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We received several questions from our readers about the video “Updated BruxZir Cleaning, Cementing & Bonding Protocol,” available at glidewelldental.com.

Dear Dr. DiTolla,

I was watching your video on bonding zirconia crowns, and you mentioned sandblasting with 50-micron aluminum oxide to decontaminate them. As many of us have microetchers with 50-micron aluminum oxide, is this as good as using Ivoclean® (Ivoclar Vivadent; Amherst, N.Y.) for bond strength, or should we still use the Ivoclean?

– Gary L. France, DDS
La Mesa, Calif.

Dear Gary,

In the research I was referring to, sandblasting was still found to be inferior to using Ivoclean, even under the best-case scenario with the sandblasting pressure set at 2.5 bar. That approach is still too iffy for me, so I continue to use Ivoclean after trying crowns in intraorally. At first I only used it on zirconia crowns being placed on short clinical preps, and then one day I started using it on all zirconia and IPS e.max® crowns (Ivoclar Vivadent) — just to be safe. It’s a simple step that seems well worth the effort.

– Mike

Dear Dr. DiTolla,

I saw your video on using Ivoclean to clean zirconia crowns. You didn’t mention a RelyX™ resin cement (3M™ ESPE™; St. Paul, Minn.) as a good cement for BruxZir® crowns. 3M reports that this phosphoric acid/methacrylate cement is good for just about everything. Have you had problems with people using it? I always get nervous about trying new bonding agents/cements/resins, but I have just started using it. 3M seems proud of it, and so far, I have not had any problems with it. Do you have any recommendations for that particular cement?

– Colin Lentz, DDS
Dacula, Ga.

Dear Colin,

The new RelyX Ultimate Adhesive Resin Cement from 3M ESPE, when used in combination with their Scotchbond™ Universal Adhesive (which contains the phosphate monomer MDP), should work just fine for cementing BruxZir crowns. The bigger point, however, is to make sure you use Ivoclean after trying zirconia-based crowns in the mouth, to eliminate the salivary phosphates and give the Scotchbond Universal Adhesive something to bond to. I haven’t personally used it because I am so happy with the handling characteristics of Ceramir® Crown & Bridge luting cement (Doxa Dental; Newport Beach, Calif.), but I would stick with the RelyX if you are having good results with it.

– Mike

Dear Dr. DiTolla,

I just watched your technique video on cementing/bonding BruxZir crowns. I hardly ever bond my BruxZir crowns; I almost exclusively cement them with 3M ESPE’s RelyX RMGI luting cement, just because of its ease of use and cleanup. With that being said, I always cement them like I do my PFMs, and I was under the impression that was OK. If your techniques in this video will help retention, then I will change my technique, especially if crowns are overtapered. Ivoclean, Z-PRIME™ Plus (Bisco Inc.; Schaumburg, Ill.), then RelyX Luting Plus — would that help retention? Since RelyX has glass ionomers in it also, I didn’t know whether using a resin primer would help or hurt the situation. Please advise. I love the BruxZir crowns, and I just want to make sure I am cementing them the best that I can.

– Christopher Capehart, DDS
Lewisville, Texas

Dear Christopher,

I have cemented nearly all of my BruxZir crowns with RelyX Luting Plus and have had only one come off — a very short crown on a lower second molar. You can still use RelyX to cement your BruxZir crowns and be fine. I have started supplementing it with the Ivoclean after we try the crown in the mouth, and I now use Ceramir Crown & Bridge luting cement from Doxa Dental, since it bonds to the zirconia material itself. It seems like an easy enough step to implement, and I know it will increase the bond of my RMGI to the crown itself. I also hit the prep with some G5™ All-Purpose Desensitizer (Clinician’s Choice; New Milford, Conn.) to try to kill most of the bacteria that ends up on the tooth during temp and try-in. So, my preferred method is now: Ivoclean and Ceramir in the crown, and G5 (or GLUMA® Desensitizer [Heraeus Kulzer; South Bend, Ind.]) on the prep. Honestly, if you continue to do what you are doing, you shouldn’t have any problems. You could go to my method just on shorter preps, or use Ivoclean/Z-PRIME Plus/RelyX Luting cement.

– Mike

Dr. Ellis Neiburger’s article, “Speed Dentistry: Fast Is Better – Up to a Point,” which was featured in the Summer 2012 issue of Chairside® (Vol. 7, Issue 3), also elicited a flurry of reader responses:

Dear Dr. DiTolla,

I enjoy Chairside, and I wanted to write you about the poor ethics I feel Dr. Neiburger has. I would not ever care to begin reading another article by him. I would be embarrassed to ever have a patient read this. I would not ever want him to treat me (or any of my patients). This article detracts from your lab, which I am enjoying.

Sorry, I just needed to let you know my thoughts. So different a philosophy I admire, like Dr. Pankey’s, where you make money, enjoy and get to know your patients, and can be proud of what you do.

Sincerely,

– Ed Olsen, DDS
Hardwick, Vt.

Dear Dr. DiTolla,

Just received the latest issue and must BARK about the speed dentistry article. I don’t know any patients that like to feel rushed in the chair. Most patients want some conversation and for the staff to “kiss them” first before sticking them and grinding on them. I think Dr. Speed is more interested in making tons of money as opposed to treating a real human being. How can you treat a patient you don’t know? Quit talking so much?! How impersonal. Get rid of difficult patients?! How do you advertise for “good patients” only? Rapid injections? OW!

I feel dentistry is becoming way too impersonal — nobody has time or MAKES time to get to know anyone anymore. Slow down! Be in the moment! You can’t take your money with you! Be a good human being and the money you need will come.

– Carol Dudley, dental assistant for 25 years
Greenville, N.C.

Response from Dr. Neiburger:

It’s a great pleasure to respond to Dr. Olsen and dental assistant Dudley and their misunderstandings about speed dentistry. Most of the negative comments I receive come from professionals who are troubled by new ideas or wish to keep the status quo, no matter what the economic or health improvements could be for the patients and staff.

Speed dentistry is a way of looking at the delivery of dentistry to the patient. The faster you do invasive treatments, while maintaining quality, the better off the patient will be. Rather than dehumanize dental treatment, speed dentistry can reduce actual and psychological suffering. It reduces the trauma and abuse inherent in some dental treatments (e.g., extractions). It can also provide more time for the important socialization, treatment discussions and just plain visiting that is so necessary to maintain a close personal connection with each patient and ensure future visits, referrals and cariogenic, fattening snacks around the holidays. It fits all practices since the practitioner decides how it is implemented and to what degree. Because it requires a bit more planning and energy (working faster and more efficiently), speed dentistry is not for the lazy.

Dr. Olsen and Ms. Dudley are focusing on the possibility of using speed dentistry to increase income at the expense of rushing patients through; but in reality, speed dentistry gives the practitioner and the patient more time since treatment time is shortened, leaving more relaxed time available to all. That is what one would call “being a good human being.” If you doubt this explanation, ask your patients what they would prefer: a five-minute or a 25-minute extraction? A 15-minute or a one-hour root canal? A seven-minute or a 30-minute prophy? It all can be done faster and better (and you don’t have to buy a kit or take the course).

– E.J. Neiburger, DDS

Chairside Magazine: Volume 7, Issue 4

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