Hot Topic with Dr. Gordon Christensen Dr. Christensen Presents the Latest in Glass Ionomers

This show opens with Ruddle sharing some of his excitement around Major League Baseball’s spring training. Next, Ruddle discusses the major contributions Dr. Gordon Christensen has made in dentistry before a very special guest presentation by Dr. Christensen on a hot topic of his choice. After, Ruddle follows up with some of his own commentary to close out Dr. Christensen’s presentation. Stay tuned for the end of the show for a very emotional Show & Tell.

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Show Content & Timecodes


00:09 - INTRO: Baseball's Spring Training
05:17 - SEGMENT 1: Dr. Gordon Christensen Presents a Hot Topic
30:47 - SEGMENT 2: Post-Presentation Discussion
37:22 - CLOSE: Show & Tell

Extra content referenced within show:

  • Practical Clinical Courses: www.pccdental.com
  • Clinicians Report: www.cliniciansreport.org
  • Clinicians Report Reprint "EndoActivator" (see downloadable PDF below)

  • Select PDF content displayed below. See Ruddle's complete library of downloadable PDF content at www.endoruddle.com/pdfs

    See also Ruddle's complete Just-In-Time® Video Library at www.endoruddle.com/jit

    Related Materials & Show Notes

    Clinicians Report Reprint
    "EndoActivator"
    Jun 2009

    Dr. Gordon Christensen's Clinicians Report on EndoActivator: "Easy and Effective Agitation of Endo Irrigation Solutions"

    Related Polls
    Disclaimer

    This transcript is made available by The Ruddle Show in an effort to share opinions and information, and as an added service. Since all show text has been transcribed by a third party, grammatical errors and/or misspellings may occur. As such, we encourage you to listen/watch the show whenever possible and use the transcript for your own general, personal information. Any reproduction of show content (visual, audio or written) is strictly forbidden.

    INTRO: Baseball’s Spring Training

    Lisette

    Welcome to The Ruddle Show. I’m Lisette, and this is my dad, Cliff Ruddle. Are you excited to be filming another Ruddle Show?

    Cliff

    I am. I’m exactly happy to be here. Two left this season, and then, more beyond.

    Lisette

    Okay. Well, it’s springtime now, and that means that it’s Major League Baseball spring training. And for those of you who do not know, why don’t you enlighten us about the Cactus League and the Grapefruit League?

    Cliff

    Oh, great. So, there’s 30 teams in Major League Baseball. 15 play, roughly, in the National League, 15 play in the American League. And as a preparation for the season, which is a long one, 162 games, they go to Florida. That’s been called the Grapefruit League. And then, the other half go to Arizona, and that’s called the Cactus League. So, it's a great place to go, watch a few games, and see maybe some new talent. Speaking of “Something old is new again,” new players coming and going, in 1918, a guy that pitched for the Boston Red Sox – probably none of you have ever heard of him. He was a pitcher named Babe Ruth.

    And he got forced into action that day, because what happened is, their first baseman was injured, and they said, “Babe, you go play first base.” And he said, “Well, I’m not an infielder, and I don’t know how to bat.” His first at-bat, he hit a homerun, and his second at-bat, he hit one 573 feet. It left the stadium. It went across a big boulevard that was outside the stadium, kept traveling outbound, and landed in an alligator pond at an alligator farm.

    Lisette

    [laughs]

    Cliff

    So, spring training brings us new players, new looks, and Babe Ruth went on to be called the “Sultan of Swat.”

    Lisette

    Okay [laughingly]. Well, I know that when Isaac played Little League, every year around this time, there was quite a few families that made road trips to Arizona, to watch spring training.

    Cliff

    Oh, right.

    Lisette

    And it was like a tradition for them.

    Cliff

    Well, back to these two leagues, the Cactus and the Grapefruit League, it wasn’t always like this, but in recent years, the owners have plowed millions of dollars into these stadiums, because it’s always about money, it seems like. But they attract a lot of cold-weather fans. People from Chicago, the Northeast, where it’s really still winter, they love to go to the Cactus and the Grapefruit League, because it’s sunny, it’s warm. The stadiums are cozy, they’re throw-back stadiums. They seat about 10,000. With COVID this year, they’re going to let about 2,500 in. But they have all kinds of food. They get to get close to the players. They get more autographs. They get to talk to rookies. So, yeah. It’s a pilgrimage.

    Lisette

    Well --

    Cliff

    Oh, and I might add, in Arizona, the stadiums, all of them, are within 57 minutes of each other.

    Lisette

    -- okay. By car?

