Very Clinical: Difficult Crown Preps (and other student questions)

[00:00:00] Okay, let's talk about one of the most underrated tools in your practice, the dental mirror. It's in your hand all day, every day. But have you ever thought about how much it actually impacts your work? If your mirrors aren't giving you a crystal clear view, you're working harder than you need to. That's where Zerk comes in with their Crystal HD Dental Mirrors. I love these mirrors. I keep two in every single setup just in case I drop one. These aren't your average mirrors. They're so much brighter than the standard ones. That means better visibility, reduced eye strain, and more confidence during every procedure.

[00:00:28] And they're durable and lightweight, designed to reduce hand fatigue and improve ergonomics so you can work comfortably even during those long demanding days. Plus, your patients will love them too. Available in a variety of vibrant colors, these mirrors are made with durable resin to prevent galvanic shock and eliminate the unpleasant clanking against teeth, ensuring a more comfortable experience for everyone. Upgrade one of the most important tools in your kit with Crystal HD Dental Mirrors from Zerk. The moment you bring one into the oral cavity, you'll be amazed at the clarity and brightness. It's like seeing your procedures in a whole

[00:00:58] new light. Maintaining optimal ergonomics is essential for a long and healthy dental career. That's where BQE comes in. BQE stands for Back Quality Ergonomics. I swear by a BQE model called the Ergodynamic, but they have a variety of styles that can fit you and your whole team. Keep listening to Very Dental to hear a conversation I recently had with Stephen Hoxma of BQE about their commitment to creating the best seating for dental teams. If you're looking to improve your workspace and well-being, check them out at BQE-USA.com.

[00:01:30] This is a production of the Very Dental Podcast Network. Welcome to the Very Clinical Podcast, brought to you by Zerk Dental Products. In about the time it takes to do an MO on three, we will entertain and enlighten you with tips and tricks for regular daily dentistry. Here's Kevin and Zach.

[00:01:56] What is up, Very Clinical listeners? Welcome back to yet another episode of the podcast. I am Zach Miners, coming to you from Kansas City, Missouri. With me, as always, my trusty co-host, Dr. Kevin. Hair, Fryer. Kevin, what is happening in Cleveland? I'm eating my peanuts and Cracker Jack. How is the baseball season going already? It's going. And Cleveland and the Royals were the opening series. What's the prediction for the AL Central?

[00:02:27] I think it is going to be extremely competitive amongst every team that's not the White Sox. And Cleveland, historically, usually ends up getting it when it's a toss-up like that. So I would say the Guardians, probably. And I hope the Royals get a wild card spot. I think it will be a very interesting, long haul here. So let's bring in our other guests. Go ahead, Zach.

[00:02:57] We've got just from yesterday or last week's show, we've got Alan Mead. If you listen to this podcast feed, you might have heard one of his shows. Never. Alan, what's up? Never happened. And then we've got our very dental student, Buddy Mo. What's going on? Not a whole lot. What's up with you guys? Not much. Mo, do you like baseball? So I've never watched baseball. All right. So when you come to Cleveland or Kansas City, you've never been to a baseball game?

[00:03:25] I've maybe been to like a high school baseball game, but more for like socializing than... All right. I'm just going to say this. I've said this before on podcasts. Baseball is the best game ever invented. Game. Not necessarily sport. Sport. Game. It is more of a game, I think. You're right. It's a game. There's a lot more going on than meets the eye, and that's what's so great about it. But anyway... Okay. I got one more thing, Kevin.

[00:03:55] Before we get into straight dental... Yeah, yeah, yeah. So AI is coming to dentistry. You're buying AI for your office. You know, care stack. Yeah. X-ray stuff. Do you want AI to come to baseball in the form of a robo-ump for balls and strikes? I do. You want to see it happen? I do. You do not. Why not? AI is better. You like AI. Yeah.

[00:04:19] So I thought a lot about this today, and I did read a quote from, I think, Joey Cora. Like, the doomsday scenario, World Series, braces loaded, two outs. You need a run to... Or two runs to win the game or whatever. And it comes down to the robo-call.

