Dentistry Uncensored with Howard Farran
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356 Adhesive Dentistry with John Kanca : Dentistry Uncensored with Howard Farran

356 Adhesive Dentistry with John Kanca : Dentistry Uncensored with Howard Farran

4/7/2016 9:11:09 AM   |   Comments: 0   |   Views: 734

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AUDIO - DUwHF #356 - John Kanca



Dr. John Kanca is one of the true pioneers in adhesive dentistry. He validated etching of dentin and made it an everyday reality. Dr. Kanca also created the concepts of wet bonding and pulse activation. Dr. Kanca has received fellowships in the Academy of General Dentistry, Academy of Dental Materials, America Academy of Cosmetic Dentistry and the Academy of Esthetic Dentistry. He has been the recipient of numerous awards including the Gordon Christensen Recognition Lecturer Award and has lectured on every continent except Antarctica.

 

www.ApexDentalMaterials.com

Speaker 1:

We are live at Las Vegas. The last day, day three of the Townie Meeting 2016. This is our 14th annual Townie Meeting is it? I am here with my idol, my role model. I've got tell you a story about John Kanca. When I started Dental Town in '98, not even one percent of the dentists had internet connection. I would go in the lecture room and say, "How many of you guys have internet?" There'd be 100 dentists in the room. One guy would raise. I'd say, "What is your email address?" He wouldn't even know. I'd say, "Why did you get the internet?" He'd say, "The kid's teacher said we needed to get it for homework assignments to do term papers on planet mars, or whatever."

 

 

'94 to 2004 Dental Town couldn't really grow very well because we were waiting for dentists to get on the internet. When they started getting on the internet it seems like everywhere I went, the top 10 most famous speakers in the world, John Kanca was the only one on there. So many times I would hear dentists talk and they say, "I heard these idiots arguing or whatever. I heard it's a dumb forum." Someone else would say, "Dude, John Kanca's on that forum." They'd say, "Really? John Kancas' on that forum?" You were the guy who validated Dental Town for the first day. I say from 1998 to at least 2005 you were the single validation to Dental Town. I'll always be forever grateful for that.

 

Speaker 2:

Happy to be able to help Howard.

 

Speaker 1:

You're posting, my god. What do you have? What do you have 40,000 posts?

 

Speaker 2:

44,382 I think it was as of yesterday.

 

Speaker 1:

Tell these young kids ... The bottom line is only five percent of Americans have ever listened to a podcast, you're probably talking to about 8,000 dentists right now. The truth is, most of them are juniors and seniors. I'd say 20% are juniors and seniors in dental school. The other 79% are probably within five years out. For every guy that sends me an email at howard@dentaltown.com and says, "I just want you to know there's an old guy like me listening to your show." The next 100 will be young kids. For young kids, tell them ... You were very historically important in dentistry. You were the one before any of us ever ... We heard it first from you that you could sketch dentin. Your email is, I don't want to give away your email address. It was webbonder@something. Tell the kids your historical relation with bonding.

 

Speaker 2:

I was coming out of practice. I spent a few years just in private practice solo.

 

Speaker 1:

What year did you get out of school?

 

Speaker 2:

'78.

 

Speaker 1:

1978. Where was that?

 

Speaker 2:

Yukon.

 

Speaker 1:

1978 Yukon.

 

Speaker 2:

After about four years I just had a hankering to do more professionally. I started reading the literature and taking a part in some of the meetings. I wanted to have my on a paper in the literature. I tried to figure out some mechanism for that to happen. I ended up buying a hardness tester and evaluating hardnesses of composites and published that paper in 1983 in Quintessence. I published a series of papers along that line, evaluating the hardnesses of composite as they were light polymerized. Back then lights were much weaker and composites didn't polymerize as thoroughly. You had to polymerize a two millimeter layer of composite for 40 seconds. That give you an idea of how far things have come since then.

 

 

I started going to research meetings and I ran into Bertillati. I'm seeing him talking about etching Dentin. He's had been to Japan and knew a professor from Siamba. I saw him talking about it. I, belonging to the current crowd, said, "No, you can't do that." What I determined to do was to go prove he was wrong. That you couldn't-

 

Speaker 1:

Fusayama?

 

Speaker 2:

That they were all wrong.

 

Speaker 1:

Wrong about what?

 

Speaker 2:

Etching dentin. That you couldn't do it.

 

Speaker 1:

That you couldn't do it.

 

Speaker 2:

Then I started asking myself questions. For instance, the liquid in zinc-phosphate cement is phosphoric acid. In fact it's 85% phosphoric acid. Somehow he could mix that into a little zinc-oxide, put that on a tooth, and leave it there for thirty years. Putting 37% on for 20 seconds was really really bad. What I did was, I read every bio-compatibility paper written since 1945. I had my two boys, who were young at the time. They were playing with their G.I. Joes and I'm reading the papers. All of a sudden one day in the Yukon library it hit me. I had a revelation. I literally had a revelation. I erupted out with a rather nasty expletive. I realized in that moment what was wrong. I knew what was happening, what should have happened, and what had gone wrong with everybody's thinking.

