CLEARFIL MAJESTY ES COMPOSITES

CLINICAL CASES

Clarence P. Tam

Clarence is originally from Toronto, Canada, where she completed her Doctor of Dental Surgery and General Practice Residency at the University of Western Ontario and the University of Toronto, respectively. Clarence’s practice is limited to cosmetic and restorative dentistry and she is well- published to both the local and international dental press, writing articles, reviewing and developing prototype products and techniques in clinical dentistry. She frequently and continually lectures internationally. Clarence is the Chairperson and Director of the New Zealand Academy of Cosmetic Dentistry.

Predictable ultimate esthetics

Kuraray Majesty ES-2 Premium shade guides were used to ascertain the enamel, dentin and effect shades prior to tooth dehydration. A1 Enamel, A1 Dentin, Trans Clear and Trans Amber were selected. It was noted that a value enhancer (i.e. Majesty Esthetic HO) may need to be used to enhance the value of the bleached teeth.

The patient was anaesthetised and the old Class IV restoration removed (Figure 3). The teeth were isolated using a curved serrated metal strip (Komet) to protect the adjacent dentition. Following micro air abrasion using 27 micron aluminium oxide, the enamel was selectively etched and a self- etching bond (Clearfil Universal Bond) applied.

As there was no opportunity to complete a diagnostic wax-up, the lingual shelf was completed freehand, with the help of a Mylar strip. As the Digital Smile Design specified a 0.9mm extension of tooth 11M into the diastema, this dictated the dimension of our lingual shelf. As this area only features enamel, A1 Enamel (A1E) was placed to full contour in this area (Figure 4). The midline was refined and shaped using Sof-Lex discs (3M ESPE) and the final dimension of 11 measured with calipers to ensure perfect mesiodistal symmetry with 21 (Figure

Figure 1. Initial situation.

Figure 2. Pre-operative situation showing lack of symmetry between 11 and 21, a misshapen, visible fracture repair on 21 and the midline diastema that the patient desired closed.
Figure 3. Intraoperative situation showing extent of preparation on 21.
Figure 4. Freehand: Lingual shelf-guided by pre-crimped Mylar strip replicating the DSD-guided width change. A1 Enamel.
Figure 5. Following layering to full contour with A1 Enamel, the width of 11 was measured with Cali-era to ensure perfect symmetry with the proposed 21.
Figure 6. Freehand: Lingual shelf of 21 guided by pre-crimped Mylar strip. Mesial frame completed. A1 Enamel.
Figure 7. First dentin mass layer: A1 Dentin.
Figure 8. Second dentin mass layer: A1 Dentin featuring incisal dentin lobule irregularity and characterisation.
Figure 9. Application of Translucent Clear in a thin worm over the incisal irregularities.
Figure 10. Both Translucent Clear and a thicker layer of Translucent Amber were brushed into position incisally.
The Mylar strip was placed on the lingual axial aspect of 21 and the lingual shelf built to a thickness of 0.3mm, extending facially to the mesiofacial line angle (Figure 6). The join line was addressed next. Two layers of A1 Dentin (A1D) were placed with the second layer extending incisally and featuring dentin lobule irregularity and small connections to the incisal edge (Figures 7-8). Following placement of a thin layer of Translucent Clear within these dentin ngerlings incisally, a thicker worm of Translucent Amber was placed at the incisal edge and brushed into place (Figures 9-10). At this stage, the join line was invisible but we still had space for additional dentin volume, needed to brighten the value of the restoration (Figure 11).
The value was toned up using a thin layer of Majesty Esthetic HO (Hollywood Opaque) before the enamel volume was replaced using A1 Enamel. Primary, secondary and tertiary anatomy were established using a combination of Sof-Lex discs (3M), red-stripe needle-point diamond burs (Mani), Astropol polishers (Ivoclar Vivadent), 45 micron diamond grit and 5 micron diamond grit progressive rubber polishers (Clinician’s Choice) (Figure 12). Finishing and polishing was completed using an Astrobrush (Ivoclar Vivadent) and 1 micron aluminium oxide paste (Enamelize, Cosmedent) in conjunction with Flexibuff discs (Cosmedent) (Figure 13).
Figure 11. Join line assessment: invisible. Value: slightly darker than desired. Solution: add a thin layer of Hollywood Opaque (HO).
Figure 12. Enamel volume layered and with primary anatomy completed, pencil markings denote planned secondary anatomy positions.
Figure 13. Immediate post-operative result.
The final result demonstrates successful placement of a seamless Class IV restoration to a dimension symmetrical to that of the contralateral tooth whilst simultaneously respecting the need to close the diastema; all guided by Digital Smile Design and facial landmarks. Clearfil Universal Bond features a time-tested, 10-MDP monomer with multi-modal functionality for a predictable bond to hydroxyapatite.

The selective etch technique was used as Erhardt et al demonstrated a detrimental effect on shear bond strength of a total etch technique using a self-etching bonding system on a dentin substrate.2 The composite system used (Majesty ES-2) displayed remarkably smooth handling and esthetic properties that were perfectly predictable featuring ultimate esthetics (Figure 14).
Figure 14. Final esthetic integration demonstrating optical properties and outstanding biomimicry by the Majesty ES-2 system.

CLEARFIL™ MAJESTY ES-2 Pro Technique

Stefano Daniele

Figure 1. Before CLEARFIL™ MAJESTY ES-2 Pro Technique.
Step 1: bleaching 21 with 35% hydrogen peroxide
Step 2: Shade match with A1D, A3D and Translucent Gray.
Step 3: Preparation 21 after rubberdam isolation
Step 4: Total-etch procedure

CLEARFIL MAJESTY ES Premium

Dr. Nicola Scotti on CLEARFIL MAJESTY™ ES Flow

ENJOY WORKING WITH A FLOWABLE COMPOSITE

Easy application. Great modeling. Fast finishing.

Dr. Nicola Scotti from the Turin University (Italy) shows us how to make a Class V restoration fast and easy by replacing dentin and enamel. The special syringe makes his flow application easy. Especially when he pulls away the syringe, the composite stays in place. Thanks to the improved consistency he is always in control of the uncured composite.

During modeling, he already gets a feel for his color selection. The color of the flowable composite before and after stay virtually the same. He nicely models the composite into shape to minimize the adjustments after final curing.

He decides not to adjust the restoration anymore. With his one-step polisher, he simply finishes his restoration in seconds.