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Case by Dr. Sofien Riahi

Anterior dental trauma often results in aesthetic concerns that require careful and conservative management. Today, minimally invasive adhesive techniques enable clinicians to restore function and appearance with highly predictable and natural-looking results. Direct composite restorations, in particular, offer an effective solution by combining tissue preservation with excellent aesthetic integration.

TREATMENT NEED

A 31-year-old patient attended our practice seeking aesthetic improvement following a previous uncomplicated trauma to her upper and lower incisors. At the initial clinical visit, a consultation was carried out, including photographic documentation and intraoral scans.

Fig. 1. Initial clinical situation revealing fractures in the incisor region.

Fig. 2. Close-up of the upper incisors that need to be restored.

TREATMENT PLAN

The proposed treatment plan involved direct composite restorations as the least invasive and most predictable treatment option. The patient accepted the proposed measures. We proceeded with digital planning of the restorations. Models of the proposed design were printed, and a silicone index was produced. At the subsequent clinical visit, shade selection was performed using the composite button technique. A1 enamel and dentin shades of CLEARFIL MAJESTY™ ES-2 (Kuraray Noritake Dental Inc.) were selected.

Fig. 3. Digital treatment planning (wax-up).

Fig. 4. Shade selection using the composite button technique.

CLINICAL PROCEDURE

Local anaesthesia was administered, and the operative field was isolated with rubber dam. A smooth bevel was created using diamond burs, an Arkansas stone, and 3M™ Sof-Lex™ discs (Solventum). The surfaces of the involved teeth were sandblasted and etched with phosphoric acid etchant, while the adjacent teeth were protected using a metal strip. Then, the two-bottle self-etch adhesive CLEARFIL™ SE Bond 2 (Kuraray Noritake Dental Inc.) was applied.

The silicone index was filled with CLEARFIL MAJESTY ES-2 (A1 enamel shade) and inserted to build up the palatal shell of the restorations. The proximal walls were restored using Garrison matrices and CLEARFIL MAJESTY™ ES Flow (Kuraray Noritake Dental Inc.) in A1 shade. The internal anatomy of the restorations was recreated using A1 dentin shade of CLEARFIL MAJESTY ES-2. A clear effect shade was used to mimic the natural translucency of the incisal edges. The halo effect was reproduced using A1 dentin shade. Layering was completed with A1 enamel shade. The restorations were then finished and polished.

Fig. 5. Operative field after isolation with rubber dam.

Fig. 6. Minimally invasive tooth preparation with a diamond bur.

Fig. 7. Use of an Arkansas stone for tooth preparation.

Fig. 8. Preparation finishing with a Sof-Lex™ disc.

Fig. 9. Silicone index …

Fig. 10. … filled with composite to build up the palatal shell.

Fig. 11. Palatal enamel consisting of CLEARFIL MAJESTY ES-2, A1 enamel shade.

Fig. 12. Proximal walls shaped with the aid of Garrison matrices using flowable composite.

Fig. 13. Recreation of the internal anatomy.

Fig. 14. Internal anatomy completed.

Fig. 15. Application of a clear effect shade in the incisal area.

Fig. 16. Reproduction of the halo effect.

Fig. 17. Completion of the anatomical shape with a final enamel layer.

Fig. 18. Both restorations built up.

Fig. 19. Light-curing through a layer of glycerin gel to block oxygen.

Fig. 20. Finishing procedure carried out with a diamond bur.

Fig. 21. Immediate treatment outcome.

TREATMENT OUTCOME

The patient was satisfied with the achieved result. The restorations were virtually indistinguishable from natural tooth structure – with a smooth transition from teeth to composite and natural incisal effects. The surface structure also contributed to a natural appearance. As the patient was happy with the procedure and the outcome, the lower incisors were restored in the same way.

Fig. 22. Smile of the patient.

Fig. 23. Lateral view of the restorations revealing a natural surface texture.

Fig. 24. Lateral view from the right completing the picture.

Fig. 25. Successfully restored lower incisors.

CONCLUSION

The presented case shows that modern adhesive dentistry enables predictable and minimally invasive procedures that deliver fast and true-to-life results. The CLEARFIL MAJESTY ES-2 system offers a wide range of shades and translucencies, allowing seamless outcomes through a polychromatic layering technique.

Dentist:

SOFIEN RIAHI

Dr. Sofien Riahi is a graduate of the Medical University of Sofia, Faculty of Dentistry, and the founder of a private dental clinic in Sofia, Bulgaria. He specializes in restorative and prosthetic dentistry, with a strong focus on delivering high-quality, patient-centered care. He lectures on topics such as composite restorations of anterior teeth and complex interdisciplinary rehabilitations. Dr. Riahi has received eleven international Smile of the Year awards. Since 2025, he has been a Key Opinion Leader for Kuraray Noritake Dental Inc.

Clinical case by Dr Manuel Tinto

Nowadays, minimally invasive techniques aimed at preserving healthy tooth structure are favoured for the direct restoration of teeth in the posterior region. Universal materials used in this context make it possible to reduce the chair time while supporting high-quality aesthetic and functional results.

The following case example illustrates the combined use of Caries Detector, CLEARFIL™ Universal Bond Quick 2, CLEARFIL MAJESTY™ ES Flow Universal Low and Super Low, and CLEARFIL MAJESTY™ ES-2 Universal (all Kuraray Noritake Dental Inc.) for the treatment of two interproximal lesions on the maxillary right second premolar and first molar (FDI notation: teeth # 15 and 16; Fig. 1).

Fig. 1. Pre-operative photograph.

To guide the selective removal of carious dentin, Caries Detector was used, allowing visual distinction between infected and affected dentin (Figs. 2 and 3). Excavation was performed dry, at low speed, using a Cera-Bur bur until complete removal of the dye. This resulted in clean, non-geometric cavities (Fig. 4).

Fig. 2. Application of Caries Detector.

Fig. 3. The more intense the colour, the more carious the tissue.

Fig. 4. Finished and cleaned cavities.

After matrix placement (Figs. 5 and 6), a universal adhesive (CLEARFIL™ Universal Bond Quick 2) was applied (Fig. 7). This product produces a thin film and offers excellent wettability, making it particularly suitable in the presence of undercuts. We prefer an adhesive approach with selective enamel etching for 15 seconds. CLEARFIL MAJESTY™ ES Flow Universal Low (Fig. 8) was placed on the cavity floor to level out irregularities, followed by reconstruction of the interproximal walls using CLEARFIL MAJESTY™ ES-2 Universal paste. The Quad Matrix system allows both walls to be shaped simultaneously.

Fig. 5. Matrices in place and double-ended wedge (Quad Matrix) to improve the cervical seal on both matrices.

