New liquid ceramic FC Paste Stain for full-contour solutions with KATANA Multi-layered Zirconia - Features and 3D-technique.

ROBERTO ROSSI 

"YOU CAN’T STOP THE WAVES, BUT YOU CAN LEARN TO SURF"

Born in Savona in 1989, he studied and got his diploma at “Mazzini” Dental School, the one dental school in his hometown, and he still lives there. In 2007 he was awarded the National Award for Best Dental Technician in Turin. Since 2008 he has been working at Daniele Rondoni’s Dental Lab and he is now in charge of the aesthetic planning of dental restorations. He shares this task with Master Dental Technician Daniele Rondoni, with whom he decides which strategy and materials – composites or ceramic especially – to opt for. In 2011 he coauthored with Mr. Rondoni “Sei faccette additive in composito” (Six additional composite facets), an article published in Dental Labor, 5/2011. A teacher at NISC, Noritake Italian Study Club since 2014, he is also a teacher at the AAT Community College – a reality he feels especially attached to – and he is in charge of the photographic services and social network profiling of the lab.

When art meets technology;
Logical evolution of design and techniques: Microlayering with Kuraray Noritake new porcelains. 

DANIEL RONDONI
Born in Savona in 1961, he lives and works in his hometown where he has been the manager and director of his own laboratory since 1982.

By Dr. PhD. Jusuf Lukarcanin

Is it possible to fulfil high aesthetic demands by restoring anterior teeth with composite resin? It is – provided that several important factors are respected. One of these factors is the faithful reproduction of the natural tooth morphology, which has a decisive impact on aesthetics and function. Moreover, success is determined by the selection of the right shades of high-quality composite resin and their purposeful combination using proper layering techniques.

Introduction

The aesthetic appearance of direct anterior restorations is affected by proper shade selection on the one hand and the creation of a natural shape and texture on the other¹. Hence, the dental practitioner’s own artistic skills play a decisive role. According to Fahl, information about the tooth morphology and function, and the optical properties of the tooth should be taken into consideration when the most suitable restorative material and shade are selected².

These minimally invasive composite restorations are no longer a temporary solution for the anterior region. Instead, they are regarded as an adequate alternative to indirect restorations, as they are both durable and able to closely imitate the natural tooth structure³⁴.

Clinical case example 1

This 45-year-old female patient presented with a diastema and a disproportion in the size and shape of her maxillary central incisors (Fig. 1). In the first step, a detailed case history was taken and an intra-oral examination was carried out. Subsequently, the initial situation was recorded by taking intra-oral photographs, which would allow for a computer-aided morphological evaluation and treatment planning (Fig. 2).

Fig. 1: Pre-operative image.

Fig. 2: Digital mock-up.

The patient’s second visit started with a professional tooth cleaning procedure followed by isolation of the maxillary anterior teeth. Afterwards, the tooth shade was determined and appropriate composite shades were selected. In this case, the shades A2E, Amber Translucent and A3D of CLEARFIL™ Majesty ES-2 Premium (Kuraray Noritake Dental, Japan) appeared to be most suitable. In addition, a mock-up was created using mock-up resin in order to produce a silicone key.

Opting for a minimally invasive procedure, no mechanical tooth preparation using drills was performed after removal of the mock-up. Instead, the enamel was merely etched with 35% phosphoric acid gel (K-Etchant, Kuraray Noritake Dental) to increase the surface roughness. After rinsing and drying, the adhesive agent (CLEARFIL™ Universal Bond, Kuraray Noritake Dental) was applied to the etched surfaces. Composite layering started with the build-up of palatal shells with the aid of the silicone key. Following light-curing of the shells, a small amount of composite in the dentin shade A3D was applied to the proximal surfaces using a thin spatula and a brush. The aim was to reduce light transmission in the area of the dentin core. The restoration was completed with a combination of the composite shades A2E (enamel) and Amber Translucent, which were applied using a modeling brush.

Finishing and polishing was accomplished using flexible rubber polishing discs containing diamond particles (CLEARFIL™ Twist DIA, Kuraray Noritake Dental) with a low-speed handpiece. No additional finishing and contouring was necessary due to the use of a brush during layering, which ensured the creation of a natural shape and surface texture. Figure 3 shows the outcome of the restoration procedure.

Fig. 3: Treatment outcome immediately after polishing.

Oral hygiene training was provided and follow-up examinations were performed after three, six and twelve months (Fig. 4). Healthy hard and soft tissue conditions were observed during these visits.

Fig. 4: Clinical situation at the one-year recall.

