Special MAJESTY ES-2 Universal - Clinical Cases Brochure Compact, time-saving and aesthetic How many different shades of composite do you need to create appealing restorations in virtually every clinical situation? If you opt for “CLEARFIL MAJESTY™ ES-2” Universal shade concept, a few shades will do the trick. With wonderful support of our internationally recognized key opinion leaders, we have prepared a Clinical Case brochure of “CLEARFIL MAJESTY™ ES-2” Universal for you. The brochure highlights a variety of clinical cases in the anterior and posterior region to show the all about excellent properties of our latest composite. Let the pictures speak for themselves! Click here to view. Enjoy! Start Reading: Special MAJESTY ES-2 Universal - Clinical Cases Brochure 17 mars 2022
REALITY review of CLEARFIL MAJESTY™ ES-2 Universal Would you like to skip shade matching in direct posterior restorative procedures? You can, with CLEARFIL MAJESTY™ ES-2 Universal. See what the REALITY Evaluators have to say about the innovative product with a single posterior shade! Read the report to learn more! Content Highlights: Product overview Strengths and Weaknesses Manufacturer's page Start Reading: REALITY | RATINGS & REVIEWS | CLEARFIL MAJESTY™ ES-2 Universal 17 janv. 2022
Premolar case with CLEARFIL MAJESTY™ ES-2 Universal Case by Dr. Clarence P. Tam, HBSC, DDS, AAACD, FIADFE Case background A stable ASA 2 65 year old female presented to the practice for restorative dentistry with a medical history significant for a non-descript immunoglobulin deficiency, for which she receives regular infusions. She reports no known drug allergies. Clinically, she was diagnosed with an occlusal peripheral rim fracture leaving a food trap on tooth 14 (FDI notation). Tooth 15 featured an extensive amalgam with extreme proximity to the distal marginal ridge, which exhibited distal vertical axial fractures as a result of cyclic expansion-contraction over time. The restorative goal of minimally invasive direct dentistry would be complicated by the undoubtedly dark dentin substrate under the amalgam. A material was sought that featured both an excellent chameleon mechanism as well as physical properties to maximize the prognosis of direct restorations in this area. Restorative procedure The patient was subjected to topical anesthetic prior to buccal infiltration using 1 carpule of 2% Lignocaine with 1:100,000 epinephrine. A rubber dam was affixed prior to preparation of tooth 15MO with dissection of the distal vertical marginal ridge fracture. The margins of tooth 14O and 15MOD were refined before bevelling as the ends of enamel rods facilitate better bonding relative to the sides of enamel rods. A 27 micron aluminum oxide micro air abrasion treatment was completed prior to affixing, wedge and matrix to reconstruct the mesial marginal ridge of tooth 15. A matrix-in-matrix solution was used to recreate the proximoaxial contour of 15D. This provided hermetic closure at the proximogingival cavosurface margin as well as an ideal contour for the missing axial wall. Following a total etch technique, a 2% Chlorhexidine scrub was completed for 30 seconds and the dentin blot dried to a moist state. A 5th generation bond was applied, air thinned and cured as per manufacturer instructions. Microlayers are important during the delicate first 5 minutes of hybrid layer formation, and were completed using 0.25 mm increments of CLEARFIL MAJESTY™ Flow (Kuraray Noritake Dental Inc.). This technique can be expected to increase significantly the shear bond strength to dentin1,2. This was completed both in the proximal box floor area as well as mid-occlusally. The marginal ridge was completed using CLEARFIL MAJESTY™ ES-2 Universal (Kuraray Noritake Dental Inc.). Since the dentin base was heavily stained, CLEARFIL MAJESTY™ Flow was used before utilizing CLEARFIL MAJESTY™ ES-2 Universal in a lobe-by-lobe creation of occlusal anatomy. Post-operative occlusal checks verify that the restoration is conformative to occlusion and esthetically excellent with no visible marginal show. Rationale for material choice The marginal ridges were micro-layered horizontally as was the floor of the resulting Class I preparation as per a reduced layer thickness-technique modification of Nikolaenko et al3, whereas the highest shear bond strengths were found when a 1mm horizontal layering technique was used. CLEARFIL MAJESTY™ ES-2 Universal is at the forefront of a simplified restorative armamentarium for the modern practice. It takes cloud-shading one step further by offering a “Universal” shaded composite featuring Light Diffusion Technology (LDT) with simultaneous ideal sculptability, optical metamerism and physical properties for use in any restorative situation in the mouth. Featuring barium glass nano fillers and proprietary pre-polymerized nanoparticle fillers, the latter boasts a high refractive matrix that is able to disperse light and fool the eye with even the thinnest of layers, obviating the need for opaquer composites in cases like the one featured. When paired with CLEARFIL MAJESTY™ Flow in a conservative layered technique, the 81% filled flowable produces a radiographically well-demarcated layer, and the superficial CLEARFIL MAJESTY™ ES-2 Universal boasts an easy-to-polish robust single shade restorative solution that will virtually fulfil all of your restorative needs for non-bleaching patients. Physically, with compressive strength is rated at 348 MPa and flexural strength at 116 MPa, CLEARFIL MAJESTY™ ES-2 Universal is in the range of natural enamel and dentin. The built-in fluorescence