Case by Dr. Onur Alp Yünük

Beautiful teeth, a bright, flawless smile: Meeting the aesthetic demands of patients asking for veneer treatment can be challenging. While some patients share concrete ideas on how their new teeth should look, it is more difficult for others to express their expectations. In this case, it is important to select a treatment approach that allows for modifications – be it in the form of an extended planning phase including digital smile design or by placing composite restorations that can be easily modified intraorally.

The latter approach was selected for a young female patient who presented to our clinic as she was dissatisfied with her composite veneers that had been placed on the upper incisors (Figs. 1 to 4). During intraoral examination, it became evident that the existing restorations on her maxillary incisors and canines had irregular, rough surfaces, discoloured margins and compromised structural integrity of the composite material. In accordance with these findings, removing the existing restorations at the maxillary anterior teeth and re-establishing optimal aesthetic and functional integrity with new direct composite restorations were planned (teeth between #13 - #23 according to the FDI notation). The patient stated that she would like us to add more individuality and character to her teeth and have a brighter smile than with her existing restorations.

Fig. 1. Composite veneers on the maxillary incisors showing aesthetic and functional integrity issues.

Fig. 2. Occlusal view of the maxillary anterior teeth with visible defects in the composite veneers.

Fig. 3. Lateral view from the right revealing surface irregularities.

Fig. 4. Lateral view from the left revealing a large debonded and chipped area.

REPLACEMENT OF THE COMPOSITE VENEERS

To reproduce the translucency characteristics of the patient’s natural teeth and fulfil her aesthetic demands, the use of a polychromatic layering system and a dual-layer technique was planned. This would allow for a nice play of translucencies in the anterior area.

During the shade selection phase, the Bilaminar Shade Assessment Technique (BSAT) was employed, which is based on the color combination of dentin and enamel composites. In this technique, the intended enamel shade was stratified over the target dentin chroma to evaluate the resultant shade created by the two composite color layers. The materials were polymerized on the tooth surface without bonding agents; thus, the cumulative color perception resulting from stratification, rather than the individual shades of the materials, was verified for harmony with the natural tooth structure at the onset of treatment. Photos were taken with a camera equipped with a cross-polarized filter (Fig. 5). Subsequently, the fixed retainer was removed, as were the existing composite veneers. To save as much of the underlying healthy tooth structure as possible, the procedure was performed under magnification and blue-light illumination. The selected instruments were red- and yellow-band diamond burs as well as tungsten carbide burs. Figure 6 shows the result of the procedure.

Fig. 5. Shade determination – image taken with the aid of a cross-polarizing filter that eliminates reflections.

Fig. 6. Teeth after the removal of the deficient composite veneers.

The teeth were isolated using rubber dam, which was secured with floss in the cervical area. Then, restoration procedures were initiated on the teeth. After etching of the enamel and application of a self-etching bonding agent (CLEARFIL™ SE Bond 2, Kuraray Noritake Dental Inc.), CLEARFIL MAJESTY™ ES-2 Premium (Kuraray Noritake Dental Inc.) was applied: The dentin core with its pronounced mamelons was modelled using the shade A1D. The incisal edges and mamelons were highlighted with spots of white tint. To create an opalescent effect, a thin layer of the translucent shade Blue was placed on top, while the enamel parts were built up with the enamel shade WE. Since the retainer had been removed, a clear aligner was fabricated and delivered to the patient at the end of the session for use until the subsequent appointment.

Fig. 7. Isolation with rubber dam for restoration of the lateral incisors and canines.

Fig. 8. Vestibular enamel layer applied to the teeth.

Fig. 9. Shape and shade of the restorations created according to the patient’s expectations.

After finishing and polishing with Twist DIA for composite, the patient was sent home and a new appointment was made for re-evaluation and final adjustments.

In the control appointment, the patient asked us to slightly reduce the incisal translucencies and brightness in her maxillary incisors and alter the shape of all restored teeth: She requested longer maxillary central incisors with softer, more rounded line angles and a smoother incisal contour. Rubber dam was placed again. Then, the vestibular surfaces of the composite restorations on the maxillary incisors were reduced slightly using red- and yellow-band diamond burs. To roughen the surface and enhance the topography for optimal micromechanical interlocking, the composite surface was sandblasted with 50-μm aluminium oxide particles. Phosphoric acid etchant, silane and CLEARFIL™ SE Bond 2 were applied sequentially as part of the adhesive protocol. The restorations were then modified by lengthening, shade correction using CLEARFIL MAJESTY™ ES-2 Premium in the shades A1D and A1E and refining of the anatomical contours (Figs. 10 and 11).

Fig. 10. Modification of the central incisor restorations.

Fig. 11. Modified smile with more regular tooth forms and contours as well as a more natural tooth shade.

During this final appointment, the patient expressed that she was very happy with her new smile. The restoration surfaces were re-polished, a new retainer was bonded and final photographs were taken (Figs. 12 to 16).

Fig. 12. Final treatment outcome – frontal view.

Fig. 13. Final treatment outcome – occlusal view.

Fig. 14. Final treatment outcome – lateral view.

Fig. 15. Final treatment outcome – the patient’s smile.

Fig. 16. Detailed view of the inner colour structure – made visible with the aid of a polarized filter.

CONCLUSION

Talking to patients about every detail of the treatment and listening attentively to their ideas, expectations and demands does not always protect us from adjustments – simply because they need to see what they get to be able to judge if they like it. Luckily, selecting appropriate materials and techniques enables dental practitioners to create new smiles that can be modified without harming healthy tooth structure, so that making even the most demanding patients happy is no longer a challenge.

Dentist:

ONUR ALP YÜNÜK

Dr. Onur Alp Yünük completed both his undergraduate and doctoral education at Istanbul University. He currently serves as an Assistant Professor in the Department of Restorative Dentistry at the Istinye University Faculty of Dentistry. His work primarily focuses on direct composite restorations of anterior teeth and on polychromatic layering systems.

“Adding new value to dental care”

Few manufacturers can claim one century of innovation. However, as Kuraray celebrates its 100^th anniversary, its subsidiary, Kuraray Noritake Dental—shaped by this legacy—remains humble and focused on its holistic vision for improving the delivery of oral care.

Reflecting on this centenary, Satoshi Yamaguchi, president of Kuraray Noritake Dental, shares his perspective on how the company’s long-standing ethos continues to shape its direction. In this exclusive interview, he discusses Kuraray Noritake Dental’s latest solutions and the way the company combines scientific expertise with consistent quality, clear and evidence-based information, support grounded in everyday clinical needs, and a stable supply chain. The ultimate aim, Yamaguchi says, is to bring new value to dental care and contribute to more reliable and efficient clinical practice.

Mr Yamaguchi, could you tell us about your professional background and how you first joined Kuraray?

