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System Overview
Products
Dr. David Clark
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Frequently Asked Questions
Dr. Clark is often asked questions about his articles and presentations. The following are actual questions Dr. Clark has received, and his answers.
I am going to use my new bioclear matrix on a deeply restored anterior tooth today. I'm very excited about it. In anticipation of today's appointment, I reviewed the DVD again and noticed Dr. Clark's beautiful explorer. I believe it had an endodontic tip on one end and a regular explorer tip on the other. It was titanium nitride coated. Could you please tell me who makes this explorer so that I may procure one myself. I would greatly appreciate it.
Thank you very much.
Sincerely,
Daniel M. Whiteman, D.M.D.
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(Reply from Dr. Clark to Daniel)
Dear Daniel,
When I get a moment I try to answer a few emails.
I am so pleased that you are excited about the Bioclear system. It has been a very long journey...
We are carrying all of the micro-restorative instruments including the"Clark Explorer". It does not leave grey streaks on enamel or layered composite like normal explorers. Yes, I sweat the little stuff!
The instruments are available from us now, they will not be on the website for another month or so. I will have Kristin send one, and I will also have her send one set of the micro-pliers. Let us know how you like them.
Cheers
David
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(Reply from Daniel to Dr. Clark)
Hi David,
I can't imagine what it takes to take a product to market. Congratulations on your success so far. I'm sure it is only the beginning.
I first became aware of your product/techniques in Dentistry Today. I
have always been a fan of microdentistry, even before it had a name
associated with it. I always hated the "extension for prevention"
concepts and pretty much rejected them once I got out of school (back in
'93). I eventually started to do slot preps on my own (to the chagrin of
my bosses I have to say). I love your saucer technique in that it really
is conceptualized for composites. How right you were when you stated
that our previous preparations for composites were simply amalgam preps
filled with composite. In addition, the logical idea to bring the
finish-able margin into the accessible zone by finishing the "flash" (so
to speak) is quite simply brilliant. Anyhow, I'm really just writing to
say thanks for your email and of course, thanks for sending me the
instruments. That is most generous... I just thought some positive
feedback on your products and techniques are deserved. Looks like you're
leaving your mark on our profession.
Much thanks,
Daniel.
Do you suggest IPX for each matrix?
Yes it is recommended to use the IPX with each matrix. In a restorative case such as diastema closure or deep decay you would need to first create a home ("NEST" or undercut) first to hold the IPX then the placement of IPX will allow for a secure matrix and slight separation of the teeth.
Dave,
I was an attendee at your recent class in Lafayette Co, I was excited to see an alternative to the old composite system. I have tried the bioclear on three different occasions and have not been happy with the contact, it seems the plastic wedge rides a little high in the box area. I did not use a ring on any of my attempts, in the class you only thought that to be necessary when doing back to back class 2 restorations.
my question is, am I doing something wrong or is the learning curve fairly steep to make your system fly?
thanks, and by the way I am seriously looking into buying a microscope, the exposure to that kind of visibility was eye opening.
--Gordon
It is very nice to hear from you.
First things first, I couldn't sleep when I read your email about your problems using the Bioclear system and for your Class II's. There is a learning curve but only because the process is so different than in the past. When you have it down pat it will be EASIER FASTER and BETTER than the old approach.
There are at least 3 things that could happen that would be giving you trouble. Here are some tips. I am going to cc my friend Dr. Steve Urback who has actually done more of these than I have.
- The prep must clear the neighboring tooth by at least 3/4ths of a millimeter. Otherwise the Interproximator will not pass by and it will "hang up" inside or slightly inside of the saucer prep. Because the Interproximator is so soft, It can actually end up part way inside the prep and part way past the gingival margin. Plus, it is translucent so it can be deceiving to your eyes at first. That is the most common mistake that we made in the beginning. REMEDY: Try the interproximator first, before the matrix. If it doesn't slide easily you will need more clearance. Make the saucer a little bigger. More enamel rods will be opened up. Better bond!
- The prep may have ended up more like a slice rather than a saucer. REMEDY: Well now we have a bit of a problem. If there is no undercut apical to the prep. then there is nothing to keep the Interproximator from riding up. In that case or in a deep case I will do minor electrosurgery on the "col" or papilla to make a home for the matrix and interproximator. Then I will use a Narrow Isthmus or the Thin Interproximator that will lightly stabilize the matrix without deforming it.
- What about using a separator routinely? ANSWER: There is no problem using a separator routinely, it just takes a little more time but the contact will be more snug. This will not help, however, if the Interproximator is stuck partly or completely inside of the prep.
- The prep is ok but the Interproximator is still having trouble passing through to the undercut. REMEDY: Use a little liquid hand soap when you slide the interproximator into position. I'm using liquid soap nearly every time now to make it easier and to not disturb the matrix. I use soap for every Narrow Isthmus Interproximator to avoid breakage.
