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AUDIO - HSP #154 - Stephen Kuzmak
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VIDEO - HSP #154 - Stephen Kuzmak
Learn Dr. Kuzmak's approach to anterior composite dentistry, and his dental idols from Dentaltown.
I was born and raised in the Baltimore area. I attended University of Maryland Dental School and graduated in 2007. There I was a class President and also ASDA president.
I attended Towson University, graduated 2003 in Bio / pre-med, and also had an art scholarship.
I joined Dentaltown as a senior student and have been active ever since.
Around 2012, I came across "The Disciples of Smithson Thread" and obtained focus and direction in my clinical dentistry. Outstanding direct composite dentistry is my clinical focus, passion, and obsession.
Howard Farran: It is a huge honor today to be interviewing a man on Dentaltown who's a legend with 5,000 post time with me. My god. I'm a huge fan of yours for a long time. You've been a member since 2007. You don't look old enough to be on Dentaltown since 2007. I think you started as a dental student, didn't you?
Stephen Kuzmak: I did. If I shaved, I'd look like I'm in dental school but yeah, I started as a student. I signed up formally I think right about graduation time but I had been following Dentaltown a little bit and got signed up. I think that summer, I came out to the first [vegas 00:00:45]. It might have been the first time I was a dentist but maybe seven, eight months after graduation and 2007, that was the year I'm at Dentaltown.
Howard Farran: You know what? I have to check. I laughed so hard because every time I meet a dental student, they're always telling me, "Oh, yeah. We just sit in the back row and surf Dentaltown on our iPhones during our boring lectures at school."
Stephen Kuzmak: Exactly.
Howard Farran: I'm saying, "Oh, my God. That is hilarious." What I want to get you on is you're legendary in your anterior cosmetic work, your direct composites. Would you say that's your forte or your main focus?
Stephen Kuzmak: I'd say it's my wheelhouse. I have the schedule and then I have the anterior case. Everybody out, be quiet. It's go time. That's definitely my forte. It's what I enjoy probably the most as a dentist. It's one of the things I enjoy most, I mean outside of spending time with family and loved ones. It's pretty much a hobby. It's an addiction.
It's something that gives me I guess my art fix now which is nice to have that at times during your career to have something that is on that ... Somewhere it's got a passion center and a happy center so when I do anterior resin, it makes me happy, I really enjoy it. I have a bit of artistic side of me and I think it comes out with anterior resin more than anything else in dentistry.
Howard Farran: I have to admit I love dentistry, too, and I love family. I have four boys. I was so excited because this morning, I won by two-thirds majority at the Outstanding Father of the Year Award. No just kidding.
Anyway, I like to talk about not whatever [degree is on 00:02:37]. I always say success is about how many uncomfortable conversations you're willing to have. Let's start with the most uncomfortable conversation in your wheelhouse and that is: If it was your own child and they needed veneers, would you do direct composite or would you reduce tooth a millimeter and do an indirect porcelain veener?
What do you think of laminates where you don't reduce anything and you [cement 00:03:07] a fake fingernail on the front of the tooth? A lot of the dentist say, "Well, I'm not going to do that because it thickens up the tooth." I'm like, "But this girl already has augmented boobs. She has clown make-up all over her face or hair has got all kinds of chemicals, wax, mousse. Am I being weird of preserving tooth structure?"
What would you do if your wife, your sister, your mom wanted a million-dollar movie star smile? Would you do direct composite? Would you do laminates on unprepared teeth or would you reduce the teeth a millimeter and a half do indirect porcelain veneers? How is that for an opening question?
Stephen Kuzmak: There you go. Big discussion. Big discussion. I think every case is different. You'll hear that all the time. Dentists say, "Every case is different in my hands" and that kind of thing. Largely, if they're young patient, I'm more comfortable with direct. If they're an older patient, I'm more comfortable with direct. That's just me in my wheelhouse.
Howard Farran: You said younger, direct.
Stephen Kuzmak: Both direct.
Howard Farran: Both direct.
Stephen Kuzmak: I like direct. I mean you'd probably be surprised how little ... I put a bur to a tooth for anterior stuff. Usually, I don't have to. A lot of times, I'll do veneers and I'll just grab the most [bulbous 00:04:27] line angle and let's just leave that as the distal lobe and do a three-quarter veener off a distal line angle and rotate it out. You can always remove tooth later if you have to. I think it's better.
If you're going to remove some tooth structure if they're over 40, the pulps are starting to get smaller. I think you're going to set that tooth up to hopefully see them through life. I think if you go indirect early on [and do reducing 00:04:55] tooth structure, you're setting that tooth up 50, 70 years down the road to maybe a questionable prognosis. That's just my hunch.
There's times when you need to do a crown or you maybe need to do a three-quarter crown with some of the risk factors and that kind of thing. I'll tell you what. I had my aha moment with direct. It actually came from a Dentaltown guy named Tif Qureshi who did the Inman Aligner CE on Dentaltown.
Howard Farran: Out of London.
Stephen Kuzmak: I took that. He's also really good at Class IV's, incisal edges and bleaching and bonding. He showed me cases that I thought were impossible without going to really using some kind of lab-fabricated veeners where he would whiten teeth, align them usually with an Inman Aligner, sometimes even intrude or extrude a little bit and then he would just do whitening and then he would do really nice composite resins to finish off shapes and colors and that kind of thing.
I couldn't get over it. "Really? You're not touching these teeth with a bur or you're not ..." It's just something that was foreign at that time. That was a couple of years ago where that's really become what ... I think it's a good way. I think if you can do less to a tooth, the better it is. At least in the front and then putting risk factors aside.
Howard Farran: When you get excited about anterior composite case, what kind of case are you talking about? Are you talking about indirect veneers or are you talking about just Class III's, Class IV's, interproximal decay? What cases get you the most excited?
Stephen Kuzmak: Composite veneer. The whole tooth. Probably the most excitement is a single composite veneer to match the adjacent central incisor. That's the one.
Howard Farran: Okay. My number one complaint on podcast is you don't do enough. I think the reason podcasts are going to explode is because when we were little, we had a weird behavior where we could sit in a chair and read a book with no pictures and most people, they just weren't readers. They'd always say when we were little, "All readers are leaders. All leaders are readers."
But now, I think reading has exploded because of Amazon and iTunes and now little kids are doing audio books while they're riding their bicycle or they're playing or they're on a treadmill. Most of my fans, about 7,000 dentists are listening to [Bershow 00:07:20] now they all say the same thing, "I got an hour to commute to work" so they want more podcasts. They got an hour drive to and from work five days a week so they want 10 a week.
The second biggest complaint and I'm going to throw that on you is they go, "Be more specific." What composite? What bonding agent?" Can you just sit there? I don't want to bore you to death but can you walk through for my listeners just the infinite detail from what type of bur, what type of bonding agent and just walk us through an anterior direct composite case?
Stephen Kuzmak: Oh, sure. Sure.
Howard Farran: Let's do it. Let's do it.
