No Author Selected

Case by Andreas Chatzimpatzakis

A CONCEPT EVEN FOR AESTHETICALLY DEMANDING CASES

The micro-layering technique is regarded as a more efficient, streamlined approach used as an alternative for full porcelain layering. It requires aesthetic, high-strength ceramics like lithium disilicate or zirconia as a base and – ideally – a set of porcelains specifically designed for reduced layer thicknesses that allows users to focus on imitating the characteristics of enamel. A high-quality example is CERABIEN™ MiLai (Kuraray Noritake Dental Inc.). Consisting of a set of internal stains and porcelains with a firing temperature of just 740 °C and a coefficient of thermal expansion in the range of 9.5~11.0×10-6/K (50 °C – 500 °C), this product works well on lithium disilicate and zirconia.

Its aesthetic potential is surprisingly high: Depending on case-specific requirements, users are given the choice between maximum efficiency using a single-bake technique and maximum aesthetics achieved with more complex layering. The latter option is demonstrated below using the example of six maxillary anterior veneers.

Fig. 1. Lithium disilicate frameworks (Amber Press) on the model.

Fig. 2. CERABIEN™ MiLai Value Liner 1 applied to the framework. This porcelain is typically used on lithium disilicate for wash baking.

Fig. 3. First build-up with CERABIEN™ MiLai CCV2 in the cervical section, …

Fig. 4. … Value Liner 2, …

Fig. 5. … Creamy Enamel in the middle area …

Fig. 6. … and Tx used to add ultimate translucency.

Fig. 7. Appearance of the restorations after the first bake.

Fig. 8. Outcome of the internal staining procedure.

Fig. 9. Application of CERABIEN™ MiLai LT1 for a standard translucency and opalescence effect, …

Fig. 10. … E2, …

Fig. 11. … a mixture of E2 and ELT1 (mixing ratio: 50:50) for translucency and brightness and along the marginal ridges, …

Fig. 12. … Tx mixed with Royal Blue (mixing ratio 70:30) for a blueish translucency in the incisal area…

Fig. 13. … as well as a final layer of LTx to add ultimate translucency and opalescence to the whole enamel surface.

Fig. 14. Outcome of the third bake.

Fig. 15. Cutback for the final layer of porcelain.

Fig. 16. Final layer of CERABIEN™ MiLai added to the central and lateral incisors for translucency.

Fig. 17. Situation after the fourth bake, grinding and use of a rubber polisher.

Fig. 18. Outcome of the fifth bake (self-glaze).

Fig. 19. Beauty shots …

Fig. 20. … of the restorations …

Fig. 21. … on the model.

TRULY BEAUTIFUL OUTCOMES POSSIBLE

This case example reveals that CERABIEN™ MiLai is much more than just a maximum-efficiency solution: With the current line-up of porcelains and internal stains, truly beautiful restorations can be produced. Hence, users are given high flexibility regarding not only the high-strength framework material they prefer, but also the effort and time they would like to invest. This makes CERABIEN™ MiLai a versatile porcelain system that meets many needs and covers a wide range of applications in the dental laboratory.

Dental technician:

ANDREAS CHATZIMPATZAKIS

Andreas graduated from the Dental Technology Institute (TEI) of Athens in 1999. During his studies he followed a program at the Helsinki Polytechnic Department of Dental Technique, where he trained on implant superstructures and all ceramic prosthetic restorations. As of 2000, he is running the ACH Dental Laboratory in Athens, Greece, specialized on refractory veneers, zirconia and long span implant prosthesis. In 2017 Andreas visited Japan where he trained under the guidance of Hitoshi Aoshima, Naoto Yuasa and Kazunabu Yamanda and become International Trainer for Kuraray Noritake Dental Inc..

CLEARFIL MAJESTY™ ES Flow Universal WINT RESEARCH AWARD

EIGENSCHAPPEN IN HET KORT

 
Naast de intuïtieve kleurselectie biedt het flowable composiet nog een enorm voordeel: de uitzonderlijk hoge sterkte. Met een buigsterkte van 152 MPa en een compressiekracht van of 374 MPa is CLEARFIL MAJESTY™ ES Flow Universal (Super Low) net zo sterk als veel pasta-achtige composieten. Het is zodoende ook te gebruiken voor belaste delen en wordt geïndiceerd voor:

• Directe restauraties voor alle caviteitsklassen, cervicale laesies (bijvoorbeeld worteloppervlakcariës, V-vormige defecten), gebitsslijtage en tanderosie
• Caviteitsbasis/voering
• Correctie van positie en -vorm (bijvoorbeeld sluiting van diasteem, malformatie van elementen)
• Intra-orale reparatie van gefractureerde restauraties
• Cementeren van inlays, onlays en veneers – keramisch en composiet – met een dikte van minder dan 2 mm

VERBLUFFENDE IN-VITRO PRESTATIES

 
CLEARFIL MAJESTY™ ES Flow Universal wist op alle vlakken uitstekende prestaties neer te zetten. De fysieke eigenschappen hoorden bij de allerbeste voor flowable composieten en het niveau was vergelijkbaar met dat van pasta-achtige composieten. Geconstateerd werd dat de radiopaciteit ideaal was, net als de viscositeit; het materiaal behoudt na het aanbrengen zijn aanvankelijke vorm. En hoewel er slechts twee kleuren beschikbaar zijn, constateerden ook de onderzoekers dat met CLEARFIL MAJESTY™ ES Flow Universal een breed scala aan natuurlijke tandkleuren gerealiseerd kan worden.

OVER DENTAL ADVISOR

PANAVIA™ Veneer LC WINS PREFERRED PRODUCT AND RESEARCH AWARDS

PANAVIA™ Veneer LC has been singled out for a Research Award in the category Research – Veneer Cement by Dental Advisor and for a Preferred Product Award in the category Cement: Esthetic Resin. Published in the January/February 2025 issue of the US-based organisation, the annual Top Product, Preferred Product or Research Awards are given to those materials and devices deemed by the publication’s consultants to deliver the best practice-based or lab-based performance in their categories.

