PANAVIA SA Cement Universal | self-adhesive cement | no primer
8.2 g/4.6 ml
1 Syringe per shade
20 Mixing tips
9.2 g/5 ml
1 syringe per shade
8.2g/4.6ml
3 syringes per shade
40 Mixing tips
10 Endo tips (SS)
Universal (A2)
Translucent
9.2 g/5 ml
2 Syringes per shade
Mixing spatula
Mixing pad
4ml
1 Bond (5ml)
3 Bonds (5ml each)
1 Bottle (1ml)
50 Unit-Dose
50 Applicator Brushes (Fine Silver)
5 Unit-Dose (0.1ml)
5 Applicator Brushes
YOUR EVERYDAY CEMENT
PANAVIA™ SA Cement Universal is suitable for most restorative materials including glass ceramics
Easy handling, 60-second working time, gum-friendly excess removal and storage at room temperature make it your go-to everyday cement
There is no need for primers, even when cementing glass ceramics, which saves time and effort
Bonds to zirconia and lithium disilicate without additional primers
Very easy excess clean-up
Storage at room temperature
Easy application with little pressure
Automix or handmix delivery
When you require fast, easy, durable cementation, even to glass ceramics, PANAVIA™ SA Cement Universal is the answer. Suitable for almost all indirect work, including adhesive bridges, even post placement in root canals, it gives you more control than ever before. Thanks to easier application, it does away with the need for a dispenser. In addition, our Universal (A2) shade delivers outstanding aesthetics. There’s also a translucent shade and an opaque white shade for your specific needs. The result is that your cementations are now more versatile and easier than ever.
1. When cementing to uncut enamel or placing adhesion bridges, acid etch with phosphoric acid (e.g. K -ETCHANT™ Syringe) to the enamel surface. Cementation of veneers is not indicated.
A unique blend of curing technologies ensures your cement cures quickly with a durable seal. As our hydrophilic initiators make contact with the moist dentin, the self-curing reaction is accelerated (Fig. 1). And when you start to cure your cement, with light-curing the reaction is accelerated by the radical amplifiers (Fig. 2).
Two options of polymerization, the same easy clean-up result.
Filler load: 62 wt % (40 vol %)
Flexural strength: 91 MPa
Flexural modulus: 4.6 GPa
Compressive strength: 301 MPa
Film thickness: approx. 14 µm
Filler load: 62 wt % (40 vol %)
Flexural strength: 91 MPa*
Flexural modulus: 4.6 GPa*
Compressive strength: 301 MPa*
Storage temperature: 2-25 °C
Water sorption: 27 µg/mm³*
Film thickness: approx. 14 µm
Radiopacity: 170 % AI
F-ion release: 67 µg/g
Working time (23 °C): 60 sec.
*Dual curing of the paste (combination of self- and light-curing). According to ISO 4049:2009. Source: Kuraray Noritake Dental Inc. The final result may be influenced by minor evaluation conditions. See ISO regulations.
Choose the most appropriate cement for each clinical situation
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Ingenious monomer and curing technology - the science behind PANAVIA cementing solutions
PANAVIA SA Cement Universal is a forerunner in self-adhesive resin cements containing the unique LCSi monomer that adheres to virtually every material including glass ceramics without the need for a separate primer.
Using a unique silane coupling agent built into the paste - LCSi monomer - the cement delivers a strong, durable chemical bond to porcelain, lithium disilicate and composite resin. The original MDP monomer present in the paste too, allows for chemical reactiveness with zirconia, dentin and enamel.
Building on the success of our PANAVIA SA Cement Plus, PANAVIA SA Cement Universal also offers the same wide range of indications for adhesion and is suitable for crowns/bridges, inlays/onlays, posts, and even adhesion bridges. Thanks to its powerful single-step bonding formula, cementation is easier than ever before. The product is available in both automix and handmix options.
Kuraray Noritake Dental’s original MDP technology was created in 1981 and engineered to push adhesive dental materials to their maximum performance. Since launching PANAVIA with the original MDP in 1983 it has become a worldwide success. That’s why we integrated MDP in most of our adhesive products, like gold standard CLEARFIL SE BOND. Still today, more than 30 years after its invention, MDP continues to have an impact on the dental world. It has recently even been used by other manufacturers. We are honored that they chose MDP to improve their adhesive products. But what is MDP actually? It’s a functional monomer (10-Methacryloyloxydecyl Dihydrogen Phosphate) that is the connector between our adhesive materials and the tooth structure, metal alloys and zirconia. Only the best functional monomer technology will enable you to provide the most durable treatment.
A self-adhesive resin cement such as PANAVIA SA Cement Universal gives me reliable application pared down to a few steps. Thanks to the simple and uncomplicated workflow (single-step process) offered by this material, it can theoretically replace conventional cements in the clinic. The esthetic properties are good; removing excess cement is straightforward and easy on the gums. From my point of view PANAVIA SA Cement Universal is ideal for use in my daily practice.
For a long time, I have been sceptical about the use of self-adhesive cements. Nevertheless, I decided to test PANAVIA SA Cement Universal. I like the fact that the primer is integrated in the paste, eliminating the need for a separate component. Moreover, the product offers a convenient handling and easy excess removal. I have a good feeling about using the product in combination with CLEARFIL Universal Bond Quick: Ease of use combined with proven protocols!
Materials that we can depend on are extremely important to us. That’s why we have worked for years with PANAVIA SA Cement Universal. This resin cement provides a lasting and durable bond combined with an extremely low rate of complications. It is also easy to use. A big plus is that there is no need for an additional primer. Other features that have impressed us are that it is easy to remove any excess and we can store it at room temperature. PANAVIA SA Cement Universal—a resin cement that is part of our daily routine today and will be for years to come.
Due to superior aesthetics, stability and retention, it is nowadays recommended to use adhesive resin cements rather than conventional cements for restoration placement. In this context, PANAVIA™ SA Cement Universal offers the perfect combination of quality and an exceptionally easy handling. The interaction between the original MDP monomer and the LCSi silane monomer developed by Kuraray Noritake enables a quick and easy placement in a single step. Independent of the restorative material, even in the case of silicate and hybrid ceramics, a separate primer is no longer needed. Thanks to PANAVIA™ technology, this resin cement offers the highest possible quality and reliability.
How to select either PANAVIA V5 or PANAVIA SA Cement Universal?
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With PANAVIA™ SA Cement Universal and KATANA™ Zirconia
With PANAVIA™ SA Cement Universal and KATANA™ Zirconia
By using PANAVIA™ SA Cement Universal and its proprietary dual-monomer technology, you can now simplify the bonding of restoration to implant abutments without the use of separate primers or silane. Independent research has confirmed this new dual-monomer technology does not sacrifice adhesion or durability on glass-based ceramics or zirconia. The technique, in this case study, is for custom fabricated abutment & KATANA™ Zirconia YML crown, however, the basic technique on the treatment of the abutment and restoration may be used with any implant restoration combination as long as the proper surface treatments for type of material is followed.
Basic technique on the treatment of the abutment and restoration.
Fig. 1. Check Initial Fit of Abutment & Restoration: abutment & crown margins should be checked to ensure proper fit.
Fig. 2. Protect base of implant with putty or light-cure block-out resin. The base of the implant should be covered so that it is not air abraded accidentally.
Fig. 3. Abrade titanium abutment with 50 μm alumina oxide powder.
Fig. 4. Clean abutment with KATANA™ Cleaner: Apply KATANA™ Cleaner by rubbing each area for 10 seconds.
KATANA™ Cleaner is a universal cleaner that is indicated to clean metal, zirconia & glass-based restorations. It is also an intra oral cleaner that may be used on dentin and enamel.
Bonding to zirconia has been proven to be durable in research going back to the 1990’s with the original MDP adhesive monomer in the PANAVIA™ resin cements. The three requirements to bonding zirconia are:
Fig. 1. Air abrade KATANA™ Zirconia at 14-58 psi.
Fig. 2. Dispense & mix PANAVIA™ SA Cement Universal (it is available in automix or handmix formulations).
Fig. 3. Apply PANAVIA™ SA Cement Universal to the abutment or inside the crown.
Fig. 4. Seat restoration on abutment.
Fig. 5. Remove excess resin with a dry micro-applicator or brush.
Fig. 6. You may light-cure the margins after cleaning up all excess resin. If you fully cure excess resin, It can be difficult to remove. If difficult to remove, change curing time or distance with your light.
Fig. 7. Leave restoration on abutment to self-cure fully for approximately 10 minutes at room temperature.
Fig. 8. Final check of custom abutment KATANA™ Zirconia YML crown on model.
Dentist:
JEAN CHIHA
Technician Jean Chiha CDT, Santa Ana, CA USA
Mr. Chiha is the owner of North Star Dental Laboratory and Milling Center, Santa Ana, CA, and has served as President of the Dental Lab Owners Association of California since 2013. He is a 1985 graduate of Institut Dento Technic, a private dental technology school in France. Mr. Chiha lectures internationally on dental communication and case planning. Jean lectures around the world on a variety of topics and has carved out a niche with his extensive knowledge of zirconia. Affectionately referred to as “Mr. Katana” due to his involvement in the creation of the material.
