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Interview with Dr. Ludivine Facon

Individual prophylaxis, early defect detection and treatment, minimally invasive restorative techniques: In her joint dental practice in Anstaing, France, Dr. Ludivine Facon does everything in  her power to keep her patients’ teeth healthy for their lifetime. When we met her at the International Dental Show in Cologne, where she was a speaker for Kuraray Noritake Dental Inc., we asked her to share information about her treatment philosophy and how flowable injection fits into her overall approach.

Your treatment philosophy seems to be minimally invasive. Would you please tell us a bit more about it?

Ever since I started treating patients, my priority has always been to preserve the dental tissues and to be as minimally invasive as possible when restoration is required. My interest in prevention started with my thesis in 2000, which focused on oral health prevention in Quebec, Canada, a country where prophylactic care is an integral part of dental treatment. I have always been highly interested in individual prophylaxis, which naturally led me to focus on minimally invasive treatments. My goal is to stay as low as possible on the therapeutic gradient, always thinking about the long-term benefits for the patient.

What are the benefits of this approach for your practice?

Integrating prophylaxis for every patient into my practice allows me to work with excellent surface conditions for bonding. The oral environment is sanitized before applying conservative restorations, and carious lesion removal is kept to a minimum.

When defects – be it a carious lesion or severe tooth wear – are present, I use the following instruments and materials that allow for truly minimally invasive interventions:

• Rondoflex 50-micron sandblaster to roughen the surface,
• Micro diamond burs to remove what is necessary,
• Layered composites for single-tooth restorations,
• Injected composites when multiple teeth are involved.

Case predestined for composite injection, as multiple teeth in the maxilla need to be treated (smile makeover).

What dental materials do you use for your restorative procedures?

I am a hands-on dentist, and in my daily practice, I strictly follow surface preparation and bonding protocols recommended for CLEARFIL™ Universal Bond Quick 2 (Kuraray Noritake Dental Inc.). In addition, I use high-quality composites from Kuraray Noritake Dental Inc. For layering, CLEARFIL MAJESTY™ ES-2 Premium Enamel and Dentin are my got-to solution, while I use CLEARFIL MAJESTY™ ES Flow Low for injection.

What are the benefits of a conservative approach for your patients?

Patients appreciate the fact that my treatment approach is as conservative as possible while still allowing for easy reintervention if necessary, preserving as much healthy dental tissue as possible. Another significant advantage is the moderate cost, which makes the treatment more accessible.

How does composite injection fit into this philosophy?

This technique allows for an easy reconstruction of multiple teeth by transferring a wax-up designed in the lab into the mouth via an injection of modern flowable composite into a transparent silicone index. Patients like this technique because it is aesthetic, reliable, reproducible and minimally invasive. A major advantage is that it allows for touch-ups and repairs, making it a reassuring solution. In some cases, no tooth preparation is needed at all—we simply add material, making the whole treatment truly non-invasive.

Why do you think this technique is promising?

It is a trendy and promising technique because:

• It is non-invasive --> preserves tissues --> aligns with minimally invasive dentistry.
• It is predictable --> due to the index, the technique is reproducible.
• It is easier than traditional layering --> saves chair time and improves patient comfort.
• It is cost-effective --> a cheaper alternative to ceramic veneers.
• It allows for repairs at any time, making it a reassuring option.

How did you proceed before knowing this technique?

In the anterior region, I used traditional composite layering with a wax-up and a palatal silicone index. It allowed me to rebuild the palatal wall and provide for precise incisal edge placement. In the posterior region, I used inlays, onlays, or overlays made of lab-processed reinforced composite or lithium disilicate.

Transparent silicone index with injection hole used to inject the flowable composite and restore the tooth to its planned shape.

What made you start using the new technique?

There has been an explosion in demand for smile enhancements, especially among young adults. The composite injection technique is an appealing alternative for reshaping smiles in young patients with intact teeth but unsatisfactory size or shape. It is less invasive than veneers, which have gained popularity due to social media trends, but often require significant tooth preparation.

How did you proceed in the beginning?

I first discovered the technique in a specialized journal in 2019, then trained myself using online tutorials. Of course, there were some trial-and-error moments, but it is a very accessible technique—even for beginners. To achieve optimal results, I believe that proper case selection and treatment planning are key. One of the most important preconditions for aesthetic outcomes is that the patient’s teeth have a simple shade structure. If the shade structure of the teeth is complex or the required restoration is large, it is better to layer the dentin before injecting the enamel. Moreover, it is essential to produce two models in the wax-up phase, not just one: An “intermediate wax-up model” with every other tooth featuring the wax-up, while the remaining teeth remain unmodified. The second is a “full wax-up model” with all teeth reshaped.

Considering these aspects, it is possible to obtain great outcomes quite quickly. The learning curve is steep, however – as with every new technique to be implemented – you need to step out of your comfort zone.

Apart from CLEARFIL™ Universal Bond Quick 2 and CLEARFIL MAJESTY™ ES Flow Low you already mentioned, what instruments and materials do you use?

