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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 COMBINATION OF EFFECT LIQUIDS AND MICRO-LAYERING ON HIGHLY AESTHETIC ZIRCONIA IS THE EFFECTIVE WAY TO ACHIEVE OUTSTANDING RESULTS

Case by Leonidas Dimitriou, MDT

As an addition to its well-aligned portfolio of multi-layered zirconia (KATANA™ Zirconia Multi-Layered series) and veneering porcelain for zirconia (CERABIEN™ ZR), Kuraray Noritake Dental Inc. has recently introduced a set of dyeing liquids. Esthetic Colorant for KATANA™ Zirconia is applied to the surface of the monolithic or anatomically reduced zirconia restoration prior to the final sintering procedure. In this way, it is possible to imitate typical internal colour effects of natural teeth quite easily. Depending on the desired outcome, users may add just a final layer of glaze, liquid ceramics or stains and porcelains to their zirconia restorations treated with Esthetic Colorant. The following two case examples are used to demonstrate two different procedures involving the use of the effect liquids.

CASE EXAMPLE 1

In the first case, we produced three two-unit splinted crown restorations for six maxillary anterior teeth. The zirconia crowns (made of KATANA™ Zirconia YML) were anatomically reduced and individualized with Esthetic Colorant mainly in the incisal and cervical areas immediately after milling. For the application of the selected liquids, we used the Liquid Brush Pen specifically developed for Esthetic Colorant. The restorations were dried for half an hour, placed in the sintering furnace for sintering according to the recommended protocol for KATANA™ Zirconia and subsequently finished with CERABIEN™ ZR porcelains. Finally, CERABIEN™ ZR Paste Stain Glaze was applied for the final high-gloss finish.

Fig. 1. Pre-sintered anatomically reduced crowns after milling.

Fig. 2. Esthetic Colorant applied to the milled restorations.

Fig. 3. Appearance of the individualized restorations after the final sintering procedure.

Fig. 4. Restorations after porcelain layering.

FINAL SITUATION

Fig. 5. Final restorations with a natural appearance. The effects created with Esthetic Colorant shine from deep within the restorations.

Fig. 6. Lateral view of the final restorations from the left.

Fig. 7. Lateral view of the final restorations from the right.

CASE EXAMPLE 2

In this second case, two three-unit restorations were produced using KATANA™ Zirconia YML in the colour A3. We designed and milled them in full contour, then reduced them with hand instruments by 0.2 mm and added some texture effects to the surface before applying Esthetic Colorant. In this case, we played with different shades of Esthetic Colorant. Even when applied on a minimally reduced or monolithic surface, the liquids are able to create a nice depth effect as they diffuse into the zirconia structure. The amount of liquid applied is easily controlled with the Liquid Brush Pen, so that the intensity of the colours is predictable. After sintering, we added some internal stains, CERABIEN™ ZR Luster Porcelain and a final layer of CERABIEN™ ZR FC Paste Stain Glaze to finish the restorations. The outcome speaks for itself.

Fig. 8. Milled monolithic restorations with a pronounced surface texture.

Fig. 9. Vestibular and palatal surfaces individualized with Esthetic Colorant to create and intensify some natural colour effects.

Fig. 10. Appearance of the restorations immediately after sintering.

Fig. 11. Restorations after internal staining.

Fig. 12. A layer of luster porcelain applied to the minimally reduced restorations.

FINAL SITUATION

Fig. 13. Final outcome after glazing.

Dentist:

LEONIDAS DIMITRIOU, MDT

Case by CDT Daniele Rondoni and MDT Roberto Rossi

Working with high-translucency, multi layered zirconia (KATANA™ Zirconia Multi-Layered series from Kuraray Noritake Dental Inc.) paves the way toward indirect restorations that are closely adapted to our patients’ needs. Reduced wall thicknesses allow for minimally invasive tooth preparations, while polished zirconia in the occlusal contact areas provides for an antagonist-friendly behaviour. All this is possible due to the high aesthetic potential and homogeneous structure of the materials, which work well with a full-contour design or slight vestibular cutback. For individualization or characterization, different options are available. The portfolio of finishing solutions from Kuraray Noritake Dental has just been complemented by Esthetic Colorant for KATANA™ Zirconia, a set of twelve dyeing liquids for the company’s multilayered zirconia. They are applied to the milled restoration surface prior to sintering.

Some readers may wonder why there is a need for effect liquids applied to pre-shaded zirconia with a multi-layered colour structure. Being aware of natural teeth’s unique play of colours stemming from the shape and shade of the dentin core, however, the reason is quite obvious: Esthetic Colorant diffuses into the zirconia structure, hence allowing us to create depth effects even in monolithic restorations. Moreover, it enables the user to pre-treat tissue areas, and even by using the liquids on cutback designs, we are able to reproduce case-specific internal optical characteristics quite easily. Our standard approach for the use of Esthetic Colorant on KATANA™ Zirconia HTML Plus is described by means of the following case example: An implant- and tooth-based twelve-unit bridge with a slight vestibular cutback design, finished with Esthetic Colorant and CERABIEN™ ZR Porcelain.

