fbpx

Immediate Dentine Sealing Tutorial Part 2 – PDP174

In the previous episode, Jaz and Zahid explored the foundational concepts of IDS and its transformative potential in preserving dentine integrity for bonding.

In this Part 2 of Immediate Dentine Sealing (IDS) series, Jaz and Zahid turn their focus onto the critical stages of the fit appointment and reactivation process to ensure you realise the full benefits of IDS.

Watch PDP174 on Youtube

Protrusive Dental Podcast: Summarized Infographic of Immediate Dentine Sealing (IDS) Clinical Step-by-Step PDF

Click Here to Request your PDF Copy

Need to Read it? Check out the Full Episode Transcript below!

Highlights of this episode:

  • 00:00 Local Anaesthetic after IDS?
  • 03:19 Trying in the Onlay
  • 11:53 Ceramic Bonding Protocol
  • 16:28 Immediate Dentine Sealing (IDS) Re-Activation
  • 18:31 Disadvantages of Immediate Dentine Sealing (IDS)
  • 21:56 Zirconia For Indirect Adhesive Dentistry?
  • 23:22 Evolution of Immediate Dentine Sealing (IDS)

If you didn’t see the first episode, don’t forget to check out Part 1 before you dive into this one.

Check out Zahid’s courses

Click below for full episode transcript:

Jaz's Introduction: So after listening to part one of this episode, you now can do immediate dentine sealing, but it's kind of not finished yet because when the patient comes back and you remove the temporary onlay, be it a bisacryl temporary like we discussed, or like a clip or a Telio, you still have to reactivate your immediate dentine sealing.

Jaz’s Introduction:
So this episode will walk you through that entire process and I’m so glad that part one was received so well. In fact, while I’m recording this introduction, I’m having a look. We just published 173, which is the part one of this episode of Immediate Dentine Sealing, and I’m reading your comments and I’m just amazed about how well this episode has done.

Ayesha Iqbal said it’s so good. Well, thank you so much, Ayesha. Muhammad Hammoda says, thank you for your priceless efforts. Well, we really appreciate that. It’s a team effort. One of these episodes I’ve calculated takes about 32 hours of time to edit. So really appreciate that. And Jayaraj Menon says, hi from Malaysia.

Well, hello back to you from Malaysia, Jayaraj I went to Malaysia and had such a lovely time. I visited Penang and Kuala Lumpur and also Langkawi. So all of these beautiful places. And I had such a great cultural experience, such great food. My biggest regret. It’s because I didn’t know about it. I didn’t know about Ramly Burger, right?

I only found out about Ramly Burger while I was in Singapore and I didn’t get to go back to Malaysia. So huge regret is not eating at Ramly Burger in Malaysia. So if you have the chance to eat at this place, apparently it’s absolutely iconic.

Anyway, I digress. In the last episode, I left you on a cliffhanger. I’m asked Zahid about whether you can skip the local anesthetic if you’ve done a good immediate dentine sealing. So the first thing you’ll hear is us discussing that. But if you haven’t listened to part one already, please do check it out.

Protrusive Dental Pearl
The Protrusive Dental Pearl for this episode is a beautiful infographic that Team Protrusive has made for you. Our infographics are pretty famous now. Like, they are exactly what you need to summarize an entire episode, and much more. It’s a helpful visual guide. So if you’d like to download this infographic, if you’re a Protrusive Guidance member, just check out the Protrusive Vault section. Or, under the Premium episode, you’ll see that the PDF download is there for you to check out, it’s also available as an image.

If you’re not yet a premium member then you can check out protrusive.co.uk/ids. That’s forward slash ids and I’ll be able to email you that pdf myself. Just before we go to the main episode just want to say thank you so much. I’ve been absolutely blown away because just yesterday we opened the door to Protrusive Guidance, our new and improved app.

And I’ve been blown away by the number of requests. Now, please be patient because I’m only allowing dental professionals into this network. I want this to be a really safe space and I want us to have this place to be nice and geeky with each other. I think defining, point about being a Protruserati is that you are humble, you are kind, you are geeky, you love the little details and you love to share and learn.

So please do join. To join the community is completely free. If you head over to protrusive. app, it should, by the time this recording, take you to the Protrusive Guidance platform. If it doesn’t, by the way, I’ll put it in the show notes. But very soon, we’re moving away from my existing platform to the new one, and the new platform has a big space that you don’t even have to pay for.