    Cliff

    Yeah. So, if you like staying in Scottsdale or Phoenix, every day you can go to watch teams.

    Lisette

    Okay. Well, I know last year, spring training had a little bit of a different look, because COVID was becoming a problem. And also, there was the baseball cheating scandal, which you might remember. Let’s – okay. There’s that graphic.

    Cliff

    Well, that’s – was about this time last year.

    Lisette

    Yeah. And if you don’t remember what the baseball cheating scandal was about, the Astros – the Houston Astros had some sign-stealing scheme that they used, just to summarize really quickly. And they used it against the Dodgers in, I guess it was maybe the 2017 World Series, and the Dodgers lost. And at – no Astros players got punished. So, that was kind of a thing. We actually did a little segment on it. But yeah. I guess the only punishment we thought was going to happen at the time was that when they went to play, all the fans would boo [laughs] them. But then, there were no fans. So, I guess, what was their punishment?

    Cliff

    Oh, that’s easy. The Dodgers won the World Series in 2020. That was the punishment.

    Lisette

    That was really exciting. That was probably one of the most exciting World Series I’ve ever seen. And not – I mean, just the whole playoffs, because the Dodgers were so close to losing, many times. And then --

    Cliff

    Oh, yeah.

    Lisette

    -- they ended up winning.

    Cliff

    And then, they had to play kind of in a little bubble. And probably what some of the international people don’t know, they didn’t even get to play in their home stadium, for four of the – theoretically, of seven World Series games. They played in Arlington, Texas.

    Lisette

    Right. So, I guess it was a little bit of redemption, when the Dodgers won. So, it’s a new beginning --

    Cliff

    Go, David Landwehr!

    Lisette

    -- [laughs] it’s a new beginning. And I’m excited to see what this season brings. But right now, we’re going to get on with our show. So, let’s get started.

    SEGMENT 1: Dr. Gordon Christensen Presents a Hot Topic

    Lisette

    Okay. So, today, we have a special guest presentation, which you will see momentarily. Every now and then, we thought it would be nice to have a guest clinician give a presentation that covers a topic that maybe my dad wouldn’t lecture on, being an endodontist. That said, we also recognize that many of our viewers represent all different disciplines of dentistry and would be interested in a variety of topics. So, today, we have a presentation by Dr. Gordon Christensen on something that he has identified as a hot topic.

    Cliff

    Yeah. I asked Gordon to lecture on hot topics, because he has his pulse, like I guess I would say I’ve – almost nobody I’ve ever met before, on what’s going on in dentistry worldwide. So, he’s an absolute authority on material science and its applications to restorative dentistry. So, that would make him an expert. Then, he is very good at his education. He’s a master teacher. He’s a gifted clinician, and he’s quite a resource for all kinds of education, tapes, articles, insights, things we’ll talk about. So, anyway – and he’s a friend. So, it was pretty easy to identify Gordon as contributing to interdisciplinary dentistry on The Ruddle Show.

    Lisette

    Well, for those of you who don’t already know Dr. Christensen -- and he is quite famous, so probably a lot of you do. But he is founder and CEO of Practical Clinical Courses, which is an educational company that offers courses in all disciplines of dentistry, including patient education. They also offer videos and articles. Then, he is also cofounder and CEO of the Clinicians Report Foundation, which tests new dental products and then reports results to the profession, so that clinicians can make more educated product purchases.

    Cliff

    And for many decades, he’s been an absolute shining North Star for the profession to follow, so we don’t end up with closets full of unused products, devices, and materials. So, to stimulate this network, 450 clinicians, unpaid, work under Gordon’s tutelage, 19 different countries, and they evaluate per year about 20,000 evaluations. And they’re looking at things – dental products like materials, devices, equipment, and even analyzing techniques.

    So, all this together, you get a lot of information, and you can save yourself a lot of heartache and false forays into the [laughs] – off the path of excellence, if you just stay tuned to something like this. As an example, many years ago, 2009, I believe, they studied the EndoActivator. It got rave reviews, and it was used around the country by different clinicians, and that’s how people have the confidence to buy things.

    Lisette

    And you can also trust him to publish the truth, too. So, when you send him the EndoActivator, whatever results he finds, those – that’s what’s going to be published.

    Cliff

    You do accept that.

    Lisette

    Okay. Well, it’s excellent that he – that the Foundation even exists. I know on our show we’ve talked a lot about the flood of new technology coming to market all the time, and how does the clinician know what is an improvement – what represents an improvement on what already exists. So, it’s great that this Foundation is here. Because even Gordon points out in his presentation that often, product information can be misleading, and sometimes it’s even false. And --

    Cliff

    Thank God we don’t have that in endodontics!

