Opti Bond XTR Universal SelfEtch Bonding Agent An

Opti. Bond XTR Universal Self-Etch Bonding Agent An Advancement in Adhesive Dentistry

Outline ØAnalysis of Chemical/Physical Properties ØOpti. Bond XTR Clinical Review ØOpti. Bond XTR/NX 3 system

Why Bonding Agents are Needed Bonding Agent Functions Hydrophilic • A “coupling agent” linking two dissimilar substances together • Wet tooth surface • Penetrate smear layer • Seal dentin tubules Hydrophobic

Mechanisms of Dental Bonding Chemical Bonding Tooth Structure HO O P ++ Ca _ _ O O P OH O Mechanical Bonding Macro-mechanical (Tooth preparation) Substrates Ionic Micro-mechanical (Chemical treatments) Covalent Adhesive

Bonding Agent Generations Total etch Self etch # of components Etchant Primer Adhesive Generation Kerr products 4 th 5 th Opti. Bond Solo Opti. Bond FL Plus 1991 1995 6 th Opti. Bond XTR 2011 7 th Opti. Bond All-In -One 2006

Shortcomings of Bonding Agents Enamel Etch/Adhesion Bond Incompatibilities 4 th Gen Post-Op Sensitivity X 5 th Gen X 6 th Gen X 7 th Gen X X X Excessive Film Thickness X X

What Does This Mean for the Clinician? Multiple Bottles for Multiple Procedures. . . DIRECT INDIRECT Ceramic Veneers Porcelain/Composite and/or Many adhesives and different bonding procedures in office! Metal or PFM Crown

Shortcomings of Modern Bonding Agents Enamel Etch/Adhesion Excessive Film Thickness Bond Incompatibilities Post-Op Sensitivity

Inadequate Enamel Etching & Adhesion Control 6 th generation, 50, 000 X Self-Etch (6 th/7 th Gen) • Mildly acidic • Lower etch quality • Lower enamel bond strength • Require enamel etching Swift E, et al, J Esthet Restor Dent. 2011 Dec; 23(6): 390 -6. doi: 10. 1111/j. 1708 -8240. 2011. 00465. x. Epub 2011 Oct 17. 7 th generation, 50, 000 X Phosphoric Acid 50, 000 X

Bond Incompatibility Self-cured Resin Cement/Core Material Hydrophobic • PFM Crowns Teritary amine (Base) • Metal Crowns • Opaque Restorations • Bulk-Fill Composite Core Material Acid/Base Reaction and Phase Separation Single Bottle Adhesive System Hydrophilic - Acidic • 5 th Generation Total-etch Adhesive • 7 th Generation Self-etch Adhesive Water

Post-Operative Sensitivity Pulpal floor Leading to nerve endings Dentin Open dentinal tubules Hot/Cold stimulus Rapid fluid movement in tubules disturbing nerve endings therefore inducing pain & discomfort Open tubules and poor adhesion are primary sources for sensitivity

Example Open space between collagen fibers maintained by water st i o M t p Acid Etching Ke Ø Adhesive penetration facilitated Ø Maximized micromechanical bonding Ø Enhanced sealing Ov e Dentin covered with “Smear Layer” r-D Collagen fibers collapsed and space between collagen fibers closed rie d Ø Adhesives fail to re-wet/re-expand the collapsed collagen fibers Ø Adhesive penetration hindered Ø Compromised bonding & post-op sensitivity

Excessive Film Thickness >35μm SEM magnified at 2, 000 X

Kerr Solution Opti. Bond XTR: A TRUE Universal Adhesive

The Science of Opti. Bond XTR Universal Adhesive

Opti. Bond is a True Universal Adhesive Reason 1 - Indicated for ALL Direct and Indirect Procedures Direct Bonding • Light-cured composite and compomer restorations • Composite/ceramic/metal repairs • Cavity sealing for amalgam restorations • Sealing of hypersensitive and/or exposed root surfaces • Core build-ups (self-cured, light-cured, or dual-cured) Indirect Bonding • Veneers • Porcelain, composite, and metal-based (including zirconia-based and alumina-based) inlays, onlays, crowns, bridges • Endodontic posts • Cavity sealing as a pretreatment for indirect restorations Opti. Bond XTR can effectively be used for all dental procedures

Opti. Bond is a True Universal Adhesive Reason #2 – No need for separate ancillary products DIRECT INDIRECT Ceramic Veneers Porcelain/Composite Metal or PFM Crown and/or Opti. Bond XTR increases office efficiency and reduces technique confusion

Superior Chemistry Drives Opti. Bond XTR Performance Opti. Bond XTR Primer: • Effectively Etches • Deep and effective dentin penetration and sealing • Desensitizing Opti. Bond XTR Adhesive • Efficient polymerization • Optimized hydrophobic chemistry • Primes all indirect resotrations • Highest material compatibility

