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

Atbrīvojieties no stresa izmantojot plūstošos materiālus. Vai ir plūstošs kompozītmateriāls, kas pilda savus solījumus? Daži tirgū pieejamie plūstošie materiāli sniedz mazāku izturību un estētiku un/vai tos ir grūti apstrādāt. Tas rada iespaidu, ka plūstošie kompozītmateriāli ir nedaudz sliktāki par pastveida kompozītmateriāliem. Paskaidrosim, kāpēc CLEARFIL MAJESTY™ ES Flow atšķiras no citu zīmolu plūstošajiem kompozītmateriāliem, un noskaidrosim, kā silanizācija atklāj jaunu plūstošo materiālu iespēju laikmetu. 

Zobu kompozītmateriālu galvenās sastāvdaļas ir sveķi un pildvielas, kas tiek rūpīgi apvienoti, lai iegūtu apstrādājamu, polimerizējamu materiālu, ko var izmantot, lai izveidotu cietu zobu restaurāciju. Ir svarīgi, lai pildviela paliktu matricā. Lai to panāktu, pildvielas daļiņām jāspēj pielipt matricai. Savienojošais līdzeklis (silāns) atvieglo ķīmisko saķeri starp diviem kompozīta komponentiem. Silāns ir bifunkcionāla virsmaktīvā viela, kas saistās ar pildvielu un polimerizācijas laikā reaģē ar matricas monomēriem. 

PAREIZA SILANIZĀCIJA  

Tas var šķist viegli, bet realitāte atšķirās. Sajaucot pildvielu un sveķus rodas problēma. Pildvielas daudzums, ko var pievienot sveķu maisījumam, ir ļoti ierobežots. Konsistence ļoti ātri paceļas tik daudz, ka sanāk tik tikko apstrādājams maisījums. Mūsdienu kompozītmateriāli satur arvien mazākas pildvielas daļiņas. Pie nemainīga tilpuma, jo mazākas ir pildvielas daļiņas, jo lielāka ir kopējā pārklājamā platība, vēl ātrāk padarot maisījumu nepraktisku. Tāpēc ir nepieciešami augstas kvalitātes silāni, lai maksimāli palielinātu pildvielas daļiņu mitrināšanas spēju un izveidotu augstas kvalitātes kompozītmateriālu.

NEREDZAMAIS MEISTARDARBS 

Ne visi silāni un silanizācijas metodes ir vienādas. Kuraray Noritake Dental demonstrē vienu no saviem šedevriem šajā jomā. Mēs, līderi silānu tehnoloģiju jomā, izmantojam tikai ļoti stabilus, īpašus silānus. Viens no izmantotajiem silāniem ir īpaši izstrādāts garās ķēdes silāns: Long Carbon Chain Silane (LCSi). Šo silānu mēs izmantojam mūsu plūstošo kompozītmateriālu sērijā: CLEARFIL MAJESTY™ ES FLOW. 

Mūsu ekspertu silanizācijas rezultāts:

• Augsta pildvielas slodze, neapdraudot apstrādājamību; 
• Loti stabilas restaurācijas pat pēc slodzes; 
• Augsta mitrumizturība; 
• Liela izturība; 
• Izturīgas, dabiskas restaurācijas; 
• ļoti ierobežota ūdens absorbācija;  
• Optimāla apstrāde; 

1. attēls: Vienāda daudzuma sveķu un dažādi apstrādātu pildvielu maisījumi. Pa kreisi: neapstrādāts. Pa vidu: parasti apstrādāts. Pa labi: apstrādāts ar Kuraray.

Jo augstāka ir silāna kvalitāte, jo labāka ir pildvielu mitrināmība, jo vairāk pildvielas var pievienot sveķiem, negatīvi neietekmējot apstrādājamību. Papildu pozitīvais aspekts, izmantojot mūsu augstas kvalitātes silānus, ir tas, ka tie ievērojami novērš pildvielas daļiņu atdalīšanos no sacietējušā kompozītmateriāla. Mūsu kompozītmateriāliem ir arī ļoti ierobežota ūdens absorbācija, kas arī lielā mērā ir saistīta ar silanizāciju. 

