429 Too Many Requests

It is difficult to cover every flowable composite indication with a single viscosity: Sometimes, you need it to stay put where applied or malleable to create a specific shape. In other situations, you need it runny so that it flows into every corner or undercut. In order to meet all those needs, Kuraray Noritake Dental Inc. offers CLEARFIL MAJESTY™ ES Flow with three different levels of flowability: High, Low, and Super Low. The level of flowability is selected depending on the indication, the geometry and size of the cavity. For example, the high-flowability option is best suited as a cavity liner, while the super low flowability variant is preferable in the context of composite veneering.

However, the material has much more to offer, as confirmed by the consultants of the Dental Advisor who have honored the product with an Editors’ Choice and a Top Product Award for the seventh time in a row (Volume 39, Number 01, January-February 2022).

The 29 Dental Advisor consultants tested the medium flowability variant (Low) of CLEARFIL MAJESTY™ ES Flow in their dental practices. They assessed the product’s performance regarding placement/handling, aesthetics, viscosity and polishability. All four properties received an “excellent” rating. CLEARFIL MAJESTY™ ES Flow Low shows no running during placement, while it offers a good adaptation to the cavity walls and even flows into narrow areas. Equipped with Kuraray Noritake Dental Inc.’s Light Diffusion Technology, the material integrates seamlessly with the surrounding tooth structure and a glossy surface is obtained simply by wiping with a cotton roll soaked in alcohol.

Due to these properties and a convincing overall performance, the product received a 98 percent rating, and all 29 consultants stated that they would recommend CLEARFIL MAJESTY™ ES Flow to a colleague. Since 2015, the product has won the Top Product Award time and again, and with its three viscosities, it is likely to become your favourite product for an even broader range of indications.

By Dinesh Sinha, BDS, PHD, Senior Technical and Marketing Manager Dental Division, Kuraray America, Inc.

The all-ceramic restoration market, including that for zirconia, lithium disilicate, and lithium silicate, has been growing rapidly worldwide since the beginning of the 2000s. With the increasing market demand, various dental manufacturers market different dental ceramics that can be used in many dental prosthetic applications. These materials require different minimum thicknesses and preparations to successfully function in the oral environment.

STRENGTH OF DENTAL CERAMICS (FLEXURAL STRENGTH)

The most common method of measuring ceramic strength is by evaluating its flexural strength (in megapascals, MPa). The flexural strength test applies a force on the top of a ceramic specimen, which causes the specimen to bend and fracture. The International Standards Organization (ISO) and the ADA have developed a standard for measuring the flexural strength of dental ceramics. Two methodologies are commonly used today:

• The biaxial flexural strength method (Figure 1): a circular, ceramic specimen/disc that is supported by 3 points, and force is applied in the middle.
• The 3-point bend method (Figure 2a): a rectangular specimen/bar is used and supported by 2 points, and force is applied in the middle. The 3-point bending test for flexural strength is mostly used with zirconia.

Both tests are acceptable; however, ceramics tend to produce higher values when tested with the biaxial method compared to the 3-point bend method. Furthermore, even in a 3-point bending test, if the span lengths (Figures 2b and 2c) of the specimens are increased, ceramic tends to bend abruptly and fail or crack easily. The span length setting in the 3-point bending test for flexural strength plays a critical role in establishing the flexural strength test value. The ISO does provide a guidance on testing that ceramic bars can be in the span length of 12 to 30 mm, but 12 mm and 30 mm can produce completely different flexural strengths. In other words, the shorter the span length, the higher the flexural strength. It is important that clinicians or dental ceramists understand the testing conditions before comparing or selecting the best ceramic for suitable clinical conditions.

Fig. 1: Biaxial Bending Flexural Strength Test.

Fig. 2: 3-point Bending Flexural Strength Test with different span lengths.

INCREASING THE STRENGTH OF CERAMICS

The most straightforward method of increasing the strength of a ceramic is to increase its thickness. This means the preparation depth needs to be higher and may not be favorable in a minimal intervention. There are times when the clinical situation itself may limit the thickness to which a tooth can be prepared (eg, lower incisors). In these cases, another option is to select a stronger ceramic material. In general, dental zirconia has a higher strength compared to lithium disilicate.

Another option is to adhesively (resin) bond the ceramic restoration to the tooth surface. This will easily increase the fracture resistance of a ceramic. Kuraray Noritake Dental Inc. has a legacy of inventing groundbreaking technologies in resins and ceramics. We invented and introduced the Original MDP monomer in 1981. All Kuraray Noritake PANAVIA™ cement brands (Figure 3) contain this MDP monomer. These cements perform best with KATANA™ Zirconia material (Kuraray Noritake Dental Inc.) (Figure 4). Currently, due to the wide availability of different materials, it is important to understand and properly interpret ceramic strength before comparing or selecting material for clinical use.

