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Interview with Ghaith Alousi, DT

He inspires dental technicians with his passion and creativity as a course instructor, and with Nature Style, he has developed a well-conceived concept for the creation of lifelike anterior restorations. We are talking about Ghaith Alousi, a dental technician based in Wiesbaden, Germany. While course participants usually attend his training courses eager to learn from his experience and technical knowledge, they often return to their laboratories bursting with positive energy, truly inspired and deeply motivated to break new ground.

Ghaith Alousi, what is the dental technician’s primary mission?

In my eyes, dental technicians are not artists; rather, their primary mission is to replicate nature – both functionally and aesthetically. Every tooth, like every patient, is as unique as a fingerprint. To recreate a natural tooth as accurately as possible, we must listen, observe, and understand. To truly perceive the details that matter, however, we need to know where to focus our attention. In my opinion, the three golden keys to anterior aesthetics are paramount: balanced translucency and opacity, morphology, and surface texture.

What about colour?

While colour is undoubtedly a crucial aspect, I believe it is often overemphasized. Many dental technicians focused on aesthetic anterior restorations find themselves preoccupied solely with colour. However, natural teeth – the model we aim to replicate – embody far more than just a blend of hues.

First and foremost, we must understand how light interacts with teeth. They diffuse light in a unique manner, with different layers of enamel and dentin each possessing distinct optical properties. Additionally, the individual shape and surface texture of a tooth significantly affect the perceived attractiveness of a patient’s smile and overall facial appearance. Therefore, I have learned to prioritize these elements, observing nature closely and striving to comprehend what I see before embarking on the replication process.

Fig. 1. Light-optical properties of natural teeth imitated with KATANA™ Zirconia YML, Esthetic Colorant and CERABIEN™ ZR porcelain (Kuraray Noritake Dental Inc.).

Let’s take a brief look at each of the three golden keys, starting with the light-optical properties.

To truly grasp how light interacts with natural teeth, we must first examine their structure. Natural teeth consist of various layers, each displaying unique light-optical behaviours, with enamel and dentin being the most significant. Upon closely observing the dentin core of a tooth, we realize it is not only responsible for the tooth’s fundamental colour but also exhibits distinct opacity – it does not transmit light; instead, it reflects and absorbs it. In contrast, enamel presents a different scenario: its thickness varies with factors such as the patient’s age, but it is consistently highly translucent. This translucency allows a portion of light to pass through, with only a minimal amount reflected or absorbed.

Once we have a solid understanding of the natural light dynamics inherent in a patient’s teeth, the next step is to replicate these characteristics using selected materials. Thus, comprehending the light-optical properties of available materials, choosing them wisely, and applying them effectively are crucial milestones on the path to success.

What about morphology?

I firmly believe that mastering morphology – the replication of natural tooth shapes – can significantly impact a dental technician’s work. The growing popularity of carving workshops in Japan and other parts of the world reinforces this idea. Aspiring technicians avoid using standard dental libraries that produce generic smiles for their patients. Rather than traveling long distances to attend workshops and build our own mental library of tooth shapes, we can explore the intricacies of form and shape right in our dental laboratories through careful observation and consistent practice. Some technicians capture images of the teeth they encounter, while others concentrate on their own teeth or those of colleagues and patients. This approach allows for the replication of shapes using materials like wax or ceramics. By honing our observation and replication skills, we expand our personal knowledge base. This commitment to detail fosters true mastery – a continuous journey toward perfection.

Fig. 2. Example of a natural surface texture reproduced with CERABIEN™ MiLai and different diamond burs, stones and rubber polishers.

Is surface texture similarly important?

Absolutely. The surface texture of a restoration, even more than its hue, must precisely match that of surrounding or opposing teeth to achieve a natural appearance. To accomplish this, we must understand and replicate the intricate interplay of micro- and macrotextures that create a tooth’s natural look. Macrotexture encompasses the tooth’s overall surface characteristics, including varying concavities, convexities, line angles, and vertical V-shaped grooves. In contrast, microtexture focuses on finer details, such as growth lines (striae of Retzius), perikymata, small grooves, and the degree of surface gloss. A keen eye is essential to replicate every surface detail harmoniously so that light interacts optimally, creating reflections, shadows, and highlights exactly where they are needed.

