A LETTER TO DR JOHN ABOUT WHY WE NEED THE BANDBENDER™

Bandbender™Dr John W writes…

“I think with the use of sectionals which provide a properly contoured inter proximal and a good contact very few practitioners will use the Bandbender™.”

HI John;

You got me going. You don’t think the dental profession needs the Bandbender™? Wrong! I’ll start as I will conclude, How much can you know about flight when you don’t have wings?
WHERE SECTIONALS LEAVE OFF:
I would agree with your statement except that sectionals confine the placement of composites to conservative boxes. With the Bandbender™there is no reason to stop using composite when there is a cusp to replace, or an entire lingual surface missing, or no cusp structure at all. The resins are not a problem – we now are fully capable of the work on the materials side. I’ve been doing large complex posterior resins for 25  years. Even with inferior resins and low output curing lights. I commonly am seeing 25 years of service. That was using burnished brass matrix bands in the early days, with about an 80% success rate, but since 2000, with the Bandbender, a 100% success rate.
HARD TIMES: ARE YOU READY FOR ECONOMIC DOWNTURN?
In prosperous times and places we can just move on to crowns when restorations get big. It’s not that crowns don’t work as a strategy. It just that crowns leave out about 40% of the population and maybe 50% in hard times, and everybody but the elite of the Third World..But here in North America there  will always be  a segment of the population that will never be able to afford crown treatment or for whom it just isn’t possible or for whom there isn’t time.
I guess some people are happy to be able to include only 50% of the population in their dental public health strategy, but in my practice I am not. I treat real people in real life situations, and I rarely have to leave people out of a restorative option to a broken down posterior tooth.
THESE PATIENTS CAN’T HAVE CROWNS:
Think about these very typical patients and their life situations-
  • the elderly,
  • the terminally ill,
  • students,
  • the unemployed,
  • the underemployed,
  • travelers and transients,
  • welfare recipients,
  • emergencies, both real and imagined-
  • for example , the hysterical mother of the bride two days before the wedding who loses a facial cusp,…..
  • ……..business men just about to leave for an extended business trip…
  • And then there are the clinical considerations…
  • ……..where the need for ferrule requires  crown lengthening and that is more destructive and actually reduces prognosis – periodontal morbidity
  • ……….the reduction necessary for crown esthetics invades deep dentin in young patients and increases pulpal morbidity

WHEN THE DOOR CLOSES ON CROWNS:

You can’t crown your way out for these people.  We need to get real. We have our heads screwed up early  by dental school dogma about “Ideal Dentistry” and somehow feel badly if we aren’t placing the known alternatives for large amounts of tooth structure. We also  enjoy the profitability.

The Bandbender™ is a game-changer and extends the boundaries of known alternatives. We can knock those antiquated  known boundaries right out of the ball park.

With the Bandbender™in our quiver we can stop trying to squeeze our patients into our known boundaries and respond flexibly to their needs. Anything with a root can be restored provided you can place the matrix, and , using “margin elevation” you can render even the deepest boxes supragingival, wedgeable and matrixable. You know that, John, you do it along with other Bertolottians to move patients into conservative adhesive onlays when boxes are too deep.

HERE’S WHY WE NEED BANDBENDERS™ IN OUR PRACTICES:
Being able to take the above situations  seamlessly  in stride and produce a bulletproof restoration in an expedient amount of time…… that won’t break  its marginal ridge, because there is enough bulk in the right places, and will have a solid contact with a proximal surface of the right contour……that’s the value of the Bandbender™.
CLINICAL FRUSTRATIONS YOU HATE: SAY GOODBYE
Have you not faced these frustrations?…….
          your new large composite restoration is  un-flossable because the occlusal embrasure is non-existent because you have a pinpoint contact that is too high…..
         or you have an open contact that packs food and drives the patient crazy and makes them complain to their friends about you and your shi**y dentistry……,
          or three weeks later makes you set aside chair time for a free-of-charge subsequent patch job where all your profit vanishes….
         and you end up on the defensive as to why it came out that way the first time….
          and it is still an aggravating experience because you know you did an incompetent job and it upsets your mood for the next appointment…..
          and you lost your business shirt placing it in the first place……..
           and lost isolation restoring the missing tooth with a Tofflemire, with which you first replaced the missing cusp or lingual surface   and then, in a mess of oozing tissue fluids added sections and rings, ending up with a bunch of resin interfaces that look…well, not quite right if you are honest, having contaminated the oxygen-inhibited layer…
         and you’re behind schedule now and have made this not-right thing for $400 and you tell the patient that this won’t last for very long and will need a crown…
ARE YOU SAYING WE DON’T NEED CROWNS? WHERE ARE CROWNS STILL ADVANTAGEOUS?
This is why I developed the Bandbender™- to end these situations once and for all. Once I had the matrix, I learned the other expertises which are in my Handbook of Composite Excellence to place a sound restoration in a profitable length of time so  that they can walk out of the office with and have no troubles. When patients are bruxers, high cosmetic cases, and second molars- less so since nanos came into play- I consider a crown an advantage.