For treatment planning including the wax-up, I use digital technology via Smilecloud, but a traditional wax-up works just as well. The production of the silicone index is the most delicate part when doing it in-house. I recommend using EXACLEAR (GC), the only truly effective transparent silicone currently available. Adjacent teeth are isolated with PTFE tape. Finishing instruments that have proven their worth are:

• Scalpel Blade No. 12,
• 3M™ Sof-Lex™ Contouring and Polishing Discs (Solventum),
• Red-ring fine diamond burs,
• TWIST™ DIA for Composite polishers (Kuraray Noritake Dental Inc.).

Intermediate wax-up model: One tooth with wax-up followed by one tooth without.

Full wax-up model.

Do you believe that the quality of the outcome is affected by the composite material you use?

Absolutely! New high-filled flowable composites, like CLEARFIL MAJESTY™ ES Flow Low, offer excellent mechanical properties and polishability, making them very promising.

Highly aesthetic treatment outcome after injection of CLEARFIL MAJESTY™ ES Flow Low.

What material characteristics impact overall quality?

First of all, the optical properties or shade matching ability of the material are crucial. I like the fact that I can select from a variety of shades when using CLEARFIL MAJESTY™ ES Flow. Once the right shade is selected and the thickness of the injected layer does not exceed 1 mm, the optical properties of the restorations may be expected to be exceptional.

Moreover, we need a material with great flow properties (fluid, but not too runny), which is virtually void-free. I prefer using low viscosity flowable composites like CLEARFIL MAJESTY™ ES Flow Low (two other flowabilities – HIGH and SUPER LOW – are also available). The physical properties (mechanical strength) and polishability plus polish retention are also important. They are usually excellent with premium flowable composites.

What are your most important clinical tips and tricks?

For beginners:

• Press firmly on the cervical area of the silicone index to reduce excess material upon removal.
• Finish the proximal area thoroughly before moving to the next injection step. This way, you provide for perfect key positioning for the following teeth.

If you follow the protocol, the technique is very beginner friendly!

What is your opinion about the emerging hybrid "layering & injection" technique?

This hybrid technique complicates the original injection technique, which is meant to simplify composite restorations. However, it is very useful in cases where aesthetic complexity requires layering. For maximum mimicry with this technique, I would love to have injectable composites in an enamel shade at my disposal.

Would you please share your final thoughts with us?

Take your time planning! Observe, document, take photos, use digital tools! Less is more.

Dr. Facon, thank you very much!

Dentist:

LUDIVINE FACON

Dr. Ludivine Facon graduated from the University of Lille, where she developed a solid foundation in dentistry. Passionate about periodontology and dental aesthetics, Dr. Facon pursued specialized training to refine her skills in these fields. In 2007, she completed clinical periodontology training at the Charon Clinic, followed by individual dental prophylaxis training with Michel Blique in 2008. From 2013 to 2014, she attended the long cycle program at the Académie du Sourire in Aix-en-Provence, enhancing her expertise in dental aesthetics. Dr. Facon continued to build on her knowledge with international training, including at the International Institute of Periodontology in Montreal in 2015, and a veneer training course at the GAD Center in Bordeaux the same year. In 2016, she further advanced in mucogingival surgery at the Académie de Parodontologie in Aix-en-Provence. Always keeping up with the latest developments, she participated in the CIDAE training in Brussels in 2022. More recently, in 2024, Dr. Facon completed a course in composite layering and injection, led by Guillaume Piskorski, the French specialist in injected composite technique, in Lille. With extensive expertise, Dr. Facon is also an educator in direct aesthetic composites, having taught at the University of Lille in 2020, 2022, 2023, and 2024.

In part two of this veneer workflow, Roberto Rossi completes the restoration by applying CERABIEN™ MiLai lusters to the pre-stained and sintered KATANA™ Zirconia YML. Watch as he enhances surface texture, gloss, and lifelike detail through precise finishing techniques.

With just a few simple steps, Roberto creates depth, dynamic light effects, and natural contours that rival real enamel. The process is intuitive and efficient, delivering a high-end finish—culminating in a final self-glazing fire for a polished, natural result.

An intelligent solution for dental technicians seeking efficiency without compromising on aesthetics.

In the first part of this aesthetic veneer workflow, dental technician Roberto Rossi demonstrates how to apply internal stains to KATANA™ Zirconia YML. This crucial step enhances the restoration by adding depth, translucency, and natural character from within.

After refining the anatomy and surface texture, Roberto skillfully blends and applies selected shades such as A+, Fluoro, and Incisal Blue. These shades create depth, opalescence, and inner vitality that radiate through the final restoration.

A must-watch for dental technicians looking to elevate their zirconia restorations with advanced, yet straightforward, internal staining techniques.

EUROPEAN KOLS EXPERIENCE INNOVATION AND CRAFTSMANSHIP IN JAPAN

This September, seventeen of Kuraray Noritake Dental’s Key Opinion Leaders (KOLs) from across Europe—representing nine countries—embarked on a remarkable journey to Japan. The program offered a rare opportunity to experience the heart of Kuraray Noritake Dental’s culture of innovation, craftsmanship, and collaboration.

A JOURNEY OF INSIGHT AND INSPIRATION

The tour began in Tokyo, where the group traveled by bullet train to Nagoya to explore some of Japan’s cultural and professional landmarks. Visits to Nagoya Castle and the historic Noritake Garden provided glimpses into the artistry and heritage that continue to inspire our company’s ceramic technologies today.

