Phosphoric acid is not only used for etching enamel and dentin surfaces within dental bonding procedures, but also frequently as an intra- and extra-oral cleaning agent for tooth structure and dental restorations. But is phosphoric acid always the right choice?

Direct Restorations

Many bonding procedures are performed using self-etch adhesive systems. When applied to the prepared tooth surface, the acidic monomers in the primer and/or the bond partially remove and modify the smear layer, resulting in a thin hybrid layer. A substantial amount of hydroxyapatite crystals remain on the slightly etched surface, enabling both chemical and mechanical adhesion between the adhesive and the dental tissue. If the bonding surface in the cavity is contaminated e.g. with blood or saliva, and phosphoric acid is applied for cleaning and decontamination, it etches the tooth structure, too, resulting in the removal of HAp. This will prevent the desired chemical adhesion, between the bonding system and the tooth, which may lead to compromised bond strength. Hence, cleaning with phosphoric acid may have a negative effect in this context and cannot be recommended.

Great cleaning results with no negative effect on the performance of the dental adhesive are obtained with the universal cleaning solution KATANA™ Cleaner. It contains an MDP salt of triethanolamine (MDP-TEA), as well as 'free' MDP. With a pH of 4.5, KATANA™ Cleaner is essentially neutral, meaning that, unlike phosphoric acid, it does not remove hydroxyapatite from the tooth. However, it does still effectively eliminate any saliva and/or blood contamination.

Indirect Restorations

For materials containing glass, such as lithium disilicate and feldspathic porcelain, phosphoric acid is a tried-and-tested agent for removing contamination, such as deposits produced when etching these materials with hydrofluoric acid. However, routine use of phosphoric acid to remove contamination from indirect restorations may not be wise. In fact, its use on zirconia is not recommendable, as it could inhibit the desired chemical adhesion of phosphate monomers in the bonding agent to the surface of the zirconia restoration.

When cementing prosthetics using self-adhesive resin cements like PANAVIA™ SA Cement Universal or cements that use self-etching primers (e.g. PANAVIA™ F2.0 or PANAVIA™ V5), the use of phosphoric acid on dentin is not recommended for the same reasons as in the case of direct restorations.

No pitfalls, no restrictions

Unlike 35% phosphoric acid, KATANA™ Cleaner is a product that cleans reliably without inducing negative side effects – independent of the type of tooth structure, kind of restorative material and planned bonding procedure. Hence, it is a universal cleaning solution that allows you to streamline your procedures.

Phosphoric acid is not only used for etching enamel and dentin surfaces within dental bonding procedures, but also frequently as an intra- and extra-oral cleaning agent for tooth structure and dental restorations. But is phosphoric acid always the right choice?

Direct Restorations

Many bonding procedures are performed using self-etch adhesive systems. When applied to the prepared tooth surface, the acidic monomers in the primer and/or the bond partially remove and modify the smear layer, resulting in a thin hybrid layer. A substantial amount of hydroxyapatite crystals remain on the slightly etched surface, enabling both chemical and mechanical adhesion between the adhesive and the dental tissue. If the bonding surface in the cavity is contaminated e.g. with blood or saliva, and phosphoric acid is applied for cleaning and decontamination, it etches the tooth structure, too, resulting in the removal of HAp. This will prevent the desired chemical adhesion, between the bonding system and the tooth, which may lead to compromised bond strength. Hence, cleaning with phosphoric acid may have a negative effect in this context and cannot be recommended.

Great cleaning results with no negative effect on the performance of the dental adhesive are obtained with the universal cleaning solution KATANA™ Cleaner. It contains an MDP salt of triethanolamine (MDP-TEA), as well as 'free' MDP. With a pH of 4.5, KATANA™ Cleaner is essentially neutral, meaning that, unlike phosphoric acid, it does not remove hydroxyapatite from the tooth. However, it does still effectively eliminate any saliva and/or blood contamination.

Indirect Restorations

For materials containing glass, such as lithium disilicate and feldspathic porcelain, phosphoric acid is a tried-and-tested agent for removing contamination, such as deposits produced when etching these materials with hydrofluoric acid. However, routine use of phosphoric acid to remove contamination from indirect restorations may not be wise. In fact, its use on zirconia is not recommendable, as it could inhibit the desired chemical adhesion of phosphate monomers in the bonding agent to the surface of the zirconia restoration.

