Clinical Case

NX3 and OptiBond XTR in Total

dark-cure mode: A challenging
three-unit bridge based on endocrown
Dr. Aleksander Maj

NX3 and OptiBond XTR in Total darkcure mode: A challenging three-unit

bridge based on endocrown
Dr. Aleksander Maj,
DDS

Aleksander Maj graduated from the Medical University of Silesia in 2000. Dr. Majs current
professional interests are low-invasive (adhesive) prosthetics, implantoprothetics and orthodontics,
after many years of activity in the fields of endodontics and classical prosthetics as well as the
completion of full training courses in periodontology and implantology. He is currently working at
the Reden MAYO-DENT Medical Centre in Dbrowa Grnicza, Poland. His papers are published
in dentistry periodicals. Dr. Majs hobbies include photography, bird watching, mountain biking and
kitesurfing. His solid knowledge of English and French helps him communicate at international
congresses and training sessions. Dr. Maj has been performing lectures, carrying out training
schemes and workshops in the area of prosthodontics since 2008.

The cementation of adhesive restorations differs greatly from the

cementation of retentive restorations. In the case of the latter, a
number of factors play a role, including the total surface area, the
degree of convergence of the abutment, the height of its walls and
its anti-rotation features. An adhesive restoration has for all intents
and purposes, no retention. Ensuring that such a restoration is
permanently fixed in place depends solely and exclusively on the
bonding process (adhesion) and this must be done painstakingly
using the appropriate materials. Not without significance here is the
choice of the bonding system and composite cement. In the case
study presented below we used OptiBond XTR and a conventional
Nexus NX3 resin composite cement that is compatible with it.
Their compatibility lies in the fact that the ingredients of the cement
trigger polymerisation of the bond, as a consequence of which
the bonding agent does not have to be light-cured separately. If
it were light-cured it would be only 10 microns thick. An additional
advantage of OptiBond XTR is that it can be used as a replacement
for a silane.
A 45 year old patient sought treatment for the replacement of tooth #
25 that was missing (Fig. 1, 2). Replacing the tooth with an implantsupported crown was made difficult by the low descending recess
of the maxillary sinus and the patients excessive cigarette smoking

habit approximately one pack a day. The patient did not want to
risk implant placement, but opted instead for a non-conventional
bridge made with Premise Indirect composite material.
To achieve this goal, a class II cavity preparation was used for
tooth 24,using an existing composite restoration that was removed
and the preparation was slightly extended to include the mesial
fissure. The second part of the bridge was based on an endocrown
placed in tooth 26, which had undergone root canal treatment.
This procedure required completely removing the existing filling,
removing caries from the distal surface and lowering the functional
and non-functional cusps by 2 mm (Fig. 3). Impressions were made
in a a 2-step technique using A-silicone impression material (Panasil
+ Take1 Advanced) (Fig. 4). After the impression was made, the
prosthetic field was protected with a provisional restoration.
The cementation was performed under full isolation using a dental
dam. The internal surface of the restoration (Fig. 5, 6, 7) was
sandblasted with aluminium oxide, rinsed with a water spray, dried,
and then covered OptiBond XTR Adhesive (Kerr) (Fig. 8). Usually,
prior to applying the bonding system, the bonded surface of the
restoration should be covered with an appropriate silane, but this is
not necessary for OptiBond XTR.

Fig. 1 Pre-operative occlusal view of missing tooth 25, existing fillings on teeth 24 and 26.
Fig. 2 Buccal view of non-vital discoloured tooth # 26.
Fig. 3 Tooth preparation for bridge tooth 26 prepared for endocrown.
Fig.4 Impression of the prepared teeth using a 2-step procedure.

The provisional restoration was then removed. The remainder of

the temporary cement was removed with OptiClean (Kerr) and the
surface area of the previously applied bonding agent was refreshed
with a sandblaster. The abutment teeth were rinsed and gently dried
with an air stream. The tissue surfaces were covered with OptiBond
XTR (Fig. 9), applying in sequence the self-etching OptiBond XTR
Primer and OptiBond XTR Adhesive bonding agent. The Primer
was rubbed into the surface for 20 seconds and smoothed out with
a medium air stream for 5 seconds. Next, OptiBond XTR Adhesive
was applied and gently rubbed in for 15 seconds. The bonding
agent was first spread out with a gentle and later with a strong air
stream so as to achieve a uniform, thin layer on the surface of the
abutments.
For cementation purposes NX3 (Kerr) composite cement was
used, the components of which allow the OptiBond XTR bonding
agent to harden, thereby eliminating the need for separate
polymerisation of the bonding agent applied on the restoration and
preparation surface. On the one hand, this made the work easier,
and on the other it protected against any possible polymerisation
of an overly thick layer of bonding agent, which as a consequence
may impede proper seating of the restoration, although with a thin
layer of OptiBond XTR equal to 10 microns (as declared by the
manufacturer) this should not pose any problem.

certain that polymerisation would occur in full. Excess cement

(Fig. 11) was removed with a flat plastic instrument, following brief,
preliminary polymerisation, when the cement had achieved gel form
(Fig. 12, 13). After the excess cement was removed, the margins
of the restoration were light cured with a Demi Ultra (Kerr) lamp, for
20 seconds on each side. Small amounts of excess material were
removed with a fine-grained, diamond coated bur and the whole
polished with an Opti1Step (Kerr) rubber and an Occlubrush (Kerr)
brush.
Protecting the molar following root canal treatment with an
endocrown is a good alternative to a classic crown, mainly on
account of the savings made in terms of prepared tissue. The
diversity of adhesive restorations that simply require bonding to
the remaining surface of a tooth and without the need for retentive
grinding allows for the use of hybrid bridges that connect together
different types of restorations. In the present case we used a bridge
consisting of an inlay and an endocrown as well as a span bridge
modelled with polyethylene fibres embedded into the Premise
Indirect material (Fig. 14, 15, 16, 17).

The spaciousness of the endocrown suggested the need for the use
of the dual cured NX3 Clear shade cement (Fig. 10). In this mode,

Fig. 5 Adhesive bridge made with Premise Indirect

composite resin material.
Fig.6 Details of anatomy of occlusal surface.
Fig. 7 View from preparation side
Fig.8 Sixth generation bonding system OptiBond XTR
(Kerr) in disposable Unidose packs.
Fig. 9 Application of bonding agent to tissue surface.
Fig. 10 Cement NX3 dual-cure version (self/light-cure),
Clear shade.
Fig. 11 View immediately after placement of restoration

excess cement is visible.

Figs 12,13 Removal of excess cement after brief,
preliminary light polymerisation
Fig. 14 Occlusal view of bonded restoration.
Fig. 15 Buccal view of bonded restoration
Figs 16,17 Follow-up after 16 months.

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