Since 2010, thanks to its increased translucency, KATANA™ HT has become paramount in fully meeting the ever more demanding aesthetics in restorations where a zirconia frame is used in combination with new generation ceramics CZR. Such ceramics feature an enhanced leucite balancing, which makes them stronger and more durable.

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

Since 2013, ML-Multi Layer technology has made it possible to skip the infiltration phase through multi-layered dentine/enamel millable discs. Such Multi-layered discs allow CUT-BACK solutions that definitely improve the function-related result as the palatal part of the restoration can be manufactured by using KATANA™ ML Zirconia only. Thus, without limiting the aesthetic results (which are reached by enamel-ceramic LUSTER porcelain with “MICRO LAYERING technique”, the restoration benefits of the low abrasiveness of the functional-occlusal areas which is reached through simple and effective mechanical polishing without either surface staining or glasuring.

Fig. 5.

Fig. 6.

Fig. 7.

Fig. 8.

Fig. 9.

New generation KATANA™ UTML and STML introduced in 2015 can be used for anterior restoration thanks to the cubic zirconia based products that have been made available to make it possible to conceive a bi-layer to mono-layer transition in most clinical situations.

Cubic zirconia features superior optical behavior. Although mechanically inferior in performance to conventional zirconia, KATANA™ UTML and STML are aging-resistant, while UTML offers the same translucency as lithium disilicate based solution.

“ZERO-CUTBACK technique” is one of the ideal techniques that can be achieved with cubic zirconia solution. They can perfectly replicate digital projects without any need for subsequent layering and can be easily painted and mechanically polished in the palatal area.

Fig. 10.

Fig. 11.

Fig. 12.

Fig. 13.

Fig. 14.

Fig. 15.

Kuraray Noritake Dental has also developed CZR FC Paste Stain with a wide range of coloring pastes specially designed for full anatomical solution of multi-layered zirconia. Their effectiveness is proven to be enhanced when used with “ULTRA MICRO LAYERING technique” on thin glasure or thin transparent ceramic mass.

Another advantage with STML and UTML products is the lower thickness, respectful of the latest micro-invasive dentistry standards and current market requests.

Fig. 16.

Excellent flexural strengths higer than 550/750 MPa allow restoration to feature micro-invasive thicknesses from 0.4 mm on, p.e. on laminates. Unlike PFZ, zirconia lower thicknesses ensure better results.

Fig. 17.

Fig. 18.

Fig. 19.

Fig. 20.

Fig. 21.

Fig. 22.

Above all, new generation zirconia makes the digital work-flow more efficient and performing, from the intra-oral impression to the final product which can be manufactured “model-free”.

Fig. 23.

Fig. 24.

Thus a new procedure standard is introduced, where simplified adhesive cementation through composite cements opens the the way to zirconia-based adhesive restoration techniques. Regarding adhesion, unlike glass-ceramic, zirconia is not etchable, yet it can be fixed through phosphate monomer MDP, i.e. Panavia™ V5

Fig. 29.

Fig. 30.

Fig. 31.

Fig. 32.

Fig. 33.

Fig. 34.

Fig. 35.

Dentist:

DANIELE RONDONI, MDT

• Graduating in 1979, Daniele Rondoni opened a laboratory in 1982, which is also the home of the AAT Community College he founded.
• Teacher and counsellor for the “Italian School for Dental Technicians”at the University of Chieti, University of Sienna and University of Rome Tor Vergata.
• EAED and IAED Active Member and a SICED Associate and O.L.
• International Instructor for Kuraray Noritake Dental products.
• Author of “Tecnica della Multistratificazione in ceramica” (Ceramic Multilayering Technique) and a lab manual about the use of composite materials, introducing his own method – the “Inverted Hardness Layering System”.

