Unustage see voolav frustratsioon: kas teate mõnda voolavat komposiiti, mis teeb seda, mida lubab? Mõned turul saadavad voolavad komposiidid on nõrgemad ja ebaesteetilisemad ja/või neid on keerulisem käsitseda. See jätab mulje, nagu oleks kõik voolavad komposiidid pastakomposiitidest kuidagi kehvemad. Lubage meil selgitada, miks CLEARFIL MAJESTY™ ES Flow erineb teiste kaubamärkide voolavatest komposiitidest, ja näidata, kuidas asjatundlik silaanimine avab uue ajastu voolavatele komposiitidele. 

Hambaravi komposiitide peamised komponendid sisaldavad vaiku ja täiteaineid, mis on hoolikalt kombineeritud, et saada töödeldav, polümeriseeritav materjal, mida saab kasutada tugeva restauratsiooni loomiseks. On oluline, et täiteaine jääks matriiksi. Selle saavutamiseks peavad täiteosakesed suutma matriiksile kinnituda. Sidusaine (silaan) hõlbustab kahe komposiidi komponendi vahelist keemilist adhesiooni. Silaan on kahefunktsiooniline pindaktiivne aine, mis seondub täiteainega ja reageerib polümerisatsiooni ajal matriiksi monomeeridega. 

Õige silaanimine  

See võib tunduda lihtne, kuid tegelikkus on midagi muud. Täiteaine ja vaigu segamisel tekib üks probleem. Vaigusegusse saab lisada ainult piiratud hulga täiteainet. Konsistents suureneb kiiresti tasemele, kus segu on raskesti töödeldav. Tänapäeva komposiitides on üha väiksemad täiteosakesed. Sama mahu juures, mida väiksemad on täiteosakesed, seda suurem on kaetav ala, muutes segu veelgi vähem praktiliseks. Seega on vaja kvaliteetse komposiidi saamiseks kvaliteetseid silaane, et maksimeerida täiteosakeste märgamisvõimet. 

Nähtamatu meistriteos  

Kõik silaanid ja silaanimistehnikad pole ühesugused. Kuraray Noritake Dental näitab ühte oma meistriteost selles valdkonnas. Silaanitehnoloogia liidritena kasutame ainult väga stabiilseid ja spetsiaalseid silaane. Üks kasutatud silaanidest on spetsiaalselt välja töötatud pikaahelaline silaan. Pika süsinikahelaga silaan (LCSi). Seda silaani kasutame oma suure täiteainesisaldusega voolavas komposiidis CLEARFIL MAJESTY™ ES FLOW. 

Meie professionaalse silaanimise tulemus: 

• Kõrge täiteosakeste sisaldus ilma töödeldavust ohustamata 
• Väga stabiilsed restauratsioonid, isegi pärast kulumist 
• Väga niiskuskindel 
• Väga tugev 
• Vastupidavad, loomuliku välimusega restauratsioonid 
• Väga vähene vee imendumine 
• Optimaalne käsitsetavus 

Joonis 1: Sama koguse vaigu ja erinevalt töödeldud täiteosakeste segud. Vasakul: töötlemata. Keskel: tavapäraselt töödeldud. Paremal: Kuraray töödeldud. 

Mida kõrgem on silaani kvaliteet, seda parem on täiteaine märgavus, seda rohkem täiteainet saab vaigule lisada töödeldavust negatiivselt mõjutamata. Meie kvaliteetsete silaanide kasutamise veel üks positiivne aspekt on see, et need aitavad oluliselt vältida kõvastunud komposiidi täiteosakeste lahtitulemist. Meie komposiidid imavad ka väga piiratud mahus vett, mis on suuresti seotud ka silaanimisega. 

Täiteaine, eelnevalt nimetatud silaani ja vähese viskoossusega vaigu segu võimaldavad meil luua suure täiteainesisaldusega voolava komposiidi, millel on universaalsed kasutusalad. Säilivad nii voolavuse omadused kui ka optimaalne töödeldavus ning samal ajal jääb komposiit väga tugevaks.

Joonis 2: Mida edasiarenenum on silaanitehnoloogia, seda rohkem täiteainet saab lisada samale vaigukogusele. 