Fig. 1. Restoration with sintering support removed from the blank.

Fig. 2. Esthetic Colorant for KATANA™ Zirconia: Available shades.

Fig. 3. Frontal view of the milled restoration after the application of Esthetic Colorant. A chromatic map is not needed since the colours of the applied liquids are clearly visible.

Fig. 4. Occlusal view of the milled restoration after the application of Esthetic Colorant. The liquids were applied with the Liquid Brush Pen for Esthetic Colorant.

Fig. 5. Frontal view: Appearance of the restoration after sintering.

Fig. 6. Occlusal view: Appearance of the restoration after sintering.

Fig. 7. Beautiful translucency and mamelon structures in the incisal area.

Fig. 8. Situation after the application of a thin layer of CERABIEN™ ZR Porcelain, which creates an enamellike window effect and reveals the play of colours found underneath.

Fig. 9. Restoration after firing and glazing.

FINAL SITUATION

Fig. 10. Beauty shots…

Fig. 11. … of the final restoration.

Easy handling and application, impressive colour effects: Esthetic Colorant perfectly fits into our micro-layering approach with a cutback design adjusted to the age and needs of every patient. Being applied on the pre-sintered zirconia surface, the liquids do not require any extra heat treatment – the restoration is simply dried and then sintered as usual. Esthetic Colorant may be used instead of or in combination with internal stains, luster porcelains and liquid ceramics – whatever complements a laboratory’s existing approach to highly aesthetic zirconia restorations.

Dentists:

Case by Dr. David Garcia Baeza and DT. Pilar Ballesteros Galan

Shade determination in the planning phase, shade evaluation at try-in: How is it possible to accomplish these highly important tasks in the production of lifelike anterior restorations without meeting the patient in person? A computer-based shade documentation and try-in system is a great solution. Download this clinical case example describing the aesthetic restoration of two maxillary anterior teeth to learn more about one such system and its use!

Case by Dr. Yohei Sato, DMD, PhD, Department of Removable Prosthodontics, Tsurumi University School of Dental Medicine, JAPAN and Dr. Keisuke Ihara, CDT, i-Dental Lab, JAPAN

Fig. 1. The patient was referred to our hospital by an orthodontist. The chief complaints were improper esthetics of the teeth due to black triangles at the edges of the gaps between the teeth and occlusal wear of the teeth.

Fig. 2. On the basis of the pre-treatment diagnosis using a mockup, the abutments were prepared without anesthesia, keeping in mind that the enamel should be preserved to the extent possible.

Fig. 3. Since a fixation retainer was installed on the palate side, it was difficult to take impressions using silicone. Therefore, an intraoral scanner for impression taking was used.

Fig. 4. A layer of porcelain on each of KATANA™ Zirconia STML substrates was applied to complete the laminate veneer resto-rations. The inner surface of each restoration was sandblasted, being careful to prevent chipping.

Fig. 5. After trial fitting, bonding inhibiting substances as blood and saliva were removed using KATANA™ Cleaner.

Fig. 6. Milling. CLEARFIL™ CERAMIC PRIMER PLUS, which contains the phosphoric ester monomer MDP, was applied and dried using compressed air.

Fig. 7. The surface of each tooth was cleaned and treated with K-ETCHANT Syringe for 10 seconds before washing it away with water and compressed air-dried the area.

Fig. 8. PANAVIA™ V5 Tooth Primer was applied and left it for 20 seconds, then compressed air-dried it.

Fig. 9. PANAVIA™ Veneer LC Paste was applied and the laminate veneer was seated. For this case, we treated six teeth during one session.

Fig. 10. The unpolymerized excess paste was removed with a brush. PANAVIA™ Veneer LC Paste is a light-cured type, which was designed to provide sufficient working time.

Fig. 11. This photo shows the results after the final light curing. Since the excess cement was easily removed, there were almost no cement residues.

FINAL SITUATION

Fig. 12. The photo shows the inside of the oral cavity one month after the fitting of the laminate veneer restorations. It can also be noted that the teeth’s marginal gingiva has been improved, thanks to the good fit of the laminate veneer restorations.

The vacation period is over and we all are slowly returning back to our everyday routines and work. With all the travel and holidays in the last months you might have missed this great article in the LabLine Summer edition: Graftless solutions and implant-supported monolithic zirconia fixed prostheses.

It is an extensive, beautiful and detailed case report created and documented by team of well known and respected KOLs: Fortunato Alfonsi, Antonio Barone, Marco Stoppaccioli, Romeggio Stefano and Vincenzo Marchio.

Check it out by clicking here.

Case by MDT Daniele Rondoni and Dr. Enzo Attanasio.

Veneers made of zirconia? In some cases, like the one presented below, monolithic zirconia veneers may be an option. Reasons for selecting a latest-generation zirconia such as “KATANA™ Zirconia” YML include its very high translucency and a wall thickness of only 0.3 to 0.4 mm supporting minimally invasive tooth preparation. Due to a highly automated production procedure, the manual effort involved may be reduced, while highly aesthetic outcomes are possible.