Stephen Kuzmak: What happens to a tooth? Let's say you want to do a ... How about a broken down, big Class IV, number 8 and it's discolored? You want to do that one?
Howard Farran: Absolutely.
Stephen Kuzmak: Let's go for it. All right. Number 8 is discolored, broken down. They come in. Let's say you have an hour to get this down. They come in. It's broken down tooth. Let's say it's even under treated but still you have a lot of tooth structure left where you don't need really ... I think anterior teeth do really well but I like to put off crowns so I want to go right to a composite veneer. The first thing I'm going to do is numb him up, rubber dam, go to a Sil-Tech Putty. I sometimes will double up on the hardener when you mix it to make it set a little bit quicker and do a Sil-Tech Putty with the broken tooth. You're not going to build up a tooth and do a putty stent. You're going to leave the tooth broken.
Howard Farran: Okay. My job is to estimate questions that the listener is having so that they [know them 00:08:57]. What's a Sil-Tech Putty?
Stephen Kuzmak: Sil-Tech Putty is I believe ... Oh, gosh. Who manufactures it? I'll have to ... I bet it's [put in there 00:09:06].
Howard Farran: I mean is it a polyether, a polyvinyl, an impression material, a ball or ...?
Stephen Kuzmak: It comes in a jar. You got the canister. It's like a putty except it's very accurate. Then instead of a putty with another putty, it's a putty then you add a gel hardener. You mix the two together and then you hold it up palatal and also the incisal in the broken part of the tooth and after about two minutes, it will set up fairly firm but it'll have a little bit of flexibility.
Howard Farran: Why do want this?
Stephen Kuzmak: When you do this, now you have a palatal matrix of the broken tooth and you have an incisal shape of the adjacent teeth. You then cut off at the facial plane all the stuff above in front of the facial of the incisal edge and you approximate it in the broken tooth. Now, you have basically just the palatals up to the incisal and then it's off. You then take a flute ball composite bur that I think everybody has. It can be any number of flutes, and I think mine are 10 flutes, and then you actually drill out in the putty that broken piece to make it look like the adjacent tooth.
You're doing some work in the putty and patient is sitting there. The more you can do it away from the patient, the better. You then bring that putty over, line it up, take a look at the shape in your putty and if you like it, you put Teflon tape on the two adjacent teeth, etch your tooth or go ahead and maybe remove maybe four-tenths of millimeter on the facial or three-tenths, just a little bit of room to opaque it out if it's a dark tooth. Then you get an etch prime bond. I use Total-Etch with OptiBond FL then you go ahead ...
Howard Farran: That's [coat 00:10:45]
Stephen Kuzmak: Yeah. It's what I like. Then you go ahead and then you have now a bonded tooth with Teflon tapes on both sides. With a Teflon tape on the adjacent teeth, bring the matrix back over and you'll going to take it off and you put in a palatal posterior composite that is going to then start working the palatal enamel. That's called your palatal shell. You take it on the matrix. [Stab 00:11:13] it there. Bring it up behind the teeth and then you connect it to the palatal enamel on that tooth.
You can then cure it, 10 seconds with a VALO Light, remove it and now you have a palatal wall. Now, you have your broken tooth a palatal wall. Then I use a Bioclear posterior. Actually, for me they work really well to go ahead and approximate the broken edge. I now place a Bioclear or you can use an anterior but I like to cut it back a little so I can get in and work it from the facial first to the incisal [inaudible 00:11:47]. Then I work it from the facial, use a Bioclear as my proximal matrix and then I'll go ahead and cure that and again, it's usually that palatal enamel shade.
Now, I have the outline of the tooth all ready to go for body shades. At that point, I typically almost start to finish use Cosmedent for everything for the anterior. Cosmedent tints, microfill, facial and I'll usually then use a nano of the color I want to use. A2 Nanofill. Nano replace most of the dentin. At that point, I will then use the Solar A2 microfill and replace most of the enamel surface but I'll leave some room if there's a mamelon development or a proximal that looks kind of that achromatic enamel shade and I'll leave some room for Incisal Light microfill and then I'll go ahead and apply that as well and then cure and then you go to polishing and shaping a little bit. That's my technique.
Howard Farran: What percent of dentists have never used the putty? What did you call it again?
Stephen Kuzmak: Sil-Tech Putty.
Howard Farran: Sil-Tech Putty. What percent of dentists would you say have never used Sil-Tech Putty for that technique or the Teflon tape?
Stephen Kuzmak: I don't know. Oh, gosh. Maybe 20% have used Teflon tapes. Sometimes I'll say Teflon tape ... I can't go a couple of hours at work without Teflon tape or something. People [are going to 00:13:11] say, "What do you mean?" Yeah. I use Teflon tape a lot.
Howard Farran: I believe you're correct. Four out of five dentists have never used Teflon tapes. Explain what Teflon tape is. Where do you buy it? Why do you use it?
Stephen Kuzmak: Teflon tape. Plumbing aisle, Home Depot. There's three or four colors. You just got to get white. Don't get the real thick stuff because then it's too thick, just the ... I think it's five-eighths inch thick.
Howard Farran: Plumbers use it because if you put it on the grooves when you screw in the grooves, it seals?
Stephen Kuzmak: Exactly. It seals.
Howard Farran: That's interesting.
Stephen Kuzmak: It works really nice. You can floss a tooth and you can sneak in the whole piece of plumber's tape and cover the tooth in Teflon. It's watertight so if you have etching on the tooth next to it, you dry it off, remove the Teflon tape and that tooth has never been touched. You could keep a tooth covered with Teflon tape a little bit and it will prevent it from dehydrating. You can set color ...
Howard Farran: You like the Teflon tape so you're not acid etching and getting any bonding agent on the person.
Stephen Kuzmak: Exactly right. It gives you just a little room, too, when you remove it. Just a little room to sneak a Mylar or a Bioclear or something else which is nice. We have to keep it clean.
Howard Farran: That's an incredible pearl. When dentists don't use the Sil-Tech Putty, what are they having? They're having the freehand and shape it all from scratch.
Stephen Kuzmak: Likely. Yeah. You can use any bite registration. It may not handle as well but you can do the same thing with any bite registration or probably even a medium body PBS would get you at least in the ballpark. You might have a little more give in it so you're off a little bit but any of those is probably going to get you in the ballpark closer than freehand. Freehanding is a little difficult on a large Class IV.
Howard Farran: Okay. I have to keep answering questions. You dropped two words that they might not understand. First, why did you pick Cosmedent when there's probably a hundred composite companies and when do you use a nanofill versus a microfill?
Stephen Kuzmak: First off, I like Cosmedent. They have probably the highest, longest lasting polishable composite in their microfill because of the way the filler particles are universally small but yet it's a beautiful material. It really replicates enamel shine and enamel properties very well.
They also have a shade called Incisal Light which is just beautiful. If you add it to some of the areas of the enamel in a way and you shine light from the sides, it will iridesce. Almost like the dentin will iridesce from angles or have that sparkle to it. It will do the same thing. It really adds vitality.
