429 Too Many Requests

Case by DT Andreas Chatzimpatzakis and Dr Evi Lianou

Selecting the right materials for a successful rehabilitation of edentulous jaws with fixed implant-based prostheses can be quite challenging. High strength and stability are needed to securely connect the implants, biocompatibility is a must and the functional, aesthetic and financial expectations of the patient need to be respected. Experience shows that – in many situations – the combination of a titanium bar with a zirconia framework finished using the micro-layering technique is a great option. This material combination and approach meets the demands mentioned, while supporting efficient procedures and aesthetic outcomes.

In the present case, a 53-year-old male patient with a history of periodontal disease presented in the dental office of Dr Evi Lianou (Dental Clinic, Lamia, Greece). Due to a poor prognosis of the remaining teeth, it was planned to extract them. As a removable full denture was not an option for the patient, the treatment plan included the insertion of four implants in the mandible and six in the maxilla, followed by a healing phase and subsequent definitive rehabilitation with screw-retained, titanium bar-based zirconia superstructures finished by micro-layering. The following figures and captions describe the technical procedure.

Fig. 1. Initial clinical situation showing several remaining teeth with a poor prognosis.

Fig. 2. Screw-retained titanium bar for the mandible.

Fig. 3. Screw-retained titanium bar for the maxilla.

Fig. 4. Mandibular restoration: Milled framework made of KATANA™ Zirconia HTML PLUS (Kuraray Noritake Dental Inc.) with a minimal (0.3 mm) vestibular cutback placed only on the six anterior teeth.

Fig. 5. Maxillary restoration: Milled framework made of KATANA™ Zirconia HTML PLUS with a minimal vestibular cutback (0.3 mm) placed only on the six anterior teeth.

Fig. 6. Mandibular restoration, 33-43 internal staining with CERABIEN™ MiLai Internal Stains (Kuraray Noritake Dental Inc.). 34-37 & 44-47 External characterization with CERABIEN™ ZR FC Paste Stain.

Fig. 7. Maxillary restoration 13-23 internal staining with CERABIEN™ MiLai Internal Stains. 14-17, 24-27 External characterization with CERABIEN™ ZR FC Paste Stain.

Fig. 8. Mandibular and maxillary restorations on the model: Additional internal staining to the anterior. Posterior teeth were completed with CERABIEN™ ZR FC Paste Stain.

Fig. 9. Mandibular restoration after the application of CERABIEN™ MiLai Porcelains LT1 mixed with CCV2 (ratio 50:50) for the cervical and Tx for the incisal.

Fig. 10. Maxillary restoration after the application of CERABIEN™ MiLai Porcelains LT1 mixed with CCV2 (ratio 50:50) for the cervical and Tx for the incisal third.

Fig. 11. Mandibular restoration after the bake, showing some typical characteristics of aged teeth.

Fig. 12. Maxillary restoration after the bake, showing some typical characteristics of aged teeth.

Fig. 13. Mandibular restoration with applied tissue porcelains and corrections in the tooth area.

Fig. 14. Maxillary restoration with applied tissue porcelains and corrections in the tooth area.

Fig. 15. Mandibular restoration after finishing glazing and polishing.

Fig. 16. Maxillary restoration after finishing glazing and polishing.

Fig. 17. Final restorations on the model.

Fig. 18. Final restorations in the patient’s mouth.

Fig. 19. New smile of the patient.

Fig. 20. Patient with new fixed dental prostheses.

CONCLUSION

The described material combination and technique allows for efficient workflows, while supporting aesthetic, durable treatment outcomes. With functional surfaces designed in plain, polished zirconia and just a tiny layer of porcelain in the vestibular region, the restorations are made to last. Moreover, the selected framework material and porcelain system are a perfect match.

The chosen porcelain system works well with other zirconia brands and even with lithium disilicate. It can be used with or without internal stains, making it a versatile tool suitable for a wide range of applications, patient needs, and aesthetic demands.

Case report by Dr Mediha Isikver

Tooth fractures and secondary caries are frequently observed in posterior teeth, often resulting from occlusal stress, restoration failure, or secondary bacterial infiltration. These conditions compromise tooth integrity, function, and aesthetics. With advancements in adhesive dentistry, minimally invasive and durable restorative solutions have become achievable. Material selection plays a critical role in the success of composite restorations, influencing marginal adaptation, wear resistance, and patient satisfaction. This case report describes the step-by-step clinical management of a fractured and secondary carious permanent molar restored using materials from Kuraray Noritake Dental Inc.

CASE PRESENTATION

A 32-year-old female patient presented to the clinic with sensitivity and discomfort in the upper left posterior region. Clinical examination revealed a distal wall fracture on tooth #26 (maxillary left first molar) with a secondary carious lesion extending subgingivally. Radiographic evaluation confirmed the absence of periapical pathology. Adjacent teeth (#25 and #27) showed early carious activity, but the patient opted for the restoration of tooth #26 only. The tooth was asymptomatic to percussion and showed normal vitality on pulp testing.

Fig. 1. Initial clinical view of tooth #26 under rubber dam isolation.

