Uudiste peateema
We wish you a successful New Year and hope you will join us on our journey in 2025.
Article by Dr. Florian Zwiener
Modern multi-layered zirconia such as KATANA™ Zirconia STML (Kuraray Noritake Dental Inc.) already meets high aesthetic demands due to its natural colour gradient and high translucency. To achieve further characterisation and optical adjustment to the adjacent teeth, there are essentially two options: veneering with feldspathic ceramic or glazing and individualisation with ceramic stains.
While there are still many indications for veneering, especially in the anterior area, more and more cases can now be solved with monolithic restorations. This allows for a time-efficient chairside workflow with same-day treatment, eliminating the need for temporary restorations. Additionally, the absence of a porcelain layer reduces the wall thickness of the restoration and thus the space required, allowing for less invasive preparation. This also reduces the risk of endodontic complications induced by tooth preparation (grinding trauma). Another advantage is a significant reduction in the chipping risk.
Below are the essential steps for individualisation using ceramic stains, demonstrated through the example of a molar crown.
The restoration is designed in full contour as usual, ideally dry-milled, and then sintered. After sintering, the restoration is first sandblasted (aluminium oxide 50 μm, 1 to 1.5 bar pressure). This microscopic roughening of the ceramic surface enables an optimal bond with the glaze. Subsequently, the restoration should be cleaned using a steam cleaner or an ultrasonic cleaner to remove all blasting residue.
The functional restoration surfaces must then be polished to avoid the risk of excessive abrasion on the enamel of the opposing dentition, as zirconia is harder than enamel. Following this, optional glazing and characterization with ceramic stains can be performed. However, for areas not in the aesthetic zone, such as the palatal surfaces of maxillary anterior teeth, this is not necessarily required.
Fig. 1. Sintered and sandblasted zirconia crown.
Fig. 2. Occlusal high-gloss polish.
Fig. 3. TWIST™ DIA for Zirconia (Kuraray Noritake Dental Inc.) enables efficient polishing of zirconia in three steps.
The shades A+, B+, C+, and D+ of the paste-like ceramic stain CERABIEN™ ZR FC Paste Stain (Kuraray Noritake Dental Inc.) enhance the chroma in the cervical area when applied in the respective tooth shade. They are used to strengthen the multicolour effect of the zirconia or to darken the restoration overall. By mixing the stains with glaze or clear glaze in different ratios, the intensity can be adjusted.
Cervical 1 and 2 are suitable for replicating exposed cervical areas or discolouration. Cervical 1 is also useful for marking fissures, as it gives the crown depth and structure without appearing overly dark. Patients typically reject excessively pronounced fissure effects. Since fissure areas in multi-layered materials generally lie in the lightest part of the block (in the enamel layer), it may make sense to darken them slightly with A+, while white hypermineralisations can be replicated on the cusp tips. A narrow band of Grayish Blue below the cusp tips creates an optical translucency effect. In cases where this translucency appears too dark blue or greyish, mixing Grayish Blue with Dark Grey can modify the appearance.
By mixing various colours, numerous different tones can be created. For instance, by adding Yellow to A+, its slightly brownish colour can be adjusted to a warmer, more yellowish tooth shade. It is generally advisable to capture the patient‘s tooth shade with a photo and a custom-made colour ring of the corresponding material before preparation. This can serve as a reference during production, especially in the laboratory, where lighting conditions may differ.
For pronounced characterisations or fine details, it may be necessary to carry out multiple firings to avoid unwanted running effects between the colours and the glaze. This is particularly recommended when replicating anatomical details with high sharpness, such as enamel cracks or local discolourations. For this, a glaze and base shade are first applied and fired, and finer structures are added in a second firing. Alternatively, a fixative firing of the stains without glaze can be performed first, with only a glaze layer fired in the second step. A benefit of CERABIEN™ ZR FC Paste Stain is that its appearance during application closely matches the final firing result. In thick consistency, glaze can also be used to easily rebuild missing proximal contacts.
Alternatives:
Fig. 4. CERABIEN™ ZR FC Paste Stain assortment for the practice laboratory.
Fig. 5. Discoloured fissures can be accurately replicated with an ISO10 endodontic file.
Fig. 6 and 7. Glazing and staining in one firing.
Fig. 8. Shade determination using a custom-made KATANA™ Zirconia STML colour ring (A3.5).
Fig. 9. Bridge made from KATANA™ Zirconia STML, sandblasted and occlusally polished.
Fig. 10. Finished glazed and characterised restoration.
Fig. 11. Bridge 14-16 in place.
Fig. 11. Bridge 14-16 in place.
Dentist:
FLORIAN ZWIENER
Before being allowed to market a dental composite filling material, it must, among other things, meet the set standards within ISO 4049:2019 Dentistry - Polymer-based restorative materials. Prompted by the tremendous positive response Kuraray Noritake Dental Inc. received from users of the CLEARFIL MAJESTY™ ES Flow series, we asked the Nordic Institute of Dental Materials (NIOM), an independent research institute, to test this product line on key aspects within the said ISO standard.
While it was not mandatory for us to have the CLEARFIL MAJESTY™ ES Flow series tested, our confidence in the quality of our product prompted us to do so. NIOM thoroughly evaluated CLEARFIL MAJESTY™ ES Flow in all three different levels of flowability: High, Low, and Super Low (Fig. 1). Among the properties assessed were depth of cure, flexural strength, water sorption and solubility, and colour stability after irradiation and water sorption. NIOM found that regarding all properties, the three flowabilities and different shades proved to comply with the requirements.
