TRULY EXCITED TO KICK OFF DAY 1

Tomorrow at 09:00 a.m., the International Dental Show in Cologne will open its doors for the 41^st time. At our booth E010/F019 in hall 11.3, our warm-hearted, knowledgeable team from all-over the world simply cannot wait to show you the latest innovations from Kuraray Noritake Dental Inc.

If you are looking for new products geared to the demands of modern dental practices, ask the team about CLEARFIL™ Universal Bond Quick 2 – a new-generation universal adhesive. Or watch out for CLEARFIL MAJESTY™ ES Flow Universal – a flowable composite with a simplified shade concept. Both products are part of our UNIVERSAL EXCELLENCE family: A range of materials and tools designed to work seamlessly in your hands, reduce complexity of restorative workflows and give you enough time to focus on fulfilling the individual desires and needs of every single patient.

Fig. 1. UNIVERSAL EXCELLENCE family: Streamlined solutions designed to elevate your restorative procedures.

An innovation truly streamlining finishing procedures in the dental laboratory is CERABIEN™ MiLai – a set of low-fusing porcelains and internal stains specifically developed for micro-layering on zirconia and lithium disilicate. The slim shade range reduces complexity while giving you enough choices to provide for great outcomes – aesthetically and functionally.

Fig. 2. CERABIEN™ MiLai system consisting of 16 base shades and 15 internal stains, which are easy to select and manage.

Would you like to learn more about these and other products showcased in Cologne? Visit us in Hall 11.3 at Booth # E010 or find out more on our website.

We look forward to meeting you!

Interview with Mathias Fernandez Y Lombardi

INTRODUCING CERABIEN™ MiLai LOW-FUSING PORCELAINS AND INTERNAL STAINS

Highly aesthetic lithium disilicate or zirconia-based framework materials combined with a micro-layer of porcelain are becoming the new standard for producing lifelike all-ceramic restorations. For those wondering why it’s worth adopting the new technique, how to start, how to improve and which materials to use, we had a conversation with a true expert in all things ceramic: Mathias Fernandez Y Lombardi, Head of Technical Marketing – Europe at Kuraray Europe GmbH.

Mathias Fernandez Y Lombardi, do you believe in micro-layering as a technique that is capable of streamlining procedures in the dental laboratory while fulfilling high aesthetic demands?

Yes, I truly believe that micro-layering is the next step in the evolution of indirect restorative techniques and materials. This evolution is driven by improvements in the area of framework materials, which are becoming more and more tooth-like in their appearance. We have moved from metal to opaque, high-strength zirconia and – more recently - high-translucency multi-layered zirconia and lithium disilicate, which no longer require thick porcelain layers to achieve lifelike outcomes. In this context, it’s only natural that a new technique has emerged.

Kuraray Noritake Dental Inc. is well-known as a pioneer in multi-layered zirconia technology and veneering porcelains. Are there any products particularly suitable or specifically developed for micro-layering?

We offer a series of high-translucency, multi-layered zirconia perfectly suited for micro-layering on the one hand and an aligned portfolio of internal stains and porcelains specifically developed for micro-layering on the other. The zirconia portfolio includes three different blank types with a multi-layered colour structure (KATANA™ Zirconia UTML, STML and HTML Plus), one variant with flexural strength, translucency and colour gradation (KATANA™ Zirconia YML), but also the timeless classic HT for the frameworks should be mentioned. While the first three offer a uniform strength and are chosen based on the indication, KATANA™ Zirconia YML with its multi-layered strength is a universal material suitable for an extremely wide range of applications.

The set of internal stains and porcelains specifically designed for the micro-layering technique that we just introduced is CERABIEN™ MiLai. With this addition to the CERABIEN™ family, we offer a perfect complement to the KATANA™ Zirconia Multi-Layered series, and with it, a revolutionary workflow that significantly deviates from traditional methods, enabling us to deliver greater efficiency, cost savings, and more flexibility. However, CERABIEN™ MiLai is not only compatible with KATANA™ Zirconia, but also with aesthetic zirconia from other manufacturers and reinforced silicate ceramics such as lithium disilicate with a CTE value within 9.5-11.0×10-⁶/K (50 °C – 500 °C).

Fig. 1. Overview of CERABIEN™ MiLai Low-Fusing Porcelains.

Fig. 2. Overview of CERABIEN™ MiLai Internal Stains.

Why should a dental technician start using the micro-layering technique and invest in a new set of porcelains for this purpose?

The reasons to start micro-layering are obvious: depending on the design, micro-layering can eliminate or minimize the chipping risk. Moreover, the technique is highly efficient, as the number of layers and bakes is drastically reduced. This results in a reduced thickness of the restoration facilitating minimally invasive preparations and a less complex layering procedure that even beginners are able to learn and implement very quickly. A new set of porcelains specifically developed for micro-layering like CERABIEN™ MiLai can further support the feasibility of the technique and the quality of the outcomes achieved even by beginners. Due to the shortage of skilled workers in dental laboratories, this aspect is becoming increasingly important.

How does CERABIEN™ MiLai support users in achieving aesthetic, high-quality outcomes right from the start?

With traditional porcelain systems, it can be challenging to create all the desired individual shade effects in a layer of only 0.03 mm to 0.6 mm thickness. With CERABIEN™ MiLai, this isn’t the case as the system is specifically designed for this purpose. The saturation and translucency of the porcelains are matched to the framework materials and adjusted to the volume of the porcelain layer. The compact line-up makes it quite easy to select and combine the right shades for satisfying results right from the start. More experienced users can mix the different components for additional effects, so that there are no limits to their creativity.

