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Howard:
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It is just a huge honor today for me to be podcast interviewing my idol, my role model, Dr. Byoung Suh, who I've had the pleasure of listening to lecture several times over the last 30 years. Dr. Byoung Suh is the founder and president of Bisco Dental Products Incorporated, which is located in Schaumburg, Illinois. With his background in research and chemistry, his focus at Bisco is on dental materials, research, and product development. He has over 30 patents and 19 patents pending and has published more than 30 articles and 80 abstracts.
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Dr. Suh has become a well-known and sought after lecturer and teacher lecturer extensively in the U.S. and Canada, as well as in over 40 countries internationally. He has given more than 250 lectures and presentations at different dental associations and research conventions around the world.
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I have been trying to get you on the show for two years and I finally did it. Thank you so much for coming on today. How are you doing, doc?
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Dr. Suh:
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Very good. Thank you, Howard. It's my pleasure to be talking to you. I think this is the first time I'm doing in this format in adhesive dentistry.
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Howard:
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I know. This is your first podcast and it took me two years to get ya and it's just a huge honor you came on the show today. There's so many kids out there that see the name Bisco and they don't know who started Bisco. Just like they'll see Glidewell Lab, but they don't know there's a Jim Glidewell. You have the most amazing story and I wish we'd start out with just saying ... How did you get into dentistry? Tell them your story.
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Dr. Suh:
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From where?
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Howard:
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From birth. Where were you born? Seoul?
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Dr. Suh:
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Actually I was born in Korea, South Korea [inaudible 00:01:57] southern part of the city. I went to Seoul for college. Then, I finished college and then I worked for about four years in chemical plant making urea fertilizer. Which the company was built by American aide, actually. So, many American engineers and chemists were working there. That's where I spent about four years before I came to United States.
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Howard:
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Why did you come? Why did you leave Korea and come to the United States?
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Dr. Suh:
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Oh, well while I was working with American chemists and engineers, I became aware of that, "Okay, I need more advanced study." I like to do it, but America. At the time, Korea was a very economically poor. Nobody probably could afford to send their kids to United States as students. I'm in the same category. I saved money during four years for airfare and maybe one semester that it cost in America. I left with $50 in my pocket, which they allowed a student going out to study $50, that's it, because they didn't have any foreign currency. So, there was the legal money I could bring, the $50. Then, a friend of mine gave $10, so I had $60 arrived in San Francisco, January 30, 1964. Long time ago.
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Then, I finished school after four years. Then, came to Chicago and ... Before I can, maybe I should give a little bit of life I spent in student time. After first semester was done, summer vacation came, so I had to make money. First I went to a restaurant, "Could you give me dishwasher job?" Owner said, "Do you have any experience?" I said, "No." I should have said yes, but honestly I didn't have experience as dishwasher and they didn't give me the job. At the time, a friend of mine was working as busboy in Reno Sahara Club. I called him up, "Hey, I cannot even get the dishwasher job." He said, "Well, if you come to Reno, I'll get you a busboy job." He was a student from Brigham Young University, so he was summertime, he gets there to get a job.
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I went to Reno. I got a busboy job and worked for four months, 3 months, summer vacation. I saved enough money to register next quarter or next semester. Then, about Christmastime, money ran out again. At the time, at the same school, there was a friend of mine, a few years older than me was bellhop at Hilton Inn Airport in San Francisco airport, Hilton Inn. I asked him to get me a job. He sent me to C.J., a bell captain, I met him. He said, "Well, if you're a friend ... name was Mr. Moon ... Mr. Moon sent, I'll give you a job. However, working hours are following: Saturday night 11:00 'til Sunday morning 9:00 and Sunday night 11:00, Monday morning 9:00. Can you do it?" I said, "No. I can't do it." I have no way of making money other than that. That was a nice job 'cause it's weekends except Monday you have to go to school but I did it until I got a scholarship within one and half year. Then, I was okay. Anyway, that was my student life. One and half year working as busboy and bellhop.
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Howard:
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Where did you meet your lovely wife at?
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Dr. Suh:
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In Chicago. Actually, when I came to Chicago I met. Let me explain that. After finishing school, I heard many jobs would be available in the Chicago area. I came and got a job as chemist. First time was medicine chemical and then ... Actually, I met my wife briefly at the church, Korean United Methodist Church, where some of my friends introduced my current wife and that's how I met. Then, we had three daughters. That's only complaint I have. No boys!
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Howard:
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Well, I have all boys, no daughters. I've had dinner with your daughters before. They're so amazingly intelligent. One's lawyer, two of the three work for you. One's a lawyer, right?
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Dr. Suh:
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No, no. Not lawyer, more ... No, actually none of them lawyer. First one is more like a CPA, NBA from MIT and second one is international marketing from Brown, and third one is actually a architect.
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Howard:
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Wow! That is amazing. That's ... What an American story. All of America was just built on 500 years of immigration and it's been a brain drain of the world and I wish we could get back to our roots. You got a B.S., a Bachelors in Science, a Masters in Science, and PhD. How did you end up in dentistry?
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Dr. Suh:
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That's probably because I got a second job in Chicago. Actually, I was working as a chemist in first job. My boss, technical director, was moving to another company. There was later found out there was W.A. Erickson and Company. My boss from first company asked me, "Hey Byoung, do you want to follow me where I'm going? I'm moving to another company." Obviously he kind of liked my work environment or work attitude. So I said, "Okay." I followed him. I found out there was company called W.A. Erickson, which is a very small dental manufacturer. At the time, there was nothing like a composite was out there yet.
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Howard:
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So you followed your boss to W.A. Erickson and Company, which was small dental manufacturing company?
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Dr. Suh:
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Correct. Then, one year later, Adaptic dental composite came out to the market from Johnson and Johnson. I didn't know if course. Many of my new company ... Dr. Erickson, actually the company was owned by Dr. Erickson.
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Howard:
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He was dentist?
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Dr. Suh:
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He was no dentist, he was a chemist.
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Howard:
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Okay.
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Dr. Suh:
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Okay. He asked me ... Actually his advisors, a couple of advisors were there and came to me, "Byoung, can you make something like Adaptic?" I said, "What's Adaptic?" He said, "A dental composite." I said, "What's a dental composite?" Oh, well he brought me package of dental Adaptic. I looked at it, there was a brochure or information sheet. All it was made out of was bis-GMA and filler. So I said, "Okay, well let me see if I can make it." I was looking to buy bis-GMA in the market. At the time, nobody sold bis-GMA on the market. I looked up the structure, since I'm a chemist. I synthesized my own bis-GMA.