I want this community to be there for everyone, whether you’re a dental student or an experienced dentist, a place to share cases, a place to mentor each other and guide each other. So if you bleed Protrusive Blue and you’d like to be part of the Protruserati, Download the protrusive guidance app. Sign up for the free community membership and it’ll be great. Say hello to you on the platform. Now let’s join Zahid and the main episode.

Main Episode:
So when we now come to the fit appointment, I have heard that because we’re doing immediate dentine sealing, it’s so good that you may not need to use local anesthetic. I just give local. I just prefer to give local. I want to be known as a painless dentist, right? So I just give local. But I know some colleagues say because I’ve sealed the dentine, I will skip the LA. Where do you stand on that?

[Zahid]
So like we were discussing before about working in the specific, so you can’t have one rule for everything. I think there’s specific patients that would tolerate having indirect restoration fitted without LA, but the majority of patients would not tolerate that. The reason why I would say that is because you’ve got, when you’re going to do your indirect restoration segmentation, you’re going to do that under isolation with rubber dam.

You’re going to place your clamp, that clamp might pinch in the gingiva. The patient might not like that very much. Especially when after you’re cementing your restoration. Also with the light cure will generate some heat as well. And some patients do and some patients don’t. But some patients do feel it when you’re light curing. Especially if you’re-

[Jaz]
If it’s root filled, again, once again, if it’s root filled, again, that might be one that might sway you a little bit more if you can isolate in a way that’s not damaging or traumatic, then yeah, that might again sway you to using no LA.

[Zahid]
But generally when it comes to, especially when it comes to the cleanup. I think LA is important or is, would have been important beforehand because I’m using like a number 12 scalpel, I’m using a sickle scaler, I’m using polishing strips in between the teeth. I’m going around with an ultrasonic scaler as well with a thin tip. I’m doing all these things to make sure I’ve removed all the excess everywhere.

And the majority of patients would not tolerate that without a local anesthetic. So it is possible in an ideal scenario. But I’d say if you want to have an easy life, if you don’t want to worry about your patient being in pain during the procedure, don’t be smart, just numb him up. Don’t have to face a situation later on when you’ve isolated the whole situation, you’re in this scenario, you’re doing your cementation and then the patient just can’t tolerate it.

You take everything off and numb him up again. And then you’re just adding on minutes to your appointment and more stress to you. So yes, you can do it. And some people do it routinely. But I would say just make your life easy and just numb them up from the beginning.

[Jaz]
We’re on the same page there, totally. So you’ve numbed them up, you’ve removed the temporary using mosquitoes or whatever, you’re going to get your rubber dam back on. Actually, before, let’s just complete the process, right? So me personally, I’m cleaning the tooth before I get the dam on, because I do, I know some people are against it.

Like some people say there’s no point trying in because you’ve tried it on the model and you’re happy with everything on the model. Then there are some risks of trying in overlays and onlays to fractures and also dropping out of patient’s mouth, all sorts of things that can happen have happened to both of us, I’m sure. And also contaminating it, bloody, bloody, blah, and you can’t reliably check the occlusion with it. All these sorts of factors. What do you do?

[Zahid]
There are certain labs that will offer to silanate your restorations for you before they send it back to you. Like your Emax restoration. But to me that makes no sense.

[Jaz]
You mean, you mean etch, not silanate. You mean, you mean etch, right?

[Zahid]
So there’s some, I mean, the majority were HFH, but some will also silanate the restoration for you.

[Jaz]
Really? I didn’t know this.

[Zahid]
Yes.

[Jaz]
I honestly didn’t know this. Okay.

[Zahid]
So that to me makes absolutely no sense because I’m going to try in the restoration before I cement it. So I don’t want to contaminate that layer. But yeah, so like you, I’d remove the temporary, clean up the preparation, try on the restoration to make sure it fits. I’ve never had an issue.

[Jaz]
And the contacts, you’ve got to get the contacts, right? I mean, fair enough exclusion can be difficult to assess, but the contacts, you’ve got to check the contacts and marginal integrity. One in 20, I might reject.

[Zahid]
Yeah. It also helps you plan in terms of how you’re going to submit your restoration. Let’s say the contacts are a little bit tight. You either going to, if they’re very tight and your restoration is just not sitting, you’re either going to send it back. Or you’re going to adjust it chair side with your technique, with the articulating paper on the floss to check where the tight contacts are, or if it’s slightly tight, then you know maybe I need to pre wedge this area to create a little bit of space in between the teeth so I can cement this and it will be okay.

