment qui colle a été résolu par une formulation permettant un nettoyage très facile.

Les composants sont réduits puisque le produit contient le monomère MPD original de Kuraray Noritake Dental Inc. et l'agent combinant le silane qu'est le monomère LCSi original, pour une adhésion solide et durable. Alors que le MDP crée une liaison chimique solide et durable avec l'émail, la dentine, le métal et la zircone, le LCSi assure l'adhésion à la résine composite, la porcelaine et les céramiques de type silice (comme le disilicate de lithium), rendant ainsi inutiles les apprêts séparés.

Cela signifie qu'il suffit d'un seul composant qui rationnalise la procédure avec pour résultat un gain de temps et une forte réduction du risque d'erreur. Grâce à ses propriétés, PANAVIA™ SA Cement Universal est idéal pour les procédures au quotidien comme le collage permanent de couronnes et bridges en zircone, disilicate de lithium, céramique hybride ou même en métal.

Solution polyvalente, puissante et esthétique
Pour ceux qui accordent de l'importance à une force d'adhésion et une esthétique maximales, PANAVIA™ V5 est la solution. Le système fiable de collage double polymérisation consistant dans un apprêt dentaire, une pâte de collage et un apprêt céramique, produit la force d'adhésion et l'esthétique les plus élevées de la gamme de collage PANAVIA™.

Ainsi, c'est un excellent choix pour toute une variété de restaurations indirectes et pour les procédures tenon-core. Comme les composants bien alignés sont toujours combinés et appliqués de la même manière, la normalisation est favorisée, ce qui conduit à des résultats prévisibles.

Le spécialiste des facettes
Pour accomplir des tâches aussi exigeantes que le collage de facettes, chaque praticien dentaire a besoin de temps. En particulier s'agissant de poser plusieurs facettes simultanément pour le meilleur résultat esthétique possible, faire la course contre le temps de prise est contreproductif. C'est pourquoi Kuraray Noritake Dental Inc. a développé PANAVIA™ Veneer LC, un système de ciment de résine photo-polymérisable avec un temps de travail long de 200 secondes* sur l'apprêt, ce qui permet aux utilisateurs de commencer la polymérisation quand ils sont prêts à le faire.

PANAVIA™ Veneer LC offre également une viscosité de la pâte et une consistance bien alignées pour une distribution et un placement faciles, et existe en quatre teintes à haute résistance chromatique pour une esthétique de longue durée. Enfin, le système assure une élimination facile de l'excédent après semi-polymérisation et une excellente force d'adhésion dans la durée.

**Temps de travail : sensibilité à la lumière (8 000 lux, ISO 4049)

Satisfaire les attentes
Les trois produits mentionnés sont précisément ce dont vous avez besoin pour couvrir chaque préférence personnelle et indication spécifique. Ils reposent sur la longue expertise de Kuraray Noritake Dental Inc. dans le développement de ciments de résine adhésifs. Le premier produit de la marque PANAVIA™ a été introduit dans les années 1980 et, depuis, la société n'a jamais cessé d'améliorer son portefeuille de produits en combinant les technologies existantes, comme le monomère MDP original, avec les nouveaux développements, tels le monomère LCSi et la technologie Touch Cure. Tout cela a fait émerger la gamme actuelle de colles résine faciles à utiliser et hautement esthétiques qui fournissent une force d'adhésion du plus haut niveau.

Case by Kokla Thalia, Postgraduate student in Restorative Dentistry program, Faculty of Dentistry, National and Kapodistrian University of Athens, Greece

Restoring Class II cavities can be challenging due to limited access to the posterior area, where the interproximal contact needs to re-established in a proper way. Inadequate contacts tend to result in increased plaque accumulation, food impaction and, as a consequence, the development of caries and irritation of the interproximal gingiva. Therefore, it is essential that the interproximal contact is restored based on the model of nature. A suitable matrix system and a proper clinical protocol can help us succeed in this context. The following clinical case is used to illustrate a possible strategy.

Fig. 1. Initial clinical situation. 23-year-old female patient with caries on the mandibular left second premolar.

Fig. 2. Situation after cavity preparation, isolation of the working field with rubber dam and the placement of a sectional matrix fixed with a ring. It is essential that the matrix imitates the natural shape of the contact area, which is usually rather flat or concave cervically and convex in the middle and occlusal parts.

