PANAVIA™: 40 years of success in adhesive luting DID YOU EVER WONDER WHY THE PRODUCTS OF THE PANAVIA™ BRAND OFFER SUCH OUTSTANDING PERFORMANCE? You probably know that they all contain the original MDP monomer developed in the early 1980s. It has attracted much attention because it is such an excellent adhesive monomer. This phosphate ester monomer forms a very strong bond to tooth structure, zirconia, and dental metals. It has been used in every PANAVIA™ product. In reality, however, other catalytic technologies and ingredients alongside MDP are important technological contributors supporting the performance of our cementation solutions. INGREDIENTS AFFECTING THE POLYMERISATION REACTION One of these decisive additional technologies and ingredients is the polymerization catalyst triggering the curing process. Different from the MDP monomer used in every PANAVIA™ product, the polymerization catalyst has been continuously improved since the introduction of PANAVIA™ EX in 1983. New versions have been developed for PANAVIA™ 21, PANAVIA™ Fluoro Cement and PANAVIA™ V5, for example. Another important component also affecting the curing process is the Touch Cure Technology used in two of the three major products of the current PANAVIA™ Portfolio: PANAVIA™ V5 and PANAVIA™ Veneer LC. This technology was first used in PANAVIA™ 21, which was launched in 1993. The contact of the chemical polymerization activator contained in the self-etching primer with the resin cement paste accelerates the polymerization of the cement from the adhesive interface, thus providing better adhesion of the resin cement. In developing PANAVIA™ V5, we reviewed the chemical composition of the existing PANAVIA™ products and updated it substantially. The Touch Cure technology has also been adopted for use in the case of PANAVIA™ V5 Tooth Primer and the concomitantly used PANAVIA™ V5 Paste. When cementing veneers with PANAVIA™ Veneer LC, we also use PANAVIA™ V5 Tooth Primer for conditioning teeth. This also involves the application of Touch Cure technology for achieving an adhesive connection with the tooth without compromising the working time of the cement paste. ADDITIONAL ADHESIVE MONOMERS Even in the field of adhesive monomers, we did not stand still: We developed the LCSi monomer, a long carbon chain silane-coupling agent which made possible to integrate the function of a ceramic primer in our universal self-adhesive resin cement PANAVIA™ SA Cement Universal. With its high level of hydrophobicity, this monomer provides stable, long-term bond strength. Generally speaking, it may be said that the reason bond durability may drop is a hydrolytic reaction damaging the chemical bond between the silica contained in the glass ceramics and the silane-coupling agent. THREE PRODUCTS COVERING VIRTUALLY EVERY NEED By combining these technologies and ingredients smartly, we have succeeded in developing a resin cement portfolio that covers virtually every need. With PANAVIA™ V5, PANAVIA™ SA Cement Universal and PANAVIA™ Veneer LC, it is possible to treat a wide variety of cases. The products allow for the luting of various types of restorations, prosthetic appliances and for the placement of posts and produce great outcomes if used properly according to the instructions for use. PANAVIA™ V5 is the resin cement that has the widest range of uses among the three cement systems just mentioned. It covers almost all the intended uses of the other two cements. Therefore, it is possible for the dental practitioner to choose the right cement system for treatment, according to the cases arriving at the clinic and patient needs, from among these three major resin cement products: PANAVIA™ V5, a resin cement with a wide range of applications; PANAVIA™ SA Cement Universal, a simple and easy-handling self-adhesive resin cement; and PANAVIA™ Veneer LC when there is a need to bond laminate veneers. EXPLORING NEW OPPORTUNITIES The good thing about developing technologies in a company like Kuraray Noritake Dental is that their application is not limited to a certain product or product group. The R&D Department always carries out research on how to leverage the benefits of the technologies in other applications. Take, for example, KATANA™ Cleaner, which was released in 2019. This cleaning agent can be used to remove saliva, blood, temporary cement, or other contaminants that can adhere to the surfaces of teeth or prosthetic devices during trial fitting and temporary cementation of a prosthetic device. This unique product has been developed by taking advantage of the surfactant function of the MDP monomer. CONCLUSION Hence, it is mainly our long-standing knowledge and experience in the development of dental resin cements and adhesive solutions that provides for the excellence of the current PANAVIA™ Portfolio. We know how to improve on existing technologies, to never stop developing new ones and to continuously look for the best way to combine proven and new components to obtain the best possible outcomes. In the steps of the product development procedure, clinical tests are conducted and feedback from dental practitioners is gathered in order to take into account the extreme conditions found in the oral environment. In the past 40 years, this strategy has proven successful, and we are sure it will help us to develop many other innovative products that offer ideal support in striving to improve the oral health of patients. Sep 19, 2023
Shaping the future of dentistry KURARAY NORITAKE DENTAL INC.'S AWARD-WINNING SOLUTIONS IN 2025 In our dynamic dental landscape, the demand for cutting-edge materials and devices that enhance clinical outcomes, simplify workflows and address individual patient needs continues to rise. Dental professionals never stop looking for such products that support them and their teams in achieving exceptional treatment outcomes safely and efficiently. In a short-lived world with new products being introduced frequently, however, it can be challenging to identify and choose the right solutions. Independent evaluations that assess practical application on one hand and laboratory as well as clinical performance on the other are among the most trusted sources of information. Each year, the Dental Advisor, a respected authority in dental product testing, recognizes those dental products that consistently perform at the highest levels. In its Top & Preferred Product as well as Research Awards published in the January/February 2025 issue of the Dental Advisor, several products from Kuraray Noritake Dental Inc. earned well-deserved recognition. Among this year’s winners are a new flowable composite as well as tried-and-tested favourites that continue to shape the field of restorative and adhesive dentistry. RESEARCH AWARD WINNERS According to Dental Advisor (www.dentaladvisor.com), “Companies that receive Research Awards demonstrate a commitment to advancing dental technology and enhancing patient care.” Features and physical properties are tested in the Dental Advisor Biomaterials Research Center to evaluate the scientific performance of the materials and recognize those products with the most promising blend of characteristics. CLEARFIL MAJESTY ES Flow Universal This brand-new flowable composite with a simplified shade concept has just earned the prestigious Research Award from the Dental Advisor. While the material is available in two flowabilities (Low and Super Low) in Europe, Low is the variant offered in the United States and tested in the Dental Advisor Biomaterials Research Center. According to the test results, the material stands out mainly due to its high mechanical properties and exceptional shade matching abilities. Its flexural strength and compressive strength are level with those of the strongest packable composites on the market. And although only two shades are offered, laboratory testing confirms that the material matches a broad range of natural tooth shades. This brings both simplicity and efficiency to restorative procedures without compromising on aesthetics and durability. PANAVIA Veneer LC (RESEARCH AWARD AND PREFERRED PRODUCT) PANAVIA Veneer LC has been revered for its exceptional bond strength and aesthetic outcomes in veneer applications. Testing confirmed that – when the components recommended in the United States (PANAVIA Veneer LC Paste, CLEARFIL™ Universal Bond Quick and CLEARFIL™ Ceramic Primer Plus) are used – bond strength is high after artificial ageing. This applies to various substrates including enamel, dentin, silica-based ceramics (lithium disilicate) and zirconia. The system also showed the best gloss retention and wear properties compared to two other leading veneer cements tested. TOP PRODUCT AWARD WINNERS Every year, the Top Product Award is awarded to materials and devices in different dental categories. The winners are selected based on clinical evaluations and laboratory test results. This award offers valuable insights as the tests are conducted under real-life conditions: “Our dedicated volunteer evaluators provide unbiased insights from their real-world experiences, ensuring that only the very best receive this prestigious accolade”, as stated on www.dentaladvisor.com. CLEARFIL MAJESTY™ ES Flow A consistent winner, CLEARFIL MAJESTY™ ES Flow has earned the Top Award again this year, reinforcing its status as a top performer in the composite resin category. Praised for its ease of use, excellent handling, and natural aesthetic appearance, this material is the go-to solution for clinicians who demand versatility and a superior finish. CLEARFIL™ SE Protect CLEARFIL™ SE Protect continues to lead the category of self-etch adhesives with its antibacterial effects and fluoride release. With a proven track record of clinical excellence, it secured a Top Award this year for its remarkable performance in both bonding and long-term performance, making it an indispensable product in restorative dentistry. PANAVIA™ SA Cement Universal The epitome of simplicity in self-adhesive cementation, PANAVIA™ SA Cement Universal earned a Top Award for its ability to bond reliably to a wide range of substrates without the need for additional primers. Its easy handling and consistent results have made it the preferred choice for clinicians looking for top performance and simplicity. TEETHMATE™ DESENSITIZER For the eighth year running, TEETHMATE™ DESENSITIZER has received a Top Award, highlighting its superior performance in the treatment of hypersensitivity. This non-invasive solution remains a favourite for addressing sensitivity issues, thanks to long-lasting pain relief. PREFERRED PRODUCT AWARD WINNERS Based on clinical evaluations and in-vitro tests, the Dental Advisor selects “those items that not only excel in performance but also resonate with the needs of dental practitioners”. As explained on www.dentaladvisor.com, these products receive a Preferred Product Award. CLEARFIL™ CERAMIC PRIMER PLUS Achieving Preferred Product status for its ability to bond to a wide variety of restorative materials, CLEARFIL™ CERAMIC PRIMER PLUS continues to shine in providing exceptional bond strength, particularly to silica-based ceramics, zirconia, and composites. Its consistent performance has earned it the recognition of clinicians worldwide. PANAVIA™ Veneer LC (PREFERRED PRODUCT & RESEARCH AWARD) This product not only excels in the laboratory setting, but also in the practice environment. Among the features highlighted by the consultants in the latter are its ease of excess clean-up, working time and aesthetics. A COMMITMENT TO EXCELLENCE At Kuraray Noritake Dental Inc., the pursuit of excellence is embedded in every product. The awards just won are a reflection of the company’s dedication to empowering dental professionals with solutions that improve patient care and optimize clinical workflows. From restorative materials to adhesive solutions, Kuraray Noritake Dental Inc.’s products support a wide range of applications that enhance both daily practice and patient outcomes. The recognition received from the Dental Advisor in 2025 is a testament to the ongoing research, development, and commitment to excellence at Kuraray Noritake Dental Inc. As the practice of dentistry continues to evolve, clinicians can be sure that the people behind Kuraray Noritake Dental Inc. will never stop pushing the boundaries of dental science and listening to their needs to develop products that lead the way. After all, it is your clinical success and your patients’ quality of life that motivates us every day. Apr 29, 2025
Universal resin cement: did you ever think about a third application mode? Article by Prof. Lorenzo Breschi Fewer bottles, more choices – this is possibly the shortest way to describe the category of universal resin cements. Being self-adhesive, these dual-cure resin-based cements allow for a single-component workflow without the need for separate tooth or restoration primers in many clinical situations. The bond strength obtained in this way is usually high enough to provide for a stable bond between the tooth and the restoration in a wide range of indications. However, it is slightly lower than that achieved with conventional resin cement systems consisting of several components (typically tooth primer, resin cement and restoration primer). Apart from the self-adhesive application mode, universal resin cements may be combined with additional system components to increase the bond strength to tooth structure or the restorative material, respectively. This opens up new possibilities with regard to the product’s use: depending on the required or desired bonding performance, the universal resin cement may be applied alone or in combination with a tooth primer, a restoration primer or both components. In addition, hybrid concepts become feasible, as explained in this article that focuses on PANAVIA™ SA Cement Universal (Kuraray Noritake Dental Inc.) as an example. Self-adhesive luting: for many indications PANAVIA™ SA Cement Universal is a dual-cure universal resin cement that is indicated for a wide range of applications when used in the self-adhesive mode. The bond established to restorative substrates (including silicate ceramics) is high without the use of a separate primer or silane1-4. This is due to two different adhesive monomers contained in the formulation – the Original MDP Monomer and the LCSi Monomer (a long carbon-chain silane coupling agent responsible for a strong chemical bond to silicate ceramics). Hence, it is possible to use the resin cement without any additional component applied on the side of the restoration – even in cases with a lack of retention and consequently high bond-strength requirements. A strong bond to enamel and dentin is also obtained in the self-adhesive mode. In certain situations, however, it may be useful to further increase the bond strength to tooth structure with the aid of a tooth primer. Adhesive luting: for challenging situations The tooth primer recommended for PANAVIA™ SA Cement Universal is CLEARFIL™ Universal Bond Quick (Kuraray Noritake Dental Inc.). Its application is recommended whenever a user feels that the treatment would benefit from an extraordinarily strong and durable chemical bond, i.e. in particularly challenging situations with insufficient mechanical retention. The effectiveness of this measure has been confirmed in an in-vitro study conducted in Japan, in which the 24-hour micro-tensile bond strength to dentin was increased significantly by the application of the universal adhesive5. When a separate adhesive is used, however, the importance of a completely dry working field increases. The reason is that the moisture tolerance of resin cements is usually higher than that of adhesives. Consequently, the application of a rubber dam is highly recommended. Selective adhesive luting: for short abutments and subgingival margins For situations in which proper isolation of the working field with a rubber dam is difficult, a third application option is available and proposed by a group of Italian researchers: Selective Adhesive Luting. In this case, CLEARFIL™ Universal Bond Quick is applied solely to those parts of the prepared tooth that allow for proper moisture control, while relying on the self-adhesive functionality of PANAVIA™ SA Cement Universal in areas where it is challenging to obtain the desired dry working field. Situations which are predestined for this technique are abutment teeth with a subgingival preparation margin and particularly short abutment teeth (that hinder the placement of a rubber dam). The effectiveness of the selective adhesive luting technique has been verified in an in-vitro study that compared the three adhesive strategies – self-adhesive luting, full adhesive luting and selective adhesive luting – with the aid of shear bond strength testing6. The results of the tests show that users are able to enhance the bond strength of PANAVIA™ SA Cement Universal to dentin and enamel by applying the adhesive to a part of the tooth surface only. For the cementation system consisting of PANAVIA™ SA Cement Universal and CLEARFIL™ Universal Bond Quick, the full adhesive and the selective adhesive approach led to similar outcomes. For situations in which proper isolation of the working field with a rubber dam is difficult, a third application option is available and proposed by a group of Italian researchers: Selective Adhesive Luting. RECOMMENDED STEPS FOR SELECTIVE ADHESIVE LUTING Fig. 1. Tooth preparation. Fig. 2. Selective etching of the enamel with phosphoric acid etchant. Fig. 3. Application of the universal adhesive + air-drying. Fig. 4. Crown placement after application of the resin cement into the crown. Fig. 5. Tack-curing. Fig. 6. Excess removal and final light curing. Fig. 7. Treatment outcome at a recall after one year. Benefits of selective adhesive luting Apart from the desired (long-term) increase in bond strength achieved by applying a separate adhesive to a part of the or the whole prepared tooth surface, the technique offers additional benefits. Compared to multi-step cementation systems, the protocol is simplified as no separate restoration primer is needed. Light-curing of the adhesive is not required as long as the user stays within the recommended system. And in contrast to the full adhesive approach requiring rubber dam placement, the need for this step is eliminated in the selective adhesive approach. In this way, the chair-time is reduced and patient comfort increased. Conclusion Depending on the indication, clinical variables and individual preferences, users of universal resin cements like PANAVIA™ SA Cement Universal may select the technique that is likely to deliver the best clinical outcomes. It is this flexibility and the generally wide range of applications that makes the innovative product category truly universal. With fewer components to be used, universal materials facilitate the streamlining and standardization of clinical procedures, while with fewer bottles to be stored, they help staff gain control over order and storage management as well. Dentist: LORENZO BRESCHI Prof. Lorenzo Breschi is Professor of Restorative Dentistry and Dental Materials at the University of Bologna. He is actively involved in research on the ultrastructural aspects of enamel and dentin. He is Past-President of the Academy of Dental Materials (ADM), President-Elect of the European Federation of Conservative Dentistry (EFCD), President-Elect of the Dental Materials Group IADR, President-Elect of the Italian Academy of Conservative Dentistry (AIC), President-Elect of the International Academy of Adhesive Dentistry (IAAD). References 1. Cowen M, Cunha S, Powers JM. Novel Cement Bond Strength to Multiple Substrates. DENTAL ADVISOR Biomaterials Research Center, Biomaterials Research Report, Number 132 – June 16, 2020.2. Patel N, Anadioti E, Conejo J, Ozer F, Mante F, Blatz M. Bond Strength of Different Self-Adhesive Resin Cements to Zirconia” (2021). Dental Theses. 62. https://repository.upenn.edu/dental_theses/62.3. Yoshihara K, Nagaoka N, Maruo Y, Nishigawa G, Yoshida Y, Van Meerbeek B. Silane-coupling effect of a silane-containing self-adhesive composite cement. Dent Mater. 2020 Jul;36(7):914-926.4. Irie M, Tokunaga E, Maruo Y, Nishigawa G, Yoshihara K, Nagaoka N, Minagi S, Matsumoto T. Shear bond strength of a resin cement to CAD/CAM Blocks for molars. P-2, 37th Annual Meeting of the Japanese Society of Adhesive Dentistry 2018.5. Ohara N. Bonding strength of resin cement containing silane coupling agent to dentin or core resin. Results presented at the 150th meeting of the Japanese Society of Conservative Dentistry.6. Breschi L, Josic U, Maravic T, et al. Selective adhesive luting: A novel technique for improving adhesion achieved by universal resin cements. J Esthet Restor Dent. 2023;1-9. doi:10.1111/jerd.13037. May 7, 2024