    Lisette

    -- [laughs] also, something also interesting is that Dr. Christensen’s wife, Dr. Rella Christensen, is also very involved in the Foundation. I think we have a picture to show of both of them.

    Cliff

    Fabulous! Well, you know something, Rella might be one of the actual true stars behind the scenes, because when Gordon gets all of this information – I mean, he’s highly involved. But let me just say, Rella has a PhD in physiology and microbiology, and she runs the in vivo. She’s wearing the blue coats. They – you’ll see this in the show. But anyway, she has a whole team and a whole floor, and they have patients come in. These patients are paid. The dentists aren’t paid. And they study restoratives, composites, glass ionomers, castings, and they have decades of research on this.

    So, they can tell you what’s working and what’s not working. And she runs TRAC, and TRAC stands for Technologies in Restorative and Caries Research. So, she’s a big part of the Clinicians Report, because a lot of the evidence comes from her team.

    Lisette

    Okay. So, Dr. Christensen, besides running Practical Clinical Courses and the CR Foundation, he’s also helped initiate two new dental schools. He has delivered over 50,000 hours of CE, lecturing worldwide. He has produced hundreds of multimedia dental presentations, published countless articles in textbooks, and also, on top of all of that, still maintains a private practice in Provo, Utah, as a prosthodontist. So [laughingly] --

    Cliff

    Gordon never sleeps!

    Lisette

    -- so, without further ado, let’s watch the presentation.

    [Presentation Begins]

    Christensen

    It’s a genuine pleasure for me to have the opportunity to spend a few minutes with your clients. And you asked me to get a hot topic, and that’s what my initial slide is.

    You’ll see I represent a couple of organizations, Clinicians Report, on the left logo, and Practical Clinical Courses, on the right. We have a huge team of people who work with us. We’ve got 50 people who are involved with all of the research. The white coats do the in vitro, the blue coats do the in vivo. In vivo runs as – we’ve got over 20 years of research on thousands of crowns and lasers and whatever! The black coats make all of the educational products that we have, and they’re sold internationally. That’s how we support ourselves, because we take no money from companies, and we take no money from the federal government, thank goodness! You’ve asked me to talk about a hot topic in this few minutes. It’s really surprising to me that that is the hottest topic that we’ve got in restorative dentistry right now: improved glass ionomers.

    Improved glass ionomers? What the heck is improved about them? A lot! Antimicrobiologic restoratives. This is the first time in the history of dentistry, when something in a resin material will kill the bugs that light on it. And it doesn’t dissipate. We’ll get on to that in a minute. Now, this next one shows very clearly glass ionomer and resin-modified glass ionomer materials. And if your screen is big enough, the way you’re showing it, you’ll see we have quite a few CR choices. On the left of that slide, you will see a lot of big green CRs. That means they were the best products.

    Dr. Rella Christensen, my wife, Dr. Rella has shown clearly that the only materials that actually impregnate ions into the adjacent tooth structure are the pure glass ionomers. Even the resin-modified glass ionomers have a problem, and the resins are pathetic! The resins that you’re putting in, in restorations, are frankly only a plug in the hole, with a wide-open Grand Canyon microscopically, all around a composite resin restoration. So, we are absolutely delighted to see coming very rapidly some antimicrobiologic materials. As you look at the glass ionomers, let’s start with those. The glass ionomers have changed markedly.

    Equia Forte GC and Equia Forte HT, from GC, have led this change. These glass ionomers are now far more easy to use. They’re more putty-like, when they get a little viscosity to them. They’re stronger. They’re easier to use. They are triturated, which is a little negative to me, but nevertheless, the Europeans seem to like it, and the Asians. So, that is GC. They’re the leader. 3M followed very rapidly after them, with Ketac Universal, from 3M. Ketac Universal is very similar to Equia Forte. And then, Voco came along with the IonoStar Plus, which is very comparable to the other two. They’re all a whole [with emphasis] new generation of glass ionomers. Literally, an entirely new generation. And interestingly enough -- let’s keep looking.

    There is a product now coming from the same company that makes the silver diamine fluoride, SMART Advantage, releasing more fluoride than any other product we have ever tested! Now, releasing of fluoride sounds good. It is! And since conventional glass ionomers have a contiguous apposition to the adjacent tooth structure and release the fluoride ion right into the tooth, many products that allege that right now do not do that. They just say they do it, and our research negates it. So, there’s SMART Advantage, coming from the same company that makes your silver diamine fluoride, and that’s what it looks like.

