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Adhesive Protocols for Direct and Indirect Restorations · The Dental Edge

• 0:01
  SPEAKER_00: Welcome to the Dental Edge, where clinical precision meets a cutting-edge approach to dentistry.
• 0:06
  SPEAKER_00: In each episode, we bring you conversations with the best and brightest minds in the profession, diving deep into the latest clinical innovations and the intersection of technology in your practice.
• 0:17
  SPEAKER_00: Learn from some of the brightest minds in the field as they share invaluable insights to help you elevate your clinical skills and stay ahead in the ever-evolving world of dentistry.
• 0:28
  SPEAKER_00: If you're a tech-savvy dentist ready to sharpen your edge, you're in the right place.
• 0:34
  SPEAKER_02: When you look at an x-ray of a broken arm, the fracture is right there on screen.
• 0:38
  SPEAKER_02: It's binary.
• 0:39
  SPEAKER_02: The doctor just points to that jagged white line and says, Okay, there it is.
• 0:43
  SPEAKER_02: Let's cast it.
• 0:44
  SPEAKER_01: Right?
• 0:44
  SPEAKER_01: It's obvious to most.
• 0:45
  SPEAKER_02: But then you step into the world of restorative dentistry, and suddenly that psychologically engineered approach goes completely out the window.
• 0:53
  SPEAKER_01: Oh, definitely.
• 0:54
  SPEAKER_01: Dentistry can at times feel and be more abstract than what lies in maps of X-rays and scanners.
• 0:59
  SPEAKER_02: That's because you're trying to rebuild a tooth in a wet environment.
• 1:02
  SPEAKER_02: On a moving patient at that, using microscopic chemical reactions, it all gets murky really fast.
• 1:08
  SPEAKER_01: Yes, and it can feel daunting to even the most seasoned dental professionals.
• 1:14
  SPEAKER_01: The stakes are super high during restorations because if those chemical reactions fail, the whole restoration fails.
• 1:21
  SPEAKER_01: The figurative glue just stops holding and all your hard work is undone.
• 1:25
  SPEAKER_02: This is why today's deep dive is dedicated to clearing up those murky areas for you.
• 1:29
  SPEAKER_02: Guiding you through uncertainties, we're tearing into a masterclass on predictable adhesive protocols for direct and indirect restorations.
• 1:36
  SPEAKER_02: A major thank you to the sponsors of today's episode, Bisco.
• 1:40
  SPEAKER_02: The amazing teams and products from Bisco are always innovating the field of dentistry.
• 1:45
  SPEAKER_02: It's always interesting learning how products and technique enhancements can lead to better outcomes for ourselves as dental professionals and the patients we treat.
• 1:53
  SPEAKER_01: Yes, and we're so fortunate to be able to unpack these restorative dentistry game changers.
• 1:59
  SPEAKER_01: The goal here is to give you absolute clinical confidence while your patients are in the chair.
• 2:04
  SPEAKER_01: You never just crossing your fingers and hoping a crown stays put will showcase some key success strategies highlighted in today's age of restorative dentistry.
• 2:14
  SPEAKER_01: As always, today's learning group has been brought together by the partners of dental learning.
• 2:20
  SPEAKER_01: To check out today's original topics of discussion, head over to www.dentallearning.net.
• 2:27
  SPEAKER_02: Right, and success with confidence through proven means.
• 2:30
  SPEAKER_02: We're pulling our discussions today from a clinical presentation by Dr.
• 2:33
  SPEAKER_02: Devin McClintock.
• 2:35
  SPEAKER_02: As a DDS from the University at Buffalo School of Dental Medicine and a fellow of the Academy of General Dentistry, Dr.
• 2:41
  SPEAKER_02: McClintock's passions and shared knowledge are something to really be appreciated.
• 2:45
  SPEAKER_01: Indeed, she did a two-year cosmetic residency with the AACD under Dr.
• 2:50
  SPEAKER_01: Adamo Nutter Antonio, and she's a COI center graduate on the AACD Board of Directors.
• 2:56
  SPEAKER_01: And get this, she bought her own practice, Precision Dentistry of Williamsburg, the same year she had her first child.
• 3:04
  SPEAKER_02: Which is just wild to think about.
• 3:06
  SPEAKER_02: Starting your own practice while simultaneously learning to be a parent.
• 3:10
  SPEAKER_02: She's a really fascinating individual with a lot of drive.
• 3:13
  SPEAKER_02: It gives way into her approaches with dental restorations.
• 3:16
  SPEAKER_02: They aren't just going through step by step of the chemistry, although we will definitely get into that.
• 3:21
  SPEAKER_02: It's her overarching philosophy, a mindset thing.
• 3:24
  SPEAKER_01: Yeah, hers is framed around this concept from Carol Dweck's book, Mindset.
• 3:28
  SPEAKER_01: Dr.
• 3:28
  SPEAKER_01: McClintock's favorite quote from the book is: Becoming is better than being.
• 3:33
  SPEAKER_02: I love that quote too.
• 3:34
  SPEAKER_02: It implies that you're never truly finished learning, and you should invest in yourself.
• 3:39
  SPEAKER_01: Yes.
• 3:39
  SPEAKER_01: Dr.