PANAVIA™: 40 years of success in adhesive luting DID YOU EVER WONDER WHY THE PRODUCTS OF THE PANAVIA™ BRAND OFFER SUCH OUTSTANDING PERFORMANCE? You probably know that they all contain the original MDP monomer developed in the early 1980s. It has attracted much attention because it is such an excellent adhesive monomer. This phosphate ester monomer forms a very strong bond to tooth structure, zirconia, and dental metals. It has been used in every PANAVIA™ product. In reality, however, other catalytic technologies and ingredients alongside MDP are important technological contributors supporting the performance of our cementation solutions. INGREDIENTS AFFECTING THE POLYMERISATION REACTION One of these decisive additional technologies and ingredients is the polymerization catalyst triggering the curing process. Different from the MDP monomer used in every PANAVIA™ product, the polymerization catalyst has been continuously improved since the introduction of PANAVIA™ EX in 1983. New versions have been developed for PANAVIA™ 21, PANAVIA™ Fluoro Cement and PANAVIA™ V5, for example. Another important component also affecting the curing process is the Touch Cure Technology used in two of the three major products of the current PANAVIA™ Portfolio: PANAVIA™ V5 and PANAVIA™ Veneer LC. This technology was first used in PANAVIA™ 21, which was launched in 1993. The contact of the chemical polymerization activator contained in the self-etching primer with the resin cement paste accelerates the polymerization of the cement from the adhesive interface, thus providing better adhesion of the resin cement. In developing PANAVIA™ V5, we reviewed the chemical composition of the existing PANAVIA™ products and updated it substantially. The Touch Cure technology has also been adopted for use in the case of PANAVIA™ V5 Tooth Primer and the concomitantly used PANAVIA™ V5 Paste. When cementing veneers with PANAVIA™ Veneer LC, we also use PANAVIA™ V5 Tooth Primer for conditioning teeth. This also involves the application of Touch Cure technology for achieving an adhesive connection with the tooth without compromising the working time of the cement paste. ADDITIONAL ADHESIVE MONOMERS Even in the field of adhesive monomers, we did not stand still: We developed the LCSi monomer, a long carbon chain silane-coupling agent which made possible to integrate the function of a ceramic primer in our universal self-adhesive resin cement PANAVIA™ SA Cement Universal. With its high level of hydrophobicity, this monomer provides stable, long-term bond strength. Generally speaking, it may be said that the reason bond durability may drop is a hydrolytic reaction damaging the chemical bond between the silica contained in the glass ceramics and the silane-coupling agent. THREE PRODUCTS COVERING VIRTUALLY EVERY NEED By combining these technologies and ingredients smartly, we have succeeded in developing a resin cement portfolio that covers virtually every need. With PANAVIA™ V5, PANAVIA™ SA Cement Universal and PANAVIA™ Veneer LC, it is possible to treat a wide variety of cases. The products allow for the luting of various types of restorations, prosthetic appliances and for the placement of posts and produce great outcomes if used properly according to the instructions for use. PANAVIA™ V5 is the resin cement that has the widest range of uses among the three cement systems just mentioned. It covers almost all the intended uses of the other two cements. Therefore, it is possible for the dental practitioner to choose the right cement system for treatment, according to the cases arriving at the clinic and patient needs, from among these three major resin cement products: PANAVIA™ V5, a resin cement with a wide range of applications; PANAVIA™ SA Cement Universal, a simple and easy-handling self-adhesive resin cement; and PANAVIA™ Veneer LC when there is a need to bond laminate veneers. EXPLORING NEW OPPORTUNITIES The good thing about developing technologies in a company like Kuraray Noritake Dental is that their application is not limited to a certain product or product group. The R&D Department always carries out research on how to leverage the benefits of the technologies in other applications. Take, for example, KATANA™ Cleaner, which was released in 2019. This cleaning agent can be used to remove saliva, blood, temporary cement, or other contaminants that can adhere to the surfaces of teeth or prosthetic devices during trial fitting and temporary cementation of a prosthetic device. This unique product has been developed by taking advantage of the surfactant function of the MDP monomer. CONCLUSION Hence, it is mainly our long-standing knowledge and experience in the development of dental resin cements and adhesive solutions that provides for the excellence of the current PANAVIA™ Portfolio. We know how to improve on existing technologies, to never stop developing new ones and to continuously look for the best way to combine proven and new components to obtain the best possible outcomes. In the steps of the product development procedure, clinical tests are conducted and feedback from dental practitioners is gathered in order to take into account the extreme conditions found in the oral environment. In the past 40 years, this strategy has proven successful, and we are sure it will help us to develop many other innovative products that offer ideal support in striving to improve the oral health of patients. Sep 19, 2023
Universal cement that offers a strong, durable bond and needs no separate primer AWARD WINNING PRODUCT DENTAL ADVISOR has once again recognized PANAVIA™ SA Cement Universal as a Top Product in the category of Indirect Restoratives. This dual-cure, fluoride-releasing, radiopaque self-adhesive resin cement adheres to virtually all substrates — including lithium disilicate — in a single-step procedure without the need for a separate primer or silane. It also offers easy, gingival-friendly removal of excess cement and requires no refrigeration. SCIENCE BEHIND THE PRODUCT It is because PANAVIA™ SA Cement Universal combines two innovative technologies in a single product that a strong and durable bond can be achieved in a single step. The silane-coupling agent, LCSi monomer, establishes a durable, chemical bond with porcelain, lithium disilicate, and composite resin; and the original MDP monomer provides for chemical reactiveness with zirconia, dentin and enamel. WIDE INDICATION RANGE Due to its unique chemistry PANAVIA™ SA Cement Universal represents a convenient, versatile, and efficacious single solution to practitioners’ everyday cementation needs for a wide variety of indications, including cementation of crowns/bridges, inlays/onlays, posts, splints, and even adhesion bridges. EVALUATION In its commendation, DENTAL ADVISOR stated, “As tested in DENTAL ADVISOR Laboratories, PANAVIA™ SA Cement Universal with an incorporated silane primer had exceptional initial bond strength to dentin, lithium disilicate, and zirconia.” The benefits and quality of PANAVIA™ SA Cement Universal were further reflected in the findings and feedback of the 31 clinical evaluators who tested the cement during 516 applications. They praised its ease of use, handling characteristics, and aesthetics, and gave it an overall clinical rating of 96 percent. Among their comments: "Has an ideal film thickness and flows well.”, "You can use this in a moist environment with no issues.” , and “Excess cement peels right away from the margin.” ABOUT DENTAL ADVISOR The Top Product and Preferred Product Awards conferred by US-based DENTAL ADVISOR were initially introduced to help busy practitioners make sense of the numerous new solutions indicated for less invasive techniques and standardised or simplified procedures, ultimately, to achieve better outcomes regularly. DENTAL ADVISOR conducts its practice-based clinical evaluations and product performance tests shortly after product launch. It publishes results annually online in its January/February issue to help potential users identify high-quality new dental materials and determine which among them are best suited to fulfil their individual requirements. Mar 5, 2024
Universal products: Getting a grip on costs in the dental office A pioneer in digital dental photography, the editor-in-chief of the “International Journal of Esthetic Dentistry” and a supporter of universal products: We are talking about Dr Alessandro Devigus, the owner of a private practice in Bülach, Switzerland. At the International Dental Show 2023 in Cologne, we had a conversation with him about his favourite products from Kuraray Noritake Dental Inc. and the concept of universal excellence. Dr Adham Elsayed, Clinical and Scientific Manager at Kuraray Noritake Dental Inc., interviewing Dr Alessandro Devigus. Dr Devigus, why did universal products attract your attention? We all would like to reduce the number of products and components used in our dental offices to make our lives easier and more predictable. Several years ago, when the first universal products started entering the dental market, I realized that these products and the concept behind them are able to help me achieve this goal. For what kinds of treatments do you currently use universal products? The main field of application is restorative dentistry, in indirect and direct restorative workflows, which often go hand in hand. Whenever possible and in accordance with the needs and desires of the patient, I opt for minimally invasive direct composite restorations, often realized using universal products. Cosmetic corrections or tooth wear treatments in the lower jaw, for example, are often carried out in a prepless procedure with resin composite applied with a single-shade technique. For anterior restorations in the upper jaw of the same patient, however, I might opt for ceramic restorations, luted with a universal resin cement. What are your favourite indirect restorative materials, for which indications do you use them and when do universal products come into play? I produce most of my single-tooth restorations chairside with CEREC. In the anterior region, the choice is usually between different types of glass ceramic materials. In some indications, when two central incisors or all four maxillary incisors need to be restored, zirconia is also a suitable option. In these cases and for indirect restorations in the posterior region, KATANA™ Zirconia Block is my preferred material. Having tested many different types of chairside zirconia, I can say that this product simply offers the most natural colour gradation and the desired vitality. Hence, finishing is quick and easy. At the same time, the high flexural strength of the material supports me in my striving for minimally invasive preparations. For definitive placement of the produced overlays and crowns, PANAVIA™ SA Cement Universal from Kuraray Noritake Dental Inc. is my dual-cure resin cement of choice. It bonds to virtually every surface including lithium disilicate without a separate primer and offers a good flowability that facilitates restoration placement. An additional feature contributing to a quick and stress-free clinical procedure is its easy and gingiva-friendly excess removal after tack curing. What about direct restorations? One of my favourite resin composites is CLEARFIL MAJESTY™ ES-2 Universal (Kuraray Noritake Dental Inc.). Its single shade for the posterior and two shades for the anterior region offer just the right combination of translucency and intrinsic colour to imitate a large number of tooth shades. The effect is that it blends in nicely with the surrounding tooth structure without appearing grayish. In the posterior region, I was able to observe a certain masking potential, so that discoloured abutment teeth do not cause any problems. With this material, the shade determination step is eliminated. Clinical workflows are also simplified by the use of CLEARFIL™ Universal Bond Quick. The universal adhesive is not only versatile as it is suitable for many indications and all etching techniques, but also extraordinarily quick in its application, as the need for an extensive rubbing into the tooth structure is eliminated. In this way, it is possible to streamline direct restorative procedures. Why do you use so many products from Kuraray Noritake Dental Inc.? I simply like products from Japanese companies. They stand for quality, integrity and clinical relevance. Japanese people seem to be deeply committed to the company they work for and to their work, pay attention to every detail and try to deliver the best outcomes possible. This attitude is reflected in Kuraray’s mission “For people and the planet—to achieve what no one else can.”, and it is reflected in the products of the company as well. They offer the properties I need to deliver high-quality dental treatments. You said that making your life easier and more predictable is the main reason for you to opt for universal materials. Please explain. In the first place, using fewer products and components that are easy and quick in their application allows me to get a grip on costs. With fewer steps and fewer bottles, shortened application times and standardized workflows, the time a patient needs to sit in the chair is reduced, which allows me to save the most valuable factor in the office: my time. At the same time, material storage and order management are streamlined, so that it is much easier to keep track of dates of expiry, hence saving material costs as well. And the best thing about it is that all these savings are possible without compromising treatment quality. Provided that the user is able to handle the materials properly – which is facilitated by the minimal number of steps and ease of use – the quality of the outcomes is extremely high! Dr Devigus, we thank you for sharing your insights with us. Jul 13, 2023
Choose PANAVIA™ Veneer LC and veneer cementation becomes a success Prosthodontic treatment concepts have evolved over the past decades. While some time ago, porcelain-fused-to-metal crowns and bridges were placed wherever a defect was too large for a direct restoration, the current trend is toward less invasive therapies with highly aesthetic, tooth-coloured materials. These modern treatment concepts can lead to reliable outcomes when a high-performance resin cement system is used that establishes a durably strong bond to tooth structure on one side and the restoration on the other. The reason is that less invasive often means that restorations have minimal or no retentive elements and extremely thin walls, and a strong chemical bond is a mechanism that holds them in place over time. Depending on the type of restoration and area in the mouth, aesthetic properties of the cementation system are also extremely important, as the typically highly translucent, thin restorations tend to reveal the appearance of the structures underneath to a certain extent. Universal cements In the context of striving toward the streamlining of clinical procedures in restorative dentistry, several manufacturers have developed resins cements that work with fewer components and are suitable for a large number of indications. PANAVIA™ SA Cement Universal is a popular example. The self-adhesive, dual-cure resin cement is the only product of its category that works as a standalone solution even on glass ceramics (without the need for a separate primer). The need for specialists There are specific clinical situations, however, that require more working time than a dual-cure resin cement can offer. This is the case whenever multiple non-retentive restorations are to be placed simultaneously, a technique that is recommended for veneers. The greatest benefits of placing the thin and highly aesthetic restorations at once lie in the proper positioning of the restorations and in the minimized risk of contamination: When the veneers are placed one after the other, a slightly malpositioned and already fixed veneer might hinder proper positioning of the adjacent restorations and haemorrhage occurring in the context of excess cement removal or finishing of the margin might contaminate the working field. When all veneers are placed simultaneously, repositioning is possible, while excess removal and polishing are accomplished in a moment when blood and debris will no longer endanger the integrity of the restorations, which increases the security during the whole procedure. This task is best fulfilled by a light-curing veneer specialist. Handling of a thin ceramic veneer. Required properties of veneers cements Undoubtedly, the key feature of a specialist resin cement system is a long working time sufficient for simultaneous cementation of multiple restorations. In addition, its consistency and handling properties are also important as they can help users overcome the challenge of accurate positioning and reduce the time and effort involved in veneer placement. And finally, the system needs to provide excellent bond strength over time and support long-lasting aesthetics, properties valuable for every kind of resin cement, but the latter being particularly important for thin restorations in the aesthetic zone. Luckily, PANAVIA™ Veneer LC offers all those features. The system consists of PANAVIA™ V5 Tooth Primer that establishes a strong bond to enamel and dentin, PANAVIA™ Veneer LC Paste as the cement and the CLEARFIL™ CERAMIC PRIMER PLUS that has been part of PANAVIA™ V5 cementation system. The latter is responsible for a high bond strength to all types of restorative materials. Mastering the working time challenge The light-curing cement paste offers a long working time of 200 seconds* due to its excellent stability under ambient light. As a consequence, dental practitioners may place multiple veneers simultaneously without having to race against setting. Polymerization may be started whenever the user is ready for it. The one-component self-etching tooth primer (PANAVIA™ V5 Tooth Primer) does not contain any photo initiators and does not cure alone. When applied, it etches and penetrates into the tooth surface for 20 seconds and is ready to bond strongly to PANAVIA™ Veneer LC Paste. The integrated touch-cure technology is the key feature safeguarding a high bond strength to tooth structure without shortening the working time. *Working time under ambient light on PANAVIA™ V5 Tooth Primer (8000 Lux): 200 seconds Providing for precise placement In order to streamline the clinical seating procedure from cement application to polishing, PANAVIA™ Veneer LC has been equipped with a set of well-balanced handling properties. Newly developed spherical silica fillers in the cement provide that it stays put where applied, but flows well when the veneer is seated on the tooth – for easy placement without drifting or sagging. During application across the intaglio surface, the resin cement does not stick to the application tip, a property achieved by the addition of nanocluster filler technology. The special design of the syringe’s application tip optimizes control over the amount of cement applied. Ans last but not least, excess cement may be easily removed in one piece using an explorer after a one-second tack-cure, while polishing of the margins is quickly accomplished. Hiding the margins Being extremely thin, highly translucent and mainly used to restore teeth in the exposed anterior region of the maxilla, veneers have to be placed with a cement that is and remains undetectable underneath the restoration and at its margins. PANAVIA™ Veneer LC is available in four highly aesthetic shades with matching try-in pastes, so that a precise shade match with the restoration can be achieved and verified in the patient’s mouth. Additional features contributing to undetectable margins are the resin cement’s flowability and low film thickness: They enable users to easily produce an evenly distributed, thin cement layer for aesthetic outcomes. For those afraid that coffee, tea, acidic drinks or constant tooth brushing might reveal the margins over time, there is good news as well: PANAVIA™ Veneer LC offers a high polish retention and colour stability over time. The well-balanced formulation and the touch-cure technology are responsible for this resistance to discolouration. Trusted expertise All these beneficial features make PANAVIA™ Veneer LC worth testing. Additional arguments are the fact that its primers are tried and tested components of the highly popular PANAVIA™ V5 system and that Kuraray Noritake Dental Inc. is a proven expert on adhesive products. It developed the original MDP Monomer in 1981 and introduced the first adhesive resin cement containing this monomer in 1983. Since then, the company has improved existing formulations and developed existing technologies that ultimately resulted in the current line-up of cementation solutions for every need and indication. Excellent gloss retention is one of the properties providing for undetectable margins over time. Aug 23, 2022