The second question is nanofill is a typical posterior composite. It's just got bigger particles that are nano size. In addition, it polishes pretty well but mainly it's a durable composite. Your Microhybrid is probably your most durable composite and also very, very suitable palatal shell. If you're doing a small, one of those guys on the front tooth that keeps on shifting a small shift, microhybrid might hold up a little better than anything else. Those are all from Cosmedent. Their website is great. It's a great company.
Howard Farran: It's got a lot of tutorial videos on their website.
Stephen Kuzmak: Yeah. It's got about 50 absolutely gorgeous Cosmedent tips of the month with fantastic clinicians that ... It's a good company. They have their products that they sell at very reasonable cost. Then they also have a lot of videos how to use their product to a very high degree and so it's really nice.
Howard Farran: What's amazing is Buddy who's the owner ...
Stephen Kuzmak: Yeah. Buddy Mopper. He's terrific.
Howard Farran: He started as a pedodontist, pediatric dentist.
Stephen Kuzmak: Right. He did. Yeah.
Howard Farran: Go figure. One of the most cosmetic dentist legends started in pediatric. Carl Misch started in removable dentures.
Stephen Kuzmak: Really?
Howard Farran: Then he became an implantologist. Speaking of videos ...
Stephen Kuzmak: [Inaudible 00:17:03] dentures. They never seem to work well. There you go.
Howard Farran: What got him frustrated is when I think he got most interested in implants is when all these people were saying that the implants weren't strong enough because they kept breaking and he's like, "Dude, that's because you don't understand the denture you put on." You got to get the denture right and then the implant helps support it.
You can have a completely malocclusion denture that doesn't fit right and then hammer it down with titanium. You got to cross train. You got to know the removable and you got to know the fixed. You just can't just be a fixed prosthodontist and have no clue on removables and you can be a removable guy and understand fixed. You got a course on Dentaltown. Talk about your course on anterior composite dentistry.
Howard Farran: Yeah. Along with two of my good friends, Matt Costa and Arthur Volker. Matt Costa is from outside Lancaster, Pennsylvania and Arthur Volker is in Queens, New York. The three of us have a course coming up, October 10th, in Quarryville, Pennsylvania called "The Daily Grind: Maximizing Outcomes with Composite Resin" where we're going to go over our techniques for posterior, a little bit on smile design and then also anterior composite.
It's going to be focused on hands-on so you're going to work on mannequins and we're going to have an instrument package that's going to be yours to take home so you can do exactly what we do at the course when you go home and work on your own patient so I'm pretty excited.
Howard Farran: That's you and Artie?
Stephen Kuzmak: Yeah. Artie. You've met Artie.
Howard Farran: Artie Volker?
Stephen Kuzmak: Yeah.
Howard Farran: V-O-L-K-E-R.
Stephen Kuzmak: Exactly.
Howard Farran: Who's the third one you said? Matt ...
Stephen Kuzmak: Matt Costa. C-O-S-T-A.
Howard Farran: Where's Matt from?
Stephen Kuzmak: He's outside Lancaster, Pennsylvania. Quarryville, Pennsylvania.
Howard Farran: What's confusing is there's a Mark Costa, too.
Stephen Kuzmak: Okay.
Howard Farran: Yeah. Do you know Mark?
Stephen Kuzmak: I don't know Mark.
Howard Farran: He's more on practice management and organization. He's one of those guys who comes in every operatory, everything is exactly in the same place. [Crosstalk 00:19:02] Well, I'm excited about your course.
Stephen Kuzmak: Yeah. I'm excited, too.
Howard Farran: Is it a hands-on participation class or is it a lecture class?
Stephen Kuzmak: Yeah. We're going to do a morning and an afternoon lecture. The morning lecture, Matt is going to give for about an hour, hour and a half on a really posterior composite design, cavity preparation, the importance of why it should be conservative, how to be conservative, the importance of peripheral rims of enamel, Class II design and then he's going to do a Class II hands-on. We're all going to help teach that to the participants for the rest of the morning. That's going to be the 8:00 to 12:00.
From 1:00 to 2:00, Artie is going to go ahead and share about smile design and some cosmetic things for smiling, movement of teeth a little bit on orthodontic appliances and that kind of thing. Then he's going to segue into really the tooth design which is what I'm going to take over how you understand how a Number 8 and Number 9 look together, how do you do certain parts of Number 8 or ... things like that, how do you do a Class IV and that kind of thing.
I'm going to then go and head and do a step by step Class IV for the hands-on for the afternoon. We're going to go through a multilayered Class IV and each participant is going to learn how to do it. There's a lot of tricks and there's a lot of things that ... It will speed up your learning. For instance, like a Mylar Pull. If you've never done a Mylar Pull, it's a huge trick. It's really simple but you have to see it to do it and things like that.
There's a few tricks to understanding the adjacent tooth really well. "Oh, that's how you can quickly copy that part of that tooth. Oh." There's a lot of these little tricks that are very helpful to learn. Also, the instruments are different and the way you apply composite is very different if you haven't seen how it's done. If someone has only done compules of composite and they never placed a ball of composite and pressed it to where it should go and used a brush to smooth it, it's very different.
So some of these hands-on portions, we hope that people mess up. Hey, it's better to mess up with us where we can show you here's how you can correct that. Let's practice this movement a few times. That's what we really want to do and we're all very excited. Very excited.
Howard Farran: Is this your first one, the three of you?
Stephen Kuzmak: This is the first one, the three of us. Yeah. We're a new little think-tank group, the three of us. We met up ...
Howard Farran: That is so awesome. You met on Dentaltown.
Stephen Kuzmak: We met up on Dentaltown. Yeah. That's how.
Howard Farran: That is awesome. If you ever want to do one in Phoenix, I'll promote the logistics for it in Phoenix. We got 3,600 dentists in Phoenix, Arizona. If you have one of your hands-on deal or maybe you should do that at the Townie Meeting sometime.
Stephen Kuzmak: Hey, let's do it. Let's do it.
Howard Farran: I think it’s great. Now, I've interviewed Artie but we were rushed. We were at the Grand Hyatt. I only got 20 minutes with him. Send Matt my way. Tell him I had to do a podcast.
Stephen Kuzmak: Yeah. You bet. He's a great guy. Matt is my friend and everything but he's just a mentor in a lot of ways. He's a little bit ahead of where I want to be as a dentist and he's been great.
When we formed the three of us as a group, I mean we said the first [reason 00:22:21] is that we can each become better dentists. We're held accountable. Secondly, it's to teach something, you've got to know it. Thirdly, we get along really well. There's a lot of jokes, a lot of fun texts in this thing. [They're good guys 00:22:36].
Howard Farran: Where can a listener find out more of this? Have you guys got a website up?
