429 Too Many Requests

Case by Dumitru Leahu

INTRODUCTION

Complex anterior rehabilitations require careful control of shape, colour and optical properties. In this implant-supported restoration, a KATANA™ Zirconia YML framework was combined with CERABIEN™ ZR and CERABIEN™ MiLai (all Kuraray Noritake Dental Inc.) to achieve the desired aesthetic outcome.

FRAMEWORK DESIGN

A 1mm vestibular cut-back and a free zirconia incisal third were incorporated into the framework design to provide sufficient space for the ceramic layers. KATANA Zirconia YML was used for the implant-supported restoration (Fig. 1). The sintering temperature was 1,550 °C.

Fig. 1. Framework design with a 1mm vestibular cut-back and a free zirconia incisal third.

MATERIAL:

KATANA Zirconia YML

CERABIEN ZR BASE BUILD-UP

The first ceramic firing with high-fusing CERABIEN ZR porcelain was used to create well-defined and stable concavities with sufficient value and brightness (Fig. 2). The materials used were 0.5 NW Body, Enamel 1, LTx, Tissue 3 and Tissue 4. The firing temperature was 940 °C.

Fig. 2. Base build-up with CERABIEN ZR using 0.5 NW Body, Enamel 1, LTx, Tissue 3 and Tissue 4.

MATERIAL:

CERABIEN ZR

INTERNAL CHARACTERISATION

Internal characterisation was performed with CERABIEN MiLai internal stains (Fig. 3). Cervical 2 + Bright (mixed in a ratio of 40/60), White + (A+) + Bright (50/10/40), and Tissue Red + Bright (60/40) were applied as indicated. The firing temperature was 700 °C. The internal stains were used to reproduce the internal anatomy and characterisation of the restoration and to support the colour match with the natural teeth (Figs. 4 to 6).

Fig. 3. Internal characterisation with CERABIEN MiLai internal stains.

Fig. 4. Detail of the incisal characterisation. (left)

Fig. 5. Detail of the cervical characterisation. (right)

Fig. 6. Intraoral reference for matching the restoration to the natural teeth.

FINAL BUILD-UP WITH CERABIEN MILAI

The bridge was finished with low-temperature CERABIEN MiLai porcelain. LT1, LTx and ELT₁ were used for the final build-up (Fig. 7). The firing temperature was 780 °C. Tissue 1 was subsequently applied to create the final gingival shape (Fig. 8). This time, the firing temperature was 740 °C. Figures 9, 10 and 11 show the finished restoration extraorally, at intraoral try-in and after definitive placement on the implants.

Fig. 7. Final ceramic build-up with LT₁, LTx and ELT₁.

Fig. 8. Gingival build-up with Tissue 1.

Fig. 9. Finished implant-supported bridge.

Fig. 10. Final restoration at try-in.

Fig. 11. Final intraoral result.

CONCLUSION

The presented hybrid approach combines the advantages of high- and low-fusing porcelains for the aesthetic individualisation of anterior zirconia restorations. The high-fusing CERABIEN ZR porcelain can be used to establish the basic morphology and optical foundation before proceeding with lower-temperature characterisation and final layering. As the previously fired CERABIEN ZR layers remain stable during the subsequent CERABIEN MiLai firings, the restoration can be further individualised while maintaining the structures already established.

UNCOMPROMISED.
UNMATCHED.
YOURS.

Case by DT Roberto Rossi

BIO-INSPIRED

White and pink aesthetic rehabilitations require a workflow that combines accurate framework design with controlled ceramic layering. When each step is carefully planned, the optical properties of the framework material can be fully exploited, reducing the need for extensive ceramic layering. The following case illustrates this workflow using a bio-inspired approach.

In this case, a micro-layering technique was used to reproduce the vestibular aesthetics while preserving the morphology of the zirconia framework. KATANA™ Zirconia YML was combined with the low-firing ceramic CERABIEN™ MiLai (both Kuraray Noritake Dental Inc.), making this combination well suited to this type of restoration.

FRAMEWORK DESIGN

To enhance the bio-design effect, in which the framework morphology reproduces the natural distribution of dentin and enamel, an accurate milling strategy is essential. The planned framework morphology should be reproduced faithfully, without losing detail in the proximal areas or at the transition between the white and pink aesthetics (Fig. 1). The optical properties of the milled framework (Fig. 2) and the accuracy of the milled surface (Fig. 3) provide the basis for a predictable aesthetic result.

Fig. 1. Milled restoration within the disc.

Fig. 2. Milled zirconia framework reproducing the cut-back design.

Fig. 3. Detailed view of the accurately milled framework surface.

Once the framework has been correctly sintered, the optical properties of the multilayer zirconia and the effect of the cubic zirconia phase can be fully appreciated. Before sintering, however, particular attention should be paid to the framework surface. Any adjustments should preserve, or even improve, the original morphology created during the CAD design stage. The framework should exhibit a smooth, dense surface, free from roughness and porosity, providing the ideal basis for the subsequent characterisation procedures (Fig. 4).

Fig. 4. Framework surface after sintering, surface texturing and finishing.

The shade of the KATANA Zirconia YML disc should generally be selected one shade lighter than the desired final shade. This helps to avoid excessive chroma and a low-value appearance in areas where the zirconia is thicker, while maintaining flexibility during the subsequent characterisation and layering procedures (Fig. 5).

Fig. 5. Sintered framework on the model.

Thanks to the varying light transmission through the different thicknesses of the bio-designed incisal area, the dentinal effect becomes clearly visible after sintering (Fig. 6). Rather than masking these optical properties, the following steps are designed to enhance them through internal characterisation and selective micro-layering.