Interjection:
Hey guys, Jaz. I’m just going to interject with the floss trick. In case you miss it, this is actually really powerful. I didn’t know about this for many years, and my buddy, Ricky Bhopal, prosthodontist, taught me it. And I just think, what a terrible way I used to check contacts before this. Like, usually I’m trying the crown in, and I’ve got this articulating paper on this Miller forceps, and I’m trying to kind of feed it in between the crown and the adjacent tooth and trying to tug on it.

To see where this crown is tight, which contact in which area is tight. And that’s really difficult. And I’ve had these scenarios whereby the crown has fallen out and the patient has almost swallowed it. So this way, using the floss, AKA the floss trick of checking for tight contacts is so much easier. So you’ve tried the crown in and it’s not fully seating, or it could be the onlay for example.

And it’s not seating because it’s too fat. It’s too wide. And sometimes this could be because the adjacent teeth have kind of drifted in, right? If you haven’t got temporary or it’s been lost, or sometimes you had an open contact and now that’s kind of got closed. So whatever caused it, the scenario now is you’re bonding this crown in and you can’t even check the margins because you can’t seat the tooth down.

So what you need to do is get some floss, any old floss, right? I personally like tape, taped floss and I get my red articulating paper. I use a AccuFilm and I would pinch the floss and I would drag that pinched floss all the way across the floss. So now you’ve got white floss and then in the middle is red floss and then it’s white floss.

Okay? So the middle portion of the floss has now got ink on it. Now my assistant will hold the crown very securely with her finger. So she’s got a hold on that and I will floss it. And as I floss down, it’ll eventually go through, but when it goes through, it will leave the mark exactly where you need to adjust that crown.

If that’s what’s appropriate for that crown. Now you could do this mesial and distal, and then it gives you an area to adjust. So I like to use a rugby ball diamond, like a very fine ones. And I’ve got a whole ceramic polishing kit. I think the one I use by Diacomp. And then you try it again and you keep going until you get that nice contact that you desire.

And it’s been a few years of me using this and it works really well. So if you’re checking contacts any other way, stop it, switch to the floss trick and you will not regret it.


So that trial insertion gives you so much information in terms of what might I need to change in my protocol for cementation to make sure everything fits correctly. And that’s usually what I’ll do. So yeah, I would clean up the preparation, try on the restoration, make sure everything’s good in terms of how it’s fitting and where it’s fitting and making sure that will also help me assess, is there a slight discrepancy between where the restoration finishes and where my preparation finishes?

Is that going to cause a problem if I use a resin cement, as opposed to a heated composite? Do I need to fill that discrepancy with a heated composite? So I think just checking on the model is just not enough. You can get great accuracy with scanners as well as with impressions, but there’s always a degree of inaccuracy that comes with first taking an impression, then pouring up a model, then create the lab, develop the restoration before sending it back to you.

So there’s lots of areas that can be developed in that period. It’s not like you’ve just got the tooth there and then you’re cementing a restoration that’s a like for like fit. There’s errors along the way that could develop. So, yeah.

[Jaz]
How long are you spending at the fit appointment for a standard overlay?

[Zahid]
45 minutes.

[Jaz]
Yeah, same, same. A lot of people will say, whoa, you guys are slow, what not. But we do all these checks, man. Like, I enjoy those appointments and 45 minutes is the right time. It’s sometimes even then I might run late. It’s been like really tight contacts. So the occlusion needs lots of adjustment.

But most of the time I’m finishing five minutes early or on time. And it’s not like a rushed or stressed appointment. You’re really taking a lot of care and pride in every little step. You know when I’m bonding, in my mind, I’m seeing like a scanning electron microscope of the dentine. I’m seeing the hybrid layer forming.

Like this is just the way my mind works. Right. And I feel like it helps a day go quicker. It helps to bring some fulfillment and enjoyment. I know you’re the same in terms of when you’re doing these steps, right?

[Zahid]
Yeah, for sure. For sure. I think trying to, for me personally, my philosophy is just to make sure if you’re going to do it, do it right the first time, don’t try and rush things.

And then something fails and then you have to correct it. If you’re going to do it, do it right the first time, take your time, do it properly. And then you’re confident in your work that you’ve provided. Especially working in general practice, we see our recourse. We see these restorations that we’ve placed on the patients that are wearing these restorations, you know.

We see where we might have failed at this. There’s a little something missing here or this is not fitting as well as I would have liked. So, if you don’t want to look at your crap work, just don’t do crap work. Take pride in the work that you do.

