Nii paljude turul saada olevate adhesiivide, tsementide ja taastavate materjalide korral on raske otsustada, milline toode sobib individuaalseteks lahendusteks kõige paremini. Otsene testimine hambaravi praksises on võimatu, sest saada olevaid lahendusi on väga palju. Laboratoorsed uuringud annavad teavet üksikute toote omaduste kohta, kuid ei võimalda tavaliselt luua üldpilti. Lisaks on erinevate analüüside tulemused harva erinevate analüüsitingimuste tõttu võrreldavad. Kliinilised uuringud on tavapäraselt väga kasulikud, sest võimaldavad hinnata valitud materjalide kliinilist (pikaajalist) toimivust, kuid need avaldatakse tavaliselt aastaid pärast toote turuletulekut. Seega ei ole need saadaval varajastes staadiumites. Väga heaks teabe allikaks on praksistes teostatud hinnangud, sest nad toetavad võimalikke kasutajaid kõrge kvaliteediga hambaravi materjalide tuvastamisel.

Üheks institusiooniks, mis viib läbi ja avaldab praktikal põhinevaid kliinilisi hinnanguid ning toote toimivuse analüüse, on Ameerika Ühendriikides paiknev DENTAL ADVISOR. Üks kord aastas saavad parima toimivusega hambaravi materjalid ja seaded auhinnad Top Product ja Preferred Product Award. Võitjate nimekiri avaldatakse veebis (www.dentaladvisor.com) ja jaanuari-veebruari numbris ajakirjas DENTAL ADVISOR. Aastal 2021 olid mitmed ettevõtte Kuraray Noritake Dental Inc. tooted auhinnavõitjate seas.

Auhinnad Top Product Award

CLEARFIL™ SE Protect sai auhinna Top Product kategoorias „Otsesed restauratiivmaterjalid, kinnitusmaterjalid: isesöövitavad materjalid“. Isesöövituva adhesiivi moodustumine põhineb kahe-etapilisel isesöövitava adhesiivi moodustumise kuldstandardil, kuid CLEARFIL™ SE BOND sisaldab lisaks MDPB monomeeri, mis on antibakteriaalse kaviteete puhastavate omadustega, ning fluoriidi pikaajaliseks fluoriidi vabastamiseks. Ajakirja DENTAL ADVISOR auhinna väljaandmine põhines materjalianalüüsil, mida viisid läbi 13 DENTAL ADVISOR-i konsultanti ja toimetajat oma hambaarstipraksistes kuue nädala jooksul. Oma suurepärase toimivuse tõttu sai antibakteriaalne isesöövituv adhesiiv 98 protsendilise kliinilise hinnangu.

Kuuendat aastat järjest sai parima Top Product kategoorias „Otsesed restauratsioonid, komposiit, kõrgelttäidetav modelleeritav“ toode CLEARFIL MAJESTY™ ES Flow.

Universaalne voolav komposiit, mis sai ka auhinna Editor’s Choice, on saadaval kolmes voolavusastmes kõrgest väga madalani*. See võimaldab kasutajal valida sobiva viskoossuse igaks kliiniliseks lahenduseks. Kõrge voolavusega variant on parim kaviteetide laineriks ja vaikkatteks IDS protseduuridel. Väga vähe voolav variant on eriti sobilik laminaatide paigaldamisel ja isegi tagumiste tippude ülesehitamiseks. Universaalset voolavat komposiiti testisid 29 ajakirja DENTAL ADVISOR konsultanti rohkem kui 900 kasutuskorra vältel. Hinnatud omadused - paigaldamine/käitlemine, esteetika, viskoossus ja poleeritavus - hinnati suurepärasteks. Selle tulemusena on soovitati toodet 100 protsenti ja üleüldine kliiniline hinnang oli 98 protsenti.

* DENTAL ADVISOR hindas ainult keskmise voolavusastmega toodet (Low), sest kaks teist versiooni ei ole Ameerika Ühendriikides saadaval.

Toode, mis saavutas tunnustuse ajakirja Dental Advisor kollektiivilt juba seitsmendat korda järjest on TEETHMATE™ DESENSITIZER, mida kasutatakse ülitundlikkuse raviks.

Auhinna Top Product võitnud toode disainiti hüdroksüapatiidi (HAp) tootmiseks, mis täidab avatud dentiini tuubuleid ja emailipragusid. See toob endaga kaasa olulise ülitundlikkuse vähenemise, kui seda kanda paljastatud, mehhaaniliselt töödeldud või värskelt ette valmistatud dentiinile. Kui toodet kasutada restauratiivses hambaravis, ei ole tootel TEETHMATE™ DESENSITIZER negatiivset mõju adhesiivide või tsementide sideme tugevusele. Ajakiri DENTAL ADVISOR viis läbi kuus kuud kestnud kliinilise hinnangu, millesse kaasati 27 igeme taandumisega seonduva ülitundlikkusega patsienti. Toote kasutamine oli väga efektiivne kohese ja isegi pikaajalise (kuus kuud) ülitundlikkuse leevendamisel. Tänu sellele sai toode suurepärase hinnangu skooriga 96 protsenti.