Fig. 3. Large tooth created with CERABIEN™ ZR.

How do you practice?

To practice replicating surface texture and morphology, I typically start with enlarged model teeth, first using wax and later transitioning to my preferred dental materials and instruments. The increased size of the working base allows for easier detection, reproduction, and assessment of relevant morphology and surface details compared to original-sized tooth forms. This enlargement also facilitates the evaluation of light-optical properties. For the final assessment, I often apply silver or gold powder to the surface of the model tooth, which highlights even the finest surface nuances. This method makes it easy to identify areas that are well-executed and those that may need improvement.

Fig. 4. Gold powder applied to anterior restorations …

Once I achieve a high level of quality with the enlarged model teeth, I transfer the acquired skills to real-life applications by working with actual-sized teeth. This practice framework allows me to continuously enhance my basic skills. Moreover, each time I start working with a new instrument or material, this approach streamlines the initial learning curve, quickly elevating my performance to a high standard.

Fig. 5. … to evaluate their shape and surface texture.

What are your preferred material combinations for different indications / needs?

For cases with highest aesthetic demands, CERABIEN™ ZR (Kuraray Noritake Dental Inc.) is my favourite porcelain system. I This system can be utilized either as a standalone solution for producing veneers using the refractory die technique or in conjunction with a zirconia framework – typically crafted from KATANA™ Zirconia variants such as KATANA™ Zirconia UTML, STML, HTML Plus, or YML (also from Kuraray Noritake Dental Inc.) – in a full layering approach.

I frequently employ this combination to produce single crowns in the anterior region, selecting the framework material based on the colour of the underlying tooth structure and the appearance of adjacent teeth. An alternative approach is layering with CERABIEN™ MiLai, which consists of internal stains and porcelains compatible with zirconia and lithium disilicate. I prefer to combine this system with the previously mentioned zirconia variants or with lithium disilicate, predominantly using the porcelain to replicate enamel. Sometimes, I employ the system’s internal stains to enhance the result with natural colour effects.

Apart from observing closely, selecting appropriate materials and copying carefully, are there any additional factors decisive for great treatment outcomes from the technician’s point of view?

To my mind, there are two additional essential factors: Proper interaction and communication within the restorative team and personal interaction with the patient. Especially in the highest aesthetic demand cases, meeting a patient in person is very important. They are usually invited to visit the dental laboratory twice, prior to treatment planning and for try-in. Nothing can replace personal interaction with them and a genuine impression of the initial situation. After all, we need to give them a sense of security and build trust, while analysing their character, facial characteristics, skin colour and more allows us to produce perfectly matching restorations.

Fig. 6. Full layering approach with CERABIEN™ ZR on a KATANA™ Zirconia YML framework.

And the restorative team?

We share a common goal: to fulfil the desires of our patients. I firmly believe that achieving this requires a united effort from the entire team. Collaboration hinges on appreciative and open communication at all levels and demands absolute honesty. Furthermore, everyone involved must be committed to continuously developing their skills.

I hold high expectations not only for my own work but also for the contributions of each dentist in our team. After all, their work forms the foundation of what I do. For example, when a dentist invests in an intraoral scanner and starts providing digital records, it is my responsibility to verify whether the quality of those scans meets our high standards. If I notice that the quality could be improved, I approach the situation with respect, offering constructive feedback and guidance to help them deliver quality scans consistently. This is crucial, as high-quality scans are the prerequisite for creating outstanding restorations.

In my experience, most dental practitioners appreciate this kind of honest and supportive communication. It creates an environment where we can all grow and evolve together.

Do you have any additional comments?

Be authentic, strive for excellence, and approach each day as an exhilarating opportunity. Courage plays a vital role, too – the readiness to venture beyond your usual routines, such as experimenting with different shades to discover new possibilities, fosters growth. Even if the outcome does not meet your expectations, there is valuable insight to gain from the experience that can guide you in the future. To reach new horizons, be open to exploring uncharted paths.

