Taking Chances and How Those Chances Shape Our Future

Oh, the things I’ve gotten to do in my life!Some have been a result of dumb luck, being in the right place at the right time—like catching that foul ball at a Royals game about 10 years ago. Yet some of the best things that have happened in my life were simply being faced with an opportunity and thinking: “What the heck? Take some chances.”

In the fall of 2017, long before we even thought a pandemic could happen, I was browsing my Twitter (now called X) feed and being a geek, I follow a lot of National Aeronautics and Space Administration (NASA) feeds. On that fateful day I saw a post stating that they were looking for people with a love of NASA and a social media following/presence. The offer was to apply for a special program that would allow those lucky enough to be chosen to come to Kennedy Space Center in Florida and witness a rocket launch while continually posting to their social media channels about the experience.

Now, I’m no social media guru. I don’t have tons of followers. However, I immediately thought: “What the heck? The worst that can happen is that they say no and I get to tell people NASA turned me down.” I mean, in my geeky mind, even a rejection from NASA was something to crow about.

Six months later, on April 2, 2018, I was getting a full-blown tour of the Kennedy Space Center and all the tech glory it contained. Then I stood in the press section and watched SpaceX launch a Falcon rocket to the International Space Station. I was as close to that launch as NASA deemed safe, and let me tell you, the shock wave that came off that thing hit me in the chest like a full-volume Led Zeppelin concert. It was magnificent and awe inspiring.

So what does this have to do with dentistry? Simply put, many of us in the profession are sticklers.We find something that works and we tend to stick with it—sometimes way longer than we should.In the days before digital impressions, I used to tell salespeople the hardest thing to do was to get a doctor to change their impression material—and that was so true.

However, change is good. Bluntly put, change works. Dentistry is a high-burnout profession. Not many people hang it up early, but a lot of us struggle mightily in clinical practice. Like baseball, we go through slumps and streaks. Sometimes you get a phase where it seems you can do no wrong.Patients get numb in seconds, crowns fit like they were sent straight from heaven to your office, and that class IV composite on No. 9 looks like the tooth never fractured. Other times you send folks home because anesthesia didn’t take, endo files fracture, and your “simple” crown fits like the proverbial “socks on a rooster.” The good news is that tough times don’t last but tough people do.

So this month let’s consider some things that, from a restorative standpoint, will make your life easier and your clinical results exactly what you expect of yourself.

Bonding Agents

So much of what we do today depends on chemistry, and yet not many of us have degrees in the field. That can make bonded procedures stressful and sometimes confusing.Lots of bottles, lots of syringes, and lots of confusion are frequently the norm for us.What works with what?If I bond a post with this material, will it stay or is the patient going to come back in 3 months with a crown in their hand that contains all the buildup and the post?

I love chemistry, but I am by far not an expert in the subject and that is why I love to keep it simple.One of my favorite bonding agents is Futurabond U from VOCO. There are 2 genius parts of this product. The first is that it works with everything. When the smart people at VOCO say “universal,” they mean universal. The material is both light cure and dual cure. That means even in bonded posts, the material will set in areas that the curing light will never reach adequately. Plus, it works with every bonded material out there. Futurabond U is material agnostic, which means that composites, buildup materials, and bonded cements work equally well with impressive bond strengths.

The second impressive thing about Futurabond U is the packaging/dispensing system. It comes in a blister pack that holds the 2 components of the system in separate wells. Simply push on the bubble in the package and those 2 components flow together. You then break the foil on the package and stir the contents. The genius of this is that every mix is a fresh mix. You never have to worry about solvent evaporation or the material losing potency sitting in a bottle or syringe.

Another terrific bonding agent is from Vista Apex and is called RE-GEN Universal Adhesive, which works with every material. The product is the first universal bonding agent that employs bioglass as an active ingredient. In keeping with the idea of simplicity and predictability, bioglass has more than 50 years of medical use. It was originally developed for use in orthopedic surgeries to stimulate bone growth in difficult cases. What is amazing about bioglass in our profession is that it forms a hydroxyapatite-like surface where it touches tooth structure, which means it promotes the regeneration of healthy tooth structure (hence the name RE-GEN).

