This episode aims to shine light NOT on the matrix itself, but the adhesive philosophy followed by those that use Bioclear matrices.

Everything you wanted to know about the Bioclear system (but never asked!)

As we continue to celebrate Adhesive Month (now spilling over into March!), we’re thrilled to bring you insights into the principles of cavity preparation and adhesion a la Bioclear.

In this first part of our series, we’ll uncover the ‘unconventional’ yet highly effective techniques employed by practitioners like Dr. David Carroll and his colleague, Diana McKenna. One of the key highlights we’ll explore is the Bioclear approach, which challenges traditional norms by utilizing a single large increment, diverging from the conventional use of small increments.

https://youtu.be/mn_FRhSIGCk
Watch PDP178 on Youtube

Protrusive Dental Pearl: If there’s a disagreement between you and your principal or associate about practice philosophies, arrange a face-to-face meeting. Work together to find common ground and reach a win-win solution that benefits both parties and aligns with the practice’s goals. Effective communication is key, whether it’s with our patients or our colleagues.

Need to Read it? Check out the Full Episode Transcript below!

Highlights of this episode:
0:00 Introduction
7:22 Journey into Bioclear
15:30 Bioclear Philosophy
19:19 Posterior Bioclear Matrices and Wedges
20:58 Clinical Protocol for PosteriorInjection Molding
25:08 Alternative Cleaning Methods
26:38 Advantages of Bioblaster Over Aluminum Oxide
28:14 Addressing Concerns about Shrinkage Stress
31:15 Technique for Deep Restorations
32:44 The Hip
33:29 Bonding Protocol
37:31 Posterior Composite Selection
39:56 Bulk Fill Composite Application
41:05 Posterior Overmolding and Tidying Up
43:33 Evolution of Dental Education and Bioclear
46:33 Stress-Reduced Direct Composite and Finding a Repeatable System
50:53 Outro

Struggling with rubber dam placement? Check out my Quick and Slick Rubber Dam series! It includes a one-hour walkthrough for isolating quadrants AND 30+ clinical videos showing procedures in full detail (POV). Access it on Ultimate Education Plan via Protrusive Guidance

If you loved this episode, make sure to check out PDP177 – Fast Modelling Composite Technique.

Click below for full episode transcript:
Jaz's Introduction: So you might have come across the BioClear matrices. They've been kind of taken dentistry by storm over the last few years. I was first exposed to them maybe about, gosh, nine, ten years ago. And this mad scientist type figure came on the scene, Dr. David Clark. And I just loved his quirkiness, his humour and just the way his brain worked.

Jaz’s Introduction:
Now, fast forward some years, I used their anterior matrices for black triangle closure. I had some good success. And as an associate, I never got to purchase the posterior matrices, although I did do a hands on workshop and I was quite impressed. But today, this episode is not about any matrix system. It’s not a sponsored episode.

It is just to shine a light on some really important principles that we can learn from the bioclear philosophy. We’re just about still in adhesive month, it’s February, so we’re focusing on adhesive dentistry and maybe part two will fall into early March. Now in this part one we focus on posterior. What are the principles of cavity preparation and the BioClear approach?

I mean how do they do it with just one big increment, very different to the small increments that we’re used to using. In fact they’re very similar themes to the last episode we discussed with Dr. Ahmed Tadfi on the fast modeling composite technique. And so there are a few crossovers. So we’re really spoiling you this month with these really cool episodes about posterior bread and butter at adhesive dentistry, and it was great to host a Protruserati Dr. David Carroll and his colleague, Diana McKenna. Look, David has been a Protruserati for over a year. I used to love seeing his very kind comments on YouTube, and then he joined Protrusive Guidance and we’ve been DMing each other, just a great guy and I love his cases on social media. And it’s a privilege to host him as a BioClear instructor on our episode.

I’m gonna give you a little spoiler for later in the episode. Dr. David Caroll is very lucky, you see. He’s good at what he does, but sometimes with the rubber dam, he says, you know what, I’m not fussed for the rubber dam. So he’ll walk out and then Diana will do his complete isolation on the rubber dam for him.

We all need a Diana in our lives. Now if you are someone who aspires to do your own rubber dam isolation, I’m just kidding with you David obviously, but seriously if you’re struggling with rubber dam, check out my quick and slick rubber dam series. It’s got a one hour complete walkthrough of how I isolate quadrants and then 30 plus clinical videos for anterior and posterior uncut, like the entire two minute, five minute, seven minute sequence of how I isolate these quadrants through my OxoCam point of view film.

It’s like a point of view that you see through my loops, and that’s included in the Ultimate Education Plan of protrusive. The website for that is protrusive.App and the platform is called Protrusive Guidance.

Hello Protruserati. I’m Jaz Gulati and welcome back. It’s your favorite dental podcast. I’m actually super excited tomorrow I’m flying to Chicago for the AES, American Equilibration Society for most favorite things, occlusion, TMD, and of course I’ll be there for the midwinter as well. Obviously, by time this comes out, this message would’ve not reached you, so I’m hoping I’ll be able to meet some of the Protruserati in Chicago.

Protrusive Dental Pearl
The Protrusive Dental Pearl I have for you for this episode is a non-clinical one. You see, one of the Protruserati reached out to me and asked if I would anonymously post on Protrusive Guidance. Now, the whole Anon posting on Facebook is a bit too much, but I’m hoping to breed a culture in Protrusive Guidance whereby we can share our failures and challenges and not having to feel like we go Anon.

However, there are some sensitive issues that we discuss sometimes that I feel is the reason why Anonymous was actually designed in the first place. So I was happy to do this particular Anon post. It was about a Protruserati having some friction as an associate with their principal. And I don’t want to delve too many details away.

I don’t want to give any identities away. But sometimes, I mean, the lesson here is sometimes we don’t fully see eye to eye with our principal. Now, whether the issue is about how much annual leave you get or how the rota system is working for your nurses or DAs, it could be so many things that you have some sort of a friction over.

