CLEARFIL MAJESTY™ ES Flow Universal VINNER FORSKNINGSPRIS

Kuraray Noritake Dental Inc. har nettopp lansert en flytende kompositt med et forenklet fargekonsept: CLEARFIL MAJESTY™ ES Flow Universal. Som publisert i januar/februar 2025-utgaven av det USA-baserte Dental Advisor, mottok det splitter nye produktet en prestisjefylt forskningspris for sin overbevisende in-vitro-ytelse.

EGENSKAPER I ET NØTTESKALL

I Europa ble CLEARFIL MAJESTY™ ES Flow Universal nylig lansert i to viskositeter – Low og Super Low, mens i USA er Super Low-varianten tilgjengelig. For å gjøre fargeutvelgelsen enkel, er materialet utstyrt med en smart kombinasjon av emaljelignende translusens, dentinlignende kromaticitet og unik Light-Diffusion Technology (LDT). Dette gir enestående evne til fargetilpasning og gjør det mulig å begrense fargespekteret til bare to komplementære nyanser – universal (U) og universal dark (UD). Etter herding blender materialet naturlig inn med den omkringliggende tannstrukturen.

Bortsett fra intuitiv fargeutvelgelse, tilbyr den flytende kompositten en annen stor fordel: dens eksepsjonelt høye styrke. Med en bøyestyrke på 152 MPa og en trykkstyrke på 374 MPa er CLEARFIL MAJESTY™ ES Flow Universal (Super Low) like sterk som mange komposittmaterialer i pastaform. Dermed er den egnet selv i belastede områder og indikert for:

• Direkte restaureringer for alle kavitetsklasser, cervikale lesjoner (f.eks. rotkaries, V-formede defekter), tannslitasje og tannerosjon
• Kavitetssåle / liner
• Korrigering av tannposisjon og tannform (f.eks. lukking av diastema, tannmisdannelser)
• Intraoral reparasjon av frakturerte restaureringer
• Sementering av keramiske og kompositt-inlays, onlays og fasetter med mindre enn 2 mm tykkelse

IMPONERENDE IN-VITRO-YTELSE

Varianten med Super Low flyteevne, som tilbys i USA, ble testet ved Dental Advisor Biomaterials Research Center og sammenlignet med to andre flytende kompositter. Blant egenskapene som ble evaluert var materialenes bøyestyrke, elastisitetsmodul, bruddseighet, trykkstyrke og røntgentetthet. I tillegg vurderte forskerne materialenes evne til fargetilpasning i forbindelse med restaurering av klasse V-kaviteter i A1-, B2-, C3- og D4-fargede protese-tenner. Til slutt ble også røntgentetthet og flyteegenskaper testet.

CLEARFIL MAJESTY™ ES Flow Universal presterte svært godt på alle områder. De fysiske egenskapene viste seg å være blant de høyeste for flytende kompositter og på et tilsvarende nivå som alternativer i pastaform. Røntgentettheten ble vurdert som ideell, det samme gjaldt viskositeten, ettersom materialet beholder sin opprinnelige form etter påføring. Og selv om det kun tilbys i to nyanser, bekreftet forskerne at CLEARFIL MAJESTY™ ES Flow Universal tilpasser seg et bredt spekter av naturlige tannfarger.

OM DENTAL ADVISOR

Top Product- og Preferred Product-prisene fra Dental Advisor, en USA-basert organisasjon, ble etablert for å hjelpe travle tannleger med å navigere i mangfoldet av nye dentale løsninger, spesielt for mindre invasive teknikker og standardiserte prosedyrer. Disse prisene har som mål å identifisere produkter som konsekvent forbedrer behandlingsresultater. Dental Advisor gjennomfører kliniske evalueringer og tester av produktenes ytelse kort tid etter lansering, og publiserer årlige resultater på nett for å hjelpe tannleger med å identifisere høykvalitets dentale materialer som passer deres spesifikke behov. Research Awards ble opprettet for å hedre produsenter av dentale produkter som viser et kontinuerlig engasjement for forskning, utvikling og videreutvikling av dentale materialer for å heve kvaliteten på behandlingen.

