The marketing material states that the matrices in the porcelain kit are ultra-thin. When I asked my CRD rep to order the porcelain kit she told me the only difference between the porcelain kit and the other kits is the inclusion of porcelain etch and silane. Is this true or are the matrices in the porcelain kit different from the matrices in the other composite kits?
- Stephen
DR. CLARK'S RESPONSE:
No the porcelain kit also has a roll of ultra-thin mylar that is 5 mil versus 20 mil which means it's only about 19 microns instead of 75 microns thick. That is an addition to regular thickness Bioclear Matrices that are also in anterior and posterior kits. It also has some neat opaquers.
Welcome to the blog
Thursday, July 9, 2009
Is this true or are the matrices in the porcelain kit different from the matrices in the other composite kits?
Thursday, June 25, 2009
Do Dental Composites Always Shrink Toward the Light?
David,
Watched your video of restoring a biscuspid, very interesting system. Did you bulk cure the restoration, and if so did you use the curing light on each side in an attempt to pull the material outward towards the light to compensate for shrinkage? I believe studies have shown that composite does not shrink towards the light, it shrinks towards the strongest bond in the prep boundaries also influenced by the C factor.
Do Dental Composites Always Shrink Toward the Light?: J Dent Res 77(66) June 1998
David
DR. CLARK'S RESPONSE:
Dear David
You are correct, we do not have any evidence that the composite shrinks toward the light. There is, however, some consensus that the composite that cures first has the first foothold and that it may have an advantage. Because the gingival margin is always the weak link, It doesn't hurt to do all that we can to help it. C factor, the amount of enamel rods and the angle of engagement (saucer versus GV Black walls) are probably more important to determine which margin experiences the most "suck back".
The C factor of the Clark Class II is so low that we can fill in one increment. I am currently doing an article on these topics at the request of 3M which I will send the final draft of if you promise NOT TO DISSEMINATE until it publishes. My 2 hour lecture on the topic will be available shortly on dentaledu.tv (Just taped it this weekend). It gives a very thorough discussion of C-factor and other topics that you have interest in. I am so happy that you have such a good feel for these issues, not too many dentists take the time. Good for you.
Warm regards,
David
David,
Thanks for the response. I do like playing devil's advocate on stuff like this. I didn't watch all of the videos so I don't know what you do with say an MOD. The case shown is saucer but in restorations that extend well into the central fossa areas it might be a higher C factor. Also when you create the flare for the saucer the ends of polymerization are farther apart so potentially more shrinkage between ends. I remember someone years ago was putting composite over flow and curing together. I cure the flow first so it gets a maximum foothold before the filled resin.
I promise not to share any of the article with anyone until published and would be glad to read it and give you my feedback. There is a huge need for the average general dentist to improve direct composites and I'm glad dentists like you are thinking about it and making it better.
David
DR. CLARK'S RESPONSE:
For all medium, large, and amalgam retreatment cases I suggest rebuilding the occlusal separately, then prepping the interproximal and restoring each saucer independently so the C factor remains favorable. As far as a larger size impacting shrinkage, everything that we have seen shows that a feather edge on a flattened restoration (assuming enamel margins) will not have any problems. My theory is that a feather edge over a flat surface area encourages the composite to dissipate the stress and shrinkage by simply shrinking toward the tooth instead of toward the center of the composite mass and since there are no opposing walls in the prep, the tooth is too strong to accept any stress,
So in the end, no white lines no micro fracturing,
Think about placing a large thin composite on the facial of an upper incisor to cover decalcification or stain. The margins look perfect year after year.
Dentin is another story.
Cheers
Watched your video of restoring a biscuspid, very interesting system. Did you bulk cure the restoration, and if so did you use the curing light on each side in an attempt to pull the material outward towards the light to compensate for shrinkage? I believe studies have shown that composite does not shrink towards the light, it shrinks towards the strongest bond in the prep boundaries also influenced by the C factor.
Do Dental Composites Always Shrink Toward the Light?: J Dent Res 77(66) June 1998
David
DR. CLARK'S RESPONSE:
Dear David
You are correct, we do not have any evidence that the composite shrinks toward the light. There is, however, some consensus that the composite that cures first has the first foothold and that it may have an advantage. Because the gingival margin is always the weak link, It doesn't hurt to do all that we can to help it. C factor, the amount of enamel rods and the angle of engagement (saucer versus GV Black walls) are probably more important to determine which margin experiences the most "suck back".
