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Article by Dr. Florian Zwiener

Modern multi-layered zirconia such as KATANA™ Zirconia STML (Kuraray Noritake Dental Inc.) already meets high aesthetic demands due to its natural colour gradient and high translucency. To achieve further characterisation and optical adjustment to the adjacent teeth, there are essentially two options: veneering with feldspathic ceramic or glazing and individualisation with ceramic stains.

While there are still many indications for veneering, especially in the anterior area, more and more cases can now be solved with monolithic restorations. This allows for a time-efficient chairside workflow with same-day treatment, eliminating the need for temporary restorations. Additionally, the absence of a porcelain layer reduces the wall thickness of the restoration and thus the space required, allowing for less invasive preparation. This also reduces the risk of endodontic complications induced by tooth preparation (grinding trauma). Another advantage is a significant reduction in the chipping risk.

Below are the essential steps for individualisation using ceramic stains, demonstrated through the example of a molar crown.

PREPARATION

The restoration is designed in full contour as usual, ideally dry-milled, and then sintered. After sintering, the restoration is first sandblasted (aluminium oxide 50 μm, 1 to 1.5 bar pressure). This microscopic roughening of the ceramic surface enables an optimal bond with the glaze. Subsequently, the restoration should be cleaned using a steam cleaner or an ultrasonic cleaner to remove all blasting residue.

The functional restoration surfaces must then be polished to avoid the risk of excessive abrasion on the enamel of the opposing dentition, as zirconia is harder than enamel. Following this, optional glazing and characterization with ceramic stains can be performed. However, for areas not in the aesthetic zone, such as the palatal surfaces of maxillary anterior teeth, this is not necessarily required.

PREPARATION: STEPS AT A GLANCE

1. Sandblasting of the sintered restoration (Al2O3 50 μm, 1-1.5 bar)
2. Cleaning (steam cleaner or ultrasonic cleaner)
3. Polishing the occlusal/palatal contact areas

Fig. 1. Sintered and sandblasted zirconia crown.

Fig. 2. Occlusal high-gloss polish.

Fig. 3. TWIST™ DIA for Zirconia (Kuraray Noritake Dental Inc.) enables efficient polishing of zirconia in three steps.

STAINING AND GLAZING

The shades A+, B+, C+, and D+ of the paste-like ceramic stain CERABIEN™ ZR FC Paste Stain (Kuraray Noritake Dental Inc.) enhance the chroma in the cervical area when applied in the respective tooth shade. They are used to strengthen the multicolour effect of the zirconia or to darken the restoration overall. By mixing the stains with glaze or clear glaze in different ratios, the intensity can be adjusted.

Cervical 1 and 2 are suitable for replicating exposed cervical areas or discolouration. Cervical 1 is also useful for marking fissures, as it gives the crown depth and structure without appearing overly dark. Patients typically reject excessively pronounced fissure effects. Since fissure areas in multi-layered materials generally lie in the lightest part of the block (in the enamel layer), it may make sense to darken them slightly with A+, while white hypermineralisations can be replicated on the cusp tips. A narrow band of Grayish Blue below the cusp tips creates an optical translucency effect. In cases where this translucency appears too dark blue or greyish, mixing Grayish Blue with Dark Grey can modify the appearance.

By mixing various colours, numerous different tones can be created. For instance, by adding Yellow to A+, its slightly brownish colour can be adjusted to a warmer, more yellowish tooth shade. It is generally advisable to capture the patient‘s tooth shade with a photo and a custom-made colour ring of the corresponding material before preparation. This can serve as a reference during production, especially in the laboratory, where lighting conditions may differ.

For pronounced characterisations or fine details, it may be necessary to carry out multiple firings to avoid unwanted running effects between the colours and the glaze. This is particularly recommended when replicating anatomical details with high sharpness, such as enamel cracks or local discolourations. For this, a glaze and base shade are first applied and fired, and finer structures are added in a second firing. Alternatively, a fixative firing of the stains without glaze can be performed first, with only a glaze layer fired in the second step. A benefit of CERABIEN™ ZR FC Paste Stain is that its appearance during application closely matches the final firing result. In thick consistency, glaze can also be used to easily rebuild missing proximal contacts.

STAINING AND GLAZING: STEPS AT A GLANCE

1. Glaze with Glaze/Clear Glaze
2. Increase chroma (in the cervical area or over large areas) with A+, B+, C+, or D+
   - Adjust intensity by mixing with Glaze/Clear Glaze
   - Create a warmer tone by mixing with Yellow
3. Replicate discolouration/exposed cervical areas: Cervical 1 and 2
4. Customise fissure areas
   - Darken with A+, B+, C+, or D+
   - Accentuate fissures with Cervical 1
5. Customise cusp tips
   - Replicate hypermineralisations with White
   - Create a band below with Grayish Blue (translucency effect)
   - Adjust translucency effect below cusp tips by mixing with Dark Grey
6. Firing

Alternatives:

1. First firing: Glaze plus base shade, second firing: Finer structures
2. First firing: Fixative stain firing without glaze, second firing: Glaze firing

Fig. 4. CERABIEN™ ZR FC Paste Stain assortment for the practice laboratory.

Fig. 5. Discoloured fissures can be accurately replicated with an ISO10 endodontic file.

Fig. 6 and 7. Glazing and staining in one firing.

Fig. 8. Shade determination using a custom-made KATANA™ Zirconia STML colour ring (A3.5).

Fig. 9. Bridge made from KATANA™ Zirconia STML, sandblasted and occlusally polished.

Fig. 10. Finished glazed and characterised restoration.

Fig. 11. Bridge 14-16 in place.

FINAL SITUATION

Fig. 11. Bridge 14-16 in place.

Dentist:

FLORIAN ZWIENER

CLEARFIL MAJESTY™ ES FLOW RECEIVES “NIOM TESTED” QUALITY SEAL

Before being allowed to market a dental composite filling material, it must, among other things, meet the set standards within ISO 4049:2019 Dentistry - Polymer-based restorative materials. Prompted by the tremendous positive response Kuraray Noritake Dental Inc. received from users of the CLEARFIL MAJESTY™ ES Flow series, we asked the Nordic Institute of Dental Materials (NIOM), an independent research institute, to test this product line on key aspects within the said ISO standard.

While it was not mandatory for us to have the CLEARFIL MAJESTY™ ES Flow series tested, our confidence in the quality of our product prompted us to do so. NIOM thoroughly evaluated CLEARFIL MAJESTY™ ES Flow in all three different levels of flowability: High, Low, and Super Low (Fig. 1). Among the properties assessed were depth of cure, flexural strength, water sorption and solubility, and colour stability after irradiation and water sorption. NIOM found that regarding all properties, the three flowabilities and different shades proved to comply with the requirements.

We are pleased to have gone the extra mile and proud that an independent party verified that our product meets the stringent ISO standards.

Fig. 1. CLEARFIL MAJESTY™ ES Flow in its three different levels of flowability.

IMPLICATIONS FOR CLINICAL USE

These test results are an external proof for users of the popular flowable composite series that they safely can be used as specified by Kuraray Noritake Dental Inc. in the product’s instructions for use. The NIOM test results obtained regarding the depth of cure imply that, when applied to the recommended layer thickness, the composite will polymerise adequately – which is essential for a great long-term performance. In addition, all three flowabilities offer sufficient strength and water sorption/solubility behaviour even to be suitable for restorations, including the occlusal surface of molars and pre-molars. This means that the materials are very well suited for a wide range of indications, including restoring all cavity classes and repairing existing restorations and cementing (Fig. 2).