FASTER AND BETTER CUSTOM SECTIONALS AT A LOW PRICE:

As well, John, I make my own sectionals using the Bandbender™ and don’t have to maintain an inventory of expensive little boxes in every operatory. Or suffer the frustration of trying in several only to find that none of them actually are right and go back to the most likely one and throw away the others- hardly tine effective or cost effective.

I just measure the embrasure- the height and width  of the box, and the interproximal distance with a periodontal probe, and dial in that shape from a flat band using the Bandbender™and in about 60 seconds I’m underway with placement.
HAVE RINGS AND SECTIONALS NOT SOLVED ALL CONTACT PROBLEMS?
I use the rings like everyone else of course, they are a huge aid, and the new wide soft  pads are beautiful  but the enormous array of stupid little wedges on the market cannot be surpassed by a well trimmed sycamore wedge that closes the gingival margin against hemorrhage or overhang, without crushing the contour created in the band.
When a ring cannot be used, I adapt the band to the adjacent tooth using the Trimax or Contact Pro instruments.
Another thing to hate about sectionals is that they do not always have a flat collar at the gingival that allows you to wedge to the gingival margin, and then the sectional crushes when wedged. Lately in journals I have started to see composite placed down past the prepared margin -the result of matrix contour carried past the prepared margin, using one of those hollow wedges that sits like a saddle over the papilla. Is this our new normal?-intentional overhang? How good is the  adhesion to an unprepared enamel or cementum margin see Enamel Axiom #1
Another limitation of sectionals are those arches with mal-posed teeth where a ring cannot be placed.
THE BANDBENDER™ MAKES GREAT ECONOMIC SENSE
John I have found that the economics make sense- just one failed contact costs hundreds of $  in re-treatment time. Throwing out those boxes of sectionals saves thousands. Keeping happy and cool all day is priceless.
What do other practitioners do in all the places where I use the Bandbender™? Bring out the forceps?-  or maybe amalgam if a they know how, but, by the way, the Bandbender makes good amalgam contour easier too.
ANOTHER PROBLEM SOLVER: EXCELLENT TEMPORARIES FOR CONSERVATIVE ONLAYS:
Another application –  excellent temporaries for conservative onlays and inlays. I began making conservative inlay temps inside a contoured band with flowable, LC or DC, but lately use super-white “pulp cap” flowables like Therafil or Calcimol LC, etc,  After desensitizing the dentin with Microprime, sometimes placing Dycal on the pulpal floor or in the corners of the boxes to make removal easier, we cast the temp inside a contoured band.  Comfortable, strong, quick. If you wish, you can lubricate the prep, remove, trim and cement Or just leave it well contoured,occluded and smooth without cement. Saves time.
You can also paint one or two prep walls with a little Dycal on a brush to make subsequent removal easier. If it lingers after the temp is removed It will etch out if simulatneously  cleansed with a rotary brush. If there is no retentive form a tiny drop of bond on the center of the pulpal floor will usually hold it without cement.
UPDATES FROM TUCKER CAST GOLD TEMPORARY METHOD:
These tricks are updated  cousins to the paint-in-place acrylic temporary method developed by the venerable Dr. Tucker  of world cast gold fame. There are 60 study clubs around the world doing it this way. That was an expedient technique for the times, but it stank up the office, was not essentially healthy, and tissue hated it, so Dr Tucker invented a method-to put warm gutta percha in the box floors first, which required that the boxes be retentive, and that limits application to today’s non-retentive adhesion-based prep designs.
A contoured circumferential matrix can be a very quick  way to temporize and move on for both retentive and non-retentive preps. There are lots of ways to play it, as you can see.
LOOKING AHEAD NOT BACKWARD:
So this is why the profession needs Bandbenders™, John, for progressive solutions. But we still have forceps, amalgam, removable dentures, crowns, and fast talking if we don’t.
John, this is  not personal, this is spoken to the profession, about a world of possibilities they don’t see because they don’t have the device. How much can you know about flight when you don’t have wings?
Cheers,
Peter
On 2019-03-30 6:46 a.m., John Wilson wrote:
I think with the use of sectionals which provide a properly contoured inter proximal and a good contact very few practitioners will use the band bender. 
John

On Mar 29, 2019, at 9:48 AM, Peter