By Dr Salvatore Scolavino and DT Francesco Napolitano 

The dental laboratory is confronted with the greatest aesthetic challenge whenever it comes to the restoration of a single incisor with natural adjacent teeth. In the following case, a young patient had undergone endodontic treatment of her tooth 21 (fig. 1) while all other teeth showed their natural appearance. Tooth 21 was due for replacement now (fig. 2).

Fig. 1:  X-Ray after endodontic treatment (with new crown on tooth 21 in place).

Fig. 2: The former restoration with which the patient showed up in the dentist’s practice.

To keep the natural identity, together with preserving the gingiva outline, the decision was taken in favour of a monolithic zirconia restoration, with a layered block for a full-contour crown. KATANA™ Zirconia STML (Kuraray Noritake Dental) provides for four gradational layers from „Body/Dentine“ (cervical area) to „Enamel“ (incisal aera), varying in chroma and translucency. Using this kind of milling block, it is possible to imitate the natural progression from yellowish to whitish-blue, and this in an easy manner. At the same time this way, the endodontic post wouldn’t shine through and make any aesthetic difference. On the other hand, the zirconia irradiates into the gingiva and results in a natural looking shade allover the anterior area. Furthermore for a lively and most natural-identical appeal, it was intended to individualize the crown by surface stains. With the product CZR™ FC Paste Stain by Kuraray Noritake Dental, 27 shades are available, together with fluorescence. What is essential in the front, too, is this well proven experience: All zirconia material enhances the close gingival attachment and provides for stable results of the pink-and-white aesthetics.

The dentist built up the stump 21, prepared it according to the specifications for zirconia and took the impression (fig. 3). The plaster model followed (fig. 4) and was scanned to start then the digital process. After designing, the crown was milled and tried-in at the next session with the patient (fig. 5).

Fig. 3: Impression taking after preparing tooth 21.

Fig. 4: Plaster model - the prothetic baseline of the case.

Fig. 5: Try-in of the zirconia crown in the patient’s mouth with rubber dam.

SHAPE AND COLOUR

Right when starting the case, the teeth of both jaws had been scrutinized: first for shape. Special attention was payed to the interproximale space between 11 and 21 because this area had worn out in the meantime (see again fig. 2). It was also necessary to move closer to each other the approximale margins 21/22 resp. 11/12 in their cervical-middle parts. When giving the zirconia crown its final shape, this resulted in a widely swinging outer line distally 21. For harmony reasons, tooth 11 was extended distally, too. Here, the clinician used the direct filling composite CLEARFIL MAJESTY™ Classic, shade A2 (fig. 6, 7 and 8). This nano-hybrid composite by Kuraray Noritake Dental is easy-sculpting and integrated fully with the milled crown.

It was most important for crown 21 and tooth 11 too, to create a 3D effect of the tooth structure and an age-appropriate vestibular surface texture. For this, the characteristics of the adjacent teeth and allover both jaws were examined meticulously in general and in detail. Surface burs, discs, stones, and similar instruments sophisticatedly engraved pericymatia and a groove here and there, thus accomplishing the perfect natural look.

Fig. 6: Tooth 11 before recontouring the shape distally.

Fig. 7: Finished crown 21 on the plaster model. Notice: In order to match the shape of crown 21 and close-up the margins 11/12, composite has been added in the interproximal space.

Fig. 8: Finishing the new distal outline of tooth 11.

The final colour touch was given to both teeth by surface staining: with a thin layer of FC Paste Stain measuring only 50-70 micrometers in depth, different shades were applicated. The entire range was used from yellow/orange to blue and white (fig. 9a-d) in order to provoke the effect of mamelons and other structures in all thirds of the restorations.

Fig. 9a: Definitive fitting of the restoration.

Fig. 9b: Directly after the fitting.

FINAL SITUATION

Fig. 9c: View of the lips with the restoration in place.

Fig. 9d: Natural look of the upper and lower jaws.

WHAT IS THE OFFICIAL KURARAY NORITAKE DENTAL APP?

This is an official app that keeps you informed about the latest updates on how to use our products, as well as our new products at your own time and convenience.

WHAT ARE ITS CHARACTERISTICS?

EASY TO GET PRODUCT INFORMATION!

Various product brochures are posted. Do you want to check the usage and product contents? Then install the app and get the information you want to know immediately.

MAGAZINE ARTICLES AND VIDEOS

New magazine articles and videos are also posted. Various visual approaches allow you to see product features and operating procedures.

