Crack in the Amour

I totally forgot to talk to you about the Masters. I will do that and then I will talk to you about a case I did this week.

First of all, if you are a golfer, YOU HAVE TO GO to the Masters. Everyone says they would love to go. Just go, for crying out loud! It’s just money. This year I was given a ticket, but as you may know, I went about 4 years ago with my father and paid about $270 for a ticket. It was so worth it.

My father said, "I didn't think I would ever get to do this. Thank you so much for taking me." I guess his generation still thinks something like this is unattainable. Ours is the "Let’s do this" kind of generation.
If it costs, so what?

I am trying not to retire at 60 or 65. My plan is to retire a little every year (which is why my wife and I go on big trips). I don't want to wait to do something that is only $270. I realize that is a lot of money, but if you could have seen my dad’s face, you would understand.

Anyway, this year I got a ticket and my buddy bought one ($350). We drove up after church on Sunday. I stayed at a friend’s house that lives about 5 miles from Augusta National. Augusta is kind of a one-horse town but it comes alive for a week in the spring. The club is exclusive and the tickets are hard to get, but once you are in, it is easy. Parking is free. Sandwiches (palmetto cheese) are $1.50, and beers and cokes are $1. No, that is not a misprint.

One thing that gets you is the merchandise store. The only place to get Masters shirts and towels and tees and ball marker stuff is at the Masters. It is not that they charge a lot (most of the stuff is reasonable), but you just end up buying a bunch of stuff.

We got there at 7 a.m, and hadn't spent any money on anything other than gas. I left the merchandise tent at 7:30 a.m. and spent $500. That is also not a misprint. In my life I have spent $500 on clothes but... Two shirts for me, one for my wife, one for my dad, two t-shirts for a couple of friends, a hat and I got a pullover (which was really nice) and BOOM $500.

I just can't describe it. The elevation is unreal. The people are nice. The golfers are thrilled to be there and very friendly. The grass and the course are almost perfect. Remember, if you are a golfer, YOU HAVE TO GO. Doctor’s orders. Anyway, here are the photos.

There is only one way in and this is what it looked like at 7:55 a.m. They open at 8 a.m.

The madness that is the merchandise shop.

Lee Westwood at hole #3

Tiger and Mark O'Meara

The Big Oak by the club house

Hole #10, where Bubba Watson hit that miraculous shot to win the tourney.

This is Amen Corner: the green of #11 is on the right, famous #12 is in the middle, and the tee of #13 is way back on the left.

Now, the blog topic. I have a rash of central incisors that have had vertical cracks in them. In the last couple of months, I have actually recommended crowns to quite a few of these people. Now, you know how conservative I am. But these cracks have been palatable.

Usually when you see craze lines you run your explorer over them and they’re smooth. These really made me think the tooth was cracking in half. I could see the crack in the x-ray. I went back 4 years and looked at their bitewings; I could see the crack getting bigger.

This is a first for me. I have never prepped a central incisor because of this crack. I really felt like the vitality of this tooth was in danger. No symptoms but a huge crack in their front tooth.

I have a woman coming back in a couple of weeks. I recommended both the central be done and another one be done. I prepped this tooth yesterday, and much to my surprise, the crack continued. After I got the enamel off the facial, this allowed more light into the tooth and I could start to see the crack on the ling. So instead of a veneer, which I considered, I did a full coverage crown. You can see on this photo that the crack is still there in the prep.


Here is the picture of the tooth before prepping. Looking at this photo, I know that the other central is definitely in danger of the same thing. I told the patient this. But there is no radiographic crack yet.


I didn't know what to tell this patient. I didn't know if I should tell her that this tooth could possibly act up. I don't know if this tooth is going to need endo in the future. didn't know if this was the ultimate treatment. Does it matter if I do an all-porcelain crown or should I use PFM?

Crazy, but I am going to look at these cracks a lot different now. I still don't think I am going to treat every one of them, but I think if I can see the crack on the x-ray, I definitely am going to start planting the crown seed.

Do you guys see a lot of this? Have you seen someone that has lost a central because of this? Let me know.

Have a great weekend.
john

Now, I Need Your Help

Hey all,

Hope everyone had a great Easter. I went to Miami and spent Easter with my wife's family (who I consider my family). We had a great time. One thing though: no one in my family likes golf. I sat in the living room and watched The Master's all by myself. It was awesome. Too bad I didn't have anyone to share it with.
Their thing is baseball, so I can say I watched a ton of baseball.

