Clinical case by Dr. Frank Heldenbergh

The advancements in zirconia in contemporary dentistry nowadays allow for a wider range of applications, including in the anterior sector, and for chairside production using dedicated CAD/CAM systems. Even without a cutback, KATANA™ Zirconia Block (STML), combined with CERABIEN™ ZR FC Paste Stain (both Kuraray Noritake Dental Inc.), offer an extremely satisfactory aesthetic solution.

In the present patient case, the materials were chosen to replace old PFM crowns on the maxillary central incisors. The planned treatment was in accordance with the patient's wishes, and carried out in a single appointment.

CASE DESCRIPTION

The patient asked for a replacement of the existing crowns on the two maxillary central incisors (teeth 11 and 21, FDI notation). The porcelain-fused-to-metal (PFM) restorations had been in place for about thirty years (Figure 1). She desired aesthetic improvements and slight repositioning of these two teeth.

TREATMENT PLAN

In agreement with the patient, it was decided to perform the entire procedure in one appointment: removal of the existing crowns, digital impressions, production, and bonding of new restorations. The periodontium was healthy with no bleeding. The only uncertainty was whether the existing crowns were cemented onto inlay-cores or if they were Richmond crowns. A preliminary silicone impression was taken as a precautious measure: in case something unexpected prevented the new crowns from being bonded during the session, it would be easily possible to produce temporary crowns.

Fig. 1. Initial clinical situation.

TREATMENT

Using a diamond bur followed by a tungsten carbide bur, the existing crowns were removed, revealing that they indeed were Richmond crowns. Because the anatomy of the intra-radicular posts clearly contraindicates an attempt to remove these posts, it was decided to trim the crowns to transform them into inlay cores rather than risk further damage. The corono-peripheral preparations were reworked at the same time. One of the major challenges was related to the necessity of masking the metal of the transformed coronal-radicular reconstructions. Luckily, the space available was sufficient for the production of full zirconia crowns with a significant thickness (Figure 2). The target shade of the crowns was chosen in consultation with the patient (Figure 3).

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

Fig. 3. Shade determination using a shade tab: A2 was the appropriate shade.

Subsequently, impressions were taken using and intraoral scanner, the virtual models were checked and the crowns designed, considering the patient's request to have her two incisors slightly retracted (Figures 4 and 5).

Fig. 4. Virtual models of the patient’s teeth with the newly designed crowns, revealing the space available for a slight retraction.

Fig. 5. Designing of the two crowns.

The two crowns were milled from KATANA™ Zirconia Block 14Z A2 (Figure 6). A quick reminder: unlike lithium disilicate, zirconia prosthetic parts cannot be tried in immediately after milling, as they are around 20 percent larger than their final size after sintering. Final sintering was performed within about 18 minutes using the furnace SINTRA CS (ShenPaz Dental Ltd). After this process, the crowns may be tried on to check their fit, shape, shade and optical integration.

Fig. 6. Milled crowns in the CAD/CAM blocks.

For finishing of the restorations, different options are available. In this case, we decided not to limit ourselves to mechanical polishing of the prosthetic parts, as zirconia does not fluoresce like natural teeth. To add fluorescence as an optical feature, the surface was lightly stained and glazed with CERABIEN™ ZR FC Paste Stain (Figure 7).

Fig. 7. Crowns in the furnace after staining and glazing with liquid ceramics.

After firing, the two incisor crowns were tried in again using a try-in paste corresponding to the chosen resin cement system (PANAVIA™ V5, Kuraray Noritake Dental). In this way, the final appearance was simulated to validate the shade of the cement. The intaglio surfaces of the crowns were then sandblasted before applying CLEARFIL™ CERAMIC PRIMER PLUS as the restoration primer. The prepared teeth were treated with KATANA™ Cleaner (Kuraray Noritake Dental Inc.) to decontaminate the surface from proteins in saliva and possibly blood. Those clean surfaces are ideal for bonding. After thorough rinsing and drying, PANAVIA™ V5 Tooth Primer (containing MDP monomer for bonding with the hydroxyapatite and metal of the preparation) was applied according to the manufacturer’s instructions (Figure 8).

Fig. 8. Selected cementation system and try-in.

Subsequently, PANAVIA™ V5 Paste was applied into the first crown, which was then seated, followed by tack curing (brief photopolymerization for three to five seconds), excess removal and final light curing from all sides.

The procedure was then repeated for the second maxillary central incisor. The result instantly satisfied the patient, both in terms of aesthetics (adaptation, position of the new crowns, mimicry) and the comfort provided (Figures 9 and 10).

Fig. 9. Crowns immediately after placement.

Fig. 10. Aesthetically pleasing and comfortable result.

At a recall after four months, soft tissue conditions were ideal and the patient was happy with the outcome (Figures 11 to 13). The selected zirconia had nice optical properties, masking of the metal posts was successful and the natural surface texture contributed its share to a nice overall picture. The retracted position of the teeth was also perceived positively by the patient, while comfort and function were excellent.