USEFUL AUTOMATIC PUSH NOTIFICATION FUNCTION!

You will receive notifications such as application update information, new product information, magazine articles and others. With this function, you don’t need to worry about missing the latest news anymore. You can also get updated information about dental adhesive and ceramic materials that are indispensable for daily clinical use. Obtain and use valuable information for your medical treatment.

SUPPORT FOR YOUR DAILY CLINICAL PRACTICE!

“KATANA™ Color Simulator” that allows you to perform color simulation of KATANA™ Zirconia on the screen for the conditions of the abutment tooth and the target color of the prosthesis. In addition, “Cementation Guide” will help you with your procedures using our cements (PANAVIA™ SA Cement Universal and PANAVIA™ V5) through step by step instructions in which you will be able to select the type of abutment and prosthetic restoration.

Since you can easily view it from your smartphone or tablet, you can access it anytime and anywhere. There is no doubt that it will also be very useful as a staff training tool.

YOU’VE GOT LOTS OF BENEFITS! WHY DON’T YOU CHECK IT OUT?!

Download it here:

 Kuraray Noritake Dental

By Daniele Rondoni, RDT

Hybrid designing meets the functional needs in term of lower abrasiveness and higher toughness.

Step 1
Zirconia Frame (KATANA Zirconia HTML A2) cut-back designed to minic anatomical dentin structure and incisal frame.

Step 2
Application of Internal Stain.

Step 3
Completion of Internal Stain firing.

Step 4
Application of Luster, Clear Cervical and Opacious Body.

Step 5
Completion of firing.

Step 6
Completion of glaze (self-glaze) firing.

Step 7
Polishing of lingual side.

Step 8
Post-operative view.

4-Years Post-operative.

Mind the Gap!

Webinar about the key factors which influence the gap between the margin of prepared tooth and restoration, also about accuracy evaluations of milled materials and resin cement removal techniques during cementation.

Dr JOSEF KUNKELA, DMD, PHD

1993
Dentistry graduate of First Medical Faculty of Charles University, Prague, Czech Republic

1995
Fellow in Medical Faculty of Charles University Prosthodontic Department in Hradec Králové, Czech Republic

1999
Gained Second Degree Specialization in Prosthodontics

2001
Named external teacher of the Prosthodontic Department at the Charles University Clinic of Dentistry in Hradec Králové and Palacky University in Olomouc, Czech republic

2009
Named president of Czech Society of CAD/CAM Dentistry

2010
Founder of KUNKELA Campus, International CAD/CAM Traning Center in Jindrichuv Hradec, Czech Republic (Certified Exclusive DentsplySirona Training Center)

2018
Finished postgraduate doctoral degree PhD, thesis Dental Office Management and Marketing (University of Economics Prague)

Certified CEREC trainer by the International Society of Computerized Dentistry (ISCD)

Member of DSD (Digital Smile Design) Master Team

Member of MicroVision Group

Member of SKYN Concept Team

Member of Academy of Digital Dentistry

Board Member of ADDA (Association of Digital Dentistry Academies)

Ambassador of DDS (Digital Dentistry Society)

CEREC Beta Tester

CEREC Guide Beta Tester

CEREC Advocate

Key Opinion Leader in the area of digital dentistry

International speaker at the field of Digital Dentistry, Guided Implantology, Management & Marketing

By Drs. Mart Ramaekers

A 20-year-old patient was dissatisfied with her discolored composite restorations on her maxillary central incisors and the right lateral incisor. The original restorations had been placed after an accident with traumatic dental injuries approximately five years ago. We went through all available options that would enable us to improve the aesthetics of her anterior teeth and finally opted for replacement of the existing restorations by new direct restorations made of composite resin.

Prior to the restorative procedure, a home bleaching procedure was carried out with Opalescence 10% (Ultradent). In addition, a palatal silicon index was produced to record the shape and morphology of the existing restorations and dentition.

Initial situation

Frontal view of the initial situation.

Lateral view: The discolorations are particularly visible on the maxillary right central and lateral incisor.

Close-up view of the upper anterior teeth.

The existing restorations were removed after the administration of local anesthesia. Then, labial and palatal bevels were created, followed by sandblasting of the prepared tooth structure with alumina (50 μm). Hereafter, the enamel was etched for 30 seconds (K-Etchant Syringe, Kuraray Noritake Dental), before the primer and bond of CLEARFIL™ SE BOND (Kuraray Noritake Dental) were used according to the instructions.

