AME: 5 Tips for Rock Solid Interproximal Contacts

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[00:00:49] [SPEAKER_00] Alan Mead is a dentist with too much time on his hands and too much recording equipment in his basement. Armed with an obsession to bring entertaining and informative content to the dental world in a way that's never been done before. I give you the Alan Mead experience.

[00:01:32] [SPEAKER_00] We're still waiting to know if they're best in show, but at very least they were outstanding. So I can say I'm an award-winning baker. So the Midland County Fair is starting right now. We brought our animals over, which is this year a reduced amount of animals at the Midland County Fair. We have one goat and we have six ducks. And that's all we brought. And that was plenty. Thank you very much.

[00:01:57] [SPEAKER_00] And we've competed. My sons have competed in a bunch of different categories of 4-H projects. I mentioned the molasses cookies that Jacob and I baked yesterday that won at least outstanding, possibly best in show.

[00:02:16] [SPEAKER_00] Jacob put together a duck, like duckling to duck, like record-keeping project that won best in show. Thank you very much. He deserved it. He worked his tail off on that. And his presentation to the judges had a lot of flair. And the notebook that he put together had all kinds of adorable duck pictures. He couldn't lose. He couldn't lose! Adorable duck pictures and the flair that that kid has, he couldn't lose.

[00:02:45] [SPEAKER_00] And what else? He entered three things today and got outstandings in all three of them, which is like the purple ribbon. Not even the blue ribbon, but the purple ribbon. What else did he do? He did, yeah, I can't even remember. It was great though. Oh, he had a 3D printed chess set. And the only reason he didn't win best in show is because that category didn't have best in show.

[00:03:04] [SPEAKER_00] So, yeah, we're having a pretty good year at the Midland County Fair. Sean also won several outstandings for art projects and woodworking projects. So it's been a great fair. This might be a guy can dream, honest to God. This might be the last fair that we participate in 4-H. Sean is already a high school graduate. He's on the tail end of his eligibility, if you will.

[00:03:30] [SPEAKER_00] Well, and Jacob's not that into it, although it's hard not to be kind of into it when you go in there and you freaking crush every, literally got the best score you could get on three things, three out of three today. Makes it look easy. It's fun. So anyhow, I'm recording this in between trips back and forth to the fairgrounds. We got our camper over there a little while ago, and we are now trying to put stuff in the camper and get it to cool down. It's like 90 degrees and humid here. It's a frigging nightmare.

[00:03:57] [SPEAKER_00] Central Michigan in August is both fantastic and terrible. It is, you forget in February when it's cold and dark and miserable, how nice it is here. But I will tell you, the hot and humid is also a hard way to be. So we've had a busy summer and it is wrapping up. I can hardly believe I'm saying that, but it's already mid-August here.

[00:04:24] [SPEAKER_00] So I have a great podcast for you today. I'm pretty excited to talk about this. It's something that I think about quite often. It's something that every dentist deals with, and I feel like we don't talk about it in a scientific way at all, because I'm not sure that there is a way to talk about it scientifically. But I can tell you the thing that inspired me to talk about it. So last week I told you that I had a filling come out. And I still have a temporary, and I haven't gotten it fixed yet.

[00:04:53] [SPEAKER_00] So I'm working on getting down to see Dr. Grimes, see if she can take care of me. But I have a temporary in there, so I'm not. But when you have a filling out, you are hyper-aware of the contact, the interproximal contact between teeth, because everything gets stuck in there. In fact, it's like it doesn't even – I don't even know how. How does food know to get stuck down there? When you're chewing something, how does it – and clearly it's physics.

[00:05:23] [SPEAKER_00] I mean, I must be in the chewing stroke or whatever, and it gets pressed. But I'm going to tell you, it takes no time at all – when you've got a hole between the teeth, it takes no time at all for stuff to get stuck in there. And for me, I have some contacts that are light. They're biologically light. I mean, they're not decayed, but they're light. And I do think that – I think the fact that we have a ligament on our teeth, we actually can get wear in the interproximal contact just by regular tooth movement. So my contacts have gotten lighter as I've gotten older.

