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Discover the next step in the evolution of multi-layered zirconia!

Let us introduce you to KATANA™ Zirconia YML, the next step in the evolution of multi-layered zirconia! The material of superlatives will take center stage at the KATANA™ Zirconia YML Virtual Kick-Off Symposium on July 3, 2021. Renowned experts from the scientific and practical field will share important facts and first-hand information on the unique allrounder and its ability to empower dental laboratories.

Celebrating the launch of the new member to our KATANA™ Zirconia family, we will show you how aesthetic outcomes are achieved with minimal effort, how design flexibility puts you in control and how the pace of procedures is accelerated without compromising quality.

Hence, participation is highly recommended for everyone striving for more: more safety, more reliability, more simplicity and, ultimately, more time.

Registration and further information: www.kuraraysymposium.info

Case by Dr. Aleksandra Łyżwińska, DMD

The maxillary left first molar had a Class I cavity on the occlusal surface restored with resin composite many years ago. The restoration needed to be replaced due to severe signs of wear and discolouration, as well as, the occurrence of secondary caries. After removal of the existing restoration and caries excavation, CLEARFIL™ SE BOND 2 was applied to the cavity to establish a stong and long-lasting chemical adhesion to the available enamel and dentin. Containing the original MDP monomer, the bonding agent is able to fulfill this task reliably. Subequently, the bottom of the cavity was filled with CLEARFIL MAJESTY™ ES Flow - Super Low A2, which shows an excellent marginal adaptation and provides for an even surface. The occlusal surface was built up with CLEARFIL MAJESTY™ ES-2 Classic A2 that blends in very well with the adjacent tooth structure, and characterized with some tints for an even more natural appearance.

Fig. 1. Initial intraoral photograph showing the defective restoration on the maxillary first molar after isolation with rubber dam.

Fig. 2. Occluso-lingual view of the initial situation revealing the wear effect.

Fig. 3. Tooth cavity with a matte surface after cavity preparation.

Fig. 4. Glossy cavity surface after application of CLEARFIL™ SE BOND 2.

Fig. 5. Appearance of the molar immediately after placement of a bottom layer of CLEARFIL MAJESTY™ ES Flow - Super Low A2 and modelling of the occlusal surface anatomy with CLEARFIL MAJESTY™ ES-2 Classic A2.

Fig. 6. Linguo-occlusal view of the situation.

Fig. 7. Appearance of the molar …

Fig. 8. … after the application of some tints.

Fig. 9. Result of the finishing …

Fig. 10. … and polishing procedure.

FINAL SITUATION

Fig. 11. Aesthetic treatment outcome after rubber dam removal …

Fig. 12. … and checking of the occlusal contact points.

Dentist:

DR. ALEKSANDRA ŁYŻWIŃSKA
Warsaw, Poland

Dr. 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.

Case by Dr. Michael Morgan, DDS

Small to moderate-sized posterior restorations are the bread-and-butter of every dental practice. In a procedure that is carried out so frequently, it is particularly useful to work with a restorative material that handles well and has excellent optical properties that blend in a variety of clinical situations – like CLEARFIL MAJESTY™ ES-2 Universal. The product is available in a single universal shade for the posterior region, which enables users to increase their efficiency and eliminates the need for shade determination or laborious multi-shade layering.

When used with CLEARFIL™ SE Protect adhesive and CLEARFIL MAJESTY™ ES Flow, the innovative universal restorative allows me to confidently restore 70 to 80 percent of my simple posterior composite restorations. It handles extremely well, being slightly soft but not sticky, which allows quick shaping and anatomy formation. The procedure is fast and simple, and it leads to natural outcomes, as shown using the following case example. Anyone who has tested CLEARFIL MAJESTY™ ES-2 Universal in the clinical environment will most likely agree that the material is an easy-to-use workhorse every dentist should have in their composite toolbox.

Fig. 1 Initial clinical situation. Second premolar with a composite restoration and first molar with an amalgam restoration in need of replacement.

Fig. 2 Immediate post-operative image.

Fig. 3 Image taken one week after the treatment showing rehydrated tissues and a smooth optical integration of the direct restorations.

Dentist:

DR. MICHAEL MORGAN, DDS

Case by Dr. Aleksandra Łyżwińska, DMD

One tooth. Two appointments. Two lesions appeared in the upper right second premolar of this 17-year-old patient. We decided to restore the mesial lesions first. Caries was excavated and, due to pulp exposure, direct pulp capping performed with mineral trioxide aggregate (MTA). Chemical adhesion to dentin and the biomaterial was established with the 10-MDP-containing universal adhesive CLEARFIL™ Universal Bond Quick, used in the self-etch mode. One benefit of this material is related to the fact that no extensive rubbing onto the surface is required. Blue composite was placed to mark the region of the exposed pulp, and CLEARFIL MAJESTY™ ES Flow - Super Low A2 was applied to the bottom of the cavity. Due to its high flexural strength, this material is a perfect dentin replacement. The rest of the tooth was restored with temporization material. To fill up the core, bulk-fill flowable composite OliBulk MD was used.

