Dr Julien Molia juhtum

JAH, SEE TÖÖTAB!

Paljude hambaarstide jaoks on saanud selgeks, et voolavaid komposiite on hea kasutada tugevamate pakitud komposiitide ja indirektsetele restauratsioonide alusmaterjalina või ajutise materjalina. Paljud neist aga eeldavad, et nende kasutusala on kehvade mehaaniliste omaduste tõttu piiratud.

UUS VOOLAVATE KOMPOSIITIDE PÕLVKOND

Õnneks ei vasta see enam tõele. Mitmed uusima põlvkonna voolavad komposiidid – näiteks CLEARFIL MAJESTY™ ES Flow ja CLEARFIL MAJESTY™ ES Flow Universal (Kuraray Noritake Dental Inc.) – on mehaaniliste omadustega, mis on võrreldavad paljude pakitavate alternatiividega. Seetõttu on näidustuste valik oluliselt laienenud. Näiteks CLEARFIL MAJESTY™ ES Flow Universalil on tootja andmetel kõrge täiteaine sisaldus (75–78 massiprotsenti), paindetugevus üle 150 MPa ning survetugevus üle 370 MPa. Tänu oma tugevusele on see usaldusväärne ja püsiv lahendus, sobides ka koormustkandvatesse piirkondadesse, nagu on tagumiste hammaste oklusaalpinnad.

Sellel voolaval komposiidil on aga eeliseid veelgi. See on saadaval kahes voolavuse astmes – LOW ja SUPER LOW –, et vastata nii erinevatele isiklikele eelistustele kui ka spetsiifilistele näidustustele, ning vaid kahes toonis (universaalne ja universaalne tume). Kahe tooniga saab toone intuitiivselt valida isegi esihammaste piirkonnas. Seda võimaldavad erinevad tehnoloogiad, sealhulgas optimeeritud valgusdifusiooni tehnoloogia ja emaililaadne läbipaistvus.

Järgnev kliiniline juhtum näitab, kuidas CLEARFIL MAJESTY™ ES Flow Universal muudab tagahammaste restauratsioonide teostamise oluliselt lihtsamaks.

JUHTUMIUURING

Patsient pöördus vastuvõtule eesmärgiga asendada alalõua parempoolsetes molaarides (hambad nr 46 ja 47 vastavalt FDI tähistusele) kaks amalgaamrestauratsiooni (joonis 1). Et hõlbustada täitmist ja tagada kohandumine kaviteedi seintega, otsustati kasutada ainsa materjalina CLEARFIL MAJESTY™ ES Flow Universali (LOW). Restaureeritavate hammaste asetus tegi tooni valiku lihtsaks. Toon U (universaalne) on loodud sobima ideaalselt kõigi tagahammaste restauratsioonideks.

Amalgaamrestauratsioonid eemaldati ja kaaries puhastati, säilitades seejuures võimalikult palju tervet hambakude (joonised 2 ja 3). Valiti selektiivne emaili söövitusmeetod, millele järgnes universaalse adhesiivi (CLEARFIL™ Universal Bond Quick 2, Kuraray Noritake Dental Inc.) pealekandmine. Seejärel täideti kaviteet CLEARFIL MAJESTY™ ES Flow Universali LOW versiooniga ja kaviteetidele kanti valitud toon U (joonis 4). Tänu süstla uuenduslikule disainile ei sisalda pealekantav voolav komposiit sisuliselt üldse tühimikke. Järgides toote kasutusjuhiseid, ei ületanud iga kihi paksus 2 millimeetrit (joonised 5 ja 6). Sellel on otsustav mõju lõpliku restauratsiooni pikaajalisele toimivusele. Igat kihti tuleb põhjalikult valguskõvastada 10 kuni 20 sekundit (sõltuvalt valguslambist) enne, kui järgmine kiht peale kantakse. Nagu näidatud joonisel 7, saab valitud materjali vähese voolavuse tõttu oklusaalpinna morfoloogiat mõningal määral vormida. Täpsemate anatoomiliste detailide restaureerimise vajadusel võib kasutada püsivamat SUPER LOW varianti. Restauratsiooni läikivaks poleerimiseks kulus vaid mõni sekund (joonis 8).

