Article by doctors Tom Boujenah and Olivier Boujenah.

KEEP IT SIMPLE WHILE MEETING THE PATIENT’S INDIVIDUAL DEMANDS

Every day in our practices, we are faced with a choice between different treatment options. Experience, scientific literature, and patient preferences all help guide us toward one direction or another.

The case presented below could have been managed using a different approach, but the chosen solution aligned with our philosophy: keep it simple while meeting the patient’s individual demands.

A PATIENT WITH HIGH AESTHETIC DEMANDS

A young patient, in his early twenties, presented for consultation with a purely aesthetic concern. He had been wearing a double-retainer resin-bonded fixed dental prosthesis (Maryland bridge) (Figure 1) for several years, placed due to the congenital absence of the mandibular central incisors. Although the bridge had served him well functionally, the patient now wished to replace it with a more aesthetic solution, better matching the current shade of his natural teeth. After clinical and radiographic assessment, several treatment options were considered, taking into account the patient’s age, bone volume, and aesthetic expectations.

The final decision was to fabricate a new resin-bonded bridge, optimized in terms of both design and shade, using a multilayered zirconia to achieve a natural-looking result.

Fig. 1. Initial situation

Fig. 2. iTero 5D+ optical scan

PRELIMINARY STEPS IN THE DENTAL OFFICE

A pre-treatment impression of the bridge was taken before removal, using the iTero 5D+ scanner (Align Technology; Figure 2). These pre-treatment scans, which are performed almost systematically for our prosthetic reconstructions, allow the laboratory to capture the volume of the existing prosthesis, replicate the previous shape (if suitable), and often visualize wear facets. This helps minimize or even eliminate the need for subsequent adjustments. Then, the existing resin-bonded bridge was removed, and the abutment teeth were prepared as minimally invasive as possible. Once again, the intraoral scanner was used to take an impression of the situation (Figure 3).

Fig. 3. Impression after bridge removal and minimal preparation of the lingual surfaces

PRODUCTION OF THE RESIN-BONDED BRIDGE

The scan was sent directly from the intraoral scanner to the Design4me platform (a 3D design platform) to carry out the digital design of the planned bridge (Figures 4 and 5). A repositioning key was also designed by the dental technicians to provide for accurate seating of the bridge during cementation (Figure 6). The material of choice was KATANA™ Zirconia YML, a multi-layered zirconia from Kuraray Noritake Dental Inc., shade B1. It seemed most appropriate due to its outstanding physical and aesthetic properties—specifically its gradient in shade translucency and flexural strength (Figure 7).

Fig. 4. Design of the new bridge using exocad software (Design4me platform)

Fig. 5. View of the soft tissue underneath the bridge showing slight gingival compression

Fig. 6. Repositioning key designed using exocad software (Design4me platform)

Fig. 7. KATANA™ Zirconia YML disc (shade shown not representative of the case presented)

The production centre, DIGISMILE, subsequently received the STL files of the bridge and the positioning key, modeled by the dental technicians on the Design4me platform, ready for milling and printing. We also provided the laboratory with intraoral photos to replicate the surface texture, possible characterizations, and shades. The laboratory performed the milling of the bridge using a DWX-52D milling machine (Roland DG). Polishing, surface finishing, and staining were carried out using Komet burs and Miyo liquid porcelain (Jensen). The repositioning key, meanwhile, was 3D printed with a NextDent 5100 3D Printer (3D Systems) using surgical guide resin (Figure 8).

Fig. 8. Milled bridge and 3D-printed key after polishing and staining

DEFINITIVE PLACEMENT IN THE DENTAL OFFICE

The adhesive cementation procedure is one of the most critical steps of the whole workflow. Once the bridge had arrived in the dental office and try-in was successfully completed, the focus was on moisture control and the establishment of ideal bonding conditions. In this context, strict working field isolation with saliva ejectors, cotton rolls, and ideally a rubber dam is essential, followed by the pre-treatment of the abutment teeth and the retainer wings of the zirconia bridge.

PRE-TREATMENT OF THE TOOTH STRUCTURE

Since the tooth preparations are strictly limited to enamel, the following conservative bonding protocol was adopted:

• Etching with phosphoric acid for 30 seconds on the enamel surfaces.
• Thorough rinsing with water, followed by gentle drying without desiccating the enamel.
• Application of PANAVIA™ V5 Tooth Primer (Kuraray Noritake Dental Inc.), followed by thorough drying with mild air after a 20-second waiting time. This primer contains MDP, which is essential for reliable enamel/zirconia adhesion.

PRE-TREATMENT OF THE ZIRCONIA WINGS OF THE BRIDGE

Even though the intaglio surface was sandblasted in the laboratory, it is crucial to repeat this step in the clinic:

• Cleaning with KATANA™ Cleaner (Kuraray Noritake Dental Inc.) for 10 seconds or ultrasonic cleaning for 5 minutes, followed by rinsing with water.
• Sandblasting with 50 μm aluminum oxide (Al2O3) at 2 bar.
• Application of CLEARFIL™ Ceramic Primer Plus (Kuraray Noritake Dental Inc.) to the intaglio surface without rinsing, followed by gentle drying. This primer also contains MDP, providing for a proper chemical bond to zirconia.

ADHESIVE CEMENTATION

With all surfaces pre-treated appropriately, adhesive cementation proceeded as follows:

• Application of PANAVIA™ V5 Paste (universal shade A2) to the intaglio of the bridge.
• Insertion of the bridge using the repositioning key.
• Light curing (“tack” cure) for 3 to 5 seconds to stabilize the restoration.
• Removal of excess resin cement with a dental explorer. Alternatively, excess may be removed immediately with a soft brush before applying to light cure for the margins.
• Final complete light curing according to the manufacturer’s instructions (Figures 9 and 10).

Fig. 9. Clinical situation captured immediately after cementation

Fig. 10. Lateral view of the restoration immediately after cementation

TREATMENT OUTCOME

Thanks to the pre-treatment scan and the overlay of the old bridge with the new one, no adjustments were necessary, although occlusion control remained essential. At a recall after 18 months, gingival integration was satisfactory: The patient was able to use interdental brushes and maintain the prosthesis properly (Figures 11 and 12).

Fig. 11. Clinical situation 18 months after definitive placement

Fig. 12. Lateral view at 18 months

CONCLUSION

In this clinical case, the choice to produce a double retainer resin-bonded bridge, almost identical in design to the previous one, may seem conservative. However, this decision is supported by several factors: The patient’s good tolerance of the previous prosthesis, the tissue integrity of the abutment teeth, and, most importantly, the opportunity to significantly improve aesthetics thanks to advances in materials and bonding techniques, which allowed us to keep preparations minimal and minimally invasive.

This new bridge, designed with highly aesthetic multilayer zirconia and bonded using a strict protocol, achieved a perfectly integrated and natural result without resorting to more invasive options (therapeutic gradient). Furthermore, this approach invites the restorative team to consider emerging trends in resin-bonded bridge design, notably the option of two single-retainer cantilever bridges, which might be considered in similar cases in the future.

This case highlights the importance of individualized treatment planning, which does not rely solely on innovation, but on precise clinical assessment, attentive listening to patient needs and expectations, careful implementation of available tools, and the use of high-quality materials and protocols.