- What else helps? REMEDY: Once you have snugged the Interproximator into position, release the ends, relax, and then grab the ends or the hemostats again, apply see-saw pressure and at the same time apical pressure while giving the Interproximator a good hard stretch. Often this second round of pressure is better because you have repositioned your fingertips or hemostats to a more favorable or more apical orientation. Or maybe my hands were tired. Either way I do this "second snug" quite often.
- What more? REMEDY: Did you aggressively pre-wedge to "deflate" the papilla? The Interproximator is too gentle to do this on its own. YOU MUST PRE-WEDGE EACH CASE!
- What helps in severe cases such as altered active eruption or Dilantin hyperplasia where the papilla won't go away. REMEDY: I use a tiny electrosurgery tip to trench a nice area for the Bioclear Matrix and Interproximator. If that seems aggressive, compare that to the problems that will ensue if the restoration leaks, packs food, or you give up and cut a normal prep that predisposes the tooth to fracture.
Be patient! It is worth the effort!
P.S. Dear Gordon, I am forwarding a note from Dr. Steve Urback regarding the Bioclear Matrix system.
-- Cheers, David
Dave, I think you gave him great suggestions. All I would add is that, as you said, sometimes it is hard to see if the interproximator is riding up and creating a concavity above the gingival margin. I routinely use a cord placement instrument to push the interproximator down. The clear matrix can be pushed towards the prep to do this, and it springs back into place once you remove the instrument. I would suggest using the bitine ring for a while, and after he has created some very tight contacts, he will have the confidence to try some without. You have to be extra careful with the rings, because when it squeezes the interproximator it can push it up into the prep if it isn’t far enough down to begin with. Encourage him not to give up, this is the best thing that has happened to posterior composites since they came into existence.
Bioclear is an interesting concept, but I'm leary about the proximal bonding to the occlusal. Does this present problems?
-- Kenneth
Dear Kenneth,
Great question. We have had no problems placing composite next to freshly cut composite, especially freshly placed composite. We treat it just like enamel.
I am far more concerned about creating ideal shapes to control C factor and this is a very nice way to accomplish that, and to be able to create ideal rounded profiles, good solid contacts and well sealed gingival margins. Those things I worry about.
In fact, most of the composites on the market other than 3M Filtek Supreme Plus are actually made from chunks of pre-polymerized composite that are essentially ground up and then remanufactured/remixed with thinner composite. That is how the fumed silica based composites are able to get such high filler content. The 3M product has a robust patent on their zirconia filler system, and are able to pack more filler without having to grind and re-mix.
Regardless, we have seen nearly perfect results on follow up. I will cc to my friends at 3M to see if they have anything further to add.
Warm regards,
David
Does the bioclear matrix system cause a slight diastema due to it's thickness?
-- Rich
Dear Rich,
Thanks for your question.
- It is interesting that contacts are a fairly complex issue that don't receive a lot of attention. One of the things that we have seen is that with the anatomic, rounded contacts from the Bioclear prototypes is that the tightness issue is less crucial. In other words, a broad, rounded contact is much safer than a "point contact" that is tight. I very rarely have a problem with the diastema closures even when I don't use the "Interproximaor".
- For the posteriors/Class II cases, I always use an interproximator and the contacts are very snug.
- For back to back posteriors I use a bi-tine ring that has a specific resting area on the interproximator that provides even more separation and back to back simultaneously injection molded posteriors have snug contacts, even though there are 2 thicknesses of Mylar.
- The Bioclear anatomically created matrices are heated and pressed which thins the contact area to less than the 2 mil original thickness.
- In 6 months we plan to introduce the "butterfly, which will be a one piece matrix for back to back anteriors and posteriors that will have a single thickness of Mylar at the contact.
- For anteriors diastema closures, from now on I will always do them simultaneously because one at a time is a miserable and problematic procedure. If contacts are not as tight as I would like when finished (which hasn't been a problem so far) I will:
- place an interproximator
- prophy-jet or sand blast the incisal half of both
- remove the interproximator, replace the Bioclear matrices then place the largest Interproximator to spread the teeth, then quickly etch and rinse, apply bonding resin, air thin slightly but don't core, then inject paste to augment the contact. I haven't had to do it yet but we teach it in the hands-on courses.
Warm regards,
David
What Bioclear Matrix should I use for the distal of a canine?
-- John
Dear John,
Thanks for your question.
- For the time being I would use an ETCM or TCM or (Extra Tall Curved Molar or a Tall Curved Molar) for an upper canine.
- For a lower canine that is typically a little flatter, I would use an ETFM or TFM (Extra Tall Flat Molar or Tall Flat Molar).
- The other option is to use an incisor matrix, and those would include a Universal or side specific (Right Hand/Left Hand) Incisor Matrix
Warm regards,
David
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