Joonis 1. Välja vahetatavad kaks amalgaamrestauratsiooni.

Joonis 2. Olukord pärast olemasolevate amalgaamrestauratsioonide eemaldamist.

Joonis 3. Suurema kaviteedi põhjas on nähtav amalgaamist tihti tekkiv määrdumine.

Joonis 4. Täitmise protseduur: voolava komposiidi esimese kihi pealekandmine.

Joonis 5. Teine molaar on juba täidetud, esimene molaar vajab veel ühte kihti voolavat komposiiti.

Joonis 6. Täidis valmiskujul.

Joonis 7. Pinnal on hea morfoloogia ja toonid sobituvad loomulikul viisil.

Joonis 8. Ravi tulemus pärast kofferdami eemaldamist. Restauratsioonid sulanduvad loomulikult ümbritsevasse hambastruktuuri – nii tooni kui ka pinna läike poolest.

LIHTSASTI KASUTATAV ALTERNATIIV PAKITAVATELE KOMPOSIITIDELE

Eriti suu raskesti ligipääsetavates piirkondades võib hästi tasakaalustatud mehaaniliste omadustega voolava komposiidi kasutamine olla hea alternatiiv pakitavatele komposiitidele. Parem toonisobivus, mullideta pealekandmine, hea kohandumisvõime ning lihtne vormimine ja kiire poleerimine muudavad hambaarsti töö oluliselt lihtsamaks. 

Dentist:

JULIEN MOLIA

Dr Julien Molia lõpetas ülikooli 2008. aastal, kaitstes lõputöö arvutipõhise implantoloogia teemal. Ta asutas Saint-Jean-de-Luzis üldhambaravi praksise, kus on sellest ajast alates keskendunud implantoloogiale ja lõualuu rekonstrueerimisele. 2017. aastal omandas ta teise ülikoolikraadi implantoloogias, et oma teadmisi ajakohastada ja täiendada. Samuti on ta läbinud täiendkoolitusi digitaalse hambaravi, ortodontiliste minikruvide ja mukogingivaalkirurgia alal. Hinnates kudede säilitamist, täiendas ta end eraviisiliselt dr Gil Tirlet’ ja Jean-Pierre Attali juures Pariisis. Dr Molia on kliinilistele uuringutele ja innovatsioonile pühendunud koostöörühma Sud-Ouest Bioteam asutajaliige.

CLEARFIL MAJESTY™ ES Flow Universal VÕITIS TEADUSAUHINNA

Kuraray Noritake Dental Inc. on äsja turule toonud lihtsustatud toonikontseptsiooniga voolava komposiidi: CLEARFIL MAJESTY™ ES Flow Universal. USA Dental Advisori 2025. aasta jaanuari/veebruari numbris avaldati, et see täiesti uus toode pälvis oma veenva in vitro toimivuse eest maineka teadusauhinna.

LÜHIDALT SELLE OMADUSTEST

Euroopas toodi hiljuti turule CLEARFIL MAJESTY™ ES Flow Universal kahes viskoossuses – madal (Low) ja eriti madal (Super Low), samas kui Ameerika Ühendriikides on saadaval ainult ülimadala viskoossusega variant. Tooni valimise hõlbustamiseks on materjalis nutikalt kombineeritud emaililaadne läbipaistvus, dentiinilaadne värvus ja ainulaadne valgusdifusiooni tehnoloogia (LDT). See tagab erakordse toonide sobitamise võime ja võimaldab kasutada minimaalset toonivahemikku, mis koosneb vaid kahest üksteist täiendavast toonist – universaalne (U) ja universaalne tume (UD). Pärast valguskõvastamist sulandub materjali värvus märkamatult ümbritseva hambastruktuuri omaga.

