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Clinical case by Kostia Vyshamirski, DT

Digital technologies for computer-aided imaging, planning, design and manufacturing are valuable tools that support dental technicians in their daily work. Combined with traditional approaches, those digital tools allow us to assess, shape, and finally meet or even exceed patient expectations. The case below is a perfect example: We produced 20 natural bleach restorations made of KATANA™ Zirconia YML and CERABIEN™ ZR Porcelains and of Noritake Super Porcelain EX-3 (Kuraray Noritake Dental Inc.), respectively.

INITIAL SITUATION

The aim was to create a new white, still natural smile. It was decided to replace the old crowns in the maxilla and to create a wider and brighter smile by adding laminate veneers in the maxilla and mandible.

Fig. 1. Initial clinical situation.

DIGITAL SMILE DESIGN AND DIAGNOSTIC WAX-UP

Digital smile design and a diagnostic wax-up are great tools for analysing and planning a new smile. Intraoral scans and portrait photographs of the patient served as the basis for the development of the ideal proportions and shapes. Once the virtual designing of the new restorations was completed (software: exocad DentalCAD), the wax-up models were printed. By transferring the wax-up into the patient’s mouth via an index or matrix, it is possible to test and assess the outcome intraorally. In this step, aesthetic and functional analysis should be the priority.

Fig. 2. Digital smile design based on an image.

Fig. 3. Computer-aided waxing up in the maxilla based on the smile design.

Fig. 4. Completed virtual wax-up for the maxilla and mandible.

Fig. 5. Wax-up transferred into the patient’s mouth for functional and aesthetic analysis.

Fig. 6. The planned new bright smile.

ALVEOLAR PRINTED MODEL

Precise and functional models are essential for the production of accurate, aesthetic restorations in the laboratory. The model builder software SHERAeasy-model (SHERA) and a 3D printer (ASIGA MAX UV, Asiga) were used to produce solid models and alveolar models with full gingival information and removable dies.

Fig. 7. Alveolar models printed in gingiva and tooth colours.

Fig. 8. Printed models with articulator holding plates and removed dental elements.

REFRACTORY DIE DUPLICATION AND ARTICULATION

The refractory die technique allows for the production of extremely thin-walled restorations and hence supports minimal tooth structure removal. For this reason, the approach seems best suited for all previously untreated teeth without major defects. The printed dies were duplicated in the refractory die material before mounting the models in the articulator for a transfer of the maxillomandibular relations.

Fig. 9. Process of duplicating printed dies in the refractory material.

Fig. 10. Articulating the models.

PRODUCTION OF THE RESTORATIONS

To achieve the best results, it is essential to select the best material for each specific situation. For the production of the crown frameworks used to restore the six maxillary anterior teeth, KATANA™ Zirconia YML in the shade NW appeared to be the ideal option. Their intaglio surfaces were treated with Esthetic Colorant (Kuraray Noritake Dental Inc.) in the shade OPAQUE to prevent a shining through of the discolourations found on some of the prepared teeth. After sintering of the frameworks in a high-temperature sintering furnace (Nabertherm) at 1,550° C, CERABIEN™ ZR porcelains were applied as illustrated below. For the creation of natural effects inside the restorations – i.e. between the layers of porcelain –, we use the internal stain technique (ILS). This procedure is very predictable and fast. Each step during porcelain build-up and staining was recorded with photos to monitor the entire process and to capture all information on the individual protocol steps. The porcelain veneers (Super Porcelain EX-3, Kuraray Noritake Dental Inc.) were produced on the refractory dies to restore the premolars in the maxilla and central incisors to second premolars in the mandible.

Fig. 11. Refractory dies and zirconia frameworks on the model.

Fig. 12. Wax-up on the model with removable dies.

Fig. 13. KATANA™ Zirconia YML frameworks on the model.

Fig. 14. Opacity control with CERABIEN™ ZR Opacious Body OB White to optimise brightness.

Fig. 15. Application of CERABIEN™ ZR Body NW0.5 to restore the cores of the crowns using a silicon index.