    The elevate SMART Advantage is one of the products you need to look at. Now, are the resin-modified glass ionomers any good? The answer is yes, that’s the – one of the most popular products, but they’ve changed it very recently into this concept, Automix LC. Much easier to mix, releasing a heck of a lot of fluoride, and the releasing of the fluoride is good, but the releasing of the fluoride will gradually dissipate, because it gets out of the product. The newer product that I’m going to show you in a minute, for the first time in dentistry, does not deplete its reservoir during service.

    What’s a competitive product with GC Fuji Automix LC? 3M Ketac Nano, been around a while. And what can you use that works like a composite that actually releases fluoride? One we use fairly often is a filler, Dyract Xtra, from our friends at Dentsply. So, I’ve given you a little variety there. But here’s the new thing. Are you awake right now? Infinix. It’s a composite. Are they really attempting to sell you the composite? Yeah. But they’re really attempting to sell you the concept. What’s the concept? There’s a benzoguanamine chloride addition to the molecule, and that benzoguanamine chloride actually, as any organism touches it, dies! Dies!

    So, you have an antimicrobiologic composite for the first time in the history of dentistry. Are they going to just sell that? No, they’re going to sell the concept to the other material companies that are making your composite resins. You’re going to see a major change coming up very shortly with this concept of benzoguanamine chloride in the molecule itself. Now, I wanna give you a current state of the art, and I’ll finish this little technique series for you. The current combination of glass ionomer and composite is a major good way to do your current restorative dentistry, before these other antimicrobiologic materials come along.

    You’ve got either a – in this case, a dentin replacement, which I’m going to show you in a minute, or you’ve got it as – such as this one, where there’s no glass ionomer on the external. It’s all covered over. So, there are two ways to do it. You’re looking at this little slide down here that shows the old-fashioned sandwich technique. But let’s modify it. Here I go. You ready? Extracted tooth, obviously. Prep, huge prep. Too big, but that would be a replacement of an old amalgam or an old composite. Two 1-minute applications of 5 percent glutaraldehyde, 35 percent hydroxyethylmethacrylate. The most commonly used product has been Gluma. A less expense one is MicroPrime G, which many are using. That’s what I’m using, right there. Okay.

    Two, one-minute application kills [with emphasis] the microorganisms to the pulp. Without doing that, all you’re doing is putting a plug in the hole, giving the microorganism something to eat. It’s pathetic. Now, what have we got? Suction the liquid off. Don’t blow it off, because that glutaraldehyde getting on the soft tissue irritates it a little bit. Keep it in the tooth. Suck it off! Then what? In comes the – one of the new glass ionomers. We’re looking at Equia Forte right there. You squeeze that in, you use an instrument of whatever turns you on. I like those little Colona instruments on the left. Rella tends to like the one from Ivoclar you’re looking at on the right.

    But you’re putting a coating on the inside of that prep. And then, what are you going to do? You haven’t acid etched. You haven’t done anything. All you’ve done is impregnated the dentinal canals. And in a molar like that, there will be three million dentinal canals. Now, use your – whatever turns you on. Either a selective etch, such as I’m showing there, or a total etch is fine, or a self-etch. I tend to like a selective etch, because it – it does not alter any dentin that is exposed there, and it doesn’t harm the glass ionomer that’s partially set. That takes about two minutes to get it to that level. Then, a bonding agent over the top of it, such as you’re seeing there. And then, composite on the top, and a little finishing, and you end up with that.

    Now, what have you done? What have you done to that? I’ve been into this now about the time Cliff wanted me to get in. So, I’m going to show you the old sandwich technique again, in a larger view, and that’s what that looks like! If you were to look at the – this next image, one of the most important things is a good, dry field. We have a whole video on this now, the 3514. That’s showing preventive methods in restorative materials. I’d suggest you look at that video. Our websites I’ll give you in a minute, and our phone number. But what have we done with that technique? Look at it.

    Glass ionomer, as with most other restorations, a dry field is almost mandatory. We have a Young frame, a heavy rubber dam, and a clamp on the molar tooth that we’re going to be treating. And it is a first molar. The second molar is missing. As you look up closely, you will see demineralization going clear down below the clamp, into the dentin. So, this would be a Class V. Internally, it will be Equia Forte, which is what? You just saw the Universal – Ketac Universal, and this is the other company, and they’re both just equally as putty, as you will see in a minute. So, remember the technique, now. And we’re going to cut the prep with a standard 330 bur. I will do that and let you look at it, in just a moment.