Bioglass also has the amazing property of broad antimicrobial effects, which means that it helps promote healing and prevention of recurrent caries at the margin of restorations. Considering how recurrent caries is the main problem in adhesive dentistry, being able to kill bacteria at the marginal interface is a huge plus. Studies show that the average life span of a multiple surface composite restoration is around 5 years. I feel we can do better than that and I firmly believe RE-GEN products can help with that.

Materials With Benefits

One line that I feel the profession needs to know more about is the Giomer-containing products by Shofu. Giomer is a proprietary filler particle that Shofu created and engineered. The products that contain Giomer release and recharge 6 ions: fluoride, strontium, sodium, aluminum, silicate, and borate. When these ions are combined, they inhibit plaque while neutralizing the acids that plaque-containing microbes create.

It’s a bit amazing to me that Giomer was created well over 20 years ago and yet many practitioners are not aware of it. As I noted above, the average life span of a multisurface composite is around 5 years. The margin is where the battle of restorative longevity is won and lost. Sending in as many reinforcements as we can to the margin can truly help make a big difference in our clinical outcomes.

I’d like to also add that Shofu has done a tremendous job in keeping prices low for its outstanding materials. As a business owner, the doctor is always performing a high-wire act to ensure profitability and Shofu is helping us in that area. As I’ve said many times in the past here, you can have the best hands in the profession, but if you cannot stay in business, you won’t be able to help many of those in desperate need of our care.

Proper Contours

The goal of all restorative dentistry is to return the tooth being treated and the patient back to a state of health that can be maintained. In striving to achieve that sometimes difficult goal, it is important not only to place the correct material but also to place it well. Contours and contact matter to the longevity of a restoration. The restoration must return the tooth to as close to ideal as clinically possible while also allowing the patient to be able to perform their home care routine.

Composites can be difficult to place properly. The problem stems from several factors, but perhaps the most common one is that many of the matrix systems we use were designed to be used with amalgam. Composite is a completely different material from amalgam and it is important that we use a matrix system that is designed for use with it.Garrison Dental Solutions recently released a “leap forward” sectional matrix system called the Strata-G and it definitely bears a close look.

The Strata-G kit is a complete system for placing composites with amazing results. It contains rings, assorted bands (for both posterior and anterior), assorted Strata-G wedges, ring placement forceps, and mini polishers.

The system is designed to make it as easy as possible to create multisurface composites that have proper contacts and proper contours. The bands are manufactured to re-create the contour of the tooth while the rings, made of nitinol (ni-ti), open easily yet contract with a significant force. These rings allow for easy placement yet due to the ni-ti they hold the bands exceptionally well. This incredible material also creates pressure that slightly separates the adjacent teeth. When the ring is removed, the periodontal ligament rebounds, returning the teeth to their original position and in the process creating a snug and ideal contact. Basically, the form of the band creates ideal contours while the ring allows for ideal contacts.

The wedges are also key. The underside is a V shape and is formed out of a flexible polymer. The V and the polymer allow the band to have flexibility. This allows the wedge to slide easily against the band, and the wedge can bend inward at the greatest curvature of the gingival box while also expanding as it enters and exits the area. The result is a gingival margin that is sealed with minimal chance of an overhang because the wedge allows the band to perfectly contour to the gingival margin.

Wrapping Up

What I’ve hoped to accomplish here is to encourage you to try some new things that have worked well for me. Dentistry is a constantly changing landscape, and there are lots of things coming to market that can really impact our abilities, our stress levels, and our clinical outcomes. If you are looking for better ways to help make your treatment better, I encourage you to step just a bit outside your comfort zone and give some new things and new ways a try. Progress continues unabated and we need to change simply to stay current. See you next month!