The C factor of the Clark Class II is so low that we can fill in one increment. I am currently doing an article on these topics at the request of 3M which I will send the final draft of if you promise NOT TO DISSEMINATE until it publishes. My 2 hour lecture on the topic will be available shortly on dentaledu.tv (Just taped it this weekend). It gives a very thorough discussion of C-factor and other topics that you have interest in. I am so happy that you have such a good feel for these issues, not too many dentists take the time. Good for you.
Warm regards,
David
David,
Thanks for the response. I do like playing devil's advocate on stuff like this. I didn't watch all of the videos so I don't know what you do with say an MOD. The case shown is saucer but in restorations that extend well into the central fossa areas it might be a higher C factor. Also when you create the flare for the saucer the ends of polymerization are farther apart so potentially more shrinkage between ends. I remember someone years ago was putting composite over flow and curing together. I cure the flow first so it gets a maximum foothold before the filled resin.
I promise not to share any of the article with anyone until published and would be glad to read it and give you my feedback. There is a huge need for the average general dentist to improve direct composites and I'm glad dentists like you are thinking about it and making it better.
David
DR. CLARK'S RESPONSE:
For all medium, large, and amalgam retreatment cases I suggest rebuilding the occlusal separately, then prepping the interproximal and restoring each saucer independently so the C factor remains favorable. As far as a larger size impacting shrinkage, everything that we have seen shows that a feather edge on a flattened restoration (assuming enamel margins) will not have any problems. My theory is that a feather edge over a flat surface area encourages the composite to dissipate the stress and shrinkage by simply shrinking toward the tooth instead of toward the center of the composite mass and since there are no opposing walls in the prep, the tooth is too strong to accept any stress,
So in the end, no white lines no micro fracturing,
Think about placing a large thin composite on the facial of an upper incisor to cover decalcification or stain. The margins look perfect year after year.
Dentin is another story.
Cheers
Is the Bioclear light a pulse light?
Hello,
Is the bioclear light a pulse light. I don't want it getting too hot is the reason I ask. I couldn't find any info on it to say one way or another and I know that 5 sec LED lights can heat up without the pulse.
Thank you.
Ryan
DR. CLARK'S RESPONSE:
Dear Ryan,
You have a very good question.
While I did research and lecturing for CRA I learned an awful lot about curing lights.
Warm regards,
David
Is the bioclear light a pulse light. I don't want it getting too hot is the reason I ask. I couldn't find any info on it to say one way or another and I know that 5 sec LED lights can heat up without the pulse.
Thank you.
Ryan
DR. CLARK'S RESPONSE:
Dear Ryan,
You have a very good question.
While I did research and lecturing for CRA I learned an awful lot about curing lights.
- Pulsed and ramped curing have never been shown to have any clinical significance in their attempt to reduce stress of curing.
- There is stress from asymmetrical curing, that's why the bioclear method encourages simultaneous curing from buccal and lingual with 2 lights.
- The Bioclear /Vector light does not get hot at the tip after 5 seconds. HOWEVER all rapid cure lights have a tremendous photon transfer to the tooth, that's why hey cure so fast. All of these rapid cure lights can create heat in the tooth because so many photons are hitting the tooth at once. The recommendation that we gave at the CRA lectures was to begin to air cool or air suction after 3 or 4 seconds to keep the tooth cool We have several thousand doctors who are doing the Bioclear method and post operative sensitivity is very low. If we were heating the pulp xcessively, we would be seeing problems, and we are not.
Warm regards,
David
Tuesday, June 2, 2009
How do I get the resin in and pack it if the matrix is over the buccal and lingual aspects of the prep?
I have had quite good results so far from my trial anterior and diastema closure kits. One problem I have experienced is that once in place, the matrix blocks off the access for resin placement. I have bent it out of the way, but this sometimes runs the risk of disturbing the soft tissue /gingival seal or distorts the matrix. Any advice as to how to get the resin in and pack it if the matrix is over the buccal and lingual aspects of the prep?
Dr. Lisa Chong
3006 Bloor St. West
Toronto, ON M8X 1C2
DR. CLARK'S RESPONSE:
If you are having access problems you can:
I use all of the above, depending on the case.