Dentist:

GHAITH ALOUSI

Ghaith Alousi, born in 1994, successfully completed his training as a master dental technician in 2013 in Damascus, Syria, where he gained initial experience in a dental laboratory. From 2014 to 2016, he worked independently in Damascus, using his craftsmanship to produce ceramic work such as frameworks, veneers, crowns and bridges, and implant-based restorations. He also engaged in shade determination, photography, and CAD/CAM technology.

He came to Germany in 2016 and quickly felt at home. Through further education, he has continuously expanded his knowledge and skills and is currently working as a dental technician in Wiesbaden. To achieve the best possible results, Ghaith Alousi places great value on collaboration with dentists and personal contact with patients.

Seamless, streamlined cooperation between dentist and dental technician is a recipe for success. The KIZUNA Symposium (Japanese for “bond, connection between people”) explores precisely that. Here are five key reasons you shouldn’t miss it:

1  A UNIQUE EXPERIENCE

KIZUNA is more than an event – it is a philosophy of collaboration. It brings together dentists and dental technicians, creating a shared space for dialogue, learning, and inspiration. Different perspectives converge in one direction: effective and harmonious patient care. The symposium features joint sessions at the beginning and end of the day, with separate sessions for dentists and dental technicians in between.

2  EXCELLENT SPEAKERS

Moderated by the inspiring Dr. Agnieszka Pacyk, the symposium brings together 14 leading professionals from across Europe. Expect scientific excellence, state-of-the-art technologies, the power of AI, new approaches, and plenty of practical tips and tricks. Learn from the very best – for example, MDT Nondas Vlachopoulos and MDT Antonio Corradini, who will conclude the day with a two-hour lecture on excellence in dentistry through outstanding cooperation.

3  NEXT-LEVEL NETWORKING

On the evening before the KIZUNA Symposium, a unique social gathering will set the tone for the day ahead. Guests will enjoy an exclusive dinner featuring authentic Japanese cuisine, blending refined flavours with artistry and elegance. This special evening will not only delight your senses, but also create the perfect atmosphere for networking and informal conversations with colleagues, lecturers, and fellow participants from across Europe. To make the night even more memorable, special attractions inspired by Japanese culture will be offered.

4  SUPERB VENUE AND ACCOMMODATION POSSIBILITIES

The ICE Kraków Congress Centre is a modern and prestigious venue that will become the heart of the KIZUNA symposium. Located in the very center of Kraków, will provide an inspiring setting for dialogue, innovation, and the exchange of expertise, blending Japanese precision with European openness. Near the ICE, you’ll find a wide selection of hotels within walking distance, offering both convenience and comfort throughout your stay. These hotels are not only ideally located for the event, but also nestled close to Kraków’s historic landmarks, allowing you to experience the city’s charm.

5 BEAUTIFUL KRAKÓW

Discover Kraków, a UNESCO World Heritage gem. The city is rich in history and charm – from the iconic Wawel Castle to the vibrant Cloth Hall in the Main Market Square. Stroll through historic districts like Kazimierz and Podgórze, relax in the greenery of Planty Park, and uncover hidden treasures throughout the city. Whether tasting traditional pierogi or admiring Gothic architecture, Kraków offers countless unforgettable experiences.

For more information click here.

See you in Kraków!

BUSTING MYTHS AROUND HIGH-STRENGTH CERAMICS IN DENTISTRY

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

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

1. ZIRCONIA IS AESTHETICALLY INFERIOR TO LITHIUM DISILICATE

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

CONCLUSION

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

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

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

CONCLUSION

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

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

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

CONCLUSION 

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

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

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

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

CONCLUSION 

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

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

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

CONCLUSION 

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

6. ADHESIVE LUTING OF ZIRCONIA-BASED RESTORATIONS IS IMPOSSIBLE

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

CONCLUSION

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

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

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

CONCLUSION

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

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

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

CONCLUSION

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

ZIRCONIA A TRUE ALLROUNDER

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

REFERENCES

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

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

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

HOW IT WORKS

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

 
Features contributing to procedural simplicity include:

