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Interview with Dr. Enzo Attanasio

TIME-SAVING DIRECT RESTORATION TECHNIQUES FOR EVERY DENTAL PRACTITIONER

Passionate dental practitioner, renowned speaker and inventor of the BEST.FIT technique: Dr. Enzo Attanasio has a lot of valuable insights to share with his audience. At this year’s International Dental Show in Cologne, he lectured on three different topics at Kuraray Noritake Dental Inc’s booth, including “Flow Injection Technique” and “BEST.FIT: A Hybrid Technique for Efficient and Aesthetic Restoration of Anterior Teeth”. We seized the opportunity to talk to him about the most important facts, tips and tricks he presented.

Dr. Attanasio, would you please summarize the key messages of the two lectures just mentioned, starting with “Flow Injection Technique”?

If there is a revolutionary technique that combines the benefits of prosthetic and restorative dentistry, it is certainly the flowable injection technique, also referred to as injection moulding. Nowadays, we have exceptional flowable composites at our disposal, which are absolutely on par with the packable ones in terms of mechanical and optical properties. Unfortunately, however, many dental practitioners are not yet aware of these products. In my lecture titled “Flow Injection Technique”, I wanted to highlight the potential of these materials and the technique. In addition, my aim was to provide a precise recipe that enables the audience to reproduce it in their dental office as early as next week. My presentation covered the whole workflow, from case selection to the production of the wax up and the silicone index, up to the injection of the flowable composite itself.

What about “BEST.FIT: A Hybrid Technique for Efficient and Aesthetic Restoration of Anterior Teeth”?

In the lecture focusing on flowable injection, we explored the limits and strengths of this technique. BEST.FIT is an evolution of this technique that seeks to overcome the limits of both, flowable injection and standard anterior direct restoration techniques. At the same time, it leverages the strengths of those techniques, with the ultimate aim of putting the clinician in a position to face an anterior restoration without major stress.

Let us focus on the flowable injection technique first. When and why do you opt for this technique?

Flowable injection has the same fields of application as other direct and indirect restoration techniques. It is very well suited for young patients desiring veneer treatment, for example. In the era of social media, with images of influencers that underwent aesthetic dental treatment being omnipresent, our children grow up with high aesthetic expectations. When they present in our dental offices and ask for a smile makeover, they are often too young to be treated ceramic veneers. Those with a clear need for aesthetic treatment are ideal candidates for a smile makeover with the flowable injection technique: This technique is micro-invasive, produces restorations that are easily modified or repaired at any time, and allow for treatment with ceramics at a later date. Other target groups include individuals who cannot afford highly expensive treatments with ceramics, but go in for high quality and aesthetics, and those with a severely worn dentition. For the latter group, we can use the technique to produce medium to long-term mock ups that increase the vertical dimension of occlusion. Moreover, direct restorations produced using this technique may be combined with ceramic restorations in this target group to reduce the cost of the therapy. Hence, the technique is versatile and it is very important that a clinician is able to make use of it.

What is the difference between this technique and the BEST.FIT technique you developed?

The flowable injection technique uses a digital or conventional wax-up to produce a transparent silicone index that serves as a shell for the injection of flowable composite. Once injected, the composite is cured through the index. In this way, the desired anatomical shape is obtained with minimal effort. However, the technique allows for single-shade restorations only. The BEST.FIT Technique is a hybrid technique I developed to address this limitation and leverage the advantages of both, flowable injection and classical direct anterior restoration techniques. It involves the creation of the dentin core by hand, followed by the injection of the layer imitating the enamel through a transparent index. This is particularly beneficial in the context of treating young people, where I feel the need to incorporate incisal translucencies into my anterior restorations. An article describing the technique was published in 2024¹.

When do you prefer this technique over the flowable injection technique?

Every time I need to incorporate different levels of translucency into my restorations, the BEST.FIT technique is my first choice. This is especially important when it is not planned to restore “the social six”, but to treat single teeth in the maxillary anterior region. In this case, I have to replicate the adjacent natural teeth with their natural internal anatomy. Whenever those teeth have a complex internal colour structure, a single-shade technique would not lead to the desired result, because playing with different opacities is essential. This is what the BEST.FIT technique allows me to do in an efficient way.

No matter whether you opt for the flowable injection or the BEST.FIT technique, proper isolation of the working field is an important prerequisite for long-term success. What are your tips in this context?

As shown in one of my lectures, it is possible to use rubber dam in some cases. However, any dental practitioner opting for rubber dam should keep in mind that when placing the dam, there will always be a band of tooth near the gum, which will remain covered by the dam. This is fine as long as we do not have to cover discolouration in the cervical area. In this case, we can ask the dental technician to start waxing up a millimetre away from the gingival margin. Staying supragingivally means that the transparent silicone index may be trimmed in that area as well and the rubber dam will stay in place during its placement. This significantly reduces the risk of contaminating the bonding surface with saliva. Another factor to be considered carefully is the positioning of the clamps. Ideally, the silicone index is shaped in a way that the clamp does not interfere with its insertion. For protection of the adjacent teeth, PTFE tape has proven its worth.

How important is bonding for both techniques and what are the key success factors in this context?

Bonding is a fundamental part of every modern restorative treatment. To provide for optimal bonding conditions in the context of restoring teeth using the flowable injection or BEST.FIT technique, we should always try to use rubber dam. If this is not possible, we need to be very careful to keep the working field dry and clean until the injection is completed. This means that any contamination with blood and saliva must be avoided. Especially during the injection step, this is only feasible when the surrounding soft tissues are perfectly healthy. The selection of a high-quality bonding agent and the following of the recommended protocols are also important factors for the establishing of a strong, long-lasting bond on the clean and dry surface. In my daily practice, I started using a universal adhesive in combination with selective etching of the enamel approximately ten years ago. Ever since the introduction of CLEARFIL™ Universal Bond Quick (Kuraray Noritake Dental Inc.), this product is my universal adhesive of choice for direct and indirect restoration procedures. When I graduated 20 years ago, I started with classical three-step adhesive systems used in the etch-&-rinse technique. I would never go back, as CLEARFIL™ Universal Bond Quick provides reliable bonding with virtually no postoperative sensitivity.

