Very Clinical: Tissue Management for Fun and Profit with Mo

[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.

[00:00:29] Hello everybody. Welcome to another episode of the Very Dental Student Podcast. I'm your host, Muhammad Abu Basha. And we're back again. I got Kevin and Zach here. Kevin and Zach, how are you guys doing?

[00:00:39] I'm great. You know what's been happening to me? I'm having these dreams that I'm in dental school.

[00:00:46] And I have-

[00:00:46] They're back?

[00:00:47] Yes, I haven't studied for the test. And instead of studying, I've been talking to some dental student on the internet. But meanwhile, I've neglected my studies. So, how are you doing Mo?

[00:01:05] Sounds like- Sounds oddly familiar.

[00:01:08] Yeah.

[00:01:08] Familiar story.

[00:01:09] I was worried these conversations might bring back these dreams.

[00:01:12] Yeah, me too.

[00:01:13] But it hasn't happened yet. So that's good. Yeah.

[00:01:15] That's good.

[00:01:16] Well, I think the bit we talked about starting off with was favorite dental school instructors.

[00:01:22] Yeah.

[00:01:23] So, who wants to start us off?

[00:01:26] Zach, you want to go first?

[00:01:27] Sure.

[00:01:29] My favorite dental school instructor, and this guy won instructor of the year like multiple times. Everyone loved this guy.

[00:01:36] He was this Asian doc, Dr. Cho, that had a real thick Asian accent. And he was the removable guy.

[00:01:44] And removable in school, I mean, removable sucks. But removable in school, extra sucked. And I mean, this guy was like really good about holding your hand through it and like, you know, teaching the patients to hang in there.

[00:01:59] Like, so, he just made it, he made removable fun. It was fun to work with him. He had a good sense of humor. And just the guy cared about his students and he cared about helping out. I think he realized, I think he realized that the dental school process sucked.

[00:02:20] Yeah.

[00:02:21] And so he was like, you know, he's not, he never deviated from it. He didn't tell you how to really do it. But he at least helped you through the process to just get you out of there. So and I appreciate that. I appreciate the self awareness there.

[00:02:38] I'm not going to say that this guy was my favorite. I'm just remembering what I would say was an act of kindness.

[00:02:47] Where, you know, most of our dental school instructors were kind of dicks. And I remember I did a crown prep on a lower back husband on this lady. And after the appointment was over, I don't know what I said to this woman. I don't, I don't even know.

[00:03:03] But, but this guy's name was Dr. Bailey. And he said, you know what, you really did a good job with her. You really managed that well. It's like meant a lot to me.

[00:03:12] And then he said, we're supposed to select a couple of you seniors to be the team dentist for the football team for Ohio State or Buckeyes.

[00:03:25] So he's like, I want to nominate you for that. So I was like floored because I don't, I didn't consider myself really that good of a clinical student.

[00:03:36] I was good with the books. But anyway, I was like, okay, great. So I got a tour of the training facility and it was me and another guy.

[00:03:46] And of course the other guy got it, but just to be even nominated for that was, I thought was awesome.

[00:03:51] That's a cool tour to be on too. I mean, that's neat to be in the running for that.

[00:03:54] Yeah. You know, they had built a new training facility, which I had never been to a football training facility before. And this was 1988 or nine.

[00:04:05] And I don't, I mean, I've seen on TV what an NFL training facility looks like now, but I don't think that it looked like them that then.

[00:04:14] Like it was just amazing. You know, indoor practice field, full length field and, you know, the weight room and all that.

[00:04:23] But anyway, that's cool.

[00:04:24] I was, I was in a sea of, of Dick's. Dr. Bailey was nice to me.

[00:04:30] That's awesome. Yeah. Very cool story. I don't have anything.

[00:04:34] I don't have anything that neat, but probably my favorite faculty that I've worked with so far.

[00:04:39] So we have like a general practice director that is like, basically like they're in charge of getting us graduated.

[00:04:48] So, so mine is Dr. Spates. She, she's basically the person I do all my crowns with and fourth year I'll be doing all my operative with her as well.

[00:04:58] Um, but they also assign, assign us patients and, uh, you know, just make sure we're progressing appropriately.

