Why should you have Esthetic Colorant in your lab?

Esthetic Colorant for “KATANA™ Zirconia” is a set of easy-to-use shading liquids diffusing into the zirconia structure and enabling imitation of variety of internal shade structures.

It is an excellent choice for creating initial characteristics of the restoration before the sintering procedure, and by doing so laying groundwork for the final fast and easy individualization.

Check out the video to learn about the features of Esthetic Colorant and the resulting benefits.

A discoloured abutment tooth, a metal post or tooth-coloured gum areas: It is not always possible to meet the target tooth or gum shade with a pre-shaded zirconia framework. Porcelain layering on a differently coloured base, however, is likely to deliver unexpected outcomes. The “CERABIEN™ ZR” Shade Base line-up has been developed and recently extended by Kuraray Noritake Dental Inc. for those who would like to avoid surprises and provide for a favourable framework colour, right from the start of porcelain layering. The five new opaque shades deliver approximately five times higher opacity than conventional “CERABIEN™ ZR” Shade Base porcelains, and can mask the base colour much more effectively for even more lifelike restorations.

The “CERABIEN™ ZR” Shade Base opaque shade line-up consists of three shades that reproduce tooth colour: Opaque White as a bleaching shade, Opaque Light as an A2 shade, and Opaque Dark as an A3.5 shade. They may be mixed or applied as delivered to the zirconia framework in thin layers to mask severely discoloured or metal areas. In most situations with a severely discoloured base, a precise matching of the target shade is achieved by applying an opaque shade as a first layer and a target-coloured “CERABIEN™ ZR” Shade Base as a second layer.

The other two new opaque shades – “CERABIEN™ ZR” Opaque Light Tissue and Opaque Dark Tissue – are used in a similar way to create a pink-opaque base in the gum areas of tooth-coloured zirconia frameworks (e.g. made of KATANA™ Zirconia Multi-Layered discs), which is perfect for reproducing gingival colour. Applied as a thin coating, the opaque tissue shades neutralise the tooth colour and their moderate reflection improves the colour effect of the subsequently applied tissue porcelains.

With their high masking ability, the new opaque shades make it even easier to adjust zirconia framework colours for highly aesthetic porcelain layering – no matter whether the base colour of a tissue or tooth area needs to be optimized.

Testimonial article by Dr. Michael Teitelbaum, DMD, MAGD, FACD

A self-adhesive resin cement that contains MDP and LCSi monomers, allowing it to adhere to virtually every material without the need for a separate primer.

Ready to say goodbye to complicated bonding procedures, Dr. Michael Teitelbaum said hello to simplicity with Kuraray Noritake Dental Inc.‘s PANAVIA™ SA Cement Universal, a versatile cementation solution that simplifies his restorative workflow without sacrificing long-term bond strength. “PANAVIA™ is a name I’ve known and trusted since my prosthodontic program over 30 years ago,” shared Dr. Teitelbaum, who said PANAVIA™ SA Cement Universal allows him to confidently cement restorations because of its long-term reliability.

ALL-IN-ONE CEMENTATION SOLUTION

A self-adhesive resin cement that eliminates the need for a separate primer, PANAVIA™ SA Cement Universal contains a unique LCSi monomer that delivers a strong, durable chemical bond to porcelain, lithium disilicate, and composite resin, while a MDP monomer chemically reacts with zirconia, dentin, and enamel. “When I find myself cementing zirconia, my go-to cement is PANAVIA SA™ Cement Universal because it contains MDP, the magic ingredient that lets it actually bond to zirconia,” Dr. Teitelbaum explained. Thanks to a single-step bonding formula, PANAVIA™ SA Cement Universal is an easy-to-use, all-in-one cementation solution, and the material is available in both automix and handmix options. “One of the nice things about PANAVIA™ SA Cement Universal is if you’re in a hurry, maybe doing multiple units or working alone, you can use the automixing syringe tip and inject it into each crown,” said Dr. Teitelbaum. “Or if you’re naturally fast, like my assistant of over 20 years, you can hand mix the cement and load it directly into the crowns.”

“My go-to cement is PANAVIA™ SA Cement Universal because it contains MDP, the magic ingredient that lets it actually bond to zirconia.”

