Q&A with the Swiss Master - Dr Didier Dietschi

Join your hosts, Dr Jill Fisher and Dr Michael Mandikos, for an exclusive conversation with the Swiss Master of Aesthetic Dentistry, Dr Didier Dietschi.

Together, they discuss the future of aesthetic dentistry, simplified adhesive techniques, achieving long-term colour stability, and the importance of ethical, patient-centred treatment.

Whether you're looking to refine your clinical techniques or gain a fresh perspective on modern restorative dentistry, this episode is packed with practical insights from one of the world's leading authorities in aesthetic dentistry.

Visit correctdentistry.com to explore specialist-led online CPD and continue growing your clinical knowledge. 

This podcast is brought to you by CORRECT DENTISTRY

Transcript

SPEAKER_00 0:07

Welcome back to the Correct Dentistry Podcast. And as always, I'm joined by Dr. Michael Mandikos, but we have a very, very special guest with us today, Dr. Didier Dietchi, all the way from Geneva. Didia, you've been to Australia many many times, and I've been lucky enough to meet with you many times in Australia. But can you tell us about your place of residence in Geneva and where you work? I understand you have the most spectacular practice on the water. Can you tell us about where you're from and what kind of dentistry you like to do?

SPEAKER_01 0:40

Well, uh hello everyone. Very nice to be with you. And well, as I said, I'm coming from uh from Geneva, Switzerland, um, the French part of Switzerland, and at the very end of the western part, which is surrounded by French. So our mother language is, of course, French. And I would say that the city of Geneva is quite spectacular when it comes to the Bay of Geneva. And uh in a couple of weeks we will celebrate the 20th anniversary of the foundation of our new clinic, where in fact I had the idea to organize also our education center. So it's very well located, both for patients and also for attendees to our programs. And uh it is true that when the weather is good, which is not every day to be honest, uh we will see uh we will see the lake, of course, we'll see the buildings around the bay and also the mountains, and right during this period the mountains are capped with uh snow, and it's a quite spectacular view of the water. Uh the relatively old buildings because Geneva is a rather old uh city and a beautiful uh it's not the Alps, it's the Jura, which is a little bit smaller chain of mountains, but of course covered by snow in the winter, and it's really beautiful. I would say we are very, very lucky. We never expected to find such an amazing place, but we are very happy to be there. And uh well, the kind of dentistry we we we try to apply on our daily life is just focused on quality, ethics, and aesthetics. But aesthetics is more a little bit of a promotional uh promotional uh element that we attach to our uh to the name of our clinic, but we really pretend to be really ethical at the first place, know of a treatment, trying always to combine the very best, uh the very best solution uh according to the real needs of the patient. It's needs-driven but not commercially driven.

SPEAKER_00 2:48

I think that was very clear today in your program. Um, obviously, been speaking today on anterior restorations in composite, and speaking a lot on the joy that you get from building teeth and the heartache you get from prepping teeth back. I think so much of what we see on social media is about indirect veneers and prepping teeth, and you sp treat teeth so conservatively and beautifully, and you use composite as a long-lasting restoration. I think a lot of us feel like composite is a temporary measure to get us into ceramics, but you don't think of composite in that way, and and um a very conservative dentist.