When cementing prosthetics using self-adhesive resin cements like PANAVIA™ SA Cement Universal or cements that use self-etching primers (e.g. PANAVIA™ F2.0 or PANAVIA™ V5), the use of phosphoric acid on dentin is not recommended for the same reasons as in the case of direct restorations.

No pitfalls, no restrictions

Unlike 35% phosphoric acid, KATANA™ Cleaner is a product that cleans reliably without inducing negative side effects – independent of the type of tooth structure, kind of restorative material and planned bonding procedure. Hence, it is a universal cleaning solution that allows you to streamline your procedures.

CERABIEN™ ZR
High translucent and opal porcelain for True-to-life, highly aesthetic restoration.

Blue-tinged light translucency at incisor edge of enamel was reproduced with LTx and LT Royal Blue.

Initial situation.

LTx and LT Royal Blue were used at the incisor edges to reproduce the bluish opalescence and translucency effect.

Step 1: Build-up of internal structures.

In order to reproduce the mamelon structure with stain and dentin color, Internal Stains were applied, then baked.

Step 2: Applied the first Internal Stain, then baked it.

In order to reproduce the stain in the internal enamel structure, Luster porcelains were applied and baked as a base.

Step 3: Applied the first enamel structure, then baked.

In order to reproduce the white spot and the incisor halo, Internal Stains were applied before baking.

Step 4: Applied the second Internal Stain before baking it.

To reproduce the subtle color and translucency of enamel, Luster porcelains were applied before baking.

Step 5: Applied the second enamel structure before baking it.

Step 6: Final situation.

Photos: Courtesy of Otani Dental Clinic, MDT Ryuzo Shiba and MDT Naoto Yuasa.

CERABIEN™ ZR
High translucent and opal porcelain for True-to-life, highly aesthetic restoration.

Blue-tinged light translucency at incisor edge of enamel was reproduced with LTx and LT Royal Blue.

Initial situation.

LTx and LT Royal Blue were used at the incisor edges to reproduce the bluish opalescence and translucency effect.

Step 1: Build-up of internal structures.

In order to reproduce the mamelon structure with stain and dentin color, Internal Stains were applied, then baked.

Step 2: Applied the first Internal Stain, then baked it.

In order to reproduce the stain in the internal enamel structure, Luster porcelains were applied and baked as a base.

Step 3: Applied the first enamel structure, then baked.

In order to reproduce the white spot and the incisor halo, Internal Stains were applied before baking.

Step 4: Applied the second Internal Stain before baking it.

To reproduce the subtle color and translucency of enamel, Luster porcelains were applied before baking.

Step 5: Applied the second enamel structure before baking it.

Step 6: Final situation.

Photos: Courtesy of Otani Dental Clinic, MDT Ryuzo Shiba and MDT Naoto Yuasa.

New liquid ceramic FC Paste Stain for full-contour solutions with KATANA Multi-layered Zirconia - Features and 3D-technique.

ROBERTO ROSSI 

"YOU CAN’T STOP THE WAVES, BUT YOU CAN LEARN TO SURF"

Born in Savona in 1989, he studied and got his diploma at “Mazzini” Dental School, the one dental school in his hometown, and he still lives there. In 2007 he was awarded the National Award for Best Dental Technician in Turin. Since 2008 he has been working at Daniele Rondoni’s Dental Lab and he is now in charge of the aesthetic planning of dental restorations. He shares this task with Master Dental Technician Daniele Rondoni, with whom he decides which strategy and materials – composites or ceramic especially – to opt for. In 2011 he coauthored with Mr. Rondoni “Sei faccette additive in composito” (Six additional composite facets), an article published in Dental Labor, 5/2011. A teacher at NISC, Noritake Italian Study Club since 2014, he is also a teacher at the AAT Community College – a reality he feels especially attached to – and he is in charge of the photographic services and social network profiling of the lab.

New liquid ceramic FC Paste Stain for full-contour solutions with KATANA Multi-layered Zirconia - Features and 3D-technique.

