DENTAL ADVISOR Editor’s Choice and 2023 Preferred Product award recipient, quickly provides durable bond in a single procedure

CLEARFIL™ Universal Bond Quick has been named a 2023 Editor’s Choice by DENTAL ADVISOR, which evaluates dental products and equipment and publishes its findings annually. It has also received recognition as DENTAL ADVISOR’s Preferred Product this year in the category of Universal Bonding Agents. The 31 consultants who evaluated its application during 1,065 usages gave it the excellent overall rating of 98%.

CLEARFIL™ Universal Bond Quick is a single-bottle fluoride-releasing, universal adhesive with MDP monomer and amide monomer chemistry called rapid bond technology. This combination of the MDP monomer, which creates a strong chemical bond to hydroxyapatite, and newly developed hydrophilic amide monomer, which is highly hydrophilic, is responsible for fast chemical bonding and quick penetration into dental tissue. Because the amide monomer rapidly permeates dentin and enamel, it eliminates the need for long rubbing application of the adhesive into the dentin and reduces the wait time after application. After curing, the innovative amide monomer forms a moisture-resistant cross-linked polymer network.

As a result, the bonding is moisture-resistant and stable, with durable results. This method, which reduces application time without compromising bond strengths, sealing, or desensitizing, also reduces technique sensitivity.

A fast and versatile agent that bonds directly to dentin, enamel, metals, zirconia and lithium disilicate restorative materials, CLEARFIL™ Universal Bond Quick is suitable for bonding direct and indirect restoration and can be used for total-etch, selective-etch, or self-etch methods. When mixed with CLEARFIL™ DC Activator, CLEARFIL™ Universal Bond Quick becomes dual-cure and has universal use with both self- and dual-cured resin cements and core build-up resins. 

The practitioners evaluating the product commented on its ease in dispensing and placement, viscosity, suitability for all bonding procedures, and convenience. Among their remarks were: “Perfect viscosity. Ease of use and speed were great.” and “Great for replacement of silane to prime crowns for cementation with resin cement - will self-cure with the dual-cured resin.”

Honors such as Editor’s Choice that are conferred by US-based DENTAL ADVISOR were introduced to help busy practitioners make sense of the numerous new solutions indicated for less invasive techniques, standardized or simplified procedures, and better outcomes on a regular basis. DENTAL ADVISOR conducts its practice-based clinical evaluations and product performance tests shortly after product launch, and publishes results annually online to help potential users identify high-quality new dental materials and determine which among them are best suited to fulfill their individual requirements.

A pioneer in digital dental photography, the editor-in-chief of the “International Journal of Esthetic Dentistry” and a supporter of universal products: We are talking about Dr Alessandro Devigus, the owner of a private practice in Bülach, Switzerland. At the International Dental Show 2023 in Cologne, we had a conversation with him about his favourite products from Kuraray Noritake Dental Inc. and the concept of universal excellence.

Dr Adham Elsayed, Clinical and Scientific Manager at Kuraray Noritake Dental Inc., interviewing Dr Alessandro Devigus.

Dr Devigus, why did universal products attract your attention?

We all would like to reduce the number of products and components used in our dental offices to make our lives easier and more predictable. Several years ago, when the first universal products started entering the dental market, I realized that these products and the concept behind them are able to help me achieve this goal.

For what kinds of treatments do you currently use universal products?

The main field of application is restorative dentistry, in indirect and direct restorative workflows, which often go hand in hand. Whenever possible and in accordance with the needs and desires of the patient, I opt for minimally invasive direct composite restorations, often realized using universal products. Cosmetic corrections or tooth wear treatments in the lower jaw, for example, are often carried out in a prepless procedure with resin composite applied with a single-shade technique. For anterior restorations in the upper jaw of the same patient, however, I might opt for ceramic restorations, luted with a universal resin cement.

What are your favourite indirect restorative materials, for which indications do you use them and when do universal products come into play?

