KATANA™ Zirconia STML est un matériau très populaire qui est utilisé dans de nombreux laboratoires dentaires de par le monde. Comparé aux matériaux des cadres zircone traditionnels avec une structure polycristalline principalement tétragonale, le matériau contient plus d‘oxyde d‘yttrium, ou yttria, créant une structure de matériau différente et avec un impact sur les propriétés optiques et physiques (translucidité augmentée, résistance à la flexion diminuée). Par conséquent, le champ d‘indication se limite aux restaurations d‘une seule dent et aux bridges à deux ou trois unités dans les zones antérieures et postérieures. Le principal avantage réside dans un potentiel esthétique beaucoup plus élevé, ce qui fait que le matériau est principalement utilisé pour la production de restaurations monolithiques ou à micro cut-back personnalisé avec une microcouche de porcelaine.

Bien que les indications et procédures techniques soient bien connues, il semble subsister des zones d’ombre concernant la manipulation par le professionnel dentaire. Le collage conventionnel est-il possible et recommandé ou une procédure d’assemblage adhésif est-elle préférable? Le pré-traitement de surface est-il identique pour une zircone tétragonale ou faut-il une autre procédure? Et que peut-on attendre quant au comportement des restaurations KATANA™ Zirconia STML sur le long terme? La littérature scientifique disponible fournit certaines réponses.

POSE DÉFINITIVE DE RESTAURATIONS AVEC KATANA™ ZIRCONIA STML

Collage conventionnel ou assemblage adhésif? En principe, les deux procédures sont possibles lorsque la restauration à poser est conçue dans une optique de rétention. On admet généralement qu’une couronne à couverture totale fournit suffisamment de rétention pour un collage conventionnellorsque la dent-pilier a au moins 4 mm de hauteur et que l’angle de convergence des parois axiales varie entre 6 et 12 ou au maximum 15 degrés1,2.
La raison en est que la résistance à la flexion du matériau est supérieure à 350 MPa3, la valeur critique pour le collage conventionnel. Les ciments conventionnels étant opaques et disponibles dans une seule teinte, l’utilisation d’un ciment de résine (auto-)adhésif peut toutefois être préférable, dans une optique d’esthétique, pour tous les matériaux de restauration hautement translucides. Quoi qu’il en soit, ces produits sont obligatoires à chaque fois qu’une conception préparatoire à macro-rétention n’est pas faisable ou pas souhaitée. Pour résumer, l’utilisation d’un ciment de résine auto-adhésif ou adhésif est préférable dans de nombreuses situations. Un argument en faveur des ciments de résine auto- adhésifs est l’effort moindre que requiert leur utilisation. Mais qu’en est-il du pré traitement de la zircone? Indépendamment du type de zircone dentaire utilisé, le mordançage à l’acide hydrofluorique est inefficace en raison de l’absence de matrice de verre dans le matériau. Cependant, il est clair qu’une modification de la surface est nécessaire pour créer une adhésion solide et durable à tout système de ciment de résine4,5. En général, la méthode recommandée pour la zircone haute résistance est le sablage avec des particules d’oxyde d’aluminium ou un revêtement de silice tribochimique4. La taille des particules doit être petite (≤ 50 μm) et la pression basse (approx. 1 bar) pour éviter d’affaiblir les propriétés mécaniques du matériau3,4. Avec les variantes de matériau moins résistantes, le risque d’affaiblissement du matériau semble être plus élevé5, de sorte qu’il est alors encore plus important de travailler avec une pression basse et une taille de particule moindre5-8. Dans le cas de KATANA™ Zirconia toutefois, il a été rapporté que le « sablage alumine a fortement augmenté la résistance à la flexion biaxiale de KATANA™ STML. »9 Cela signifie que le sablage correct des Bien que les indications et procédures techniques soient bien connues, il semble subsister des zones d’ombre concernant la manipulation par le professionnel dentaire. Le collage conventionnel est-il possible et recommandé ou une procédure d’assemblage adhésif est-elle préférable? Le pré-traitement de surface est-il identique pour une zircone tétragonale ou faut-il une autre procédure ? Et que peut-on attendre quant au comportement des restaurations KATANA™ Zirconia STML sur le long terme? La littérature scientifique disponible fournit certaines réponses. restaurations avec KATANA™ Zirconia STML n’a pas affecté la résistance à la flexion du matériau, laquelle a même été augmentée en raison des propriétés spécifiques de la zircone de Kuraray Noritake Dental.