PANAVIA™ Veneer LC: cement for the most challenging esthetic conditions AWARD WINNING PRODUCT DENTAL ADVISOR, which annually honors as Top Product or Preferred Products items deemed by the publication’s consultants to deliver the best practice-based performance in their categories, singled out PANAVIA™ Veneer LC for a Research Award in the Lab Performer: Veneer Cement category in its January/February 2024 edition. This particular award is given to products that performed exceptionally well when tested independently in Dental Advisor Laboratories. ABOUT THE PRODUCT PANAVIA™ Veneer LC is a specialized veneer cement designed to provide exceptional bond strength to various substrates, along with outstanding gloss retention and wear resistance. The cement utilizes smaller-diameter spherical filler particles, facilitating easy dispensing from the syringe and excellent flowability for minimal film thickness. All of these attributes contribute to virtually no change in gloss or surface appearance of veneer margins over time. WHAT WAS RESEARCHED The basis of PANAVIA™ Veneer LC’s selection this year was research that compared three esthetic veneer cements, including PANAVIA™ Veneer LC, for bond strength, adhesion properties, gloss retention, and wear resistance. The investigators’ testing of these attributes reflects the challenges such products must meet – “Ideally, esthetic veneer cements should have a long working time, curing on demand, excellent color stability, and high strength”. To assess bond strength to multiple substrates, the cements were subjected to six months of artificial aging to dentin, enamel, IPS e.max CAD, and Zirconia using thermocycling. To test wear resistance after toothbrush erosion, the testing method involved measuring depth of wear, change in surface roughness, and change in gloss based on a simulation of about 5.5 years of regular toothbrush use. EVALUATION RESULTS The investigators reported that PANAVIA™ Veneer LC “had the best gloss retention of the three cements tested and a very even wear pattern,” noting further that “having limited surface roughness after toothbrush abrasion can help lower staining and bacterial adhesion.” Overall, they said, “The PANAVIA™ Veneer LC cement system showed excellent adhesion properties and exceptional gloss retention and wear resistance,” concluding, “Due to its excellent properties, PANAVIA™ Veneer LC Paste can meet the most challenging esthetic conditions of veneer cementation.” COMPLETE REPORT Would you like to read the full report1 shared by Dental Advisor? Download the pdf now! ABOUT DENTAL ADVISOR Awards conferred by US-based DENTAL ADVISOR were originally introduced to help busy practitioners make sense of the numerous new solutions indicated for less invasive techniques and standardized or simplified procedures, ultimately, to achieve better outcomes on a regular basis. To determine items to be named Top Products and Preferred Products, DENTAL ADVISOR conducts practice-based clinical evaluations and product performance tests shortly after product launch. It publishes results annually online in its January/February issue to help potential users identify high-quality new dental materials and determine which among them are best suited to fulfill their individual requirements. 1 Cowen M, Powers JM. Translating the Science: Veneer Cement Bond Strength Durability and Resistance. Dental Advisor. 40:36;2023. Feb 6, 2024
“Simply apply and dry, and you’re done”: CLEARFIL™ CERAMIC PRIMER PLUS Combining ease of use and excellent viscosity, CLEARFIL™ CERAMIC PRIMER PLUS is a stable and universal prosthetic primer designed for all restorations. By incorporating Kuraray Noritake Dental’s original MDP monomer and a silane monomer, it is able to provide an enhanced adhesive surface for ceramics, hybrid ceramics, composites and even metals. CLEARFIL™ CERAMIC PRIMER PLUS is best used in conjunction with the adhesive resin cement PANAVIA™ V5 to ensure durable restorations. The key to CLEARFIL™ CERAMIC PRIMER PLUS’s performance is in the monomers it possesses. The MDP monomer strongly bonds to metals and zirconia, while the silane coupling agent MPS efficiently adheres to composites and all silica-based ceramics. “What makes CLEARFIL™ CERAMIC PRIMER PLUS different to other primers is its stability,” says Peter Schouten, Technical Manager at Kuraray Noritake Benelux. “Normally, activated silanes are very unstable. However, the well-balanced formula of CLEARFIL™ CERAMIC PRIMER PLUS provides it with a shelf life of three years after production, making it easy and predictable to use.” Procedural simplicity Every element of CLEARFIL™ CERAMIC PRIMER PLUS is designed to deliver maximal procedural simplicity. It is packaged in an easy-to-squeeze bottle that dispenses the solution easily and accurately. Whereas other similar products need to be left in place for one minute or more, this primer is immediately effective upon application. “CLEARFIL™ CERAMIC PRIMER PLUS benefits the dentists by offering a reliable primer for all materials, without being difficult to apply or use,” says Schouten. “From titanium to zirconia, from lithium disilicate to composite—simply apply and dry, and you're done.” PANAVIA™ V5 A resin cement with unrivalled procedural simplicity and predictability, PANAVIA™ V5 is a member of Kuraray Noritake Dental’s PANAVIA family. It sets a new standard for adhesion, allowing for self-cure dentine bond strengths equal to our gold-standard light-cure bonding agent, CLEARFIL SE BOND. PANAVIA™ V5 offers natural aesthetic stability in shading through its amine-free paste, which is available in five shades and has been scientifically proven to demonstrate a lower level of post-curing colour variance than amine-based cements. CLEARFIL™ CERAMIC PRIMER PLUS and PANAVIA™ V5 Providing strong bonding to not just hydroxyapatite, but to metals and zirconia as well, PANAVIA™ V5 is designed for use in conjunction with CLEARFIL™ CERAMIC PRIMER PLUS. The cementation procedure is efficient and effective: use PANAVIA V5 Tooth Primer for the pretreatment of the tooth, CLEARFIL™ CERAMIC PRIMER PLUS for the priming of the restoration, and PANAVIA™ V5 for the cementation. Apr 18, 2019
Universal adhesive in the context of different repair procedures Article by Dr. Michał Jaczewski When working with composite, one of the most important aspects is to understand the mechanisms of adhesion. Choosing the right composite is one thing, but choosing a suitable bonding system and using it correctly is an equally important aspect affecting the long-term performance of a direct restoration. There are many bonding products on the market - two-bottle (primer and bond) but also single-bottle systems. For anyone trying to select an ideal adhesive for a specific clinical case, the sheer number of available products can be challenging. The temptation to use them all, in slightly different ways, has the potential to create errors. In my dental practice, I am committed to simplifying procedures. This is why I started looking for a bonding system that would offer a sense of security in terms of adhesion, but also ease of use in different clinical situations. I have opted for the 8th-generation bonding agent with the desired features - CLEARFIL™ Universal Bond Quick (Kuraray Noritake Dental Inc.). The single-bottle universal adhesive is ideal for a broad variety of bonding procedures carried out in the dental office. IMPRESSIVE FEATURES CLEARFIL™ Universal Bond Quick can be used in the total-etch as well as the selective enamel etching technique in combination with an etching gel such as K-ETCHANT Syringe (Kuraray Noritake Dental Inc.). It is also a self-etching adhesive. Used in combination with the dual-cure build-up material CLEARFIL™ DC CORE PLUS or the dual-cure universal resin cement PANAVIA™ SA Cement Universal (both Kuraray Noritake Dental Inc.), it is also an ideal choice for cementation in the root canal and for cementing inlays or crowns made of a variety of different restorative materials – from metal to zirconia or lithium disilicate. Efficient clinical procedures are supported by the incorporated Rapid Bond Technology, which eliminates the need for extensive rubbing or waiting for the adhesive to penetrate the substrate and the solvent to evaporate. Among the key components of this technology are hydrophilic amide monomers, which allow the adhesive solution to penetrate moist dentin extraordinarily quickly, while also having a high curing ability. In addition, the original MDP monomer is included in the formulation. Together with the amide monomers, it provides for a high bond strength to enamel and dentin – achievable in a simple procedure of application, air-drying and light-curing. The described properties turn CLEARFIL™ Universal Bond Quick into one of the most versatile and easy-to-use adhesive bonding solutions in the dental office. Operator sensitivity is low, as is its technique sensitivity, since the three-step procedure is always the same. The following case examples illustrate its use in the context of different repair procedures. REPAIR OF COMPOSITE RESTORATIONS One of the major benefits of using composite as a restorative material lies in the fact that it may be modified and repaired at any time. Regardless of whether an air bubble is detected on the surface, the shade needs to be adjusted, a fracture occurs or materials need to be added as a result of wear, modification or repair is easily accomplished without needing to sacrifice additional amounts of healthy tooth structure. Whenever a silicone index has been produced for the initial treatment and is still available, and the user knows which composite has been utilized for the original restoration, the Flowable Injection Technique may be selected as a particularly easy and efficient way of repairing a restoration. However the recommended protocol is slightly different depending on the state of the restoration surface. CASE EXAMPLE 1: IMMEDIATE REPAIR PROCEDURE When a restoration has been damaged or an air bubble has appeared during injection of a flowable composite, the procedure is slightly different. In this case, the oxygen inhibition layer is usually still present on the surface of the restoration. Therefore, it is possible to simply apply an additional portion of composite (Figs. 1a to 1d). Even after contamination of the composite surface with water, saliva or blood, this measure is possible. The surface merely needs to be rinsed thoroughly and dried before applying the new portion of composite. For maximum safety, a universal adhesive may be used as well. Fig. 1a. Repair procedure applicable for defect within a composite restoration whenever the oxygen inhibition layer has not yet been removed: Air bubble detected in the interproximal region. Fig. 1b. Application of a new portion of composite after rinsing and drying. The adjacent surface is protected with PTFE tape. Fig. 1c. Repositioned silicone index used to give the restoration the originally planned shape. Fig. 1d. Final restoration. CASE EXAMPLE 2: REPAIR PROCEDURE AFTER POLISHING If a similar defect is detected during finishing and polishing, i.e. when the oxygen inhibition layer has already been removed (Fig. 2), a roughening of the surface is strictly necessary. With a bevelled preparation of the area with the air bubble, optimal conditions are created for another layer of composite that blends in well with the surrounding material (Fig. 3). After bevelling, the surface needs to be sandblasted and cleaned either with KATANA™ Cleaner (Kuraray Noritake Dental Inc.) (Fig. 4a) or with 37 % orthophosphoric acid (Fig. 4b). After thorough rinsing and drying, an additional portion of composite may be applied to the surface (Figs. 5a to 5c). As the defect is small, the composite may be applied instead of injected and the silicone index repositioned afterwards. Fig. 2. Void on the surface, detected during finishing. Fig. 3. Removed void and bevelled area around the defect. Fig. 4a. Option 1: Cleaning of the surface with KATANA™ Cleaner. Fig. 4b. Option 2: Etching with K-ETCHANT Syringe. Fig. 5a. Application of composite (CLEARFIL MAJESTY™ ES Flow Low). Fig. 5b. Repositioning of the original silicone index to obtain the desired shape. Fig. 5c. Final restoration with a nice blend-in of the different layers of composite. CASE EXAMPLE 3: REPAIR PROCEDURE AFTER TWO OR MORE WEEKS For damaged restorations which have been in place for more than two weeks, an ideal composite-composite interface needs to be created by bevelling and roughening of the surface. A perfect example is presented in Figure 6. The most important step influencing the success of the procedure is proper preparation of the composite surface. To lay the foundation for a strong bond between the new and the old composite as well as for aesthetic outcomes, a bevel needs to be created (Figs 7a and 7b) to facilitate a smooth transition between the two layers. Once the bevel is completed, the surface should be sandblasted with alumina particles sized 27 μm (Fig. 8). The following recommended steps are etching of the composite with 37 % orthophosphoric acid (Fig. 9) and finally application of CLEARFIL™ Universal Bond Quick (Fig. 10). As the universal adhesive contains a silane coupling agent, separate silane application is not necessary. Instead, the new layer of composite may be applied immediately e.g. using the flowable injection technique with an existing matrix (Fig. 11). Fig. 6. Fractured anterior composite restoration benefitting hugely from repair – the remaining composite is in a great state regarding colour and shape. Fig. 7a. Bevelling with dedicated instruments. Fig. 7b. Ideal bevel created to provide for a strong bond and great optical blend-in. Fig. 8. Sandblasting of the surface with alumina particles. Fig. 9. Phosphoric acid etching. Fig. 10. Application of the universal adhesive. Fig. 11. Composite applied using the flowable injection technique. Fig. 12. Treatment outcome. CONCLUSION The three described repair protocols are straightforward and work well – provided that a strong bond is established at the composite-composite interface. The way it is established may be slightly different depending on whether the oxygen inhibition layer is still present or has already been removed. Using a universal adhesive like CLEARFIL™ Universal Bond Quick, the procedure is simplified owing to elimination of steps such as the separate application of silane. Dentist: MICHAŁ JACZEWSKI Michał Jaczewski graduated from Wroclaw Medical University in 2006 and today runs his private practice in the city of Legnica, Poland. He specializes in minimally invasive dentistry and digital dentistry and is the founder of the Biofunctional School of Occlusion. Here he lectures and runs workshops with focus on full comprehensive patient treatments. Sep 27, 2024
PANAVIA™ family: Three options, all general cementation needs covered 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. Dec 20, 2022
Optimizing clinical outcomes of KATANA™ Zirconia restorations The KATANA™ Zirconia Multi-Layered series from Kuraray Noritake Dental Inc. (Kuraray Noritake Dental) is popular among dental technicians and dentists around the world, as it offers great mechanical and optical properties. The available materials have different levels of translucency and strength, and a multi-layered structure that facilitates the creation of lifelike restorations. Furthermore, they are very well processable, which results in a high milling accuracy and smooth margins. Together, these properties are highly valuable for every dental office, as they result in precisely fitting, durable and beautiful restorations that help you exceed your patients’ expectations. Clinical long-term success of these zirconia restorations, however, is not only determined by the material choice and laboratory processing alone. The way clinical procedures such as cementation and intra-oral adjustments are carried out have a decisive impact as well. In order to support you in your striving for a long-lasting bond between the tooth and the restoration, and to facilitate intra-oral polishing, Kuraray Noritake Dental has developed a wide variety of in-office products designed to make your life easier and your practice even more successful. Remove bond-strength compromising proteins When proteins present in blood and saliva are deposited on the bonding surfaces of teeth or dental restorations, the bonding performance of dental adhesives and self-adhesive resin cements will be compromised. As it is impossible to keep these surfaces free of oral fluids at try-in, effective cleaning strategies are required. In tests comparing different methods and cleaning agents, sandblasting and the use of KATANA™ Cleaner have been highly successful in removing the proteins from the bonding surfaces1. As KATANA™ Cleaner is a biocompatible material (unlike other often strongly alkaline zirconia cleaners), it is suitable for intra- and extra-oral use. Hence, it is the perfect solution for cleaning your KATANA™ Zirconia restorations as well as prepared enamel and dentin before cementation. The product has a high cleaning effect and is easy to use: simply rub it in for ten seconds, rinse and dry. Obtain a reliable bond with fewer components Fewer components and fewer procedure steps, this is what an increasing number of dental practitioners strives for when it comes to cementing zirconia restorations. For all of them, PANAVIA™ SA Cement Universal is the solution. The self-adhesive resin cement contains the proprietary long carbon-chain silane coupling agent (LCSi Monomer) developed by Kuraray Noritake Dental that delivers a strong, durable chemical bond to porcelain, lithium disilicate and composite resin without the need for a separate primer. The original MDP monomer, also present in the paste, allows for chemical reactiveness with zirconia, dentin and enamel. Therefore, the product is indicated for a wide range of indications (including adhesion bridges) without the need for separate priming and bonding. Another important fact is that excess removal requires a significantly lower force compared to other cements. This was already the case for product’s predecessor PANAVIA™ SA Cement Plus, as reported by a researcher from Tufts University in Boston, Massachusetts2. For specifically demanding cases, you may increase the bond strength of PANAVIA™ SA Cement Universal to tooth structure with the aid of CLEARFIL™ Universal Bond Quick. Choose the proven and familiar multi-step system For all those who would like to stick to multi-step procedures they have trusted for years, PANAVIA™ V5 is the go-to product. It is suitable for all restorations, including those that demand the highest possible bond strength. It is the strongest cement Kuraray Noritake Dental ever developed, and with five shades, it is the most aesthetic one, too. This allows you to cement all tooth-coloured restorations with confidence, no matter whether they have a retentive or non-retentive design. PANAVIA™ V5 is designed to work perfectly with KATANA™ Zirconia, and is indicated for cementing a wide range of indirect restorations, and also for post-and-core procedures and amalgam bonding. Create antagonist-friendly surfaces Studies have shown that surface roughness of a restoration has a larger impact on the wear of the antagonist than the hardness of the dental material. This means that for an antagonist-friendly behaviour, the restoration surfaces need to be perfectly polished. This task is easily accomplished with TWIST™ DIA for Zirconia, which may be used after intra-oral adjustments or in the context of maintenance measures. The flexible polishing spirals with an innovative shape offer you various application benefits for excellent polishing results. TWIST™ DIA for Zirconia is highly suitable for occlusal surface polishing as the shape and contour of the zirconia restoration is maintained. As they are sterilizable, the spirals may be reused. A winning team for reliable results By using a restorative material, cleaning solution, cementation system and polishing spirals from Kuraray Noritake Dental, you will benefit from streamlined procedures and reliable results. The products are not only designed to work with each other, but also thoroughly tried and tested for combined use, so that you can carry out your procedures with utmost confidence. References 1 Data source: Kuraray Noritake Dental Inc.2 A. Roberta et. al., J Dent Res Vol #98 (Spec Iss A), #3624, Determination of Excess Removability of Self-adhesive Resin Cements May 10, 2022