Isekinnituva tsemendi kategoorias sai auhinna Top Product PANAVIA™ SA Cement Plus. See kaksikhooldusega isekinnituv vaiktsement eristub oma kasutusmugavuse, meeldiva viskoossuse ja lihtsa jääkide eraldamise poolest pärast valgusimpulssidega kõvastamist.

Tooted Preferred Product

Aastal 2021 toodete Preferred Product seas, mis pääsesid valikusse Editor’s Choice, on PANAVIA™ SA Cement Universal. See aastal 2020 auhinna Top Product võitnud isekinnituv universaalne vaiktsement sisaldab unikaalset LCSi monomeeri. See monomeer on silaanil põhinev ning sisaldab oma molekulis unikaalset pikka süsinikahelat. Süsinikahel loob kestva keemilise sideme portselaniga, liitiumdisilikaadiga ja vaiktsmendiga ilma lisasilaani sisaldava praimeri vajaduseta. Teine valemis sisalduv võtmetehnoloogia on algne MDP monomeer, mis tagab keemilise reaktiivsuse tsirkooniga, dentiiniga ja emailiga. Koos tagavad tehnoloogiad, et PANAVIA™ SA Cement Universal tekitab tugeva ja kestva ühenduse peaaegu kõikide restauratiivsete materjalidega ilma eraldi praimeri vajaduseta. Toote käsitsemisomadused, esteetika ja igemesõbralikkus said väga head kuni suurepärased hinnangust 31-lt kliiniliselt hindajalt, kes kasutasid tsementi 516 rakenduses. Üleüldine kliiniline hinnang oli 96%.

Lisaks oli toode CLEARFIL™ Universal Bond Quick teist aastat järjest ajakirja Dental Advisor konsultantide eelistatud toode Preferred Product.

Universaalset sidusainet võib peale kanda isesöövitava tehnikaga või koos K-ETCHANT süstlaga emailile söövitamise või täieliku söövitamise tehnikaga. Sidusaine sisaldab kiire sideme loomise tehnoloogiat, milleks on algne MDP monomeer koos innovatiivsete hüdrofiilsete amiidide monomeeridega. Sidusaine töötab koheselt ja ilma lisa-ekspositsiooniaja vajaduseta, mitmete kihtide pealekandmisteta ja ilma liigse hambastruktuuri hõõrumiseta. Kiire ja lihtne pealekandmise protseduur oli üks peamistest põhjusteks, miks ajakirja DENTAL ADVISOR konsultandid valisid toote CLEARFIL™ Universal Bond Quick tooteks Preferred Product ja valikuks Editor’s Choice kliinilise hinnanguga 98 protsenti.

Lõpetuseks valiti toode CLEARFIL™ CERAMIC PRIMER PLUS tooteks Preferred Product aastatel 2019, 2020 ja 2021 ning valikuks Editor’s Choice aastal 2021. Toode sisaldab algset MDP monomeeri ja silaani monomeeri, mis tagavad suurepärase sideme tugevuse igasuguste restauratiivsete materjalidega, nt silikaadipõhistele keraamikatele, tsirkoonile, komposiitidele ja isegi metallidele. Kasutajad võidavad protseduuride lihtsusest, sest toode lihtsalt kantakse aluspinnale ja kuivatatakse pärast soovituslikku eeltöötlust. Kliinilises hinnangus saavutas toode soovitustaseme 96 protsenti ja üleüldise DENTAL ADVISOR konsultantide hinnangu 96 protsenti.

Kokkuvõte

Enamus ettevõtte Kuraray Noritake Dental tooteid, mis võitsid käesoleval aastal auhinna, põhinevad vaigu tehnoloogiatel, mis on üheks meie võtmekompetentsidest. Me arendasime oma algse MDP monomeeri välja 1980-ndate aastate keskel. Tegemist on funktsionaalse monomeeriga, mis on hädavajalik komponent meie kõikides sideainetes, mida me oleme turule toonud tänase päevani, sh auhinnatud CLEARFIL™ SE Protect, PANAVIA™ SA Cement Universal, CLEARFIL™ Universal Bond Quick ja CLEARFIL™ CERAMIC PRIMER PLUS. See on ainult üks meie mitmetest ekspertiisivaldkondadest. Me pakume kasutajatele ka ennetavaid tooteid ja mitmeid restauratiivseid materjale komposiidi täitematerjalidest nagu CLEARFIL MAJESTYTM ES Flow kuni hambakeraamikani nagu KATANA™ Zirconia UTML, STML ja HTML. Me näeme auhindade võitmist positiivse tõestusena usaldusväärsest toote töökindlusest, mis toetab hambaarste nende eesmärkide saavutamisel.

Vahel peab see olema voolav, et oleks võimalik täita kõik nurgad, ja vahel on vaja, et see püsiks paigaldatud kohas või oleks sobiva kuju loomiseks modelleeritav. Sama viskoossusega oleks raske teostada kõiki komposiitide vajalikke näidustusi. Selle tõttu pakub Kuraray Noritake Dental Inc. toodet CLEARFIL MAJESTY™ ES Flow kolme erineva voolavusastmega: High, Low ja Super Low. Voolavusaste valitakse vastavalt näidustusele ning kaviteedi geomeetriale ja suurusele. Näiteks on hea voolavusega valik parim kaviteedi laineriks, samas kui väga vähese voolavusega toodet võiks eelistada laminaatide paigaldamiseks.