- Michael Teitelbaum, DMD, MAGD, FACD –

VERSATILE AND EASY TO USE

PANAVIA™ SA Cement Universal adheres to virtually all restorative materials without the need for a separate primer, silane, or etchant, simplifying the cementation workflow for clinicians and saving time for patients. “I have a patient who not only gags but makes more saliva than the Colorado River,” joked Dr. Teitelbaum. “It was nearly impossible [with other cements] to keep No. 31 dry long enough to sandblast, etch, prime, mix cement, load the crown and seat it. PANAVIA™ SA Cement Universal was the only cement I could get to work for him.” After the restoration is placed, any excess cement is easy to clean up after a quick 2 to 5 second light cure. “Once you’ve fully seated the crown, you can wave the curing light over the margins for a couple of seconds to just start the set. The excess material easily pops off while still in the rubbery phase,” said Dr. Teitelbaum. PANAVIA™ SA Cement Universal comes in 3 shades, universal (A2), translucent and white, which Dr. Teitelbaum says are suitable for most situations. “For translucent restorations, like inlays where the margins might be visible, I prefer a translucent or universal shade cement,” he said. “But where I may need to see the cement again someday, like an opaque crown or post, I prefer straight white.” Suitable for crowns, bridges, inlays/onlays, posts, and adhesion bridges, PANAVIA™ SA Cement Universal is a versatile cementation solution for virtually every material.

Dentist:

MICHAEL TEITELBAUM
DMD, MAGD, FACD

2023 IS A YEAR OF RABBIT, BUT DID YOU KNOW THAT...

• Rabbits’ eyes are on the sides of their head, meaning they can see almost all the way around them.
• A rabbit’s best feature? Their long ears! Growing up to 10 centimeters in length, rabbits can turn their ears by 180 degrees, keeping a careful listen out for predators.
• A rabbit’s teeth never stop growing! Instead, they’re gradually worn down as the rabbit chews on grasses, wildflowers and vegetables.*

*We at Kuraray Noritake Dental wonder - does this make a rabbit the ideal patient?

Is it possible to reduce the number of different cements used in a dental office? In most cases, it is. Kuraray Noritake Dental Inc. is convinced that one or two resin cement systems are usually enough to cover every indication and every need for general cementation. The selection of products may be different depending on personal preferences and the focus on specific dental treatments.

That is why the company offers three high-quality resin cements, with which it is possible to meet the needs and desires of every dentist and patient. One product is available for those who would like to keep it as simple as possible while taking advantage of the multiple benefits resin cements offer over conventional cements. Another system is designed for those who demand highest possible bond strength and aesthetics. And finally, a light-curing system has been developed as a specialized solution for veneer cementation.

In order to facilitate decision making, this article provides in-depth information on each of the three systems and their specific strengths.

The everyday cement

Keeping cementation simple and efficient is possible by minimizing the number of work steps and components and solving existing challenges. The self-adhesive dual-cure resin cement PANAVIA™ SA Cement Universal has been designed for these purposes. The challenge of removing sticky excess cement is overcome by a formulation that allows for very easy excess clean-up.

Components are reduced as the product incorporates Kuraray Noritake Dental Inc.’s Original MDP Monomer and original silane coupling agent, the LCSi Monomer, for a strong and durable bond. While MDP establishes a strong and long-lasting chemical bond to enamel, dentin, metal and zirconia, LCSi is responsible for bonding to resin composite, porcelain and silica-type ceramics (like lithium disilicate), eliminating the need for separate primers.

This means that a single component is needed, which streamlines the procedure, leading to time savings and a minimized potential for errors. Due to its properties, PANAVIA™ SA Cement Universal is ideal for everyday procedures such as the permanent cementation of crowns and bridges made of zirconia, lithium disilicate, hybrid ceramic or even metal.

The strong and aesthetic allrounder

For those who place importance on achieving the highest possible bond strength and aesthetics, PANAVIA™ V5 is the solution. The reliable dual-cure cementation system consisting of a tooth primer, a cement paste and a ceramic primer produces the highest bond strength and aesthetics from the PANAVIA™ cement range.

Therefore, it is an excellent choice for a whole range of indirect restorations and for post-and-core procedures. As the well-aligned components are always combined and applied in the same way, standardization is supported, leading to predictable outcomes.