Stephen Kuzmak: We have a website for the course but the easiest way is just on the Dentaltown. We have a thread. I think it's got about 165 posts up about any interest in the course from Steve Kuzmak, Matt Costa, and Arthur Volker. That's the easiest way to do it. People are talking a lot about it so it should be up in today's topics and that kind of thing. They can also look up either of us on Dentaltown.
Howard Farran: What's the date of that? October what?
Stephen Kuzmak: October 10th. Saturday, October 10th.
Howard Farran: In what city?
Stephen Kuzmak: Quarryville, Pennsylvania.
Howard Farran: Quarryville, Pennsylvania. Is that near ...? Howard Goldstein is in Bethlehem, Pennsylvania.
Stephen Kuzmak: He's in Bethlehem. He's probably about an hour and a half north.
Howard Farran: Is he going to go to the course?
Stephen Kuzmak: I don't know yet. I don't know that I've heard from them.
Howard Farran: Yeah. Maybe meet ...
Stephen Kuzmak: He's a good guy though. I'd love for him to come down.
Howard Farran: Yeah. Maybe Hogo can go and maybe I can get out, too. I don't know what my date is on October 10th but I just think that [we'd be rocking on 00:23:33]. I'm so damn proud of you guys because like I say, I'm a huge fan of your 5,000 post.
Stephen Kuzmak: Thank you.
Howard Farran: It's not only are they informative and educational but you're always fun. I mean you guys just exude a lot of fun and karma. I watched some big fight with Artie at a bar in New York. I forgot the fight.
Stephen Kuzmak: It's probably the Mayweather-Pacquiao.
Howard Farran: Yeah. It was the Mayweather fight.
Stephen Kuzmak: Right.
Howard Farran: It was the Mayweather fight. It was so funny because everybody was so obsessed with this fight and there was four dentists having beers and nachos.
Stephen Kuzmak: And not talking about the fight.
Howard Farran: I don't think anybody even watched the fight. I mean it was just so damn fun, the energy. I want to talk about more uncomfortable stuff that you don't want to hear about.
Stephen Kuzmak: Oh, sure.
Howard Farran: Rubber dam. Come on. Really? That's anal. Are you being anal, dude, using the rubber dam?
Stephen Kuzmak: Yes, yes. You could say that. You're not going to use it unless you see the benefit. The benefit, sometimes you don't see it right away until you use it. You're going to notice things like ... Sometimes I don't use a rubber dam. I'll use an IsoDry. Sometimes you're in a rush and I have a medium volume PPO and you just got to get something done and almost no time at all and sometimes you get it done.
I use rubber dam a lot more than I used to because of I want to get somewhere that I'm not. The rubber dam is a vehicle that in order to get ... I mean you know this. I've read a lot of things about you. To get where you want to be, you're going to have to do something different. You can't do the same thing so you're going to have to change protocol and that's hard. If you talk to dentists, a lot of dentists don't want to change a protocol. That's "Well, this is how I do things."
For me, I, about six months ago, really focused on using it. I remember going a week, a few months back where I told the staff I am not going to do anything in the mouth without a rubber dam, anything. If I'm going to polish a tooth, rubber dam and so it was a neat week. You realize hey, three of my 10 best crown preps were that week. Five of my top 10 posterior composites were that week. Two of my anterior cases that I thought were the best I've ever done were that week.
If you did a rubber dam challenge, just do one week rubber dams, you'll notice some of my best work were that week. Can I do this all the time? Was I going slow out? Maybe early in the week, I was going slow. If you want to get really, really good, you're have to change protocols. Some people that might be going from not using anything to maybe just a rubber dam plan, if that's their next step for some isolation or if they haven't done anything like that, just going to an Isodry, that might be the next step.
Eventually, you'll get where you'll see the rubber dam is more comfortable than the Isolite. I didn't think that would happen but it is. You'll have less people complain about it. You'll also realize you like it more because you can see everything very clearly and it's enjoyable. It really is very enjoyable.
Howard Farran: Sorry I have to blow my nose. I swam my ironman distance this morning in the pool. Two hours and 18 minutes, 2.4 miles so I have about 88 gallons of water in my sinus.
Stephen Kuzmak: That's impressive.
Howard Farran: There's somebody listening that doesn't know what you mean by Isolite. I'm always trying to guess questions.
Stephen Kuzmak: Sure.
Howard Farran: You said rubber dam, Isolite. I think two things people might be questioning is: What is an Isolite? Number two, when you're doing an anterior case, do you punch 10 holes and clamp [a second bite, a second bite 00:27:10] or are you one of those dentists that makes a one-inch long slit and the rubber dam is more likely to hold back cheek and tongue and ...?
Stephen Kuzmak: There are times you do both. There are times when you do both and there are plenty of times where you just do one hole. One hole. I'm going to do a cervical part of the tooth that I already know I'm going to use A3 and you can do a one hole and treat it like an endodontic ... and you can use a 211 or a 212 clamp and really get a nice cervical isolation. It's really easy. You can relax. You can do dentistry at the one hand and just relax. Slug is not going to get there.
Howard Farran: Explain to the listener what an Isolite is and when do you use an Isolite? What percent of time do you use an Isolite versus a rubber dam or is there a time ...?
Stephen Kuzmak: I probably use the Isolite when I'm doing sealants or just some small things, a couple of them throughout a Number 15 lingual ped or some ... Usually no anesthesia. If I'm going to get them numbed up, I'm going to go to rubber dam. If there are just some small areas, sometimes I'll use an Isodry. I don't usually isolate with the lite. I just use the Isodry on a Kona Adapter.
To say what the Isolite and the Isodry are, it's manufactured I believe by Isolite Systems. It's two pieces of clear plastic. One that kind of goes around the tongue and roof of the mouth area and then it gets thin in the back of the mouth and it gets wide again for the other side and holds the cheek back. Then the roof of the mouth extension wraps the other side and has a bite block. It can hold back the tongue and the cheek from both the upper teeth and the bottom teeth on one side of the mouth. It's nice to have.
If I'm doing a quadrant for instance, 18 to 22 or I'll get some work, Class II's especially, nothing is just fun as a rubber dam. It takes a minute to get it on. It doesn't take too long. You then floss pile some teeth to really hold it down cervically and get it a nice seal. You can see clearly and you can take your time.
Howard Farran: Do you like those rubber corns? I don't know the name of it where you [sledge it 00:29:17].
Stephen Kuzmak: Wedge it with the yellow guy or the orange guy to wedge it?
Howard Farran: It's like a two millimeter thick floss rubber but you stretch it [then let it pop to it 00:29:24] then you let it go and ...
Stephen Kuzmak: Exactly. Yeah.
Howard Farran: Do you use those?
Stephen Kuzmak: I use about an inch and a half to hold the rubber dam down in its most anterior spot. You can get them from Ultradent or from Pearson's probably from most of the larger companies perhaps of wedges.
Howard Farran: You opened up a can of words but you're the one who said it not me. You said sealants. There's a lot of people in Dentaltown that post really good studies that say 40% of sealants have failed at the end of the year and at the end of two years, they're almost all failed. What do you think of sealants today? When are you using sealants? Have you seen these studies where a lot of people are saying after one year and a half or not working anymore or leaking or ...?