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I think that's what eventually put me in the dental field and dental resin chemistry and became a, in a way, expert now. Because I was starting from the beginning or synthesis of bis-GMA-
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Howard:
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And what year did you make that first batch of bis-GMA?
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Dr. Suh:
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1970.
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Howard:
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1970.
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Dr. Suh:
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Yeah. Adaptic came out 1969 toward the end of 1969.
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Howard:
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Wow.
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Dr. Suh:
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Then, I synthesized 1970 and I developed a very stable composite catalyst paste part or composite, 1971. Finished within one and half year, I made a better than Adaptic composite. What I mean is, when you say catalyst, catalyst means peroxide has to be there. With bis-GMA, with a peroxide, it's not stable because the peroxide tends to decompose to free radical, it becomes hardened. I had to find out the good way to do it and I found it. That's why we made a much better, stable, more stable catalyst system. So from there, Erickson Company sold to Henry Shein, Darby, HealthCo, you name it. All the private label, we produced from Erickson.
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Howard:
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What was it called?
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Dr. Suh:
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We didn't make our own. So, HeathCo brand, or Schein brand or Swedish company. All of the people, we made OEM company in a way. We just make it, put their label, send it to them. Erickson never marketed directly. As OEM company, we were successful. Then after about ten years, I became a little weary. What I mean is, about 40 plus years old and you start to think about, "Am I going to work for somebody for rest of my life or could I do something my own?" That's where I was struggling, a couple months internally. I didn't share with my wife at the time on that though process.
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Then two-three months later, my wife said, "Hey Byoung, something wrong with you. What's wrong with you lately?" Apparently, she realized I'm not normal. I [inaudible 00:13:24] what I was struggling with, the thinking process. That's how she encouraged me, "Well, if you do that way, why don't you try your own? However, you better make it in three years," that's what she said.
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Howard:
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She gave you three years. So, what year did you start Bisco then?
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Dr. Suh:
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Bisco started in 1981, but I quit the company 1980. Erickson Company, I quit 1980. However, I couldn't start immediately because what I had signed with the Erickson Company, non-competition agreement. I found out that I could not work in the same field or sale. I couldn't start anything in same area within one year in 50-100 miles diameter area in Chicago. If I went to other state, I could start. But, if you're starting a new company moving family there, it's not a good idea. I was actually, so called, [inaudible 00:14:38] found out that I was quitting the Erickson and he suggested I join them. I said, "No, thank you but I'm not going to be employed anymore."
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I went to San Diego, started at Carbomedic now probably no longer existing or sold to somebody else. [inaudible 00:15:02] called into implant and things like that. I started working with that company called Carbomedic at the time. Then one year later, I came back to Chicago and started a company, Bisco. Now, do you know why the Bisco name? Have you ever heard?
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Howard:
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Well, I imagine it's bis-GMA company?
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Dr. Suh:
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Well, now my full name was Byoung In Suh.
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Howard:
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How do you spell In?
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Dr. Suh:
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Okay, I'll put this screen here. Okay, do you see the screen?
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Howard:
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Yes. Byoung In Suh Company.
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Dr. Suh:
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Yeah. So, if you take the initials, Bisco. That's how I named my company. That's where came from.
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Howard:
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Nice.
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Dr. Suh:
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So, that's how I started 1981, actually July 2nd. One thing I want to mention here is that when I quit Erickson, 1980, I realized that dentistry needed a couple of products, adhesives. Which will bond to tooth structure and metal sub strait. I was thinking two chemical magic compounds, I will have to invent. After I started 1981, immediately I was just ... I had maybe 4 or 5 people working for me. I had a couple of orthodontic dentist was making for TP Lab, American Orthodontics, things like that. As we OEM label, while I was doing it, I couldn't afford to spend a lot of time to invent a chemical or a synthesized chemical.
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About 1984, now I was enough financially I could afford to spend time, so I hired a synthetic chemist. We discussed what chemical will bond to tooth, what chemical will bond to metal. We came up with the structure and then he started synthesizing. Probably about 80-90 compounds we synthesized. Then we test to tooth and test to metal. Eventually, we came down to so called, we are using BPDM in [inaudible 00:17:50] BPDM and DSTN. Also, we found out any of this, let's say BPDM, will bond to tooth as well as metal.
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That's where I introduced and developed All-Bond, 1990. We finished developing in 1989, introduced 1990. If you remember, later on we'll talk about Generation. I'll talk about it. I said, this is 4th generation, because before then was a ten year, was Scotchbond and so I called this is 4th generation universal. The meaning of universal, at the time, I meant was, it can bond to tooth as well as metal. You could do direct and indirect at the same time. That's why I mentioned as a universal adhesive.
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The other thing I brought with the universal adhesive, no, the All-Bond, was new concept, total-etch and wet bonding concept. Of course, 1990, etching dentine was taboo, that was a no-no. They were almost getting mad at me, "How can you say you can bond to dentine?" Because many of the dentist were taught, don't etch dentine. Acid will kill pulp. I have read enough articles Brännström and Charlie Cox, pulp is killed by bacteria, not the material. So, I knew that's where I could say, you can etch pulp better bonding. Then we found out after you're etching it, you have to have a wet-bonding concept.
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Otherwise, if you etch, you expose collagen. If you dry it, collagen is all collapsed. Your adhesive cannot penetrate, that's why you have a pro-bonding. We came up with, John Kanca is involved here.
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Howard:
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Did you say John Kanca?
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Dr. Suh:
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Yes, John Kanca was involved. When I developed, I was giving samples to evaluate and that when we were discussing. Technically, John Kanca should get some credit in a sense. I did all the research, when you etch dentine, you look under and see [inaudible 00:20:54] and it's right. When you dry it, it's all collapsed. When you keep it moist, collagen you can see all freely flooded. Then when you apply adhesive with acetone solvent, acetone has a water chasing effect. So, you can just go through to the tubals and then push out the water. Resin is there, then [inaudible 00:21:22]. Now you have a resin [inaudible 00:21:24]. That's how we know and we proved in terms of SEN evidence and everything like that. When we had all that with a total-etch concept, which was totally against everybody, we started.
