BEHIND-THE-SCENES OF NIIGATA FACTORY

Take a tour of Kuraray Noritake Dental Inc.'s state-of-the-art Niigata Plant, where high-quality dental materials come to life.

This fascinating video highlights our meticulous production process, from initial R&D to final inspections, showcasing the care and precision that go into creating bonding agents, composite resins, and cements. Learn how strict hygiene control, advanced machinery, and skilled craftsmanship ensure a consistent supply of premium dental materials to over 90 countries worldwide.

Watch the video to discover how innovation and dedication drive better oral health for people around the globe!

This year, the Kuraray Noritake Dental stand will be packed with news from the world of dentistry, so we offer not just one reason to visit, but a whole range: new chairside products, new labside products, inspiring lectures, enlightening hands-on demonstrations… And the best thing? You don´t have to choose just one thing, come and see them all at the Kuraray Noritake Dental booth in Hall 11.3 | Stand E010!

Chairside – smart streamlined solutions

When it comes to a dental practice, our vision is clear: a world where your materials and tools work seamlessly in your hands, where complexity is minimized, and where you are given enough time to focus on what matters most: the individual desires and needs of every single patient. This is the future of dentistry - and we are leading the way. Come discover our new additions to the UNIVERSAL EXCELLENCE family: a flowable universal composite and a new generation of a universal bond!

Labside – speed and aesthetics hand in hand

No matter whether a minimally invasive procedure or the best aesthetic outcomes are desired: Kuraray Noritake Dental has the products for you. New in the portfolio: CERABIEN™ MiLai - low-fusing porcelains and internal stains. Come and see for yourself its ultra-thin layering, exceptional mechanical properties and consistent handling for both zirconia and lithium disilicate. And while you're there, have a coffee while speed-sintering with our KATANA™ Zirconia discs takes place in real time.

Get inspired by 12 expert speakers on 2 stages

Are you a user of or interested in one of Kuraray Noritake Dental’s products or solutions, but eager to learn more about their practical use from proven experts in your field? From Wednesday until Saturday, we offer a programme of exciting lectures and live demonstrations - this time simultaneously on two stages: one dedicated to chairside and the other one to labside topics!

Warm welcome

Everyone, from sales person to scientific marketeer, looks forward to giving you a warm welcome, answering your questions and introducing you to the world of innovative Kuraray Noritake Dental products, solutions and workflows. And while you are already in Cologne anyway, why not enjoy the breathtaking beauty of the old town? Have you ever seen its famous Gothic Cathedral? Or its Old Town inviting you to stroll through its narrow alleys, finding traces of history around every corner? This year's IDS offers so many reasons to attend that it's hard not to accept the invitation.

Additional information and the full programme of lectures and hands-on courses at the IDS is available online.

Discover a detailed walkthrough of an advanced shade reproduction technique with this comprehensive guide by DT Tomáš Forejtek. Tailored for professionals working with CERABIEN™ ZR ceramics (Kuraray Noritake Dental Inc.) and the eLAB protocol, this case study provides step-by-step insights into achieving exceptional results, from documentation to shade selection and framework design to final polish. Whether you are refining your craft or exploring new methods, this resource is a valuable addition to your toolkit.

Article by Peter Schouten

Ceramic primers vary widely in composition and effectiveness, despite what their name might suggest. Most common primers include silane, but silane alone is insufficient for pre-treating all materials commonly used in indirect restorations before bonding.

Silane—typically in the form of γ-MPS—has a strong affinity for silica- or glass-based materials. While certain metals and their oxides can chemically react with silane, other components provide a stronger and more reliable bond to metals and metal oxides and should be seriously considered.

For metal(oxide) pretreatment in bonding, the MDP monomer is far more reactive than silane. The original MDP monomer, developed by Kuraray Co., Ltd. in 1981, remains the highest-quality MDP available, as confirmed by research.¹

CLEARFIL™ CERAMIC PRIMER PLUS is a single-component adhesive primer that forms strong bonds with a wide range of restorative materials. This two-in-one primer incorporates the original MDP monomer, which establishes a robust bond with metals and zirconia. Simultaneously, the silane coupling agent (γ-MPS) ensures excellent adhesion to resin composites, hybrid ceramics, and glass-based ceramics such as lithium disilicate and porcelain.

ENHANCED BOTTLE DESIGN

The primer bottle is designed for effortless one-handed operation. Its unique nozzle ensures precise dispensing, minimizing the risk of contamination and spills.

PROVEN EFFECTIVENESS OF MDP-CONTAINING PRIMERS

To enhance the bonding of prosthetic materials, use a primer containing both MDP and silane. Numerous studies have demonstrated the effectiveness of this combination.

OPTIMAL PRIMING FOR ADHESIVE CEMENTING

These studies underscore the critical role of MDP-containing primers in achieving reliable and durable adhesion for prosthetic materials. Products containing only silane, such as RelyX™ Ceramic Primer (3M ESPE), are less effective at creating a durable bond between resin cements or composites and ceramic- or metal-based prosthetic materials.

Image from clinical case by MDT Rondoni and Dr. Attanasio

STRAIGHTFORWARD AND EFFICIENT

The use of CLEARFIL™ CERAMIC PRIMER PLUS is straightforward: just apply it to the bonding surface, dry it, and proceed with the following treatment step. Incorporated into your process to streamline adhesion preparation and achieve reliable results!

JUST APPLY AND DRY

CLEARFIL™ CERAMIC PRIMER PLUS may be applied to any restoration surface after the required pretreatment. Pretreat the adherent surface of the restoration as indicated:

* If your laboratory already treated with a hydrofluoric acid, cleaning and activating with K-ETCHANT Syringe just before applying CLEARFIL™ CERAMIC PRIMER PLUS is recommended.

