DT News - MEA - Empowering products for restorative dentists

Dental Tribune Middle East

Tue. 21 March 2023

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Dr Rafael Beolchi is a restorative dentist working in aesthetic dentistry and oral rehabilitation in private practice. He teaches around the world, focusing on advanced handling of dental materials with an easy step-by-step approach. He applies his clinical and scientific knowledge as a consultant for the dental industry towards the development of new and better dental products. In this regard, Dental Tribune Middle East & Africa, speaks with him in this interview about his use and experience of Ultradent products and the practical training in direct aesthetic dentistry that he will be giving in Dubai in September 2023.

Could you tell us a little bit about yourself, how you got into dentistry and what fields you lecture on?

My story with dentistry started when I was a kid and wanted to combine biology, a topic that I loved, with fine manual work, playing with and fixing things. Dentistry brings these two worlds together: the biology involved in caring for a human being and the restoration of something that has being damaged or even destroyed. The field of restorative dentistry was a natural choice to combine both.

How did you start using Ultradent’s products in your practice?

I began very early on when I was still a student. I remember it very well: in 1997, when I was in my third year of dental school, a friend gave me an Ultradent product—I didn’t know then about Ultradent though. The product was a liner to protect the pulp floor, but instead of being chemically activated by mixing two pastes, it was light cured. This material is still available, its name is Ultra-Blend Plus. I remember how the quality of what I was doing became instantly so much better. It was also the first time that I got a compliment from a teacher about the quality of my work. I recall getting back to this friend of mine and asking what the product was, because it made me a better dentist instantly, enabling a better, faster, cleaner procedure. Using Ultra-Blend Plus when I was a student is when I felt I was in control for the first time. From that moment, I then started looking into what other products and solutions the company offered. As I began to learn about the products, I realised that these were unique products. I soon realised that if Ultradent makes a product, it’s because that product will make either my life or the patient’s life easier or better, or it can offer faster processes, or it is stronger, maybe all of these benefits combined. My journey with Ultradent has been one of getting to know the products and becoming a better dentist also because of that.

Dentists are a little bit like mechanics in that they like to have their own toolbox and tools, including customised tools for certain cases or procedures. If you had to pick your toolbox, which Ultradent products would you say are your favourites?

That is a very good comparison! I would say that Ultradent’s tools are the premium ones that anyone can have, and I have so many favourites, so that’s a tough one. I just mentioned the oldest one that I still use, but there are others that helped me a lot in the beginning and still do. One of those is Sable Seek, a caries indicator. For restorative work, I use composite resins, and if I want them to look good and to last, I need to lightcure, and for that VALO is fundamental. The breakthrough that VALO brought when it was launched, around 14 years ago, completely changed the way that dentistry understands light polymerisation and the impact that it has on the longevity of composite restorations. It’s difficult to talk about VALO without also mentioning Ultradent’s composites, which I have been using since a long time. There are so many little satellite products, like PermaSeal for preserving the integrity of the margins, Composite Wetting Resin for proper spreading of composite to give the proper characteristics of dentine and enamel, and Peak, one of the strongest bonding agents I’ve ever used.

For the VALO X curing light, could you explain to our readers why it is top of the top for you?

I think that it is top of the top because of the breakthrough of VALO X. Lightcuring is a topic that I have been researching actively for the last ten years, having become very interested in it around 13 or 14 years ago owing to the nature of my clinical work, and just after my Master’s degree. The major breakthrough of VALO X is that it was the first curing light to break the barrier of 1.0 cm² of tip area, with a footprint now of 1.2 cm². That goes against the trend of many other companies, which for the last 15 years have been diminishing their tips in order to artificially increase irradiance numbers to make us believe that they are powerful. They have dense lights in small areas, but they are not powerful, requiring several light-polymerising cycles to cover a tooth. This information is not widely known. Logically, a smaller footprint means a denser light but in a tip that doesn’t cover even half a tooth, Ultradent has gone in the opposite direction. We as dentists want to cover as much of the tooth as we can, so smaller footprints don’t help. Designing a light with a large footprint able to produce the amount of energy needed is not easy, and that’s for me the major breakthrough of VALO X. It enables proper light polymerisation, often in only one curing cycle, even in the cases of larger MOD restorations and larger direct veneers, ensuring longevity and everything that we want in our restorations, such as polishability retaining, and microleakage reduction.

Do you use Ultradent cheek retractors?

Because I work a lot in anterior teeth, I commonly use cheek retractors. Ultradent has just launched one called Umbrella, and I’ve got a good story to tell about it too. When I was still practising in Brazil, before moving to Europe, I used a prototype of the Umbrella on a case I was working at, a full-mouth prosthodontic case. I was performing the restorative work on 12 anterior teeth, from canine to canine in the maxillary arch and from canine to canine in the mandibular arch. That was the first time that I used what then was named Umbrella.