My Kuraray journey began with a strong aspiration to contribute to public health. I was drawn to the company’s extensive expertise in chemical manufacturing and the potential to apply its technologies in the medical field. I started in the medical development division, where I was involved in research and development activities. Later, I transitioned to a marketing role at Kuraray America and, upon returning to Japan, resumed my position in development. This allowed me to engage with the dental healthcare business from both a technical and a commercial perspective. Subsequently, I served as head of the dental business at Kuraray Europe in Germany, where I oversaw sales operations across the European region. These international experiences have profoundly shaped my professional approach, enabling me to lead with a global mindset and remain attuned to the specific needs of local markets.

How has this international experience shaped your approach as president of Kuraray Noritake Dental?

Through my international assignments, I came to recognise the importance of addressing the diverse values held across different countries and regions. In the field of dental materials, preferences often differ. In many parts of Europe and Asia, natural aesthetics are widely valued; in the US, treatment efficiency is often prioritised; and in South America, there is often an emphasis on balancing aesthetics with cost-effectiveness. Although these are general tendencies and can vary, they provide a useful guide in meeting the specific needs of each market.

Satoshi Yamaguchi, president of Kuraray Noritake Dental, previously served as head of Kuraray Europe’s dental business, based in Germany.

My goal is to establish a robust framework for delivering reliable, evidence-based information to dental professionals. We are striving to strengthen the foundation of trust by facilitating the collection of credible data and case studies from both internal and external sources, ensuring that the information we provide contributes to greater confidence in clinical practice. In addition, we place strong emphasis on how this information is communicated. By leveraging multiple channels—presentations at academic conferences and seminars, contributions to journals and communication through digital platforms, for example—we are creating an integrated system that ensures our messages reach dental professionals effectively.

How does Japan’s role as a dental innovation hub influence the company’s global operations?

In Japan, there is a focus on creating scientifically proven technologies and transforming them into trusted dental solutions. At Kuraray, a prime example is our original adhesive monomer, MDP. This solution exhibits exceptional bond strength, even when using traditionally difficult substrates such as metals and zirconia. Today, MDP is recognised as a proven global standard in adhesive monomers and is widely used by dental material manufacturers around the world.

Scientifically valid technologies developed in Japan are being utilised in clinical settings worldwide, supported by reliable, evidence-based information. This tradition is a driving force behind Kuraray Noritake Dental. We honour it by prioritising materials that can function like natural tooth substances over the long term in the oral environment—ensuring clinical reliability through durability, defined as the preservation of strength and aesthetics. Building on this foundation, we continuously enhance the value of our products by expanding indications and improving usability.

How important is the European market in your overall strategy?

The European market plays a vital role in advancing our efforts in quality assurance and information dissemination. Given the strictly enforced medical device regulations and environmental laws, we proactively work to enhance quality and reliability in our operations in the region, including in the areas of product design, packaging and product information. In turn, these initiatives help to improve the accuracy of product development and information dissemination for all markets.

At the same time, we are strategically expanding our global business operations, focusing on the US, Asia and South America. To ensure the consistent delivery of high-quality products and services, we are working in close collaboration with local dental professionals, educational institutions and partner companies. By leveraging the expertise gained through our operations in Europe and adapting this to the unique needs and cultures of other regions, we continue to provide reliable solutions for dental professionals worldwide.

Kuraray Noritake Dental introduced several new materials last year. What can you tell us about these materials and the clinical needs they were designed to meet?

At the 2025 International Dental Show, we introduced CLEARFIL MAJESTY ES Flow Universal, CLEARFIL Universal Bond Quick 2 and CERABIEN MiLai. These products are based on our concept of Universal Excellence, a philosophy that emphasises scientifically grounded performance and outcomes.

Dental practitioners in clinical settings seek materials that they can use with confidence. To meet these needs, we ensured that these materials embody the principles of Universal Excellence. This means versatile, high-performance solutions that streamline clinical workflows by minimising the number of required components and procedural steps. In this way, the products support decision-making in daily dental practice and laboratory work.

KATANA Zirconia is recognised for aesthetics and strength. What sets your proprietary zirconia powder and multilayer technology apart in today’s competitive CAD/CAM market?

We consistently develop and manage raw material powders in-house. By focusing on proprietary material development, we have created high-quality dental zirconia that combines aesthetics and mechanical strength. In addition, our advanced manufacturing technologies and strict quality control standards ensure stable and reliable product quality. Furthermore, by utilising our proprietary zirconia powder and working closely with manufacturers of milling machines and sintering furnaces, we have significantly reduced both processing and sintering times in the fabrication of zirconia restorations.

One notable example is KATANA Zirconia ONE SPEED CROWN, which supports a streamlined chairside workflow. We have developed a new zirconia powder that can reach a highly activated state with little energy. This accelerates the sintering process, thereby achieving an ultra-short sintering time of just 9 minutes. Furthermore, our zirconia and multilayer technology enable natural gradation by varying both shade and translucency across the layers of the zirconia disc—closely replicating the appearance of natural teeth. In KATANA Zirconia YML, each layer contains a different concentration of yttria: the upper layers offer natural colouration and high translucency, and the lower layers deliver superior strength. Owing to this advanced material design and multilayer technology, the KATANA Zirconia series combines outstanding aesthetics and mechanical performance and contributes to greater efficiency in clinical workflows.

Kuraray has regional offices in China and Brazil. How do you adapt product development and clinical education to the diverse needs of these fast-growing markets?

China and Brazil are two of the world’s fastest-growing dental care markets, characterised not only by their large populations but also by a growing interest in quality dental care, rapidly advancing adoption of CAD/CAM technologies and ongoing development of clinical dental education. We address these evolving needs by delivering products and clinical support tailored to the specific dental requirements and educational styles of each country.

For example, we continue to meet the demand for our adhesive dental materials—such as the CLEARFIL and PANAVIA series—by offering hands-on seminars and webinars in local languages. By sharing clinically relevant information backed by scientific evidence, we contribute to improving the quality of local dental care.

In addition, user feedback gathered through our local offices serves as a valuable source of insight for product development. By incorporating market-specific trends, preferences in product handling and differences in clinical education styles into the development of new products, we can deliver locally optimised quality solutions.

Kuraray Noritake Dental is expanding production at its new plant in Miyoshi in Japan. How will this affect supply chain resilience and product innovation?

Leading up to this year, we significantly strengthened our global supply system for dental materials. At the heart of this initiative was the strategic expansion of production capacity at our Miyoshi plant, where we ultimately aim to roughly double production capacity. This facility specialises in the manufacturing of inorganic dental materials such as zirconia and porcelain and plays a critical role in our business strategy through technological expertise, rigorous quality control and product development capabilities.

Additionally, by strengthening collaboration between our manufacturing site and our research and development, we are working to establish a system that enables rapid incorporation of feedback from clinical settings into product improvements. These efforts also contribute to enhancing our product development capabilities, allowing us to deliver dental material products that meet market needs in a timely manner. We view this as a vital step towards better meeting the expectations of dental professionals worldwide and elevating our market presence.

As the Kuraray Group marks its 100^th anniversary, what vision is Kuraray Noritake Dental pursuing for the future of dental care?

