Case by Dt. Koray Kendir, DDS, Turkey (İzmir)

SAMMENDRAG

Denne kliniske kasuistikken beskriver en direkte posterior komposittrestaurering utført ved bruk av Kuraray Noritake Dental Inc. sitt «Universal Excellence»-konsept. Et universelt adhesiv (CLEARFIL™ Universal Bond Quick 2) og et høyfyllt, flytende kompositt med universalfarge (CLEARFIL MAJESTY™ ES Flow Universal) ble benyttet for å oppnå både enkel arbeidsflyt og forutsigbarhet. Trinnvis dokumentasjon viser isolasjon, kavitetspreparering, deep margin elevation (DME), adhesivprotokoll og sluttrestaurering.

KLINISK BESKRIVELSE

En 38 år gammel kvinnelig pasient oppsøkte klinikken med blødning mellom tennene og ising mellom overkjevens venstre hjørnetann og første premolar (tennene #23 og #24 etter FDI-systemet). Klinisk undersøkelse viste åpen margin og sekundær karies ved det gingivale området av den eksisterende restaureringen på tann #23. Etter isolering med kofferdam ble trinnvis behandling igangsatt.

KLINISK PROSEDYRE

Trinn 1. Tann #23 viste en åpen gingival margin og karies (Fig. 1).

Trinn 2. Trinn 2. Etter fjerning av emalje ble karies ekskavert ned til gingivalnivå. Lesjonen på tann #24 ble observert å strekke seg subgingivalt (Fig. 2).

Trinn 3. Etter fullstendig kariesekskavering og raffinering av kaviteten ble behovet for deep margin elevation (DME) på tann #24 tydelig (Fig. 3).

Trinn 4. DME ble utført på tann #24 ved hjelp av en tilpasset seksjonskile. Først ble selektiv ets og CLEARFIL™ Universal Bond Quick 2 applisert, etterfulgt av CLEARFIL MAJESTY™ ES Flow Universal (Super Low)  (Fig. 4–6).

Trinn 5. Etter fullført DME ble egnet matrisebånd plassert, og direkte restaurering av tennene #23 og #24 ble utført med CLEARFIL MAJESTY™ ES Flow Universal (Super Low) (Fig. 7–9). Takket være materialets brukervennlighet, fargetilpasning og utmerkede poleringsegenskaper ble denne krevende DME-behandlingen gjennomført effektivt og forutsigbart.

Behandlingsresultatet vises i figur 10 og 11.

Fig. 1: Preoperativt bilde under kofferdamisolering

Fig. 2: Klinisk situasjon etter kariesekskavering

Fig. 3: Ferdigpreparerte kaviteter med dyp margin på premolaren

Fig. 4: Tilpasset kile plassert for å heve marginen

Fig. 5: Bukkal visning etter DME med universelle produkter

Fig. 6: Okklusal visning etter DME med universelle produkter

Fig. 7: Plassering av seksjonsmatrise

Fig. 8: Bukkal visning av restaurering med universalfarget flytende kompositt (Super Low)

Fig. 9: Okklusal visning av restaurering med universalfarget flytende kompositt

Fig. 10: Okklusal visning av endelige restaureringer (#23 og #24), som viser fargeharmoni, anatomisk form og høy glans

Fig. 11: Bukkal visning av endelige restaureringer (#23 og #24), som viser fargeharmoni, anatomisk form og høy glans

DISKUSJON

Universelle adhesiver og moderne flytende kompositter forenkler posteriore direkte restaureringer ved å redusere teknisk sensitivitet, samtidig som de gir holdbare resultater. I dette tilfellet ga CLEARFIL™ Universal Bond Quick 2 sterk adhesjon med minimal påføringstid. Det universelle flytende komposittmaterialet viste utmerket tilpasning, polerbarhet og slitestyrke. Selv med en subgingival margin som krevde DME, ble behandlingen gjennomført med en effektiv og strømlinjeformet tilnærming, uten at kvaliteten ble kompromittert.

CONCLUSION

Kombinasjonen av CLEARFIL™ Universal Bond Quick 2 og CLEARFIL MAJESTY™ ES Flow Universal  gjør det mulig for klinikere å utføre forutsigbare og effektive posteriore restaureringer. Deres universelle allsidighet og gode håndteringsegenskaper samsvarer med konseptet «Universal Excellence», og støtter en enkel, men pålitelig klinisk praksis i hverdagen.

Etikk og faglig tilknytning

Alle prosedyrer ble utført i samsvar med standard odontologisk praksis. Pasienten ga samtykke til behandling og publisering av anonymiserte kliniske bilder. Forfatteren samarbeider med Kuraray Noritake Dental Inc. som rådgiver; innholdet reflekterer klinisk erfaring.

