ADHESIVE LUTING: A DRIVER OF INNOVATION

What would modern restorative treatments be like without the availability of high-performance (self-)adhesive resin cements? Tooth preparations would still be much more invasive due to the need for sufficient mechanical retention between the tooth and the restoration. At the same time, it would be impossible to restore teeth with many innovative, tooth-coloured materials such as low-strength ceramics and composite. In short, restorative dentistry would be much less developed than it is today.

When the first resin cements were introduced several decades ago, however, the achieved progress came at the expense of simplicity: Adhesive luting procedures were highly complex and the many different components quite technique sensitive. Luckily, this has changed over the years due to continued development efforts ultimately resulting in the products that are currently available. The resin cement line-up of Kuraray Noritake Dental Inc. consists of three main products: the dual-cure three-component system PANAVIA™ V5, the single-component dual-cure universal resin cement PANAVIA™ SA Cement Universal and the light-curing PANAVIA™ Veneer LC.

For those who would like to learn more about the three systems, this 10^th issue of the BOND Magazine is definitely worth reading. It reveals important details about the 40-year history of the PANAVIA™ brand, sheds light on the strengths of each resin cement to facilitate indication-specific cement selection and provides in-depth information about their clinical use. In addition, two articles are dedicated to hot topics around the luting of restorations made of zirconia, a popular restorative material that some still consider to be unsuitable for adhesive luting procedures. For everyone wondering how it is possible to successfully lute minimally invasive restorations made of zirconia, the article titled “Innovative resin cements forming the basis of minimally invasive prosthodontics” is highly recommended. Those unsure about how to proceed with 5Y-TZP should read the article “How to cement restorations made of high-translucency zirconia”. Interesting information about cleaning options prior to adhesive luting rounds out the content of this magazine.

Click here to read. Enjoy reading!

Start Reading: BOND | VOLUME 10 | 10/2023

Previous versions:

BOND | VOLUME 9 | 08/2022

BOND | VOLUME 8 | 12/2021

BOND | VOLUME 7 | 10/2020

Case by Kanstantsin Vyshamirski

A male patient (47 years of age) presented to his dentist with severe damage to his teeth. His main request was to increase aesthetics, to achieve a more pleasing envisaged aesthetic area. A side request was to achieve a ‘whitening but natural look’. This was achieved by using a lighter colour palette of zirconia and porcelain materials.

The final result was achieved through the creation of a wax-up, followed by a mock-up, provisional restoration and finally adhesive bonding of the zirconia crowns.

INITIAL SITUATION

Fig. 1. Initial situation. Male patient (47 years of age).

Fig. 2. Planning the new smile according to patient’s aesthetic and functional parameters.

Fig. 3. Mock-up in place to check the new look in the patient’s mouth.

Fig. 4. KATANA™ Zirconia YML shade A1 crowns with labial cutback after milling.

Fig. 5. Crowns after sintering on the plaster model.

Fig. 6. Noritake CERABIEN™ ZR porcelain layering map.

Fig. 7. Finishing the labial surface using both polishing and selfglaze. On the palatal side of the crowns only CERABIEN™ FC Paste Stain stains and glaze were used for finishing. To aid in optimisation of the soft tissue condition the palato-cervical and near proximal areas were polished.

Fig. 8. Finished crowns on the plaster model.

Fig. 9. Try-in using PANAVIA™ V5 White try-in paste, to confirm the proper appearance. For the final adhesive cementation PANAVIA™ V5 White has been used.

FINAL SITUATION

Fig. 10. Situation after seven months. The result is aesthetically pleasing and the gingival condition excellent.

Fig. 11. Recall after 1.5 years.

Dentist:

KANSTANTSIN VYSHAMIRSKI

Kanstantsin started his dental technician career in 2014. His speciality is aesthetic prosthetic porcelain works. Kanstantsin is an experienced user of KATANA™ Zirconia and Noritake porcelains. He owns his lab in Riga, Latvia.

Photo credits to Giuliano Moustakis

Can you imagine a world without multi-layered zirconia? The invention of a zirconia material with natural colour gradation and well-balanced translucency and strength led to fundamental changes in the way zirconia-based restorations are produced. When the first product of its kind – KATANA™ Zirconia ML – was introduced to the dental market exactly ten years ago, dental technicians all over the world suddenly started rethinking their manufacturing concepts.

Since then, the trend towards a decreased thickness of the porcelain layer, a limiting of this layer to the vestibular area and the production of monolithic restorations is clearly perceivable. Technicians have developed their own concepts of micro-layering, which allow for more patient-centred approaches. This is also due to the fact that the total wall thicknesses of the restorations may be decreased without compromising the aesthetics. The line-up of multi-layered zirconia currently available from Kuraray Noritake Dental Inc. (KATANA™ Zirconia UTML, STML, HTML Plus and KATANA™ Zirconia YML with additional translucency and strength gradation) enables users to make indication-related material choices for the production of restorations that are precisely aligned to the individual demands of each case.

The reasons to choose KATANA™ quality

But why choose KATANA™ Zirconia instead of any other multi-layered zirconia disc? According to experienced users of the KATANA™ Zirconia Multi-Layered series, there are many reasons to opt for KATANA™.

For Jean Chiha, owner at North Star Dental Laboratories and Milling Center in Santa Ana, California, it is the combination of optical and mechanical properties that makes the difference: 

“KATANA™ Zirconia is the game changing material with well-balanced esthetics and strength!”. 

Naoki Hayashi, president of Ultimate Styles Dental Laboratory in Irvine, California, aesthetics is the most decisive argument to opt for the discs from Kuraray Noritake Dental Inc. He states:

“KATANA™ Zirconia discs offer trusted esthetics which gives me confidence in my clinical cases”.

Naoto Yuasa, chief ceramist at Otani Dental Clinic in Tokyo, adds predictability as an important factor:

“KATANA™ sustains my passions for aesthetic restorations and those of a predictable future in the long run”, whereas dependability is the key element.

For Hiroki Goto, the laboratory manager at Sheets and Paquette Dental Practice in Newport Beach, California reports:

“Without KATANA™ there is no pride. Haven’t experienced it yet? You have to see how reliable it is!”

Finally, we have asked Kazunobu Yamada, a pioneer in making porcelain laminate veneers using complementary color techniques and a first-hour user of KATANA™ Zirconia, what comes to his mind when thinking about KATANA™ Zirconia. According to the president of CUSP Dental Laboratory in Nagoya City, there is a clear link between the product name and its characteristics:

“Did you know that the word "KATANA" also means "protection against misfortune and evil"? Katana zirconia, the culmination of many years of research and development by Kuraray Noritake, has an unparalleled quality. KATANA™, for me, is truly "Protection for all technicians".”