 

 

Then I also knew you could etch dentin and it was fine. I started to do that. I actually joined forces with John Gwinnett early on. He provided me with some invaluable information about interface relationships with composite resins and tooth structure. We worked together for many many years. It taught me what was going on. I had all my ducks lined up. I had my literature, I had my research, everything lined up. One day at the Academy of Cosmetic Dentistry in 1989 at Frenchman's Reef I was doing a lecture. I'm a founding member of the Academy of Cosmetic Dentistry. I said out loud to the audience, "I wasn't going to tell you this." If you ever want a room, you probably know this, full of people to stop what they're doing and get quiet and turn around and look at you, you just say, "I wasn't going to tell you this."

 

 

I went on to talk about etching dentin. The place just exploded. My name was on everywhere. My face was everywhere. This is the guy who's going to destroy dentistry. This is the guy who's going to kill dentistry. This is the guy who's going to kill patients. In one of the tabloids someone said, "I want to practice next to his office." That's kind of how, professionally, I was received. Nobody ever asked me questions about is this really the right thing? What have you done? I got hammered. The summer of '89 was a very difficult year for me professionally. I was getting pounded from all sides. I realized then you just had to wait it out. Then just accept that this was going to happen. It happened with etching dentin. Then soon after that I discovered wet bonding.

 

 

As I was doing research for that I kept doing samples. I would get a certain bond strength and a certain standard deviation. As I thought, I've got some high numbers and I've got some low numbers, how did I get those high numbers? What I did was tried drying it more. The numbers where actually started to drop and my standard deviation went up. I did it more and the number dropped further and the standard deviation went higher. You kind of intuitively go, I'm going the wrong way. Even though that didn't make sense. What I started to do was not dry it as much. All of a sudden the numbers started creeping up. I left it a little more moist and the numbers jumped up. Then I just shook off the water and put the adhesive and the numbers skyrocketed.

 

 

They were bond strength numbers nobody had ever seen before. The standard deviation was really tight. I presented that at the research meeting IADR and other meetings. Again people said, "You're full of crap. That's not going to work. You can't do that. You're wrong." I had another one of those things that I had to sit out and wait. I take pleasure in knowing that dentistry changed courses twice because of things that I discovered. I'm grateful for that. It didn't make me personally wealthy but ...

 

Speaker 1:

Repeat the two things.

 

Speaker 2:

Validation of dentin etching and the explanation for why people thought that you couldn't do it. I explained why you could and the factors for ... Let me give you an example. There were etched teeth. They put acid on animal teeth and then they put a control material in. Two weeks later there would be a burn in the pulp. Two weeks. I'm thinking, why two weeks? I saw an article by Gunnar Bergenholtz in 1978 who had taken bi-alkalized bacteria, put it on a smear layer and got abscesses in the pulp within 30 hours. I realized that the pulp could react very very quickly. Why would a phosphoric acid take two weeks to cause a reaction?

 

 

Then I started looking at the controlled material. I saw the controlled material. When you put the controlled material into different cell cultures all of the cells in a culture die. A controlled material was zinc-oxide eugenol. That control material was what people had always called bland and non-irritating and kind to the teeth. It is anything but. What was happening back then is they would etch the dentin tubules be opened up. They'd put this noxious material in there and over two weeks it would diffuse into the pulp and cause a chemical burn. That's why. They attributed that to the acid, but it was always the control material. That's kind of how I solved it at that point. Like I said, it took reading all of the literature to understand that.

 

Speaker 1:

John, a lot of those are confused because there are so many generations of bonding. What generation are we on now, eight?

 

Speaker 2:

Yeah thereabouts.

 

Speaker 1:

Can you explain what was generation one, two, three, four, five, six, seven, eight.

 

Speaker 2:

You'll have a little bit of different opinion on this. The first dental adhesive restorative was severaton.

 

Speaker 1:

Severaton?

 

Speaker 2:

Severaton, and that appeared in 1948.

 

Speaker 1:

Oh okay. I was going to say, "How did I miss that one?" I wasn't born then. Severaton? Are you kidding me? Who made that?

 

Speaker 2:

Oh god, who made that? I think it was DeTrey if I'm not mistaken?

 

Speaker 1:

Who?

 

Speaker 2:

DeTrey.

 

Speaker 1:

I've never even heard of that one.

 

Speaker 2:

It's D-e-T-r-e-y.

 

Speaker 1:

Are they still around.

 

Speaker 2:

No they're not. I think they got taken up by Denstsply if I'm not mistaken. That was 1948. It appears in the literature in 1952. In the British Dental Journal. Kramer and McClain wrote a paper about it. What was really interesting about that paper was that Kramer and McClain describe what they call an aniline die. What they call a blue staining layer. That blue staining layer, that same layer, 29 years later was finally called a hybrid layer by Nobuo Nakabyashi. They were actually the first ones to see a hybrid layer. That was fascinating.

 

 

That was really the first one. Then came about 1977 Kuraray put out New Bond. They had New Bond which is a phosphate esther-based material. In 1981 3M presented Scotchbond. The original Scotchbond, which was also a phosphate esther. These materials were the second generation. You would etch the enamel only. As if anybody could do that.

 

Speaker 1:

What was generation one?