[Jaz]
It’s a journey. It’s a journey. Look, I’m sure we can both look at our previous work in early years and see the improvement we’ve made over the years. It’s important to keep striving. It’s important to keep striving and keep learning and keep applying. So, talking of applying, you’ve now applied the rubber dam one and let’s not go into interest time. Let’s not go, oh, actually, no. I think that would be a disservice. We’ve come this far now.

Let’s just talk about treatment of your ceramic as well. It’s probably gonna be a two part episode here. So let’s talk about the treatment of the ceramic. Are you using Ivoclean? Cause I use Ivoclean at the moment. Or are you using your AquaCare or what are your steps? Cause you’ve now tried it in. Technically your onlay is dirty, right? So what are you doing to clean it?

[Zahid]
So in terms of how I clean, you’re using the Ivoclean, so that’s like everything in one. So you don’t have to worry too much about how much time you’re taking. But for me, so once I’ve tried it in, then it will get a hydrofluoric acid etch.

Once that’s done, then I’ll use the phosphoric acid etch. Once that’s done, then it will go into an ultrasonic bath for five minutes. I use water, but you can use alcohol as well.

[Jaz]
And water is like legit? Is that halal? Is that kosher? Distilled?

[Zahid]
Distilled water.

[Jaz]
It’s okay, yeah?

[Zahid]
Yeah.

[Jaz]
Distilled water, like, in terms of where it lives in my surgery, like, is it a special package with distilled water or what?

[Zahid]
I think it’s just the stuff you can get from whatever they use in decon. Really. As long to be honest. As long as it’s clean water, I think you’ve not problem. But these are just the minutia of the steps to help keep everything clean. So your hydropholic acid etch will sort of prime the surface of the ceramic to get it ready for bonding.

Then you ortho phosphoric acid etch will remove any precipitates that have been developed from potentially overarching the crystals that develop on the surface. Then your ultrasonic bath will also remove any precipitate that might be there. Once that’s all done.

[Jaz]
I know some people use steam cleaning as well as a way to clean. That’s a valid option. I know Rustom Moopin does that. I went to his practice many years ago, shout out to him, he did that. I’m using the IvoClean and then I’m doing the HF etching. Then I’m also doing the phosphoric acid. See, I’ve got a ultrasonic bath. Shout out to Andy McIntyre from Scotland who got me onto his jewelry cleaner. Ultrasonic bath, right, from Amazon. Is that, is that what you’re using as well?

[Zahid]
Yeah, it’s just like this big. It’s a tiny little thing.

[Jaz]
Mine’s a bit bigger, man. I don’t know why I went for the jumbo size. It literally sat there and Zoe, my nurse, is so pissed off me, like, Jaz, you bought this thing. When are you going to open it? Right? I’m like, I will come to it. I will come to it kind of thing. Right? These little fine details of distilled water, alcohol. I’m kind of on the fence of what to use. I’m probably going to have to open it. And yes, to use that is gold standard, right? So you put it in there for three minutes, I believe you said.

And then that point, you’ve got a nice etched surface of your ceramic. And then I’m a Panavia fan boy. A lot of time, obviously, if there’s a larger marginal discrepancy, I’ll be using heated composites with a totally agreement there, but as part of the protocol, you’re using the ceramic primer, the white bottle.

[Zahid]
Yes.

[Jaz]
Right. To silenate.

[Zahid]
Exactly. Yeah. So that’s a really important step. So you need to make sure if you’re using an Emax restoration, that you need to know how you treat the surface of that restoration when you’re cementing it. So you need to make sure whichever resin, cement, or if you’re using heated composite that you do silanate the surface of the ceramic before you fit it.

Because it’s like parts of a sandwich. Like you’ve got your base layer bread, which is your dentine. Then you’ve got your margarine or butter, which is your whatever you want to use, which is then your dentine bonding adhesive. And then you’ve got your reinforcement with your flowable, which is like, let’s say your lettuce.

Then you’ve got your composite with your resin cement, which is like your tomatoes. Then you’ve got your silane. Which is your next layer your cheese basically and then you’ve got your ceramic after that which is the other name of the bread. This is a vegetarian sandwich. But yeah, and then so all those layers need to be fit together for this to work so So that’s why silanating your restoration is really important.

And then there’s other little things that you can do. Like, there’s evidence to show that heating the silane also helps with your cementation protocol. So the way I would do is, if you go back, I’ve tried the restoration and I’m happy with the restoration seating. Then I’ve got my rubber dam isolation done.

