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

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

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

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

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

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

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

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

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. 2011 Dec;23(6):390-6. doi: 10.1111/j.1708-8240.2011.00465.x. Epub 2011 Oct 17. 9

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

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

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

Excessive Film Thickness SEM magnified at 2,000X 13

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

The Science of OptiBond XTR Universal Adhesive 15

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

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

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

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

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

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

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. 2011 Dec;23(6):390-6. doi: 10.1111/j.1708-8240.2011.00465.x. Epub 2011 Oct 17. 22

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

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

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

Clinical Evaluation of OptiBond XTR 26

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

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

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

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

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

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

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

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

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

OptiBond XTR + NX3 The PERFECT Match 37

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

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

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

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

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

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

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

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

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

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

The CEREC Challenge 48

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

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

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

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

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