[00:05:52] [SPEAKER_00] I have some restored contacts, and actually I have quite a few restored contacts in gold. I was – I think I've said this on the podcast before. I was a boards patient for the Western Regional Boards back in 1997. I suspect Lance Timmerman was probably there in Oregon when I was there being a patient. It's great. Four hours, numb, rubber dam on, never came off,

[00:06:19] [SPEAKER_00] just holding a tray of instruments and asking anyone who wanted to look at my mouth to evaluate the preparation of the DO gold inlay prep that was done. Ah, the good old days. Oregon was cool, though. I'll say that, man. That was – it was a free trip out west. It was pretty good. In any case, so I have some restored interproximal contacts. I have several that are not restored. And to be honest, a lot of them are loose. A lot of them are light at best. And so I get stuff stuck in them.

[00:06:48] [SPEAKER_00] But then when you have one that's flat open, it is a nightmare. And I don't know if dentists are hyper aware of interproximal contacts in their own mouth or not. I'm not sure. It's a good question. I think I might put that up as a poll in the Very Dental Facebook group because it's an interesting question. Are dentists hyper aware of their own interproximal contacts? In the same way that as soon as you got to dental school, you realized that you weren't doing that good of a job flossing your teeth and taking care of your teeth. Like it was like a week and a half into dental school. Like, oh, my God.

[00:07:18] [SPEAKER_00] I have not been doing a good job at all. I have a father who's a dentist. And I was in the dental chair a lot before dental school because I had ortho for about eight years of my life on and off. My dad had braces on me. I had had interior bonding. And then basically I have porcelain veneers. I had porcelain veneers before porcelain veneers were cool. Like I had porcelain veneers back in the early 90s. And they're the same ones that dad put on in 1992 or whatever.

[00:07:44] [SPEAKER_00] I have a giant gap between my two front teeth that's been, you know, covered up by porcelain veneers for that long. So, yeah, I have a lot of contacts that are restored. I have quite a few that aren't. And I have quite a few that are light. And I handle them pretty well. I floss a lot. I take interproximal brushes with me wherever I go. And the gum flexi brush or whatever. God, I've talked about it. They're great. And they have this little thing you can have. It's a little canister that you can have in your pocket. They're fantastic.

[00:08:12] [SPEAKER_00] So, but I also, I worked on my dad this week. And we, it's been something we've talked about doing for a long time. And the poor guy's got, he's got just like every mead. He has wisdom teeth. We all, we have like Neanderthal mouths. I'm not sure quite how we have so much room. But he didn't want to lose his wisdom tooth. And the biggest problem he was having, although he had two teeth that had had endo in the past few years, really needed restoration. They were pretty beat up teeth. And I was a little worried about how restorable they were. They turned out great, actually.

[00:08:41] [SPEAKER_00] But I will say we were not, I was not going to put a crown on a freaking hyper erupted wisdom tooth. But he had a contact that was horribly light. And I cannot believe the amount of debris that comes out of there. And you, and he's complained about it. Like, oh my gosh, I got to floss this thing all the time. But even then, I don't even probably know. He didn't even realize how much stuff was still, like, even though you think you got it, I don't think you did. Interproximal contacts are a whole thing.

[00:09:07] [SPEAKER_00] Like, honestly, I don't think we talk about it enough. I honestly think interproximal contacts, like light interproximal contact, that is like a, that's like a pathology on its own. And I don't think we really talk about it. Because, you know, so what I want to talk about is, you know, the best ways to make sure you get rock solid interproximal contacts.

[00:09:34] [SPEAKER_00] And I mean, the control that a dentist has over that is generally we're talking about class two restorations, usually some kind of a, you know, a direct restoration. I'll say a couple things about, about like crowns, crowns bridges, you know, when you've got an indirect. In fact, my answer for making sure I have ideal interproximal contacts is to have a lab, the lab that I use in the same building.

[00:09:59] [SPEAKER_00] So that if it's light, I can run it over there and they can add a contact to my crown quite easily. And if they're heavy, I can reduce them to the way that I like them. And then if I over reduce it, I can always have them added. Chad, my lab technician, should hopefully not be listening to this because I don't take advantage of them too much.

[00:10:20] [SPEAKER_00] But I will say that I have gotten a lot more picky about the ideal form of my interproximal contacts on indirect restorations because I have a lab close by. So when I'm, I kind of, if I had my way, I would rather they start heavy so I can adjust them. I would rather that they're perfect all the time. And I have to say, I get really good. He's really dialed it in with my scanner and my preparations and stuff.

