Case by Dr. Clarence P. Tam, HBSC, DDS, AAACD, FIADFE

Case background

A stable ASA 2 65 year old female presented to the practice for restorative dentistry with a medical history significant for a non-descript immunoglobulin deficiency, for which she receives regular infusions. She reports no known drug allergies. Clinically, she was diagnosed with an occlusal peripheral rim fracture leaving a food trap on tooth 14 (FDI notation). Tooth 15 featured an extensive amalgam with extreme proximity to the distal marginal ridge, which exhibited distal vertical axial fractures as a result of cyclic expansion-contraction over time. The restorative goal of minimally invasive direct dentistry would be complicated by the undoubtedly dark dentin substrate under the amalgam. A material was sought that featured both an excellent chameleon mechanism as well as physical properties to maximize the prognosis of direct restorations in this area.

Restorative procedure

The patient was subjected to topical anesthetic prior to buccal infiltration using 1 carpule of 2% Lignocaine with 1:100,000 epinephrine. A rubber dam was affixed prior to preparation of tooth 15MO with dissection of the distal vertical marginal ridge fracture. The margins of tooth 14O and 15MOD were refined before bevelling as the ends of enamel rods facilitate better bonding relative to the sides of enamel rods. A 27 micron aluminum oxide micro air abrasion treatment was completed prior to affixing, wedge and matrix to reconstruct the mesial marginal ridge of tooth 15. A matrix-in-matrix solution was used to recreate the proximoaxial contour of 15D. This provided hermetic closure at the proximogingival cavosurface margin as well as an ideal contour for the missing axial wall.

Following a total etch technique, a 2% Chlorhexidine scrub was completed for 30 seconds and the dentin blot dried to a moist state. A 5th generation bond was applied, air thinned and cured as per manufacturer instructions. Microlayers are important during the delicate first 5 minutes of hybrid layer formation, and were completed using 0.25 mm increments of CLEARFIL MAJESTY™ Flow (Kuraray Noritake Dental Inc.). This technique can be expected to increase significantly the shear bond strength to dentin^1,2.

This was completed both in the proximal box floor area as well as mid-occlusally. The marginal ridge was completed using CLEARFIL MAJESTY™ ES-2 Universal (Kuraray Noritake Dental Inc.). Since the dentin base was heavily stained, CLEARFIL MAJESTY™ Flow was used before utilizing CLEARFIL MAJESTY™ ES-2 Universal in a lobe-by-lobe creation of occlusal anatomy. Post-operative occlusal checks verify that the restoration is conformative to occlusion and esthetically excellent with no visible marginal show.

Rationale for material choice

The marginal ridges were micro-layered horizontally as was the floor of the resulting Class I preparation as per a reduced layer thickness-technique modification of Nikolaenko et al³, whereas the highest shear bond strengths were found when a 1mm horizontal layering technique was used.

CLEARFIL MAJESTY™ ES-2 Universal is at the forefront of a simplified restorative armamentarium for the modern practice. It takes cloud-shading one step further by offering a “Universal” shaded composite featuring Light Diffusion Technology (LDT) with simultaneous ideal sculptability, optical metamerism and physical properties for use in any restorative situation in the mouth. Featuring barium glass nano fillers and proprietary pre-polymerized nanoparticle fillers, the latter boasts a high refractive matrix that is able to disperse light and fool the eye with even the thinnest of layers, obviating the need for opaquer composites in cases like the one featured. When paired with CLEARFIL MAJESTY™ Flow in a conservative layered technique, the 81% filled flowable produces a radiographically well-demarcated layer, and the superficial CLEARFIL MAJESTY™ ES-2 Universal boasts an easy-to-polish robust single shade restorative solution that will virtually fulfil all of your restorative needs for non-bleaching patients. Physically, with compressive strength is rated at 348 MPa and flexural strength at 116 MPa, CLEARFIL MAJESTY™ ES-2 Universal is in the range of natural enamel and dentin. The built-in fluorescence is very enamelomimetic, which is excellent for nightclub social situations.