[00:04:45] Or it comes down to the human being call on the strike or ball. How do you feel about that? Like, that's where really the rubber meets the road. I mean, there's a million games between opening day and the last game of the World Series. You know what I'm saying? And if the robo-call is going to be, like, the defined borders of the zone, and it isn't going to be subject to any, like...

[00:05:14] There's no feelings. Maybe the umpire with the two outs is going to be like, I don't want to call... I have a called third strike to end this game. You know? Maybe he can't make that call. The robot... I've got a great story. It's not baseball. I can tell it in 30 seconds. I was a camp counselor up in Maine. Summer after my junior year of college. You were a summer camp guy? Oh, yeah. I was. In Maine. They had a color war, which is like a week of...

[00:05:45] The colors were green and white, and the green team and white team. And I was pink team. I was part of the umps. So they called them pink team. And one of the last events, and they were close to tide, was the rope burn. This rope that had been out on the dock, you know, underwater for the entire season. And so they had to build a fire tall enough to burn through this rope. And the one thing that they couldn't do is you can't touch the rope. It's only a fire. I was the pink team guy, and I saw them touch the rope. No one else saw it.

[00:06:14] And I had to call it. And everyone hated. Everyone hated me. Yeah. Oh, my God. Yeah. So I'm going to tell you what. That ump, I wouldn't want to be that ump either. I could have used a little AI back in 1992 with the rope burn. Where I'm going to be a hypocrite with my AI obsession is that I think the umpire brings some personality to the game. For sure. And the human element... Yeah.

[00:06:44] Well, Kevin, I like some human element in my carries diagnosis. So, yeah. But that's just... I mean, that's a good point. All right. Let's talk about this for a second. How does the AI work in baseball? The umpire makes a call. If the catcher or the batter disagrees and taps their helmet, then it goes to the AI. Correct? That's how it goes right now. Oh, I thought we were going to go straight. I thought it was going to be... Is it in the minor leagues? It's just a straight monitor? That's how they experimented in spring training, right?

[00:07:13] Oh, well, I didn't know that. Okay. Right. All right. So, the difference... That's horrible. The difference with my AI for carries detection is the AI is making the call first, and then I'm judging it after that. That's fair. You know what I mean? Okay. That's fair. So, it's an interesting point. I will concede some hypocrisy in my judgment here, but I don't know.

[00:07:42] It's probably inevitable that it's coming, right? You know what would be even better is first downs in football. Yeah. I mean, they've already got that system. Tennis referees are basically gone. Yeah. You know what I mean? Yeah. Yeah. Hawkeye's got that whole thing covered. Yeah. Yeah. Yeah. It's a matter of time. Yeah. It is. Does anybody watch a lot of professional soccer? Probably just me. Nope. So, they already have... We're Americans.

[00:08:07] So, they already have a video-assisted referee in most professional soccer leagues around the world. Okay. And what it is, is there's somebody assigned to the video-assisted referee, which it has a lot of technology. They call it goal line technology. It can track the exact line of the ball. And it can...

[00:08:34] The AI can tell the referee every time there's a touch on the ball. So, sometimes you can't really see that the ball's been touched. Like, it doesn't change the trajectory of the ball very much. For like an offside situation? For offsides is the biggest use. Or for like a goal that maybe wasn't a goal. Like, it's not very clear whether it completely passed the line. And even for like the most recent implication of this was there was like a double touch on

[00:09:02] a penalty kick that was like not obvious at all. But the technology sensed two touches. Like, so it's like... So, I agree with... Last time Alan was at my house, I sensed two touches. Yeah. Only two? So, I think that should be in all sports where there's still the actual referee. And then there's a team that tells him whenever, hey, like... That's like replaying football. Yeah. And basketball. And baseball. Sure. Yeah. That's a good point.

[00:09:32] Yeah. Okay. Very clinical listeners. If you did not listen to Very Dental Student yesterday or last week, you haven't tried out most podcasts at all. You should. A, you should. He does a nice job. B, we've been answering his Q&As from fellow student listeners. So, this is a continuation of that. If you like this and want more of that, then check out some of his episodes. Yeah, there's a bunch. I'm going to turn it over to him and let him ask us more questions from students and then we'll round table it.