Fig. 16. CERABIEN™ ZR porcelains E1 and LTX applied to create translucency at the incisal edge.

Fig. 17. Prepared surface ready for internal stain application.

Fig. 18. Creation of mamelons and incisal effects with CERABIEN™ ZR internal stains.

Fig. 19. Adaptation of the incisal third with a mamelon mixture of internal stain shades (white, mamelon orange and bright).

Fig. 20. Outcome of the internal staining procedure.

Fig. 21. CERABIEN™ ZR Luster application using the Interchangeable Build-up Technique, application of CCV1 in the cervical area.

Fig. 22. CERABIEN™ ZR porcelains ELT1 used for the core, LTX for the incisal area and ELT3 for the ridges.

Fig. 23. Restorations finished by carving, hand polishing and a self-glaze bake.

Fig. 24. Layering map summarizing the porcelain layering procedure.

FIT ASSESSMENT AND TRY-IN

When the production process was complete, the restorations were placed on the solid models (printed master casts). This step is very important to validate the passive fit and contact points of each crown and veneer. Afterwards, it was time to try-in and check all the restorations intra-orally.

Fig. 25. Final restorations ready for fit assessment.

Fig. 26. Maxillary restorations: Checking of the passive fit and contacts on the model.

Fig. 27. Mandibular restorations: Checking of the passive fit and contacts on the model.

Fig. 28. Intra-oral try-in of the crowns.

DEFINITIVE PLACEMENT AND FINAL OUTCOME

Refractory ceramic veneers were cemented via an adhesive protocol using a resin-based composite. Opaque glass ionomer cement was used to cement the zirconia crowns.

At the recall about one month after restoration placement, we saw amazing gum conditions and a happy, healthy and beautiful smile!

Fig. 29. Image taken right after definitive placement of the crowns.

Fig. 30. Nice pink-and-white aesthetics achieved with the all-ceramic restorations.

Fig. 31. Amazing gum conditions found one month after restoration placement.

Fig. 32. Happy, healthy and beautiful smile.

Fig. 33. The new smile exceeds expectations.

Dentists:

Case by Andreas Chatzimpatzakis

With CERABIEN™ ZR, Kuraray Noritake Dental Inc. offers a whole porcelain portfolio for the finishing of restorations based on zirconia. Originally developed for complex layering techniques, the synthetic feldspathic porcelain powders, liquid ceramics, internal and external stains allow for the creation of beautiful dental artwork. We love to work with the system as it offers consistent handling and mechanical properties, allowing us to produce predictable outcomes.

However, the complexity of the system with its huge number of different shades can pose challenges to less experienced users. This complexity is further increased when different substructure materials are used, as CERABIEN™ ZR works exclusively on zirconia, so that users would need to select and manage a second porcelain system when opting for a lithium disilicate framework, for example.

For dental technicians who would like to keep it smartly simple, the new CERABIEN™ MiLai line-up is certainly a great solution. Specifically developed for micro-layering on pre-shaded, highly translucent substructure materials such as lithium disilicate or a latest-generation zirconia, CERABIEN™ MiLai porcelains and internal stains may be applied in a thin (micro-) layer on restorations with a small (vestibular) cut-back. Just like CERABIEN™ ZR, the new system is based on synthetic feldspathic porcelain delivering consistent properties, but the line-up is reduced to 15 internal stains and 16 porcelains. As the CERABIEN™ MiLai has a firing temperature of 740 °C (1,364 °F), it works on oxide ceramics like zirconia, but also on reinforced silicate ceramics like lithium disilicate*.

*The material should have CTE value within 9.5~11.0×10^-6 /K (50~500 °C)

Consequently, the system may be used as the universal porcelain system for micro-layering on aesthetic ceramics. With its slim portfolio, it fits the philosophy of creating impressive restorations with fewer components, layers and bakes very well, as demonstrated in two different case examples below.

VENEERS BASED ON LITHIUM DISILICATE

Fig. 1. Six anterior veneers made of lithium disilicate (Amber Press LTA2 HASS Bio), designed with a slight cut-back to create the space needed for micro-layering.