Listen, I reread my last post and I think I might have misrepresented Triodent a little. Here is the thing: Triodent is getting bigger. They had something like 10 reps in the USA. One of the ways they were getting the word out about their products was by supporting lecturers (like me). And it worked; their products are doing very well. Recently they have come into an agreement with Ultradent to distribute their products. Seems like a win-win.

Now, on to the topic de jour. I want to ask some advice. You know dentists are basically on islands. Things like this help, but for the most part, most of us are doing things on our own. So, I don't know what is normal sometimes.

For instance, you take a tooth out and 4 weeks later there is a bone spicule sticking out of the patient’s gums. You go in there and take it out. Do you charge for something like this? Or, better yet, what if they have a dry socket? Not your fault. But next thing you know, you are changing dressing two, maybe three, times. All of this I do for free. But I have to tell you that I can't remember the last time someone came to me with a dry socket. It must have been over 6 years ago.

How about this? You do a deep filling. The tooth starts to hurt, so you relieve the occlusion (free). Then the tooth doesn't stop hurting. IT is throbbing and very tender to the touch. Uh oh. This bad boy needs a root canal. So you do the root canal and there are no problems there. Do you charge for the access filling?

Some of you would then recommend a crown (I think that if it was small enough to do a filling, just because it has an access filling doesn't mean it needs a crown, but we won't get into that). Do you charge for the build-up to fill in the hole left by the root canal? What if you do a crown and the same thing happens? Do you charge to fill the access hole?

What if you do a denture? We all know that there are two types of people that get dentures. The first type is the patient that you deliver the denture to, but then never see again (I have just read about this patient in books). The second type is the patient you deliver the denture to, and then this happens:

You ask if there are any high spots or areas that might be rubbing. The patient says that everything feels great. But, a week later, they are back. You do some adjustments and then the patient says, "That feels great. Thanks for everything. You are the best."

A week later, they are back. You do some adjustments and then the patient says, "That feels great. Thanks for everything. You are the best."

A week later, they are back. You do some adjustments and then the patient says, "That feels great. Thanks for everything. You are the best."

A week later, they are back. You do some adjustments and then the patient says, "That feels great. Thanks for everything. You are the best."

Here is the thing. My father says that 3 adjustments come with a new denture. Fine. But when do you tell the patient this? Before the denture is made? All you are doing is telling them that things may not be perfect, but give us three times to fix it. How about after you deliver the denture? Or do you tell them 3 adjustments are on the house after the second adjustment? Then it looks to the patient like you think he is crazy.

How about things like a baby tooth? If I have to take a tooth out on a 5 year old and it has big time root structure, that is easy. I charge them full $100. If the tooth is wiggling there and the parent wants you to take it out before it is naturally going to come out (even though you tell them that the thing is like a week away from coming out), what do you charge for that? If you go in there, put a 2x2 around it and take it out with your fingers, do you still charge $100? I think this is unfair and I guarantee they are going to think that, too. I think even $75 might be too much. I mean, the mom didn't even get a chance to sit down in the reception chair when the kid comes out.

I don't know. I know I am a wuss when it comes to valuing myself. What are you guys doing? I know I asked a lot of questions, but the more you answer, the better I (and other readers) will become.

Thanks. Have a great Thursday.

john

Popcorn and Wine

Greetings,

I hope everyone is happy and healthy as we speed through 2012. For those of you who read my “Big Valley” blog, a quick update: we have running water! There is still a lot of construction to do, but being able to flush a toilet is something I never thought I would take for granted.

I have had stomach issues for years. I have been to every GI doctor you can think of. I have had every prodding and poking test they can come up with. I am usually given some sort of acid reducer and told to relax because most of this is being brought on by stress. Well, that could very well be. I do tend to hold things in, so it made sense that stress would be a factor in my stomach problems. As time went by, the whole “gluten” sensitivity issue was brought to my attention, and thinking back, I could really associate my stomach pains to eating a meal with bread or pasta, etc.

About a year ago, I decided to try the gluten- free diet. Believe it or not, I felt really good. The pains were not nearly as bad, so I thought I was on to something. =I was very strict (or at least I thought I was) about my gluten intake. I would have a gluten- free chocolate protein bar every morning with my coffee, or a gluten- free whey protein shake. Sometimes I would have scrambled eggs and bacon, being very careful not to have any bread. Anyone who has had these pains knows exactly what I’m talking about. It’s almost debilitating. Staying up all night or sleeping on the couch. This gets to be tiring after years and years. I couldn’t figure out why I was still miserable if I was eliminating all the gluten from my diet.

