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.

Case by Michal Jaczewski

This patient came to the clinic to improve the aesthetics of her smile. After an aesthetic and functional analysis, it was decided to align and restore the teeth using a minimally invasive protocol with flowable composite.

INITIAL SITUATION

Fig. 1. The patient had worn teeth, visible abrasion, erosion and crowding in the lower arch.

Fig. 2. Situation after orthodontic treatment, full arch ready to restore.

Fig. 3. A silicon mould is used for the Flowable Injection Technique to restore the teeth with flowable composite. The silicone injection mould had injection channels prepared and was placed to check for proper fit.

Fig. 4. For this case it was decided to use CLEARFIL MAJESTY™ ES Flow Low in shade XW.

Fig. 5. Teflon tape was used, in order to separate the teeth.

Fig. 6. The restoration is completely additive; the teeth are not prepared at all. Total etching of the enamel is the best pre-treatment in this situation. K-Etchant Syringe (35% phosphoric acid) was applied for 10 seconds.

Fig. 7. A surgical suction tip was used in order to carefully remove the phosphoric acid gel and protect the isolations on the teeth. Followed by rinsing off completely with water in the usual manner.

Fig. 8. Each tooth was gently air dried for 10 seconds. CLEARFIL™ Universal Bond Quick was applied with a rubbing motion without additional waiting time. Followed by drying of the entire bonding treated surfaces by blowing mild air for more than 5 seconds until the bonding no longer moves.

Fig. 9. Light curing of each bonded tooth for 10 sec.

Fig. 10. The silicon mould is used to inject CLEARFIL MAJESTY™ ES Flow Low (optimal flowability, and properties for a case like this).

Fig. 11. Using the protocol „Treat one, skip one” several teeth are restored simultaneously.

Fig. 12. Situation directly after first round of injections.

Fig. 13. Situation after restoring all teeth, before polishing.

Fig. 14. To create a natural gloss the following polishing protocol was used: 1.) Sof-Lex™* discs, 2.) CLEARFIL™ Twist DIA for Composite polishing wheels, 3.) diamond paste and finally zinc oxide paste.

*Not a brand name of Kuraray Noritake Dental.

Fig. 15. High-shine results after polishing.

FINAL SITUATION

Fig. 16. Final restoration, immediately after treatment.

Fig. 17. Final restoration after 2 days.

Dentist:

MICHAL JACZEWSKI

Michał Jaczewski graduated from Wroclaw Medical University in 2006 and today runs his private practice in the city of Legnica, Poland. He specializes in minimally invasive dentistry and digital dentistry and is the founder of the Biofunctional School of Occlusion. Here he lectures and runs workshops with focus on full comprehensive patient treatments.

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

Interview with Yoshihisa Yamada
General Manager, Technology Division of Kuraray Noritake Dental Inc.

KATANA™ Zirconia ML was introduced ten years ago, at the IDS 2013 in Cologne, as the dental industry’s first zirconia product with a multi-layered colour structure. Since that event, KATANA™ Zirconia ML blanks have become very popular. Continued development efforts have led to the current line-up of multi-layered materials, KATANA™ Zirconia UTML, STML and HTML PLUS, and our latest product – KATANA™ Zirconia YML. Our new technology with colour, translucency and strength gradation is found in KATANA™ Zirconia YML.

Photo credits to MDT Giuliano Moustakis.

How important was the invention of the Kuraray Noritake Dental’s original multi-layered technology for the dental market?

Our impression is that the material has had a significant impact on the dental market. Being the first zirconia material with a multi-layered colour structure, KATANA™ Zirconia ML was our first product of its class to offer the properties needed for the efficient production of full-contour zirconia restorations with a natural look. Before its introduction, the “full-contour zirconia” concept had not been widely accepted due to the aesthetic properties of the zirconia materials available so far: Many of them lacked the desired level of translucency, while others needed to be treated with dyeing liquids or stains in a complex procedure to obtain a natural shade appearance. With the launch of multi-layered zirconia blanks, which successfully added natural colour gradation to the structure, aesthetic full-contour zirconia restorations started to become popular among dental technicians worldwide. The high potential of the technology was confirmed at the IDS 2013 show, when we saw not only end-users, but also engineers from competing companies come to look at this product.

4-layer colour structure of KATANA™ multi-layered discs.

Photo credits to MDT Daniele Rondoni.

What changes were driven forward by the introduction of KATANA™ Zirconia ML?