[00:05:04] And she's also just the nicest human I've ever met in my life. So she'd probably be my favorite.

[00:05:10] And then, um, we also have one guy in removable that reminds me a lot of what Zach was saying.

[00:05:16] I mean, he's just a white guy, but his name is just a white guy.

[00:05:22] But yeah, he's pretty fly.

[00:05:23] Just a white guy.

[00:05:24] Yeah. But he's, his name is Dr. Woods and he has a very, I don't know, comedic, like just relief about him.

[00:05:32] And he's, he's definitely the one you go to if you just need, you just need something to be fixed.

[00:05:36] He just takes care of things.

[00:05:38] So, well, uh, these instructors, if you're listening, most of the good guy and give them good grades on everything.

[00:05:44] Let's get them out of here so we can practice in the real world.

[00:05:47] Yes.

[00:05:48] I agree.

[00:05:50] All right.

[00:05:50] So, uh, the last episode we talked about, um, crowns and one thing time, kind of an offshoot of that, um, that we can talk about is tissue management.

[00:06:00] So we talked a little bit about how I can really get in the way of a crown prep appointment or a delivery appointment.

[00:06:08] So, uh, where do you guys want to start with that?

[00:06:13] Um, so you're going to be shown and told a lot of different ways to, to, to manage tissue.

[00:06:24] Um, and here's the, here's the deal because there's all these like pastes and goos and all this stuff.

[00:06:32] And some of it is going to be sold as like an, like an easier, simpler way to do things.

[00:06:37] And you have to be cautious with, with that because there's a reason that cord has been the standard for, for things for a long time.

[00:06:48] And it continues to be so in the most, a lot of the most discerning docs are still using cord.

[00:06:54] Kevin cord, right?

[00:06:55] A hundred percent.

[00:06:56] Almost always.

[00:06:56] Almost always.

[00:06:57] Almost always.

[00:06:59] And, and often too, probably right.

[00:07:01] Two more.

[00:07:02] Almost always.

[00:07:02] Like let's, let's stop for a minute.

[00:07:04] Yeah.

[00:07:05] If you're, if you're sending your crown to the lab, they need to see the margin.

[00:07:11] And if you're doing this digitally or analog, you have to have some separation of the tissue from the margin, or it's just, you can't see it.

[00:07:23] And they're just guessing.

[00:07:25] And in my case, if someone's designing it, it still happens where perhaps the assistant can't see where the margin is, but I prepped it for the last 20 minutes.

[00:07:37] And I know, you know, where it is, you have to get that separation both vertically and horizontally.

[00:07:45] And if you don't do that, you're, you're going to have crummy results.

[00:07:50] And I have never, Zach, have you ever used any of these pastes?

[00:07:55] Yeah.

[00:07:56] Well, I'm getting to the pace.

[00:07:57] I have the pace and the pastes have a place, but not the way they're advertised.

[00:08:01] But anyway, I'm, I'm getting off the.

[00:08:03] All right.

[00:08:04] Well, of course, I will concede the floor back to our representative from Kansas city.

[00:08:09] So go ahead, Zach.

[00:08:11] Okay.

[00:08:13] So the cords for, you know, well, for one, you're going to cords.

[00:08:18] It sucks too.

[00:08:19] It sucks to place it.

[00:08:20] But like, if you get the right instrument and you try a few different brands, you just find one that you like packing in there.

[00:08:27] That's going to make a huge difference.

[00:08:29] I like the ones that have some epinephrine or aluminum chloride baked into them too.

[00:08:34] You know, they're going to say, oh, the epinephrine.

[00:08:36] But if someone can't tolerate the epinephrine, they can tolerate the epinephrine, you know, get, get the good epinephrine cord.

[00:08:43] It's good to know.

[00:08:44] Cause the, the, the, the, the hemadense and hemo, hemo, those things.

[00:08:48] Great.

[00:08:49] Soak the cord, soak the tissue, whatever.

[00:08:51] The pastes, they're going to tell you the pace replaced the cord.

[00:08:55] No, they don't replace the cord.

[00:08:57] However, there's plenty of instances where either they're bleeding so badly or you've got such a deep pocket that it's like you need a cord, another cord.