Fig. 2. Restorations after the application of CERABIEN™ MiLai Value Liner 1 followed by wash firing and internal staining. This type of porcelain increases the value of lithium disilicate restorations. By staining the core, we control the chroma and add some internal characteristic effects. In this case, we added Cervical 2 to the marginal area and characterized the incisal third with Cervical 2 and Incisal Blue 1 & 2.

Fig. 3. First porcelain layer consisting of CERABIEN™ MiLai LT1 applied to the cervical, ELT1 to the mesial third and TX to the incisal third before …

Fig. 4. … and after the first bake.

Fig. 5. Application of internal stains for special effects like cracks, intense chroma etc.

Fig. 6. Second porcelain layer consisting of CERABIEN™ MiLai LT1 applied to the canines as well as the cervical third of the central and lateral incisors, while the middle and incisal third of the four incisors is individualised with LTx.

Fig. 7. Finished restorations on the master cast.

Fig. 8. Lateral view of the restorations highlighting their natural surface texture.

ANTERIOR BRIDGEWORK BASED ON ZIRCONIA

Fig. 1. KATANA™ Zirconia HTML Plus (A2 shade) structure immediately after milling.

Fig. 2. Appearance of the substructure after sintering.

Fig. 3. High translucency of the zirconia with the applied CERABIEN™ MiLai stains and porcelains on teeth and gingiva.

Fig. 4. Palatal view of the individualized restoration before the firing process.

Fig. 5. Restoration ready for try-in.

CONCLUSION

The two different cases confirm that CERABIEN™ MiLai works very well on lithium disilicate and zirconia. Despite the reduced number of stains and shades, it is possible to imitate most of the shades and individual effects found in natural teeth, which are important for lifelike outcomes. Hence, the new material is worth a try for everyone who prefers standardized and simplified procedures.

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..

With improving mechanical properties and evolving (injection-based) techniques, the use of flowable composites is becoming increasingly popular as a permanent solution in the aesthetic zone. Consequently, the originally challenging task of shade matching becomes relevant with this material class as well. That is why Kuraray Noritake Dental Inc. introduces CLEARFIL MAJESTY™ ES Flow Universal – a flowable composite with an intuitive shade-matching concept.

Available in two flowabilities and two beautifully complementary shades, universal (U) and universal dark (UD), CLEARFIL MAJESTY™ ES Flow Universal turns shade matching into an effortless endeavour. Shade U is suitable for almost all posterior and anterior cavities and shades. UD (Universal dark) shows best results in cavities of shade B3 and beyond that are lacking a back wall, such as Class IV cavities. Hence, U or UD are intuitively selected – no shade guide needed. This is feasible due to a smart combination of an enamel-like translucency, dentin-like chroma and unique Light-Diffusion Technology (LDT). The placement procedure is simplified by the clever syringe design that reduces the risk of formation of air bubbles, extruding the composite without dripping, while the low stickiness facilitates handling and sculpting with the syringe tip. Once cured, the material seamlessly blends with the surrounding tooth structure. In this way, minimal effort is involved in the creation of beautiful restorations.

With a flexural strength over 150 MPa, a compressive strength over 370 MPa and high filler loading of 75, resp. 78 wt/%), CLEARFIL MAJESTY™ ES Flow Universal rivals with its mechanical properties those of conventional paste-type composites. Thanks to this, the material is suitable for use even for stress-bearing areas like occlusal surfaces. This opens the door to a wide range of applications, including restorations of all cavity classes, direct veneering, simplified restoration of multiple teeth with the flowable injection technique, and intraoral repairs. In addition, the mechanical properties provide for an easy, time-saving polishing procedure and long-lasting gloss. So well equipped, the material positions itself as a high-performance permanent restoration solution offering both aesthetic excellence and structural reliability.

