Very Clinical: Teaching Mo Anterior Composite

[00:00:01] This is a production of the Very Dental Podcast Network.

[00:00:16] Welcome to the Very Clinical Podcast. In about the time it takes to do an MO on three, we will entertain and amaze you with tips and tricks on regular daily dentistry. Here's Kevin and Zach.

[00:00:28] Very Dental student listeners and Very Clinical listeners, I have a very cool announcement for you.

[00:00:35] So if you listen to the whole feed where you listen to all the different shows that we put out here at the Very Dental Podcast Network, you know that the Very Clinical show is our Tuesday show.

[00:00:46] And it features Dr. Kevin Fryer and Dr. Zach Miners as the hosts. This has been going on for years, years and years.

[00:00:54] And then more recently in the last couple of years, we also have a show called the Very Dental Student Podcast, which features our host, Mohamed Aboubasha.

[00:01:02] He's currently a third year student at Oklahoma in dental school.

[00:01:07] So each of these shows kind of has their own sort of way of doing things.

[00:01:13] I've had the honor of being on both shows multiple times in a lot of different capacities.

[00:01:18] But what's interesting is, is Zach and Kevin and Mo, I don't think have ever podcasted before now.

[00:01:25] So what we have is this epic crossover between Very Clinical and the Very Dental Student Podcast.

[00:01:32] And today, today and tomorrow, actually, you're going to hear kind of like two sessions worth of that of that interaction.

[00:01:40] And they talk a little bit about dental school. And it's very cool. It's really exciting to hear all three of these guys.

[00:01:45] Because maybe at some point, the four of us can get on an episode and I don't know, do like Dental Jeopardy or something like that.

[00:01:54] That would be epic. In any case, you have a lot. Actually, they have multiple episodes that they've recorded.

[00:02:00] Then, like I said, the next two days, you'll be hearing from them.

[00:02:04] So I'm just going to put it in one day is going to be very Dental Student episode.

[00:02:08] The next day will be very clinical, but they'll be kind of consistent.

[00:02:11] There's a sort of one after the other. So don't be too surprised by that.

[00:02:14] And so with that, I give you the Very Dental Student and the Very Clinical Podcast.

[00:02:20] Hello, everybody. Welcome to another episode of the Very Dental Student Podcast.

[00:02:23] I'm your host, Muhammad Abubasha.

[00:02:26] And we're back again with Kevin and Zach. Kevin and Zach, how are you guys doing?

[00:02:31] Great. I feel like I'm back in school again.

[00:02:35] I also feel like I'm back in school. I'm hoping you're going to teach me something, though.

[00:02:39] Yeah. Yeah. I don't know if I'm qualified to teach anything.

[00:02:44] Watch one, see one, do one. Wait, watch one, do one, teach one.

[00:02:48] Yeah, there it is. Exactly.

[00:02:51] I did want to say I had a breakthrough with one faculty. Let me use two SEPTA.

[00:02:57] Oh, whoa.

[00:02:58] At the beginning of an appointment.

[00:03:00] Did you punch him?

[00:03:01] So that was actually yesterday.

[00:03:02] Did you threaten him?

[00:03:05] Yep.

[00:03:06] Yeah.

[00:03:06] Oh, okay.

[00:03:09] How did that work, though?

[00:03:10] What were you doing and how'd it work?

[00:03:12] Um, we were actually doing a pretty simple procedure.

[00:03:16] It was actually just a filling.

[00:03:17] And I just talked to him.

[00:03:19] I was like, you know, I feel like one carp of lidocaine just isn't enough.

[00:03:23] I've also been talking to some, some mentors of mine.

[00:03:27] Um, and they don't, they don't feel like it's enough.

[00:03:29] And he was like, well, yeah, just go for it.

[00:03:31] He was the first one who'd ever, who'd ever said that to me.

[00:03:35] Everybody else is like super weird about it.

[00:03:37] Huh?

[00:03:37] I love how that person have a different background.

[00:03:40] Like, are they still in the field?

[00:03:42] They like just recently retired.

[00:03:45] Yeah.

[00:03:46] There it is.

[00:03:47] Yeah.

[00:03:47] Yeah.

[00:03:48] I love how this has become an anesthetic driven podcast.

[00:03:52] Behind the scenes, that's all we talk about.

[00:03:55] It's so funny.

[00:03:57] I'm still sure.

[00:03:58] I told you, I, I tried the, uh, the one lidocaine challenge, see if how, how far I could get

[00:04:03] my day and I didn't make it at 15 minutes.

[00:04:06] Yeah.

[00:04:06] That's no good.

[00:04:07] No good.

[00:04:08] I don't like that.

[00:04:09] I don't like that challenge.

[00:04:11] Not taking it, Kevin.

[00:04:12] I'm not going to take that challenge.

[00:04:13] No, I got, uh, I'm selling time here.

[00:04:16] I'm not selling, I'm not selling.

[00:04:19] I'm not selling.

[00:04:20] Yeah.

[00:04:21] Uh, cool stuff.