Nagoya castle.

That evening, an official dinner in Nagoya brought together the European guests and key members of the Kuraray Noritake Dental team, including Ms. Kiyoko Ban, Mr. Yoshihisa Yamada, and Mr. Kazuhiro Yamada. It was an evening filled with rich conversations, meaningful connections, and a shared vision for the future of dental excellence.

FROM CONCEPT TO CREATION: VISITING THE MIYOSHI AND NIIGATA FACTORIES

The following day, the KOLs visited the Miyoshi Factory, where the company’s ceramic products such as KATANA™ Zirconia are manufactured, and  attended insightful presentations by their European peers — including Jorgen Gad, Sophie Dallem, Dumitru Leahu, Marios Georgoulis, Stratos Chatzichristos, and Kamila Krzepkowska — followed by a comprehensive factory tour and in-depth discussions  with R&D experts on zirconia and dental lab materials, providing unique professional insights.

Discussion with Kuraray Noritake Dental team at Miyoshi Factory.

Presentation given by DT Sophie Dallem and DT Dumitru Leahu at Miyoshi Factory.

Presentation given by DT Marios Georgoulis at Miyoshi Factory.

The tour also brought our KOLs to Niigata, where participants experienced firsthand the research and development process behind Kuraray Noritake Dental’s renowned products. A highlight was the hands-on demonstration of CLEARFIL MAJESTY™ ES Flow Universal, allowing each participant to engage directly with the materials and processes that define the company’s quality.

Hands-on course at Niigata plant.

CONNECTING THROUGH COLLABORATION

Between technical sessions, the group visited the Tokyo office and showroom, sharing open discussions with our Japanese colleagues at the headquarters, followed by a sightseeing tour through Tokyo’s landmarks — from the Imperial Palace to Tokyo Tower. These shared experiences strengthened the sense of partnership and mutual respect not only between the European and Japanese teams but also between the KOLs themselves and the company.

“It was an incredible experience meeting exceptional people worldwide, among them top specialists.” 
—    DT Kamila Krezpkowska, Poland

Discussion with Kuraray Noritake Dental team at the Tokyo headquarters.

WORDS FROM OUR KOLS

The feedback from participants was overwhelmingly positive:

“It was truly a lifetime experience — both inspiring and invaluable for me as a dental technician. Witnessing how the materials we use every day are created gave me an even deeper appreciation for the craft behind them.”
— DT Marios Georgoulis, Greece

“I’m so impressed by the organization, the endless friendliness, the openness, and the willingness to answer all my questions. It was a wonderful time, filled with so many experiences.” 
— Dr. Bernhild Stamnitz, Germany

“It was a life experience I will never forget and I am very grateful I got this opportunity to be there.[…] The drive and compassion of all the workers in office, but also at the factory were very impressive to see. The view I had about the quality of your product improved more than it already was.” 
—  Dr. Mark Laske, Netherlands

A SHARED COMMITMENT TO EXCELLENCE

The KOL Japan Tour 2025 was more than a professional visit—it was a bridge between continents, uniting people through shared values of precision, innovation, and artistry. Kuraray Noritake Dental extends heartfelt thanks to all participants and to the teams in Japan who made this unforgettable experience possible.

Group picture at the Kuraray Noritake Dental office in Tokyo.

Arigato!

CLEARFIL MAJESTY™ ES Flow Universal VINNER FORSKARPRIS

EGENSKAPERNA I ETT NÖTSKAL

I Europa har CLEARFIL MAJESTY™ ES Flow Universal nyligen lanserats i två viskositeter - Low och Super Low, medan Super Low är tillgänglig i USA. För att det ska vara enkelt att välja färg är materialet försett med en smart kombination av emaljliknande translucens, dentinliknande kroma och den unika Light-Diffusion Technology (LTD). Kombinationen ger exceptionell färgmatchning med hjälp av endast två nyanser - universal (U) och universal dark (UD). När materialet är härdat smälter det helt naturligt in bland omgivande tandstruktur.

• Direkta ersättningar för alla kavitetsklasser, cervikala skador (t.ex rotytekaries, kilformiga defekter) tandslitage och tanderosion
• Baseliner
• Korrigering av tandens position och fom (t. ex. diastemaslutning,
• Intraoral reparation av frakturerad protetik
• Cementering av inlägg (keramik och komposit), onlays och fasader tunnare än 2 mm

FÖRBLUFFANDE IN-VITROPRESTANDA

OM DENTAL ADVISOR

PANAVIA™ Veneer LC WINS PREFERRED PRODUCT AND RESEARCH AWARDS

PANAVIA™ Veneer LC has been singled out for a Research Award in the category Research – Veneer Cement by Dental Advisor and for a Preferred Product Award in the category Cement: Esthetic Resin. Published in the January/February 2025 issue of the US-based organisation, the annual Top Product, Preferred Product or Research Awards are given to those materials and devices deemed by the publication’s consultants to deliver the best practice-based or lab-based performance in their categories.

BENEFITS IN A NUTSHELL

PANAVIA™ Veneer LC is a specialized veneer cement designed to provide exceptional bond strength to various substrates, along with outstanding gloss retention and wear resistance. The resin cement utilizes smaller-diameter spherical filler particles, facilitating easy dispensing from the syringe and excellent flowability for minimal film thickness. All of these attributes contribute to virtually no change in gloss or surface appearance of veneer margins over time.