The origin of well-balanced properties

It seems that the KATANA™ Zirconia Multi-Layered line-up stands out due to set of valuable properties enabling a dental technician to produce beautiful, high-quality restorations every time. The secret of success lies in meticulous raw material selection and controlled processing from the powder to the pre- sintered blank carried out at the production facilities of Kuraray Noritake Dental Inc. in Japan. They provide for the high product quality that is responsible for the materials’ outstanding behaviour supporting the best possible outcomes.

Clinical case by Dr. Florian Zwiener

The 85-year-old female patient presented after osteosynthesis of a multiple mandibular fracture she had sustained after a fall. During fixation, a massive nonocclusion had occurred in the left posterior region of the mandible (teeth 34 to 37; FDI notation). The patient desired to be able to chew properly again in this area. After endodontic treatment of the two avulsed central incisors, which had been replanted in the hospital, and periodontal therapy, a bite elevation was planned on the left side.

The idea was to restore the teeth and elevate the bite with three onlays and a crown made of lithium disilicate (IPS e.max CAD, Ivoclar Vivadent). During tooth preparation, however, a longitudinal root fracture was detected on the first molar. Therefore, only the first premolar was restored in this session. For this purpose, an onlay was produced chairside (with the CEREC system, Dentsply Sirona) and adhesively luted with PANAVIA™ V5 (Kuraray Noritake Dental Inc.). The first molar was extracted. One week later, the extraction socket, which was still healing, was modelled for the ovoid pontic using an electrotome loop. The second premolar and molar were prepared as abutment teeth for a bridge. The bridge was then milled from KATANA™ Zirconia Block for Bridge in the shade A3.5 and individualized with CERABIEN™ ZR FC Paste Stain (both Kuraray Noritake Dental inc.). After another week, the bridge was luted with the self-adhesive resin cement PANAVIA™ SA Cement Universal (Kuraray Noritake Dental Inc.) following sandblasting.

Fig. 1. Situation after multiple mandibular fracture on the left side.

Fig. 2. Clinical situation at the initial appointment in the dental practice.

Fig. 3. Open bite in the mandibular left posterior region.

Fig. 4. Bridge design …

Fig. 5. … using the CEREC Software.

Fig. 6. Due to the bright shade of the teeth in the cusp area, the restoration was positioned high in the KATANA™ Zirconia Multi-Layered Block.

Fig. 7. Surface texturing in the pre-sintered state (prior to the final sintering procedure).

Fig. 8. Bridge after a seven-hour sintering cycle.

Fig. 9. Appearance of the bridge after individualization with CERABIEN™ ZR FC Paste Stain …

Fig. 10. … and two glaze firings.

Fig. 11. Clinical situation after restoring the teeth with a lithium disilicate onlay and a zirconia bridge.

FINAL SITUATION

Fig. 12. Onlay and bridge in place (after adhesive luting with PANAVIA™ V5 and self-adhesive luting with PANAVIA™ SA Cement Universal).

Fig. 13. Final X-ray used to check for excess cement around the bridge.

Dentist:

DR. FLORIAN ZWIENER

Dr. Florian Zwiener is a distinguished dental professional known for his expertise in Endodontics, Prosthodontics, and CAD/CAM technology. Born in Cologne, Germany, he developed a passion for dentistry and pursued his education at the University of Cologne, where he obtained his degree in Dentistry. Currently, Dr. Florian Zwiener practices at the Dr. Frank Döring Dental Clinic in Hilden, Germany. Here, he continues to apply his specialized knowledge and skills, ensuring that his patients receive the highest quality of care. Follow Dr. Zwiener on Instagram: @dr.florian_zwiener.

Case by Kanstantsin Vyshamirski

A male patient (47 years of age) presented to his dentist with severe damage to his teeth. His main request was to increase aesthetics, to achieve a more pleasing envisaged aesthetic area. A side request was to achieve a ‘whitening but natural look’. This was achieved by using a lighter colour palette of zirconia and porcelain materials. The final result was achieved through the creation of a wax-up, followed by a mock-up, provisional restoration and finally adhesive bonding of the zirconia crowns.

Initial situation

Fig. 1. Initial situation. Male patient (47 years of age)

Fig. 2. Planning the new smile according to patient’s aesthetic and functional parameters.

Fig. 3. Mock-up in place to check the new look in the patient’s mouth.

Fig. 4. KATANA™ Zirconia YML shade A1 crowns with labial cutback after milling.

Fig. 5. Crowns after sintering on on the plaster model.

Fig. 6. Noritake CERABIEN™ ZR porcelain layering map.

Fig. 7. Finishing the labial surface using both polishing and selfglaze. On the palatal side of the crowns only CERABIEN™ FC Paste Stain stains and glaze were used for finishing. To aid in optimisation of the soft tissue condition the palato-cervical and near proximal areas were polished.

Fig. 8. Finished crowns on the plaster model.

Fig. 9. Try-in using PANAVIA™ V5 White try-in paste, to confirm the proper appearance. For the final adhesive cementation PANAVIA™ V5 White has been used.

Final situation

Fig. 10. Situation after seven months. The result is aesthetically pleasing and the gingival condition excellent.

Fig. 11. Recall after 1.5 years

Click here for the product page for more details

What can you expect to find online

- General information about:
- KATANA™ Zirconia YML
- CERABIEN™ ZR porcelains
- FC Paste Stain
- PANAVIA™ V5
- Full Product Assortment
- Safety Data Sheets
- Instructions For Use
- Technical Information

Kanstantsin started his dental technician career in 2014. His speciality is aesthetic prosthetic porcelain works. Kanstantsin is an experienced user of KATANA™ Zirconia and Noritake porcelains. He owns his lab in Riga, Latvia.

Case report with Dr. José Ignacio Zorzin

Rationalizing clinical workflows: This is the main reason for the use of universal products in adhesive dentistry. They are suitable for a wide range of indications and different application techniques, fulfil their tasks with fewer components than conventional systems and often involve fewer steps in the clinical procedure. Universal adhesives are a prominent example.

How do universal adhesives contribute to a streamlining of workflows?

When restoring teeth with resin composite, the restorative material will undergo volumetric shrinkage upon curing. By bonding the restorative to the tooth structure with an adhesive, the negative consequences of this shrinkage – marginal gap formation, marginal leakage and staining, hypersensitivity issues and the development of secondary caries – are prevented. The first bonding systems available on the dental market were etch-and-rinse adhesives, which typically consisted of three components: an acid etchant, a primer and a separate adhesive. Later generations combined the primer and the adhesive in one bottle, or were two or one-bottle self-etch adhesives. Universal adhesives (also referred to as multi-mode adhesives) may be used with or without a separate phosphoric acid etchant.

