In the early 1990s, Kuraray introduced CLEARFIL™ LINER BOND 2, the first self-etching adhesive, to the world. Among the products that this system has led to is the award-winning CLEARFIL™ SE Protect, which was introduced in 2004 and remains highly valued by dental professionals across the world. By combining Kuraray Noritake Dental’s famed original MDP monomer with the antibacterial 12-methacryloyloxydodecylpyridinium bromide (MDPB) monomer, this self-etching adhesive is able to kill bacteria on contact. How is this possible? Let’s find out.

Pyridinium holds the key

The crucial element that provides CLEARFIL™ SE Protect with its antibacterial cavity cleansing ability is contained in the MDPB monomer. The pyridinium group in this monomer is positively charged, whereas the cell structures of bacteria are, generally speaking, negatively charged. This means that they are automatically attracted to the positively charged contact points of the MDPB monomer, causing these bacteria cell membranes to lose their electrical balance and be destroyed. This process—bacteriolysis—kills the bacteria.

The bactericidal mechanism of MDPB is presumed to be similar to that of the well-known antibacterial agent cetylpyridinium chloride, which is in many toothpastes and mouthwashes.

Certified biocompatibility

The MDPB monomer is immobilised during the polymerisation of the bonding and remains latently active without affecting the dental patient’s own cells. Unlike the situation when other cavity hygiene products are used, this process—patented by Kuraray Noritake Dental—does not have a negative impact on the bond strength and even ensures that there are no long-term cytotoxic effects on the patient’s own body cells such as odontoblasts. These results have been confirmed by the official biological evaluation for medical devices known as the ISO 10993 series.

Award-winning results with CLEARFIL™ SE Protect

With its antibacterial effect, high bond strength to enamel and dentine and long-term fluoride release, CLEARFIL™ SE Protect is reliable, versatile and future-proofed. This tried-and-tested two-step self-etching bonding system is fast and easy to use for direct restorations. For bonding indirect restorations and core build-ups, simply mix it with Kuraray Noritake Dental’s CLEARFIL™ DC Activator according to the instructions for use.

Thanks to its combination of MDP and MDPB monomers, CLEARFIL™ SE Protect leads to predictable, durable restorations—and it has received plenty of accolades from dental experts as a result. In 2022, this adhesive again received a Top Product Award in the Direct Restoratives, Bonding Agent: Self-Etch category from DENTAL ADVISOR. This was the fourth year in a row that it earned such recognition, and in addition, the 13 DENTAL ADVISOR consultants and editors gave CLEARFIL™ SE Protect a stunning 98% overall clinical rating.

Case by Dr. Clarence P. Tam, HBSC, DDS, AAACD, FIADFE

Case background

A stable ASA 2 65 year old female presented to the practice for restorative dentistry with a medical history significant for a non-descript immunoglobulin deficiency, for which she receives regular infusions. She reports no known drug allergies. Clinically, she was diagnosed with an occlusal peripheral rim fracture leaving a food trap on tooth 14 (FDI notation). Tooth 15 featured an extensive amalgam with extreme proximity to the distal marginal ridge, which exhibited distal vertical axial fractures as a result of cyclic expansion-contraction over time. The restorative goal of minimally invasive direct dentistry would be complicated by the undoubtedly dark dentin substrate under the amalgam. A material was sought that featured both an excellent chameleon mechanism as well as physical properties to maximize the prognosis of direct restorations in this area.

Restorative procedure

The patient was subjected to topical anesthetic prior to buccal infiltration using 1 carpule of 2% Lignocaine with 1:100,000 epinephrine. A rubber dam was affixed prior to preparation of tooth 15MO with dissection of the distal vertical marginal ridge fracture. The margins of tooth 14O and 15MOD were refined before bevelling as the ends of enamel rods facilitate better bonding relative to the sides of enamel rods. A 27 micron aluminum oxide micro air abrasion treatment was completed prior to affixing, wedge and matrix to reconstruct the mesial marginal ridge of tooth 15. A matrix-in-matrix solution was used to recreate the proximoaxial contour of 15D. This provided hermetic closure at the proximogingival cavosurface margin as well as an ideal contour for the missing axial wall.