Clinical case example 2

This 30-year-old female patient had a diastema, irregularly shaped anterior teeth and showed signs of abrasive tooth wear (Fig. 5). Following a detailed anamnesis and intra-oral examination, the tooth shade was determined and the composite CLEARFIL™ Majesty ES-2 Premium selected in the monochromatic shade Universal A1.

Fig. 5: Pre-operative clinical situation.

Following the isolation of the working field, 35% phosphoric acid etchant (K-Etchant) was applied to the enamel of all teeth between the maxillary right canine and the maxillary left first molar. The surfaces were then treated with a universal bonding agent (CLEARFIL™ Universal Bond) as recommended by the manufacturer. Modeling was carried out with a thin spatula and a modeling brush for composite. Neither a silicone key nor any wetting or modeling resin were used in the procedure. For polishing, the flexible polishing discs CLEARFIL™ Twist DIA were used at low rotational speed. Thanks to the use of the modeling brush, no additional finishing with diamond-coated instruments was necessary. Figures 6 and 7 show the final restoration at baseline and one week after completion of the treatment.

Fig. 6: Treatment outcome at the day of the restorative procedure.

Fig. 7: Clinical situation after one week.

This patient also received oral hygiene training and presented for recalls three, six and twelve months after the treatment. The patient maintained an exemplary oral hygiene behaviour, so that it came as no surprise that the soft tissues were healthy and the restorations were in a perfect condition after one year (Fig. 8).

Fig. 8: Clinical situation one year after the restorative treatment.

Discussion

Nowadays, direct composite restorations are becoming increasingly popular. Especially for young patients and all those who do not want to sacrifice large amounts of healthy tooth structure, the technique is an ideal treatment option⁵. In many cases, aesthetic outcomes are possible without mechanical tooth preparation, but a selective etching procedure only⁶.

The clinical lifetime of these restorations depends on many factors. Important prerequisites for high-quality outcomes include the selection of a suitable composite material with the required surface hardness, appropriate finishing and polishing, a good oral hygiene behaviour, and proper maintenance measures during periodical follow-up visits. As a matter of course, the manual skills of the dental practitioner and the use of selected materials according to the manufacturer’s instructions for use also have a direct impact on the long-term success of the restorations⁷⁸⁹. A user’s inability to meet one of these requirements and failure to carry out all working steps correctly may have a direct impact on the quality of the restoration.

Conclusion

Composite resin is a popular material class for the production of aesthetic anterior restorations die to their straightforward use and rapid application, good repair options and high aesthetic potential when used properly . The two case examples illustrate that a treatment with composite resin is often the best treatment option when a non-invasive procedure completed within a single visit is desired.

About the author

Dr. Jusuf Lukarcanin is a Certified Dental Technician (DCT) and a Doctor of Dental Science (DDS). He studied dentistry at the Ege University Dental Faculty in Izmir, Turkey, where he obtained a Master's degree in 2011. In 2018, he received a PhD degree from the Department of Restorative Dentistry of the same university, where he also worked as a researcher for six years. Between 2012 and 2019, Dr. Lukarcanin was the head doctor and general manager at Ozel Gen Dental Clinic (OZEL GEN Ağız ve Diş Sağlığı Polikliniği) in Izmir. Currently, he works at Tinaztepe GALEN Hospital in the Tinaztepe Health Group of Tinaztepe University and in the Department of Research & Development of GULSA Company in Izmir.

References

^{1. Heymann HO (1987) The artistry of conservative esthetic dentistry Journal of the American Dental Association 115(Supplement)14-23.}

^{2. Fahl N Jr (2012) Single-shaded direct anterior composite restorations: A simplified technique for enhanced results Compendium of Continuing Education in Dentistry 33(2) 150-154.}

^{3. Barrantes, J. C. R., Araujo Jr, E., & Baratieri, L. N. (2014). Clinical Evaluation of Direct Composite Resin Restorations in Fractured Anterior Teeth. Odovtos-International Journal of Dental Sciences, (16), 47-61.}

^{4. Vargas M (2011) Clinical techniques: Monocromatic vs. polycromatic layering: How to select the appropriate technique ADA Professional Product Review 6(4) 16-17.}

^{5. Ferracane, J. L. (2011). Resin composite—state of the art. Dental materials, 27(1), 29-38.}

^{6. Norling, N. A. (2010). Combining “prep-less” and conservatively prepared veneers to correct enamel defects and asymmetry. Journal of Cosmetic Dentistry, 2010.}

^{7. Ölmez, A., & Kisbet, S. (2012). Kompozit rezin restorasyonlarda bitirme ve polisaj işlemlerindeki yeni gelişmeler. Acta Odontologica Turcica, 30(2), 115-22.}

