Universal Flowables: Transforming Aesthetic and Restorative Dentistry

Well, I think what you're seeing now is now we've gone from the packable side of composites to the universals. Now you're going to start seeing it move way more to the universal flowable side of things. So same type of simplification, for instance, with the Majesty ES Flow Universal, what they have is they're down to two shades. I mean, so they've got it to a point now where they're using proper technology and light emission and those type of things that they can simplify this down to a two-shade system that covers basically the whole gamut. Welcome to the Phil Klein Dental Podcast. If you think about the countless products and services we rely on to get through a single day, it's truly mind-boggling. Many of these innovations didn't exist until recently, and some weren't even imaginable 50 years ago. Dentistry is no exception to this rapid evolution. In fact, it's changing at an incredible pace, making it challenging for many clinicians to keep up. Today we're focusing on dental composites. From the early days of adaptic and concise, we've made remarkable strides, but the potential for improvement seems limitless. These advancements not only deliver better clinical outcomes, but also enable more conservative dentistry and ease of use. Modern restorative composites are easier to handle, come in fewer shades, and flow beautifully to perfection. Joining us today is Dr. Troy Schmedding, who will share insights on the latest in dental composites and how he leverages these materials to achieve outstanding restorative and aesthetic results. Dr. Schmedding is an assistant professor in the Department of Reconstructive Dental Sciences and co-course director for integrated preclinical technique at UOP Dentistry. He practices in Walnut Creek, California and enjoys lecturing nationally and internationally to fellow colleagues on restorative anesthetic dentistry. Dr. Schmedding, it's a pleasure to have you on the show. Well, it's always a pleasure to be here. Thanks for having me. 30 years now or in that range of experience that you have doing restorative anesthetic dentistry. There's certainly a lot you've learned over the years, and it's great that you take the time to share it with our audience. So to get this episode going, there's a lot of composites out there to choose from. And it's important to find one for the practice that everybody enjoys using that not only performs well clinically, but also offers the clinician ease of use, handling characteristics that you like, shelf life, and so forth, and cost, actually. So you have a pretty busy practice out there in California. How did you go about selecting your go-to composite where you got everybody on board? And what has it done for you as a clinician, your staff, and also your clinical cases? Yeah, I mean, I think if we talk about composites, it's an interesting topic because it sure changed so dramatically. And dramatically for the better, I should say. I remember, I think coming out, my first composite kit I bought was like 64 shades or some crazy thing, right? And if you go back further, I remember the single shade composites, basically adaptic and concise. That's all we had. And those could be generally used, you know, a little bit throughout the mouth, so to speak. They kind of carried it to the anterior a little bit, but they were really never very good in the anterior, right? Posterior, yeah, they had some durability. They got a little stained, a little broken down over time. And I think it's just an evolution of materials that we're starting to see because for me. The nanohybrids, I guess we're calling them now, is really a new interesting category. And I think everyone should be in a nanohybrid at this point. And I really truly believe there are great anterior to posterior restorations. I do a fair amount of anterior composite work. And I can tell you, I can use the same material from the front to the back like I never have before. I used to rely a lot on microfills and those beautiful lysine on the cake composites. And don't get me wrong, they're still a great thing to have in your practice. But I find myself going to them less and less. And the reason being is because I can truly get a great shine out of these materials now. The formulations of these materials is what's really changed in how we're utilizing, whether it be, you know, depending on your company, of course, it's zirconia based or silica based or whatever it may be. But ultimately, they've come into utilizing some nano clustering or this ability to create more of a spherical formulation within these materials. And what that means to you and I generally is a couple of things. For one, it's going to require a lot better handling. The handling on the newer composites. are so much better. And the reason you can tell that is because most of you probably still have dental instruments that you use from dental school from about 30 years ago. And you notice they're not sticking quite as bad as they used to with the older composites. So a greater new avenue in handling. And the reason is that spherical formulation. But the other thing you'll find now is how about shade simplification, right? I mean, now a shade system is generally five shades for the most part. Most companies come out with five shades. Obviously, we have the single shade, the tokyamos and those things that came along. But ultimately, yeah, the inventory has gone way down, which obviously for you and I and everyone else out there that's practicing, it's a huge bonus, right, in terms of inventory. You're not having to throw away tons and tons of composite. You can order small amounts of composite. So that's