• 3:40
  SPEAKER_01: McClintock thrives on continuous improvement and understanding how mindset really drives her clinical success.
• 3:47
  SPEAKER_01: She takes these incredibly complex, highly technique-sensitive procedures and boils them down to simple yet visual, repeatable steps.
• 3:57
  SPEAKER_02: Let's unpack this further, because once we have that mindset locked in, then we start applications of these ideas and techniques.
• 4:04
  SPEAKER_02: Imagine before she even opens a bottle of adhesive, she has to deal with that wet, chaotic environment we talked about.
• 4:10
  SPEAKER_02: How does she take control of the oral cavity?
• 4:13
  SPEAKER_01: Well, she builds a dry dock, literally.
• 4:15
  SPEAKER_01: Her entire protocol hinges on meticulous isolation, usually with rubber dams.
• 4:20
  SPEAKER_02: Okay.
• 4:21
  SPEAKER_02: I have to stop you right there because I hear rubber dam and I immediately think of all the complaints I've heard from patients and during setup.
• 4:28
  SPEAKER_01: Oh, I know.
• 4:28
  SPEAKER_01: Like a lot of clinicians feel they're a bit old school or they take way too much time and can induce a sort of like dental PTSD in the patient.
• 4:39
  SPEAKER_02: Right?
• 4:39
  SPEAKER_02: I mean, working without one is like a plumber trying to fix a pipe while the water is still running.
• 4:43
  SPEAKER_02: Is she really advocating for a dam on every single case?
• 4:47
  SPEAKER_01: Dr.
• 4:47
  SPEAKER_01: McClintock does, and for reasons that go far beyond just keeping the tooth dry.
• 4:52
  SPEAKER_01: To your point about the plumber analogy, it is spot on.
• 4:55
  SPEAKER_01: Trying to bond composite to a wet tooth is literally like a plumber trying to chemically weld a pipe with the water on full blast.
• 5:02
  SPEAKER_02: It just doesn't work and isn't the right conditions for the desired outcomes.
• 5:06
  SPEAKER_01: You are fighting the laws of physics because dental materials are notoriously hydrophobic.
• 5:11
  SPEAKER_01: They hate moisture.
• 5:12
  SPEAKER_02: Okay, the plumber analogy paints a pretty bleak picture of bond strength.
• 5:16
  SPEAKER_02: But what about the patient's experience?
• 5:18
  SPEAKER_02: I get moisture control, but a sheet of rubber stretched across their mouth feels like medieval torture to some people.
• 5:23
  SPEAKER_01: It's surprisingly counterintuitive.
• 5:25
  SPEAKER_01: When it's placed correctly, it improves patient comfort extensively.
• 5:29
  SPEAKER_02: Really?
• 5:29
  SPEAKER_02: How so?
• 5:30
  SPEAKER_01: Think about a patient with a severe gag reflex, right?
• 5:33
  SPEAKER_01: Without a dam, water from the handpiece and debris from the old filling are just constantly pooling at the back of their throat.
• 5:40
  SPEAKER_02: Oh yeah, they feel like they're choking or keep gasping for air.
• 5:44
  SPEAKER_01: Exactly.
• 5:44
  SPEAKER_01: They feel like they're drowning.
• 5:46
  SPEAKER_01: The rubber dam eliminates that waterboarding sensation entirely, protecting the isolated area above.
• 5:52
  SPEAKER_02: Huh.
• 5:52
  SPEAKER_02: I guess I hadn't considered the drowning aspect.
• 5:54
  SPEAKER_02: You're physically blocking the debris from ever reaching the airway.
• 5:58
  SPEAKER_01: Precisely.
• 5:58
  SPEAKER_01: And that's our first major reason for isolation, airway protection.
• 6:02
  SPEAKER_01: I mean, you are working with tiny matrix bands, burrs, hand instruments.
• 6:07
  SPEAKER_02: Yes, and the back of the throat is a total magnet for those things.
• 6:10
  SPEAKER_01: It is.
• 6:11
  SPEAKER_01: And a swallowed instrument means an emergency hospital visit, chest x-rays, the works.
• 6:16
  SPEAKER_01: The rubber dam takes that risk down to virtually zero.
• 6:19
  SPEAKER_02: What else does this dry dock do for the clinician?
• 6:22
  SPEAKER_01: It dramatically enhances visibility.
• 6:24
  SPEAKER_01: Dr.
• 6:24
  SPEAKER_01: McClintock often uses lighter colored latex-free dams, usually purple in her preference.
• 6:30
  SPEAKER_02: Okay, purple, please elaborate.
• 6:32
  SPEAKER_01: Well, it's because the light from loops actually bounces off that purple material and illuminates your field of view.
• 6:39
  SPEAKER_01: It naturally retracts the cheeks and tongue, turning this dark, cramped cavern into a brightly lit workspace.
• 6:46
  SPEAKER_02: And the purple is specifically to avoid latex allergies, I assume?
• 6:49
  SPEAKER_01: Usually, yeah.
• 6:50
  SPEAKER_01: But she does note a very practical exception.
• 6:52
  SPEAKER_01: If you have a case with inflamed, really heavily bleeding gums and you need aggressive retraction to get the tissue out of the way, a latex-free dam might just tear.