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

CONVINCING CLINICAL PERFORMANCE

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

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

ABOUT DENTAL ADVISOR

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

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

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

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

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

PROPERTIES IN A NUTSHELL

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

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

100 PERCENT RECOMMENDATION RATE

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

GREAT FEEDBACK

Evaluators shared the following comments:

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

ABOUT DENTAL ADVISOR

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

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

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

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

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

Start Reading: BOND | VOLUME 12 | 07/2025

Previous versions:

BOND | VOLUME 11 | 07/2024

BOND | VOLUME 10 | 10/2023

BOND | VOLUME 9 | 08/2022

BOND | VOLUME 8 | 12/2021

BOND | VOLUME 7 | 10/2020

Case by Francesco Ferretti, MDT

Is it possible to produce lifelike porcelain veneers using lithium disilicate and a porcelain system with a reduced number of internal stains and porcelains designed for micro-layering? This is what we wanted to find out when we decided to test the new CERABIEN™ MiLai line-up. As loyal users of the CERABIEN ZR family for porcelain layering on zirconia, we hoped that the new product would offer similar handling and optical properties.

The CERABIEN™ MiLai line-up consists of 15 internal stains and 16 porcelains, which are - like CERABIEN ZR - based on synthetic feldspathic porcelain technology from Kuraray Noritake Dental Inc. With a comparatively low firing temperature of 740 °C (or 1,364 °F), the system may be used on zirconia as well as silicate ceramic restorations, provided that the CTE value of the materials is between 10.2 and 10.5 × 10^-6/K (50 °C – 500 °C). This is true for lithium disilicate, our preferred base material for the production of ceramic veneers. The thickness of the porcelain layer is usually smaller than 0.5 mm, which allows us to exploit the aesthetic potential of the underlaying ceramic, while creating some individual effects for the underlying structure and the enamel. A clinical case predestined for the use of the new system is shown below.

Fig. 1. Young male patient with discoloured composite restorations on his maxillary central incisors.

Fig. 2. The patient was unhappy with his smile aesthetics, so that it was decided to place more durable ceramic veneers.

Fig. 3. Appearance of the central incisors after minimally invasive tooth preparation.

Fig. 4. Veneers made of lithium disilicate individualized with CERABIEN™ MiLai placed on the model.

Fig. 5. Intraoral view of the teeth after adhesive cementation of the veneers.

Fig. 6. Close-up view of the anterior teeth.

Fig. 7. Smooth optical integration of the veneers: They show some individual effects and are virtually indistinguishable from natural tooth structure of the adjacent lateral incisors.

Fig. 8. Black-and-white photograph of the maxillary anterior teeth.

Fig. 9. Smile aesthetics.

Fig. 10. Beautiful treatment outcome.

COMPACT SYSTEM

The compact line-up of CERABIEN™ MiLai with its nicely developed internal stains and porcelains enables us to imitate the patient’s natural teeth very well in the great majority of cases. Shades are easily selected and the favourable consistency of the porcelains facilitates application in thin layers. Due to the reduced thickness of the porcelain layer, it is possible to play with the optical properties of the underlying lithium disilicate, creating a final restoration with a natural appearance despite the simplified procedure.

Dentist:

FRANCESCO FERRETTI, MDT

Born in Rome on March 15, 1957, Francesco Ferretti received his dental technician diploma from the Edmondo de Amicis Institute in Rome and began working independently in 1980. His dental career has been versatile and impressive - working under Prof. Mario Martignoni, being partner at ORAL DESIGN Center in Rome (founded by Mr. Willi Geller and Mr. Francesco Felli) and having his own Estech Dental Studios, are just some of the highlights.

He taught the advanced course in prosthesis at the University of Chieti from 2002 to 2010 and the postgraduate course in prosthesis at the University of Naples Federico II in 2007.

He has been using metal free methods for more than 30 years, specialized in prosthesis and implants, has published articles and research in Italian, American, Russian and Asian magazines and has been a speaker at various international conferences and courses.