Stephen Kuzmak: Oh, yeah.
Howard Farran: What is your thoughts on sealants? Do you still recommend them for ... If your six-year-old daughter came in to you and had four virgin six-year molars pop through, would you put sealants on?
Stephen Kuzmak: No. I haven't done sealants on anyone under ... I'm going to call them sealants but I mean usually, they're stains at a periphery of a composite or they're ... No. I don't do too many sealants on adolescents and kids. They can work if done well. I think there's a lot of wisdom in using something as a glass ionomer base. I think a lot of small things of sealants I do, they're more on dentistry that's there than a tooth that has never had anything. A lot of times it's an edge of a filling that needs to get resealed because it's soft.
Howard Farran: Okay. Back to your own kid or your niece or nephew. What do you think about blowing out the pit and fissures on a six-year-old girl? Four six-year molars are in. What do you think about the preventive resin restorations where you'll go in there and take a diamond and clean out the pit and fissures and you're usually going to always be in [dentin 00:31:21] and then doing an [occlusal 00:31:22] composite to prevent future decay. Do you think that's too aggressive? Do you think there's a place for that? What are your thoughts on that?
Stephen Kuzmak: There's a place probably for it if you do it really well and if risk assessment is what's driving you. A lot of times, the higher risk caries are in Medicaid in lower income areas. My kids don't really know what soda is. They don't know what juice is. It's just different.
Howard Farran: Yeah. You're Caribbean so you're giving them vodka and that can cause decay, too, right?
Stephen Kuzmak: Yeah. There's a place for it. I don't know enough about six-year-olds and risk assessment and that kind of thing. I have to probably look at a lot of pedodontists and get some really good feedback, but then you have to go to different areas, too. There's kids that tolerate a lot of things to be really well done and then there's kids that they can't sit still and that kind of thing but I don't see many kids. I mean I see maybe 10 kids a year.
Howard Farran: It seems like the California dental schools are the only ones really getting behind caries risk assessment because you just mentioned a lot of variables. Socio-economic, education of parents. There are so many variables. Have you even seen that at California dental schools where ... What is that caries risk assessment system they're using their [big promotions of 00:32:38]?
Stephen Kuzmak: I'm not so sure. For me, it's just common sense. I always think if I'm putting in dentistry, it's going to be more prone to becoming a cavity than nature's enamel for the most part. I don't do a lot of them but if I do a small PRR or a sealant, you got to have something to keep it dry during the entire procedure. The other thing is I get back to Teflon. You can put a little Teflon when you have a little operculum. If you go gently, you can put a little Teflon tape back between the operculum area and the tooth and get it dry. I mean so you can do them well but I don't see many kids. I just don't. In my area, I don't have that.
Howard Farran: Describe your practice. Your TownsenView.com in Townsen, Maryland. Is that ...?
Stephen Kuzmak: In Towson. T-O-W-S-O-N, Towson, Maryland.
Howard Farran: Is that a suburb of Baltimore?
Stephen Kuzmak: Yeah. Just north of Baltimore.
Howard Farran: What was it like going to the first dental school of the United States of America?
Stephen Kuzmak: It's good school. Really, really good school. I can't complain. I came out and graduated I was ready to be a dentist. I didn't think I needed a ...
Howard Farran: What year did that school open? Do you remember?
Stephen Kuzmak: I think it was 1840.
Howard Farran: 1840. Wow. That is amazing.
Stephen Kuzmak: Yeah.
Howard Farran: We're 35 minutes down. I only got you for 25 minutes. What do you think of these 7,000 listeners? What are other things do you want to talk about that you think would be the best use of your time?
Stephen Kuzmak: Best use of my time. I would just say think of dentistry in some ways, you want to be happy at work. To me and probably for you, too, there's a component in my head that says I'm happiest when I'm growing as a person. Maybe it's not professionally or maybe it's something else but when I'm growing as a person, specifically when I'm doing something that I used to not be able to do. That to me is really fun.
I like sometimes to think of myself in three parts: My past self, Steve you see today and then my future self. Then I'll sometimes think my past self couldn't do that crown prep like I could today. I'm excited because I know my future self will one day be able to do a crown prep that I can't do yet today. Same thing with composite. I'll do a front tooth and I'm like, "You know what? But in two years, I'm going to be able to be better than who I am today at this."
I picked some things in dentistry, not everything. I don't know that I'm getting better extractions. I tried but I think it's very good and healthy for people's well-being, specifically for dentists, because it is a stressful job to have a component of dentistry that's for you. By that I mean it's not for the patient. The patient is going to benefit, but this is for me. I'm doing this for my own development.
That's something that will change the perspective a little bit as a professional. You're doing the right thing but you're doing it to achieve a level that your past self couldn't do and it's stressing out you now but you know you're going to be better as a person and you can add something to your ... You can walk around town, "Hey, I can do something that I couldn’t do six months ago." That's a neat feeling. You can definitely get it with dentistry. You can get it too through art, music, weightlifting, athletic events, army in training, all these other things. That's a very healthy thing I think for humans.
The second thing I would say is do what's right for the patient. Patients respect you for doing really what's right. They may not like it while you're doing it and sometimes patients don't like isolation in their mouth. They just want a soft piece of cotton candy and that's all. That's all I can have.
I mean I had a lady yesterday. "Ah, don't put me back. I get this." I'll say, "Are you okay though?" "Yeah. I'm okay but don't put me ..." "Well, I need to put you back. I want to do my absolute best job for you and it's going to really help me out to put you back." "Oh, okay. Well, just put me back slowly." So you can think that this is for me. I want to enjoy this career as much as I can. Most dentists are doing okay financially [inaudible 00:36:58] For the newer graduates, there's a little more debt but that's what I would say. Try to pick at least one spot in your career that's for you, whatever can be. That's what I would say is to go with that thought.
Howard Farran: You're an outstanding teacher because your positive energy and karma and enthusiasm just exudes from every corner of you. I mean really.
Stephen Kuzmak: Yeah. Oh, thanks, Howard.
Howard Farran: I don't know if a lot of my thinking ... I'm sure a lot of it has to do with my mother because I never saw dentistry as a job or an occupation. I saw it as a vocation. My two older sisters left high school and became nuns. My mom's goal for me was to be the first American pope. I know all the popes are Italians and she wanted an American pope. I think I brought that childhood into dentistry because I always see it as a vocation. I mean Mother Theresa didn't get paid to do her job and being a successful million-dollar practice is a side effect of just wanting to do a good job and loving what you're doing and totally committed to it.
My boys say that my lifestyle is that of a monk. I mean I don't spend any money because that's not ... I don't do all that to go buy a jet ski or a condo or a vacation escape. I mean probably everything I do is just either two subjects. My four boys or dentistry. I have four boys and a granddaughter I would say.