**When using with PANAVIA™ V5 or CLEARFIL™ DC CORE PLUS

Universal prosthetic primer designed for a strong bond and procedural simplicity

Author:

PETER SCHOUTEN

References

1. Yoshihara K., et al.(2015) Functional monomer impurity affects adhesive performance, Dental Materials, Volume 31, Issue 12, https://doi.org/10.1016/j.dental.2015.09.019. Pilo, R., et al. (2018). “Effect of tribochemical treatments and silane reactivity on resin bonding to zirconia.” Dent Mater 34(2): 306-316.
2. Cao, Y., et al. (2021). The effects of four primers and two cement types on the bonding strength of zirconia. Annals of Translational Medicine. 10. 10.21037/atm-21-4909.
3. Reymus, M., et al. (2019). “Bonding to new CAD/CAM resin composites: influence of air abrasion and conditioning agents as pretreatment strategy.” Clin Oral Investig 23(2): 529-538.
4. Uğur, M., et al. (2023). Effect of ceramic primers with different chemical contents on the shear bond strength of CAD/CAM ceramics with resin cement after thermal ageing. BMC Oral Health. 23. 10.1186/s12903-023-02909-z.
5. Pilo, R., et al. (2018). “Effect of tribochemical treatments and silane reactivity on resin bonding to zirconia.” Dent Mater 34(2): 306-316.
6. Inokoshi, M., et al. (2014). “Bonding effectiveness to different chemically pre-treated dental zirconia.” Clin Oral Investig 18(7): 1803-1812.

THE ART OF RESTORING SMILES: MASTERING THE CHALLENGE OF A SINGLE CENTRAL INCISOR

Restoring a single maxillary central incisor is possibly the biggest challenge a dental technician can face in everyday work. Especially when a patient is young, it is extremely important to restore her or his smile to its original beauty. Any restoration that is perceivable as such might have a negative impact on their self-confidence and quality of life even in the long term.

A STORY OF JOY AND DESPERATION

Take Ioanna, a 14-year-old girl who presented in her dental office in a state of desperation. In the hours before, she had been floating on cloud nine: Her favourite band performed in Cyprus for the first time and she had managed to buy tickets for herself and her best friend. Thrilled, they had arrived at the concert, the band started playing and the crowd danced to the music. It felt like this was going to be the best day of her life. At the time the band played its most popular song, people were delirious, jumping up and down in ecstasy. Between all the exuberant dancing and laughing, however, Ioanna suddenly was hit by a strong push. She fell, her face hitting something hard – a seat in front of her. Pain froze time and it took a few seconds before she understood what had happened: Tasting blood in her mouth, she explored her teeth with her tongue and realized that one of her central incisors had fractured.

AFFECTING THE QUALITY OF LIFE

This is one of the many touching stories we listen to every day. A fall during a concert, a push at somebody’s birthday party, a car accident: There are many incidences that can ruin a young, beautiful smile. By paying attention to the involved patients and their stories, one will come to realize how strongly some of them are affected by all this. They cover their mouths when they laugh or hold back their smiles.

Any dental technician who is committed to restoring their lost smile in the best possible way is probably aware of the impact his or her work can have and the responsibility coming with it: A Beautiful result will restore not only their smile, but also their self-confidence, will let them start laughing happily, expressing themselves comfortably and simply enjoying social interaction again (Figs. 1 to 5). Compromised outcomes, on the other hand, might have the opposite effect. Being aware of this role should be every technician’s motivation to become better day by day. Evolve for these moments, when our work brings tears of joy to our patients.

Fig. 1. Layering sketch for the restoration of a fractured central incisor in three layers: Layer one.

Fig. 2. Layering sketch for the restoration of a fractured central incisor in three layers: Layer two.

Fig. 3. Layering sketch for the restoration of a fractured central incisor in three layers: Layer three. After the first bake, small details were integrated, followed by a second bake. Finally, the restoration was finished with CERABIEN™ ZR FC Paste Stain and Glaze.

Fig. 4. Treatment outcome able to restore not only the smile, but also the self-confidence of the young girl.

Fig. 5. Immediately after cementation of the restoration, the restoration is barely identifiable, only the soft tissue needs some time for recovery.

ASPECTS TO BE CONSIDERED

But how to proceed in restoring single central incisors in the best possible way? The success of this type of restoration is hidden in the shape, which is the most difficult part. Managing to create a natural morphology is more than half the battle. The other important part is colour. The key to reproducing colour is in understanding how the utilized porcelains work. It is all about light reflection, absorption, translucency and opalescence, value and characteristic details. The more you gain experience and understand the optical properties of teeth and ceramics, the better your outcomes will be. Support is offered by a camera, a macro lens and a twin flash, which are used to capture and analyse the intraoral situation. For an initial analysis and understanding of shape and colour, I like to see the patients in my dental laboratory. Feeling the colour helps to develop the most realistic picture of what needs to be created. The key to successful realisation of the plan just developed is the use of reliable, easy-to-handle materials – in my case KATANA™ Zirconia and CERABIEN™ ZR Porcelains (both Kuraray Noritake Dental Inc.).

POSSIBLE STEPS

The first thing to focus on when starting to produce an anterior restoration – like in the case presented in figures 6 to 14 – is the correct value of the tooth. As soon as the framework or base is produced in the right value, you need to place what you see. Does the adjacent tooth show mamelons, traces of blue and orange? Those characteristics simply need to be observed and copied. There is no need to create something fancy. The tricky part is to use the available space reasonably. When there is plenty of space for the porcelain, it may be challenging to keep the value of the framework and avoid a greyish appearance. Depending on the die colour, age of the patient, natural surface texture and space available, an appropriate layering approach and finishing technique may be selected.

Fig. 6. Replacement of an anterior crown: Prepared tooth with severe discolouration. The adjacent central incisor has a special shape and vivid inner colour structure.