Fig. 1: Prepared teeth and isolated working field prior to treatment using the BEST.FIT technique.

Fig. 2: Palatal silicone index produced over the wax-up model with silicone putty material to allow for the build-up of the palatal wall and the layering of the dentin core by hand.

Fig. 3: Transparent silicone key for the injection step, produced over the wax-up model using an impression tray. The injection holes are ideally integrated with the cannula of the flowable composite syringe starting inside the index.

What about silicone index preparation for the flowable injection and BEST.FIT technique?

Usually, a silicone index used for mock-up creation in the patient’s mouth is made of vinyl polysiloxane putty material that is modelled by hand. Transparent silicone materials used to produce a silicone index for the flowable injection and BEST.FIT technique have a lower viscosity. Hence, an impression tray is needed to record the details of the wax-up. In this context, it is important to select a tray of the right size, fill it well with silicone material and place it carefully over the wax-up. After all, we need a high accuracy and dimensional trueness of the silicone index as well as a sufficient wall thickness that gives it the required rigidity and avoids distortions during injection moulding.

What composite materials do you combine when using the BEST.FIT technique and use for flowable injection?

When modelling the dentinal structures by hand, you may use your favourite packable composite. After all, the procedure is the same as any classical anterior restoration procedure. All the materials I usually use for the classical steps of direct anterior restoration production are perfectly suitable for all steps prior to the build-up of the vestibular layer. When employing the BEST.FIT technique, it is essential to leave 0.5 mm of space buccally for the subsequent injection step. When opting for the flowable injection technique, the injection will follow immediately after application of the adhesive. In both cases, it is possible to inject any kind of flowable composite. These materials are typically transparent enough to reveal all the details of the dentin core found underneath – like the incisal effects created with the BEST.FIT technique.

Let us focus on the BEST.FIT technique. Do you have any recommendations regarding the modelling of the dentin core?

If you have to copy a contralateral tooth, use a polarized filter on your camera to eliminate all the reflections on the enamel. This will allow you to see through the enamel and analyse the anatomical form of the natural dentin structure. If you cannot copy and are inventing an internal colour structure, my advice is to consider the age of the patient you are treating. Distinct mamelons are characteristic of younger patients. Every age has its anatomical internal characteristics that must be followed to obtain lifelike results in the end.

Fig. 4: Distinct mamelons created by hand to restore the smile of a young patient.

How do you make sure that the space available is ideal for the buccal enamel layer?

It is fundamental to always use a silicone key that is cut vertically to measure the space left buccally or the enamel layer. This layer must not be too thick or too thin – as I mentioned, 0.5 mm seem to be ideal. Too much enamel placed buccally over the dentin framework will make the entire restoration appear low in value. It will look grey and not blend well with the surrounding tooth structure. On the other hand, an enamel surface that is too thin will too strongly expose the opaque colour of the dentin, resulting in the opposite effect.

How to avoid air bubbles during injection?

First of all, it is very important to choose a flowable composite well filled into the syringe during the industrial process. CLEARFIL MAJESTY™ ES Flow (Super Low and Low, Kuraray Noritake Dental Inc.) are completely free of bubbles inside the syringe. In addition, the injection technique is really important. It is essential to bring the needle tip to the cervical margin. Positioned there, we can start injecting the composite. When the tip is completely surrounded by composite, we can start to move the syringe slowly back towards the incisal area and the insertion hole without releasing the pressure on the plunger, making sure that the tip always remains immersed in the flowable composite. It is very important to keep a controlled and constant pressure to have a good result.

What are your recommendations for successful finishing of restorations created using the flowable injection or BEST.FIT technique?

As with every composite restoration, it is very important to finish and polish the surface thoroughly as the long-term performance of our restoration is strictly linked to the final surface quality. Ideally, the final photopolymerization is performed under a layer of glycerin gel. With regards to the following finishing steps, there is one substantial difference between the described techniques and free-hand layering: Both moulding techniques allow us to reproduce the surface texture created by the dental technician on the wax-up in a very precise way. With a high-quality index and correct injection, it is possible to skip the surface texturing step during finishing completely. We just have to remove the peripheral excess and polish with rubbers, discs and filters. Fortunately, flowable composites like CLEARFIL MAJESTY™ ES Flow are very easy to polish, while their gloss retention is great.

Fig. 5: High-gloss surfaces of restorations created with CLEARFIL MAJESTY™ ES Flow.

How do the described restorative techniques fit into your daily procedures?

Every time I need to restore or modify the aesthetic appearance of my patients’ teeth, I start with the defining of a target. If the desired outcome is achievable with composite instead of ceramics, and whenever a micro-invasive approach is needed, I opt for one of the two techniques. They are good enough to solve a lot of restorative cases in a great way; and they allow me to save a lot of chair time. Consider that all finishing steps dedicated to the texture of an anterior restoration is no longer necessary. A concrete example: I would expect a treatment involving free-hand modelling of restorations from canine to canine to take three to four hours, while the flowable injection technique might enable me to accomplish the task within one and a half hours!

Is it difficult to implement those techniques in a general dental practice?

Absolutely not! The learning curve for those techniques is quite short. Of course, it is essential to understand the materials and follow the correct protocols to apply them effectively. However, when compared to techniques like the direct layering of composite veneers, these approaches are significantly simpler and better accessible to every clinician. It all starts with a correct diagnosis, and a good project together with the technician, whose work is as important as the clinician’s for the success of the project. The wax-up and the silicone index are fundamental. My suggestion is also to learn the fundamentals of digital smile design when starting to use the flowable injection and BEST.FIT techniques. Digital smile design allows for streamlined communication between practice and laboratory, but also with the patient.

What is your final remark?

Knowledge, protocols, and materials are the keys to perfect results. If even one is missing, failure is just around the corner.

Reference

1. Attanasio E. BEST.FIT: A hybrid technique for efficient and aesthetic restoration of anterior teeth. Cosmetic Dentistry 2024:1, 38 – 41.