SPEAKER_01 3:28

Yes, that's really uh it's it's more than uh it's more than a pleasure, it's an obsession somehow. But in fact, contrarily to many dentists who only do indirect and have very little experience with direct, I'm doing both techniques. I'm using a lot of ceramics. I do a lot of restorative dentistry going from direct to indirect, and I'm not choosing composit only because that's my only option that I offer to my patients. I think that I'm I'm really capable today to find the right indications for composites and also for ceramics. And I think we should not oppose both techniques anymore because each have or each of both biomaterials have their proper indications. Yes, there is this gray zone where somebody who has more experience with composites can still do a great treatment and get a fantastic aesthetic outcome with direct bonding, while others might go a little bit quicker with ceramics, but trying anyway to be conservative. What I think is more important, not only the technique and the biomaterial, is that we don't treat teas which do not need to be treated, whatever the material that we use. Now, apparently there is a burst in London, a burst of direct vinering technique. They call it one-hour smile. I don't know how many teas they can do in one hour, but I've seen some cases. Well, there's some things which are not too bad, but many things which, of course, I cannot really agree with. So it's it's not only a matter to go direct versus indirect, it's just to do the right things. And part of the real indications for direct bonding is where we can go no prep and in young patients, because we are very often in not stabilized environment, genuine profile is not stabilized, we might still have some orthodontic movements happening, and commodity is just the ideal material because you can modify anytime. While with ceramics, we all know that when we place ceramic restorations, basically they are not going to be modified, they are more going to be replaced in case. And if you just think about the maturation, the gengible profile, you don't want to place indirect restoration in the mouths of really young patients, even young adults, especially if you have a CIN biotype, you more want to delay the moment you will go with indirect restorations. But again, it's just a matter of needs and not to not to act too early and to be away from commercial dentists, because at the end of the day, if the main reason to do things is to make money, it will never be the right uh treatment, whether we use compiled it or ceramics.

SPEAKER_02 6:12

Didia, that's an interesting point, and we've had several podcasts where we've discussed, I guess, or touched on the ethics of dentistry and over-treatment and unnecessary treatment and types of treatment, and we've also sort of focused on um trying to provide some guidelines or ideas to to younger dentists. We have uh a lot of our listener base is a younger dental group, and of course they're heavily influenced by what they see on social media. I hadn't heard of the one-hour smile, but now I might go looking to see exactly what that is. I think today that you you know you beautifully showcased um form corrections and and being able to 100% no prep on a tooth. And these are teeth that do need treatment because they are very slightly aesthetically compromising the patient's smile, and maybe there's a psychological component, or there is a little bit of breakdown to the teeth, but you're you're making these incredible changes to a smile with with zero biological impact in a way that is, you know, really quite long-lasting and and you know really changes the patient's smile. I mean, it was wonderful. Where I guess I'm going with that is that, you know, I've been very lucky to know you for many years, I've been influenced by you, and I'm a prosthetist, and I try not to prep teeth. And and you know, you said it today, you said, you know, it makes you stops you from sleeping at night when you have to prep a tooth. I feel the same way. I look at teeth often and think, how can I do this? If it needs an indirect restoration, well, it must be partial coverage, and how partial can I be? But what I really wanted to to sort of go to was if you were talking to a younger dental base, if you were talking like you did to me many, many years ago through your lectures, whether you knew it or not, and you wanted to have a very deliberate impact on that younger dentist, and you want to communicate to them, you know, that um be be conservative, treat the tooth only as it needs to, don't over-treat. Where does a younger dentist start? Because they graduate from dental school with some basic skills. They probably graduate with a direction which is conservative, and in fact, you know in a hands-on class, you know, you ask someone to cut a class two cavity, they cut the tiniest cavity you've ever seen. So they have a natural tendency to be conservative. But if you were trying to talk to some new graduates now and you were saying, Well, you know, I know you want to do all these different things, where would you direct them to start in terms of I don't know, anything from case selection or courses that they should look at, types of courses? It's a big question.