Fig. 7. Framework made of KATANA™ Zirconia ML in the shade A3. The target shade being A3.5, a quite opaque material was selected in a slightly brighter shade to achieve the required masking effect.

Fig. 8. Single-bake layering procedure: Application of CERABIEN™ ZR Opacious Body, …

Fig. 9. … Cervical Body, …

Fig. 10. … Body and Transitional Body.

Fig. 11. Incisal cut-back …

Fig. 12. … and creation of the mamelon structure.

Fig. 13. Application of Aqua Blue 1 …

Fig. 14. … followed by T Blue …

Fig. 15. … and Luster Porcelains.

Fig. 16. Halo effect created with Body.

Fig. 17. Treatment outcome. (After a first bake followed by minor adjustments, a second bake, surface texturing and glazing with CERABIEN™ ZR FC Paste Stain Clear Glaze.)

CONCLUSION

Creating a single central takes us out of our comfort zone. By paying attention, observing the adjacent teeth carefully and using materials we really understand, it is possible to meet or exceed our patients’ expectations. While specific tools like cameras and experience with the utilized materials offer support in producing predictable outcomes, my main credo is “If you want things around you to change, you must first change yourself”. For continued improvement, it is thus necessary to focus on professional growth and advancement. With the right mentors who will teach us the secrets of stratification and inspire and motivate us to continue advancing, it becomes easier to restore the smiles and self-confidence of our patients every time they need us to.

Acknowledgements

Special thanks go to the dental practitioners who treated the patients presented above – Andreas Skyllouriotis DDS, MSD, Surgically-Trained Prosthodontist, and Theo Odysseos, DDS, Diplomate, American Board of Oral Implantology / Implant Dentistry.

Dental Technician:

VASILIS VASILIOU

Vasilis Vasiliou was born in Nicosia, Cyprus, and graduated from the Technical School for Dental Technicians in Athens in 2004. He has furthered his education by attending several advanced seminars led by mentors and experts in the field, such as Ilias Psarris and Nondas Vlachopoulos.

Throughout his career, Vasilis has made significant contributions to the dental community, including presenting at various conferences in Greece and publishing articles in Greek dental magazines. Since 2020, he has been a key opinion leader for MPF Brush Company and, since 2022, a HASS Ambassador. Vasilis has been an active member of the International Team for Implantology (ITI) since 2019.

Together with his father, Vasilis runs a successful dental laboratory in Nicosia, specializing in all-ceramic and implant restorations. His extensive experience and commitment to excellence have established him as a respected professional in his field.

Interview with Dr. Efe Celebi

In March 2024, Dr Ahmad Al-Hassiny, Director of the Institute of Digital Dentistry, shared his observations from LMT Lab Day 2024 in Chicago, noting that over 90 percent of U.S. dental laboratories and nearly 50 percent of dental practices have already adopted digital technologies and workflows. These advancements streamline the production of dental models, restorations across various materials, and much more.

Our company Kuraray Noritake Dental Inc. is dedicated not only to developing high-quality products and constantly adapting them to the needs of dentistry, but also to streamlining procedures in the dental laboratory and practice. Aiming to understand the current needs of dental technicians and dental practitioners around the world to provide what would really make a difference, we are in close dialogue with experts in the field. We love to listen to their stories, learn how digital technologies and artificial intelligence are already transforming dental procedures and see how we can contribute to a smooth transition – e.g. with products that support efficient workflows and great outcomes.

Lately, we had the chance to sit down with a leading figure in Turkey’s digital dentistry transformation, Dr Efe Celebi, to discuss the current landscape and future of digital innovation in dentistry. Being convinced that his experience is worth being shared with a broader audience, we have summarized the conversation.

Dr. Celebi, you’re known as a pioneer in digital dentistry. What drove you to establish companies with a strong digital focus?

As the founder of Dentgroup, Turkey’s largest Dental Service Organization (DSO), I have always believed in the power of digital dentistry. My goal was to establish digital workflows for producing indirect restorations, beginning with intraoral scanning at our practices. Initially, we sought laboratory partners in Turkey willing to make this transition with us. But at that time, none of our partner labs were prepared to take the leap, so we decided to build our own. Digitalization, after all, is simplifying work in almost every field, and dentistry is no exception. So, in 2015, we founded DentLab to provide cutting-edge digital laboratory services.

How did you go about implementing digital workflows?

From the very beginning, we aimed to digitize every aspect of our work—from production to data management and communication. Our practices already used our own practice management software, DentSoft, successfully. To connect our clinics with the lab, we developed a specialized lab module. This allowed our dental practitioners to submit every order electronically. It was a huge improvement over the old process, where forms with sketches were mailed physically, just as it had been in in the old days. Now, practitioners can select the teeth in need of treatment, specify restoration colour and design, and upload radiographs, photos, and intraoral scans with just a few clicks. Over time, we have continuously enhanced communication features between clinics and labs, adding things like delivery date notifications for orders, so patients can book their next appointment before they even leave the clinic. These tools have greatly improved coordination between our dentists and lab technicians.

How is communication organized in the software?

We created a chat-style communication area where different team members can talk, with all records saved and accessible to anyone involved in a treatment. This setup is a major improvement over phone calls, as every detail—from treatment notes to radiographs and photos—is stored and easy to reference. We even enabled practitioners to rate the products they receive, and every necessary remake is documented along with the responsible technician. This feedback system has allowed us to maintain high-quality standards, identify issues, and provide targeted training where needed.

Modern digital technologies used at DentLab to provide cutting-edge digital laboratory services.

Have you made other improvements in workflow and communication between clinics and laboratories?

DentLab initially served Dentgroup practices exclusively, but we eventually opened its services to other clinics. In this context, we set standards for incoming orders—from the required data to impression quality. If an order does not meet these standards, we reserve the right to reject it, explaining why, so the submitter can improve. We also implemented a loyalty programme and developed a special, trackable package with a QR code to prevent loss of items in transit. This innovation lets both the team in the lab and the clinic track each package’s location in real time, solving a common logistical challenge. We have even patented this unique packaging system.