Dentists:

OLIVIER BOUJENAH

Dr. Olivier Boujenah earned his Doctorate in Dental Surgery from Paris V in 1994 and a University Diploma in Maxillofacial Surgical Rehabilitation from Paris VII in 2008. A pioneer in digital dentistry, he founded DIGISMILE, a training center and fully digital laboratory, and DIGISMILE LAB, dedicated to prostheses and surgical guides. He teaches in the Master’s program in Digital Dentistry at the University of Geneva and has pursued advanced training at Harvard University in digital workflows and guided surgery.

TOM BOUJENAH

Dr. Tom Boujenah graduated from the European University of Madrid in 2023 and completed a University Diploma in Oral Implant Rehabilitation at the Pitié-Salpêtrière Hospital in Paris. Based in private practice in the 16th district of Paris, he focuses on aesthetic and functional oral rehabilitation with a particular interest in implant dentistry and digital workflows. Passionate about innovation, he integrates the latest advances in implantology, prosthodontics, and digital dentistry to deliver personalized and long-lasting treatments.

The impact of a material switch in the dental laboratory

Switching to a different type of zirconium is not something you do lightly. Was the leap to KATANA™ Zirconia worth it? Three dental lab owners share their experience!

Not all zirconium oxide materials are created equal. Dental technicians worldwide recognise that zirconium oxide discs vary significantly in quality depending on their composition and manufacturing process. The most noticeable differences lie in their mechanical and optical properties, both of which are determined during production. At first glance, zirconium oxide products from leading manufacturers may seem similar. However, —sometimes invisible—differences can exist. Achieving the highest quality requires the use of premium raw materials, advanced cleaning and pressing techniques, and precise pre-sintering methods. These factors help ensure superior results while minimizing the risk of remakes. Selecting a high-quality zirconium oxide product is crucial, particularly when working with complex structures or specialised processing techniques. The right choice can significantly impact the final outcome and durability of dental restorations.

We had a conversation with three decision makers of Norwegian dental laboratories to learn more about their reasons to switch to the KATANA™ Zirconia Multi Layered Series (Kuraray Noritake Dental Inc.) and their path to success with these materials. Espen Rørstad is the owner and general manager of Vestfold Dental in Tønsberg, Lucas Andvik the general manager of Cicero Dental AS in Trondheim and Hilsen Egil Berg the general manager of dental technology at Berg Dental in Askim. They are happy to share their experience and practical tips and tricks.

Time for change

The reasons to start testing alternative zirconium oxide materials were different: Espen Rørstad, who has been a dental technician for 24 years, was looking for improvements in strength and aesthetics: “Nowadays, zirconium materials are evolving quickly, and specifically those blanks with multi-layered colour, translucency and flexural strength attracted my attention. I first tested a material from another leading manufacturer. Then, I received a single disc of KATANA™ Zirconia YML. I was immediately impressed by the homogeneous, densely pressed material and its optical properties. Ever since my first trial case with KATANA™ YML, I have not used any other zirconium oxide again.”

Choosing the right material

Hilsen Egil Berg uses KATANA™ Zirconia YML for most indications, and KATANA™ Zirconia HTML Plus for large reconstructions of ten or more units. The design is predominantly monolithic with a small (vestibular) cutback. The approach of Espen Rørstad is similar. He also uses KATANA™ Zirconia YML on a regular basis for reconstructions with up to ten units, even on implants in combination with Ti-bases. “For larger-span restorations, I most frequently opt for KATANA™ Zirconia HTML Plus or, occasionally KATANA™ Zirconia HT combined with a traditional layering approach”. Lucas Andvik uses all four types of multi-layered zirconia from Kuraray Noritake Dental Inc. (KATANA™ Zirconia UTML, STML, HTML Plus and YML) to have the best of all worlds.

Establishing workflows

Switching materials always means investing time and effort until processes run smoothly and predictably. According to Espen Rørstad, it did not take long with KATANA™ Zirconia to get the parameters right and obtain high-quality results. According to him, a factor that is critical for good outcomes with KATANA™ Zirconia YML is positioning of the restoration in the disc. “Proper positioning is key to success – long-span reconstructions are only stable if positioned according to the manufacturer’s recommendations. The learning curve is quite steep and we have no issues with fractures,” he says. Lucas Andvik slightly adjusted his production procedure to provide for great outcomes: “Initially, we tried to position our restorations in blanks of the heights we had used before, and this turned out to be quite challenging. In order to have enough space for the connectors and be able to position long-span restorations in the middle of the disc as recommended, we started utilising higher blanks. With this strategy, the initial challenges were a thing of the past.”

What makes KATANA™ Zirconia different

KATANA™ Zirconia is engineered with precision at every step of the production process, from raw powder production to disc pressing, every step is tightly controlled for consistency and quality. It’s the result of decades of expertise in ceramics and full in-house control. Every disc reflects that precision and expertise, offering you high quality zirconium oxide with outstanding features;

• Dual gradient structure (YML): A seamless transition in both translucency and strength.
• High green-state stability: Thin margins, no chipping. Fewer sprues, smoother carving, and optimal material use.
• Targeted yttria balance: Optical translucency where needed, strength where it matters, each layer is purposefully composed.
• Speed sintering: 54-minute cycles delivering consistent aesthetics and mechanical performance.
• Optimized density and CTE: Uniform density and a stable coefficient of thermal expansion in all layers ensure minimized sintering deformation and high fitting accuracy.

Easy carving

One of the practical benefits of using KATANA™ Zirconia is the fact that it is perfectly suitable for carving. Lucas Andvik states: “Carving is easier with KATANA™ Zirconia than with other materials. It is even possible to go close to the margins without increasing the fracture risk. Other materials seem to be much less dense and softer, which may result in marginal fractures. Carving is really a feature that transformed our inhouse production procedure and contributes to great outcomes.” Espen Rørstad and Hilsen Egil Berg agree that carving feels great with this material, while the former also stresses that the overall aesthetics when using the carving technique are very well received by partners from dental offices.

Mastering the sintering process for optimal results

A procedure known as a critical step in the production procedure is the sintering. Virtually every leading manufacturer of hightranslucency zirconium oxide advises users to calibrate furnaces and check the achieved temperatures on a regular basis to provide for optimal outcomes. The actual sintering protocols recommended for each material, however, are very different. Kuraray Noritake Dental Inc. offers three sintering programms valid for all four materials of the KATANA™ Zirconia Multi-Layered series: The standard sevenhour programme is available for all kinds of prostheses, while the high-speed 54-minute and 90 minute programmes are suitable for restorations with up to three units. For KATANA™ Zirconia Blocks, even18-minute sintering is possible. Lucas Andvik uses the seven-hour programme for over-night sintering of all large restorations, and speed sintering for single-tooth restorations and small bridgeworks during the day. With his new furnace, he simply adopted the recommended protocols. Espen Rørstad modified the protocols slightly for his furnace and regards speed sintering as a great option for rush cases. Hilsen Egil Berg prefers over-night sintering. He reports: “It is really important to have a high-quality, modern furnace, calibrate it regularly and follow the manufacturer’s instructions. My recommendation for everyone experiencing issues is to pay extra attention to warming up and cooling down properly. That way, you achieve the highest possible strength and aesthetics, including an absolutely smooth transition between the different layers in the blank.”