Kuid materjalil on lisaks veel palju pakkuda. Seda on kinnitanud ka konsultandid ajakirjast Dental Advisor, kes on autasustanud toodet auhindadega Editors’ Choice ja Top Product Award kuuendat korda järjest (Vol 38, number 01, jaanuar–veebruar 2021).

Ajakirja Dental Advisor 29 konsultanti testisid oma hambaarstipraksistes keskmise voolavusega (Low) CLEARFIL MAJESTY™ ES Flow toodet. Nad hindasid toote toimivust paigaldamise/käitlemise, esteetika, viskoossuse ja poleeritavuse osas. Kõigi nelja omaduse osas oli hinnang suurepärane. CLEARFIL MAJESTY™ ES Flow Low ei voola paigalduse ajal, samas kohandub hästi kaviteedi seintega ja voolab ka kitsastesse piirkondadesse. Ettevõtte Kuraray Noritake Dental Inc. kerge difusiooni tehnoloogia võimaldab materjalil sujuvalt ümbritseva hambastruktuuriga ühilduda ja läikiv pind saavutatakse ainult alkoholis immutatud vatitampooniga pühkides.

Tänu nendele omadustele ja veenvale üleüldisele toimivusele, saavutas toode 98 protsendilise hinnangu ja kõik 29 konsultanti märkisid, et nad soovitaksid toodet CLEARFIL MAJESTY™ ES Flow kolleegile. Alates aastast 2015 on toode võitnud korduvalt auhinna Top Product Award ja tänu oma kolmele viskoossusele on toode tõenäoliselt valikuks veel laialdasemate näidustuste korral

Kas ei oleks tore, kui kõiki ülitundlikkusi saaks ravida ühe hambaravi materjaliga? Toode, mis efektiivselt ja püsivalt katab igeme taandumisest, hammaste erosioonist või liigsest harjamisest tingitud dentiini tuublite paljastumise, samas toimib ka professionaalse hammaste puhastajana, hambakivi eemaldajana ja juurte planeerijana, hammaste valgendajana ning restauratiivsetel protseduuridel? Asjaolu, et ettevõtte Kuraray Noritake Dental Inc.TEETHMATE™ DESENSITIZER sobib ideaalselt kõikideks nendeks näidustusteks, pakkudes pikaajalist ülitundlikkuse kergendamist, on üks nendest põhjustest, miks see võitis ajakirja Dental Advisor auhinna seitsmendat aastat järjest

TEETHMATE™ DESENSITIZER on disainitud kristalliseerima hüdroksüapatiiti (HAp) põhjast ülespoole ja see katab paljastatud dentiini tuubulid ja emaili praod usaldusväärselt.

Toode koosneb looduslikust kaltsiumist ja fosfaadist. Seetõttu võib seda kanda värskelt ettevalmistatud hambastruktuurile, ilma järgnevalt kasutatavate hambaravi adhesiivide või tsementide sideme tugevust negatiivselt mõjutamata.

Ajakirja Dental Advisor konsultandid viisid läbi kuus kuud kestva kliinilise uuringu, et hinnata toote TEETHMATE™ DESENSITIZER toimivust. Nad valisid oma praksistest 27 ülitundlikkusprobleemidega patsienti. Mõjutatud hammaste leidmiseks kasutati testimist külma õhuga ning tuvastati 54 mõjutatud hammast. Esialgsel hinnangul paluti patsientidel hinnata iga hamba ülitundlikkust 5-punktilisel skaalal (1 = raske, püsiv ülitundlikkus, 5 = tundlikkus puudub). Järgnevalt kanti peale toodet TEETHMATE™ DESENSITIZER vastavalt kasutusjuhistele. Tundlikkust hinnati uuesti koheselt pärast ravi ja kuue kuu möödumisel. Protseduurijärgselt teatas 91 protsenti patsientidest ainult vähest juhuslikku tundlikkust või tundlikkus puudus. Pärast kuue kuu möödumist oli see sama 85%-l patisentidest. See näitab, et toode on väga efektiivne kohese ja isegi pikaajalise ülitundlikkuse ravis.

Selle tõttu ei ole üllatav, et TEETHMATE™ DESENSITIZER on ajakirja Dental Advisor auhinna Top Product Award võitjate seas olnud igal aastal vahemikus 2015 kuni 2021.

Uuringutulemused kinnitavad materjali efektiivsust operatsioonieelse ja -järgse tundlikkuse vähendamisel hammaste valgendamisel1 ja mitteotsestel taastamisprotseduuridel2. Nii on võimalik usaldada toote kindlat toimimist laialdastel rakendusaladel.