Images courtesy of MDT Daniele Rondoni.

Fig. 3. Virtually unlimited design options: crown with a full micro cut-back, crown with a vestibular cut-back and monolithic restoration.

Furthermore, the versatility of CERABIEN™ MiLai is a key feature that results in great outcomes. The system can be used on lithium disilicate and zirconia, a monolithic surface, a vestibular cut-back or a full micro cut-back. With this broad application spectrum, dental technicians are likely to use CERABIEN™ MiLai daily, which allows them to develop a true understanding of the components and to establish work routines very quickly. As a consequence, the outcomes become predictable and controllable. This is further supported by consistent handling and optical properties – all the result of a single core technology.

Please tell us more about this technology.

The core technology used in CERABIEN™ MiLai is synthetic feldspathic ceramic technology. Originally developed for Super Porcelain EX-3 and adjusted to the specific needs of CERABIEN™ ZR in the first step and CERABIEN™ MiLai more recently, this technology is responsible for consistent properties. This is because the formulation never needs to be aligned due to changing natural components. However, I believe that the greatest benefit of using feldspathic porcelain lies in the elimination of shadow effects. Everyone familiar with layering natural feldspathic porcelains on ceramics will know the typical greyish shadows appearing in restorations after several firing cycles. They originate from inhomogeneities in the material caused by micro-movements during firing. Showing no movements in this phase, synthetic felspathic porcelains from Kuraray Noritake Dental Inc. are the first and only porcelains preventing this effect. Finally, the further developed version of the technology allowed us to realize a low firing temperature of just 740 °C while maintaining the desired coefficient of thermal expansion. This is essential for the material’s compatibility with lithium disilicate.

Are there any other benefits arising from the low firing temperature?

The low firing temperature definitely offers an economic benefit, as the process consumes less energy and takes less time compared to high-temperature firing cycles. Moreover, the wear of the furnace is reduced. Finally, the low temperature is of interest for users of CERABIEN™ ZR in specific indications: Some ceramists like to combine the systems especially in cases with artificial gingiva. They create the porcelain work on the teeth with CERABIEN™ ZR first and then individualize the gingival area with CERABIEN™ MiLai. Due to the low firing temperature, the form, colour and surface of the previously applied veneering porcelain will remain stable.

Image courtesy of MDT Ioulianos Moustakis.

Fig. 4. Application of CERABIEN™ MiLai Tissue Porcelains on a complex restoration with the teeth already finalized.

Image courtesy of MDT Ioulianos Moustakis.

Fig. 5. Application of CERABIEN™ MiLai Internal Stains on a zirconia bridge.

Do you have any application technique recommendations for CERABIEN™ MiLai?

The best aesthetic outcomes are obtained by using the internal stain technique. By applying the stains first, it is possible to create natural depth effects despite the minimal thickness of the porcelain layer. The stains are easy to use and the outcomes are impressive. The micro-layer of porcelain applied on top acts like a window imitating the enamel, which contributes to a tooth-like appearance. Due to the compact line-up and easily manageable effects, this technique is even suitable for beginners.

Is the procedure different depending on the base material (lithium disilicate versus zirconia)?

Most of the steps are identical. However, surface conditioning may be different depending on the material used (as described in the material manufacturer’s instructions for use). Moreover, Value Liner 1 or Value Liner 2 is typically used on lithium disilicate for wash baking, whereas Translucent or Luster are recommended for this step on zirconia. When space is limited, internal stains may be applied directly. All following steps – the optional but highly recommended application of internal stains, the building-up of Translucent or Luster and baking, morphological corrections, the glaze bake and finishing – are identical.

What are the options for glazing?

CERABIEN™ MiLai porcelains offer a self-glaze effect obtained by fine-polishing (with PEARL Surface C) followed by glaze baking. This leads to a natural gloss, while maintaining the anatomical details. Alternatively, CERABIEN™ ZR FC Paste Stain Glaze or Clear Glaze can be applied and fixed by baking. These liquid ceramics allow users to add some structural details, while the surface appears glossier. However, the procedure is more time-consuming due to the additional application step.

Do you have any recommendations regarding the indication-specific selection of the framework or base material?

Traditionally, lithium disilicate has been the material of choice for aesthetic single anterior restorations, while zirconia was predominantly used for multi-unit restorations and restorations in the posterior area. With the availability of KATANA™ Zirconia STML / UTML and CERABIEN™ MiLai, zirconia is becoming increasingly attractive for the production of minimally invasive veneers, crowns and the like. A thin-walled restoration made of KATANA™ Zirconia, speed-sintered in just a few minutes and combined with a thin layer of CERABIEN™ MiLai, results in an incredibly strong restoration with several aspects that lithium disilicate simply cannot match. The preparation technique for zirconia is much more favourable for dentists - for example marginal adaptation and biocompatibility, especially regarding gingival healing, are superior. Aesthetically, there is no risk of a greyish effect when using zirconia with CERABIEN™ MiLai, while lithium disilicate needs to be treated with Value Liner to prevent this. Additionally, the ease of cementation with PANAVIA™ SA Cement Universal further enhances the quality of the restoration in the fastest possible timeframe, allowing for quick and flexible responses to dentists’ needs.