Unique patented delivery box used at DentLab to prevent loss of items.

Do you provide guidance on materials and tools for clinics?

Yes, as part of our commitment to quality, we recommend specific intraoral scanners and even distribute them to customers outside our network. We also advise clinics on material choices, pre-treatment needs, and compatible resin cements for permanent placement of the produced restorations. Our protocols cover the entire restorative procedure. For aesthetic cases, we recommend starting with a smile design and using mock-ups. The mock-up evaluation lets practitioners and patients provide feedback, so the responsible lab technician can produce the final restoration with precision.

With digital workflows so well-established, do you think technicians still benefit from meeting patients face-to-face?

Not necessarily. Occasionally, a dentist may request a patient visit the lab, and we accommodate this. However, digitalization has made physical distance irrelevant, as clinics and labs can now work seamlessly from anywhere. In fact, we serve offices in Europe without any face-to-face interactions between patients and lab technicians. For patients, especially in a city like Istanbul, avoiding long travel times is a big plus, while we can still ensure high-quality outcomes.

Would you say digitalization has improved treatment quality overall?

Absolutely. There is a learning curve to digital processes, but once practitioners adjust, the quality is noticeably higher. In traditional workflows, practitioners might bend the rules, asking technicians to work with suboptimal impressions, for example. Digital systems do not allow for such shortcuts; preparation quality is clear from the scan, and impression errors can be corrected instantly before submitting to the lab. Additionally, digital scans will never shrink, distort, or tear during production, unlike physical impressions.

What are the main challenges associated with digital dentistry today?

The biggest challenge is simply taking the first step. Dentistry has been hesitant to change after decades of doing things the same way. Going digital requires an investment in both time and money. But those who make the switch find the rewards—better outcomes and more efficient procedures—well worth it.

What is next for digital dentistry?

With AI advancing quickly, the field is evolving in exciting ways. Today, we can combine digital impressions, facial scans, photographs, and 3D imaging to create a “virtual patient”. Some clinics are already using software to analyze digital data, like dental X-rays, and I predict that robot-assisted or even autonomous clinical procedures are on the horizon. Imagine robot arms taking impressions or patients scanning their own teeth with smartphones. Impression-taking procedures carried out at home already support aligner treatments in some cases. As these technologies advance, the need for dental assistants will likely decrease. The digital future for dentistry is incredibly promising, filled with tools that can transform patient care and practice efficiency on a global scale.

Example of beautiful, precisely fitting all-ceramic restorations produced at DentLab.

INTRODUCING BRAND NEW PRODUCTS FOR SUCCESS WITH STREAMLINED, SMART SOLUTIONS

Kuraray Noritake Dental is pleased to announce that at IDS 2025 it will present a number of innovations that fundamentally improve dental procedures without compromising the quality of the result. Additionally, a number of internationally recognized experts will present their lectures and hands-on demonstrations on two separate stages: one dedicated to chair-side and the other one to lab-side topics. All of this represents not one, but a whole host of reasons to visit the stand (repeatedly).

CHAIR-SIDE NOVELTIES: UNIVERSAL EXCELLENCE

Development of the new products is rooted in a deep understanding of the demands of modern dental practice. Balancing complex procedures, tight schedules and patient needs is no easy task. That is why Kuraray Noritake´s team has been on a relentless journey to streamline, enhance and refine every step of work for decades. The vision is clear: a world where materials and tools work seamlessly in the dentist´s hands, where complexity is minimized, and where professionals are given enough time to focus on what matters most: the individual desires and needs of every single patient. Discover new additions to the UNIVERSAL EXCELLENCE family: a flowable universal composite and a new iteration of a universal bond.

CLEARFIL MAJESTY™ ES Flow Universal represents a fundamental shift in the idea of what universal composites can achieve. By integrating high filler loading and achieving high flexural strength, CLEARFIL MAJESTY™ ES Flow Universal challenges the traditional view of flowable composites as merely temporary fixes. Instead, it positions itself as a permanent solution capable of delivering both aesthetic excellence and structural reliability. Its unique light diffusion technology allows working with just two shades, and, in addition to that, offers a choice of two flowability options for easy handling.

CLEARFIL™ Universal Bond Quick 2 is the latest evolution in dental bonding technology, offering a streamlined, efficient solution for dental practitioners. Following the success of its predecessor CLEARFIL™ Universal Bond Quick, the new version “2” offers a redefined monomer technology that delivers exceptional bonding performance with minimal effort. Kuraray Noritake´s proprietary Advanced Rapid Bond Technology combines three key monomers – the original MDP, Amide and Urethane Tetra Methacrylate. Designed to enhance workflows, this adhesive provides robust performance across a wide variety of clinical situations.

LAB-SIDE NOVELTIES

Patient-centered prosthodontic approaches are enabled by innovative restorative materials and their correct processing in the dental laboratory. No matter whether a minimally invasive procedure or the best aesthetic outcomes are desired: Kuraray Noritake Dental has the solutions. In 2025, a new “smart” finishing material is being launched, delivering both on efficiency and aesthetics.

CERABIEN™ MiLai is a set of porcelains and internal stains specifically designed for the micro-layering technique. The name “MiLai” is derived from the term “micro-layering” and the Japanese word “mirai” (which means future). The innovative product based on synthetic feldspar enables dental technicians to add the final touch to their restorations in a simple and time-saving procedure – for outstanding aesthetics right from the start. The low firing temperature of CERABIEN™ MiLai (740°C) makes it the go-to solution for the finishing of both oxide ceramic (e.g. zirconia) and silicate ceramic (e.g. lithium disilicate) restorations. With fewer lines of porcelain needed, the porcelain inventory is reduced further and fewer decisions need to be taken.