• 7:02
  SPEAKER_02: Oh, right.
• 7:02
  SPEAKER_02: Because it doesn't have the same stretch.
• 7:04
  SPEAKER_01: So in those specific tough scenarios, she'll switch to a traditional blue latex dam and pair it with a heavy-duty B4 clamp.
• 7:11
  SPEAKER_01: The latex is structurally stronger, so it can push past the inflammation without ripping.
• 7:16
  SPEAKER_02: So you adapt the tool to the tissue.
• 7:18
  SPEAKER_02: That makes sense.
• 7:19
  SPEAKER_02: Okay, so if we've got the purple dam on, the tongue is out of the way, and the field is bright and dry, how does that fundamentally change the chemistry of fixing a broken tooth?
• 7:26
  SPEAKER_02: Let's say for cases with direct restorations.
• 7:29
  SPEAKER_01: It changes everything because now you can actually rely on the chemical glue, the bonds, the adhesions.
• 7:36
  SPEAKER_01: To see this in action, Dr.
• 7:37
  SPEAKER_01: McClintock presented this really striking case involving a 25-year-old patient named Ben.
• 7:42
  SPEAKER_02: Yes, the guy who came in looking like a 16-year-old because he was congenitally missing tooth number seven and tooth number 10.
• 7:48
  SPEAKER_02: This wonky, peg-shaped lateral incisor.
• 7:51
  SPEAKER_01: Yes, he had just finished ortho.
• 7:53
  SPEAKER_01: The spaces were all opened up and he needed restorations.
• 7:56
  SPEAKER_01: Now, she could have prepped that peg lateral for an indirect veneer or a crown, but that requires grinding away perfectly healthy tooth structure.
• 8:05
  SPEAKER_01: Even though it's small, it's healthy.
• 8:07
  SPEAKER_01: Grinding it away just to create a path of insertion for a lab-made ceramic violates the core principle of conservative dentistry.
• 8:15
  SPEAKER_02: Right.
• 8:15
  SPEAKER_02: Preserve what you can, where you can, when you can.
• 8:18
  SPEAKER_01: So she opts for a direct composite approach.
• 8:20
  SPEAKER_01: She builds the teeth by hand directly in the mouth, relying entirely on the adhesive bond to hold the composite to whatever natural enamel and dentin is there.
• 8:29
  SPEAKER_02: I want to get really granular here.
• 8:30
  SPEAKER_02: The dam is on.
• 8:32
  SPEAKER_02: She's got her instruments ready.
• 8:33
  SPEAKER_02: What is the actual sequence before she starts packing composite onto Ben's tooth?
• 8:38
  SPEAKER_01: Okay, first, she mechanically cleans and roughens the surface using aluminum oxide.
• 8:43
  SPEAKER_01: Then comes the chemical preparation.
• 8:45
  SPEAKER_01: She applies her etch, rinses, and applies the adhesive.
• 8:49
  SPEAKER_02: Pretty standard so far.
• 8:50
  SPEAKER_01: Right, but then she does something crucial that many clinicians either rush through or just do completely incorrectly.
• 8:56
  SPEAKER_01: She meticulously evaporates the solvent.
• 8:58
  SPEAKER_02: Evaporating the solvent?
• 9:00
  SPEAKER_02: You mean the liquid carrier inside the adhesive bottle?
• 9:02
  SPEAKER_01: Yes, exactly.
• 9:03
  SPEAKER_02: Usually I just see people grab the air water syringe on their chair and give it a massive blast of air to thin it out.
• 9:09
  SPEAKER_02: Is there a better way?
• 9:10
  SPEAKER_01: A blast from the standard syringe is actually one of the main reasons bonds fail prematurely.
• 9:15
  SPEAKER_01: Let's look at the microscopic anatomy of the dentin.
• 9:18
  SPEAKER_01: When you etch it, you expose this delicate network of collagen fibrils.
• 9:22
  SPEAKER_02: Okay, go on.
• 9:23
  SPEAKER_01: Imagine a fluffy microscopic sponge sitting on the tooth surface.
• 9:27
  SPEAKER_02: Okay, I have my microscopic sponge pictured.
• 9:29
  SPEAKER_01: Your adhesive is dissolved in a solvent like water, ethanol, or acetone.
• 9:36
  SPEAKER_01: That liquid carrier helps pull the adhesive deep down into the pores of that sponge.
• 9:42
  SPEAKER_01: But the solvent has to go away before you cure it, leaving only the adhesive resin behind.
• 9:48
  SPEAKER_02: Right, you want the glue, not the water.
• 9:50
  SPEAKER_01: Exactly.
• 9:51
  SPEAKER_01: Now, if you blast that sponge with a high-pressure air syringe, the physical force of the air smashes the collagen fibrils completely flat.
• 9:58
  SPEAKER_02: Oh wow.
• 9:59
  SPEAKER_02: So instead of a porous sponge absorbing the glue, you've just flattened it into this closed-off mat.
• 10:04
  SPEAKER_02: The glue is just sitting right on top.
• 10:06
  SPEAKER_01: Yes, the adhesive cannot penetrate deeply, which means you get a shallow, weak hybrid layer.