I produce most of my single-tooth restorations chairside with CEREC. In the anterior region, the choice is usually between different types of glass ceramic materials. In some indications, when two central incisors or all four maxillary incisors need to be restored, zirconia is also a suitable option. In these cases and for indirect restorations in the posterior region, KATANA™ Zirconia Block is my preferred material. Having tested many different types of chairside zirconia, I can say that this product simply offers the most natural colour gradation and the desired vitality. Hence, finishing is quick and easy. At the same time, the high flexural strength of the material supports me in my striving for minimally invasive preparations. For definitive placement of the produced overlays and crowns, PANAVIA™ SA Cement Universal from Kuraray Noritake Dental Inc. is my dual-cure resin cement of choice. It bonds to virtually every surface including lithium disilicate without a separate primer and offers a good flowability that facilitates restoration placement. An additional feature contributing to a quick and stress-free clinical procedure is its easy and gingiva-friendly excess removal after tack curing.

What about direct restorations?

One of my favourite resin composites is CLEARFIL MAJESTY™ ES-2 Universal (Kuraray Noritake Dental Inc.). Its single shade for the posterior and two shades for the anterior region offer just the right combination of translucency and intrinsic colour to imitate a large number of tooth shades. The effect is that it blends in nicely with the surrounding tooth structure without appearing grayish. In the posterior region, I was able to observe a certain masking potential, so that discoloured abutment teeth do not cause any problems. With this material, the shade determination step is eliminated. Clinical workflows are also simplified by the use of CLEARFIL™ Universal Bond Quick. The universal adhesive is not only versatile as it is suitable for many indications and all etching techniques, but also extraordinarily quick in its application, as the need for an extensive rubbing into the tooth structure is eliminated. In this way, it is possible to streamline direct restorative procedures.

Why do you use so many products from Kuraray Noritake Dental Inc.?

I simply like products from Japanese companies. They stand for quality, integrity and clinical relevance. Japanese people seem to be deeply committed to the company they work for and to their work, pay attention to every detail and try to deliver the best outcomes possible. This attitude is reflected in Kuraray’s mission “For people and the planet—to achieve what no one else can.”, and it is reflected in the products of the company as well. They offer the properties I need to deliver high-quality dental treatments.

You said that making your life easier and more predictable is the main reason for you to opt for universal materials. Please explain.

In the first place, using fewer products and components that are easy and quick in their application allows me to get a grip on costs. With fewer steps and fewer bottles, shortened application times and standardized workflows, the time a patient needs to sit in the chair is reduced, which allows me to save the most valuable factor in the office: my time. At the same time, material storage and order management are streamlined, so that it is much easier to keep track of dates of expiry, hence saving material costs as well. And the best thing about it is that all these savings are possible without compromising treatment quality. Provided that the user is able to handle the materials properly – which is facilitated by the minimal number of steps and ease of use – the quality of the outcomes is extremely high!

Dr Devigus, we thank you for sharing your insights with us.

Article by Michael Braian DDS, CDT, PHD

Digital advancements revolutionized dentistry, providing efficient, precise dental care¹. Intraoral scanners replace traditional impressions, enabling virtual models for procedures like implant placement, orthodontics, and prosthodontics². Scan bodies aid in digitizing implants, while CAD/CAM improves prosthesis design and fabrication³. Milling and 3D printing offer speed, accuracy, and complexity in creating dental prostheses⁴. These innovations promise a bright future for dental professionals and patients.

The integration of digital technologies in dentistry has brought about significant advancements in dental care1. This case study presents a comprehensive dental rehabilitation of a patient utilizing a digital workflow, including extraction, dentures, implant surgery, intraoral scanning, 3D printed try-ins, and the fabrication of the final monolithic prosthetic construction.

EXTRACTION OF SEVERELY DECAYED TEETH

The first step in the patient‘s dental rehabilitation involved the extraction of severely decayed teeth. This procedure was necessary to eliminate the source of infection and discomfort and to prepare the oral cavity for the subsequent steps in the rehabilitation process. The dentures are later used to simplify the guided surgery planning⁵. Following the extraction, the patient was provided with appropriate postoperative care instructions and a healing period was allowed before proceeding with the next steps (Fig.1).

Fig. 1. Severely decayed teeth prior to extraction.

DENTURES DURING THE HEALING PERIOD

During the healing period of approximately seven months, the patient was fitted with dentures to replace the extracted teeth. This temporary solution allowed the patient to maintain oral function, appearance, and confidence while the extraction sites healed, and the oral tissues prepared for the implant surgery⁶.