 

Speaker 2:

Generation one was Severaton.

 

Speaker 1:

All right and what was-

 

Speaker 2:

Generation two was New Bond and Scotchbond.

 

Speaker 1:

New Bond and Scotchbond. Okay.

 

Speaker 2:

That one you would treat the enamel with phosphoric acid and then you would mix these two materials up, put them on a dentin, and go. These initially were self-curing materials.

 

Speaker 1:

New Bond was Kurray? K-U-R-R-A-Y

 

Speaker 2:

Kuraray. K-U-R-A-R-A-R-Y.

 

Speaker 1:

Okay, K-U-R-A-R-A-R-Y.

 

Speaker 2:

Kuraray. These were just self-curing materials. You'd mix them, two parts. Mix them and put them on the dentin in the enamel that you'd etched. You'd have to wait for them to set. They're meeker, but at least it was a start. The third generation materials were materials in which you would etch the enamel and then you had a primer that you placed on a dentin. You would acid etch the enamel and then place a primer on the dentin. Then you had a bonding resin. Now you have three parts. There are three parts to the story. There's the phosphoric acid etching of enamel, primer on the dentin, and then a bonding resin on top of that. Those were okay. The dirty secret here ...

 

 

This is about the time now when people were worrying about etching dentin, getting acid on dentin. Because that's a no-no. As you sit there and watch these materials that had these primers, the secret was these primers were becoming more and more acidic. Because to make anything stick to a tooth you have to acid treat the tooth. One way or the other you have to acidify the surface. In order for these resins to stick. They were putting other materials that were acidic ... It seemed that as long as it wasn't phosphoric acid then it was okay to put on dentin. It could be nitric acid. It could be sulfuric acid. As long as it wasn't' phosphoric acid then we're okay. That's kind of what was going on. That was the third generation.

 

 

The fourth generation is the generation I created. Then became total etch. Once we broke through that barrier we could create materials to just put phosphoric acid on dentin and enamel without ... It's hard. I don't know who thinks they can really put phosphoric acid on enamel only. I think that's a stupid thing, to be honest with you. How can you this? This stuff is slopping in especially in the bottom of boxes. You have thin little layers of enamel. How are you going to get ... It's absurd. Now we were free to phosphoric acid on dentin and enamel.

 

 

Then there were primers. Primers could be in one bottle, or primers could be in an A or B type primer. You had primers to put on enamel and dentin and then a bonding resin. The difference the third and fourth was total etch. That's where you went total etch.

 

Speaker 1:

Does your license plate on your Porsche say total etch?

 

Speaker 2:

It should say that but it shouldn't say that. It says Dr. John.

 

Speaker 1:

Dr. John? Why didn't you go with total etch, or wet bonder?

 

Speaker 2:

I like Dr. John. I've had Dr. John license plates since 1976.

 

Speaker 1:

It is a Porsche isn't it?

 

Speaker 2:

9-11 yeah. This is right about the time when wet bonding was discovered. Let me step back just a sec. I had this concept for a fourth generation system. Which was phosphoric acid. I took tenure A and B, and I had Scotchbond two resin for light cure. I had dual cure Scotchbond for bonding on crowns. I kind of created the concept of bonding on crowns. I wrote the first article on this. It was in Ron Jordan's book. One of the aesthetics books. I have a chapter in there on how to bond on crowns, it's 1989.

 

 

We went from there, right about this time we started talking about wet bonding. That's where wet bonding came in, that fourth generation. I took this concept that I had, the phosphoric acid, tenure A and B, and Scotchbond and I went to 3M with it. They didn't want anything to do with it, because you're putting acid on dentin patient's going to die. You're going to go to Hell. Then I took it to Kur. They said patient's going to die. You're going to go to Hell. They didn't want anything to do with it. The only company that would listen to that was Bisco. They hedged bets, but this system that I created is the system that became All-Bond.

 

Speaker 1:

With Byung Sung out of Korea.

 

Speaker 2:

Byung Sung yeah.

 

Speaker 1:

He was born in Seoul and then he moved to Chicago?

 

Speaker 2:

He was born outside of Seoul in a small town. Then he immigrated to the states. He was working for another company then he decided to form his own company.

 

Speaker 1:

What's the name of that city outside of Chicago? Chavanaugh?

 

Speaker 2:

Schaumburg is where the-

 

Speaker 1:

Schaumburg, Illinois.

 

Speaker 2:

That's where the company is.

 

Speaker 1:

Were you guys collaborators on All-Bond? You took it to him?

 

Speaker 2:

The concept of the acid etch, A and B, and resin that was what I had. He had a couple other monomers to work with. This little NTGMA in primer A. He had his own monomer in part B which was called BPM.

 

Speaker 1:

He was a chemical engineer?

 

Speaker 2:

He was an organic chemist. He had a background in that as well. First he offered a partial etch of dentin then finally wen't full blown into full total etch. That's where All-Bond came from.

 

Speaker 1:

All-Bond was a game changer.