DISCUSSION

Although lithium disilicate has so far been considered the material of choice for prosthetic work in the anterior region, zirconia is nowadays proving to be an extremely satisfactory alternative from every point of view: milling, strength, aesthetics, assembly (among other things, no hydrofluoric acid is required for bonding). KATANA™ Zirconia Blocks (STML) with a multi-layered colour structure in a single 4Y-TZP zirconia block, combined with CERABIEN™ ZR FC Paste Stain, offer a remarkable solution. This applies to treatments around the replacement of existing crowns as well as first-line treatments with less invasive preparations (verti-prep) than those required by other types of ceramics.

Fig. 11. The patient’s smile at a recall after four months.

Fig. 12. Great optical integration.

Fig. 13. Natural surface texture contributing to success Control pictures after four months taken by Emmanuel Charleux.

Dentist:

FRANK HELDENBERGH

Dr. Frank Heldenbergh graduated with a Doctor of Dental Surgery degree from the University of Reims in 1988.Driven by a passion for prosthetics, he pursued further specialization as a Prosthetic Resident at the UFR Odontology of Reims from 1990 to 1992. Dr. Heldenbergh’s dedication to advancing dental practices led him to join the Board of the Academy of Adhesive Dentistry in 1999. His commitment to this field has been unwavering, and he currently serves as the Vice President of A.D.D.A.-R.C.A.

Recognized for his expertise in ceramic veneers, inlays and onlays, Dr. Heldenbergh supervised practical work for the Paris Odontological Society from 2000 to 2018, shaping the skills of many aspiring dentists. His influence extended to the A.D.F. Congress, where he supervised practical work on ceramic veneers from 2000 to 2016. In 2017, he was the Head of Practical Work at A.D.F., a role that allowed him to further contribute to the advancement of dental education and practices. In 2018, he was the Head of Practical Work for ceramic veneers at the Paris Odontological Society.

Recognizing the importance of technology in modern dentistry, Dr. Heldenbergh pursued a University Degree in CAD/CAM from Toulouse in 2022. This addition to his qualifications highlights his dedication to staying at the forefront of dental innovation.

Vienkārša procedūra, uzticams rezultāts. To vēlas lielākā daļa zobārstu veicot netiešās restaurācijas. Šajā klīniskajā gadījumā tiek parādīts vienkāršs, bet ļoti sekmīgs klīniskais protokols litija disilikāta kroņa cementēšanai.

Att. 1.  Litija disilikāta kronis pēc iekšpuses kodināšanas ar skābi un laikošanas.

Att. 2a.  KATANA™ Cleaner uzklāšana uz kroņa, lai likvidētu asiņu un siekalu paliekas, kā arī citu piesārņojumu, kas var ietekmēt jebkuras sveķu cementa sistēmas veiktspēju.

VAI Att. 2b.  Kā alternatīvu KATANA™ Cleaner var iepildīt jaukšanas traukā.

Att. 3. KATANA™ Cleaner aplicēšana uz restaurācijas.

Att. 4. KATANA™ Cleaner tādā pašā veidā tiek uzklāts uz sagatavotā zoba virsmas (ierīvējot desmit sekundes, pēc kā noskalojot un nožāvējot).

Att. 5. PANAVIA™ SA Cement Universal ieklāšana notīrītajā kronī.

Att. 6. Cements satur unikālu silāna saķeres līdzekli – LCSi monomēru, spēcīgai un uzticamai saķerei ar litija disilikātu un citiem atjaunojošiem materiāliem, piemēram, keramiku un hibrīdkeramiku.

  Silāns tiek aktivizēts Original MDP sajaukšanas uzgalī

Att. 7. Viegla liekā cementa noņemšana pēc divu līdz piecu sekunžu sacietēšanas.

Att. 8. Liekais cements ir gēlveida stāvoklī un tas ar zondi tiek noņemts vienā gabalā.

GALA REZULTĀTS

Att. 9. Ārstēšanas rezultāts uzreiz pēc kroņa cementēšanas.

Dentist:

RICHARD YOUNG DDS

KLĪNISKO GADĪJUMU UN ATTĒLUS SNIEDZ DDS RICHARD YOUNG, SAN BERNARDINO, CA

Ompozītmateriālu restaurācijas izturība ir atkarīga no daudziem faktoriem. Daži ir ārpus praktizējošā ārsta ietekmes sfēras un ir cieši saistīti ar pacientu. Piemēram, zobu birstes un pastas veids, tīrīšanas tehnika, diēta, stimulanti un higiēnas ieradumi ietekmē restaurāciju. Tomēr vislabākā apdares un pulēšanas protokola ievērošana pilnībā ir zobārsta ziņā. 

Pareizas pulēšanas mērķis ir noņemt skābekli kavējošo slāni un radīt gludu restaurācijas virsmu. Pareizi pulēta  restaurācija neuzsūks krāsojošās vielas no pārtikas, dzērieniem vai stimulatoriem, kas noved pie kompozītmateriāla krāsas maiņas, nodrošinot ilgstošu restaurācijas estētisko rezultātu. 