For those users who would like to maximise their clinical efficiency without compromising on treatment quality, the combination with other high-quality materials of Kuraray Noritake Dental Inc.’s universal portfolio – e.g. with CLEARFIL™ Universal Bond Quick 2 – is highly recommended. Consisting of fewer components and requiring fewer steps, these products reduce the procedural complexity and smooth the way for great outcomes. More information about CLEARFIL MAJESTY™ ES Flow Universal and the whole universal portfolio is available online.

To meet the demands of modern dental practices, Kuraray Noritake Dental Inc. is continually refining existing materials and developing new ones. As part of this commitment, the company introduces CLEARFIL™ Universal Bond Quick 2, the latest advancement in dental bonding technology. Designed to enhance clinical workflows, this adhesive delivers robust performance across a wide range of applications.

The use of CLEARFIL™ Universal Bond Quick 2 provides a variety of benefits, made possible by the combination of proprietary Advanced Rapid Bond Technology, a newly designed filler dispersion method, and seamless integration with other essential products like restoratives and self-adhesive resin cements. Advanced Rapid Bond Technology features three monomers: the original MDP Monomer, Amide Monomer, and Urethane Tetra Methacrylate (UTMA) Monomer.

The Amide Monomer facilitates rapid penetration into the tooth structure,using its hydrophilic properties . This eliminates the need for waiting after application, saving time and minimizing the risk of contamination. This feature makes the product ideal for situations where moisture control is challenging. The newly added UTMA Monomer is a key component in creating a high-strength bonding layer that resists shrinkage forces. Meanwhile, the MDP Monomer, in combination with other well-matched components, ensures a consistent and durable bond to both enamel and dentin.

The new filler dispersion method provides two significant benefits: it enhances the product’s flowability without reducing the filler content, enabling easy application while forming a thin, uniform bonding layer. This minimizes the risk of pooling and helps maintain the original morphology of the prepared tooth.

CLEARFIL™ Universal Bond Quick 2 can be stored at room temperature (max. 25°C) and does not require shaking, making it ready to use at any time. Furthermore, it is well-suited for a variety of clinical scenarios, including direct restoration procedures, cementation of indirect restorations with self-adhesive resin cements, and core build-up procedures. A separate dual-cure activator is not required.

For clinicians seeking to maximize efficiency without compromising treatment quality, combining this adhesive with other high-quality materials from Kuraray Noritake Dental Inc.’s universal portfolio is highly recommended. These products, consisting of fewer components and requiring fewer procedural steps, simplify workflows and pave the way for exceptional clinical outcomes.

More information about CLEARFIL™ Universal Bond Quick 2 and the universal portfolio is available online at https://www.kuraraynoritake.eu/.

Whether you’re working with zirconia or lithium disilicate, CERABIEN™ MiLai simplifies your process with one unified application method for both materials. This innovative system not only saves valuable time but also ensures outstanding aesthetics and top-quality results.

In this video, we guide you through each step, demonstrating just how easy it is to achieve consistently beautiful outcomes. If you’ve already heard about CZR Milai, now’s the perfect opportunity to see it in action.

Watch the video to learn more about its key features and see the step-by-step application!

FRESH IDEAS AND HOW TO IMPLEMENT THEM

Are you looking forward to return home after several days full of networking and gathering information on new products, techniques and services? Are you ready to use the newly acquired knowledge in your clinical or technical work environment? If so, we wish you a successful start with all our heart. If you are still in Cologne, looking for even more practical input, we would like to invite you to visit our Booth # E010 in Hall 11.3, get in touch with our team on site for in-depth conversations and product demonstrations and explore tomorrow’s lecture programme.

The lectures for clinicians will be held in German:

If you have missed a presentation or would like to watch it again at home or in the office, we have great news for you: All the lectures and hands-on demonstrations will be available on demand soon! In case of questions or suggestions, please do not hesitate to contact your local Kuraray Noritake Dental representative, who will definitely be happy to help!

A full overview of our innovative solutions is also available online. 

