1. OptiBond XTR Universal Self-Etch Bonding Agent
An Advancement in Adhesive Dentistry 1

2. Outline Analysis of Chemical/Physical Properties
OptiBond XTR Clinical Review
OptiBond XTR/NX3 system 2

3. Why Bonding Agents are Needed
Hydrophobic
Hydrophilic
Bonding Agent Functions
A “coupling agent” linking two dissimilar substances together
Wet tooth surface
Penetrate smear layer
Seal dentin tubules 3

4. Mechanisms of Dental Bonding
Chemical Bonding
Covalent
Ionic
Ca++
Tooth Structure P O_ O HO _O OH
Mechanical Bonding
Micro-mechanical
(Chemical treatments)
Macro-mechanical
(Tooth preparation)
Substrates
Adhesive 4

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

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

7. What Does This Mean for the Clinician?
Multiple Bottles for Multiple Procedures. . .
DIRECT
INDIRECT
Ceramic Veneers
Porcelain/Composite
Metal or PFM Crown
Many adhesives
and different bonding
procedures in office!
and/or 7

8. Shortcomings of Modern Bonding Agents
Enamel Etch/Adhesion
Bond Incompatibilities
Post-Op Sensitivity
Excessive Film Thickness 8

9. Inadequate Enamel Etching & Adhesion
Control
6th generation, 50,000X
7th generation, 50,000X
Phosphoric Acid 50,000X
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 Dec;23(6): doi: /j x. Epub 2011 Oct 17. 9

10. Bond Incompatibility 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
Single Bottle Adhesive System
5th Generation Total-etch Adhesive
7th Generation Self-etch Adhesive
Hydrophilic - Acidic
Water 10

11. 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 11

12. Example Kept Moist Acid Etching Over-Dried
Open space between collagen fibers maintained by water
Adhesive penetration facilitated
Maximized micromechanical bonding
Enhanced sealing
Kept Moist
Dentin covered with “Smear Layer”
Acid Etching
Adhesives fail to re-wet/re-expand the collapsed collagen fibers
Adhesive penetration hindered
Compromised bonding & post-op sensitivity
Collagen fibers collapsed and space between collagen fibers closed
Over-Dried 12

13. Excessive Film Thickness
SEM magnified at 2,000X 13

14. A TRUE Universal Adhesive
Kerr Solution
OptiBond XTR:
A TRUE Universal Adhesive 14

15. The Science of OptiBond XTR
Universal Adhesive 15

16. OptiBond 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
OptiBond XTR can effectively be used for all dental procedures 16

17. OptiBond 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
OptiBond XTR increases office efficiency and reduces technique confusion 17

18. Superior Chemistry Drives OptiBond XTR Performance
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 18

19. OptiBond XTR PRIMER Chemistry
GPDM adhesive monomer
Ternary Solvent System: Water/Ethanol/Acetone
Hydrophilic/hydrophobic co-monomers (i.e., HEMA)
Photoinitiator
pH = 1.6 19

20. GPDM Monomer OptiBond technology platform Chemical Bonding Ionic GPDM
Covalent
Ionic
Ca++
Tooth Structure P O_ O HO _O OH
OptiBond
technology platform O P H
GPDM 20

21. Patented OptiBond Self-Etch Ternary Solvent System
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 21

22. Etch Pattern and Immediate Bond Strength
OptiBond FL = 41MPa
OptiBond XTR (XTR) = 40MPa
ClearFil SE Bond = 33MPa
Xeno IV= 18MPa
OptiBond XTR’s Ternary Solvent System maximizes
etching efficacy
Swift E, et al, J Esthet Restor Dent Dec;23(6): doi: /j x. Epub 2011 Oct 17. 22

23. OptiBond XTR Dentin Sealing and Priming
SEM images magnified at 2,000X and 10,000X
OptiBond 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 23

24. OptiBond 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 pH of cured adhesive provides universal bond compatibility with all self-/dual-cured cements/composites
Low Film Thickness: 5µ
OptiBond XTR’s novel monomer technology provides strength, compatibility, and high performance to all procedures 24

25. Film Thickness Comparison
ClearFil SE (~35 microns)
~35μm
~5μm
SEM images magnified at 2,000X
SEM images magnified at 2,000X
OptiBond XTR (~5 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 25

26. Clinical Evaluation of OptiBond XTR26

27. Highest Bond Performance
OptiBond XTR bond strength in both dentin and enamel was statistically superior to leading self-etch bonding agents
3rd Party Testing, State University New York, Buffalo
Published at IADR (March 2011, San Diego, California, USA), abstract # 2463 27

28. OptiBond XTR demonstrated the highest Bond Retention
OptiBond XTR provides highly durable bonds for all restorations
Dr. Lorenzo Breschi, University of Trieste 28

