Dental Product Insights: BISCO's Thera Family – an Interview with Lauren Yasuda Rainey, DDS

Video Transcript:

Noah Levine: Hello, I'm Noah Levine Editorial Director with Dental Products Report. Today I'm joined by Dr Lauren Yasuda, Rainey. And she's here to talk with us a little bit about some cutting edge materials in the dental industry. Dr. Rainey, thanks so much for joining us.

Lauren Yasuda Rainey, DDS: Hi. Good morning. Thanks so much for having me.

Noah Levine: Well, to get started, can you tell everyone who's watching a little bit about yourself and the type of practice you do?

Lauren Yasuda Rainey, DDS: Sure, I'm currently doing a bit of a split schedule. About half of my time is in clinical practice, and the other half of my time is in education. It wasn't always that way. I am a former owner. I owned and operated my own solo practice in Berkeley, California for almost 7 years, and recently relocated to the Pacific Northwest to be closer to some extended family. So currently, I'm an associate. And I think I bring a bit of a unique perspective as a former owner, and not like a soon to be retiree to the practice that I work in. A lot of people that sell tend to be sort of at the end of their sort of clinical years. And that's certainly not me. But I would say in the last decade of my career in the bay, I was treating a mostly retiree population, like 65 Plus demographic. So I saw a lot of worn teeth, broken amalgams, fractured teeth, abfractions, and a pretty heavy focus on direct restorative was my focus there. And in education, I do kind of a mixed bag of stuff. I teach direct restorative techniques, mostly using composite as an alternative for crowns, a little bit about soft tissue management and clinical dentistry, and also a little bit about how to take your practice to a fee for service model. So that is kind of the scope of what I'm working on right now.

Noah Levine: Well, that is wonderful. And we really appreciate you taking the time to talk with us. And we did want to talk a little bit about the Thera line of products from BISCO. And I guess to start off, how long have you use these products and kind of what first attracted you to put these into your practice?

Lauren Yasuda Rainey, DDS: Yeah, so the Thera products in particular, I've been using those for a little over a year now. But I've been using products from BISCO since about 2016, 2017. In 2017, a fantastic 20-plus-year, veteran, prosth assistant joined my practice, and she was an absolute wealth of knowledge on materials and materials selection. Having sat chairside, with a fairly prominent prosthodontist in downtown San Francisco. So she's who first introduced me to BISCO. But mostly she had a sense of what products were really lasting for a long time. And, you know, when she started saying, "Hey, you should start using these adhesives and take a look at their product line." That's what like first introduced me to their products in particular. And the Thera line wasn't something that I really knew about, and that was on me, til a little over a year ago. And once I started to really learn more about their benefits, I was diving in headfirst. You know, I've been that solo provider out there. It's easy to get into the habit of doing what you do and using what you use. But having a vested interest now in education that really helps keep me up to date on developments in real life anecdotal evidence, both from like what I'm doing in my educational peers in dental products. So that's the long answer to how I started using their stuff.

Noah Levine: Now, they've got a range of products in this line, but with things like TheraCal LC, and TheraBase, and mostly these are, you know, as you mentioned, cements and liners and products that are used beneath restorations. Is that your primary use, kind of what do you you know, go to and how do you decide this is a case where I want to put a Thera product in that mouth?

Lauren Yasuda Rainey, DDS: Yeah, for sure. So, again, my sort of clinical demographic has been a 65 plus crowd and a lot of those teeth are pretty heavily restored even before I even get in there. So I'm reaching for these things if there's deep caries and like lots of exposed dentin. You know, JADA released the recommendations for selective caries removal in July of 2023 as their sort of desired prep design, and that's something I've actually been practicing for some time, so it's nice to see it actually in the literature. You don't always need to go directly into the pulp to remove everything that you can. Leave a little bit of that orange-brown dentin in there, as long as it's, you know, not like mushy, but being able to add something from the Thera line to that affected dentin.

Noah Levine: And, you know, obviously, there is no shortage of selection for dentists to pick from when it comes to the materials they're choosing. So why do you think people should be choosing materials that have a calcium and you know, some of these materials also, in some cases, release fluoride as well or recharged fluoride? What is the benefits that patients get? And why should these be considerations for clinicians?

Lauren Yasuda Rainey, DDS: Again, I'm treating a lot of dentition, that's like pretty well, seasoned, maybe we could say. When we're working with teeth that are already had an occlusal, and then they get an MOA, and they get a DO, and now we're either looking at an MOD, or full coverage, or full coverage for the second or third time, I'm gonna throw everything I've got from the science perspective. And I know and I trust that BISCO has their line of scientists, and they are looking at these materials from, you know, the chemical sort of side of things, and I'm looking at it from the clinical side. And if we can marry those two things together, then I know that these products are going to be working with the tooth, and with me, not against it.