TREATMENT PROTOCOL

1. Isolation and caries removal: The tooth was isolated with rubber dam. The existing defective restoration and carious tissue were carefully removed using tungsten carbide burs and a slow-speed handpiece.
2. Surface cleaning: After preparation, KATANA™ Cleaner was applied to remove contaminants and optimize bonding surface quality.
3. Bonding procedure: A single-step, self-etch adhesive, CLEARFIL™ Universal Bond Quick 2, was applied to both enamel and dentin following the protocol recommended by the manufacturer.
4. Restorative phase: The deep and undercut areas were resin coated with CLEARFIL MAJESTY™ ES Flow Universal Low (U shade), ensuring adaptation and stress relief in undercut regions. The remaining cavity was restored incrementally using CLEARFIL MAJESTY™ ES-2 Universal (U shade) paste-type composite, with each 2 mm layer light-cured for 20 seconds.

Fig. 2. Clinical view of tooth #26 after removal of the defective restoration and carious tissue.

Fig. 3. Application of KATANA™ Cleaner to remove contaminants and optimize bonding surface quality after preparation.

Fig. 4. Selective enamel etching performed on tooth #26.

Fig. 5. CLEARFIL™ Universal Bond Quick 2 applied to both enamel and dentin following the manufacturer’s recommended protocol.

Fig. 6. Resin coating with CLEARFIL MAJESTY™ ES Flow Universal Low (U shade).

Fig. 7. Reconstruction of the mesial and distal walls with CLEARFIL MAJESTY™ ES-2 Universal (U shade) composite.

Fig. 8. Incremental build-up of cusps and occlusal anatomy using CLEARFIL MAJESTY™ ES-2 Universal composite, refined with a brush for contour adjustment.

Fig. 9. Initial finishing of the composite restoration performed with darkcoloured TWIST™ DIA for Composite (medium) rubber points to refine surface texture and anatomy.

Fig. 10. Final polishing performed with light-coloured TWIST™ DIA for Composite (fine) rubber points to achieve a highgloss, smooth surface.

FINAL SITUATION

Fig. 11. Final view of the restoration after occlusal adjustment and polishing.

CONCLUSION

This case demonstrates that adhesive and restorative systems from Kuraray Noritake Dental Inc. offer a reliable, efficient and effective approach for treating fractured and secondary carious posterior teeth. The integration of self-etch adhesives and high performance composites contributes to durable and aesthetically pleasing restorations. Continuous follow-up is essential to evaluate the long-term clinical behaviour of these materials.

Dentist:

MEDIHA ISIKVER

Dr Mediha Isikver is a graduate of the Ege University Faculty of Dentistry and the co-founder of Klinik M in Istanbul, Turkey. She focuses her professional practice on aesthetic and restorative dentistry, with particular expertise in composite laminate layering, porcelain laminates, and smile design. Believing that every smile tells its own story, she aims to create personalized aesthetic transformations that blend natural harmony with artistic detail.

Case by Dr. Onur Alp Yünük

COMBINING HIGH-PERFORMANCE TOOLS AND MATERIALS FOR A PREDICTABLE OUTCOME

Direct composite restorations are a high-quality treatment option even when large amounts of tooth structure need to be replaced. This is due to recent advancements in resin composite materials and adhesive technology. By selecting appropriate materials and layering techniques combined with modern digital tools for colour difference evaluation, it is possible to predictably produce highly aesthetic outcomes, as demonstrated in the following case example.

THE CHALLENGE

A young male patient presented to our clinic requesting the replacement of his existing composite restorations on his maxillary incisors (teeth #12 and #11 according to the FDI notation). Clinical examination revealed extensive restoration loss on the lateral incisor. Furthermore, anatomical irregularities, discolouration, and loss of surface gloss were observed on tooth #11. The adjacent central incisor exhibited similar issues regarding colour and surface polish.

In consultation with the patient, it was decided to replace the existing restorations using a modern composite material specifically developed for dual-shade layering – CLEARFIL MAJESTY™ ES-2 Premium (Kuraray Noritake Dental Inc.). For an exact shade analysis, photographs were taken with and without a cross-polarized filter (Figs. 1 to 4).

Fig. 1. Frontal view of the teeth with extensive restoration loss on the maxillary left lateral incisor.

Fig. 2. Cross-polarized photograph of the teeth allowing for a detailed analysis of the shade irregularities.

Fig. 3. Lateral view of the teeth.

Fig. 4. Lateral view – cross-polarized photograph.

THE SOLUTION

Following removal of the existing restorations, rubber dam was placed for working field isolation. A self-etching adhesive (CLEARFIL™ SE Bond 2, Kuraray Noritake Dental Inc.) was applied in the selective enamel etching mode before establishing the palatal shell using CLEARFIL MAJESTY™ ES-2 Premium in the shade A1E (Figs. 5 and 6). The mamelon structures were reconstructed with CLEARFIL MAJESTY™ ES-2 Premium in the shade A1D, while the translucent shade Blue was applied to the opalescent zone. Finally, yellow and white tints were used for characterization. Fig. 7 illustrates the appearance before, Fig. 8 after finishing and polishing.

Fig. 5. Palatal shell established with the enamel shade A1E of the selected composite.

Fig. 6. Lateral view of the teeth during the restoration procedure.