Kompozītmateriāla pulēšana ir process, kuram jāpievērš īpaša uzmanība. Tas sastāv no vairākiem soļiem un principiem: 

• Apdares disku izmantošana ļauj iegūt gludu restaurācijas virsmu, noņemt lieko kompozītmateriālu un piešķirt restaurācijai galīgo formu. Ir svarīgi atcerēties, ka ar zobārstniecības uzgali 1:1 ir jāstrādā uz samitrinātas virsmas ar maksimālo ātrumu 5000-10 000 apgr./min.

• Pulēšanas gumijām tirgū ir daudz veidu un formu. Viena no universālākajām, kas īpaši izstrādāta kompozītmateriāliem, ir TWIST™ DIA for Composite. Tas ir komplekts, kas sastāv no divām gumijām ar dažādu abrazivitātes pakāpēm. Pirmā (tumši zilā) tiek izmantota sākotnējais rupjai pulēšanai, bet otrā (gaiši zilā) tiek izmantota gala spīdumam un gludumam. Jāatceras, ka darbs ar šiem instrumentiem jāveic uz sausas virsmas bez ūdens dzesēšanas. Sausā apstrāde rada zobu pulpas kairinājuma risku, tāpēc darba ātrums jāierobežo no 5000 līdz 10 000 apgr./ min. un jāizvairās no pārmērīga spiediena.

• Nākamais solis ir dimanta pulēšanas pasta ar gradientu no 1 līdz 5 mikroniem. Kopā ar šo pastu ieteicams izmantot pulēšanas kazas saru suku. Sukas veids nav svarīgs, tomēr neizmantojiet cietus sarus, kas varētu saskrāpēt kompozītmateriālu. Izmantojot pulēšanas suku un pulēšanas pastu, ir iespējams sasniegt grūti aizsniedzamas vietas, piemēram, zobu kakliņa zonu un proksimālās virsmas. Papildus šim solim tiek izmantota celuloīda dimantu saturoša abrazīvā plāksnīte lai precīzāk pulētu proksimālās virsmas. Lai neizmainītu kontaktpunktus, ir jāizmanto mazāk abrazīvas (īpaši smalkas) plāksnītes.

• Nākamais solis, lai palielinātu restaurācijas spīdumu un aizsargātu to pret krāsas maiņu, ir alumīnija oksīda pasta ar kokvilnas pulēšanas suku. Šādas pastas izmantošana, kas sākotnēji bija paredzēta keramikai, nodrošina īpaši gludu virsmu un augstu restaurācijas virsmas spīdumu. Šo darbību veic sausā vidē  ar maksimālo ātrumu 5000–10 000 apgr./min.

Visās tehnikās, tātad arī plūstošās injekcijas metodē, pulēšanas līmenis ietekmē restaurācijas izturību un optiskās un estētiskās īpašības. Tāpēc šim zoba restaurācijas galvenajam solim vajadzētu veltīt pietiekami daudz laika. Kompozītmateriāliem ir raksturīgs dažāds sastāvs un pildvielu daudzums, kas ne tikai ietekmē to īpašības, bet arī to pulēšanas vieglumu. Dažos gadījumos procedūra ir jāatkārto vairākas reizes, lai panāktu "spoguļa efektu".  CLEARFIL MAJESTY™ ES Flow ir kompozītmateriāls, ko ir ļoti viegli pulēt līdz augstam spīduma līmenim neskatoties uz tā lielo pildvielu saturu. Īpaši pielāgotas gumijas, sukas un pastas ļauj viegli izveidot gludu virsmu, tādējādi veicinot noturīgu rezultātu. 

BEFORE

AFTER

3-YEARS RECALL

LIECIET TIEM MIRDZĒT, LIECIET VIŅIEM SMAIDĪT! 

Dentist:

MICHAL JACZEWSKI

Mihals Jačevskis 2006. gadā absolvēja Vroclavas Medicīnas universitāti un šodien vada savu privātpraksi Legnicas pilsētā Polijā. Viņš specializējas minimāli invazīvā zobārstniecībā un digitālajā zobārstniecībā un ir Biofunkcionālās oklūzijas skolas dibinātājs. Šeit viņš lasa lekcijas un vada seminārus, koncentrējoties uz visaptverošu pacientu ārstēšanu. 

Kompozītmateriālu restaurācija ir visizplatītākā procedūra, ko veic zobārsts. Zobārstniecībā tiek izmantotas daudzas restaurācijas metodes un dažādi restaurācijas materiāli. Neatkarīgi no materiāla veida, restaurācijas metodes un pielietošanas vietas, izplatīta problēma ir gaisa burbuļi kompozītmateriālu slāņos vai uz to virsmas. Kompozītmateriāla restaurācijai jābūt viendabīgai, lai nodrošinātu pildījuma hermētiskumu un tā izturību. Burbuļu defektu labošana ir apnicīga, un dažkārt ir nepieciešams nomainīt pildījumu vai tā daļu. Atkarībā no kompozītmateriāla veida (plūstošs vai pastas kompozītmateriāls) un/vai uzklāšanas tehnikas defektu daudzums var atšķirties, taču ir vairāki izraisošie faktori. 

