No Author Selected

By Julian Leprince, UCLouvain

PROXIMAL RESTORATION
POSTERIOR // 26 DEEP DISTAL

• Patient stated they experienced occasional sensitivity to heat/cold.
• Preoperative bite-wing X-ray. Carious lesions in 26 M and D.
• Decided to monitor 26 M (caries limited to the outer dentin zone > just 35% of these lesions were cavitated; per Hintze et al., Caries Res 1998).
• Decided to treat 26 D; treatment classified as difficult due to the limited juxtaosseous space.

• Clinical preoperative situation.
• Rubber dam positioned (clamp on 27, ligatures at elements 25-26-27), limited connection at the height of 27 palatally. Deemed acceptable due to the absence of blood and saliva.
• A gray discoloration can be observed at the height of the mesial marginal ridge (limited) and distally (extensive). An old composite restoration is visible in the distal fossa.

• Positioning a protective system – a combination of a plastic wedge and a straight small metal plate – to prevent damage to the neighboring element during the mounting process.

• Drilling through the enamel to access the softened dentin, which can be excavated with a hand tool.

• First phase of removing the proximal enamel.

• Removing the unsupported proximal enamel.
• Excavating the softened dentin. The difference in texture in the dentin is visible.
• Note the damage to the protective system, which appears to justify its use.

• Cleaned cavity after removing the protection system.
• The current recommendations from the ORCA (European Organisation for Caries research) state that where caries is deep, partial excavation is required but restricted to the softened dentin. With regard to the pulp, work must be carried out to ensure that it is not exposed (Carvalho et al., Caries Res 2016). The successes achieved with this approach outweigh those achieved with complete excavation. In contrast, the cavity edges (enamel and dentin; as per JAD) are treated so that only hard and healthy tissue is present, which is more favorable for marginal contact.

• Positioning a matrix band with box.
• A wooden wedge is used to position the matrix band against the element on the palatal side, while Teflon is used on the vestibular side.

• Contact between the matrix band and the bottom of the proximal cavity.
• The matrix band runs precisely until beyond the edge of the cavity.
• The cavity is deep enough so that the concavity between the root is visible distovestibularly and palatally.
• The connection of the matrix band is incomplete due to the concavity, but the seal that is achieved by the matrix and improved by using Teflon is thereby deemed to be adequate, including as no contamination is observed. The bonding procedure is then begun.

• Selective etching of the enamel with 37% phosphoric acid (K-Etchant Syringe) for 20 seconds, followed by thorough flushing with the multifunction spray.

• After drying, the etched enamel has a chalky appearance.
• In this case study, the preferred choice was the type of selfetching adhesive system used here (CLEARFIL™ SE BOND). This is because the technology used appears to have a favorable outcome when used on eroded dentin, thanks to the ability of MDP to bond chemically to calcium in the partially demineralized dentin (Perdigao, Dent Mater 2010).
• This procedure was chosen to create an optimum bond.

• It is clearly visible at the height of the cavity edge that the excavation extends to the hard dentin. In the axial section, excavation is limited to as far as the soft dentin to reduce the risk of exposing pulp.

• Applying the self-etching primer to the dentin for 20 seconds, followed by drying.
• Applying the bonding (B), followed by light curing for 10 seconds.
• Applying a small amount of flowable composite (F) (e.g. CLEARFIL MAJESTY™ ES Flow), restricted to the interradicular concavity.
• Note the change in the appearance of the dentin, from matt to glossy.

• Positioning a horizontal layer of composite (max. 2 mm) to raise the proximal margin.
• Light curing of each layer with an output of 1,000 mW/cm2 for 20 seconds (Leprince et al., Oper Dent 2010).

• Positioning a sectional matrix, in conjunction with a separating ring and a wooden wedge, to achieve an accurate anatomy of the proximal restoration.
• The composite is positioned by adding successive 2-mm layers (the number of bonded surfaces must be minimized).