Fig. 7. Restoration before finishing and polishing.

Fig. 8. Appearance of the restorations after finishing and polishing.

THE OUTCOME

To evaluate the final colour integration, another photograph was taken with a cross-polarized filter, holding a grey reference card in place for calibration (Figs. 9 and 10). The lateral view of the restored teeth (Fig. 11) reveals that not only the right colour combination, but also a natural surface texture is required for a highly aesthetic outcome.

Fig. 9. Frontal view of the restored teeth taken with a cross-polarized filter.

Fig. 10. Gray reference card calibration and the resulting L*a*b* coordinates of the restoration.

Fig. 11. Lateral view of the restored teeth stressing the importance of surface texture.

DISCUSSION AND CONCLUSION

Observation, supported by modern tools for photography and image analysis (like polarized filters and L*a*b* coordinates), is an important skill needed for the lifelike reconstruction of teeth with direct composite materials. By combining this skill with a high-performance composite system that offers fixed shade combinations and innovative light diffusion technology for a nice blend-in with the surrounding tooth structure, creating beautiful restorations becomes a predictable business.

In the case presented, the patient was very satisfied with the outcome in terms of aesthetics and function. At regular recalls, the quality of the restorations is checked – they still offer a very nice functional and aesthetic integration.

Dentist:

ONUR ALP YÜNÜK

Dr. Onur Alp Yünük completed both his undergraduate and doctoral education at Istanbul University. He currently serves as an Assistant Professor in the Department of Restorative Dentistry at the Istinye University Faculty of Dentistry. His work primarily focuses on direct composite restorations of anterior teeth and on polychromatic layering systems.

Case report by Vasilis Vasiliou

AESTHETIC RESTORATION OF MAXILLARY INCISORS

Falling in love, applying for a first job, attending a best friend’s wedding: There are so many occasions for young people when looking gorgeous is important. That is why restoring a young patient’s smile to its natural beauty is a special task that demands a lot from us. We need to listen to their touching stories, understand their specific needs and desires – and finally find a way to exceed their expectations. Whenever our plan works and is performed correctly, the outcome will be rewarded with extreme gratitude by those affected. After all, it is not only the smile we restore, but also the patients’ self-confidence and quality of life.

SINGLE BAKE, NATURAL RESULT

The good news: Even highly aesthetic all-ceramic restorations can be produced with a minimal number of bakes. Modern framework materials and porcelain systems allow us to imitate a natural play of colours and translucencies, a virtually unlimited number of individual effects and a vivid surface texture in a predictable way. A possible procedure is illustrated below. The materials utilized in this case were KATANA™ Zirconia STML and CERABIEN™ ZR (Kuraray Noritake Dental Inc.) and the restoration was completed using the One-Bake technique developed by MDT Nondas Vlachopoulos.

Fig. 1. Frameworks made of KATANA Zirconia STML in the shade A1.

Fig. 2. Single-bake layering procedure: Application of CERABIEN ZR Opacious Body in the cervical …

Fig. 3. … and mamelon areas.

Fig. 4. CERABIEN ZR Body porcelain applied in the body area.

Fig. 5. CERABIEN ZR Transitional Dentine used to increase the translucency in the incisal part.

Fig. 6. CERABIEN ZR Opacious Body added in specific areas to create more reflaction.

Fig. 7. Incisal cut-back and creation of the mamelon structure as well as adding of T Blue to give depth.

Fig. 8. … in the body and distal incisal areas.

Fig. 9. Application of Aqua Blue 1 and T Blue on the incisal edges to produce a youthful translucency.

Fig. 10. Creation … effect

Fig. 11. … of mamelons.

Fig. 12. Application of Luster porcelains: LTx, …

Fig. 13. … ELT1 …

Fig. 14. … and LT1.

Fig. 15. Cutback of the dentin for the creation of a halo effect.

Fig. 16. Final shape: Halo effect created with Body.

Fig. 17. Treatment outcome after a first bake followed by minor adjustments, surface texturing and glazing with CERABIEN™ ZR FC Paste Stain Clear Glaze.

Fig. 18. Restorations adhesively cemented in the patient’s mouth.

CONCLUSION

Restoring a young patient’s smile is a particularly challenging task, as the quality of the outcome has a huge effect on the self-confidence and quality of life of the affected person. By listening closely to our patients’ stories, understanding their needs and knowing our materials well, we are able to deliver exactly what they need. It is their positive feedback and happiness that drives me to never stop learning and practicing with my ceramics and porcelains for continued improvement and even better outcomes.

I would like to express my gratitude to Dr. Loukia Pedoulou for the professional partnership and clinical support in achieving this result.

Dental Technician:

VASILIS VASILIOU

Vasilis Vasiliou was born in Nicosia, Cyprus, and graduated from the Technical School for Dental Technicians in Athens in 2004. He has furthered his education by attending several advanced seminars led by mentors and experts in the field, such as Ilias Psarris and Nondas Vlachopoulos.

Throughout his career, Vasilis has made significant contributions to the dental community, including presenting at various conferences in Greece and publishing articles in Greek dental magazines. Since 2020, he has been a key opinion leader for MPF Brush Company and, since 2022, a HASS Ambassador. Vasilis has been an active member of the International Team for Implantology (ITI) since 2019.