Dentist:

DR. ENZO ATTANASIO

Enzo Attanasio graduated in 2008 with a degree in Dentistry and Dental Prosthetics from the Magna Graecia University of Catanzaro. In 2009, he specialized in the use of lasers and new technologies in the treatment of oral and perioral tissues at the University of Florence. That same year, he also attended Prof. Arnaldo Castellucci’s course in Clinical Endodontics at the Teaching Center of Microendodontics in Florence, where he later completed his training in Surgical Microendodontics in 2012. In 2017, he took a course on direct and indirect adhesive restorations at Prof. Riccardo Becciani’s Think Adhesive training center in Florence, where he later became a tutor. Today, Dr. Attanasio, a member of the Italian AIC and based in Lamezia Terme, Italy, has a special interest in Endodontics and Aesthetic Conservative Dentistry.

Article by Dr. Aleksandra Łyżwińska, Dental Hygienist Radosław Michalak, Warsaw, Poland.

Good polishing discs are essential tools for restorative dentists. Investing in high-quality polishing systems really pays off if you use them correctly. In my practice, a single set of TWIST™ DIA for Composite discs can last through polishing 60-80 restorations.

Here are some seven simple tips to help you get the most out of your polishing discs and keep them in top shape:

1. Stick to the recommended speed: 3000–8000 RPM for TWIST™ DIA for Composite discs.

2. Always follow the rotation direction—keep it going forward, in line with the shape of the polisher.

3. Use a properly functioning micromotor—a broken rotor causes vibrations and uneven movement and will wreck the disc. (Photo 1)

Photo 1: A broken rotor in a low-speed handpiece causes non-axial movement of the polishing disc.

4. Polish without pressing too hard—more pressure does not mean better results; overheating can make the composite dull. (Photo 2)

Photo 2: Polish gently without applying too much pressure. More pressure doesn’t mean better results.

5. Be patient and polish with gradation—spend at least 30 seconds polishing each restoration with one disc. (Photo 3)

Photo 3: Spend at least 30 seconds polishing each tooth with a single disc.

6. Do not soak the discs too long—use a timer during disinfection, and follow the manufacturer’s instructions for rotary instrument disinfectants. (Photo 4)

Photo 4: Do not soak the polishers for too long. Use a timer during disinfection and follow the manufacturer’s recommendations for rotary instrument disinfectants.

7. Avoid deformation—sterilize the discs in loose packs and do not crush them with heavier instruments in the autoclave. (Photo 5)

Photo 5: Avoid deformation—sterilize the discs in loose packs and do not crush them with heavier instruments in the autoclave.

The idea for these tips came up after I started working at a new clinic. On my second shift, my favorite TWIST™ DIA for Composite discs literally fell apart in my hands. The blue sun-shaped working part of a rubber, completely detached from the metal spindle. What went wrong?

My longtime assistant from another practice, Radosław Michalak, and I played detective. In our previous practice, Radosław personally oversees the disinfection and sterilization process. Properly maintained discs are used dozens of times before the working part starts showing the metal underneath. (Photo 6)

Photo 6: Changes in the appearance of the TWIST™ DIA for Composite from brand new to after 80 uses.

This led us to ask: What caused the discs to fail after just one shift at the new clinic?

My process in both practices was the same:

• polishing with a functioning micromotor (rotor checked),
• speed of 6000 RPM,
• rotation direction forward, in line with the shape of thedisc,
• polishing without pressure of disc against the tooth,
• long polishing time, min. 30 seconds per tooth with each disc,
• polishing with gradation (3 different discs + ultra-fine nylon brush).

Through deduction, we concluded that the only difference in handling the discs between the former and present practices might have occurred during the disinfection and sterilization processes. This turned out to be spot-on!

In our clinic routine, we are using a disinfection solution for rotary instruments which is based on a combination of quaternary ammonium compounds at 2% concentration. The manufacturer prescribes an exposure time of five minutes. In the new practice, however, the assistants overlooked the recommended disinfection time for rotary instrument solutions. My discs were “immersed” after the first procedure around 11:30 AM and removed from the solution around 9:00 PM. Such prolonged soaking caused the disintegration of the working part of the disc, which later detached from the metal spindle.

It is also worth noting that not all disinfectants are suitable for cleaning silicone polishing discs. Besides the disinfectant’s composition and exposure time, temperature is crucial. The instructions for TWIST™ DIA for Composite discs specify not exceeding 42^oC. The most common overheating occurs during disinfection in an ultrasonic cleaner. After disinfection, discs should be rinsed thoroughly under running water and dried completely.

A second potential issue is deformation of the discs during autoclave sterilization. To avoid this, it is useful to place discs in wide packs where they will not bend. Packs should be loosely placed in the autoclave. If the pack is compressed with heavier instruments, the discs may also bend. Such deformation permanently damages the disc, drastically reducing its lifespan. The photos clearly show localized flattening during sterilization and subsequent excessive, uneven wear during use. (Photo 7)

Photo 7: The moment of deformation and uneven wear of the disc as a result.

Radosław Michalak, in addition to being an invaluable dental assistant and hygienist, a meticulous detective, is also a photography enthusiast. Almost all photos in this article were taken by him.

For more information on effective and safe polishing, refer to one of my previous articles on www.kuraraynoritake.eu. In one of them, I demonstrate how to polish the intricate morphology of posterior composite restorations. The article also highlights other clinical aspects of polishing, such as finishing the smallest fissures, avoiding overheating of the composite (which leads to loss of gloss), and preventing white lines at the transition between the composite and the tooth. Feel free to check it out!

Dentist:

ALEKSANDRA ŁYŻWIŃSKA DMD

Aleksandra Łyżwińska graduated from the Medical University of Warsaw, where she later served as a lecturer and assistant in the Department of Conservative Dentistry with Endodontics. In her daily practice, she focuses on the broad field of adhesive dentistry. She is passionate about minimally invasive techniques and vital pulp therapy. Since 2020, she has been conducting courses in conservative dentistry, collaborating with major training centers in Poland and around the world. She is a key opinion leader for Kuraray Noritake. In her training sessions, she demonstrates that dental caries management doesn‘t have to be boring, and that the bond in the bottle is just as exciting as a spy movie. Instagram users know her as the creator of the educational profile for dentist @aleksandra.lyzwinska.