A PANAVIA™ Family story
Is it possible to reduce the number of different cements used in a dental office? In most cases, it is. Kuraray Noritake Dental Inc. is convinced that one or two resin cement systems are usually enough to cover every indication and every need for general cementation. The selection of products may be different depending on personal preferences and the focus on specific dental treatments.
That is why the company offers three high-quality resin cements, with which it is possible to meet the needs and desires of every dentist and patient. One product is available for those who would like to keep it as simple as possible while taking advantage of the multiple benefits resin cements offer over conventional cements. Another system is designed for those who demand highest possible bond strength and aesthetics. And finally, a light-curing system has been developed as a specialized solution for veneer cementation.
In order to facilitate decision making, this article provides in-depth information on each of the three systems and their specific strengths.
The everyday cement
Keeping cementation simple and efficient is possible by minimizing the number of work steps and components and solving existing challenges. The self-adhesive dual-cure resin cement PANAVIA™ SA Cement Universal has been designed for these purposes. The challenge of removing sticky excess cement is overcome by a formulation that allows for very easy excess clean-up.
Components are reduced as the product incorporates Kuraray Noritake Dental Inc.’s Original MDP Monomer and original silane coupling agent, the LCSi Monomer, for a strong and durable bond. While MDP establishes a strong and long-lasting chemical bond to enamel, dentin, metal and zirconia, LCSi is responsible for bonding to resin composite, porcelain and silica-type ceramics (like lithium disilicate), eliminating the need for separate primers.
This means that a single component is needed, which streamlines the procedure, leading to time savings and a minimized potential for errors. Due to its properties, PANAVIA™ SA Cement Universal is ideal for everyday procedures such as the permanent cementation of crowns and bridges made of zirconia, lithium disilicate, hybrid ceramic or even metal.
The strong and aesthetic allrounder
For those who place importance on achieving the highest possible bond strength and aesthetics, PANAVIA™ V5 is the solution. The reliable dual-cure cementation system consisting of a tooth primer, a cement paste and a ceramic primer produces the highest bond strength and aesthetics from the PANAVIA™ cement range.
Therefore, it is an excellent choice for a whole range of indirect restorations and for post-and-core procedures. As the well-aligned components are always combined and applied in the same way, standardization is supported, leading to predictable outcomes.
The veneer specialist
When fulfilling such demanding tasks as cementing veneers, every dental practitioner needs time. Especially when placing multiple veneers at once for the best aesthetic outcomes, having to race against the setting time is counterproductive. For this reason, Kuraray Noritake Dental Inc. developed PANAVIA™ Veneer LC, a light-curing resin cement system with an extended working time of 200 seconds* on the primer, which allows users to initiate polymerization whenever they are ready for it.
PANAVIA™ Veneer LC also offers a well-aligned paste viscosity and consistency for easy dispensing and seating, and comes in four highly colour-stable shades for long-lasting aesthetics. Finally, the system provides for easy excess removal after tack-curing and an excellent bond strength over time.
** Working time: sensitivity to light (8000 lux, ISO 4049)
Meeting expectations
The three products mentioned are precisely what is needed to cover every personal preference and specific indication. They are based on Kuraray Noritake Dental Inc.’s long-standing expertise in the development of adhesive resin cements. The first product from the PANAVIA™ brand was introduced in the 1980s and since then, the company never stopped improving the portfolio by combining existing technologies like the original MDP Monomer with newly developed ones, such as the LCSi Monomer and the Touch Cure Technology. All this ultimately resulted in the current lean portfolio of easy-to-use and highly aesthetic resin cements that provide top-level bond strength.
by using PANAVIA SA Cement Universal and CLEARFIL Universal Bond Quick
PANAVIA SA Cement Universal
KATANA Cleaner
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KATANA Cleaner
KATANA Cleaner
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PANAVIA SA Cement Universal
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PANAVIA SA Cement Universal
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PANAVIA: One Strong Family
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How to ensure clinical long-term success in bonding
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
with PANAVIA™ SA Cement Universal
With PANAVIA™ SA Cement Universal
By using PANAVIA™ SA Cement Universal and its proprietary dual-monomer technology, you can now simplify the bonding of any restoration to implant abutments without the use of separate primers or silane. Independent research has confirmed this new dual-monomer technology does not sacrifice adhesion or durability on glass-based ceramics or zirconia. The technique, in this case study, is for Ti-Base Implants, however, the basic technique on the treatment of the abutment and restoration may be used with any implant restoration combination.
Fig. 1. After attaching the abutment to the implant analog.
Fig. 2. Protect the base of the abutment with block out resin & light-cure.
Fig. 3. Air abrade the Titanium Abutment with 30-50 μm Alumina Powder @ 32 PSI.
Fig. 4. Clean abutment with KATANA™ Cleaner (10’s Rubbing, Rinse & Dry).
KATANA™ Cleaner is a universal cleaner that is indicated to clean metal, zirconia & glass-based restorations. It is also an intra oral cleaner that may be used on dentin and enamel.
Fig. 1. Mark Index position on implant analog.
Fig. 2. Mark index position (notch) on crown.
Fig. 1. If Lithium Disilicate, HF acid etch Internal Surfaces, with 5% HF etch for 20’seconds then rinse & dry. If Zirconia, air abrade, at 14-58 PSI.
Fig. 2. Inject PANAVIA™ SA Cement Universal (White Shade) onto treated & cleaned abutment.
Fig. 3. Align index points & seat crown onto abutment.
Fig. 4. Place crown & implant into clamps & lightly tighten.
Fig. 5. Tack-Cure Clean-Up: Light-Cure excess cement for 2-5 seconds (time depends on light output & distance held).
Fig. 6. Remove excess cement & block-out resin with an explorer. PANAVIA™ SA Cement Universal has extremely easy clean-up.
Fig. 7. Wipe off remaining resin with gauze.
Fig. 8. Remove index mark with alcohol & gauze.
Fig. 9. Clean & polish restoration prior to seating. Surfaces coming in contact with soft-tissue should be polished.
Dentist:
GREG CAMPBELL
Dentist Greg Campbell DDS, Long Beach, CA USA
Greg Campbell, DDS is recognized internationally as an expert on integrating CAD/CAM dentistry into offices and is frequently sought out by industry leaders to lecture about Digital Dentistry. Dr. Campbell has a great understanding of Digital Technology and trains other dentists how to use this technology and is a certified Advanced CEREC Trainer. He is a former Beta tester for Sirona Dental and has authored two books on CAD/CAM dentistry. Dr. Campbell has created multiple polishing kits used for ceramics and has been trained on advanced adhesion materials, research & techniques and utilizing them clinically for over 8 years. Dr Campbell was an Alpha and Beta Tester for KATANA™ STML.
Dr. Campbell graduated from the University of Southern California School of Dentistry and completed advanced training in Cosmetic Dentistry at UCLA and maintains a private practice in Long Beach California.
A combination for maximum aesthetics
By DT Simone Maffei and Dr. Filippo Menini
Nowadays, digital workflows in prosthodontics are well-established, and many modern dental laboratories have already embraced the option of producing monolithic restorations or restorations with a minimal cut-back for micro-layering in a fully digital environment.
The spread of digital technologies and the availability of new restorative materials with improved aesthetic properties have increased the popularity of this technique among dental technicians. This way of working offers considerable advantages for daily procedures, starting with improved ways of communication between the clinician and dental technician. For example, it is now possible to view and evaluate impressions with the whole treatment team including the dental technician almost instantaneously after impression taking – and without anyone having to leave their office.
In addition to advanced communication options, digital technologies have allowed us to use materials that otherwise could not be processed, such as zirconia and hybrid composites. As a consequence, lots of innovative materials conquered the market, and this has opened up the possibility to always select what is perfectly suited for each specific clinical situation. Adapting to these trends is absolutely essential for anyone who wants to meet a modern dental practitioner’s increased demands.
Working with digital workflows has allowed us to broaden the scope of action of the modern laboratory, enabling virtually effortless collaboration with clinicians hundreds or thousands of kilometres away. The case presented below is a perfect example: In our dental laboratory in Modena, we produced two anatomical crowns made of KATANA™ Zirconia for a patient who needed a combination of direct and indirect restorative treatment to be carried out by Dr. Filippo Menini in Belluno, about 300 km to the northwest. The whole communication and coordination between practice and laboratory was performed remotely and without us seeing the patient.
Monolithic restorations offer countless clinical and technical advantages. With a major part of the process accomplished by machines, they truly rationalize procedures. The challenge resulting from this simplification, however, lies in the achieving of excellent aesthetics.
Whereas until a few years ago, it was very difficult to accomplish this task due to the poor optical properties of the available materials, today we can safely say that we have materials, techniques and protocols at our disposal that allow us to obtain aesthetically acceptable results. At the same time, those materials offer excellent mechanical resistance to the forces and stress to which they are exposed in the oral cavity and a very high precision of fit, if these restorations are produced in a fully digital workflow.
We have chosen to work with prosthetic materials and finishing solutions from a company that manufactures and develops them in-house: Kuraray Noritake Dental Inc. (Kuraray Noritake). They offer zirconia discs for milling as well as effect liquids, veneering porcelain and liquid ceramics for an aesthetic finish and even resin cement systems for adhesive luting – all from a single source. This gives us the advantage of using clear and predictable working protocols from fabrication to cementation of the restoration.