CLEARFIL™ SE Protect WINS TOP PRODUCT AWARD AGAIN IN 2025

For the 11^th consecutive time, the self-etch adhesive CLEARFIL™ SE Protect has been named a Top Product by Dental Advisor. This recognition was announced in the January/February 2025 issue of the publication, which highlights dental materials and equipment that deliver top-notch, practice-based performance. CLEARFIL™ SE Protect was honored in the Direct Restoratives – Bonding Agent: Self-Etch category for its exceptional attributes, which go beyond providing a reliable bond.

PROPERTIES IN A NUTSHELL

CLEARFIL™ SE Protect is a trusted tool built on the same system as the gold-standard adhesive CLEARFIL™ SE BOND, offering excellent bond strength to both enamel and dentin. Additionally, it features an antibacterial cavity-cleansing effect, thanks to the proprietary MDPB monomer it contains. This eliminates the need for a separate cavity cleanser.

 
In short, CLEARFIL™ SE Protect provides the following benefits:

• Fast and simple procedure with minimal technique sensitivity.
• Excellent bond strength for enamel and dentin.
• Long-lasting bond strength.
• Antibacterial cavity-cleansing effect.
• Virtually no post-operative sensitivity.

This highly versatile adhesive system can be used for:

• Direct restorations using light-cured composite resin or compomer.
• Cavity sealing as a pretreatment for indirect restorations.
• Treatment of hypersensitive and/or exposed root surfaces.
• Intraoral repairs of fractured crowns/bridges made of porcelain, hybrid ceramics or composite resin using light-cured composite resin.
• Surface treatment of prosthetic appliances made of porcelain, hybrid ceramics and cured composite resin.
• Core build-ups using light- or dual-cured composite resin.

SPECIAL CHARACTERISTIC: ANTIBACTERIAL EFFECT

CLEARFIL™ SE Protect contains Kuraray Noritake Dental Inc.'s renowned original MDP monomer combined with the 12-Methacryloyloxydodecylpyridinium bromide (MDPB) monomer. The latter monomer is responsible for the product’s antibacterial cavity-cleansing ability: It contains a positively charged pyridinium group, which attracts bacteria cells in the oral cavity that are generally negatively charged. When docking to the positively charged contact points of the MDPB monomer, the cell membranes of these bacteria lose their electrical balance and are destroyed. This process known as bacteriolysis is powerful and effective, leading to clean cavities as ideal foundations for long-lasting restorations. During polymerisation of the adhesive layer, the MDPB monomer is immobilized. Afterwards, it remains latently active without affecting the dental patient’s own cells.

OUTSTANDING 98 PERCENT CLINICAL RATING

The product’s impressive features are reflected in a six-week evaluation by Dental Advisor’s editors and consultants, who placed over 150 restorations. Using a 1-5 rating scale, consultants gave it an amazing 98 percent clinical rating.

The practitioners noted no post-operative sensitivity. They highlighted that the primer and bond wet the tooth evenly, and found the antibacterial and fluoride-releasing properties to be “an added benefit.” Regarding treatment of hypersensitive teeth or exposed root surfaces, they observed that CLEARFIL™ SE Protect is effective in reducing sensitivity.

ABOUT DENTAL ADVISOR

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

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

Interview with Dr. Enzo Attanasio

TIME-SAVING DIRECT RESTORATION TECHNIQUES FOR EVERY DENTAL PRACTITIONER

Passionate dental practitioner, renowned speaker and inventor of the BEST.FIT technique: Dr. Enzo Attanasio has a lot of valuable insights to share with his audience. At this year’s International Dental Show in Cologne, he lectured on three different topics at Kuraray Noritake Dental Inc’s booth, including “Flow Injection Technique” and “BEST.FIT: A Hybrid Technique for Efficient and Aesthetic Restoration of Anterior Teeth”. We seized the opportunity to talk to him about the most important facts, tips and tricks he presented.

Dr. Attanasio, would you please summarize the key messages of the two lectures just mentioned, starting with “Flow Injection Technique”?

