Though one is a master dental technician and the other a dentist, Daniele Rondoni and Dr Nicola Scotti share a passion for discovering new materials and technologies to better provide aesthetic, durable restorations for patients. Here, they discuss their dental journeys and how they have integrated Kuraray Noritake Dental’s KATANA™ Zirconia range into their workflows.

How did you get started in dentistry, and what was it about dentistry that first interested you?
Dr Nicola Scotti: Well, my professional interest goes back 15 or 20 years at this point, but I was first introduced to dentistry as a child through my father, who was a dentist himself. I grew up looking at teeth, looking at models, and it was something that was just in my blood. When I had to decide what to study, I followed my heart and decided to become a dentist, and ever since I have remained dedicated to learning new things about it.

Daniele Rondoni: I have a similar story to Nicola. My uncle was a dental technician and that influenced my decision to become a dental technician and open up my own dental laboratory. Though there were many things that interested me, I have always focused on the major possibility that this profession offers, the opportunity not only to use your hands but also to combine this skill with the newest dental technologies available.

Regarding this combination of manual and digital skills, do you still see a role for the dental professional as a craftsperson in this increasingly digital industry?
Scotti: Dentistry, even if the digital influence continues to grow, will surely continue to be a profession defined by what we can do with our hands. You cannot complete a restoration, for example, without having these manual skills. There is also the matter of personalisation. Though machines can create flawless dental restorations in great numbers, it is the artistry of the dental technician that allows our patients to have customised solutions made with the materials and the shapes that suit them best. If you want to provide natural-looking restorations for your patients, digital dentistry is a great tool to use, but you need to have manual skills and a passion for the work as well.

Rondoni: As a dental technician, it is important to remember that my work depends on technology, and so in this way, digital dentistry and the new-generation dental materials have helped my work greatly. Using this technology for individual situations is an essential part of my role, and excellent materials like Kuraray Noritake Dental’s KATANA™ Zirconia range make my artistic vision regarding these situations more easily achievable.

Scotti: In my opinion, even if 90 per cent of the workflow is digital in nature, you need that artistic input and vision for the remaining 10 per cent in order to really create a successful restoration. With KATANA™ Zirconia, these two aspects come together and allow you to create something really amazing.

Speaking of the KATANA™ Zirconia range from Kuraray Noritake Dental, is this material a part of your everyday workflow at this point? What do you see as its benefits?
Rondoni: It is definitely a part of my everyday workflow. I have worked with Noritake materials for many years, but when Kuraray released its newest generation of zirconia, it totally changed my approach in the dental laboratory. Over the last five years, KATANA™ Zirconia has greatly influenced my workflow; it allows me to use certain technologies without forgoing artistic needs, and since it’s available in different translucencies and shades and so on, I can create aesthetic restorations for individual cases with ease.

Scotti: In the past, I didn’t regard zirconia as a material for dentists. We used to take the impression and then ask the dental technician to use zirconia to make a restoration, but we didn’t use the material ourselves. What the KATANA™ Zirconia Block for chairside has introduced is a totally new concept of how zirconia can be used by dentists themselves. Having a material that can create monolithic full-contour restorations, even single crowns, is incredible. Its aesthetic qualities are fantastic as well, as Daniele mentioned, and it gives us a truly new option for treating patients.

Earlier this year, Kuraray Noritake Dental invited dental professionals from all over Europe to a symposium in Berlin that highlighted the newest research and clinical findings with the KATANA™ Zirconia Block, the latest addition to the KATANA™ family. Among those to present was Dr Nicola Scotti, an assistant professor at the Department of Cariology and Operative Dentistry at the University of Turin’s Dental School and operator of his own private practice.

Dr Scotti began working with Kuraray Noritake Dental’s range of products in 2012, having been asked to test the CLEARFIL MAJESTY™ ES-2 composite resin before its launch, and soon afterwards began what he terms a “close collaboration” with the company. “I consider Kuraray Noritake Dental to be a very serious company, one built on strong scientific foundations and with a great interest in innovation and consulting with opinion leaders,” he added.

When Dr Scotti was presented with the opportunity to use the KATANA™ Zirconia Block in April 2018, it required a significant learning curve as he had never used zirconia for restorations before. “I am not a dental technician, and when I received the Block for the first time, I realised that I would have to add some skills to be able to work the material in the best possible way,” he said. With the assistance of master dental technician Daniele Rondoni—facilitated by Kuraray Noritake Dental—Dr Scotti was able to learn how to process and characterise zirconia, as well as understand the optical behaviour of KATANA™. “I must say that the material, overall, is easy to use and provides amazing aesthetic results,” he added.

