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ABSTRACT

During the last two decades we have been experiencing an exceptional evolution in adhesive restorative dentistry. Indeed, innovative materials and techniques have been proposed to achieve long-lasting restorations, which could also guarantee an user-friendly use and reliable clinical results. This is particularly true if one considers the rapid evolution of adhesive systems, composites and resin cements. The correct use of such materials, along with the basic principles to obtain a reliable and long-lasting adhesion to dental substrates (e.g. enamel and dentine) can be considered still not totally clear for many clinicians and other dental practitioners.

Thus, this lecture will aim at presenting the state of the art on adhesion to enamel and dentine through an accurate analysis of our most recent scientific observations and laboratory data. Furthermore, laboratory data obtained during our recent in vitro studies to evaluate the adhesive performance and longevity of a new generation self-adhesive cement (Panavia SA Universal) to a polycrystalline ceramic substrate (Zirconia, HT Katana) and to a vitreous ceramic (lithium disilicate) will be also presented and discussed .

PROFESSOR DR SAURO SALVATORE
(Orcid number: 0000-0002-2527-8776)

Dr Sauro is currently professor in dental biomaterials and minimally invasive dentistry at the “Departamento de Odontología, Facultad de Ciencias de la Salud, Universidad CEU-Cardenal Herrera”, coordinator of the "Dental Research" and Director (Principal Investigator) of the research group "In Situ Dental Tissues Engineering and Minimally Invasive Therapeutic Adhesive Rehabilitation" at the University CEU Cardinal Herrera of Valencia.

He is also honorary senior lecturer, at the Faculty of Dentistry, King's College London Dental Institute (KCLDI), Visiting Professor at the Sechenov University of Moscow, School of Dentistry, Moscow, Russia and honorary Professor at the dental school - University of Hong Kong

He obtained his Ph.D in "Dental Biomaterials Research Pre-clinical Dentistry", and post-doctorate in "Dental Biomaterials/Pre-clinical Dentistry" at King's College London Dental Institute, London.

Dr. Sauro has been working in dental biomaterials, preventive and minimally invasive dentistry research for 15 years (JCR - H-Index: 32) and he has published, in collaboration with internationally renowned researchers, more than 100 articles in international peer-review journals with high impact in the dental and biomaterials field, along with more than 300 abstracts of research in international conferences, as well as two international and one national patents.

Professor Sauro is also part of the "editorial board" several peer-review and vice president of the Dental Material Group “DMG” of the "IADR - International Association of Dental Research".

ZIRCONIA: TEN YEARS AFTER ITS USE

Considered one of the most recent materials in the field of dentistry and despite being a relatively young material, zirconia has taken on an ever-widening space in the last decade and seems destined to play a fundamental role in the future. The success can be traced back to several factors that allowed this material to be considered a viable alternative to dental alloys, through a rapid and evolutionary path and an innovative use of the technologies associated with it. The report will highlight, through the exposure of significant and chronologically exposed clinical cases, the evolutionary process of zirconia and the technologies applied to it ten years after its use.

ABOUT MARCO STOPPACCIOLI

• Specialized in implant prosthesis and digital technologies
• Opinion leader for dental factories
• Currently carries out his professional activity with his team in Dental Team Work

OCCUPATION

• Dental Team Work laboratory owner since 1987
• Dental technician, specialist in implantology

EXPERIENCE

• Collaboration with the Department of Dentistry, University of L’Aquila, for 15 years
• Conference Speaker at national and international conferences
• Regional President of National Association of Dental Technician Owners (ANTLO)
• Teacher of ANTLO Education
• Trainer in theoretical-practical course regarding implantology and new technologies

EDUCATION AND TRAINING COURSES

• Diploma as dental technician in 1984
• Attendance of numerous advanced courses in Implant technologies in Italy and abroad

Adhesive luting of all-ceramic restorations

The adhesive cementation of dental restorations is becoming increasingly important and is changing the treatment methods in restorative dentistry. This webinar shows which methods can be used to durably lute all-ceramic restorations - both silicate ceramics and zirconia ceramics. 

The clinically proven procedure is clearly illustrated using clinical examples such as ceramic Tabletops (onlays without retentive preparation) and single-wing resin bonded fixed dental prothesis in the anterior and posterior region.