BENEFITS IN A NUTSHELL

PANAVIA™ Veneer LC is a specialized veneer cement designed to provide exceptional bond strength to various substrates, along with outstanding gloss retention and wear resistance. The resin cement utilizes smaller-diameter spherical filler particles, facilitating easy dispensing from the syringe and excellent flowability for minimal film thickness. All of these attributes contribute to virtually no change in gloss or surface appearance of veneer margins over time.

EXCELLENT PROPERTIES IN VITRO

To assess the scientific performance of PANAVIA™ Veneer LC, its features and physical properties, specifically its bond strength to various substrates after artificial aging and its wear resistance, were tested in the Dental Advisor Biomaterials Research Center. The investigators’ testing of these attributes reflects the challenges such products must meet – “Ideally, esthetic veneer cements should have a long working time, curing on demand, excellent color stability, and high strength”.

To assess bond strength to dentin, enamel, IPS e.max CAD, and zirconia, the cements were subjected to six months of artificial aging using thermocycling. To test wear resistance after toothbrush abrasion, the testing method involved measuring depth of wear, change in surface roughness, and change in gloss based on a simulation of about 5.5 years of regular toothbrush use.

The investigators reported that PANAVIA™ Veneer LC “had the best gloss retention of the three cements tested and a very even wear pattern,” noting further that “having limited surface roughness after toothbrush abrasion can help lower staining and bacterial adhesion.” Overall, they said, “The PANAVIA™ Veneer LC cement system showed excellent adhesion properties and exceptional gloss retention and wear resistance,” concluding:

OUTSTANDING RATING OF 96 PERCENT

In addition, the product was tested in the clinical setting. 25 clinical evaluators used PANAVIA™ Veneer LC cement system in their dental offices. After a total of 166 uses, the light-curing resin cement received “excellent” to “very good” ratings with regard to completeness of the kit, the shade of the try-in pastes, ease of clean-up of the try-in pastes and excess cement, viscosity, working time and lack of shade shift after curing.

The evaluator’s clinical tips included:

• „Use a micro brush or rubber tip to clean up excess cement before curing.”
• „Apply glycerin gel to the margins after placing the veneer with the cement to eliminate the oxygen inhibition layer and ensure a complete cure before light curing through the gel.”

In their comments, they praised the ease of use of the system, the design of the syringes, the shade options and shade match between try-in and cement shades, e.g.:

• “The white shade of the cement was opaque enough for efficient masking of discolored tooth structure.”
• “Great esthetics, very easy to use, complete system.”

This resulted in an overall clinical rating of 96 percent and an equally high recommendation rate.

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. Research Awards were initiated to honour those manufacturers of dental products with an ongoing commitment to research, development and advancement of dental materials to enhance treatment quality.

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

CLEARFIL™ Universal Bond Quick 2

Bij veel moderne tandartspraktijken zijn efficiency en betrouwbaarheid erg belangrijk. CLEARFIL™ Universal Bond Quick 2 biedt een eenvoudige en hoogwaardige oplossing voor bonding met uitzonderlijke resultaten. Dankzij Kuraray Noritak’s Advanced Rapid Bond Technology biedt dit adhesief u snelheid, veelzijdigheid en betrouwbaarheid voor al uw restauratiebehoeften.

Wat is CLEARFIL™ Universal Bond Quick 2?

CLEARFIL™ Universal Bond Quick 2 is een geavanceerd tandheelkundig adhesief dat is ontwikkeld voor het stroomlijnen van restauratieve procedures. Het is compatibel met alle etstechnieken en biedt een betrouwbare hechting op zowel glazuur als dentine, wat resulteert in een sterke en uniforme bondinglaag. Door de veelzijdigheid is het geschikt voor zowel directe als indirecte restauraties en voor stompopbouw en intra-orale reparaties.

Wat zijn de indicaties voor CLEARFIL™ Universal Bond Quick 2?

Universal Bond Quick 2? Dit adhesief is ontwikkeld voor diverse klinische toepassingen: 

• Directe restauraties met lichtuithardende composiet
• Sealen van een geprepareerde caviteit of abutment als voorbehandeling voor indirecte restauraties
• Behandeling van blootliggende worteloppervlakken
• Behandeling van overgevoelige elementen
• Intra-orale reparatie
• Stiftcementatie en stompopbouw
• Cementeren van indirecte reparaties

Waarom werkt CLEARFIL™ Universal Bond Quick 2 zo goed? 

De uitzonderlijke prestaties komen door de Advanced Rapid Bond Technology bestaande uit drie ingrediënten met hoogwaardige prestaties: 

• Origineel MDP-monomeer: De door KURARAY CO., LTD. ontwikkelde MDPmonomer zorgt voor een uitzonderlijk sterke hechting aan hydroxyapatiet en een breed scala aan andere materialen, waaronder zirconia. Dit resulteert in een uitstekende en duurzame verbinding die zijn prestaties langdurig behoudt.
• Amidemonomeer: Dit uiterst hydrofiele monomeer zorgt voor snelle penetratie in de tandstructuur, zodat er na het aanbrengen niet hoeft te worden gewacht. Met het oog op een sterke en duurzame bevestiging vormt dit monomeer tijdens de polymerisatie een stabiel en hydrofoob crosslink-netwerk.
• Urethane Tetra Methacrylate (UTMA) monomeer: Dit uiterst hydrofiele monomeer zorgt voor snelle penetratie in de tandstructuur, zodat er na het aanbrengen niet hoeft te worden gewacht. Met het oog op een sterke en duurzame bevestiging vormt dit monomeer tijdens de polymerisatie een stabiel en hydrofoob crosslink-netwerk.

