Made in the Shade Dentistry: Discover the Wonders of Single Shade Composite

You're listening to the Phil Klein Dental Podcast Thanks for joining us. I'm Dr. Phil Klein. Today, we'll be talking about how a single-shade composite system can decrease chair time, lower overhead, and at the same time, create exceptional aesthetic results. Our guest is Dr. Stephanie Vondrak, and she's going to tell us all about it. She owns and operates a private practice in Elkhorn, Nebraska. She's a firm believer that dental CE is paramount to delivering comprehensive patient care. And she herself has pursued over 600 hours of postdoctorate education in TMD, occlusion, orthodontics, and sleep apnea, including the Panky Institute, the Schuster Center, and the American Academy of Craniofacial Pain. Before we get started, I would like to mention that Dr. Vondrak's webinar, titled Choose Simple, Improve Your Day, the Benefits of Single Shade Composites, is now available as an on-demand webinar on VivaLearning.com. Simply type in the search field Vondrak, V-O-N-D-R-A-K, and you'll see it. Dr. Vondrak, it's a pleasure to have you on the show. Thank you so much. I appreciate having this opportunity. Yeah, we're very happy to have you on the show, Dr. Vondrak. And as we talked offline... offer a broad array of advanced services. Very impressive. You treat TMD, sleep apnea, a variety of orthodontic cases. You fabricate craniofacial growth appliances for children and so forth. And you mentioned that it's really important to you amidst all these different services that you have a really high quality composite and one that is a single shade composite. So if you can elaborate on that, that would be great. So, you know, when I see a new patient for the first time, I always introduce myself and let them know I'm a health center dentist, which is great. That usually then their question back is, what's a health center dentist? And I say, well, in my practice, you have the opportunity to become as healthy as you wish to be. So some patients come in and they just need simple dentistry, which obviously composite is a big part of general practice dentistry. And when you can use single shade composites, which is one of the things we're going to talk about, it makes life a whole lot easier. But even the cases where patients want to go and not just have general dentistry, but treat their sleep apnea, or they want to look at treating a TMJ problem, or there's all different applications for using these composites, which is made. practice so much easier and simpler in such a complicated time to practice dentistry. So are you seeing a momentum in the dental profession where dentists are moving away from the multi-shade kind of complex kits where they have 30 different shades and 20 different dent and shades and so forth and they're consolidating their inventory relying on these single shade systems and I know there's one in particular that you really like which we'll talk about but do you see that happening? Absolutely. I think the biggest thing is that not all general dentists are aware that single shade composite exists. And, you know, Omni Chroma is the brand that I really like and that works very well. And the reason why single shade is so great is that when you want to deliver a really great results and you ask me about health centered. So when I'm doing health center dentistry, my goal is to have the tooth, have biological tooth form and look as if I never even put a composite on it. Well, if I have to go through three or four different shades and a whole armamentarium of different composites, that takes a lot of time. And then if I don't have a shade right, then you got to take a pigment off. So being able to just put one shade on, maybe block out some dark color, I think we'll talk about that. But other than that, it's so simple and it's made life so much easier. So I do think that's the direction dentistry is headed. So specifically, how has single shade composites help you kind of define yourself and your vision for your practice? I know it's kind of a theoretical question, but if you could answer that into real world dentistry so that our audience could literally understand how that vision that you had with single shade composites would apply to their practice. Well, think about, for example, doing a class four composite on a front tooth. So you have a child that comes in that breaks off, you know, a big chunk of number eight. You know, that can be really tricky to restore. And so when you're looking at what you want to do, well, I want to make sure for that child that they don't grow up with a front tooth that they're embarrassed about. or isn't going to hold up for many years. And so being able to get that healthy and then get them to take care of it and understand it, I think the better it looks, the more it helps the child to then take care of it. So when you can go in and use some blocker shade to kind of mask out where light's going to transmit, and then you're just going to cover it with the single shade composite and polish, that's going to give you a lot more time to talk to the parent, go over home care things. Then you might run over late trying to figure out exactly which shades you need to make it work. So I would think when I'm looking at my practice, being able to incorporate it has saved me so much time, which my goal being to have individualized care, I need time to talk and spend with my patients. So by using single shades, it's freed up time, which has then allowed me to have more time with my vision, which is kind of reaching that overall goal. Now, do you work more on children than adults where matching the shade precisely? is not as critical with children? No, I would say I work more, well, it's probably about 50-50. So when it comes to composite, I do use it quite a bit with