Dentist:

KORAY KENDIR

Dr. Koray Kendir er utdannet ved det odontologiske fakultetet ved Hacettepe University og medgründer av en privat tannklinikk i İzmir. Han spesialiserer seg innen digital odontologi, smile design og datastøttede restaureringer. Dr. Kendir er kjent for sin innovative tilnærming, og er en hyppig foredragsholder på nasjonale tannlegekongresser samt rådgiver for flere dentale selskaper.

Cases by MDT Leonidas Dimitriou

INTRODUCTION

Patient demands and expectations have never been as concrete as in this day and age: Influenced by role models on social media and new aesthetic standards, our patients ask for brighter smiles or for restorations with specific tooth forms rather than demanding a perfect copy of nature. For us dental technicians, the challenge lies in finding a perfect balance between fulfilling these demands and respecting established biomimetics-inspired principles of aesthetics and function.

To accomplish this task, we need to know which principles need to be respected and where there is room for creativity. At the same time, it is essential to be well-informed about the latest technological advancements and developments in dental materials to be able to select the most appropriate restorative approaches. Only by understanding the selected materials and technological tools very well, will we be able to exploit their potential and deliver the best possible restorative solution. To sum up, we need to keep one foot in the boat of science and the other in the boat of art. Only by balancing both can we navigate the rapid advancements in the field effectively - ensuring they serve patients’ best interests while avoiding practices that lack purpose or meaning.

The challenge lies in finding a perfect balance between fulfilling the patient‘s demands and respecting established biomimetics-inspired principles of aesthetics and function.

MATERIAL CHOICES

Our favored framework materials for the production of aesthetic anterior restorations include KATANA™ Zirconia UTML, KATANA™ Zirconia STML discs (both Kuraray Noritake Dental Inc.) and lithium disilicate-based press ingots Amber® Press (HASS). These high-strength ceramics are ideal for fulfilling the aesthetic and functional demands of anterior restorations. Their balanced optical properties allow for the creation of lifelike restorations. Their physical and mechanical properties, on the other hand, are responsible for stability during all clinical steps from try-in to permanent placement, proven bonding ability and a certain error tolerance: Minor adjustments or modifications are possible without the risk of inducing cracks or dimensional changes when firing repeatedly. Finally, both materials are digital workflow compatible, which means that procedures are quick, mock-up, temporary restoration and definitive restoration easily aligned, and remakes facilitated.

The restorations are usually designed in full contour; a labial cutback of 0.3 to 0.5 mm creates sufficient space for the veneering porcelain. The preferred layering approach is micro-layering combined with the internal live stain technique, which offers the benefits of a controlled procedure and predictable, highly aesthetic outcomes with brilliant depth effects in short time. A layering material that precisely meets our needs regarding the preferred approach and is perfectly compatible with both, lithium disilicate and zirconia, is CERABIEN™ MiLai (Kuraray Noritake Dental Inc.).

The following two case reports are used to illustrate how this material combines with the different framework materials, revealing further benefits of the selected ceramics and techniques.

CASE #01

LITHIUM DISILICATE VENEERS

This 36-year-old female patient wanted to replace her bonded composite veneers. She expressed the demand for a brighter smile with a bleached color (NW 0.5) selected for her six maxillary anterior teeth and first premolars. However, she wanted the tooth preparation for this treatment to be as minimally invasive as possible.

In addition, she specifically requested that the teeth be square in form, with the lateral incisors the same length as the central incisors and the incisal edges straight, without rounded corners – clearly influenced by modern aesthetic standards. We explained our concerns regarding potential aesthetic and functional issues that might necessitate further intervention or adjustments, but she remained firm in her choices.

FROM DESIGN TO PRESSED FRAMEWORK

In line with the patient’s demands, it was planned to restore her maxillary teeth from first premolar to first premolar with lithium disilicate veneers (Amber® Press HT in the shade W2), which would allow for the desired minimally invasive preparations and bright appearance. Following tooth preparation, an analog impression was taken and sent to our laboratory. After the production of the model, the case was digitalized for the virtual designing of the veneers. In order to create space for the porcelain, the labial surfaces of the full-contour restorations were reduced by 0.3 mm with the software (exocad® DentalCAD, Figs. 1 and 2).

The frameworks were then milled in wax and pressed in Amber® Press HT W2 (Figs. 3 and 4). Sprues were cut and the surfaces of the veneer frameworks processed with a Diagen-Turbo-Grinder Ø 3,5 x 11 mm Cone and Wheel.

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By Dr Wiktor Pietraszewski BSC(HONS) DMD

INTRODUCTION

According to personal experience, the cementation of glass ceramic veneers is one of the most stressful and technique-sensitive procedures in restorative dentistry. This is not only due to the minimal margin for error, but also the high aesthetic standards that must be met to deliver a result satisfying both clinician and patient. Modern protocols emphasize conservative preparation, ideally remaining entirely within enamel, or at the very least, minimising extension into dentin. It is essential to understand that both preparation design and extent should not be planned in isolation. Instead, they must be carefully co-planned through thorough communication and collaboration between clinician and technician, ensuring the final result is both biologically respectful and aesthetically predictable.

