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Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356
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1456 Dr. Dennis Brown of Greater Curve on a Different Approach to Class II Composites : Dentistry Uncensored with Howard Farran

1456 Dr. Dennis Brown of Greater Curve on a Different Approach to Class II Composites : Dentistry Uncensored with Howard Farran

9/9/2020 2:00:00 PM   |   Comments: 0   |   Views: 292
Dr. Dennis E. Brown, DDS has been practicing dentistry for 42 years.  He is a Vietnam  veteran.   After leaving the Army he attended The Ohio State University receiving his DDS degree in 1977.  Dr. Brown opened a private practice in his hometown of Owensville, Ohio in October 1978.  Dr. Brown combined his practice with Cincinnati Dental Services in 2018. He is also the founder and owner of Greater Curve.


VIDEO - DUwHF #1456 - Dennis Brown


AUDIO - DUwHF #1456 - Dennis Brown


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It is just a huge honor for me today to be podcast interviewing Dr Dennis Edward Brown DDS who's been practicing dentistry for 43 years he's a Vietnam Veteran thank you for serving our country Dennis after leaving the army he attended the Ohio state university receiving his DDS degree in 1977. dry brown opened a private practice in his hometown of Owensville Ohio in October 1978 Dr brown combined his practice with Cincinnati dental services in 2018 he is also the founder and owner of greater curve the unique curvature of the greater curb matrix band provides dentists the ability to restore both anterior and posterior teeth with predictable tight anatomical contacts the greater curve matrix isolates well throughout the bonding procedure and dentists can restore difficult multi-cusp composite restorations I’ve been wanting to get you on for so long he has a course on dentaltown learning online presents simplify composites by Dennis Brown owner of greater curve tufflemeyer bands uh that's agd number is 250 the course is everyone's giving it five stars um but before we get into this podcast Dennis i know you're from Ohio and uh so was my beloved both of us had a friend Sally McKenzie who passed away yesterday at the age of 69 r.i.p to Sally McKenzie 1951-2020 i just want to read her obituary do you mind if i read her a bit i knew sally that's sandy here oh my gosh Sally McKenzie the founder of McKinney management and a leader in the nation's dental practice management field passed away unexpectedly on September 1st at her home she had moved from Ohio and retired in tarpon springs Florida she leaves a void that will not be easily filled as sally dedicated her career more than 50 years in dentistry to improving the profession advancing the cause of women as owners of dental businesses for more than a decade Sally was the publisher the new dentist opening the door so that countless young dentists could be heard born in Barnesville Ohio to a mother who worked as a dental assistant sally became working for a dental office at age 16 two days after high school graduation she began her first career as a dental assistant at age 25 she taught dental assisting at a vocational program in the public schools of Columbus Ohio by age 30 she started her first business and employment agency for women dental professionals her true business passion her second business McKinney management spanned more than 30 years and thousands of dental offices including mine she helped to advance in personal management profitability she was the first consultant i hired back in like 87 a true task master who frequently described her business with this is my special sauce we can do better sally was known to be a hard bargaining negotiator who would remind her adversaries your word is all you have in life she spoke frequently of the lessons she learned from the friend she counted as her trusted mentors in business Phil Bonner Howard Farran that Johnson and Hugh Dougherty as Bet Johnson said to sally i will be forever grateful i got more than a glimpse of a powerful woman who pulled herself up from nothing to become everything she was a life force when sally entered a room there is no question a woman worth meeting had arrived sally's career can best be summed up in her own words taken from letters she wrote rejecting an offer to sell control of her business after a careful review consideration paying attention to my gut i am respectfully declining the proposal on one important premise i am an independent-minded businesswoman this is what made me successful this is what makes me the happiest salami kinsey leaves her beloved tom Bennett her niece Tara and countless admirers who live and careers in dentistry shelf to save um we were fortunate enough to uh podcast interview her just a month ago uh sally McKenzie um running a dental office during a pandemic was episode 1414 but uh long live sally McKenzie god dang i love her and she'd be mad at me if i was sad she would she would just sit there and say she had a great life we should be celebrating her life um when i was little it was confusing because my pedigree is all Irish and so we go to Wichita to parsons Kansas and when i s and an Irish wake see they were Irish Catholics so um they thought all the protestants cried at funerals because they didn't really believe but the Irish they believed so it was like a three-day drunken fest and you had to uh um stand up and say the most embarrassing moments and just you know just and it was just uh they were all celebrating that this person's in heaven and they were still stuck down here on earth but um god she uh how did you know her um you were in Ohio tell me uh what you knew i had met sally several times you know in seminars and I’m way back then uh way back in the 80s i may have attended a seminar that she had given so but i never have had her in my office resident consultant through that you know i never had her my gosh it was uh when i got out there i knew i wasn't going to spend my whole life reinventing the wheel i first wanted to know what everyone knew about the wheel so i started um bringing in dental consoles she was the first one and uh to this day 30 years later i still hear people say like in my team well sally wouldn't agree with that oh my gosh she was great um thank you so much for coming on the show and uh my god on dental town you are um i mean really you're beyond a legend uh you have um my gosh you not only do you have 2 000 posts on dental town they're not opposed you know one thing about counting posts is um a lot of posts like i agree or i disagree or no way or whatever you know but your poster always cases with photos and showing technique i mean those 1823 post from 2002 to 20 20 18 years so you're doing about 100 posts a year gosh darn thank you so much you've educated so many dentists especially with your online ce course on dental town i got to start off with um you know they say necessity is the mother of invention um what the hell went wrong with your first class 2 composite that made you start the greatest class ii composite uh toefl meyer company in dentistry today well first of all i want to thank you for dental town i mean to me it's a great place to hang out and you know the imagination that took you to have the concept and learn the skills whatever you need to do to make it happen I’m very appreciative so um well let's start the mutual admiration club and it'll only be two members just me and you and we'll just uh meet up and uh I’ll bring the Jamison so you're so what went wrong your first class two composite i assume the patient died i mean to start a whole fortune 500 company the greater curve after this thing i i imagine you're still suffering post-traumatic stress disorder from your first cause to composite well here's what i started doing class twos and you know there'd be times where uh you have a contact but it's a little white and so now you got this dilemma is that good enough you know and then what do you do you look well where am i in the world you know you look at the schedule and so you know the hygienists need you know you're backed up ten minutes so you know then you get the floss out you try that contact again then you'll damp it didn't get