Then while I’m sort of getting everything ready with the rubber dam, I’ve given my nurse the restoration to do all the HF. She does all that. I taught her how to do it, so she does it.

[Jaz]
After initially sounding like the most biggest control freak in the world, suddenly you just drop this bomb on us, you delegate to a nurse, what the hell?

[Zahid]
No, I trust her, she’s an amazing nurse. And her OCD is worse than mine. So, that’s a really, really important. So yeah. So while that’s all happening, I’m getting everything else ready for the cementation stage of the restoration. And then, yeah, so after you’ve heated, if you’re choosing to heat your silane, it also helps to heat the restoration because if you’re using heated composite, then it helps.

So keeping everything nice and warm, because obviously your paste composite will become rapidly cold very quickly. Yeah. And then you’re cementing your restoration, basically. And I use Panavia as well.

[Jaz]
Now, we didn’t talk about actually activating the IDS.

[Zahid]
Ah, yes, yes. So, in terms of activation of the IDS, so that would be done after you’ve got your rubber dam on, everything’s kosher, everything’s ready. You’ve cleaned up, you’ve removed your temporary cement, that’s all cleaned off the preparation and now you need to activate your IDS again to get it ready for cementation. So, you can either, obviously the gold standard is to use air abrasion, but you can also use pumice paste again, or you can roughen the surface with a coarse bur at low speed.

But you need to get rid of that sort of surface layer of your IDS to reactivate it and get ready for bonding. And those are the three different ways that you can do that.

[Jaz]
Okay. Now, I mean, it kind of makes sense to me, I guess, to reactivate it, but all this time it hasn’t. If the temporary stayed on, it hasn’t touched saliva. And if you’ve been raised, lick with rubber dam and stuff, reactivating it. I still do it. And I use my air abrasion and activate and stuff. But I always look at the scientific basis or common sense approach. I do it because that’s what the protocol says. I don’t know who knows how much difference it makes in terms of, is it actually reactivating anything? I don’t know.

[Zahid]
Yeah. Yeah. No. But for me, it’s like making sure everything is clean as possible. So I don’t want, I don’t want any little bits of Tempbond or anything like that. Anywhere near my preparation, I guess also it can help with removing bacteria, bacteria and ingress that will happen underneath your restoration, that sort of stuff. But yeah, it’s just for me, making sure everything is as clean as possible. That’s really, really important.

[Jaz]
And that’s it really, isn’t it? That there’s nothing more to it other than air abrasion and then you’re ready to carry on. So that is the final step of the IDS that happens a few weeks later, unless you’re like, CEREC kind of thing a few hours later, but that in terms of activating it and now you’re ready to do the bonding protocol.

And if like, as per panavia is about to touch on, it’s about putting the tooth primer all over the IDS and the enamel and there wouldn’t be any dentine exposed because you’ve covered it all with the IDS, right? That’s the whole point. And then you’re ready to use a protocol as per Panavia.

[Zahid]
Yep, exactly.

[Jaz]
Okay. So we’re pretty much covered in part one about how to actually do the initial appointment. Part two, we talked about nuances of overlays and onlays and actually how to activate it, which is a very simple thing to do. But let’s talk about actually. the disadvantages of IDS. Are there any bad points of IDS that we should consider?

Because we know the advantages. You mentioned that in episode one of this series, whereby it increases the microtensile bond strength and it seals the dentine. So hopefully the patient will have less sensitivity at home. And it just makes sense. You don’t want your freshly exposed dentine, those poor tubules to be exposed to saliva and bacteria, you know, totally makes sense. What is the downside of it?

[Zahid]
So the disadvantages can be that it can be very technique sensitive. It can add stress to your preparation appointment, which you may not necessarily need if you’ve got other stresses around you at the same time. Because in dentistry, there’s many factors involved. It’s not just a tooth.

There’s a patient, there’s a nurse, there’s your surgery. So it can add that extra layer of stress to your appointment. But there’s also other things that you have to do under rubber dam isolation. I would say you don’t necessarily have to, but if you want to do it properly, then doing it under rubber dam isolation is essential.

Interjection:
Hey guys, it’s Jaz interjecting with some advice. If you’re struggling with rubber dam, then please check out my quick and slick rubber dam webinar and the 32 clinical videos that supplements it, showing through the loop view of real time, me putting rubber dam on

Now it sounds really boring, me putting rubber dam on, but if you’re struggling with isolation, it’s actually way better than shadowing someone. When you’re shadowing someone and you’re over their shoulder, trying to catch the nuances of what they’re doing, it’s difficult, but the way I’ve recorded it through my loops, the view you get.