SPEAKER_01 8:42

Yeah, it's a it's uh it's a question that will require a little bit of implementation. But it's true that what I liked the last couple of years, uh, I interacted with two groups of uh students, master students, this is postgraduate, still young colleagues, but already with normally we ask them to get a minimum three years of clinical experience before they will enter the master program. So they are not completely freshly graduated dentists and also undergraduate uh dentist. And those two categories of uh students, so to speak, are to me the best audience because we can really try to guide them toward the right uh direction, and less contamination they have in their thinking process through social media, because today the biggest problem we have is social medias, because they only get partial information, and uh there is the format of social media doesn't bring people to think too much. It's more visual, you see before and after, it might be sometimes quite spectacular, but you do not really understand the consequences of doing too much dentistry at a very young age. And I remember I remember to have seen videos, uh, but not fake videos, actually, real videos of treatments. Um that was for an interview about um dental truurism, and you see a young woman being treated by two dentists at the same time, and they are cutting teeth from both sides of the mouse. And you see the head of the patient moving in all directions. And I think this is quite obvious for everyone, even non-professional, that it is completely wrong. And there is only one drive behind, let's say, behind this kind of dentistry. It's just to make money, to sell dentistry. And that is the biggest problem in a profession. And it starts, I think it starts with defining defining objective aesthetic guidelines and trying to, it's it's not gonna be very easy, but trying first to convince the young dentist that just prepping teas and covering teas in general with some restorative material is not something which is necessarily needed and logical, and also doing a lot of efforts in uh educating patients, trying to make them come back to more natural aesthetics. So there is still those two trends basically fighting each other on in the profession. Those who want to go super, super white, then it cannot be natural anymore, and those who look for more natural aesthetics. So I think patient education might be ultimately the way to bring back things into a let's say a good balance so that we we do a little bit less dentistry because maintaining restorations. We had a lot of discussions within uh the European Academy of Aesthetic Dentistry, especially during the meetings, between the more uh conservative dentists who do more ceramics than direct bonding and bleaching, and those who are more modern, let's say. And we always come back to that notion that ceramics is more durable in terms of aesthetics, lifespan is much better. But that's true only when you have a thick biotype, perfect hygiene, and a super talented ceramist. So I think we we need to give uh we need to give more objective information also to young dentists and explain them really the limits in terms of longevity, the limits in terms of biomechanical involvement of what we do. Because even compiled it up to a certain extent. Now we have this injection molding technique that becomes very fashionable. But if your index is not super precise, then you inject flow, you put flow everywhere on above the T's, below the T's. It's just conceptually completely crazy. It's a technique that is one of the most difficult techniques that I have seen. And the preparation needs to be impeccable, and the amount of finishing you need to get really clean margins is enormous. So it's all but a such a simple technique. But if you just compromise the quality, it's a very quick, uh, a very quick fix. This sort of uh one-hour smile that we we we see now everywhere. But I really hope that little by little also the population will start to understand that uh doing restorations as consequences because we need to maintain everything that we do with SPREP, will need to be replaced, cannot be just repaired or fixed, we need to replace. And at the end of the day, the only way we can really change uh aesthetic dentistry is by education patients. And I even find at a certain moment, but it's it's a big, big project. Academies like ours should probably communicate also toward patients, not only toward professionals. That we we make patients understand that what they receive sometimes is good just for a very short moment. But they dentists who do this damage their dentition. But this is the profession that needs to be to be uh also fighting this overtreatment. It's um a little bit of a mix of different thoughts that I I presented, but uh I really hope we can really also educate young dentists. It's it's um we need to target our efforts toward two different groups, young dentists and patients.

SPEAKER_00 14:18

Yeah. I I hope I can ask this question as the young-ish dentist you speak of. Um because thank you. I I feel like one of the things, one of the questions that came up several times today was would would the composite break? And are you com comfortable that that composite is going to last? And you showed case after case after case, and you spoke you know, many year follow-ups, and and perhaps the failures in inverted commas were that the patient was brushing too hard and some of your beautiful anatomy was lost, or there was some staining perhaps from their oral hygiene not being perfect, but you didn't show many cases of breakage of the composite. And in fact, one of the answers to the question was that you you just don't see that. From a youngish dentist perspective, I think when we're at university, we don't believe composite can do that. And I know you know composite better than anybody, but I think we're prepped at the undergraduate level to believe that if you want something to last, you use ceramic, and you can use composite as an interim, or you can do something sort of pretty with it, but it won't last very long, it'll stain, it'll chip, it'll break. You need the patient to wear that splint every night or it'll fall apart, they have to have perfect oral hygiene. But you didn't present it in that way. Can you elaborate on that?

SPEAKER_01 15:33

Yeah. We might have risk factors that are like parafunctions that might lead to uh to breakage. But it's also just how we treatment plan the case. We need to identify cases which are at risk for fractures versus those which are not at risk. There are a few things that we should avoid to do. If you do very thin layers of compiled on functional surfaces, yes, it might break because you have something a little bit softer, a very hard and stiff substrate, and you create too much stress within the material and at the interface. When you have more space, you reduce tremendously uh the risk.