But the Protrusive Pearl here is dialogue. Always, always, always be willing to engage in dialogue. I think there’s so much behind the scenes where people are grumbling and they’re getting upset and they’re exchanging emails and Whatsapps and voice notes and stuff maybe. But what we really need is face to face dialogue.

There’s a magic and beauty of face to face. So if you’re in a situation where you’re not really seeing eye to eye with your principal, I would. And if you’re a principal, if you think your associates really not following the philosophies of your practice, you both need to arrange a face to face meeting and try to seek a win win.

There is always a win win. If you can’t find a win win, you’re not searching hard enough. So I’m hoping just by this gentle reminder of the importance of dialogue and face to face interaction that may help some relationships between principals and associates out there. Thank you so much and let’s join the main episode.

Main Episode:
Dr. David Carroll and Diana McKenna, thank you so much for joining us on today’s podcast on BioClear. How are you guys?

[David]
We’re doing great, Jaz.

[Diana]
Good, excited.

[Jaz]
It’s so nice to have you and for those who are listening on Spotify and Apple, there’s a giant fish behind you guys. All right. So this obviously is a reflective of David. Can I call you David?

[David]
Absolutely.

[Jaz]
David’s passion for fishing, which I recently discovered as you joined Protrusive Guidance and then I read your bio, second generation dentist, prosthodontist. And I just have to say, when I see people like you. People I look at like, wow, this guy’s a specialist and I see your cases, stuff like, how did he end up in the, the Protrusiveverse?

It is absolutely so humbling to find clinicians like you, who I just admire and you’re so brilliant, to come and just listen and learn and be open to hearing new ideas. And I’ve been seeing, you’ve been commenting on the YouTube channel for the last six months. You’ve been so supportive.

You’ve been sending lovely things on Instagram to our team. Just thank you so much. It really does a lot for our enthusiasm, our confidence as a small, but mighty team producing content. So thanks for supporting young dentists. I just really want to just get that out of my system now.

[David]
Well, Jaz, I think your educational channel that you’ve built is so awesome and so needed in dentistry. And when I started in dentistry, the only way that we could really learn is we had to go to meetings. We would have to travel. We would have to book airplane tickets and hotel and everything. It was really expensive to learn from clinicians that were much further ahead than we were. And we all wanted to go hear our mentors and the people that we looked up to and the people that we knew were much further ahead than we were.

And it was just so taxing. You had to take time out of the practice. My dad, I’m a second generation dentist. So my dad and I would travel together and we would go to these meetings and see these things. And but today thanks to your platform and the content that you’re bringing is so valuable.

And I really think that it’s a, just a great service. So I’m learning from you and I’m learning a lot from you. I need, there’s no doubt in my mind way more about occlusion and TMJ than I do. No doubt. I’m totally iron billet ball.

[Jaz]
You’re very sweet.

[David]
And I’m going to take your, I’ll absolutely going to take your every course that you put out, but I love all the people that you interview and here we’re on this side of the Atlantic, so I’m not so familiar with some of your mentors over there, so I’m learning the talented people over on that side. I mean, we have one person in common that one of my mentors is Tif Qureshi, all right, and totally he’s one of my biggest mentors. But other than Tif, I wasn’t too familiar with all the names and people that you’ve interviewed. So I’m learning from you guys all the time.

[Jaz]
Well, what I love doing is bringing Protruserati on the show, right? People who just embody the values of Protrusive, which is the nicest and geekiest. And I just, I definitely see that in you. I want to learn a bit more about Diana as well and how you guys work together. Before we delve into that about BioClear stuff, that’s going to come later. But I always like to spend just a couple minutes to explore an individual’s journey. So in the context of everything you do or the smile makeovers, I see that you post on Instagram David.

How did you get into the BioClear? How did you get into this pathway? And maybe a little bit before then, why prosthodontist is this something that maybe your dad inspired you? Or how did you fall into this?

[David]
So, my dad and I were both doing a lot of ceramic rehabs. And so, I became a prosthodontist because I knew my dad was doing a lot of that type of work. And so, I wanted to come in knowing a little bit more than average, and I didn’t want to become just a clone of my father. I wanted to become my own individual. And I also didn’t, at the time I took prosth training, there was no implant training in undergrad level, and we didn’t even touch an implant as a dental student.

So the grad prosth program had, everyone was touching all the implants. So I went up there to learn implant dentistry. So when I came in with my dad, we were doing a lot of ceramic rehabs, and one day my dad says, Meena, he says, you got to figure out something to do with these lower anterior teeth, because when they’re a little crowded and things don’t work out well, he says, the ceramics is really not a good modality.

He says, it’s just, it’s not right. He says, so why don’t you learn to straighten out the teeth? So I went in and started going into ortho and I started, that’s how I found Tif. Tif was in the United States teaching a course over here and I learned from him and then I started doing Inman Aligner, which you may be familiar with, right?

And I started straightening teeth. And then, of course, we started to end up cases with black triangles, right? And we get them straight, but now they’ve got black triangles. So I started researching black triangle and I come across David Clark. I see him in Orlando. I watch him do a case live in front of like 70 dentists and nothing is working right as you can imagine, Jaz, he’s going to go live and do a clinical case, right?

And we’re in a hotel. He’s got a crappy little compressor that’s not generating enough power. The suction system is not right. Everything is off. Right. And and at the same time he’s speaking and lecturing and I’m thinking this guy is crazy. There’s something not right. And at the end, he actually got a very respectable clinical result in that circumstance.

And I was just like, wow, I was blown away. And without cutting the teeth, everything turned out pretty good. And I said, this is a game changer and you don’t see a lot of game changers in dentistry. I’ve been out of prosth for 30 years, and it’s something comes along like implants, that’s a game changer.

Clear aligner ortho, that’s a game changer. BioClear is a game changer, and you just don’t get a lot of those. So when they come along when you’re a young dentist, you see something like that, you need to jump on it. Full steam ahead. Don’t think about it. Just go and learn and try. And that’s what I did.