kids with the appliances that I use and on general dentistry. But for adults, when I'm doing a lot of bigger cases, like we'll talk about maybe opening up the vertical dimension where I put composite on all of the cusp tips of the lower posterior teeth in an hour. I can add it to all of those teeth. I can change the VDO, which can help so much if you have, you know, let's say you have a tooth like number 15 that's got a really short clinical crown height. And you've got to do a crown back there. You can open the VDO. It'll help you so much in not having to reduce the occlusal so much on tooth number 15. And then you're going to have better retention of your crown. So that's great because now all their lower teeth, you can't even tell that I added it. I can do it in such a short period of time. It's very durable, very polishable. So I do a lot of work like that, that single shade Omnichroma specifically has really helped me. So when you compare the aesthetics to what you used before, and I assume you used a kit, a composite system that offered many different shades. How do you compare the aesthetics at the end of the day between the two? So yeah, so I started using the composites probably around 2018, I want to say. So I've had several years. The aesthetics are, I think they're better in the sense that... like the polish and the sheen that I'm able to get at the end better with the single shade composite than with the pigmented composite. And, you know, I wasn't unhappy with what I had at the time. It's just that when this came out, it looked like such an easier way to do it. And then I've really, you know, gotten my system down to where it works very, very well. And it's a very simple, smooth system. So the aesthetics are excellent. What about the dentist who's working in a high end aesthetic practice? Can that person get away with using a single shade system and achieve the same kind of aesthetics that they're accustomed to? Good question. Well, my feeling is that... dentistry, it's very difficult to always say you can only do 100% of one thing or another. I feel like as soon as you say that in dentistry, something will come to change that rule no matter what you're doing. That's just being very honest for those of us who have practiced a long time. So I can't say that you can eliminate everything for every possibility. But if you have a high-end aesthetic practice, I would say 9 times out of 10 or 99 times out of 10. of 100, you could go to the Omnichroma or the single shade composite. The only times I've really found an issue where I absolutely couldn't get that is if somebody wanted to change their shade to be bright white. Because if you think about this, we're doing the single shade composite is structural color. So the filler particle absorbs the light and then it shines back the shade of the natural tooth. So if they want to change the shade of their tooth, that's going to be difficult to do if they want to get a super, super bright white bleached look. Now, I personally, if someone wants to come in for an aesthetics like that and wants to get really bright Hollywood white teeth, they're probably looking at porcelain anyway. I think it's very challenging to do that well with composite period. And so most of the time, once the value is correct in the teeth and they've bleached or whatever, That's when single shade works very, very well. So in a high-end aesthetic practice, my guess is if they want to change the shade that much, they're probably looking at porcelain or zirconia or Emacs or something like that. So there's definitely a huge use for the single shade composite. So what are your best tips and tricks for achieving a smooth final polish with margins that literally or virtually disappear? So it's going to sound funny. I don't know what other dentists will think when they hear me say this, but... use my finger a lot when I'm getting that final polish, especially on the front teeth. So I only have about three different instruments that I use, and I love using wetting resin. There's a lot of different wetting resins on the market, but I look at composite almost as something that I'm painting with. And so less is more. I talk a lot about this when I do the webinars. You put just a little bit on, and you use your glove to kind of smooth it with some wetting resin on your glove and your instruments. I think when you do that and you can kind of push the composite right up to your margin and past it and you don't cure your composite until you pretty much like where it is, it helps a lot. You know, I feel like in dental school, they had us just pile it on and then we're supposed to carve it back and it was supposed to look great. That really doesn't work well. So I always talk about getting a really good contour where you're using your finger, using a couple of really nice composite instruments, and you're getting it very, very smooth before you cure. And then you can just use a few polishers and it's great. Any particular polishers that you like that you could recommend to our audience? Sure. When you're coming to contouring, so contouring is getting your shape, you know, looking at all the different angles to make sure that you have your incisal edge correct from an occlusal view, from facial. I move all around and look. I like to use my Singer Burrs. They work very, very well with... the single shade composite material um i use those and then i like to have a contouring instrument there's some really great contouring instruments that look similar to a scalar but are designed to just remove composite like at the margin and then once you've done those things just the soft flex discs that have been around forever work beautifully and that's really all you need right and that's i think 3m is i think that's right yes So to wrap up this podcast, and it's been