Fig. 6. Varying light transmission of the framework.

INTERNAL STAINING

The first stage of framework individualisation is carried out using the Internal Live Stain (ILS) technique (Chroma map 1). At this stage, the zirconia framework is considered the dentinal core of the restoration. The technique is simple to apply, provides an immediate visual effect and is particularly suitable for mirror-image tooth groups as well as white and pink aesthetic rehabilitations (Figs. 7 and 8).

Chroma map 1. Initial internal staining planned.

Fig. 7. Dots of internal stains applied to visualize the planned ILS procedure.

Fig. 8. Planned distribution of the internal stains.

The initial application aims to increase the chroma of the zirconia, while maintaining a high value in the incisal third. The high value of KATANA Zirconia YML helps preserve the overall brightness of the restoration after subsequent micro-layering with CERABIEN MiLai.

The Globule Painting technique used consists of three stages: application, shading and inspection. It also offers a modular approach, allowing additional applications whenever a higher level of individualisation is required.

At this stage, only the deeper optical effects should be reproduced with internal stains. Incisal Blue 2 is used to create opalescence, A+ to increase chroma, and Salmon Pink together with Tissue Red to characterise the gingival tissues (Figs. 9a to c). The internal effects are then assessed before firing. After firing, the colours retain their appearance (Fig. 10), allowing the technician to proceed directly to the micro-layering stage.

Fig. 9a. Incisal Blue 2 applied to the incisal area.
Fig. 9b. A+ applied to increase chroma.
Fig. 9c. Salmon Pink and Tissue Red applied to characterise the gingival tissues.

Fig. 10. Framework after firing following the initial internal staining.

Chroma map 2. Comparison of the planned and completed internal staining.

MICRO-LAYERING

After internal staining, the restoration is ready for micro-layering with CERABIEN MiLai. Depending on the effects to be reproduced and the space provided by the CAD design, translucent, opalescent and lustre porcelains can be used to reproduce the enamel layer. Opaque dentin porcelains, used individually or in combination, can be applied in the cervical and middle thirds or to create a more opaque mamelon effect.

The build-up follows a defined sequence (Layering map 1). CCV2 is applied to maintain translucency while increasing chroma (Fig. 11). LT₁ is serves as the main lustre porcelain in the middle third (Fig. 12), while E₂ is used as a transition dentin in the incisal area and provides the basis for the subsequent effects (Fig. 13).

Layering map 1. Overview of the planned micro-layering procedure.

Fig. 11. CCV2 applied to maintain translucency while increasing chroma in the cervical area.

Fig. 12. LT₁ applied as the principal lustre porcelain in the middle third.

Fig. 13. E₂ applied as transition dentin in the incisal area.

To enhance opalescence while maintaining translucency, Aqua Blue 2 is applied to the incisal area (Fig. 14). Value Liner 1 is then applied within the E₂ layer, while Aqua Blue 2 is placed over the incisal edge to increase the contrast of the mamelons (Fig. 15).

Fig. 14. Aqua Blue 2 applied to enhance opalescence.

Fig. 15. Value Liner 1 and Aqua Blue 2 applied to increase mamelon contrast.

The basic morphology is completed with a further application of LT₁, filling the transition between the cervical and incisal areas (Fig. 16). For the gingival portion of the restoration, Tissue 5 is used to reproduce the deeper reddish areas, while Tissue 6 is applied to the superficial alveolar tissues (Fig. 17). After firing, the optical effects created by the internal staining and micro-layering become clearly visible (Fig. 18).

Fig. 16. LT₁ applied to complete the transition between the cervical and incisal areas.

Fig. 17. Tissue 5 and Tissue 6 applied to reproduce the gingival tissues.

Fig. 18. Restoration after firing following the micro-layering procedure.

ILS ADJUSTMENT

One of the strengths of the ILS technique is its modularity. Multiple effects can be applied during the initial characterisation, or the firing cycles can be separated to allow additional effects to be added later. Since the internal stains are designed to remain stable during firing and the internal stains contain no internal flux, further characterisation can be carried out without compromising the previous application.

Another advantage is the immediate appearance of the applied effects. This allows the technician to assess the colour distribution directly during application and compare the result with the desired outcome. The colour stability of the internal stains after firing also provides excellent control throughout the procedure. The appearance observed before firing closely corresponds to the fired result, making it possible to verify the characterisation before the restoration is returned to the furnace. This can be particularly useful when digital shade-matching systems, such as photography or spectrophotometry, are used.

Before applying a second layer of internal stains, the fired surface should be refined with fine diamond burs to obtain a smooth surface for the stains (Fig. 19). At this stage, the superficial enamel effects are refined by reinforcing selected characterisation effects, enhancing opalescence and adding localised spots (Chroma map 3).

In the present case, a mixture of White and Mamelon Orange 2 (4:1) was applied to enhance the mamelons. Incisal Blue 2 was then placed adjacent to the mamelons to enhance the contrast.

Chroma map 3. Map visualizing the planned ILS adjustment.

Fig. 19. Refinement of the framework surface before the second application of internal stains.

FINAL LAYERING

The final layering stage is used to refine both the morphology and the enamel effects using lustre and enamel porcelains. At this stage, all areas characterised with ILS should be covered with ceramic.

LT₁ can be used to complete the cervical and middle thirds where no further increase in chroma is required while maintaining the value of the restoration. At the same step, LTx is applied from the middle third towards the incisal area to increase translucency and create a lower-value effect in the incisal region (Fig. 20). ELT₁ is then used to refine the morphology and reproduce the natural contrast of enamel by creating the impression of greater enamel thickness in the proximal areas. For the gingival tissues, Tissue 5 is applied to compensate for shrinkage between the teeth and in the deeper areas, while Tissue 1 is used to reproduce the translucent appearance of the superficial gingival tissues (Fig. 21).