Fig. 2. Three variants of CLEARFIL MAJESTY™ ES Flow and the suggested use areas.

GREAT AESTHETICS AND HANDLING

On top of these well-balanced mechanical properties, CLEARFIL MAJESTY™ ES Flow in its innovative syringe handles well due to an easy dispensing, bubble-free application, easy sculpting facilitated by its non-sticky formulation, and easy polishing behaviour. Coming in a variety of shades (Fig. 3) and equipped with proprietary Light Diffusion Technology, the material in its three different levels of flowability blends nicely and effortlessly with the surrounding tooth structure, creating a natural overall look. Both handling and aesthetics have been rated very good to excellent by dental advisor consultants in the context of a clinical evaluation.

Fig. 3. Overview of shades available per flowability.

NIOM also provides proof of the positive aesthetic properties: the institute's tests to evaluate colour stability after irradiation and water sorption reveal that CLEARFIL MAJESTY™ ES Flow is expected to remain stable over time. This feature is important for the long-term aesthetics of the restorations created with the materials.

Choose a reliable, high-quality, flowable, direct restorative material that withstands rigorous testing.

Straipsnyje pateikiamas naujojo metodo aprašymas ir pristatomi pasiekto poveikio moksliniai įrodymai. Straipsnį parengė prof. L. Breschi ir jo kolegos iš Bolonijos universiteto. Straipsnio pavadinimas „Selective adhesive luting: A novel technique for improving adhesion achieved by universal resin cements“ (liet. Selektyvus adhezinis cementavimas. Naujas adhezijos gerinimo metodas naudojant universalius dervinius cementus). 

„PANAVIA™ SA Cement Universal“ yra universalus dervinis cementas, kuris, taikant savaiminės adhezijos metodą, be jokių papildomų komponentų gali būti naudojamas daugelyje klinikinių situacijų. Jis taip pat puikiai susiriša su ličio disilikatu – nereikia atskiro silano buteliuko. In vitro tyrimai parodė, kad dervinis cementas yra atsparus drėgmei ir universalus, todėl sukuria tvirtą ir patvarų ryšį su beveik visų rūšių restauracinėmis medžiagomis, taip pat su emaliu ir dentinu. 

Vis dėlto geriausias surišimas su danties šoniniu paviršiumi pasiekiamas tada, kai kaip atskiras danties praimeris aplikuojama „CLEARFIL™ Universal Bond Quick“. Todėl ypač sudėtingose ​​situacijose verta rinktis šį dvikomponentį adhezinio cementavimo metodą. Jis ne toks sudėtingas, palyginti su tradiciniu adhezinio cementavimo metodu, ir leidžia pasiekti puikių rezultatų. 

Visgi norint, kad universalūs adhezyvai surištų tinkamai, darbo laukas turi būti visiškai sausas, o savaiminės adhezijos derviniai cementai yra mažiau jautrūs drėgmei. Taigi, ko gero, jums kils klausimas, kuris metodas yra tinkamiausias, jei reikia kiek įmanoma stipresnio cheminio surišimo su emaliu ir dentinu, tačiau sunku arba neįmanoma tinkamai izoliuoti naudojant guminį koferdamą, pavyzdžiui, dėl to, kad atrama yra trumpa arba preparuoto danties kraštas yra subgingivalinėje padėtyje. Tokiu atveju geriausias sprendimas yra selektyvus adhezinis cementavimas. 

Selective application of a universal adhesive to those areas of etched enamel that are not at risk of being contaminated by moisture.

Lengva procedūra, patikimas rezultatas – daugumos odontologų noras dedant netiesiogines restauracijas. Šis klinikinio atvejo pavyzdys naudojamas norint parodyti lengvą, bet labai sėkmingą ličio disilikato vainikėlio cementavimo klinikinį protokolą.

1 pav. Ličio disilikato vainikėlis baigus ėsdinti vidinį paviršių vandenilio fluorido rūgštimi ir primatavus

2a pav.  „KATANA™ Cleaner“ aplikavimas į vainikėlį, kad būtų visiškai pašalinti teršalai, pavyzdžiui, kraujo ir seilių baltymai, galintys pakenkti bet kokios dervinio cemento sistemos savybėms

ARBA 2b pav.  Arba „KATANA™ Cleaner“ aplikuojamas į maišymo duobutę

3 pav.  „KATANA™ Cleaner“ aplikavimas ant restauracijos

4 pav.  „KATANA™ Cleaner“ aplikuojamas ant preparuotos danties struktūros tokiu pat būdu (dešimt sekundžių trinama, po to nuplaunama ir džiovinama)

5 pav.  „PANAVIA™ SA Cement Universal“ cemento aplikavimas į nuvalytą vainikėlį

6 pav.  Cemento sudėtyje yra unikalios silanavimo medžiagos – LCSi monomero, užtikrinančio stiprų ir patikimą sukibimą su ličio disilikatu ir kitomis restauracinėmis medžiagomis, tokiomis kaip stiklo keramika ir hibridinė keramika

  Silanas maišymo antgalyje aktyvuojamas originaliu MDP

7 pav.  Lengva valyti itin trumpai pakietinus (2–5 sekundes)

8 pav.  Dervinio cemento perteklius yra gelio formos ir pašalinamas vienu kartu, naudojant odontologinį zondą

GALUTINĖ SITUACIJA

9 pav.  Gydymo rezultatas iškart uždėjus vainikėlį

Dentist:

RICHARD YOUNG DDS

ATVEJĮ APRAŠĖ IR VAIZDUS PATEIKĖ BURNOS CHIRURGAS DR. RICHARDAS YOUNGAS, SAN BERNARDINAS, KALIFORNIJA

Kompozitinės restauracijos ilgaamžiškumas priklauso nuo daugelio veiksnių. Kai kurie iš jų nepatenka į gydytojo įtakos sferą ir yra labai susiję su pacientu, pavyzdžiui, įtaką restauracijai daro dantų šepetėlis ir pastos tipas, dantų valymo metodas, mityba, stimuliuojančios medžiagos ir higienos įpročiai. Tačiau nuo odontologo priklauso, ar jis laikosi geriausio apdailos ir poliravimo protokolo. 

Tinkamai atliekamu poliravimu siekiama pašalinti deguonies inhibicinį sluoksnį ir sukurti lygų restauracijos paviršių. Taisyklingai nupoliruota restauracija nesugers dažomųjų medžiagų, kurių yra maiste, gėrimuose ar stimuliuojančiosiose medžiagose ir dėl kurių pakinta kompozito spalva, taigi estetinis restauracijos rezultatas išliks ilgai. 

Kompozito poliravimas yra procesas, kuriam reikia skirti ypatingą dėmesį. Jį sudaro keli etapai ir būtina laikytis kelių principų: 

• Naudojant apdailos diskus galima išlyginti restauracinį paviršių, pašalinti kompozito perteklių ir suteikti restauracijai galutinę formą. Svarbu nepamiršti, kad sudrėkintą paviršių galima poliruoti ne didesniu kaip 5000–10 000 sūk./min. greičiu, naudojant 1:1 odontologinį antgalį. 

• Rinkoje yra daug rūšių ir formų guminių polyrų. Vienas universaliausių, specialiai sukurtų kompozitui, yra „TWIST™ DIA for Composite“. Tai rinkinys, kurį sudaro du skirtingo abrazyvumo lygio polyrai. Pirmasis (tamsiai mėlynas) naudojamas pirminiam grubiam poliravimui, antrasis (šviesiai mėlynas) – galutiniam blizgesiui ir glotnumui suteikti. Reikėtų prisiminti, kad šiais instrumentais turėtų būti apdorojamas sausas paviršius, neaušinant vandeniu. Dirbant sausuoju būdu kyla rizika sudirginti danties pulpą, todėl darbo greitis turi būti ribojamas nuo 5000 iki 10 000 sūk./min. ir vengiama per didelio spaudimo. 

