Can One Composite Do It All?

You're listening to the Phil Klein Dental Podcast Today, we'll be talking with Dr. Sarah Winter, who has a cosmetic-focused practice in La Jolla, California. Until recently, she used two different composite systems for her direct restorative cases, a micro-fill composite for the anterior in order to get high polishability, and a bulk fill for the posterior, which provided lots of strength. But recently, she found one material that actually does both, which has made her life and the life of her staff a whole lot easier. To tell us about what she's using and why is our guest, Dr. Sarah Winter. Dr. Winter, it's a pleasure to have you back on the show. Hi, Phil. It's a pleasure to be back on the show. Thanks for having me. Yeah, our pleasure. So what are some of your key considerations when choosing a composite for your direct restorative work? I think probably a lot of the considerations that all of us dentists have, when it's in the back of the mouth, I want something that's going to hold up well. I want something that's going to fill in all those little crevices. When it's in the front, I want to make sure that I have a wide variety of shades available. I want something that's going to be strong, and I want something that's going to polish really, really well and be beautiful. And with all the advancements of dental materials, specifically direct restoratives, Aren't many of these companies coming out with composites that do all this? Or did you have to really sift through what's out there, try it, evaluate it, talk to your colleagues? What's the process of actually selecting the one you want to use for your practice? And like I mentioned, it seems like a lot of them should be equally as good. I think there's a lot of great products on the market. For years, and all of those things that you talked about went into it, you know, the CE that we take, I take into account when you're using products in the CE and what all of the other, for example, cosmetic dentists, if I'm taking cosmetic, anterior cosmetic classes, I'm definitely going to veer more towards some of the... anterior composites that are used there I want to make sure that they polish really well again so that's an anterior case for posterior I want to make sure that it's strong that the colors are you know good but that's not quite as important to me I love a bulk fill at times so that you can get that depth of cure in the posterior I personally have always had composite that I use for aesthetics and composite that I use for strength. And they weren't the same. I love Cosmodent. Historically, I've always loved Cosmodent for my anterior aesthetic composites. And in the posterior, I would veer more towards Filtec. I have tried a variety of others and those have kind of been the ones that I've... come back to just because i like the way that they work in my hands and i like their longevity for for what they are recently echo sit elements came out and it's composite that has both very high polishability and high strength. They also have a variety of shades so I have slowly been incorporating them to both my anterior and my posterior. They polish really really well for the anterior and they're strong for the anterior so I'm not getting as much of those little corner chips that you can get if you're doing anterior composites you know and the incisal edges tend to be a little bit weaker. So we talked offline, Dr. Winter, about your desire to use micro fills in the past because you wanted to get this perfect polish. But then you had some issues with that. And that kind of led you to explore new options in composite. And right now, obviously, you're very happy with what you found. Tell us about that transition. So one of the things, and I think this speaks more to the dentists that are concerned with cosmetic dentistry, but for me, I... want my work to be beautiful i photograph all of my work i want the patient to love it and so for years and years i've been using a microfill in the in the anterior region and it polishes beautifully and it looks phenomenal and i take the photos and the patient is really happy and then a week or two later you get a phone call that there's a chip here or a chip there and it goes from a really great patient experience to a really negative patient experience and so while i might be happy when i'm taking the pictures i definitely am up that night you know kind of hoping and crossing my fingers to a certain extent so having a system where i can get all the shades that i that I want and need to be able to do this beautiful interior cosmetic work and having it be simplified across the board as far as the shades that are offered. For example, in other brands that I've used, you know, there's like super bright one, super bright two, super bright three, you know, there's so much shade selection that it can be overwhelming. And so this really, I feel like is simple and that there's like enamel bright. enamel light, enamel medium. It's words that we all know and understand. And you can grab when you have that emergency chip on number eight that you're squeezing in and you only have, you know, half hour, 45 minutes. But additionally, I know it's going to polish really well. I know my photo is going to look really good. And in the end, I sleep a little bit better because I'm not getting those phone calls that there's all those microchips and the color sloughing off. So I feel like. that for me has become more and more and more of a go-to just for that reason alone. And I'm more and more just loving how it's performing in my practice. So it seems that many dentists are trending towards single shade direct restorative materials. We, you know, we know what those materials are. We've heard about them in the marketing of those products, et cetera. And these products that claim to be single shade are designed to kind of blend into the dentition. What's your feeling on that whole concept? I loved the idea and I definitely brought them into my practice and tried them. They're purported to have, you know, chameleon effect. So you you know, once you get them in and you cure them, they sort of blend really well. What I was finding is that after, you know, a few months and definitely. more so over time. To me, they looked gray. And so for me, I've veered away from using those. I didn't think that the chameleon effect was working quite as well as I wanted it to work. So I prefer to go back to things that have actual variety of shades that I can use to just color match anterior teeth. You're not a firm believer of the single shade concept because that has been trending. You're not. Personally, no, not for my anterior composites. Right, but you have reduced your inventory by not using an anterior and a posterior composite, two separate systems, right? With the one you mentioned earlier, the Echosit. Yes, the Echosit elements. I feel like it's kind of a game changer. I'm super pleased with it. How do you typically discover a new composite just so our listeners could understand the best way to possibly transition to another brand? I mean, obviously. It seems to me I'm not a restorative dentist. I was an endodontist. But when I tried a new file system, if I liked it, then I would say, yeah, this is worth looking into. And I would try it and see how it went. Do you trial these composites before you go full out and purchase them? Yeah, absolutely. A lot of times it's definitely word of mouth. It's definitely continuing education. My colleagues that I. sort of look up to and and respect what they're doing and i've seen their work social media nowadays there's a lot of dentists on social media who