Voolavus 

CLEARFIL MAJESTY™ ES Flow tooteperes on kolme erinevat voolavust, mis sobivad teie eelistuse ja restauratsiooni tüübiga: suur, vähene või väga vähene. 

Tugevus 

CLEARFIL MAJESTY™ ES Flow sisaldab kuni 75 massiprotsenti, 59 mahuprotsenti täiteainet, mis annab paremad (mehaanilised) omadused, muutes selle sobivaks isegi posterioorsete restauratsioonide jaoks. 

Suure täiteaine sisalduse tõttu on CLEARFIL MAJESTY™ ES Flow’ga tehtud restauratsioonid väga tugevad. Piisavalt tugevad isegi tagumiste hammaste raviks. CLEARFIL MAJESTY™ ES Flow on isegi tugevam kui enamik universaalseid pastalaadseid komposiite (vaadake allpool toodud joonist). Pidev koormus ei mõjuta tugevust ega terviklikkust negatiivselt. Suur niiskuskindlus soodustab aga pikaajalist tugevust ja stabiilset esteetikat. Meie CLEARFIL MAJESTY™ ES FLOW täiteained koosnevad nii mikroskoopilistest täiteosakestest kui ka täiteosakesteste klastritest (0,18 µm kuni 3,5 µm). Need tasakaalustatud täiteained põhjustavad ka selliseid hinnatuid omadusi nagu kontroll doseerimise üle, paigalpüsimine ja mittekleepuvus. 

Täiteaine tüüp on suuresti vastutav ka CLEARFIL MAJESTY™ ES Flow restauratsioonide pikaajalise läike säilimise eest. Poleerimine on kiire, võttes vaid mõne sekundi. Kõrge läige tekib isegi pinda alkoholiga immutatud marli või vatirulliga pühkides. Valguse hajumise tehnoloogia, mida põhjustavad suuresti CLEARFIL MAJESTY™ ES FLOW täiteosakeste klastrid, võimaldab värvust hõlpsalt sobitada ja restauratsioonil sujuvalt ümbritsevate hambastruktuuridega sulanduda.

Lõpetuseks 

Võib öelda, et meie pädevus silaani- ja teiste tehnoloogiate (nt Light Diffusion Technology) vallas kandub edasi meie komposiitide, sh CLEARFIL MAJESTY™ ES Flow, kvaliteedile. Kolmes erinevas voolavusastmes CLEARFIL MAJESTY™ ES Flow tooteseeria tooted on väga mitmekülgsed ja suurepäraselt töödeldavad, väga tugevad, lihtsalt poleeritavad ja erakordset kauakestva läikega. See üks komposiit sobib nii esi- kui ka tagahammaste restauratsiooniks, parandamiseks või tsementimiseks templi-, süstimis- või mistahes muu tehnikaga. 

• *ei ole ettevõtte Kuraray Noritake Dental Inc. kaubamärk. CLEARFIL MAJESTY™ ES Flow Low katsetulemused. Vastavalt standardile ISO 4049:2009. Allikas: Kuraray Noritake. Dental Inc. 

Case by Aleksandra Łyżwińska DMD, Warsaw, Poland

Dental injuries can be stressful for patients, parents of pediatric patients, and dentists alike. The following tips offer support in turning the treatment of crown fractures into a simple, quick and predictable procedure. In the case described, we opted for a reattachment of fractured crown fragments.

YOUNG PATIENT WITH A FRACTURED CENTRAL INCISOR

A 16-year-old patient presented immediately after an accident. Her maxillary left central incisor was fractured, involving half of the coronal enamel and dentin (Fig. 1). The pulp was not involved, but the fracture line was quite close to the pulp (Fig. 2). After examination and radiographic evaluation, the patient was anesthetized. When placing the rubber dam, it tore between the left central and lateral incisor (Figs. 3 and 4). Due to the patient’s young age and limited willingness to cooperate, the decision was made to proceed without replacing the rubber dam. This was expected to work well in this specific region due to the limited flow of saliva from the palate and a low associated risk of contamination.

Fig. 1. Fractured maxillary left central incisor at the day of the accident.

Fig. 2. Occlusal view of the maxillary anterior teeth with the pulp of the fractured central incisor shining through.

