By Dr. Gintautas Rumbaitis, DDS

A CLINICAL CASE EXAMPLE

Low polymerization shrinkage, high strength and excellent wear resistance are among the most important criteria when selecting a restorative material for the posterior region. Low shrinkage supports marginal integrity after curing, while high mechanical strength provides for long-term stability even under high occlusal load. High wear resistance, in turn, contributes to long-term morphological stability. Together, these characteristics form the basis for the long-term success of posterior restorations.

The CLEARFIL MAJESTY™ family from Kuraray Noritake Dental Inc. offers materials designed to meet these requirements. They enable the creation of restorations that not only provide an appealing aesthetic outcome, but - more importantly - effectively restore the function and anatomy of the teeth. The portfolio includes a range of paste-type composites supporting different shade concepts, from single-shade to multi-shade approaches, as well as high-strength flowable composite materials.

CLEARFIL MAJESTY™ ES Flow is available in three levels of flowability and multiple shades. The universal alternative introduced in 2025, CLEARFIL MAJESTY™ ES Flow Universal, is offered in Low and Super Low flowabilities and two shades. These flowable materials provide the mechanical properties required for the successful restoration of all cavity classes. They can be used alone or in combination with paste-type composites, allowing clinicians to select the restorative concept best suited to each clinical situation.

A restoration procedure combining the new flowable material with a paste-type composite from the MAJESTY family (CLEARFIL MAJESTY ES-2) is demonstrated below using a clinical case example.

The patient presented for replacement of existing composite restorations in the posterior region. Clinical examination revealed that the restoration on the maxillary left first molar (FDI notation: tooth #26) showed marginal leakage as well as insufficient anatomical structure and occlusal height (Fig. 1). Replacement of the restoration was therefore planned. The clinical procedure is illustrated and described in Figures 2-12, while Figures 13-15 show the treatment outcome.

Fig. 1. Restoration on the first molar that needs to be replaced.

Fig. 2. Situation after removal of  the existing restoration. Removal  of the remains near the cavity floor performed using a carbide burr, without water, at slow speed.

Fig. 3. Cavity checked using Caries Detector (Kuraray Noritake Dental Inc.) for remaining decay.

Fig. 4. A distal crack is observable on the proximal wall of the first molar.

Fig. 5. Appearance after dissection of the cracked area and careful removal of the remnants of the composite restoration.

Fig. 6. Tooth after placement of a sectional matrix and sandblasting of the surface with 27 µm aluminium oxide powder.

Fig. 7. Selective etching with phosphoric acid etchant for 15 seconds.

Fig. 8. Strengthening of the cavity floor with fibres embedded in CLEARFIL™ AP-X composite (Kuraray Noritake Dental Inc.)

Fig. 9. Application of CLEARFIL MAJESTY ES Flow Universal in the shade UD (Universal Dark) in 2 mm increments, primarily to replace the dentin.

Fig. 10. Modelling of the occlusal area with CLEARFIL MAJESTY ES Flow Universal in the shade U (Universal).

Fig. 11. Modelling finished.

Fig. 12. Brown stains and CLEARFIL MAJESTY ES-2 in the shade WD applied for optical effects.

Fig. 13. Result of the polishing procedure.

Fig. 14. Buccal view of the polished restoration.

Fig. 15. Immediate treatment outcome with the tooth structure still being dehydrated.

CONCLUSION

The presented clinical case demonstrates how posterior teeth can be restored predictably and efficiently using materials from the CLEARFIL MAJESTY ES-2 portfolio. The combination of CLEARFIL MAJESTY ES Flow Universal as a flowable base layer and CLEARFIL MAJESTY ES-2 as a paste-type composite enables controlled placement, excellent adaptation to the cavity walls and the precise reconstruction of anatomical structures.

Thanks to their low polymerization shrinkage, high mechanical strength and excellent wear resistance, the materials support marginal integrity and functional stability over time. At the same time, the wide range of flowabilities and shade concepts provides dental practitioners with the flexibility desired to adapt the restorative concept to individual preferences and clinical situations.

CHOOSE AWARD-WINNING TEETHMATE DESENSITIZER

Immediate relief, long-term protection, and easy application — these are key requirements when managing dentin hypersensitivity. With TEETHMATE™ DESENSITIZER, Kuraray Noritake Dental Inc. offers a non-invasive, clinically proven solution designed to provide rapid and lasting relief.

TEETHMATE DESENSITIZER is a powder-liquid formulation that, once mixed, creates a hydroxyapatite slurry. Applied to exposed or freshly prepared dentin, this slurry seals open dentinal tubules. As the material sets, hydroxyapatite crystals are formed, providing a biomimetic barrier that supports both immediate pain relief and long-term sensitivity reduction — without affecting bond strength when applied in the context of restorative procedures.

Key benefits of TEETHMATE DESENSITIZER include:
•    Ease of mixing and application
•    Scientifically proven long-term effect
•    Tissue-friendliness and biocompatibility
•    Compatibility with restorative procedures – no effect on bond strength

DENTAL ADVISOR TOP PRODUCT AWARD

Hydroxyapatite formation: a true game changer

The clinicians who tested TEETHMATE DESENSITIZER in clinical practice identified the material's ability to form hydroxyapatite in an easily applicable slurry consistency as a top feature. In a long-term study conducted by the Dental Advisor, hypersensitivity relief was achieved in 85% of patients.

Representative comments included: "TEETHMATE DESENSITIZER is easy to apply and seems to provide consistent relief…" and "at six months, the majority of patients continue to experience marked improvement from their preoperative sensitivity or no sensitivity at all."

These outcomes contributed to a high overall clinical performance rating and the product's continued recognition as a Top Product in its category – the twelfth time in a row.

DEMONSTRATING LONG-TERM EFFECTIVENESS

By earning another Dental Advisor Top Product Award in 2026, TEETHMATE DESENSITIZER continues to demonstrate long-term effectiveness in managing dentin hypersensitivity. Its biomimetic mechanism of action, ease of use, and clinically proven relief make it a trusted solution for both preventive and restorative treatment protocols.

For more information, visit Dental Advisor.

WITH AWARD-WINNING CLEARFIL SE Protect

While many clinical situations call for a bonding agent that delivers strong, durable adhesion quickly and easily, some cases demand more than that. Developed by Kuraray Noritake Dental Inc., CLEARFIL™ SE Protect goes beyond dependable bonding performance by offering additional protective benefits – most notably an antibacterial cavity-cleansing effect.

CLEARFIL SE Protect is a proven two-step self-etch adhesive built on the same trusted platform as the recognized Gold Standard - CLEARFIL™ SE BOND, known for its excellent bond strength to tooth structure. 

In addition, CLEARFIL SE Protect incorporates two advanced technologies: long-term fluoride release and the antibacterial MDPB monomer, which destroys bacteria on contact. These added benefits eliminate the need for a separate cavity cleanser, contributing to both clinical efficiency and restorative longevity. As a result, the product has once more been named a Top Product in the Direct Restoratives – Bonding Agent: Self-Etch category by Dental Advisor.

The key features of CLEARFIL SE Protect include:

• Fast, simple application with minimal technique sensitivity
• A tried-and-tested two-step self-etch system providing high bond strength to enamel and dentin
• An effective antibacterial cavity-cleansing action
• Virtually no post-operative sensitivity

DENTAL ADVISOR RECOGNITION: LONG-TERM PERFORMANCE AND ANTIBACTERIAL PROPERTIES

This year, Dental Advisor consultants highlighted CLEARFIL SE Protect's long-term clinical performance and antibacterial effectiveness as top features. Long-term studies confirmed strong resistance to microleakage and the absence of marginal staining.