For mer informasjon, besøk Dental Advisor på: www.dentaladvisor.com 

PANAVIA™ Veneer LC WINS PREFERRED PRODUCT AND RESEARCH AWARDS

PANAVIA™ Veneer LC has been singled out for a Research Award in the category Research – Veneer Cement by Dental Advisor and for a Preferred Product Award in the category Cement: Esthetic Resin. Published in the January/February 2025 issue of the US-based organisation, the annual Top Product, Preferred Product or Research Awards are given to those materials and devices deemed by the publication’s consultants to deliver the best practice-based or lab-based performance in their categories.

BENEFITS IN A NUTSHELL

PANAVIA™ Veneer LC is a specialized veneer cement designed to provide exceptional bond strength to various substrates, along with outstanding gloss retention and wear resistance. The resin cement utilizes smaller-diameter spherical filler particles, facilitating easy dispensing from the syringe and excellent flowability for minimal film thickness. All of these attributes contribute to virtually no change in gloss or surface appearance of veneer margins over time.

EXCELLENT PROPERTIES IN VITRO

To assess the scientific performance of PANAVIA™ Veneer LC, its features and physical properties, specifically its bond strength to various substrates after artificial aging and its wear resistance, were tested in the Dental Advisor Biomaterials Research Center. The investigators’ testing of these attributes reflects the challenges such products must meet – “Ideally, esthetic veneer cements should have a long working time, curing on demand, excellent color stability, and high strength”.

To assess bond strength to dentin, enamel, IPS e.max CAD, and zirconia, the cements were subjected to six months of artificial aging using thermocycling. To test wear resistance after toothbrush abrasion, the testing method involved measuring depth of wear, change in surface roughness, and change in gloss based on a simulation of about 5.5 years of regular toothbrush use.

The investigators reported that PANAVIA™ Veneer LC “had the best gloss retention of the three cements tested and a very even wear pattern,” noting further that “having limited surface roughness after toothbrush abrasion can help lower staining and bacterial adhesion.” Overall, they said, “The PANAVIA™ Veneer LC cement system showed excellent adhesion properties and exceptional gloss retention and wear resistance,” concluding:

OUTSTANDING RATING OF 96 PERCENT

In addition, the product was tested in the clinical setting. 25 clinical evaluators used PANAVIA™ Veneer LC cement system in their dental offices. After a total of 166 uses, the light-curing resin cement received “excellent” to “very good” ratings with regard to completeness of the kit, the shade of the try-in pastes, ease of clean-up of the try-in pastes and excess cement, viscosity, working time and lack of shade shift after curing.

The evaluator’s clinical tips included:

• „Use a micro brush or rubber tip to clean up excess cement before curing.”
• „Apply glycerin gel to the margins after placing the veneer with the cement to eliminate the oxygen inhibition layer and ensure a complete cure before light curing through the gel.”

In their comments, they praised the ease of use of the system, the design of the syringes, the shade options and shade match between try-in and cement shades, e.g.:

• “The white shade of the cement was opaque enough for efficient masking of discolored tooth structure.”
• “Great esthetics, very easy to use, complete system.”

This resulted in an overall clinical rating of 96 percent and an equally high recommendation rate.

ABOUT DENTAL ADVISOR

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

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

Workflow for sealing a prepared abutment tooth (for indirect restorations and CLEARFIL Universal Bond Quick 2.

Workflow for cementation of indirect restorations with PANAVIA SA Cement Universal and CLEARFIL Universal Bond Quick 2.

Interview with the team at Kuraray Noritake Dental Inc., who developed and brought to life this new universal adhesive.

Streamlining, enhancing and refining adhesive procedures – these are the aims of an 5-person team at Kuraray Noritake Dental Inc. in Japan. Recently, the team has developed a next-generation universal adhesive CLEARFIL™ Universal Bond Quick 2 that offers quick and easy application combined with an optimised bonding performance. To learn more about the goals and achievements of the development project, and the benefits of the product, we had a conversation with them.

From left to right: Ryo Matsuura and Ryota Murayama (R&D Department), Kazutoshi Ikeda (Production Department), Marina Okada and Yamato Nojiri (Planning & Development Department).

Why did you decide to improve CLEARFIL™ Universal Bond Quick?