Sur la base de ces constats, les procédures recommandéespour la zircone haute translucidité sont les suivantes:

OPTION 1
Air abrasion à l’oxyde d’aluminium suivie de l’application d’un ciment de résine auto-adhésif contenant 10-MDP6

OPTION 2
Revêtement silice tribochimique suivi d’une silanisation de la surface d’adhésion6

Contenant le monomère MDP original et l’agent combinant le silane à longue chaîne carbonée (monomère LCSi), le ciment de résine auto-adhésif à double polymérisation PANAVIA™ SA Cement Universal convient pour les deux procédures. PANAVIA™ SA Cement Universal est disponible en version seringue à mélange automatique et en tant que système à mélange manuel qui se présentent sous forme de pâtes. Une pâte contient le monomère MDP original dans un environnement hydrophile et l‘autre le monomère LCSi inactif dans un environnement de monomères hydrophobes. À l‘extraction de la pâte, ils sont mélangés dans l‘embout de mélange (automatique) de la seringue ou déposés sur une plaque de mélange (manuel) et mélangés à la main. Ensuite, le matériau est simplement appliqué à la surface intérieure de la restauration et celle-ci est posée. L‘élimination de l‘excédent de ciment est la plus facile après semipolymérisation (2 à 5 secondes).

CELA FONCTIONNE-T-IL BIEN DANS L‘ENVIRONNEMENT CLINIQUE?

Le meilleur moyen de vérifier si la procédure décrite réussitdans l’environnement clinique est de mener une étude clinique. C’est exactement ce qu’a fait un groupe de chercheurs de l’université Complutense à Madrid, Espagne, avec la combinaison de matériaux KATANA™ Zirconia STML et PANAVIA™ SA Cement Universal10. Dans le cadre de l’essai clinique prospectif, 30 couronnes postérieures avec KATANA™ Zirconia STML ont été posées sur 24 individus qui avaient besoin de restaurations dentaires postérieures. Les dents ont été préparées selon les recommandations pour les restaurations tout céramique, autorisant une épaisseur de paroi d’environ 1 mm (épaisseur de paroi minimale recommandée de KATANA™ Zirconia STML pour des couronnes dans la zone postérieure: 1,0mm). Les restaurations ont été frittées, caractérisées et glacées comme le recommande le fabricant des matériaux, puis elles ont été essayées. Préalablement au collage, la surface intérieure des restaurations a été prétraitée avec des particules d’oxyde d’aluminium (50 μm, pression 1 bar) avant un nettoyage ultrasons. L’utilisation de PANAVIA™ SA Cement Universal était également en ligne avec les recommandations du fabricant. Une évaluation clinique des couronnes a été réalisée après 6, 12 et 24 mois au moyen du système d’évaluation qualité de la California Dental Association (CDA). Les paramètres évalués dans ce système sont la surface et la couleur des restaurations, leur forme anatomique et l’intégrité marginale des couronnes. Après 24 mois, les taux de réussite et de survie étaient de 100%. Pour les trois paramètres cités, les couronnes ont obtenu la note «satisfaisant» (score de 3 ou 4) ; l’intégrité marginale (paramètre-clé pour juger des performances du ciment de résine) obtenant la note «excellent» (le plus haut score possible de 4) pour la totalité des 30 cas.

CONCLUSION

Les chercheurs ont conclu que «les excellents résultats obtenus dans cette étude suggèrent que les couronnes zircone monolithiques dento-portées de troisième génération dans les régions postérieures semblent constituer une bonne alternative aux couronnes métal-céramique, couronnes zircone monolithiques de seconde génération et couronnes zircone à facettes. Une étude sur le long terme sera nécessaire pour confirmer cette étude de courte durée.» Ainsi, il semble que KATANA™ Zirconia STML et PANAVIA™ SA Cement Universal forment une équipe prometteuse et que le respect des protocoles recommandés tels que précités soit susceptible de produire d‘excellents résultats qui restent stables pendant de nombreuses années.