The 31-year-old patient presented with multiple carious lesions, inadequate restorations and in particular a destructive caries in the maxillary right second premolar (tooth #15, FDI notation, Fig. 1). The latter tooth was endodontically treated and built up using a glass fibre post. The X-ray revealed carious lesions and infiltrated margins of the restorations (Fig. 2). The treatment plan for this quadrant included direct composite restorations on the first premolar and first molar (teeth # 14 and 16) and an indirect zirconia crown used to restore the second premolar (tooth #15; Fig. 3). In addition, a zirconia crown needed to be produced for the mandibular right second premolar (tooth #45).
Fig. 1. Initial clinical situation in the maxillary right quadrant.
Fig. 2. Radiograph showing carious lesions and restorations with marginal leakage.
Fig. 3. Marked surfaces that will be treated.
During the first session, the clinician restored the first molar and premolar with composite (Figs. 4 and 5). In addition, the tooth preparation on the maxillary and the mandibular second premolar was performed using the biologically oriented preparation technique (BOPT; Figs. 6 and 7). Two single-tooth temporaries were then produced, recreating a cervical profile according to the BOPT (Fig. 8). In the next step, the digital impression was taken using the double chord technique (Fig. 9). The file generated by the intraoral scanner was first analysed using a greyscale view. This view allows for a better assessment of the quality of the acquired data than the coloured image (Fig. 10). The temporary restorations were finished, polished and placed on the teeth using temporary cement (Fig. 11).
Fig. 4. Restoration procedure on the maxillary first molar.
Fig. 5. Restoration procedure on the maxillary first premolar.
Fig. 6. BOPT crown preparation on the maxillary second premolar.
Fig. 7. Detail of the subgingival preparation, using burs with calibrated notches, taking care not to touch the supra-crestal attachment complex, but precisely taking care to remain within the width of the sulcus.
In the dental laboratory, we received the intraoral scans in the STL format: Both arches with the prepared teeth and the usual bit register (vestibular scan of the arches in occlusion). Following a careful evaluation of the impressions and the quality of the triangulation of the points of the STL file detected by the scan, a full-contour design of the crowns was performed (zero cutback crowns). This allows us to obtain an emergence profile, according to the BOPT, which is extremely accurate. The anatomy was developed taking into account the functional movements of the patient, which were based on information retrieved from a virtual articulator integrated in the CAD software. These movements can be verified and – if necessary – corrected on the physical articulator in a subsequent step. As it is possible to use the same type of articulator (in our case ARTEX by Amann Girrbach) both in the virtual environment and the real one (control phase) offers the advantage of using the same settings and consequently the same movements in both worlds (Fig. 12).
Fig. 8. Production of the temporary restoration.
Fig. 9. Digital impression taken using the double cord technique: a 000-sized cord soaked in aluminium chloride is placed in the sulcus as the first cord, followed by a non-soaked cord of size 1.
Fig. 10. Greyscale view of the impression, facilitating the clinical evaluation.
Fig. 11. Cementation of the temporary restoration.
Fig. 12. Virtual models based on the digital impression of both arches, with the software-designed full-contour crowns in different views.
The STL files of the designed restorations were sent to the CAM software for milling of the zirconia crowns with a 5-axis CNC machine. The material of choice was in this case KATANA™ Zirconia YML (Kuraray Noritake Dental Inc), which is multi-layered in strength, translucency and colour, and thus suitable for a variety of cases (Fig. 13). Once milling was finished, the elements were removed from the disc and their surface treated with diamond burs and specific rubbers designed for the processing of pre-sintered zirconia. In this phase, it is possible to individualise the anatomy and surface texture of the restorations, a task that is very difficult to accomplish in the milling process. With the dedicated rubbers, the surface can also be smoothened, which will improve the appearance of our restorations after sintering (Fig. 14).
On top, individualization of the pre-sintered restorations was accomplished with Esthetic Colorant (Kuraray Noritake). These new effect liquids have been specifically developed for KATANA™ Zirconia. They contain a special primer that limits the depth of penetration, which results in an appearance similar to external stains, while a depth effect is created. Precise application of the liquids is possible with the Liquid Brush Pen. The Esthetic Colorant line-up consists of twelve colours to facilitate stock management in the dental laboratory, while still providing for natural aesthetics and perfect harmony in the oral cavity. Impact on the flexural strength of the zirconia substructure by the liquids is kept to a minimum, as they have been optimised to limit this effect and avoid fractures. (Fig. 15).
Sintering is carried out in a specially calibrated furnace, scrupulously following the protocol recommended by the manufacturer. Afterwards, the finishing procedure can be continued. With special stones, the cervical edge was first regularised: In the deeper, subgingival areas, the intraoral scanner usually has some difficulties capturing all the necessary information. As a consequence, the STL file is triangulated with some irregularities at the cervical margin. These irregularities need to be regularised, before the thickness of the margin is reduced to '0'. In fact, during milling it, is created with a thickness of 0.2 mm to avoid micro-chipping that would compromise the accuracy of the cervical margin. Figure 16 shows both the thickness of the cervical margin, which, despite the finishing preparation, retains a thickness of 0.2 mm, and the irregular course of the same due to the irregular shape of the STL file around the sulcus.
Fig. 13. KATANA™ Zirconia YML blank with milled crowns.
Fig. 14. Finishing with diamond burs and specific rubbers for pre-sintered zirconia.
Fig. 15. Individualisation with Esthetic Colorant.
Fig. 16. Finishing of the restorations after sintering.
The restorations were then sandblasted with 50-μm aluminium dioxide at 2 bar pressure and cleaned under a steam jet. After an evaluation of the colour revealed after sintering, the finishing phase was completed with the aid of CERABIEN™ ZR FC Paste Stain (Kuraray Noritake Dental Inc.) and polishing instruments. The ceramic emulsions FC Paste Stain allow us to adjust the chroma and value of the restorations and to imitate all those aesthetic features that will improve integration in the oral cavity. With this technique, it is very easy to achieve the desired shade match, as the appearance of the stain applied to the surface is exactly like its appearance after firing. In this way, it is easy to monitor the outcome and – if desired – compare with a reference and adjust whenever necessary (Figs. 17 and 18).
For cementation of the restorations, the clinician used PANAVIA™ SA Cement Universal in combination with KATANA™ Cleaner (both Kuraray Noritake Dental Inc.). The cleaner has a pH value of 4.5 be used both intra and extra-orally, improving adhesion in all restorative procedures. PANAVIA™ SA Cement Universal is the only self-adhesive resin cement containing the unique LCSi monomer – a long carbon-chain silane coupling agent. In combination with the original MDP monomer, which is also present in the paste and enables chemical adhesion with zirconia, dentin, enamel and metal alloys, this coupling agent provides for adhesion of the cement to any material, including glass-ceramics, without the need for a separate primer (Figs. 19, 20 and 21). At the cementation appointment, the last planned direct reconstruction of the maxillary second molar (tooth #17) was also carried out.
Fig. 17. Characterisation with CERABIEN™ ZR FC Paste Stain.
Fig. 18. Finished restorations ready to be handed over to the clinician.
Fig. 19. Cementation procedure in the maxilla: Sandblasting of the tooth and cleaning of the tooth structure with KATANA™ Cleaner.
Fig. 20. Cementation procedure in the maxilla: Sandblasting of the crown’s intaglio and cleaning of the restoration with KATANA™ Cleaner.
Fig. 21. Cementation procedure in the maxilla: Self-adhesive cementation with PANAVIA™ SA Cement Universal.
Fig. 22. Direct restoration procedure on the second molar.
Fig. 23. Restorations immediately after finishing and polishing.
Fig. 24. Detailed view of the restored quadrant.
Fig. 25. Occlusal view of the maxillary teeth.
The aesthetic integration provided by the high quality of KATANA™ Zirconia YML, combined with the pre- and post-sintering individualisation, made it possible to achieve an excellent integration of the anatomical zirconia crowns. Figures 22 to 25 show the outcome in the newly restored maxillary right quadrant with natural tooth structure, direct composite restorations and the monolithic zirconia crown.
DT SIMONE MAFFEI
Simone Maffei, a dental technician since 1996 (IPSIA L.Galvani Reggio Emilia), embarked on his career in Modena at his father William's laboratory. Throughout his professional journey, he has demonstrated a commitment to excellence by participating in numerous courses led by prominent international speakers. These courses span the realms of dental technology and photography. Presently, Maffei is not only a respected speaker at national and international conferences but has also contributed articles to both Italian and foreign sector magazines. His written works delve into the intricate intersection of dental photography and the aesthetics of the smile. A testament to his expertise, Maffei earned recognition as the recipient of the prestigious AIOP International Award in 2014. He actively shares his knowledge by conducting courses in Italy and abroad, focusing on dental technology, dental photography, natural ceramic layering techniques, and the three-dimensional coloring of monolithic restorations. As a valued member of the Digital Dental Revolution (DDR) Team, Maffei serves as a speaker at courses and international conferences, where he imparts insights on various facets of digital dentistry. Simone Maffei is also the proud owner of the Laboratorio Odontotecnico Maffei in Modena. Collaborating with his sister Elisa, the laboratory specializes in crafting aesthetic ceramic reconstructions for both natural teeth and implants, showcasing a dedication to the art and science of dental aesthetics. Active Member of AIOP SOSPESO – Accademia Italiana di Odontoiatria Protesica (Italian Academy of Prosthetic Dentistry). Ordinary Member of SIPRO Società Italiana Protesi e Riabilitazione Orale (Italian Society of Oral Prosthetics and Rehabilitation).
