BUSTING MYTHS AROUND HIGH-STRENGTH CERAMICS IN DENTISTRY

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 Many of the original limitations and restrictions are no longer valid, and new opportunities arise for users in the dental setting.

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

1. ZIRCONIA IS AESTHETICALLY INFERIOR TO LITHIUM DISILICATE

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

CONCLUSION

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

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

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

CONCLUSION

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

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

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

CONCLUSION 

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

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

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

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

CONCLUSION 

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

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

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

CONCLUSION 

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

6. ADHESIVE LUTING OF ZIRCONIA-BASED RESTORATIONS IS IMPOSSIBLE

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

CONCLUSION

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

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

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

CONCLUSION

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

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

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

CONCLUSION

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

ZIRCONIA A TRUE ALLROUNDER

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

REFERENCES

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

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

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

HOW IT WORKS

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

 
Features contributing to procedural simplicity include:

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

CONVINCING CLINICAL PERFORMANCE

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

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

ABOUT DENTAL ADVISOR

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

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

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

CLEARFIL™ Universal Bond Quick 2 is de nieuwste universele bonding van Kuraray Noritake Dental Inc., ontwikkeld als directe opvolger van het succesvolle CLEARFIL™ Universal Bond Quick. Met een zorgvuldig ontwikkelde samenstelling en verbeterde eigenschappen is dit adhesief ontworpen om de klinische workflow nog verder te optimaliseren – met behoud van de betrouwbaarheid waar het merk om bekendstaat. 

Het gebruik van CLEARFIL™ Universal Bond Quick 2 biedt een verscheidenheid aan voordelen, een nieuw ontworpen vulstofdispersiemethode en naadloze integratie met andere essentiële producten zoals composieten en zelfadhesieve composietcementen. Dit alles wordt mogelijk gemaakt door de combinatie van monomeren in de gepatenteerde Advanced Rapid Bond Technology. De Advanced Rapid Bond Technology bevat drie monomeren: het originele MDP-monomeer, een amidemonomeer en het Urethaan Tetra Methacrylaat (UTMA) monomeer. 

Het amide monomeer zorgt voor een snelle penetratie in de tandstructuur dankzij de hydrofiele eigenschappen. Hierdoor is het niet nodig om te wachten na het aanbrengen, wat tijd bespaart en het risico op contaminatie minimaliseert. Deze eigenschap maakt het product ideaal voor situaties waar vochtbeheersing een uitdaging is. Het nieuw toegevoegde UTMA-monomeer is een sleutelcomponent in het creëren van een zeer sterke hechtlaag die in hoge mate bestand is tegen krimpkrachten. Ondertussen zorgt het MDP-monomeer, in combinatie met andere goed op elkaar afgestemde componenten, voor een consistente en duurzame hechting aan zowel glazuur als dentine. 

De nieuwe vulstofdispersiemethode biedt twee belangrijke voordelen: het verbetert de vloeibaarheid van het product zonder het vulstofgehalte te verlagen, waardoor het gemakkelijk kan worden aangebracht en een dunne, uniforme hechtlaag wordt gevormd. Dit minimaliseert het risico op pooling en helpt de oorspronkelijke morfologie van de preparatie te behouden.

CLEARFIL™ Universal Bond Quick 2 is direct gebruiksklaar, hoeft niet geschud te worden en kan op kamertemperatuur bewaard worden. Het is geschikt voor een breed scala aan indicaties: van directe restauraties tot cementeren met zelfadhesieve composietcementen en stompopbouw – zónder de noodzaak van een dual-cure activator, ook in combinatie met andere merken. 

Meer informatie over CLEARFIL™ Universal Bond Quick 2 en Universal Excellence is online beschikbaar op www.kuraraynoritake.eu  

Case by Dr. Julien Molia

YES, IT WORKS!

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

A NEW GENERATION OF FLOWABLES

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

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

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

CASE EXAMPLE

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

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

Fig. 1. Two amalgam restorations to be replaced.

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

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

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

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

Fig. 6. Filling completed.

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

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

EASY-TO-USE ALTERNATIVE TO PACKABLE COMPOSITES

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

Dentist:

JULIEN MOLIA

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

Case by Andreas Chatzimpatzakis

When dental technicians from all over the world started using the micro-layering technique, they simply combined a reduced number of porcelains and stains from their original porcelain system. After some time, porcelains specifically designed for micro-layering were introduced to the dental market. Consequently, early adopters had to decide whether or not to switch to one of those new systems.