If there is a revolutionary technique that combines the benefits of prosthetic and restorative dentistry, it is certainly the flowable injection technique, also referred to as injection moulding. Nowadays, we have exceptional flowable composites at our disposal, which are absolutely on par with the packable ones in terms of mechanical and optical properties. Unfortunately, however, many dental practitioners are not yet aware of these products. In my lecture titled “Flow Injection Technique”, I wanted to highlight the potential of these materials and the technique. In addition, my aim was to provide a precise recipe that enables the audience to reproduce it in their dental office as early as next week. My presentation covered the whole workflow, from case selection to the production of the wax up and the silicone index, up to the injection of the flowable composite itself.

What about “BEST.FIT: A Hybrid Technique for Efficient and Aesthetic Restoration of Anterior Teeth”?

In the lecture focusing on flowable injection, we explored the limits and strengths of this technique. BEST.FIT is an evolution of this technique that seeks to overcome the limits of both, flowable injection and standard anterior direct restoration techniques. At the same time, it leverages the strengths of those techniques, with the ultimate aim of putting the clinician in a position to face an anterior restoration without major stress.

Let us focus on the flowable injection technique first. When and why do you opt for this technique?

Flowable injection has the same fields of application as other direct and indirect restoration techniques. It is very well suited for young patients desiring veneer treatment, for example. In the era of social media, with images of influencers that underwent aesthetic dental treatment being omnipresent, our children grow up with high aesthetic expectations. When they present in our dental offices and ask for a smile makeover, they are often too young to be treated ceramic veneers. Those with a clear need for aesthetic treatment are ideal candidates for a smile makeover with the flowable injection technique: This technique is micro-invasive, produces restorations that are easily modified or repaired at any time, and allow for treatment with ceramics at a later date. Other target groups include individuals who cannot afford highly expensive treatments with ceramics, but go in for high quality and aesthetics, and those with a severely worn dentition. For the latter group, we can use the technique to produce medium to long-term mock ups that increase the vertical dimension of occlusion. Moreover, direct restorations produced using this technique may be combined with ceramic restorations in this target group to reduce the cost of the therapy. Hence, the technique is versatile and it is very important that a clinician is able to make use of it.

What is the difference between this technique and the BEST.FIT technique you developed?

The flowable injection technique uses a digital or conventional wax-up to produce a transparent silicone index that serves as a shell for the injection of flowable composite. Once injected, the composite is cured through the index. In this way, the desired anatomical shape is obtained with minimal effort. However, the technique allows for single-shade restorations only. The BEST.FIT Technique is a hybrid technique I developed to address this limitation and leverage the advantages of both, flowable injection and classical direct anterior restoration techniques. It involves the creation of the dentin core by hand, followed by the injection of the layer imitating the enamel through a transparent index. This is particularly beneficial in the context of treating young people, where I feel the need to incorporate incisal translucencies into my anterior restorations. An article describing the technique was published in 2024¹.

When do you prefer this technique over the flowable injection technique?

Every time I need to incorporate different levels of translucency into my restorations, the BEST.FIT technique is my first choice. This is especially important when it is not planned to restore “the social six”, but to treat single teeth in the maxillary anterior region. In this case, I have to replicate the adjacent natural teeth with their natural internal anatomy. Whenever those teeth have a complex internal colour structure, a single-shade technique would not lead to the desired result, because playing with different opacities is essential. This is what the BEST.FIT technique allows me to do in an efficient way.

No matter whether you opt for the flowable injection or the BEST.FIT technique, proper isolation of the working field is an important prerequisite for long-term success. What are your tips in this context?

As shown in one of my lectures, it is possible to use rubber dam in some cases. However, any dental practitioner opting for rubber dam should keep in mind that when placing the dam, there will always be a band of tooth near the gum, which will remain covered by the dam. This is fine as long as we do not have to cover discolouration in the cervical area. In this case, we can ask the dental technician to start waxing up a millimetre away from the gingival margin. Staying supragingivally means that the transparent silicone index may be trimmed in that area as well and the rubber dam will stay in place during its placement. This significantly reduces the risk of contaminating the bonding surface with saliva. Another factor to be considered carefully is the positioning of the clamps. Ideally, the silicone index is shaped in a way that the clamp does not interfere with its insertion. For protection of the adjacent teeth, PTFE tape has proven its worth.