Together with his father, Vasilis runs a successful dental laboratory in Nicosia, specializing in all-ceramic and implant restorations. His extensive experience and commitment to excellence have established him as a respected professional in his field.

Case by Dt. Koray Kendir, DDS, Turkey (İzmir)

INTRODUCTION

Trauma-related fractures of anterior teeth require a precise balance between aesthetics and function, often under emotional pressure from the patient. This clinical case demonstrates the restorative rehabilitation of a previously mismanaged central incisor using CLEARFIL MAJESTY™ ES-2 Premium and PANAVIA™ V5 (both Kuraray Noritake Dental Inc.). The team worked to re-establish biological, functional, and aesthetic harmony.

CASE SUMMARY

A 23-year-old female patient presented one month after a traumatic injury involving tooth #11 (FDI notation). Immediate root canal treatment and a direct composite build-up had been performed elsewhere in a single visit. The existing restoration showed poor aesthetics and marginal adaptation (Fig. 1).

Fig. 1. Initial clinical situation.

CLINICAL PROCEDURE

STEP 1: ISOLATION AND REMOVAL OF OLD RESTORATION

For the planned rehabilitation, the tooth was isolated with rubber dam (Figs. 2 and 3) and the existing composite restoration was removed. Gutta-percha from the previous endodontic treatment was found to be severely coronally trimmed (Fig. 4). This poses a risk of future discolouration. Consequently, the gutta-percha was condensed apically to a more biologically appropriate level using a downpack device (Figs. 5 to 9).

Fig. 2. Isolation of the working field with rubber dam: Labial view.

Fig. 3. Isolation of the working field with rubber dam: Occlusal view.

Fig. 4. Gutta-percha from the previous treatment.

Fig. 5. Gutta-percha removed, …

Fig. 6. … placed back into the root canal …

Fig. 7. … and condensed …

Fig. 8. … with a downpack device.

Fig. 9. Result of the procedure: Occlusal view.

STEP 2: CORE BUILD-UP

Subsequently, a fiber-reinforced composite was used to provide root-anchored support for the core structure. Then, the bonding surface was treated with phosphoric acid etchant, CLEARFIL™ Universal Bond Quick (Kuraray Noritake Dental Inc.) was applied as a universal adhesive and the core build-up was performed with CLEARFIL MAJESTY™ ES-2 Premium A1D (Figs. 10 to 13).

Fig. 10. Etching with phosphoric acid etchant.

Fig. 11. Application of the universal adhesive.

Fig. 12. Core build-up after thorough light curing.

Fig. 13. Intra-oral periapical radiograph or the treated tooth.

STEP 3: PREPARATION AND DIGITAL IMPRESSION

For definitive restoration, a 3/4 crown preparation was performed and an intraoral scan was taken. Moreover, a temporary crown was fabricated (Fig. 14) and shade photos were taken to finalize the session.

Fig. 14. Temporary restoration in place.

STEP 4: FINAL CEMENTATION

Once the lithium disilicate restoration was received from the laboratory, the temporary crown was removed and the abutment tooth was evaluated (Figs. 15 and 16). Try-in was performed using PANAVIA™ V5 Try-in Paste White to check shade and fit (Fig. 17). No modifications were required; the selected try-in paste contributed to a lifelike appearance of the restoration. For definitive placement, the intaglio surface of the crown was etched with hydrofluoric acid (Fig. 18). Figure 19 shows the appearance of the intaglio after this measure. To provide for optimal bonding conditions, the tooth surface was then cleaned with KATANA™ Cleaner (Kuraray Noritake Dental Inc.), which should be applied with a rubbing motion to the contaminated prepared tooth for more than ten seconds (Figs. 20 to 22). It may also be used to clean the intaglio of a restoration, which is contaminated with blood and saliva e.g. after try-in.

Fig. 15. Situation after removal of the temporary crown: Labial view.

Fig. 16. Situation after removal of the temporary crown: Occlusal view.

Fig. 17. Try-in of the lithium disilicate crown.

Fig. 18. Etching of the crown’s intaglio surface with hydrofluoric acid.

Fig. 19. Appearance of the etched surface.

Fig. 20. Cleaning of the abutment tooth …

Fig. 21. … surface covered with the cleaning agent.

Fig. 22. Thorough rinsing, which should be followed by drying with air.

Adhesive cementation itself was accomplished with the three-component PANAVIA™ V5 (Figs. 23 to 28): The prepared tooth structure and build-up was treated with PANAVIA™ V5 Tooth Primer, the intaglio surface of the crown with CLEARFIL™ CERAMIC PRIMER PLUS. Finally, PANAVIA™ V5 Universal (White) was extruded into the crown and the crown placed. Excess cement is best removed in the gel phase – i.e. after brief polymerization for 3 to 5 seconds before final light curing is performed. Alternatively, it may be removed immediately after seating the restoration with a brush or similar instrument. In this case the first option was chosen. The treatment outcome after rubber dam removal and final clinical and aesthetic evaluation is displayed in Figure 29.

Fig. 23. Priming of the tooth structure.

Fig. 24. Selected resin cement.