The veneer specialist

When fulfilling such demanding tasks as cementing veneers, every dental practitioner needs time. Especially when placing multiple veneers at once for the best aesthetic outcomes, having to race against the setting time is counterproductive. For this reason, Kuraray Noritake Dental Inc. developed PANAVIA™ Veneer LC, a light-curing resin cement system with an extended working time of 200 seconds* on the primer, which allows users to initiate polymerization whenever they are ready for it.

PANAVIA™ Veneer LC also offers a well-aligned paste viscosity and consistency for easy dispensing and seating, and comes in four highly colour-stable shades for long-lasting aesthetics. Finally, the system provides for easy excess removal after tack-curing and an excellent bond strength over time.

** Working time: sensitivity to light (8000 lux, ISO 4049)

Meeting expectations

The three products mentioned are precisely what is needed to cover every personal preference and specific indication. They are based on Kuraray Noritake Dental Inc.’s long-standing expertise in the development of adhesive resin cements. The first product from the PANAVIA™ brand was introduced in the 1980s and since then, the company never stopped improving the portfolio by combining existing technologies like the original MDP Monomer with newly developed ones, such as the LCSi Monomer and the Touch Cure Technology. All this ultimately resulted in the current lean portfolio of easy-to-use and highly aesthetic resin cements that provide top-level bond strength.

The prerequisite for adhesive luting is a reliable bond between the tooth and the restorative material. The quality of the bond depends on the resin cement and its correct application. The state of the bonding surface also plays a decisive role. The surfaces of the tooth and restoration must be conditioned and clean. We spoke with Dr. Adham Elsayed.

All-ceramic restorations require adhesive luting. Is this true for all restorative materials (zirconia, lithium disilicate, hybrid ceramics, etc.)?

Yes and no, several factors must be taken into account. The first important factor are the material properties, especially the flexural strength. Fortunately, clear guidelines based on scientific studies are available. As a guideline, all materials with a flexural strength of less than 350 MPa should be placed with an adhesively luted. Correct adhesive luting stabilizes the restoration and tooth structure. Restorative materials of higher strength (e.g. reinforced glass-ceramics, lithium disilicate ceramics, zirconia, etc.) can be cemented with conventional methods. However, some studies indicate that an adhesive luting can improve the overall stability, whereas others show no significant difference.

Another factor guiding the decision for or against adhesive luting is the preparation design. For crowns and bridges, the decisive factor is whether the operator has been able to adhere to the preparation guidelines (minimum abutment height of 4 mm and maximum convergence of 15 degrees)1-5 in order to create the required retention and resistance form for conventional cementation. Minimally invasive restorations, such as resin-bonded fixed dental prothesis (FDPs), veneers and inlay FDPs, are based on a non-retentive preparation design. In such cases, only adhesive luting can ensure adequate retention.

Aesthetics is another important factor. Besides the restorative material, the luting material also has a major impact on the optical outcome. For highly translucent ceramics in particular, it is recommended to resort to adhesive luting. While conventional cements are usually only available as opaque materials, resin composites come in different colours with higher colour stability (PANAVIA V5 or PANAVIA SA Universal).

How should the surface be pre-treated or conditioned for adhesive luting?

Pre-treatment of the surface depends on the structure or microstructure of the ceramic. Silicate ceramics (e.g. glass ceramics) have a glass phase and can be etched. Etching increases the surface area, thus preparing it for adhesive luting. In contrast, oxide ceramics like zirconia as well as composites have no or neglectable amount of glass phase. They cannot be etched. Their surface is conditioned by air-abrasion (with aluminium oxide). This is the only current method which is scientifically proven for achieving a dependable bond with these materials.

How important is correct cleaning of the tooth and restoration surface for the quality of the bond?

The restoration surface must be decontaminated immediately prior to luting. Contamination must be removed thoroughly. Rinsing with water or alcohol has been shown to be insufficient. Therefore, cleaning solutions such as KATANA Cleaner have been developed.

Rub it in, rinse and dry—that's all—for optimal bonding procedures. Unlike other cleaning products, which have to be rubbed in for longer and are only suitable for extraoral use due to their high pH value, KATANA Cleaner is applied within 10 sec. and is suitable for both intraoral and extraoral use.

