429 Too Many Requests

Case by Max Andrup

This is the story of cusp fracture due to cuspal tension. This is a common weakness of amalgam-restored teeth associated with expansion of the restorative material. The affected maxillary right first premolar was restored with a crownlay.

For seating of the crownlay, the use of warmed light-curing resin composite (CLEARFIL™ AP-X) has proven its worth. Compared to a dual-cure luting resin, the selected material offers many benefits including the fact that the heat assists in the conversion of monomers to polymers, the time available to remove excess is almost unlimited, and the composite offers better bio-mechanical properties as well as a lower polymerization shrinkage stress.

Fig. 1. Pre-operative situation. The patient requested for an emergency appointment, where we temporarily fixed the lost buccal cusp and made a new appointment for a crownlay preparation. After removing the amalgam and temporary filling, the remaining amount of tooth structure was quite beneficial with a large lingual cusp and a ring of enamel around the whole tooth.

Fig. 2. The decision was made to reduce the lingual cusp and to place a crownlay working in compression. As the thickness of the cusp was adequate for an onlay, this treatment option would have been equally suitable. After tooth preparation, immediate dentin sealing was performed: For this purpose, I air-abraded the dentin to remove the smear layer and give the adhesive the best condition for a strong bond to dentin. Then, CLEARFIL™ SE Protect was applied to the tooth surface and covered with a thin layer of flowable resin composite (CLEARFIL MAJESTY™ Flow) to ensure a total seal.

Fig. 3. The resin composite surface was air-abraded with 50 μm zirconia particles, followed by selective etching of the enamel with a 35-percent phosphoric acid etchant. After try-in of the crownlay made of lithium disilicate, the tooth surface and the restoration were cleaned with KATANA™ Cleaner.

FINAL SITUATION

Fig. 4. The cleaned crownlay was pre-treated with CLEARFIL™ Ceramic Primer, before warmed CLEARFIL™ AP-X was applied to both tooth structure and restoration for luting. The colour of the crownlay matched the colour of the adjacent premolar, while the visible part of the restored tooth’s remaining structure was stained from amalgam corrosion.

Dentist:

Max Andrup graduated from the University of Umeå in 2010 and today runs his private practice in the city of Hudiksvall, Sweden. He has a passion for restorative dentistry with a biomimetic approach.

By Dr Alessandro Devigus

This video illustrates the Cementation of Katana STML Crowns with Panavia V5.

Dentist:

DR. ALESSANDRO DEVIGUS

Dr. Alessandro Devigus received his degree from Zurich University, Switzerland, in 1987. Since 1990 his working in his own private practice with a focus on CAD CAM and Digital Dentistry. He is also CEREC Instructor at the Zurich Dental School.

Dr. Alessandro Devigus is an active member of the European Academy of Esthetic Dentistry (EAED), founder of the Swiss Society of Computerized Dentistry, Neue Gruppe member, ITI fellow and speaker.

Dr. Devigus is editor-in-chief of the International Journal of Esthetic Dentistry, author of various publications and an international lecturer.

Case by Max Andrup

This patient had requested for an emergency appointment and presented with severe erosive tooth wear in several teeth, a crack in the mesial wall of the maxillary first molar and a failing direct restoration with recurrent decay on the adjacent second premolar. I decided to replace the direct resin composite restoration immediately as this was the main cause of discomfort. It was decided to restore the other defects during the next appointment.

The resin composite of choice was CLEARFIL MAJESTY™ ES-2 (Universal shade concept), an innovative material with a single universal shade designed for posterior restorations. The manufacturer claims that, due to the integration of Kuraray Noritake Dental Inc.’s light diffusion technology, this universal shade nicely blends in with the surrounding tooth structure virtually independent of its colour. Curious about the real potential of this concept, I wanted to put the material to a test.

Fig. 1. Pre-operative situation revealing signs of severe erosive tooth wear, a cracked mesial wall of the first molar and a failed filling on the second premolar with recurrent decay.