Fig. 25. Tooth structure ready for crown placement.

Fig. 26. Restoration in place.

Fig. 27. Lateral view of the restoration.

Fig. 28. Final light curing of the crown.

Fig. 29. Treatment outcome immediately after rubber dam removal.

CONCLUSION

This case highlights a comprehensive restorative approach to preserving a traumatized anterior tooth at risk of loss, while restoring both function and aesthetics. The strong core foundation provided by CLEARFIL MAJESTY™ ES-2 Premium and the reliable adhesive performance of PANAVIA™ V5 played a pivotal role in the successful procedure and outcome.

Dentist:

KORAY KENDIR

Dt. Koray Kendir is a graduate of Hacettepe University Faculty of Dentistry and the co-founder of a private dental clinic in İzmir. He specializes in digital dentistry, smile design, and computer-aided restorative treatments. Known for his innovative approach, Dr. Kendir is a frequent speaker at national dental congresses and serves as an advisor to several dental companies.

Case by DT Vasilis Vasiliou

MICRO-LAYERING WITH CERABIEN MiLai

No matter whether young or old, male or female: Our patients deserve a beautiful smile that matches their adjacent teeth, their face, their character and their individual needs. To be able to produce beautiful restorations that change their life for the better, we (as dental technicians) have to observe closely – and to listen attentively to the stories they tell.

‘We have to observe closely – and to listen attentively to the stories our patients tell us.’
– Vasilis Vasiliou –

Mr Andreas is a perfect example. He presented in the dental office in need of a full-mouth rehabilitation and the wish to improve the aesthetics of his smile. He asked for an age-appropriate, natural restoration design.

After careful observation and listening, I decided that the best way to restore his maxillary incisors would be with zirconia restorations. The plan was to mill the frameworks using low-value KATANA™ Zirconia YML, shade D3 (Kuraray Noritake Dental Inc.). To facilitate the integration of some natural characteristic effects, a framework design with a primarily vestibular cutback was selected. The finishing technique of choice was micro-layering with CERABIEN™ MiLai (Kuraray Noritake Dental Inc.), a porcelain designed specifically for this approach.

Important steps in the finishing procedure were:

• Characterization of the milled zirconia with colouring liquids
• Pre-treatment of the sandblasted zirconia surfaces with SS Fluoro and Margin porcelain
• Internal staining with CERABIEN™ MiLai internal stains
• Application of CERABIEN™ MiLai luster porcelains

LABORATORY WORKFLOW

Zirconia splinted crowns were designed in full contour with the aid of the Leahu Library featuring tailored tooth designs (part of the Truedental Library available for exocad DentalCAD design software; Fig. 1), cut back merely in the vestibular area using the ‘calma’ reduction option (Fig. 2), and then milled and characterized with colouring liquids to optimize the chroma.

Figure 3 shows the sintered frameworks on the model, Figure 4 the try-in in the patient’s mouth. As the fit and shape of the restorations turned out to be excellent, it was time to plan the internal staining and micro-layering procedure (Figs. 5 and 6), always trying to imitate nature as closely as possible.

The tricky part is to use the available space wisely – the reason why a detailed layering sketch is useful even when in the context of micro-layering. Once the planned layering procedure had been put to practice (Figs. 7 to 10), the surface texture was finalized and the restorations were tried in again for an aesthetic evaluation. Finally, they were cemented with the adhesive resin cement PANAVIA™ V5 (Kuraray Noritake Dental Inc.).

The beautiful treatment outcome is shown in Figure 11.

Fig. 1. Computer-aided design of the zirconia frameworks: Splinted crows displayed in a transparent mode to show the abutment teeth.

Fig. 2. Computer-aided design of the zirconia frameworks: Outer contour of the splinted crowns with a strongly elaborated surface texture and sufficient room for micro-layering.

Fig. 3. Restorations after characterization with colouring liquids and sintering on the model.

Fig. 4. Try-in of the restorations.

Fig. 7. Internal staining – specific characteristics elaborated for a natural depth effect.

Fig. 8. Layering in the cervical and body areas.

Fig. 9. Final layering with luster porcelains to complete the morphology.

Fig. 10. Final restorations after surface finishing and polishing as well as glazing on the model.

Fig. 11. Treatment outcome.

CONCLUSION

The patient was thoroughly satisfied with the treatment outcome and confident that his investment was well worth it. By tailoring my approach to his unique needs, carefully observing his teeth, smile, and facial expressions, and utilizing my extensive knowledge of materials, I was able to achieve this goal successfully.

Nonetheless, I remain committed to continuous improvement by critically evaluating each restoration and seeking areas for enhancement. My dedication to growth, supported by exceptional mentors who share innovative techniques and insights, supports me in staying at the forefront of my field, striving at consistently delivering the best possible care.

I am deeply grateful to Dr. Zinonas Evagorou for invaluable partnership and clinical expertise, which were instrumental in achieving this result.

Dental Technician:

VASILIS VASILIOU

Vasilis Vasiliou was born in Nicosia, Cyprus, and graduated from the Technical School for Dental Technicians in Athens in 2004. He has furthered his education by attending several advanced seminars led by mentors and experts in the field, such as Ilias Psarris and Nondas Vlachopoulos.