Fig. 20. Application of LT₁ and LTx during the final layering stage.

Fig. 21. Completed enamel and gingival layering.

SURFACE TEXTURE AND FINISHING

After firing the enamel layer, the surface texture is refined using diamond burs of different shapes to reproduce a natural surface morphology (Fig. 22). Before self-glazing, gold powder can be applied to highlight the surface texture and facilitate its evaluation (Fig. 23).

Fig. 22. Surface texture reproduced with rotary instruments.

Fig. 23. Gold powder applied to highlight the surface texture before self-glazing.

Self-glazing enhances the quality and compactness of the porcelain while preserving the natural concavities and convexities of the surface texture. Following glazing, the surface can be refined mechanically using ceramic polishing rubbers to achieve the final polish.

The restoration can be evaluated under different lighting conditions to assess the optical properties of KATANA Zirconia YML (Fig. 24), the micro-layering effects (Fig. 25) and the surface texture. The final result demonstrates the harmony between the white and pink aesthetics (Fig. 26).

Fig. 24. Transmitted-light view revealing the optical properties of the restoration.

Fig. 25. Micro-layering effects visible in the finished restoration.

Fig. 26. Final white and pink aesthetic result.

FINAL REMARKS

This case demonstrates how controlled internal characterisation and selective micro-layering can be used to preserve and enhance the optical properties of a zirconia framework. By combining accurate framework design with minimal ceramic application, highly natural white and pink aesthetics can be achieved in a predictable and efficient workflow.

UNCOMPROMISED.
UNMATCHED.
YOURS.

Case by DT Ghaith Alousi

MATERIALS USED

KATANA Zirconia YML

ZIRCONIA BLANK

High-esthetic multilayer zirconia blank with a natural colour gradient from cervical to incisal. Combines high flexural strength with excellent translucency. Ideal for partial veneering.

CERABIEN MiLai

VENEERING CERAMIC

New-generation veneering ceramic specifically developed for zirconia and lithium disilicate restorations. Excellent adhesion to zirconia, natural light optics, wide range of masses for detailed layering techniques.

CERABIEN MiLai Internal Stains

STAIN COLORS

Incisal Blue 1, Mamelon Orange 2, A+, Tissue Pink, Salmon Pink, White – all mixed with Bright for optimal consistency and application precision.

CERABIEN MiLai Masses

CERAMIC MASSES

Tx, Creamy Enamel, LTx, CCV-2, ELT₁ for teeth. Tissue 1, 4, 6 for the gingiva.

INTRODUCTION

The technique represents a modern, efficient approach to dental laboratory aesthetics: rather than voluminous ceramic build-ups, minimal yet precisely applied layers are used, which in combination with the intrinsic aesthetic of the zirconia framework achieve an extraordinary result.

In this case report, dental technician Ghaith Alousi documents step-by-step the fabrication of a facially layered maxillary anterior zirconia restoration based on KATANA™ Zirconia YML and the novel veneering ceramic CERABIEN™ MiLai. The key feature: the palatal surface remains monolithic zirconia, while only the vestibular surface is veneered with CERABIEN MiLai. This combines the stability of zirconia with the incomparable aesthetics of a hand-layered porcelain.

STEP 1: ZIRCONIA FRAMEWORK BEFORE SINTERING

CAD/CAM Milling · KATANA Zirconia YML · Green State

The framework was deliberately designed for partial labial veneering: the vestibular surface provides sufficient space for the CERABIEN MiLai ceramic. While the palatal surfaces are entirely monolithic, the occlusal contact points remain on the mechanically superior zirconia.

Fig. 1. Framework before sintering. Framework after milling.

MATERIAL:

KATANA Zirconia YML

STEP 2: AFTER SINTERING

Sintering · Multi-Layer Aesthetics · Sandblasting

Following the sintering cycle at 1550 °C, the KATANA Zirconia YML framework reveals its full multi-layered character. The impressive colour gradient – from a warm, yellowish-cream tone cervically to the cool, translucent incisal edge – is the direct result of the pigment layering integrated into the blank.

The framework was cleaned directly after sintering using sandblasting only (110 μm, 1.5 bar), with no further processing.

Fig. 2. Sintered framework vestibular view – multi-layered colour gradient after sintering.

Fig. 3. Sintered framework - palatal view – monolithic zirconia structure.

PROCESSING:

• Sintering (1550 °C)
• Sandblasting

STEP 3: FIRST STAIN LAYER

CERABIEN MiLai Internal Stains · Colour Foundation · Internal Characterisation

Prior to ceramic layering, a differentiated stain layer is applied directly to the sintered zirconia framework. This layer serves as the colour foundation and internal characterisation – defining depth effect and individuality.

Colour distribution by zone:

Incisal: Incisal Blue 1 + Bright 20 % – to simulate the natural opalescence effect.
Mid incisor area: Mamelon Orange 2 + Bright 20 % – to replicate the characteristic mamelon structure.
Cervical area & interproximal: A+ + Bright 20 % – for increased chroma and saturation in the cervical third.
Gingival area: Tissue Pink + Salmon Pink – for natural tissue toning.

Fig. 4. CERABIEN MiLai Internal Stains applied – unfired state.