Références:
1 Edelhoff D, Özcan M. To what extent does the longevity of fixed dental prostheses depend on the function of the cement? Working Group 4 materials: cementation. Clin Oral Implants Res. 2007;18 Suppl
3:193-204. 2 Güth JF, Stawarczyk B, Edelhoff D, Liebermann A. Zirconia and its novel compositions: What do clinicians need to know? Quintessence Int. 2019;50(7):512-20. 3 Kern M, Beuer F, Frankenberger
R, Kohal RJ, Kunzelmann KH, Mehl A, Pospiech P, Reis B. All-ceramics at a glance. An introduction to the indications, material selection, preparation and insertion techniques for all-ceramic restorations.
Arbeitsgemeinschaft für Keramik in der Zahnheilkunde. 3rd English edition, January 2017. 4 Comino-Garayoa R, Peláez J, Tobar C, Rodríguez V, Suárez MJ. Adhesion to Zirconia: A Systematic Review of Surface
Pretreatments and Resin Cements. Materials (Basel). 2021 May 22;14(11):2751. 5 Mehari K, Parke AS, Gallardo FF, Vandewalle KS. Assessing the Effects of Air Abrasion with Aluminum Oxide or Glass Beads to
Zirconia on the Bond Strength of Cement. J Contemp Dent Pract. 2020 Jul 1;21(7):713-717. 6 Chen B, Yan Y, Xie H, Meng H, Zhang H, Chen C. Effects of Tribochemical Silica Coating and Alumina-Particle Air
Abrasion on 3Y-TZP and 5Y-TZP: Evaluation of Surface Hardness, Roughness, Bonding, and Phase Transformation. J Adhes Dent. 2020;22(4):373-382. 7 Alammar A, Blatz MB. The resin bond to high-translucent
zirconia-A systematic review. J Esthet Restor Dent. 2022 Jan;34(1):117-135. 8 Soto-Montero J, Missiato AV, dos Santos Dias CT, Giannini M. Effect of airborne particle abrasion and primer application on the
surface wettability and bond strength of resin cements to translucent zirconia. J Adhes Sci Technol, Online publication May 2022. 9 Inokoshi M, Shimizubata M, Nozaki K, Takagaki T, Yoshihara K, Minakuchi S,
Vleugels J, Van Meerbeek B, Zhang F. Impact of sandblasting on the flexural strength of highly translucent zirconia. J Mech Behav Biomed Mater. 2021 Mar;115:104268. 10 Gseibat M, Sevilla P, Lopez-Suarez
C, Rodríguez V, Peláez J, Suárez MJ. Prospective Clinical Evaluation of Posterior Third-Generation Monolithic Zirconia Crowns Fabricated with Complete Digital Workflow: Two-Year Follow-Up. Materials (Basel).
2022 Jan 17;15(2):672. (https://pubmed.ncbi.nlm.nih.gov/35057389/)

A pioneer in digital dental photography, the editor-in-chief of the “International Journal of Esthetic Dentistry” and a supporter of universal products: We are talking about Dr Alessandro Devigus, the owner of a private practice in Bülach, Switzerland. At the International Dental Show 2023 in Cologne, we had a conversation with him about his favourite products from Kuraray Noritake Dental Inc. and the concept of universal excellence.

Dr Adham Elsayed, Clinical and Scientific Manager at Kuraray Noritake Dental Inc., interviewing Dr Alessandro Devigus.

Dr Devigus, why did universal products attract your attention?

We all would like to reduce the number of products and components used in our dental offices to make our lives easier and more predictable. Several years ago, when the first universal products started entering the dental market, I realized that these products and the concept behind them are able to help me achieve this goal.

For what kinds of treatments do you currently use universal products?