LOOKING FOR PORCELAINS AND INTERNAL STAINS FOR MICRO-LAYERING ON LITHIUM DISILICATE AND ZIRCONIA?

The innovative product CERABIEN™ MiLai, based on synthetic feldspar, enables dental technicians to add the final touch to their zirconia or lithium disilicate restorations in a simple and time-saving procedure – for outstanding aesthetics right from the start.

Check out the video to learn about the features of CERABIEN MiLai and the resulting benefits.

PANAVIA™ SA Cement Universal RECEIVES TOP PRODUCT AWARD

The US-based Dental Advisor has recognized PANAVIA™ SA Cement Universal as a Top Product in the category of Indirect Restoratives — Cement: Self-Adhesive Resin for the sixth consecutive year. This recognition was announced in the January/February 2025 issue of the publication. PANAVIA™ SA Cement Universal is a dual-cure, fluoride-releasing, radiopaque self-adhesive resin cement that adheres to virtually every substrate — including lithium disilicate — in a single-step procedure without the need for a separate primer or silane.

INNOVATIVE MONOMER COMBINATION

It is because PANAVIA™ SA Cement Universal combines two innovative technologies in a single product that a strong and durable bond can be achieved in a single step. The silane-coupling agent, LCSi monomer, establishes a durable, chemical bond with porcelain, lithium disilicate, and composite resin; and the original MDP monomer provides for chemical reactiveness with zirconia, dentin and enamel.

BENEFITS IN A NUTSHELL

Due to its unique chemistry PANAVIA™ SA Cement Universal represents a convenient, versatile, and efficacious single solution to practitioners’ everyday cementation needs. It is:

• Suitable for a wide variety of indications, including cementation of crowns/bridges, inlays/onlays, posts, splints, and even adhesion bridges
• Suitable for a wide variety of restorative materials (including lithium disilicate) without separate primers
• Offers easy, gingival-friendly excess removal
• Ready for use immediately as it requires no refrigeration

OUTSTANDING OVERALL CLINICAL RATING: 96 PERCENT

The performance of the product was tested by the Dental Advisor in the clinical and laboratory setting, resulting in a research report and a clinical evaluation. For the latter, 31 clinical evaluators tested the cement during 516 applications. They praised the cement’s ease of use, handling characteristics, and aesthetics, and gave it an overall clinical rating of 96 percent. Among their comments:

• “Good flow and film thickness.”
• “Amazing viscosity, tack-cure ability and very easy clean-up.”
• “My assistant does not have to get it out of the refrigerator as it can be stored at room temperature.”
• "Can be used in a moist environment with no setting issues."

The laboratory data confirmed very high initial shear bond strength values on dentin, lithium disilicate and zirconia.

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.

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

Case by MDT Andreas Chatzimpatzakis

EFFECTIVE FINISHING OF A ZIRCONIA FRAMEWORK WITH CERABIEN™ MiLai

‘Modern concepts are based on the smart combination of different materials.’

The implant-prosthetic restoration of edentulous jaws requires more than functional stability. Modern concepts are based on the smart combination of different materials. In the presented case, a titanium bar provides for a stable connection between the implants, while a zirconia framework offers the necessary strength and fracture resistance. Both materials stand out due to their high biocompatibility, the good soft tissue attachment properties of zirconia being particularly noteworthy. The real challenge in the selected type of restoration, however, begins with aesthetic realization. Micro-layering techniques promise efficiency combined with aesthetics – but this often comes with compromises, e.g. in terms of handling. With CERABIEN™ MiLai (Kuraray Noritake Dental Inc.), a new path is now being taken here.

MDT Andreas Chatzimpatzakis, Athens

The rapid development of all-ceramic framework materials such as zirconia and lithium disilicate calls for new veneering concepts. CERABIEN™ MiLai (Kuraray Noritake Dental inc.) picks up on the strengths of classic powder ceramics and optimizes them for the requirements of micro-layering – the reinterpretation of a classic, so to speak. The basis for this is provided by synthetic feldspathic ceramic technology, in which Kuraray Noritake Dental Inc. has decades of experience. The company developed its first synthetic dental ceramics back in the late 1980s – expertise that is now also used in the low-fusing porcelain system CERABIEN™ MiLai for micro-layering. Unlike natural feldspathic ceramics, the synthetic version provides for consistent properties without the need to adjust the formulation due to altering raw materials. This is reflected in stable coefficients of thermal expansion and a uniform particle distribution; prerequisites for aesthetic results and colour stability. Another decisive advantage is evident during the firing process: the special composition prevents micro-movements in the material during firing, which can lead to inhomogeneities and gray haze effects with conventional ceramics. This property is indispensable for micro-layering, as any irregularity, no matter how small, would be immediately visible in the thin ceramic layers.

INITIAL SITUATION

The presented case illustrates the technical procedure around the restoration of an edentulous maxilla. The prosthetic work was produced after the placement of six implants and their osseointegration. In consultation between the practice team around prosthodontist Dr Georgios Siavikis, laboratory technician and patient, the decision was made to restore the teeth with a bar-supported bridge construction. A CAD/CAM-fabricated titanium bar (Atlantis® BridgeBase, Dentsply Sirona) formed the basis. Due to its high manufacturing precision, it would provide for a passive fit of the reconstruction on the implants. The material of choice for the superstructure was zirconia, which was to be finalized using micro-layering due to the patient’s high aesthetic demands.

Fig. 1. Computer-aided design of the implant bar.

Fig. 2. Computer-aided design of the zirconia framework – transparent view revealing the BridgeBase.

Fig. 3. Computer-aided design of the zirconia superstructure.

WHY CHOOSE MICRO-LAYERING?

