CERABIEN™ MiLai in Daily Use

A tooth with crack lines, a characteristic round shape, age-related changes, or medication-induced discoloration — there’s no one-size-fits-all solution when it comes to all-ceramic anterior restorations, even when the porcelain system and production technique are defined.

To support technicians who wish to simplify their layering workflow using the micro-layering technique and CERABIEN™ MiLai — whether just getting started or looking to refine their process — we’ve collaborated with DT Dumitru Leahu to create a Chroma Map Catalogue featuring seven typical anterior restoration scenarios.

Each case example includes a detailed screenshot of the framework design, chroma maps outlining the planned steps, images of internal staining and micro-layering procedures, and the final restoration on the model. You’ll also find essential information about the selected framework material, target shade, and other relevant details.

We invite you to use the CERABIEN™ MiLai Catalogue as a step-by-step guide to success or simply as inspiration for individual cases. It offers a fast track to understanding the material’s optical properties and will make planning your next micro-layering case more intuitive. No need to start from scratch — instead, adapt what’s already there and gradually develop your own maps and techniques.

Interested in the CERABIEN™ MiLai Chroma Map Catalogue?

Download it here!

Interview with Takehiro Kameya
Manager of the Technology Division of Kuraray Noritake Dental Inc.

How did you identify the need for a universal flowable restorative?

Packable composites with a universal shade concept are becoming increasingly popular worldwide. This fact made us assume that there is a demand for the flowable type as well. Users will also benefit from simplified procedures and a reduced number of shades to be stocked, with a positive impact on inventory management. Accordingly, we introduced the universal flowable composite in Japan, where it already holds a significant market share. Users have been utilizing it for various cases with excellent feedback. As it turned out to be very well received in Japan, we approached the European team to extend the release area to Europe, and the decision was made to launch it. We pushed forward with commercialization in an ultra-short period of about one year.

Does it really create added value to use a universal flowable composite in addition to the universal packable variant?

Yes, several benefits arise from the additional use of a modern flowable composite. This is because – unlike earlier products – the latest generation of flowable composites offers sufficient mechanical strength to be used for regular restorations. The advantages of using a flowable composite include the ability to flow into even the narrowest parts of a (sometimes complex) cavity, which provides for easy and quick filling procedures, and to an intimate adaptation at the adhesive interface leading to a tight seal.

What are the differences between CLEARFIL MAJESTY™ ES Flow and CLEARFIL MAJESTY™ ES Flow Universal?

CLEARFIL MAJESTY™ ES Flow Universal maintains the distinctive features of CLEARFIL MAJESTY™ ES Flow, such as convenient dispensing, handling and sculpting, extremely easy and quick polishing, long-lasting gloss and great mechanical properties. Due to their high strength, both products can be used not only as liners, but also for regular direct restoration procedures. The difference lies in the shade concept. CLEARFIL MAJESTY™ ES Flow Universal introduces a universal shade system, allowing it to adapt to a wide range of colour tones with fewer shade variations.

Please describe the shade concept behind CLEARFIL MAJESTY™ ES Flow Universal. How many shades are available and how are they selected?

The CLEARFIL MAJESTY™ ES Flow Universal line-up consists of two shades: Universal (U) and Universal Dark (UD). U is an excellent choice for all posterior restorations, independent of the target shade. In the anterior region and cervical area (Class III, IV and V cavities), U is best suited for restoring teeth of the shades A1 to A3 (including B1, B2, C1, C2, D2, D2, D3 and D4), while UD is the shade of choice to match the target shades A3.5 to A4 (including B3, B4, C3 and C4).

Color matching with anterior and posterior restorations.

Why do you offer an additional shade for the anterior region?

Universal-shade composites need to take on the colour of the surrounding tooth structure to deliver a perfect match for a great number of target shades. In the posterior area, large amounts of surrounding tooth structure are usually available with several cavity walls still present. This facilitates the taking on of the tooth colour compared to cavities in the anterior region. Here, light easily passes through, so that the colour of the composite itself is more likely to be reflected. This can lead to limitations in colour matching. In the case of CLEARFIL MAJESTY™ ES Flow Universal, the U shade that turned to be ideal for the posterior area showed some colour-matching limitations in anterior restorations of darker teeth. Hence, we decided to offer a second colour option specifically designed for these situations. With U and UD, CLEARFIL MAJESTY™ ES Flow Universal offers great colour adaptability from light to dark shades and hence addresses the need for precise colour matching especially in the anterior region.

Developing just two shades of composite to cover so many target tooth shades sounds challenging. How did you evaluate whether the available shades are appropriate in the clinical environment?

Indeed, it has been quite challenging to develop the U shade, which is able to match a wider range of tooth colours for both anterior and posterior teeth than the U shade of CLEARFIL MAJESTY™ ES-2 Universal. In order to evaluate and fine-tune the shades we developed, we repeatedly conducted filling tests using a wide range of experimental shades in artificial teeth and extracted teeth of various tooth colours. Additionally, the final selection of shades was visually evaluated by consulting dental practitioners who used the composite in the clinical setting.

What are the greatest challenges in the context of determining and selecting the right shade in the clinical environment?

The major drawback of classical shade determination is that it simply increases the chair time. For both, the dental practitioner and the patient, however, minimizing chair time is the ultimate goal, as it reduces costs and increases patient comfort. A true drawback in terms of time and comfort is a colour mismatch produced due to an error during shade determination: it may necessitate intra-oral adjustments or, in the worst case, the creating of a new restoration.

CLEARFIL MAJESTY™ ES Flow Universal is available in two viscosities – Low and Super Low. Why is this the case and what is the difference in use?