[00:10:49] [SPEAKER_00] But if I'm going to go anywhere, I'd rather they start heavy and I have to adjust. And this is the one thing you need to remember. Easy for a guy to say who has a lab right next door who can repair any flubs that he has with this. But when you're adjusting interproximal contacts on a crown, say, or an onlay or basically an indirect, you need to adjust. You need to be intentional about your adjustment. In other words, you don't want to say, ah, just dust it a little bit.

[00:11:18] [SPEAKER_00] Because otherwise, I use a straight lab handpiece. I've used that basically for my whole career. I won't, I really try not to do it with a handpiece in the operatory. I just don't feel like I have as good a control over it that way. But what I find is that I, okay. First thing, if there's any question at all, if you didn't groom your contact prior to impression, adjust the interproximal contact on the tooth next door to it if you can.

[00:11:46] [SPEAKER_00] If it's not broad, I'll start there. Then I'll go in and if I have to adjust in the lab, I'm going to adjust, I'm going to get after it. I'm not going to just dink with it. Because typically I'm using a zirconia and that's, it's very hard. So when you don't, when you don't adjust enough, it takes a long time to do it. And so I feel quite confident that I can get after it with a stone and get a better contact, get my idealized contact. Because if I go too far, I've got a lab to fall back on. That's a terrible, I mean, it's easy for me to say, right? But here I am.

[00:12:15] [SPEAKER_00] This is where I, this is what I do. So I really want it to be, I want it to, I want it to hold floss nicely. I almost want it too heavy. And that's the other thing. I will oftentimes leave it a little on the heavy side in approximately. This is for natural teeth, for implants. God, that's a whole other podcast. And I'm not even going to talk about that because, but for, for natural teeth, I'm going to leave it a little, little heavier maybe than I think I should, because I think the ligament can, can adjust a little bit.

[00:12:44] [SPEAKER_00] If the patient comes back and says, I just have a hard time getting floss in there. It's easy. It's easy. I can get a wedge in there and get a, get a, um, interproximal, you know, basically one of the contact saws with some grid on it. And I can, I can, I can lighten it that way too. I got no problem doing that. I'd rather it starts out a little heavy for it, for indirects. But realistically, everyone knows how to do that. They've done that a million times. And as long as you know the materials you're using and the, and the, the tools you have, not super hard to do, not too tough.

[00:13:11] [SPEAKER_00] Now, rock solid class two contacts are first off. If, if that contact is light, it's your fault. If you have an open contact or a light contact after a class two restoration, it's your fault. Unless, unless it's an upper second molar. And sometimes those can walk themselves open. That's there's we've had it's, it happens. It doesn't happen all the time, but you know, so sometimes you can adjust the bite on it and close them up. But the reality is if you got a light contact when they leave, it's on you.

[00:13:42] [SPEAKER_00] And I used to, I used to go, it feels bad if you've worked your butt off to get a contact and then you get the floss in there. It doesn't hold you like, ah, it's the worst. But you know what? The time to fix that is right now. Get a handpiece and open that back up and do it again. That's the time to do it. If you have never struggled with that, you're a better person than I am because I have before, especially when I'm running behind or the patient's really tough to work on or they're, they're sort of complaining or, or your isolation's not great or whatever.

[00:14:11] [SPEAKER_00] You're just like, ah, but you got to do it. Got to do it. But the other thing is, is that there's a few ways you can almost always guarantee a really good class two contact. I'm going to talk about it. We've talked about them all many times on the podcast, but I'm going to just put them all here in one, one place. So first off, if you've never had an open contact or a light contact, you don't know. You don't know the nightmare of it. It is bad. And a lot of times patients aren't understanding about it. I actually on, I will oftentimes floss contacts that have any questions, even on an exam.

[00:14:41] [SPEAKER_00] Sometimes I'll floss all of them because I want to know because that's, if you get food impaction in the light contact, it's a, it's a, you know, it's a risk for decay. It's honestly a risk for perio to be honest, like traumatic stuff. So it's, it's worth, worth checking. So, okay, here's the tips. The tips I'm going to give you for, for rock solid context with class two restorations. First tip comes before you ever spin a handpiece. You pre-wedge.

[00:15:05] [SPEAKER_00] It's called pre-wedge and you take a wedge and you, it's, you take the, the firmest, firmest sized wedge. You can get in there and put it in between the tooth that you're going to work on. So, and honestly, if, if you can, I'll give you anesthesia. And once I know they're numb enough to be comfortable, I'll drop that wedge in there. And if, if I'm waiting for them to get completely numb, sometimes I'll just walk away with the wedge in there.