Following a total etch technique, a 2% Chlorhexidine scrub was completed for 30 seconds and the dentin blot dried to a moist state. A 5th generation bond was applied, air thinned and cured as per manufacturer instructions. Microlayers are important during the delicate first 5 minutes of hybrid layer formation, and were completed using 0.25 mm increments of CLEARFIL MAJESTY™ Flow (Kuraray Noritake Dental Inc.). This technique can be expected to increase significantly the shear bond strength to dentin^1,2.

This was completed both in the proximal box floor area as well as mid-occlusally. The marginal ridge was completed using CLEARFIL MAJESTY™ ES-2 Universal (Kuraray Noritake Dental Inc.). Since the dentin base was heavily stained, CLEARFIL MAJESTY™ Flow was used before utilizing CLEARFIL MAJESTY™ ES-2 Universal in a lobe-by-lobe creation of occlusal anatomy. Post-operative occlusal checks verify that the restoration is conformative to occlusion and esthetically excellent with no visible marginal show.

Rationale for material choice

The marginal ridges were micro-layered horizontally as was the floor of the resulting Class I preparation as per a reduced layer thickness-technique modification of Nikolaenko et al³, whereas the highest shear bond strengths were found when a 1mm horizontal layering technique was used.

CLEARFIL MAJESTY™ ES-2 Universal is at the forefront of a simplified restorative armamentarium for the modern practice. It takes cloud-shading one step further by offering a “Universal” shaded composite featuring Light Diffusion Technology (LDT) with simultaneous ideal sculptability, optical metamerism and physical properties for use in any restorative situation in the mouth. Featuring barium glass nano fillers and proprietary pre-polymerized nanoparticle fillers, the latter boasts a high refractive matrix that is able to disperse light and fool the eye with even the thinnest of layers, obviating the need for opaquer composites in cases like the one featured. When paired with CLEARFIL MAJESTY™ Flow in a conservative layered technique, the 81% filled flowable produces a radiographically well-demarcated layer, and the superficial CLEARFIL MAJESTY™ ES-2 Universal boasts an easy-to-polish robust single shade restorative solution that will virtually fulfil all of your restorative needs for non-bleaching patients. Physically, with compressive strength is rated at 348 MPa and flexural strength at 116 MPa, CLEARFIL MAJESTY™ ES-2 Universal is in the range of natural enamel and dentin. The built-in fluorescence is very enamelomimetic, which is excellent for nightclub social situations.

FINAL SITUATION

References

1. Bertschinger C, Paul SJ, Luthy H, Scharer P. Dual application of dentin bonding agents: effect on bond strength. Am J Dent. 1996;9(3):115-119.
2. Magne P, Kim TH, Cassione D, Donovan TE. Immediate dentin sealing improves bond strengths of indirect restorations. J Prosthet Dent. 2005;94(6):511-519.
3. Nikolaenko SA, Lohbauer U, Roggendorf M, Petschelt A, Dasch W, Franenberberger R. Influence of C-Factor and layering technique on microtensile bond strength to dentin. Dental Mater. 2004;20(6):579-585.

Innovativ teknologi bakom PANAVIA Veneer LC

I dessa Highlights diskuterar vi teknologier och hur de bidrar till de många fördelarna med nya PANAVIA Veneer LC

Testimonial article by Dr. Troy Schmedding, USA

From PANAVIA™ EX to PANAVIA™ V5, Kuraray Noritake Dental Inc.‘s flagship product line of cements continues to evolve to offer reliable adhesion, enhanced ease of use, and superior esthetics.

Dentistry has certainly evolved in the years since Kuraray Noritake Dental Inc. developed the phosphate monomer MDP. But over the past 4 decades, it has rooted itself in restorative dentistry as the tried-and-true ingredient that clinicians rely on for strong adhesion to tooth structure as well as metals and zirconia. MDP is a key ingredient in the manufacturer’s flagship PANAVIA™ line of cements, which continues to evolve in line with a growing variety of indirect restorative materials from which to choose.

One example of this evolution is PANAVIA™ SA Cement Universal, one of the first true universal self-adhesive resin cements to hit the market. In addition to the original MDP monomer, it incorporates the LCSi monomer, a silane-based carbon chain in a dual-barrel system that forms a chemical bond with glass and ceramic materials.

“PANAVIA™ SA Cement Universal allows you to achieve a strong bond no matter which substrate is being used.”

