According to Master Ceramist, Randall Berry, 3 out of 10 multi-unit restoration procedures fail due to poor isolation during cementation. In this piece, Randall will share how dentists can avoid procedure redo’s and ultimately get time and dollars back in their pocket.
Watch this video to learn how to save time during cementation procedures by:
- Creating a predictable oral environment
- Reducing distractions and disorganization in dental settings
- Achieve a well-lit field to confidently find all decay that needs to be removed
Rolando Mia: Good morning, everybody! And welcome to Dental Voice on the Case with Zyirs. My name is Rolando Mia. The purpose of Dental Voice on the Case is to share with you how professionals in our industry deal with issues and problems on a day-to-day basis.
Today, we have a very special guest. His name is Randall Berry; Randy. He is a CDT, MDT, and I had the pleasure of working at DenMat with him previously. Now, Randy is going to share with us, based on his experience, the two biggest time sucks in dental cementation cases. So, first of all, welcome, Randy. Thank you for joining us.
Two Influencers That Lead to Failed Restorations
Randy Berry: Thank you, Ro. I really appreciate the opportunity to speak today on Dental Voice. What I want to talk about is disorganization and the distractions in the office.
Recently, there was a particular doc that I was in with to seat eight units, but I happened to make a single unit, and he’s like, “Hey, follow me in the office.” So I walked in, the assistant had already had the temporary crown off. She had everything ready to go. He walks in, gloves up, sits down, there’s wet cotton rolls in the mouth, he takes them out, puts dry ones in. She um, says, “Ah there’s a little bit of red.” So, he takes the crown, loads it up, puts it on, and says, “Clean it up, take an x-ray.”
To me, in my mind, as somebody who has seated many cases and assisted seating many cases, that was, that was probably one of the scariest things I’ve ever seen. Therefore, I need to show you is what good isolation looks like. I think what we need to show you is how it can be easier, how we can save time, and have a better predictable result.
Rolando Mia: Awesome! Let’s play this.
Randy Berry: In this video, a lot of you may or may not have ever tried Teflon tape. I personally love Teflon tape, whether I’m doing one unit, or whether I’m with the doctor and we’re doing ten anterior veneers.
As you can see, with the retraction, the constant evacuation, protection in the back of the throat, you can see that the doctor is seeing clearly, everything is nice and visible. It’s clean, it’s optimal and you know that this is a predictable result.
It’s Not “Just a Single Unit”
When I walk in to a dentist’s operatory and they have an isolation system like this, I feel so much better about doing big cases with them. The word, “just” is probably one of the largest words I ever hear. They say, “It’s just a single unit.” That same single unit, it may be great today, um, and you might get it in, but if you notice on this video, the contacts are protected. The field is perfectly, dry the way that they want it.
Now, maybe he will take his air water syringe and put a little bit of air on there. You notice there’s nothing on the mirror. There’s no mist, no spray, no contamination. A lot of the times, you know you, most of the time, almost all of the time, you have an assistant with a large evacuation, and/or, she’ll have the salvia ejector in the back of the throat, to catch the puddle back here. So, the doctor, the doctor’s fighting to get room in the mouth.
Here, the doctor is working basically alone. The assistant is one step ahead of him, able to aid him into putting the restoration in the correct way. When I see this, I love it. I want to work with this guy, because I know for a fact we’re not going to have remakes. In this crown, it may be fine in everybody’s else’s hands.
I get asked every single day, every single time I go out, “What’s the best cementation system? What systems are the best?” That’s a loaded question. So, I just say whatever is best in your hands, um because it doesn’t matter. If you could have the best bonding system, but if you don’t follow manufacturer’s instructions, and you don’t have this kind of isolation, and your field’s contaminated, I don’t care what you use, it’s not going to work.
This doctor as you can see has got this thing already in, this video is about two and a half, three minutes long. This is how long it took him to seat this crown. All the preparation was done the correct way. When he walked in, isolation was done, patient’s ready to go. The magician can now sit down and do his magic and that’s to make beautiful smiles.
The Importance of Good Isolation
If we, anytime we contaminate this field or we even tamper with this field, we’re just introducing bad things that could happen. As you see, he’s taking the Teflon tape out, meticulously here. He grabs a pair of hemostats cause there’s a little strand left he’ll go ahead and remove this as you can see.
I really think that this is important. I know that some people think, “Oh it’s just a single unit, why put all of that in there?” Again, the word “just”, I hear it all the time. Well, that crown just broke. Part of that is, is because it was contaminated and not all your cements set up.
So, you’re at half cementation, half of it didn’t set, so now the bite changes, things happen, and it breaks in three weeks, or it breaks in four months, or it breaks in two years. Look at these contacts. The contacts are perfect. It’s a good snap through, get some cleaned out, notice there’s not a lot of, there’s no saliva, there’s no blood. You noticed that there were even there was cement that he flaked off. He wasn’t worried about assistant trying to reach back there with the saliva ejector and pick it out. It goes to the back and gets sucked up with this kind of a system.
Anybody that I work with that uses Isolite®, I love to go to their office and place cases because I know that the results are going to be predictable. This is the optimal way of seating a crown. One crown, three crowns, eight crowns or even twenty. If you notice, after everything’s all cleaned up, everything’s good.