References

1. Mehta D, Jyothi S, Moogi P, Finger WJ, Sasaki K. Novel treatment of in-office tooth bleaching sensitivity: A randomized, placebo-controlled clinical study. J Esthet Restor Dent. 2018 May;30(3):254-258.
2. Shetty R, Bhat AN, Mehta D, Finger WJ. Effect of a Calcium Phosphate Desensitizer on Pre- and Postcementation Sensitivity of Teeth Prepared for Full-Coverage Restorations: A Randomized, Placebo-Controlled Clinical Study. Int J Prosthodont. 2017 Jan/Feb;30(1):38-42.

Conventional Cementation Vs. Adhesive Luting

Proper luting of indirect restoration is critical in achieving long-term success as it highly influences the retention of the restoration.

With the availability of different types of cements, the decision of choosing the suitable luting agent and method can be confusing for the practitioner. Especially with the wide use of contemporary restorative materials such as new generations of highly translucent zirconia as well as reinforced-composites, it is important to take into consideration that the properties of such materials differ highly from metal or earlier generations of zirconia.

Subsequently, the choice of the luting agent must be appropriate to achieve satisfying results and long-term success. Therefore, the aim of this online seminar is to provide insights for the clinicians on choosing the correct luting agent that can help achieve satisfactory results for the dentist as well as the patients.

Dr Adham Elsayed

• PhD degree in Prosthodontics and Implantology from the University of Kiel, Germany
• Certified Specialist in Prosthodontics, German Society for Prosthetic Dentistry and Biomaterials (DGPro)
• Certified Specialist in Implantology, German Society for Implant Dentistry (DGI)
• Clinical & Scientific Manager DACH, Kuraray Europe GmbH

Case by Francesco Ferretti and Marco Nicastro

Aesthetic restoration of anterior teeth using KATANA™ UTML Full anatomical crowns, with vestibular stratification and BOPT*¹.

^{*1 Biologically Oriented Preparation Technique}

Initial situation

Final result

Shows excellent aesthetic properties of KATANA™ UTML and the perfect integration in harmony with pink tissues.

Figure 1. The patient requested a solution for an aesthetic problem due to unnatural look of old restorations and black triangles coming from past history of periodontitis. The resulting retraction of the tissues had left the margins of the prosthesis clearly visible, and the loss of the papilla peaks, together with the numerous black spaces between the crowns, required a complex therapeutic approach.

Figure 2. The treatment plan for the periodontal problems con-sisted of a non-surgical approach, with scaling and root planing, and the replacement of the previously fixed prostheses to recondition the marginal tissues and facilitate the restoration of a new, aesthetically pleasing gingival architecture.

Figure 3. From a functional point of view, we decided to reduce the deep frontal bite to restore a correct overjet-overbite ratio. This reduction was also important from an aesthetic point of view, as it allowed us to shape the various elements correctly.

Figure 4. We usually remove old prostheses before beginning a periodontal treatment, and make a first, provisional restoration to create an environment in which the soft tissues can heal. If we have to work beyond the cement enamel joint (CEJ), we prefer a vertical preparation for posts, and the purpose of the provisional restoration is to condition the marginal tissues using Dr. Loi’s BOPT.

Figure 5. For the BOPT, the vertical preparation of the post has a finish line that extends inside the gingival sulcus. The temporary conditioning of the tissues induced by the provisional prosthesis allows us to modify the level of the gingival parables to a certain extent.

Figure 6. The image on the left shows the clinical healing of the tissues one month after the initial periodontal treatment. The role of the provisional restoration, appropriately realigned, is clear. The conditioning of the tissue has been achieved by means of the provisional restoration, which has modified the level and shape of the marginal tissue. Once filled with correctly fitted crowns, the interproximal spaces will be further reduced after the definitive restoration.

Figure 7. The correct management of the provisional restoration is crucial for the healing of the tissues. The placement of a provisional restoration before the periodontal therapy has allowed us to create the right environment for complete healing. At the same time, the vertical preparation has allowed us to gradually condition the marginal gingival tissue by shortening or lengthening the provisional restoration as necessary.

Figure 8. One of the advantages of a vertical preparation is that taking the final impression is easy, because the absence of a horizontal finish line greatly simplifies the procedure. On the other hand, the BOPT also requires the taking of an impression of the sub-gingival portion of the preparation. The dental technician will have to decide marginal shape of restorations according to the position of the gingival line in consultation of the clinician, and based on the tests conducted with the provisional restoration.

Figure 9. After the casting of the model, we prepared the gingival area to accommodate an ideal configuration of gingival parables.

Figure 10. After making a wax model, we assessed whether the height of the gingival zenith level could be further corrected. This photo shows that gingival level of 21 was not yet ideal, so we stretched it distally.

Figure 11. Once the wax model was complete, we extracted the element from the model and evaluated its protrusion. It was only after joining the gingival protrusion to the arbitrary margin of the preparation that we proceeded to a scan and milled the crowns.

Figure 12. The restoration was carried out with Katana™ UTML zirconia based on the new formulation of cubic zirconium oxide. This ultra tralucent material was chosen because we were working with light and non-discolored posts.

Figure 13. We finished the crowns on a positional impression to help to improve the gingival adaptation; we had some dispersion of the tissues in the first precision impression due to the use of retractors. We finished the crowns with CZR FC Paste Stain colours and glaze.

