Case by Dumitru Leahu

INTRODUCTION

Complex anterior rehabilitations require careful control of shape, colour and optical properties. In this implant-supported restoration, a KATANA™ Zirconia YML framework was combined with CERABIEN™ ZR and CERABIEN™ MiLai (all Kuraray Noritake Dental Inc.) to achieve the desired aesthetic outcome.

FRAMEWORK DESIGN

A 1mm vestibular cut-back and a free zirconia incisal third were incorporated into the framework design to provide sufficient space for the ceramic layers. KATANA Zirconia YML was used for the implant-supported restoration (Fig. 1). The sintering temperature was 1,550 °C.

Fig. 1. Framework design with a 1mm vestibular cut-back and a free zirconia incisal third.

MATERIAL:

KATANA Zirconia YML

CERABIEN ZR BASE BUILD-UP

The first ceramic firing with high-fusing CERABIEN ZR porcelain was used to create well-defined and stable concavities with sufficient value and brightness (Fig. 2). The materials used were 0.5 NW Body, Enamel 1, LTx, Tissue 3 and Tissue 4. The firing temperature was 940 °C.

Fig. 2. Base build-up with CERABIEN ZR using 0.5 NW Body, Enamel 1, LTx, Tissue 3 and Tissue 4.

MATERIAL:

CERABIEN ZR

INTERNAL CHARACTERISATION

Internal characterisation was performed with CERABIEN MiLai internal stains (Fig. 3). Cervical 2 + Bright (mixed in a ratio of 40/60), White + (A+) + Bright (50/10/40), and Tissue Red + Bright (60/40) were applied as indicated. The firing temperature was 700 °C. The internal stains were used to reproduce the internal anatomy and characterisation of the restoration and to support the colour match with the natural teeth (Figs. 4 to 6).

Fig. 3. Internal characterisation with CERABIEN MiLai internal stains.

Fig. 4. Detail of the incisal characterisation. (left)

Fig. 5. Detail of the cervical characterisation. (right)

Fig. 6. Intraoral reference for matching the restoration to the natural teeth.

FINAL BUILD-UP WITH CERABIEN MILAI

The bridge was finished with low-temperature CERABIEN MiLai porcelain. LT1, LTx and ELT₁ were used for the final build-up (Fig. 7). The firing temperature was 780 °C. Tissue 1 was subsequently applied to create the final gingival shape (Fig. 8). This time, the firing temperature was 740 °C. Figures 9, 10 and 11 show the finished restoration extraorally, at intraoral try-in and after definitive placement on the implants.

Fig. 7. Final ceramic build-up with LT₁, LTx and ELT₁.

Fig. 8. Gingival build-up with Tissue 1.

Fig. 9. Finished implant-supported bridge.

Fig. 10. Final restoration at try-in.

Fig. 11. Final intraoral result.

CONCLUSION

The presented hybrid approach combines the advantages of high- and low-fusing porcelains for the aesthetic individualisation of anterior zirconia restorations. The high-fusing CERABIEN ZR porcelain can be used to establish the basic morphology and optical foundation before proceeding with lower-temperature characterisation and final layering. As the previously fired CERABIEN ZR layers remain stable during the subsequent CERABIEN MiLai firings, the restoration can be further individualised while maintaining the structures already established.

UNCOMPROMISED.
UNMATCHED.
YOURS.

By Jade Sidou Trabuc, CDT

Lifelike results: restoration of a micro-layered lateral incisor using CERABIEN™ MiLai ceramic. Internal characterization and minimal layering were performed to reproduce a natural shape, harmonious translucency, and realistic surface texture. Powders used: CCV2 and LTx, internal staining for effects, and surface stains to reproduce details and harmonize the smile.

7 MISTAKES TO AVOID TO ACHIEVE A NATURAL RESULT

Aesthetic failures in ceramic restorations are almost never the fault of the material itself. In ten years of laboratory practice, I have rarely seen a restoration fail because of the zirconia or the ceramic material. What I observe instead is a series of recurring mistakes – often invisible during the fabrication process – that ultimately compromise the final result under natural lighting conditions or during intraoral evaluation.

KATANA™ Zirconia YML and CERABIEN™ MiLai (Kuraray Noritake Dental Inc.) are materials with remarkable optical properties. Their interaction with light closely resembles that of natural dentition, provided that the entire fabrication process is carried out consistently. The quality of a restoration is not determined by the number of effects applied; rather, it depends on understanding the principles that govern the perception of shade, translucency and surface texture.

Born from my daily experience in the laboratory, this article presents the seven most common mistakes I have observed – both in my own work and among fellow technicians – when fabricating micro-layered restorations. For each of them, I explain why it occurs, what its optical consequences are, and which practical solution can be implemented immediately.

• Mistake n°1: Choosing the wrong translucency from the start
• Mistake n°2: Copying a photograph instead of understanding the natural tooth
• Mistake n°3: Neglecting the impact of clinical preparation
• Mistake n°4: Trying to correct shade with ceramic alone
• Mistake n°5: Creating excessive contrast between ceramic effects
• Mistake n°6: Underestimating the importance of polishing and surface finish
• Mistake n°7: Evaluating your work under a single light source

FRAMEWORK, OPTICAL INTERPRETATION AND CLINICAL PREPARATION

Mistake n°1 – Choosing the wrong translucency from the start

Why it happens: The selection of KATANA Zirconia YML is often driven by habit or used as a default choice because of its outstanding versatility in terms of mechanical strength, without considering the actual clinical situation – namely, the colour of the underlying substrate (light or dark abutment, cast post-and-core/inlay core). The translucency/opacity level of KATANA Zirconia (UTML, STML or HTML PLUS) should be selected according to the shade of the prepared abutment, the available reduction thickness and the brightness of the adjacent teeth.

Consequences: A framework that is too translucent over a dark abutment will create a deep greyish effect that cannot subsequently be corrected with ceramic layering. Conversely, an excessively opaque framework blocks the transmission of light, resulting in a dull, chalky and lifeless appearance.

Solution: Always assess the shade of the prepared abutment before ordering the disc. Use the KATANA Zirconia YML selection guides, which correlate abutment value, available reduction thickness and the target shade. When working with lithium disilicate over C3 or D4 abutments, favour ML or HT blocks to preserve brightness without allowing the underlying darkness to influence the final surface appearance.

Mistake n°2 – Copying a photograph instead of understanding the natural tooth

Why it happens: The temptation to reproduce exactly the shade photograph provided by the clinician is strong. However, a photograph is an interpretation of light, not light itself. It flattens volumes, exaggerates certain reflections and eliminates subtle transitions.

Consequences: Effects are reproduced without understanding their origin. An incisal halo visible in a photograph may simply be an optical illusion created by the angle of the flash. Attempting to replicate it in ceramic may result in an artificial and static appearance.

Solution: Learn to read a tooth rather than copy it. Analyse the distribution of the developmental lobes, the direction of light in the photograph, and distinguish genuine areas of translucency from simple reflections. With CERABIEN MiLai, we work by considering how light circulates within the restoration, rather than focusing solely on its surface appearance.

Mistake n°3 – Neglecting the impact of clinical preparation

Why it happens: The dental technician works from the impression or digital model provided by the clinician. It is not always possible to reject an under-reduced or irregular preparation, particularly when working under tight deadlines.

Consequences: Insufficient tooth reduction forces the technician to fabricate a framework that is too thin, leaving inadequate space for CERABIEN MiLai ceramic layering. A discoloured preparation, or a nonopaque post-and-core restoration, compromises the entire optical chain: even the finest ceramic cannot compensate for an opaque, greyish underlying substrate.

Solution: Establish a systematic communication protocol with the clinician, including a space assessment form (facial, occlusal and interproximal clearance), photographs of the abutment shade taken under natural light and, whenever possible, under polarized lighting. Never hesitate to request preparation modifications in writing. A well-documented fabrication report protects the dental technician and contributes to a better clinical outcome.

CERAMIC CANNOT COMPENSATE FOR EVERYTHING

Mistake n°4 – Trying to correct shade with ceramic alone

This is one of the most common – and most time-consuming – mistakes. It stems from a misconception: that layering ceramic is a universal shade-correction tool. In reality, the final colour of a micro-layered restoration is the result of an equation with four variables – framework, abutment, cement shade and ceramic – and modifying one without taking the others into account is bound to fail.

In practical terms: if the selected KATANA Zirconia YML framework is too light for a C4 abutment, applying a more saturated CERABIEN MiLai ceramic on the surface will produce a restoration with two different appearances – too warm in reflected light and too grey in transmitted light. Light reflection and light transmission do not behave in the same way, and the human eye perceives both simultaneously.

Practical solution: Establish the complete optical chain before you begin. Know the shade of the cement planned by the clinician (or ask for this information specifically), evaluate the framework under transmitted light before layering, and build the restoration with the overall value in mind rather than focusing solely on the surface shade.