You mentioned speed sintering as a factor contributing to a streamlined workflow. Studies have shown, however, that this step might weaken the mechanical and aesthetic properties of zirconia. Do you recommend speed sintering despite this fact?

Indeed, speed sintering does affect the translucency and flexural strength of some zirconia variants. This is probably the reason why dental technicians have been reluctant to change their established practices of sintering overnight – despite the availability of high-speed furnaces. However, KATANA™ Zirconia is an exception: Due to our unique powder formulation, we are able to offer zirconia with a composition that is completely independent from other brands of dental zirconia. With this, we are able to fundamentally change the traditional workflow of an end-user and offer more flexibility, speed and efficiency, resulting in less energy consumption, stress and costs. In a study conducted at the Division of Biomaterials at the University of Alabama at Birmingham¹, three different high-translucency zirconia materials including KATANA™ Zirconia Block (KATANA™ Zirconia STML) were sintered according to a traditional and a high-speed sintering schedule. Prior to sintering and afterwards, the three-point bending strength, translucency and grain structure were analysed. The material from Kuraray Noritake Dental Inc. was the only zirconia with properties that remained unaffected after speed sintering. Internal testing confirmed this finding for all variants of the KATANA™ Zirconia Multi-Layered series. As a result, we do recommend speed sintering of our materials, delivering true economic and time advantages.

With highly potent materials for micro-layering now available, do you think that full ceramic layering is going to be a thing of the past?

I am convinced that in the near future the great majority of dental restorations will be produced using aesthetic framework materials and simplified micro-layering techniques. However, full porcelain layering is here to last. There will always be a demand for a few highly-skilled ceramists serving the needs of individuals with the highest aesthetic demands. It is like tailor-made versus off-the-peg suits: the tailor-made ones are the best you can buy, but most people wear off-the-peg ones, which are perfectly adequate in virtually every environment.

Thank you very much!

Reference

1. Lawson NC, Maharishi A. Strength and translucency of zirconia after high-speed sintering. J Esthet Restor Dent. 2020 Mar;32(2):219-225. doi: 10.1111/jerd.12524. Epub 2019 Sep 13. PMID: 31515932.

Mathias Fernandez Y Lombardi

EU Scientific Manager
Dental Ceramics & CAD/CAM Materials
Kuraray Europe GmbH

2013
Successful completion of an apprenticeship as a dental technician at Seuthe dental laboratory in Plettenberg, Germany

2018
Successful completion of dental technology studies at the University of Osnabrück, Germany. Graduation as an engineer in dental technology

Since March 2018
Employee of Kuraray Europe GmbH

Interview with Tomohiro Emoto.

Kuraray Noritake Dental Inc. Launched its first porcelain for porcelain-fused-to-metal restorations – Noritake Super Porcelain AAA*, still available after more than 30 years under the name Noritake Super Porcelain EX-3* – in 1987. The knowledge acquired since then formed the basis for the development of CERABIEN™ ZR and the brand-new CERABIEN™ MiLai portfolio. How much of Noritake Super Porcelain is found in CERABIEN™ MiLai?

*Noritake Super Porcelain AAA and Noritake Super Porcelain EX-3 were designed and launched by Noritake Company Ltd., the predecessor of Kuraray Noritake Dental Inc.

Naturally, the knowledge we have acquired on developing porcelain products has been fully applied in the development of CERABIEN™ MiLai. The methods used to handle Synthetic Feldspar - such as low firing technologies, stable thermal expansion even with multiple baking, particle distribution control – are amongst the most important findings we have acquired since the development of Noritake Super Porcelain AAA. This expertise has been utilized to create both the design concept and development of CERABIEN™ MiLai.

WHAT ARE THE MOST DECISIVE DIFFERENCES FROM OTHERS?

The most decisive difference between CERABIEN™ MiLai and others is that we focus on micro-layering technique with this product. CERABIEN™ MiLai enables you to express life-like colours even with thin layers of porcelain. Also, this is the first porcelain we have launched which is compatible with lithium disilicate as well as zirconia.

Photo: MDT Andreas Chatzimpatzakis

WITH CERABIEN™ ZR BEING AVAILABLE AND CLINICALLY SUCCESSFUL, WHY DID YOU DECIDE TO DEVELOP A NEW LINE OF PORCELAINS AND INTERNAL STAINS?

The best way that we propose to create aesthetic restorations is Porcelain Fused to Zirconia (PFZ) with CERABIEN™ ZR. However, this method requires high levels of expertise and experience which is a lengthy learning curve for beginner dental technicians. As a result, Full Contour Zirconia (FCZ), which does not require such advanced skills and expertise, and which allows virtually anyone to create (albeit not perfect but nevertheless acceptable) restorations, is becoming increasingly popular. CERABIEN™ MiLai sits in the middle of these two methods. It enables technicians to create more aesthetic restorations with a simple, single micro-layering technique, making it ideal for those who wish to produce aesthetic restorations but without the high learning-curve associated with the traditional method, or those who use lithium disilicate materials.

CERABIEN™ MiLai enables you to express life-like colours even with thin layers of porcelain.

IS CERABIEN™ MILAI THE ANSWER TO THE NEW GENERATION OF MILLABLE CERAMIC MATERIALS THAT HAVE IMPROVED A LOT IN TERMS OF MECHANICAL BUT ALSO OPTICAL PROPERTIES IN RECENT YEARS, SUCH AS THE ENTIRE KATANA™ ZIRCONIA LINE-UP, TO OFFER FOR THIS KIND OF MATERIALS A FASTER AND ALSO HIGHLY AESTHETIC FINISHING OPTION?