It is absolutely amazing. So you get to see exactly how I position my fingers, the exact protocol that me and my assistant follow for daily bread and butter rubber dam isolation. The webinar itself is called Quick and Slick Rubber Dam and I’ve separated the different videos in terms of anterior, upper left quadrant, lower right quadrant, et cetera, et cetera.

So everything’s on there. And to access this, you need an ultimate education plan, which can be purchased through protrusive. app. The other webinars you get with this are Verti Prep for Plonkers. You get Premium clinical videos and you get the brand new sectioning school. So if you’re struggling with extractions, then this can be absolutely amazing for you. Oh, and you can get CPD as well while you’re at it. So check out protrusive. app if you want to have a deep dive into my masterclasses.


And maybe not, you may not be, some people may not be that slick at placement of rubber dam or inverting the dam correctly. Other things that disadvantages are that you have to change your protocol, especially with your temporaries. You have to be aware that once you go through that one scenario of your temporary bonding to your preparation, you never want to go through that again.

When you have to sit there at your cementation appointment and trade off your temporary restoration and cry afterwards to get them back in again. You won’t want to go through that any more times.

[Jaz]
It’s another layer of complexity, but like everything, the juice must be worth the squeeze. And I think to get the best bond strength and less post op sensitivity or whatever, it makes sense to do.

And just like we said in the first version of this, or the first iteration of our series together about Marco Gresnigt and his research about veneers bonded to dentine and how amazing that they’re doing, it just makes, it’s a no brainer to me. Nowadays everyone should be IDSing.

All the materials are readily available. Yes. It takes more time. Yes. It’d be more technique sensitive, but once you get the flow of it and yes, you have to mitigate the whole temporary sticking to it, but it just makes sense. What I want to know is just for completeness for everyone is. When you do it. So, for example, we discussed, okay, anytime you’re bonding, right?

Anytime you’re doing an adhesive indirect. Now, this could be a lithium disilicate onlay. This could be a lithium disilicate or feldspathic veneer, for example, that’s got some dentine underneath, for example. How about some of our colleagues that are using zirconia adhesively? So maybe they’re doing, I don’t do this by the way, but I know some people that do like zirconia overlays and onlays. I guess I should be asking them. I don’t think you do this, but tell us about that.

[Zahid]
So with recent developments, especially, so the main proponent of bonding zirconia is Marcus Blatz and he’s put out a lot of information online about how to cement adhesively using zirconia. I personally cherry picked particular cases if I’m trying to bond adhesively with zirconia. But I think it’s-

[Jaz]
We do a resin bonded bridges like and that works, but you’re on enamel at that point. But like, let’s say you’re doing that lower molar that we started off in episode one and you do the exact same protocol, except in your lab docket, instead of taking Emax or lithium disilicate, you’ve selected zirconia.

Some people do it for strength or whatever, but I just think the bonding predictability it’s getting there, but it’s not as tried and tested as lithium disilicate. So I guess what I’m getting at is if you are doing that anyway, benefit of immediate dentine sealing is still, it’s a characteristic of the tooth. It’s a characteristic of the dentine. It’s still worth doing it, right?

[Zahid]
It’s not, I would say IDS is not dependent on the indirect restoration that you place. IDS is dependent on the tooth itself. So regardless, if you’re using a non precious metal, if you’re bonding gold adhesively, whatever you’re bonding adhesively, it’s important for the tooth to be protected with IDS for sure.

[Jaz]
Okay. And last question now is, in 2005, Pascal Magne, as you said published that about IDS and I’ve seen a lot of stuff come through and everyone’s very excited still. And it’s something I didn’t get taught back then in school and I love doing it and you do as well. Has anything actually changed?

And I think you mentioned in our pre chat about endodontics, something that might have changed because is there any benefit of a non vital tooth having IDS if it’s no longer a living structure, if you like, you see, because there’s no pulp anymore. So what does the literature have to say about that?

[Zahid]
So the literature is not so clear cut about using root treated teeth. All the data that’s out there traditionally has all been on vital teeth. Maybe it’s somewhere, something that can be assessed in the future in terms of, is there any difference with living collagen and dead collagen?

[Jaz]
What about all those benchtop studies? I mean, I guess if they’re doing it on extracted teeth, but by that regard, not acting like the real thing.