CERABIEN MiLai INTERNAL STAINS:

• Incisal Blue 1 + Bright 20 % (incisal area)
• Mamelon Orange 2 + Bright 20 % (mamelons)
• A+ + Bright 20 % (cervical & interproximal areas)
• Tissue Pink (gingiva)
• Salmon Pink (gingiva)

STEP 4: FIRST CERAMIC LAYER & WASH BAKE

Tx + Tissue 1 · Bonding Fire · Bond Optimisation

After firing the stains, the first ceramic layer is applied using CERABIEN MiLai Tx for the tooth areas and Tissue 1 for the gingiva. The goal is to establish an optimal bond between ceramic and zirconia.

A deliberate wash bake is performed: the firing temperature is raised above the normal reference value so that the ceramic mass flows more readily and bonds optimally to the zirconia surface. A liner or wash fire is intentionally omitted.

Fig. 5. First ceramic layer – unfired, frontal view.

Fig. 6. Frontal view – raw first layer.

CERABIEN MiLai MASSES:

• Tx (Translucent) – tooth portions
• Tissue 1 – gingival area
• Firing mode: wash bake (elevated temperature)

STEP 5: AFTER WASH BAKE

Bond Verification · Preparation for Second Stain Layer

The result after the wash bake shows a first ceramic layer fused to the zirconia. The surface appears smooth and uniformly glossy. The Tx layer enhances the intrinsic translucency of KATANA Zirconia YML and allows the multi-layer colour gradient to shine through harmoniously.

Fig. 7. After wash bake – Tx and Tissue 1 perfectly fused to zirconia.

STEP 6: SECOND STAIN LAYER – DETAIL CHARACTERISATION

Natural Cracks · White · Surface Individualization

In the second stain layer, the focus is on maximum precision and detail. CERABIEN MiLai internal stain White is used to apply fine, naturally appearing crack lines (Natural Cracks) to the tooth surface.

These subtle whitish crack lines develop in natural teeth through enamel stresses and impart to them their unmistakable, vital character. They run anatomically correctly in a vertical direction, varying in intensity and length – exactly as found in nature.

Fig. 8. Close-up – fine crack lines with white stain.

Fig. 9. Second stain overview – harmonious detail distribution.

CERABIEN MiLai INTERNAL STAIN:

• White – Natural Cracks / craquelé lines

STEP 7: SECOND CERAMIC LAYER – MAIN BUILD-UP

Morphology · Enamel Masses · Gingival Design

The second ceramic layer requires the highest concentration on colour, morphology, and surface texture simultaneously. This is the main build-up, during which the final form of the restoration is established.

Tooth masses – zonal strategy:

Creamy Enamel establishes the warm body tone. LTx (Luster Translucent) imparts opalescent vitality. CCV-2 (Clear Cervical 2) provides transparent chroma cervically. ELT₁ (Enamel Luster 1) completes the incisal zone with a delicate enamel gloss.

Gingival masses:

Tissue 1, 4, and 6 create a differentiated tissue appearance with light, mid, and deep tones.

Fig. 10. Main build-up – Unfired state.

CERABIEN MiLai MASSES – TEETH:

• Creamy Enamel – body zone
• LTx (Luster Translucent) – opalescent vitality
• CCV-2 (Clear Cervical 2) – cervical chroma
• ELT₁ (Enamel Luster 1) – incisal enamel gloss

Fig. 11. Main build-up – Close-up – surface texture.

Fig. 12. Main build-up – Close-up – surface texture.

CERABIEN MiLai MASSES – GINGIVA:

• Tissue 1 – light, delicate tissue areas
• Tissue 4 – mid gingival tone
• Tissue 6 – depth, shadow, interdental papillae

STEP 8: SECOND CERAMIC FIRING

Not Yet Finished · As-Fired State

The result after the second ceramic firing is already convincing in its raw form. The fired mamelon structures, the fine crack lines, and the differentiated gingival design are clearly visible. The final surface texture and form will be refined in the next step through mechanical finishing.

Fig. 13. After second firing – not yet finished.

STEP 9: MECHANICAL FINISHING

Morphology Refinement · Before Self-Glaze Firing

Mechanical finishing requires artisanal expertise and a trained aesthetic eye. Diamond burs are used to bring form, proportions, and surface texture to their final level.

Special attention is given to surface texture: perikymata, vertical lobule structures, and the cervicogingival transition are individually incorporated. The palatal side remains completely untouched.

Fig. 14. After finishing.

Fig. 15. Finishing, perikymata and surface texture.

STEP 10: FINAL RESULT

Self-Glaze Firing & Mechanical Polishing

The self-glaze firing differs fundamentally from a conventional glaze firing: no glaze material is applied. The restoration is heated to just below the softening temperature of the ceramic – the surface begins to flow on its own, creating an extremely natural, vital gloss that fully preserves the incorporated texture.

Fig. 16 & 17. Final result.

An applied glaze mass would partially level the fine perikymata and crack lines. The self-glaze firing instead preserves exactly that individuality so precisely incorporated during finishing. The final mechanical polishing completes the high gloss and accentuates the translucency of the tissue.

Fig. 18. Cervicogingival transition.

Fig. 19. Final result – close-up.

FINISHING STEPS:

• Self-glaze firing (no applied glaze mass)
• Mechanical polishing of ceramic surfaces

CONCLUSION

KATANA Zirconia YML and CERABIEN MiLai from Kuraray Noritake Dental Inc. open new dimensions in aesthetic dental technology. The combination of an intrinsically highly aesthetic multi-layer zirconia blank with CERABIEN MiLai, a veneering ceramic system designed for micro-layering on zirconia as well as lithium disilicate restorations, enables highly natural aesthetic outcomes with minimal material usage. The conscious omission of a liner firing, the targeted use of wash bake for optimal bonding, and the decision to make use of self-glaze firing instead of conventional glazing all express a thoughtful, material-oriented philosophy. The documented steps make clear that esthetic excellence is not the result of complexity. It is the result of precision, material understanding, and an unerring eye for detail.