Our anniversary presents an opportunity to reflect on the spirit that has shaped the company over the last 100 years. At the heart of our company lies a philosophy of embracing challenges: “For people and the planet—to achieve what no one else can”. Long before the term “corporate social responsibility” became widespread, we were addressing social issues through the power of technology and developing materials that improve lives. That ethos continues to underpin our business today.

Since entering the dental industry as a chemical products manufacturer, we have remained committed to craftsmanship and quality. As noted earlier, because dental materials are used inside patients’ mouths over extended periods, we consider durability to be a particularly critical factor. This durability encompasses strength and aesthetics, which together form the foundation of reliable clinical performance.

However, even products backed by advanced technology may not fully convey their intrinsic value to users. That is why we strive to provide reliable, evidence-based information and deliver trusted products to clinical settings.

What can you tell us about future initiatives at the company?

Through collaborative product development with dental clinicians, we aim to incorporate more insights from the front lines of dental care. By actively listening to dental professionals and technicians, we aim to further address the real-world challenges that they face and deliver products that more effectively meet daily clinical demands. We also aim to build greater trust with dental clinicians by sharing reliable, evidence-based information and clearly communicating the scientific evidence and development background behind our products. Additionally, in support of our commitment to sustainability, we aim to offer responsible choices to users through designing products with environmental considerations in mind and reducing our overall environmental impact.

Through these initiatives, we will continue adding new value to dental care by leveraging our material design expertise, which is rooted in the founding spirit of our company. We aspire to remain a trusted partner for dental professionals around the world—one that they can rely on with confidence.

Originally published on Dental Tribune website on March 4^th, 2026.

Clinical case by Dr. Giuseppe Iacona

The Flowable Injection Technique represents an innovative and predictable approach for the direct aesthetic restoration of one or more teeth in a single appointment (Fig. 1). This methodology, resulting from close collaboration between clinician and technician, allows reproducible results from the very first intervention, offering patient comfort and long-term durability.

In the case presented, the patient wished to close a diastema between the mandibular central incisors (teeth #31 and 41 according to the FDI notation; Fig. 1). Following clinical, radiographic and periodontal assessment, the injection technique was selected, ruling out orthodontic treatment and veneer solutions.

Fig. 1. Extraoral photographs of the patient: initial situation.

The technique involves the injection of flowable composite through a transparent index (made of silicone or 3D-printed resin), produced from a digital or conventional mock-up (Figs. 1 to 2). It represents a viable treatment option thanks to the combination of advanced composite materials and digital technology.

Intraoral and facial scans were taken to create digital models of the patient’s maxilla and mandible (Fig. 2). Matching the scans made it possible to virtually simulate the initial situation. Based on this dataset, a wax-up was generated and converted into a 3D-printed model and a putty index for wax-up transfer into an intra-oral mock-up.

Transferred into the patient’s mouth through injection of the material into the index, the mock-up (Fig. 3) allowed aesthetic and functional evaluation by providing a preview of the final outcome.

Fig. 3. Mock-up in the patient’s mouth.

Subsequently, the two direct veneers were fabricated using the Flowable Injection Technique in a single appointment (Fig. 4). After placing gingival retraction cords with astringent gel (Fig. 5), isolation with PTFE tape was performed and the surfaces were etched (Figs. 6 and 7), followed by application of the adhesive CLEARFIL™ Universal Bond Quick 2 (Kuraray Noritake Dental Inc., Fig. 8).

Fig. 4. Baseline.

Fig. 5. Application of retraction cords soaked in astringent gel.

Fig. 6. Isolation of adjacent teeth with dental PTFE tape.

Fig. 7. Etching with phosphoric acid etchant.

Fig. 8. Application of CLEARFIL™ Universal Bond Quick 2.

Fig. 9. Injection indices.

Fig. 10. Placement of the injection index.

Fig. 11. Final treatment outcome.

FINAL CONSIDERATIONS

CLEARFIL MAJESTY™ ES Flow Universal (Kuraray Noritake Dental Inc.) stands out for its excellent aesthetic properties, high compressive and flexural strength, and outstanding blend-in ability. Its translucency characteristics, which vary according to thickness, allow for a polychromatic effect using a single material, particularly in the universal variant. The material’s chameleon effect supports seamless colour integration with adjacent teeth, making the restoration indistinguishable from natural tooth structure. This provides for long-term durability, a low incidence of fractures and highly satisfactory results, making it ideal for addressing a wide range of aesthetic and functional requirements.

Dentist:

GIUSEPPE IACONA

Case by Jotautas Kaktys, DDS

Post-endodontic restorative treatments can be quite challenging, mainly because so many decisions need to be made. It is up to the clinician to evaluate the structural condition of the tooth to decide whether a direct or indirect restoration should be selected, which cusps to overlay and which ones to keep, and whether a post or fiber placement is required. Depending on the amount and condition of remaining tooth structure, a direct or indirect restorative approach may be more adequate; while selecting the indirect approach means they have the choice between lots of different restorative materials and restoration designs.

A CASE AS AN EXAMPLE

At our &SMILE clinic in Kaunas, Lithuania, the main goal is always to preserve as much natural tooth structure as possible without compromising the longevity of the restoration. Consequently, we opt for the least invasive approach reasonable, thereby using materials that mimic the mechanical and optical properties of the natural dentition. In this context, hybrid ceramics such as KATANA™ AVENCIA™ Block 2 are often a valuable choice.

The following case is used as an example to demonstrate the biomimetic approach in a situation that required an endodontic revision followed by an indirect restoration of the tooth that had previously been restored with composite.

STRUCTURALLY COMPROMISED MOLAR RESTORATION

The patient came in for a regular routine checkup. A massive composite restoration on her maxillary right first molar (FDI notation: tooth #16) attracted our attention as it appeared to be structurally compromised: Clinical examination revealed some occlusal porosities along the restoration margin, as well as cracked and chipped areas (Fig. 1). The buccal margin was stained and leaky (Fig. 2), while on the palatal surface, some micro-cracks were visible in the surrounding tooth structure (Fig. 3).

Fig. 1. Initial clinical situation with a large composite restoration that shows porosities at the margin.

Fig. 2. Buccal surface of the first molar with a stained, leaky margin.

Fig. 3. Palatal surface with micro-cracked tooth structure.

As the tooth had been endodontically treated elsewhere several years ago, a radiograph was taken (Fig. 4). This radiograph revealed that the canals were not filled to the apices of the roots. However, as the patient showed no symptoms, the decision was made to go for an indirect restoration without any endodontic retreatment: Reasons to opt for an indirect restoration included the large size of the existing composite restoration and the compromised condition of the surrounding tooth structure. Cementing indirect restorations offers additional benefits of virtually no polymerization shrinkage as well as minimal stress to the remaining and already compromised tooth structure and results in better mechanical properties. The tooth shade was determined immediately: The adjacent premolar had a tooth shade resembling A3 in the middle third, while the occlusal third showed some whitish spots and appeared brighter, similar to A2 (Fig. 5). This information was recorded for the dental laboratory.