[Zahid]
Yes. So Pascal Magne’s studies that he did were on, were on freshly extracted teeth, which were then, the IDS was done and then they were sectioned and tested. Obviously it’s hard to do the studies on anything that’s living inside the mouth, but those tests that were done were done on freshly extracted teeth. So as close to sort of vital teeth as possible. But I guess-

[Jaz]
Rather than freshly extracted endodontically filled teeth, for example.

[Zahid]
Exactly. Yeah, exactly. Exactly. So there is a question there that is there any added benefit of using the IDS for non vital teeth? Teeth that may have been non vital for a very long time. If you’ve got your discolored, sclerosed dentine. Are you gaining any added benefit from doing ideas to that surface after you freshly cut it?

I would still say that definitely be some sort of benefit to it because you’re still priming, the collagen is still there, whether it’s dead or not, it’s still there. And your dentine is still there. Your dentine or tubules, everything is still there. And you still want to get your solvent and your resin into those areas, get those tags and create.

That area of adhesion and strength, but in terms of what’s new with regards to IDS, it’s the pre endodontic IDS. So rather than using IDS to improve the bond strength, you’re using it also before you do your endodontic treatment to protect the dentine, to stop contaminants like bacteria, saliva, and in all of your endodontic irrigants that you’re using to damage that dentine.

So you’ve sort of, let’s say it’s a vital case like an irreversible pulpitis. You’ve accessed into the tooth and now before you’re going on ahead and doing your endodontic treatment, you just sort of place your PTFE over the access or over where the pulp chamber is and then you do your etch, your prime and bond onto the dentine surface.

That would seal off the dentine and protect it from any contamination because we know that sodium hypochlorite and EDTA, we know what they do on dentine when it comes to doing root canal treatment. We know EDTA works on the dentine, it removes the smear layer. They can also damage the dentine that’s around, and then the sodium hypochlorite denatures organic substance, so it will denature the collagen.

So if you want to improve the bond strength of your eventual restoration after your endodontic treatment, and by providing IDS, you can protect that crucial area.

[Jaz]
I’ve never done that, but it makes sense, right? It makes sense in how you describe it there. So, okay, I guess that’s something that’s another thing that we’ve learned today, and we can actually apply.

Zahid, you’ve answered every single question I had about immediate dentine sealing, and you did it brilliantly, and it was a really nice spa with you, and discuss all these geeky, adhesive things that us Protruserati really love, and that’s why you do Bleed Blue. How can we follow you on the socials cause you’ve got a really cool Instagram handle. And then how can we learn more from you?

[Zahid]
So on Instagram, my Instagram account is @yourdentistzahid. It’s a bit weird that that’s my Instagram handle because my Instagram account is sort of dentist facing, not patient facing, but that was always my sort of my go to from the beginning that if I was going to play, put anything on Instagram, I wanted it to be beneficial for dentists and something that people could learn from.

Cause it’s great. You can just post stuff before and afters and it looks great. People are like, Oh, wow. But if, if you want to help people and show them how you do it and get more engagement with the community, then I think being able to show them what you do, reflect on your own failures and your successes and discuss these things.

I think that’s the best way for us to grow and get better as a community of dentists for sure. So, yeah, so my Instagram is @yourdentistzahid.

[Jaz]
And some courses that I saw that you’ve put out recently. Yes, I’ve seen some posters. It looks very exciting. I saw that you’re covering adhesive but also my beloved vertipreps as well.

You’re doing some of that as well. So, I see your work and it is great in both adhesive dentistry and vertical. And what I love about people like you and Alan Burgin is that, there is no such thing as everything is going to be an onlay or everything’s going to be vertical. You are very much, every toothpint’s merit. So tell us more about your course.

[Zahid]
So, yeah, I think it’s a long time coming. Because I do a lot of putting, put a lot of stuff out there on Instagram, but eventually I needed to take the next step and actually sort of teach in person. And that’s where Zohaib Khawaja, he approached me about running a course.

And I was like, yes, I’m ready. And he’s an excellent dentist as well. He has lots of experience with teaching also. And so he is restorative, especially in social sort of dentistry. I can’t list off all the MSCs that he’s got, but he’s got too many, man. But yeah, he also teaches at Guys to the undergrads and postgrads as well.

And yeah, so we decided that we wanted to create a course where we could help upscale newly qualified dentists and dentists that have been qualified for a long time, who wanted, who see all of this stuff that’s out there with the IDS and onlays, overlays, vertipreps, but don’t know necessarily how to do it.