is very enamelomimetic, which is excellent for nightclub social situations. FINAL SITUATION Dentist: DR CLARENCE P. TAM, HBSC, DDS, AAACD, FIADFE Clarence is originally from Toronto, Canada, where she completed her Doctor of Dental Surgery and General Practice Residency at the University of Western Ontario and the University of Toronto, respectively. Clarence’s practice is limited to cosmetic and restorative dentistry and she is well-published to both the local and international dental press, writing articles, reviewing and developing prototype products and techniques in clinical dentistry. She frequently and continually lectures internationally. Clarence is the Immediate Past Chairperson of the New Zealand Academy of Cosmetic Dentistry. She is currently one of two individuals in Australasia to hold Board-Certified Accredited Member Status with the American Academy of Cosmetic Dentistry. Clarence is an Opinion Leader for multinational dental companies Kuraray Noritake, J Morita Corp, Henry Schein NZ, Ivoclar Vivadent, Dentsply Sirona, 3M, Kerr, GC Australasia, SDI and Coltene and is the only Voco Fellow in Australia and New Zealand. She holds Fellowship status with the International Academy for DentoFacial Esthetics and is a passionate and approachable individual, committed to having an interactive approach with patients in all of her cases to maximize predictability. References 1. Bertschinger C, Paul SJ, Luthy H, Scharer P. Dual application of dentin bonding agents: effect on bond strength. Am J Dent. 1996;9(3):115-119.2. Magne P, Kim TH, Cassione D, Donovan TE. Immediate dentin sealing improves bond strengths of indirect restorations. J Prosthet Dent. 2005;94(6):511-519.3. Nikolaenko SA, Lohbauer U, Roggendorf M, Petschelt A, Dasch W, Franenberberger R. Influence of C-Factor and layering technique on microtensile bond strength to dentin. Dental Mater. 2004;20(6):579-585. 20 sept. 2022
CLEARFIL MAJESTY™ ES-2 Universal by Peter Schouten The introduction of universal composites, which are not only universal in terms of application range but also in terms of shade adaptation, effectively marks the dawn of a new type of composite. This prompts a reinterpretation of the term "universal composite." CLEARFIL MAJESTY™ ES-2 is a nanohybrid composite family. Nowadays, nanohybrid composites are commonly used as universal composites. They have a high filler content, they are strong, and they have exceptionally good polishability characteristics1. The newest variant in the CLEARFIL MAJESTY™ ES-2 range is CLEARFIL MAJESTY™ ES-2 Universal shade concept. For this composite; we expand the definition of universal and include shade coverage. Posteriorly, a single material in a single shade is sufficient to cover the entire VITA™ range. This means that no shade determination is required. For the anterior zone, we offer two shade variants: a lighter and a darker variant (UL and UD). The lighter variant is used in the A1-A2 range and the darker for shades from A3 onwards. There is sufficient overlap between UL and UD ensuring no specific shade determination is necessary. Finally, for situations that require extra lightness and brightness, an additional UW shade is available. What makes CLEARFIL MAJESTY™ ES-2 Universal unique in comparison to other universal or single-shade composites? The difference with CLEARFIL MAJESTY™ ES-2 Universal, is that without using an additional opaque composite, sometimes called a blocker, a successful, superbly matching restoration can be constructed. Not only with smaller cavities, but also with larger class I and II restorations. And, when used anteriorly, even an extensive Class IV restoration can be successfully constructed using CLEARFIL MAJESTY™ ES-2 Universal. So, it is not only for those small class III or V lesions. Why Kuraray Noritake Dental Inc. can do this where others cannot, is to a large extent, thanks to optimized light diffusion technology (LDT). By using this technology in composites with the right translucency, the light is scattered and reflected in such a way that the composite blends in with the surrounding tooth structure. Where others use the widely-employed chameleon effect, Kuraray Noritake Dental Inc. adds an extra dimension in the form of LDT. With the chameleon effect, light passes through the material and is reflected off the walls of the cavity. The perceived shade of the restoration is therefore the shade of the cavity walls. If the cavity is too large, thus requiring a larger amount of filling material, the light has to travel further and a large proportion of the light is absorbed. With this, the brightness of the restoration is reduced and the shade of the cavity walls no longer accurately reflected. Our LDT allows light to be scattered within the composite itself, in addition to being reflected off the cavity walls. As a result, CLEARFIL MAJESTYTM ES-2 Universal is a particularly forgiving composite. This feature will be familiar to those who have used CLEARFIL MAJESTY™ ES-2 family products before. CLEARFIL MAJESTY™ ES-2 Universal is the result of sophisticated filler, matrix and silane technology. It offers a solution for all your routine composite work. A consistently superb restoration where shade determination is a thing of the past. Reference 1 Ilie, N., & Hickel, R. (2011). Resin composite restorative materials. Aust Dent J, 56 Suppl 1, 59-66. doi:10.1111/j.1834-7819.2010.01296.x 28 sept. 2021