Plūstošās injekcijas metodē mēs izmantojam plūstošus kompozītmateriālus, kas acīmredzami viegli plūst, bet ir arī jutīgi pret nepareizu uzklāšanu.  Pirmais gaisa burbuļu veidošanās cēlonis ir paša materiāla viendabīgums. Ražošanas posmā vai lietošanas laikā šļircē var veidoties burbuļi. Izmantojot augstākās kvalitātes produktus, mēs varam būt pārliecināti, ka tiek piegādāts augstākās kvalitātes materiāls un ka šļirces struktūra un dizains nodrošina pareizu darbību, lai samazinātu gaisa burbuļu veidošanos materiālā.

CLEARFIL MAJESTY™ ES Flow kompozītmateriāls ir izstrādāts, lai novērstu gaisa burbuļu veidošanos izspiešanas laikā. Šļirces un virzuļa īpašais dizains ierobežo materiāla pilēšanu kā arī atpakaļplūsmu izspiešanas laikā vai pēc tās.

Unikāla drošības funkcija šļirces iekšpusē ir īpašā O veida gredzena konstrukcija, kas neļauj materiālam plūst pēc spiediena atlaišanas un vienlaikus rūpējas par minimālu ievilkšanu, kā arī novērš virzuļa pārmērīgu ievilkšanos. 

Vēl viens gaisa burbuļu veidošanās iemesls ir gaisa iekļūšana šļircē apzināti ievelkot virzuli. Ja praktizējošajam ārstam vai palīgpersonālam ir ieradums pēc kompozītmateriāla ievadīšanas ievilkt virzuli, tas var izraisīt gaisa iekļūšanu šļircē. Turpmākās lietošanas laikā gaiss, visticamāk, parādīsies restaurācijā kā gaisa pora. 

Plūstošās injekcijas metodē mēs izmantojam silikona matricu kurā mēs ievadam materiālu, lai izveidotu zobu. Matricai ir cieši jāpieguļ zobiem un tā nedrīkst kustēties vai tikt pārvietota injekcijas laikā. Ja tā notiek, var parādīties gaisa burbuļi. Nospiežot un pēc tam atlaižot matricu radīsies piesūkšanās efekts un kompozītmateriāls tiks noņemts no zoba, kā arī no matricas. Lai izvairītos no defektiem, no materiāla injicēšanas brīža līdz polimerizācijai jāsaglabā matricas stabilitāte. 

Var izmantot dažādas silikona matricu modifikācijas, lai ierobežotu tās stabilitāti un samazinātu nekontrolēta spiediena risku uz zobu. Redzamais piemērs parāda matricas pareizu un nepareizu izvietojumu uz augšžokļa zobu modeļa, lai nodrošinātu augstu stabilitāti un darba efektivitāti. 

Vēl viens iemesls gaisa iekļūšanai restaurācijā ir injekcijas atveres platums. Ja atvere ir pārāk cieša, ievietošanas vai uzklāšanas laikā matricu var pārvietot ar uzklāšanas uzgali. Lai izvairītos no šīs problēmas, atveri var paplašināt, lai varētu brīvi ievietot, kā arī manipulēt ar uzgali injekcijas laikā. Plašāka atvere arī ļauj izplūst gaisam izspiešanas laikā. Tomēr vissvarīgākais ir uzklāt materiālu ar nepārtrauktu spiedienu un izvairoties no uzgaļa izvilkšanas un atkārtotas ievietošanas matricā.  Tā rezultātā var izveidoties nevienmērīgs kompozītmateriāla slānis. 

Dentist:

MICHAL JACZEWSKI

Mihals Jačevskis 2006. gadā absolvēja Vroclavas Medicīnas universitāti un šobrīd vada savu privātpraksi Legnicas pilsētā Polijā. Viņš specializējas minimāli invazīvā zobārstniecībā un digitālajā zobārstniecībā, kā arī ir Biofunkcionālās oklūzijas skolas dibinātājs. Šeit viņš lasa lekcijas un vada seminārus, koncentrējoties uz visaptverošu pacientu ārstēšanu

Intervija ar Dr. Michał Jaczewski

Plūstošās injekcijas metode kļūst par populāru tehniku, ko izmanto, lai estētiski restaurētu vairākus zobus ar plūstošu kompozītmateriālu. Mihals Jačevskis ir slavens pasniedzējs, kurš māca zobārstiem prasmes, kas nepieciešamas, lai veiksmīgi izmantotu šo tehniku. Viņš 2006. gadā absolvēja Vroclavas Medicīnas universitāti Polijā un kopš 2011. gada vada savu privātpraksi Legnicas pilsētā. Viņš ir Biofunkcionālās oklūzijas skolas dibinātājs, vada apmācības visaptverošās zobu ārstēšanas jomā, un aizraujas ar estētisko digitālo zobārstniecību. Starptautiskajā 2023. gada zobārstniecības izstādē Ķelnē viņš mums nodemonstrēja, kad, kāpēc un kā savā zobārstniecības kabinetā izmanto plūstošu injekciju. 

Vai jūs, lūdzu, varat aprakstīt šo tehniku dažos vārdos? 

