OptiBond XTR Universal Self-Etch Bonding Agent

An Advancement in Adhesive Dentistry

1

Analysis of Chemical/Physical Properties

Outline

OptiBond XTR Clinical Review

OptiBond XTR/NX3 system

Why Bonding Agents are Needed

Hydrophilic Hydrophobic

Bonding Agent Functions•A “coupling agent” linking two dissimilar substances together•Wet tooth surface•Penetrate smear layer•Seal dentin tubules

Mechanisms of Dental Bonding

Chemical BondingChemical Bonding

CovalentCovalent

IonicIonic

Ca++

Tooth Structure

PO_

OO

HOP

_O

O O

OH

Mechanical BondingMechanical Bonding

Micro-mechanical

(Chemical treatments)

Micro-mechanical

(Chemical treatments)

Macro-mechanical

(Tooth preparation)

Macro-mechanical

(Tooth preparation)

Substrates

Adhesive

Bonding Agent Generations

5

Total etch Self etch

# of components

Etchant

Primer

Adhesive

Generation 4th 5th 6th 7th

OptiBondOptiBond FL

1991

OptiBond Solo Plus1995

Kerr productsOptiBond All-

In-One2006

OptiBond XTR 2011

Shortcomings of Bonding Agents

Enamel Etch/Adhesion Bond Incompatibilities Post-Op Sensitivity Excessive Film Thickness

4th Gen XX XX

5th Gen XX XX

6th Gen XX XX XX

7th Gen XX XX XX

7

Porcelain/Composite Metal or PFM Crown

DIRECT INDIRECT

Ceramic Veneers

and/or

Many adhesives and different bondingprocedures in office!

Multiple Bottles for Multiple Procedures. . .

What Does This Mean for the Clinician?

8

Shortcomings of Modern Bonding Agents

Enamel Etch/Adhesion

Bond Incompatibilities

Post-Op Sensitivity

Excessive Film Thickness

Inadequate Enamel Etching & Adhesion

9

Self-Etch (6th/7th 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.

6th generation, 50,000X 7th generation, 50,000X

Phosphoric Acid 50,000X

Control

Bond Incompatibility

Single Bottle Adhesive System•5th Generation Total-etch Adhesive•7th Generation Self-etch Adhesive

Hydrophilic - Acidic

Water

Self-cured Resin Cement/Core Material

•PFM Crowns•Metal Crowns•Opaque Restorations•Bulk-Fill Composite Core Material

Hydrophobic Teritary amine (Base)

Acid/Base Reaction and Phase Separation

Post-Operative Sensitivity

11

Dentin

Open dentinaltubules

Pulpal floorLeading to nerveendings

Hot/Cold stimulus

Rapid fluid movement intubules disturbingnerve endings thereforeinducing pain & discomfort

Open tubules and poor adhesion are primary sources for sensitivity

Example

Dentin covered with “Smear Layer”

Open space between collagen fibers maintained by water

Adhesive penetration facilitatedMaximized micromechanical bondingEnhanced sealingKep

t Moi

st

Adhesives fail to re-wet/re-expand the collapsed collagen fibers

Adhesive penetration hinderedCompromised bonding & post-op sensitivity

Collagen fibers collapsed and space between collagen fibers closed

Over-Dried

Acid Etching

13

>35μm

SEM magnified at 2,000X

Excessive Film Thickness

14

OptiBond XTR:A TRUE Universal Adhesive

Kerr Solution

15

The Science of OptiBond XTR Universal Adhesive

OptiBond is a True Universal Adhesive

16

Direct Bonding

Light-cured composite and compomer restorationsComposite/ceramic/metal repairsCavity sealing for amalgam restorationsSealing of hypersensitive and/or exposed root surfacesCore build-ups (self-cured, light-cured, or dual-cured)

Indirect Bonding

VeneersPorcelain, composite, and metal-based (including zirconia-based and alumina-based) inlays,

onlays, crowns, bridgesEndodontic postsCavity sealing as a pretreatment for indirect restorations

Reason 1 - Indicated for ALL Direct and Indirect Procedures

OptiBond XTR can effectively be used for all dental procedures

Porcelain/Composite Metal or PFM Crown

DIRECT INDIRECTCeramic Veneers

and/or

Reason #2 – No need for separate ancillary products

OptiBond is a True Universal Adhesive

OptiBond XTR increases office efficiency and reduces technique confusion

OptiBond XTR Primer:• Effectively Etches• Deep and effective dentin penetration and sealing• Desensitizing