Fig. 1. Volumetric shrinkage of resin composite restoratives and its clinical consequences.

Which technique to choose depends on the indication and the clinical situation. In most cases, the best outcomes are obtained after selective etching of the enamel¹. Bonding to enamel is generally found more effective when the enamel is etched with phosphoric acid, while the application of phosphoric acid on large areas of dentin involves the risk of etching deeper than the adhesive is able to hybridize. When the cavity is small, however, selective application of the phosphoric acid etchant to the enamel surface may not be possible, so that a total-etch approach is most appropriate. Finally, in the context of repair, the self-etch approach may be the first choice, as phosphoric acid might impair the bond strength of certain restorative materials by blocking the binding sites. By using a universal adhesive, all these cases may be treated appropriately, as the best suitable etching technique can be selected in every situation.

Apart from the differences related to the use or non-use of phosphoric acid etchant on the enamel or enamel-and-dentin bonding surface, the clinical procedure is always similar with the same universal adhesive. The following clinical case is used to illustrate how to proceed with CLEARFIL™ Universal Bond Quick (Kuraray Noritake Dental Inc.) in the selective enamel etch mode, and it includes some details about the underlying mechanism of adhesion.

How to proceed with selective enamel etching?

A clinical example.

This patient presented with a fractured maxillary lateral incisor, luckily bringing the fragment with him. Hence, it was decided to adhesively lute the fragment to the tooth with an aesthetic flowable resin composite.

Fig. 2. Patient with a fractured maxillary lateral incisor.

Fig. 3. Close-up of the fractured tooth.

Fig. 4. Working field isolated with rubber dam.

As proper isolation of the working field makes the dental practitioner’s life easier, a rubber dam was placed using the split-dam technique. It works well in the anterior region of the maxilla, as the risk of contamination with saliva from the palate is minimal. Once the rubber dam was placed, the bonding surfaces needed to be slightly roughened to refresh the dentin. As the surfaces were also slightly contaminated with blood and it is important to have a completely clean surface for bonding, KATANA™ Cleaner was subsequently applied to the tooth structure, rubbed into the surfaces for ten seconds and then rinsed off. The cleaning agent contains MDP salt with surface-active characteristics that remove all the organic substances from the substrate. The fragment was fixed on a ball-shaped plugger with (polymerised) composite and also cleaned with KATANA™ Cleaner.

Fig. 5. Cleaning of the tooth …

Fig. 6. … and the fragment with KATANA™ Cleaner.

What followed was selective etching of the enamel on the tooth and the fragment for 15 seconds. Whenever selective enamel etching is the aim, it is essential to select an etchant with a stable (non runny) consistency – a property that is offered by K-ETCHANT Syringe (Kuraray Noritake Dental Inc.). Both surfaces were thoroughly rinsed and lightly dried before applying CLEARFIL™ Universal Bond Quick with a rubbing motion. This adhesive is really quick: Study results show that the bond established immediately after application is as strong and durable as after extensive rubbing into the tooth structure for 20 seconds.^2,3 The adhesive layer was carefully air-dried to a very thin layer and finally polymerized on the tooth and on the fragment.

Fig. 7. Selective etching of the enamel of the tooth …

Fig. 8. … and the fragment with phosphoric acid etchant.

Fig. 9. Application …

Fig. 10. … of the universal bonding agent.

Fig. 11. Polymerization of the ultra-thin adhesive layer on the tooth …

Fig. 12. … and the fragment.

What happens to dentin in the selective enamel etch (or self-etch) mode?

After surface preparation or roughening, there is a smear layer on the dentin surface that occludes the dentinal tubules, forms smear plugs that protect the pulp and prevents liquor from affecting the bond. When self-etching the dentin with a universal adhesive, this smear layer is infiltrated and partially dissolved by the mild self-etch formulation (pH > 2) of the universal adhesive. At the same time, the adhesive infiltrates and demineralizes the peritubular dentin. The acid attacks the hydroxyapatite at the collagen fibrils, dissolves calcium and phosphate and hence enlarges the surface. Then, the 10-MDP contained in the formulation reacts with the positively loaded calcium (and phosphate) ions. This ionic interaction is responsible for linking the dentin with the methacrylate and thus for the formation of the hybrid layer.^4,5

In the total-etch mode, the phosphoric acid is responsible for dissolving the smear layer and demineralising the hydroxyapatite. This leads to a collapsing of the collagen fibrils, which need to be rehydrated by the universal adhesive that is applied in the next step. Whenever the acid penetrates deeper into the structures than the adhesive, the collagen fibrils will remain collapsed. This will most likely result in clinical issues including post-operative sensitivity⁶.

When applying the adhesive system, a dental practitioner rarely thinks about what is happening at the interface⁷. However, every user of a universal adhesive should be aware of the fact that a lot is happening there. This is why it is so important to use a high-performance material with well-balanced properties and strictly adhere to the recommended protocols.

Fig. 13. Schematic representation of dentin after tooth preparation: The smear layer on top with its smear plugs occluding the dentinal tubules protects the pulp and prevents liquor from being released into the cavity.

Fig. 14. Schematic representation of dentin after the application of a universal adhesive containing 10-MDP: The mild self-etch formulation partially dissolves and infiltrates the smear layer, while at the same time demineralizing and infiltrating the peritubular dentin5.

In the present case, the tooth and the fragment now needed to be reconnected. For this purpose, CLEARFIL MAJESTY™ ES-Flow (A2 Low) was applied to the tooth structure. The fragment was then repositioned with a silicone index, held in the right position with a plier and light cured. To obtain a smooth margin and glossy surface, the restoration was merely polished. The patient presented after 1.5 years for a recall and the restoration was still in a perfect condition.

Fig. 15. Reconnecting the fragment with the tooth structure.

Fig. 16. Treatment outcome.

Why is it important to adhere to the product-specific protocols?

Universal adhesives contain lots of different technologies in a single bottle. While this fact indeed allows users to rationalize their clinical procedures, it also requires some special attention. As every highly developed material, universal adhesives need to be used according to the protocols recommended by the manufacturer. In general, materials may only be expected to work well on absolutely clean surfaces, while contamination with blood and saliva is likely to decrease the bond strength significantly. Depending on the type of universal adhesive, active application is similarly important, as is proper air-drying and polymerization of the adhesive layer. In addition, care must be taken to use the material in its original state, which means that it needs to be applied directly from the bottle to avoid premature solvent evaporation or chemical reactions. When adhering to these rules, universal adhesives offer several benefits from streamlined procedures to simplified order management and increased sustainability, as fewer bottles are needed and likely to expire before use.

