A strong bond is half the battle Clinical case by Dr. Zygintas Jonaitis MINIMALLY INVASIVE INDIRECT RESTORATION PROCEDURE IN THE POSTERIOR REGION The aim of preserving as much natural tooth structure as possible is ever-present in modern restorative concepts. No matter whether a direct or indirect restorative procedure is preferred, a whole array of tools, techniques and materials are available that help make the clinician's life easier and treatment outcomes more predictable and durable. Those solutions are designed to facilitate identification of tooth structure that needs to be removed, aid cavity cleansing or maximise the bonding performance without adding complexity to the treatment. Using the following clinical example, a possible restorative workflow is described. RESTORATION REPLACEMENT REQUIRED This patient presented with a composite restoration on a first molar that attracted our attention. The very extensive composite restoration was worn, lacked good anatomical form and proper occlusal contacts, showed leakage and signs of secondary caries (Fig. 1). The tooth reacted to sweets and cold. It was clear that repair was not the best option: the restoration needed to be replaced. Due to the size of the existing composite filling, it was decided to place an indirect partial restoration that would allow us to save as much natural tooth structure as possible while providing for long clinical service life. Fig. 1. Initial clinical situation. SELECTIVE CARIES REMOVAL After rubber dam placement, the existing restoration was removed carefully, revealing secondary caries underneath the composite (Figs. 2 and 3). To facilitate selective caries removal down to remineralisable (non-infected) dentin, Caries Detector was applied (Fig. 4). This liquid stains only the infected tissue, so that it is easily identified and selectively removed using diamond instruments (Fig. 5). This helps users preserve remineralisable (affected) dentin that may be left untouched and – whenever well-sealed – does not pose a risk for the future restoration. Fig. 2. Isolation of the working field with rubber dam. Fig. 3. Removal of the old composite restoration. Fig. 4. Application of Caries Detector to visualise infected dentin. Fig. 5. Cavity after the removal of infected dentin. ADHESIVE PROCEDURE AND BIO-BASE CREATION To create a stable basis for the indirect restoration, the tooth surface was first cleaned thoroughly using KATANA™ Cleaner (Fig. 6). This cleaning agent developed for intra- and extra-oral use effectively removes contaminants that might compromise adhesion from the surface – a decisive step as a strong and durable bond is the creation of a stable foundation. Subsequently, CLEARFIL™ SE Protect, a self-etching adhesive with MDPB, an antibacterial monomer was applied according to the manufacturer's instructions for use (Fig. 7). Next, a layer of poly ethylene fiber, wettened with CLEARFIL SE Protect Bond was placed and covered with flowable composite (CLEARFIL MAJESTY™ ES Flow Universal). Hereafter a layer of fiber reinforced flowable composite was placed and cured. An impression was taken with an intra-oral scanner and a glass-ceramic restoration produced in the laboratory. Fig. 6. Cleaning of the tooth structure with KATANA Cleaner. Fig. 7. Self-etch adhesive with anti bacterial effect applied to the tooth structure. Fig. 8. Foundation created with fibres, bond and flowable composite. Fig. 9. Completed with a layer consisting of short-fibre reinforced composite. TOOTH PREPARATION AND ADHESIVE CEMENTATION Tooth preparation was performed (Fig. 10). followed by pre-treatment of all surfaces to provide for a strong and durable connection between the foundation and the indirect restoration. The bonding surface of the glass ceramic restoration was etched with hydrofluoric acid before applying a ceramic primer (CLEARFIL™ Ceramic Primer Plus) . Followed by applying PANAVIA™ V5 Paste onto the restoration (Fig. 12). The tooth structure and foundation were treated according to the manufacturers instructions with the system-specific PANAVIA V5 Tooth Primer before placing the restoration. The cement was light-cured thoroughly, restoration margins were cleaned and polished (Fig. 13) and the rubber dam was removed. Figures 14 and 15 show the treatment outcome. Fig. 10. Prepared tooth prior to adhesive cementation. Fig. 11. Pre-treatment of the bonding surface of the restoration with a ceramic primer. Fig. 12. Application of the selected adhesive resin cement onto the restoration. Fig. 13. Restoration in place. Fig. 14. Occlusal view of the final restoration. Fig. 15. Occlusal view of the final restoration CONCLUSION The described procedure shows the restoration of a posterior tooth's anatomy and occlusal contacts in cases with severe loss of sound tooth structure. The remaining tissue is preserved wherever possible, while the protective foundation provides for a tight seal of the underlying tooth structure. Utilizing the indirect restoration method supports the restoration's marginal integrity. A long clinical service life may be expected. Jul 22, 2026