Universal adhesives like CLEARFIL™ Universal Bond Quick are very well received by dental practitioners all over the world mainly due to their versatility and procedural simplicity. In the clinical setting, however, we have identified room for improvement. For example, it can be difficult to establish thin, uniform and strong bonding layers with the currently available products. Water and solvents in universal adhesives often limit the formation of a strong bond layer. A thin bonding layer and the relatively thick oxygen inhibition layer make this type of bonding agent susceptible to degradation by water sorption from dentinal moisture. Highly viscous bonding agents also complicate the ease of application in small cavities and can easily lead to pooling of the adhesive in critical parts of the cavity. Adhesives with a relatively high viscosity may pool or accumulate along margins, and may form a layer that is too thick and may change the morphology of the abutment tooth, a critical factor potentially affecting the fit of an indirect restoration. Generally, bonding agents with a low film thickness and/or are low-filled or unfilled, in turn have a potentially negative effect on the strength of the bonding layer. At Kuraray Noritake Dental Inc., we wanted to address the aforementioned issues and have developed a universal adhesive that is easy to apply and facilitates the establishing of thin, uniform bonding layers exhibiting high strength.

What are the indications of CLEARFIL™ Universal Bond Quick 2?

The new universal adhesive is indicated for bonding procedures in the context of creating direct restorations with light-cured composite, sealing of a prepared cavity or abutment tooth as a pretreatment for indirect restorations, treatment of exposed root surfaces and hypersensitive teeth, and also the intraoral repair of fractured restorations. Furthermore, the product is a suitable adhesive in post-cementation and core build-up procedures as well as in adhesive cementing of indirect restorations. When used in the context of the cementing of indirect restorations, the bonding to tooth structure of PANAVIA™ SA Cement Universal and of other manufacturers’ self-adhesive resin cements improves, leading to higher bond strengths.

What are the corresponding general benefits of CLEARFIL™ Universal Bond Quick AND CLEARFIL™ Universal Bond Quick 2?

The general benefits of both products are that they may be used with any etching procedure, plus the fact that there is no need to wait for the adhesive to penetrate the tooth structure after application. In addition, both products contain the original MDP monomer and the amide monomer, responsible for the formation of a thin and strong surface coating. Both products exhibit low technique sensitivity and are suitable for a wide range of indications. Finally, the adhesive monomers and fluoride offer extra protection to the underlying dentin.

Monomer image from the brochure

You mentioned the original MDP monomer as one of the essential components of the new adhesive and its predecessor. Is there a difference between this original MDP monomer and other MDP monomers available on the market?

Our MDP monomer is the only MDP monomer that is manufactured using the originally developed synthesis and purification process. Research has shown that the way MDP is manufactured has indeed an impact on the performance of the monomer itself1. While impurities and dimers detected in MDP monomers synthesized elsewhere negatively affected the immediate and aged micro-tensile bond strength in the in-vitro study, our MDP monomer shows high purity and more favourable test results.

Most universal adhesives need to be rubbed into the tooth structure extensively for 10 to 20 seconds. What did you do to eliminate the waiting time independent of the etching procedure, which led to an ultra-quick application procedure?

It is the amide monomer which is mainly responsible for an improved penetration speed into the tooth structure. The hydrophilicity of this monomer is much higher than the hydrophilicity of the HEMA monomer that is typically used. This provides for a better penetration into the moist dentin. The amide monomer’s polymerisation characteristics are better, and, following polymerisation, leads to higher stability in a wet environment due to the formation of a highly cross-linked polymer network. In combination with MDP, an efficient long-term performance will likely be achieved. For optimal outcomes, the adhesive is simply rubbed into the tooth structure as described in the IFU: “Apply BOND with a rubbing motion to the entire cavity wall with the applicator brush. No waiting time is required.”

What are the additional benefits that CLEARFIL™ Universal Bond Quick 2 has to offer?

First of all, we improved the viscosity and film thickness by optimizing the manufacturing method. The thin adhesive layer prevents pooling in the cavity, around abutments and along margins, creating a uniform bonding layer. Simply put, the new adhesive is applied thinly and spreads evenly. At the same time, the product offers high mechanical strength and excellent resistance to water sorption. Its bond strength is high in all etching modes and the new formulation allows for the product to be stored at room temperature.

Please explain the clinical benefit of an improved mechanical strength.