a little bit tighter so you know i hated to be in that position and so you know i i thought you know there's got to be a way to just to have class twos be more predictable i don't mean that this happened to me every day but there'd be times where it just you know you'd be caught you know you go why didn't that why didn't that work so um i started looking you know what's causing the problem and basically you know the um we restore teeth as far as class twos we kind of just borrow the old amalgam system where we're trying to wedge and separate teeth apart and uh for compiler for amalgam that seemed to work pretty well and it's almost been reliable well for composites it doesn't always work and you know what we have now is you know our sectional matrices and that's that seems to be the most popular way to restore class twos um but you know there were some problems there um you know some people some teeth just do not give you a paradigm ligament just tight and that no matter how much you try to wedge or place your spring the tooth does not give so once you remove the matrix you got a light contact um teeth with got wide embrasures I’m not sure what a white embrasure is but some you know where you get the composite needs to travel a little bit further than a normal class ii composite so it's difficult to get the composite to extend to the continuous tooth contact and still have a tight contact and there's uh teeth with deep root decay so there you guys you need to seal the tooth the sub-gingival you're trying to seal out the contaminants and still maintain a tight contact and teeth with deep root decay very often here white embrasures as well so you know i saw that that was a problem where my sexual matrix was not always you know there for me um teeth with short clinical crowns little tiny maybe a tiny tooth but some teeth are just not I’m not tall so the time you put in the wedge and all the hardware you needed to separate the teeth the contact would be very occlusal and because there just wasn't enough room for everything and short teeth the whole sectional spring tends to pop off so you know i found that i had problems getting good contacts on shorter teeth and then then you got mods you know with mods now you're placing your wedge to the mesial and you're forcing the two distally and then then you replace your wedge and your sexual spring at the distal of the tooth and now you're forcing the tooth immediately and it's like the two says you know what do you want me to do here you're forcing me back and forth so what do you end up you end up you know very often with a light contact with an mod and the other side's tight the other side light so uh these are the things that that i you know realize that my essential matrices just were not doing it for me so i i started to think um well i had this greater curved band that i just used for classifies and i just had it for me i had a high school student she'd come in and make him up for me and um i called him Laura Vance because her name was Laura but uh in any event she would make these bands and i use them for class fives and one day i said well you know this let's just try a class two with this this greater curveband that i had and uh i thought well what if i just put a little hole right where the contact is and no wedge needed that work therefore I’m just building the tooth in a neutral position and because i know going composite directly on into your teeth work great because I’ve done it for quite some time so let's see if it works on the posterior teeth so after i made the little openings well actually what i do it i scratched where i wanted the hole to be took the band off made the hole put it back on and uh did my composite little bowl i had good contacts you know measle and distal on this mod i said well maybe i got something here so that's basically what I’m doing is I’m building teeth with the greater curve system in a neutral position I’m not worried about wedging and trying to establish contacts in that manner you said so many profound things i don't know even where to start but let's start um i always you know old guys like us should be trying to transfer our knowledge to our replacements and um the technical stuff's easy it's the mental stuff that's hard and so i want to get your experience i mean how many posterior composites have you done in your lifetime I’m thinking ten thousand i i guess you're right i mean oh i don't know 77 so and that you know class 2 composites or composites anteriorly posteriorly that's light blood and dentistry now well if you work 40 hours a week 50 weeks a year that's 2 000 hours if you did one an hour uh how many do you think you did a oh generally you do at least four or five anyway i was in a real practice so i saw those distractions as well so you know it's hard to wrap your mind around um these judgment calls and so i want to go back to um you know you said you did a class two matrix um the contact wasn't that tight uh you're running late the hygienist is waiting uh on an exam and how should a you know a quarter of our viewers are still in dental kindergarten school and the rest are all under 30. everybody sends me an email howardtown.com or puts a comment in the YouTube deal that they're babies and so the patients right you know you're you just finish this thing you go to floss and it's just not quite like you like it but you're running late the hygienist is waiting on exam the um the patient is in pain for six out of ten times they they're on some volume insurance plan where you know you might be losing money or breaking even or making minimum wage um what makes you does the patient have anything to do with your decision of redoing like if it was a dentist in your chair you'd obviously redo it if it was someone who's really into their teeth and takes care of their teeth and all that you do it but what about um you know it's the same thing with having other people pay for your health care you know like say you need a 50 000 knee replacement um the um the 20 countries uh will replace it for you for free of charge um without any co-payment and I’ve always said well if you know there should be a 10 co-payment on all health care because it makes the patient make a better decision um does this patient have skin in the game i mean if you're getting a 50 000 free knee replacement for medicare you should come up with 5000 and if you say and when you say that half of them say uh hell no I’m not paying five grand I’m going to go eat my buffering well then why should my taxes pick up 50 if you don't care and same thing on teeth is it are you a bad person if you sit here thinking okay look this guy he hasn't had his teeth clean in five years I’m i mean doesn't um floss he doesn't brush he doesn't care um and good do you think good enough is um good enough uh for people who don't have any skin in the game versus good enough is not good enough it needs to be great if the patient has a lot of um great you know skin in the game and they really care like you know your patient's a hygienist a dental assistant is a yoga instructor and only eats kale i mean do you do that or do you not or does that not ever play into your psychology obviously you're trying not to have that play in your psychology um but do you believe do you believe that though if I’m in the moment you know i honestly don't think all that if i feel like this has got to be redone it's got to be redone i just bite the bullet and do so um well yeah if it if it has to be redone but I’m talking about the judgment I’m talking about the gray zone it's going to be good enough and then you look at the person as they this is the person i see pretty reliably at least once a year you know that's the person i may let go because when they come through hygiene I’ll be able to follow up and if it just being a food impact just like then what are you doing but my main point was i just hated when i was in that position so i want to do something more predictable so i would never had to not be in that position in the future you know that that was my that was my goal and so you're uh a dentist and the thing i like about dentists is you know dentists and uh podiatrists and veterinarians and chiropractors they always own