ROBERTO ROSSI 

"YOU CAN’T STOP THE WAVES, BUT YOU CAN LEARN TO SURF"

Born in Savona in 1989, he studied and got his diploma at “Mazzini” Dental School, the one dental school in his hometown, and he still lives there. In 2007 he was awarded the National Award for Best Dental Technician in Turin. Since 2008 he has been working at Daniele Rondoni’s Dental Lab and he is now in charge of the aesthetic planning of dental restorations. He shares this task with Master Dental Technician Daniele Rondoni, with whom he decides which strategy and materials – composites or ceramic especially – to opt for. In 2011 he coauthored with Mr. Rondoni “Sei faccette additive in composito” (Six additional composite facets), an article published in Dental Labor, 5/2011. A teacher at NISC, Noritake Italian Study Club since 2014, he is also a teacher at the AAT Community College – a reality he feels especially attached to – and he is in charge of the photographic services and social network profiling of the lab.

When art meets technology;
Logical evolution of design and techniques: Microlayering with Kuraray Noritake new porcelains. 

DANIEL RONDONI
Born in Savona in 1961, he lives and works in his hometown where he has been the manager and director of his own laboratory since 1982.

When art meets technology;
Logical evolution of design and techniques: Microlayering with Kuraray Noritake new porcelains. 

DANIEL RONDONI
Born in Savona in 1961, he lives and works in his hometown where he has been the manager and director of his own laboratory since 1982.

With so many different adhesives, cements, and restorative materials available on the dental market, it seems difficult to decide which products are best suited to fulfil the individual requirements. A direct comparison obtained through testing of all products in the dental office is simply impossible due to the great number of available solutions. Laboratory investigations provide information about specific product properties, but usually cannot create the overall picture. Moreover, the results of different tests are barely comparable due to variations in the test conditions. Clinical study results are very useful as they shed light on the clinical (long-term) performance of selected materials, but they are usually published years after a product’s launch. Hence, they are not available in the early stages. A great source of information are practice-based evaluations, as they support potential users in identifying high-quality dental materials.

One of the institutions conducting and publishing practice-based clinical evaluations and product performance tests is the US-based DENTAL ADVISOR. Once per year, the dental materials and equipment with the best performance receive a Top Product or Preferred Product Award. The list of winners is published online (www.dentaladvisor.com) and in the January-February issue of the DENTAL ADVISOR. In 2020, numerous products from Kuraray Noritake Dental were among the award winners.

Top Product Awards

CLEARFIL™ SE Protect received a Top Product Award in the category Direct Restoratives, Bonding Agent: Self-Etch. The self-etch adhesive is based on the formulation of the gold standard two-step self-etch adhesive CLEARFIL™ SE Bond, but contains an extra MDPB monomer offering an antibacterial cavity-cleansing effect and fluoride for long-term fluoride release. The honoring of the DENTAL ADVISOR is based on a material test carried out by 13 DENTAL ADVISOR consultants and editors in their dental offices for six weeks. Due to its excellent performance, the antibacterial self-etch adhesive received a 98 percent clinical rating.

For the fifth year in a row, the Top Product Award in the category Direct Restoratives, Composite: Highly Filled Flowable went to CLEARFIL MAJESTY™ ES Flow. The universal flowable composite comes in three different levels of flowability, from high to super low*. This enables the user to choose the right viscosity for every clinical situation – with the high flowability variant being the perfect choice for cavity lining and repair procedures, and the super low flowability option being specifically suited for direct veneer procedures, build-up of posterior cusps etc. The universal flowable composite was tested by 29 consultants of the DENTAL ADVISOR in more than 900 clinical applications. The evaluated properties – placement/handling, esthetics, viscosity and polishability – were rated “excellent”. This led to a recommendation rate of 100 percent and a 98 percent overall clinical rating.

^{*DENTAL ADVISOR evaluated only the standard level of flowability (Low), because other two variants are not available in US.}

Our third product receiving a Top Product Award in 2020 is PANAVIA™ SA Cement Universal (category: Cement: Self-Adhesive). The self-adhesive universal resin cement contains the unique LCSi monomer. This monomer is a silane coupling agent, which has an unique long carbon chain in its molecule, that establishes a durable, chemical bond with porcelain, lithium disilicate and composite resin without the need for a separate primer. The other key technology present in the formulation is the original MDP monomer, which ensures chemical reactiveness with zirconia, dentin and enamel. Together, the technologies ensure that PANAVIA™ SA Cement Universal produces a strong and durable bond with virtually every restorative material without the need for a separate primer. Its handling characteristics, aesthetics and gingival friendliness received very good to excellent ratings from 31 clinical evaluators, who used the cement in 516 applications. The result of the overall clinical rating was 96 percent.