SPEAKER_02 16:12

Is there a number that you loosely associate with thin spaces?

SPEAKER_01 16:18

Well, that's very strictly related to the function or the existence of parafunctions. But I would say to be safe, we should never go below one to one and a half millimeter. And more parafunctional forces increase theoretically, more uh more uh space you need to have. But the magics into compared is that when you get a certain thickness, but of course, you cannot necessarily add so much volume everywhere, but as soon as you get a certain amount of material, it will start to deform, and that creates mechanical resilience. And for instance, on the lower frontiers, in wear cases, I nearly never do ceramic restorations. I use a lot of hybrid, uh hybrid um let's say uh protocols where we use ceramics for certain restorations and competitive everywhere I can be more conservative, but lower insiders, even in super heavy bruxes, you basically never see chipping. It nearly doesn't break at all. So it's a matter of volume. You you cannot get layers very, very thin, or if you have a compliant patient with uh with the nigga, then it's it's gonna work much better. But again, the risk factors which are critical for composite restorations are also critical for wear cases. And there is a one case that I I will show tomorrow that was really uh uh a quite interesting case, very, very severe extreme wear. I've got the first fracture after two years chipping, but that was on my Emacs upper restorations. Lower compounds are completely intact. So it's uh I don't want to simplify and to say that composite will work better than ceramics, but stiffness might not be always uh absolutely perfect uh property. But in general, we need good oral hygiene, really heavy broxers might generate failures also with ceramics, let's be honest, and thin biotype will lead to recession, so then your veneers will become stained at the margins, you will you will see the difference between the residual to structure and the veneers. So life aesthetic lifespan of ceramics is not necessarily by principle much better. And the longevity price ratio, provided you develop you you you learn doing compiled it right, it's very often in favor of compiled it whenever it is technically possible. But if I have a patient who really needs vine ears and doesn't have strict financial limitations, I'm more likely to use ceramics. But I do super super conservative preps, and most of the time it's only just doing a finishing line so that I can have a clean margin. And creating a teeny bit of space interproximal so that I can I don't need to close completely the embrasures and create natural forms.

SPEAKER_02 19:21

Yeah, it's a it's um I think you uh highlighted in the presentations today and yesterday, and also what I've seen in the past, the longevity of composite. And you know, you're you're hinting pretty strongly at how well it can behave in even extreme cases. And I think because of your influence, um, you know, uh my my friend Tony is is exactly the same. We see these big wear cases, and they're cases where the teeth are so badly broken down. If you treated them conventionally well, prosthetically conventionally, you prep away the last of the good tooth. So logically you want to just try and leave that and augment it. And my experience has now been, I've with the benefit of some some years now in in practice, what you're reporting, which is that the composites do very well over a long period of time. And that's a fantastic thing. And I think that that goes partly, Jill, to what you were saying before about how we're conditioned very basically at dental school, that ceramics last a long time, composites don't. So we can, through much of the work you've shown and and and you know, techniques you've pioneered, we can demonstrate that ceramics, you know, aren't necessarily going to outlast composites. So that that question can go to bed. The other question, in regards to, well, you know, I've got a big dental dental loan, you know, from studying and uh and the other people on Instagram are making a lot of money, you know, I have to make a lot of money too. Um, you know, the reality is it's it's just price point. I mean, you don't have to butcher lots of teeth and do unnecessary ceramics. You could also do a whole lot of unnecessary no-prep composite additions to teeth and they might last longer and create an equally poor aesthetic result, or you could do them really nicely and they could be a really nice result. But instead of charging $100 for your composite, you could charge $200 or $300 or $500 and not damage the tooth. And I think that really the value of your program, Stydia, is being able to show the people that attend how relatively simply you can create such nice results, and then you show us the the the durability of the materials, the long-term nature. Today you were highlighting with the Inspiro material. Um so I know that I've got Inspiro in my mouth that you did in 2013, so it's um it must be 12, 13 years old. So I don't know if it was in prototype stage or whether it was the actual final material. But now you've seen it for over a decade and you were commenting on how colour fast it is, how how good its colour is.