We are pleased to have gone the extra mile and proud that an independent party verified that our product meets the stringent ISO standards.
Fig. 1. CLEARFIL MAJESTY™ ES Flow in its three different levels of flowability.
These test results are an external proof for users of the popular flowable composite series that they safely can be used as specified by Kuraray Noritake Dental Inc. in the product’s instructions for use. The NIOM test results obtained regarding the depth of cure imply that, when applied to the recommended layer thickness, the composite will polymerise adequately – which is essential for a great long-term performance. In addition, all three flowabilities offer sufficient strength and water sorption/solubility behaviour even to be suitable for restorations, including the occlusal surface of molars and pre-molars. This means that the materials are very well suited for a wide range of indications, including restoring all cavity classes and repairing existing restorations and cementing (Fig. 2).
Fig. 2. Three variants of CLEARFIL MAJESTY™ ES Flow and the suggested use areas.
On top of these well-balanced mechanical properties, CLEARFIL MAJESTY™ ES Flow in its innovative syringe handles well due to an easy dispensing, bubble-free application, easy sculpting facilitated by its non-sticky formulation, and easy polishing behaviour. Coming in a variety of shades (Fig. 3) and equipped with proprietary Light Diffusion Technology, the material in its three different levels of flowability blends nicely and effortlessly with the surrounding tooth structure, creating a natural overall look. Both handling and aesthetics have been rated very good to excellent by dental advisor consultants in the context of a clinical evaluation.
Fig. 3. Overview of shades available per flowability.
NIOM also provides proof of the positive aesthetic properties: the institute's tests to evaluate colour stability after irradiation and water sorption reveal that CLEARFIL MAJESTY™ ES Flow is expected to remain stable over time. This feature is important for the long-term aesthetics of the restorations created with the materials.
Choose a reliable, high-quality, flowable, direct restorative material that withstands rigorous testing.
By Dr. Michał Jaczewski
Komposiitrestauratsiooni vastupidavus sõltub paljudest teguritest. Mõned neist on väljaspool hambaarsti kontrolli ja on tugevalt seotud patsiendiga. Näiteks mõjutavad restauratsiooni hambaharja ja hambapasta tüüp, harjamistehnika, toitumine, stimulandid ja hügieeniharjumused. Parima viimistlus- ja poleerimisprotokolli järgimine on aga täielikult hambaarsti kätes.
Õige poleerimise eesmärk on eemaldada hapniku inhibatsioonikiht ja tekitada sile restauratsiooni pind. Õigesti poleeritud restauratsioon ei ima toidu, joogi või stimulantide värvimisaineid, mis põhjustavad komposiidi värvimuutust, tagades seeläbi restauratsiooni algse väljanägemise püsimise.
Komposiidi poleerimine on protsess, millele tuleks erilist tähelepanu pöörata. See koosneb mitmetest etappidest ja põhimõtetest:
Kõigi tehnikate, sh ka voolava komposiidi tehnika puhul mõjutab poleerituse tase restauratsiooni vastupidavust ning optilisi ja esteetilisi omadusi. Seetõttu tuleks sellele pühendada piisavalt aega. Komposiite iseloomustavad erinevad koostised ja täiteainete hulgad, mis mõjutavad mitte ainult nende omadusi, vaid ka seda, kui lihtsalt neid saab poleerida. Mõnel juhul tuleb protseduuri korrata mitu korda, et saavutada „peegelsiledus“. CLEARFIL MAJESTY™ ES Flow on komposiit, mis on hoolimata selle suurest täiteaine sisaldusest lihtsasti poleeritav väga läikivaks. Spetsiaalselt kohandatud kummid, harjad ja pastad võimaldavad hõlpsalt luua sileda pinna, aidates seeläbi kaasa püsiva tulemuse saavutamisele.
BEFORE
AFTER
3-YEARS RECALL
PANE NAD LÄIKIMA, PANE NAD NAERATAMA!
Dentist:
MICHAL JACZEWSKI
Michał Jaczewski lõpetas 2006. aastal Wroclawi Meditsiiniülikooli ja juhib praegu erapraksist Legnica linnas Poolas. Ta on spetsialiseerunud minimaalselt invasiivsele hambaravile ja digitaalsele hambaravile ning on biofunktsionaalse oklusioonikooli asutaja. Siin peab ta loenguid ja viib läbi töötubasid, mis keskenduvad patsiendi täielikule tervikravile.
Article by Dr. Michał Jaczewski
Resin composites are wonderful restorative materials: They allow for minimally invasive, defect oriented tooth preparation, may be modelled as desired, and can be modified and repaired whenever necessary. To achieve all of this, however, a strong and long-lasting bond is an absolute requirement. The bond needs to be established either between enamel and dentin on one side and the resin composite on the other, or between the existing and the newly applied composite material.
Committed to keeping clinical procedures as simple as possible, I use an 8th-generation bonding agent – CLEARFIL™ Universal Bond Quick (Kuraray Noritake Dental Inc.) in my dental office. Containing Rapid Bond Technology, it allows for a particularly easy and straightforward use without the need for extensive rubbing or long waiting times. At the same time, it bonds well to various substrates including enamel, dentin and resin composite as it contains the original MDP monomer.
