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Article by Dr. Clarence Tam HBSc, DDS, FIADFE, AAACD

A CHAMELEON SUPERCOMPOSITE

INTRODUCTION

The name of the game in modern-day esthetic and restorative dentistry is that of Responsible Esthetics. The goal of treatment typically strives to correct any structural and cosmetic shortfalls in both biologically-driven and trauma-affected teeth with the precise, artistic placement of various replacement layers, all whilst respecting and retaining a maximal volume of residual tooth structure. Anterior teeth can be affected by enamel and dentin dysplasia, caries and sclerotic conditions and are characterized by a laundry list of genetically-derived and environmentally-acquired conditions with an esthetic deficit that often threaten an individual’s functional and psychosocial integrity if not restored to the seamless picture of health.

Missing and defective tooth structure must be categorized into its attendant enamel and dentin components. Both substrates are distinctly different in composition, with enamel being highly inorganic in nature and dentin proportionately more collagenous in nature. The latter stratum is responsible for the refraction of light, the expression of the true color of the tooth, namely the hue and the endowment of fracture toughness or resilience in functional performance. The value and chroma are the other elements of color and are modified by the thickness of enamel. The replacement of enamel has been found to be best substituted from a biomechanical perspective by adhesively-bonded indirect porcelain restorations, and dentin using both composite resin and short fiber reinforced composite (SFRC), the latter imparting increased fracture toughness in large volume replacement restorations, especially those with pericervical structural deficits.

In adolescent patients, the gold standard of treatment involves direct composite resin, as often zero to minimal tooth structure preparation is required as a foundation to the bonded restorative. It would be impractical to use bonded indirect restorations when the development of the dentition in puberty is continuous, especially with the retraction of gingiva as one progresses to young adulthood. Resin composite allows prescience in the opportunity to predictably modify and/or add to the existing restoration if dental bleaching for the other teeth is desired or if a further traumatic incident is encountered. The ability to modify bonded porcelain is not predictable and frequent marginal failures occur due to a lower shear bond strength to bonded composite, especially after thermocycling. This is despite our ability to establish a chemical linkage via silane coupling agents from silicate ceramics to resin composite especially at a blended interface.

STATEMENT OF PROBLEM

Dental shades in clinical dentistry have long been classified using the VITA^* Classical A1 – D4 shade guide. Despite being ubiquitous in dental practices, composite resin systems with corresponding shade systems do not satisfactorily match to their purported shade¹. Floriani et al found that various mixtures of different shades in one system was required to achieve an acceptable color match with the VITA^* Classical shades using the CIEDE2000 formula. Testing another composite resin, they found that none of the A1, A2 or A3 shades matched acceptably to the standard shade guide². Indeed, even with indirect ceramic layering systems, a wide range of unacceptable discrepancy was noted between VITA^* labeled porcelain shades and the actual shade guide³. The VITA^* Classical shade guide became the standard in dental shade classification with the release of its A1-D4 shade guide in 1985. The majority of human-tested dental shades has been found to be in the A-family (78.5%), followed by C (13.2%), D (5.2%) and B (3.1%)¹. As such, the shade accuracy of a given composite system must be important if they are to be visually naturomimetic.

CHAMELEON EFFECT DEVELOPMENT

There are myriad composite resin systems featuring a simplified shade Universal system that have acceptable chameleon effects due to their balance of translucency, light transmission, diffusion and refractive index properties. There is a concern over how these optical properties may change after both thermocycling and wet storage, potentially compromising the excellent initial esthetic blend⁴. Refractive index (RI) is best optimized when the RI of the inorganic fillers match closely with the RI of the cured organic matrix, typically in a range between 1.47 and 1.52⁵. If the match is dissimilar, this drives up the opacity of the restoration due to heightened refraction and reflection at the filler/matrix interface⁶.

Layering of composite to mask an intraoral defect is complicated by the need to mask any linear defects such as fracture lines superimposed over the shadowing of the dark intraoral cavity in addition to regional color variations. It is confounded by the requirement to recreate natural maverick and translucent effects particularly in the incisal window region of upper and lower incisors and canines, giving the illusion of a virgin, healthy tooth. This has been historically difficult to accomplish in anterior teeth given the need to block out restorative interfaces with natural tooth structure and recreate a seamless internal structure and details. This detailed layer belies a well contoured enamel layer with realistic translucency, polishability and accurate primary and secondary anatomy.

Adding to the complexities described above, the histoanatomical approach to composite layering dictates that missing enamel is replaced by enamel shades, and dentin by the corresponding dentin shade in the appropriate shade. This shade must be selected at the very start of the appointment, as often even a minute of dehydration has a negative effect on both the perceptibility threshold and acceptability threshold of teeth⁷, resulting in the incorrect shade.

DEVELOPMENT

CLEARFIL MAJESTY™ ES-2 is a value-based super-nanofilled composite system that covers 15 VITA^* shades in just 4 shade options with its Universal series. This Universal series provides a chameleon effect and has 4 variants: Universal (U), Universal Light (UL), Universal Dark (UD) and Universal White (UW). It is the VITA^*-approved shading concept relative to color accuracy. Incorporating nano-fillers that consist of silanated barium glass fillers and slanted silica nanoclusters, its wear resistance is high and features minimal abrasiveness against the functional antagonist. The RI of both inorganic filler and organic matrix are well-matched, and the high refractive index of the composite mimics and is extremely similar to natural enamel (1.613) and dentin (1.540), thanks to an innovation labeled Light Diffusion Technology (LDT), which distorts light in a similar way dental tissue does⁸. There is comfort that the stability of refractive index and other optical transmission properties remains statistically stable even after artificial thermocycling and water-storage aging studies⁴. The color stability of CLEARFIL MAJESTY™ ES-2 has been proven over time, where a direct comparison to Filtek Ultimate showed CLEARFIL MAJESTY™ ES-2 to feature significantly less color variation from baseline and marginal functional wear over a three to four year period in teeth featuring amelogenesis imperfecta⁹. This color substantivity is important as dietary and environmental stressors applied over time should have as minimal effect on the restoration to ensure continued esthetic integration.

CLINICAL PROTOCOL

CLEARFIL MAJESTY™ ES-2 Universal is a monochromatic solution that covers the five key shades featured in the CLEARFIL MAJESTY™ ES-2 Premium. As such, it exhibits the most significant LDT relative to all five shades, as its ability is equal when blending to higher value translucent shades as it does to cervical chromatic shades. In a Class IV restoration with a defined fracture line, the challenge is to restore the tooth in a minimal volume of available space. The alchemy requires a complete visual occlusion of the fracture line position, and recreation of internal and external opaque and translucent anatomy along with maverick staining, craze lines and effects. In anterior teeth, the idiom of “the less you see, the less you notice” is not true, especially due to the presence of incisal edge window effects as above, however, materials with the best light diffusion and structure transference properties should be utilized to ensure the highest probability of success.

