I love this! One small note: Putty (packable) bulk-cure composites, like Filtek Bulk One, Simplishade Bulk Fill, etc., do have less shrinkage, but significantly less? Not so much. Once you get into the bulk fill flowables, it is catastrophic in many cases. How do I know this? I measured the polymerization shrinkage force myself using a block of 6061 aluminum and a Keyence LM series digital microscope. (Block has a 4x5mm channel cut into one side of it, offset so that one wall is 2mm thick and the other is 4mm thick. Take pre-cure and post-cure dimensional measurements, including the channel widths pre- and post. With that, use the known modulus of the aluminum, the inside area of the 2mm wall, and the distance that wall moved and Bob's yer Uncle! Polymerization shrinkage force. Like...it's obviously not that simple, but you get the picture.) So, in doing this, I found the following: Filtek Supreme Universal placed and cured in bulk (using Peak Universal from Ultradent - The strongest adhesive on the market...by far with a film thickness of about 5 microns) pulled that 2mm wall in, on average, between 22-28 microns. This is fully cured from the top and both sides of the prep with the Monet curing laser from the CAO Group. I then layered the prep with 2mm wedges. So, the bottom left corner across the channel is 2mm up the other side. Cure. Level it off with more composite...cure...repeat to the finish. This protocol yielded an average contraction of 9-13 microns. Bulk One and Simplyshade Bulk Fill, placed incrementally (to avoid incorporating interfacial voids) and cured in bulk came in at 10 microns and 8 microns, respectively. I have used this method to evaluate pretty much every "bulk-fill" on the market over the last 3 or so years and published a couple articles on the findings in Dr. Gordon Christensen's Clinician's Report. (I am the resident dental materials scientist there...) So why the hesitation when it comes to bulk fill materials? #1. Just because it says "bulk fill" doesn't mean it is "low-shrink." Bulk One and Simplyshade Bulk Fill are category standouts in terms of shrinkage. The first goal in formulating these materials was combatting light attenuation, not shrinkage. Second, even though these materials are deemed "cured," NONE of them are as hard as Filtek Supreme. Not even close. Most suffer in terms of flexural strength and modulus as well. My advice is to stick with what you know in terms of composites. Stay away from flowables. Use RMGI if you need a liner of some sort and the biggest thing...work on your preparatory techniques in regards to removing the smear layer, fixing the demineralized zone, and then follow it with the placement of a quality 5th gen like Peak or the gold standard of gold standards...Optibond FL from Kerr. The bond margin is the most important part of any resin-based restoration. If that leaks for any reason, the restoration has failed. It's no longer a matter of "if"...just when. And that's my 2 cents. Take them for what they are worth.
So sorry it took me some time to get to this comment - I can't believe this was buried. I loved reading it and so grateful for your 2 cents! If ever you want to geek out on dental materials on the podcast I would most welcome you on the show!
By composite fibre post , he mean fibre post ( carbon or quartz fibre embeded in bisgma and epoxy resin matrix ) , right? The one shown in thumbnail?? Secondoy whats your view on FRC post ( everstick post ) ? Which post you prefer??
yes doc that's correct (they are not the same as the resin composite that we use but a 'composite' term is often used) - I think the everstick post makes sense to customise to the canal shape but not sure if this is clinically significant (ie. lack of studies to prove superiority - or rather, I haven't seen any studies myself)
Hello Dr Gulati. Thank you! Stumbled upon your video few weeks ago and extremely happy about it. Very informative and interactive videos in which you share challenges and difficulties you faced during your initial days of practice and get experts which makes it interesting. Will watch all your videos and I am sure it will help me a lot to be a better dentist.
The technique of doing direct metal cast post,core with accompanying ferrule seems to be a lost art among modern dentists. These are long,precise procedures which give longest service.They rarely fail and if they do fail as the expert says it will vertically fracture by splitting longitudinally which makes extraction very easy without need for alveolectomy. Fiber posts sales are through the roof but most of them are lying in the clinics in unopened boxes.When the fracture happens , always at cervical level with an eerie ability at the most inappropriate time , sometimes as early as an year,we have to pray very well that extraction happens without the extensive removal of alveolar bone.That would be a cosmetic nightmare and would need bone grafting and prolonged healing time.
What about prefabricated active metal post that comes in 6 sizes of diamter and 4 different length , short , medium , large and XL.. i find them very easy to use ?? Seconly length of post shojld be just below alveoler crest , no need to bring it till 5mm apical GP??
yes below alveolar crest is most important feature - I don't think we need to be so rigid in getting to 5mm of apical GP. I do like these posts actually as they are stiff
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I love this! One small note: Putty (packable) bulk-cure composites, like Filtek Bulk One, Simplishade Bulk Fill, etc., do have less shrinkage, but significantly less? Not so much. Once you get into the bulk fill flowables, it is catastrophic in many cases. How do I know this? I measured the polymerization shrinkage force myself using a block of 6061 aluminum and a Keyence LM series digital microscope. (Block has a 4x5mm channel cut into one side of it, offset so that one wall is 2mm thick and the other is 4mm thick. Take pre-cure and post-cure dimensional measurements, including the channel widths pre- and post. With that, use the known modulus of the aluminum, the inside area of the 2mm wall, and the distance that wall moved and Bob's yer Uncle! Polymerization shrinkage force. Like...it's obviously not that simple, but you get the picture.)