The antibacterial cavity-cleansing effect is achieved through the MDPB monomer, which contains a positively charged pyridinium group that attracts negatively charged bacterial cells. Upon contact, the bacterial cell membrane is disrupted, resulting in bacteriolysis and a clean cavity surface – an ideal foundation for durable restorations. Once polymerised, the MDPB monomer becomes immobilised, remaining latently active without causing harm to surrounding tissues.

Evaluators also praised the product's handling characteristics and lack of post-operative sensitivity. One evaluator commented, "The flow of the primer and bond is easily controlled using the unique dispensing system".

A DEPENDABLE BONDING SOLUTION

By combining proven adhesive performance with antibacterial protection and long-term success, CLEARFIL SE Protect continues to set itself apart in the self-etch category. Its repeat recognition by Dental Advisor underscores its value as a dependable, multifunctional bonding solution for clinicians seeking both efficiency and enhanced patient outcomes.

For more information, visit Dental Advisor.

Clinical case by Dr. Zygintas Jonaitis

MINIMALLY INVASIVE INDIRECT RESTORATION PROCEDURE IN THE POSTERIOR REGION

The aim of preserving as much natural tooth structure as possible is ever-present in modern restorative concepts. No matter whether a direct or indirect restorative procedure is preferred, a whole array of tools, techniques and materials are available that help make the clinician's life easier and treatment outcomes more predictable and durable. Those solutions are designed to facilitate identification of tooth structure that needs to be removed, aid cavity cleansing or maximise the bonding performance without adding complexity to the treatment. Using the following clinical example, a possible restorative workflow is described.

RESTORATION REPLACEMENT REQUIRED

This patient presented with a composite restoration on a first molar that attracted our attention. The very extensive composite restoration was worn, lacked good anatomical form and proper occlusal contacts, showed leakage and signs of secondary caries (Fig. 1). The tooth reacted to sweets and cold. It was clear that repair was not the best option: the restoration needed to be replaced. Due to the size of the existing composite filling, it was decided to place an indirect partial restoration that would allow us to save as much natural tooth structure as possible while providing for long clinical service life.

Fig. 1. Initial clinical situation.

SELECTIVE CARIES REMOVAL

After rubber dam placement, the existing restoration was removed carefully, revealing secondary caries underneath the composite (Figs. 2 and 3). To facilitate selective caries removal down to remineralisable (non-infected) dentin, Caries Detector was applied (Fig. 4). This liquid stains only the infected tissue, so that it is easily identified and selectively removed using diamond instruments (Fig. 5). This helps users preserve remineralisable (affected) dentin that may be left untouched and – whenever well-sealed – does not pose a risk for the future restoration.

Fig. 2. Isolation of the working field with rubber dam.

Fig. 3. Removal of the old composite restoration.

Fig. 4. Application of Caries Detector to visualise infected dentin.

Fig. 5. Cavity after the removal of infected dentin.

ADHESIVE PROCEDURE AND BIO-BASE CREATION

To create a stable basis for the indirect restoration, the tooth surface was first cleaned thoroughly using KATANA™ Cleaner (Fig. 6). This cleaning agent developed for intra- and extra-oral use effectively removes contaminants that might compromise adhesion from the surface – a decisive step as a strong and durable bond is the creation of a stable foundation. Subsequently, CLEARFIL™ SE Protect, a self-etching adhesive with MDPB, an antibacterial monomer was applied according to the manufacturer's instructions for use (Fig. 7). Next, a layer of poly ethylene fiber, wettened with CLEARFIL SE Protect Bond was placed and covered with flowable composite (CLEARFIL MAJESTY™ ES Flow Universal). Hereafter a layer of fiber reinforced flowable composite was placed and cured. An impression was taken with an intra-oral scanner and a glass-ceramic restoration produced in the laboratory.

Fig. 6. Cleaning of the tooth structure with KATANA Cleaner.

Fig. 7. Self-etch adhesive with anti bacterial effect applied to the tooth structure.

Fig. 8. Foundation created with fibres, bond and flowable composite.

Fig. 9. Completed with a layer consisting of short-fibre reinforced composite.

TOOTH PREPARATION AND ADHESIVE CEMENTATION

Tooth preparation was performed (Fig. 10). followed by pre-treatment of all surfaces to provide for a strong and durable connection between the foundation and the indirect restoration. The bonding surface of the glass ceramic restoration was etched with hydrofluoric acid before applying a ceramic primer (CLEARFIL™ Ceramic Primer Plus) . Followed by applying PANAVIA™ V5 Paste onto the restoration (Fig. 12). The tooth structure and foundation were treated according to the manufacturers instructions with the system-specific PANAVIA V5 Tooth Primer before placing the restoration. The cement was light-cured thoroughly, restoration margins were cleaned and polished (Fig. 13) and the rubber dam was removed. Figures 14 and 15 show the treatment outcome.

Fig. 10. Prepared tooth prior to adhesive cementation.

Fig. 11. Pre-treatment of the bonding surface of the restoration with a ceramic primer.

Fig. 12. Application of the selected adhesive resin cement onto the restoration.

Fig. 13. Restoration in place.

Fig. 14. Occlusal view of the final restoration.

Fig. 15. Occlusal view of the final restoration

CONCLUSION

The described procedure shows the restoration of a posterior tooth's anatomy and occlusal contacts in cases with severe loss of sound tooth structure. The remaining tissue is preserved wherever possible, while the protective foundation provides for a tight seal of the underlying tooth structure. Utilizing the indirect restoration method supports the restoration's marginal integrity. A long clinical service life may be expected.

Ett fall av Dr Onur Alp Yünük  

Vackra tänder och ett felfritt leende: Att leva upp till patienternas estetiska krav på fasadbehandlingar kan vara en utmaning. Vissa patienter har konkreta idéer om hur deras nya tänder ska se ut, medan andra har svårare att uttrycka sina förväntningar. I de fallen är det viktigt att välja en behandling som ger utrymme för modifiering - antingen i form av en mer omfattande planering med digital smile design, eller genom att göra kompositersättningar som enkelt kan modifieras intraoralt. 

Den senare metoden valdes i det här fallet: En ung kvinna som sökte sig till vår klinik eftersom hon var missnöjd med de fasader hon hade i överkäksfronten (Fig. 1 till 4). Vid undersökningen konstaterades att de befintliga ersättningarna hade en ojämn och rå yta, missfärgade kantanslutningar och att kompositen hade dålig hållfasthet. För att skapa optimal funktion och estetik beslutades att de befintliga ersättningarna skulle avlägsnas och ersättas av nya kompositersättningar i hela överkäksfronten (tand #13 till #23 enligt FDI). Patienten uttryckte önskemål om mer individualisering och karaktär för att får ett finare leende.

Fig. 1: Kompositfasaderna i överkäksfronten uppvisade otillfredställande estetik och funktion.

Fig. 2: Ocklusal bild med synliga defekter på kompositfasaderna.

Fig. 3: Lateral vy (höger sida) avslöjar ojämnheter i ytan.

Fig. 4: Lateral vy (vänster sida) avslöjar ett stort område där kompositen släppt.

NYA KOMPOSITFASADER

För att imitera translucensen hos patientens egna tänder och för att uppfylla hennes estetiska önskemål användes ett polykromatiskt system och dualskiktsteknik för ett fint, optiskt samspel av translucenser i det anteriora området.