Throughout his career, Vasilis has made significant contributions to the dental community, including presenting at various conferences in Greece and publishing articles in Greek dental magazines. Since 2020, he has been a key opinion leader for MPF Brush Company and, since 2022, a HASS Ambassador.

Vasilis has been an active member of the International Team for Implantology (ITI) since 2019.

Together with his father, Vasilis runs a successful dental laboratory in Nicosia, specializing in all-ceramic and implant restorations. His extensive experience and commitment to excellence have established him as a respected professional in his field.

Case by Dr. Michał Jaczewski

FLOWABLE INJECTION TECHNIQUE

What are the most important properties of a flowable composite used for the flowable injection technique? Personal experience shows that balanced optical properties are essential, with an appropriate translucency, blend-in ability and surface gloss leading the way. However, the mechanical properties are also important, not least because the restorative material will be in direct contact with the antagonist teeth. And finally, handling properties are essential: The right level of flowability is needed for proper injection, while a void-free application is required for an intact, stain-resistant surface.

For the last seven years, CLEARFIL MAJESTY™ ES Flow Low (Kuraray Noritake Dental Inc.) has been my go-to flowable composite for the flowable injection technique. Its level of flowability is ideal for the technique in the anterior and posterior region. Whenever a lower flowability is needed, it is possible to switch to the Super Low variant. Moreover, I like the shade offering, which – together with the superior polishability of the material – leads to natural aesthetics. Finally, its mechanical properties are so good that the product is approved for a wide indication range without load limitations.

When the company announced the introduction of CLEARFIL MAJESTY™ ES Flow Universal, which comes in just two universal shades and two different levels of flowability (Low and Super Low), I immediately decided to give it a try: The prospect of balanced properties I am already familiar with, combined with a simplified shade selection sounded very promising. So far, the new product comes up to my expectations: The following case example reveals the simplicity of the procedure and the beauty of the results. The patient presented during orthodontic (aligner) treatment for a shape correction in the anterior region due to wear of the incisal edge.

Fig. 1. Initial clinical situation: Patient in need of a shape correction in the maxillary incisor region.

Fig. 2. Application of CLEARFIL™ Universal Bond Quick 2 (Kuraray Noritake Dental Inc.) to the enamel of a central incisor, which has been merely roughened by air abrasion with aluminium oxide (50 μm at low pressure) followed by etching with a phosphoric acid etchant.

Fig. 3. Transparent silicon index placed in the mouth and CLEARFIL MAJESTY ES Flow Universal Low (U shade) already injected in the position of the maxillary right central incisor.

Fig. 4. Shape correction on the maxillary right central incisor completed.

Fig. 5. Situation after finishing and polishing of the incisor restorations.

Fig. 6. Nice shade match leading to a smooth blend-in with the surrounding natural tooth structure.

Fig. 7. Immediate treatment outcome supporting an improvement of the smile aesthetics and hence, the patient‘s quality of life during aligner therapy.

RESULTS THAT SPEAK FOR THEMSELVES

Like its related product CLEARFIL MAJESTY ES Flow, the universal-shade version CLEARFIL MAJESTY ES Flow Universal offers properties which are – from a personal perspective – ideal for the flowable injection technique. The shade-matching properties are astonishing; the translucency is quite high when placed in thin layers (so that enamel is very well imitated), and the polishability is as good as that of CLEARFIL MAJESTY ES Flow. For virtually effortless, bubble-free injection, the product comes in a nicely designed syringe. And last but not least, the product’s mechanical properties provide peace of mind even in the posterior region.

Dentist:

MICHAŁ JACZEWSKI

Michał Jaczewski graduated from Wroclaw Medical University in 2006 and today runs his private practice in the city of Legnica, Poland. He specializes in minimally invasive dentistry and digital dentistry and is the founder of the Biofunctional School of Occlusion. Here he lectures and runs workshops with focus on full comprehensive patient treatments.

Case by DT Andreas Chatzimpatzakis

AESTHETIC AND EFFICIENT SMILE MAKEOVER

Most patients asking for a smile makeover desire custom solutions rather than an off-the-peg smile: Individual tooth shapes that fit their face and their character, an internal play of colours that matches their age and natural dentition. Modern dental materials allow us to deliver what they demand in many situations – usually at a reasonable price.

For a long time, however, we have been facing challenges when combining cosmetic and medically indicated treatment – e.g. a smile makeover including the rehabilitation of a missing lateral incisor. A straightforward solution – using lithium disilicate veneers alongside a zirconia cantilever bridge, both finished with their respective porcelain systems – would have been complicated by potential differences in the final appearance. With CERABIEN™ MiLai (Kuraray Noritake Dental Inc.), a set of internal stains and porcelains designed for micro-layering, the situation is different: Suitable for micro-layering on zirconia and lithium disilicate, it supports its user ideally in creating a harmonious smile even when the two framework materials are combined.