• After removing the matrix band, defects can be observed in the shape (slight oversize); this should be corrected carefully with a curved scalpel and/or the drill.
• A paro curette is used, in conjunction with floss wire and a fine abrasive strip, to remove any excess adhesive, for example.

FINAL SITUATION

• Correcting the anatomy is followed by adjustment of the occlusion and polishing.
• The composite chosen for the restoration (CLEARFIL MAJESTY™ Posterior) has a high filler loading (weight percentage of inorganic filler >80%), which produces an elasticity modulus of >16 GPa; this is comparable to the elasticity modulus values reported for dentin (Randolph et al., Dent Mater 2016).

Dentist:

JULIAN LEPRINCE
UCLouvain

Julian Leprince studied dentistry at UCLouvain, and is now head of the division of Conservative Dentistry & Endodontics at Cliniques universitaires Saint-Luc (Brussels, Belgium), associate professor at UCLouvain and head of the DRIM research group (www.drim-ucl.be).

By Julian Leprince, UCLouvain

PROXIMAL RESTORATION
POSTERIOR // 26 DEEP DISTAL

• Patient stated they experienced occasional sensitivity to heat/cold.
• Preoperative bite-wing X-ray. Carious lesions in 26 M and D.
• Decided to monitor 26 M (caries limited to the outer dentin zone > just 35% of these lesions were cavitated; per Hintze et al., Caries Res 1998).
• Decided to treat 26 D; treatment classified as difficult due to the limited juxtaosseous space.

• Clinical preoperative situation.
• Rubber dam positioned (clamp on 27, ligatures at elements 25-26-27), limited connection at the height of 27 palatally. Deemed acceptable due to the absence of blood and saliva.
• A gray discoloration can be observed at the height of the mesial marginal ridge (limited) and distally (extensive). An old composite restoration is visible in the distal fossa.

• Positioning a protective system – a combination of a plastic wedge and a straight small metal plate – to prevent damage to the neighboring element during the mounting process.

• Drilling through the enamel to access the softened dentin, which can be excavated with a hand tool.

• First phase of removing the proximal enamel.

• Removing the unsupported proximal enamel.
• Excavating the softened dentin. The difference in texture in the dentin is visible.
• Note the damage to the protective system, which appears to justify its use.

• Cleaned cavity after removing the protection system.
• The current recommendations from the ORCA (European Organisation for Caries research) state that where caries is deep, partial excavation is required but restricted to the softened dentin. With regard to the pulp, work must be carried out to ensure that it is not exposed (Carvalho et al., Caries Res 2016). The successes achieved with this approach outweigh those achieved with complete excavation. In contrast, the cavity edges (enamel and dentin; as per JAD) are treated so that only hard and healthy tissue is present, which is more favorable for marginal contact.

• Positioning a matrix band with box.
• A wooden wedge is used to position the matrix band against the element on the palatal side, while Teflon is used on the vestibular side.

• Contact between the matrix band and the bottom of the proximal cavity.
• The matrix band runs precisely until beyond the edge of the cavity.
• The cavity is deep enough so that the concavity between the root is visible distovestibularly and palatally.
• The connection of the matrix band is incomplete due to the concavity, but the seal that is achieved by the matrix and improved by using Teflon is thereby deemed to be adequate, including as no contamination is observed. The bonding procedure is then begun.

• Selective etching of the enamel with 37% phosphoric acid (K-Etchant Syringe) for 20 seconds, followed by thorough flushing with the multifunction spray.

• After drying, the etched enamel has a chalky appearance.
• In this case study, the preferred choice was the type of selfetching adhesive system used here (CLEARFIL™ SE BOND). This is because the technology used appears to have a favorable outcome when used on eroded dentin, thanks to the ability of MDP to bond chemically to calcium in the partially demineralized dentin (Perdigao, Dent Mater 2010).
• This procedure was chosen to create an optimum bond.

• It is clearly visible at the height of the cavity edge that the excavation extends to the hard dentin. In the axial section, excavation is limited to as far as the soft dentin to reduce the risk of exposing pulp.