• Kitas etapas – deimantinės poliravimo pastos, kurios gradientas nuo 1 iki 5 mikronų, naudojimas. Su šia pasta rekomenduojama naudoti poliravimo rato formos šepetėlį. Šepetėlio tipas nėra svarbus, tačiau nesirinkite standžių šerių šepetėlio, kad nesubraižytumėte kompozito. Naudojant poliravimo šepetėlį ir poliravimo pastą galima pasiekti sunkiai prieinamas vietas, pavyzdžiui, danties kaklelio sritį ir tarpdantinius paviršius. Be šio etapo, tarpdantiniams paviršiams tiksliau poliruoti naudojama celiulioidinė abrazyvinė juostelė su deimanto dalelėmis. Tam, kad nepasikeistų kontaktiniai taškai, reikia naudoti mažai abrazyvines („Super Fine“) juosteles. 

• Siekiant padidinti restauracijos blizgesį ir apsaugoti ją nuo spalvos pasikeitimo, medvilniniu poliravimo šepetėliu apdorojama su aliuminio oksido pasta. Naudojant tokią pastą, kuri iš pradžių buvo skirta keramikai, gaunamas išskirtinai lygus paviršius ir didelis restauracinio paviršiaus blizgesys. Šis etapas atliekamas sausoje aplinkoje ne didesniu kaip 5000–10 000 sūk./min. greičiu. 

Taikant visus metodus, taigi ir takaus kompozito švirkštimo metodą, poliravimo lygis turi įtakos restauracijos ilgaamžiškumui ir optinėms bei estetinėms savybėms. Todėl šiam esminiam dantų restauravimo etapui reikia skirti pakankamai laiko. Kompozitai pasižymi skirtinga sudėtimi ir užpildo dalelių kiekiu, o tai turi įtakos ne tik jų savybėms, bet ir poliravimo sudėtingumo lygiui. Kai kuriais atvejais, norint pasiekti veidrodžio efektą, procedūrą tenka kartoti kelis kartus. „CLEARFIL MAJESTY™ ES Flow“ yra kompozitas, kurį labai lengva poliruoti iki itin didelio blizgesio, nepaisant didelio užpildo dalelių kiekio. Specialiai pritaikyti guminiai polyrai, šepetėliai ir pastos leidžia lengvai sukurti lygų paviršių ir taip prisidėti prie ilgalaikio rezultato. 

BEFORE

AFTER

3-YEARS RECALL

KAD BLIZGĖTŲ, KAD ŠYPSOTŲSI! 

Dentist:

MICHAL JACZEWSKI

Michałas Jaczewskis 2006 m. baigė Vroclavo medicinos universitetą, šiuo metu dirba savo privačiame kabinete Lenkijoje, Legnicos mieste. Jo specializacija – minimaliai invazinė odontologija ir skaitmeninė odontologija. M. Jaczewskis yra Biofunkcinės okliuzijos mokyklos įkūrėjas. Šioje mokykloje jis skaito paskaitas ir veda seminarus, kuriuose daugiausia dėmesio skiriama visapusiškam pacientų gydymui. 

Restauravimas naudojant kompozitines restauracijas yra dažniausia odontologo atliekama procedūra. Odontologijoje naudojama daugybė restauravimo metodų ir įvairių restauracinių medžiagų. Nepriklausomai nuo medžiagos tipo, restauravimo būdo ir aplikavimo vietos, dažna problema yra oro burbuliukai kompozitinių sluoksnių paviršiuje arba ant jų.  Kompozitinė restauracija turi būti vienalytė, kad plomba būtų sandari ir tarnautų ilgą laiką. Burbuliukų sukeltų defektų šalinimas yra varginantis procesas, o kartais net tenka keisti užpildą ar jo dalį. Defektų skaičius gali būti įvairus ir priklauso nuo kompozito tipo (takus arba pastos konsistencijos kompozitas) ir (arba) aplikavimo metodo, tačiau yra keletas šiuos defektus sukeliančių veiksnių. 

Taikant takaus kompozito švirkštimo metodą naudojami takūs kompozitai, kurie akivaizdžiai lengviau teka, bet turi būti tinkamai naudojami. Pirmoji oro burbuliukų susidarymo priežastis yra pačios medžiagos homogeniškumas. Burbuliukų gali būti įtraukiama į švirkštą gamybos etape arba naudojant. Naudodami aukščiausios kokybės produktus, galime būti tikri, kad tiekiama aukščiausios kokybės medžiaga ir kad dėl švirkšto struktūros ir konstrukcijos medžiagoje susidarys mažiau oro burbuliukų. 

„CLEARFIL MAJESTY™ ES Flow“ kompozitas sukurtas taip, kad dozuojant oro burbuliukų nesusidarytų. Speciali švirkšto ir stūmoklio konstrukcija riboja lašėjimo ir medžiagos tekėjimo atgal dozavimo metu arba baigus dozuoti galimybę.

Švirkšto viduje yra unikali apsaugos sistema – speciali sandarinimo žiedo konstrukcija, kuri neleidžia medžiagai tekėti nebespaudžiant ir kartu užtikrina minimalų atitraukimą taip, kad stūmoklis per daug neatsitrauktų. 

Kita oro burbuliukų susidarymo priežastis yra oro patekimas į švirkštą specialiai atitraukiant stūmoklį. Jei išspaudęs kompozitą gydytojas arba asistentas yra įpratęs atitraukti stūmoklį, tai darant į švirkštą gali patekti oro. Naudojant ateityje restauracijoje greičiausiai bus oro ir susidarys tuštuma (burbuliukai).

Taikydami takaus kompozito švirkštimo metodą naudojame silikoninį gidą, į kurį aplikuojame medžiagą, norėdami atkurti dantį. Švirkščiant gidas turi tvirtai priglusti prie danties ir nejudėti. Priešingu atveju gali atsirasti oro burbuliukų. Paspaudus ir atleidus gidą sukeliamas siurbimo efektas ir kompozitas atsitraukia nuo danties ir gido. Siekiant išvengti defektų, nuo medžiagos įšvirkštimo momento iki polimerizacijos gidas turi būti spaudžiamas vienoda jėga.

Norint apriboti gido mobilumą ir sumažinti dantį veikiančio nekontroliuojamo spaudimo riziką gali būti naudojamos įvairios silikoninio gido modifikacijos. Tai gali būti, pavyzdžiui, ant kaitaliojimo principu („vienas taip, vienas ne“) pagrįsto modelio sukurtas gidas, kuris užtikrina labai aukštą stabilumo ir darbo saugos laipsnį. 

WIDTH OF THE INJECTION HOLE

Kita priežastis, dėl kurios į restauraciją patenka oro, yra švirkštimo angos plotis. Jei anga per ankšta, įkišant ar aplikuojant antgalis gali pajudinti gidą. Siekiant išvengti šios problemos angą galima išplėsti, kad būtų galima laisvai įstatyti ir valdyti antgalį švirkščiant. Platesnė anga taip pat leidžia švirkštimo metu išeiti orui. Vis dėlto svarbiausia, kad medžiaga būtų aplikuojama nuolat spaudžiant, neištraukiant antgalio ir neįstatant jo į gidą. Antraip gali susidaryti netolygus kompozitinis sluoksnis. 

