00:00:00: If you want to make a high-end interior,

00:00:03: direct restoration of course you need a really good composite like the ones from DC you probably want to have a silicon,

00:00:11: key and to wax up and once you have to wax up you can kind of argue why not making the injection molding technique with a clear silicone.

00:00:20: Index made out of exactly and just choose injection molding technique I'll talk about that topic with serhat and cost us who are also having an online lecture about.

00:00:35: This topic as a GC November Symposium I hope you like the discussion.

00:00:39: Music.

00:00:49: Welcome to Today's Show I'm connected to serhat köken and cost us guys I'm really glad that you both are here online with me how are you guys thank you I'm fine.

00:01:02: It's great to be here thanks for having us thanks for the invite.

00:01:05: You two are having a lecture together for the GC November Symposium it's a really interesting topic because cost us your kind of known for direct composite sand cost us you are known for injection molding and you're going to talk about this topic

00:01:20: will you like each other after the lecture or.

00:01:24: Good point actually we don't know what's going to happen at the end of this but we're gonna.

00:01:33: Almost fight but in a good dental way in a civilized way so I'm gonna be on my corner and serhat what do you think I think they will enjoy we are we plant something different.

00:01:47: It's still be a really interesting conversation but causes what questions are you

00:01:55: don't doing any direct composite sand the interior's anymore just injection molding I'm happy you asking me this because I'm giving a workshop a lecture tomorrow for GC UK on injection molding

00:02:08: and I just updated my presentation and that the disadvantages are the limitations I wrote down these killing.

00:02:17: I messaged serhat 2 days ago that you lose your skills a little bit because I had to do something free hunt

00:02:26: and okay I've got my very good flat Plastics and my beautiful kind of Accords and Essentials and I had to really think it wasn't just natural

00:02:37: so do everything in moderation including injection molding because free hand,

00:02:45: is the king and will always be the king so I've been doing it a lot the injection molding and not have to be a little bit careful because you need to have,

00:02:55: the excellent freehand skills so I have to do a bit of 50/50 from now on yes I agree,

00:03:02: sad you also tried out the injection molding I mean versus really educational video you produced with exaclear basically if someone asks me how does exactly work I just show them this video and that's it

00:03:14: at that time I tried to take a video.

00:03:18: Several times I failed maybe more than 15 and maybe I think costes knows this is not that easy they think that all it's really simple just you get the impression with the exaclear.

00:03:33: And then you just inject the composite however it is that difficult like.

00:03:39: Taking an impression with an exaclear sometimes is a disaster that you lose.

00:03:46: Your time material and you go back and restart taking the impression and that video was amazing cause by chance I don't know we made something,

00:03:59: really interesting and it was viewed on Facebook more than 8,000 28.

00:04:07: Eight hundred twenty-eight thousand times on zero danta so yes people thinks that I'm doing injection molding

00:04:15: solvent however it's not true I'm doing mostly directs is you see

00:04:20: I already kind of had a small workshop with you at the IDS 2017 I think you're like a master of the brush Kostas mentioned that he's using flat Plastics so but the brushes with the modeling liquid are basically changed my called direct composite a world when I start using them I think in 2015

00:04:39: probably I think in 2015 Stephan Brown it

00:04:43: posted the video before the IDS how you used the brush on a video and everybody in the internet on Facebook was going crazy really I need this brush and we need to buy it and it's still a great brush have you ever found an alternative to this brush set,

00:04:57: unfortunately Sable brush is unique material when I'm do layering when I'm doing free hand.

00:05:04: I couldn't find any alternative as you mentioned that cost us is using plastic rubber or rubber rubber tip instruments.

00:05:12: The modeling locate no I didn't try anything.

00:05:16: Nick's I think the best material for this layering technique is sable brush with the modeling.

00:05:26: I didn't try it I know other material have you ever used the brush cost us but have it actually I do run the the Phantom heads.

00:05:36: Course for the training specialists in and Kings London King's College London where I teach and I'm responsible for teaching off the free hand.