their own business you know so many physicians don't have any business in the game they're all employees at hospitals and things like that so you already had the business skills of running your dental office um did you see the vision of greater curve i mean how early on did you realize you were this was going to turn into a serious business that helped dennis from Kathmandu to Kansas to Australia i mean you have another uh um the v dental Australia v dental.com.eu is that your company or what is that actually it's I’m a supplier of my bands for that particular company yeah because i know i lecture down under every five years and they were huge fans of yours for years I’m a wholesaler for beatdown so and i have been you know a number of distributors overseas but how many um how many years did you own your own dental business before you started greater curve and my own dental business in like 78 79 uh in greater curve i started o6 it was o6 when i started radar curve and you know and then greater curve got his start on dentaltown that's where i that's where i launched it so um you know i put together a little website it was a terrible website but you know i got it together and i was able to take orders put on dental town and i tell you that first night it was incredible because i put a few cases up and uh actually boost the block because he's been on downtown quite a bit he's wanted to put the first case up because he got him who was it very happy with my bands and did you say it was Bruce lebock Bruce oh Bruce LeBlanc yeah in Louisiana absolutely yeah so i said I’m ready to go i got my website I’m ready to take orders put a case up Bruce so Bruce puts the case up and boy clicks start hitting that case and then you know i by this time i hit a good library cases so i just started putting them on dental town and it was fun that first night it was just a ball because people because it was a different concept you know people have never seen anything like well first of all you know make an opening in the band directly into oral was like foreign to dentists it's like you can't do that i mean i got pushed back you said you can't do that that inappropriate you can't you can't you can't adjust that and I’m thinking that's ridiculous we adjust working contacts we work just balancing contacts um we adjust t for frameworks metal frameworks so what's so precious about this interproximal enamel so and especially when i make the little opening it's a i use a composite burr it's a little tiny football one and it's just a side to side motion very gradual I’m just barely sweeping away the matrix the stainless and just barely exposing the contact and what do i get well um what i do is get a contact that's got both width and a contact that's got depth so what I’m actually doing is mirror imaging the contact with the adjacent tooth so I’m taking full advantage of that surface and what i also love about um what you could do with dentaltown is starting that company um posting on that is um you're connected with your customer so you're getting feedback so you're posting a case so you're marketing but you're connected so if somebody doesn't like something or wants feedback i mean it's all connected i mean it's just perfect when a supplier and the people demanding the supply and demand equation is all connected did you feel that Bruce leblanc um out of lsu in Louisiana um did you feel his feedback uh or did you feel that um his or other county's feedback did it um change anything that you were doing um well not really i mean uh i had a number of dentists using my little matrix before i put it out there because obviously when you start something like this you want to make certain it works so i want enough dentists out there that thought the product was worthy of investing money further into it and so uh that's how i got started with it um and then of course i you know put it on dental town it really took off but the concept really hasn't changed since the day i put it up in those six we have a we have a brass band now which is kind of nice because it's more malleable and you can burnish in emergency contours better than the stainless so the stainless and the brass they each have their advantage but as far as making any real changes that was the only change i really made it's just a material change with the brass so do you sell these all through distributors or do you sell direct right now it's all direct our distributors are overseas but as far as USA it's all direct so talk about that because um it's been it's been an amazing 32-year journey i mean i remember having dinner with john miles um in Chicago at the airport Hilton and he was telling me that um you know the distributors mark stuff up you know 38 40 percent and then he's competing against companies to sell direct like ultra dent and denmat and things like that and he said i don't understand it he says i got a thousand reps in the field but all the orders go through patterson shine benko burkhard and then you know they mark everything up and then when i just get a list of my sales i don't get a list of the actual purchasers of who bought what and now dentsply sirona you know you'll notice the newer companies like tulsa dental their endodontic division from ben johnson that sells direct talk about the decision because a lot of people are seduced with well my god i mean i have instant distribution if i go through a distributor kind of like you can have the greatest products in the world but with no marketing you don't sell any but if you got Walmart to carry it on there 4 000 stores where 92 percent of Americans are within an hour drive but it costs a lot of money so what was the um what made you go direct instead of through distributor well i i just i like control you know i just want the control um i don't feel need to go direct i feel like the words getting out there but i don't need to have distributors uh obviously i use the overseas distributor just because it's you know you know it's way to get into that market but as far as USA is concerned i think most people now are pretty starting to get familiar with the greater curve so i don't really see a need to have a distribution channel in the USA all right but did you ever shop it around i mean did you ever see what the cost would be if you went through uh say benko or shine you know i stay indirect i keep my costs down or i keep the cost down to my to my customers and so you know and so what is the cost right now well you know uh package of 100 is 54 yes so 54 for a pack of yeah which is very similar to you know a sexual matrix a little tiny band it's basically the same cost as using one of those well let's talk about the technicals because a lot of times you know young dentists they're going to work as an associate in some somebody's office and the assistant just has bands there and they might not even know all the different names if they go to your website greatercurve.com um you show a standard band a white brass um and a u-band um why do you have three types of bands all right um i guess each band has a different usage you know you basically have a standard band wide band and a u-band and then they all come in stainless and then they all come in a brass version and so you know the workhorse is this is the standard grader curve stainless steel band the wide band is great if you got like tall teeth or anterior teeth so you know actually i use a coughing wire for anterior teeth which might seem unusual to folks but boy can i get a seal on why i have control of the emergence contour so you know with a mylar strip or a wood wedge you get black triangles you don't get the seal so the greater curve matrix works beautifully for anterior teeth so uh so you got the white band from taller teeth and then the u-band just abandon each actually has a more exaggerated arc and that's really good for class fives because you can slip that down over the teeth and pass the margin and get the you know especially you've got a sub gingival class five you get that ginger out of the way and one unique thing about the greater curve is it just happens to be not that i planned it that way but when you crank down on the greater curb band because of its exaggerated arc it pulls in