How to cement restorations made of high translucency zirconia KATANA™ Zirconia STML and PANAVIA™ SA Cement Universal Photo: KATANA ™ Zirconia STML NW with CERABIEN ™ ZR FC Paste StainSergio R. Arias DDS, MS Sung Bin Im, MDC, CDT KATANA™ Zirconia STML is a highly popular material used in many dental laboratories around the world. Compared to traditional zirconia framework materials with a mainly tetragonal polycrystalline structure, the material has a higher yttria content, leading to a different material structure with an impact on the optical and physical properties (the translucency is increased, the flexural strength reduced). As a consequence, the indication range is limited to single-tooth restorations and two to three-unit bridges in the anterior and posterior regions. The greatest benefit lies in a much higher aesthetic potential, which is responsible for the fact that the material is predominantly used for the production of monolithic restorations or those with a micro cut-back individualized with a micro-layer of porcelain. While the indications and technical procedure are well-known, there seem to be some obscurities regarding the handling in the dental office. Is conventional cementation possible and recommended or is an adhesive luting procedure preferable? Is the surface pre-treatment the same as for tetragonal zirconia or is a different procedure required? And what may be expected regarding the long-term behaviour of KATANA™ Zirconia STML restorations? A close look into the available scientific literature provides some guidance. Definitive placement of restorations made of KATANA™ Zirconia STML Conventional cementation or adhesive luting? In principle, both procedures are possible when the restoration to be placed has a retentive design. It is generally accepted that a full coverage crown provides sufficient retention for conventional cementation when the abutment tooth is at least 4 mm high and the convergence angle of the axial walls ranges between 6 and 12 or maximally 15 degrees.1,2 The reason is that the flexural strength of the material is higher than 350 MPa,3 the critical value for conventional cementation. As conventional cements are opaque and available in a single shade, however, the use of a (self-)adhesive resin cement may be preferable with all high-translucency restorative materials for aesthetic reasons. Anyway, these products are mandatory whenever a macro-retentive preparation design is not feasible or wanted. To sum up, the use of a self-adhesive or adhesive resin cement is preferable in many situations. An argument in favour of self-adhesive resin cements is the lower effort involved in their use. But what about the pre-treatment of the zirconia? No matter what type of dental zirconia is used, etching with hydrofluoric acid is ineffective due to the lack of glass matrix in the material. However, it is clear that surface modification is necessary to establish a strong and durable bond to any resin cement system.4,5 The method generally recommended for high-strength zirconia is sandblasting with aluminium oxide particles or tribochemical silica coating.4 The particle size should be small (≤ 50 µm) and the pressure low (about 1 bar) to avoid a weakening of the material’s mechanical properties.3,4 For lower-strength material variants, this risk of weakening the material seems to be higher,5 so that it becomes even more important to work with a low pressure and particle size.5-8 In the case of KATANA™ Zirconia, however, it was reported that “alumina-sandblasting significantly increased the biaxial flexural strength of KATANA STML”.9 This means that proper sandblasting of restorations made of KATANA ™ Zirconia STML did not affect the flexural strength of the material, which was even increased because of the specific properties of zirconia from Kuraray Noritake Dental. Based on these findings, the following procedures are recommended for high-translucency zirconia: Option 1 Aluminium oxide air-abrasion followed by the use of a self-adhesive resin cement containing 10-MDP.6 Option 2 Tribochemical silica coating followed by silanization of the bonding surface.6 As the dual-cure self-adhesive resin cement PANAVIA™ SA Cement Universal contains the Original MDP monomer and the long carbon-chain silane coupling agent (LCSi Monomer), it is suited for both procedures. PANAVIA™ SA Cement Universal is available in an automix syringe and a handmix system, which consist of a paste-paste formulation. One paste contains the Original MDP monomer in a hydrophilic monomer environment and the other contains the inactive LCSi Monomer in an environment of hydrophobic monomers. When extruding the pastes, they are mixed in the syringe’s mixing tip (automix) or dispensed on a mixing pad and mixed by hand (handmix). Afterwards, the material is simply applied to the intaglio of the restoration and the restoration is placed. Cleanup of excess cement is easiest after tack-curing (2 to 5 seconds). Does this work well in the clinical environment? The best way to check whether the described procedure is successful in the clinical environment is by conducting a clinical study. This is exactly what a group of researchers from the University Complutense of Madrid, Spain, has done with the material combination KATANA™ Zirconia STML and PANAVIA™ SA Cement Universal.10 Within the framework of the prospective clinical trial, 30 posterior crowns made of KATANA™ Zirconia STML were placed in 24 individuals in need of posterior tooth restorations. The teeth were prepared as recommended for all-ceramic restorations, allowing for a wall thickness of approximately 1 mm (recommended minimum wall thickness of KATANA™ Zirconia STML for crowns in the posterior region: 1.0 mm). The restorations were sintered, characterized and glazed as recommended by the material manufacturer and subsequently tried in. Prior to cementation, the intaglio of the restorations was pre-treated with aluminium oxide particles (50 µm, 1 bar pressure) followed by ultrasonic cleaning. The use of PANAVIA™ SA Cement Universal also was in line with the manufacturer’s recommendations. A clinical evaluation of the crowns was performed after 6, 12 and 24 months using the California Dental Association (CDA) quality evaluation system. The parameters evaluated in this system are the surface and colour of the restorations, their anatomical form and the marginal integrity of the crowns. After 24 months, the success and survival rates were 100 percent. Regarding all three parameters, the crowns received a “satisfactory” (Score 3 or 4) rating, marginal integrity (the key parameter to judge the performance of the resin cement) received an “excellent (the highest possible Score 4) in all 30 cases. Conclusion The researchers concluded that “the excellent results obtained in this study suggest that the third-generation tooth-supported monolithic zirconia crowns in posterior regions seem to be a good alternative to metal-ceramic crowns, second-generation monolithic zirconia crowns, and veneered zirconia crowns. A long-term study is necessary to confirm this short-period study.” Hence, it seems that KATANA™ Zirconia STML and PANAVIA™ SA Cement Universal are a promising team, and that adhering to the recommended abovementioned protocols is likely to produce excellent results that are stable over many years. References 1. 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 3:193-204.2. Güth JF, Stawarczyk B, Edelhoff D, Liebermann A. Zirconia and its novel compositions: What do clinicians need to know? Quintessence Int. 2019;50(7):512-20.3. Kern M, Beuer F, Frankenberger R, Kohal RJ, Kunzelmann KH, Mehl A, Pospiech P, Reis B. All-ceramics at a glance. An introduction to the indications, material selection, preparation and insertion techniques for all-ceramic restorations. Arbeitsgemeinschaft für Keramik in der Zahnheilkunde. 3rd English edition, January 2017.4. Comino-Garayoa R, Peláez J, Tobar C, Rodríguez V, Suárez MJ. Adhesion to Zirconia: A Systematic Review of Surface Pretreatments and Resin Cements. Materials (Basel). 2021 May 22;14(11):2751.5. Mehari K, Parke AS, Gallardo FF, Vandewalle KS. Assessing the Effects of Air Abrasion with Aluminum Oxide or Glass Beads to Zirconia on the Bond Strength of Cement. J Contemp Dent Pract. 2020 Jul 1;21(7):713-717.6. Chen B, Yan Y, Xie H, Meng H, Zhang H, Chen C. Effects of Tribochemical Silica Coating and Alumina-Particle Air Abrasion on 3Y-TZP and 5Y-TZP: Evaluation of Surface Hardness, Roughness, Bonding, and Phase Transformation. J Adhes Dent. 2020;22(4):373-382.7. Alammar A, Blatz MB. The resin bond to high-translucent zirconia-A systematic review. J Esthet Restor Dent. 2022 Jan;34(1):117-135.8. Soto-Montero J, Missiato AV, dos Santos Dias CT, Giannini M. Effect of airborne particle abrasion and primer application on the surface wettability and bond strength of resin cements to translucent zirconia. J Adhes Sci Technol, Online publication May 2022.9. Inokoshi M, Shimizubata M, Nozaki K, Takagaki T, Yoshihara K, Minakuchi S, Vleugels J, Van Meerbeek B, Zhang F. Impact of sandblasting on the flexural strength of highly translucent zirconia. J Mech Behav Biomed Mater. 2021 Mar;115:104268.10. Gseibat M, Sevilla P, Lopez-Suarez C, Rodríguez V, Peláez J, Suárez MJ. Prospective Clinical Evaluation of Posterior Third-Generation Monolithic Zirconia Crowns Fabricated with Complete Digital Workflow: Two-Year Follow-Up. Materials (Basel). 2022 Jan 17;15(2):672. (https://pubmed.ncbi.nlm.nih.gov/35057389/). Mar 14, 2023
A combination for maximum aesthetics in modern zirconia rehabilitations By DT Simone Maffei and Dr. Filippo Menini EVOLUTION IN PROSTHODONTICS Nowadays, digital workflows in prosthodontics are well-established, and many modern dental laboratories have already embraced the option of producing monolithic restorations or restorations with a minimal cut-back for micro-layering in a fully digital environment. The spread of digital technologies and the availability of new restorative materials with improved aesthetic properties have increased the popularity of this technique among dental technicians. This way of working offers considerable advantages for daily procedures, starting with improved ways of communication between the clinician and dental technician. For example, it is now possible to view and evaluate impressions with the whole treatment team including the dental technician almost instantaneously after impression taking – and without anyone having to leave their office. In addition to advanced communication options, digital technologies have allowed us to use materials that otherwise could not be processed, such as zirconia and hybrid composites. As a consequence, lots of innovative materials conquered the market, and this has opened up the possibility to always select what is perfectly suited for each specific clinical situation. Adapting to these trends is absolutely essential for anyone who wants to meet a modern dental practitioner’s increased demands. LONG DISTANCE DENTAL COLLABORATION Working with digital workflows has allowed us to broaden the scope of action of the modern laboratory, enabling virtually effortless collaboration with clinicians hundreds or thousands of kilometres away. The case presented below is a perfect example: In our dental laboratory in Modena, we produced two anatomical crowns made of KATANA™ Zirconia for a patient who needed a combination of direct and indirect restorative treatment to be carried out by Dr. Filippo Menini in Belluno, about 300 km to the northwest. The whole communication and coordination between practice and laboratory was performed remotely and without us seeing the patient. MATERIAL CHOICES Monolithic restorations offer countless clinical and technical advantages. With a major part of the process accomplished by machines, they truly rationalize procedures. The challenge resulting from this simplification, however, lies in the achieving of excellent aesthetics. Whereas until a few years ago, it was very difficult to accomplish this task due to the poor optical properties of the available materials, today we can safely say that we have materials, techniques and protocols at our disposal that allow us to obtain aesthetically acceptable results. At the same time, those materials offer excellent mechanical resistance to the forces and stress to which they are exposed in the oral cavity and a very high precision of fit, if these restorations are produced in a fully digital workflow. We have chosen to work with prosthetic materials and finishing solutions from a company that manufactures and develops them in-house: Kuraray Noritake Dental Inc. (Kuraray Noritake). They offer zirconia discs for milling as well as effect liquids, veneering porcelain and liquid ceramics for an aesthetic finish and even resin cement systems for adhesive luting – all from a single source. This gives us the advantage of using clear and predictable working protocols from fabrication to cementation of the restoration. CLINICAL CASE The 31-year-old patient presented with multiple carious lesions, inadequate restorations and in particular a destructive caries in the maxillary right second premolar (tooth #15, FDI notation, Fig. 1). The latter tooth was endodontically treated and built up using a glass fibre post. The X-ray revealed carious lesions and infiltrated margins of the restorations (Fig. 2). The treatment plan for this quadrant included direct composite restorations on the first premolar and first molar (teeth # 14 and 16) and an indirect zirconia crown used to restore the second premolar (tooth #15; Fig. 3). In addition, a zirconia crown needed to be produced for the mandibular right second premolar (tooth #45). Fig. 1. Initial clinical situation in the maxillary right quadrant. Fig. 2. Radiograph showing carious lesions and restorations with marginal leakage. Fig. 3. Marked surfaces that will be treated. During the first session, the clinician restored the first molar and premolar with composite (Figs. 4 and 5). In addition, the tooth preparation on the maxillary and the mandibular second premolar was performed using the biologically oriented preparation technique (BOPT; Figs. 6 and 7). Two single-tooth temporaries were then produced, recreating a cervical profile according to the BOPT (Fig. 8). In the next step, the digital impression was taken using the double chord technique (Fig. 9). The file generated by the intraoral scanner was first analysed using a greyscale view. This view allows for a better assessment of the quality of the acquired data than the coloured image (Fig. 10). The temporary restorations were finished, polished and placed on the teeth using temporary cement (Fig. 11). Fig. 4. Restoration procedure on the maxillary first molar. Fig. 5. Restoration procedure on the maxillary first premolar. Fig. 6. BOPT crown preparation on the maxillary second premolar. Fig. 7. Detail of the subgingival preparation, using burs with calibrated notches, taking care not to touch the supra-crestal attachment complex, but precisely taking care to remain within the width of the sulcus. In the dental laboratory, we received the intraoral scans in the STL format: Both arches with the prepared teeth and the usual bit register (vestibular scan of the arches in occlusion). Following a careful evaluation of the impressions and the quality of the triangulation of the points of the STL file detected by the scan, a full-contour design of the crowns was performed (zero cutback crowns). This allows us to obtain an emergence profile, according to the BOPT, which is extremely accurate. The anatomy was developed taking into account the functional movements of the patient, which were based on information retrieved from a virtual articulator integrated in the CAD software. These movements can be verified and – if necessary – corrected on the physical articulator in a subsequent step. As it is possible to use the same type of articulator (in our case ARTEX by Amann Girrbach) both in the virtual environment and the real one (control phase) offers the advantage of using the same settings and consequently the same movements in both worlds (Fig. 12). Fig. 8. Production of the temporary restoration. Fig. 9. Digital impression taken using the double cord technique: a 000-sized cord soaked in aluminium chloride is placed in the sulcus as the first cord, followed by a non-soaked cord of size 1. Fig. 10. Greyscale view of the impression, facilitating the clinical evaluation. Fig. 11. Cementation of the temporary restoration. Fig. 12. Virtual models based on the digital impression of both arches, with the software-designed full-contour crowns in different views. The STL files of the designed restorations were sent to the CAM software for milling of the zirconia crowns with a 5-axis CNC machine. The material of choice was in this case KATANA™ Zirconia YML (Kuraray Noritake Dental Inc), which is multi-layered in strength, translucency and colour, and thus suitable for a variety of cases (Fig. 13). Once milling was finished, the elements were removed from the disc and their surface treated with diamond burs and specific rubbers designed for the processing of pre-sintered zirconia. In this phase, it is possible to individualise the anatomy and surface texture of the restorations, a task that is very difficult to accomplish in the milling process. With the dedicated rubbers, the surface can also be smoothened, which will improve the appearance of our restorations after sintering (Fig. 14). On top, individualization of the pre-sintered restorations was accomplished with Esthetic Colorant (Kuraray Noritake). These new effect liquids have been specifically developed for KATANA™ Zirconia. They contain a special primer that limits the depth of penetration, which results in an appearance similar to external stains, while a depth effect is created. Precise application of the liquids is possible with the Liquid Brush Pen. The Esthetic Colorant line-up consists of twelve colours to facilitate stock management in the dental laboratory, while still providing for natural aesthetics and perfect harmony in the oral cavity. Impact on the flexural strength of the zirconia substructure by the liquids is kept to a minimum, as they have been optimised to limit this effect and avoid fractures. (Fig. 15). Sintering is carried out in a specially calibrated furnace, scrupulously following the protocol recommended by the manufacturer. Afterwards, the finishing procedure can be continued. With special stones, the cervical edge was first regularised: In the deeper, subgingival areas, the intraoral scanner usually has some difficulties capturing all the necessary information. As a consequence, the STL file is triangulated with some irregularities at the cervical margin. These irregularities need to be regularised, before the thickness of the margin is reduced to '0'. In fact, during milling it, is created with a thickness of 0.2 mm to avoid micro-chipping that would compromise the accuracy of the cervical margin. Figure 16 shows both the thickness of the cervical margin, which, despite the finishing preparation, retains a thickness of 0.2 mm, and the irregular course of the same due to the irregular shape of the STL file around the sulcus. Fig. 13. KATANA™ Zirconia YML blank with milled crowns. Fig. 14. Finishing with diamond burs and specific rubbers for pre-sintered zirconia. Fig. 15. Individualisation with Esthetic Colorant. Fig. 16. Finishing of the restorations after sintering. The restorations were then sandblasted with 50-μm aluminium dioxide at 2 bar pressure and cleaned under a steam jet. After an evaluation of the colour revealed after sintering, the finishing phase was completed with the aid of CERABIEN™ ZR FC Paste Stain (Kuraray Noritake Dental Inc.) and polishing instruments. The ceramic emulsions FC Paste Stain allow us to adjust the chroma and value of the restorations and to imitate all those aesthetic features that will improve integration in the oral cavity. With this technique, it is very easy to achieve the desired shade match, as the appearance of the stain applied to the surface is exactly like its appearance after firing. In this way, it is easy to monitor the outcome and – if desired – compare with a reference and adjust whenever necessary (Figs. 17 and 18). For cementation of the restorations, the clinician used PANAVIA™ SA Cement Universal in combination with KATANA™ Cleaner (both Kuraray Noritake Dental Inc.). The cleaner has a pH value of 4.5 be used both intra and extra-orally, improving adhesion in all restorative procedures. PANAVIA™ SA Cement Universal is the only self-adhesive resin cement containing the unique LCSi monomer – a long carbon-chain silane coupling agent. In combination with the original MDP monomer, which is also present in the paste and enables chemical adhesion with zirconia, dentin, enamel and metal alloys, this coupling agent provides for adhesion of the cement to any material, including glass-ceramics, without the need for a separate primer (Figs. 19, 20 and 21). At the cementation appointment, the last planned direct reconstruction of the maxillary second molar (tooth #17) was also carried out. Fig. 17. Characterisation with CERABIEN™ ZR FC Paste Stain. Fig. 18. Finished restorations ready to be handed over to the clinician. Fig. 19. Cementation procedure in the maxilla: Sandblasting of the tooth and cleaning of the tooth structure with KATANA™ Cleaner. Fig. 20. Cementation procedure in the maxilla: Sandblasting of the crown’s intaglio and cleaning of the restoration with KATANA™ Cleaner. Fig. 21. Cementation procedure in the maxilla: Self-adhesive cementation with PANAVIA™ SA Cement Universal. Fig. 22. Direct restoration procedure on the second molar. Fig. 23. Restorations immediately after finishing and polishing. Fig. 24. Detailed view of the restored quadrant. Fig. 25. Occlusal view of the maxillary teeth. RESULT The aesthetic integration provided by the high quality of KATANA™ Zirconia YML, combined with the pre- and post-sintering individualisation, made it possible to achieve an excellent integration of the anatomical zirconia crowns. Figures 22 to 25 show the outcome in the newly restored maxillary right quadrant with natural tooth structure, direct composite restorations and the monolithic zirconia crown. ABOUT THE AUTHORS DT SIMONE MAFFEI Simone Maffei, a dental technician since 1996 (IPSIA L.Galvani Reggio Emilia), embarked on his career in Modena at his father William's laboratory. Throughout his professional journey, he has demonstrated a commitment to excellence by participating in numerous courses led by prominent international speakers. These courses span the realms of dental technology and photography. Presently, Maffei is not only a respected speaker at national and international conferences but has also contributed articles to both Italian and foreign sector magazines. His written works delve into the intricate intersection of dental photography and the aesthetics of the smile. A testament to his expertise, Maffei earned recognition as the recipient of the prestigious AIOP International Award in 2014. He actively shares his knowledge by conducting courses in Italy and abroad, focusing on dental technology, dental photography, natural ceramic layering techniques, and the three-dimensional coloring of monolithic restorations. As a valued member of the Digital Dental Revolution (DDR) Team, Maffei serves as a speaker at courses and international conferences, where he imparts insights on various facets of digital dentistry. Simone Maffei is also the proud owner of the Laboratorio Odontotecnico Maffei in Modena. Collaborating with his sister Elisa, the laboratory specializes in crafting aesthetic ceramic reconstructions for both natural teeth and implants, showcasing a dedication to the art and science of dental aesthetics. Active Member of AIOP SOSPESO – Accademia Italiana di Odontoiatria Protesica (Italian Academy of Prosthetic Dentistry). Ordinary Member of SIPRO Società Italiana Protesi e Riabilitazione Orale (Italian Society of Oral Prosthetics and Rehabilitation). FILIPPO MENINI Dr. Filippo Menini graduated in Dentistry and Dental Prosthetics from the Universidad Europea De Madrid in 2017. He has been passionately dedicated to the study of direct and indirect adhesive techniques in the field of conservative dentistry. He became a Regular Member of the Italian Academy of Conservative Dentistry in 2018 and the Italian Academy of Prosthetic Dentistry in 2019. In November 2021, he joined the Think Adhesive Members, and since February 2022, he has been a contract tutor at the University of Siena in the Endo-Resto master program taught by Professor Grandini. Dr. Menini has attended numerous courses in conservative dentistry, endodontics, periodontology, and adhesive prosthetics to manage his work in a multidisciplinary perspective. He has his dental practice in Belluno. Mar 29, 2024