THE CASE

The case to be discussed today is rather unique in that it arose unexpectedly, without the luxury of typical pretreatment planning steps such as a diagnostic wax-up or mock-up. These were omitted due to time and budget constraints on the patient’s part — a reality many clinicians can relate to. The rationale behind this approach will become clearer as we progress through the case. The patient is a 70-year-old retiree, whom I have been managing for several years. Treatment thus far has focused on stabilising and gradually improving her posterior restorations, with the longer-term aim of addressing the anterior dentition to enhance both function and aesthetics.

Nowadays, financial considerations often pose a significant barrier to patients accepting comprehensive treatment plans from the outset. As such, effective communication and phased treatment planning become essential tools in fostering patient trust and long-term commitment. This particular visit was an emergency appointment, with the patient presenting with a fractured porcelain veneer on her maxillary left central incisor — tooth 21 according to the FDI notation (Fig. 1). Fortunately, because of the existing phased approach to her care, we were well-positioned to transition into an aesthetic restorative phase with minimal resistance or hesitation from the patient.

Fig. 1. Pre-operative view - emergency: Chipped existing ceramic veneer.

Fig. 2. The plan - Digital Smile Design - 4 x porcelain veneers - 4 x direct composite restorations.

THE PLAN

After careful discussion, it was decided to remove and replace the four existing porcelain veneers and to replace four existing Class V stained composite restorations with fresh new direct composite (Fig. 2). Everyone involved was happy with the plan, sure it would adequately fulfil the patient’s aesthetic expectations and even surpass them. At the emergency appointment, time was so limited that only the temporary restoration of the chip with direct composite was feasible. Time was an important factor going forward: the patient wanted to proceed and have the case completed as soon as possible.

Main features of the Digital Smile Design (DSD) plan

1. Lengthening - central incisors – incisal edges to reflect the length of the canine tips
2. Equal gingival zeniths
3. Masking of the cervical defects

PREPARATION, SCAN & TEMPORISATION

The first step involved building up the teeth using a flowable composite to create a rough direct mock-up (Fig. 3), guided by the DSD plan (Fig. 2). This mock-up provided a visual and functional prototype, of which an impression was taken to aid in the fabrication of interim temporary restorations for the provisional phase of treatment.

Preparations were carried out using OptraGate isolation. The existing veneers were first removed using high-grit diamond burs at high speed. Once the bulk of the old material was cleared, gingival retraction was achieved using retraction cord, allowing for improved visibility and access. The preparations were then refined with lower-grit diamond burs at a reduced speed to ensure precision and tissue safety. The primary objectives of the preparation phase were to establish harmonious gingival zeniths and to adequately cover the cervical defects that were evident in the previous restorations (Figs. 4 and 5).

Fig. 3. Mock-up made of flowable composite.

Fig. 4. Class V composite restorations replaced on teeth 13, 23, 24 and 25.

Fig. 5. Situation after preparation of the maxillary incisors.

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Case by DT Andreas Chatzimpatzakis and Dr Evi Lianou

Selecting the right materials for a successful rehabilitation of edentulous jaws with fixed implant-based prostheses can be quite challenging. High strength and stability are needed to securely connect the implants, biocompatibility is a must and the functional, aesthetic and financial expectations of the patient need to be respected. Experience shows that – in many situations – the combination of a titanium bar with a zirconia framework finished using the micro-layering technique is a great option. This material combination and approach meets the demands mentioned, while supporting efficient procedures and aesthetic outcomes.

In the present case, a 53-year-old male patient with a history of periodontal disease presented in the dental office of Dr Evi Lianou (Dental Clinic, Lamia, Greece). Due to a poor prognosis of the remaining teeth, it was planned to extract them. As a removable full denture was not an option for the patient, the treatment plan included the insertion of four implants in the mandible and six in the maxilla, followed by a healing phase and subsequent definitive rehabilitation with screw-retained, titanium bar-based zirconia superstructures finished by micro-layering. The following figures and captions describe the technical procedure.

Fig. 1. Initial clinical situation showing several remaining teeth with a poor prognosis.

Fig. 2. Screw-retained titanium bar for the mandible.

Fig. 3. Screw-retained titanium bar for the maxilla.

Fig. 4. Mandibular restoration: Milled framework made of KATANA™ Zirconia HTML PLUS (Kuraray Noritake Dental Inc.) with a minimal (0.3 mm) vestibular cutback placed only on the six anterior teeth.

Fig. 5. Maxillary restoration: Milled framework made of KATANA™ Zirconia HTML PLUS with a minimal vestibular cutback (0.3 mm) placed only on the six anterior teeth.

Fig. 6. Mandibular restoration, 33-43 internal staining with CERABIEN™ MiLai Internal Stains (Kuraray Noritake Dental Inc.). 34-37 & 44-47 External characterization with CERABIEN™ ZR FC Paste Stain.