Fig. 6. Quad Matrix ring in position.

Fig. 7. Application of CLEARFIL™ Universal Bond Quick 2 after selective enamel etching (15 s).

Fig. 8. Placement of CLEARFIL MAJESTY™ ES Flow Universal (U) Low as a cavity liner.

The Class I cavity was completed by layering two materials:

• CLEARFIL MAJESTY™ ES Flow Universal (UD) Super Low for deep and difficult-to-reach areas, simulating dentin.
• CLEARFIL MAJESTY™ ES-2 Universal for the final layer, thanks to its handling, strength and aesthetics. The universal shade blends in perfectly with the surrounding structure (Figs. 9 to 11).

Fig. 9. Restorations carried out using a combination of flowable composite and paste composite.

Fig. 10. Finished restorations refined and polished under rubber dam.

Fig. 11. Finished restorations after checking of the occlusal contacts.

FINAL CONSIDERATIONS

Caries Detector allows selective removal of infected dentin while preserving healthy tooth structure. CLEARFIL™ Universal Bond Quick 2 provides for optimal penetration even in complex cavities. The combination of CLEARFIL MAJESTY™ ES-2 and ES Flow materials provides precise filling, natural aesthetics and long-term durability. Finally, the utilization of universal materials simplifies the clinical protocol, resulting in predictable, minimally invasive and long-lasting restorations.

Dentist:

MANUEL TINTO

In 2019, Manuel Tinto obtained his degree in Dentistry and Dental Prosthetics with a thesis on guided implant surgery at the School of Medicine and Surgery of the University of Milano-Bicocca. In 2019, he completed the postgraduate course “Problem solving in periodontology” at the University of Ferrara.

In 2021, he completed the postgraduate programme in “Aesthetic reconstructive periodontal and peri-implant surgery” at Vita-Salute San Raffaele University.

In daily practice, he focuses on restorative dentistry, adhesive prosthodontics, periodontology and the treatment of temporomandibular disorders.

USER FEEDBACK ON PROCEDURES AND OUTCOMES

The use of universal products – whether solitary or combined – offers practical benefits, which are experienced differently depending on the clinical context, techniques selected and each user’s individual preferences. Key advantages include reduced treatment time, lower costs, fewer components and steps, fewer potential errors and ultimately more satisfied patients. The following compilation of statements from experienced dental practitioners on the universal concept and the products offered by Kuraray Noritake Dental Inc. in general will help you assess in what way they might allow you to elevate your workflows.

RATIONALIZING CLINICAL WORKFLOWS

Streamlining or rationalizing clinical workflows in restorative dentistry is always worth striving for. Procedures are often complex and materials demand strict adherence to recommended protocols, so that using universal solutions with standardized protocols for a wide range of indications is a promising approach. Dr José Ignacio Zorzin, Associate Professor at the Department of Operative Dentistry and Periodontology at the Friedrich-Alexander-University of Erlangen-Nürnberg in Erlangen, Germany, stated in an article: “Rationalizing clinical workflows: This is the main reason for the use of universal products in adhesive dentistry. They are suitable for a wide range of indications and different application techniques, fulfil their tasks with fewer components than conventional systems and often involve fewer steps in the clinical procedure.”

INCREASING PREDICTABILITY AND EFFICIENCY

Predictability and efficiency in direct posterior restoration procedures are the main reasons for Dr Koray Kendir, the co-founder of a private dental clinic in İzmir, Turkey to choose universal adhesives and composites. In a case report, he stated that “the combination of CLEARFIL™ Universal Bond Quick 2 and CLEARFIL MAJESTY™ ES Flow Universal allows clinicians to perform predictable, efficient posterior restorations. Their universal applicability and handling properties align with the “Universal Excellence” concept, supporting simplified, yet reliable daily practice.”

Fig. 1. Clinical image from the case report of Dr Koray Kendir: Cavities ready for the restorative procedure.

Fig. 2. Clinical image from the case report of Dr Koray Kendir: Occlusal view of the teeth restored with a universalshade flowable composite with super-low flowability.

GETTING A GRIP ON COSTS

Dr Alessandro Devigus, the owner of a private practice in Bülach, Switzerland, shared in an interview that the cost factor is most important for him: “In the first place, using fewer products and components that are easy and quick in their application allows me to get a grip on costs. With fewer steps and fewer bottles, shortened application times and standardized workflows, the time a patient needs to sit in the chair is reduced, which allows me to save the most valuable factor in the office: my time.” And there is even more to it: “At the same time, material storage and order management are streamlined, so that it is much easier to keep track of dates of expiry, hence saving material costs as well. And the best thing about it is that all these savings are possible without compromising treatment quality,” he continued.

If you would like to benefit from the described workflow enhancements, it is probably worth giving universal excellence products from Kuraray Noritake Dental Inc. a try. For those who prefer to start with a single universal solution instead of transforming whole procedures immediately, the following feedback from clinicians may be enlightening.

UNIVERSAL CLEANER: SUITABLE EVEN FOR USE IN THE PATIENT’S MOUTH

The probably most special feature of KATANA™ Cleaner is its universal applicability. It cleans not only virtually every restorative material very well, but also works intra-orally to clean enamel and dentin after tooth preparation. Dr Richard Young from San Bernadino, CA, USA, uses it intra- and extra-orally, stressing that it “contains MDP based surfactant that breaks down blood and saliva – removing contamination.”

Fig. 3. Extra-oral application of KATANA Cleaner to remove contamination from a lithium disilicate crown by Dr Richard Young.

Fig. 4. Intra-oral application of KATANA Cleaner to remove contamination from the prepared tooth by Dr Richard Young.

UNIVERSAL ADHESIVE: SKIPPING THE WAITING TIME

Zero waiting time is probably the most striking feature of CLEARFIL Universal Bond Quick 2. While other universal adhesives need to be rubbed into any surface extensively, the product is applied within a few seconds. This reduces the risk of contamination and saves time. Based on his clinical experience, Dr Kendir confirmed that it works well: “In this case, CLEARFIL Universal Bond Quick 2 provided strong adhesion with minimal application time.”

Talking about universal adhesives in general, Dr Zorzin stressed that adhering to the protocols described in a material manufacturer’s instructions for use is particularly important: “Universal adhesives contain lots of different technologies in a single bottle. While this fact indeed allows users to rationalize their clinical procedures, it also requires some special attention. As every highly developed material, universal adhesives need to be used according to the protocols recommended by the manufacturer.” For CLEARFIL Universal Bond Quick 2, this protocol is particularly easy.