The main field of application is restorative dentistry, in indirect and direct restorative workflows, which often go hand in hand. Whenever possible and in accordance with the needs and desires of the patient, I opt for minimally invasive direct composite restorations, often realized using universal products. Cosmetic corrections or tooth wear treatments in the lower jaw, for example, are often carried out in a prepless procedure with resin composite applied with a single-shade technique. For anterior restorations in the upper jaw of the same patient, however, I might opt for ceramic restorations, luted with a universal resin cement.

What are your favourite indirect restorative materials, for which indications do you use them and when do universal products come into play?

I produce most of my single-tooth restorations chairside with CEREC. In the anterior region, the choice is usually between different types of glass ceramic materials. In some indications, when two central incisors or all four maxillary incisors need to be restored, zirconia is also a suitable option. In these cases and for indirect restorations in the posterior region, KATANA™ Zirconia Block is my preferred material. Having tested many different types of chairside zirconia, I can say that this product simply offers the most natural colour gradation and the desired vitality. Hence, finishing is quick and easy. At the same time, the high flexural strength of the material supports me in my striving for minimally invasive preparations. For definitive placement of the produced overlays and crowns, PANAVIA™ SA Cement Universal from Kuraray Noritake Dental Inc. is my dual-cure resin cement of choice. It bonds to virtually every surface including lithium disilicate without a separate primer and offers a good flowability that facilitates restoration placement. An additional feature contributing to a quick and stress-free clinical procedure is its easy and gingiva-friendly excess removal after tack curing.

What about direct restorations?

One of my favourite resin composites is CLEARFIL MAJESTY™ ES-2 Universal (Kuraray Noritake Dental Inc.). Its single shade for the posterior and two shades for the anterior region offer just the right combination of translucency and intrinsic colour to imitate a large number of tooth shades. The effect is that it blends in nicely with the surrounding tooth structure without appearing grayish. In the posterior region, I was able to observe a certain masking potential, so that discoloured abutment teeth do not cause any problems. With this material, the shade determination step is eliminated. Clinical workflows are also simplified by the use of CLEARFIL™ Universal Bond Quick. The universal adhesive is not only versatile as it is suitable for many indications and all etching techniques, but also extraordinarily quick in its application, as the need for an extensive rubbing into the tooth structure is eliminated. In this way, it is possible to streamline direct restorative procedures.

Why do you use so many products from Kuraray Noritake Dental Inc.?

I simply like products from Japanese companies. They stand for quality, integrity and clinical relevance. Japanese people seem to be deeply committed to the company they work for and to their work, pay attention to every detail and try to deliver the best outcomes possible. This attitude is reflected in Kuraray’s mission “For people and the planet—to achieve what no one else can.”, and it is reflected in the products of the company as well. They offer the properties I need to deliver high-quality dental treatments.

You said that making your life easier and more predictable is the main reason for you to opt for universal materials. Please explain.

In the first place, using fewer products and components that are easy and quick in their application allows me to get a grip on costs. With fewer steps and fewer bottles, shortened application times and standardized workflows, the time a patient needs to sit in the chair is reduced, which allows me to save the most valuable factor in the office: my time. At the same time, material storage and order management are streamlined, so that it is much easier to keep track of dates of expiry, hence saving material costs as well. And the best thing about it is that all these savings are possible without compromising treatment quality. Provided that the user is able to handle the materials properly – which is facilitated by the minimal number of steps and ease of use – the quality of the outcomes is extremely high!

Dr Devigus, we thank you for sharing your insights with us.

Article by Michael Braian DDS, CDT, PHD

Digital advancements revolutionized dentistry, providing efficient, precise dental care¹. Intraoral scanners replace traditional impressions, enabling virtual models for procedures like implant placement, orthodontics, and prosthodontics². Scan bodies aid in digitizing implants, while CAD/CAM improves prosthesis design and fabrication³. Milling and 3D printing offer speed, accuracy, and complexity in creating dental prostheses⁴. These innovations promise a bright future for dental professionals and patients.

The integration of digital technologies in dentistry has brought about significant advancements in dental care1. This case study presents a comprehensive dental rehabilitation of a patient utilizing a digital workflow, including extraction, dentures, implant surgery, intraoral scanning, 3D printed try-ins, and the fabrication of the final monolithic prosthetic construction.