The risk of decreasing the film thickness lies in a possible decrease in the strength of the bonding layer which can lead to reduced bond durability. By introducing a new multifunctional urethane methacrylate monomer, we have been able to increase the strength. The effective advantage of the new bonding agent is that it can easily be used in small, difficult-to-access cavities or in cavities with complex morphology. The result is a thin yet strong adhesive layer that also allows for easy placement of any type of restoration.

How did you manage to improve the storage conditions?

Component stability was not an issue with CLEARFIL™ Universal Bond Quick. However, for a stable viscosity, it needed low-temperature storage. By optimizing the manufacturing method and decreasing the viscosity of CLEARFIL™ Universal Bond Quick 2, storage at room temperature became possible.

Was it difficult to integrate the new components and keep the existing benefits? How did you manage?

Integrating new components and removing others always means that the whole formulation needs to be rebalanced properly. This was particularly challenging for the multifunctional urethane methacrylate monomer we wanted to add. It improves the strength and hardness of the universal adhesive, but may affect adhesion depending on the amount of the compound in the formulation. Consequently, we needed to carefully find optimal balance, which took some time and required thorough testing, but in the end, we succeeded.

At the moment, the immediate dentin sealing technique is popular in indirect restoration procedures. What makes CLEARFIL™ Universal Bond Quick 2 suited for this technique?

Immediate dentin sealing is indeed a popular and useful technique that can result in significantly increased retention, reduced marginal leakage, improved bond strength, and less postoperative sensitivity. Using CLEARFIL™ Universal Bond Quick 2 in this context is beneficial as the procedure is quick, the resulting bonding layer is thin and strong, and the dentin is effectively protected.

Why should a dental practitioner switch to CLEARFIL™ Universal Bond Quick 2?

For users of CLEARFIL™ Universal Bond Quick, switching to CLEARFIL™ Universal Bond Quick 2 is worthwhile, as it offers additional advantages and improved performance while retaining the benefits of its predecessor. For users of other universal adhesives, the major benefit lies in the shortened application time: CLEARFIL™ Universal Bond Quick 2 is the only universal adhesive that can achieve a high bond strength and a high-strength bonding layer without any waiting time. In addition, it is suitable for a wide range of indications including core build-up procedures and cementation.

Thank you very much for these insights!

References
1. Yoshihara K, Nagaoka N, Okihara T, Kuroboshi M, Hayakawa S, Maruo Y, Nishigawa G, De Munck J, Yoshida Y, Van Meerbeek B. Functional monomer impurity affects adhesive performance. Dent Mater. 2015 Dec;31(12):1493-501.

CERABIEN™ MiLai in Daily Use

A tooth with crack lines, a characteristic round shape, age-related changes, or medication-induced discoloration — there’s no one-size-fits-all solution when it comes to all-ceramic anterior restorations, even when the porcelain system and production technique are defined.

To support technicians who wish to simplify their layering workflow using the micro-layering technique and CERABIEN™ MiLai — whether just getting started or looking to refine their process — we’ve collaborated with DT Dumitru Leahu to create a Chroma Map Catalogue featuring seven typical anterior restoration scenarios.

Each case example includes a detailed screenshot of the framework design, chroma maps outlining the planned steps, images of internal staining and micro-layering procedures, and the final restoration on the model. You’ll also find essential information about the selected framework material, target shade, and other relevant details.

We invite you to use the CERABIEN™ MiLai Catalogue as a step-by-step guide to success or simply as inspiration for individual cases. It offers a fast track to understanding the material’s optical properties and will make planning your next micro-layering case more intuitive. No need to start from scratch — instead, adapt what’s already there and gradually develop your own maps and techniques.

Interested in the CERABIEN™ MiLai Chroma Map Catalogue?

Download it here!

CLEARFIL™ Universal Bond Quick 2

I moderne odontologi er effektivitet og pålitelighet nøkkelfaktorer for mange klinikker. CLEARFIL™ Universal Bond Quick 2 tilbyr en brukervennlig, høytytende bondeløsning som gir eksepsjonelle resultater. Med sin Advanced Rapid Bond Technology muliggjør denne adhesiven en rask og enkel applisering, samtidig som den eliminerer unødvendige steg og reduserer teknisk sensitivitet.

Hva er CLEARFIL™ Universal Bond Quick 2?