[00:09:08] And then, and then I throw some paste on the top or you've got a really thin biotype where it's like, okay, I can get one cord in, but that second cord isn't going to happen.

[00:09:15] And then you can blast some of that pace on top of that and put one of those compression caps on.

[00:09:20] And that's going to get the job done the majority of the time.

[00:09:22] But the, the best thing is, is to have a broad armamentarium of like options to use because tissue management, when it goes badly, it will make you hate doing crown stuff.

[00:09:35] You know, it's like the, the great tissue person, that's a snap, snap deal, but the bad tissue deals are bad.

[00:09:40] So I like the, I like the, the, the pace.

[00:09:44] Um, the one I use is made by Safco.

[00:09:46] It's called Hemo track.

[00:09:48] They're like those clay pace.

[00:09:49] It's nice to have that.

[00:09:51] I use it on maybe one out of every, you know, three or four of my cases, but always after cord, not in lieu of it.

[00:09:58] Um, lasers and electro surge units.

[00:10:01] Kevin's electro surge guy.

[00:10:03] I'm still working on it for you, Kevin.

[00:10:04] Yeah.

[00:10:05] And, uh, it's still, I didn't ask my answer today.

[00:10:09] I know.

[00:10:10] Yeah.

[00:10:10] Uh, lasers are good.

[00:10:12] They don't replace the cord for me.

[00:10:14] Like I don't like there.

[00:10:15] You can see plenty of things on YouTube where they laser around the pocket and they'll say, oh, that'll, that'll make it so that you can take your impression.

[00:10:23] I have not had that happen for me.

[00:10:25] Kevin, you use electro surge.

[00:10:26] Does it replace cord for you?

[00:10:28] No.

[00:10:28] So a typical scenario for the electro surge, which I mean, I'm going to equate to a laser and please don't let everyone's brain explode over you.

[00:10:36] You're removing some tissue with a device.

[00:10:41] All right.

[00:10:42] It's burning tissue away.

[00:10:44] Um, typically this would be on the mesial or distal where there's either deep decay under a previous, uh, filling or a deep.

[00:10:56] Previous margin for, from a crown or whatever.

[00:10:59] You've got some crummy tissue there.

[00:11:01] I'm packing cord everywhere else and then blasting out that tissue.

[00:11:05] It just in that area.

[00:11:07] Yep.

[00:11:08] And, um, you know, the electro surge will cauterize like the laser will, but you, you can't, the difference.

[00:11:19] This is a kind of a niche thing, but if you have, I'm trying to draw out the scenario in our minds.

[00:11:28] If you have, let's say on the mesial, you had some sort of previous crummy restoration and the tissue is swollen there.

[00:11:35] If you, uh, scan that and I'm trying to design that my CERC is going to adapt to that tissue contour that was there.

[00:11:45] And that don't want.

[00:11:46] Right.

[00:11:46] Right.

[00:11:46] So I've got to get that out of the way.

[00:11:48] I can't digitally remove that.

[00:11:51] Um, like you could, if you poured up a dye.

[00:11:55] So that's another reason that I need that.

[00:11:59] I need some, some sort of way to remove tissue.

[00:12:04] So I, for sure.

[00:12:05] Like, and I don't know what they're obviously, Mo, you probably, do you have access to a laser of some sort very easily?

[00:12:12] Or are they teaching you basically to use like a, just cut off the tissue with the, you know, the diamond?

[00:12:17] Well, so we, for a very short period of time, we were, the school was trialing a laser.

[00:12:23] So we had one actually, but we don't have it now, but maybe they're going to get it back.

[00:12:29] I don't know.

[00:12:29] Maybe they're going to actually make the purchase.

[00:12:30] But right now in terms of tissue management, the workflow they have us do is we start with a double zero epi cord.

[00:12:38] And then if we need to pack the second cord on top of that, we do that.

[00:12:42] Do you have to get that checked?

[00:12:44] No.

[00:12:46] They allow you more than one.

[00:12:48] Do they only give you one cord?

[00:12:49] Do they hold it?

[00:12:50] Like, there you go.

[00:12:52] No.

[00:12:54] We have, we have double zero in our, in our prep kits, uh, double zero epi and non epi.

[00:13:00] But if we need a larger one, we throw the non epi out.