WINNING STRATEGIES FOR CERAMIC LAYERING AND CHAIRSIDE PROCEDURES

Are you looking for advice on how to achieve excellence in all-ceramic restorations from no less a figure than Nondas Vlachopoulos? Or would you like to take a deep dive into aesthetic restoration techniques and success factors in chairside procedures? In both cases, it is definitely worth visiting the IDS booth of Kuraray Noritake Dental Inc. tomorrow.

The lecture programme for dental technicians and practitioners already has a lot to offer:

Moreover, our Kuraray Noritake Dental team is eager to share their knowledge and introduce you to our world of innovative products, solutions and workflows. One of the focus products for laboratories this year: CERABIEN™ MiLai, a brand-new set of low-fusing porcelains and internal stains designed for micro-layering not only on zirconia, but also on lithium disilicate. See for yourself how this product is capable of transforming your technical workflows; and learn how your experienced colleagues use it to fulfil even the highest aesthetic demands.

More information including the complete lecture programme and a full overview of innovative solutions is available online.

See you tomorrow in Hall 11.3 at our Booth # E010!

CONCEPTS FOR SUCCESS WITH FLOWABLE COMPOSITES AND MICRO-LAYERING

Would you like to learn more about the flowable injection technique and the benefits for your practice? Or are you interested in mastering internal staining combined with micro-layering in your laboratory? In-depth knowledge about those and other approaches, practical tips on how to implement them and perfectly suitable products will be presented tomorrow at the IDS booth of Kuraray Noritake Dental Inc.

On two different stages, specific lecture programmes for dental practitioners and dental technicians are offered:

In addition, our knowledgeable staff will be happy to present innovative products like the brand-new CLEARFIL MAJESTY™ ES Flow Universal with its simplified shade concept. Experience its handling properties and blend-in ability yourself by testing it on model teeth, get in touch with the product’s developers or scientific experts, and see how easily the material – and the presented techniques – might transform your daily procedures! We look forward to seeing you in Hall 11.3 at our Booth # E010!

More information including the complete lecture programme is available online.

EXCITING START OF THE LECTURE PROGRAMME

Colourful booth, lots of enthusiastic visitors: Our first day at the International Dental Show in Cologne is a full success. Tomorrow, we are going to up the ante and start our lecture programme. In the afternoon, our renowned partner clinicians and technicians will shed light on clinical or technical procedures and approaches that will allow you the leverage the full potential of our innovative products.

Chairside, different direct restorative procedures and our universal portfolio will take centre stage:

Labside, the focus will be on redefining laminate veneers and minimal layering:

Do not miss the chance to visit us, watch the lectures and connect with the speakers for practical tips. Our team is also happy to share their in-depth knowledge about our products and procedures. We look forward to seeing you in Hall 11.3 at our Booth # E010!

More information including the complete lecture programme is available online.

Cases by DT Ioulianos Moustakis and MDT Andreas Chatzimpatzakis

Producing dental restorations that are not recognizable as such – this is probably the ultimate goal of every dental technician. For a long time, pursuing this goal was complicated by core materials whose optical properties were very different from those of natural teeth. The dark metal or opaque zirconia substructures had to be masked by applying multiple layers of intensively coloured ceramic powders, topped by more translucent porcelains imitating the enamel.

The rise of modern, tooth-coloured core materials such as lithium disilicate and zirconia has changed the game. With a core that is highly aesthetic, translucent and close to the final shade, it became much easier to produce a restoration that is virtually indistinguishable from the adjacent teeth. The thickness of the porcelain layer decreased as did the number of shades to be combined and necessary bakes to be conducted. The use of the existing porcelain systems for the new micro-layering techniques posed several new challenges: those systems originally developed for opaque zirconia were indicated for the more translucent zirconia core materials, but usually not for lithium disilicate. Moreover, the complexity of the systems made their use unnecessarily complicated for inexperienced users.

