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Katana STML: Posterior Workhorse

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Hey All,

It's been a while since I've posted anything.  Long summer and trying to get back at it.  I think for all of us on here, we are thankful for technology and the constant evolution of materials and digital dentistry.  

This case I'm sharing is something that all of us see each day.  How I approach this today is different than I would have approached this pre SpeedFire and pre-Katana.  I simply love the fit of Zirconia and the anatomy right out of the mill.  I can be much more conservative with my margin preprations and edge stability of Zirconia during milling is wonderful.  The other reason I do a lot of chairside zirconia and Katana is that I love the ability to cement on those deep margins or those patients where it is really difficult to isolate and bond well.  (I will say that Kuraray-Noritake does not advocate cementing Katana STML with RMGI)  To make myself feel better on these cases where I am not bonding Katana, I am making sure my fissure height on my design is 1.20mm or greater.

So here is a case that I just did.  Tooth #30 had gold onlay that came off.  

I tend to choose a shade that is one shade darker than I am shooting for.  In this case, I wanted to match the shade of the occlusal 1/2 of tooth #29.  I felt like that was A1 so I choose A2 Katana STML.

Deep recurrent decay that I removed and built back up to ideal. 

It does take extra time but I do think there is significant improvement in esthetics with a Katana crown that has been glazed versus polish only.  In this case, I pre-polish my crowns before I sinter them.  Post sinter, I lightly air abrade the crown to take away the surface tension so the glaze will adhere uniformly.  In this case, I choose to use Empress Stain and Glaze and fire on P4.  

I schedule all of my crowns for 2 hours so this isn't really a huge deal for me to spend the extra time for a glaze fire.  I tell the patients it will be about a 45 minute wait.  During this time I am doing another procedure.   I haven't received a complaint from a patient.  But our team does prep all patients before they schedule to expect to be at the office for 2 hours.  

Overall I'm quite happy with the final results and esthetics.  I know there are some that don't have a SpeedFire and doing Katana is not possible, but for those of you that do, I think Katana is a wonderful material and I am using it more and more.


Nice case Dan. Just about every molar this year has been Katana for me as well. 


I've been flip flopping between what you do here and going back to emax.  


Nice work brother. #pwt


This looks great, I am considering switching to Katana too for molars vs emax, but are you bonding Katana or cementing it. Some of my last years lab zirconium crowns have come off, they were bonded in all cement on tooth, I wasn’t air abrading then, I do now. Sometimes processing of emax is a bit much


One of the dentists at our office saw somewhere that with 4.6 you can tweak a couple settings that allow katana to be milled faster and fired faster. Is everyone doing this? Any downsides? We also love katana, and any way to make the mill and fire times faster is huge. Also FWIW I think than manufacturer wants you to use panavia bc they make both products... we use RMGI to cement for most cases.


On 9/7/2019 at 7:21 am, David Sullivan said... One of the dentists at our office saw somewhere that with 4.6 you can tweak a couple settings that allow katana to be milled faster and fired faster. Is everyone doing this? Any downsides? We also love katana, and any way to make the mill and fire times faster is huge. Also FWIW I think than manufacturer wants you to use panavia bc they make both products... we use RMGI to cement for most cases.

With the last material parch for 4.6 there is a shorter cycle. 

Limitations:

The restoration may not have any areas that are greater than 3mm. If below this threshold 18 minutes sinter. If above around 22. A newer patch will be out that improves on the thickness requirement will be out this fall


Thanks peter. How about the fast milling? Apparently changing a couple setting even causes it to mill quicker. Anyone see increases in chipping or crowns that don’t fit as well? We don’t want to change settings unless quality is maintained.


Thanks Rohini. This case I cemented with 3M Rely X RMGI. I know all of the protocols from Kuraray Noritake and they are recommending full bonding protocol with either Panavia V5....or using their Panavia SA Cement Plus. This is a self etch, dual cure cement with fluoride release. They have three different shades (Universal-A2, Translucent and White). Air abrade, disinfect the prep and go. When I’ve used Panavia SA Cement Plus, I personally pair it with Kuraray’s Quick Bond. The literature has been quite good on this product.

If I’m going to use any of Kuraray’s products for Katana, I would use the Panavia SA Cement Plus. I personally don’t want to go through the hassle of full bond protocol with Panavia V5 or Ivoclar’s Variolink Esthetic DC (my go to bonded Cement). I prep Zirconia with retention and resistance form so I’m not so worried about adherence of the crown but more about fractural toughness (hence me bumping up my fissure height when I don’t plan to bond).

Just my humble opinion


David, I am fast milling. No problems with chipping on my end. The 18 min sintering program is there with the software upgrade. As it has been stated in other threads about Katana, if you have 3mm of thickness anywhere on your restoration, the speed fire will default back to a 30 minute sinter. It is a little annoying but at that point my patients are fine with the extra 15 min. My team sees this and tells the patient that there will be just a little extra processing time.


Ok thanks Daniel!


Great post, I couldn't agree with you more. Katana is such a workhorse and great restoration.


