TBU # 023: How To Increase Your Profits... by waiting?Oct 15, 2022
Read Time: 3 min.
Over the past 10 years of studying dentistry, everyone has always talked about going faster, quicker, less steps, and less visits. People assume that the patient wants less trips to see you. While I have to imagine that statement is true, I also have to imagine that people also don't want to come back in to fix something they just paid for.
One of my personal business goals of biomimetic dentistry is to limit the amount of redos, repeated chair time uses, limit recurring phone calls, etc. All of those things lead to loss of revenue, production time and ultimately patient dissatisfaction.
This is why I love biomimetic dentistry. All of these are eliminated. Patients come in for treatment one time. ONE TIME. Hardly ever am I having someone come back in to fix a filling that fell out, schedule a limited exam for post operative pain, or even fix something that has broken. When they have, its like 2-3 times a YEAR! Those things just don't happen in this office. I treat that tooth and they're on their way.
I'd like to think I'm an above average dentist, but this isn't anything that is unique to me. I dare say most biomimetic dentists experience this in their office.
So what the secret???
Yup. You wait.
You wait on your restorations and go slow. There are a few steps that are super important and should not be skipped. At the top of that list is ensuring that the hybrid layer has had adequate time to mature and polymerize.
*****As quick review, the hybrid layer is formed once we place our primer and bond and then cure the bond. We've essentially created an interworking meshwork of resin tags that are woven inside the freshly cut dentin and is an interPHASE. One material is phased into the other. ******
By giving enough time for this layer to form, we are almost guaranteeing that we will have a proper strong and sturdy foundation to build our restorations on. This is also one reason biomimetic dentists love fiber, it protects the hybrid layer (more on that at a later date).
There is a lot of science that goes into the concepts that I just mentioned above. In the interest of time, I'm going to highlight just one of those supporting articles.
In an article titled
"Influence of Delayed Placement of Composite Over Cured Adhesives on Dentin Bond Strength of Single-application Self-etch Systems"
it states that delayed composite placement over the cured adhesives (hybrid layer) are suggested for optimum dentin bond strength.
They tested placement of composite Immediately and increments of 1 minutes, 2 minutes, 5 minutes, and 10 minutes. They then tested the shear bond strengths. They also tested 6 different kinds of bonding systems. To be honest, none of which I like or use.
I kinda ruined the punchline, but as you can guess, we see and increase in ALL of the systems.
Another interesting find they discovered was the way the bonding systems failed. As you can guess, the shorter the wait time or faster the placement, the more likely it was to have an a bonding failure. Nothing stayed attached. However,
"The predominant failure was adhesive failure for groups with an earlier composite placement period. The failure modes tended to change to cohesive failure with prolonged delays in composite placement for all adhesive systems tested."
So the early groups, the bonding adhesive layer would come off the dentin and would be attached to the composite. In the later groups. the cohesive failures mean that the bonds were breaking between the bonding layer and the composite. So the hybrid layer stayed intact with the later groups.
Analyzing how things fail helps us to know which step didn't work and which step we need to improve, change or otherwise modify. The cohesive failure shows us that the more time we wait, the less "catastrophic" failures we will have. That means we will have lower amount of redos, lower amount of fixes, lower amount of fillings falling out. Which then equates to more money in the practice and more open chair time to do what you want to do.
So the one actionable tip?
Wait at least 5 min after curing the hybrid layer before curing the next layer. You can still work to build up other portions, but its good to wait before proceeding on to the next step.
Spend some time waiting for the hybrid layer to mature and polymerize. A few minutes can pay off a lot for you later on.
Whenever you're ready, there are 4 other ways I can help you:
1. Work with me 1:1 to grow your biomimetic dental practice.
2. Take one of our online courses that covers this topic in more detail.
3. Join our ever growing community, surround yourself with like-minded biomimetic dentists.
4. Download our 53 page biomimetic protocols guide for posterior direct restorations.