• Applying the self-etching primer to the dentin for 20 seconds, followed by drying.
• Applying the bonding (B), followed by light curing for 10 seconds.
• Applying a small amount of flowable composite (F) (e.g. CLEARFIL MAJESTY™ ES Flow), restricted to the interradicular concavity.
• Note the change in the appearance of the dentin, from matt to glossy.

• Positioning a horizontal layer of composite (max. 2 mm) to raise the proximal margin.
• Light curing of each layer with an output of 1,000 mW/cm2 for 20 seconds (Leprince et al., Oper Dent 2010).

• Positioning a sectional matrix, in conjunction with a separating ring and a wooden wedge, to achieve an accurate anatomy of the proximal restoration.
• The composite is positioned by adding successive 2-mm layers (the number of bonded surfaces must be minimized).

• After removing the matrix band, defects can be observed in the shape (slight oversize); this should be corrected carefully with a curved scalpel and/or the drill.
• A paro curette is used, in conjunction with floss wire and a fine abrasive strip, to remove any excess adhesive, for example.

FINAL SITUATION

• Correcting the anatomy is followed by adjustment of the occlusion and polishing.
• The composite chosen for the restoration (CLEARFIL MAJESTY™ Posterior) has a high filler loading (weight percentage of inorganic filler >80%), which produces an elasticity modulus of >16 GPa; this is comparable to the elasticity modulus values reported for dentin (Randolph et al., Dent Mater 2016).

Dentist:

JULIAN LEPRINCE
UCLouvain

Julian Leprince studied dentistry at UCLouvain, and is now head of the division of Conservative Dentistry & Endodontics at Cliniques universitaires Saint-Luc (Brussels, Belgium), associate professor at UCLouvain and head of the DRIM research group (www.drim-ucl.be).

During the strange and difficult times caused by the COVID-19 pandemic, the top priority for dentists across the world has been to keep themselves and their patients safe. To do so, not only have many dental practices been shut down, but also in-person dental congresses, symposia and other events have been postponed indefinitely.

As a result of these shutdowns, countless dentists have found it difficult to keep up to date with all of the latest scientific and product developments in the dental world. Our webinars highlight how Kuraray Noritake Dental’s emphasis on education allows you to stay informed and evolve professionally - all from the comfort of your own home.

A range of on-demand webinars

When the pandemic began, Kuraray Noritake Dental quickly set about establishing a state-of-the-art, self-hosted webinar platform. The master dental technician Daniele Rondoni hosted the debut webinar, in which he eloquently discussed the art of micro-layering with Kuraray’s new porcelains.

Since then, a number of adventurous and intelligent dental professionals have shared their knowledge and insight through further webinars. Dr Josef Kunkela, a key opinion leader in digital dentistry and the founder of the KUNKELA Campus, informed participants about the crucial factors that influence the gap between the margin of the prepared tooth and the restoration. Meanwhile, zirconia, oral scanners and feather edge preparation - the winning triad of today’s prosthetic therapy - were the focal points of Dr Davide Cortellini’s engaging presentation.

These free webinars, along with others presented by such figures as Dr Michael Braian and Dr Piero Simeone, are all available for on-demand viewing through Kuraray Noritake Dental’s webinar library.

“At Kuraray Noritake, we’re focused on creating more universal and streamlined dental workflows,” says Maurice Bonn, marketing manager for Europe. “This naturally extends to our series of educational webinars, which have featured such industry-leading products as PANAVIA™ V5 and the KATANA™ Zirconia series.”

“Dental professionals can look forward to more webinars hosted by some of the industry’s best and brightest in the coming months,” adds Bonn.

Clinical cases to broaden your knowledge

Kuraray Noritake Dental’s investment in research and development is just part of the reason for the company’s continued success. Now, clinical cases involving KATANA™ Zirconia HTML and CLEARFIL MAJESTY™ ES-2 and even a full-mouth rehabilitation using three different types of KATANA™ Zirconia are all available for easy access through the company’s website.

A newsroom packed with new information

Webinars, clinical cases, interviews, product news and more - there is only one place where all of these can be found in abundance, and that is the Kuraray Noritake Dental newsroom.