I used Umbrella for the first time with a female patient for 4 hours straight, from 8 a.m. until noon, and again from 2 p.m. to 6 p.m. That was the first time that a patient of mine had worn a cheek retractor for so long without complaining. I thought that this might have been a one-time thing and something unique of that patient, maybe also because many female patients tend to deal with discomfort better than most male patients. The next week, however, I performed an even larger restorative procedure, a full-mouth, this time on a man. Most of my male patients are more sensitive—me included to be honest. He too wore it for 4 hours in the morning and 4 hours in the afternoon without complaint. It is the only cheek retractor that I have ever used that patients can wear for so long. There’re several nice things about Umbrella, like the tongue retractor, but the key feature for me is the spring-like action, keeping the mouth open just right so that it doesn’t tire the muscles responsible for opening and closing the mouth. The mandible rests at a relaxed position, and that is why it is so comfortable.

There are some cheek retractors out there that are like a ticking bomb: you know that after 30 minutes or so they will eventually go off, springing out of the mouth owing to the moisture that builds around it and the patient’s lips. Working with them means that you’re always tense, since you never know when they’re going to jump out of the mouth. Umbrella is very stable. It’s an amazing solution: it’s comfortable for the patient and for me because I can work reassured that it’s going to stay in place until I move it.

Having given many lectures and courses here, you are familiar with the level of knowledge and clinical practice of dentists in the region. What is your feedback and what message do you have for dentists in the Middle East?

My feedback is a compliment! I’ve been fortunate enough in my work to travel to many places and countries and have seen many different realities. I remember that the first time that I came here I offered a condensed course and so I pushed the participants a little bit, and I was pleasantly surprised at the good response and that the whole group could manage. I knew that only participants with proper education and training and a good level of dental practice would follow if pushed like this. It’s not very often that this is the case, but here in Dubai I managed to go a little further than what I’m usually used to. It’s a good experience when you can fly a little higher and everybody keeps pace.

Being able to come back and teach is a beautiful opportunity. I am always happy to come here because of my experience with the Middle Eastern culture and people when I lived in Brazil. In the last century, Brazil has welcomed lots of people from the Middle East, so it’s a culture that we embraced in Brazil. We love the culture. We love the food, particularly. We love the people. So for me, it is good see its origins. I would like to invite everybody who is interested in direct composite restorations, who would like to learn how to handle simple to complex cases and who would like to see some of the techniques that I’ve been applying for almost two and half decades to attend. It will be a pleasure to have everybody on board here in Dubai in September.

Another important topic to mention is that, while there is much focus on anterior restorations, in my office and for most practitioners, posterior restorations are what pays the bills at the end of month. Posterior restorations pose different challenges. They are less aesthetic, of course, but they’re more anatomical, so the challenges in posterior restorations are less about aesthetics and more about anatomy. Aesthetics we can achieve with a good composite, but getting a good contact point is mandatory and often a little challenging. Here too, Ultradent has a helpful product, launched last year. It’s called Halo. It’s a sectional matrix system like others in the market, but each of the components offer some innovation. The ring is narrow and can be used on the maxillary arch and mandibular arch. The metal part of the ring is made of nickel–titanium, which exerts gentle and constant pressure. The ring also has a little beak, which helps with the interproximal anatomy. The matrix band has a tiny, half of a millimetre, detail on the occlusal aspect that gives a little guidance as to where the marginal ridge should be. We all know that the marginal ridge is the first place where we need to do occlusal adjustment when finishing a Class II restoration. Any hint at where the marginal ridge should be saves us a lot of time on occlusal adjustment and makes it a little bit more predictable. Regarding the wedge, what Ultradent wanted to achieve was a gentle wedge that gives the feeling of a wooden wedge, that is, active wedging, helping to spread the teeth apart a little for better separation. By having a better separation, we can get a better contact point. Together, these little differences on the ring, the matrix band and the wedge make this a beautiful system for posterior restorations and make it predictable to get good contact points as well.

You’re coming back here in September to lecture and do a hands-on course for the CAPP Training Institute in Dubai. Could you give us a little bit of an overview of what you’re going to be lecturing on, what the hands-on course will entail and why you like to lecture on those topics just generally?

Similar to last year, I’m going to cover direct composite restorations and focus on the simplification of the techniques even for challenging cases, so I won’t be talking much about simpler cases. Of course, in order to handle complex cases, we need to do proper diagnosis and have proper training on the procedure and what we are looking for. The techniques become simplified by understanding proper diagnosis, and with proper diagnosis comes proper planning, and then proper treatment. Also I’m going to talk about dental whitening, a fundamental and non-invasive step which makes our lives easier in the restorative processes, and I’m pretty sure that we’re going to have enough time to talk a little bit about diode lasers in dentistry. I think that they’re a great tool even for restorative dentists like me who are not surgeons or periodontists, facilitating numerous aspects of clinical care.

Editorial note: Dr Rafael Beolchi’s hands-on course is titled “Direct aesthetic dentistry: New materials and techniques for anterior restorations” and will take place on 14, 15 and 16^th of September at the CAPP Training Institute in Dubai. Participants can earn 14 continuing education credits.

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