Simplifying esthetic composite reconstructions using CLEARFIL MAJESTY™ ES-2 Universal Article by Dr. Clarence Tam HBSc, DDS, FIADFE, AAACD A CHAMELEON SUPERCOMPOSITE INTRODUCTION The name of the game in modern-day esthetic and restorative dentistry is that of Responsible Esthetics. The goal of treatment typically strives to correct any structural and cosmetic shortfalls in both biologically-driven and trauma-affected teeth with the precise, artistic placement of various replacement layers, all whilst respecting and retaining a maximal volume of residual tooth structure. Anterior teeth can be affected by enamel and dentin dysplasia, caries and sclerotic conditions and are characterized by a laundry list of genetically-derived and environmentally-acquired conditions with an esthetic deficit that often threaten an individual’s functional and psychosocial integrity if not restored to the seamless picture of health. Missing and defective tooth structure must be categorized into its attendant enamel and dentin components. Both substrates are distinctly different in composition, with enamel being highly inorganic in nature and dentin proportionately more collagenous in nature. The latter stratum is responsible for the refraction of light, the expression of the true color of the tooth, namely the hue and the endowment of fracture toughness or resilience in functional performance. The value and chroma are the other elements of color and are modified by the thickness of enamel. The replacement of enamel has been found to be best substituted from a biomechanical perspective by adhesively-bonded indirect porcelain restorations, and dentin using both composite resin and short fiber reinforced composite (SFRC), the latter imparting increased fracture toughness in large volume replacement restorations, especially those with pericervical structural deficits. In adolescent patients, the gold standard of treatment involves direct composite resin, as often zero to minimal tooth structure preparation is required as a foundation to the bonded restorative. It would be impractical to use bonded indirect restorations when the development of the dentition in puberty is continuous, especially with the retraction of gingiva as one progresses to young adulthood. Resin composite allows prescience in the opportunity to predictably modify and/or add to the existing restoration if dental bleaching for the other teeth is desired or if a further traumatic incident is encountered. The ability to modify bonded porcelain is not predictable and frequent marginal failures occur due to a lower shear bond strength to bonded composite, especially after thermocycling. This is despite our ability to establish a chemical linkage via silane coupling agents from silicate ceramics to resin composite especially at a blended interface. STATEMENT OF PROBLEM Dental shades in clinical dentistry have long been classified using the VITA* Classical A1 – D4 shade guide. Despite being ubiquitous in dental practices, composite resin systems with corresponding shade systems do not satisfactorily match to their purported shade1. Floriani et al found that various mixtures of different shades in one system was required to achieve an acceptable color match with the VITA* Classical shades using the CIEDE2000 formula. Testing another composite resin, they found that none of the A1, A2 or A3 shades matched acceptably to the standard shade guide2. Indeed, even with indirect ceramic layering systems, a wide range of unacceptable discrepancy was noted between VITA* labeled porcelain shades and the actual shade guide3. The VITA* Classical shade guide became the standard in dental shade classification with the release of its A1-D4 shade guide in 1985. The majority of human-tested dental shades has been found to be in the A-family (78.5%), followed by C (13.2%), D (5.2%) and B (3.1%)1. As such, the shade accuracy of a given composite system must be important if they are to be visually naturomimetic. CHAMELEON EFFECT DEVELOPMENT There are myriad composite resin systems featuring a simplified shade Universal system that have acceptable chameleon effects due to their balance of translucency, light transmission, diffusion and refractive index properties. There is a concern over how these optical properties may change after both thermocycling and wet storage, potentially compromising the excellent initial esthetic blend4. Refractive index (RI) is best optimized when the RI of the inorganic fillers match closely with the RI of the cured organic matrix, typically in a range between 1.47 and 1.525. If the match is dissimilar, this drives up the opacity of the restoration due to heightened refraction and reflection at the filler/matrix interface6. Layering of composite to mask an intraoral defect is complicated by the need to mask any linear defects such as fracture lines superimposed over the shadowing of the dark intraoral cavity in addition to regional color variations. It is confounded by the requirement to recreate natural maverick and translucent effects particularly in the incisal window region of upper and lower incisors and canines, giving the illusion of a virgin, healthy tooth. This has been historically difficult to accomplish in anterior teeth given the need to block out restorative interfaces with natural tooth structure and recreate a seamless internal structure and details. This detailed layer belies a well contoured enamel layer with realistic translucency, polishability and accurate primary and secondary anatomy. Adding to the complexities described above, the histoanatomical approach to composite layering dictates that missing enamel is replaced by enamel shades, and dentin by the corresponding dentin shade in the appropriate shade. This shade must be selected