Preferred Products

Among the 2020 Preferred Products is CLEARFIL™ Universal Bond Quick. The universal bonding agent may be applied using the self-etch technique or – together with K-ETCHANT syringe – in the selective enamel etch or total-etch technique. Containing our rapid bond technology – a combination of the original MDP monomer with innovative hydrophilic amide monomers – the adhesive works instantly and without the need for extended exposure times, application of multiple layers or extensive rubbing into the tooth structure. The fast and easy application procedure was one of the main reasons for the consultants of the DENTAL ADVISOR to select CLEARFIL™ Universal Bond Quick as a Preferred Product. In 2017, it already became the DENTAL ADVISOR Editor’s Choice with a 98 percent score in a clinical evaluation.

For the second year in a row, the universal prosthetic primer CLEARFIL™ Ceramic Primer Plus and TEETHMATE™ DESENSITIZER for hypersensitivity treatment. CLEARFIL™ Ceramic Primer Plus contains the original MDP monomer and a silane monomer, which ensure excellent bond strength to all kinds of restorative materials, i.e. to silica-based ceramics, zirconia, composites and even metals. Users benefit from procedural simplicity as the product is just applied and dried to the bonding surface after the recommended pretreatment. After clinical testing, the product received a recommendation rate of 96 percent and a 96 percent overall score from the DENTAL ADVISOR consultants.

TEETHMATE™ DESENSITIZER was designed to create hydroxyapatite (HAp), which is able to occlude open dentinal tubules and enamel cracks. This leads to a significant reduction of hypersensitivities when applied to exposed, mechanically treated or freshly prepared dentin. When used in the context of restorative treatment, TEETHMATE™ DESENSITIZER does not have a negative effect on the bond strength of dental adhesives or cements. A clinical evaluation conducted by the DENTAL ADVISOR resulted in an excellent rating with a score of 96 percent.

Conclusion

Most of the Kuraray Noritake Dental products that received an award this year are based on resin technologies, one of our key competencies. In the 1980s, we developed the original MDP monomer, a functional monomer, which is an essential component of any adhesive product we introduced down to the present day, including the award-winning CLEARFIL™ SE Protect, PANAVIA™ SA Cement Universal, CLEARFIL™ Universal Bond Quick and CLEARFIL™ Ceramic Primer Plus. This is only one of our many areas of expertise. We also provide users with preventive products and a whole range of restorative materials – from composite filling materials like CLEARFIL MAJESTY^TM ES Flow to dental ceramics like KATANA™ Zirconia UTML, STML and HTML. We see the winning of the awards as a positive proof of a reliable product performance that supports dental practitioners in reaching their own goals.

With so many different adhesives, cements, and restorative materials available on the dental market, it seems difficult to decide which products are best suited to fulfil the individual requirements. A direct comparison obtained through testing of all products in the dental office is simply impossible due to the great number of available solutions. Laboratory investigations provide information about specific product properties, but usually cannot create the overall picture. Moreover, the results of different tests are barely comparable due to variations in the test conditions. Clinical study results are very useful as they shed light on the clinical (long-term) performance of selected materials, but they are usually published years after a product’s launch. Hence, they are not available in the early stages. A great source of information are practice-based evaluations, as they support potential users in identifying high-quality dental materials.

One of the institutions conducting and publishing practice-based clinical evaluations and product performance tests is the US-based DENTAL ADVISOR. Once per year, the dental materials and equipment with the best performance receive a Top Product or Preferred Product Award. The list of winners is published online (www.dentaladvisor.com) and in the January-February issue of the DENTAL ADVISOR. In 2020, numerous products from Kuraray Noritake Dental were among the award winners.

Top Product Awards

CLEARFIL™ SE Protect received a Top Product Award in the category Direct Restoratives, Bonding Agent: Self-Etch. The self-etch adhesive is based on the formulation of the gold standard two-step self-etch adhesive CLEARFIL™ SE Bond, but contains an extra MDPB monomer offering an antibacterial cavity-cleansing effect and fluoride for long-term fluoride release. The honoring of the DENTAL ADVISOR is based on a material test carried out by 13 DENTAL ADVISOR consultants and editors in their dental offices for six weeks. Due to its excellent performance, the antibacterial self-etch adhesive received a 98 percent clinical rating.