[00:15:29] [SPEAKER_00] Because it's, because what happens is it, allegedly, it compresses the ligament gradually while you prepare. And so it kind of, kind of starts separate. I tell, I don't call it a wedge to the patient either. I always say, I'm going to put a separator in here. Because some of her, it's not technically like an orthodontic separator. You're putting a frigging wedge in there and the kind of wedge you use for restorations. But I want to separate those teeth from the beginning.

[00:15:52] [SPEAKER_00] Because I want them separated for a little while before I've got my, I don't want, I don't want to be separating right for the first time when I've got a matrix in there. It's, you get a much better contact if you open this up for a little while. The teeth have quite a bit of capacity to move. When we're talking about the micro movement that we're getting to make sure we have a really tight interproximal contact, there's quite a bit of movement that can happen. So you want it to be in there for a little while. It protects the, it can protect the papilla. That's kind of nice too.

[00:16:22] [SPEAKER_00] When, the thing is, even if you don't nick the papilla, if you put a wedge in there and you pull the wedge out, it's still probably going to bleed. I have, I have yet to find a wedge that's gentle enough on a papilla that's actually putting pressure on it that doesn't cause bleeding when you pull it out. Even if you didn't hit it with a burr. So, but it, I mean, it does, it does keep you from hitting it with a burr, which maybe would make it bleed more. I don't know. Crazy Dental already has some of the lowest prices on dental supplies anywhere. But you know what's even crazier? Free shipping.

[00:16:51] [SPEAKER_00] Head over to crazydentalprices.com, load up your cart, and use coupon code VERYSHIP. That's VERYSHIP for free shipping on every single order. Plus, every time you use that code, CRAZY DENTAL kicks back support to the Very Dental Podcast Network. Save money, get free shipping, and support the show. Use code VERYSHIP today. So, that's, and then, you know, once you get the wedge back in there, it'll help with bleeding. Basically, it's the pressure that keeps it from bleeding when you're actually restoring the tooth.

[00:17:19] [SPEAKER_00] But I don't know that it necessarily, if the wedge isn't in there, it's not doing anything for bleeding. So, so along with the wedging is that you're going to use a different wedge, more than likely, almost, almost always. Sometimes I'm a little lazy about this, but I shouldn't be. Almost always. Once you've pre-wedged and you've got a preparation, you're happy with your preparation, you're going to use the next wedge size up for the restoration. Because you've already opened that contact enough that you can probably fit a bigger one in there.

[00:17:48] [SPEAKER_00] And frankly, I want my contact to be so heavy when I'm done that I might have to lighten it a little bit to get floss through it, right? That's how heavy I want it. So, if you use a second wedge or stage your wedges, so you've got your, my typical go-to wedge, I don't mind saying, is the BioClear diamond wedges. They're far and away, in my hands, they're the best wedges out there. I've used a lot of them. There's a lot that work fine.

[00:18:14] [SPEAKER_00] But I, what I like about the BioClear ones is how they kind of almost fish hook underneath that contact. And they hold their place really well. As long as you can get, a rubber dam will hold up any wedge. And I love the guys who have the most beautiful Instagram rubber dam stuff. Somehow I can never see those guys struggling to get a wedge to not go under the dam. I do sometimes. But it's, that's one of the things I like about the BioClear one. It kind of goes down and up as it goes underneath the contact.

[00:18:44] [SPEAKER_00] I don't know. In any case, you're going to use the, stage your wedges so you've got a bigger wedge for when you're restoring than you use to separate it. It's fantastic. And it will give you more movement, more separation when you're restoring. And so this is, I honestly think that's one of the biggest tips, the second bigger wedge to make sure you really can get a solid contact. Now, here's the other thing. I'm typically using a sectional matrix of some sort. I use BioClear a lot. The BioClear matrices a lot.

[00:19:13] [SPEAKER_00] And I use a lot of their method. I really use, you know, the heated composite. I use all that stuff a lot. I will oftentimes use a Garrison slick sectional wedge too, for whatever reason. Sometimes if I'm having, sometimes I got to say, the BioClear posterior matrices are awesome. And I do love the contour that they give. Sometimes they're fussy to get.

[00:19:35] [SPEAKER_00] If you haven't prepped that deep, like if you're not really deep, sometimes it's hard to get past that ledge of your gingival seat with those. Maybe because they have so much curve on them, I don't know. So occasionally I'm going to use a metal matrix if I don't want to drop my gingival seat further just to get the, you know, for, as they would call at the University of Minnesota in the mid-90s, convenience form.

