Very Dental: "Super Flowables," Color Stability and the Bioclear Method with Dr. David Clark

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[00:00:56] Welcome to the Very Dental Podcast, where you'll find entertaining and relevant conversations with visionaries, clinicians and your friends in the dental space. Now here's your host, Dr. Alan Mead.

[00:01:08] Very Dental people, welcome to another episode of the Very Dental Podcast. Joining me, like the Tom Hanks of the Very Dental Podcast. Tom Hanks is the guest that was on Saturday Night Live the most. And I feel like Dr. David Clark has to be approaching that. He really does. Welcome back to the show, David Clark. How are you doing? Thank you, Alan. Thanks.

[00:01:29] So I was on a webinar, I think it was last week. I guess it was last Friday. I think it was last Friday. That's right. And you were in the same studio that you're sitting in now. You're getting a lot of use out of that studio. But that studio is the place to be for Dave. Yeah. I've got all my friends here. I've got my mother's help and all my matrices. Exactly. You don't ever get to leave. They don't even let you get out of there. It's just where you live. Exactly.

[00:01:54] Exactly. So you had a webinar that you kind of, BioClear users from far and wide were joining you on this webinar because there was some kind of, well, you've had a lot of stuff going on with BioClear. Not the least of which was the release of the TSS matrix system, which is amazing. We talked about that the last time and I've had a chance to use it for a while. I love it.

[00:02:16] I literally just love it. Just like, I can't believe everyone's not using this already. It's fantastic. You've also got new contact saws, BioClear, which look fantastic. Oh, yeah. Yeah, yeah, yeah. I mean, you've just got a ton of stuff, but you've got some big materials changes that I wanted to do. Yeah, yeah, yeah, yeah, yeah. Go for it. Tell us everything. Okay, so let's give you a little update. We did another podcast. I don't know. You need to tell me. We did the heart attack podcast. Yeah, we did that one, yep. We do it all the time. Yep. How many people have listened to that podcast?

[00:02:46] A lot. I could go look, but a lot. I've gotten a lot of questions on it. And of course, we put the PDF of the slideshow in there, too. So it's super, like, it's great because you can go right to that and just get all the information on it. So yeah, we've been podcasting a lot lately. Is that hundreds or thousands of people? Thousands, thousands. Really? Oh, yeah. Oh, yeah. So anyway, for those of you that heard that podcast, I was a dead guy for a while. Yeah, yeah. So, yeah. And so I just thought I'd give you a little tiny update on that because it kind of relates to TSS. Maybe I talked about this last time. I don't know.

[00:03:15] But yeah, after they brought me back, I was in coma for three days. I came out of my coma, right? And the first thing that I remember I said this is I looked at my hands and they look like big, fat, orange. Yeah, big, orange sauce. It's like, what is – I am really messed up. Yeah. I took my hands and I thought, I am really trash, right? So then you go through this existential thing where, like, what am I going to do? Am I going to retire? Because, you know, this is a wake-up call or whatever.

[00:03:43] And I thought about it for about a minute and I said, no, no, no. I love doing this and I need to build the TSS system. Seriously. Seriously. That was – I was like – because I've been wanting – ever since we built an anatomic matrix, once we quit using flat mylar, the dream was to have a matrix that was exactly duplicate of a tooth. And, of course, you'd have to have, you know, 16 of them because you have to have the mesial and the distal for every single tooth. And so anyway, so –

[00:04:08] By the way, every time I use one that's a different – a surface that I haven't really gotten out lately, I'm like, ah, he won't get this. This one won't be right. And every time, it's exactly right. It's pretty funny, actually. Let me talk about that because now that we've had some time to do it, right? We didn't have the technology. We didn't have the money. We didn't have the time. It was just no way it was going to happen. So we had to go through all these iterations to be where we are today and that's just the way it is, right? Yep. So I wanted to share a little thing though, Alan. This is pretty interesting.

[00:04:38] I'm trying to be a little bit more human after my little incident. A little near-death thing. Yeah. Okay. So anyway, so I'm talking to my cardiologist and he's this great guy, Dr. Zhang, right? And he's from China and he's like this classic Chinese guy that won the math contest. His glasses fall down and he pushes him up. His glasses fall down and he pushes him up. He's got terrible English. I can barely understand him and he's so smart and he's so funny.

[00:05:05] And he sits and talks to me about lots of stuff and he must fall way behind on his schedule. But he's such an old soul, man. I love this. I love Dr. Zhang. And so he goes, David, you know, you were talking about my meds and I passed all my stuff. And my heart is like a 69 Pontiac that won the demolition derby, right? Yeah. It's like the last car that's still running. It's got a woogity wheel and a broken windshield and it's smoking out the back and it's still running. Okay. So that's me.