• 10:12
  SPEAKER_01: So instead of a harsh air blast, Dr.
• 10:14
  SPEAKER_01: McClintock has her assistant bring in the high-speed vacuum.
• 10:18
  SPEAKER_02: The vacuum?
• 10:19
  SPEAKER_01: Yes.
• 10:20
  SPEAKER_01: They hold the vacuum close to the tooth, and the suction gently pulls the solvent out into the air.
• 10:26
  SPEAKER_01: It evaporates it without applying any crushing downward force on those fragile collagen fibrils.
• 10:31
  SPEAKER_02: That is wild.
• 10:33
  SPEAKER_02: Use the vacuum's ambient airflow to dry it, keeping the sponge standing tall.
• 10:37
  SPEAKER_02: That makes so much mechanical sense, and it's a detail that takes, what, three extra seconds?
• 10:42
  SPEAKER_01: A little bit of time for a massive adjustment in structural strength.
• 10:46
  SPEAKER_01: But if we connect this to the bigger picture for a moment, mastering how you evaporate a solvent helps dictate the lifespan of the restoration.
• 10:53
  SPEAKER_01: If you crush the collagen, Ben's teeth might look great when he walks out today, but over the next year, that weak bond is going to degrade.
• 11:00
  SPEAKER_01: Because it's shallow, the margins will stain, microscopic gaps will form, and eventually the composite could chip or just pop off entirely.
• 11:07
  SPEAKER_02: Man, Ben would be devastated after all that work, time, and money.
• 11:10
  SPEAKER_01: By getting the chemistry right at the microscopic level, Dr.
• 11:13
  SPEAKER_01: McClintock was able to confidently layer opaque composite to mimic the missing dentin, build the enamel, and finish four restorations in one day that will better stand the test of time.
• 11:24
  SPEAKER_02: That is eye-opening.
• 11:25
  SPEAKER_02: But hand layering composite is one thing, right?
• 11:28
  SPEAKER_02: You are controlling every variable right there in the chair.
• 11:31
  SPEAKER_02: Let's look at the other side of her workflow.
• 11:33
  SPEAKER_02: What happens when you introduce an indirect restoration?
• 11:36
  SPEAKER_02: Like a crown manufactured by a lab?
• 11:38
  SPEAKER_02: Now we have a middleman, and the chemistry gets way more complicated, right?
• 11:42
  SPEAKER_01: It does.
• 11:43
  SPEAKER_01: And Dr.
• 11:43
  SPEAKER_01: McClintock uses a very helpful framework for these scenarios.
• 11:47
  SPEAKER_01: She makes a clear distinction between a cohesive approach and an adhesive approach.
• 11:52
  SPEAKER_02: To me, cohesive sounds like traditional brick and mortar masonry.
• 11:55
  SPEAKER_02: You cut the tooth into a specific geometric shape, and the crown fits over it like a sleeve.
• 12:00
  SPEAKER_02: The physical shape of the preparation and the mechanical interlocking of the cement are doing all the holding, structurally speaking.
• 12:07
  SPEAKER_01: Right, exactly.
• 12:08
  SPEAKER_02: Whereas adhesive means you have these flat, unretentive surfaces, and you are affixing them with bonding agents, praying to the chemical glue gods that it doesn't fall off.
• 12:16
  SPEAKER_02: Am I sort of on the right track?
• 12:17
  SPEAKER_01: Yes and no, that brick and mortar analogy hits the nail on the head.
• 12:22
  SPEAKER_01: To illustrate this, we share the case of Chris.
• 12:24
  SPEAKER_01: Chris needed a set of old porcelain fuse to metal crowns replaced.
• 12:28
  SPEAKER_01: Because these were older full coverage preparations, the tooth underneath was already ground down into parallel walls.
• 12:34
  SPEAKER_02: So that's the cohesive retention?
• 12:36
  SPEAKER_01: Yes.
• 12:37
  SPEAKER_01: The geometry of the tooth is essentially holding the crown in place.
• 12:40
  SPEAKER_02: You could practically wedge the new crown on and friction would just keep it there.
• 12:44
  SPEAKER_02: So why worry about advanced adhesives at all in that case?
• 12:46
  SPEAKER_02: Just use some basic cement and send them home.
• 12:49
  SPEAKER_01: Because Dr.
• 12:49
  SPEAKER_01: McClintock uses a belt and suspenders philosophy.
• 12:52
  SPEAKER_01: She has the mechanical cohesive retention, that's the belt, but she still applies advanced non-retentive adhesive protocols, the suspenders, for better security and clinical outcomes.
• 13:03
  SPEAKER_02: Gotcha.
• 13:04
  SPEAKER_02: Interesting analogy.
• 13:05
  SPEAKER_02: Please continue.
• 13:06
  SPEAKER_01: She wants the mechanical grip and the absolute strongest chemical bond possible.
• 13:11
  SPEAKER_01: She isn't leaving anything to chance.
• 13:13
  SPEAKER_01: She's taking measures into her own hands.
• 13:15
  SPEAKER_01: Chris will also appreciate this after all is said and done.
• 13:18
  SPEAKER_02: So the lab sends back these beautiful new crowns for Chris.