The decision to opt for micro-layering is based on tangible benefits: In addition to economic efficiency, the thin layer of porcelain provides a high level of safety and significantly reduces the risk of chipping. In addition, the ultra-thin porcelain layer enables a controlled approach to porcelain layering. However, we must be aware that with micro layering, around 80 to 90 percent of the restoration’s final shape is already created in the framework. Although this leads to maximum control during layering, it also places high demands on the selected framework material. With porcelain layer thicknesses in the micro range, the zirconia needs to be convincing in terms of aesthetics and mechanical strength. For our long-span bridge construction, we chose KATANA™ Zirconia HTML Plus (Kuraray Noritake Dental Inc.), a material that combines high strength with natural translucency. We deliberately opted for a disc in the shade A2 – one shade lighter than the desired target shade A3. This strategic choice enabled us to play with the colours during layering and implementation of the internal stain technique.

Fig. 4. Multi-Layered zirconia with a high strength and translucency used as a framework material.

WHY OPT FOR INTERNAL STAINING?

The internal stain technique is no longer an insider tip, but is one of the supreme all-ceramic disciplines. Kuraray Noritake Dental Inc. has perfected the technique over decades together with dental technicians. We particularly value the technique in our day-to-day laboratory work, as it gives restorations an individual touch that sets them apart from standard work. Unlike superficial stains, the internal staining creates a characterization from inside the restoration with a lively play of colours that unfolds naturally in changing light conditions.

Until now, it has been challenging to combine the advantages of the internal stain technique with those of micro-layering. Although we have put various approaches to a test and detected solutions that do work, we have always come up against technical limitations. The combination of both techniques – micro-layering and internal staining – places special demands on the porcelain system: It needs to allow characterization from the inside and at the same time be able to be processed in ultra-thin layers. CERABIEN™ MiLai closes the previous gap. As a low-fusing porcelain system, it combines the advantages of the internal stain technique with the efficiency of micro-layering. Being a powder-based porcelain system, the product may be used in the familiar way – only much more efficiently. The possibility of adjusting the consistency to individual needs gives us the precise control we need for minimal layer thicknesses. With 16 porcelains and 15 internal stains, the system remains manageable without compromising on design.

Fig. 5. The low-fusing porcelain CERABIEN™ MiLai is designed for micro-layering on zirconia and lithium disilicate.

FRAMEWORK PREPARATION

After milling and sintering, the framework in its cut-back design was processed systematically: The first step was to treat the zirconia surface with a diamond bur – under water cooling to avoid microcracks. In this phase, it is also possible to incorporate fine anatomical details such as mamelon structures or marginal ridges. To provide for a strong bond, the surface of the framework was then sandblasted with 50 μm alumina particles. In this context, it is important to apply a moderate pressure that conditions the surface without weakening the structure. Framework preparation was completed with ultrasonic cleaning for ten minutes. All this created the basis for a reliable bond between the framework and the veneering porcelain.

Fig. 6. Zirconia framework prepared for finishing.

INTERNAL STAINING MEETS MICRO-LAYERING

Next on the list was internal staining. It is often the smallest details that have the biggest effect – be it a prominent marginal ridge or an intensive cervical colouration. Sometimes, however, less is more. It is often a question of the dental technician’s artistic sensitivity and – of course – the individual situation. In this case, Tissue Red was used for a vivid effect of the gingival areas, while a combination of Cervical 2, Incisal Blue 1 and Mamelon 2 was chosen to give the teeth a three-dimensional depth effect. Subsequent micro-layering was carried out selectively: CCV2 in the cervical area, Creamy Enamel for lighter margins and LT1 for the desired standard translucency and opalescence. The gingiva was given its natural depth through a sophisticated interplay of shades and shapes – with a base of Tissue 1 and 5, while the keratinized areas were given their characteristic appearance with a 60/40 mixture of Tissue 1 and TX.

Fig. 7. Internal staining: Targeted application of the stains on the framework as the basis for the three-dimensional colour effect of the restoration.

Fig. 8. Micro-layering: Ultra-thin layering on the characterized framework gives the restoration its final shape and light dynamics.

What followed was the first bake. CERABIEN™ MiLai is a low-fusing porcelain. Its firing temperature of 740 °C is not only the enabler of its compatibility with various framework materials (zirconia, lithium disilicate), but also reduces the risk of distortion or micromovements causing unwanted changes in shape during repeated firings. Minor shape corrections were made after the first bake. In this step, a particular advantage of powder ceramics in micro-layering becomes apparent: they allow for precise modelling of even the finest structures and textures. The surface structure with its lively textures gives the work its natural appearance. The final glaze firing leveraged the self-glazing effect of CERABIEN™ MiLai.

Fig. 9. Occlusal view of the finished restoration.

Fig. 10. Clearly visible internal colour characteristics.

Fig. 11. Lively surface structure with interplay of concave and convex areas both in the area of the teeth and the gingiva.

Fig. 12. Restoration in situ; edentulous maxilla with an implant-based zirconia bridge. The patient’s wishes regarding individual aesthetics are fulfilled thanks to internal staining and micro-layering (CERABIEN™ MiLai) – effectively, economically and safely.

EFFECTIVE AND FLEXIBLE

In the case presented, we combined the internal stain technique with micro-layering to fulfil the patient’s individual aesthetic demands. However, CERABIEN™ MiLai is just as suitable for micro layering without internal staining – fast, straightforward and effective. And this is precisely the advantage of this system: it offers the flexibility to go your own way – tailored to the respective situation and to the framework material (zirconia and lithium disilicate), eliminating the need to store different porcelain systems. Particularly useful: CERABIEN™ MiLai can be combined with the tried-and-tested CERABIEN™ ZR porcelain. Thanks to the low firing temperature, areas that have already been layered remain stable in shape and colour. The high versatility makes CERABIEN™ MiLai our preferred system for effective micro-layering. MiLai YOUR WAY – we have found our way with it and know that we have the right solution for every case.

‘THE HIGH VERSATILITY MAKES CERABIEN™ MILAI OUR PREFERRED SYSTEM FOR EFFECTIVE MICRO-LAYERING.’

Dental technician:

ANDREAS CHATZIMPATZAKIS

Andreas Chatzimpatzakis 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. Since the year 2000, he has been running the ACH Dental Laboratory in Athens, Greece, specialized on refractory veneers, zirconia and long-span implant prosthesis. In 2017, Andreas travelled to Japan, where he was trained by Hitoshi Aoshima, Naoto Yuasa and Kazunabu Yamanda to become an Official Trainer for Kuraray Noritake Dental Inc.