 
Lisaks intuitiivsele toonivalikule pakub voolav komposiit veel ühte olulist eelist: see on erakordselt tugev. Paindetugevuse 152 MPa ja survetugevuse 374 MPa poolest on CLEARFIL MAJESTY™ ES Flow Universal (Super Low) sama tugev kui paljud pastatüüpi komposiidid. Selle tõttu sobib see kasutamiseks isegi koormustkandvates piirkondades ja selle kasutusnäidustused on järgmised:

• direktsed restauratsioonid kõikide kaviteedi klasside, hambakaela kahjustuste (nt juurepinna kaaries, v-kujulised defektid), hammaste kulumise ja erosiooni korral
• kaviteedi aluskiht / lainer
• hammaste asendi ja kuju korrigeerimine (nt diasteemi sulgumine, hammaste väärareng)
• murdunud restauratsioonide suusisene parandamine
• keraamiliste ja komposiidist inlay’de, onlay’de ja alla 2 mm paksuste laminaatide tsementimine

VAPUSTAV TOIMIVUS IN VITRO

Ameerika Ühendriikidele pakutavat ülimadala voolavusega varianti testiti Dental Advisori biomaterjalide uurimiskeskuses ja võrreldi kahe teise voolava komposiidiga. Hinnatud omaduste hulka kuulusid materjalide paindetugevus, elastsusmoodul, purunemiskindlus, survetugevus ja röntgenkontrastsus. Lisaks hindasid uurijad materjalide toonisobivust V klassi kaviteetide taastamisel A1, B2, C3 ja D4 tooniga proteeshammastel. Lõpuks testisid nad röntgenkontrastsust ja voolavusomadusi

 
CLEARFIL MAJESTY™ ES Flow Universal toimis igas kategoorias suurepäraselt. Füüsikalised omadused olid voolavate komposiitide seas ühed parimad ja sarnased pastatüüpi alternatiividega. Röntgenkontrastsus ja viskoossus olid ideaalsed, kuna materjal säilitab pärast pealekandmist oma algse kuju. Kuigi saadaval on vaid kaks tooni, kinnitasid uurijad, et CLEARFIL MAJESTY™ ES Flow Universal sobitub hästi paljude loomulike hambatoonidega.

TEAVE DENTAL ADVISORI KOHTA

USA-s asuva organisatsiooni Dental Advisor parima ja eelistatud toote auhinnad loodi selleks, et aidata hõivatud hambaravitöötajatel leida uusi hambaravilahendusi, eriti vähem invasiivsete tehnikate ja standardiseeritud protseduuride jaoks. Auhindade eesmärk on tuvastada tooteid, mis annavad järjepidevalt häid tulemusi. Dental Advisor viib läbi kliinilisi hinnanguid ja toote toimivuse teste vahetult pärast toote turuletulekut ning avaldab iga-aastased tulemused veebis, et aidata hambaravitöötajatel leida kvaliteetseid hambaravimaterjale, mis vastaks nende spetsiifilistele vajadustele. Teadusauhinnad loodi, et tunnustada hambaravitoodete tootjaid, kes on pühendunud teadustööle, arendamisele ja hambaravimaterjalide täiustamisele ravi kvaliteedi parandamiseks.

Lisateabe saamiseks külastage Dental Advisori veebilehte aadressil: www.dentaladvisor.com

PANAVIA™ Veneer LC WINS PREFERRED PRODUCT AND RESEARCH AWARDS

PANAVIA™ Veneer LC has been singled out for a Research Award in the category Research – Veneer Cement by Dental Advisor and for a Preferred Product Award in the category Cement: Esthetic Resin. Published in the January/February 2025 issue of the US-based organisation, the annual Top Product, Preferred Product or Research Awards are given to those materials and devices deemed by the publication’s consultants to deliver the best practice-based or lab-based performance in their categories.

BENEFITS IN A NUTSHELL

PANAVIA™ Veneer LC is a specialized veneer cement designed to provide exceptional bond strength to various substrates, along with outstanding gloss retention and wear resistance. The resin cement utilizes smaller-diameter spherical filler particles, facilitating easy dispensing from the syringe and excellent flowability for minimal film thickness. All of these attributes contribute to virtually no change in gloss or surface appearance of veneer margins over time.