Its composition and resulting versatility make CLEARFIL™ Universal Bond Quick the first choice for many indications including non- to minimally-invasive repair procedures. As it works extraordinarily well in situations where we want to bond to dentin, enamel or old composite (Fig.1), it is usually not necessary to remove the whole existing restoration that needs to be repaired or modified. Instead, preparation may be limited to the composite part, so that no additional tooth structure needs to be removed.
Fig. 1. CLEARFIL™ Universal Bond Quick establishes a strong bond to dentin, enamel or old composite.
Depending on the condition of the existing restoration surface, the repair protocol may be slightly different. The basic steps are as follows:
- No surface treatment required, rinse with water in case of contamination with blood or saliva, followed by air-drying and (optionally) adhesive application
- Apply new layer of composite immediately
- Remove the composite around the defect and create a bevel at the cavity margin with rotating instruments
- Sandblast the surface with aluminium oxide particles
- Fresh composite surface: Clean the surface with KATANA™ Cleaner (Kuraray Noritake Dental Inc.) or etch with phosphoric acid etchant
- Composite surface older than two weeks: Etch with phosphoric acid etchant
- Apply the universal adhesive (which contains silane)
- Apply a new layer of composite
When an old composite restoration needs to be replaced – e.g. because the existing restoration shows discolouration or the patient asks for a brighter shade – it is possible to remove only a part of the composite and leave the rest in place to save the underlying healthy tooth structure. Accurate control over the amount of material removed and the amount of material left in place is offered by the use of UV light. Under UV light, the composite is perfectly visible (Fig. 2). Hence, a highly conservative structure removal is supported (Fig. 3).
Fig. 2. Controlling structure removal with UV light, which nicely reveals the old composite.
Fig. 3. Tooth preparation with rotating instruments.
Creating a clean, micro-retentive composite surface ideal for bonding: This is the aim of sandblasting the affected composite area with aluminium oxide particles (Fig. 4). The particle size I prefer is 27 μm. Residual particles, may be removed with 37% orthophosphoric acid, which needs to be rinsed off thoroughly before air-drying the surface (Figs. 5a and 5b).
Fig. 4. Air-abrasion with 27 μm aluminium oxide particles.
Fig. 5a. Phosphoric acid etching. Adjacent teeth are protected with PTFE tape.
Fig. 5b. Thorough rinsing to remove the etchant from the surface.
When bonding to old composite, silanisation of the surface is recommended to increase the bond strength. On dentin, a separate silane shows no positive effect. Hence, it is recommended to apply a separate silane to the composite surface only, a challenging task in situations with a surface consisting of tooth structure and composite. As CLEARFIL™ Universal Bond Quick contains silane, the separate silane application step may be skipped, which clearly simplifies the procedure (Figs. 6a and 6b).
Fig. 6a. Application of CLEARFIL™ Universal Bond Quick to the prepared surface.
Fig. 6b. Solvent evaporation with a gentle stream of air.
Whenever detected during restoration, defects in the composite layer or air bubbles can be repaired or eliminated right away. As long as the oxygen inhibition layer is still present, another layer of composite may be applied immediately without any prior steps. However, if the surface has been contaminated by saliva or blood (Figs. 7a and 7b) or it is unclear whether we are bonding to dentin, enamel or composite, CLEARFIL™ Universal Bond Quick may be applied (Fig. 8). On top, a new layer of composite is placed to restore the defect (Fig. 9).
Fig. 7a. Composite surface with a defect near the margin with blood contaminating the affected area.
Fig. 7b. Composite surface with a defect near the margin after thorough rinsing and drying.
Fig. 8. Application of the universal adhesive.
Fig. 9. Application of composite material to restore the defect.
If the defect is small, it is possible to apply the flowable composite directly and remove the excesses (Fig. 10). The obtaining of a natural shape and smooth transition between old and new composite, however, is simplified by the use of a silicone index or matrix (Fig. 11), which might still be present from the original restoration procedure. A possible outcome of this type of repair is shown in Figure 12; both images were taken prior to finishing and polishing.
Fig. 10. Flowable composite spreading and excess removal.
Fig. 11. Silicone index placed over the teeth including the tooth with the defect.
Fig. 12. Outcome of the flowable injection procedure.
Elimination of bubbles or defects in a freshly created restoration, changes in the colour of an existing filling or a shape correction due to wear processes: Modifying composite restorations can be easy – provided that appropriate materials and techniques are used. One of the key elements on the path to success is the selection of a suitable adhesive system, preferably a universal single-bottle adhesive like CLEARFIL™ Universal Bond Quick, which allows for streamlined procedures and supports excellent outcomes. By respecting the provided tips, it is possible to create the desired outcomes in a minimally invasive, straightforward way, laying the foundation for long-lasting aesthetics and function.
Dentist:
MICHAŁ JACZEWSKI
Michał Jaczewski graduated from Wroclaw Medical University in 2006 and today runs his private practice in the city of Legnica, Poland. He specializes in minimally invasive dentistry and digital dentistry and is the founder of the Biofunctional School of Occlusion. Here he lectures and runs workshops with focus on full comprehensive patient treatments.
Leaving work at work, unplugging your mind from the dental office is not rocket science - provided that high-quality dental materials are used. Ideally, they are well-adapted to operator, case, and patient-specific needs. When it comes to restoring cavities with composite, Kuraray Noritake Dental Inc. has got the right products for any dental professional.
The CLEARFIL MAJESTY ES family of dental composites is composed of different product lines designed to meet specific needs. Altogether, the line-up offers a solution for every technique and handling preference, clinical situation and patient requirement.