How important is bonding for both techniques and what are the key success factors in this context?

Bonding is a fundamental part of every modern restorative treatment. To provide for optimal bonding conditions in the context of restoring teeth using the flowable injection or BEST.FIT technique, we should always try to use rubber dam. If this is not possible, we need to be very careful to keep the working field dry and clean until the injection is completed. This means that any contamination with blood and saliva must be avoided. Especially during the injection step, this is only feasible when the surrounding soft tissues are perfectly healthy. The selection of a high-quality bonding agent and the following of the recommended protocols are also important factors for the establishing of a strong, long-lasting bond on the clean and dry surface. In my daily practice, I started using a universal adhesive in combination with selective etching of the enamel approximately ten years ago. Ever since the introduction of CLEARFIL™ Universal Bond Quick (Kuraray Noritake Dental Inc.), this product is my universal adhesive of choice for direct and indirect restoration procedures. When I graduated 20 years ago, I started with classical three-step adhesive systems used in the etch-&-rinse technique. I would never go back, as CLEARFIL™ Universal Bond Quick provides reliable bonding with virtually no postoperative sensitivity.

Fig. 1: Prepared teeth and isolated working field prior to treatment using the BEST.FIT technique.

Fig. 2: Palatal silicone index produced over the wax-up model with silicone putty material to allow for the build-up of the palatal wall and the layering of the dentin core by hand.

Fig. 3: Transparent silicone key for the injection step, produced over the wax-up model using an impression tray. The injection holes are ideally integrated with the cannula of the flowable composite syringe starting inside the index.

What about silicone index preparation for the flowable injection and BEST.FIT technique?

Usually, a silicone index used for mock-up creation in the patient’s mouth is made of vinyl polysiloxane putty material that is modelled by hand. Transparent silicone materials used to produce a silicone index for the flowable injection and BEST.FIT technique have a lower viscosity. Hence, an impression tray is needed to record the details of the wax-up. In this context, it is important to select a tray of the right size, fill it well with silicone material and place it carefully over the wax-up. After all, we need a high accuracy and dimensional trueness of the silicone index as well as a sufficient wall thickness that gives it the required rigidity and avoids distortions during injection moulding.

What composite materials do you combine when using the BEST.FIT technique and use for flowable injection?

When modelling the dentinal structures by hand, you may use your favourite packable composite. After all, the procedure is the same as any classical anterior restoration procedure. All the materials I usually use for the classical steps of direct anterior restoration production are perfectly suitable for all steps prior to the build-up of the vestibular layer. When employing the BEST.FIT technique, it is essential to leave 0.5 mm of space buccally for the subsequent injection step. When opting for the flowable injection technique, the injection will follow immediately after application of the adhesive. In both cases, it is possible to inject any kind of flowable composite. These materials are typically transparent enough to reveal all the details of the dentin core found underneath – like the incisal effects created with the BEST.FIT technique.

Let us focus on the BEST.FIT technique. Do you have any recommendations regarding the modelling of the dentin core?

If you have to copy a contralateral tooth, use a polarized filter on your camera to eliminate all the reflections on the enamel. This will allow you to see through the enamel and analyse the anatomical form of the natural dentin structure. If you cannot copy and are inventing an internal colour structure, my advice is to consider the age of the patient you are treating. Distinct mamelons are characteristic of younger patients. Every age has its anatomical internal characteristics that must be followed to obtain lifelike results in the end.

Fig. 4: Distinct mamelons created by hand to restore the smile of a young patient.

How do you make sure that the space available is ideal for the buccal enamel layer?

It is fundamental to always use a silicone key that is cut vertically to measure the space left buccally or the enamel layer. This layer must not be too thick or too thin – as I mentioned, 0.5 mm seem to be ideal. Too much enamel placed buccally over the dentin framework will make the entire restoration appear low in value. It will look grey and not blend well with the surrounding tooth structure. On the other hand, an enamel surface that is too thin will too strongly expose the opaque colour of the dentin, resulting in the opposite effect.