CLEARFIL MAJESTY™ ES Flow Universal WINS RESEARCH AWARD

Kuraray Noritake Dental Inc. has just launched a flowable composite with a simplified shade concept: CLEARFIL MAJESTY™ ES Flow Universal. As published in the January/February 2025 issue of the US-based Dental Advisor, the brand-new product earned a prestigious Research Award for its convincing in-vitro performance.

PROPERTIES IN A NUTSHELL

In Europe, CLEARFIL MAJESTY™ ES Flow Universal was just launched in two viscosities – Low and Super Low, while in the United States, the Super Low variant is available. To provide for an effortless shade selection procedure, the material is equipped with a smart combination of an enamel-like translucency, dentin-like chroma and unique Light-Diffusion Technology (LDT). This leads to exceptional shade-matching abilities and allows for a minimal shade range of just two complementary shades – universal (U) and universal dark (UD). Once cured, the material naturally blends with the surrounding tooth structure.

 
Apart from intuitive shade selection, the flowable composite offers another major advantage: Its exceptionally high strength. With a flexural strength of 152 MPa and a compressive strength of 374 MPa, CLEARFIL MAJESTY™ ES Flow Universal (Super Low) is as strong as many paste-type composites. Consequently, it is suitable for use even in stress-bearing areas and indicated for:

• Direct restorations for all cavity classes, cervical lesions (e.g. root surface caries, v-shape defects), tooth wear, and tooth erosion
• Cavity base / liner
• Correction of tooth position and tooth shape (e.g. diastema closure, tooth malformation)
• Intraoral repair of fractured restorations
• Cementation of ceramic and composite inlays, onlays and veneers with less than 2 mm thickness

STUNNING IN-VITRO PERFORMANCE

The Super Low flowability variant offered the United States was tested in the Dental Advisor Biomaterials Research Center and compared to two other flowable composites. Among the properties evaluated were the materials’ flexural strength, modulus of elasticity, fracture toughness, compressive strength and radiopacity. Moreover, the investigators assessed the shade-matching ability of the materials in the context of restoring Class V cavities in A1, B2, C3, and D4-shaded denture teeth. Finally, they put the radiopacity and flow properties to a test.

 
CLEARFIL MAJESTY™ ES Flow Universal performed very well in all respects. Physical properties turned out to be among the highest of flowable composites and on a similar level as paste-type alternatives. Radiopacity was found to be ideal, as was the viscosity, as the material holds its initial shape after application. And although only two shades are offered, the investigators confirmed that the CLEARFIL MAJESTY™ ES Flow Universal matches a broad range of natural tooth shades.

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

Case by Andreas Chatzimpatzakis

PUTTING CERABIEN™ MiLai TO THE TEST

Nowadays, lithium disilicate and highly translucent variants of zirconia are among the most popular ceramic materials processed in the dental laboratory. Their favourable optical properties allow us to opt for simplified finishing approaches such as micro-layering in a great majority of cases. For dental technicians, this means a reduction of the manual workload without compromising the quality of the outcomes.

Recently, Kuraray Noritake Dental Inc. has launched a new set of porcelains and internal stains specifically developed for micro-layering, which works not only with zirconia but also with lithium disilicate. The CERABIEN™ MiLai line-up consists of 16 porcelains and 15 internal stains, which – the manufacturer claims – are easy to select and manage. As the more universal approach with a single porcelain for silicate ceramics and zirconia enables us to streamline inventory management and to standardize layering procedures, we decided to test the new product in the laboratory setting. The following case is a documentation of the first try of CERABIEN™ MiLai on lithium disilicate (Amber Press, HASS Bio).

Fig. 1. Anatomically reduced crown structures made of lithium disilicate (Amber Press LT, shade A2).

Fig. 2. Crowns after the application of CERABIEN™ MiLai Value Liner 1 generally used to increase the value of lithium disilicate restorations, followed by wash firing.

Fig. 3. Situation after CERABIEN™ MiLai Internal Stains: A+ is applied in the cervical area to enhance the chroma, and Mamelon Orange 2 alternating with Incisal Blue 1 are used to imitate the mamelon structures in the incisal area.

Fig. 4. Crowns after the first and second bake with CERABIEN™ MiLai Porcelain LT1 applied in the cervical area to add translucency and opalescence to the enamel, E2 mixed with ELT (ratio: 60/40) to optimize the body area and LTx to boost the incisal translucency and opalescence.

Fig. 5. Restorations finalized with CERABIEN™ ZR FC Paste Stain Clear Glaze and external stains to add some lines incisally.

Fig. 6. Lateral view of the restorations.

Fig. 7. Natural translucency and internal optical structure revealed in transmitted light.

CONCLUSION

The outcome achieved at the first go with the CERABIEN™ MiLai line-up for micro-layering on lithium disilicate is very satisfying. I feel that we can achieve great results with this system, which is indeed easy to select and manage. The reduced number of shades clearly comes in handy especially for beginners, who will be grateful for the option of creating lifelike restorations with fewer decisions to be made, and less effort involved compared to conventional ceramic line-ups. The possibility of standardizing and streamlining procedures by using a single porcelain system for all micro-layering procedures is likely to improve the life of every dental technician.

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™ Universal Bond Quick 2

In modern dentistry, efficiency and reliability are key elements for many practices. CLEARFIL™ Universal Bond Quick 2 offers a low effort, high-performance bonding solution providing exceptional results. With its Advanced Rapid Bond Technology, this adhesive allows for quick and easy application, eliminating unnecessary steps and reducing technical sensitivity.

WHAT IS CLEARFIL™ Universal Bond Quick 2?

CLEARFIL™ Universal Bond Quick 2 is an advanced dental adhesive designed to streamline restorative procedures. Compatible with etching techniques of your choice, it provides strong adhesion to enamel and dentin, ensuring a strong and uniform bond layer. Its versatility makes it suitable for both direct and indirect restorations, as well as core build-ups and intraoral repairs.