EXCELLENT PROPERTIES IN VITRO

To assess the scientific performance of PANAVIA™ Veneer LC, its features and physical properties, specifically its bond strength to various substrates after artificial aging and its wear resistance, were tested in the Dental Advisor Biomaterials Research Center. The investigators’ testing of these attributes reflects the challenges such products must meet – “Ideally, esthetic veneer cements should have a long working time, curing on demand, excellent color stability, and high strength”.

To assess bond strength to dentin, enamel, IPS e.max CAD, and zirconia, the cements were subjected to six months of artificial aging using thermocycling. To test wear resistance after toothbrush abrasion, the testing method involved measuring depth of wear, change in surface roughness, and change in gloss based on a simulation of about 5.5 years of regular toothbrush use.

The investigators reported that PANAVIA™ Veneer LC “had the best gloss retention of the three cements tested and a very even wear pattern,” noting further that “having limited surface roughness after toothbrush abrasion can help lower staining and bacterial adhesion.” Overall, they said, “The PANAVIA™ Veneer LC cement system showed excellent adhesion properties and exceptional gloss retention and wear resistance,” concluding:

OUTSTANDING RATING OF 96 PERCENT

In addition, the product was tested in the clinical setting. 25 clinical evaluators used PANAVIA™ Veneer LC cement system in their dental offices. After a total of 166 uses, the light-curing resin cement received “excellent” to “very good” ratings with regard to completeness of the kit, the shade of the try-in pastes, ease of clean-up of the try-in pastes and excess cement, viscosity, working time and lack of shade shift after curing.

The evaluator’s clinical tips included:

• „Use a micro brush or rubber tip to clean up excess cement before curing.”
• „Apply glycerin gel to the margins after placing the veneer with the cement to eliminate the oxygen inhibition layer and ensure a complete cure before light curing through the gel.”

In their comments, they praised the ease of use of the system, the design of the syringes, the shade options and shade match between try-in and cement shades, e.g.:

• “The white shade of the cement was opaque enough for efficient masking of discolored tooth structure.”
• “Great esthetics, very easy to use, complete system.”

This resulted in an overall clinical rating of 96 percent and an equally high recommendation rate.

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

Interview with the team at Kuraray Noritake Dental Inc., who developed and brought to life this new universal adhesive.

Streamlining, enhancing and refining adhesive procedures – these are the aims of an 5-person team at Kuraray Noritake Dental Inc. in Japan. Recently, the team has developed a next-generation universal adhesive CLEARFIL™ Universal Bond Quick 2 that offers quick and easy application combined with an optimised bonding performance. To learn more about the goals and achievements of the development project, and the benefits of the product, we had a conversation with them.

From left to right: Ryo Matsuura and Ryota Murayama (R&D Department), Kazutoshi Ikeda (Production Department), Marina Okada and Yamato Nojiri (Planning & Development Department).

Why did you decide to improve CLEARFIL™ Universal Bond Quick?

Universal adhesives like CLEARFIL™ Universal Bond Quick are very well received by dental practitioners all over the world mainly due to their versatility and procedural simplicity. In the clinical setting, however, we have identified room for improvement. For example, it can be difficult to establish thin, uniform and strong bonding layers with the currently available products. Water and solvents in universal adhesives often limit the formation of a strong bond layer. A thin bonding layer and the relatively thick oxygen inhibition layer make this type of bonding agent susceptible to degradation by water sorption from dentinal moisture. Highly viscous bonding agents also complicate the ease of application in small cavities and can easily lead to pooling of the adhesive in critical parts of the cavity. Adhesives with a relatively high viscosity may pool or accumulate along margins, and may form a layer that is too thick and may change the morphology of the abutment tooth, a critical factor potentially affecting the fit of an indirect restoration. Generally, bonding agents with a low film thickness and/or are low-filled or unfilled, in turn have a potentially negative effect on the strength of the bonding layer. At Kuraray Noritake Dental Inc., we wanted to address the aforementioned issues and have developed a universal adhesive that is easy to apply and facilitates the establishing of thin, uniform bonding layers exhibiting high strength.

What are the indications of CLEARFIL™ Universal Bond Quick 2?

