429 Too Many Requests

WINNING STRATEGIES FOR CERAMIC LAYERING AND CHAIRSIDE PROCEDURES

Are you looking for advice on how to achieve excellence in all-ceramic restorations from no less a figure than Nondas Vlachopoulos? Or would you like to take a deep dive into aesthetic restoration techniques and success factors in chairside procedures? In both cases, it is definitely worth visiting the IDS booth of Kuraray Noritake Dental Inc. tomorrow.

The lecture programme for dental technicians and practitioners already has a lot to offer:

Moreover, our Kuraray Noritake Dental team is eager to share their knowledge and introduce you to our world of innovative products, solutions and workflows. One of the focus products for laboratories this year: CERABIEN™ MiLai, a brand-new set of low-fusing porcelains and internal stains designed for micro-layering not only on zirconia, but also on lithium disilicate. See for yourself how this product is capable of transforming your technical workflows; and learn how your experienced colleagues use it to fulfil even the highest aesthetic demands.

More information including the complete lecture programme and a full overview of innovative solutions is available online.

See you tomorrow in Hall 11.3 at our Booth # E010!

CONCEPTS FOR SUCCESS WITH FLOWABLE COMPOSITES AND MICRO-LAYERING

Would you like to learn more about the flowable injection technique and the benefits for your practice? Or are you interested in mastering internal staining combined with micro-layering in your laboratory? In-depth knowledge about those and other approaches, practical tips on how to implement them and perfectly suitable products will be presented tomorrow at the IDS booth of Kuraray Noritake Dental Inc.

On two different stages, specific lecture programmes for dental practitioners and dental technicians are offered:

In addition, our knowledgeable staff will be happy to present innovative products like the brand-new CLEARFIL MAJESTY™ ES Flow Universal with its simplified shade concept. Experience its handling properties and blend-in ability yourself by testing it on model teeth, get in touch with the product’s developers or scientific experts, and see how easily the material – and the presented techniques – might transform your daily procedures! We look forward to seeing you in Hall 11.3 at our Booth # E010!

More information including the complete lecture programme is available online.

EXCITING START OF THE LECTURE PROGRAMME

Colourful booth, lots of enthusiastic visitors: Our first day at the International Dental Show in Cologne is a full success. Tomorrow, we are going to up the ante and start our lecture programme. In the afternoon, our renowned partner clinicians and technicians will shed light on clinical or technical procedures and approaches that will allow you the leverage the full potential of our innovative products.

Chairside, different direct restorative procedures and our universal portfolio will take centre stage:

Labside, the focus will be on redefining laminate veneers and minimal layering:

Do not miss the chance to visit us, watch the lectures and connect with the speakers for practical tips. Our team is also happy to share their in-depth knowledge about our products and procedures. We look forward to seeing you in Hall 11.3 at our Booth # E010!

More information including the complete lecture programme is available online.

Cases by DT Ioulianos Moustakis and MDT Andreas Chatzimpatzakis

Producing dental restorations that are not recognizable as such – this is probably the ultimate goal of every dental technician. For a long time, pursuing this goal was complicated by core materials whose optical properties were very different from those of natural teeth. The dark metal or opaque zirconia substructures had to be masked by applying multiple layers of intensively coloured ceramic powders, topped by more translucent porcelains imitating the enamel.

The rise of modern, tooth-coloured core materials such as lithium disilicate and zirconia has changed the game. With a core that is highly aesthetic, translucent and close to the final shade, it became much easier to produce a restoration that is virtually indistinguishable from the adjacent teeth. The thickness of the porcelain layer decreased as did the number of shades to be combined and necessary bakes to be conducted. The use of the existing porcelain systems for the new micro-layering techniques posed several new challenges: those systems originally developed for opaque zirconia were indicated for the more translucent zirconia core materials, but usually not for lithium disilicate. Moreover, the complexity of the systems made their use unnecessarily complicated for inexperienced users.