Additional information and the full programme of lectures and hands-on courses at the IDS is available online.

Case by A/Prof Alan Yap, BDS (Syd), MDSc Hons (Pros)(Syd), FAANZP

Since 1983 PANAVIA™ by Kuraray Noritake Dental Inc. has been the gold standard for dental cements throughout the world. Their latest cement, PANAVIA™ Veneer LC, sets a new standard for porcelain veneer cements through incredible performance and ease of use. The following clinical case demonstrates the use of PANAVIA™ Veneer LC.

A 31-year-old female (Fig. 1) was referred for porcelain veneers to replace lost tooth structure and to improve aesthetics. The patient exhibited moderate attrition of her anterior and bicuspid teeth (Fig. 2), the result of nocturnal bruxism and a tendency to an edge-to-edge occlusion. She had a Class I malocclusion on a Skeletal Class I tending III base with the right maxillary canine in cross-bite. The treatment plan included orthodontic treatment, porcelain veneers, and an occlusal splint.

Fig. 1

Fig. 2

Orthodontic treatment (by Dr Nour Tarraf) included full-fixed appliances with TADs and IPR of mandibular anteriors, and arch retractions to reduce protrusion (Fig. 3, post-orthodontic treatment). A preliminary digital design (Fig. 4) was performed to guide the diagnostic wax-up and a digital mock-up (Fig. 5) was utilised to verify the diagnostic wax-up prior to carrying out the intra-oral mock-up. The patient was unable to afford the restoration of the maxillary bicuspids until a later stage so the reconstruction was limited to the maxillary anterior teeth.

Fig. 3

Fig. 4

Fig. 5

Using the diagnostic wax-up, silicone keys were fabricated to guide tooth preparations. Orthodontic treatment allowed prosthetic treatment to be additive in design which meant that tooth preparations could be conservative. Labial reductions were limited to 0.3 mm and incisal reductions were performed only where needed to create an incisal butt joint for the veneer (Fig. 6). Minimal preparations allowed the veneers to be bonded almost entirely to enamel, which is important for the long-term survival of porcelain veneers (Ref 1). There was no need to significantly mask the colour of the cervical region of the tooth and non-carious cervical lesions were absent, so fine chamfer margins were prepared at equi-gingival level.

Fig. 6

Splinted provisional veneers (Fig. 7) were fabricated using bisacryl ensuring sufficient interdental space to allow hygiene access for small interdental brushes. The labial surface of the provisional veneers were glazed with a unfilled resin and cemented using the spot-etch technique, ensuring all excess flowable composite was removed prior to curing (Fig. 8). Twice daily interdental cleaning of the provisional veneers and thorough brushing of labial margins during the provisional phase maintained soft tissue health, important for the try-in and cementation of the definitive veneers.

Fig. 7

Fig. 8

A dry try-in of the definitive veneers was performed to check the fit of the veneers and a wet try-in was performed using try-in paste to assess aesthetics. The PANAVIA™ Try-in pastes accurately mimic the cement shades. Four useful shades are available (Fig. 9). The White and Brown shades are useful to correct small discrepancies in shade requiring subtle increases or decreases in shade value respectively. Conveniently the try-in pastes are the same as the PANAVIA™ V5 range of try-in pastes (excluding opaque). Following the try-in procedure the teeth were isolated using rubber dam and the floss ligature technique. KATANA™ Cleaner (Fig. 10) was used to clean the veneers prior to silanating with CLEARFIL™ CERAMIC PRIMER PLUS (Fig. 11).

Fig. 9

Fig. 10

Fig. 11

Veneers that have not been pre-etched should be etched with hydrofluoric acid prior to silanization. The use of the ProsMate™ Baton allows the cleaning, etching and silanization of all veneers simultaneously (Fig. 12). The veneers are arranged systematically on the ProsMate™ Tray ready for the cementation procedure (Fig. 13). Tooth surfaces were pre-treated with phosphoric acid (K-ETCHANT Syringe) and PANAVIA™ V5 Tooth Primer (Fig. 14).

Fig. 12

Fig. 13

Fig. 14

The newly designed cement applicator tip reduces air bubbles and the wide 16-gauge tip (Fig. 15) allows light and easy control of cement extrusion while also providing efficient wide coverage during application. PANAVIA™ Veneer LC has excellent handling because of its ideal paste consistency. It is non-sticky and its viscosity prevents the cement from flowing beyond the veneer margins until the veneer is seated. It is not runny or stringy. Furthermore its thixotropic properties results in lower film thickness during seating of the veneer. These excellent handling properties are due to the development of new filler technology which consists of spherical silica and nano cluster fillers (Fig. 16). The “touch-cure” mechanism of PANAVIA™ V5 Tooth Primer importantly seals the bonding interface while the extended working time and stability of the cement under ambient light allows the simultaneous cementation of multiple veneers. In this case all six lithium disilicate veneers (technical work by Yugo Hatai) were cemented simultaneously with PANAVIA™ Veneer LC Paste (Clear).

Fig. 15

Fig. 16

Tack-curing each veneer for one second allowed smooth and easy bulk removal of excess cement with an explorer (Fig. 17). Remaining excess of uncured paste was removed with brushes. Final curing was performed by light curing lingual and labial surfaces.

Fig. 17

The optical characteristics of PANAVIA™ Veneer LC, use of fine chamfer margins, and well-fitting translucent restorations produces a gradual and smooth transition of colour from tooth to veneer where margins disappear and soft tissues respond in a healthy way (Fig. 18). The color stability, excellent abrasion resistance and high gloss durability of PANAVIA™ Veneer LC preserves integrity and aesthetics at the margins over the long term. The extraordinary bond strength of PANAVIA™ products, so familiar to our profession over the last 20 years, is still second to none (Fig. 19).

