Een nieuw ontwerp voor de PANAVIA Veneer LC-spuit
Dankzij de speciaal ontworpen spuit en applicatietip van PANAVIA Veneer LC wordt het materiaal gemakkelijk gedoseerd, met optimale controle over het appliceren.

Minimally invasive procedures using highly aesthetic restorations is what patients expect when they seek restorative treatment. With the various types of restorations available today, it is possible to meet these expectations – provided that the right materials are used.

For the placement of veneers, a resin cement must be selected that supports long-lasting aesthetics, is easily applied, offers a working time sufficient for simultaneous cementation of multiple restorations and provides excellent bond strength. The new “PANAVIA™ Veneer LC” is precisely what you need.

What is the workflow you ask? Check out the video to see the full workflow using PANAVIA V5 Primer and CLEARFIL Ceramic Primer Plus.

One of the key features when talking about cements is the ease of removal of excess cement. Our newest cement - PANAVIA™ Veneer LC - offers the ideal paste consistency, a low film thickness and long working time.

But how about excess removal? Do you wonder how do we compare to other similar products?

Check out this video demonstrating an excess removal comparison between PANAVIA Veneer LC and other brands.

PANAVIA™ Veneer LC

Great solution for challenging task

PANAVIA™ family just got bigger! We are introducing the new PANAVIA™ Veneer LC – the specialist cement that offers aesthetics, excellent paste viscosity, easy handling and 200 seconds(!) working time under ambient light (8000 lux.). Coming in four different shades with matching try-in pastes from PANAVIA™ V5 system, it allows users to take into account the individual shade requirements and deliver highly aesthetic outcomes when cementing veneers, inlays and overlays.

Join our free webinar now and be the first to learn all the details about this new and exciting product from Kuraray Noritake Dental Inc..

ABOUT DR JORGE ESPIGARES, DDS, PHD

Dr. Jorge Espigares received his DDS degree at the Faculty of Dentistry, University of Granada in Spain and obtained his PhD degree under the supervision of Prof. Tagami at Tokyo Medical and Dental University in Japan. Specialized in Cariology and Operative Dentistry, Dr. Jorge Espigares has clinical experience in Spain and UK, and has authored and coauthored full-length research publications with his colleagues at TMDU.

PRESENTATION OF A STUDY WITH ILLUSTRATIVE CASES

by Dr. Yohei Sato, DMD, PhD and Dr. Keisuke Ihara, CDT.

INTRODUCTION

In recent years, the application and advancement of digital technology in dentistry has made it possible to accomplish the fabrication of highly accurate prosthetic zirconia appliances that were difficult to mill using the previously available technology. In addition, thanks to advances in adhesive dentistry and the advent of cements that bond strongly to a diverse range of materials, cements have come into wide clinical use that can cope with the many types of materials used for the fabrication of prosthetic appliances.

At our hospital, we select the treatment method most suitable for each case by appropriately specifying various types of prosthetic appliance according to the status of each case. For example, we may specify zirconia prosthetic restorations fabricated by the CAD/CAM system, or silica-based ceramic prostheses, or those made of lithium disilicate glass, as the case dictates.

PANAVIA™ V5 is a resin cement system that bonds strongly to various types of prosthetic appliance, as well as to tooth structure. PANAVIA™ Veneer LC, a new resin cement system developed by Kuraray Noritake Dental Inc., has suitable characteristics for bonding laminate veneers, using two types of primer that can be used in common with PANAVIA™ V5. Here are some clinical examples of its advantages as a resin cement system used for laminate veneers restorations.