KATANA Zirconia restoration: Pre-treatment for adhesive luting 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. Dec 13, 2022
Conventional cementation or adhesive luting - A guideline A guideline with regard to contemporary materials The retention of the fixed prosthodontic restorations is a critical factor for the long-term success, as the loss of crown retention is one of the main reasons for failure of crowns and fixed dental prosthesis (FDP) (1, 2). There are three main elements that need to be considered to achieve proper retention of the restorations; the tooth preparation, the restorative material and the luting agent. TOOTH PREPARATION During tooth preparation there are some important features to be considered, such as the height, angle and surface texture of the abutment tooth, in order to achieve an adequate retention and resistance form which provide stability of the restorations to resist dislodgment and subsequent loss (3). Retention form is responsible for counteracting tensile stresses, whereas resistance form counteracts shear stresses (4). In order to achieve a sufficient retention and resistance form for full coverage crowns it is recommended that the height of the abutment tooth should be at least 4 mm and that the optimal convergence angle should range from 6 to 12 degrees with a maximum of 15 degrees (1, 5-8). RESTORATIVE MATERIAL With the continuous introduction of new restorative materials to the dental market it is important to take into consideration the different mechanical properties of the various materials. The composition and the surface properties of the material have a decisive role in the ability to accomplish mechanical and/or chemical attachment to the restoration and therefore achieving required retention. LUTING AGENT The luting agent is the connection between the tooth and the restoration. Proper luting of indirect restoration is critical in achieving long-term success as it highly influences the retention of the restoration as well as tightly sealing the gap between the restoration and the tooth. Although there are several classifications for the definitive luting agents, they can be , however, classified into two main categories based on the ability to achieve chemical connection to different substrates; conventional (e.g. zinc phosphate, glass-ionomer and resin-modified glass-ionomer cements) and adhesives. Most commonly used and best documented adhesive luting agents are the adhesive composite resin cements. Composite resin cements can be further classified according to the chemical composition into traditional full-adhesive resin cement and self-adhesive resin cements, both also differ in the bonding procedure. The full-adhesive resin cements require pre-treatment of the tooth structure and restorative material using separate adhesive systems. In this combination of the resin cement and the adhesive system, very durable chemical bonding can be reached. To simplify the luting procedure and eliminate the need of using several components, the self-adhesive resin cements are a good choice for the daily busy practice, in which reliable bonding can be achieved in only one simple step of cement application, mostly without additional primers or bonding agents. With the availability of different types of cements, the decision of choosing the suitable luting agent and method can be confusing for the practitioner. Especially with the wide use of contemporary restorative materials such as new generations of highly translucent zirconia as well as reinforced-composites, it is important to take into consideration that the properties of such materials differ highly from metal or earlier generations of zirconia. Subsequently the choice of the luting agent must be appropriate to achieve satisfying results and long-term success. Therefore, in this article, the authors aim to provide insights for the clinicians on choosing the correct luting agent that can help achieve satisfactory results for the dentist as well as the patients. CONVENTIONAL CEMENTATION OR ADHESIVE LUTING? The choice of whether to use a conventional cement or an adhesive resin cement depends on several factors, the key factors are: Retention and resistance form of the abutment tooth. Mechanical and optical properties of the restorative material (flexural strength and translucency). Simplicity of the workflow and special requirements of the working environment. 1) RETENTION AND RESISTANCE FORM OF THE ABUTMENT TOOTH Minimal-invasive restorations, such as resin-bonded FDP, labial and occlusal veneers and inlay-retained FDP are based on a non-retentive preparation form. In this case the only possible method to achieve retention is the adhesive luting (9-11). Even though such preparations completely lack a retentive form, long-term success of the restorations is well-documented when using a durable resin cement (e.g. PANAVIA™ 21, Kuraray Noritake Dental Inc., Japan) and proper bonding procedure (10, 11). For full-coverage restorations (e.g. crowns and FDPs), the guidelines for tooth preparation discussed before (minimum height of 4 mm and maximum convergence of 15 degrees) need to be applied in order to achieve the retention and resistance form required to make cementation with a conventional luting agent acceptable. However, in reality this retention form is hard to realize due to several factors. In cases of severe loss of tooth substance, achieving a minimum height of the abutment tooth is only possible with building up the tooth using a core build-up material which in some cases can be considered time consuming especially when the required build-up is minor (for example 1-2 mm). Moreover, increasing the height through core build-up is sometimes not possible, as in cases with short clinical crowns and insufficient occlusal clearance that is essential to provide the minimum thickness required for the restorative material. In such cases surgical crown lengthening is necessary to increase the height of the tooth without compromising the occlusal space required, which can be time consuming for the clinician and undesirable for the patient as it involves a surgical procedure and extends the treatment process. Concerning the convergence angle, several studies showed that in reality and in daily practice of the dentist, the preparation angle is much higher than 15 degrees (5, 6, 12, 13). For instance, preparations from general practitioners were evaluated digitally and compared to clinical recommendations and it was found that the mean convergence angle was 26.7 degree with the distopalatal angle being 31.7 degree (12). Based on the previous concerns, it can be concluded that achieving a proper retention form during daily practice is hard to realize and thus conventional cementation in such cases can present clinical problems especially on the long term. Therefore, adhesive luting can be recommended in these cases as an alternative to conventional cementation (6, 14). For full-coverage restorations with preparation designs featuring at least some mechanical retention, the use of self-adhesive resin cements can be considerate a good alternative as it provides high clinical success rates (9, 15). Conclusion / Clinical Significance: For non-retentive minimal-invasive restorations, traditional full-adhesive luting is a must. For full-coverage restorations, full-adhesive or self-adhesive luting is recommended. In case a retentive preparation with minimum height of 4mm and convergence angle of 6-12 degrees, adhesive luting as well as conventional cementation can be used. 2) MECHANICAL AND OPTICAL PROPERTIES OF THE RESTORATIVE MATERIAL Flexural strength and translucency of the restorative material are critical factors that influence the decision which luting agent to use. a) Flexural strength As a general guideline for all-ceramic restorations, ceramics with low and medium flexural strength under 350 MPa should be adhesively luted with composite resin cements, as these restorations rely on resin bonding for reinforcement and support (9, 14, 16). This includes feldspathic-, glass-, hybrid-ceramics and composite. Although discussions on conventional cementation versus adhesive luting for high-strength ceramics with flexure strength of more than 350 MPa have been going on for a long time (9), there are several studies showing an increased stability and strength of all types of ceramics, even lithium disilicate and zirconia, when they are adhesively luted (9, 17-20). It is also important to consider that the documented success of most conventional cements is mainly combined with restorations made of metal or early generations of zirconia. Nonetheless, the clinical success of new generations of high-translucent zirconia can be significantly influenced by the luting agent as these new generations have notably lower flexural strength (9). And therefore, attention has to be paid to minimal material thickness together with adhesive luting to ensure long-term clinical success and prevent fractures (9). Conclusion / Clinical Significance: For glass-ceramic, hybrid-ceramics and composites, adhesive luting is a must. For lithium disilicate and zirconia restorations, adhesive luting is highly recommended. For metal restorations, adhesive luting as well as conventional cementation can be used. b) Translucency To meet the increasing esthetic demands of the patients, new materials and techniques are continuously introduced, aiming to provide the perfect esthetic restorations. This includes not only new restorative materials but also new modifications to the luting agents as well. Highly translucent ceramics can deliver superior esthetics and therefore their popularity and clinical applications expanded widely among clinicians. It is nevertheless very important for the clinician to apprehend that the final esthetic result is influenced by the complete restorative complex and not just by the restorative material, as the luting agent is a key factor in achieving the desired high esthetics (21-24). For that reason, the choice of an opaque conventional cement for cementation of high-translucent restoration should not be recommended as it can negatively influence the final esthetic results. Therefore, composite resin cements are the material of choice, as they are available in different shades and translucencies for the clinician to be able to choose the suitable resin cement to achieve the desired esthetics based on the restorative material and thickness as well as the color of the underlying abutment. Some composite resin cements offer try-in paste so that the clinician and the patient can visualize the final results before luting and therefore better choose the appropriate shade of the resin cement. Conclusion / Clinical Significance: For all translucent ceramic restorations, adhesive luting is highly recommended. For metal and opaque high-strength zirconia restorations, adhesive luting as well as conventional cementation can be used. 3) SIMPLICITY OF THE WORKFLOW AND SPECIAL REQUIREMENTS OF THE WORKING ENVIRONMENT The process of adhesive luting with full-adhesive composite resin cements (e.g. PANAVIA™ V5, Kuraray Noritake Dental Inc.) requires separate etching and priming procedures usually using a self-etch adhesive system (e.g. PANAVIA™ V5 Tooth Primer, Kuraray Noritake Dental Inc.) as well as a primer for the restorative material such as a universal primer that can be used for different substrates including metal, ceramics and composites (e.g. CLEARFIL™ CERAMIC PRIMER PLUS, Kuraray Noritake Dental Inc.). These procedures are technique sensitive and intolerant to contaminations, therefore the luting process needs a dry oral environment avoiding any contamination, such as saliva or blood, preferably using rubber dam, as any contamination can compromise the bond strength. Therefore, inability to maintain dry field as in case of subgingival preparation margins is considered a contraindication for traditional full-adhesive luting. However, this method provides very durable bond strength, therefore it is the luting method of choice for minimal invasive non-retentive preparations, such as resin-bonded FDPs, labial and occlusal veneers and inlay-retained FDPs, in which the retention is mainly dependent on the adhesion (9-11). Still, in everyday practice, clinicians seek efficiency and effectivity by using a simple but durable luting agent for the insertion of full-coverage restorations such as tooth-or implant-supported crowns and FDPs. Although the conventional cements are simple and fast in their use, they provide little or no adhesion at all and therefore they are not recommended in several cases (6, 9, 14, 15, 19, 20). A simple but reliable method can be well accomplished by the use of self-adhesive resin cements (e.g. PANAVIA™ SA Cement Universal, Kuraray Noritake Dental Inc.) as they can be considered the best alternative for full-adhesive adhesive luting in less critical situations that do not rely entirely on adhesion (9, 15). Furthermore, self-adhesive resin cements are not as technique sensitive and intolerant to contaminations as traditional full-adhesive resin cements. Typically, a MDP phosphate monomer is integrated in the self-adhesive resin cement, which is required to chemically bond to different substrates, making it possible for the resin cement to chemically bond to non-precious metals and zirconia as well as tooth substance. However, regardless of the self-adhesive resin cement, the use of a separate silane coupling agent is still required when bonding to silica-based ceramics (e.g. leucite, lithium silicate and lithium disilicate), hybrid ceramics and composite restorations. Recently, a unique self-adhesive resin cement (PANAVIA™ SA Cement Universal, Kuraray Noritake Dental Inc.) was introduced: through an innovative and distinctive production technology, a silane-coupling agent (long carbon chain silane (LCSi)) is integrated in the cement, and thus being the real universal adhesive system that completely eliminate the need for any other adhesive or primer when being used for all substrates including glass ceramics. So the luting process can be in this case truly shortened to one step. Therefore, this unique cement combines several advantages of adhesive luting as well as the straightforward procedure of the conventional cementation without compromising the clinical success, regardless of the type of the restorative material. As a conclusion, adhesive luting has more benefits over conventional cementation, regarding retention, esthetics, stabilization of the tooth and the restoration as well as preventing micro leakage (6, 9, 14-17, 19, 20, 25, 26) (Table 1). Moreover, there are no absolute contraindications for adhesive luting other than hypersensitivity to methacrylate monomers, as self-adhesive resin cements can be used in cases where full-adhesive resin cements are contraindicated, such as inability to avoid contamination (Table 2). As a result, adhesive luting can be generally used in every clinical situation, whereas conventional cementation is limited (Table 3). Dentist(s): Prof. Dr. Florian BeuerProfessor and Chair, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité – Universitätsmedizin Berlin, Germany. Dr. Adham ElsayedClinical and Scientific manager, Kuraray Europe GmbH, Hattersheim, Germany. References 1. Ladha K, Verma M. Conventional and contemporary luting cements: an overview. J Indian Prosthodont Soc. 2010;10(2):79-88.2. Schwartz NL, Whitsett LD, Berry TG, Stewart JL. Unserviceable crowns and fixed partial dentures: life-span and causes for loss of serviceability. J Am Dent Assoc. 1970;81(6):1395-401.3. Gilboe DB, Teteruck WR. Fundamentals of extracoronal tooth preparation. Part I. Retention and resistance form. J Prosthet Dent. 1974;32(6):651-6.4. Muruppel AM, Thomas J, Saratchandran S, Nair D, Gladstone S, Rajeev MM. Assessment of Retention and Resistance Form of Tooth Preparations for All Ceramic Restorations using Digital Imaging Technique. J Contemp Dent Pract. 2018;19(2):143-9.5. 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 3:193-204.6. Güth JF, Stawarczyk B, Edelhoff D, Liebermann A. Zirconia and its novel compositions: What do clinicians need to know? Quintessence Int. 2019;50(7):512-20.7. 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):196-200.8. 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):318-24.9. Blatz MB, Vonderheide M, Conejo J. The Effect of Resin Bonding on Long-Term Success of High-Strength Ceramics. J Dent Res. 2018;97(2):132-9.10. Chaar MS, Kern M. Five-year clinical outcome of posterior zirconia ceramic inlay-retained FDPs with a modified design. J Dent. 2015;43(12):1411-5.11. Kern M, Passia N, Sasse M, Yazigi C. Ten-year outcome of zirconia ceramic cantilever resin-bonded fixed dental prostheses and the influence of the reasons for missing incisors. J Dent. 2017;65:51-5.12. Guth JF, Wallbach J, Stimmelmayr M, Gernet W, Beuer F, Edelhoff D. Computer-aided evaluation of preparations for CAD/CAM-fabricated all-ceramic crowns. Clin Oral Investig. 2013;17(5):1389-95.13. Nordlander J, Weir D, Stoffer W, Ochi S. The taper of clinical preparations for fixed prosthodontics. J Prosthet Dent. 1988;60(2):148-51.14. Blatz MB. Long-term clinical success of all-ceramic posterior restorations. Quintessence Int. 2002;33(6):415-26.15. Blatz MB, Phark JH, Ozer F, Mante FK, Saleh N, Bergler M, et al. In vitro comparative bond strength of contemporary self-adhesive resin cements to zirconium oxide ceramic with and without air-particle abrasion. Clin Oral Investig. 2010;14(2):187-92.16. Kern M, Thompson VP, Beuer F, Edelhoff D, Frankenberger R, Kohal RJ, et al. All ceramics at a glance. 3rd English Edition ed: AG Keramik; 2017.17. Attia A, Abdelaziz KM, Freitag S, Kern M. Fracture load of composite resin and feldspathic all-ceramic CAD/CAM crowns. J Prosthet Dent. 2006;95(2):117-23.18. Borges GA, Caldas D, Taskonak B, Yan J, Sobrinho LC, de Oliveira WJ. Fracture loads of all-ceramic crowns under wet and dry fatigue conditions. J Prosthodont. 2009;18(8):649-55.19. Campos F, Valandro LF, Feitosa SA, Kleverlaan CJ, Feilzer AJ, de Jager N, et al. Adhesive Cementation Promotes Higher Fatigue Resistance to Zirconia Crowns. Oper Dent. 2017;42(2):215-24.20. Weigl P, Sander A, Wu Y, Felber R, Lauer HC, Rosentritt M. In-vitro performance and fracture strength of thin monolithic zirconia crowns. J Adv Prosthodont. 2018;10(2):79-84.21. Calgaro PA, Furuse AY, Correr GM, Ornaghi BP, Gonzaga CC. Post-cementation colorimetric evaluation of the interaction between the thickness of ceramic veneers and the shade of resin cement. Am J Dent. 2014;27(4):191-4.22. Chang J, Da Silva JD, Sakai M, Kristiansen J, Ishikawa-Nagai S. The optical effect of composite luting cement on all ceramic crowns. J Dent. 2009;37(12):937-43.23. Turgut S, Bagis B. Effect of resin cement and ceramic thickness on final color of laminate veneers: an in vitro study. J Prosthet Dent. 2013;109(3):179-86.24. Volpato CA, Monteiro S, Jr., de Andrada MC, Fredel MC, Petter CO. Optical influence of the type of illuminant, substrates and thickness of ceramic materials. Dent Mater. 2009;25(1):87-93.25. Al-Makramani BMA, Razak AAA, Abu-Hassan MI. Evaluation of load at fracture of Procera AllCeram copings using different luting cements. J Prosthodont. 2008;17(2):120-4.26. Gu XH, Kern M. Marginal discrepancies and leakage of all-ceramic crowns: influence of luting agents and aging conditions. Int J Prosthodont. 2003;16(2):109-16. Feb 2, 2021
Innovation - Optimising bond quality with Katana Cleaner from Kuraray Noritake dental A strong and durable bond between the tooth and the restoration is a decisive factor influencing the long-term performance of dental restorations. The quality of the bond, however, is not only affected by the bonding agent or cementation solution used, but also by the condition of the bonding surface. For those who would like to ensure clean tooth and restoration surfaces in an easy way, Kuraray Noritake Dental has developed KATANA™ Cleaner, a universal cleaner with MDP salt and a pH of 4.5 for intra- and extra-oral application. It has been proven that proteins present in saliva and blood have a negative effect on the performance of dental adhesives. Especially in indirect procedures, however, it is impossible to keep the bonding surfaces free of oral fluids. At try-in at the latest, the prepared tooth and the restoration are contaminated and need to be cleaned. Rinsing with water does not have the desired effect, and even with many available cleaners, a certain amount of proteins are usually left on the surface. Tests show that by using KATANA™ Cleaner or by sandblasting, the desired high cleaning effect needed is obtained, without compromising bond strength. This is true for KATANA™ Zirconia restorations, while KATANA™ Cleaner also leads to the desired results on dentin and enamel – surfaces in the oral cavity for which sandblasting and most of the other cleaners are not indicated. The use of KATANA™ Cleaner offers yet another advantage: the cleaning procedure is extraordinarily simple, quick and neat. The universal cleaner comes in a bottle with an innovative flip-top cap, enabling single-handed dispensing onto the dish. It is then rubbed into the surface of the restoration and the prepared tooth structure or the abutment for ten seconds, rinsed with water and dried. Thanks to the high surface activity of MDP salt, these ten seconds are sufficient to remove the proteins on the substrate almost completely, creating conditions very similar to those found on a non-contaminated bonding surface. Subsequently, the selected bonding agent or cementation solution – e.g. PANAVIA™ V5 or PANAVIA™ SA Cement Universal – is applied according to the maufacturer’s usage instructions. The result is a strong long-lasting bond, which gives users a peace of mind. Pilot users who have already tested the product agree that KATANA™ Cleaner is the easy way to optimise bond quality and streamline any adhesive procedure. Feb 19, 2020