Under färgtagningen användes den bilaminära färgbedömningstekniken (BSAT), som bygger på färgkombinationen av dentin- och emaljkompositer. I denna teknik lades den önskade emaljfärgen i skikt över den önskade dentinfärgen för att utvärdera den resulterande färgen som skapades av de två kompositfärgskikten. Materialen polymeriserades på tandytan utan bonding för att verifiera den kumulativa färguppfattningen som uppstod genom skiktningen, snarare än materialens individuella nyanser, för att säkerställa harmoni med den naturliga tandstrukturen vid behandlingens början. Fotografier togs med en kamera utrustad med ett korspolariserat filter (Fig. 5). Därefter avlägsnades retainern, liksom de befintliga kompositfasaderna. För att bevara så mycket som möjligt av den underliggande friska tandstrukturen utfördes ingreppet under förstoring och med blått ljus, röda och gula diamanter samt hårdmetallfräsar.

Fig. 5: Färgtagning - bilden är tagen med korspolariserande filter som eliminerar ljusreflexer.

Fig. 6: Tänderna när de defekta fasaderna avlägsnats.

Tänderna isolerades med kofferdam som säkrades med tandtråd i de cervikala områdena. Därefter påbörjades behandlingen. Emaljen etsades och behandlades med självetsande bonding (CLEARFIL™ SE Bond 2, Kuraray Noritake Dental Inc.) och CLEARFIL MAJESTY™ ES-2 Premium (Kuraray Noritake Dental Inc.)  appliceras: dentinkärnan med sin uttalade mamelonstruktur modellerades med A1D. De incisala skären accentuerades med hjälp av vita pigment. För att skapa en opalescerande effekt skiktades ett tunt lager av den translucenta färgen Blue vid incisalskären. Emaljskiktet byggdes upp med emaljfärgen WE. Eftersom retainern tagits bort framställdes en transparent aligner som patienten ombads att använda fram till nästa behandlingstillfälle.

Fig. 7: Isolering med kofferdam inför behandling av lateraler och hörntänder.

Fig. 8: Det vestibulära emaljskiktet skiktas på tänderna.

Fig. 9: Form och färg enligt patientens önskemål.

Efter finishering och polering med Twist DIA for Composite skickades patienten hem och en ny tid bokades för utvärdering och slutjustering.

Vid kontrollen bad patienten oss att minska den incisala translucensen och valören en aning samt att ändra tändernas form: Hon ville ha längre centraler med mjukare och rundare hörn och med en jämnare incisal form. Kofferdam placerades igen och de vestibulära ytorna slipades ner en aning  med hjälp av röda och gula diamanter. För att förbättra förutsättningarna för optimal mikromekanisk anslutning ruggades och sandblästrades ytan med 50µm aluminiumdioxid. Fosforsyra, silan och CLEARFIL™ SE Bond 2 applicerades steg-för-steg som en del av det adhesiva protokollet. Ersättningarna modifierades sedan genom förlängning, färgen korrigerades med CLEARFIL MAJESTY™ ES-2 Premium, A1D och A1E och den anatomiska formen f injusterades (Fig. 10 och 11).

Fig. 10: Modifiering av ersättningarna på de centrala incisiverna.

Fig. 11: Modifierat leende: Tänderna har fått en jämnare form och kontur och en naturligare färg.

Vid det sista behandlingstillfället uttryckte patienten att hon var mycket nöjd med sitt nya leende. Ersättningarnas ytor polerades igen, en ny retainer bondades fast och slutresultatet fotograferades (Fig. 12 till 16).

Fig. 12: Slutresultat - frontal vy.

Fig. 13: Slutresultat - ocklusal vy.

Fig. 14: Slutresultat - lateral vy.

Fig. 15: Slutresultat - patientens leende.

Fig. 16: Detaljerad bild av innerstrukturen - som blir synlig med ett polariserande filter.

SAMMANFATTNING

Att prata med patienterna om varje liten detalj i behandlingen och att lyssna uppmärksamt på deras idéer, förväntningar och krav räcker inte alltid för att förhindra att det ändå blir en del justeringsarbete - helt enkelt därför att patienterna behöver se resultatet innan de kan avgöra om de tycker om det eller inte. Turligt nog ger rätt val av material och teknik tandläkaren utrymme att skapa ett nytt leende som kan modifieras utan att man skadar frisk tandvävnad. Det är alltså inte längre så svårt att göra även den mest krävande patienten nöjd.

ACCORDING TO DENTAL ADVISOR: CLEARFIL MAJESTY ES Flow

Exceptional aesthetics, precise handling, and dependable performance are the hallmarks of a flowable composite clinicians return to year after year. With CLEARFIL MAJESTY™ ES Flow, Kuraray Noritake Dental Inc. delivers a highly filled flowable composite designed to offer versatility across a wide range of restorative procedures, without compromising aesthetics.

In 2026, the medium viscosity variant of CLEARFIL MAJESTY ES Flow (Low) was once again recognised by Dental Advisor. It earned a Top Product Award in the category Direct Restoratives – Composite: Highly-Filled Flowable for the 10^th time! This continued recognition underscores its consistent clinical performance and long-standing trust among dental professionals.

CLEARFIL MAJESTY ES Flow is available in three flowability options in Europe, allowing clinicians to select the ideal viscosity for each indication.

Containing Kuraray Noritake Dental Inc.'s Light Diffusion Technology, the material delivers natural-looking restorations that blend seamlessly with the surrounding tooth structure.

Key advantages of CLEARFIL MAJESTY ES Flow include:
•    Outstanding aesthetics with lifelike opacity and shade blending
•    Three flowability options for maximum clinical flexibility
•    Excellent handling properties 
•    Easy finishing and polishing
•    A syringe design that helps prevent voids and dripping

ELEVEN-TIME RECOGNITION FOR AESTHETICS AND HANDLING

CLEARFIL MAJESTY ES Flow's eleventh Dental Advisor Award reflects its ability to deliver reliable results in everyday clinical practice. Evaluators consistently highlighted the composite's excellent handling, controlled viscosity, and highly aesthetic outcomes.

Minimal finishing and polishing were necessary thanks to the material's natural opacity and shade behaviour, while the high filler content was found to support stability without slumping. The updated syringe design was also praised for contributing to smooth dispensing and reduced risk of air bubbles.

Evaluator feedback included comments such as: "The material blended so well with the tooth structure that you had to look hard to find the interface" and "My go-to flowable composite. Looks beautiful in any clinical case, any class, anywhere".

A PROVEN FAVOURITE

Earning a Product Award for the eleventh time, CLEARFIL MAJESTY ES Flow stands as a proven favourite in highly filled flowable composites. Its combination of aesthetic excellence, dependable handling, and clinical versatility continues to make it a trusted choice for restorative dentistry – year after year.

For more information, visit Dental Advisor.

THE IMPACT OF A MATERIAL SWITCH IN THE DENTAL LABORATORY

Switching to a different type of zirconium is not something you do lightly. Was the leap to KATANA™ Zirconia worth it? Three dental lab owners share their experience!

Not all zirconium oxide materials are created equal. Dental technicians worldwide recognise that zirconium oxide discs vary significantly in quality depending on their composition and manufacturing process. The most noticeable differences lie in their mechanical and optical properties, both of which are determined during production.

At first glance, zirconium oxide products from leading manufacturers may seem similar. However, -sometimes invisible- differences can exist. Achieving the highest quality requires the use of premium raw materials, advanced cleaning and pressing techniques, and precise pre-sintering methods. These factors help ensure superior results while minimizing the risk of remakes.

Selecting a high-quality zirconium oxide product is crucial, particularly when working with complex structures or specialised processing techniques. The right choice can significantly impact the final outcome and durability of dental restorations.

We had a conversation with three decision makers of Norwegian dental laboratories to learn more about their reasons to switch to the KATANA™ Zirconia Multi-Layered Series (Kuraray Noritake Dental Inc.) and their path to success with these materials. Espen Rørstad is the owner and general manager of Vestfold Dental in Tønsberg, Lucas Andvik the general manager of Cicero Dental AS in Trondheim and Egil Berg the general manager of dental technology at Berg Dental in Askim. They are happy to share their experience and practical tips and tricks.