are putting out some amazing content educational content and that will kind of spark some interest but it usually comes down to a colleague that i look up to and respect the work that they're doing making a suggestion or talking about what they're using and then and whether that's in a ce course or just talking to them personally. And then I will usually grab a couple colors and try it, usually on family and the girls in the office and myself, and then go from there. How good are the composites that claim to be universal in that they fulfill all the dentist's clinical needs, both posteriorly and anteriorly? Are those reliably universal as they claim to be? I haven't found a ton of composites personally that I've used that have claimed to be universal. I've always sort of known, you know, I'm going to use a microfill for high polishability, but I know that what... giving up is strength. And then vice versa. Sometimes I'll use one of my other posterior composites if I really need strength in the anterior. But this EcoSight, you know, the science is there for sure. And then, of course, how it works in my hands. And from what I found, this specifically just that EcoSight really lives up to what it says. The benefit of this particular product that you like, EcoSight, you're saying that it has the polishability similar. to a microfill but it obviously has a much more strength how did they accomplish that um well they they will tell you that it's the nano cluster that there's these really evenly spaced clusters of filler those nanoparticles inside of a microfill and it's because of that really even sort of non-clustering of the filler that that's how you get that really high polishability and because it's so nano filled you're going to get all the strength as well so I feel like that's a win-win a the shade matching has become much easier even for my team they've come to know you know before I even get in the room which shades I'm probably going to use and 95% of the time they're dead on and then b it's not chipping the same way that the composite I was using previously was. And so that becomes a no-brainer as a clinician. And you use a separate adhesive for this from a different brand before you put this. Yeah, tell us about that. I use Bisco. I've used Bisco for years. I use the Allbond 3 or the Allbond Universal sort of depending. And mostly for my anterior, I'm going to use the Albon 3. And for my posterior, I'm going to use the Albon Universal. It's been my go-to. I'm super happy with it. I don't find a lot of post-operative sensitivity, period. Historically didn't. I'm not getting any post -operative sensitivity using the Echosit. How is this used on molars? I mean, for molars, I feel like the, you know, I was happy I was using Filtec in the posterior. and i feel like i'm using echo sit in the posterior mostly because i have one system and it just works really well so you know i was happy with philtek i personally love the workability in my hands of echo sight you know marginally above the philtek it's a little less sticky and it It kind of flows in a little bit easier, but still has that workability where you can create the anatomy. So for me, it's almost in the posterior, it was more of an ease of use. I have one system, I have one box, and all of the composite that we need is going to come from there. So that was as important for me as the other attributes that it has. So you mentioned also that your staff really likes the material. Now, that's a kind of interesting point. I usually don't hear that when I do these podcasts. Most of the time they're talking about what they like, but it's important that the staff is comfortable with the material. So tell us about that. And you mentioned the shades. So it can be pretty busy. And the girls that I have have been here for a long time. And we have one person who's new. So it's wonderful to be able, like, I rely on them. So if they can get everything out and they're familiar with it and it's just, you know, so simple, they can pull the colors for me. can pull some of the alternate colors. They can try on the colors. If they can get everything laid out for me, it's less work for me when I get into the room, less work for them because they don't have to try and guess and pull out five different tubs of composite to see what's going to work for this particular case. And so it just makes it a much more seamless experience, both for the staff and for me, and then ultimately for the patient as well. And what about the delivery system of this composite? yeah no i love it because it has both it has the um it has it in the gun which i mostly will use for the posterior um and then it has it in the the car peels the other thing that is nice is it doesn't tend to dry out like a lot of the you know a lot of the other composites i have if the top isn't all the way on which happens when you're busy and you're cleaning up and moving on it dries out you almost have to throw away like that top you know four millimeters of of composite which adds up economically as we all know i haven't been noticing that with the echo set at all so far it's been great um so it's just a lot of those little details that create a better work experience and make it more and more of you know our go-to and we started slow and we started small with it you know and then we got you know more and more and then it just it's almost interesting how it literally just kind of evolves and you're like oh we haven't used what we used to use in two months and so and then you realize like i don't you know i think i don't need to use that i haven't thrown it away But we haven't used it in several months at this point. So it's sort of the slow evolution of our go-to for all of those little reasons that create a better work experience. Yeah, and those little reasons are really important for workflow. There's no question about it because dentists have so many things to do clinically and there are stressors throughout the day. You certainly don't want to be frustrated with... having the material dry out because the cap's been off for a minute and a half. And I don't know how other dentists feel about this, but when you are doing an anterior composite and the staff is so familiar, the girls, I say the girls, my assistants are so familiar with the color. wheel that they can pull out the exact colors instead of pulling out the bin and having me kind of go through them or pulling out the paper that has them all like that's amazing to me and i'm so proud of them they take more ownership it's it's you know it's a great benefit so i find it really interesting you mentioned that you kind of transition to this new material you keep the old material around but then you find yourself using the new material quite often if not for every patient. And then eventually you can realize you're not going to reorder the old material, but you keep it around just in case you see some indication that it might not be as great as you were hoping it would be. Exactly. Yes. I'm hoping that's a universal dental thing. We keep, I still have, you know, I still have so much. vintage dental things in this office yeah you can eventually you'll donate it to a dental museum and all your old materials yeah and eventually echo sit will be part of a dental museum everything i mean new materials keep coming out but i know this dmg material is getting good reviews and i'm glad we got to talk about it and uh thank you very much for your input dr winter and we'll have you on future podcasts soon thank you so much all right thanks phil i appreciate it If you're enjoying this 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.