As part of his presentation, Dr Scotti showed several case studies that had been conducted with KATANA™ Zirconia Block. One of these focused on a 24-year-old male patient referred to him with a discoloured upper incisor resulting from blunt trauma. “The patient had a fairly immediate aesthetic need, but in this case I was unable to perform external whitening to lessen the discolouration,” explained Dr Scotti. “However, I was able to solve the case by creating an adhesive crown made from a KATANA™ Zirconia Block. Though the cervical area still showed a slight colour difference to the neighbouring teeth, it was not visible in the patient’s smile and he was extremely happy with the result,” Dr Scotti continued.

Overall, Kuraray Noritake Dental’s KATANA™ Zirconia Block is a great step forward for zirconia restorations, according to Dr Scotti. “Ten years ago, no one would have imagined being able to make a central incisor restoration out of zirconia,” he said. “Thanks to the multi-layered technology behind the natural aesthetics of this block, today this is no longer a dream.”

As the operator of his own dental practice in the German town of Laer and a member of the Digital Dental Academy in Berlin, Dr Hendrik Zellerhoff is clearly a very busy man. Fortunately, his integration of Kuraray Noritake Dental’s KATANA Zirconia Block into his daily workflow means that he is able to deliver high-quality restorations to his patients faster than ever. In this interview, Dr Zellerhoff explains how he uses the block and how his patients have responded to it.

Dr Zellerhoff, can you tell us a little bit about your background as a dentist?
In 2003, I began working as an assistant and at this time I worked with the CEREC system, a system for which I am now a certified trainer. In 2005, I opened my own dental practice in Laer, which I continue to operate to this day.

When did you first begin to work with Kuraray Noritake Dental’s range of products?
I think it was about four or five years ago that the laboratory that I worked with told me how good Kuraray Noritake’s KATANA Zirconia discs were for sintering and fabricating full-zirconia crowns. At that point, however, I was only looking for materials that would work with CEREC, and so it wasn’t until early 2018, when I went on a course in Leipzig in Germany where the KATANA Zirconia Block was being demonstrated, that I really saw how I could use this product in my practice. The block’s integration with the CEREC system means that it is now possible for me to provide high-strength aesthetic zirconia restorations for my patients accurately and quickly.

How frequently do you use the KATANA Zirconia Block during your daily work as a dentist?
I think around once a day, on average. It varies—sometimes I may make restorations for three different patients on one day, and then it’s four days until I use it again. My CEREC is only able to conduct wet milling, however, which is obviously slower than the 15-minute time span made possible through dry milling, and this limits how often I can use it.

What do you like most about this zirconia solution?
For me, it both feels and looks very real, so it has this aesthetic function going for it. Its multilayered, highly translucent appearance definitely helps to achieve more natural-looking restorations. However, the mechanical strength of the material is also something that I like, as it means that it can be used for restorations with thinner walls and sharper margins than those made with glass-ceramics.

With the release of the KATANA Zirconia Bridge Block, do you expect to use this zirconia solution more?
Oh, absolutely! The ability to make aesthetic bridges in the molar area and in a single visit is a revelation to me.

What has the response from your patients been?
They love it! These procedures can be realised on the same day as their initial appointment, and this means that my practice has patients coming from far outside of the small town in which I live. We even get people coming all the way from Switzerland to receive KATANA-based treatments—that’s how positive the response has been.

With this focus on digital dentistry, is there still a role for the dentist as a craftsperson?
I love to work with an entirely digital workflow. If a machine can do something better or faster than I am able to, then that is all right with me. As far as I can see, the future of dentistry will be digital. At the end of the day, the goal stays the same—to provide my patients with results that they are happy with.

With over 30 years of experience as a dentist and researcher, Dr Paolo Baldissara of the University of Bologna in Italy could be forgiven for slowing down a bit. This is far from happening, however, as he continues to be at the forefront of ceramic restoration material developments and their integration into CAD/CAM workflows.

When presenting at a symposium held in Berlin in Germany by Kuraray Europe earlier this year, Dr Baldissara highlighted how the company’s patented multilayered zirconia technology allows the KATANA™ Zirconia Block to effectively mimic the shade gradation of natural teeth. He commenced his presentation by outlining the general shift towards metal-free restorations, which in his opinion has been driven by a number of factors, the high value now placed on aesthetics in dentistry chief among them.