[00:13:04] Okay.

[00:13:04] That's good.

[00:13:05] I'm not even joking.

[00:13:06] Sometimes we use it out of way, like as the second cord, like the epi first.

[00:13:11] And then, I don't know if we want a larger cord, we have to go to, oh, then you have to go get it approved.

[00:13:17] It doesn't have to be approved.

[00:13:18] We just go, go have to go ask for it.

[00:13:21] Cause it doesn't come in all the kids.

[00:13:22] Yeah.

[00:13:23] But all right, I'm going to send you some anesthetic and like a, like a number two cord kit.

[00:13:29] Okay.

[00:13:29] Yeah.

[00:13:30] So that's kind of where we start.

[00:13:32] And then if we still don't have the proper tissue retraction from that,

[00:13:38] then we go ahead and get – we make our own compression caps using Blue Bite.

[00:13:43] So we just squirt Blue Bite like on the prep.

[00:13:46] Oh, my God.

[00:13:46] That's what they taught us.

[00:13:48] So we squirt Blue Bite on the prep and have them like put enough to where they can bite onto it.

[00:13:53] And then once it's hardened, we have like a retraction paste from 3M that we put in there and then have them do that.

[00:14:03] So that's what we've been taught in class.

[00:14:06] If those three steps don't work for you, then I honestly don't know what the next step would be.

[00:14:14] I haven't gotten there.

[00:14:15] But they did mention like literally using just a burr to do like some –

[00:14:21] All right, so let's talk about like some adjuncts.

[00:14:28] Occasionally – not occasionally, often I will use Xylocaine with 1 to 50,000 epinephrine to try to stop things.

[00:14:41] So that is something I'll pull out of my bag of tricks.

[00:14:49] Yep.

[00:14:50] And then good old Viscostat.

[00:14:53] That's another thing I'll pull out of my bag of tricks also.

[00:14:58] And then another thing that I'll try is – harkens back to the first days of this podcast.

[00:15:06] The good old Alicerte peroxide.

[00:15:14] And in my scenario, I just needed to stop for a couple seconds so I could scan it.

[00:15:21] Like that – the prime scan is so quick.

[00:15:25] I've literally like scanned the tooth except for the one part that's bleeding and then dried that off and scanned it really quick.

[00:15:32] And then I'll just worry about the bonding later.

[00:15:37] But the Viscostat, the 1 to 50,000, the peroxide, all of those are – and the electrosurge.

[00:15:44] And occasionally running a composite finishing burr with no water and just whacking off some tissue.

[00:15:55] What did you say?

[00:15:57] And then what do you do?

[00:15:58] Well, this is done in the privacy of my operatory.

[00:16:02] Okay.

[00:16:03] The whacking off.

[00:16:07] Zach, you ever use the – we talked about this.

[00:16:09] I don't use the whack-off technique.

[00:16:13] Is that on your Onlay fans page?

[00:16:15] Yes, it's on my Onlay fans page.

[00:16:17] Oh, my God.

[00:16:18] This podcast is going to come out with a R rating.

[00:16:22] Yeah, for sure.

[00:16:24] Banned in most schools.

[00:16:25] But have you ever used the burr technique?

[00:16:30] Yes, I've used the burr technique.

[00:16:32] Although a lot less, you know, after buying a laser.

[00:16:36] Joe, we talked about this privately.

[00:16:40] And I thought about this.

[00:16:41] The first time I tried it, it worked.

[00:16:44] Like I had beginner's luck.

[00:16:46] Yes.

[00:16:46] And then, meh, since then.

[00:16:49] Okay.

[00:16:51] Sometimes it's going to go well.

[00:16:53] And then sometimes it's going to create so much blood that it's going to be tough to go.

[00:17:02] Bottom line is I think the tissue management is a serious enough problem that you're going to get into with some of these crown replacements where there's decay.

[00:17:12] Yes.

[00:17:12] And there's an existing crown.

[00:17:15] Overhanging amalgams.

[00:17:17] Areas where there's an open contact and food's getting jammed into it.

[00:17:21] You're going to have some real nightmare days with tissue management that they did not prepare me for.

[00:17:26] Correct.

[00:17:27] In school.

