Hugh Flax, DDS, AACD, MICOI

G-CEM ONE is a self-adhesive resin cement that is formulated to combine high bond strength, effortless clean-up, and lasting esthetics. It also features a self-curing ability for a wide range of indications. It is designed to be universal, non–technique sensitive, and versatile and effective in all cementation procedures for any type of restoration. It is indicated for the cementation of all types of ceramic, resin, and metal-based inlays, onlays, crowns, and bridges.

Dentistry continues to evolve on multiple levels, with changes in indirect restorative materials, the need for reproducible results, and implementation of cementation.

Cementation is highly influenced by variabilities in tooth preparation and length, enamel and dentin substrates, restorative properties, and surface adhesion, as well as curing light transmission through the materials, which is compromised with metal and zirconia.

Many dentists around the world have this “wish list” of qualities:

Reliable: optimal performance for retentive and nonretentive preparations

Universal: excellent bond strength to tooth and all substrates, including zirconia, metal alloys, glass ceramics, and hybrid ceramics

Technique insensitive: exceptional self-curing ability and moisture tolerance for peace of mind

Esthetic: invisible, wear-resistant margins for esthetic outcomes

Simple: reduced inventory, reproducible results, and optimized workflow

Fortunately, GC America recently developed G-CEM ONE™—a dual-cure, self-adhesive resin cement with high adhesive bond strength, which can be used for extended indications when using its optional Adhesive Enhancing Primer (AEP). The objective of this system is to provide dentists with 1 simple solution for all day-to-day procedures.

The beauty of AEP is that it can be applied and dried without light curing. With GC America’s Touch Cure technology, the accelerator in the AEP reacts with the initiator in the cement during crown luting, which enhances curing capacity independent of light. It not only overcomes the light transmission issue in all restorations, but it also reliably overcomes challenging situations such as:

Low retentive preparations for onlays, inlays, and veneers

Fifteen members of Catapult Education were asked to evaluate G-CEM ONE, which is built on tried-and-true existing technology. The evaluators typically use a resin-modified glass ionomer or other resin cement for most of their cementations. In terms of finding a supreme cement, the evaluators were overwhelmingly looking for one that could be used on all substrates and would be easy to handle and clean up. Surprisingly, although many thought bond strength was important, it didn’t seem as important as the handling and cleanup of the material.

Most of the evaluators cemented at least 5 restorations with the material and, to this date, this evaluator has cemented more than 40. The most common restoration cemented was hybrid ceramic inlays and onlays, followed by porcelain-fused-to-metal bridges, and then lithium disilicate crowns and zirconia crowns. The following is what the group found:

More than 80% of the evaluators noted that they used the adhesive primer most of the time, with one evaluator stating, “If I could add more bond strength, why wouldn’t I use it?”

Handling was not an issue for anyone, with nearly 99% of the evaluators liking how G-CEM ONE handled. Evaluators noted that the syringe size and extrusion force of the material were also very good.

Cleanup methods varied between evaluators; 60% of the evaluators tack-cured the material and then cleaned it up, and the remainder waited for it to partially set and cleaned it up easily when it was rubbery or used a brush to wipe away the cement when wet. More than 90% felt cement removal was easy.

More than 80% said they would purchase the G-CEM ONE, and 100% said they would recommend this to a colleague.

Overall, the group of 15 doctors were very impressed with many of the added features. This is a strong evaluation, especially in a product category for which every clinician is looking for a more idyllic solution.

A vacationing patient from out of state broke her 20-year-old ceramic crown on tooth No. 8 while chewing. Although the tooth had remaining tooth structure to create a ferrule, the preexisting post had fractured and would ideally be removed by an endodontist prior to replacing the crown.

Fortunately, the crown could be accurately recemented with G-CEM ONE using AEP, and the missing porcelain could be replaced using G-ænial™ Universal Injectable
composite (GC America), so the patient could resume her vacation with a big smile and get more ideal care when time and convenience were optimal.

Case No. 1

A 40-year-old patient with heavy bruxing needed a preexisting crown replaced on an endodontic tooth that had limited occlusal space. After her tooth was rebuilt, a zirconia crown was treated by air abrading internally and painted with an methacryloyloxydecyl dihydrogen phosphate (MDP) product. After carefully painting the short prep with AEP, the crown was easily cemented and cleaned up with G-CEM ONE.