Fig. 18

Fig. 19

“KATANA” is a registered trademark or trademark of NORITAKE CO., LIMITED - “PANAVIA” and “CLEARFIL” are registered trademarks or trademarks of KURARAY CO., LTD.

References

1. Layton DM, Walton TR. The up to 21-year clinical outcome and survival of feldspathic porcelain veneers: accounting for clustering. Int J Prosthodont. 2012 Nov-Dec; 25(6):604-12. PMID: 23101040.

Intervju med Dr. Michał Jaczewski

Flowable injection technique er i ferd med å bli en populær teknikk for estetisk restaurering av flere tenner samtidig med flow-kompositt. Michal Jaczewski er en anerkjent instruktør som lærer tannhelsepersonell ferdighetene som trengs for å bruke teknikken med suksess. Han ble uteksaminert fra Wroclaw Medical University (Polen) i 2006 og driver egen privatpraksis i byen Legnica siden 2011. Han er grunnlegger av Biofunctional School of Occlusion, som driver opplæring innen emnet omfattende tannbehandlinger, og er lidenskaplig interessert i estetisk, digital tannbehandling. På IDS i Køln i 2023 viste han oss når, hvorfor og hvordan han bruker flowable injection på klinikken.

Kan du beskrive teknikken med få ord?

Flowable injection technique er en enkel, forutsigbar og reproduserbar metode å restaurere tenner på ved hjelp av flow-kompositt. Den er basert på en oppvoksing som det produseres en silikonindeks over. Indeksen fungerer så som form for injeksjonen av flow-kompositten. Kompositten lysherdes så gjennom den transparente silikonen. Den største fordelen med teknikken er at den krever liten eller ingen preparering av tennene. Den er en minimalt invasiv teknikk som kan brukes både av nybegynnere og av erfarne tannleger. Ved å bruke en kompositt med velbalansert opasitet i en tykkelse på 0,3 mm. og en spesiell protokoll for poleringen, er det mulig å oppnå fremragende resultater både optisk og morfologisk.

Når begynte du å bruke flowable injection technique, og hva er de viktigste indikasjonene?

Jeg begynte å bruke teknikken i 2018. Den var opprinnelig tenkt for restaurering av fortenner, men i dag brukes den med suksees for posteriore tenner, også. Slik jeg tenker, er den spesielt nyttig når formen på flere tenner skal korrigeres for å gi et penere smil, både for unge og eldre. Dette kan være tilfelle etter ortodontisk behandling. Tannbuen rettes opp og restaureres så til perfeksjon ved hjelp av flowable injection technique. Jeg bruker også teknikken for en makeover av smilet, for å bygge opp slitte tenner og for å øke bitthøyden ved total restaurering. I sistnevnte tilfelle, kan restaureringen enten være temporær eller permanent.

Hvordan starter du når du planlegger å restaurere en pasients tenner med flowable injection technique?

Den viktigste fasen, som har stor betydning for teknikkens suksess, er planleggingsfasen. Den består av dokumentasjon, avtrykkstaging og fremstilling av wax up og mock up og oså fremstilling av silikon-indeksen. Du kan sevfølgelig arbeide på den tradisjonelle måten med silikonavtrykk og konvensjonell oppvoksing, men bruk av digital teknologi i denne fasen vil forbedre arbeidsflyten betraktelig. Jeg starter vanligvis med foto- og videodokumentasjon og en scanning. Registrering av centric relasjon og okklusjon er også nødvendig. Så fremstiller jeg en virtuell oppvoksing ved hjelp av digital smile design software. På dette stadium er det viktig å ta hensyn til pasientens ansikts-karakteristika. Dette utføres best ved bruk av facial flow konseptet. Basert på den resulterende designen, kan et virtuelt behandlingsresultat vises og diskuteres med pasienten. Når resultatet er akseptert, printes modellen med wax up i ulike versjoner: den fulle wax upp modellen og en "interlip modell" hvor annenhver tann er med wax up og annenhver tann uten. Disse modellene brukes for å fremstille de nødvendige slikon-indeksene.

Digital Smile Design: Pasient med alvorlig tannslit.

Virtuell wax up vist i pasientens munn.

Modeller som er printet på grunnlag av virtuell mock-up.

Silikon-indeks fremstilt på alternerende (interlip) modell

Når, og hvorfor, lager du mere enn én silikon-indeks?

Det er spesielt nyttig å arbeide med den komplette og den alternerende indeksen når man planlegger å restaurere alle tennene i overkjeven. Å starte med den alternerende indeksen gir meg ekstra stabilitet og legger grunnlaget for et nøyaktig resultat, særlig når det gjelder den planlagte bitthøyden. I underkjeven, hvor håndteringen av indeksen og kompositten er vanskeligere pga. saliva og bløtvev som beveger seg, anbefaler jeg alltid å dele inn arbeidsfeltet i tre seksjoner- én anterior og to posteriore, og arbeide på dem separat.

Hvordan preparerer du tennene og sprøyter inn flow-kompositten?

I de fleste kasus, er alt vi trenger å rue opp emaljeoverflaten for bonding-prosedyren. Dette er vanligvis mulig ved hjelp av sandblåsing med aluminiumoksid (50 mikrometer med lavt trykk) Så etses emaljen med fosforsyre og det påføres en bonding. Silikon-indeksen er utstyrt med et injeksjonshull incisalt. Dette lages enkelt med spissen på kompositt-sprøyten ved at den trykkes gjennom materialet fra innsiden til utsiden. I posteriore del kan det være nyttig å bruke et fastere materiale og bruke to hull for hver tann på hver sin cusp -ett for injeksjon, og ett for evakuering. På en hard indeks må man bruke et diamantbor til dette. Jeg plasserer indeksen, injiserer kompositten fra bunn til topp, lysherder kort tid og fjerner indeksen. Endelig polymerisering gjøres etter at indeksen er fjernet og under et lag glycerin-gel. Når overskuddsmateriale er fjernet og den proksimale delen av restaureringen er polert, gjentas prosessen for de andre tennene, før restaureringene poleres.