Fig. 7. Maxillary restoration 13-23 internal staining with CERABIEN™ MiLai Internal Stains. 14-17, 24-27 External characterization with CERABIEN™ ZR FC Paste Stain.

Fig. 8. Mandibular and maxillary restorations on the model: Additional internal staining to the anterior. Posterior teeth were completed with CERABIEN™ ZR FC Paste Stain.

Fig. 9. Mandibular restoration after the application of CERABIEN™ MiLai Porcelains LT1 mixed with CCV2 (ratio 50:50) for the cervical and Tx for the incisal.

Fig. 10. Maxillary restoration after the application of CERABIEN™ MiLai Porcelains LT1 mixed with CCV2 (ratio 50:50) for the cervical and Tx for the incisal third.

Fig. 11. Mandibular restoration after the bake, showing some typical characteristics of aged teeth.

Fig. 12. Maxillary restoration after the bake, showing some typical characteristics of aged teeth.

Fig. 13. Mandibular restoration with applied tissue porcelains and corrections in the tooth area.

Fig. 14. Maxillary restoration with applied tissue porcelains and corrections in the tooth area.

Fig. 15. Mandibular restoration after finishing glazing and polishing.

Fig. 16. Maxillary restoration after finishing glazing and polishing.

Fig. 17. Final restorations on the model.

Fig. 18. Final restorations in the patient’s mouth.

Fig. 19. New smile of the patient.

Fig. 20. Patient with new fixed dental prostheses.

CONCLUSION

The described material combination and technique allows for efficient workflows, while supporting aesthetic, durable treatment outcomes. With functional surfaces designed in plain, polished zirconia and just a tiny layer of porcelain in the vestibular region, the restorations are made to last. Moreover, the selected framework material and porcelain system are a perfect match.

The chosen porcelain system works well with other zirconia brands and even with lithium disilicate. It can be used with or without internal stains, making it a versatile tool suitable for a wide range of applications, patient needs, and aesthetic demands.

Case report by Dr Mediha Isikver

Tooth fractures and secondary caries are frequently observed in posterior teeth, often resulting from occlusal stress, restoration failure, or secondary bacterial infiltration. These conditions compromise tooth integrity, function, and aesthetics. With advancements in adhesive dentistry, minimally invasive and durable restorative solutions have become achievable. Material selection plays a critical role in the success of composite restorations, influencing marginal adaptation, wear resistance, and patient satisfaction. This case report describes the step-by-step clinical management of a fractured and secondary carious permanent molar restored using materials from Kuraray Noritake Dental Inc.

CASE PRESENTATION

A 32-year-old female patient presented to the clinic with sensitivity and discomfort in the upper left posterior region. Clinical examination revealed a distal wall fracture on tooth #26 (maxillary left first molar) with a secondary carious lesion extending subgingivally. Radiographic evaluation confirmed the absence of periapical pathology. Adjacent teeth (#25 and #27) showed early carious activity, but the patient opted for the restoration of tooth #26 only. The tooth was asymptomatic to percussion and showed normal vitality on pulp testing.

Fig. 1. Initial clinical view of tooth #26 under rubber dam isolation.

TREATMENT PROTOCOL

1. Isolation and caries removal: The tooth was isolated with rubber dam. The existing defective restoration and carious tissue were carefully removed using tungsten carbide burs and a slow-speed handpiece.
2. Surface cleaning: After preparation, KATANA™ Cleaner was applied to remove contaminants and optimize bonding surface quality.
3. Bonding procedure: A single-step, self-etch adhesive, CLEARFIL™ Universal Bond Quick 2, was applied to both enamel and dentin following the protocol recommended by the manufacturer.
4. Restorative phase: The deep and undercut areas were resin coated with CLEARFIL MAJESTY™ ES Flow Universal Low (U shade), ensuring adaptation and stress relief in undercut regions. The remaining cavity was restored incrementally using CLEARFIL MAJESTY™ ES-2 Universal (U shade) paste-type composite, with each 2 mm layer light-cured for 20 seconds.

Fig. 2. Clinical view of tooth #26 after removal of the defective restoration and carious tissue.

Fig. 3. Application of KATANA™ Cleaner to remove contaminants and optimize bonding surface quality after preparation.

Fig. 4. Selective enamel etching performed on tooth #26.

Fig. 5. CLEARFIL™ Universal Bond Quick 2 applied to both enamel and dentin following the manufacturer’s recommended protocol.

Fig. 6. Resin coating with CLEARFIL MAJESTY™ ES Flow Universal Low (U shade).

Fig. 7. Reconstruction of the mesial and distal walls with CLEARFIL MAJESTY™ ES-2 Universal (U shade) composite.

Fig. 8. Incremental build-up of cusps and occlusal anatomy using CLEARFIL MAJESTY™ ES-2 Universal composite, refined with a brush for contour adjustment.

Fig. 9. Initial finishing of the composite restoration performed with darkcoloured TWIST™ DIA for Composite (medium) rubber points to refine surface texture and anatomy.