Any contamination is detrimental for the adhesive bond. At try-in of the restoration, for example, its surface becomes contaminated. Saliva, possibly blood, etc. accumulate and the proteins contained act to isolate all subsequently applied components (e.g. the primer). Any contamination must therefore be thoroughly removed prior to the bonding procedure. This is also the case for direct adhesive restorations. KATANA Cleaner offers a simple and quick way to accomplish this task.

What makes KATANA Cleaner so interesting for the user?

The special features of KATANA Cleaner are its integrated MDP salt and mild pH-value. Let's look at the function of the MDP salt. Rubbed in (for 10 seconds), the cleaner causes the contaminant particles (e.g. remnants from the work process, proteins from saliva, blood, etc.) to adhere to the MDP salt, like a magnet. The contamination is flushed out of the surface by rinsing with water. This ability is attributable to the MDP salt and makes KATANA Cleaner interesting and easy to use. In addition, the pH-value allows us to use the cleaning solution both intraorally and extra-orally, which is another special feature. We generally recommend the use of KATANA Cleaner—for both direct and indirect restorations. Thanks to the universal applicability of the cleaning solution, only one material is needed, while the time required is extremely low. Even for bonding abutments on a titanium base, cleaning with KATANA Cleaner is recommendable as it provides for an ideal basis (before applying the primer). In this case, contamination (e.g. finger grease, residues of the air abrasive) could also act as an insulator and impair the quality of the bond.

References:

1. Ladha K, Verma M. Conventional and contemporary luting cements: an overview. J Indian Prosthodont Soc. 2010;10(2):79-88.
2. Edelhoff D, Özcan M. To what extent does the longevity of fixed dental prostheses depend on the function of the cement? Working Group 4 materials: cementation. Clin Oral Implants Res. 2007;18 Suppl 3:193-204.
3. Güth JF, Stawarczyk B, Edelhoff D, Liebermann A. Zirconia and its novel compositions: What do clinicians need to know? Quintessence Int. 2019;50(7):512-20.
4. Smith CT, Gary JJ, Conkin JE, Franks HL. Effective taper criterion for the full veneer crown preparation in preclinical prosthodontics. J Prosthodont. 1999;8(3):196-200.
5. Uy JN, Neo JC, Chan SH. The effect of tooth and foundation restoration heights on the load fatigue performance of cast crowns. J Prosthet Dent. 2010;104(5):318-24.

Are you looking for an easy to use solution for your clinical workflows?

In this short video Swiss dentist Dr. Alessandro Devigus shares his experience using dual curing and self-adhesive cement PANAVIA SA Cement Universal.

CLEARFIL MAJESTY™ ES-2 Universal and CLEARFIL™ Universal Bond Quick have helped me create long-lasting and aesthetic composite restorations with little to no sensitivity for my patients.­

- Donald Jetter, DMD –

Despite getting its start in the early 1900s manufacturing semi-synthetic fibers (former company of Kuraray Co., Ltd.), today, Kuraray Noritake Dental Inc. is known to clinicians as a restorative powerhouse—especially to those who have relied on its advanced material science for years to achieve consistently successful restorations. One reason for Kuraray’s success is the company’s introduction of adhesive monomers to dentistry nearly 4 decades ago. Years of careful research ultimately led to the development of the MDP monomer, whose molecular structure yields greater adhesion and a stronger chemical bond to enamel, dentin, metal, and zirconia. It is the foundation of all products in Kuraray’s CLEARFIL™ and PANAVIA™ product lines, and likely what has led teams of clinicians to crown several of these materials as DPS* Best Products.

CLEARFIL™: A STRONG BOND & AESTHETIC FILL

For restorative dentists, building a strong restoration calls for an artful combination of technique and materials. To satisfy the latter, Donald Jetter, DMD, relies on CLEARFIL™ adhesives and composites. “We have been using Kuraray’s CLEARFIL™ composites and bonding materials in our practice for a very long time now,” he shared. “Our dental supply rep first suggested the material to us as a cost-effective alternative to the composite we were previously using, and that she always received positive feedback from other doctors who had tried it. I reluctantly ordered some and have never looked back.”

