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Lesson Materials

Learn in more detail about 3M Scotchbond Universal Plus, its attributes, and techniques for best results.

Welcome, congratulations on taking an important step towards improving your practice by using the Bioclear Method. A revolutionary approach to restorative dentistry. The difference you’ll make for your patients can be life-changing. As you move forward, we want you to understand why the Bioclear Method uses 3M materials to help optimize results.

We believe any change in your practice should be kept as simple as possible.

That’s why there are just five primary 3M products used in the Bioclear Method. All scientifically proven to elevate procedures and results.

3M Filtek Supreme Ultra Universal Restorative and 3M Filtek Supreme Flowable Restorative are used for anterior restorations. They’re color coded blue. So you know they work together in the interior.

3M Filtek One Bulk Fill Restorative and 3M Filtek Bulk Fill Flowable work together for posterior restorations. They’re color coded green as perfect partners for posterior restorations. Blue is for beautiful anterior restorations. And green is for great posterior results. It’s that easy.

With all 3M composites, 3M Scotchbond Universal Plus Adhesive is recommended. That’s the five product lineup for success with the Bioclear Method. Our learning modules will help you see why 3M materials were chosen for the Bioclear Method. We’ll also explain how they’ve been validated through more than five years of extensive scientific studies.

Now, let’s take a closer look at 3M Scotchbond Universal Plus Adhesive. It evolved from the number 1 universal dental adhesive platform from 3M and provides gold standard adhesion to all dental substrates, including glass ceramic, without the need for a separate primer, saline, or activator. It’s also the first universal adhesive with dentin-like radiopacity to help reduce the risk of misdiagnosis and potentially invasive over-treatment when radiolucency is mistaken for decay.

And it bonds to caries-affected dentin to support minimally invasive dentistry and the preservation of tooth structure. When sealing caries-affected dentin, it forms a well-defined void-free hybrid layer. This has been shown to stop caries’ progression.

This module will help explain why Scotchbond Universal Plus Adhesive is recommended with all restorations placed using the Bioclear Method. We’ll give a brief product description then you’ll hear from Dr. Charlie Regalado about his experience using this adhesive and the Bioclear Method.

3M Lead Product Development specialist, Dr. Christoph Thalacker, will weigh in with the science-based benefits and present the studies that back them up. Finally, we’ll look at some chair side tips for incorporating Scotchbond Universal Plus Adhesive into the Bioclear Method in your practice.

Today, we’ve got two experts with us to discuss the benefits of 3M Scotchbond Universal Plus Adhesive, and the scientific studies that back up its advantages. They are Dr. Charlie Regalado, full faculty member at the Bioclear Learning Center, and 3M Lead Product Development Specialist, Dr. Christoph Thalacker. Let’s start with Dr. Regalado. Can you tell us how the improved radiopacity of 3M Scotchbond Universal Plus Adhesive has improved diagnostics in your practice?

I love Scotchbond Universal Plus Adhesive. And one of the reasons why I love it, is the improved radiopacity. The radiopacity is now similar to dentin. And that gives me a lot of comfort, when I’m trying to diagnose caries on a radiograph. I think for far too long, dentists have always been left to ponder, when is the right time to replace this composite? Is that decay? Or is it just some other kind of a product that is too radiolucent?

Well, the Scotchbond Universal Plus Adhesive is take care of that problem for us because now we have uniform radiopacity from the floor of the prep, all the way to the top. And frankly, it’s a good look on my composites. And that gives me the confidence that I’ve done my job well.

Great, thank you. Now to Christoph Thalacker. How do you go about creating a radiopaque universal adhesive?

Historically, radiopacity of dental materials has been achieved by using radiopaque inorganic fillers. As these filler particles are heavier than the resin, they tend to settle out of a low-filled dental adhesive. And so you have to remember to shake the bottle every time you use it. Another disadvantage is that they thicken the adhesive and lead to unfavorable high-risk handling.

Our approach was to develop a novel cross-linking radiopaque resin, which has heavy atoms as part of the molecular structure. These heavy atoms of hot radiopacity, similar to an X-ray contrast agent. As this resin replaces the Bis-GMA from the original Scotchbond Universal formulation, the viscosity is very similar and handling was rated very well by the participants in the field evaluation.

Here you can see the radiopacity of human dentin, Scotchbond Universal Plus, and a number of well-known adhesives. According to the ISO standards, it is measured in percent of aluminum. Dentin has a radiopacity similar to that of aluminum 100%, or in other words, the radiopacity of 1 millimeter of dentin is equivalent to 1 millimeter of aluminum.