NIEUWE VULSTOF
De uitstekende verwerking van PANAVIA™ Veneer LC is te danken aan de nieuw ontwikkelde sferische silicavuldeeltjes en de nanoclustervullers (vulstof gehalte: 66 wt%, 47 vol%). Dankzij de thixotropische eigenschappen van het cement zijn inzakken of wegvloeien niet meer aan de orde. PANAVIA™ Veneer LC staat garant voor een beheerste applicatie; het blijft op zijn plaats waar het wordt aangebracht, maar vloeit goed tijdens het plaatsen van de facing(s).
Dankzij de consistentie en lage filmdikte (≈ 8 μm) zorgt PANAVIA™ Veneer LC voor een dunne, gelijkmatig verdeelde cementlaag. Dit bevordert een gemakkelijke plaatsing, zonder verstoring. Bovendien liggen hoogesthetische Gladde cementranden binnen handbereik dankzij het gebruik van uitsluitend zeer kleine, sferische vulstofdeeltjes (deeltjesgrootte: 0,05 μm - 8 μm); tevens is afwerken gemakkelijker en wordt de gladheid behouden.

SILICAVULLERS
Mede door gebruik te maken van de nieuw ontwikkelde, sferische silicavuldeeltjes blijft het cement zitten waar het wordt aangebracht, maar vloeit het goed tijdens de plaatsing van de veneer. Gemakkelijke plaatsing, zonder wegvloeien en inzakken, is daardoor een feit. Tijdens het aanbrengen op het hechtoppervlak van het werkstuk plakt het composietcement niet aan de applicatietip; een eigenschap die te danken is aan de toevoeging van sferische nanoclustervullers aan de pasta.

Deze nieuwe vulstofdeeltjes resulteren in

een uitstekend gladheidsniveau en behoud

van glans evenals een gemakkelijke verwerking.

VISCOSITEIT & THIXOTROPIE
De viscositeit van een cement is essentieel en dient laag genoeg te zijn om breuk van de voorziening tijdens plaatsing te voorkomen. Tegelijkertijd mag het cement niet zo vloeibaar zijn dat het wegvloeit tijdens het plaatsen en de positionering van de restauratie.
Aangezien PANAVIA™ Veneer LC een geoptimaliseerd mengsel bevat van vulstoffen en kunsthars, verandert de viscositeit onder druk. Dit verschijnsel is thixotropie. De pasta wordt onder druk vloeibaarder tijdens de plaatsing en positionering van de veneer. Naarmate de druk afneemt, neemt de viscositeit toe. Dankzij de thixotropische eigenschap van PANAVIA™ Veneer LC laat de pasta zich gemakkelijk doseren, is er weinig druk nodig om de voorziening te plaatsen en is de overmaat gemakkelijk te verwijderen. Kortom, optimale controle.

Materialen met dezelfde viscositeit hoeven niet per se dezelfde thixotropie te hebben. Viscositeit wordt beïnvloed door temperatuur en druk. De mate en snelheid waarmee een materiaal bij verlaging van de druk terugkeert naar de originele viscositeit hangt af van de thixotropie van het materiaal.

INNOVATIEVE UITHARDINGSTECHNOLOGIE
PANAVIA™ Veneer LC is een lichtuithardend cement, dat verschillende technologieën combineert om u de hoogst mogelijke hechtsterkte te bieden.

SEALING VAN DE INTERFACE
Een verbeterde touchcure-technologie wordt gebruikt om een langere verwerkingstijd te realiseren met behoud van de hoge hechtsterkte waar PANAVIA™ om bekend staat. PANAVIA™ Veneer LC voegt, in combinatie met PANAVIA™ V5 Tooth Primer, een belangrijk chemisch element toe aan een lichtuithardend cement. PANAVIA™ V5 Tooth Primer is een zelfetsende primer voor tandweefsel (dentine en glazuur), die het tandoppervlak betrouwbaar verzegelt zodra deze in contact komt met PANAVIA™ Veneer LC Paste. Deze ‘milde’ touch-cure-reactie zet alleen de uitharding van de adhesieve interface in gang en brengt onmiddellijk een sterke hechting aan glazuur en dentine tot stand, echter zonder de uitharding van het cement - en daarmee de verwerkingstijd - te beïnvloeden.