POLISHING, SURFACE TEXTURE, AND LIGHT MANAGEMENT

Mistake n°6 – Underestimating the importance of polishing and surface finish

The surface condition of a ceramic restoration is one of the most critical factors influencing its final optical appearance – and one of the most frequently overlooked. Surface texture acts as an interface between incident light and the observer.

An excessively smooth surface reflects light specularly, creating bright highlights that may reveal subtle shade imperfections. Conversely, an overly rough surface scatters light in an uncontrolled manner, lowering the perceived value and accentuating chromatic irregularities. With CERABIEN MiLai ceramics, glazing plays a particular role: it homogenizes the micro-textures generated during the layering process and contributes to the perception of depth. A glaze layer that is either too thick or too thin alters the hierarchy of the visual layers. When properly mastered, post-firing manual polishing can even surpass glazing in terms of naturalness, as it enables the reproduction of differentiated anatomical textures – smoother in the cervical area and more textured in the incisal region.

Practical solution: Sequence the polishing procedure according to the different anatomical areas. Use silicone polishers with progressively finer grit sizes while maintaining light, constant pressure. For monolithic restorations fabricated from KATANA Zirconia YML, complete the polishing protocol with a 1-μm diamond paste to achieve a surface smoothness comparable to that of natural enamel. When working with CERABIEN MiLai layered restorations, create the surface texture before glazing using a fine rotary instrument, and verify the surface condition prior to the final firing cycle.

Mistake n°7 – Evaluating your work under a single light source

Dental laboratories are often equipped with cool white fluorescent lighting – practical for daily work, but misleading when evaluating a restoration. Cool light tends to overestimate value (brightness), suppress red and yellow hues, and diminish the perception of translucency. A restoration that appears ideal under these conditions may look gray or dull in natural daylight, and excessively warm under the incandescent lighting commonly found in residential environments.

This phenomenon, known as metamerism, is particularly critical with highly fluorescent ceramics such as CERABIEN MiLai. Fluorescent pigments respond differently depending on the spectral composition of the light source: a highly fluorescent restoration may appear exceptionally vibrant under UV-rich natural light or ultraviolet illumination, yet much more ordinary under filtered artificial lighting.

Ignoring this optical behavior can lead to restorations whose appearance changes unexpectedly once placed intraorally.

Practical solution: Implement a three-light evaluation protocol consisting of natural daylight (diffused northern light), warm artificial light (3000 K), and neutral fluorescent or LED lighting (4000 K).

Under each lighting condition, assess the restoration first in isolation and then in context, positioned on the model and adjacent to the neighboring teeth.

The variations in optical behavior observed under these different light sources will reveal more about the quality and integration of the restoration than any other evaluation method.

This three-light evaluation protocol makes it possible to detect metamerism before delivery, anticipate the restoration‘s behavior under the various lighting conditions encountered by the patient, and validate the fluorescence of the ceramic under different spectral conditions.

CONCLUSION: OPTICAL MASTERY BEFORE OPTICAL EFFECTS

After years of working with KATANA Zirconia YML and CERABIEN MiLai, one conviction remains unchanged: it is not the materials that limit the outcome, but our understanding of how to use them. These seven mistakes are not professional failures – they are logical pitfalls that every dental technician encounters on the path to excellence. Identifying, naming, and understanding them is already half the journey.

What distinguishes an average restoration from an exceptional one is rarely the complexity of its layering. More often, it is the consistency of the decisions behind it: selecting the appropriate zirconia translucency and opacity according to the clinical situation; accurately interpreting the optical characteristics of the natural dentition; maintaining an effective dialogue with the clinician regarding tooth preparation and cement selection; exercising restraint in the use of effects; applying meticulous polishing protocols; and adhering to a disciplined lighting evaluation procedure. These are simple principles, yet their systematic application has the power to elevate the overall quality and consistency of a laboratory‘s work.

After years of experience, I have found that CERABIEN MiLai, with its exceptional chromatic richness and optical behavior closely resembling that of natural dental tissues, reveals its full potential only when used with discernment. It is unforgiving of excess – but generously rewards mastery. This is precisely why, in my view, it is one of the most faithful layering systems available today, capable of adapting equally well to single-unit and multi-unit restorations. Its versatility and optical consistency allow the ceramist to achieve highly natural results while maintaining complete control over the restorative process.

“A natural restoration should not draw attention to itself. It should simply feel right. It is optical principles – not the quantity of effects that create the illusion of life.”

– Jade Sidou Trabuc

UNCOMPROMISED.
UNMATCHED.
YOURS.

Clinical Case Report by Dr. Koray Kendir

PEG-SHAPED LATERAL INCISOR RESTORED WITH UNIVERSAL COMPOSITE (6-MONTH FOLLOW-UP)

Peg-shaped lateral incisors present a unique restorative challenge, combining aesthetic demands with the need for precise morphological reconstruction. While direct composite restorations offer a minimally invasive solution, long-term success is often compromised when anatomical principles are overlooked or when repeated additive approaches fail to address underlying structural deficiencies.

This case report describes the management of a peg-shaped maxillary lateral incisor using a simplified, anatomy-driven approach with a universal composite system.

INITIAL PRESENTATION AND CLINICAL HISTORY

A 35-year-old male patient presented with a unilateral peg-shaped maxillary left lateral incisor (tooth #22, FDI notation). The patient's dental history revealed multiple direct composite restorations placed since the age of 16, all performed without tooth preparation. However, these restorations failed approximately every two years due to fractures or severe marginal discolouration.

Fig. 1. Initial clinical situation: Vestibular view of the existing restoration.

CLINICAL ASSESSMENT AND PRE-OPERATIVE EVALUATION

Rubber dam isolation was performed and baseline clinical photographs were taken. The existing restoration was limited to closing the mesial and distal diastemas, resulting in significant marginal discrepancies and morphological disharmony. A palatal view revealed a more critical issue: concave, non-cleansable proximal contact areas, leading to food impaction and periodontal risk.

Fig. 2. Initial clinical situation: Palatal view of the existing restoration.

MINIMALLY INVASIVE PREPARATION

The primary goal was the complete removal of the failing composite without compromising the underlying natural tooth structure. Following removal, the tooth required three-dimensional expansion: mesially and distally, incisally, and labially.

Key anatomical considerations during reconstruction:

• Incisocervical positioning of mesial and distal contact areas.
• Contact area geometry (point vs. surface contact).
• Incisal edge position and line angle symmetry.
• Correct palatal wall orientation.

Fig. 3. Failing composite completely removed without compromising the tooth structure.

ADHESIVE PROTOCOL AND MATERIAL SELECTION

To support a streamlined workflow and maintain focus on anatomical reconstruction, the Universal Excellence product series was selected.

• Bonding: CLEARFIL™ Universal Bond Quick 2 was applied using a simplified one-step protocol, providing rapid and reliable adhesion.
• Restoration: CLEARFIL MAJESTY™ ES-2 Universal in U shade was chosen to provide predictable and harmonious aesthetics with a single-shade approach, allowing the clinician to focus on the primary anatomical determinants of form and function rather than complex multi-shade layering.

STRATIFICATION AND POLYMERIZATION

The composite was applied using a layering technique to minimize polymerization shrinkage stress, while gradually building the predetermined anatomical landmarks. Post-operative results demonstrated a seamless integration with the surrounding dentition.

Fig. 4. Single-shade layering of the vestibular surface.

Fig. 5. Palatal view of the tooth during layering.

Fig. 6. Finished and polished restoration surface.

Fig. 7. The composite restorations seamlessly integrated with the adjacent tooth structure.

Fig. 8. Frontal view of all maxillary anterior teeth.

SIX-MONTH FOLLOW-UP

The patient was recalled after six months for evaluation. Due to the superior polishability and high mechanical strength of CLEARFIL MAJESTY ES-2 Universal, the restoration maintained its surface lustre and marginal integrity with no signs of wear or staining.

Fig. 9. Appearance of the restorations six months after treatment.

Fig. 10. Close-up of the restoration, confirming smooth optical integration.

Fig. 11. The surface of the restoration still appears well-polished and unstained after six months.

CONCLUSION

While complex layering techniques can enhance optical properties, they may inadvertently shift focus away from fundamental anatomical principles. The Excellence system from Kuraray Noritake Dental Inc. offers a practical and dependable solution for complex morphological challenges, supporting both clinician focus and long-term clinical success.

Read more about Universal Excellence: https://www.kuraraynoritake.eu/en/newsroom/universal-excellence-smart-streamlined-solutions-for-modern-restorative-dentistry

Discover Universal Excellence products in practice: https://www.kuraraynoritake.eu/en/newsroom/universal-excellence-in-restorative-dentistry

More Clinical Cases from Dr Kendir:

https://www.kuraraynoritake.eu/en/newsroom/posterior-direct-composite-restoration-within-the-universal-excellence-concept

https://www.kuraraynoritake.eu/en/newsroom/restoring-confidence-after-trauma-a-biomimetic-approach

Case by DT Roberto Rossi

BIO-INSPIRED

White and pink aesthetic rehabilitations require a workflow that combines accurate framework design with controlled ceramic layering. When each step is carefully planned, the optical properties of the framework material can be fully exploited, reducing the need for extensive ceramic layering. The following case illustrates this workflow using a bio-inspired approach.