Prof. Dr. Matthias Kern 

since 1997: Chairman Department of Prosthodontics at Kiel University 
2012 - 2016: President of the German society for Prosthetic dentistry (DGPro)
2017 - 2018: Vice-President of the IADR Prosthodontic Research Group
2018 - 2019: President of the IADR Prosthodontic Research Group
2020: Awarded the 2020 IADR Distinguished Scientist Award for Research in Prosthodontics and Implants

By Aleksandra Łyżwińska, DMD

This patient required the replacement of an insufficient composite restoration of the mandibular right second premolar. It was planned to restore the tooth using a combination of CLEARFIL MAJESTY™ ES Flow – Super Low A3 and CLEARFIL MAJESTY™ ES-2 Classic A3 with some tints. CLEARFIL™ SE BOND 2 was the adhesive of choice. It produces a reliable chemical adhesion to dentin and enamel as it contains 10-MDP. The best results are obtained after selective enamel etching.

Fig. 1 Initial clinical situation.

Fig. 2 Removal of the existing restoration reveals carious tissue underneath.

Fig. 3 Appearance of the cavity after caries excavation and preparation.

Fig. 4 Dried tooth structure after selective enamel etching with a sectional matrix in place.

Fig. 5 Build-up of the interproximal wall with CLEARFIL MAJESTY™ ES-2 Classic (shade A3) after the use of CLEARFIL™ SE BOND 2.

Fig. 6 Successful transformation of a Class II cavity to Class I.

Fig. 7 Cavity filled with CLEARFIL MAJESTY™ ES Flow (Super Low A3).

Fig. 8 Appearance of the tooth after the application of a final layer of CLEARFIL MAJESTY™ ES-2 Classic (shade A3) and some tints.

Fig. 9 Polished restoration on the mandibular right second premolar.

FINAL SITUATION

Fig. 10 Treatment result ...

Fig. 11 ... after rubber dam removal.

Dentist:

ALEKSANDRA ŁYŻWIŃSKA
Warsaw, Poland

Aleksandra Łyżwińska, DMD, is a passionate aesthetic and adhesive dentist. Driven by Evidence Based Dentistry, her goal includes using modern composite materials and bonding agents in her clinical practise. In addition to her primary job, she worked as a lecturer and an assistant professor at the Department of Conservative Dentistry and Endodontics of Medical University of Warsaw, her alma mater.

By Aleksandra Łyżwińska, DMD

INITIAL SITUATION

Fig. 1 MOD filling with marginal leakage, secondary caries, and significant mechanical weakening.

Fig. 2 Cavity preparation extending over the buccal and palatal cusps.

Fig. 3 Direct restoration created with CLEARFIL MAJESTY™ ES-2 Classic, shade A2, and stains.

Fig. 4 Appearance of the restoration after polishing with CLEARFIL™ TWIST DIA.

FINAL SITUATION

Fig. 5 Repolishing during check-up one week later. The restoration shows an excellent color integration and natural gloss.

Dentist:

ALEKSANDRA ŁYŻWIŃSKA
Warsaw, Poland

Aleksandra Łyżwińska, DMD, is a passionate aesthetic and adhesive dentist. Driven by Evidence Based Dentistry, her goal includes using modern composite materials and bonding agents in her clinical practise. In addition to her primary job, she worked as a lecturer and an assistant professor at the Department of Conservative Dentistry and Endodontics of Medical University of Warsaw, her alma mater.

By D.T. Pier Francesco Golfarelli

Digital workflow and CAD/CAM shaping have now become a daily practice that helps to manage most cases, including the most extensive re-adaptations (rehabilitations).

KATANA™ HTML zirconia was selected, in consultation with the specialist, for the case presented here. It was principally chosen for its aesthetic and mechanical properties. One of our selection criteria was the advantageous lower abrasiveness level of zirconia. Because of its density, this material is less abrasive than the more traditional ceramics in combination with adequate mechanical polishing. Based on the initial situation, once the assembly in the articulator was completed, we designed a structure with anterior cutbacks for maximum aesthetics, while for the posterior teeth a monolithic solution was chosen for maximum strength and quality of the functional surfaces.

With the CORE & SHELL technique developed by the Noritake Italian Study Club, I can now fully exploit the optical properties of KATANA™ zirconia by integrating it, in the anterior area, with Noritake CERABIEN™ ZR ceramics. In the images here you can see the aesthetic results of the anterior and side areas, the mechanically polished monolithic surfaces and the special Noritake glaze.