29. Marginal integrity studies
OptiBond XTR Yielded Excpetional Marginal Integrity in Class I Restorations
Total etch on enamel
Continuous Margin
Marginal integrity studies
by optical microscope
High marginal integrity without the use of phosphoric acid sets OptiBond XTR apart from other self-etch bonding agents
Study conducted by Dr. Uwe Blunck, Berlin 29

31. OptiBond XTR demonstrtaed Consistently High Bond Strength
3rd Party Testing At 5 Independent Research Facilities
OptiBond XTR provides predictable bond performance 31

32. Battle of the Bonds, France
330 tests during the day. Total of 18,225 tests
OptiBond XTR provides predictable bond performance 32

33. Proven clinical performance with OptiBond 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)
OptiBond XTR Proves as Effective as OptiBond FL In-Vivo Clinical Trials without
the need for Phosphoric etch
Prof. Bart van Meerbeek, Catholic University of Leuven 33

34. Superior Bond Compatibility with OptiBond XTR
OptiBond XTR Comparative Dentin Bond Strengths with Resin Cements
in Self-Cure Mode vs. 5th and 7th Generation Adhesives
*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
OptiBond XTR can be used with all light, self-and dual-cure resin materials without the need for additional components 34

35. Excellent Bond Compatibility
OptiBond XTR was light cured first. Cements were allowed to self-cure. Kerr internal data. 35

36. OptiBond XTR – “The Right Science”
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 36

37. OptiBond XTR + NX3
The PERFECT Match 37

38. NX3 is compatible, stable, and universal.
NX3 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 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 is compatible, stable, and universal. 38

39. Novel Initiator System
Free Radicals
to Initiates Polymerization +
Tertiary Hydroperoxide
PTU
Superior esthetics due to self-bleaching property of its unique redox initiator system
Only dual-cure cement on the market indicated for Veneer cementation
Excellent shelf-life and gel/set time stability , and Enhanced bond compatibility 39

40. Color Stability Uncured
Discoloration of Uncured Catalyst Pastes after Aging for 8 weeks at 37°C
Before Aging
Nexus2
RelyX ARC
Calibra
Variolink II
NX3
After Aging
Color Stability of NX3
Internal data
NX3 has the highest esthetic properties 40

41. NX3 has the highest esthetic properties
Color Stability Cured
Comparison of dual-cure resin cements – clear shade
After Aging for 28 weeks in 37°C Water
NX3
Variolink® II
RelyX™ ARC
Calibra ®
Initial
After
Aging
Internal data
NX3 has the highest esthetic properties 41

42. NX3 Color Stability vs. Multilink Cured
Color stability of leading resin cements after aging for 28 weeks in 37°C water
NX3
Multilink*
Initial
After
Aging
Internal data
*Multilink aged 12 weeks 42

43. 3rd Party Verification of Color Stability
T. Hilton et al, IADR 2010 Abst 2246, “A Comparison of Resin Cement Color Stability Over 6 Months”,
Oregon Health & Science University. 43

44. Universal Compatibility with all Bonding Agents
Comparative Dentin Bond Strengths with Resin Cements
in Self-Cure Mode vs. 5th and 7th Generation Adhesives
*Indirect Dentin Bond Strength. All bonding agents were light-cured. Cements were allowed to self-cure. Kerr internal data. 44

45. Bond Strength to Different Substrates
Dentin, Gold, Rexillium, Lava, Porcelain, Composite
Internal Data 45

46. Excellent Bond Strength in Total Dark-Cure Mode
OptiBond XTR/NX3 Prep
Excellent Bond Strength in Total Dark-Cure Mode
*All systems were evaluated when used in total dark cure mode (no light used) 46
Dr. Carlos Munoz, State University New York, Buffalo

47. Excellent Bond Strength to Porcelain
OptiBond XTR/NX3
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. 47

48. The CEREC Challenge 48

49. Evaluation Protocol Evaluation Involved: Immediate Post-Op Sensitivity
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.
Preparing Crown
Evaluation Involved:
Immediate Post-Op Sensitivity
Ease of use
Clean-up
Color Stability
Bonding Protocol
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.
Scrub OptiBond XTR PRIMER onto the prep for 20 seconds.
Air thin with medium air 5 seconds.
After seating the restoration, tack cure excess NX3 for 2 seconds. Clean excess.
Light cure all surfaces for 20 seconds.
Final Cementation/Seating 49

50. OptiBond XTR Adhesive 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.”
*Rating scale from 1 to 5, where 1 = Strongly Disagree, 5 = Strongly Agree 50

51. Clean-Up of NX3 Cement Question Average Score*
“Clean-up is a very important attribute when performing indirect procedures.”
5.00
“I liked the clean-up of NX3.”
“NX3 was easier to clean than Multilink Automix cement.”
4.75
*Rating scale from 1 to 5, where 1 = Strongly Disagree, 5 = Strongly Agree 51

52. Color Stability 2 weeks aging in office drawer 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.”
“The color of set NX3 is much better than Multilink after 4 weeks.”
“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 52

53. OptiBond 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
A Truly Universal Bonding Agent 53