Expedited Excellence: Increase Your Efficiency With Restorative Dentistry

You're listening to The Dr. Phil Klein Dental Podcast from Viva Learning.com. Welcome to the show. I'm Dr. Phil Klein. Stressors in dentistry have never been higher. Increased cost of doing business, inflation, supply chain issues, and short staffing, to name a few. So it's so important now more than ever that we work efficiently. Today, we'll be discussing strategies to increase our efficiency in both direct and indirect restorative dentistry in order to keep costs down without sacrificing quality. Our guest is Dr. Joshua Austin. He maintains a full -time restorative dentistry practice in San Antonio, Texas. He is an editorial director and columnist for Dental Economics Magazine, focusing on dental products and technology. Dr. Austin lectures around the country to study clubs and dental meetings about these topics, along with digital marketing and mental health. Before we get started, I would like to mention that Dr. Austin's webinar, titled Expedited Excellence, Increase Your Efficiency with Restorative Dentistry, is now available as an on-demand webinar on VivaLearning.com. Simply type in the search bar Austin, A-U-S-T-I-N, and you'll see it. It's an excellent webinar for every dental team member to watch. I highly recommend it. Dr. Austin, it's a pleasure to have you on Dental Talk. Drill to be here, Dr. Klein. Thank you so much for having me. Yeah, so we're all experiencing rising costs and inflation, and that, of course, applies to the field of dentistry as well. So in light of that, when it comes to restorative dentistry, what is a practical way to fight the rising costs of inflation that also affect our practices? It's so interesting in dentistry because of managed care, right? And so if we ran a sandwich shop, it would be super easy to just raise the cost of a sandwich, right? That's easy to do. But if you participate in any PPO plans or any managed care types of situations, you can't just do that. So we're getting hit with all the extra costs and fees and all that stuff that are getting passed down to us from inflation and gas prices. and all that stuff, your delivery costs go up, just everything go up. And so we don't really have a way to turn to, especially if you participate in insurances. So what we have to do is just be more efficient in our practice and basically produce more dentistry in the same amount of time. That's the only answer that we have. Now, if you're a fee-for-service practice and you don't participate in any plans, it's easy to just raise your fees by... eight percent or five percent or whatever you want it to be but for most of us who practice pragmatically um you know that just isn't an option so the only option we have is to be faster and more efficient those two things so i guess this is leading into using materials that obviously are more efficient to work with i mean compared to the old days where we had these kits that had you know 55 shades in it everybody was doing dentin shade enamel shade it looked great in ce presentations by the top people in the country but the average dentist who wants to go to work and make a living i mean it just wasn't that practical so where are we now today with materials and how can materials help us i assume you're going in that direction with managing rising costs For sure. So we used to do a spring cleaning day in my office where we'd like mark off half the day or three quarters of the day and I'd order lunch for the team and we would just clean everything out, right? Like go through all the drawers, all the cabinets, the storage room and throw away any expired stuff, any stuff that went bad. And it was my simultaneous favorite day of the year because it decluttered everything. And it was also my least favorite day of the year because I would stare at this basically big pile of money that we just lit on fire. right? And so the thing t these big kits, right? And so like, you know, t adhesive kits that we need for one l or these different primers that we need for another indication and we use it a couple times, but it's not the standard thing that we end up throwing those out because they go bad. And so what I really wanted my whole car that can do everything. And so I've really been looking for that for a long time. And the reason I look at bottles is because every bottle we order in dentistry, it's like $170, every single one. It doesn't matter if it's a 5ml bottle or something, it's $170. And so you throw away enough of those that you didn't use all of or that dried up or expired, you know, you start to realize that that's just all wasted profit, right? Or that's all wasted overhead. So, you know, the idea of an adhesive system that could be used for everything was really something that I've been kind of looking for, because that was always kind of the deal. If you had a special cement that needed a special primer or something like that, like that's the stuff that would go bad. So, you know, with universal adhesives, we're moving in that direction where we have the ability. To kind of have one material in our office that we use for a lot of things, whether that be direct restorations, indirect restorations, you name it, we can use this one universal adhesive for it. And that's really a great thing for us. And it really cuts down on the number of things we have to buy to execute our everyday restorative dentistry. So when you say universal adhesive, tell us what you're actually talking about as far as the material itself and its clinical applications. The term universal