IMPLANT SURGERY

In the upper jaw, six implants were placed, while only four were placed in the lower jaw (Fig.2). This decision was based on the patient‘s individual needs and oral anatomy. Studies have shown that the number of implants required for optimal support and stability depends on various factors, including bone quality and quantity, implant position, and prosthesis design⁷. Research suggests that six implants in the upper jaw and four in the lower jaw are sufficient to provide adequate support for a full-arch fixed prosthesis, with high success rates and patient satisfaction reported⁷. Additionally, placing fewer implants can help reduce surgical time and cost, as well as minimize the risk of complications associated with multiple implant placements. Therefore, this approach was deemed appropriate for this particular patient‘s case.

2023 DENTAL ADVISOR Top Product is an everyday cement that eliminates the need for a separate primer

PANAVIA™ SA Cement Universal adheres to virtually all substrates, including lithium disilicate, in a single procedure without the need for a separate primer or silane, and it also offers easy, gingival-friendly removal of excess cement and requires no refrigeration. Therefore it is no wonder that this year DENTAL ADVISOR gave PANAVIA™ SA Cement Universal Top Product award in the category of Indirect Restoratives.

What makes its strong and durable bond possible without the added step of applying a separate substrate is that PANAVIA™ SA Cement Universal combines two innovative technologies in a single product. The silane coupling agent, LCSi monomer, establishes a durable, chemical bond with porcelain, lithium disilicate, and composite resin; and the original MDP monomer provides for chemical reactiveness with zirconia, dentin and enamel.

The result is a convenient, versatile, and efficacious single solution to practitioners’ everyday cementation needs for a wide variety of indications, including cementation of crowns/bridges, inlays/onlays, posts, splints, and even adhesion bridges.

The significant benefits and quality of PANAVIA™ SA Cement Universal are reflected in the study findings and feedback of the 31 DENTAL ADVISOR clinical evaluators who used the cement in 516 applications and gave it an overall clinical rating of 96 percent. Their comments on its ease of use, handling characteristics, and aesthetics included: “Good flow and film thickness;” “Amazing viscosity, tack cure-ability, and very easy cleanup;” and “Great color match, and I liked the universal ability to work with so many substrates.”

The Top Product or Preferred Product Awards conferred by US-based DENTAL ADVISOR were introduced to help busy practitioners make sense of the numerous new solutions indicated for less invasive techniques, standardized or simplified procedures, and better outcomes on a regular basis. DENTAL ADVISOR conducts its practice-based clinical evaluations and product performance tests shortly after product launch, and publishes results annually online to help potential users identify high-quality new dental materials and determine which among them are best suited to fulfill their individual requirements.

For more information visit the website of DENTAL ADVISOR: www.dentaladvisor.com.

Five-time DENTAL ADVISOR Top Product delivers more than a reliable bond

For the fifth time CLEARFIL™ SE Protect has made DENTAL ADVISOR’S list of Top Products for 2023, placing it among dental materials and equipment deemed to deliver the best practice-based performance based on the publication’s annual review of such products.

Featured in the Bonding Agent Self-etch category, CLEARFIL™ SE Protect is a self-etch adhesive that offers more than just a reliable bond. It is:

• Antibacterial (self-etch) primer thanks to containing MDPB monomer
• Built on the same system of the gold standard adhesive CLEARFIL™ SE BOND
• Possible to use it for extended indications of core build-up and indirect restoration with CLEARIFL™ DC Activator.

All in all - surely a great addon to your dental toolbox.

Application of CLEARFIL SE Protect is also truly versatile – you can use it for any direct restorations, but in particular when treating hypersensitive teeth. It is also widely used for core build-up with self- or dual-cured resin materials and for cementation with composite resin cement in combination with CLEARFIL™ DC Activator.