We decided to offer two types of flowability with different thixotropic properties to cater to users’ preferences in terms of handling. Basically, there is no difference in usage between Low and Super Low. However, users are encouraged to use composites with different thixotropic properties according to their preferences and the specific case. For example, Super Low is useful for shaping the occlusal surface of posterior teeth. Low can be widely used for applications such as lining and filling in the cervical area and on proximal surfaces.

CLEARFIL MAJESTY™ ES Flow Universal – Great mechanical properties.

What are the technologies behind CLEARFIL MAJESTY™ ES Flow Universal that provide for a great blend-in?

The probably most popular technology used in this product is our proprietary Light Diffusion Technology. We determined the optimal light diffusion based on the observation that a strong diffuse reflection of incident light results in whitening, and weak light diffusion makes it easier to take on dark colours in the oral cavity, darkening the filling site. In addition, we focused on chroma adjustment: The universal shade concept is based on the ability to take on the colour of the surrounding tooth structure and blend with it. Therefore, we have set the chroma to be easily harmonized with a wide range of tooth shades. Finally, the translucency of the material was adjusted via its submicron fillers and silica clusters. Evaluation by key opinion leaders supported us in determining an appropriate level of translucency.

How to proceed in cases with discoloured tooth structure underneath – is there a need for masking with a blocker or opaquer?

The necessity depends on the degree of discolouration. Due to the light diffusion properties of CLEARFIL MAJESTY™ ES Flow Universal, it is generally believed that blocking is not required, and shading can be achieved. However, in cases of severe discolouration, it may be beneficial to fill the bottom of the cavity with A2D or A3D shades of CLEARFIL MAJESTY™ ES Flow, or to use CLEARFIL™ ST Opaquer.

What did you do to avoid void formation during application?

We have adopted the same packaging design used in CLEARFIL MAJESTY™ ES Flow to avoid void formation in this product as well. The innovative container design minimizes the gap between the needle tip and the syringe when the tip is attached.

Are there any recommendations of when to use CLEARFIL MAJESTY™ ES Flow and when to opt for CLEARFIL MAJESTY™ ES Flow Universal?

While the universal variant can be used for general lining and filling applications as described in the instruction for use, CLEARFIL MAJESTY™ ES Flow is recommended for those cases in which the tooth structure is covered and the colour of the entire tooth needs to be changed. Direct veneers are a perfect example. In those situations, the use of different shades and opacities is clearly beneficial.

What is the future of flowable composites?

As information on clinical performance and physical properties data continues to spread, the trust in flowable composites is expected to increase in Europe, leading to its expanded usage. Furthermore, an increased demand is anticipated due to the development of filling methods using flowable composites in conjunction with moulds or matrices.

TAKEHIRO KAMEYA

Interview with Ghaith Alousi, DT

He inspires dental technicians with his passion and creativity as a course instructor, and with Nature Style, he has developed a well-conceived concept for the creation of lifelike anterior restorations. We are talking about Ghaith Alousi, a dental technician based in Wiesbaden, Germany. While course participants usually attend his training courses eager to learn from his experience and technical knowledge, they often return to their laboratories bursting with positive energy, truly inspired and deeply motivated to break new ground.

Ghaith Alousi, what is the dental technician’s primary mission?

In my eyes, dental technicians are not artists; rather, their primary mission is to replicate nature – both functionally and aesthetically. Every tooth, like every patient, is as unique as a fingerprint. To recreate a natural tooth as accurately as possible, we must listen, observe, and understand. To truly perceive the details that matter, however, we need to know where to focus our attention. In my opinion, the three golden keys to anterior aesthetics are paramount: balanced translucency and opacity, morphology, and surface texture.

What about colour?

While colour is undoubtedly a crucial aspect, I believe it is often overemphasized. Many dental technicians focused on aesthetic anterior restorations find themselves preoccupied solely with colour. However, natural teeth – the model we aim to replicate – embody far more than just a blend of hues.

First and foremost, we must understand how light interacts with teeth. They diffuse light in a unique manner, with different layers of enamel and dentin each possessing distinct optical properties. Additionally, the individual shape and surface texture of a tooth significantly affect the perceived attractiveness of a patient’s smile and overall facial appearance. Therefore, I have learned to prioritize these elements, observing nature closely and striving to comprehend what I see before embarking on the replication process.

Fig. 1. Light-optical properties of natural teeth imitated with KATANA™ Zirconia YML, Esthetic Colorant and CERABIEN™ ZR porcelain (Kuraray Noritake Dental Inc.).

Let’s take a brief look at each of the three golden keys, starting with the light-optical properties.

To truly grasp how light interacts with natural teeth, we must first examine their structure. Natural teeth consist of various layers, each displaying unique light-optical behaviours, with enamel and dentin being the most significant. Upon closely observing the dentin core of a tooth, we realize it is not only responsible for the tooth’s fundamental colour but also exhibits distinct opacity – it does not transmit light; instead, it reflects and absorbs it. In contrast, enamel presents a different scenario: its thickness varies with factors such as the patient’s age, but it is consistently highly translucent. This translucency allows a portion of light to pass through, with only a minimal amount reflected or absorbed.

Once we have a solid understanding of the natural light dynamics inherent in a patient’s teeth, the next step is to replicate these characteristics using selected materials. Thus, comprehending the light-optical properties of available materials, choosing them wisely, and applying them effectively are crucial milestones on the path to success.

What about morphology?