Dentist:

MICHAL JACZEWSKI

Michałas Jaczewskis 2006 m. baigė Vroclavo medicinos universitetą, šiuo metu dirba savo privačiame kabinete Lenkijoje, Legnicos mieste. Jo specializacija – minimaliai invazinė odontologija ir skaitmeninė odontologija. M. Jaczewskis yra Biofunkcinės okliuzijos mokyklos įkūrėjas. Šioje mokykloje jis skaito paskaitas ir veda seminarus, kuriuose daugiausia dėmesio skiriama visapusiškam pacientų gydymui.

Interviu su Michał Jaczewski

Takaus kompozito švirkštimo metodas populiarus ir yra taikomas norint estetiškai atkurti kelis dantis naudojant takų kompozitą. Michał Jaczewski yra garsus instruktorius, mokantis odontologus įgūdžių, reikalingų norint sėkmingai taikyti šį metodą. M. Jaczewski 2006 m. baigė Vroclavo medicinos universitetą (Lenkijoje), o nuo 2011 m. dirba savo privačiame kabinete Legnicos mieste. Jis yra Biofunkcinės okliuzijos mokyklos, kurioje vedami mokymai visapusiško dantų gydymo srityje, įkūrėjas. Jo aistra – estetinė skaitmeninė odontologija. 2023 m. tarptautinėje odontologijos parodoje Kelne M. Jaczewski mums pademonstravo ir papasakojo, kada, kodėl ir kaip savo odontologijos kabinete taiko takaus kompozito švirkštimo metodą. 

Ar galėtumėte trumpai apibūdinti šį metodą? 

Takaus kompozito švirkštimo metodas yra paprastas, nuspėjamas, lengvai pakartojamas būdas atkurti dantis naudojant takų kompozitą. Jis pagrįstas vaškiniu modeliu, ant kurio gaminamas silikoninis gidas. Būtent šis gidas yra svarbiausias elementas švirkščiant takų kompozitą, kuris kietinamas šviesoje per skaidrų silikoną. Svarbiausias privalumas yra tas, kad dirbant šiuo metodu nereikia jokio danties paruošimo arba pakanka tik minimalaus danties paruošimo. Tai minimaliai invazinis metodas, kurį gali naudoti tiek pradedantieji, tiek patyrę odontologai. Naudojant gerai subalansuotą 0,3 mm storio opakišką kompozitą ir taikant specialų poliravimo protokolą, galima pasiekti puikų morfologinį ir optinį rezultatą. 

Kada pradėjote taikyti takaus kompozito švirkštimo metodą ir kokios yra jo pagrindinės indikacijos? 

Metodą pradėjau taikyti 2018 metais. Jis buvo išrastas priekiniams dantims atkurti, tačiau šiais laikais sėkmingai naudojamas ir atkuriant galinius dantis. Mano nuomone, jis ypač naudingas, kai reikia koreguoti kelių dantų formą ir pagerinti tiek pagyvenusių, tiek jaunų pacientų šypseną. To gali prireikti baigus ortodontinį gydymą. Taikant šį neinvazinį metodą dantys paprasčiausiai sulygiuojami ir atkuriama tobula jų forma. Takaus kompozito švirkštimo metodą taip pat taikau šypsenai pertvarkyti, susidėvėjusiems dantims atstatyti ir sąkandžio aukščiui pakeisti visos burnos rekonstrukcijos kontekste. Pastaruoju atveju restauravimas gali būti laikinas ir naudojamas vidutinės trukmės ar ilgalaikio „pabandymo“ tikslais. Visgi tokios restauracijos gali būti ir galutinės. 

Nuo ko pradėti planuojant atkurti paciento dantis takaus kompozito švirkštimo metodu? 

Svarbiausias etapas, turintis didelę įtaką šio metodo sėkmei, yra planavimo etapas. Jį sudaro dokumentavimas, atspaudų ėmimas, vaškinio modelio ir maketo sukūrimas bei silikoninio gido gamyba. Žinoma, galite dirbti tradiciniu būdu su silikoniniu atspaudu ir įprastiniu vaškiniu modeliu, tačiau skaitmeninių technologijų naudojimas šiame etape kur kas pagerins jūsų darbo eigą. Aš dažniausiai pradedu nuo dokumentavimo etapo – darau nuotraukas, vaizdo įrašus ir skaitmeninį atspaudą. Taip pat reikalingi centrinio žandikaulių santykio ir okliuzijos įrašai. Tada naudojant skaitmeninę šypsenos dizaino programinę įrangą sukuriamas virtualus vaškinis modelis. Šiame etape svarbu atsižvelgti į paciento veido ypatybes. Užduotį geriausia atlikti naudojant „Facial Flow“ koncepciją. Remiantis gauta konstrukcija, virtualus gydymo rezultatas gali būti rodomas pacientui ir su juo aptariamas. Patvirtinus planą, spausdinamos skirtingos vaškinio modelio versijos: visas vaškinis modelis ir kaitaliojimo principu (angl. interlip) pagrįstas modelis – vienas dantis su vaškiniu modeliu, kitas be. Šie modeliai naudojami norint pagaminti reikiamus gidus iš skaidraus silikono. 

Skaitmeninės šypsenos projektas. Pacientas, kurio dantys labai nusidėvėję 

Paciento burnoje pavaizduotas virtualus vaškinis modelis 

Modeliai, atspausdinti pagal virtualų maketą 

Silikoninis gidas, pagamintas ant kaitaliojimo principu (interlip) pagrįsto modelio 

Kada ir kodėl gaminate daugiau nei vieną silikoninį gidą? 

Su viso modelio ir kaitaliojimo principu pagrįstu (daliniu) silikoniniu gidu ypač naudinga dirbti, kai planuojama atkurti visus viršutinio žandikaulio dantis. Pradedant nuo kaitaliojimo principu pagrįsto gido pasiekiamas papildomas stabilumas ir sukuriamas tikslaus rezultato pagrindas, ypač atsižvelgiant į planuojamą sąkandžio aukštį. Visada rekomenduoju apatiniame žandikaulyje, kur dėl seilių ir judančių minkštųjų audinių gidą ir kompozitą valdyti sunkiau, darbo lauką padalyti į tris dalis (vieną priekinę ir dvi galines sritis) ir dirbti su šiomis sritimis atskirai. 

Kaip ruošiate dantis ir švirkščiate takų kompozitą? 

Daugeliu atvejų tereikia emalio paviršių šiurkštinimo surišimo procedūrai atlikti, o tai paprastai daroma naudojant oro abraziją aliuminio oksido dalelėmis (50 µm žemu slėgiu). Tada emalis ėsdinamas fosforo rūgšties ėsdikliu ir aplikuojama universali rišamoji medžiaga. Silikoniniame gide yra švirkštimo anga kandamajame krašte. Tai nesunku padaryti spaudžiant takaus kompozito švirkšto kaniulę. Galinėje srityje gali būti pravartu naudoti kietesnę medžiagą ir integruoti po dvi angas kiekvieno danties atskiruose gumburuose: vieną – švirkštimui, kitą – medžiagai ištekėti. Naudojant kietąjį gidą šiai procedūrai reikalingas deimantinis grąžtas. Įdedu gidą, iš apačios į viršų švirkščiu takų kompozitą, šiek tiek pakietinu medžiagą šviesoje ir išimu gidą. Galutinė polimerizacija atliekama tik išėmus gidą ir aplikavus glicerino gelio sluoksnį. Pašalinus medžiagos perteklių ir iki galo padarius proksimalinės restauracijos dalies apdailą, procedūra pakartojama su kitais dantimis prieš poliruojant restauracijas. 

Ar turite dirbant šiuo metodu pamėgtų produktų? 