A 15 year old ASA I female presented to the practice exhibiting aged, chromatic composite restorations with poor marginal integration and gross axial overhangs; essentially a gross failure of primary anatomy and esthetics. She had been involved in a bike accident where she high-sided off braking sharply in a face-meets-concrete scenario, resulting in an uncomplicated moderate enamel-dentin fracture with blushing, affecting both the facial and palatal aspects of tooth 1.1 and a mild uncomplicated enamel dentin fracture affecting the distoincisobuccolingual aspect of tooth 2.1. The restoration overhangs were significant, extending into the proximal contour zone, thus obviating effective interdental cleaning. Vitality tests were confirmed along with radiographs to exclude the presence of apical pathology. The patient accepted the option of pre-prosthetic whitening, to improve the value characteristics of the adjacent teeth, allowing the selection of a brighter value shade combination. Intraoral digital scans were acquired and custom bleaching trays with a no reservoir, cervical seal-priority design were fabricated. The patient was instructed to bleach overnight for a 2 week period using a 10% carbamide peroxide solution (Opalesence, Ultradent Products, UT) until her maximal value was reached. Her baseline shade of the incisors was a 1M1/2M1 combination in the upper incisors and a 2M1 in the lower incisors. On final post-bleach assessment she exhibited a lightened shade of VITA^* 0M3 in all incisors. The patient was instructed to use a fluoride-containing, amorphous calcium phosphate complex (ToothMousse Plus, GC America) during the following 2 weeks after cessation of whitening whilst the residual oxygen radical species dissipated from the teeth.

Fig. 1. Pre-operative unrestricted smile 1:2 ratio view, teeth 1.1 and 2.1 with old, defective composite restorations with excessive chroma.

On the day of the procedure, the pre-dehydrated shade was assessed using the supplied “real composite” shade guide tabs featured in the CLEARFIL MAJESTY™ ES-2 Premium system, with the enamel shade being WE (White Enamel) and the dentin shade WD (White Dentin). It was assessed that both white maverick effects as well as a moderate halo effect was desired along with moderate to strong translucency in the incisal window.

The patient was anesthetized using 1.5 carpules of 2% Lignocaine with 1:100,000 epinephrine (Septodont) before a rubber affixed with individual ties for the central incisors (NicTone Medium). Excavation of the old restorative material was undertaken, and the residual natural incisal edge was found to be undermined by a through-and-through fracture. Thus, the preparation was converted into a true Class IV design, with the facioincisal cavosurface margin subjected to an infinity bevel. The maxillary central incisors were isolated from the lateral incisors by way of a serrated metal strip (Komet) and the prepared surfaces subjected to micro particle abrasion using a 29 micron aluminum oxide powder in 17.5% ethanol carrier (Aquacare). The surfaces were subsequently treated with a calcium sodium phosphosilicate powder (Sylc, Aquacare) to increase the inorganic content of the prepared surface especially extending into the exposed tubules. The teeth were etched using a 33% orthophosphoric acid before a 1 minute 2% chlorhexidine scrub (Vista Products). The surface was reduced to a moist dentin surface before the bond applied, air thinned and cured.

A Mylar strip was pre-crimped in the palatoproximal line angles and positioned on the linguoaxial surface of both teeth 1.1 and 2.1. There is no shade guide for the CLEARFIL MAJESTY™ ES-2 Universal U shade, as it bears a significant chameleon effect however it does come in a light (L) and dark (D) variant. The UL shade was deemed the most suitable for the palatal or lingual shelf, with an average thickness of 0.3mm. This layer was applied in a freehand fashion with a focus on establishing the desired outline form of the tooth relative to the contralateral 2.1. The Mylar matrix setup was removed and a precurved metal matrix (Garrison Slickband, Garrison Dental) was oriented in a position perpendicular to its normal placement interproximally, and the end of the curved band tucked into the sulcus before being secured by a wedge. In this way, there is light separation of the central incisors and an intimate contact between the matrix band and the mesial edge of the freshly applied lingual shelf. A 0.5mm frame extending more than halfway through the contact point was created and cured. The process was repeated on tooth 2.1 with the goal of recreating both lingual and proximal walls of the restoration, leaving only the facial volume to be replaced.

Fig. 2. Pre-crimped Mylar matrix repeated on the DIBP aspect of tooth 2.1 to close the available space. CLEARFIL MAJESTY™ ES-2 Universal UL is used here.

Block-out of the composite extensions against the natural tooth structure was achieved by opacification using an opaque composite resin (WD, CLEARFIL MAJESTY™ ES-2 Premium, Kuraray Noritake Dental Inc.) layered in both horizontal and vertical increments. It is noted that the restorative join line must be completely obscured at the end of layering the dentin volume, otherwise the case will have almost certain esthetic failure. The internal dentin anatomy and its inherent variation was created to mirror that of the 2.1, which had minimal compromise of its incisal window with details intact. A super translucent composite resin (Clear, CLEARFIL MAJESTY™ ES-2 Premium, Kuraray Noritake Dental Inc.) was placed between the lobes of the dentin layers and cured. A 9:1 ratio of white: orange tint was mixed and placed on the incisal edge and proximoincisal corners to recreate the halo effect. A pure white tint was placed in gentle dentin mamelon-connecting spider legs up to the incisal edge to impart the realism. This was layered in a manner consistent with the appearance of the 2.1.

Fig. 3. Both horizontal and vertical dentin composite increments are demonstrated mimicking the contralateral tooth.

Fig. 4 & 5. Final immediate post-operative result after finishing and polishing.

DISCUSSION

The esthetic merit of this case is foundationally supported by composite resin technology on multiple levels. The color and physical stability over time needs to be proven in order for the clinician to have faith in its prognostication. Specifically, the material needs to have an excellent and well-matched refractive index, and one that is unaffected by both water and thermocycling stressors.

The palatal shelf was fabricated using a new-generation super nano-filled universal composite system that boasts a strong chameleon effect. If it is our intention to fool the eye, to obscure, then this first layer works well to start the blockout process of the darkness of the mouth behind the fracture line of the restored tooth. Following this, the chroma and value of the tooth are corrected using the dentin, simultaneous to its continued opacification of the fracture line and intraoral darkness. Both dentin and enamel layers are applied histoanatomically, that is, in a manner respecting the various thickness zones observed in nature.

Ultimately, esthetic success in direct composite resin is not dictated on the first day post-operatively. Factors are in play, from dehydration to occlusal wrinkles that need to be ironed out and corrected. The win depends on what material is used, along with how that material was developed to what standards, and why shade accuracy is so important in a world of variety. In a dental world with myriad composite options, we are looking for precision. Precision in technology leads to efficiency and physicoesthetic maintenance in clinical results. This ultimately results in a boost to clinician-patient confidence and an optimal prognosis.