UNIVERSAL COMPOSITES: GREAT SHADE-MATCHING PROPERTIES

Lately, an experienced user of CLEARFIL MAJESTY™ ES Flow, Dr Michał Jaczewski from Legnica in Poland, tested the universal-shade option CLEARFIL MAJESTY ES Flow Universal – also in the low flowability variant. He confirmed that the reduced number of shades works well: The product “offers properties which are – from a personal perspective – ideal for the flowable injection technique. The shadematching properties are astonishing; the translucency is quite high when placed in thin layers (so that enamel is very well imitated), and the polishability is as good as that of CLEARFIL MAJESTY ES Flow. For virtually effortless, bubble-free injection, the product comes in a nicely designed syringe. And last but not least, the product’s mechanical properties provide peace of mind even in the posterior region.”

Fig. 5. Clinical image from the report of Dr Michał Jaczewski: Flowable composite injected into the transparent index.

Fig. 6. Clinical image from the report of Dr Michał Jaczewski: Central incisors beautifully restored.

According to Dr Jusuf Lukarcanin, MEDICANA International Hospital Izmir, Turkey, the same is true for the universal paste-type composite CLEARFIL MAJESTY™ ES-2 Universal. He states: “My first reaction to this material was: This is a Game-Changer. The results are magical. Smoother and easy handling properties, high-gloss, more natural light distribution and the process is simple. Aside from being able to skip the shade selection step, your workflow remains the same as with traditional composites. At first, I might have been a little sceptical about replacing all the different colours of composites we use in office every day. But after a couple of tries I found out that it indeed works every time, in some cases even without the use of a blocker. Simply ingenious!”

Fig. 7. Clinical image from Dr Jusuf Lukarcanin: Diastema closure in a 28-year-old female patient - initial clinical situation.

Fig. 8. Clinical image from Dr Jusuf Lukarcanin: Diastema closure in a 28-year-old female patient - upper anteriors treated with CLEARFIL MAJESTY ES-2 Universal in the shade UW.

UNIVERSAL RESIN CEMENT: NO PRIMER NEEDED

Primer for tooth structure, cement paste, ceramic primer and silane: PANAVIA™ SA Cement Universal has it all in a single syringe. With no extra bottles needed, it provides for streamlined cementation procedures. That is why Dr Devigus uses it as his standard solution for definitive placement of CEREC overlays and crowns: “It bonds to virtually every surface including lithium disilicate without a separate primer and offers a good flowability that facilitates restoration placement. An additional feature contributing to a quick and stress-free clinical procedure is its easy and gingiva-friendly excess removal after tack curing.”

Watch the video to hear what exactly Dr Alessandro Devigus says about PANAVIA SA Cement Universal:

CONCLUSION

Experience shared by clinicians from different clinical environments demonstrates that universal solutions can make restorative dentistry more efficient, predictable and economical. By reducing the number of materials, steps and technique sensitivities, universal products help streamline workflows while maintaining high clinical performance.

Smooth and efficient procedures, easy shade matching, and great clinical outcomes are key expectations in modern restorative dentistry. Kuraray Noritake Dental Inc. continues to support these needs through ongoing innovation in advanced dental materials. Building on the success of CLEARFIL MAJESTY™ ES Flow, with its multiple flowabilities and extensive shade range, a flowable composite with a simplified universal shade concept was developed.

Launched in Europe in 2025, CLEARFIL MAJESTY™ ES Flow Universal is available in two flowabilities – Super Low and Low. It is a highly filled flowable composite featuring submicron fillers (Super Low: 78% and Low: 75% by weight, respectively) and light diffusion technology.

Its universal shade system allows one shade (U) to cover the VITA classical A1-D4 system shades. For cavities in darker teeth (B3 and darker shades) with limited surrounding tooth structure – such as Class III and IV cavities – a second darker shade (UD) is available.

While the material is available in two flowabilities in Europe, Super Low is the variant offered in the United States and tested by the Dental Advisor.

CLEARFIL MAJESTY ES Flow Universal is gaining increasing clinical acceptance thanks to:

• A simplified two-shade concept
• Excellent handling properties
• High mechanical strength – comparable to paste-type composites
• Easy polishing and long-lasting gloss
• A well-designed syringe and tip system that helps minimise voids and dripping

DENTAL ADVISOR RESEARCH AWARD

Laboratory tests confirm strength, stability, and efficient placement

Independent in-vitro testing conducted at the Dental Advisor Biomaterials Research Center demonstrated that CLEARFIL MAJESTY ES Flow Universal (Super Low) delivers some of the highest physical property values within its class, including flexural strength, fracture toughness, and compressive strength.

The material also showed excellent shade matching across a broad range of tooth shades when compared with other universal-shade composites. Radiographic analyses further confirmed that the syringe and tip design contribute to minimal void formation, supporting reliable and efficient placement. Viscosity testing revealed a low-flow, no-slump consistency, allowing precise anatomical sculpting and controlled cusp build-up.

These results were key factors in earning the Dental Advisor Research Award, which recognizes outstanding physical property testing and a strong commitment to research-driven product development.

Dental Advisor Top Product Award

Clinicians praise handling, translucency, and blend-in ability

Beyond laboratory performance, CLEARFIL MAJESTY ES Flow Universal (Super Low) also excelled in clinical practice, which was a key factor in earning a Dental Advisor Top Product Award. Evaluators highlighted its ideal viscosity and impressive blend-in ability achieved through optimised translucency, light diffusion technology and fine-tuning of the chroma.

The simplified shade system and delivery design translated into confident, predictable results in daily practice, as reflected in evaluator feedback such as: "Excellent shade matching and no air bubbles." These attributes make the material well suited for a wide range of restorative applications in both anterior and posterior regions.

Scientific excellence and clinical practicality smartly combined

By receiving both the Dental Advisor Research Award and the Top Product Award, CLEARFIL MAJESTY ES Flow Universal (Super Low) demonstrates a strong balance of scientific excellence and clinical practicality. Its combination of simplified shade matching, high mechanical performance, and convenient handling makes it a versatile solution for clinicians seeking efficiency without sacrificing aesthetics or strength.

Part of Expanding Universal Excellence Portfolio

At Kuraray Noritake Dental Inc., we understand the demands of modern dental practices. Balancing complex procedures, tight schedules, and patient care is no easy task. That is why we have spent years refining our materials—so you can focus on what matters most: your patients.

Our Universal Excellence portfolio streamlines your workflows, offering you high-quality materials and tools that work seamlessly with your expertise.

CLEARFIL MAJESTY ES Flow Universal is the latest resin-based addition to our universal portfolio. Being suitable for a wide range of applications within direct and indirect restorative workflows, it is a valuable complement to existing universal paste-type composite CLEARFIL MAJESTY™ ES-2 Universal and universal resin cement PANAVIA™ SA Cement Universal.