Will you explain that you're humble and that you give a lot of credit and you talk fondly about Dr. Ed, Lane, Doc Terry? Tell these viewers because a lot of these viewers have never even been on Dentaltown. You're probably talking to a couple thousand people right now that have never logged on to Dentaltown. Why do you talk so fondly of Dr. Ed, Lane and Doc Terry?
Stephen Kuzmak: There's a bunch of them. I mean [newcomers 00:38:51] go through what I've ... What have I learned from Dr. Ed? He's a big rubber dam user. He crown preps against a rubber dam clamp. That's his trick for why I think his line looks so smooth. I'm one of them. I've learned Class II's a lot from Dr. Ed. Also, Cory Glenn. I learned his wedge technique where you place a wedge and then you prep Class II to the wedge and you can see it really clearly where you're going.
Dr. Ed is a big mentor to a lot of us Townies. Lane is probably one of the craftiest, most intelligent prosthodontist in the world using [nano 210 00:39:25] and still has film radiographs so it's not even digital, a nano 201. That just means you're something. That means you're something. He's really good. I really enjoyed his Color CE on Dentaltown. Doc Terry, I've learned a lot to push resin to push it hard. In posteriors resins, the microhybrids or he uses a Z50. He does his full mouth makeovers with resin. I mean that shows eight and 10-year recalls and 15-year recalls.
Howard Farran: Okay. I'm going to throw you the biggest comment that Doc Terry is always going to get. "Well, how long is that going to last?" Because in the dentists mind, it's not a PFM or a full crown or an indirect veneer cement. What do you say to all those dentists that say, "Oh, yeah. It looks great. It's unbelievable, massively conservative and gorgeous but how long is that going to last?"
Stephen Kuzmak: The only way to say this is I once in a while will get somebody to do a free case, not for charity, but if I'm doing it for free, it's again for me. I don't care how they're feeling. I'll tell them I'm going to take my time. I'm going to probably get your back and touch it up. I'm going to take photos. Once in a while, I'll put something on Craigslist, "Hey, I'm looking to do a free composite veneer case for marketing and for photos" and that kind of thing.
What's funny is how often will somebody ... Now, think about this. Somebody will say on Craigslist to me, "I have bonding. It needs to get updated. Starting to look bad, was done 30 years ago." You just let all of these risk factors [inaudible 00:40:59] on Craigslist in the health and beauty and okay, so they're not even going to a dentist [inaudible 00:41:04]. You have these things. If someone's on Craigslist and looking at dentistry things free, they're probably not going to a dentist. They probably don't have the best home care and yet this is done 30 years ago.
So I would bet you take out parafunction for some of the stuff. I'll bet you a lot of things will last longer than you think. I think if you say 10-year on average, I think that's probably maybe toward the low side. Some of the small stuff will happen though where you have a small chip on the composite veneer but that's because your microfill or your delicate material got too far to the edge and they could catch it [in an excursion 00:41:44] and you get a tiny chip. It's very simple to repair.
I'll bet you it lasts maybe not quite as long as a crown but when you're redoing a crown, you might be going to an implant. When redoing bonding, you might be going to a crown so you can leave it that way and say this stuff lasts as twice as long as a crown because you're going to get one life out of it and then you're going to go to a crown or you're going to go to something else. That's what's nice about it. If you can put off a crown another decade, hey, do it for the most part.
I think it lasts really well. I haven't seen anything yet fail. I've seen a few stains and a few things have improved and a few small microfill chips but I haven't seen for instance all composite veneer shear off [inaudible 00:42:24] and I'll push [them a bit 00:42:26].
Howard Farran: I want to change subjects completely.
Stephen Kuzmak: Go for it.
Howard Farran: A lot of dentists they think before they're going to do an anterior crown that they should whiten it, that they should get them in for a cleaning and bleach and then a lot of them think that you need to step back like, "Hey, if I whiten your teeth, and I wouldn't do anything today because it's going to step back and two weeks later, it's going to be halfway dark again." Will you talk about those issues that they're worried about.
Stephen Kuzmak: Yeah. Sure, sure. I mean if someone ... You have to ask that. You certainly have to ask that if you're going to do a single anterior crown. You better know what shade they're going to end up at for long haul and don't use some powerful bleaching to get them there. You just use a couple of white strips and just bleach up a little bit. That way, you're at a level that's easily attainable for the long haul.
Howard Farran: A couple of white strips. You mean the Crest [take-off 00:43:18] Whitestrips?
Stephen Kuzmak: Yeah. Just Crest Whitestrips, something that's easy from the pharmacy. I mean I recommend that a lot. We do an office bleaching. I do the opalescence and custom trays for an affordable price. That way, they can continually do it. You'd be surprised. I mean A1 blends with a fairly lightly light teeth and with fairly not quite that light teeth. It's just a great shade. If your contour is right and your effect is right, the way it reflects light off your teeth is believable and a mirror image of the adjacent teeth, A1 is going to go with a lot of teeth. A1, A2 and A3 are going to be one of your anteriors.
I have a lot of bleaching addicts in my office so I sometimes will go to a B1 but a lot of A1s are going to blend whether they bleach a little bit or they revert back to their shades. So yeah, you have think about those things. You'll have to think that.
Howard Farran: [I guess 00:44:16] there's lot of people wondering. Some people say that to really get this right, the operatory needs to have a window so you're getting natural light as opposed to lights from fluorescent bulbs. Some dentists will go as far as to take out their fluorescent bulbs and put in special bulbs that have [crosstalk 00:44:31]
Stephen Kuzmak: Yeah. 550 degrees kelvin and this. Yeah. I've heard that.
Howard Farran: What are your thoughts ...
Stephen Kuzmak: I mean Lane Ochi ... Lane wears blue scrubs. He says your yellow visual acuity is best after looking at blue so he wears blue scrubs. I wear blue scrubs as well but just because it blends every ... I mean blue is a common color.
Howard Farran: Okay. You said that way too fast. You just blew my mind. Explain why he wears blue slower.
Stephen Kuzmak: Lane Ochi wears blue scrubs. He said this I believe on his Townie CE because when you look at blue and then look at yellows and white shades, your acuity, your color ability to see is actually heightened a little bit. If you look at blue and blue and blue and look at a white wall, you'll see that kind of yellow tint so it heightens I guess the way the cones are in your eyes for yellows and so you can see the color a little bit better.
Howard Farran: Wow.
Stephen Kuzmak: I'm lucky my operatories are almost bright by floor to ceiling windows and so we have a nice northern light come in through all the time. I look at it under this light, under the lamp from the operatory, I'm also looking against the window light and that kind of thing. You got to take a look at colors a bit.
There's a few other ways to look at color but the easiest one is going to be to, if you're doing composites, to make composite shade tabs. Take an A1, make a denture tooth shade tab out of your composite and then hold that up or you can do a combination. I'm going to do a A1 and in my Incisal Light enamel shade on top of it and then you make that into a nice shade tab and you can hold it up and look. That's probably how I do a lot of colors for [inaudible 00:46:16].