Samen vormen deze monomeren de basis van CLEARFIL™ Universal Bond Quick 2 en zorgen voor een snel, betrouwbaar en veelzijdig adhesief voor al uw restauratiebehoeften.

Waarom kiezen voor CLEARFIL™ Universal Bond Quick 2?

CLEARFIL™ Universal Bond Quick 2 zorgt voor meer efficiency zonder in te leveren op de kwaliteit. De Advanced Rapid Bond Technology integreert MDP, Amide en Urethane Tetra Methacrylate (UTMA) monomeren om te zorgen voor een sterke en uniforme bondinglaag. Dit zorgt voor een gelijkmatige verdeling en een betrouwbare hechtsterkte op zowel glazuur als dentine. De formule met lage viscositeit zorgt voor een dunne en uniforme bondinglaan en daarmee voor minder kans op pooling. 

Andere voorbeelden zijn:

• Snel en eenvoudig aanbrengen
• Een consistent sterke en duurzame bonding
• Veelzijdigheid voor diverse restauratietechnieken
• Een geminimaliseerd risico op pooling
• Compatibiliteit met zelfhechtende composietcementen
• Opslag op kamertemperatuur

Hoe wordt CLEARFIL™ Universal Bond Quick 2 aangebracht? 

Het aanbrengen gaat gemakkelijk en efficiënt voor diverse klinische scenario‘s. Gebruik het adhesief voor:

• Self-etch
• Selective-etch
• Total-etch

Het is beschikbaar in zowel flesjes als unit doses, waardoor het flexibel aansluit op uiteenlopende praktijkbehoeften en eenvoudig naar wens kan worden toegepast.

De Ultimate Bonding Solution: CLEARFIL™ Universal Bond Quick 2

Als nieuwste innovatie op het gebied van tandheelkundige bonding zorgt CLEARFIL™ Universal Bond Quick 2 voor efficiency, betrouwbaarheid en veelzijdigheid. Geen wachttijd meer, geen uitgebreid inwrijven en geen verschillende lagen meer. Zo zorgt dit adhesief voor versimpelde procedures én voor sterke en duurzame restauraties. Met zijn uitzonderlijke prestaties en vereenvoudigde workflow is het echt de „effortless bond“ voor de moderne tandartspraktijk.

Het hart van de universele portfolio

CLEARFIL™ Universal Bond Quick 2 vormt de verbindende schakel tussen verschillende producten in onze portfolio. Tevens is het compatibel met zelfhechtende cementen van andere fabrikanten, zodat u meer keuzevrijheid heeft. 

CLEARFIL™ Universal Bond Quick 2 vormt de verbindende schakel tussen verschillende producten in onze portfolio. Tevens is het compatibel met zelfhechtende cementen van andere fabrikanten, zodat u meer keuzevrijheid heeft.

Interview with the team at Kuraray Noritake Dental Inc., who developed and brought to life this new universal adhesive.

Streamlining, enhancing and refining adhesive procedures – these are the aims of an 5-person team at Kuraray Noritake Dental Inc. in Japan. Recently, the team has developed a next-generation universal adhesive CLEARFIL™ Universal Bond Quick 2 that offers quick and easy application combined with an optimised bonding performance. To learn more about the goals and achievements of the development project, and the benefits of the product, we had a conversation with them.

From left to right: Ryo Matsuura and Ryota Murayama (R&D Department), Kazutoshi Ikeda (Production Department), Marina Okada and Yamato Nojiri (Planning & Development Department).

Why did you decide to improve CLEARFIL™ Universal Bond Quick?

Universal adhesives like CLEARFIL™ Universal Bond Quick are very well received by dental practitioners all over the world mainly due to their versatility and procedural simplicity. In the clinical setting, however, we have identified room for improvement. For example, it can be difficult to establish thin, uniform and strong bonding layers with the currently available products. Water and solvents in universal adhesives often limit the formation of a strong bond layer. A thin bonding layer and the relatively thick oxygen inhibition layer make this type of bonding agent susceptible to degradation by water sorption from dentinal moisture. Highly viscous bonding agents also complicate the ease of application in small cavities and can easily lead to pooling of the adhesive in critical parts of the cavity. Adhesives with a relatively high viscosity may pool or accumulate along margins, and may form a layer that is too thick and may change the morphology of the abutment tooth, a critical factor potentially affecting the fit of an indirect restoration. Generally, bonding agents with a low film thickness and/or are low-filled or unfilled, in turn have a potentially negative effect on the strength of the bonding layer. At Kuraray Noritake Dental Inc., we wanted to address the aforementioned issues and have developed a universal adhesive that is easy to apply and facilitates the establishing of thin, uniform bonding layers exhibiting high strength.

What are the indications of CLEARFIL™ Universal Bond Quick 2?

The new universal adhesive is indicated for bonding procedures in the context of creating direct restorations with light-cured composite, sealing of a prepared cavity or abutment tooth as a pretreatment for indirect restorations, treatment of exposed root surfaces and hypersensitive teeth, and also the intraoral repair of fractured restorations. Furthermore, the product is a suitable adhesive in post-cementation and core build-up procedures as well as in adhesive cementing of indirect restorations. When used in the context of the cementing of indirect restorations, the bonding to tooth structure of PANAVIA™ SA Cement Universal and of other manufacturers’ self-adhesive resin cements improves, leading to higher bond strengths.

What are the corresponding general benefits of CLEARFIL™ Universal Bond Quick AND CLEARFIL™ Universal Bond Quick 2?

The general benefits of both products are that they may be used with any etching procedure, plus the fact that there is no need to wait for the adhesive to penetrate the tooth structure after application. In addition, both products contain the original MDP monomer and the amide monomer, responsible for the formation of a thin and strong surface coating. Both products exhibit low technique sensitivity and are suitable for a wide range of indications. Finally, the adhesive monomers and fluoride offer extra protection to the underlying dentin.