On 9/7/2019 at 7:40 am, Daniel Wilson said... Thanks Rohini. This case I cemented with 3M Rely X RMGI. I know all of the protocols from Kuraray Noritake and they are recommending full bonding protocol with either Panavia V5....or using their Panavia SA Cement Plus. This is a self etch, dual cure cement with fluoride release. They have three different shades (Universal-A2, Translucent and White). Air abrade, disinfect the prep and go. When I’ve used Panavia SA Cement Plus, I personally pair it with Kuraray’s Quick Bond. The literature has been quite good on this product. If I’m going to use any of Kuraray’s products for Katana, I would use the Panavia SA Cement Plus. I personally don’t want to go through the hassle of full bond protocol with Panavia V5 or Ivoclar’s Variolink Esthetic DC (my go to bonded Cement). I prep Zirconia with retention and resistance form so I’m not so worried about adherence of the crown but more about fractural toughness (hence me bumping up my fissure height when I don’t plan to bond). Just my humble opinion

Thank you Dr Wilson, is it okay to use quik bond with Panavia V5, After air abrading I use the quik bond on intaglio of the crown and total etch plus same bond on the tooth as well. Then I use Panavia V5 or SA which ever I have in stock. Are you saying that SA plus cement doesnt need any bonding but it can still be used if preferred. You also mentioned you bumped the thickness to 1.2, in Central fissure, what is recommended I remember 1 mm correct me if I am wrong. There are very few videos on katana bonding in the DL section, one that is there only shows the two step bond with separate primers for teeth and ceramic. I have been using only quik bond the green bottle will that be okay or do I need to buy a separate bottle of ceramic primer. Also is this white bottle primer similar to monobond plus.Sorry too many questions, I tried looking up the videos and searched the boards too, couldnt' find the answers I am looking for. TIA

Rohini


+1 for RMGI protocol for Zirconia. The panavia V5 protocol has failed multiple times with monibond S. I feel the primer is very finicky. Would highly encourage a unidose version of the silane to ensure stability short-term (TBD). Long-term I would still chose RMGI for Zirconia until better literature suggests different.


On 9/7/2019 at 7:44 pm, Rohini Singh said...
On 9/7/2019 at 7:40 am, Daniel Wilson said... Thanks Rohini. This case I cemented with 3M Rely X RMGI. I know all of the protocols from Kuraray Noritake and they are recommending full bonding protocol with either Panavia V5....or using their Panavia SA Cement Plus. This is a self etch, dual cure cement with fluoride release. They have three different shades (Universal-A2, Translucent and White). Air abrade, disinfect the prep and go. When I’ve used Panavia SA Cement Plus, I personally pair it with Kuraray’s Quick Bond. The literature has been quite good on this product. If I’m going to use any of Kuraray’s products for Katana, I would use the Panavia SA Cement Plus. I personally don’t want to go through the hassle of full bond protocol with Panavia V5 or Ivoclar’s Variolink Esthetic DC (my go to bonded Cement). I prep Zirconia with retention and resistance form so I’m not so worried about adherence of the crown but more about fractural toughness (hence me bumping up my fissure height when I don’t plan to bond). Just my humble opinion

Thank you Dr Wilson, is it okay to use quik bond with Panavia V5, After air abrading I use the quik bond on intaglio of the crown and total etch plus same bond on the tooth as well. Then I use Panavia V5 or SA which ever I have in stock. Are you saying that SA plus cement doesnt need any bonding but it can still be used if preferred. You also mentioned you bumped the thickness to 1.2, in Central fissure, what is recommended I remember 1 mm correct me if I am wrong. There are very few videos on katana bonding in the DL section, one that is there only shows the two step bond with separate primers for teeth and ceramic. I have been using only quik bond the green bottle will that be okay or do I need to buy a separate bottle of ceramic primer. Also is this white bottle primer similar to monobond plus.Sorry too many questions, I tried looking up the videos and searched the boards too, couldnt' find the answers I am looking for. TIA

Rohini

1st question.  I would not personally use Quick Bond with Panavia V5.  Just use their tooth primer with MDP.

2nd question.  Kuraray does not recommend using quick bond on the intaglio of the crown.  If you are choosing to air abrade and then silanate, I would use Monobond Plus or Kuraray's Clearfil Ceramic Primer Plus.

3rd question.  I will just relay what is on their website.  Again, I have either just bonded (usual bonding protocol with air abrasion and silanation of intaglio of crown and selective etch and prime and bond of tooth) or cement with RMGI.  I like the idea of Kuraray's Panavia SA Cement Plus but I just don't have enough experience with it to speak as an expert.  T

4th question.  There is no occlusal offset when you mill, so this will be set to 0 micrometers. Occlusal milling offset only works when you are grinding.

5th question:  As I stated earlier, Monobond Plus and Ceramic Primer Plus are both silanating agents


Excellent presentation Dan... you are never short of details and good information! 

Mark


Thank you Dr Wilson for taking the time to answer all my questions.
I did go on kurary Noritake’s website to learn a bit more. I couldn’t find it written clearly anywhere, and I spent all morning reading, what to use on intaglio of zirconia restorations. The clearfil ceramics primer is for conventional porcelain and emax. It says not needed for metal oxide or metal. Quick Bond has silane and MDP both, also has k etchant in it. So indicated for all direct and indirect bonding . It can be used as self etch, selective or total etch. Kurary says silanation only in glass ceramics silicate containing materials, zirconia has no silicate, so no silane needed. After air abrasions it doesn’t specify if MDP containing bond quick or universal should be applied or not. But it does say that bond has MDP so it can be used where compatible with material. So my interpretation of all this for zirconia is as follows:
After air abrasions, ultrasonic clean for 2 mins-recommendation by kurary, I just use ivoclean. Then a layer of MDP containing bond, air dry and thin out. Prep the tooth with self selective or total etch and MDP bond and then use any cement V5 or SA or any other in light cure mode. Meaning full light cure. If using in DC mode then must use a DC activator whether using a quick bond or universal bond.
Difference between quick bond and universal bond is there is no wait time for quick bond just scrub air dry and cure, to avoid manual error of time with each restoration. I may may have also read to cure the bond on restoration after thinning it out for more optimal bonding results. I did not think they have laid out the rules very clear on there website, but this is what I made out of it.
Thank you for your help


Rohini- no need for the “Dr Wilson” around here. He either goes by Dan or Mr. Aadland 🤣


Kris dropped the 🎤. 😂


Mr Aadland it is 👌