Howard Farran: So instead of using the shade tab, you take a compule and squeeze it out and make a tooth and cure that and use that as a shade tab?
Stephen Kuzmak: Yeah. Except there's a step further. I'll take a denture shade tab, a VITA shade tab, take off just one, put it in a putty and make a model of it and then take off that tab, the denture tooth, put it back in the putty and then fill it all up with composite and then shape it and then cure that and then you have a composite on a shade tab. Then you spend time polishing it and adding some morphology so you have a fairly good morphology of a central incisor.
Then you can use that edge to edge with a Number 8 or a Number 9 and then get an idea on is my composite shade A1, similar to your tooth shade A1? That gives you a little more info than looking at a VITA shade A1 because A1 between manufacturers is quite different. It's just quite different so you have to know your own shades in your office compared to the ones [crosstalk 00:47:23] ...
Howard Farran: You primarily use Cosmedent.
Stephen Kuzmak: Yeah. Partially, it's because if you have one manufacturer, you can learn it really well.
Howard Farran: I want to ask you some more uncomfortable questions.
Stephen Kuzmak: Sure.
Howard Farran: I just love interviewing you. A lot of kids are walking in a school and they're saying, "I'm $250,000 in debt and now do I need to buy a $150,000 CAD/CAM machine to be a great dentist?" I mean, do they need to almost increase their debt another 60%? What's your thoughts on CAD/CAM?
Stephen Kuzmak: It's probably great. I don't have it. I haven't used it yet. I don't have a CEREC yet.
Howard Farran: What about your two friends, Matt and Artie?
Stephen Kuzmak: They both have CERECs. Yeah. They're both doing some beautiful CEREC work and they really love it.
Howard Farran: You're a classic example that you can be a great cosmetic dentist and not have one and then your best friends and buddies, Artie and Matt, they do it.
Stephen Kuzmak: Yeah.
Howard Farran: Talk about that. Why do you not have one?
Stephen Kuzmak: Because it costs $150,000 and I'm still a fresh graduate. You can get to use CEREC, about 30,000 but again for me to get good at CEREC, I'm going to have to also learn how to tint a CEREC crown number 8. You can't mill a block, put it on a tooth and expect it to look right. There's a lot of [finessey 00:48:55] things of tinting out a CEREC indirect restoration that learning composite tinting and such will help you.
Probably one of the best in the country is Gregory Mark. He's in Queens as well and he has a post in Dentaltown. He flies to Moscow and throughout the world teaching CEREC and he says he learned some of his anterior staining techniques from watching some of my cases with composite. He says they teach themselves.
If you learn composite and learn how to use a touch of great tint for an incisal effect for translucence, that's going to correspond. When you go to CEREC, it's going to be a lot easier to do a number 8 crown and understand how I can replicate a translucent effect with a great tint. Then for CEREC they get back in the oven for a few minutes. With composite, you can cut into the tooth a little bit, tint it and put a clear shade on top and you're done in just a few minutes as well.
Howard Farran: I know you and I are both conservative as far as tooth structure and I think one of the human conditions of the mind is everything is extreme really; yes, no, black, white, up, down. You know what I mean? So they'll get a CEREC and then everything is a CEREC. A lot of on tooth surface, it's a lot more conservative prep if you don't have to prep the things [in dark drawers 00:50:17]. You know what I mean?
Stephen Kuzmak: Right.
Howard Farran: If my prep all doesn't have to draw, a lot of times I can have a more conservative prep so I think humans tend to be extremist and I think as you get older and older and older, you tend to be a moderate and life is really 50 shades of gray.
Stephen Kuzmak: It really is. It really is. I mean we all see things differently. Between Matt and Artie and myself, we see some teeth a little bit differently. I may see a tooth and I may think it's A1 but I would use maybe a violet and a blue shade for something. Matt may use a gray shade or a little bit of a violet gray tint. Artie may say I'm just going to go just a little gray and that's fine. We all vary. We all vary and we're all on that journey together to being the best we can be but we're all meant to have some variation.
Howard Farran: A lot of your variation goes from before you were a dentist. You have a love for art. Talk about that.
Stephen Kuzmak: Yeah. I painted. Really throughout high school I developed a love and passion for drawing and painting and mainly watercolors. Surprisingly, watercolors are hard. They have a learning curve that's forever. My art teacher said, "Steve, you should learn watercolors" and he says, "Remember it takes about 30 of them till you get it." I could remember being, at 15, like, "This is terrible." But somewhere around number 20 he said, "Use a hair dryer."
That's a good life lesson. I have been doing something the same way. You add a protocol change and all of a sudden, oh, now I can dry that shade and move on. There's things that change in protocol and now it's different. That always develop your fine hands skills but it's not nearly as fine actually as dentistry but it helps. It definitely helps. The other thing though is it can also hurt you. If you have an art background or this or that, you may come in with some ego in some ways. You'd think "But I can do it. I've been doing art all my life." You may not listen to the right protocol and you got to unlearn some of the things to actually do it correctly. You have to go through those things, too.
One of the things in art, for painting and drawing they teach you is not at all right for dentistry, it just doesn't correspond and that was make your darks dark and your lights light. If you can imagine I see a tooth with a little bit of darkness here and a little bit of light here and all of a sudden I do it and it's way dark and way light and so things like that you have to unlearn. Some of the general ideas will correspond but nothing beats repetition with those people who are maybe doing what you want to do and they're right there with you. That's where you're going to grow quickest.
Howard Farran: Why do you use pencils?
Stephen Kuzmak: Pencils are really excellent ways to see line angles specifically. I would say line angles for 79 and 10 and then for your ... There's this facial table. It goes up in about three or four millimeters from the cervical peak and then it comes down about a millimeter shy of each side. You have his table and you can find it with a pencil. You can just basically draw two of them and two very curvy almost like a shell or something.
Draw this shape with a pencil, flatten a little bit to that shape and then carve the other sides to the ... That line angle, when you're all set and done will be what glistens when you shine light on from angles. That line angle will be highlighted. If you can get them to match, you go with it. If you get our incisal edges to look right and then those line angles to match, even if your shade isn't right, you're still going to match because your eye is going to find value first and then contour second and probably your light reflections are third.
Somewhere around four, five or six are where my favorite part [of them 00:54:21] is probably tinting the incisal effects is where that actually comes in to apply. That's why I use a pencil. The second spot is for usually in younger people, you're going to have depression. One in the mesial third and one in the distal third. [Newton Fahl 00:54:36] calls them twin Eiffel towers. You can draw those out with a pencil and you can polish into those shapes and make some really beautiful anatomy. That's why I use pencils.
Lastly, if you take pencil to your ... Don't do this unless you're going to put your ego aside. If you take pencil to your composite tooth interface, it's going to highlight with graphite your irregularities and you're going to have a few marks you thought were perfectly smooth and they're not smooth and you got to continue polishing. It will show you errors. It will show you contour very well. It's a good tool. I have I think a box of 250 cocktail pencils from Staples or golfing pencils. I'll just use one and toss it. I think they're 10 cents each but it takes out ...