So I started taking trips out to Seattle, which is a long way from Miami. I started taking trips out there and learning and learning and and just back again, like Abdul Rahman. I know you have, I’ve saw him on one of your programs, same thing. Once you go out there, you realize, all right, there’s a lot of nuances to the technique.

There’s a lot of technique to it, a lot of little things. It’s not necessarily hard, but it’s very detailed. So I kept going and learning and learning and the method has evolved a lot since, since I started. The matrices are much better. The system’s much more refined. So it’s gotten better and better.

[Jaz]
It definitely has a luxury feel to it. And I’ve been using BioClear myself. Haven’t done so for a little while now, but I previously, I’ve still got the kind of older generation, new generations with the color tab and the gauge, very sophisticated, very clever. And I’m sure we’ll talk about that actually.

But what I like about what you said there is how under difficult circumstances, Dr. David Clark was able to produce a respectful result. And that’s what we need because when you have any technique, If it’s overly technique sensitive, and if it’s overly difficult to use, how can the average dentist, average hands, reproduce it?

And a lot of the listeners and watchers here are international. They’re in Bangladesh, they’re in Philippines, they’re in countries where perhaps they don’t have access to even the best light cures. I know there’s a research in India showing how poor quality light curing can be. And so in those tough scenarios, how can we help clinicians all over the world to get good results?

And that’s what it’s about. In fact, in England, other than I feel familiar with soccer or football, there’s a saying, can they do it on a cold Tuesday night in Stoke? So yes, this team is really good, but can they do it in these kinds of scenarios, basically? And that’s what it always reminds me of. So we’ll definitely unpack that. Diana McKenna, please tell us about how you have been working alongside David into sort of his programs.

[Diana]
Well, I started working for Dr. David about eight years ago. And I was pretty much assisting him. And I think he has started with this journey about 8 to 10 years. And it has been really great because we have seen how from the beginning, how the results were not the most amazing. Like we saw some like ledges here and there.

[Jaz]
I love how brutally honest you are. This is good. We need to hear it. This this is why I got you on today because I saw that you guys are about this. This is really good to hear.

[Diana]
It’s a, no, it’s because it’s very difficult, not very difficult, but people can, or dentists cannot think that they’re going to master this technique from the first case.

[Jaz]
Especially if they’re learning from Facebook or something, right? Because the temptation sometimes is to see some photo in a magazine. Or someone’s using BioClear, and then you go to your reputable supplier, you buy it, and then you start just making up and winging it. That’s not when you get the best results, I think, and I’m sure you’re going to cover that as well.

It’s a bit like when you read the papers, the scientific journals, and then you’re trying to extrapolate the data from the journals. But if you’re using the different materials that were used in the journal in a different way, and if you’re etching for the wrong number of seconds compared to what they did in that journal to get that result, you can’t expect to get the same result.

And I learned that as myself, actually, various tools, products, techniques, philosophies. And when I tried to wing it, it was some good results and some hiccups. But when I went on a course to actually learn, just like David said, the nuances, and then you come away with a, a real enlightened moment. So I think that’s exactly what you’re saying as well.

[Diana]
Yes, that’s correct. Like, you need one, you need experience. You need to keep trying. Because BioClear is a technique that, one, you need to go to the courses. Like, we have an intro course that we teach once a month, and it’s a great point to like, okay, the dentists can see, they can see the basics of the technique, but if they want to do more or they want to learn more, ideally they should go to the different learning centers.

And also practice. I think it’s a technique that you have to keep practicing. Because it’s a learning curve that you learn from your mistakes. You learn from what you’re doing. Like we have been learning. I don’t know, at the beginning we had problems with the light cure. So we learned that we needed a light cure that was stronger. So it’s a process, but it’s kind of fun. I think it has been a really fun journey for us.

[Jaz]
It looks very rewarding, and I mean, all of the cases that you post, and not only just black triangle closures, but all sorts of resin cases, and I think what we owe it now is what this episode is about is, I don’t want this episode to be about like, this is not like a sponsored episode about a product.

What I’d like to really tune into is the science and philosophy. Right? Because there are some, let’s say, some naysayers who think, hmm, but how could this work if that’s the case? And we need to address those concerns, but also we need to understand, okay, what are the philosophies? What are the quick wins that you can share?

So that when someone does after going on the course, for example, come on to their first case, what are the little things to remember to that you can actually improve? The success of that dentist. So the first question I’m going to start with is, can you just describe what actually is the method and and how I know there’s the anterior BioClear, there’s also posterior matrices. Can you just briefly describe what this entails?

[David]
Yeah. So BioClear is basically a form of injection molding dentistry. And basically you’re using anatomic matrices and anatomic forms to either surround part of the tooth. Or potentially surround the whole tooth and inside those forms, which are anatomic to wherever you’re at.

So if you’re on a distal of a central, there’s a matrices for that. If you’re doing class twos, there’s a matrices for that. And basically then you’re surrounding either a portion of that tooth. Or the whole tooth. So if it’s an anterior tooth, we might say it’s a 180 or it’s a 360. You either wrapped half of the tooth or you wrap the whole tooth.

And that’s a big designation between conventional bonding, let’s say traditional bonding and BioClear. So we say in BioClear, it doesn’t go in the tooth. It goes around the tooth or on the tooth and that’s changes. Then the sort of the dynamics of how you work with the material and trying to get away from the disadvantages of composite and turn them into advantages for us.

[Jaz]
Well just about that actually, I asked Dr Abdul Rahman as well actually, but I want to hear from you and your perspective and those who perhaps haven’t heard that because that one was more visual and did actually make it to the Spotify listeners so it’d be good to cover it now, is you say 180, 360 and I like that way of thinking, is there a scope?

Maybe there isn’t, I don’t think there is, but is there a scope to do 90 degrees? What I mean by that is, if you’re trying to close a diastema, can you do just the distal portion? Or do you really need to cover facially as well with the technique? What, when, how do you get the best results? Are there any disadvantages of doing just one side only or one proximal surface only?