very tight around the cervical part of tooth so you get a beautiful seal as well so now you got a circumferential seal around the tooth so i mean i can go further now so your new band is good for let's say you've got a real wide embrasure the u-bound see one thing about the greater curve is a standard band a standard tachometer band the traditional been in dentistry forever when you crank down on it collapses into the tube with a greater curve when you tighten it actually flares out and goes up against the adjacent teeth and that's the advantage of a greater curve over a standard matrix band so now we come back to the advantage of the stainless is it's very stiff the disadvantage of the stainless band is it's stiff yeah so when you place it over a tooth let's say you got a d o and the m the measle part is still very tight well a brass band is going to collapse so you want to go with the stainless you've got an mod you might want to go with the brass because it's very malleable and it can be easily placed around mod and you can you burnish in your contours as needed and it's very easy to make a contact opening so uh brass works really well for like an mod and for anterior teeth you know brass is very pliable and it works beautifully for uh the brass version you know brass version wide because most anterior teeth are tall it's a nine millimeter width in the middle the brass works beautifully for anterior teeth so you have to look at the situation you know the restorative requirements and you know you pick the band that beats you know the ability to do what you want so the um the original talpha meyer matrix bands were designed um for amalgams though right no not really not really but the original i they were just for uh i designed it for composites because again if you put a standard no I’m talking about the uh the toffelmeier um you know the generic word uh topham matrix band not yours with an album you can put that standard ban on you can condense your mouth and it will force the band to go up against the adjacent too then it stays there composite you don't have that luxury you know the band overcomes a composite and so when you come to a composite you got to make certain your matrix forms a composite so that's with a greater curve it flares out against the adjacent two so it's up against the adjacent teeth to begin to begin with now you can use a greater curve for amalgams very well i mean especially orange and brazier space so um i want to um i want I’m going to go over your uh um starter kit just because i want to see why um it has what it has so your product starter kit how much is your product starter kit we have two versions uh one is for 120 and the other is 295 and basically um the there's a retainer in the starter kit and the 295 the larger kit has two retainers my retainers that i modify or make for a greater curve they're designed so you can crank down on the band more tightly without breaking also i the little vice portion of the band open that groove up a little bit so the band slips in a lot easier it's a lot easier to get the band in within the retainer quicker so i do some modifications on the my retainers and I’ve been getting a lot of good feedback on my retainers as well so the starter kit um you started with um 96 standard 48 micro thin 48 wide 48 micro wide 48 u-bands 48 micro u bands and i imagine if you were in dental school and you haven't done 10 class 2 composites you're still probably trying to wonder why sometimes you need a micro thin a micro wide a micro why do you need a micro um as opposed to a standard first of all personally i do not use a microphone i just i had dennis who wanted them so i put it out there for them but since i made contact openings through the matrix it doesn't matter how thick the material is so i find this different material is easier to manipulate and work with but some dentists still do not want to put in the little contact opening that's fine with me the microphone is going to work better for them so that's why i came out with the micro thin version oh when i was asked about the top of my i was on talking about the invention do you know who um who invented that thing uh the talpha meyer doctor Benjamin franklin tophermeier and uh that was uh from 1896 to 1963 wow that is just amazing how cool is that um so um so what do you so yeah let's say you're a student you haven't done 10 um you've done 10 000. um it's i i think it's the hardest part of the composite i mean at their stage the game that's probably missing a lower block getting anesthesia maybe patient skills talking to the patient but um what do you think a young student um should think about when they're doing these um composites and contacts uh that now that you picked up over 40 years that you know how could we make them pick up what you know faster wow i can tell you this you know on my website maybe i have too many cases but you go on my website and you can pick what you want to do whether it be a class five class two buildups with the occlusal stamp technique you know i have tons of cases on my website so anybody would want to be educated on how i do dentistry or composite dentistry it's all there on the greater curb website and maybe the uh clinical what is it clinical tips there's a link says clinical tips and there's tons of cases yes there is amazing cases and you got YouTube videos on it and uh all kinds of stuff um so um did you when you started your career were you also doing posterior amalgams oh yeah i mean there was no i didn't do composites when i started my career 78 as far as post here and when we started doing composites back in the day they weren't very good were they no i mean i stayed away from the longest time oh my god when i graduated in 87 um Dr Moore in charge of the umkc operative department gave each one of us a deal to sign an ethics pledge to restorative dentistry that we would not do the newfangled composite junk and we would stick to amalgam fillings and gold restorations and pfms was the new thing and i mean it's just come a long way but my question is and you know the uh the only thing new in life is the history we haven't learned um do you think the composite class ii composites that we've replaced the amalgam with today the ones we're doing today 2020 or let's say 2000 and 2020. um how do how long do they last compared to the amalgams we were doing in the 80s would you say well i think you know the thing about you know composites is meticulous detail if you follow you know you just have to be very meticulous about how you place them but i think they have some tremendous advantage especially now with the more bioactive composites of becoming available if you place a composite like i said being very meticulous about how you do the work i mean i think it's going to last as long as an amount in fact i think let's say this let's say you have a very conservative occlusal amalgam or a very conservative the class is probably going to hold up pretty well if you have a large buildup and you want to do it in composite i think a well done composite that's multiple multi-cusp i think that's going to last longer than the amalgam that was done correctly because i got a ton of them out there that i did 10 years ago that come back look as good as the day i place them i'd be a little aware but boy they're sealed so why do you think every dentist answers just like you do i mean every dentist just answers that question verbatim in my hands you know in mr magic um but it just doesn't show up in the insurance data or the um research i mean you can't go to pubmed or to your friends in the insurance company looking at millions of claims and ever come i mean basically the macro data looks like the posterior composites are about six and a half years and that's being kind to them and the amalgams are 38. i mean how i mean one's metal it's you know they fail from biology recurrent decay and the metal one is half mercury i mean they don't put that in the multivitamin the other half i mean silver that's silver diamine fluoride antibacterial you got 10 and stannous fluoride is 10. i mean the amalgam is metal and it's all toxic anti-life stuff in the biosphere and uh the other one's an inert plastic so you know how i mean