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subgingival margins, I don’t need something translucent.
I’ll probably go with a resin-modified glass ionomer. If I’m
doing that PFM and I’ve got supragingival margins because
I did a 360 porcelain butt joint, I’ll use a self-etching, selfpriming
resin cement because I don’t want the white at the
margins; I want the translucency of those resin cements.
If I’m doing full-coverage or I’m doing BruxZir or I’m
doing lithium disilicate, but my prep is such that I’ve got
great retention form and great resistance form, I’ll use a
self-etching, self-priming resin cement. Or, I might actually
even bond and go to a true dual-cure resin cement, and that
would more depend on isolation than it would the material.
So if I’m going to have problems isolating and I need to get
in and out quick and I want a true cement, I’m using a selfetching,
self-priming. If I have great isolation and I really
want to bond this, I’m going to go to something dual-cure
in the posterior. In the anterior, I just use regular light-cure
veneer cement.
MD: Our dentists love brand names. Give me some examples of
your favorite resin-modified glass ionomers.
LB: Right now, my favorite resin-modified glass ionomer
is RelyX Luting Plus (3M ESPE ), and I’ve actually been
using that for years. I used that when it was Vitremer
Luting Cement. They’ve just changed the name a few times
over the years. So I am still using that. As far as my dualcure
resin cement, right now I’m using NX3 Nexus ® Third
Generation from Kerr, and I use that because one of the
things you run into with dual-cure resin cements is you
need to think about your dentin adhesive and make sure
it’s compatible. Kerr’s new self-etching OptiBond XTR
actually is cured by their NX3, so it turns it into a dual-cure
dentin adhesive. I am a little old-fashioned because I still
don’t cure dentin adhesives prior to indirect placement.
MD: Oh, look at you. You’re bucking the trend! You are going
old school. It makes sense, as long as you’re confident in your
ability to cure that. I think that’s a good idea.
LB: Exactly. So I’ll use the OptiBond XTR with the NX3.
I also use Multilink ® Automix from Ivoclar. I use them
interchangeably. When do I choose one versus the other?
Part of it, for me, probably has to do with working time.
If I’ve got a patient that’s really great, and I’m not worried
about getting in and out, I’ll probably using NX3. Multilink,
for me, sets so much faster. If I do need to get in and out
and get it cured because I’m worried about patient isolation
or something like that, I’ll go to Multilink.
MD: I think that makes sense.
LB: For anteriors, Variolink ® Veneer (Ivoclar Vivadent) is
my preferred veneer cement. I also do keep RelyX Veneer
Cement (3M ESPE ) in the office. The reason I keep the
RelyX is because it’s more viscous. So if I think I need
something to fill a bigger gap underneath, then I’ll use the
RelyX. Especially with a 0.3 or 0.5 millimeter veneer, I like
that the Variolink isn’t viscous; it doesn’t feel like you’re
going to crack something when you seat it.
MD: Exactly. I know doctors who actually use Herculite ®
(Kerr) to seat veneers. And you know they’re prepping at least
a millimeter to be able to push a veneer down and not have
it crack with an actual composite resin underneath it, versus
cement. So as I have gotten more conservative and our veneers
have gotten thinner and thinner, I have gone to something
that’s a little less viscous, where you feel like you can get it
completely seated, move it around and really get it settled
without feeling like you’re going to crack the veneer down the
middle. That would obviously be a mess.
Well, Lee Ann, I want to thank you so much for your time today.
It’s been a fascinating look at how you got to where you are,
and what you’re currently doing in your practice. I like that it
all has a common sense ring to it. Even though you spent all
the time that you have at these institutions of higher learning,
it sounds like you still have that connection to what most of us
are going through on a daily basis as we treat these patients. It
doesn’t sound like you’re telling us to go in and do full-mouth
equilibration on every patient who walks in the door, even if
they are just there for a Class I composite.
LB: No, I don’t do that. (laughs)
MD: I like that. That’s what I like about you, that your approach
is more common sense. That’s what really resonates with
dentists. They need something that’s going to work for them in
their practices and in the outside world, where they can still
make a good living. But, like you said, they need to be able to be
focused on not stepping into those huge potholes, where you’re
prepping those lower second molars and things like that. That’s
why I think your courses are so good, because they’re going to
help dentists avoid those nightmare cases, the ones you never
forget and make it hard to sleep at night.
I’m going to recommend that our readers go to your website
and see where you’re going to be next. If they can’t get out to
one of your lectures, I hope they will look you up and find one
of your webinars, so they can connect with you that way.
Chairside readers: Please read Lee’s blog. It’s a fantastic blog; I
read it all the time. She’s very dedicated to making sure she puts
something up on a regular basis. In fact, I’m kind of jealous
and wish I had the drive to be able to update something as often
as she does.
I appreciate what you do for our profession, Lee, and I
appreciate you spending an hour with us. Thanks so much.
LB: My pleasure. It’s always fun to talk with you. CM
Dr. Lee Ann Brady is a privately practicing general dentist in Glendale, Ariz., and a
nationally recognized educator and writer. Contact her at www.leeannbrady.com or
lee@leeannbrady.com.
Interview with Dr. Lee Ann Brady55