For the second appointment, the temporary was removed and caries was excavated in the distal area of the tooth as well. Following cavity preparation, CLEARFIL™ SE BOND 2 was applied to obtain a strong bond to the remaining composite material and the tooth structure. Both cavities were restored with a combination of CLEARFIL MAJESTY™ ES Flow - Super Low A2 and CLEARFIL MAJESTY™ ES-2 Classic A2.

Fig. 1. Intraoral photograph of the initial situation after isolation with rubber dam.

Fig. 2. Situation after cavity preparation and pulp exposure.

Fig. 3. Mineral trioxide aggregate (MTA) applied to cover and protect the exposed pulp tissue.

Fig. 4. Marking of the exposed pulp area with blue composite.

Fig. 5. Appearance of the cavity after application of the universal adhesive in the self-etch mode.

Fig. 6. Cavity filled up to the level of the interproximal enamel wall with CLEARFIL MAJESTY™ ES Flow - Super Low A2.

Fig. 7. Second visit: Prepared cavities.

Fig. 8. Situation after bonding, build-up of the interproximal walls with paste-like composite, filling with flowable material and coverage with a final layer of paste-like CLEARFIL MAJESTY™ ES-2 Classic A2.

Fig. 9. Appearance of the restored tooth before contouring.

Fig. 10. Result of the polishing procedure …

Fig. 11. … carried out with a rubber polisher and the CLEARFIL™ Twist DIA System.

FINAL SITUATION

Fig. 12. Treatment outcome …

Fig. 13. … immediately after rubber dam removal.

Dentist:

DR. ALEKSANDRA ŁYŻWIŃSKA
Warsaw, Poland

Dr. 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.

Case by Dr. Jorge F. Zapata, DDS

When replacing amalgam restorations, we often see that the remaining tooth structure is severely stained. Nevertheless, a defect-oriented preparation is preferable over a procedure that involves the removal of healthy, but stained dentin as well. Long-lasting direct restorations with a natural look are obtained by using the universal adhesive CLEARFIL™ Universal Bond Quick, CLEARFIL MAJESTY™ Flow as a cavity liner, CLEARFIL MAJESTY™ ES-2 Premium Dentin to mask the stained areas and a final layer of CLEARFIL MAJESTY™ ES-2 Universal. The following case example confirms that this product combination leads to a nice optical integration.

Fig. 1 Pre-operative image: Maxillary second premolar and first molar with amalgam restorations in need of replacement.

Fig. 2 Situation after removal of the existing amalgam restorations.

Fig. 3 Immediate treatment outcome.

Dentist:

DR. JORGE F. ZAPATA, DDS

Interview with Peter Schouten, Technical Manager, Kuraray Europe Benelux

PRECISION - STRENGTH - POLISHABILITY

When creating KATANA™ AVENCIA™ Block for CAD/CAM, our goal was to develop a block that would be easy to grind while delivering a smooth surface. Of course, its mechanical properties had to be first-rate, and we aimed for excellent gloss retention. Finally, it goes without saying that KATANA™ AVENCIA™ Block restorations had to be durable as well as being suitable for adhesive cementing.

Existing hybrid ceramic blocks on the market (except for VITA™ Enamic) are produced in the same way as direct dental filling composites, namely, silanized filler mixed with synthetic resin. The composite is then formed into a block or a mold and polymerised. The disadvantages are a non-uniform distribution of the filler particles and an increased risk of trapped air which can result in voids. Instead, KATANA™ AVENCIA™ Block uses the unique Filler Press and Monomer Infiltration method, developed by Koichi Okada et al. The treatment of the filler is what makes this method so unique.

Nano-sized silica fillers pre-treated with silane combined with nano-sized alumina fillers are densely compressed into a block which is subsequently impregnated with resin. Finally, the blocks are polymerized by heat to achieve a maximized degree of polymerization. Blocks manufactured in this way have a dense, homogenous and virtually void-free structure.

SEM photos show the microstructure of KATANA™ AVENCIA™ Block, in a comparison with other materials. KATANA™ AVENCIA™ Block is filled densely and uniformly with only nano-sized filler.