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One other thing I can talk about is when we were introducing, normally etchant at the time was 35 or 37% phosphoric acid. If you're talking about total etch and if you're thinking of 35% it's too strong. So I said, maybe I should develop an etchant with a lesser concentration of phosphoric acid so dentist could feel a little easier. I made every 5%; 5%, 10%, 15%, 20, 25, phosphoric acid solution. Then I etched enamel 5 second, no 15-20 seconds. Which one will etch it enough? I investigated. I found out 10% phosphoric acid will etch cut enamel enough to be bonded. Then, what about uncut enamel. Uncut enamel required longer time, okay, higher concentration. We looked at it. It took about 32%, 30% was enough to re-etch the uncut enamel.
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We decided to introduce two etchant, one we call All-Etch was 10% and Uni-Etch was 32%. We had all one kit with the 10% phosphoric acid solution and then Uni-Etch came, which is 32% phosphoric acid containing. All other ingredients the same, but etchant was different. When, do you know, we sold 80% dentists was using usually 10%. 20% was 32%. However, now we don't even sell 10%. Come to think of it, making dentists acceptable to totally etch concept was actually because we had a 10% weaker phosphoric acid so dentists have felt a little easier when you use first time.
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Anyway, that's the story, along with the All-Bond.
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Howard:
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Who was the other dentist you mentioned, Charlie Cox?
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Dr. Suh:
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Yeah, Charlie Cox. He had many articles actually. He was in the field studied when he was in Alabama, University of Alabama. Mostly ... Actually the best guy's paper was Martin Brännström's paper.
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Howard:
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Martin, who?
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Dr. Suh:
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Brännström, B, R, A, two dot on top a.
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Howard:
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Umlaut.
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Dr. Suh:
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Umlaut. Brännström.
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Howard:
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Was that the Brännström's theory of hydrodynamic theory?
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Dr. Suh:
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Yeah.
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Howard:
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Yeah. I remember that. That was amazing. Where is Martin Brännström and Charlie Cox now?
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Dr. Suh:
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Actually, I don't know. Charlie Cox, I know he is alive but I don't know where. I don't think he's associated with the university. He kind of disappeared. He became kind of strange.-
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Howard:
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What about Martin Brännström?
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Dr. Suh:
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Well, he's in Sweden. I don't think he is still in this world, I'm not sure.
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Howard:
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Interesting. That is amazing. What was the next part of your journey?
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Dr. Suh:
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Well, once you have that made and then as Bisco, we were developing a ... Orthodontic companies came to me to develop adhesive or cement orthodontic application. I did that. So, we are actually good supplier orthodontic universe. We are not selling our labels.
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Howard:
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So, you're an OEM, an original equipment manufacturer?
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Dr. Suh:
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Yes, yes.
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Howard:
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Now, what about Japan's role in all this? Wasn't there Fusayama from Japan? Wasn't he involved in this journey?
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Dr. Suh:
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No, actually Fusayama was actually in Japan. You know, Japan all went to self-etch route. Fusayama was talking medical faculty. He's actually [inaudible 00:26:20] faculty and teacher. I know him, but let's say he's the first one, first one had the histology slide came to now Washington, D.C., NIH.
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He gave a lecture in front of many well-known dentist, as well as faculty people. Showing that etching dentine did not harm pulp. It showed histology data. Then, I was sitting back and I saw almost all of them were shaking heads when he said that. That was, at the time, U.S. dentist ... Actually, all the white dentists. All did not believe that using etchant is correct.
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Howard:
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What year was that lecture?
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Dr. Suh:
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That lecture could have been maybe 1992, '91, around '92. I know his story. What he did is actually he was ... So Japan clear for the [inaudible 00:27:33] people had a chemist made some original [inaudible 00:27:38] compound ... product with MDP. Then gave to Fusayama Japanese professor, sensei. He had a test made specimen of dentine bonded specimen and put into water bottle. Then winter time, put it right next to the window, which is cold. He didn't use modern equipment, he just put in there for sunshine, cold and hot weather, and maybe a couple of years later he looked at it, that was good. He believed in that chemical bonding is possible with that and then he tried to do histological study and then he showed that etching dentine, if you did good bonding, no harm done on pulp chamber. That's what he was doing. That was Fusayama.
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Japan, because of ... I know why ... because of national insurance system you cannot spend a lot of time etching, bonding, self-etch direction. So total etch never ... Of course at the time nobody knew total etch, but his idea, etching dentine is no problem, we can do good bonding. Nobody picked up in Japan or anywhere else, I picked up. I met his philosophy, proven. That's why I know him well or so actually, you know Ray Bertolotti?
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Howard:
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Absolutely.
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Dr. Suh:
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Yeah. Ray Bertolotti every year he ... He's still doing in Yosemite seminar. He invited me and Fusayama and John Kanca to Yosemite seminar for one week. That's where we met, Fusayama. Then also, I had to ... He has to go to Seattle, ADA meeting at the time, so Fusayama and me flew together to Washington ... to Seattle. At the time, we shared a lot of ideas and conversation I had.
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Howard:
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What's he doing now? Is he still working?
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Dr. Suh:
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He passed away. He passed away about five years ago. Yeah.
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Howard:
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That was four legends, you Fusayama, Bertolotti, John Kanca. Those are the four heads of dental Mount Rushmore. We should do that. We should make a Mount Rushmore and put those four head on there.
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Dr. Suh:
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Okay.
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Howard:
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And call it Mount Bonding More. You know, looking back at this, it seemed to ... The scientific revolution in materials is what was the foundation for the whole cosmetic revolution.
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Dr. Suh:
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Right, yeah.
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Howard:
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The only reason the 80's and 90's and 2000's was all about bleaching, bonding, veneers, is because it was a revolution in dental materials.
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Dr. Suh:
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Correct. Yeah.
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Howard:
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You were a big part of that. I mean, congratulations on that. You basically changed dentistry. We went from gold and amalgam and partials and dentures, to the entire whiter, brighter, sexier teeth, cosmetic revolution. Which all came from fundamental research and development that gave dentists these new technologies.
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Dr. Suh:
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Yeah. I agree to that statement. If you want to do cosmetic or aesthetic dentistry, you cannot do it without adhesion dentistry. If you don't know how to bond correctly, you fail. I think we gave, or at least adhesive dentistry development and theory plus practical application, all of these things were essential for me and to me. That's why I spent a lot of time doing research and writing papers, talking to people, things like that.
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At the end, I heard many dentists ... Dentists are not keen with the chemistry, so when I lecture will always include ... I cannot just say, do this way, do this way, I have to give a reason why you do that. That is my nature. So, when I do .... when I give a reason, I have to include some chemistry and some people appreciate, some people, "Well, I don't know anything about that." But many people ask me, "Hey Byoung, I know you talked one hour, two hours, I didn't get half of them. I wish I can find something to read it. That would help greatly."