    Couple things to notice here. Notice that the suction is coming horizontally off the lingual. And believe it or not, that will take away about 90 percent of any aerosol. Also, guess what? I’m cutting that prep – you’re hearing the electric handpiece go, right now. I’m cutting that prep without water. That’s been proven for many, many years. Don’t use water spray on a small prep. Now, I changed from a 330 to an 1156 round-ended bur. And now, we will use a tapered diamond to put a little bevel on the enamel part. You’ll notice there’s a bevel all the way around all of the enamel. We’re getting down into dentin, here. So, that does not need the bevel.

    And then, we will put a little retention in it. A one-quarter or one-half round bur is excellent. Don’t trust just the bond. The bevel here gives it retention, and the retention in the line angles, point angles, also gives it retention. A micro brush, as you can see, and Gluma, or any one of the others, but we actually use MicroPrime most of the time. How long does this go on? You should have it by now. Two, one-minute applications. Can you cut it shorter? Yeah. But it’s not quite as effective. And Rella would be berserk if I said that. She wants two, one-minute applications. After the glutaraldehyde, you could select whatever you want, the high HT, stands for high translucency. Don’t kid yourself. It isn’t.

    Either one is excellent. The fluoride release is outstanding. Okay? That goes right into the prep. I’m not using a conditioner, although the company suggests that could be done. It’s the same vehicle liquid as is in the material itself. The glass ionomer is now going internally. We’ll let it get a slight bit of body to it. And then, with an isopropyl alcohol lubricated instrument, this is the Colona set from American Eagle, I will compact that into place. Isn’t that a difference from the original glass ionomers? I mean, I can’t even compare it. It actually is quite – not putty, but at least it has a viscosity to it, which the older ones did not have. They were sticky and slimy. I couldn’t even do that, that I’ve just done, with the older one.

    Okay. What’s that looking like? It’s looking like we filled the internal. There’s a little slobber over the margins. We’ll get that in a minute. And I’ll show it to you. The glass ionomer is already set, and it hasn’t even been two minutes. It takes about two and a half minutes, so it is – it is rock, all the way around here. Now we’re going to acid etch. The gingival margin is basically dentin, or it’s close to dentin. So, we’ll acid etch the glass ionomer and the rest of the tooth prep. Normal etch, most popular of which, as you know, is the Ultradent product, Ultra-Etch. That started this whole gelatinous etching concept. And the normal 15 seconds.

    Now, the obvious question is, what does that do to the glass ionomer? And one of our scientists has shown very clearly that it makes it very irregular and so what? It has retention! There was excellent retention. What’s this? We just acid etched it, so what is this? It’s another little brief coat of glutaraldehyde, not two minutes. And then, you can either blot that, as I’m going to do right now, or you can use very slight air on it. Not much. And now, your normal bond over that acid-etched surface and over the glass ionomer, which is now roughened. Blow that thin. And in blowing it thin, we basically have got it one minor coat. And we will not cure that, because – you could cure it, but if you do, you see a little line juncture with the tooth.

    Now, we’re using Filtek Supreme Ultra in this particular one. And I’ll use the best instrument we have in dentistry right now, and that is my fat finger. And now, what do we have? We have something very cariostatic inside, and we have something very wear resistant and relatively aesthetic on the outside. Cure, now. That’s a VALO Light. Being cooled by the other dental assistant. We used a 7901 bur, and we then used a poly tip from Ivoclar, which is one of my very favorite polishing instruments. And that’s the net effect. Now, it’s a little darker than the tooth. Why is it? Because they’re all dehydrated.

    We’ll take the dam off and let you see it. Well, there is it! You can see when it comes back to the color of the tooth, it’s going to be pretty close. And nobody’s going to see it anyway, back there. But that is a real preventive restoration, leaking fluoride ion all around the margins of the composite. And that might be something you’ve never thought about before. What have you done? What have you done? Look at this. If this doesn’t impress you, you’ve been asleep! The disinfection goes clear to the pulp. The desensitization goes clear to the pulp, by the glutaraldehyde. There’s a chemical seal of the glass ionomer to the internal portion of the prep. I mean, literally, ionic exchange. There’s high fluoride release, provided by the glass ionomer, and there’s long-term caries prevention, provided by the fluoride, wear resistance by the composite, and aesthetic acceptability.

    Well, I’ve mumbled to you for 15 or 20 minutes. And if this interests you, go to our website. It’s pccdental.com, cliniciansreport.org. More importantly and more interesting, come to Utah. Cliff gives courses for us here routinely, and Cliff is the God of Endo. I hope you know that. He and a couple other guys rule that whole area. I congratulate you, Cliff. You’ve done an astounding job of making endo reliable, predictable, and not having endo fail after a few years. As they claim, 20 percent of American GP endo is in some way defective by, believe it or not, five years.