Fig. 3. Etching of the tooth structure with phosphoric acid etchant. Afterwards, the adhesive needs to be applied (in this case, Universal Bond Quick was used according to the manufacturer’s instructions).

Fig. 4. CLEARFIL MAJESTY™ ES-2 Premium in the shade A3E is applied in the distal box to build up the wall first. In this way, the available space is used to model the most critical part of the restoration before simply filling the cavity in increments with the dentin shade A3D.

FINAL SITUATION

Fig. 5. Final restoration after finishing and polishing. In accordance with the concept behind CLEARFIL MAJESTY™ ES-2 Premium with its pre-defined shade combinations, the final enamel layer was build-up using the shade A3E. However, the use of a single opacity is also possible in the posterior region depending on the aesthetic demands.

CONCLUSION

By elevating deep interproximal margins, it is possible to focus on the critical designing of the contact point when there is still sufficient space available to do so. This simplifies the procedure, while all that is left to do can be managed in a straightforward way like a Class I restoration.

JUST COLOR: ESTHETIC COLORANT FOR KATANA ZIRCONIA

The natural tooth impresses with wonderful light-optical effects - characteristic features that result from the inner structure of the tooth. Imitating these specific effects in zirconia restorations with the staining technique or micro-layering has shown limitations so far. Kuraray Noritake has addressed this problem. Based on solid research and development work, an amazingly simple solution was created - Esthetic Colorant for KATANA Zirconia.

Mr. Stratos Chatzichristos CDT will present Esthetic Colorant in detail in this online webinar. He will show how the aesthetically individual effect of a zirconia restoration can be intensified with the new effect liquids and will showcase practical application and material science basics. Learn how to achieve a zirconia restoration with truly impressive aesthetics.

Topics:

•    basics about Esthetic Colorant for KATANA Zirconia
•    differences to traditional staining and infiltration solutions
•    areas of application of Esthetic Colorant
•    achieving a true color effect
•    masking effect for the zirconia framework (discolored stumps or metallic abutments)
•    economic advantages of using Esthetic Colorant
•    material basics of zirconia

“Very nice handling properties”

PAVANIA™ Veneer LC receives 4.6 rating in REALITY’s Five Star Award

After a FirstLook evaluation published in May 2022, a team of evaluators from REALITY RATINGS & REVIEWS has thoroughly tested PANAVIA™ Veneer LC in the clinical practice environment – with great outcomes. The purely light-cured resin cement received 4.6 out of 5 stars in the Five Star Award, the most convincing features being its handling and viscosity.

While most of the evaluators used PANAVIA™ Veneer LC for the permanent cementation of veneers, some also tested the onlay indication (restricted to high-translucency materials of a material-specific maximum thickness). Those who decided to polish the margins (43 %) found that the resin cement is very well polishable with little effort. Among the handling properties highlighted were easy seating with virtually no drifting, non-stickiness and easy excess removal – both after tack curing and in the cement’s uncured state. In addition, the evaluators praised the minimal film thickness and favourable viscosity, which has a considerable impact on the ease of seating. The working time was sufficient for all evaluators, independent of their way of working (filtering/blocking dental unit light or not, placing multiple veneers simultaneously or one veneer at a time).

The shade offering – PANAVIA™ Veneer LC is available in the four shades Clear, Universal/A2, Brown/A4 and White – was regarded adequate by most evaluators (79 %), the most popular shade being Clear. One evaluator stated that “I think the “clear” shade is my new favorite. It seems to have a brightness to it compared to other clear or translucent cements.”. Being the only shade with a high opacity, White was found to have a decisive impact on the appearance of the final restoration. The try-in pastes were well-received for their handling and easy rinse-off ability.

The PANAVIA™ Veneer LC kit available in Europe consists of PANAVIA™ Veneer LC Paste, PANAVIA™ V5 Tooth Primer and CLEARFIL™ CERAMIC PRIMER PLUS. Hence, it builds confidence by sharing primers with the proven PANAVIA™ V5, while its long working time and specific handling properties add extra benefits that are extremely valuable during veneer cementation. Click here to read the full evaluation!

HOW MANY SHADES DO WE NEED?

