Transcript Adhesives Sales Training

Adhesives Sales Training
Danny Forcucci – Marketing Manager, Clinical
When to Use a Dental Adhesive?
• By first applying a layer of adhesive to the tooth structure, modern resin-based
restorative materials, such as composites and resin-based luting cements are able to
adhere.
• Adhesive material is always used before placing a direct composite restoration,
unless the doctor is using a self-adhesive composite.
• Adhesive material is always used before placing an indirect restoration with an
adhesive luting-composite system (e.g. Variolink II, Variolink Veneer).
• Adhesive material is not necessary when using a self-adhesive resin cement, GlassIonomer, Resin-Modified-Glass-Ionomer, or any other conventional cement.
Direct vs. Indirect Restorations
Direct
Every adhesive is indicated for direct restorations.
Indirect
An adhesive may not be indicated for use with adhesive resin cements, when placing
indirect restorations for these possible reasons:
a) Film thickness
- The thickness of the adhesive might prevent the restoration from not
fully seating, especially if cured prior to seating the restoration.
b) Incompatible chemistries
- Formulation of adhesive may be incompatible with formulation of
luting-composite (cement).
c) Curability of restorative material
- The adhesive might not contain the activators required to cure the
cement.
d) Pooling
- The viscosity might cause the adhesive to “pool” in the corners which
could prevent the restoration from fully seating.
Total Etch Technique
Also known as “etch & rinse” the “total-etch” term refers
to the procedure whereby both enamel and dentin are
etched with phosphoric acid before bonding. This
technique is typically used when bonding primarily to
enamel (e.g. veneers, inlays, onlays.)
Total Etch Technique
Enamel
Before
etching
After
etching
Dentin
The (phosphoric) acid demineralizes the
enamel to roughen or etch the surface. The
adhesive can then penetrate the porosities
and form an interlocking micromechanical
bond for the highest bond strength.
The acid removes the smear layer, opening the
dentin tubules, and demineralizes the
intertubular dentin.
The adhesive can then penetrate the open
dentin tubules and form resin tags which
results in the highest bond strength.
Total Etch Technique
What is the “Smear Layer?”
A thin layer with small crystalline characteristics composed mainly of saliva
and bacteria. It appears on the surface of teeth that have undergone dental
instrumentation procedures such as “prepping” with a dental bur. Not easily
rinsed away, it must be removed by acid etching with phosphoric acid.
Total Etch Technique
Acid-Etching + Rinsing
Source: Sturdevant's Art and Science of Operative Dentistry, 6th Edition
Primer/Adhesive + Composite
Potential Hybrid Zone
Total Etch Technique
Critical aspects to bond to dentin
When air drying the dentin before applying
the adhesive, it is important not to over dry
(desiccate) the dentin because this would
collapse the collagen network and prevent
the adhesive from infiltrating the dentinal
tubules.
DRY Collapsed
Moist- Fluffy
Self Etch Technique
The “self-etch” term refers to the procedure whereby the
tooth surface is not etched with phosphoric acid. Instead
acidic resin, incorporated into the adhesive system itself,
etches and primes the surface in one step. This
technique is typically used when bonding primarily to
dentin.
Reduced Risk of Post-Operative Sensitivity
Dentinal tubules are not completely opened. The adhesive material etches and penetrates in one
step, making the etching depth and depth of the adhesive’s penetration the same.
More Technique Tolerant
The concern about over drying the dentin discussed on the previous slide does not apply to the self
etch technique because the doctor does not need to dry the surface before applying the adhesive.
Selective Etch Technique
The “selective etch” term refers to the procedure
whereby only the enamel edges of the preparation
are “selectively” etched with phosphoric acid.
•
Selective etching incorporates the advantages of Total Etch (highest bond to enamel) and Self Etch
(reduced risk of post-operative sensitivity).
•
However, bond strength can be compromised and post operative sensitivity could occur if the dentin is
inadvertently etched with phosphoric acid.
Light- / Self- / Dual-Cure Adhesives
Light Cure
The adhesive must be exposed to a curing light.
Self Cure
The adhesive must be left to polymerize on its own without a curing light. These adhesives
do not contain any light-initiators and therefore are not affected by curing lights.