FILIPPO MENINI
Dr. Filippo Menini graduated in Dentistry and Dental Prosthetics from the Universidad Europea De Madrid in 2017. He has been passionately dedicated to the study of direct and indirect adhesive techniques in the field of conservative dentistry. He became a Regular Member of the Italian Academy of Conservative Dentistry in 2018 and the Italian Academy of Prosthetic Dentistry in 2019. In November 2021, he joined the Think Adhesive Members, and since February 2022, he has been a contract tutor at the University of Siena in the Endo-Resto master program taught by Professor Grandini. Dr. Menini has attended numerous courses in conservative dentistry, endodontics, periodontology, and adhesive prosthetics to manage his work in a multidisciplinary perspective. He has his dental practice in Belluno.
Recommendations based on preparation design and the selected materials
A guideline with regard to contemporary materials
The retention of the fixed prosthodontic restorations is a critical factor for the long-term success, as the loss of crown retention is one of the main reasons for failure of crowns and fixed dental prosthesis (FDP) (1, 2). There are three main elements that need to be considered to achieve proper retention of the restorations; the tooth preparation, the restorative material and the luting agent.
TOOTH PREPARATION
During tooth preparation there are some important features to be considered, such as the height, angle and surface texture of the abutment tooth, in order to achieve an adequate retention and resistance form which provide stability of the restorations to resist dislodgment and subsequent loss (3). Retention form is responsible for counteracting tensile stresses, whereas resistance form counteracts shear stresses (4).
In order to achieve a sufficient retention and resistance form for full coverage crowns it is recommended that the height of the abutment tooth should be at least 4 mm and that the optimal convergence angle should range from 6 to 12 degrees with a maximum of 15 degrees (1, 5-8).
RESTORATIVE MATERIAL
With the continuous introduction of new restorative materials to the dental market it is important to take into consideration the different mechanical properties of the various materials. The composition and the surface properties of the material have a decisive role in the ability to accomplish mechanical and/or chemical attachment to the restoration and therefore achieving required retention.
LUTING AGENT
The luting agent is the connection between the tooth and the restoration. Proper luting of indirect restoration is critical in achieving long-term success as it highly influences the retention of the restoration as well as tightly sealing the gap between the restoration and the tooth. Although there are several classifications for the definitive luting agents, they can be , however, classified into two main categories based on the ability to achieve chemical connection to different substrates; conventional (e.g. zinc phosphate, glass-ionomer and resin-modified glass-ionomer cements) and adhesives. Most commonly used and best documented adhesive luting agents are the adhesive composite resin cements.
Composite resin cements can be further classified according to the chemical composition into traditional full-adhesive resin cement and self-adhesive resin cements, both also differ in the bonding procedure. The full-adhesive resin cements require pre-treatment of the tooth structure and restorative material using separate adhesive systems. In this combination of the resin cement and the adhesive system, very durable chemical bonding can be reached.
To simplify the luting procedure and eliminate the need of using several components, the self-adhesive resin cements are a good choice for the daily busy practice, in which reliable bonding can be achieved in only one simple step of cement application, mostly without additional primers or bonding agents.
With the availability of different types of cements, the decision of choosing the suitable luting agent and method can be confusing for the practitioner. Especially with the wide use of contemporary restorative materials such as new generations of highly translucent zirconia as well as reinforced-composites, it is important to take into consideration that the properties of such materials differ highly from metal or earlier generations of zirconia. Subsequently the choice of the luting agent must be appropriate to achieve satisfying results and long-term success. Therefore, in this article, the authors aim to provide insights for the clinicians on choosing the correct luting agent that can help achieve satisfactory results for the dentist as well as the patients.
CONVENTIONAL CEMENTATION OR ADHESIVE LUTING?
The choice of whether to use a conventional cement or an adhesive resin cement depends on several factors, the key factors are:
1) RETENTION AND RESISTANCE FORM OF THE ABUTMENT TOOTH
Minimal-invasive restorations, such as resin-bonded FDP, labial and occlusal veneers and inlay-retained FDP are based on a non-retentive preparation form. In this case the only possible method to achieve retention is the adhesive luting (9-11).
Even though such preparations completely lack a retentive form, long-term success of the restorations is well-documented when using a durable resin cement (e.g. PANAVIA™ 21, Kuraray Noritake Dental Inc., Japan) and proper bonding procedure (10, 11).
For full-coverage restorations (e.g. crowns and FDPs), the guidelines for tooth preparation discussed before (minimum height of 4 mm and maximum convergence of 15 degrees) need to be applied in order to achieve the retention and resistance form required to make cementation with a conventional luting agent acceptable.
However, in reality this retention form is hard to realize due to several factors.
In cases of severe loss of tooth substance, achieving a minimum height of the abutment tooth is only possible with building up the tooth using a core build-up material which in some cases can be considered time consuming especially when the required build-up is minor (for example 1-2 mm). Moreover, increasing the height through core build-up is sometimes not possible, as in cases with short clinical crowns and insufficient occlusal clearance that is essential to provide the minimum thickness required for the restorative material. In such cases surgical crown lengthening is necessary to increase the height of the tooth without compromising the occlusal space required, which can be time consuming for the clinician and undesirable for the patient as it involves a surgical procedure and extends the treatment process.
Concerning the convergence angle, several studies showed that in reality and in daily practice of the dentist, the preparation angle is much higher than 15 degrees (5, 6, 12, 13). For instance, preparations from general practitioners were evaluated digitally and compared to clinical recommendations and it was found that the mean convergence angle was 26.7 degree with the distopalatal angle being 31.7 degree (12).
Based on the previous concerns, it can be concluded that achieving a proper retention form during daily practice is hard to realize and thus conventional cementation in such cases can present clinical problems especially on the long term. Therefore, adhesive luting can be recommended in these cases as an alternative to conventional cementation (6, 14). For full-coverage restorations with preparation designs featuring at least some mechanical retention, the use of self-adhesive resin cements can be considerate a good alternative as it provides high clinical success rates (9, 15).
Conclusion / Clinical Significance:
2) MECHANICAL AND OPTICAL PROPERTIES OF THE RESTORATIVE MATERIAL
Flexural strength and translucency of the restorative material are critical factors that influence the decision which luting agent to use.
a) Flexural strength
As a general guideline for all-ceramic restorations, ceramics with low and medium flexural strength under 350 MPa should be adhesively luted with composite resin cements, as these restorations rely on resin bonding for reinforcement and support (9, 14, 16). This includes feldspathic-, glass-, hybrid-ceramics and composite.
Although discussions on conventional cementation versus adhesive luting for high-strength ceramics with flexure strength of more than 350 MPa have been going on for a long time (9), there are several studies showing an increased stability and strength of all types of ceramics, even lithium disilicate and zirconia, when they are adhesively luted (9, 17-20).
It is also important to consider that the documented success of most conventional cements is mainly combined with restorations made of metal or early generations of zirconia. Nonetheless, the clinical success of new generations of high-translucent zirconia can be significantly influenced by the luting agent as these new generations have notably lower flexural strength (9). And therefore, attention has to be paid to minimal material thickness together with adhesive luting to ensure long-term clinical success and prevent fractures (9).
Conclusion / Clinical Significance:
b) Translucency
To meet the increasing esthetic demands of the patients, new materials and techniques are continuously introduced, aiming to provide the perfect esthetic restorations. This includes not only new restorative materials but also new modifications to the luting agents as well. Highly translucent ceramics can deliver superior esthetics and therefore their popularity and clinical applications expanded widely among clinicians. It is nevertheless very important for the clinician to apprehend that the final esthetic result is influenced by the complete restorative complex and not just by the restorative material, as the luting agent is a key factor in achieving the desired high esthetics (21-24).
For that reason, the choice of an opaque conventional cement for cementation of high-translucent restoration should not be recommended as it can negatively influence the final esthetic results. Therefore, composite resin cements are the material of choice, as they are available in different shades and translucencies for the clinician to be able to choose the suitable resin cement to achieve the desired esthetics based on the restorative material and thickness as well as the color of the underlying abutment. Some composite resin cements offer try-in paste so that the clinician and the patient can visualize the final results before luting and therefore better choose the appropriate shade of the resin cement.
Conclusion / Clinical Significance:
3) SIMPLICITY OF THE WORKFLOW AND SPECIAL REQUIREMENTS OF THE WORKING ENVIRONMENT
The process of adhesive luting with full-adhesive composite resin cements (e.g. PANAVIA™ V5, Kuraray Noritake Dental Inc.) requires separate etching and priming procedures usually using a self-etch adhesive system (e.g. PANAVIA™ V5 Tooth Primer, Kuraray Noritake Dental Inc.) as well as a primer for the restorative material such as a universal primer that can be used for different substrates including metal, ceramics and composites (e.g. CLEARFIL™ CERAMIC PRIMER PLUS, Kuraray Noritake Dental Inc.). These procedures are technique sensitive and intolerant to contaminations, therefore the luting process needs a dry oral environment avoiding any contamination, such as saliva or blood, preferably using rubber dam, as any contamination can compromise the bond strength. Therefore, inability to maintain dry field as in case of subgingival preparation margins is considered a contraindication for traditional full-adhesive luting. However, this method provides very durable bond strength, therefore it is the luting method of choice for minimal invasive non-retentive preparations, such as resin-bonded FDPs, labial and occlusal veneers and inlay-retained FDPs, in which the retention is mainly dependent on the adhesion (9-11).