a big one. Now, how do you choose a composite? You know, you ask someone why they like their composite and the number one reason by every dentist is I like how it handles, right? So I can't argue that. You're the one placing it. You're the one playing with it. But what I would recommend is that you look at a quality manufacturer. I mean, there's some really good materials out there and I'm not sure there's a true leader in the best composites out there because I think they're all pretty good and I've played with a lot of them on the market. Some I don't like quite as well and generally it comes down to a handling. And the second thing for me is the polish. I got to have a system that polishes relatively easy. And the great thing about the newer composites today are that you can polish these in two steps now. Used to be three-step polishing systems in the older days. Now these newer step ones, you can do a nice polish in a good quick two steps. What do you use for polishing? I'm a big Meissinger guy. So I use a lot of the Meissinger products. And what I like about theirs is they have the little twisties, the little... I don't even know. I think they're called twisties, but they're kind of that little funny shape type thing that really, really works well. But they also have points and the other things that you need to adequately get into the grooves and just create really nice seals. But yeah, I mean, I think the composite today is a kind of a vast array of materials. I do think the nano hybrids are where to be for sure. They provide strength and they provide beauty for the first time in a composite. I can truly say that. And so, yeah, I mean, I don't really have a true go-to. I mean, I use a Karari obviously a lot. I'm a Karari guy because of what I have in relationship to years of experience. But I can't say there's a go-to and I think there's a lot of great ones out there to be, which is great. And I do want to point out to our listeners, Dr. Schmedding, the point that you made on a previous episode that you prefer, if possible, to use all the materials. regarding a direct restorative from the same company. Of course, if the R&D is solid and you trust the company and you love the materials, it rules out the risk of incompatibilities. Of course, it allows you to go back to the manufacturer for technical support, where you can tell them that you've basically employed their adhesive, their etch, their composite restorative all together, and maybe you're having an issue. So it does simplify things and take the variables out. But having said that, there are, of course, many options when it comes to composite. So let me ask you this. Do you recommend that a dentist try the composite first, obviously, through samples that companies give out? Is that how you were you an evaluator for this particular example where it's clear for majesty? Yes, is what you like, right? what is the yeah so i yeah i think that's a great point i think always sample something before you buy it and they're more than happy to give you samples But yeah, I think that's a great way to test it and try it and see what you like in relationship to, like I said, most of the times it's handling, right? So most of the times it's handling in regards to how you works well in your hands. But yeah, I think that's a great, a great clinical point for sure. Reach out to your reps or whoever's in your area and get some samples of these different materials. How much does your staff play in composite restorative work? Do you do everything yourself or do you? have delegate out some stuff to your staff where you actually want their opinion on certain products as well um you know when it comes to composite and stuff i'm probably pretty selfish to be honest with you hands-on fully hands because i am the one dealing with that right from an inventory side i think they appreciate where we're at now in relationship to ordering and how simplified that is but yeah i mean It's a great point you bring up. Getting your staff involved in anything you can do in your office is a big thing. I mean, you want buy-in and you want that, especially in today's technology world. I mean, because your staff is really carrying you in relationship to a lot of the printing and the milling and the scanning and the things that we're doing in the office today. So material-wise, I'm probably a little bit overbearing in the sense that I probably do a lot of my own discussions and figure out what I'm using. So you've transitioned from using Clear Fill Majesty ES Flow to the new universal version of that. Clear Fill Majesty ES Flow Universal. What's the difference between those two versions of that composite and what has it done for you clinically? Well, I think what you're seeing now is now we've gone from the packable side of composites to the universals. Now you're going to start seeing it move way more to the universal flowable side of things. So same type of simplification, for instance, with the Majesty ES Flow Universal, what they have is they're down to two shades. I mean, so they've got it to a point now where they're using proper technology and light emission and those type of things that they can simplify this down to a two shade system that covers basically the whole gamut. And in combination with that, they're also upping the physical properties of these materials. So for instance, with the ES flow universal, you've got the ability to use this in the posterior. You could take this up fully into occlusion. I probably wouldn't do it in the largest restoration you've ever done, but I would certainly bring it into a very moderately low load bearing type situation, feel very comfortable to bring this up into occlusal contact. It's