EXCELLENT PROPERTIES IN VITRO

To assess the scientific performance of PANAVIA™ Veneer LC, its features and physical properties, specifically its bond strength to various substrates after artificial aging and its wear resistance, were tested in the Dental Advisor Biomaterials Research Center. The investigators’ testing of these attributes reflects the challenges such products must meet – “Ideally, esthetic veneer cements should have a long working time, curing on demand, excellent color stability, and high strength”.

To assess bond strength to dentin, enamel, IPS e.max CAD, and zirconia, the cements were subjected to six months of artificial aging using thermocycling. To test wear resistance after toothbrush abrasion, the testing method involved measuring depth of wear, change in surface roughness, and change in gloss based on a simulation of about 5.5 years of regular toothbrush use.

The investigators reported that PANAVIA™ Veneer LC “had the best gloss retention of the three cements tested and a very even wear pattern,” noting further that “having limited surface roughness after toothbrush abrasion can help lower staining and bacterial adhesion.” Overall, they said, “The PANAVIA™ Veneer LC cement system showed excellent adhesion properties and exceptional gloss retention and wear resistance,” concluding:

OUTSTANDING RATING OF 96 PERCENT

In addition, the product was tested in the clinical setting. 25 clinical evaluators used PANAVIA™ Veneer LC cement system in their dental offices. After a total of 166 uses, the light-curing resin cement received “excellent” to “very good” ratings with regard to completeness of the kit, the shade of the try-in pastes, ease of clean-up of the try-in pastes and excess cement, viscosity, working time and lack of shade shift after curing.

The evaluator’s clinical tips included:

• „Use a micro brush or rubber tip to clean up excess cement before curing.”
• „Apply glycerin gel to the margins after placing the veneer with the cement to eliminate the oxygen inhibition layer and ensure a complete cure before light curing through the gel.”

In their comments, they praised the ease of use of the system, the design of the syringes, the shade options and shade match between try-in and cement shades, e.g.:

• “The white shade of the cement was opaque enough for efficient masking of discolored tooth structure.”
• “Great esthetics, very easy to use, complete system.”

This resulted in an overall clinical rating of 96 percent and an equally high recommendation rate.

ABOUT DENTAL ADVISOR

The Top Product and Preferred Product Awards from Dental Advisor, a US-based organization, were initiated to help busy practitioners navigate the variety of new dental solutions available, particularly for less invasive techniques and standardized procedures. These awards aim to identify products that improve outcomes consistently. Dental Advisor conducts clinical evaluations and product performance tests shortly after a product’s launch and publishes annual results online to help practitioners identify high-quality dental materials suited to their specific needs. Research Awards were initiated to honour those manufacturers of dental products with an ongoing commitment to research, development and advancement of dental materials to enhance treatment quality.

For more information, visit Dental Advisor at: www.dentaladvisor.com

Interview with the team at Kuraray Noritake Dental Inc., who developed and brought to life this new universal adhesive.

Streamlining, enhancing and refining adhesive procedures – these are the aims of an 5-person team at Kuraray Noritake Dental Inc. in Japan. Recently, the team has developed a next-generation universal adhesive CLEARFIL™ Universal Bond Quick 2 that offers quick and easy application combined with an optimised bonding performance. To learn more about the goals and achievements of the development project, and the benefits of the product, we had a conversation with them.

From left to right: Ryo Matsuura and Ryota Murayama (R&D Department), Kazutoshi Ikeda (Production Department), Marina Okada and Yamato Nojiri (Planning & Development Department).

Why did you decide to improve CLEARFIL™ Universal Bond Quick?

Universal adhesives like CLEARFIL™ Universal Bond Quick are very well received by dental practitioners all over the world mainly due to their versatility and procedural simplicity. In the clinical setting, however, we have identified room for improvement. For example, it can be difficult to establish thin, uniform and strong bonding layers with the currently available products. Water and solvents in universal adhesives often limit the formation of a strong bond layer. A thin bonding layer and the relatively thick oxygen inhibition layer make this type of bonding agent susceptible to degradation by water sorption from dentinal moisture. Highly viscous bonding agents also complicate the ease of application in small cavities and can easily lead to pooling of the adhesive in critical parts of the cavity. Adhesives with a relatively high viscosity may pool or accumulate along margins, and may form a layer that is too thick and may change the morphology of the abutment tooth, a critical factor potentially affecting the fit of an indirect restoration. Generally, bonding agents with a low film thickness and/or are low-filled or unfilled, in turn have a potentially negative effect on the strength of the bonding layer. At Kuraray Noritake Dental Inc., we wanted to address the aforementioned issues and have developed a universal adhesive that is easy to apply and facilitates the establishing of thin, uniform bonding layers exhibiting high strength.

What are the indications of CLEARFIL™ Universal Bond Quick 2?