FINAL SITUATION

Dentist:

DR CLARENCE P. TAM, HBSC, DDS, AAACD, FIADFE

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 Immediate Past Chairperson of the New Zealand Academy of Cosmetic Dentistry.

She is currently one of two individuals in Australasia to hold Board-Certified Accredited Member Status with the American Academy of Cosmetic Dentistry. Clarence is an Opinion Leader for multinational dental companies Kuraray Noritake, J Morita Corp, Henry Schein NZ, Ivoclar Vivadent, Dentsply Sirona, 3M, Kerr, GC Australasia, SDI and Coltene and is the only Voco Fellow in Australia and New Zealand. She holds Fellowship status with the International Academy for DentoFacial Esthetics and is a passionate and approachable individual, committed to having an interactive approach with patients in all of her cases to maximize predictability.

References

1. Bertschinger C, Paul SJ, Luthy H, Scharer P. Dual application of dentin bonding agents: effect on bond strength. Am J Dent. 1996;9(3):115-119.
2. Magne P, Kim TH, Cassione D, Donovan TE. Immediate dentin sealing improves bond strengths of indirect restorations. J Prosthet Dent. 2005;94(6):511-519.
3. Nikolaenko SA, Lohbauer U, Roggendorf M, Petschelt A, Dasch W, Franenberberger R. Influence of C-Factor and layering technique on microtensile bond strength to dentin. Dental Mater. 2004;20(6):579-585.

Innovativ teknologi bag PANAVIA Veneer LC

I dette Highlights kommer vi ind på de teknologier og de mange fordele ved den nye PANAVIA Veneer LC

Testimonial article by Dr. Troy Schmedding, USA

From PANAVIA™ EX to PANAVIA™ V5, Kuraray Noritake Dental Inc.‘s flagship product line of cements continues to evolve to offer reliable adhesion, enhanced ease of use, and superior esthetics.

Dentistry has certainly evolved in the years since Kuraray Noritake Dental Inc. developed the phosphate monomer MDP. But over the past 4 decades, it has rooted itself in restorative dentistry as the tried-and-true ingredient that clinicians rely on for strong adhesion to tooth structure as well as metals and zirconia. MDP is a key ingredient in the manufacturer’s flagship PANAVIA™ line of cements, which continues to evolve in line with a growing variety of indirect restorative materials from which to choose.

One example of this evolution is PANAVIA™ SA Cement Universal, one of the first true universal self-adhesive resin cements to hit the market. In addition to the original MDP monomer, it incorporates the LCSi monomer, a silane-based carbon chain in a dual-barrel system that forms a chemical bond with glass and ceramic materials.

“PANAVIA™ SA Cement Universal allows you to achieve a strong bond no matter which substrate is being used.”

- Troy Schmedding, DDS –

A STRONG BOND THAT’S SIMPLE TO CREATE

But all chemistry aside, what’s in it for the clinician? As dental educator and author Dr. Troy Schmedding points out, the key benefit of PANAVIA™ SA Cement Universal is eliminating the confusion over how to treat different substrates. This is because the material adheres to virtually every material without the need for a separate primer. “The plus side for the practitioner is that the confusion of ‚how do I condition zirconia‘ or ‚how do I condition glass ceramics‘ is no longer an issue because the paste formulation allows you to achieve a strong bond no matter which substrate is being used - whether it is the MDP monomer allowing strong adhesion to zirconia or the LCSi monomer forming a chemical bond with glass ceramics,” he shared.

DIALING UP THE AESTHETICS

Kuraray Noritake Dental Inc. considers PANAVIA™ V5 the most esthetic cement it has ever created. Available in 5 shades - White, Brown, Universal, Clear, and Opaque – it took researchers over 10 years to develop and features an anime-free catalyst that allows for superior colour stability and improved bond strength to dentin. And like its predecessors, PANAVIA™ V5 offers a simple cementation procedure that is compatible with all indications, from crown-and-bridge and implant abutments to ceramic inlays and laminate veneers.