Dentist:

DR. JOSÉ IGNACIO ZORZIN

Dr. José Ignacio Zorzin graduated as dentist at the Friedrich-Alexander University of Erlangen-Nürnberg, Germany, in 2009. He obtained his Doctorate (Dr. med. dent.) in 2011 and 2019 his Habilitation and venia legendi in conservative dentistry, periodontology and pediatric dentistry (“Materials and Techniques in Modern Restorative Dentistry”). Dr. Zorzin works since 2009 at the Dental Clinic 1 for Operative Dentistry and Periodontology, University Hospital Erlangen. He lectures at the Friedrich-Alexander University of Erlangen-Nürnberg in the field of operative dentistry where he leads clinical and pre-clinical courses. His main fields of research are self-adhesive resin luting composites, dentin adhesives, resin composites and ceramics, publishing in international peer-reviewed journals.

References

1. Van Meerbeek, B.; Yoshihara, K.; Van Landuyt, K.; Yoshida, Y.; Peumans, M. From Buonocore‘s Pioneering Acid-Etch Technique to Self-Adhering Restoratives. A Status Perspective of Rapidly Advancing Dental Adhesive Technology. J Adhes Dent 2020, 22, 7-34.
2. Kuno Y, Hosaka K, Nakajima M, Ikeda M, Klein Junior CA, Foxton RM, Tagami J. Incorporation of a hydrophilic amide monomer into a one-step self-etch adhesive to increase dentin bond strength: Effect of application time. Dent Mater J. 2019 Dec 1;38(6):892-899.
3. Nagura Y, Tsujimoto A, Fischer NG, Baruth AG, Barkmeier WW, Takamizawa T, Latta MA, Miyazaki M. Effect of Reduced Universal Adhesive Application Time on Enamel Bond Fatigue and Surface Morphology. Oper Dent. 2019 Jan/Feb;44(1):42-53.
4. Fehrenbach, J., C.P. Isolan, and E.A. Münchow, Is the presence of 10-MDP associated to higher bonding performance for self-etching adhesive systems? A meta-analysis of in vitro studies. Dental Materials, 2021. 37(10): 1463-1485.
5. Van Meerbeek, B., et al., State of the art of self-etch adhesives. Dental Materials, 2011. 27(1): 17-28.
6. Pashley, D.H., et al., State of the art etchand-rinse adhesives. Dent Mater, 2011. 27(1): 1-16.
7. Vermelho, P.M., et al., Adhesion of multimode adhesives to enamel and dentin after one year of water storage. Clinical Oral Investigations, 21(5): 1707-1715.

Noen selskaper gjør hovedsaklig bruk av grunnleggende teknologier som er utviklet av andre for å forbedre produktene sine og lansere nye, mens andre produsenter utfører grunnleggende forskning og teknologiutvikling i egen bedrift. Er denne forskjellen relevant for dem som gjør daglig bruk av de resulterende produktene på tannklinikken eller på det tanntekniske laboratoriet? Vi mener det, siden produsenter med en dypere forståelse for de underliggende komponentene, kjemien og teknologiene er i stand til å løse utfordringer og respondere på brukernes behov raskere og mer fleksibelt. Artikkelen beskriver påvirkningen som flere grunnleggende teknologier utviklet av Kuraray Noritake Dental Inc., har hatt på sementeringen av indirekte restaureringer.

Adhesiv sementering før og nå

Muligheten for å frese dentale restaureringer av diverse keramer har åpnet nye muligheter innen protetikken. Svært estetiske restaureringer kan fremstilles og sementeres. Noe som ofte undervurderes i denne sammenhengen, er den rollen som adhesive sementer spiller. Ikke bare muliggjør de translucente, estetiske, tannfargede restaureringer, men de baner også vei for mindre invasive prepareringer og design av restaureringer. Tidligere systemer for adhesiv sementering med kjemisk binding mellom tann og restaurering hadde dessverre dårlige langtidsresultater og høy teknikksensitivitet, samtidig som arbeidsprosedyren var ekstremt komplisert. Teknologi som er utviklet av Kuraray Noritake Dental Inc., har gjort signifikante bidrag til bedre langtidsresultater og forenklet arbeidsprosess.

Optimalisering av langtids bonding-resultater

For å oppnå bedre langtidsresultater av tidlige bondingprosedyrer (spesielt til dentin), bestemte Kuraray, en forløper for Kuraray Noritake Dental Inc., seg for å fokusere på utviklingen av en kraftigere adhesiv monomer på 1970-tallet. Det første trinnet på utviklingen som ledet frem til suksess, var introduksjonen av fosfat-monomeren Phenyl-P i 1976. Fem år senere, etter fortsatte anstrengelser for å forbedre og raffinere molekylstrukturen, kunne man så introdusere den poulære MDP monomeren som er i stand til å gi sterk og holdbar binding til emalje, dentin, metaller og zirkonium.

Det faktum at MDP monomeren fremdeles inngår i alle adhesiver og adhesive sementeringssystemer fra Kuraray Noritake Dental Inc., og i mellomtiden er tatt i bruk av andre produsenter for å optimalisere bindingsstyrken og holdbarheten på bindingen for produktene, viser bare hvor genial denne oppfinnelsen var. I motsetning til MDP som er produsert andre steder, fremhever den Originale MDP seg takket være en renhet som ingen har kunnet matche. Studier viser at dette nivået på renhet har en positiv effekt på ytelsen1. Ved at den tilbyr stabilitet i fuktige omgivelser, har MDP monomeren bidratt til en mere konsistent ytelse for de produktene som inneholder den.

Ulike MDP monomerer har ulik renhetsgrad og ulik bindingsstyrke.

Tre eksperimentelle, selvetsende primere ble fremstilt. De inneholdt 15 vekt% 10-MDP som ble levert fra ulike kilder. KN (Kuraray Noritake), PCM (Tyskland) og DMI (Designer molecules Inc. USA). Data med tillatelse fra Dr. Kumiko Yushihara.