For more information, visit Dental Advisor and the Kuraray Noritake Dental Europe website.

Today's dental practitioners are expected to deliver highly aesthetic, minimally invasive treatments that last – often within tighter schedules, with fewer assistants and under increasing financial and operational pressure. These factors can lead to elevated stress levels. With high patient expectations and a multitude of treatment options available, clinicians must make numerous decisions while the complexity of clinical procedures continues to increase.

Being aware of these dynamics and the associated challenges, Kuraray Noritake Dental Inc. has developed materials designed to make the clinician's work easier in many respects.

ADHESIVE DENTISTRY: OPPORTUNITIES AND CHALLENGES

To better understand this approach, let us take adhesive dentistry as an example. Being the driving force behind less invasive tooth preparations and the use of highly aesthetic tooth-coloured materials such as composites and ceramics, adhesive dentistry has significantly improved restorative dental care.

At the same time, the need to establish a strong and durable chemical bond between tooth structure and restorative material has made clinical procedures more complex than ever. Daily challenges include selecting the appropriate material and technique, preparing tooth structure correctly, controlling moisture and contamination, managing etching and pre-treatment protocols for each restorative material, and layering restorations predictably.

Intelligent simplification: Reducing complexity without compromising quality

The solutions Kuraray Noritake Dental Inc. has developed in recent years are materials that adapt to multiple indications, techniques and substrates – without adding procedural burden. The focus is not simply on innovation, but on meaningful innovation, leading to materials that genuinely streamline and simplify workflows.

While individual universal materials already offer flexibility, the thoughtful combination of compatible products can truly transform clinical procedures. When materials are designed to work together seamlessly, efficiency increases and variability decreases.

Universal product combinations from Kuraray Noritake Dental Inc. are designed to:

• Reduce the number of clinical steps
• Decrease technique sensitivity
• Improve workflow efficiency
• Simplify inventory management
• Reduce overall costs
• Support consistently high-quality treatment outcomes

The goal is not simplification for its own sake. Instead, the aim is to reduce complexity while maintaining the high performance required for predictable and durable clinical outcomes.

By aligning product features with proven clinical protocols, Kuraray Noritake Dental Inc. enables practices to work smarter, not harder.

Universal Excellence: product portfolio for simplified restorative procedures

The universal product portfolio of Kuraray Noritake Dental Inc. consists of five core products: The universal bond CLEARFIL™ Universal Bond Quick 2, the paste type composite CLEARFIL MAJESTY™ ES-2 Universal, the flowable alternative CLEARFIL MAJESTY™ ES Flow Universal, the universal resin cement PANAVIA™ SA Cement Universal and KATANA™ Cleaner as a universal cleaning solution designed for intra- and extra-oral use.

DENTAL ADVISOR HIGHLIGHTS THE SUITABILITY OF KATANA Cleaner FOR INTRA-ORAL USE

Clean surfaces – whether tooth structure or restorative materials – are essential for reliable and long-lasting adhesion in restorative dentistry. To achieve this, clinicians require a cleaning agent that removes contaminants such as blood or saliva efficiently and thoroughly, without adding complexity to the workflow. KATANA™ Cleaner was developed by Kuraray Noritake Dental Inc. to meet these clinical demands.

 
Recognized with a 2026 Research Award in the category Research – Restoration Cleaner, KATANA Cleaner is a truly universal cleaning solution for both restorations and tooth structure. Designed for intra-oral and extra-oral use, it contains MDP salt, which effectively removes contamination from a wide range of surfaces, supporting bond integrity during adhesive procedures.

 
Key benefits of KATANA Cleaner include:

• High cleaning efficacy based on the surface-active characteristics of MDP salt
• Mild pH value (4.5), allowing effective intra-oral application
• Simple, time-efficient application requiring just ten seconds of surface rubbing 

DENTAL ADVISOR RESEARCH AWARD: RECOGNITION FOR CLEAN SURFACES THAT SUPPORT OPTIMAL BOND STRENGTH

The Dental Advisor Research Team conducted in-vitro testing to evaluate the cleaning performance of KATANA Cleaner and its impact on bond strength with indirect restorative substrates. In these studies, zirconia and lithium disilicate surfaces were contaminated with saliva and subsequently treated with KATANA Cleaner. SEM analysis revealed virtually perfect surface cleanliness, which contributed to optimal bond strength levels. The Research Team also noted that KATANA Cleaner is “one of the few products commercially available that can be used intra-orally...”

SUITABLE SOLUTION FOR MANAGING CONTAMINATION

With its universal applicability, gentle yet highly effective cleaning effect and proven ability to restore optimal bond strength, KATANA Cleaner offers clinicians an excellent solution for managing contamination in adhesive dentistry. Its recognition with a 2026 Dental Advisor Research Award underscores its relevance and highlights its suitability for a wide range of indications.

PART OF EXPANDING UNIVERSAL EXCELLENCE PORTFOLIO

At Kuraray Noritake Dental Inc., we understand the demands of modern adhesive dentistry. Reliable adhesion depends not only on high-performing bonding materials, but also on proper surface preparation and contamination management throughout the workflow.

That is why KATANA Cleaner is part of our expanding Universal Excellence portfolio. Designed for both intra-oral and extra-oral use, it helps clinicians optimize adhesive procedures by efficiently removing contamination from tooth structure and restorative materials.

Supporting clean bonding surfaces in a simple and time-efficient manner, KATANA Cleaner complements restorative workflows involving products such as CLEARFIL™ Universal Bond Quick 2 and PANAVIA™ SA Cement Universal — contributing to predictable and durable adhesion across a wide range of clinical indications.

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

I moderne tannlegepraksis er det et sterkt behov for materialer som kombinerer enkel håndtering og effektivitet i prosedyrene med estetiske og holdbare resultater. Slike materialer gjør det mulig for tannleger å oppnå ønskede resultater mer effektivt, slik at de kan bruke mer tid på personlig kontakt med pasientene sine.

I forbindelse med direkte restaurerende behandlinger, har valget av kompositt en stor innvirkning på både prosedyrenes enkelhet og kvaliteten på resultatene. Dette er grunnen til at universelle kompositter i pastakonsistens, som CLEARFIL™ MAJESTY ES-2 Universal (Kuraray Noritake Dental Inc.), blir stadig mer populære. Med CLEARFIL™ MAJESTY ES Flow Universal, har det samme selskapet nå introdusert en flytende kompositt som gir tilsvarende fordeler, oppsummert nedenfor ved å svare på dine viktigste spørsmål.