at the very start of the appointment, as often even a minute of dehydration has a negative effect on both the perceptibility threshold and acceptability threshold of teeth7, resulting in the incorrect shade. DEVELOPMENT CLEARFIL MAJESTY™ ES-2 is a value-based super-nanofilled composite system that covers 15 VITA* shades in just 4 shade options with its Universal series. This Universal series provides a chameleon effect and has 4 variants: Universal (U), Universal Light (UL), Universal Dark (UD) and Universal White (UW). It is the VITA*-approved shading concept relative to color accuracy. Incorporating nano-fillers that consist of silanated barium glass fillers and slanted silica nanoclusters, its wear resistance is high and features minimal abrasiveness against the functional antagonist. The RI of both inorganic filler and organic matrix are well-matched, and the high refractive index of the composite mimics and is extremely similar to natural enamel (1.613) and dentin (1.540), thanks to an innovation labeled Light Diffusion Technology (LDT), which distorts light in a similar way dental tissue does8. There is comfort that the stability of refractive index and other optical transmission properties remains statistically stable even after artificial thermocycling and water-storage aging studies4. The color stability of CLEARFIL MAJESTY™ ES-2 has been proven over time, where a direct comparison to Filtek Ultimate showed CLEARFIL MAJESTY™ ES-2 to feature significantly less color variation from baseline and marginal functional wear over a three to four year period in teeth featuring amelogenesis imperfecta9. This color substantivity is important as dietary and environmental stressors applied over time should have as minimal effect on the restoration to ensure continued esthetic integration. CLINICAL PROTOCOL CLEARFIL MAJESTY™ ES-2 Universal is a monochromatic solution that covers the five key shades featured in the CLEARFIL MAJESTY™ ES-2 Premium. As such, it exhibits the most significant LDT relative to all five shades, as its ability is equal when blending to higher value translucent shades as it does to cervical chromatic shades. In a Class IV restoration with a defined fracture line, the challenge is to restore the tooth in a minimal volume of available space. The alchemy requires a complete visual occlusion of the fracture line position, and recreation of internal and external opaque and translucent anatomy along with maverick staining, craze lines and effects. In anterior teeth, the idiom of “the less you see, the less you notice” is not true, especially due to the presence of incisal edge window effects as above, however, materials with the best light diffusion and structure transference properties should be utilized to ensure the highest probability of success. A 15 year old ASA I female presented to the practice exhibiting aged, chromatic composite restorations with poor marginal integration and gross axial overhangs; essentially a gross failure of primary anatomy and esthetics. She had been involved in a bike accident where she high-sided off braking sharply in a face-meets-concrete scenario, resulting in an uncomplicated moderate enamel-dentin fracture with blushing, affecting both the facial and palatal aspects of tooth 1.1 and a mild uncomplicated enamel dentin fracture affecting the distoincisobuccolingual aspect of tooth 2.1. The restoration overhangs were significant, extending into the proximal contour zone, thus obviating effective interdental cleaning. Vitality tests were confirmed along with radiographs to exclude the presence of apical pathology. The patient accepted the option of pre-prosthetic whitening, to improve the value characteristics of the adjacent teeth, allowing the selection of a brighter value shade combination. Intraoral digital scans were acquired and custom bleaching trays with a no reservoir, cervical seal-priority design were fabricated. The patient was instructed to bleach overnight for a 2 week period using a 10% carbamide peroxide solution (Opalesence, Ultradent Products, UT) until her maximal value was reached. Her baseline shade of the incisors was a 1M1/2M1 combination in the upper incisors and a 2M1 in the lower incisors. On final post-bleach assessment she exhibited a lightened shade of VITA* 0M3 in all incisors. The patient was instructed to use a fluoride-containing, amorphous calcium phosphate complex (ToothMousse Plus, GC America) during the following 2 weeks after cessation of whitening whilst the residual oxygen radical species dissipated from the teeth. Fig. 1. Pre-operative unrestricted smile 1:2 ratio view, teeth 1.1 and 2.1 with old, defective composite restorations with excessive chroma. On the day of the procedure, the pre-dehydrated shade was assessed using the supplied “real composite” shade guide tabs featured in the CLEARFIL MAJESTY™ ES-2 Premium system, with the enamel shade being WE (White Enamel) and the dentin shade WD (White Dentin). It was assessed that both white maverick effects as well as a moderate halo effect was desired along with moderate to strong translucency in the incisal window. The patient was anesthetized using 1.5 carpules of 2% Lignocaine with 1:100,000 epinephrine (Septodont) before a rubber affixed with individual ties for the central incisors (NicTone Medium). Excavation of the old restorative material was undertaken, and the residual natural incisal edge was found to be undermined by a through-and-through fracture. Thus, the preparation was converted into a true Class IV design, with the facioincisal cavosurface margin subjected to an infinity