[00:05:34] It's not up to factory specifications, but it works enough to keep me alive. And the question is, how long is the old guy going to be around? That's a pretty interesting question. So if you go to research, anybody who has a heart attack is going to die about eight years sooner. Yep. Yep. So if the average male lives to 82, I've got a lot of time left, right? So he said, but he says, this is really interesting.

[00:06:01] He says, you know, the average is, you know, you're going to live 15 years after your heart attack. But he goes, a lot of guys only make it for five years after their heart attack and they are gone. Let me tell you who those guys are. They're gone. They're morbidly obese. They don't have a purpose in their life. They don't take their heart pills very often. They don't get much exercise and they don't have family support. Those are the five things. And he goes, if you have those five things, if you're not morbidly obese, if you get a little bit of exercise,

[00:06:30] if you take your pills, if you have a purpose and if you have family support, you guys live 30 years longer. Okay. The real determinant, when you look at the research, he says it's a heterogeneous pool of people. Sure. So just to say you're going to die eight years sooner, that's not fair. Yeah. Because I'm so fortunate that I have those five things. Yeah, for sure. Anyway, those are five things that the cardiologist says is going to help you to live. Yeah. That was interesting. Anyway. That's very interesting. Very interesting. Okay. So the teeth this matrix, tooth and surface specifics.

[00:07:00] So some of your people haven't had a chance to look at this, but it's insane. Richard Young picked it up one time. He looked at it. He goes, there is a lot going on here. There is. That's a good way to put it. There is a lot. And so here's the thing. Maxillary incisor teeth are complicated. Yeah. Number one, the facial is completely different than the palatal. Facial has three surfaces. It has three planes, the gingival, middle, and incisal third. A lot of people that make ugly crowns or ugly composites, I may have done in the past, they're flat. They don't have three planes. Yeah.

[00:07:29] So they bulge out, then they come in, and they come in. And the palatal is the opposite. It's got this big, huge pile of enamel on the palatal, and then it goes concave, and then it goes flat. So the facial and the lingual are unrelated. And then the mesial is different than the distal, somewhat. But then the thing that's bigger is in cross-section, it's trapezoidal. So if you have a universal matrix, which everything was until TSS, when we did a big case, the linguals were always fighting each other.

[00:08:00] Like just a bunch of people jammed in the elevator. And so the lingual, we'd always have to tuck it in, and they were too thick, right? Yep. And it didn't have that. But when you close a black triangle or a peg lateral, you're going to have a rectangular looking tooth at the gingival, and that's just the way it is. And it looks amazing, and everyone loves it, because you have to. You have to. You have to have exaggerated emergence profiles for either black triangle, peg lateral, or diastema. Yep. The thing is, if you have a normal papilla, and the tooth is relatively in the right place,

[00:08:30] the TSS is your matrix, because it does all the work, right? Yep. And so we, Alan, remember you had the four-day class. Yep. And on day four, you went from canine to canine, a bunch of apple core teeth. Yeah. And you were scrambling to get those teeth injection molded. It was a lot. It was a lot, yeah. And a lot of shaping. Yep. And you got there, and it was really beautiful. That's a very good point. Like, you're glad to get the injection molding, however, it's a lot of shaping. Like, there's a lot of dead soldiers, those Zoflex discs, man. Yeah.

[00:08:59] A lot of dead soldiers. You're right. So then, so then at the last four-day class, I was there with Lauren Wilson, who's amazing. And we were sitting there at the instructor's desk, and a lady dentist walks over at two o'clock. Yeah. Usually we don't get done until five. Yeah, yeah, yeah. She comes over at two o'clock, she hands me your model, and she says, I'm done. Yeah. And Lauren and Wilson and I looked at each other.

[00:09:26] No one gets done until at the earliest four o'clock. Yeah. But you're using the TSS with that. Yes. Yep. Because there's no black triangles, no peg laterals. It's just a wear case. And you're going to use three times as many TSS matrices as the BT matrix on average. Yeah. Yeah. So that was a wake-up call, okay? So anyway, it's a mega change.

[00:09:50] And it's hard to describe how many levels ahead this matrix is than anything we've done before. Mm-hmm. It's all about creating the ability to focus on something else. In other words, I want to manage the patient's expectations. I want to manage color. I want to look at their lip. I want to focus on all this big picture stuff.

[00:10:12] But if I'm struggling just to get the matrix to fit, and if I'm struggling because it's too rectangular here and there, and the canines... Yeah, you're a lot of shaping. Oh, yeah. Canines are off. You know? For sure. If I can get rid of most of that and just let that be on autopilot, then everything is so much more... It's more fun, Alan. It's more fun. A hundred percent. Yeah. And save your emotional energy for the nuancy stuff, right? I agree. I agree.