    Cliff, thanks for doing these little podcasts. I appreciate the opportunity to share a moment with you and hope the viewers got something out of this brief introduction. Watch now for oncoming antimicrobiologic materials. It’s the biggest jump we’ve had in restorative dentistry in many years! Infinix is the first product. Look at it. Thank you.

    SEGMENT 2: Post-Presentation Discussion

    Lisette

    Well, that was an excellent presentation. Dr. Christensen is a really polished speaker, and I really admire all the work he does with the Foundation, which is all non-profit, by the way.

    Cliff

    Yeah. I got a kick out of them all sitting out there in their chairs, in their black coats, their white coats, their blue coats, and the coats – the color of the coat meant something! It was like a code. And so, I was thinking, as I saw the presentation, we only have five people in our operation, but maybe we should have colored coats.

    Lisette

    Yeah. That might be helpful, so we can know [laughs] who does what job [laughs].

    Cliff

    A one-man band [laughs].

    Lisette

    Well, one thing that really struck me in the presentation, and part of the reason it struck me, because we had talked about it on a previous show, when we did a segment on the future of endodontics. And in that segment, you had said that there was a trend moving away from mechanical solutions toward biomedical solutions.

    Cliff

    Right.

    Lisette

    And that seems to be what we are seeing here, with the Infinix product, which is an antimicrobiologic composite, with the benzalkonium chloride in the molecule itself. And that makes any organism that touches it die. I think that’s what Dr. Christensen said.

    Cliff

    It’s exactly what he said. In fact, to play off of what you just said, in endodontics, we’re moving towards biomedical solutions to historically what were mechanical – they use mechanical problems to solve them. But an example would be gutta-percha. Something as simple as something that’s been around for over 100 years, but Nathan Lee, Dr. Lee, can take a long chain hydrocarbon, and he can pull it in these big machines. And then, then you can add nano particles. And nano particles mean we can control the heat wave, we can extend the heat wave, if you will. We can put in antimicrobial reagents. We can put in regenerative reagents. So, that’s gutta-percha.

    And then, of course, sealer, and you’ve seen that with really popular tricalcium silicates, known as bioceramic sealers. And in those cases, they like to talk about how they release calcium phosphate, which is a – it’s a regenerative material. So, yeah. We’re seeing that in our gutta-percha master cones, a lot of emphasis on sealers to make them more biocompatible and regenerative. So, yeah. Trends are coming. And then, like you said, the Infinix and its benzalkonium chloride is exactly that, with that release into the adjacent tooth structure, which we’ll talk about.

    Lisette

    Okay. So, Gordon also talked about the glass ionomers that have this fluoride-releasing capability. And I think he said it sounds like that there’s an initial burst, followed by three to five parts per million, over weeks, maybe months?

    Cliff

    Yeah. I actually – when I watched the show, I was embarrassed, but I had to contact Gordon again, because we hear a lot of claims in dentistry about – well, like the BCC sealers. They have a high pH. Well, how do you have a high pH? You’re releasing materials constantly. That could mean, according to Josette Camilleri, you could have degradation of the physical properties of the material, because things can’t just keep leaching out of material and still have the same physical properties. But Gordon personally answered my query, and he said essentially that there is the burst that you mentioned, and the 3- to 5-part-per-million, Rella measured it out for at least weeks to months.

    But Gordon said because of the electrochemical conductivity, when you put a glass ionomer like Infinix up against a prepared wall, you can have – it’s like a quaternary ammonium product, so it’s antibacterial. But it can penetrate deep into tubules. And then, there’s some kind of electrochemical, where there might be some exchange back and forth. But that just kind of goes on forever, apparently.

    Lisette

    Yeah. Well, I guess, is there – I guess there might not be concern about the physical properties changing, if something’s being released and not --

    Cliff

    That’s because it’s this kinda like – I got – I’m not an expert in restorative dentistry, but from the presentation and doing some homework, and then getting the answer to my query, it sounds like when you put these new – these are the new generation glass ionomers. They all had fluoride in them, but these release like never, ever before. That’s the whole distinction here. And he identified Infinix as the leader. And he even said that Infinix isn’t really – he said, of course they’re selling composites, but they’re selling the concept.

    And they would like their concept to be in all restoratives. The concept simply is benzalkonium chloride is an antimicrobial, and with the bonding in the tooth structure, and this electrochemical reaction back and forth through tubules and restorative, you maintain a completely antimicrobial environment.

    Lisette

    Yeah. I definitely – I think with the benzalkonium chloride in the molecule itself makes it work differently than maybe the traditional glass ionomers?