A NEW CUSTOM SMILE

The following patient case is a perfect example: A female patient with a missing lateral incisor, multiple visible composite restorations in the anterior region and an enamel fracture at her incisal edge desired a smile makeover. The selected materials were Amber Press LT (HASS), shade A1, for four veneers on the central incisors and the left lateral incisor and canine (teeth # 11, 21, 22 and 23 according to the FDI notation) and KATANA™ Zirconia YML (Kuraray Noritake Dental Inc.), shade A2, for the planned cantilever bridge on the maxillary right canine, replacing the missing lateral incisor (teeth # 12 and 13).

Fig. 1. Female patient with a missing maxillary lateral incisor and multiple composite restorations in the anterior area – a smile makeover is desired.

Fig. 2. Patient with mock-up.

Fig. 3. Minimally invasive preparation through the mock-up, which takes into account the minimum space required for the planned materials and restorations.

Fig. 4. Teeth prepared for the all-ceramic restorations.

Fig. 5. Occlusal view of the maxillary teeth after tooth preparation.

Fig. 6. Full-contour veneers and cantilever bridge on the model.

Fig. 7. Restorations after a cutback limited to the vestibular and incisal area.

Fig. 8. CERABIEN™ MiLai LT₁ is applied to the middle and cervical area of the zirconia cantilever bridge.

Fig. 9. CERABIEN™ MiLai Value Liner 2...

Fig. 10. … and Value Liner 1 applied to the incisal area of the central and lateral incisor restorations.

Fig. 11. CERABIEN™ MiLai porcelain Creamy Enamel mixed with Value Liner 2 (70/30) added to the middle and cervical areas of the four lithium disilicate restorations to increase and control the value.

Fig. 12. ... while E2 is added to the incisal area of both canines.

Fig. 13. Restorations covered by a layer of Tx ...

Fig. 14. ... and LTx.

Fig. 15. Appearance of the restorations after the first bake.

Fig. 16. Adding translucency and opalescence to the cervical area with LT₁ and brightness to the ridges with Creamy Enamel.

Fig. 17. Completion of the enamel surface with a cover layer of LTx, which is responsible for a high translucency and opalescence.

Fig. 18. Result of the second bake.

Fig. 19. Final restorations with a natural self-glaze effect on the model.

Fig. 20. Final restorations with a natural self-glaze effect in the patient’s mouth.

Fig. 21. Smooth optical integration of the restorations.

Fig. 22. Beautiful treatment outcome.

CONCLUSION

With the described approach and selected materials, it was possible to create restorations with a natural shade, shape and texture. They matched not only the appearance of the remaining natural teeth, but also showed internal consistency across the selected framework materials. The technical procedure was quite straightforward and efficient, while the result speaks for itself.

Special thanks to Dr. Kanellos Ioannis for the collaboration on this case and for kindly providing the pre- and post-treatment photographs that complemented it.

Dental technician:

ANDREAS CHATZIMPATZAKIS

Based in Athens, Greece, Andreas Chatzimpatzakis is the founder and director of ACH Dental Laboratory (since 2000), specializing in refractory veneers, lithium disilicate, zirconia, and implant prostheses. He graduated in Dental Technology from the University of West Attica and received advanced training in all-ceramic restorations in Helsinki and Japan under renowned masters including Shigeo Kataoka.

Since 2017, he has served as an international trainer for Kuraray–Noritake Dental Inc., delivering lectures and hands-on courses worldwide on advanced ceramic techniques. He has also held roles as Key Opinion Leader for MPF Brush Co., Ambassador for Hass Co., and Editor-in-Chief of Laborama. An active member of the Hellenic Academy of Aesthetic Dentistry, his work and articles have been published in both Greek and international journals.

Case by Dt. Koray Kendir, DDS, Turkey (İzmir)

ABSTRACT

This clinical case report presents a posterior direct composite restoration performed using Kuraray Noritake Dental Inc.’s “Universal Excellence” product concept. A universal adhesive (CLEARFIL™ Universal Bond Quick 2) and a highly filled, universal-shade flowable composite (CLEARFIL MAJESTY™ ES Flow Universal) were utilized to achieve both simplicity and predictability. Step-by-step documentation demonstrates isolation, cavity preparation, deep margin elevation, adhesive protocol, and final restoration.

CASE DESCRIPTION

A 38-year-old female patient presented with complaints of interdental bleeding and cold sensitivity between her maxillary left canine and first premolar (teeth #23 and #24, FDI notation). Clinical examination revealed an open margin and secondary caries at the gingival floor of the existing restoration on tooth #23. After rubber dam isolation, the stepwise treatment procedure was initiated.

CLINICAL PROCEDURE

Step 1. Tooth #23 exhibited an open gingival margin and caries (Fig. 1).

Step 2. After enamel removal, caries was excavated down to the gingival level. The lesion on tooth #24 was observed to extend subgingivally (Fig. 2).

Step 3. After complete caries excavation and cavity refinement, the need for deep margin elevation (DME) on tooth #24 became evident (Fig. 3).

Step 4. Deep margin elevation (DME) was performed on tooth #24 using a custom sectional wedge. First, selective etching and CLEARFIL™ Universal Bond Quick 2 were applied, followed by the placement of CLEARFIL MAJESTY™ ES Flow Universal (Super Low) (Figs. 4 to 6).