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Clinical case by Dr. Claudia Mazzitelli and Dr. Edoardo Mancuso

INTRODUCTION

Dental aesthetics are gaining increasing importance and require predictable, rapid, and affordable treatments. Minimally invasive dentistry favours direct restorations, which are now simplified by the evolution of flowable composites. Recent variants of flowable composites offer optical and mechanical characteristics equal or superior to those of paste-type composites. The evolution of flowable resins has led to widespread application using the flowable injection technique (FIT). In addition, the possibility of 3D printing an index for injection reduces operator-dependent variability, providing for high-level aesthetics.

CLINICAL CASE

A 24-year-old patient complained of an unattractive smile. After clinical and radiographic examinations, an aesthetic restoration using FIT was planned. A digital wax-up, created on the basis of intraoral scans (Trios 5, 3Shape), allowed for the design of a customised index or template, which was printed using transparent resin (IBT Flex Resin, Formlabs). After preparation and isolation, the teeth were sandblasted, etched, and a universal adhesive (CLEARFIL™ Universal Bond Quick 2) was applied and light-cured. Flowable composite (CLEARFIL MAJESTY™ ES Flow Low) was injected through the injection holes in the index, followed by thorough curing, finishing and polishing (TWIST™ DIA for Composite, all Kuraray Noritake Dental Inc.).

RESULTS

The treatment, completed in two hours, led to immediate and stable aesthetic improvement, confirmed during check-ups after one week and six months, with excellent gum health and restoration maintenance.

DISCUSSION

FIT offers predictable aesthetic results, a digital workflow option, and reduced clinical time compared to indirect restorations, while maintaining the possibility of future prosthetic treatments. The evolution of flowable composites and 3D-printed indexes has improved the accuracy of clinical transfer and reproducibility, allowing for rapid, conservative aesthetic solutions.

CLINICAL CASE

A 24-year-old male patient presented at our practice dissatisfied with the aesthetics of his smile, with an impact on his spontaneity and social life. After taking his medical and dental history, an interview was conducted to understand his aesthetic and functional expectations as well as financial possibilities.

The clinical visual examination, accompanied by photographs, static and dynamic videos, periodontal analysis, and radiographs, revealed incongruous Class IV restorations on teeth 11 and 21 (FDI notation), with asymmetry of the anterior maxillary region  (Fig. 1). Aesthetic rehabilitation using the Flowable Injection Technique (FIT) extended to the six maxillary anterior teeth was therefore proposed.

Fig. 1. Initial clinical situation.

TREATMENT PLANNING

An intraoral scanner (Trios 5, 3Shape) was used for impression taking. The resulting digital model was used to create a digital wax-up, which then served as the basis for digitally designing an index for the injection of the flowable composite (Fig. 2). The index was printed in transparent resin (IBT Flex Resin, Formlabs) (Fig. 3). Once post-processing was complete, calibrated injection holes were integrated. They allow for insertion of the syringe tip and precise injection of the flowable composite (Fig. 4).

Fig. 2. Computer-aided index design.

Fig. 3. 3D-printed transparent index for composite injection.

Fig. 4. Injection holes integrated in the incisal areas of the index.

OPERATIVE PROCEDURE

After obtaining informed consent from the patient, the old restorations on the maxillary central incisors were removed with diamond burs under irrigation. The margins were finished and bevelled (Fig. 5). The index was positioned on the upper arch and evaluated for stability and retention. To produce the restorations alternately, PTFE tape (0.076 mm) was applied to isolate the adjacent teeth. The surfaces of the teeth to be restored were sandblasted with aluminium oxide (50 µm), etched with 37 % orthophosphoric acid etchant for 15 seconds, rinsed, and dried (Fig. 6).

Fig. 5. Maxillary central incisors after restoration removal and bevelling of the margins.

Fig. 6. Etching of the tooth surfaces with orthophosphoric acid etchant.

A universal adhesive (CLEARFIL™ Universal Bond Quick 2, Kuraray Noritake Dental Inc.) was then applied (Fig. 7) and polymerized with an LED curing light (SmartLite® Pro, Dentsply Sirona) for 10 seconds per tooth (Fig. 8).

A flowable composite (CLEARFIL MAJESTY™ ES Flow Low, colour W, Kuraray Noritake Dental Inc.) was injected through the holes until the index of the first prepared tooth was filled (Fig. 9). After light-curing for 40 seconds per tooth through the transparent index, the template was removed and the restoration was light-cured for a second time. Excess composite was then removed with a scaler.

Fig. 7. Application of a universal adhesive.

Fig. 8. Light-curing of the adhesive layer.

Fig. 9. Flowable composite injection.

The same procedure was subsequently repeated for the other teeth to be treated, isolating those already restored using PTFE tape (Figs. 10 to 15).

Fig. 10. Restored teeth isolated with PTFE tape.

Fig. 11. Etching of the tooth structure with 37 % orthophosphoric acid etchant.

Fig. 12. Application of the universal adhesive.

Fig. 13. Light-curing of the adhesive layer.

Fig. 14. Injection of the flowable composite into the index.

Fig. 15. Light-curing of the flowable composite through the transparent index.

Once the index was removed and excess material was eliminated. Then, the teeth were isolated with rubber dam using the split dam technique to improve patient comfort and visibility, and the restorations were finished with fine-grained diamond burs. Finally, progressive polishing was performed with polishing discs  (TWIST™ DIA for Composite, Kuraray Noritake Dental Inc.) (Figs. 16 and 17).

Fig. 16. Polishing of the restorations with the pre-polisher.

Fig. 17. Final polishing with the high-gloss polisher.

CLINICAL RESULTS

Once the restorations were completed (Figs. 18 and 19) and the occlusal and dynamic contacts were checked, the patient expressed immediate satisfaction. This was confirmed at the one-week follow-up (Fig. 20). The rehabilitation took a total of two hours, including photographic documentation. This represents a rapid, minimally invasive and cost-effective treatment compared to indirect restorations.

Fig. 18. Treatment outcome.

Fig. 19. Detailed view of the freshly restored teeth.

Fig. 20. Post-operative photograph taken after one week.

The six-month check-up (Figs. 21 and 22) not only confirmed the survival of the restorations but also showed excellent gingival health, demonstrating the correctness of the emergence profile and the high polishability of the cervical margins obtained with this restorative technique.

Fig. 21. Restorations at the six-month recall.

Fig. 22. Optical integration of the new restorations into the overall picture.

DISCUSSION

The Flowable Injection Technique is now a valid alternative in the field of direct restoration, as it combines operational simplicity with predictable aesthetic results. The main advantage lies in the reduction of variability linked to the operator's manual skills, thanks to the guiding role of the index, which allows the digital design or initial wax-up to be transferred with high accuracy. The aesthetic outcome is therefore highly controllable, while the clinical approach complies with the principles of minimally invasive dentistry. Added to this is the efficiency of the method, which allows for shorter operating times and lower costs compared to rehabilitation with indirect restorations. At the same time, it maintains the possibility of a subsequent transition to more complex prosthetic solutions.