Fig. 2. Appearance of the tooth after removal of the direct composite restoration. The recurrent caries is obvious.

Fig. 3. Caries Detector applied to the decayed tooth structure.

Fig. 4. Establishing of a peripheral zone totally free of caries with the aid of Caries Detector. It may be useful to apply the dye several times.

Fig. 5. The final situation after several applications of Caries Detector. The peripheral zone is completely free of caries, which is a strict requirement for the establishment of a perfect seal during bonding. Affected caries stained light pink is not removed not to risk going near the pulp.

Fig. 6. Build-up of the proximal wall with CLEARFIL MAJESTY™ ES-2 (U shade) after the application of CLEARFIL™ SE Protect and a small layer of CLEARFIL MAJESTY™ ES Flow in a thickness of about 0,5 mm. By focusing on the proximal wall connecting to enamel first, the hybrid layer is given the time needed to mature. Not putting a new increment on top of the hybrid layer for the first five minutes will lead to an increased bond strength to dentin.

FINAL SITUATION

Fig. 7. Appearance of the tooth immediately after finishing and polishing. Although the rubber dam is still in place and the tooth structure is not yet rehydrated, it is evident that the composite blends in very well with the remaining tooth structure to form a seamless margin.

Dentist:

Max Andrup graduated from the University of Umeå in 2010 and today runs his private practice in the city of Hudiksvall, Sweden. He has a passion for restorative dentistry with a biomimetic approach.

By Aleksandra Łyżwińska, DMD

The MOD restoration on the maxillary left second premolar of this patient was in need of replacement. It was decided to create a direct composite overlay with CLEARFIL MAJESTY™ ES Flow - Super Low A3, CLEARFIL MAJESTY™ ES-2 Classic A2. CLEARFIL™ SE BOND 2 was used after selective etching of the enamel to establish a chemical bond to enamel and dentin. For the finishing and polishing procedure, abrasive discs were used first, followed by silicon carbide rubber instruments and the CLEARFIL™ Twist DIA system.

Fig. 1. Initial clinical situation revealing the composite restoration to be replaced on the second premolar.

Fig. 2. Occlusal view of the teeth after cavity preparation including cusp reduction.

Fig. 3. Lateral view of the teeth after cavity preparation.

Fig. 4. Matrix band held in place with wedges and two rings.

Fig. 5. Situation after etching, bonding, removal of one ring, and build-up of the interproximal walls with CLEARFIL MAJESTY™ ES-2 Classic in the shade A2.

Fig. 6. Cavity filled with CLEARFIL MAJESTY™ ES Flow - Super Low A3.

Fig. 7. Occlusal surface restored with CLEARFIL MAJESTY™ ES-2 Classic in the shade A2.

Fig. 8. Polishing with the pre-polisher of the CLEARFIL™ Twist DIA system.

Fig. 9. Polishing with the high-shine polisher of the CLEARFIL™ Twist DIA system.

Fig. 10. Appearance of the restoration immediately after rubber dam removal and checking of the occlusal contacts.

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Fig. 11. Linguo-occlusal view of the treatment outcome.

Fig. 12. Lateral view of the treatment outcome.

Dentist:

ALEKSANDRA ŁYŻWIŃSKA
Warsaw, Poland

Aleksandra Łyżwińska, DMD, is a passionate aesthetic and adhesive dentist. Driven by Evidence Based Dentistry, her goal includes using modern composite materials and bonding agents in her clinical practise. In addition to her primary job, she worked as a lecturer and an assistant professor at the Department of Conservative Dentistry and Endodontics of Medical University of Warsaw, her alma mater.

By Dr. Michał Sucholdolski

This patient was concerned about the discoloration that had appeared on the occlusal surface of the mandibular left first molar. In an intraoral examination, caries was diagnosed in this area.