For the fifth year in a row, the Top Product Award in the category Direct Restoratives, Composite: Highly Filled Flowable went to CLEARFIL MAJESTY™ ES Flow. The universal flowable composite comes in three different levels of flowability, from high to super low*. This enables the user to choose the right viscosity for every clinical situation – with the high flowability variant being the perfect choice for cavity lining and repair procedures, and the super low flowability option being specifically suited for direct veneer procedures, build-up of posterior cusps etc. The universal flowable composite was tested by 29 consultants of the DENTAL ADVISOR in more than 900 clinical applications. The evaluated properties – placement/handling, esthetics, viscosity and polishability – were rated “excellent”. This led to a recommendation rate of 100 percent and a 98 percent overall clinical rating.

^{*DENTAL ADVISOR evaluated only the standard level of flowability (Low), because other two variants are not available in US.}

Our third product receiving a Top Product Award in 2020 is PANAVIA™ SA Cement Universal (category: Cement: Self-Adhesive). The self-adhesive universal resin cement contains the unique LCSi monomer. This monomer is a silane coupling agent, which has an unique long carbon chain in its molecule, that establishes a durable, chemical bond with porcelain, lithium disilicate and composite resin without the need for a separate primer. The other key technology present in the formulation is the original MDP monomer, which ensures chemical reactiveness with zirconia, dentin and enamel. Together, the technologies ensure that PANAVIA™ SA Cement Universal produces a strong and durable bond with virtually every restorative material without the need for a separate primer. Its handling characteristics, aesthetics and gingival friendliness received very good to excellent ratings from 31 clinical evaluators, who used the cement in 516 applications. The result of the overall clinical rating was 96 percent.

Preferred Products

Among the 2020 Preferred Products is CLEARFIL™ Universal Bond Quick. The universal bonding agent may be applied using the self-etch technique or – together with K-ETCHANT syringe – in the selective enamel etch or total-etch technique. Containing our rapid bond technology – a combination of the original MDP monomer with innovative hydrophilic amide monomers – the adhesive works instantly and without the need for extended exposure times, application of multiple layers or extensive rubbing into the tooth structure. The fast and easy application procedure was one of the main reasons for the consultants of the DENTAL ADVISOR to select CLEARFIL™ Universal Bond Quick as a Preferred Product. In 2017, it already became the DENTAL ADVISOR Editor’s Choice with a 98 percent score in a clinical evaluation.

For the second year in a row, the universal prosthetic primer CLEARFIL™ Ceramic Primer Plus and TEETHMATE™ DESENSITIZER for hypersensitivity treatment. CLEARFIL™ Ceramic Primer Plus contains the original MDP monomer and a silane monomer, which ensure excellent bond strength to all kinds of restorative materials, i.e. to silica-based ceramics, zirconia, composites and even metals. Users benefit from procedural simplicity as the product is just applied and dried to the bonding surface after the recommended pretreatment. After clinical testing, the product received a recommendation rate of 96 percent and a 96 percent overall score from the DENTAL ADVISOR consultants.

TEETHMATE™ DESENSITIZER was designed to create hydroxyapatite (HAp), which is able to occlude open dentinal tubules and enamel cracks. This leads to a significant reduction of hypersensitivities when applied to exposed, mechanically treated or freshly prepared dentin. When used in the context of restorative treatment, TEETHMATE™ DESENSITIZER does not have a negative effect on the bond strength of dental adhesives or cements. A clinical evaluation conducted by the DENTAL ADVISOR resulted in an excellent rating with a score of 96 percent.

Conclusion

Most of the Kuraray Noritake Dental products that received an award this year are based on resin technologies, one of our key competencies. In the 1980s, we developed the original MDP monomer, a functional monomer, which is an essential component of any adhesive product we introduced down to the present day, including the award-winning CLEARFIL™ SE Protect, PANAVIA™ SA Cement Universal, CLEARFIL™ Universal Bond Quick and CLEARFIL™ Ceramic Primer Plus. This is only one of our many areas of expertise. We also provide users with preventive products and a whole range of restorative materials – from composite filling materials like CLEARFIL MAJESTY^TM ES Flow to dental ceramics like KATANA™ Zirconia UTML, STML and HTML. We see the winning of the awards as a positive proof of a reliable product performance that supports dental practitioners in reaching their own goals.