[00:17:27] And you're going to throw everything at that.

[00:17:29] You know, if you're lucky enough to have a laser, that's going to help.

[00:17:31] But you're going to need the cord.

[00:17:33] You're going to need the pace.

[00:17:34] You're going to need the compression cap.

[00:17:36] You're going to need time, which is honestly sometimes one of the hardest things to come up with.

[00:17:42] Just get that scan or impression done correctly.

[00:17:47] But I think that's – I think tissue management is honestly one of the toughest parts of – can be one of the toughest parts of a crown prep.

[00:17:55] But I agree.

[00:17:57] Yeah.

[00:17:57] I mean, luckily I haven't had any really crazy scenarios.

[00:18:02] But I guess that's lucky and unlucky because I guess I need to learn what to do in those situations.

[00:18:09] But here's the thing, Mo.

[00:18:10] I don't think you're going to – you're going to have to practice a couple of years.

[00:18:15] Like five before you come to all these scenarios and are proficient enough to recognize what's happening and turn on a dime to get things done.

[00:18:29] And then occasionally you'll run into this scenario where you've thrown everything at it and you just can't get it to stop.

[00:18:38] Because maybe you don't have the right stuff or you don't have the time.

[00:18:41] I mean, it's been a very long time since I've temporized a case just to have them back to re-scan or re-impress.

[00:18:53] But I mean, that certainly is on the table as something that is possible.

[00:18:58] Yeah.

[00:18:59] For sure.

[00:18:59] Yeah.

[00:19:01] This is a little off topic, but what is – I don't know if you've heard of this technique,

[00:19:07] but what is y'all's view on like deep margin elevation to get you guys out of tricky situations like that?

[00:19:14] I'm not a fan.

[00:19:16] But I just think that philosophically, if I can isolate it to place my composite there,

[00:19:29] why can't I isolate it to place my margin there?

[00:19:32] I will use that very, very, very, very sparingly.

[00:19:37] Zach, what do you think?

[00:19:39] I'm in Team Kevin on this.

[00:19:41] And I know that there's a lot of people that really like deep margin elevation.

[00:19:45] But if it's that deep down in there, how is your composite going to bond there?

[00:19:53] And then –

[00:19:54] Now you've got one, two, three margins to worry about.

[00:19:57] Yeah.

[00:19:58] So no.

[00:19:59] Now, have I placed a margin on an amalgam on one of those horrible like second molars

[00:20:05] where the third molar ran into the tooth, caused some decay?

[00:20:10] I've definitely put crown margins on amalgam with success and would probably do it again.

[00:20:16] But I don't like to put them on resin.

[00:20:20] I'm not as good as the tomorrow tooth.

[00:20:23] Yeah, I just don't –

[00:20:24] They can pull that off.

[00:20:25] And I'm not even 100% sure they're good enough to do it either.

[00:20:29] Yeah.

[00:20:30] You can't follow these things long enough.

[00:20:33] Like are they going to show us that it failed in five years?

[00:20:36] They're not.

[00:20:36] They don't even follow the patient that long.

[00:20:38] You know, like this is like the same thing as the CapTech or CrapTech, you know, the –

[00:20:45] Dicor.

[00:20:45] Or Dicor or –

[00:20:50] I just lost my train of thought.

[00:20:52] That's okay.

[00:20:53] Those sorts of things where it seemed like a great idea and then it just – it wasn't.

[00:20:59] So, you know, I want to see how these things survive five years.

[00:21:07] But, you know, the other thing is, Zach, how often are you sending someone for crown length inning?

[00:21:16] Yeah.

[00:21:16] And a posterior tooth.

[00:21:18] You know?

[00:21:19] Not.

[00:21:20] So –

[00:21:20] Not as often as perio would like me to.

[00:21:23] Right.

[00:21:23] So, that's also something that we – you kind of neglect in a general practice.

[00:21:30] Like there's no way I would – that's not going to happen very often.

[00:21:36] Once a year.

[00:21:37] Once every two years.

[00:21:38] It's just not going to happen.

[00:21:40] What's your personal feelings on the biological width?

[00:21:45] It was such a big deal when we were in dental school.

[00:21:47] Always.