Monomer image from the brochure

You mentioned the original MDP monomer as one of the essential components of the new adhesive and its predecessor. Is there a difference between this original MDP monomer and other MDP monomers available on the market?

Our MDP monomer is the only MDP monomer that is manufactured using the originally developed synthesis and purification process. Research has shown that the way MDP is manufactured has indeed an impact on the performance of the monomer itself1. While impurities and dimers detected in MDP monomers synthesized elsewhere negatively affected the immediate and aged micro-tensile bond strength in the in-vitro study, our MDP monomer shows high purity and more favourable test results.

Most universal adhesives need to be rubbed into the tooth structure extensively for 10 to 20 seconds. What did you do to eliminate the waiting time independent of the etching procedure, which led to an ultra-quick application procedure?

It is the amide monomer which is mainly responsible for an improved penetration speed into the tooth structure. The hydrophilicity of this monomer is much higher than the hydrophilicity of the HEMA monomer that is typically used. This provides for a better penetration into the moist dentin. The amide monomer’s polymerisation characteristics are better, and, following polymerisation, leads to higher stability in a wet environment due to the formation of a highly cross-linked polymer network. In combination with MDP, an efficient long-term performance will likely be achieved. For optimal outcomes, the adhesive is simply rubbed into the tooth structure as described in the IFU: “Apply BOND with a rubbing motion to the entire cavity wall with the applicator brush. No waiting time is required.”

What are the additional benefits that CLEARFIL™ Universal Bond Quick 2 has to offer?

First of all, we improved the viscosity and film thickness by optimizing the manufacturing method. The thin adhesive layer prevents pooling in the cavity, around abutments and along margins, creating a uniform bonding layer. Simply put, the new adhesive is applied thinly and spreads evenly. At the same time, the product offers high mechanical strength and excellent resistance to water sorption. Its bond strength is high in all etching modes and the new formulation allows for the product to be stored at room temperature.

Please explain the clinical benefit of an improved mechanical strength.

The risk of decreasing the film thickness lies in a possible decrease in the strength of the bonding layer which can lead to reduced bond durability. By introducing a new multifunctional urethane methacrylate monomer, we have been able to increase the strength. The effective advantage of the new bonding agent is that it can easily be used in small, difficult-to-access cavities or in cavities with complex morphology. The result is a thin yet strong adhesive layer that also allows for easy placement of any type of restoration.

How did you manage to improve the storage conditions?

Component stability was not an issue with CLEARFIL™ Universal Bond Quick. However, for a stable viscosity, it needed low-temperature storage. By optimizing the manufacturing method and decreasing the viscosity of CLEARFIL™ Universal Bond Quick 2, storage at room temperature became possible.

Was it difficult to integrate the new components and keep the existing benefits? How did you manage?

Integrating new components and removing others always means that the whole formulation needs to be rebalanced properly. This was particularly challenging for the multifunctional urethane methacrylate monomer we wanted to add. It improves the strength and hardness of the universal adhesive, but may affect adhesion depending on the amount of the compound in the formulation. Consequently, we needed to carefully find optimal balance, which took some time and required thorough testing, but in the end, we succeeded.

At the moment, the immediate dentin sealing technique is popular in indirect restoration procedures. What makes CLEARFIL™ Universal Bond Quick 2 suited for this technique?

Immediate dentin sealing is indeed a popular and useful technique that can result in significantly increased retention, reduced marginal leakage, improved bond strength, and less postoperative sensitivity. Using CLEARFIL™ Universal Bond Quick 2 in this context is beneficial as the procedure is quick, the resulting bonding layer is thin and strong, and the dentin is effectively protected.

Why should a dental practitioner switch to CLEARFIL™ Universal Bond Quick 2?

For users of CLEARFIL™ Universal Bond Quick, switching to CLEARFIL™ Universal Bond Quick 2 is worthwhile, as it offers additional advantages and improved performance while retaining the benefits of its predecessor. For users of other universal adhesives, the major benefit lies in the shortened application time: CLEARFIL™ Universal Bond Quick 2 is the only universal adhesive that can achieve a high bond strength and a high-strength bonding layer without any waiting time. In addition, it is suitable for a wide range of indications including core build-up procedures and cementation.

Thank you very much for these insights!

References
1. Yoshihara K, Nagaoka N, Okihara T, Kuroboshi M, Hayakawa S, Maruo Y, Nishigawa G, De Munck J, Yoshida Y, Van Meerbeek B. Functional monomer impurity affects adhesive performance. Dent Mater. 2015 Dec;31(12):1493-501.

Case by Dr. Julien Molia

Ja, HET WERKT!

In de gedachten van veel tandartsen is het stevig verankerd dat flowable composieten geschikte liner- of basismaterialen zijn onder sterkere packable composieten en indirecte restauraties of als tijdelijk materiaal. Velen van hen nemen echter aan dat het gebruik beperkt is vanwege hun slechte mechanische eigenschappen.

NIEUWE GENERATIE FLOWABLES

Maar gelukkig behoort dat nu tot het verleden: Meerdere van de nieuwste generatie flowable composieten – zoals CLEARFIL MAJESTY™ ES Flow en CLEARFIL MAJESTY™ ES Flow Universal (beide van Kuraray Noritake Dental Inc.) – beschikken over mechanische eigenschappen die niet onderdoen voor de eigenschappen van packables. Als gevolg daarvan is het indicatiespectrum uitgebreid. Zo blijkt uit gegevens van de fabrikant dat CLEARFIL MAJESTY™ ES Flow Universal een hoog vulstofgehalte van 75 tot 78 wt/%, een buigsterkte van meer dan 150 MPa en een compressiekracht boven 370 MPa biedt. Dankzij deze hoge sterkte is het materiaal geschikt als betrouwbare en permanente oplossing die zelfs geschikt is voor belaste gebieden, zoals de occlusale oppervlakken van posterieure tanden.