Dual Cure
The adhesive can be either light- or self-cured. These adhesives usually require a dual-cure
activator, or must come in contact with a dual-cure resin material (e.g. cement).*
*Note: Some adhesives, such as ExciTE F DSC, must be light cured unless it comes in contact
with a dual-cure resin material (e.g. Variolink II base & catalyst mixture.)
Compatibility with Light- / Self- / Dual-Cure
Materials
• Practically all adhesives are compatible with light cured restorative
materials.
• Some adhesives (such as AdheSE One F and ExciTE F) are not compatible
with self- / dual-cure restorative materials because they do not contain the
initiators required for polymerization of the materials.
• Some adhesives (such as AdheSE) are compatible with dual-cure materials
only when used with an additional dual-cure activator
Chemical Composition
• Adhesives typically contain these three components that serve the following functions:
• Solvent : Surface wetting, infiltration, evaporation leaving behind only resin
• Functional monomers: Chemical bonding to tooth structure
• Fillers: Viscosity properties
Types of Solvents
Advantages
Disadvantages
Acetone
•
Dries quickly
•
•
•
Highly volatile
Can not expand collapsed collagen
Effective only on moist dentin
Ethanol
•
•
Dries well after application
Tolerant of dentin moisture
•
Some extra drying time required
(compared to acetone) to evaporate
solvent
Water
•
•
Expands collapsed collagen
Tolerant of dentin moisture
•
Adhesive layer must be adequately dried
to remove the water
Longest drying time
•
Generations of Bonding Agents
Gen. Type of System
Steps
IV Product
With each generation…
•Reduced # of components
•Reduced # of working steps
•Faster application procedures
ExciTE® F
• ExciTE F is a light-curing, fluoride releasing, singlecomponent total-etch adhesive used in:
•
•
direct restorations (composites)
adhesive luting of indirect restorations (ceramics, lab
processed composites) involving light-curing cements
• ExciTE F is available in the unique VivaPen, in bottles
or in Soft-Touch Single-Dose vessels
ExciTE® F DSC
• ExciTE F DSC – Dual-Cure Single-Component – is a dual-curing, fluoride releasing
adhesive for enamel and dentin bonding, which is used in combination with the
total-etch technique.
• ExciTE F DSC has been further designed for clinical cases where light cannot be
used for curing and when chemically curing composites are employed.
AdheSE®
• AdheSE is a self-etching, light-curing, twocomponent adhesive system for enamel and
dentin bonding used in:
•
direct restorations
(composites, compomers)
AdheSE DC Activator
Enables the AdheSE system to be used in conjunction
with self- or dual-curing composites or luting material
AdheSE® One F
• AdheSE is a self-etching, light-curing,
single-component, fluoride releasing
adhesive system used in:
• direct restorations
(composites, compomers)
Clinical Procedure
Self Etch – AdheSE One F
Disperse excess with a
strong stream of air to
evaporate solvent
Light-cure for 10
seconds
Apply one layer of ExciTE F
to moist prep and agitate
for at least 10 seconds
Gently apply air to
evaporate solvent
Apply a layer of AdheSE One F
and agitate for 20 seconds
Total Etch – ExciTE F
Etch enamel and dentin
with phosphoric acid then
rinse and lightly air dry
Dr. A. Peschke, Liechtenstein
Light-cure for 10
seconds
Solution-based Selling
Doctor’s Concerns Relating to Adhesives:
•Post-operative sensitivity
•Bond strength/retention
•Product waste
•Practice productivity
Post-Operative Sensitivity
Not properly sealing the dentin tubules causes pressure or ionic changes in the fluid flow
that exists in the dentin tubules, which stimulates post operative sensitivity.
The released fluoride in AdheSE One F and ExciTE F can support the sealing of the tubules
by forming calcium fluoride, which may help prevent dentinal fluid movement and the postoperative sensitivities associated with it.
Post-Operative Sensitivity
Incomplete coverage of the bonding surface could result in poor bond strength
and possibly also cause post-operative sensitivity.
• Acetone is a highly volatile material.
• Therefore, adhesives that have an acetone-based solvent, such as BISCO AllBond, are composed of approximately 30% resin material and 70% solvent.
• Acetone-based adhesives require multiple coats to ensure that the resin
(active ingredients) are coated on the bonding surface for proper coverage.