CLEARFIL™ Universal Bond Quick 2 er et avansert dentalt adhesiv utviklet for å effektivisere restaureringsprosedyrer. Det er kompatibelt med valgfri etsningsteknikk og gir sterk adhesjon til både emalje og dentin, og sikrer et sterkt og jevnt bindelag. Dets allsidighet gjør det egnet for både direkte og indirekte restaureringer, samt oppbygging av kjerne og reparasjoner intraoralt.

Hvor kan denne bondingløsningen brukes

CLEARFIL™ Universal Bond Quick 2 er ideell for enhver tannklinikk som ønsker et pålitelig og brukervennlig adhesiv. Enten man utfører rutinemessige direkte restaureringer eller ere indirekte prosedyrer, gir dette adhesivet konsekvent ytelse og en forenklet arbeids yt.

Hva er indikasjonene for CLEARFIL™ Universal Bond Quick 2?

Dette bindemiddelet er utviklet for en rekke kliniske anvendelser:

• Direkte restaureringer med lysherdet komposittresin
• Forsegling av preparert kavitet eller abutmenttann som forbehandling for indirekte restaureringer
• Behandling av eksponerte rovover ater
• Behandling av hypersensitive tenner
• Intraorale reparasjoner av brukne restaureringer
• Postsementering og oppbygging av kjerne
• Sementering av indirekte restaureringer

Hvorfor fungerer CLEARFIL™ Universal Bond Quick 2 så godt?

Nøkkelen til den eksepsjonelle ytelsen ligger i den proprietære Advanced Rapid Bond Technology, som består av tre høyytelsesingredienser:

• Original MDP-monomer: Utviklet av KURARAY CO., LTD., gir denne monomeren en enestående binding til hydroksyapatitt og et bredt spekter av materialer, inkludert zirkoniumoksid. Den sikrer en fremragende binding som forblir stabil over tid.
• Amid-monomer: En svært hydro l monomer som gjør rask penetrering inn i tannstrukturen mulig, uten behov for ventetid etter påføring. Under polymerisering danner den et stabilt, hydrofobt og kryssbundet nettverk for en sterk og holdbar binding.
• Uretan Tetra Metakrylat (UTMA) monomer: Denne multifunksjonelle monomeren styrker selve bindelaget, øker motstanden mot krympningskrefter samtidig som den opprettholder et tynt og jevnt adhesivlag.

Sammen utgjør disse monomerene grunnlaget for CLEARFIL™ Universal Bond Quick 2, og gir et raskt, pålitelig og allsidig adhesiv for alle dine restaureringsbehov.

Hvorfor velge CLEARFIL™ Universal Bond Quick 2?

CLEARFIL™ Universal Bond Quick 2 øker effektiviteten uten å gå på kompromiss med kvaliteten. Den Advanced Rapid Bond Technology integrerer MDP-, Amid- og Uretan Tetra Metakrylat (UTMA)-monomerer for å skape et sterkt og jevnt bindelag. Dette gir jevn fordeling og fremragende adhesjon til både emalje og dentin. Den lavviskøse formelen danner en tynn, jevn  lm, noe som reduserer risikoen for opphopning og øker forutsigbarheten.

Ytterligere fordeler inkluderer:

• Rask og enkel påføring
• Konsekvent holdbar vedheft
• Allsidighet på tvers av ulike restaureringsteknikker
• Minimert risiko for opphopning og forurensning
• Kompatibel med selvheftende resinsementer
• Praktisk oppbevaring ved romtemperatur

Hvordan påfører man CLEARFIL™ Universal Bond Quick 2?

Påføringen er enkel og effektiv, og kan tilpasses ulike kliniske situasjoner. Adhesivet kan brukes i:

• Selvetsingsmodus for en moderne, rask og effektiv tilnærming
• Selektiv etsingsmodus for ekstra styrke i emaljebinding
• Totaletsingsmodus for en konvensjonell tilnærming

Det finnes både i aske og i enhetsdose, slik at det kan tilpasses ulike behov i praksisen og sikrer enkel bruk etter behov.