Consequently, Kuraray Noritake Dental Inc. developed a new porcelain system for micro layering on zirconia and lithium disilicate core materials. The portfolio of CERABIEN™ MiLai, which refers to micro-layering and the Japanese word for future (mirai), consists of 15 internal stains (13 tooth colours including Bright to boost the translucent and Fluoro to boost the fluorescent effect, and two tissue colours) and 16 porcelains (12 tooth porcelains and four tissue porcelains). Hence, it enables dental technicians to implement a modernized version of the original Internal Live Stain Technique developed by Hitoshi Aoshima in the early 1990s in a porcelain layer of minimal thickness.

The following demo cases are used to show how to achieve lifelike aesthetic restorations based on aesthetic zirconia and on lithium disilicate. Illustrating each step, the cases allow users to anticipate how much time and effort can be saved compared to traditional layering techniques.

CASE 1

MAXIMALLY SIMPLE APPROACH ON LITHIUM DISILICATE

In this case, the idea was to restore the six maxillary anterior teeth in a simple way. The selected core material for the planned veneers was Amber Press (HASS Bio) LT in the shade B1. The lithium disilicate restorations were pressed with a micro cut-back and their fit was checked on the model, followed by surface texturing, sandblasting and steam cleaning [Fig. 1a]. When the veneers are milled instead of pressed, the procedure is the same. After that, the restorations are ready for the application of the CERABIEN™ MiLai internal stains for characterization of the core. In order to achieve the desired result, it is critical to mix the selected stains with the internal stain Bright responsible for a translucent effect. The chroma map for internal staining is shown in figure 1b, the outcome of the procedure in figure 1c. Subsequently, the veneers were built up to their final anatomy with selected CERABIEN™ MiLai Porcelains [Fig. 1d] to imitate the enamel and create a window effect. In this approach, simple layering and a single bake are sufficient to create the desired restoration. After glazing with Clear Glaze, finishing of the restorations was accomplished with paper-abrasive cones, a rubber polisher and polishing paste. The outcome is shown in figure 1e.

Fig. 1a. Pressed lithium disilicate veneers after surface optimization (grinding), sandblasting and steam cleaning on the model.

Fig. 1b. Chroma map for the application of CERABIEN™ MiLai Internal Stains to the lithium disilicate surface. We selected B+ (red colour) for the cervical area. For the proximal and middle incisal areas, Incisal Blue 1 & 2 (gradient blue colour) were applied and incisally in the middle, we chose Cervical 2 (orange colour). Tip: all internal stains were mixed with Bright and IS Liquid.

Fig. 1c. Appearance of the veneers after the application of CERABIEN™ MiLai Internal Stains.

Fig. 1d. CERABIEN™ MiLai Porcelains applied on top of the internal stains: LT1 is used for the cervical area (red) and a mixture of TX and E2 (30:70 ratio) for the middle and the incisal third.

Fig. 1e. The final restorations after glazing with Clear Glaze and mechanical polishing using paper-abrasive cones, a rubber polisher and Pearl Surface Z (Kuraray Noritake Dental Inc.).

Images courtesy of Andreas Chatzimpatzakis.

CASE 2

ADVANCED APPROACH ON LITHIUM DISILICATE

In order to imitate a more complex inner colour structure with mamelons, different levels of translucency and more individual effects, a slightly more complex micro-layering approach was selected. Again, the core was produced using Amber Press in the LT variant and the shade B1. After pressing and fitting on the model, we reduced the incisal third to create space for the transparent porcelain [Fig. 2a]. Subsequently, an extremely thin layer of CERABIEN™ MiLai Porcelain adding translucency to the enamel surface (TX) was applied in the incisal third of the veneers [Fig. 2b]. In this way, it is possible to create an optimally translucent basis for the application of the internal stains. The first bake was conducted and the surfaces were sandblasted as well as steam cleaned to create the conditions needed for internal staining [Figs. 2c and 2d]. The chroma map for and outcome of the internal stain application are shown in figures 2e and 2f. Afterwards, a final layer of CERABIEN™ MiLai Porcelain was applied [Fig. 2g]. All four incisors received a layer of LTx to add ultimate translucency and opalescence to the enamel, while LT1 was the material of choice in the cervical third of the canines, where LTx completed the layer in the other areas. As LT1 is slightly less translucent and opalescent, a natural effect is obtained in this way. The outcome obtained after glazing and mechanical polishing is shown in Figure 2h.