SPEAKER_01 21:52

Well, it is through that one uh frequent uh complaint from dentists when we speak about extensive. Aesthetic work done with composite is that the dentist might do something really very beautiful, invest a lot of time and energy into doing those composite restorations, and unfortunately, and that's really a chemistry problem that we have a lack of color stability, and the color is really shifting to something that is no longer really acceptable and satisfactory, and that that's a big problem. It was really a huge, huge deficiency of former commodity generations. It goes with the purity of raw materials, and it's true that not every company is probably using the highest quality of raw materials, chemical raw materials. Probably also the light curing mechanism process has been refined, also leaving less unreacted chemicals. But what I'm talking about light curing, permeization, it's also something that could have been deficient from the clinician side. That with us intention to do so, restorations were not, or the competitive was not fully polymerized. And that could definitely lead to change in color. But probably some products, not all of them, unfortunately, today are more color stable. And you were mentioning the Insparo. The Insparo is has been up to now the most color stable material that I've ever been working with. And that's why today I'm a little bit reluctant even to try any other material. I've been trying nearly everything new on the market for uh about 30 years. Now I found something that is so good in my hands. Of course, I learned really well how to use it, but it's super simple, and we like this biliminar approach, natural layering concept. Wherever you need to replace dentin, you use your dentin replacement material. Wherever you need to replace enamel, you use your replacement enamel, and that's it. And for 90% of the cases, that's all what you need to do. Very predictable, because you just need to look on the tues where the tissue is missing and the references of dentin, where the dentin, where the enamel is. Occasionally, if you have some polychromatic effects, we have the effect shades to do so. And we have a good shade guide as well, so we can simulate any combination of dentin and enamel, which is a great benefit for the dentist because there is no guessing. You can confirm that this combination of dentine and enamel will match the natural tooth color. So that's also another aspect that unfortunately, and I do not understand why so many companies just stop providing shade guides. We know it's very expensive, especially the one of the product you mentioned, the Inspiral. It's a very expensive shade guide to produce, but it's it has such a unique uh function and and capability to let me do the right shade that I would not mind even uh having to spend a little bit more money for a shade guide of that type.

SPEAKER_02 25:12

Yeah, I think you you showed it today, and I think the group understood, and and I've been fortunate to use your this product you developed. I mean you were so instrumental in the development of it for many years now, and the shading is is that that bit. And and I tell people, you know, there there are many practices in Australia that use it, but there's I think there's 23 or 24 prostodontists in the country that use it. So if you if you kind of were to generalize and say prostodontists don't use much composite, well those guys that and girls that really want to do the high end are using this material. And and the practical element that I'm trying to tell people is that, you know, it's it's shades and opacities are designed so well that if you place them where, as you said, dentine is missing, you put the dentine uh opacity material, you put the enamel in the right thickness, it just works. The material does the work for you, so you don't have to think as hard. But because it's so close to natural tooth structure and none of us necessarily nail the skills as well as you do, if we put a little bit too much dentine or a little bit too much enamel, it's very, very forgiving. Whereas there are other materials on the market that aren't designed anatomically as well. And if you don't, you know, first of all, you have to work out how much to use because it's not anatomical, and if you get it wrong, it's really obvious. So that is something that that has really been a an absolute godsend with the material. Um but but I did, as the you know, person instrumental behind it, I sort of wanted to ask, um, when it came to shading, what was it that that you saw that just I mean, because you you did all this research on tooth shade to develop this material, what was it that you saw in the composites that were available that made you say, well, you know, that there needs to be a different way? And and then can you comment why aren't other companies there's only half a dozen that have taken up this approach?