- Troy Schmedding, DDS –

A STRONG BOND THAT’S SIMPLE TO CREATE

But all chemistry aside, what’s in it for the clinician? As dental educator and author Dr. Troy Schmedding points out, the key benefit of PANAVIA™ SA Cement Universal is eliminating the confusion over how to treat different substrates. This is because the material adheres to virtually every material without the need for a separate primer. “The plus side for the practitioner is that the confusion of ‚how do I condition zirconia‘ or ‚how do I condition glass ceramics‘ is no longer an issue because the paste formulation allows you to achieve a strong bond no matter which substrate is being used - whether it is the MDP monomer allowing strong adhesion to zirconia or the LCSi monomer forming a chemical bond with glass ceramics,” he shared.

DIALING UP THE AESTHETICS

Kuraray Noritake Dental Inc. considers PANAVIA™ V5 the most esthetic cement it has ever created. Available in 5 shades - White, Brown, Universal, Clear, and Opaque – it took researchers over 10 years to develop and features an anime-free catalyst that allows for superior colour stability and improved bond strength to dentin. And like its predecessors, PANAVIA™ V5 offers a simple cementation procedure that is compatible with all indications, from crown-and-bridge and implant abutments to ceramic inlays and laminate veneers.

“Kuraray Noritake Dental Inc. has an incredibly strong reputation in adhesive dentistry, so it should offer clinicians a lot of comfort and flexibility to partner with not only a reputable company, but one that continues to research and evolve their key products,” concluded Dr. Schmedding.

Dentist:

DR. TROY SCHMEDDING, DDS
USA

Article from Dental product shopper, vol. 14 No. 5

Uppnå hög appliceringskontroll med den nya sprutan och spetsen!
Enkel dispensering och hög appliceringskontroll uppnås tack vare den speciellt designade sprutan och appliceringsspetsen för PANAVIA Veneer LC. Bilden nedan visar alla de nya egenskaperna

One of the key features when talking about cements is the ease of removal of excess cement. Our newest cement - PANAVIA™ Veneer LC - offers the ideal paste consistency, a low film thickness and long working time.

But how about excess removal? Do you wonder how do we compare to other similar products?

Check out this video demonstrating an excess removal comparison between PANAVIA Veneer LC and other brands.

PANAVIA™ Veneer LC

Great solution for challenging task

PANAVIA™ family just got bigger! We are introducing the new PANAVIA™ Veneer LC – the specialist cement that offers aesthetics, excellent paste viscosity, easy handling and 200 seconds(!) working time under ambient light (8000 lux.). Coming in four different shades with matching try-in pastes from PANAVIA™ V5 system, it allows users to take into account the individual shade requirements and deliver highly aesthetic outcomes when cementing veneers, inlays and overlays.

Join our free webinar now and be the first to learn all the details about this new and exciting product from Kuraray Noritake Dental Inc..

ABOUT DR JORGE ESPIGARES, DDS, PHD

Dr. Jorge Espigares received his DDS degree at the Faculty of Dentistry, University of Granada in Spain and obtained his PhD degree under the supervision of Prof. Tagami at Tokyo Medical and Dental University in Japan. Specialized in Cariology and Operative Dentistry, Dr. Jorge Espigares has clinical experience in Spain and UK, and has authored and coauthored full-length research publications with his colleagues at TMDU.

PRESENTATION OF A STUDY WITH ILLUSTRATIVE CASES

by Dr. Yohei Sato, DMD, PhD and Dr. Keisuke Ihara, CDT.

INTRODUCTION

In recent years, the application and advancement of digital technology in dentistry has made it possible to accomplish the fabrication of highly accurate prosthetic zirconia appliances that were difficult to mill using the previously available technology. In addition, thanks to advances in adhesive dentistry and the advent of cements that bond strongly to a diverse range of materials, cements have come into wide clinical use that can cope with the many types of materials used for the fabrication of prosthetic appliances.

At our hospital, we select the treatment method most suitable for each case by appropriately specifying various types of prosthetic appliance according to the status of each case. For example, we may specify zirconia prosthetic restorations fabricated by the CAD/CAM system, or silica-based ceramic prostheses, or those made of lithium disilicate glass, as the case dictates.

PANAVIA™ V5 is a resin cement system that bonds strongly to various types of prosthetic appliance, as well as to tooth structure. PANAVIA™ Veneer LC, a new resin cement system developed by Kuraray Noritake Dental Inc., has suitable characteristics for bonding laminate veneers, using two types of primer that can be used in common with PANAVIA™ V5. Here are some clinical examples of its advantages as a resin cement system used for laminate veneers restorations.

