429 Too Many Requests

The introduction of universal composites, which are not only universal in terms of application range but also in terms of shade adaptation, effectively marks the dawn of a new type of composite. This prompts a reinterpretation of the term "universal composite."

CLEARFIL MAJESTY™ ES-2 is a nanohybrid composite family. Nowadays, nanohybrid composites are commonly used as universal composites. They have a high filler content, they are strong, and they have exceptionally good polishability characteristics¹.

The newest variant in the CLEARFIL MAJESTY™ ES-2 range is CLEARFIL MAJESTY™ ES-2 Universal shade concept. For this composite; we expand the definition of universal and include shade coverage.

Posteriorly, a single material in a single shade is sufficient to cover the entire VITA™ range. This means that no shade determination is required. For the anterior zone, we offer two shade variants: a lighter and a darker variant (UL and UD). The lighter variant is used in the A1-A2 range and the darker for shades from A3 onwards. There is sufficient overlap between UL and UD ensuring no specific shade determination is necessary.

Finally, for situations that require extra lightness and brightness, an additional UW shade is available.

What makes CLEARFIL MAJESTY™ ES-2 Universal unique in comparison to other universal or single-shade composites?
The difference with CLEARFIL MAJESTY™ ES-2 Universal, is that without using an additional opaque composite, sometimes called a blocker, a successful, superbly matching restoration can be constructed. Not only with smaller cavities, but also with larger class I and II restorations. And, when used anteriorly, even an extensive Class IV restoration can be successfully constructed using CLEARFIL MAJESTY™ ES-2 Universal. So, it is not only for those small class III or V lesions.

Why Kuraray Noritake Dental Inc. can do this where others cannot, is to a large extent, thanks to optimized light diffusion technology (LDT). By using this technology in composites with the right translucency, the light is scattered and reflected in such a way that the composite blends in with the surrounding tooth structure.

Where others use the widely-employed chameleon effect, Kuraray Noritake Dental Inc. adds an extra dimension in the form of LDT. With the chameleon effect, light passes through the material and is reflected off the walls of the cavity. The perceived shade of the restoration is therefore the shade of the cavity walls. If the cavity is too large, thus requiring a larger amount of filling material, the light has to travel further and a large proportion of the light is absorbed. With this, the brightness of the restoration is reduced and the shade of the cavity walls no longer accurately reflected.

Our LDT allows light to be scattered within the composite itself, in addition to being reflected off the cavity walls. As a result, CLEARFIL MAJESTYTM ES-2 Universal is a particularly forgiving composite. This feature will be familiar to those who have used CLEARFIL MAJESTY™ ES-2 family products before.

CLEARFIL MAJESTY™ ES-2 Universal is the result of sophisticated filler, matrix and silane technology. It offers a solution for all your routine composite work. A consistently superb restoration where shade determination is a thing of the past.

Reference

¹ Ilie, N., & Hickel, R. (2011). Resin composite restorative materials. Aust Dent J, 56 Suppl 1, 59-66. doi:10.1111/j.1834-7819.2010.01296.x

Case by Dr. Michael Morgan, DDS

Small to moderate-sized posterior restorations are the bread-and-butter of every dental practice. In a procedure that is carried out so frequently, it is particularly useful to work with a restorative material that handles well and has excellent optical properties that blend in a variety of clinical situations – like CLEARFIL MAJESTY™ ES-2 Universal. The product is available in a single universal shade for the posterior region, which enables users to increase their efficiency and eliminates the need for shade determination or laborious multi-shade layering.

When used with CLEARFIL™ SE Protect adhesive and CLEARFIL MAJESTY™ ES Flow, the innovative universal restorative allows me to confidently restore 70 to 80 percent of my simple posterior composite restorations. It handles extremely well, being slightly soft but not sticky, which allows quick shaping and anatomy formation. The procedure is fast and simple, and it leads to natural outcomes, as shown using the following case example. Anyone who has tested CLEARFIL MAJESTY™ ES-2 Universal in the clinical environment will most likely agree that the material is an easy-to-use workhorse every dentist should have in their composite toolbox.

Fig. 1 Initial clinical situation. Second premolar with a composite restoration and first molar with an amalgam restoration in need of replacement.

Fig. 2 Immediate post-operative image.

Fig. 3 Image taken one week after the treatment showing rehydrated tissues and a smooth optical integration of the direct restorations.

Dentist:

DR. MICHAEL MORGAN, DDS

Case by Dr. Jorge F. Zapata, DDS

When replacing amalgam restorations, we often see that the remaining tooth structure is severely stained. Nevertheless, a defect-oriented preparation is preferable over a procedure that involves the removal of healthy, but stained dentin as well. Long-lasting direct restorations with a natural look are obtained by using the universal adhesive CLEARFIL™ Universal Bond Quick, CLEARFIL MAJESTY™ Flow as a cavity liner, CLEARFIL MAJESTY™ ES-2 Premium Dentin to mask the stained areas and a final layer of CLEARFIL MAJESTY™ ES-2 Universal. The following case example confirms that this product combination leads to a nice optical integration.

Fig. 1 Pre-operative image: Maxillary second premolar and first molar with amalgam restorations in need of replacement.

Fig. 2 Situation after removal of the existing amalgam restorations.

Fig. 3 Immediate treatment outcome.

Dentist:

DR. JORGE F. ZAPATA, DDS

By Dr. Jusuf Lukarcanin

Direct resin composite restorations are a great option for diastema closure, shape correction and even an optical alignment of anterior teeth. The treatment approach is conservative with no or only minimal tooth preparation required, and with the right materials, it is possible to obtain beautiful outcomes, which is decisive in the aesthetically demanding anterior region. In this context, one might assume that a wide range of available shades and a meticulous shade selection process are important preconditions for a successful shade match. The following case examples show, however, that great outcomes can also be achieved in a simplified way using CLEARFIL MAJESTY™ ES-2 Universal, a game-changing resin composite with only two shade options for the anterior region.

CLINICAL CASE 1

Fig. 1 Initial situation of a young patient with maxillary and mandibular diastemata to be closed.

Fig. 2 Treatment outcome after direct diastema closure with CLEARFIL MAJESTY™ ES-2 Universal in the shade UL (Universal Light). A precise colour match and a natural gloss are obtained. Apart from the fact that the procedure is simplified be eliminating the need for shade determination and selection, the workflow is the same as with traditional composites.

Fig. 3 Close-up view of the initial and the final situation. A smooth transition from the teeth to the restorations is obtained.

CLINICAL CASE 2

Fig. 1 Female patient with multiple diastemata asking for a minimally-invasive, aesthetic treatment option.

Fig. 2 Treatment outcome after composite veneering with CLEARFIL MAJESTY™ ES-2 Universal in the shade UL (Universal Light).

Fig. 3 The patient’s smile - her teeth have a natural, lighter appearance.

CLINICAL CASE 3

Fig. 1 Young patient with malpositioned maxillary central and lateral incisors.

Fig. 2 Irregularities visible when the patient is smiling. She opted for composite veneering instead of an orthodontic approach.

Fig. 3 Treatment outcome after optical alignment and correction of teeth’s shapes using CLEARFIL MAJESTY™ ES-2 Universal in the shade UL (Universal Light).

„My first reaction to this material was: this is a Game-Changer.“

The results are magical. Smoother and easy handling properties, high-gloss, natural light distribution and the process is simple. Aside from being able to skip the shade selection step, your workflow remains the same as with traditional composites. At first, I might have been a little skeptical about replacing all the different shades of composites we use in office every day. But after a couple of tries I discovered that it indeed works every time, in most cases even without the use of a blocker. Simply ingenious!

Dr. Jusuf Lukarcanin

Dentist:

DR. JUSUF LUKARCANIN

Dr. Jusuf Lukarcanin is a Certified Dental Technician (DCT) and a Doctor of Dental Science (DDS). He studied dentistry at the Ege University Dental Faculty in Izmir, Turkey, where he obtained a Master‘s degree in 2011. In 2017, he received a Ph.D. degree from the Department of Restorative Dentistry of the same university. Between 2012 and 2019, Dr. Lukarcanin was the head doctor and general manager at a private clinic in Izmir. Between 2019 and 2020, he worked at Tinaztepe GALEN Hospital as a Restorative Dentistry specialist, between 2020-2022 he worked at MEDICANA International Hospital Izmir as a Restorative Dentistry specialist. Currently he is an owner of a private clinic for aesthetics and cosmetics in Izmir.

Case by Dr. Vincenzo Picciariello

Innovative single-shade composites are an attractive option at least for posterior restorations, as they allow clinicians to skip laborious steps and save time. Nevertheless, the aesthetic and functional demands are high. The following case example demonstrates how CLEARFIL MAJESTY™ ES-2 Universal performs in the clinical environment and reveals how well the material blends in with surrounding tooth structure.

A 33-year-old female patient came to the clinic with a request to replace amalgam restorations in the upper right quadrant (Fig. 1). The second molar had an occlusal carious lesion, while the amalgam restoration on the first molar showed marginal leakage most likely leading to secondary caries. After the placement of rubber dam (Fig. 2), the existing restorations were removed, revealing secondary caries in the first molar and the second premolar (Fig. 3). The cavities were finished using fine-grained diamond burrs and sonic instruments and subsequently sandblasted with 50-micron aluminium oxide in order to facilitate the adhesive procedures (Fig. 4). In this way, the surface energy, bonding surface area, and surface roughness are increased and the wetting ability of the adhesive is improved for a high-quality bond with the enamel and dentin.

Fig. 1. Pre-operative image.

Fig. 2. Isolation of the working field with rubber dam.

Fig. 3. Secondary caries visible after removal of the amalgam restorations.

Fig. 4. Completed cavity preparation with air-abraded bonding surfaces.

Wooden wedges, sectional matrices and relative separator rings were placed to transform the Class II MOD cavity of the first molar into a Class I cavity by means of the centripetal build-up technique (Fig. 5). On each tooth, selective etching of the enamel was performed with 35% phosphoric acid etching gel (K-ETCHANT Syringe, Kuraray Noritake Dental Inc.), which was removed by thorough rinsing and drying, before applying the two components of CLEARFIL™ SE BOND – the self-etching primer and the light-curing bonding agent. The bond was treated with a gentle stream of air to make a uniform surface and finally, the adhesive layer was light cured for 40 seconds. The procedure was completed with immediate dentin sealing using a flowable composite (CLEARFIL MAJESTY™ ES-FLOW Low in the shade A3) in controlled thicknesses.

The restoration of the cavities was completed using CLEARFIL MAJESTY™ ES-2 Universal (Kuraray Noritake Dental Inc.) in the only available posterior shade Universal. In order to characterize the fissures and enhance the appearance of the occlusal morphology, staining agent in the shade dark-brown was applied. CLEARFIL™ Twist DIA (Kuraray Noritake Dental Inc.) was the polishing system of choice. After polishing, the difference in colour between the restorations and the visibly dehydrated enamel surfaces could be observed (Fig. 6). Upon inspection after 30 days, the restorations showed adequate and satisfactory chromatic integration (Fig. 7).

Fig. 5. Wedges, sectional matrices and rings placed for build-up of the first molar’s proximal walls.

Fig. 6. Image taken immediately after polishing with dehydrated enamel and the rubber dam still in place.

FINAL SITUATION

Fig. 7. Picture of the treatment outcome taken after 30 days.

The treatment of this quadrant demonstrates how CLEARFIL MAJESTY™ ES-2 Universal composite is an integrative innovation to the Kuraray Noritake Dental Inc. line of composites that allows the clinician to simplify the modeling procedures for direct restorations in the posterior regions, obtaining excellent aesthetic and functional results.

Dentist:

DR. VINCENZO PICCIARIELLO

Graduated from the faculty of dentistry and dental prostheses of Bari in 2009; specialized in direct and indirect conservative dentistry. Completed his training in aesthetic adhesive restorative dentistry in Geneva by attending the Anterior Bio-Esthetic Restorations Master Program of Dr. Didier Dietschi. He perfected himself under the guidance of Dr. Salvatore Scolavino and Dr. Gaetano Paolone at WeRestore in Rome. Member of the Italian Academy of Conservative Dentistry. Author of national and international publications.

Speaker at national and international conferences on adhesive dentistry topics. Since 2009, he has been working as a freelancer in Bitonto, dedicating himself mainly to implant and periodontal surgery and to adhesive aesthetic restorative-prosthetic dentistry.

Fig. 1. Initial situation: caries lesions and insufficient restorations are detected on the occlusal surface of the second molar.

Fig. 2. Situation after placement of rubber dam for moisture control.

Fig. 3. Appearance of the teeth following caries removal and placement of sectional matrix.

Fig. 4. Etch-and-Rinse technique (Enamel for 30 sec. and Dentin for 15 sec.).

Fig. 5. Situation after rinsing. Etch patterns are visible in the enamel.

Fig. 6. Appearance of the teeth following application of CLEARFIL™ Universal Bond Quick.

Fig. 7. Cavity lining with a layer of flowable composite (CLEARFIL MAJESTY™ ES-Flow Low, A2).

Fig. 8. Occlusal view of the final restorations produced with CLEARFIL MAJESTY™ ES-2 Universal (U shade).

Fig. 9. Situation after rubber dam removal and occlusal adjustments.

FINAL SITUATION

Fig. 10. Follow-up after 7 days.

Case by Dr. Michał Pokojski

Universal resin composites with a simplified shade concept are popular as they streamline direct restoration procedures. Unfortunately, many of the available products that claim to blend in well with the surrounding tooth structure independent of its shade need a blocker or opaquer to mask dark areas. According to Kuraray Noritake Dental, CLEARFIL MAJESTY™ ES-2 Universal is different. This is why I decided to test its Universal shade (U) designed for all kinds of restorations in the posterior region in the context of replacing an amalgam restoration.

The restoration that needed to be replaced due to secondary caries was located in the maxillary molar region of a male patient. As usual under amalgam restorations, the remaining healthy tooth structure showed some discolouration. The cavity was prepared, the enamel etched and the whole bonding surface treated with CLEARFIL™ SE Bond. Subsequently, the restoration was built up using CLEARFIL MAJESTY™ ES-2 Universal in several layers. For a natural appearance, some brown tint was added to the fissures before finishing and polishing. The restoration shows a natural integration into the surrounding structure and is able to mask the discolouration on the cavity floor.

Fig. 1. Pre-operative image showing the amalgam restorations to be replaced.

Fig. 2. Appearance of the tooth after removal of the amalgam, caries excavation and cavity preparation.

Fig. 3. Tooth built up with CLEARFIL MAJESTY™ ES-2 Universal (U shade).

FINAL SITUATION

Fig. 4. Immediate treatment outcome.

Dentist:

DR. MICHAŁ POKOJSKI

Dr. Michał Pokojski is a graduate of the Medical University of Łódź, Poland. He maintains his private practice in Starachowice, Świętokrzyskie Voivodeship. His passion is endodontics and esthetic conservative dentistry. In his everyday duties microscope and camera are his main tools to provide his patients with professional and precise procedures and to ensure proper level of communication and understanding. His practice was guided by EBD from the very beginning, because in his opinion knowledge, scientific facts and dedication for what you do are the fundamentals of medicine and dentistry as well. His goal is to treat patients at the highest level of quality using the best available materials, instruments and procedures. His cases are well-known in the world thanks to modern ways of communication like Facebook and Instagram.

Case by Dr Adrien Lavenant

Introduction

The patient consulted for a follow-up examination and presented with recurrent caries at the maxillary right first molar. A direct treatment with composite needed to be performed. We decided to use Kuraray Noritake Dental Inc.´s CLEARFIL MAJESTY™ ES-2 Universal composite for several reasons: the efficiency of the treatment, favourable handling properties and ease of use.

The clinical case illustrations below show the step-by-step approach carried out during a 30-minute treatment session.

Fig. 1. Initial situation showing an occlusal caries lesion on the maxillary right first molar.

Fig. 2. Pre-operative X-ray.

Fig. 3. Isolation of the working field with rubber dam.

Fig. 4. Situation after caries excavation and tissue preparation.

Fig. 5. Cavity ready for the application of the universal composite: CLEARFIL™ Universal Bond Quick is visible on dentin and enamel and the cavity floor is covered by a thin layer of CLEARFIL MAJESTY™ ES Flow Low.

Fig. 6. Appearance of the tooth after buildup of the restoration with several layers of CLEARFIL MAJESTY™ ES-2 Universal composite (in the shade U developed for the posterior area).

Fig. 7. Stains applied in the occlusal fissures ensure an even more natural appearance.

Fig. 8. Final result after polishing with CLEARFIL™ Twist DIA and checking of the occlusion.

Fig. 9. Final result immediately after rubber dam removal.

Fig. 10. Post-operative X-ray.

FINAL SITUATION

Fig. 11. Check-up after 15 days with rehydrated dental tissues.

Dentist:

DR ADRIEN LAVENANT

Dr Adrien Lavenant obtained his DDS degree at the University of Aix-Marseille in 2010. He pursued his post-graduate education in the field of periodontology, restorative and aesthetic dentistry (University Aix-Marseille and Paris).

Dr Lavenant is a former member of the teaching staff of the University of Aix-Marseille since 2011 and he continues to teach in the postgraduate program in restorative and aesthetic dentistry.

Since 2010, he owns a private practice in Aix-en-Provence specialised in restorative, prosthetic and aesthetic implant dentistry. He has been part of the international Bio-emulation group since 2019 and shares his philosophy of patient care in accordance with the principles of biomimetic dentistry.

Case by Dr. Max Andrup

This patient presented with a fractured amalgam restoration in the occlusal aspect of the mandibular right first molar. The cavity was shallow resulting in a very favourable C-factor. The C-factor describes the relationship between bonded and unbonded restorative material surfaces and is used as an indicator for polymerization shrinkage stress development in a cavity. Hence, it is essential to manage this factor when working with resin composites.

Fig. 1. Initial situation with the fractured amalgam restoration. In the distal aspect of the restoration, some recurrent decay is also visible.

Fig. 2. First molar ready for a new restoration after removal of the amalgam and bevelling of the enamel.

Fig. 3. Selective etching of the enamel prior to the application of CLEARFIL™ SE Protect into the cavity. Selective etching is performed in order to maximize the bond strength to enamel (by etching) and to dentin (without etching).

FINAL SITUATION

Fig. 4. Final situation after restoration of the cavity with CLEARFIL MAJESTY™ ES-2 Universal in the shade U developed for posterior restorations. The favourable C-factor and the fact that the polymerization shrinkage stress produced by the selected material is very low provide the conditions for a good long-term behaviour of the new restoration.

Dentist:

Dr. Max Andrup graduated from the University of Umeå in 2010 and today runs his private practice in the city of Hudiksvall, Sweden. He has a passion for restorative dentistry with a biomimetic approach.

Case by Dr. Michał Pokojski

When restoring primary carious lesions in the posterior area with composite, I wish to use a material that allows me to produce high-quality outcomes in an efficient procedure. The most important qualities of the restoration are its perfect marginal integrity and reliable long-term behaviour, which set the stage for a long and healthy life of the otherwise healthy tooth.

Reliability paired with ease of use is what I expected from the selected material combination: CLEARFIL™ SE Bond 2, a popular self-etch adhesive containing the original MDP monomer, and CLEARFIL MAJESTY™ ES-2 Universal. According to Kuraray Noritake Dental, the innovative resin composite comes with a universal shade concept and mechanical properties such as shrinkage, wear resistance and colour stability similar to those of proven CLEARFIL MAJESTY™ products. As a single shade is available for the posterior region, the need for shade determination is eliminated, which allows the dental practitioner to focus on the clinical work steps. In this case, a small primary defect in a third molar was restored. The outcome speaks for itself.

Fig. 1. Situation during cavity preparation revealing the carious lesion.

Fig. 2. Prepared cavity after the application of the bonding agent.

FINAL SITUATION

Fig. 3. Treatment outcome with the composite harmoniously integrated into the surrounding structure.

Dentist:

DR. MICHAŁ POKOJSKI

Dr. Michał Pokojski is a graduate of the Medical University of Łódź, Poland. He maintains his private practice in Starachowice, Świętokrzyskie Voivodeship. His passion is endodontics and esthetic conservative dentistry. In his everyday duties microscope and camera are his main tools to provide his patients with professional and precise procedures and to ensure proper level of communication and understanding. His practice was guided by EBD from the very beginning, because in his opinion knowledge, scientific facts and dedication for what you do are the fundamentals of medicine and dentistry as well. His goal is to treat patients at the highest level of quality using the best available materials, instruments and procedures. His cases are well-known in the world thanks to modern ways of communication like Facebook and Instagram.