Figure 14. The surface colours and the slight contrast created are highlighted in this black-and-white image taken with a blue filter.

Figure 15. In this translucent image, we can see the natural translucent effect of KATANA™ UTML and invisible fusion between abutments and crowns.

Figure 16. Clinical image one year after cementation made with PANAVIA V5; this shows the good clinical condition of the marginal tissue, with no signs of inflammation or bleeding. The BOPT allowed us to optimise the level of the gingiva without resorting to periodontal surgery, while the shape of the new crowns has made it possible to close all interproximal spaces for an optimally aesthetic result.

Figure 17. The brightness of the restorations (thanks to the use of a particularly translucent zirconia) combined with the shape of the incisors, has greatly im-proved the aesthetic of the restoration, even though the condition initially appeared to be particularly unfavourable.

Figure 18. Compared to the previous prostheses, the incisal reduction allowed not only for the optimisation of the functional phase by reducing the overbite, but also made it possible to achieve a more natural aesthetic, with the contour of the incisal margins following that of the lower lip.

Dentists:

FRANCESCO FERRETTI

Born in Rome on 15th March 1957, Francesco Ferretti gets his degree as dental technician at the Institute “Edmondo de Amicis”, in Rome. In 1980, he starts working and, from 1987 to 1994, he cooperates with IVOCLAR VIVADENT giving consulting as ceramist. In 1992 he starts working exclusively with Prof. Mario MARTIGNONI.

• After one year cooperation with Prof. Martignoni, he starts working with the ORAL DESIGN CENTER founded in Rome by Mr. Willi Geller, and becomes a partner, improving prosthesis esthetics.
• Is registered outside the course of dentistry at the University of Rome Tor Vergata.
• In 2001, he founds ESTECH DENTAL STUDIOS, in cooperation with Pentron for technical training and consulting.
• He has published articles and studies in Italian and American magazines. He is interested in Metal Free techniques.
• Winner of the 2004 Polcan Aiop.
• He is a member of: ANTLO LAZIO ( National Association of Lab Owners) with the president of the Lazio region 2013-2014.
• National cultural manager ANTLO 2017-2020.
• Teacher of prosthetics perfectioning at the University of Chieti for the year 2002, he has been re-confirmed for the year 2003, 2004, 2005 to deal with Metal Free.
• Teacher of prosthetics perfectioning at the University of Naples 2006.
• He has participated as a speaker at numerous conferences in Italy. ESCD member has participated as a speaker at ten in Florence 2009 and Turin 2013.

MARCO NICASTRO

Marco Nicastro takes a degree in “Odontoiatria e Protesi Dentaria (Dentistry and Dental Prosthesis) at the University of Rome “ La Sapienza in 1989. Since the beginning he is interested in prosthesis restoration dentistry and aesthetic problems.

• From 1990 to 1996 he attends Prof. Martignoni’s studio, where he develops his prosthesis knowledge.
• From 1993 to 1998 he cooperates as lecturer with the Oral Design Centre in Rome, directed by Mr. Ferretti and Mr. Felli, giving lectures and courses about aesthetic restoration either in Italy or in foreign countries. In the same period he enlarges his experience in aesthetics, attending training courses at the University of Geneva, in Switzerland.
• Since 1993 he has been cooperating with Mr. Francesco Ferretti in the organization of Courses and Conferences, paying particular attention to metal free methodology.
• Vice President of the European Society of Cosmetic Dentistry (ESCD).
• Founding member and active member of Gimnasium interdisciplinary CAD-CAM (GICC).
• Active member of the Italian Society of Conservative Dentistry (SIDOC).
• Partner of the Italian Academy of Prosthetic Dentistry (AIOP).
• President of Like Mine Dental Education in Rome since 2001.
• He won, with Francesco Ferretti, the Polcan award of the Italian Accademy of Prosthetic Dentistry in 2004.

With so many different adhesives, cements, and restorative materials available on the dental market, it seems difficult to decide which products are best suited to fulfill the individual requirements. A direct comparison obtained through testing of all products in the dental office is simply impossible due to the great number of available solutions. Laboratory investigations provide information about specific product properties, but usually cannot create the overall picture. Moreover, the results of different tests are barely comparable due to variations in test conditions. Clinical study results are very useful as they shed light on clinical (long-term) performance of selected materials, but they are usually published years after a product’s launch. Hence, they are not available in the early stages. A great source of information are practice-based evaluations, as they support potential users in identifying high-quality dental materials.

One of the institutions conducting and publishing practice-based clinical evaluations and product performance tests is the US-based DENTAL ADVISOR. Once per year, the dental materials and equipment with the best performance receive a Top Product or Preferred Product Award. The list of winners is published online (www.dentaladvisor.com) and in the January-February issue of the DENTAL ADVISOR. In 2021, numerous products from Kuraray Noritake Dental Inc. were among the award winners.