SPEAKER_01 27:01

Yeah, it's at the very beginning I had talks with different companies because that was a pure uh a pure concept coming from research concept. There's an idea to simplify layering and to go from multi-layers to only two layers. It's quite evident today. It has been some attempt to go even simpler with a single uh single sort of universal uh chameleon effect composite, but it has limitations to or it can be used successfully only in very small cavities. But when you have a big defect, there is no way you can have a single material that will mimic the superposition of natural dentin and enamel. So that was quite obvious. But that was as simple as it could be, two layers. So we did a lot of spectrophotometry to get um a data bank about natural tissues, optical properties, but not measuring or not trying to extract those data from the whole twos. So with section tees, that was quite easy for dentin, a lot more demanding for enamel, but we managed to get enough samples of enamel to be able to know about their color values, opacity values, um, evaluating fluorescence and appalescence. And with those data, I visited different uh competitive manufacturers because we had no true natural earring concept system. We also wanted to get dent in not with multiple shades but with a single uh single shade or U. And that was all this was rather new. And the answer that I got from the majority of big competitive manufacturers was okay, we understand your concept, it seems to be very appealing, but basically, companies were afraid to lose their market shares. They didn't want to come with another material competing with with their existing material. That was one aspect. So basically, that's still the case for the biggest competitive manufacturers in the world, that they have such big market shares, they are just afraid to touch anything. As long as they sell, they are compounded in the same amount, they will not probably switch to this uh naturally going concept.

SPEAKER_02 29:16

So recognizing that the the principles, that the concept you'd put together was better, recognizing it was more accurate, in theory it should apply more easily to the clinician. Profits were really the the barrier. Like if we make something, we've got to cannibalize our existing market share. And that was the barrier.

SPEAKER_01 29:35

Yeah, and and also not only, I think the responsibility lies not only not only uh on their side, but also on the market side, because dentists are so reluctant to move away from their so-called comfort zone. And they were so much, especially the American market, they were so much attached to their vita concept and also this multiple layer concept with all the limits it has that just companies were afraid. So it was just a shared responsibility between the dentists and the companies. Dent supply made the move, but they made it for the European market, but they didn't try to bring this bilaminar approach to the United States. They kept their multi-layer approach with a vita shaded material. But also something that has been difficult for many big companies is that they work with many opinion leaders, and they all have a little bit of their own vision and concept, and as soon as something new is coming, they will like to put their fingerprints on the new system. And that's also something that we realized. The first company that entrusted that concept was called Inweldent, and the CEO, who was someone who spent his entire life in dentistry, who really understands dentistry, he looked carefully. It took a couple of months before the company will give me your feedback. But they said, okay, I see the work you have done to come up with this concept, it's scientifically validated, it's clean work. So I basically entrust you to uh help us developing this material, but you're gonna be the only one giving the final okay to go on the market. We don't want any. They made a market field, but anyway, they never allowed other opinion leaders to modify the original recipe. Right. Which I think has been the only way we could bring really the exact concept to the market. And that has been the same with uh Edelvised Dentistry and afterwards Adalvice TR that they have given me a task and a responsibility, but also the full uh the full uh let's say control of the final shades. And that is probably why not too many, not too many brains were uh it's so simple at the end because we had the optical data from natural tissues. I just had actually to validate the quality of the chemistry that will mimic those shades. But we didn't want to, that is not my concept. That was just a concept of mother nature. And at the moment you agree with the very basic, simple, logical idea to say if we want to get a composite that mimics natural to structure, we need just to mimic the optical properties of natural dentin and in animal. And you need somebody who understands a little bit about optical properties and measurements techniques, and just to say, yes, now I have the right data.

SPEAKER_00 32:39

Yeah.

SPEAKER_02 32:39

Well, okay, so I I'm gonna sort of wrap things up because you've had a big day. I want to ask you one more question. And so, you know, there are some dentists that are listening who use Inspiro, and to them, congratulations, and you're probably enjoying the benefits. There'll be some other people that aren't using it and they're seeing colour change three, well, hopefully not three years, maybe five, eight years later. So they're looking at these restorations and they have to deal with them. So I my question is two parts. First of all, if they thought that they could cut back the restoration and add to it to resurface it or revenere it, I was going to ask if you could give them some advice on technique to use to do that, like the physical, you know, what you're gonna use a diamond, then you're gonna do this, then you're gonna do that. And the second question would be let me ask let I'll I'll get you to answer that first.