After using CLEARFIL MAJESTY™ ES-2 in the A2 shade for several years with success, Dr. Jetter was excited to try out CLEARFIL MAJESTY™ ES-2 Universal, a single-shade composite for posterior restorations. It uses Light Diffusion Technology to mirror the way tooth structure distorts light, resulting in a virtually seamless blend between the restoration and surrounding dentition. Additionally, enamel-like translucency allows for easy polishing to a high gloss. “The new universal shade seems just a bit lighter than the A2 shade but works well to match adjacent tooth structure,” said Dr. Jetter. “I tried another universal shade product that came out prior to CLEARFIL MAJESTY™ ES-2 Universal, but I experienced material failure with it, and it did not handle as well as Kuraray’s material.”

CLEARFIL MAJESTY™ ES-2 Universal pairs well with CLEARFIL™ Universal Bond Quick, a single-bottle adhesive that houses both the original MDP monomer and AMIDE-based chemistry, which rapidly permeates dentin and enamel to eliminate waiting time and dramatically reduce water absorption. Together, the two monomers provide a unique Rapid Bond Technology. Dr. Jetter and his team has been using CLEARFIL™ Universal Bond Quick since it first came to market, after successfully using its predecessor, CLEARFIL™ Universal Bond, for many years. “I like these products because they are single-bottle, fluoride-releasing, universal adhesives with low odor that help achieve less postop sensitivity,” he shared. “I would highly recommend CLEARFIL MAJESTY™ ES-2 Universal and CLEARFIL™ Universal Bond Quick to other dentists, as they’ve helped me create long-lasting and aesthetic composite restorations with little to no sensitivity for my patients.”

PANAVIA™ SA Cement Universal: CEMENTATION SIMPLIFIED

Designed to remove both primer and silane from the cementation procedure, PANAVIA™ SA Cement Universal contains not one, but two monomers: the original MDP monomer and the LCSi monomer, which allows for a strong bond to porcelain, lithium disilicate, and composite resin. “In my 12 years of clinical practice, I have tried using a variety of different cements and what I find myself gravitating toward is the versatile powerhouse of Kuraray’s PANAVIA™, which makes sense since Kuraray revolutionized bonding by introducing the MDP monomer to the world,” said Bilyana Tesic, DDS, who practices in Monterey, CA. After using earlier generations of PANAVIA™ cements, which required mixing several bottles together before application, Dr. Tesic was excited when PANAVIA™ SA Cement Universal changed all that. “PANAVIA™ SA Cement Universal simplified this process into a single step delivered via automix dispenser. Voilà! One cement to rule them all.” Dr. Tesic has been using PANAVIA™ SA Cement Universal for the past two years, and what she appreciates most about the material is its versatility. “It is a self-adhesive, radiopaque, dual-cure resin cement that bonds to enamel, dentin, composite, semi-precious and precious metal, porcelain, fiber posts, and zirconia. It’s easy to dispense and even easier to clean up. Fast setting time, no need to refrigerate, and no postop sensitivity. That all adds up to no headache. I recommend it to anyone looking to simplify their cementation protocols without losing any bond strength.”

PANAVIA™ V5: 'V' IS FOR VERSATILITY

The strongest dentin bonding cement that Kuraray has ever developed, PANAVIA™ V5 simplifies cementation of crowns, bridges, inlays, onlays, veneers, and posts and cores. PANAVIA™ V5’s MDP-based Tooth Primer offers high bond strength in the self-cure mode thanks to unique catalyst technology, while a 1-bottle surface treatment applies to all indirect restorations. “I loved being able to cement a metal post-and-core and ceramic crown all at the same time with the same product,” said Dr. J. Jerald Boseman, who took part in the DPS product review of PANAVIA™ V5. He added that the cement was easier to use, had a longer set time, and was less technique-sensitive than similar products. Available in 5 shades–White, Brown, Universal, Clear, and Opaque–with corresponding try-in pastes, PANAVIA™ V5 offers easy removal of excess cement after light-curing. Just one drop creates a durable bond to hydroxyapatite, metals, composites, and zirconia. “So far, the retention has been good with excellent handling properties,” shared J. Michael Heider, DDS, who has also used previous generations of PANAVIA™ products. “I’m glad to see the best characteristics of PANAVIA™ are being improved further.”

Did you know that humans make up to 30,000 decisions every day? Especially in the busy laboratory environment, decisions often have to be made blazingly fast and under time pressure. At least there is one decision we can spare you: Choosing your all-ceramic material! The reason is that we offer you an all-rounder for everyday laboratory use—reliable, safe and with top colour fidelity—KATANA™ Zirconia YML.