VERWERKINGSTIJD
Tijdens cementeerprocedures wordt de verwerkingstijd beïnvloed door verschillende externe factoren. De technologie achter PANAVIA™ Veneer LC houdt rekening met die factoren. Dankzij de touch-cure-technologie wordt de tandinterface onmiddellijk verzegeld; de basis voor een hoge hechtsterkte. Dankzij de uithardingstechnologie profiteert u van een lange verwerkingstijd van 200 seconden onder omgevingslicht* voordat de ideale plasticiteit en dus de verwerkbaarheid van PANAVIA™ Veneer LC afneemt. Binnen dit tijdsbestek kunt u uw (meerdere) veneers comfortabel plaatsen en positioneren. De uiteindelijke polymerisatie vindt plaats tijdens de lichtuitharding, zodat het cement optimaal uithardt.

*Omgevingslicht; circa 8.000 lux

Case by Dr. Aleksandra Łyżwińska, Warsaw, Poland

ABSTRACT

Indirect overlays are the contemporary restoration standard for posterior teeth with extensive hard tissue loss. They provide for cuspal coverage, which decreases the likeliness of coronal and/or root fracture. At the same time and in contrast to crowns, overlay preparations minimize the removal of sound tooth structure especially in the cervical region, which is a critical factor.¹ Modern dental resin composites allow for direct cuspal coverage in a single-visit appointment. The results of in-vitro studies suggest that these direct overlays are a suitable alternative to their indirect counterparts in specific situations.^2-6 The following case report is used to describe the direct restoration procedure by means of a maxillary right molar with an extensive, deep MOD lesion.

INTRODUCTION

In the context of treating a tooth with an extensive carious lesion, a biomechanical risk assessment should be performed. The primary method of reducing the likeliness of tooth fracture is treatment with a restoration that provides cuspal coverage. The contemporary gold standard for biomechanically compromised teeth are adhesively cemented overlays as an alternative to crowns.¹ Another option that does not involve labwork is a direct overlay restoration.^2-6 The direct approach is especially suitable for long-term temporization, which may be required during orthodontic treatment, for example.

CLINICAL CASE

The 40-year-old male patient was referred to my office before an orthodontic and prosthetic treatment. Intraoral examination (Figs. 1 and 2) revealed:

• Tetracycline discolouration,
• Multiple extensive composite restorations with marginal leakage,
• Primary and secondary carious lesions, and
• Significant mechanical weakness^7,8 (mesio-occluso-distal (MOD) cavities, cusp loss, cracks).

Fig. 1. Initial situation – extensive MOD composite resin restoration.

Fig. 2. Initial situation – unacceptable contact points, palatal wall crack line.

Based on a clinical and radiological examination (Fig. 3), it was decided to restore the maxillary right first molar with a direct overlay, which should serve as a long-term temporary for the duration of orthodontic treatment. Once the local anaesthetic had been administered, rubber dam was placed in the first quadrant and the cusps of the affected first molar were reduced. For subgingival tooth preparation, a rubber dam sheet was temporarily moved behind the second upper molar (Fig. 4). In order to obtain a good emergence profile of the restoration and a tight fit of the sectional matrix, the gingivectomy was performed with an electric surgical knife (Surtron 50D, LED SPA) (Fig. 5). The main advantages of a diathermal cut are instant tissue coagulation and hemostasis⁹.

Fig. 3. Bite-wing radiograph: Maxillary fist molar with an overhang and negative profile of the distal wall.

Fig. 4. Initial preparation with reduction of the cusps and exposure of gingiva.

Fig. 5. Gingivectomy performed using a surgical electric knife.

In accordance with the European Society of Endodontology’s guidelines on the management of deep caries¹⁰, the deepest part of the cavity was cleaned in full rubber dam isolation (Nic Tone Dental Dam, MDC Dental) (Fig. 6). Carious-tissue excavation was carried out using round burs, then the enamel and dentin were air-abraded with 50-μm aluminum oxide (Microetcher IIa, Danville). Multiple cracks, penetrating through the enamel and partially the dentin, occurred within the mesial and palatal walls. The presence of cracks crossing the dentin-enamel junction is an absolute indication to cuspal coverage^8,11.