TIME FOR CHANGE

The reasons to start testing alternative zirconium oxide materials were different: Espen Rørstad, who has been a dental technician for 24 years, was looking for improvements in strength and aesthetics: "Nowadays, zirconium materials are evolving quickly, and specifically those blanks with multi-layered colour, translucency and flexural strength attracted my attention. I first tested a material from another leading manufacturer. Then, I received a single disc of KATANA™ Zirconia YML. I was immediately impressed by the homogeneous, densely pressed material and its optical properties. Ever since my first trial case with KATANA Zirconia YML, I have not used any other zirconium oxide again."

"I was immediately impressed by the homogeneous, densely pressed material and its optical properties."

- Espen Rørstad -

CHOOSING THE RIGHT MATERIAL

Egil Berg uses KATANA Zirconia YML for most indications, and KATANA™ Zirconia HTML Plus for large reconstructions of ten or more units. The design is predominantly monolithic with a small (vestibular) cutback. The approach of Espen Rørstad is similar. He also uses KATANA Zirconia YML on a regular basis for reconstructions with up to ten units, even on implants in combination with Ti-bases. "For larger-span restorations, I most frequently opt for KATANA Zirconia HTML Plus or, occasionally KATANA™ Zirconia HT combined with a traditional layering approach". Lucas Andvik uses all four types of multi-layered zirconia from Kuraray Noritake Dental Inc. (KATANA Zirconia UTML, STML, HTML Plus and YML) to have the best of all worlds.

ESTABLISHING WORKFLOWS

Switching materials always means investing time and effort until processes run smoothly and predictably. According to Espen Rørstad, it did not take long with KATANA Zirconia to get the parameters right and obtain high-quality results. According to him, a factor that is critical for good outcomes with KATANA Zirconia YML is positioning of the restoration in the disc. "Proper positioning is key to success - long-span reconstructions are only stable if positioned according to the manufacturer's recommendations. The learning curve is quite steep and we have no issues with fractures," he says. Lucas Andvik slightly adjusted his production procedure to provide for great outcomes: "Initially, we tried to position our restorations in blanks of the heights we had used before, and this turned out to be quite challenging. In order to have enough space for the connectors and be able to position long-span restorations in the middle of the disc as recommended, we started utilising higher blanks. With this strategy, the initial challenges were a thing of the past."

EASY CARVING

One of the practical benefits of using KATANA Zirconia is the fact that it is perfectly suitable for carving. Lucas Andvik states: "Carving is easier with KATANA Zirconia than with other materials. It is even possible to go close to the margins without increasing the fracture risk. Other materials seem to be much less dense and softer, which may result in marginal fractures. Carving is really a feature that transformed our inhouse production procedure and contributes to great outcomes." Espen Rørstad and Egil Berg agree that carving feels great with this material, while the former also stresses that the overall aesthetics when using the carving technique are very well received by partners from dental offices.

"Carving is easier with KATANA Zirconia than with other materials."

- Lucas Andvik -

MASTERING THE SINTERING PROCESS FOR OPTIMAL RESULTS

A procedure known as a critical step in the production procedure is the sintering. Virtually every leading manufacturer of high-translucency zirconium oxide advises users to calibrate furnaces and check the achieved temperatures on a regular basis to provide for optimal outcomes. The actual sintering protocols recommended for each material, however, are very different. Kuraray Noritake Dental Inc. offers three sintering programms valid for all four materials of the KATANA Zirconia Multi-Layered series: The standard seven-hour programme is available for all kinds of prostheses, while the high-speed 54-minute and 90-minute programmes are suitable for restorations with up to three units. For KATANA™ Zirconia Blocks, even 18-minute sintering is possible. Lucas Andvik uses the seven-hour programme for over-night sintering of all large restorations, and speed sintering for single-tooth restorations and small bridgeworks during the day. With his new furnace, he simply adopted the recommended protocols. Espen Rørstad  modified the protocols slightly for his furnace and regards speed sintering as a great option for rush cases. Egil Berg prefers over-night sintering. He reports: "It is really important to have a high-quality, modern furnace, calibrate it regularly and follow the manufacturer's instructions. My recommendation for everyone experiencing issues is to pay extra attention to warming up and cooling down properly. That way, you achieve the highest possible strength and aesthetics, including an absolutely smooth transition between the different layers in the blank."

MICRO-LAYERING: A GAME CHANGER FOR FINISHING

In all three dental laboratories, the integration of KATANA Zirconia has led to a shift towards higher-efficiency finishing approaches. Espen Rørstad reports: "The switch to KATANA Zirconia enabled us to increase the amount of monolithic and micro cut-back zirconium oxide restorations from around 40 to 80 percent. In the anterior area, we use a minimal vestibular cutback and micro-layering, while the restorations are purely monolithic and only minimally pre-coloured in the posterior area. Classical layering is only delivered on special request." Egil Berg states: "We completely stopped using traditional porcelain layering approaches and prefer micro-layering instead - especially in combination with KATANA Zirconia YML. The aesthetic outcomes are so good that a cosmetic dentist recently called me and asked if I had used lithium disilicate instead of zirconium." Lucas Andvik also likes to add a little bit of porcelain: "We moved away from a full cutback to micro-layering approaches, using the same porcelain system for lithium disilicate and zirconium oxide," he says. In subgingival areas, he often just polishes the restorations for highest biocompatibility, a concept that is very well received by dental practitioners.

HAPPY WITH THE RESULTS?

Egil Berg concludes: "Once you have implemented the workflow and set all parameters, working with KATANA Zirconia is really great. My staff likes its handling during carving, the efficient workflows and predictable results. Although sometimes the product may be more expensive than other brands' zirconium oxide, the total economy is a lot better: We do no longer face any issues with fractures and remakes, and due to the homogeneous material structure, the service life of our milling tools is extended, while, at the same time, the edge stability of the milled restorations is increased. The blanks are so homogeneous that I am able to sinter long-span restorations without a lateral support!"

The conclusion of Lucas Andvik is similarly good: "everyone in my laboratory working with KATANA Zirconia is more than satisfied. My co-founder, Katharina, has tested many different materials on behalf of notable manufacturers and has never seen anything that compares to KATANA. All the technicians that work with KATANA here consider it to the most versatile and aesthetic we have ever utilized. I think that all four variants are super nice to work with. My personal recommendation is to attend one of the courses offered by Kuraray Noritake Dental Inc. The instructors are super knowledgeable and we got a completely new conception of zirconium oxide as well as practical advice that was really useful for our daily work."

"The blanks are so homogeneous that I am able to sinter long-span restorations without a lateral support!"

- Egil Berg -

Espen Rørstad is sure that "in terms of aesthetics, KATANA Zirconia is the best zirconium oxide tested, and I really tested a lot in the past decades! I am happy with the material, the interaction with the Kuraray Noritake Dental team and the support offered. My team is also happy with the material, but even more important is the positive feedback of my customers: One of them requested a specific zirconium all the time, and when we switched, we did not tell him immediately. Now he knows and is very happy with what he gets." Espen is sure that economically, KATANA Zirconia YML is even able to compete with cheap zirconium oxide brands, as the production procedure is much more efficient and the results are predictable.

Switching zirconium oxide materials is a significant investment in both time and resources, but for many dental laboratories, the results speak for themselves. The experiences shared by these Norwegian technicians demonstrate that KATANA Zirconia offers a balance of aesthetics, strength, and efficiency. While adapting to new workflows takes effort, the improved outcomes, fewer remakes, and enhanced handling make the transition worthwhile. For those considering the switch, thorough testing and training are key to ensuring a smooth and successful integration.