[00:10:02] Yep. So, the first one is, how do you manage difficult crown preparations, especially for patients with limited opening or with like really weird alignment? I feel like we had this conversation. We just talked about this on the Pet Peeve one. Very recently. Yeah. Yeah. Limited opening is, I'd love to hear Kevin's take on it because I'm still a wuss about it. But there's at some point, like, isn't there a point where you can't do it?

[00:10:31] I mean, like, I won't lie to you. I've done plenty of crown preps I wasn't proud of because of the limiting factors of the patient. There's a time when I'm almost like, man, I just, this isn't going to work. I don't know. I mean, and Kevin doing the rubber dam on everything might make the difference too. No, you can't rubber dam some of those short second rollers. I mean, good luck. You can't, but I, my, my gut, my gut reaction to Muhammad's question was rubber dam. I kind of figured. Yeah. Yeah.

[00:10:59] If you can get it on, then you could probably prep the tooth. So that's number one. Number two is oral sedation. You can do a lot of stuff if they're sedated. And that's, that's a pretty good point. That has been a big, I was going to say game changer. Can I say game changer? You can, you can, you'll be mocked, but yes, you can. I don't like it, Kevin. I wish you could. It's been a big paradigm shift. Yes.

[00:11:26] My journey, my oral sedation journey has really benefited my practice and my patients. So rubber dam. Um, also don't be, uh, too hard on yourself. If you cut a crummy crown prep, you did the best you could. Yeah. But there's other situations though, that don't have to do with either tight lips or limited openings too.

[00:11:50] There's just like crappy teeth where it's, where it's subgingible or those long roots because of recession and stuff like that. Um, and so I guess on some of those one, boy, it's sure nice to have an electrosurgery laser. Yeah. We just, we talked about on the previous show for some of those scenarios where the cavity is sub, subgingible. Tissue anesthesia. I'm going to tell you, I go back to the PDL syringe where you can, like, it makes a big difference when they're super numb on the tissue.

[00:12:18] You can, you can pack cord really aggressively if you need to, or you can, you know, you can even, like you said, the laser, all that stuff. I, I love, and actually if I'm placing a rubber dam too with a retainer, um, I like to have super numb tissue. So you can, if you get, if you have to just pinch a tissue, I mean, it's like, uh, if you, if you got to, you got to, that's it's. And I think patients don't really complain about it when they're super numb that way. Yeah, for sure. Good anesthesia.

[00:12:43] The, you know, uh, having all the like pastes and goos out there to like for bleeding situations, like, um, the, uh, the, the, the kind of the clay paste, the, what is called a dry Z or, uh, Yeah, the, uh, Traxedent. Yeah. Yep. That's, I, I like the Traxedent stuff. I'll say that he, he, a stringed dent X from that is really good. Although it's, it gets that black scuzz. Very messy. Yeah.

[00:13:11] It gets the black scuzz and you'll have to clean up the preparation when you seat the crown. You just have to. Sometimes though, also you just need time. It's like, you gotta like see those in advance and just be like, man, I'm going to need an extra 15 minutes. Yeah. The tissue is going to take. Yeah. You're not going to get this crown rubbed then in a tidy hour. Yeah. I don't know. What about you, Kevin? What about, you know? Yeah, I'm just thinking that some of these were like, you see the patient on the schedule and you have this gut reaction.

[00:13:36] Like, oh my God, I know this person can't open, but then I've had this happen and I'm going to go back to, if I can put the rubber dam on, like all of a sudden, you know, it's a breeze. So don't dismiss my rubber damness. Try it. You'll like it. Yeah. All right. Well, what's, what's next? All right. So the next is kind of a practice management type question. What is your advice on managing team conflicts?

[00:14:06] Oh my God. We just had one. We just had. I'm so bad at this. I'm terrible at this. So that's good. Can I go first? Please. Please. You might go last too. Yeah. Cause I don't know if, I don't know if I have anything. All right. So, um, I have a office manager and what we call a clinical manager. Right.