An appropriate rubber dam isolation is essential in adhesive dentistry. Beyond the obvious advantage of a clean operation field uncontaminated by saliva and moisture, the rubber dam contributes to keeping periodontal tissues at a distance form a tooth. In order to ensure both, maximum retraction and sufficient space to work, the rubber dam was inverted (introduced to the gingival sulcus) and stabilized using PTFE tape (Fig. 7). The mesial wall was restored using a blue 3D Composite-Tight 3D Fusion matrix ring (Garrison) and a medium standard Sectional Contoured Metal Matrix (TOR VM, Fig. 8). Due to its extensiveness and shape, restoration of the distal wall was more difficult to perform.

Fig. 6. Rubber dam newly placed in the interproximal area. Full isolation is essential for the excavation of the infected dentin in the deepest part of the cavity.

Fig. 7. PTFE tape placement for improving isolation in the gingival area. Al₂O₃ sandblasting.

Fig. 8. Mesial matrix fit.

The first attempt to adapt an elongated Sectional Contoured Metal Matrix and the green 3D Composite-Tight 3D Fusion (Garrison) ended with failure (Fig. 9). The matrix was changed for a longer and more curved one (Fig. 10). The ring was replaced by a smaller Palodent V3 Ring (Dentsply Sirona, Fig. 11). Due to the depth of the carious lesion, an antibacterial adhesive system was used (CLEARFIL™ SE Protect, Kuraray Noritake Dental Inc.). It contains the MDPB monomer, which offers an antibacterial effect that lasts even after hybrid layer formation^12-14. Furthermore, the fluoride included in the bond liquid intensifies the cariostatic mechanism of CLEARFIL™ SE Protect and supports the so-called “Super Dentin” formation¹⁵.

Fig. 9. Insufficient fit of the distal matrix.

Fig. 10. New, longer and more curved matrix in place.

Fig. 11. Different matrix ring placed in the distal area.

After polymerization of the bonding agent, the nanohybrid flowable composite resin (CLEARFIL MAJESTY™ ES Flow High, Kuraray Noritake Dental Inc.) was applied in a thin layer. The proximal wall was restored using both packable (CLEARFIL MAJESTY™ ES-2 Universal, Kuraray Noritake Dental Inc.) and flowable composite resin (CLEARFIL MAJESTY™ ES Flow Super Low, Kuraray Noritake Dental Inc.) (Figs. 12 and 13). Core build-up was performed with bulk-fill type composite. The cusps were reconstructed free-hand with the previously used CLEARFIL MAJESTY™ ES-2 Universal (Figs. 14 and 15). The universality of this product provides for a good optical integration and blending with the adjusted tissue, regardless of the colour of the underlying tooth structure. The fissures were gently highlighted using brown tints.

Fig. 12. Thin layer of flowable composite resin CLEARFIL MAJESTY™ ES Flow High (A2) applied on the cavity floor. The proximal walls are built up with build-up by CLEARFIL MAJESTY™ ES-2 Universal and CLEARFIL MAJESTY™ ES Flow Super Low (A2).

Fig. 13. Proximal walls build-up – palatal view.

Fig. 14. Core build-up. Free-hand cusp coverage with CLEARFIL MAJESTY™ ES-2 Universal, palatal view.

Fig. 15. Cusp coverage – occlusal view.

The initial polishing was performed with the rubber dam still in place. The excesses of composite resin were removed with the aid of abrasive discs, diamond burs and a “Brownie” polisher (BAL, Nevadent). Pre-polishing and high-shine polishing were executed with TWIST™ DIA for Composite (Kuraray Europe GmbH.) supported by a goat hair brush (Micerium) (Figs. 16 to 17).

Fig. 16. Occlusal surface after surface modeling with CLEARFIL MAJESTY™ ES-2 Universal and initial polishing.

Fig. 17. Occlusal surface after modeling with CLEARFIL MAJESTY™ ES-2 Universal and initial polishing – palatal view.

After removal of the rubber dam, the occlusal contact points of the direct overlay were adjusted (Figs. 18 and 19). Every spot touched by the burr was subsequently repolished according to the previously described protocol (Figs. 20 and 21).

Fig. 18. Occlusal adjustment. Contact points recorded with articulation paper (100 μm).