[00:10:37] And I would say with my experience with these matrices, and I've had them for a couple months now, that's been the experience I've had for sure. I really look forward to interior stuff for the fact that you can kind of... This is the thing that... I don't know if I'm supposed to say this or not. It's a lot faster. It's a lot faster. Yeah! Like you said, there's just a lot less shaping, a lot less trimming, a lot less... You get to the point where you're polishing a lot faster. Yes. It's never been about faster. No, it hasn't. That's right.

[00:11:07] But faster is better because you start running out of steam and time. Yeah. Yep. Anyway, so anyway. Yeah, it's fine. I'm glad you're having fun with that. Okay. I definitely am, yes. So that has impacted a lot of what we do in anterior teeth in a major way, right? And we're still coming to terms with what a big change it is as far as we can handle tougher cases. We can just... Yeah. Anyway, so... I mean, you can teach the system faster, honestly, on some level. Yes. It's just pull it out of the box. So I figure out, is it an O2? Do I trim it?

[00:11:36] No, just try to take... Try to know your tooth numbers. Yep. Yep. Your mesia from your distal. Yep. Anyway. Cool. All right. Next thing that's massively impactful to everybody doing Bioclear. When we started using composite before we did Bioclear, before we were injection molding, it was a patchwork material. We did fillings. And we always used A2, right? Or A3, right? Every once in a while. Every once in a while.

[00:12:03] Molding and then covering like the whole tooth and then three teeth and then six teeth. Nobody's going to want six teeth to go from A3 to A3. They're going to want to go to extra white. Sorry, we live in America. Yep. So if you're in the United States, Canada, Australia, Korea, some of these other places, they want white teeth. So we started moving up to B1, white and extra white. And when you cover the whole tooth, this is really interesting for color stability. Yes. Yes. When you cover the whole tooth and it's next to a tooth that hasn't been injection molded,

[00:12:32] oh my goodness, do you see the color shift. So you can have a corner of a tooth turn dark and you don't see it as much, which seems counterintuitive. Yeah. If you have the whole tooth covered, you see the color change. So what happened was nobody knew that Filtrex Supreme Ultra, the way we were using it, turns yellow. And so I've shown a bunch of cases where I did thousands of teeth in extra white, white and B1, and now they all look like, after eight or nine years, they look like A3. And after three years, they look like A2.

[00:13:02] So it's a gradual process. And before we started thinking of Bioclear, thinking of composite as a rejuvenating, as a replacement for porcelain, it was a padford material. We used A2 and nobody saw a problem. Yeah. Because actually with a big fat bevel on it, you could blend it in nicely. But this is what you're covering. You're covering whole teeth is what you're talking about. Yes. And we... When you were... I wanted... I really was desperate to ask. And of course, you had no time to answer questions. But my question was, was this...

[00:13:29] Were you noticing this as a surface phenomena? Like if you came in and dusted the facial of something like that, or was it through and through? Alan, it's like sin. It goes all the way through to the soul. Exactly. Oh, no. Yeah. Yeah. Yeah. So, and the other thing is, you know, it's... You guys teach this, you know, you're doing a lot of rehabs. You're doing a lot of smile designs. You're doing... And so, like when you're doing this, of course, you have the option to give the patient, let's go light.

[00:13:59] Let's go light. You can do this. And then, oh, man. So that... And for a year or two, it looked amazing. A year three, it started to get a little bit dingy. And then year five and six, it was literally like A2 or A3. Yeah. It looked like they smoked, man. Yeah. And it just... How many patients did you accuse of picking up a smoking habit? What are you doing with that? What are you... You got to put the cigars down. And then we started telling people, don't drink coffee. They quit drinking coffee. I mean, it's like nothing worked.

[00:14:27] So at the bottom line is, you know, I'm very grateful that 3M has helped support BioClear and do all that. But we completely lost confidence in Filtek Supreme Ultra, flowable taste to make a tooth anything brighter than A2. If you're using A1, B1, anything like that, it's going to turn yellow. So, and I've had a lot of research on this. And here's what happens. These composite companies, it's like whack-a-mole. You know, everybody knows what whack-a-mole is, right? Yep. So when they start like, oh, let's find the composite that has the best shine. So everybody tries to do that.

[00:14:57] And then they say, let's find a composite that has less wear. Okay. And then Omnichroma comes along. Yeah. Comes along. And then everybody wants to have a composite that's a single shade, that's essentially translucent. Translucent. And just use one shade. The problem with Omnichroma is you can't bring up the value of the tooth. Yeah. And so most people want white teeth. So if you're doing single tooth dentistry, it's okay. But see, now everybody's trying to take back all the market share that Omnichroma got because it's whack-a-mole. Okay. Now they're whacking the mole of Bono shade, right?