The new KATANA™ Zirconia YML is suitable for every indication and delivers uncompromising outcomes. Its special blank structure results from a combination of newly developed raw materials with different yttrium oxide content. This makes KATANA™ Zirconia YML the all-rounder that allows its users to standardize, streamline and simplify their procedures. Save decision-making time and use the time gained for the really pleasant things in everyday laboratory work, like perfect aesthetic finishing, planning or talking to the patient.

KATANA™ Zirconia YML and the path to perfection

Simply beautiful—the KATANA™ Zirconia story is epitomized by enthusiasm for all-ceramics and a passion for aesthetics. Dental technicians' wishes were taken into account, as were the findings of science and materials technology. The state of the raw materials, the purity of the powders, as well as the homogeneity and density of the blanks—the material properties are specifically matched. In conjunction with a meticulously designed in-house manufacturing process, the result is the dependable high material quality for which KATANA™ Zirconia is known and loved.

The success of KATANA™ Zirconia is based on a remarkable feature: Only KATANA™ Zirconia is made using Kuraray Noritake Dental Inc.'s unique, patented raw material technology*. Kuraray Noritake Dental Inc. is one of the few zirconia manufacturers with exclusive access to its own raw material. On this basis, it has succeeded time and again in setting new pioneering trends on the market. The company was the first to launch multi-layered zirconia—its Original Multi-Layered Technology—on the market. Now, with KATANA™ Zirconia YML, a new era in multi-layered zirconia is beginning.

*EP2024300

What makes KATANA™ Zirconia YML so special?

The answer is easy: predictable outcomes. Users benefit from reliable performance, accurate results and easy use. Its high colour fidelity makes the KATANA™ Zirconia Multi-Layered series so distinctive, as does the precision and perfection that zirconia provides. All the masterly competence of dental specialists in one disc! Dental technicians benefit from high cost-effectiveness and productivity. Assured colour fidelity and precision also provide for relaxed working.

New raw material technology

KATANA™ Zirconia YML is based on a new raw material technology derived from decades of zirconia experience. The zirconia imparts translucency as well as flexural strength, together with its proven multilayer colour structure. The special structure results from a combination of new raw materials with different yttrium oxide content. This makes KATANA™ Zirconia YML the ideal all-rounder with which work processes can be standardized, streamlined and simplified.

KATANA™ Zirconia YML combines raw materials with different yttrium oxide content. The result is an all-rounder material with colour, translucency and strength gradation.

More simplicity in the dental lab

The high density and homogeneity of the material provides for excellent marginal quality and edge stability. Seamless multi-layered technology produces a natural appearance with smooth colour and translucency gradients, no transition lines, and more besides. Highly aesthetic results are achieved with minimal effort. Thanks to the high colour stability, dental technicians achieve the desired aesthetics without laborious post-processing. The reliable predictability of the outcomes makes work even more fun.

Monolithic anterior and posterior crowns are half polished and half individualized with CERABIEN™ ZR FC Paste Stain and then glazed. (Images courtesy of DT Enrico Ferrarelli and MDT Daniele Rondoni)

More assurance in the dental lab

The individual layers in the multi-layered blank are optimally matched and shrink homogeneously in the final sintering process. The result is a high level of dependability and optimum quality of results. KATANA™ Zirconia YML is made using Kuraray Noritake Dental Inc.'s patented raw material technology, whereby even the raw material comes from within the company. This represents a clear advantage over most other zirconia manufacturers, as it allows every parameter to be fine-tuned. The variables are optimized for reliable application—down to the smallest detail. This means highly accurate fitting in everyday laboratory work. Retro-adaption or repeated fabrication do not even arise. And if you need to step up the pace: Harmonious material structure and high zirconia competence are prerequisites for optional high-speed sintering too, which is a valuable asset for every dental lab.

More flexibility in the dental lab

High flexural strength in the dentin area, yet high translucency in the enamel area—these features allow KATANA™ Zirconia YML to cover every all-ceramic indication. The zirconia is suitable for producing long-span monolithic bridges as well as thin-walled crowns, cut-back frameworks for micro-layering and even veneer restorations. Due to this versatility, it is possible to replace other ceramic CAD/CAM materials in the laboratory. This makes inventory management so much easier!