“I began using zirconia back in 2005 for prosthodontics in my department at Bologna, and it has greatly improved in quality since then,” said Dr Baldissara. “Generally speaking, the shift towards zirconia only started when a high-strength substitute for metal that was able to be processed with CAD/CAM systems with high accuracy became available.”

It was at the 2015 International Dental Show in Cologne in Germany where Dr Baldissara was first introduced to KATANA™ Zirconia UTML and STML, both of which impressed him with their high levels of translucency. “I started to use them almost immediately, mainly in their monolithic form, for research and in clinical practice,” he said. “My opinion of them was very high, as they allowed me to make cost-effective single crowns and multi-unit restorations with excellent aesthetic properties with scattered and diffused light. This is, ultimately, what patients want.”

Dr Baldissara began using the KATANA™ Zirconia Block in 2018 and expressed his excitement with how its high-speed sintering allows for fast processing of restorations. He recommended dry milling for a number of reasons: not only does it allow for the translucency of the zirconia to be maintained, it also helps to avoid contamination from other ceramic powders that may persist in the milling unit. In addition, he encouraged attendees to frequently replace the burs of their milling units for optimal results and reduced risk of chipping.

“Dry milling and high-speed sintering of the KATANA™ Zirconia Block is an extremely promising technology,” said Dr Baldissara. “In my opinion, it is the correct way to make aesthetic and mechanically strong restorations for the patient.”

Steve Meeze definitely has it: a passion for dentistry. Yet, there was a time when he was unhappy in his job as a dental practitioner. Fundamental changes were necessary to lay the foundations for finding personal fulfillment in his work. We spoke to him about his motivation to do things differently and about the path he has chosen and is following down to the present day.

Many students of dentistry would like to run their own dental office one day. For you, this dream came true, but you ultimately decided to take a different path. Why did this change seem necessary?

After graduation in 1983, running my own dental office seemed to be a great plan: I wanted to be independent, grow my patient base, and become successful, which went very smoothly in the beginning. This economic success, however, did not protect me against starting to feel unhappy and burned-out after several years. Once I began to take my negative emotions seriously and to search for the underlying causes, I realized that is was not merely the workload that troubled me. The truth was that I was missing a sense of purpose in many of my daily tasks. This seemed to be the reason for my lack of energy and motivation to proceed with what I had started. Luckily, I was able to find my personal “why” after some time.

Where did you find your own fulfillment or sense of purpose?

I ultimately found it in the field of conservative dentistry. The reason is that direct restorative treatments with composite allow me to do amazing things in a non-invasive or minimally invasive way. Doing no harm and always being able to go back simply feels good, and my patients are incredibly grateful for what I do. Their gratitude is my reward. This is why I decided to dedicate myself exclusively to treating patients with composite.

How do you do this?

In 2009, I sold my own dental office and started working in different practices in Flanders. In this process, I established some highly valuable partnerships with colleagues, who appreciate my skills and refer their patients to me mainly in the course of interdisciplinary treatment. These orthodontists or surgeons need someone who puts the finishing touches to their work. And this is exactly what I do: I create a beautiful smile at the end of an often complex treatment. Other patients approach me on their own accord with fractured or misshaped teeth and the desire for esthetic improvement. In any case, I listen to them carefully before I start planning. Knowing what is on their minds, I can treat them with confidence. The most precious moment for me is when I hand over the mirror and let them evaluate my work. Their positive reaction, the glint in their eyes is what motivates me every day.

Is there a specific technique you use in your daily work?

Yes, I use the Light Facing Concept I developed to solve esthetic issues in the anterior region. This technique focuses of creating a harmony without the need to sacrifice large amounts of healthy tooth structure. With this concept, a fractured anterior tooth, for example, is restored in three steps: Initially, a single dentin shade of composite of the same color as the fractured tooth is used to create the desired tooth shape and make the fracture line disappear. In this step, shade selection is independent of the final color I would like to reach. Subsequently, I correct the color with an opaque material and try to match the shade of the adjacent teeth as exactly as possible. If necessary, I create mamelons and other individual characteristics in this layer. The final step is carried out on all anterior teeth whenever the appearance of the treated tooth differs from the others: A light facing – i.e. a very thin layer of more or less translucent composite – is added to mask the differences. In cases with minimal shade differences, a composite with a high translucency is used, while a more opaque material is preferable whenever the differences are more apparent.

What is your preferred material for the Light Facing Concept?

My personal experience shows that the best results are obtained with CLEARFIL MAJESTY ES-2 Premium composite from Kuraray Noritake. It simply offers the best mimetic (chameleon) effect of all composite materials I have tested so far, and I have tested many of them. The material tends to blend in with the surrounding tooth structure, and only four shade combinations are usually sufficient to cover the whole range of my patients’ tooth shades. I love this virtually magical effect!