SPEAKER_01 33:31

Okay. Yeah, that that's a very common situation for different reasons. Could be chipping, could be color shift. We need to resurvey the restoration, but mechanically, basically the additive interface is intact, the integrity, the may let's say the maybe the anatomical integrity of the restoration is maintained, you just want to improve aesthetics or repair a chipping. You have a company that has been in the mouse for years and years and years, so we can say chemically it's a dead piece of composite. You have no chemistry that can be really reactivated efficiently. So you need to base your uh let's say your repair or modification on micromechanical retention through sand blasting. Alternative to this is a very short etching with buffered hydrofluoric acid, like we use for ceramics, but it's a little bit more tricky to use, and normally in Europe it's getting more and more critical to use it because we should not use it in the in the mouse too much. But if you use rubber dam, it's fine, but it's uh we we don't use anymore that protocol so often. Then we could use a silin if we don't have two bond to dentin at the same time or uh close to it. 10 MDP that we have in a lot of primers uh for ceramics or uh bonding agents, or other products like the Optibon FL, which has another multifunctional monomer, GPDM, uh, and then bonding. Never like your bonding if you don't cover the entire surface because you don't want to get a transparent layer in between different uh areas of the restoration, and then you add your fresh material. So that's the best we can do by today, just adding a little bit of chemical uh adhesion through a silin, 10 MDP or GPDM, and um then bonding and the fresh composites. Bonding, if you are in contact with dentin nearby, your repair exposes dentin, then you normally go with just no silane because it's incompatible with dentin adhesion, but we use a multifunctional uh monomer, 10 MTP or GPDM, and we we bond on all the surfaces at the same time.

SPEAKER_02 35:48

Okay, so the the second part of the question then, and you you sort of answered it a little bit, and you sort of said assuming that the adhesive interface is intact. So there's some composite bonding on a tooth, it's discolored, they cut back some of it and they re-venere it. But underneath you're saying assuming that the interface to the tooth is intact. And you were giving some some anecdotal data today about your long-term restorations that at different times you've had to cut out for various reasons, and you can't find the adhesive interface. And if I'm not paraphrasing you incorrectly, you said, you know, and if I use this magic product, and we've talked about it, Optibond FL, but you could comment on some other chemistries maybe. You said once you put that on the tooth properly, it's for life, it's there forever. So this is leading to this idea then that any dentist listening, if they saw a chipped posterior restoration, is there scope for these people to be repairing the restoration rather than cutting everything out and replacing it? Can you kind of s put something together there with your thoughts and we'll we'll leave it at that?

SPEAKER_01 36:55

Yeah, it's it's one of the key uh the key questions. Maybe let's use the example of posterior restoration, class one and class two restorations. The main reason for failures are two, recurrent decay and bulk fractures. And if you think a little bit biomechanically, you realize that if you experience a bulk fracture or recurrent decay, it's likely because the addisive interface is failing. So, first thing, of course, we we check carefully the entire restoration interface, trying to observe eventually some deficiencies in the addhisive interface. Um, if it's shipping, that's okay. If it's uh a larger fracture, it could also possibly mean that some part of the restoration has been under-polymerized. So it's more fragile, fragile than it should be. But if it's not something that I have done myself, and I have all records of the technique that I've used, the product that I have used as an adhesive, and using rubber dam and optimon FL, which is a very well-known product, and I have no financial interest with Kerr or Optimon FL, but it's it's known to be the best adhesive, the one providing the highest bone strengths and the most stable bone strengths of all adhesives which are on the market. Yeah, technically, it should be applied following very, very precise protocol, but like every other adhesive, by the way. Um but maybe one question that I can ask to the patient is to know whether the previous dentist was using rubber dam or not. If the previous dentist was not using rubber dam, I'm more likely to replace everything. If it's a restoration that I place myself, knowing the adhesive that I used, the protocol that I used, then I'm more likely to repair. Because now there is a big question in research is to define exactly those parameters to decide whether we redo everything or we just repair. And with a lot of cases that I do for uh too swear, if I see the restorations are being cleaned, I will modify the restorations rather than to replace everything. Looking at X-rays, checking really carefully the interface, asking the patient if he remembers that the rubber dam was used, and also trying to have an idea when the restoration was made. It's difficult if you see in the mouse that obviously all the restorations were made at a different time. But in some other situations, you see that you obviously at least groups of restorations seem to be done at the same time because they look very similar. You see the material is the same, so then we can gather, uh we can gather eventually uh information. If it's too uh if it's too uh foggy or we really we are not sure, sometimes it's better to redo the restorations. It's so that when I start to prep, I'm still giving myself the possibility to change opinion. If I see when I I prep that I'm getting this sensation, or not even sensation, I see that I can find the interface. There is no way, when it's not so well bonded, when you get at the interface, certain moment the material detaches. When it's really still well bonded, it's you need to grind up to the very last micron of compiled it, and you you're not even sure whether you're into the compiled or already cutting the tubes. Then maybe I will say, if the colour is not too bad, okay, let's keep what remains and and modify it and repair.