Resin Composite Core Build-Ups and Post Cementation Article by Peter Schouten The restoration of endodontically treated teeth often requires the use of core build-ups to provide a foundation for the final restoration. Historically, root posts served as a common method to enhance retention and stability for core build-ups. However, resin composite materials have gained popularity for core build-ups due to their excellent aesthetics, adhesive properties, and versatility. As the reinforcement of the remaining tooth structure (and replacing the missing tooth structure) remains fundamental, the decision to use a root post is a subject of ongoing debate. This article aims to explore several key factors related to restoring endodontically treated teeth using resin composite with or without the introduction of a root post. HISTORY Core build-ups with a root post originally used metal as a post material for their strength. Stainless steel, titanium, and gold were popular choices. However, concerns about potential complications like root fractures prompted a shift in treatment philosophy. The advent of adhesive dentistry brought about the rise of resin composite core build-ups, offering a less invasive and more conservative alternative. The possibility of bonding restorative materials to dental tissue reduced the need to remove sound dental tissue. This shift in perspective allows for a more conservative approach, prioritizing tooth preservation while still providing sufficient strength and retention for long-term success. POST OR NO POST Preserving as much tooth structure as possible is a general prerequisite in modern dentistry. Therefore, omitting the use of a post must be considered, especially in cases where root dentine must be sacrificed to create sufficient space and access to insert the post. The decision to use a post should consider the following factors: The amount and quality of the remaining tooth structure* The presence of a ferrule effect The clinician's experience *Several studies suggest that in cases where an adequate amount of tooth structure remains and when the remaining tooth structure is of good quality, root posts may not be necessary. THE AMOUNT AND QUALITY OF THE REMAINING TOOTH STRUCTURE Preserving as much dental tissue as possible is the first requirement. The presence of at least two intact axial walls is considered ideal for optimal clinical outcomes. Teeth with no- or only one residual wall appear to have reduced survival rates compared to teeth with more than one wall. THE PRESENCE OF A FERRULE EFFECT The ferrule effect refers to the presence of a circumferential band of tooth structure encircling the coronal portion of the tooth. This effect has been shown to contribute significantly to the resistance of the restored tooth to fracture. Minimal ferrule dimensions are not set in stone. Some general recommendations can be given to help evenly distribute forces, resist occlusal forces, and give enough retention. The ferrule should ideally extend at least 2 mm above the cementoenamel junction, have a circumferential width of approx. 1 mm and a thickness of 1 to 1.5 mm. Finally, the axial walls should have a slight taper towards the occlusal plane. *This flowchart has been put together with the greatest care. The “workflows” shown in this article only intended as a brief indication of the actual procedure to follow. This procedure is for general information purposes only and no rights may be derived from it. Always follow the instructions for use (IFU) that come with the product(s). THE ADHESIVE APPROACH Proper adhesive techniques should be employed to maximise the bond strength between the post, luting agent, and root canal walls. Here are several issues to look out for: Debonding It is believed that debonding is one of the most common failures in teeth restored with adhesively cemented endodontic posts and can be directly associated with adhesive bonding issues within the root canal (e.g., insufficient polymerisation, inadequate application of adhesive, resin and reduced evaporation of solvents). The right choice of materials plays an important role here. Appropriate Post-Cementation Procedure First of all the selection of the proper adhesive system should consider factors such as bond strength, biocompatibility, and ease of use. Various adhesive strategies have been suggested for cementing posts, ranging from the separate application of adhesive (etch-and-rinse as well as self-etch adhesives) and resin cement, to the use of self-adhesive resin cement. Compared to etch-and-rinse adhesives, the bond strength of self-etch systems to root canal dentine seems not strongly affected by the post-space region. Zenthöfer et al. concluded the performance of self-etch adhesives to be comparable with that of materials processed using the total-etch technique, at least in the short term. Clean Surface An adequately performed adhesive cementing procedure, including a clean dentine surface, seems important for the success of the coronal restoration of endodontically treated teeth.