[00:14:28] And my, um, hierarchy is that they are actually above me. Kind of like, it's like, uh, the King in chess. The King, you know, really is the top, but the queen does everything. You know what I mean? Sure. Sure. So, uh, that's a fancy way of me saying I've delegated this, these problems to somebody else, but I am the ultimate, I signed the paycheck paychecks. I'm the ultimate authority.

[00:14:58] So it has taken a lot of coaching for, um, um, our clinical manager coaching of me to help her to see how to manage people. So last week, last Thursday, there was a squabble, um, and it got kind of loud.

[00:15:24] And, uh, my clinical manager and my office manager got these two people in a back room and my office is right next door to that. And it was getting loud and it took everything I had to just sit there and not intervene. Um, but at one point I did walk in and my clinical manager said, I've got this, trust me, get out of here. And so I did.

[00:15:54] I would, I would love that. Yeah. Yeah. That sounds awesome. Then she and the two squabblers, I said, that's fine, but I want to talk to everyone when, when we're done and, uh, she and the two squabblers came into my office. I closed the door and I said, I don't want to know what happened. I don't care. Then I looked both of them in the eyes and said, you both are very valuable to me, but you're even more valuable when you get along.

[00:16:23] So let's get along. Mm-hmm. That's good. Like, um, you know, uh, you two are, you should behave like sisters to which my clinical manager just said, Oh, sisters. I hate my sister. Yeah. Right. But you, you, you squabble with your sister, but then you make up cause you still love each other. So just, and since last week up until today, I mean, including today, they've been fine.

[00:16:51] So, uh, I, I delegated that out and, but it took some prior years of coaching to get what I wanted. Yeah. Hey, it's Kate, the dental assistant, and it's time to get very clinical in this episode's very clinical corner. Are you ready? Dr. Mead? I'm ready. I want to ask your advice on storage. Sure thing. What's the question? So my team is always looking in multiple places for the same or similar materials. And I feel like no one knows exactly where anything is. Do other practices struggle with this too?

[00:17:21] Yes, many practices do. And I'll be honest, legacy errors are to blame for this current state of quote unquote organization in dental practices. So tell me what you mean by legacy errors. A legacy error is when somebody starts a process or a system with no scientific background or research or education. They just make the decision and then train their successors on the way that they want things to happen. And then what works for that one person. So that sounds like it could cause problems over the long run.

[00:17:49] It can, especially when the person that sets the system leaves and then the next person comes in and then makes changes. And now we're creating more confusion because where it was isn't where it was the last time. How do you change that or how can you prevent it? Create standard operating procedures and then define spaces for the procedure specific materials and then the general disposables as well. So give me an example of that. Procedure specific materials are the ones that you need to actually perform your procedure. For example, bonding agents, cement, sutures, gutta percha.

[00:18:17] Often they're expensive and expirable. And those should be stored in a central location where their quantities and expiration dates can be monitored closely. What about the general disposables? Those are the items that we need for pretty much every single patient. PPEs, barriers, and cotton products are to name a few. And those should be stored in a separate room or closet due to their bulky packaging and quantities. And we don't want to waste valuable space and central sterilization on those items. So two storage spaces for dental materials beats the 15 places that we have them. Absolutely.

[00:18:48] Listeners, if you want to avoid legacy errors and have a timeless organizational system, check out the show notes on where to start. I wish I could say I'm as good as that. I'm not. No, I don't have an answer that anyone should care about. That's the same here. Same here. My answer is lunch isn't very far away and I can leave. That's my answer. It's not a great answer. I can give a longer answer on why this happens though.

[00:19:18] But it would be kind of long. So I mean, I... Sounds like another show. Well, we are tribal in nature as human beings and we are competitive. And the things we compete on, we can compete on brute force. Meaning I could walk in or Mohammed could walk in every day or Alan or Zach and say, this is the way we're going to do things from now on.

[00:19:46] And you can be a real a-hole and demand that things are done a certain way. That's brute force. And that's never going to work long term. People are not going to follow. You're right. In the workplace, people are not going to follow you if you do that. The other way you can compete is on virtue, which is even worse because virtue means that...