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That's why I decided to write a book. I decided to write a book and so it took a long time. I'm not a good writer, but I can write something in chemistry or translation all of it [inaudible 00:33:08]. So, I did it. Then, I published. That was 5-6 years ago.
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Howard:
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Is it on Amazon?
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Dr. Suh:
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Yeah, actually ... Can you see this book?
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Howard:
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Oh, nice. Principles of Adhesion Dentistry. Nice. Frankie, find me that. So, that came out and how are you selling it?
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Dr. Suh:
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Aegis, aegis.
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Howard:
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Aegis is publishing?
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Dr. Suh:
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Yeah, this is the one.
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Howard:
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And it's on Amazon?
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Dr. Suh:
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Is it on Amazon? I'm not ... I don't follow up. It's published 2013.
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Howard:
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You know what would be really, really, nice marketing for that?
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Dr. Suh:
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Yeah. I think so.
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Howard:
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Is to ... I think a really great way to market it would be to write an article for Dentaltown Magazine, summarizing your book and we'll put that in the magazine. That goes to 125,000 dentists.
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I've been begging you since 2004 to put an online CE course on Dentaltown because these kids now, they don't like to go to conventions and all that stuff. We put up 400 courses, Byoung, and they've been listened to a million times.
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Dr. Suh:
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That's a good idea. We actually, I think we were talking ... Well, Carol was talking to me, one day we should do this. Each chapter maybe once or something like that. I remember hearing that.
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Howard:
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Let's do that, Byoung. It'd be such a honor to have you on there. That would just be just amazing. I would absolutely love that.
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Dr. Suh:
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Okay. Sure.
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Howard:
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So, we'll do an article in the magazine about your book. Then, an online course. I'm also trying to change the culture in the United States where, United States dentists for years they only wanted to listen to other dentists. They didn't want to listen to the dental company. They think the dental company is trying to sell them something.
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Yet, when you go to Europe, you go to the Cologne meeting, you don't have all these lectures. When a dentist wants to know about a company, they just like to go talk to the owner of the company and Americans, it's a totally different culture. I think the IDF meeting in Cologne is a far more psychologically healthy, functional, atmosphere because the dentists there want to shake the hands of the guy who invented this implant or adhesive or whatever.
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Dr. Suh:
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That is true.
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Howard:
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They want to go to the horse's mouth. The American dentists, when I started Dentaltown in 1998, they didn't want any dental manufacturers on there. In fact today, Orthotown still won't. Orthotown, you could only get on if you are an orthodontist because they don't want to hear anybody from all these companies for whatever insane reasons. I stuck to my guns in '98, they said, "Well, these guys are trying to sell something." I'm like, "What are you? A volunteer? What do you do, free dentistry? How come you can sell root canals and crowns to your patients but Bisco can't sell you a bonding agent?"
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It's crazy. The only reason dentists look so good is because of the companies like you created that made us look so good. If you didn't make these amazing products, then we'd be sitting outside on a rug with stuff we bought from Home Depot.
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I want to be a critic of yours though.
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Dr. Suh:
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Okay. I'm ready.
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Howard:
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Now, I want to throw you under bridge, okay? Before bonding, before adhesion, these fillings were amalgam. They were half mercury, and you never find mercury in a multi-vitamin, no one recommends that you eat it to grow hair or anything. The other half is silver, zinc, copper, and tin, which are all anti-bacterial. Silver's used by-[crosstalk 00:37:07]
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Dr. Suh:
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[crosstalk 00:37:08] all those things.
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Howard:
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It seems like when you go listen to adhesive dentistry courses, they always talk about how strong their bond is and the composite, how strong the wear rate is. But in the field, Byoung, my fillings don't fail because they wore down and fell out, they fail because they were eaten by bacteria from the biofilm.
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Dr. Suh:
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Yeah.
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Howard:
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Do you think that the amalgam was better for resistance against the biofilm than the cosmetic revolution of making these fillings, these tooth colored fillings?
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Dr. Suh:
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Yes, actually amalgam was more resistant and more successful because first it's anti-bacterial. Even mercury or zinc or those things. That's one thing. But I think more than that is expansion. When you cure this kind of slightly expanded so have no gaps. If there was gap and then corroded material would block up. There was a reason that although they look good, but it ... use the purpose. So, that's amalgam.
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You talk about composite. Composite part is actually mostly educational gap between dentist and manufacturer of adhesive. What I mean is, adhesive, at least in the market, some of them are good, some of them are not good. I can admit that, but if you use correctly, should perform pretty good. That's one issue. The other issue is a composite. Composite, it's all ... Composite means what, monomer and filler. As long as you have monomers, when you cure it, it shrinks. Now, when you shrink, so called the shrink and stress is exerting on the cavity. What does stress do? Keep it not bonded well or immediately to bond. Especially, change of a flaw, because everything is light curing lifting up.
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What's the result? Sensitivity. Sensitivity is when you have a gap between filling material and tooth. That means you have a dentine tubes open. That's where hydrodynamics area comes in. As soon as you pump the fluid, you have sensitivity.
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Nowadays there's product called the bulk filling material. Everybody calls for it because dentists like to use just one shot deal. If it's a small cavity, then okay. It's a large cavity, even though it's a bulk-fill, if I am a dentist for my wife or my kids, I wouldn't go bulk-fill. Use the same bulk-fill material, at least build up, so you minimize shrink and stress. Adhesion is fighting against shrink and stress. If you through immediately, you immediately de-bonded. If it's do immediate de-bonding because the stress is still there eventually, you will crack.
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What I'm saying is here is, you have to use adhesive correctly and then you should minimize shrink and stress of whatever you're using composite. In that respect, actually self-cure composite is a little better than light-cure composite. Why? Light-cure composite is your curing within 10 seconds, shrink and stress just comes all of sudden versus self-cure, slowly cures, right? Two or three minutes. Shrink and stress will be a little bit negated by flexing the surface of composite. Again, dentist doesn't not like that or so [inaudible 00:41:43] self-cure is not aesthetically good. If I am becoming, I give dentist up to [inaudible 00:41:54] I'll use a self-cure enamel potion like a composite. That will be my ideal bonding. That's what I can say. If you try to short-cut, you will be rewarded with some problems.