Recently I decided to take a blood test that would determine if, in fact, I was sensitive to wheat and gluten. The results were more than shocking. Of course, (which I could have told them) anything with wheat and gluten came back as a high reaction. But, here is the list of all the other things I can never eat again for THE REST OF MY LIFE:

Eggs
Milk
Whey
Chocolate
ALL dairy
Asparagus
Green peppers
Pork
Almonds
Yeast (No beer? Are you kidding me?)
Cod
Crab
Avocados
Kidney beans
Coffee
Honey
Sugar

I will let your brains absorb that for a minute and see if you come up with the same thing I do. I think most of you figured it out. My diet now consists of popcorn and wine. They are the only two things NOT on the list! I have been going to the movies more, which is kind of fun (Hunger Games was good). Ok, it’s not that bad, but close. It’s been about 10 days now and I have been really good at not having any of those foods. Believe it or not, I have not had one stomach problem. I guess from now on, I will have to determine if a bad stomachache is worth eating or drinking something I shouldn’t. I will have to choose wisely.

Have a great week and think of me when you go to the movies.

Scott

OSHA

Is it just me or did Easter come up pretty fast? People are calling and asking if we are open today and I am wondering why they would be asking that. Duh! It’s Good Friday. Life has been so crazy that I have forgotten to look at the calendar. Usually the house is decorated and there is plenty of notice from my wife and staff, but apparently it has been the same for them.

There are a couple of things going on in the lecture front. I didn't know if it was out yet, but Triodent (the ones that are sponsoring my lecture) have basically sold their USA distribution to Ultradent. So Triodent is now Ultradent. They said to me that as of May 1st, they couldn't honor any of their commitments.

I called Ultradent and asked them if they plan to honor Triodent’s commitments. And basically they said no. They politely said that they have to see me first. I can understand that, but it still stinks. Uh, well, I had about 6 lectures planned that they were supposed to pay me for. If I have to do a couple of lectures for free then so be it; I need the experience anyway.

But another trail got hot while all this was happening. Kuraray (whom I tried to start a relationship with before because I use their products every day) called me. Turns out they might want to sponsor me. They are sending their clinical director from Arizona and regional director from Atlanta to come see me speak in Tampa in a couple of weeks. And they want to have lunch. Uh oh. Oh my gosh - the pressure. I don't know if I am any good yet, considering I have given the lecture once. Well I have been working pretty hard on the lecture lately. I will let you know how it goes.

Today I want to talk to you about my experience with OSHA. I am going to come out and say it: I have been bad. I think you are supposed to have a staff member in charge of doing ALL things OSHA. In the last 5 years, we have had some staff turnover. People have retired, people who were part-time needed full-time. Now that the smoke has cleared, we began to realize that we have not done the things we need to do in a loooooonnnnnngggggg time. We called in a consultant (a past OSHA employee) to come into our office and get us back up to snuff before the hammer comes down on us.

A couple of things about this. This guy makes every infraction sound like a "they can shut you down" infraction. This office is 30 years old, and we have had the same electric plugs for 30 years. He wants us to change 30 regular plugs to GFI plugs because they are within 6 feet of water. We had to buy log books. We have to have paper employee files. We have to have everyone's immunizations on record and, according to him, they have to be under lock and key (and if you don't have the actual paper from the doctor you have to sign a form saying you swear to have the right immunization). We have to have an emergency exit route drawn up and posted. We all have to have completed a class so we know all this and we have to sign something saying that we all know where the log books are. We are apparently using the wrong kind of sharps containers (they have to be clear). We have to know who manufactures our red bags and their phone number and put it in the log book so OSHA knows we are using the right kind. All of the soap and cleaning supplies have to be labeled with a MSDS tag.

There has to be an eye washing station. We have one, but the caps covering the things are gone. He said we have to replace the caps. First question: Why? Second question: How the heck are we going to find caps for an eye washing station?

This little update is going to cost us over $2,000. I mean, changing 30 GFI plugs is going to be expensive. We had to buy all the appropriate log books. I have to pay for everyone to have the OSHA class. Arghhh!!!