PANAVIA SA Cement Universal NAMED A TOP PRODUCT BY DENTAL ADVISOR

Strong, durable adhesion in a simplified single-step cementation procedure – this is what clinicians expect from a modern self-adhesive resin cement. With PANAVIA™ SA Cement Universal, Kuraray Noritake Dental Inc. delivers a versatile cementation solution designed to bond to virtually every restorative substrate – without requiring a separate primer or silane.

Key benefits of PANAVIA SA Cement Universal include:
•    Wide variety of indications, including cementation of crowns/bridges, inlays/onlays, posts, splints, and even adhesion bridges
•    Adheres to a wide variety of restorative materials (including lithium disilicate) without separate primers
•    Easy, gingival-friendly excess removal
•    Ready for use immediately as it requires no refrigeration

DENTAL ADVISOR TOP PRODUCT AWARD

Open options and minimized materials are the top features

PANAVIA SA Cement Universal contains two advanced monomers – the LCSi monomer as a silane coupling agent and the original MDP monomer – to establish a strong chemical bond to a wide variety of substrates. It is thus no surprise that "Open Options" (as it adheres to virtually all substrates) and "Minimized Materials" (as it does not need any separate adhesive and primers) were the top features that made the product win a Top Product Award in 2026 (and every year since 2020).

Evaluators also enjoyed its user-friendly handling with an "Amazing viscosity, tack cure-ability and very easy cleanup" as well as the fact that it "can be used in a moist environment with no setting issues".

Its user-friendly handling and predictable outcomes make it a popular choice for clinicians who value both efficiency and performance.

Dependable choice for efficient cementation

By earning the Dental Advisor Top Product Award for the seventh consecutive year, PANAVIA SA Cement Universal once again demonstrates excellent performance in clinical practice. Its innovative monomer technology, simplified protocol, and consistent bonding performance make it a dependable choice for efficient, universal cementation.

PANAVIA SA Cement Universal AS PART OF THE EXPANDING PORTFOLIO

At Kuraray Noritake Dental Inc., we understand the demands of modern dental practices. Balancing complex procedures, tight schedules, and patient care is no easy task. That is why we have spent years refining our materials—so you can focus on what matters most: your patients.

Our Universal Excellence portfolio is designed to streamline clinical workflows, providing high-quality materials that work seamlessly together and support efficient, reliable treatment outcomes.

For more information, visit Dental Advisor and the Kuraray Noritake Dental Europe website.

Article by Peter Schouten

Att restaurera endodontiskt behandlade tänder kräver oftast någon form av pelaruppbyggnad som stöd för den protetiska ersättningen. Historisk har rotstift varit en vanlig metod för att öka retention och stabilitet vid pelaruppbyggnad. Tack vare utmärkt estetik, adhesion och mångsidighet har dock har kompositmaterial blivit populärt att använda vid pelaruppbyggnad. Eftersom förstärkning av kvarvarande tandstruktur (liksom ersättning av saknad sådan) är fundamentalt förblir valet att använda rotstift en fråga för fortsatta diskussioner.

Målet med den här artikeln är att utforska flera nyckelfaktorer relaterade till restauration av endodontiskt behandlade tänder med hjälp av komposit, med eller utan rotstift.

HISTORIK

Ursprungligen användes rotstift av metall för styrkans skull. Stål, titan och guld var populära val. Betänkligheter avseende eventuella komplikationer ledde dock till ett skifte i behandlingsfilosofin.

Inträdet av adhesiva behandlingar gav möjlighet att framställa kompositpelare som ger utrymme för bevarande och mindre invasiva behandlingar. Möjligheten att bonda dentala material till tandvävnad minskade behovet av att avverka frisk vävnad. Detta skifte ger utrymme för konserverande behandlingar som prioriterar bevarandet av tanden och som ändå ger både styrka och retention nog för hållbara behandlingsresultat.

STIFT ELLER INTE

Att bevara så mycket tandsubstans som möjligt är en given förutsättning inom modern tandvård. Därför behöver man överväga om man kan utesluta användningen av rotstift; särskilt i de fall där rotdentin måste offras för att skapa plats för stiftet. Beslutet att använda rotstift bör baseras på följande faktorer:
1. Den kvarvarande tandsubstansens mängd och kvalitet*
2. Förekomsten ferrulle-effekt
3. Tandläkarens egen erfarenhet

* Flera studier visar att rotstift kanske inte är nödvändigt i de fall där förekomsten av tandsubstans är tillräcklig och där den kvarvarande tandsubstansen är av god kvalitet.

OMFATTNING OCH KVALITET PÅ DEN KVARVARANDE TANDSTRUKTUREN

Det viktigaste är att bevara så mycket tandvävnad som möjligt. Förekomsten av minst två intakta, axiala väggar anses optimalt för bästa möjliga behandlingsresultat. Tänder som saknar, eller bara har en axial vägg, har visat sig ha sämre prognos än de med mer än en återstående axial vägg.

FÖREKOMSTEN AV FERRULE-EFFEKT

Ferrule-effekt innebär att ett cirkumferent band av tandsubstans omsluter den koronala delen av tanden. Det har visat sig att denna effekt i hög grad bidrar till den restaurerade tandens motståndskraft mot frakturer. De minimala dimensionerna för ferrulen är inte fastställda, det finns dock några allmänna rekommendationer som kan hjälpa till att fördela krafterna jämnt, motstå ocklusala krafter och ge tillräcklig retention. Höjden på den återstående tanden bör vara minst 2 mm över emalj-cementgränsen, ha en cirkumferent bredd på 1-1,5 mm. De axiala väggarna bör ha en svag konvergensvinkel koronalt åt.

* Detta flödesschema har tagits fram med största omsorg. “Arbetsflödena” som visas i denna artikel är endast avsedda som en kortfattad indikation på det faktiska förfarandet. Denna procedur är bara avsedd för allmän information och inga rättigheter kan härledas från den. Följ alltid bruksanvisningen som medföljer produkten/produkterna.

DET ADHESIVA ARBETSSÄTTET

Det är viktigt att använda rätt adhesivtekniker för att maximera bindningsstyrkan mellan pelare, cement och rotkanalens ytor. Här följer flera potentiella problem att hålla ögonen på:

DEBONDING

Debonding tros vara en av de vanligaste orsakerna till att behandlingar där tänder som behandlats med adhesivt cementerade stift misslyckas. Detta kan direkt associeras med de problem som adhesiv cementering i rotkanalen innebär (d.v.s otillräcklig polymerisation, felaktig applicering av adhesiv, resin och dåligt evaporerade lösningsmedel). Rätt materialval spelar en avgörande roll i dessa fall.

KORREKT CEMENTERING AV STIFT

Först och främst ska valet av adhesivsystem avgöras av faktorer som bindningsstyrka, biokompatibilitet och användarvänlighet. Många olika strategier föreslås för adhesiv cementering av stift: från separat applicering av adhesiven (etsa-och-skölja eller självadhesiva cementsystem) och resincement, till användning av självadhesiva resincement. Jämfört med adhesiver som ska etsas och sköljas av, tycks bindingsstyrkan hos sjävadhesiva system inte påverkas nämnvärt av området där stiftet sitter. Zenthöfer et al. har funnit att prestandan hos självetsande adhesiver kan jämföras med de material som processas med hjälp av totaletsteknik - åtminstone ur det kortare perpektivet.