** Remaining sealer after post-space preparation negatively influences the bondability of the root canal dentine. Tian et al. conducted a study comparing the effectiveness of different sealer cleaning methods prior to bonding procedures. They found KATANA™ Cleaner to be capable of restoring the bonding potential to sealer contaminated dentine. KATANA Cleaner is designed to clean zirconia surfaces, with an interesting option to use as an intra-oral cleaner. The cleansing solution comprises a 10-MDP-triethanolamine salt and 'the original' 10-MDP. The MDP salt weakens the surface tension of the contaminant and enables it to be rinsed off with water. **Among others, both Breschi et al. and Scotti et al. reported the influence of remaining sealer and gutta-percha, as well as the smear layer created by the drills shaping the post space. Both diminish the penetration and chemical action of the agents used to bond fibre posts. Achieving clean dentinal surfaces after mechanical post-space preparation seems critical for optimal post-retention, particularly when resin cement is used. Several options to clean the post-space have been suggested. Some suggested a pre-treatment with a chelating agent and sodium hypochlorite before post-cementation. Others suggest the use of ultrasonic instrumentation in association with EDTA prior to the bonding procedure, resulting in a decrease in debris and in open tubules. Tian, F. et al. found KATANA Cleaner to be capable of restoring the bonding potential to sealer contaminated dentine. Direct Composite Resin Core Build-Ups Today, the use of direct composite resins for core build-ups has become popular. Their use permits the conservation of dentine and facilitates adhesive bonding to the radicular and root dentine. The continuous development of (self-adhesive) resins, both cement and build-up materials, has provided greater applicability to endodontically treated tooth restoration. With proper tooth preparation, adhesive techniques and protocols, direct composite resin can provide predictable and long lasting results. CLEARFIL Universal Bond Quick 2 and CLEARFIL DC CORE PLUS Using adhesives in core build-ups and post & core restorations can be challenging because of the need for adequate energy from the curing light to polymerise the adhesive properly. To overcome curing problems in deeper root canal regions, manufacturers have developed self-cure promoters that can be added to light-curable adhesives. These, however, can lead to pooling of the adhesive in the apical area of post preparations, hampering the insertion of the post to the desired depth and also limit the working time. Kuraray Noritake Dental Inc. addressed this clinical issue with an advanced and improved single-component self-etch adhesive, CLEARFIL™ Universal Bond Quick 2, when combined with CLEARFIL™ DC CORE PLUS dual-cure core build-up resin composite. New initiators have been added to the adhesive and core build-up resin as an alternative to using a self-cure promoter, causing CLEARFIL Universal Bond Quick 2 to set when CLEARFIL DC CORE PLUS contacts the adhesive. Improved properties Kuraray Noritake Dental Inc. has improved their dual-cure core build-up resin, CLEARFIL DC CORE PLUS, to offer better flow during dispensing and stability afterwards of the uncured resin core material. The filler technology has been modified in a way that the paste became thixotropic. This "non-slumping formula" enables easy dispensing and allows the creation of a build-up without the need for a matrix. The improved flow also permits its use, combined with CLEARFIL Universal Bond Quick 2, for the cementation of posts, resulting in a product that is suitable for post cementation as well as the build-up. Core composite or adhesive cement? In clinical situations where a post is included, the post-cementing process can be covered with either CLEARFIL DC CORE PLUS or PANAVIA™ SA Cement Universal. The latter one can be used with or without CLEARFIL Universal Bond Quick 2. Choosing between the two products is, for a large part, dependent on the space between the post and the canal wall: Tight-fit: So-called tight-fit situations, meaning the post snugs tightly to the canal, might benefit from using a highly bondable resin cement of low thickness (PANAVIA SA Cement Universal). Loose-fit: Loose-fit cases need a larger amount of resin-based material and are better off using a material that has better physical properties for use as a filling material (CLEARFIL DC CORE PLUS) instead of cement. CONCLUSION The general prerequisite in modern dentistry is to preserve as much tooth structure as