Fig. 19. Occlusal adjustment. Contact points recorded with articulation paper (100 μm= and articulation foil (16 μm).

Fig. 20. Final effect after polishing with TWIST™ DIA for Composite.

FINAL SITUATION

Fig. 21. Final effect – palatal view.

CONCLUSION

As a result of decades of improvements mainly with regard to the filler density and polishability, modern dental composites offer a great gloss retention and favourable wear properties. In addition, polymerization shrinkage has been decreased due to the integration of nanohybrid filler technology. Those features allow us to restore biomechanically compromised teeth using a direct restoration technique.

Direct overlays are a suitable alternative for a conventional indirect restoration in many situations.^18,19 According to researchers, the advantages of direct restorations with cuspal coverage include minimal tooth preparation, vital pulp-oriented treatment, the possibility to treat patients in a single appointment and a potentially lower cost of the treatment.^18-20 However, it should be emphasized that the presented technique requires advanced restorative skills that need to be acquired first before starting to implement it.

Dentist:

DR. ALEKSANDRA ŁYŻWIŃSKA
Warsaw, Poland

Dr. Aleksandra Łyżwińska is a restorative dentist. She graduated from the Warsaw Medical University in 2017, where she was an assistant professor at the Department of Conservative Dentisyty and Endodontics. Her focus lies in modern adhesive techniques, resin composites and biomaterials.

REFERENCES

1. Dietschi D, Duc O, Krejci I, Sadan A. Biomechanical considerations for the restoration of endodontically treated teeth: a systematic review of the literature--Part 1. Composition and micro- and macrostructure alterations. Quintessence Int. 2007 Oct;38(9):733-43.
2. van Dijken JW. Direct resin composite inlays/onlays: an 11 year follow-up. J Dent. 2000 Jul;28(5):299-306. doi: 10.1016/s0300-5712(00)00010-5. PMID: 10785294.
3. Mondelli RF, Ishikiriama SK, de Oliveira Filho O, Mondelli J. Fracture resistance of weakened teeth restored with condensable resin with and without cusp coverage. J Appl Oral Sci. 2009 May-Jun;17(3):161-5.
4. Deliperi S, Bardwell DN. Multiple cuspal-coverage direct composite restorations: functional and esthetic guidelines. J Esthet Restor Dent. 2008;20(5):300-8; discussion 309-12.
5. Deliperi S, Bardwell DN. Clinical evaluation of direct cuspal coverage with posterior composite resin restorations. J Esthet Restor Dent. 2006;18(5):256-65; discussion 266-7.
6. Mincik J, Urban D, Timkova S, Urban R. Fracture Resistance of Endodontically Treated Maxillary Premolars Restored by Various Direct Filling Materials: An In Vitro Study. Int J Biomater. 2016;2016:9138945.
7. Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. J Endod. 1989 Nov;15(11):512-6.
8. Banerji S, Mehta SB, Millar BJ. The management of cracked tooth syndrome in dental practice. Br Dent J. 2017 May 12;222(9):659-666.
9. Bashetty K, Nadig G, Kapoor S. Electrosurgery in aesthetic and restorative dentistry: A literature review and case reports. J Conserv Dent. 2009 Oct;12(4):139-44.
10. European Society of Endodontology (ESE) developed by:, Duncan HF, Galler KM, Tomson PL, Simon S, El-Karim I, Kundzina R, Krastl G, Dammaschke T, Fransson H, Markvart M, Zehnder M, Bjørndal L. European Society of Endodontology position statement: Management of deep caries and the exposed pulp. Int Endod J. 2019 Jul;52(7):923-934.
11. Lynch CD, McConnell RJ. The cracked tooth syndrome. J Can Dent Assoc. 2002 Sep;68(8):470-5.
12. Hashimoto M, Hirose N, Kitagawa H, Yamaguchi S, Imazato S. Improving the durability of resindentin bonds with an antibacterial monomer MDPB. Dent Mater J. 2018 Jul 29;37(4):620-627.
13. Imazato S, Kinomoto Y, Tarumi H, Torii M, Russell RR, McCabe JF. Incorporation of antibacterial monomer MDPB into dentin primer. J Dent Res. 1997 Mar;76(3):768-72.
14. Imazato S, Kinomoto Y, Tarumi H, Ebisu S, Tay FR. Antibacterial activity and bonding characteristics of an adhesive resin containing antibacterial monomer MDPB. Dent Mater. 2003 Jun;19(4):313-9.
15. Nakajima M, Okuda M, Ogata M, Pereira PN, Tagami J, Pashley DH. The durability of a fluoride-releasing resin adhesive system to dentin. Oper Dent. 2003 Mar-Apr;28(2):186-92.
16. Bore Gowda V, Sreenivasa Murthy BV, Hegde S, Venkataramanaswamy SD, Pai VS, Krishna R. Evaluation of Gingival Microleakage in Class II Composite Restorations with Different Lining Techniques: An In Vitro Study. Scientifica (Cairo). 2015;2015:896507.
17. Oficjalne informacje producenta Kuraray Noritake Dental https://www.kuraraynoritake.eu/pl/clearfil-majesty-es-flow (dostęp 08.02.2022).
18. Angeletaki F, Gkogkos A, Papazoglou E, Kloukos D. Direct versus indirect inlay/onlay composite restorations in posterior teeth. A systematic review and meta-analysis. J Dent. 2016 Oct;53:12-21.
19. Dhadwal AS, Hurst D. No difference in the long-term clinical performance of direct and indirect inlay/onlay composite restorations in posterior teeth. Evid Based Dent. 2017 Dec 22;18(4):121-122.
20. Banerji S, Mehta SB, Millar BJ. Cracked tooth syndrome. Part 2: restorative options for the management of cracked tooth syndrome. Br Dent J. 2010 Jun;208(11):503-14.
21. Opdam NJ, Roeters JJ, Loomans BA, Bronkhorst EM. Seven-year clinical evaluation of painful cracked teeth restored with a direct composite restoration. J Endod. 2008 Jul;34(7):808-11.
22. van Dijken JW. Direct resin composite inlays/onlays: an 11 year follow-up. J Dent. 2000 Jul;28(5):299-306.