For me as a frequent user of CERABIEN™ ZR (Kuraray Noritake Dental Inc.), a porcelain system based on synthetic feldspathic porcelain developed for porcelain layering on zirconia frameworks, switching to any micro layering porcelain system was not an option. However, when I had the chance to test the brand-new CERABIEN™ MiLai porcelains and internal stains (Kuraray Noritake Dental Inc.), I grabbed it for two reasons. Firstly, the simplicity! I was surprised how easily I could achieve a high aesthetic result without using too many different ceramic powders. Secondly with this system, I have a micro-layering porcelain system at my disposal that works for both, zirconia and lithium disilicate. Farther more, the product is well-aligned to CERABIEN™ ZR – and offers a very similar handling.

CASE EXAMPLE

The following case is a nice example of how it may be used in the anterior region. The male patient had already been treated with monolithic zirconia crowns from another dental laboratory in the posterior region. Now, he desired a maxillary anterior smile makeover due to discoloured composite restorations and signs of tooth wear. The decision was made to produce six veneers with frameworks made of lithium disilicate (Amber Press), individualized with CERABIEN™ MiLai using the micro-layering technique. I would like to thank the prosthodontist Dr Konstantina Aggelara for the excellent collaboration and the intra oral photos.

For layering, I simply applied CERABIEN™ MiLai Value Liner 1. Then, I used CCV2 in the cervical and Tx in the incisal area, as well as Liner 2 for the mamelons. Internal stains were applied after the first bake. Subsequently, the canines were completed with LT1. The lateral and central incisors were built up with LT1 in the cervical area, Creamy Enamel on the marginal ridges and the middle and E2 mixed with Tx in the ratio 70/30 in the incisal area.

Fig. 1. Initial situation: The patient was unhappy with his lip line and facial appearance, …

Fig. 2. … particularly due to discoloured composite restorations and severe wear in the maxillary anterior region.

Fig. 3. Shade determination after tooth preparation.

Fig. 4. Restorations produced with Amper Press (Shade LT A2), individualized with CERABIEN™ MiLai.

Fig. 5. Lateral view: The internal play of colours (internal stains) creates a nice effect. Natural shading and surface texture.

FINAL SITUATION

Fig. 6a and 6b. Restorations placed in the patient’s mouth.

THE PERFECT COMPLEMENT TO MY STANDARD PORCELAIN SYSTEM

As hoped, CERABIEN™ MiLai offers similarly great handling properties as CERABIEN™ ZR – probably mainly due to the fact that it is also based on synthetic feldspathic ceramic. It is not only responsible for consistent handling, but also for predictable optical properties, eliminating unwanted shadow effects. As the system is designed for micro-layering, it offers a natural appearance when applied in thin layers. This fact – in addition to the broader compatibility (to high-strength oxide and silicate ceramics) – makes it worthwhile to consider using a specific porcelain system for micro-layering. Experience shows that it works just as well on zirconia as it does on lithium disilicate, so that combining both framework materials in a single patient becomes a lot easier, while the line-up is neat.

Dental technician:

ANDREAS CHATZIMPATZAKIS

Andreas graduated from the Dental Technology Institute (TEI) of Athens in 1999. During his studies he followed a program at the Helsinki Polytechnic Department of Dental Technique, where he trained on implant superstructures and all ceramic prosthetic restorations. As of 2000, he is running the ACH Dental Laboratory in Athens, Greece, specialized on refractory veneers, zirconia and long span implant prosthesis. In 2017 Andreas visited Japan where he trained under the guidance of Hitoshi Aoshima, Naoto Yuasa and Kazunabu Yamanda and become International Trainer for Kuraray Noritake Dental Inc..

CLEARFIL MAJESTY™ ES Flow (Low) WINS AWARD FOR THE TENTH TIME

Again, CLEARFIL MAJESTY™ ES Flow (Low) has been named a Top Product by Dental Advisor in 2025. This recognition was announced in the January/February 2025 issue of the publication, which highlights dental materials and equipment that deliver top-notch, practice-based performance. The medium viscosity version—Low of CLEARFIL MAJESTY™ ES Flow—was honored as the Top Product in the category Direct Restoratives – Composite: Highly-Filled Flowable. In Europe, the material is available in three distinct flowability levels.

PROPERTIES IN A NUTSHELL

Rather than restricting practitioners to a single viscosity that may not suit all flowable composite needs, CLEARFIL MAJESTY™ ES Flow offers a range of options. The product includes one version firm enough to stay in place when applied, another malleable enough to be shaped, and a third, more fluid, designed to flow into every corner and undercut. This variety allows clinicians to choose the best option for each procedure—opting for the high flowability variant for cavity linings and resin coatings in immediate dentin sealing (IDS), or the super-low flowability version for direct veneers and cusp build-ups.