SPEAKER_00 40:30

Okay. Didia, thank you so much for all of your information. I could talk to you forever, honestly. I think we need a part two for this. I I mean, in in you're talking before about um taking Inspiro to the market and and having people understand what it can actually do. And I mean I've in the type of practice where if the patient's over 40, they get A3, if they're under 40, they get A2, and then occasionally I'll say to ladies, I'm gonna use Inspiro, and they get this kit out with nearly special gloves on because it's just so special, and we treat it like that, and then they think, oh, she's gonna do something really fancy here. But but what I think I'm gonna take away from listening to you today, and I learned something different from you every time, but I'm I'm gonna use that kit all the time because your techniques are simple. I'm not I'm not meaning to say that what you're doing is simple at all, but you talk about this really stepwise process, and I think it is really procedural, and I think we can achieve it and use the inspiral all the time. So that's what I've taken away from today, and I appreciate everything you've taught us.

SPEAKER_01 41:36

Thank you, both of you, for your very kind, uh, very kind words. Yes, it's like everything. Uh simple simplicity is usually a good way forward to get success. When it's overcomplicated, maybe that is something that should be limited to only very few dentists. But I think direct bonding is something that already with the layering and with the protocols that we have been uh using the last two days, it can bring direct bonding to uh basically to a very high level of success in everybody's hands or every dentist's hands. Who has the will and interest to do it to do it well? Because at the end, the big factor at the end is the dentist. You need to mean well for your patients and for yourself, because doing nice restorations is one of the most rewarding um, let's say, successes or successes in our professional life. And what I what I said, I don't like so much cutting teeth, doesn't give me any pleasure. Rebuilding tees with us having to cut them in beforehand is really something that is super motivating and makes me happy every day of my life when I wake up to go to passion. To work as a dentist.

SPEAKER_00 42:53

Yes. Well, you're very generous with all of your knowledge and you give us such inspiration. If you haven't heard Didier speak, please look him up. He has the most spectacular textbook that you could um, I don't know, weigh down some kind of coffee table. Yeah, that's true.

SPEAKER_02 43:11

So well, they're so beautiful. The photographs are immaculate. You put it there and a non-Dennis is going to look at them and go wow, look at this.

SPEAKER_00 43:16

Totally agree. Look up the textbook, look up Dr. Didier Dietci. Dietzci.

SPEAKER_01 43:22

Dieci or Diety is correct. Dicci is the French pronunciation. Dieci is more the Italian and German because it's a German name, the correct pronunciation from the original uh country where the name is coming from. But thank you both of you, Jill and Michael, for uh the interview and for giving me the chance to be with you here in uh Brisbane. It has been two wonderful days, and there is another two coming.

SPEAKER_02 43:45

Two to go. Yes, two to go. Thank you, Diddy. Thank you very much.

SPEAKER_01 43:49

You're welcome.