possible. Based on the premises identified in this article, the choice for the placement of a post and the use of the restorative materials can be decided based on the case in front of the clinician. The stability of core build-ups is no longer dependent on the support by a post. After analyzing the remaining tissue and keeping in mind the success factors for a strong bond, patients can be offered highly aesthetic and sustainable restorations without large interventions. *This flowchart has been put together with the greatest care. The “workflows” shown in this article only intended as a brief indication of the actual procedure to follow. This procedure is for general information purposes only and no rights may be derived from it. Always follow the instructions for use (IFU) that come with the product(s). Please note that only a selection of treatment options have been explored. Our main focus is on the use of a core build-up composite and fibre post placement. The following sources of information were used in writing this article: • Zenthofer, A., Bermejo, J. L., Bomicke, W., Frese, C., Gulmez, R., Rammelsberg, P., & Ohlmann, B. (2022). Early failures when using three different adhesively retained core build-up materials-a randomized controlled trial. Clin Oral Investig, 26(2), 1927-1936. doi:10.1007/s00784-021-04170-6• Tian, F., Jett, K., Flaugher, R., Arora, S., Bergeron, B., Shen, Y., & Tay, F. (2021). Effects of dentine surface cleaning on bonding of a self-etch adhesive to root canal sealer-contaminated dentine. J Dent, 112, 103766. doi:10.1016/j.jdent.2021.103766• Bhuva, B., Giovarruscio, M., Rahim, N., Bitter, K., & Mannocci, F. (2021). The restoration of root filled teeth: a review of the clinical literature. Int Endod J, 54(4), 509-535. doi:10.1111/iej.13438• Ozcan, M., & Volpato, C. A.M. (2020). Current perspectives on dental adhesion: (3) Adhesion to intraradicular dentine: Concepts and applications. Jpn Dent Sci Rev, 56(1), 216-223. doi:10.1016/j.jdsr.2020.08.002• Lazari, P. C., de Carvalho, M. A., Del Bel Cury, A. A., & Magne, P. (2018). Survival of extensively damaged endodontically treated incisors restored with different types of posts-and-core foundation restoration material. J Prosthet Dent, 119(5), 769-776. doi:10.1016/j.prosdent.2017.05.012• Carvalho, M. A., Lazari, P. C., Gresnigt, M., Del Bel Cury, A. A., & Magne, P. (2018). Current options concerning the endodontically-treated teeth restoration with the adhesive approach. Braz Oral Res, 32(suppl 1), e74. doi:10.1590/1807-3107bor-2018.vol32.0074• Magne, P., Lazari, P. C., Carvalho, M. A., Johnson, T., & Del Bel Cury, A. A. (2017). Ferrule-Effect Dominates Over Use of a Fiber Post When Restoring Endodontically Treated Incisors: An In Vitro Study. Oper Dent, 42(4), 396-406. doi:10.2341/16-243-L• Scotti, N., Rota, R., Scansetti, M., Migliaretti, G., Pasqualini, D., & Berutti, E. (2012). Fiber post adhesion to radicular dentine: The use of acid etching prior to a one-step self-etching adhesive. Quintessence Int, 43(7), 615-623. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22670257• Ferrari, M., Vichi, A., Fadda, G. M., Cagidiaco, M. C., Tay, F. R., Breschi, L., Goracci, C. (2012). A randomized controlled trial of endodontically treated and restored premolars. J Dent Res, 91(7 Suppl), 72S-78S. doi:10.1177/0022034512447949• Breschi, L., Mazzoni, A., De Stefano Dorigo, E., & Ferrari, M. (2009). Adhesion to Intraradicular• Dentine: A Review. Journal of Adhesion Science and Technology, 23(7-8), 1053-1083. doi:10.1163/156856109X440957• Watzke, R., Blunck, U., Frankenberger, R., & Naumann, M. (2008). Interface homogeneity of adhesively luted glass fiber posts. Dent Mater, 24(11), 1512-1517.doi:10.1016/j.dental.2008.03.022• Fokkinga, W. A., Kreulen, C. M., Bronkhorst, E. M., & Creugers, N. H. (2007). Up to 17-year controlled clinical study on post-and-cores and covering crowns. J Dent, 35(10), 778-786. doi:10.1016/j.jdent.2007.07.006• Fokkinga W.A. Post it? Reconstruction of the endodontically treated tooth. Thesis. ISBN: 978-90-9021726-0• Fokkinga, W. A., Kreulen, C. M., & Creugers, N. H. (2006). [In vitro fracture behaviour of composite crowns with and without posts]. Ned Tijdschr Tandheelkd, 113(8), 313-318. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16933594 Aug 14, 2026
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
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
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