Silikoniniam gidui naudoju EXACLEAR (GC), nes tai yra skaidriausias rinkoje silikonas. Mano mėgstamiausias takaus kompozito švirkštimo metodo kompozitas yra mažo klampumo „CLEARFIL MAJESTY™ ES Flow“ („Kuraray Noritake Dental Inc.“). Savo odontologijos kabinete ir per kursus turėjau galimybę išbandyti daugybę skirtingų produktų. Taip sužinojau, kad „Kuraray Noritake Dental“ medžiaga turi keletą privalumų. Tai šiuolaikiškas nanokompozitas, išsiskiriantis daugybe indikacijų ir dideliu atspalvių asortimentu. Galima rinktis iš trijų šio produkto klampumų, todėl jis gali būti naudojamas įvairiose klinikinėse situacijose. Pradėjau jį naudoti prieš penkerius metus. Taikant takaus kompozito švirkštimo metodą mano pirmasis pasirinkimas yra „Low“ variantas, nes jis yra universaliausias ir tinka tiek priekiniams, tiek galiniams dantims. Didžiausi privalumai, turėję įtakos mano apsisprendimui jį naudoti, yra natūrali estetika ir puikios poliravimo savybės. Galite pasiekti įspūdingą efektą neturėdami jokių specialių įgūdžių. Kaip rišamąją medžiagą man labiau patinka naudoti „CLEARFIL™ Universal Bond Quick“, nes tada darbo eiga tampa dar lengvesnė, greitesnė ir labiau nuspėjama. Poliravimui sukūriau savo protokolą.

Kaip darote restauracijų apdailą ir jas poliruojate?

Pradedu nuo proksimalinės srities naudodamas poliravimo juosteles ir kartais proksimalinį pjūklelį. Koreguojant formą pasiteisino trys skirtingi deimantiniai ir karbidiniai grąžtai. Paskui naudoju švelnius arba ypač švelnius „Sof-Lex™“ apdailos ir poliravimo diskus (3M), skirtus kontūravimui ir užbaigimui, ir guminius polyrus „TWIST DIA™ for Composite“ („Kuraray Noritake Dental Inc.“), kurie jau sukuria gražų, natūralų paviršiaus blizgesį beveik be pastangų. Tada naudojamas ožkų plaukų diskinis šepetėlis su deimantine poliravimo pasta („Diamond excel“, FGM) ir galiausiai – medvilninis ratukas su aliuminio oksido poliravimo pasta („Pasta Grigia II“, „anaxDENT“). Taip galima sukurti veidrodinę apdailą.

Emalio ėsdinimas fosforo rūgšties ėsdikliu 

Įstatytas galutinis silikoninis gidas 

„CLEARFIL™ Universal Bond Quick“ aplikavimas 

Situacija iškart sušvirkštus „CLEARFIL MAJESTY™ ES Flow (Low)“, sukietinus šviesoje ir išėmus silikoninį gidą 

Proksimalinės dalies koregavimas sukamaisiais instrumentais 

Kokie yra didžiausi takaus kompozito švirkštimo metodo privalumai?

Pacientams ir gydytojams odontologams didžiausi privalumai – laiko ir pinigų taupymas. Daugelis pacientų negali sau leisti keraminių laminačių ir labai džiaugiasi, kai jiems pasiūloma aukštos kokybės alternatyva, kurią galima sukurti per vieną apsilankymą. Procedūra nereikalauja danties preparavimo, o restauracijas galima nesunkiai pataisyti arba, jei pageidaujama, pakeisti jų spalvą, todėl gydymo metu praktiškai nėra jokios rizikos. Gydytojai odontologai dažniausiai gali pradėti gydyti pacientus išklausę vieną kursą. Praktikuodami jie pasiekia tobulą rezultatą, tačiau ir pirmieji rezultatai dažnai būna gana įspūdingi, todėl pradedantiesiems nereikia didelių investicijų – nei laiko, nei naujų medžiagų. Žinoma, galite investuoti daug laiko į apdailos ir poliravimo procedūrą, bet esu tikras, kad rasite tinkamą pastangų ir rezultato pusiausvyrą. 

Takaus kompozito švirkštimo metodui taikyti reikalingas instrumentų rinkinys

Ar turite kokių nors rekomendacijų, kaip pradėti taikyti šį metodą? 

Visų pirma norėčiau paskatinti kiekvieną išeiti iš savo komforto zonos ir reguliariai bandyti ką nors naujo. Pradėti dirbti su takaus kompozito švirkštimo metodu man buvo didžiulis pokytis į gerąją pusę, daugiau niekada nenorėčiau dirbti be jo. Patarčiau prieš pradėdamas naudoti šį metodą būtinai baigti kursą, kuriame įgytumėte visų pirmojo atvejo sėkmei užtikrinti reikalingų teorinių žinių, o gal net ir sudalyvauti praktiniame seminare.

Michał Jaczewski per savo pristatymą „Kuraray Noritake Dental“ stende Kelne. 

Technical Specialist for Chairside, Volkan Kacmaz, Introduces Himself

Volkan Kacmaz not only worked as a dentist in Turkey, but he also managed two clinics and earned a Master of Business Administration in Berlin. His diverse experiences seem to have led him to his current role as a Technical Specialist at Kuraray Noritake Dental Inc., headquartered near Frankfurt. Who is this friendly, smiley, and curious team member, and why did he specifically choose Kuraray?

While most dentists continue practicing dentistry throughout their careers, Volkan Kacmaz chose a different path. After graduating in 2011, he established his own dental clinic in Istanbul. A few years later, he served in the military for a year as a military dentist. Afterward, he founded two more franchise clinics, taking on the dual roles of manager and dentist. It was during this time that he realized dentistry wasn’t limited to clinical practice. “I’m eager to learn and have always been curious about how products work, the processes behind them, research and development, and the launch of new innovations,” he explains.

INNOVATION

In 2022, Kacmaz became the first dentist to enrol at the Berlin School of Economics and Law, where he learned about marketing, sales, negotiation, and regulations. Upon completing his Master of Business Administration, he made a deliberate decision to join Kuraray Noritake. “Kuraray Noritake's products are of very high quality, both labside and chairside. I already knew this from my experience as a dentist. The company has an excellent and trustworthy reputation among dental professionals,” he says.

Kacmaz also admires the innovative nature of the company. “Kuraray Noritake is responsible for some of the most significant innovations in dentistry. Just look at products like PANAVIA™ cement, the original MDP monomer, and multi-layered zirconia discs and blocks. It’s easy to see that Kuraray Noritake is a major force in the dental market. With their commitment to continuous improvement and innovation, you could call them the Apple of the dental world,” he adds.

Another aspect Kacmaz appreciates is Kuraray Noritake's product lineup. “The catalog isn't extensive, but it’s highly specialized. The company doesn’t produce just any product, but focuses on the ones it excels at, ensuring top-notch quality.” Lastly, Kacmaz loves the company culture. “It's a very respectful environment. I’ve had some bad experiences with respect in the past,” he says with a laugh, referring to his time in the military. “But at Kuraray Noritake, you can feel the respect for employees, which is very important to me. I’m very happy to be part of the Kuraray Noritake family.”

COURAGE

When comparing dentistry in Turkey to Western Europe, Kacmaz doesn’t see significant differences. “The brands, quality, and approaches are all the same.” However, he has noticed one small distinction: German dentists aren’t as enthusiastic about digital dentistry as their Turkish counterparts.

Kacmaz draws on all his previous experiences and knowledge in his role as part of the scientific marketing team. His responsibilities include finding scientific support for marketing initiatives. He collaborates with lecturers and dentists to manage research studies using Kuraray Noritake products, works to update measurements in response to market dynamics, and evaluates new products.