it's like saying the plastic fork at kfc lasts longer than the metal one in your kitchen drawer well again it just comes back to you if you're very meticulous about how you place the composite it's going to it's going to hold up well i mean it just is but it's easy i do think i do think the holy grail i mean ever I’ve been talking to those ceos for my whole career and I’ve always i remember sitting down on bob ganley i said you know bob your comp iva claire composites are inert and they're replacing a massively anti-bacterial amalgam and he says i know how would i know the holy grail is to make he says we there's 30 000 chemicals that are antibacterial and he says we we're scouring them and that's the holy grails to make a composite uh that's actually antibacterial well that'd be great i mean the other one he wanted I’m no science guy i mean i just find a material that works for me and I’m just a good clinic i try to be the best clinical dentist that i can be and when you start talking about materials and all that sort of thing i can't help you but because where i was trying to go with this is to the young kids that um we started um with um you know doing amalgams with Benjamin franklin toefl meyer and um so when you started doing um posterior composites you were using an amalgam talphamire uh from the century before and so what i wanted to do is how was the traditional toffelmeyer failing you um to make you um want to start this whole new one what was wrong with the Benjamin franklin i mean was it his name when you tighten it collapses in against the tooth and so composite is very dependent on the matrix amalgam you can force the amalgam in there and it's going to stretch the matrix you can actually loosen it up a little bit allow the amalgam to stretch i mean you can open up the matrix a little bit back in your amalgam and it's going to maintain its shape when you do a composite you can't do that it's too plastic so the matrix has to be perfect and for the for the composite to fit the tooth or to be the way you want it so that's when i came up with the greater curve system because when you tighten that band it spreads out against the adjacent teeth okay and uh so did it did it fail you a little i mean did you um do you think i mean how many years did you do posterior composites with Benjamin franklin alpha Meyer’s amalgam telfmeyer before he had greater curve actually i went to sectional matrices before i did any kind of composites with a cosmetic okay so you went from the top of myer to sectional matrix yeah tonight it was that was the old system where you had a very simple ring you know i i never use the more sophisticated sectional matrices out there now the ones with the you know i mean i just never used them because by that time i was working very well with my greater curve system so i felt i never felt a need to go to a sexual matrix huh that was uh yeah that was a uh it's been a long journey on composite set and then they were sensitive the bonding agent was uh sensitive and the only one that listened to the clinicians remember back then when posterior composites were getting good uh um everybody on dental town um you know if you did a hundred you had some sensitivity you know um what was your sensitivity like with posterior composites in the 80s versus the 90s versus the 2000s versus 2010 to this day so um what year do you think you did your first poster composite oh gee i don't know um i mean did you do them in school you graduated from the ohio state in 77 mid-90s maybe you know i would say that's probably why i quit using album because that's when i started becoming very comfortable with composite and by that time the bonding agents were good enough that again if you really follow the instructions carefully uh he had very clean preps i never really had a lot of sensitivity problems even back then so sensitivity was never a problem for you no i mean i can't say it never but i can't say it was a day in day out resembling a problem though so what bonding agent are you using now um right now uh i'd be honest with you i haven't been in the office since march since the covet thing here so right but i mean i mean your last thousand fillings uh i was i um gee i was I’m trying to think about buying an agent that i used what composite oh i love the activa uh i like activa for a base if it's a very conservative restoration I’ll use active all the way to the cooler surface but it's a larger composite um I’ll use active as a base and then i would place a more conventional hybrid on top of that i think this is a good um question to go to because um you picked um activa which is what i was talking about earlier you know an active ingredient and of course activa is a bioactive composite from pulp dent and that's kind of pulp then sayings and they have a ton of fans on dental town no doubt about it um do you think um the act activa bioactive restorative composite is um really a measurable thing i mean do you think it's the journey towards a bioactive posterior composite that will help defense against by al all the things in biology from archaea to eukaryotes to prokaryotes to fungi i was amazed last year when i never saw it coming when that research paper came out that said that fungi was a absolute crucial component in forming a decay the fungi had to work with the uh streptococcus mutans to form a barrier around and they were working together and the fungus was to block everything around it so uh i mean it's just it'll be it would be so cool to come back in 5 000 years to find out what you know whatever what was all going on uh but do you think um pulp then they're on the right track everybody knows you need something bioactive in the biosphere um do you think um it's a the first to journey into bioactive and do you think it's um measurable and real as of today well again you know how bioactive it is i think it's certainly more bioactive than a normal composite or the standard composite we've been working with quite some time i i trusted enough that you know if I’m doing a crown and i got a very deep self-gingival prep I’ll place bio I’ll place the activa in the base and then I’ll prep on the activa in other words the activa then I’ll be prepping on to structure as far as the margins are concerned and activa both because i would have a very smooth well sealed composite deep sub gingival than some margin crown margin waist of gingival i find that when you do that uh you can even violate the biological width and the gingiva that's just fine um i do this all the time with the anterior teeth you know how you place it well sealed I’ll use activa base on anterior teeth and then put a you know conventional composite on top of it if i want to but i think if you have a well sealed composite sub gingival leave it you know prep your crowns you know and uh don't try to get down to structure 360. i think you're better off prepping your super gingival if you can and have a composite margin i mean let's face it if you if you cement a crown with a composite cement what's your margin it's composite anyway so uh you know if you if you're college you've got a well-sealed composite you've got the field really dry and not dry but you gotta seal off so there's no contaminants and you place an active in there i really have the activa at the sub-gingival area than a crown margin uh i cannot tell you um how much i loved uh in the 80s using those copper bands i mean i was always when i needed drying we take those soft copper bands and cramming around the tooth which leads to my next question um for these kids um so um the greater curve is just i mean you got to try the starter kid this is uh no commercial dennis did you give me any money to come on the show today okay we'll talk about that no i said did you didn't uh but you didn't say okay i didn't hear you did say i didn't know you did say that if i let you come on the show you'd let me wear your wig for a week and uh you have the nicest wig and uh but so let's talk about um retraction of tissue keeping it dry do you use a zero chord and a one chord do you use a two chord technique zero one uh some people are using a diode laser since you know when they when i came out school the first one was fifty thousand now