Micro-layering: A game changer for finishing

In all three dental laboratories, the integration of KATANA™ Zirconia has led to a shift towards higher-efficiency finishing approaches. Espen Rørstad reports: “The switch to KATANA™ Zirconia enabled us to increase the amount of monolithic and micro cut-back zirconium oxide restorations from around 40 to 80 percent. In the anterior area, we use a minimal vestibular cutback and micro-layering, while the restorations are purely monolithic and only minimally pre coloured in the posterior area. Classical layering is only delivered on special request.” Hilsen Egil Berg states: “We completely stopped using traditional porcelain layering approaches and prefer micro-layering instead – especially in combination with KATANA™ Zirconia YML. The aesthetic outcomes are so good that a cosmetic dentist recently called me and asked if I had used lithium disilicate instead of zirconium.” Lucas Andvik also likes to add a little bit of porcelain: “We moved away from a full cutback to micro-layering approaches, using the same porcelain system for lithium disilicate and zirconium oxide,” he says. In subgingival areas, he often just polishes the restorations for highest biocompatibility, a concept that is very well received by dental practitioners.

Happy with the results?

Hilsen Egil Berg concludes: “Once you have implemented the workflow and set all parameters, working with KATANA™ Zirconia is really great. My staff likes its handling during carving, the efficient workflows and predictable results. Although sometimes the product may be more expensive than other brands’ zirconium oxide, the total economy is a lot better: We do no longer face any issues with fractures and remakes, and due to the homogeneous material structure, the service life of our milling tools is extended, while, at the same time, the edge stability of the milled restorations is increased. The blanks are so homogeneous that I am able to sinter long-span restorations without a lateral support!”

The conclusion of Lucas Andvik is similarly good: "everyone in my laboratory working with KATANA™ Zirconia is more than satisfied. My co-founder, Katharina, has tested many different materials on behalf of notable manufacturers and has never seen anything that compares to KATANA™. All the technicians that work with KATANA™ here consider it to the most versatile and aesthetic we have ever utilized. I think that all four variants are super nice to work with. My personal recommendation is to attend one of the courses offered by Kuraray Noritake Dental Inc. The instructors are super knowledgeable and we got a completely new conception of zirconium oxide as well as practical advice that was really useful for our daily work.”

Espen Rørstad is sure that “in terms of aesthetics, KATANA™ Zirconia is the best zirconium oxide tested, and I really tested a lot in the past decades! I am happy with the material, the interaction with the Kuraray Noritake Dental team and the support offered. My team is also happy with the material, but even more important is the positive feedback of my customers: One of them requested a specific zirconium all the time, and when we switched, we did not tell him immediately. Now he knows and is very happy with what he gets.” Espen is sure that economically, KATANA™ Zirconia YML is even able to compete with cheap zirconium oxide brands, as the production procedure is much more efficient and the results are predictable.

Switching zirconium oxide materials is a significant investment in both time and resources, but for many dental laboratories, the results speak for themselves. The experiences shared by these Norwegian technicians demonstrate that KATANA™ Zirconia offers a balance of aesthetics, strength, and efficiency. While adapting to new workflows takes effort, the improved outcomes, fewer remakes, and enhanced handling make the transition worthwhile. For those considering the switch, thorough testing and training are key to ensuring a smooth and successful integration.

PRACTICAL IMPLEMENTATION TIPS

• Review and adjust milling, sintering, and finishing protocols to match the manufacturer’s recommendations.
• Train technicians on best practices for positioning restorations within the blank to ensure strength and aesthetics.
• Optimise material selection for different cases
• Regularly calibrate sintering furnaces and check temperature accuracy to avoid issues like fractures or compromised aesthetics.
• Work closely with the supplier for technical support and guidance when setting up new workflows.

ACHIEVE CONSISTENT, NATURAL-LOOKING RESTORATIONS WITH CONFIDENCE

Shade selection is one of the most critical steps in restorative dentistry — and one of the most challenging. The KATANA™ Zirconia Shade Selection Guide provides practical, evidence-based recommendations to help clinicians and technicians achieve predictable, lifelike results every time.

Inside, you’ll find clear guidance on how abutment color, restoration thickness, milling and sintering conditions, and finishing methods influence the final shade outcome. Backed by Kuraray Noritake Dental’s expertise, this guide is designed to simplify your decision-making, minimize remakes, and support optimal aesthetics across different workflows.

Download now and equip your practice or lab with proven strategies for shade selection success.

High-quality dental zirconia is crucial in prosthodontic treatments to ensure patient satisfaction and long-term success. The use of high-quality zirconia helps in achieving perfectly fitting restorations that are both aesthetically pleasing and durable, minimizing the need for remakes and extra appointments. Low-quality zirconia, however, can lead to various issues such as poor optical properties, improper fit, and inferior biocompatibility, which may go undetected until they cause clinical problems like gingival recession or early restoration failure. Therefore, selecting high-quality zirconia with the right composition, followed by correct processing, is essential for optimal outcomes in dental restorations.

THE DEVELOPMENT OF DENTAL ZIRCONIA

In the late 1990s, the first CAD/CAM-fabricated Zirconia coping was launched as an alternative to the non-aesthetic metal substructure, providing a strong and more aesthetic framework for porcelain-fused restorations. More recent developments in zirconium oxide have led to a shift from full-baked to monolithic use. This has largely overcome mechanical complications such as chipping and delamination and at the same time avoiding the need for the preparation of much of the tooth structure. Leading to prosthetic restorations that retain as much of the structure as possible.

Dental zirconia has traditionally been manufactured mainly from the tetragonal zirconia crystals with a minor proportion of approximately 3 mol% yttria stabilizer (3Y-TZP); this type is extremely strong but has low translucency.¹ By increasing the amount of yttria added to zirconia to around 5 mol%, the translucency is significantly improved because of the presence of a higher amount of zirconia crystals in the cubic form. This zirconia material is often referred at as 5Y-partially stabilized zirconia (5Y-PSZ). However, this increase in translucency comes at the cost of a decrease in mechanical strength.² The introduction of multi-layered zirconia by Kuraray Noritake Dental Inc. marked a significant advancement in zirconia technology, paving the way for highly aesthetic monolithic restorations. The development of a more aesthetic zirconia resulted in a steep decline of metal-ceramic usage in favour of ceramic prostheses. Nevertheless, there are still concerns about the quality of zirconium oxide prostheses. Not only about adhesiveness, but also about fit and processing. Several clinical reports show outcomes with high success rates up to 97% over more than 15 years.² However, there are also reports showing catastrophic failures of zirconia dental restorations. Let’s look at a very important root cause of these failures; the processing procedure.

ALTHOUGH ALL ZIRCONIA BLANKS MAY LOOK SIMILAR, QUALITY AND PROPERTIES CAN DIFFER WIDELY AS THEY ARE AFFECTED BY:

✓ The quality of the raw materials

✓ Raw material processing

✓ Blank pressing

✓ Pre-sintering

OVERVIEW OF POTENTIAL PROBLEMS AND CLINICAL CONSEQUENCES FOR PATIENTS

ROOT CAUSES OF ZIRCONIA FAILURES

Failures in zirconia restorations can often be traced back to the processing procedures used before the materials reach dental clinics. Most dental manufacturers source their zirconia powder from third-party suppliers, giving them limited control over the quality of the material they receive. Zirconia milling blank manufacturers typically press the raw powders, into disks around 100 mm in diameter, which are then pre-sintered to add mechanical stability. The exact formulations of these blanks are often proprietary and not disclosed. Variations during the disc pressing process can introduce air voids and impurities, negatively impacting the quality of the final restorations.² Dental laboratories further process these blanks by milling them into final shapes based on the 3D profiles provided and then sinter them at temperatures above 1,400°C to achieve the desired final phase. Each blank is designed with an enlargement factor to account for shrinkage during sintering. However, detailed processing procedures, such as milling and finishing, are often typically unavailable. As a result, the exact chemical composition, microstructure, and processing of zirconia materials for dental applications varies significantly depending on the manufacturer and laboratory involved. These variations make the production of zirconia restorations a complex and often unpredictable process.