Top Product Awards

CLEARFIL™ SE Protect received a Top Product Award in the category Direct Restoratives, Bonding Agent: Self-Etch. The self-etch adhesive is based on the formulation of the gold standard two-step self-etch adhesive CLEARFIL™ SE BOND but contains an extra MDPB monomer offering an antibacterial cavity-cleansing effect and fluoride for long-term fluoride release. The honoring of the DENTAL ADVISOR is based on a material test carried out by 13 DENTAL ADVISOR consultants and editors in their dental offices for six weeks. Due to its excellent performance, the antibacterial self-etch adhesive received a 98 percent clinical rating.

For the sixth year in a row, the Top Product Award in the category Direct Restoratives, Composite: Highly Filled Flowable went to CLEARFIL MAJESTY™ ES Flow.

The universal flowable composite that also became the Editor’s Choice comes in three different levels of flowability, from high to super low*. This enables the user to choose the right viscosity for every clinical situation – with the high flowability variant being the perfect choice for cavity lining and as a resin coat in IDS procedures, and the super low flowability option being specifically suited for direct veneer procedures and even for build-up of posterior cusps etc. The universal flowable composite was tested by 29 consultants of the DENTAL ADVISOR in more than 900 clinical applications. The evaluated properties – placement/handling, aesthetics, viscosity and polishability – were rated “excellent”. This led to a recommendation rate of 100 percent and a 98 percent overall clinical rating.

^{*DENTAL ADVISOR evaluated only the standard level of flowability (Low), because other two variants are not available in US.}

A product that earned recognition from the Dental Advisor for the seventh time already is TEETHMATE™ DESENSITIZER for hypersensitivity treatment.

The product that won a Top Product Award this year was designed to create hydroxyapatite (HAp), which is able to occlude open dentinal tubules and enamel cracks. This leads to a significant reduction of hypersensitivities when applied to exposed, mechanically treated or freshly prepared dentin. When used in the context of restorative treatment, TEETHMATE™ DESENSITIZER does not have a negative effect on the bond strength of dental adhesives or cements. A six-month clinical evaluation conducted by the DENTAL ADVISOR involving 27 patients with gingival recession-related hypersensitivity revealed that the use of the product is very effective in providing immediate and even long-term (six-months) hypersensitivity relief. This resulted in an excellent rating with a score of 96 percent.

In the category Self-Adhesive Cement, an additional Top Product Award went to PANAVIA™ SA Cement Plus. The dual-cure self-adhesive resin cement stands out due to its ease of use, favorable viscosity and an easy excess removal feature after tack-curing.

Preferred Products

Among the 2021 Preferred Products that also received an Editor’s Choice label is PANAVIA™ SA Cement Universal. The Top Product Award winning self-adhesive universal resin cement from 2020 contains the unique LCSi monomer. This monomer is a silane coupling agent, which has a unique long carbon chain in its molecule. This carbon chain establishes a durable, chemical bond with porcelain, lithium disilicate and composite resin without the need for a separate silane containing primer. The other key technology present in the formulation is the original MDP monomer, which ensures chemical reactiveness with zirconia, dentin and enamel. Together, the technologies ensure that PANAVIA™ SA Cement Universal produces a strong and durable bond with virtually every restorative material without the need for a separate primer. Its handling characteristics, aesthetics and gingival friendliness received very good to excellent ratings from 31 clinical evaluators, who used the cement in 516 applications. The result of the overall clinical rating was 96 percent.

Moreover, CLEARFIL™ Universal Bond Quick was honored as a Preferred Product by the Dental Advisor consultants for the second consecutive year.

The universal bonding agent may be applied using the self-etch technique or – together with K-ETCHANT syringe – in the selective enamel etch or total-etch technique. Containing our rapid bond technology – a combination of the original MDP monomer with innovative hydrophilic amide monomers – the adhesive works instantly and without the need for extended exposure times, application of multiple layers or extensive rubbing into the tooth structure. The fast and easy application procedure was one of the main reasons for the consultants of the DENTAL ADVISOR to select CLEARFIL™ Universal Bond Quick as a Preferred Product and Editor’s Choice with a 98 percent score in a clinical evaluation.

Finally, CLEARFIL™ CERAMIC PRIMER PLUS became a Preferred Product in 2019, 2020 and 2021, and an Editor’s Choice in 2021. It contains the original MDP monomer and a silane monomer, which ensure excellent bond strength to all kinds of restorative materials, i.e., to silica-based ceramics, zirconia, composites and even metals. Users benefit from procedural simplicity as the product is just applied and dried to the bonding surface after the recommended pretreatment. In a clinical evaluation, the product received a recommendation rate of 96 percent and a 96 percent overall score from the DENTAL ADVISOR consultants.

Conclusion

Most of the Kuraray Noritake Dental products that received an award this year are based on resin technologies, one of our key competencies. In the 1980s, we developed the original MDP monomer, a functional monomer, which is an essential component of any adhesive product we introduced down to the present day, including the award-winning CLEARFIL™ SE Protect, PANAVIA™ SA Cement Universal, CLEARFIL™ Universal Bond Quick and CLEARFIL™ CERAMIC PRIMER PLUS. This is only one of our many areas of expertise. We also provide users with preventive products and a whole range of restorative materials – from composite filling materials like CLEARFIL MAJESTY™ ES Flow to dental ceramics like KATANA™ Zirconia UTML, STML and HTML. We see the winning of the awards as a positive proof of a reliable product performance that supports dental practitioners in reaching their own goals.