The backlight photograph makes it strikingly visible: light flows through the restoration as through a natural tooth – proof of the harmonious interplay of KATANA Zirconia YML and CERABIEN MiLai.

UNCOMPROMISED.
UNMATCHED.
YOURS.

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INTRODUCTION

Patient demands and expectations have never been as concrete as in this day and age: Influenced by role models on social media and new aesthetic standards, our patients ask for brighter smiles or for restorations with specific tooth forms rather than demanding a perfect copy of nature. For us dental technicians, the challenge lies in finding a perfect balance between fulfilling these demands and respecting established biomimetics-inspired principles of aesthetics and function.

To accomplish this task, we need to know which principles need to be respected and where there is room for creativity. At the same time, it is essential to be well-informed about the latest technological advancements and developments in dental materials to be able to select the most appropriate restorative approaches. Only by understanding the selected materials and technological tools very well, will we be able to exploit their potential and deliver the best possible restorative solution. To sum up, we need to keep one foot in the boat of science and the other in the boat of art. Only by balancing both can we navigate the rapid advancements in the field effectively - ensuring they serve patients’ best interests while avoiding practices that lack purpose or meaning.

The challenge lies in finding a perfect balance between fulfilling the patient‘s demands and respecting established biomimetics-inspired principles of aesthetics and function.

MATERIAL CHOICES

Our favored framework materials for the production of aesthetic anterior restorations include KATANA™ Zirconia UTML, KATANA™ Zirconia STML discs (both Kuraray Noritake Dental Inc.) and lithium disilicate-based press ingots Amber® Press (HASS). These high-strength ceramics are ideal for fulfilling the aesthetic and functional demands of anterior restorations. Their balanced optical properties allow for the creation of lifelike restorations. Their physical and mechanical properties, on the other hand, are responsible for stability during all clinical steps from try-in to permanent placement, proven bonding ability and a certain error tolerance: Minor adjustments or modifications are possible without the risk of inducing cracks or dimensional changes when firing repeatedly. Finally, both materials are digital workflow compatible, which means that procedures are quick, mock-up, temporary restoration and definitive restoration easily aligned, and remakes facilitated.

The restorations are usually designed in full contour; a labial cutback of 0.3 to 0.5 mm creates sufficient space for the veneering porcelain. The preferred layering approach is micro-layering combined with the internal live stain technique, which offers the benefits of a controlled procedure and predictable, highly aesthetic outcomes with brilliant depth effects in short time. A layering material that precisely meets our needs regarding the preferred approach and is perfectly compatible with both, lithium disilicate and zirconia, is CERABIEN™ MiLai (Kuraray Noritake Dental Inc.).

The following two case reports are used to illustrate how this material combines with the different framework materials, revealing further benefits of the selected ceramics and techniques.

CASE #01

LITHIUM DISILICATE VENEERS

This 36-year-old female patient wanted to replace her bonded composite veneers. She expressed the demand for a brighter smile with a bleached color (NW 0.5) selected for her six maxillary anterior teeth and first premolars. However, she wanted the tooth preparation for this treatment to be as minimally invasive as possible.

In addition, she specifically requested that the teeth be square in form, with the lateral incisors the same length as the central incisors and the incisal edges straight, without rounded corners – clearly influenced by modern aesthetic standards. We explained our concerns regarding potential aesthetic and functional issues that might necessitate further intervention or adjustments, but she remained firm in her choices.

FROM DESIGN TO PRESSED FRAMEWORK

In line with the patient’s demands, it was planned to restore her maxillary teeth from first premolar to first premolar with lithium disilicate veneers (Amber® Press HT in the shade W2), which would allow for the desired minimally invasive preparations and bright appearance. Following tooth preparation, an analog impression was taken and sent to our laboratory. After the production of the model, the case was digitalized for the virtual designing of the veneers. In order to create space for the porcelain, the labial surfaces of the full-contour restorations were reduced by 0.3 mm with the software (exocad® DentalCAD, Figs. 1 and 2).

The frameworks were then milled in wax and pressed in Amber® Press HT W2 (Figs. 3 and 4). Sprues were cut and the surfaces of the veneer frameworks processed with a Diagen-Turbo-Grinder Ø 3,5 x 11 mm Cone and Wheel.

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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.

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.

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.

Case by MDT Andreas Chatzimpatzakis and DDS Manousos Pissadakis

ONE SOLUTION, MULTIPLE NEEDS COVERED

The treatment of young patients with a dental condition that affects the appearance of multiple teeth – like enamel hypomineralisation or hyperplasia – is particularly challenging for the restorative team. Dental practitioners and technicians need to be aware of the fact that the condition often involves a life-long disease burden, which typically goes hand in hand with an immense treatment need and increasingly invasive measures required with advancing age. It is their task to make the situation as bearable as possible for patients by delivering treatment that is very well aligned to their specific aesthetic, functional and financial needs, both in the short and long term.