they're down to twenty five hundred um do you um if you did a hundred fillings how many of them did you use rubber band uh talk about the whole procedure okay now you can't lost me are you dumb out for a crown prep no a an um an mod composite on a first-year six-year molar okay that because that that is the most common i mean the four six-year molars and when you look at insurance charge i mean you take the 32 teeth there's four big spikes on this six year molars it's the tooth most likely to have an mod a root canal a crown an attraction an implant i mean my god i mean it looks like to me it looks like at least a third of all the dollars that chan's hands have to do with that six year molar which blows my mind that um dentistry pediatric dentists still want to put a sealant on a six-year-old some crappy sealant where you acid etching pits and fissures filled with oreo cookies and doritos and you're trying to bond to enamel dude you're bonding to a graham cracker and to drill that out and do an occlusal composite or to take microair abrasion and clean out if you just take microair abrasion sprout pin fissures you're in detona 100 of the time but i just think the sealant should be replaced with a preventative resin restoration and i think that if they're girls make them tooth colored because they're all really into that peacock thing uh like ducks like you know one duck is the mallards really pretty and the other one's just brown and um the um i think that um boys i think their sealant should be a preventative amalgam i mean just you know it comes in prep it out do your amalgam and i bet you that tooth wouldn't even nothing would happen until they were 40 years old but that's a whole other lecture but yeah so let's go to the sixer molars and the mod composite okay so you mean how i restore that i mean let me go through your technique do you use a rubber dam do you use cord retraction do you use a laser for tissue mod composite first of all yes um you know a lot of these are you know very deep some gingivally and so you got that to deal with and so i don't necessarily use a rubber dam because sometimes you get these real deep sub-gingival composites and the rubber dam for me just gets in the way i find with the greater curve matrix that you actually get very good isolation because you got a circumferential matrix around the tooth so I’ll use some you know little dry aids or you know some absorbent triangles in the buccal mucosa let's say we're working on three um with the greater curve band if you if one side of the prep is very deep and the other side is not so deep you can actually trim the band on the cervical portion allows the matrix to drop all the way down and again because the greater curve when you tighten it pulls in very tight so you usually get a very nice seal at the at this at the base of the prep so now you got it sealed i make my little contact openings ready to go so i will i would then just finish my composite like i normally would with your bonding agent you want to you know i probably do a activa base and then do a conventional hybrid on top of that and then you know people always say well you know you made an opening in the matrix now your contact is bonded to the adjacent tooth and i say yeah that's true that's fine uh what you'll do then you have to realize the bond is against a very smooth surface and you know you the contacts you know let's say the contacts may be a millimeter and a half wide and maybe a millimeter deep so it's not a hard surface so I’ll use a little I’ll use a spatula metal spatula and you put it between the teeth and the matrix and you torque it a little bit you tell your patients you're a little pop because you're going to break that contact that bonded contact in fact it actually has a name it's called a mopper pump by you know it's a buddy mopper came up with that term when he would pop contacts and so you tell the patient you're a little hear that and they think oh something broke you just prepare them for it and then you remove the matrix you i use sema stacks and you clamp the hemostat on the matrix and you give it a little bit of a twist to pull the greater curve band laterally you know just has to move just a half millimeter and it'll come right out and sometimes you may have to put a serrate saw you know some kind of separating disc not separating this but a little i use a series saw by then that it's does it looks like a little hacksaw but it doesn't really take away composite and move it through the contact but i have a very nice contact you know because it was a direct contact i built the tooth in a neutral position so i have a good contact visual and distal and i did it without wedging i was able to build in contours as needed and so i didn't have all this complicated expensive hardware um that with the sectional matrix you know one thing about the sexual matrix things um you know they look good but you know after a couple of sterilization cycles they start looking bad and uh you know they lose their attention and then again your assistant usually ends up throwing those out and you need to replace them because they're so small so again you just need a top more band or being a greater current band or top of mirror once in a while I’ll wedge it not in the sense of I’m wedging in the traditional sense of separating teeth I’m just simply placing the wedge here to hold the matrix up against the margin uh you mentioned the serie saw by dr bob ibsen at denman I’m trying to think who was that dentist that lectured all around the country for 40 years who loved this series i was from new york um i don't know i met i met the inventor at one time must have been him so uh was he a new york guy in new york i could say oh my god and when you come out with this um did you go did you show it to a Harold burke the founder of pulp then cur corporation when you started your greater curve did you go uh you're using activa that was started by um pulp then it was started by dr Harold burke did you go show it to him did you try to get bob ibsen's feedback at denmat uh dr Harold burke's feedback at pulp then did you look at those kind of colleagues for help or feedback or you know i just you know started just started doing it and put it out there and you know let dennis decide whether it works for them well i mean i love the i love that necessity is the mother of all invention and you're a doctor you got eight years of college you already learned your math physics chemistry biology running your own business uh you just did it i was just wondering if there was a how the community of the existing people out there of the dentist that had companies if they were more your uh if they were helpful they're friendly allies or if it's competitive i mean when you go to some business world it's like uh oh who's that guy Kevin O’Leary on shark tank he's he says my god if my competitors were drowning the first thing i do is stick a hose in their mouth and I’m like slow down spanky i I’m competitive but I’m not sticking a hose in someone's mouth that's drowning but uh i was just wondering if uh the other dentist owned companies like dan fisher of ultradam bob ibsen those guys came to your aid to help you to help you along i i never made any real contact with any of them because they really reached out to me a lot when i when i started going and when i started dental town uh bob ibsen called me up and he goes I’m just he goes you know he goes i don't know you and i hope you're smart and uh um he goes I’m looking at your advertising deal i just i want to buy the uh inside front cover the back cover the inside back uh I’ve never even read the magazine i just don't want this concept to fail he goes you know having a website community where all the dentists can go together and talk remember this five years for facebook he said this is so important um just um here I’ll buy those three ads for a year send me the bill he goes i don't want you to fail so i was wondering if um people who sell composites like bob bibson or dan fisher's like you know these poster composites and making tight contacts these are this is such a pain in the butt it'd be good for the whole industry if dennis could uh make their contacts faster easier higher