^{8. Senawongse, P., & Pongprueksa, P. (2007). Surface roughness of nanofill and nanohybrid resin composites after polishing and brushing. Journal of Esthetic and Restorative Dentistry, 19(5), 265-273.}

^{9. Giacomelli, L., Derchi, G., Frustaci, A., Bruno, O., Covani, U., Barone, A., Chiappelli, F. (2010). Surface roughness of commercial composites after different polishing protocols: an analysis with atomic force microscopy. The open dentistry journal, 4, 191.}

^{10. Hickel, R., Heidemann, D., Staehle, H. J., Minnig, P., & Wilson, N. H. F. (2004). Direct composite restorations. Clin Oral Invest, 8, 43-44.}

^{11. Korkut, B., Yanıkoğlu, F., & Günday, M. (2013). Direct composite laminate veneers: three case reports. Journal of dental research, dental clinics, dental prospects, 7(2), 105.}

Clearfil Majesty™ ES-Flow - en universell mycket kompakta flytbara komposit

I mitten av 2019-talet påbörjade Dental Advisor sin fokusering på förenklade kompositer. En betydande del var relaterad till användningen av flytbara kompositer. I dagsläget kan universella högfyllda flytbara material, inklusive den prisbelönta Clearfil Majesty™ ES Flow, betraktas som lämpliga för restaureringar i alla kavitetsklasser (I till V).

Eftersom Clearfil Majesty™ ES Flow är tillgängligt nu i tre olika flytbarhets nivåer är användningsområdet ännu mer utökat.

Den unika designen på insidan av sprutan i kombination med hanteringsegenskaperna för själva kompositen gör Clearfil Majesty™ ES Flow till en mycket användarvänlig komposit.

Spruta-nål-tip-kombinationen erbjuder dig inte bara produkten utan också ett modelleringsinstrumentet. Inga separata instrument behövs längre. Materialflöde och modellering kan görs i ett enda steg från och med nu.

Kuraray Noritakes silan-teknik

Dentala kompositer kan helt enkelt inte existera utan silan. Bland annat fungerar silan som en koppling mellan påfyllningspartiklarna filler och syntetiskt resin. En annan av dess funktioner är att öka fuktkapaciteten hos filler. Detta innebär att mer filler kan tillföras till det syntetiska resin utan att påverka blandningens användbarhet; Ju högre kvalitet på silan, desto mer filler kan tillsättas det syntetiska resin utan att orsaka ett hanteringsproblem. En högkvalitativ silan är också viktig för att förhindra att filler partiklarna frigör sig från kompositen. Våra kompositer kännetecknas också av exceptionellt låg vattenabsorption på grund av den använda silanen.

Kuraray Noritake är ledande inom silanteknologi. Vår utvecklingsavdelning är outtröttlig när det gäller att vidareutveckla vår silanteknologi. Vi lanserade nyligen PANAVIA™ SA CEMENT UNIVERSAL, som för första gången innehåller en mycket stabil silan. Vi pratar här om en så kallad långkedjig silan; Long Carbon Chain Monomer (LCSi). Denna silan har utvecklats speciellt för vårt kompakta flytbara komposit CLEARFIL MAJESTY™ ES FLOW.

Kombinationen av filler och ovannämnda silan, plus ett Bis-GMA-fritt syntetiskt resin, har gjort det möjligt att producera en högfiller, flytbar komposit som är en universalkomposit. Med CLEARFIL MAJESTY™ ES FLOW har vi lyckats upprätthålla både flytbarhet och hanteringsegenskaper på optimala nivåer, samt att säkerställa att kompositen ger enastående böj- och tryckhållfasthets egenskaper för alla tre flytbarheterna Super-Low, Low och High

En avgörande faktor som påverkar bindningstyrkan mellan tandvävnad och restauration för dess livslängd är användandet av ett kraftfullt och hållbart cemeteringsmaterial som t. ex. PANAVIA™ V5. Kvalitativ adhesiva bindning, är inte bara relaterad till cementets pasta och primer vid användning, men också av tillståndet hos bondingytan. För att säkerställa ren tandvävnader - och restaurationsytor har man på Kuraray Noritake Dental utvecklat KATANA™ Cleaner, ett allsidigt rengöringsmedel med MDP-salt och med ett pH på 4,5 för intra- och extraoral applicering.

