The Clear Advantage: Injection Molding for Composite Veneers

The overwhelming statement is always, wow, you can do that? And yes, absolutely we can. Then that's when we start breaking out, okay, here's the pictures that I can show you before and afters that we've done all these with composite. In a lot of cases with no anesthesia, because think about it, we're not cutting the teeth down. I'm not saying that every patient can handle that, but I'll tell you the vast majority of the cases I've done in the last 10 years with this system that we're going to talk about soon, I've done with no anesthesia. Welcome to the Phil Klein Dental Podcast. Today we're talking with Dr. Stephen Shaw, a 2003 graduate of the University of Tennessee College of Dentistry, who's passionate about patient comfort and always on the cutting edge of dental technology. Dr. Shaw shares how he's transforming cosmetic dentistry in his practice with an innovative system for creating composite veneers chairside. No printing, no lab work, and no mess. It starts with a simple intraoral scan uploaded to the Clarity Portal. Within 48 hours, he receives a digital wax-up and a 3D preview of the final case. And when patients see it, their response is always the same. When can we start? According to Dr. Shaw, this technique offers big advantages. It's efficient, fast, highly profitable, and incredibly conservative. In fact, it often requires little or no removal of tooth structure. and in those cases, no anesthesia. Plus, it makes beautiful veneer results accessible to patients who might not otherwise afford ceramic veneers. So if you're looking for a minimally invasive, affordable, and patient-pleasing alternative to traditional ceramics, stick around. I think you'll enjoy this episode. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases and our entire production team will really appreciate it. Dr. Shaw, thanks for joining us on the show. My pleasure, Phil. Glad to be here. Yeah, we're happy to have you on because there's no question that minimally invasive dentistry... is catching on by leaps and bounds on all fronts of dentistry, for that matter. And that includes cosmetic dentistry. So tell us what you think is behind this growing trend, specifically in the cosmetic dentistry arena. Well, I think you have to look at what is driving our patients' perceptions more than anything else. Because, you know, any dentist that operates... in a private practice. We're honing our skills. We're adopting different modalities, but at the end of the day, we're pleasing our patients. We're trying to offer services that give our patients the results they want. And I think the majority of us as practitioners are trying to mind the preservation of natural tooth structure in doing that. So I got out of school in 2003, so about 22 years ago. when you look at what has happened in the realm of cosmetic dentistry, considering I got a great education at University of Tennessee, a great education, but. we really didn't cover a whole lot of cosmetic dentistry. And so when I got out of school, I was kind of on my own and I had to learn a lot of those things. But also what happened is, is there was a bit of a material revolution, you know, in the early 2000s, you know, we started to see these resins being delivered, these different materials, and all of a sudden we're bonding porcelain and we're doing all these phenomenal things. And I feel like dentistry got to be just, it turned into... of a chemical wild wild west because all these products we went from just a couple of pages in the catalogs for cosmetic dental materials to all of a sudden we have these huge sections of all these different materials with great capabilities some of them you know came and went because maybe the chemistry wasn't all there and then some of them stuck around and so we've kind of built on that to be able to deliver all these these different modalities that that don't necessarily hinge upon the traditional, hey, let's cut teeth down, let's temporize them with acrylics, and then let's put all the cosmetic or the design and artistic control in the hands of our lab techs in order to deliver what our patients want. And then on top of that, if people are paying attention to what mainstream media is pushing, you're looking at a lot of negativity toward traditional cosmetic dentistry, which when I say traditional, I mean, bonded porcelain laminates that involve cutting away tooth structure. Yeah, I think you're 100% right there, Dr. Shaw. Patients have a lot more information than they did many years ago. They're much more attuned to what's going on in the dental office regarding their teeth. And just like we are with nutrition and chemicals in our foods and pesticides, they're also aware that dentists have a drill and enamel doesn't grow back. This is something that's certainly driving, I think, the demand for conservative dentistry. And I think this is affecting the manufacturer where they're bringing techniques and processes to the dentist based on that demand of the patient toward conservative dentistry. And I think a great example of that is what we're going to be talking about very shortly, and that is injection molding chair-side composite veneers. Phil, you're absolutely right. The patients are being