I know OSHA is important. I know they are trying to make me safer and I know that I should be up to date on all this. But man, can they nick pick you to death. I can see how this would make some dentists say, “Just forget it .We’ll worry about it if they come.” My father has been doing this for 41 years and has never seen an OSHA rep (knock on wood).

And just when we are in the middle of all this, the fire chief comes around and starts inspecting our place for fire safety. We have to have a new sign out front to tell the firemen about the building. We have to change two EXIT signs that are not working properly. And we have two extinguishers that are almost out of date.

When I got into this business, all I wanted to do was help people. They never told me about this stuff in dental school.

Anyone have any "I'm going to shut you down" OSHA stories? Come on, misery loves company.

I hope you all have a blessed Easter.
john


Remember the reason for the season. Easter is a day where we celebrate Jesus dying for our sins (on Friday) and then rising from the dead (Sunday), essentially defeating death and opening up the gates of heaven for us. It is a great day in the Christian world (and, of course, there is lots of candy). It is the most meaningful holiday of the calendar for me. If you have any questions about Easter or want to contact me about anything, I am always available at Jgammichia@aol.com.

Adhesives: The Game

Hey all,

Sorry about Friday. My editor told me in advance to send the blog to a different email, and I didn't. So I sent this blog into cyberspace only for it not to be seen until after the weekend. My fault.

The sting of last weekend’s loss is still dull, but it is going away. I think watching the games being played is going to make it worse again. We should be there. I told my friend that watching basketball this weekend is like seeing your old girlfriend with some other guy at a dance. BUT I did get Masters tickets (just Monday's practice round). I am so excited. Hopefully the azaleas in full bloom will make me forget about the pain in my heart.

I will tell you about my Masters experience on Friday, but here is a tease.



I am not reading as fast lately. I am so busy wearing all my hats that I don't have that much time to read. But I did finish the book Samson and the Pirate Monks. It was okay. It is about this pastor of a church who was addicted to sex and pornography. He spent over $300,000 on prostitutes and porn. The book is more about his recovery than his addiction. I think it would have been better if he detailed his addiction. Society nowadays wants all the dirt.

I am now reading The Boy that Came Back from Heaven, a book is about a father and son. They were in a car accident and the boy was hurt badly (his head separated from his spinal cord). The doctors told the parents that no one has ever survived these injuries. I think the story is going to be that he survives and he talks about his time in Heaven. I have heard so many people talking about it and someone finally gave it to me, so I picked it up. I will let you know.

Okay, where were we? I have all this new knowledge of the science behind the new generations of adhesives. And like most things that are new to me, I usually bounce them off the experts. I usually go to two or three different places. I go to one of the top guys at the University of Florida College of Dentistry Biomaterials department. I go to REALITY and ask the question on their expert forum. And I go to Clinicians Report.

So Clearfil SE Protect? I went to CR and looked up the last adhesive study:

Fourth generation bond strength..................Dentin 39 and Enamel 34MPa
The best 6th generation (Peak)...................Dentin 50 and Enamel 46 (Wow!)
SE Bond..........................................Dentin 47 and Enamel 38
SE Protect.......................................Dentin 25 and Enamel 30 (Hmmm)

I wrote to the author of the article and I asked him how he felt about giving up half the bond strength just to add the bromide in the solution. He told me that he talked to Kuraray (manufacturer of Clearfil) and they said that they have a problem with the way CR did their study. So now who do you believe? Do you believe the manufacturer or do you believe the independent study?

I did call my contact at Kuraray (don't I sound so high society?) to get an idea of how Kuraray feels about the above. How does one company get one result and one company get another? He said he was going to call me about it.

Then I wrote my researcher in Gainesville and asked him what he knows about MMPs and how he feels about putting bromides or CHX in the solution. He said, “"Whether or not MMP means anything, I am not so sure. For example, in a recent study from Leuven, they could not detect any MMP when Clearfil SE was used, but found it after the use of Optibond FL. Personally, I am far from convinced that it plays any role at all. The reason is simply that Gwinnet did some studies where he had removed all collagen by use of collagenase, and the bond strength was as good as with collagen. I personally believe that one of the keys is to get an intimate contact between the primer and the hard dentin surface and then get rid of moisture before the resin is placed and cured. Under such conditions you form tons of van der Waal bonds. If water to any greater extent can reach that region, the van der Waal bonds may fail."

Oh man, now he is saying that collagen might not be the deal at all. So do we listen to the company, the independent study, or the researcher? Confused yet?

