Leveraging the latest in resin technology; Is your material contemporary?

You're listening to The Dr. Phil Klein Dental Podcast from Viva Learning.com. Welcome to the show. I'm Dr. Phil Klein. Today we'll touch on trends, advancements, and developments in the area of composite resins. The conversation will range from practitioner preferences through the latest and greatest in material science advancements. Our guest is Dr. Foroud Hakim, who holds a full-time position in the Department of Preventive and Restorative Dentistry at University of the Pacific. He has maintained a private practice for over 30 years, where his deep ties with the dental industry allow for beta testing and consulting for new product evaluation and development. Dr. Hakim, it's a pleasure to have you on Dental Talk. Awesome, Phil. It's always great to talk to you. Before we get started, I would like to let our audience know that Dr. Hakim presented an excellent webinar on Viva Learning. elevate your game great materials and techniques equal results and profitability so if you missed that live event please watch the on -demand version on viva learning.com just type in hakim h-a-k-i-m in the search field at viva learning.com and you'll find his webinar really worth watching i highly recommend it so to begin what have you observed dr hakim with regards to composite resin trends over the last 30-plus years of your clinical practice? And if you would, include the doctor's perspective, the patient's perspective, and even the manufacturer's, for that matter. Great question. I'll start with the simplest one, which is the patient's perspective. Quite simply, they fully embraced the notion of being able to get tooth-colored fillings. In fact, they expect it. Aesthetic outcomes are now an expectation, whether they're shopping for pure cosmetic dentistry. or need-based health dentistry, there's the unsaid expectation that we want our teeth to look good. And so composites have been an answer to their prayers in that sense. That's a slam dunk. From the doctor's perspective, it really kind of determined by the relative decade of training, which group of doctors you're talking about. I would say roughly anybody that's graduated in the 2000s and forward, they really went through training in an era where they were fully immersed into the composite age, kind of the white. age of dentistry and so they grew up doing this stuff they're familiar with it they're conversant with it they understand how important it is to keep up with trends when you go back a decade or two and go back to the uh those of us that graduated in the silver age of dentistry or even before me the golden age of dentistry it was a little bit more challenging you know first us docs had to uh first learn to accept composites overcome certain biases about their longevity and performance get to where we understood the material science better and then eventually learn how to put it in play in our practices but ultimately you know the goal was always to be able to deliver aesthetic restorations that don't just look good but are durable and lasting finally i would say from the manufacturer's perspective that's probably the most complex of the three these folks have put decades of commitment towards you know funding towards r d and material science improvements trying to enhance materials composites to behave better handle better perform better or more aesthetic more durable so on and so forth and meanwhile they've had to figure out how to move the needle with regards to sales and marketing and education so one of the ways they've done this a big focus over the last decade for manufacturers has been by this value proposition centered around trying to provide materials that give you a notion of improved speed delivery efficiency and practice inventory reduction you know simplifications with shade selection for example and reducing the number of skews you have to keep on the shelf that might you know expire introducing bulk fills and things that help the operator deliver a dentistry better and hopefully faster modulating viscosity so we can fill smaller cavities because there's a big emphasis on minimally invasive dentistry and some of those principles of tooth preservation yeah i remember those days where inventory was just crazy they had these systems that had 30 shades and they came in these tremendous boxes it had everything in the book in that box that was just so unwieldy right i mean it was it wasn't really practical except for a small number of dentists that specialized in doing that kind of direct composite cosmetic dentistry right exactly i was kind of for the one percenters what is it guys like you went back to the manufacturers and said this is overkill you know 95 of the dentists are using 10 of what's in this kit Correct. The leading, the most frequently ordered shade is A2. Many manufacturers know. They listen. Whether we say it or they see what's selling, they realize it's ultimately to our best benefit. They know they have to compete for market share, so they figure out what the trends are. They work developing better products, and ultimately us and our patients are the winners because new products come out. Right. I remember the days, though, where KOLs were showing their cases in CE presentations, and they were... you know direct restorative techniques using all these different shades um and i guess you know that's what they were doing and manufacturers follow that lead but then the large mass audience of dentists just said we can't do this practically and make a living right exactly exactly it was it was the sexy dentistry that sold right but it wasn't the daily dentistry that actually occurred but now you can do daily dentistry in a very aesthetic way with the materials you're talking about Definitely, definitely. And so as the manufacturers of work to kind of improve some of these things, you know, if you're asking what they've done and how they've developed it, I would say probably every seismic shift with technology and composites comes down to one primary most important thing. And that's been that ongoing modification with regards to the filler, the filler technology. As we increase the glass, we're able to reduce the resin and how we modify that glass. really affects the final outcome. So we've evolved from these early kind of very site-specific micro-fills and macro-fills back in my generation when I first started doing it, where they were for the front of the mouth and the back of the mouth, and they each had their weak links, but that's what we needed to do, multiple products to get through the day. And then they modified it a little bit, and we started to go to the hybrid filler composites, and eventually the micro-hybrids came along. Really, the last 10 -plus years, manufacturers have fully kind of... develop the nano hybrid, and I'm doing air quotes, generation of composites. And essentially what they're doing is they're modulating their filler particle size using such small size particles in the magnitude of 20 times smaller than a red blood cell. And so while these things are solids, they're able to get them to behave like liquids, which really, really gives them