Dentist:

CLARENCE TAM

*VITA is a trademark of VITA Zahnfabrik, Bad Sackingen, Germany

References

1. Elamin HO, Abubakr NH, Ibrahim YE. Identifying the tooth shade in group of patients using Vita Easyshade. Eur J Dent. 2015 Apr-Jun;9(2):213-217. doi: 10.4103/1305-7456.156828. PMID: 26038652; PMCID: PMC4439848.
2. Floriani F, Brandfon BA, Sawczuk NJ, Lopes GC, Rocha MG, Oliveira D. Color difference between the vita classical shade guide and composite veneers using the dual-layer technique. J Clin Exp Dent. 2022 Aug 1;14(8):e615-e620. doi: 10.4317/jced.59759. PMID: 36046166; PMCID: PMC9422970.
3. Gurrea J, Gurrea M, Bruguera A, Sampaio CS, Janal M, Bonfante E, Coelho PG, Hirata R. Evaluation of Dental Shade Guide Variability Using Cross-Polarized Photography. Int J Periodontics Restorative Dent. 2016 Sep-Oct;36(5):e76-81. doi: 10.11607/prd.2700. PMID: 27560681.
4. Almasabi W, Tichy A, Abdou A, Hosaka K, Nakajima M, Tagami J. Effect of water storage and thermocycling on light transmission properties, translucency and refractive index of nanofilled flowable composites. Dent Mater J. 2021 May 29;40(3):599-605. doi: 10.4012/dmj.2020-154. Epub 2020 Dec 24. PMID: 33361663.
5. Arai Y, Kurokawa H, Takamizawa T, et al.. Evaluation of structural coloration of experimental flowable resin composites. J Esthet Restor Dent. 2020;e12674.
6. Ota M, Ando S, Endo H, et al.. Influence of refractive index on optical parameters of experimental resin composites. Acta Odontol Scand. 2012;70(5):362–367.
7. Suliman S, Sulaiman TA, Olafsson VG, Delgado AJ, Donovan TE, Heymann HO. Effect of time on tooth dehydration and rehydration. J Esthet Restor Dent. 2019 Mar;31(2):118-123. doi: 10.1111/jerd.12461. Epub 2019 Feb 23. PMID: 30801926.
8. Meng Z, Yao XS, Yao H, Liang Y, Liu T, Li Y, Wang G, Lan S. Measurement of the refractive index of human teeth by optical coherence tomography. J Biomed Opt. 2009 May-Jun;14(3):034010. doi: 10.1117/1.3130322. PMID: 19566303.
9. Tekçe N, Demirci M, Sancak EI, Güder G, Tuncer S, Baydemir C. Clinical Performance of Direct Posterior Composite Restorations in Patients with Amelogenesis Imperfecta. Oper Dent. 2022 Nov 1;47(6):620-629. doi: 10.2341/21-106-C. PMID: 36281978.

2025 MARKS THE YEAR OF THE SNAKE

Case by CDT Mathias Berger, France

Every patient is unique. Their specific backgrounds, functional needs and aesthetic demands need to be respected in any prosthodontic treatment plan. However, the importance of an individual treatment approach increases with the number of teeth to be replaced: After all, the impact of the restorations on facial aesthetics and on the patient’s quality of life is never greater than when all teeth are missing. Fortunately, adequate dental materials and techniques are available for a patient-centered, individual approach, no matter what challenges need to be overcome.

A patient with bruxism

In the present case, an elderly male patient with bruxism was in need of a new maxillary denture. Since the placement of five implants in the maxilla, he had no proprioception in this jaw. This lack of sensation had an impact on the overdenture to be produced: material and design needed to be carefully selected in a way that it would withstand uncontrolled chewing forces. As technical complications are easier to repair than biological complications, the overdenture should not be unbreakable – instead, the replacement of single units should be easily manageable.

Two-part denture design

The solution was a two-part design with a milled bar consisting of the gum area and tooth abutments (fig. 1) combined with single crowns. The material of choice for the bar was KATANA™ Zirconia HTML Plus (Kuraray Noritake Dental Inc.) with a uniform flexural strength of 1,150 MPa throughout the disc, while the single crowns were milled from KATANA™ Zirconia YML that offers natural translucency and strength gradation. While a monolithic design was selected for the posterior crowns, the six crowns for the anterior region received a micro-cutback for aesthetic micro-layering with CERABIEN™ ZR Porcelain. The shade scheme for individualization of the anterior crowns is shown in fig. 2. In a nutshell, customization was performed with the Internal Stains Cervical 1, Grayish Blue, Dark Grey and A+. The finishing layer on the incisors was created mainly using LT0 materials with some CCV-3 on the cervical and LT Natural on the mesial and distal lobes. On the canines, LT1 was used instead of LT0. The posterior crowns were merely finished with liquid ceramics (CERABIEN™ ZR FC Paste Stain, Kuraray Noritake Dental Inc.).

Fig. 1. Sintered bar milled from KATANA™ Zirconia HTML Plus.

Fig. 2. Chroma map for micro-layering in the anterior region.

Fig. 3 shows the finished single crowns with their individual, age-appropriate shade effects on the sintered bar. After checking the fit of the crowns, the gum areas of the bar were individualized using CERABIEN™ ZR Tissue Porcelain (fig. 4). Subsequently, the crowns were luted to the zirconia abutments (fig. 5), leaving screw access holes in aesthetically uncritical positions (fig. 6). The final overdenture ready for try-in is shown in fig. 7. Due to an excellent fit on the implants (fig. 8), it was possible to immediately fix the overdenture with the screws, close the access holes with composite and discharge the patient. The final appearance is shown in fig. 9.

Fig. 3. Finished crowns on the sintered bar.

Fig. 4. Bar with individualized gum areas.

Fig. 5. Placement of the central incisor crowns on the bar.

Fig. 6. Occlusal screw access hole in the finished overdenture.

Fig. 7. Overdenture ready for try-in.

Fig. 8. Intraoral try-in of the aesthetic overdenture.

FINAL SITUATION

Fig. 9. Treatment outcome.

CONCLUSION

This patient case is a good example of how important it is to respect the patient’s background, age and specific demands when producing dental restorations. Thanks to the great variety of restorative materials with different mechanical and optical properties available, it is possible to create suitable prosthetics for virtually every patient. However, for this purpose, it is important to stay up to date regarding new products launched and techniques developed. This way, it is often even possible to create beautiful and durable solutions in a simplified and efficient procedure such as micro-layering on innovative zirconia with a high aesthetic potential.

Dentist:

CDT MATHIAS BERGER

Satoshi Yamaguchi, President, Kuraray Noritake Dental Inc.