[00:21:48] I kept hearing about it all the time.

[00:21:50] Biological width.

[00:21:52] What is your theory on biological width, Kevin?

[00:21:54] I mean, it's definitely a thing.

[00:21:56] It is a thing.

[00:21:58] I will violate it when I need to violate it.

[00:22:03] Ooh.

[00:22:03] And, you know, it's also a thing with implants, by the way.

[00:22:08] You know, that same philosophy or the same physiology exists.

[00:22:16] But that's another topic.

[00:22:17] So, yeah, I'm a violator.

[00:22:21] Are you Zach?

[00:22:22] What are they – yeah.

[00:22:24] Yeah.

[00:22:25] A lot.

[00:22:25] Mm-hmm.

[00:22:26] Today.

[00:22:26] Today.

[00:22:27] Mm-hmm.

[00:22:27] You know?

[00:22:28] And I felt good about it.

[00:22:29] Yeah.

[00:22:29] Kind of gave me a charge, you know?

[00:22:31] Yeah.

[00:22:32] Mo, what are they teaching you?

[00:22:34] Are they teaching deep margin elevation?

[00:22:36] I feel like that's something you picked up on YouTube and not in a class.

[00:22:38] Yeah, they're definitely not teaching it at the school.

[00:22:41] Yeah, I would think so.

[00:22:41] I mentioned it to a couple faculty and got a little bit of a scalding.

[00:22:47] I was going to say, did they put you in timeout?

[00:22:49] Yeah, they basically told me I was going to get sued and thrown in jail.

[00:22:53] Yeah.

[00:22:53] I mean, that's not going to happen.

[00:22:55] But I would also give you a scolding too.

[00:22:57] I don't think it's a good technique.

[00:22:59] And I see people that are pulling that off all the time, and that's great.

[00:23:05] Yeah.

[00:23:07] But it's not for me.

[00:23:10] I wish I was seeing those people showing, like, hey, here's one I did in 2009, and it still looks great.

[00:23:18] Correct.

[00:23:18] Yeah.

[00:23:18] But I don't think they – no one tracks their patience that long.

[00:23:21] When those fail, they're going to fail spectacularly.

[00:23:23] Yeah.

[00:23:24] Yeah.

[00:23:24] I definitely – I mean, I haven't even done enough crowns.

[00:23:28] I can't have my own view on any of this stuff, right?

[00:23:32] Right.

[00:23:32] Sure.

[00:23:33] No, of course not.

[00:23:34] I was just – I like asking since I see it on all the different –

[00:23:39] Are you wearing loops, Mo?

[00:23:42] Yeah, I am.

[00:23:43] All right.

[00:23:44] Okay.

[00:23:44] You wear a headlight?

[00:23:45] Yes.

[00:23:46] Okay.

[00:23:46] So I –

[00:23:47] You're also way ahead of –

[00:23:48] I did not do that in dental school.

[00:23:50] No.

[00:23:50] And, you know, there was – there came a time where you started – I started doing more crown preps on teeth that had composite in them, and I could not tell the difference between what the tooth structure was and what a composite was.

[00:24:02] So I got some loops.

[00:24:04] So, you know, that's how things advanced, too.

[00:24:07] And also my eyes got older.

[00:24:09] Yeah.

[00:24:10] Yeah.

[00:24:10] I mean, we – I have that issue all the time, telling between composite and tooth.

[00:24:15] I guess it's still maybe my eyes aren't trained as well.

[00:24:18] Yeah.

[00:24:18] Make sure you pick a core material that's, like, bright.

[00:24:22] Bright white.

[00:24:23] Yeah.

[00:24:24] Bright.

[00:24:24] Yeah.

[00:24:25] Like, paint, like, toilets more white, you know?

[00:24:27] Yeah.

[00:24:27] Do you guys – you guys like using the – I don't know.

[00:24:30] Like, I know there's, like, blue core material as well.

[00:24:32] No, I don't do that.

[00:24:33] I did that for a while, but you can't do that if you're – have any sort of aesthetic.

[00:24:38] I mean, if you're placing zirconia, I don't see why that would be an issue.

[00:24:41] You could.

[00:24:42] I just don't want to – then we're having a different conversation about inventory control.