Dentist:

DINESH SINHA, BDS, PHD

First published in: A Journal of Dental Technology | November/December 2021

One of the key features when talking about cements is the ease of removal of excess cement. Our newest cement - PANAVIA™ Veneer LC - offers the ideal paste consistency, a low film thickness and long working time.

But how about excess removal? Do you wonder how do we compare to other similar products?

Check out this video demonstrating an excess removal comparison between PANAVIA Veneer LC and other brands.

PANAVIA™ Veneer LC

Great solution for challenging task

PANAVIA™ family just got bigger! We are introducing the new PANAVIA™ Veneer LC – the specialist cement that offers aesthetics, excellent paste viscosity, easy handling and 200 seconds(!) working time under ambient light (8000 lux.). Coming in four different shades with matching try-in pastes from PANAVIA™ V5 system, it allows users to take into account the individual shade requirements and deliver highly aesthetic outcomes when cementing veneers, inlays and overlays.

Join our free webinar now and be the first to learn all the details about this new and exciting product from Kuraray Noritake Dental Inc..

ABOUT DR JORGE ESPIGARES, DDS, PHD

Dr. Jorge Espigares received his DDS degree at the Faculty of Dentistry, University of Granada in Spain and obtained his PhD degree under the supervision of Prof. Tagami at Tokyo Medical and Dental University in Japan. Specialized in Cariology and Operative Dentistry, Dr. Jorge Espigares has clinical experience in Spain and UK, and has authored and coauthored full-length research publications with his colleagues at TMDU.

Minimally invasive procedures using highly aesthetic restorations is what patients expect when they seek restorative treatment. With the various types of restorations available today, it is possible to meet these expectations – provided that the right materials are used.

For the placement of veneers, a resin cement must be selected that supports long-lasting aesthetics, is easily applied, offers a working time sufficient for simultaneous cementation of multiple restorations and provides excellent bond strength. The new “PANAVIA™ Veneer LC” is precisely what you need.

What is the workflow you ask? Check out the video to see the full workflow using PANAVIA V5 Primer and CLEARFIL Ceramic Primer Plus.

Are you looking for an easy and simple finishing method for full contour crowns? How about using CERABIEN ZR FC Paste Stain?

Check out the videos created by @danielerondoni and @mr.roberto.rossi and get started!

Thanks to constant efforts in research and development, leading dental companies have managed to introduce new products that allow for less invasive techniques, standardized or simplified procedures and better outcomes on a regular basis. With so many different materials available on the dental market, however, it seems difficult to decide which products are best suited to fulfill the individual requirements. A direct comparison obtained through testing of all products in the dental office is simply impossible due to the great number of available solutions. Laboratory investigations provide information about specific product properties, but usually cannot create the overall picture. Moreover, the results of different tests are barely comparable due to variations in test conditions. Clinical study results are very useful as they shed light on clinical (long-term) performance of selected materials, but they are usually published years after a product’s launch. Hence, they are not available in the early stages. A great source of information are practice-based evaluations, as they support potential users in identifying high-quality dental materials.

One of the institutions conducting and publishing practice-based clinical evaluations and product performance tests is the US-based DENTAL ADVISOR. Once per year, the dental materials and equipment with the best performance receive a Top Product or Preferred Product Award. The list of winners is published online (www.dentaladvisor.com) and in the January-February issue of the DENTAL ADVISOR. In 2022, numerous products from Kuraray Noritake Dental Inc. were among the award winners.

Top Product Awards

Minimum intervention dentistry has gained increasing popularity in recent years. A product that even allows for a non-invasive approach is TEETHMATE™ DESENSITIZER for hypersensitivity treatment. This year, the product won a Top Award from the Dental Advisor for the eighth year in a row.

The material was designed to create hydroxyapatite (HAp), which is able to occlude open dentinal tubules and enamel cracks. This leads to a significant reduction of hypersensitivities when applied to exposed, mechanically treated or freshly prepared dentin. When used in the context of restorative treatment, TEETHMATE™ DESENSITIZER does not have a negative effect on the bond strength of dental adhesives or cements. A six-month clinical evaluation conducted by the DENTAL ADVISOR involving 27 patients with gingival recession-related hypersensitivity revealed that the use of the product is very effective in providing immediate and even long-term (six-months) hypersensitivity relief. This resulted in an excellent rating with a score of 96 percent.

Delivering a strong and durable bond to enamel and dentin is one of the preconditions for minimally invasive direct restoration procedures. A self-etch adhesive that offers more than just a reliable bond is CLEARFIL™ SE Protect. The product received a Top Product Award in the category Direct Restoratives, Bonding Agent: Self-Etch for the fourth time. It is based on the formulation of the gold standard two-step self-etch adhesive CLEARFIL™ SE BOND, but contains an extra MDPB monomer offering an antibacterial cavity-cleansing effect and fluoride for long-term fluoride release. The honoring of the DENTAL ADVISOR is based on a material test carried out by 13 DENTAL ADVISOR consultants and editors in their dental offices for six weeks. Due to its excellent performance, CLEARFIL™ SE Protect received a 98 percent clinical rating.