What is your personal conclusion?

When I made the decision to start doing what really makes me happy, I could not be sure that I had chosen the right path. Retrospectively, I know that giving up my present career and taking steps towards personal fulfillment has been exactly the right thing to do. I love the fact that I can satisfy my patients’ desires without sacrificing healthy tissue, and my Light Facing Concept implemented with MAJESTY ES-2 make it easy for me to obtain the results they have been dreaming of.

CASE EXAMPLES

Fig. 1 : Case example: Color change with composite – initial clinical situation.

Fig. 2.: Case example: Color change with composite – treatment outcome.

Fig. 3: Case example: Shape correction with composite – initial clinical situation.

Fig. 4:  Case example: Shape correction with composite – immediate treatment outcome.

Combining ease of use and excellent viscosity, CLEARFIL™ CERAMIC PRIMER PLUS is a stable and universal prosthetic primer designed for all restorations. By incorporating Kuraray Noritake Dental’s original MDP monomer and a silane monomer, it is able to provide an enhanced adhesive surface for ceramics, hybrid ceramics, composites and even metals. CLEARFIL™ CERAMIC PRIMER PLUS is best used in conjunction with the adhesive resin cement PANAVIA™ V5 to ensure durable restorations.

The key to CLEARFIL™ CERAMIC PRIMER PLUS’s performance is in the monomers it possesses. The MDP monomer strongly bonds to metals and zirconia, while the silane coupling agent MPS efficiently adheres to composites and all silica-based ceramics. “What makes CLEARFIL™ CERAMIC PRIMER PLUS different to other primers is its stability,” says Peter Schouten, Technical Manager at Kuraray Noritake Benelux. “Normally, activated silanes are very unstable. However, the well-balanced formula of CLEARFIL™ CERAMIC PRIMER PLUS provides it with a shelf life of three years after production, making it easy and predictable to use.”

Procedural simplicity

Every element of CLEARFIL™ CERAMIC PRIMER PLUS is designed to deliver maximal procedural simplicity. It is packaged in an easy-to-squeeze bottle that dispenses the solution easily and accurately. Whereas other similar products need to be left in place for one minute or more, this primer is immediately effective upon application. “CLEARFIL™ CERAMIC PRIMER PLUS benefits the dentists by offering a reliable primer for all materials, without being difficult to apply or use,” says Schouten. “From titanium to zirconia, from lithium disilicate to composite—simply apply and dry, and you're done.”

PANAVIA™ V5

A resin cement with unrivalled procedural simplicity and predictability, PANAVIA™ V5 is the latest addition to Kuraray Noritake Dental’s PANAVIA family. It sets a new standard for adhesion, allowing for self-cure dentine bond strengths equal to our gold-standard light-cure bonding agent, CLEARFIL SE BOND. PANAVIA™ V5 offers natural aesthetic stability in shading through its amine-free paste, which is available in five shades and has been scientifically proven to demonstrate a lower level of post-curing colour variance than amine-based cements.

CLEARFIL™ CERAMIC PRIMER PLUS and PANAVIA™ V5

Providing strong bonding to not just hydroxyapatite, but to metals and zirconia as well, PANAVIA™ V5 is designed for use in conjunction with CLEARFIL™ CERAMIC PRIMER PLUS. The cementation procedure is efficient and effective: use PANAVIA V5 Tooth Primer for the pretreatment of the tooth, CLEARFIL™ CERAMIC PRIMER PLUS for the priming of the restoration, and PANAVIA™ V5 for the cementation.

In February 2019, Kuraray Noritake Dental Inc. (President: Kiyoyuki Arikawa), with its Head Office in Chiyoda-ku...

In 1983, Kuraray introduced the patented MDP monomer in its PANAVIA™ EX cement. 35 years later, MDP monomer-based resin cements have been scientifically proven to provide the most favourable bond values when cementing zirconia. With the recent introduction of the all-ceramic KATANA™ Zirconia Block, cementation is still best achieved with the PANAVIA and CLEARFIL families of products.

Cementation to zirconia

The KATANA™ Zirconia Block possesses a tooth-like translucency and impressive flexural strength, making it a preferable option to lithium silicate glass. For strong and reliable bonding to the existing tooth structure, it is best to use PANAVIA™ V5 Tooth Primer for the pretreatment of the tooth and CLEARFIL™ CERAMIC PRIMER PLUS for the priming of the restoration. Since both of these utilise MDP monomer technology, you can be assured of easy adhesion with the PANAVIA™ V5 system.