When utmost simplicity is desired, a highly innovative universal solution such as CLEARFIL MAJESTY ES-2 Universal is an excellent choice. This paste-type composite system includes only four shades: Universal, Universal Light, Universal Dark, and Universal White.
The Universal shade has the highest translucency and is, therefore, most suitable in cases where several cavity walls are still present, such as in Class I or II cavities and the cervical area. In cavities where light easily passes through, the lower-translucency variants Universal Light (for teeth with shades up to A3) and Universal Dark (for teeth darker than A3) are the best options. Universal White is the go-to solution for young patients and whitened teeth. Consequently, there is usually no need for a shade guide, and the optical properties allow application without an opaquer or blocker in most of cases. Both features greatly simplify the clinical procedure.
Clinicians who prefer classical single-shade layering according to a shade guide and a greater number of shades available may prefer CLEARFIL MAJESTY ES-2 Classic. With a line-up of 18 shades, it supports straightforward procedures and leads to aesthetic results.
Whenever the aesthetic needs are very high, such as in the context of restoring a large cavity in the aesthetic anterior region, CLEARFIL MAJESTY ES-2 Premium may be the best option. Designed for simplified multi-shade layering, it comes with fixed shade combinations of dentin and enamel opacity, that greatly support predictable outcomes.
All the CLEARFIL MAJESTY ES paste-type composite systems offer a well-balanced viscosity and excellent mechanical properties, including
A flowable composite completes the portfolio. As the ideal level of viscosity depends on individual preferences and on the specific indication, CLEARFIL MAJESTY ES Flow comes in three different flowabilities: high, low and super low.
They have:
In addition, they are well-received for their easy application, fast polishing and high polish retention. All these features make the product a true versatility powerhouse. Moreover, it is offered in an innovative syringe designed for bubble-free application of the desired amount of composite and easy modelling.
The CLEARFIL MAJESTY ES portfolio offers highly suitable products for many clinical situations, demands and treatment techniques. As they support predictable outcomes and long-lasting success, using them gives dental practitioners the peace of mind needed to leave work at work and truly enjoy their free time—in the evening at home, on weekends or on holiday.
For more information about Kuraray Noritake Dental Inc.’s composite solutions visit the website.
Article by Dr. Michał Jaczewski
When working with composite, one of the most important aspects is to understand the mechanisms of adhesion. Choosing the right composite is one thing, but choosing a suitable bonding system and using it correctly is an equally important aspect affecting the long-term performance of a direct restoration.
There are many bonding products on the market - two-bottle (primer and bond) but also single-bottle systems. For anyone trying to select an ideal adhesive for a specific clinical case, the sheer number of available products can be challenging. The temptation to use them all, in slightly different ways, has the potential to create errors. In my dental practice, I am committed to simplifying procedures.
This is why I started looking for a bonding system that would offer a sense of security in terms of adhesion, but also ease of use in different clinical situations. I have opted for the 8th-generation bonding agent with the desired features - CLEARFIL™ Universal Bond Quick (Kuraray Noritake Dental Inc.). The single-bottle universal adhesive is ideal for a broad variety of bonding procedures carried out in the dental office.
CLEARFIL™ Universal Bond Quick can be used in the total-etch as well as the selective enamel etching technique in combination with an etching gel such as K-ETCHANT Syringe (Kuraray Noritake Dental Inc.). It is also a self-etching adhesive. Used in combination with the dual-cure build-up material CLEARFIL™ DC CORE PLUS or the dual-cure universal resin cement PANAVIA™ SA Cement Universal (both Kuraray Noritake Dental Inc.), it is also an ideal choice for cementation in the root canal and for cementing inlays or crowns made of a variety of different restorative materials – from metal to zirconia or lithium disilicate. Efficient clinical procedures are supported by the incorporated Rapid Bond Technology, which eliminates the need for extensive rubbing or waiting for the adhesive to penetrate the substrate and the solvent to evaporate. Among the key components of this technology are hydrophilic amide monomers, which allow the adhesive solution to penetrate moist dentin extraordinarily quickly, while also having a high curing ability. In addition, the original MDP monomer is included in the formulation. Together with the amide monomers, it provides for a high bond strength to enamel and dentin – achievable in a simple procedure of application, air-drying and light-curing.
The described properties turn CLEARFIL™ Universal Bond Quick into one of the most versatile and easy-to-use adhesive bonding solutions in the dental office. Operator sensitivity is low, as is its technique sensitivity, since the three-step procedure is always the same. The following case examples illustrate its use in the context of different repair procedures.
One of the major benefits of using composite as a restorative material lies in the fact that it may be modified and repaired at any time. Regardless of whether an air bubble is detected on the surface, the shade needs to be adjusted, a fracture occurs or materials need to be added as a result of wear, modification or repair is easily accomplished without needing to sacrifice additional amounts of healthy tooth structure. Whenever a silicone index has been produced for the initial treatment and is still available, and the user knows which composite has been utilized for the original restoration, the Flowable Injection Technique may be selected as a particularly easy and efficient way of repairing a restoration. However the recommended protocol is slightly different depending on the state of the restoration surface.
When a restoration has been damaged or an air bubble has appeared during injection of a flowable composite, the procedure is slightly different. In this case, the oxygen inhibition layer is usually still present on the surface of the restoration. Therefore, it is possible to simply apply an additional portion of composite (Figs. 1a to 1d). Even after contamination of the composite surface with water, saliva or blood, this measure is possible. The surface merely needs to be rinsed thoroughly and dried before applying the new portion of composite. For maximum safety, a universal adhesive may be used as well.