Yes, it is. Formerly, zirconia materials were mono-coloured and not translucent. However, the improvement of zirconia materials, which began with KATANA™ Zirconia ML followed by KATANA™ Zirconia STML/UTML and KATANA™ Zirconia YML, has been an ongoing process and the aesthetics of the material itself is now very high thanks to improvements in translucency. This has led to the development of CERABIEN™ MiLai, a simple process that can achieve highly aesthetic restorations with thin layers, making the most of the high translucency of the zirconia materials.

WHAT ARE THE SPECIFIC NEEDS OF USERS FAVORING THE MICRO-LAYERING TECHNIQUE WITH RESPECT TO FEATURES OF THE VENEERING PORCELAIN?

When dental zirconia materials were first launched, chipping issues with porcelains for dental zirconia materials were a problem. At that time, dental porcelains were built up on a zirconia framework, the design of which failed to take into account the final shape. As a result, dental technicians were prone to building excessive thickness into porcelain layers which were unable to resist high occlusal pressure. Nowadays, it is standard for the final shape to be taken into account in the framework design resulting in reduced chipping issues. I must mention here that CERABIEN™ ZR, which was launched at that time, showed a higher endurance ratio than others in trials and was well accepted by the market.

What we want to offer with CERABIEN™ MiLai is a similar or developed version concept of this framework design. You can reduce the risk of problems post-installation of the restoration by minimizing the porcelain thickness while maximizing the area of dental zirconia which has such strong properties that almost no chipping issue can be expected.

As a result, the micro-layering technique, which can prevent post-installation problems, should prove ground-breaking for dental technicians.

Photo: MDT Giuliano Moustakis

WHAT DID YOU DO TO MEET THESE DEMANDS?

The thinking behind the development of CERABIEN™ MiLai has been to focus on delivering thin layering that replicates the enamel structure, thus allowing technicians to achieve desired shades regardless of the depth of a layer.

HOW DID YOU MANAGE TO DECREASE THE FIRING TEMPERATURES AND WHAT IS THE EFFECT OF THIS FEATURE?

Up to now, it has generally been tricky to achieve low firing temperature while maintaining a low coefficient of thermal expansion, because they contradict each other. However, thanks to the technologies and knowledge we have cultivated since the development of Noritake Super Porcelain AAA, we could finally be breaking through this obstacle. As a result, CERABIEN™ MiLai can even be used with lithium disilicate materials, which should be baked at low temperature to avoid damaging the material.

DUE TO THE FACT THAT CERABIEN™ MILAI CAN BE APPLIED NOT ONLY TO ZIRCONIA BUT ALSO TO LITHIUM DISILICATE MATERIALS, E.MAX FOR EXAMPLE, HAVE NEW SHADES/MASSES BEEN SPECIALLY DEVELOPED THAT HAVE BEEN PERFECTLY ADAPTED FOR LITHIUM DISILICATE MATERIALS?

The Value Liner has primarily been developed to achieve high aesthetics from lithium disilicate materials, even lithium disilicate which has high translucency compared to zirconia materials. Also, the key for adapting for lithium disilicate is the firing temperature which I mentioned earlier. To match the colour of restoration with the tooth, the selection of framework colour is important both for lithium disilicate materials and zirconia materials. We recommend selecting one shade brighter than the target shade taking into consideration the utilization of internal stain to express the detailed character of a tooth.

CERABIEN™ MiLai can even be used with lithium disilicate materials, which should be baked at low temperature to avoid damaging the material.

WHAT DID YOU DO TO ENABLE THE IMITATION OF VIRTUALLY EVERY TOOTH SHADE WITH JUST 16 PORCELAINS AND 15 INTERNAL STAINS?

We have prepared Value Liner porcelains, which can be utilized for adjusting the value of restorations. These Value Liner porcelains and internal stains are important to adjust colour and express detailed characters. As micro-layering does not require body porcelains, since it is expected that the framework material itself – either zirconia or lithium disilicate – would express the dentine structure, adjusting the colour and value respectively with internal stains and Value Liners is essential. To reproduce the enamel structure, users can use the 16 shades of porcelains as they are, or they can mix the shades to find the desired colour. These 16 porcelains and 15 internal stains have been through trials conducted with KOLs across the world, including Europe, so we want to reassure you that even the world’s most skilled KOLs have tested and confirmed quality and effectiveness of CERABIEN™ MiLai.

Photo: MDT Giuliano Moustakis

WHAT IS THE BENEFIT OF THIS SLIM LINE-UP?

The biggest benefit of CERABIEN™ MiLai is a simple procedure. Thanks to its simplicity, not only Kuraray Noritake Dental porcelain users but also new users and beginners can achieve excellent results with this porcelain series without struggling with complicated procedures.

HOW LONG DID IT TAKE YOU TO DEVELOP CERABIEN™ MILAI (FROM THE INITIAL IDEA TO THE AVAILABLE PRODUCT)?

We initially came up with the concept in 2015 when KATANA™ Zirconia STML and UTML were launched. The development project itself was started in 2019.

We created CERABIEN™ MiLai believing that the micro-layering technique would become the standard in porcelain restorations and that CERABIEN™ MiLai would become the material of choice for dental technicians.

DID YOU COME ACROSS ANY SPECIFIC CHALLENGES DURING THE DEVELOPMENT PROCESS?