Fig. 3. Rubber dam placed and torn between the left central and lateral incisor.

Fig. 4. Occlusal view of the teeth isolated with rubber dam.

REMOVAL OF UNSUPPORTED ENAMEL PRISMS

In order to provide for a high-quality bond and natural aesthetics, unsupported enamel prisms should be removed. As the use of burs might be too invasive (removing too much structure) and thus hinder the alignment of crown fragments, air-abrasion with 50 μm alumina particles was the method of choice. To avoid iatrogenic pulp exposure, the deepest part of the affected tooth was protected with a colored flowable composite before sandblasting (Fig. 5). The adjacent teeth were protected using a metal strip (Fig. 6). Several seconds of air abrasion were sufficient to remove the enamel prisms and obtain a homogeneous enamel surface (Fig. 7). Subsequently, the colored flowable composite was removed from the dentin surface and the tooth fragment was treated in the same way.

Fig. 5. Preparations for sandblasting: Dentin area near the pulp protected with flowable composite.

Fig. 6. Protection of the adjacent teeth with a metal strip.

Fig. 7. Homogeneous enamel surface after air abrasion.

JOINING OF THE FRAGMENT WITH THE REMAINING TOOTH STRUCTURE

After air-abrasion treatment, the fit of the tooth and the fragment was checked and approved (Fig. 8). To improve retention of the fractured crown portion, it was bonded to a micro applicator using composite resin. Alternatively, prefabricated prosthetic carriers may be used. Then, selective etching of the enamel was performed on the tooth and the fragment (Figs. 9 and 10). During this procedure, the adjacent teeth were protected with a celluloid strip (Fig. 11). To better adapt the strip to the distal surface, a curved wedge was placed interproximally (Fig. 12).

The bonding system of choice was CLEARFIL™ SE Bond 2 (Kuraray Noritake Dental Inc.). After applying this adhesive to the tooth and the fragment (Fig. 13), a small portion of CLEARFIL MAJESTY™ ES Flow Super Low (Kuraray Noritake Dental Inc.) in the shade A2 was applied to the part of the fragment treated with adhesive.* After careful repositioning of the fragment and while holding it in place with the micro applicator, the composite was light cured.

Fig. 8. Perfect fit of the fragment to the tooth.

Fig. 9. Selective etching of the enamel on the tooth …

Fig. 10. … and the fragment.

Fig. 11. Position of the wedge …

Fig. 12. … used for better adaptation to the distal surface.

Fig. 13. Fragment treated with CLEARFIL™ SE Bond 2 PRIMER and BOND, which were both carefully air-dried, while the Bond was also light cured.

Fig. 14. Fragment back in place.

Fig. 15. Occlusal view of the teeth with the reattached fragment perfectly fitting the mould.

EXCESS REMOVAL AND POLISHING

Excess composite was removed with a scalpel blade and abrasive discs. The entire restoration was then polished using TWIST™ DIA for Composite (Kuraray Noritake Dental Inc., Fig. 16). A nice optical integration was obtained immediately after finishing due to fact that the fragment was stored in water during the waiting time and treatment. As observed with teeth isolated with rubber dam during treatment, teeth undergo dehydration outside the oral cavity. The effect is much stronger in the latter setting, making a fragment become chalky white. By keeping the fragment in water, dehydration is limited to a minimum and it is possible to properly evaluate the aesthetic outcome. This has a positive impact on patient satisfaction. In the present case, the fragment and the tooth structure had a similar appearance, both showing a slightly increased brightness as a result of manipulation under rubber dam or in the air, respectively.

Fig. 16. Immediately after polishing, the fragment has almost the same brightness as the tooth thanks to water storage. A slight dehydration effect is visible.

TREATMENT OUTCOME

To achieve optimal aesthetics and long-lasting gloss, the composite was repolished one week later (Fig. 17). This was accomplished with a light blue high-shine rubber polisher of the TWIST™ DIA for Composite system, followed by polishing with diamond paste and a goat hair brush.

Fig. 17. Treatment outcome after one week.