Den ultimate bindeløsningen: CLEARFIL™ Universal Bond Quick 2

Som den nyeste innovasjonen innen dental binding, gir CLEARFIL™ Universal Bond Quick 2 effektivitet, pålitelighet og allsidighet. Ved å eliminere ventetid, omfattende gnissing og behovet for påføring av  ere lag, forenkler dette adhesivet prosedyrer samtidig som det skaper sterke og langvarige restaureringer. Med sin enestående ytelse og forenklede arbeids yt er det virkelig «alt-i-ett»-bindemiddelet for moderne tannpraksiser.

Kjernen i den universelle porteføljen

Hos Kuraray Noritake Dental Inc. forstår vi kravene i moderne tannpraksiser. Å balansere komplekse prosedyrer, tett timeplan og pasientomsorg er ingen enkel oppgave. Derfor har vi brukt år på å forbedre våre materialer – slik at du kan fokusere på det som betyr mest: dine pasienter. Våre universelle produkter forenkler arbeids yten din, og gir deg høykvalitets materialer og verktøy som fungerer CLEARFIL MAJESTY™ ES-2 Universal sømløst med din ekspertise. CLEARFIL™ Universal Bond Quick 2 utgjør bokstavelig talt forbindelsen mellom  ere universelle resinbaserte produkter i vår portefølje. I tillegg er det ikke nødvendig med en separat dobbeltherdende aktivator når det brukes sammen med andre produsenters selvadherende sementer.

Interview with Takehiro Kameya
Manager of the Technology Division of Kuraray Noritake Dental Inc.

How did you identify the need for a universal flowable restorative?

Packable composites with a universal shade concept are becoming increasingly popular worldwide. This fact made us assume that there is a demand for the flowable type as well. Users will also benefit from simplified procedures and a reduced number of shades to be stocked, with a positive impact on inventory management. Accordingly, we introduced the universal flowable composite in Japan, where it already holds a significant market share. Users have been utilizing it for various cases with excellent feedback. As it turned out to be very well received in Japan, we approached the European team to extend the release area to Europe, and the decision was made to launch it. We pushed forward with commercialization in an ultra-short period of about one year.

Does it really create added value to use a universal flowable composite in addition to the universal packable variant?

Yes, several benefits arise from the additional use of a modern flowable composite. This is because – unlike earlier products – the latest generation of flowable composites offers sufficient mechanical strength to be used for regular restorations. The advantages of using a flowable composite include the ability to flow into even the narrowest parts of a (sometimes complex) cavity, which provides for easy and quick filling procedures, and to an intimate adaptation at the adhesive interface leading to a tight seal.

What are the differences between CLEARFIL MAJESTY™ ES Flow and CLEARFIL MAJESTY™ ES Flow Universal?

CLEARFIL MAJESTY™ ES Flow Universal maintains the distinctive features of CLEARFIL MAJESTY™ ES Flow, such as convenient dispensing, handling and sculpting, extremely easy and quick polishing, long-lasting gloss and great mechanical properties. Due to their high strength, both products can be used not only as liners, but also for regular direct restoration procedures. The difference lies in the shade concept. CLEARFIL MAJESTY™ ES Flow Universal introduces a universal shade system, allowing it to adapt to a wide range of colour tones with fewer shade variations.

Please describe the shade concept behind CLEARFIL MAJESTY™ ES Flow Universal. How many shades are available and how are they selected?

The CLEARFIL MAJESTY™ ES Flow Universal line-up consists of two shades: Universal (U) and Universal Dark (UD). U is an excellent choice for all posterior restorations, independent of the target shade. In the anterior region and cervical area (Class III, IV and V cavities), U is best suited for restoring teeth of the shades A1 to A3 (including B1, B2, C1, C2, D2, D2, D3 and D4), while UD is the shade of choice to match the target shades A3.5 to A4 (including B3, B4, C3 and C4).

Color matching with anterior and posterior restorations.

Why do you offer an additional shade for the anterior region?

Universal-shade composites need to take on the colour of the surrounding tooth structure to deliver a perfect match for a great number of target shades. In the posterior area, large amounts of surrounding tooth structure are usually available with several cavity walls still present. This facilitates the taking on of the tooth colour compared to cavities in the anterior region. Here, light easily passes through, so that the colour of the composite itself is more likely to be reflected. This can lead to limitations in colour matching. In the case of CLEARFIL MAJESTY™ ES Flow Universal, the U shade that turned to be ideal for the posterior area showed some colour-matching limitations in anterior restorations of darker teeth. Hence, we decided to offer a second colour option specifically designed for these situations. With U and UD, CLEARFIL MAJESTY™ ES Flow Universal offers great colour adaptability from light to dark shades and hence addresses the need for precise colour matching especially in the anterior region.