Fig. 10. Final polishing performed with light-coloured TWIST™ DIA for Composite (fine) rubber points to achieve a highgloss, smooth surface.

FINAL SITUATION

Fig. 11. Final view of the restoration after occlusal adjustment and polishing.

CONCLUSION

This case demonstrates that adhesive and restorative systems from Kuraray Noritake Dental Inc. offer a reliable, efficient and effective approach for treating fractured and secondary carious posterior teeth. The integration of self-etch adhesives and high performance composites contributes to durable and aesthetically pleasing restorations. Continuous follow-up is essential to evaluate the long-term clinical behaviour of these materials.

Dentist:

MEDIHA ISIKVER

Dr Mediha Isikver is a graduate of the Ege University Faculty of Dentistry and the co-founder of Klinik M in Istanbul, Turkey. She focuses her professional practice on aesthetic and restorative dentistry, with particular expertise in composite laminate layering, porcelain laminates, and smile design. Believing that every smile tells its own story, she aims to create personalized aesthetic transformations that blend natural harmony with artistic detail.

Case by Dr. Onur Alp Yünük

COMBINING HIGH-PERFORMANCE TOOLS AND MATERIALS FOR A PREDICTABLE OUTCOME

Direct composite restorations are a high-quality treatment option even when large amounts of tooth structure need to be replaced. This is due to recent advancements in resin composite materials and adhesive technology. By selecting appropriate materials and layering techniques combined with modern digital tools for colour difference evaluation, it is possible to predictably produce highly aesthetic outcomes, as demonstrated in the following case example.

THE CHALLENGE

A young male patient presented to our clinic requesting the replacement of his existing composite restorations on his maxillary incisors (teeth #12 and #11 according to the FDI notation). Clinical examination revealed extensive restoration loss on the lateral incisor. Furthermore, anatomical irregularities, discolouration, and loss of surface gloss were observed on tooth #11. The adjacent central incisor exhibited similar issues regarding colour and surface polish.

In consultation with the patient, it was decided to replace the existing restorations using a modern composite material specifically developed for dual-shade layering – CLEARFIL MAJESTY™ ES-2 Premium (Kuraray Noritake Dental Inc.). For an exact shade analysis, photographs were taken with and without a cross-polarized filter (Figs. 1 to 4).

Fig. 1. Frontal view of the teeth with extensive restoration loss on the maxillary left lateral incisor.

Fig. 2. Cross-polarized photograph of the teeth allowing for a detailed analysis of the shade irregularities.

Fig. 3. Lateral view of the teeth.

Fig. 4. Lateral view – cross-polarized photograph.

THE SOLUTION

Following removal of the existing restorations, rubber dam was placed for working field isolation. A self-etching adhesive (CLEARFIL™ SE Bond 2, Kuraray Noritake Dental Inc.) was applied in the selective enamel etching mode before establishing the palatal shell using CLEARFIL MAJESTY™ ES-2 Premium in the shade A1E (Figs. 5 and 6). The mamelon structures were reconstructed with CLEARFIL MAJESTY™ ES-2 Premium in the shade A1D, while the translucent shade Blue was applied to the opalescent zone. Finally, yellow and white tints were used for characterization. Fig. 7 illustrates the appearance before, Fig. 8 after finishing and polishing.

Fig. 5. Palatal shell established with the enamel shade A1E of the selected composite.

Fig. 6. Lateral view of the teeth during the restoration procedure.

Fig. 7. Restoration before finishing and polishing.

Fig. 8. Appearance of the restorations after finishing and polishing.

THE OUTCOME

To evaluate the final colour integration, another photograph was taken with a cross-polarized filter, holding a grey reference card in place for calibration (Figs. 9 and 10). The lateral view of the restored teeth (Fig. 11) reveals that not only the right colour combination, but also a natural surface texture is required for a highly aesthetic outcome.

Fig. 9. Frontal view of the restored teeth taken with a cross-polarized filter.

Fig. 10. Gray reference card calibration and the resulting L*a*b* coordinates of the restoration.

Fig. 11. Lateral view of the restored teeth stressing the importance of surface texture.

DISCUSSION AND CONCLUSION

Observation, supported by modern tools for photography and image analysis (like polarized filters and L*a*b* coordinates), is an important skill needed for the lifelike reconstruction of teeth with direct composite materials. By combining this skill with a high-performance composite system that offers fixed shade combinations and innovative light diffusion technology for a nice blend-in with the surrounding tooth structure, creating beautiful restorations becomes a predictable business.

In the case presented, the patient was very satisfied with the outcome in terms of aesthetics and function. At regular recalls, the quality of the restorations is checked – they still offer a very nice functional and aesthetic integration.