00:05:45: And the injection molding so we have the full support of GC with the modeling liquids and the brushes that the brushes are amazing I mean there,

00:05:55: such small enough to be rigid but they get into places they're not very flexible,

00:06:01: the just right I mean okay then my nurse kind of loses them because she thinks there,

00:06:09: just rubbish so I like how what do you do with them here the modeling liquid is actually changed the game because it makes things.

00:06:21: To sculpt exactly as you want to sculpt them there is no element of stickiness and even if you use kind of metal instruments.

00:06:31: Hold two 10mm instruments or whatever that modeling liquid is great actually the modeling liquid I use it for injection molding to,

00:06:39: since you asked me about the modeling liquids very briefly when I put my Teflon tapes on the alternate teeth

00:06:48: and I have to protect them from searching till and G premium Bond the the Teflon tape sometimes it goes away or if the suction comes it will pull it away and if you just wet it it's not enough so I just

00:07:02: paint a little bit of multilingual quit on the Teflon which has enough.

00:07:07: Wait and enough surface tension to just make it stick on the tooth so

00:07:13: I always get my modeling liquid out even for injection molding a small joke but yes it's the freehand will always be kind of the

00:07:26: stent Kink and yeah I do like the the brushes but for the proximal areas still using some very fine metal,

00:07:36: flat Plastics but that's just the way I,

00:07:39: learned free hands from My Mentor in Geneva but when we talk about free hand we might have to talk about also

00:07:48: but sometimes we of course have a pellets Earnest and we're using that sometimes we even might have and wax up but we're using I mean said are there any cases where you build it really from the ground up free hand without any

00:08:00: stents or which times are using a pretzel stands for sure you mean the types of stands that I'm using for directs I'm using Pootie.

00:08:10: Just put it with that light buddy that works fine but you need to be careful while.

00:08:17: You are taking the impression if you are experienced with that material.

00:08:23: And you don't have any problems on the palatal aspect of your restoration and later on I do layer the enamel shell enamel composite in order to prepare the palatal shot.

00:08:35: And I sometimes use Sable brush with the modeling so at that makes your work.

00:08:43: More efficient have you ever seen sat on Facebook we have some pad people are not using a palette systems but even use Buckle stands

00:08:52: yeah it is it is possible to go completely free and without any stands without any impression I do it but it means that.

00:09:00: Finally you need to work carefully on the palatal aspect which means you need to work with the mirror I don't like to work with the mirror actually I want to spend less time.

00:09:13: On the pulse of part of the.

00:09:15: Food that I restored so I use pulses shout technique but as you said on social media on Facebook you see lots of.

00:09:24: Tons of cases and they all restore differently yes sometimes I do restore using just minor strip it's possible to create,

00:09:34: something similar that you do with the silicone index it's possible but if you ask me Golden Sun that for that is the.

00:09:44: Silicone index like.

00:09:46: Put thee or you can also use exactly I don't know what does what is European cost us about using exaclear for the.

00:09:57: Yeah I know what you mean it's I mean the reason why I got into injection molding about 5 years ago was that in hospital where I teach we do a lot of tooth wear cases.

00:10:11: We were having the whole diagnostic phase Smile Design wax up mock-up.

00:10:16: And then we were not able to replicate that so we were using a PBS.

00:10:23: A palatal stent but for very severe cases you have to do the palatal in two steps because if you're adding 7 millimeters height,

00:10:33: the composite at the bottom is not going to set so you introduced like the the gingival half.

00:10:41: Then the coronal half of the palatal and then you do the Buckle so each step has to talk to the other one and you get some lines in between so that is a small problem

00:10:53: since I started working with injection molding we actually started using exaclear,

00:10:59: to do the palatal silicone keys because you can add it like.

00:11:05: Monolithic one big lump of composite seven millimeters tall or even 1 centimeter to or whatever and still curate in one goal okay,

00:11:17: if it's too deep then you have the depth issues but that's very rare so that's actual material the exaclear is not

00:11:26: be unique for injection molding it's an be used for the stamp technique or what we just described but you know much more about this or have because you have,

00:11:36: mastered the art of the,

00:11:38: of that stump Nick technique on posteriors which is very applicable to the average general dentist like single tooth Dentistry at the injection molding the number one indication is a Roshan.