 

Speaker 2:

Oh boy it was a game changer. Absolutely. The funny thing ... I don't have really tons of regrets in my life. I should have asked for a piece of the action and I didn't. This is one piece of advice I do have for people. At this time I was thinking history. I'm going to make history, and I did. I changed dentistry two or three times. I changed it completely. That's great, but that doesn't put your kids through college. I'm thinking history, I'm going to be in history, yes. I should have been thinking tuition, tuition, tuition. My advice is if you have choice between rich and famous, take rich. You can buy famous.

 

Speaker 1:

You're two boys that you put through school are lawyers. You're really a dental lawyer. You read that literature ... Most people just look at the summary box and say what do I need to know. How do I do it? You always read that literature like-

 

Speaker 2:

I'm an investigator.

 

Speaker 1:

Yeah. You remind me of some Baptist minister quoting the old testament. You just know all the quotes. You just know all the research.

 

Speaker 2:

I appreciate that.

 

Speaker 1:

You can quote that off the top of your head.

 

Speaker 2:

I have a capacity for remembering things like that. Now we're back. We're at fourth generation. The fifth generation now begins the pursuit of expediency and mediocrity.

 

Speaker 1:

What do you mean by expediency and mediocrity?

 

Speaker 2:

We're going to try to shorten the number of steps. We're going to take the steps down from three parts. We're going to now have a phosphoric acid. Now we take the primer and the bonding resin and combine them into one bottle. That's the fifth generation. Using things like one step, like prime and bond. This kind of thing. This is your fifth generation material.

 

 

The sixth generation material is further effort at expediency. Sixth generation materials don't have any phosphoric acid around and in them. They depend on acidic monomers to attach to teeth. For the most part though, they do not etch enamel as well as phosphoric or as well as other things. You've given up something when you're using this sixth generation material. Those have it, did it in two parts. Either you put part one and part two, or you mix the two together and put it on. Sixth generation were two parts, but no phosphoric acid, no resin.

 

 

Then we jump to the seventh generation. Which is now, again, the great leap into mediocrity. We try to do everything in one bottle. All you have is one bottle. Again, you're depending on acidic nature-

 

Speaker 1:

What are those brands?

 

Speaker 2:

You have things like All-Bond Universal, 3M's adper adhesive universal, a number of those. We have one superb like that. In my opinion you should never use those without somehow conditioning the enamel first. They just don't etch in it. They'll stick pretty decently to dentin, because dentin is easier to work with. The key in adhesive dentistry, in long-term survival of restorations, is making sure you've done adequate preparation and etching of enamel. My advice is absolutely to make sure somehow you condition the enamel surface-

 

Speaker 1:

We're at eight now.

 

Speaker 2:

I would argue that what I created, the newest material Surpass, that we have. I would argue it's a newer generation, but it's kind of a combination of two generations. It's a little bit of the fourth and a little bit of the sixth. It's three bottles, but there's no rinsing. The nice part about Surpass is it emulates a fourth generation material, but there's no rinsing. There's no how wet is it, how dry is it? Everything is either all wet or all dry. Just a minute, let me make a point.

 

 

The fourth generation has been called the gold standard. Today that's as good as you can do, other than Surpass. That's realistically as good as you can do. Nothing is better than, again I would argue that Surpass is better ... Pretty much nothing is better than the fourth generation of materials. People are seeking to doing things faster and faster willing sometimes to give up performance for that. What I tried to do was create something like a fourth generation material. It was just much easier to use. You didn't have to rinse anything. You didn't have to worry about how dry it was, how wet it was. I would argue that was a successor generation.

 

Speaker 1:

Where along this journey ... You did start your own bonding company.

 

Speaker 2:

Actually I didn't. I joined forces with a couple of my good friends, Scott Lamerand and Chris Kulton. Who formed their own company. They use to work for Bisco. They had left Bisco several, I think it was probably 20 years ago now, and formed their own company.

 

Speaker 1:

What are their names?

 

Speaker 2:

Scott Lamerand.

 

Speaker 1:

Scott Lamerand. How do you spell Lamerand?

 

Speaker 2:

E-R-A-N-D.

 

Speaker 1:

R-A-N-D.

 

Speaker 2:

Chris Kulton.

 

Speaker 1:

Chris

 

Speaker 2:

K-U-L-T-O-N

 

Speaker 1:

K-U-L-T-O-N

 

Speaker 2:

They had that company-

 

Speaker 1:

Apex?

 

Speaker 2:

Apex Dental Materials. They had formed it.

 

Speaker 1:

Why the Apex for the root? Why did they like that name?

 

Speaker 2:

They liked the Apex because of the height, the highest point in dentistry.

 

Speaker 1:

Oh the highest point in dentistry. I was thinking the Apex ... I was thinking endo. Okay, Apex. The highest point in dentistry.

 

Speaker 2:

We're trying to avoid endo.

 

Speaker 1:

They started Apex 20 years ago and you were part of that team? Just a consultant?

 

Speaker 2:

No, I was still a consultant for Bisco. We had, shall we say, a difference of opinion about things. About 2001 ... Let's just say that things didn't go the way I wanted them to go.

 

Speaker 1:

Product-wise? Financial-wise?