Case by Dr. Salvatore Scolavino

After decades of developing and improving the matrix chemistry and filler technology contained in resinbased composites, the products available for direct restorative procedures finally seemed technically mature. What remained challenging, however, was the management of the extremely wide range of tooth shades and opacities available for each product: The dentin, body and enamel masses had to be selected and combined in the right way to obtain a perfect colour match and optical integration with the surrounding tooth structure. The difficulties associated with shade selection and calibration of layer thicknesses (particularly the top enamel layer) required to obtain the desired optical (desaturation) effects have now also finally been overcome.

The reason is that further improvements of the composites’ optical properties, mainly achieved through a careful selection and combination of fillers, have enabled the production of materials with optimized light diffusion properties. These properties enable the restorations to blend in smoothly with the adjacent tooth structure, thus paving the way for a single-shade concept (SSC). This concept involves the use of a single mass of composite to restore the function and aesthetics compromised by the loss of dental structure.

This translates into a significant saving of chair time and a high predictability of aesthetic outcome. A composite material supporting a single-shade technique needs to have medium opacity and a technology ensuring that the incoming light is absorbed, reflected and scattered in the right way to merge effortlessly with the surrounding natural dentition and create a biomimetic effect. The following clinical case reveals how the Light Diffusion Technology used in the CLEARFIL MAJESTY™ ES-2 Universal composite system (Kuraray Noritake Dental Inc.) leads to a highly predictable aesthetic integration obtained using the SSC.

Case description

The 30-year-old female patient presented for a check-up, during which it appeared that her composite restorations in the second quadrant (the maxillary left first and second molar) needed to be replaced due to marginal leakage (Fig. 1). Once the rubber dam was in place (Fig. 2), the existing composite restorations were removed using a round multi-blade bur, which allowing for a selective removal of composite and carious tissue. The extension of the cavity was performed with a truncated cone diamond bur (fine). Once the cavity preparation was completed (Fig. 3), the enamel and dentin surfaces were cleaned by sandblasting with aluminium oxide (50 μm). Selective etching of the enamel was performed with K-ETCHANT Syringe (Kuraray Noritake Dental; Fig. 4), followed by thorough rinsing and drying of the tooth (Fig. 5). For the adhesive procedure with CLEARFIL™ SE BOND 2 (Kuraray Noritake Dental), the primer was applied first (Fig. 6), rubbed into the tooth surface for 40 seconds and air-dried. The bond was subsequently applied in the same manner (Fig. 7). After several seconds of air flowing to create homogeneous surface the adhesive was light-cured for 40 seconds (Fig. 8). As the last phase of the adhesive procedure, a 1-mm-thick layer of flowable composite (CLEARFIL MAJESTY™ ES-Flow Super Low A3, Kuraray Noritake Dental) was applied to cover the adhesive on the dentin (Figs. 9 and 10).

Fig. 1. Pre-operative clinical image.

Fig. 2. Isolation with rubber dam.

Fig. 3. First and second molar after cavity preparation.

Fig. 4. Selective etching of the enamel.

Fig. 5. Cavities ready for the adhesive procedure.

Fig. 6. Application of the tooth primer.

Fig. 7. Glossy appearance of the cavities after application of the bond.

Fig. 8. Light-curing of the adhesive layer.

Fig. 9. Application of flowable composite.

Fig. 10. Cusp-by-cusp modelling of the universal composite.

In the modelling phase, the posterior shade U of the composite CLEARFIL MAJESTY™ ES-2 Universal was placed using the cusp-by-cusp technique (Figs. 11 and 12). In order to improve the optical integration of the restorations, some brown stain (CHROMA ZONE™ COLOR STAIN Dark Brown, Kuraray Noritake Dental) was added to the fissures (Fig. 13). For finishing, we used a multi-blade ball-shaped bur and an Arkansas Flame abrasive stone (Fig. 14). Polishing of the restorations was accomplished with the TWIST™ DIA system (EVE; Fig. 15). After rubber dam removal, the occlusal check was performed with articulating paper (Fig. 16), minimal adjustments were made and the surfaces repolished. The integration of the restorations after 30 days fully meets the clinical expectations (Figs. 17 to 20).