Whenever all-ceramic restorations seem most appropriate, material and technique selection are particularly important: Protection of the affected teeth from extrinsic influences, the saving of sound tooth structure and the safeguarding of the long-term stability of the restorations are key to success. Depending on the aesthetic expectations of the patient, veneers made of zirconia or lithium disilicate, produced with a minimal vestibular cutback and finished using the micro-layering technique, are a great option. A prime example of an innovative porcelain system specifically developed for this technique is CERABIEN™ MiLai (Kuraray Noritake Dental Inc.). It includes a collection of internal stains and porcelains that fire at just 740 °C. With this low firing temperature and a coefficient of thermal expansion between 9.5~11.0×10-6/K (50 °C – 500 °C), this product is ideal for use with lithium disilicate and zirconia. In addition, it offers impressive aesthetic capabilities: Depending on the specific needs of each case, users can adjust the level of complexity and number of bakes.

CASE EXAMPLE

In the present case of a young female patient with hypomineralisation, it was decided to follow a straightforward approach to restore the maxillary teeth for the time being. For this purpose, we produced a wax-up and transferred it into the patient’s mouth in the form of a mock-up. Following guided tooth structure removal trough this mock-up, an impression was taken. The restorations were designed in full contour, pressed using lithium disilicate-based press ingots (Amber® Press LTW3, HASS Corp.) and cut back slightly in the vestibular area (reduction: 0.3 mm). The selected micro-layering system was applied according to the internal stain technique. The following CERABIEN™ MiLai Internal Stains were used: A little Red in the cervical, and Mamelon 2, Incisal Blue 1 and White in the incisal third. What followed was build-up with CERABIEN™ MiLai Porcelains Tx incisally and LTx proximally; some whitish lines were created with Value Liner 1. Then, I applied a mixture of E2 and ELT1 in the middle and LT1 in the cervical area. After the bake, the restorations were treated with green stones, sandpaper and rubber wheels to pre polish the surface. After glazing with CERABIEN™ ZR FC Paste Stain Clear Glaze, final polishing was carried out.

The whole treatment procedure including tooth preparation, shade determination, veneer production and adhesive cementation is illustrated below.

Fig. 1. Portrait of the patient prior to treatment.

Fig. 2. Enamel defects in the maxilla and mandible.

Fig. 3. Initial clinical situation in the maxilla with whitish-brown discolouration and composite restorations in need of replacement.

Fig. 4. Mock-up in the patient’s mouth.

Fig. 5. Labial reduction through the mock-up: The depth of tooth preparation is controlled by using a depth guide and by marking the created depth grooves with a colour marker.

Fig. 6. Silicon index used to check the space created for the veneers.

Fig. 7. Prepared teeth ready for impression taking and temporization.

Fig. 8. Shade determination for the veneers.

Fig. 9. Pressed lithium-disilicate restorations on the model.

Fig. 10. Appearance of the restorations after internal staining.

Fig. 11. Appearance of the teeth after build-up with CERABIEN™ MiLai Porcelain.

Fig. 12. Final restorations on the model.

Fig. 13. Adhesive cementation procedure carried out for two teeth at once: Isolated teeth and a perfectly dry working field.

Fig. 14. Etching of the tooth structure with phosphoric etchant (K-ETCHANT Syringe, Kuraray Noritake Dental Inc.).

Fig. 15. PANAVIA™ V5 Tooth Primer (Kuraray Noritake Dental Inc.) applied to the etched tooth surfaces.

Fig. 16. Veneers – pre-treated with hydrofluoric acid and CLEARFIL™ Ceramic Primer Plus – filled with PANAVIA™ V5 Paste (Both from Kuraray Noritake Dental Inc.) and placed in the patient’s mouth.

Fig. 17. Restorations after excess removal.

Fig. 18. All eight restorations in place.

Fig. 19. Treatment outcome after two weeks.

Fig. 20. Portrait of the patient taken two weeks after treatment.

CONCLUSION

Repeated dental treatment, increasing invasiveness of the measures, often resulting in early tooth loss: To break the vicious cycle in young patients with enamel defects, it is important to carefully evaluate the treatment need and select the appropriate solutions. As dental technicians, we can contribute to long-term treatment success by using high quality materials and production techniques that allow us to create restorations that last.

The presented material combination and the micro-layering technique are very well suited as they offer the required mechanical and optical properties for high aesthetics and durability. Plus, the risk of complications is low due to the high biocompatibility and the layer of porcelain limited to non-load-bearing areas.

Case by Andreas Chatzimpatzakis

Many modern, tooth-coloured dental materials enable us to achieve more with less. By using high-strength ceramics with a multi-layered colour structure and natural translucency, for example, the path to the desired outcomes involves fewer components, smaller layers and a reduced number of bakes. A possible streamlined procedure is illustrated below. The main materials used were KATANA™ Zirconia HTML PLUS for the screw-retained implant-supported superstructure and CERABIEN™ MiLai (both Kuraray Noritake Dental Inc.) for vestibular micro-layering.

Fig. 1. Zirconia-based screw-retained implant-supported prosthesis after milling and carving to obtain a natural surface texture.

Fig. 2. Restoration after sintering. To intensify the colour characteristic of the multi-layered blanks, the surface was treated with Esthetic Colorant (mainly in the incisal area and the gum parts).

Fig. 3. Appearance after the application of CERABIEN™ MiLai SS Fluoro.

Fig. 4. Restoration after the application of CERABIEN™ MiLai internal stains. They add some natural shading effects to the tooth and gum areas.

Fig. 5. Restoration on the model after micro-layering. In the cervical area, CERABIEN™ MiLai LT1 was mainly used, while the middle and incisal areas were individualized with E2 and Tx, the latter adding a seamless gradient in translucency. For the gingiva, the choice fell on the tissue porcelains 1, 5 and 6.

Fig. 6. Finished restoration on the model.

Fig. 7. The micro-layer of porcelain has a brilliant effect.

Fig. 8. The lifelike appearance is due to a smart combination of surface texturing …

Fig. 9. … and micro-layering with a comprehensive set of internal stains plus porcelains.

