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Case by Dr. Jusuf Lukarcanin

Restoring posterior cavities is a standard task we perform virtually every day. Yet, it is a challenging procedure as access to the affected teeth is often limited. This fact complicates many steps from working field isolation to material application and sculpting. By streamlining procedures and establishing protocols that are followed every time, it is possible to achieve predictable outcomes even in difficult situations, as shown below.

Fig. 1. Class II cavity in a second molar after caries removal and cavity preparation.

Fig. 2. Working field isolation.

Fig. 3. Application of adhesive (e.g. CLEARFIL S³ BOND PLUS) into the cavity.

Fig. 4. Build-up of the proximal wall with CLEARFIL MAJESTY™ ES-2 Classic (Kuraray Noritake Dental Inc.) in the shade A2.

Fig. 5. Build-up of the dentin core using the incremental technique with CLEARFIL MAJESTY™ ES-2 Premium in the shade A2D.

Fig. 6. Contouring of the occlusal enamel layer made of CLEARFIL MAJESTY™ ES-2 Premium in the shade A2E.

Fig. 7. Polishing of the restoration with Twist DIA for Composite.

FINAL SITUATION

Fig. 8. Treatment outcome.

Dentist:

DR. JUSUF LUKARCANIN

Dr. Jusuf Lukarcanin is a Certified Dental Technician (DCT) and a Doctor of Dental Science (DDS). He studied dentistry at the Ege University Dental Faculty in Izmir, Turkey, where he obtained a Master‘s degree in 2011. In 2017, he received a Ph.D. degree from the Department of Restorative Dentistry of the same university. Between 2012 and 2019, Dr. Lukarcanin was the head doctor and general manager at a private clinic in Izmir. Between 2019 and 2020, he worked at Tinaztepe GALEN Hospital as a Restorative Dentistry specialist, between 2020-2022 he worked at MEDICANA International Hospital Izmir as a Restorative Dentistry specialist. Currently he is an owner of a private clinic for aesthetics and cosmetics in Izmir.

Compact, time-saving and aesthetic

How many different shades of composite do you need to create appealing restorations in virtually every clinical situation? If you opt for “CLEARFIL MAJESTY™ ES-2” Universal shade concept, a few shades will do the trick.

With wonderful support of our internationally recognized key opinion leaders, we have prepared a Clinical Case brochure of “CLEARFIL MAJESTY™ ES-2” Universal for you. The brochure highlights a variety of clinical cases in the anterior and posterior region to show the all about excellent properties of our latest composite. Let the pictures speak for themselves!

Click here to view. Enjoy!

Start Reading: Special MAJESTY ES-2 Universal - Clinical Cases Brochure

Case by Dr. Nicola Scotti

When restoring posterior teeth with resin composite, functional aspects such as tight and anatomically correct proximal contacts and a naturally shaped occlusal surface that is wear-resistant and antagonist-friendly are even more important than a perfect optical integration. This is why every dental practitioner should avoid spending a lot of time on shade selection in these cases and focus on the factors that have an impact on the reliability and longevity of the restoration. Great support in accomplishing this task is offered by CLEARFIL MAJESTY™ ES-2 Universal, a resin composite with a single universal shade (U) for the posterior region that eliminates the need for shade taking and selection. At the same time, it offers good marginal adaptation, low shrinkage stress and high wear resistance needed for great long-term results.

Fig. 1. Initial situation with a wide primary carious lesion in the distal aspect of the second premolar.

Fig. 2. Premolar after isolation of the working field with rubber dam, caries excavation and cavity preparation.

Fig. 3. Placement of a sectional matrix and a wedge to optimize the fit. Both are held in place with a separation ring, which increases the interproximal space and hence ensures tight, anatomically correct proximal contacts.

Fig. 4. Build-up of the proximal wall with CLEARFIL MAJESTY™ ES-2 Universal (U shade) following selective enamel etching with phosphoric acid (K-ETCHANT Syringe) and bonding with CLEARFIL™ SE Bond.