The biggest challenge we faced was the development of a material which would be compatible with lithium disilicate. We had already produced porcelains which are compatible with zirconia or metal, but up to that point we had not created porcelains for lithium disilicate before CERABIEN™ MiLai. Not only did we have to develop the material within our R&D department, but also alter the production and inspection processes in collaboration with many other departments.

THE PRODUCT NAME CERABIEN™ MILAI IS DERIVED FROM THE WORD "MIRAI", WHICH MEANS AS MUCH AS "FUTURE" IN JAPANESE. HOW MUCH FUTURE IS THERE IN THIS MATERIAL OR, TO BE MORE PRECISE, IS THIS MATERIAL A PIONEER FOR THE FUTURE PRODUCTION OF HIGHLY AESTHETIC RESTORATIONS?

We created CERABIEN™ MiLai believing that the micro-layering technique would become the standard in porcelain restorations and that CERABIEN™ MiLai would become the material of choice for dental technicians.

Building up dental porcelains is not an easy process; it takes time to acquire the knowledge and master the technique. On top of this, dental technicians have long been plagued with post-installation problems such as chipping.

Micro-layering with CERABIEN™ MiLai enables every dental technician, from newcomers through to those with many years’ experience, to create better restorations. It is our hope that dental technicians everywhere will get to experience the ease at which aesthetic restorations can be realised with CERABIEN™ MiLai, just adding one step of micro-layering.

WHAT IS YOUR VISION WITH REGARD TO FUTURE DEVELOPMENTS IN THE AREA OF PORCELAIN FOR CERAMIC LAYERING?

Personally, I think the trend will continue to shift towards easier handling while maintaining good aesthetics, as can be seen by the recent increase in popularity of the micro-layering technique.

WHAT ABOUT THE POTENTIAL OF NEW CERAMIC CAD/CAM MATERIALS AND THEIR SUITABILITY FOR MONOLITHIC USE?

We believe that monolithic use will increase further, because the perception of aesthetics is changing among patients as well as dentists and dental technicians. Before, a "natural" restoration was considered acceptable; now it can also be "cosmetically" aesthetic. Formerly, it was said that monolithic use was not suitable as it could not reproduce life-like restorations. Now, we believe it will be increasingly embraced as patients show a demand for cosmetically aesthetic restorations.

Our KATANA™ Zirconia has mechanical advantages: high strength and high translucency, and high potential in longevity. Since dental zirconia appeared in dental material market, its aesthetics have been improved remarkably. And we, at Kuraray Noritake Dental Inc., have been developing outstanding CAD/CAM materials and will continue creating innovative materials from now on too.

We are convinced that developing better products for monolithic use is crucial for releasing dentists and dental technicians from complicated procedures while at the same time giving patients a sense of safety as well as aesthetic satisfaction.

WHY SHOULD A DENTAL TECHNICIAN TEST CERABIEN™ MILAI?

We are convinced that, once dental technicians who use either zirconia materials or lithium disilicate to make restorations, experience the ease at which they can achieve aesthetically-pleasing restorations with CERABIEN™ MiLai, demand will grow. We would therefore like to encourage all dental technicians to give it a go and see the results for themselves!

IS THERE ANYTHING ELSE YOU WOULD LIKE TO ADD FOR CUSTOMERS?

Thank you so much for reading this article to the end. I am very honoured to finally launch CERABIEN™ MiLai. This product is the result of many struggles. I am firmly convinced that it is the answer for any dental technician eager to realise high levels of aesthetics in a restoration in just a simple step. I would ask them to please try out CERABIEN™ MiLai for themselves and experience what will become standard practice in the future, right now.

TOMOHIRO EMOTO

R&D Department Technical Group Manager
Japan Academy of Esthetic Dentistry Executive Member
Academic Lecture Committee Member

With highly aesthetic ceramic materials available for the production of indirect restorations, it is no longer necessary to always design high strength frameworks and add multiple layers of porcelain. Nowadays, due to the rapid technological and optical improvements of zirconia and Lithium Disilicate (LiDiSi), a restoration may be manufactured with a monolithic design or minimal cut-back. Using appropriate materials, a less complex micro-layering technique will produce the desired outcomes, even if the aesthetic expectations are high. A new porcelain system specifically designed for this purpose is CERABIEN™ MiLai from Kuraray Noritake Dental Inc. The compact line-up of low-fusing porcelains and internal stains for micro-layering supports effiicient, economic finishing procedures leading to outstanding aesthetics at the first go.

The CERABIEN™ MiLai system consists of 16 base shades and 15 internal stains, which are easy to select and manage, and may even be mixed for additional shade effects. Due to the low firing temperature of all system components (740° C / 1,364° F), CERABIEN™ MiLai is not only compatible with zirconia, but also with silicate ceramic (such as IPS e.max) substructures. This means that fewer lines of porcelain are needed, the porcelain inventory is reduced once again, and fewer decisions need to be taken.

In order to provide for persistent handling properties and predictable outcomes, CERABIEN™ MiLai, like all other porcelains from Kuraray Noritake Dental Inc., are based on synthetic feldspathic porcelain technology. It is special in that its material structure and particle distribution resemble those of natural teeth, and its properties remain stable even after multiple firing cycles – giving dental technicians exactly what they expect. CERABIEN™ MiLai (tooth shades) are fluorescent, which adds to the vitality and life-like appearance of the restorations.