quality lower cost yeah i mean that's what i that's of course that's my objective uh but as far as you know hooking up with any of these other companies nobody's ever approached me and um christopher hitchens uh told a story about there was um an atheist on his dead bed um it was his mentor hitchens was an atheist but it was his mentor and when he was on his deathbed um catholic priest and everybody kept coming because they knew he was going to confess at the end because he didn't want to go to hell and here you are um you just confessed on dentistry uncensored that you don't use a rubber dam so I’m thinking at least what 80 percent of all the townies they already know you're going to hell so are you going to be uh the chief dentist in charge of hell is that is that your goal talk about that because is it extremism because we go through all this stuff where you know um when they told me i had to practice under rubber dam the rest of my life the first thing i did is saying well that's easy i just went in my operatory and i tacked a rubber dam right to the ceiling and i thought damn i um check done that I’ll always practice on a rubber dam but then you had um those um mouth um what's the isolites come out um you got if you know there's all kinds of different assistants but you have an assistant that can retract the tongue so talk about rubber dam because it is uh it's not a venial sin it's a mortal sin uh all people do bonding posterior without a rubber dam I’m pretty sure are going to go to hell due to the comments that you see on social media so talk about the rubber dam because don't you agree it's taboo i mean and a lot of dentists i guarantee if they were 30 years old they don't have the guts to go on social media and say i did this without a rubber dam all right i do most of my dentistry without a rubber dam gosh so that that's out there because i i get the isolation i need i mean now if i couldn't get the isolation rubber dam goes on there but i just don't see it's necessary i know i have my own version of isolation it's available on dental town it's called the saliva injector yeah slide injector holder you know i work with that and i use the uh the neo drys and actually i use the neo dry on the lingual side with my saliva injector holder and i have my greater curve matrix which is circumferential seal around the tooth and so i have no problem keeping saliva out of my preps now and one thing i had one time or once in a while with a rubber dam is you know unfortunately saliva and bonding agent kind of look alike so once a while you have a little bit of leakage underneath the rubber dam and you're going is that saliva is that bonding agent well i don't have that problem without because i don't use a rubber dam i can tell if I’m getting leakage so i find i can do great dentistry without using a rubber dam and this way i am um do you feel i mean you put an online ce course on and in the middle of the pandemic uh you did that on 6 25 just three months ago um do you feel um talk about that course and do you think people listening to you right now would have um i mean the objectives are accomplished excellent isolation uh did you think they would really learn um everything you're talking about right now if they watch that course you know i introduced my saliva holder in that course and i show one case where the patient had this very bulbous tongue and he was overweight and very thick buccal mucosa and i with the neo drives and using my saliva ejector holder i was able to do a crown on a on a second mole a lower second hole and i agree that isolate the fact i use it when i see through the crown so uh in that course you'll see how i use that saliva ejector holder okay um i can't believe we went over an hour and you have an online ce course where they could get you know very well done very well reviewed everyone loves it since you've already admitted you're going to hell anyway um and by the way do you have a roommate um if you're looking for a roommate i remember i remember in dental school umkc had this i had looking for a roommate list and i put my name on that and george rui called me up and it worked out perfectly have you signed on a list for a roommate or anything do you know in hell because you did something else i mean if you weren't going to hell the first time you sold to a dso right you sold your office to Cincinnati dental services with dr Larry s frost um talk about that um what was that like how many offices does uh Cincinnati dental services have how many are they up to i don't know it's less than 10 i think they had maybe eight i i couldn't i work out one of them exclusively uh for me that's been a great experience i was somewhat reluctant you know because i had control but this worked out beautifully just because uh i said i want to be able to do photography or i want to do video and it's fine do it i say i want to use certain materials and i want to have control of my treatment plans they said fine and they have never said a word about how i want to do my dentistry so it was the best of both worlds i could just be a dentist all day and play dentists all day and not worry about all the other stuff so for me selling my practice to uh to joining up with Cincinnati dental services was worked out beautifully so you're right they uh they do two four six eight who do we appreciate they have eight offices around uh Cincinnati and this is what I’ve been telling everybody that i you know i don't like the term dsos because it includes you know a guy with like larry with eight offices with a guy like bob fontana who's got 800 and you know um so much of the uh it's so difficult to wear all those hats in dentistry that you got to start limiting you know if you're going to learn invisalign when anybody tells me they're going to learn something i always say okay well what are you going to give up because don't tell me you're going to master placing implants and endo and invisalign you know you can't do everything and when you just have one layer then you can bring in full-time people for just hr accounting um bookkeeping um you know uh marketing it's just it's just easier i just they just do but they can take advantage a very low cost uh advertising on radio and tv that's been decimated the prices on radio oh my god when i got out of school i couldn't believe people paid that for a radio commercial now you can buy an hour uh for a hundred bucks in phoenix you know um so i so one layer one flat i don't care how big they get if they stay flat but um having a second layer i just don't see i have not seen how it works and obviously wall street hasn't seen how it works because none of them are publicly traded so um so you're just working for one family um are you are you retired now or are you going to go back or you're going to go back you're going to go back i think once this covet thing all kind of we get our vaccine and i tend to go back i was i was down one day a week which was just perfect they were comfortable with it so i intend to go back and start a game uh finally but so but are you staying out now because you're kind of want to avoid the coronavirus yeah I’m 73 and i think I’m healthy enough i go back but uh jennifer my wife says you're not going in there yet so when she gives me the go ahead I’m in so what are you still doing for jennifer how come jennifer wants you alive and not dead with the insurance uh premium is that who you're looking at right now tell her to come to the screen as a witness I’m calling a witness tell jennifer to come behind in front of the camera and tell us why she still wants you to stay alive it sounds like you're underinsured have you have you told your life insurance broker i don't have enough insurance because my wife still wants me to be alive but do you feel um but that dso they're running eight offices do you feel that it it's that like you're at home i mean that you uh treat other people like you want to be treated you tend to go back i really enjoyed it uh i mean i still it's nice i go i go in to do destroy because i want to not because i have to and so you know that's great and again i can do dashboard play dennis all day not to worry about all the other stuff involved with the practice so that's