The radiopacity of Scotchbond Universal Plus is statistically not different from that of dentin. But significantly higher than the radiopacity of the other adhesives tested. I think all of you have seen similar X-rays, questionable radiolucency under restorations, where you are not sure whether this comes from pooling of a radiolucent adhesive, secondary carriers, marginal gaps or voids.

Radiopaque Scotchbond Universal Plus helps avoid these radiolucencies and therefore minimizes misdiagnosis of secondary carriers compared to other universal adhesives. Actually, in a survey among 309 general practitioners from Europe and the US, 51% of participants stated that they need to interpret at least one questionable X-ray per day, where the radiolucent area under an existing restoration.

Excellent. Thanks for that. Back to Dr. Regalado. Clinically speaking, why is it important that 3M Scotchbond universal plus adhesive bonds to caries-affected dentin?

I could answer that question looking at two different scenarios. One would be a scenario where a dentist is trying to remove all the decay in the preparation but inadvertently misses some. That can happen. And it’s the greatest comfort for me to know that even if it did happen, that caries-affected dentin will still be well-bonded to and sealed.

The second scenario is for dentists that choose to not really enter into the pulp of the tooth. It’s a deep-cary situation, but rather than entering the pulp, they’ll clean the cavity prep as much as possible near there and then go ahead with the adhesive process. And that is where the Scotchbond Universal Plus would for me in my opinion, have its optimum benefit and ability to bond to that caries-affected dentin. This is a real game-changer for us.

Thank you doctor. Now, Christoph what has changed? Why can you now bond to caries-affected dentin when using 3M Scotchbond Universal Plus Adhesive?

Over the past years, minimally invasive dentistry has become a big trend. The goal is to save as much tooth structure as possible, in order to increase the longevity of the tooth. According to minimally invasive preparation guidelines, maintaining vitality of the pulp is more important than complete caries removal.

Therefore, on the cavity floor, only soft caries-infected tissue should be removed with firm caries-affected tissue as the endpoint. In deep lesions, even spots of soft-infected tissue can be left behind in order not to open the pulp. For Scotchbond Universal Plus, we exchange the Bis-GMA resin of the original Scotchbond Universal for the new radiopaque resin, which by the way enabled a bisphenol A-derivative free formulation.

As we were well aware of the growing importance of minimally invasive dentistry and preparation techniques, we tested our formulation, not only for bone strength to sound dentin but also to caries-affected dentin. We were very happy to see that we achieved similar shear bond strength to caries-affected dentin and sound dentin as they control Scotchbond Universal Adhesive on sound dentin. Together with a well-defined hybrid layer, this makes it well-suited for minimally invasive dentistry procedures.

Thank you Christoph. Now, can you tell us, why is it important to always cure adhesive on dentin when injection molding?

In contrast to enamel, dentin contains a high level of moisture, dentinal fluid, especially in deep cavities, there can be a continued flow of dentinal fluid, which can dilute the adhesive. This can cause poor bone strength and post-operative sensitivities.

If you cure the adhesive immediately after the application, you seal the dentin, stop the fluid flow, and avoid these kind of issues. As you can see here, we increased shear bond strength to dentin of Scotchbond Universal Plus to over 30 megapascals, which compares favorably to its predecessor and a number of recent competitive universal adhesives.

Thank you Christoph. Now, Dr. Regalado, every dentist is concerned about patient comfort, what kind of post-operative sensitivity have you seen with your patients after using 3M Scotchbond Universal Plus Adhesive?

When it comes to the issue of post-op sensitivity and Scotchbond Universal Plus Adhesive that is an easy one for me to answer. It’s essentially nothing. Now, there are some very strict guidelines I always adhere to when I’m doing that etch in process in these patients teeth, especially on dentin. But I have not had any problem, no sensitivity with this material at all.

Now, often I’m doing the total-etch technique. It’s very important to follow those guidelines. But many times, I’m using selective etch. And I’m not etching the dentist at all. But either way, it doesn’t matter. I have not had one report of post-op sensitivity. And believe me I do ask my patients about it.

Thank you doctor. Christoph, can you explain the science behind sensitivity and how it is minimized by 3M Scotchbond Universal Plus Adhesive?

Scotchbond Universal Plus contains the same adhesive monomers, solvents, and initiators, and co-polymer as its predecessor Scotchbond Universal Adhesive. The clinically proven and most researched universal adhesive on the market since September, 2011. Therefore, it shows similar formation of a well-defined void-free hybrid layer and identical formation of resin tags that infiltrate and seal open dentinal tubules on dry and moist dentin.