Opti. Bond XTR PRIMER Chemistry • GPDM adhesive monomer • Ternary Solvent System: Water/Ethanol/Acetone • Hydrophilic/hydrophobic co-monomers (i. e. , HEMA) • Photoinitiator p. H = 1. 6

GPDM Monomer Chemical Bonding Opti. Bond technology platform Tooth Structure HO O P ++ Ca _ _ O O P OH Ionic O O O GPDM Covalent

Patented Opti. Bond Self-Etch Ternary Solvent System v Water: Introduce etching, penetration v Ethanol: Wetting and priming, homogeneous monomer layer v Acetone: Shelf life stability, fast evaporation to promote etching Maximizes etching, conditioning, sealing, and desensitizing

Etch Pattern and Immediate Bond Strength Opti. Bond FL = 41 MPa Clear. Fil SE Bond = 33 MPa Opti. Bond XTR (XTR) = 40 MPa Xeno IV= 18 MPa Opti. Bond XTR’s Ternary Solvent System maximizes etching efficacy Swift E, et al, J Esthet Restor Dent. 2011 Dec; 23(6): 390 -6. doi: 10. 1111/j. 1708 -8240. 2011. 00465. x. Epub 2011 Oct 17.

Opti. Bond XTR Dentin Sealing and Priming SEM images magnified at 2, 000 X and 10, 000 X Opti. Bond XTR’s Ternary Solvent System drives penetration to produce exceptional sealing and optimizes priming Internal data, published in IADR (March 2011, San Diego, California, USA), abstract # 1101

Opti. Bond XTR ADHESIVE Chemistry 0. 4 micron Barium glass filler and nono-silica filler for reinforcing the adhesive layer A tri-functional monomer provides enhanced cross-linking density , improved curing, and enhanced mechanical strength Neutral p. H of cured adhesive provides universal bond compatibility with all self-/dualcured cements/composites Low Film Thickness: 5µ Opti. Bond XTR’s novel monomer technology provides strength, compatibility, and high performance to all procedures

Film Thickness Comparison ~5μm SEM images magnified at 2, 000 X Opti. Bond XTR (~5 microns) ~35μm SEM images magnified at 2, 000 X Clear. Fil SE (~35 microns) Less is more. . . Thinner film retains margins for precise fitting of indirect restorations Internal data, published in IADR (March 2011, San Diego, California, USA), abstract # 1101

Clinical Evaluation of Opti. Bond XTR

Highest Bond Performance Opti. Bond XTR bond strength in both dentin and enamel was statistically superior to leading self-etch bonding agents 3 rd Party Testing, State University New York, Buffalo Published at IADR (March 2011, San Diego, California, USA), abstract # 2463

Opti. Bond XTR demonstrated the highest Bond Retention Opti. Bond XTR provides highly durable bonds for all restorations Dr. Lorenzo Breschi, University of Trieste

Opti. Bond XTR Yielded Excpetional Marginal Integrity in Class I Restorations Total etch on enamel Continuous Marginal integrity studies by optical microscope High marginal integrity without the use of phosphoric acid sets Opti. Bond XTR apart from other self-etch bonding agents Study conducted by Dr. Uwe Blunck, Berlin

Opti. Bond XTR demonstrtaed Consistently High Bond Strength 3 rd Party Testing At 5 Independent Research Facilities Opti. Bond XTR provides predictable bond performance

Battle of the Bonds, France 330 tests during the day. Total of 18, 225 tests Opti. Bond XTR provides predictable bond performance

Proven clinical performance with Opti. Bond XTR Randomized clinical trial evaluating the clinical effectiveness of a ‘two-step self-etch adhesive’ in cervical Class-V non-carious erosion/abrasion/abfraction lesions (6 -mo Results) Opti. Bond XTR Proves as Effective as Opti. Bond FL In-Vivo Clinical Trials without the need for Phosphoric etch Prof. Bart van Meerbeek, Catholic University of Leuven

Superior Bond Compatibility with Opti. Bond XTR Comparative Dentin Bond Strengths with Resin Cements in Self-Cure Mode vs. 5 th and 7 th Generation Adhesives *Indirect Dentin Bond Strength of 5 th & 7 th Gen Adhesives (with Self-Cured Calibra, Variolink, and NX 3 Resin Cement). All bonding agents were light-cured. Cements were allowed to self-cure. K Opti. Bond XTR can be used with all light, self-and dual-cure resin materials without the need for additional components

Excellent Bond Compatibility Opti. Bond XTR was light cured first. Cements were allowed to self-cure. Kerr internal data.