CLEARFIL™ SE Protect offers you following features:

• Virtually no post-operative sensitivity
• Excellent bond strength for enamel and dentin
• Fast and simple procedure with low technique sensitivity

These attributes are reflected in the study findings and comments of the 13 DENTAL ADVISOR editors and consultants—seven of whom had previously used CLEARFIL™ SE BOND in their practices. After CLEARFIL™ SE Protect was assessed over a six-week period during which over 150 restorations were placed, it received a 98% clinical rating by consultants using a 1-5 rating scale,

The practitioners evaluating the product found no post-operative sensitivity. Among their observations mentioned in the online DENTAL ADVISOR report were the fact that the primer and bond wet the tooth evenly. They also mentioned that CLEARFIL™ SE BOND is effective in the reduction of sensitivity when placed on areas of recession or similar areas of sensitive tooth structure.

The Top Product or Preferred Product Awards conferred by US-based DENTAL ADVISOR were introduced to help busy practitioners make sense of the numerous new solutions indicated for less invasive techniques, standardized or simplified procedures, and better outcomes on a regular basis. DENTAL ADVISOR conducts its practice-based clinical evaluations and product performance tests shortly after product launch, and publishes results annually online to help potential users identify high-quality new dental materials and determine which among them are best suited to fulfill their individual requirements.

For more information visit the website of DENTAL ADVISOR: www.dentaladvisor.com

DENTAL ADVISOR Top Product to address everyday dental challenges

For the 8^th straight year, CLEARFIL MAJESTY™ ES Flow has been included among DENTAL ADVISOR’S Top Products, which is made up of dental materials and equipment deemed to deliver the best practice-based performance based on the publication’s annual review of such products.

Featured in the Direct Restorative category, CLEARFIL MAJESTY™ ES Flow comes in three different levels of flowability designed to cover a range of flowable composite indications that cannot be addressed with a single viscosity. Whether the practitioner needs the product to be firm enough to stay put where applied, malleable enough to create a specific shape, or runny enough to flow into every corner or undercut, one of the three versions is appropriate for the job. For example, the high flowability variant is the perfect choice for cavity linings and as a resin coat in immediate dentin sealing (IDS) procedures, while the super low flowability option is suitable for direct veneer procedures and for build-up of posterior cusps etc.

Equipped with Kuraray Noritake Dental Inc.’s Light Diffusion Technology, the universal flowable composite integrates seamlessly with the surrounding tooth structure. If no recontouring required, then a glossy surface can be obtained simply by wiping with a cotton roll soaked in alcohol.

The version tested by the 29 DENTAL ADVISOR consultants in more than 900 applications in their dental practices was the medium flowability variant (Low) of CLEARFIL MAJESTY™ ES Flow. They evaluated properties including placement/handling, aesthetics, viscosity, and polishability and rated all to be “excellent,” with no running during placement and a good adaptation to the cavity walls and when flowed into narrow areas. This led to a recommendation rate of 100 percent and a 98 percent overall clinical rating.

Among their comments were: “The material blended so well with the tooth structure that you had to look hard to find the interface;” “Syringe design prevents oozing from the tip;” and “Readily apparent on radiographs.”

The Top Product or Preferred Product Awards conferred by US-based DENTAL ADVISOR were introduced to help busy practitioners make sense of the numerous new solutions indicated for less invasive techniques, standardized or simplified procedures, and better outcomes on a regular basis. DENTAL ADVISOR conducts its practice-based clinical evaluations and product performance tests shortly after product launch. It publishes results annually online in its January/February issue to help potential users identify high-quality new dental materials and determine which among them are best suited to fulfill their individual requirements.

For more information visit the website of DENTAL ADVISOR: www.dentaladvisor.com.

WEBINAR BY PROF. DR. SVEN RINKE

Enhance your knowledge and skills in the field of all-ceramic restorations! We invite you to watch the recording of the recent webinar titled "Cementation of All-Ceramic Restorations" by the esteemed Professor Dr. Sven Rinke.

Whether you currently incorporate all-ceramic restorations in your daily practice or aspire to offer them, this webinar recording is a valuable resource that you shouldn't miss. Professor Dr. Rinke, an expert in the field, delves into the key aspects of implementing an all-ceramic treatment concept that guarantees predictable long-term success and superior aesthetic outcomes while utilizing a limited number of materials and straightforward treatment strategies.