NYA FILLER
PANAVIA™ Veneer LC:s utmärkta hantering beror mycket på de nyutvecklade sfäriska fillerna av kiseldioxid och filler i nanokluster (fillerhalt: 66 % vikt, 47 % volym). Tack vare cementets tixotropa egenskaper kommer inte fasaderna att glida eller lossna. PANAVIA™ Veneer LC ger en kontrollerad applicering, det stannar där det applicerats men flyter väl vid placering av fasaden/fasaderna.
Tack vare dess konsistens och låga filmtjocklek (≈ 8 μm), ger PANAVIA™ Veneer LC ett tunt, jämnt distribuerat cementskikt. Detta bidrar till enkel placering utan interferenser. Dessutom gör användningen av endast små, sfäriska filler (Partikelstorlek: 0,05 μm – 8 μm) högestetiska och släta marginaler möjliga och främjar enkel polerbarhet och glansens hållbarhet.

FILLER AV KISELDIOXID
Nyutvecklade sfäriska filler av kiseldioxid i cementet gör att det stannar där det applicerats, men flyter väl under placering av fasaden. Ger en enkel placering utan att fasaden glider eller lossnar. Vid applicering på fasadens inre yta, klibbar inte resincementet till applikationsspetsen, en egenskap som det fått tack vare de sfäriska nanoklustren med fillers.

Dessa nya fillertyper ger en
utomordentlig nivå av släthet
och glansretention såväl som
enkel hantering.

VISKOSITET & TIXOTROPI
Viskositeten hos ett cement är viktig och måste vara tillräckligt låg för att undvika att protetiken frakturerar vid placeringen. Samtidigt får den inte vara så flytande att den rinner av under appliceringen och placeringen av restaurationen. Eftersom PANAVIA™ Veneer LC innehåller en optimerad mix av filler och resin, ändras dess viskositet när det påverkas av tryck. Detta fenomen är känt som tixotropi.
Cementet blir mer flytande under tryck vid placering och positionering av fasaden. När trycket minskar, ökar viskositeten igen. Tack vare den tixotropa egenskapen hos PANAVIA™ Veneer LC, är cementet lätt att dispensera och endast ett lätt tryck behövs för att positionera protetiken och överskottet är enkelt att avlägsna. I korthet: maximal kontroll.

Material med samma viskositet har inte nödvändigtvis samma tixotropi. Temperatur och tryck påverkar viskositeten. Graden av och nivån på hur mycket ett material återfår sin ursprungliga viskositet när trycket minskas beror på materialets tixotropi.

INNOVATIV HÄRDNINGSTEKNOLOGI
PANAVIA™ Veneer LC är ett ljushärdande cement som kombinerar flera teknologier för att ge dig högsta möjliga
bindningsstyrka.

FÖRSEGLING AV GRÄNSSNITTET
En modifierad teknologi för kontakthärdning används för att ge en längre arbetstid men bibehålla den höga bindningsstyrka som PANAVIA™ är välkänt för. PANAVIA™ Veneer LC, i kombination med PANAVIA™ V5 Tooth Primer, bidrar med ett viktigt kemiskt element till ett ljushärdande cement. När PANAVIA™ Veneer LC pastan kommer i kontakt med självetsande primer PANAVIA™ V5 Tooth Primer, förseglar den för tandstruktur (dentin och emalj) det tand-adhesiva gränssnittet. med den. Denna ”milda” kontakthärdning initierar polymeriseringen endast vid det adhesiva gränssnittet och åstadkommer en stark omedelbar bindning till emalj och dentin, men påverkar inte stelningen av cementet och därför inte heller arbetstiden.

ARBETSTID
Vid procedurer med cementering, är det flera externa faktorer som påverkar arbetstiden. Teknologin bakom PANAVIA™ Veneer LC tar hänsyn till dessa faktorer. Teknologin för kontakthärdning ger en omedelbar försegling av gränssnittet mot tanden. Grunden för höga bindningsstyrkor. Ljushärdningsteknologin ger dig en arbetstid på 200 sekunder under omgivande ljus* innan PVLC börjar förlora sin ideala plasticitet för formning. Under dessa 200 sekunder kan du bekvämt placera och positionera (ett flertal) fasader. Den slutliga polymeriseringen sker vid belysning med härdljuslampan och låter cementet härda fullständigt.