Great handling and aesthetic outcomes are probably the major benefits CLEARFIL MAJESTY™ ES Flow has to offer. For the seventh year in a row, the Top Product Award in the category Direct Restoratives, Composite: Highly Filled Flowable went to this material.

The universal flowable composite that also became the Editor’s Choice comes in three different levels of flowability, from high to super low*. This enables the user to choose the right viscosity for every clinical situation – with the high flowability variant being the perfect choice for cavity lining and as a resin coat in IDS (Immediate Dentin Sealing) procedures, and the super low flowability option being specifically suited for direct veneer procedures and even for build-up of posterior cusps etc. The universal flowable composite was tested by 29 consultants of the DENTAL ADVISOR in more than 900 clinical applications. The evaluated properties – placement/handling, aesthetics, viscosity and polishability – were rated “excellent”. This led to a recommendation rate of 100 percent and a 98 percent overall clinical rating.

*DENTAL ADVISOR evaluated only the standard level of flowability (Low), because other two variants are not available in US.

Preferred Products

Among the 2022 Preferred Products are two truly universal solutions: The time-saving CLEARFIL™ Universal Bond Quick and easy-to-use PANAVIA™ SA Cement Universal.

CLEARFIL™ Universal Bond Quick became a Preferred Product of the Dental Advisor consultants for the third time. The universal bonding agent may be applied using the self-etch technique or – together with K-ETCHANT syringe – in the selective enamel etch or total-etch technique. Containing our rapid bond technology – a combination of the original MDP monomer with innovative hydrophilic amide monomers – the adhesive works instantly and without the need for extended exposure times, application of multiple layers or extensive rubbing into the tooth structure. The fast and easy application procedure was one of the main reasons for the consultants of the DENTAL ADVISOR to select CLEARFIL™ Universal Bond Quick as a Preferred Product and Editor’s Choice with a 98 percent score in a clinical evaluation.

PANAVIA™ SA Cement Universal became a Preferred Product in 2021 and 2022, won a Top Product Award in 2020 and is listed as the Editors’ Choice. The self-adhesive universal resin cement contains the unique LCSi monomer. This monomer is a silane coupling agent, which has a unique long carbon chain in its molecule. LCSi monomer establishes a durable, chemical bond with porcelain, lithium disilicate and composite resin without the need for a separate silane containing primer. The other key technology present in the formulation is the original MDP monomer, which provides for chemical reactiveness with zirconia, dentin and enamel. Together the technologies make it possible, that PANAVIA™ SA Cement Universal produces a strong and durable bond with virtually every restorative material without the need for a separate primer. Its handling characteristics, aesthetics and gingival friendliness received very good to excellent ratings from 31 clinical evaluators, who used the cement in 516 applications. The result of the overall clinical rating was 96 percent.

Finally, CLEARFIL™ Ceramic Primer Plus became a Preferred Product in 2019, 2020, 2021 and 2022, and received the Editors’ Choice label due to its excellent performance in the clinical evaluation. It contains the original MDP monomer and a silane monomer, which ensure excellent bond strength to all kinds of restorative materials, i.e., to silica-based ceramics, zirconia, composites and even metals. Users benefit from procedural simplicity as the product is just applied and dried to the bonding surface after the recommended pretreatment. In a clinical evaluation, the product received a recommendation rate of 96 percent and a 96 percent overall score from the DENTAL ADVISOR consultants.

Conclusion

Most of the Kuraray Noritake Dental products that received an award this year are based on resin technologies, one of our key competencies. In the 1980s, we developed the original MDP monomer, a functional monomer, which is an essential component of any adhesive product we introduced down to the present day, including the award-winning CLEARFIL™ SE Protect, PANAVIA™ SA Cement Universal, CLEARFIL™ Universal Bond Quick and CLEARFIL™ Ceramic Primer Plus. This is only one of our many areas of expertise. We also provide users with preventive products and a whole range of restorative materials – from composite filling materials like CLEARFIL MAJESTY™ ES Flow to dental ceramics like KATANA™ Zirconia UTML, STML, an updated HTML PLUS and the brand-new KATANA™ Zirconia YML. We see the winning of the awards as a positive proof of a reliable product performance that supports dental practitioners in reaching their own goals.

In 1976, Kuraray introduced its first adhesive monomer—the phosphate monomer Phenyl-P. Over the following years, the company’s commitment to research and development saw continued efforts to improve and refine this monomer’s molecular structure. Kuraray eventually achieved this goal by creating a molecule with greater capability to adhere to the tooth structure, low solubility and effectiveness in bonding to metal: the MDP monomer.