Kuraray Noritake Dental Inc. is one of the few manufacturers handling the entire dental zirconia production process, including raw material processing, in-house. This end-to-end control allows us to ensure exceptional product quality across all materials. A core principle of Kuraray Noritake is the of a higher amount of zirconia crystals in the cubic form. This zirconia material is often referred at as 5Y-partially stabilized zirconia (5Y-PSZ). However, this increase in translucency comes at the cost of a decrease in mechanical strength.² The introduction of multi-layered zirconia by Kuraray Noritake Dental Inc. marked a significant advancement in zirconia technology, paving the way for highly aesthetic monolithic restorations. The development of a more aesthetic zirconia resulted in a steep decline of metal-ceramic usage in favour of ceramic prostheses. Nevertheless, there are still concerns about the quality of zirconium oxide prostheses. Not only about adhesiveness, but also about fit and processing. Several clinical reports show outcomes with high success rates up to 97% over more than 15 years.² However, there are also reports showing catastrophic failures of zirconia dental restorations. Let’s look at a very important root cause of these failures; the processing procedure. seamless integration of quality performance and ease of use, backed by a strong commitment to providing the right materials and support. As the producer of KATANA™ Zirconia, Kuraray Noritake’s meticulous oversight at every stage of production guarantees consistent quality, enabling us to confidently stand behind the excellence of our products.

KATANA™ PRODUCTION

All our zirconia offerings begin their journey to the dental lab in our Japanese facility where raw zirconia ore is processed to a high quality raw powder. Several delicate treatments are done as next steps, including the addition of several fine-tuned essential components like stabilisers and binders. Kuraray Noritake Dental Inc. benefits from in-house production of the raw materials required for dental zirconia. This provides the perfect base on which to use our multi-layering technology and add any other elements needed to create superior quality and purity of the formulation as well as a precise alignment of the desired properties.

From powder to blank pressing, Kuraray Noritake Dental Inc. uses a unique and highly meticulous pressing process that provides for absolute uniform pressing distributions. Every detail is carefully calculated, managed, and controlled. This phase of the process takes several days, underscoring our goal to achieve the most aesthetic product. The results are uniform mechanical and optical properties, outstanding margin stability, high surface quality and a very controlled sintering deformation. By removing the variables for the dental lab, KATANA™ Zirconia provides a reliable material that will give you the same result, every single time.

In the final stage of production, as our KATANA™ Zirconia blanks are prepared for packaging, each disc undergoes a meticulous manual quality check. This last, hands-on inspection ensures that every KATANA™ Zirconia disc meets the highest standards of excellence that we promise. By giving each disc this personal  attention, we guarantee that the quality and performance of our products consistently exceed expectations, reflecting our unwavering commitment to perfection in every detail.

Kuraray Noritake Dental Inc’s state-of-the-art production facilities enable us to create highly stable pre-sintered blanks with precisely the right rigidity to withstand all kinds of milling. This stability makes KATANA™ Zirconia a product that can be fully used without braking in situations where a large part of the disc already has been milled. Something that frequently occurs with lower quality products that are less strong in green-state. This highly stable quality also makes it possible to shorten the sinter time on KATANA™ Zirconia discs up to 54 minutes for single tooth restorations and bridges with up to three units.

NATURAL COLOUR GRADIENT

Kuraray Noritake is well aware of the importance of varying levels of chroma and translucency in various parts of a natural tooth. Our aim has been to mimic this effect even without the use of porcelain layering. In areas where the dentin core is revealed, a tooth is highly chromatic and rather opaque. In contrast, those parts of a tooth mainly composed of enamel – such as the incisal edge - are highly translucent and have a low chroma. Our patented KATANA™ Zirconia multi-layered technology has been developed to precisely imitate this gradient in chroma and translucency and shows a virtually seamless transition between layers, resulting in a tooth-like appearance without the need for porcelain layering. The four types of multi-layered KATANA™ Zirconia (UTML, STML, YML* and HTML PLUS) have a four-layer colour grading structure. The optical outcome is revealed immediately after sintering.

THE LATEST DEVELOPMENT IN ZIRCONIA

Our commitment to quality performance and ease of use is at the heart of everything we do. In line with these core values, we have pushed the boundaries of dental zirconia technology with our latest innovation: KATANA™ Zirconia YML for flawless aesthetics combined with high strength. In this revolutionary design we developed a multi-layered zirconia with additional flexural-strength and smooth translucency gradation; KATANA™ Zirconia YML.

Furthermore, all KATANA™ Zirconia YML discs are designed using ratios rather than fixed measurements of different layers in the multi-layered structure, this means that regardless of the disc’s thickness, there is always a consistent ratio of 35% of raw material that constitutes the translucent enamel zone. Hence, discs with an increased height, which are typically used to produce larger restorations, will always offer sufficient space in the enamel zone, while smaller discs are optimized for smaller restorations.

THE DESIGN CHOICES MADE ON KATANA™ ZIRCONIA YML GREATLY ENHANCES THE ADVANTAGES FOR THE LAB TECHNICIAN

✓ The ratio design offers design flexibility due to strategic layering.

✓ The accurate reflection of colour and translucency reduce the need for extensive finishing.

✓ Stable CTE throughout the disc allowing to produce high precision full arch restorations.

✓ Uniform, void free and high green-state stability for higher nesting flexibility thus higher output.

✓ Relatively high hardness in the green state, for easy green-state modification and fine tuning without the risk of fracturing or chipping.

✓ The hardness also allows for milling thinner restorations including sharp margins, thereby improving marginal fit.

✓ The part of a prosthesis from the body layer of KATANA™ Zirconia YML can be adjusted thinner than that of other high translucency zirconia, resulting in higher translucency in the body part.

MARGINAL STABILITY AND ENHANCED FITTING ACCURACY

KATANA™ Zirconia YML shows sharp margins and less chipping , thereby leading to better marginal fit. Thinner restorations show that this good result in sharp margin supports the use of KATANA™ Zirconia YML.

Even if the restoration margins have been milled to a very thin profile, they still show smooth margins without any chipping.

EVERYTHING THE LAB NEEDS

Kuraray Noritake offers four different types of multi-layered dental zirconia to cover every indication as well as a single-layer HT option to produce frameworks and long-span bridges. In the below chart you can view the range of recommended applications for all KATANA™ Zirconia Multi-layer discs.

CONCLUSION

The choice of dental zirconia significantly impacts the success of dental restorations, translating directly into daily practice for the lab technician. High-quality zirconia, such as that produced by Kuraray Noritake Dental Inc., ensures less cracking and chipping during the manufacturing process, reducing the likelihood of costly redoes due to fit or colour deviations. Superior quality of the zirconia powder, like those in KATANA™ Zirconia, allows for speed sintering, accelerating production without compromising the integrity of the restorations. Additionally, the advanced multi-layered zirconia designs, like Kuraray Noritake’s, reduce the need for extensive porcelain layering to achieve aesthetic results, streamlining the process, and enhancing efficiency.