Opti. Bond XTR – “The Right Science” The RIGHT Science: acidic monomer , solvent system, novel adhesive chemistry Ø Efficient etching and priming: the best among all self-etch adhesives studied Ø Excellent marginal integrity Ø Low film thickness Ø High bond strength Ø Bond compatibility with resin cements Ø Durable bonding Ø Reduced post-operative sensitivity Ø True Universal - All indications, no ancillary products required

Opti. Bond XTR + NX 3 The PERFECT Match

NX 3 Summary • Patented special redox initiator system that is entirely different from traditional BPO/tertiary amine system used in other self-cure/dual-cure resin cement. • Unlike traditional BPO/tertiary amine system, the self-curing capability for redox initiator system used in NX 3 is not negatively impacted by the acidic oxygeninhibited layer of light-cured adhesives. • As a result, NX 3 is compatible with all light-cured adhesives in self-cure or dual cure mode. NX 3 is compatible, stable, and universal.

Novel Initiator System Free Radicals to Initiates Polymerization + PTU Tertiary Hydroperoxide • Superior esthetics due to self-bleaching property of its unique redox initiator system o Only dual-cure cement on the market indicated for Veneer cementation • Excellent shelf-life and gel/set time stability , and Enhanced bond compatibility

Color Stability Uncured Discoloration of Uncured Catalyst Pastes after Aging for 8 weeks at 37°C NX 3 Nexus 2 Rely. X ARC Calibra Color Stability of NX 3 Before Aging After Aging Internal data NX 3 has the highest esthetic properties Variolink II

Color Stability Cured Comparison of dual-cure resin cements – clear shade After Aging for 28 weeks in 37°C Water NX 3 Variolink® II Calibra ® Initial After Aging Internal data NX 3 has the highest esthetic properties Rely. X™ ARC

NX 3 Color Stability vs. Multilink Cured Color stability of leading resin cements after aging for 28 weeks in 37°C water NX 3 Multilink* Initial After Aging Internal data *Multilink aged 12 weeks

rd 3 Party Verification of Color Stability • T. Hilton et al, IADR 2010 Abst 2246, “A A Comparison of Resin Cement Color Stability Over 6 Months”, Mon • Oregon Health & Science University.

Universal Compatibility with all Bonding Agents Comparative Dentin Bond Strengths with Resin Cements in Self-Cure Mode vs. 5 th and 7 th Generation Adhesives *Indirect Dentin Bond Strength. All bonding agents were light-cured. Cements were allowed to self-cure. Kerr internal data.

Bond Strength to Different Substrates Dentin, Gold, Rexillium, Lava, Porcelain, Composite Internal Data

Opti. Bond XTR/NX 3 Prep Excellent Bond Strength in Total Dark-Cure Mode *All systems were evaluated when used in total dark cure mode (no light used)

Opti. Bond XTR/NX 3 Excellent Bond Strength to Porcelain *All systems were evaluated when used in total dark cure mode. All substrates were etched with HF. Internal Kerr Data.

The CEREC Challenge

Evaluation Protocol Preparing Crown Etch the CEREC restoration with hydrofluoric acid for 1 minute and rinse. Apply Opti. Bond XTR ADHESIVE for 15 seconds (omit VERSA PRIMER) then air thin. Evaluation Involved: • Immediate Post-Op Sensitivit Bonding Protocol Scrub Opti. Bond XTR PRIMER onto the prep for 20 seconds. Air thin with medium air 5 seconds. Brush Opti. Bond XTR ADHESIVE onto prep for 15 seconds. • Ease of use Air thin with medium air and strong air for 5 seconds. Light curing is OPTIONAL when using NX 3. • Clean-up • Color Stability Final Cementation/Seating After seating the restoration, tack cure excess NX 3 for 2 seconds. Clean excess. Light cure all surfaces for 20 seconds.

Opti. Bond XTR Adhesive Question Average Score* “Using Opti. Bond Adhesive in place of Silane was easy to implement. ” 4. 5 “I feel this protocol will streamline my CEREC procedures. ” 4. 5 *Rating scale from 1 to 5, where 1 = Strongly Disagree, 5 = Strongly Agree

Clean-Up of NX 3 Cement Question Average Score* “Clean-up is a very important attribute when performing indirect procedures. ” 5. 00 “I liked the clean-up of NX 3. ” 5. 00 “NX 3 was easier to clean than Multilink Automix cement. ” 4. 75 *Rating scale from 1 to 5, where 1 = Strongly Disagree, 5 = Strongly Agree

Color Stability 2 weeks aging in office drawer Question Average Score* “The initial color of freshly set NX 3 is much better than Multilink. ” 4. 00 “The color of set NX 3 is much better than Multilink after 1 week. ” 4. 33 “The color of set NX 3 is much better than Multilink after 2 weeks. ” 4. 00 “The color of set NX 3 is much better than Multilink after 4 weeks. ” 4. 00 “A reduction in color shift helps preserve the esthetics of my CEREC. ” 5. 00 *Rating scale from 1 to 5, where 1 = Strongly Disagree, 5 = Strongly Agree

Opti. Bond is a True Universal Adhesive Reason #2 – No need for separate ancillary products DIRECT INDIRECT Ceramic Veneers Porcelain/Composite and/or A Truly Universal Bonding Agent Metal or PFM Crown