[00:04:23] Well, one thing, uh, since we're reminiscing about dental school, I guess one thing I wanted

[00:04:28] to talk to you guys about was, um, if you remember your favorite trip while you were

[00:04:32] in dental school, I'm getting ready to go on one next month, this month.

[00:04:36] Depending when it comes out.

[00:04:37] So.

[00:04:38] All right.

[00:04:38] Well, let's start with you.

[00:04:39] Where are you going?

[00:04:40] So I'm actually going to, uh, to Pakistan.

[00:04:43] My wife is from Pakistan.

[00:04:44] I've never been there.

[00:04:45] Excellent.

[00:04:45] Cool.

[00:04:46] So we're going to go visit her grandpa.

[00:04:48] So should be a very interesting trip.

[00:04:51] That's a big trip.

[00:04:52] Yeah.

[00:04:53] It is a big time trip.

[00:04:54] Right on.

[00:04:55] That's cool.

[00:04:55] I think we leave on, we leave on Saturday and we actually technically arrive on Monday

[00:05:01] because of the time difference too.

[00:05:03] Yeah.

[00:05:03] So it's a time traveling trip to Pakistan.

[00:05:06] Yeah, exactly.

[00:05:08] Excellent.

[00:05:09] Love it.

[00:05:11] Uh, Zach, how about you?

[00:05:12] Favorite?

[00:05:13] I know you, you did some Las Vegas thing, right?

[00:05:17] Actually.

[00:05:17] Yeah, I, I, I did.

[00:05:19] I was going to, I know, I think I've brought this up.

[00:05:21] Yeah, but I think we did a spring break.

[00:05:22] I like hearing it again.

[00:05:23] Uh, we did, uh, my senior year of dental school, a bunch of the guys that, uh, that,

[00:05:29] that, that hung out together, kind of big old Vegas, uh, spring break trip.

[00:05:35] And that was a lot of fun.

[00:05:37] A lot of, a lot of good times out there.

[00:05:39] That had been my first time out there when I was old enough to, to gamble.

[00:05:44] And, uh, it was cool.

[00:05:45] I had a good time.

[00:05:46] It was good, good, good bonding trip.

[00:05:48] And, uh, the older guys, uh, they taught me a lot of things.

[00:05:52] I learned a lot.

[00:05:54] Was it reminiscent of the hangover movie?

[00:05:57] Yes.

[00:05:58] There was a tiger in the room.

[00:06:03] No, no one, no one pulled their own tooth or anything like that.

[00:06:06] But, uh, uh, there, there definitely was plenty of, uh, forgotten, forgotten evenings

[00:06:12] for sure.

[00:06:13] In a good way.

[00:06:15] Excellent.

[00:06:17] What about you, Kevin?

[00:06:18] Well, um, I was always too poor to go on any trips at all, except for freshmen, our first

[00:06:27] year of dental school, spring break.

[00:06:29] Um, my best friend ever, um, was also living in Columbus at the time.

[00:06:36] And I had a week or whatever off.

[00:06:39] So, I had family living in Myrtle Beach.

[00:06:42] So we took a road trip to Myrtle Beach.

[00:06:44] And like a lot of things, you know, like half the fun is getting there.

[00:06:48] So, um, there's still some stories that we tell from the ride there.

[00:06:53] And then just sort of sat on the beach and threw a football around for a week and drove

[00:07:04] home.

[00:07:04] Nothing that exciting, but fond memories nonetheless.

[00:07:08] Do you think that still applies to half the funds getting there?

[00:07:12] I don't think that applies anymore.

[00:07:13] Hmm.

[00:07:14] Well, I'm like getting there.

[00:07:15] I do still.

[00:07:17] So, I, I, I elected to drive to North Carolina last week instead of flying.

[00:07:23] Wow.

[00:07:24] How about how was that?

[00:07:25] Eight hours.

[00:07:26] Okay.

[00:07:26] That's not horrible.

[00:07:27] Uh, you know, the time alone, just, uh, you know, with your thoughts and I don't know.

[00:07:34] I like it.

[00:07:35] That's cool.

[00:07:36] Yeah.

[00:07:37] A road trip is fun.

[00:07:38] A spontaneous road trip is the best.

[00:07:40] Yeah.

[00:07:41] Well, I haven't done that.

[00:07:42] Yeah.

[00:07:42] I'm not hearing that in a long time.

[00:07:44] Correct.

[00:07:45] I've done a spontaneous flight to Utah.

[00:07:48] A couple of times.

[00:07:49] That's cool.

[00:07:50] In fact, that's cool.

[00:07:52] Relatively spontaneous.

[00:07:53] You know what I mean?

[00:07:55] All right, Muhammad.

[00:07:56] Lay it on us.

[00:07:57] What are we talking about today?

[00:07:59] Well, we've already covered posterior composites and I was thinking, um, a natural way to go

[00:08:05] now is to talk about anterior composites workflows for that.

[00:08:09] Okay.

[00:08:11] So as far as what we get taught in our school is, um, we're using mylar strip for class threes

[00:08:17] and fours and basically just place it, wedge it at your bond prime.

[00:08:23] Just like, just like any other situation.

[00:08:25] Let me, let me ask you a question.

[00:08:27] Is that mylar strip shaped like a tooth?

