2 Clinical Tips…From Me??

As you likely know by now, I've never ventured into the
clinical realm of dentistry when it comes to dispensing advice
that will help you grow your practice. There are SO many
great clinical mentors out there that I find no need to focus
on clinical issues...there's plenty of that available.

Where you NEED me to focus is on the BUSINESS SYSTEMS and
MARKETING and COMMUNICATIONS issues that truly make the
biggest difference between a rockin' practice and a rocky
practice! And frankly, that's where my personal interests
are in coaching dentists, and what I enjoy sharing the most.

That said, I'm still a pretty dadgum good dentist, and I'm
proud of the exquisite results we achieve in my practice.
So today I want to share a couple of cool clinical tips that
have made a huge difference in the quality of my composite
restorations over the past couple of years. Here they are:

1- The PRE-Etch. Now that I use self-etching primers and bonding
agents with my composites, I realize that uncut enamel does
not bond well with self-etching products. So, to allow a more
solid bond at the margins of the restorations, I etch the
tooth with good ole phosphoric acid, just before I begin prepping.

All I do is cover the surface to be prepped with the gel, let
sit for about 15 seconds, and then I start prepping with water
spray. I extend just beyond the expected margins, so any uncut
enamel will be pre-etched.

The result: a MUCH better, higher strength bond at the margins
of my composite restorations. I'm seeing no ditching or chipping
at the margins, no "step" margins...just a nice smooth transition
even several years later. My margins were never "bad" to begin
with. They're just BETTER now!

2- The "Clear Gel Cure". I picked this one up from Dr. Newton
Fahl, bondodontist extraordinaire from Brazil. As you know,
the outermost layer of composite doesn't actually cure because
of the presence of oxygen. This oxygen inhibited layer, if left
exposed, will never completely cure and will show defects later
down the road. Not good.

Some dentists overfill the prep, cure, and then cut back to the
appropriate finished position. That's too much work for me.
I like to sculpt the composite to right where I want it to be,
and then stop and cure. Then finishing time is minimized.

So after I cure the composite initially, my assistant coats the
composite with a thin layer of clear gel. We use KY, but you
could use just about anything that seals oxygen out. Then
recure through the gel for an additional 10 seconds with a
powerful curing light. And VOILA...you're done!

Now you KNOW that there is no oxygen inhibited layer that will
get in the way of your long-term results. I finish the margins,
check occlusion if necessary, and I'm done. The results are
nothing short of gorgeous...and you can FEEL the difference with
your bur as you are finishing. It's hard as a ROCK!

I know that you may have heard about these techniques before.
But just in case you haven't, you've GOTTA try them! And they
make such a big difference in the long-term results (up to 5
years SO FAR with best margins ever), that I had to share them
with you.

More of my "normal" stuff next time. Until then, enjoy!

All my best,
Chris

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