Fig. 2a. Lithium disilicate veneers reduced for the advanced layering procedure involving more porcelains and bakes.

Fig. 2b. Thin layer of TX applied to the incisal third of the restorations to boost the translucency in this area.

Fig. 2c. Appearance of the veneers after the first bake.

Fig. 2d. Ceramic surfaces after sandblasting and steam cleaning.

Fig. 2e. Chroma map for the application of the internal stains. Cervical 2 was used for the cervical third, Incisal Blue 2 for the proximal regions and Mamelon Orange 2 for the mamelons. As mentioned before, the selected internal stains were mixed with Bright.

Fig. 2f. Appearance of the veneers after the bake of the applied CERABIEN™ MiLai Internal Stains.

Fig. 2g. Final build-up to reach the desired shape of the veneers. LTx is the only material applied to the central and lateral incisors, while the canines are built up with LTx in the incisal and middle and LT1 in the cervical third.

Fig. 2h. Glazed and polished veneers on the model.

Images courtesy of Andreas Chatzimpatzakis.

CASE 3

ADVANCED APPROACH WITH GUM AREAS ON ZIRCONIA

In this case, a highly complex ten-unit bridge with gum parts in the anterior region had to be produced. The selected framework material was KATANA™ Zirconia HTML Plus (Kuraray Noritake Dental Inc.), which offers a multi-layered colour structure, an optimized translucency and the high flexural strength required for long-span bridges. The restoration was milled in an anatomically reduced design and the surface texture was optimized with rotating instruments before sintering [Fig. 3a]. After the final sintering procedure, the restoration had a favourably high translucency in the incisal region and a natural shade structure [Figs. 3b and 3c]. In the first step of the micro-layering procedure, the application of the CERABIEN™ MiLai Internal Stains was planned and carried out [Figs. 3d and 3e]. Subsequently, different layers of CERABIEN™ MiLai Porcelain were applied. The images 3f to 3h reveal which shades were combined and illustrate the procedure, while the outcome before and after the last bake is shown in Figures 3i to 3k. In the next step, the gum areas were completed using the CERABIEN™ MiLai tissue porcelains Tissue 4, 5 and 6 in the order and locations described in Figures 3l to 3o. In the final layer, Tissue 1 was mixed with ELT1 to imitate the labial frenulum and with LTx to create a smooth transition to the natural gingiva [Figs. 3p and 3q]. The final restoration is shown in Figure 3r.

Fig. 3a. Milled restoration after surface texturing.

Fig. 3b. Shade and translucency of the sintered zirconia restoration.

Fig. 3c. Highly translucent bridge on the model.

Fig. 3d. Chroma map for the application of CERABIEN™ MiLai Internal Stains.

Fig. 3e. Applying a mixture of Bright, Salmon Pink and Tissue Pink to the gum area.

Fig. 3f. Application of CERABIEN™ MiLai E2 to add translucency to the structure.

Fig. 3g. Application of Tx and a mixture of Tx and CCV-2 to individualize the cervical and incisal areas while boosting the translucency of the enamel in the middle and incisal third.

Fig. 3h. Adding a final layer of LT1 for additional translucency and opalescence.

Fig. 3i. Appearance of the ten-unit bridge before the bake – labial view.

Fig. 3j. Appearance of the ten-unit bridge before the bake – palatal view.

Fig. 3k. Appearance of the ten-unit bridge after the bake.

Fig. 3l. Application of small amounts of Tissue 5 …

Fig. 3m. … covered with a layer of Tissue 6 alternating with Tissue 5.

Fig. 3n. Following another bake, Tissue 5 is applied in the proximal areas.

Fig. 3o. How to combine Tissue 6 and Tissue 4 in the next layer.

Fig. 3p. How to complete the tissue layer with Tissue 1, locally mixed with ELT1 or LTx.

Fig. 3q. Restoration before the final bake.

Fig. 3r. Final ten-unit bridge ready for placement.

Images courtesy of Ioulianos Moustakis.