Listen, me and you are the same. We sit back and do our work. We are dentists. We want to do good work and do the best we can for our patients. There is no way we can get involved in all the research and all the back and forth that is obviously going on in the product manufacturing side. And if you do try to learn everything, you can see that your head will spin right off.

This is almost like a game. But who is the referee? Who is going to tell me THE TRUTH? I don't know, but I will keep working on the answer. And I am hoping it is not MONEY.

Have a great week.
john

Shades and Cosmetics

Spring is here. Everything in north central Florida is neon green. The weather is nice enough to break a sweat in shorts and a tank top, so we must jump in the pool to cool off. Hope that does not make any of our northern readers to upset.

Let's talk about shades and cosmetics. I have a case on a very sweet girl I am trying to get nailed down on No. 7. Let me go over the history of this tooth and how we got to where we are today.

This tale starts about three years ago when “Susie Q” walks in the door with No. 7 fractured just above the attached gingiva. The tooth had previous endo with a build up and no post from an unknown provider. The tooth/crown and buildup had fractured. We go over the options and decide a post and crown would be needed, though somewhat guarded due to the limited ferrule effect.

Everything goes well, at least for about three years. Then she comes back one day with the root fractured No. 7. Now, after a lengthy discussion, we decide an implant was best since three-fourths have had very little restorative work. My office refers her to an implant place and everything goes well. After initial healing, we place a temporary to help soft tissue development. After a few months everything is going well and we start the restoration process. The patient has thick biotype tissue and everything is healing well. We end up using a Atlantis custom abutment with a layered zirconia crown.

Now the fun begins. No, it is not the dreaded black triangles of death! But, the shade and cosmetics of the crown is driving the patient and me crazy. After about six shade checks, multiple photos, the lab sending a ceramist over for a shade match, and the patient traveling about 75 miles to the lab for an in lab shade match—we get it.

Before she goes to the lab, I tell her to look at everything, the shade, phonetics ... I mean everything! I tell her not to leave the lab until she is totally happy with the crown. She returns from the lab and everyone agrees the color is great, finally. It is cemented and everyone thinks it looks great.

Well, that does not last long. A few phone calls later, the patient decides she needs me to look at it. She now thinks that it is on crooked and the contour is not right. She has gotten herself worked up in such a emotional mess over the weekend about it. “Susie Q” says her family thinks it looks great and they all like it. However, she is just not sure if she likes it! There is a little too much roundness to the facial and the incisal edge is a tad to flared.

I tell her that there is only so much I can do to change it, and that all the shading is on the surface so the color could be effected if I adjust it. Reluctantly, I break the glaze and adjust the crown. I make a few changes to the labial and line angles and she thinks it looks better. I am not sure how she will feel in a few days, but at least now she seems happy.

I get a case like this every few years, and it is always a single anterior on a female. I always tell them before we start that one of the more difficult things for a dentist to do is match a single anterior front tooth! I warn them it could possibly take several shade checks and visits to get it right. I want to warn them and set their expectations before beginning so it does not look like I am a bumbling idiot every time we have to send it back. This crown takes the cake. It has been the most difficult one in a while.

I know there are all kinds of gadgets out there for shade matching. We look at them in natural light with neutral backgrounds, all that text book stuff. Sometimes the human/emotional factor will override everything. I want to make my patients happy; however, chasing perfection with a patient can make you go crazy at times—especially when it seems perfection is a moving target.

Have a good week!

J.J.

Adhesive 101

Hey all,

I had a really rough weekend. I don't know when I have been more disappointed by sports in my life. I don't know if you watched the college basketball games this weekend or not, but the Gators lost in a heart-breaker. We were winning by 13 with 8 minutes to play when we had a total collapse. I thought we were the better team (at least we were for 32 minutes of the game). I am telling you, I think I need a sports therapist.

Now every time I hear someone talking about the Final Four I turn the station (radio or TV).If I hear the word Louisville, I get physically sick. I had to kick a Louisville fan off this blog for good after she made a comment about it. I am looking into how to get her dental license revoked. She messed with the wrong blogger.

It has been a tough week for me. Saturday night, I woke up in a cold sweat (it could have been from the alcohol) at 2:30 a.m. and I couldn't go back to sleep. It gave me an opportunity to watch a movie I had, The Girl with the Dragon Tattoo. Wow, was this movie graphic. Very explicit in a lot of ways. Good movie, but very graphic. I told you I read the book and that was really good.