Deze flowable composiet heeft echter nog meer te bieden: Het is leverbaar in twee niveaus van vloeibaarheid – LOW en SUPER LOW – en kan worden ingezet voor een breder scala aan persoonlijke voorkeuren en individuele indicatiespecifieke behoeften. En dat in slechts twee kleuren (Universal en Universal Dark). Dit laatste biedt het voordeel van intuïtieve kleurselectie, zelfs in het anterieure gebied, en is mogelijk dankzij een mix van technologieën voor kleuraanpassing, waaronder een technologie voor geoptimaliseerde lichtdiffusie en een glazuurachtige translucentie.

De volgende casus laat zien hoe CLEARFIL MAJESTY™ ES Flow Universal mijn leven eenvoudiger maakt bij posterieure restauratieprocedures.

CASUS

Bij deze patiënt moesten twee amalgaam restauraties in de mandibulaire rechter molaren (tanden # 46 en 47 volgens de internationale tandnummering) worden vervangen (afb. 1). Omdat het vulling mogelijk maakt en garant staat voor een voortreffelijke aanpassing op de caviteitswanden werd besloten CLEARFIL MAJESTY™ ES Flow Universal LOW te gebruiken als enig restauratiemateriaal. De positie van de te restaureren tanden maakte de kleurselectie eenvoudig: De kleur U (Universal) is geschikt voor alle posterieure restauraties.

De amalgaam restauraties werden verwijderd en cariës geëxcaveerd waarbij zoveel mogelijk van de gezonde tandstructuur werd behouden (afb. 2 en 3). Er werd een selectieve techniek voor het etsen van glazuur gekozen, gevolgd door het aanbrengen van een universeel adhesief (CLEARFIL™ Universal Bond Quick 2, Kuraray Noritake Dental Inc.). Vervolgens werden CLEARFIL MAJESTY™ ES Flow Universal in de LOW versie en de geselecteerde kleur U aangebracht in de caviteiten (afb. 4). Het innovatieve design van de spuit zorgt dat de aangebrachte flowable composiet zo goed als gatenvrij is. In lijn met de gebruiksaanwijzingen bij het product was de dikte van iedere laag max. 2 mm om volledige uitharding te garanderen (afb. 5 en 6), een beslissende factor voor de langetermijnprestaties van de definitieve restauraties. Iedere laag moet gedurende 10 tot 20 seconden (afhankelijk van de uithardingslamp) grondig uitharden voordat de volgende laag wordt aangebracht. Zoals getoond in afbeelding 7 maakt de lage vloeibaarheid van het geselecteerde materiaal enige mate van modelleren van de morfologie van het occlusale oppervlak mogelijk. In situaties waarbij meer anatomische details moeten worden hersteld, kan de stevigere SUPER LOW variant een optie zijn. Het tot hoogglans polijsten van de restauraties nam niet meer dan een paar seconden in beslag (afb. 8).

Afb. 1: Twee te vervangen amalgaam restauraties.

Afb. 2: Situatie na verwijderen van de bestaande amalgaam restauraties.

Afb. 3: Voor amalgaam kenmerkende verkleuring is zichtbaar onderaan in de grotere caviteit.

Afb. 4: Vulprocedure: Aanbrengen van de eerste laag f lowable composiet.

Afb. 5: Tweede molar al gevuld, eerste molar heeft nog een laag flowable composiet nodig.

Afb. 6: Vulprocedure voltooid.

Afb. 7: Mooie morfologie van het oppervlak en vermenging van kleuren.

Afb. 8: Resultaat na verwijdering van de cofferdam. De restauraties voegen zich qua kleur en oppervlakglans mooi naar de omringende gebitsstructuur.

EENVOUDIG ALTERNATIEF VOOR PACKABLE COMPOSIETEN

Met name in de lastig te bereiken gebieden in de mond kan het gebruik van een flowable composiet met uitgebalanceerde mechanische eigenschappen een goed alternatief zijn voor packables. Dankzij geavanceerde kleuraanpassing, vrijwel gatenvrij aanbrengen, eenvoudig aanpassen en modelleren en snel polijsten wordt het leven van de tandarts echt een stuk eenvoudiger.

Dentist:

JULIEN MOLIA

Dr. Julien Molia studeerde in 2008 af met een scriptie over computergestuurde implantologie. Hij heeft een algemene tandartspraktijk opgezet in Saint-Jean-de-Luz en richt zich op implantaatbehandelingen en kaakreconstructies. In 2017 behaalde hij een tweede universitaire graad in de implantologie om zijn expertise bij te werken en te verdiepen. Daarnaast heeft hij geavanceerde trainingen gevolgd op het gebied van digitale tandheelkunde, orthodontische minischroeven en mucogingivale chirurgie. Op basis van zijn toewijding aan weefselbehoud volgde hij privétrainingen bij Dr. Gil Tirlet en Dr. JeanPierre Attal in Parijs. Dr. Molia is een van de oprichters van het Franse Southwest BioTeam, een groep waarbinnen professionals toegewijd aan klinisch onderzoek en innovatie samenwerken.

Case by Kostia Vyshamirski, DT

KATANA™ Zirconia YML AND CERABIEN™ MiLai

Virtually every patient in need of restorative treatment desires functional restorations with an aesthetic appearance. However, the individual expectations and needs may be very different depending on the clinical situation (state of the natural tooth structure, parafunctional behaviour, periodontal health etc.), the patient’s financial resources and personal preferences. A versatile material combination fulfilling many different needs and desires is KATANA™ Zirconia YML finished using micro-layering with the new CERABIEN™ MiLai (both Kuraray Noritake Dental Inc.).

