ZIRCONIA: NEW INSIGHTS INTO TRIED AND PROVEN MATERIAL

You learn from your mistakes, but it’s better if you can learn from those of others. Dr. Dirawi will share his experience, tips and tricks when it comes to creating perfect Zirconia restorations.
Having great material like KATANA Zirconia is an excellent starting point. Yet to achieve highly aesthetic outcome you need to be aware of the unexpected pitfalls and challenges that can be prevented.
Join our webinar and learn what Dr. Dirawi has to say after years of using Zirconia. Bonus – we will have a conversation about cementation of zirconia as well, to achieve durable robust results.

DR WISSAM DIRAWI DDS, MALMÖ, SWEDEN

• Teacher at Malmö Dental University in Sweden
• Researcher in the fields of ceramics and implant complications
• Long clinical experience from public dental care and private dental care
• Expert in ceramics, implants and digital dentistry
• 2018 - Specialist in Oral Prosthodontics
• 2000 - DDS

By Magdalena Osiewicz, DDS, MSc, PhD

Fig. 1 Defective composite resin restoration in molars.

Fig. 2 Application of CLEARFIL™ SE BOND 2 to cavities.

Fig. 3 Restoration of the cavities with CLEARFIL MAJESTY™ Posterior in the A2 Classic shade.

Fig. 4 Final restorations of Class I and II with CLEARFIL MAJESTY™ Posterior and polish with CLEARFIL™ Twist DIA.

CLEARFIL MAJESTY™ Posterior is a resin composite with high strength and great optical properties developed for posterior restorations and suitable even for the most demanding patients. Figure 1 shows the initial clinical situation with insufficient resin composite restorations in the lower molars. After removal of the old fillings, the cavities were treated with CLEARFIL™ SE BOND 2 (Figure 2).

Then, I restored them with CLEARFIL MAJESTY™ Posterior in the A2 Classic shade (Figure 3). The fissures were highlighted with brown color modifier. Finally, finishing was performed in three steps: The excess of composite resin was removed with a fine-grained diamond bur. Final contouring was accomplished with a carbide bur, before CLEARFIL™ Twist DIA was used to obtain a natural gloss (Figure 4).

CLEARFIL MAJESTY™ Posterior is characterized by high mechanical strength, hardness and bending strength, a low coefficient of thermal expansion, low polymerization shrinkage and good aesthetics. Due to these features and a reliable long-term behavior, CLEARFIL MAJESTY™ Posterior should have a place in every dental office for direct posterior restorations. Excellent outcomes are achievable and therefore I recommend its use.

Dentist:

Magdalena Osiewicz, DDS, MSc, PhD

Department of Integrated Dentistry, Jagiellonian University, Krakow, Poland.

Department of Dental Materials Science, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

Department of Integrated Dentistry, Jagiellonian University, Krakow, Poland.

Department of Dental Materials Science, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

Zirconia, Oral scanner, feather edge preparation: the “winning triad”

The introduction of digital technology associated with the development of the latest zirconia materials offers the clinical and the dental technician a wide range of solutions to achieve aesthetics and function in a simple, predictable and above all conservative way. A further type of vertical preparation called "Minimally Invasive Vertical Preparation" has been introduced, applicable to numerous prosthetic clinical situations including cases of aesthetics. Minimally invasive vertical preparations, new type of zirconia and intraoral scanners represent a “winner triad” for today's prosthetic therapy.

ABOUT DR DAVIDE CORTELLINI

Graduated with honors in Dentistry at the University of Siena in 1992, wins the scholarship of the Italian Society of Periodontology (SIDP) for the year 1994-95. He therefore has the opportunity to attend the Department of Periodontology and Fixed Prosthesis of Prof. NP. Lang at the University of Bern in Switzerland, carrying out clinical and research activities. He obtained the title of "Doctor Medicinae Dentium" (D.M.D.) at the same University in 2000.

Author of scientific publications in international journals, he is an Active Member  of the Italian Academy of Prosthetic Dentistry (AIOP). Active member of the International Academy of Digital Dentistry (IADDM). He lectures in Italy and abroad, and he owns his private practice in Riccione mainly oriented to digital, aesthetic and complex prosthetic rehabilitations.

At Kuraray Noritake Dental Inc. we are proud that our products are being developed using innovative technologies, paying attention to detail and keeping in mind the needs of our customers.

We are committed to offering outstanding products that provide dental professionals with the flexibility for self-expression and creativity, adding value and delivering superb aesthetic results to each and every procedure.

Usability, simplicity and, of course, quality always in mind - providing dental professionals with materials that will make their daily practice stress free.

As a prove that our products meet the needs of dentists and lab technicians alike, we are happy to share with you the EC Certificates of Full Quality Assurance System that we have received from The Notified Body.  Those can be downloaded below.

Chairside products

Labside products

Join Dr Michael Braian on the webinar focusing on the bonding procedure of monolithic Zirconia to Ti-base utilising PANAVIA V5 procedures. 

ABOUT DR MICHAEL BRAIAN

Michael Braian, DDS, CDT, PhD is an international reference in the Digital Dentistry area as he has been working with technology in the dental field for almost 15 years. His professional profile combines every key aspect in dentistry as he is a Dentist, Certified Dental Technician and has a PhD in Digital Dentistry by Malmö University.

Mind the Gap!

Webinar about the key factors which influence the gap between the margin of prepared tooth and restoration, also about accuracy evaluations of milled materials and resin cement removal techniques during cementation.

Dr JOSEF KUNKELA, DMD, PHD

1993
Dentistry graduate of First Medical Faculty of Charles University, Prague, Czech Republic

1995
Fellow in Medical Faculty of Charles University Prosthodontic Department in Hradec Králové, Czech Republic

1999
Gained Second Degree Specialization in Prosthodontics

2001
Named external teacher of the Prosthodontic Department at the Charles University Clinic of Dentistry in Hradec Králové and Palacky University in Olomouc, Czech republic

2009
Named president of Czech Society of CAD/CAM Dentistry

2010
Founder of KUNKELA Campus, International CAD/CAM Traning Center in Jindrichuv Hradec, Czech Republic (Certified Exclusive DentsplySirona Training Center)

2018
Finished postgraduate doctoral degree PhD, thesis Dental Office Management and Marketing (University of Economics Prague)

Certified CEREC trainer by the International Society of Computerized Dentistry (ISCD)

Member of DSD (Digital Smile Design) Master Team

Member of MicroVision Group

Member of SKYN Concept Team

Member of Academy of Digital Dentistry

Board Member of ADDA (Association of Digital Dentistry Academies)

Ambassador of DDS (Digital Dentistry Society)

CEREC Beta Tester

CEREC Guide Beta Tester

CEREC Advocate

Key Opinion Leader in the area of digital dentistry

International speaker at the field of Digital Dentistry, Guided Implantology, Management & Marketing

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

ROBERTO ROSSI 

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

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

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

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

By Dr. PhD. Jusuf Lukarcanin

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

Introduction

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

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

Clinical case example 1

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

Fig. 1: Pre-operative image.

Fig. 2: Digital mock-up.

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

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

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

Fig. 3: Treatment outcome immediately after polishing.

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

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

Clinical case example 2

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

Fig. 5: Pre-operative clinical situation.

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

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

Fig. 7: Clinical situation after one week.

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

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

Discussion

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

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

Conclusion

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

About the author

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

References

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Kuraray Noritakes silan-teknik

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

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

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

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

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

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

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

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