Case No. 2

GC America has created a reliable, efficient, and easy-to-implement cementation product that could be considered a “Swiss Army knife” for handling multiple types of indirect restorations that can be used for retentive and nonretentive preparations. Even better, when isolation is a challenge, research and our study have proven that G-CEM ONE can overcome saliva contamination, assuming strict adherence to manufacturer instructions and using AEP.

Overall, GC America has produced a true winner.

1. Ishii R, Yokoyama M, Tamura T, Takamizawa T, Miyazaki M. Shear bond strength of resin cements to saliva contaminated dentin. 2020. 153rd Meeting of the Japanese Society of Conservative Dentistry. P24. (available only in Japanese)

Articles

Evaluators found GC America’s dual-cure, self-adhesive resin cement to be a reliable, efficient cementation product. 

G-CEM ONE Offers a Simple Solution for Everyday Procedures

	As the use of composite has become more commonplace since the 1980s, there has been an evolution from self- to light-cure, high to low wear, etc. The journey to find the ideal tooth-colored direct restorations has been extraordinary. Characteristics like flexural strength, opacity, handling, polishability and esthetics are nuanced and often individually valued.

	Ultimately, a product comes along that makes one say, “Winner!” COLTENE’s BRILLIANT EverGlow

 fits that description. The material is described by COLTENE as a universal submicron hybrid composite and is applied in 2-mm increments. It also has excellent polishability and strength comparable to 

3M’s Filtek™ Supreme Ultra Universal Restorative

. Its “Duo Shade” feature aids in excellent esthetics and simplified shading for a chameleon effect with more efficient placement.

	The combination of easy handling, strength and polishability should be a big help to every clinician.

Related reading: Choosing the right composite for your patients

 engaged 29 of its evaluators to test BRILLIANT EverGlow’s many qualities. This group had some of its own common traits and differences:

		One-third of the evaluators use the industry leader in composite sales, 3M’s Filtek™ Supreme Ultra Universal Restorative.

		As typical with most dental offices, more than one composite was used by the majority of the evaluators.

What were the important qualities we were looking for in a composite and how did BRILLIANT EverGlow match up?

		Handling (in terms of sculptability, non- sticky, non-tacky, wax type feel, contouring, etc.) - Almost every evaluator commented on such in one way or the other. Fifty percent of the evaluators thought it was excellent, while almost 40 percent rated handling as good. That diversity of opinion is fairly typical in composite evaluations with individual comments like “ideal,” “too tacky,” “needing a warmer,” or “not needing a warmer.”

		Polishability was rated even higher than handling with 19 of 28 evaluators rating it as excellent.

		Opacity/translucency wasn’t evaluated as a group.

		Overall experience was rated good to excellent by 25 of 28 evaluators.

		In regard to purchasing the product, 22 of 28 evaluators commented “yes,” which is very high for a composite evaluation.

 by the group is that it’s a very good overall composite. Many of the evaluators found this to be similar to their favorite current composites, which is a high compliment because they’re comparing it to their preferred brands.

	For these reasons, BRILLIANT EverGlow has earned the Catapult Vote of Confidence.

	A middle-aged patient presented with a desire for a healthier, more youthful smile that was compromised by crowding and wear. A conservative approach of ABB (alignment, bleaching and bonding) was recommended, starting with aligner care with Invisalign (

	Fig. 1                                                                                               Fig. 2

	Post-orthodontic care wasn’t rushed to establish solid tooth positions and occlusion. This involves three months of retention along with deprogramming, 

Related reading: 4 reasons more adults are considering orthodontic treatment

	Repair of chipped and damaged teeth was done additively using an erbium laser, thin, low-depth diamond bevels and placement of BRILLIANT EverGlow

	A fearful patient seeking multidisciplinary changes needed treatment of decayed bilateral lower molars. The goal was to preserve tooth structure and restore directly (

	Fig. 4                                                                                              Fig. 5

	Restoring the posterior molars was easily done with BRILLIANT EverGlow. It was easily condensed and sculpted to anatomical contours and polished to a lifelike shine (

 wanted to conservatively improve her smile at tooth #7, where it was dark from retrusion and old compositematerial that was poorly shaped. To correct this matter, a strategy to whiten the surrounding teeth while a blueprint of an improved shape/volume was created on a model would be followed by gently reshaping line angles and doing a direct veneer on the challenging tooth (

	Fig. 6                                                                                                    Fig. 7

	Tooth #7 was conservatively prepared to remove old composite buccally and interproximally. After microetching with aluminum oxide and rinsing with chlorhexidine, 37% phosphoric acid was applied and rinsed thoroughly with water and then lightly dried.