Minimally invasive preparations, aesthetic high-quality materials, patient-centered approaches: these are the key ingredients needed for successful restorative dentistry. Eleven renowned dental clinicians, technicians and scientists from all around Europe shared their own strategies for success during the IN.DIRECT SYMPOSIUM on Aesthetic Dental Collaboration that took place on November 5, 2022 at Kristallwelten Swarovski in Wattens near Innsbruck, Austria.

Kazumitsu Nakatsuka, Head of the Business Unit Medical at Kuraray Europe GmbH, extended a warm welcome to the 132 professionals in Wattens and more than 1,500 online participants. He introduced the two chairmen of the event, Prof. Nicola Scotti from the University of Turin (Italy) and Prof. Dr. Mathias Kern from the University of Kiel (Germany). They guided through the programme with its eight lectures focusing on different aspects of restorative dentistry.

The speakers of the IN.DIRECT Symposium: MDT Daniele Rondoni, Prof. Lorenzo Breschi, MDT Nondas Vlachopoulos, Dr. Claudia Scholz, Dr. Andrea Schädler, Prof. Nicola Scotti, Prof. Dr. Mathias Kern, Dr. Davide Cortellini, DT Laura Canale and MUDr. Josef Kunkela, Ph.D. Missing: Prof. Dr. Benedikt Spies.

Consider a feather-edge preparation for full-coverage crowns

Whenever a patient is in need of full-coverage crowns, a clinician should consider opting for a feather-edge preparation instead of a chamfer or shoulder preparation. This was the key message of Dr. Davide Cortellini from Riccione (Italy), who held his lecture together with DT Laura Canale from Rimini. According to the speakers, the feather-edge preparation allows for greater preservation of healthy tooth structures, provides for stability and aesthetics of the gingival tissues and is effortlessly captured with an intraoral scanner. The technique is technically challenging in that the restorative material needs to be thinned out considerably at the margin. With its low minimum wall thickness, high edge stability and superior mechanical properties, monolithic zirconia seems to be the best suited material for this approach.

DT. Laura Canale and Dr. Davide Cortellini.

Offer single-retainer resin-bonded bridges as an alternative to implants

When a single tooth is missing in the anterior region, single-retainer resin-bonded bridges made of 3Y-TZP zirconia may be the best-suitable option preferred by a patient. As Prof. Dr. Mathias Kern stressed during his lecture, they are the only immediate treatment option for young patients with incomplete dentoalveolar development, fit into narrow edentulous spaces (< 7 mm) and are feasible in cases with angulated roots or insufficient bone quantity. Moreover, they have the same positive impact on the patient’s quality of life as implants, while they are clinically proven with high survival rates of 95.4 percent after 15 years¹. Even in the canine and posterior area, zirconia-based single-retainer resin-bonded bridges offer promising results. Key to success is a meticulous bonding procedure involving low-pressure air-borne particle abrasion and the use of an adhesive resin cement system containing MDP (e.g., PANAVIA™ V5).

Give preference to monolithic restorations on implants

On implants, monolithic restorations seem to have the edge over veneered ones. The reason was presented by Prof. Dr. Benedikt Spies from the University of Freiburg (Germany): technical complications are less likely to occur. Lithium disilicate is the proven solution for single units, while zirconia (with its higher strength) leads to promising results in multi-unit reconstructions. One of the beneficial properties of zirconia is the fact that a perfectly polished surface will remain smooth even after aging and loading, which is an indicator of antagonist-friendly behaviour.

Save tooth structure by choosing cubic zirconia with a zero or micro cutback

With its favourable aesthetic properties, cubic zirconia allows users to reduce the wall thickness of their restorations for minimally invasive treatments. As revealed by Prof. Nicola Scotti and MDT Daniele Rondoni from Savona (Italy), the plastic-elastic behaviour of cubic zirconia is similar to that of enamel, so that it is ideally suited as a replacement of enamel structures. The decision to opt for a purely monolithic design and individualization with liquid ceramics (CERABIEN™ ZR FC Paste Stain) or a micro cutback with a micro-layering approach is mainly guided by aesthetics. The amount of reduction in the case of a cutback should be age-related according to Daniele Rondoni, with slightly more porcelain added in young than in older patients. In any case, the occlusal contact surface should be in zirconia and very well polished.