driven by a lot of this media. They're also being driven by people that they know that have gone through the traditional cosmetic. restorative, let's say the makeover kind of generation that we saw, you know, everybody had to have this big makeover when they've seen a lot of those cases not go so well. So they're driven by that kind of pain point. They're also, you know, let's face it, a lot of America is not able to come into their dental office and cough up $1,500 per porcelain veneer to make their smile better. They are looking for not only more conservative biologic processes, they want more conservative. conservative financial process. Yeah, without a doubt. So these, as we're going to talk about, especially when you start getting into the efficiency of digital workflow, we can deliver some pretty amazing results. And we don't have to go all the way there with the financial. We still make money off these things because, you know, notice I use the word efficiency. You know, we can make these processes efficient. By doing that, we can make money and we can still, you know. please our patients and give them the cosmetics, but then also deliver on the biologic side where we're being conservative. So when it comes to conservative dentistry in your practice, Dr. Shaw, what are some of the products that you depend on, especially with the technique of direct restorative veneers that you do chair side? First of all, you've got to have a good recipe to have a good meal. You've got to have a good recipe to make sure that you can deliver what everybody wants. And that starts with that you cannot make a good composite veneer if you don't have good composite resin. So we have a lot of companies out there that have just put, and I've met a lot of the designers behind a lot of these products, and wow, talk about the brilliant minds that are sitting in labs every day trying to come. up with the next big thing for us so that we can have materials that handle outstanding and that look amazing and then have that durability and that longevity so that we can take these cases the extra mile. And then now we're getting into a huge push going back to that efficiency word, which is so important now with running, especially if you're an autonomous small dental practice like myself, we can't inventory. I mean, we can, but it doesn't make sense. to inventory just a thousand different shades and type of composite you know we need some of these materials that are coming out now that uh that where we can take shade systems and they've compressed those into you know, smaller systems where you might be able to get by with the majority of cases with maybe just three different choices. You know, like the newest one that I've really fallen in love with is the Solventum, the Filtec Easy Match system. And you got three composites, three tube, three bottles you have to stock. And we can do some pretty outstanding, you know, of course we get the Filtec pedigree behind that. that system but but they've thrown a bunch of of awesome chemistry into that so that we can kind of pick a shade range and it kind of masks itself in to get those shades, you know, to blend in and look vital and we don't have to sit. And it's kind of like, you know, taking an artist's palette of paint and instead of having 50 on there, we all of a sudden we're painting with three. And that's very refreshing. So with that simplified palette and with the template that is available through Solventum, through the Clarity Portal, which we're going to get into. This is a totally doable situation for most dentists, even if you're not particularly brilliant artistically. But tell us about what it's doing for case acceptance. for those patients that would otherwise not get veneers at all because of the cost when we do it the traditional indirect way. Typically, I've trained my hygienists in those re-care visits to look at those patients that might say, hey, I really would like to change my smile, but I don't want my teeth cut down and I don't have the kind of money it takes to do the, let's say, the Hollywood makeover. So I guess I just won't get anything done. And we hear that a lot. And I think that's a big part of the patient. population in, in America. It's just, well, I just won't do anything about it. I'll just live with it. So what happens is when that conversation and recare happens and, uh, or occurs and, uh, and, and they get that explanation that, that, Hey, we can, we can do all these things with composite and it, and it's all these advantages that you and I have, have already mentioned. The overwhelming statement is always, wow, you can do that. And, and yes, absolutely we can. Then that's when we start breaking out. Okay. Here's the pictures that I can show you before and after is that we've done all these with composite. In a lot of cases with no anesthesia, because think about it, we're not cutting the teeth down. I'm not saying that every patient can handle that, but I'll tell you the vast majority of the cases I've done in the last 10 years with this system that we're going to talk about soon, I've done with no anesthesia. The amazing thing here, Dr. Shaw, is that many dentists who are fearful about handcrafting beautiful veneers chairside. can do this right because it