got enough viscosity to it that allows you to build ridges and some proper contours. It's not runny. not sloughing. So it's kind of a new evolution on how you like or how you may or may not like to place flowable composites because flowable composites really, at the end of the day, are the easiest of all of our composites to place. I mean, I think we'd all feel pretty simple with that, meaning you can simply take a syringe, place it in there, move it around with a little bit of Explorer, whatever you need. And it's pretty easy, right? The packing side of it's okay, but packing does what to it? It causes voids. It creates a lot of different things that we as technicians put into our own. whereas flowables are pretty easy to apply. And then, like I said, with the viscosity and the materials that you're dealing with, there is a wide range of viscosities out there. The ES Flow Universal is certainly gravitating towards more of the low flow types things. So it doesn't have the flowability. It gives you more manipulation with it. But that's kind of the evolution I'm seeing with the flowables is they're now starting to see more of a universal approach. So with Clear Film Majesty ES Flow Universal, you're still using a flowable, with even less viscosity, like a baseline or down in the box or areas where you want to ensure adaptation, correct? Yeah, I do put a base liner down there in terms of a flowable. So I usually will always cover up my bonding agent with about a half a millimeter of flowable. Just kind of my technique. I mean, a lot of people probably do it. I've done a lot of research on it and it really helps with kind of the fortifying the hybrid layer, giving a little bit more of a maturation to that hybrid layer. It gives you a little better longevity and I'm hoping less secondary decay or leakage or anything that's going on there. So I do do that. Yeah. be honest with you i'll probably use the majesty es flow the original right and it's just got a little bit more viscosity to it a little bit more wettability so to speak so it covers it up a little bit better for me and then from there i can take the es flow universal and go directly over the top of that and and no more than a one millimeter increment for me i generally go about one millimeter of increments of flowable versus two is with a packable um that's just my own personal preference but generally that's the way i will tackle that problem and if I feel comfortable. I'll bring it all the way up into occlusion without any hesitation at all, just because of the physical property of this material, or I'll cap it depending on the situation. Yeah. What do you cap it with if you need to? I'll do a conventional nano hybrid like the Majesty ES Classic or the Premium line. That's the original composite restorative that they probably had years ago. Yeah. What's the super low flow? I mean, it's funny how they use these superlatives. You know, they have flow, then they have low flow, then they have super low flow. I don't know who makes these names up, but the super low flow is kind of a viscous material, even though it has the word flow in it. It doesn't really flow that much, does it? It doesn't. It stays in place. And so I think the benefit of that is for people that are utilizing it for core buildups or different things like that, where it's not runny, it'll hold its place. Even for even doing even. like modifying a marginal ridge or adding to a transverse ridge or whatever it may be in a direct restorative, it does allow you the ability to stack. So everything just doesn't flatten out. So it does give you some stackability, which is important depending on what you're trying to create. So maybe it's not for you, maybe it is, but ultimately it's another viscosity that's out there that can do different things for you. So how do you avoid, Dr. Schmedding, voids in air bubble formation when using a flowable resin composite? Yeah, that's a great... That's a great question because flowables can be a real nuisance. They seem really easy to place, but you can certainly cause bubbles. So one of the biggest things, the simplest thing you can do is just use tip submersion, meaning do not take your tip out of that material. So meaning coming in and out with your tip into the material certainly adds to the flowability, or excuse me, the ability to create bubbles and whatnot. The ES Flow Universal actually has a tip that they've created that goes with the system that helps to minimize the amount of bubbles. that may be incorporated in packaging. So quality manufacturers are important on that side of things too, because some of the lesser grade, I would say flowables actually have a packing issue where they are actually packed with a lot of bubbles in them. And so when you're dispensing, you're just directly bringing those bubbles into the solution. So quality reputable companies important from that. And then on a technique side, like I said, I can't. emphasize enough how important it is to keep that tip submerged, use a little bit of a, you know, a perioprobe or a explorer to manipulate that material. But less manipulation is better with any dental material, in my opinion. So when it comes to our restorative cases, not every case is clear cut. Sometimes we are in that gray area where we can go either with a full crown or with a direct restorative composite. So what is your guideline for making that decision, number one? And number two, when you do make the decision, what does the conversation with the patient look like? Yeah. So I think, you know, prior, prior restorative care on the tooth, how many restorations has had, how big are we getting in terms of inner cuspal, that type of thing still kind of falls