EXTRACTION OF SEVERELY DECAYED TEETH

The first step in the patient‘s dental rehabilitation involved the extraction of severely decayed teeth. This procedure was necessary to eliminate the source of infection and discomfort and to prepare the oral cavity for the subsequent steps in the rehabilitation process. The dentures are later used to simplify the guided surgery planning⁵. Following the extraction, the patient was provided with appropriate postoperative care instructions and a healing period was allowed before proceeding with the next steps (Fig.1).

Fig. 1. Severely decayed teeth prior to extraction.

DENTURES DURING THE HEALING PERIOD

During the healing period of approximately seven months, the patient was fitted with dentures to replace the extracted teeth. This temporary solution allowed the patient to maintain oral function, appearance, and confidence while the extraction sites healed, and the oral tissues prepared for the implant surgery⁶.

IMPLANT SURGERY

In the upper jaw, six implants were placed, while only four were placed in the lower jaw (Fig.2). This decision was based on the patient‘s individual needs and oral anatomy. Studies have shown that the number of implants required for optimal support and stability depends on various factors, including bone quality and quantity, implant position, and prosthesis design⁷. Research suggests that six implants in the upper jaw and four in the lower jaw are sufficient to provide adequate support for a full-arch fixed prosthesis, with high success rates and patient satisfaction reported⁷. Additionally, placing fewer implants can help reduce surgical time and cost, as well as minimize the risk of complications associated with multiple implant placements. Therefore, this approach was deemed appropriate for this particular patient‘s case.

2023 DENTAL ADVISOR Top Product is an everyday cement that eliminates the need for a separate primer

PANAVIA™ SA Cement Universal adheres to virtually all substrates, including lithium disilicate, in a single procedure without the need for a separate primer or silane, and it also offers easy, gingival-friendly removal of excess cement and requires no refrigeration. Therefore it is no wonder that this year DENTAL ADVISOR gave PANAVIA™ SA Cement Universal Top Product award in the category of Indirect Restoratives.

What makes its strong and durable bond possible without the added step of applying a separate substrate is that PANAVIA™ SA Cement Universal combines two innovative technologies in a single product. The silane coupling agent, LCSi monomer, establishes a durable, chemical bond with porcelain, lithium disilicate, and composite resin; and the original MDP monomer provides for chemical reactiveness with zirconia, dentin and enamel.

The result is a convenient, versatile, and efficacious single solution to practitioners’ everyday cementation needs for a wide variety of indications, including cementation of crowns/bridges, inlays/onlays, posts, splints, and even adhesion bridges.

The significant benefits and quality of PANAVIA™ SA Cement Universal are reflected in the study findings and feedback of the 31 DENTAL ADVISOR clinical evaluators who used the cement in 516 applications and gave it an overall clinical rating of 96 percent. Their comments on its ease of use, handling characteristics, and aesthetics included: “Good flow and film thickness;” “Amazing viscosity, tack cure-ability, and very easy cleanup;” and “Great color match, and I liked the universal ability to work with so many substrates.”

The Top Product or Preferred Product Awards conferred by US-based DENTAL ADVISOR were introduced to help busy practitioners make sense of the numerous new solutions indicated for less invasive techniques, standardized or simplified procedures, and better outcomes on a regular basis. DENTAL ADVISOR conducts its practice-based clinical evaluations and product performance tests shortly after product launch, and publishes results annually online to help potential users identify high-quality new dental materials and determine which among them are best suited to fulfill their individual requirements.

For more information visit the website of DENTAL ADVISOR: www.dentaladvisor.com.

Five-time DENTAL ADVISOR Top Product delivers more than a reliable bond

For the fifth time CLEARFIL™ SE Protect has made DENTAL ADVISOR’S list of Top Products for 2023, placing it among dental materials and equipment deemed to deliver the best practice-based performance based on the publication’s annual review of such products.

Featured in the Bonding Agent Self-etch category, CLEARFIL™ SE Protect is a self-etch adhesive that offers more than just a reliable bond. It is:

• Antibacterial (self-etch) primer thanks to containing MDPB monomer
• Built on the same system of the gold standard adhesive CLEARFIL™ SE BOND
• Possible to use it for extended indications of core build-up and indirect restoration with CLEARIFL™ DC Activator.