adhesive is kind of a term that's been given out. over the last seven or eight years to the generation of adhesives that some people would call a seventh generation adhesive. Some people would call it an eighth generation adhesive. That's getting in the weeds a little bit. What we know for sure about universal adhesives is a couple of things. Number one is you can etch with them with phosphoric acid etch if you want. You don't have to. These all have self etch monomer systems, and so they do work by themselves without any etch. I prefer to selectively etch mine, so I get a really good enamel etch with the phosphoric acid. And then I use the more gentle self-etched monomer that's in the adhesive system to etch the dentin, and that works great. So that's one component that we know about universal adhesives that it should have, is it should give us some flexibility in whatever etch technique we decide to use. The second thing about universal adhesives that would make it a universal would be you can use it for direct and indirect restorations. So you can use it for your direct composites, whether that be anterior or posterior, and you could also use it to deliver an indirect restoration like an inlay, onlay, veneer, crown, any of those things. The companies that we see today that are best utilizing this are using that adhesive, that universal bonding adhesive. as a primer for their cement system that's specifically designed to work together. And so that's a really sweet spot where we can really maximize the uses of our adhesive, our dentin bond agent, to get the fullest effect. And so part of the reason that we can do that is something called the MDP monomer, which is in a lot of these universal adhesives, and that allows us to bond to metal, ceramic, composite, enamel, and dentin. And as far as I know, that's everything that we possibly could need to bond to so those are kind of the the two qualifications that really to me make a universal adhesive so when you do that cleanup once a year now that you've been switched over to a universal adhesive what are we looking at now what happens are you not throwing anything away no there's still some stuff that goes bad but it's never that right it's never my adhesive because i i mean i i feel like i'm going through it all the time right so you know we may have to order a couple bottles a month or whatever because i'm using it for so many things so i don't have to worry about the adhesive going bad but i do have to worry going about going bad or like those hemostatics those like little things like that you know that that sometimes go go bad or the weird like a6 shade of composite that you needed to order for one patient still don't have a great answer for those but uh that's that's one of the advantages of when i was practicing being an endodontist we had like no inventory waste i mean yeah you guys had it you guys had the overhead system the best one you just needed like some k files and some bleach like man you guys are running at like 70 percent profit that was a pretty sweet deal yeah I loved practicing and did it for about 13 years so tell us which universal system you're using and that applies to both the adhesive system and also the cement system that goes with that because I know there's dentists that always like to work within a system for a number of reasons and then also tell us about the bulk fill composite that you use as a day -to-day product yeah so i i'm one of those guys i like to work within the same system because i know that these materials are engineered to work well together and there's a lot of good systems on the market the one that i kind of keep coming back to is the scotch bond universal line of products by 3m It's a great universal adhesive that I use for my everyday direct composites. And then I use it with their new Reliax Universal Cement. So Scotchvine Universal Plus plus Reliax Universal Cement gives me a ton of different options restoratively so that I don't have to have other bottles around. And then for my direct restorative material, I really like Filtek One. It's a bulk fill product. I use that mainly in the posterior. I don't use it often in the interior. But for my posterior restorations, using a bulk fill, I think, is a really nice option. It decreases the number of steps that I have to do. It decreases the polymerization shrinkage. And it just makes a more streamlined workflow so that we can get composite restorations done faster. And I don't know anybody that just loves composites. They're always kind of one of those things we have to do. They're sort of one of the harder procedures we have to do technically. They're technique sensitive, but they're also one of the lower profit restorations. that we have. And so we have to be efficient with them and doing quadrant dentistry and taking care of a few at a time, you know, is one way to maximize that. And so, you know, being able to work quickly and put in a good product that's not going to cause sensitivity afterwards because of shrinkage stress. You know, to me, it's Phil Tech One. I'm always looking for a posterior restorative material that gives me some options. And so Phil Tech One comes in a paste and a flowable that work together. And so I like having that flexibility. So for a big class one. I might just use paste. If we have a smaller, more conservative class two prep, I may put a little flowable in there first and then go to the paste. And for a tiny little like fissurotomy type situation, I may just use flowable. And so having that option there is really nice. Just gives me