During the strange and difficult times caused by the COVID-19 pandemic, the top priority for dentists across the world has been to keep themselves and their patients safe. To do so, not only have many dental practices been shut down, but also in-person dental congresses, symposia and other events have been postponed indefinitely.

As a result of these shutdowns, countless dentists have found it difficult to keep up to date with all of the latest scientific and product developments in the dental world. Our webinars highlight how Kuraray Noritake Dental’s emphasis on education allows you to stay informed and evolve professionally - all from the comfort of your own home.

A range of on-demand webinars

When the pandemic began, Kuraray Noritake Dental quickly set about establishing a state-of-the-art, self-hosted webinar platform. The master dental technician Daniele Rondoni hosted the debut webinar, in which he eloquently discussed the art of micro-layering with Kuraray’s new porcelains.

Since then, a number of adventurous and intelligent dental professionals have shared their knowledge and insight through further webinars. Dr Josef Kunkela, a key opinion leader in digital dentistry and the founder of the KUNKELA Campus, informed participants about the crucial factors that influence the gap between the margin of the prepared tooth and the restoration. Meanwhile, zirconia, oral scanners and feather edge preparation - the winning triad of today’s prosthetic therapy - were the focal points of Dr Davide Cortellini’s engaging presentation.

These free webinars, along with others presented by such figures as Dr Michael Braian and Dr Piero Simeone, are all available for on-demand viewing through Kuraray Noritake Dental’s webinar library.

“At Kuraray Noritake, we’re focused on creating more universal and streamlined dental workflows,” says Maurice Bonn, marketing manager for Europe. “This naturally extends to our series of educational webinars, which have featured such industry-leading products as PANAVIA™ V5 and the KATANA™ Zirconia series.”

“Dental professionals can look forward to more webinars hosted by some of the industry’s best and brightest in the coming months,” adds Bonn.

Clinical cases to broaden your knowledge

Kuraray Noritake Dental’s investment in research and development is just part of the reason for the company’s continued success. Now, clinical cases involving KATANA™ Zirconia HTML and CLEARFIL MAJESTY™ ES-2 and even a full-mouth rehabilitation using three different types of KATANA™ Zirconia are all available for easy access through the company’s website.

A newsroom packed with new information

Webinars, clinical cases, interviews, product news and more - there is only one place where all of these can be found in abundance, and that is the Kuraray Noritake Dental newsroom.

ABSTRACT

During the last two decades we have been experiencing an exceptional evolution in adhesive restorative dentistry. Indeed, innovative materials and techniques have been proposed to achieve long-lasting restorations, which could also guarantee an user-friendly use and reliable clinical results. This is particularly true if one considers the rapid evolution of adhesive systems, composites and resin cements. The correct use of such materials, along with the basic principles to obtain a reliable and long-lasting adhesion to dental substrates (e.g. enamel and dentine) can be considered still not totally clear for many clinicians and other dental practitioners.

Thus, this lecture will aim at presenting the state of the art on adhesion to enamel and dentine through an accurate analysis of our most recent scientific observations and laboratory data. Furthermore, laboratory data obtained during our recent in vitro studies to evaluate the adhesive performance and longevity of a new generation self-adhesive cement (Panavia SA Universal) to a polycrystalline ceramic substrate (Zirconia, HT Katana) and to a vitreous ceramic (lithium disilicate) will be also presented and discussed .

PROFESSOR DR SAURO SALVATORE
(Orcid number: 0000-0002-2527-8776)

Dr Sauro is currently professor in dental biomaterials and minimally invasive dentistry at the “Departamento de Odontología, Facultad de Ciencias de la Salud, Universidad CEU-Cardenal Herrera”, coordinator of the "Dental Research" and Director (Principal Investigator) of the research group "In Situ Dental Tissues Engineering and Minimally Invasive Therapeutic Adhesive Rehabilitation" at the University CEU Cardinal Herrera of Valencia.