Noah Levine: So we've talked a little bit about the properties of these products, and the fact that they are helping the teeth restore itself a little bit at the, you know, marginal area where we have a lot of recurrent decay problems with patients, and especially older patients who often have had work done on their teeth. So you know, why are these are the types of products that dental professionals should be looking at, for those situations, and do they have a chance to help prevent further recurrent decay from the for these patients so that they won't have need another restoration, as soon as they might?

Lauren Yasuda Rainey, DDS: Yeah, I think you've nailed it on the head there that these are already teeth that are compromised, by the time I get in there. If we can give the tooth any further chance of inhibiting recurrent decay, and having an alkaline pH is really important for that. And these products, I know do have that alkaline pH. We know now that the bacteria that cause cavities, like a slightly acidic environment. If we can keep that environment, just you know, north of pH neutral and get everything a little bit basic, we know that those bacteria won't really have an opportunity to thrive. So from that perspective, sure, like that will decrease the risk of recurrent decay moving forward. From a clinical perspective, these products are radiopaque. So we can see them on the x-ray. They're very easy to see that there is a very clear demarcation between restoration, cement, and tooth, and we will be able to see those on recalls and be able to kind of like tackle those recurrent areas a little bit sooner, because there's not going to be that question of is that or isn't that cement? Or is that or isn't that restoration? It becomes clear from not only what I'm looking at, but also the hygiene team and the assisting team as well.

Noah Levine: Now, two of the products in the Thera line TheraCal LC and TheraBase are both, as the name would apply base liner materials. Not every clinician uses a base or a liner in every case. How would you decide this is a case where I really want to place a base layer beneath the restoration?

Lauren Yasuda Rainey, DDS: That's probably not a great question for me. I don't place a lot of bases to be to be frank, and I'm really finding that the TheraCal LC kind of acts as both of those things. So I'm not reaching for TheraBase as often as I would for TheraCal. If I'm already looking at the dentin looking a little bit blushed a little bit pink, if I'm looking at the radiograph, and I'm kind of like, I know that I'm getting close, that's when I'm saying, "You know what, let's give this tooth every opportunity to heal itself with the materials that we're working with." So I think that's a person to person, clinician to clinician question. I know there's a lot of people out there that just say, "Hey, let's go straight to Endo." I love endodontists. I've worked with a great endodontist before, but I'm not rushing to get in there any sooner than I need to. So for me, it just gives me a little bit of peace of mind. And I can share with our patients that, "Hey, I put a little bit of medicament next to your nerve, it seemed like we might be getting a little close. Call me if you're having some sensitivity, but I I did everything I could today to make sure that you're comfortable." And so a little bit of reassurance for my own heart, but also for our patient's minds goes a long way.

Noah Levine: Now, the cement in this product line TheraCem is dual-cure cement. What are some of the advantages you find in working with that type of cement product?

Lauren Yasuda Rainey, DDS: So, a lot of providers are using it. There's more zirconia now than, you know, 10,15 years ago. And one of the benefits of the TheraCem is that it's self adhesive. Also calcium releasing, and a cement that contains MDP. That means that it allows material to bond to zirconia without the need for extra primers. The cementation protocol can be very efficient and streamlined, you don't utilize other things going on. The MDP makes it a great option for adhering to dentin, enamel, and restorative materials. Altogether, it has a pretty low film thickness, which means it's not going to be like goopy and thick. So when you go to seat your restoration, that's not going to end up you know, high on the occlusion. And again, the radiopacity makes it very easy to visualize in the moment and postop. And this can be reviewed pretty clearly with patients on a postop radiograph if they're interested, and looking at that, it acts as a great patient informational and educational tool.

Noah Levine: Now, you mentioned kind of the simplicity of application, that's something BISCO likes to you know, design for. How does that play out clinically for you, and is that something that you really are looking for, when you're evaluating if the material is going to fit into your practice?

Lauren Yasuda Rainey, DDS: it's not the first thing I look at, but if there's a product that needs to have an extra dry, you know, 4 bottles, 18 steps, that becomes really challenging for not only me to know, but for an assisting team to also know. And I know right now there's a lot of flux in the dental industry, especially in teams. So if we can make this simple, where I can remember the steps, and I can communicate that very quickly, and the assisting team, depending on you know which one of the assistants is working with you, if they can communicate that to each other, we don't need this to be a game of telephone with 18 steps because something's gonna get lost along the way. And then what's gonna end up happening is the patient suffers from that. That's not something that's going to bother me, that will clinically affect the patient's outcome. So, you know, I'm a big fan of, you know, less is more. And if we can make sure that we've got a product that's going to be effective every single time. That works for me.