[00:20:16] I worked really hard today, Mohammed, but Alan was in the back getting snacks and on his phone. So the virtue means that I'm pumping myself up because by my nature, I want to compete and raise myself up in the hierarchy of my tribe. This is a strategy that I can compete by putting everyone else down and trying to show that I'm more virtuous than everyone.

[00:20:46] Which is classic in a dental office, yeah. But the problem is that no one is virtuous enough because I will ask everyone here, because I've given this little lecture before, has anyone here ever told a lie? We all have, right? Not in the last minute. Yeah. So none of us are virtuous enough. So that competition doesn't work.

[00:21:07] What does work in my office, and it's come for me to believe this with my heart, is competing on ability, on competence. Who's the best at what they do? So the reason my clinical manager and my office manager are at the position they are, because they are very good. They are the best. So they rose up. They didn't rise up because they were tattling on other people.

[00:21:35] And they didn't rise up because they walked in the door one day and said, everyone's going to listen to me. They rose up because they were beyond competent. So the best way to compete amongst your little tribe is to be the best. Be undeniable. There you go. Be undeniable in my office, and you will be rewarded. That's really good. That's excellent. Yeah, that's awesome. I feel like that should be an entire episode just for itself. Probably, yeah.

[00:22:03] We can move to the next question, which maybe I don't know exactly how you guys want to go about this, but how do you determine when you refer an extraction versus attempt it yourself? So let's start with like what's the – like if all things equal like patient-wise, patient being like a good patient, then what is kind of – Or you're talking about just the tooth itself, you're not going to base it on their – I was going to say – Medical stuff.

[00:22:29] It's medical history or perceived amount of wimpiness. Yeah. Behavioral or medical. Yeah, yeah. How crazy are you? Crazy person. How likely are you to call me eight times asking if this is healing okay? Yeah. Let's say it's like your most normal patient. Okay. Honestly, if it's my most normal patient, I'm more likely to go out on a limb. Like I'm more likely to try a tougher tooth, honestly. And I can – because with those people, I can be very straight with them too.

[00:23:00] Sure. But also you're talking to two guys in this conversation that have a CT that may help them with anatomical considerations that I don't have. There it is. There it is. That CT tells you a lot. But I mean let's – if you want to just boil it down to like brass tacks, if it's like a tissue or bony impacted type of situation,

[00:23:24] there's just not enough money for me to go through that type of hassle if it's like a third molar type of situation. And the rest of it is just going to be – are there weird curves in the roots? Is it really long and skinny? What kind of bone does this person have? Are they a 300-pound dude with like a bunch of tori or is it just like a – or is there a regular – kind of a regular archetype to their bone? Those are the things I'm looking at to determine what –

[00:23:53] Even with all the information, they will sometimes surprise you too. And surprise you either way. Surprise you either way. You're going to get surprised by some things. I had a woman last month. It was a wisdom tooth. It was a big cavity. The cavity was big enough like that the tooth had moved because like it was one of those things where – and she was a heavier set black woman and you're like, oh, the bone sometimes on that is really like what I've run into. And it rolled out like nothing.

[00:24:22] It was great. She thought I was a hero. So I was expecting it to be worse. But honestly, it's probably better to have expectations of it being really tough than not, I guess. Kevin, you're the best person here at extractions. I think there's no competition to that. Is there – on a good patient, what would it take for you to be like, you know what? I just – I'm not going to do this. You'd be better off my oral surgeon. Assuming no medications, they're not a wimpy patient. They're not crazy. They're normal.

[00:24:52] Is there anything that you're going to say no to? My list has shortened. I mean – Yeah, I'm sure it has. It's dwindled. But I don't know. Certainly, I'm not – wisdom teeth, which we already mentioned. I don't really care to lower wisdom teeth in particular. But thick bone. So the big tour I do, like I'm talking about. Yeah, the big tour I do.