comes with a template that gets delivered to the office and you're going to talk about that in a minute and they inject the composite directly into the template and with very little finishing work you have a beautiful set of veneers so it just makes it so easy for dentists that normally wouldn't do this and of course it gives the patient a whole nother option as far as beautifying their smile without spending the money that indirect would cost and without the reduction of tooth structure that's normally required for ceramic indirect restorations. The playing field has been absolutely leveled with this. When you look at the artistry and the mastery that it took to deliver... you know, let's say profound cases with, you know, aesthetic anterior cases with composite, man, most, you mentioned it a minute ago, most dentists would say, not on my watch. It's not worth my time. I wouldn't even try to do it. And not because they're not a good practitioner, just because there are too many variables there. So what this process does, it takes so many of those variables out and it's using a digital workflow that are utilizing one that we already, we already. have adopted you know most dentists are we're we've we've already graduated from all the the putties and the and the different uh alginates and all that stuff so so we're all most of us are digital anyway so uh so what we do is is embrace the fact that okay we can start designing this based on this platform using the technology that i think was just brilliant to come up with and a lot of us said you know look We learned how to kind of sort of do this in dental school, but it still wasn't efficient enough. What if we had this? Well, the product that I was involved in from a clinical trial standpoint, going all the way back to 2017, is that PhilTech matrix. And I watched it start from just a pretty rudimentary design. And we were using traditional impression methods to now it is a lightning fast digital workflow that allows us to take our... our patient's data, our diagnostic data really, really quickly. We acquire it digitally. We upload that into the Clarity Oral Care Portal, which I believe we're now just calling the Clarity Portal. Once it's in there, we can design, we can add length, we can add spaces, we can do all that. So based on the needs that we put into the templates, then within a week or so, you can have a 3D printed template that clips onto your patient's teeth that account. for that gap between the tooth and the desired shape that we're looking for. And next thing you know, you know, of course there is a clinical workflow that goes along with it that is just bonding composite like we do every day. There are a few key things that you have to do right, but none of them are, it's not rocket science. It's once again, going back to the top, the theme of leveling the bar, we can trust that any practitioner can do this. Then they can use that template to injection mold that shape. onto those teeth. And it gets you about 85 to 90% where you want to be. All the tough stuff, like where the line angles go, where that incisal edge needs to sit, how tight the contacts are, all that's done. So where in the workflow do you get the opportunity to approve the design, the digital wax up of the veneers, since that's done in that portal system by Solventum? And then of course, I assume you use that wax up to show the patient to get case acceptance. How does that workflow play out? What we do is, you know, identify the need. Then we scan the patient, you know, gather the diagnostics. We, you know, upload those into, along with some pictures, into the Clarity Portal. And then within about 48 hours, you will get a notification saying that, hey, we've got a design for you to approve. And then once you approve that design, which usually At the point of that design, that's whenever, for lack of a better term, you pitch it to the patient. Say, hey, you know, we talked about what we wanted to do for your smile the other day. Well, check out this virtual model and we'll send them a little video. Here's your virtual model. And then I've actually been blessed enough to be part of a beta test for a product that's coming soon through the portal, which is a smile simulator. So I can send them a simulation of what their smile will look like based on the design that I put in. And then. and then shoot them the virtual model rotating around. And you talk about ecstatic patients. So they're not even in the office when you do this. They're not even in the office when they do it. They're at home. So it's one visit of a scan, which takes a few minutes. Then they're out of the office. Exactly. And like I said, it would be best if that visit is in recare. That's when you're cooking as far as efficiency. So it doesn't really take up your time because your hygienist is doing the scan? Boom. You got it, Phil. That's certainly very efficient for your office. So when the patient gets the visual. the video that's created from the digital wax up, which shows them what can be done with their teeth. What do they usually say? And what's the next step in the workflow? When can we do it is usually what I hear. And I'll tell them, well, I'm going to prove this design. Then my financial coordinator will usually get on the