How to avoid air bubbles during injection?

First of all, it is very important to choose a flowable composite well filled into the syringe during the industrial process. CLEARFIL MAJESTY™ ES Flow (Super Low and Low, Kuraray Noritake Dental Inc.) are completely free of bubbles inside the syringe. In addition, the injection technique is really important. It is essential to bring the needle tip to the cervical margin. Positioned there, we can start injecting the composite. When the tip is completely surrounded by composite, we can start to move the syringe slowly back towards the incisal area and the insertion hole without releasing the pressure on the plunger, making sure that the tip always remains immersed in the flowable composite. It is very important to keep a controlled and constant pressure to have a good result.

What are your recommendations for successful finishing of restorations created using the flowable injection or BEST.FIT technique?

As with every composite restoration, it is very important to finish and polish the surface thoroughly as the long-term performance of our restoration is strictly linked to the final surface quality. Ideally, the final photopolymerization is performed under a layer of glycerin gel. With regards to the following finishing steps, there is one substantial difference between the described techniques and free-hand layering: Both moulding techniques allow us to reproduce the surface texture created by the dental technician on the wax-up in a very precise way. With a high-quality index and correct injection, it is possible to skip the surface texturing step during finishing completely. We just have to remove the peripheral excess and polish with rubbers, discs and filters. Fortunately, flowable composites like CLEARFIL MAJESTY™ ES Flow are very easy to polish, while their gloss retention is great.

Fig. 5: High-gloss surfaces of restorations created with CLEARFIL MAJESTY™ ES Flow.

How do the described restorative techniques fit into your daily procedures?

Every time I need to restore or modify the aesthetic appearance of my patients’ teeth, I start with the defining of a target. If the desired outcome is achievable with composite instead of ceramics, and whenever a micro-invasive approach is needed, I opt for one of the two techniques. They are good enough to solve a lot of restorative cases in a great way; and they allow me to save a lot of chair time. Consider that all finishing steps dedicated to the texture of an anterior restoration is no longer necessary. A concrete example: I would expect a treatment involving free-hand modelling of restorations from canine to canine to take three to four hours, while the flowable injection technique might enable me to accomplish the task within one and a half hours!

Is it difficult to implement those techniques in a general dental practice?

Absolutely not! The learning curve for those techniques is quite short. Of course, it is essential to understand the materials and follow the correct protocols to apply them effectively. However, when compared to techniques like the direct layering of composite veneers, these approaches are significantly simpler and better accessible to every clinician. It all starts with a correct diagnosis, and a good project together with the technician, whose work is as important as the clinician’s for the success of the project. The wax-up and the silicone index are fundamental. My suggestion is also to learn the fundamentals of digital smile design when starting to use the flowable injection and BEST.FIT techniques. Digital smile design allows for streamlined communication between practice and laboratory, but also with the patient.

What is your final remark?

Knowledge, protocols, and materials are the keys to perfect results. If even one is missing, failure is just around the corner.

Reference

1. Attanasio E. BEST.FIT: A hybrid technique for efficient and aesthetic restoration of anterior teeth. Cosmetic Dentistry 2024:1, 38 – 41.

Dentist:

DR. ENZO ATTANASIO

Enzo Attanasio graduated in 2008 with a degree in Dentistry and Dental Prosthetics from the Magna Graecia University of Catanzaro. In 2009, he specialized in the use of lasers and new technologies in the treatment of oral and perioral tissues at the University of Florence. That same year, he also attended Prof. Arnaldo Castellucci’s course in Clinical Endodontics at the Teaching Center of Microendodontics in Florence, where he later completed his training in Surgical Microendodontics in 2012. In 2017, he took a course on direct and indirect adhesive restorations at Prof. Riccardo Becciani’s Think Adhesive training center in Florence, where he later became a tutor. Today, Dr. Attanasio, a member of the Italian AIC and based in Lamezia Terme, Italy, has a special interest in Endodontics and Aesthetic Conservative Dentistry.