*Omgivande ljus: cirka 8 000 lux

Minimally invasive procedures using highly aesthetic restorations is what patients expect when they seek restorative treatment. With the various types of restorations available today, it is possible to meet these expectations – provided that the right materials are used.

For the placement of veneers, a resin cement must be selected that supports long-lasting aesthetics, is easily applied, offers a working time sufficient for simultaneous cementation of multiple restorations and provides excellent bond strength. The new “PANAVIA™ Veneer LC” is precisely what you need.

What is the workflow you ask? Check out the video to see the full workflow using PANAVIA V5 Primer and CLEARFIL Ceramic Primer Plus.

Case by Dr. Aleksandra Łyżwińska, Warsaw, Poland

ABSTRACT

Indirect overlays are the contemporary restoration standard for posterior teeth with extensive hard tissue loss. They provide for cuspal coverage, which decreases the likeliness of coronal and/or root fracture. At the same time and in contrast to crowns, overlay preparations minimize the removal of sound tooth structure especially in the cervical region, which is a critical factor.¹ Modern dental resin composites allow for direct cuspal coverage in a single-visit appointment. The results of in-vitro studies suggest that these direct overlays are a suitable alternative to their indirect counterparts in specific situations.^2-6 The following case report is used to describe the direct restoration procedure by means of a maxillary right molar with an extensive, deep MOD lesion.

INTRODUCTION

In the context of treating a tooth with an extensive carious lesion, a biomechanical risk assessment should be performed. The primary method of reducing the likeliness of tooth fracture is treatment with a restoration that provides cuspal coverage. The contemporary gold standard for biomechanically compromised teeth are adhesively cemented overlays as an alternative to crowns.¹ Another option that does not involve labwork is a direct overlay restoration.^2-6 The direct approach is especially suitable for long-term temporization, which may be required during orthodontic treatment, for example.

CLINICAL CASE

The 40-year-old male patient was referred to my office before an orthodontic and prosthetic treatment. Intraoral examination (Figs. 1 and 2) revealed:

• Tetracycline discolouration,
• Multiple extensive composite restorations with marginal leakage,
• Primary and secondary carious lesions, and
• Significant mechanical weakness^7,8 (mesio-occluso-distal (MOD) cavities, cusp loss, cracks).

Fig. 1. Initial situation – extensive MOD composite resin restoration.

Fig. 2. Initial situation – unacceptable contact points, palatal wall crack line.

Based on a clinical and radiological examination (Fig. 3), it was decided to restore the maxillary right first molar with a direct overlay, which should serve as a long-term temporary for the duration of orthodontic treatment. Once the local anaesthetic had been administered, rubber dam was placed in the first quadrant and the cusps of the affected first molar were reduced. For subgingival tooth preparation, a rubber dam sheet was temporarily moved behind the second upper molar (Fig. 4). In order to obtain a good emergence profile of the restoration and a tight fit of the sectional matrix, the gingivectomy was performed with an electric surgical knife (Surtron 50D, LED SPA) (Fig. 5). The main advantages of a diathermal cut are instant tissue coagulation and hemostasis⁹.

Fig. 3. Bite-wing radiograph: Maxillary fist molar with an overhang and negative profile of the distal wall.

Fig. 4. Initial preparation with reduction of the cusps and exposure of gingiva.

Fig. 5. Gingivectomy performed using a surgical electric knife.

In accordance with the European Society of Endodontology’s guidelines on the management of deep caries¹⁰, the deepest part of the cavity was cleaned in full rubber dam isolation (Nic Tone Dental Dam, MDC Dental) (Fig. 6). Carious-tissue excavation was carried out using round burs, then the enamel and dentin were air-abraded with 50-μm aluminum oxide (Microetcher IIa, Danville). Multiple cracks, penetrating through the enamel and partially the dentin, occurred within the mesial and palatal walls. The presence of cracks crossing the dentin-enamel junction is an absolute indication to cuspal coverage^8,11.

An appropriate rubber dam isolation is essential in adhesive dentistry. Beyond the obvious advantage of a clean operation field uncontaminated by saliva and moisture, the rubber dam contributes to keeping periodontal tissues at a distance form a tooth. In order to ensure both, maximum retraction and sufficient space to work, the rubber dam was inverted (introduced to the gingival sulcus) and stabilized using PTFE tape (Fig. 7). The mesial wall was restored using a blue 3D Composite-Tight 3D Fusion matrix ring (Garrison) and a medium standard Sectional Contoured Metal Matrix (TOR VM, Fig. 8). Due to its extensiveness and shape, restoration of the distal wall was more difficult to perform.