Rolando Mia: So in your experience, as you’ve been going through and working with the clinicians, from a time perspective, what would you say are some of the biggest issues and the biggest time sucks that you’ve seen, top one, top two?
Randy Berry: Yeah. I think one of the first ones that I want to talk about, when I walk into an office, and I’m not talking the appearance of an office, what I’m talking about is disorganization.
Keep Working if Your Assistant Needs to Leave the Room
I’ve been in several offices where the assistant had to go grab a different saliva ejector, had to go grab the different evacuator, had to go grab something. She always had to leave the room. The doctor just sat there. These types of systems allow the doctor to keep working. I think that disorganization is a huge problem. Right now in today’s world, our changed world, some states are still closed, where the patients have to sit in the parking lot. So, I think time right now is the most critical thing.
When Ro asked me, there was four or five things he asked me to talk about, and I said, if we can, if we can talk about time, the rest of those will follow. So, I think disorganization is probably the largest one I’ve seen recently.
The other one is distraction. Every single person they’re all talking in their collars, they all have lighting systems, they have to do hygiene checks, there’s just tons of distraction. When you have things ready to go when you walk in, as I said, you guys are the magician, you make it happen. I’m in the lab making it happen behind the scenes.
I really think that you should be able to take out your earbuds, and take off your collar device, sit down, put these units in, and focus on what you’re doing. Get in, get out. Know that I’m not going to get the call that I get at least once every couple of months, “Hey Randy, remember you came out here and helped me with those eight units?”, and I say, “Yes, Doc. It went great.”, and they say, “One of your, one of those units changed colors.”
Porcelain Does Not Change Colors
I want to let you guys know; porcelain does not change colors. We all fire, whatever kind you’re using, at a certain temperature, it doesn’t change. I have showcases for 20 years, it’s still the same color as they worked 20 years ago. So, what’s happening is you have microleakage, the cementation wasn’t isolated. You didn’t have a perfect field like you see in this video.
It makes life so much easier. One of the other things when I’m out there, is I’m looking also for a doctor, and it’s not because I want to go out with every first case, because obviously, I’m not making any money doing that as a lab owner. What I’m also doing is interviewing this process, because I think, “Is this going to be a long-term problem for me?”
Again, you might save time by not isolating, or not using something like isolate, right now, but what happens in, what happens next year, when this same patient calls and says, “hey, this crowns, something’s going on with this crown”, and you take it, and there’s a cracking, or it’s discoloring. Now, there’s one appointment. Next appointment, you have to come in, and cut everything off. You must reimpress. You must send it back to the lab, and it’s, then it becomes the finger pointing of, where was the bonding? Where was this work? Did you guys actually set the lab, was it contaminated at the lab, or was it contaminated at the office? So, I really think that we can eliminate redo’s, which is probably the very worst nightmare for all of us. As a lab owner, we cannot do it, [you can].
Rolando Mia: You, you just mentioned redo’s, I was going to ask, one out of ten restorations fail. Is that the experience that you’re seeing, because of issues with contamination?
Randy Berry: With the kind of cases that I’m doing, that include a large amount of units, I’m going to say it’s probably three out of ten, or even four out of ten. Like I said, within that first couple of months, even the first couple of years.
I have, you know, sixteen veneers. I flew out to California because I knew that somebody out there knew isolation and knew bonding. So, I flew from the Chicago area to California to have mine put in. I think that that’s how important that it is to me as a lab owner. And I think it should be important to all of us.
Rolando Mia: So you can dramatically reduce the issue of pop-offs, or reduce, by not having distractions, making sure you’re prepared, and then ensuring that your fields are nice and clean.
Need to Evolve Beyond Cotton Rolls
Randy Berry: 100%. I think that that’s one of the things that excites about doing this talk, because it’s really hard, I’m the lab guy. I’m also out there in the offices, every single week, and that’s, like again, you don’t know how good it makes me feel when I walk in, and their office is organized, they have a good bonding system, they follow all the instructions, they have a good isolation system. As we all know, today’s standard in shades is standard, American standard, is toilet bowl weight. I still think that the American standard today for isolation is cotton rolls and evacuators. I think that it’s time to change this, especially with the time crunches that we’re all in today.
Rolando Mia: Awesome. First of all, Randy, thank you so much for sharing that. I love the fact that you’ve worked with so many clinicians and the feedback of the insights that you give us is, is real.
Randy Berry: Reach out to Zyris about this awesome video that you watched. When I was going to do this talk, they showed me many videos and there was one of one somebody seating five units, or six units. There was one of eight units, but I think we’ve all forgotten the basics, so I really wanted to go with this video, because I keep hearing the same word. I know we all do, “just, it’s just a single crown”. That single crown I think is equally as important as eight, because if you can do a single crown with the best isolation, the best, with the best predictable outcome, then I know for a fact that I’m comfortable doing your lab work for eight or ten or twenty units.
Rolando Mia: Excellent. Well, first, thank you. I would be remiss in not mentioning that Randy was with the military. Thank you so much for your service.
Thank you for your support, and thank you for joining us on Dental Voice, On the Case. I appreciate it so much.