“Kuraray Noritake Dental Inc. has an incredibly strong reputation in adhesive dentistry, so it should offer clinicians a lot of comfort and flexibility to partner with not only a reputable company, but one that continues to research and evolve their key products,” concluded Dr. Schmedding.

Dentist:

DR. TROY SCHMEDDING, DDS
USA

Article from Dental product shopper, vol. 14 No. 5

Opnå høj applikationskontrol med den nye sprøjte og spids!
Nem dispensering og høj applikationskontrol opnås takket være den specialdesignede sprøjte og applikationsspidsen på PANAVIA Veneer LC. Billedet nedenfor viser dig alle de nye funktioner.

Minimally invasive procedures using highly aesthetic restorations is what patients expect when they seek restorative treatment. With the various types of restorations available today, it is possible to meet these expectations – provided that the right materials are used.

For the placement of veneers, a resin cement must be selected that supports long-lasting aesthetics, is easily applied, offers a working time sufficient for simultaneous cementation of multiple restorations and provides excellent bond strength. The new “PANAVIA™ Veneer LC” is precisely what you need.

What is the workflow you ask? Check out the video to see the full workflow using PANAVIA V5 Primer and CLEARFIL Ceramic Primer Plus.

One of the key features when talking about cements is the ease of removal of excess cement. Our newest cement - PANAVIA™ Veneer LC - offers the ideal paste consistency, a low film thickness and long working time.

But how about excess removal? Do you wonder how do we compare to other similar products?

Check out this video demonstrating an excess removal comparison between PANAVIA Veneer LC and other brands.

PANAVIA™ Veneer LC

Great solution for challenging task

PANAVIA™ family just got bigger! We are introducing the new PANAVIA™ Veneer LC – the specialist cement that offers aesthetics, excellent paste viscosity, easy handling and 200 seconds(!) working time under ambient light (8000 lux.). Coming in four different shades with matching try-in pastes from PANAVIA™ V5 system, it allows users to take into account the individual shade requirements and deliver highly aesthetic outcomes when cementing veneers, inlays and overlays.

Join our free webinar now and be the first to learn all the details about this new and exciting product from Kuraray Noritake Dental Inc..

ABOUT DR JORGE ESPIGARES, DDS, PHD

Dr. Jorge Espigares received his DDS degree at the Faculty of Dentistry, University of Granada in Spain and obtained his PhD degree under the supervision of Prof. Tagami at Tokyo Medical and Dental University in Japan. Specialized in Cariology and Operative Dentistry, Dr. Jorge Espigares has clinical experience in Spain and UK, and has authored and coauthored full-length research publications with his colleagues at TMDU.

PRESENTATION OF A STUDY WITH ILLUSTRATIVE CASES

by Dr. Yohei Sato, DMD, PhD and Dr. Keisuke Ihara, CDT.

INTRODUCTION

In recent years, the application and advancement of digital technology in dentistry has made it possible to accomplish the fabrication of highly accurate prosthetic zirconia appliances that were difficult to mill using the previously available technology. In addition, thanks to advances in adhesive dentistry and the advent of cements that bond strongly to a diverse range of materials, cements have come into wide clinical use that can cope with the many types of materials used for the fabrication of prosthetic appliances.

At our hospital, we select the treatment method most suitable for each case by appropriately specifying various types of prosthetic appliance according to the status of each case. For example, we may specify zirconia prosthetic restorations fabricated by the CAD/CAM system, or silica-based ceramic prostheses, or those made of lithium disilicate glass, as the case dictates.

PANAVIA™ V5 is a resin cement system that bonds strongly to various types of prosthetic appliance, as well as to tooth structure. PANAVIA™ Veneer LC, a new resin cement system developed by Kuraray Noritake Dental Inc., has suitable characteristics for bonding laminate veneers, using two types of primer that can be used in common with PANAVIA™ V5. Here are some clinical examples of its advantages as a resin cement system used for laminate veneers restorations.