I firmly believe that mastering morphology – the replication of natural tooth shapes – can significantly impact a dental technician’s work. The growing popularity of carving workshops in Japan and other parts of the world reinforces this idea. Aspiring technicians avoid using standard dental libraries that produce generic smiles for their patients. Rather than traveling long distances to attend workshops and build our own mental library of tooth shapes, we can explore the intricacies of form and shape right in our dental laboratories through careful observation and consistent practice. Some technicians capture images of the teeth they encounter, while others concentrate on their own teeth or those of colleagues and patients. This approach allows for the replication of shapes using materials like wax or ceramics. By honing our observation and replication skills, we expand our personal knowledge base. This commitment to detail fosters true mastery – a continuous journey toward perfection.

Fig. 2. Example of a natural surface texture reproduced with CERABIEN™ MiLai and different diamond burs, stones and rubber polishers.

Is surface texture similarly important?

Absolutely. The surface texture of a restoration, even more than its hue, must precisely match that of surrounding or opposing teeth to achieve a natural appearance. To accomplish this, we must understand and replicate the intricate interplay of micro- and macrotextures that create a tooth’s natural look. Macrotexture encompasses the tooth’s overall surface characteristics, including varying concavities, convexities, line angles, and vertical V-shaped grooves. In contrast, microtexture focuses on finer details, such as growth lines (striae of Retzius), perikymata, small grooves, and the degree of surface gloss. A keen eye is essential to replicate every surface detail harmoniously so that light interacts optimally, creating reflections, shadows, and highlights exactly where they are needed.

Fig. 3. Large tooth created with CERABIEN™ ZR.

How do you practice?

To practice replicating surface texture and morphology, I typically start with enlarged model teeth, first using wax and later transitioning to my preferred dental materials and instruments. The increased size of the working base allows for easier detection, reproduction, and assessment of relevant morphology and surface details compared to original-sized tooth forms. This enlargement also facilitates the evaluation of light-optical properties. For the final assessment, I often apply silver or gold powder to the surface of the model tooth, which highlights even the finest surface nuances. This method makes it easy to identify areas that are well-executed and those that may need improvement.

Fig. 4. Gold powder applied to anterior restorations …

Once I achieve a high level of quality with the enlarged model teeth, I transfer the acquired skills to real-life applications by working with actual-sized teeth. This practice framework allows me to continuously enhance my basic skills. Moreover, each time I start working with a new instrument or material, this approach streamlines the initial learning curve, quickly elevating my performance to a high standard.

Fig. 5. … to evaluate their shape and surface texture.

What are your preferred material combinations for different indications / needs?

For cases with highest aesthetic demands, CERABIEN™ ZR (Kuraray Noritake Dental Inc.) is my favourite porcelain system. I This system can be utilized either as a standalone solution for producing veneers using the refractory die technique or in conjunction with a zirconia framework – typically crafted from KATANA™ Zirconia variants such as KATANA™ Zirconia UTML, STML, HTML Plus, or YML (also from Kuraray Noritake Dental Inc.) – in a full layering approach.

I frequently employ this combination to produce single crowns in the anterior region, selecting the framework material based on the colour of the underlying tooth structure and the appearance of adjacent teeth. An alternative approach is layering with CERABIEN™ MiLai, which consists of internal stains and porcelains compatible with zirconia and lithium disilicate. I prefer to combine this system with the previously mentioned zirconia variants or with lithium disilicate, predominantly using the porcelain to replicate enamel. Sometimes, I employ the system’s internal stains to enhance the result with natural colour effects.

Apart from observing closely, selecting appropriate materials and copying carefully, are there any additional factors decisive for great treatment outcomes from the technician’s point of view?

To my mind, there are two additional essential factors: Proper interaction and communication within the restorative team and personal interaction with the patient. Especially in the highest aesthetic demand cases, meeting a patient in person is very important. They are usually invited to visit the dental laboratory twice, prior to treatment planning and for try-in. Nothing can replace personal interaction with them and a genuine impression of the initial situation. After all, we need to give them a sense of security and build trust, while analysing their character, facial characteristics, skin colour and more allows us to produce perfectly matching restorations.

Fig. 6. Full layering approach with CERABIEN™ ZR on a KATANA™ Zirconia YML framework.

And the restorative team?

We share a common goal: to fulfil the desires of our patients. I firmly believe that achieving this requires a united effort from the entire team. Collaboration hinges on appreciative and open communication at all levels and demands absolute honesty. Furthermore, everyone involved must be committed to continuously developing their skills.

I hold high expectations not only for my own work but also for the contributions of each dentist in our team. After all, their work forms the foundation of what I do. For example, when a dentist invests in an intraoral scanner and starts providing digital records, it is my responsibility to verify whether the quality of those scans meets our high standards. If I notice that the quality could be improved, I approach the situation with respect, offering constructive feedback and guidance to help them deliver quality scans consistently. This is crucial, as high-quality scans are the prerequisite for creating outstanding restorations.

In my experience, most dental practitioners appreciate this kind of honest and supportive communication. It creates an environment where we can all grow and evolve together.

Do you have any additional comments?

Be authentic, strive for excellence, and approach each day as an exhilarating opportunity. Courage plays a vital role, too – the readiness to venture beyond your usual routines, such as experimenting with different shades to discover new possibilities, fosters growth. Even if the outcome does not meet your expectations, there is valuable insight to gain from the experience that can guide you in the future. To reach new horizons, be open to exploring uncharted paths.

Dentist:

GHAITH ALOUSI

Ghaith Alousi, born in 1994, successfully completed his training as a master dental technician in 2013 in Damascus, Syria, where he gained initial experience in a dental laboratory. From 2014 to 2016, he worked independently in Damascus, using his craftsmanship to produce ceramic work such as frameworks, veneers, crowns and bridges, and implant-based restorations. He also engaged in shade determination, photography, and CAD/CAM technology.