Trending article: 7 horrifying procedures dentists used to do

	ONE COAT 7 UNIVERSAL (COLTENE) bonding agent was applied/dried for 25 seconds and cured for 10 seconds (

). Using a putty matrix, a thin layer of translucent shade was adapted and sculpted to create a lingual incisal “scaffold” to frame the primary anatomy of the tooth as well as the lingual occlusal anatomy (

	Fig. 8                                                                                                Fig. 9

	The A1/B1 Duo Shade was applied and layered using a compule of material on the facial surface following the two planed anatomy of the tooth as well as the mesiodistal line angles of the contralateral tooth and buccal contours of the adjacent teeth (

Read more: Treating periodontal disease with Perio Protect

	Smoothing the gingival margins and refining the primary anatomy was performed with a 12 fluted carbide ET9 finishing bur and coarse/fine composite finishing discs. Secondary anatomy was created with a fine diamond flame-shaped diamond to develop depressions between the three labial lobes. Occlusion was verified and adjusted with a 12 fluted egg-shaped bur (

	Fig. 10                                                                                              Fig. 11

	Interproximal polishing was done with various grits of strips to aid in flossing and to decrease the risk of stain buildup in the future (

 Step 2 Polishers and a felt polishing disc with aluminum oxide paste created a natural high gloss finish for esthetics and longevity (

	Fig. 12                                                                                              Fig. 13

	The close-up, post-treatment photo demonstrates the beautiful blend of color and anatomical congruency for this minimal change to the patient’s smile (

). The patient was ecstatic about the simple and natural improvement in her appearance - especially doing this with no anesthesia given her heart condition. It was gratifying to help this young mother feel more confident again. The transitional approach with a very reliable composite could be a stepping stone for our patient’s desire for an ideal smile when her medical condition stabilizes. (

How BRILLIANT EverGlow can be used to create esthetic and long-lasting tooth-colored restorations. 

A breakthrough in composite restorations

	The use of lasers in dentistry today has evolved from its beginnings in 1960.

	In that year, Theodore H. Maiman, using a theory originally postulated by Einstein, created a device where a ruby crystal medium was stimulated by energy, and radiant, laser light was emitted from the crystal. In other words, he developed the first laser and called it Maser.

	The search for a laser system with broader applications in dentistry led Dr. Terry Meyers and his brother William, an ophthalmologist, to select the Nd: YAG laser for experiments on the removal of incipient caries. Soon after, they began developing the first true dental laser system, which, according to textbooks and published literature, sparked the dental laser revolution and the first widespread exposure of lasers to dentistry.

	In May 1991, the FDA granted a marketing clearance to American Dental Laser for soft-tissue uses. Awareness surged forward, and there were several major research projects underway using newer wavelengths in the experimental cutting of enamel and dentin. A valuable concept developed by Miserendino and Pick was that laser energy could create analgesia in a tooth because the natural waveguides in tooth structure could deliver energy to the pulpal that would decrease perceived pain in the C-afferent fibers.

	The 1990s saw birth of erbium that had an absorption affinity to water and hydroxyapatite, as well as, somewhat, to melanin. By May 1997, Premier Laser obtained the first marketing clearance from the FDA to cut enamel and dentin in adults using an Er: YAG laser, a device readily available in dermatology and plastic surgery. In 1998, after more than 10 years of research and investigation, 

 obtained a marketing clearance for an Er: YSGG device to allow cutting hard tissue in adults with a similar clearance for children soon thereafter (1999). There were further breakthroughs in laser endodontics (2002), apicoectomy (2002), cutting and shaving oral osseous tissues (2003), as well as the most complete list of procedures related to periodontal therapy, including laser curettage and osseous crown lengthening (2004). Other laser companies have managed to obtain a few of these same clearances later.