Fig. 11. Glossy appearance of the cavities after application of the bond.

Fig. 12. Completed occlusal anatomy.

Fig. 13. Stained fissures.

Fig. 14. Matte surfaces after finishing.

Fig. 15. High-gloss surfaces after polishing.

FINAL SITUATION

Fig. 16. Whole quadrant after rubber dam removal and the occlusal check.

Fig. 17. Whole quadrant at the 1-month-recall.

Fig. 18. Occlusal view of the restorations …

Fig. 19. … after one month.

Conclusion

The innovative composite system CLEARFIL MAJESTY™ ES-2 Universal, which consists of two shades for the anterior and a single shade option for the posterior region, offers the properties needed for a successful implementation of the single shade technique. Used in the posterior region, the material is sufficiently opaque to mask optical irregularities of the underlying tooth structure, while it is translucent enough to provide for an imperceptible optical transition from the tooth structure to the restoration. Irrespective of the tooth shade, the restoration merges smoothly with the surrounding natural dentition, creating a harmonic overall picture.

Dentist:

DR. SALVATORE SCOLAVINO

Dr. Salvatore Scolavino, graduated with honors in Dentistry and Dental Prosthesis from the University of Naples. Dr. Salvatore is a specialist in aesthetics and direct and indirect anterior and posterior adhesive restorations. His focus lies with Conservation, Endodontics and Prosthetics in particular. He is an active member of prestigious academies and scientific societies: AIC -Italian Academy of Conservation, IAED -Italian Academy of Esthetic Dentistry and SIDOC (Italian Society of Conservative Dentistry. Since 2004, he has private practice Nola, Italy.

Dr. Scolavino is a founder of werestoreit.it, an inspiring site that offers abundance and variety of aesthetic clinical cases. Author of the book published by Quintessence Publishing „Direct Restorations in the posterior regions“, author of scientific publications in national and international journals, he is speaker at courses and conferences in Italy and abroad.

By Univ.-Prof. Dr. Florian Beuer MME

There is still some confusion among dental practitioners about how to cement zirconia restorations. In general, all types of cements – adhesive or self-adhesive resin cements and conventional cements – are compatible with all types of zirconia. The actual choice should be based on the restoration design (retentive or non-retentive), the translucency of the zirconia and the clinical situation (feasibility of working field isolation).

When to use which type of cement

The use of adhesive resin cements is mandatory whenever the highest possible bond strength is required. This is the case with one-wing Maryland bridges and other types of restorations lacking micromechanical retention, and with two-piece implant abutments.

In some other situations where retention is not an issue, adhesive or self-adhesive resin cements may have a beneficial effect. The major reason is their more esthetic appearance compared to conventional cements, which offers advantages whenever a highly translucent restorative material is used (e.g. KATANA Zirconia UTML). An important precondition for adhesive luting, however, is a dry working field. Consequently, conventional cements are preferable in the context of placing crowns, bridges and other types of restorations with retentive designs whenever opaque zirconia framework materials are used and / or it is difficult to ensure a dry working field.

How to pre-treat the tooth and the restoration

The highest bond strength of adhesive resin cements to zirconia is obtained after sandblasting with alumina (particle size max. 50 µm, pressure approx. 1 bar). Hence, this procedure is highly recommended. Subsequent steps may be different depending on the cement system employed and should be carried out according to the manufacturer’s instructions for use. On the side of the tooth, enamel etching is important independent of the products used.

Which products to use

In each of the cement classes, there are many different products to choose from. My recommendation is to select a proven and easy-to-use luting material. Among those products achieving the same high bond strength, the solution requiring the fewest application steps seems preferable as it reduces the risk of application errors. At Charité – University Medicine Berlin, we count on PANAVIA cements, which are based on many years of expertise in developing products for adhesive luting of zirconia.

Dentist:

PROF. DR. FLORIAN BEUER

Professor and Chair, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité – Universitätsmedizin Berlin, Germany.