 

Speaker 2:

I discovered pulse activation. I created pulse activation in 1996. I published a paper on this. Bisco created a light called a VIP, variable intensity polymerizer. They had a booklet with it about pulse activation. There were seven references in there. I wasn't even in there. I would have never even got credit for ... I'm the guy who created the concept. I thought that was pretty unfair. I was ready to create another system. What happened, as I saw it, he got all the money and I was just hoping for credit. Then I saw the credit being taken away too.

 

Speaker 1:

Who were they giving the credit to?

 

Speaker 2:

Him, the president of the company, of Bisco.

 

Speaker 1:

Byung Sung?

 

Speaker 2:

Yeah. That's kind of how it went. I reached a breaking point with that. I wanted to do something, because I had a concept to create another bonding system. I departed, then I joined forces with ... Heard Scott was around and I called Scott. I said, "You want to work with me on something?" I had always liked Scott. We got along very very well. He said sure. From that point, right about 2001, we got together in 2001/2002. We started creating things. We created first Simplicity and then a few years later we created Surpass.

 

Speaker 1:

What year did Simplicity come out?

 

Speaker 2:

2002.

 

Speaker 1:

2002 was Simplicity?

 

Speaker 2:

Yep.

 

Speaker 1:

Surpass was what?

 

Speaker 2:

2006.

 

Speaker 1:

Which one of those do you like better?

 

Speaker 2:

Surpass.

 

Speaker 1:

Surpass?

 

Speaker 2:

Surpass is killer.

 

Speaker 1:

Did Surpass surpass simplicity?

 

Speaker 2:

Yes it did. yesterday I had a friend of mine in my private messages in Dental Town. I get a lot of those in Dental Town. Kids, especially younger ones looking for advice. They tell me, "The guy I work for won't let me buy the right materials and I'm supposed to use this. Can you tell me the best way to use this." I do try to help them out. He said that somebody sent me quote from a Bisco ad that says that All-Bond too is still unsurpassed. That's exactly why it was written like that.

 

Speaker 1:

You're not an owner of Apex then.

 

Speaker 2:

If you look in the corporate minutes I'm not. We have an understanding, basically it's a three-way ownership. By the letter of the law, I'm not. I am from the standpoint-

 

Speaker 1:

Could your two lawyer sons defend you if something went wrong?

 

Speaker 2:

Oh yes. Oh yeah. I own the patents ...

 

Speaker 1:

Oh you own the patents. Explain to these people ... Dentistry's kind of weird in the fact that when you go to a course they're always showing full-mouth rehabs, yet 96 out of 100 crowns sent to a lab are one unit. The bottom line is, what I do every single week the most is an MOD composite on a molar. Anybody can do an occlusal, but an MOD's tough. Especially you don't want post-op sensitivity. You don't want to contact. You don't want them packing food. Will you just detail how you would do an MOD composite on a first molar?

 

Speaker 2:

We premise that, we remove all of the decay properly.

 

Speaker 1:

Would you numb it up with septocaine, articaine?

 

Speaker 2:

Carbocaine is my go to.

 

Speaker 1:

Why is that?

 

Speaker 2:

I just like carbocaine. It's a fairly good anesthetic and it's a fairly short-term anesthetic. You can use it on anybody. You don't have to worry about systemic conditions at all. I've just been-

 

Speaker 1:

Really?

 

Speaker 2:

I've always enjoyed that for-

 

Speaker 1:

How long has that been your go-to?

 

Speaker 2:

About 30 years.

 

Speaker 1:

Why did you leave lidocaine? Why did you not join the setpocaine revolution?

 

Speaker 2:

It just didn't do anything for me. I didn't see it as a necessity.

 

Speaker 1:

Carbocaine's supposed to be what just a half hour?

 

Speaker 2:

I get about an hour, hour and a half, out of it.

 

Speaker 1:

You get an hour, hour and a half?

 

Speaker 2:

Yeah, but it's not going to be as durable as lidocaine or epinephrine would be. Plus, like I said, you avoid systemic issues. You're not going to hurt anybody with tachycardia or atrial fibrillation. You're not running afoul of that at all.

 

Speaker 1:

You numb up with carbocaine.

 

Speaker 2:

Yep.

 

Speaker 1:

I remember back in the day with Dental Town '98 at another thing I give you credit for, that you didn't mention is no one used a rubber dam back then. The joke that you practice under a rubber dam? Yeah I mounted one on the wall so that I'm always practicing under a rubber dam. What do you think about isolation? Do you like rubber dams? Do you like isolite?

 

Speaker 2:

Isolation is absolutely critical. Isolite is a marvelous way to gain isolation as well. Now you have a number of opportunities to get isolation. A rubber dam is absolutely a great way to do it, and is a necessity.

 

Speaker 1:

Not to detour off on a tangent, but one of the reasons I get upset about the way dentists talk about almagam. I've seen this is three different countries in Africa and Asia. Ryan when we go to foreign countries when we're traveling around, when we see a dental office we hit the brakes. We jump out of the car. We knock on their door. I watched this dentist in Africa. The person sitting in a chair like this. He's all excited. He numbs it up and he's showing me, so excited. There's a cavity and it's on a canine buckle.