[David]
Yeah, so you can definitely do the diastema closure by just doing half a tooth and half a tooth. However, over time, composite is going to change color different than the tooth. The tooth is going to change color also. And then the composite is going to change color. So the patient has to understand that that’s going to need to be replaced.

More often than if you were to cover the whole tooth, depending on their habits, whether they’re drink a lot of coffee, a lot of red wine, a lot of dark tea. That’s what we talked to them about and we have not been able to predict which patient is going to color shift more than some other patients.

Some patients we bring them back five, six, seven years later, there’s no change at all. We just see the material looks exactly the same. Other people, the color does migrate. So that’s something that’s one of in the list of advantages and disadvantages between ceramic and composite. We cover that with the patient. So that the patient understands when they’re choosing composite and choosing BioClear, that is one of the potential disadvantages, is that long term color stability.

[Jaz]
But really, by wrapping onto the labial and veneering the entire surface, you are helping to mitigate that risk, right? Because if you’ve got a nice smooth veneer layer and no transition mid facial between the composite and the tooth, I can now see why, when I have seen, Marco Maiolino, Abdul Rahman, yourself post these cases quite often going in the labial.

Initially I used to think, hmm, because you might have seen a video I made recently actually about my preference for after orthodontics. Respecting that beautiful enamel, but sometimes when you have got black triangles and you’re trying to close diastema using the via clear way, I understand why just a thin bit of composite to create that uniformity in the color.

It makes sense to me. If I was to shift my focus now to posteriors, and for those who aren’t familiar, these are these, you know, very beautifully curved anatomical matrices posteriorly that you can put in, you’ve got these, the diamond wedges of via clear are the best. I use them for when I’m doing a non via clear case. These are just. Fantastic wedges. Can you just say in your own words what makes the BioClear diamond wedges unique and special?

[David]
Well, the wedges are like the matrices, they’re anatomic, so you can select the wedge. There’s even one for the furcation and the molars, so that you can select a wedge with the furcation and either use that side or use the other side.

The other thing is that if you’re going to use anatomic matrices in the posterior, your wedge has to be very low profile. Because if the wedge comes up too high, now it’s starting to distort that matrices. And that’s one thing you always have to keep in mind with BioClear is that you’re not trying to do anything that will distort that matrices. Because it’s anatomic the way it is, but if you use something that crushes it or bends it, or inverts it, then you’re going to end up with not such a nice result.

[Jaz]
I mean, the superpower is the shape, isn’t it? The power is in the shape that it gives you. And just like you said, if you wedge too aggressively, you create a convexity into the matrix, and which would actually show up as a concavity in the restoration, right?

And that’s not going to be hygienic and stuff. So, but the wedges, when I’ve got a deep case, and most wedges in that scenario would actually not be able to get down low enough. The diamond wedge has been brilliant. So I just wanted to give that point for those who aren’t familiar, even just with the wedges, they’re absolutely fantastic, beautifully designed.

When you’re using the protocol for posterior, let’s say you’ve got the matrix in place. Let’s say you’ve got the wedge in there. Let’s say you’ve got the ring in there. And you’re happy that you’re going to get a nice profile. Can you just describe the clinical protocol in terms of the whole etching, bonding, curing? Just so we can understand what a typical injection molding looks like posteriorly. And then based on that, I want to just ask a few more questions on just technique, just geeky stuff.

[David]
Okay. Yeah. We love all that. We love all the geeky stuff, right? We can geek out all day. No problem there. Yeah. So the first thing is when you have to think when you are going to bioblast the tooth or clean that tooth.

And when does that come in? So my preference is to bioblast after I prep. So I will very commonly clean up the tooth first. And take the old restorative material out. I will do my anatomic changes to the shape of the prep because commonly we’re cutting out amalgam and the amalgam has parallel walls and a GV black design and composite should not go into that same shape.

Okay. That’s one of the key things engineering wise that Dr. Clark has taught us all is that composite bonding is not going to make up for bad engineering. You have to re-engineer that tooth. Okay. And we’ll talk about how you have to flare it out. You have to actually sacrifice some enamel so that you can get this tooth more into compression.

Okay. If you just stick composite into a GV black prep, it’s going to function like white amalgam. You’re not going to get cuspal splinting. You’re not going to get the benefits of the composite and you’re working against the material. Okay. You’re working against it. So we take the old material out, refine the shape.

Now we’re going to bioblast or clean the area. So I use the bioblaster from BioClear. Abdul Rahman is using a different device. And I’m not sure what Marco is using, but everyone is cleaning something with something like that. All right.

[Jaz]
So I remember just, I didn’t know the bioblaster existed firstly. So thanks for sharing. I didn’t know existed as a product. So that’s good to know. I remember David Plunk just proving a really good point. And then you would probably imagine as well that no matter how much he scaled the tooth, no matter how much pumice, et cetera, he used, there was always, when he disclosed, there was always plaque until you aerated, until you introduce air particle abrasion.

It was dirty. And that’s what causes the staining. That’s what causes the bond failures and all the issues with it that we have in at least dentistry is not having a clean enough surface. So the bioblast, is there anything unique? is it sand and water together?

[David]
It is with water and it’s aluminum trihydroxide, which is a little bit different than aluminum oxide. Aluminum oxide is a much harder particle and a smaller particle. So, it’s more for cutting. So, when you blast the inside, the intaglio, one of your favorite words, the intaglio surface of a zirconium crown, when you hit that with aluminum oxide, that’s, you’re really going at it with a hard sand and you’re really going at it to alter the surface, right?

So, that will cut a tooth and that will cut into a tooth pretty rapidly. So, instead we’re using a softer powder, which is a larger particle size and it’s designed to clean a tooth. Kind of like a Prophy-Jet and you disclose, you disclose it so you see everywhere the plaque is and now you blast all of that off because remember with BioClear, your margin is not really your traditional margin.