Har du noen favorittprodukter for teknikken?

Til silikon-indeksen bruker jeg EXACLEAR (GC) fordi det er den mest transparente silikonen på markedet. Favorittkompositten min for flowable injection technique er CLEARFIL MAJESTY™ ES Flow  med lav viskositet (Kuraray Noritake Dental Inc.). På klinikken min og på kursene mine, har jeg hatt sjansen til å prøve ut mange ulike produkter. I denne sammenhengen har jeg funnet ut at kompositten fra Kuraray Noritake Dental Inc. har noen fordeler. Den er en moderne nano-kompositt med et bredt indikasjonsspektrum og stort fargeutvalg. Med de tre viskositetene kan den brukes i mange ulike kliniske situasjoner. Jeg begynte å bruke den for fem år siden til flowable injection technique. Low varianten er mitt førstevalg, fordi den er den mest allsidige og er egnet for både anteriore og posteriore tenner. De mest avgjørende grunnen for min beslutning om å bruke den, er den naturlige estetikken og de fremragende poleringsegenskapene. Du kan oppnå en spektakulær effekt uten spesielle ferdigheter. Som bonding foretrekker jeg CLEARFIL™ Universal Bond Quick. Den gjør arbeidsgangen enda enklere, raskere og mere forutsigbar. Til poleringen har jeg utviklet min egen protokoll.

Hvordan pusser og polerer du restaureringene dine?

Jeg starter approksimalt med polerstrips og noen ganger en proksimal sagtannet strips. For justering av form, har tre ulike diamanter og karbidbor vist seg å være verdifulle. deretter fortsetter jeg med fine eller ekstra-fine Sof-Lex skiver (3M) for konturering og puss og gummipolerere TWIST DIA™ for Composite (Kuraray Noritake Dental Inc.), som allerede de skaper en fin, naturlig overflateglans med lite anstrengelser. Så bruker jeg en geitehårs-børste med diamantpasta (Diamond excel, FGM) og til slutt bruker jeg et bomullshjul med en aluminiumoksid poleringspasta (Pasta Grigia II, anaxDENT). På denne måten er det mulig å oppnå en speilblank finish.

Syreets av emaljen med fosforsyre.

Fullstendig silikon-indeks på plass.

Applisering av CLEARFIL™ Universal Bond Quick.

Situasjon umiddelbart etter injeksjon av CLEARFIL MAJESTY™ ES Flow (Low), lysherding og fjerning av silikon-indeksen.

Proksimale justeringer med roterende instrumenter.

Hva er de største fordelene med flowable injection technique?

For pasienter og behandlere er den største fordelen at man sparer tid og penger. Mange pasienter har ikke råd til keramiske skallfasetter, og de er svært glade for å få tilbud om et alternativ av høy kvalitet som kan leveres i én enkelt seanse. Prosedyren er uten preparering og restaureringen kan enkelt repareres eller justeres i fargen hvis ønskelig, så risikoen ved denne behandlingen er svært lav. Tannlegen er gjerne klar for å ta i bruk teknikken etter å ha gjennomgått ett eneste kurs. Mens øvelse gjør mester, er resultatene gjerne imponerende allerede fra start. Det er ikke snakk om store investeringer hverken i tid eller utstyr for å begynne. Selvfølgelig kan man bruke mye tid på puss og polering, men jeg er sikker på at du vil finne den rette balansen mellom innsats og resultat.

Instrumentsett for flowable injection technique.

Har du noen anbefalinger om hvordan man skal begynne å bruke teknikken?

Først og fremst vil jeg oppmuntre alle til å forlate komfortsonen og begynne med noe nytt. For meg ble det å begynne å arbeide med flowable injection technique en skikkelig gamechanger, og jeg kan ikke tenke meg å arbeide uten igjen. Før du går i gang, vil jeg anbefale alle å gå på et kurs for å lære teorien som ligger bak et vellykket resultat, og kanskje også et arbeidskurs. 

Michał Jaczewski during his presentation at the Kuraray Noritake Dental booth in Cologne.

Viktigheten av høykvalitets protetisk behandling

Høy kvalitet på behandlingen er trolig det viktigste elementet på veien til tilfredse pasienter. Ved hvert enkelt besøk, ønsker  pasienten å føle seg ivaretatt av kompetent tannhelsepersonell, mens tid i stolen og antall konsultasjoner bør reduseres til det nødvendige minimum. I protetisk sammenheng betyr dette at en restaurering skal passe perfekt med én gang og være holdbar, for å unngå omgjøringer og ekstra tannlegebesøk.

Men hvordan er det mulig å levere høykvalitets restaureringer med perfekt tilpasning hver gang? Blant potensielle årsaker til problemer med kvaliteten på indirekte restaureringer er feil som gjøres på klinikken eller på laboratoriet, problemer med kommunikasjonen, og ofte noe som blir oversett, bruk av zirkonium av dårlig kvalitet.

Zirkoniumrestaureringer, moderne og estetiske dentale løsninger.

For over 20 år siden kom zirkonium inn på dental-markedet som en erstatning for metall ved fremstilling av kroner og broer. Begge materialer, zirkonium og metall, ble vanligvis kombinert med et lag porselen som var brent på metallet eller zirkoniumet. I de følgende årene fokuserte flere av de ledende dentalprodusentene (som f.eks. Kuraray Noritake Dental Inc.), på materialforbedringer. Disse forbedringene transformerte gradvis materialet fra  et opakt, hvitt kjernemateriale til et keramisk materiale med et tannlignende utseende og fremragende mekaniske egenskaper. De nyeste zirkonium-variantene som finnes med ulike grader av translucens og styrke, anses av tannbehandlere over hele verden for å være det beste behandlingsalternativet for et bredt utvalg av pasienter og indikasjoner. Én grunn er at de trenger bare et tynt lag porselen eller ikke porselen i det hele tatt. En annen grunn er at de trenger liten veggtykkelse, slik at de muliggjør konservativ preparering, samtidig som de har lang levetid. Vel å merke hvis man bruker et høykvalitets materiale.