DIREKT FRAMSTÄLLDA PELARE AV RESINKOMPOSIT

Att direktframställa pelare med resinkompositer har idag blivit ett vanligt tillvägagångssätt. Kompositerna tillåter bevarande av dentin och möjliggör adhesiv bonding till det radikulära rotdentinet. Den ständiga utvecklingen av (självadhesiva) resiner, både cement och fyllnadsmaterial, har ökat användbarheten i samband med endodontiska behandlingar. Med korrekt preparation av tanden, adhesivteknik och protokoll, kan man skapa både pålitliga och hållbara resultat med direkt komposit.

CLEARFIL™ Universal Bond Quick 2 OCH CLEARFIL™ DC CORE PLUS

Att använda adhesiver i samband med pelaruppbyggnad och vid behandlingar med stift och pelare kan vara utmanande eftersom det kräver att härdningslampan har tillräckligt mycket energi för att polymerisera adhesiven ordentligt. För att komma runt härdningsproblemet i de djupare delarna av rotkanalen har tillverkare utvecklat katalysatorer för självhärdning som kan adderas till de ljushärdande adhesiverna. De här tilläggen kan dock ge ansamlingar av adhesiven i det apikala området, vilket kan förhindra att stiftet hamnar på rätt djup men också förkorta arbetstiden. Kuraray Noritake Dental Inc. har tacklat det här kliniska problemet med den avancerade och förbättrade självetsande enkomponentsadhesiven, CLEARFIL™ Universal Bond Quick 2, i kombination med den dualhärdande kompositen för pelaruppbyggnad, CLEARFIL™ DC CORE PLUS. Nya initiatorer har adderats till både adhesiven och kompositen som alternativ till att använda en självhärdande katalysator, vilket gör att CLEARFIL™ Universal Bond Quick 2 härdar när den kommer i kontakt med CLEARFIL™ DC CORE PLUS.

FÖRBÄTTRADE EGENSKAPER

Kuraray Noritake Dental Inc. har förfinat sitt dualhärdande pelarresin, CLEARFIL™ DC CORE PLUS, och gett produkten förbättrad flytbarhet under dispensering och stabilitet hos det ohärdade materialet. Fillerteknologin har modifierats på ett sätt som gör pastan tixotrop. Den här ”icke-sjunkandeformulan” underlättar dispensering och tillåter formandet av en uppbyggnad utan matris.. Den förbättrade sammansättningen gör också att den, tillsammans med CLEARFIL™ Universal Bond Quick 2, kan användas för cementering av stift. Det gör att produkten kan användas för både stiftcementering och pelaruppbyggnad.

PELARKOMPOSIT ELLER ADHESIVT CEMENT?

I kliniska situationer som involverar stift kan cementeringen utföras med hjälp av antingen CLEARFIL™ DC CORE PLUS eller PANAVIA™ SA Cement Universal. Det sistnämna cementet kan användas med eller utan CLEARFIL™ Universal Bond Quick 2. Valet mellan de två olika produkterna avgörs av utrymmet mellan stiftet och rotkanalens väggar:
1. TÄTPASSNING: När pelaren har en tät omkramning av dentinet kan det vara gynnsamt att använda ett tunt och högbondande cement (PANAVIA™ SA Cement Universal).
2. LÖSPASSNING: När löspassning föreligger krävs en större mängd resinbaserat material och det är mest gynnsamt att använda ett material som har bättre fysikaliska egenskaper som fyllnadsmaterial (CLEARFIL™ DC CORE PLUS) istället för ett cement.

*Detta flödesschema har tagits fram med största omsorg. “Arbetsflödena” som visas i denna artikel är endast avsedda som en kortfattad indikation på det faktiska förfarandet. Denna procedur är bara avsedd för allmän information och inga rättigheter kan härledas från den. Följ alltid bruksanvisningen som medföljer produkten/produkterna. Observera att endast ett urval av behandlingsalternativ har undersökts. Vårt huvudfokus ligger på användningen av komposit för pelaruppbyggnad och placering av fiberstift.

SAMMANFATTNING

Ett huvudkrav inom modern tandvård är att bevara så mycket tandstruktur som möjligt. Baserat på de premisser vi identifierat i den här artikeln kan valet att använda stift och användningen av restorativa material avgöras av det aktuella fallet. Pelaruppbyggnadens stabilitet är inte längre beroende av stödet från ett stift. Efter analys av den tandsubstans som finns kvar och genom att hålla i minnet vad som ger en stark bindning kan patienterna erbjudas en högestetisk och hållbar ersättning utan stora ingrepp.

PETER SCHOUTEN
Teknisk chef
Kuraray Europe Benelux, Norden, Baltikum

Som kemisk analytiker använder han sin bakgrund för att, vid första påseendet, göra komplexa (produkt-) teknologier transparenta. Hans passion är att kommunicera och dela information om användningen av produkter och teknologier på ett begripligt sätt.

DENTAL ADVISOR AWARDS 2026

Smooth and quick procedures, enhanced patient experience, and great treatment outcomes – this is virtually every dental practitioner's goal. Kuraray Noritake Dental Inc. supports this ambition through continuous innovation in advanced dental materials and devices. Building on the success of the popular universal bonding agent CLEARFIL™ Universal Bond Quick, its successor CLEARFIL™ Universal Bond Quick 2, introduced in 2025, takes simplicity and performance to the next level.

CLEARFIL Universal Bond Quick 2 offers:
-    Rapid application with no waiting time and no need for rubbing
-    A strong and durable bond to enamel and dentin
-    A high-strength bonding layer with increased resistance to shrinkage forces
-    Maximum flexibility across a wide range of clinical indications
-    Minimized risk of pooling thanks to enhanced flowability and even spreading

DENTAL ADVISOR RESEARCH AWARD

Laboratory testing confirms consistent performance

Research conducted for the in-vitro evaluation demonstrated excellent bond strength to both enamel and dentin, even after artificial aging and under saliva-contaminated conditions. This highlights the adhesive's consistent performance in challenging, non-ideal clinical environments such as the oral cavity.

The evaluation also confirmed a thin film thickness (below 5 µm), supporting precise seating of indirect restorations and maintaining a strong, durable bonding interface. These results reflect the scientific rigor behind CLEARFIL Universal Bond Quick 2 and were a key factor in receiving the Dental Advisor Research Award, which recognizes outstanding physical property testing and innovation in dental materials.

DENTAL ADVISOR PREFERRED PRODUCT AWARD

Evaluators highlight smooth and efficient handling

CLEARFIL Universal Bond Quick 2 was also named a Dental Advisor Preferred Product, based on both laboratory data and extensive clinical evaluation resulting in a 98% overall clinical rating. Consultants particularly praised the product's rapid working time, enabled by a unique formulation combining the Original MDP with AMIDE and newly developed UTM monomers.

The ability to apply the adhesive and proceed immediately resonated strongly with evaluators: "Extremely quick application time that allowed me to get right to work. Every time-saving ability is ideal." With its low film thickness, easy handling, and predictable results, CLEARFIL Universal Bond Quick 2 integrates seamlessly into everyday clinical workflows while supporting consistent outcomes.

A RARE COMBINATION OF SCIENTIFIC EXCELLENCE AND REAL-WORLD CLINICAL VALUE

By earning both the Dental Advisor Research Award and the Preferred Product Award, CLEARFIL Universal Bond Quick 2 demonstrates a rare combination of scientific excellence and real-world clinical value. Its advanced bonding technology, ease of use, and dependable performance make it a compelling solution for clinicians seeking efficiency without compromise.

THE HEART OF THE UNIVERSAL EXCELLENCE PORTFOLIO

At Kuraray Noritake Dental Inc., we understand the demands of modern dental practices. Balancing complex procedures, tight schedules, and patient care is no easy task. That is why we have spent years refining our materials—so you can focus on what matters most: your patients.