INNOVATIV HÆRDNINGSTEKNOLOGI
PANAVIA™ Veneer LC er en lyspolymeriserende cement, der kombinerer flere teknologier for at give dig den højest mulige bindingsstyrke.

FORSEGLING AF ADHÆSIONSFLADEN
Modificeret kontakthærdningsteknologi bruges til at opnå en længere arbejdstid, samtidig med at den høje bindingsstyrke, som PANAVIA™ er kendt for, bevares. PANAVIA™ Veneer LC kombineret med PANAVIA™ V5 Tooth Primer tilfører et vigtigt kemisk element til en lyspolymeriserende cement.

PANAVIA™ V5 Tooth Primer som er en selvætsende primer til tandstruktur (dentin og emalje), forsegler tandoverfladen sikkert, så snart PANAVIA™ Veneer LC kommer i kontakt med den. Denne ”milde” kontakthærdning initierer kun polymeriseringen ved adhæsionsfladen og skaber en øjeblikkelig stærk binding til emalje og dentin, men påvirker ikke cementens afbinding og dermed heller ikke arbejdstiden.

ARBEJDSTID
Under cementeringsprocedurer påvirker flere eksterne faktorer din arbejdstid. Teknologien bag PANAVIA™ Veneer LC tager højde for disse
faktorer. Kontakthærdningsteknologien giver mulighed for øjeblikkelig forsegling af adhæsionsfladen. Grundlaget for høje bindingsstyrker.
Lyspolymeriseringsteknologien giver dig en arbejdstid på 200 sekunder under omgivende lys*, før PANAVIA™ Veneer LC begynder at miste sin
ideelle formbarhed. I løbet af disse 200 sekunder kan du nemt placere og positionere op til flere facader. Den endelige polymerisering finder
sted under belysningen med hærdelampen og gør at cementen hærder fuldstændigt.
*Omgivende lys; ca. 8.000 lux

NYE FYLDSTOFFER
PANAVIA™ Veneer LC’s fremragende håndtering forbedres yderligere af de nyudviklede sfæriske silikafillere (fillerindhold: 66 vægtprocent, 47 volumenprocent). Takket være cementens tiksotrope egenskaber kommer facaderne ikke til at glide eller løsne. PANAVIA™ Veneer LC giver en kontrolleret påføring, den bliver siddende, der hvor den påføres, men flyder godt under placering af facaden/facaderne. Takket være dens konsistens og lave filmtykkelse (≈ 8 μm) giver PANAVIA™ Veneer LC et tyndt, jævnt fordelt cementlag. Dette bidrager til nem placering uden forstyrrelser. Desuden gør anvendelsen af kun små, sfæriske fillere (partikelstørrelse; 0,05 μm - 8 μm) det muligt at opnå meget æstetiske og glatte kantområder og byder på forbedret polerbarhed og glansbestandighed.

SILIKAFILLERE
Nyligt udviklede sfæriske silikafillere i cementen sørger for, at den bliver siddende, hvor den påføres, men flyder godt under placering af facaden. Giver mulighed for nem placering, uden at facaden glider eller løsner. Ved applicering på facadens indre overflade klæber resincementen ikke til påføringsspidsen, en egenskab, der opnås ved tilsætning af sfæriske nanoklynge-fyldstoffer.

Disse nye fillertyper resulterer
i fremragende glatheds,
glansbevaring samt nem
håndtering.