The vacation period is over and we all are slowly returning back to our everyday routines and work. With all the travel and holidays in the last months you might have missed this great article in the LabLine Summer edition: Graftless solutions and implant-supported monolithic zirconia fixed prostheses.

It is an extensive, beautiful and detailed case report created and documented by team of well known and respected KOLs: Fortunato Alfonsi, Antonio Barone, Marco Stoppaccioli, Romeggio Stefano and Vincenzo Marchio.

Check it out by clicking here.

LAMINATE VENEER RESTORATION
USING LITHIUM DISILICATE

WITH PANAVIA™ Veneer LC (Clear)
Case by Yohei Sato (DMD, PhD) and Keisuke Ihara (CDT)

Fig. 1 The patient visited would like to have the a aesthetics
of the maxillary right and left lateral incisors improved.

Fig. 2 A silicon guide fabricated from a diagnostic wax model
was applied and the necessary clearances were determined.

Fig. 3 Since the lateral teeth are microdonts, the
preparation of each abutment was completed by simply
exposing a fresh enamel surface to be covered with
laminate veneers.

Fig. 4 A layer of porcelain was applied on the lithium
disilicate substrate, to complete the laminate veneers.

Fig. 5 The veneer was conditioned according to the
prosthesis‘ IFU. After trial fitting, the intaglio surface of the
laminate veneer was cleaned with KATANA™ Cleaner.

Fig. 6 CLEARFIL™ CERAMIC PRIMER PLUS was applied and
dried to prime the restoration.

Fig. 7 The preparation was cleaned with KATANA™ Cleaner.
Applied and rubbed for more than 10 seconds. Then, it
was washed off sufficiently (until the cleaner color had
completely disappeared), and dried with compressed air.

Fig. 8 K-ETCHANT Syringe was applied and left for 10
seconds before water-rinsing and compressed air-drying.