KURARAY NORITAKE DENTAL INC. EXCELS IN DENTAL TECHNOLOGY, FOCUSING ON STRENGTH, AESTHETICS AND GLOBAL ADAPTABILITY

Kuraray Noritake Dental Inc., a leader in dental materials and technology, blends innovation with a deep commitment to oral health. Established from the merger of Kuraray Medical Inc. and Noritake Dental Supply Co., Limited, the company excels in providing dental bonding agents, fillings, cements, porcelains, zirconia and CAD/CAM blocks. This synergy has allowed the company to push the boundaries of dental science.

“We aim to enhance global oral health and wellness.”

President Satoshi Yamaguchi highlights the company's approach: "We focus on strength, aesthetics and speed in our products. By developing our own zirconia powder and partnering with CAD/CAM system manufacturers, we achieve high-quality, durable and efficient dental solutions." This commitment is evident in the firm's flagship product, KATANA™ Zirconia Block, renowned for its durability and aesthetic appeal.

Kuraray Noritake Dental is also striving to develop new products for more longterm predictable dental treatment with bioactive properties. The company is not just focused on developed markets like the U.S. and Europe. Mr. Yamaguchi explains: "Understanding local treatment situations is key. In addition to the U.S. and Europe, having sales offices in places like Brazil and China helps us tailor our products to regional demands." This global presence ensures the company remains at the forefront of dental technology, adapting to diverse market needs.

Tooth crown made from KATANA™ Zirconia

Looking ahead, Mr. Yamaguchi envisions Kuraray Noritake Dental as more than just a technological innovator. "In five years, I hope we are seen not only as a tech company but as a holistic provider of oral care solutions," he says. With a commitment to reducing "invisible stress" for dental professionals and patients, the company aims to enhance global oral health and wellness.Original article published in Newsweek Magazine on September 20th, 2024 Written by The Worldfolio

Article by Dr. Florian Zwiener

Modern multi-layered zirconia such as KATANA™ Zirconia STML (Kuraray Noritake Dental Inc.) already meets high aesthetic demands due to its natural colour gradient and high translucency. To achieve further characterisation and optical adjustment to the adjacent teeth, there are essentially two options: veneering with feldspathic ceramic or glazing and individualisation with ceramic stains.

While there are still many indications for veneering, especially in the anterior area, more and more cases can now be solved with monolithic restorations. This allows for a time-efficient chairside workflow with same-day treatment, eliminating the need for temporary restorations. Additionally, the absence of a porcelain layer reduces the wall thickness of the restoration and thus the space required, allowing for less invasive preparation. This also reduces the risk of endodontic complications induced by tooth preparation (grinding trauma). Another advantage is a significant reduction in the chipping risk.

Below are the essential steps for individualisation using ceramic stains, demonstrated through the example of a molar crown.

PREPARATION

The restoration is designed in full contour as usual, ideally dry-milled, and then sintered. After sintering, the restoration is first sandblasted (aluminium oxide 50 μm, 1 to 1.5 bar pressure). This microscopic roughening of the ceramic surface enables an optimal bond with the glaze. Subsequently, the restoration should be cleaned using a steam cleaner or an ultrasonic cleaner to remove all blasting residue.

The functional restoration surfaces must then be polished to avoid the risk of excessive abrasion on the enamel of the opposing dentition, as zirconia is harder than enamel. Following this, optional glazing and characterization with ceramic stains can be performed. However, for areas not in the aesthetic zone, such as the palatal surfaces of maxillary anterior teeth, this is not necessarily required.

PREPARATION: STEPS AT A GLANCE

1. Sandblasting of the sintered restoration (Al2O3 50 μm, 1-1.5 bar)
2. Cleaning (steam cleaner or ultrasonic cleaner)
3. Polishing the occlusal/palatal contact areas

Fig. 1. Sintered and sandblasted zirconia crown.

Fig. 2. Occlusal high-gloss polish.

Fig. 3. TWIST™ DIA for Zirconia (Kuraray Noritake Dental Inc.) enables efficient polishing of zirconia in three steps.

STAINING AND GLAZING

The shades A+, B+, C+, and D+ of the paste-like ceramic stain CERABIEN™ ZR FC Paste Stain (Kuraray Noritake Dental Inc.) enhance the chroma in the cervical area when applied in the respective tooth shade. They are used to strengthen the multicolour effect of the zirconia or to darken the restoration overall. By mixing the stains with glaze or clear glaze in different ratios, the intensity can be adjusted.

Cervical 1 and 2 are suitable for replicating exposed cervical areas or discolouration. Cervical 1 is also useful for marking fissures, as it gives the crown depth and structure without appearing overly dark. Patients typically reject excessively pronounced fissure effects. Since fissure areas in multi-layered materials generally lie in the lightest part of the block (in the enamel layer), it may make sense to darken them slightly with A+, while white hypermineralisations can be replicated on the cusp tips. A narrow band of Grayish Blue below the cusp tips creates an optical translucency effect. In cases where this translucency appears too dark blue or greyish, mixing Grayish Blue with Dark Grey can modify the appearance.

By mixing various colours, numerous different tones can be created. For instance, by adding Yellow to A+, its slightly brownish colour can be adjusted to a warmer, more yellowish tooth shade. It is generally advisable to capture the patient‘s tooth shade with a photo and a custom-made colour ring of the corresponding material before preparation. This can serve as a reference during production, especially in the laboratory, where lighting conditions may differ.

For pronounced characterisations or fine details, it may be necessary to carry out multiple firings to avoid unwanted running effects between the colours and the glaze. This is particularly recommended when replicating anatomical details with high sharpness, such as enamel cracks or local discolourations. For this, a glaze and base shade are first applied and fired, and finer structures are added in a second firing. Alternatively, a fixative firing of the stains without glaze can be performed first, with only a glaze layer fired in the second step. A benefit of CERABIEN™ ZR FC Paste Stain is that its appearance during application closely matches the final firing result. In thick consistency, glaze can also be used to easily rebuild missing proximal contacts.

STAINING AND GLAZING: STEPS AT A GLANCE

1. Glaze with Glaze/Clear Glaze
2. Increase chroma (in the cervical area or over large areas) with A+, B+, C+, or D+
   - Adjust intensity by mixing with Glaze/Clear Glaze
   - Create a warmer tone by mixing with Yellow
3. Replicate discolouration/exposed cervical areas: Cervical 1 and 2
4. Customise fissure areas
   - Darken with A+, B+, C+, or D+
   - Accentuate fissures with Cervical 1
5. Customise cusp tips
   - Replicate hypermineralisations with White
   - Create a band below with Grayish Blue (translucency effect)
   - Adjust translucency effect below cusp tips by mixing with Dark Grey
6. Firing

Alternatives:

1. First firing: Glaze plus base shade, second firing: Finer structures
2. First firing: Fixative stain firing without glaze, second firing: Glaze firing

Fig. 4. CERABIEN™ ZR FC Paste Stain assortment for the practice laboratory.