Hope that helps,
David
Dr. Lisa Chong
3006 Bloor St. West
Toronto, ON M8X 1C2
DR. CLARK'S RESPONSE:
If you are having access problems you can:
- Place the paste composite indirectly by syringing it on the facial and or palatal, and then "patty cake" it into the interproximal with a flat composite instrument (I like our Bioclear/Hartzell titanium coated B6-7T "Composite Placing Instrument") and then you can bend the matrix less. I am doing that technique more and more. Place a small dollop of flowable first to eliminate voids. The flowable canula is small enough that you should be able to insert it directly under the teased matrix without excessive distortion of the matrix. The larger paste syringe creates a lot more matrix movement.
- Cut back a small area of the flange that is blocking your access.
- Have the assistant tease the matrix away with an explorer while you are placing material
- Change mirror position
- Use the Universal 10 mm matrices (Flat Universal 10 or Curved Universal 10). These are more "open matrices" with good cervical shapes.
I use all of the above, depending on the case.
Hope that helps,
David
Friday, May 22, 2009
Which materials (matrix and interproximator) would be suitable for an in-the-mouth repair?
Hi, Dr Clark,
I have been, for some time, what I consider to be a practitioner and advocate of MID but your article raised my consciousness about aspects of our contemporary approach. The use of microscopes over loupes is inarguably an advantage. But the paradigm shift of class 2 preparation design is most thought provoking. I plan to begin using the Bioclear matrices with the interproximators.
I saw a patient today who had a 1mm diastema between the upper first and second molars.This was produced by a relatively small mesial marginal ridge fracture of the porcelain on a porcelain-fused to-metal crown on the second molar. I was interested in attempting an in-the-mouth repair using your system. Which materials (matrix and interproximator) would be suitable for this type of repair? Is there a description of the technique on the Bioclear website? Do you think these repairs are durable?
Thanks for your help.
Joseph Ritz, DMD
Wayne, PA
DR. CLARK'S RESPONSE:
Dear Joseph,
I have repaired several of these marginal ridge fractures and most have done well. (Including one on my wife!). The website or your DVD have a step by step in the "yellow" or porcelain section.
http://www.bioclearmatrix.com/Articles.asp?ID=170
Remember that many of these fractures may have been precipitated by marginal ridges that were either just too tall or were too "sharp" and were unsupported with a bit of a point contact. This stems from an under-contoured emergence profile in some cases, or a poor contact on the adjacent tooth that probably could have been smoothed or contoured at the time the crown was done. Make sure and address those to increase your chance of success.
Let me know how it goes and take some pictures if you can. Call technical support also with any questions.
Cheers,
David
I have been, for some time, what I consider to be a practitioner and advocate of MID but your article raised my consciousness about aspects of our contemporary approach. The use of microscopes over loupes is inarguably an advantage. But the paradigm shift of class 2 preparation design is most thought provoking. I plan to begin using the Bioclear matrices with the interproximators.
I saw a patient today who had a 1mm diastema between the upper first and second molars.This was produced by a relatively small mesial marginal ridge fracture of the porcelain on a porcelain-fused to-metal crown on the second molar. I was interested in attempting an in-the-mouth repair using your system. Which materials (matrix and interproximator) would be suitable for this type of repair? Is there a description of the technique on the Bioclear website? Do you think these repairs are durable?
Thanks for your help.
Joseph Ritz, DMD
Wayne, PA
DR. CLARK'S RESPONSE:
Dear Joseph,
I have repaired several of these marginal ridge fractures and most have done well. (Including one on my wife!). The website or your DVD have a step by step in the "yellow" or porcelain section.
http://www.bioclearmatrix.com/Articles.asp?ID=170
Remember that many of these fractures may have been precipitated by marginal ridges that were either just too tall or were too "sharp" and were unsupported with a bit of a point contact. This stems from an under-contoured emergence profile in some cases, or a poor contact on the adjacent tooth that probably could have been smoothed or contoured at the time the crown was done. Make sure and address those to increase your chance of success.
Let me know how it goes and take some pictures if you can. Call technical support also with any questions.
Cheers,
David
Tuesday, March 17, 2009
Can you comment on the use of the interproximator and finishing tips that are quick and effective?
Hi David,
As you know, I am writing an article that features some of the concepts the Opinion Leaders conveyed upon.
I have attached an anterior case. It does not use an interproximator, and I am still not rockin’ w/the rock star finish, but I think it is good.
I tried to outline the infinity margin – can you elaborate on it so we are on the same page.
Can you comment on the use of the interproximator and finishing tips that are quick and effective? I still can’t seem to use the rubber points to my advantage.