For at adhesive resinsementer skal kunne levere sterk binding og god marginal forsegling, er det imidlertid ikke nok å inneholde en adhesiv monomer. Effektiv
polymerisering av denne monomeren er også viktig- og dette er ikke alltid så lett å oppnå. For å kunne oppnå effektiv lysherding og kjemisk herding av PANAVIA™ V5, utviklet Kuraray Noritake Dental Inc. Touch-Cureteknologien. Nøkkelkomponenten i denne teknologien er en nylig utviklet, svært aktiv polymerisasjonsakselerator i PANAVIA™ V5 Tooth Primer som virker i samspill med den sure MDP monomeren. Straks sementen kommer i kontakt med den allerede primede tannoverflaten, starter polymeriseringen. I PANAVIA™ Veneer LC, en lysherdende sement som bruker desamme primerne, får vi samme virkningsmekanisme. Polymeriseringen starter umiddelbart i kontaktsonen mellom sement og primet tann, mens PANAVIA™ Veneer LC sementpastaen har den egenskapen at den har lang arbeidstid i rombelysning og polymeriseres ved lysherding.

For eksempel ble dette fenomenet evaluert for PANAVIA™ F2.0., forgjengeren til PANAVIA™ V5. Resultatet av studien var at PANAVIA™ F2.0 viste mye bedre marginal forsegling enn andre sementer som ble testet2. Denne dokumenterte, sikre forseglingen av spalten fører til lavere marginal lekkasje, til en høy polymerisasjonsgrad selv i selvherdende modus (uten lysherding eller hvor lyset fra herdelampen er blokkert), og derfor til en spesielt sterk binding.

En annen fordel ved å inkorporere av polymerisasjons-akseleratoren, er at den virker som et sterkt reduksjonsmiddel. Det nøytraliserer natrium-hypokloritt som er hyppig brukt som irrigasjonsmiddel ved endodontisk behandling, slik at den negative påvirkningen dette stoffet har på bindingsstyrken til senere anvendt sement elimineres.

Forenkler sementeringen av glass-keramikk

Færre flasker, færre trinn og strømlinjeformede sementeringsprosedyrer: Dette er grunnen til at selv-adhesive resinsementer har blitt utviklet og introdusert fra tidlig på 2000-tallet. De fleste av disse produktene har imidlertid et begrenset indikasjonsområde. De virker bra på zirkonium, metall, emalje og dentin, men de er enten ikke indisert, eller trenger en ekstra silan-primer, for bonding av glass-keramikk. PANAVIA™ SA Cement Universal, som inneholder MDP, er annerledes takket være en annen proprietær teknologi fra Kuraray Noritake Dental Inc.: LCSi monomeren, et silan -koblende middel med lang karbonkjede. Denne monomeren danner en sterk kjemisk binding med komposittresin, porselen og silikatkeramikk (som f.eks. litium disilikat). Slik elimineres behovet for en separat silankomponent (primer eller adhesiv). Ved å øke fordelene ved denne teknologien, skiller PANAVIA™ SA Cement Universal seg klart fra andre selv-adhesive resinsementer som en ekte én-komponent sement som også kan brukes til glass-keramikk.

Hvis ønskelig, kan produktets bindingsstyrke til tannen økes ved å bruke den populære universaladhesiven CLEARFIL™ Universal Bond Quick som inneholder Rapid Bond Technology. Denne teknologien har blitt utviklet av Kuraray Noritake Dental Inc. for å løse problemene som er relatert til den langsomme penetrasjonen av, særlig fuktig dentin, som kjennetegner universaladhesivene. For å oppnå skikkelig penetrasjon må disse adhesivene gnugges aktivt inn i tannen i lang tid, eller brukeren må vente en tid før lysherding. Rapid Bond Technology består av den originale MDP monomeren kombinert med hydrofile amid monomerer. Dette gjør at bondingen trenger raskt og dypt inn i fuktig dentin. Resultatet er kortere appliseringstid og enklere arbeidsgang uten at bindingsstyrken påvirkes negativt.

Konklusjon

Teknologier utviklet av Kuraray Noritake Dental Inc. har bidratt sterkt til forbedret bindingsstyrke ved adhesiv sementering og til at selvadhesive resinsementer virkelig har blitt egnet til universelt bruk.. Selskapet tilbyr et strømlinjeformet produktutvalg av høyeffektive resinsementer for alle brukere og for alle typiske kliniske kasus. Færre komponenter og færre trinn er nødvendige og prosedyrene er forenklet. Dette fører til færre feilslag og estetiske restaureringer med lang levetid. I tillegg til de teknologi-relaterte fordelene, tilbyr de nevnte produktene mange andre fordelaktige egenskaper. En detaljert beskrivelse finnes på kuraraynoritake.eu.   

Referanser

*) Functional monomer impurity affects adhesive performance.; Yoshihara K, Nagaoka N, Okihara T, Kuroboshi M, Hayakawa S, Maruo Y, Nishigawa G, De Munck J,
Yoshida Y, Van Meerbeek B. Dent Mater. 2015 Dec;31(12):1493-501.
**) Touch-Cure Polymerization at the Composite Cement-Dentin Interface.; Yoshihara K, Nagaoka N, Benino Y, Nakamura A, Hara T, Maruo Y, Yoshida Y, Van Meerbeek
B.J Dent Res. 2021 Aug;100(9):935-94

Noen selskaper nyttiggjør seg hovedsaklig av grunnleggende teknologier som er utviklet av andre for å forbedre produktene sine og lansere nye, mens andre selskaper utfører grunnleggende forskning og teknologiutvikling i egen bedrift. Er denne forskjellen relevant for den som bruker de ferdigutviklede produktene i sitt daglige virke på tannklinikker og tanntekniske laboratorier? Det er den så absolutt- siden produsenter som utvikler alt fra bunnen av vanligvis har en dypere forståelse av produktene og produksjonsprosessene, og dette gjør det enklere å modifisere spesifikke egenskaper, løse problemer som oppstår og respondere på markedets behov. Denne artikkelen beskriver hvordan flere grunnleggende teknologier som er utviklet av Kuraray Noritake Dental Inc. har forandret arbeidsgangen ved fremstilling av direkte komposittrestaureringer.

Direkte restaureringer- fra komplisert til enkelt

Adhesiv restorativ tannbehandling med bruk av høyeffektive dentale adhesiver og resinkompositter, er for tiden en av de mest populære metodene å behandle kariøse tenner på. I dag er en enkelt flaske med universaladhesiv og én eller to farger og opasiteter med universalkompositt vanligvis tilstrekkelig for å skape estetiske og holdbare resultater, vel å merke hvis man velger de riktige produktene. Slik har det imidlertid ikke alltid vært. I lang tid var teknikkene for å legge direkte komposittfyllinger temmelig kompliserte. Adhesivene var teknikksensitive og besto av flere flasker og flere trinn med lange appliseringstider. Fyllingsmaterialene, på sin side, kunne bare gi naturtro resultater hvis flere farger og opasiteter ble kombinert på en riktig måte. Og selv om de kompliserte prosedyrene ble utført på en korrekt måte, var risikoen for mikrolekkasje, misfarging og eventuell sekundærkaries-utvikling relativt høy. Kuraray Noritake Dental Inc. fokuserte tidlig på å løse disse problemene, og det startet med Original MDP Monomer som ble utviklet i 1981.