[00:15:27] What they all need to be looking at is let's develop a composite that doesn't turn yellow. It doesn't color, like the color shift after a couple of years. That's scary. Right. But if Omnichroma, it's just see-through. It's not young. It doesn't change the color. So they don't care. But I'm going to use that because I want big, beautiful, white, California teeth, right? All my Bioclear patients. So we've created a problem that nobody saw. And now all of a sudden it's a huge problem. So we did a lot of research and Dr. Richard Young and some other folks were using Karari. They never switched to Filtec. Yep.

[00:15:55] And Richard's shown me so many cases where they were done in B1 and white and they have no color shift. And then I started- I was in class with Richard Young the very first time he took a Bioclear. I literally was there when you and he met for the first time. I didn't know him well. And he would not stop talking about that composite even then. He wouldn't. I was so irritated with him. I'm like, Richard, be quiet. Just listen to the instructions. Exactly. It's ironic. He'll love this.

[00:16:23] It's just ironic when we're turning around and we're using the stuff that he was using back then. That's kind of hilarious. Yeah. Yeah. And so now we understand why it matters so much. Number one, we're covering the whole tooth. Number one, we've moved to brighter shades. So if you're doing patchwork dentistry or you're using A2, nobody cares. It's not going to change so much for you. It's already yellow to your eye. You don't see the shift. It's like spilling a latte in a white shirt's problem.

[00:16:51] So anyway, so we created a problem that no one anticipated and no one has an answer for, but Karari already had the answer. And so then I took a look at color stability. And at the alumni summit, I'm going to talk about eight or nine things we've learned about why composites may or may not be color stable. And it is really nebulous. I'm not even going to get into it. Yeah. Because when you talk about degree of conversion and all these other things, it has a plus and a minus, and it's just like crazy.

[00:17:21] But what Karari has and what GC has, both Japanese company, is they do special stuff to their filler particles. So what they believe is the reason that Filtec is turning so yellow is they don't have any coating on their particles. Okay. And so if you put siline coupling on the particle, then you have a chemical bond in addition to a mechanical bond. So the stain can't penetrate through the rocks. Okay. That's their answer and other proprietary secrets about why it's different.

[00:17:50] So we switched wholesale over to Karari. We're going to talk a little bit about super flowables because that's another massive game changer. So we have three massive game changers. TSS. Yep. A color stable composite that we're not going to be embarrassed of. And now we can use super flowables and skip the pace, which is life changing. So let's talk about, so with this Karari business, they have a flowable majesty flow, which everyone always talks about majesty flow.

[00:18:16] It has the same filler content as their pace, 71% by weight. Okay. It's been heat tested for six weeks at 140 degrees. So people are going, oh no, only brand X has been heat tested. No, most of these composites are heat tested. So the reason that Karari, he's tested it for six weeks at 140 is because they're going to ship their composite to Iraq where the ambient temperature is 140 degrees in the warehouse. Okay. Fair enough. So it's all been heat tested.

[00:18:44] And the thing about heating, it's like aspirin. Nobody ever proved that aspirin was safe, but we've been taking billions of tablets for a hundred years and nobody's gotten cancer. So we've learned just empirically that aspirin is safe. Crazy Dental already has some of the lowest prices on dental supplies anywhere, but you know what's even crazier? Free shipping. Head over to crazydentalprices.com, load up your cart and use coupon code very ship. That's very ship for free shipping on every single order.

[00:19:12] Plus every time you use that code, crazy dental kicks back support to the very dental podcast network, save money, get free shipping and support the show. Use code very ship today. So basically everybody's heating everything at this point. Yeah. Yeah. Let somebody manufacturer scare you to say that the heat hasn't been heat tested. It's aspirin. Everybody's heating everything. Just don't use APX. Don't heat APX. Okay. Some weird composite. So anyway. All right. So, so then the super flowables, what does that allow us to do?

[00:19:42] Okay. Now, Alan, when you first injection molded your first tooth and you put the adhesive in and then you put the hot flow in and you pumped in the hot paste and there was this mammoth, like volcano composite that was just piled up in there because we had to have the paste displaced the flowable because the flowable was weaker. You were chasing it. It really, honestly, it worked. It worked. You understood. Once you saw it, like you'd see it and you'd go, wow, why are we doing the two materials?

[00:20:11] And then you'd realize that the reality is, is that the very, very edge was always the flowable. You're pushing the flowable out. So the flowable is like a lubricant for the paste. Yeah. Yeah. We have adhesive as a surfactant, flowables as a surfactant, and the paste goes in and displaces most of it. Exactly. Why did we do that? Because the flowables were inferior. Yep. Okay. In fact, at University of Minnesota, one of the students told me that he used flowable on a patient. They called him into the Dean's office. I got kicked out of school for using flowable. Yeah.