a huge advantage in the sense that they can use that as a backbone of these contemporary materials. lead to better optics, better handling, better aesthetics, mitigate shrinkage, which was always an issue with composites, better fracture toughness, wear performance, polish, handling feel, the list goes on and on. Through this filler modulation, they've been able to deliver composites with varying viscosities, where now we have multiple pages and catalogs just dedicated to flowable composites only. On top of that, there's a trend where doctors like to modify the viscosity of their body composites by warming them. And that's been a big adjunct for us as well in practice. So let me ask you this. In the era of nanotechnology, where we've really made a big leap with the filler particles, which you just explained, do all the new composites have these characteristics? And if so, how does a practitioner know which material to choose? You know, that's a great question. I'll start with saying how folks choose their composites. Basically, it comes down to three things. Probably the most common is handling. doctors want to be able to grab something that works well in their hands and they do it and sometimes that'll lead to a good choice and sometimes it'll lead to a good choice that might be a little antiquated after handling then it comes down to aesthetics how nice does the final product look And finally, how easily can I polish it? Is it a lot of steps or does it get to a good level faster quickly? So that being said, there are composites from a decade ago, two decades ago, that are flagship composites, big names by big manufacturers. People get accustomed to using them. And the assumption is that they are the latest and the greatest. And they may have been the best that the market had to offer, but they may be a micro hybrid. be that they're creatures that have and that's what they're ordering so i think it's really important to stay ahead of this and a lot of the composites that are kind of worth their way now have nano fillers in there and of course there's proprietary variances between the different companies but a lot of them have nano fillers and so i would urge people to look at their composites and see what generation it's from uh you might be missing out if not if you're not using the right thing yeah so in your opinion what's the biggest like deal breaker or non-negotiable when it comes to choosing a composite Exactly what we said. It's got to be contemporary, meaning it's got to have nanohybrid technology in it. The science just vets that out. So if you have legacy products, you are using the best of what was rather than the best of what is. After that, the next deal breaker, I have to have viscosity modulation, meaning when I do composite, and for example, one of the brands that I use quite a bit is Grandioso from Voco. Besides their body composites, they actually offer flowables in three viscosities. They have a light flow, their average flow, and their heavy flow material. And there's a dramatic difference between how these flowables move, which means that they can get to tight nooks and crannies and spaces where I've done very small preparations, yet they can be a heavier filled flowable that can hold its weight under some occlusal load where there's still minimally invasive preps on top of the tooth. or maybe even in an invisalign aligner when i want to pre-fill those attachment templates put it off to the side and not have it run out until i marry it to the tooth all the way down to their true body composite they're on their 10th year anniversary now and i've had this composite in play in my practice for quite a while it's amazing the results we get and how good these composites look because of that filler technology yeah i've talked to a lot of kols on podcasts and they seem to really like local products across the board Grandioso keeps coming up. And they have another product. Is it Viscalor that is in a warming system? And that seems to be a game changer. Correct. So they've got a new developed product, Viscalor and Viscalor Bulk, which is a composite made to be warmed. And they have a proprietary gun, which uses near infrared technology to warm it. A lot of folks like that composite. But the nice thing is all of their contemporary... whether it's Grandioso, Viscalore, Admira Fusion, they're all built on nanoparticle size. So you can choose the one that you want. And even if you're not using the Viscalore with the near-infrared gun, they have a caps warmer. So you could put any of their composites in these composite warmers, modulate the behavior of it and the viscosity of it, and kind of get the best of both worlds. Have your cake and eat it too. So in closing for this podcast, and the information's been great, Dr. Hakeem, as usual, what would you... Say to a dentist who's either now starting their own practice or they're recently graduated dental school or they're using, as you mentioned, antiquated composites that may not be the most contemporary. You know, obviously the R&D doesn't lend into those products as the newer ones do. To make that decision to buy a new system for an office is a big decision, right? Because you have some training with your staff, inventory. And you have the confidence of your older products because they basically served you well over the years. And now you want to change to a new or more contemporary composite. Now you use Voco. How would someone make that decision where they make that switch? Yeah, I would say don't buy the flavor of the month. Get well educated on it. Get reps in for training. Go to CE courses with KOLs. You know, the Viva platform is great for that, for example. and really shop and make sure especially if you're going into a practice you may be inheriting a practice that has some legacy products in there and they've just been habitually on reorder and they've worked well for a number of years but build your platform on one that's simple where you don't have to store 37 shades you can get by with your most aesthetically demanding cases with maybe eight or nine shades and do a lot of your traditional post your work with the same two or three that also offers the appropriate viscosity flowables a couple of options in there so that the inventory is simple for your staff but it's not limiting for when you have an aesthetic need but it's simplified and it's futuristic and thinking in the sense that it's not something that you're going to have to change out of in two years that'll be something that will work well for you for the next half a decade to a decade the reality is these days though you have to be willing to adapt and change more frequently because the changes come just technology drives changes faster these days and so you got to stay on top of it yeah absolutely great advice to our audience and really appreciate your input Dr. Hakim and we appreciate all the uh contributions you've made on the ce platform that we distribute across the world Viva Learning you're covering both the podcasts and the webinar side and we really appreciate your participation over the years keep it coming thank you so much thank you Phil it's always great talking to you