Teeth previously isolated with a rubber dam and the fractured crown fragment had undergone rehydration and returned to their natural colour. The colour adaptation is satisfactory. Harmonious light reflections on the labial surface of the treated tooth a beautiful, natural shine have made the fracture site nearly invisible. In addition to aesthetic value, good therapeutic results were also achieved - the tooth responds appropriately to stimuli and is pain-free.

CONCLUSION

The described approach is a valuable treatment option for anterior trauma cases with relatively large fragments that are still available. By reattaching the natural structure, the need for complicated and time-consuming multi-shade layering and free-hand modeling is eliminated, while all the remaining natural tooth structure is saved. Instead of preparing the tooth, a removal of the unsupported enamel prisms and roughening of the surface is absolutely sufficient. Key elements for a great optical integration and long-lasting success are the proper use of a high-performance adhesive as well as the selection of a composite that has the ability to properly blend into its environment and offers a nature-like gloss retention. The selected materials offer precisely these features, so that the great outcome may be expected to last.

*CLEARFIL MAJESTY™ ES Flow Super Low is indicated for cementation purposes. The cementation of tooth fragments, however, is not explicitly mentioned in the instructions for use. The decision to use the product in this context was made by the dental practitioner in charge of the treatment.

Dentist:

ALEKSANDRA ŁYŻWIŃSKA DMD

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

Technical Specialist for Chairside, Volkan Kacmaz, Introduces Himself

Volkan Kacmaz not only worked as a dentist in Turkey, but he also managed two clinics and earned a Master of Business Administration in Berlin. His diverse experiences seem to have led him to his current role as a Technical Specialist at Kuraray Noritake Dental Inc., headquartered near Frankfurt. Who is this friendly, smiley, and curious team member, and why did he specifically choose Kuraray?

While most dentists continue practicing dentistry throughout their careers, Volkan Kacmaz chose a different path. After graduating in 2011, he established his own dental clinic in Istanbul. A few years later, he served in the military for a year as a military dentist. Afterward, he founded two more franchise clinics, taking on the dual roles of manager and dentist. It was during this time that he realized dentistry wasn’t limited to clinical practice. “I’m eager to learn and have always been curious about how products work, the processes behind them, research and development, and the launch of new innovations,” he explains.

INNOVATION

In 2022, Kacmaz became the first dentist to enrol at the Berlin School of Economics and Law, where he learned about marketing, sales, negotiation, and regulations. Upon completing his Master of Business Administration, he made a deliberate decision to join Kuraray Noritake. “Kuraray Noritake's products are of very high quality, both labside and chairside. I already knew this from my experience as a dentist. The company has an excellent and trustworthy reputation among dental professionals,” he says.

Kacmaz also admires the innovative nature of the company. “Kuraray Noritake is responsible for some of the most significant innovations in dentistry. Just look at products like PANAVIA™ cement, the original MDP monomer, and multi-layered zirconia discs and blocks. It’s easy to see that Kuraray Noritake is a major force in the dental market. With their commitment to continuous improvement and innovation, you could call them the Apple of the dental world,” he adds.

Another aspect Kacmaz appreciates is Kuraray Noritake's product lineup. “The catalog isn't extensive, but it’s highly specialized. The company doesn’t produce just any product, but focuses on the ones it excels at, ensuring top-notch quality.” Lastly, Kacmaz loves the company culture. “It's a very respectful environment. I’ve had some bad experiences with respect in the past,” he says with a laugh, referring to his time in the military. “But at Kuraray Noritake, you can feel the respect for employees, which is very important to me. I’m very happy to be part of the Kuraray Noritake family.”

COURAGE

When comparing dentistry in Turkey to Western Europe, Kacmaz doesn’t see significant differences. “The brands, quality, and approaches are all the same.” However, he has noticed one small distinction: German dentists aren’t as enthusiastic about digital dentistry as their Turkish counterparts.

Kacmaz draws on all his previous experiences and knowledge in his role as part of the scientific marketing team. His responsibilities include finding scientific support for marketing initiatives. He collaborates with lecturers and dentists to manage research studies using Kuraray Noritake products, works to update measurements in response to market dynamics, and evaluates new products.