[00:25:19] That's really – it's just going to be – but, you know, one of the things that I tell the implant class is just, you know, like coming up with a strategy ahead of time. Visualizing the whole thing ahead of time. Yep. And playing the game in your head before you do it. And if I play that game in my head and I'm like, this is going to take a lot longer or we're going to have 800 phone calls afterwards, then I'm not going to do it.

[00:25:45] Watch your – be careful with your endodontically treated teeth, especially if the roots are longer. And, you know, watch your really old – some of that perio bone is horrible sometimes too. Yeah. Be cognizant of that. If I didn't have a handpiece, that would limit a lot of things, right? Like if – like I do. I have multiple at this point. But, like, that has changed surgery for me a lot. The fact that I'm – I used to be scared to use a handpiece.

[00:26:15] I don't want to have to use a handpiece. My God, that's like – that's everything. Like – It is. So I have two follow-up questions. Is there a way to tell on a CT the density of the bone around the tooth you're looking at? Or is it just kind of a – I'm not really looking at that. I'm looking at – Curvatures. Curvatures. Root undercuts. Yeah, the hook. Yeah. Yeah. So when you guys talk about bone density, you're just – You're going to look at the dude. Yeah.

[00:26:46] You're educated. You're going to look like – Big bony ex-oxoces and stuff like that. Yeah. You're going to know that's not for you. You know? That's not it. So I had one of those yesterday. A guy comes to see me from Florida. Oh, my gosh. Wow. So, like, I can't – I couldn't refer him.

[00:27:16] Right. I understand. So my strategy, big dude, big tori, my strategy was different. And actually, I'm going to say I got lucky. I rolled both those teeth out with minimal effort. But, you know, there was sectioning and, you know, creating purchase points and all that sort of stuff to have a time to get things going. So, but –

[00:27:44] What – when you refer, though, is going to determine – be determined a lot based on your – what your experience level is with these. Yeah. And – Can you suture? Can you handpiece? All that kind of stuff. So, Mohamed, when you say extraction versus three of us, you know, it's different. You haven't done enough. Yeah. Your friends haven't done enough. You need a lot of reps and you need to get in trouble and get yourself out of trouble. Yeah. And that – A crappy deal, too.

[00:28:13] I remember when I was in dental school, and it sounds like some of the dental schools do it significantly different. We had – we rotated through oral surgery for, like, less than a month. There were, like, four of us per rotation or something like that. And honestly, that wasn't enough time to even learn how to luxate a tooth. I remember – I remember getting out of dental school and still thinking just I'm going to put an instrument on it. It's going to wiggle out. I'm going to hope it's going to wiggle out.

[00:28:37] That's the dumbest thing I've ever – I mean, like – and there may have been people trying to teach me that, but there were – it was a hot mess. I did not learn what I needed to learn in dental school. From teaching people, I either have to unlearn them bad habits or relearn them everything. Yeah. You know. Yeah, I can see that. But it's – I believe that. Yeah. Yeah. All right. Keep going. Keep going, Mo. All right. Next one.

[00:29:01] Is there any specific CE courses that you would recommend for a new dentist? Yeah. So – Or like a brand new dentist, like right out of the gate? Let's say, like, first two years. What to do during the first two years if you're going to take any CE? Composites. Take a composite course. Whatever you learn in school is not good enough. Yeah. It can be YouTube. It doesn't even necessarily have to be, like, a big major travel to course.

[00:29:28] But my God, get your class two composite, class three composite down. Get it down. Yeah. Or a basic crown prep course because whatever you learn in school is also not going to be good enough for that. So that's – and then – Learn endo from Kevin. Attraction thing or learn endo from Kevin. You haven't done enough. No matter what dental school you went to, you haven't done enough endo to really know what you're doing.

[00:29:54] At the end of the day, you've got to be able to do those fillings right and sensitivity-free. And you didn't learn enough in school to do that. So I would say a filling course. So I'll press on you and I'm going to ask for a specific course or a specific – I'm sorry. YouTube. Yeah, I would say YouTube. Do you mind? And I'll look one up for you. You guys are so lucky. Yeah, you're so lucky to have a good –

[00:30:17] You can learn composites, crown prep, reverse crown prep technique from the TOLA. Boom, there's your crown prep course. I'm sure there's a good – It's pretty funny. I like Cosminent's courses, but they are – most of them are way too high level for what the regular – I bet Dennis Hartley has a – Dennis's courses would be good. I mean, Smithson is an amazing teacher, but frankly, there's very few people in the world that can do what he does and he's trying to teach that.