Fig. 1a. Repair procedure applicable for defect within a composite restoration whenever the oxygen inhibition layer has not yet been removed: Air bubble detected in the interproximal region.
Fig. 1b. Application of a new portion of composite after rinsing and drying. The adjacent surface is protected with PTFE tape.
Fig. 1c. Repositioned silicone index used to give the restoration the originally planned shape.
Fig. 1d. Final restoration.
If a similar defect is detected during finishing and polishing, i.e. when the oxygen inhibition layer has already been removed (Fig. 2), a roughening of the surface is strictly necessary. With a bevelled preparation of the area with the air bubble, optimal conditions are created for another layer of composite that blends in well with the surrounding material (Fig. 3). After bevelling, the surface needs to be sandblasted and cleaned either with KATANA™ Cleaner (Kuraray Noritake Dental Inc.) (Fig. 4a) or with 37 % orthophosphoric acid (Fig. 4b). After thorough rinsing and drying, an additional portion of composite may be applied to the surface (Figs. 5a to 5c). As the defect is small, the composite may be applied instead of injected and the silicone index repositioned afterwards.
Fig. 2. Void on the surface, detected during finishing.
Fig. 3. Removed void and bevelled area around the defect.
Fig. 4a. Option 1: Cleaning of the surface with KATANA™ Cleaner.
Fig. 4b. Option 2: Etching with K-ETCHANT Syringe.
Fig. 5a. Application of composite (CLEARFIL MAJESTY™ ES Flow Low).
Fig. 5b. Repositioning of the original silicone index to obtain the desired shape.
Fig. 5c. Final restoration with a nice blend-in of the different layers of composite.
For damaged restorations which have been in place for more than two weeks, an ideal composite-composite interface needs to be created by bevelling and roughening of the surface. A perfect example is presented in Figure 6. The most important step influencing the success of the procedure is proper preparation of the composite surface. To lay the foundation for a strong bond between the new and the old composite as well as for aesthetic outcomes, a bevel needs to be created (Figs 7a and 7b) to facilitate a smooth transition between the two layers. Once the bevel is completed, the surface should be sandblasted with alumina particles sized 27 μm (Fig. 8). The following recommended steps are etching of the composite with 37 % orthophosphoric acid (Fig. 9) and finally application of CLEARFIL™ Universal Bond Quick (Fig. 10). As the universal adhesive contains a silane coupling agent, separate silane application is not necessary. Instead, the new layer of composite may be applied immediately e.g. using the flowable injection technique with an existing matrix (Fig. 11).
Fig. 6. Fractured anterior composite restoration benefitting hugely from repair – the remaining composite is in a great state regarding colour and shape.
Fig. 7a. Bevelling with dedicated instruments.
Fig. 7b. Ideal bevel created to provide for a strong bond and great optical blend-in.
Fig. 8. Sandblasting of the surface with alumina particles.
Fig. 9. Phosphoric acid etching.
Fig. 10. Application of the universal adhesive.
Fig. 11. Composite applied using the flowable injection technique.
Fig. 12. Treatment outcome.
The three described repair protocols are straightforward and work well – provided that a strong bond is established at the composite-composite interface. The way it is established may be slightly different depending on whether the oxygen inhibition layer is still present or has already been removed. Using a universal adhesive like CLEARFIL™ Universal Bond Quick, the procedure is simplified owing to elimination of steps such as the separate application of silane.
Dentist:
MICHAŁ JACZEWSKI
Michał Jaczewski graduated from Wroclaw Medical University in 2006 and today runs his private practice in the city of Legnica, Poland. He specializes in minimally invasive dentistry and digital dentistry and is the founder of the Biofunctional School of Occlusion. Here he lectures and runs workshops with focus on full comprehensive patient treatments.
Artikli autor dr. Michał Jaczewski
Komposiitrestauratsioon on kõige tavalisem protseduur, mida hambaarst läbi viib. Hambaarstide kasutuses on palju erinevaid restauratiivseid tehnikaid ja materjale. Sõltumata materjali tüübist, restaureerimismeetodist ja selle kasutuskohast on põhiliseks probleemiks õhumullid komposiitkihtide pinnal või sees. Komposiitrestauratsioon peab olema homogeenne, et tagada täidise tihedus ja vastupidavus. Mullide defektide parandamine on tülikas ja nõuab mõnikord täidise või selle osa asendamist. Defektide hulk võib varieeruda sõltuvalt komposiidi tüübist (voolav või pasta) ja/või paigaldustehnikast, kuid teada on mitu peamist tegurit.
Voolava komposiidi süstimistehnika puhul kasutame voolavaid komposiite, mis ilmselgelt voolavad kergesti, kuid on ka tundlikud kasutustehnika suhtes. Esimene õhumullide tekkimise põhjus on materjali enda homogeensus. Mulle võib süstlasse sattuda tootmise etapis või kasutamise ajal. Kasutades parimaid tooteid, saame olla kindlad, et materjal on kõrgeima kvaliteediga ja et süstla struktuur ja disain vähendavad kasutamisel õhumullide tekkimise tõenäosust materjalis.
CLEARFIL MAJESTY™ ES Flow komposiit on loodud vältima õhumullide teket doseerimise ajal. Süstla ja kolvi eriline disain piiravad materjali tagasivoolu võimalust doseerimise ajal või pärast seda ja samuti vähendavad tilkumise võimalust.