Consequently, Kuraray Noritake Dental Inc. developed a new porcelain system for micro layering on zirconia and lithium disilicate core materials. The portfolio of CERABIEN™ MiLai, which refers to micro-layering and the Japanese word for future (mirai), consists of 15 internal stains (13 tooth colours including Bright to boost the translucent and Fluoro to boost the fluorescent effect, and two tissue colours) and 16 porcelains (12 tooth porcelains and four tissue porcelains). Hence, it enables dental technicians to implement a modernized version of the original Internal Live Stain Technique developed by Hitoshi Aoshima in the early 1990s in a porcelain layer of minimal thickness.

The following demo cases are used to show how to achieve lifelike aesthetic restorations based on aesthetic zirconia and on lithium disilicate. Illustrating each step, the cases allow users to anticipate how much time and effort can be saved compared to traditional layering techniques.

CASE 1

MAXIMALLY SIMPLE APPROACH ON LITHIUM DISILICATE

In this case, the idea was to restore the six maxillary anterior teeth in a simple way. The selected core material for the planned veneers was Amber Press (HASS Bio) LT in the shade B1. The lithium disilicate restorations were pressed with a micro cut-back and their fit was checked on the model, followed by surface texturing, sandblasting and steam cleaning [Fig. 1a]. When the veneers are milled instead of pressed, the procedure is the same. After that, the restorations are ready for the application of the CERABIEN™ MiLai internal stains for characterization of the core. In order to achieve the desired result, it is critical to mix the selected stains with the internal stain Bright responsible for a translucent effect. The chroma map for internal staining is shown in figure 1b, the outcome of the procedure in figure 1c. Subsequently, the veneers were built up to their final anatomy with selected CERABIEN™ MiLai Porcelains [Fig. 1d] to imitate the enamel and create a window effect. In this approach, simple layering and a single bake are sufficient to create the desired restoration. After glazing with Clear Glaze, finishing of the restorations was accomplished with paper-abrasive cones, a rubber polisher and polishing paste. The outcome is shown in figure 1e.

Fig. 1a. Pressed lithium disilicate veneers after surface optimization (grinding), sandblasting and steam cleaning on the model.

Fig. 1b. Chroma map for the application of CERABIEN™ MiLai Internal Stains to the lithium disilicate surface. We selected B+ (red colour) for the cervical area. For the proximal and middle incisal areas, Incisal Blue 1 & 2 (gradient blue colour) were applied and incisally in the middle, we chose Cervical 2 (orange colour). Tip: all internal stains were mixed with Bright and IS Liquid.

Fig. 1c. Appearance of the veneers after the application of CERABIEN™ MiLai Internal Stains.

Fig. 1d. CERABIEN™ MiLai Porcelains applied on top of the internal stains: LT1 is used for the cervical area (red) and a mixture of TX and E2 (30:70 ratio) for the middle and the incisal third.

Fig. 1e. The final restorations after glazing with Clear Glaze and mechanical polishing using paper-abrasive cones, a rubber polisher and Pearl Surface Z (Kuraray Noritake Dental Inc.).

Images courtesy of Andreas Chatzimpatzakis.

CASE 2

ADVANCED APPROACH ON LITHIUM DISILICATE

In order to imitate a more complex inner colour structure with mamelons, different levels of translucency and more individual effects, a slightly more complex micro-layering approach was selected. Again, the core was produced using Amber Press in the LT variant and the shade B1. After pressing and fitting on the model, we reduced the incisal third to create space for the transparent porcelain [Fig. 2a]. Subsequently, an extremely thin layer of CERABIEN™ MiLai Porcelain adding translucency to the enamel surface (TX) was applied in the incisal third of the veneers [Fig. 2b]. In this way, it is possible to create an optimally translucent basis for the application of the internal stains. The first bake was conducted and the surfaces were sandblasted as well as steam cleaned to create the conditions needed for internal staining [Figs. 2c and 2d]. The chroma map for and outcome of the internal stain application are shown in figures 2e and 2f. Afterwards, a final layer of CERABIEN™ MiLai Porcelain was applied [Fig. 2g]. All four incisors received a layer of LTx to add ultimate translucency and opalescence to the enamel, while LT1 was the material of choice in the cervical third of the canines, where LTx completed the layer in the other areas. As LT1 is slightly less translucent and opalescent, a natural effect is obtained in this way. The outcome obtained after glazing and mechanical polishing is shown in Figure 2h.