OptiBond XTR Adhesive• Efficient polymerization• Optimized hydrophobic chemistry• Primes all indirect resotrations • Highest material compatibility

Superior Chemistry Drives OptiBond XTR Performance

19

•GPDM adhesive monomer•Ternary Solvent System: Water/Ethanol/Acetone•Hydrophilic/hydrophobic co-monomers (i.e., HEMA)•Photoinitiator

pH = 1.6

OptiBond XTR PRIMER Chemistry

20

Chemical BondingChemical Bonding

CovalentCovalent

IonicIonic

Ca++

Tooth Structure

PO_

OO

HOP

_O

O O

OH

OptiBond technology platform

OO

O

OO

PO OH

OH

GPDM

GPDM Monomer

Water: Introduce etching, penetration Ethanol: Wetting and priming, homogeneous monomer layer Acetone: Shelf life stability, fast evaporation to promote etching

Maximizes etching, conditioning, sealing, and desensitizing

Patented OptiBond Self-Etch Ternary Solvent System

OptiBond FL = 41MPa OptiBond XTR (XTR) = 40MPa

ClearFil SE Bond = 33MPa Xeno IV= 18MPa

Etch Pattern and Immediate Bond Strength

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.

OptiBond XTR’s Ternary Solvent System maximizes etching efficacy

SEM images magnified at 2,000X and 10,000X

OptiBond XTR Dentin Sealing and Priming

Internal data, published in IADR (March 2011, San Diego, California, USA), abstract # 1101

OptiBond XTR’s Ternary Solvent System drives penetration to produce exceptional sealing and optimizes priming

OptiBond XTR ADHESIVE Chemistry

24

A tri-functional monomer provides enhanced cross-linking density , improved curing, and enhanced mechanical strength

Neutral pH of cured adhesive provides universal bond compatibility with all self-/dual-cured cements/composites

0.4 micron Barium glass filler and nono-silica filler for reinforcing the adhesive layer

Low Film Thickness: 5µ

OptiBond XTR’s novel monomer technology provides strength, compatibility, and high performance to all procedures

OptiBond XTR (~5 microns) ClearFil SE (~35 microns)

SEM images magnified at 2,000X

~5μm ~35μm

SEM images magnified at 2,000X

Film Thickness Comparison

Internal data, published in IADR (March 2011, San Diego, California, USA), abstract # 1101

Less is more . . . Thinner film retains margins for precise fitting of indirect restorations

26

Clinical Evaluation of OptiBond XTR

27

3rd Party Testing, State University New York, Buffalo Published at IADR (March 2011, San Diego, California, USA), abstract # 2463

Highest Bond Performance

OptiBond XTR bond strength in both dentin and enamel was statistically superior to leading self-etch bonding agents

OptiBond XTR demonstrated the highest Bond Retention

28

Dr. Lorenzo Breschi, University of Trieste

OptiBond XTR provides highly durable bonds for all restorations

Study conducted by Dr. Uwe Blunck, Berlin

Continuous Margin

Marginal integrity studies by optical microscope

Total etch on enamel

OptiBond XTR Yielded Excpetional Marginal Integrity in Class I Restorations

High marginal integrity without the use of phosphoric acid sets OptiBond XTR apart from other self-etch bonding agents

31

3rd Party Testing At 5 Independent Research Facilities

OptiBond XTR demonstrtaed Consistently High Bond Strength

OptiBond XTR provides predictable bond performance

Battle of the Bonds, France330 tests during the day. Total of 18,225 tests330 tests during the day. Total of 18,225 tests

OptiBond XTR provides predictable bond performance

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)

33

Prof. Bart van Meerbeek, Catholic University of Leuven

OptiBond XTR Proves as Effective as OptiBond FL In-Vivo Clinical Trials without the need for Phosphoric etch

Proven clinical performance with OptiBond XTR

34

Superior Bond Compatibility with OptiBond XTROptiBond XTR Comparative Dentin Bond Strengths with Resin Cements

in Self-Cure Mode vs. 5th and 7th Generation Adhesives

OptiBond XTR can be used with all light, self-and dual-cure resin materials without the need for additional components

*Indirect Dentin Bond Strength of 5th & 7th Gen Adhesives (with Self-Cured Calibra, Variolink, and NX3 Resin Cement). All bonding agents were light-cured. Cements were allowed to self-cure. K

Excellent Bond Compatibility

OptiBond XTR was light cured first. Cements were allowed to self-cure. Kerr internal data.