After the introduction of KATANA™ Zirconia ML, many companies started developing multi-layered zirconia discs, creating a new dental product category with an added technical and clinical value. We are convinced that the invention of Kuraray Noritake Dental has played a major role in the shift from zirconia exclusively used as a framework material to alternative approaches including full-contour zirconia restorations. If only monochromatic zirconia discs had been available, we imagine that an increased number of dental technicians would have embraced the concept of using liquid colourants to achieve a natural appearance of full-contour crowns and bridges. That would have prevented monolithic zirconia restorations from becoming as popular as they are today.

How did the KATANA™ Zirconia ML technology evolve over the past ten years?

Based on our unique core technology developed for inventing KATANA™ Zirconia ML, we have been continuing making efforts to create even better products. One of Kuraray Noritake Dental’s great strengths is its ability to develop all the raw materials for its zirconia products inhouse. This makes it possible for us to adjust the boundaries between the layers as inconspicuously as possible, even when discs consist of multiple layers. This enabled us to provide multi-layered discs with the required strength and aesthetic qualities, and with a stable, predictable shrinkage rate. In the past ten years, we have focused on adding new materials with different levels of translucency and strength to offer a portfolio that meets the demands of virtually every dental technician, practitioner and patient.

For example, the advent of KATANA™ Zirconia STML, which has even better aesthetic qualities than KATANA™ Zirconia ML, has made it possible to use it all by itself to create highly aesthetic restorations, with no need to characterize or individualize the restorations. Of course, if you use KATANA™ Zirconia Multi-Layered discs and treat the restorations with a surface staining agent, such as CERABIEN™ ZR FC Paste Stain, you can create even more aesthetic restorations in a shorter time.

What are the benefits of Kuraray Noritake Dental’s multi-layered technology, as compared with other manufacturer’s solutions?

KATANA™ Zirconia multi-layered discs offer the advantage of delivering the proper colour even when they are sintered at high speed. There are two reasons for this. First, we developed unique raw materials with suitable characteristics for high-speed firing. This allows the creation of restorations with the same strength, stability, and aesthetics to be achieved after both short- and long-time firing. The second reason is that we possess the technical know-how concerning excellent shading that Noritake Dental Supply, one of Kuraray Noritake Dental’s predecessors, cultivated during its many years spent developing ceramic materials. Noritake Co., Ltd., parent company of Noritake Dental Supply, is a long-established ceramic manufacturer that is famous for its tableware and other outstanding products. It is this background that allows us to properly control pigment coloration using our inorganic pigment know-how and to provide unique firing schedules. These two strengths enable us to bring unique advantages to our products. That is, they remain stable and retain appropriate colouration even under rapid firing schedules.

CERABIEN™ ZR FC Paste Stain being applied to KATANA™ Zirconia restoration.

Photo credits to MDT Roberto Rossi.

How did you manage to shorten the sintering times so significantly, resulting in your speedy sintering with uniform protocols?

When shorter sintering times became possible, Kuraray Noritake Dental recommended that KATANA™ Zirconia ML be sintered for seven hours. After that, when a new furnace claiming being capable of short-time firing was launched, we used it to fire KATANA™ Zirconia ML on a trial basis. We found, happily, that our zirconia material was uniquely compatible with rapid firing. This was the beginning of our full-fledged study of short-time firing of our zirconia material. You could say that we began investigating short-time firing almost by accident. Then, while developing KATANA™ Zirconia STML and KATANA™ Zirconia UTML, successors of KATANA™ Zirconia ML, we focused on incorporating short-time firing into their features and made various adjustments, finally achieving the optimal combination of factors for the successful short-time firing of zirconia.

What are the benefits of Kuraray Noritake Dental’s second-generation multi-layered technology, as compared with other manufacturer’s solutions?

One advantage of KATANA™ Zirconia YML is that it can be applied to treat a wider range of cases without complex limitations on position within the disc. The reason: it delivers this high level of aesthetics while still maintaining great strength. This advantage of being appropriate for a wider range of cases also simplifies inventory management. In addition, users benefit from our expertise in developing raw materials and reproducing colour with ceramics. This expertise enabled us to develop a zirconia product in which each layer has a different level of translucency, while great strength and admirable aesthetics are maintained throughout the whole blank.

The sintering recommendation is only a guideline; some adjustments may be required depending on each individual furnace. If the furnace cannot be set according to the 54- or 90-minute sintering schedule, speed sintering cannot be used.

* The restorations may be removed at 800°C or less depending on the circumstances.
** For the sintering schedule of KATANA™ Zirconia HT, please refer to the Handy Chart in product packaging.

Is it really possible to address every case using only KATANA™ Zirconia YML?