00:11:52: And rows of tooth wear on multiple teeth lots of palatal surfaces 6 8 teeth and instead of breaking your neck

00:12:00: and going in there to do the kind of single umm and the palatal cusp of the upper premolar this listen I mean this is hard okay so that's where injection molding comes in is,

00:12:10: let's say a winner but I see what serhat does with exaclear and is like wow man this guy takes it to the next level so,

00:12:19: you use it a lot serhat to tell us how do you do this stamp technique on the posterior stamp technique on the posterior it does actually.

00:12:29: Last year that I tried first what the exaclear I just tried to.

00:12:36: Copy the opposite surface of course after having the rubber Dam on the mouth and then after the rubber Dam isolation.

00:12:46: You just wait you know the setting time of the exaclear it is 5 to 7 minutes.

00:12:54: And then you get,

00:12:57: you remove the silicone and then wait and do check if its proper you need to see the impression you have if it's covering all the organs of surface or not.

00:13:09: And you need to be careful about.

00:13:11: It's margins if they it will be if you you need to think about later on if it will be difficult.

00:13:20: To place with the to place the on the prepared occlusal area because sometimes the.

00:13:30: Exaclear stamp is very large so you need to adjust I mean you need to trim the sides maybe using a blade.

00:13:40: So you need to shorten in some Buckle or palatal parts maybe the distal extension.

00:13:48: In order Ian you need to control all these extensions and.

00:13:54: It is easy when you work with GC equia equia is great material because it's bulk.

00:14:03: You don't need to repeat some space so you just inject directly without the stamp and you put.

00:14:13: Stamp exaclear stamp on and wait and then you remove that sit with the.

00:14:20: GC quoi the exaclear is amazing but when you work with the resin composite then you need to be careful about polymerization shrinkage because you cannot complete the field.

00:14:34: Cavity in one increment so you need to be careful to eliminate the risk.

00:14:42: That it is always shrinking when you are using the compass so.

00:14:49: When I work with the composite I try to finish firstly distal part down the middle part down the.

00:14:59: Like I do not completely I do not finish all restoration at once so not only incrementing but also superficially I.

00:15:10: Divide the work into two or three phases so,

00:15:15: this is how I look but if I work with glass ionomer like gcq ah then it's,

00:15:21: complete the very simple only about material single increment and the work is amazing in class ones not only could not own class to for sure I'm not using this technique for class to adjust for class 1,

00:15:34: Restorations which is the first time I had someone using equia together with exactly the same for me I'm learning something here.

00:15:44: You know Aquarius.

00:15:47: Very simple it looks easy but modeling the acquire I mean creating or puzzle surface.

00:15:55: Is difficult you need to use bars you need to use some rubbers or.

00:16:02: The rotary instruments or you work with the stamp and then you're not worried about the final shape so that's so easy with the

00:16:11: stamp Tech I usually to use the stem technique with like some flow or some liquid rubber Dam and kind of a Teflon which was which is a nice idea I mean I picked it up on style Italiano

00:16:25: but I found out but usually this flows are never as precise sometimes as I wanted it and if what my experience are with exactly so far it's actually that's super precise so,

00:16:40: probably depends how you how the angle of application is in the class one filling or actually you need to be sure about the fit of the,

00:16:49: silicone before you start the next phase before you drill you you need to check the fit of the silicone if you do not have the exact path of insertion.

00:17:00: Then finally you cannot Place correctly so you will have complete the wrong occlusal surface so I think the criteria is,

00:17:10: observing or testing the setting of the silicone,

00:17:15: stamp on the seat before you start drilling what do you think of yeah I agree and when I use the exaclear in the injection molding the difference is that I don't do it inside the mouth I do it on a model.

00:17:30: Which means that I have the ability to put it in a Hydro Flask.