    Cliff

    Exactly.

    Lisette

    So, I think Gordon did tell you that the initial research looks very promising, but maybe they’re still going to do more research on it, I think?

    Cliff

    Well, I asked him this, because you’re getting a little ahead of me. Because that’s the homerun for endodontists, right? How do we close the access cavity?

    Lisette

    Okay. Well, I actually didn’t ask you that, but I was going to ask you that. Is that what you [laughs] --

    Cliff

    Well, yeah. Because I want to know, if this is so good for open sandwich and closed sandwich restorations, then what about the closed sandwich, where we have a four-wall – well, with the floor, we have five walls. But if we have axial walls and a floor, could we use his concept to repair through an existing restorative that’s well fitting and aesthetically pleasing, biologically acceptable to the soft tissue, could we patch our endodontic access cavity preparation with what he just showed? And he said more research would be needed.

    But he said what I thought right here is, “What’s there not to like, Cliff? Glutaraldehyde kills bacteria! Glass ionomers like benzalkonium chloride create that interface.” And he said, “The composites wear like enamel in a restorative.” So, he was very, very excited about it.

    Lisette

    Okay. Well, yeah. It does look like there’s a lot of promise in the future as far as glass ionomers go, and I’m really glad that we could have that kind of different kind of presentation than we would normally do. So, we’ll do it again in the future.

    Cliff

    Yeah. So, thank you, Gordon. It was fabulous! You hit it right out of the park. The viewers are going to love it. And I have Infinix on order.

    CLOSE: Show & Tell

    Lisette

    So, we’re going to close our show today with some show and tell. Are you ready for some show and tell?

    Cliff

    I absolutely am. In fact, why don’t you go first?

    Lisette

    Okay. Is what I brought for show and tell is, I brought my black belt, because I train in karate. Our system is Shaolin Kempo, and when I say “our system,” I mean I train with my son, Isaac, and Eva, my daughter used to train as well. So, when I say “our system,” I mean United Studios of Self-Defense. So, anyway, this is – means Shaolin Chuen Fa, and that is our system, Shaolin Kempo, which means the law of the fist is what Kempo is. So, anyway, I started training in 2009, and at that point, Isaac, my son, had already been training for 4 years, since he was 6. And I watched him every lesson, and I was thinking, “You know, I can do this. I think I can do this stuff.”

    And I was always kind of athletic and worked out a lot. So, after my divorce, I decided, “You know what? This will be a new start.” And so, I started training, and you know, this doesn’t represent to me like so much as an accomplishment, as it represents like a journey and the path my life has taken. It took me five years to get my black belt, but that involved taking off a year because of a torn ACL, which I tore in karate, doing a jumping scissor kick. Then, I also went to China, twice, during that time, in 2011 and 2013. And we trained at the Shaolin Temple.

    And here I have a picture of us at the Shaolin Temple. This is my new husband, Adam. He’s an – he does karate, too, but he’s in a different system of karate. And since that time, Eva has quit karate, but I’m always hopeful that she’s going to get back into it. She quit at a brown belt. And so, me, Adam, and Isaac are all black belts. And the interesting thing about that is, I actually have trained longer since my black belt than before my black belt.

    Cliff

    That’s impressive.

    Lisette

    And to me, it’s just a lifestyle. And I train with Isaac, my son, and we trained all last year during COVID, too. We kept that going. So, we’re pretty strict about training. And I have to say that one thing you said to me, a long time ago, and I think we might’ve even talked about it on our show before, and I thought of this one day when I was running. Right after I took my karate test, in 2014, I – while I was running in the morning, it wasn’t even light yet, I was thinking, “Before enlightenment, chop wood, carry water. After enlightenment, chop wood, carry water.”

    I’m going to [laughs] start crying. And so, I’m – for me, it’s just been the same thing, after. I trained as hard as I could before, and I train as hard as I can every day. Every day that I train, I put in 100 percent, and I – I even told my sensei, “I think I’m going to know you for a very long time.” So, I plan to keep training. So, for me, it’s – I mean, I’m happy I accomplished this, but at the same time, it’s more like a life choice, and I plan to keep training for a long time. So, for me, it just represents a journey that I’m on.

    Cliff

    I don’t think for you it was ever about the stripes. I think it was like the road to excellence is an endless journey.

    Lisette

    No, as a matter of fact, my – I told my sensei and Isaac, we both agreed that you know what? We’re not even looking to test, because we’re not about what rank we are. I don’t need to have that validation that I’m a certain rank. I said, “We just wanna keep training, and we just wanna keep training forever. So, just please keep teaching us new things and we’ll just keep practicing the old things, too.’” So, that’s – for me, it’s just something I do as part of my life now.