Hvordan kan du oppnå estetiske og holdbare restaureringer med flytende kompositt?

CLEARFIL MAJESTY™ ES Flow Universal er en flytende løsning med to komplementære nyanser, utviklet for intuitiv fargetilpasning og som støtter et bredt spekter av restaurerende prosedyrer. Materialet kombinerer praktiske flyteegenskaper med avansert fargeblandingsevne og fremragende mekaniske egenskaper.

Low

• Bøyestyrke: 151 MPa
• Trykkfasthet: 373 MPa
• Fyllstoffinnhold: 75 vekt% / 59 vol%
• Røntgentetthet: 140 % Al

Super Low

• Bøyestyrke: 152 MPa
• Trykkfasthet: 374 MPa
• Fyllstoffinnhold: 78 vekt% / 60 vol%
• Røntgentetthet: 150 % Al

Hva er CLEARFIL MAJESTY™ ES Flow Universal?

CLEARFIL™ MAJESTY ES Flow Universal er et lysherdende, røntgentett komposittresin utviklet for en rekke kliniske situasjoner, tilgjengelig i to viskositeter og to nyanser. Produktet benytter nanofiller-teknologi som gir kontrollert flyt, god poleringsbestandighet og naturlig restaurerende utseende. Den sømløse integreringen av kompositten oppnås gjennom en smart kombinasjon av emaljelignende translucens, dentinlignende fargetone og Light-Diffusion Technology (LDT). Den emaljelignende translucensen gjør at lys kan passere gjennom materialet, noe som forbedrer fargeintegrasjonen med den omkringliggende tannstrukturen. LDT gjør at restaureringene sprer lys på en lignende måte som emalje og dentin. Sammen med den finjusterte fargetonen bidrar disse egenskapene til en jevn optisk integrasjon av materialet i tannens naturlige struktur.

Hvor kan du bruke 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 f issure sealing and repairs, it is formulated for use in both conservative and comprehensive treatment plans.

CLEARFIL MAJESTY™ ES Flow Universal  kan brukes til:

• Direkte restaureringer i alle kavitetklasser, cervikale lesjoner (f.eks. rotsurfacekaries, V-formede defekter), tannslitasje og tannerosjon
• Kavitetbunn / liner
• Korreksjon av tannstilling og tannform (f.eks. lukking av diastema, tannmisdannelser)
• Intraoral reparasjon av frakturerte restaureringer

Hvordan gjøres fargevalg?

Med CLEARFIL MAJESTY™ ES Flow Universal er fargevalget helt enkelt. De to komplementære nyansene, Universal (U) og Universal Dark (UD), velges intuitivt – ingen fargeguide er nødvendig. Shade U passer for de f leste posteriore og anteriore restaureringer. Shade UD egner seg best for mørkere tenner (B3 og mørkere) med lite omkringliggende tannsubstans, inkludert klasse III- og IV-kaviteter. Avhengig av kavitetklasse og pasientens alder velger du den nyansen som passer best.

Fargeintegrasjon for anteriore og posteriore restaureringer

Hva bidrar til ytelsen til CLEARFIL MAJESTY™ ES Flow Universal?

Formuleringen inneholder flere egenskaper som sikrer høy klinisk effektivitet:

• Nanofiller-teknologi: Opprettholder et optimalt fyllstoffinnhold for redusert krymping, forbedret slitestyrke og langvarig poleringsbestandighet.
• Universell fargetilpasning: Gir god visuell integrasjon med omkringliggende tannsubstans og forenkler fargevalget.
• Tiksotrop håndtering: Flyter under trykk ved applisering, men forblir stabil når den er på plass, noe som gir presis applisering.

Hvorfor velge CLEARFIL MAJESTY™ ES Flow Universal?

Tannleger kan ha nytte av CLEARFIL™ MAJESTY ES Flow Universal på grunn av:

• Forutsigbar håndtering og applisering
• Estetiske resultater for både anteriore og posteriore restaureringer
• Motstand mot slitasje og overflatedegradering
• Røntgentetthet som støtter radiografisk evaluering
• Allsidighet på tvers av ulike restaurerende behov

Hvordan appliseres CLEARFIL MAJESTY™ ES Flow Universal?

Bruken er enkel og passer inn i standard kliniske arbeidsrutiner:

1. Forbered og isoler området etter behov.
2. Påfør et kompatibelt adhesiv (f.eks. CLEARFIL™ Universal Bond Quick 2).
3. Appliser materialet med sprøyte og finspiss-applikator.
4. Lysherd i henhold til produsentens retningslinjer (typisk 20 sekunder, avhengig av nyanse og lyslampe).
5. Fullfør med finishing og polering for å ferdigstille restaureringen.

Sprøytebasert applisering gir kontrollert påføring og høy brukervennlighet.

Direkte restaurering med CLEARFIL MAJESTY™ ES Flow Universal:

Er CLEARFIL MAJESTY™ ES Flow Universal  evaluert av uavhengige kilder?

Ja. CLEARFIL™ MAJESTY ES Flow Universal (Super Low) er evaluert av tannhelsepersonell gjennom tredjeparts testing og fagfellevurderte tilbakemeldinger. Nylig mottok produktet Research Award 2025 fra The Dental Advisor. I sin konklusjon uttalte evaluatorene fra den amerikanske publikasjonen:

«Testing viser at denne kompositten har blant de høyeste fysiske egenskapene for flytende kompositter, og at den kan måle seg med de sterkeste pakkbare komposittene når det gjelder bøyestyrke og trykkfasthet – med en ideell røntgentetthet.»

En allsidig flytende løsning:  CLEARFIL MAJESTY™ ES Flow Universal

CLEARFIL MAJESTY™ ES Flow Universal er utviklet for å støtte restaurerende prosedyrer ved å kombinere kontrollert håndtering, estetisk integrasjon og mekanisk holdbarhet. Det kan være et praktisk valg for klinikere som ønsker en pålitelig flytende kompositt til et bredt spekter av kliniske situasjoner.

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Universal Excellence – Smarte og strømlinjeformede løsninger

Hos Kuraray Noritake Dental Inc. forstår vi kravene i moderne tannlegepraksis.  Å balansere komplekse prosedyrer, stramme tidsplaner og pasientenes behov er ingen enkel oppgave. Derfor har vi over lang tid jobbet målrettet med å forenkle, forbedre og raffinere hvert eneste trinn i ditt arbeid. Vår visjon er tydelig: en verden der materialene og verktøyene dine fungerer sømløst i dine hender, der kompleksitet reduseres til et minimum, og der du får tid til å fokusere på det som virkelig betyr noe – de individuelle behovene og ønskene til hver eneste pasient. Dette er fremtidens odontologi, og sammen gjør vi den mulig.