[00:08:31] No, it's, it's just like a little strap.

[00:08:33] Yeah.

[00:08:34] Okay.

[00:08:34] Yep.

[00:08:34] I just wondered.

[00:08:36] Just curious.

[00:08:39] How do they, how do they teach you to polish it?

[00:08:42] Um, we have, we have like the same polishers that we use.

[00:08:47] It's like, uh, I honestly couldn't tell you the brand, but, um, like they want us to go

[00:08:51] red football, yellow football, white football.

[00:08:54] And then there's like, uh, white, green, pink polishers.

[00:09:00] And that's what we use for pretty much all of the components.

[00:09:02] Sounds expensive.

[00:09:03] It's a lot of, it's a lot of, a lot of devices.

[00:09:06] Yeah.

[00:09:07] I think.

[00:09:07] I never heard of a white football.

[00:09:10] You know, like the little midget, like the little midget birds.

[00:09:13] Yeah.

[00:09:13] The yellow.

[00:09:14] I, I know about, well, whatever.

[00:09:17] I see brown ones on, on TV.

[00:09:26] Um, how do they, how do they teach you to fix or have you even had the opportunity

[00:09:33] to fix like a small chip in a like upper anterior or lower anterior too?

[00:09:40] So I haven't had the opportunity to actually do one.

[00:09:42] Um, but what we've talked about in lecture is if it's small chip with like, you won't

[00:09:49] have any retention.

[00:09:50] So they're teaching us to do like a bevel, a really, really large bevel.

[00:09:55] Okay.

[00:09:56] Someone's, someone's telling me something.

[00:09:58] Okay.

[00:09:58] Yeah.

[00:09:59] That's good.

[00:10:00] That's something, something that's a start.

[00:10:03] Yeah.

[00:10:03] But I haven't, I haven't actually gotten to do it.

[00:10:06] So, and we do have available like the different, like the enamel shade, dentin shade, translucent

[00:10:14] shade, but I haven't used any of that honestly in clinic.

[00:10:19] Kevin, how do you, how do you, or your EFTA, how do you do a anterior composite these days?

[00:10:26] What, what matrix are you using?

[00:10:27] Um, I prefer to use like a bio clear shaped matrix when possible.

[00:10:34] Um, it really all depends on the situation, but a flat mylar strip, I don't think gives

[00:10:40] you the correct contour.

[00:10:42] Um, so we don't, I, I don't do many of those anymore, but my EFTA does, she did one today.

[00:10:50] That was actually, she knocked the dog of the park on, uh, Invisalign patient that we're

[00:10:57] done with.

[00:10:58] And she had some edge bonding that needed to be done.

[00:11:01] But, um, I believe she probably used a flat mylar strip for that because it was just

[00:11:05] like a class four that a minimal class four.

[00:11:08] So, um, but yeah, I mean, nothing fancy here.

[00:11:15] No, um, no multiple shades of composite or no dentin shades.

[00:11:21] No, I, I, I, I shied away from that.

[00:11:27] Um, honestly, you know, a lot of those teeth need grounds or veneers.

[00:11:33] And in my opinion, like the bonding is only going to get you so far.

[00:11:37] And I don't want to get off in a diversion of, uh, that far, but it's just, if you, again,

[00:11:48] if you practice long enough, you're going to be redoing a lot of those and get frustrated.

[00:11:52] So, this is just my experience.

[00:11:55] Zach lay it on us.

[00:11:57] So, I, I don't have the, I have some of the bioquiddler, uh, matrices.

[00:12:02] I don't use it very often.

[00:12:03] I use Garrison's Blue View, which is a contoured, um, matrix for, uh, class threes and fours.

[00:12:12] I also sometimes will use just Teflon tape on the adjacent tooth and, and kind of bond to

[00:12:18] that and smooth it back.

[00:12:20] Um, here's the deal.

[00:12:22] I think the school made, made these composites seem like they were going to be pretty, pretty

[00:12:28] easy.

[00:12:29] And some of them are for sure, but you're going to run into a bunch of them that like

[00:12:35] either the ones that go below the gum line and you're dealing with blood or those little

[00:12:40] chips that they're talking about.

[00:12:42] Those will be your, your nightmares if you don't get them.

[00:12:45] Like, because that is a common emergency is the, like the lower interior.

[00:12:51] They chip off the incisal link, upper inside, you know, the upper, they're going to chip

[00:12:55] off, you know, one of the little corners of the incisors.

[00:13:00] And those, those will, you will do those.

[00:13:03] And then you're going to do them again.

[00:13:04] It's like three to six months and you're not going to get paid for it.

[00:13:06] And it will become a constant problem for you.

[00:13:10] And some of it is, some of it's bonding, some of it's occlusion, some of it's, some of it's,

[00:13:16] you know, habits like nail biting, you don't recognize and you don't know to recognize it.

[00:13:19] And some of it's materials.

[00:13:21] Um, like for sure, they're going to show you how to mess around with like those shades,

[00:13:26] translucent.

[00:13:26] Yep.

[00:13:27] You know what?

[00:13:28] That's cool.