[00:20:38] Well, so that's the thing is flowables are weak and crappy. Well, they were. I mean, you look at, you know, you look at like, oh, what's, what's the, I can't remember the brand, but the first bulk fill was Dentsply's. Oh. Sure fill. Yeah, yeah, yeah. Oh, for us, weak, see-through, weak, but they got the market share. Everybody thought, oh, all flowables are weak because the first ones were weak.

[00:21:04] Anyway, so this Karari super flowable is paste in a syringe. You don't need to use paste. Okay. So there's all kinds of things. So when you're doing Bioclear, we do a little thing called a bump out. Let's say I'm doing a black triangle case. Okay. And the patient not only wants her black triangles treated, but they want to go from A3 to extra white. You have to make sure there's enough volume. And the BT matrix, black triangle matrix doesn't always give you enough volume. So sometimes it would press against the tooth and you'd get brown show through and you wanted to kill yourself. Okay. Okay.

[00:21:33] And so what we would do is we would make a bump out. So we'd edge the tooth and make two little flowable dots. Boom, boom. On each line angle, mesian distal at the middle of the tooth to put the matrix one millimeter away from the tooth. They don't have to worry about pumping a lot of paste in to give me the one millimeter because you need one millimeter of body shade to change the color. Cover the shade. Yep. Yep. But sometimes we didn't get a millimeter because it was a universal matrix. It would hit the tooth in a couple of places because the BT matrix was not designed as a

[00:22:03] veneering matrix to push the tooth out. But we pushed the limits. And so we do these little bump outs. Okay. So I got two little bump outs on the mesial distal of a master central incisor to hold the matrix a millimeter off the tooth. And then there's no stress. You know, you're going to get the color. Yep. Yep. Well, here's the problem. I used Philtech because they're flowable, such a different color. It like two little gray eyeballs. We can see that. Because the flow didn't match the paste. Okay.

[00:22:30] Then I'm like, then I quit doing bump outs and then I had trouble with, with, you don't get doing a color upgrade because I need a millimeter of fullness. So a lot of the things that we did, we suffered because the flowable was not the same as the paste. Majesty flowable is the same as the paste and it's just paste in a flowable syringe. And there's only one difference is it has a lower modulus, the flow, the super flowable does. So if you have a tooth, that's got a weak cingulum, go ahead and push some paste in there

[00:22:58] because you want to have the tooth a little stiffer at the cingulum. So in this case, you've got the flowable, but you've also got a paste you can use. That's going to be the same. And it matches. Okay. Yeah. But we're using less and less of it because it's really only, it's just a little bit stiffer. Yep. If the tooth is strong, you don't need the paste. You can just go straight flowable. Cause in a lot of cases, I mean, uh, class three, small class four, you're not adding that much anyhow. So you can use the flowable to, okay. Okay. And you know what? I'm trying to use it. I'm trying to use it. On my son, he chipped his front teeth. He's playing basketball.

[00:23:28] A guy smacked his head into him. And he finally, one day he goes, dad, I'm like, Oh my gosh, Ryan. He chipped two millimeters off his beautiful front teeth. And the enamel is still pretty robust. I took cold flowable composite. It was PhilTech. I took cold flowable composite and just painted it on the incisal edges. Cause you can do that when the teeth are young and there's no dent in. And those flowable repairs on his incisal edges are there six years later. So it's not like composites pretty strong on compression, right? Yeah.

[00:23:52] So, so we can do super flowables, but we, there's only two that I really trust. So the Karari super flowable is the magic, the ES and it's miraculous. Okay. And that's your, that's your anterior go-to. That's my anterior go-to. And then, um, this next one is pretty exciting for me. Like I have, I ordered, I ordered some as soon as I heard, heard the, the, go ahead. There's four things. Well, three and 3.5. Okay. The next thing is 0.5.

[00:24:21] The new Callie Fisherotomy burr. Okay. Yeah, yeah, yeah, yeah. Okay. Oh yeah. So that finally got done. They're available from Bioclair. We, we designed them. Eventually you can, we'll be able to get them from Shine, but right now you can get them definitely from Bioclair. A lot of us had a 5.56 burr to cut an occlusal restoration, which most schools still teach, which is an abomination. It is 5.56 burrs have mutilated more human beings than any instrument in the history of modern medicine or warfare. Okay. Yeah. They are horrendous.

[00:24:51] So this is why I developed the Fisherotomy burr a long time ago, which was a nice way to open up a groove. The problem is it was parallel sided. You couldn't really get any restored material in there and you would trap a lot of air bubbles. Yep. You'd have this really narrow Fisherotomy prep. If it was, you know, if you're getting in there and get some stain or early decay out, it was unrestorable. So we developed the Calla Lily Fisherotomy burr, which looks like a Hershey's kiss. So it's got the same point, but it's flared like a Hershey's kiss. I have the diamond version of the Hershey's kiss.