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Howard:
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You should do an online CE course on this. In fact, you might want to do several courses on this. This is very profound. The thing I don't understand is ... I get on the dual-cure that it's not quite as pretty as the self-cure but maybe that's true for women, but for men, I'm a dentist for 54 years, I never see men's molars. That's where most of the recurrent decay and sensitivity is. Not on the anterior incisors. I grew up ... All of my restorations are gold.
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Dr. Suh:
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That's the best one.
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Howard:
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You haven't seen one yet. People don't see posterior molars in men ever. Maybe in a woman sometimes, they might see. I think some of this extreme cosmetics on a back molar is pretty silly.
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Dr. Suh:
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That is true. I'm not talking only molar, pretty molars, size-wise, size issue here because shrink and stress is related to the bulk.
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Howard:
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When I look at the insurance data, where they're doing hundred of millions of claims. Then, they line up the 32 teeth, it's just those four, six year molars where you have these monstrous spikes. They're the tooth most likely to get a filling, a crown, a root canal, extracted, an implant, a bridge. So on those four molars, in fact that is the most amazing thing. I want to talk to you about that. The minute that first molar, that six year molar erupts, it's the tooth mostly likely to have everything go wrong with it.
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What would you recommend for the initial sealant? Do you believe in sealants? You're an organic chemist. When you're acid etching a six year molar, your acid etching pits and fissures filled with debris and crud, whatever. Do you think a sealant is a real ideology or do you think those fissures should be removed?
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Dr. Suh:
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[crosstalk 00:44:23] Resin sealant after etching. Applying sealant on young tooth. That's what you're talking about?
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Howard:
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Yes.
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Dr. Suh:
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Well, I think filling fissures is a source of bacteria invasion. So, yes I agree filling fissure sealant will not last long. If you don't etch it, it doesn't last long because you cannot adhere well. Idea of applying sealant in any form, there are so many things lately came out. Certain resin filling with glass, I know people mix it and so on. Application of sealant, I think it's a very clinically worthwhile. Although, it has to be checked every six months or one year but-
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Howard:
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Would you have to check it every six months or year if you removed the pits and fissures? If you took a fissurotomy bur or microabrasion or something.
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Dr. Suh:
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Then you fill. Yeah.
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Howard:
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Basically, an elusive composite, which would be called preventive resin restoration.
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Dr. Suh:
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Well, to me less invasion should be better. Without making little ridge, you can still etch and seal. Now the sealant, again, this is a concept. Sealant is normally, you don't have any solvent. Just resin. Resin itself if not easy to penetrate, okay. Actually, we studied this. If you apply adhesive first, adhesive and solvent.
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Now, wherever you had the fissure sealant gets a little hole there. If you etch and then apply the adhesive primer first, then you apply sealant, the sealant will go far into the fissure area. That's what we know. That has been published, probably in the rest of Illinois.
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Howard:
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A lot of kids are confused about all the generations of bonding agents. It seems like every other year there's a new generation. What generation are we on now? Are we at 10 now? Are we in double digits?
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Dr. Suh:
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That's why I made a slide for that. First, I will show you slide and then explain. Okay, now you see it?
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Howard:
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Nice slide.
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Dr. Suh:
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Okay, what I showed there is I went through all the generations and I had an arrow with All-Bond 2, Scotchbond Multi Purpose. Actually, that's the one I introduced 1990. I explained to you. I called 4th generation universal with these two. Then, six months of one year later, Scotchbond Multi Purpose came in because all All-Bond 2 you could do direct, indirect, everything. That's why they introduced the Scotchbond 2 became multi purpose later on. That's 4th generation.
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Let's just start from there because the 1st generation, I don't think they called themselves 1st generation. Then Clearfill Bond, Scotchbond came in 2nd and then 3rd is Tenure and Scotchbond 2. So, 1990 All-Bond 2 became a total-etch concept in addition, I explained it, wet-bonding concept was there. Then just little bit complained, this is too many steps. So, we simplified to one step or priming bond or single bond. That was still total-etch. Number of steps is the last column.
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Then, Japan came up with self-etch system. That was two layer or two step primer and bond. Then, 6th generation, if you look at it, 2000, Prompt L-Pop was example. It was kind of simple for dentist but there was a very bad product, I can tell you that.
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Howard:
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Was that my Espe, back when it was in Germany?
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Dr. Suh:
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Yeah, yeah. That's what Espe. Actually, this is the product developed by Espe and 3M introduced as their product. But, I can tell you that was a very bad product.
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Howard:
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Do you know where the name Prompt-L Pop came from?
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Dr. Suh:
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No.
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Howard:
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Yeah, I talked to the marketing director. I go, "Where'd you get that name?" He goes, "Well, prompt means fast and it looks like a lollipop. So we called it Prompt-L Pop."
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Dr. Suh:
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Right.
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Howard:
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I thought ...[crosstalk 00:49:44]
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Dr. Suh:
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But that was then, so now I have the two bottles purposes in there. That means that is a bottle and the other bottle you mix it in one step. Mix it and then you apply as one step. Then, I-Bond came up, they said, "Oh! This is improved instead two bottles, it's one bottle." That's [inaudible 00:50:09] because self-etch, what that means, self-etch means you have acidic components, acidic monomers in it. If you put acid with monomers, monomer's not going to survive a long time.
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Anyway, I don't know how I didn't know that but, they came out. They called it, 7th generation. Let's say, okay, because simply by the bottle number. That's the end of generation actually, I can say that. Then, I put 8th generation as universal adhesive. Now, how do remember all these generations? Forget about it.
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Howard:
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Can you email me these slides?
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Dr. Suh:
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Yeah, that's what I'm going to do.
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Howard:
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Okay, great.
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Dr. Suh:
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Before I ship it out. Do you see it?
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Howard:
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I do.
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Dr. Suh:
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Okay, now this one, I made it with animation but you cannot. Anyway, here I combined it all together. I gave little bracket. First are adhesives by layers. Dentists apply primer up on the resin, so each is one layer. If you look at that concept. Left side of the bracket, total-etch 3-step, self-etch 2-step, and example there. Clearfill SE Bond as a self ... it's All-Bond, too.
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So what do you do? You apply total-etch [inaudible 00:51:38], you apply red light indicates, and then that's etched. Animation will take off that, but now this is not animated so it's still there. You wash out, first thing, you apply primer. Next one is bonding resin. Now it's two layer, right?
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Now you go right side of the column, the bracket or row or whatever that is, now this is a total-etch single step or single bond, self-etch single step. Total-etch two step, single step.
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Howard:
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Can you put the animation in a YouTube video? The YouTube video is very easy to share on social media.