Noah Levine: Now, you we've talked a little bit about the fact that these are materials that provide benefits to the patient after they leave practice, is this something that you talk with the patients about, during the treatment or after the treatment? And, you know, what do you like to share about the materials you choose?

Lauren Yasuda Rainey, DDS: Yeah, absolutely. I would say I absolutely am an oversharer with patients about what we're doing and why. Okay, so I'll say we talked to it just a hair about fluoride, but I'll say, you know, I do see a handful of patients that are not open to fluoride, they're not open to BPAs, or whatever it is. And that's important for me to be knowledgeable on ,which of the products contain things like that. Those patients tend to feel heard when we make a point to discuss, like, we're going to use this product and why and then that way, I can also respect their preferences. They're the one that's wearing the restoration home, not me. But I would say for the vast majority of patients that I treat, I ask if they're if they're open to, you know, we're going to rely on a little bit of science, is that okay with you. And here's why. And I think that worked for me, especially in Berkeley, I was about a mile from UC Berkeley, so lots of engineers, lots of highly cerebral individuals, many people that are used to sort of evidence and going back to the evidence. So when I go to the evidence, and I can feel confident about what that says, I'm happy to share that with our patient. And I think that should be part of the informed consent. Informed consent is a conversation about what we're going to do, why we're going to do it, here are the risks, the benefits, the alternatives to treatment. And I'm happy to take 18 pictures during the process and share those with the patient at the end of the appointment. So I think that for the patients that want to hear it, I'm happy to have that conversation. I think it gives our practice a lot of credibility, if myself and the team are knowledgeable on what we're doing and why. And if we can answer any questions a patient has, it puts their mind at ease. They can't see what we're doing, like poking around in their, you know, in increments of millimeters, but if we can communicate to them that we have used materials today that are going to allow your body to heal. We're going to use materials today that have stood the test of time. We're going to use materials today that I know work well with the materials that were like that they are compatible with each other. Again, I think that being able to rely on the science and communicate that to our patients leads to a lot of patient raport. And if there's something that goes you know, haywire if the nerve starts to act up, I know that I've done everything that I could. And more often than not, the patients are not upset because they have been informed that, hey, we try and X, Y and Z things. Now we've got a pivot to Plan B.

Noah Levine: When you talk to patients about, you know, the properties of these Thera products, and the fact that they are going to produce calcium that's going to help your tooth heal and are going to be alkaline and help prevent bacteria from you know, living right there. What's the response you get? Are they even aware that, you know, these types of things are possible, let alone normal in the dental industry?

Lauren Yasuda Rainey, DDS: I would say they are a little bit surprised. Unless they've known me for some time, in which case we have a conversation about acid/base chemistry almost from the very first appointment. That's part of our like clinical intake is doing a caries risk assessment and caries risk assessment includes how often are you snacking? What kind of toothpaste you're using, what are you drinking at home? Is it water? Is it sparkling water? And can we bring sort out those acid/base balance challenges, sort of back to neutral. So that conversation is not usually new. But if we can take that conversation from like a global oral health perspective, and then target that down to the individual tooth, I think people are surprised. And a lot of times kind of go, "Ooh, I don't want bacteria living in my crown. That sounds you know, that doesn't sound very nice. So yeah, please, like whatever you're gonna do to prevent that bacterial overgrowth, like by all means, you know, I trust you to use your judgment. And thank you for cleaning out whatever mess is in there."

Noah Levine: Wonderful. Well, is there anything that we haven't talked about around the Thera products or this type of decisions that you make when you're choosing the products to use with your patients,

Lauren Yasuda Rainey, DDS: I think the only thing that I would say is that some of the older sort of bases and liners came in these little tubes, and you had to mix them together on this little like the little instrument the dycal with a little ball on there. And that can be a little bit tedious to get a honey-like consistency and then bring it over not drip it on the rest of the tooth or to place it exactly where you want it. With the BISCO products, the Thera line especially, I mean, they have everything is you know, the tip mixes onto the tube and then you just inject it directly into the tooth that doesn't drip everywhere. It's very visually easy to see, you're not putting it in there and like wondering like, where did it go. The fact that some of these are dual-cure is great, because if it's in a deep, hard to reach corner area, and you'll know that it will set up on its own because never like you're never putting these are rarely putting these products like right on the top of the tooth where everything is peachy. These are hard to reach places these are teeth that are already compromised. So I think the ease of placement, the ease of use, and the fact that it has the mixing tips already on there, make it a very predictable outcome.

Noah Levine: Well, Dr Lauren Yasuda Rainey, thank you so much for joining us today and sharing some of your experience with our audience.

Lauren Yasuda Rainey, DDS: Absolutely. Thanks for having me.