So, in doing this, I found the following:
Filtek Supreme Universal placed and cured in bulk (using Peak Universal from Ultradent - The strongest adhesive on the market...by far with a film thickness of about 5 microns) pulled that 2mm wall in, on average, between 22-28 microns. This is fully cured from the top and both sides of the prep with the Monet curing laser from the CAO Group. I then layered the prep with 2mm wedges. So, the bottom left corner across the channel is 2mm up the other side. Cure. Level it off with more composite...cure...repeat to the finish. This protocol yielded an average contraction of 9-13 microns. Bulk One and Simplyshade Bulk Fill, placed incrementally (to avoid incorporating interfacial voids) and cured in bulk came in at 10 microns and 8 microns, respectively.
I have used this method to evaluate pretty much every "bulk-fill" on the market over the last 3 or so years and published a couple articles on the findings in Dr. Gordon Christensen's Clinician's Report. (I am the resident dental materials scientist there...)
So why the hesitation when it comes to bulk fill materials? #1. Just because it says "bulk fill" doesn't mean it is "low-shrink." Bulk One and Simplyshade Bulk Fill are category standouts in terms of shrinkage. The first goal in formulating these materials was combatting light attenuation, not shrinkage. Second, even though these materials are deemed "cured," NONE of them are as hard as Filtek Supreme. Not even close. Most suffer in terms of flexural strength and modulus as well. My advice is to stick with what you know in terms of composites. Stay away from flowables. Use RMGI if you need a liner of some sort and the biggest thing...work on your preparatory techniques in regards to removing the smear layer, fixing the demineralized zone, and then follow it with the placement of a quality 5th gen like Peak or the gold standard of gold standards...Optibond FL from Kerr. The bond margin is the most important part of any resin-based restoration. If that leaks for any reason, the restoration has failed. It's no longer a matter of "if"...just when.
And that's my 2 cents. Take them for what they are worth.
So sorry it took me some time to get to this comment - I can't believe this was buried. I loved reading it and so grateful for your 2 cents! If ever you want to geek out on dental materials on the podcast I would most welcome you on the show!
Can I use flowable composite for luting fiber post
if it's a dual cure type or chemical cure, you could
Great discussion!
thank you David always for your kind comments
Hi dr! I'm watching your video right now. Lets see what's new knowledge I can get now. Greetings from Mexico 😊
Thank you Doc - hope you find it useful!
By composite fibre post , he mean fibre post ( carbon or quartz fibre embeded in bisgma and epoxy resin matrix ) , right? The one shown in thumbnail??
Secondoy whats your view on FRC post ( everstick post ) ?
Which post you prefer??
yes doc that's correct (they are not the same as the resin composite that we use but a 'composite' term is often used) - I think the everstick post makes sense to customise to the canal shape but not sure if this is clinically significant (ie. lack of studies to prove superiority - or rather, I haven't seen any studies myself)
@@protrusive thank you sir 🙂 I'm myself fcps qualified specialist from Pakistan, and yes I appreciate your efforts 👏
Hello Dr Gulati. Thank you!
Stumbled upon your video few weeks ago and extremely happy about it.
Very informative and interactive videos in which you share challenges and difficulties you faced during your initial days of practice and get experts which makes it interesting. Will watch all your videos and I am sure it will help me a lot to be a better dentist.
thank you doc!!
The technique of doing direct metal cast post,core with accompanying ferrule seems to be a lost art among modern dentists. These are long,precise procedures which give longest service.They rarely fail and if they do fail as the expert says it will vertically fracture by splitting longitudinally which makes extraction very easy without need for alveolectomy.
Fiber posts sales are through the roof but most of them are lying in the clinics in unopened boxes.When the fracture happens , always at cervical level with an eerie ability at the most inappropriate time , sometimes as early as an year,we have to pray very well that extraction happens without the extensive removal of alveolar bone.That would be a cosmetic nightmare and would need bone grafting and prolonged healing time.
I have to second this comment. Well described. 👍
What about prefabricated active metal post that comes in 6 sizes of diamter and 4 different length , short , medium , large and XL.. i find them very easy to use ??
Seconly length of post shojld be just below alveoler crest , no need to bring it till 5mm apical GP??
yes below alveolar crest is most important feature - I don't think we need to be so rigid in getting to 5mm of apical GP. I do like these posts actually as they are stiff