WHERE CAN THIS BONDING SOLUTION BE USED?

CLEARFIL™ Universal Bond Quick 2 is ideal for any dental practice seeking a reliable and easy-to-use adhesive. Whether performing routine direct restorations or several indirect procedures, this adhesive delivers consistent performance and a simplified workflow.

WHAT ARE THE INDICATIONS OF CLEARFIL™ Universal Bond Quick 2?

This bonding agent is designed for a variety of clinical applications:

• Direct restorations using light-cured composite resin
• Sealing of a prepared cavity or abutment tooth as a pretreatment for indirect restorations
• Treatment of exposed root surfaces
• Treatment of hypersensitive teeth
• Intraoral repairs of fractured restorations
• Post cementation and core build-ups
• Cementation of indirect restorations

WHY DOES CLEARFIL™ Universal Bond Quick 2 WORK SO WELL?

The key to its exceptional performance lies in its proprietary Advanced Rapid Bond Technology, which consists of three high performance ingredients:

• Original MDP Monomer: Invented by KURARAY CO., LTD., this monomer provides unmatched bonding strength to hydroxyapatite and a wide range of materials, including zirconium oxide. It provides for an excellent bond that remains stable over time.
• Amide Monomer: A highly hydrophilic monomer that allows for rapid penetration into the tooth structure, eliminating the need for waiting after application. During polymerisation, it forms a stable, hydrophobic cross-linked network for a strong and durable bond.
• Urethane Tetra Methacrylate (UTMA) Monomer: This multifunctional monomer enhances the strength of the bonding layer itself, increasing resistance to shrinkage forces while maintaining a thin and uniform adhesive layer.

Together, these monomers form the foundation of CLEARFIL™ Universal Bond Quick 2, providing a fast, dependable, and versatile adhesive for all your restorative needs.

WHY CHOOSE CLEARFIL™ Universal Bond Quick 2?

CLEARFIL™ Universal Bond Quick 2 enhances efficiency without sacrificing quality. Its Advanced Rapid Bond Technology integrates MDP, Amide, and Urethane Tetra Methacrylate (UTMA) monomers to create a strong, uniform bond layer. This allows for even spreading and superior bond strength to both enamel and dentin. The low-viscosity formula forms a thin, even film, reducing risk of pooling and enhancing predictability.

Additional benefits include:

• Quick and straightforward application
• Consistently durable bond strength
• Versatility across different restorative techniques
• Minimized risk of pooling and contamination
• Compatibility with self-adhesive resin cements
• Convenient room temperature storage

HOW DO YOU APPLY CLEARFIL™ Universal Bond Quick 2?

Application is simple and efficient, accommodating various clinical scenarios. The adhesive can be used in:

• Self-etch mode for a more modern, fast and effective approach
• Selective-etch mode for additional enamel bond strength
• Total-etch mode for a conventional approach

It is available in both bottle and unit-dose options, catering to different practice needs and ensuring easy, on-demand use.

THE ULTIMATE BONDING SOLUTION: CLEARFIL™ Universal Bond Quick 2

As the latest innovation in dental bonding, CLEARFIL™ Universal Bond Quick 2 delivers efficiency, reliability, and versatility. By eliminating waiting time, extensive rubbing, and the need for application of multiple layers, this adhesive simplifies procedures while creating strong, long-lasting restorations. With its exceptional performance and simplified workflow, it truly is the „everything bond“ for modern dental practices.

THE HEART OF THE UNIVERSAL PORTFOLIO

At Kuraray Noritake Dental Inc., we understand the demands of modern dental practices. Balancing complex procedures, tight schedules, and patient care is no easy task. That is why we have spent years refining our materials—so you can focus on what matters most: your patients.

Our universal products simplify your workflow, offering you high-quality materials and tools that work seamlessly with your expertise. CLEARFIL™ Universal Bond Quick 2 forms literally the connection between several universal resin-based products of our portfolio. Plus: there is no need for a separate dual-cure activator when used with other manufacturers’ self-adhesive cements.

KURARAY NORITAKE DENTAL INC.'S AWARD-WINNING SOLUTIONS IN 2025

In our dynamic dental landscape, the demand for cutting-edge materials and devices that enhance clinical outcomes, simplify workflows and address individual patient needs continues to rise. Dental professionals never stop looking for such products that support them and their teams in achieving exceptional treatment outcomes safely and efficiently. In a short-lived world with new products being introduced frequently, however, it can be challenging to identify and choose the right solutions. Independent evaluations that assess practical application on one hand and laboratory as well as clinical performance on the other are among the most trusted sources of information.

Each year, the Dental Advisor, a respected authority in dental product testing, recognizes those dental products that consistently perform at the highest levels. In its Top & Preferred Product as well as Research Awards published in the January/February 2025 issue of the Dental Advisor, several products from Kuraray Noritake Dental Inc. earned well-deserved recognition. Among this year’s winners are a new flowable composite as well as tried-and-tested favourites that continue to shape the field of restorative and adhesive dentistry.

RESEARCH AWARD WINNERS

According to Dental Advisor (www.dentaladvisor.com), “Companies that receive Research Awards demonstrate a commitment to advancing dental technology and enhancing patient care.” Features and physical properties are tested in the Dental Advisor Biomaterials Research Center to evaluate the scientific performance of the materials and recognize those products with the most promising blend of characteristics.

CLEARFIL MAJESTY ES Flow Universal

This brand-new flowable composite with a simplified shade concept has just earned the prestigious Research Award from the Dental Advisor. While the material is available in two flowabilities (Low and Super Low) in Europe, Low is the variant offered in the United States and tested in the Dental Advisor Biomaterials Research Center. According to the test results, the material stands out mainly due to its high mechanical properties and exceptional shade matching abilities. Its flexural strength and compressive strength are level with those of the strongest packable composites on the market. And although only two shades are offered, laboratory testing confirms that the material matches a broad range of natural tooth shades. This brings both simplicity and efficiency to restorative procedures without compromising on aesthetics and durability.