For every case that can be treated either with KATANA™ Zirconia STML, KATANA™ Zirconia UTML, or KATANA™ Zirconia HTML PLUS, KATANA™ Zirconia YML is also an option. Hence, it is possible to use only KATANA™ Zirconia YML for all your zirconia cases – which is probably one of the reasons for its great popularity. It features both great strength and excellent aesthetics, and – being so versatile – it helps simplify inventory management. Of course, Kuraray Noritake Dental’s other multi-layered materials feature outstanding properties as well. Depending on the features you need, it would also be an option to select from these products - KATANA™ Zirconia STML, KATANA™ Zirconia UTML, or KATANA™ Zirconia HTML PLUS – to realize your ideal restorations.

KATANA™ Zirconia YML, finished with CERABIEN™ ZR.

Photo credits to MDT Giuliano Moustakis.

Why is the KATANA™ brand in general so popular among dental technicians around the world?

We think that dental technicians choose KATANA™ because they find that they can create highly aesthetic restorations using simple, straightforward steps.

Is there any further development potential in multi-layered technology?

On the basis of our technical know-how, there is always room for improvement. That is why we never stop innovating and listening to the voice of our customers. Developing what supports them in improving their outcomes while providing for more predictable, less stressful procedures is our ultimate goal. Right now, we expect to develop products with even greater strength, increased translucency, and outstanding aesthetics that will have a natural look resembling real teeth, even when the material used is full-contour zirconia.

Dentist:

YOSHIHISA YAMADA

We are thrilled to share with you our latest brochure – KATANA Zirconia Restoration System, featuring Kuraray Noritake Dental Inc’s product line-up that is dedicated to creating true-to-live restorations.

The KATANA Zirconia Family brochure features a range of lab-side products that are designed to meet the needs of modern dental professionals.

Our zirconia materials offer excellent strength and aesthetics, making them a top choice for prosthetic dentistry. In the new KATANA Zirconia Family brochure, you can read detailed information, key technical parameters, and suggested indication ranges for all our zirconia products - KATANA Zirconia UTML, STML, HTML PLUS, YML and HT. Also, we look at other products from our range such as CERABIEN ZR Porcelain, FC Paste Stain and  Esthetic Colorant that are and excellent choice for characterization of zirconia restorations, provide an overview of the sintering programs of KATANA Zirconia multi-layered discs and offer useful tips and tricks on how to best handle our zirconia.

With the KATANA Zirconia Family brochure, you will have all the basic information you need to make informed decisions about materials suitable for your dental lab.

Have a read, learn more and stay up to date!

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 Kokla Thalia, Postgraduate student in Restorative Dentistry program, Faculty of Dentistry, National and Kapodistrian University of Athens, Greece

Restoring Class II cavities can be challenging due to limited access to the posterior area, where the interproximal contact needs to re-established in a proper way. Inadequate contacts tend to result in increased plaque accumulation, food impaction and, as a consequence, the development of caries and irritation of the interproximal gingiva. Therefore, it is essential that the interproximal contact is restored based on the model of nature. A suitable matrix system and a proper clinical protocol can help us succeed in this context. The following clinical case is used to illustrate a possible strategy.

Fig. 1. Initial clinical situation. 23-year-old female patient with caries on the mandibular left second premolar.

Fig. 2. Situation after cavity preparation, isolation of the working field with rubber dam and the placement of a sectional matrix fixed with a ring. It is essential that the matrix imitates the natural shape of the contact area, which is usually rather flat or concave cervically and convex in the middle and occlusal parts.

Fig. 3. Etching of the tooth structure with phosphoric acid etchant. Afterwards, the adhesive needs to be applied (in this case, Universal Bond Quick was used according to the manufacturer’s instructions).

Fig. 4. CLEARFIL MAJESTY™ ES-2 Premium in the shade A3E is applied in the distal box to build up the wall first. In this way, the available space is used to model the most critical part of the restoration before simply filling the cavity in increments with the dentin shade A3D.

FINAL SITUATION

Fig. 5. Final restoration after finishing and polishing. In accordance with the concept behind CLEARFIL MAJESTY™ ES-2 Premium with its pre-defined shade combinations, the final enamel layer was build-up using the shade A3E. However, the use of a single opacity is also possible in the posterior region depending on the aesthetic demands.

CONCLUSION

By elevating deep interproximal margins, it is possible to focus on the critical designing of the contact point when there is still sufficient space available to do so. This simplifies the procedure, while all that is left to do can be managed in a straightforward way like a Class I restoration.