VISKOSITET OG TIKSOTROPI
Viskositeten på en cement er vigtig og skal være tilstrækkelig lav for at forhindre protesen i at sprække under placeringen. Samtidig må
den ikke være så flydende, at den løber af under applicering og placering af restaureringen.
Da PANAVIA™ Veneer LC indeholder en optimeret fyldstof/resinblanding, kan dens viskositet ændres under tryk. Fænomenet kaldes
tiksotropi. Cementen bliver mere flydende under tryk under placeringen og positioneringen af facaden. Når trykket falder, øges
viskositeten igen. På grund af den tiksotrope egenskab ved PANAVIA™ Veneer LC, er cementen nem at dosere, og det kræver kun let
tryk at placere restaureringen, og det overskydende materiale er let at fjerne. Kort sagt: maksimal kontrol.

Materialer med samme viskositet har ikke nødvendigvis samme tiksotropi. Temperatur og tryk påvirker viskositeten. Graden og
hastigheden, hvormed et materiale vender tilbage til sin oprindelige viskositet, når trykket reduceres, afhænger af materialets tiksotropi.

Some companies mainly make use of basic technologies developed by others to improve their products and introduce new ones, while other companies conduct fundamental research and basic technology development inhouse. Is this difference relevant for someone who uses the resulting products in the dental practice or laboratory on a daily basis? It is – as companies developing everything from scratch usually have a deeper understanding of the products and their production procedures, which makes it easier for them to modify specific features, solve existing problems and respond to market needs. This article describes the impact of two basic technologies developed by Kuraray Noritake Dental Inc. on the production of zirconia-based indirect restorations.

All-ceramic evolution

A milled monolithic or only minimally reduced core made of high-strength ceramics plus a micro-layer of porcelain: this is today’s success formula for the production highly aesthetic indirect restorations. The approach is by far less complex and time-consuming than traditional production and layering procedures, while its outcomes can be quite impressive. Concerning aesthetics and function, however, it is essential that the right types of material are selected and combined.

The core: Multi-Layered Zirconia Technology

When the first opaque zirconia framework materials conquered the dental market, leading manufacturers never grew tired of stressing that not all zirconia is alike. Instead, huge quality differences do exist depending on the raw materials selected as well as the processing techniques and equipment used for blank production. With an increasing aesthetic potential of the core materials and a decreasing thickness of the veneering porcelain on top, this fact becomes more relevant than ever.

When Kuraray Noritake Dental Inc. identified the need for more aesthetic zirconia core materials with a higher translucency and a tooth-like colour structure, it decided to develop a completely new type of dental zirconia. It started establishing a sophisticated raw material production, blank pressing and pre-sintering process inhouse. This was the basis for the development of the dental industry’s first polychromatic blank with a seamless colour structure and precise shade match with tabs of the VITA™ classical shade guide. In order to identify the best ingredients and procedures, the R&D team experimented with different raw materials, formulations and grain sizes, developed ways to optimize the purity of the ingredients and focused on perfectioning the homogeneity and density of the blanks and – of course – the integrity of the different layers. Currently, three different products based on this original Multi-Layered Zirconia Technology are available for dental laboratories: KATANA™ Zirconia UTML, KATANA™ Zirconia STML and KATANA™ Zirconia HTML PLUS. They offer different levels of translucency and flexural strength.

KATANA™ Zirconia Multi-Layered disc with four-layer colour structure.

Three different products with four-layer colour structure, differing in terms of translucency and flexural strength.

In June of 2021, Kuraray Noritake Dental Inc. introduced a new, next level Multi-Layered Zirconia disc – KATANA™ Zirconia YML. This time, the company responded to the marked need for a universal zirconia with a high aesthetic potential. The blanks offer colour, translucency and flexural strength gradation – with the highest translucency in the enamel and the highest flexural strength in the lowest body layer.

KATANA™ Zirconia YML: Multi-Layered Zirconia disc with colour, translucency and flexural strength gradation.

All Multi-Layered Zirconia discs and technology incorporated in them support the production of lifelike restorations with reduced hand work. No matter whether the user prefers to work with materials offering a uniform strength and selects them depending on the indication or with the universal solution: the finishing effort is reduced considerably due to the optimized translucency and natural colour gradation of the core materials. At the same time, the quality of the produced restorations is high thanks to regular margins, smooth surfaces and a precise fit (as a result of the homogeneous, high-density structure with low porosity and a high level of purity).