• 13:22
  SPEAKER_02: Before we even think about cement, we have to try them in to check the fit and the color.
• 13:26
  SPEAKER_02: Her protocol here completely threw me.
• 13:27
  SPEAKER_02: Dr.
• 13:28
  SPEAKER_02: McClintock uses water-based KY jelly.
• 13:30
  SPEAKER_01: I know.
• 13:31
  SPEAKER_01: It sounds so bizarre when you first hear it, but logically, it's brilliant.
• 13:35
  SPEAKER_01: During the try-in phase, you need a medium to temporarily hold the crown onto the tooth so you can check how it looks.
• 13:42
  SPEAKER_01: If you try it in totally dry, it won't seat properly and light won't transmit through it naturally.
• 13:47
  SPEAKER_01: So the color looks wrong.
• 13:49
  SPEAKER_02: But what about standard try-in paste?
• 13:51
  SPEAKER_02: Don't manufacturers make gels specifically for this?
• 13:54
  SPEAKER_01: They do, but traditional try-in paste can be an absolute nightmare to clean out of the microscopic grooves inside the crown.
• 14:01
  SPEAKER_01: If you leave even a tiny trace of that paste behind, it blocks your permanent cement from bonding.
• 14:06
  SPEAKER_02: Oh, that makes sense.
• 14:08
  SPEAKER_01: Keep in mind you have to do this quickly.
• 14:10
  SPEAKER_01: As the patient sits there with their mouth open, their natural teeth are dehydrating, which makes them appear whiter than they actually are.
• 14:18
  SPEAKER_02: Ah, so if you take 20 minutes wrestling with a messy trion paste, you are color matching to a dehydrated tooth.
• 14:24
  SPEAKER_02: When they rehydrate tomorrow, the crown won't match anymore.
• 14:26
  SPEAKER_01: Exactly.
• 14:27
  SPEAKER_01: Water-based KY jelly solves all of that.
• 14:29
  SPEAKER_01: It's thick enough to hold the restoration securely.
• 14:32
  SPEAKER_01: It's optically clear, so light transmits perfectly for an immediate color read.
• 14:36
  SPEAKER_01: And most importantly, because it is strictly water-based, it washes out of the crown instantly with a quick spray of water.
• 14:43
  SPEAKER_01: It leaves zero residue behind.
• 14:46
  SPEAKER_02: That is a phenomenal dental hack.
• 14:48
  SPEAKER_02: Cheap, safe, and entirely solves the residue problem.
• 14:51
  SPEAKER_02: So we've verified the color.
• 14:52
  SPEAKER_02: The patient loves it.
• 14:53
  SPEAKER_02: Now we are staring at the inside of this lab-made crown, the Entablio surface, and we have to prep it for cementation.
• 15:00
  SPEAKER_02: This is where I want to push back on common knowledge.
• 15:02
  SPEAKER_02: We always talk about bonding the crown to the tooth, but her suggestions make it very clear that this is a huge misconception within the industry.
• 15:09
  SPEAKER_01: It is a massive misconception.
• 15:11
  SPEAKER_01: You are not bonding the tooth to the crown.
• 15:14
  SPEAKER_01: You are creating a sandwich.
• 15:15
  SPEAKER_02: A sandwich?
• 15:16
  SPEAKER_01: Yes.
• 15:17
  SPEAKER_01: You bond the tooth to the cement and you bond the cement to the crown.
• 15:21
  SPEAKER_01: If either side of that sandwich fails, the whole thing falls apart.
• 15:24
  SPEAKER_02: So how do we prep the crown side of the sandwich?
• 15:27
  SPEAKER_02: I imagine you can't just slap universal adhesive on every material the lab sends you.
• 15:32
  SPEAKER_01: You definitely cannot.
• 15:33
  SPEAKER_01: The Entaglio surface treatment has to match the specific structural makeup of the material.
• 15:38
  SPEAKER_01: Let's look at the major categories.
• 15:40
  SPEAKER_01: First is zirconia.
• 15:41
  SPEAKER_01: Zirconia is an incredibly dense, strong crystal.
• 15:44
  SPEAKER_01: It lacks the glassy silica matrix found in traditional porcelain.
• 15:48
  SPEAKER_01: Because it's so tough, it can actually handle mechanical roughening.
• 15:51
  SPEAKER_01: So for zirconia, you use an air abrasion unit, specifically 27 micron aluminum oxide at 40 psi, to blast the inside and create microscopic scratches.
• 16:02
  SPEAKER_02: So we physically rough up the zirconia.
• 16:04
  SPEAKER_02: What's the chemical step?
• 16:05
  SPEAKER_01: Once it's roughened, you apply a primer like Z prime.
• 16:09
  SPEAKER_01: The magic ingredient in Z prime is MDP monomers.
• 16:13
  SPEAKER_01: Think of MDP as a molecular bridge that has a specific affinity for the metals in zirconia on one end and the resin in your cement on the other.
• 16:22
  SPEAKER_01: It chemically links them together.
• 16:24
  SPEAKER_02: Got it.
• 16:25
  SPEAKER_02: Zirconia gets blasted with sand and primed with MDP.