back to some early diagnostic type stuff for sure. And then the overall wear and tear of that particular patient. I mean, how aggressive are they? How hard are they on their teeth? And yes, financials does come apart. We all agree and I'll deal with that on a daily basis. We would love if every patient was wealthy enough to crown everything in their mouth. But from a diagnostic standpoint, it still comes down to two structure remaining. Do I feel comfortable? doing bigger restorations than I did? Yeah. You know, an amalgam was a fine material for its time, but certainly it didn't give you much in terms of increasing strength to the tooth structure. And so I think you get that, but you know, you got to weigh the pros and the cons because like we talked about, I think earlier, maybe that was offline that we talked a little bit about, you know, being minimally invasive and how dangerous that can be relying on retention or making things break or whatnot. So yeah, you still need to make sound decisions based off of what you see visually and then have upfront conversations with your patients and allow them to obviously make the final choice, but be educated enough to get to a good decision-making point. So what was your main reason not to mill chairside in your practice? Now, I know you're using an intraoral scanner, but you decided not to go with chairside milling, one visit dentistry. Yeah. Yeah. So we use internal scanner. We just, you know, I think milling is great. I think it's there. I think it's a great opportunity for any dentist that wants to get into that game. But I think it's just kind of comes down to a different flow of your office as well. Are you willing to take the time to? educate staff, get staff involved to do the milling, the printing, that type of stuff, whatever you may be doing. But I think it's there. I think it really is a personal choice. Do you want to do more lab work on your side? Do you want to change the structure of your office? How do you view it happening? Fortunately for us, I think technologically, we've got an opportunity to have great materials and indirect restoratives being created in the office on a day-to-day basis. I just haven't chose that. Maybe I will down the road, but for me right now, I think it's just kind of become a situation where I like my lab relationship. I like how we work together. Those type of things, yeah. So in retrospect, when chairside milling became the rage, a lot of the you know, the big sales pitch was one day dentistry. You can market this as the patient walks out the door with their final crown. You're not seeing patients like leaving your practice to go two miles away to another dentist because they can get their crown on one visit. What's your thoughts on that? You know, it's funny you said that because that was a big pitch back in the day and I don't hear it nearly as much as I used to. Have I had patients go to another office because of that? Yeah. And you know, I think that was probably 10, 15, 12 years ago, somewhere around that timeframe. Right. Recently, I don't hear that. I haven't had that conversation with a patient, whether that best be they're not seeing in the marketing side of things, the patients, or however that works. But yeah, that's a funny question because you're right. It was a big deal at the time. It was. Yeah, it's interesting because I interviewed a dentist not too long ago on the show who has a chairside setup, chairside milling setup, and he uses it and he likes to create these restorations in one visit and deliver it to the patient. But he said more than half the time, he sends it out to the lab anyway. So he has more of a hybrid approach. But I think the big sales pitch was obviously a marketing thing where dentists were telling their patients, you come one visit and you got your crown. He told me that it's not a big deal with his patients, whether they get it that day or not, because either way, they're walking out with a beautiful provisional. It gives them an opportunity to try that prosthesis out before they get the final delivery, which does have some value there. But regarding your impression taking, I assume you're a big fan of, the intraoral scanner. Yeah, I couldn't live without my intraoral scanner now. I think it's, patients really do like that. That is a big thing with them. The goop days, not many enjoy the goop as much. So yeah, you know, that's kind of the great thing about dentistry we're in right now. Technologically, I mean, there's so many avenues you can go down as a dentist and be the dentist you want to be because lab work's not for everybody. Some people soak it up and love it, but I don't think there's a right or wrong to any of this. Because it's an investment, and if you don't want to do it, don't do it. Because you've got to jump in all the way if you're going to jump in, in my personal opinion. I've seen a lot of guys and talked to a lot of guys that spent a lot of money on technology, and they end up kicking themselves for doing it. But I think technology, I think it's fun. I think that's a really drives dentistry today in terms of creativity and giving you an option to love dentistry more and more because thank God we're not back in just the days of, you know, amalgam fillings and gold crown. I think the vast majority of us enjoy that. It's kind of an entrepreneur type thing too. You can kind of build and do it the way you want to do it. And I think it's awesome. Yeah, that's a very good point. What about CBCT, Dr. Schmedding? Do you see that as something more than just an oral surgeon implant or an endodontist has? I mean, are we looking at GPs using CBCT 3D imaging for diagnostic protocol so they can actually see things that