As the occlusal surface was almost intact initially, it was decided to restore the tooth with resin composite using the stamp technique. For this purpose, the occlusal anatomy was recorded using CLEARFIL MAJESTY™ ES Flow in the shade A3, which was stamped onto the occlusal surface and fixed to an applicator by light curing. Afterwards, the carious tissue was removed with the aid of caries-detector dye. Following cleaning of the prepared cavity and application of the bonding agent (CLEARFIL™ SE BOND 2), CLEARFIL MAJESTY™ ES Flow (A3) was applied to the cavity floor. The final occlusal layer was created with CLEARFIL MAJESTY™ ES-2 in the shade A3. The stamp was used to transfer the original occlusal anatomy to the new surface before light curing. A natural gloss was obtained by polishing of the surface with the CLEARFIL™ Twist DIA system.

Fig. 1. Initial clinical situation with an occlusal surface affected by caries.

Fig. 2. Appearance of the tooth after the application of caries detector dye during cavity preparation.

Fig. 3. Stamp created with flowable resin composite.

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Fig. 4. Treatment outcome.

Dentist:

Dr. Michał Sucholdolski is a graduate of Silesia Medical University in Zabrze, Poland. He has attended various national and international conferences on microscopic dentistry, endodontic treatment and aesthetic restorative dentistry.

He makes use of innovative dental approaches such as Digital Smile Design, the MicroVision preparation concept, minimally invasive preparation techniques and modern direct restoration techniques.

He is a Member of the Polish Association of Endodontic Treatment and author of scientific work and publications in dental magazine.

By Dr Alessandro Devigus

Fig. 1. Initial situation with fractured PFM crown.

Fig. 2. Initial situation with fractured PFM crown – problem of deep bite.

Fig. 3. Situation after removal of old crowns and placement of retraction cord.

Fig. 4. Milled crowns before sintering with Speedfire.

Fig. 5. Crowns after sintering.

Fig. 6. Try-in of sintered crowns.

Fig. 7. Crowns after glaze and stain.

Fig. 8. Try-in of finished crowns.

Fig. 9. Crowns after adhesive cementation with PANAVIA™ V5 A2.

FINAL SITUATION

Dentist:

DR. ALESSANDRO DEVIGUS

Dr. Alessandro Devigus received his degree from Zurich University, Switzerland, in 1987. Since 1990 his working in his own private practice with a focus on CAD CAM and Digital Dentistry. He is also CEREC Instructor at the Zurich Dental School.

Dr. Alessandro Devigus is an active member of the European Academy of Esthetic Dentistry (EAED), founder of the Swiss Society of Computerized Dentistry, Neue Gruppe member, ITI fellow and speaker.

Dr. Devigus is editor-in-chief of the International Journal of Esthetic Dentistry, author of various publications and an international lecturer.

By Dr Luca Dusi

For purely aesthetic reasons, this patient asked for the reconstruction of her cone-shaped upper right lateral incisor (12). The patient was offered a treatment including a first phase of orthodontic therapy aimed at recovering the space necessary to be able to reconstruct the lateral incisor to its ideal size. As the patient refused to undergo this orthodontic therapy, it was decided to restore the tooth with resin composite and match its size to the space already available.

The adhesive system used was CLEARFIL™ SE BOND 2, while the restoration was created with the new composite CLEARFIL MAJESTY™ ES-2 Universal. Although this material is designed for the single-shade technique with only two shades matching the anterior tooth shades, I decided to combine both pastes to achieve the best possible outcome. The shade UD (Universal Dark) was used to reconstruct the cervical and central portion of the lateral incisor. The incisal portion was restored with UL (Universal Light).

Fig. 1. Initial situation with a cone-shaped upper right lateral incisor (12).

Fig. 2. Image of the initial situation taken with a polarising filter for shade evaluation purposes.

Fig. 3. The new CLEARFIL MAJESTY™ ES-2 Universal composite with only two shades for the anterior region was chosen. It offers a good optical integration thanks to Kuraray Noritake Dental’s Light Diffusion Technology.