 

 

He's drilling and drilling and drilling it. Gets a pulp exposure. I don't think he's aware of it. I know he's not. She keeps sitting up spitting water. Spitting in a five gallon. Then he gets out this nice bonding kit, which I notice he paid about 1/10th about what I paid for it in Africa. He puts on the etch. She didn't like the taste so she swishes, spits it out. Then he paints on the resin. She didn't like that taste. She rinses, spits out.

 

 

Then he cures it. Then he puts on the composite. Then he light cures it. Then he spends like 20 minutes polishing it for a whole beauty. When it was all over, I thought to myself, "There's no isolation." There's two million dentists and I think about 500,000 practice like U.S., Canada, Western Europe, Australia, New Zealand. Then there's a million in the middle. There's 500,000 John that they don't have the mechanics for isolation. Anything they read, everybody's bad mouthing amalgam. I want to ask you this, if you can't get isolation, would amalgam be a better material?

 

Speaker 2:

Oh it sure would. If you really can't-

 

Speaker 1:

Dental Town people think if you're doing amalgam you're a communist, Nazi, Stalin, Idi Amin.

 

Speaker 2:

I gave up amalgams 30 years ago. It wasn't because anything wrong with it. It was just a decision I made. I do think that would be a great place for amalgam, because it will survive in unfortunate, or undesirable, circumstances.

 

Speaker 1:

If you can't get isolation and you can't get moisture control, amalgam's a better restoration.

 

Speaker 2:

I would argue that that's a really good choice. Something like a high-density glass ionomer.

 

Speaker 1:

What would you say to these dentists who, I hear them, you see them post that mercury amalgam is toxic. It's probably causing autism. It probably caused my hair loss. Seriously, I had all my hair. I went to Creighton freshman year. I went to dental school. Got my first eight occlusal amalgams. All my fissures where stained. They did occlusal amalgams. That year all my hair fell out. Can we say, for a fact, that my eight mercury fillings caused my hair loss?

 

Speaker 2:

No I think it might have been going to Creighton.

 

Speaker 1:

It was just going to Creighton? What do you say ... You hear the mercury haters.

 

Speaker 2:

I think that's nonsense. It's just nonsense. There really isn't any evidence. Actually, I had one patient in my life. I remember one patient who had contact sensitivity to amalgam. I actually saw that. Each place to get class-5 buckle amalgam where the amalgam would touch his, he'd have a rash. He'd have an eruption in that spot. I took them out and it went away. It was the only thing I've ever seen like it. I've never seen anything like it since. That could have been anything.

 

Speaker 1:

What did you think of that whole Hal Huggins revolution that we went through?

 

Speaker 2:

I give it no credibility at all.

 

Speaker 1:

They're charging people that live in trailer parks $30,000 to remove all their mercury, all this evacuation. They're wearing that NASA suit on the moon. What do you think of all that?

 

Speaker 2:

I think it's absurd, frankly.

 

Speaker 1:

You're a literature freak.

 

Speaker 2:

Yeah, I think it's absurd.

 

Speaker 1:

You're not seeing anything in the literature that would warrant some poor lady in a trailer paying $30,000 to have all of her mercury toxic things removed?

 

Speaker 2:

You're going to know how many amalgams there are in people's teeth in the United States right? Do you have an idea?

 

Speaker 1:

What billions?

 

Speaker 2:

If it was going to show up, it would show up. If these patterns were real it would show up. You'd know it. You would know it. It's just not there. It's not there. It doesn't make sense. I give it no credibility at all.

 

Speaker 1:

Just staying on mercury a little bit. Some people say that drilling out old amalgams to ... Some dentists say, "I don't place amalgams." But I'm drilling it out. I'm smelling mercury vapor all day. Is that harming me, my assistant, my staff?

 

Speaker 2:

It is true that if you cut an amalgam dry you're going to generate more mercury vapor than if you cut it wet. If an amalgam is being cut, it should be cut wet, not dry. Then you should have a high volume suction near it also. I know of absolutely no examples in the literature of anybody suffering for having an amalgam removed.

 

Speaker 1:

Wouldn't a sample size of 150 ... There's 125,000 dentists who work full time. There's 30,000 specialists. There's actually 211,000 people in America who are alive that have a dental degree, if you can't everyone who has retired and hasn't died. Wouldn't that be a big enough sample to show-

 

Speaker 2:

Wouldn't you see it in the providers?

 

Speaker 1:

Would you?

 

Speaker 2:

Yeah, you sure would.

 

Speaker 1:

You absolutely would.

 

Speaker 2:

Because they're the ones who are totally exposed to it all the time, placing it, removing it. Again, there's no pattern in that. It just doesn't exist.

 

Speaker 1:

These guys all have money, access to healthcare. They're in the system. There's no research for that?

 

Speaker 2:

No.

 

Speaker 1:

You would use carbocaine. That surprised me that you said that. You'd use a rubber dam or an isolite. What do you use? What personally do you ...

 

Speaker 2:

It's both. It depends on how I'm approaching this. Isolite is great but you can't get it for everybody. Not everybody will accept it. That's okay. Then you use a rubber. We'll just kind of get that in place, then start removing whatever we need to remove out of the tooth. If it's an MOD, now I'm going to secure my matrices. I'm going to use a V3 ring from Triodent.