CONFIDENCE AND CONTROL

Full ceramic layering can produce beautiful results, but can be quite complex and time-consuming. In times with limited availability of skilled personnel and high-performance materials being offered, it may be a valuable strategy to opt for micro-layering with CERABIEN™ MiLai whenever appropriate. The system provides precise control over the layering and shading procedure, so that highly aesthetic and functional outcomes are easily and confidently obtained.

Case by Andreas Chatzimpatzakis

A CONCEPT EVEN FOR AESTHETICALLY DEMANDING CASES

The micro-layering technique is regarded as a more efficient, streamlined approach used as an alternative for full porcelain layering. It requires aesthetic, high-strength ceramics like lithium disilicate or zirconia as a base and – ideally – a set of porcelains specifically designed for reduced layer thicknesses that allows users to focus on imitating the characteristics of enamel. A high-quality example is CERABIEN™ MiLai (Kuraray Noritake Dental Inc.). Consisting of a set of internal stains and porcelains with a firing temperature of just 740 °C and a coefficient of thermal expansion in the range of 9.5~11.0×10-6/K (50 °C – 500 °C), this product works well on lithium disilicate and zirconia.

Its aesthetic potential is surprisingly high: Depending on case-specific requirements, users are given the choice between maximum efficiency using a single-bake technique and maximum aesthetics achieved with more complex layering. The latter option is demonstrated below using the example of six maxillary anterior veneers.

Fig. 1. Lithium disilicate frameworks (Amber Press) on the model.

Fig. 2. CERABIEN™ MiLai Value Liner 1 applied to the framework. This porcelain is typically used on lithium disilicate for wash baking.

Fig. 3. First build-up with CERABIEN™ MiLai CCV2 in the cervical section, …

Fig. 4. … Value Liner 2, …

Fig. 5. … Creamy Enamel in the middle area …

Fig. 6. … and Tx used to add ultimate translucency.

Fig. 7. Appearance of the restorations after the first bake.

Fig. 8. Outcome of the internal staining procedure.

Fig. 9. Application of CERABIEN™ MiLai LT1 for a standard translucency and opalescence effect, …

Fig. 10. … E2, …

Fig. 11. … a mixture of E2 and ELT1 (mixing ratio: 50:50) for translucency and brightness and along the marginal ridges, …

Fig. 12. … Tx mixed with Royal Blue (mixing ratio 70:30) for a blueish translucency in the incisal area…

Fig. 13. … as well as a final layer of LTx to add ultimate translucency and opalescence to the whole enamel surface.

Fig. 14. Outcome of the third bake.

Fig. 15. Cutback for the final layer of porcelain.

Fig. 16. Final layer of CERABIEN™ MiLai added to the central and lateral incisors for translucency.

Fig. 17. Situation after the fourth bake, grinding and use of a rubber polisher.

Fig. 18. Outcome of the fifth bake (self-glaze).

Fig. 19. Beauty shots …

Fig. 20. … of the restorations …

Fig. 21. … on the model.

TRULY BEAUTIFUL OUTCOMES POSSIBLE

This case example reveals that CERABIEN™ MiLai is much more than just a maximum-efficiency solution: With the current line-up of porcelains and internal stains, truly beautiful restorations can be produced. Hence, users are given high flexibility regarding not only the high-strength framework material they prefer, but also the effort and time they would like to invest. This makes CERABIEN™ MiLai a versatile porcelain system that meets many needs and covers a wide range of applications in the dental laboratory.

Case by Kostia Vyshamirski, DT

KATANA™ Zirconia YML AND CERABIEN™ MiLai

Virtually every patient in need of restorative treatment desires functional restorations with an aesthetic appearance. However, the individual expectations and needs may be very different depending on the clinical situation (state of the natural tooth structure, parafunctional behaviour, periodontal health etc.), the patient’s financial resources and personal preferences. A versatile material combination fulfilling many different needs and desires is KATANA™ Zirconia YML finished using micro-layering with the new CERABIEN™ MiLai (both Kuraray Noritake Dental Inc.).

This system supports low invasive preparations due to a favourable minimum wall thickness of the merely monolithic multi-layered zirconium oxide prosthesis and a minimal thickness of the porcelain layer in the aesthetic zone. Moreover, the high strength zirconium oxide prosthesis combined with only a very thin layer of porcelains makes this technique extremely useful in patients with parafunctional habits like bruxism. Last but not least, consisting of a carefully compiled selection of internal stains and porcelain shades, CERABIEN™ MiLai supports the creation of individual 3D shade effects that mimic those of natural teeth even when space is limited. The following case example reveals how this is possible.

INITIAL SITUATION

The patient presented with concerns related to both function and appearance. During the diagnostic phase, it was determined that increasing the vertical dimension of occlusion (VDO) and creating a wax-up in the new jaw position would be necessary to improve both the occlusion and the aesthetic appearance of the smile.

Fig. 1. Intraoral scan of the maxillary teeth revealing severe tooth wear.

Fig. 2. Intraoral scan of both jaws confirming the need for an increase of the VDO.

Fig. 3. Intraoral scan: Occlusal view of the maxillary teeth.

TREATMENT PLANNING AND COMPUTER-AIDED DESIGN

Following the approval of the wax-up, the treatment plan was created. It consisted of restoring the four anterior incisors with zirconia crowns and performing direct composite restorations on the posterior and lower teeth. To conserve as much of the healthy tooth structure as possible, the space created was aligned to the required wall thickness of the planned restoration (framework + micro-layer of porcelain in the vestibular areas only). Following an aesthetic analysis, the crowns were designed with a minimal vestibular cutback. This was due to the patient’s functional problems, which would increase the chipping risk in case of using a more heavy cutback design with a thicker, more conventional porcelain layer. KATANA™ Zirconia YML offers exceptional aesthetics, requiring only a 0.3 mm reduction for the porcelain to achieve natural results. Therefore, it was the logical material choice for this specific case.