His goal? “To become an authority in the dental world,” he says with a smile. It may sound like an ambitious goal, but Kacmaz has learned to dream big. “The biggest decision of my life was leaving my comfort zone and moving to a country where I didn’t speak the language. But I believe it’s a courage you have to show. If you don’t, your dreams and plans will fade, and you’ll miss out on everything.”

LEARNING NEW THINGS

Moving to Germany, which Kacmaz describes as "the epicentre of the dental market," hasn’t always been easy. Coming from a Mediterranean culture, he was used to a more communal and lively environment. In Germany, he noticed that shops close early, and people value their privacy. Another challenge has been the language. While he prefers English, he says, “ein bisschen Deutsch, nicht so gut.”  Fortunately, Kuraray Noritake provides him with German lessons, and he has the best teacher at home—his three-year-old daughter, who learns the language faster than he does and sometimes corrects him.

Despite the challenges, all the adapting and hard work have been worth it. “I’ve realized that there are no limits to learning. Whether you’re in your 40s, 50s, or even 60s, there’s always something new to discover. You just have to be open to it.”

CONTACT

Volkan Kacmaz can be reached at +49 69 305 35134 or via volkan.kacmaz@kuraray.com.

ABOUT KURARAY NORITAKE DENTAL INC.

Kuraray was founded in 1926 in Kurashiki, Japan. Today, it is a leading global manufacturer of medical products, materials, textiles, chemicals, resins, and more. In 2012, Kuraray Medical and Noritake Dental Supply merged to form Kuraray Noritake Dental Inc. The company continues to deliver reliable dental bonding agents, ceramics, and other products to over 90 countries worldwide. Well-known products include the KATANA™ Zirconia range, CLEARFIL™ Universal Bond Quick, and PANAVIA™ resin cements.

Case by Dr. Jusuf Lukarcanin

For all cases that require a particularly bright tooth shade – e.g. children or patients with bleached teeth / asking for a bleached effect in their restorations – CLEARFIL MAJESTY™ ES-2 Universal in the shade UW is likely to be the first choice. The young patient aged 28 shown below asked for diastema closure including shape and shade correction: She wanted to have a brighter, more beautiful smile.

Fig. 1. Initial clinical situation.

Fig. 2. Shape and shade correction were desired in this case.

Fig. 3. Treatment outcome …

Fig. 4. … leading to the beautiful smile the patient desired.

Reasons for selecting universal white:

- Cases requiring a particularly high brightness or value

- Restorations in deciduous teeth

- Restorations in bleached teeth

Universal white properties:

- Well-balanced translucency

- High light-scattering effect

CONCLUSION

One universal composite, four shades: In the case of CLEARFIL MAJESTY™ ES-2 Universal, this portfolio is absolutely sufficient for single-shade restorations even in the aesthetically demanding anterior region. Properties such as a nice blend-in effect, a great polishability and gloss retention over time support dental practitioners in creating beautiful restorations. As shade determination may be based on very few criteria instead of a complex shade guide, the whole restoration procedure becomes less stressful and more efficient. Furthermore, with only four shades to stock and usually no blocker needed, the number of materials on stock is reduced, leading to facilitations in stock management as well.

Dentist:

JUSUF LUKARCANIN

Dr. Jusuf Lukarcanin is a Certified Dental Technician (DCT) and a Doctor of Dental Science (DDS). He studied dentistry at the Ege University Dental Faculty in Izmir, Turkey, where he obtained a Master‘s degree in 2011. In 2017, he received a Ph.D. degree from the Department of Restorative Dentistry of the same university. Between 2012 and 2019, Dr. Lukarcanin was the head doctor and general manager at a private clinic in Izmir.

Between 2019 and 2020, he worked at Tinaztepe GALEN Hospital as a Restorative Dentistry specialist, between 2020-2022 he worked at MEDICANA International Hospital Izmir as a Restorative Dentistry specialist. Currently he is an owner of a private clinic for aesthetics and cosmetics in Izmir.

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.

UNIVERSAL ADHESIVE

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.

CLINICAL PROTOCOL

Depending on the condition of the existing restoration surface, the repair protocol may be slightly different. The basic steps are as follows:

PROTOCOL 1: OXYGEN INHIBITION LAYER STILL ON THE SURFACE

- 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

PROTOCOL 2: OXYGEN INHIBITION LAYER ALREADY REMOVED FROM THE COMPOSITE SURFACE

- 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

CLINICAL RECOMMENDATIONS

1. STAY IN THE COMPOSITE DURING PREPARATION

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.