Custom abutment implant cementation technique With PANAVIA™ SA Cement Universal and KATANA™ Zirconia By using PANAVIA™ SA Cement Universal and its proprietary dual-monomer technology, you can now simplify the bonding of restoration to implant abutments without the use of separate primers or silane. Independent research has confirmed this new dual-monomer technology does not sacrifice adhesion or durability on glass-based ceramics or zirconia. The technique, in this case study, is for custom fabricated abutment & KATANA™ Zirconia YML crown, however, the basic technique on the treatment of the abutment and restoration may be used with any implant restoration combination as long as the proper surface treatments for type of material is followed. INITIAL FIT OF ABUTMENT & RESTORATION Basic technique on the treatment of the abutment and restoration. Fig. 1. Check Initial Fit of Abutment & Restoration: abutment & crown margins should be checked to ensure proper fit. Fig. 2. Protect base of implant with putty or light-cure block-out resin. The base of the implant should be covered so that it is not air abraded accidentally. Fig. 3. Abrade titanium abutment with 50 μm alumina oxide powder. Fig. 4. Clean abutment with KATANA™ Cleaner: Apply KATANA™ Cleaner by rubbing each area for 10 seconds. KATANA™ Cleaner is a universal cleaner that is indicated to clean metal, zirconia & glass-based restorations. It is also an intra oral cleaner that may be used on dentin and enamel. TREATMENT OF KATANA™ Zirconia RESTORATION WORKFLOW Bonding to zirconia has been proven to be durable in research going back to the 1990’s with the original MDP adhesive monomer in the PANAVIA™ resin cements. The three requirements to bonding zirconia are: Air abrade zirconia with 50 μm alumina oxide powder. Clean zirconia Apply an MDP-Based Primer or resin cement. PANAVIA™ SA Cement Universal contains the original MDP that was developed & patented in 1981 by Kuraray Dental. Fig. 1. Air abrade KATANA™ Zirconia at 14-58 psi. Fig. 2. Dispense & mix PANAVIA™ SA Cement Universal (it is available in automix or handmix formulations). Fig. 3. Apply PANAVIA™ SA Cement Universal to the abutment or inside the crown. Fig. 4. Seat restoration on abutment. Fig. 5. Remove excess resin with a dry micro-applicator or brush. Fig. 6. You may light-cure the margins after cleaning up all excess resin. If you fully cure excess resin, It can be difficult to remove. If difficult to remove, change curing time or distance with your light. Fig. 7. Leave restoration on abutment to self-cure fully for approximately 10 minutes at room temperature. Fig. 8. Final check of custom abutment KATANA™ Zirconia YML crown on model. Dentist: JEAN CHIHA Technician Jean Chiha CDT, Santa Ana, CA USA Mr. Chiha is the owner of North Star Dental Laboratory and Milling Center, Santa Ana, CA, and has served as President of the Dental Lab Owners Association of California since 2013. He is a 1985 graduate of Institut Dento Technic, a private dental technology school in France. Mr. Chiha lectures internationally on dental communication and case planning. Jean lectures around the world on a variety of topics and has carved out a niche with his extensive knowledge of zirconia. Affectionately referred to as “Mr. Katana” due to his involvement in the creation of the material. Jul 30, 2024
Innovative resin cements forming the basis of minimally invasive prosthodontics Article by Dr. Adham Elsayed High-performance adhesive resin cements are often the enablers of minimally invasive prosthodontic treatments. When the main aim is to save as much healthy tooth structure as possible, preparation designs that offer sufficient macro-mechanical retention for conventional cements are usually abandoned. The designs chosen instead need to rely on a strong and durable chemical adhesion established between the tooth structure and the restorative material – a task successfully accomplished by modern adhesive resin cement systems. An excellent example of a minimally invasive, non-retentive preparation and restoration design is the single-retainer resin-bonded fixed dental prosthesis (RBFDPs), nowadays usually made of 3Y-TZP zirconia. With its single cantilever bonded to the oral and proximal enamel surface of an adjacent tooth, it requires minimal to no healthy tooth structure removal. The RBFDP is often used to replace a congenitally missing tooth – in many cases a maxillary lateral incisor – in young patients with incomplete dentoalveolar development and narrow edentulous spaces unsuitable for conventional implant placement1 (Fig. 1 and 2). Additional factors hindering implant therapy – like an insufficient bone volume or angulated roots – are also not an issue for this type of restoration. And compared to orthodontic gap closure, the treatment approach with a RBFDP is less risky, as it does not affect the vertical jaw relationship, prevent canine guidance or compromise the aesthetic appearance2. Finally, it is much less invasive than conventional FDPs, which is usually not a treatment option for young patients in the anterior region. The level of patient satisfaction and the success rates of this treatment approach are impressive3-7. Fig. 1-2. Replacement of both congenitally missing maxillary lateral incisors with single-retainer zirconia RBFDPs after soft tissue augmentation and gingival margin correction. Despite the numerous advantages and excellent clinical performance – single-retainer RBFDP made of zirconia showed a survival of 98.2 percent and a success rate of 92.0 percent after ten years4 – many dental practitioners still opt for alternative treatment options. The reason may be a lack of trust in the bond strength and durability to zirconia. However, this bond can be very strong and durable – provided that a few rules are respected. HOW TO ESTABLISH A STRONG BOND TO THE TOOTH STRUCTURE In order to decide whether a missing tooth may be successfully replaced by a single-retainer RBFDP made of zirconia, the abutment tooth should be examined carefully. It needs to be vital and largely free of caries or direct restorations, while the oral enamel surface must be large enough for resin bonding1. In addition, the space required for the placement of a retainer wing (thickness: about 0.7 mm) needs to be available, as a non-contact design is important for the success of the restoration. Among the preparation designs described in the literature is a lingual veneer and small proximal box preparation with retentive elements located in the enamel only1, or no preparation at all7. For restoration placement, the abutment tooth is treated as usual: after cleaning e.g., with fluoride-free prophylaxis paste, phosphoric acid etchant is applied to the bonding surface, which is then thoroughly rinsed and dried. HOW TO ESTABLISH A STRONG BOND TO THE RESTORATION The recommended pre-treatment for the bonding surface of the retainer wing made of zirconia is small-particle (50 μm) aluminium oxide air-abrasion at a low pressure (approx. 1 bar)8,9, followed by ultrasonic cleaning. Figures 3 (A-E) shows the sequence of surface treatment of zirconia restorations. As a visual aid for a controlled air-abrasion treatment, the marking of the surface with a pen has proven its worth. The whole air-abrasion procedure should be carried out after try-in, during which the tooth surface and the restoration usually becomes contaminated through contact with saliva and sometimes blood. Proteins present in saliva and blood that contaminate the bonding surface are safely removed in this way, while the required surface modification necessary to establish a strong and durable bond to the selected resin cement system is achieved10. FIGURE 3: SEQUENCE OF SURFACE TREATMENT OF ZIRCONIA RESTORATION. Fig. 3A. Cleaning of the restoration prior to luting with water steam cleaner. Fig. 3B. Marking of the bonding surface as an visual aid for the air-abrasion. Fig. 3C. Air-abrasion with 50-μm Al2O3 particles with 1 bar pressure. Fig. 3D. Application of a primer containing 10-MDP. Fig. 3E. Application of the composite resin cement. WHICH RESIN CEMENT SYSTEM TO CHOOSE Subsequently, the components of the resin cement system are applied. Regarding the selection of the system, it is generally recommended to use a restoration primer or resin cement that contains 10-Methacryloyloxydecyl dihydrogen phosphate (10-MDP)11. In this way, a high-quality chemical bond is established. Among the resin cement systems used in the available long-term clinical studies is PANAVIA™ 21 (Kuraray Noritake Dental Inc.)4-6. Launched in 1993, this anaerobic-curing adhesive resin cement contains several important technologies like the MDP monomer and the Touch Cure Technology found in PANAVIA™ V5, the state-of-the art dual-cure multi-bottle adhesive resin cement system of the company. In order to further improve the bonding performance of this present product, however, the team of developers reviewed the basic composition, updated existing technologies and combined them with completely new ingredients. Even with PANAVIA™ 21 introduced 30 years ago, high success rates were obtained4-6. The few observed failures were mainly due to chipping of the veneering ceramic or debonding. Sometimes caused by traumatic incidents, the debondings resulted in no further damage and the restorations were simply rebonded using the same cementation system and procedure. One might expect that with its improved formulation, PANAVIA™ V5 will offer an even stronger and more durable bond than predecessor products, so that it is even better suited for such demanding applications as the resin-bonded fixed dental prosthesis. In a pilot study, this assumption was confirmed7. Without any preparation of the abutment tooth, but a defined size of the bonding surface of at least 35 mm2, the team of researchers placed 24 monolithic zirconia resin-bonded bridges (made of KATANA™ Zirconia HT) to replace congenitally missing lateral incisors. The palatal sides of the central incisors were cleaned with pumice paste and treated with phosphoric acid, while the bonding surfaces of the restorations were sandblasted with aluminum oxide particles (50 μm, 2.5 bar pressure). Afterwards, twelve restorations were luted with PANAVIA™ V5, the other twelve with PANAVIA™ F2.0 (another earlier-version resin cement from Kuraray Noritake Dental Inc.). After an observation period of 32 to 50.47 months, the success and survival rates in the PANAVIA™ V5 group were 100 percent. In the other group, a connector fracture, a chipping and two debondings occurred. Based on these results, the authors of the publication concluded that “it has been seen that the new generation cement (PANAVIA™ V5) is more successful”7. CONCLUSION For many years, minimally invasive indirect restorative approaches like the replacement of missing incisors with resin-bonded fixed dental prostheses have been performed successfully by some dental practitioners. Many others, however, still seem to be hesitant whether these approaches will lead to the desired results in their hands. The available clinical study results, however, have confirmed that the procedure is highly advantageous and successful, while ongoing development efforts in the field of adhesive resin cements have led to products further decreasing the failure rates related to debonding. Even if a debonding occurs, however, no damage is usually done, so that the restoration can be rebonded again with little effort. These findings – together with the well-known benefits of minimally invasive dentistry in general – should encourage dental practitioners to start exploring the full potential of adhesive dentistry for themselves. In this context, PANAVIA™ V5 is definitely an excellent choice. References 1. Sasse M, Kern M. All-ceramic resin-bonded fixed dental prostheses: treatment planning, clinical procedures, and outcome. Quintessence Int. 2014 Apr;45(4):291-7. doi: 10.3290/j.qi.a31328. PMID: 24570997.2. Tetsch J, Spilker L, Mohrhardt S, Terheyden H (2020) Implant Therapy for Solitary and Multiple Dental Ageneses. Int J Dent Oral Health 6(6): dx.doi. org/10.16966/2378-7090.332.3. Wei YR, Wang XD, Zhang Q, Li XX, Blatz MB, Jian YT, Zhao K. Clinical performance of anterior resin-bonded fixed dental prostheses with different framework designs: A systematic review and meta-analysis. J Dent. 2016 Apr;47:1-7. doi: 10.1016/j.jdent.2016.02.003. Epub 2016 Feb 11. PMID: 26875611.4. Kern M, Passia N, Sasse M, Yazigi C. Ten-year outcome of zirconia ceramic cantilever resin-bonded fixed dental prostheses and the influence of the reasons for missing incisors. J Dent. 2017 Oct;65:51-55. doi: 10.1016/j.jdent.2017.07.003. Epub 2017 Jul 5. PMID: 28688950.5. Kern M. Fifteen-year survival of anterior all-ceramic cantilever resin-bonded fixed dental prostheses. J Dent. 2017 Jan;56:133-135.6. Sasse M, Kern M. Survival of anterior cantilevered all-ceramic resin-bonded fixed dental prostheses made from zirconia ceramic. J Dent. 2014 Jun;42(6):660-3. doi: 10.1016/j.jdent.2014.02.021. Epub 2014 Mar 5. PMID: 24613605.7. Bilir H, Yuzbasioglu E, Sayar G, Kilinc DD, Bag HGG, Özcan M. CAD/CAM single-retainer monolithic zirconia ceramic resin-bonded fixed partial dentures bonded with two different resin cements: Up to 40 months clinical results of a randomized-controlled pilot study. J Esthet Restor Dent. 2022 Oct;34(7):1122-1131. doi: 10.1111/jerd.12945. Epub 2022 Aug 3. PMID: 35920051.8. Kern M. Bonding to oxide ceramics—laboratory testing versus clinical outcome. Dent Mater. 2015 Jan;31(1):8-14. doi: 10.1016/j.dental.2014.06.007. Epub 2014 Jul 21. PMID: 25059831.9. Kern M, Beuer F, Frankenberger R, Kohal RJ, Kunzelmann KH, Mehl A, Pospiech P, Reis B. All-ceramics at a glance. An introduction to the indications, material selection, preparation and insertion techniques for all-ceramic restorations. Arbeitsgemeinschaft für Keramik in der Zahnheilkunde. 3rd English edition, January 2017.10. Comino-Garayoa R, Peláez J, Tobar C, Rodríguez V, Suárez MJ. Adhesion to Zirconia: A Systematic Review of Surface Pretreatments and Resin Cements. Materials (Basel). 2021 May 22;14(11):2751.11. Al-Bermani ASA, Quigley NP, Ha WN. Do zirconia single-retainer resin-bonded fixed dental prostheses present a viable treatment option for the replacement of missing anterior teeth? A systematic review and meta-analysis. J Prosthet Dent. 2021 Dec 7:S0022-3913(21)00588-6. doi: 10.1016/j.prosdent.2021.10.015. Epub ahead of print. PMID: 34893319. Aug 15, 2023
Adhesive cementation of a KATANA™ Zirconia HT 3-unit bridge with PANAVIA™ V5 Case by Dr. Shoji Kato of Takanawa Dental Office, Japan 1. After preparing the abutments An anterior bridge made of crown and bridge resin has become dislodged. The abutments are vital teeth. 2. Prosthesis A PFZ bridge with a frame fabricated using KATANA™ Zirconia HT12. 3. Application of Try-in Paste Evaluate the shade of the cement before cementation. 4. Try-in After checking the cement’s shade, rinse the prosthesis and tooth surface with water to remove Try-in Paste. 5. Pretreatment of the prosthesis (A) Sandblast the prosthesis (at 0.3 to 0.4 MPa), clean with an ultrasonic cleaner for 2 minutes, then dry. 6. Pretreatment of the prosthesis (B) Apply CLEARFIL™ CERAMIC PRIMER PLUS and blow dry with air. 7. Pretreatment of the abutments (C) Apply Tooth Primer, allow it to react for 20 seconds, then blow dry with air. 8. Application of Paste Use Universal. 9. Placement of the prosthesis After placement, remove excess cement using a piece of gauze, a small brush, etc. 10. Light-curing Light-cure the entire surface of the prosthesis, including the margins. 11. Final polymerization Make sure the prosthesis is left in place, unmoved, for 3 minutes. Nov 9, 2021
Clinical case - Central incisor veneers with PANAVIA V5 By Irfan AbasDental implantologist & restorative dentist Irfan Abas is a specialist in the field of oral implantology & restorative dentistry and an international speaker on the subject. He has given more than 20 presentations, workshops and live surgery courses throughout the world. TP - a dutch dental magazine, of which he is also editor, has published multiple articles under his name. Another highlight is a publication in the NTvT, in collaboration with Prof. Gert Meijer (Radboud UMC), under whose supervision Abas successfully completed the four-year postdoctoral training Reconstructive Dentistry in 2014. He is also an instructor and lecturer for the AAIE and chair of MINEC Netherlands. Irfan Abas has his own practice in Bussum, the Netherlands (tandartsabas.nl). A healthy 42 year-old male patient requested reconstruction of his central incisors, which were badly worn. Pre-Treatment After producing the mock-up, grooves were prepared through the mock-up. To fit two lithium disilicate veneers, a preparation of 1 mm was required. After removing the mock-up, the preparation was perfected. Checking the space using a silicone mold. Definitive preparation (frontal) Temporary veneers made from temporary resin based material (Protemp) Spot-etching before bonding the temporary veneers in place. A small amount of flowable composite applied to the etched surfaces. Light curing the entire surface of the temporary veneers. Finished temporary veneers. The veneers constructed by the dental technician. Checking the fit of the veneers Rubber dam fitted to enable controlled adhesive cementation. Etching with 35% phosphoric acid K-Etchant Syringe for 10 seconds. Treatment with selfetching primer PANAVIA™ V5 Tooth Primer (left on for 20 sec.) Etching of the lithium disilicate veneers with hydrogen fluoride. Clearfil Ceramic Primer Plus MDP-silane primer applied to the veneers. Veneers secured to a placement instrument before definitive cementation PANAVIA V5 Paste applied to the inner surface of the veneer. PANAVIA V5 Paste spread over the veneer. Veneer fitted and excess removed. Light curing (minimum 10 sec.). Immediately after the adhesive cementation with PANAVIA V5. Immediately post-op. Immediately post-op. Two months post-op. One year post-op. One year post-op. Dec 16, 2019
Cementation of lithium disilicate crown Using KATANA™ Cleaner and PANAVIA™ SA Cement Universal Case by Dr. Richard Young Fig. 1. HF etch and try-in complete. Fig. 2. Dispense KATANA™ Cleaner into mixing well. Fig. 3. Rub for 10 seconds, then rinse and dry. Fig. 4. Rub for 10 seconds, then rinse and dry. KATANA™ Cleaner contains MDP based surfactant that breaks down blood and saliva - removing contamination. Fig. 5. Apply cement directly onto restoration (glass ceramic, zirconia, metal or composite resin). Fig. 6. PANAVIA™ SA Cement Universal contains MDP and LCSi monomers, providing for durable bonding even to lithium disilicate restorations. Fig. 7. Tack-cure for 2-5 seconds. Fig. 8. Tack-curing results in nice gel-like-state and excess is removed with ease. FINAL SITUATION Fig. 9. Final situation. Dentist: DR. RICHARD YOUNG Dec 21, 2021