In this case, a micro-layering technique was used to reproduce the vestibular aesthetics while preserving the morphology of the zirconia framework. KATANA™ Zirconia YML was combined with the low-firing ceramic CERABIEN™ MiLai (both Kuraray Noritake Dental Inc.), making this combination well suited to this type of restoration.

FRAMEWORK DESIGN

To enhance the bio-design effect, in which the framework morphology reproduces the natural distribution of dentin and enamel, an accurate milling strategy is essential. The planned framework morphology should be reproduced faithfully, without losing detail in the proximal areas or at the transition between the white and pink aesthetics (Fig. 1). The optical properties of the milled framework (Fig. 2) and the accuracy of the milled surface (Fig. 3) provide the basis for a predictable aesthetic result.

Fig. 1. Milled restoration within the disc.

Fig. 2. Milled zirconia framework reproducing the cut-back design.

Fig. 3. Detailed view of the accurately milled framework surface.

Once the framework has been correctly sintered, the optical properties of the multilayer zirconia and the effect of the cubic zirconia phase can be fully appreciated. Before sintering, however, particular attention should be paid to the framework surface. Any adjustments should preserve, or even improve, the original morphology created during the CAD design stage. The framework should exhibit a smooth, dense surface, free from roughness and porosity, providing the ideal basis for the subsequent characterisation procedures (Fig. 4).

Fig. 4. Framework surface after sintering, surface texturing and finishing.

The shade of the KATANA Zirconia YML disc should generally be selected one shade lighter than the desired final shade. This helps to avoid excessive chroma and a low-value appearance in areas where the zirconia is thicker, while maintaining flexibility during the subsequent characterisation and layering procedures (Fig. 5).

Fig. 5. Sintered framework on the model.

Thanks to the varying light transmission through the different thicknesses of the bio-designed incisal area, the dentinal effect becomes clearly visible after sintering (Fig. 6). Rather than masking these optical properties, the following steps are designed to enhance them through internal characterisation and selective micro-layering.

Fig. 6. Varying light transmission of the framework.

INTERNAL STAINING

The first stage of framework individualisation is carried out using the Internal Live Stain (ILS) technique (Chroma map 1). At this stage, the zirconia framework is considered the dentinal core of the restoration. The technique is simple to apply, provides an immediate visual effect and is particularly suitable for mirror-image tooth groups as well as white and pink aesthetic rehabilitations (Figs. 7 and 8).

Chroma map 1. Initial internal staining planned.

Fig. 7. Dots of internal stains applied to visualize the planned ILS procedure.

Fig. 8. Planned distribution of the internal stains.

The initial application aims to increase the chroma of the zirconia, while maintaining a high value in the incisal third. The high value of KATANA Zirconia YML helps preserve the overall brightness of the restoration after subsequent micro-layering with CERABIEN MiLai.

The Globule Painting technique used consists of three stages: application, shading and inspection. It also offers a modular approach, allowing additional applications whenever a higher level of individualisation is required.

At this stage, only the deeper optical effects should be reproduced with internal stains. Incisal Blue 2 is used to create opalescence, A+ to increase chroma, and Salmon Pink together with Tissue Red to characterise the gingival tissues (Figs. 9a to c). The internal effects are then assessed before firing. After firing, the colours retain their appearance (Fig. 10), allowing the technician to proceed directly to the micro-layering stage.

Fig. 9a. Incisal Blue 2 applied to the incisal area.
Fig. 9b. A+ applied to increase chroma.
Fig. 9c. Salmon Pink and Tissue Red applied to characterise the gingival tissues.

Fig. 10. Framework after firing following the initial internal staining.

Chroma map 2. Comparison of the planned and completed internal staining.

MICRO-LAYERING

After internal staining, the restoration is ready for micro-layering with CERABIEN MiLai. Depending on the effects to be reproduced and the space provided by the CAD design, translucent, opalescent and lustre porcelains can be used to reproduce the enamel layer. Opaque dentin porcelains, used individually or in combination, can be applied in the cervical and middle thirds or to create a more opaque mamelon effect.

The build-up follows a defined sequence (Layering map 1). CCV2 is applied to maintain translucency while increasing chroma (Fig. 11). LT₁ is serves as the main lustre porcelain in the middle third (Fig. 12), while E₂ is used as a transition dentin in the incisal area and provides the basis for the subsequent effects (Fig. 13).

Layering map 1. Overview of the planned micro-layering procedure.

Fig. 11. CCV2 applied to maintain translucency while increasing chroma in the cervical area.

Fig. 12. LT₁ applied as the principal lustre porcelain in the middle third.

Fig. 13. E₂ applied as transition dentin in the incisal area.

To enhance opalescence while maintaining translucency, Aqua Blue 2 is applied to the incisal area (Fig. 14). Value Liner 1 is then applied within the E₂ layer, while Aqua Blue 2 is placed over the incisal edge to increase the contrast of the mamelons (Fig. 15).

Fig. 14. Aqua Blue 2 applied to enhance opalescence.

Fig. 15. Value Liner 1 and Aqua Blue 2 applied to increase mamelon contrast.

The basic morphology is completed with a further application of LT₁, filling the transition between the cervical and incisal areas (Fig. 16). For the gingival portion of the restoration, Tissue 5 is used to reproduce the deeper reddish areas, while Tissue 6 is applied to the superficial alveolar tissues (Fig. 17). After firing, the optical effects created by the internal staining and micro-layering become clearly visible (Fig. 18).

Fig. 16. LT₁ applied to complete the transition between the cervical and incisal areas.

Fig. 17. Tissue 5 and Tissue 6 applied to reproduce the gingival tissues.

Fig. 18. Restoration after firing following the micro-layering procedure.

ILS ADJUSTMENT

One of the strengths of the ILS technique is its modularity. Multiple effects can be applied during the initial characterisation, or the firing cycles can be separated to allow additional effects to be added later. Since the internal stains are designed to remain stable during firing and the internal stains contain no internal flux, further characterisation can be carried out without compromising the previous application.

Another advantage is the immediate appearance of the applied effects. This allows the technician to assess the colour distribution directly during application and compare the result with the desired outcome. The colour stability of the internal stains after firing also provides excellent control throughout the procedure. The appearance observed before firing closely corresponds to the fired result, making it possible to verify the characterisation before the restoration is returned to the furnace. This can be particularly useful when digital shade-matching systems, such as photography or spectrophotometry, are used.

Before applying a second layer of internal stains, the fired surface should be refined with fine diamond burs to obtain a smooth surface for the stains (Fig. 19). At this stage, the superficial enamel effects are refined by reinforcing selected characterisation effects, enhancing opalescence and adding localised spots (Chroma map 3).

In the present case, a mixture of White and Mamelon Orange 2 (4:1) was applied to enhance the mamelons. Incisal Blue 2 was then placed adjacent to the mamelons to enhance the contrast.

Chroma map 3. Map visualizing the planned ILS adjustment.

Fig. 19. Refinement of the framework surface before the second application of internal stains.

FINAL LAYERING

The final layering stage is used to refine both the morphology and the enamel effects using lustre and enamel porcelains. At this stage, all areas characterised with ILS should be covered with ceramic.

LT₁ can be used to complete the cervical and middle thirds where no further increase in chroma is required while maintaining the value of the restoration. At the same step, LTx is applied from the middle third towards the incisal area to increase translucency and create a lower-value effect in the incisal region (Fig. 20). ELT₁ is then used to refine the morphology and reproduce the natural contrast of enamel by creating the impression of greater enamel thickness in the proximal areas. For the gingival tissues, Tissue 5 is applied to compensate for shrinkage between the teeth and in the deeper areas, while Tissue 1 is used to reproduce the translucent appearance of the superficial gingival tissues (Fig. 21).

Fig. 20. Application of LT₁ and LTx during the final layering stage.

Fig. 21. Completed enamel and gingival layering.

SURFACE TEXTURE AND FINISHING

After firing the enamel layer, the surface texture is refined using diamond burs of different shapes to reproduce a natural surface morphology (Fig. 22). Before self-glazing, gold powder can be applied to highlight the surface texture and facilitate its evaluation (Fig. 23).

Fig. 22. Surface texture reproduced with rotary instruments.

Fig. 23. Gold powder applied to highlight the surface texture before self-glazing.

Self-glazing enhances the quality and compactness of the porcelain while preserving the natural concavities and convexities of the surface texture. Following glazing, the surface can be refined mechanically using ceramic polishing rubbers to achieve the final polish.

The restoration can be evaluated under different lighting conditions to assess the optical properties of KATANA Zirconia YML (Fig. 24), the micro-layering effects (Fig. 25) and the surface texture. The final result demonstrates the harmony between the white and pink aesthetics (Fig. 26).

Fig. 24. Transmitted-light view revealing the optical properties of the restoration.

Fig. 25. Micro-layering effects visible in the finished restoration.