Case by Daniele Rondoni, MDT

Evolution in the field of aesthetic dentistry never stops: KATANA™ Zirconia proves its aesthetic potential while also being great function-wise. The full zirconia palatal area is combined with an aesthetic buccal part where CZR Luster mass is only used.

Fig. 1. KATANA™ Zirconia HTML with vestibular cut-back opalescence bio-design.

Fig. 2. Palatal ”zirconia-free“ solution.

Fig. 3. Aesthetic vestibular layering with Luster porcelain.

Fig. 4. Manually polished palatal surface with Pearl Surface Z diamond paste.

Fig. 5. Self glazing in furnace for vestibular porcelain.

Fig. 6. Initial case.

Fig. 7. Hybrid solution.

Fig. 8. Palatal Zirconia free.

FINAL SITUATION

Fig. 9. 4 Years follow-up.

Dentist:

DANIELE RONDONI, MDT

Born in Savona in 1961 where he lives and has worked in his own laboratory since 1982 with his collaborators. Graduated from the dental technician school IPSIA “P. Gaslini” in Genoa in 1979. He continued his education by attending relevant workshops for the “Italian dental school“ and broadened his professional experience in Switzerland, Germany and Japan. Since 2011 Kuraray Noritake Dental International Instructor.

With CLEARFIL MAJESTY™ ES-2, the shade transition from composite to tooth is virtually invisible. The secret to this lies in light diffusion technology. How does this work?

Before we discuss the technology in detail, here are some more information about our CLEARFIL MAJESTY™ ES-2 composites. All CLEARFIL MAJESTY™ ES-2 composites are suitable for both anterior and posterior applications. The different variants within the ES-2 family are characterized by supreme handling and a long working time, and the fact that they do not slump during modeling. A key feature of these composites is the ease with which restorations blend into their surroundings. This results in durable and aesthetic restorations.

In CLEARFIL MAJESTY™ ES-2 composites, two types of fillers are used. Barium glass particles form the basis of the filler. Alongside this, advanced prepolymerized filler particles are added. The latter type is called light diffusion filler, since it is primarily these filler particles that achieve a light-scattering effect within the composite.

The way in which a restoration 'adjusts itself', to the shade of the tooth to be restored, is not the same for all composites. Most composite manufacturers make use of the so-called 'chameleon effect'. A composite that is sufficiently translucent allows light to pass through. Light is reflected off the walls of the cavity, whereby the composite restoration assumes the shade of the adjacent tooth structure.

In cavities that aren't too large with a sufficient amount of surrounding tooth structure, this chameleon effect works well enough. However, with larger cavities or in the absence of underlying tooth structure, as is often the case with anterior restorations, the aesthetic blending effect is limited. The brightness is far from satisfactory, and the restoration looks gray.

At Kuraray Noritake Dental Inc., we do things differently.

Besides the optimized translucency in CLEARFIL MAJESTY™ ES-2 composites, it's the light diffusion technology that makes the restoration blend seamlessly with the adjacent tooth structure. Thanks to the combination of these two parameters — translucency and light diffusion — the capabilities are far more extensive than with just translucency.

The different dental tissues have different opacities. Enamel is more translucent than dentin. However, the degree of translucency/opacity of both tissues is not always the same. Age, thickness of the structure and various intrinsic and extrinsic factors all play a role.

Depending on the desired end result, the most appropriate member(s) of the CLEARFIL MAJESTY™ ES-2 family is/are selected for the restoration.

In aesthetic restorations in which opacity differences need to be considered, a layering system is necessary. More uniform restorations are easily constructed with a composite that has broad shade and opacity coverage.

CLEARFIL MAJESTY™ ES-2 Premium for highly esthetic restorations.

CLEARFIL MAJESTY™ ES-2 Universal for routine aesthetic restorations involving few or no opacity differences.