Fig. 5. Discoloured fissures can be accurately replicated with an ISO10 endodontic file.

Fig. 6 and 7. Glazing and staining in one firing.

Fig. 8. Shade determination using a custom-made KATANA™ Zirconia STML colour ring (A3.5).

Fig. 9. Bridge made from KATANA™ Zirconia STML, sandblasted and occlusally polished.

Fig. 10. Finished glazed and characterised restoration.

Fig. 11. Bridge 14-16 in place.

FINAL SITUATION

Fig. 11. Bridge 14-16 in place.

Dentist:

FLORIAN ZWIENER

AV Dr. Clarence Tam, HBSC, DDS, AAACD, FIADFE

Anvendelse av skallfasetter av porselen for å forbedre form, farge og stilling på fortenner er en vanlig teknikk innen estetisk tannbehandling. Det biomimetiske målet ved tannrestaurering er ikke bare kosmetisk, men også funksjonelt. Det er avgjørende å huske på at det intakte emaljeskallet palatinalt og buccalt på anteriore tenner er ansvarlig for deres medfødte bøyestyrke. Når tannstrukturen er skadet ved endodontisk behandling, karies eller traumer, må ingen anstrengelser skys når det gjelder å bevare gjenværende tannstruktur og etterstrebe å gjenopprette eller øke styrken så den er på linje med en intakt tann.

BAKGRUNN

En 55 år gammel kvinnelig pasient tok kontakt på klinikken fordi hun ønsket å bleke tennene. Hun ble forklart at blekingen ikke ville ha effekt på en eksisterende skallfasett på 12. Denne ville måtte byttes ut etter blekingen. Pasientens utgangsfarge var VITA* 1M1 og 2M1 (på gingivale halvpart) Blekeprotokollen var nattbleking med 10% karbamidperoksid i 3-4 uker. Fargen var da VITA* 0M3 både på overkjeve og underkjeve. Det var derfor en vesentlig fargeforskjell på 12 og de øvrige tennene. Dessuten var en klasse III komposittfylling på 22 blitt mere synlig. Tann 22 matchet heller ikke 12 i dimensjon, og det ble derfor besluttet å fremstille skallfasetter av litium disilikat på begge lateraler. Tann 23 hadde mild attrisjon på cuspen, men pasienten ønsket ingen behandling av dette på det nåværende stadium. Behandlingen besto derfor i å etablere bilateral harmoni, for så å gjenopprette buccal kontur og cusp på 23 i nær fremtid.

BEHANDLINGEN

En digital smile design protokoll var ikke nødvendig for denne behandlingen, som besto i å behandle lateralene. En viss individuell og kjønnsbasert variasjon er vanlig for disse tennene. Før LA ble fargen for restaureringen tatt ut ved hjelp av fotos i polarisert og upolarisert lys.

Fig. 1. Referansefoto med 18% nøytral grått kort.

Grunnfargen (body) var Vita OM2 med en blokkfarge BL2. Pas ble bedøvd med 1,5 karpule med 2% Lignocaine med 1:100,000 adrenalin, før kofferdam ble satt på.(Split dam teknikk). Skallfasetten på 12 ble spaltet og fjernet fra tannen, og en minimal invasiv preparering gjort ferdig på 22 (Fig.2). Det ble gjort en delvis utskifting av den gamle komposittfyllingen mbp på12. Adhesjon til gammel kompositt ble oppnådd både ved sandblåsing og en silan (CLEARFIL™ CERAMIC PRIMER PLUS. Prepareringsgrensene ble frisket opp, og retraksjonstråd dyppet i aluminiumklorid-løsning ble pakket i sulcus. Fargen på de preparerte tennene ble notert. Endelig avtrykk ble tatt med light-body og heavy-body silikonmateriale i metall-skje. Pasienten fikk temporære restaureringer og fikk beskjed om å få fargen bekreftet på laboratoriet (grovbrent). Modellene som er fremstilt på laboratoriet bekrefter den minimal invasive fremgangsmåten.

Fig. 2. Preparering for skallfasetter på 12 og 22.

Da arbeidene kom fra laboratoriet, ble pas. bedøvd og provisoriene ble fjernet. Prepareringene ble rengjort og forberedt for bonding ved sandblåsing med 27 mikron aluminiumoksid-pulver med trykk på 30-40 psi. Skallfasettene ble prøvd på plass med innprøvingspasata (PANAVIA™ V5 Tryin- Paste Clear, Kuraray Noritake Dental Inc.). Retraksjonstråder ble plassert og adhesiv overflate på restaureringene ble behandlet med 5% flussyre i 20 sek. før silanet (CLEARFIL™ CERAMIC PRIMER PLUS) ble applisert. (Fig. 3). Tannoverflaten ble etset med 33% fosforsyre i 20 sek. og skylt. En primer med MDP (PANAVIA™ V5 Tooth Primer) ble så applisert på tannen (Fig. 4) og lufttørket som beskrevet i bruksanvisningen. Så ble sementen (PANAVIA™ Veneer LC Paste Clear) (Fig. 5) applisert og skallfasetten ble satt på plass. Overskuddssementen hadde en ikke-rennende konsistens og holdt skallfasetten på plass mens kanttilpasning ble sjekket, og ble så raskt lysherdet i 1 sek. (tack cure) (Fig.6).

Fig. 3. CLEARFIL™ CERAMIC PRIMER PLUS ble applisert på de flatene som skulle bondes.

Fig. 4. PANAVIA™ V5 Tooth Primer applisert på etsede tannflater.

Fig. 5. PANAVIA™ Venneer LC Paste Clear appliseres på skallfasettens innside.

Fig. 6. PANAVIA™ Veneer LC Paste Clear umiddelbart etter at fasetten er satt på plass. Legg merke til den viskøse, ikkerennende konsistensen som gjør det enkelt å fjerne sementen både i uherdet fase og i gel-fasen.

Sementen forvandles til gel-form, noe som gjør fjerning av overskudd og rengjøring av restaureringen mye enklere (Fig. 7). Kantene på restaureringen dekkes med en klar glycerin-gel før endelig herding for å eliminere oksygeninhibisjon. (Fig. 8).

Fig. 7. Fjerning av overskudds-sement etter lysherding i 1 sek. (tack-cure)

Fig. 8. Sluttherding av skallfasetter samtidig buccalt fra og palatinalt fra.

Kantene pusses til høyglans og restaureringene sjekkes i okklusjon og artikulasjon. Postoperative bilder viser usynlige skjøter (Fig. 9).

Fig. 9. Postoperativ estetisk tilpasning av skallfasetter på 12 og 22.

Vurdering med foto i polarisert lys viser at restaureringene er integrert både estetisk og funksjonelt (Fig. 10), Nå venter estetisk forbedring av tann 23 for å matche 13.

SLUTTRESULTAT

Fig. 10. Endelig resultat vurdert i polarisert lys.