Fig. 26. Final white and pink aesthetic result.

FINAL REMARKS

This case demonstrates how controlled internal characterisation and selective micro-layering can be used to preserve and enhance the optical properties of a zirconia framework. By combining accurate framework design with minimal ceramic application, highly natural white and pink aesthetics can be achieved in a predictable and efficient workflow.

UNCOMPROMISED.
UNMATCHED.
YOURS.

Case by Dr. Onur Alp Yünük

A STEP-BY-STEP GUIDE TO POLYCHROMATIC LAYERING

Complicated crown fractures in the anterior region present both functional and aesthetic challenges. They require a restorative approach that closely mimics natural tooth structure. Thanks to modern developments in adhesive dentistry and composite materials, it is possible to achieve highly aesthetic outcomes in a minimally invasive way.

This case report outlines a straightforward, yet highly aesthetic approach to restoring a traumatised lateral incisor using a polychromatic layering technique. By combining precise shade selection, anatomical analysis, and controlled composite layering, it is possible to recreate the optical properties of natural dentition and achieve seamless optical integration.

CASE OVERVIEW

A young female patient visited our clinic with a history of dental trauma, which resulted in a complicated crown fracture of her maxillary left lateral incisor (tooth #22, FDI notation). After completing the necessary endodontic and periodontal treatments for the affected tooth, we placed a temporary composite restoration. This case outlines a straightforward yet highly aesthetic approach to restoring the tooth using a polychromatic layering technique.

Fig. 1. Initial presentation of a complicated crown fracture on tooth #22 following dental trauma.

VISUAL ASSESSMENT AND SHADE MATCHING

Before beginning the definitive restorative phase, we took initial baseline photographs. Using a cross-polarized filter allowed us to evaluate the true internal optical properties of the adjacent dentition without distracting light reflections. Shade matching was performed using a bilaminar colour selection technique in conjunction with the cross-polarized filter to provide for absolute precision.

Fig. 2. Tooth #22 temporarily restored with composite resin after the completion of endodontic and periodontal treatments.

Fig. 3. Pre-operative view and cross-polarized photograph taken before initiating the definitive restorative treatment.

Fig. 4. Shade selection performed using a bilaminar technique combined with an image taken with a cross-polarized filter for accurate colour mapping.

CLINICAL EXECUTION

Following rubber dam isolation, the temporary restoration was carefully removed and the adhesive system (CLEARFIL™ SE BOND 2) was applied. Before layering the composite, we analysed the primary and secondary anatomy of the adjacent teeth from the occlusal plane to guide the build-up.

Fig. 5. Rubber dam isolation and complete removal of the provisional restoration.

Fig. 6. Occlusal view allowing for the evaluation of the primary and secondary anatomy of the adjacent teeth.

THE RESTORATION WAS CARRIED OUT IN SYSTEMATIC LAYERS

• Dentin core: We established the artificial dentin layer using CLEARFIL MAJESTY™ ES-2 in shades A3D and A2D (Kuraray Noritake Dental Inc.).
• Marginal ridges and incisal edge: The mesial and distal marginal ridges were built using CLEARFIL MAJESTY ES-2 A2, while CLEARFIL MAJESTY ES-2 Blue was applied to the incisal region to mimic natural translucency.
• Characterization: To replicate natural internal characteristics, we applied white and yellow tints. A quick control photograph taken at this stage with a cross-polarized filter is useful to verify the internal effects.
• Final enamel layer: The restoration was completed with a final layer of CLEARFIL MAJESTY ES-2 WE. Immediate post-operative photographs were taken right after the procedure.

Fig. 7. Artificial dentin layering utilizing CLEARFIL MAJESTY ES-2 A3D and A2D shades.

Fig. 8. Artificial dentin layering utilizing CLEARFIL MAJESTY ES-2 A3D and A2D shades.

Fig. 9. CLEARFIL MAJESTY ES-2 A2 used for the marginal ridges and CLEARFIL MAJESTY ES-2 Blue for the incisal area. Application of white and yellow tints for internal characterization, verified with a cross-polarized filter.

Fig. 10. Immediate post-operative views after finalizing the restoration with CLEARFIL MAJESTY ES-2 WE composite.

Fig. 11. Immediate post-operative view taken with a cross-polarized filter.

MANAGING COMPLICATIONS

During the course of treatment, the adjacent central incisor (tooth #21) failed to respond to vitality tests. Consequently, endodontic treatment and internal bleaching were successfully performed on tooth #21 in the subsequent sessions.

FINAL OUTCOME

At the final follow-up appointment, comprehensive control photographs were taken. An occlusal view confirmed the successful recreation of both primary and secondary anatomy. Most importantly, evaluating the final result with a cross-polarized filter image demonstrated a seamless colour integration with the surrounding natural teeth.

Fig. 12. Occlusal view confirming the successful recreation of the primary and secondary anatomy.

Fig. 13. Cross-polarized control photograph demonstrating seamless composite shade integration.

Fig. 14. Final result.

Case by DT Ghaith Alousi

MATERIALS USED

KATANA Zirconia YML

ZIRCONIA BLANK

High-esthetic multilayer zirconia blank with a natural colour gradient from cervical to incisal. Combines high flexural strength with excellent translucency. Ideal for partial veneering.

CERABIEN MiLai

VENEERING CERAMIC

New-generation veneering ceramic specifically developed for zirconia and lithium disilicate restorations. Excellent adhesion to zirconia, natural light optics, wide range of masses for detailed layering techniques.

CERABIEN MiLai Internal Stains

STAIN COLORS

Incisal Blue 1, Mamelon Orange 2, A+, Tissue Pink, Salmon Pink, White – all mixed with Bright for optimal consistency and application precision.

CERABIEN MiLai Masses

CERAMIC MASSES

Tx, Creamy Enamel, LTx, CCV-2, ELT₁ for teeth. Tissue 1, 4, 6 for the gingiva.

INTRODUCTION

The technique represents a modern, efficient approach to dental laboratory aesthetics: rather than voluminous ceramic build-ups, minimal yet precisely applied layers are used, which in combination with the intrinsic aesthetic of the zirconia framework achieve an extraordinary result.

In this case report, dental technician Ghaith Alousi documents step-by-step the fabrication of a facially layered maxillary anterior zirconia restoration based on KATANA™ Zirconia YML and the novel veneering ceramic CERABIEN™ MiLai. The key feature: the palatal surface remains monolithic zirconia, while only the vestibular surface is veneered with CERABIEN MiLai. This combines the stability of zirconia with the incomparable aesthetics of a hand-layered porcelain.

STEP 1: ZIRCONIA FRAMEWORK BEFORE SINTERING

CAD/CAM Milling · KATANA Zirconia YML · Green State

The framework was deliberately designed for partial labial veneering: the vestibular surface provides sufficient space for the CERABIEN MiLai ceramic. While the palatal surfaces are entirely monolithic, the occlusal contact points remain on the mechanically superior zirconia.

Fig. 1. Framework before sintering. Framework after milling.

MATERIAL:

KATANA Zirconia YML

STEP 2: AFTER SINTERING

Sintering · Multi-Layer Aesthetics · Sandblasting

Following the sintering cycle at 1550 °C, the KATANA Zirconia YML framework reveals its full multi-layered character. The impressive colour gradient – from a warm, yellowish-cream tone cervically to the cool, translucent incisal edge – is the direct result of the pigment layering integrated into the blank.

The framework was cleaned directly after sintering using sandblasting only (110 μm, 1.5 bar), with no further processing.

Fig. 2. Sintered framework vestibular view – multi-layered colour gradient after sintering.

Fig. 3. Sintered framework - palatal view – monolithic zirconia structure.

PROCESSING:

• Sintering (1550 °C)
• Sandblasting

STEP 3: FIRST STAIN LAYER

CERABIEN MiLai Internal Stains · Colour Foundation · Internal Characterisation

Prior to ceramic layering, a differentiated stain layer is applied directly to the sintered zirconia framework. This layer serves as the colour foundation and internal characterisation – defining depth effect and individuality.

Colour distribution by zone:

Incisal: Incisal Blue 1 + Bright 20 % – to simulate the natural opalescence effect.
Mid incisor area: Mamelon Orange 2 + Bright 20 % – to replicate the characteristic mamelon structure.
Cervical area & interproximal: A+ + Bright 20 % – for increased chroma and saturation in the cervical third.
Gingival area: Tissue Pink + Salmon Pink – for natural tissue toning.

Fig. 4. CERABIEN MiLai Internal Stains applied – unfired state.

CERABIEN MiLai INTERNAL STAINS:

• Incisal Blue 1 + Bright 20 % (incisal area)
• Mamelon Orange 2 + Bright 20 % (mamelons)
• A+ + Bright 20 % (cervical & interproximal areas)
• Tissue Pink (gingiva)
• Salmon Pink (gingiva)

STEP 4: FIRST CERAMIC LAYER & WASH BAKE

Tx + Tissue 1 · Bonding Fire · Bond Optimisation

After firing the stains, the first ceramic layer is applied using CERABIEN MiLai Tx for the tooth areas and Tissue 1 for the gingiva. The goal is to establish an optimal bond between ceramic and zirconia.