00:17:34: And then it fully problem arises whenever I actually made the next layer without Hydro Flask it was still giving the surface detail,

00:17:43: it was not a problem but it had lots of little air porosities so I couldn't see through it that well but.

00:17:52: When I take an exaclear in order to do posteriors then I have to.

00:17:58: Can't eat a lot and I have to spend quite a lot of time to allow for the clamp whereas when you are doing an exaclear in the mouth,

00:18:08: you have to,

00:18:09: cut it very little because you just did it it's already fit so that's the reason why kind of I rely on the equator of the tooth for referencing,

00:18:20: I cannot rely on soft tissue referencing for that reason,

00:18:25: I haven't found a way for injection molding to work with rabbit damn they are fighting against each other they are like,

00:18:35: it's like two people in the same room who are like there's a lot of electricity so I think that's a disadvantage for injection molding let's be honest and if at the front of the mouth.

00:18:48: You get away with it you put Teflon you put retraction code you put kind of ultra Gates,

00:18:54: and you say it's we'll split them or whatever but at the back of the mouth we cannot do adhesive Dentistry without isolation it's like forget about it.

00:19:04: So the referencing is not as good whereas anteriorly I've got excellent referencing

00:19:11: but and losing the rubber Dam so that's a disadvantage

00:19:14: but actually if I would use exactly and cases like you're doing I fought for sure go for a split them technique if possible of course because that's kind of okay and okay isolation because what I am always worried but the patient is closing the mouth

00:19:31: it's the wrong time and that's why I like run with it.

00:19:34: Yes true actually if you think about it the whole thing about isolation is about 45 seconds from the minute you edge until you hybridize.

00:19:45: That is the critical moment if there's blood and water before or blood and water after who cares but for that one minute it needs to be super super good now yes the split thumb.

00:19:59: Protects from the tongue and the lips and it's a good alternative.

00:20:05: At least for injection molding absolutely but we all know that the gold standard is the full damn which which is a bonus for free hand.

00:20:14: And also layering I mean serhat is amazing at layering whether it's.

00:20:21: Accord or Essentia just controlling the laces is very important okay now with the new.

00:20:30: Chords have you found her hat that you don't need that much layering or you.

00:20:37: Put a bit of a O2 or some kind of Dentin in the back,

00:20:42: yes when it's a class for case a fracture central incisor for example when more than in size of 1/3 is involved in the within this fracture.

00:20:54: Then I usually use an pack shaped like a o 1 or AO 2 palette Ali in order to,

00:21:01: increase the opacity of Total Restoration so otherwise everything the look great so yet whenever I'm using genial series like the previous one original genial and the new one.

00:21:13: The Accord I'm always using OPAC Shades if I have a large I mean longer.

00:21:21: Restoration longer a fracture in the incisal part of the I mean if half of the tooth of a central incisor is fractured for sure I'm using but if the fracture is only,

00:21:33: in the in size of 1/3,

00:21:36: yes there is no need for a pact Shades and about your idea not to use all shades just single shade with like a one or a two shapes for single restoration without layering.

00:21:50: Yeah I think it's possible but you need to there is always a compromise when you use.

00:21:57: Single shit like you don't have the translucent incisal Edge so.

00:22:03: This is correct this is up to the dentist if you ask the patient's they do not,

00:22:11: differentiate whether with the enamel or with that because they do not understand they do not know only we can see with the magnified pictures but I know some people who are doing dentistry in UK they are using.

00:22:26: Single Shades without animal and they are saying Edge bonding after alignment.

00:22:31: It's very popular in UK what do you think cost us using single shared without enamel.

00:22:37: It is it is because a lot of people in this country in the UK yes they will move the teeth then they will bleach the teeth.

00:22:48: And then they will do very small editions which has its limitation because volume of composite surface area and it has to be,

00:22:58: pretty opaque single shade because if we take a Vita one.

00:23:04: Horan and number one it's going to look great I mean we have all done that so it works in high-value cases because you bleach the teeth.

00:23:14: They are B1 plus so you take a dent in shade.