Build-up of the palatal walls with a first increment of ‘enamel’ composite (CLEARFIL MAJESTY™ ES-2 Premium A2E, Kuraray Noritake Dental) using the silicon index.

Creation of the mesial and distal marginal ridges in A2E enamel composite. The procedure was facilitated by the vertical placement of sectional matrices (Contact Matrices Stiff Flex Large, Danville) in the interproximal space.

Creation of the dentin core and the dentinal mamelons by placement of an opaque composite increment (CLEARFIL MAJESTY™ ES-2 Premium, A2D). It increases the opacity in the middle third of the restoration.

Filling of the space between the mamelons with translucent composite (CLEARFIL MAJESTY™ ES-2 Premium, Translucent Clear).

Labial finishing of the restorations with a layer of semi-translucent composite (CLEARFIL MAJESTY™ ES-2 Premium, A2E).

Application of glycerin gel on top of the last layer of composite to prevent formation of an oxygen inhibited layer during the final light-curing procedure. Final contouring and polishing were performed by using red (fine) and yellow (x-fine) finishing diamonds followed by high gloss polishing with CLEARFIL™ TWIST DIA (Kuraray Noritake Dental).

Final situation

Frontal view of the final situation.

Lateral view: No shade differences or restoration margins are visible.

Close-up view of the new restorations on the upper anterior teeth.

Ceramist:

Drs. Mart Ramaekers

Academic education
2002 - 2007   Tandheelkunde, Radboud Universiteit Nijmegen

Non-academic education
2013 - 2014   Academy of Reconstructive Dentistry, Beuningen
2019              Biomimetic Dentistry, Los Angeles

Career
2008 - 2013    Mondzorg Jekerdal Maastricht
2013 - 2015    De Drietand Maastricht
2009 - 2020    Amalia Kliniek Kerkrade
2020 - now      Espenbos Kliniek Cadier en Keer

Materials used: Kuraray Noritake Dental: CLEARFIL™ SE BOND 2, K-Etchant Syringe, CLEARFIL MAJESTY™ ES-2 Premium Enamel A2E, CLEARFIL MAJESTY™ ES-2 Premium Dentin A2D , CLEARFIL MAJESTY™ ES-2 Premium Translucent Clear and CLEARFIL™ TWIST DIA. Heavy Putty (Provil Novo, Heraeus Kulzer), Glycerine gel (K-Yelly Johnson&Johnson), Rubberdam non-latex Heavy (Sigma), Contact Matrices Stiff Flex Large (Danville), Optragate Regular (Ivoclar)

Phosphoric acid is not only used for etching enamel and dentin surfaces within dental bonding procedures, but also frequently as an intra- and extra-oral cleaning agent for tooth structure and dental restorations. But is phosphoric acid always the right choice?

Direct Restorations

Many bonding procedures are performed using self-etch adhesive systems. When applied to the prepared tooth surface, the acidic monomers in the primer and/or the bond partially remove and modify the smear layer, resulting in a thin hybrid layer. A substantial amount of hydroxyapatite crystals remain on the slightly etched surface, enabling both chemical and mechanical adhesion between the adhesive and the dental tissue. If the bonding surface in the cavity is contaminated e.g. with blood or saliva, and phosphoric acid is applied for cleaning and decontamination, it etches the tooth structure, too, resulting in the removal of HAp. This will prevent the desired chemical adhesion, between the bonding system and the tooth, which may lead to compromised bond strength. Hence, cleaning with phosphoric acid may have a negative effect in this context and cannot be recommended.

Great cleaning results with no negative effect on the performance of the dental adhesive are obtained with the universal cleaning solution KATANA™ Cleaner. It contains an MDP salt of triethanolamine (MDP-TEA), as well as 'free' MDP. With a pH of 4.5, KATANA™ Cleaner is essentially neutral, meaning that, unlike phosphoric acid, it does not remove hydroxyapatite from the tooth. However, it does still effectively eliminate any saliva and/or blood contamination.

Indirect Restorations

For materials containing glass, such as lithium disilicate and feldspathic porcelain, phosphoric acid is a tried-and-tested agent for removing contamination, such as deposits produced when etching these materials with hydrofluoric acid. However, routine use of phosphoric acid to remove contamination from indirect restorations may not be wise. In fact, its use on zirconia is not recommendable, as it could inhibit the desired chemical adhesion of phosphate monomers in the bonding agent to the surface of the zirconia restoration.