Post-Operative Sensitivity
• Ivoclar Vivadent adhesives are acetone-free, which enable them to contain
more than 70% resin and less than 30% solvent…allowing for true one-coat
applications.
• Furthermore, the unique chemistry of AdheSE One F and ExciTE F creates a
visible glossy layer on the surface during application to assure uniform
coverage and sealing of the dentin and enamel.
Bond Strength/Retention
•
•
•
Many adhesives contain an acetone-based solvent.
Acetone has a high level of evaporation.
Removing the bottle cap for each use causes some evaporation of the solvent which
could reduce bond strength.
Ivoclar Vivadent adhesives are
acetone-free, allowing the
adhesive to be used for longer
periods of time without affecting
bonding results.
Habib, C.; Kugel G; Tufts University, Boston, USA, 2000
Product Waste
• Most single dose products have enough material for three
applications. Therefore 2/3 of the material could be wasted.
• With a bottle, it’s difficult to dispense the exact amount of
adhesive needed for a procedure. Therefore, it’s common to
have significant waste with the bottle delivery form.
• There is virtually no waste when using the VivaPen because it
dispenses only what is needed.
Productivity
• ExciTE F DSC comprises a special patented applicator, which is coated with the
initiators required for the dual-curing action.
• When the applicator is dipped into the adhesive solution, the initiators mix with the
adhesive and impart it with the dual-curing properties.
• Fast, easy application
Applicator coated with initiator crystals under the electron microscope
Selling Advantages of the VivaPen
Fresh Material Every Time
Virtually no evaporation of solvent in VivaPen because the locking mechanism within the
cannula prevents air from entering the pen. Fresh material from the first to last drop
No Waste
The VivaPen has virtually no waste because it dispenses only what is needed
Fast Application
The “application” time of the VivaPen is significantly less than bottle because the doctor
simply “clicks & bonds”
Ergonomic Design
The VivaPen features a unique, ergonomic design allowing the adhesive to be applied in a
relaxed manner. The slim, pen-like shape and the angled brush cannula are modeled after
the time-tested design of dental instruments.
IFU on the Product
The adhesive IFU is printed on the side of the VivaPen, making it very easy for the
doctor to ensure that the proper instructions are followed for optimal performance
Feature/Benefit Summary
ExciTE® F
Feature
Benefit
10 second scrub
Fast application
Fluoride release
Reduce risk of post-op sensitivity by “plugging”
the tubules with calcium fluoride
Visible glossy surface
High bond strength and reduced risk of post-op
sensitivity by ensuring complete coverage
Acetone-free
Consistently high bond strength first to last drop
Stable at room temperature
No need to store in refrigerator and bring down to
room temperature before using
High resin content
Multiple coats not required
3 delivery forms, including
unique VivaPen
Accommodated doctor’s preference
Feature/Benefit Summary
ExciTE® F DSC
Feature
Benefit
Innovative brush
technology
Fast application
Ultra-low film thickness
Ensure accurate fit of indirect restorations
Fluoride release
Reduce risk of post op sensitivity by “plugging” the
tubules with calcium fluoride
Pre-curing not required
Ensure accurate fit of indirect restorations
Acetone-free
Consistently high bond strength first to last drop
Stable at room temperature
No need to store in refrigerator and bring down to
room temperature before using
High resin content
Multiple coats not required
Feature/Benefit Summary
AdheSE®
Feature
Benefit
Color coordinated bottle
with matching color and
instructions on
dispensing well
Easy and accurate application
Acetone-free
Consistently high bond strength first to last
drop
Stable at room
temperature
No need to store in refrigerator and bring
down to room temperature before using
High resin content
Multiple coats not required
Feature/Benefit Summary
AdheSE® One F
Feature
Benefit
Acetone-free
Consistently high bond strength first to last
drop
Stable at room
temperature
No need to store in refrigerator and bring
down to room temperature before using
High resin content
Multiple coats not required
Fluoride release
Reduce risk of post op sensitivity by
“plugging” the tubules with calcium fluoride
Visible glossy surface
High bond strength and reduced risk of postop sensitivity by ensuring complete coverage
Sales Tools
AdheSE One F brochure
(627528)
ExciTE F brochure
(633212)
ExciTE F scientific
documentation
Adhesive Power Point
presentation