His goal? “To become an authority in the dental world,” he says with a smile. It may sound like an ambitious goal, but Kacmaz has learned to dream big. “The biggest decision of my life was leaving my comfort zone and moving to a country where I didn’t speak the language. But I believe it’s a courage you have to show. If you don’t, your dreams and plans will fade, and you’ll miss out on everything.”

LEARNING NEW THINGS

Moving to Germany, which Kacmaz describes as "the epicentre of the dental market," hasn’t always been easy. Coming from a Mediterranean culture, he was used to a more communal and lively environment. In Germany, he noticed that shops close early, and people value their privacy. Another challenge has been the language. While he prefers English, he says, “ein bisschen Deutsch, nicht so gut.”  Fortunately, Kuraray Noritake provides him with German lessons, and he has the best teacher at home—his three-year-old daughter, who learns the language faster than he does and sometimes corrects him.

Despite the challenges, all the adapting and hard work have been worth it. “I’ve realized that there are no limits to learning. Whether you’re in your 40s, 50s, or even 60s, there’s always something new to discover. You just have to be open to it.”

CONTACT

Volkan Kacmaz can be reached at +49 69 305 35134 or via [email protected].

ABOUT KURARAY NORITAKE DENTAL INC.

Kuraray was founded in 1926 in Kurashiki, Japan. Today, it is a leading global manufacturer of medical products, materials, textiles, chemicals, resins, and more. In 2012, Kuraray Medical and Noritake Dental Supply merged to form Kuraray Noritake Dental Inc. The company continues to deliver reliable dental bonding agents, ceramics, and other products to over 90 countries worldwide. Well-known products include the KATANA™ Zirconia range, CLEARFIL™ Universal Bond Quick, and PANAVIA™ resin cements.

Article by Dr. Michał Jaczewski

Resin composites are wonderful restorative materials: They allow for minimally invasive, defect oriented tooth preparation, may be modelled as desired, and can be modified and repaired whenever necessary. To achieve all of this, however, a strong and long-lasting bond is an absolute requirement. The bond needs to be established either between enamel and dentin on one side and the resin composite on the other, or between the existing and the newly applied composite material.

UNIVERSAL ADHESIVE

Committed to keeping clinical procedures as simple as possible, I use an 8th-generation bonding agent – CLEARFIL™ Universal Bond Quick (Kuraray Noritake Dental Inc.) in my dental office. Containing Rapid Bond Technology, it allows for a particularly easy and straightforward use without the need for extensive rubbing or long waiting times. At the same time, it bonds well to various substrates including enamel, dentin and resin composite as it contains the original MDP monomer.

Its composition and resulting versatility make CLEARFIL™ Universal Bond Quick the first choice for many indications including non- to minimally-invasive repair procedures. As it works extraordinarily well in situations where we want to bond to dentin, enamel or old composite (Fig.1), it is usually not necessary to remove the whole existing restoration that needs to be repaired or modified. Instead, preparation may be limited to the composite part, so that no additional tooth structure needs to be removed.

Fig. 1. CLEARFIL™ Universal Bond Quick establishes a strong bond to dentin, enamel or old composite.

CLINICAL PROTOCOL

Depending on the condition of the existing restoration surface, the repair protocol may be slightly different. The basic steps are as follows:

PROTOCOL 1: OXYGEN INHIBITION LAYER STILL ON THE SURFACE

- No surface treatment required, rinse with water in case of contamination with blood or saliva, followed by air-drying and (optionally) adhesive application

- Apply new layer of composite immediately

PROTOCOL 2: OXYGEN INHIBITION LAYER ALREADY REMOVED FROM THE COMPOSITE SURFACE

- Remove the composite around the defect and create a bevel at the cavity margin with rotating instruments

- Sandblast the surface with aluminium oxide particles

- Fresh composite surface: Clean the surface with KATANA™ Cleaner (Kuraray Noritake Dental Inc.) or etch with phosphoric acid etchant

- Composite surface older than two weeks: Etch with phosphoric acid etchant

- Apply the universal adhesive (which contains silane)

- Apply a new layer of composite

CLINICAL RECOMMENDATIONS

1. STAY IN THE COMPOSITE DURING PREPARATION

When an old composite restoration needs to be replaced – e.g. because the existing restoration shows discolouration or the patient asks for a brighter shade – it is possible to remove only a part of the composite and leave the rest in place to save the underlying healthy tooth structure. Accurate control over the amount of material removed and the amount of material left in place is offered by the use of UV light. Under UV light, the composite is perfectly visible (Fig. 2). Hence, a highly conservative structure removal is supported (Fig. 3).

Fig. 2. Controlling structure removal with UV light, which nicely reveals the old composite.

Fig. 3. Tooth preparation with rotating instruments.

2. INCREASE ADHESION BY SANDBLASTING

Creating a clean, micro-retentive composite surface ideal for bonding: This is the aim of sandblasting the affected composite area with aluminium oxide particles (Fig. 4). The particle size I prefer is 27 μm. Residual particles, may be removed with 37% orthophosphoric acid, which needs to be rinsed off thoroughly before air-drying the surface (Figs. 5a and 5b).

Fig. 4. Air-abrasion with 27 μm aluminium oxide particles.

Fig. 5a. Phosphoric acid etching. Adjacent teeth are protected with PTFE tape.

Fig. 5b. Thorough rinsing to remove the etchant from the surface.

3. USE A UNIVERSAL ADHESIVE THAT CONTAINS SILANE

When bonding to old composite, silanisation of the surface is recommended to increase the bond strength. On dentin, a separate silane shows no positive effect. Hence, it is recommended to apply a separate silane to the composite surface only, a challenging task in situations with a surface consisting of tooth structure and composite. As CLEARFIL™ Universal Bond Quick contains silane, the separate silane application step may be skipped, which clearly simplifies the procedure (Figs. 6a and 6b).

Fig. 6a. Application of CLEARFIL™ Universal Bond Quick to the prepared surface.

Fig. 6b. Solvent evaporation with a gentle stream of air.

4. IF IN DOUBT, USE A UNIVERSAL ADHESIVE DURING REPAIR PROCEDURES

Whenever detected during restoration, defects in the composite layer or air bubbles can be repaired or eliminated right away. As long as the oxygen inhibition layer is still present, another layer of composite may be applied immediately without any prior steps. However, if the surface has been contaminated by saliva or blood (Figs. 7a and 7b) or it is unclear whether we are bonding to dentin, enamel or composite, CLEARFIL™ Universal Bond Quick may be applied (Fig. 8). On top, a new layer of composite is placed to restore the defect (Fig. 9).

Fig. 7a. Composite surface with a defect near the margin with blood contaminating the affected area.

Fig. 7b. Composite surface with a defect near the margin after thorough rinsing and drying.

Fig. 8. Application of the universal adhesive.

Fig. 9. Application of composite material to restore the defect.

5. IF AVAILABLE, PLACE A SILICONE INDEX TO SIMPLIFY ANATOMICAL SHAPING

If the defect is small, it is possible to apply the flowable composite directly and remove the excesses (Fig. 10). The obtaining of a natural shape and smooth transition between old and new composite, however, is simplified by the use of a silicone index or matrix (Fig. 11), which might still be present from the original restoration procedure. A possible outcome of this type of repair is shown in Figure 12; both images were taken prior to finishing and polishing.

Fig. 10. Flowable composite spreading and excess removal.

Fig. 11. Silicone index placed over the teeth including the tooth with the defect.

Fig. 12. Outcome of the flowable injection procedure.