So your interface, what we call the tooth restorative interface, is going to end up on uncut enamel, enamel that you never cut with a bur. And if that enamel hasn’t been cleaned, plaque free, blast off the pellicle, and all that, you’re not going to get adhesion, and it’s going to stain, and it’s going to leak. So that’s where that protocol comes in, is to that sequence of events that you have to blast, you have to blast.

[Jaz]
Beautiful. Well, before you move on from after you cleaned it and aerated and blasted it, which I’m a big fan of, the top question I get, David, the number one question I get, guys, is, A dentist will email me and say, Jaz, I don’t have an aerobrasion unit.

Can I use the Prophy-Jet? Can I use those sort of cleaning powders? Will that be adequate? And I don’t know. I feel as though for what we’re trying to achieve, like especially on dentine, I don’t think it’ll be aggressive enough on dentine is my viewpoint. To remove biofilm, maybe you’ll be good enough on enamel.

But I don’t know if you guys got any science on this or any bioclear opinion on is the the Prophy-Jet kind of stuff, does it do anything?

[David]
Have you worked with a Prophy-Jet? No, so I haven’t worked with-

[Jaz]
Polishing powder rather than a slightly more bracer powder.

[David]
Correct. So what I tell my students that from all over every month is I tell them test it, disclose a tooth, take your Prophy-Jet and go after it and see if you can blast every bit of that disclosing solution off of that tooth. If you’re successful with that, I have a feeling you’re going to probably be okay. I mean, it’s definitely going to be much better than nothing. Absolutely. Much better.

[Jaz]
But it goes back to what I said earlier, to get the best results, you’ve got to follow the recipe book. And the recipe book says bioblast or air particle abrasion, and I’m a big believer in that.

So for all those dentists out there who are not using an abrasion moment, really save up. That’s the next big investment. You can use it for all sorts of dentistry, even for your zirconia, just like you mentioned. So amazing. So now bioblasted before we put the matrix on, which makes sense because I guess If you put the matrix on, you get like a matte surface of the matrix if you were to do it with it on.

[David]
Yeah. And another point is that one of the reasons why we like the bioblaster as opposed to aluminum oxide is that when you use aluminum oxide, it’s a very, very fine particle. So you have to be careful how much of that you end up breathing and inhaling.

[Jaz]
Absolutely.

[David]
Right? So when we do the intaglio surface of zirconium, we are in a little vent, a laboratory thing, which we bought them from Danville Engineering. And they’re little, just sit in the operatory. So two of our operatories have those things. We always go inside there and do the air particle in there. Because when you do aluminum oxide, you see the particles just in your light. Your loops and your light, you see that stuff floating around you.

[Jaz]
David, that stuff is in my beard right now. Literally, I could just dust off my beard. There’d probably be aluminum oxide flying all over my microphone. I’m just being real, real, real with you here. It’s everywhere.

[David]
I thought you were just getting a little gray and aging, maybe.

[Jaz]
Yeah, it’s definitely not that. It’s definitely the aluminum oxide. Let’s say that.

[David]
Yeah, so in aluminum trihydroxide, what goes in the bioblaster, it’s a heavy, heavy particle, so it’s messy. Like we have to drape the patient because the stuff will go around and so we cover the patient up and we cover them and cover their face and everything. And when that stuff hits you, you feel it. If it bounces off and hits you, it feels like you got hit with a little rock.

[Jaz]
Oh wow.

[David]
So the good part of that is there’s some plus to that. The plus of that is that it doesn’t float. Okay, cool. It just, boom, it just sinks. So, and if you’re going to be doing a lot of this kind of dentistry, you don’t want to be breathing this stuff all the time. So, you want something that’s just going to drop and hit the floor, and then you can sweep up and clean up, and you don’t want this stuff floating around you.

[Jaz]
Very valuable insight. Brilliant. So, after the cleaning, let’s say you’ve done the matrix, and what I’m really interested in is, the whole bit about some dentists being concerned about the shrinkage stress if you’re going to do an injection molding posteriorly. That’s really the main myth I want you to bust. So can you just describe the protocol and then how the protocol lends itself to perhaps not being conforming to this myth?

[David]
Okay, well, I know that, like Diana asked me, that was one of the first things that she talked to me about when she came in with me. And we started doing BioClear. She started saying, what about the C factor? What about the C factor? Because you’re doing like these huge volumes, right? And in the beginning, I was a little worried myself because that’s what we’re taught. That’s what we learned. We should layer.

We should layer and layer because otherwise the c factor. Yeah, it’s gonna get the c factor is this monster that’s gonna get us, right? And we’re all gonna go to dental hell and so, but then what happened is, you know, what’s weird, Jaz, is that it never happened. You know, we started doing, we followed the protocol, and I don’t want to say that the c factor is meaningless, but let’s just say that it was really over blown.

Like it’s not the monster that it was made out to be. If you get the engineering, right. And you do the protocol, right, then. The C factor is largely mitigated and you don’t have to worry so much about the C factor, okay? And there’s some advantages to layering, but there’s disadvantages to layering too.

There’s disadvantages. We know when you try to layer, the layers don’t go together seamless. We can cut those, cross section those. And we see that even with the best clinicians, there’s gaps and there’s things that are not desirable about layering. Now, we have to layer sometimes on deep restorations with BioClear because, not because of C factor, but because of the light.

Because the light is only going to penetrate so far, right? And so when we look at these restorations, we’re not thinking, oh my god, there’s too much shrinkage. We’re thinking, is the light going to get there or not? And that’s the change, how you have to change how you think. It’s all about the light. So you have to have the high powered light, but then you, that high powered light on bulk Filtek is only going to go maximum five millimeters, really maximum.

Okay. So if we’re working on a bicuspid, it’s a relatively small tooth. We know we can come from buccal and lingual, we can do three point curing and we can get to that restoration. But if we’re working on a big molar. And it’s a big tooth and you have a great big guy and he’s got these big teeth. Okay, four millimeters, I’m thinking is max because I can’t come from buccal and lingual is not going to help a whole lot. That tooth is huge. So that’s where you’re thinking about it.