[00:13:29] Except that people, in my opinion, people are willing to accept a slightly less amazing

[00:13:36] look if it actually stays.

[00:13:38] Correct.

[00:13:38] And so, for those areas, like those chipped areas, you need a good micro hybrid because

[00:13:44] that is the like, most fracture resistant composite.

[00:13:49] And you need to, in my opinion, you need a micro etcher in your ops.

[00:13:55] I don't know, Kevin, I don't know if you mess around with micro etchers or not.

[00:13:57] Um, yes, I have actually.

[00:13:59] So, um, Zach, why don't you, Mohamed, have you ever used a micro etcher?

[00:14:03] Do you even know what a micro etcher is?

[00:14:04] Is that the same as like an air abrasion unit?

[00:14:07] Kind of.

[00:14:08] Kind of.

[00:14:08] Yeah, it's aluminum oxide comes out of it.

[00:14:11] Yeah.

[00:14:11] Particle abrades the tooth.

[00:14:13] Um, but, uh.

[00:14:15] So tell us the benefit of that, Zach.

[00:14:17] You're creating a whole bunch more micro porosities in your mammal to actually get some bond strength.

[00:14:22] So, I mean, the bevel helps, but that does more.

[00:14:26] And then man, etch, etch the, etch the snot out of those.

[00:14:30] And, and, uh, you know, uh, I, I prefer the method on those of overbuilding it and then cutting it back.

[00:14:42] And Kevin, I use the same polishing system.

[00:14:44] We're on the super snap, right?

[00:14:46] Super snap from Shofu.

[00:14:47] Become like an overbuilder and a cutter backer.

[00:14:50] That is so much easier.

[00:14:51] Yep.

[00:14:51] Like trying to build it perfect.

[00:14:54] That, that never worked for me.

[00:14:56] It was easier to just blob it on and then, you know.

[00:15:00] So you're sculpting it.

[00:15:01] Trim it till it was bad.

[00:15:02] Yeah.

[00:15:02] I got another, uh, pro tip.

[00:15:05] Please.

[00:15:05] I started doing a couple of years ago is so before I just talk about that, I almost blew it right there.

[00:15:14] Um, what, what is your step-by-step technique, Muhammad for like class four?

[00:15:22] Okay.

[00:15:23] So you, you've beveled it and what's next.

[00:15:27] So if it, if I need like something to like guard me from the adjacent tooth, then I'll put in the mylar strip.

[00:15:34] If I've already done the bevel, then I'll etch.

[00:15:38] Um.

[00:15:39] All right.

[00:15:39] Stop right there.

[00:15:40] Are you pumicing at all?

[00:15:43] Um, no.

[00:15:44] Zach, are you pumicing?

[00:15:45] Yeah.

[00:15:46] Every, while, while a tooth is, um, the way I do it is that while the tooth's getting numb, assuming it needs anesthetic, some of those.

[00:15:54] Yeah.

[00:15:55] You can get away with not doing that.

[00:15:56] But assuming it does, it's, it's going to get numbed.

[00:15:59] And then I'm going to blast my micro lecture and I'm going to say, Hey, look, I'll see you in a few minutes.

[00:16:03] My system is going to go through.

[00:16:05] I'll just polish that and clean off all the dust while I'm gone.

[00:16:08] And then I'll come back and get started.

[00:16:10] Why?

[00:16:11] That's why it's time saver.

[00:16:13] Plus I want it clean.

[00:16:14] Yeah.

[00:16:15] Cause if it's not clean, you're not going to bond with it.

[00:16:17] So what I started doing, this is why I stopped you, Muhammad, is I used, uh, I used disclosing solution.

[00:16:23] To see where all the plaque is because all of your, we've had, um, Nate, um, on here, on here a bunch of times.

[00:16:33] Um, all of those stuff, all of the bonding studies done in the lab are on extracted, clean, very clean teeth.

[00:16:44] Right.

[00:16:45] And human teeth in there, a human mouth is not clean.

[00:16:50] Okay.

[00:16:50] So I use disclosing agent and then I pumice the heck or I remove all that.

[00:16:56] I'm removing all the plaque.

[00:16:58] I want to block bond to a plaqueless tooth.

[00:17:01] Kevin, even on the posterior teeth, while, while I'm gone and letting the anesthetic soak in, the assistant is instructed to, you know, pumice and floss.

[00:17:10] That's why, that's why you have better success than most.

[00:17:13] Cause you're not bonding to plaque.

[00:17:15] It's you can't bond to plaque.

[00:17:17] I mean, you can't have a strong bond to plaque.

[00:17:20] Right.

[00:17:21] So you have to get rid of all that.

[00:17:24] So my question is, is the mechanical, just like drilling of the tooth, not cleaning it also?

[00:17:32] Not always.

[00:17:33] You'd be surprised.

[00:17:34] So what I often do is use the disclosing agent.

[00:17:38] Then I started doing my bevel and then I look and see what's left.

[00:17:40] And a lot of times there's still stuff on it.

[00:17:44] So that needs to be.

[00:17:46] I think it cleans it some, but if they, if you, in those courses, they always tell you that you're bonding beyond your bevel.

[00:17:53] Correct.