This system supports low invasive preparations due to a favourable minimum wall thickness of the merely monolithic multi-layered zirconium oxide prosthesis and a minimal thickness of the porcelain layer in the aesthetic zone. Moreover, the high strength zirconium oxide prosthesis combined with only a very thin layer of porcelains makes this technique extremely useful in patients with parafunctional habits like bruxism. Last but not least, consisting of a carefully compiled selection of internal stains and porcelain shades, CERABIEN™ MiLai supports the creation of individual 3D shade effects that mimic those of natural teeth even when space is limited. The following case example reveals how this is possible.

INITIAL SITUATION

The patient presented with concerns related to both function and appearance. During the diagnostic phase, it was determined that increasing the vertical dimension of occlusion (VDO) and creating a wax-up in the new jaw position would be necessary to improve both the occlusion and the aesthetic appearance of the smile.

Fig. 1. Intraoral scan of the maxillary teeth revealing severe tooth wear.

Fig. 2. Intraoral scan of both jaws confirming the need for an increase of the VDO.

Fig. 3. Intraoral scan: Occlusal view of the maxillary teeth.

TREATMENT PLANNING AND COMPUTER-AIDED DESIGN

Following the approval of the wax-up, the treatment plan was created. It consisted of restoring the four anterior incisors with zirconia crowns and performing direct composite restorations on the posterior and lower teeth. To conserve as much of the healthy tooth structure as possible, the space created was aligned to the required wall thickness of the planned restoration (framework + micro-layer of porcelain in the vestibular areas only). Following an aesthetic analysis, the crowns were designed with a minimal vestibular cutback. This was due to the patient’s functional problems, which would increase the chipping risk in case of using a more heavy cutback design with a thicker, more conventional porcelain layer. KATANA™ Zirconia YML offers exceptional aesthetics, requiring only a 0.3 mm reduction for the porcelain to achieve natural results. Therefore, it was the logical material choice for this specific case.

Fig. 4. Minimally invasive preparations for the crowns.

Fig. 5. Occlusal view of the preparations.

Fig. 6. Aesthetic analysis – a crucial step for achieving the desired new smile.

Fig. 7. Frontal view of the crowns in their final cutback design.

Fig. 8. Lateral view of the crowns in the CAD software.

CROWN PRODUCTION

Immediately after milling, the zirconia surface was treated with effect liquids. This kind of pre-sintered characterization helps enhance the characteristics of zirconia restorations. In the presented case, orange stain was applied to the cervical area, while a blue stain was used at the incisal edge. In addition, a white opaque liquid was applied to the inner surface of the central zirconia crowns to block out any discolouration from the underlying tooth structure. Following final sintering, the vestibular layer of porcelain was built up with CERABIEN™ MiLai using a combination of internal stains and porcelain micro-layering. After morphological adjustments and surface polishing, the restorations were completed by applying CERABIEN™ ZR FC Paste Stain and Glaze. Final polishing was then performed to enhance the natural appearance of the surfaces.

Fig. 9. Effect liquids applied to the cervical and incisal areas of the crowns.

Fig. 10. Treatment of the central incisor crowns’ inner surfaces.

Fig. 11. KATANA™ Zirconia YML framework after sintering.

Fig. 12. CERABIEN™ MiLai Internal Stains and Porcelains.

Fig. 13. Prepared vestibular surfaces ready for application of the internal stains.

Fig. 14. Application of 0.2-0.3 mm layers of CERABIEN™ MiLai porcelain: CCV2 for the cervical area, LT1 – Creamy Enamel for the main body and luster, LTX at the incisal edge.

Fig. 15. Frontal view of the final restorations on the model.

Fig. 16. Lateral view of the final restorations on the model.

Fig. 17. Polished and glazed palatal surfaces of the crowns.

FINAL OUTCOME

The finalized restorations showcase great details, crafted with CERABIEN™ MiLai internal stains and porcelains. The result are natural-looking restorations. An additional benefit of using zirconia as a restorative material is its excellent compatibility, which is evident in the healthy gingival conditions.

Fig. 18. Restorations in place.

Fig. 19. Natural-looking restorations in the patient’s mouth.

Dental Technician:

KOSTIA VYSHAMIRSKI

DT Kostia Vyshamirski, Riga, Latvia

After earning his Dental Technician Certificate from the Medical College in Minsk, Belarus, in 2014, Kostia began his career as a dental technician, focusing on aesthetic clinical cases that integrate the latest digital and manual technologies. Moving to Riga, Latvia, in 2015 greatly expanded his professional opportunities.

With over a decade of experience, Kanstantsin Vyshamirski now conducts courses, lectures, and seminars worldwide. He is a member of the DTG (Dental Technician Guild), a professional group of dental technicians based in the USA, and an invited guest of the AAED (American Academy of Esthetic Dentistry), an exclusive, invitation-only organization.

Operating his own lab in Riga, Latvia, Kanstantsin specializes in aesthetic prosthetic porcelain work and is an experienced, passionate user of KATANA™ Zirconia and Noritake porcelains.

CERABIEN™ MiLai in Daily Use

A tooth with crack lines, a characteristic round shape, age-related changes, or medication-induced discoloration — there’s no one-size-fits-all solution when it comes to all-ceramic anterior restorations, even when the porcelain system and production technique are defined.

To support technicians who wish to simplify their layering workflow using the micro-layering technique and CERABIEN™ MiLai — whether just getting started or looking to refine their process — we’ve collaborated with DT Dumitru Leahu to create a Chroma Map Catalogue featuring seven typical anterior restoration scenarios.

Each case example includes a detailed screenshot of the framework design, chroma maps outlining the planned steps, images of internal staining and micro-layering procedures, and the final restoration on the model. You’ll also find essential information about the selected framework material, target shade, and other relevant details.