In addition to its handling advantages, this universal flowable composite incorporates Kuraray Noritake Dental Inc.’s Light Diffusion Technology. It boasts exceptional aesthetic properties, enabling the creation of lifelike restorations that seamlessly blend with the surrounding tooth structure.

100 PERCENT RECOMMENDATION RATE

CLEARFIL MAJESTY™ ES Flow (Low), the medium flowability variant, was tested by 29 Dental Advisor consultants in 909 clinical uses. Evaluations focused on key properties such as placement/handling, aesthetics, viscosity, and polishability, with all features receiving an "excellent" rating. As a result, the product earned a 100 percent recommendation rate and a 98 percent overall clinical rating.

GREAT FEEDBACK

Evaluators shared the following comments:

• The material blended so well with the tooth structure that you had to really look to find the interface.”
• “Syringe design prevents oozing from the tip.”
• “One of the best flowable composites I have used.”
• “My go-to flowable composite. Looks beautiful in any clinical case, any class, anywhere.”

ABOUT DENTAL ADVISOR

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

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

In modern dental practice, there is a strong need for materials that combine convenient handling and procedural efficiency with aesthetic, durable results. These materials enable dental practitioners to achieve desired outcomes more efficiently, enabling them to spend more time on personal interaction with their patients.

In the context of direct restorative treatments, the selected resin composite has a strong impact on the simplicity of procedures and the quality of the outcomes: This is why universal paste-type composites, such as CLEARFIL™ MAJESTY ES-2 Universal (Kuraray Noritake Dental Inc.) are becoming increasingly popular. With CLEARFIL™ MAJESTY ES Flow Universal, the same company has now introduced a flowable composite that offers similar benefits, summarized below by answering your key questions.

How can you achieve aesthetic, durable restorations with flowable ease?

CLEARFIL™ MAJESTY ES Flow Universal is a flowable solution with two complementary shades designed for intuitive shade matching that supports a range of restorative procedures. It combines practical flow characteristics with advanced shade-blending ability and outstanding mechanical properties.

Low

• Flexural strength 151 MPa.
• Compressive strength 373 MPa.
• Filler load 75 wt/% / 59 vol%.
• Radiopacity 140 % Al.

Super Low

• Flexural strength 152 MPa.
• Compressive strength 374 MPa.
• Filler load 78 wt/% / 60 vol%.
• Radiopacity 150 % Al.

What is CLEARFIL™ MAJESTY ES Flow Universal?

CLEARFIL™ MAJESTY ES Flow Universal is a light-cured, radiopaque composite resin designed for a variety of clinical situations, available in two viscosities and 2 shades. It features nano-filler technology that allows for controlled flow, polish retention, and natural-looking restorations. Seamless blending of the composite is achieved by having a smart combination of an enamel-like translucency, dentin-like chroma and Light-Diffusion Technology (LDT). The enamel-like translucency allows light to transmit through the material, enhancing the color integration with surrounding tooth structure. LDT makes restorations diffuse light in a similar way as enamel and dentin. Together with the fine-tuned chroma, these characteristics contribute to a smooth optical integration of the material into the surrounding tooth structure.

Where can you use CLEARFIL™ MAJESTY ES Flow Universal?

This flowable composite is intended for a wide scope of restorative needs. From Class I-V restorations to pit and fissure sealing and repairs, it is formulated for use in both conservative and comprehensive treatment plans.

CLEARFIL™ MAJESTY ES Flow Universal may be used for:

• Direct restorations for all cavity classes, cervical lesions (e.g. root surface caries, v-shape defects), tooth wear, and tooth erosion.
• Cavity base / liner.
• Correction of tooth position and tooth shape (e.g. diastema closure, tooth malformation).
• Intraoral repair of fractured restorations.

How is shade selection accomplished?

Shade selection is virtually effortless with CLEARFIL MAJESTY™ ES Flow Universal. The two complementary shades, universal (U) and universal dark (UD), are intuitively selected – no shade guide needed. Shade U is suitable for most posterior and anterior restorations. UD performs best in darker-shade teeth (B3 and above) with a low amount of surrounding tooth structure, including Class III and IV cavities. Depending on the cavity class and age of the patient, you may pick the shade that fits best.

Color matching with anterior and posterior restorations.

What contributes to the performance of CLEARFIL™ MAJESTY ES Flow Universal?