[00:17:54] So you're, you're going to eventually get to a spot where you didn't clean it.

[00:17:58] And I don't think that the edge alone cleans that, cleans that stuff off.

[00:18:03] Right.

[00:18:04] Sure.

[00:18:05] No way it does.

[00:18:07] And so what I've found since we've done that, I still like, I think the, the worst emergency in the world to me is one of those tiny little chips.

[00:18:16] I mean, I'd rather just move off your tooth and not even bonded on some of those.

[00:18:20] Um, and that, that's actually, that's a, that's a good lesson for the podcast too.

[00:18:24] Some of those need to just be, you just need to get your discs and polish those off.

[00:18:30] Especially if you look at their bite close enough.

[00:18:32] And that's another pro tip too.

[00:18:33] Yeah.

[00:18:34] If you look at their bite close, close enough and you are an Invisalign provider that cracked a bite.

[00:18:40] But I mean, that's way, this way beyond what we're talking about now, but I have less of those.

[00:18:46] Well also the kind of person who comes in with a tiny chips, maybe not ready to like, you know, they're hoping for an inexpensive solution.

[00:18:54] Not bad.

[00:18:55] Not always, but yeah, I get it.

[00:18:57] I mean, sometimes that's going to save you from the heartache of redoing it in six months or three months or whatever.

[00:19:07] But I don't know where we're going with this.

[00:19:09] You can, that's okay.

[00:19:10] That's tiny chips.

[00:19:11] I just, I just hate them.

[00:19:12] I'd rather just smooth them up.

[00:19:13] Oh, I got another pro tip on the tiny chips, especially if they're on the mandibular and it's always on the lingual.

[00:19:18] Yes.

[00:19:19] And it's the most chip.

[00:19:19] It's always on the lingual.

[00:19:22] Like overbuild those things.

[00:19:23] Tell the patient, Hey, look, I'm going to make this thick on the lingual and your tongue's going to, it's going to feel weird.

[00:19:29] And then they're going to use, you can get used to it, but it'll be less likely to break.

[00:19:35] Reduce my review rates on those, a high percentage.

[00:19:41] Make it thick.

[00:19:44] Okay.

[00:19:44] Yeah.

[00:19:45] That makes sense.

[00:19:46] Or it's worth, but I mean, that might not pass in operative level.

[00:19:49] It'll be like, Hey, you didn't smooth that back enough.

[00:19:51] It's not, it doesn't look like the, the tube next to it.

[00:19:54] Yeah.

[00:19:55] You, you only replace the broken area on those laryngears.

[00:19:59] Odds are.

[00:20:00] You have less to bond to the enamel.

[00:20:02] There's not as much enamel.

[00:20:04] Exactly.

[00:20:04] That's true.

[00:20:05] And it's not, it's not a sin on some of those teeth, all the interior or, you know, upper or lower.

[00:20:10] So like take a round burr and put some, you know, put a few retention points in those, some of those teeth also.

[00:20:18] Those, those are a serious problem though.

[00:20:20] Kevin's, Kevin is right.

[00:20:21] Right.

[00:20:21] Those will, those will burn up a lot of your time and will frustrate you more than anything.

[00:20:26] And that's why I'd rather, not rather, the patient at least needs to be told that there's an occlusion problem or a clenching and grinding problem, which leads us to sleep apnea, which is way beyond what we're going to talk here about.

[00:20:39] But there's a reason why those teeth are chipping and it's not just.

[00:20:42] Always look at their nails.

[00:20:44] Yeah.

[00:20:44] Always look at their nails too.

[00:20:46] Always.

[00:20:47] That saved me a bunch.

[00:20:48] And their toenails.

[00:20:53] Oh?

[00:20:54] Yeah.

[00:20:54] You never know.

[00:20:56] Take off your shoes, sir.

[00:20:58] Let me, let me look at your toenails.

[00:21:00] Let's see if we can add that into the, the school protocol.

[00:21:03] Probably.

[00:21:04] For class four.

[00:21:07] The other one that you're going to run into in the anterior is those like gum line ones.

[00:21:10] Yes.

[00:21:11] So have you done that yet?

[00:21:13] Muhammad.

[00:21:13] Like a class five.

[00:21:14] Yeah.

[00:21:15] Um, I haven't done one on anterior.

[00:21:18] No.

[00:21:18] Okay.

[00:21:19] Um, I guess I did one on a K nine, a lower K nine.

[00:21:23] So yeah, actually.

[00:21:25] Did they teach you to pack cord on those?

[00:21:27] Uh, yeah, I did pack cord.

[00:21:29] Um, that's good.

[00:21:31] It was like an, it was like an ab fraction lesion.

[00:21:34] Yes.

[00:21:34] So I didn't really do much prep.

[00:21:37] I did do a little bit of a bevel on the facial.

[00:21:41] Um, but yeah.

[00:21:43] All right.

[00:21:43] That's another area where there's probably a ton of plaque.

[00:21:46] Yeah.

[00:21:47] It needs to be removed.

[00:21:49] Um, Zach, you're packing cord, right?

[00:21:51] Oh yeah.

[00:21:52] Yeah.

[00:21:52] Definitely packing cord.