[Jaz]
So that’s why you’re doing the cervical portion first, getting it fully cured and then do more traditional injection molding as per the BioClear technique to resume the rest, yeah?

[David]
Correct. And since you can’t really wedge that deep one without bending the matrices, That’s where your friend Maciek came up with that floss wedge. Yes. All right. We use that a lot. Love it. Okay, because what that’ll do is it’ll tighten that matrices up just a little bit. Just a little bit. Just to keep it there for you to build that first layer.

Now you light cure that. Now you can go back and take out and do the diamond wedge. Pick your favorite diamond wedge and wedge it and the purpose of that wedge is not separation power we have a ring that will give us enough separation power. The purpose of that wedge is to anchor that matrices so that matrices does not lift up when you drop that ring on because that’s how you get in trouble which we learned I learned the hard way.

[Jaz]
Of course.

[David]
All right when that ring goes on if that matrices lifts up a little bit and is not fully seated and then you injection mold and you pressurize this system, you get something that you don’t want.

[Jaz]
Absolutely.

[David]
You get something that you’re going to have to go in there and drill it out and start over because you’re going to get what we call a blowout and we don’t like blowouts.

[Jaz]
That’s a bad, messy day at the office. I can totally imagine that. I’m trying to think. The cervical part, I see Marco, who I’m seeing in June actually in Sicily, I’m excited to go visit him, but that cervical portion, he calls it the hip. Is that bioclear terminology philosophy or is that something that he’s, he’s made up of?

[David]
Well, we used to call it the, David used to call it The Hip, and he used to compare different hips based on and he kind of got away from that because he got away from that because some people were offended by The Hip. Okay. Yeah. Well, we won’t go in. It used to be a Kardashian or or Aniston or something like that. So we got away from that. We got away from that.

[Jaz]
Well, the hips don’t lie. We know that the hips don’t lie as Shakira said. Just briefly describe the protocol. Let’s say you’ve got the Bioblaze, so the Bioblasting, got the Matrix on. Let’s say you’ve secured it. Can you just tell me exactly which bonds you’re using? Now, how many seconds you’re etching for? Are you doing a total etch or selected etch? Which bond you’re using at this in 2024? Obviously these things change. Someone’s listening in 2027. It might be different because it’s denser, it’s dynamic. But what’s your current protocol for like a standard DO using the Bioclear system?

[David]
Okay, so we’ll do a total etch. We don’t do selective etch. And we’ll do, basically, I’ll do 30 seconds on the etch, which I know is a little bit more than some people might do, but I do 30 seconds and then what makes it easy is I also do we rinse out dry, get everything cleaned up and now we’ll do 30 seconds on the bonding agent.

So we’re using scotch bond universal plus alright, so it’s a basically. It has the potential to self etch dentine, but it will really not self-etch enamel very well. I don’t know that any of them will self-etch enamel very well, which is why we do total etch technique, okay?

[Jaz]
So, are you etching the dentine as well?

[David]
Yes. Okay, fine, fine, okay.

[Jaz]
So, etch, definitely etch enamel and also dentine, got it.

[David]
Correct, correct. And now we go in with the bonding agent and one of the keys to not getting sensitivity is to not rush that step. That bonding agent, whatever you are using, you need to massage that in there and give the dentine time to really absorb that.

Okay? And the modern bonding agents, if you give them enough time and you massage it in there, we set a timer. 30 seconds. The company says 20 seconds. We go for 30. And if you massage that in there for 30 seconds, and then let that soak up, if dentine is exposed, we always light cure that coat, that first coat of adhesive.

Okay. And that is shown to have benefit to doing that. So, we will end up going with another layer of adhesive that we do not light cure. As part of the protocol. So the second layer of adhesive becomes a wetting agent. That’s our wetting agent.

[Jaz]
This is exactly the doubt I had that you’ve just completely just cleared out which I thought that okay if you’re not curing that first one because I thought the whole protocol was you don’t cure the bond and then you go straight to flowable and then the heat to composite and just make mix it all together and that’s the beauty of it but you really helped me understand that that. If you’re an enamel anteriorly that perhaps you don’t need to cure that bond you keep it uncured is that correct?

[David]
That’s correct.

[Jaz]
Okay super.

[David]
That’s correct.

[Jaz]
Going back to the posterior you’ve now cured that first layer after a generous massaging and just a little geeky point right I’ve seen these scanning electron microsoft images all these micro brushes and essentially what you have is very hairy dentine.

Okay. I imagine my dentine looks like this. Okay. Very hairy dentine. Okay. So some dentists, I know they use more like the paintbrush, like the black bristles, like a long strands. Is there a bio clear approved way of doing it?

[David]
I don’t think there’s a BioClear approved way, but what I prefer to do is I like the little sponges on the deep dentine because I feel like I can massage that better. And I know that I’m getting the adhesive on that area. Okay, so that my first coat that I’ve gone on dentine massage, massage, massage. Okay, 20, 30 seconds. We time it. Okay, air thin, air thin. Now, light cure. All right. Now, the second layer of adhesive that I will not cure that I will apply with the brush because the brush I can go around the corners.

All right, because the matrices is going around that tooth. And it’s wrapping and it’s going into areas that are uncut. So I’d like that brush to kind of tease it around, tease it around, and tease it around. Same thing when I’m doing black triangle closure in the anterior, the brushes can tease around the adhesive and make sure that adhesive is getting everywhere that you want. Then you’re gonna air thin which is going to also disperse the adhesive. But now you already got it there. You’re already good to go.

[Jaz]
Perfect. And then at that point, just finish off by saying exactly which flow we’re using and which composite system you’re using. Obviously it’s a heated composite system. Just tell us a bit more about the finalized posterior protocol so we can just understand about it a bit more.

[David]
Okay. So in the anterior system, we like to play with some different composites because I’m geeky like you. I’m super geeky. And I get bored if I’m using the same composite on everything because I want to see different cosmetic effects of different composites, okay?