Plūstošās injekcijas metode ir vienkāršs, paredzams, atkārtojams veids, kā atjaunot zobus, izmantojot plūstošu kompozītmateriālu. Tā ir balstīta uz izvaskojumu, kram tiek izgatavota silikona matrica. Šī matrica pēc tam kalpo kā atslēga plūstoša kompozītmateriāla injekcijai, kas tiek sacietināta gaismā caur caurspīdīgo silikonu. Vissvarīgākais ieguvums ir tas, ka šī metode darbojas gandrīz visos gadījumos ar ļoti minimālu zobu sagatavošanu. Tā ir minimāli invazīva metode, ko var izmantot gan iesācēji, gan pieredzējuši zobārsti. Izmantojot kompozītmateriālu ar labi sabalansētu necaurredzamību 0,3 mm biezumā un īpašu pulēšanas protokolu, ir iespējams sasniegt izcilus morfoloģiskos un optiskos rezultātus.

Kad sākāt izmantot plūstošās injekcijas metodi un kādas ir tās galvenās indikācijas? 

Es sāku izmantot šo metodi 2018. gadā. Sākotnēji tā tika izgudrota priekšzobu atjaunošanai, taču mūsdienās to veiksmīgi izmanto arī aizmugurējiem zobiem. Manuprāt, tas ir īpaši noderīgi ikreiz, kad ir jākoriģē vairāku zobu forma, lai uzlabotu pacienta smaidu neatkarīgi no tā, vai pacients ir jauns vai vecs. Piemēram, pēc ortodontiskās ārstēšanas. Zobus vienkārši iztaisno un pēc tam atjauno ideālā formā, izmantojot šo neinvazīvo tehniku. Plūstošo injekciju izmantoju arī smaida uzlabošanai, nodilušu zobu atjaunošanai un oklūzijas vertikālās dimensijas maiņai pilnīgas mutes rekonstrukcijas kontekstā. Pēdējā gadījumā restaurācija var būt īslaicīga un izmantota vidējam vai ilgtermiņa "testam". Tomēr tā var kalpot arī kā galīgā restaurācija. 

Kā sākt plānot pacienta zobu restaurāciju ar plūstošās injekcijas metodi? 

Vissvarīgākais posms, kas būtiski ietekmē šīs metodes panākumus, ir plānošanas posms. Tas sastāv no dokumentācijas, nospiedumu noņemšanas, vaskojuma izgatavošanas, kā arī silikona matricas izveides. Jūs, protams, varat strādāt tradicionālā veidā ar silikona nospiedumu un parasto vasku, taču digitālo tehnoloģiju izmantošana šajā posmā ievērojami uzlabos jūsu darba plūsmu. Es parasti sāku ar foto un video dokumentāciju un digitālo nospiedumu. Ir nepieciešami arī centrisko attiecību un oklūzijas rādītāji. Pēc tam, izmantojot digitālo smaida dizaina programmatūru, tiek izveidots digitāls vaskojums. Šajā solī ir svarīgi ņemt vērā pacienta sejas īpatnības. Tas ir uzdevums, ko vislabāk var paveikt, izmantojot sejas plūsmas koncepciju. Pamatojoties uz iegūto dizainu, virtuālo ārstēšanas rezultātu var parādīt un apspriest ar pacientu. Pēc apstiprināšanas izveidotais zobu vaskojums tiek izprintēts dažādās versijās: pilnais vaskojuma modelis un modelis ar mainīgu dizinu - viens zobs ar vaskojumu, kuram seko zobs bez tā. Šos modeļus izmanto, lai izgatavotu matricas no caurspīdīga silikona. 

Digitālais smaida dizains: pacients ar izteiktu zoba nodilumu. 

Pacienta mutē tiek parādīts digitālais vaskojums.

Modeļi tiek printeti uz digitālā uzvaskojuma pamata. 

Silikona matrica tiek izgatavota uz mainīga modeļa.

Kad un kāpēc jūs izgatavojat vairāk nekā vienu silikona matricu? 

Īpaši noderīgi ir strādāt ar pilno un mainīgo (daļējo) silikona matricu, plānojot atjaunot visus zobus augšžoklī. Ar mainīgo matricu man tiek nodrošināta papildus stabilitāte un tiek likts pamats precīzam rezultātam, īpaši attiecībā uz plānoto oklūzijas augstumu. Apakšžoklī, kur ir grūtāk rīkoties ar matricu un kompozītmateriālu siekalu klātbūtnes un kustīgu mīksto audu dēļ, vienmēr iesaku sadalīt darba lauku trīs daļās – vienā priekšējā un divās aizmugurējās daļās – un strādāt ar tiem atsevišķi. 

Kā jūs sagatavojat zobus un ievadāt plūstošo kompozītmateriālu? 