bevel. The maxillary central incisors were isolated from the lateral incisors by way of a serrated metal strip (Komet) and the prepared surfaces subjected to micro particle abrasion using a 29 micron aluminum oxide powder in 17.5% ethanol carrier (Aquacare). The surfaces were subsequently treated with a calcium sodium phosphosilicate powder (Sylc, Aquacare) to increase the inorganic content of the prepared surface especially extending into the exposed tubules. The teeth were etched using a 33% orthophosphoric acid before a 1 minute 2% chlorhexidine scrub (Vista Products). The surface was reduced to a moist dentin surface before the bond applied, air thinned and cured. A Mylar strip was pre-crimped in the palatoproximal line angles and positioned on the linguoaxial surface of both teeth 1.1 and 2.1. There is no shade guide for the CLEARFIL MAJESTY™ ES-2 Universal U shade, as it bears a significant chameleon effect however it does come in a light (L) and dark (D) variant. The UL shade was deemed the most suitable for the palatal or lingual shelf, with an average thickness of 0.3mm. This layer was applied in a freehand fashion with a focus on establishing the desired outline form of the tooth relative to the contralateral 2.1. The Mylar matrix setup was removed and a precurved metal matrix (Garrison Slickband, Garrison Dental) was oriented in a position perpendicular to its normal placement interproximally, and the end of the curved band tucked into the sulcus before being secured by a wedge. In this way, there is light separation of the central incisors and an intimate contact between the matrix band and the mesial edge of the freshly applied lingual shelf. A 0.5mm frame extending more than halfway through the contact point was created and cured. The process was repeated on tooth 2.1 with the goal of recreating both lingual and proximal walls of the restoration, leaving only the facial volume to be replaced. Fig. 2. Pre-crimped Mylar matrix repeated on the DIBP aspect of tooth 2.1 to close the available space. CLEARFIL MAJESTY™ ES-2 Universal UL is used here. Block-out of the composite extensions against the natural tooth structure was achieved by opacification using an opaque composite resin (WD, CLEARFIL MAJESTY™ ES-2 Premium, Kuraray Noritake Dental Inc.) layered in both horizontal and vertical increments. It is noted that the restorative join line must be completely obscured at the end of layering the dentin volume, otherwise the case will have almost certain esthetic failure. The internal dentin anatomy and its inherent variation was created to mirror that of the 2.1, which had minimal compromise of its incisal window with details intact. A super translucent composite resin (Clear, CLEARFIL MAJESTY™ ES-2 Premium, Kuraray Noritake Dental Inc.) was placed between the lobes of the dentin layers and cured. A 9:1 ratio of white: orange tint was mixed and placed on the incisal edge and proximoincisal corners to recreate the halo effect. A pure white tint was placed in gentle dentin mamelon-connecting spider legs up to the incisal edge to impart the realism. This was layered in a manner consistent with the appearance of the 2.1. Fig. 3. Both horizontal and vertical dentin composite increments are demonstrated mimicking the contralateral tooth. Fig. 4 & 5. Final immediate post-operative result after finishing and polishing. DISCUSSION The esthetic merit of this case is foundationally supported by composite resin technology on multiple levels. The color and physical stability over time needs to be proven in order for the clinician to have faith in its prognostication. Specifically, the material needs to have an excellent and well-matched refractive index, and one that is unaffected by both water and thermocycling stressors. The palatal shelf was fabricated using a new-generation super nano-filled universal composite system that boasts a strong chameleon effect. If it is our intention to fool the eye, to obscure, then this first layer works well to start the blockout process of the darkness of the mouth behind the fracture line of the restored tooth. Following this, the chroma and value of the tooth are corrected using the dentin, simultaneous to its continued opacification of the fracture line and intraoral darkness. Both dentin and enamel layers are applied histoanatomically, that is, in a manner respecting the various thickness zones observed in nature. Ultimately, esthetic success in direct composite resin is not dictated on the first day post-operatively. Factors are in play, from dehydration to occlusal wrinkles that need to be ironed out and corrected. The win depends on what material is used, along with how that material was developed to what standards, and why shade accuracy is so important in a world of variety. In a dental world with myriad composite options, we are looking for precision. Precision in technology leads to efficiency and physicoesthetic maintenance in clinical results. This ultimately results in a boost to clinician-patient confidence and an optimal prognosis. Dentist: CLARENCE TAM *VITA is a trademark of VITA Zahnfabrik, Bad Sackingen, Germany References 1. Elamin HO, Abubakr NH, Ibrahim YE. Identifying the tooth shade in group of patients using Vita Easyshade. Eur J Dent. 2015 Apr-Jun;9(2):213-217. doi: 10.4103/1305-7456.156828. PMID: 26038652; PMCID: PMC4439848.2. Floriani F, Brandfon BA, Sawczuk NJ, Lopes GC, Rocha MG, Oliveira D. Color difference between the vita classical shade guide and composite veneers using the dual-layer technique. J Clin Exp Dent. 2022 Aug 1;14(8):e615-e620. doi: 