When cementing prosthetics using self-adhesive resin cements like PANAVIA™ SA Cement Universal or cements that use self-etching primers (e.g. PANAVIA™ F2.0 or PANAVIA™ V5), the use of phosphoric acid on dentin is not recommended for the same reasons as in the case of direct restorations.

No pitfalls, no restrictions

Unlike 35% phosphoric acid, KATANA™ Cleaner is a product that cleans reliably without inducing negative side effects – independent of the type of tooth structure, kind of restorative material and planned bonding procedure. Hence, it is a universal cleaning solution that allows you to streamline your procedures.

CERABIEN™ ZR
High translucent and opal porcelain for True-to-life, highly aesthetic restoration.

Blue-tinged light translucency at incisor edge of enamel was reproduced with LTx and LT Royal Blue.

Initial situation.

LTx and LT Royal Blue were used at the incisor edges to reproduce the bluish opalescence and translucency effect.

Step 1: Build-up of internal structures.

In order to reproduce the mamelon structure with stain and dentin color, Internal Stains were applied, then baked.

Step 2: Applied the first Internal Stain, then baked it.

In order to reproduce the stain in the internal enamel structure, Luster porcelains were applied and baked as a base.

Step 3: Applied the first enamel structure, then baked.

In order to reproduce the white spot and the incisor halo, Internal Stains were applied before baking.

Step 4: Applied the second Internal Stain before baking it.

To reproduce the subtle color and translucency of enamel, Luster porcelains were applied before baking.

Step 5: Applied the second enamel structure before baking it.

Step 6: Final situation.

Photos: Courtesy of Otani Dental Clinic, MDT Ryuzo Shiba and MDT Naoto Yuasa.

New liquid ceramic FC Paste Stain for full-contour solutions with KATANA Multi-layered Zirconia - Features and 3D-technique.

ROBERTO ROSSI 

"YOU CAN’T STOP THE WAVES, BUT YOU CAN LEARN TO SURF"

Born in Savona in 1989, he studied and got his diploma at “Mazzini” Dental School, the one dental school in his hometown, and he still lives there. In 2007 he was awarded the National Award for Best Dental Technician in Turin. Since 2008 he has been working at Daniele Rondoni’s Dental Lab and he is now in charge of the aesthetic planning of dental restorations. He shares this task with Master Dental Technician Daniele Rondoni, with whom he decides which strategy and materials – composites or ceramic especially – to opt for. In 2011 he coauthored with Mr. Rondoni “Sei faccette additive in composito” (Six additional composite facets), an article published in Dental Labor, 5/2011. A teacher at NISC, Noritake Italian Study Club since 2014, he is also a teacher at the AAT Community College – a reality he feels especially attached to – and he is in charge of the photographic services and social network profiling of the lab.

When art meets technology;
Logical evolution of design and techniques: Microlayering with Kuraray Noritake new porcelains. 

DANIEL RONDONI
Born in Savona in 1961, he lives and works in his hometown where he has been the manager and director of his own laboratory since 1982.

With so many different adhesives, cements, and restorative materials available on the dental market, it seems difficult to decide which products are best suited to fulfil the individual requirements. A direct comparison obtained through testing of all products in the dental office is simply impossible due to the great number of available solutions. Laboratory investigations provide information about specific product properties, but usually cannot create the overall picture. Moreover, the results of different tests are barely comparable due to variations in the test conditions. Clinical study results are very useful as they shed light on the clinical (long-term) performance of selected materials, but they are usually published years after a product’s launch. Hence, they are not available in the early stages. A great source of information are practice-based evaluations, as they support potential users in identifying high-quality dental materials.

One of the institutions conducting and publishing practice-based clinical evaluations and product performance tests is the US-based DENTAL ADVISOR. Once per year, the dental materials and equipment with the best performance receive a Top Product or Preferred Product Award. The list of winners is published online (www.dentaladvisor.com) and in the January-February issue of the DENTAL ADVISOR. In 2020, numerous products from Kuraray Noritake Dental were among the award winners.

Top Product Awards

CLEARFIL™ SE Protect received a Top Product Award in the category Direct Restoratives, Bonding Agent: Self-Etch. The self-etch adhesive is based on the formulation of the gold standard two-step self-etch adhesive CLEARFIL™ SE Bond, but contains an extra MDPB monomer offering an antibacterial cavity-cleansing effect and fluoride for long-term fluoride release. The honoring of the DENTAL ADVISOR is based on a material test carried out by 13 DENTAL ADVISOR consultants and editors in their dental offices for six weeks. Due to its excellent performance, the antibacterial self-etch adhesive received a 98 percent clinical rating.