Extremely regular margins of a KATANA™ Zirconia crown after milling, which is also a result of the favourable material structure.

The micro-layer: Synthetic Feldspathic Porcelain Technology

Differences are not only found in zirconia, but also in the performance of veneering porcelains. They typically consist of feldspathic porcelain, and most of them are based on natural feldspar. Depending on where this feldspar is mined, it may have slightly different properties. That is why manufacturers of this natural feldspar-based veneering porcelains need to adjust their formulations from time to time, and handling and aesthetic properties might be somewhat different with every new system purchased. In the 1980s, these variations in the composition of natural feldspar led to unpredictable material properties causing difficulties in reproducing the natural tooth colour and even porcelain fractures and cracks appearing after firing of porcelain-fused-to-metal (PFM) restorations. A limited colour stability was also an issue.

For Noritake, one of the parent companies of Kuraray Noritake Dental Inc., these issues were reason enough to start developing a different kind of porcelain. After analysing the issues and weighing the possibilities, a completely new Synthetic Feldspathic Porcelain Technology was developed. It provides for stable coefficients of thermal expansion, particle distribution and colour, as it is no longer dependent on natural sources of feldspar.

Originally, this technology was used in Super Porcelain AAA (EX-3) introduced in 1987, a veneering porcelain for metal frameworks. However, the technology also formed the basis for the development of CERABIEN™ ZR Porcelain and CERABIEN™ ZR FC Paste Stain for porcelain layering on zirconia. This line-up of internal stains and porcelains was specifically developed for micro-layering on zirconia.

All products have one thing in common: as they are based on synthetic feldspathic porcelain, they offer consistent mechanical and handling properties and predictable shade effects. The material structure and particle distribution resemble those of natural teeth, supporting lifelike outcomes. A reduced effort is achieved with the liquid ceramic system CERABIEN™ ZR FC Paste Stain used on a monolithic restoration or one with a minimal cut-back (0.1 mm).

Different micro-layering approaches with CERABIEN™ ZR FC Paste Stain…

…and CERABIEN™ ZR Internal Stain plus Luster Porcelain leading to highly aesthetic outcomes.

Connecting elements: Touch-Cure and Monomer Technology

When needing to cement the finished prosthetic restorations on implant abutments or frameworks, it is essential to select a cementation system that is able to fulfil high aesthetic and functional demands. The PANAVIA™ family of resin cements from Kuraray Noritake Dental Inc. contains many different technologies that provide for a high bond strength to various substrates and a tight marginal seal. The key technology incorporated in any cement is the Original MDP Monomer invented by Kuraray in 1981. It is capable of establishing a particularly strong and long-lasting bond to enamel, dentin, metal and zirconia. The self-adhesive resin cement PANAVIA™ SA Cement Universal also contains the LCSi Monomer, a Long Carbon-chain Silane coupling agent. This monomer forms a strong chemical bond with resin composite, porcelain and silica-type ceramics (like lithium disilicate), so that the need for a separate silane component (a primer or adhesive) is eliminated when bonding these types of prosthetic restorations. PANAVIA™ V5, the strongest cement in PANAVIA™ line, is equipped with Touch-Cure Technology. It seals the interface between the tooth and the restoration to prevent micro-leakage, provides for a high polymerisation ratio even when dark-curing and hence delivers a strong bond in virtually every situation.

Conclusion

KATANA™ and CERABIEN™ are excellent partners that allow for a simplified approach to lifelike restorations. The high level of quality and reliable performance offered by the solutions are due to proprietary technologies and streamlined inhouse production procedures that really make a difference. And whenever needing to cement prosthetic restorations on implant abutments or frameworks, PANAVIA™ resin cement systems based on proprietary monomer and curing technology are a perfect choice.