Interview with Dr Imad Ghandour

In recent years, zirconia has emerged as the preferred choice for dentists who wish to perform restorative procedures with a reliable and metal-free material. With the recent development of multi-layered aesthetic high-translucency options, zirconia’s popularity has further increased. In comparison to the opaque whiteness of older generations of zirconia, these newer versions have an enhanced appearance and functionality that makes them suitable for natural-looking anterior restorations.

Kuraray Noritake Dental’s KATANA Zirconia disc range is made with a proprietary zirconia powder - processed in-house - that gives it its natural appearance. Suitable for zirconia prostheses, from single crown to full arch, it is an ideal option for restorations in both the anterior and posterior regions. We spoke with Dr Imad Ghandour, a prosthodontist with a strong scientific background and a private practice in Le Cannet in France, about his experiences with the KATANA Zirconia range in restorative procedures.

Dr Ghandour, when did you first start using zirconia as a material for your restorations?

In 1998, when I was still sintering manually, I began using zirconia alumina. It was nice to have an alternative to metal alloys that was much more aesthetic. From 2003, however, I started with VITA blocks, but only for frameworks - I would still build up with ceramics. Now, with so much of dentistry being digitally focused, there is a need for a material that can be milled without changing anything in the morphology of the teeth. Why? Because we need to be able to reproduce the treatment plan as accurately as possible. Simply put, the KATANA Zirconia range solves this need for me.

With respect to dentistry being digitally focused, how has this changed the role of the dentist regarding performing restorative procedures?

Well, it is clear that we have entered the age of digital dentistry. Around 80 per cent of restorations are conducted via CAD/CAM systems and without dentists even touching the materials themselves. There are great advances being made in the technologies that are available for everyday use in dental practices worldwide, and many of them can be used to assist dentists performing restorative procedures. It is important, though, to keep in mind that these technological advancements alone will not lead to better results - they should supplement the requisite hands-on skills and techniques that all dentists must first learn. With this base of fundamentals, we can then use digital dentistry to make restorative procedures more predictable and reproducible. Of course, to ensure the best results in restorative procedures, dentists also need to use the materials that have the best aesthetic and mechanical properties.

For how long have you been using Kuraray Noritake Dental’s KATANA Zirconia range, and what has your experience been?

I have been using KATANA Zirconia for a little bit more than one year. In that time, I have primarily used the KATANA Zirconia STML (Super Translucent Multi Layered) line and have been pleasantly surprised by how natural-looking the restorations I have made with the material are. For example, when I sinter a crown made of Katana Zirconia STML, I am amazed at how much the sintered material is reminiscent of a pearl - it truly brings to mind the idea of one’s teeth being one’s pearly whites.

When using KATANA, how do you ensure that you select the correct shade to achieve a natural look?

Firstly, no one - not a dentist nor a dental technician - can be absolutely certain that the shade and chroma of the restoration that is in one’s hand will be the same once it is in position in the oral cavity. This is due to the complexities of the oral environment - the pinkness of the gingivae, for one, can have a large impact on how the restoration appears, often making it seem far duller than it does in the light of a dental laboratory. This can cause dental practitioners to compensate and make prostheses that appear far brighter than they will when they are in place.

With a product like KATANA and its related glazing materials, however, I can create crowns and other restorations that have an optimal fluorescence and translucency and are able to maintain their shading better than any other ceramic material I have used. I am able to select a shade with the confidence that it will look exactly the same once placed inside the mouth, with its chroma remaining unabsorbed by the gingiva. Achieving a natural look, then, depends on choosing a shade that is as close to that of the surrounding dentition as possible. Since KATANA Zirconia UTML (Ultra Translucent Multi Layered) is available in 16 standard shades and a further four enamel shades, there is no shortage of options in this regard.

How does the multi-layered technology of KATANA Zirconia help you to achieve optimal and natural-looking aesthetic results?

Well, firstly, the layering of the material is designed to replicate the colour and translucency progression of natural teeth, which allows for restorations to blend in as much as possible. This multi-layered technology has also proved itself to be very handy when I am sintering crowns made of KATANA Zirconia. Simply put, if one sinters a crown quickly, it will be a little more opaque. If one sinters it at a higher temperature and quite slowly, it will be much more translucent. The multi-layered aspect of KATANA Zirconia is excellent in that it gives me the ability to make restorations more or less translucent depending on what is required.

With 40 years of success in the commercial dental products market, Kuraray Noritake Dental has firmly established its commitment to providing leading-edge solutions for adhesive dentistry. The 1983 introduction of the PANAVIA™ EX resin cement, which utilized Kuraray’s original MDP monomer technology, set the industry standard for adhesion and has continued to do so for over 30 years since. With PANAVIA™ V5, and PANAVIA™ SA Cement Universal which is the latest addition to PANAVIA™ family, Kuraray Noritake Dental presents a pair of resin cements designed for strong, durable bonding for zirconia-based and other restorations.