Dentist:

CLARENCE TAM

References

1. Magne P, Douglas WH. Rationalization of esthetic restorative dentistry based on biomimetics. J Esthet Dent. 1999;11(1):5-15. doi: 10.1111/j.1708-8240.1999.tb00371.x. PMID: 10337285.
2. Magne P, Douglas WH. Porcelain veneers: dentin bonding optimization and biomimetic recovery of the crown. Int J Prosthodont. 1999 Mar-Apr;12(2):111-21. PMID: 10371912.
3. Pongprueksa P, Kuphasuk W, Senawongse P. The elastic moduli across various types of resin/dentin interfaces. Dent Mater. 2008 Aug;24(8):1102-6. doi: 10.1016/j.dental.2007.12.008. Epub 2008 Mar 4. PMID: 18304626.
4. Source: Kuraray Noritake Dental Inc. Samples (beam shape; 25 x 2 x 2 mm): The solvents of each material were removed by blowing mild air prior to the test.

Article by Dr. Michał Jaczewski

Komposittrestaureringer er den vanligste prosedyren som tannleger utfører. Det er mange teknikker og materialer som brukes innen restaurerende tannbehandling. Uavhengig av hvilke materialer og teknikker som brukes, er luftblærer inne i- eller på overflaten av komposittlagene et vanlig problem. Komposittrestaureringen bør være homogen for å sikre at fyllingen er tett og holdbar. Reparasjon av luftblærer er omstendelig og ofte kreves det at hele eller deler av fyllingen erstattes. Avhengig av type kompositt (flow eller vanlig) og/eller teknikken ved legging, vil antall defekter variere, men det er flere årsaksfaktorer.

Ved Flowable Injection Technique bruker vi flytende kompositt. Denne flyter selvfølgelig lett, men er også følsom for feilaktig applisering. Den første årsaken til at luftblærer oppstår, ligger i selve materialet. Blærer kan inkorporeres i sprøyten under fremstillingen eller ved appliseringen. Ved å bruke førsteklasses produkter kan vi være trygge på at både materialet og sprøyten er av en slik kvalitet at dannelsen av luftblærer inne i materialet reduseres så mye som mulig.

CLEARFIL MAJESTY™ ES Flow kompositt er designet for å forhindre dannelse av luftblærer under appliseringen. Den spesielle utformingen av sprøyte og stempel begrenser faren for drypping eller tilbakestrømming av materiale under eller etter applisering.

En unik sikkerhetsdetalj er den spesielle o-ringen inne i sprøyten som forhindrer at materialet fortsetter å komme ut etter at trykket på stempelet opphører og samtidig hindrer for stor tilbaketrekking  av stempel og materiale.

En annen årsak til luftblærer er at luft suges inn i sprøyten fordi stempelet trekkes tilbake av operatøren etter at materialet er applisert. Dette vil ganske sikkert suge luft inn i sprøyten slik at det vil dannes luftblærer ved neste gangs bruk.

Til Flowable Injection Technique bruker vi en silikonindeks som vi sprøyter komposittmaterialet inn i. Indeksen skal passe nøyaktig til tannen, og skal ikke kunne bevege seg under injeksjonen. Hvis den gjør dette, kan det dukke opp luftblærer. Å trykke og så slippe indeksen vil gi en sugeeffekt og trekke kompositten bort fra både indeksen og tannen. For å unngå defekter, må indeksen utsettes for konstant trykk fra det øyeblikket kompositten injiseres til den er ferdig polymerisert.

Forskjellige modifikasjoner av silikonindeksen kan brukes for å redusere mobiliteten og risikoen for ukontrollert press mot tannen. Et eksempel er en indeks som er laget på en modell hvor annenhver tann er vokset opp. Denne har en høy grad av stabilitet.

En annen grunn til at man får luft inn i restaureringen, er størrelsen på injeksjonskanalen. Hvis hullet er for trangt, vil indeksen kunne bevege seg når spissen på sprøyten settes inn eller under injeksjonen. For å unngå dette, må kanalen utvides så mye at spissen kan føres inn og beveges litt under injeksjonen. En videre kanal tillater også at luft kan unnslippe under appliseringen av kompositt. Viktigst er det imidlertid å injisere med jevnt trykk og å unngå å trekke ut og sette inn spissen under injeksjonen. Dette kan resultere i et komposittlag som ikke er ensartet.

Dentist:

MICHAL JACZEWSKI

Michał Jaczewski ble uteksaminert ved Wroclaw Medical University i 2006 driver i dag sin egen privatpraksis i byen Legnica, Polen. Han har minimal invasiv tannbehandling og digital tannbehandling som spesialfelt, og er grunnlegger av Biofunctional School of Occlusion. Her foreleser han og holder arbeidskurs med fokus på totalbehandling av pasienter.

CLEARFIL MAJESTY™ ES FLOW RECEIVES “NIOM TESTED” QUALITY SEAL

Before being allowed to market a dental composite filling material, it must, among other things, meet the set standards within ISO 4049:2019 Dentistry - Polymer-based restorative materials. Prompted by the tremendous positive response Kuraray Noritake Dental Inc. received from users of the CLEARFIL MAJESTY™ ES Flow series, we asked the Nordic Institute of Dental Materials (NIOM), an independent research institute, to test this product line on key aspects within the said ISO standard.

While it was not mandatory for us to have the CLEARFIL MAJESTY™ ES Flow series tested, our confidence in the quality of our product prompted us to do so. NIOM thoroughly evaluated CLEARFIL MAJESTY™ ES Flow in all three different levels of flowability: High, Low, and Super Low (Fig. 1). Among the properties assessed were depth of cure, flexural strength, water sorption and solubility, and colour stability after irradiation and water sorption. NIOM found that regarding all properties, the three flowabilities and different shades proved to comply with the requirements.

We are pleased to have gone the extra mile and proud that an independent party verified that our product meets the stringent ISO standards.

Fig. 1. CLEARFIL MAJESTY™ ES Flow in its three different levels of flowability.

IMPLICATIONS FOR CLINICAL USE

These test results are an external proof for users of the popular flowable composite series that they safely can be used as specified by Kuraray Noritake Dental Inc. in the product’s instructions for use. The NIOM test results obtained regarding the depth of cure imply that, when applied to the recommended layer thickness, the composite will polymerise adequately – which is essential for a great long-term performance. In addition, all three flowabilities offer sufficient strength and water sorption/solubility behaviour even to be suitable for restorations, including the occlusal surface of molars and pre-molars. This means that the materials are very well suited for a wide range of indications, including restoring all cavity classes and repairing existing restorations and cementing (Fig. 2).


Fig. 2. Three variants of CLEARFIL MAJESTY™ ES Flow and the suggested use areas.