Unikaalne O-rõnga konstruktsioon süstla sees takistab materjali voolamist pärast rõhu vabanemist ja väldib kolvi liigset tagasitõmbumist.
Teine õhumullide tekkimise põhjus on õhu sattumine süstlasse kolvi tahtliku tagasitõmbamise teel. Kui hambaarst või assistent on harjunud pärast komposiidi manustamist kolbi tagasi tõmbama, võib õhk süstlasse pääseda. Edasisel kasutamisel tekib restauratsiooni tõenäoliselt õhutühimik.
Voolava komposiidi süstetehnikas kasutatakse silikoonvormi, millesse lisatakse materjali hamba ülesehitamiseks. Vorm peaks hamba külge tihedalt sobituma ja ei tohi süstimise ajal liikuda. Kui see juhtub, võivad tekkida õhumullid. Vormi vajutamine ja seejärel vabastamine põhjustab vaakumefekti ja tõmbab komposiidi nii hamba kui ka vormi küljest eemale. Defektide vältimiseks tuleks vormile pidevat survet avaldada alates materjali süstimisest kuni polümerisatsioonini.
Silikoonvormi erinevaid modifikatsioone saab kasutada selle liikuvuse piiramiseks ja hamba suhtes kontrollimatu surve riski vähendamiseks. Selline näide on interlip (vahelduva hamba) mudeli põhjal valmistatud vorm, mis tagab suure stabiilsuse ja tööohutuse.
Teine põhjus õhu sattumiseks restauratsiooni on süsteaugu suurus. Kui auk on liiga kitsas, võib otsiku sisestamise või kasutamise ajal vorm paigast liikuda. Selle probleemi vältimiseks võiks auku laiendada, et võimaldada otsiku lihtne sisestamine ja kasutamine süstimise ajal. Laiem avaus võimaldab õhul doseerimise ajal väljuda. Kõige olulisem on aga materjali peale kanda pidevat rõhku avaldades ja vältida otsiku vormist väljatõmbamist ja uuesti sisestamist. See võib põhjustada ebaühtlast komposiitkihti.
Kas soovite rohkem teada voolava süstimistehnika kohta? Lugege põhjalikku ja inspireerivat intervjuud Michal Jachzewski
Hambaarst:
MICHAL JACZEWSKI
Michał Jaczewski lõpetas 2006. aastal Wroclawi Meditsiiniülikooli ja juhib praegu erapraksist Legnica linnas Poolas. Ta on spetsialiseerunud minimaalselt invasiivsele hambaravile ja digitaalsele hambaravile ning on biofunktsionaalse oklusioonikooli asutaja. Siin peab ta loenguid ja viib läbi töötubasid, mis keskenduvad patsiendi täielikule tervikravile.
Intervjuu Michał Jaczewski
Voolavate komposiitide süstimise tehnika on muutumas populaarseks tehnikaks, mida kasutatakse mitme hamba esteetiliselt restaureerimiseks voolava komposiidiga. Michał Jaczewski on tunnustatud instruktor, kes õpetab hambaarstidele seda tehnikat. Ta lõpetas Wroclawi Meditsiiniülikooli (Poola) 2006. aastal ja juhib alates 2011. aastast oma erapraksist Legnica linnas. Michal on Biofunktsionaalse Oklusiooni Kooli asutaja, mis viib läbi koolitusi tervikliku hambaravi valdkonnas ning tunneb suurt huvi digitaalse esteetilise hambaravi vastu. 2023. aastal Kölnis rahvusvahelisel hambaarstide näitusel näitas ta meile, millal, miks ja kuidas ta kasutab oma hambaarstipraksises voolava komposiidi süstimise tehnikat.
Voolava komposiidi süstimise tehnika võimaldab lihtsal, ootuspärasel ja korrataval moel taastada hambaid voolava komposiidiga. See põhineb vahamudelil, mille põhjal valmistatakse silikoonist vorm. See vorm täidetakse seejärel voolava komposiidiga, mis valguskõvastatakse läbipaistva silikooni kaudu. Selle tehnika suurim eelis on, et see toimib hamba ettevalmistuseta või väga vähese ettevalmistusega. See on minimaalselt invasiivne tehnika, mida võivad kasutada nii algajad kui ka kogenud hambaarstid. Kasutades hästi tasakaalustatud opaaksusega komposiiti paksusega 0,3 mm ja spetsiaalset poleerimisprotokolli, on võimalik saavutada suurepäraseid morfoloogilisi ja optilisi tulemusi.
Seda tehnikat hakkasin kasutama 2018. aastal. See leiutati algselt esihammaste restaureerimiseks, kuid tänapäeval kasutatakse seda edukalt ka tagumises piirkonnas. Minu arvates on see eriti kasulik, kui patsiendi naeratuse nimel on vaja parandada mitme hamba kuju, olenemata sellest, kas patsient on noor või vana. See võib olla vajalik pärast ortodontilist ravi. Hambad ühtlustatakse ja seejärel taastatakse nende täiuslik kuju selle mitteinvasiivse tehnikaga. Kasutan ka voolava komposiidi süstimist naeratuse ümberkujundamiseks, kulunud hammaste taastamiseks ja oklusiooni vertikaalse mõõtme muutmiseks kogu suu rekonstrueerimise kontekstis. Viimasel juhul võib restauratsioon olla ajutine ja seda kasutatakse keskmise kuni pikaajalise ravi „testimiseks“. Kuid see võib olla ka lõplik restauratsioon.