All in all - surely a great addon to your dental toolbox.

Application of CLEARFIL SE Protect is also truly versatile – you can use it for any direct restorations, but in particular when treating hypersensitive teeth. It is also widely used for core build-up with self- or dual-cured resin materials and for cementation with composite resin cement in combination with CLEARFIL™ DC Activator.

CLEARFIL™ SE Protect offers you following features:

• Virtually no post-operative sensitivity
• Excellent bond strength for enamel and dentin
• Fast and simple procedure with low technique sensitivity

These attributes are reflected in the study findings and comments of the 13 DENTAL ADVISOR editors and consultants—seven of whom had previously used CLEARFIL™ SE BOND in their practices. After CLEARFIL™ SE Protect was assessed over a six-week period during which over 150 restorations were placed, it received a 98% clinical rating by consultants using a 1-5 rating scale,

The practitioners evaluating the product found no post-operative sensitivity. Among their observations mentioned in the online DENTAL ADVISOR report were the fact that the primer and bond wet the tooth evenly. They also mentioned that CLEARFIL™ SE BOND is effective in the reduction of sensitivity when placed on areas of recession or similar areas of sensitive tooth structure.

The Top Product or Preferred Product Awards conferred by US-based DENTAL ADVISOR were introduced to help busy practitioners make sense of the numerous new solutions indicated for less invasive techniques, standardized or simplified procedures, and better outcomes on a regular basis. DENTAL ADVISOR conducts its practice-based clinical evaluations and product performance tests shortly after product launch, and publishes results annually online to help potential users identify high-quality new dental materials and determine which among them are best suited to fulfill their individual requirements.

For more information visit the website of DENTAL ADVISOR: www.dentaladvisor.com

DENTAL ADVISOR Top Product to address everyday dental challenges

For the 8^th straight year, CLEARFIL MAJESTY™ ES Flow has been included among DENTAL ADVISOR’S Top Products, which is made up of dental materials and equipment deemed to deliver the best practice-based performance based on the publication’s annual review of such products.

Featured in the Direct Restorative category, CLEARFIL MAJESTY™ ES Flow comes in three different levels of flowability designed to cover a range of flowable composite indications that cannot be addressed with a single viscosity. Whether the practitioner needs the product to be firm enough to stay put where applied, malleable enough to create a specific shape, or runny enough to flow into every corner or undercut, one of the three versions is appropriate for the job. For example, the high flowability variant is the perfect choice for cavity linings and as a resin coat in immediate dentin sealing (IDS) procedures, while the super low flowability option is suitable for direct veneer procedures and for build-up of posterior cusps etc.

Equipped with Kuraray Noritake Dental Inc.’s Light Diffusion Technology, the universal flowable composite integrates seamlessly with the surrounding tooth structure. If no recontouring required, then a glossy surface can be obtained simply by wiping with a cotton roll soaked in alcohol.

The version tested by the 29 DENTAL ADVISOR consultants in more than 900 applications in their dental practices was the medium flowability variant (Low) of CLEARFIL MAJESTY™ ES Flow. They evaluated properties including placement/handling, aesthetics, viscosity, and polishability and rated all to be “excellent,” with no running during placement and a good adaptation to the cavity walls and when flowed into narrow areas. This led to a recommendation rate of 100 percent and a 98 percent overall clinical rating.

Among their comments were: “The material blended so well with the tooth structure that you had to look hard to find the interface;” “Syringe design prevents oozing from the tip;” and “Readily apparent on radiographs.”

The Top Product or Preferred Product Awards conferred by US-based DENTAL ADVISOR were introduced to help busy practitioners make sense of the numerous new solutions indicated for less invasive techniques, standardized or simplified procedures, and better outcomes on a regular basis. DENTAL ADVISOR conducts its practice-based clinical evaluations and product performance tests shortly after product launch. It publishes results annually online in its January/February issue to help potential users identify high-quality new dental materials and determine which among them are best suited to fulfill their individual requirements.

For more information visit the website of DENTAL ADVISOR: www.dentaladvisor.com.

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.