We invite you to use the CERABIEN™ MiLai Catalogue as a step-by-step guide to success or simply as inspiration for individual cases. It offers a fast track to understanding the material’s optical properties and will make planning your next micro-layering case more intuitive. No need to start from scratch — instead, adapt what’s already there and gradually develop your own maps and techniques.

Interested in the CERABIEN™ MiLai Chroma Map Catalogue?

Download it here!

Interview with Ghaith Alousi, DT

He inspires dental technicians with his passion and creativity as a course instructor, and with Nature Style, he has developed a well-conceived concept for the creation of lifelike anterior restorations. We are talking about Ghaith Alousi, a dental technician based in Wiesbaden, Germany. While course participants usually attend his training courses eager to learn from his experience and technical knowledge, they often return to their laboratories bursting with positive energy, truly inspired and deeply motivated to break new ground.

Ghaith Alousi, what is the dental technician’s primary mission?

In my eyes, dental technicians are not artists; rather, their primary mission is to replicate nature – both functionally and aesthetically. Every tooth, like every patient, is as unique as a fingerprint. To recreate a natural tooth as accurately as possible, we must listen, observe, and understand. To truly perceive the details that matter, however, we need to know where to focus our attention. In my opinion, the three golden keys to anterior aesthetics are paramount: balanced translucency and opacity, morphology, and surface texture.

What about colour?

While colour is undoubtedly a crucial aspect, I believe it is often overemphasized. Many dental technicians focused on aesthetic anterior restorations find themselves preoccupied solely with colour. However, natural teeth – the model we aim to replicate – embody far more than just a blend of hues.

First and foremost, we must understand how light interacts with teeth. They diffuse light in a unique manner, with different layers of enamel and dentin each possessing distinct optical properties. Additionally, the individual shape and surface texture of a tooth significantly affect the perceived attractiveness of a patient’s smile and overall facial appearance. Therefore, I have learned to prioritize these elements, observing nature closely and striving to comprehend what I see before embarking on the replication process.

Fig. 1. Light-optical properties of natural teeth imitated with KATANA™ Zirconia YML, Esthetic Colorant and CERABIEN™ ZR porcelain (Kuraray Noritake Dental Inc.).

Let’s take a brief look at each of the three golden keys, starting with the light-optical properties.

To truly grasp how light interacts with natural teeth, we must first examine their structure. Natural teeth consist of various layers, each displaying unique light-optical behaviours, with enamel and dentin being the most significant. Upon closely observing the dentin core of a tooth, we realize it is not only responsible for the tooth’s fundamental colour but also exhibits distinct opacity – it does not transmit light; instead, it reflects and absorbs it. In contrast, enamel presents a different scenario: its thickness varies with factors such as the patient’s age, but it is consistently highly translucent. This translucency allows a portion of light to pass through, with only a minimal amount reflected or absorbed.

Once we have a solid understanding of the natural light dynamics inherent in a patient’s teeth, the next step is to replicate these characteristics using selected materials. Thus, comprehending the light-optical properties of available materials, choosing them wisely, and applying them effectively are crucial milestones on the path to success.

What about morphology?

I firmly believe that mastering morphology – the replication of natural tooth shapes – can significantly impact a dental technician’s work. The growing popularity of carving workshops in Japan and other parts of the world reinforces this idea. Aspiring technicians avoid using standard dental libraries that produce generic smiles for their patients. Rather than traveling long distances to attend workshops and build our own mental library of tooth shapes, we can explore the intricacies of form and shape right in our dental laboratories through careful observation and consistent practice. Some technicians capture images of the teeth they encounter, while others concentrate on their own teeth or those of colleagues and patients. This approach allows for the replication of shapes using materials like wax or ceramics. By honing our observation and replication skills, we expand our personal knowledge base. This commitment to detail fosters true mastery – a continuous journey toward perfection.

Fig. 2. Example of a natural surface texture reproduced with CERABIEN™ MiLai and different diamond burs, stones and rubber polishers.

Is surface texture similarly important?

Absolutely. The surface texture of a restoration, even more than its hue, must precisely match that of surrounding or opposing teeth to achieve a natural appearance. To accomplish this, we must understand and replicate the intricate interplay of micro- and macrotextures that create a tooth’s natural look. Macrotexture encompasses the tooth’s overall surface characteristics, including varying concavities, convexities, line angles, and vertical V-shaped grooves. In contrast, microtexture focuses on finer details, such as growth lines (striae of Retzius), perikymata, small grooves, and the degree of surface gloss. A keen eye is essential to replicate every surface detail harmoniously so that light interacts optimally, creating reflections, shadows, and highlights exactly where they are needed.

Fig. 3. Large tooth created with CERABIEN™ ZR.

How do you practice?

To practice replicating surface texture and morphology, I typically start with enlarged model teeth, first using wax and later transitioning to my preferred dental materials and instruments. The increased size of the working base allows for easier detection, reproduction, and assessment of relevant morphology and surface details compared to original-sized tooth forms. This enlargement also facilitates the evaluation of light-optical properties. For the final assessment, I often apply silver or gold powder to the surface of the model tooth, which highlights even the finest surface nuances. This method makes it easy to identify areas that are well-executed and those that may need improvement.

Fig. 4. Gold powder applied to anterior restorations …

Once I achieve a high level of quality with the enlarged model teeth, I transfer the acquired skills to real-life applications by working with actual-sized teeth. This practice framework allows me to continuously enhance my basic skills. Moreover, each time I start working with a new instrument or material, this approach streamlines the initial learning curve, quickly elevating my performance to a high standard.

Fig. 5. … to evaluate their shape and surface texture.

What are your preferred material combinations for different indications / needs?

For cases with highest aesthetic demands, CERABIEN™ ZR (Kuraray Noritake Dental Inc.) is my favourite porcelain system. I This system can be utilized either as a standalone solution for producing veneers using the refractory die technique or in conjunction with a zirconia framework – typically crafted from KATANA™ Zirconia variants such as KATANA™ Zirconia UTML, STML, HTML Plus, or YML (also from Kuraray Noritake Dental Inc.) – in a full layering approach.