PANAVIA Veneer LC (RESEARCH AWARD AND PREFERRED PRODUCT)

PANAVIA Veneer LC has been revered for its exceptional bond strength and aesthetic outcomes in veneer applications. Testing confirmed that – when the components recommended in the United States (PANAVIA Veneer LC Paste, CLEARFIL™ Universal Bond Quick and CLEARFIL™ Ceramic Primer Plus) are used – bond strength is high after artificial ageing. This applies to various substrates including enamel, dentin, silica-based ceramics (lithium disilicate) and zirconia. The system also showed the best gloss retention and wear properties compared to two other leading veneer cements tested.

TOP PRODUCT AWARD WINNERS

Every year, the Top Product Award is awarded to materials and devices in different dental categories. The winners are selected based on clinical evaluations and laboratory test results. This award offers valuable insights as the tests are conducted under real-life conditions: “Our dedicated volunteer evaluators provide unbiased insights from their real-world experiences, ensuring that only the very best receive this prestigious accolade”, as stated on www.dentaladvisor.com.

CLEARFIL MAJESTY™ ES Flow

A consistent winner, CLEARFIL MAJESTY™ ES Flow has earned the Top Award again this year, reinforcing its status as a top performer in the composite resin category. Praised for its ease of use, excellent handling, and natural aesthetic appearance, this material is the go-to solution for clinicians who demand versatility and a superior finish.

CLEARFIL™ SE Protect

CLEARFIL™ SE Protect continues to lead the category of self-etch adhesives with its antibacterial effects and fluoride release. With a proven track record of clinical excellence, it secured a Top Award this year for its remarkable performance in both bonding and long-term performance, making it an indispensable product in restorative dentistry.

PANAVIA™ SA Cement Universal

The epitome of simplicity in self-adhesive cementation, PANAVIA™ SA Cement Universal earned a Top Award for its ability to bond reliably to a wide range of substrates without the need for additional primers. Its easy handling and consistent results have made it the preferred choice for clinicians looking for top performance and simplicity.

TEETHMATE™ DESENSITIZER

For the eighth year running, TEETHMATE™ DESENSITIZER has received a Top Award, highlighting its superior performance in the treatment of hypersensitivity. This non-invasive solution remains a favourite for addressing sensitivity issues, thanks to long-lasting pain relief.

PREFERRED PRODUCT AWARD WINNERS

Based on clinical evaluations and in-vitro tests, the Dental Advisor selects “those items that not only excel in performance but also resonate with the needs of dental practitioners”. As explained on www.dentaladvisor.com, these products receive a Preferred Product Award.

CLEARFIL™ CERAMIC PRIMER PLUS

Achieving Preferred Product status for its ability to bond to a wide variety of restorative materials, CLEARFIL™ CERAMIC PRIMER PLUS continues to shine in providing exceptional bond strength, particularly to silica-based ceramics, zirconia, and composites. Its consistent performance has earned it the recognition of clinicians worldwide.

PANAVIA™ Veneer LC (PREFERRED PRODUCT & RESEARCH AWARD)

This product not only excels in the laboratory setting, but also in the practice environment. Among the features highlighted by the consultants in the latter are its ease of excess clean-up, working time and aesthetics.

A COMMITMENT TO EXCELLENCE

At Kuraray Noritake Dental Inc., the pursuit of excellence is embedded in every product. The awards just won are a reflection of the company’s dedication to empowering dental professionals with solutions that improve patient care and optimize clinical workflows. From restorative materials to adhesive solutions, Kuraray Noritake Dental Inc.’s products support a wide range of applications that enhance both daily practice and patient outcomes.

The recognition received from the Dental Advisor in 2025 is a testament to the ongoing research, development, and commitment to excellence at Kuraray Noritake Dental Inc. As the practice of dentistry continues to evolve, clinicians can be sure that the people behind Kuraray Noritake Dental Inc. will never stop pushing the boundaries of dental science and listening to their needs to develop products that lead the way. After all, it is your clinical success and your patients’ quality of life that motivates us every day.

MEET AND GREET THE NEWEST EDITION TO OUR ADHESIVE FAMILY - CLEARFIL Universal Bond Quick 2

IN SHORT ABOUT CLEARFIL Universal Bond Quick 2

CLEARFIL™ Universal Bond Quick 2 represents the latest innovation in dental bonding technology, providing a streamlined and efficient solution for dental practitioners.

Compatible with all etching techniques, it is suitable for direct and indirect restorations as well as core build-up procedures, offering the versatility and flexibility essential for modern dentistry.

In addition to delivering consistent and predictable results, CLEARFIL™ Universal Bond Quick 2 eliminates waiting time, extensive rubbing, and the need for multiple layers. This saves valuable time for dentists while reducing the risk of errors and contamination, particularly in cases where moisture control is challenging.

Powered by Advanced Rapid Bond Technology, this adhesive provides for a strong, durable bond to enamel, dentin, and composite, supporting long-lasting and reliable restorations.

WORKFLOWS

In this blog, we showcase six essential workflows featuring CLEARFIL™ Universal Bond Quick 2 in action. From achieving seamless direct restorations with both paste-type and flowable composites to mastering advanced procedures like cementation and abutment sealing, these videos highlight the versatility and efficiency of this remarkable product.

Watch these videos to see how it fits seamlessly into diverse clinical scenarios of modern dental practice.

Direct restoration workflow with CLEARFIL MAJESTY ES-2 Universal composite and CLEARFIL Universal Bond Quick.

Direct restoration workflow with CLEARFIL MAJESTY ES Flow Universal (Super Low) composite and CLEARFIL Universal Bond Quick.

Direct restoration workflow with CLEARFIL MAJESTY ES Flow Universal (Low) composite and CLEARFIL Universal Bond Quick.

Post cementation and core build-up workflow with CLEARFIL DC CORE PLUS and CLEARFIL Universal Bond Quick 2.

Workflow for cementation of indirect restorations with PANAVIA SA Cement Universal and CLEARFIL Universal Bond Quick 2.

Workflow for sealing a prepared abutment tooth (for indirect restorations and CLEARFIL Universal Bond Quick 2.