Fig. 2a. Lithium disilicate veneers reduced for the advanced layering procedure involving more porcelains and bakes.

Fig. 2b. Thin layer of TX applied to the incisal third of the restorations to boost the translucency in this area.

Fig. 2c. Appearance of the veneers after the first bake.

Fig. 2d. Ceramic surfaces after sandblasting and steam cleaning.

Fig. 2e. Chroma map for the application of the internal stains. Cervical 2 was used for the cervical third, Incisal Blue 2 for the proximal regions and Mamelon Orange 2 for the mamelons. As mentioned before, the selected internal stains were mixed with Bright.

Fig. 2f. Appearance of the veneers after the bake of the applied CERABIEN™ MiLai Internal Stains.

Fig. 2g. Final build-up to reach the desired shape of the veneers. LTx is the only material applied to the central and lateral incisors, while the canines are built up with LTx in the incisal and middle and LT1 in the cervical third.

Fig. 2h. Glazed and polished veneers on the model.

Images courtesy of Andreas Chatzimpatzakis.

CASE 3

ADVANCED APPROACH WITH GUM AREAS ON ZIRCONIA

In this case, a highly complex ten-unit bridge with gum parts in the anterior region had to be produced. The selected framework material was KATANA™ Zirconia HTML Plus (Kuraray Noritake Dental Inc.), which offers a multi-layered colour structure, an optimized translucency and the high flexural strength required for long-span bridges. The restoration was milled in an anatomically reduced design and the surface texture was optimized with rotating instruments before sintering [Fig. 3a]. After the final sintering procedure, the restoration had a favourably high translucency in the incisal region and a natural shade structure [Figs. 3b and 3c]. In the first step of the micro-layering procedure, the application of the CERABIEN™ MiLai Internal Stains was planned and carried out [Figs. 3d and 3e]. Subsequently, different layers of CERABIEN™ MiLai Porcelain were applied. The images 3f to 3h reveal which shades were combined and illustrate the procedure, while the outcome before and after the last bake is shown in Figures 3i to 3k. In the next step, the gum areas were completed using the CERABIEN™ MiLai tissue porcelains Tissue 4, 5 and 6 in the order and locations described in Figures 3l to 3o. In the final layer, Tissue 1 was mixed with ELT1 to imitate the labial frenulum and with LTx to create a smooth transition to the natural gingiva [Figs. 3p and 3q]. The final restoration is shown in Figure 3r.

Fig. 3a. Milled restoration after surface texturing.

Fig. 3b. Shade and translucency of the sintered zirconia restoration.

Fig. 3c. Highly translucent bridge on the model.

Fig. 3d. Chroma map for the application of CERABIEN™ MiLai Internal Stains.

Fig. 3e. Applying a mixture of Bright, Salmon Pink and Tissue Pink to the gum area.

Fig. 3f. Application of CERABIEN™ MiLai E2 to add translucency to the structure.

Fig. 3g. Application of Tx and a mixture of Tx and CCV-2 to individualize the cervical and incisal areas while boosting the translucency of the enamel in the middle and incisal third.

Fig. 3h. Adding a final layer of LT1 for additional translucency and opalescence.

Fig. 3i. Appearance of the ten-unit bridge before the bake – labial view.

Fig. 3j. Appearance of the ten-unit bridge before the bake – palatal view.

Fig. 3k. Appearance of the ten-unit bridge after the bake.

Fig. 3l. Application of small amounts of Tissue 5 …

Fig. 3m. … covered with a layer of Tissue 6 alternating with Tissue 5.

Fig. 3n. Following another bake, Tissue 5 is applied in the proximal areas.

Fig. 3o. How to combine Tissue 6 and Tissue 4 in the next layer.

Fig. 3p. How to complete the tissue layer with Tissue 1, locally mixed with ELT1 or LTx.

Fig. 3q. Restoration before the final bake.