I frequently employ this combination to produce single crowns in the anterior region, selecting the framework material based on the colour of the underlying tooth structure and the appearance of adjacent teeth. An alternative approach is layering with CERABIEN™ MiLai, which consists of internal stains and porcelains compatible with zirconia and lithium disilicate. I prefer to combine this system with the previously mentioned zirconia variants or with lithium disilicate, predominantly using the porcelain to replicate enamel. Sometimes, I employ the system’s internal stains to enhance the result with natural colour effects.

Apart from observing closely, selecting appropriate materials and copying carefully, are there any additional factors decisive for great treatment outcomes from the technician’s point of view?

To my mind, there are two additional essential factors: Proper interaction and communication within the restorative team and personal interaction with the patient. Especially in the highest aesthetic demand cases, meeting a patient in person is very important. They are usually invited to visit the dental laboratory twice, prior to treatment planning and for try-in. Nothing can replace personal interaction with them and a genuine impression of the initial situation. After all, we need to give them a sense of security and build trust, while analysing their character, facial characteristics, skin colour and more allows us to produce perfectly matching restorations.

Fig. 6. Full layering approach with CERABIEN™ ZR on a KATANA™ Zirconia YML framework.

And the restorative team?

We share a common goal: to fulfil the desires of our patients. I firmly believe that achieving this requires a united effort from the entire team. Collaboration hinges on appreciative and open communication at all levels and demands absolute honesty. Furthermore, everyone involved must be committed to continuously developing their skills.

I hold high expectations not only for my own work but also for the contributions of each dentist in our team. After all, their work forms the foundation of what I do. For example, when a dentist invests in an intraoral scanner and starts providing digital records, it is my responsibility to verify whether the quality of those scans meets our high standards. If I notice that the quality could be improved, I approach the situation with respect, offering constructive feedback and guidance to help them deliver quality scans consistently. This is crucial, as high-quality scans are the prerequisite for creating outstanding restorations.

In my experience, most dental practitioners appreciate this kind of honest and supportive communication. It creates an environment where we can all grow and evolve together.

Do you have any additional comments?

Be authentic, strive for excellence, and approach each day as an exhilarating opportunity. Courage plays a vital role, too – the readiness to venture beyond your usual routines, such as experimenting with different shades to discover new possibilities, fosters growth. Even if the outcome does not meet your expectations, there is valuable insight to gain from the experience that can guide you in the future. To reach new horizons, be open to exploring uncharted paths.

Dentist:

GHAITH ALOUSI

Ghaith Alousi, born in 1994, successfully completed his training as a master dental technician in 2013 in Damascus, Syria, where he gained initial experience in a dental laboratory. From 2014 to 2016, he worked independently in Damascus, using his craftsmanship to produce ceramic work such as frameworks, veneers, crowns and bridges, and implant-based restorations. He also engaged in shade determination, photography, and CAD/CAM technology.

He came to Germany in 2016 and quickly felt at home. Through further education, he has continuously expanded his knowledge and skills and is currently working as a dental technician in Wiesbaden. To achieve the best possible results, Ghaith Alousi places great value on collaboration with dentists and personal contact with patients.

Seamless, streamlined cooperation between dentist and dental technician is a recipe for success. The KIZUNA Symposium (Japanese for “bond, connection between people”) explores precisely that. Here are five key reasons you shouldn’t miss it:

1  A UNIQUE EXPERIENCE

KIZUNA is more than an event – it is a philosophy of collaboration. It brings together dentists and dental technicians, creating a shared space for dialogue, learning, and inspiration. Different perspectives converge in one direction: effective and harmonious patient care. The symposium features joint sessions at the beginning and end of the day, with separate sessions for dentists and dental technicians in between.

2  EXCELLENT SPEAKERS

Moderated by the inspiring Dr. Agnieszka Pacyk, the symposium brings together 14 leading professionals from across Europe. Expect scientific excellence, state-of-the-art technologies, the power of AI, new approaches, and plenty of practical tips and tricks. Learn from the very best – for example, MDT Nondas Vlachopoulos and MDT Antonio Corradini, who will conclude the day with a two-hour lecture on excellence in dentistry through outstanding cooperation.

3  NEXT-LEVEL NETWORKING

On the evening before the KIZUNA Symposium, a unique social gathering will set the tone for the day ahead. Guests will enjoy an exclusive dinner featuring authentic Japanese cuisine, blending refined flavours with artistry and elegance. This special evening will not only delight your senses, but also create the perfect atmosphere for networking and informal conversations with colleagues, lecturers, and fellow participants from across Europe. To make the night even more memorable, special attractions inspired by Japanese culture will be offered.

4  SUPERB VENUE AND ACCOMMODATION POSSIBILITIES

The ICE Kraków Congress Centre is a modern and prestigious venue that will become the heart of the KIZUNA symposium. Located in the very center of Kraków, will provide an inspiring setting for dialogue, innovation, and the exchange of expertise, blending Japanese precision with European openness. Near the ICE, you’ll find a wide selection of hotels within walking distance, offering both convenience and comfort throughout your stay. These hotels are not only ideally located for the event, but also nestled close to Kraków’s historic landmarks, allowing you to experience the city’s charm.

5 BEAUTIFUL KRAKÓW

Discover Kraków, a UNESCO World Heritage gem. The city is rich in history and charm – from the iconic Wawel Castle to the vibrant Cloth Hall in the Main Market Square. Stroll through historic districts like Kazimierz and Podgórze, relax in the greenery of Planty Park, and uncover hidden treasures throughout the city. Whether tasting traditional pierogi or admiring Gothic architecture, Kraków offers countless unforgettable experiences.

For more information click here.

See you in Kraków!