# Superb Universal Adhesive Technique- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

This is a step-by-step procedure using Superb Universal Adhesive.

Thomas W. Mitchell, DDS, FAGD
18 and 19 with failing composites done in China. The DB cusp of 14 has fractured that buccal extension on 19, so I flattened out that area on 14 to get more room for composite on 19 buccal.
Thomas W. Mitchell, DDS, FAGD
This is the prep on 18. I changed it later on to extend into the groove between the MMR and the MB cusp.
Thomas W. Mitchell, DDS, FAGD
First step is Clean and Boost, and it is left on for 15-20 seconds to etch the enamel really well. This step cleans the debris off the prep and pre etches the enamel without over etching the dentin.
Thomas W. Mitchell, DDS, FAGD
Here's the etched enamel on 18
Thomas W. Mitchell, DDS, FAGD
And the etched enamel on 19
Thomas W. Mitchell, DDS, FAGD
BondSaver D is the next step. Bond Saver “D” utilizes a proprietary ingredient to prevent bond degradation, while also acting as a rewetting agent, desensitizer/collagen stiffener and disinfectant, as it contains fluoride, glutaraldehyde, chlorhexidine and HEMA.
Thomas W. Mitchell, DDS, FAGD
Just flood some Bondsaver D on to re-wet the prep and blot or blow off the puddles. Be sure to leave the surface shiny wet. (Wet Bonding)
Thomas W. Mitchell, DDS, FAGD
Then apply 3 liberal coats of Superb Universal Adhesive and air dry thoroughly after the third application. (Completely Dry)
Thomas W. Mitchell, DDS, FAGD
Now add a thin layer of Titan Flowable composite. This is A2 shade. In very deep areas I use WO Titan to define the close proximity to the pulp in case the restoration is ever revisited.
Thomas W. Mitchell, DDS, FAGD
Co-cure the Superb with the Titan. If you have a Valo light you can turn it up to plasma mode "XTRA POWER" (3200mW/cm2) and just light activate for 3 seconds. Otherwise for a standard power light, 10 sec light activation.
Thomas W. Mitchell, DDS, FAGD
This is Exquisite Restoration nano composite. Due to its extremely low shrinkage, one increment up to 4mm can be placed as a bulk fill. I usually like to place one side at a time, light activating each for 3 sec. with the Valo light on XTRA POWER. I usually don't connect the Buccal cusps with the Lingual cusps to avoid additional stress as the composite shrinks during curing. Exquisite Restoration has such low shrinkage that it really doesn't matter, but it does matter with older composites, which have much higher shrinkage.
Thomas W. Mitchell, DDS, FAGD
Then I add the Lingual cusps and contour in the anatomy I want.
Thomas W. Mitchell, DDS, FAGD
Then I add the Lingual cusps and contour in the anatomy I want.
Thomas W. Mitchell, DDS, FAGD
And the Lingual cusps.
Thomas W. Mitchell, DDS, FAGD
Remove the dam and check the occlusion. It was high right where I thought it would be on the buccal extension of 19.
Thomas W. Mitchell, DDS, FAGD
To adjust, I use the diamonds in this “Kanca Posterior Composite Finishing Kit” by Brasseler. They made it at Dr. John Kanca’s instruction. I'm usually real skeptical about designated kits like this, but I love this one. Every one of the diamonds cut smoothly on composite without digging in.
Thomas W. Mitchell, DDS, FAGD
Here you can see the shapes, although in this photo they're not in the right order with the numbering on the box. I use all of them at one time or another. On this case I used the big round one for the occlusal adjustment and the smaller triangular one to finish the grooves. (Note: Dr. Kanca does not receive compensation for these. He had this made to help us).
Thomas W. Mitchell, DDS, FAGD
After adjustment I clean the surface first with pumice, then Clean and Boost
Thomas W. Mitchell, DDS, FAGD
Then seal and glaze the composite with one coat of Superb Universal Adhesive.

Conclusion: 

As our materials have improved and our knowledge of bonding has increased, so has the complexity of our procedures. It's important to understand all the details of the "why's" and the chemistry/physics of these procedures. The end results we're getting are significantly better than what we could produce even a few years ago. We are now consistently able to build beautiful, complex restorations rather simply, knowing they'll withstand all the trauma our patients will put them through. Hope this helps.

Case by: 

Thomas W. Mitchell, DDS, FAGD