Plaanimise etapp mõjutab selle tehnika edukust kõige rohkem. See hõlmab dokumenteerimisest, jäljendi võtmist ning vahamudeli ja näidisvormi loomist, samuti silikoonist vormi loomist. Muidugi saate ka töötada traditsioonilisel viisil, kasutades silikoonjäljendit ja harilikku näidisvormi, kuid selles etapis teeb digitaaltehnoloogiate kasutamine töövoo palju lihtsamaks. Alustan tavaliselt foto ja video tegemisega ja digitaalse jäljendi loomisega. Samuti on vaja dokumenteerida kesktelg ja oklusioon. Seejärel saab luua virtuaalse näidisvormi, kasutades digitaalset hammaste kujundamistarkvara. Selles etapis on oluline arvestada patsiendi näo omapäradega. Seda saab parimini saavutada näo harmoonia (facial flow) kontseptsiooni põhjal. Loodud kujunduse põhjal saab näidata virtuaalse ravi tulemust ja seda patsiendiga arutada. Kui see on heaks kiidetud, prinditakse vahamudel erinevates versioonides: täielik vahamudel ja interlip-mudel, millel vahelduvad vahamudeliga ja vahamudelita hambad. Neid mudeleid kasutatakse, et luua läbipaistvast silikoonist soovitud vorm.
Digitaalne naeratuse kujundamine: tugevalt kulunud hammastega patsient.
Virtuaalne vahamudel patsiendi suus.
Virtuaalse maketi alusel prinditud mudelid.
Silikoonmudel, mis on valmistatud vahelduva (interlip) mudeli alusel.
Täieliku ja vahelduva (osalise) silikoonvormi kasutamine on eriti kasulik, kui kavatsete taastada kõik ülalõua hambad. Vahelduva vormiga alustamine on stabiilsem ja loob aluse täpse tulemuse saavutamiseks, eriti seoses kavandatud oklusiooni kõrgusega. Alalõual, kus vormi ja komposiidi käsitlemine on sülje ja liikuvate pehmete kudede tõttu raskem, soovitan alati töövälja jagada kolmeks osaks - üks eesmine ja kaks tagumist piirkonda - ja nendega eraldi tegeleda.
Enamikul juhtudel on vaja ainult sidustamiseks karestada emaili pinnad, mida saab tavaliselt teha õhkabrasiooniga alumiiniumoksiidiga (50 pm madalal rõhul). Seejärel söövitatakse email fosforhappega ja kantakse peale universaalne sidusaine. Silikoonvorm on varustatud süstimisavaga lõikeserva ääres. See on kergesti tehtav, surudes voolava komposiidi süstla nõela läbi materjali seestpoolt väljaspoole. Tagahammaste piirkonnas võib olla kasulik kasutada kõvemat materjali ja teha iga hamba jaoks eraldi köbrukestel kaks auku - üks süstimiseks ja teine väljavooluks. Kõva vormi puhul võib selle protseduuri jaoks vaja minna teemantpuuri. Panen vormi paika, süstin voolavat komposiiti alt üles, valguskõvastan materjali natuke aega ja eemaldan vormi. Lõplik polümerisatsioon viiakse läbi pärast vormi eemaldamist ja glütseriinigeeli kihi pealekandmist. Kui liigne materjal on eemaldatud ja restauratsiooni proksimaalne osa on täielikult viimistletud, korratakse protseduuri teiste hammaste puhul enne restauratsioonide poleerimist.
Silikoonvormi jaoks kasutan EXACLEAR-i (GC), kuna see on turul saadaolevast silikoonist kõige läbipaistvam. Minu lemmik komposiit voolava süstimistehnika jaoks on vähese viskoossusega CLEARFIL MAJESTY™ ES Flow (Kuraray Noritake Dental Inc.). Olen enda hambaarstipraksises ja kursuste ajal saanud võimaluse testida palju erinevaid tooteid. Selle põhjal arvan, et Kuraray Noritake Dental materjalidel on mõned eelised. See on kaasaegne nano-komposiit, millel on lai kasutusala ja suur toonide valik. Kolme viskoossuse astmega saab seda kasutada erinevates kliinilistes olukordades. Ma hakkasin seda kasutama viis aastat tagasi ja voolava süstemeetodi jaoks on minu esimene valik vähese viskoossusega variant, kuna see on kõige universaalsem ja sobib nii eesmiste kui ka tagumiste hammaste jaoks. Peamised eeliseid, mis mõjutasid minu otsust seda kasutada, on selle loomulik esteetika ja parem poleeritavus. Hea tulemus on võimalik saavutada ilma eriliste oskusteta. Sidusainena eelistan kasutada CLEARFIL™ Universal Bond Quicki, mis muudab tööprotsessi veelgi lihtsamaks, kiiremaks ja korratavamaks. Poleerimiseks olen välja töötanud oma protokolli.
Alustan proksimaalsest piirkonnast poleerimisribadega ja mõnikord proksimaalse saega. Kuju kohandamiseks on osutunud kasulikuks kolm erinevat teemant- ja karbiidpuuri. Seejärel jätkan peenete või eriti peenete Sof-Lex™-i viimistlus- ja poleerimisketastega (3M), mida kasutatakse kontuurimiseks ja viimistlemiseks, ning komposiidi kummist poleerijatega TWIST DIA™ (Kuraray Noritake Dental Inc.), millega saab väikse vaevaga anda hea ja loomuliku pinnaläike. Seejärel kasutan kitsekarvadest ratasharja ja teemantpoleerimispastat (Diamond excel, FGM) ning viimasena puuvillast ketast alumiiniumoksiidist poleerimispastaga (Pasta Grigia II, anaxDENT). Sel viisil on võimalik luua peegelsile pind.