Vairumā gadījumu viss, kas mums nepieciešams, ir emaljas virsmu apstrāde cementēšanai, kas parasti ir iespējama ar gaisa strūklas apstrādi ar alumīnija oksīdu (50 µm zemā spiedienā). Pēc tam emalja tiek kodināta ar fosforskābes kodinātāju un universālu saiti. Tiek uzlikta matrica. Tā ir aprīkota ar injekcijas atveri incisālā malā. Tas ir viegli paveicams ar plūstošā kompozītmateriāla šļirces galu, kuru ir jāizspiež cauri matricai no iekšpuses uz ārpusi. Aizmugurējā rajonā ieteicams izmantot cietāku priekšmetu un katram zobam izveidot divus caurumus uz atsevišķām virsmām – vienu injekcijai un otru ārējai plūsmai. Cietajai matricai šai procedūrai ir nepieciešams dimanta urbulis. Es uzlieku matricu, injicēju plūstošo kompozītmateriālu no apakšas uz augšu, nedaudz gaismā sacietinu materiālu un noņemu matricu. Galīgo polimerizāciju veic pēc matricas noņemšanas un glicerīna gēla slāņa uzklāšanas. Kad liekais materiāls ir noņemts un restaurācijas proksimālā daļa ir perfekti pabeigta, procedūru atkārto pārējiem zobiem pirms restaurāciju pulēšanas. 

Vai jums ir kādi iecienītākie produkti šai metodei?

Silikona matricai izmantoju EXACLEAR (GC), jo tas ir caurspīdīgākais tirgū pieejamais silikons. Mans iecienītākais kompozītmateriāls plūstošai injekcijas metodei ir CLEARFIL MAJESTY™ ES Flow ar zemu viskozitāti (Kuraray Noritake Dental Inc.). Manā zobārstniecības kabinetā un kursu laikā man bija iespēja izmēģināt daudz dažādu produktu. Šajā kontekstā es atklāju, ka Kuraray Noritake Dental materiāls sniedz vairākas priekšrocības. Tas ir moderns nano kompozītmateriāla veids ar plašu indikāciju klāstu un lielu toņu piedāvājumu. Pateicoties tā trim viskozitātēm, to var izmantot daudzās dažādās klīniskās situācijās. Es sāku to lietot pirms pieciem gadiem, un plūstošās injekcijas metodei Low variants ir mana primarā izvēle, jo tas ir universālākais, kas piemērots priekšējiem un aizmugurējiem zobiem. Būtiskākās priekšrocības, kas ietekmēja manu lēmumu to izmantot, ir tā dabiskā estētika un izcilā pulējamība. Jūs varat iegūt iespaidīgu efektu bez īpašām prasmēm. Kā saistvielu es izvēlos izmantot CLEARFIL™ Universal Bond Quick, kas padara manu darba plūsmu vēl vienkāršāku, ātrāku un paredzamāku. Pulēšanai esmu izstrādājis savu protokolu.

Kā jūs beigās apstrādājat un pulējat savas restaurācijas? 

Es sāku proksimālajā zonā ar pulēšanas plāksnītēm un dažreiz proksimālo zāģveida loksnīti. Formas korekcijai trīs dažādi dimanta un karbīda urbuļi ir pierādījuši savu nozīmi. Pēc tam es izmantoju smalkus vai īpaši smalkus Sof-Lex™ Finishing and Polishing Discs (3M), ko izmanto konturēšanai un apstrādei, un gumijas pulēšanas līdzekļus TWIST DIA™ for Composite (Kuraray Noritake Dental Inc.), kas bez piepūles rada patīkamu, dabisku virsmas spīdumu. Pēc tam tiek izmantota kazas saru suka ar dimanta pulēšanas pastu (Diamond excel, FGM) un visbeidzot, es izmantoju kokvilnas pulieri kopā ar alumīnija oksīda pulēšanas pastu (Pasta Grigia II, anaxDENT). Tādā veidā iespējams izveidot spoguļveida virsmu. 

Emaljas kodināšana ar fosforskābes kodinātāju. 

Silikona matricas uzstādīšana.

CLEARFIL™ Universal Bond Quick uzklāšana. 

Situācija uzreiz pēc CLEARFIL MAJESTY™ ES Flow (Low) injekcijas, cietināšanas gaismā un silikona matricas noņemšanas.

Proksimālās korekcijas ar rotējošiem instrumentiem. 

Kādas ir plūstošās injekcijas metodes lielākās priekšrocības? 

Pacientiem un zobārstiem lielākās priekšrocības ir laika un naudas ietaupījums. Daudzi pacienti nevar atļauties keramikas venīrus, un viņi ir ārkārtīgi priecīgi, ka viņiem tiek piedāvāta kvalitatīva alternatīva, ko var uzlikt vienā apmeklējuma reizē. Procedūrai nav vajadzīga sagatavošana, un, ja nepieciešams, restaurācijas var viegli koriģēt vai mainīt krāsu, tādējādi ārstēšanai praktiski nav nekāda riska. Zobārsti parasti var sākt ārstēt pacientus pēc tam, kad viņi ir apmeklējuši tikai vienu kursu. Lai gan praktiski treniņi attīsta prasmes, arī pirmie rezultāti nereti jau ir diezgan iespaidīgi, tāpēc iesācējiem nav jāiegulda milzīgi ieguldījumi – ne laika ziņā, ne jaunos materiālos. Protams, jūs varat ieguldīt daudz laika apstrādes un pulēšanas procedūrā, taču esmu pārliecināts, ka jūs atradīsit pareizo līdzsvaru starp piepūli un rezultātu. 