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Dr. Suh:
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Oh, okay. Yeah, we can do that.
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Howard:
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Yeah, put it on a YouTube.
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Dr. Suh:
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Yeah, okay. Alright. Now, you see this, you have one layer remaining resin on the right side. Now you see two layer adhesive, one layer adhesive. So, one layer adhesive to dentists it's simple. They will like it, however, as I mentioned L-Pop like material was so acidic, so hydrophilic. Because you had to have water, acidic [inaudible 00:52:58] so it just cured it but immediately water will attack or saliva will attack. That's not good.
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[00:53:27]
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So, it's called very hydrophilic. That's why this could never have the self-etch material until All-Bond 3 or All-Bond SE came out. I knew so much, we did a lot of research on this area. We have something like Franklin Tate, David Pasterly. We worked on L-Pop like product. If you applied it, cured it, you put composite on top and then later when you look at it, water from dentinal tubal can go through the adhesive and accumulate all underneath the composite.
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Then when you test it, you can see water droplet right under the composite. That's when it's bad. We called the all-cured, simplified, self-etch adhesive is permeable and permeable membrane. Hydrophilic and permeable membrane, meaning water can attack.
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That's why I could never market that kind of product. I decided to develop hydrophobic material, All-Bond 3, All-Bond SE. How I did it, it's too much time ... Made hydrophobic means water cannot go through. Then, I found out that through many ... six years of lab test results, if you make hydrophobic material, one layer adhesive is good enough. You don't have to have two layer adhesive. That's what All-Bond U, universal adhesive. Universal adhesive, even though it's one layer, because it is made hydrophobic. Again, you can ask me, but it will take quite a bit of time, so I don't think it will be a good time to do it. Some other time, if we have another opportunity we can do that.
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If it's hydrophobic, now you can be one layer or we have total-etchable or self-etchable. It compares MDP, acidic monomer, I mentioned, but with a small amount of water. Whereas other self-etch product, actually all universal adhesive currently in the market has more than 10% water in it. That water makes the adhesive acidic, pH 2.3, 4, 5, 6. That brings another subject called compatibility between adhesive and sulfur cement. That is, if you have ... Let's say you applied Scotchbond, Scotchbond Universal applied. You dry 10 seconds.
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Do you think that all of water, which is about 10% water will be evaporated or still there? Answer is, water is still there. Then, the pH is still 2.7. Well, then acidity is still there. Then you put self-cure material on top.
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Now, self-cure has a base of catalyst and base contains [inaudible 00:56:48] which is called base again. Acid, base, neutralize it [inaudible 00:56:57] compound. That means, catalyst base cannot react to create free radicals to give you polymerization. Therefore, right in the place where you need cement is not polymerized the bonding. That's called adhesive self-cure composite or resin cement compatibility. In all self-etch adhesive has one monomer acidic, mostly MDP and then some amount of water.
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We have 2.5% water. All the others attempt to but 16% of water in there. What the difference is, if you have only 2.5% water, shows acidic nature when you apply it, but when you dry it, 10 seconds, all the water is gone. It's no longer acidic. That's why sulfur cement can have no problem, no compatibility issue.
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Again, this subject, not many people know. This is called incompatibility between acidic adhesive and total-cure cement. Total-cure means light-curable and self-curable. That's an issue here. Universal adhesive, as we know, we test it. Scotchbond U is very hydrophobic, if you can evaporate water off. We tested how long it takes to evaporate water is about 90 seconds. [inaudible 00:58:46] just to do their job. When you use all universal adhesive, when you dry after application, when you dry it, 10 seconds will not evaporate all of the water in the universal adhesive. That gives you no problem with the immediate light-cure composite, but if you use on top of a self-cure material that interface will not polymerize for you. [inaudible 00:59:20] That is fissure.
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Again, I don't think many people know, but we published this once in a while but not ... We are working on to compare every universal adhesive measure pH, measure water amount, and then bonding tests, and then aging, one year. Immediately you cannot distinguish it, unless you age it. So, we are aging it right now. That's what's going on. In terms of chemistry knowledge, we ... me and our chemist know quite a bit. When I talk like this, that's because his product. I don't do that. It's really a chemist point of view I look at.
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Howard:
|
I think it's a weird culture in the United States when it comes to dentist and manufacturers. In Europe, this is not an issue. European dentists want to know what these amazing ... I mean, you were so passionate about this. You even started an entire company. You've been doing this for basically ... Well, how old is Bisco now?
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Dr. Suh:
|
36 years.
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Howard:
|
I mean, you've been doing this for 36 years. Probably 2/3 of the people listening to you right now aren't even 36 years old. I enjoy your passion, I enjoy the trust and I think it's very dysfunctional to say ... They have these thoughts in their head like Jesus going to the temple kicking over the money changers or something like that.
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But, what the money changers were, those were currency exchangers and they were taking a big margin. The American Dental Association, they still won't even let the people on the floor take a credit card and make a sale because they're a non-profit. Well, maybe you shouldn't follow a non-profit. Maybe that's not good business advice. I'd rather take my business advice from a millionaire than a non-profit, but yeah it's weird.
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I don't have a problem with it, I stuck to my guns and said Dentaltown will be for anyone who works full-time in the sovereign profession of dentistry. Whether you're a hygienist, assistant, dental manufacturer, a scientist ... You have a Bachelors in Science, a Masters in Science and PhD. and most of these dentists, when they go learn about bonding, they'll go listen to dentist lecturer and if that dentist was pulled to the side by an organic chemist, he would show he knows nothing.
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How many of these dentists could go one-on-one with your standard organic chemist?
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Dr. Suh:
|
Well, they are not trained in that. When you talk about lectures, I listen once in a while. Some of the people, they talk ... Lecturers are not correctly talking about, I find many of them.
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Howard:
|
Well, yeah, it's obvious. I know several scientists over the years that work for Bisco, 3M, Ivoclar, and they just sit there and show me the transcripts of what these people are saying. That it's just completely wrong. So, you go to Dentaltown, you should make a great online course, because that was my next question.
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A lot of these young dentists are asking on Dentaltown, they just come out of school, they want to learn more, they want to learn more about adhesion, direct composites. You can't do direct composites ad cosmetic dentistry if you don't understand adhesion. What would you tell that young student, if they wanted to learn more? How could they really learn more?
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Dr. Suh:
|
Well, they'll have to come to Bisco. Actually, that's a very good question. You have to be able to attempt ... First, you have to select the right person's lecture and then listen. If you go to most of the lecturers in the circuit, they don't even know ... except [inaudible 01:03:52] the science behind, so how can they teach. To me, young dentists from school probably has to learn from the basics first, before you can apply it.