[00:21:54] Cause there's no way you can bond to a circular fluid and you need to get the.

[00:21:58] Uh, gingival tissue out of the way.

[00:22:00] So you can get access there and polish it and trim it properly.

[00:22:03] Yes.

[00:22:04] Did they tell you those ab fractions are also one of the highest fail?

[00:22:08] Yes.

[00:22:09] You know?

[00:22:10] Yes.

[00:22:10] Highest fail fill areas for sure.

[00:22:12] Yeah.

[00:22:12] Like those, those, if I've learned anything on those, it's like, there's something about

[00:22:17] that really smooth surface that needs to get, you know, really roughened up.

[00:22:25] And Alan, if Alan Mead was on this, he would say, oh yeah, you got to bevel those almost

[00:22:31] all the way up to the incisal edge.

[00:22:33] It's like, you get all like extreme over bevel.

[00:22:36] Giant bevels.

[00:22:38] Yeah.

[00:22:38] He likes big bevels and cannot lie.

[00:22:41] That's right.

[00:22:42] But no, those, those ab fraction ones, those, those are another one that'll, you'll,

[00:22:46] we'll do it.

[00:22:47] And then it's like, okay, I really hope it makes it to the three year insurance.

[00:22:51] We know.

[00:22:53] Yeah.

[00:22:53] You know, uh, reimbursement space where this pops back out on.

[00:22:57] Yeah.

[00:22:58] So I do, I have one kind of followup.

[00:23:00] So you talk about over bulking and cutting back.

[00:23:04] Um, what kind of burrs do you like to use whenever you're cutting back, especially on

[00:23:09] the, on like the, uh, upper anteriors on the facial?

[00:23:13] I use the discs.

[00:23:15] Uh, I do have a, I guess I have a, um, uh, kind of a, uh, tapered, 12 fluted instrument,

[00:23:25] always a 12 flute, 12 fluted instrument, uh, to, to kind of, to do the initial cut back

[00:23:30] on it.

[00:23:31] Um, and on the lingual side, I'm, I have like a football, 12 fluted football style bird that

[00:23:36] does the same thing.

[00:23:37] Kevin, what do you have?

[00:23:37] I have a red stripe scenario.

[00:23:39] Red stripe.

[00:23:40] Red stripe.

[00:23:40] Okay.

[00:23:40] You do it with diamond.

[00:23:41] Yeah, I'll do.

[00:23:42] And then, uh, but I, I do think that learning how to be a good disker is a good, uh, pro

[00:23:49] tip.

[00:23:50] Um, you can get a lot of good contour with the black disc.

[00:23:56] Um, so you have to, uh, use that judiciously, but like I, you know, there's a skill, a learned

[00:24:08] skill of contouring these teeth and looking at it from all different angles with your mirror

[00:24:14] and all that.

[00:24:15] Um, and then, you know, doing like a gross contour with the black disc and then moving

[00:24:20] through the sequence.

[00:24:23] Oh, here's a pro tip for shade matching these things.

[00:24:28] Take the, take the shade, put the composite on the tooth and get it before.

[00:24:32] Yes.

[00:24:32] That's like the one thing I do before I numb.

[00:24:34] Um, cause I knew I want the tooth is close to like the form that they came in with because

[00:24:40] once that starts dehydrating, that shade lightens up so quick.

[00:24:45] So that's like, you know, take some composite, put it on the, pat it on the tooth, cure it,

[00:24:49] make sure you're, make sure you're right.

[00:24:52] And then, and then do the rest of it.

[00:24:54] Uh, that's, that's your, that's your surefire way to end up with a shade match.

[00:24:58] And then you usually have to tell the person, okay, this might not look great right now.

[00:25:03] It's your tooth dehydrated, but yeah, I promise you in a few hours, the rehydrates will

[00:25:08] look great.

[00:25:09] That's, that's certainly a pay for the day with words thing that is always been a payoff.

[00:25:14] But for sure, I did, I don't think I was taught very well to disc.

[00:25:17] I mean, we had soft flex discs around the school, but they mostly taught birds.

[00:25:22] Like what you're talking about, you, the, the discs will be way better and we'll leave

[00:25:28] to a way smoother surface.

[00:25:30] And so the discs that we have available to us, um, they only go on the slow speed handpiece

[00:25:36] and they also don't have like, it's only on the front where there's any roughness, not

[00:25:43] on the back.

[00:25:45] Yep.

[00:25:45] So you can't, you can't like pull.

[00:25:47] And I always feel like I want to like pull.

[00:25:49] I don't know why.

[00:25:50] So you're, you're going to buy a disc system that's better once you are done.

[00:25:55] It does that because though, like, uh, the Shofu super snap, I mean, I'm not, there's plenty

[00:26:01] of disc systems that are wonderful.

[00:26:03] Uh, but those do have on all the, the, the polishing phases, they have grit on both sides

[00:26:10] so that you can do that.

[00:26:12] And, uh, yeah, that's, that's, and they don't have a, they're almost like an orbital waxer

[00:26:17] for your car as opposed to having like the soft flex always had that metal, uh, mandrel

[00:26:22] right in the center of it.