A deliberate wash bake is performed: the firing temperature is raised above the normal reference value so that the ceramic mass flows more readily and bonds optimally to the zirconia surface. A liner or wash fire is intentionally omitted.

Fig. 5. First ceramic layer – unfired, frontal view.

Fig. 6. Frontal view – raw first layer.

CERABIEN MiLai MASSES:

• Tx (Translucent) – tooth portions
• Tissue 1 – gingival area
• Firing mode: wash bake (elevated temperature)

STEP 5: AFTER WASH BAKE

Bond Verification · Preparation for Second Stain Layer

The result after the wash bake shows a first ceramic layer fused to the zirconia. The surface appears smooth and uniformly glossy. The Tx layer enhances the intrinsic translucency of KATANA Zirconia YML and allows the multi-layer colour gradient to shine through harmoniously.

Fig. 7. After wash bake – Tx and Tissue 1 perfectly fused to zirconia.

STEP 6: SECOND STAIN LAYER – DETAIL CHARACTERISATION

Natural Cracks · White · Surface Individualization

In the second stain layer, the focus is on maximum precision and detail. CERABIEN MiLai internal stain White is used to apply fine, naturally appearing crack lines (Natural Cracks) to the tooth surface.

These subtle whitish crack lines develop in natural teeth through enamel stresses and impart to them their unmistakable, vital character. They run anatomically correctly in a vertical direction, varying in intensity and length – exactly as found in nature.

Fig. 8. Close-up – fine crack lines with white stain.

Fig. 9. Second stain overview – harmonious detail distribution.

CERABIEN MiLai INTERNAL STAIN:

• White – Natural Cracks / craquelé lines

STEP 7: SECOND CERAMIC LAYER – MAIN BUILD-UP

Morphology · Enamel Masses · Gingival Design

The second ceramic layer requires the highest concentration on colour, morphology, and surface texture simultaneously. This is the main build-up, during which the final form of the restoration is established.

Tooth masses – zonal strategy:

Creamy Enamel establishes the warm body tone. LTx (Luster Translucent) imparts opalescent vitality. CCV-2 (Clear Cervical 2) provides transparent chroma cervically. ELT₁ (Enamel Luster 1) completes the incisal zone with a delicate enamel gloss.

Gingival masses:

Tissue 1, 4, and 6 create a differentiated tissue appearance with light, mid, and deep tones.

Fig. 10. Main build-up – Unfired state.

CERABIEN MiLai MASSES – TEETH:

• Creamy Enamel – body zone
• LTx (Luster Translucent) – opalescent vitality
• CCV-2 (Clear Cervical 2) – cervical chroma
• ELT₁ (Enamel Luster 1) – incisal enamel gloss

Fig. 11. Main build-up – Close-up – surface texture.

Fig. 12. Main build-up – Close-up – surface texture.

CERABIEN MiLai MASSES – GINGIVA:

• Tissue 1 – light, delicate tissue areas
• Tissue 4 – mid gingival tone
• Tissue 6 – depth, shadow, interdental papillae

STEP 8: SECOND CERAMIC FIRING

Not Yet Finished · As-Fired State

The result after the second ceramic firing is already convincing in its raw form. The fired mamelon structures, the fine crack lines, and the differentiated gingival design are clearly visible. The final surface texture and form will be refined in the next step through mechanical finishing.

Fig. 13. After second firing – not yet finished.

STEP 9: MECHANICAL FINISHING

Morphology Refinement · Before Self-Glaze Firing

Mechanical finishing requires artisanal expertise and a trained aesthetic eye. Diamond burs are used to bring form, proportions, and surface texture to their final level.

Special attention is given to surface texture: perikymata, vertical lobule structures, and the cervicogingival transition are individually incorporated. The palatal side remains completely untouched.

Fig. 14. After finishing.

Fig. 15. Finishing, perikymata and surface texture.

STEP 10: FINAL RESULT

Self-Glaze Firing & Mechanical Polishing

The self-glaze firing differs fundamentally from a conventional glaze firing: no glaze material is applied. The restoration is heated to just below the softening temperature of the ceramic – the surface begins to flow on its own, creating an extremely natural, vital gloss that fully preserves the incorporated texture.

Fig. 16 & 17. Final result.

An applied glaze mass would partially level the fine perikymata and crack lines. The self-glaze firing instead preserves exactly that individuality so precisely incorporated during finishing. The final mechanical polishing completes the high gloss and accentuates the translucency of the tissue.

Fig. 18. Cervicogingival transition.

Fig. 19. Final result – close-up.

FINISHING STEPS:

• Self-glaze firing (no applied glaze mass)
• Mechanical polishing of ceramic surfaces

CONCLUSION

KATANA Zirconia YML and CERABIEN MiLai from Kuraray Noritake Dental Inc. open new dimensions in aesthetic dental technology. The combination of an intrinsically highly aesthetic multi-layer zirconia blank with CERABIEN MiLai, a veneering ceramic system designed for micro-layering on zirconia as well as lithium disilicate restorations, enables highly natural aesthetic outcomes with minimal material usage. The conscious omission of a liner firing, the targeted use of wash bake for optimal bonding, and the decision to make use of self-glaze firing instead of conventional glazing all express a thoughtful, material-oriented philosophy. The documented steps make clear that esthetic excellence is not the result of complexity. It is the result of precision, material understanding, and an unerring eye for detail.

The backlight photograph makes it strikingly visible: light flows through the restoration as through a natural tooth – proof of the harmonious interplay of KATANA Zirconia YML and CERABIEN MiLai.

UNCOMPROMISED.
UNMATCHED.
YOURS.

Visit the product page for more details.

In busy dental laboratory environments, efficiency matters just as much as reliability. TiBase cementation is performed daily — but reducing unnecessary steps while maintaining strong, durable bonding can make a real difference in productivity and consistency.

 
In this video, we demonstrate a streamlined, step-by-step approach using PANAVIA SA Cement Universal for cementing zirconia restorations to titanium bases. From surface pretreatment and sandblasting to cement application and final finishing, the workflow is designed to simplify the process without compromising performance.

By adopting a more efficient cementation protocol, you can save time, reduce technique sensitivity, and achieve predictable, long-term results in implant-supported restorations.

 
Discover more: Learn more about PANAVIA™ SA Cement Universal and the KATANA™ Zirconia portfolio.

Case by Jotautas Kaktys, DDS

An endodontically treated, structurally compromised mandibular molar with recurrent failure of direct composite restorations presents both biomechanical and aesthetic challenges. In patients with parafunctional habits such as bruxism, excessive tensile forces further increase the risk of fracture. This case report describes a minimally invasive, cost-conscious approach using a CAD/CAM hybrid material (KATANA™ AVENCIA™ Block 2, Kuraray Noritake Dental Inc.) to restore function, strength, and aesthetics while preserving remaining tooth structure.

CASE EXAMPLE: INITIAL SITUATION

The patient presented with a structurally compromised mandibular first molar and reported repeated failure of composite restorations, as well as dissatisfaction with aesthetics (Figs. 1 to 3). Longevity, strength, and cost-effectiveness of the treatment were key concerns.

Clinical findings, including worn canines and multiple cervical lesions, indicated a bruxing patient with group guidance during lateral movements, leading to excessive tensile stress and increased fracture risk. An indirect restoration with cusp coverage was indicated. Due to financial limitations and uncertain endodontic prognosis, a CAD/CAM hybrid material KATANA AVENCIA Block 2 ML (Kuraray Noritake Dental Inc.) in the shade A3 (Fig. 4) was selected.

Fig. 1. Initial situation: Buccal view of the mandibular first molar in need of treatment due to a cervical lesion and a leaking composite restoration.

Fig. 2. Buccal view of the teeth in occlusion.

Fig. 3. Occlusal view of the tooth revealing a number of defects.

Fig. 4. Shade selection: Image taken with the A3 tab of the VITA classical A1-D4 shade guide for communication with the dental technician.

TOOTH PREPARATION AND IMMEDIATE DENTIN SEALING

Preparation was kept minimally invasive to preserve remaining tooth structure while creating space for adequate material thickness (~1.5 mm; Figs. 5 and 6). Weak cusps were reduced with minimal biological sacrifice.

After sandblasting and pre-treatment of the old composite and fiber post surfaces with silane, exposed dentin was sealed using CLEARFIL™ SE Protect and coated with CLEARFIL MAJESTY™ ES Flow (Low flowability, shade A3D; both Kuraray Noritake Dental Inc.; Figs. 7 and 8). Due to the presence of sclerotic dentin, we decided to reactivate the surface and use a two-step self-etch system instead of a universal adhesive. Resin coating was performed to protect the underlying tooth structure and mask discolouration.

Fig. 5. Tooth preparation preserving the remaining enamel and the cervical tissues.

Fig. 6. Adequate occlusal clearance.