The new universal adhesive is indicated for bonding procedures in the context of creating direct restorations with light-cured composite, sealing of a prepared cavity or abutment tooth as a pretreatment for indirect restorations, treatment of exposed root surfaces and hypersensitive teeth, and also the intraoral repair of fractured restorations. Furthermore, the product is a suitable adhesive in post-cementation and core build-up procedures as well as in adhesive cementing of indirect restorations. When used in the context of the cementing of indirect restorations, the bonding to tooth structure of PANAVIA™ SA Cement Universal and of other manufacturers’ self-adhesive resin cements improves, leading to higher bond strengths.

What are the corresponding general benefits of CLEARFIL™ Universal Bond Quick AND CLEARFIL™ Universal Bond Quick 2?

The general benefits of both products are that they may be used with any etching procedure, plus the fact that there is no need to wait for the adhesive to penetrate the tooth structure after application. In addition, both products contain the original MDP monomer and the amide monomer, responsible for the formation of a thin and strong surface coating. Both products exhibit low technique sensitivity and are suitable for a wide range of indications. Finally, the adhesive monomers and fluoride offer extra protection to the underlying dentin.

Monomer image from the brochure

You mentioned the original MDP monomer as one of the essential components of the new adhesive and its predecessor. Is there a difference between this original MDP monomer and other MDP monomers available on the market?

Our MDP monomer is the only MDP monomer that is manufactured using the originally developed synthesis and purification process. Research has shown that the way MDP is manufactured has indeed an impact on the performance of the monomer itself1. While impurities and dimers detected in MDP monomers synthesized elsewhere negatively affected the immediate and aged micro-tensile bond strength in the in-vitro study, our MDP monomer shows high purity and more favourable test results.

Most universal adhesives need to be rubbed into the tooth structure extensively for 10 to 20 seconds. What did you do to eliminate the waiting time independent of the etching procedure, which led to an ultra-quick application procedure?

It is the amide monomer which is mainly responsible for an improved penetration speed into the tooth structure. The hydrophilicity of this monomer is much higher than the hydrophilicity of the HEMA monomer that is typically used. This provides for a better penetration into the moist dentin. The amide monomer’s polymerisation characteristics are better, and, following polymerisation, leads to higher stability in a wet environment due to the formation of a highly cross-linked polymer network. In combination with MDP, an efficient long-term performance will likely be achieved. For optimal outcomes, the adhesive is simply rubbed into the tooth structure as described in the IFU: “Apply BOND with a rubbing motion to the entire cavity wall with the applicator brush. No waiting time is required.”

What are the additional benefits that CLEARFIL™ Universal Bond Quick 2 has to offer?

First of all, we improved the viscosity and film thickness by optimizing the manufacturing method. The thin adhesive layer prevents pooling in the cavity, around abutments and along margins, creating a uniform bonding layer. Simply put, the new adhesive is applied thinly and spreads evenly. At the same time, the product offers high mechanical strength and excellent resistance to water sorption. Its bond strength is high in all etching modes and the new formulation allows for the product to be stored at room temperature.

Please explain the clinical benefit of an improved mechanical strength.

The risk of decreasing the film thickness lies in a possible decrease in the strength of the bonding layer which can lead to reduced bond durability. By introducing a new multifunctional urethane methacrylate monomer, we have been able to increase the strength. The effective advantage of the new bonding agent is that it can easily be used in small, difficult-to-access cavities or in cavities with complex morphology. The result is a thin yet strong adhesive layer that also allows for easy placement of any type of restoration.

How did you manage to improve the storage conditions?

Component stability was not an issue with CLEARFIL™ Universal Bond Quick. However, for a stable viscosity, it needed low-temperature storage. By optimizing the manufacturing method and decreasing the viscosity of CLEARFIL™ Universal Bond Quick 2, storage at room temperature became possible.

Was it difficult to integrate the new components and keep the existing benefits? How did you manage?

Integrating new components and removing others always means that the whole formulation needs to be rebalanced properly. This was particularly challenging for the multifunctional urethane methacrylate monomer we wanted to add. It improves the strength and hardness of the universal adhesive, but may affect adhesion depending on the amount of the compound in the formulation. Consequently, we needed to carefully find optimal balance, which took some time and required thorough testing, but in the end, we succeeded.

At the moment, the immediate dentin sealing technique is popular in indirect restoration procedures. What makes CLEARFIL™ Universal Bond Quick 2 suited for this technique?

Immediate dentin sealing is indeed a popular and useful technique that can result in significantly increased retention, reduced marginal leakage, improved bond strength, and less postoperative sensitivity. Using CLEARFIL™ Universal Bond Quick 2 in this context is beneficial as the procedure is quick, the resulting bonding layer is thin and strong, and the dentin is effectively protected.

Why should a dental practitioner switch to CLEARFIL™ Universal Bond Quick 2?

For users of CLEARFIL™ Universal Bond Quick, switching to CLEARFIL™ Universal Bond Quick 2 is worthwhile, as it offers additional advantages and improved performance while retaining the benefits of its predecessor. For users of other universal adhesives, the major benefit lies in the shortened application time: CLEARFIL™ Universal Bond Quick 2 is the only universal adhesive that can achieve a high bond strength and a high-strength bonding layer without any waiting time. In addition, it is suitable for a wide range of indications including core build-up procedures and cementation.

Thank you very much for these insights!