• 16:28
  SPEAKER_02: What if the lab sends us a true porcelain like lithium desilicate, which most people know as Emacs?
• 16:33
  SPEAKER_02: Do we blast that too?
• 16:34
  SPEAKER_01: Never.
• 16:35
  SPEAKER_01: That is a critical error.
• 16:36
  SPEAKER_02: Really?
• 16:37
  SPEAKER_02: How so?
• 16:37
  SPEAKER_01: If you blast Emacs or field spathic porcelain with aluminum oxide, the impact introduces microscopic fractures deep into the material.
• 16:47
  SPEAKER_01: You will fundamentally ruin the structural integrity of the crown before it even goes in the mouth.
• 16:52
  SPEAKER_01: It will just shatter under chewing pressure a few months down the line.
• 16:56
  SPEAKER_02: That's terrifying.
• 16:57
  SPEAKER_02: So if we can't physically scratch it, how do we create texture for the cement to grab onto?
• 17:02
  SPEAKER_01: We use chemical abrasion.
• 17:03
  SPEAKER_01: For lithium desilicate, you apply a 9.5% hydrofluoric acid to the inside of the crown for exactly 20 seconds.
• 17:11
  SPEAKER_01: If it's a slightly different glass, like uh feldspathic porcelain, you leave that same HF acid on for exactly 60 seconds.
• 17:19
  SPEAKER_02: Hydrofluoric acid is serious stuff.
• 17:21
  SPEAKER_01: It literally eats glass.
• 17:23
  SPEAKER_01: A crucial clinical warning here: you never let hydrofluoric acid near the patient's natural tooth or soft tissue.
• 17:32
  SPEAKER_01: It causes severe and sometimes irreversible tissue necrosis.
• 17:36
  SPEAKER_01: It is strictly an extra oral chemical for treating the porcelain outside of the mouth.
• 17:41
  SPEAKER_02: And if the lab already etched it before they shipped it to us, do we do it again just to be safe?
• 17:45
  SPEAKER_01: No, you skip the HF step entirely.
• 17:48
  SPEAKER_01: Over-etching is just as bad as error A braiding.
• 17:52
  SPEAKER_01: If you leave HF acid on too long or double-etch it, it dissolves way too much of the glass matrix.
• 17:59
  SPEAKER_01: The porcelain becomes weak and chalky, and the bond will ultimately fail.
• 18:03
  SPEAKER_02: Oh, really?
• 18:04
  SPEAKER_01: Assuming you are the one doing the etching in the operatory, after that 20 or 60 seconds, you rinse it off.
• 18:09
  SPEAKER_01: You will notice a white frosty crystalline residue left behind inside the crown.
• 18:14
  SPEAKER_02: That it looks like white salt stuck to the inside.
• 18:16
  SPEAKER_02: You can't just cement over that, right?
• 18:18
  SPEAKER_01: No, those salts will block the bond.
• 18:20
  SPEAKER_01: To clean them out, you scrub the inside with standard 35% phosphoric acid, rinse it thoroughly, and then dry it.
• 18:28
  SPEAKER_01: Finally, you apply a two-part Selane primer.
• 18:32
  SPEAKER_02: Explain the Seleine for me.
• 18:33
  SPEAKER_02: I know MDP bridges zirconia.
• 18:35
  SPEAKER_02: What is Selaine doing?
• 18:36
  SPEAKER_01: Selaine is another chemical bridge, but specifically designed for glass.
• 18:40
  SPEAKER_01: One end of the Selaine molecule bonds to the exposed silica in the etched porcelain, and the other end bonds to the methacrylate in your resin cement.
• 18:49
  SPEAKER_02: Fascinating.
• 18:50
  SPEAKER_01: It's the chemical handshake that makes the whole cohesive adhesive sandwich work.
• 18:55
  SPEAKER_01: Once the seleine is on, you put the crown in a dark, light proof box so the ambient room light doesn't start curing anything prematurely.
• 19:03
  SPEAKER_02: Here's where it gets really interesting.
• 19:05
  SPEAKER_02: The crown is locked in the dark box, completely optimized.
• 19:08
  SPEAKER_02: I love that she does the etching herself in the operatory.
• 19:10
  SPEAKER_02: It takes 60 seconds, but she takes total control of the variables instead of hoping the lab tech didn't accidentally leave the acid on for three minutes while checking their phone.
• 19:19
  SPEAKER_01: Exactly.
• 19:19
  SPEAKER_01: Control is her ultimate triumph.
• 19:21
  SPEAKER_01: Which brings us to the final most stressful phase: the actual cementation.
• 19:25
  SPEAKER_02: Okay.
• 19:26
  SPEAKER_02: The tooth is prepped, the crown is primed, but bringing them together is a total race against the clock.
• 19:32
  SPEAKER_02: Moisture is trying to get in, blood might start seeping.
• 19:35
  SPEAKER_02: How do we keep this from turning into a disaster?
• 19:37
  SPEAKER_01: By following her golden rule during controlled cementation.
• 19:41
  unknown: Dr.
• 19:41
  SPEAKER_01: McClintock's strict protocol is that you must never cement more than two restorations at the exact same time.
• 19:47
  SPEAKER_02: Wait, even on a big case?