[00:25:19] I got it as soon as I came back in November. That diamond does, you can't get the shape. No. No. It's really hard. Any manipulation of another burr. I use all diamonds for prepping anyhow. Yeah, yeah, yeah. You put your, it's wild when you put your, basically when you put your bevel on with that thing, it's crazy. Oh my God. Because it's humanly possible. It's crazy. Yeah.

[00:25:45] So what we've known when we finally did some research on this, we don't ever want to cut a flat bevel. I mean, we never want to cut a concave bevel. We need to cut a convex bevel. Yes. But the bird that's needed to cut a convex bevel needs to be? Super concave. Concave. Okay. There was only one. And you know who discovered that burr to do radius beveling? Who? Rosemond Dental School. Interesting. Because they were having a hard time teaching dentists how to take a flat. It's a hard thing.

[00:26:14] It's actually a really hard thing to do. It's like mylar. It's the wrong stinking shape. Yeah. Okay. I always was like, when I was at, when I was doing the, I was always like, I'm a little anxious to show you my bevel because I'm not sure that I got quite what you're trying to get you. Because I mean, the BioClear bevel is a little different, described differently than other bevels. But I mean, then they handed out in November, they handed each person a Hershey Kissbird. I'm like, ha ha! It was definitely a lot easier. One little problem. That will not end cut. Okay?

[00:26:41] So you want to open up those grooves with the carbide version of that, which is really a cool bird. I'm looking forward to that. I don't have that one yet. And then I've got a great case. I'll, I'm going to be doing, I'll be showing it somewhere for you. And anyway, then you go in with the Hershey's Kissbird and do the radius bevel and you're done. And it's awesome. So here's the thing. You've got the shape. It doesn't look like anything we've ever shaped before. It's the inverse of a GV black pretended boxy prep. Whenever I look at a magazine and there's a boxy prep on the cover, I just, my stomach

[00:27:11] just goes, oh God, really? Yeah. Showing that? Anyway, this shape is unrestorable with paste. That shape is unrestorable with paste. And so when we're doing big occlusals or any occlusal, we put the flowable in and you put the paste in and it's just like, it's, it's like playing hockey and cowboy boots. Okay. Okay. You're playing hockey against Canadians and you're wearing cowboy boots. You're sliding around. It's just like, it does. It's the wrong material.

[00:27:41] Yeah. So with this new super flowable by GC, it is paste in a flowable syringe. And so GC is pretty crafty. GC is a Japanese company. They're getting bigger. They figured it out. This is a, what they call it, a bulk injectable. And I said, I think I know why you're calling it a bowl injectable. You don't want to use the F word. Yeah. Yes. Yes. They didn't want to call it earlier. Floables. Floables kind of got a, got a label on them. Bad rap. So anyway, they call it a bulk injectable.

[00:28:11] I said, this is a flowable that you're calling an injectable. And he said, yes, we are. And I said, you know, that's genius. So here's what you do with this. You don't have, it's not stackable or condensable or carvable or whatever. You tease it. Yeah. Tease. It's like a, it's an interesting sort of mix between a flowable composite and pudding. And you can kind of shape cuss with it. Once you get your knack with it, you just pull it up to the cuss tips with the tip.

[00:28:38] And the thing is, it's got the same, it's got a higher compressive strength than most paste composites. Let me repeat. This super flowable GC, I don't know how they did it, has a higher compressive strength, higher tensile strength than most paste composites. So dude, I am done using paste composite for most of my days. And I lived off adhesive flow paste for 20 years. So it is a bulk material.

[00:29:07] In other words, can you cure it at a bulk depth similar to what you were doing with the- Four millimeters depth to cure on the occlusal. Four millimeters if you're using stupid metal matrix. Five millimeters when you're doing buccal lingual curing with bicarbonate matrix because you get an extra millimeter with what's called three-point light curing where you cure from the buccal lingual. So I get five millimeters depth to cure. Even though it's only rated at four, it's rated with a metal matrix. So with clear matrix on the inner procs, you get five. So it's the same as any other bulk felt. And there's always a fudge factor.

[00:29:37] It probably cures more like seven. Sure, sure. But anyway, so it's got, and the whole mitigation, polymerization, shrinkage stress is kind of voodoo marketing. It has the same polymerization, shrinkage stress as other bulk felt. So what do I want? I want a material that actually fits the new cavity prep. It's not an amalgam substitute because last time I looked, we're not using amalgam. So the P word, really packable? There's no such thing as packable. No, there never was. Yeah.