Fig. 9 PANAVIA™ V5 Tooth Primer was applied and left for 20
seconds before mild compressed-air drying.

Fig. 10 PANAVIA™ Veneer LC Paste was applied to the
intaglio surface of the laminate veneer.

Fig. 11 The laminate veneer was seated and the fit
checked. Then, the excess cement was tack-cured (not
more than 1 second at each point) and removed. Finally,
the restoration was light-cured and finished.

FINAL SITUATION

Fig. 12 The laminate veneer restorations one month after
placement. The morphology and color of the right and
left lateral incisors have been improved, providing a good
balance to the entire anterior dentition.

LAMINATE VENEER RESTORATION
USING KATANA™ Zirconia STML

WITH PANAVIA™ Veneer LC (Clear)
Case by Yohei Sato (DMD, PhD) and Keisuke Ihara (CDT)

Fig. 1 The patient was referred by an orthodontist. The main
complaints were improper aesthetics of the teeth due to dark
triangles betwen the teeth and incisal wear.

Fig. 2 On the basis of the pre-treatment diagnosis using
a mockup, the teeth were prepared, with keeping in mind
that the enamel should be preserved to the maximal extent
possible.

Fig. 3 A fixation retainer was present at the palatal side,
making it difficult to take coventional silicon impressions.
Therefore, an intraoral scanner was used.

Fig. 4 A layer of porcelain was applied to each KATANA™
Zirconia STML laminate veneer to complete the restorations.
The inner surface of each restoration was sandblasted, being
careful to prevent chipping.

Fig. 5 After trial fitting, bonding inhibiting substances as
blood and saliva were removed using KATANA™ Cleaner.

Fig. 6 CLEARFIL™ CERAMIC PRIMER PLUS was applied and
dried using compressed air.

Fig. 7 The surface of each tooth was cleaned and treated
with K-ETCHANT Syringe for 10 seconds before washing it
away with water and drying with compressed air.

Fig. 8 PANAVIA™ V5 Tooth Primer was applied and left f

Fig. 9 PANAVIA™ Veneer LC Paste was applied and the
laminate veneers were seated. For this case, we placed six
veneers during one session.

Fig. 10 The unpolymerized excess paste was removed with
a brush according to the wet clean-up technique.

Fig. 11 The result after final light curing. Since the excess
cement was easily removed, there were almost no cement
residues.

FINAL SITUATION

Fig. 12 Result one month after placement of the laminate
veneer restorations. The marginal gingiva has been improved
thanks to the good fit of the laminate veneer restorations.

- A commemoration of the company’s 10th anniversary –

We asked Mr. Sadaaki Matsuyama, who was then the president of Kuraray Medical, and Ms. Kiyoko Ban, who was then the company advisor of Noritake Dental Supply, about episodes that occurred during the business integration between their two companies.

What were your impressions of each other at that time?

Ms. Ban: I had known Mr. Matsuyama for about 10 years before the integration. When I first met him, I got the idea he was "scary," but as we talked I discovered we had a nice rapport. I finally came to the firm conclusion that he is a very pleasant person!

Mr. Matsuyama: We made some small talk when we met at exhibitions, and because we used the same distributors in Japan, we had many opportunities to talk to each other at New Year's parties and other distributors’ gatherings. She said that I looked "scary", but at first I felt that Ms. Ban looked quite tough (laughs). Later, I came to have the impression that she was someone with whom I could talk frankly.

What were your impressions of each other's companies before the integration?

Ms. Ban: Kuraray had entered the dental industry before Noritake did and they were well known in the field of dental adhesives. I respected them. We had something in common, in that we were both companies that had not specialized in dentistry, but were now doing business in this new-to-us field.

Mr. Matsuyama: Noritake occupies a high share in Japanese dental ceramics market and Kuraray occupies a high share in Japanese dental adhesives market, so neither company had a big lineup of dental products. Neither of us was a great big company doing extensive business in the dental industry. Still, it seemed to me that we both had outstanding, worldwide-recognized technological capabilities.

How did the two companies turn up with the idea of integration?