CONCLUSION

Elimination of bubbles or defects in a freshly created restoration, changes in the colour of an existing filling or a shape correction due to wear processes: Modifying composite restorations can be easy – provided that appropriate materials and techniques are used. One of the key elements on the path to success is the selection of a suitable adhesive system, preferably a universal single-bottle adhesive like CLEARFIL™ Universal Bond Quick, which allows for streamlined procedures and supports excellent outcomes. By respecting the provided tips, it is possible to create the desired outcomes in a minimally invasive, straightforward way, laying the foundation for long-lasting aesthetics and function.

Dentist:

MICHAŁ JACZEWSKI

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

Leaving work at work, unplugging your mind from the dental office is not rocket science - provided that high-quality dental materials are used. Ideally, they are well-adapted to operator, case, and patient-specific needs. When it comes to restoring cavities with composite, Kuraray Noritake Dental Inc. has got the right products for any dental professional.

The CLEARFIL MAJESTY ES family of dental composites is composed of different product lines designed to meet specific needs. Altogether, the line-up offers a solution for every technique and handling preference, clinical situation and patient requirement.

UNIVERSAL SOLUTION FOR UTMOST SIMPLICITY

When utmost simplicity is desired, a highly innovative universal solution such as CLEARFIL MAJESTY ES-2 Universal is an excellent choice. This paste-type composite system includes only four shades: Universal, Universal Light, Universal Dark, and Universal White.

The Universal shade has the highest translucency and is, therefore, most suitable in cases where several cavity walls are still present, such as in Class I or II cavities and the cervical area. In cavities where light easily passes through, the lower-translucency variants Universal Light (for teeth with shades up to A3) and Universal Dark (for teeth darker than A3) are the best options. Universal White is the go-to solution for young patients and whitened teeth. Consequently, there is usually no need for a shade guide, and the optical properties allow application without an opaquer or blocker in most of cases. Both features greatly simplify the clinical procedure.

CLASSIC AND PREMIUM OPTIONS FOR SINGLE- AND DUAL-SHADE LAYERING

Clinicians who prefer classical single-shade layering according to a shade guide and a greater number of shades available may prefer CLEARFIL MAJESTY ES-2 Classic. With a line-up of 18 shades, it supports straightforward procedures and leads to aesthetic results.

Whenever the aesthetic needs are very high, such as in the context of restoring a large cavity in the aesthetic anterior region, CLEARFIL MAJESTY ES-2 Premium may be the best option. Designed for simplified multi-shade layering, it comes with fixed shade combinations of dentin and enamel opacity, that greatly support predictable outcomes.

MECHANICAL PROPERTIES

All the CLEARFIL MAJESTY ES paste-type composite systems offer a well-balanced viscosity and excellent mechanical properties, including

• a high flexural strength of 118 MPa
• a filler load of 78 wt%
• a compressive strength of 347 MPa
• a low volumetric shrinkage of 1.9 %
• a curing depth of 2.0 mm and
• a long working time under ambient light of 4.5 minutes
  
  

VERSATILITY POWERHOUSE IN THREE VISCOSITIES>

A flowable composite completes the portfolio. As the ideal level of viscosity depends on individual preferences and on the specific indication, CLEARFIL MAJESTY ES Flow comes in three different flowabilities: high, low and super low.

They have:

• a high flexural strength of 145, 151 and 152 MPa, respectively
• a filler load of 71, 75 and 78 wt%, respectively
• a compressive strength of 358, 373 and 374 MPa, respectively and
• a working time under ambient light of 100 seconds.

In addition, they are well-received for their easy application, fast polishing and high polish retention. All these features make the product a true versatility powerhouse. Moreover, it is offered in an innovative syringe designed for bubble-free application of the desired amount of composite and easy modelling.

THE IDEAL PORTFOLIO FOR PEACE OF MIND

The CLEARFIL MAJESTY ES portfolio offers highly suitable products for many clinical situations, demands and treatment techniques. As they support predictable outcomes and long-lasting success, using them gives dental practitioners the peace of mind needed to leave work at work and truly enjoy their free time—in the evening at home, on weekends or on holiday.

For more information about Kuraray Noritake Dental Inc.’s composite solutions visit the website.

Article by Dr. Michał Jaczewski

When working with composite, one of the most important aspects is to understand the mechanisms of adhesion. Choosing the right composite is one thing, but choosing a suitable bonding system and using it correctly is an equally important aspect affecting the long-term performance of a direct restoration.

There are many bonding products on the market - two-bottle (primer and bond) but also single-bottle systems. For anyone trying to select an ideal adhesive for a specific clinical case, the sheer number of available products can be challenging. The temptation to use them all, in slightly different ways, has the potential to create errors. In my dental practice, I am committed to simplifying procedures.

This is why I started looking for a bonding system that would offer a sense of security in terms of adhesion, but also ease of use in different clinical situations. I have opted for the 8^th-generation bonding agent with the desired features - CLEARFIL™ Universal Bond Quick (Kuraray Noritake Dental Inc.). The single-bottle universal adhesive is ideal for a broad variety of bonding procedures carried out in the dental office.

IMPRESSIVE FEATURES

CLEARFIL™ Universal Bond Quick can be used in the total-etch as well as the selective enamel etching technique in combination with an etching gel such as K-ETCHANT Syringe (Kuraray Noritake Dental Inc.). It is also a self-etching adhesive. Used in combination with the dual-cure build-up material CLEARFIL™ DC CORE PLUS or the dual-cure universal resin cement PANAVIA™ SA Cement Universal (both Kuraray Noritake Dental Inc.), it is also an ideal choice for cementation in the root canal and for cementing inlays or crowns made of a variety of different restorative materials – from metal to zirconia or lithium disilicate. Efficient clinical procedures are supported by the incorporated Rapid Bond Technology, which eliminates the need for extensive rubbing or waiting for the adhesive to penetrate the substrate and the solvent to evaporate. Among the key components of this technology are hydrophilic amide monomers, which allow the adhesive solution to penetrate moist dentin extraordinarily quickly, while also having a high curing ability. In addition, the original MDP monomer is included in the formulation. Together with the amide monomers, it provides for a high bond strength to enamel and dentin – achievable in a simple procedure of application, air-drying and light-curing.

The described properties turn CLEARFIL™ Universal Bond Quick into one of the most versatile and easy-to-use adhesive bonding solutions in the dental office. Operator sensitivity is low, as is its technique sensitivity, since the three-step procedure is always the same. The following case examples illustrate its use in the context of different repair procedures.

REPAIR OF COMPOSITE RESTORATIONS

One of the major benefits of using composite as a restorative material lies in the fact that it may be modified and repaired at any time. Regardless of whether an air bubble is detected on the surface, the shade needs to be adjusted, a fracture occurs or materials need to be added as a result of wear, modification or repair is easily accomplished without needing to sacrifice additional amounts of healthy tooth structure. Whenever a silicone index has been produced for the initial treatment and is still available, and the user knows which composite has been utilized for the original restoration, the Flowable Injection Technique may be selected as a particularly easy and efficient way of repairing a restoration. However the recommended protocol is slightly different depending on the state of the restoration surface.

CASE EXAMPLE 1: IMMEDIATE REPAIR PROCEDURE

When a restoration has been damaged or an air bubble has appeared during injection of a flowable composite, the procedure is slightly different. In this case, the oxygen inhibition layer is usually still present on the surface of the restoration. Therefore, it is possible to simply apply an additional portion of composite (Figs. 1a to 1d). Even after contamination of the composite surface with water, saliva or blood, this measure is possible. The surface merely needs to be rinsed thoroughly and dried before applying the new portion of composite. For maximum safety, a universal adhesive may be used as well.