By Kazunobu Yamada, RDT

With the new KATANA™ Zirconia YML it is extraordinarily easy to produce beautiful restorations. Brilliance and vitality may be added simply by applying CERABIEN™ ZR FC Paste Stain to the monolithic restoration after surface preparation.

A possible technique is demonstrated by Kazunobu Yamada, RDT, in this video.

What if Kuraray Noritake Dental had not developed the MDP monomer?

What would the quality of adhesive dentistry be if Kuraray Noritake had not developed the MDP monomer? MDP has proved to be a very effective functional monomer for creating durable bonding to enamel, dentine and metals. The best-known products containing MDP are CLEARFIL™ SE BOND and PANAVIA™.

Structure of Adhesive monomer MDP

Adhesion to various substrates is possible Thanks to MDP (methacryloyloxydecyl dihydrogen phosphate), which has been shown to create a long term, durable and stable bond to both dental tissue and metal oxides. Research conducted over the past few decades has demonstrated the effectiveness of MDP. The first Kuraray Noritake Dental product to contain MDP was PANAVIA EX. Various other adhesive and cementation systems followed. Our latest products, PANAVIA™ V5 and CLEARFIL™ Universal Bond, also rely to a large extent on the performance of the original MDP monomer. MDP has the following structure:

1. terminal double bond group for polymerisation
2. hydrophobic alkylene group to maintain a delicate balance between hydrophobic and hydrophilic properties and
3. hydrophilic phosphate group for performance of the acid demineralisation and chemical bonding to tooth structure.

Fig. 1. The chemical structure of adhesive monomer (MDP).

History

In the years between 1978 and the late 1990s, it became possible to increase the bond strength to dentine to more than the intrinsic strength of the dentine itself. MDP played a major role in these developments. The solid ionic bond with calcium from the HAp in dental tissue means that such failures as occur are cohesive in the dentine rather than being failures of the adhesive. Apart from in vitro studies confirming this bond strength, the long term clinical durability recorded over 13 years is also impressive.

Research

Research from Yaun et al., 2007, shows that defects along the interface are largely responsible for degradation of the hybrid layer. CLEARFIL™ SE BOND exhibited no such defects. So it was expected that SE BOND would also prove to have a stable connection to dental tissue. Recently, Peumans et al. From Leuven University, Belgium found CLEARFIL™ SE BOND to still have excellent clinical effectiveness after 13 years.

In their publication in the Journal of Dental Research 83, 2004, Yoshida et al. concluded that the choice of the adhesive monomer played a significant role in the effectiveness of the adhesive. They found MDP to be the best and fastest in tests for chemical adhesion (ionic bonding) and stability in a moist environment (insoluble) – better and more stable than 4-MET and Phenyl-P, in that order.

After 35 years, MDP is still in a class of its own. To date, no manufacturer has been able to develop an adhesive monomer with better adhesion properties combined with durable bond strength. Many attempts have been made, but none have succeeded. In the meantime, Kuraray’s patent on MDP has expired. This has opened up the market for other manufacturers to synthesise their own MDP. Only a few non-dental chemical companies are supplying MDP to other manufacturers of adhesive systems, and the synthesis of high-purity MDP remains extremely difficult.

More recently, Kumiko Yoshihara et al. published ‘Functional monomer impurity affects adhesive performance’, in Dental Materials 31 (2015) 1493-1501. They concluded that the three MDP’s they studied exhibited different levels of purity. Differences in the resultant hybrid layers were observed in all three MDP versions: both impurities and the presence of dimers had an effect on the etching efficacy of the HAp, and also on the intensity of nano-layer presence and the immediate bond strength.

μTBS of MDP’s from different origin

Yoshihara Ket al. Functional monomer impurity affects adhesive performance Dent Mater 31, 1493-1501, 2015.

Fig. 2.

Explanation

The three 10-MDP’s studied in this study clearly revealed a different purity. Differences in the ultrastructure of the resultant hybrid layers were observed for the three 10-MDP versions. Both the impurities and the presence of dimers affected the etching efficacy of HAp, the intensity of nano layering and the ïmmediate’ bond strength.