A key enabler of this approach is the evolution of flowable composites. The latest generation has overcome the historical limitations of fragility and wear, offering mechanical and optical characteristics comparable to, if not superior to, paste-type composite materials. This progress has made it possible to use flowable materials not only as a complementary support, but as the real protagonist of a restorative technique that aims to simplify clinical work and improve the predictability of results.

Furthermore, the development of 3D printing applied to the production of transparent indexes has introduced a further leap in quality. The digital workflow makes it possible to reduce manufacturing times, standardize procedures, achieve high reproducibility, and design customized templates based on intraoral scans. The accuracy of clinical transfer is thus significantly increased, with a positive impact on the quality and stability of the final restoration.

The synergy between high-performance flowable resins and 3D-printed digital index therefore offers clinicians the option of offering patients aesthetic solutions that are rapid, accessible, and at the same time adhere to the principles of modern conservative dentistry.

CONCLUSION

The Flowable Injection Technique, supported by the latest generation of flowable composites and the potential of 3D printing, represents a modern and effective restorative strategy. The clinical case presented highlights how it is possible to offer patients a satisfactory, rapid, and conservative aesthetic treatment, while keeping open the option of a future transition to indirect restorations.

By combining innovative materials and digital technologies, this technique marks a step forward towards increasingly predictable, accessible, and patient-centred cosmetic dentistry.

Dental technicians:

CLAUDIA MAZZITELLI

Scientific director of the Dental Biomaterials Laboratory.

Clinical tutor for the International Master's Degree in Conservative Dentistry and Aesthetic Prosthetics, head of teaching activities for the Degree Course in Dental Hygiene at the University of Bologna.

Speaker at numerous national and international conferences and author of scientific publications in high-impact indexed journals.

EDOARDO MANCUSO

Expert in conservative and prosthetic dentistry with a minimally invasive approach.

Collaborates with international research groups on adhesive techniques and minimally invasive preparations.

Practices as a freelancer in Bologna.

Speaker and author of scientific papers presented at national and international conferences, publishes articles in leading scientific journals.

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Hulac S, Kois JC. Managing the transition to a complex full mouth rehabilitation utilizing injectable composite. J Esthet Restor Dent. 2023 Jul;35(5):796-802. doi: 10.1111/jerd.13065.

Lawson NC, Greene Z, Machado N, Tadros D, Robles A, Rocha M. Resin Composite Depth of Cure Through Transparent Matrix Materials Used for Injection Molding. Oper Dent. 2025 Mar 1;50(2):185-193. doi: 10.2341/24-100-L.

Case by Dt. Koray Kendir, DDS, Turkey (İzmir)

SAMMANFATTNING

Det här fallet visar hur en posterior kompositfyllning framställs med hjälp av Kuraray Noritake Dental Inc.s produktkoncept “Universal Excellence” En universaladhesiv (CLEARFIL™ Universal Bond Quick 2) och komposit med universalfärg och med hög fillerhalt (CLEARFIL MAJESTY™ ES Flow Universal) användes för göra behandlingen både enkel och förutsägbar. Steg-för-steg visas torrläggning, preparation, elevation av en subgingival preparationsgräns, adhesivprotokoll och slutlig ersättning.

FALLBESKRIVNING

En 38-årig kvinna sökte sig till kliniken på grund av besvär med ilningar och gingival blödning mellan den vänstra hörntanden och den första premolaren i överkäken (tand 23 och 24, enligt FDI). Den kliniska undersökningen avslöjade en blottad preparationsgräns och sekundärkaries i det gingivala området under den befintliga lagningen på 23dp. Efter torrläggning med kofferdam påbörjades den stegvisa behandlingen.

BEHANDLINGSGÅNG

Steg 1. Tand 23 uppvisade blottad preparationsgräns och karies (Fig. 1).

Steg 2. Emalj avverkades, karies exkaverades ner till i nivå med gingivan. Kariesskadan på tand 24 omfattade även det subgingivala området (Fig. 2).

Steg 3. Efter fullständig exkavering av kariesangreppet och justering av preparationen blev det tydligt att preparationsgränsen på tand 24 behövde höjas upp, sk deep margin elevation, (DME) (Fig 3).

Steg 4. DME utfördes på tand 24 med hjälp av en specialgjord kil. Först selektivetsades ytan men CLEARFIL™ Universal Bond Quick 2  följt av CLEARFIL MAJESTY™ ES Flow Universal (Super Low) (Fig. 4 0ch 5).

Steg 5. När preparationsgränsen flyttats koronalt förbereddes tänderna med passande matrisband och tänderna 23 och 24 fylldes med CLEARFIL MAJESTY™ ES Flow Universal (Super Low) (Figur 7 och 9). Det här lite knepiga fallet, som krävde DME, kunde hanteras med effektivitet och framgång tack vare att materialet är lätthanterat, har så fin färgadaption och utmärkta poleringsegenskaper

Behandlingsresultatet kan du se i figur 10 och 11.

Fig. 1: Preoperativ bild med kofferdam för torrläggning.

Fig. 2: Klinsik bild efter kavitetsutforming, inna kariesexcavering gjorts.

Fig. 3: Färdigexcaverade och justerade kaviteter med subgingival preparationsgräns på premolaren.

Fig. 4: En specialanpassad kil på plats inför att höja cervikala kanten med komposit.

Fig. 5: Buckal vy av tänderna. Cervikala gränsen på 24 förhöjd med hjälp av universalprodukter.

Fig. 6: Ocklusal vy av tänderna. Cervikala gränsen på 24 förhöjd med hjälp av universalprodukter.

Fig. 7: Matrisband på plats.

Fig. 8: Buckal vy. Tänderna lagade med en flytande komposit med viskositeten Super low och färgen Universal.

Fig. 9: Ocklusal vy. Tänderna lagade med en flytande komposit - universalfärg.

Fig. 10: Ocklusal vy. Det färdiga resultatet på 23 och 24 uppvisar matchande färg, anatomi och ytglans.

Fig. 11: Buckal vy. Det färdiga resultatet på 23 och 24 uppvisar matchande färg, anatomi och ytglans.

DISKUSSION

Universaladhesiver och moderna flytande kompositer är mindre teknikkänsliga och det förenklar posteriora direktfyllningar och ger hållbara resultat. I det här fallet gav CLEARFIL™ Universal Bond Quick 2 god adhesion med minsta möjliga arbetstid. Den flytande universalkompositen uppvisar utmärkt anpassning, polerbarhet och hållbarhet. Till och med i det här fallet - med subgingival preparationsgräns som krävde höjning av cervikala kanten - kunde behandlas med en smidig metod utan kompromissad kvalitet.

CONCLUSION

Kombinationen av CLEARFIL™ Universal Bond Quick 2 och CLEARFIL MAJESTY™ ES Flow Universal ger förutsägbara och effektiva posteriora fyllningar. Materialens mångsidiga användning och enkla hantering ryms i konceptet “Universal Excellence” som gör det dagliga arbetet enkelt och tryggt.