[00:20:01] [SPEAKER_00] Which is to say that the prep, I'm prepping to make it more convenient for me to put my matrix in there. Instead, I'll sometimes use a metal matrix to get in there. And placing your matrix, you got to know too that you can't use the same size matrix for every tooth. I want to. I swear to God, I want to. I have a tendency to try it and then I'll think to myself, I look at this, I'm like, my marginal ridge is in a goofy place and the contour is going to be mixed up. So make sure that at the top of your matrix is level with the marginal ridge next door to it.

[00:20:30] [SPEAKER_00] And you'll find out by looking at it and going, damn it, it's not. I mean, you'll be able to tell. It's pretty obvious. So then you're going to put a ring, a separation ring. A twin ring from BioClear is a pretty common one in my hands, although I have the full, I have all the Garrison ones too. I tend to like both these depending on the situation. But what you have to remember, and this goes great, the BioClear people love this and so do the Garrison people. And I hate this, but it's true.

[00:21:00] [SPEAKER_00] Those only have so much life in them. They're nickel titanium and they have a lot of separation power, but you can't use them forever. They wear out and they get less and less strength, if you will, in pushing those things apart. And the problem is, if you're not paying close attention, you might not notice it, but you want to use one that's on the newer rather than older. Because the more you've used them, the less oomph they have to separate teeth.

[00:21:29] [SPEAKER_00] And you want a lot of oomph when you're separating teeth. Like I said, this is one of the main things you can do to make sure that when you're done, you can barely get the damn matrix out and you've got to lighten the contact because it's too heavy. There's nothing better than having to do that. If you have to do that, you have succeeded, Grasshopper. You have done what needs to be done. That's how tight it should be. It would be great if you could lighten the contact because you have to. But, you know, I think a lot of us realize it's not often that way.

[00:21:57] [SPEAKER_00] A lot of times we're just hoping for a decent contact at that point. So, but yeah, these rings will wear out and no one likes to buy. Rings are not a sexy thing to spend money on. I mean, Garrison and BioClear would probably disagree with me, but I mean, it's not sexy like a new laser, new freaking, I don't know, microscope or, I don't know, fill in the blank. New guided biofilm removal system, new CT scan, you know, composite rings, not that sexy.

[00:22:27] [SPEAKER_00] However, they don't last forever. So you got to get new ones pretty regularly. I don't know if there is such an instrument to tell you when your ring is dead. I don't know. I'm not sure. So I'm going to say this, do it more often than less because it's just, there's honestly nothing worse than a patient saying, they're getting stuff stuck in between their new filling. There is nothing worse. And guess what? You're going to lose money on that deal because you got to numb them up and fix it because you shouldn't be able to sleep at night.

[00:22:56] [SPEAKER_00] If you've done that to these patients, just saying, I say that as a guy who spent the last weekend getting stuff out of a really bad interproximal contact. So you should, if you leave light contacts, you should lose sleep. I'm not going to say that you're a bad person, but I'm not going to not say that you're a bad person either. If you do that, that's, that's like the worst thing ever. So, especially since class twos, direct restorations, that's on you. It's light contacts, your fricking fault. Understand it. So just do all these things.

[00:23:25] [SPEAKER_00] Here's a huge tip that I have only more recently really understood. And this is a really good one for indirect restorations too. The contact, the next, the next door contact to whatever you're doing. You need to groom that. There are almost no contacts that are ideal. So you need to flatten that thing off. You need a nice, broad contact to build to.

[00:23:48] [SPEAKER_00] Whether we're talking about an indirect, like a crown or an onlay, or a direct restoration, you want to have a nice, broad contact to build to. Now, I typically do this with a soft flex disc. Now, unless it's a crown, if it's a, you know, it's like a zirconia or it's some kind of porcelain or something like that. A lot of those are too hard for, if it's an older, if it's a PFM, you could use a, you could use a soft flex disc.

[00:24:12] [SPEAKER_00] But you're going to probably need to get some kind of a diamond, like a very fine diamond burr on, on a, like a, if it's a zirconia or a lithium desilicate or something like that. Those are just too hard. A disc isn't going to probably do that in my opinion. And you kind of, you don't want to flatten it so it's not anatomic, but you want to, you want to make sure that it's not coming to a point. You want a nice, broad, hate to say it, but kind of flat thing to build to. It's so much better.