Our Universal Excellence products simplify your workflow, offering you high-quality materials and tools that work seamlessly with your expertise. CLEARFIL Universal Bond Quick 2 forms literally the connection between several universal resin-based products of our portfolio.

For more information, visit Dental Advisor.

Ett fall av dr Onur Alp Yünük

KOMBINERA HÖGKVALITATIVA REDSKAP OCH MATERIAL FÖR HÅLLBARA RESULTAT

Direkta kompositersättningar är ett högkvalitativt behandlingsalternativ, även i de fall då mycket tandvävnad måste ersättas. Detta beror på de senaste framstegen inom kompositmaterial och limteknik. Genom att välja lämpliga material och skiktningstekniker i kombination med moderna digitala verktyg för utvärdering av färgskillnader är det möjligt att på ett förutsägbart sätt uppnå mycket estetiska resultat, vilket framgår av följande fallbeskrivning.

Utmaningen

En ung man sökte sig till vår klinik med önskemål om att byta ut befintliga kompositersättningar i överkäken (tand #12 och #11 enligt FDI). Den kliniska undersökningen avslöjade omfattande retentionsförlust på den laterala incisiven. Dessutom observerades anatomiska avvikelser, missfärgning och förlust av ytglans på tand #11. Den andra centralen uppvisade liknande problem gällande färg och ytputs.

Vid konsultationen beslutades att byta ut de befintliga ersättningarna med hjälp av ett modernt kompositmaterial, särskilt framtaget för dualskiktning – CLEARFIL MAJESTY™ ES-2 Premium (Kuraray Noritake Dental Inc.).  För en exakt färganalys togs fotografier både utan och med korspolariserande filter (Fig. 1 till 4).

Fig. 1: Frontal vy: Omfattande retentionsförlust på den höger lateralen.

Fig. 2: Korspolariserat fotografi tillåter detaljerad analys av färgavvikelserna.

Fig. 3: Lateral vy.

Fig. 4: Laterl vy - korspolariserat fotografi.

Lösningen

De ursprungliga ersättningarna avlägsnades varefter området isolerades med hjälp av kofferdam. Selektiv etsning av emaljen utfördes och därefter applicerades självetsande adhesiv (CLEARFIL™ SE Bond 2, Kuraray Noritake Dental Inc.) varefter de palatinala ytorna byggdes upp med CLEARFIL MAJESTY™ ES-2 Premium,  nyans A1E (Fig- 5 och 6). Mamelonstrukturen återskapades med hjälp av CLEARFIL MAJESTY™ ES-2 Premium, nyans A1D, och den translucenta nyansen Blue applicerades i det opalescerande området. Slutligen användes gula och vita pigment för karaktärisering. Figur 7 visar utseendet före polering och figur 8 efter.

Fig. 5: Palatinalytorna skapas med hjälp av emaljmassan A1E.

Fig. 6: Lateral vy visar tänderna under behandlingen.

Fig. 7: Ersättningarna före finishering och puts.

Fig. 8: Ersättningarna efter finishering och puts.

Resultatet

För att kunna utvärdera det färdiga resultatet fotograferades ersättningen med korspolariserande filter och ett gråkort som referens och för kalibrering (Fig. 9 och 10). Den laterala vyn av de färdiga ersättningarna (Fig. 11) visar både att rätt färgkombination använts och den naturliga yttextur som krävs för ett högestetiskt resultat.

Fig. 9: Frontal vy med korspolariserande filter.

Fig. 10: Kalibrering med det grå referenskortet och L*a*b*koordinaterna för ersättningen.

Fig. 11: Lateral vy som understryker vikten av yttextur.

DISKUSSION OCH SAMMANFATTNING

Observation med stöd av moderna verktyg för fotografi och bildanalys (som polariserande filter och L*a*b*-koordinater) är viktiga färdigheter för att skapa naturliga och levande ersättningar av kompositmaterial. Genom att kombinera de här färdigheterna med högkvalitativ komposit med bestämda färgkombinationer och innovativ light diffusion technology - som ger fantastiskt färgadaption till omgivande tandstruktur - är det inte svårt att skapa vackra ersättningar.

I fallet som presenterats här blev patienten nöjd med resultatet både vad gäller estetik och funktion. Vid de regelbundna återbesöken kontrolleras ersättningarna - och de uppvisar fortsatt fin funktion och utmärkt estetik.

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.

INITIATORS

To provide for a high strength of the adhesive layer and a favourable degree of conversion, dental adhesives are typically cured before the composite is applied. Universal adhesives contain a photo initiator that sets off the radical polymerisation reaction when light of a specific wavelength is absorbed. Chemical initiators are found in self- or dual-cure resin cements, but not in single-bottle adhesives. Studies have revealed that the initiator concentration has an impact on the mechanical properties of the materials they are part of ^6,7.

FILLERS

Unlike composite restorative materials, which are always filled, dental adhesives may or may not contain fillers. Fillers are usually added for two main reasons: to increase the viscosity of the adhesive and to strengthen the adhesive layer. The viscosity has a direct impact on the thickness and quality of the adhesive layer. If the viscosity is too low, the risk increased of some areas of the tooth structure remaining uncovered resulting in an incomplete adhesive layer. In addition, an overly thin adhesive layer may be weak due to the inhibition of oxygen, which prevents proper curing of the contained resin⁶. If the viscosity is too high, however, application into the root canal and deep Class II cavities is often difficult thus increasing the risk of pooling or adhesive accumulation along margins. Moreover, air-blowing and complete solvent evaporation may also prove challenging.

SILANE COUPLING AGENT

A silane coupling agent is usually part of the formulation as well. They are the link between the resin matrix and the filler particles in the formulation and offer protection against degradation.

SOLVENTS

Solvents – typically water and ethanol or acetone – are essential parts of adhesive formulations. This is because dentin only bonds well to hydrophilic materials. Together with the hydrophilic monomers found in the formulation, the solvents provide for an environment favourable for dentin bonding⁶. Moreover, their task is to re-expand the collapsed collagen fibrils on the demineralized dentin surface. Most modern dental adhesives contain water and ethanol as solvents. However, ethanol cannot be used in combination with certain types of monomers.

CHEMISTRY IMPROVEMENTS ENABLING THE ESSENTIAL BENEFITS

There are certain components and technologies, like monomers and monomer combinations, which are used by various dental industry manufacturers in their universal adhesives. While some certainly offer advantages, potential drawbacks lie in their toxicity in the uncured state, possible unwanted interactions with other components and the like.

Many of the essential benefits of CLEARFIL Universal Bond Quick 2 are due to improvements or changes in those key components. Specifically, the resin formulation and the filler technology have been altered to provide for higher strength and an improved handling. The following paragraphs will describe the changes, the key components used and the benefits arising from them.

1. RESIN TECHNOLOGY: QUICK AND STRAIGHTFORWARD APPLICATION PROCEDURE

Adhesive penetration into the tooth structure is strongly influenced by monomers contained in the formulation. A monomer commonly used for this purpose is the highly hydrophilic hydroxyethylmethacrylate (HEMA)⁶. Although HEMA provides important benefits such as supporting homogeneous integration of components within the adhesive, its hydrophilic character – even after polymerization – may lead to water sorption, which can negatively influence the long-term mechanical properties of adhesive systems⁸. According to the results of an in-vitro study, high concentrations of HEMA in adhesive formulations may not only lead to poor mechanical properties (including bond strength), but also to a higher risk of bond degradation⁹. For these reasons, reducing the dependency on high levels of HEMA in universal adhesives and complementing it with alternative monomers is considered advantageous. However, this measure requires careful selection of the alternative monomer and precise alignment with the existing ingredients to prevent negative effects. In some cases, manufacturers have selected alternative monomers that lead to a lower bond strength or (unlike HEMA) lead to cytotoxic effects even after polymerisation¹⁰.