He came to Germany in 2016 and quickly felt at home. Through further education, he has continuously expanded his knowledge and skills and is currently working as a dental technician in Wiesbaden. To achieve the best possible results, Ghaith Alousi places great value on collaboration with dentists and personal contact with patients.

Seamless, streamlined cooperation between dentist and dental technician is a recipe for success. The KIZUNA Symposium (Japanese for “bond, connection between people”) explores precisely that. Here are five key reasons you shouldn’t miss it:

1  A UNIQUE EXPERIENCE

KIZUNA is more than an event – it is a philosophy of collaboration. It brings together dentists and dental technicians, creating a shared space for dialogue, learning, and inspiration. Different perspectives converge in one direction: effective and harmonious patient care. The symposium features joint sessions at the beginning and end of the day, with separate sessions for dentists and dental technicians in between.

2  EXCELLENT SPEAKERS

Moderated by the inspiring Dr. Agnieszka Pacyk, the symposium brings together 14 leading professionals from across Europe. Expect scientific excellence, state-of-the-art technologies, the power of AI, new approaches, and plenty of practical tips and tricks. Learn from the very best – for example, MDT Nondas Vlachopoulos and MDT Antonio Corradini, who will conclude the day with a two-hour lecture on excellence in dentistry through outstanding cooperation.

3  NEXT-LEVEL NETWORKING

On the evening before the KIZUNA Symposium, a unique social gathering will set the tone for the day ahead. Guests will enjoy an exclusive dinner featuring authentic Japanese cuisine, blending refined flavours with artistry and elegance. This special evening will not only delight your senses, but also create the perfect atmosphere for networking and informal conversations with colleagues, lecturers, and fellow participants from across Europe. To make the night even more memorable, special attractions inspired by Japanese culture will be offered.

4  SUPERB VENUE AND ACCOMMODATION POSSIBILITIES

The ICE Kraków Congress Centre is a modern and prestigious venue that will become the heart of the KIZUNA symposium. Located in the very center of Kraków, will provide an inspiring setting for dialogue, innovation, and the exchange of expertise, blending Japanese precision with European openness. Near the ICE, you’ll find a wide selection of hotels within walking distance, offering both convenience and comfort throughout your stay. These hotels are not only ideally located for the event, but also nestled close to Kraków’s historic landmarks, allowing you to experience the city’s charm.

5 BEAUTIFUL KRAKÓW

Discover Kraków, a UNESCO World Heritage gem. The city is rich in history and charm – from the iconic Wawel Castle to the vibrant Cloth Hall in the Main Market Square. Stroll through historic districts like Kazimierz and Podgórze, relax in the greenery of Planty Park, and uncover hidden treasures throughout the city. Whether tasting traditional pierogi or admiring Gothic architecture, Kraków offers countless unforgettable experiences.

For more information click here.

See you in Kraków!

Case by Tomas Forejtek

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.

Dentist:

TOMAS FOREJTEK

Tomas Forejtek is a dental technician based in Brno, Czech Republic. After graduating top of his class in 2001, he joined a prestigious private clinic where he developed a strong focus on ceramic restorations. Within three years, he became certified in fixed prosthetics and was appointed head of the dental lab. Known for his intuitive and hands-on approach, Tomas enhanced his skills through both local and international training, drawing key inspiration from mentors such as Sascha Hein and Naoto Yuasa. In 2010, he opened his own lab in Brno, specializing in high-quality, esthetic restorations. Since 2016, he has focused on single central cases using the eLAB protocol and became an official eLAB instructor in 2018.

BUSTING MYTHS AROUND HIGH-STRENGTH CERAMICS IN DENTISTRY

Crowns, bridges, partial restorations: When it comes to replacing or restoring an individual’s teeth with fixed dental prostheses, the choice is often between the high-strength ceramics - lithium disilicate and zirconia. Originally, the higher aesthetic potential of silicate ceramics made them particularly suitable for single tooth restorations, while the high-strength option zirconia was predominantly used for bridges and frameworks. Due to continuous improvements in the development of dental ceramics and adhesive technology, things have changed. Many of the original limitations and restrictions are no longer valid, and new opportunities arise for users in the dental setting.

In the following, we will address certain persisting myths about the use of zirconia and lithium disilicate in dentistry. In this context, you will receive an update on what is possible with the materials today and guidance on how and when to use them.

1. ZIRCONIA IS AESTHETICALLY INFERIOR TO LITHIUM DISILICATE

The original zirconia used in dentistry was whitish-opaque. Therefore, it was used as a framework material only. To create aesthetic restorations, it was necessary to apply a relatively thick layer of veneering porcelain. More recent generations of zirconia, however, include variants with a particularly high translucency and a multi-layered colour structure. These variants allow for less complex finishing techniques such as micro-layering or external staining. KATANA™ Zirconia UTML (Kuraray Noritake Dental Inc.), for example, is one of the most translucent zirconia materials on the dental market. Depending on the test method used, it offers a similar or only somewhat lower translucency compared to lithium disilicate (IPS e.max CAD LT, Ivoclar Vivadent)^1-4. The desired natural result is achieved as light reaches – and reflects – the underlying tooth structure. Consequently, true-to-life restorations can be produced in an efficient, highly automated workflow.

CONCLUSION

Depending on the variant of zirconia and lithium disilicate used, both materials offer similar aesthetic properties, while even the highest-translucency zirconia is stronger than the highest-strength lithium disilicate available. Material selection may therefore be based on other criteria such as preparation depth for example.