[00:24:42] [SPEAKER_00] If you have a point on one side, it's hard not to have a point contact. So you want to have a nice, broad, and then you want to be able to build a nice, broad contact to it, broad to broad. And that might not be how human teeth anatomically look, but that is how I want my class two or crown or onlay contact to look. I want it to be hyper-biological. Oh, that's a good word. Hyper-biological. I want it.

[00:25:10] [SPEAKER_00] I don't want a point contact. I want flat against flat, and I want it to be a challenge for them to get that floss through. Because if it's a challenge to get the floss through, it's also a challenge for the celery to get stuck in there. Or the roast beef, or choose your own favorite stringy food, whatever. It's pretty gross. It's gross to say it. You know what's more gross? When you're digging that stuff out in between your dad's second, upper second, and upper third mold, that's also pretty gross. And he was miserable because of it too.

[00:25:40] [SPEAKER_00] I will say this. I beat him up pretty good, and I figured he was going to be sore. He was sore for the first day, and he said, oh my gosh, the thing that I noticed the most is that contact. It feels so much better. So this is another reason that I was inspired to talk about this because it's really important. It's more important than they ever – no one ever talks about that. They talk about how highly polished and contoured your beautiful anterior veneers are. Great. Good. You know what? I do a lot of interproximal contacts with class twos.

[00:26:06] [SPEAKER_00] I do a ton of those, and patients love it when they don't have to think about it. And this is what – this is the way you make it so you don't have to think about it. Just do all these things and make sure that when they leave, it's almost too hard to floss. I know that sounds crazy, but it's true because it'll wear. It will get lighter. It just will. If they have a ligament, it will. It's going to happen. So you're going to want to make sure that you've got broad contact to build to. So flatten it in whatever way you need to.

[00:26:34] [SPEAKER_00] And I don't want it to be flat, but you know what I'm saying. You'd much rather – you know how upper molars have that just crazy – they have a broad contact buccalingually as well as occlusal gingerly. They just have this big fat contact. And I kind of want every tooth in the mouth to have that kind of contact if I'm building a contact to it. That's all I'm saying. Hyperbiologic. I should trademark that. That should be like a mead trademark. Hyper, hyperbiologic. No point contacts. They suck. If you want to do that in your porcelain because you're really good at things, great.

[00:27:03] [SPEAKER_00] But I would much rather have a big contact there that is not going to get stuff stuck in it because your patients will never be calling you on the weekend because they have celery stuck in their teeth. Last, this is a BioClear thing. I'm going to call it this. But what's interesting is I think whatever matrix you're using will work well with this. Dr. Clark created an instrument called the push-pull instrument, which basically – once you have your matrix to place where you like it,

[00:27:33] [SPEAKER_00] your wedge is placed, your ring is in place. Everything is the way you want it. What we have is this amazing material that we don't – we can use to stick to teeth, but also we can use it outside of the matrix. Okay. So flowable composite is amazing. If you take – this works great with the clear mylar matrices with BioClear.

[00:28:01] [SPEAKER_00] So you take unheated, in his case, unheated flowable composite, and you basically – you take an instrument. He has a specific instrument that helps make the contacts really broad, and I'll put it in the show notes. It's a cool instrument. But you can also just use kind of a placement instrument or a paddle or something like that. But you're going to pull if it's a mesial contact or you're going to push if it's a distal contact.

[00:28:25] [SPEAKER_00] But you're going to place some flowable composite on the outside of your matrix along with your ring or whatever, and you're going to place that uncured. You're going to push or pull, and you're going to have your assistant cure that. And what that does is it takes any flexibility that that matrix has, and it kind of locks it in place. This is a huge trick. Look, it's a trick that I haven't known that long, and this is the difference between having an open contact and not in a lot of cases.

[00:28:53] [SPEAKER_00] If you've done all the other stuff, you probably are going to get a great contact. This is the cheat code. This push-pull with flowable composite bracing, you cannot do any better. And it will work with a non-BioClear matrix. I'm sorry, Dr. Clark. I know you don't want to hear that, but it does. It works with whatever matrix you're using. It works particularly well with BioClear because they're mylar and they have a little bit more flex than a lot of the metal matrices. But this is a great trick for anyone. Now, what's funny is when you do this, sometimes it's obvious that you've made a difference.