Fig. 7. Immediate dentin sealing and resin coating.

CLEARFIL SE Protect for IDS (Immediate Dentin Sealing).

CLEARFIL MAJESTY ES Flow High for RC (resin coating).

CLEARFIL™ CERAMIC PRIMER PLUS for adhesion to old sandblasted composite.

Fig. 8. Tooth ready for intraoral scanning.

DIGITAL WORKFLOW

The intraoral situation was digitised using an intraoral scanner (Figs. 9 to 11). This enabled efficient computer-aided design and manufacturing (exocad DentalCAD; Figs. 12 to 14). The occlusal design was adjusted to minimise tensile forces during lateral movements. The restoration was milled and required only minimal finishing and polishing (TWIST™ DIA for Composite, Kuraray Noritake Dental Inc.), which was quick and effective (Fig. 15).

Fig. 9. Digital model of maxilla and mandible revealing sufficient space for the planned restoration.

Fig. 10. Preparation margins clearly visible both in the coloured …

Fig. 11. … and the black-and-white modes of the software.

Fig. 12. Computer-aided design in the laboratory using exocad DentalCAD.

Fig. 13. Milled restoration with milling sprue positioned at the buccal wall – an area which is easily adjustable (no interproximal or occlusal contacts affected) and stable.

Fig. 14. Milled restoration with smooth margins (no irregularities) due to non-brittleness of the hybrid ceramic material.

Fig. 15. Polishing is accomplished in two to three minutes and leads to great results.

TRY-IN AND PLACEMENT

Tissues had healed nicely in the three weeks between impression taking and final restoration placement (Fig. 16). Try-in confirmed a perfect fit of the restoration. Optical integration was difficult to assess without try-in paste (Fig. 17), but the patient was happy anyway, so that it was decided to move on immediately.

Isolation was achieved using a retraction cord (size 00) and PTFE tape (Fig. 18). As the bonding substrate consisted mainly of enamel and composite, a universal adhesive CLEARFIL™ Universal Bond Quick was selected. It was applied after phosphoric acid etching and treated with a gentle stream of air until the adhesive layer was uniformly thin (no pooling) and the surface did no longer move. As some remaining exposed dentin was present, the adhesive was polymerised to stabilize the hybrid layer. The restoration was pretreated (sandblasting, cleaning, CLEARFIL CERAMIC PRIMER PLUS) and adhesively cemented using a light-curing resin cement system to provide for dependable bonding.

Fig. 16. Healthy tissues at the delivery visit.

Fig. 17. Try-in of the restoration to assess the fit – no adjustments were necessary.

Fig. 18. Soft tissue management and moisture control with a retraction cord and PTFE tape, surface sandblasted to prepare for adhesive cementation.

TREATMENT OUTCOME

While the soft tissues were still slightly retracted after treatment and the optical integration difficult to assess due to dehydrated tooth structure (Fig. 19), radiographic examination confirmed proper biological integration (Fig. 20) and the patient was satisfied immediately. When she returned for a check-up after six months, we saw healthy soft tissues, a great marginal seal and proper aesthetic integration (Fig. 21). The restoration margins blended in nicely, no signs of wear were detectable and polish retention was great (Fig. 22).

Fig. 19. Immediate treatment outcome.

Fig. 20. Final radiograph.

Fig. 21. Restoration at a recall after six months. The gingiva appears healthy and has grown over the restoration margin, which is a sign of the material's biocompatibility.

Fig. 22. Smooth occlusal surface without any signs of wear.

CONCLUSION

Minimally invasive cusp coverage with KATANA AVENCIA Block 2 offers a predictable and cost-effective solution for structurally compromised posterior teeth. This is because the production procedure involves fewer manual steps, such as characterisation and glazing, while completely eliminating the need for heat treatment. A high level of automation further supports this efficiency. Successful outcomes depend on preserving the remaining tooth structure, careful treatment planning, and adherence to the recommended adhesive protocols.

Special thanks to dental technician Tautvilas Kaktys (my twin brother) and the dental laboratory RiCreo for their outstanding laboratory support and craftsmanship.

PREFERRED PRODUCT RECOGNITION FOR CLEARFIL CERAMIC PRIMER PLUS

Efficient workflows, simplified protocols, and excellent  adhesion are essential in modern indirect restorative procedures. With CLEARFIL™ CERAMIC PRIMER PLUS, Kuraray Noritake Dental Inc. offers a versatile, one-step universal primer designed to streamline bonding while delivering consistent, high bond strength.

CLEARFIL CERAMIC PRIMER PLUS is formulated to promote strong, durable adhesion to a wide range of restorative materials, including silica-based ceramics, zirconia and composite restorations. By integrating advanced functional monomers into one universal primer, it optimizes both performance and clinical protocols.

Key benefits of CLEARFIL CERAMIC PRIMER PLUS include:
•    Universal, one-step primer for indirect restorations
•    Strong, durable bond to silica-based ceramics, zirconia, and composites
•    Streamlines procedures and reduces chair time
•    Easy application with predictable results
•    Trusted performance in daily clinical practice

DENTAL ADVISOR PREFERRED PRODUCT AWARD

Recognized for versatility and performance

The main feature that made CLEARFIL CERAMIC PRIMER PLUS win a Preferred Product Award in 2026 (and in previous years since 2018) is its versatile, one-step formulation, which performed very well in laboratory testing and in the clinical environment.

Among the clinical evaluators' comments was: "Easy to use on a variety of materials," while the product's wetting ability and the speed of application were highlighted as well. These outcomes contributed to a high overall clinical performance rating (of 96%) in the original clinical evaluation.

An efficient universal primer

By once again earning the Dental Advisor Preferred Product Award, CLEARFIL CERAMIC PRIMER PLUS reinforces its reputation as an efficient and strong universal primer. Its combination of simplified handling and proven bonding performance makes it an essential solution for modern indirect restorative workflows.

For more information, visit Dental Advisor.

TiBase cementation is a routine step in many dental laboratory workflows — yet it remains a critical one. Getting the bond right between zirconia restorations and titanium bases is essential for the long-term success of implant-supported restorations.

 
In this video, we walk through a complete, step-by-step lab protocol using PANAVIA™ V5, covering all key stages from surface preparation and controlled sandblasting to priming, cement application, and final finishing. The workflow is designed to help you achieve consistent, high-strength adhesion while maintaining efficiency and control in your daily lab work.

By following this structured approach, you can minimise risk, improve predictability, and deliver durable clinical outcomes.

 
Discover more: Explore PANAVIA V5 and the KATANA™ Zirconia range.

Article by Peter Schouten

The restoration of endodontically treated teeth often requires the use of core build-ups to provide a foundation for the final restoration. Historically, root posts served as a common method to enhance retention and stability for core build-ups. However, resin composite materials have gained popularity for core build-ups due to their excellent aesthetics, adhesive properties, and versatility. As the reinforcement of the remaining tooth structure (and replacing the missing tooth structure) remains fundamental, the decision to use a root post is a subject of ongoing debate.

This article aims to explore several key factors related to restoring endodontically treated teeth using resin composite with or without the introduction of a root post.

HISTORY

Core build-ups with a root post originally used metal as a post material for their strength. Stainless steel, titanium, and gold were popular choices. However, concerns about potential complications like root fractures prompted a shift in treatment philosophy.

The advent of adhesive dentistry brought about the rise of resin composite core build-ups, offering a less invasive and more conservative alternative. The possibility of bonding restorative materials to dental tissue reduced the need to remove sound dental tissue. This shift in perspective allows for a more conservative approach, prioritizing tooth preservation while still providing sufficient strength and retention for long-term success.

POST OR NO POST

Preserving as much tooth structure as possible is a general prerequisite in modern dentistry. Therefore, omitting the use of a post must be considered, especially in cases where root dentine must be sacrificed to create sufficient space and access to insert the post. The decision to use a post should consider the following factors:

1. The amount and quality of the remaining tooth structure*
2. The presence of a ferrule effect
3. The clinician's experience

*Several studies suggest that in cases where an adequate amount of tooth structure remains and when the remaining tooth structure is of good quality, root posts may not be necessary.

THE AMOUNT AND QUALITY OF THE REMAINING TOOTH STRUCTURE

Preserving as much dental tissue as possible is the first requirement. The presence of at least two intact axial walls is considered ideal for optimal clinical outcomes. Teeth with no- or only one residual wall appear to have reduced survival rates compared to teeth with more than one wall.

THE PRESENCE OF A FERRULE EFFECT

The ferrule effect refers to the presence of a circumferential band of tooth structure encircling the coronal portion of the tooth. This effect has been shown to contribute significantly to the resistance of the restored tooth to fracture. Minimal ferrule dimensions are not set in stone. Some general recommendations can be given to help evenly distribute forces, resist occlusal forces, and give enough retention. The ferrule should ideally extend at least 2 mm above the cementoenamel junction, have a circumferential width of approx. 1 mm and a thickness of 1 to 1.5 mm. Finally, the axial walls should have a slight taper towards the occlusal plane.