Fig. 1 CAD Shaping - 3Shape Dental Designer

Fig. 2 Structure design with cutbacks

Fig. 3 KATANA™ HTML structure

Fig. 4 Occlusal surface – details

Fig. 5 Shade stain

Fig. 6 Shade Stain (SS)

Fig. 7 Core

Fig. 8 Internal Live Stain (ILS)

Fig. 9 Shell

Fig. 10 Shell Tissue

FINAL SITUATION

Fig. 11 Layering Details

Dentist:

D.T. Pier Francesco Golfarelli
Noritake Italian Study Club Teacher, Forlì

By Dr Adham Elsayed

This video illustrates the Treatment Concepts for minimal-invasive Composit-Overlay.

Dr. Elsayed uses KATANA AVENCIA, PANAVIA SA Cement Universal, CLEARFIL MAJESTY™ ES Flow, CLEARFIL Universal Bond Quick, K-ETCHANT, KATANA Cleaner and CLEARFIL Twist DIA and shows how to use different flowable composites for techniques like cervical margin relocation and cavity design optimization. Then an overlay was milled from KATANA AVENCIA and luted with PANAVIA SA Cement Universal, after cleaning with KATANA Cleaner.

By Dr Adham Elsayed

This video explains the concept of doing class I restorations in less than 10 minutes.

Dr. Elsayed uses Clearfil Majesty ES Flow, Clearfil Universal Bond Quick and Clearfil Twist Dia and shows one of the advantages of flows over conventional composites. Using stamp technique (optional), fast and easy restorations can be done using Clearfil Universal Bond Quick (no waiting time) and different viscosities of flows. This is very practical for composite restorations in the molar area.

Dentistry is currently experiencing an interesting evolution. While dentists are becoming increasingly specialised, the demand for products that can be used for all indications continues to grow. These systems and materials are part of a universal trend in dentistry—a trend that Kuraray Noritake Dental is extremely well suited to accommodate.

Advancing adhesive dentistry

As the technology has developed, dental adhesives have progressed from no-etching to total-etching and then self-etching systems. In 1978, Kuraray Noritake Dental introduced CLEARFIL™ BOND SYSTEM-F, the world’s first total-etching adhesive system. More than four decades later, the company is still setting standards with CLEARFIL™ Universal Bond Quick, a one-step dental bonding agent that can be used in total-etching, self-etching and selective-etching modes.

Combining Kuraray’s original MDP monomer with hydrophilic amide monomers, CLEARFIL™ Universal Bond Quick is designed to be less technique-sensitive than other one-step solutions and has been proved scientifically to deliver stronger, more stable bonds.

It is not just bonding agents that are becoming universally applicable either. A dental cement like Kuraray Noritake’s PANAVIA™ SA Cement Universal builds upon the success of previous generations of PANAVIA™ to deliver optimal bonding to dental tissue as well as to metal and zirconia materials. This self-adhesive resin cement always requires the same procedure, even when bonding porcelain, lithium disilicate and composites, without the need for a primer. The reason? It’s the addition of a unique long carbon chain silane.

Universal composites and cleaners

The silane technology behind PANAVIA™ SA Cement Universal can also be found in CLEARFIL MAJESTY™ ES Flow, a universal flowable composite suitable for all cavity classes. Its small, durable filler particles help to ensure excellent flexural and mechanical strength, while special cluster fillers provide a light diffusion effect similar to that of natural teeth. Creating aesthetically natural and reliable restorations is easier than ever with CLEARFIL MAJESTY™ ES Flow.

As the latest addition to the CLEARFIL MAJESTY™ ES series, CLEARFIL MAJESTY ES-2 Universal offers a smart and easy-to-use system that will work for the vast majority of your daily cases. Its light-cure, radiopaque restorative material which provides accurate color matching, high polishability and excellent physical properties, makes the product ideal for both anterior and posterior restorations. What makes this Universal series truly special is that the shades cover all shades of the VITA classical A1-D3 shade standard with a limited number of syringes/PLTs depending on the cavity class. If you opt for CLEARFIL MAJESTY™ ES-2 Universal, just a few shades will do the trick.