Smooth

Owing to the high filler content with filler particles of up to a maximum of 40 μm, KATANA™ AVENCIA™ Block is not only strong but also extremely easy to grind. Thanks to smooth result the next step - polishing - is simplicity itself.

Strong

The KATANA™ AVENCIA™ Block is yet another example of how we have fully exploited our knowledge and expertise in the silanisation of fillers. The nano-sized, optimally silanised silica fillers establish tight connection between silica and resin-matrix. This is essential when aiming to achieve strong and stable prosthetics.

*Not a trademark of Kuraray Noritake Dental Inc.
** Test Condition: Toothbrush wear test using tooth paste. Load: 250 g.
Source: Kuraray Noritake Dental Inc.

Polishability

The dense, homogenous, and void free structure of KATANA™ AVENCIA™ Block is the reason that the high gloss easily achieved with polishing only will be long-lasting. KATANA™ AVENCIA™ Block shows virtually no reduction of gloss after tens of thousands of brushing movements in the toothbrush test.

For optimum, long-lasting and durable results, it goes without saying that KATANA™ AVENCIA™ Block restorations should be affixed with one of the products from the PANAVIA™ family.

Wouldn’t it be great to have a single dental material indicated for the treatment of all kinds of hypersensitivities? A product that effectively and durably occludes exposed dentinal tubules caused by gingival recession, dental erosion or excessive toothbrushing, but also works in the context of professional tooth cleaning, scaling and root planning, tooth whitening or restorative procedures? The fact that Kuraray Noritake Dental Inc.’s TEETHMATE™ DESENSITIZER is ideally suited for all those indications by providing lasting hypersensitivity relief is surely one of the reasons for its winning of a Dental Advisor award for the seventh consecutive year.

Designed to crystallize hydroxyapatite (HAp) from the ground up, TEETHMATE™ DESENSITIZER reliably seals exposed dentinal tubules and enamel cracks.

Consisting of natural calcium and phosphate, the product may even be applied to freshly prepared tooth structure without negatively affecting the bond strength of subsequently utilized dental adhesives or cements.

The consultants of the Dental Advisor conducted a six-month clinical study to be able to evaluate the performance of TEETHMATE™ DESENSITIZER. They selected 27 patients with hypersensitivity issues in their dental practices. Thermal testing with cold air was used to identify the affected teeth, 54 of which were included in the evaluation. For the initial assessment, patients were asked to evaluate their level and frequency of hypersensitivity per tooth on a five-point scale (1 = severe, persistent sensitivity to 5 = no sensitivity). Subsequently, TEETHMATE™ DESENSITIZER was applied according to the instructions for use. Sensitivity was evaluated again immediately after the treatment and six months later. At baseline, 91 percent of the patients stated that they had no or only mild, sporadic sensitivity, which was still the case for 85 percent after six months. This indicates that the product is very effective in providing immediate and even long-term hypersensitivity relief.

Hence, it is not surprising that TEETHMATE™ DESENSITIZER has been among the winners of the Dental Advisor’s Top Product Award every year between 2015 and 2021.

Study results that confirm the material’s effectiveness in reducing pre- and post-operative sensitivity in the context of tooth whitening¹ and indirect restoration procedures² are also available, so that users can count on a reliable performance in a wide range of indications.

References

1. Mehta D, Jyothi S, Moogi P, Finger WJ, Sasaki K. Novel treatment of in-office tooth bleaching sensitivity: A randomized, placebo-controlled clinical study. J Esthet Restor Dent. 2018 May;30(3):254-258.
2. Shetty R, Bhat AN, Mehta D, Finger WJ. Effect of a Calcium Phosphate Desensitizer on Pre- and Postcementation Sensitivity of Teeth Prepared for Full-Coverage Restorations: A Randomized, Placebo-Controlled Clinical Study. Int J Prosthodont. 2017 Jan/Feb;30(1):38-42.

Case by Dr. Aleksandra Łyżwińska, DMD

The case presented is regarding a patient with two discoloured composite restorations located in the distal aspect of the maxillary right central incisor and the mesial aspect of the adjacent lateral incisor. A replacement of these restorations was planned due to marginal leakage and for aesthetic reasons. During cavity preparation, a vestibular bevel was created in the enamel of the lateral incisor to provide for a smooth blend-in of the restoration and to improve adhesion. After selective etching of the enamel with phosphoric acid gel, CLEARFIL™ SE BOND 2 was applied. The adhesive contains the original 10-MDP monomer, which establishes a strong bond by adhering to dentin chemically. The restorations were created with CLEARFIL MAJESTY™ ES Flow - Low A2 and CLEARFIL MAJESTY™ ES-2 Classic in the shade A2. Final polishing was accomplished in a four-step procedure with abrasive discs, an aluminum oxide rubber polisher, and the two-disc CLEARFIL™ Twist DIA polishing system.