10.4317/jced.59759. PMID: 36046166; PMCID: PMC9422970.3. Gurrea J, Gurrea M, Bruguera A, Sampaio CS, Janal M, Bonfante E, Coelho PG, Hirata R. Evaluation of Dental Shade Guide Variability Using Cross-Polarized Photography. Int J Periodontics Restorative Dent. 2016 Sep-Oct;36(5):e76-81. doi: 10.11607/prd.2700. PMID: 27560681.4. Almasabi W, Tichy A, Abdou A, Hosaka K, Nakajima M, Tagami J. Effect of water storage and thermocycling on light transmission properties, translucency and refractive index of nanofilled flowable composites. Dent Mater J. 2021 May 29;40(3):599-605. doi: 10.4012/dmj.2020-154. Epub 2020 Dec 24. PMID: 33361663.5. Arai Y, Kurokawa H, Takamizawa T, et al.. Evaluation of structural coloration of experimental flowable resin composites. J Esthet Restor Dent. 2020;e12674.6. Ota M, Ando S, Endo H, et al.. Influence of refractive index on optical parameters of experimental resin composites. Acta Odontol Scand. 2012;70(5):362–367.7. Suliman S, Sulaiman TA, Olafsson VG, Delgado AJ, Donovan TE, Heymann HO. Effect of time on tooth dehydration and rehydration. J Esthet Restor Dent. 2019 Mar;31(2):118-123. doi: 10.1111/jerd.12461. Epub 2019 Feb 23. PMID: 30801926.8. Meng Z, Yao XS, Yao H, Liang Y, Liu T, Li Y, Wang G, Lan S. Measurement of the refractive index of human teeth by optical coherence tomography. J Biomed Opt. 2009 May-Jun;14(3):034010. doi: 10.1117/1.3130322. PMID: 19566303.9. Tekçe N, Demirci M, Sancak EI, Güder G, Tuncer S, Baydemir C. Clinical Performance of Direct Posterior Composite Restorations in Patients with Amelogenesis Imperfecta. Oper Dent. 2022 Nov 1;47(6):620-629. doi: 10.2341/21-106-C. PMID: 36281978. 31 déc. 2024
Interview: Dr Adham Elsayed discusses CLEARFIL MAJESTY™ ES-2 Universal In this interview, Dr Adham Elsayed, certified specialist in dental prosthodontics and implants and clinical and scientific manager at Kuraray Noritake Dental, details the benefits of the company’s new CLEARFIL MAJESTY™ ES-2 Universal composite and explains its application in the daily dental workflow. Though dentists are becoming increasingly specialised, there’s a growing demand for products that can be used for all indications. How does CLEARFIL MAJESTY™ ES-2 Universal fit this model? First, we need to explain the meaning of the term ‘universal’ in this context. Previously, there have been two types of composites that differ according to the area of application: anterior composites, used in Class III, IV and V restorations where the aesthetic outcome is the priority, and posterior composites, in which the mechanical properties like strength and wear rate are more important. Universal composites, then, are those that can be used for all types of restorations in the anterior as well as the posterior region. Another way in which ‘universal’ can be considered is in relation to shade. In this case, the term is used to describe a restorative composite system that exists in fewer shades, one that can adapt to the tooth structure independent of the colour of the tooth. A major benefit of this type of composites is that it offers a simplified workflow. CLEARFIL MAJESTY™ ES-2 Universal is essentially universal in both meanings: it is one system that can be used for posterior and anterior restorations, and it is also provided in only three shades—one for posterior, and two for anterior. Universal products, whether they are luting cements, bonding agents or composites, are attractive to dentists as long as they offer simplification of the treatment procedure without compromising quality and durability. How does CLEARFIL MAJESTY™ ES-2 Universal build upon the success of the CLEARFIL MAJESTY™ range? The CLEARFIL MAJESTY™ family is very well established at this stage. It includes such products as CLEARFIL MAJESTY™ Posterior, one of the most popular posterior composites owing to its superior mechanical properties and minimal polymerisation shrinkage. CLEARFIL MAJESTY™ ES-2 is an extensive system that is highly beneficial thanks to its outstanding optical properties and ability to produce high-end aesthetics in the anterior region using Kuraray Noritake Dental’s multilayering technique. The three flowable alternatives of CLEARFIL MAJESTY™ ES Flow, with different consistencies, are also other successful members of the family. Kuraray Noritake Dental now continues the success story of CLEARFIL MAJESTY™ with the latest innovative product that can change the definition of the universal composite. CLEARFIL MAJESTY™ ES-2 Universal incorporates several attributes from the well-established ES-2 and ES Flow, including Kuraray Noritake Dental’s light diffusion technology (LDT). Speaking of LDT—how does this technology benefit the composite? LDT allows the material to scatter and reflect light rays at many different angles, which, in turn, allows the composite restoration to diffuse light in a similar way to the surrounding tooth structure. Hence, it eliminates aesthetic problems like the visibility of restoration and preparation borders. Thanks to innovative LDT, optimal particle fillers and opacity, CLEARFIL MAJESTY™ ES-2 Universal blends seamlessly with the surrounding tooth structure and emulates natural teeth, eliminating the need for shade selection. As you mentioned, CLEARFIL MAJESTY™ ES-2 Universal comes with one shade for posterior restorations and two for anterior restorations. Can such a reduced shade range still truly deliver aesthetic restorations? CLEARFIL MAJESTY™ ES-2 Universal is not the first composite on the market with a reduced shade system. However, we can safely say that it is the first to focus on aesthetics and not just on