But, in the posterior game, we strictly go Bulk Fill 3M. Because, I’m not trying to win any cosmetic competition on a second molar. And I think that in the back of the mouth, it’s all about function and being good contact, painless, chew on it, doesn’t break. So it’s all about the engineering.

And the restorations come out cosmetically pleasing, but we only have maybe two or three shades of bulk fill tech. Okay. And that’s just what’s worked for us in our hands using the 3M system. And we know that if we follow the protocol from BioClear, we know we do the bulk fill, then we know we have very, very low incidence of post op sensitivity.

Especially if you practice selective carries retention, which is another discussion, but you have to practice that correctly and just keep the deepest portion right before you think you’re going to hit the pole. Don’t take that out.

[Jaz]
The best liner is dentine. Even if it’s slightly carries in, that’s the best liner, isn’t it?

[David]
100%. You will avoid so many root canals if you do not go after that last portion. But remember that your CEJ, your DEJ, those junctions there where the carries tends to run along those areas there, you have to make sure that that is clean, clean, completely clean. And so you have a very good seal.

You have to seal, everything has to be sealed up tight. It only works, selective caries retention only works if you keep the bugs out and you’re letting the bugs in, you’re going to get a root canal for sure. So, yeah.

[Jaz]
I remember Dr. David Plunk referring to it as the modified haul technique, which I really liked, actually. So, for those in the UK, especially, very familiar about the haul technique and stuff. I don’t want to go into it too much, but it’s a great point you raised there. I’m not familiar, excuse my ignorance, I’m not familiar with the bulk fill is it a paste or is it all flow?

[David]
It’s a paste. So, we’re gonna go with a flow and a paste. There’s flowable and paste. So, we’re gonna go on that last layer where we didn’t cure the adhesive. Now we’re gonna bulk fill. So we do an uncured adhesive, then the flow, and then the paste. So the paste is basically gonna disperse and displace most of that flowable.

So, probably 80, 90 percent of our restoration is gonna be paste. And maybe only 10 percent is gonna end up flow. So it’s basically like taking an impression with the old polyvinyl impression that we like to do so you’re gonna be light body, heavy body you’re dispersing it you’re spreading. So, you’re filling in all the nooks and crannies and that the paste is also giving you that wrap it’s making the material travel and giving you that wrap around the tooth.

[Jaz]
The pace is like a putty. Compressing away, pushing away the light body. And I can definitely visualize that. I like that. I love those photos on social media of dentists doing posterior BioClear and they’ve just overmolding you guys call it, right? You overmold it, and then when you remove the matrix.

You just see the beautiful, strong, solid contact, right? And then obviously it’s messy, but I know having done this technique myself, that it looks really scary the first time you do it, but it’s so quick to just adjust it, right? And so a common concern someone may have who’s not familiar with the system is, whoa, this looks like really messy, but when you actually take your carbides to it, it’s very simple to tidy up. Any comments on the tidy up?

[David]
Yeah, you can’t be afraid of the bulk. You can’t be afraid. When you make mistakes with BioClear is because you under inject. When you under inject, then you get voids, then you get bubbles in areas that you’re not supposed to get them, right? You have to go full on on the system, and you have to pressurize that system, and then the magic happens.

And then you, when you have the bulk, we will go at it with coarse diamonds, and then disc. Also, even in the posterior. We’ll use the disc the soflex disc with, we take it facing towards the head of the handpiece, like not the traditional way.

[Jaz]
On the backhand, on the backhand.

[David]
Yes, exactly. And then pull. You use that disc to pull your restoration back into the proper shape, so that, so where you have the buccal and the lingual excess, use that disc and pull that restoration in and it will go quick. And another point Jaz, I like to emphasize is that let the occlusion dictate your anatomy.

Okay. In the back of the mouth on molars, all right, do not carve in detailed anatomy. Okay. You have to stop yourself. You have to stop what you were taught and don’t go for all this fancy stuff because what you’re doing is you’re really potentially weakening that restoration. You’re putting deep trenches and deep fossas in there.

And then you’re going to make it look all day. And what you’re doing, you’re taking away material, you’re taking away bulk, you’re taking away coverage over dentine, and you’re not benefiting the patient. The patient is not going to perish from lack of chewing efficiency. So let the opposing arch dictate your anatomy.

And that’s it. If you want to round the marginal ridges with the disc a little bit, you pull that disc over the marginal ridges, you’ll round them, they’ll look nice and thick and heavy, and you’re going to make a restoration that’s going to be there for a long time. That’s what you’re looking for.

Because remember, we have the reason why dental schools are going after BioClear now is because the stuff that we were taught, that I was taught, and probably that you were taught, it doesn’t work. It doesn’t work. Right? It’s not working out. Because these professors in the dental school knew that they were seeing amalgams that were 20, 25 years old, 30 years old.

They put composite in a tooth with a student trying to do the work that, the way that they’re being taught. And then there’s another student taking it back out in three years. Because it’s leaking, it’s got decay, and it’s not working. Because for too long we tried to say, okay, well, we’re going to take a GV Black Prep and we’re just going to do a little bit of this and a little bit of that.

But we’re basically gonna pretend it’s amalgam and that it didn’t work. It just didn’t work. So that’s why the dental schools is, it’s a huge leap for a dental school to try to implement any part of BioClear. It’s a huge undertasking. I mean, it’s like crazy, like they would, so David Clark and I and Diana, the three of us were just introducing it to a dental school here in Florida. And David tells me, he says, it’s easier to move heaven and earth than to move a dental school curriculum.

Yes. Absolutely. You know? So for them to want to go this, to try to implement any part of it, even if they’re not taking the whole package, if they’re just going to try to take something like class twos, it’s a massive undertaking.

Huge step. Huge, huge step. And they’re motivated because they see that the stuff that we were largely taught in school. It didn’t work out. You have to recreate a different system. Is there a composite resin has nothing to do with gold or amalgam? And if GV black were alive today, he would say what are you doing?

