Clinical Cases and Labside

CERABIEN MiLai advanced layering kit for restoring anterior implant aesthetics with minimal layering

Case by Leonidas Dimitriou, MDT

The combination of high-strength zirconia and modern micro-layering concepts allows highly aesthetic implant restorations with excellent optical properties while preserving the strength of the framework. This case demonstrates the use of the new CERABIEN™ MiLai Advanced Layering Kit (Kuraray Noritake Dental Inc.). The new kit with additional porcelain shades expands the possibilities for experienced technicians seeking natural depth, vitality and soft tissue characterisation while maintaining minimal ceramic thickness.

CASE INTRODUCTION

A 72-year-old female patient presented with tooth and bone loss resulting from advanced periodontal disease. Due to existing systemic health conditions, treatment was limited to the placement of two implants without additional bone or soft tissue augmentation.

Two MiS INTERNAL HEX implants (3.75 × 13 mm) were placed. Since the available bone anatomy required a pronounced labial implant inclination, angled titanium bases from Dynamic Abutment Solutions were selected to redirect the screw channels by up to 28 degrees. This prevented unfavourable labial or incisal screw access and provided the foundation for an aesthetic anterior restoration.

A KATANA™ Zirconia YML Disc (Kuraray Noritake Dental Inc.) was selected for the implant-supported bridge because it combines high strength with natural translucency. The framework was designed with full support in the incisal third to maximise mechanical stability during functional movements while allowing facial micro-layering with CERABIEN MiLai porcelains.

CLINICAL AND LABORATORY PROCEDURE

To create lifelike restorations, the internal live stain technique was used in combination with the micro-layering concept. This approach was intended to achieve natural optical effects using only a very thin porcelain layer. Figures 1–20 illustrate the complete laboratory and clinical workflow, from the master model and CAD design of the zirconia framework through framework fabrication, intraoral try-in, surface preparation, staining, layering and final delivery.

Fig. 1. Model with implant analogs – labial view highlighting the inclination of the implants.

Fig. 2. Model with implant analogs – occlusal view.

Fig. 3. Computer-aided design of the zirconia framework – labial view.

Fig. 4. Computer-aided design of the zirconia framework – occlusal view.

Fig. 5. Computer-aided design of the zirconia framework – palatal view.

Fig. 6. Designed zirconia framework – palatal view.

Fig. 7. Sintered zirconia framework on the model – labial view.

Fig. 8. Sintered zirconia framework on the model – palatal view.

Fig. 9. Intraoral try-in of the framework.

Fig. 10. Framework after sandblasting with alumina particles (50μm, 2 bar).

Fig. 11. Framework after application of a foundation layer with CERABIEN MiLai Tx and a first bake (max. temperature 780 °C / 1 min. hold time).

Chroma map: Plan for the application of the internal stains.

Fig. 12. CERABIEN MiLai internal stains applied and fired at 740 °C with vacuum.

Layering map 1: Plan for the application of the porcelains.

Layering map 2: Plan for the application of the tissue porcelains.

Fig. 13. Layered restoration before the bake (max. temperature 760 °C, hold time 45 sec.).

Fig. 14. Layered restoration after the bake.

Fig. 15. Corrective layering (bake: max. temperature: 750 °C, hold time 30 sec.).

Fig. 16. Grinding and morphology corrections.

Fig. 17. Finished restoration on the model after glazing with CERABIEN™ ZR FC Paste Stain at 730 °C for 40 sec.

Fig. 18. Close-up of central incisors and tissue surface details.

Fig. 19. Definitive restoration in the patient's mouth.

Fig. 20. Treatment outcome after two months.

CONCLUSION

This case demonstrates how KATANA Zirconia YML and the CERABIEN MiLai Advanced Layering Kit complement each other in demanding anterior implant restorations. The combination of internal staining and minimal layering enabled a restoration with natural depth, stable value and lifelike aesthetics while preserving the mechanical advantages of zirconia. The new dentin porcelains provided consistent shade and value, while the complementary translucent materials added depth to the zirconia framework. The resulting ceramic surface showed an enamel-like texture, and the gingival porcelains closely resembled natural soft tissue in both texture and colour. Together, these characteristics provide experienced dental technicians with greater flexibility for individual characterisation within a conservative micro-layering workflow.

Special thanks to George Antoniou, D.D.S., for managing this clinical case and kindly providing the clinical photographs.