References
1. Yoshihara K, Nagaoka N, Okihara T, Kuroboshi M, Hayakawa S, Maruo Y, Nishigawa G, De Munck J, Yoshida Y, Van Meerbeek B. Functional monomer impurity affects adhesive performance. Dent Mater. 2015 Dec;31(12):1493-501.

Case by Dr. Julien Molia

JA, DET FUNKAR! 

Bland många tandläkare har det blivit en etablerad uppfattning att flytande kompositer är bra som underlagsmaterial under starkare packbara kompositer och indirekta restaurationer eller som provisoriskt material. Många utgår ifrån att användningen av flytande kompositer begränsas av de dåliga mekaniska egenskaperna.

EN NY GENERATION FLYTANDE KOMPOSITER

Lyckligtvis är detta inte längre sant: Många moderna flytande kompositer - som CLEARFIL MAJESTY™ ES Flow och CLEARFIL MAJESTY™ ES Flow Universal (båda från Kuraray Noritake Dental Inc.) - är behäftade med mekaniska egenskaper som är fullt jämförbara med de hos många kompositer av pastatyp. På så sätt har användningsområdet breddats. CLEARFIL MAJESTY™ ES Flow Universal har , enligt tillverkaren, en fyllnadgrad på 75 till 78 %vikt,  böjhållfasthet på mer än 150MPa och tryckhållfasthet som är högre än 370 MPa. Tack vare hållfastheten är den en pålitlig och permanent lösning som fungerar även i områden med stora påfrestningar, d.v.s ocklusalytor i det posteriora området.

Den här flytbara kompositen har dock mer att erbjuda: Den finns tillgänglig i två flytbarheter - LOW och SUPER LOW - för att möta personliga preferenser och individspecifika behov. Vidare finns den i endast två nyanser som ger fördelen av intuitiv färgmatchning - till och med i det anteriora området. Detta möjliggörs av en blandning av färgmatchande teknologier, inkluderat optimerad ljusspridning och emaljliknande translucens.

Följande exempelfall visar hur CLEARFIL MAJESTY™ ES Flow Universal förenklar mitt liv när det kommer till posteriora fyllningar.

EXEMPELFALL

Denna patient sökte för att få två amalgamfyllningar i underkäken (tand 46 och 47 enligt FDI) utbytta (Fig.1). Eftersom det skulle underlätta fyllningen och ge bra anslutning till kavitetens väggar föll valet på CLEARFIL MAJESTY™ ES Flow Universal som det enda restorativa materialet. Positionen på de tänder som skulle bahandlas gjorde färgvalet enkelt: Shade U (universal) är gjord för att fungera perfekt för alla posteriora ersättningar.

Amalgamfyllningarna avlägsnades och karies exkaverades och så mycket av den friska tandvävnaden som möjligt bevarades (Fig.2 och 3). Tanden etsades selektivt och behandlades därefter med universaladhesiv (CLEARFIL™ Universal Bond Quick 2, Kuraray Noritake Dental Inc.) Därefter applicerades CLEARFIL MAJESTY™ ES Flow Universal, med flytbarhet LOW och nyans U i kaviteterna (Fig. 4). Tack vare den innovativa sprutdesignen är den applicerade kompositen så gott som helt fri från blåsor. I enlighet med instruktionerna för produkten och för att garantera fullständig härdning var inget skikt tjockare än 2 mm. (Fig. 5 och 6). Härdningen är helt avgörande för ersättningens hållbarhet över tid. Varje skikt ska härdas fullständigt under 10 till 20 sekunder (beroende på vilken härdningslampa som används) innan nästa skikt appliceras. Som framgår av Figur 7 tillåter den låga graden av  flytbarhet hos det valda materialet en viss modellering av den ocklusala morfologin. När fler anatomiska detaljer ska återskapas är den stadigare varianten SUPER LOW ett alternativ. Det tog bara några sekunder att putsa ersättningen till högglans (Fig.8).

Fig. 1: Två amalgamfyllningar som ska bytas ut.

Fig. 2: Amalgamfyllningarna är avlägsnade.

Fig. 3: Typiska missfärgningar av amalgam är synliga  i botten på den större kaviteten.

Fig. 4: Fyllning: Applicering av den första skiktet f lytande komposit.

Fig. 5: Den andra molaren är komplett fylld, den första molaren behöver ytterligare ett skikt flytande komposit.

Fig. 6: Fyllningarna är färdiga.

Fig. 7: Fin morfologi och färgmatchning.

Fig. 8: Behandlingsresultat efter att kofferdam avlägsnats. Ersättningarna smälter in fint bland granntänderna - med både färg och ytglans.

ETT LÄTTANVÄNT ALTERNATIV TILL PASTAKOMPOSITER

Användningen av flytande komposit med väl avvägda mekaniska egenskaper kan vara ett bra alternativ till pastakompositer - särskilt i de områden i munnen som är svåråtkomliga. Avancerade möjligheter till färgmatchning, praktiskt taget blåsfri applicering, enkel anpassning och modellering och snabb polering förenklar verkligen livet för tandläkaren.