Developed and then patented by Kuraray in 1981, the MDP monomer remains, to this day, the leading functional monomer for reliable adhesion to various substrates including enamel and dentine. Research has repeatedly shown that products that utilise this monomer create long-term, durable and stable bonds to dental tissues, non-noble metals and zirconia ceramic. Simply put, it is hard to know where adhesive dentistry would be without the MDP monomer.

An unmatched level of purity

One of the secrets behind the success of Kuraray Noritake’s MDP monomer is its uniquely high-quality nature. The patent that Kuraray held on the monomer has expired, opening up the market for other manufacturers to synthesise their own MDP. However, a study conducted by Yoshihara et al.¹ found that, of the three adhesive MDP monomers they examined, differences in purity levels were visible and affected the intensity of nano-layering and resultant bond strength. Unsurprisingly, the bond strength displayed by Kuraray Noritake’s original and highly pure MDP was the highest measured.

“It’s very clear that the MDP monomer is one of the most effective monomers available, given its primary chemical binding potential to hydroxyapatite,” Prof. Bart Van Meerbeek, a leading authority on dental bonding agents, said in an interview with Dental Tribune International.

“Essentially, a universal adhesive that contains a high concentration of very pure MDP monomer should perform the best,” he added, when asked about universal bonding systems.

A monomer with many applications

The first Kuraray product to use the MDP monomer was PANAVIA EX resin cement. Introduced in 1983, PANAVIA EX quickly became known as a facilitator of reliable adhesion, and the PANAVIA family of adhesive resin cements, including PANAVIA V5 and PANAVIA SA Cement Universal, still employs the MDP monomer to provide first-class bonding for dental professionals worldwide.

Of course, the MDP monomer forms the backbone of a number of products in Kuraray Noritake Dental’s current CLEARFIL range of bonding systems, such as the gold standard CLEARFIL SE BOND, a mild two-step self-etching, light-cured bonding agent. CLEARFIL Universal Bond Quick, the company’s universal single-step dental bonding agent, utilises rapid bond technology. The synergistic combination of the original MDP monomer and hydrophilic amide monomers works to create a lasting bond faster and more easily than ever.

There have been more than 40 years of evidence, and the conclusion is clear: Kuraray Noritake Dental’s MDP monomer has changed dental bonding for the better.

Learn more about the MDP monomer here.

References

1. Yoshihara K. et al. Functional monomer impurity affects adhesive performance. Dent Mater. 2015 Dec;31(12):1493–1501.

A newcomer in the PANAVIA family – PANAVIA Veneer LC. Cementation of the veneers can be a challenging task, but with this specialist product in house, outstanding results can be achieved with ease.

Check out the video to learn about the features of PANAVIA Veneer LC and the resulting benefits.

Finishing of six anterior elements with gingival flange produced from high-strength KATANA™ Zirconia – from surface morphology adjustments to micro-layering.

FOREWORD

Innovative high-translucency, multi-layered variants of zirconia feature well-balanced optical and outstanding mechanical properties. Their use allows for better outcomes of laboratory-based digital workflows and makes it possible to fulfil the increasing functional demands we are facing in the clinical environment. Depending on individual, case-specific needs, laboratory technicians can select a suitable zirconia and the distinctive technical approach delivering the desired outcomes. For this purpose, it is essential to develop a deep understanding of the available materials, their chromatic adaptability and general aesthetic potential, the design and finishing options and their correct technical implementation as well as the most important case-specific selection criteria. In combination with advanced laboratory-based communication skills, this knowledge will enable us to fulfil or even exceed the patient’s expectations by delivering a highly aesthetic, functional restoration.

Let us assume that a six-unit anterior bridge with gum area on implants is needed. For the ideal prosthetic solution, white aesthetics is fundamental, but a perfect harmony will only be achieved if the gingival texture and colour is reproduced in a natural way, as the gingiva is considered the “aesthetic frame” of the dental restoration. Our solution is a monolithic restoration made of KATANA™ Zirconia YML, finished using a 3D micro-layering technique with CERABIEN™ ZR.

OBJECTIVE

In this Master Course, you will acquire the theoretical knowledge needed to select the appropriate zirconia and finishing technique for every individual case and the practical skills required for the finishing of the six-unit bridge with gum area – from surface texturing to 3D micro-layering on teeth and gums.

YOU WILL LEARN TO:

✔ Select the appropriate type of KATANA™ Zirconia ML
✔ Re-finish pre-sintered zirconia
✔ Optimize the sintering process
✔ Re-finish and prepare the zero cut-back elements
✔ Accomplish micro-layering with CERABIEN™ ZR porcelain
✔ Perform mechanical finishing and polishing

For more information please visit: https://www.danielerondoni.com/courses/