Dentist:

ONUR ALP YÜNÜK

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

Case report by Vasilis Vasiliou

AESTHETIC RESTORATION OF MAXILLARY INCISORS

Falling in love, applying for a first job, attending a best friend’s wedding: There are so many occasions for young people when looking gorgeous is important. That is why restoring a young patient’s smile to its natural beauty is a special task that demands a lot from us. We need to listen to their touching stories, understand their specific needs and desires – and finally find a way to exceed their expectations. Whenever our plan works and is performed correctly, the outcome will be rewarded with extreme gratitude by those affected. After all, it is not only the smile we restore, but also the patients’ self-confidence and quality of life.

SINGLE BAKE, NATURAL RESULT

The good news: Even highly aesthetic all-ceramic restorations can be produced with a minimal number of bakes. Modern framework materials and porcelain systems allow us to imitate a natural play of colours and translucencies, a virtually unlimited number of individual effects and a vivid surface texture in a predictable way. A possible procedure is illustrated below. The materials utilized in this case were KATANA™ Zirconia STML and CERABIEN™ ZR (Kuraray Noritake Dental Inc.) and the restoration was completed using the One-Bake technique developed by MDT Nondas Vlachopoulos.

Fig. 1. Frameworks made of KATANA Zirconia STML in the shade A1.

Fig. 2. Single-bake layering procedure: Application of CERABIEN ZR Opacious Body in the cervical …

Fig. 3. … and mamelon areas.

Fig. 4. CERABIEN ZR Body porcelain applied in the body area.

Fig. 5. CERABIEN ZR Transitional Dentine used to increase the translucency in the incisal part.

Fig. 6. CERABIEN ZR Opacious Body added in specific areas to create more reflaction.

Fig. 7. Incisal cut-back and creation of the mamelon structure as well as adding of T Blue to give depth.

Fig. 8. … in the body and distal incisal areas.

Fig. 9. Application of Aqua Blue 1 and T Blue on the incisal edges to produce a youthful translucency.

Fig. 10. Creation … effect

Fig. 11. … of mamelons.

Fig. 12. Application of Luster porcelains: LTx, …

Fig. 13. … ELT1 …

Fig. 14. … and LT1.

Fig. 15. Cutback of the dentin for the creation of a halo effect.

Fig. 16. Final shape: Halo effect created with Body.

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

Fig. 18. Restorations adhesively cemented in the patient’s mouth.

CONCLUSION

Restoring a young patient’s smile is a particularly challenging task, as the quality of the outcome has a huge effect on the self-confidence and quality of life of the affected person. By listening closely to our patients’ stories, understanding their needs and knowing our materials well, we are able to deliver exactly what they need. It is their positive feedback and happiness that drives me to never stop learning and practicing with my ceramics and porcelains for continued improvement and even better outcomes.

I would like to express my gratitude to Dr. Loukia Pedoulou for the professional partnership and clinical support in achieving this result.

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.

Case by DT Vasilis Vasiliou

MICRO-LAYERING WITH CERABIEN MiLai

No matter whether young or old, male or female: Our patients deserve a beautiful smile that matches their adjacent teeth, their face, their character and their individual needs. To be able to produce beautiful restorations that change their life for the better, we (as dental technicians) have to observe closely – and to listen attentively to the stories they tell.

‘We have to observe closely – and to listen attentively to the stories our patients tell us.’
– Vasilis Vasiliou –

Mr Andreas is a perfect example. He presented in the dental office in need of a full-mouth rehabilitation and the wish to improve the aesthetics of his smile. He asked for an age-appropriate, natural restoration design.

After careful observation and listening, I decided that the best way to restore his maxillary incisors would be with zirconia restorations. The plan was to mill the frameworks using low-value KATANA™ Zirconia YML, shade D3 (Kuraray Noritake Dental Inc.). To facilitate the integration of some natural characteristic effects, a framework design with a primarily vestibular cutback was selected. The finishing technique of choice was micro-layering with CERABIEN™ MiLai (Kuraray Noritake Dental Inc.), a porcelain designed specifically for this approach.

Important steps in the finishing procedure were:

• Characterization of the milled zirconia with colouring liquids
• Pre-treatment of the sandblasted zirconia surfaces with SS Fluoro and Margin porcelain
• Internal staining with CERABIEN™ MiLai internal stains
• Application of CERABIEN™ MiLai luster porcelains

LABORATORY WORKFLOW

Zirconia splinted crowns were designed in full contour with the aid of the Leahu Library featuring tailored tooth designs (part of the Truedental Library available for exocad DentalCAD design software; Fig. 1), cut back merely in the vestibular area using the ‘calma’ reduction option (Fig. 2), and then milled and characterized with colouring liquids to optimize the chroma.

Figure 3 shows the sintered frameworks on the model, Figure 4 the try-in in the patient’s mouth. As the fit and shape of the restorations turned out to be excellent, it was time to plan the internal staining and micro-layering procedure (Figs. 5 and 6), always trying to imitate nature as closely as possible.