[00:26:23] So you couldn't like, I want to put that thing on the, on the tooth and let it, you know,

[00:26:29] just really just sand away.

[00:26:32] So that's, yeah, I think, uh, the benefit to the disc is it conforms to the, this is

[00:26:39] going to be the nerdiest thing I'm going to say all night, the planar, planar shape of

[00:26:43] the tooth.

[00:26:45] That makes sense.

[00:26:46] Yeah.

[00:26:46] Like it's going to adapt to that and allow you to polish it.

[00:26:50] Yeah, no, that makes perfect sense.

[00:26:53] I, I've seen a lot of like videos and, um, like YouTube videos and stuff of people disking.

[00:27:01] And I feel like I always want to try it, but I watch those alone at night.

[00:27:06] Yeah.

[00:27:07] A lot of black discs on my search history.

[00:27:12] Oh man.

[00:27:14] Kevin, are you, are you a cutter backer also?

[00:27:17] Yeah.

[00:27:17] I prefer, no, no, no.

[00:27:19] I prefer that.

[00:27:21] I mean, I think what over time, um, I'm a slight overbuilder, not a huge overbuilder.

[00:27:30] Okay.

[00:27:30] All right.

[00:27:30] I want to get it close, but I'm not, I want to definitely go on the over than the under

[00:27:37] so I can cut it back.

[00:27:39] So I can cut it back because I feel like if I've got a, some sort of bulk there and we've

[00:27:43] got some sort of amount of tooth left that I can use the contour of the tooth to, you know,

[00:27:51] make it shaped right.

[00:27:54] It's, it's a better way to go for sure.

[00:27:58] So, um, whenever you are closer to, uh, the gingiva, do you feel like you also do that with a disc or do you ever get out like a flame carbide or anything like that?

[00:28:10] Yes.

[00:28:11] Flame carbide.

[00:28:11] I'll probably do that with a flame.

[00:28:13] Yep.

[00:28:13] Okay.

[00:28:14] Yep.

[00:28:14] Cause those discs can really cut up the gingiva.

[00:28:18] Right.

[00:28:18] If I'm not.

[00:28:19] Yeah, for sure.

[00:28:20] And I, I think everyone is going to have a story about how they unfortunately kind of

[00:28:24] like slipped with the disc and, uh, you know, really, really did a number on someone's, uh,

[00:28:33] um, I, I have, that's always a bummer of a day because man, those things slice quick.

[00:28:38] That is for sure.

[00:28:40] So that's, that's, and that's, and it's a bloody, there's a bloody areas to share.

[00:28:44] Mm-hmm .

[00:28:45] The other thing is you're going to find the lower interior operative sucks a lot more than

[00:28:52] upper interior operative.

[00:28:54] You know, uh, especially in your like geriatric population.

[00:28:57] Some of those are brutal and I'm using more and more, I mean, it's not a red horse here,

[00:29:06] but like more equia on those lower interiors, especially on the people that aren't going

[00:29:10] to like complain about the shade match.

[00:29:13] Then, uh, then, then resin it's, it really works well on those, uh, not a class four,

[00:29:20] but just like your threes and fives.

[00:29:22] Yeah.

[00:29:23] Don't, don't be afraid to get that stuff out, especially those gum line areas where you're

[00:29:27] having trouble keeping it dry.

[00:29:30] Uh, you'll just be frustrated with the composite cause it's going to look great when you're

[00:29:33] done and then you're going to see it on recall and it's going to have that dark line right

[00:29:38] in your margin.

[00:29:38] Yeah.

[00:29:39] And that's just the beginning of the fail.

[00:29:41] Correct.

[00:29:43] Yeah.

[00:29:44] Um, so I do remember them, them telling us that if aesthetics are not a concern for

[00:29:50] those classified lesions that we should consider glass ionomer.

[00:29:53] Not on the ab fractions.

[00:29:55] Don't do it.

[00:29:55] They will fail immediately.

[00:29:57] Not on the ab fractions.

[00:29:58] No, don't do it on the ab fractions.

[00:30:00] If you know, it's an ab fraction.

[00:30:02] Don't, don't do that.

[00:30:03] It's an instantaneous fail.

[00:30:05] Um, but on the carries, carry a space ones.

[00:30:08] Yes.

[00:30:08] Sure.

[00:30:08] Absolutely.

[00:30:10] Okay.

[00:30:11] But never an ab fraction.

[00:30:13] Okay.

[00:30:14] Because there's a, because there's a force issue and they, the, the glass ionomer has,

[00:30:20] it has less of a bond, which you would think would mean it failable.

[00:30:24] It's a more consistent bond, but it's a less of one.

[00:30:27] And those require a lot of bond to get them to hold.

[00:30:30] Cause there's a force problem.

[00:30:31] There's a fusion problem.

[00:30:32] It's so much.

[00:30:33] Yeah.

[00:30:35] Makes sense.

[00:30:36] Um, any other tips or.

[00:30:38] Anything to consider when doing anterior composites off the rip?

[00:30:45] Um, I'm a big fan of the opturgate.

[00:30:48] Yeah.