During the webinar, two types of cementation techniques are showcased: self-adhesive cement (PANAVIA SA Cement Universal, Kuraray Noritake Dental Inc.) and adhesive composite material (PANAVIA V5, Kuraray Noritake Dental Inc.). Professor Dr. Rinke provides a comprehensive step-by-step concept that offers easy-to-follow instructions, which you can readily incorporate into your daily routine.

The webinar recording covers a wide range of important topics, including:

• An update on material-specific recommendations for preparing all-ceramic restorations, ensuring you stay up-to-date with the latest advancements.
• Established procedures and materials for adhesive cementation of glass-ceramic and zirconia restorations, enabling you to implement best practices in your clinical work.
• A discussion on the relevance of conventional cementation and its viability in today's dental landscape.
• Valuable tips and strategies for avoiding failures and flaws in all-ceramic restorations, ultimately improving your treatment outcomes.

Don't miss out on this chance to elevate your skills and expand your expertise in all-ceramic restorations. We are confident that the knowledge shared in this webinar recording will have a positive impact on your daily practice and help you achieve superior outcomes.

Watch now at your own convenience!

DR. SVEN RINKE

Sven Rinke’s vast experience and expertise in the field of Prosthodontics and Implantology has seen him taking on a wide range of roles in universities, private practice, and the dental industry.

In 1992, he joined the School of Dentistry Department of Prosthodontics, Georg-August-University, Göttingen, and later worked as Senior Lecturer for Material Sciences and Prosthetic Dentistry before taking on the role of Associate Professor. Sven has also been a Visiting Assistant Professor at the Harvard School of Dental Medicine’s Department of Restorative Dentistry.

Since 1996 Sven has run a private practice specializing in prosthodontics and implantology as well as being a scientific consultant for Degussa Dental. He was Head of Clinical Research at Degussa Dental GmbH where, from 2002, he headed up the Foundation of EC EviDent Consulting (Clinical research and scientific transfer management).

Other achievements include membership of the Assigned Board Specialist of Oral Implantology and Assigned Board Specialist of Periodontics plus a MSc in Oral Implantology and another in Periodontology.

Since 2013, Sven has worked in the Venia Legendi for Dentistry, Georg-August-University, Göttingen, Germany, and the university’s Department of Prosthodontics.

He has also won numerous awards, recognising his extensive expertise in Prosthodontics and Implantology.

LabLine magazine is an English language publication catering to the field of lab-side dentistry. It provides comprehensive coverage of the latest techniques and trends in dental laboratory technology and materials, showcasing them via sophisticated, challenging and aesthetic clinical cases done by some of the most known experts in Europe. With its expertly curated content, LabLine serves as an invaluable resource for dental professionals seeking to enhance their knowledge and stay at the forefront of the industry.

In the SPRING edition of LabLine you can find a wonderful AESTHETIC CASE by Mikel Villar Gonzales and DT Pilar Ballesteros Galan. The patient, a 21-year-old female had a hypoplasia defect on her permanent teeth, 1.1 and 1.2., presumably due to trauma on her deciduous anterior teeth. Click the image below and check out how the case was done!

The 46^th congress of European Prosthodontic Debates, also known as EPA2023, will take place in Vilnius, Lithuania 14-16^th of September, 2023.

It stands as a pinnacle gathering for dental professionals and researchers in the field of prosthodontics. This highly anticipated event serves as a platform to exchange knowledge, share insights, and engage in lively discussions on the latest advancements, achievements and challenges in prosthodontics.

EPA2023 promises to be an extraordinary occasion, attracting more than 50 experts from across Europe and beyond. Renowned speakers will present the newest advances in clinical prosthodontics and restorative dentistry. Daniele Rondoni, Matthias Kern, Nicola Scotti and Kazuyoshi Baba are only some of experts at the event; check out complete speaker line-up on the website www.epa2023.lt.

The event will feature thought-provoking debates, where experts will engage in intellectual discourse on current topics of prosthodontics, stimulating a lively exchange of ideas and perspectives. Special attention will be given to the successful application of digital solutions.

Beyond the scientific program, EPA2023 will provide ample opportunities for networking and collaboration. Attendees will have the chance to interact with colleagues, forge new partnerships, and establish connections with industry leaders, further enriching their professional networks.