Still, in everyday practice, clinicians seek efficiency and effectivity by using a simple but durable luting agent for the insertion of full-coverage restorations such as tooth-or implant-supported crowns and FDPs. Although the conventional cements are simple and fast in their use, they provide little or no adhesion at all and therefore they are not recommended in several cases (6, 9, 14, 15, 19, 20). A simple but reliable method can be well accomplished by the use of self-adhesive resin cements (e.g. PANAVIA™ SA Cement Universal, Kuraray Noritake Dental Inc.) as they can be considered the best alternative for full-adhesive adhesive luting in less critical situations that do not rely entirely on adhesion (9, 15). Furthermore, self-adhesive resin cements are not as technique sensitive and intolerant to contaminations as traditional full-adhesive resin cements.
Typically, a MDP phosphate monomer is integrated in the self-adhesive resin cement, which is required to chemically bond to different substrates, making it possible for the resin cement to chemically bond to non-precious metals and zirconia as well as tooth substance. However, regardless of the self-adhesive resin cement, the use of a separate silane coupling agent is still required when bonding to silica-based ceramics (e.g. leucite, lithium silicate and lithium disilicate), hybrid ceramics and composite restorations.
Recently, a unique self-adhesive resin cement (PANAVIA™ SA Cement Universal, Kuraray Noritake Dental Inc.) was introduced: through an innovative and distinctive production technology, a silane-coupling agent (long carbon chain silane (LCSi)) is integrated in the cement, and thus being the real universal adhesive system that completely eliminate the need for any other adhesive or primer when being used for all substrates including glass ceramics. So the luting process can be in this case truly shortened to one step.
Therefore, this unique cement combines several advantages of adhesive luting as well as the straightforward procedure of the conventional cementation without compromising the clinical success, regardless of the type of the restorative material.
As a conclusion, adhesive luting has more benefits over conventional cementation, regarding retention, esthetics, stabilization of the tooth and the restoration as well as preventing micro leakage (6, 9, 14-17, 19, 20, 25, 26) (Table 1). Moreover, there are no absolute contraindications for adhesive luting other than hypersensitivity to methacrylate monomers, as self-adhesive resin cements can be used in cases where full-adhesive resin cements are contraindicated, such as inability to avoid contamination (Table 2). As a result, adhesive luting can be generally used in every clinical situation, whereas conventional cementation is limited (Table 3).
Dentist(s):
Prof. Dr. Florian Beuer
Professor and Chair, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité – Universitätsmedizin Berlin, Germany.
Dr. Adham Elsayed
Clinical and Scientific manager, Kuraray Europe GmbH, Hattersheim, Germany.
References
1. Ladha K, Verma M. Conventional and contemporary luting cements: an overview. J Indian Prosthodont Soc. 2010;10(2):79-88.
2. Schwartz NL, Whitsett LD, Berry TG, Stewart JL. Unserviceable crowns and fixed partial dentures: life-span and causes for loss of serviceability. J Am Dent Assoc. 1970;81(6):1395-401.
3. Gilboe DB, Teteruck WR. Fundamentals of extracoronal tooth preparation. Part I. Retention and resistance form. J Prosthet Dent. 1974;32(6):651-6.
4. Muruppel AM, Thomas J, Saratchandran S, Nair D, Gladstone S, Rajeev MM. Assessment of Retention and Resistance Form of Tooth Preparations for All Ceramic Restorations using Digital Imaging Technique. J Contemp Dent Pract. 2018;19(2):143-9.
5. Edelhoff D, Özcan M. To what extent does the longevity of fixed dental prostheses depend on the function of the cement? Working Group 4 materials: cementation. Clin Oral Implants Res. 2007;18 Suppl 3:193-204.
6. Güth JF, Stawarczyk B, Edelhoff D, Liebermann A. Zirconia and its novel compositions: What do clinicians need to know? Quintessence Int. 2019;50(7):512-20.
7. Smith CT, Gary JJ, Conkin JE, Franks HL. Effective taper criterion for the full veneer crown preparation in preclinical prosthodontics. J Prosthodont. 1999;8(3):196-200.
8. Uy JN, Neo JC, Chan SH. The effect of tooth and foundation restoration heights on the load fatigue performance of cast crowns. J Prosthet Dent. 2010;104(5):318-24.
9. Blatz MB, Vonderheide M, Conejo J. The Effect of Resin Bonding on Long-Term Success of High-Strength Ceramics. J Dent Res. 2018;97(2):132-9.
10. Chaar MS, Kern M. Five-year clinical outcome of posterior zirconia ceramic inlay-retained FDPs with a modified design. J Dent. 2015;43(12):1411-5.
11. Kern M, Passia N, Sasse M, Yazigi C. Ten-year outcome of zirconia ceramic cantilever resin-bonded fixed dental prostheses and the influence of the reasons for missing incisors. J Dent. 2017;65:51-5.
12. Guth JF, Wallbach J, Stimmelmayr M, Gernet W, Beuer F, Edelhoff D. Computer-aided evaluation of preparations for CAD/CAM-fabricated all-ceramic crowns. Clin Oral Investig. 2013;17(5):1389-95.
13. Nordlander J, Weir D, Stoffer W, Ochi S. The taper of clinical preparations for fixed prosthodontics. J Prosthet Dent. 1988;60(2):148-51.
14. Blatz MB. Long-term clinical success of all-ceramic posterior restorations. Quintessence Int. 2002;33(6):415-26.
15. Blatz MB, Phark JH, Ozer F, Mante FK, Saleh N, Bergler M, et al. In vitro comparative bond strength of contemporary self-adhesive resin cements to zirconium oxide ceramic with and without air-particle abrasion. Clin Oral Investig. 2010;14(2):187-92.
16. Kern M, Thompson VP, Beuer F, Edelhoff D, Frankenberger R, Kohal RJ, et al. All ceramics at a glance. 3rd English Edition ed: AG Keramik; 2017.
17. Attia A, Abdelaziz KM, Freitag S, Kern M. Fracture load of composite resin and feldspathic all-ceramic CAD/CAM crowns. J Prosthet Dent. 2006;95(2):117-23.
18. Borges GA, Caldas D, Taskonak B, Yan J, Sobrinho LC, de Oliveira WJ. Fracture loads of all-ceramic crowns under wet and dry fatigue conditions. J Prosthodont. 2009;18(8):649-55.
19. Campos F, Valandro LF, Feitosa SA, Kleverlaan CJ, Feilzer AJ, de Jager N, et al. Adhesive Cementation Promotes Higher Fatigue Resistance to Zirconia Crowns. Oper Dent. 2017;42(2):215-24.
20. Weigl P, Sander A, Wu Y, Felber R, Lauer HC, Rosentritt M. In-vitro performance and fracture strength of thin monolithic zirconia crowns. J Adv Prosthodont. 2018;10(2):79-84.
21. Calgaro PA, Furuse AY, Correr GM, Ornaghi BP, Gonzaga CC. Post-cementation colorimetric evaluation of the interaction between the thickness of ceramic veneers and the shade of resin cement. Am J Dent. 2014;27(4):191-4.
22. Chang J, Da Silva JD, Sakai M, Kristiansen J, Ishikawa-Nagai S. The optical effect of composite luting cement on all ceramic crowns. J Dent. 2009;37(12):937-43.
23. Turgut S, Bagis B. Effect of resin cement and ceramic thickness on final color of laminate veneers: an in vitro study. J Prosthet Dent. 2013;109(3):179-86.
24. Volpato CA, Monteiro S, Jr., de Andrada MC, Fredel MC, Petter CO. Optical influence of the type of illuminant, substrates and thickness of ceramic materials. Dent Mater. 2009;25(1):87-93.
25. Al-Makramani BMA, Razak AAA, Abu-Hassan MI. Evaluation of load at fracture of Procera AllCeram copings using different luting cements. J Prosthodont. 2008;17(2):120-4.
26. Gu XH, Kern M. Marginal discrepancies and leakage of all-ceramic crowns: influence of luting agents and aging conditions. Int J Prosthodont. 2003;16(2):109-16.
Using the latest-generation self-adhesive resin cements
USING THE NEXT-GENERATION SELF-ADHESIVE CEMENTS
by Dr. Tomohiro Takagaki.
INTRODUCTION
In recent years, the use of CAD/CAM systems for the production of indirect restorations has become increasingly popular. The shortage of young, qualified staff in the field of dental technology in Japan1) is likely to contribute to a further increase of automated production techniques such as CAD/CAM, which require fewer manual production steps compared to traditional manufacturing techniques. Also globally, the number of restorations fabricated using CAD/CAM systems is rapidly increasing. This leads to an even more widespread use of innovative, tooth-coloured restorative materials such as zirconia, silicate ceramics and resins.