On-demand webinar: Understanding dental laser wavelengths and how they affect procedures 

	Despite these gains in treating multiple tissue substrates, the erbium laser was not optimally absorbed by enamel and dentin. As a result, cutting on tooth structure was slower than desired in terms of efficiency (cutting speed) and pulpal comfort perceived by patients. Fortunately, in the early 2000s, researchers led by Daniel Fried and John Featherstone at the University of California San Francisco ultimately found a 9.3-μm wavelength CO2 laser system (unlike the previous 9.6-μm and 10.6-μm settings) that more optimally utilized low energy laser pulses (1-5 mJ /pulse) delivered at a high repetition rate (400-Hz) would be more feasible for removing dental hard tissues with minimal peripheral thermal damage to enamel, dentin and pulpal tissues.

	With that technological breakthrough, dentists now have a more reliable method to perform minimally invasive care, utilizing the ability of this unique wavelength to safely, effectively, quickly and comfortably perform caries removal, cavity preparation and intraoral soft-tissue surgery with reduced need for conventional drills to complete the procedures6. At this time, the only 9.3-μm wavelength CO2 laser to have FDA approval for these applications is the 

Solea laser (manufactured by Convergent Dental)

Related reading: Dental laser market projected to almost double in the next few years

	Benefits of the 9.3-μm wavelength CO2 laser

	The newest development in laser restorative care raises the bar on more conservative and needle-free dentistry for multiple reasons:

	- The new, unique CO2 9.3 μm wavelength (cleared by the FDA for hard, soft and osseous tissue use) is highly  absorbed by hydroxyapatite, which vaporizes enamel, giving you the power to work anywhere in the oral cavity with speed and ease.

	- The Solea cuts soft tissue like native CO2 (10.6 μm) very cleanly and with less hemorrhage and discomfort during and after the procedure.

	- This system has computer-controlled advanced technology utilizing galvo-optimized cutting patterns for the laser and a variable speed foot pedal that facilitates control similar to the intuitive handpiece. The integration of this computer-aided preparation (CAP) system enables the variable spot sizes (width control) and variable speed foot pedal (allows cutting and relaxation of tissue).

More on lasers: 5 things you need to know about laser dentistry

	The evolution of lasers in the last 40 years has made patient care more comfortable and less invasive, which makes dental care more attractive to the public. The 9.3-μm CO2 dental laser is the greatest advancement in this arena. Future updates in the technology with periodontal pocket care, closed flap gum lifts and root canal therapy are certainly forthcoming. This will allow the Solea to be a bigger asset in patient care for general dentists and specialists.
	
	In addition to the improved criteria for prevention and risk assessment, creating even more minimally invasive methods of preserving natural enamel and creating an anti-aging theme in contemporary dental care, utilizing laser care is a desirable modality for removing diseased or undesirable tissue. The evidence-based findings of the past, in addition to advances in know-how and materials, have built a brighter future for our profession. 

	Watch a video of three different laser dentistry cases below:

Dr. Hugh Flax is known for his leadership in cosmetic dentistry. A past president of the American Academy of Cosmetic Dentistry, he has lectured and authored in Europe, Japan, Canada and the United States on lasers, smile design and advanced restorative techniques to enhance the skills of dental teams in making their care world-class.

Webinar: How all-tissue lasers enhance the traditional dental model

The use of lasers in dentistry today has evolved from its beginnings in 1960.

3 cases showing the breakthrough of laser dentistry

	The growth of multiple options to serve patients’ esthetic and functional needs and desires requires mastery of disciplines that usually necessitate a coordinated and collaborative team approach with multiple specialties.

Often, the information is in the form of the traditional database of radiographs, photos, models and diagnostic wax ups, as well as new 3D digital technologies such as cone beam (DICOM files) and impressions (STL files). More importantly, creating a shared vision of the final esthetic communicates infinite details of the patient’s hopes and dreams and presents higher accountabilities between the restorative, orthodontic and surgical partners (aka the three Rs: relocate, replace and restore).

Want new patients?	Free e-book: The Dentist's Guide to Using Technology to Attract and Retain New Patients

Fortunately, with this high level of expectations, there are innovative, conservative and dynamic methods that keep everyone on the same page and satisfy a patient’s emotional appearance needs during interdisciplinary care that may take several months or years.
	This article will demonstrate how the general dentist can “quarterback” and design success as an architect and an artist.