Fig. 3r. Final ten-unit bridge ready for placement.

Images courtesy of Ioulianos Moustakis.

ABOUT THE AUTHORS

DT IOULIANOS MOUSTAKIS
Germany

Dental Technician/Photographer
1985 - 1987 Studied at the School of Dental Technology (SBIE) in Athens / Greece
1997 - 1998 Master school in Berlin
2007 - Education as Maxillofacial prosthetic technician (IASPE)
2010 - Advanced education in Functional diagnosis temporomandibular joint
2011 - 2012 Curriculum implant prosthetics for dental technicians (DGZI)
2013 - 2014 Education as a graphic designer at the Media Design Hochschule (MDH) in Berlin
2015 - 2017 Education as a photographer at the Photocentrum of the Gilberto Bosques VHS Friedrichshain-Kreuzberg
2014 - 2016 - 2018 Further training at Noritake/Kuraray in Japan
2019 - International Instructor Noritake/Kuraray
2019 - Certified trainer of Teeth Morphology carving (Osaka Ceramic Training Center)
1998 - Implant Dental Studio - Athens/Greece
2010 - Zirkler & Moustakis Dental Technology - Falkensee/Germany
2020 - Giuliano Dentaldesign - Falkensee/Germany

Publications in Dental Journals
2014 - 5/2014 Dental Dialogue/Germany
2015 - 10/2015 The International Journal of Dental Technology/Japan
2018 - 1/2018 Cosmetic Dentistry/Germany
2018 - 4/2018 Zahntechnik Zeitung/Germany
2018 - 5/2018 Das Dental Labor/Germany
2018 - 5/2018 Dental Dialogue/Italy
2018 - 10/2018 Laborama/Greece
2019 - 1/2019 LabLine/Hungary
2019 - 3-4/2019 Dental Technologies/UK
2020 - 4/2020 LabLine/Hungary
2021 - 1+2 LabLine/Hungary
2021 - 5/2021 + 12/2021 Quintessenz Zahntechnik/Germany
2021 - 4/2021 QDRP France

Competitions
2013 – 6th place at the 8th KunstZahnWerk contest by Candulor
2017 – 5th place at the 10th KunstZahnWerk contest by Candulor
2017 – 1st place at the 10th KunstZahnWerk contest by Candulor as "Best Documentation“
2020 – 1st place at the 4th Panthera Master Cup by Panthera Dental

Memberships
NGSC Noritake Greek Study Club
DGZI German Society of Dental Implantology
IASPE International Association for Surgical Prosthetics and Epithetics
Key Opinion Leader (KOL) at company MPF Brush Company
Key Opinion Leader (KOL) at company Candulor
Key Opinion Leader (KOL) at company Kuraray/Noritake

MDT ANDREAS CHATZIMPATZAKIS
Greece

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.

From the year 2000, he is running the ACH Dental Laboratory in Athens, Greece, specialized on refractory veneers, zirconia and long span implant prosthesis.

ACH Dental Laboratory is Co-operating lab with the National and Kapodistrian University of Athens for the MSc degree in Dental Laboratory Materials.

From 2016 he is key opinion leader for the MPF Brush.co.

On 2017 he visits Japan where he trained from Hitoshi Aoshima, Naoto Yuasa and Kazunabu Yamanda and becomes International Trainer for Kuraray – Noritake company.

In 2018 he became Editor-in-chief for the dental technician magazine “LABORAMA” published by OMNIPRESS co.

On 2019 he studies carving, morphology and all ceramic restorations at the Osaka Ceramic Training Center by Shigeo Kataoka.

On 2019 he establishes the Dental Technicians’ Coaching Services and coaches dental technicians to improve their work.

Andreas has also conducted several lectures and hands on seminars in Greece and abroad and published articles in Greek and international magazines.

His lecture “An exciting journey … to be a dental technician” is about inspiring dental technicians to improve their work by observing and emulate natural teeth using the internal live stain technique.

Article first published in Labline Magazine Issue 45, Spring 2022 edition.