 

Speaker 1:

That's out of Australia?

 

Speaker 2:

Yeah.

 

Speaker 1:

New Zealand.

 

Speaker 2:

Out of New Zealand. I actually met Simon McDonnell. I think it was 2004/2005 when he had the original ni-ti prototype. I saw the original prototype.

 

Speaker 1:

Were you in Auckland, New Zealand at the time?

 

Speaker 2:

Yeah I was in Auckland.

 

Speaker 1:

That's where he is?

 

Speaker 2:

Yeah. That's where I ran ... He came up to me and said, "What do you think of this?" I looked at it and-

 

Speaker 1:

Didn't he sell that company?

 

Speaker 2:

I think he did.

 

Speaker 1:

To Dentsply.

 

Speaker 2:

To Dentsply, yeah. When I saw that prototype, I knew immediately this was going to work. I said, "I'm going to use this one." I never liked any of the other rings. They didn't really do much, but this was going to work.

 

Speaker 1:

He had another buddy with him, Marshall White.

 

Speaker 2:

Yes.

 

Speaker 1:

You're his god. Marshall loves the literature. I can't talk to Marshall for five minutes without your name coming up three times.

 

Speaker 2:

I really appreciate that. Marshall's a great guy. He's a really good guy. I would use the V3 rings, their tab matrices, fix the rings. After I get the rings in I'm going to use the wedges. I do like the wedges. Their what we originally called wave wedges. We put them in-

 

Speaker 1:

Stop there. There's low-cost wooden wedges that some people say when they get wet they shrink.

 

Speaker 2:

When they get wet they expand, not shrink. They get weaker. When they absorb water, they swell.

 

Speaker 1:

Wouldn't that be a good thing?

 

Speaker 2:

It gets softer.

 

Speaker 1:

It expands, but then it gets soft?

 

Speaker 2:

Yeah. It's like a piece of wood lying in a river for a long time.

 

Speaker 1:

You like wood or plastic?

 

Speaker 2:

I like the plastic ones.

 

Speaker 1:

Why?

 

Speaker 2:

They'll stay where you put them. They're shape is preferable to the wooden ones. I either use the flexi-wedges or the wave wedges. Those are my two choices. I like them.

 

Speaker 1:

Flexi or wave? Who makes flexi and wave?

 

Speaker 2:

Common Sense Dental does I believe.

 

Speaker 1:

Common Sense Dental does them both?

 

Speaker 2:

Makes the flexi. The wave wedges come from Triodent. This is all inserted. Once I've got my cavity preparation complete. I have the matrix and I have it all set to go. Then I'm going to pick up my Clean and Boost. This is a product we make. It's an acid-based ... It has acids and alcohols in it. You use it to clean the cavity preparation. Just clean it up.

 

Speaker 1:

What's it called?

 

Speaker 2:

Clean and Boost.

 

Speaker 1:

Clean and Boost.

 

Speaker 2:

Yep.

 

Speaker 1:

Okay.

 

Speaker 2:

Clean and Boost leaves a pristine tooth surface. You have something in there that will clean the organics. Something in there that will clean the inorganic and remove all the junk that's in a cavity prep. I put that on there for about 10 seconds and rinse it out. Then I would dry the tooth. The way I'm doing it, I dry the tooth severely. Then we apply Surpass. Surpass 1 is a mixture of acids, but it's mostly water. It's going to re-hydrate the tooth and etch the tooth at the same time. We put the Surpass 1 on. It stays on for 10/12 seconds. Three coats of Surpass 2 are applied directly onto that. Surpass 1 is not dried.

 

Speaker 1:

Are you putting it in with a dropper, or are you scrubbing it-

 

Speaker 2:

No, brushes. They're color coded brushes.

 

Speaker 1:

Are you just painting it? Are you burnishing and scrubbing it?

 

Speaker 2:

Surpass 1 is agitated. You kind of agitate the thing around it to kind of rub it into the tooth a bit. If you leave it wet and then just three brush-fulls of Surpass. They don't have to be rubbed in, just applied. Just wick them in and go. Once the three brush-fulls are in, you dry it. You dry that severely. The more dry you make the Surpass 2, the better bond you're going to have. This is what I love about this stuff. You dry it as much as you possible can. Then you put Surpass 3 on, and thin that out as much as you can. After all three parts are in, light activate it 10 seconds. The nice part about Surpass is that it's either all wet or all dry. There is nothing between.

 

 

The same technique that is used in a class one or a class two is used in a class four, class five, bonding on crowns. There is one technique no matter what you're doing. It can be used under anything. That's what it was for. It's supposed to be a true universal material. It sticks to anything self-cure, dual-cure, light-cure. Everything sticks to it. Anyway, I have my cavity prep. Now I have my adhesive in, I've light activated it. The next thing I'm going to do is put a little flowable in the bottom of that cavity prep. All along the line angles. Carrying out to the cavosurface-

 

Speaker 1:

What brand?

 

Speaker 2:

Titan. Titan is ours.

 

Speaker 1:

Apex makes Titan.

 

Speaker 2:

Yeah, Titan.

 

Speaker 1:

Is that a dual-cure?

 

Speaker 2:

No it's light activated.