2. ZIRCONIA-BASED RESTORATIONS ARE WEAKER THAN LITHIUM DISILICATE-BASED ONES DUE TO THE NEED OF A PORCELAIN LAYER ON TOP OF ZIRCONIA

This assumption is true for the first generations of dental zirconia. For modern zirconia materials with a high translucency and multi-layered colour structure, however, the situation is different. They are suitable for the production of monolithic restorations or restorations with a minimal (vestibular) cutback and a micro-layer of porcelain. With occlusal contact areas made of plain (polished or glazed) zirconia, these restorations are stronger than monolithic lithium disilicate restorations, while the chipping risk is minimized. In fact, even the weakest zirconia offers a significantly higher flexural strength than lithium disilicate (IPS e.max CAD LT, Ivoclar Vivadent)^2,3. Thanks to the high edge stability of zirconia after milling, the restorations are also highly stable, a favourable property for long-term success.

CONCLUSION

The flexural strength of zirconia is generally higher than that of lithium disilicate (800 to 1,200 MPa for zirconia versus 360 to 460 MPa for lithium disilicate), and due to the improved aesthetic potential of the available materials, a full porcelain layer is no longer required. Hence, zirconia restorations are usually very strong and durable.

3. FINISHING OF ZIRCONIA RESTORATIONS IS MORE COMPLICATED THAN FINISHING OF LITHIUM DISILICATE RESTORATIONS

When using modern, aesthetic zirconia materials, finishing techniques are quite similar. The most popular technique for both, high-translucency zirconia and lithium disilicate, is micro-layering. Based on a full-contour restoration design and a subsequent cutback limited to the vestibular area, a micro-layer of porcelain (often a specific porcelain line-up developed for micro-layering) is applied. With CERABIEN™ MiLai from Kuraray Noritake Dental Inc., the standard procedure consists of internal staining, the application of luster porcelains and final glazing. Fewer layers and fewer bakes are required compared to full porcelain layering. However, aesthetic zirconia can also be used for the production of monolithic restorations, which are characterized with paste stains and glazed.

CONCLUSION 

As a monolithic design or minimal cutback of restorations based on modern zirconia materials is an option, finishing of zirconia is just as easy as finishing of lithium disilicate restorations. The technique depends on the desired outcome.

4. ZIRCONIA-BASED RESTORATIONS ARE MORE INVASIVE THAN THOSE MADE OF LITHIUM DISILICATE

This myth is also based on the assumption that zirconia needs a thick porcelain layer on top to produce aesthetic results. Since this is not the case and great outcomes are possible with monolithic designs or micro-layering approaches, a minimally invasive preparation design is supported by the use of zirconia as a restorative material. Due to a comparatively high strength even of the high-translucency variants, the minimum wall thickness is quite low (e.g. 0.4 mm for veneers made of KATANA™ Zirconia UTML or STML and 0.5 mm for posterior crowns made of KATANA™ Zirconia HTML Plus)*. This allows for a defect-oriented tooth structure removal.

*In general, the minimum wall thickness depends on the product and the indication.

CONCLUSION 

Depending on the type of zirconia and the finishing method, zirconia supports the production of minimally invasive restorations.

5. DUE TO THEIR HARDNESS, MONOLITHIC ZIRCONIA RESTORATIONS HARM THE OPPOSING DENTITION

When manufacturers of dental zirconia started promoting the monolithic use of zirconia, in-vitro studies were soon available to prove that it is not the hardness of the material, but the smoothness of the surface that determines how kind or harmful a dental restoration is to the opposing dentition^5-8. According to those studies, well-polished zirconia surfaces maintained their smoothness and showed a superior self-wear and wear to the opposing tooth structure compared to other restorative materials including lithium dislilicate^6-8. As glaze - unlike the polished surface - tended to wear off over time, it was stressed that a perfectly polished restoration surface is essential for a wear-friendly long-term behaviour. The in-vitro study results were also confirmed in vivo^9,10. According to the latest umbrella review focusing on this topic, polished monolithic zirconia causes lower antagonist enamel wear than metal ceramics, feldspathic porcelains and lithium disilicate tested¹⁰.

CONCLUSION 

Provided that the surface is smooth, monolithic zirconia restorations are kind to the opposing natural tooth structure. Over time, the opposing enamel wear may be expected to be on a similar level as natural enamel wear.

6. ADHESIVE LUTING OF ZIRCONIA-BASED RESTORATIONS IS IMPOSSIBLE

When oxide ceramics like zirconia are processed and pre-treated in the same way as silicate ceramics like lithium disilicate, the obtained bond strength is lower. Using the correct pre-treatment protocol, however, it is possible to establish a strong and durable chemical bond between the tooth structure and the zirconia. Otherwise, it would not be possible to place single-retainer resin-bonded bridges made of high-strength zirconia (3Y-TZP) successfully, for example. Their design is largely non-retentive, so that a strong bond is of paramount importance. It is established by air-abrading the bonding surface of the zirconia retainer wing with aluminium oxide (50 μm) at a low pressure (approx. 1 to 2.5 bar) after try-in^11,12, followed by ultrasonic cleaning, the use of a restoration primer that contains 10-MDP¹³ and the application of a high-performance resin cement like PANAVIA™ V5 (Kuraray Noritake Dental Inc.)¹⁴. Using this protocol with a predecessor of the resin cement just mentioned, ten-year survival and success rates were above 90 percent¹⁵. The described protocol is in line with the APC concept recommended by Prof Dr. Markus Blatz, which includes (A) airborne-particle abrasion, (P) zirconia primer, and (C) adhesive composite resin application¹⁶.

CONCLUSION

Using an appropriate protocol including small particle air-abrasion after try-in and a high-performance adhesive resin cement system with MDP primers, a strong and long-lasting chemical bond to zirconia can be established.