Kuraray Noritake’s stringent quality control, with its end-to-end in-house production, guarantees consistent and reliable zirconia products. The all-rounder KATANA™ Zirconia YML, designed using precise ratios rather than fixed measurements, offers greater flexibility in design and nesting, ensuring consistent quality across varying restoration sizes. By selecting high-quality zirconia with meticulous quality control, dental labs can achieve optimal outcomes in both performance and aesthetics, ultimately benefiting both technicians, dentists, and patients.

REFERENCES

1. Yarahmadi M., Roa J.J., Zhang J., Cabezas L., Ortiz-Membrado L., Llanes L., Fargas G.; Micromechanical properties of Yttria-doped zirconia ceramics. Journal of the European Ceramic Society, Volume 43, Issue 7, July 2023, Pages 2884-2893.
2. Liao, Y., PhDa, Gruber, M. BSEa ; Lukic H., BSEa; McLees J., CDTb ; Chen S., PhDc ; Boghosian A., DDSd ; Megremis S., MS, PhDa; Survey of the mechanical and physical behaviors of yttria-stabilized zirconia from multiple dental laboratories. Journal Reprint Line (2023) 2, 100018

HOW TO OPTIMIZE ALL-CERAMIC RESTORATION BOTH AESTHETIC AND MECHANICAL?

A homogeneous porcelain structure, a strong bond between framework and veneering layer and a natural play of colours: All those characteristics of a high-quality all-ceramic restoration are not only strongly dependent on manual skills of the dental technician, but also on ideal firing conditions.

Only with a well maintained and properly functioning furnace and the right protocols, it is possible to obtain consistently great results in terms of aesthetics and function.

This is true for all kinds of all-ceramic restorations consisting of a framework and a veneering layer: It applies to full layering with a classical anatomical framework design and a relatively thick layer of porcelain, as well as to various cut-back designs finished using the modern micro-layering technique. A material that belongs to the latter category of porcelains and is becoming increasingly popular among dental technicians worldwide is CERABIEN™ MiLai (Kuraray Noritake Dental Inc.). The set of low-fusing porcelains and internal stains has been specifically developed for micro-layering, and works well with different variants of lithium disilicate and zirconia.

While the firing parameters provided by manufacturers like Kuraray Noritake Dental serve as reliable and thoroughly tested guidelines, experienced technicians often explore beyond these standards to achieve the highest possible aesthetic and functional outcomes.

This is precisely what MDT Nondas Vlachopoulos has done with CERABIEN MiLai. A distinguished expert in porcelain layering, he uses this material in his own dental laboratory “AestheticLab” in Athens and during his trainings. Drawing on his deep understanding of ceramic behaviour and extensive experience with a variety of furnaces, he has developed a refined protocol tailored to his lab conditions and artistic goals.

CERABIEN MiLai Baking Schedule by MDT Nondas Vlachopoulos.

His adjustments — such as overbaking the wash layer for structural homogeneity, adding vacuum during internal staining to avoid opacity, or fine-tuning temperatures depending on the ceramic zone (tissue vs. enamel) — are all examples of how small changes can lead to noticeable improvements in both aesthetics and function. Such expert refinements are only possible due to the exceptional flexibility of CERABIEN MiLai, enabled by its unique synthetic feldspar matrix. This advanced material composition offers excellent thermal stability and responsiveness, making it ideal for both standard use and high-level customization. Several leading technicians, including Alek Aronin, have independently followed similar approaches — confirming that Nondas’ schedule reflects a broader best practice among top users.

The above baking schedule has been validated on the furnaces Nondas Vlachopoulos uses in his laboratory on a daily basis – AUSTROMAT™ 624 (Dekema) and checked also in Programat® P510 (Ivoclar Vivadent). He truly recommends using this baking schedule independent of the ambient conditions and the furnace used: “As a hands-on course instructor at the International Dental Exhibition and Conference (IDEX) Istanbul 2025 on May 9, I used a local furnace for the first time. With the aid of my protocols, baking CERABIEN MiLai restorations in this type of furnace the outcome was as if have been fired my laboratory.”

According to Nondas Vlachopoulos, getting started with the new schedule is easy: “Just follow the IFU of your materials and equipment, enter the parameters and that’s it.” He recommends to conduct a trial bake first, before moving on to real patient cases.

For more information on how to maximize the potential of your furnace and material, have a look at our firing guide!

Dentist:

NONDAS VLACHOPOULOS

Nondas Vlachopoulos was born in Toronto, Canada, and graduated from the School of Dental Technology in 1985. He earned a BSc (Hons) from the Technological Educational Institution of Athens in 1989 and founded AestheticLab in Athens in 1990. An expert in aesthetic all-ceramic and implant restorations, Nondas is an international member of the American Academy of Cosmetic Dentistry, an editorial reviewer for the Journal of the AACD, and a member of the Hellenic Academy of Esthetic Dentistry. In 2024, he received the Kenneth D. Rudd Award from the American Prosthodontic Society.

He collaborates with the Department of Prosthodontics at the Eastman Institute for Oral Health (University of Rochester, USA),  and has worked with the Dental School of the National and Kapodistrian University of Athens. Since 2015, he contributes to the postgraduate MSc program in Dental Biomaterials.

Nondas is a global lecturer and hands-on educator, presenting in the USA, South America, Europe, Asia, Australia, and the Middle East. He has published in both Greek and international dental journals and serves as an opinion leader for Noritake Dental and MPF Brush Co. in Greece.

Interview with Takehiro Kameya
Manager of the Technology Division of Kuraray Noritake Dental Inc.

Comment avez-vous identifié le besoin d’un restauratif fluide universel?

Les composites compacts avec un concept de teinte universelle gagnent en popularité dans le monde entier. Nous en avons déduit qu’il y aurait également une demande pour le type fluide. Les utilisateurs bénéficieront eux aussi de procédures simplifiées et d’un nombre réduit de teintes à entreposer, avec un impact positif sur la gestion des stocks. Ainsi, nous avons introduit le composite fluide universel au Japon où il a déjà conquis une belle part de marché. Les utilisateurs y ont eu recours pour divers cas, avec d’excellents retours. Au vu de l’accueil très favorable au Japon, nous nous sommes rapprochés de l’équipe européenne pour étendre la mise sur le marché en Europe, et la décision a été prise de la lancer. Nous avons bouclé la commercialisation dans un laps de temps extrêmement court d’environ un an.

L’utilisation d’un composite fluide universel en plus d’une variante universelle compacte constitue-t-elle vraiment une valeur ajoutée?

Oui, l’ajout d’un composite fluide moderne apporte plusieurs avantages. En effet, contrairement à des produits précédents, la dernière génération de composites fluides offre suffisamment de résistance mécanique pour être utilisée pour les restaurations régulières. Utiliser un composite fluide a notamment pour avantage qu’il s’adapte aux cavités les plus étroites (et complexes) pour un remplissage rapide et facile et à l’interface adhésive pour bien sceller.

Quelles sont les différences entre CLEARFIL MAJESTY™ ES Flow et CLEARFIL MAJESTY™ ES Flow Universal?