a lot of flexibility for a lot of different presentations that I may run into. Yeah. And you're using products, of course, that have a long track record of success. Ix and Scotchbine have been around for a long time. and you know you have that confidence level so as far as cements go do you think the cement market is currently too complex and confusing and you know what should most dentists do about this it is there's so many different cements right and and when you boil cements down what it really comes down to is is one of two things the first thing you gotta you got to ask is do i want to loot a restoration in or do i want to bond a restoration in and that's entirely up to the clinical situation if i'm using a zirconia crown in the posterior where i have plenty of tooth height and the tooth isn't over tapered at all with my preparation then i'm going to loot that restoration in so like a um reliax looting cement would be a great option right um and if i'm using more like a glass ceramic or I have a zirconia prep that is short or over tapered, then I'm going to use a resin cement to put that in. Once we get into the resin cements, we can get into the weeds a little bit about which one is which. But I think the biggest question to ask is, does the cement require you to put a primer on first? And you want to try to probably err towards that side, especially if you need retention. If you need retention from your cement, we're talking about a short preparation, a thin reduction. or an overtapered prepara to use a cement that requires you to put on first. And so that's what's great about the Scotch Mine Universal Plus and Relax Universal is that I already have that adhesive. I already have that primer around my office. I'm using it in other procedures every day. So it's super easy for me to have it out, put a layer of that on the inside of the crown, a layer of it on the preparation. and and and bond that restoration in and know for sure i'm getting really good retention really good uh you know a really strong bond strength between both the tooth and the cement and then the cement and the restorative material and know that we're doing a good thing so it just gives me a lot of flexibility for all of those situations without having to have a bunch of extra products around my office. Right, and this really helps with your staff as well, right? The whole learning curve. If you have to hire someone new, they could come on board fairly quickly versus the old days. We had so many products in the cabinet. Well, and it used to be I would handle like glass ceramic, like lithium disilicate and zirconia differently. But it used to be that zirconia was so ugly that it was easy to tell. And zirconia has gotten so much prettier now. that it's sometimes I have to look at the x-ray sometimes or the lab slip or the script sometimes to tell if it's zirconia or lithium disilicate. And so to expect my assistant to know the difference and then to pull out a different product based on whichever one I think is just, I think it's asking a lot. So, hey, if the inside of the crown is white, we have out Scotchbond Universal Plus and Reliax Universal. That's it. And so it just makes the workflow super easy, super streamlined. And we always have out what we need because it's a simple armamentarium. It's a simple setup. And I think that goes a long way. Yeah, no, that's great advice. You did mention bulk fill just before. How does bulk fill composite fit into your restorative armamentarium? How often do you use it? Is this something you're becoming very dependent on for restorative dentistry? Yeah, definitely in the posterior. So it's my go-to product for posterior direct restorations. We know that has a lower polymerization shrinkage than the previous sort of incremental fill generations. And that helps us a lot of different ways. It helps us. in preventing gap formati with recurrent decay and sen helps us with fracture streng have those sort of like increments that butt up aga potential starts of fractures of fractures down the road. So we know advantages of restoring a tooth with b you know the boost in efficiency of not having to do all those layers and and when i was in dental school i was taught to do composites where we uh only touched two walls with any one layer and that is really easy to do on a typodon it's not easy to do in a mouth and so i think a lot of times in the past we were using traditional composites as bulk fills, and they weren't designed to do that. Whereas the bulk fills like Filtek One are designed to do that. They're designed to be built with four millimeter increments, touching all the walls and all that. And their chemistry is designed to make it to where they can cure it that depth and not cause any problems down the road. So I think it's already what we were doing. Let's use a material that's engineered for that. Yeah, it makes total sense. So for those of you, and I'm talking to the audience now, that periodically have clean -out day where you buy everybody pizza and you go through the cabinets and look at everything that's expired, hopefully listening to this podcast that you will be reducing the amount of stuff you're throwing away and hopefully saving a lot of money, just as he is, using products that work well together in a system. And hopefully you'll be improving chair-side efficiency and long-term clinical success with products that work together. Thanks so much, Dr. Austin. Really appreciate your insight. We certainly look forward to having you on more podcasts and webinars in the future. Thanks, Dr. Klein.