Dentist:

JULIEN MOLIA

Dr. Julien Molla tog sin examen 2008 med en uppsats om datorassisterad implantologi. Han startade en allmänpraktik i Saint-Jean-de-Luz, där han sedan har fokuserat på implantatkirurgi och käkrekonstruktion. 2017 tog han ännu en examen i implantologi i syfte att uppdatera och fördjupa sim expertis. Han har också fortbildat sig inom digital tandvård, ortodontiska miniskruvar och mukogingival kirurgi. Då han är hängiven vävnadsbevarande tandvård har han fått privat undervisning av Drs. Gil Tirlet och Jean-Pierre Attal i Paris. Dr. Molla är en av grundarna till The French Southwest Bio Team, en samarbetsgrupp hängivna klinisk forskning och innovation.

CERABIEN™ MiLai in Daily Use

A tooth with crack lines, a characteristic round shape, age-related changes, or medication-induced discoloration — there’s no one-size-fits-all solution when it comes to all-ceramic anterior restorations, even when the porcelain system and production technique are defined.

To support technicians who wish to simplify their layering workflow using the micro-layering technique and CERABIEN™ MiLai — whether just getting started or looking to refine their process — we’ve collaborated with DT Dumitru Leahu to create a Chroma Map Catalogue featuring seven typical anterior restoration scenarios.

Each case example includes a detailed screenshot of the framework design, chroma maps outlining the planned steps, images of internal staining and micro-layering procedures, and the final restoration on the model. You’ll also find essential information about the selected framework material, target shade, and other relevant details.

We invite you to use the CERABIEN™ MiLai Catalogue as a step-by-step guide to success or simply as inspiration for individual cases. It offers a fast track to understanding the material’s optical properties and will make planning your next micro-layering case more intuitive. No need to start from scratch — instead, adapt what’s already there and gradually develop your own maps and techniques.

Interested in the CERABIEN™ MiLai Chroma Map Catalogue?

Download it here!

Interview with Ghaith Alousi, DT

He inspires dental technicians with his passion and creativity as a course instructor, and with Nature Style, he has developed a well-conceived concept for the creation of lifelike anterior restorations. We are talking about Ghaith Alousi, a dental technician based in Wiesbaden, Germany. While course participants usually attend his training courses eager to learn from his experience and technical knowledge, they often return to their laboratories bursting with positive energy, truly inspired and deeply motivated to break new ground.

Ghaith Alousi, what is the dental technician’s primary mission?

In my eyes, dental technicians are not artists; rather, their primary mission is to replicate nature – both functionally and aesthetically. Every tooth, like every patient, is as unique as a fingerprint. To recreate a natural tooth as accurately as possible, we must listen, observe, and understand. To truly perceive the details that matter, however, we need to know where to focus our attention. In my opinion, the three golden keys to anterior aesthetics are paramount: balanced translucency and opacity, morphology, and surface texture.

What about colour?

While colour is undoubtedly a crucial aspect, I believe it is often overemphasized. Many dental technicians focused on aesthetic anterior restorations find themselves preoccupied solely with colour. However, natural teeth – the model we aim to replicate – embody far more than just a blend of hues.

First and foremost, we must understand how light interacts with teeth. They diffuse light in a unique manner, with different layers of enamel and dentin each possessing distinct optical properties. Additionally, the individual shape and surface texture of a tooth significantly affect the perceived attractiveness of a patient’s smile and overall facial appearance. Therefore, I have learned to prioritize these elements, observing nature closely and striving to comprehend what I see before embarking on the replication process.

Fig. 1. Light-optical properties of natural teeth imitated with KATANA™ Zirconia YML, Esthetic Colorant and CERABIEN™ ZR porcelain (Kuraray Noritake Dental Inc.).

Let’s take a brief look at each of the three golden keys, starting with the light-optical properties.

To truly grasp how light interacts with natural teeth, we must first examine their structure. Natural teeth consist of various layers, each displaying unique light-optical behaviours, with enamel and dentin being the most significant. Upon closely observing the dentin core of a tooth, we realize it is not only responsible for the tooth’s fundamental colour but also exhibits distinct opacity – it does not transmit light; instead, it reflects and absorbs it. In contrast, enamel presents a different scenario: its thickness varies with factors such as the patient’s age, but it is consistently highly translucent. This translucency allows a portion of light to pass through, with only a minimal amount reflected or absorbed.

Once we have a solid understanding of the natural light dynamics inherent in a patient’s teeth, the next step is to replicate these characteristics using selected materials. Thus, comprehending the light-optical properties of available materials, choosing them wisely, and applying them effectively are crucial milestones on the path to success.

What about morphology?

I firmly believe that mastering morphology – the replication of natural tooth shapes – can significantly impact a dental technician’s work. The growing popularity of carving workshops in Japan and other parts of the world reinforces this idea. Aspiring technicians avoid using standard dental libraries that produce generic smiles for their patients. Rather than traveling long distances to attend workshops and build our own mental library of tooth shapes, we can explore the intricacies of form and shape right in our dental laboratories through careful observation and consistent practice. Some technicians capture images of the teeth they encounter, while others concentrate on their own teeth or those of colleagues and patients. This approach allows for the replication of shapes using materials like wax or ceramics. By honing our observation and replication skills, we expand our personal knowledge base. This commitment to detail fosters true mastery – a continuous journey toward perfection.

Fig. 2. Example of a natural surface texture reproduced with CERABIEN™ MiLai and different diamond burs, stones and rubber polishers.

Is surface texture similarly important?