“The purity of 10-MDP present in commercial dental primers, adhesives and cements can be expected to influence bonding performance.”

Case by Dr. Salvatore Scolavino

The establishing of a stable occlusal relationship is one of the biggest challenges dental practitioners are facing when restoring posterior teeth with resin composite, but it is a task with a decisive impact on the integrity of the masticatory apparatus. A poor static and dynamic occlusion may have a negative effect on the restored tooth, the periodontal apparatus, and also on the opposing dentition.¹ Ideally, the occlusal anatomy of direct restorations is designed in a way that occlusal forces are directed along the long axis of the tooth, which is achieved when each cusp tip in occlusal contact touches a flat surface. Horizontally directed forces, on the other hand, should be avoided, as they tend to cause tipping and increase the risk of cuspal fracture, tooth mobility etc.

In cases concerning improper occlusal relationship involving tipping of restored teeth, it may be possible to stabilize the situation by replacing the restoration and re-establishing a proper occlusion. If carried out correctly and early enough, this restorative approach may be a way around orthodontic treatment. The following clinical case is used to demonstrate how to create a functional occlusal surface right away – without larger adjustments. The whole restorative procedure is simplified by the use of a universal composite with a single posterior shade that eliminates the need for shade determination and shade selection, while it produces lifelike treatment outcomes.

Case description

This patient presented with direct composite restorations in the mandibular left first and second molar that were lacking an elaborated occlusal morphology (Fig. 1). The second molar appeared to be tipped mesially towards the first molar (Figs. 2 and 3), which resulted in improper occlusal relationships and a decreased position of the mesial marginal ridge. In order to verify the clinical and radiographic observation of an improper occlusal relationship, the occlusal contacts were recorded with articulating paper (Fig. 4). As expected, there was an uneven distribution of occlusal contacts, which were exclusively located in the distobuccal area on the second molar, and not matching the tooth-restoration interface on both molars.

Fig. 1. Pre-operative clinical situation: Occlusal view.

Fig. 2. Pre-operative clinical situation: Lateral view revealing the tipping of the second molar.

Fig. 3. Pre-operative bite-wing radiograph confirming the tipping issue.

Fig. 4. Checking of the occlusal contacts.

Planned approach

As orthodontic treatment was not an option, it was decided to replace the composite restorations, thereby treating the Class I cavity of the second molar as if it were a Class II cavity. This would allow us to increase the height of the mesial marginal ridge and establish the proper occlusion.

Preliminary measures

Once the rubber dam was placed (Fig. 5), the existing composite restorations were removed and the cavity slightly extended with a diamond chamfer bur (Fig. 6). The result of this procedure is shown in Figure 7. In order to provide an anatomical build-up of the mesial wall, a sectional matrix was mounted with the aid of a wooden wedge and a separator ring (Fig. 8).

Fig. 5. Isolation with rubber dam, held in place with a clamp and a wedge.

Fig. 6. Tooth preparation with a diamond chamfer bur.

Fig. 7. Appearance of the teeth after preparation.

Fig. 8. Sectional matrix, wedge and separator ring in place.

Adhesive procedure

After selective etching of the enamel (K-ETCHANT GEL, Kuraray Noritake Dental Inc.) (Fig. 9), the enamel bonding surfaces had a chalky-white appearance, which indicates properties that are favourable for bonding (Fig. 10). The adhesive procedure was performed with CLEARFIL™ SE BOND 2 (Kuraray Noritake Dental; Fig. 11). In the first step, the primer of the system was applied and actively rubbed into the surface for 40 seconds, and air-dried. Subsequently, the bond was used in the same manner. After complete evaporation of the solvent, the bonding surface was light-cured for 40 seconds to ensure proper polymerisation. The cavity floor was then covered with a 1 mm thick layer of flowable composite (CLEARFIL MAJESTY™ ES FLOW SUPER LOW A3, Kuraray Noritake Dental).