The new universal adhesive is indicated for bonding procedures in the context of creating direct restorations with light-cured composite, sealing of a prepared cavity or abutment tooth as a pretreatment for indirect restorations, treatment of exposed root surfaces and hypersensitive teeth, and also the intraoral repair of fractured restorations. Furthermore, the product is a suitable adhesive in post-cementation and core build-up procedures as well as in adhesive cementing of indirect restorations. When used in the context of the cementing of indirect restorations, the bonding to tooth structure of PANAVIA™ SA Cement Universal and of other manufacturers’ self-adhesive resin cements improves, leading to higher bond strengths.

What are the corresponding general benefits of CLEARFIL™ Universal Bond Quick AND CLEARFIL™ Universal Bond Quick 2?

The general benefits of both products are that they may be used with any etching procedure, plus the fact that there is no need to wait for the adhesive to penetrate the tooth structure after application. In addition, both products contain the original MDP monomer and the amide monomer, responsible for the formation of a thin and strong surface coating. Both products exhibit low technique sensitivity and are suitable for a wide range of indications. Finally, the adhesive monomers and fluoride offer extra protection to the underlying dentin.

Monomer image from the brochure

You mentioned the original MDP monomer as one of the essential components of the new adhesive and its predecessor. Is there a difference between this original MDP monomer and other MDP monomers available on the market?

Our MDP monomer is the only MDP monomer that is manufactured using the originally developed synthesis and purification process. Research has shown that the way MDP is manufactured has indeed an impact on the performance of the monomer itself1. While impurities and dimers detected in MDP monomers synthesized elsewhere negatively affected the immediate and aged micro-tensile bond strength in the in-vitro study, our MDP monomer shows high purity and more favourable test results.

Most universal adhesives need to be rubbed into the tooth structure extensively for 10 to 20 seconds. What did you do to eliminate the waiting time independent of the etching procedure, which led to an ultra-quick application procedure?

It is the amide monomer which is mainly responsible for an improved penetration speed into the tooth structure. The hydrophilicity of this monomer is much higher than the hydrophilicity of the HEMA monomer that is typically used. This provides for a better penetration into the moist dentin. The amide monomer’s polymerisation characteristics are better, and, following polymerisation, leads to higher stability in a wet environment due to the formation of a highly cross-linked polymer network. In combination with MDP, an efficient long-term performance will likely be achieved. For optimal outcomes, the adhesive is simply rubbed into the tooth structure as described in the IFU: “Apply BOND with a rubbing motion to the entire cavity wall with the applicator brush. No waiting time is required.”

What are the additional benefits that CLEARFIL™ Universal Bond Quick 2 has to offer?

First of all, we improved the viscosity and film thickness by optimizing the manufacturing method. The thin adhesive layer prevents pooling in the cavity, around abutments and along margins, creating a uniform bonding layer. Simply put, the new adhesive is applied thinly and spreads evenly. At the same time, the product offers high mechanical strength and excellent resistance to water sorption. Its bond strength is high in all etching modes and the new formulation allows for the product to be stored at room temperature.

Please explain the clinical benefit of an improved mechanical strength.

The risk of decreasing the film thickness lies in a possible decrease in the strength of the bonding layer which can lead to reduced bond durability. By introducing a new multifunctional urethane methacrylate monomer, we have been able to increase the strength. The effective advantage of the new bonding agent is that it can easily be used in small, difficult-to-access cavities or in cavities with complex morphology. The result is a thin yet strong adhesive layer that also allows for easy placement of any type of restoration.

How did you manage to improve the storage conditions?

Component stability was not an issue with CLEARFIL™ Universal Bond Quick. However, for a stable viscosity, it needed low-temperature storage. By optimizing the manufacturing method and decreasing the viscosity of CLEARFIL™ Universal Bond Quick 2, storage at room temperature became possible.

Was it difficult to integrate the new components and keep the existing benefits? How did you manage?

Integrating new components and removing others always means that the whole formulation needs to be rebalanced properly. This was particularly challenging for the multifunctional urethane methacrylate monomer we wanted to add. It improves the strength and hardness of the universal adhesive, but may affect adhesion depending on the amount of the compound in the formulation. Consequently, we needed to carefully find optimal balance, which took some time and required thorough testing, but in the end, we succeeded.