why it's worked out so well for me and how old's larry now larry frost larry foss the uh founder of uh Cincinnati dental services i guess he's my age i don't know 73 and do you think he's going to stay a small you know a very large group practice aid or do you think he has ambitions to go you know bigger do you think he has an exit strategy where one day he's going to sell it to another a larger dso well you know i think you know right now there are American dental partners as it is so oh okay that's what i did not know so he he sold the American dental partners it is you know how i don't know what that relationship is but he's with American dental partners because that's the game in dsos um their exit strategy is um they're not they don't go public on nasdaq like snapchat can they um they just you know one uh they'll you know the first time they'll play they'll play with somebody who'll throw in five to ten million and then their exit strategy is out someone does you know ten to a hundred million and then their act strategy someone does hunter it just it just keeps giving it to bigger fish that's what's going on now um but um but you're happy there I’m happy there because they still act you know i could still be independent how i want to do my dentistry you know that changes then you know I’m out of there i don't need to be there but right now it's just a great relationship and you know and the hygienists they have in the organization are just wonderful they really care and they do great work so uh everybody really strives to do the best they can that is awesome and so final words um well you give final words to the graduating class of covid 2020. they just graduated three months ago uh my gosh last year at this time there would have been 5 000 help wanted ads on dental town for associates with 1 000 practices for sale now there's 2 000 guys selling their offices and only 1 000 jobs out there and it's all dsos like Cincinnati dental service has eight offices that now they sounds like they sold to American dental partners um what advice would you give and that that's why i love the dsos they're the only ones employing uh my new homey replacements i just got at a dental kindergarten school but what advice would you give to these young kids that I’m 400 000 in debt they're underemployed um they're in the middle of the pandemic what would you say to them nice i don't know it's hard for me to give advice to them in that regard because i never was in that position so you know i i could just say you know you know keep your integrity keep your integrity and do the best dentistry you can and educate yourself you know just keep being and beyond dental town i mean that's a wealth of information whatever you have a question about you can go in dental town do a search and you're going to you're going to find an answer and so just constantly educate yourself you know get better and really get better at the basics place wonderful composite restorations that hold up and do well you know get good at you know extractions because that's always going to be there and so just like i said just be good at the basics you know get good at some basic perio so you know have that basic there and then once you have that foundation and you want to move out on your own fine then you can start you know specializing maybe implants i think you know a general density does his own implants i think would be a good place to go so uh that's that would be my advice you didn't mention endo getting people out of pain right you know yeah be good at end though i mean but now with all the instruments and the different techniques and uh armaturium that's available endo a general dentist can do really good end though so you know when you talk about more in those and i get a little bit because i think you know when it comes to more endos i think you really had a good endodontic they have a ct you know machine because there's so many hidden canals and so easy to miss them but i think you know from my customers forward you know i think a general dentist can do beautiful window well let's talk about that because we know that if an endodontist is a molar root canal in five years five percent extracted and if a general dentist like um does it it's ten percent um you have scale in group practice do you have a does Cincinnati dental services have a full-time endodontist uh that goes uh into the location to do the endo or do you have to refer um so but when you were there but when you left um did they have any specialists rotate in the office oh they had a periodontist who was very good he placed implants and did perio she placed she placed implants yeah so let me just uh let me just finalize with one little um detail there so what the dsos are seeing is they um they get kids in um they graduate they teach them how to place implants and then two three years later they're gone and somewhere else and then on implants um if you do five implants and one of them fails it takes the profit dollars from the first four to replace the fifth so there's no money in the game um if you're not unless you're redoing your own failed implant for free where your free labor and then it still costs your opportunity time but you obviously have opportunity time on the opportunity cost but um the dsos um they want endodontists doing all molars and they want oral surgeons or periodontists to place all implants because you're not going to grow a scalable profitable dso by having general dentists especially the young ones the first five years out of school holy moly um if they place 10 implants for you before they you know they change jobs every year millennials do from here to fang stocks um but if they um place 10 implants in and do a hundred molar endos for you um you will not make any money if you stand behind your work warranty everything we've always warranted everything five years um you know you don't you want to you know so uh so that's kind of the future but hey buddy between me and you your product massively helped me it was so awesome when that came out i mean uh my gosh i loved it i still love it um you've done so much for dentistry and you're the time you've spent posting 1800 cases i mean you're just so selfless you're just a hell of a guy i truly love you i respect you and I’m sorry that you're going to go to hell when you die well meet you there i guess all right and when you get there if you need a roommate just uh go to the sign up sheet and write your name and I’ll uh I’ll be rooming with you so uh um have a great wonderful pandemic and I’ll see you on the message boards well i'd be might as well let people know you know hey if they wanted to call the office it's you know it's eight six four wedges but you might say well how do i get a phone number with four wedges you know it's eight six four nine three four three seven which you know is eight six four wedges i at one time i had a car numeral four then wedges w e eight six four wedges you might wonder why i have that because you know I’m not I’m sort of anti-wedge because it's not needed but i had a carnival wedge at one time it went nowhere so i still had the phone number so i kept it so that's how that's how we got eight six four wedges and uh anybody wants to you know I’m happy to answer questions i do it all so what's the number without the four wedges eight six what uh four nine three four three seven four nine three four nine three four three seven three 3437 spells eight six four wedges wow okay well uh another you know if they want to email me you know it's info you know just a generic info a greater curve always happy to reply i mean i i spent a lot of time on the phone with dennis so anybody wants to speak to me personally has any questions not a problem so if they want to talk to you personally it's eight six four wedges and i mean and uh yeah the nine is a w you're uh very good well hey dennis thank you so much for coming on the show um you definitely left the playground to dentistry better than you found it thank you for doing so much for dentistry and uh have a rocking hot day thank you very much howard thank you have a good day as well thank you
Category: Restorative Dentistry
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