Speaking of books and movies, I had to take my son to see The Hunger Games because he and I both read the book. I thought it was okay. The book was so good that I thought the movie was going to have trouble living up to it. It did, but I thought it was a pretty good movie. It was a 2 and a half hour movie and when it was done I was like, "That was it? It was too short.”

Okay, topic. I told you that from time to time I am going to test-run my lecture on you guys. I have been spending a lot of time reading up on bonding agents, trying to learn the science behind them. Not to act all "la dee da," but more so I can answer questions if they arrive. If I am going to go up there and speak, I kind of have to know this stuff, even if I am not going to talk much about it.

I don't really want to spend much time on it and I don't want people to be bogged down in the details of stuff they don't really need to know. Clinicians Report says, "If you like your material and it is close to the top of the list, just keep doing what you are doing." That means that people don’t want to be bothered with the details, they just want to know the stuff they are using is okay.

But I thought the stuff I am reading is interesting enough to let you guys know about it. I will do my best to not screw up the science. And if you are a dental geek and get into this stuff, let me know and I will try to do more of it. I think I will tell you what I know today and then have a counterpoint tomorrow.

Adhesives are a big thing in posterior composites. Fourth generation adhesives were the gold standard of bonding strength. Now, 6th generations are giving the 4th generations a run for their money. The bond strength is there at the time of the filling placement (we know this), but the issue is becoming that dentin bond strength is diminishing over time. So what is going on?

Have you heard of things called MMPs - matrix metalloproteinases? Me neither. These are "a family of zinc-dependent structural and functional related endopeptidases that are capable of degrading extracellular matrix proteins." [Did I make your eyes just glaze over? stay with me.] In Gammichia speak, MMPs = bad.

Let me back up. The goal of manufacturers is to develop bonding adhesives that completely encapsulate the conditioned collagen fibrils through total infiltration of resin. Collagen fibrils that are completely surrounded by resin are protected from degradation. These are not my words. I am quoting a lot from an article written by Gregg Helvey, DDS. (By the way, this guy is in private practice. How do you dentistry all day and know this much about adhesives? Boggles my mind.)

If the adhesive does its job right, it is supposed to protect the collagen from degradation. But none of the adhesives are doing it completely. They are also saying studies have shown that host-derived proteinases also contribute to the breakdown of collagen matrices. This means there is going to be breakdown in a filling at the adhesive level. But the host of the filling has something to do with it. You and I see this every day. One filling you do starts to look like crap in 5 years and others you did 14 years ago, look awesome. In Gammichia speak, certain people you put a filling in will break down a filling faster.

Turns out, MMPs are bound to the collagen matrix in a mineralized state where they are covered with extrafibrillar and intrafibrillar apatite crystallites. While the MMPs remain in this mineralized state, they are inactive. So we are having the unprotected collagen being degraded by MMPs because the adhesive is not doing its job. In Gammichia speak, crystallized collagen = good.

Cool so far, isn't it?

Naturally, once scientists know this, they are going to try to create a bonding agent to fully crystallize the collagen, protecting it from degradation. So, scientists have found that acid-etched collagen matrixes don't degrade if in an aqueous solution of 0.2% chlorhexidine (CHX), like Consepsis. They do degrade over time, but this is definitely a step in the right direction. They are finding that the degradation doesn't start until 9-18 months after bonding. In Gammichia speak, Consepsis before the acid etch stage = good.

But 0.2% chlorhexidine (CHX) is not the only MMP inhibition. There are a ton of other things, bromide being one of them. Can you imagine if they had a bonding agent with bromide in it? That would be smart.

In fact, the people at Kuraray are way ahead of us. This is something else that boggles my mind. I am hearing about this MMP stuff for the first time, yet they already have a product for that. That means the research has been done on MMPs. That means all the research and development has been done on a product. That means the product has been made and is available all before I hear about MMPs.

There is a product that is called Clearfil SE Protect that incorporates bromide. That means there is a product that is Clearfil SE plus an aqueous solution of bromide that fully crystallizes the collagen, protecting it from breakdown.

How can we do more? How about releasing fluoride in an adhesive? Well, guess what. They have thought about that, too. There is a product called Clearfil Tri-S Plus. That is, Clearfil SE+bromide+fluoride. Incredible right?

Okay, let’s stop there for today. My head hurts.

Have a great Thursday.
john