Demand for placing restorations using the principle of adhesion by resin cements is more and more increasing in daily clinical settings. However, it is difficult and complicated to condition the tooth and restoration surfaces using many primers correctly. In addition, the combination of many different components is time-consuming, complex and cost-intensive. Self-adhesive resin cements, which do not require conditioning the surface of teeth or some restorations with primers, have been released recently, and have become popular among dental practitioners. However, there are many reports2) on the dislodgement of resin-based CAD/CAM restorations and full-zirconia crowns that have been placed using self-adhesive cements. Hence, demand is high for a resin cement system that is both simple to use and reliable in performance.
In this document, I explain the fundamental technology of resin cement systems and their range of applications. In addition, I will introduce the method of using a next-generation self-adhesive cement, PANAVIA™ SA Cement Universal (Kuraray Noritake Dental Inc., Fig. 1), as an example.
Optimising bond quality by minimising contamination
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.
Universal Excellence
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PANAVIA SA Cement Universal
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CLEARFIL Universal Bond Quick 2
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PANAVIA SA Cement Universal
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Universal Excellence
CLEARFIL Universal Bond Quick 2
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Novel technique: less complex, yet with better adhesion to dentin
Article by Prof. Lorenzo Breschi
Fewer bottles, more choices – this is possibly the shortest way to describe the category of universal resin cements. Being self-adhesive, these dual-cure resin-based cements allow for a single-component workflow without the need for separate tooth or restoration primers in many clinical situations. The bond strength obtained in this way is usually high enough to provide for a stable bond between the tooth and the restoration in a wide range of indications. However, it is slightly lower than that achieved with conventional resin cement systems consisting of several components (typically tooth primer, resin cement and restoration primer).
Apart from the self-adhesive application mode, universal resin cements may be combined with additional system components to increase the bond strength to tooth structure or the restorative material, respectively. This opens up new possibilities with regard to the product’s use: depending on the required or desired bonding performance, the universal resin cement may be applied alone or in combination with a tooth primer, a restoration primer or both components. In addition, hybrid concepts become feasible, as explained in this article that focuses on PANAVIA™ SA Cement Universal (Kuraray Noritake Dental Inc.) as an example.
PANAVIA™ SA Cement Universal is a dual-cure universal resin cement that is indicated for a wide range of applications when used in the self-adhesive mode. The bond established to restorative substrates (including silicate ceramics) is high without the use of a separate primer or silane1-4. This is due to two different adhesive monomers contained in the formulation – the Original MDP Monomer and the LCSi Monomer (a long carbon-chain silane coupling agent responsible for a strong chemical bond to silicate ceramics). Hence, it is possible to use the resin cement without any additional component applied on the side of the restoration – even in cases with a lack of retention and consequently high bond-strength requirements.
A strong bond to enamel and dentin is also obtained in the self-adhesive mode. In certain situations, however, it may be useful to further increase the bond strength to tooth structure with the aid of a tooth primer.
The tooth primer recommended for PANAVIA™ SA Cement Universal is CLEARFIL™ Universal Bond Quick (Kuraray Noritake Dental Inc.). Its application is recommended whenever a user feels that the treatment would benefit from an extraordinarily strong and durable chemical bond, i.e. in particularly challenging situations with insufficient mechanical retention. The effectiveness of this measure has been confirmed in an in-vitro study conducted in Japan, in which the 24-hour micro-tensile bond strength to dentin was increased significantly by the application of the universal adhesive5. When a separate adhesive is used, however, the importance of a completely dry working field increases. The reason is that the moisture tolerance of resin cements is usually higher than that of adhesives. Consequently, the application of a rubber dam is highly recommended.
For situations in which proper isolation of the working field with a rubber dam is difficult, a third application option is available and proposed by a group of Italian researchers: Selective Adhesive Luting. In this case, CLEARFIL™ Universal Bond Quick is applied solely to those parts of the prepared tooth that allow for proper moisture control, while relying on the self-adhesive functionality of PANAVIA™ SA Cement Universal in areas where it is challenging to obtain the desired dry working field. Situations which are predestined for this technique are abutment teeth with a subgingival preparation margin and particularly short abutment teeth (that hinder the placement of a rubber dam).
The effectiveness of the selective adhesive luting technique has been verified in an in-vitro study that compared the three adhesive strategies – self-adhesive luting, full adhesive luting and selective adhesive luting – with the aid of shear bond strength testing6. The results of the tests show that users are able to enhance the bond strength of PANAVIA™ SA Cement Universal to dentin and enamel by applying the adhesive to a part of the tooth surface only. For the cementation system consisting of PANAVIA™ SA Cement Universal and CLEARFIL™ Universal Bond Quick, the full adhesive and the selective adhesive approach led to similar outcomes.
For situations in which proper isolation of the working field with a rubber dam is difficult, a third application option is available and proposed by a group of Italian researchers: Selective Adhesive Luting.
Fig. 1. Tooth preparation.
Fig. 2. Selective etching of the enamel with phosphoric acid etchant.
Fig. 3. Application of the universal adhesive + air-drying.
Fig. 4. Crown placement after application of the resin cement into the crown.
Fig. 5. Tack-curing.
Fig. 6. Excess removal and final light curing.
Fig. 7. Treatment outcome at a recall after one year.
Apart from the desired (long-term) increase in bond strength achieved by applying a separate adhesive to a part of the or the whole prepared tooth surface, the technique offers additional benefits. Compared to multi-step cementation systems, the protocol is simplified as no separate restoration primer is needed. Light-curing of the adhesive is not required as long as the user stays within the recommended system. And in contrast to the full adhesive approach requiring rubber dam placement, the need for this step is eliminated in the selective adhesive approach. In this way, the chair-time is reduced and patient comfort increased.
Depending on the indication, clinical variables and individual preferences, users of universal resin cements like PANAVIA™ SA Cement Universal may select the technique that is likely to deliver the best clinical outcomes. It is this flexibility and the generally wide range of applications that makes the innovative product category truly universal. With fewer components to be used, universal materials facilitate the streamlining and standardization of clinical procedures, while with fewer bottles to be stored, they help staff gain control over order and storage management as well.
Dentist:
LORENZO BRESCHI
Prof. Lorenzo Breschi is Professor of Restorative Dentistry and Dental Materials at the University of Bologna. He is actively involved in research on the ultrastructural aspects of enamel and dentin. He is Past-President of the Academy of Dental Materials (ADM), President-Elect of the European Federation of Conservative Dentistry (EFCD), President-Elect of the Dental Materials Group IADR, President-Elect of the Italian Academy of Conservative Dentistry (AIC), President-Elect of the International Academy of Adhesive Dentistry (IAAD).
1. Cowen M, Cunha S, Powers JM. Novel Cement Bond Strength to Multiple Substrates. DENTAL ADVISOR Biomaterials Research Center, Biomaterials Research Report, Number 132 – June 16, 2020.
2. Patel N, Anadioti E, Conejo J, Ozer F, Mante F, Blatz M. Bond Strength of Different Self-Adhesive Resin Cements to Zirconia” (2021). Dental Theses. 62. https://repository.upenn.edu/dental_theses/62.
3. Yoshihara K, Nagaoka N, Maruo Y, Nishigawa G, Yoshida Y, Van Meerbeek B. Silane-coupling effect of a silane-containing self-adhesive composite cement. Dent Mater. 2020 Jul;36(7):914-926.
4. Irie M, Tokunaga E, Maruo Y, Nishigawa G, Yoshihara K, Nagaoka N, Minagi S, Matsumoto T. Shear bond strength of a resin cement to CAD/CAM Blocks for molars. P-2, 37th Annual Meeting of the Japanese Society of Adhesive Dentistry 2018.
5. Ohara N. Bonding strength of resin cement containing silane coupling agent to dentin or core resin. Results presented at the 150th meeting of the Japanese Society of Conservative Dentistry.
6. Breschi L, Josic U, Maravic T, et al. Selective adhesive luting: A novel technique for improving adhesion achieved by universal resin cements. J Esthet Restor Dent. 2023;1-9. doi:10.1111/jerd.13037.
Stress-free cementing procedures: PANAVIA SA Cement Universal at a glance
CLEARFIL Universal Bond Quick 2
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with PANAVIA SA Cement Universal
Why PANAVIA is a brand to be trusted
You probably know that they all contain the original MDP monomer developed in the early 1980s. It has attracted much attention because it is such an excellent adhesive monomer. This phosphate ester monomer forms a very strong bond to tooth structure, zirconia, and dental metals. It has been used in every PANAVIA™ product. In reality, however, other catalytic technologies and ingredients alongside MDP are important technological contributors supporting the performance of our cementation solutions.
One of these decisive additional technologies and ingredients is the polymerization catalyst triggering the curing process. Different from the MDP monomer used in every PANAVIA™ product, the polymerization catalyst has been continuously improved since the introduction of PANAVIA™ EX in 1983. New versions have been developed for PANAVIA™ 21, PANAVIA™ Fluoro Cement and PANAVIA™ V5, for example. Another important component also affecting the curing process is the Touch Cure Technology used in two of the three major products of the current PANAVIA™ Portfolio: PANAVIA™ V5 and PANAVIA™ Veneer LC. This technology was first used in PANAVIA™ 21, which was launched in 1993. The contact of the chemical polymerization activator contained in the self-etching primer with the resin cement paste accelerates the polymerization of the cement from the adhesive interface, thus providing better adhesion of the resin cement. In developing PANAVIA™ V5, we reviewed the chemical composition of the existing PANAVIA™ products and updated it substantially. The Touch Cure technology has also been adopted for use in the case of PANAVIA™ V5 Tooth Primer and the concomitantly used PANAVIA™ V5 Paste. When cementing veneers with PANAVIA™ Veneer LC, we also use PANAVIA™ V5 Tooth Primer for conditioning teeth. This also involves the application of Touch Cure technology for achieving an adhesive connection with the tooth without compromising the working time of the cement paste.