He is also honorary senior lecturer, at the Faculty of Dentistry, King's College London Dental Institute (KCLDI), Visiting Professor at the Sechenov University of Moscow, School of Dentistry, Moscow, Russia and honorary Professor at the dental school - University of Hong Kong

He obtained his Ph.D in "Dental Biomaterials Research Pre-clinical Dentistry", and post-doctorate in "Dental Biomaterials/Pre-clinical Dentistry" at King's College London Dental Institute, London.

Dr. Sauro has been working in dental biomaterials, preventive and minimally invasive dentistry research for 15 years (JCR - H-Index: 32) and he has published, in collaboration with internationally renowned researchers, more than 100 articles in international peer-review journals with high impact in the dental and biomaterials field, along with more than 300 abstracts of research in international conferences, as well as two international and one national patents.

Professor Sauro is also part of the "editorial board" several peer-review and vice president of the Dental Material Group “DMG” of the "IADR - International Association of Dental Research".

ZIRCONIA: TEN YEARS AFTER ITS USE

Considered one of the most recent materials in the field of dentistry and despite being a relatively young material, zirconia has taken on an ever-widening space in the last decade and seems destined to play a fundamental role in the future. The success can be traced back to several factors that allowed this material to be considered a viable alternative to dental alloys, through a rapid and evolutionary path and an innovative use of the technologies associated with it. The report will highlight, through the exposure of significant and chronologically exposed clinical cases, the evolutionary process of zirconia and the technologies applied to it ten years after its use.

ABOUT MARCO STOPPACCIOLI

• Specialized in implant prosthesis and digital technologies
• Opinion leader for dental factories
• Currently carries out his professional activity with his team in Dental Team Work

OCCUPATION

• Dental Team Work laboratory owner since 1987
• Dental technician, specialist in implantology

EXPERIENCE

• Collaboration with the Department of Dentistry, University of L’Aquila, for 15 years
• Conference Speaker at national and international conferences
• Regional President of National Association of Dental Technician Owners (ANTLO)
• Teacher of ANTLO Education
• Trainer in theoretical-practical course regarding implantology and new technologies

EDUCATION AND TRAINING COURSES

• Diploma as dental technician in 1984
• Attendance of numerous advanced courses in Implant technologies in Italy and abroad

Adhesive luting of all-ceramic restorations

The adhesive cementation of dental restorations is becoming increasingly important and is changing the treatment methods in restorative dentistry. This webinar shows which methods can be used to durably lute all-ceramic restorations - both silicate ceramics and zirconia ceramics. 

The clinically proven procedure is clearly illustrated using clinical examples such as ceramic Tabletops (onlays without retentive preparation) and single-wing resin bonded fixed dental prothesis in the anterior and posterior region.

Prof. Dr. Matthias Kern 

since 1997: Chairman Department of Prosthodontics at Kiel University 
2012 - 2016: President of the German society for Prosthetic dentistry (DGPro)
2017 - 2018: Vice-President of the IADR Prosthodontic Research Group
2018 - 2019: President of the IADR Prosthodontic Research Group
2020: Awarded the 2020 IADR Distinguished Scientist Award for Research in Prosthodontics and Implants

By Aleksandra Łyżwińska, DMD

This patient required the replacement of an insufficient composite restoration of the mandibular right second premolar. It was planned to restore the tooth using a combination of CLEARFIL MAJESTY™ ES Flow – Super Low A3 and CLEARFIL MAJESTY™ ES-2 Classic A3 with some tints. CLEARFIL™ SE BOND 2 was the adhesive of choice. It produces a reliable chemical adhesion to dentin and enamel as it contains 10-MDP. The best results are obtained after selective enamel etching.

Fig. 1 Initial clinical situation.

Fig. 2 Removal of the existing restoration reveals carious tissue underneath.

Fig. 3 Appearance of the cavity after caries excavation and preparation.

Fig. 4 Dried tooth structure after selective enamel etching with a sectional matrix in place.

Fig. 5 Build-up of the interproximal wall with CLEARFIL MAJESTY™ ES-2 Classic (shade A3) after the use of CLEARFIL™ SE BOND 2.