00:23:19: You put it on the incisal edge and the whole tooth is super dense super opaque anyway,

00:23:26: so you get away with it but if you use a conventional Vita based system it's going to look great but for the high-value cases it actually,

00:23:39: does work now.

00:23:41: For the monolithic like monoshade kind of injectable cases that I do the a ones and the aid tools.

00:23:52: Going to be a bit more glassy.

00:23:56: And they're going to show the line if you will we all know what I mean by the line whereas the day one and the Big W.

00:24:04: For the XP W if you're going crazy if you women they are all pakka.

00:24:08: They are opaque and they block things out how much thickness do they need then don't need a lot they need about half a millimeter.

00:24:17: Seven tenths of a millimeter buccal lingual e they block out that line so whenever you going on the high-value cases you have an advantage but when you're going for your.

00:24:27: To thwart patient who is not aesthetically driven.

00:24:30: That's where the ao2 comes out mmm so I still do injection molding but I will do a little bit of freehand ao2.

00:24:41: Looking at the wax up so that I don't go beyond the wax up otherwise my stent wants it so I will block out the glassy

00:24:49: Edge has with a bit of a old to give that density and then the A1 genial injectable will come on top because if it was only going to be a 1 or a 2 so more glassy material its we all understand that.

00:25:04: In this case you're using the ao1 a or to free hand before you inject yes.

00:25:10: This is may be called semi injection Technica,

00:25:16: it's a famous director it's called it's called cheating

00:25:24: but we learn from our mistakes I mean that's every person who does Composites has done all the mistakes in the world so you think to yourself okay next time let's not to do that so the ao2,

00:25:37: he's an amazing material last year when a o1 came out I think it was quite recent that ao1 came out I'm not sure if it was available before.

00:25:47: It was available in in the past series of the genome you could get a 0100.

00:25:56: Maybe on the injectable it wasn't,

00:25:58: Maybe I'm Wrong maybe I missed it for the AL to is super valuable it's like always there as your backup because you need,

00:26:08: to block things out and that opaque Dentin is amazing it's interesting Direction where it's going down,

00:26:18: once I tried injection molding technique on a very young patient something like 6.

00:26:25: Or five years in age with a pediatric dentist friend of mine,

00:26:30: in her Clinic we tried this technique with monoshade layering and as Costa said.

00:26:38: We had a problem like we it was not possibly to block the margins.

00:26:44: Without by using monoshade so later we taught that our mistake was not the place and of pack shade on the margin as Costa.

00:26:55: Smashing now.

00:26:58: And if you had tried that ao1 or ao2 there just to block the margin so we could not have in that case a demarkation line.

00:27:08: So I agree totally agree with Costa using this ao1 or a 2802.

00:27:14: Could possibly increase the quality of the restoration I think it will improve the.

00:27:21: Aesthetics it will it helps a lot I mean especially for normal value cases a three-day two-day ones before high value.

00:27:32: It's easy you get away with anything you can use MD from Essentia and it's going to look perfect on the incisal edge because it's such a high value case but

00:27:43: basically with these a O2 business you make the tooth a little bit longer,

00:27:48: by adding a bit of a O2 and then you rely on the facial addition so

00:27:53: my nurse always gets the ao2 out is like on standby waiting.

00:28:01: So it's not true injection molding monoshade but you kind of that's why I think injection molding is like driving an automatic car.

00:28:14: You you have to know how to drive manual and if you are lazy like me you can buy an automatic car but the license is going to be manual and it takes 20 years.

00:28:28: At least for me serhat probably he was born with the skills but it took me 20 years to learn the freehand skills and now I don't use ago injection hook.

00:28:40: Actually.

00:28:41: That's kind of nice clothing were spoofs driver's license actually you two guys are really great I am I think the lecture you're doing will be a lot of fun.

00:28:54: Sad at the end one little surprise I promised you.

00:28:59: You did a podcast with the dental hex podcast in 2015 yes and because I kind of followed you

00:29:06: I always kind of listened to your podcast it was really interesting I would put it put it on the show now it's about how you evolve became a dentist went to the Army and everything but the funny thing is actually

00:29:19: but this is this was my first time when I look at you listen to any Dental podcasts and I kind of started listening to dental podcast so much that I started even my own so it's actually kind of your fault is that.