How can surface cleaning improve bond strength in restorative dentistry? DENTAL ADVISOR HIGHLIGHTS THE SUITABILITY OF KATANA Cleaner FOR INTRA-ORAL USE Clean surfaces – whether tooth structure or restorative materials – are essential for reliable and long-lasting adhesion in restorative dentistry. To achieve this, clinicians require a cleaning agent that removes contaminants such as blood or saliva efficiently and thoroughly, without adding complexity to the workflow. KATANA™ Cleaner was developed by Kuraray Noritake Dental Inc. to meet these clinical demands. Recognized with a 2026 Research Award in the category Research – Restoration Cleaner, KATANA Cleaner is a truly universal cleaning solution for both restorations and tooth structure. Designed for intra-oral and extra-oral use, it contains MDP salt, which effectively removes contamination from a wide range of surfaces, supporting bond integrity during adhesive procedures. Key benefits of KATANA Cleaner include: High cleaning efficacy based on the surface-active characteristics of MDP salt Mild pH value (4.5), allowing effective intra-oral application Simple, time-efficient application requiring just ten seconds of surface rubbing DENTAL ADVISOR RESEARCH AWARD: RECOGNITION FOR CLEAN SURFACES THAT SUPPORT OPTIMAL BOND STRENGTH The Dental Advisor Research Team conducted in-vitro testing to evaluate the cleaning performance of KATANA Cleaner and its impact on bond strength with indirect restorative substrates. In these studies, zirconia and lithium disilicate surfaces were contaminated with saliva and subsequently treated with KATANA Cleaner. SEM analysis revealed virtually perfect surface cleanliness, which contributed to optimal bond strength levels. The Research Team also noted that KATANA Cleaner is “one of the few products commercially available that can be used intra-orally...” SUITABLE SOLUTION FOR MANAGING CONTAMINATION With its universal applicability, gentle yet highly effective cleaning effect and proven ability to restore optimal bond strength, KATANA Cleaner offers clinicians an excellent solution for managing contamination in adhesive dentistry. Its recognition with a 2026 Dental Advisor Research Award underscores its relevance and highlights its suitability for a wide range of indications. PART OF EXPANDING UNIVERSAL EXCELLENCE PORTFOLIO At Kuraray Noritake Dental Inc., we understand the demands of modern adhesive dentistry. Reliable adhesion depends not only on high-performing bonding materials, but also on proper surface preparation and contamination management throughout the workflow. That is why KATANA Cleaner is part of our expanding Universal Excellence portfolio. Designed for both intra-oral and extra-oral use, it helps clinicians optimize adhesive procedures by efficiently removing contamination from tooth structure and restorative materials. Supporting clean bonding surfaces in a simple and time-efficient manner, KATANA Cleaner complements restorative workflows involving products such as CLEARFIL™ Universal Bond Quick 2 and PANAVIA™ SA Cement Universal — contributing to predictable and durable adhesion across a wide range of clinical indications. For more information, visit Dental Advisor at dentaladvisor.com. May 20, 2026
Universal Excellence in restorative dentistry USER FEEDBACK ON PROCEDURES AND OUTCOMES The use of universal products – whether solitary or combined – offers practical benefits, which are experienced differently depending on the clinical context, techniques selected and each user’s individual preferences. Key advantages include reduced treatment time, lower costs, fewer components and steps, fewer potential errors and ultimately more satisfied patients. The following compilation of statements from experienced dental practitioners on the universal concept and the products offered by Kuraray Noritake Dental Inc. in general will help you assess in what way they might allow you to elevate your workflows. RATIONALIZING CLINICAL WORKFLOWS Streamlining or rationalizing clinical workflows in restorative dentistry is always worth striving for. Procedures are often complex and materials demand strict adherence to recommended protocols, so that using universal solutions with standardized protocols for a wide range of indications is a promising approach. Dr José Ignacio Zorzin, Associate Professor at the Department of Operative Dentistry and Periodontology at the Friedrich-Alexander-University of Erlangen-Nürnberg in Erlangen, Germany, stated in an article: “Rationalizing clinical workflows: This is the main reason for the use of universal products in adhesive dentistry. They are suitable for a wide range of indications and different application techniques, fulfil their tasks with fewer components than conventional systems and often involve fewer steps in the clinical procedure.” INCREASING PREDICTABILITY AND EFFICIENCY Predictability and efficiency in direct posterior restoration procedures are the main reasons for Dr Koray Kendir, the co-founder of a private dental clinic in İzmir, Turkey to choose universal adhesives and composites. In a case report, he stated that “the combination of CLEARFIL™ Universal Bond Quick 2 and CLEARFIL MAJESTY™ ES Flow Universal allows clinicians to perform predictable, efficient posterior restorations. Their universal applicability and handling properties align with the “Universal