phone with them sometime in the next 24 hours. We're looking at this much per tooth, which that's, you know, usually a geographic kind of thing, you know, in different parts of the country. You know, these restorations cost different amounts. We won't get into all that. But they usually have that quick discussion. And I've never had somebody turn, never had anybody turn down. Usually they're so excited about the possibility that they're like, look, book it as soon as we can. We usually book it two weeks out. Within seven to 10 days, the matrix shows up in a clear package. You know, it's got a box. with a little kind of a Ziploc type heavy-duty bag that's got it in there, and that's all you need. So it's basically the aesthetic zone. We're talking about 18th? Yes, we are. So regarding the template, Dr. Shaw, you get one template back for those eight teeth, and that handles all of the veneers. It's all done in one shot. If you're going to go back to the second premolars, if you want to do 10, they have separate little pieces that fit on those. So you do those restorations separately. But the front six are done in one shot if you want to do that. How do you keep the composite from connecting to each other? Well, as you clip, the matrix has a part that fits on the lingual and then a part that fits on the facial, almost like a bit of a clamshell design. And there's little fins that are printed in a certain way that they fit in between the teeth. So it gives you that separation. Sometimes we have to take some little separating strips and just kind of get in there and get little adhesions out of the way. But that's pretty standard for even when you do porcelain veneers, you can get cement in between teeth. So we have to clear that. Right. And how do you... prepare the teeth and also what do you do to the template to inject through it talk to us about that So the, once the, of course you just need to make sure the teeth are clear plaque. So you want to buff them down with, I like pumice. You can air braid, just make sure everything's clean. Then just standard, standard bonding protocol. You're going to, you're going to etch according to the etchant that you use. You're going to place a bonding resin. You want to really air thin it out. You don't want big pools there that could interfere with those fins getting in between the teeth. Then a cure. There's no way to fit a rubber dam in because that would interfere. with the matrix being seated. So a product like Obdragate helps a lot to get, you know, just retraction of the lips. So you then place the matrix and it's got little doors that you open up for each tooth that you're going to. And those are already there. And they're already there. So you place the matrix, clip it in, then open the doors and then inject the composite, which Solventum gives you a bit of a recipe guide. tells you how much, based on the shape that you're trying to achieve, how much composite you're more than likely going to use per tooth. So you know, okay, on number six, we need half an ampoule of Easy Match Bright. So you know kind of how much to put in the composite warmer if you're warming, which I would recommend that you put in there. And I think it's important right now to mention, you know, most any universal composite can be used with this system. That's another thing that I love. I always joke around and say, you know, if it were my product, I would say using any composite other than what I produce will cause the patient's head to explode or something like that. But no, I mean, I think it's pretty gracious of Solventum to say, look, you can use any universal composite with this because there's a release agent on there that is compatible with virtually all composites. I would say stay away from anything that's got any kind of a glass ionomer base to it or even a G. geomer-based, like Beautifil. I believe there's one called Genial. And there are a couple of which I think are wonderful composites. I love using those day-to-day, especially for the fact that, you know, we learned about them in school as compomers. So I love the fact that you get, you know, great, great resin characteristics, but you also have some glass ionomer characteristics. It's like a resin modified. It's a little similar to a resin modified glass ionomer. It is, but it's more like a composite. And they're great. products, but I would probably steer clear of those because maybe it's just anecdotal. I have noticed that those things really can adhere to plastics. So like anytime I'm using just a simple Mylar strip, it is a very noticeable difference between how much force I have to use to remove that plastic from there. So I'd be afraid to float a whole set in something like that. And granted, maybe that could be tested, but I'd say for right now, probably stay away from those. Well, the goal is, though, you're looking for premium aesthetics because these are veneers. That's right. So the glass ionomer part of it may not be as critical if you're doing it in the social six or social eight group of teeth. Correct. Or even Phil, I'll tell you, probably the primary group that I get are post-ortho front four. We do a ton of those. Teenagers, young adults that have great canines that maybe have discrepancies, maybe not peg laterals, but