Even in the field of adhesive monomers, we did not stand still: We developed the LCSi monomer, a long carbon chain silane-coupling agent which made possible to integrate the function of a ceramic primer in our universal self-adhesive resin cement PANAVIA™ SA Cement Universal. With its high level of hydrophobicity, this monomer provides stable, long-term bond strength. Generally speaking, it may be said that the reason bond durability may drop is a hydrolytic reaction damaging the chemical bond between the silica contained in the glass ceramics and the silane-coupling agent.
By combining these technologies and ingredients smartly, we have succeeded in developing a resin cement portfolio that covers virtually every need. With PANAVIA™ V5, PANAVIA™ SA Cement Universal and PANAVIA™ Veneer LC, it is possible to treat a wide variety of cases. The products allow for the luting of various types of restorations, prosthetic appliances and for the placement of posts and produce great outcomes if used properly according to the instructions for use.
PANAVIA™ V5 is the resin cement that has the widest range of uses among the three cement systems just mentioned. It covers almost all the intended uses of the other two cements. Therefore, it is possible for the dental practitioner to choose the right cement system for treatment, according to the cases arriving at the clinic and patient needs, from among these three major resin cement products: PANAVIA™ V5, a resin cement with a wide range of applications; PANAVIA™ SA Cement Universal, a simple and easy-handling self-adhesive resin cement; and PANAVIA™ Veneer LC when there is a need to bond laminate veneers.
The good thing about developing technologies in a company like Kuraray Noritake Dental is that their application is not limited to a certain product or product group. The R&D Department always carries out research on how to leverage the benefits of the technologies in other applications. Take, for example, KATANA™ Cleaner, which was released in 2019. This cleaning agent can be used to remove saliva, blood, temporary cement, or other contaminants that can adhere to the surfaces of teeth or prosthetic devices during trial fitting and temporary cementation of a prosthetic device. This unique product has been developed by taking advantage of the surfactant function of the MDP monomer.
Hence, it is mainly our long-standing knowledge and experience in the development of dental resin cements and adhesive solutions that provides for the excellence of the current PANAVIA™ Portfolio. We know how to improve on existing technologies, to never stop developing new ones and to continuously look for the best way to combine proven and new components to obtain the best possible outcomes. In the steps of the product development procedure, clinical tests are conducted and feedback from dental practitioners is gathered in order to take into account the extreme conditions found in the oral environment. In the past 40 years, this strategy has proven successful, and we are sure it will help us to develop many other innovative products that offer ideal support in striving to improve the oral health of patients.
PANAVIA SA Cement Universal
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Results of a practice-based clinical evaluation
DENTAL ADVISOR has once again recognized PANAVIA™ SA Cement Universal as a Top Product in the category of Indirect Restoratives. This dual-cure, fluoride-releasing, radiopaque self-adhesive resin cement adheres to virtually all substrates — including lithium disilicate — in a single-step procedure without the need for a separate primer or silane. It also offers easy, gingival-friendly removal of excess cement and requires no refrigeration.
It is because PANAVIA™ SA Cement Universal combines two innovative technologies in a single product that a strong and durable bond can be achieved in a single step. The silane-coupling agent, LCSi monomer, establishes a durable, chemical bond with porcelain, lithium disilicate, and composite resin; and the original MDP monomer provides for chemical reactiveness with zirconia, dentin and enamel.
Due to its unique chemistry PANAVIA™ SA Cement Universal represents a convenient, versatile, and efficacious single solution to practitioners’ everyday cementation needs for a wide variety of indications, including cementation of crowns/bridges, inlays/onlays, posts, splints, and even adhesion bridges.
In its commendation, DENTAL ADVISOR stated, “As tested in DENTAL ADVISOR Laboratories, PANAVIA™ SA Cement Universal with an incorporated silane primer had exceptional initial bond strength to dentin, lithium disilicate, and zirconia.”
The benefits and quality of PANAVIA™ SA Cement Universal were further reflected in the findings and feedback of the 31 clinical evaluators who tested the cement during 516 applications. They praised its ease of use, handling characteristics, and aesthetics, and gave it an overall clinical rating of 96 percent. Among their comments: "Has an ideal film thickness and flows well.”, "You can use this in a moist environment with no issues.” , and “Excess cement peels right away from the margin.”
The Top Product and Preferred Product Awards conferred by US-based DENTAL ADVISOR were initially introduced to help busy practitioners make sense of the numerous new solutions indicated for less invasive techniques and standardised or simplified procedures, ultimately, to achieve better outcomes regularly.
DENTAL ADVISOR conducts its practice-based clinical evaluations and product performance tests shortly after product launch. It publishes results annually online in its January/February issue to help potential users identify high-quality new dental materials and determine which among them are best suited to fulfil their individual requirements.
Procedure using a dedicated intra- and extra-oral cleaner
Using KATANA™ Cleaner and PANAVIA™ SA Cement Universal
Case by Dr. Richard Young
Fig. 1. HF etch and try-in complete.
Fig. 2. Dispense KATANA™ Cleaner into mixing well.
Fig. 3. Rub for 10 seconds, then rinse and dry.
Fig. 4. Rub for 10 seconds, then rinse and dry. KATANA™ Cleaner contains MDP based surfactant that breaks down blood and saliva - removing contamination.
Fig. 5. Apply cement directly onto restoration (glass ceramic, zirconia, metal or composite resin).
Fig. 6. PANAVIA™ SA Cement Universal contains MDP and LCSi monomers, providing for durable bonding even to lithium disilicate restorations.
Fig. 7. Tack-cure for 2-5 seconds.
Fig. 8. Tack-curing results in nice gel-like-state and excess is removed with ease.
FINAL SITUATION
Fig. 9. Final situation.
Dentist:
DR. RICHARD YOUNG
CLEARFIL Universal Bond Quick 2
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Universal products and their impact on clinical and management procedures
A pioneer in digital dental photography, the editor-in-chief of the “International Journal of Esthetic Dentistry” and a supporter of universal products: We are talking about Dr Alessandro Devigus, the owner of a private practice in Bülach, Switzerland. At the International Dental Show 2023 in Cologne, we had a conversation with him about his favourite products from Kuraray Noritake Dental Inc. and the concept of universal excellence.
Dr Adham Elsayed, Clinical and Scientific Manager at Kuraray Noritake Dental Inc., interviewing Dr Alessandro Devigus.
We all would like to reduce the number of products and components used in our dental offices to make our lives easier and more predictable. Several years ago, when the first universal products started entering the dental market, I realized that these products and the concept behind them are able to help me achieve this goal.
The main field of application is restorative dentistry, in indirect and direct restorative workflows, which often go hand in hand. Whenever possible and in accordance with the needs and desires of the patient, I opt for minimally invasive direct composite restorations, often realized using universal products. Cosmetic corrections or tooth wear treatments in the lower jaw, for example, are often carried out in a prepless procedure with resin composite applied with a single-shade technique. For anterior restorations in the upper jaw of the same patient, however, I might opt for ceramic restorations, luted with a universal resin cement.
I produce most of my single-tooth restorations chairside with CEREC. In the anterior region, the choice is usually between different types of glass ceramic materials. In some indications, when two central incisors or all four maxillary incisors need to be restored, zirconia is also a suitable option. In these cases and for indirect restorations in the posterior region, KATANA™ Zirconia Block is my preferred material. Having tested many different types of chairside zirconia, I can say that this product simply offers the most natural colour gradation and the desired vitality. Hence, finishing is quick and easy. At the same time, the high flexural strength of the material supports me in my striving for minimally invasive preparations. For definitive placement of the produced overlays and crowns, PANAVIA™ SA Cement Universal from Kuraray Noritake Dental Inc. is my dual-cure resin cement of choice. It bonds to virtually every surface including lithium disilicate without a separate primer and offers a good flowability that facilitates restoration placement. An additional feature contributing to a quick and stress-free clinical procedure is its easy and gingiva-friendly excess removal after tack curing.
One of my favourite resin composites is CLEARFIL MAJESTY™ ES-2 Universal (Kuraray Noritake Dental Inc.). Its single shade for the posterior and two shades for the anterior region offer just the right combination of translucency and intrinsic colour to imitate a large number of tooth shades. The effect is that it blends in nicely with the surrounding tooth structure without appearing grayish. In the posterior region, I was able to observe a certain masking potential, so that discoloured abutment teeth do not cause any problems. With this material, the shade determination step is eliminated. Clinical workflows are also simplified by the use of CLEARFIL™ Universal Bond Quick. The universal adhesive is not only versatile as it is suitable for many indications and all etching techniques, but also extraordinarily quick in its application, as the need for an extensive rubbing into the tooth structure is eliminated. In this way, it is possible to streamline direct restorative procedures.