This helps prevent movement of dentinal fluid under a restoration, which is the main cause of post-operative sensitivity according to Brannstrom Hydrodynamic Theory. Like its predecessor Scotchbond Universal Plus affords virtually no post-operative sensitivities.

In the first– in-vivo field evaluation in Europe and the US, 309 dentists used Scotchbond Universal Plus over 20,000 times for different applications. 146 of these dentists were currently using Scotchbond Universal as the preferred adhesive while 163 doctors preferred other adhesives. 99% of the Scotchbond Universal users and 98% of the users of competitive adhesives reported the same or less post-operative sensitivity for Scotchbond Universal Plus.

Like the original Scotchbond Universal, Scotchbond Universal Plus also affords a strong marginal seal. In vitro study by Dr. Blanc from the Charité University in Berlin, Germany, Scotchbond Universal Plus showed 97% to 99% continues tight margin after artificial aging in the same range as gold standard three-step action and Rinse adhesives.

Thank you. Finally, let’s talk about injection molding since it’s a vital part of the Bioclear Method. Why does this adhesive work for you during injection molding Dr. Regalado? And do you worry about the initial yellow color of 3M Scotchbond Universal Plus Adhesive?

The reason why Scotchbond Universal Plus Adhesive works for me in my injection molding procedures really comes down to one thing, I know it works. The research has been pretty plain and pretty extensive, Scotchbond Universal Plus Adhesive is a great adhesive. It’s going to bond to enamel of course. But the bond to dentin and even affect the dentin is just a game-changer for us.

Now, I actually love it because it’s a little bit thicker. Now, some people want it thin. But I actually like the thickness. And the reason why I like it, is because I can see it. An injection molding requires that you cover that tooth with that adhesive as a wetting agent prior to the injection molding your composites.

So I can see it. I know it’s there. I know it’s a great bond. It’s pretty much a no-brainer for me that this is the best adhesive on the market for injection molding. And I’m not worried about the color one bit. Now, I used to. I understand it. People can see a little intensity yellow color. Well, most adhesives, I would say, have the same camper quinoa in it, which creates that yellow tint. But here’s the thing, when you cure it properly the color goes away. And so it’s not visible anymore.

Now, that could be an advantage to me because it tells me that I’ve properly cured my composite. So if you look at your composite it has a little bit of a yellow tint to it that means you haven’t cured enough or your light isn’t deep enough to cure. And maybe you need to get that light checked. So I would say, no, the color doesn’t bother me at all. In fact, I think it’s an advantage for me.

Final question for you Christoph. Does injection molding affect bond strength, since you’re placing an uncured layer of adhesive over a cured layer and curing the adhesive flowable and universal restorative as a complex?

No, placing an uncured layer of adhesive over a cured layer and curing the adhesive flowable and Universal Restorative as a complex does not affect bone strength. There is no statistical difference in shear bond strength when using cured versus cured plus uncured layer of the adhesive in the universal composite injection molding technique. It’s just important to remember to cure the first layer of adhesive in order to seal the dentin and maximize dentin bond strength.

And why is it yellow before it’s cured?

The yellow color comes from the camphorquinone photoinitiator in Scotchbond Universal Plus. While the color may appear quite intense for a thick layer of uncured Scotchbond Universal Plus, it becomes virtually invisible if the adhesive is thinned out and cured. You may actually take advantage of the yellow color as an aid in placement, air drying, and curing of the adhesive.

Thank you again Dr. Regalado and Christoph Thalacker. Excellent. You’re now a 3M Scotchbond Universal Plus Adhesive expert. Now, have time for a few important tips on how to incorporate this product into your practice and the Bioclear Method. Meet Daley Williams. She provides chair side support for restorations placed using the Bioclear Method. So she knows her stuff. Welcome Daley.

Hello, and thanks for the introduction. As far as practice integration is concerned, the best rule of thumb is the simpler the better. This is one of the reasons we recommend 3M Scotchbond Universal Plus Adhesive. It’s a one bottle universal adhesive with an easy to use flip top design. Additionally, there’s no need for separate primers, salines, or activators. It has everything you need in a single bottle.

More specifically, Scotchbond Universal Plus Adhesive simplifies your inventory by offering light-cure and dual-cure capability without the need for a separate dual-cure activator. If you’re considering efficient hygiene management, they give you the option of a unit dose kit. Ultimately, Scotchbond Universal Plus Adhesive also comes in a vial, which gives you approximately 200 applications. This adhesive is also BPA derivative-free for patients who might ask or if your practice is health and lifestyle-focused.

Thanks for learning about the Bioclear Method. Please assign this module to your staff members in Bioclear Expand. To learn more, go to 3M.com/Bioclear.