And when considering Kuraray Noritake’s forays into universal solutions, let us not forget the new KATANA™ Cleaner, a non-abrasive cleaner that, unlike other options on the market, can be used both intra- and extra-orally. Backed by extensive scientific research, the KATANA™ Cleaner comes with a single-handed delivery cap and an extremely straightforward method of application: simply apply with a rubbing motion for at least 10 seconds, rinse with water and air-dry before cementation.

Making dentistry more streamlined

The modern dental practice is often multidisciplinary in its nature, which can result in the need to store many more products than there might be space for. Through these universal products and others, Kuraray Noritake is aiming to make dentistry simpler and more efficient.

This case was conducted by Dr Davide Cortellini, owner of Studio Cortellini in Riccione in Italy, and dental technician Angelo Canale, owner of Canale dental laboratory in Rimini in Italy.

This patient came to the clinic to improve her chewing ability and aesthetic level. The physical examination revealed the presence of several endogenous erosive lesions that made chewing difficult, in addition to partly affecting the esthetics due to decrease in enamel thickness and the presence of dyschromic composite restorations. The possibility of using the new types of both tetragonal and cubic multilayer zirconia made it possible for us to plan the complete covering of all the elements with extremely conservative crowns with thicknesses between 0.5 and 1 mm in the axial and occlusal areas and up to 0.2 mm at the margin.

VERTICAL PREPARATIONS

Very conservative vertical preparations were carried out in the enamel without anesthesia. In the upper arch, the front group was prepared for full-veneer crowns, while the lower front group was treated with conventional lithium disilicate veneers without interproximal separation. In this case too, vertical preparations were carried out without finishing line. The impression was made using a 3Shape TRIOS intraoral scanner. The technician modeled the zirconia restorations that were then completed by the ceramist.

Knife Edge Preparation

SCANNING SEQUENCE

Digital DV models of temporary teeth

The three different materials were selected on the basis of the specific positions inside the mouth:

• UTML for the anterior teeth
• STML for the premolars
• HTML for the molars

The final result shows excellent integration between the 3 different types of zirconia and a good natural feeling.

MINIMAL PREP KATANA™ (KATANA™ MICRO LAYER)

HARMONIC OPTICAL INTEGRATION

The full-mouth rehabilitation procedure using three different types of zirconia led to a functional and beautiful treatment outcome. The optical integration between the materials is excellent and the high translucency especially in the anterior region creates a true-to-life appearance.

APPROACH WITH MINIMAL INVASIVE PREPARATIONS - REPORT ON THE SELECTION OF MULTI-LAYERED ZIRCONIA

Dental zirconia is no longer just the opaque framework material introduced two decades ago. Nowadays, it offers the high strength needed for long-span bridges, dentin-like translucency and strength perfect for thin-walled posterior crowns, or enamel-like optical properties for beautiful anterior restorations - depending on its composition and structure. Kuraray Noritake offers three types of dental zirconia - three with a multilayered structure created using patented powder coloring technology. They differ with regard to their optical and mechanical properties, which makes it possible to choose an ideal material for every clinical situation.

Dentists:

DR. DAVIDE CORTELLINI

Dr. Cortellini graduated with honours in Dentistry and Dental Prosthetics from the University of Siena in 1992. He won the scholarship of the Italian Society of Periodontology for the year 1994-95. He then received the opportunity to attend the Department of Periodontology and Fixed Prosthetics of Prof. NP. Lang at the University of Bern in Switzerland, carrying out clinical and research activities. He obtained the title of „Doctor Medicinae Dentium“ (D.M.D.) at the same university in 2000. Dr. Cortellini is the author of scientific publications in international journals of aesthetic dentistry. He is an active member and advisor to the Italian Academy of Prosthetic Dentistry, and a member of the International Academy for Digital Dental Medicine. He holds conferences in Italy and abroad and is dedicated to clinical activity in his own practice in Riccione, where he primarily focuses on aesthetic and digital prosthetics and complex prosthetic rehabilitation.

CDT. ANGELO CANALE

Mr. Canale is a dental technician graduated high school in 1981. He’s the owner of a dental laboratory in Rimini since 1986. He is specialized in fixed prosthesis on natural teeth and on implants with a metal free approach using different kind of materials. He is always interested about digital technique using CAD-CAM systems (in his laboratory the 80% of the work comes from digital impressions). He is co-author of international publications on PPAD, QDT, EJED and THE JOURNAL OF ADHESIVE DENTISTRY concerning the use of metal free in prosthesis. He is a speaker in national and international congress.