[00:30:47] You know, it's like so – Dennis's hands-on thing. What was it called? Dot. It's dental online training. You cannot go wrong with anything that he does. And he's an exquisite clinician. He won't say it himself, but he is very good, like the best. I would do that because you're going to get like the hands-on portion. I've watched some of his videos. That is good money spent. Good money spent. And go all in. Get the kit sent to you and all the instruments, all that stuff. That is good money spent. I would say he would be a good – I assume he's still doing that. Oh, yeah. He's all in.

[00:31:17] Yeah, Dr. Hartley was actually one of the first people I interviewed and he sent me the kit and everything. Yeah. I went through one of his courses and it was really good. Okay. Then did you – you liked it then, right? Yeah. I mean, it's major. And he does all kinds of composite. I mean, he does veneers too. He does preps a lot, but he does a lot of composite. You could not do much better than just having whatever he offers. That's very good. Very good point. How about you, Kevin? You obviously come from a point of – Yeah, I mean – Some specific thoughts, but –

[00:31:45] We got a lot of newbies in the implant class and there is a benefit to that. But I really think you got to pay your dues first and – I agree. Get good at the basic fundamentals, crowns and fillings. And then I think there's a long-term return on investment of learning how to place green light implants.

[00:32:05] But also that's a really intensive and expensive journey or drop to get there. So, you know, I can't give you any – Kevin, when is the sweet spot for the motivated clinician? Like, let's say – I don't know. Is it like year three or four after you've gotten a few reps? Yeah, probably year three or four. All right. Do one more, Mo. We'll do the last one. So –

[00:32:34] Well, we actually kind of talked about this one, so I'll skip this one. Do you have any tricks for achieving a perfect contact when placing composite fillings? I know we talked about the importance of a good contact. Like posterior? Posterior? Let's do posterior, yeah. I got a bunch of thoughts. Okay, let's start. Pre-wedge. Pre-wedge. So as soon as they're numb, put the fattest wedge you can get in between there and let it sit for a little while.

[00:33:01] I mean, you can do it while you're prepping or whatever, but there's a lot of times where I'm just going to let it sit. If I can go do a hygiene check or something like that, I literally let the wedge sit in there for a while. And I have to tell you, that is like – that is boring and not sexy, and it works awesome. It just – it lays the groundwork for a much better contact because you've kind of opened it up. You've kind of got the ligament a little moving around and all that stuff. So that's one – and I start with like an orange – I use a lot of BioClear wedges. I'll start with an orange one.

[00:33:26] And my goal is to try and restore with a yellow one, which is a pretty big wedge. So there's that. You want to have good – you want to make sure your rings are well-torqued or new or whatever because you can't – it's hard to get a – you want to get as much separation as you can. Make sure you've – I mean, I use several different matrices and systems, and they all can work pretty well.

[00:33:56] What else do you think, guys? What am I missing? Burnish the – burnish your little matrix further, more gingival than you think you should. Yeah, yeah. Not at the top. Not just at the top because you don't want to contact. You want a contact that's as broad occlusal – yeah, exactly. So you want a broad contact. I have a question for you, Zach. When you say you burnish the matrix, I've had this problem. What part of the matrix are you burnishing?

[00:34:25] Just the gingival portion or are you coming up coronally and burn – because I feel like – I start a little bit lower, but I'm trying to kind of feel for that like the little bit of a round – you want like a marble-to-marble contact. And so you're looking to get it to that area. But what you – the mistake that I've made and we've all made is burnishing the very top of it. And then you've got this contact at the top. Yeah, it's the worst. And then you'll end up with more of an open space in between.