[00:24:47] Yeah, that's 100%.

[00:24:48] I'm going to tell you – I'm going to tell you that, like, having a multi-core in its

[00:24:52] own bonding agent is a big waste of money when you can get a different material that

[00:24:56] uses a regular bonding agent.

[00:24:58] And most of my core buildups are the composite that I'm filling teeth with.

[00:25:03] Yeah, that you normally use on a daily basis.

[00:25:05] And I'm putting it in there.

[00:25:06] Yep.

[00:25:06] Yep.

[00:25:07] Poor inventory control.

[00:25:09] Inventory control.

[00:25:10] That's a different podcast.

[00:25:12] Yeah, definitely.

[00:25:12] But it's – what you described last time to us is – it's an inventory.

[00:25:19] Nightmare.

[00:25:19] You're losing a lot of dollars there, my man.

[00:25:21] But thankfully, you're already paying a billion to go to dental school.

[00:25:24] So you should use all the stuff.

[00:25:26] $1.2 billion, but you can't have two carburels of venison.

[00:25:31] But they can use multi-core in five different bonding agents.

[00:25:34] So, you know, hey, math.

[00:25:36] Yeah.

[00:25:37] Well, the multi-core won't kill the patient like two carburels will.

[00:25:42] I forgot that it was probably going to kill them.

[00:25:44] That's true.

[00:25:44] Yeah.

[00:25:45] I forgot about that part.

[00:25:46] Thanks for reminding me.

[00:25:47] I appreciate that.

[00:25:48] Yeah.

[00:25:49] That's good.

[00:25:50] I've had a couple buddies come up to me at school and laugh about the whole anesthetic

[00:25:55] thing, the situation.

[00:25:57] So they heard us.

[00:25:57] Oh, they enjoyed the show?

[00:25:58] Good.

[00:25:59] Yeah.

[00:26:00] They've actually really, everybody that I've talked to really appreciates these episodes.

[00:26:04] So we'll keep them coming for sure.

[00:26:07] Tell them to send us fan letters.

[00:26:10] Yeah.

[00:26:10] Okay.

[00:26:11] Or questions or scenarios.

[00:26:12] Mailbag.

[00:26:12] I'd love to have an ask.

[00:26:14] We'll do an AMA.

[00:26:15] Yeah.

[00:26:16] Yeah.

[00:26:16] Maybe that, I was thinking maybe when we start, when we wrap up, we could do a, get

[00:26:22] a list of questions and we could just make them up.

[00:26:24] I love it.

[00:26:24] That's a great idea.

[00:26:26] Super.

[00:26:26] Any final words when it comes to tissue management?

[00:26:31] I think it's as important as the taper of your prep and the occlusal reduction.

[00:26:38] I mean, it's...

[00:26:39] No, it's more important than those things.

[00:26:40] It's an art, really.

[00:26:44] Okay.

[00:26:44] Yeah.

[00:26:45] Yeah.

[00:26:45] Yeah.

[00:26:46] I agree.

[00:26:46] It's more important.

[00:26:48] It really is.

[00:26:50] And it will, it will, I think it's probably the single hand, the most important, you know,

[00:26:58] part of getting a good scan and a good margin.

[00:27:02] And a good result.

[00:27:02] Your stuff.

[00:27:03] And a good result.

[00:27:04] Because I think you can make a lot of mistakes with taper or, you know, if you under reduce,

[00:27:14] they can fix it with a reduction coping.

[00:27:17] Mm-hmm.

[00:27:18] But if you pack the tissue crappy, there's no fix for it.

[00:27:22] And if the lab just does their best, you're going to have a garbage crown.

[00:27:25] So I think tissue management is a super important topic.

[00:27:29] And I don't think it gets enough play.

[00:27:31] And I don't think people are armed with enough weapons to fight all the scenarios that they're

[00:27:37] going to encounter.

[00:27:38] I agree.

[00:27:40] Awesome.

[00:27:40] That's that.

[00:27:41] All right.

[00:27:41] Well, I think we've wrapped up on there.

[00:27:44] So for the listeners, tune in next time to see what we got next.

[00:27:51] See you.

[00:27:51] All right.

[00:27:52] See you.

[00:27:52] We'll see you.