Instrumentu komplekts plūstošās injekcijas metodei. 

Vai jums ir kāds ieteikums, kā sākt izmantot šo metodi? 

Pirmkārt, vēlos mudināt ikvienu izkāpt no savas komforta zonas un regulāri izmēģināt ko jaunu. Man sākt strādāt ar plūstošo injekcijas metodi bija revolucionārs pagrieziena punkts, un es nekad vairs negribētu strādāt bez tās. Pirms sākt lietot šo metodi, es noteikti apmeklētu kursus, kuros tiek apgūtas visas teorētiskās zināšanas, kas nepieciešamas veiksmīgam pirmajam gadījumam, un varbūt pat praktisko meistarklasi.

Mihals Jačevskis savas prezentācijas laikā Kuraray Noritake Dental stendā Ķelnē. 

Case by Aleksandra Łyżwińska DMD, Warsaw, Poland

Dental injuries can be stressful for patients, parents of pediatric patients, and dentists alike. The following tips offer support in turning the treatment of crown fractures into a simple, quick and predictable procedure. In the case described, we opted for a reattachment of fractured crown fragments.

YOUNG PATIENT WITH A FRACTURED CENTRAL INCISOR

A 16-year-old patient presented immediately after an accident. Her maxillary left central incisor was fractured, involving half of the coronal enamel and dentin (Fig. 1). The pulp was not involved, but the fracture line was quite close to the pulp (Fig. 2). After examination and radiographic evaluation, the patient was anesthetized. When placing the rubber dam, it tore between the left central and lateral incisor (Figs. 3 and 4). Due to the patient’s young age and limited willingness to cooperate, the decision was made to proceed without replacing the rubber dam. This was expected to work well in this specific region due to the limited flow of saliva from the palate and a low associated risk of contamination.

Fig. 1. Fractured maxillary left central incisor at the day of the accident.

Fig. 2. Occlusal view of the maxillary anterior teeth with the pulp of the fractured central incisor shining through.

Fig. 3. Rubber dam placed and torn between the left central and lateral incisor.

Fig. 4. Occlusal view of the teeth isolated with rubber dam.

REMOVAL OF UNSUPPORTED ENAMEL PRISMS

In order to provide for a high-quality bond and natural aesthetics, unsupported enamel prisms should be removed. As the use of burs might be too invasive (removing too much structure) and thus hinder the alignment of crown fragments, air-abrasion with 50 μm alumina particles was the method of choice. To avoid iatrogenic pulp exposure, the deepest part of the affected tooth was protected with a colored flowable composite before sandblasting (Fig. 5). The adjacent teeth were protected using a metal strip (Fig. 6). Several seconds of air abrasion were sufficient to remove the enamel prisms and obtain a homogeneous enamel surface (Fig. 7). Subsequently, the colored flowable composite was removed from the dentin surface and the tooth fragment was treated in the same way.

Fig. 5. Preparations for sandblasting: Dentin area near the pulp protected with flowable composite.

Fig. 6. Protection of the adjacent teeth with a metal strip.

Fig. 7. Homogeneous enamel surface after air abrasion.

JOINING OF THE FRAGMENT WITH THE REMAINING TOOTH STRUCTURE

After air-abrasion treatment, the fit of the tooth and the fragment was checked and approved (Fig. 8). To improve retention of the fractured crown portion, it was bonded to a micro applicator using composite resin. Alternatively, prefabricated prosthetic carriers may be used. Then, selective etching of the enamel was performed on the tooth and the fragment (Figs. 9 and 10). During this procedure, the adjacent teeth were protected with a celluloid strip (Fig. 11). To better adapt the strip to the distal surface, a curved wedge was placed interproximally (Fig. 12).

The bonding system of choice was CLEARFIL™ SE Bond 2 (Kuraray Noritake Dental Inc.). After applying this adhesive to the tooth and the fragment (Fig. 13), a small portion of CLEARFIL MAJESTY™ ES Flow Super Low (Kuraray Noritake Dental Inc.) in the shade A2 was applied to the part of the fragment treated with adhesive.* After careful repositioning of the fragment and while holding it in place with the micro applicator, the composite was light cured.

Fig. 8. Perfect fit of the fragment to the tooth.

Fig. 9. Selective etching of the enamel on the tooth …

Fig. 10. … and the fragment.

Fig. 11. Position of the wedge …

Fig. 12. … used for better adaptation to the distal surface.

Fig. 13. Fragment treated with CLEARFIL™ SE Bond 2 PRIMER and BOND, which were both carefully air-dried, while the Bond was also light cured.

Fig. 14. Fragment back in place.

Fig. 15. Occlusal view of the teeth with the reattached fragment perfectly fitting the mould.

EXCESS REMOVAL AND POLISHING

Excess composite was removed with a scalpel blade and abrasive discs. The entire restoration was then polished using TWIST™ DIA for Composite (Kuraray Noritake Dental Inc., Fig. 16). A nice optical integration was obtained immediately after finishing due to fact that the fragment was stored in water during the waiting time and treatment. As observed with teeth isolated with rubber dam during treatment, teeth undergo dehydration outside the oral cavity. The effect is much stronger in the latter setting, making a fragment become chalky white. By keeping the fragment in water, dehydration is limited to a minimum and it is possible to properly evaluate the aesthetic outcome. This has a positive impact on patient satisfaction. In the present case, the fragment and the tooth structure had a similar appearance, both showing a slightly increased brightness as a result of manipulation under rubber dam or in the air, respectively.