Why were you put that composite in my prep? Well, he was smart a super smart guy and he would say that come that composite does not go in parallel walls. Okay, stop with the mechanical retention get over that you know, you have to change the mind, it’s so much easier to teach it to students because they don’t know anything. They don’t have to unlearn.

[Jaz]
The mind hasn’t been perverted. By the all the things that we see and get exposed to. I’ve just got a reflection and a praise because everything you’re saying is going back to engineering, right? The whole thing about not putting in delicate fissures. I think it goes back to the underpinning philosophy of engineering, which is great.

And I’m a big believer in young dentists students messages me saying. Jaz, I’m a little bit confused because I’m doing all these beautiful composites, but as soon as I take the rubber dam off, I have to then spend ages adjusting it, and it ends up looking flat. And then the clue is, well, if the patient’s 62 years old, and you’re gonna give them what the textbook says is a six year old’s tooth, right, it’s not gonna work, right?

Because the opposing tooth, you’ve got to look at it. And so I love that you underpinned that philosophy as well. It’s got to be age appropriate. It’s got to conform, not only to what the textbook says, it’s got to conform to the opposing tooth. And the rest is dentition in that mount. So totally agreed.

And then my last question, therefore, on the basis of engineering is this whole concept of the stress reduced direct composite, which the biometic folk are talking about the use of rib bond and fibers and that kind of stuff. Does that have a place in the biocare philosophy? Have you guys experimented with it? And then once you answer this and you give your views on this, we’ll then pivot towards

[David]
Yeah. So we have not experimented with rebond and those kinds of things and fiber reinforcing and stuff like that. I mean, to be honest, Jaz, we haven’t had a motivation to try to go that route. So, class twos are such an underappreciated restoration.

Both for dentists, like we are, it’s stressful, doing good class twos is stressful, right? And we are undercompensated, terribly undercompensated for something that is challenging to do. So once we found, and I did not go to BioClear to learn class twos at all. I didn’t even know that that was part of their protocol.

I went to learn black triangles. I had no idea. That I was going to be restructuring how I work but once you develop the protocol and you develop the system and everything like that, you will routinely, routinely, routinely just nail class twos one after the other, after the other, after the other, after the other, and there will be the one that kicks your butt. Okay. Because that’s just how life is. There’s going to be the one that’s.

[Jaz]
Extractions happens with everything, you know.

[David]
Everything, everything. There’s going to be the one that gets away from you and you’re going to sit there and you’re going to say, well, okay, but I know the system works. So something, it’s something me, I’m the problem.

And you know what? There’s a joy in that almost. Because before you don’t know if it’s the system, is it the material? Is it my matrices? Is it the, I’m using the wrong stuff? You don’t know what the problem is now you have a system that works in your hands and you routinely bum bum bum bum you one after the other one up and that lowers your stress level and practice. And you feel happier, like oh my god. Look here comes another one not that I love doing class twos because honestly Jaz I don’t.

I mean, I’m going to be honest. I don’t love, I don’t love doing class 2s. I don’t love chasing, right? Okay. But if I get a good result and I get another one, I sometimes I’m very proud of that. You take a post op x ray and you see a nice, nice result. And you say, wow, that was tough.

That was challenging. And look, we nailed it. We nailed it. So because of that, it’s the recipe is there. I don’t want to go off on some tangent trying to introduce something new that I don’t know. And I don’t have the science that I’m going to get any benefit from this. So that’s why we haven’t experimented with the protocol, you know?

[Jaz] I appreciate that and it just good to know what you guys are doing at the moment in your training centers. I love everything you said in terms of having a system that works in your hands. I feel as though when you’re a new grad and you are finding your feet and you haven’t even discover in yourself ’cause you haven’t had enough experience, what works and what doesn’t.

You’re in this constant battle in your mind, like, wait, should I do this now? You’re constantly doubting yourself. So the sooner you find a system, it could be any system. It could be the bioclear way. It could be another way. I think just try out some systems, see what works, makes the most sense in the sense of science in your mind, apply that.

And then once you find a system that’s repeatable, predictable like me personally, I love just being in the zone, I’ve got some music on, I’ve got the rubber dam on, I’m doing my class twos, I’m in a happy place because I’ve got my protocols, I’m looking for that clean surface, I’m using my air abrasion, my beard is getting stuffed, I’m happy in that place and there’s a beauty in finding and actually fighting to find the system that works in your hands, in your practice, for your patients to best serve wherever your patients are in the world.

So with that reflection, If it’s okay with you guys, shall we now just switch the conversation a little bit about anteriors? So let’s talk about anteriors. David, I don’t want to offend my American guests, okay? You, the U. S. is now, the second biggest group of British society is U. S. Okay, used to be Australia and then the U.

So overtook them. So I’m always indebted to the listenership from the States, especially them students. So great to have you, anyone who’s listening right now to this. But it’s very, I have to be, I’m actually laughing saying this, it’s very un American of you to be opting to do these beautiful composites and not doing ceramic and crowns on the anterior teeth.

Jaz’s Outro:
Well, there we have it, guys. Thank you so much for listening all the way to the end. I’ve hopefully whet your appetite for the anterior segment of this episode that we’ll cover next week. Now, as you know, I’ve been recently giving you the CPD questions, and I give you one as a teaser, but I’m actually really late because I need to go to work, and also I’ve got the flight tomorrow, and I’ve got some family time to catch up with, so just to let you know, there is 45 minutes of CPD available from protrusive.app, aka Protrusive Guidance.

I just want to thank David and Diana again, but again, they’ll be back next week to finish off the part two, which we focus more on anteriors, how do you bond to root dentine? Like, if you’re closing black triangles, you’re going to be on root dentine, right?

So that’s one of the themes that we cover. As ever, I want to thank my team, Erika, Gian, Krissel, and Mari were involved in this one. And if there’s one action you take by the end of this episode, if you’re enjoying the last episode and this episode, and you enjoy it, at the month. Please could you share it with a friend? I’d really appreciate if you could spread the word of protrusive. Thanks so much for listening all the way to the end once again. I’ll catch you same time, same place next week. Bye for now.