Fig. 1a. Repair procedure applicable for defect within a composite restoration whenever the oxygen inhibition layer has not yet been removed: Air bubble detected in the interproximal region.

Fig. 1b. Application of a new portion of composite after rinsing and drying. The adjacent surface is protected with PTFE tape.

Fig. 1c. Repositioned silicone index used to give the restoration the originally planned shape.

Fig. 1d. Final restoration.

CASE EXAMPLE 2: REPAIR PROCEDURE AFTER POLISHING

If a similar defect is detected during finishing and polishing, i.e. when the oxygen inhibition layer has already been removed (Fig. 2), a roughening of the surface is strictly necessary. With a bevelled preparation of the area with the air bubble, optimal conditions are created for another layer of composite that blends in well with the surrounding material (Fig. 3). After bevelling, the surface needs to be sandblasted and cleaned either with KATANA™ Cleaner (Kuraray Noritake Dental Inc.) (Fig. 4a) or with 37 % orthophosphoric acid (Fig. 4b). After thorough rinsing and drying, an additional portion of composite may be applied to the surface (Figs. 5a to 5c). As the defect is small, the composite may be applied instead of injected and the silicone index repositioned afterwards.

Fig. 2. Void on the surface, detected during finishing.

Fig. 3.  Removed void and bevelled area around the defect.

Fig. 4a. Option 1: Cleaning of the surface with KATANA™ Cleaner.

Fig. 4b. Option 2: Etching with K-ETCHANT Syringe.

Fig. 5a. Application of composite (CLEARFIL MAJESTY™ ES Flow Low).

Fig. 5b. Repositioning of the original silicone index to obtain the desired shape.

Fig. 5c. Final restoration with a nice blend-in of the different layers of composite.

CASE EXAMPLE 3: REPAIR PROCEDURE AFTER TWO OR MORE WEEKS

For damaged restorations which have been in place for more than two weeks, an ideal composite-composite interface needs to be created by bevelling and roughening of the surface. A perfect example is presented in Figure 6. The most important step influencing the success of the procedure is proper preparation of the composite surface. To lay the foundation for a strong bond between the new and the old composite as well as for aesthetic outcomes, a bevel needs to be created (Figs 7a and 7b) to facilitate a smooth transition between the two layers. Once the bevel is completed, the surface should be sandblasted with alumina particles sized 27 μm (Fig. 8). The following recommended steps are etching of the composite with 37 % orthophosphoric acid (Fig. 9) and finally application of CLEARFIL™ Universal Bond Quick (Fig. 10). As the universal adhesive contains a silane coupling agent, separate silane application is not necessary. Instead, the new layer of composite may be applied immediately e.g. using the flowable injection technique with an existing matrix (Fig. 11).

Fig. 6. Fractured anterior composite restoration benefitting hugely from repair – the remaining composite is in a great state regarding colour and shape.

Fig. 7a.  Bevelling with dedicated instruments.

Fig. 7b.  Ideal bevel created to provide for a strong bond and great optical blend-in.

Fig. 8. Sandblasting of the surface with alumina particles.

Fig. 9.  Phosphoric acid etching.

Fig. 10. Application of the universal adhesive.

Fig. 11. Composite applied using the flowable injection technique.

Fig. 12. Treatment outcome.

CONCLUSION

The three described repair protocols are straightforward and work well – provided that a strong bond is established at the composite-composite interface. The way it is established may be slightly different depending on whether the oxygen inhibition layer is still present or has already been removed. Using a universal adhesive like CLEARFIL™ Universal Bond Quick, the procedure is simplified owing to elimination of steps such as the separate application of silane.

Dentist:

MICHAŁ JACZEWSKI

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

DELICATE BALANCE BETWEEN COSTS AND AESTHETICS IN DENTAL LAB

When you are a lab owner striving to achieve high-end results using modern digital techniques, the initial investment in CAD/CAM technology is significant, followed by ongoing costs for expendable items such as milling tools and blanks. That cost can be reduced by selecting universal, high-quality materials.

Undoubtedly, zirconia stands out as one of the most popular materials on the market. From an inventory perspective, however, lab owners often find themselves purchasing multiple discs of the same shade and thickness. The reason is that they need to meet all requirements for strength and aesthetics in different settings – enabling them to cover all kinds of restorations and deliver excellent patient outcomes.

UNIVERSAL SOLUTION FOR DENTAL LABS

At Kuraray Noritake Dental Inc., we take pride in not only developing the first-ever multilayer zirconia, KATANA™ Zirconia ML, but also in our commitment to delivering the highest quality materials that we can.

KATANA™ Zirconia YML, our latest addition to the KATANA™ Zirconia line-up, exemplifies this dedication and offers universal applicability. The universal feature is based on the fact that KATANA™ Zirconia YML disc not only offers colour gradation, but also impressive flexural strength and translucency gradation, with maximum values of up to 1,100 MPa and 49 % translucency, respectively.

INHOUSE PRODUCTION - THE PATH TO HIGH QUALITY ZIRCONIA DISC

Like all our zirconia offerings, KATANA™ Zirconia YML begins its journey to the dental lab in our Japanese facility where raw zirconia powder undergoes special treatment process before the addition of essential components.

Once the material has undergone this thorough initial stage, it progresses to the pressing and pre-sintering phase to form the disc. Every detail is carefully calculated, managed and controlled. This phase of the process takes several days, underscoring our goal to achieve the most aesthetic product.

HIGH-SPEED SINTERING PROGRAM: 54 MINUTES

The unique powder formulation and refinement process, as well as the pressing and pre-sintering technique, is the key to allow our customers to realize restorations of up to three-unit bridges without any compromise in terms of aesthetics or mechanical properties using the 54-minute high-speed sintering* process.

This high quality, lengthy production process results in an exceptionally dense material, which once sintered, goes on to deliver a high strength, high aesthetic final restoration.

HIGH PRECISION SHRINKAGE AND STABLE CTE VALUES FOR EXCEPTIONAL FIT

Outstanding deformation stability during the sintering procedure, contributes to the stability during the final sintering process in the dental laboratory, providing for an exceptional fit of large-span bridges and other restorations.

MULTI-LAYERED STRUCTURE AND EASE OF POSITIONING OF RESTORATIONS IN THE BLANK

To enhance aesthetic qualities, all KATANA™ Zirconia YML discs are designed using ratios rather than fixed measurements of different layers in the multi-layered structure. This means that regardless of the disc's thickness, there is always a consistent ratio of 35 % of raw material that constitutes the translucent enamel zone. Hence, discs with an increased height, which are typically used for the production of larger restorations, will always offer sufficient space in the enamel zone, while smaller discs are optimized for smaller restorations.

ONE DISC. ALL INDICATIONS.

These qualities empower dental lab owners to deliver a wide range of restorations. The material is suitable for single crowns to full-arch structures, for full-contour designs to conventional frameworks, using a single material without compromising on aesthetics: KATANA™ Zirconia YML. For finishing, we offer a well-aligned portfolio of solutions designed for internal and external staining, micro-layering and full layering.

EXPLORE KATANA™ Zirconia YML: WEALTH OF RESOURCES, CLINICAL CASES AND FAQS

Visit our website to discover more about KATANA™ Zirconia YML. You will find useful materials such as brochure, technical guide, in-depth technical information.

Would you like to see the material in action – browse the blog section of our website that offers a variety of clinical cases and articles by world-renowned experts showcasing and proving the versatility and aesthetics of KATANA™ Zirconia YML.

*The material is removed from the furnace at 800°C. A furnace with a configurable KATANA™ Zirconia YML firing program is required.