Fig. 9. Selective etching of the enamel.

Fig. 10. Chalky-white enamel surfaces.

Fig. 11. Glossy appearance of the bonding surfaces after application of the tooth primer and bond.

Restoration procedure

Before starting to elevate the mesial wall of the second molar using the centripetal build-up technique² (Fig. 12), we analyzed the height of the marginal ridge and anatomical details of the contralateral tooth, while the adjacent molar provided orientation as well. In general, knowledge not only about the tooth’s typical anatomy, but also about the patient-specific anatomical details of the adjacent and contralateral teeth as well as the antagonist is very useful for designing the occlusal anatomy. In addition, remaining anatomical structures should be read and used. In this particular case, the restorations were completed with CLEARFIL MAJESTY™ ES-2 Universal composite (Kuraray Noritake Dental) in the posterior shade U, using the cusp-by-cusp technique (Figs. 13 to 15). In most areas, it was possible to follow the inclination of the remaining cusps and the orientation of the grooves to produce an ideal surface anatomy. For those who would like to speed up the procedure, the simultaneous modeling technique³ may be an option. In this technique, the cusps are built up simultaneously from separate increments, which remain out of contact to each other until light-cured in a single curing cycle.

Fig. 12. Mesial wall built up with composite.

Fig. 13. Application of the first increment for cusp build-up. It is useful to limit the size of the increments for controllability.

Fig. 14. Cusp-by-cusp build-up completed on the second molar.

Fig. 15. Molars with restored occlusal surfaces.

In order to improve the already great optical integration of the restorations, some stain (Dark Brown, CHROMA ZONE™ COLOR STAIN, Kuraray Noritake Dental) was applied to the fissures. A multi-blade ball shaped bur and an Arkansas Flame abrasive stone were used for finishing. Final polishing was accomplished with the TWIST™ DIA system (EVE). The immediate treatment outcome is shown in Figure 16. The patient was released after rubber dam removal, checking the static and dynamic occlusion, and conducting a control radiograph (Fig. 17). The optical integration was even better at the recall after one month due to the rehydration of the surrounding tissues (Fig. 18), while the functional integration was excellent and no occlusal adjustments were required.

Fig. 16. Immediate treatment outcome with a nice optical integration of the restorations providing for a stable occlusal relationship.

Fig. 17. Control radiograph taken after the direct restoration procedure.

FINAL SITUATION

Fig. 18. Treatment outcome at recall after 30 days.

Conclusion

The presented case example reveals how important it is to strive for occlusal stability when restoring posterior teeth with composite. Furthermore, it demonstrates how it is possible to re-establish a stable occlusal relationship, even if some tipping has already occurred. In order to get it right the first time, it is essential to make use of the remaining anatomical structures, which guide the way toward an occlusal surface that ensures a favourable distribution of occlusal forces, and therefore provides optimal conditions for a long life of the freshly restored teeth. The combined use of the presented restorative techniques with innovative materials like CLEARFIL MAJESTY™ ES-2 Universal will make the procedures simpler and even more efficient.

References

1 Sandhu S, Lal J, Singh R, Sandhu R, Sra J. Significance of establishing occlusal anatomy in operative dentistry. Saint Int Dent J 2016;2:7-10.
2 Bichacho N. The centripetal build-up for composite resin posterior restorations. Pract Periodontics Aesthet Dent. 1994 Apr;6(3):17-23.
3 Scolavino S, Paolone G, Orsini G, Devoto W, Putignano A. The Simultaneous Modeling Technique: closing gaps in posteriors. Int J Esthet Dent. 2016 Spring;11(1):58-81.

Dentist:

DR. SALVATORE SCOLAVINO

Dr. Salvatore Scolavino, graduated with honors in Dentistry and Dental Prosthesis from the University of Naples. Dr. Salvatore is a specialist in aesthetics and direct and indirect anterior and posterior adhesive restorations. His focus lies with Conservation, Endodontics and Prosthetics in particular. He is an active member of prestigious academies and scientific societies: AIC -Italian Academy of Conservation, IAED -Italian Academy of Esthetic Dentistry and SIDOC (Italian Society of Conservative Dentistry. Since 2004, he has private practice Nola, Italy.