Etik & tydlighet

Alla procedurer följde standardförfarande för tandbehandlingar. Patienten har lämnat samtycke till behandling och publicering av anonymiserade kliniska bilder. Artikelförfattarna samarbetar med Kuraray Noritake Dental Inc som rådgivare; innehållet i artikeln speglar den kliniska erfarenheten.

Dentist:

KORAY KENDIR

Dr. Koray Kendir har examen från Hacettepe University Faculty of Dentistry och han är medgrundare av en privat tandläkarklinik i Izmir. Han är specialiserad på digital tandvård, smile design och datorunderstödda, protetiska behandlingar. Dr. Kendir är känd för sina uppfinningsrika arbetsmetoder och är en ofta anlitad föreläsare vid nationella tandläkarkongresser och fungerar som rådgivare åt flera dentalföretag.

Cases by MDT Leonidas Dimitriou

INTRODUCTION

Patient demands and expectations have never been as concrete as in this day and age: Influenced by role models on social media and new aesthetic standards, our patients ask for brighter smiles or for restorations with specific tooth forms rather than demanding a perfect copy of nature. For us dental technicians, the challenge lies in finding a perfect balance between fulfilling these demands and respecting established biomimetics-inspired principles of aesthetics and function.

To accomplish this task, we need to know which principles need to be respected and where there is room for creativity. At the same time, it is essential to be well-informed about the latest technological advancements and developments in dental materials to be able to select the most appropriate restorative approaches. Only by understanding the selected materials and technological tools very well, will we be able to exploit their potential and deliver the best possible restorative solution. To sum up, we need to keep one foot in the boat of science and the other in the boat of art. Only by balancing both can we navigate the rapid advancements in the field effectively - ensuring they serve patients’ best interests while avoiding practices that lack purpose or meaning.

The challenge lies in finding a perfect balance between fulfilling the patient‘s demands and respecting established biomimetics-inspired principles of aesthetics and function.

MATERIAL CHOICES

Our favored framework materials for the production of aesthetic anterior restorations include KATANA™ Zirconia UTML, KATANA™ Zirconia STML discs (both Kuraray Noritake Dental Inc.) and lithium disilicate-based press ingots Amber® Press (HASS). These high-strength ceramics are ideal for fulfilling the aesthetic and functional demands of anterior restorations. Their balanced optical properties allow for the creation of lifelike restorations. Their physical and mechanical properties, on the other hand, are responsible for stability during all clinical steps from try-in to permanent placement, proven bonding ability and a certain error tolerance: Minor adjustments or modifications are possible without the risk of inducing cracks or dimensional changes when firing repeatedly. Finally, both materials are digital workflow compatible, which means that procedures are quick, mock-up, temporary restoration and definitive restoration easily aligned, and remakes facilitated.

The restorations are usually designed in full contour; a labial cutback of 0.3 to 0.5 mm creates sufficient space for the veneering porcelain. The preferred layering approach is micro-layering combined with the internal live stain technique, which offers the benefits of a controlled procedure and predictable, highly aesthetic outcomes with brilliant depth effects in short time. A layering material that precisely meets our needs regarding the preferred approach and is perfectly compatible with both, lithium disilicate and zirconia, is CERABIEN™ MiLai (Kuraray Noritake Dental Inc.).

The following two case reports are used to illustrate how this material combines with the different framework materials, revealing further benefits of the selected ceramics and techniques.

CASE #01

LITHIUM DISILICATE VENEERS

This 36-year-old female patient wanted to replace her bonded composite veneers. She expressed the demand for a brighter smile with a bleached color (NW 0.5) selected for her six maxillary anterior teeth and first premolars. However, she wanted the tooth preparation for this treatment to be as minimally invasive as possible.

In addition, she specifically requested that the teeth be square in form, with the lateral incisors the same length as the central incisors and the incisal edges straight, without rounded corners – clearly influenced by modern aesthetic standards. We explained our concerns regarding potential aesthetic and functional issues that might necessitate further intervention or adjustments, but she remained firm in her choices.

FROM DESIGN TO PRESSED FRAMEWORK

In line with the patient’s demands, it was planned to restore her maxillary teeth from first premolar to first premolar with lithium disilicate veneers (Amber® Press HT in the shade W2), which would allow for the desired minimally invasive preparations and bright appearance. Following tooth preparation, an analog impression was taken and sent to our laboratory. After the production of the model, the case was digitalized for the virtual designing of the veneers. In order to create space for the porcelain, the labial surfaces of the full-contour restorations were reduced by 0.3 mm with the software (exocad® DentalCAD, Figs. 1 and 2).

The frameworks were then milled in wax and pressed in Amber® Press HT W2 (Figs. 3 and 4). Sprues were cut and the surfaces of the veneer frameworks processed with a Diagen-Turbo-Grinder Ø 3,5 x 11 mm Cone and Wheel.

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INTRODUCTION

Adhesive dentistry has seen significant advancements over the past decades. Initially, dental adhesives evolved from no-etch systems to etch-and-rinse systems, which consisted of multiple components. From then on, manufacturers shifted focus toward simplifying the procedure. Different generations of self-etch adhesives and, finally multi-mode or universal adhesives were the result. The latter category, introduced in the early 2010s, nowadays comprises numerous products offered by many different manufacturers.

In general, universal adhesives offer more procedural freedom and simplicity than multi-step, multi-bottle systems as well as good adhesion. According to a recent review¹, adhesive properties have improved and manufacturers have also succeeded in reducing the technique sensitivity of the adhesive systems. However, hybrid layer degradation still seems to be a relevant issue for many modern products available on the market. Moreover, feedback from clinicians reveals that there are several areas of concern where bonding systems in general can be improved. These include the risk of contamination due to a lengthy procedure or the need for rubbing, pooling of the adhesive in corners and accumulation along margins. Moreover, some adhesives are challenging to introduce into narrow cavities, while their curability may be limited.

That is why Kuraray Noritake Dental Inc. decided to develop a new-generation universal adhesive that addresses these areas of concern: CLEARFIL™ Universal Bond Quick 2. This latest evolution in dental bonding technology is based on decades of knowledge in the development of clinically successful dental adhesives at Kuraray Noritake Dental Inc. It retains all the benefits of its predecessor – the current extensively tested and clinically proven CLEARFIL™ Universal Bond Quick – adding higher strength and improved handling.^2-5

THE ESSENTIAL BENEFITS OF CLEARFIL Universal Bond Quick 2

CLEARFIL Universal Bond Quick 2 offers the following essential benefits:

• Quick and straightforward application procedure
• High-strength bonding layer
• Consistently durable bond
• Ease of application
• Minimised risk of pooling
• Procedural freedom
• Immediate availability for clinical use

For all those who wonder how the improvements were implemented, which technologies are responsible for them and whether there is scientific proof, the following paragraphs are worth reading. They summarize essential general knowledge about adhesive formulations, explain potential issues and their causes, and address every benefit featured by CLEARFIL Universal Bond Quick 2, explaining all the important details around it.