2. INCREASE ADHESION BY SANDBLASTING

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.

3. USE A UNIVERSAL ADHESIVE THAT CONTAINS SILANE

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.

4. IF IN DOUBT, USE A UNIVERSAL ADHESIVE DURING REPAIR PROCEDURES

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.

5. IF AVAILABLE, PLACE A SILICONE INDEX TO SIMPLIFY ANATOMICAL SHAPING

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.

CONCLUSION

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.

UNIVERSAL SOLUTION FOR UTMOST SIMPLICITY

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.

CLASSIC AND PREMIUM OPTIONS FOR SINGLE- AND DUAL-SHADE LAYERING

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.

MECHANICAL PROPERTIES

All the CLEARFIL MAJESTY ES paste-type composite systems offer a well-balanced viscosity and excellent mechanical properties, including

• a high flexural strength of 118 MPa
• a filler load of 78 wt%
• a compressive strength of 347 MPa
• a low volumetric shrinkage of 1.9 %
• a curing depth of 2.0 mm and
• a long working time under ambient light of 4.5 minutes
  
  

VERSATILITY POWERHOUSE IN THREE VISCOSITIES>

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:

• a high flexural strength of 145, 151 and 152 MPa, respectively
• a filler load of 71, 75 and 78 wt%, respectively
• a compressive strength of 358, 373 and 374 MPa, respectively and
• a working time under ambient light of 100 seconds.

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 IDEAL PORTFOLIO FOR PEACE OF MIND

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 8^th-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.

IMPRESSIVE FEATURES

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.

REPAIR OF COMPOSITE RESTORATIONS

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.

CASE EXAMPLE 1: IMMEDIATE REPAIR PROCEDURE

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.

CASE EXAMPLE 2: REPAIR PROCEDURE AFTER POLISHING

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.

CASE EXAMPLE 3: REPAIR PROCEDURE AFTER TWO OR MORE WEEKS

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.

CONCLUSION

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

KOMPOSIITTAASTUSED HAMBARAVIS

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.

MATERJALI VALIK

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.

SÜSTLA KONSTRUKTSIOONI TÄHTSUS

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.

KOLVI VÄLJA tõmmates

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.

RÕHU TÄHTSUS INDEKSILE

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.

SÜSTEAVA LAIUS

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. 

Kas võiksite seda tehnikat lühidalt kirjeldada? 

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. 

Millal hakkasite kasutama voolava komposiidi süstimise tehnikat ja mis on selle peamised näidustused? 

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. 

Kuidas alustada, kui tahta ravida patsiendi hambaid voolava komposiidi süstimise tehnikaga? 

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. 

Millal ja miks te valmistate rohkem kui ühe silikoonvormi? 

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. 

Kuidas hambaid ette valmistada ja voolavat komposiiti süstida? 

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. 

Kas teil on selle tehnika jaoks välja kujunenud mõni lemmiktoode? 

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. 

Kuidas te viimistlete ja poleerite oma restauratsioone? 

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. 

Mis on voolava komposiidi süstimise tehnika peamised eelised? 

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. 

Kas teil on soovitusi, kuidas seda tehnikat hakata kasutama? 

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. 

DELICATE BALANCE BETWEEN COSTS AND AESTHETICS IN DENTAL LAB

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.

UNIVERSAL SOLUTION FOR DENTAL LABS

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.

INHOUSE PRODUCTION - THE PATH TO HIGH QUALITY ZIRCONIA DISC

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.

HIGH-SPEED SINTERING PROGRAM: 54 MINUTES

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.

HIGH PRECISION SHRINKAGE AND STABLE CTE VALUES FOR EXCEPTIONAL FIT

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.

MULTI-LAYERED STRUCTURE AND EASE OF POSITIONING OF RESTORATIONS IN THE BLANK

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.

ONE DISC. ALL INDICATIONS.

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.

EXPLORE KATANA™ Zirconia YML: WEALTH OF RESOURCES, CLINICAL CASES AND FAQS

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.