the laterals are not ideal. The incisal edges of the centrals are not where you need to be. Getting that uniformity framed in between two good canines. talk about, one, it's very dynamic in the result, the cosmetic result, and insanely fast to deliver. Those are great cases. So, you know, and I can say, you know, they're efficient and they can be very lucrative too. So when it comes to actually injecting the composite into the template, as you described, is there any particular protocol that you prefer as far as which tooth first? Let's say we're doing the anterior incisors, seven through 10. What I like to do is, and this is just a personal preference because I've done quite a few of those. Let's say I'm, I am doing seven through 10. So I'll pop the door open. I will, you know, my own protocol for filling, you know, I make sure and you don't want to overfill, even though when. When you fill composite into the space and you shut the door, there's a little hole at the incisal edge that any excess composite will squeeze out. You do want some of that composite to squeeze out because that way you know the mold is full. However, you don't want to overfill it because we all know how strong hydraulic pressure is. You know, we move parts of mountains with hydraulics. That's what construction machines use. So, you know, you think about when you're jamming a bunch of composite in this space, if you put two... much and you squeeze that door shut, you could flex the matrix. So the key is getting just a little bit more than you need and shut that door. You want a little bit of weepage out of that little hole. You scrape that out of the way and then go ahead and cure that. Now, once that's cured, I've noticed that that matrix is locked into place. So then what I do is I fill the next three, four or five, whatever. I fill those all at one time. Just boom, boom, boom, boom. There's no point in stopping to cure, then cure it all at one time. What you wouldn't want to do is fill them all. And, you know, while you're closing doors and all that, allow the matrix to move or flex. And I mean, I think that's kind of a universal thing anytime we're using any kind of template in dentistry. So being able to lock that thing in with that first one, you know, with that cured composite and the door is shut, then, hey, hit the gas pedal, fill them all. Which is your two? that you do first i would do i'm right-handed so i do the one that's closest to me so if i'm doing the front six i will start with six course, I'm in the 12 o'clock position behind the patient. So I'm going to fill six, lock that in. If I'm doing seven through 10, I'm going to start with seven. And how do you remove the matrix when you're all cured up? At that point, once it's cured and you're done filling, which it happens pretty fast, there's no need in belaboring that. You just want to fill them all. You want to make sure you've got enough in each space. Clear any excess that you can from the weep holes. cure them and then I take a spoon and I prop between you know a small spoon a prop in between the kind of the spine of the matrix and then the little the the the tab for the door and and pry up you pop all the doors open then you unclip the matrix from the sides and then separate the facial from the lingual part and and typically it all comes apart pretty pretty easy sometimes because those fins might reach way in there because you've got a diastomer you're closing sometimes it can be a little little challenging to get it apart but i you know i've just once again i've done a lot of these cases i've never had one get quote unquote stuck or anything like that right so overall the aesthetics on this the patient must be thrilled because it's a one visit deal they're done Right. After one and a little bit of polishing, a little finishing and polishing, I assume. I did a six unit case a couple of months ago for a young lady that had had ortho twice. She had had quite a bit of dentistry as far as some fillings and just was not happy with her smile. We we did the front six in and I've used it in several presentations of mine. The front six with. I believe it was a XWB Phil tech and probably hour and 20 minutes start to finish. And that's with getting all the excess composite after the matrix is removed. Like I said, it gets you about 85, 90% there. So getting all the excess, you know, contouring, polishing, clearing contacts, making sure all the embrasures are right. And when I gave her that mirror, I wish I'd had a video camera going cause she'd started bawling. She was so happy. No, it's emotional. It's an emotional thing. I get a lot of a lot of I mean, people just don't believe how good they look. And it's and it's a process that, as I mentioned, you know, you're not in a lot of cases, you're not numbing their face all up. You're not drilling your teeth down. You don't have to send them out with temporaries and say, well, you know, the new ones are going to look a lot or the real ones are going to look a lot better than that. And don't get me wrong. There's still a place I still do. I still have no problem. When the patient dictates and the situation dictates, I'm still doing porcelain veneers. I love some Emax veneers, so I'm still doing those. But there is such a great little