7. ZIRCONIA IS UNSUITABLE FOR RUSH CASES DUE TO THE NEED OF SINTERING THE RESTORATIONS AFTER MILLING

By using zirconia variants that are suitable for speed sintering, smaller restorations can be produced within very short time. Single-unit restorations and small bridges (up to three units) made of materials of the KATANA™ Zirconia Multi-Layered Series, for example, may be speed-sintered within 54 minutes, provided that a suitable furnace is used. This leads to a considerable reduction of the production time and is a great option for rush cases. For a true chairside workflow and same-day dentistry, KATANA™ Zirconia Block is a great option. It offers the same optical and mechanical properties as KATANA™ Zirconia STML and can be sintered even faster – in just 18 minutes.

CONCLUSION

By using suitable zirconia materials and equipment, production times of zirconia restorations are no longer an issue when it comes to rush cases.

8. ALL HIGH-STRENGTH CERAMICS HAVE A SIMILARLY WIDE RANGE OF INDICATIONS

In fact, the range of indications varies with the flexural strength and fracture toughness of the materials. While the use of lithium disilicate is limited to the production of single-tooth restorations and small bridges, zirconia typically covers a wider range of indications, with the high-strength variants being even suited for long-span bridges. The most versatile variants of zirconia are those with flexural strength gradient – like KATANA™ Zirconia YML. This material offers a particularly high translucency in the enamel layer and a high strength in the body layers. Therefore, it is well suited for the production of single-tooth restorations and of highly complex structures such as long-span bridges – depending on where the restoration is positioned in the disc.

CONCLUSION

Zirconia offers a wider range of indications than lithium disilicate. By selecting one of those variants with a multi-layered structure offering flexural strength gradation, it is possible to cover virtually every indication, while other variants are better suited for specific needs (highest translucency option for aesthetically demanding cases, highest strength option for complex long-span designs).

ZIRCONIA A TRUE ALLROUNDER

Modern versions of dental zirconia are high-performance materials with well-balanced optical and mechanical properties typically suitable for a wide range of indications. As a zirconia user, you may choose to employ a single material with flexural strength gradation for virtually every situation or prefer to select different products depending on case-specific demands. You have the freedom to select the preferred finishing technique from traditional layering to just polishing and may opt for minimally invasive restoration designs. The latter is due to proven protocols establishing a long-lasting bond to zirconia. For everyone with particularly high quality demands, the KATANA™ Zirconia Multi-Layered series is worth a try. The raw material composition is unique, the powder is developed in-house in Japan and the blanks are produced in a perfectly aligned procedure delivering a homogeneous, densely pressed material for restorations with an accurate fit, high strength and superior edge stability.

REFERENCES

<sup>1. F. Beuer, J. Schweiger, ConsEuro 2015 London, Kuraray Satellite Symposium, May 14th 2015. 
2. Kwon SJ, Lawson NC, McLaren EE, Nejat AH, Burgess JO. Comparison of the mechanical properties of translucent zirconia and lithium disilicate. J Prosthet Dent. 2018 Jul;120(1):132-137. 
3. Reale Reyes A, Dennison JB, Powers JM, Sierraalta M, Yaman P. Translucency and flexural strength of translucent zirconia ceramics. J Prosthet Dent. 2023 Apr;129(4):644-649. 
4. Harada K, Raigrodski AJ, Chung KH, Flinn BD, Dogan S, Mancl LA. A comparative evaluation of the translucency of zirconias and lithium disilicate for monolithic restorations. J Prosthet Dent. 2016 Aug;116(2):257-63. 
5. Janyavula S, Lawson N, Cakir D, Beck P, Ramp LC, Burgess JO. The wear of polished and glazed zirconia against enamel. J Prosthet Dent. 2013 Jan;109(1):22-9. 
6. Preis V, Weiser F, Handel G, Rosentritt M. Wear performance of monolithic dental ceramics with different surface treatments. Quintessence Int. 2013 May;44(5):393-405. 
7. Lawson NC, Janyavula S, Syklawer S, McLaren EA, Burgess JO. Wear of enamel opposing zirconia and lithium disilicate after adjustment, polishing and glazing. J Dent. 2014 Dec;42(12):1586-91. doi: 10.1016/j.jdent.2014.09.008. Epub 2014 Sep 23. PMID: 25257823. 
8. Sripetchdanond J, Leevailoj C. Wear of human enamel opposing monolithic zirconia, glass ceramic, and composite resin: an in vitro study. J Prosthet Dent. 2014 Nov;112(5):1141-50. 
9. Hartkamp O, Lohbauer U, Reich S. Antagonist wear by polished zirconia crowns. Int J Comput Dent. 2017;20(3):263-274. 
10. Shah N, Nerkar H, Badwaik P, Ahuja B, Malu R, Bhanushali N. An evaluation of antagonist enamel wear opposing full-coverage zirconia crowns versus other ceramics full-coverage crowns and natural enamel - An umbrella review. J Indian Prosthodont Soc. 2024 Jul 1;24(3):217-224. 
11. Kern M. Bonding to oxide ceramics—laboratory testing versus clinical outcome. Dent Mater. 2015 Jan;31(1):8-14. 
12. Kern M, Beuer F, Frankenberger R, Kohal RJ, Kunzelmann KH, Mehl A, Pospiech P, Reis B. All-ceramics at a glance. An introduction to the indications, material selection, preparation and insertion techniques for all-ceramic restorations. Arbeitsgemeinschaft für Keramik in der Zahnheilkunde. 3rd English edition, January 2017. 
13. Al-Bermani ASA, Quigley NP, Ha WN. Do zirconia single-retainer resin-bonded fixed dental prostheses present a viable treatment option for the replacement of missing anterior teeth? A systematic review and meta-analysis. J Prosthet Dent. 2021 Dec 7:S0022-3913(21)00588-6. 
14. Bilir H, Yuzbasioglu E, Sayar G, Kilinc DD, Bag HGG, Özcan M. CAD/CAM single-retainer monolithic zirconia ceramic resin-bonded fixed partial dentures bonded with two different resin cements: Up to 40 months clinical results of a randomized-controlled pilot study. J Esthet Restor Dent. 2022 Oct;34(7):1122-1131. 
15. Kern M, Passia N, Sasse M, Yazigi C. Ten-year outcome of zirconia ceramic cantilever resin-bonded fixed dental prostheses and the influence of the reasons for missing incisors. J Dent. 2017 Oct;65:51-55. doi: 10.1016/j.jdent.2017.07.003.
16. Blatz MB, Alvarez M, Sawyer K, Brindis M. How to Bond Zirconia: The APC Concept. Compend Contin Educ Dent. 2016 Oct;37(9):611-617; quiz 618.</sup>