[00:34:52] And the person is going to complain of getting food in it. So you want to burnish lower than you think and not necessarily hit the like top part of the tooth, in my opinion. And so that and those little rings, almost all the pliers for those rings have a portion where you can re-squeeze your ring. Yeah, yeah. Yeah, re-squeeze. Kind of re-torque it. Do that more often than you should or train your assistants to do that more often than you should. That makes a big difference, yeah.

[00:35:25] You know, getting good separation and getting mediocre to poor separation. And that's how you can keep your bands. Those things are very expensive even if you use the knockoffs like I do. Squeeze. Get a good contact. Squeeze before you squirt. Yep, squeeze before you squirt. You got it. Never forget. So I don't know.

[00:35:46] I want your thoughts on this because most of my posterior fillings, class twos, I have – I don't know what I'm doing wrong, but I get a really, really tight contact that I can't fit floss in. Okay, yes, that happens sometimes. So you're overburnishing it then or you must have a really new ring and you don't need to burnish it much. Also, it depends on the contour of your matrix a little bit too. Sometimes if you're using like a real flat sort of not rounded matrix, you can get kind of a blocky contact that way.

[00:36:16] Because I know that like my dad never used this matrix, like a sexual matrix that had any contour to it. He used basically a Toffermeyer band that was kind of straight up and down. And that'll give you weird shaped context. If you can get an anatomic matrix, that's pretty – and there's – I mean like I use BioClear, which are Mylar. I use Garrison. I use all kinds of different ones, but I like the contoured ones. Do your rings seem really new though? Do they seem like really fresh or do they seem beat up?

[00:36:43] No, but I think the matrices we use are – Really thin? They're like thin and flat. Like you basically – they're not pre-contoured. So I think that might be – Like a first girlfriend. Wow. Burnish more gingivly, but maybe don't put as much pressure on it. It sounds like you're getting plenty of separation. It's funny because I hate the too tight of contact because then you kind of have one of the little saws almost to open it up.

[00:37:12] When you can't get floss through, that sucks. It's like how did I – how did that happen? You know? Okay. For what it's worth. Good to know. Okay. Sometimes if you can't get floss through – let me say this. Sometimes if you can't get floss through, if you can open up the occlusal embrasure a little bit, round that with a disc or whatever. That's what I'm thinking might be happening. Yes. Check that because a lot of times if you can just get it past that, it'll go down. The other thing is I started using the stuff they call Gorilla Floss. I don't even remember the company.

[00:37:40] But it's like a non-shredding floss. Oh, my God. Is that amazing? Well, it's really funny. If you can get the Gorilla Floss through a contact that you couldn't get through regular floss, a lot of times it's bonding agent. It's bonding agent is hanging you up. If you can get that out of the way, a lot of times you've got a nice solid contact that's not too heavy. So don't give up. If it's too heavy to get floss through, round those occlusal embrasures on your marginal ridge. That a lot of times is enough to get you – It means you probably burnish it too high. Yeah. And you're closing yourself off sort of. Yep.

[00:38:10] Your contact's probably proper. You just can't get it started. Get to it. Yeah. Yep. Yeah. Correct. I definitely think that's what I'm doing is I'm burnishing all the way up, which I shouldn't be. Yeah. You don't need to hit the top. Not the top. I'm a burnisher from way back. I've been burnishing a lot. You seem like an OG burnisher. OG. You kind of seem like that. Yeah. I started burnishing when I was a teenager. All right, guys. Any take backs, apologies, double downs? Anything?

[00:38:40] No. No. It's been a good one. Mo, you're a legend. Yeah. You are. You think – How many questions did you leave on the table? How many more episodes? Well, I'm super impressed with all of them. They're good questions. They are good questions. Legitimately good. Yeah. We only have three questions left, so maybe I'll just have to put these back in the bank and do another one later. Let them cook for a little while. Maybe in the summer or something. You bank them and Kevin will burnish them out another time. That's right. Yeah. Hey, thank you guys for listening.

[00:39:09] Check out the Very Clinical Facebook page if you want or not. I don't care really. You should. But you should. And we will see you next Tuesday. See you. Excellent. See you next week. See you next week. See you next week. See you next week.