Fig. 6. Rubber dam newly placed in the interproximal area. Full isolation is essential for the excavation of the infected dentin in the deepest part of the cavity.

Fig. 7. PTFE tape placement for improving isolation in the gingival area. Al₂O₃ sandblasting.

Fig. 8. Mesial matrix fit.

The first attempt to adapt an elongated Sectional Contoured Metal Matrix and the green 3D Composite-Tight 3D Fusion (Garrison) ended with failure (Fig. 9). The matrix was changed for a longer and more curved one (Fig. 10). The ring was replaced by a smaller Palodent V3 Ring (Dentsply Sirona, Fig. 11). Due to the depth of the carious lesion, an antibacterial adhesive system was used (CLEARFIL™ SE Protect, Kuraray Noritake Dental Inc.). It contains the MDPB monomer, which offers an antibacterial effect that lasts even after hybrid layer formation^12-14. Furthermore, the fluoride included in the bond liquid intensifies the cariostatic mechanism of CLEARFIL™ SE Protect and supports the so-called “Super Dentin” formation¹⁵.

Fig. 9. Insufficient fit of the distal matrix.

Fig. 10. New, longer and more curved matrix in place.

Fig. 11. Different matrix ring placed in the distal area.

After polymerization of the bonding agent, the nanohybrid flowable composite resin (CLEARFIL MAJESTY™ ES Flow High, Kuraray Noritake Dental Inc.) was applied in a thin layer. The proximal wall was restored using both packable (CLEARFIL MAJESTY™ ES-2 Universal, Kuraray Noritake Dental Inc.) and flowable composite resin (CLEARFIL MAJESTY™ ES Flow Super Low, Kuraray Noritake Dental Inc.) (Figs. 12 and 13). Core build-up was performed with bulk-fill type composite. The cusps were reconstructed free-hand with the previously used CLEARFIL MAJESTY™ ES-2 Universal (Figs. 14 and 15). The universality of this product provides for a good optical integration and blending with the adjusted tissue, regardless of the colour of the underlying tooth structure. The fissures were gently highlighted using brown tints.

Fig. 12. Thin layer of flowable composite resin CLEARFIL MAJESTY™ ES Flow High (A2) applied on the cavity floor. The proximal walls are built up with build-up by CLEARFIL MAJESTY™ ES-2 Universal and CLEARFIL MAJESTY™ ES Flow Super Low (A2).

Fig. 13. Proximal walls build-up – palatal view.

Fig. 14. Core build-up. Free-hand cusp coverage with CLEARFIL MAJESTY™ ES-2 Universal, palatal view.

Fig. 15. Cusp coverage – occlusal view.

The initial polishing was performed with the rubber dam still in place. The excesses of composite resin were removed with the aid of abrasive discs, diamond burs and a “Brownie” polisher (BAL, Nevadent). Pre-polishing and high-shine polishing were executed with TWIST™ DIA for Composite (Kuraray Europe GmbH.) supported by a goat hair brush (Micerium) (Figs. 16 to 17).

Fig. 16. Occlusal surface after surface modeling with CLEARFIL MAJESTY™ ES-2 Universal and initial polishing.

Fig. 17. Occlusal surface after modeling with CLEARFIL MAJESTY™ ES-2 Universal and initial polishing – palatal view.

After removal of the rubber dam, the occlusal contact points of the direct overlay were adjusted (Figs. 18 and 19). Every spot touched by the burr was subsequently repolished according to the previously described protocol (Figs. 20 and 21).

Fig. 18. Occlusal adjustment. Contact points recorded with articulation paper (100 μm).

Fig. 19. Occlusal adjustment. Contact points recorded with articulation paper (100 μm= and articulation foil (16 μm).

Fig. 20. Final effect after polishing with TWIST™ DIA for Composite.

FINAL SITUATION

Fig. 21. Final effect – palatal view.

CONCLUSION

As a result of decades of improvements mainly with regard to the filler density and polishability, modern dental composites offer a great gloss retention and favourable wear properties. In addition, polymerization shrinkage has been decreased due to the integration of nanohybrid filler technology. Those features allow us to restore biomechanically compromised teeth using a direct restoration technique.