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Clinical case by Dr Luca Alibrandi

In the field of aesthetic dentistry, achieving natural, durable and predictable results requires the use of advanced materials, precise instruments and clinical expertise. Thanks to its versatility and the included innovative technology, CLEARFIL MAJESTY™ ES Flow Universal (Kuraray Noritake Dental Inc.) supports clinicians in standardising aesthetic rehabilitation even in complex cases (Figs 1–3).

Fig. 1. Initial situation with multiple diastemas in the maxillary anterior region. The patient does not wish to undergo indirect veneer therapy.

Fig. 2. Patient with a deep bite and atypical swallowing, which has caused flaring, particularly in the maxillary left anterior region. The patient refuses orthodontic treatment.

Fig. 3. Detail of the maxillary anterior region.

CLEARFIL MAJESTY™ ES Flow Universal is a monochromatic flowable composite that simplifies colour management thanks to its guided shade system, supporting aesthetic harmony without the complexity of multiple shades. Available in two levels of viscosity (Low and Super Low), it offers excellent handling for different restorative areas.

The Low version (75 wt%, 59 vol%) has a flexural strength of 151 MPa and a compressive strength of 373 MPa. It is ideally suited for anterior areas and for injection into IVENEER matrices, thanks to its easy handling and long-lasting gloss. Radiopacity (140% Al) provides for visibility on follow-up radiographs.

The Super Low version, with a filler content of 78 wt% (60 vol%) and radiopacity of 150% Al, has a flexural strength of 152 MPa and compressive strength of 374 MPa. Ideal for posterior sectors, it offers durability and resistance even under high functional loads.

The optimised syringe design supports precise dispensing, reducing waste and facilitating application. Both formulations allow easy polishing and long-lasting shine.

Combined use with IVENEER matrices (Fig. 4) makes it possible to precisely shape incisal morphology, creating an ideal contour and a protected environment that improves surface polymerisation (Fig. 5). The result is a stronger, glossier and more durable restoration. Flowable composites facilitate adaptation of shape and correction of natural proportions, contributing to a harmonious outcome.

The composite veneers can subsequently be refined using subtractive or additive techniques (Figs. 6 to 8), adapting to situations such as wide and irregular diastemata, simplifying the workflow and improving the final result.

Fig. 4. IVENEER in position under rubber dam: these innovative matrices, used with conventional isolation, provide a highly effective seal to prevent contamination during the injection phase.

Fig. 5. Polymerisation is always started on the palatal side to allow resin contraction towards the enamel and to increase adhesion of direct restorations.

Fig. 6. The polishing phase is facilitated by the creation of an environment that helps limit the oxygen-inhibited layer via the matrices. In this case, however, subtractive modelling of the elements is required to recreate overall harmony.

Fig. 7. Post-injection situation.

Fig. 8. Surface texturing with longitudinal morphological characterisations to improve coronal proportions.

Fig. 9. Detailed view of the central incisors after polishing.

FINAL CONSIDERATIONS

The combined use of CLEARFIL MAJESTY™ ES Flow Universal and IVENEER matrices represents a significant advancement in aesthetic incisor restoration. The composite’s properties (strength, handling and gloss), together with the preformed matrices, allow natural, high-quality results to be achieved in reduced treatment times. Thanks to the new technique, even patients with financial limitations can access effective treatments and regain their smile (Fig. 9).

Dentist:

LUCA ALIBRANDI

Luca Alibrandi graduated in Dentistry and Dental Prosthetics from Universidad Europea de Madrid in 2014. From 2015 to 2017, he specialised in Periodontology and Implantology with a full-time, two-year Master’s degree at the same university, completing a thesis entitled “Evaluation of Different Peri-Implant Treatments”, while actively attending the practice of Professor Ricardo Fernandez.

A member of SIPRO, AIOP, SIDP, SEPA, SEPES and ITI, since 2014 he has further developed his professional training by attending the practice of Dr Agostino Scipioni and collaborating at the private practice of Professor Dario De Leonardis.

He attended the annual AIOP Advanced Training Course in Analogue and Digital Prosthetics in 2018/19.

He currently works at the Alibrandi Dental Practice as a specialist in periodontology, implantology and prosthodontics.

Since 2023, he has collaborated as a lecturer for the intraoral scanner company 3Shape, producing educational materials and delivering training events in the field of prosthodontics.

“Adding new value to dental care”

Few manufacturers can claim one century of innovation. However, as Kuraray celebrates its 100^th anniversary, its subsidiary, Kuraray Noritake Dental—shaped by this legacy—remains humble and focused on its holistic vision for improving the delivery of oral care.

Reflecting on this centenary, Satoshi Yamaguchi, president of Kuraray Noritake Dental, shares his perspective on how the company’s long-standing ethos continues to shape its direction. In this exclusive interview, he discusses Kuraray Noritake Dental’s latest solutions and the way the company combines scientific expertise with consistent quality, clear and evidence-based information, support grounded in everyday clinical needs, and a stable supply chain. The ultimate aim, Yamaguchi says, is to bring new value to dental care and contribute to more reliable and efficient clinical practice.

Mr Yamaguchi, could you tell us about your professional background and how you first joined Kuraray?

My Kuraray journey began with a strong aspiration to contribute to public health. I was drawn to the company’s extensive expertise in chemical manufacturing and the potential to apply its technologies in the medical field. I started in the medical development division, where I was involved in research and development activities. Later, I transitioned to a marketing role at Kuraray America and, upon returning to Japan, resumed my position in development. This allowed me to engage with the dental healthcare business from both a technical and a commercial perspective. Subsequently, I served as head of the dental business at Kuraray Europe in Germany, where I oversaw sales operations across the European region. These international experiences have profoundly shaped my professional approach, enabling me to lead with a global mindset and remain attuned to the specific needs of local markets.

How has this international experience shaped your approach as president of Kuraray Noritake Dental?

Through my international assignments, I came to recognise the importance of addressing the diverse values held across different countries and regions. In the field of dental materials, preferences often differ. In many parts of Europe and Asia, natural aesthetics are widely valued; in the US, treatment efficiency is often prioritised; and in South America, there is often an emphasis on balancing aesthetics with cost-effectiveness. Although these are general tendencies and can vary, they provide a useful guide in meeting the specific needs of each market.

Satoshi Yamaguchi, president of Kuraray Noritake Dental, previously served as head of Kuraray Europe’s dental business, based in Germany.