The tricky part is to use the available space wisely – the reason why a detailed layering sketch is useful even when in the context of micro-layering. Once the planned layering procedure had been put to practice (Figs. 7 to 10), the surface texture was finalized and the restorations were tried in again for an aesthetic evaluation. Finally, they were cemented with the adhesive resin cement PANAVIA™ V5 (Kuraray Noritake Dental Inc.).

The beautiful treatment outcome is shown in Figure 11.

Fig. 1. Computer-aided design of the zirconia frameworks: Splinted crows displayed in a transparent mode to show the abutment teeth.

Fig. 2. Computer-aided design of the zirconia frameworks: Outer contour of the splinted crowns with a strongly elaborated surface texture and sufficient room for micro-layering.

Fig. 3. Restorations after characterization with colouring liquids and sintering on the model.

Fig. 4. Try-in of the restorations.

Fig. 7. Internal staining – specific characteristics elaborated for a natural depth effect.

Fig. 8. Layering in the cervical and body areas.

Fig. 9. Final layering with luster porcelains to complete the morphology.

Fig. 10. Final restorations after surface finishing and polishing as well as glazing on the model.

Fig. 11. Treatment outcome.

CONCLUSION

The patient was thoroughly satisfied with the treatment outcome and confident that his investment was well worth it. By tailoring my approach to his unique needs, carefully observing his teeth, smile, and facial expressions, and utilizing my extensive knowledge of materials, I was able to achieve this goal successfully.

Nonetheless, I remain committed to continuous improvement by critically evaluating each restoration and seeking areas for enhancement. My dedication to growth, supported by exceptional mentors who share innovative techniques and insights, supports me in staying at the forefront of my field, striving at consistently delivering the best possible care.

I am deeply grateful to Dr. Zinonas Evagorou for invaluable partnership and clinical expertise, which were instrumental in achieving this result.

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.

Case by Dr. Michał Jaczewski

FLOWABLE INJECTION TECHNIQUE

What are the most important properties of a flowable composite used for the flowable injection technique? Personal experience shows that balanced optical properties are essential, with an appropriate translucency, blend-in ability and surface gloss leading the way. However, the mechanical properties are also important, not least because the restorative material will be in direct contact with the antagonist teeth. And finally, handling properties are essential: The right level of flowability is needed for proper injection, while a void-free application is required for an intact, stain-resistant surface.

For the last seven years, CLEARFIL MAJESTY™ ES Flow Low (Kuraray Noritake Dental Inc.) has been my go-to flowable composite for the flowable injection technique. Its level of flowability is ideal for the technique in the anterior and posterior region. Whenever a lower flowability is needed, it is possible to switch to the Super Low variant. Moreover, I like the shade offering, which – together with the superior polishability of the material – leads to natural aesthetics. Finally, its mechanical properties are so good that the product is approved for a wide indication range without load limitations.

When the company announced the introduction of CLEARFIL MAJESTY™ ES Flow Universal, which comes in just two universal shades and two different levels of flowability (Low and Super Low), I immediately decided to give it a try: The prospect of balanced properties I am already familiar with, combined with a simplified shade selection sounded very promising. So far, the new product comes up to my expectations: The following case example reveals the simplicity of the procedure and the beauty of the results. The patient presented during orthodontic (aligner) treatment for a shape correction in the anterior region due to wear of the incisal edge.

Fig. 1. Initial clinical situation: Patient in need of a shape correction in the maxillary incisor region.

Fig. 2. Application of CLEARFIL™ Universal Bond Quick 2 (Kuraray Noritake Dental Inc.) to the enamel of a central incisor, which has been merely roughened by air abrasion with aluminium oxide (50 μm at low pressure) followed by etching with a phosphoric acid etchant.

Fig. 3. Transparent silicon index placed in the mouth and CLEARFIL MAJESTY ES Flow Universal Low (U shade) already injected in the position of the maxillary right central incisor.

Fig. 4. Shape correction on the maxillary right central incisor completed.

Fig. 5. Situation after finishing and polishing of the incisor restorations.

Fig. 6. Nice shade match leading to a smooth blend-in with the surrounding natural tooth structure.

Fig. 7. Immediate treatment outcome supporting an improvement of the smile aesthetics and hence, the patient‘s quality of life during aligner therapy.

RESULTS THAT SPEAK FOR THEMSELVES

Like its related product CLEARFIL MAJESTY ES Flow, the universal-shade version CLEARFIL MAJESTY ES Flow Universal offers properties which are – from a personal perspective – ideal for the flowable injection technique. The shade-matching properties are astonishing; the translucency is quite high when placed in thin layers (so that enamel is very well imitated), and the polishability is as good as that of CLEARFIL MAJESTY ES Flow. For virtually effortless, bubble-free injection, the product comes in a nicely designed syringe. And last but not least, the product’s mechanical properties provide peace of mind even in the posterior region.