 

Speaker 1:

I mean is it a ... What type of composite is it?

 

Speaker 2:

Flowable composite.

 

Speaker 1:

Flowable composite?

 

Speaker 2:

Yeah. I like that because you can place flowable composite in the bottom. You can see if there's any problems. See if there's any defects, or if there's any bubbles or voids. You can see it. That's a very very critical spot. The bottom of that cavosurface margin, in that box. That's where teeth die. That's where restorations die. You have to be really really careful about making sure that it stays secure and properly constructed. You get the flowable in there. That's light activated for 10 seconds. Then we incrementally start to add another composite that we, Exquisite Restoration which is again from Apex. That goes in. We fill that up and then light activate the segments. Then, off comes the matrix and the rubber dam. We do the adjustments and polish and all that.

 

Speaker 1:

By the way, you talk about putting your kids through college. Why isn't that an online CE course John? I've been begging you since 19 ... We started online CE in 2004. Now they're on the iPhone. They're on the Android, the Samsung, the iPad. Here's where you hit it on the phone. We put up 350 courses. They've been viewed over 550,000 times. You'd be selling Surpass and Titan, and all that in countries, well you could find them on a map. A lot of our listeners couldn't find some of these. That's a big procedure. The thing that these young kids are doing with their iPhone is, instead of going to a course like you and I had to always go to conventions. We had to get on a plane, stay in a hotel for the convention. These guys, since it's Apple, they get the Apple TV. Have you heard of the Apple TV?

 

Speaker 2:

I've heard of it.

 

Speaker 1:

Yeah, it's just a little thing the size of an iPhone. They pull this up on their iPhone and then they hit their big screen, or bedroom, or front room, whatever TV's on.

 

Speaker 2:

Cast it?

 

Speaker 1:

Now they're watching it on their 60 inch big screen and surround sound. They tell me that once you take a course in your own living room rocking chair, on your own surround sound where you can pause it if you need to go to the bathroom or get a beer. They just never want to sit in a convention again. That would just be ... See, there's one by Restorative Dentistry. The top one is Nicholas Cante. Why isn't that John Kanca, with 40,000 posts on Dental Town.

 

Speaker 2:

We're going to have to do that.

 

Speaker 1:

I wish you would. It would be the best damn marketing you ever did for your company. What I like about it is, you're a legend. You're the real deal. The other thing I like about you the most is ... The thing I respected you the most about, not just your contribution to dentistry, but why did O.J. not take the witness stand? Because he killed his wife and her boyfriend. They can't put him on the witness stand. So many of these ... There's 210,000 dentists on Dental Town, but who is conspicuously missing? People out there are lecturing. Saying shit that they couldn't say in a message board room where guys like you would just start quoting research. Saying, "Dude, you're full of shit." They can't take the witness stand. Dammit, you have been on the witness stand since 1998. No matter what anybody throws at you, you're there. You're laughing. You're answering it and you won over the whole damn community.

 

Speaker 2:

Again, I appreciate the kind words.

 

Speaker 1:

You have. What I want to do is make this message faster, easier, higher-quality/lower cost. That's an online CE course on their iPhone. When they're laying in their bed watching TV and there's nothing on, they just ... If you think about this. If you look at your big screen TV and you think it's really big, put your iPhone in front of it then move it back to where you can't see your big screen TV and you're about right here.

 

Speaker 2:

Yep.

 

Speaker 1:

That's what they do. They put in their headphones. I had a woman tell me this. My husband's laying next to me asleep and I've got my iPhone on. It's leaning next to his pillow and I've got my headphones in. I'm watching online CE. They're getting credit for ... It's a game changer.

 

Speaker 2:

Yeah.

 

Speaker 1:

We need to make all your information faster, easier, higher quality/lower cost available to the masses. That should be a game changer for your company.

 

Speaker 2:

That would be a nice thing.

 

Speaker 1:

Now you take out the rubber dam. Is polishing cosmetic, or is that real? Some people talk about when you're done with a composite you should acid etch the margins and reapply flowable-

 

Speaker 2:

Yeah, I like doing that. I like sealing restorations. I typically will go back and seal restorations.

 

Speaker 1:

At the time it's done?

 

Speaker 2:

At the time it's done.

 

Speaker 1:

Talk about that.

 

Speaker 2:

Polishing is a necessity.

 

Speaker 1:

It is a necessity.

 

Speaker 2:

You don't want to have rough surfaces. Rough surfaces will attract plaque. You definitely want to have a smooth surface. You want to have thick pits in there. You don't want to have stuff accumulating in it to stain it. It's a mess. Yes, you do want to polish restorations. I don't think you have to go crazy putting all kinds of tertiary anatomy in stains and putting decay back in the teeth. I find that folly. I do need to create good occlusion, a functional occlusion. If all you do is make sure they're properly an occlusion, both in centric and para-functional movements, then you've done something well. I do like to go back and seal them, just in case. There's always potential for little defects along the margins. I like to go back and seal those things. That's important to me.

 

Speaker 1:

Do you agree or disagree with this statement. We start out in college and we learn math, and then applied math. Math is just math. It's one plus one equals two. There's no philosophy.

 

Speaker 2: