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.

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.

By D.T. Pier Francesco Golfarelli

Digital workflow and CAD/CAM shaping have now become a daily practice that helps to manage most cases, including the most extensive re-adaptations (rehabilitations).

KATANA™ HTML zirconia was selected, in consultation with the specialist, for the case presented here. It was principally chosen for its aesthetic and mechanical properties. One of our selection criteria was the advantageous lower abrasiveness level of zirconia. Because of its density, this material is less abrasive than the more traditional ceramics in combination with adequate mechanical polishing. Based on the initial situation, once the assembly in the articulator was completed, we designed a structure with anterior cutbacks for maximum aesthetics, while for the posterior teeth a monolithic solution was chosen for maximum strength and quality of the functional surfaces.

With the CORE & SHELL technique developed by the Noritake Italian Study Club, I can now fully exploit the optical properties of KATANA™ zirconia by integrating it, in the anterior area, with Noritake CERABIEN™ ZR ceramics. In the images here you can see the aesthetic results of the anterior and side areas, the mechanically polished monolithic surfaces and the special Noritake glaze.

Fig. 1 CAD Shaping - 3Shape Dental Designer

Fig. 2 Structure design with cutbacks

Fig. 3 KATANA™ HTML structure

Fig. 4 Occlusal surface – details

Fig. 5 Shade stain

Fig. 6 Shade Stain (SS)

Fig. 7 Core

Fig. 8 Internal Live Stain (ILS)

Fig. 9 Shell

Fig. 10 Shell Tissue

FINAL SITUATION

Fig. 11 Layering Details

Dentist:

D.T. Pier Francesco Golfarelli
Noritake Italian Study Club Teacher, Forlì

By D.T. Pier Francesco Golfarelli

Digital workflow and CAD/CAM shaping have now become a daily practice that helps to manage most cases, including the most extensive re-adaptations (rehabilitations).

KATANA™ HTML zirconia was selected, in consultation with the specialist, for the case presented here. It was principally chosen for its aesthetic and mechanical properties. One of our selection criteria was the advantageous lower abrasiveness level of zirconia. Because of its density, this material is less abrasive than the more traditional ceramics in combination with adequate mechanical polishing. Based on the initial situation, once the assembly in the articulator was completed, we designed a structure with anterior cutbacks for maximum aesthetics, while for the posterior teeth a monolithic solution was chosen for maximum strength and quality of the functional surfaces.

With the CORE & SHELL technique developed by the Noritake Italian Study Club, I can now fully exploit the optical properties of KATANA™ zirconia by integrating it, in the anterior area, with Noritake CERABIEN™ ZR ceramics. In the images here you can see the aesthetic results of the anterior and side areas, the mechanically polished monolithic surfaces and the special Noritake glaze.

Fig. 1 CAD Shaping - 3Shape Dental Designer

Fig. 2 Structure design with cutbacks

Fig. 3 KATANA™ HTML structure

Fig. 4 Occlusal surface – details

Fig. 5 Shade stain

Fig. 6 Shade Stain (SS)

Fig. 7 Core

Fig. 8 Internal Live Stain (ILS)

Fig. 9 Shell

Fig. 10 Shell Tissue

FINAL SITUATION

Fig. 11 Layering Details

Dentist:

D.T. Pier Francesco Golfarelli
Noritake Italian Study Club Teacher, Forlì

By Dr Adham Elsayed

This video illustrates the Treatment Concepts for minimal-invasive Composit-Overlay.

Dr. Elsayed uses KATANA AVENCIA, PANAVIA SA Cement Universal, CLEARFIL MAJESTY™ ES Flow, CLEARFIL Universal Bond Quick, K-ETCHANT, KATANA Cleaner and CLEARFIL Twist DIA and shows how to use different flowable composites for techniques like cervical margin relocation and cavity design optimization. Then an overlay was milled from KATANA AVENCIA and luted with PANAVIA SA Cement Universal, after cleaning with KATANA Cleaner.