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CLEARFIL™ Ceramic Primer Plus ACHIEVES PREFERRED PRODUCT STATUS FOR THE EIGHTH TIME

A Preferred Product of Dental Advisor’s consultants for its ability to bond to a wide variety of restorative materials: CLEARFIL™ Ceramic Primer Plus received this recognition every year since 2018. This year’s awards have been published in the January/February 2025 issue of the publication. The universal primer provides exceptional bond strength, particularly to silica-based ceramics, zirconia, and composites. Its consistent performance has earned it the recognition of clinicians worldwide.

HOW IT WORKS

CLEARFIL™ Ceramic Primer Plus is a single-bottle primer that combines the power of two essential components: the original MDP monomer, which creates a strong bond with metals and zirconia, and the silane coupling agent MPS, which ensures excellent adhesion to composites and silica-based ceramics. This dual chemistry enables exceptional bonding performance across a variety of materials. Designed to work seamlessly with PANAVIA™ V5 and PANAVIA™ Veneer LC, it provides a reliable foundation for long-lasting indirect restorations.

 
Features contributing to procedural simplicity include:

• Primer bottle designed for effortless one-handed operation.
• Unique nozzle for precise dispensing.
• Straightforward application: Just apply and dry.

CONVINCING CLINICAL PERFORMANCE

In a clinical evaluation, the consultants of the Dental Advisor testing the product highlighted its efficiency and ease of use. They stated: "Quick to apply and wets ceramic well" and “Easy to use on a variety of materials”.

As a result, the product received a clinical performance rating of 96 percent. Comparing the universal primer to the product they currently used, all consultants were sure that CLEARFIL™ Ceramic Primer Plus shows an equal or even better overall performance.

ABOUT DENTAL ADVISOR

The Top Product and Preferred Product Awards from Dental Advisor, a US-based organization, were initiated to help busy practitioners navigate the variety of new dental solutions available, particularly for less invasive techniques and standardized procedures. These awards aim to identify products that improve outcomes consistently. Dental Advisor conducts clinical evaluations and product performance tests shortly after a product’s launch and publishes annual results online to help practitioners identify high-quality dental materials suited to their specific needs.

For more information, visit Dental Advisor at: www.dentaladvisor.com

Achieving consistent, high-quality ceramic restorations requires more than just premium materials — it demands a deep understanding of your tools and processes. The CERABIEN™ MiLai Firing Guide is designed to help dental technicians unlock the full potential of this advanced micro-layering porcelain system. With tips on optimal furnace positioning, trial baking, and troubleshooting, this guide supports efficient, aesthetic results every time. Whether you're new to CERABIEN™ MiLai or looking to refine your firing process, this resource lays the groundwork for success.

Tenkindama šiuolaikinės odontologijos praktikos poreikius, „Kuraray Noritake Dental Inc.“ nuolat tobulina ir kuria naujas medžiagas. Įgyvendindama šį įsipareigojimą, bendrovė pristato „CLEARFIL™ Universal Bond Quick 2“ – naujausią dantų klijavimo technologijos laimėjimą. Šie klijai gerina klinikinį darbą ir patikimai veikia įvairiose srityse. 

„CLEARFIL™ Universal Bond Quick 2“ – tai daugybė privalumų, kuriuos užtikrina patentuotos pažangios greito sujungimo technologijos bei naujo užpildo dispersijos metodo ir vientisos integracijos su svarbiais produktais (pavyzdžiui, plombų medžiagomis ir savaime lipniu dervos cementu) derinys. Pažangi greitojo sujungimo technologija apima tris – originalųjį MDP, amido ir uretano tetrametakrilato (UTMA) – monomerus. 

Hidrofilinių savybių amido monomeras greitai įsiskverbia į danties struktūrą. Užtepus nereikia laukti, dėl to sutaupoma laiko ir mažinama infekcijos rizika. Dėl šios savybės produktas idealiai tinka tais atvejais, kai sudėtinga kontroliuoti drėgmę. Pridėtas naujas UTMA monomeras yra pagrindinis komponentas, sukuriantis labai stiprų jungiamąjį sluoksnį, atsparų susitraukimo jėgoms. O MDP monomeras kartu su kitomis gerai suderintomis sudedamosiomis dalimis nuosekliai ir patvariai sukibina su emaliu ir dentinu. 

Be kitų privalumų, naujasis užpildo dispersijos metodas reikšmingas tuo, kad produktas yra takesnis nemažinant užpildo kiekio ir lengvai tepamas, todėl galima suformuoti ploną, vientisą jungiamąjį sluoksnį. Taigi jis nesikaupia ir išlaikoma pirminė paruošto danties morfologija. 