Fig. 16. Immediately after polishing, the fragment has almost the same brightness as the tooth thanks to water storage. A slight dehydration effect is visible.

TREATMENT OUTCOME

To achieve optimal aesthetics and long-lasting gloss, the composite was repolished one week later (Fig. 17). This was accomplished with a light blue high-shine rubber polisher of the TWIST™ DIA for Composite system, followed by polishing with diamond paste and a goat hair brush.

Fig. 17. Treatment outcome after one week.

Teeth previously isolated with a rubber dam and the fractured crown fragment had undergone rehydration and returned to their natural colour. The colour adaptation is satisfactory. Harmonious light reflections on the labial surface of the treated tooth a beautiful, natural shine have made the fracture site nearly invisible. In addition to aesthetic value, good therapeutic results were also achieved - the tooth responds appropriately to stimuli and is pain-free.

CONCLUSION

The described approach is a valuable treatment option for anterior trauma cases with relatively large fragments that are still available. By reattaching the natural structure, the need for complicated and time-consuming multi-shade layering and free-hand modeling is eliminated, while all the remaining natural tooth structure is saved. Instead of preparing the tooth, a removal of the unsupported enamel prisms and roughening of the surface is absolutely sufficient. Key elements for a great optical integration and long-lasting success are the proper use of a high-performance adhesive as well as the selection of a composite that has the ability to properly blend into its environment and offers a nature-like gloss retention. The selected materials offer precisely these features, so that the great outcome may be expected to last.

*CLEARFIL MAJESTY™ ES Flow Super Low is indicated for cementation purposes. The cementation of tooth fragments, however, is not explicitly mentioned in the instructions for use. The decision to use the product in this context was made by the dental practitioner in charge of the treatment.

Dentist:

ALEKSANDRA ŁYŻWIŃSKA DMD

Aleksandra Łyżwińska graduated from the Medical University of Warsaw, where she later served as a lecturer and assistant in the Department of Conservative Dentistry with Endodontics. In her daily practice, she focuses on the broad field of adhesive dentistry. She is passionate about minimally invasive techniques and vital pulp therapy. Since 2020, she has been conducting courses in conservative dentistry, collaborating with major training centers in Poland and around the world. She is a key opinion leader for Kuraray Noritake. In her training sessions, she demonstrates that dental caries management doesn‘t have to be boring, and that the bond in the bottle is just as exciting as a spy movie. Instagram users know her as the creator of the educational profile for dentist @aleksandra.lyzwinska.

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 volkan.kacmaz@kuraray.com.

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.

Case by Dr. Jusuf Lukarcanin

For all cases that require a particularly bright tooth shade – e.g. children or patients with bleached teeth / asking for a bleached effect in their restorations – CLEARFIL MAJESTY™ ES-2 Universal in the shade UW is likely to be the first choice. The young patient aged 28 shown below asked for diastema closure including shape and shade correction: She wanted to have a brighter, more beautiful smile.

Fig. 1. Initial clinical situation.

Fig. 2. Shape and shade correction were desired in this case.

Fig. 3. Treatment outcome …

Fig. 4. … leading to the beautiful smile the patient desired.

Reasons for selecting universal white:

- Cases requiring a particularly high brightness or value

- Restorations in deciduous teeth

- Restorations in bleached teeth

Universal white properties:

- Well-balanced translucency

- High light-scattering effect

CONCLUSION

One universal composite, four shades: In the case of CLEARFIL MAJESTY™ ES-2 Universal, this portfolio is absolutely sufficient for single-shade restorations even in the aesthetically demanding anterior region. Properties such as a nice blend-in effect, a great polishability and gloss retention over time support dental practitioners in creating beautiful restorations. As shade determination may be based on very few criteria instead of a complex shade guide, the whole restoration procedure becomes less stressful and more efficient. Furthermore, with only four shades to stock and usually no blocker needed, the number of materials on stock is reduced, leading to facilitations in stock management as well.

Dentist:

JUSUF LUKARCANIN

Dr. Jusuf Lukarcanin is a Certified Dental Technician (DCT) and a Doctor of Dental Science (DDS). He studied dentistry at the Ege University Dental Faculty in Izmir, Turkey, where he obtained a Master‘s degree in 2011. In 2017, he received a Ph.D. degree from the Department of Restorative Dentistry of the same university. Between 2012 and 2019, Dr. Lukarcanin was the head doctor and general manager at a private clinic in Izmir.

Between 2019 and 2020, he worked at Tinaztepe GALEN Hospital as a Restorative Dentistry specialist, between 2020-2022 he worked at MEDICANA International Hospital Izmir as a Restorative Dentistry specialist. Currently he is an owner of a private clinic for aesthetics and cosmetics in Izmir.

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.