Forskning har bevisats att proteiner som finns närvarande i saliv och blod har en negativ effekt på egenskaperna av dentala adhesiver. Särskilt i indirekta förfaranden, är det emellertid omöjligt att hålla bindningsytor fria från kontaminering av saliv och blod. I samband med inprovning kan det hända att restaurationen kontamineras vilket behöver rengöras från

proteiner och blod, som annars förmed sig försämrad bindning. Genom att skölja med vatten eller användandet av de flertalet rengöringsmedel som finns tillgänliga, lämnas det i regel kvar en viss andel proteiner på ytan. I tester med KATANA™ Zirconia-restaurationer har man kunnat påvisa den kraftfulla rengöringseffekten genom att använda sig av KATANA™ Cleaner vilket motsvarar effekten av sandblästring uppnår som är den önskade ursprungliga kontameringsfria yta innan cemetering. Med hjälp av KATANA™ Cleaner erhålls även önskvärt resultat på intraoralt bruk av dentin och emalj - sandblästring och de flesta av de andra rengöringsmedel är inte indikerade för intraoralt bruk.

Användningen av KATANA ™ Cleaner ger ännu en fördel: arbetsflödet och rengöringsproceduren är extremt enkel, snabb och snygg. Den universella rengöringsmedlet kommer i en flaska med en innovativ flip-top-lock, vilket möjliggör enhandshantering. Sedan gnider man in medlet på den prepareade förberedda tandvävanden eller restaurationen i tio sekunder innan man sköljer och torkar. Tack vare MDP-saltets starka ytaktivitet är det fullt tillräckligt med tio sekunder för att så gott som fullständigt få bort proteinerna på ytan och på så sätt skapa en miljö förhållanden som råder på en icke-kontaminerad bondingyta. Sedan applicerar man den bonding eller cementeringspastan som har valts – t.ex. PANAVIA™ V5 eller PANAVIA™ SA Cement Universal – enligt tillverkarens användaranvisningar.

Slutprodukten blir ett starkt och mycket hållbart bindning som ger användarna ro i sinnet. Enligt förstagångs-användare som redan har provat produkten är KATANA™ Cleaner tveklöst en enkel metod att optimera bindnings kvalitet och effektivisera alla typer av adhesiva processer.

Our commitment to you:

Kuraray Noritake dental products offer dental professionals all over the world high-quality products using simple procedures with long-lasting results. With the COVID-19 outbreak, all of us are now going through difficult times which we were not prepared for. Our thoughts are with all those people who are affected by the coronavirus pandemic.

We, at Kuraray Europe GmbH, as the European sales office of Kuraray Noritake Dental Inc., feel a strong responsibility towards our customers and partners, colleagues and communities and we would like to inform you that, in spite of the challenges we are now facing, we will do our best to provide you with the services that you require:

1. Business as usual.

It is both important that we continue to provide products and services to all our customers and at the same time secure the safety of our employees. With that in mind, we have transitioned most of our employees not involved in manufacturing to working remotely and eliminated all non-essential and cross-border travel. This change should not impact in any way how you, our dear customers, contact us. We are ready, willing and able to support you. Clearly, to keep face-to-face interactions to a minimum, we will focus our communication on what is most convenient for you – either a phone call, through email or video chat (Skype, FaceTime or Google Hangout). Whatever is convenient for you!

2. Delivery

As of today, we have sufficient inventory for both dentists and dental labs, as well as reliable logistics. Thanks to our global network of dealer-depots, dental professionals all over the world will continue to have direct local access to our wide range of Kuraray Noritake Dental products. Kuraray Europe GmbH will exert every effort possible to deliver your orders on time. Parallel to this, we kindly ask you to make sure that somebody in your office will be available to receive the parcel. In case, for whatever reason this is not possible, please notify your supplier in advance.

3. Technical Services.
   Our technical service is available to meet your needs.

If there is anything else that we can do to support you, please let us know.

We wish you all the best. Take good care and stay healthy.

Sincerely,

Kuraray Europe GmbH

BU Medical

Efter att ha röstats fram som förstaprisvinnare fem år i rad av Dental Advisor, finns CLEARFIL MAJESTY^TM ES Flow nu med tre flytbarhetsgrader, och tar därmed mångsidighet till en helt ny nivå – nu kan tandläkare snabbare och lättare uppnå önskat restaurationsresultat.

Den flytande universalkompositen CLEARFIL MAJESTY^TM ES Flow är den senaste innovationen från Kuraray Noritake Dental, ett företag som prisats världen över för sin expertis inom restaurationsmaterial såsom Panavia^TM, Clearfil^TM SE Bond,  och KATANA™ multi layered zirconia. Kuraray Noritake Dental har byggt vidare på framgången med CLEARFIL MAJESTY^TM Flow och utvecklat en mycket avancerad produkt som tillhandahåller restauration, reparation och cementering i en enda produkt, utan behov av andra kompositer.