reducing the number of shades. We know from experience that using one-shade composite systems in the anterior region mostly leads to unsatisfying aesthetic results, even with the use of an opaquer composite to reduce shade-matching interference. This is due to the fact that trying to provide one shade for all posterior and anterior restorations, and for all tooth shades, compromises the aesthetic to a high extent. In other words, using a highly translucent material to try to match all restorations and shades will result in the interference of other objects in the mouth, such as the tongue, gingivae and so on. Kuraray Noritake understood this fact well and solved the problem by introducing three shades with translucencies designed to match specific indications. It is important to note the simplicity of the workflow, since only one syringe per restoration is required. This makes CLEARFIL Majesty™ ES-2 Universal a true game-changer, as it provides the perfect match between simplicity and aesthetics. What other advantages does this new composite deliver? Other advantages include the superior mechanical properties for which the CLEARFIL MAJESTY™ family is already known, such as favourable wear properties, low shrinkage stress and high strength. It can be polished easily and retains its gloss. Moreover, the handling of the material is a huge advantage: this includes a long working time of about 270 seconds under ambient light. It is non-sticky and can be sculpted easily. Which dental professionals would benefit most from this product? The perfect match between simplicity and aesthetics offers the clinician several benefits. It delivers a very straightforward time-saving procedure without compromising aesthetic results. There is no need for exact shade selection, thereby excluding visible errors of non-matching shades, and there is also a reduced amount of material stock needed. Therefore, in my opinion, this should be the product of choice for most cases in everyday practice. Advances and developments in dental materials are rapidly accelerating, and clinicians should integrate these innovations and make their daily practice more efficient with simplified workflows, time-saving procedures, fewer material selections and, accordingly, less technique sensitivity and less need for dental practice personnel to become acquainted with an abundance of materials. 9 févr. 2021
Universal shade concept meets flowable restorative Interview with Takehiro KameyaManager of the Technology Division of Kuraray Noritake Dental Inc. How did you identify the need for a universal flowable restorative? Packable composites with a universal shade concept are becoming increasingly popular worldwide. This fact made us assume that there is a demand for the flowable type as well. Users will also benefit from simplified procedures and a reduced number of shades to be stocked, with a positive impact on inventory management. Accordingly, we introduced the universal flowable composite in Japan, where it already holds a significant market share. Users have been utilizing it for various cases with excellent feedback. As it turned out to be very well received in Japan, we approached the European team to extend the release area to Europe, and the decision was made to launch it. We pushed forward with commercialization in an ultra-short period of about one year. Does it really create added value to use a universal flowable composite in addition to the universal packable variant? Yes, several benefits arise from the additional use of a modern flowable composite. This is because – unlike earlier products – the latest generation of flowable composites offers sufficient mechanical strength to be used for regular restorations. The advantages of using a flowable composite include the ability to flow into even the narrowest parts of a (sometimes complex) cavity, which provides for easy and quick filling procedures, and to an intimate adaptation at the adhesive interface leading to a tight seal. What are the differences between CLEARFIL MAJESTY™ ES Flow and CLEARFIL MAJESTY™ ES Flow Universal? CLEARFIL MAJESTY™ ES Flow Universal maintains the distinctive features of CLEARFIL MAJESTY™ ES Flow, such as convenient dispensing, handling and sculpting, extremely easy and quick polishing, long-lasting gloss and great mechanical properties. Due to their high strength, both products can be used not only as liners, but also for regular direct restoration procedures. The difference lies in the shade concept. CLEARFIL MAJESTY™ ES Flow Universal introduces a universal shade system, allowing it to adapt to a wide range of colour tones with fewer shade variations. Please describe the shade concept behind CLEARFIL MAJESTY™ ES Flow Universal. How many shades are available and how are they selected? The CLEARFIL MAJESTY™ ES Flow Universal line-up consists of two shades: Universal (U) and Universal Dark (UD). U is an excellent choice for all posterior restorations, independent of the target shade. In the anterior region and cervical area (Class III, IV and V cavities), U is best suited for restoring teeth of the shades A1 to A3 (including B1, B2, C1, C2, D2, D2, D3 and D4), while UD is the shade of choice to match the target shades A3.5 to A4 (including B3, B4, C3 and C4). Color matching with anterior and posterior restorations. Why do you offer an additional shade for the anterior region? Universal-shade composites need to take on the colour of the surrounding tooth structure to deliver a perfect match for a great number of target shades. In the posterior area, large amounts of surrounding