Optimalisering av kvaliteten på bondingen

Den Originale MDP Monomeren adresserte problemet med langtidsresultatene for adhesive systemer. MDPs hydrofile (fosfat) grupper danner en spesielt sterk og varig binding med kalsium i hydroksylapatitt,
hovedkomponenten i emalje og dentin. MDP-Ca saltet som dannes, skaper grunnlaget for et stabilt, sterkt og holdbart hybridlag. I kombinasjon med resinet i bondingen, dannes en tett forsegling av kaviteten etter lysherding. Frem til i dag er MDP en essensiell komponent av et hvilket som helst adhesivt produkt fra Kuraray Noritake Dental Inc., og er nøkkelkomponenten som gjør at CLEARFIL™ SE Bond har blitt Gullstandarden for selvetsende adhesiv-systemer.

Imidlertid var vi i Kuraray Noritake Dental Inc. overbeviste om at dentale adhesiver burde sørge for mer enn bare en sterk og holdbar binding, og derfor begynte vi å fokusere på å løse et annet problem, nemlig demineralisering og kariesutvikling som skyldes gjenværende bakterier i kaviteten. Basert på erfaringen fra utviklingen av andre adhesive monomerer, oppfant Kuraray Noritake Dental Inc. MDPB monomeren som har en antibakteriell, kavitetsrensende effekt. Til forskjell fra antibakterielle midler som kan risikere å hemme bindingsstyrken til den påfølgende bondingen, dreper MDPB de gjenværende bakteriene uten å påvirke bondingprosessen. Den finnes i primeren til det selvetsende toflaske-systemet CLEARFIL™ SE Protect og immobiliseres ved polymeriseringen.

Den baktericide mekanismen til MDPB er antatt å ligne den til det velkjente antibakterielle midlet CPC (cetylpyridinklorid), som finnes i mange tannpastaer og munnskyllevæsker.

Mens to-flaske selvetsende adhesiver allerede har forenklet den adhesive prosedyren, tar en-flaske universaladhesiver det hele et skritt videre. Det er en utfordring å samle ingrediensene fra multi-step systemene i én flaske uten å ødelegge for stabiliteten til produktet. Dagens teknologi gjør det imidlertid mulig. For å forsegle overflaten så raskt som mulig etter appliseringen, må penetrasjonen av monomerene inn i tannvevet være så rask og effektiv som mulig. Imidlertid blir penetrasjonen ofte forsinket av monomerer som trenger lengre tid på å trenge inn i tannstrukturen,og særlig inn i fuktig dentin. Noen ganger må også middelet gnugges inn. Dette er grunnen til at Kuraray Noritake Dental Inc. fokuserte på å utvikle Rapid Bond Technology. Denne består av den originale MDP monomeren kombinert med nylig utviklede hydrofile tverrbundne amid monomerer, og er integret i CLEARFIL™ Universal Bond Quick. De hydrofile amid monomerene sørger for rask, dyp og fullstendig penetrasjon av dentinet og etter herding dannes et sterkt tverrbundet polymer-nettverk som er ansvarlig for en sterk og holdbar binding. Således er ventetid og gnugging eliminert, og en tett forsegling med lang levetid oppnås etter lysherding.

Vanwege hun hydrofiliciteit (wateraffiniteit) dringen de amidemonomeren van de Rapid Bond Technology goed door in het dentine. Na lichtuitharding heeft de bonding een lage waterabsorptie en daarmee een hoge verouderingsbestendigheid.

Optimalisering av direkte restaureringer

Kombinasjon av flere sjikt, farger og opasiteter: Bruken av svært kompliserte sjikt-teknikker for å skape naturtro komposittrestaureringer, er heldigvis for mange kliniske situasjoner noe som hører fortiden til. Årsaken er høyt utviklede resin-kompositter som går i ett med omgivende tannstruktur. For å oppnå denne fordelaktige egenskapen, har Kuraray Noritake Dental Inc. utviklet sin egen Light Diffusion Technology (LDT). Denne teknologien er bygd inn spesielle prepolymeriserte fillerpartikler som virker som millioner av mikroprismer som sprer og refelekter lys og farge fra den omgivende tannstrukturen. Fillerpartiklene er optimalisert i størrelse, fordeling og brytningsindeks, og går i ett med omgivelsene på en uovertruffen måte. Hele CLEARFIL MAJESTY™ produktserien inneholder denne proprietære filler-teknologien. Det seneste produktet, CLEARFIL MAJESTY™ ES 2 Universal hvor Kuraray Noritake Dental inc. tar i bruk neste bnivå av LDT, tillater ensingelfarge teknikk med forenklet fargeuttak. Det finnes i to farger for anteriort bruk og én enkelt farge for det posteriore området, men den smelter inn så flott at så å si alle fargen i VITA Classic A1-D4 skalaen er dekket.

Refleksjon og lysgjennomgang på riktig måte gir fremragende optisk integrasjon . Lysdiffusjons-fillerne i CLEARFIL MAJESTY™ ES 2 fra Kuraray Noritake Dental Inc.Inc.

Siden gode optiske kvaliteter ikke bare er avhengige av optisk integrasjon og usynlige restaureringsgrenser, har Kuraray Noritake Dental Inc.nogså utviklet fillere som sørger for resten- en naturlig overflateglans og gode poleringsresultater som holder lenge. Løsningen, som er innebygd i CLEARFIL MAJESTY™ ES flow med tre ulike viskositeter, kalles Submicron Filler Technology. Den består av skinnende fillerpartikler av submikron størrelse. Disse fillerpartiklene er så små at lysrefleksjonen gir en naturlig effekt selv etter slitasje. Kuraray Noritake Dental Inc.s eksepsjonelle silanteknologi brukes til å forene millioner av disse submikron fillerpartiklene og holde dem sammen over tid. Dette tillater høyt fillerinnhold i komposittene med lav viskositet, og reduserer vannopptaket som ellers ville føre til nedbryting av den herdede kompositten. Den perfekte balansen mellom de blanke submikron fillerne, lysdiffusjonsfillerne, resinmatrisen og proprietær silan-teknologi er ansvarlig for en balansert kombinasjon av mekaniske og optiske egenskaper.

Eksempel på en singel-farge restaurering fremstilt med CLEARFIL MAJESTY™ ES-2 Universal.