PANAVIA™ V5

PANAVIA™ V5 is a resin cement with exceptional procedural simplicity and predictability. It sets a new standard for adhesion to the KATANA™ Zirconia Block or other zirconia, allowing for self-cure dentine bond strengths equal to our gold-standard light-cure bonding agent, CLEARFIL™ SE BOND. PANAVIA™ V5 offers natural aesthetic stability in shading through its amine-free paste, which is available in five shades and has been scientifically proven to demonstrate a lower level of post-curing colour variance than other cements.

PANAVIA™ SA Cement Universal

PANAVIA™ SA Cement Universal is a forerunner in self-adhesive resin cements that adheres virtually to all materials including glass ceramics. The original silane coupling agent, LCSi monomer, incorporated in the paste creates a strong chemical bond to porcelain, lithium disilicate and composite resin. Available in an automix or handmix option, its high concentration of MDP monomer allows for increased chemical reactiveness with zirconia, which, combined with mechanical retention created by sandblasting, has been demonstrated as crucial for durable bonding to this material. Building upon the success of our PANAVIA™ SA Cement Plus, it offers a wide range of indications for adhesion and is suitable for crowns/bridges, inlays/onlays, posts, and even adhesion bridges.

Case by Aleksandra Łyżwińska, DMD

This clinical case concerns a patient with a lesion on the occluso-distal aspect of the mandibular left first premolar. We opted for a direct treatment approach with a combination of flowable and high-viscosity composite resin (CLEARFIL MAJESTY™ ES Flow - Super Low A2, CLEARFIL MAJESTY™ ES-2 Classic A2). In order to establish a strong bond between the tooth structure and the restorative material, we decided to selectively etch the enamel and then apply a clinically proven self-etch adhesive (CLEARFIL™ SE BOND 2).

Fig. 1. Initial clinical situation.

Fig. 2. Appearance of the premolar after caries removal.

Fig. 3. Placement of a sectional matrix for anatomical shaping, the establishing of tight interproximal contacts and protection of the adjacent tooth.

Fig. 4. Appearance of the tooth structure after selective enamel etching.

Fig. 5. Interproximal wall built up with CLEARFIL MAJESTY™ ES-2 Classic (A2 shade) and cavity filled with CLEARFIL MAJESTY™ ES Flow - Super Low A2.

Fig. 6. After initial polishing.

FINAL SITUATION

Fig. 7. Occlusal view of the treatment outcome after finishing and polishing.

Fig. 8. Follow up after 1 week.

Dentist:

ALEKSANDRA ŁYŻWIŃSKA
Warsaw, Poland

Aleksandra Łyżwińska, DMD, is a passionate aesthetic and adhesive dentist. Driven by Evidence Based Dentistry, her goal includes using modern composite materials and bonding agents in her clinical practise. In addition to her primary job, she worked as a lecturer and an assistant professor at the Department of Conservative Dentistry and Endodontics of Medical University of Warsaw, her alma mater.

Case by Dr. Michał Pokojski

Universal resin composites with a simplified shade concept are popular as they streamline direct restoration procedures. Unfortunately, many of the available products that claim to blend in well with the surrounding tooth structure independent of its shade need a blocker or opaquer to mask dark areas. According to Kuraray Noritake Dental, CLEARFIL MAJESTY™ ES-2 Universal is different. This is why I decided to test its Universal shade (U) designed for all kinds of restorations in the posterior region in the context of replacing an amalgam restoration.

The restoration that needed to be replaced due to secondary caries was located in the maxillary molar region of a male patient. As usual under amalgam restorations, the remaining healthy tooth structure showed some discolouration. The cavity was prepared, the enamel etched and the whole bonding surface treated with CLEARFIL™ SE Bond. Subsequently, the restoration was built up using CLEARFIL MAJESTY™ ES-2 Universal in several layers. For a natural appearance, some brown tint was added to the fissures before finishing and polishing. The restoration shows a natural integration into the surrounding structure and is able to mask the discolouration on the cavity floor.

Fig. 1. Pre-operative image showing the amalgam restorations to be replaced.

Fig. 2. Appearance of the tooth after removal of the amalgam, caries excavation and cavity preparation.

Fig. 3. Tooth built up with CLEARFIL MAJESTY™ ES-2 Universal (U shade).

FINAL SITUATION

Fig. 4. Immediate treatment outcome.

Dentist:

DR. MICHAŁ POKOJSKI

Dr. Michał Pokojski is a graduate of the Medical University of Łódź, Poland. He maintains his private practice in Starachowice, Świętokrzyskie Voivodeship. His passion is endodontics and esthetic conservative dentistry. In his everyday duties microscope and camera are his main tools to provide his patients with professional and precise procedures and to ensure proper level of communication and understanding. His practice was guided by EBD from the very beginning, because in his opinion knowledge, scientific facts and dedication for what you do are the fundamentals of medicine and dentistry as well. His goal is to treat patients at the highest level of quality using the best available materials, instruments and procedures. His cases are well-known in the world thanks to modern ways of communication like Facebook and Instagram.