Related reading: GC America unveils NEW GC FUJIROCK line in bulk packaging


	A 35-year-old female patient with a history of unsuccessful surgical exposure/orthodontics eruption and subsequent extraction and bridge reported to our office with a misplaced implant at tooth position No. 11. Because of the compromised bone volume caused by the rotated first bicuspid, the surgeon in South America was unable to access a proper location for the implant three dimensionally, which compromised the trajectory toward the labial, as well as the attached gingiva. With the situation creating an unacceptable esthetic, biologic and functional risk, the patient accepted a long-range treatment plan of orthodontic and surgical site development prior to placing an implant. This would be followed by restorative care with an implant-supported crown using custom zirconia abutment for No. 11 and porcelain restoration on adjacent teeth to create an ideal smile enhancement.

Check out the following video to view the step-by-step case:

Related reading: In memory: Richard Atanay of GC America

Continue reading about the procedure on Page 2 ...

To be able to communicate our future goals and parameters to the orthodontist and periodontist, records were gathered and shared, including 

 to road map the journey. The sequencing of care was “brainstormed” in the following phases:

		Full orthodontic realignment of the teeth, in addition to creating adequate space for increased bone volume and implant placement. The pre-existing transitional bridge was to be split to allow for distal rotation of tooth No. 12 to create more optimal intradental space.

		Esthetic verification of the ideal placement of tooth No. 11 with an updated provisional restoration, as well as CBCT analysis for surgical planning.

		Soft tissue and block osseous grafting prior to a tapered implant placement with a surgical guide.

		Restoration as listed above and occlusal maintenance with a retainer and protective appliance.

Related reading: GC America introduces GC Initial MC Classic line

 Following two years of orthodontic therapy, a space was created between Nos. 10 and 12, necessitating a more ideal wax up to plan a provisional that diagrammed pink/white balance and position of the missing canine.

A lined silicon matrix was created to help duplicate this intraorally (

). The patient was given the opportunity to home whiten using her 

 retainers. Also the gingival shades were assessed prior to anesthesia of the tissues, which would affect blood flow and color in the area of treatment.

 After local anesthesia, the length of tooth No. 10 was enhanced using an all-tissue 

 with soft tissue settings of 2 watts/20% water/20% air.

Bisacryl Luxatemp Ultra B1 material (DMG America)

 with an embedded custom cut and resin-coated strip of 3 mm wide 

 that added structural reinforcement to prevent cracks from propagating.

After full curing of the restoration, it was shaped and equilibrated. Some excess material was cut back facially to allow for layering of 

GRADIA® gum shades composite material (GC America)

Using GRADIA Pink instructions from the manufacturer,3 we roughened the resin surface by sandblasting with 27 micron aluminum oxide using a 

 After full curing of the restoration, it was shaped and equilibrated. Some excess material was cut back facially to allow for layering of GRADIA® gum shades composite material (GC America).

 was placed on the roughened surface to wet the Bisacryl and promote adhesion and was light cured for one minute. Finally, two colors were layered anatomically and separately onto the surface. The initial application (shade G23) was placed more apically and corresponds to a darker, unattached gingival tissue. The final layer (shade G21) was blended into the G23 and sculpted to match adjacent attached gingiva.

Video: GC America's G-CEM LinkAce tackles the common challenge of indirect restorative treatments

 Unfilled resin helped the application of this material. This was smoothed and shaped to mirror the corresponding anatomy including the papillae.

 The tooth portion of the restoration was tinted with a thin layer of ochre shade to blend with enamel on tooth No. 9 using 

 The provisional was completely sealed with

 to enhance physical and optical durability. Afterward, it was carefully cemented using 

, which contains fluoride, potassium nitrate and chlorhexidine for pulpal protection.

 Following this procedure, the incisal edges, which had been worn down from excessive function, were enhanced to promote better esthetics. Given that this was an additive technique, light beveling of the enamel surface was followed by Prepstart microabrasion (rinsed by 

) and 37 percent phosphoric acid (washed thoroughly away by water and lightly dried to allow some moisture with no desiccation of the surface). Placement of a multipurpose resin and curing for a minimum of 30 seconds will help prime the surface for the restorative material.