With these properties, CERABIEN™ MiLai is the outstandinig solution for every dental technician who would like to turn the finishing of zirconia and lithium disilicate restorations into a straightforward, efficient and economic procedure that produces predictably beautiful outcomes every time.

Når man jobber med kompositt, er en av de viktigste aspektene å forstå mekanismene for adhesjon. Å velge riktig kompositt er én ting, men å velge et passende bonding-system og i tillegg bruke det riktig er et like viktig aspekt som påvirker langtidsprestasjonen til en direkte restaurering.

Det finnes mange bonding-produkter på markedet – to flasker (primer og bond), men også singel-flaske-systemer. For de som prøver å velge et ideelt adhesiv for et spesifikt klinisk tilfelle, kan antall tilgjengelige produkter være utfordrende. Fristelsen i å bruke dem alle på forskjellige måter, kan resultere i defekter. I min tannlegepraksis er jeg opptatt av å forenkle prosedyrer.

Derfor startet jeg å se etter bondingssytemer som tilbyr en sikkerhet når det gjelder adhesjon, men også enkel håndtering i ulike kliniske situasjoner. Jeg har valgt et bonding-system fra 8. generasjon med ønskede egenskaper – CLEARFIL™ Universal Bond Quick (Kuraray Noritake Dental Inc.). Det universelle adhesivet i én flaske er ideelt for et bredt spekter av bonding-prosedyrer i tannlegepraksis.

Imponerende egenskaper

CLEARFIL™ Universal Bond Quick kan brukes både med total-etsing og selektiv etsing av emalje i kombinasjon med et etsegel som K-ETCHANT Syringe (Kuraray Noritake Dental Inc.). Det er også et selvetsende adhesiv. Brukt i kombinasjon med det dualherdende oppbyggingsmaterialet CLEARFIL™ DC CORE PLUS, eller det dualherdende universelle resinsementet PANAVIA™ SA Cement Universal (begge fra Kuraray Noritake Dental Inc.), vil det være ideelt for sementering i rotkanaler og for sementering av inlays eller kroner laget av ulike restaureringsmaterialer – fra metall til zirkonia, eller litiumdisilikat. Effektive kliniske prosedyrer støttes av den innebygde Rapid Bond Technology, som eliminerer behovet for omfattende innarbeiding, eller i påvente av at adhesivet skal trenge inn i substratet og at løsningsmiddelet skal fordampe. Blant de viktigste komponentene i denne teknologien er de hydrofile amidmonomerene, som gjør at adhesivløsningen trenger raskt inn i fuktig dentin, samtidig som den har en høy herdeevne. I tillegg er den originale MDP-monomeren en del av formuleringen. Sammen med amidmonomerene gir det høy bindestyrke til emalje og dentin – oppnås gjennom en enkel prosedyre av påføring, lufttørking og lysherding.

De beskrevne egenskapene gjør CLEARFIL™ Universal Bond Quick til en av de mest fleksible og brukervennlige adhesivløsningene i praksis. Produktet har lav operatøravhengighet og er lite teknikkfølsomt, siden tre-trinnsprosedyren alltid er den samme. De følgende kasusbeskrivelsene illustrerer anvendelsen i ulike reparasjonsprosedyrer.

Reparasjon av komposittrestaureringer

En av de største fordelene ved å bruke kompositt som restaureringsmateriale er at det kan endres og repareres når som helst. Enten det oppdages en luftboble på overflaten, at fargen må justeres, en oppstått fraktur, eller at materiale må tilføyes som følge av slitasje, kan modifikasjon eller reparasjon enkelt utføres uten å ofre mer av den friske tannstrukturen. Hvis det opprinnelig ble laget en silikonindeks for behandlingen og denne fortsatt er tilgjengelig, i tillegg til at behandleren kjenner til hvilken kompositt som ble benyttet i den opprinnelige restaureringen, kan Flowable Injection Technique være en spesielt enkel og effektiv metode for å reparere restaureringen. Imidlertid vil den anbefalte protokollen variere noe avhengig av tilstanden til restaureringsoverflaten.

Kasus 1: Umiddelbar reparasjonsprosedyre

Når en restaurering har blitt skadet eller en luftboble har oppstått under påføring av en flytende kompositt, er prosedyren noe annerledes. I dette tilfellet er oksygeninhibisjonslaget vanligvis fortsatt til stede på overflaten av restaureringen. Derfor er det mulig å enkelt påføre et nytt lag med kompositt (Fig. 1a til 1d). Selv etter kontaminering av komposittoverflaten med vann, spytt eller blod, kan denne metoden fortsatt benyttes. Overflaten må bare skylles grundig og tørkes før den nye porsjonen med kompositt påføres. For maksimal sikkerhet kan et universelt adhesiv også benyttes.

Figur 1a: Reparasjonsprosedyre som kan brukes ved en defekt i en komposittrestaurering, så lenge oksygeninhibisjonslaget ikke er fjernet: Luftboble oppdaget i det interproksimale området

Figur 1b: Påføring av ny porsjon med kompositt etter skylling og tørking. Den tilstøtende overflaten beskyttes med PTFE-tape.

Figur 1c: Reposisjonert silikonindeks brukt for å gi restaureringen den planlagte formen.