Fig. 5. A thin layer of flowable composite (CLEARFIL MAJESTY™ ES FLOW High) applied to the cavity floor to act as a resin coat.

Fig. 6. Restoration completed with CLEARFIL MAJESTY™ ES-2 Universal (U shade). While the universal shade composite blends in very well with the surrounding tooth structure, the natural look is completed by adding a tiny bit of brown tint to the fissure.

Fig. 7. Treatment outcome immediately after rubber dam removal. The proximal contact is tight and the occlusal anatomy well-shaped for the patient’s individual masticatory dynamics. The margin of the restoration is virtually invisible, while the buccal cusp appears lighter due to dehydration of the natural tooth structure.

FINAL SITUATION

Fig. 8. Treatment outcome after two months.

Conclusion

The present case demonstrates that the selected composite is well-suited for simplified restoration procedures in the posterior region. The material handles well, offers the same mechanical properties as other materials from the CLEARFIL MAJESTY™ ES-2 series and blends in harmoniously with the surrounding structures without being too translucent. This way, it is possible to waive the shade-taking process without compromising the treatment outcome. The time saved in this context may be spent on functional aspects – or even on another patient.

Dentist:

DR. NICOLA SCOTTI

Case by Dr. Kristine Aadland.

Fig. 1. Preparation.

The patient’s old PFM bridge (shown here) was removed, and the existing preps for teeth #6 and #8 were modified with a medium chamfer with smooth and rounded edges to accommodate a 3-unit KATANA™ Zirconia bridge. There was no abutment for tooth #7, as that space serves as the pontic. Tooth #9 was similarly prepared to receive a single-unit KATANA™ crown.

Fig. 2. Define Restorations.

To begin, each restoration type is defined in the CEREC software, as the design mode (Biogeneric Individual), material type (KATANA™ Zirconia Block), and milling device (CEREC MC XL).

Fig. 3. Digital Impression.

A digital impression of the upper arch was performed using CEREC Primescan.

Fig. 4. Restoration Design.

The patient did not like the size of her centrals and wanted them smaller. She also didn’t like that her smile was slanted/canted. While designing, it really helps to use the patient’s old smile as a reference. This is why I used Bioindividual when designing the restorations, and added a BioCopy folder in the acquisition screen. I can ghost over the previous smile and readily see where I am.

Fig. 5. Restoration Design: Occlusal.

The BioCopy design function is also utilized to ensure a correct occlusal profile.

Fig. 6. Milling.

A KATANA™ Zirconia Block for bridge (14Z L) was used for the 3-unit bridge, and a KATANA™ Zirconia 12Z single-unit block was used for the single crown. The bridge block mills out in about 18 minutes, which is the fastest-milled chairside bridge block currently available.

Fig. 7. Characterization & Sintering.

Kuraray Noritake CERABIEN™ ZR FC Paste Stain and Glaze Kit was used for characterizing. The colors are very natural and it is not simply a metal oxide like other stains, but actually adding porcelain, giving the restorations more vitality. The oven cycle is quick at approximately 10 minutes, which means multiple fires are easy to do without excess time.

Fig. 8. Seating & Final Smile.

PANAVIA™ SA Cement Universal and CLEARFIL™ Universal Bond Quick were used for cementation and bonding. I love the ease of use and clean-up with PANAVIA™ SA Cement Universal, and its MDP monomer creates a strong chemical bond to the tooth structure and zirconia. CLEARFIL™ Universal Bond Quick has a quick technique without reducing bond strengths, releases fluoride and has a low film thickness. I simply rub CLEARFIL™ Universal Bond Quick into the tooth for a few seconds and air dry. There is no need to light-cure, since it cures very well with PANAVIA™ SA Cement Universal. The patient was very happy with the results. She loved that she no longer saw metal margins, and her smile was much more uniform and lifelike.

DR. KRISTINE AADLAND