Step 5. After completion of the DME (deep margin elevation), appropriate matrix bands were placed, followed by a direct restoration of teeth #23 and #24 with CLEARFIL MAJESTY™ ES Flow Universal (Super Low) (Figs. 7 to 9). Thanks to the material’s easy handling, shade adaptation, and excellent polishability, this challenging DME case was successfully and efficiently managed.

The treatment outcome is shown in Figures 10 and 11.

Fig. 1. Preoperative view under rubber dam isolation.

Fig. 2. Clinical situation after caries excavation.

Fig. 3. Refined cavities with a deep margin on the premolar.

Fig. 4. Custom wedge placed to elevate the margin.

Fig. 5. Buccal view of the teeth after deep margin elevation with universal products.

Fig. 6. Occlusal view of the teeth after deep margin elevation with universal products.

Fig. 7. Placement of a sectional matrix.

Fig. 8. Buccal view of the teeth restored with a universal-shade flowable composite with super low flowability.

Fig. 9. Occlusal view of the teeth restored with a universal-shade flowable composite.

Fig. 10. Occlusal view of the final restorations of teeth #23 and #24, showing colour blending, anatomical form, and surface gloss.

Fig. 11. Buccal view of the final restorations of teeth #23 and #24, showing colour blending, anatomical form, and surface gloss.

DISCUSSION

Universal adhesives and modern flowable composites simplify posterior direct restorations by reducing technique sensitivity while providing for durable outcomes. In this case, CLEARFIL™ Universal Bond Quick 2 provided strong adhesion with minimal application time. The universal flowable composite demonstrated excellent adaptability, polishability, and durability. Even with a subgingival margin requiring DME, a streamlined approach was achieved without compromising quality.

CONCLUSION

The combination of CLEARFIL™ Universal Bond Quick 2 and CLEARFIL MAJESTY™ ES Flow Universal allows clinicians to perform predictable, efficient posterior restorations. Their universal applicability and handling properties align with the “Universal Excellence” concept, supporting simplified, yet reliable daily practice.

Ethics & Disclosure

All procedures were performed in accordance with standard dental practice. The patient provided informed consent for treatment and publication of anonymized clinical images. Author collaborates with Kuraray Noritake Dental Inc. as an advisor; content reflects clinical experience.

Dentist:

KORAY KENDIR

Dt. Koray Kendir is a graduate of Hacettepe University Faculty of Dentistry and the co-founder of a private dental clinic in İzmir. He specializes in digital dentistry, smile design, and computer-aided restorative treatments. Known for his innovative approach, Dr. Kendir is a frequent speaker at national dental congresses and serves as an advisor to several dental companies.

Case by Andreas Chatzimpatzakis

For zirconia-based screw-retained implant-supported prostheses, diverse finishing concepts are available. Most of them are quite complex and time-consuming. A streamlined approach that brings efficiency into the finishing procedure without compromising aesthetics and function is micro-layering with CERABIEN™ MiLai (Kuraray Noritake Dental Inc.) on a zirconia superstructure with just a slight vestibular cutback. A possible technical procedure is demonstrated using the following case example. The patient was treated by prosthodontist Dr. Georgios Siavikis from Ioannina, Greece.

Fig. 1. Occlusal view of an implant-supported overdenture made of KATANA™ Zirconia HTML PLUS (Kuraray Noritake Dental Inc.) for a male patient with an edentulous maxilla and a removable partial denture in the mandible.

Fig. 2. Frontal view of the milled and sintered screw-retained implant-supported prosthesis.

Fig. 3. Appearance after the application of CERABIEN™ MiLai SS Fluoro and internal stains to enhance the natural shading of the restoration in the tooth and gum areas.

Fig. 4. Result of micro-layering with CERABIEN™ MiLai porcelains LT1 for the cervical as well as E2 and TX for the middle and incisal sections for a seamless gradient in translucency. For an optimal gingival harmony and match with the surrounding tissue, the tissue shades 1, 5 and 6 were applied.

Fig. 5. The restoration after finishing.

Fig. 6. The gingiva and tooth areas have a natural appearance …

Fig. 7. … due to a natural colour, translucency and surface texture.

Fig. 8. Intraoral harmony.

PREDICTABLE OUTCOMES

In this case, the use of an aesthetic, high-strength multi-layered zirconia was a true enabler of a streamlined finishing technique. As a convinced and frequent user of CERABIEN™ ZR, micro-layering with CERABIEN™ MiLai appeared to work flawlessly right from the start. The systems are perfectly aligned to each other, and as they are both based on synthetic feldspathic technology, they offer consistent material properties. These provide precise control over the layering and shading, thus supporting a highly aesthetic and well-integrated implant restoration.

Dental technician:

ANDREAS CHATZIMPATZAKIS

Andreas graduated from the Dental Technology Institute (TEI) of Athens in 1999. During his studies he followed a program at the Helsinki Polytechnic Department of Dental Technique, where he trained on implant superstructures and all ceramic prosthetic restorations. As of 2000, he is running the ACH Dental Laboratory in Athens, Greece, specialized on refractory veneers, zirconia and long span implant prosthesis. In 2017 Andreas visited Japan where he trained under the guidance of Hitoshi Aoshima, Naoto Yuasa and Kazunabu Yamanda and become International Trainer for Kuraray Noritake Dental Inc..