Pildvielas, iepriekš minētā silāna un zemas viskozitātes sveķu maisījuma kombinācija ļauj mums izveidot ļoti piepildītu plūstošo materiālu, kas ir universāls kompozītmateriāls. Tiek saglabātas gan plūstamība, gan optimāla apstrādājamība, vienlaikus nodrošinot ļoti izturīgu kompozītmateriālu.

2. attēls: Jo sarežģītāka ir silāna tehnoloģija, jo vairāk pildvielas var pievienot tādam pašam sveķu daudzumam. 

PLŪSTAMĪBA 

CLEARFIL MAJESTY™ ES Flow saime piedāvā trīs dažādas plūstamības pakāpes, kas atbilst jūsu vēlmēm un restaurācijas veidam: augsta, zema vai īpaši zema. 

IZTURĪBA

CLEARFIL MAJESTY™ ES Flow pildvielas saturs ir līdz 75 masas%, 59 tilp.%, kas nodrošina izcilas (mehāniskās) īpašības, padarot to piemērotu pat aizmugurējām restaurācijām. 

KO TAS NOZĪMĒ JUMS?

Kā mūsu zināšanas palīdz jums kā zobārstam?

Daļēji augstā pildvielu satura dēļ restaurācijas, kas izgatavotas ar CLEARFIL MAJESTY™ ES Flow, ir ļoti izturīgas. Pietiekama izturība pat uzklāšanai aizmugurējiem zobiem. CLEARFIL MAJESTY™ ES Flow ir pat stiprāka nekā vairums universālo pastveida kompozītmateriālu (skatiet diagrammu zemāk). Atkārtota piepildīšana negatīvi neietekmē izturību un integritāti. Tajā pašā laikā augsta mitruma izturība veicina ilgstošu izturību un ilglaicīgu, stabilu estētiku. Mūsu CLEARFIL MAJESTY™ ES FLOW pildvielas sastāv gan no submikronu, gan klasteru pildvielas daļiņām (no 0,18 μm līdz 3,5 μm). Ļoti novērtētās apstrādes īpašības, piemēram, kontrolēta uzklāšana, noturēšanās vietā un nelipšana, lielā mērā ir arī pateicoties šīm sabalansētajām pildvielām.

Pildvielas veids lielā mērā arī atbild par CLEARFIL MAJESTY™ ES Flow restaurāciju ilgstošu spīdumu. Pulēšana notiek ātri, tikai dažās sekundēs. Pat tikai noslaukot virsmu ar spirtā samērcētu marles vai vates tamponu spīdums jau ir ievērojams. CLEARFIL MAJESTY™ ES FLOW gaismas difūzijas tehnoloģija, kas lielā mērā iegūta no nanoklasteru pildvielas daļiņām, nodrošina izcilas krāsu saskaņošanas īpašības, ļaujot restaurācijai nemanāmi saplūst ar apkārtējiem zobu audiem.

SECINĀJUMI 

Var droši teikt, ka mūsu zināšanas silanizācijas un citu tehnoloģiju jomā (piemēram, gaismas difūzijas tehnoloģija) ļoti pozitīvi ietekmē mūsu kompozītmateriālu kvalitāti, tostarp CLEARFIL MAJESTY™ ES Flow. CLEARFIL MAJESTY™ ES Flow ir trīs dažādi plūstamības līmeņi, un ir pieejams ļoti daudzpusīgs produktu klāsts, kas nodrošina lielisku apstrādi, augstu izturību, vieglu pulējamību un izcilu pulēšanas noturību. Neatkarīgi no tā, vai vēlaties to izmantot, lai atjaunotu, labotu vai cementētu priekšējo vai aizmugurējo daļu, izmantojot spiedoga tehniku, plūstošās injekcijas metodi vai kādu citu, tas ir vienīgais jums nepieciešamais kompozīts!

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 [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.

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.

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.