My goal is to establish a robust framework for delivering reliable, evidence-based information to dental professionals. We are striving to strengthen the foundation of trust by facilitating the collection of credible data and case studies from both internal and external sources, ensuring that the information we provide contributes to greater confidence in clinical practice. In addition, we place strong emphasis on how this information is communicated. By leveraging multiple channels—presentations at academic conferences and seminars, contributions to journals and communication through digital platforms, for example—we are creating an integrated system that ensures our messages reach dental professionals effectively.

How does Japan’s role as a dental innovation hub influence the company’s global operations?

In Japan, there is a focus on creating scientifically proven technologies and transforming them into trusted dental solutions. At Kuraray, a prime example is our original adhesive monomer, MDP. This solution exhibits exceptional bond strength, even when using traditionally difficult substrates such as metals and zirconia. Today, MDP is recognised as a proven global standard in adhesive monomers and is widely used by dental material manufacturers around the world.

Scientifically valid technologies developed in Japan are being utilised in clinical settings worldwide, supported by reliable, evidence-based information. This tradition is a driving force behind Kuraray Noritake Dental. We honour it by prioritising materials that can function like natural tooth substances over the long term in the oral environment—ensuring clinical reliability through durability, defined as the preservation of strength and aesthetics. Building on this foundation, we continuously enhance the value of our products by expanding indications and improving usability.

How important is the European market in your overall strategy?

The European market plays a vital role in advancing our efforts in quality assurance and information dissemination. Given the strictly enforced medical device regulations and environmental laws, we proactively work to enhance quality and reliability in our operations in the region, including in the areas of product design, packaging and product information. In turn, these initiatives help to improve the accuracy of product development and information dissemination for all markets.

At the same time, we are strategically expanding our global business operations, focusing on the US, Asia and South America. To ensure the consistent delivery of high-quality products and services, we are working in close collaboration with local dental professionals, educational institutions and partner companies. By leveraging the expertise gained through our operations in Europe and adapting this to the unique needs and cultures of other regions, we continue to provide reliable solutions for dental professionals worldwide.

Kuraray Noritake Dental introduced several new materials last year. What can you tell us about these materials and the clinical needs they were designed to meet?

At the 2025 International Dental Show, we introduced CLEARFIL MAJESTY ES Flow Universal, CLEARFIL Universal Bond Quick 2 and CERABIEN MiLai. These products are based on our concept of Universal Excellence, a philosophy that emphasises scientifically grounded performance and outcomes.

Dental practitioners in clinical settings seek materials that they can use with confidence. To meet these needs, we ensured that these materials embody the principles of Universal Excellence. This means versatile, high-performance solutions that streamline clinical workflows by minimising the number of required components and procedural steps. In this way, the products support decision-making in daily dental practice and laboratory work.

KATANA Zirconia is recognised for aesthetics and strength. What sets your proprietary zirconia powder and multilayer technology apart in today’s competitive CAD/CAM market?

We consistently develop and manage raw material powders in-house. By focusing on proprietary material development, we have created high-quality dental zirconia that combines aesthetics and mechanical strength. In addition, our advanced manufacturing technologies and strict quality control standards ensure stable and reliable product quality. Furthermore, by utilising our proprietary zirconia powder and working closely with manufacturers of milling machines and sintering furnaces, we have significantly reduced both processing and sintering times in the fabrication of zirconia restorations.

One notable example is KATANA Zirconia ONE SPEED CROWN, which supports a streamlined chairside workflow. We have developed a new zirconia powder that can reach a highly activated state with little energy. This accelerates the sintering process, thereby achieving an ultra-short sintering time of just 9 minutes. Furthermore, our zirconia and multilayer technology enable natural gradation by varying both shade and translucency across the layers of the zirconia disc—closely replicating the appearance of natural teeth. In KATANA Zirconia YML, each layer contains a different concentration of yttria: the upper layers offer natural colouration and high translucency, and the lower layers deliver superior strength. Owing to this advanced material design and multilayer technology, the KATANA Zirconia series combines outstanding aesthetics and mechanical performance and contributes to greater efficiency in clinical workflows.

Kuraray has regional offices in China and Brazil. How do you adapt product development and clinical education to the diverse needs of these fast-growing markets?

China and Brazil are two of the world’s fastest-growing dental care markets, characterised not only by their large populations but also by a growing interest in quality dental care, rapidly advancing adoption of CAD/CAM technologies and ongoing development of clinical dental education. We address these evolving needs by delivering products and clinical support tailored to the specific dental requirements and educational styles of each country.

For example, we continue to meet the demand for our adhesive dental materials—such as the CLEARFIL and PANAVIA series—by offering hands-on seminars and webinars in local languages. By sharing clinically relevant information backed by scientific evidence, we contribute to improving the quality of local dental care.

In addition, user feedback gathered through our local offices serves as a valuable source of insight for product development. By incorporating market-specific trends, preferences in product handling and differences in clinical education styles into the development of new products, we can deliver locally optimised quality solutions.

Kuraray Noritake Dental is expanding production at its new plant in Miyoshi in Japan. How will this affect supply chain resilience and product innovation?

Leading up to this year, we significantly strengthened our global supply system for dental materials. At the heart of this initiative was the strategic expansion of production capacity at our Miyoshi plant, where we ultimately aim to roughly double production capacity. This facility specialises in the manufacturing of inorganic dental materials such as zirconia and porcelain and plays a critical role in our business strategy through technological expertise, rigorous quality control and product development capabilities.

Additionally, by strengthening collaboration between our manufacturing site and our research and development, we are working to establish a system that enables rapid incorporation of feedback from clinical settings into product improvements. These efforts also contribute to enhancing our product development capabilities, allowing us to deliver dental material products that meet market needs in a timely manner. We view this as a vital step towards better meeting the expectations of dental professionals worldwide and elevating our market presence.

As the Kuraray Group marks its 100^th anniversary, what vision is Kuraray Noritake Dental pursuing for the future of dental care?

Our anniversary presents an opportunity to reflect on the spirit that has shaped the company over the last 100 years. At the heart of our company lies a philosophy of embracing challenges: “For people and the planet—to achieve what no one else can”. Long before the term “corporate social responsibility” became widespread, we were addressing social issues through the power of technology and developing materials that improve lives. That ethos continues to underpin our business today.

Since entering the dental industry as a chemical products manufacturer, we have remained committed to craftsmanship and quality. As noted earlier, because dental materials are used inside patients’ mouths over extended periods, we consider durability to be a particularly critical factor. This durability encompasses strength and aesthetics, which together form the foundation of reliable clinical performance.

However, even products backed by advanced technology may not fully convey their intrinsic value to users. That is why we strive to provide reliable, evidence-based information and deliver trusted products to clinical settings.

What can you tell us about future initiatives at the company?