The formulation includes several features aimed at clinical effectiveness:

• Nano-filler technology: Maintains an optimal filler load for reduced shrinkage, enhanced wear resistance, and long-term polish retention.
• Universal shade adaptation: Offers good visual integration with surrounding tooth structure, supporting streamlined shade selection.
• Thixotropic handling: Flows under pressure during placement but remains stable once in position, enabling precise application.

Why consider CLEARFIL™ MAJESTY ES Flow Universal?

Clinicians may find CLEARFIL™ MAJESTY ES Flow Universal beneficial due to its:

• Predictable handling and delivery.
• Aesthetic outcomes for both anterior and posterior restorations.
• Resistance to wear and surface degradation.
• Radiopacity that supports radiographic evaluation.
• Adaptability across a variety of restorative needs.

How do you apply CLEARFIL™ MAJESTY ES Flow Universal?

The application is straightforward and fits into standard clinical workflows:

1. Prepare and isolate the area as required.
2. Apply a compatible adhesive (e.g., CLEARFIL™ Universal Bond Quick 2).
3. Dispense the material using the syringe and fine-tip applicator.
4. Light-cure according to the manufacturer’s guidelines (typically 20 seconds, depending on the shade and curing light used).
5. Finish and polish to complete the restoration.

Syringe-based delivery supports controlled application and convenience.

Direct restoration with CLEARFIL MAJESTY™ ES Flow Universal.

Has CLEARFIL™ MAJESTY ES Flow Universal been evaluated by independent sources?

Yes. CLEARFIL™ MAJESTY ES Flow Universal (Super Low) has been evaluated by dental professionals through third-party testing and peer-reviewed feedback. Most recently, it received Research Award 2025 from The Dental Advisor. In their conclusion, the evaluators from the U.S.-based publication stated:

“Testing shows this composite to have among the highest physical properties for flowable composites that rivals the strongest packable composites in flexural strength, and compressive strength with an ideal radiopacity.”

A versatile flowable option: CLEARFIL™ MAJESTY ES Flow Universal

CLEARFIL™ MAJESTY ES Flow Universal is intended to support restorative procedures by combining controlled handling, aesthetic integration, and mechanical durability. It can be a practical choice for clinicians seeking a dependable flowable resin for a wide range of clinical scenarios.

Read more >

Universal Excellence - Smart Streamlined Solutions

At Kuraray Noritake Dental Inc., we understand the demands of modern dental practices. Balancing complex procedures, tight schedules, and patient needs is no easy task. That is why we have been on a relentless journey to streamline, enhance, and refine every step of your work for decades. Our vision is clear: a world where your materials and tools work seamlessly in your hands, where complexity is minimized, and where you are given enough time to focus on what matters most: the individual desires and needs of every single patient. This is the future of dentistry, and together, we’re making it happen.

Read more >

Case by Dt. Koray Kendir, DDS, Turkey (İzmir)

INTRODUCTION

Trauma-related fractures of anterior teeth require a precise balance between aesthetics and function, often under emotional pressure from the patient. This clinical case demonstrates the restorative rehabilitation of a previously mismanaged central incisor using CLEARFIL MAJESTY™ ES-2 Premium and PANAVIA™ V5 (both Kuraray Noritake Dental Inc.). The team followed a biomimetic approach to re-establish biological, functional, and aesthetic harmony.

CASE SUMMARY

A 23-year-old female patient presented one month after a traumatic injury involving tooth #11 (FDI notation). Immediate root canal treatment and a direct composite build-up had been performed elsewhere in a single visit. The existing restoration showed poor aesthetics and marginal adaptation (Fig. 1).

Fig. 1. Initial clinical situation.

CLINICAL PROCEDURE

STEP 1: ISOLATION AND REMOVAL OF OLD RESTORATION

For the planned rehabilitation, the tooth was isolated with rubber dam (Figs. 2 and 3) and the existing composite restoration was removed. Gutta-percha from the previous endodontic treatment was found to be severely coronally trimmed (Fig. 4). This poses a risk of future discolouration. Consequently, the gutta-percha was condensed apically to a more biologically appropriate level using a downpack device (Figs. 5 to 9).

Fig. 2. Isolation of the working field with rubber dam: Labial view.

Fig. 3. Isolation of the working field with rubber dam: Occlusal view.

Fig. 4. Gutta-percha from the previous treatment.

Fig. 5. Gutta-percha removed, …

Fig. 6. … placed back into the root canal …

Fig. 7. … and condensed …

Fig. 8. … with a downpack device.

Fig. 9. Result of the procedure: Occlusal view.