tooth structure are usually available with several cavity walls still present. This facilitates the taking on of the tooth colour compared to cavities in the anterior region. Here, light easily passes through, so that the colour of the composite itself is more likely to be reflected. This can lead to limitations in colour matching. In the case of CLEARFIL MAJESTY™ ES Flow Universal, the U shade that turned to be ideal for the posterior area showed some colour-matching limitations in anterior restorations of darker teeth. Hence, we decided to offer a second colour option specifically designed for these situations. With U and UD, CLEARFIL MAJESTY™ ES Flow Universal offers great colour adaptability from light to dark shades and hence addresses the need for precise colour matching especially in the anterior region. Developing just two shades of composite to cover so many target tooth shades sounds challenging. How did you evaluate whether the available shades are appropriate in the clinical environment? Indeed, it has been quite challenging to develop the U shade, which is able to match a wider range of tooth colours for both anterior and posterior teeth than the U shade of CLEARFIL MAJESTY™ ES-2 Universal. In order to evaluate and fine-tune the shades we developed, we repeatedly conducted filling tests using a wide range of experimental shades in artificial teeth and extracted teeth of various tooth colours. Additionally, the final selection of shades was visually evaluated by consulting dental practitioners who used the composite in the clinical setting. What are the greatest challenges in the context of determining and selecting the right shade in the clinical environment? The major drawback of classical shade determination is that it simply increases the chair time. For both, the dental practitioner and the patient, however, minimizing chair time is the ultimate goal, as it reduces costs and increases patient comfort. A true drawback in terms of time and comfort is a colour mismatch produced due to an error during shade determination: it may necessitate intra-oral adjustments or, in the worst case, the creating of a new restoration. CLEARFIL MAJESTY™ ES Flow Universal is available in two viscosities – Low and Super Low. Why is this the case and what is the difference in use? We decided to offer two types of flowability with different thixotropic properties to cater to users’ preferences in terms of handling. Basically, there is no difference in usage between Low and Super Low. However, users are encouraged to use composites with different thixotropic properties according to their preferences and the specific case. For example, Super Low is useful for shaping the occlusal surface of posterior teeth. Low can be widely used for applications such as lining and filling in the cervical area and on proximal surfaces. CLEARFIL MAJESTY™ ES Flow Universal – Great mechanical properties. What are the technologies behind CLEARFIL MAJESTY™ ES Flow Universal that provide for a great blend-in? The probably most popular technology used in this product is our proprietary Light Diffusion Technology. We determined the optimal light diffusion based on the observation that a strong diffuse reflection of incident light results in whitening, and weak light diffusion makes it easier to take on dark colours in the oral cavity, darkening the filling site. In addition, we focused on chroma adjustment: The universal shade concept is based on the ability to take on the colour of the surrounding tooth structure and blend with it. Therefore, we have set the chroma to be easily harmonized with a wide range of tooth shades. Finally, the translucency of the material was adjusted via its submicron fillers and silica clusters. Evaluation by key opinion leaders supported us in determining an appropriate level of translucency. How to proceed in cases with discoloured tooth structure underneath – is there a need for masking with a blocker or opaquer? The necessity depends on the degree of discolouration. Due to the light diffusion properties of CLEARFIL MAJESTY™ ES Flow Universal, it is generally believed that blocking is not required, and shading can be achieved. However, in cases of severe discolouration, it may be beneficial to fill the bottom of the cavity with A2D or A3D shades of CLEARFIL MAJESTY™ ES Flow, or to use CLEARFIL™ ST Opaquer. What did you do to avoid void formation during application? We have adopted the same packaging design used in CLEARFIL MAJESTY™ ES Flow to avoid void formation in this product as well. The innovative container design minimizes the gap between the needle tip and the syringe when the tip is attached. Are there any recommendations of when to use CLEARFIL MAJESTY™ ES Flow and when to opt for CLEARFIL MAJESTY™ ES Flow Universal? While the universal variant can be used for general lining and filling applications as described in the instruction for use, CLEARFIL MAJESTY™ ES Flow is recommended for those cases in which the tooth structure is covered and the colour of the entire tooth needs to be changed. Direct veneers are a perfect example. In those situations, the use of different shades and opacities is clearly beneficial. What is the future of flowable composites? As information on clinical performance and physical properties data continues to spread, the trust in flowable composites is expected to increase in Europe, leading to its expanded usage. Furthermore, an increased demand is anticipated due to the development of filling methods using flowable composites in conjunction with moulds or matrices. TAKEHIRO KAMEYA 16 sept. 2025