Fig. 4. Minimally invasive preparations for the crowns.

Fig. 5. Occlusal view of the preparations.

Fig. 6. Aesthetic analysis – a crucial step for achieving the desired new smile.

Fig. 7. Frontal view of the crowns in their final cutback design.

Fig. 8. Lateral view of the crowns in the CAD software.

CROWN PRODUCTION

Immediately after milling, the zirconia surface was treated with effect liquids. This kind of pre-sintered characterization helps enhance the characteristics of zirconia restorations. In the presented case, orange stain was applied to the cervical area, while a blue stain was used at the incisal edge. In addition, a white opaque liquid was applied to the inner surface of the central zirconia crowns to block out any discolouration from the underlying tooth structure. Following final sintering, the vestibular layer of porcelain was built up with CERABIEN™ MiLai using a combination of internal stains and porcelain micro-layering. After morphological adjustments and surface polishing, the restorations were completed by applying CERABIEN™ ZR FC Paste Stain and Glaze. Final polishing was then performed to enhance the natural appearance of the surfaces.

Fig. 9. Effect liquids applied to the cervical and incisal areas of the crowns.

Fig. 10. Treatment of the central incisor crowns’ inner surfaces.

Fig. 11. KATANA™ Zirconia YML framework after sintering.

Fig. 12. CERABIEN™ MiLai Internal Stains and Porcelains.

Fig. 13. Prepared vestibular surfaces ready for application of the internal stains.

Fig. 14. Application of 0.2-0.3 mm layers of CERABIEN™ MiLai porcelain: CCV2 for the cervical area, LT1 – Creamy Enamel for the main body and luster, LTX at the incisal edge.

Fig. 15. Frontal view of the final restorations on the model.

Fig. 16. Lateral view of the final restorations on the model.

Fig. 17. Polished and glazed palatal surfaces of the crowns.

FINAL OUTCOME

The finalized restorations showcase great details, crafted with CERABIEN™ MiLai internal stains and porcelains. The result are natural-looking restorations. An additional benefit of using zirconia as a restorative material is its excellent compatibility, which is evident in the healthy gingival conditions.

Fig. 18. Restorations in place.

Fig. 19. Natural-looking restorations in the patient’s mouth.

Case by DT Tomas Forejtek, Forejtek Dental Lab and Dr Ladislav Gregor, Sorriso Dental Clinic

In prosthodontics, assessing the individual needs and expectations of every patient is a crucial factor on the road to success. When it comes to producing fixed dental prostheses, the art is in tailoring the material combination, framework design and finishing concept precisely to the case-specific functional and aesthetic demands. In this context, the availability of high-performance evaluation tools and the freedom to choose between different variants of high-strength ceramics is worth gold.

CASE EXAMPLE

Take the case of a middle-aged female patient: She presented with very unsatisfactory metal-ceramic crowns (Fig. 1) and asked for an aesthetic improvement of the situation. The crowns on her maxillary central incisors and the right lateral incisor clearly needed to be replaced not only for aesthetic, but also for functional reasons. As anterior interferences were present and orthodontic treatment was not an option, the decision was made to select a ceramic material with a particularly high strength – KATANA™ Zirconia HT (Kuraray Noritake Dental Inc.) – and to opt for a design that would support the incisal edge with zirconia. Consequently, porcelain layering (with CERABIEN™ ZR, Kuraray Noritake Dental Inc.) would be limited to the vestibular region. The laboratory procedure – including shade determination and reproduction with the aid of the eLAB® shade matching system* – is illustrated in Figures 2 to 9.

^{*The eLAB® system is a registered trademark of Sascha Hein. It is an independent tool for dental shade determination and communication and is not developed or distributed by Kuraray Noritake Dental Inc.}

Fig. 1. Initial clinical situation.

Fig. 2. Situation after removal of the existing crowns and preparation of the tooth structure for the planned all-ceramic restorations.

Fig. 3. Shade determination with the eLAB® system.

Fig. 4. Layering map for the use of CERABIEN™ ZR on all three crowns.

Fig. 5. Layering procedure: Shade verification.

Fig. 6. Try-in of the crowns to assess the fit and the shade match.

Fig. 7. Palatal view of the crowns on the model.

Fig. 8. Frontal view of the crowns on the model: A natural surface texture is obtained.

Fig. 9. Natural look of the restorations.

THE RESULTS

Fig. 10. Crowns after adhesive cementation with PANAVIA™ V5 (Kuraray Noritake Dental Inc.).

Fig. 11. Aesthetic treatment outcome.

A precise reproduction of the patient’s tooth shade, despite the challenging individual aesthetics.

THE KEY TO SUCCESS: INDIVIDUAL APPROACH, HIGH-QUALITY MATERIALS

The present case is a perfect example of an aesthetically and functionally challenging situation that needed an individual treatment approach. By taking into account the patient- and case-specific requirements and using our material-related knowledge wisely, it was possible to develop an adequate treatment plan. High-quality materials and a smartly selected design concept lay the foundation for long-term success. Valuable tools used during porcelain layering (specifically the eLAB® system) – on the other hand – paved the way for a precise reproduction of the patient’s tooth shade, despite the challenging individual aesthetics: The crowns were delivered on the first attempt.