CLEARFIL MAJESTY™ ES Flow Universal conserve les caractéristiques spécifiques de CLEARFIL MAJESTY™ ES Flow telles que la commodité de distribution, manipulation et modelage, le polissage extrêmement facile et rapide, la brillance longue durée et les excellentes propriétés mécaniques. Grâce à leur résistance élevée, les deux produits peuvent être utilisés pour les bords, mais aussi pour les procédures de restauration directe régulières. La différence réside dans le concept de teinte. CLEARFIL MAJESTY™ ES Flow Universal introduit un système de teinte universelle, qui lui permet de s’adapter à une vaste palette de tons avec moins de variations de teinte.

Pouvez-vous décrire le concept de teinte de CLEARFIL MAJESTY™ ES Flow Universal ? Combien de teintes sont disponibles et comment sont-elles sélectionnées?

La gamme CLEARFIL MAJESTY™ ES Flow Universal se compose de deux teintes : Universal (U) et Universal Dark (UD). U constitue un excellent choix pour toutes les restaurations postérieures, indépendamment de la couleur visée. Dans les zones antérieure et cervicale (cavités des classes III, IV et V), U est l’idéal pour restaurer des dents dans les teintes A1 à A3 (y compris B1, B2, C1, C2, D2, D2, D3 et D4), alors que UD est la teinte de choix pour correspondre aux teintes cibles A3.5 à A4 (y compris B3, B4, C3 et C4).

Correspondance des teintes avec les restaurations antérieures et postérieures

Pourquoi proposez-vous une teinte supplémentaire pour la zone antérieure?

Les composites à teinte universelle doivent assimiler la couleur de la structure dentaire alentour pour offrir une correspondance parfaite avec une multitude de teintes cibles. Dans la zone postérieure, de grandes quantités de structure dentaire alentour sont généralement disponibles avec plusieurs parois de cavité toujours présentes. Cela facilite l’assimilation de la couleur de dent par rapport aux cavités de la zone antérieure. À cet endroit, la lumière traverse facilement, de sorte que la couleur du composite lui-même est davantage susceptible d’être reflétée. Cela peut limiter la correspondance des teintes. Dans le cas de CLEARFIL MAJESTY™ ES Flow Universal, la teinte U, qui s’est avérée idéale pour la zone postérieure, a montré certaines limites dans la correspondance de teinte pour les dents plus foncées des restaurations antérieures. Nous avons ainsi décidé de prévoir une deuxième option de couleur, spécifiquement conçue pour ces situations. Avec U et UD, CLEARFIL MAJESTY™ ES Flow Universal offre une excellente adaptabilité de couleur du clair au foncé et répond donc au besoin de correspondance de teinte précise, en particulier dans la zone antérieure.

Développer seulement deux teintes de composite pour couvrir autant de teintes cibles de dents semble relever du défi. Comment avez-vous déterminé que les teintes disponibles seraient adaptées dans un environnement clinique?

En effet, il n’a pas été simple de développer la teinte U qui est capable, à la fois pour les dents antérieures et les dents postérieures, de correspondre à une plus grande palette de couleurs de dents que la teinte U de CLEARFIL MAJESTY™ ES-2 Universal. Afin d’évaluer et de perfectionner les teintes que nous avons développées, nous avons réalisé à plusieurs CLEARFIL MAJESTY™ ES Flow Universal – Excellentes propriétés mécaniques Low Résistance à la flexion 151 MPa Résistance à la compression 373 MPa Charge de remplissage 75 % du poids/59 % vol. Radio-opacité 140 % Al reprises des tests de remplissage à l’aide d’une vaste palette de teintes expérimentales dans des dents artificielles et dents extraites de diverses couleurs. En outre, la sélection finale de teintes a été évaluée visuellement par des praticiens dentaires consultants qui ont utilisé le composite dans une configuration clinique.

What are the greatest challenges in the context of determining and selecting the right shade in the clinical environment?

The major drawback of classical shade determination is that it simply increases the chair time. For both, the dental practitioner and the patient, however, minimizing chair time is the ultimate goal, as it reduces costs and increases patient comfort. A true drawback in terms of time and comfort is a colour mismatch produced due to an error during shade determination: it may necessitate intra-oral adjustments or, in the worst case, the creating of a new restoration.

Quels sont les principaux défis pour la détermination et la sélection de la teinte correcte dans un environnement clinique?

Le plus gros inconvénient dans la détermination de teinte classique est simplement qu’elle augmente le temps de fauteuil. Or réduire le temps de fauteuil est le but ultime du praticien dentaire et du patient car cela fait baisser les coûts et améliore le confort du patient. Un véritable inconvénient en termes de temps et de confort est une mauvaise correspondance de couleur due à une erreur pendant la détermination : elle peut nécessiter des ajustements intra-oraux ou, au pire, la création d’une nouvelle restauration.

CLEARFIL MAJESTY™ ES Flow Universal – Great mechanical properties.

CLEARFIL MAJESTY™ ES Flow Universal est disponible en deux différents niveaux de fluidité : Low (fluidité basse) et Super Low (fluidité ultra-basse). Comment cela se fait-il et quelle est la différence dans l’utilisation?

Nous avons décidé d’offrir deux niveaux de fluidité avec des propriétés thixotropiques différentes pour satisfaire les préférences des utilisateurs dans le domaine de la manipulation. Fondamentalement, il n’y a aucune différence d’utilisation entre Low et Super Low. Cependant, les utilisateurs sont encouragés à utiliser des composites aux propriétés thixotropiques différentes en fonction de leurs préférences et du cas spécifique.  Par exemple, Super Low est utile pour modeler la surface occlusale des dents postérieures. Low peut être largement utilisé pour des applications comme le lining et le remplissage dans la zone cervicale et sur les surfaces proximales.

Quelles sont les technologies utilisées dans CLEARFIL MAJESTY™ ES Flow Universal Super Low pour assurer un fondu parfait?

La technologie la plus populaire utilisée dans ce produit est probablement notre propre technologie de diffusion de la lumière (Light Diffusion Technology, LDT). Nous avons déterminé quelle était la diffusion optimale de la lumière en observant qu’une forte réflexion diffuse de lumière incidente entraîne un blanchiment et qu’une faible diffusion de la lumière facilite l’assimilation des couleurs foncées dans la cavité orale, assombrissant l’emplacement du remplissage. En outre, nous nous sommes concentrés sur l’ajustement de la chrominance : Le concept de teinte universelle est basé sur la capacité d’assimiler la couleur de la structure dentaire alentour et de s’y fondre.  C’est pourquoi nous avons adapté la chrominance de manière à ce qu’elle s’harmonise facilement avec une vaste palette de teintes de dent. Enfin, la translucidité du matériau a été ajustée au moyen de ses charges submicroniques et clusters de silice. Nous nous sommes appuyés sur l’évaluation de leaders d’opinion clés pour déterminer un niveau adéquat de translucidité.

Comment procéder dans les cas de structure dentaire décolorée en-dessous – faut-il masquer avec un bloqueur ou opaquer?