Fig. 1. Initial situation: Young female patient with misshaped and misaligned maxillary incisors. Digital smile design is used to reveal the ideal proportions and positions of the anterior teeth.

Fig. 2. Ideal tooth proportions and positions displayed over a picture of the teeth after orthodontic treatment and the creation of a mock-up. The positions are ideal and the tooth shapes obtained with the mock-up only need some minor adjustments.

Fig. 3. Facial view of the patient with the planned veneers blended in.

Fig. 4. Guided tooth structure removal with the aid of a silicone index. The minimum wall thickness of the selected material – “KATANA™ Zirconia” YML – is 0.4 mm.

Fig. 5. Matched digital impressions of the maxilla and mandible taken after tooth preparation.

Fig. 6. Monolithic restoration made of “KATANA™ Zirconia” YML placed on the resin model after the 7-hour final sintering.

Fig. 7. Lateral view of the master cast with the six veneers individualized with the liquid ceramic system CERABIEN™ FC Paste Stain.

Fig. 8. Tooth-like translucency of the veneers on the model.

Fig. 9. Intra-oral try-in with two different shades of the PANAVIA™ V5 Try-in Paste: A2 is used in the right and Clear in the left quadrant. It was decided by the dentist to use A2 shade.

Fig. 10. Lateral view of the cemented veneers. The result is a natural surface texture, which contributes to a natural appearance of the restorations.

Fig. 11. Frontal view of the veneers in place.

Fig. 12. Treatment outcome immediately after rubber dam removal.

FINAL SITUATION

Fig. 13. Treatment outcome with healthy soft tissues two weeks after treatment.

Fig. 14. Gums are healthy and the restorations show a great optical integration with the adjacent posterior teeth.

Dentists:

Case by Keisuke Ihara, RDT, Yohei Sato, DMD, PhD and Tsurumi University School of Dental Medicine.

MINIMAL CUT-BACK DESIGN

Accommodate esthetics and function, achieves natural color and surface texture due to thin porcelain layer.

Step 1.  Teeth preparation.

Step 2.  Inner crowns were placed on the abutments.

Step 3.  Zirconia Frame (KATANA Zirconia HTML A1) cut-back designed for incisal frame.

Step 4.  Application of Cerabien™ ZR (CZR) for making base color and firing.

Step 5.  Application of Internal Stain and firing.

Step 6.  The final restoration and inner crown parts.

Step 7.  Post-operative view.

Multiple porcelain layering with Internal Stain technique

In 2015, Kuraray Noritake Dental Inc. launched the new KATANA Zirconia UTML and STML. With this outstanding multi-layered zirconia you can reach high level of esthetic in less steps than usual working steps of layering porcelain technique. Just mill and sinter. Due to great properties of this new material, you will get a high esthetic and natural like result. On the other hand, there are many works existing in clinical situation that only professional handmade can achieve the highest esthetic level. Multiple porcelain layering and Internal Stain technique have bigger possibility sometime to show beyond natural.

Fig. 1. Pre-operative photo.

Fig. 2. After preparation.

Fig. 3. Checking the fit of Zirconia Frameworks on model.

Fig. 4. After 1st baking of OB as washbake.

Fig. 5. After wash-baking, using with Internal Stain A+ on the margin area to make a natural cervical color from Zirconia.

Fig. 6. Applying Opacious Body (OBA1) considering with mamelon structure. And apply Body A2B to make high chrome area on cervical area.

Fig. 7. After baking Opacious Body (OBA1).

Fig. 8. After applying Body porcelain (A2B), using wit Cut-Back method to make a space for applying Enamel & Luster porcelains.

Fig. 9. Applying Enamel porcelain (E2) and Luster Porcelain (T Blue) for explaining translucent gradation on the edge of mamelon.

Fig. 10. Applying E2 for making White-band and LT1 for making incisal edge. Considering of porcelain shrinkage after baking, apply 13% bigger than final shape.

Fig. 11. After baking.

Fig. 12. Internal Stain application Applying A+ for cervical color and White for make white spots on incisal area.

Fig. 13. Applying E2 on Cervical area and LT1 for covering surface. And using with E2 on the edge of incisal to make Hallow Effect.

Fig. 14. After baking and morphological correction. Then self-glazing.

Fig. 15. End result.

Fig. 16. Post-operative photo.

Courtesy: Kanare Technical Center in Japan

Case by Sung Bin Im, MDC, CDT and Sergio R Arias, DDS, MS

MINIMAL CUT-BACK DESIGN

KATANA multi-layered zirconia allows me to achieve great esthetic and functional outcomes on high risk patients.

Step 1. Titanium Abutments (#7, 9) were placed on the solid model.

Step 2. Zirconia Frame (KATANA Zirconia HT10) cut-back designed to minic anatomical dentin structure and incisal frame.

 
Step 3. Application and firing of Cerabien™ ZR (CZR) to achieve target shade and incisal effect.

Step 4. Completion of Internal Stain firing.

Step 5. Completion of Luster and Clear Cervical layering.

Step 6. Surface detail check.

Step 7. Post-operative view.