Figur 1d: Endelig restaurering

Kasus 2: Reparasjonsprosedyre etter polering

Hvis en lignende defekt oppdages under finpussing og polering, altså når oksygeninhibisjonslaget allerede er fjernet (Fig. 2), er det helt nødvendig å gjøre overflaten ru. Ved å skråpreparere til området med luftboblen skapes optimale forhold for et nytt lag med kompositt som integrerer naturlig sammen med omkringliggende materiale (Fig. 3). Etter skråprepareringen må overflaten sandblåses og renses enten med KATANA™ Cleaner (Kuraray Noritake Dental Inc) (Fig. 4a) eller med 37 % ortofosforsyre (Fig. 4b). Etter grundig skylling og tørking kan et nytt lag med kompositt påføres på overflaten (Fig. 5a til 5c). Siden defekten er liten, kan kompositten påføres manuelt i stedet for å injiseres, og silikonindeksen kan deretter reposisjoneres

Figur 2: Hulrom på overflaten oppdaget under etterbehandling.

Figur 3: Fjernet tomrom og skråpreparert området rundt defekten.

Figur 4a: Alternativ 1: Rengjøring av overflaten med KATANA™ Cleaner

Figur 4b: Alternativ 2: Etsing med K-ETCHANT Syringe.

Figur 5a: Påføring av kompositt (CLEARFIL MAJESTY™ ES Flow).

Figur 5b: Påføring av kompositt (CLEARFIL MAJESTY™ ES Flow).

Figur 5c: Endelig restaurering med en jevn overgang mellom de ulike komposittlagene.

Kasus 3: Reparasjonsprosedyre etter to eller flere uker

For skadede restaureringer som har vart i mer enn to uker, må det etableres en optimal binding mellom komposittlagene ved å skråpreparere og gjøre overflaten ru. Et godt eksempel illustreres i figur 6. Det viktigste steget for å sikre en vellykket prosedyre er riktig forberedelse av komposittoverflaten. For å legge grunnlaget for sterk binding mellom det nye og gamle komposittlaget, samt sikre et estetisk resultat, må det prepareres til en skråkant (figur 7a og 7b) for å oppnå en jevn overgang mellom lagene. Når skråkanten er ferdig, bør overflaten sandblåses med 27 μm aluminiumoksidpartikler (figur 8). Følgende anbefalte steg er etsing av kompositten med 37 % ortofosforsyre (figur 9) og deretter påføring av CLEARFIL™ Universal Bond Quick (figur 10). Siden det universelle adhesivet inneholder en silan-koblingsagent, er det ikke nødvendig med separat silanpåføring. I stedet kan det nye komposittlaget påføres umiddelbart, for eksempel ved bruk av flowable injeksjonsteknikken med en matrise (figur 11).

Figur 6: Frakturert anterior komposittrestaurering som har stor nytte av reparasjon – den gjenværende kompositten er i god stand i henhold til farge og form.

Figur 7a: Skråpreparering med spesialtilpassede instrumenter.

Figur 7b: Ideell skråkant preparert for å sikre sterk binding og en naturlig estetisk overgang.

Figur 8: Sandblåsing av overflaten med aluminiumoksidpartikler.

Figur 9: Etsing med fosforsyre.

Figur 10: Påføring av det universelle adhesivet.

Figur 11: Kompositt påført ved bruk av flowable injeksjonsteknikken.

Figur 12: Behandlingsresultat.

Konklusjon

De tre beskrevne reparasjonsprotokollene er enkle og fungerer godt – forutsatt at det etableres en sterk binding i komposittlagene. Måten det etableres på kan variere avhengig av om oksygeninhibisjonslaget fortsatt er tilstede eller om det er fjernet. Ved bruk av et universelt adhesiv som CLEARFIL™ Universal Bond Quick forenkles prosedyren, ettersom separat påføring av silan elimineres.

Dentist:

MICHAŁ JACZEWSKI

Michal Jaczeweski ble uteksaminert fra Wroclaw Medical University i 2006 og driver i dag sin private praksis i byen Legnica i Polen. Han spesialiserer seg på minimal invasiv- og digital tannbehandling, og er grunnleggeren av Biofunctional School of Occlusion. Her holder han forelesninger og arrangerer workshops med fokus på omfattende pasientbehandlinger.

No matter whether you are a dental practitioner or dental technician, there is one thing you surely want to avoid: failure of indirect restorations. While it is clear that on both sides, the use of high-performance materials and appropriate techniques will contribute to achieving the desired outcomes, there is one aspect that should generally be given more attention: proper communication and exchange of information between the dental practice and laboratory.

As a dental professional: Are you aware of the information and details your case partners need to know in order to achieve the best possible result regarding fit, function and aesthetics?

For both, dental practitioner and dental technician, it is essential to know what precisely the respective partner does need to produce the desired outcomes. Hence, if it is not clear what information is needed and how it should be delivered, it is essential to sit down with your partner and find out. The goal of this personal or virtual meeting should be the establishing of a standardized flow of information between your companies. The necessary information might differ depending on the complexity of the case, but most details are always the same.

During the meeting, it is essential to focus on every step in the procedure that benefits from interaction between the practice and laboratory. It starts after the patient’s initial appointment and ends when the restoration is in place. In the following sections, the required information for indirect restoration planning, possible ways of communication to provide for a healthy flow of required information and important details are listed.

Teamwork starts before the actual treatment

Most dental technicians know a lot about the different restorative materials available and their suitability for specific clinical situations. Leverage this knowledge by involving your partner early – ideally before tooth preparation. This is most important for complex reconstructions, but also relevant when a single tooth needs to be restored: The restorative material and restoration design (monolithic, cutback, framework) have an impact on the space required and hence on the amount of tooth structure that needs to be removed. Aiming to opt for the least invasive treatment possible, it is essential that tooth preparation is limited to the necessary minimum.