KEY COMPONENTS OF UNIVERSAL ADHESIVES

Universal adhesives are based on highly complex formulations with many different constituents and technologies combined in a single bottle. The most essential parts found in virtually every universal adhesive are:

RESIN COMPONENTS

Just like composite restorative materials, dental adhesives are resin-based materials. This means that different kinds of cross-linking and functional monomers are the beating heart of the formulation. Functional monomers are initially hydrophilic and form linear polymers upon curing, while cross linking polymers are hydrophobic and form stronger, highly cross-linked polymer networks.⁶ They are added to adhesive formulations to fulfil different tasks: some monomers are used to promote adhesion to tooth structure or composite resin, while others are used as etching or demineralizing agents, wetting enablers, and agents promoting penetration into the tooth structure. Hence, they have an impact on application properties, bond strength to various substrates including enamel and dentin, strength, hydrolytic stability and overall durability of the bonding layer, and more.

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References

1. 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 Feb;41(2):141-158.
2. Jaggi M, Karlin S, Zitzmann NU, Rohr N. Shear bond strength of universal adhesives to human enamel and dentin. J Esthet Restor Dent. 2024 May;36(5):804-812.
3. Peumans M, Vandormael S, De Coster I, De Munck J, Van Meerbeek B. Three-year Clinical Performance of a Universal Adhesive in Non Carious Cervical Lesions. J Adhes Dent. 2023 Jun 8;25(1):133-146. doi: 10.3290/j.jad.b4186751. PMID: 37387551.
4. de Almeida RAM, Lima SNL, Nassif MV, Mattos NHR, de Matos TP, de Jesus Tavarez RR, Cardenas AFM, Bandeca MC, Loguercio AD. Eighteen-month clinical evaluation of a new universal adhesive applied in the “no-waiting” technique: a randomized clinical trial. Clin Oral Investig. 2023 Jan;27(1):151-163. doi: 10.1007/s00784-022-04703-7. Epub 2022 Sep 6. PMID: 36068369; PMCID: PMC9447982.
5. De Almeida R, Siqueira F, Verde T, Naupari-Villasante R, Reis A, Loguercio AD, Cardenas A. Prolonged application time effects on universal adhesives in non-carious cervical lesions: An 18-month split mouth randomized clinical trial. J Dent. 2024 Jan;140:104800. doi: 10.1016/j.jdent.2023.104800. Epub 2023 Dec 4. PMID: 38056759.
6. Van Landuyt KL, Snauwaert J, De Munck J, Peumans M, Yoshida Y, Poitevin A, Coutinho E, Suzuki K, Lambrechts P, Van Meerbeek B. Systematic review of the chemical composition of contemporary dental adhesives. Biomaterials 2007; 28(26):3757-85.

By Dr Wiktor Pietraszewski BSC(HONS) DMD

INTRODUCTION

According to personal experience, the cementation of glass ceramic veneers is one of the most stressful and technique-sensitive procedures in restorative dentistry. This is not only due to the minimal margin for error, but also the high aesthetic standards that must be met to deliver a result satisfying both clinician and patient. Modern protocols emphasize conservative preparation, ideally remaining entirely within enamel, or at the very least, minimising extension into dentin. It is essential to understand that both preparation design and extent should not be planned in isolation. Instead, they must be carefully co-planned through thorough communication and collaboration between clinician and technician, ensuring the final result is both biologically respectful and aesthetically predictable.

THE CASE

The case to be discussed today is rather unique in that it arose unexpectedly, without the luxury of typical pretreatment planning steps such as a diagnostic wax-up or mock-up. These were omitted due to time and budget constraints on the patient’s part — a reality many clinicians can relate to. The rationale behind this approach will become clearer as we progress through the case. The patient is a 70-year-old retiree, whom I have been managing for several years. Treatment thus far has focused on stabilising and gradually improving her posterior restorations, with the longer-term aim of addressing the anterior dentition to enhance both function and aesthetics.

Nowadays, financial considerations often pose a significant barrier to patients accepting comprehensive treatment plans from the outset. As such, effective communication and phased treatment planning become essential tools in fostering patient trust and long-term commitment. This particular visit was an emergency appointment, with the patient presenting with a fractured porcelain veneer on her maxillary left central incisor — tooth 21 according to the FDI notation (Fig. 1). Fortunately, because of the existing phased approach to her care, we were well-positioned to transition into an aesthetic restorative phase with minimal resistance or hesitation from the patient.

Fig. 1. Pre-operative view - emergency: Chipped existing ceramic veneer.

Fig. 2. The plan - Digital Smile Design - 4 x porcelain veneers - 4 x direct composite restorations.

THE PLAN

After careful discussion, it was decided to remove and replace the four existing porcelain veneers and to replace four existing Class V stained composite restorations with fresh new direct composite (Fig. 2). Everyone involved was happy with the plan, sure it would adequately fulfil the patient’s aesthetic expectations and even surpass them. At the emergency appointment, time was so limited that only the temporary restoration of the chip with direct composite was feasible. Time was an important factor going forward: the patient wanted to proceed and have the case completed as soon as possible.

Main features of the Digital Smile Design (DSD) plan

1. Lengthening - central incisors – incisal edges to reflect the length of the canine tips
2. Equal gingival zeniths
3. Masking of the cervical defects

PREPARATION, SCAN & TEMPORISATION

The first step involved building up the teeth using a flowable composite to create a rough direct mock-up (Fig. 3), guided by the DSD plan (Fig. 2). This mock-up provided a visual and functional prototype, of which an impression was taken to aid in the fabrication of interim temporary restorations for the provisional phase of treatment.

Preparations were carried out using OptraGate isolation. The existing veneers were first removed using high-grit diamond burs at high speed. Once the bulk of the old material was cleared, gingival retraction was achieved using retraction cord, allowing for improved visibility and access. The preparations were then refined with lower-grit diamond burs at a reduced speed to ensure precision and tissue safety. The primary objectives of the preparation phase were to establish harmonious gingival zeniths and to adequately cover the cervical defects that were evident in the previous restorations (Figs. 4 and 5).

Fig. 3. Mock-up made of flowable composite.

Fig. 4. Class V composite restorations replaced on teeth 13, 23, 24 and 25.

Fig. 5. Situation after preparation of the maxillary incisors.

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WHAT IS THE PURE CONTROL PROTOCOL?

PURE Control is a three-step evaluation protocol developed by MDT Andreas Chatzimpatzakis for dental technicians that helps achieve predictable aesthetic ceramic restorations.

The protocol allows ceramists to maintain aesthetic control when working with zirconia, lithium disilicate and micro-layering techniques.

INTRODUCTION

Achieving natural aesthetics in ceramic restorations is one of the greatest challenges in modern dental laboratory work. While digital workflows and monolithic restorations have improved efficiency, they often lack the optical complexity and vitality of natural teeth.