[00:30:06] And so it has everything that we need. And- Okay. Here's something that, here's something that- Let me back up, Alan. So, of course, have you ever had a mullet? Of course. Okay, good, good. I still have one. Okay. Back in college, yes. For sure. What was a mullet? It was- It was all business up front and a party in the back. Yeah. So what it is, is we have Karari in the front and GC in the back. Okay.

[00:30:35] Because Karari does not have a bulk fill. Because they were probably in the same place. Oh, bulk fills are bad. Yeah. You know, they realize that flowables didn't have to be bad, but they're finally figuring out that maybe bulk fills aren't bad. So we're using GC in the back and Karari in the front. And if I need to have a really, really white back tooth, I'll push in some Filtec 1 because Filtec 1 has the best aesthetics of any bulk fill. Okay.

[00:31:04] The brightest bulk fill they've got is like A1.5 or something. A1 looks more like A1.5. So if I've got a patient that's really fussy, wants a really white occlusal- You've still got that in your- Got that. Or, you know, if it's not too thick, you could just pump in some Karari on top. Okay. So there's not a- If you're using that, you're not super worried about color shifting in the posterior as much as you are in the anterior anyhow. Well, no. We're not going to get color shifting with the GC because it's actually color stable too. Because they have super voodoo sauce in their formulation. Okay.

[00:31:33] So they don't- Their anterior composites probably don't color shift. Based on what I'm reading and based on all the science, I just haven't- I don't have a bunch of doctors who have injection molded with GC in the anterior. And I know we'll have some eventually. You know, I won't- We won't know squat for four years. You really need to check it in four years. So we have four-year outcomes with a bunch of docs using Karari. But GC apparently could be color stable. But in the back of the mouth- It's less of a concern.

[00:32:02] And you're not color shifting in the same way in the back of the mouth that you are in the anterior. No. And, you know, we're not using super bright composites to begin with back there because they don't have them yet. So that's not a worry. So just- And so we have- We're working with two different companies now, which is great. You know? I'll have all the links to these materials and everything in the show notes so people don't have to keep track of this as they're listening. Now, there's some listeners right now. They're in their cars. They're probably grousing a little bit. And we need to fill this.

[00:32:31] First off, a flowable, they're worried that they're not going to get an interproximal contact by using a flowable. And of course, realistically, it was never about that with a flowable or a base because you can't push composite. You can't create a contact. It's not, like you said, it's not packable. But everyone, it's hard. It's hard to get your brain around a flowable straight up in the posterior. But it was never packable. The matrix has to create the contact. The material is not creating the contact.

[00:33:00] And I think that is hard for dentists who are trained on amalgam to kind of let go of, right? That's like something that we kind of learned that that's how we get our contact. And you have to understand that is not how you get a composite. No matter what system you're using, it's not how you get it. You don't get it. Yeah. And the thing is, we've gone away from these really thick, thick, thick packable components. Yeah. It's not packable anyway. Yeah. And then like PhilTech 1, who a lot of people use, that's like butter. That's almost, it's like halfway to flowable. So you're not going to expand the matrix with amalgam. Okay. So here's the deal.

[00:33:28] So when I, next time you come to the Learning Center or the next time we have a lecture, we have like five things. The way we achieve a tight contact whenever we're using a matrix, the only way to achieve a contact is to temporarily displace a tooth or two teeth. We have to displace teeth. We have to push the teeth apart. So when the matrix comes out, the teeth go bam, back together. There's five ways to displace a tooth. If you're doing a black triangle, you sand the contact gently. You don't open the contact. You pry the teeth apart.

[00:33:58] The matrix goes in. And this, these, these, these 75 micron bioclon matrices literally push the teeth apart when you have an existing contact. So the matrix temporarily displaces both teeth. You drive it in as you're prying the teeth apart. Teeth are temporarily displaced. Matrix comes out. What happens? Bam. If you don't temporarily displace the tooth, you're dead. And if you're next to an implant, it's harder to do. So what's the other way to displace a tooth? A wedge. Okay.

[00:34:25] But the best way to displace a tooth is with the twin universal at 29 newtons of tooth separation, which is way higher than, than wooden wedges are way higher than most, most separators. So a really super powerful separator displaces the teeth. So when the matrix comes off, the teeth come together. But the one thing you got to do is you got to do the spot weld push pull technique. I'm superstitious about it now. Whether I, I do it for everything now. No, you have to. You have to.

[00:34:54] It's one of these things where I used to think that you could say, well, you know, and if you're going to get a light contact, it's because you didn't do this. And it's, it's, what's really funny is I always get it when I do that. It's not hard to do either. It's really, it's, it's, it's, it's easy to do once everyone in the room, your assistant and yourself are all on board to do it. It's, it's just, it's just part of the process at that point. Yeah. With, especially with mylar, that's kind of stiff. It can bounce off the neighboring tooth composite all day long. You can take it off and there's a millimeter space. Yeah. Well, especially with mylar, you have no choice.