Konklusjon

Adhesive monomerer, fillerteknologier og silan-teknologi sørger for en solid kombinasjon av fillerpartikler, klynger og resinmatrise. Kuraray Noritake Dental Inc. er helt klart en ekspert med høy tillit når det gjelder adhesive restaureringer.. De proprietære teknologiene som er utviklet i de site ti-årene har definitivt bidratt til en bedre (langtids) kvalitet for direkte restaureringer, slik at pålitelige og estetiske resultater har blitt enklere å oppnå.

Interview with Andreas Chatzimpatzakis

Fewer bakes, fewer ceramic powders - there is clearly a trend toward simplification in the production of zirconia-based prosthetic work. This is also true for implant-based restorations, which often involve gum parts. DT Andreas Chatzimpatzakis, international trainer for Kuraray Noritake Dental Inc., and the owner of ACH Dental Laboratory in Athens, Greece, shares his approach to high aesthetics in implant prosthodontics in the following conversation.

You are a user of the CERABIEN™ ZR portfolio from the outset. When did you test the products for the first time and why?

Well, it was many years ago when I finished my very first zirconia-based restoration. The reason to test CERABIEN™ ZR was that when I asked the dental technician who had milled the framework which porcelain system to use. He suggested to use CERABIEN™ ZR, which I did. I was immediately impressed by the system and by the outcome I was able to achieve on the first attempt.

Did you ever test any other porcelain systems for ceramic layering?

Yes. Before I becoming an international trainer for Kuraray Noritake Dental Inc., I had the opportunity to test many other porcelain systems for layering on zirconia. Based on this experience, I can say that CERABIEN™ ZR is unique and the best system I have ever used. The reason is that its translucency and chroma are extremely close to natural teeth. In addition, due to a controlled firing shrinkage, a One-Bake Technique may be employed even in long-span restorations.

Your hands-on demonstration at the Kuraray Noritake Dental booth during the IDS 2023 in Cologne focused on White and Pink Aesthetics achieved with CERABIEN™ ZR. Is there a specific concept you use?

Nowadays, everyone producing dental restorations – no matter whether based on natural teeth or on implants – is confronted with increasing aesthetic demands of patients and dental practitioners. The high demands are developed because life-like restorations and cosmetic dental treatment outcomes are presented everywhere in the web and on social media. The showcased quality of outcomes is simply expected, even if the financial budget is limited. To be able to fulfil these demands in the field of implant-based prosthodontics, I have developed an approach that allows me to achieve high aesthetics with little effort. My concept is based on using not too many ceramic powders. For extra chroma and special characterization, I rely on the power of the internal live stain technique, first introduced by Hitoshi Aoshima-sensei.

Please summarize the most important details of your presentation.

The first important detail is the design and characterization of the framework. Before sintering, I apply Esthetic Colorant for KATANA™ Zirconia. After the sintering process, shade base stain and internal stains are mixed and applied. In this way, I create a nice canvas that helps me to achieve a life-like result with only a few selected ceramic powders. In most cases, three to five powders are enough to produce a great result. Among the powders used most frequently are Opacious Body, Body, LTX, Mamelon and CCV. After the first bake and a little grinding, I make use of internal stains again. They offer support in the controlling of the chroma and the integration of special characteristics. When this step is completed, the final build-up is done with one or two ceramic powders, most of the times LT1 and Enamel or LT0. Pink aesthetics are usually created with Tissue 1, 3 and 5. For the free gingiva, LT Coral is my go-to solution. The major goal is always to obtain maximum quality in a minimum of time. To achieve this, a good knowledge of the materials and of course practicing – on both, porcelain build-up and morphology – are strictly required.

Fig. 1. Complex implant-based restoration: Framework design.

Fig. 2. Esthetic Colorant …

Fig. 3.  … applied prior to the final sintering procedure.

Fig. 4. Appearance after sintering.

Fig. 5. Final outcome.

Are there any concrete tips and tricks you would like to share?

For the characterization of the framework, I mix the internal stains with shade base stain powders; mostly with SS Fluoro. For the first bake, especially when the restoration is large and the amount of ceramic to be applied huge, I reduce the heating rate up to 38 degrees per minute. I also increase the drying process up to 17 or even 20 minutes depending to the restoration. Experience shows that these measures optimize the aesthetic outcomes.

You often mention that it is extraordinarily important to understand the morphology of natural teeth to be able to produce beautiful restorations. Why is this the case?

A successful prosthetic restoration needs to offer proper function and aesthetics. Function means a precise fit, perfect contact points and occlusion, a proper emergence profile and interproximal embrasures for self-cleaning etc. All this is described by the term morphology. Aesthetics, on the other hand, is guided by shape and colour. The effort required to establish a proper morphology is much higher (about 70 percent of the total work) than the effort involved in obtaining the right translucency, opalescence and chroma.

What instruments do you use to imitate the morphology of natural teeth and how do you do it?

I usually make use of the Optimum™ Spring Ceramic Brush Size 8 (MPF Brush Co.), stones and diamond burs for detailed grinding and carving after the final bake. I studied morphology at the Osaka Ceramic Training Centre in Japan with Shigeo Kataoka-sensei. According to him, a key factor in creating a perfect macro and micro morphology lies in the shadows. To be able to take into account the interference of light and shadow during grinding, a light source is placed on one side of the restoration.

How many bakes do you need to produce highly aesthetic restorations?

It depends on the case, although in many situations, I nowadays opt for some kind of micro-layering. Lately, I have used micro-layering a lot with internal stain directly on the zirconia framework. In other cases, I do a quick first bake, then the internal staining, a final bake and glazing. For small or single-unit restorations in the posterior region, a One-Bake Technique is often sufficient. Even a Zero-Bake approach using Esthetic Colorant on a monolithic zirconia restoration may be appropriate here, and it is very convenient. If there is a restoration with high aesthetic demands – these are typically single anterior restorations – the technique I select depends on the shade. In some cases, using only the internal stain technique is enough to reach a high aesthetic level, while in other cases, additional steps need to be taken. To my mind, there is no single technique that fits all cases. As mentioned before, I try to achieve high aesthetics in a minimum of time.

Fig. 6. Clinical example of achieving high aesthetics in a minimum of time: Before …

Fig. 7. … and after crown placement.

Fig. 8. High aesthetics …

Fig. 9. … achieved in a minimum of time.

Did your approach change due to the availability of high-translucency zirconia materials with colour (and flexural strength) gradation?