*This flowchart has been put together with the greatest care. The “workflows” shown in this article only intended as a brief indication of the actual procedure to follow. This procedure is for general information purposes only and no rights may be derived from it. Always follow the instructions for use (IFU) that come with the product(s).

THE ADHESIVE APPROACH

Proper adhesive techniques should be employed to maximise the bond strength between the post, luting agent, and root canal walls. Here are several issues to look out for:

Debonding

It is believed that debonding is one of the most common failures in teeth restored with adhesively cemented endodontic posts and can be directly associated with adhesive bonding issues within the root canal (e.g., insufficient polymerisation, inadequate application of adhesive, resin and reduced evaporation of solvents). The right choice of materials plays an important role here.

Appropriate Post-Cementation Procedure

First of all the selection of the proper adhesive system should consider factors such as bond strength, biocompatibility, and ease of use. Various adhesive strategies have been suggested for cementing posts, ranging from the separate application of adhesive (etch-and-rinse as well as self-etch adhesives) and resin cement, to the use of self-adhesive resin cement. Compared to etch-and-rinse adhesives, the bond strength of self-etch systems to root canal dentine seems not strongly affected by the post-space region. Zenthöfer et al. concluded the performance of self-etch adhesives to be comparable with that of materials processed using the total-etch technique, at least in the short term.

Clean Surface

An adequately performed adhesive cementing procedure, including a clean dentine surface, seems important for the success of the coronal restoration of endodontically treated teeth.** Remaining sealer after post-space preparation negatively influences the bondability of the root canal dentine. Tian et al. conducted a study comparing the effectiveness of different sealer cleaning methods prior to bonding procedures. They found KATANA™ Cleaner to be capable of restoring the bonding potential to sealer contaminated dentine.

Direct Composite Resin Core Build-Ups

Today, the use of direct composite resins for core build-ups has become popular. Their use permits the conservation of dentine and facilitates adhesive bonding to the radicular and root dentine. The continuous development of (self-adhesive) resins, both cement and build-up materials, has provided greater applicability to endodontically treated tooth restoration. With proper tooth preparation, adhesive techniques and protocols, direct composite resin can provide predictable and long lasting results.

CLEARFIL Universal Bond Quick 2 and CLEARFIL DC CORE PLUS

Using adhesives in core build-ups and post & core restorations can be challenging because of the need for adequate energy from the curing light to polymerise the adhesive properly. To overcome curing problems in deeper root canal regions, manufacturers have developed self-cure promoters that can be added to light-curable adhesives. These, however, can lead to pooling of the adhesive in the apical area of post preparations, hampering the insertion of the post to the desired depth and also limit the working time. Kuraray Noritake Dental Inc. addressed this clinical issue with an advanced and improved single-component self-etch adhesive, CLEARFIL™ Universal Bond Quick 2, when combined with CLEARFIL™ DC CORE PLUS dual-cure core build-up resin composite. New initiators have been added to the adhesive and core build-up resin as an alternative to using a self-cure promoter, causing CLEARFIL Universal Bond Quick 2 to set when CLEARFIL DC CORE PLUS contacts the adhesive.

Improved properties

Kuraray Noritake Dental Inc. has improved their dual-cure core build-up resin, CLEARFIL DC CORE PLUS, to offer better flow during dispensing and stability afterwards of the uncured resin core material. The filler technology has been modified in a way that the paste became thixotropic. This "non-slumping formula" enables easy dispensing and allows the creation of a build-up without the need for a matrix. The improved flow also permits its use, combined with CLEARFIL Universal Bond Quick 2, for the cementation of posts, resulting in a product that is suitable for post cementation as well as the build-up.

Core composite or adhesive cement?

In clinical situations where a post is included, the post-cementing process can be covered with either CLEARFIL DC CORE PLUS or PANAVIA™ SA Cement Universal. The latter one can be used with or without CLEARFIL Universal Bond Quick 2. Choosing between the two products is, for a large part, dependent on the space between the post and the canal wall:

1. Tight-fit: So-called tight-fit situations, meaning the post snugs tightly to the canal, might benefit from using a highly bondable resin cement of low thickness (PANAVIA SA Cement Universal).
2. Loose-fit: Loose-fit cases need a larger amount of resin-based material and are better off using a material that has better physical properties for use as a filling material (CLEARFIL DC CORE PLUS) instead of cement.

CONCLUSION

The general prerequisite in modern dentistry is to preserve as much tooth structure as possible. Based on the premises identified in this article, the choice for the placement of a post and the use of the restorative materials can be decided based on the case in front of the clinician. The stability of core build-ups is no longer dependent on the support by a post. After analyzing the remaining tissue and keeping in mind the success factors for a strong bond, patients can be offered highly aesthetic and sustainable restorations without large interventions.

*This flowchart has been put together with the greatest care. The “workflows” shown in this article only intended as a brief indication of the actual procedure to follow. This procedure is for general information purposes only and no rights may be derived from it. Always follow the instructions for use (IFU) that come with the product(s). Please note that only a selection of treatment options have been explored. Our main focus is on the use of a core build-up composite and fibre post placement.

The following sources of information were used in writing this article:

• Zenthofer, A., Bermejo, J. L., Bomicke, W., Frese, C., Gulmez, R., Rammelsberg, P., & Ohlmann, B. (2022). Early failures when using three different adhesively retained core build-up materials-a randomized controlled trial. Clin Oral Investig, 26(2), 1927-1936. doi:10.1007/s00784-021-04170-6
• Tian, F., Jett, K., Flaugher, R., Arora, S., Bergeron, B., Shen, Y., & Tay, F. (2021). Effects of dentine surface cleaning on bonding of a self-etch adhesive to root canal sealer-contaminated dentine. J Dent, 112, 103766. doi:10.1016/j.jdent.2021.103766
• Bhuva, B., Giovarruscio, M., Rahim, N., Bitter, K., & Mannocci, F. (2021). The restoration of root filled teeth: a review of the clinical literature. Int Endod J, 54(4), 509-535. doi:10.1111/iej.13438
• Ozcan, M., & Volpato, C. A.M. (2020). Current perspectives on dental adhesion: (3) Adhesion to intraradicular dentine: Concepts and applications. Jpn Dent Sci Rev, 56(1), 216-223. doi:10.1016/j.jdsr.2020.08.002
• Lazari, P. C., de Carvalho, M. A., Del Bel Cury, A. A., & Magne, P. (2018). Survival of extensively damaged endodontically treated incisors restored with different types of posts-and-core foundation restoration material. J Prosthet Dent, 119(5), 769-776. doi:10.1016/j.prosdent.2017.05.012
• Carvalho, M. A., Lazari, P. C., Gresnigt, M., Del Bel Cury, A. A., & Magne, P. (2018). Current options concerning the endodontically-treated teeth restoration with the adhesive approach. Braz Oral Res, 32(suppl 1), e74. doi:10.1590/1807-3107bor-2018.vol32.0074
• Magne, P., Lazari, P. C., Carvalho, M. A., Johnson, T., & Del Bel Cury, A. A. (2017). Ferrule-Effect Dominates Over Use of a Fiber Post When Restoring Endodontically Treated Incisors: An In Vitro Study. Oper Dent, 42(4), 396-406. doi:10.2341/16-243-L
• Scotti, N., Rota, R., Scansetti, M., Migliaretti, G., Pasqualini, D., & Berutti, E. (2012). Fiber post adhesion to radicular dentine: The use of acid etching prior to a one-step self-etching adhesive. Quintessence Int, 43(7), 615-623. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22670257
• Ferrari, M., Vichi, A., Fadda, G. M., Cagidiaco, M. C., Tay, F. R., Breschi, L., Goracci, C. (2012). A randomized controlled trial of endodontically treated and restored premolars. J Dent Res, 91(7 Suppl), 72S-78S. doi:10.1177/0022034512447949
• Breschi, L., Mazzoni, A., De Stefano Dorigo, E., & Ferrari, M. (2009). Adhesion to Intraradicular
• Dentine: A Review. Journal of Adhesion Science and Technology, 23(7-8), 1053-1083. doi:10.1163/156856109X440957
• Watzke, R., Blunck, U., Frankenberger, R., & Naumann, M. (2008). Interface homogeneity of adhesively luted glass fiber posts. Dent Mater, 24(11), 1512-1517.doi:10.1016/j.dental.2008.03.022
• Fokkinga, W. A., Kreulen, C. M., Bronkhorst, E. M., & Creugers, N. H. (2007). Up to 17-year controlled clinical study on post-and-cores and covering crowns. J Dent, 35(10), 778-786. doi:10.1016/j.jdent.2007.07.006
• Fokkinga W.A. Post it? Reconstruction of the endodontically treated tooth. Thesis. ISBN: 978-90-9021726-0
• Fokkinga, W. A., Kreulen, C. M., & Creugers, N. H. (2006). [In vitro fracture behaviour of composite crowns with and without posts]. Ned Tijdschr Tandheelkd, 113(8), 313-318. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16933594

kliniskt fall av och med Viktor Henarejos-Domingo - DDS, MSc

Den moderna indirekta restaurativa tandvården utvecklas mot allt mer effektiva, digitala och förenklade protokoll. Genom att integrera CAD/CAM-teknik med universella material kan man optimera de kliniska rutinerna, minska komplexiteten i ingreppen och öka förutsägbarheten vid restaurativa behandlingar. De allra bästa resinbaserade hybridmaterialen, i kombination med självadhesiva resincment och universaladhesiver ger utmärkta
mekaniska och estetiska resultat och möjliggör samtidigt enklare och mindre teknikkänsliga cementeringsprotokoll än förr.