To address this challenge, Master Dental Technician Andreas Chatzimpatzakis developed PURE Control, a systematic evaluation protocol that helps dental ceramists achieve predictable aesthetic results—even in complex restorative cases involving different materials.

The concept focuses on three critical parameters that determine the final visual outcome of ceramic restorations:

• Value – the lightness of the restoration
• Chroma – the intensity of colour
• Shape – morphology and surface texture

By evaluating and controlling these factors step by step, dental technicians can achieve highly aesthetic and consistent results in both simple and complex prosthetic cases.

The full concept and clinical cases are available in the original publication.

IMPORTANCE OF CONTROL

Traditional ceramic buildup techniques involve the application of multiple powders, such as opaque dentins, dentins, enamels, and lusters, through one or several firings to achieve the desired aesthetics and natural appearance.

In contrast, contemporary prosthodontics often employs digital workflows and monolithic restorations. The traditional buildup technique necessitates a highly skilled ceramist to maintain control over the final outcome of the ceramic restoration, requiring a significant investment of time. On the other hand, monolithic restorations offer a straightforward and simple workflow but compromise on aesthetic appearance.

Micro-layering comes in between, applying thin ceramic layers (approximately 0.2–0.6 mm) over zirconia or lithium disilicate frameworks to recreate natural optical effects.

A PRACTICAL PHILOSOPHY FOR EVERYDAY CERAMIC WORK

Philosophy of MDT Andreas Chatzimpatzakis is that, for everyday work, it is unnecessary to engage in complex procedures involving numerous powders, which can consume valuable time. Furthermore, the use of multiple powders increases the risk of losing control over the final result, particularly for ceramists who are less experienced. At the same time, there is a desire to achieve more than what a purely monolithic restoration can offer.

His aim is to show ceramists that simplicity and control over their work are essential, and that a minimal yet effective ceramic layer is sufficient to achieve natural aesthetics in everyday laboratory practice.

FROM MONOLITHIC TO MICRO-LAYERING

All-ceramic restorations dominate modern prosthodontics thanks to their biocompatibility, strength and aesthetics. However, digital workflows and CAD/CAM production have increased the use of monolithic restorations.

While monolithic materials provide precision and reliability, they often lack the depth and vitality achieved with layered ceramics. As a result, micro-layering techniques have become increasingly popular.

Micro-layering involves applying thin ceramic layers (approximately 0.2–0.6 mm) over zirconia or lithium disilicate frameworks to recreate natural optical effects.

THE PURE CONTROL CONCEPT

PURE Control provides dental technicians with a simple and structured approach for evaluating ceramic restorations during fabrication.

The process focuses on analysing three key aesthetic parameters:

1. Value – the lightness of the restoration
2. Chroma – the colour intensity
3. Shape – morphology and surface texture

This structured evaluation allows ceramists to maintain aesthetic control throughout the layering process.

Watch the webinar of MDT Andreas Chatzimpatzakis and dive into the world of PURE Control

STEP 1: VALUE – THE MOST CRITICAL FACTOR

Value refers to the lightness or darkness of a restoration and is the most perceptible aspect of colour to the human eye.

Factors influencing value include:

• Framework opacity
• Material thickness
• Opacity/translucency of the veneering ceramic
• Internal staining
• Surface texture
• Glazing and polishing
• Lighting conditions

Recommended techniques:

• Evaluate preparation shade before selecting the core material
• Adjust framework opacity
• Use value liners and modifiers
• Apply ceramics with controlled translucency

As a general simplified guidance is to work on a higher value framework than the desired final shade.

“Value discrepancies are often immediately visible and difficult to correct later in the process.”
— Andreas Chatzimpatzakis MDT

STEP 2: CHROMA – CREATING DEPTH

Chroma refers to the intensity of colour. In natural teeth, chroma varies across the tooth structure and is often stronger in the cervical region.

Dental technicians can control chroma using:

• Internal stains
• Dentins and modifiers
• Controlled ceramic layering

“Internal stains allow ceramists to introduce depth and chromatic variation, in an easy and predictable way, even working with different core materials.”

STEP 3: SHAPE – THE FINAL DETERMINANT

Shape includes tooth morphology, surface texture, incisal edge design and reflective zones. These elements influence how light interacts with the restoration.

Final morphology is refined using enamel porcelains and luster ceramics.

“Surface texture and morphology play a crucial role in how light interacts with the restoration.”
— Andreas Chatzimpatzakis MDT

PRACTICAL WORKFLOW: APPLYING PURE CONTROL

Step 1 – Evaluate Value

• Assess preparation shade
• Select framework material, opacity and shade
• Adjust value with value liners, opaque dentins or internal stains

Step 2 – Control Chroma

• Apply internal stains
• Use modifiers to introduce colour intensity and depth
• Harmonize optical behaviour across materials

Step 3 – Refine Shape 

• Finalise with a “skin layer” of  enamel porcelains
• Adjust morphology and surface texture
• Refine line angles and reflective zones

Key Takeaways for Dental Technicians:

• Evaluate value first to establish correct lightness
• Adjust chroma to introduce colour depth
• Refine morphology to control light reflection
• Use internal stains and micro-layering for optical harmony
• Follow a structured workflow for predictable results

CONCLUSION

The PURE Control concept was developed to simplify aesthetic evaluation during the fabrication of ceramic restorations. By focusing on the three parameters that most strongly influence visual perception — Value, Chroma and Shape — dental technicians can analyze restorations in a structured and predictable way.

CERAMIC SYSTEMS DESIGNED FOR MICRO-LAYERING

Few ceramic systems are specifically developed for micro-layering techniques. One example is CERABIEN™ MiLai, a synthetic feldspar ceramic system designed for both zirconia and lithium disilicate frameworks.

The system enables ceramists to create depth and natural optical effects using very thin ceramic layers (approximately 0.3–0.5 mm).

Key components of the workflow include:

• Contains Value Liners for lightness control
• Offers Internal Stains for Chroma and depth
• Features for Enamel powders finalising the Shape and light dynamics

This approach supports a simplified yet highly predictable workflow when combined with the PURE Control evaluation process.

CONTINUE LEARNING ABOUT THE PURE CONTROL PROTOCOL AND RELATED PRODUCTS

• Watch the webinar by MDT Andreas Chatzimpatzakis
• Download the full PURE Control article
• Discover CERABIEN™ MiLai
• Discover KATANA™ Zirconia discs

Dental technician:

ANDREAS CHATZIMPATZAKIS

Andreas graduated from the Dental Technology Institute (TEI) of Athens in 1999. During his studies he followed a program at the Helsinki Polytechnic Department of Dental Technique, where he trained on implant superstructures and all ceramic prosthetic restorations. As of 2000, he is running the ACH Dental Laboratory in Athens, Greece, specialized on refractory veneers, zirconia and long span implant prosthesis. In 2017 Andreas visited Japan where he trained under the guidance of Hitoshi Aoshima, Naoto Yuasa and Kazunabu Yamanda and become International Trainer for Kuraray Noritake Dental Inc..

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