CLEARFIL™ Universal Bond Quick 2 galima laikyti kambario temperatūroje (ne aukštesnėje kaip 25 °C), jo nereikia suplakti ir naudojamas bet kada. Be to, jis puikiai tinka įvairiems klinikiniams atvejams: tiesioginėms restauracijoms, netiesioginėms restauracijoms cementuoti savaiminės adhezijos dervos cementu ir kulties atkūrimo procedūroms. Nereikia atskiro dvigubo kietėjimo aktyvatoriaus. 

Rekomenduojama gydytojams, siekiantiems maksimalaus efektyvumo ir geriausios gydymo kokybės, derinti šiuos klijus ir kitas aukštos kokybės plataus asortimento „Kuraray Noritake Dental Inc.“ medžiagas. Šie produktai, kuriuos sudaro mažiau komponentų, trumpina procedūras, paprastina darbo eigą ir atveria kelią išskirtiniams klinikiniams rezultatams. 

Daugiau informacijos apie „CLEARFIL™ Universal Bond Quick 2“ ir visą asortimentą galima rasti interneto puslapyje adresu www.kuraraynoritake.eu

Case by Dr. Julien Molia

YES, IT WORKS!

In the minds of many dental practitioners, it has become firmly established that flowable composites are nice liner or base materials below stronger packable composites and indirect restorations or as a temporization material. Many of them assume, however, that their use is limited due to their poor mechanical properties.

A NEW GENERATION OF FLOWABLES

Luckily, this is no longer true: Several flowable composites of the latest generation – like CLEARFIL MAJESTY™ ES Flow and CLEARFIL MAJESTY™ ES Flow Universal (both Kuraray Noritake Dental Inc.) – are equipped with mechanical properties, which are on par with those of many packable alternatives. Consequently, the range of indications is extended. For example, CLEARFIL MAJESTY™ ES Flow Universal, has a high filler loading of 75 to 78 wt/%, a flexural strength of more than 150 MPa and a compressive strength exceeding 370 MPa according to the manufacturer. Thanks to its high strength, it serves as a reliable and permanent solution, even suitable for stress-bearing areas such as the occlusal surfaces of posterior teeth.

However, this flowable composite has even more to offer: It is available in two levels of flowability – LOW and SUPER LOW – to serve a wider range of personal preferences and individual indication-specific needs and in just two shades (universal and universal dark). The latter offers the benefit of intuitive shade selection even in the anterior area and is enabled by a mixture of shade matching technologies, including optimized light diffusion technology and an enamel-like translucency.

The following case example reveals how CLEARFIL MAJESTY™ ES Flow Universal makes my life easier in posterior restoration procedures.

CASE EXAMPLE

This patient presented for the replacement of two amalgam restorations in the mandibular right molars (teeth # 46 and 47 according to the FDI notation) (Fig. 1). As it would facilitate filling and provide for great adaptation to the cavity walls, it was decided to use CLEARFIL MAJESTY™ ES Flow Universal LOW as the only restorative material. The position of the teeth to be restored made shade selection easy: Shade U (universal) is designed to work perfectly for all posterior restorations.

The amalgam restorations were removed and caries was excavated, while saving as much of the healthy tooth structure as possible (Figs. 2 and 3). A selective enamel etching technique was chosen, followed by the application of a universal adhesive (CLEARFIL™ Universal Bond Quick 2, Kuraray Noritake Dental Inc.). Subsequently, CLEARFIL MAJESTY™ ES Flow Universal in the LOW version and the selected shade U was applied into the cavities (Fig. 4). Thanks to the innovative syringe design, the applied flowable composite is virtually free of voids. In line with the instructions for use of the product, the thickness of each layer did not exceed 2 millimetres to provide for a complete cure (Figs. 5 and 6), which has a decisive impact on the long-term performance of the final restorations. Each layer should be thoroughly cured for 10 to 20 seconds (depending on the curing light) before the next layer is applied. As shown in Figure 7, the low flowability of the selected material allows for some modelling of the occlusal surface morphology. When more anatomical details need to be restored, the steadier SUPER LOW variant may be an option. It took just a few seconds to polish the restorations to high gloss (Fig. 8).

Fig. 1. Two amalgam restorations to be replaced.

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

Fig. 3. Typical amalgam staining is visible at the bottom of the larger cavity.

Fig. 4. Filling procedure: Application of the first layer of flowable composite.

Fig. 5. Second molar already filled, first molar in need of another layer of flowable composite.

Fig. 6. Filling completed.

Fig. 7. Nice surface morphology and shade blend-in.

Fig. 8. Treatment outcome after rubber dam removal. The restorations blend in nicely with the surrounding dentition – qua shade and surface gloss.

EASY-TO-USE ALTERNATIVE TO PACKABLE COMPOSITES

Especially in difficult-to-reach areas in the mouth, the use of a flowable composite with well-balanced mechanical properties can be a nice alternative to packable ones. Advanced shade-matching abilities, virtually void-free application, easy adaptation and modelling, and quick polishing truly simplify the life of the dental practitioner. However, many assume their use is limited due to poor mechanical properties.

Dentist:

JULIEN MOLIA

Dr. Julien Molia graduated in 2008 with a thesis on computer-assisted implantology. He established a general dental practice in Saint-Jean-de-Luz, where he has since focused on implant surgery and jawbone reconstruction. In 2017, he completed a second university degree in implantology to update and deepen his expertise. He has also pursued advanced training in digital dentistry, orthodontic miniscrews, and mucogingival surgery. Committed to tissue preservation, he trained privately with Drs. Gil Tirlet and Jean-Pierre Attal in Paris. Dr. Molia is a founding member of the French Southwest BioTeam, a collaborative group dedicated to clinical research and innovation.