[00:29:23] [SPEAKER_00] Sometimes it's not. You'll notice when you take the ring off, the flowable cracks and breaks and does all kinds of dramatic sounding stuff. And you'll have a bunch of extra flowable that comes off. But once it's all off of there, the contacts are so good. You have basically done what I wanted, which is that hyper-biological broad against broad and big broad contact that you can barely get floss through. It's great.

[00:29:48] [SPEAKER_00] You're going to have to disk that contact because it's going to be – you've gotten more composite in there than biology would normally allow. So these are my five tips for class twos.

[00:30:00] [SPEAKER_00] I really think that they're – a lot of people have been using them in a lot of ways, but I kind of wanted to put them in one place because it really – if you're struggling with class two composites, class two restorations like this, but particularly directs, and these – if you do these five tips and you're still struggling, I'd be surprised. I'd be surprised. These are all really, really good. And I have to tell you, it's tough. It's tough to talk about clinical stuff like this on an audio podcast, and I don't have any images.

[00:30:29] [SPEAKER_00] I'm just – I have video of me talking about this, but I don't have any images. I'll see if I can find some images to put up in the Very Dental Facebook group. But I'm getting better about – I'm getting better about documenting my stuff through the microscope. It is funny because I have the Zoomax from Inova. The Zoomax OMS 2050 is about as foolproof of a microscope as you can get. It's easy to use. It's also super easy to document, and I'm still weirdly lazy about it.

[00:30:58] [SPEAKER_00] I'm getting better, and I do – I really enjoy using it. And so I'm trying to get better documentation so I can actually put it up in the Facebook group or put it out on Instagram so you can see what I'm talking about. Because I'm talking about – this is like regular dental stuff. What you're not going to see from me is like some beautiful full-mouth rehab. It just doesn't – I don't do that. I'd love to do that. I just don't – I don't have a patient – I don't have a patient base that's big into that. And you can tell me that, oh, you're just not presenting it right. That's fine. I like what I do, and frankly, I have patients that this is kind of the stuff that they need in a lot of cases, the stuff that they can do.

[00:31:28] [SPEAKER_00] So we do it, and so this is regular dentistry, and most people have to deal with this. But also I'm like, eh, it's kind of what dentists do as far as I'm concerned. Anyhow, that's a whole other post really. So try these five tips. And then also the tip about indirect restorations, have a lab next door that they can fix it if you screw up the contacts. I'm sorry. It's true though. He does. He can fix it for me.

[00:31:57] [SPEAKER_00] So I am much more content at adjusting an interproximal contact on a crown or onlay because I'm pretty sure they can fix it if I mess it up. This is great stuff. That's a tip that not everyone is going to be able to do, but it is awesome to have your lab literally in the same building with you. It's fantastic. So if you guys have any questions or comments about any of this stuff, I think lots of restorative dentists have this stuff. Let's go to the Very Dental Facebook group and talk about it.

[00:32:21] [SPEAKER_00] But I'm going to start a thread asking about your favorite tips for making sure you have rock solid contacts, interproximal contacts. And I'm sure there's some that I have never even heard of or forgot, but these five, pretty solid, pretty good. So go to the Very Dental Facebook group. On Facebook, you search Very Dental. If you're not a member, you request membership and you give me one of, I've got a whole bunch of podcasts, or I've got a whole bunch of passwords out there.

[00:32:48] [SPEAKER_00] I've got Timmerman, Lipscomb, Papa Randy, Hornbrook, Bioclear, Gary, Frank, now Tiffany. There's more. McQuethy. There's more. Give me one of those and I'll let you in. It's a good group. It's not a super active group because there's not that many people. Everyone in there is a member that listens to the podcast. So you already know something about them. There's not a lot of bullshit that goes on and there's not a lot of, there's not. If you like the drama, it's probably not the right group for you.

[00:33:16] [SPEAKER_00] But if you have a question that you want regular people to answer, it's a great place to do that. I hope you'll come join. We're having a good time over there. And I hope these were helpful to you. If you like this stuff, tell a friend about it. And I guess leave a review on whatever podcast software you use. That sort of thing, that helps as well. But I'm really glad to have been able to do this. And I'm really glad that I do not have a contact that's driving me crazy right now. So I'm very pleased for that. It's a horrible thing to do to a person. Just remember that. So thanks for listening. Appreciate you guys listening. And we'll catch you next week.

[00:33:46] Bye.