The better the records, the better the fit of the final restoration

When it comes to taking records of the initial situation and the situation after tooth preparation, dental practitioners are often confronted with challenges. Limited mouth opening, a lack of time, or difficult moisture conditions are only some of the numerous factors that might prevent a clinician from taking a precise impression and bite registration. Nevertheless, it is decisive for the work in the dental laboratory to receive accurate records with all the necessary details such as the preparation margin. Understanding what exactly a dental technician needs to deliver a precisely fitting restoration will surely have a positive impact on the motivation to get the records right from the start, independent of the challenges.

Personally seeing the patient provides valuable additional information on a patient’s facial characteristics, on the status and appearance of the teeth and on their internal colour structure. These details can support a dental technician optimally in producing true-to-life dental restorations.

Structured try-in feedback facilitates targeted adjustments

Whenever try-in reveals that adjustments are required, well-structured feedback is important. It helps modify the restorations exactly as desired, hence avoiding additional appointments and wasting time in the practice and laboratory.

“Digitalization has made physical distance irrelevant, and we are able to deliver high-quality restorations even if the patient is hundreds of miles away”
- Dr Efe Celebi -

How to standardize

There are many possible ways to standardize the flow of information between the dental practice and laboratory. Depending on the individual preferences and established workflows, a personal or digital approach may be selected. Those preferring a personal approach will possibly want to develop paper forms for some steps, while relying on personal interaction for others. The digital approach uses a combination of digital imaging technologies, case management software and communication platforms to exchange relevant information.

A personal approach

At the Laboratorio odontotecnico Castellano in Bologna, Italy, the team around Vincenzo Castellano pursues the approach of personally seeing almost every patient prior to treatment planning. The laboratory technicians’ opinion is determinant for the treatment plan to be developed. Their partner practitioners value their expertise in restorative materials and digital technologies, which are evolving very quickly. The team is simply able to tell which material to choose in a specific situation to best manage the expectations of the patient and the functional needs. “Determining the restorative material in this early phase is very important, as its mechanical parameters (minimum wall thickness etc.) have an impact on the preparation design and depth. In fact, patients are always happy if they are able to meet the dental technician who produces their restorations, and – already well-informed by their dentist and the internet – often seize the opportunity to gather additional information about their planned treatment”, Vincenzo Castellano states.

Also, during subsequent appointments like try-in, the responsible dental technician is present to evaluate the situation and gather feedback from the patient directly. In his laboratory, online meetings conducted with patients substitute personal meetings only when this is the only way to enable personal interaction, as – in his opinion – personal meetings always deliver more details important for a great outcome. He says: “The most important approach to the patient is the human one. When using advanced digital technologies, we risk standardizing protocols to the extent that we forget there is an individual in front of us, with their own unique characteristics and wishes, entrusting us with their most precious asset: their smile.”

A digital approach

A perfect example of a laboratory with a purely digital approach is DentLab, a Turkish dental laboratory founded in 2015 by Dentgroup, Turkey’s largest Dental Service Organization (DSO). Its founder Dr Efe Celebi and his team have developed a special lab module for the group’s own practice management software, DentSoft. The module allows dental professionals to submit their orders electronically by using online forms and adding digital image data such as X-rays, intraoral scans, face scans and photographs. Users are able to see at a glance which data and information is strictly required. If desired, a user even receives procedural guidance: Specific devices like intraoral scanners, procedures and materials are recommended.

Once an order is submitted, the software sends a delivery date notification, so that the next appointment can be scheduled right away. Then, the incoming order is checked. Whenever some details are missing, the practice is contacted via a chat function in the software. Orders with incomplete or inaccurate data are rejected. A feedback function allows the technician to specify what needs to be repeated, improved or modified. Once accepted, the ordered items are produced and shipped to the office in a trackable box. It arrives with pre-treatment and cementation recommendations. Whenever necessary, patient feedback at try-in can be recorded on video or discussed live in a virtual meeting. “Digitalization has made physical distance irrelevant, and we are able to deliver high-quality restorations even if the patient is hundreds of miles away,” says Dr Efe Celebi. To facilitate improvement in the dental laboratory, the software has a case evaluation function that allows dental practitioners to evaluate the fit, function and look of every restoration.

“The most important approach to the patient is the human one. When using advanced digital technologies, we risk standardizing protocols to the extent that we forget there is an individual in front of us, with their own unique characteristics and wishes, entrusting us with their most precious asset: their smile.”
- MDT Vincenzo Castellano -

Conclusion

By establishing a well-structured, standardized and bidirectional flow of information between the dental office and laboratory, it is possible to improve the overall quality of prosthodontic treatments. It can be implemented with the aid of existing workflow management software, or set up according to individual demands using paper forms and personal meetings.

Anyway, sitting down together to discuss the topic of communication in a personal or virtual meeting has additional advantages, as it will help everyone involved develop a better understanding of the procedures carried out and challenges faced by their respective partner in the busy work environment. With this knowledge, it becomes easier to build a strong relationship that grows from mutual feedback and advice promoting common strategies for improvement. The result will be more streamlined work processes with less stress, higher-quality outcomes and happier patients.

We would like to express our gratitude to MDT Vincenzo Castellano and Dr Efe Celebi for sharing their individual approaches and the thinking behind them.

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.

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.

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.

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.