GREAT AESTHETICS AND HANDLING

On top of these well-balanced mechanical properties, CLEARFIL MAJESTY™ ES Flow in its innovative syringe handles well due to an easy dispensing, bubble-free application, easy sculpting facilitated by its non-sticky formulation, and easy polishing behaviour. Coming in a variety of shades (Fig. 3) and equipped with proprietary Light Diffusion Technology, the material in its three different levels of flowability blends nicely and effortlessly with the surrounding tooth structure, creating a natural overall look. Both handling and aesthetics have been rated very good to excellent by dental advisor consultants in the context of a clinical evaluation.

Fig. 3. Overview of shades available per flowability.

NIOM also provides proof of the positive aesthetic properties: the institute's tests to evaluate colour stability after irradiation and water sorption reveal that CLEARFIL MAJESTY™ ES Flow is expected to remain stable over time. This feature is important for the long-term aesthetics of the restorations created with the materials.

Choose a reliable, high-quality, flowable, direct restorative material that withstands rigorous testing.

Artikkel av prof. Lorenzo Breschi

Færre flasker, flere valgmuligheter- dette er antagelig den enkleste måten å beskrive universal resinsementer på. Fordi de er selvadhesive, muliggjør disse dualherdende, resinbaserte sementene en én-komponent arbeidsoperasjon uten behov for separate primere hverken for tann eller restaurering. I mange tilfeller vil bindingsstyrken man da oppnår være tilstrekkelig høy. Den er imidlertid noe lavere enn den som oppnås med konvensjonelle resinsement-systemer som består av flere komponenter (typisk tannprimer, resinsement og primer for restaureringen). 

Bortsett fra den selvadhesive bruksmåten, kan  universal-resinsementer kombineres med tilleggskomponenter for å øke bindingsstyrken til respektive tannvev og restaureringsmaterialer. Dette åpner opp for nye muligheter for bruk av materialene. Hvis økt bindingsstyrke er nødvendig eller ønskelig, kan universal-resinsementen brukes alene eller i kombinasjon med primer for tann eller restaurering, eller begge deler. I tillegg er hybridkonsepter gjennomførbare slik som det forklares i denne artikkelen hvor PANAVIA™ SA Cement Universal (Kuraray Noritake Dental Inc.) er brukt som eksempel

Selvadhesiv sementering: For mange indikasjoner

PANAVIA™ SA Cement Universal er en dual-herdende universal resinsement som er indisert for et bredt bruksområde når den brukes i selvadhesiv modus. Bindingen som etableres til restaureringsmaterialer (inkludert silikatkeramer) er sterk selv uten bruk av separat primer eller silan. Dette skyldes to forskjellige adhesive monomerer som inngår i materialet, original MDP og LCSi Monomer (en silankoblende forbindelse med lang karbonkjede som binder sterkt til silikatkeramikk). Derfor er det mulig å bruke resinsementen uten noen ekstra komponenter for binding til restaureringen, også i kasus med dårlig retensjon og derav følgende høye krav til bindingsstyrken.

En sterk binding til emalje og dentin oppnås også i selvadhesiv modus. I noen situasjoner kan det likevel være nyttig å øke bindingsstyrken til tannsubstans ytterligere ved bruk av en tann-primer.

Adhesiv sementering: For utfordrende kasus.

Tannprimeren som anbefales for PANAVIA™ SA Cement  Universal er CLEARFIL™ Universal Bond Quick (Kuraray Noritake Dental Inc.). Denne brukes når behandler føler behov for en ekstra sterk kjemisk binding , f.eks. ved dårlig retensjon.Effekten av dette har blitt bekreftet i in vitro studier utført i Japan hvor 24 timer micro tensile bond strength til dentin øker vesentlig ved bruk av denne tannprimeren. Imidlertid øker kravet til et fullstendig tørt arbeidsfelt når primer brukes. Årsaken er at toleransen for fukt er høyere for resinsementer enn for bondinger. Derfor er kofferdam sterkt anbefalt.

Selektiv adhesiv sementering: For korte pillarer og subgingivale prepareringsgrenser.

For de tilfellene da det er vanskelig å få på kofferdam, er en tredje bruksmodus tilgjengelig og anbefalt av en gruppe italienske forskere: nemlig Selektiv Adhesiv Sementering. I dette tilfellet appliseres CLEARFIL™ Universal Bond Quick bare på de deler av preparert tann hvor det er mulig å kontrollere fuktigheten, mens man stoler på adhesiviteten til PANAVIA™ SA Cement Universal i de områder hvor det er vanskelig å oppnå et tørt arbeidsområde. Eksempler på dette kan være subgingivale prepareringsgrenser eller svært korte pillarer hvor det er vanskelig å bruke kofferdam.

Effektiviteten av selektiv adhesiv sementering  har blitt verifisert i en in vitro studie som sammenlignet de tre strategiene selvadhesiv, fulladhesiv og selektiv adhesiv sementering. Resultatet av testen viser at det er mulig å øke bindingsstyrken for PANAVIA™ SA Cement Universal til emalje og dentin ved å applisere adhesiv (i denne studien CLEARFIL™ Universal Bond Quick), til bare deler av tannoverflaten. I denne studien ble resultatet noenlunde likt for fulladhesiv og selektiv adhesiv tilnærming.

For situasjoner hvor skikkelig isolasjon av arbeidsfeltet med kofferdam er vanskelig, kan man benytte en tredje behandlingsvariant som anbefales av en gruppe italienske forskere, nemlig Selektiv Adhesiv Sementering.

ANBEFALTE TRINN FOR SELEKTIV ADHESIV SEMENTERING

Fig. 1: Preparering av tennene.

Fig. 2: Selektiv ets av emalje med fosforsyre.

Fig. 3: Applisering av adhesiv og lufttørring.

Fig. 4. Plassering av kroner etter at de er fylt med resinsement.

Fig. 5. Kortvarig herding (tack-cure).

Fig. 6. Fjerning av overskudd og endelig lysherding.

Fig. 7. Behandlingsresultat ved recall etter 1

Fordeler med selektiv adhesiv sementering

Bortsett fra den økte  (langtids) bindingsstyrken som oppnås ved å applisere en separat adhesiv til deler av den preparerte tannflaten, har teknikken i tillegg andre fordeler. Sammenlignet med multi-step  sementerings-systemer, er protokollen forenklet siden det ikke er nødvendig med noen separat primer for restaureringen. Lysherding av adhesiven er unødvendig så lenge man holder seg til det anbefalte systemet. Dessuten er det ikke nødvendig med kofferdam. Slik sparer man stol-tid, og det er mer komfortabelt for pasienten.