Cela dépend du degré de décoloration. En raison des propriétés de diffusion de la lumière de CLEARFIL MAJESTY™ ES Flow Universal, on considère généralement qu’un blocage n’est pas nécessaire et que la nuanciation peut être effectuée. Toutefois, en cas de grave décoloration, il peut être bénéfique de remplir le fond Diffusion de la lumière avec la LDT RÉFRACTION  ET TRANSMISSION  DE LA LUMIÈRE de la cavité avec des teintes A2D ou A3D de CLEARFIL MAJESTY™ ES Flow, ou d’utiliser CLEARFIL™ ST Opaquer.

Comment avez-vous fait pour éviter la formation de vides pendant l’application?

Nous avons adopté le même conditionnement qu’avec CLEARFIL MAJESTY™ ES Flow afin d’éviter la formation de vides dans ce produit également. Le design innovant du conteneur réduit l’écart entre l’embout d’aiguille et la seringue lorsque l’embout est attaché.

Quand vaut-il mieux utiliser CLEARFIL MAJESTY™ ES Flow et quand opter pour CLEARFIL MAJESTY™ ES Flow Universal?

Alors que la variante universelle peut être utilisée d’une manière générale pour les bords et remplissages comme indiqué dans le mode d’emploi, CLEARFIL MAJESTY™ ES Flow est recommandé pour les cas dans lesquels la structure dentaire est couverte et la couleur de la dent entière doit être modifiée. Les facettes directes sont un exemple parfait. Dans ces situations, l’utilisation de différentes teintes et opacités est clairement avantageuse.

Quel est l’avenir des composites fluides?

Étant donné que les informations sur les performances cliniques et les données concernant les propriétés physiques continuent de se diffuser, nous prévoyons en Europe une hausse de la confiance dans les composites fluides et donc une utilisation renforcée. En outre, une demande accrue est attendue en raison du développement de méthodes de remplissage ayant recours à des composites fluides en conjonction avec des moules ou matrices.

TAKEHIRO KAMEYA

TEETHMATE™ DESENSITIZER RECOGNIZED AS TOP PRODUCT YET AGAIN

Dental Advisor has recognized TEETHMATE™ DESENSITIZER as a Top Product in the category of Hygiene – Desensitizer yet again. This year’s recognition – the eleventh in a row (2015 – 2025) – was announced in the January/February 2025 issue of the publication. TEETHMATE™ DESENSITIZER allows an effective non-invasive approach to the treatment of hypersensitivity – a painful condition that generally occurs when dentinal tubules are exposed – when used as directed by dental professionals.

HOW IT WORKS

TEETHMATE™ DESENSITIZER is designed to crystalize hydroxyapatite (HAp), a mineral that is naturally found in enamel and dentin, and is the human body’s strongest material. When applied to exposed, mechanically treated, or freshly prepared dentin, the calcium phosphate-based mixture blocks the exposed tubules and provides immediate pain relief. During setting, HAp is formed, providing for long-term prevention of hypersensitivity. Further, when used in the context of restorative treatment, TEETHMATE™ DESENSITIZER does not have a negative effect on the bond strength of subsequently utilized dental adhesives or cements.

BENEFITS IN A NUTSHELL

TEETHMATE™ DESENSITIZER is a versatile solution providing hypersensitivity relief independent of the cause. It is perfectly suited for

• Treatment of dentin exposed by toothbrush abrasion, gingival recession, periodontal disease and/or acid erosion.
• Treatment of dentin after mechanical tooth cleaning, scaling and/or root planing.
• Treatment of the tooth surface before and after bleaching.
• Treatment of prepared dentin for fillings and/or prosthetic restorations.

The use of the product is also beneficial as it is

• Easy to mix and apply.
• Proven to be effective.
• Tissue-friendly and highly biocompatible.

OUTSTANDING CLINICAL PERFORMANCE RATING: 96 PERCENT

In a clinical evaluation, the Dental Advisor consultants found TEETHMATE™ DESENSITIZER effective in providing hypersensitivity relief immediately following and for up to six months after application. The study evaluated 27 patients diagnosed with gingival recession-related hypersensitivity, which was diagnosed using thermal testing with cold air. For the initial assessment, patients were asked to evaluate their level and frequency of hypersensitivity per tooth on a five-point scale. They were questioned about their level of sensitivity immediately after TEETHMATE™ DESENSITIZER was applied, according to the instructions for use, and again six months later. At baseline, 91 percent of the patients stated that they had no or only mild, sporadic sensitivity, which was still the case for 85 percent after six months.

Among the consultants’ comments were

• “TEETHMATE DESENSITIZER is easy to apply and seems to provide consistent relief.”
• "At six months, the majority of patients continue to experience marked improvement from their preoperative sensitivity or no sensitivity at all."

As a result, the product received a clinical performance rating of 96 percent.

ABOUT DENTAL ADVISOR

The Top Product and Preferred Product Awards from Dental Advisor, a US-based organization, were initiated to help busy practitioners navigate the variety of new dental solutions available, particularly for less invasive techniques and standardized procedures. These awards aim to identify products that improve outcomes consistently. Dental Advisor conducts clinical evaluations and product performance tests shortly after a product’s launch and publishes annual results online to help practitioners identify high-quality dental materials suited to their specific needs.

For more information, visit Dental Advisor at: www.dentaladvisor.com

Interview with Dr. Ludivine Facon

Individual prophylaxis, early defect detection and treatment, minimally invasive restorative techniques: In her joint dental practice in Anstaing, France, Dr. Ludivine Facon does everything in  her power to keep her patients’ teeth healthy for their lifetime. When we met her at the International Dental Show in Cologne, where she was a speaker for Kuraray Noritake Dental Inc., we asked her to share information about her treatment philosophy and how flowable injection fits into her overall approach.

Your treatment philosophy seems to be minimally invasive. Would you please tell us a bit more about it?

Ever since I started treating patients, my priority has always been to preserve the dental tissues and to be as minimally invasive as possible when restoration is required. My interest in prevention started with my thesis in 2000, which focused on oral health prevention in Quebec, Canada, a country where prophylactic care is an integral part of dental treatment. I have always been highly interested in individual prophylaxis, which naturally led me to focus on minimally invasive treatments. My goal is to stay as low as possible on the therapeutic gradient, always thinking about the long-term benefits for the patient.

What are the benefits of this approach for your practice?

Integrating prophylaxis for every patient into my practice allows me to work with excellent surface conditions for bonding. The oral environment is sanitized before applying conservative restorations, and carious lesion removal is kept to a minimum.

When defects – be it a carious lesion or severe tooth wear – are present, I use the following instruments and materials that allow for truly minimally invasive interventions:

• Rondoflex 50-micron sandblaster to roughen the surface,
• Micro diamond burs to remove what is necessary,
• Layered composites for single-tooth restorations,
• Injected composites when multiple teeth are involved.

Case predestined for composite injection, as multiple teeth in the maxilla need to be treated (smile makeover).

What dental materials do you use for your restorative procedures?

I am a hands-on dentist, and in my daily practice, I strictly follow surface preparation and bonding protocols recommended for CLEARFIL™ Universal Bond Quick 2 (Kuraray Noritake Dental Inc.). In addition, I use high-quality composites from Kuraray Noritake Dental Inc. For layering, CLEARFIL MAJESTY™ ES-2 Premium Enamel and Dentin are my got-to solution, while I use CLEARFIL MAJESTY™ ES Flow Low for injection.

What are the benefits of a conservative approach for your patients?

Patients appreciate the fact that my treatment approach is as conservative as possible while still allowing for easy reintervention if necessary, preserving as much healthy dental tissue as possible. Another significant advantage is the moderate cost, which makes the treatment more accessible.