Case by Gasparatos Spyros, Postgraduate student in Restorative Dentistry program, Faculty of Dentistry, National and Kapodistrian University of Athens, Greece

Restoring anterior teeth with large defects using composite seems to be quite challenging. With high-performance materials at hand and a systematic layering concept in mind, however, it is possible to produce highly aesthetic results in a reproducible way. The clinical case below is used to illustrate a dual-shade layering technique with CLEARFIL MAJESTY™ ES-2 Premium, a composite system with pre-defined colour combinations.

CASE EXAMPLE

The patient, a young male, was unhappy with the appearance of his maxillary anterior teeth. Several years ago, his central incisors had been restored with composite. These existing restorations had defective and heavily discoloured margins, while their shade did not match the adjacent natural tooth structure. The maxillary lateral incisors were peg-shaped (microdontia). Economic considerations and the desire to save as much natural tooth structure as possible made the team decide to restore all four maxillary incisors with composite. CLEARFIL MAJESTY™ ES-2 Premium became the material of choice as it eliminates the need for complicated shade combination formulas and supports predictable outcomes.

Fig. 1. The patient’s initial smile.

Fig. 2. Intraoral image of the initial situation with defective composite restorations and microdonts. Two composite buttons on the right lateral incisor are used to verify the determined shade combination.

RESTORING THE CENTRAL INCISORS

We decided to restore the central incisors first and then focus on the lateral incisors. The tooth shade was determined using the VITA™ classical A1-D4 shade guide, while composite buttons were applied to the teeth to verify the determined shade combination. In order to simplify the restoration procedure, a palatal silicon index was produced before removing the existing restorations. During minimally invasive tooth preparation, bevels were created at the margins to provide for a smooth optical transition from the natural tooth structure to the composite.

An adhesive (CLEARFIL™ Universal Bond Quick) was applied after selective etching of the enamel to achieve a strong bond. With the aid of the silicon index, it was easy to create the palatal shells of the restorations with CLEARFIL MAJESTY™ ES-2 Premium in the shade A3E (enamel), which matches the determined tooth shade A3. The dentin core was built up with the same composite in the recommended shade A3D (dentin), mamelons were modelled and some CLEARFIL MAJESTY™ ES-2 Premium in the shade WD added for the incisal halo, while some individual effects (like enamel cracks) were imitated with brown stain. The build-up was finalized in the interproximal and labial areas with composite in the shade A3E. Between the central incisors, a wedge was used to retract the papilla and facilitate the designing of the interproximal contact area. The finished and pre-polished restorations already had a natural appearance.

Fig. 3. Central incisors after removal of the old restorations and the beveling of the enamel.

Fig. 4. Light-cured palatal shells made of CLEARFIL MAJESTY™ ES-2 Premium in the shade A3E.

Fig. 5. Build-up of the dentin core with mamelons individualized with the shade WD and brown stain.

Fig. 6. Situation after finalization of the central incisor restorations with composite in the enamel opacity.

Fig. 7. Central incisor restorations after finishing and initial polishing.

RESTORING THE LATERAL INCISORS

Tooth preparation was not required on the lateral incisors. Instead, they were merely cleaned after a slight roughening of the enamel surfaces. The build-up procedure was similar to the one used for the central incisors. The adjacent tooth was protected with PTFE tape, and the palatal shell was created with the aid of a finger instead of a silicone index. Afterwards, we focused on the build-up of the interproximal walls before a small amount of dentin was placed and the shape was finalized by applying the labial enamel layer.

Fig. 8. Build-up of the left lateral incisor.

Fig. 9. Situation after finishing and polishing.

FINAL SITUATION

Fig. 10. Final smile of the patient's demands.

CONCLUSION

Two different opacities, a single shade combination and some bleached shade plus stain for special effects – in the present patient case, a simple formula allowed us to create lifelike anterior restorations. With one enamel and one dentin paste used, it is possible to simply rebuild the natural anatomy without the risk of ending up with a bulky core that – once reduced – will lose its special optical structure. It is also easy to control the thickness of the final enamel layer with its huge impact on the light-optical properties of the whole restoration. For most patients and teeth with a simple or medium-to-complex internal colour structure, the selected concept is very well suited and will lead to pleasing outcomes.