Konklusjon

Avhengig av indikasjon, kliniske variabler og individuelle preferanser, kan brukere av universale resinsementer som PANAVIA™ SA Cement Universal, velge den teknikken som sannsynligvis vil gi det beste kliniske resultatet. Det er denne fleksibiliteten og det brede indikasjonsområdet som gjør denne innovative produktetkategorien universell. Med færre komponenter gir universalmaterialer en strømlinjeformet og standardisert klinisk prosedyre. Og færre flasker å lagre og holde styr på, gjør det lettere å ha kontroll over lagerbeholdningen, også.

Dentist:

LORENZO BRESCHI

Prof. Lorenzo Breschi is Professor er Restorative Dentistry and Dental Materials ved University of Bologna. Han er aktiv innern forskning på ultrastrukturelle aspekter ved emalje og dentin. Han er Past-President i Academy of Dental Materials (ADM), President-Elect i European Federation of Conservative Dentistry (EFCD), President-Elect i Dental Materials Group IADR, President-Elect i Italian Academy of Conservative Dentistry (AIC), President-Elect i International Academy of Adhesive Dentistry (IAAD). 

References

1. Cowen M, Cunha S, Powers JM. Novel Cement Bond Strength to Multiple Substrates. DENTAL ADVISOR Biomaterials Research Center, Biomaterials Research Report, Number 132 – June 16, 2020.
2. Patel N, Anadioti E, Conejo J, Ozer F, Mante F, Blatz M. Bond Strength of Different Self-Adhesive Resin Cements to Zirconia” (2021). Dental Theses. 62. https://repository.upenn.edu/dental_theses/62.
3. Yoshihara K, Nagaoka N, Maruo Y, Nishigawa G, Yoshida Y, Van Meerbeek B. Silane-coupling effect of a silane-containing self-adhesive composite cement. Dent Mater. 2020 Jul;36(7):914-926.
4. Irie M, Tokunaga E, Maruo Y, Nishigawa G, Yoshihara K, Nagaoka N, Minagi S, Matsumoto T. Shear bond strength of a resin cement to CAD/CAM Blocks for molars. P-2, 37th Annual Meeting of the Japanese Society of Adhesive Dentistry 2018.
5. Ohara N. Bonding strength of resin cement containing silane coupling agent to dentin or core resin. Results presented at the 150th meeting of the Japanese Society of Conservative Dentistry.
6. Breschi L, Josic U, Maravic T, et al. Selective adhesive luting: A novel technique for improving adhesion achieved by universal resin cements. J Esthet Restor Dent. 2023;1-9. doi:10.1111/jerd.13037.

Technical Specialist for Chairside, Volkan Kacmaz, Introduces Himself

Volkan Kacmaz not only worked as a dentist in Turkey, but he also managed two clinics and earned a Master of Business Administration in Berlin. His diverse experiences seem to have led him to his current role as a Technical Specialist at Kuraray Noritake Dental Inc., headquartered near Frankfurt. Who is this friendly, smiley, and curious team member, and why did he specifically choose Kuraray?

While most dentists continue practicing dentistry throughout their careers, Volkan Kacmaz chose a different path. After graduating in 2011, he established his own dental clinic in Istanbul. A few years later, he served in the military for a year as a military dentist. Afterward, he founded two more franchise clinics, taking on the dual roles of manager and dentist. It was during this time that he realized dentistry wasn’t limited to clinical practice. “I’m eager to learn and have always been curious about how products work, the processes behind them, research and development, and the launch of new innovations,” he explains.

INNOVATION

In 2022, Kacmaz became the first dentist to enrol at the Berlin School of Economics and Law, where he learned about marketing, sales, negotiation, and regulations. Upon completing his Master of Business Administration, he made a deliberate decision to join Kuraray Noritake. “Kuraray Noritake's products are of very high quality, both labside and chairside. I already knew this from my experience as a dentist. The company has an excellent and trustworthy reputation among dental professionals,” he says.

Kacmaz also admires the innovative nature of the company. “Kuraray Noritake is responsible for some of the most significant innovations in dentistry. Just look at products like PANAVIA™ cement, the original MDP monomer, and multi-layered zirconia discs and blocks. It’s easy to see that Kuraray Noritake is a major force in the dental market. With their commitment to continuous improvement and innovation, you could call them the Apple of the dental world,” he adds.

Another aspect Kacmaz appreciates is Kuraray Noritake's product lineup. “The catalog isn't extensive, but it’s highly specialized. The company doesn’t produce just any product, but focuses on the ones it excels at, ensuring top-notch quality.” Lastly, Kacmaz loves the company culture. “It's a very respectful environment. I’ve had some bad experiences with respect in the past,” he says with a laugh, referring to his time in the military. “But at Kuraray Noritake, you can feel the respect for employees, which is very important to me. I’m very happy to be part of the Kuraray Noritake family.”

COURAGE

When comparing dentistry in Turkey to Western Europe, Kacmaz doesn’t see significant differences. “The brands, quality, and approaches are all the same.” However, he has noticed one small distinction: German dentists aren’t as enthusiastic about digital dentistry as their Turkish counterparts.

Kacmaz draws on all his previous experiences and knowledge in his role as part of the scientific marketing team. His responsibilities include finding scientific support for marketing initiatives. He collaborates with lecturers and dentists to manage research studies using Kuraray Noritake products, works to update measurements in response to market dynamics, and evaluates new products.

His goal? “To become an authority in the dental world,” he says with a smile. It may sound like an ambitious goal, but Kacmaz has learned to dream big. “The biggest decision of my life was leaving my comfort zone and moving to a country where I didn’t speak the language. But I believe it’s a courage you have to show. If you don’t, your dreams and plans will fade, and you’ll miss out on everything.”

LEARNING NEW THINGS

Moving to Germany, which Kacmaz describes as "the epicentre of the dental market," hasn’t always been easy. Coming from a Mediterranean culture, he was used to a more communal and lively environment. In Germany, he noticed that shops close early, and people value their privacy. Another challenge has been the language. While he prefers English, he says, “ein bisschen Deutsch, nicht so gut.”  Fortunately, Kuraray Noritake provides him with German lessons, and he has the best teacher at home—his three-year-old daughter, who learns the language faster than he does and sometimes corrects him.

Despite the challenges, all the adapting and hard work have been worth it. “I’ve realized that there are no limits to learning. Whether you’re in your 40s, 50s, or even 60s, there’s always something new to discover. You just have to be open to it.”

CONTACT

Volkan Kacmaz can be reached at +49 69 305 35134 or via [email protected].

ABOUT KURARAY NORITAKE DENTAL INC.

Kuraray was founded in 1926 in Kurashiki, Japan. Today, it is a leading global manufacturer of medical products, materials, textiles, chemicals, resins, and more. In 2012, Kuraray Medical and Noritake Dental Supply merged to form Kuraray Noritake Dental Inc. The company continues to deliver reliable dental bonding agents, ceramics, and other products to over 90 countries worldwide. Well-known products include the KATANA™ Zirconia range, CLEARFIL™ Universal Bond Quick, and PANAVIA™ resin cements.