In CLEARFIL Universal Bond Quick and the brand-new universal adhesive CLEARFIL Universal Bond Quick 2, Kuraray Noritake Dental Inc. have incorporated an amide monomer that significantly decreases the need for HEMA. In in-vitro tests, this monomer did not show any cytotoxic effects¹⁰, while it is responsible for one of the essential benefits – the extremely quick and straightforward application procedure. It gives the adhesive its hydrophilicity in the initial, uncured state. During polymerisation, a stable, hydrophobic cross-linked network is formed. The network contributes to the durability of the bond, also thanks to its water-resistant property.

CLEARFIL Universal Bond Quick 2 takes just seconds to apply as there is no need to wait for the adhesive to penetrate the tooth structure. This feature was originally developed for its predecessor CLEARFIL Universal Bond Quick and was carried over as it turned out to work well¹¹ and has been very well received by clinicians from all over the world. Eliminating the need to wait after application speeds up the procedure, saves time and minimises the risk of contamination. This is particularly useful in situations where moisture control is a challenge or where a patient is impatient – e.g. in paediatric dentistry.

2. RESIN TECHNOLOGY: HIGH-STRENGTH BONDING LAYER

The stronger the bonding layer, the higher its resistance to shrinkage forces. Hence, it seems worth striving for a strong bonding layer to enhance the longevity of both bond and restoration. A popular strategy is the adding of cross-linking bi-or multi-functional monomers to the formulation^6,12. While the most frequently used monomers added for this purpose are UDMA, Bis-GMA and TEGDMA, Kuraray Noritake Dental Inc. added the Urethane Tetra Methacrylate Monomer (UTMA) to add mechanical strength to the adhesive system.

UTMA is a functional monomer that, due to its multiple curable sites, provides for an increased strength of the bonding layer. Both nano-hardness and ultimate tensile strength are extraordinarily high. Consequently, the adhesive offers the desired increased resistance to shrinkage forces. Moreover, it forms a highly curable, thin bonding layer.

3. RESIN TECHNOLOGY: CONSISTENTLY DURABLE BOND

The third monomer forming the advanced rapid layer technology found in CLEARFIL Universal Bond Quick 2 is the proven functional acidic monomer invented by Kuraray Noritake Dental Inc.: the Original MDP Monomer. MDP is not only well-known for its high affinity to hydroxyapatite, but also several other materials, including metals and zirconium oxide. In various studies, it has been proven to deliver an outstanding bonding performance over time^13,14.

This applies specifically to the original MDP monomer produced by Kuraray Noritake Dental Inc. In a study, it was shown that the quality and performance of the functional monomer may be different depending on how it is produced: MDP from other manufacturers contained impurities and dimer, which had a negative effect on the bonding performance of the respective adhesives¹⁵. Only the original MDP monomer exhibited a high purity and contained no dimer, with better bonding outcomes.

WATCH THE VIDEO ABOUT ADVANCED RAPID BOND TECHNOLOGY

4. FILLER TECHNOLOGY: EASE OF APPLICATION

The flow properties of an adhesive are a critical factor: as mentioned earlier, achieving an optimally formed and uniformly distributed adhesive film is essential for reliable clinical performance. Moreover, the right flow properties improve the application procedure. To realize improved flow properties without altering the filler content (which might negatively influence the mechanical strength), Kuraray Noritake Dental Inc. has redesigned the filler dispersion method originally employed by the company. The new way of adding fillers and different monomers to the formulation leads to low filler agglomeration.

Consequently, CLEARFIL Universal Bond Quick 2 is very easy to apply. Its low viscosity allows the adhesive to flow effortlessly even into narrow or hard-to-reach areas, supporting precise placement and uniform coverage.

Finally, air-blowing is easier to perform on a thin layer than when the layer is highly viscous and thick: The adhesive is evenly distributed and thinned out with a gentle stream of air. If performed correctly, this measure has a positive impact on bond stability and longevity according to scientific studies^8,16. Despite an increased flowability, the filler content in CLEARFIL Universal Bond Quick 2 is similar to that of its predecessor CLEARFIL Universal Bond Quick in supporting the formation of a strong bond.

The low viscosity of CLEARFIL Universal Bond Quick 2 allows the adhesive to flow effortlessly even into narrow or hard-to-reach areas, supporting precise placement and uniform coverage.

5. FILLER TECHNOLOGY: MINIMISED RISK OF POOLING

The new filler dispersion method also enables the formation of a thin, uniform layer independent of the cavity shape. The formation of an undesirably thick bonding layer along the margins and adhesive pooling at the bottom of the cavity are clearly a thing of the past. This is particularly advantageous in the context of creating restorations in the aesthetic zone or cementation procedures employing Immediate Dentine Sealing (IDS).

6. PROCEDURAL FREEDOM

CLEARFIL Universal Bond Quick 2 is universally applicable: It can be used in self-etch, selective etch and total-etch techniques and is thus suitable for many clinical situations and for all types of users independent of their personal preferences.

Moreover, it is approved for an extremely wide range of indications. Procedures are simplified as fewer bottles and fewer steps are required: The need for etching is eliminated, as is the need for a separate dual-cure activator when the product is used with other manufacturers’ self-adhesive cements.

CLEARFIL Universal Bond Quick 2 forms the connection between several universal resin-based products of Kuraray Noritake Dental Inc.’s portfolio:

• CLEARFIL MAJESTY™ ES-2 Universal
• CLEARFIL MAJESTY™ ES Flow Universal
• PANAVIA™ SA Cement Universal

7. IMMEDIATE AVAILABILITY FOR CLINICAL USE

Due to the carefully selected components and their precise alignment, the chemistry found in CLEARFIL Universal Bond Quick 2 is highly stable. Filler particles are extremely unlikely to agglomerate, and the novel formulation allows for storage at room temperature. This is a big advantage, as it provides for the fact that the product is always ready for use and readily available. The formulation of CLEARFIL Universal Bond Quick 2 is optimised so that it may be stored at temperatures between 2 and 25° C (36-77°F).

CLINICAL WORKFLOWS

Explore the clinical videos demonstrating how CLEARFIL Universal Bond Quick 2 can be seamlessly integrated into different workflows.

DIRECT RESTORATION WORKFLOW

CLEARFIL Universal Bond Quick 2 + CLEARFIL MAJESTY™ ES-2 Universal

DIRECT RESTORATION WORKFLOW

CLEARFIL Universal Bond Quick 2 + CLEARFIL MAJESTY™ ES Flow Universal (Super Low)

DIRECT RESTORATION WORKFLOW

CLEARFIL Universal Bond Quick 2 + CLEARFIL MAJESTY™ ES Flow Universal (Low)

POST CEMENTATION & CORE BUILD-UP WORKFLOW

CLEARFIL Universal Bond Quick 2 + CLEARFIL™ DC CORE PLUS

HOW TO CEMENT INDIRECT RESTORATIONS

CLEARFIL Universal Bond Quick 2 + PANAVIA™ SA Cement Universal

HOW TO SEAL A PREPARED ABUTMENT TOOTH

CLEARFIL Universal Bond Quick 2

CONCLUSION

Kuraray Noritake Dental Inc. is committed to continuous improvement in dentistry. With the ultimate goal of making dental professionals’ lives easier and patients happier, the company combines research, development and innovation with Japanese perfection to introduce products that make all the difference.

Decades of experience and access to highly developed adhesive technologies enable the team of researchers to develop new adhesive formulations with well-balanced properties like CLEARFIL Universal Bond Quick 2. The product handles well, is based on proven components and adds decisive innovative technologies to provide for an even better bonding performance and straightforward application.

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