Emaili söövitamine fosforhappega.
Silikoonvorm on paigas.
Toote CLEARFIL™ Universal Bond Quick kasutamine.
Olukord vahetult pärast CLEARFIL MAJESTY™ ES Flow (Low) süstimist, valguskõvastamist ja silikoonvormi eemaldamist.
Proksimaalsed kohandused pöörlevate instrumentidega.
Suurim eelis patsientidele ja hambaarstidele on ajasääst ja odav hind. Paljud patsiendid ei saa endale keraamilisi laminaate lubada ning võtavad avasüli vastu kvaliteetse alternatiivi, mille saab ära teha ühe visiidi jooksul. Protseduur ei nõua ettevalmistamist ja restauratsiooni saab hõlpsalt parandada või selle värvust muuta, mis tähendab, et protseduur on peaaegu riskivaba. Hambaarstid saavad tavaliselt alustada patsientide ravimist koheselt peale ühe koolituse läbimist. Kuigi harjutamine teeb meistriks, on selle toote puhul juba esimesed tulemused tihti üpris muljetavaldavad. Seetõttu ei ole algajate puhul aja- ja materjalikulu kuigi suur. Muidugi võite pühendada palju aega viimistlus- ja poleerimisprotseduuridele, kuid samas suudate kindlasti leida optimaalse tasakaalu töö ja tulemuse vahel.
Voolava süstetehnika instrumentide komplekt.
Esiteks tahaksin julgustada kõiki pidevalt oma mugavustsoonist välja tulema ja proovima midagi uut. Minu jaoks oli voolava süstetehnika kasutusele võtmine tõeline mängumuutja ja ma ei tahaks kunagi enam ilma selleta töötada. Enne selle tehnika kasutamist soovitaksin kindlasti osaleda kursusel, mis õpetab kogu teoreetilist poolt, mida on vaja teada edukaks esimeseks juhtumiks, ja võib-olla isegi praktilist töötuba.
Michał Jaczewski esitluse ajal Kuraray Noritake Dentali alal Kölnis.
When you are a lab owner striving to achieve high-end results using modern digital techniques, the initial investment in CAD/CAM technology is significant, followed by ongoing costs for expendable items such as milling tools and blanks. That cost can be reduced by selecting universal, high-quality materials.
Undoubtedly, zirconia stands out as one of the most popular materials on the market. From an inventory perspective, however, lab owners often find themselves purchasing multiple discs of the same shade and thickness. The reason is that they need to meet all requirements for strength and aesthetics in different settings – enabling them to cover all kinds of restorations and deliver excellent patient outcomes.
At Kuraray Noritake Dental Inc., we take pride in not only developing the first-ever multilayer zirconia, KATANA™ Zirconia ML, but also in our commitment to delivering the highest quality materials that we can.
KATANA™ Zirconia YML, our latest addition to the KATANA™ Zirconia line-up, exemplifies this dedication and offers universal applicability. The universal feature is based on the fact that KATANA™ Zirconia YML disc not only offers colour gradation, but also impressive flexural strength and translucency gradation, with maximum values of up to 1,100 MPa and 49 % translucency, respectively.
Like all our zirconia offerings, KATANA™ Zirconia YML begins its journey to the dental lab in our Japanese facility where raw zirconia powder undergoes special treatment process before the addition of essential components.
Once the material has undergone this thorough initial stage, it progresses to the pressing and pre-sintering phase to form the disc. Every detail is carefully calculated, managed and controlled. This phase of the process takes several days, underscoring our goal to achieve the most aesthetic product.
The unique powder formulation and refinement process, as well as the pressing and pre-sintering technique, is the key to allow our customers to realize restorations of up to three-unit bridges without any compromise in terms of aesthetics or mechanical properties using the 54-minute high-speed sintering* process.
This high quality, lengthy production process results in an exceptionally dense material, which once sintered, goes on to deliver a high strength, high aesthetic final restoration.
Outstanding deformation stability during the sintering procedure, contributes to the stability during the final sintering process in the dental laboratory, providing for an exceptional fit of large-span bridges and other restorations.
To enhance aesthetic qualities, all KATANA™ Zirconia YML discs are designed using ratios rather than fixed measurements of different layers in the multi-layered structure. This means that regardless of the disc's thickness, there is always a consistent ratio of 35 % of raw material that constitutes the translucent enamel zone. Hence, discs with an increased height, which are typically used for the production of larger restorations, will always offer sufficient space in the enamel zone, while smaller discs are optimized for smaller restorations.
These qualities empower dental lab owners to deliver a wide range of restorations. The material is suitable for single crowns to full-arch structures, for full-contour designs to conventional frameworks, using a single material without compromising on aesthetics: KATANA™ Zirconia YML. For finishing, we offer a well-aligned portfolio of solutions designed for internal and external staining, micro-layering and full layering.
Visit our website to discover more about KATANA™ Zirconia YML. You will find useful materials such as brochure, technical guide, in-depth technical information.
Would you like to see the material in action – browse the blog section of our website that offers a variety of clinical cases and articles by world-renowned experts showcasing and proving the versatility and aesthetics of KATANA™ Zirconia YML.
*The material is removed from the furnace at 800°C. A furnace with a configurable KATANA™ Zirconia YML firing program is required.