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My book is translated in China, Chinese, last year. They are very ... You talked about the younger dentists, young dentists they come to listen to who is lecturing, let's say 3-4 times, paid $200 and then this lecturing guy is a young guy, 37 years old Chinese dentist. He came to UCLA, he went to USC, he went to Germany. He's progressive guy, learned everything.
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Then they approach me, actually. His friend was a publisher, so apparently they were looking for some book, theoretical basic adhesion book. There was no other book. They found my book, so they approached me. "Can we publish your book?" So I said, "Okay." He picked about three or four professors to take out each chapter to translate it. Then, our chemist here at Bisco, reviewed it, okayed it. Started February of 2016 and published in October. Amazing.
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I went inaugural, when you launch the book, I went there to lecture. All of them, younger dentists. I couldn't see many older dentists. Younger dentists are very eager to learn in that area. I go to Korea, too. Younger dentist wanted to learn or spend some time. Aged dentists probably not. Only thing you can do is by reading articles, but you don't know where to start. This book has a lot of references. I think that's one of the strengths, is there is a lot of research references here as well. You can pick up basics from the book, then if you read more you can go to articles. That's one thing I can suggest.
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We do this in Bisco. Bisco Experience they call it. A university like UCLA, University of Texas, Houston, LSU, they are resident lecturers, professors, [inaudible 01:06:58] people, they come to Bisco by the number, pretend 10-20. Then, we spend three days to get a basic course. I talk about adhesion and so on. Bonding right now, when you say adhesion now it involves zirconia. Zirconia bonding, everybody thought you cannot bond to zirconia, but we came up with a Z-prime, which allows to bond to zirconia.
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If you put zirconia short crown, you must bond, otherwise it will fall off. That's what we did and we took ... Actually, this covers the zirconia bonding chemistry and what to do and also bonding to porcelain or E-max. I find that part, not many people understood correctly. I put in chapters for zirconia and bonding to silica, meaning porcelain or silica containing unaesthetic material, porcelain or E-max.
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Howard:
|
What do you think of all this zirconia replacing the BFM? Did you ever think in your lifetime that the famous porcelain fused to metal crown, which replaced the full gold crown would now just be plummeting in market share. It's almost going extinct like the dinosaurs, being replaced with zirconia.
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Dr. Suh:
|
Well, actually I didn't expect anything until last few years. Then, I saw zirconia maybe five years. At the time, I was actually, "Oh, zirconia is such a strong material." I thought you could not even scratch it or sandblasting wouldn't work on zirconia. So, I picked up, I sandblasted zirconias surface. All I can see in a patient under SEM ... "Oh, this is strange." Beyond my expectation at least. Because everybody bragged about, this is a very strong material. I thought you couldn't even sandblast it, but you can sandblast and then-
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Howard:
|
Do you think a zirconia crown should be cemented or bonded into place?
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Dr. Suh:
|
Oh, it all depends. If you are fully retentive, you can cement it. Nowadays they sell decent cement or some people go [inaudible 01:09:50] base. But, it's fully retentive. If it's a fully retentive, anything can be used. All cement, right? But if short crown with a papering, you must bond it. That's where you need the zirconia bonding primer and then the rest of them are same.
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Howard:
|
How would you bond a zirconia crown. Name the name brands ... Name how you would bond a zirconia crown that did not have a lot of retention.
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Dr. Suh:
|
Well, first, tooth treatment is either ... Let's go to this slide. Most of the crown, short crown, that means you are fairly close to the pulp chamber or not much dentine left. You may have a problem of sensitivity. I suggest that universal adhesive, selective-etch mode. Meaning, you etch only enamel, dentine, don't etch it. Then use universal adhesive, preferably All-Bond Universal, which is the best for that purpose.
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Then, zirconia crown side, you'll first lightly sandblast, meaning about 40-45 psi. Because zirconia has a crystalline structure if you have too big particle, you change the crystalline structure from tetragonal to monoclinic. We don't want to do that. This is accepted procedure.
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Howard:
|
What is your recommended sandblaster?
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Dr. Suh:
|
Sandblaster, who did it used to be Micro ... you remember that-
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Howard:
|
The Micro-etch, was that from Danville Engineering?
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Dr. Suh:
|
Yeah, we used that. Danville's Micro-etch.
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Howard:
|
I still use mine and I, gosh, I think they're 20 years old.
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Dr. Suh:
|
Yeah. The important part is how big of particle you use and what the pressure you use-
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Howard:
|
What size particle for the-
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Dr. Suh:
|
Ideally, [inaudible 01:12:02] ideally 30 micron.
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Howard:
|
30 micron.
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Dr. Suh:
|
You can use 120 micron, 100 micron.
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Howard:
|
What is the material aluminum or-
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Dr. Suh:
|
Aluminum oxide-
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Howard:
|
Aluminum oxide.
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Dr. Suh:
|
Yeah, aluminum oxides. Sand. They call sand or aluminum oxides silica particle. Aluminum oxide.
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Howard:
|
Aluminum oxide, 30 microns.
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Dr. Suh:
|
Ideal.
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Howard:
|
Ideal.
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Dr. Suh:
|
You can do 50 microns. So, 30 to 50 micron particle. About 40 to 45 psi. Then, maybe about 1-2 centimeter away sandblast it. Again, another study show instead of, this is horizontal, so instead of going this way, 90 degree on body, go angle 60 degree angle sandblasting. That gives you more retention. Theoretically, you can think if you dent it here you have created this type indentation.
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If you go this way, you have this type indentation. You're kind of helping to hold mechanical retention part. Let's go back. Alumina, 30 micron, ideal 30 micron to 50 micron. Pressure 40 to 45 psi, with about 60 degree angle to the flat surface. Then, you rise it. You have to wash it and then, ideally you ...
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Normally, what dentist does, after you prepare it you go to try it. When you're trying, saliva contains phosphate. Phosphate will react to the zirconia. You will contaminate the surface. The bonding primer will not had a chance to work. Two things, dry it first, and then you sandblast it, clean it, and then Z-prime it. Zirconia primer, we call it Z-prime, Bisco's product, it's Z-prime. Dry it, then use your choice of adhesive. In our case it will be All-Bond U or one-step, whatever ... That part is not that important.