• 19:48
  SPEAKER_01: Let's say we were doing eight anterior veneers across the front teeth.
• 19:53
  SPEAKER_01: You don't just load all eight with cement and pop them on down the line.
• 19:56
  SPEAKER_02: Doing that is begging for adhesive failure.
• 19:58
  SPEAKER_02: Think about the logistics.
• 20:00
  SPEAKER_02: If you load up eight restorations, by the time you are seeding the last one, the cement on the first one is already setting.
• 20:06
  SPEAKER_02: The patient is producing saliva.
• 20:08
  SPEAKER_02: Gums might start bleeding from the pressure.
• 20:10
  SPEAKER_01: You lose control of the environment before you even realize it.
• 20:13
  SPEAKER_01: Doing two at a time guarantees absolute chemical and mechanical control, leading to better success.
• 20:19
  SPEAKER_02: That makes a lot of sense.
• 20:20
  SPEAKER_02: So if we are doing those front teeth, what is the actual sequence?
• 20:23
  SPEAKER_01: You always start at the midline, teeth number eight and nine, and work your way outward.
• 20:29
  SPEAKER_01: Why not start on the far left and just go sequentially left to right?
• 20:34
  SPEAKER_01: Because if you seat them sequentially from one side to the other, the tiny microscopic gaps between the crowns can compound.
• 20:42
  SPEAKER_01: By the time you reach the other side, you might have shifted the patient's entire midline off center.
• 20:47
  SPEAKER_02: Oh wow, that would be terrible.
• 20:49
  SPEAKER_01: Very.
• 20:50
  SPEAKER_01: By locking in the two central incisors first, your midline is perfectly anchored.
• 20:54
  SPEAKER_01: Then you do the two laterals, then the canines.
• 20:57
  SPEAKER_02: Architectural precision.
• 20:58
  SPEAKER_02: Okay, so we are isolating teeth eight and nine.
• 21:00
  SPEAKER_02: The rubber dam is on, we are ready to cement.
• 21:03
  SPEAKER_02: What happens to the tooth surface?
• 21:04
  SPEAKER_01: First, Dr.
• 21:05
  SPEAKER_01: McClintock cleans the prep tooth using the Aquacare Air Abrasion Unit.
• 21:09
  SPEAKER_01: Again, aluminum oxide at 40 psi to obliterate any microscopic traces of temporary cement.
• 21:14
  SPEAKER_01: Then she applies her etch, but she insists on using a high viscosity etch.
• 21:18
  SPEAKER_02: Meaning it's thick like a gel instead of runny.
• 21:20
  SPEAKER_02: Why does that matter?
• 21:21
  SPEAKER_01: If you use a runny liquid etch near the gum line, it flows down into the sulcus, the pocket between the tooth and the gum.
• 21:29
  SPEAKER_01: The acid irritates the tissue, and the tissue responds by pumping out gingival cravicular fluid.
• 21:34
  SPEAKER_02: Then suddenly your dry field is flooded with biological moisture.
• 21:38
  SPEAKER_01: Precisely, and we know moisture kills the bond.
• 21:41
  SPEAKER_01: High viscosity etch stays exactly where you put it, keeping the gums calm and dry.
• 21:46
  SPEAKER_02: Those details here are just incredible.
• 21:48
  SPEAKER_02: So the tooth is etched, rinsed, and dried.
• 21:51
  SPEAKER_02: Now we apply the universal adhesive.
• 21:52
  SPEAKER_02: She uses all bond universal, right?
• 21:55
  SPEAKER_01: Yes, she does.
• 21:56
  SPEAKER_01: And here is where reading the manufacturer's microscopic instructions really Pays off.
• 22:01
  SPEAKER_01: You cannot treat all adhesives identically.
• 22:03
  SPEAKER_01: For all bond universal, Bisco requires a very specific protocol.
• 22:09
  SPEAKER_01: You apply it, actively scrub it into the tooth for 20 seconds, apply a second coat, and scrub for another 20 seconds.
• 22:18
  SPEAKER_02: You're really working it into that delicate collagen sponge we talked about earlier.
• 22:22
  SPEAKER_01: Absolutely.
• 22:23
  SPEAKER_01: Next, you have to evaporate the solvent again.
• 22:25
  SPEAKER_01: But remember, we don't want to use the standard airwater syringe.
• 22:29
  SPEAKER_02: Right, because earlier we said it flattens the sponge.
• 22:31
  SPEAKER_02: But for indirect restorations, is there another reason to avoid the standard air water syringe?
• 22:36
  SPEAKER_01: Yes, there is.
• 22:37
  SPEAKER_01: Standard three-way syringes are notorious for spitting microscopic water droplets along with the air.
• 22:43
  SPEAKER_01: If a single drop of water lands on your perfectly scrubbed adhesive layer, the bond is ruined.
• 22:48
  SPEAKER_02: Man, all that work and attention for not.
• 22:50
  SPEAKER_01: So Dr.
• 22:50
  SPEAKER_01: McClintock uses a dedicated air-only syringe to gently thin the adhesive and evaporate the solvent without any moisture contamination whatsoever.