Video: GC America explains the innovative initiator system of new G-CEM LinkAce

Using a compule delivery system, small amounts of shade BW 

 were applied and sculpted to add a more youthful look to the central incisors and help the incisal plane coincide better with lips and face.

 After polishing with multifluted carbide finishing burs, as well as abrasive discs and aluminum oxide paste, the patient was very pleased with her rejuvenated appearance.

 After taking a CBCT of the area, it was easy for the periodontist to visualize the “triangle of bone” and collaborate with us and our patient on the implant position relative to the ideally placed pontic on the provisional bridge and the need for osseous/soft tissue augmentation.4
	Phases three and four have yet to be completed. This may take another 12 months due the necessity of optimized healing from grafting and implant surgery before the restorative phase can begin. Fortunately, the patient will be able to feel comfortable with her appearance.


	Careful treatment planning of complex cases requires a collaborative approach that allows the interdisciplinary team to share information and create optimized results by not only sharing information to blueprint plans for excellence but also to allow the patient to participate in his or her care. When there are esthetic considerations, having input from specialists, lab technicians and the patient will allow the team to move forward in tandem so everyone is on the same page. Using transitional bonding offers a modality to conservatively communicate esthetic goals, test drive the blueprint and give the patient a chance to enjoy a nicer appearance during multiple phases of care that often take many months to complete. Fortunately, we have a wide palette of colors to customize and balance pink and white considerations.
	 

Review: GC America's Fuji TEMP LT has excellent handling, low film thickness

 since 1994 and became accredited in 1997. He was president of the Atlanta Chapter of the AACD (1996-1998) and founded the 

 in 2007. Dr. Flax served for two years as cochair of the Conference Advisory Committee for 2003 AACD Scientific Session in Orlando. He has been the chairman of the AACD Private Education Advisory Council, the 2008 AACD Meeting and the 2010 AACD European Meeting. He was a member of the AACD Board of Directors for more than eight years. Outside of the AACD, Dr. Flax is a member of the 

 and a fellow of both the International Academy of Dentofacial Therapeutics and ICOI. Dr. Flax practices full time in Atlanta, focusing on functional appearance-related conditions and advanced laser dentistry, as well as writing and lecturing on helping others do the same for their own practices. In 2003, he was 

’s expert on cosmetic dentistry and also appeared on 

. He has been the expert dentist on the “Meet the Products” television show and 

. Lastly, he and his practice have been featured in many women’s magazines.

 The growth of multiple options to serve patients’ esthetic and functional needs and desires requires mastery of disciplines that usually necessitate a coordinated and collaborative team approach with multiple specialties.

How to use transitional bonding for interdisciplinary care

While the results of orthodontic treatment usually bring big smiles and straighter teeth, there are some side effects that can go along with treatment as well. 

Such was the case with a recent patient. She was a college student who was about to begin nursing school and had finished her orthodontic regimen. However, she was not pleased with the results.

When she looked in the mirror, she saw discolored teeth, white spots and yellowed composites, a prominent upper left canine, inconsistent shapes and papilla, and worn edges of teeth.

She also complained of muscle tenderness and a sense of not having a consistent bite. It was determined that the prominent canine, slight fremitus of Nos. 6-11, and general tooth wear were indicative of occlusal dysfunction, while the discolored cervical composites and generalized “white spots” were indicative of a history of decalcification.

Noting the decalcification, one of the biggest questions at her exam was whether this was still an active problem. A “bioluminescence” test demonstrated a lower than optimum pH in the oral environment. The patient was put on an aggressive remineralization program using 

 was used due to its durability, natural selection of colors, and its ability to allow underlying tooth structure to enhance the composite’s appearance.

Some of the qualities that I appreciate about the Aura system are: 

•  It’s non-sticky. Less uncured resin is used, resulting in creamy handling. 

•  It’s easy to polish to a mirror finish 

•  It has large particles (60 microns). This means high filler loading and strength. 

•  A big bonus is its low flexural modulus. This means better fracture resistance as less stress at the composite interface means less debonding.

•  It has lower polymerization shrinkage.

•  It is a prepolymerized microfilled composite, making it stronger than a standard microfill.