I simply like products from Japanese companies. They stand for quality, integrity and clinical relevance. Japanese people seem to be deeply committed to the company they work for and to their work, pay attention to every detail and try to deliver the best outcomes possible. This attitude is reflected in Kuraray’s mission “For people and the planet—to achieve what no one else can.”, and it is reflected in the products of the company as well. They offer the properties I need to deliver high-quality dental treatments.
In the first place, using fewer products and components that are easy and quick in their application allows me to get a grip on costs. With fewer steps and fewer bottles, shortened application times and standardized workflows, the time a patient needs to sit in the chair is reduced, which allows me to save the most valuable factor in the office: my time. At the same time, material storage and order management are streamlined, so that it is much easier to keep track of dates of expiry, hence saving material costs as well. And the best thing about it is that all these savings are possible without compromising treatment quality. Provided that the user is able to handle the materials properly – which is facilitated by the minimal number of steps and ease of use – the quality of the outcomes is extremely high!
Dr Devigus, we thank you for sharing your insights with us.
CLEARFIL Universal Bond Quick 2
What are the main features?
It contains two types of adhesive monomers ("MDP" and "LCSi") allowing adhesion to various types of prosthetic restorations without primer treatment. It also allows fast and easy clean-up of the excess cement.
How can PANAVIA™ SA Cement Universal achieve high bond strength without primer treatment?
"MDP" provides high bond strength by chemical adhesion with its phosphate group to the surface of tooth structure, metal, metal oxide (zirconia, etc.). Furthermore, by incorporating proprietary long chain silane coupling agent "LCSi monomer", it has the property of bonding
to Silica-based ceramics(IPS e.max, porcelain etc.) without requiring primer treatment.
What are the differences among the shades?
Universal: The shade is equivalent to A2, and it is recommended for a wide range of restorations.
White: High visibility, opaque for excellent discrimination from the tooth structure (for posts, etc.).
Translucent: High transparency, it is recommended for aesthetic restorations.
Are the shades the same than the previous version, PANAVIA™ SA Cement Plus?
Yes, the shades are the same as in previous versions.
How many times can the product be used?
Automix: Approximately 15 cases (based on the number of tips attached to the paste separately)
Handmix: 60 cases (crown)
How long is operation time/setting time?
Is the long chain silane coupling agent, LCSi monomer, a new technology?
It is the first time to incorporate it in a resin cement paste for the purpose of providing adhesive property, but CLEARFIL MAJESTY™ ES Flow, etc. have been using it as a surface treatment agent of the fillers.
Can PANAVIA™ V5 tooth primer be used for tooth surface treatment?
It cannot be used. Because the chemical polymerization catalyst used is different, sufficient adhesion cannot be guaranteed. We recommend the usage of CLEARFIL™ Universal Bond Quick to enhance bond strength to tooth structure.
Is there a difference in performance between the handmix and the automix type?
There is no difference in performance whatsoever. The basic composition is the same, therefore both have the same adhesive performance. Regarding the working time, handmix takes two
minutes and automix takes one minute. When dispensing the cement from automix syringe, a mixing tip or endo tip must be used.
How should the product be stored?
Store at a temperature of 2-25°C/ 36-77°F. During storage, please avoid direct sunlight, dental light, extreme heat etc.
What are the causes of quick curing?
A1. Curing promoted by ambient light
The paste contains a light-cure catalyst that is highly photo-active, and the polymerization can be accelerated when exposed to strong light such as dental light during cementation. Please take measures to reduce the intensity of light by turning off the dental light at the time of operation. Also during and after paste mixing, any exposure to light such as direct sunlight or dental light promotes curing, so please perform the cementation operation promptly after mixing the paste.
A2. Curing promoted in intraoral environment
The curing of resin cements, such as PANAVIA™ SA Cement Universal, can be accelerated in intraoral environment where the temperature is higher than room temperature. In addition, curing of resin cements can be accelerated as well when the mixed paste is not in contact with air during the cementation procedure with prosthetic restorations. In particular, when cement is applied directly to the cavity, initial curing will start in about 40 seconds, so please perform cementation operation promptly (when used in combination with CLEARFIL™ Universal Bond Quick, the initial curing starts in about 30 seconds after cementation). As described in the Instructions for Use, the use of lentulo spiral can accelerate the polymerization of the paste beyond the desirable limits.
A3. Curing promoted by contact with water
The water drops adhering to the mixing pad or spatula may accelerate the curing, so if water drops are present, please wipe them off before use. When the product is stored in the refrigerator, to avoid water condensation, allow the product to come to room temperature for at least 15 minutes before use.
What are the reasons for the prosthetic restoration falling off, when removing excess cement?
When removing the excess cement after tack-curing, hold the restoration in place to avoid the possibility of lifting the restoration, since there could be some insufficiently cured resin cement. If dental floss is used to remove the excess cement, it should be used in the direction that does not lift the prosthetic restoration. In the case of cementation of non-translucent prosthetic restorations (e.g. metal crowns and inlays), the final curing time of 5 minutes after placement is necessary.
What are the leading factors of prosthetic restoration failure?
A1. Usage of eugenol-containing materials for pulp protection or temporary sealing, as it may inhibit the curing process of resin cement.
A2. Usage of hydrogen peroxide for cleaning cavities, as it may weaken the bond strength to the tooth structure.
A3.Usage of hemostatic agents containing ferric compounds as these materials may impair adhesion and may cause discoloration due to remaining ferric ions.
A4. Usage of hemostatic agents containing aluminum chloride. When using the above, minimize its quantity, and use caution to prevent contact with the adherent surface. Failure to do so might weaken the bond strength to the tooth structure.
A5. Contaminated cavity. If the cavity is extremely contaminated as in the case where the metal core is dropped, etc., clean it in accordance with the general regulations. In addition, residual amalgam or lining materials should be completely removed during cavity preparation to avoid poor adhesion.
A6. Unequal amount of Paste A & B is used. Make sure to dispense an equal amount of Paste A & B for mixing. If the amount of paste A & B dispensed is not equal, curing may be faster or slower and there is a possibility of poor polymerization. In the case of the automix type, before attaching a mixing tip or an endo tip, extrude small amount of the two pastes, making sure equal amounts are being dispensed through the two outlets of the syringe, and discard the test paste.
Why doesn’t PANAVIA™ SA Cement Universal cure properly on the table?
PANAVIA™ SA Cement Universal does not cure properly (or cures very slowly) in room temperature and in air, because oxygen interrupts the curing of the resin (anaerobic curing). These are normal property of resin cements.
The picture shows the paste on the mixing pad. It cannot be cured in the red area, especially in air (oxygen). If the paste amounts are very small, the paste cannot be polymerized.
How to check the product to see if it can be properly cured?
First, dispense small amounts of PANAVIA™ SA Cement Universal paste with a mixing tip and leave for 5 - 10 min. Then check to see if the paste can be dispensed from the mixing tip. (If it is hard to dispense, it works correctly) The oxygen influence of the paste is avoided in the mixing tip. For the handmix version, the inner layer of the paste will polymerize, but the outer layer may remain soft (oxygen inhibition layer).
How long is the final cure?
The final curing time is 10 seconds in case of the prosthetic restorations that are translucent. The final curing time is 5 minutes after placement of prosthetic restoration for self-curing. In the case of the cores and dental posts, seat the restoration in place for approximately 10 minutes and make sure the cement has been completely cured before preparing the abutment tooth.
Which cement application is recommended: prosthetic side or abutment side?
Although it is possible to apply cement to both prosthetic or abutment sides, curing is accelerated when applied to the abutment tooth (cavity) side. When inserting the paste directly into the cavity or root canal, placement of the prosthetic restoration should be done within 40 seconds (within 30 seconds when using CLEARFIL™ Universal Bond Quick).
Can the product be used for cementing metal (PFM)?
Yes, PANAVIA™ SA Cement Universal can be bonded to both non-precious metal alloys and precious metal alloys.
Can the product be used for fiber post cementations?
Yes, it is possible. Primer treatment to the fiber post is unnecessary, but please clean it according to the Instructions for Use after the post trial.
PANAVIA SA CEMENT UNIVERSAL
Universal (A2) shade delivers outstanding aesthetics. A translucent shade and an opaque white shade take care of your specific needs.
For cementing more versatile and easier than ever.
INTRA- AND EXTRA-ORAL RESTORATION AND PREPARATION CLEANER FOR OPTIMISED ADHESIVE PROCEDURES
THE EVERYTHING BOND
8.2 g/4.6 ml
1 Syringe per shade
20 Mixing tips
9.2 g/5 ml
1 syringe per shade
8.2g/4.6ml
3 syringes per shade
40 Mixing tips
10 Endo tips (SS)
Universal (A2)
Translucent
9.2 g/5 ml
2 Syringes per shade
Mixing spatula
Mixing pad
4ml
1 Bond (5ml)
3 Bonds (5ml each)
1 Bottle (1ml)
50 Unit-Dose
50 Applicator Brushes (Fine Silver)
5 Unit-Dose (0.1ml)
5 Applicator Brushes
THE RIGHT CHOICE EVEN FOR YOUR MOST DEMANDING AND AESTHETIC CEMENTATIONS
THE SPECIALIST THAT PUTS YOU IN CONTROL IN DELICATE VENEER CEMENTATIONS