very interesting and I really appreciate your time. Let's talk about what you talked about on a webinar, a recent webinar where you did single shade composites in quadrants. These were full arch cases and you were opening up the VDO. And that's really interesting how you, you know, used this method and you talked about how you treatment planned it and these cases. So if you could just go over that briefly, I thought that was very interesting. Sure. So, you know, I think that as dentists, we're always looking for things to make our lives a little bit easier. You know, it's been tough, I think, especially in this post -COVID world to manage all of the demands. Our overhead has gone up so much. There's been so many things. So if we can have just one shade, that helps that. And then if we can do something like opening the VDO to make this nice dentistry more successful, that simplifies our life. So what I do when I treatment plan is I always really look at the bite. And I treatment plan usually from my desk, my computer versus chair side. But when I'm doing that, I'm always looking at the bite first. And so a lot of times if the upper teeth are kind of narrow and tipped in towards the lower and you don't have much of that buckle overjet space in the posterior, anything you do could chip easier. So it's really simple to get out of that problem to add a little composite to the buckle cusp tips of the lower molars as long as they don't have a crown on them. So you isolate. You need no anesthetic. You add from, let's say, 18 to 22. And you're just kind of contouring back and getting that shape. Then I generally get the bite even on that side. And then I can use that as a guide when I'm adding to the right side. But the reason I do it is so that there's a little bit of freedom of movement of the mandible so that whatever work you're doing on the top isn't getting bumped and things aren't getting broken. So when I mentioned like a class four composite earlier. You know, one of the cases I used in the webinar was the girl who broke her front tooth. She'd never, I'd never seen her before as a patient, super deep bite with no overjet. How is my class four composite going to stay on? Right here, she's 15 with a broken tooth. So when I opened the VDO and now I get a little bit of overjet, a little bit of clearance, that can have a much longer life. Yeah, aesthetically, that must be a huge improvement for the patient's smile, their whole facial profile. Yes. Correct. Yeah. And I use that so much. You know, the main question I get when I teach that is, well, how long does it last? Well, you know, it depends on each person. There are some people that grind no matter what you do, or if there's an underlying sleep or airway issue, they're still going to grind if that's not treated. But because you're adding to everything at the same time, the wear is generally very slow. So once I add those cusp tips, most commonly, if I'm going to have something chip, it happens in the first two weeks. I don't usually add that part back. I usually just smooth it because it's kind of the body equilibrating a little bit of itself. And then after that, it's usually five, six, seven years before I have to add any composite back. So it works really well. And I do it a lot also with my TMJ patients because if I have to reposition their jaw forward a little bit to take pressure off their joints, they just might need that little bit of height to keep those joints healthy. So it's a really awesome thing to add to your practice. And what is the typical height that you're increasing in millimeters to those cusps? You know, this kind of dentistry, I feel, is like a little bit more of an art. But I would say a millimeter, maybe a millimeter and a half. It's going to depend. On a TMJ patient, sometimes that post or open bite is created when the mandible is in the right spot. So then you know you just have to reach the opposite arch. If I'm opening the VDO in like a deep bite case. then I'm just going to kind of be thinking about in my front, how much overjet do I want? And then I can kind of know from that height. So I don't have an exact measurement. I don't have a wax up. I generally start from the most posterior tooth because that's going to be the smallest opening of the jaw. And then I can look and I can adjust down until I feel like they're going to be able to move without hitting those front teeth. Then that's the right measurement. And the comfort level of the patient after you do that immediately? When they get up from the chair, do they have any? Well, they're not numb, right? Because you didn't have to give it. They're not numb. Right. So what's their feedback? Right? Because you just changed their bite. So it feels weird. This is really my process. I do it. I get it to where I think it's exactly right. And then I give them a bottle of water and I leave the room. And I say, play on your phone for 10 minutes. And they drink the water and you swallow. Your teeth touch when you swallow. And they play around with it. And then I generally come back in the room and they say, hey, doc, this one tooth feels high. Almost always. So then I mark it sitting up and adjust it and then they're generally good. I do like to see them back in two weeks for a check just to make sure they're having no issues. But by then, they're usually really good. I mean, it's going to feel weird for about 48 hours and then they just get used to it. Dr. Vondrak, that was excellent. Thank you so much for the insight. A lot of great tips in this one. And we'll see you on another podcast soon. Thank you so much. If you're enjoying our podcast, please leave a review or follow us on your favorite podcast platform. It's a great way to support our program and spread the word to others. Thanks so much for listening. See you in the next episode.