STEP 2: CORE BUILD-UP

Subsequently, a fiber-reinforced composite was used to provide root-anchored support for the core structure. Then, the bonding surface was treated with phosphoric acid etchant, CLEARFIL™ Universal Bond Quick (Kuraray Noritake Dental Inc.) was applied as a universal adhesive and the core build-up was performed with CLEARFIL MAJESTY™ ES-2 Premium A1D (Figs. 10 to 13).

Fig. 10. Etching with phosphoric acid etchant.

Fig. 11. Application of the universal adhesive.

Fig. 12. Core build-up after thorough light curing.

Fig. 13. Intra-oral periapical radiograph or the treated tooth.

STEP 3: PREPARATION AND DIGITAL IMPRESSION

For definitive restoration, a 3/4 crown preparation was performed and an intraoral scan was taken. Moreover, a temporary crown was fabricated (Fig. 14) and shade photos were taken to finalize the session.

Fig. 14. Temporary restoration in place.

STEP 4: FINAL CEMENTATION

Once the lithium disilicate restoration was received from the laboratory, the temporary crown was removed and the abutment tooth was evaluated (Figs. 15 and 16). Try-in was performed using PANAVIA™ V5 Try-in Paste White to check shade and fit (Fig. 17). No modifications were required; the selected try-in paste contributed to a lifelike appearance of the restoration. For definitive placement, the intaglio surface of the crown was etched with hydrofluoric acid (Fig. 18). Figure 19 shows the appearance of the intaglio after this measure. To provide for optimal bonding conditions, the tooth surface was then cleaned with KATANA™ Cleaner (Kuraray Noritake Dental Inc.), which should be applied with a rubbing motion to the contaminated prepared tooth for more than ten seconds (Figs. 20 to 22). It may also be used to clean the intaglio of a restoration, which is contaminated with blood and saliva e.g. after try-in.

Fig. 15. Situation after removal of the temporary crown: Labial view.

Fig. 16. Situation after removal of the temporary crown: Occlusal view.

Fig. 17. Try-in of the lithium disilicate crown.

Fig. 18. Etching of the crown’s intaglio surface with hydrofluoric acid.

Fig. 19. Appearance of the etched surface.

Fig. 20. Cleaning of the abutment tooth …

Fig. 21. … surface covered with the cleaning agent.

Fig. 22. Thorough rinsing, which should be followed by drying with air.

Adhesive cementation itself was accomplished with the three-component PANAVIA™ V5 (Figs. 23 to 28): The prepared tooth structure and build-up was treated with PANAVIA™ V5 Tooth Primer, the intaglio surface of the crown with CLEARFIL™ CERAMIC PRIMER PLUS. Finally, PANAVIA™ V5 Universal (White) was extruded into the crown and the crown placed. Excess cement is best removed in the gel phase – i.e. after brief polymerization for 3 to 5 seconds before final light curing is performed. Alternatively, it may be removed immediately after seating the restoration with a brush or similar instrument. In this case the first option was chosen. The treatment outcome after rubber dam removal and final clinical and aesthetic evaluation is displayed in Figure 29.

Fig. 23. Priming of the tooth structure.

Fig. 24. Selected resin cement.

Fig. 25. Tooth structure ready for crown placement.

Fig. 26. Restoration in place.

Fig. 27. Lateral view of the restoration.

Fig. 28. Final light curing of the crown.

Fig. 29. Treatment outcome immediately after rubber dam removal.

CONCLUSION

This case highlights a comprehensive restorative approach to preserving a traumatized anterior tooth at risk of loss, while restoring both function and aesthetics. The strong core foundation provided by CLEARFIL MAJESTY™ ES-2 Premium and the reliable adhesive performance of PANAVIA™ V5 played a pivotal role in the successful procedure and outcome.

Dentist:

KORAY KENDIR

Dt. Koray Kendir is a graduate of Hacettepe University Faculty of Dentistry and the co-founder of a private dental clinic in İzmir. He specializes in digital dentistry, smile design, and computer-aided restorative treatments. Known for his innovative approach, Dr. Kendir is a frequent speaker at national dental congresses and serves as an advisor to several dental companies.

Recently we introduced CERABIEN™ MiLai - a brand-new line of porcelains and internal stains specially developed for micro-layering on zirconia and lithium disilicate.

In this special edition of BOND magazine, we're excited to share the very first clinical cases using this innovative system. From beautifully natural veneers to streamlined lab workflows, these real-world examples show just what’s possible with CERABIEN™ MiLai.

If you’re curious about what the future of aesthetic dentistry looks like, this is the place to start!

Start Reading: BOND | VOLUME 12 | 07/2025

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BOND | VOLUME 11 | 07/2024

BOND | VOLUME 10 | 10/2023

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