•  It’s easy to polish to high gloss.

•  It has high fluorescence in the dentin and slight in the enamel and contains opalescence (bluish glow in natural light) to match natural enamels. I think this gives life to the restoration.

•  It has superb gloss retention without the “plucking effect” of large particles. 

The patient wanted a shade that was bright but also looked natural. The Aura E1 shade was selected because it was the most whitish/lightest. It has high opalescence with some degree of translucency and was designed to emulate young enamel for those who are 20 or younger.

Surface discolorations and previous composites were conservatively removed with a flame-shaped diamond, maintaining the outer enamel and creating room for the forthcoming layer of Aura.

Treatment sequence of bonding is begun with tooth Nos. 8 and 10. After outline form and gross contouring, No. 7 and No. 9 were treated in the same fashion. Tooth Nos. 5 and 6 were bonded, followed by Nos. 11 and 12. Aura’s handling properties allowed this be performed very efficiently and effectively.

 37% phosphoric acid was placed over the entire labial surface with a 30-second exposure time (since no dentin was involved) and thoroughly rinsed with water for 15 seconds each.

A universal bonding resin was placed carefully placed using a microbrush and thinned with a warm air dryer.

Each tooth being treated was cured for 20 seconds using 

light with its wide tip. Aura Enamel (Shade E1) was thinly applied and sculpted using 

 placing the gingival half first blending the interproximal. After a 40-second cure, the incisal portion is adapted to the tooth using the anatomy of the incisal edge and adjacent anatomy to guide initial contouring.

Gross finishing is achieved with a thin 16 bladed ET 9 bur to clean the gingival margins and establish labial anatomy. Interproximal surfaces were smoothed with plastic finishing strips.

Overall, she was very happy with the results and could finally flash the confident smile of completed orthodontic treatment.

How to use SDI's Aura universal composite to correct esthetics [VIDEO]

 different enough in the adhesive cement market to convert them to users? The overwhelming response was yes and the key was the handling.

Final cementation of a single or group of indirect restorations is the culmination of hard work in tooth preparation, accurate impression making, provisionalization with tissue management, technical lab work and artistry, and proximal and occlusal contact adjustments.

The grand finale is proper cementation of your adhesive or cohesive restoration(s). 

Graham (2012) listed several contemporary considerations:

		Long-term permanent seal, i.e. long-term stability and minimal degradation

		Biocompatible, both internally and externally

		Strong physical properties such as flexural and compressive strengths

		Universal usage for all ceramic and metal crowns

		Good working and setting times for single and multiple units

Given the crowded market of cement choices and the multitude of restorative options (metal; porcelain fused to metal; all-ceramic zirconia or lithium disilicate), the Catapult Group was asked to review 

, which is its newer and improved version of a composite resin cement that the manufacturer reports offers improved radiopacity; improved film thickness and setting time; and a higher degree of conversion (cure) after 15 minutes of seating and much easier clean-up of excess cement. 

The question posed to the Catapult Group is: Is DUO-LINK different enough in the adhesive cement market to convert them to users? The overwhelming response was yes and the key was the handling.

More than 90% of the evaluators would incorporate this DUO-LINK into their practices. This, without question, is an outstanding response to this cement product.

		By far, the most important area to assess for resin cements was the ability to remove excess cement.

		This was closely followed by characteristics such as: physical properties, flowability, working time, seating time, film thickness, and delivery system. All were indicative that usability and predictability were highly important to the clinicians.

		Choices in shades were also of importance to the evaluators.

		Bonds to all substrates with extremely high bond strengths

		Indications include: crowns, bridges (fixed prostheses), onlays, inlays, and posts/dowels, fabricated from metal, composite, porcelain, ceramic, zirconia, alumina, 

		Extremely easy clean-up because it is precisely formulated to allow for quick and easy removal of excess cement

		It’s highly radiopaque and can be easily identified on radiograph for quick and effective diagnosis

		Easy to use automix, dual-syringe provides a consistent mix for immediate delivery

		Universal (A2) shade can be used with most restorations and has some translucency at low film thickness

		Milky White shade is more opaque and can be used to mask darker tooth preps

Is DUO-LINK different enough in the adhesive cement market to convert them to users? The overwhelming response was yes and the key was the handling.