MDT Daniele Rondoni, Prof. Nicola Scotti and Prof. Dr. Manfred Kern during the discussion.

Open the doors for incredible aesthetics with synthetic feldspathic porcelain

The use of synthetic feldspathic porcelain (CERABIEN™ ZR) – either applied solely for porcelain layering on refractory dies or on top of zirconia frameworks – allows for a precise imitation of natural teeth with all their individual characteristics. Tips on how to exploit the full potential of aesthetic zirconia and veneering porcelain were given by MDT Nondas Vlachopoulos from Athens (Greece). He showed several clinical case examples to explain his philosophy and approach, which is minimally to non-invasive and put emphasis on respecting the biological structures. Particularly with the aid of the internal stain technique, the speaker is able to precisely reproduce virtually every characteristic optical effect – from enamel cracks to white spots – depending on the patient’s desires.

MDT Nondas Vlachopoulos.

Adhere to the recommended protocols for success in adhesive cementation

Achieving a strong and durable bond of indirect restorations to tooth structure is easier as it might seem according to Prof. Lorenzo Breschi from the University of Bologna (Italy). He recommended the use of universal resin cement (like PANAVIA™ SA Cement Universal) in the self-adhesive mode for crowns with retentive features made of non-etchable materials. Whenever retention is insufficient and a lot of dentin is exposed, an additional adhesive should be applied to the tooth structure – preferably after selective etching of the enamel. As PANAVIA™ SA Cement Universal contains silane (the LCSi monomer) and the MDP monomer, a separate restoration primer is not needed even with silica-based ceramics. However, a pre-treatment of the restoration’s bonding surface is strictly required, the method depending on whether the material is etchable or not. In cases with a subgingival preparation margin when isolation is difficult, the speaker suggested to use a selective adhesive approach with application of an adhesive everywhere but close to the gingival fluids, so that additional bond strength is offered precisely where needed.

Solve complex cases chairside step by step

Single-visit treatments are the reason for many patients to opt for chairside dentistry. In fact, various clinical situations can be solved chairside, and in many of them, zirconia is the material of choice. Dr. Claudia Scholz and Dr. Andrea Schädler from Kiel (Germany) prefer using KATANA™ Zirconia Block for many indications, and even solve complex cases like full mouth rehabilitations step by step in single units. The shared several tricks e.g. on how to realize bridges on implants by milling and placing the abutments first, scanning them like natural tooth abutments and then producing the bridge. Their experience shows that chairside dentistry is stretched to its limits when the aesthetic demands are particularly high, the insertion direction of implant-based restorations is not clear or the size of a restoration is larger than the largest available block.

Dr. Andrea Schädler and Dr. Claudia Scholz.

Select the restorative material carefully to pave the way for a precise fit

The accuracy of milled CAD/CAM restorations is strongly dependent on the material choice. As MUDr. Josef Kunkela, Ph.D. from Jindřichův Hradec (Czech Republic) showed using his own research results, the internal fit, marginal and dimensional stability (particularly important in complex, long-span reconstructions), and the surface quality of restorations vary not only between, but also within the different material classes. Among all tested materials, different types of KATANA™ Zirconia performed best with regard to the size of the cement gap, margin and surface quality and full-arch distortion. The differences between various types of zirconia may be due to differences in the material composition and blank production. Everyone valuing accuracy and quality of dental restorations should be aware of these factors and carefully select the restorative materials to pave the way for optimal outcomes.

MUDr. Josef Kunkela, Ph.D.

Modern approaches to aesthetic dentistry

CAD/CAM dentistry, innovative restorative materials and adhesive technology have clearly smoothened the way for highly aesthetic, minimally invasive restorative treatment approaches. During the IN.DIRECT Symposium, it became clear that there are many different highly successful strategies available, and that it is the task of the restorative team to select the appropriate option based on the clinical situation and the specific needs of the patient. In the end, patient satisfaction and quality of life are the main indicators of a successful restorative therapy.

The lectures will be available soon on demand on our website, in the newsroom section. Keep an eye out for the announcements on social media. Coming soon…

References

1. Kern M. Fifteen-year survival of anterior all-ceramic cantilever resin-bonded fixed dental prostheses. J Dent. 2017 Jan;56:133-135.