Dr. Scolavino is a founder of werestoreit.it, an inspiring site that offers abundance and variety of aesthetic clinical cases. Author of the book published by Quintessence Publishing „Direct Restorations in the posterior regions“, author of scientific publications in national and international journals, he is speaker at courses and conferences in Italy and abroad.

By Kazunobu Yamada, RDT

Are you looking for a convenient finishing technique that allows you to successfully start using KATANA™ Zirconia YML for the production of life-like restorations?

In this video, Kazunobu Yamada, RDT, demonstrates how texturing and polishing of the lingual surface and texturing, pre-polishing and glazing of the labial surface of an anterior crown will deliver impressive outcomes.

The introduction of universal composites, which are not only universal in terms of application range but also in terms of shade adaptation, effectively marks the dawn of a new type of composite. This prompts a reinterpretation of the term "universal composite."

CLEARFIL MAJESTY™ ES-2 is a nanohybrid composite family. Nowadays, nanohybrid composites are commonly used as universal composites. They have a high filler content, they are strong, and they have exceptionally good polishability characteristics¹.

The newest variant in the CLEARFIL MAJESTY™ ES-2 range is CLEARFIL MAJESTY™ ES-2 Universal shade concept. For this composite; we expand the definition of universal and include shade coverage.

Posteriorly, a single material in a single shade is sufficient to cover the entire VITA™ range. This means that no shade determination is required. For the anterior zone, we offer two shade variants: a lighter and a darker variant (UL and UD). The lighter variant is used in the A1-A2 range and the darker for shades from A3 onwards. There is sufficient overlap between UL and UD ensuring no specific shade determination is necessary.

Finally, for situations that require extra lightness and brightness, an additional UW shade is available.

What makes CLEARFIL MAJESTY™ ES-2 Universal unique in comparison to other universal or single-shade composites?
The difference with CLEARFIL MAJESTY™ ES-2 Universal, is that without using an additional opaque composite, sometimes called a blocker, a successful, superbly matching restoration can be constructed. Not only with smaller cavities, but also with larger class I and II restorations. And, when used anteriorly, even an extensive Class IV restoration can be successfully constructed using CLEARFIL MAJESTY™ ES-2 Universal. So, it is not only for those small class III or V lesions.

Why Kuraray Noritake Dental Inc. can do this where others cannot, is to a large extent, thanks to optimized light diffusion technology (LDT). By using this technology in composites with the right translucency, the light is scattered and reflected in such a way that the composite blends in with the surrounding tooth structure.

Where others use the widely-employed chameleon effect, Kuraray Noritake Dental Inc. adds an extra dimension in the form of LDT. With the chameleon effect, light passes through the material and is reflected off the walls of the cavity. The perceived shade of the restoration is therefore the shade of the cavity walls. If the cavity is too large, thus requiring a larger amount of filling material, the light has to travel further and a large proportion of the light is absorbed. With this, the brightness of the restoration is reduced and the shade of the cavity walls no longer accurately reflected.

Our LDT allows light to be scattered within the composite itself, in addition to being reflected off the cavity walls. As a result, CLEARFIL MAJESTYTM ES-2 Universal is a particularly forgiving composite. This feature will be familiar to those who have used CLEARFIL MAJESTY™ ES-2 family products before.

CLEARFIL MAJESTY™ ES-2 Universal is the result of sophisticated filler, matrix and silane technology. It offers a solution for all your routine composite work. A consistently superb restoration where shade determination is a thing of the past.

Reference

¹ Ilie, N., & Hickel, R. (2011). Resin composite restorative materials. Aust Dent J, 56 Suppl 1, 59-66. doi:10.1111/j.1834-7819.2010.01296.x