    Cliff

    Wow, that’s awesome.

    Lisette

    So, what about you? What did you bring to share?

    Cliff

    Well, nothing about me personally. So, this is about my pop. He was 95 when he passed away. Anyway, he went to Wichita, Kansas. He went to intermediate school, and that was 1932, ’33, and ’34. So, he was – he was born in 1917, so that was like 15, 16, and 17. So, he was just coming into his own. And he was a swimmer on the high school team, and he was a wrestler and a very good wrestler. He had some records. And then, he was probably the best in track and field. And he was good at the boys’ mile and the 800. So, anyway, what I have, to get to the story, is this.

    And what this is, is a baton. My dad’s hero, growing up, was his idol, Glenn Cunningham, who has been declared America’s best miler. And Glenn Cunningham was at the University of Kansas. So, my dad was in high school, so his hero was ahead of him in college, and he was running for the Kansas track team, and he was – he had two records. And in fact, he broke – he set the world record in the mile at 4.06. And years later, when my dad was showing me this, I wanted to know all about it. I thought this was his baton. He went to a track meet, because his coach knew the coach at University of Kansas, and the high school coach wanted his kids to see how the big guys did it and to get training, the temperance and all the things they had to do.

    And at that race, Glenn Cunningham won in a four-by relay, and my dad was talking to him afterwards, and my dad was like – you know, he was talking to Glenn Cunningham, who set the mile. And Glenn gave him this. And this was the baton that he had used in some of his victories, with the four-by miler. So, anyway, years later, I was talking to my brother-in-law, a retired dentist – in fact, just recently, and I knew that my dad was a really good miler. He had the high school record. In fact, he had the boys’ high school record for some years after he left middle school – intermediate school. But what I found out is, he ran within 6 seconds of the – of Cunningham’s record of 4:06, when he was in high school.

    Lisette

    Wow.

    Cliff

    So --

    Lisette

    Now, I see that there’s something inside of it.

    Cliff

    -- oh.

    Lisette

    You don’t have to take it out.

    Cliff

    I wasn’t going to take it out for today, but there’s a lot of mementoes in here and plaques he got that were paper in that day, and they’re rolled up in here. And the badge he had on his coat, for his chest and on his sleeve, and so, anyway, I was – I knew about this growing up, but he rarely ever talked about it. But then, when he was getting older, he asked me if I’d like this. So, I said, “Absolutely!”

    Lisette

    Well, it’s kind of like a part of him that you have, now.

    Cliff

    Well, I thought, when he gave this to me, he was actually passing on the baton.

    Lisette

    [laughs] It is a little – this is a little bit emotional. Well, you know, one thing that’s really funny, a story about Grampa Ruddle, I remember when we lived at our old house. And I – I think I was like ten years old, and I was quite into running then, too. And I remember [laughs] Grampa asked me if we wanted to race up the street. And so, I said, “Sure!” Because I thought for sure I could beat my grampa [laughs].

    Cliff

    How old was he?

    Lisette

    He was probably at least 70, then. I mean, this was like a long time before he died. And so, he was actually wearing slip-on shoes. And so, I’m like, “Okay. We’ll race.” And so, I just ran as fast as I could, and I realized – I heard some strange noise, and I – I --

    Cliff

    [laughs]

    Lisette

    -- he was behind me. Well, he ran right out of his shoes. [laughs] And so, that was funny, that he had no care about his shoes. He was just going to run as fast as he could. That – that was – it was something I’ll never forget.

    Cliff

    Well, I liked your story of the black belt, because to me, what it represented is just what you said. You don’t stop doing something when you arrive. You keep going.

    Lisette

    Right. All right. Well, that’s our show for today. And see you next time on The Ruddle Show.

    END

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    Season 5

    Release Date Show Get Notified
    06/16/21
    Common Endo Errors & Discipline Overlap
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    06/23/21
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    08/04/21
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    08/18/21
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    Disclaimer

    The content presented in this show is made available in an effort to share opinions and information. Note the opinions expressed by Dr. Cliff Ruddle are his opinions only and are based on over 40 years of endodontic practice and product development, direct personal observation, fellow colleague reports, and/or information gathered from online sources. Any opinions expressed by the hosts and/or guests reflect their opinions and are not necessarily the views of The Ruddle Show. While we have taken every precaution to ensure that the content of this material is both current and accurate, errors can occur. The Ruddle Show, Advanced Endodontics, and its hosts/guests assume no responsibility or liability for any errors or omissions. Any reproduction of show content is strictly forbidden.