And I don’t know about you, but I’ve been in a situation where I’ve seen something on Instagram or Facebook and thought, let me try that out. And then I try it out and I’ll fail miserably because I don’t actually know, I’ve seen the technique, but I don’t know how to do it properly. I don’t know the ins and outs, the nuances.

[Jaz]
And then you think that, oh, this technique is not so good, but actually you didn’t do that technique justice.

[Zahid]
Exactly. Exactly. So yeah, this course is for everyone sort of. All types of dentists, anyone who wants to upskill in terms of understanding adhesive dentistry, knowing the differences between onlays or overlays, learning how to do vertipreps, but also other things like treatment planning, bigger cases, understanding tooth wear and how to manage that, understanding occlusion.

It’s almost like a very intense crash course in adhesive restorative dentistry, but yeah, we cover lots of stuff. The mainstays are-

[Jaz]
Where is it based?

[Zahid]
So we’ve got a London course, which is unfortunately sold out. Well, I say London, but it’s in Weybridge in Surrey. That’s unfortunately sold out. But our next course, which we’ve also launched is in Manchester. And that’s got about, I think about four spaces left at the time of recording.

[Jaz]
So when is that?

[Zahid]
So that is on the 27th and 28th of April. It’s a Saturday and a Sunday. So for those dentists that don’t want to miss, that can’t take time off work, any issues like that, we’ve given you the whole weekend. So we’ve taken time away from our families to come and be with you and help teach you. But yeah, it’ll be an intense two days. It’s going to be an amazing two days.

[Jaz]
I wish you all the best for that. And I think anyone who goes to that will learn a lot. So I’d snap up those last few places. Zahid, thank you so much for everything, for being a Protruserati for all these years, for connecting and engaging on Instagram and being a true member of the Protruserati and our community. And so it’s been great to chat with you today. Thank you so much, my friend.

[Zahid]
Not a problem. I just wanted to say one last thing about you, Jaz. You are such an inspiration to everyone, all around. Everyone who’s young. I mean, we saw you with, I remember reading your name in these papers that were getting published when I was like, in my final year or in VT and thinking, who is this guy?

Why is he everywhere? But then when I finally got to meet you and sort of even just seeing you chat on YouTube and all these, ah, there’s so much learning that you provide to the general population of dentists, it’s amazing. And even in international community and then getting to go with you to Portugal.

[Jaz]
We’re getting Sicily next, if you want to come by the way.

[Zahid]
No, that’s what I was going to say. So anyone who wants to learn in a completely open environment, I would say definitely go to that Sicily course on VertiPreps. I definitely recommend it.

[Jaz]
Amazing. That’s been taught by Marco Maiolino. But no, thank you so much for your kind words, Zahid. Again, it’s been so nice to connect with you and get to know you, which is one of the best things that ever happened to me on the, on the podcast as it grew is just connecting with people like you, my friend. So, so thank you.

[Zahid]
No problem whatsoever. Thanks for having me on.

Jaz’s Outro:
Well, there we have it, guys. Thank you so much for listening all the way to the end. Now, can you answer the following question? The question is, what is the purpose of pre endodontic immediate dentine sealing? Is it A, to improve the bond strength? Is it B, to protect the dentine from contaminants before endodontic treatment? Is it C, to speed up the endodontic treatment process? Or D, to enhance the colour of the teeth? If you know the answer to this question, then you’re almost there to getting verified CPD, emailed by my CPD queen, Mari straight to your inbox.

The way you can get in on this is through the protrusive app. There’s two different memberships that you get certificates for. One is access to the premium version of the podcast where you get like the premium notes and the transcript and it opens up the Protrusive Vault so everything’s there and easy for you to download.

And about 98% of the episodes have CPD quizzes so you can go ahead and rack up those CE points as you listen to the podcast. And it’s actually amazing value. It’s about the cost of a Nando’s per month. Now if you really enjoy what Team Protrusive are doing and you want to join the ultimate education plan, that’s got all that access to the CPD from the Protrusive episodes, but you get all my masterclasses and mini courses as well.

So head over to protrusive. app to check that out. Otherwise, thank you again to my guest Zahid Sheikh, he did a wonderful job, didn’t he, of breaking down immediate dentine sealing. And I thank you, the listener and the watcher, for joining us all the way to the end. Bye for now and see you same time, same place, next week.

Hosted by
Jaz Gulati

More from this show

Episode 236