At the moment, the immediate dentin sealing technique is popular in indirect restoration procedures. What makes CLEARFIL™ Universal Bond Quick 2 suited for this technique?

Immediate dentin sealing is indeed a popular and useful technique that can result in significantly increased retention, reduced marginal leakage, improved bond strength, and less postoperative sensitivity. Using CLEARFIL™ Universal Bond Quick 2 in this context is beneficial as the procedure is quick, the resulting bonding layer is thin and strong, and the dentin is effectively protected.

Why should a dental practitioner switch to CLEARFIL™ Universal Bond Quick 2?

For users of CLEARFIL™ Universal Bond Quick, switching to CLEARFIL™ Universal Bond Quick 2 is worthwhile, as it offers additional advantages and improved performance while retaining the benefits of its predecessor. For users of other universal adhesives, the major benefit lies in the shortened application time: CLEARFIL™ Universal Bond Quick 2 is the only universal adhesive that can achieve a high bond strength and a high-strength bonding layer without any waiting time. In addition, it is suitable for a wide range of indications including core build-up procedures and cementation.

Thank you very much for these insights!

References
1. Yoshihara K, Nagaoka N, Okihara T, Kuroboshi M, Hayakawa S, Maruo Y, Nishigawa G, De Munck J, Yoshida Y, Van Meerbeek B. Functional monomer impurity affects adhesive performance. Dent Mater. 2015 Dec;31(12):1493-501.

Case by Kostia Vyshamirski, DT

KATANA™ Zirconia YML AND CERABIEN™ MiLai

Virtually every patient in need of restorative treatment desires functional restorations with an aesthetic appearance. However, the individual expectations and needs may be very different depending on the clinical situation (state of the natural tooth structure, parafunctional behaviour, periodontal health etc.), the patient’s financial resources and personal preferences. A versatile material combination fulfilling many different needs and desires is KATANA™ Zirconia YML finished using micro-layering with the new CERABIEN™ MiLai (both Kuraray Noritake Dental Inc.).

This system supports low invasive preparations due to a favourable minimum wall thickness of the merely monolithic multi-layered zirconium oxide prosthesis and a minimal thickness of the porcelain layer in the aesthetic zone. Moreover, the high strength zirconium oxide prosthesis combined with only a very thin layer of porcelains makes this technique extremely useful in patients with parafunctional habits like bruxism. Last but not least, consisting of a carefully compiled selection of internal stains and porcelain shades, CERABIEN™ MiLai supports the creation of individual 3D shade effects that mimic those of natural teeth even when space is limited. The following case example reveals how this is possible.

INITIAL SITUATION

The patient presented with concerns related to both function and appearance. During the diagnostic phase, it was determined that increasing the vertical dimension of occlusion (VDO) and creating a wax-up in the new jaw position would be necessary to improve both the occlusion and the aesthetic appearance of the smile.

Fig. 1. Intraoral scan of the maxillary teeth revealing severe tooth wear.

Fig. 2. Intraoral scan of both jaws confirming the need for an increase of the VDO.

Fig. 3. Intraoral scan: Occlusal view of the maxillary teeth.

TREATMENT PLANNING AND COMPUTER-AIDED DESIGN

Following the approval of the wax-up, the treatment plan was created. It consisted of restoring the four anterior incisors with zirconia crowns and performing direct composite restorations on the posterior and lower teeth. To conserve as much of the healthy tooth structure as possible, the space created was aligned to the required wall thickness of the planned restoration (framework + micro-layer of porcelain in the vestibular areas only). Following an aesthetic analysis, the crowns were designed with a minimal vestibular cutback. This was due to the patient’s functional problems, which would increase the chipping risk in case of using a more heavy cutback design with a thicker, more conventional porcelain layer. KATANA™ Zirconia YML offers exceptional aesthetics, requiring only a 0.3 mm reduction for the porcelain to achieve natural results. Therefore, it was the logical material choice for this specific case.

Fig. 4. Minimally invasive preparations for the crowns.

Fig. 5. Occlusal view of the preparations.

Fig. 6. Aesthetic analysis – a crucial step for achieving the desired new smile.