Excellence” concept, supporting simplified, yet reliable daily practice.” Fig. 1. Clinical image from the case report of Dr Koray Kendir: Cavities ready for the restorative procedure. Fig. 2. Clinical image from the case report of Dr Koray Kendir: Occlusal view of the teeth restored with a universalshade flowable composite with super-low flowability. GETTING A GRIP ON COSTS Dr Alessandro Devigus, the owner of a private practice in Bülach, Switzerland, shared in an interview that the cost factor is most important for him: “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.” And there is even more to it: “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,” he continued. If you would like to benefit from the described workflow enhancements, it is probably worth giving universal excellence products from Kuraray Noritake Dental Inc. a try. For those who prefer to start with a single universal solution instead of transforming whole procedures immediately, the following feedback from clinicians may be enlightening. UNIVERSAL CLEANER: SUITABLE EVEN FOR USE IN THE PATIENT’S MOUTH The probably most special feature of KATANA™ Cleaner is its universal applicability. It cleans not only virtually every restorative material very well, but also works intra-orally to clean enamel and dentin after tooth preparation. Dr Richard Young from San Bernadino, CA, USA, uses it intra- and extra-orally, stressing that it “contains MDP based surfactant that breaks down blood and saliva – removing contamination.” Fig. 3. Extra-oral application of KATANA Cleaner to remove contamination from a lithium disilicate crown by Dr Richard Young. Fig. 4. Intra-oral application of KATANA Cleaner to remove contamination from the prepared tooth by Dr Richard Young. UNIVERSAL ADHESIVE: SKIPPING THE WAITING TIME Zero waiting time is probably the most striking feature of CLEARFIL Universal Bond Quick 2. While other universal adhesives need to be rubbed into any surface extensively, the product is applied within a few seconds. This reduces the risk of contamination and saves time. Based on his clinical experience, Dr Kendir confirmed that it works well: “In this case, CLEARFIL Universal Bond Quick 2 provided strong adhesion with minimal application time.” Talking about universal adhesives in general, Dr Zorzin stressed that adhering to the protocols described in a material manufacturer’s instructions for use is particularly important: “Universal adhesives contain lots of different technologies in a single bottle. While this fact indeed allows users to rationalize their clinical procedures, it also requires some special attention. As every highly developed material, universal adhesives need to be used according to the protocols recommended by the manufacturer.” For CLEARFIL Universal Bond Quick 2, this protocol is particularly easy. UNIVERSAL COMPOSITES: GREAT SHADE-MATCHING PROPERTIES Lately, an experienced user of CLEARFIL MAJESTY™ ES Flow, Dr Michał Jaczewski from Legnica in Poland, tested the universal-shade option CLEARFIL MAJESTY ES Flow Universal – also in the low flowability variant. He confirmed that the reduced number of shades works well: The product “offers properties which are – from a personal perspective – ideal for the flowable injection technique. The shadematching properties are astonishing; the translucency is quite high when placed in thin layers (so that enamel is very well imitated), and the polishability is as good as that of CLEARFIL MAJESTY ES Flow. For virtually effortless, bubble-free injection, the product comes in a nicely designed syringe. And last but not least, the product’s mechanical properties provide peace of mind even in the posterior region.” Fig. 5. Clinical image from the report of Dr Michał Jaczewski: Flowable composite injected into the transparent index. Fig. 6. Clinical image from the report of Dr Michał Jaczewski: Central incisors beautifully restored. According to Dr Jusuf Lukarcanin, MEDICANA International Hospital Izmir, Turkey, the same is true for the universal paste-type composite CLEARFIL MAJESTY™ ES-2 Universal. He states: “My first reaction to this material was: This is a Game-Changer. The results are magical. Smoother and easy handling properties, high-gloss, more natural light distribution and the process is simple. Aside from being able to skip the shade selection step, your workflow remains the same as with traditional composites. At first, I might have been a little sceptical about replacing all the different colours of composites we use in office every day. But after a couple of tries I found out that it indeed works every time, in some cases even without the use of a blocker. Simply ingenious!” Fig. 7. Clinical image from Dr Jusuf Lukarcanin: Diastema closure in a 28-year-old female patient - initial clinical situation. Fig. 8. Clinical image from Dr Jusuf Lukarcanin: Diastema closure in a 28-year-old female patient - upper anteriors treated