Kvalitetsforskjeller på dentalt zirkonium

Kvaliteten på zirkonium kan variere avhengig av faktorer som renheten på råmaterialet (ikke bare zirkoniumet, men også alumina, yttria, fargetilsetninger osv.), den nøyaktige kjemiske sammensetningen, kornstørrelsen og partikkelfordelingen. Hvert trinn i fremstillingsprosessen (pulverblanding pressing,pre-sintring) har innvirkning på kvaliteten på diskene (optiske og mekaniske egenskaper).

Vanlige problemer som oppstår pga. zirkonium av dårlig kvalitet.

Problemer med de optiske egenskapene til en restaurering (translucens, fargeavvik, overgang mellom lagene på multi-layered materialer), vil alltid vise seg etter sintringen på laboratoriet. Det kan bli nødvendig å lage den om igjen. Andre ganger kan feilen oppdages først ved innprøving på pasienten, og dette vil ofte føre til at pasienten blir misfornøyd. Det samme vil være tilfelle for kasus med dårlig passform grunnet f.eks. inhomogen materialstruktur. Det som er enda verre, er dårlig biokompabilitet, som dårlig overflate, svake kanter, nedsatt bøyestyrke eller nedsatt bruddstyrke. Disse problemene kan ofte bare påvises med dyrt testutstyr som normalt ikke er tilgjengelig på et tannteknisk laboratorium. Dette betyr at feil vanligvis ikke oppdages før det oppstår et klinisk problem, som f.eks gingival retraksjon, økt plakk-akkumulering, slitasje, eller en feil som gir ubehag og smerter.

Oversikt over potensielle problemer og kliniske konsekvenser for pasienter

Sertifisering og standardisering av dentalt zirkonium

Dette er grunnen til at spesialister har utviklet en ISO standard (ISO 6872:2015), som beskriver in vitro tester som alle produsenter må gjennomføre på dentalt zirkonium som skal anvendes i Europa og USA, for å få FDA-godkjenning og CE-merking. De beskrevne testene brukes for å måle bøyestyrke og bruddstyrke, som antagelig er de viktigste egenskapene for langtids holdbarhet av restaureringer av materialet. Alle materialer som brukes i Europa og USA må bestå disse testene.

Hvordan du skal unngå å plassere zirkonium med lav kvalitet i dine pasienters munn

Derfor burde alle som bruker disse sertifiserte zirkoniumproduktene være trygge og i stand til å minimere materialrelatert risiko. Men den økende populariteten til dentalt zirkonium har tiltrukket seg interesse fra firmaer som vil ha en bit av kaken uten å ta bryderiet med å sikre høy produktkvalitet og gjennomgå sertifisering. Usertifiserte produkter som mangler CE-merking, har en ting felles, de utgjør en risiko for bedriften din og pasientene dine.

Så hvordan er det mulig å sikre produktkvaliteten på zirkonium på klinikken? Den gode nyheten er at det er noen enkle forholdsregler. Ved å følge dem, unngår du å sette inn piratprodukter eller lavkvalitets zirkonium i dine pasienters munn.

Tre gyldne regler for å gi pasientene dine høykvalitets zirkonium-restaureringer:

• Bestill bare produkter som er produsert innenlands eller i en region med samme standarder som dine egne: Restaureringer som produseres i dentallaboratorier i Kina, for eksempel, har lavere krav til godkjenning (derfor mangler de CE-merking),og oppfyller antagelig ikke dine forventninger.
• Snakk med ditt (norske) dentallaboratorium om hvor de får zirkoniumen sin fra: Forviss deg om at de kjøper zirkonium fra ledende produsenter (som f.eks. Kuraray Noritake Dental Inc.) gjennom autoriserte forhandlere.
• Unngå tilbud som er for gode til å være sanne: Lave priser kan virke fristende, men den endelige kostnaden for en behandling kan lett bli høyere enn vanlig når komplikasjoner inntreffer.

Hvordan bruk av sertifisert zirkonium kan påvirke pasientene dine over tid.

Ved å forvisse deg om at zirkoniumen du bruker på klinikken din oppfyller de høyest mulige kvalitets-standarder, bidrar du til å bygge opp pasientenes tillit og positive inntrykk over tid. Selv om den første kostnaden for høykvalitets zirkonium er noe høyere enn for dårligere varianter, kan totalkostnadene bli lavere fordi restaureringene holder lengre og man unngår omgjøringer. En fornøyd pasient  er ofte bedre til å følge opp munnhygieneregimer, og de er mer lojale. Dette gir deg bedre rykte og hjelper til å bygge praksisen din.

Undersøk mulighetene og velg produkter fra sertifiserte produsenter.

Hvis du ønsker å ta et steg videre, kan du sammenligne sertifiserte zirkoniumvarianter fra flere produsenter og oppdage forskjeller. Kuraray Noritake Dental Inc. f.eks., er den eneste produsenten som utfører hele produksjonsprosessen, inkludert produksjon av råvarer, i egen bedrift. På denne måten har selskapet kontroll over hvert eneste trinn og kan sørge for en fremragende produkt-kvalitet, uansett hvilken variant du velger. Med det tilgjengelige produktutvalget som består av KATANA™ Zirconia UTML (ultra-translucent, muylti-layered), KATANA™ Zirconia STML (Superior translucent, multi-layered) og den høytranslucente multilayered HTML PLUS og YML (med økt styrke og gradert translucens), er det mulig å dekke så å si enhver indikasjon.