Ms. Ban: Actually, even before we began to consider the possibility of integrating, the topic of integration came up several times during casual chats among Kuraray staff. Later, when Mr. Matsuyama, who had been working in China, returned to Japan, I began to think that we would be able to draw up a more concrete global strategy if we worked together. Finally, when Mr. Matsuyama was appointed president of Kuraray Medical, I remember that a specific discussion of integration came up between the two companies.

Mr. Matsuyama: At that time, just as Ms. Ban said, Kuraray Medical was also seriously considering a global strategy. We were thinking, "We ought to get serious about expanding our business in the global market." From a global perspective, it was clear we needed to show our face on the world market. I also had the feeling that, to succeed at that, we had to add "something" to the company as it was, in order to achieve this global expansion. It was while I was still mulling this over that the topic of business integration came up, and I saw right away that we had no choice but to move forward with this. If we intended to expand our business further and advance more aggressively into overseas markets, I thought that the integration of Noritake Dental Supply, the number one company in "inorganic" materials and Kuraray Medical, the first in "organic" materials would have a global impact and that it would be very beneficial to both companies.

Ms. Ban: Before the integration, dental materials divisions of Kuraray and Noritake had worked together in the development of dental restoration system called CLAPEARL*. Kuraray made the cement and Noritake made the porcelains suitable for use with the cement. Kuraray and Noritake have had a pretty darned good relationship since that time.

*Limited to Japan, dental restoration system consisting of several components used for porcelain laminate veneer restorative treatments. Only its dual-cure cement was exported to some areas under the name of CLEARFIL™ DC Cement.

I think the two companies integrated with each other to enhance their respective strengths further and overcome their weaknesses. What did you expect specifically?

Mr. Matsuyama: What I expected from this integration was that our people, who had been engaged only with adhesive materials, would be able to get into the world of porcelain materials. Also, I thought they would be able to widen their perspective on their own dental materials business, including how they conducted that business, by being on the inside of another company in a related field. I thought this would hold true of the employees at both companies.

Ms. Ban: That's right. We used to only look at ceramics-related areas, but after the integration, we began to pay attention to new cement products, and so on. During the early days after integration, at the IDS (International Dental Show: one of the world's largest exhibitions in the dental industry), our ceramics products and our adhesive products were displayed separately in our booth. I remember even back then I thought this was bad. Now, at exhibitions, our products are displayed in one booth, with ceramics and cement products arranged together, so visitors can take a look at both types of products at the same time. I think things have improved a lot compared with how they were at the beginning.

At the time, there was a lot of talk about "synergistic effects" arising from the integration. What kinds of synergistic effects did you first see and experience? Was it what you expected?

Ms. Ban: At the first IDS held after the birth of Kuraray Noritake Dental, I really felt the synergy arising from the integration. When I got to our booth, without even fully realizing what I was saying, I exclaimed: "This splendid booth shows what we can achieve by getting together!" I felt as if a great new company had been born. Besides, another thing that I feel great about this integration is the issue of intellectual properties. We were able to learn a lot about intellectual property rights after integrating with Kuraray Medical, and I am very thankful for that.

Mr. Matsuyama: I think the first one of the synergistic effects we obtained from the integration was that we were able to market our products from a wider perspective. For example, now that we sell CAD/CAM materials or ceramic materials, we are able to suggest suitable cements for them, as well. Previously, we could only say, "This is what we do with ceramics, and (separately) this is what we do with cements." But now, we can suggest products to customers that make up a total dental restoration system. This makes it easier for customers to get the whole picture of what we have available for them to buy. I thought that this was where the synergies from the integration first showed up.

Ms. Ban: People who know Kuraray Medical or Noritake Dental Supply well, such as those who are in the dental industry, including dentists, all said it was a wonderful integration. They all congratulated us on our integration. Kuraray Medical had long been recognized as a reliable dental adhesives manufacturer, while Noritake Dental Supply also had been accepted by many people in the dental industry as an excellent manufacturer of dental ceramic materials. I think that because both companies had good images, their integration was perceived even more favorably.