Det aktuella kliniska fallet visar hur CLEARFIL MAJESTY™ ES Flow Universal Low (UD). KATANA™ Cleaner, CLEARFIL™ Universal Bond Quick 2, KATANA™ AVENCIA™ Block 2, PANAVIA™ SA Cement Universal och putssystemet TWIST™ DIA for Composite (alla produkter finns hos Kuraray Noritake Dental Inc.) används för adhesiv behandling av en endodontiskt behandlad molar.

FALLBESKRIVNING

En 48-årig kvinna sökte sig till kliniken med en omfattande koronal skada på en underkäksmolar (tand 47). Skadan var kopplad till symtom och endodotisk behandling som hade påbörjats på en annan klinik. Efter röntgen och klinisk undersökning beslutades att slutföra den endodontiska behandlingen och att tanden därefter skulle återställas med hjälp av en CAD/CAM-framställd partialkrona. (Fig. 1).

Figur 1 (och bild på vänster sida): Utgångsläge, tand 47. Lägg märke till den omfattande koronala skadan.

Efter rotbehandlingen behövde den kvarvarande tandstrukturen justeras för att åstadkomma ett stabilt underlag för den planerade partialkronan (Fig. 2). Emaljen selektivetsades med K-ETCHANT Syringe, en 35%-ig fosforsyragel, som erbjuder precis applicering och kontrollerad konsistens. Därefter applicerades CLEARFIL™ Universal Bond Quick 2. Uppbyggnaden av tanden slutfördes sedan med CLEARFIL MAJESTY ES Flow Universal Low (UD), en flytande universalkomposit med hög fyllnadsgrad och utmärkta mekaniska egenskaper - särskilt lämpad för posteriora ersättningar som utsätts för kännbara tuggkrafter (Fig.3).

Figur 2: Röntgen och klinisk utvärdering av den skadade molaren åtföljs av endodontisk behandling innan övrig behandling påbörjas.

Figur 3: Direktuppbyggnad utförs med CLEARFIL MAJESTY™ ES Flow Universal Low (UD). Observera justeringen som görs i syfte att skapa en adekvat mängd stödvävnad inför kommande preparation.

Därefter preparerades tanden för en adhesivt cementerad partialkrona enligt principerna för defektorienterad och minimalinvasiv tandvård (Fig. 4). De digitala avtrycken togs med en intraoral skanner, TRIOS 5 (3shape) (Fig. 5). Ersättningen designades i dator och partialkronan frästes ur ett KATANA AVENCIA Block 2 av den högtranslucenta varianten (HT). Det translucenta resinbaserade hybridkeramiska CAD/CAM-blocket är särskilt lämpligt att använda vid framställning av partiella ersättningar. Materialet utmärker sig genom hög mekanisk styrka, utmärkt optisk integrering och att det är snabbpolerat (Fig. 6).

Figur 4: Anatomiskt guidad preparation för en partialkrona. Notera att frisk tandvävnad sparats och att preparationsgränserna är väldefinierade inför den kommande avtryckstagningen.

Figur 5: Digitalt avtryck och datorstödd design av ersättningen.

Figur 6: Partialkronan som frästs ut ur KATANA™ AVENCIA™ Block 2 HT. Observera den anatomiska karaktäriseringen som gynnar den estetiska integrationen.

Inför definitivcementeringen en vecka senare (Fig. 7) rengjordes både kronans insida och den preparerade tanden med KATANA Cleaner. Denna universalrengörare innehåller MDP-salt (baserat på MDP-teknologi), som på bara tio sekunder effektivt tar bort föroreningar av blod och saliv, både intra- och extraoralt (Fig. 8). Målet var att skapa optimal adhesion och på så sätt bidra till en förutsägbar och hållbar adhesivcementering.

Figur 7: Behandlingsområdet isoleras med kofferdam innan den adhesiva cementeringen påbörjas.

Figur 8: Kronans inneryta förbereds kemiskt genom sandblästring med aluminiumoxidpartiklar och rengörs med KATANA™ Cleaner.

Emaljen selektivetsades återigen med K-ETCHANT Syringe, följt av applicering av CLEARFIL Universal Bond Quick 2. Denna nya generations universaladhesiv kännetecknas av det förenklade protokolllet, med endast
en snabb applicering utan väntetid och samtidigt ger utmärkt vätbarhet och hållbar vidhäftning till både emalj och dentin (Fig. 9)

Figur 9: Rengöring av tandstrukturen med KATANA™ Cleaner, därefter emaljetsning och applicering av CLEARFIL™ Universal Bond Quick 2. Notera det förenklade protokollet för adhesiven.

Definitivcementeringen gjordes med PANAVIA SA Cement Universal Automix (Universal – A2). Detta självadhesiva universalcement innehåller både MDP-monomer och det innovativa LCSi-silanet som möjliggör kemisk bindning till zirkonia, kompositer och keramer utan ytterligare primers. Produkten är enkel att handha och överskotten enkla att avlägsna: Ett inledande två till fem sekunders ljushärdningsprotokoll gör att cementöverskottet enkelt och kontrollerat kan avlägsnas, underlättar den kliniska hanteringen och optimerar den adhesiva cementeringen. (Figs. 10, 11 och 12). Kombinationen av KATANA™ Cleaner, CLEARFIL™ Universal Bond Quick 2 och PANAVIA™ SA Cement Universal främjar ett förenklat, effektivt och arbetsflöde utan överraskningar. Det möjliggör en arbetsgång med färre komponenter och kliniska moment som inte kompromissar med vare sig bindningskvaliteten eller ersättningens livslängd.

Figur 10: Partialkronan definitivcementeras adhesivt med PANAVIA™ SA Cement Universal Automix (Universal - A2).
Lägg märke till kronans fina passform och den kontrollerade appliceringen av cement under cementeringen.

Figur 11: Avlägsnande av cementöverskott följt av punktvis härdning av PANAVIA™ SA Cement Universal Automix.

Figur 12: De viktigaste produkterna i den restaurativa proceduren, i enlighet med Kuraray Noritake Dental Inc.s koncept “Universal Excellence”.

Slutligen justerades ocklusionen och ersättningen yta polerades med TWIST DIA for Composite. Detta diamantbaserade tvåstegssystem har kapacitet att snabbt leverera en naturlig och bestående glans på både direkta och indirekta ersättningar (Figs. 13, 14 och 15).

Figur 13: Ersättningen slutpoleras med TWIST™ DIA for Composite.

Figur 14: Lateral vy av den hybridkeramiska partialkronan omedelbart efter adhesivcementering.
Observera den utmärkta kantanslutningen, anatomin och optiska integreringen.

Figur 15: Klinisk dokumentation och röntgen en månad efter adhesivcementering.

SAMMANFATTNING OCH KLINISKA SLUTSATSER

Införlivandet av universalmaterial i de digitala, restorativa protokollen ger stöd för förenkling av indirekta, adhesiva behandlingar och optimerar samtidigt den kliniska effektiviteten och minskar dessutom teknikkänsligheten. Kombinationen av CAD/CAM-framställda ersättningar och adhesiver och cement av universaltyp underlättar bevarande, effektiva och höggradigt förutsägbara behandlingar, helt i linje med kraven inom den samtida tandvården.

Litteratur:

1. Tian F, Jett K, Flaugher R, Arora S, Bergeron B, Shen Y, Tay F. Effects of dentine surface cleaning on bonding of a self-etch adhesive to root canal sealer-contaminated dentine. J Dent 2021;112:103766.
2. Breschi L, Van Meerbeek B. Editorial: Universal adhesives – to etch or not to etch? J Adhes Dent 2021;23(4):283.
3. Breschi L, Maravic T, Mazzitelli C, Josic U, Mancuso E, Cadenaro M, Pfeifer CS, Mazzoni A. The evolution of adhesive dentistry: From etch-and-rinse to universal bonding systems. Dent Mater 2025;41(2):141–158.
4. Maravić T, Mazzitelli C, Mancuso E, Del Bianco F, Josić U, Cadenaro M, Breschi L, Mazzoni A. Resin composite cements: Current status and a novel classification proposal. J Esthet Restor Dent 2023;35(7):1085–1097.
5. Sulaiman TA, Abdulmajeed AA, Altitinchi A, Ahmed SN, Donovan TE. Mechanical properties of resin-based cements with different dispensing and mixing methods. J Prosthet Dent 2018;119(6):1007–1013.