[00:35:23] You have to spot weld, push, pull. So, but what's, no, but it's the temporary. It's so for all your listeners are like, ah, it's, you have to displace the tooth. Yeah. And you can displace it three different ways. And then once you do that, then we can handle a matrix that's so tiny because that, you know, these matrices are 75 microns. So, but that you get a great contact every stinking time. Yeah. You just gotta, you just gotta, it is, there's a tendency for you to try and get it.

[00:35:51] Well, I, after November, there was a tendency for me to get a little lazy and, and I, you just don't, you can't do it. You gotta do all the things to make it work. And then when you, when you don't even think about it, it's exactly right. It's exactly right. Don't even think about it. Just do it. And it's, once you start doing it, it's not, it doesn't add any time or anything. It's easy. Here, here's how you think of this. You have to spot well, push, pull.

[00:36:10] So if you listen to the, if you mission to, if you listen to the Hispanic radio station, La Grande, whatever it is, when they're advertising to go to like O'Reilly's, lo más mejor auto parts. And then they say, go to O'Reilly's. No piensas más. Don't even think about it. Okay. Control because your life depends on it. The best thing about that is, is when you use the push pull and then you get the thing out.

[00:36:40] Sometimes you have to soften the contact because it's too tight. That's, let me, let me hip you. Let me hip you to the giant here. Okay. According to the research, there is no such thing as a contact that's too tight. So what you want to do, if you can't get the floss through it, send them home, come back in two weeks. The composite has enough give to it. It'll self-equilibrate. And you can't do that with a crown. You've got a contact. You can't get floss through. Just send them home. That's cool. Yeah. I can do that. I can do nothing. I'm excellent at doing nothing. Just ask anyone.

[00:37:10] Sometimes laziness is a virgin. Yeah, it works for me sometimes. Yeah. That's right. Because people go in there and they're freaking out because they can't get floss in there. It's like, this is a good problem. Yeah. Right? That's a good problem. And so don't touch it. It's not a crown. As a grownup, do you ever look at when you're, when you're working on other people and they have really tight contacts, you get a little jealous because every time you eat roast beef, you've got one of those little spots. And it's like naturally, you've got it that way. Yeah. So leave it tight. That's, that's the, you'll be jealous of that. That'll be good. Yeah.

[00:37:38] Well, so you've got, we have a summit coming up in October. Yeah. Program. Yeah. I'm in the, I'm on the program, but it's, the summits have always been great. It's at a nice resort and you guys sort of, we sort of take over the resort. Lots of good speakers there. Lots of, lots of actually hands-on learning stuff too. Yeah. We have a, we have a, we have a day one at the alumni summit is, is all, well, the morning is hands-on and somebody says, why do you make us work so hard? Can we have the afternoon off? So we're going to have like, we're going to actually have fun in the afternoon. Okay. Okay.

[00:38:07] The day one, but the day one has, we're going to have a TSS. Nice. Class on how to use TSS to do canine to canine. Okay. I'm going to do root overlays gone wild. Okay. Okay. That's good. Richard Young is going to do advanced photography. Then we have a photography session. Jadine will teach it for dental assistants. Okay. It's a very simplified, fun class for dental assistants to learn because it, man, it's nice when they can take some photos. Sure it is. Yeah. That's fantastic. That's great. Well, I'll put, I'll put that in the show notes too, so people can check it out.

[00:38:35] And honestly, the, I mean, the learning center is going full bore. Great. I had a great time in November. It's fantastic. It's as good as ever. And now, you know, what's funny about it is he kind of, even if you've been before, it's worth going again because David doesn't sit still for very long ever. So there's always something new. Well, it's all new. Yeah. Yeah. With the advent of the super flowables and TSS, it would be a good, you know, if anybody's been to the learning center, Tom, you'll get, we'll get, you'll let you come back for half price.

[00:39:03] If you want to repeat a class, Tonya will let you do it for half price because it's just, we, there's been a lot of awesome upgrades. Yeah. Yep. No, that's really cool. Dave, this was fantastic. I think this is good information. We'll put all the stuff in the show notes. If you have any questions or comments, come to the Facebook group. We'll, we'll get David to answer them himself. And, and again, we needed to do this after that webinar. I'm like, okay, there's a lot going on here. So I'm glad, I'm glad I got you in here. So thanks very much for your time, David. Alan, it's always a pleasure. And we'll see you in October. All right. We'll see you then.

[00:39:33] And we'll send a program for the alumni summit program over to you when it's going to be done in a week or two. So we'll send it to you and maybe post up. I will, for sure. We'll talk to you soon. Bye-bye now. You have to remember to push, pull, no pienso smas. I won't forget. I promise. Bye-bye.