Direct overlays are a suitable alternative for a conventional indirect restoration in many situations.^18,19 According to researchers, the advantages of direct restorations with cuspal coverage include minimal tooth preparation, vital pulp-oriented treatment, the possibility to treat patients in a single appointment and a potentially lower cost of the treatment.^18-20 However, it should be emphasized that the presented technique requires advanced restorative skills that need to be acquired first before starting to implement it.

REFERENCES

1. Dietschi D, Duc O, Krejci I, Sadan A. Biomechanical considerations for the restoration of endodontically treated teeth: a systematic review of the literature--Part 1. Composition and micro- and macrostructure alterations. Quintessence Int. 2007 Oct;38(9):733-43.
2. van Dijken JW. Direct resin composite inlays/onlays: an 11 year follow-up. J Dent. 2000 Jul;28(5):299-306. doi: 10.1016/s0300-5712(00)00010-5. PMID: 10785294.
3. Mondelli RF, Ishikiriama SK, de Oliveira Filho O, Mondelli J. Fracture resistance of weakened teeth restored with condensable resin with and without cusp coverage. J Appl Oral Sci. 2009 May-Jun;17(3):161-5.
4. Deliperi S, Bardwell DN. Multiple cuspal-coverage direct composite restorations: functional and esthetic guidelines. J Esthet Restor Dent. 2008;20(5):300-8; discussion 309-12.
5. Deliperi S, Bardwell DN. Clinical evaluation of direct cuspal coverage with posterior composite resin restorations. J Esthet Restor Dent. 2006;18(5):256-65; discussion 266-7.
6. Mincik J, Urban D, Timkova S, Urban R. Fracture Resistance of Endodontically Treated Maxillary Premolars Restored by Various Direct Filling Materials: An In Vitro Study. Int J Biomater. 2016;2016:9138945.
7. Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. J Endod. 1989 Nov;15(11):512-6.
8. Banerji S, Mehta SB, Millar BJ. The management of cracked tooth syndrome in dental practice. Br Dent J. 2017 May 12;222(9):659-666.
9. Bashetty K, Nadig G, Kapoor S. Electrosurgery in aesthetic and restorative dentistry: A literature review and case reports. J Conserv Dent. 2009 Oct;12(4):139-44.
10. European Society of Endodontology (ESE) developed by:, Duncan HF, Galler KM, Tomson PL, Simon S, El-Karim I, Kundzina R, Krastl G, Dammaschke T, Fransson H, Markvart M, Zehnder M, Bjørndal L. European Society of Endodontology position statement: Management of deep caries and the exposed pulp. Int Endod J. 2019 Jul;52(7):923-934.
11. Lynch CD, McConnell RJ. The cracked tooth syndrome. J Can Dent Assoc. 2002 Sep;68(8):470-5.
12. Hashimoto M, Hirose N, Kitagawa H, Yamaguchi S, Imazato S. Improving the durability of resindentin bonds with an antibacterial monomer MDPB. Dent Mater J. 2018 Jul 29;37(4):620-627.
13. Imazato S, Kinomoto Y, Tarumi H, Torii M, Russell RR, McCabe JF. Incorporation of antibacterial monomer MDPB into dentin primer. J Dent Res. 1997 Mar;76(3):768-72.
14. Imazato S, Kinomoto Y, Tarumi H, Ebisu S, Tay FR. Antibacterial activity and bonding characteristics of an adhesive resin containing antibacterial monomer MDPB. Dent Mater. 2003 Jun;19(4):313-9.
15. Nakajima M, Okuda M, Ogata M, Pereira PN, Tagami J, Pashley DH. The durability of a fluoride-releasing resin adhesive system to dentin. Oper Dent. 2003 Mar-Apr;28(2):186-92.
16. Bore Gowda V, Sreenivasa Murthy BV, Hegde S, Venkataramanaswamy SD, Pai VS, Krishna R. Evaluation of Gingival Microleakage in Class II Composite Restorations with Different Lining Techniques: An In Vitro Study. Scientifica (Cairo). 2015;2015:896507.
17. Oficjalne informacje producenta Kuraray Noritake Dental https://www.kuraraynoritake.eu/pl/clearfil-majesty-es-flow (dostęp 08.02.2022).
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