niche of patients that want to change their smile that you can use. you know, composite resins to fix that. And now that we have digitally guided templates like this and other manufacturers, we can, man, we can rock and roll and just do some great stuff for patients. We do it quick and easy. And you don't have to worry about the, really the lab work of the matrix, which is, you know, it's all covered on that clarity portal. So as we approach the bottom of this podcast, Dr. Shaw, I'd like to talk about profitability. What should we expect as far as... profitability when doing a case like the social six using this technique. Yeah, let's go back to that case I just mentioned on that young lady who got so emotional. So that was, let's just say, even with our, let's say our kumbaya time at the end of the appointment to ooh and ah in the mirror, let's say an hour and a half. That was six units, $5.95 per tooth. I always, part of booking the receipt, once I... present the case to the patient with that little video or those pictures that i'll make you know screenshots of the digital model and then uh like i said the product that's that's coming it's not quite there we're we're just in beta test for this smile simulator we uh that's when i collect for the cost of the matrix or i let the patient know Because all dentists are like, all right, well, what does this thing cost me? We all ask the same question. So one, you're not buying any big equipment. If you already have a scanner, you're already in it. You don't have to buy a printer because you're not printing this thing, at least not yet. You don't have to buy a mill. So they're like, well, how much does this thing cost? Because I got to take that into consideration per unit. Well, no, you don't. Because every single case I've ever done, I surcharge the cost of the matrix to the patient. So however they... want to pay for it that we're going to add that 200 and something or that $300 for the matrix on top of that. So I don't, we're just, we're just going to shove that in, in the cabinet and shut the doors. We don't even think about that. So in that hour and a half, we got, we got 595 times six. So you're right at about 35, $3,600. And, uh, and I'm out and I'm not out the cost of the matrix because the patient paid for that. And I, uh, I'm out probably, I, I bet that was Six or seven ampoules of composite. So, you know, you do the math on that. That's maybe 80 bucks worth. Right. And two hours of your time total, total. It was an hour and a half. It was an hour and a half. Right. There was some time talking to the patient beforehand in the hygiene. Oh, exactly. You may have, they may have called the office. There was some, probably some going back and forth with the hygienist a little bit with you there. So maybe two hours, $3,600. minus 80 yeah and it's that's amazing here's the deal it's done it's done and and that's with any of these procedures like that's the beauty of composite when you get efficient with it it's done yeah and the thing is that patient that patient may have never gotten any veneers without this option because you're not going to hand craft these one at a time that's because you still have to charge them 600 bucks and you'll be in there for the whole day Yeah. Oh yeah. And I've done that 15 years ago. Once again, I've got in the presentations that I've done, I love to talk about this kid that came in my office with bombed out front teeth. He had a, he had a, uh, an interview coming up. He was a brilliant computer science kid and he had an interview coming up and his front teeth are bombed and we had to do something quick and he couldn't afford crowns and all that good stuff. So, so I went to sculpting. I mean, it was, it was four hours of. of just no thank you i don't ever want to do that again but i mean he ended up with a beautiful result i from what i understand he got the job and got different insurance so i never saw him again but he uh you know it it turned out well but it's one of those things i don't ever want to do it again yeah i mean this is where digital digital workflow has continually expanded our options and what we could do in the office and There's no question about it. It's improved profitability based on the kind of services we can offer patients that they may have turned down before. So the case acceptance on veneers, certainly there's another half to the equation. It's like indirect, no, I can't afford it. Direct, yeah, I could go for this. you know, the immediate sense of satisfaction that is gleaned by the patient through a procedure like this. Like you said, it was like the patient was crying when they were done with it. Fantastic stuff, Dr. Shaw. It's great that you shared this whole new arena of cosmetic dentistry. And one of the best parts about it is it's so conservative. That's the big thing. As an endodontist, that's what I'm excited about is that we're not getting near the pulp. We're not cutting down teeth and we're staying away from the red zone. In football, you want to go to the red zone. In dentistry, you want to stay away from it. All right, my friend. It's far away as possible. Yeah, there you go. All right. Enjoy your day. Thank you so much, Dr. Shaw. Really appreciate your time. Bill, it was a pleasure. Thanks so much.