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Then cement-wise, now you have a choice of many, but from Bisco will be either DSM or All-G Universal. It's dual-cure cement. Zirconia has a very low light penetration ability, opaque. So, light-cure won't work completely. You have to have some self-cure ability. When you use dual-cure cement, and what I suggest is, don't try to cure it. Give it time to self-cure it, as I mentioned, self-cure alone, if it's a good dual cement, self-cure will be good enough.
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Let it self-cure and then at the end, maybe 1-2 minutes later, margin, expose margin you can just light-cure just to give little better curing at the margin because it's oxygen emission is there.
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I'll give you one example. I had some crown and my dentist used dual [inaudible 01:15:49] he light cured. I could feel tightening effect from the shrink and stress all of a sudden. That's why I said, if you're using dual-cure cement, let it self-cure first and then light-cure later on at the margin. Just to confirm the margin. I think that's what I will say, how to bond short zirconia crown.
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Howard:
|
You know, Byoung. If you created a complete online CE course on Dentaltown, you could educate so many dentists from Kansas to Kathmandu. It'd be the fastest, most efficient way. You could bring so many people up to speed on the PhD, science behind all of these concepts.
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Dr. Suh:
|
Well, so I am not that young. I'm very, honestly, I'm very happy to hear that. Okay, I will be, as long as my health allows, I will do anything. Of course.
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Howard:
|
You wouldn't want to lecture a hundred all day presentations in a hundred different cities when you could just make the lecture online one time. Then, ship it out to every country.
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Dr. Suh:
|
I agree. Let's do it then.
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Howard:
|
Yeah. I'd really love this. And your credibility, your honesty, your textbook. You started at the very beginning of this revolution. These kids are very confused. They hear a lot of misinformation. They hear a lot of incomplete information and you could just thoroughly educate them from A to Z on this.
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I want to end on ... Can I still ask you two more questions?
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Dr. Suh:
|
No problem, go ahead.
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Howard:
|
You're daughters, you have three daughters, they work for you for years. A lot of women dentists are listening to you right now and they're kind of cringing because when they get out of dental school they're going to go work for their dad at their dad's practice. A lot of them it's just kind of nerve wrecking.
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What advice would you give to the old guys like you and me listening to you, and the young girls that are going to go work with their dad? How do you do that? Do you ever get in troub ... Does your wife ever have to intervene and say ... Is she the referee? How does that relationship work?
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Dr. Suh:
|
In that are, I'm probably very fortunate. I never had that type of issues. Maybe because I behave and they behave. Parent side, I would say that younger generations are very different than the way we were educated. Especially old Korean boy, right? You'll have to not try to dominate, probably really try to listen in and give respect to them.
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At the same time, the younger side should do the same. That's the only way I see it. Also, younger people should acknowledge their parent's side because they are already established if you get in there. First thing they should do, maybe 5-6 years, learn business. Learn how to treat, learn how to react with the client before they exert, "I want to do it this way." Probably delay it, not immediately. I'm sure younger generation they're parent's generation are not exactly thinking the same way.
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But, initially, younger people should listen in to their parent's side first, so that you have a smooth transition for a long time.
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Howard:
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Wise words. My final question, you look way younger than you should. I mean, you look very, very young, a lot of my friends tell me you take anti-aging very serious. What are your ... Are you doing anything high-tech to preserve your life expectancy?
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Dr. Suh:
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Not really, but I look after my health. I do exercise seriously. Also, I play golf. Actually, I was signed up for the Smart Golf Fitness. What that means, is you develop your muscle more related to golf swing, to prevent injuries. Things like that. That's one thing I do.
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Also, I take vitamins seriously. Vitamin C, I have very high dose Vitamin C, meaning maybe between 3,000 to 6,000 a day milligram.
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Howard:
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Really? You recommend that, 3-6,000 milligrams of Vitamin C a day?
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Dr. Suh:
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Yeah, I know. Some people like to take 9,000 milligrams, so normally Vitamin C has 500 mg, 1,000 mg. I buy the 1,000 mg bottle. Lately, I take one pill, breakfast, lunch, dinner. I used to two pills each, so that becomes 6,000 mg.
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Howard:
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Now, why do you like Vitamin C? I know you're very into chemical, chemistry, chemical engineering. What is it about Vitamin C ascorbic acid that you're so enamored with?
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Dr. Suh:
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This is in a way, fighting against the free radicals. All the free radicals a bad thing, it's really something bad. Vitamin C will pick up that. That's [inaudible 01:22:26]. I know I read a long time ago, the Laurel ... Paul Lining (Linus Pauling), the chemist, very famous chemist.
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Howard:
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Yes.
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Dr. Suh:
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He was in Vitamin C. He kind of suggested this is the best thing for you to do. He was actually taking, he talked about it. I listened in that part and I started working on the Vitamin C.
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Howard:
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Do you take any other vitamins?
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Dr. Suh:
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Okay, yeah. Vitamin C, and there's folic acid, a few other things, mycin, that's mainly because of to create better blood flow. I found I have a lower red blood cell level the last few years, so I'm taking that. I do take supplement, Vitamin C, Vitamin B, B12, Vitamin B complex-
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Howard:
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What about diet? Are you vegan or you eat meat? What about that?
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Dr. Suh:
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I eat anything, everything. But not large quantities, I eat smaller quantities.
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Howard:
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Alright, well hey, again I can't tell you how over the years it was so amazing to listen to you lecture. I've listened to you lecture several times. I've been to your facility a couple of different time. I don't know if you remember that.
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I just think you're a legend and you've done so much for dentistry and it was just a huge honor to have you come on and talk today. I really hope you write an article for Dentaltown magazine and create some online courses 'cause I don't think there's anyone who could teach it better than you.
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Congratulations on all you've done for dentistry.
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Dr. Suh:
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Thank you very much, Howard. I enjoyed it very much. I didn't know time went so fast. I hoping to any time, if I have time, you have time, we can always-
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Howard:
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If you ever want to come back on the show, you just let me know. Just email me back and if there's something else you want to come back and say. If you ever want to do it again, you have an open invitation.
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Dr. Suh:
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Thank you and I will. Maybe next time we pick a subject, a smaller subject to talk about.
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Howard:
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You pick the subject. You email ... What I love the most is when you're passionate about something. I don't want to talk about something you're not passionate about. If any dental subject all the sudden makes you very passionate, then call me back and we'll talk about that again.
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Dr. Suh:
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Okay, great.
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Howard:
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Alright, have a great day.
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Dr. Suh:
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And I want to say hello to all the audience and have a good day, rest of the day.
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