[00:30:48] I don't know if they've, uh, educated you that it's, I mean, there's a lot of devices

[00:30:52] that do the retraction.

[00:30:55] Um, that one is just one of my favorites for anterior operative.

[00:31:02] I probably won't get it out for a single filling, but if I'm doing two or more, I'm definitely

[00:31:07] get that out.

[00:31:08] They do some kind of a lip retraction thing in school or do you just have to use cotton rolls?

[00:31:13] Yeah.

[00:31:14] Um, but we've been, we don't have opturgates available, but we've had it mentioned in classes.

[00:31:19] It's just not something the school stocks.

[00:31:23] but we do have like the

[00:31:25] ISOVAC that we talked about

[00:31:27] with posterior composites

[00:31:29] they like us to use

[00:31:31] that in combination with cotton rolls

[00:31:33] and whatever else

[00:31:35] I think the Opturgate

[00:31:36] in terms of a 34

[00:31:39] year career has been one of

[00:31:41] the biggest

[00:31:44] benefits or

[00:31:46] things I love

[00:31:47] the most of things that

[00:31:49] have changed to the point

[00:31:52] it's very strong

[00:31:53] to the point where

[00:31:56] way off

[00:31:57] topic but

[00:31:59] you know Zach you've ever placed the Opturgate

[00:32:01] and it just keeps coming out on certain people

[00:32:03] because of their

[00:32:04] yeah some people it sucks on you're right

[00:32:06] so I had a really big surgery

[00:32:09] today four implants

[00:32:11] got near the end

[00:32:13] thing just kept coming out

[00:32:14] I just had a suture one area

[00:32:16] it spoiled me

[00:32:19] like

[00:32:20] I like everything retracted

[00:32:22] and if I can't see it

[00:32:24] like that

[00:32:25] it's like

[00:32:27] it's like I have glaucoma or something

[00:32:31] it is

[00:32:32] it spoiled me to the point where

[00:32:34] it just you know

[00:32:35] mentally frustrated me that

[00:32:37] I couldn't use

[00:32:38] I had to grab another assistant

[00:32:39] to have them retract

[00:32:40] so I could

[00:32:41] finish this guy up today

[00:32:42] so

[00:32:44] yeah

[00:32:45] for the Opturgate

[00:32:46] it's really just getting the lips and the cheeks out of the way

[00:32:49] it's not doing much

[00:32:50] it's not like a rubber dam

[00:32:51] no

[00:32:51] but it's

[00:32:53] it's

[00:32:54] I think that

[00:32:56] if you're wearing loops

[00:32:57] and you've got all the cheeks

[00:32:58] and

[00:32:59] lips out of the way

[00:33:00] you have better access

[00:33:03] yeah I mean

[00:33:03] you can always double down

[00:33:04] and put the cotton roll

[00:33:06] you know stuff

[00:33:07] you can stuff that in under the

[00:33:10] Opturgate

[00:33:10] yeah

[00:33:10] if you need some moisture

[00:33:11] yeah

[00:33:12] or moisture control

[00:33:13] sure

[00:33:14] also you know

[00:33:15] like we were talking about

[00:33:16] with those

[00:33:17] some of those class 3s

[00:33:18] getting into the gingiva

[00:33:18] there's nothing that says

[00:33:20] you can't pack cord

[00:33:21] yes

[00:33:21] on those

[00:33:22] I do it all the time

[00:33:22] in between the

[00:33:23] in between the teeth

[00:33:25] you know

[00:33:26] you don't have to go

[00:33:26] you don't have to pack it circumferentially

[00:33:28] like with my crown prep

[00:33:29] just

[00:33:30] get some cord

[00:33:31] and pack it in between

[00:33:32] just interproximal

[00:33:33] yeah

[00:33:34] that's

[00:33:34] that's a good way

[00:33:35] to do it

[00:33:36] there are so many

[00:33:38] just little

[00:33:40] tips and tricks

[00:33:41] to like

[00:33:41] just a variety

[00:33:42] different scenarios

[00:33:43] that can come up

[00:33:43] in operative

[00:33:45] it's like

[00:33:45] they need a book

[00:33:46] that touches on like

[00:33:48] tips and tricks

[00:33:50] scenarios like this

[00:33:50] yeah like this

[00:33:51] operative tips and tricks

[00:33:52] by Zach Miners

[00:33:53] that's what you're gonna do

[00:33:54] over the summer

[00:33:55] that's my book

[00:33:55] publish it

[00:33:56] self-publish it

[00:33:56] along with the romance novel

[00:33:58] that you've been working on

[00:33:59] I

[00:34:00] yes

[00:34:00] actually

[00:34:01] I think you can

[00:34:01] know those together

[00:34:02] yes

[00:34:04] operative

[00:34:05] all coming back

[00:34:05] to the black disc

[00:34:10] thanks for having us Mo

[00:34:11] yeah

[00:34:12] thank you guys for being on

[00:34:13] thanks for putting up

[00:34:14] with our shit

[00:34:15] for the listeners

[00:34:17] please tune in next week

[00:34:19] for us to be discussing

[00:34:21] extractions

[00:34:21] thank you guys

[00:34:24] see ya