with CLEARFIL MAJESTY ES-2 Universal in the shade UW. UNIVERSAL RESIN CEMENT: NO PRIMER NEEDED Primer for tooth structure, cement paste, ceramic primer and silane: PANAVIA™ SA Cement Universal has it all in a single syringe. With no extra bottles needed, it provides for streamlined cementation procedures. That is why Dr Devigus uses it as his standard solution for definitive placement of CEREC overlays and crowns: “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.” Watch the video to hear what exactly Dr Alessandro Devigus says about PANAVIA SA Cement Universal: CONCLUSION Experience shared by clinicians from different clinical environments demonstrates that universal solutions can make restorative dentistry more efficient, predictable and economical. By reducing the number of materials, steps and technique sensitivities, universal products help streamline workflows while maintaining high clinical performance. May 29, 2026
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. Dec 21, 2021
Treatment of a fractured and secondary carious permanent molar tooth Case report by Dr Mediha Isikver Tooth fractures and secondary caries are frequently observed in posterior teeth, often resulting from occlusal stress, restoration failure, or secondary bacterial infiltration. These conditions compromise tooth integrity, function, and aesthetics. With advancements in adhesive dentistry, minimally invasive and durable restorative solutions have become achievable. Material selection plays a critical role in the success of composite restorations, influencing marginal adaptation, wear resistance, and patient satisfaction. This case report describes the step-by-step clinical management of a fractured and secondary carious permanent molar restored using materials from Kuraray Noritake Dental Inc. CASE PRESENTATION A 32-year-old female patient presented to the clinic with sensitivity and discomfort in the upper left posterior region. Clinical examination revealed a distal wall fracture on tooth #26 (maxillary left first molar) with a secondary carious lesion extending subgingivally. Radiographic evaluation confirmed the absence of periapical pathology. Adjacent teeth (#25 and #27) showed early carious activity, but the patient opted for the restoration of tooth #26 only. The tooth was asymptomatic to percussion and showed normal vitality on pulp testing. Fig. 1. Initial clinical view of tooth #26 under rubber dam isolation. TREATMENT PROTOCOL Isolation and caries removal: The tooth was isolated with rubber dam. The existing defective restoration and carious tissue were carefully removed using tungsten carbide burs and a slow-speed handpiece. Surface cleaning: After preparation, KATANA™ Cleaner was applied to remove contaminants and optimize bonding surface quality. Bonding procedure: A single-step, self-etch adhesive, CLEARFIL™ Universal Bond Quick 2, was applied to both enamel and dentin following the protocol recommended by the manufacturer. Restorative phase: The deep and undercut areas were resin coated with CLEARFIL MAJESTY™ ES Flow Universal Low (U shade), ensuring adaptation and stress relief in undercut regions. The remaining cavity was restored incrementally using CLEARFIL MAJESTY™ ES-2 Universal (U shade) paste-type composite, with each 2 mm layer light-cured for 20 seconds. Fig. 2. Clinical view of tooth #26 after removal of the defective restoration and carious tissue. Fig. 3. Application of KATANA™ Cleaner to remove contaminants and optimize bonding surface quality after preparation. Fig. 4. Selective enamel etching performed on tooth #26. Fig. 5. CLEARFIL™ Universal Bond Quick 2 applied to both enamel and dentin following the manufacturer’s recommended protocol. Fig. 6. Resin coating with CLEARFIL MAJESTY™ ES Flow Universal Low (U shade). Fig. 7. Reconstruction of the mesial and distal walls with CLEARFIL MAJESTY™ ES-2 Universal (U shade) composite. Fig. 8. Incremental build-up of cusps and occlusal anatomy using CLEARFIL MAJESTY™ ES-2 Universal composite, refined with a brush for contour adjustment. Fig. 9. Initial finishing of the composite restoration performed with darkcoloured TWIST™ DIA for Composite (medium) rubber points to refine surface texture and anatomy. Fig. 10. Final polishing performed with light-coloured TWIST™ DIA for Composite (fine) rubber points to achieve a highgloss, smooth surface. FINAL SITUATION Fig. 11. Final view of the restoration after occlusal adjustment and polishing. CONCLUSION This case demonstrates that adhesive and restorative systems from Kuraray Noritake Dental Inc. offer a reliable, efficient and effective approach for treating fractured and secondary carious posterior teeth. The integration of self-etch adhesives and high performance composites contributes to durable and aesthetically pleasing restorations. Continuous follow-up is essential to evaluate the long-term clinical behaviour of these materials. Mar 11, 2026