Well, yes! My overall approach changed more to micro-layering. Several years ago, we needed to consider how to mask the framework and how to achieve translucency in areas with limited space. The problem was solved for single-unit and small anterior bridge restorations with the availability of KATANA™ Zirconia UTML and STML. With the introduction of KATANA™ Zirconia YML, a high-translucency material became available for long-span or implant-based restorations as well. We have strength and translucency all in one disc. In most of my cases, the framework material replaces the dentin with regard to morphology and shade. Hence, I need to focus on adding the enamel by applying the transparent and translucent powders. The powders of the internal stain technique are used to characterize the framework, and with a micro-layer of porcelain, the goal of creating an aesthetic restoration in the minimum of time is achieved. This is exactly why I am sure that micro-layering is the future.

What drives you to share your knowledge with others?

My passion! I love my work! And I love to see technicians become better and better. Dental technology is an exciting journey, a journey that begins when the first impression arrives in the dental laboratory, and it ends when the final restoration is cemented into the patient’s mouth. And this journey is so exciting because we change lives. We change people’s personalities, we give them back their smile, we give them back their self-respect. Consider that every day, every single moment working on our bench trying to imitate nature… there is nothing more exciting than that!!!

My approach as an instructor is to lead dental technicians to master the art of observing natural teeth. This is the way every individual will understand morphology and shade. You need no special talent to be a very good dental technician. You need to observe! Your eyes see, your mind understands, and your hands will follow.

Alexander (Alek) Aronin is a master dental technician who dedicated himself to the creation of high-end, handmade porcelain restorations. He runs a dental laboratory and morphology school in Spain, and travels the world as a lecturer and teacher.

The greatest source of inspiration in his professional life is the book Collection of Ceramic Works by Hitoshi Aoshima. Through reading it in 1996, he discovered superb outcomes of working with dental ceramics. Moreover, the book’s content made him realize that the creation of handmade porcelain work is a result of special education and manual skills. Those who want to become masters need a lot of commitment and a striving for continuous improvement, which Alek shows in his work and his classes. We talked to him about his philosophy and his enthusiasm for the creation of lifelike restorations. He shared with us his perspective on the future of dental technology and gave some practical tips on how to achieve a high level of professional satisfaction.

Photo courtesy of Dennis Debiase

Alek, many dental technicians decide to focus on CAD/CAM technology and automated processing of dental ceramics. Due to improvements on the material side, a handmade porcelain layer is no longer necessary in many clinical cases. In this context, the manual refinement process is reduced to a minimum. Why did you decide to take a completely different path and focus on fully manual dental craftsmanship?

The shift towards automated processing is not a matter of choice for dental technicians rather, it is a natural response to the evolution of technology. The high-end manual refinement process remains unchanged. The human element, from communication to hand crafting among skilled individuals and demanding clients, has been a constant so far throughout history. This traditional connection remains stable for centuries.

Digitalisation is not the revolution in the dental industry, and I do not see the benefit of it in our narrow specialization yet. In the area we are working, we do all steps of our case faster, incomparably more precise and more profitable. But we are keeping eye on machines and waiting for a suitable one.

Machines and automated processes widely serve mass production businesses focused on fast, affordable and uniform results in a highly competitive field. Our goal and workflow are different - we provide individual work and personal attention to each of our partners and patients.

So, we do not compete with the production labs and do not interrupt each other, we coexist in parallel worlds as always. A small number of dentists and their patients will always demand personal attention and valued restorations and service of the highest quality.

Many dental technicians admire your work. Yet, you continue to strive for improvement. Why is this the case?

On one side, we are limited by static ceramic material used to mimic dynamic natural teeth that keep changing for a lifetime. On the other side, we are limited by our manual skills. I am still far away from my teachers and Japanese colleagues. My target is to improve the fabrication process. My goal is to achieve the simplicity and imperfectness like Aoshima-sensei.

Alek lecturing at the IDS 2023 in Cologne.
Photo courtesy of Dennis Debiase

We are enjoying the outcome, but prefer to focusing on the improvement of the process, and move on to create a better one. This is what I am learning in Japan, and this is what I teach my students.

Talking about learning: What are the most important aspects a dental technician who wants to improve his skills should have in mind when looking for a good teacher?

Manual skills are very important, but not the only aspect that should be taken into account. Every individual should be motivated and guided and this is a teacher’s job.

I love the traditional Japanese way of teaching and learning: The teachers are passionate, leading the way by evoking emotions and manual skills to bring the best out of every single student. My personal advice for dental technicians who want to become masters in the creation of lifelike high-end dental restorations is to select their teachers carefully and go to a private school or courses whenever they have the chance.

What are the most important tools a dental technician needs to use when trying to create high-end lifelike restorations?

I suggest to focus on four aspects:

1. Documentary dental photography - required for documentation and communication with the dental office and patients using constant (once set and never changed) parameters of the photo equipment.
2. Focus to the biomimetic additive dentistry. This is a minimum machine invasive field. Dental technicians and dentists should be able to develop a deep knowledge about clinical and lab-side procedures to be able communicate with each other.
3. Mastering morphology and function (shape carving), and anatomy (internal staining), which comes with value control and mimicking fine tooth details for best integration in the mouth.
4. Written communication (stop phone calls) is very important, this is the way how to exchange the information between the patient, clinic and lab by strict protocols.

I teach these complex skills in my morphology school and in many of my trainings worldwide. Focusing on the four aspects, a dental technician has a great chance to become a good specialist in a relatively short period of time in a narrow field.

Is material selection important for achieving great results?

I’ve been using Noritake ceramic for most of my life, and the reason is simple: Noritake created their EX-3 porcelain over 40 years ago, and it was so well-made that it has not needed any changes since.

This is showing their consistently high quality and creates unbroken succession in the valuable tradition of passing on techniques and knowledge.

Today, among different generations of dental technicians, we can use and share the same methods, vocabulary and abbreviations, powders, and temperature charts developed by our skilled teachers 30 to 40 years ago. This unique feature sets Noritake and Creation porcelains apart from all other brands and systems in the world.

The other Noritake porcelain I use quite frequently is CERABIEN™ ZR, which is also well-tried and tested and has even some more advantages than EX3.

Is there any final advice you would like to give?

To become a good professional, I suggest to developing in four parallel directions:

1. Practicing on phantoms - fabricating cases and ceramic samples. It helps to experiment and practice with varied materials and techniques.
2. Implementing the achieved techniques in clinical cases.
3. Working with case presentation PowerPoint or Keynote: documenting the working steps in pictures and videos from beginning to end.
4. Mastering the communication using e-mails. Constantly calibrate and adjust the information exchange process between the clinic and lab. Acquire deeper knowledge about the work of each other.

Good luck!