How does composite injection fit into this philosophy?

This technique allows for an easy reconstruction of multiple teeth by transferring a wax-up designed in the lab into the mouth via an injection of modern flowable composite into a transparent silicone index. Patients like this technique because it is aesthetic, reliable, reproducible and minimally invasive. A major advantage is that it allows for touch-ups and repairs, making it a reassuring solution. In some cases, no tooth preparation is needed at all—we simply add material, making the whole treatment truly non-invasive.

Why do you think this technique is promising?

It is a trendy and promising technique because:

• It is non-invasive --> preserves tissues --> aligns with minimally invasive dentistry.
• It is predictable --> due to the index, the technique is reproducible.
• It is easier than traditional layering --> saves chair time and improves patient comfort.
• It is cost-effective --> a cheaper alternative to ceramic veneers.
• It allows for repairs at any time, making it a reassuring option.

How did you proceed before knowing this technique?

In the anterior region, I used traditional composite layering with a wax-up and a palatal silicone index. It allowed me to rebuild the palatal wall and provide for precise incisal edge placement. In the posterior region, I used inlays, onlays, or overlays made of lab-processed reinforced composite or lithium disilicate.

Transparent silicone index with injection hole used to inject the flowable composite and restore the tooth to its planned shape.

What made you start using the new technique?

There has been an explosion in demand for smile enhancements, especially among young adults. The composite injection technique is an appealing alternative for reshaping smiles in young patients with intact teeth but unsatisfactory size or shape. It is less invasive than veneers, which have gained popularity due to social media trends, but often require significant tooth preparation.

How did you proceed in the beginning?

I first discovered the technique in a specialized journal in 2019, then trained myself using online tutorials. Of course, there were some trial-and-error moments, but it is a very accessible technique—even for beginners. To achieve optimal results, I believe that proper case selection and treatment planning are key. One of the most important preconditions for aesthetic outcomes is that the patient’s teeth have a simple shade structure. If the shade structure of the teeth is complex or the required restoration is large, it is better to layer the dentin before injecting the enamel. Moreover, it is essential to produce two models in the wax-up phase, not just one: An “intermediate wax-up model” with every other tooth featuring the wax-up, while the remaining teeth remain unmodified. The second is a “full wax-up model” with all teeth reshaped.

Considering these aspects, it is possible to obtain great outcomes quite quickly. The learning curve is steep, however – as with every new technique to be implemented – you need to step out of your comfort zone.

Apart from CLEARFIL™ Universal Bond Quick 2 and CLEARFIL MAJESTY™ ES Flow Low you already mentioned, what instruments and materials do you use?

For treatment planning including the wax-up, I use digital technology via Smilecloud, but a traditional wax-up works just as well. The production of the silicone index is the most delicate part when doing it in-house. I recommend using EXACLEAR (GC), the only truly effective transparent silicone currently available. Adjacent teeth are isolated with PTFE tape. Finishing instruments that have proven their worth are:

• Scalpel Blade No. 12,
• 3M™ Sof-Lex™ Contouring and Polishing Discs (Solventum),
• Red-ring fine diamond burs,
• TWIST™ DIA for Composite polishers (Kuraray Noritake Dental Inc.).

Intermediate wax-up model: One tooth with wax-up followed by one tooth without.

Full wax-up model.

Do you believe that the quality of the outcome is affected by the composite material you use?

Absolutely! New high-filled flowable composites, like CLEARFIL MAJESTY™ ES Flow Low, offer excellent mechanical properties and polishability, making them very promising.

Highly aesthetic treatment outcome after injection of CLEARFIL MAJESTY™ ES Flow Low.

What material characteristics impact overall quality?

First of all, the optical properties or shade matching ability of the material are crucial. I like the fact that I can select from a variety of shades when using CLEARFIL MAJESTY™ ES Flow. Once the right shade is selected and the thickness of the injected layer does not exceed 1 mm, the optical properties of the restorations may be expected to be exceptional.

Moreover, we need a material with great flow properties (fluid, but not too runny), which is virtually void-free. I prefer using low viscosity flowable composites like CLEARFIL MAJESTY™ ES Flow Low (two other flowabilities – HIGH and SUPER LOW – are also available). The physical properties (mechanical strength) and polishability plus polish retention are also important. They are usually excellent with premium flowable composites.

What are your most important clinical tips and tricks?

For beginners:

• Press firmly on the cervical area of the silicone index to reduce excess material upon removal.
• Finish the proximal area thoroughly before moving to the next injection step. This way, you provide for perfect key positioning for the following teeth.

If you follow the protocol, the technique is very beginner friendly!

What is your opinion about the emerging hybrid "layering & injection" technique?

This hybrid technique complicates the original injection technique, which is meant to simplify composite restorations. However, it is very useful in cases where aesthetic complexity requires layering. For maximum mimicry with this technique, I would love to have injectable composites in an enamel shade at my disposal.

Would you please share your final thoughts with us?

Take your time planning! Observe, document, take photos, use digital tools! Less is more.

Dr. Facon, thank you very much!

Dentist:

LUDIVINE FACON

Dr. Ludivine Facon graduated from the University of Lille, where she developed a solid foundation in dentistry. Passionate about periodontology and dental aesthetics, Dr. Facon pursued specialized training to refine her skills in these fields. In 2007, she completed clinical periodontology training at the Charon Clinic, followed by individual dental prophylaxis training with Michel Blique in 2008. From 2013 to 2014, she attended the long cycle program at the Académie du Sourire in Aix-en-Provence, enhancing her expertise in dental aesthetics. Dr. Facon continued to build on her knowledge with international training, including at the International Institute of Periodontology in Montreal in 2015, and a veneer training course at the GAD Center in Bordeaux the same year. In 2016, she further advanced in mucogingival surgery at the Académie de Parodontologie in Aix-en-Provence. Always keeping up with the latest developments, she participated in the CIDAE training in Brussels in 2022. More recently, in 2024, Dr. Facon completed a course in composite layering and injection, led by Guillaume Piskorski, the French specialist in injected composite technique, in Lille. With extensive expertise, Dr. Facon is also an educator in direct aesthetic composites, having taught at the University of Lille in 2020, 2022, 2023, and 2024.

In part two of this veneer workflow, Roberto Rossi completes the restoration by applying CERABIEN™ MiLai lusters to the pre-stained and sintered KATANA™ Zirconia YML. Watch as he enhances surface texture, gloss, and lifelike detail through precise finishing techniques.

With just a few simple steps, Roberto creates depth, dynamic light effects, and natural contours that rival real enamel. The process is intuitive and efficient, delivering a high-end finish—culminating in a final self-glazing fire for a polished, natural result.

An intelligent solution for dental technicians seeking efficiency without compromising on aesthetics.

In the first part of this aesthetic veneer workflow, dental technician Roberto Rossi demonstrates how to apply internal stains to KATANA™ Zirconia YML. This crucial step enhances the restoration by adding depth, translucency, and natural character from within.

After refining the anatomy and surface texture, Roberto skillfully blends and applies selected shades such as A+, Fluoro, and Incisal Blue. These shades create depth, opalescence, and inner vitality that radiate through the final restoration.

A must-watch for dental technicians looking to elevate their zirconia restorations with advanced, yet straightforward, internal staining techniques.