Best,
Jeffrey
Dr. Jeffrey M. Rosenberg
413 Bainbridge St
Philadelphia, PA 19147
DR. CLARK'S RESPONSE:
The outline is nicely displayed and looks just right. Remember that caries resistance is augmented by the distance that we create between the cavosurface and the dentin or the DEJ. You also have ten times the enamel rods and they are all cut at an oblique angle, so this should be a bulletproof restoration.
Polishing sequence
The DVD or the web shows the polish if you want to take another peek
Be patient, polishing and sculpting are a very finesse art form that very few clinicians ever master when it comes to resins or porcelain. It remains a challenge to all of us.
Cheers,
David
As you know, I am writing an article that features some of the concepts the Opinion Leaders conveyed upon.
I have attached an anterior case. It does not use an interproximator, and I am still not rockin’ w/the rock star finish, but I think it is good.
I tried to outline the infinity margin – can you elaborate on it so we are on the same page.
Can you comment on the use of the interproximator and finishing tips that are quick and effective? I still can’t seem to use the rubber points to my advantage.
Best,
Jeffrey
Dr. Jeffrey M. Rosenberg
413 Bainbridge St
Philadelphia, PA 19147
DR. CLARK'S RESPONSE:
The outline is nicely displayed and looks just right. Remember that caries resistance is augmented by the distance that we create between the cavosurface and the dentin or the DEJ. You also have ten times the enamel rods and they are all cut at an oblique angle, so this should be a bulletproof restoration.
Polishing sequence
- Carbide or diamond to remove gross excess. (if I get it just right I try to skip this step) Try not to touch any enamel.
- Brownie at right angles, wet and at medium speed, preferably in an electric handpiece
- Medium grit 3M disc,typically inverted
- Coarse pumice, the world's best pre-polisher. Evaluate the matt finish of the composite at high magnification which contrasts nicely from the shiny enamel. Back up and touch up as needed use the special Hartzell handle with a 12 blade as needed in both traditional and back action to clear the margins of flash.
- Finish with the SS White polisher. Deeper interprox areas can be reached with fine and extra fine 3M discs, usually inverted on the manual.
The DVD or the web shows the polish if you want to take another peek
Be patient, polishing and sculpting are a very finesse art form that very few clinicians ever master when it comes to resins or porcelain. It remains a challenge to all of us.
Cheers,
David
Sunday, March 15, 2009
Has any one tried modifiying the matrix by trimming off some of the facial plastic
Hello, Dr. Clark. Our office has ordered our first kit of Bioclear matrices. We look forward to trying them. We also enjoyed the step by step article in Dentistry Today magazine.
Has any one tried modifiying the matrix by trimming off some of the facial plastic above where the new contact will be? It seems like it would provide better access for adhesive and flowable. We usually close diastemata by building the fillings either directly against each other and do the Mopper Pop or use teflon tape. So not having the buccal portion of the matrix towards the incisal edge might not be a bad idea.
Please let me know if this has been tried and doesn't work so I can save some time. Thank you for your time.
Blair VanNostrand D.M.D
DR. CLARK'S RESPONSE:
Hello Dr. VanNostrand,
Try it both ways, and if you can take some photographs I promise to use them in my lectures. I encourage everyone to trim the matrices as needed. I am still experimenting myself. Having a closed off matrix is a brand new concept and has advantages and disadvantages. Watch the DVD and you might decide not to trim it back. If you are layering, I would trim it as you have suggested. Either way let me know!
Cheers,
Has any one tried modifiying the matrix by trimming off some of the facial plastic above where the new contact will be? It seems like it would provide better access for adhesive and flowable. We usually close diastemata by building the fillings either directly against each other and do the Mopper Pop or use teflon tape. So not having the buccal portion of the matrix towards the incisal edge might not be a bad idea.
Please let me know if this has been tried and doesn't work so I can save some time. Thank you for your time.
Blair VanNostrand D.M.D
DR. CLARK'S RESPONSE:
Hello Dr. VanNostrand,
Try it both ways, and if you can take some photographs I promise to use them in my lectures. I encourage everyone to trim the matrices as needed. I am still experimenting myself. Having a closed off matrix is a brand new concept and has advantages and disadvantages. Watch the DVD and you might decide not to trim it back. If you are layering, I would trim it as you have suggested. Either way let me know!
Cheers,
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