Developing just two shades of composite to cover so many target tooth shades sounds challenging. How did you evaluate whether the available shades are appropriate in the clinical environment?

Indeed, it has been quite challenging to develop the U shade, which is able to match a wider range of tooth colours for both anterior and posterior teeth than the U shade of CLEARFIL MAJESTY™ ES-2 Universal. In order to evaluate and fine-tune the shades we developed, we repeatedly conducted filling tests using a wide range of experimental shades in artificial teeth and extracted teeth of various tooth colours. Additionally, the final selection of shades was visually evaluated by consulting dental practitioners who used the composite in the clinical setting.

What are the greatest challenges in the context of determining and selecting the right shade in the clinical environment?

The major drawback of classical shade determination is that it simply increases the chair time. For both, the dental practitioner and the patient, however, minimizing chair time is the ultimate goal, as it reduces costs and increases patient comfort. A true drawback in terms of time and comfort is a colour mismatch produced due to an error during shade determination: it may necessitate intra-oral adjustments or, in the worst case, the creating of a new restoration.

CLEARFIL MAJESTY™ ES Flow Universal is available in two viscosities – Low and Super Low. Why is this the case and what is the difference in use?

We decided to offer two types of flowability with different thixotropic properties to cater to users’ preferences in terms of handling. Basically, there is no difference in usage between Low and Super Low. However, users are encouraged to use composites with different thixotropic properties according to their preferences and the specific case. For example, Super Low is useful for shaping the occlusal surface of posterior teeth. Low can be widely used for applications such as lining and filling in the cervical area and on proximal surfaces.

CLEARFIL MAJESTY™ ES Flow Universal – Great mechanical properties.

What are the technologies behind CLEARFIL MAJESTY™ ES Flow Universal that provide for a great blend-in?

The probably most popular technology used in this product is our proprietary Light Diffusion Technology. We determined the optimal light diffusion based on the observation that a strong diffuse reflection of incident light results in whitening, and weak light diffusion makes it easier to take on dark colours in the oral cavity, darkening the filling site. In addition, we focused on chroma adjustment: The universal shade concept is based on the ability to take on the colour of the surrounding tooth structure and blend with it. Therefore, we have set the chroma to be easily harmonized with a wide range of tooth shades. Finally, the translucency of the material was adjusted via its submicron fillers and silica clusters. Evaluation by key opinion leaders supported us in determining an appropriate level of translucency.

How to proceed in cases with discoloured tooth structure underneath – is there a need for masking with a blocker or opaquer?

The necessity depends on the degree of discolouration. Due to the light diffusion properties of CLEARFIL MAJESTY™ ES Flow Universal, it is generally believed that blocking is not required, and shading can be achieved. However, in cases of severe discolouration, it may be beneficial to fill the bottom of the cavity with A2D or A3D shades of CLEARFIL MAJESTY™ ES Flow, or to use CLEARFIL™ ST Opaquer.

What did you do to avoid void formation during application?

We have adopted the same packaging design used in CLEARFIL MAJESTY™ ES Flow to avoid void formation in this product as well. The innovative container design minimizes the gap between the needle tip and the syringe when the tip is attached.

Are there any recommendations of when to use CLEARFIL MAJESTY™ ES Flow and when to opt for CLEARFIL MAJESTY™ ES Flow Universal?

While the universal variant can be used for general lining and filling applications as described in the instruction for use, CLEARFIL MAJESTY™ ES Flow is recommended for those cases in which the tooth structure is covered and the colour of the entire tooth needs to be changed. Direct veneers are a perfect example. In those situations, the use of different shades and opacities is clearly beneficial.

What is the future of flowable composites?

As information on clinical performance and physical properties data continues to spread, the trust in flowable composites is expected to increase in Europe, leading to its expanded usage. Furthermore, an increased demand is anticipated due to the development of filling methods using flowable composites in conjunction with moulds or matrices.

TAKEHIRO KAMEYA