As the European Prosthodontic Debates event continues to push the boundaries of prosthodontics, EPA2023 is expected to be a landmark occasion, empowering dental professionals to advance their knowledge, skills, and expertise in the ever-evolving field of prosthodontics.

Register now for EPA2023: www.epa2023.lt

Shortly before KATANA™ Zirconia ML was launched at the IDS in Cologne ten years ago, I had the pleasure to be invited to Japan. We visited the KATANA™ Zirconia production facilities and learned from Kazunobu Yamada and Takuro Nagura how the new material worked. So far, all dental zirconia I had used was white and quite opaque.

I was immediately impressed by the complexity of the production procedure including all the measures taken by Kuraray Noritake Dental to provide for an extremely high material and blank quality. The blanks appeared to have an extremely homogeneous multi-layered structure and a high density responsible for stable edges and smooth surfaces. What we were told in the manufacturing plant was confirmed by Kazunobu Yamada, who shared his experience and showed us several full-contour cases. I was pleasantly surprised by the fact that he was able to produce impressive outcomes without adding any colour. Moreover, Kazunobu Yamada was obviously able to polish the surface of his restorations within seconds. The perfectly smooth surface would allow us avoid the use of glaze, which usually wears off very quickly, leaving a potentially rough surface that may harm the antagonist.

Based on what I had learned in Japan, I went back to Italy and started experimenting with the amazing new material. While Kazunobu Yamada had identified KATANA™ Zirconia ML as the solution for monolithic restorations in the posterior area, I started using it in every region of the mouth – with different design concepts from full-contour to micro-cutback with micro-layering in the vestibular area. The occlusal contact area was always held in plain, polished zirconia.

Fig. 1. Early example of anterior restorations made of KATANA™ Zirconia ML individualized with CERABIEN™ ZR using the new micro-layering technique.

Fig. 2. Possible cutback design.

During the testing period, I learned a lot about the new zirconia, which was so different from earlier generations. The most important insight was that that the processing conditions have a huge impact on the final outcome. Kuraray Noritake Dental provided valuable support e.g. in the form of sintering protocols and processing and finishing recommendations. This helped me develop my own workflow and concept based on a full-contour design in the posterior and different micro-cutback options with micro-layering in the anterior region. For me, this is a perfect combination of the new type of zirconia (KATANA) and the traditional porcelain material (CERABIEN™ ZR Luster Porcelain and Internal Stain).

In May 2013, at a meeting of the Noritake Study Club in Florence, Italy, I presented the new approach for the first time. Many colleagues were enthusiastic about it and started adopting it. While further developments like more translucent (cubic) material variants and a new generation multi-layered zirconia with a flexural strength and translucency gradient increased the application options and aesthetic potential, micro-layering became a truly popular approach used by dental technicians all over the world. In 2016, it was recognized as a relevat workflow during a closed meeting of the European Academy of Aesthetic Dentistry.

Fig. 3. Perfectly polished palatal zirconia surfaces of anterior restorations.

Fig. 4. More recent case showing a patient who received restorations made of KATANA™ Zirconia STML …

Fig. 5. … finished with CERABIEN™ ZR Internal Stains and a micro-layer of CERABIEN™ Luster Porcelain LT1.

But what is the major reason for the success of the concept and of multi-layered zirconia with KATANA™ Zirconia ML as the pioneer? In my opinion, it should not be implemented for greater simplicity or economic reasons, as one might assume at first thought. The time saved in the layering procedure should be spent on other tasks such as surface texturing and a fine-tuning of the processing procedure. The real benefit is that KATANA™ Zirconia ML and its successors allow for better solutions adapted to the patient’s needs. First of all, they enable us to save natural tooth structure, as the required wall thickness is reduced. They also offer mechanical advantages, as chipping is avoided, and the occlusal contact area remains smooth over time. In my dental laboratory, we changed our workflows completely and – preferring a more conservative approach whenever indicated for the case on hand – we often abandon full layering.

KATANA™ Zirconia can be considered as a great contribution to the digital workflow in the dental laboratory and office, which increases the efficiency of prosthodontic procedures. With the KATANA™ Zirconia Multi-Layered series, it is easy to hold our promise of delivering the best possible quality and aesthetics. The reason is that the materials support us in an ideal way, delivering the perfect combination of tradition and innovation.