Tack vare det patentsökta silanbindningsmedlet från Kuraray Noritake Dental som används i CLEARFIL MAJESTY^TM ES FLOW binds både submikronfillers och nanoklusterfillers stabilt i kompositen. Det gör också att CLEARFIL MAJESTY^TM ES FLOW kan ha ett högt fillerinnehåll och samtidigt behålla produktens flytbarhet. Estetiken förstärks av nanoklustret, eller ljusdiffusionfillers som gör att kompositen smälter in i den omgivande tandstrukturen.

Fördelar med CLEARFIL MAJESTY^TM ES FLOW:

DEN ENDA KOMPOSIT EN TANDLÄKARE KOMMER ATT BEHÖVA.

Pionjären Douglas Terry som gästar SACD 13-14 Mars 2020 beskriver framtiden om de flytande universalkompositen, ”This new technique is being received everywhere as revolutionary and the clinicians and technicians do not want to even take a break.” En nya spännande teknik, som Douglas Terry beskriver i sitt bokverk, Restoring with Flowables.

Mer information finns på kuraraynoritake.eu/se/clearfil-majesty-es-flow

Kuraray Europe Benelux B.V., Nordics & Baltics l infonordics@kuraray.com l + (0) 8 44 685 329

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Kuraray Noritake Dental Inc är ett företag som bildats genom samgåendet av Kuraray Medical Inc och Noritake Dental Supply Co i april 2012. Företaget drar nytta av sitt exceptionella kunnande inom organisk och oorganisk kemi för att utveckla fler exklusiva dentala produkter – från keramik till kompositer och biomaterial.

An ideal composite material should satisfy three basic requirements: function, aesthetics and biocompatibility. A member of the CLEARFIL MAJESTY family, Kuraray Noritake Dental’s CLEARFIL MAJESTY™ ES Flow combines excellent handling, polishability and mechanical strength to provide a solution for all cavity classes. This universal flowable composite employs silane and filler technologies to maximise both its procedural and aesthetic outcomes, allowing dentists to create long-lasting restorations with reduced chairside time.

A new standard for flowable composites

Traditionally, a composite’s flowability has been inversely related to its filler content. When flowable composites were first introduced in the mid-1990s, their lower viscosity was enabled by a filler level much lower than that of conventional composites. This, however, meant that these flowables fared poorly in a clinical setting, demonstrating inferior mechanical properties when compared to traditional hybrid composites.

With CLEARFIL MAJESTY™ ES Flow, dentists can now use a flowable composite with mechanical properties comparable to those of conventional alternatives. Thanks to Kuraray Noritake Dental’s silane technology, millions of submicron filler particles fit into the composite, reliably adhering to the resin and maintaining long-term stability. CLEARFIL MAJESTY™ ES Flow possesses a scientifically tested flexural strength of over 150 MPa, similar to that of a universal nano hybrid composite, making it suitable for use in Class I and II restorations.

Aesthetic restorations

However, the small, durable particles of CLEARFIL MAJESTY™ ES Flow provide more than just mechanical reliability. Special cluster fillers provide a light diffusion effect that is similar to that of natural teeth, meaning that the material blends effortlessly with the existing tooth structure. Unlike other flowables, CLEARFIL MAJESTY™ ES Flow is glossy immediately after curing. This gloss can be improved with remarkable simplicity—simply wipe the cured resin with an ethanol-moistened gauze or cotton roll to produce a smooth surface that is proven to maintain its gloss over time.

Ideal handling

CLEARFIL MAJESTY™ ES Flow’s low viscosity monomers ensure that it has excellent handling characteristics, promising better sculpting for the dentist. The flowable composite does not stick to the needle tip or to any instruments, only adhering to the area to which it is applied, while the proprietary design of the syringe itself minimises air bubbles when dispensing. Once dispensed, the paste possesses great consistency with its non-slumping formula, ensuring that it can maintain its shape. A truly universal composite, CLEARFIL MAJESTY™ ES Flow allows dentists to create highly aesthetic restorations with ease.

Obtain results in four simple steps

Creating aesthetic and durable restorations has never been more achievable. Simply prepare the cavity and apply bonding, dispense and sculpt the CLEARFIL MAJESTY™ ES Flow, light-cure and, finally, polish. It’s as easy as that.

LESEN SIE MEHR

No shade taking needed. Just one shade to cover all posterior cases. Even the larger Class I's and II's!