ABOUT THE AUTHORS

DT IOULIANOS MOUSTAKIS
Germany

Dental Technician/Photographer
1985 - 1987 Studied at the School of Dental Technology (SBIE) in Athens / Greece
1997 - 1998 Master school in Berlin
2007 - Education as Maxillofacial prosthetic technician (IASPE)
2010 - Advanced education in Functional diagnosis temporomandibular joint
2011 - 2012 Curriculum implant prosthetics for dental technicians (DGZI)
2013 - 2014 Education as a graphic designer at the Media Design Hochschule (MDH) in Berlin
2015 - 2017 Education as a photographer at the Photocentrum of the Gilberto Bosques VHS Friedrichshain-Kreuzberg
2014 - 2016 - 2018 Further training at Noritake/Kuraray in Japan
2019 - International Instructor Noritake/Kuraray
2019 - Certified trainer of Teeth Morphology carving (Osaka Ceramic Training Center)
1998 - Implant Dental Studio - Athens/Greece
2010 - Zirkler & Moustakis Dental Technology - Falkensee/Germany
2020 - Giuliano Dentaldesign - Falkensee/Germany

Publications in Dental Journals
2014 - 5/2014 Dental Dialogue/Germany
2015 - 10/2015 The International Journal of Dental Technology/Japan
2018 - 1/2018 Cosmetic Dentistry/Germany
2018 - 4/2018 Zahntechnik Zeitung/Germany
2018 - 5/2018 Das Dental Labor/Germany
2018 - 5/2018 Dental Dialogue/Italy
2018 - 10/2018 Laborama/Greece
2019 - 1/2019 LabLine/Hungary
2019 - 3-4/2019 Dental Technologies/UK
2020 - 4/2020 LabLine/Hungary
2021 - 1+2 LabLine/Hungary
2021 - 5/2021 + 12/2021 Quintessenz Zahntechnik/Germany
2021 - 4/2021 QDRP France

Competitions
2013 – 6th place at the 8th KunstZahnWerk contest by Candulor
2017 – 5th place at the 10th KunstZahnWerk contest by Candulor
2017 – 1st place at the 10th KunstZahnWerk contest by Candulor as "Best Documentation“
2020 – 1st place at the 4th Panthera Master Cup by Panthera Dental

Memberships
NGSC Noritake Greek Study Club
DGZI German Society of Dental Implantology
IASPE International Association for Surgical Prosthetics and Epithetics
Key Opinion Leader (KOL) at company MPF Brush Company
Key Opinion Leader (KOL) at company Candulor
Key Opinion Leader (KOL) at company Kuraray/Noritake

MDT ANDREAS CHATZIMPATZAKIS
Greece

Andreas graduated from the Dental Technology Institute (TEI) of Athens in 1999. During his studies he followed a program at the Helsinki Polytechnic Department of Dental Technique, where he trained on implant superstructures and all ceramic prosthetic restorations.

From the year 2000, he is running the ACH Dental Laboratory in Athens, Greece, specialized on refractory veneers, zirconia and long span implant prosthesis.

ACH Dental Laboratory is Co-operating lab with the National and Kapodistrian University of Athens for the MSc degree in Dental Laboratory Materials.

From 2016 he is key opinion leader for the MPF Brush.co.

On 2017 he visits Japan where he trained from Hitoshi Aoshima, Naoto Yuasa and Kazunabu Yamanda and becomes International Trainer for Kuraray – Noritake company.

In 2018 he became Editor-in-chief for the dental technician magazine “LABORAMA” published by OMNIPRESS co.

On 2019 he studies carving, morphology and all ceramic restorations at the Osaka Ceramic Training Center by Shigeo Kataoka.

On 2019 he establishes the Dental Technicians’ Coaching Services and coaches dental technicians to improve their work.

Andreas has also conducted several lectures and hands on seminars in Greece and abroad and published articles in Greek and international magazines.

His lecture “An exciting journey … to be a dental technician” is about inspiring dental technicians to improve their work by observing and emulate natural teeth using the internal live stain technique.

Article first published in Labline Magazine Issue 45, Spring 2022 edition.

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.