Absolutely. The surface texture of a restoration, even more than its hue, must precisely match that of surrounding or opposing teeth to achieve a natural appearance. To accomplish this, we must understand and replicate the intricate interplay of micro- and macrotextures that create a tooth’s natural look. Macrotexture encompasses the tooth’s overall surface characteristics, including varying concavities, convexities, line angles, and vertical V-shaped grooves. In contrast, microtexture focuses on finer details, such as growth lines (striae of Retzius), perikymata, small grooves, and the degree of surface gloss. A keen eye is essential to replicate every surface detail harmoniously so that light interacts optimally, creating reflections, shadows, and highlights exactly where they are needed.

Fig. 3. Large tooth created with CERABIEN™ ZR.

How do you practice?

To practice replicating surface texture and morphology, I typically start with enlarged model teeth, first using wax and later transitioning to my preferred dental materials and instruments. The increased size of the working base allows for easier detection, reproduction, and assessment of relevant morphology and surface details compared to original-sized tooth forms. This enlargement also facilitates the evaluation of light-optical properties. For the final assessment, I often apply silver or gold powder to the surface of the model tooth, which highlights even the finest surface nuances. This method makes it easy to identify areas that are well-executed and those that may need improvement.

Fig. 4. Gold powder applied to anterior restorations …

Once I achieve a high level of quality with the enlarged model teeth, I transfer the acquired skills to real-life applications by working with actual-sized teeth. This practice framework allows me to continuously enhance my basic skills. Moreover, each time I start working with a new instrument or material, this approach streamlines the initial learning curve, quickly elevating my performance to a high standard.

Fig. 5. … to evaluate their shape and surface texture.

What are your preferred material combinations for different indications / needs?

For cases with highest aesthetic demands, CERABIEN™ ZR (Kuraray Noritake Dental Inc.) is my favourite porcelain system. I This system can be utilized either as a standalone solution for producing veneers using the refractory die technique or in conjunction with a zirconia framework – typically crafted from KATANA™ Zirconia variants such as KATANA™ Zirconia UTML, STML, HTML Plus, or YML (also from Kuraray Noritake Dental Inc.) – in a full layering approach.

I frequently employ this combination to produce single crowns in the anterior region, selecting the framework material based on the colour of the underlying tooth structure and the appearance of adjacent teeth. An alternative approach is layering with CERABIEN™ MiLai, which consists of internal stains and porcelains compatible with zirconia and lithium disilicate. I prefer to combine this system with the previously mentioned zirconia variants or with lithium disilicate, predominantly using the porcelain to replicate enamel. Sometimes, I employ the system’s internal stains to enhance the result with natural colour effects.

Apart from observing closely, selecting appropriate materials and copying carefully, are there any additional factors decisive for great treatment outcomes from the technician’s point of view?

To my mind, there are two additional essential factors: Proper interaction and communication within the restorative team and personal interaction with the patient. Especially in the highest aesthetic demand cases, meeting a patient in person is very important. They are usually invited to visit the dental laboratory twice, prior to treatment planning and for try-in. Nothing can replace personal interaction with them and a genuine impression of the initial situation. After all, we need to give them a sense of security and build trust, while analysing their character, facial characteristics, skin colour and more allows us to produce perfectly matching restorations.

Fig. 6. Full layering approach with CERABIEN™ ZR on a KATANA™ Zirconia YML framework.

And the restorative team?

We share a common goal: to fulfil the desires of our patients. I firmly believe that achieving this requires a united effort from the entire team. Collaboration hinges on appreciative and open communication at all levels and demands absolute honesty. Furthermore, everyone involved must be committed to continuously developing their skills.

I hold high expectations not only for my own work but also for the contributions of each dentist in our team. After all, their work forms the foundation of what I do. For example, when a dentist invests in an intraoral scanner and starts providing digital records, it is my responsibility to verify whether the quality of those scans meets our high standards. If I notice that the quality could be improved, I approach the situation with respect, offering constructive feedback and guidance to help them deliver quality scans consistently. This is crucial, as high-quality scans are the prerequisite for creating outstanding restorations.

In my experience, most dental practitioners appreciate this kind of honest and supportive communication. It creates an environment where we can all grow and evolve together.

Do you have any additional comments?

Be authentic, strive for excellence, and approach each day as an exhilarating opportunity. Courage plays a vital role, too – the readiness to venture beyond your usual routines, such as experimenting with different shades to discover new possibilities, fosters growth. Even if the outcome does not meet your expectations, there is valuable insight to gain from the experience that can guide you in the future. To reach new horizons, be open to exploring uncharted paths.

Dentist:

GHAITH ALOUSI

Ghaith Alousi, born in 1994, successfully completed his training as a master dental technician in 2013 in Damascus, Syria, where he gained initial experience in a dental laboratory. From 2014 to 2016, he worked independently in Damascus, using his craftsmanship to produce ceramic work such as frameworks, veneers, crowns and bridges, and implant-based restorations. He also engaged in shade determination, photography, and CAD/CAM technology.

He came to Germany in 2016 and quickly felt at home. Through further education, he has continuously expanded his knowledge and skills and is currently working as a dental technician in Wiesbaden. To achieve the best possible results, Ghaith Alousi places great value on collaboration with dentists and personal contact with patients.