Fig. 4. Shade determination with the aid of cured samples of CLEARFIL MAJESTY™ ES-2 Universal UL (Universal Light) and UD (Universal Dark) on the tooth surfaces.

Fig. 5. Isolation with rubber dam.

Fig. 6. CLEARFIL™ SE BOND 2 used for the establishment of a strong bond between the tooth structure and the composite material.

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Fig. 7. The universal composite blends in well with the adjacent teeth regarding its colour and surface finish.

Dentist:

• Graduated with honors in Dentistry and Dental Prosthetics at the University of Milan in 2010.
• In 2011/2012 and 2012/2013 he held the position of Adjunct Professor for the teaching of Prosthetic Technologies at the University of Milan-Bicocca.
• Member of SIdp (Italian Society of Periodontology) and AIC (Italian Academy of Conservation).

By Daniele Rondoni, RDT

Considering different criteria to select the ideal zirconia and frame design to meet the level of esthetics requested.

Step 1
Final Preparations.

Step 2
Zirconia Frame (KATANA Zirconia STML A2) cut-back designed to reproduce translucent incisal area.

Step 3
Application of 1st Internal Stain and firing.

Step 4
Application of 1st Luster, Clear Cervical and firing.

Step 5
Application of 2nd Internal Stain and firing.

Step 6
Application of 2nd Luster, and Opacious Body.

Step 7
Completion of firing.

Step 8
Completion of morphological correction.

Step 9
Post-operative view.

By Magdalena Osiewicz, DDS, MSc, PhD

Fig. 1 Defective composite resin restoration in molars.

Fig. 2 Application of CLEARFIL™ SE BOND 2 to cavities.

Fig. 3 Restoration of the cavities with CLEARFIL MAJESTY™ Posterior in the A2 Classic shade.

Fig. 4 Final restorations of Class I and II with CLEARFIL MAJESTY™ Posterior and polish with CLEARFIL™ Twist DIA.

CLEARFIL MAJESTY™ Posterior is a resin composite with high strength and great optical properties developed for posterior restorations and suitable even for the most demanding patients. Figure 1 shows the initial clinical situation with insufficient resin composite restorations in the lower molars. After removal of the old fillings, the cavities were treated with CLEARFIL™ SE BOND 2 (Figure 2).

Then, I restored them with CLEARFIL MAJESTY™ Posterior in the A2 Classic shade (Figure 3). The fissures were highlighted with brown color modifier. Finally, finishing was performed in three steps: The excess of composite resin was removed with a fine-grained diamond bur. Final contouring was accomplished with a carbide bur, before CLEARFIL™ Twist DIA was used to obtain a natural gloss (Figure 4).

CLEARFIL MAJESTY™ Posterior is characterized by high mechanical strength, hardness and bending strength, a low coefficient of thermal expansion, low polymerization shrinkage and good aesthetics. Due to these features and a reliable long-term behavior, CLEARFIL MAJESTY™ Posterior should have a place in every dental office for direct posterior restorations. Excellent outcomes are achievable and therefore I recommend its use.

Dentist:

Magdalena Osiewicz, DDS, MSc, PhD

Department of Integrated Dentistry, Jagiellonian University, Krakow, Poland.

Department of Dental Materials Science, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

Department of Integrated Dentistry, Jagiellonian University, Krakow, Poland.

Department of Dental Materials Science, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

By Daniele Rondoni, RDT

Preoperative view

1 PFM. 3 Laminates on refractory

Postoperative view

NORITAKE SUPER PORCELAIN EX-3 CHROMATIC MAP

Dentist:

DANIELE RONDONI, RDT

Born in Savona in 1961 where he lives and has worked in his own laboratory since 1982 with his collaborators. Graduated from the dental technician school IPSIA “P. Gaslini” in Genoa in 1979. He continued his education by attending relevant workshops for the “Italian dental school“ and broadened his professional experience in Switzerland, Germany and Japan. Since 2011 Kuraray Noritake Dental International Instructor.