• 22:58
  SPEAKER_02: Okay, so once it's thinned and light cured, we load the cement into the crown, seated on the tooth.
• 23:03
  SPEAKER_02: Do we just let it sit there?
• 23:04
  SPEAKER_01: No, you have to maintain firm, continuous finger pressure in the exact path of insertion.
• 23:10
  SPEAKER_01: You cannot let up or the crown might rebound slightly.
• 23:13
  SPEAKER_01: While holding that pressure, your assistant tack cures the margins with the light for a second or two, which turns the excess cement into a gel.
• 23:22
  SPEAKER_01: Then you carefully peel away that gelled excess.
• 23:25
  SPEAKER_02: Which brings us to my absolute favorite part of her technique.
• 23:28
  SPEAKER_02: Cleaning up cement around the gum line is where things usually turn into a bloodbath, right?
• 23:32
  SPEAKER_02: The instruments poke the tissue, the gums bleed, the patient hurts, but she modifies her rubber dam right at the end to solve this.
• 23:39
  SPEAKER_01: It's brilliant.
• 23:40
  SPEAKER_01: Once the crowns are fully bonded and chemically secure, she no longer needs absolute single-tooth moisture isolation, but she still needs a clean feel to polish the margins.
• 23:50
  SPEAKER_01: So she takes scissors and snips the thin septa of the rubber dam, the little threads of rubber that go between the teeth.
• 23:57
  SPEAKER_02: So she essentially converts it into a split dam.
• 23:59
  SPEAKER_02: The dam is still hooked in the back, still retracting the lips and cheeks and catching water.
• 24:04
  SPEAKER_02: But the gum tissue between the front teeth is now exposed.
• 24:07
  SPEAKER_01: Exactly.
• 24:08
  SPEAKER_01: The papilla is exposed, giving her direct visual and physical access to the margin.
• 24:13
  SPEAKER_01: She can take her polishing points and clean away any microscopic flashes of cement without the rubber dam getting caught in the burr and without blindly digging into the tissue.
• 24:24
  SPEAKER_02: That's amazing.
• 24:25
  SPEAKER_02: I may use that in my next restorative procedure.
• 24:27
  SPEAKER_01: When you look at her postoperative photos taken mere minutes after cementing these cases, the gums look gorgeous.
• 24:35
  SPEAKER_01: There is zero bleeding.
• 24:37
  SPEAKER_01: The tissue response is perfectly pink and healthy because she managed the environment and respected the biology at every single step.
• 24:46
  SPEAKER_02: It really is a masterclass in clinical discipline, and it brings up a provocative thought I want to leave all of our listeners with today.
• 24:53
  SPEAKER_02: We hear so much about the pressure to be faster, to see more patients, to cut corners on things like rubber dams and solvent evaporation because it takes too much time.
• 25:02
  SPEAKER_02: But if taking a few extra minutes to isolate the areas of work, to use the high-speed vacuum, and to strictly follow material-specific chemistry guarantees, a restoration that lasts 20 years instead of two is more possible.
• 25:14
  SPEAKER_02: How much time, money, and reputation are we actually losing by rushing the cementation phase and hurrying ourselves as professionals through the various steps of the process?
• 25:23
  SPEAKER_02: No more hoping that the glue holds, take control each part of the way.
• 25:26
  SPEAKER_02: It completely reorients the true cost of saving time and yields success for all involved.
• 25:32
  SPEAKER_01: It absolutely does.
• 25:33
  SPEAKER_01: This loops perfectly back to Dr.
• 25:34
  SPEAKER_01: McClintock's mindset.
• 25:36
  SPEAKER_01: Becoming is better than being.
• 25:38
  SPEAKER_01: Taking the time to master these protocols isn't a burden.
• 25:41
  SPEAKER_01: It's the exact mechanism that elevates the trajectory of your entire clinical practice and professional outcomes.
• 25:48
  SPEAKER_02: Thank you everyone for tuning in for today's episode of the Dental Edge Podcast.
• 25:52
  SPEAKER_02: We'd like to give a super thank you to our incredible author doctor, Devin McClintock, and our amazing CE supporters at Bisco.
• 26:00
  SPEAKER_02: With these knowledgeable insights into predictable adhesive protocols for direct and indirect restorations, you can help more patients with clear clinical confidence and better long-term success.
• 26:09
  SPEAKER_02: To check out Dr.
• 26:10
  SPEAKER_02: McClintock's original webinar presentation, please visit www.dentallearning.net.
• 26:16
  SPEAKER_02: There, you'll also discover many more captivating discussions and learning resources to evolve your professional understandings and enhance the dental community at large.
• 26:24
  SPEAKER_02: From all of us here at the Dental Edge Podcast, we'd like to extend another major thank you to the incredible partners of Dental Learning who provide these great conversations and continuing education resources.
• 26:34
  SPEAKER_02: Without Dental Learning's commitment to dental education, none of this would be possible.
• 26:39
  SPEAKER_02: We hope you enjoyed today's conversations and maybe picked up a few tricks or hacks to consider in some of your next direct and indirect restoration cases.
• 26:47
  SPEAKER_02: We'll see you all next time for another great episode of the Dental Edge Podcast, your source for the latest and greatest in modern dentistry.