Fig. 6 Successful transformation of a Class II cavity to Class I.

Fig. 7 Cavity filled with CLEARFIL MAJESTY™ ES Flow (Super Low A3).

Fig. 8 Appearance of the tooth after the application of a final layer of CLEARFIL MAJESTY™ ES-2 Classic (shade A3) and some tints.

Fig. 9 Polished restoration on the mandibular right second premolar.

FINAL SITUATION

Fig. 10 Treatment result ...

Fig. 11 ... after rubber dam removal.

Dentist:

ALEKSANDRA ŁYŻWIŃSKA
Warsaw, Poland

Aleksandra Łyżwińska, DMD, is a passionate aesthetic and adhesive dentist. Driven by Evidence Based Dentistry, her goal includes using modern composite materials and bonding agents in her clinical practise. In addition to her primary job, she worked as a lecturer and an assistant professor at the Department of Conservative Dentistry and Endodontics of Medical University of Warsaw, her alma mater.

By Aleksandra Łyżwińska, DMD

This patient required the replacement of an insufficient composite restoration of the mandibular right second premolar. It was planned to restore the tooth using a combination of CLEARFIL MAJESTY™ ES Flow – Super Low A3 and CLEARFIL MAJESTY™ ES-2 Classic A3 with some tints. CLEARFIL™ SE BOND 2 was the adhesive of choice. It produces a reliable chemical adhesion to dentin and enamel as it contains 10-MDP. The best results are obtained after selective enamel etching.

Fig. 1 Initial clinical situation.

Fig. 2 Removal of the existing restoration reveals carious tissue underneath.

Fig. 3 Appearance of the cavity after caries excavation and preparation.

Fig. 4 Dried tooth structure after selective enamel etching with a sectional matrix in place.

Fig. 5 Build-up of the interproximal wall with CLEARFIL MAJESTY™ ES-2 Classic (shade A3) after the use of CLEARFIL™ SE BOND 2.

Fig. 6 Successful transformation of a Class II cavity to Class I.

Fig. 7 Cavity filled with CLEARFIL MAJESTY™ ES Flow (Super Low A3).

Fig. 8 Appearance of the tooth after the application of a final layer of CLEARFIL MAJESTY™ ES-2 Classic (shade A3) and some tints.

Fig. 9 Polished restoration on the mandibular right second premolar.

FINAL SITUATION

Fig. 10 Treatment result ...

Fig. 11 ... after rubber dam removal.

Dentist:

ALEKSANDRA ŁYŻWIŃSKA
Warsaw, Poland

Aleksandra Łyżwińska, DMD, is a passionate aesthetic and adhesive dentist. Driven by Evidence Based Dentistry, her goal includes using modern composite materials and bonding agents in her clinical practise. In addition to her primary job, she worked as a lecturer and an assistant professor at the Department of Conservative Dentistry and Endodontics of Medical University of Warsaw, her alma mater.

By Aleksandra Łyżwińska, DMD

INITIAL SITUATION

Fig. 1 MOD filling with marginal leakage, secondary caries, and significant mechanical weakening.

Fig. 2 Cavity preparation extending over the buccal and palatal cusps.

Fig. 3 Direct restoration created with CLEARFIL MAJESTY™ ES-2 Classic, shade A2, and stains.

Fig. 4 Appearance of the restoration after polishing with CLEARFIL™ TWIST DIA.

FINAL SITUATION

Fig. 5 Repolishing during check-up one week later. The restoration shows an excellent color integration and natural gloss.

Dentist:

ALEKSANDRA ŁYŻWIŃSKA
Warsaw, Poland

Aleksandra Łyżwińska, DMD, is a passionate aesthetic and adhesive dentist. Driven by Evidence Based Dentistry, her goal includes using modern composite materials and bonding agents in her clinical practise. In addition to her primary job, she worked as a lecturer and an assistant professor at the Department of Conservative Dentistry and Endodontics of Medical University of Warsaw, her alma mater.