Kuraray Noritake offers full-adhesive cementation with PANAVIA™ V5 and self-adhesive cementation with PANAVIA™ SA Cement Plus. Both products are designed for durable cementation of zirconia-based restorations with unparalleled procedural simplicity and predictability. PANAVIA™ SA Cement Plus also incorporates a high concentration of MDP monomer to offer increased chemical reactiveness and adhesion with zirconia.

A dentist’s perspective

Dr Alexandre Pereira Monteiro is a dentist who runs his own implant surgery practice in Cessy in France. Dr Pereira’s interests, though varied, lie primarily in aesthetic and CAD/CAM dentistry, and he has used the KATANA™ Zirconia Block since 2018. “I think these new ranges of zirconia have many advantages,” he says. “They combine aesthetic properties with translucency parameters similar to those of lithium disilicate glasses with a much higher resistance to bending and abrasion.”

For cementing restorations made with the block, Dr Pereira likes to use PANAVIA™ V5. “As a user of many adhesive systems, I know PANAVIA™ V5 very well,” he says.

“PANAVIA™ V5 has the benefit of being a system that is very polyvalent in its indications while also being very tolerant. It offers a simple, unique and easily reproducible protocol that will satisfy the majority of practitioners. Special mention must be made of the opaque version, as it is very effective for hiding a metal structure or a strongly dyschromatic tooth.”

From 12.03.-16.03.2019 IDS opens its doors again.

FLYER: BE INSPIRED ... BY OUR HANDS-ON LIVE DEMONSTRATIONS (PDF)

FLYER: BE INSPIRED ... BY OUR SPECIAL LECTURE (PDF)

Kuraray Noritake Dental, the global provider of innovative technologies in dentistry presents innovative products and interesting news, as well as classics such as PANAVIA ™ or KATANA ™ Zirconia ML.

There is brand new information in the CEREC® range. We are very pleased to announce our new, innovative KATANA ™ Zirconia Bridge Block. This MULTI-LAYERED Zirconia Block was specially designed for creating full contour restorations in the dental office. Our new KATANA ™ Zirconia Block can be used with the Dentsply Sirona CEREC system.

But also in the field of cements there is news. Introducing the new self-adhesive Universal composite PANAVIA ™ SA Cement Universal, which makes priming unnecessary. PANAVIA ™ SA Cement Universal, simple and versatile.

BE INSPIRED ... BY OUR HANDS-ON LIVE DEMONSTRATIONS

For all dental technicians, there is also exciting information from Kuraray Noritake Dental, the inventor of MULTI-LAYERED Zirconia Disks. Further developments in the field of zirconia or ceramics are presented.

A special highlight is our hands-on demonstrations on our stand with international renowned dental technicians such as Nondas Vlachopoulus (GRC), Daniele Rondoni (IT), Naoto Yuasa (JPN) or Alek Aronin (CAN).

BE INSPIRED ... BY OUR SPECIAL LECTURE

Darin O’Bryan D.D.S.

Dr. Darin O‘Bryan is faculty with CERECdoctors.com at the Scottsdale Center for Dentistry. He is also a basic and advanced trainer for Patterson, a Beta tester for Sirona and product tester for dental manufacturers. He is an internationally published author on digital and CAD/CAM dentistry and has mentored hundreds of dentists on how to integrate technology into their office.

In this presentation you will find out about the newest high strength esthetic material available for chair side milling, the KATANA Zirconia Block STML. Find out what features set this material apart from all other current materials available for same day restorations. Learn what cases KATANA is ideal for and the best bonding/cementation protocols to use to get maximum strength and longevity. You will also learn about the latest advances with the KATANA STML material, including the upcoming bridge block and faster firing cycle for chair side restorations.

BE INSPIRED .. BY OUR LIVE TALK

The highlight of the program will be our live talk at the booth in hall 11.3 D010, on Friday 15.03.2019 from 13-14 pm.

During this afternoon session the exclusive team of experts, Nondas Vlachopoulus (GR), Daniele Rondoni (IT), Naoto Yuasa (JPN) or Alek Aronin (K), will give you a roundtable discussion on modern and aesthetic dental technology and all your questions will be addressed!

Also for more in depth questions and suggestions related to our portfolio our Product specialists are at your service at the IDS!

Hall 11.3 / Booth D010 / D020 / D030

We look forward seeing you there!

Further information: +49 (0) 69 305 35835 or dental.de@kuraray.com