Dentist:

MICHAŁ JACZEWSKI

Michał Jaczewski graduated from Wroclaw Medical University in 2006 and today runs his private practice in the city of Legnica, Poland. He specializes in minimally invasive dentistry and digital dentistry and is the founder of the Biofunctional School of Occlusion. Here he lectures and runs workshops with focus on full comprehensive patient treatments.

Case by DT Andreas Chatzimpatzakis

AESTHETIC AND EFFICIENT SMILE MAKEOVER

Most patients asking for a smile makeover desire custom solutions rather than an off-the-peg smile: Individual tooth shapes that fit their face and their character, an internal play of colours that matches their age and natural dentition. Modern dental materials allow us to deliver what they demand in many situations – usually at a reasonable price.

For a long time, however, we have been facing challenges when combining cosmetic and medically indicated treatment – e.g. a smile makeover including the rehabilitation of a missing lateral incisor. A straightforward solution – using lithium disilicate veneers alongside a zirconia cantilever bridge, both finished with their respective porcelain systems – would have been complicated by potential differences in the final appearance. With CERABIEN™ MiLai (Kuraray Noritake Dental Inc.), a set of internal stains and porcelains designed for micro-layering, the situation is different: Suitable for micro-layering on zirconia and lithium disilicate, it supports its user ideally in creating a harmonious smile even when the two framework materials are combined.

A NEW CUSTOM SMILE

The following patient case is a perfect example: A female patient with a missing lateral incisor, multiple visible composite restorations in the anterior region and an enamel fracture at her incisal edge desired a smile makeover. The selected materials were Amber Press LT (HASS), shade A1, for four veneers on the central incisors and the left lateral incisor and canine (teeth # 11, 21, 22 and 23 according to the FDI notation) and KATANA™ Zirconia YML (Kuraray Noritake Dental Inc.), shade A2, for the planned cantilever bridge on the maxillary right canine, replacing the missing lateral incisor (teeth # 12 and 13).

Fig. 1. Female patient with a missing maxillary lateral incisor and multiple composite restorations in the anterior area – a smile makeover is desired.

Fig. 2. Patient with mock-up.

Fig. 3. Minimally invasive preparation through the mock-up, which takes into account the minimum space required for the planned materials and restorations.

Fig. 4. Teeth prepared for the all-ceramic restorations.

Fig. 5. Occlusal view of the maxillary teeth after tooth preparation.

Fig. 6. Full-contour veneers and cantilever bridge on the model.

Fig. 7. Restorations after a cutback limited to the vestibular and incisal area.

Fig. 8. CERABIEN™ MiLai LT₁ is applied to the middle and cervical area of the zirconia cantilever bridge.

Fig. 9. CERABIEN™ MiLai Value Liner 2...

Fig. 10. … and Value Liner 1 applied to the incisal area of the central and lateral incisor restorations.

Fig. 11. CERABIEN™ MiLai porcelain Creamy Enamel mixed with Value Liner 2 (70/30) added to the middle and cervical areas of the four lithium disilicate restorations to increase and control the value.

Fig. 12. ... while E2 is added to the incisal area of both canines.

Fig. 13. Restorations covered by a layer of Tx ...

Fig. 14. ... and LTx.

Fig. 15. Appearance of the restorations after the first bake.

Fig. 16. Adding translucency and opalescence to the cervical area with LT₁ and brightness to the ridges with Creamy Enamel.

Fig. 17. Completion of the enamel surface with a cover layer of LTx, which is responsible for a high translucency and opalescence.

Fig. 18. Result of the second bake.

Fig. 19. Final restorations with a natural self-glaze effect on the model.

Fig. 20. Final restorations with a natural self-glaze effect in the patient’s mouth.

Fig. 21. Smooth optical integration of the restorations.

Fig. 22. Beautiful treatment outcome.

CONCLUSION

With the described approach and selected materials, it was possible to create restorations with a natural shade, shape and texture. They matched not only the appearance of the remaining natural teeth, but also showed internal consistency across the selected framework materials. The technical procedure was quite straightforward and efficient, while the result speaks for itself.

Special thanks to Dr. Kanellos Ioannis for the collaboration on this case and for kindly providing the pre- and post-treatment photographs that complemented it.

Dental technician:

ANDREAS CHATZIMPATZAKIS

Based in Athens, Greece, Andreas Chatzimpatzakis is the founder and director of ACH Dental Laboratory (since 2000), specializing in refractory veneers, lithium disilicate, zirconia, and implant prostheses. He graduated in Dental Technology from the University of West Attica and received advanced training in all-ceramic restorations in Helsinki and Japan under renowned masters including Shigeo Kataoka.

Since 2017, he has served as an international trainer for Kuraray–Noritake Dental Inc., delivering lectures and hands-on courses worldwide on advanced ceramic techniques. He has also held roles as Key Opinion Leader for MPF Brush Co., Ambassador for Hass Co., and Editor-in-Chief of Laborama. An active member of the Hellenic Academy of Aesthetic Dentistry, his work and articles have been published in both Greek and international journals.