00:29:32: We are now on the podcast it's kind of cool that such a small Dental words and with your inspiring cases even the data podcasts came into place that podcast was recorded for the American dentist you know Dental town.

00:29:47: Yeah they are a group of dentists in North America especially on in the United States.

00:29:53: They asked me to be involved in that podcast with and UK dentist under Chandra pal and Arthur Volker.

00:30:02: A good friend of mine he's very active in New York and United States and we did it together.

00:30:10: In 2015 so it's interesting that you listen to my podcasts are very interesting.

00:30:20: Well when never go away okay.

00:30:24: That's like better now serhat you inspired the world of podcasts what do you remember

00:30:30: when did you listen to my podcast but what do you remember it was 2015 actually I listened to your podcast every memory because.

00:30:40: I mean I don't remember all of it

00:30:42: spot some details and I also remember that it was with our to Falcor because he posted it on Facebook I was like wow a podcast of Sarah Hart I mean it was a times where you had to your true peace Study Club and you hadn't had a website for it nobody knew what it was and Europe actually

00:31:00: but what's interesting time back when there was no Dental Instagram now we have even Dental Instagram and your,

00:31:06: you kind of have it's interesting a lot of people who are we're kind of

00:31:10: successful Dental Facebook never made the switch to dental Instagram but here one of the rare guys who kind of made the step to density Instagram as well I think Instagram is,

00:31:22: very active in my region in Istanbul and turkey and.

00:31:28: Like neighboring countries is very active I don't know if it's that popular in UK I don't know are they is very,

00:31:36: it is if you're not there nobody okay nobody count on you is like it's almost like a must to have a presence even if you're not that active

00:31:47: just to be there for people to find you because if patient a customer

00:31:52: doesn't see you there they're going to think who something's wrong with them so it kind of has a strong effect it has a strong effect and especially in New Generation in young dentist

00:32:03: oh yes of course of course needless to say that they they do not follow Facebook they think only.

00:32:10: People over 45 or 50 are just following Facebook including me I'm home almost 47 but I switch complete the not complete but

00:32:24: let's say I'm not posting so often on Facebook I love posting on Instagram because it's very simple.

00:32:31: It's a new style and it's very popular and you have good contact with the others especially with the.

00:32:39: Dental friends or you can use Instagram differently.

00:32:45: Like marketing your business but I don't do Instagram in that way I prefer to have contact with my dental friends.

00:32:53: But is really versatile I mean you can create it.

00:33:02: Different kind of marketing your business on Instagram true what do you think they have it.

00:33:12: Yeah actually I mean Germany it's not that popular yet for from the patient point of view I think

00:33:19: but it's getting a lot of tension but you kind of kind of interact with your local neighborhoods trying to be recognized and there's some dental accounts who are like more like a dented mindset accounts not to be the clinical that don't post a lot of clinical things just as mindset things I personally don't like that but

00:33:39: to the whole dentist dentist are talking about how to be successful because I always want to see if I would like their cases and then they can tell me how they are

00:33:48: be successful but that's I mean actually cost us as kind of the right balance it's like kind of four

00:33:56: patience you can kind of see that content is great its I know I'm in my,

00:34:02: I'm aiming to Target exclusively patients but it's like an addiction that who you I can't resist and just put a little bit of

00:34:12: big margin elevation is like the patient is like what is departure so because we speak the same language we love what we do or passionate we will

00:34:22: we have WhatsApp groups we have Facebook groups we have this so even if they strategies for patients only you kind of go to the right and the left all the time

00:34:31: yeah it's the new it's the south things are these days podcasts and Instagram but I hope I hope today was.

00:34:40: Fun to be continued on stage end of November I will look forward for this lecture.

00:34:48: Okay guys thank you for joining me on your Friday night thank you that you two made it possible it's really a pleasure to talk to you and see you in person soon again thanks for having us.

00:35:00: Yes thank you bye.