were just not available with 2D imaging? Yeah, we have one in our office and I'll tell you. Game changer. Yeah, and a game changer in just a lot of different ways, kind of being the quarterback a little bit, right? Get you in that quarterback mode where you're making a lot of decisions for patients in terms of where you're putting them, where you're sending them, or whatever you're doing in your office. But the wealth of information from a CBCT is just mind-blowing. It's, you know, and slightly dangerous because you need to be careful that you're not missing stuff that you're getting off of these CBCTs. But from a diagnostic standpoint, I think it's kind of the wave of the future. And I can't imagine, I mean, doing implants. I can't imagine placing implants without CBCTs. I can't imagine doing endo without a CBCT. So there's a lot of things that have really... I mean, I don't even do endo anymore because I have a CBCT, but there's just so much involved and so much I'm missing, and it's just out of my game anymore. But implants, we place some implants here, and we use that for our planning, and I just can't imagine going without something of that category. And once again, falling back into another technology thing that is just outstanding for us and the patients. Yeah, I mean, I was talking to another dentist about the most imperative technologies that a general dentist should consider. integrating into their practice and for the longest time it was the intraoral scanner but now it's it's cbct is is creeping up as one of those technologies you're going to really look at the mouth and the head neck and everything else cbct is a lot of information there it does require some additional training And there are courses that you can take. You know, even if you're a little bit older, to employ these technologies makes sense because if you're exiting, you have something really to sell. You have a whole up-to-date, state -of-the-art operation where someone comes in who's 30 looking to buy your practice. They're like, wow, this doctor has all the machinery and everything set up and there's workflow. So otherwise, it's hard to sell a practice, right, when you have no technology in there. That's just the way we're going today. So with a few minutes that we have left, Dr. Schmedding, any recommendations you could make to our audience that would help them with their practice, marketing, using restorative materials, staying attuned and up to date to new changes in the profession, and also how to see some of the things you're posting on social media, because I know you're doing that with some of your cases. Yeah, no, I think with that said, I think it's important that we all communicate like... know, one of the things we talk about social media, what a pain in the butt can be and all that kind of fun stuff. But on a dental side of things, I really enjoy social media. I think it's a great avenue for us to reach out and help one another. So, you know, feel free to reach out. If anyone wants to look at me on Instagram, Troy Schmetting DDS, pretty simple to find. But I think it's important to have communication with people. Ask what people are doing. How is their success levels? Because if you're having struggles with adhesive-based or composite-based dentistry, you need to get some help because there's a lot of good products out there and you may just be going. down the wrong road, whether it be material-wise or technique-wise. So seek out CE. Look for some CE. Lots of good ones out there. Lots of people teaching some great things. I'm not heavy on calling a local rep and asking what the products to use because they're generally pretty biased and they don't know exactly any other product than their own. But yeah, I would ask for samples. I would ask for handling things. and see how they handle for you and work for you. Early in my career was, yeah, I was a single practice and I was by myself and I didn't know what was going on. I didn't communicate with many people. But in today's world of communication platforms, there's no reason not to get involved, ask questions. Yeah, there's some nastiness on social medias and all that kind of stuff that happens. But there's a lot of good people out there too and a lot of things that can be... pot words of wisdom and teach different techniques and that kind of stuff. So lots of opportunities, get your nose out there, get involved, take CE and enjoy dentistry. And another important thing to remind our audience, and I think it's often understated is the importance of occlusion. You've been saying that for a long time. If a dentist doesn't really understand occlusion, it's really kind of crazy to go in there and start restoring the mouth. You've mentioned this many times before. Occlusion is going to win. I think I said that. I don't know when I said that to you, but occlusion wins every time. I don't care what material you have. They really do. It's going to win eventually. So, yeah, I mean, there's basics of dentistry that we still can't overlook. Yeah, we see great like social media. We see great smile designs and all these wonderful, beautiful makeovers. And, you know, but really at the end of the day, there's still some basic nuts that you have to have in dentistry. And occlusion really is where it starts for a restorative dentist. Yeah. So tell us your handle again on social media so people can get a hold of you. I'm on Instagram and it's just Troy Schmetting DDS. So feel free to follow, reach out. Love to chat with you, whatever it may be. But like I said, communication is important. Yep. Thanks again, Dr. Schmedding, for all the insight. Great discussion and we'll talk to you soon. Great. Thanks. And always good seeing you.