Transforming dentistry with ground-breaking technologies: Cementation of indirect restorations Some companies mainly make use of basic technologies developed by others to improve their products and introduce new ones, while other companies conduct fundamental research and technology development inhouse. Is this difference relevant for someone who uses the resulting products in the dental practice or laboratory on a daily basis? It is – as companies with a deep understanding of the underlying components, chemistry and technologies are able to solve existing problems and respond to market needs flexibly and quickly. This article describes the impact of several basic technologies developed by Kuraray Noritake Dental Inc. on the cementing of indirect restorations. Adhesive cementation then and now The possibility of milling dental restorations from different kinds of ceramics has opened up new opportunities in prosthodontics: highly aesthetic restorations can be produced and placed. What is often undervalued in this context is the role of adhesive cementation systems, which not only support the aesthetic appearance of the translucent, tooth-coloured restorations, but also pave the way for less invasive preparation and restoration designs. Early systems that provided for chemical adhesion between teeth and indirect restorations unfortunately offered a compromised long-term behaviour and high technique-sensitivity, while the application procedure was extremely complex. Technology development at Kuraray Noritake Dental Inc. made significant contributions to an improved long-term bonding performance of the systems and a simplified handling. Optimizing the long-term bonding performance In order to achieve long-term bonding of early cementation systems to tooth structure (especially dentin), Kuraray, a parent company of Kuraray Noritake Dental Inc., decided to focus on the development of a more powerful adhesive monomer in the 1970s. As a first step on its road to excellence, it introduced the phosphate monomer Phenyl-P in 1976. Five years later, continued efforts in improving and refining its molecular structure led to the introduction of the popular MDP Monomer that is capable of establishing a particularly strong and long-lasting bond to enamel, dentin, metal and zirconia. The fact that it is still part of every adhesive and adhesive cementation system from Kuraray Noritake Dental Inc., and meanwhile also used by other manufacturers to optimize the bond strength and bond durability of their products, stresses the ingenuity of the invention. Compared to MDP synthesized elsewhere, the Original MDP Monomer from Kuraray Noritake Dental Inc. stands out due to an unmatched level of purity. Independent Studies show that this level of purity has a positive effect on its bonding behaviour1. By offering stability in a moist environment, the MDP Monomer has contributed to a more consistent performance of the products containing it. Different MDP Monomers offer different levels of purity and a different bonding performance. Three experimental self-etch primers were prepared consisting of 15 wt.% 10-MDP provided by different sources: KN (Kuraray Noritake Dental), PCM (Germany) or DMI (Designer molecules Inc., USA). Data courtesy of Dr. Kumiko Yoshihara. For adhesive resin cement systems to deliver a strong bond with an outstanding marginal seal, however, simply containing an adhesive monomer is not enough. Effective polymerization of this monomer is necessary as well – and not always that easily accomplished. In order to provide for an effective light-cure and dark-cure performance of PANAVIA™ V5, Kuraray Noritake Dental Inc. developed the Touch-Cure Technology. The key part of this technology is a newly developed, highly-active polymerisation accelerator in PANAVIA™ V5 Tooth Primer that is able to coexist with the acidic MDP Monomer promotes polymerisation starting from the interface between the tooth and the cement as soon as PANAVIA™ V5 Paste is applied to the already primed tooth surface. In PANAVIA™ Veneer LC – a light-curing resin cement system that works with the same primers – the polymerisation accelerator in PANAVIA™ V5 Tooth Primer shows the same mechanism of action. It contributes to the polymerization of the adhesive interface, while PANAVIA™ Veneer LC Paste offers excellent ambient light stability and is polymerized by light curing. For example, this phenomenon was evaluated for PANAVIA™ F2.0, the predecessor of PANAVIA™ V5. The result of the study: PANAVIA™ F2.0 showed much better marginal sealing properties than other cement systems evaluated2. This documented secure sealing of the interface leads to a lower incidence of marginal leakage, to a very high polymerisation ratio even in the self-cure mode (without light curing or wherever the light is blocked by the restorative material) and hence to a particularly strong bond. An additional benefit arising from the incorporation of the polymerisation accelerator is its function as a strong reductant. It neutralizes sodium hypochlorite, which is commonly used as an irrigation solution during endodontic treatment, and thus eliminates its negative effect on the bond strength of the subsequently applied cement paste. A highly active polymerisation accelerator in PANAVIA™ V5 Tooth Primer promotes effective polymerisation of the cement at the adhesive interface. Simplifying glass-ceramic cementation Fewer bottles, fewer steps and streamlined cementation procedures: that is why self-adhesive resin cements have been developed and introduced in the early 2000s. Most of these products, however, have a limited indication range. They work well on zirconia, metal, enamel and dentin, but are either not recommended or need an extra silane primer for glass-ceramic bonding. The MDP-containing PANAVIA™ SA Cement Universal is different due to another proprietary technology from Kuraray Noritake Dental Inc.: the LCSi Monomer, a Long Carbon-chain Silane coupling agent. This monomer forms a strong chemical bond with resin composite, porcelain and silica-type ceramics (like lithium disilicate), so that the need for a separate silane component (a primer or adhesive) is eliminated. By leveraging the benefits of this technology, PANAVIA™ SA Cement Universal clearly sets itself apart from other self-adhesive resin cements as a true single-component cementation system even for restorations made of glass ceramics. If desired, the product’s bond strength to tooth structure can be increased by use of the popular universal adhesive CLEARFIL™ Universal Bond Quick featuring Rapid Bond Technology. This technology has been developed by Kuraray Noritake Dental Inc. to solve problems related to the slow penetration of tooth structure, especially wet dentin, typical for universal adhesives. In order to provide proper penetration, these adhesives need to be actively rubbed into the tooth structure for a long time or users have to wait for some time before light-curing the layer. Consisting of the Original MDP monomer combined with hydrophilic amide monomers, the proprietary Rapid Bond Technology provides for a high affinity to water leading to a rapid and deep penetration of wet dentin. As a consequence, application times are shortened and handling is simplified without negatively affecting the bonding performance. Conclusion Technologies developed by Kuraray Noritake Dental Inc. have strongly contributed to an improved bonding performance of adhesive cementation systems and a truly universal use of self-adhesive resin cements. As a consequence, the company offers a streamlined portfolio of high-performance resin cements for every user, for the typical clinical situations. Fewer components and fewer steps are necessary and procedures simplified – for fewer errors and aesthetic restorations that last. Apart from the technology-related benefits, the products mentioned offer many additional beneficial features. A detailed description is found online at kuraraynoritake.eu. References 1) Functional monomer impurity affects adhesive performance.; Yoshihara K, Nagaoka N, Okihara T, Kuroboshi M, Hayakawa S, Maruo Y, Nishigawa G, De Munck J, Yoshida Y, Van Meerbeek B. Dent Mater. 2015 Dec;31(12):1493-501.2) Touch-Cure Polymerization at the Composite Cement-Dentin Interface.; Yoshihara K, Nagaoka N, Benino Y, Nakamura A, Hara T, Maruo Y, Yoshida Y, Van Meerbeek B.J Dent Res. 2021 Aug;100(9):935-94. May 23, 2023
Optimizing functional and esthetic parameters in veneer cementation By Dr. Clarence Tam, HBSC, DDS, AAACD, FIADFE The use of both porcelain veneers to improve and restore the shape, shade and visual position of anterior teeth is a common technique in esthetic dentistry. The biomimetic aim in the restoration of teeth is not only the cosmetic domain, but also functional considerations. It is critical to note that the intact enamel shell of the palatal and facial walls with respect to anterior teeth are responsible for its innate flexural resistance. When dental structure has been violated by endodontic access, caries and/or trauma, every effort must be made to preserve the residual structure and strive to restore or exceed the baseline performance levels of a virgin tooth. BACKGROUND A 55 year old ASA II female with a medical history significant only for controlled hypertension presented to the practice for teeth whitening. It was foreseen that dental bleaching would not have an effect on the shade of a pre-existing porcelain veneer on tooth 1.2, and that this would need to be retreated following the procedure especially if the shade value changes were significant. The patient started with a baseline shade of VITA* 1M1:2M1; 50:50 ratio in the upper anterior region and 1M1 in the lower anterior region. Following a nightguard bleaching protocol with 10% carbamide peroxide worn overnight for 3-4 weeks, the patient succeeded in achieving a VITA* 0M3 shade in both upper and lower arches. As a result, there was a significant value discrepancy between the veneered tooth 1.2 and the adjacent teeth, and also increased chroma noted on the contralateral tooth 2.2 due to a facially-involved Class III composite restoration. This latter tooth also did not match the contralateral tooth in dimension and thus the decision was made to treat both lateral incisors with bonded lithium disilicate laminate veneers. The canine adjacent (2.3) featured localized mild to moderate cusp tip attrition, but the patient did not want to address this until following the currently-discussed veneers were placed. The goal of smile design at this stage is to ultimately establish bilateral harmony with the view to place an additional indirect restoration restoring the facial volume and cusp tip deficiency of tooth 2.3 in the near future. PROCEDURE A digital smile design protocol was not required for the initial intention, which was individual treatment of the lateral incisors, as slight variation is permitted in this tooth type, being a personality and gender marker of the smile. Prior to anesthesia, the target shade was selected using retracted photos featuring both polarized and unpolarized selections. The photographs were prepared for digital shade calibration by taking reference views with an 18% neutral gray white balance card (Fig. 1). Fig. 1. Reference photograph taken with a 18% neutral gray card. The basic body shade was VITA* 0M2 with an ingot shade of BL2. The patient was anesthetized using 1.5 carpules of a 2% Lignocaine solution with 1:100,000 epinephrine before affixing a rubber dam in a split dam orientation. The veneer on tooth 1.2 was sectioned and removed from tooth 1.2 and a minimally-invasive veneer preparation completed on tooth 2.2 (Fig. 2). Partial replacement of the old composite resin restoration was completed on the mesioincisobuccopalatal aspect of tooth 12 with the intact segment maintained. Adhesion to old composite was achieved using both micro particle abrasion and a silane coupling agent (CLEARFIL™ CERAMIC PRIMER PLUS, Kuraray Noritake Dental Inc.). Margins were refined and retraction cords soaked in an aluminum chloride solution and packed. Preparation stump shades were recorded. Final impressions were taken using both light and heavy body polyvinylsiloxane in a metal tray. The patient was provisionalized and sent away with instructions to verify the shade at the laboratory at the bisque bake stage. The models prepared by the laboratory verify the minimally-invasive nature of the case. Fig. 2. Veneer preparation tooth 1.2, 2.2. On receipt of the case, the patient was anesthetized and the provisionals removed. The preparations were debrided and prepared for bonding by abrading the surfaces using a 27 micron aluminum oxide powder at 30-40 psi. The veneers were assessed using a clear glycerin try-in paste (PANAVIA™ V5 Try-in Paste Clear, Kuraray Noritake Dental Inc.). Retraction cords were packed and the intaglio surface of the restorations treated using a 5% hydrofluoric acid for 20 seconds prior to application of a 10-MDP-containing silane coupling agent (CLEARFIL™ CERAMIC PRIMER PLUS, Kuraray Noritake Dental Inc.) (Fig. 3). The tooth surface was etched using 33% orthophosphoric acid for 20 seconds and rinsed. A 10-MDP-containing primer was applied to the tooth (PANAVIA™ V5 Tooth Primer, Kuraray Noritake Dental Inc.) (Fig. 4) and air dried as per manufacturer’s instructions. Veneer cement was loaded (PANAVIA™ Veneer LC Paste Clear, Kuraray Noritake Dental Inc.) (Fig. 5) and the veneer seated. The excess cement featured a non-slumpy character and maintained the veneer well in place during all margin verification exercises prior to a 1 second tack cure (Fig. 6). Fig. 3. CLEARFIL™ CERAMIC PRIMER PLUS applied to intaglio surfaces of veneers. Fig. 4. PANAVIA™ V5 Tooth Primer application to etched tooth surfaces. Fig. 5. PANAVIA™ Veneer LC Paste Clear shade loaded onto prepared intaglio surfaces of veneers. Fig. 6. PANAVIA™ Veneer LC Paste immediately after seating. Note the viscous, non-slumpy nature of the cement, which allows for ease of removal under both wet and gel-phase options. The cement was rendered into a gel state, which facilitated “clump” or en masse removal of cement with minimal cleanup required (Fig. 7). The margins were coated using a clear glycerin gel prior to final curing to eliminate the oxygen inhibition layer (Fig. 8). Fig. 7. Excess cement removal after tack curing for 1 second. Fig. 8. Final curing of veneers from both palatal and facial aspects simultaneously. The margins were finished and polished to high shine and the occlusion of the restorations verified as conformative. The post-operative views show excellent esthetic marginal integration (Fig. 9). Fig. 9. Post-operative esthetic integration of veneers on 1.2 and 2.2. On polarized photograph reassessment, the restorations are well-integrated into the new smile esthetically and functionally (Fig. 10), now awaiting esthetic augmentation of tooth 2.3 to match the contralateral canine. FINAL SITUATION Fig. 10. Final result with polarized photography on reassessment. RATIONALE FOR MATERIAL SELECTION Porcelain is often the chosen material for prosthetic dental veneers due to its innate stiffness in thin cross section, ability to modify and transmit light for optimal internal refraction and its bondability by way of adhesive protocols to composite resin. This trifecta allows for a maximal preservation of residual tooth structure whilst bolstering its physical function relative to flexural performance1. The elastic modulus of a tooth can be restored to 96% of its control virgin value if the facial enamel is replaced with a bonded porcelain laminate veneer2. The elastic modulus of lithium disilicate is 94 GPa whereas that of intact enamel is 84 GPa. The elastic modulus of dentin has been found to range from 10-25 GPa, whereas that of the hybrid layer can vary widely, indeed from 7.5 GPa to 13.5 GPa in a study by Pongprueska et al3. This low flexural resistance range reflects that of deep dentin and not that of superficial dentin, which does not reflect an ideal situation where a laminate veneer is bonded in as much enamel as possible, or in the worst case to superficial dentin. Maximal flexural strength of the hybrid layer is invaluable from a biomimetic standpoint. PANAVIA™ V5 Tooth Primer (Kuraray Noritake Dental Inc.) incorporates the use of the original 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) monomer, which elicits a pattern of stable calcium-phosphate nanolayering known as Superdentin, an acid-base resistant zone that is about 600x more insoluble than the monomer 4-MET, which is found in many other adhesives. Indeed, PANAVIA™ V5 Tooth Primer is used solely in conjunction with Kuraray Noritake Dental Inc. PANAVIA™ V5 cement and PANAVIA™ Veneer LC which both allow the primer to act as a bond without the need to cure the layer prior to cementation of the indirect restoration due to its dual cure potential when married together. If a bonding agent would be preferred, CLEARFIL™ Universal Bond Quick (Kuraray Noritake Dental Inc.), a multi-modal adhesive that also contains the essential amide monomer and 10-MDP components created by Kuraray Noritake Dental Inc., can be used. Of note, CLEARFIL™ Universal Bond Quick features exceptional flexural strength due to the accentuated cross-linking during polymerization afforded by the amide monomers, on the order of 120 MPa by itself4. PANAVIA™ Veneer LC is a cement system that features cutting edge technology that provides excellent esthetics and adhesive stability of your indirect restorations, whilst allowing a stress free workflow. It is a cement system that is a game changer; one that allows you to restore confidence in the patient, strength in the tooth-restoration interface, and bolsters your clinical confidence in the delivery of biomimetic excellence. Dentist: CLARENCE TAM References 1. Magne P, Douglas WH. Rationalization of esthetic restorative dentistry based on biomimetics. J Esthet Dent. 1999;11(1):5-15. doi: 10.1111/j.1708-8240.1999.tb00371.x. PMID: 10337285.2. Magne P, Douglas WH. Porcelain veneers: dentin bonding optimization and biomimetic recovery of the crown. Int J Prosthodont. 1999 Mar-Apr;12(2):111-21. PMID: 10371912.3. Pongprueksa P, Kuphasuk W, Senawongse P. The elastic moduli across various types of resin/dentin interfaces. Dent Mater. 2008 Aug;24(8):1102-6. doi: 10.1016/j.dental.2007.12.008. Epub 2008 Mar 4. PMID: 18304626.4. Source: Kuraray Noritake Dental Inc. Samples (beam shape; 25 x 2 x 2 mm): The solvents of each material were removed by blowing mild air prior to the test. Aug 29, 2023
Restoration of a single central incisor: Mastering the art of observation Case by Andreas Chatzimpatzakis Observe and copy: This is the key to nature-like dental restorations. There are many optical effects, colour transitions and morphological details in natural teeth that need to be taken in and understood – and replicating them is only possible for those who know exactly how their materials work. Once these skills are acquired, however, they enable a dental technician to produce their restorations as truly beautiful copies of nature. Even when restoring a single maxillary central incisor, the technique delivers outstanding – or inconspicuous - outcomes, as revealed by the following example. Using high-quality, translucent and gradient-shaded zirconia frameworks and porcelains, the layering technique does not have to be highly complicated. Two bakes and a number of selected effect liquids, internal stains and porcelains are usually sufficient for outcomes that exceed expectations. CASE EXAMPLE In the present case, a young male patient had a quite opaque crown on his maxillary right central incisor that needed to be replaced. During shade selection in the dental laboratory (Fig. 1), it was observed that the cervical third of the adjacent central incisor is lighter than the rest. Its shade in other areas corresponded to B4 on the VITA classical A1-D4® Shade Guide. Hence, it was decided to use a somewhat lighter material for the framework and darken the restoration especially in the middle and incisal areas with internal stains. The concrete plan was to mill a coping made of KATANA™ Zirconia STML (Kuraray Noritake Dental Inc.) in the shade A3, characterize it with Esthetic Colorant (both Kuraray Noritake Dental Inc.) and sinter the piece (Figs 2 to 4). In the following layering procedure including just two bakes, a combination of internal stains and selected porcelains (CERABIEN™ ZR, Kuraray Noritake Dental Inc.) was applied as illustrated in Figures 5 to 12. Figures 13 to 17 display the result on the model, minor adjustments during try-in and the final treatment outcome. Fig. 1. Shade selection. The cervical third of the adjacent central incisor is lighter than usual compared to the middle and incisal areas. Fig. 2. Coping made of KATANA™ Zirconia STML in the shade A3. Fig. 3. Intensification of some shade characteristics of the multi-layered blank using Esthetic Colorant in the shades Grey (middle) and Blue and Grey (incisal area). Fig. 4. Coping after sintering. Fig. 5. Colour map for internal staining, using CERABIEN™ ZR Internal Stains. Fig. 6. Result of the use of Shade Base Stain Modifier Fluoro to increase the fluorescence and internal staining as planned. Fig. 7. Application of Opacious Body OBA2, … Fig. 8. … Translucent Tx … Fig. 9.: … and Luster CCV-2. Fig. 10. Crown after the first bake. Fig. 11. Crown after the application of CERABIEN™ ZR Internal Stains: A+, Aqua Blue 2, White mixed with Cervical 2 (ratio: 30/70) for the cracks, and Cervical 2. Fig. 12. Application of Luster LT1 to finalize the shape. Fig. 13. Finished crown after the second bake on the model. Fig. 14. Evaluation of the surface texture: Observing and copying the surface details is as important as the imitation of the shade characteristics. Fig. 15. Minor texture adjustments during try-in. Fig. 16. Final restoration in place after cementation with PANAVIA™ V5 (Kuraray Noritake Dental Inc.). Fig. 17. Treatment outcome. CONCLUSION Mastering the art of observing natural teeth is the key to lifelike restorations. It allows a dental technician to develop a deep understanding of shade and morphology, which is – apart from knowing the selected materials very well – the only talent needed to reach a high level of excellence. Those who are observant and take in every detail with their eyes can be sure that their mind will understand and their hands will automatically follow. Dental technician: ANDREAS CHATZIMPATZAKIS Andreas graduated from the Dental Technology Institute (TEI) of Athens in 1999. During his studies he followed a program at the Helsinki Polytechnic Department of Dental Technique, where he trained on implant superstructures and all ceramic prosthetic restorations. As of 2000, he is running the ACH Dental Laboratory in Athens, Greece, specialized on refractory veneers, zirconia and long span implant prosthesis. In 2017 Andreas visited Japan where he trained under the guidance of Hitoshi Aoshima, Naoto Yuasa and Kazunabu Yamanda and become International Trainer for Kuraray Noritake Dental Inc.. Sep 3, 2024