Fig. 7. Frontal view of the crowns in their final cutback design.

Fig. 8. Lateral view of the crowns in the CAD software.

CROWN PRODUCTION

Immediately after milling, the zirconia surface was treated with effect liquids. This kind of pre-sintered characterization helps enhance the characteristics of zirconia restorations. In the presented case, orange stain was applied to the cervical area, while a blue stain was used at the incisal edge. In addition, a white opaque liquid was applied to the inner surface of the central zirconia crowns to block out any discolouration from the underlying tooth structure. Following final sintering, the vestibular layer of porcelain was built up with CERABIEN™ MiLai using a combination of internal stains and porcelain micro-layering. After morphological adjustments and surface polishing, the restorations were completed by applying CERABIEN™ ZR FC Paste Stain and Glaze. Final polishing was then performed to enhance the natural appearance of the surfaces.

Fig. 9. Effect liquids applied to the cervical and incisal areas of the crowns.

Fig. 10. Treatment of the central incisor crowns’ inner surfaces.

Fig. 11. KATANA™ Zirconia YML framework after sintering.

Fig. 12. CERABIEN™ MiLai Internal Stains and Porcelains.

Fig. 13. Prepared vestibular surfaces ready for application of the internal stains.

Fig. 14. Application of 0.2-0.3 mm layers of CERABIEN™ MiLai porcelain: CCV2 for the cervical area, LT1 – Creamy Enamel for the main body and luster, LTX at the incisal edge.

Fig. 15. Frontal view of the final restorations on the model.

Fig. 16. Lateral view of the final restorations on the model.

Fig. 17. Polished and glazed palatal surfaces of the crowns.

FINAL OUTCOME

The finalized restorations showcase great details, crafted with CERABIEN™ MiLai internal stains and porcelains. The result are natural-looking restorations. An additional benefit of using zirconia as a restorative material is its excellent compatibility, which is evident in the healthy gingival conditions.

Fig. 18. Restorations in place.

Fig. 19. Natural-looking restorations in the patient’s mouth.

Dental Technician:

KOSTIA VYSHAMIRSKI

DT Kostia Vyshamirski, Riga, Latvia

After earning his Dental Technician Certificate from the Medical College in Minsk, Belarus, in 2014, Kostia began his career as a dental technician, focusing on aesthetic clinical cases that integrate the latest digital and manual technologies. Moving to Riga, Latvia, in 2015 greatly expanded his professional opportunities.

With over a decade of experience, Kanstantsin Vyshamirski now conducts courses, lectures, and seminars worldwide. He is a member of the DTG (Dental Technician Guild), a professional group of dental technicians based in the USA, and an invited guest of the AAED (American Academy of Esthetic Dentistry), an exclusive, invitation-only organization.

Operating his own lab in Riga, Latvia, Kanstantsin specializes in aesthetic prosthetic porcelain work and is an experienced, passionate user of KATANA™ Zirconia and Noritake porcelains.

CERABIEN™ MiLai in Daily Use

A tooth with crack lines, a characteristic round shape, age-related changes, or medication-induced discoloration — there’s no one-size-fits-all solution when it comes to all-ceramic anterior restorations, even when the porcelain system and production technique are defined.

To support technicians who wish to simplify their layering workflow using the micro-layering technique and CERABIEN™ MiLai — whether just getting started or looking to refine their process — we’ve collaborated with DT Dumitru Leahu to create a Chroma Map Catalogue featuring seven typical anterior restoration scenarios.

Each case example includes a detailed screenshot of the framework design, chroma maps outlining the planned steps, images of internal staining and micro-layering procedures, and the final restoration on the model. You’ll also find essential information about the selected framework material, target shade, and other relevant details.

We invite you to use the CERABIEN™ MiLai Catalogue as a step-by-step guide to success or simply as inspiration for individual cases. It offers a fast track to understanding the material’s optical properties and will make planning your next micro-layering case more intuitive. No need to start from scratch — instead, adapt what’s already there and gradually develop your own maps and techniques.

Interested in the CERABIEN™ MiLai Chroma Map Catalogue?

Download it here!