For the fifth year in a row, the Top Product Award in the category Direct Restoratives, Composite: Highly Filled Flowable went to CLEARFIL MAJESTY™ ES Flow. The universal flowable composite comes in three different levels of flowability, from high to super low*. This enables the user to choose the right viscosity for every clinical situation – with the high flowability variant being the perfect choice for cavity lining and repair procedures, and the super low flowability option being specifically suited for direct veneer procedures, build-up of posterior cusps etc. The universal flowable composite was tested by 29 consultants of the DENTAL ADVISOR in more than 900 clinical applications. The evaluated properties – placement/handling, esthetics, viscosity and polishability – were rated “excellent”. This led to a recommendation rate of 100 percent and a 98 percent overall clinical rating.

^{*DENTAL ADVISOR evaluated only the standard level of flowability (Low), because other two variants are not available in US.}

Our third product receiving a Top Product Award in 2020 is PANAVIA™ SA Cement Universal (category: Cement: Self-Adhesive). The self-adhesive universal resin cement contains the unique LCSi monomer. This monomer is a silane coupling agent, which has an unique long carbon chain in its molecule, that establishes a durable, chemical bond with porcelain, lithium disilicate and composite resin without the need for a separate primer. The other key technology present in the formulation is the original MDP monomer, which ensures chemical reactiveness with zirconia, dentin and enamel. Together, the technologies ensure that PANAVIA™ SA Cement Universal produces a strong and durable bond with virtually every restorative material without the need for a separate primer. Its handling characteristics, aesthetics and gingival friendliness received very good to excellent ratings from 31 clinical evaluators, who used the cement in 516 applications. The result of the overall clinical rating was 96 percent.

Preferred Products

Among the 2020 Preferred Products is CLEARFIL™ Universal Bond Quick. The universal bonding agent may be applied using the self-etch technique or – together with K-ETCHANT syringe – in the selective enamel etch or total-etch technique. Containing our rapid bond technology – a combination of the original MDP monomer with innovative hydrophilic amide monomers – the adhesive works instantly and without the need for extended exposure times, application of multiple layers or extensive rubbing into the tooth structure. The fast and easy application procedure was one of the main reasons for the consultants of the DENTAL ADVISOR to select CLEARFIL™ Universal Bond Quick as a Preferred Product. In 2017, it already became the DENTAL ADVISOR Editor’s Choice with a 98 percent score in a clinical evaluation.

For the second year in a row, the universal prosthetic primer CLEARFIL™ Ceramic Primer Plus and TEETHMATE™ DESENSITIZER for hypersensitivity treatment. CLEARFIL™ Ceramic Primer Plus contains the original MDP monomer and a silane monomer, which ensure excellent bond strength to all kinds of restorative materials, i.e. to silica-based ceramics, zirconia, composites and even metals. Users benefit from procedural simplicity as the product is just applied and dried to the bonding surface after the recommended pretreatment. After clinical testing, the product received a recommendation rate of 96 percent and a 96 percent overall score from the DENTAL ADVISOR consultants.

TEETHMATE™ DESENSITIZER was designed to create hydroxyapatite (HAp), which is able to occlude open dentinal tubules and enamel cracks. This leads to a significant reduction of hypersensitivities when applied to exposed, mechanically treated or freshly prepared dentin. When used in the context of restorative treatment, TEETHMATE™ DESENSITIZER does not have a negative effect on the bond strength of dental adhesives or cements. A clinical evaluation conducted by the DENTAL ADVISOR resulted in an excellent rating with a score of 96 percent.

Conclusion

Most of the Kuraray Noritake Dental products that received an award this year are based on resin technologies, one of our key competencies. In the 1980s, we developed the original MDP monomer, a functional monomer, which is an essential component of any adhesive product we introduced down to the present day, including the award-winning CLEARFIL™ SE Protect, PANAVIA™ SA Cement Universal, CLEARFIL™ Universal Bond Quick and CLEARFIL™ Ceramic Primer Plus. This is only one of our many areas of expertise. We also provide users with preventive products and a whole range of restorative materials – from composite filling materials like CLEARFIL MAJESTY^TM ES Flow to dental ceramics like KATANA™ Zirconia UTML, STML and HTML. We see the winning of the awards as a positive proof of a reliable product performance that supports dental practitioners in reaching their own goals.