Fig. 1. Initial clinical situation after rubber dam placement.

Fig. 2. Detailed view of the teeth with a discoloured resin composite restoration visible in the mesial aspect of the lateral incisor.

Fig. 3. Palatal view of the teeth revealing marginal staining of the restoration in the distal aspect of the central incisor.

Fig. 4. Palatal view of the teeth after removal of the restorations and cavity preparation.

Fig. 5. Frontal view of the teeth after removal of the restorations and tooth preparation including beveling of the enamel.

Fig. 6. Upright placement of two sectional contoured matrices designed for the posterior region – palatal view.

Fig. 7. Frontal view of the sectional matrices fixed with a wedge.

Fig. 8. Palatal view of the teeth after selective enamel etching, bonding, and the application and light-curing of CLEARFIL MAJESTY™ ES Flow - Low A2 and CLEARFIL MAJESTY™ ES-2 Classic – A2.

Fig. 9. Frontal view of the situation - a concave “emergence profile” caused by matrix bending.

Fig. 10. Final layer of CLEARFIL MAJESTY™ ES Flow - Low A2 applied to the mesio-labial aspect of the lateral incisor.

Fig. 11. Occlusal view of the final composite layer prior to finishing.

Fig. 12. Polishing with the pre-polisher of the CLEARFIL™ Twist DIA system.

Fig. 13. Polishing with the high-shine polisher of the CLEARFIL™ Twist DIA system.

FINAL SITUATION

Fig. 14. Outcome of the polishing procedure.

Dentist:

DR. ALEKSANDRA ŁYŻWIŃSKA
Warsaw, Poland

Dr. 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. Jusuf Lukarcanin

Direct resin composite restorations are a great option for diastema closure, shape correction and even an optical alignment of anterior teeth. The treatment approach is conservative with no or only minimal tooth preparation required, and with the right materials, it is possible to obtain beautiful outcomes, which is decisive in the aesthetically demanding anterior region. In this context, one might assume that a wide range of available shades and a meticulous shade selection process are important preconditions for a successful shade match. The following case examples show, however, that great outcomes can also be achieved in a simplified way using CLEARFIL MAJESTY™ ES-2 Universal, a game-changing resin composite with only two shade options for the anterior region.

CLINICAL CASE 1

Fig. 1 Initial situation of a young patient with maxillary and mandibular diastemata to be closed.

Fig. 2 Treatment outcome after direct diastema closure with CLEARFIL MAJESTY™ ES-2 Universal in the shade UL (Universal Light). A precise colour match and a natural gloss are obtained. Apart from the fact that the procedure is simplified be eliminating the need for shade determination and selection, the workflow is the same as with traditional composites.

Fig. 3 Close-up view of the initial and the final situation. A smooth transition from the teeth to the restorations is obtained.

CLINICAL CASE 2

Fig. 1 Female patient with multiple diastemata asking for a minimally-invasive, aesthetic treatment option.

Fig. 2 Treatment outcome after composite veneering with CLEARFIL MAJESTY™ ES-2 Universal in the shade UL (Universal Light).

Fig. 3 The patient’s smile - her teeth have a natural, lighter appearance.

CLINICAL CASE 3

Fig. 1 Young patient with malpositioned maxillary central and lateral incisors.

Fig. 2 Irregularities visible when the patient is smiling. She opted for composite veneering instead of an orthodontic approach.

Fig. 3 Treatment outcome after optical alignment and correction of teeth’s shapes using CLEARFIL MAJESTY™ ES-2 Universal in the shade UL (Universal Light).

„My first reaction to this material was: this is a Game-Changer.“

The results are magical. Smoother and easy handling properties, high-gloss, natural light distribution and the process is simple. Aside from being able to skip the shade selection step, your workflow remains the same as with traditional composites. At first, I might have been a little skeptical about replacing all the different shades of composites we use in office every day. But after a couple of tries I discovered that it indeed works every time, in most cases even without the use of a blocker. Simply ingenious!

Dr. Jusuf Lukarcanin

Dentist:

DR. JUSUF LUKARCANIN

Dr. Jusuf Lukarcanin is a Certified Dental Technician (DCT) and a Doctor of Dental Science (DDS). He studied dentistry at the Ege University Dental Faculty in Izmir, Turkey, where he obtained a Master‘s degree in 2011. In 2017, he received a Ph.D. degree from the Department of Restorative Dentistry of the same university. Between 2012 and 2019, Dr. Lukarcanin was the head doctor and general manager at a private clinic in Izmir. Between 2019 and 2020, he worked at Tinaztepe GALEN Hospital as a Restorative Dentistry specialist, between 2020-2022 he worked at MEDICANA International Hospital Izmir as a Restorative Dentistry specialist. Currently he is an owner of a private clinic for aesthetics and cosmetics in Izmir.