Howard Farran: A golf pencil is also called a cocktail pencil?
Stephen Kuzmak: I think so.
Howard Farran: [I've just 00:55:31] heard that.
Stephen Kuzmak: I think so. They're small. That way it takes out "did you autoclave that pencil," that kind of thing so they're once and done. It's wasteful but it answers OSHA and that kind of thing. They work really well.
I don't use pencils in the posterior but an anterior, I use them a lot. Not always but I use them a whole lot especially if you can't get for some reason a line angle to look just right. We'll put a pencil mark on the adjacent tooth. Now, draw that same line on that tooth and repolish that contour a little bit and then you'll find that line angle just right.
Howard Farran: You rattled off like five or six things. You said value ... Can you go through those? Can you list those?
Stephen Kuzmak: Yeah. Your value is going to be most important as to lightness or darkness of a tooth. If you have an A1 tooth and you go C1 or B1, your value is really close. If you have an A3 tooth and you go C1, your value is going to be off a bit. A3 is lot darker. Your colors, your As, your Bs or your Cs. That's less important than getting the lightness or darkness correct. It's also less important than getting your contour and light reflection fairly correct as well.
One of the most believable things of making a front tooth look like it belongs there is if there's a small chip or small irregularity on an incisal edge of the adjacent tooth [to copy 00:56:59]. That will immediately tell nature that tooth belongs. It's got that same little irregular spot that the other tooth has. That's your contour. I know a year ago, I left most of my distals a little bit too ... They needed to get more polished in and Matt was "Steve your distals. You have a tendency to leave distals a bit."
That was always one of the things that stands out. He can see it right away. I've developed the idea to look ... You kind of blur your eyes. Okay, the lightness or darkness is right. You'll have to see it all the way to see lightness or darkness. Then you want to look at that incisal contour to get that right. Artie is really good at that. Artie really understands incisal contours and also line angles. Then you want to get your light reflections. Then lastly, there's going to be your translucent effects and some of your tints and that kind of thing.
Howard Farran: How often do you use tints?
Stephen Kuzmak: Some I don't. I would probably say 90% of my larger Class IV's I'm going to use some kind of tint. There is really three tints in a Class IV. The first would be your more obvious translucent on a young person or some older people but more on a young person. If you see someone who's 23 and he bleaches their teeth, a lot of times, you may see a little of a grayish violet tint before the edge of the tooth. That's a translucent or you can call it opalescence.
Your next tint would be when someone's older, they a lot of times will have a warmer tint on the very edge of their incisal and the middle third of a tooth. You can use something from Cosmedent like honey yellow just to warm it up a little. You get a little bit of yellow tints that are warm and then your last tint would be using something that's like a thinned out white. Sometimes I'll use white opaque [John Kanko's 00:58:51] Titan flowable for that. There are sometimes hypercalcifications on teeth which adding some white tint, a more thinned out white opaque or Cosmedent has a beautiful white tint that's just perfect and I use that, too, that will mimic that, too. They're fairly common on edges of younger patients, right on the edge.
Howard Farran: You are so artistic and I just love it. I've only got you down for a minute. I want to ask you a bizarre question.
Stephen Kuzmak: Go for it.
Howard Farran: When you're doing six, eight or 10 on the upper. I'm not talking about a single where you want to match the two. You're talking about that this the two on the right has [inaudible 00:59:30]
Stephen Kuzmak: I'll do front fours in a sitting but if I'm going the canines and premolars, I'm doing that a different day. From four I can focus. That's about two and a half hours and then you had it. That's enough.
Howard Farran: My question was sometimes you used to hear more of it back in the day like in the '80s but do girls have different shapes of teeth than boys? If you're doing the whole upper art, 10 teeth, do girls have different shapes than boys? Do you go softer on canines with girls with the vampire aggressive, you know? Because all apes and monkeys when they attack, they attack with their teeth.
Stephen Kuzmak: Right.
Howard Farran: Or do you think that that's crazy and that boys and girls have the same shape of teeth?
Stephen Kuzmak: Basically, they're same shape. There are more difference probably between boys and girls. You're probably going to have more differences in ethnicities. If you're an Asian woman, I can look at your incisal positions and see this very oval type of incisal edges. You'll see some. I think guys might have worn teeth a little more and so you'll see flatter incisal edges. You'll also see some of the darker shades more so in guys because of lack of whitening and probably home care. Maybe more coffee. I don't know. As a whole, the basics of the teeth are similar.
Howard Farran: Do you see more cases with women? Do women seem to be more cosmetically focused to do this as opposed to boys?
Stephen Kuzmak: Yes. I don't know. Probably 10 is to 1, you're have women for cosmetic cases over men. For me, too, I market we're not going to drill teeth so maybe that even makes that even further where it's, Oh, women maybe see that and say, "I want to get something done but I also don't want to have someone drill my teeth." Then they find me on the website where I say I rarely have to adjust teeth very much [inaudible 01:01:35] to move tooth structure to do these cases. I may even [inaudible 01:01:40] further but I've only done composite veneers on one guy.
I've done a composite bridge which is three composite veneers on another guy. I mean that's two cases out of probably 30 cases that have been on guys. I have one friend who needs some composite veneers. He's a guy but he's got these lines in his teeth and bonding irregularities. I don't think he is in a hurry to fix it. I think a woman who cares ... I think women know their eyes are the center of their upper face and that their teeth and lips are the center of their lower face. When you have your eyes looking all right, your teeth looking all right, you're going to have a nice face. I think guys just don't care. Not nearly as much.
Howard Farran: I'm a dentist for 28 years and every single picture I ever see of myself, I don't even show any teeth. It looks like I left my denture at home when I [take my 01:02:35] pictures. That's ironic.
Stephen Kuzmak: There you go.
Howard Farran: Hey, we're at an hour or two but I just want to sit here and say that, dude, it was an honor that you give me an hour of your time. [Inaudible 01:02:47]
Stephen Kuzmak: Oh, sure thing. Any time.
Howard Farran: I hope you have Matt do one of these, too. I feel it's my duty to make sure that most people are exposed to you. Whatever you want to do with Dentaltown, I mean if you want to do Townie or you want to do other courses, anything I can do to help you because I think the more people that get turned on to you and Artie and Matt are just going to fall in love more with their profession. It's going to be more a vocation instead of occupation.
Stephen Kuzmak: Right.
Howard Farran: I just think you're doing wonderful things for the profession of dentistry. On that note, thank you so much for an hour of your time.
Stephen Kuzmak: You got it.
Howard Farran: I will [crosstalk 01:03:26] on the boards and me or Hogo or both are going to see you October ... What was the ...?
Stephen Kuzmak: October 10th, Saturday.
Howard Farran: Saturday, October 10th and again, thank you for all that you do, buddy.
Stephen Kuzmak: You got it, Howard. Thank you so much.
Howard Farran: All right.