Ti-Base implant cementation technique With PANAVIA™ SA Cement Universal By using PANAVIA™ SA Cement Universal and its proprietary dual-monomer technology, you can now simplify the bonding of any restoration to implant abutments without the use of separate primers or silane. Independent research has confirmed this new dual-monomer technology does not sacrifice adhesion or durability on glass-based ceramics or zirconia. The technique, in this case study, is for Ti-Base Implants, however, the basic technique on the treatment of the abutment and restoration may be used with any implant restoration combination. TREATMENT OF TITANIUM ABUTMENT Fig. 1. After attaching the abutment to the implant analog. Fig. 2. Protect the base of the abutment with block out resin & light-cure. Fig. 3. Air abrade the Titanium Abutment with 30-50 μm Alumina Powder @ 32 PSI. Fig. 4. Clean abutment with KATANA™ Cleaner (10’s Rubbing, Rinse & Dry). KATANA™ Cleaner is a universal cleaner that is indicated to clean metal, zirconia & glass-based restorations. It is also an intra oral cleaner that may be used on dentin and enamel. REFERENCE INDEX POINTS TO ENSURE ACCURATE SEATING Fig. 1. Mark Index position on implant analog. Fig. 2. Mark index position (notch) on crown. TREATMENT OF RESTORATION & BONDING TO THE ABUTMENT Fig. 1. If Lithium Disilicate, HF acid etch Internal Surfaces, with 5% HF etch for 20’seconds then rinse & dry. If Zirconia, air abrade, at 14-58 PSI. Fig. 2. Inject PANAVIA™ SA Cement Universal (White Shade) onto treated & cleaned abutment. Fig. 3. Align index points & seat crown onto abutment. Fig. 4. Place crown & implant into clamps & lightly tighten. Fig. 5. Tack-Cure Clean-Up: Light-Cure excess cement for 2-5 seconds (time depends on light output & distance held). Fig. 6. Remove excess cement & block-out resin with an explorer. PANAVIA™ SA Cement Universal has extremely easy clean-up. Fig. 7. Wipe off remaining resin with gauze. Fig. 8. Remove index mark with alcohol & gauze. Fig. 9. Clean & polish restoration prior to seating. Surfaces coming in contact with soft-tissue should be polished. Dentist: GREG CAMPBELL Dentist Greg Campbell DDS, Long Beach, CA USA Greg Campbell, DDS is recognized internationally as an expert on integrating CAD/CAM dentistry into offices and is frequently sought out by industry leaders to lecture about Digital Dentistry. Dr. Campbell has a great understanding of Digital Technology and trains other dentists how to use this technology and is a certified Advanced CEREC Trainer. He is a former Beta tester for Sirona Dental and has authored two books on CAD/CAM dentistry. Dr. Campbell has created multiple polishing kits used for ceramics and has been trained on advanced adhesion materials, research & techniques and utilizing them clinically for over 8 years. Dr Campbell was an Alpha and Beta Tester for KATANA™ STML. Dr. Campbell graduated from the University of Southern California School of Dentistry and completed advanced training in Cosmetic Dentistry at UCLA and maintains a private practice in Long Beach California. Jul 16, 2024
Performance and practicality Case by A/Prof Alan Yap, BDS (Syd), MDSc Hons (Pros)(Syd), FAANZP Since 1983 PANAVIA™ by Kuraray Noritake Dental Inc. has been the gold standard for dental cements throughout the world. Their latest cement, PANAVIA™ Veneer LC, sets a new standard for porcelain veneer cements through incredible performance and ease of use. The following clinical case demonstrates the use of PANAVIA™ Veneer LC. A 31-year-old female (Fig. 1) was referred for porcelain veneers to replace lost tooth structure and to improve aesthetics. The patient exhibited moderate attrition of her anterior and bicuspid teeth (Fig. 2), the result of nocturnal bruxism and a tendency to an edge-to-edge occlusion. She had a Class I malocclusion on a Skeletal Class I tending III base with the right maxillary canine in cross-bite. The treatment plan included orthodontic treatment, porcelain veneers, and an occlusal splint. Fig. 1 Fig. 2 Orthodontic treatment (by Dr Nour Tarraf) included full-fixed appliances with TADs and IPR of mandibular anteriors, and arch retractions to reduce protrusion (Fig. 3, post-orthodontic treatment). A preliminary digital design (Fig. 4) was performed to guide the diagnostic wax-up and a digital mock-up (Fig. 5) was utilised to verify the diagnostic wax-up prior to carrying out the intra-oral mock-up. The patient was unable to afford the restoration of the maxillary bicuspids until a later stage so the reconstruction was limited to the maxillary anterior teeth. Fig. 3 Fig. 4 Fig. 5 Using the diagnostic wax-up, silicone keys were fabricated to guide tooth preparations. Orthodontic treatment allowed prosthetic treatment to be additive in design which meant that tooth preparations could be conservative. Labial reductions were limited to 0.3 mm and incisal reductions were performed only where needed to create an incisal butt joint for the veneer (Fig. 6). Minimal preparations allowed the veneers to be bonded almost entirely to enamel, which is important for the long-term survival of porcelain veneers (Ref 1). There was no need to significantly mask the colour of the cervical region of the tooth and non-carious cervical lesions were absent, so fine chamfer margins were prepared at equi-gingival level. Fig. 6 Splinted provisional veneers (Fig. 7) were fabricated using bisacryl ensuring sufficient interdental space to allow hygiene access for small interdental brushes. The labial surface of the provisional veneers were glazed with a unfilled resin and cemented using the spot-etch technique, ensuring all excess flowable composite was removed prior to curing (Fig. 8). Twice daily interdental cleaning of the provisional veneers and thorough brushing of labial margins during the provisional phase maintained soft tissue health, important for the try-in and cementation of the definitive veneers. Fig. 7 Fig. 8 A dry try-in of the definitive veneers was performed to check the fit of the veneers and a wet try-in was performed using try-in paste to assess aesthetics. The PANAVIA™ Try-in pastes accurately mimic the cement shades. Four useful shades are available (Fig. 9). The White and Brown shades are useful to correct small discrepancies in shade requiring subtle increases or decreases in shade value respectively. Conveniently the try-in pastes are the same as the PANAVIA™ V5 range of try-in pastes (excluding opaque). Following the try-in procedure the teeth were isolated using rubber dam and the floss ligature technique. KATANA™ Cleaner (Fig. 10) was used to clean the veneers prior to silanating with CLEARFIL™ CERAMIC PRIMER PLUS (Fig. 11). Fig. 9 Fig. 10 Fig. 11 Veneers that have not been pre-etched should be etched with hydrofluoric acid prior to silanization. The use of the ProsMate™ Baton allows the cleaning, etching and silanization of all veneers simultaneously (Fig. 12). The veneers are arranged systematically on the ProsMate™ Tray ready for the cementation procedure (Fig. 13). Tooth surfaces were pre-treated with phosphoric acid (K-ETCHANT Syringe) and PANAVIA™ V5 Tooth Primer (Fig. 14). Fig. 12 Fig. 13 Fig. 14 The newly designed cement applicator tip reduces air bubbles and the wide 16-gauge tip (Fig. 15) allows light and easy control of cement extrusion while also providing efficient wide coverage during application. PANAVIA™ Veneer LC has excellent handling because of its ideal paste consistency. It is non-sticky and its viscosity prevents the cement from flowing beyond the veneer margins until the veneer is seated. It is not runny or stringy. Furthermore its thixotropic properties results in lower film thickness during seating of the veneer. These excellent handling properties are due to the development of new filler technology which consists of spherical silica and nano cluster fillers (Fig. 16). The “touch-cure” mechanism of PANAVIA™ V5 Tooth Primer importantly seals the bonding interface while the extended working time and stability of the cement under ambient light allows the simultaneous cementation of multiple veneers. In this case all six lithium disilicate veneers (technical work by Yugo Hatai) were cemented simultaneously with PANAVIA™ Veneer LC Paste (Clear). Fig. 15 Fig. 16 Tack-curing each veneer for one second allowed smooth and easy bulk removal of excess cement with an explorer (Fig. 17). Remaining excess of uncured paste was removed with brushes. Final curing was performed by light curing lingual and labial surfaces. Fig. 17 The optical characteristics of PANAVIA™ Veneer LC, use of fine chamfer margins, and well-fitting translucent restorations produces a gradual and smooth transition of colour from tooth to veneer where margins disappear and soft tissues respond in a healthy way (Fig. 18). The color stability, excellent abrasion resistance and high gloss durability of PANAVIA™ Veneer LC preserves integrity and aesthetics at the margins over the long term. The extraordinary bond strength of PANAVIA™ products, so familiar to our profession over the last 20 years, is still second to none (Fig. 19). Fig. 18 Fig. 19 “KATANA” is a registered trademark or trademark of NORITAKE CO., LIMITED - “PANAVIA” and “CLEARFIL” are registered trademarks or trademarks of KURARAY CO., LTD. References 1. Layton DM, Walton TR. The up to 21-year clinical outcome and survival of feldspathic porcelain veneers: accounting for clustering. Int J Prosthodont. 2012 Nov-Dec; 25(6):604-12. PMID: 23101040. Jan 14, 2025
Case study about PANAVIA SA Cement Universal USING THE NEXT-GENERATION SELF-ADHESIVE CEMENTS by Dr. Tomohiro Takagaki. INTRODUCTION In recent years, the use of CAD/CAM systems for the production of indirect restorations has become increasingly popular. The shortage of young, qualified staff in the field of dental technology in Japan1) is likely to contribute to a further increase of automated production techniques such as CAD/CAM, which require fewer manual production steps compared to traditional manufacturing techniques. Also globally, the number of restorations fabricated using CAD/CAM systems is rapidly increasing. This leads to an even more widespread use of innovative, tooth-coloured restorative materials such as zirconia, silicate ceramics and resins. Demand for placing restorations using the principle of adhesion by resin cements is more and more increasing in daily clinical settings. However, it is difficult and complicated to condition the tooth and restoration surfaces using many primers correctly. In addition, the combination of many different components is time-consuming, complex and cost-intensive. Self-adhesive resin cements, which do not require conditioning the surface of teeth or some restorations with primers, have been released recently, and have become popular among dental practitioners. However, there are many reports2) on the dislodgement of resin-based CAD/CAM restorations and full-zirconia crowns that have been placed using self-adhesive cements. Hence, demand is high for a resin cement system that is both simple to use and reliable in performance. In this document, I explain the fundamental technology of resin cement systems and their range of applications. In addition, I will introduce the method of using a next-generation self-adhesive cement, PANAVIA™ SA Cement Universal (Kuraray Noritake Dental Inc., Fig. 1), as an example. Nov 15, 2022
Clinical Report about PANAVIA Veneer LC PRESENTATION OF A STUDY WITH ILLUSTRATIVE CASES by Dr. Yohei Sato, DMD, PhD and Dr. Keisuke Ihara, CDT. INTRODUCTION In recent years, the application and advancement of digital technology in dentistry has made it possible to accomplish the fabrication of highly accurate prosthetic zirconia appliances that were difficult to mill using the previously available technology. In addition, thanks to advances in adhesive dentistry and the advent of cements that bond strongly to a diverse range of materials, cements have come into wide clinical use that can cope with the many types of materials used for the fabrication of prosthetic appliances. At our hospital, we select the treatment method most suitable for each case by appropriately specifying various types of prosthetic appliance according to the status of each case. For example, we may specify zirconia prosthetic restorations fabricated by the CAD/CAM system, or silica-based ceramic prostheses, or those made of lithium disilicate glass, as the case dictates. PANAVIA™ V5 is a resin cement system that bonds strongly to various types of prosthetic appliance, as well as to tooth structure. PANAVIA™ Veneer LC, a new resin cement system developed by Kuraray Noritake Dental Inc., has suitable characteristics for bonding laminate veneers, using two types of primer that can be used in common with PANAVIA™ V5. Here are some clinical examples of its advantages as a resin cement system used for laminate veneers restorations. Sep 8, 2022
PANAVIA and KATANA: The perfect combination PANAVIA and KATANA: The perfect combination Scientific research has demonstrated that, when bonding zirconia, optimal bond values can only be achieved with resin cements—specifically, MDP monomer-based resin cements. With PANAVIA V5, we offer a dual-cure resin cement with dentine bond strengths equal to our gold standard light-cure bonding agent CLEARFIL SE BOND, even when used in self-cure mode. Through our KATANA Zirconia range, Kuraray Noritake Dental presents a ceramic material for restorative procedures that has excellent translucency and shade options. Together, PANAVIA V5 and KATANA Zirconia make an ideal team for durable and reliable indirect restorations. PANAVIA V5 In 1983, Kuraray introduced its patented MDP monomer in PANAVIA EX cement. With its clinically proven adhesion, our PANAVIA family has set the industry standard for adhesion for over 30 years. As the newest addition to the PANAVIA cement line, PANAVIA V5 provides strong bonding not just to zirconia but to hydroxyapatite and metals as well. Unlike other dual-cure resin cements, PANAVIA V5 offers improved bond strength to all tooth structures. Simple to use and with predictable results, PANAVIA V5 is unique in its user friendliness and procedural consistency. KATANA Zirconia Our KATANA Zirconia discs are processed using a proprietary zirconia powder, allowing it to have as natural a translucency and colour as possible. The KATANA range consists of several options designed for full-contour zirconia prostheses, from single crown to full arch: KATANA Zirconia UTML (Ultra Translucent Multi Layered), STML (Super Translucent Multi Layered), ML (Multi Layered) and HT (High Translucent). The multilayered build-up of KATANA Zirconia STML provides a translucency and chroma that gradually decrease from the cervical to incisal regions, just like natural dentition. KATANA Zirconia UTML is perfect for anterior restorations, such as veneers, owing to its natural translucency and colour gradient. With a flexural strength considerably higher than that of lithium disilicate, KATANA Zirconia has the mechanical and aesthetic properties to achieve well-balanced restorations between natural teeth in the anterior zone. An ideal team PANAVIA V5 provides a strong and durable bond between KATANA Zirconia-based restorations and the tooth structure. PANAVIA V5 resin cement offers optimal margins and predictable restorations. Always use PANAVIA V5 Tooth Primer for the pretreatment of the tooth and CLEARFIL CERAMIC PRIMER PLUS for the priming of the restoration. “We’re thrilled by the possibilities presented from the combination of PANAVIA V5 and KATANA Zirconia,” said Mitsuru Takei, Head of Technical Services at Kuraray Europe. “Together, they make achieving natural-looking restorations easier than ever.” May 28, 2018
Laminate veneer restoration using lithium disilicate glass prosthetic restorations Case by Dr. Yohei Sato, DMD, PhD, Department of Removable Prosthodontics, Tsurumi University School of Dental Medicine, JAPAN and Dr. Keisuke Ihara, CDT, i- Dental Lab, JAPAN. Fig. 1. The patient visited us with a chief complaint of a desire for improved esthetics of the maxillary right and left lateral incisors. Fig. 2. A core fabricated from a diagnostic wax model was applied and the necessary clearances were determined. Fig. 3. Since the teeth are microdonts, the preparation of each abutment was completed by simply exposing a fresh surface to be covered by the laminate veneers. Fig. 4. A layer of porcelain was applied on the lithium disilicate glass substrate, to make a complete laminate veneer. Fig. 5. After a trial fitting, the inner surface of the laminate veneer was cleaned with KATANA™ Cleaner. The inner surface was conditioned according to the prosthesis‘ IFU. Fig. 6. Milling. CLEARFIL™ CERAMIC PRIMER PLUS was applied and dried to silane couple the restoration. Fig. 7. After a trial fitting, KATANA™ Cleaner was applied to the abutment, and rubbed for more than 10 seconds. Then, it was washed off sufficiently (until the cleaner color had completely disappeared), and dried with compressed air. Fig. 8. K-ETCHANT Syringe was applied and left for 10 seconds before water-washing and compressed air-drying. Fig. 9. PANAVIA™ V5 Tooth Primer was applied and left for 20 seconds before compressed-air drying. Fig. 10. PANAVIA™ Veneer LC Paste was applied to the inner surface of the laminate veneer. Fig. 11. The laminate veneer was seated and the fit checked. Then, the excess cement was tack-cured (not more than 1 second at any one point) and removed. Finally, the restoration was light-cured and finished. FINAL SITUATION Fig. 12. This photo shows the laminate veneer restorations one month after placement. The morphology and color of the right and left lateral incisors have been improved, providing a good balance to the entire anterior dentition. Jan 17, 2023
Laminate veneer restoration using KATANA™ Zirconia STML prostheses Case by Dr. Yohei Sato, DMD, PhD, Department of Removable Prosthodontics, Tsurumi University School of Dental Medicine, JAPAN and Dr. Keisuke Ihara, CDT, i-Dental Lab, JAPAN Fig. 1. The patient was referred to our hospital by an orthodontist. The chief complaints were improper esthetics of the teeth due to black triangles at the edges of the gaps between the teeth and occlusal wear of the teeth. Fig. 2. On the basis of the pre-treatment diagnosis using a mockup, the abutments were prepared without anesthesia, keeping in mind that the enamel should be preserved to the extent possible. Fig. 3. Since a fixation retainer was installed on the palate side, it was difficult to take impressions using silicone. Therefore, an intraoral scanner for impression taking was used. Fig. 4. A layer of porcelain on each of KATANA™ Zirconia STML substrates was applied to complete the laminate veneer resto-rations. The inner surface of each restoration was sandblasted, being careful to prevent chipping. Fig. 5. After trial fitting, bonding inhibiting substances as blood and saliva were removed using KATANA™ Cleaner. Fig. 6. Milling. CLEARFIL™ CERAMIC PRIMER PLUS, which contains the phosphoric ester monomer MDP, was applied and dried using compressed air. Fig. 7. The surface of each tooth was cleaned and treated with K-ETCHANT Syringe for 10 seconds before washing it away with water and compressed air-dried the area. Fig. 8. PANAVIA™ V5 Tooth Primer was applied and left it for 20 seconds, then compressed air-dried it. Fig. 9. PANAVIA™ Veneer LC Paste was applied and the laminate veneer was seated. For this case, we treated six teeth during one session. Fig. 10. The unpolymerized excess paste was removed with a brush. PANAVIA™ Veneer LC Paste is a light-cured type, which was designed to provide sufficient working time. Fig. 11. This photo shows the results after the final light curing. Since the excess cement was easily removed, there were almost no cement residues. FINAL SITUATION Fig. 12. The photo shows the inside of the oral cavity one month after the fitting of the laminate veneer restorations. It can also be noted that the teeth’s marginal gingiva has been improved, thanks to the good fit of the laminate veneer restorations. Oct 18, 2022
PANAVIA V5 Professional Kit PANAVIA™ V5 Tooth Primer (2ml)CLEARFIL™ Ceramic Primer Plus (2ml)PANAVIA™ V5 Paste [one syringe per shade (2.4ml/4.2g): Universal (A2), Clear, Brown (A4), White, Opaque]PANAVIA™ V5 Try-in Paste [one syringe per shade (1.8ml): Universal (A2), Clear, Brown (A4), White, Opaque]K-Etchant Syringe (3ml)30 Mixing tips10 Endo tips (S)50 Applicator brushes (fine<silver>)1 Mixing dish (FPN)20 Needle tips (E) - + Add to Cart
PANAVIA V5 Paste 4.6ml/8.1g20 Mixing tips Universal (A2)ClearBrown (A4)WhiteOpaque Shade Choose an Option... - + Add to Cart
PANAVIA V5 Try-in Paste 1.8ml Universal (A2)ClearBrown (A4)WhiteOpaque Shade Choose an Option... - + Add to Cart
PANAVIA V5 Introductory Kit PANAVIA™ V5 Tooth Primer (2ml)CLEARFIL™ CERAMIC PRIMER PLUS (2ml)PANAVIA™ V5 Paste [one syringe per shade (2.4ml/4.2 g): Universal (A2), Clear]10 Mixing tips50 Applicator brushes (fine<silver>)1 Mixing dish (FPN) Shade Choose an Option... - + Add to Cart
PANAVIA V5 Standard Kit PANAVIA™ V5 Tooth Primer (2ml)CLEARFIL™ CERAMIC PRIMER PLUS (2ml)PANAVIA™ V5 Paste [one syringe per shade (4.6ml/8.1g): Universal (A2), Clear]K-ETCHANT Syringe (3ml)15 Mixing tips5 Endo tips (S)50 Applicator brushes (fine<silver>)Mixing dish (FPN)20 Needle tips (E) Shade Choose an Option... - + Add to Cart
PANAVIA™ SA Cement Universal Automix Single Pack 8.2 g/4.6 ml1 Syringe per shade20 Mixing tips Shade Choose an Option... Mix Type Choose an Option... - + Add to Cart
PANAVIA™ SA Cement Universal Handmix Single Pack 9.2 g/5 ml1 syringe per shade Shade Choose an Option... - + Add to Cart
PANAVIA™ SA Cement Universal Automix Value Pack 8.2g/4.6ml3 syringes per shade40 Mixing tips10 Endo tips (SS) Universal (A2)Translucent Shade Choose an Option... Mix Type Choose an Option... - + Add to Cart
PANAVIA™ SA Cement Universal Handmix Value Pack 9.2 g/5 ml2 Syringes per shadeMixing spatulaMixing pad Shade Choose an Option... Mix Type Choose an Option... - + Add to Cart