The RIGHT Science: acidic monomer , solvent system, novel adhesive chemistry

Efficient etching and priming: the best among all self-etch adhesives studied

Excellent marginal integrity

Low film thickness

High bond strength

Bond compatibility with resin cements

Durable bonding

Reduced post-operative sensitivity

True Universal - All indications, no ancillary products required

OptiBond XTR – “The Right Science”

37

OptiBond XTR + NX3The PERFECT Match

• 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 NX3 is not negatively impacted by the acidic oxygen-inhibited layer of light-cured adhesives.

• As a result, NX3 is compatible with all light-cured adhesives in self-cure or dual cure mode.

NX3 Summary

NX3 is compatible, stable, and universal.

Novel Initiator System

PTUTertiary 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

Free Radicals to Initiates Polymerization+

40

Color Stability UncuredDiscoloration of Uncured Catalyst Pastes after Aging for 8 weeks at 37°C

Before Aging

Nexus2 RelyX ARC Calibra Variolink II

NX3

After Aging

NX3 has the highest esthetic properties

Color Stability of NX3

Internal data

41

Color Stability Cured

NX3 Variolink® II RelyX™ ARCCalibra ®

Initial

AfterAging

Comparison of dual-cure resin cements – clear shade

After Aging for 28 weeks in 37°C Water

NX3 has the highest esthetic properties

Internal data

42

NX3 Color Stability vs. Multilink Cured

Initial

AfterAging

NX3 Multilink*

Color stability of leading resin cements after aging for 28 weeks in 37°C water

*Multilink aged 12 weeks

Internal data

3rd Party Verification of Color Stability

43

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

44

Universal Compatibility with all Bonding Agents

*Indirect Dentin Bond Strength. All bonding agents were light-cured. Cements were allowed to self-cure. Kerr internal data.

Comparative Dentin Bond Strengths with Resin Cementsin Self-Cure Mode vs. 5th and 7th Generation Adhesives

45

Internal Data

Bond Strength to Different SubstratesDentin, Gold, Rexillium, Lava, Porcelain, Composite

46

OptiBond XTR/NX3 PrepExcellent Bond Strength in Total Dark-Cure Mode

*All systems were evaluated when used in total dark cure mode (no light used)

47

OptiBond XTR/NX3Excellent Bond Strength to Porcelain

*All systems were evaluated when used in total dark cure mode. All substrates were etched with HF. Internal Kerr Data.

48

The CEREC Challenge

Evaluation Protocol

49

Etch the CEREC restoration with hydrofluoric acid for 1 minute and rinse.

Apply OptiBond XTR ADHESIVE for 15 seconds (omit VERSA PRIMER) then air thin.

After seating the restoration, tack cure excess NX3 for 2 seconds. Clean excess.

Light cure all surfaces for 20 seconds.

Preparing Crown

Bonding Protocol

Final Cementation/Seating

Evaluation Involved:

• Immediate Post-Op Sensitivity

• Ease of use

• Clean-up

• Color Stability

Scrub OptiBond XTR PRIMER onto the prep for 20 seconds.

Air thin with medium air 5 seconds.

Brush OptiBond XTR ADHESIVE onto prep for 15 seconds.

Air thin with medium air and strong air for 5 seconds.

Light curing is OPTIONAL when using NX3.

OptiBond XTR Adhesive

50

Question Average Score*

“Using OptiBond 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 NX3 Cement

51

Question Average Score*

“Clean-up is a very important attribute when performing indirect procedures.” 5.00

“I liked the clean-up of NX3.” 5.00

“NX3 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

52

Question Average Score*

“The initial color of freshly set NX3 is much better than Multilink.” 4.00

“The color of set NX3 is much better than Multilink after 1 week.” 4.33

“The color of set NX3 is much better than Multilink after 2 weeks.” 4.00

“The color of set NX3 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

2 weeks aging in office drawer

Porcelain/Composite Metal or PFM Crown

DIRECT INDIRECTCeramic Veneers

and/or

Reason #2 – No need for separate ancillary products

OptiBond is a True Universal Adhesive

A Truly Universal Bonding Agent