429 Too Many Requests

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

How did you identify the need for a universal flowable restorative?

Packable composites with a universal shade concept are becoming increasingly popular worldwide. This fact made us assume that there is a demand for the flowable type as well. Users will also benefit from simplified procedures and a reduced number of shades to be stocked, with a positive impact on inventory management. Accordingly, we introduced the universal flowable composite in Japan, where it already holds a significant market share. Users have been utilizing it for various cases with excellent feedback. As it turned out to be very well received in Japan, we approached the European team to extend the release area to Europe, and the decision was made to launch it. We pushed forward with commercialization in an ultra-short period of about one year.

Does it really create added value to use a universal flowable composite in addition to the universal packable variant?

Yes, several benefits arise from the additional use of a modern flowable composite. This is because – unlike earlier products – the latest generation of flowable composites offers sufficient mechanical strength to be used for regular restorations. The advantages of using a flowable composite include the ability to flow into even the narrowest parts of a (sometimes complex) cavity, which provides for easy and quick filling procedures, and to an intimate adaptation at the adhesive interface leading to a tight seal.

What are the differences between CLEARFIL MAJESTY™ ES Flow and CLEARFIL MAJESTY™ ES Flow Universal?

CLEARFIL MAJESTY™ ES Flow Universal maintains the distinctive features of CLEARFIL MAJESTY™ ES Flow, such as convenient dispensing, handling and sculpting, extremely easy and quick polishing, long-lasting gloss and great mechanical properties. Due to their high strength, both products can be used not only as liners, but also for regular direct restoration procedures. The difference lies in the shade concept. CLEARFIL MAJESTY™ ES Flow Universal introduces a universal shade system, allowing it to adapt to a wide range of colour tones with fewer shade variations.

Please describe the shade concept behind CLEARFIL MAJESTY™ ES Flow Universal. How many shades are available and how are they selected?

The CLEARFIL MAJESTY™ ES Flow Universal line-up consists of two shades: Universal (U) and Universal Dark (UD). U is an excellent choice for all posterior restorations, independent of the target shade. In the anterior region and cervical area (Class III, IV and V cavities), U is best suited for restoring teeth of the shades A1 to A3 (including B1, B2, C1, C2, D2, D2, D3 and D4), while UD is the shade of choice to match the target shades A3.5 to A4 (including B3, B4, C3 and C4).

Color matching with anterior and posterior restorations.

Why do you offer an additional shade for the anterior region?

Universal-shade composites need to take on the colour of the surrounding tooth structure to deliver a perfect match for a great number of target shades. In the posterior area, large amounts of surrounding tooth structure are usually available with several cavity walls still present. This facilitates the taking on of the tooth colour compared to cavities in the anterior region. Here, light easily passes through, so that the colour of the composite itself is more likely to be reflected. This can lead to limitations in colour matching. In the case of CLEARFIL MAJESTY™ ES Flow Universal, the U shade that turned to be ideal for the posterior area showed some colour-matching limitations in anterior restorations of darker teeth. Hence, we decided to offer a second colour option specifically designed for these situations. With U and UD, CLEARFIL MAJESTY™ ES Flow Universal offers great colour adaptability from light to dark shades and hence addresses the need for precise colour matching especially in the anterior region.

Developing just two shades of composite to cover so many target tooth shades sounds challenging. How did you evaluate whether the available shades are appropriate in the clinical environment?

Indeed, it has been quite challenging to develop the U shade, which is able to match a wider range of tooth colours for both anterior and posterior teeth than the U shade of CLEARFIL MAJESTY™ ES-2 Universal. In order to evaluate and fine-tune the shades we developed, we repeatedly conducted filling tests using a wide range of experimental shades in artificial teeth and extracted teeth of various tooth colours. Additionally, the final selection of shades was visually evaluated by consulting dental practitioners who used the composite in the clinical setting.

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.

CLEARFIL MAJESTY™ ES Flow Universal is available in two viscosities – Low and Super Low. Why is this the case and what is the difference in use?

We decided to offer two types of flowability with different thixotropic properties to cater to users’ preferences in terms of handling. Basically, there is no difference in usage between Low and Super Low. However, users are encouraged to use composites with different thixotropic properties according to their preferences and the specific case. For example, Super Low is useful for shaping the occlusal surface of posterior teeth. Low can be widely used for applications such as lining and filling in the cervical area and on proximal surfaces.

CLEARFIL MAJESTY™ ES Flow Universal – Great mechanical properties.

What are the technologies behind CLEARFIL MAJESTY™ ES Flow Universal that provide for a great blend-in?

The probably most popular technology used in this product is our proprietary Light Diffusion Technology. We determined the optimal light diffusion based on the observation that a strong diffuse reflection of incident light results in whitening, and weak light diffusion makes it easier to take on dark colours in the oral cavity, darkening the filling site. In addition, we focused on chroma adjustment: The universal shade concept is based on the ability to take on the colour of the surrounding tooth structure and blend with it. Therefore, we have set the chroma to be easily harmonized with a wide range of tooth shades. Finally, the translucency of the material was adjusted via its submicron fillers and silica clusters. Evaluation by key opinion leaders supported us in determining an appropriate level of translucency.

How to proceed in cases with discoloured tooth structure underneath – is there a need for masking with a blocker or opaquer?

The necessity depends on the degree of discolouration. Due to the light diffusion properties of CLEARFIL MAJESTY™ ES Flow Universal, it is generally believed that blocking is not required, and shading can be achieved. However, in cases of severe discolouration, it may be beneficial to fill the bottom of the cavity with A2D or A3D shades of CLEARFIL MAJESTY™ ES Flow, or to use CLEARFIL™ ST Opaquer.

What did you do to avoid void formation during application?

We have adopted the same packaging design used in CLEARFIL MAJESTY™ ES Flow to avoid void formation in this product as well. The innovative container design minimizes the gap between the needle tip and the syringe when the tip is attached.

Are there any recommendations of when to use CLEARFIL MAJESTY™ ES Flow and when to opt for CLEARFIL MAJESTY™ ES Flow Universal?

While the universal variant can be used for general lining and filling applications as described in the instruction for use, CLEARFIL MAJESTY™ ES Flow is recommended for those cases in which the tooth structure is covered and the colour of the entire tooth needs to be changed. Direct veneers are a perfect example. In those situations, the use of different shades and opacities is clearly beneficial.

What is the future of flowable composites?

As information on clinical performance and physical properties data continues to spread, the trust in flowable composites is expected to increase in Europe, leading to its expanded usage. Furthermore, an increased demand is anticipated due to the development of filling methods using flowable composites in conjunction with moulds or matrices.

TAKEHIRO KAMEYA