By Peter Schouten, Technical Manager, Kuraray Europe Benelux

The first flowable composites, or flowables, appeared on the dental market in the 1990s. The composition of these materials was entirely based on that of existing packable composites: They contained the same filler particles and resin matrix, but a reduced filler content. Hence, they had a lower viscosity, resulting in better flow characteristics for easy modelling and adaptability to the cavity, but weaker physical and mechanical properties than their packable counterparts. This made them not more than a useful addition to the existing portfolio of resin-based composites: They were widely used as, among others, filling material for Class V lesions and as a liner in large Class I and II cavities.

To broaden the initially limited range of indications, Kuraray Noritake Dental decided to focus on improving the mechanical and physical properties of flowables by developing an entirely new range of products: CLEARFIL MAJESTY™ ES Flow universal flowable composite. Although its predecessor; CLEARFIL MAJESTY™ Flow has higher filler loading and similar mechanical properties, the term universal indicates that the materials are universally applicable. Indeed, the potential indications are vast when compared with the range of indications of a flowable in the past. No matter whether the user wants to apply it as a liner or plans an extensive Class II restoration, CLEARFIL MAJESTY™ ES Flow is an ideal choice.

Three flowability options

As Kuraray Noritake Dental wanted to create a product that performs as desired in every indication, CLEARFIL MAJESTY™ ES Flow is available in three flowability variants. The high flowability material CLEARFIL MAJESTY™ ES Flow High (with green label) was designed for use as a liner, the filling of small imperfections and the restoration of small lesions allowing for micro-invasive preparations. The medium flowability variant CLEARFIL MAJESTY™ ES Flow Low (with blue label) is the most universal of the series and can be used for most indications. The lowest flowability option is CLEARFIL MAJESTY™ ES Flow Super Low (with red label). It may be used in the context of creating larger posterior restorations and for cementing of inlays or onlays.

Appreciated by practitioners

The fact that the product works well in the hands of the dental practitioner was confirmed in the independent publication Dental Advisor: In the issue January-February 2019 (Volume 36, Number 1), CLEARFIL MAJESTY™ ES Flow won Dental Advisor's Top Product Award for the fifth year in a row. In the report, it was described as “Universal Highly-Filled Flowable”, and this is exactly what it is!

CLEARFIL MAJESTY™ ES Flow won Dental Advisor’s Top Product Award for the fifth year in a row.

Unlike the early generation flowables, CLEARFIL MAJESTY™ ES Flow has a high filler content and a flexural strength that is higher than that of most frequently used more paste-like composites.

All three variants are high strength. Compare this with your existing composite.

Given that the universal flowable composite offers so many beneficial properties, dental practitioners might be tempted to replace the packable composite they have been using so far with CLEARFIL MAJESTY™ ES Flow. For the majority of indications, this is indeed possible. Those who do so, will also find that application and modelling directly from the syringe works very well, eliminating the need for a separate instrument.

Unique technologies

What makes the material so unique? It is probably the combination of existing and new technologies that is responsible for superior mechanical properties, a high aesthetic potential and great handling characteristics. Kuraray Noritake’s unique light diffusion technology utilized in the aesthetic composite range CLEARFIL MAJESTY™ ES-2 is also used in CLEARFIL MAJESTY™ ES Flow. Combined with proprietary filler technology, this innovative ingredient is responsible for the fact that restorations made of CLEARFIL MAJESTY™ ES Flow are assimilated within the surrounding tooth structure almost automatically.

The third decisive component is silane technology. The long-chain silane used in CLEARFIL MAJESTY™ ES Flow provides for an optimum wetting capacity of the filler particles. This is a key reason why it is possible to increase the filler percentage to such a high level. After polymerization, the strong bond between the filler and the synthetic resin, brought about by the silane, creates a long-lasting bond. The water absorption is therefore also extremely low, a property any user of composites from Kuraray Noritake may be familiar with.

The unique composition of CLEARFIL MAJESTY™ ES Flow is also responsible for a great polishability and polish retention. Polishing is effortless. Even wiping with alcohol will give a quite nice gloss.

With all these benefits combined in one product, CLEARFIL MAJESTY™ ES Flow offers unparalleled convenience when it comes to creating composite restorations. Kuraray Noritake Dental is proud to have driven technological innovation and applied new developments them in the right way to give the user endless options with a universal flowable composite.