Through collaborative product development with dental clinicians, we aim to incorporate more insights from the front lines of dental care. By actively listening to dental professionals and technicians, we aim to further address the real-world challenges that they face and deliver products that more effectively meet daily clinical demands. We also aim to build greater trust with dental clinicians by sharing reliable, evidence-based information and clearly communicating the scientific evidence and development background behind our products. Additionally, in support of our commitment to sustainability, we aim to offer responsible choices to users through designing products with environmental considerations in mind and reducing our overall environmental impact.

Through these initiatives, we will continue adding new value to dental care by leveraging our material design expertise, which is rooted in the founding spirit of our company. We aspire to remain a trusted partner for dental professionals around the world—one that they can rely on with confidence.

Originally published on Dental Tribune website on March 4^th, 2026.

Case by Dr. Onur Alp Yünük

Beautiful teeth, a bright, flawless smile: Meeting the aesthetic demands of patients asking for veneer treatment can be challenging. While some patients share concrete ideas on how their new teeth should look, it is more difficult for others to express their expectations. In this case, it is important to select a treatment approach that allows for modifications – be it in the form of an extended planning phase including digital smile design or by placing composite restorations that can be easily modified intraorally.

The latter approach was selected for a young female patient who presented to our clinic as she was dissatisfied with her composite veneers that had been placed on the upper incisors (Figs. 1 to 4). During intraoral examination, it became evident that the existing restorations on her maxillary incisors and canines had irregular, rough surfaces, discoloured margins and compromised structural integrity of the composite material. In accordance with these findings, removing the existing restorations at the maxillary anterior teeth and re-establishing optimal aesthetic and functional integrity with new direct composite restorations were planned (teeth between #13 - #23 according to the FDI notation). The patient stated that she would like us to add more individuality and character to her teeth and have a brighter smile than with her existing restorations.

Fig. 1. Composite veneers on the maxillary incisors showing aesthetic and functional integrity issues.

Fig. 2. Occlusal view of the maxillary anterior teeth with visible defects in the composite veneers.

Fig. 3. Lateral view from the right revealing surface irregularities.

Fig. 4. Lateral view from the left revealing a large debonded and chipped area.

REPLACEMENT OF THE COMPOSITE VENEERS

To reproduce the translucency characteristics of the patient’s natural teeth and fulfil her aesthetic demands, the use of a polychromatic layering system and a dual-layer technique was planned. This would allow for a nice play of translucencies in the anterior area.

During the shade selection phase, the Bilaminar Shade Assessment Technique (BSAT) was employed, which is based on the color combination of dentin and enamel composites. In this technique, the intended enamel shade was stratified over the target dentin chroma to evaluate the resultant shade created by the two composite color layers. The materials were polymerized on the tooth surface without bonding agents; thus, the cumulative color perception resulting from stratification, rather than the individual shades of the materials, was verified for harmony with the natural tooth structure at the onset of treatment. Photos were taken with a camera equipped with a cross-polarized filter (Fig. 5). Subsequently, the fixed retainer was removed, as were the existing composite veneers. To save as much of the underlying healthy tooth structure as possible, the procedure was performed under magnification and blue-light illumination. The selected instruments were red- and yellow-band diamond burs as well as tungsten carbide burs. Figure 6 shows the result of the procedure.

Fig. 5. Shade determination – image taken with the aid of a cross-polarizing filter that eliminates reflections.

Fig. 6. Teeth after the removal of the deficient composite veneers.

The teeth were isolated using rubber dam, which was secured with floss in the cervical area. Then, restoration procedures were initiated on the teeth. After etching of the enamel and application of a self-etching bonding agent (CLEARFIL™ SE Bond 2, Kuraray Noritake Dental Inc.), CLEARFIL MAJESTY™ ES-2 Premium (Kuraray Noritake Dental Inc.) was applied: The dentin core with its pronounced mamelons was modelled using the shade A1D. The incisal edges and mamelons were highlighted with spots of white tint. To create an opalescent effect, a thin layer of the translucent shade Blue was placed on top, while the enamel parts were built up with the enamel shade WE. Since the retainer had been removed, a clear aligner was fabricated and delivered to the patient at the end of the session for use until the subsequent appointment.

Fig. 7. Isolation with rubber dam for restoration of the lateral incisors and canines.

Fig. 8. Vestibular enamel layer applied to the teeth.

Fig. 9. Shape and shade of the restorations created according to the patient’s expectations.

After finishing and polishing with Twist DIA for composite, the patient was sent home and a new appointment was made for re-evaluation and final adjustments.

In the control appointment, the patient asked us to slightly reduce the incisal translucencies and brightness in her maxillary incisors and alter the shape of all restored teeth: She requested longer maxillary central incisors with softer, more rounded line angles and a smoother incisal contour. Rubber dam was placed again. Then, the vestibular surfaces of the composite restorations on the maxillary incisors were reduced slightly using red- and yellow-band diamond burs. To roughen the surface and enhance the topography for optimal micromechanical interlocking, the composite surface was sandblasted with 50-μm aluminium oxide particles. Phosphoric acid etchant, silane and CLEARFIL™ SE Bond 2 were applied sequentially as part of the adhesive protocol. The restorations were then modified by lengthening, shade correction using CLEARFIL MAJESTY™ ES-2 Premium in the shades A1D and A1E and refining of the anatomical contours (Figs. 10 and 11).

Fig. 10. Modification of the central incisor restorations.

Fig. 11. Modified smile with more regular tooth forms and contours as well as a more natural tooth shade.

During this final appointment, the patient expressed that she was very happy with her new smile. The restoration surfaces were re-polished, a new retainer was bonded and final photographs were taken (Figs. 12 to 16).

Fig. 12. Final treatment outcome – frontal view.

Fig. 13. Final treatment outcome – occlusal view.

Fig. 14. Final treatment outcome – lateral view.

Fig. 15. Final treatment outcome – the patient’s smile.

Fig. 16. Detailed view of the inner colour structure – made visible with the aid of a polarized filter.

CONCLUSION

Talking to patients about every detail of the treatment and listening attentively to their ideas, expectations and demands does not always protect us from adjustments – simply because they need to see what they get to be able to judge if they like it. Luckily, selecting appropriate materials and techniques enables dental practitioners to create new smiles that can be modified without harming healthy tooth structure, so that making even the most demanding patients happy is no longer a challenge.

Dentist:

ONUR ALP YÜNÜK

Dr. Onur Alp Yünük completed both his undergraduate and doctoral education at Istanbul University. He currently serves as an Assistant Professor in the Department of Restorative Dentistry at the Istinye University Faculty of Dentistry. His work primarily focuses on direct composite restorations of anterior teeth and on polychromatic layering systems.