Trust the Process… and the Products

When you browse through BISCO’s DPS Best Product reviews—and there’s nearly a dozen of them to read—the word “best” comes up a lot. From one clinician announcing that Core-Flo DC is “one of the best buildup materials I have ever used,” to another dentist lauding eCEMENT as “the best cement I have tried to date,” to yet another provider praising TheraBase’s continuous calcium release that “makes me feel more confident I am doing the best for my patients.”

These 3 praiseworthy BISCO products are joined by many others that have earned the coveted DPS Best Product badge over the years, with each material being ranked on its own unique set of criteria and receiving high marks for doing exactly what it is designed to do—and then some. While it’s clear that BISCO products have been delighting clinicians for over 4 decades, what may not be apparent is the time, effort, and excellence that goes into developing a new BISCO material.

“We value quality products that are backed by science,” said Nikki Janes, Manager of R&D Product Lifecycle at BISCO. “We don’t want to just go with the latest trends; we want to make sure it works.”

An Open Approach to the ‘Best Products’

With that, BISCO upholds a rigorous 5-phase process when developing any new product, which begins with vetting the initial idea and developing a prototype to validating the final design and commercializing the product so it gets into the hands of dentists—and in the mouths of their patients. “At every point of contact, we can make small adjustments, but at some point, we have to say this is what we’re looking for and we’re moving forward,” noted Janes.

Perhaps most importantly, BISCO understands that success doesn’t happen in a vacuum. Throughout the process, feedback is garnered not only from dentists using the products in daily practice, but from university researchers who can help with product testing, as well as other dental companies that have set out to address the same challenges.

“If you focus only on the research within the company, you have a single-minded route to developing the product,” shared Dr. Erick Yu, BISCO’s Manager of R&D Technology. “Dentistry should advocate an open learning space. We all have the same end goal: designing a good product for the patient.”

A Passion for Excellence

While the R&D team at BISCO, including Dr. Yu, is currently pursuing multiple key product development projects, one exceptional, historic product to note is Duo-Link Universal, a dual-cured adhesive resin cement that’s uniquely formulated for use with all indirect restorations. Deemed a DPS Best Product in 2013, it earned high marks from evaluating clinicians for its ease of use and reliable performance in all etching modes.

“While All-Bond Universal is the foundation of BISCO’s adhesive legacy and a great product, a lot of people don’t look closely enough into the cement category,” said Dr. Yu. “Designing a good cement is equally as challenging as developing a universal adhesive.”

BISCO’s commitment to creating high-quality restorative materials is trumped only by its commitment to providing dentists with products that solve common clinical challenges. Here are 5 of those restorative roadblocks, and the DPS Best Products that come to the rescue in each case.

Challenge #1: Postop Sensitivity

It’s a familiar scenario: a patient comes in for a filling, leaves the office, and you don’t expect to see or hear from them again until their next recall. But a few days later, they call to say their tooth hurts, and they’re adamant that it didn’t hurt before.

Studies show that postop sensitivity after composite restorations can be as high as 30%, and that numerous factors can be the culprit—from exposed dentin tubules, underlying periodontal disease, and occlusal interferences to voids under the restoration, improper bonding techniques, or fractured composite material.

“As a lecturing clinician I recognize that many wonderful products can be used for predictable bonding procedures, and I have utilized many over the years,” said Dr. Richard Winter, who has published articles on advanced treatment planning and general dentistry as a specialty.

“I have used All-Bond Universal since it came out because of its wonderful bond strength to many substrates, lack of postop sensitivity, and ease of use. Prior to that, I used its predecessor, All-Bond 2, with great success.”

Launched in 2012 and deemed a DPS Best Product soon after, All-Bond Universal’s versatility is an understatement. It can be used with direct and indirect restorations and is formulated to be compatible with light-, dual-, and self-cured materials. Clinicians can use it in all etch modes with no separate activator required.

“Speaking to my experience with BISCO, I can say that I rarely have seen sensitivity when using their bonding products and cementation protocols,” added Dr. Winter. “I also am a fan of their therapeutic products like TheraCem and TheraCal LC.”

Challenge #2: Cleanup of Excess Cement

TheraCem, which has been a DPS Best Product since 2017, conjures up another challenge that clinicians often face during procedures—getting rid of excess cement. While TheraCem is well-known for its continuous fluoride and calcium release, the dual-cured, self-adhesive resin cement is—like all BISCO cements—also designed for easy cleanup.

When formulating its cement line, BISCO considered the need for a seamless and efficient removal of excess cement after the initial tack-curing stage. That means the properties of these cements—TheraCem, Duo-Link Universal, eCEMENT, and Choice 2—are optimized to strike a balance between achieving the necessary bond strength and facilitating easy removal, creating a smoother workflow.

“It's self-etching, doesn’t require refrigeration, and cleans up beautifully,” said Dr. Winter, who has been using TheraCem for the past several years. “I love that it’s dual-cured, so I can flash set the marginal excess and it will continue to polymerize while I am removing the excess cement.” He added, “I appreciate the excellent bond strength, ease of use, and release of calcium and fluoride, which may provide extra protection at the crown-tooth interface. While there are many wonderful cements out there, this is one product in my armamentarium that I use frequently.”

And then there’s Duo-Link Universal, an all-around adhesive resin cement for use with virtually all indirect restorations. Available in 2 shades—Universal and Milky White—its low film thickness ensures the restoration is completely seated.

“Duo-Link Universal is by far the easiest cement to clean up that I have used in my 31 years in practice,” said Chuck Rubin, DMD. “I like the dual-cure feature and that I can control the working and setting times. This greatly improves the process of cementing indirect restorations and makes cleanup easy and stress-free.”

Another important feature to consider, noted Dr. Rubin, is film thickness.

“Duo-Link Universal has an ideal thickness for easy and predictable luting. I’ve recommended this product to many dentists over the years, including one of my associate dentists, who said it has quickly become a ‘go-to’ for all his cementation needs. The ease of use, easy cleanup, versatility, and strength make this an exceptional product.”

Challenge #3: Bonding to Zirconia

Establishing trust with patients can be a challenge. Whether it’s an established patient or someone who’s new to the practice, getting permission to drill into a painful, failing tooth and put a shiny piece of ceramic in its place is a big ask. In some ways, your word becomes your bond—not to mention the actual bond that must occur to ensure a successful restoration.

Achieving a strong bond might seem as simple as choosing the right cement. But with a variety of dental restorative materials available from which to choose, the plot thickens. Zirconia, for example, is a non-etchable ceramic that makes it immune to hydrofluoric acid. It also can’t be primed with silane, as zirconia does not contain silica.

The solution? Z-Prime Plus, a single-component primer designed to improve adhesion between composite resin cements and indirect restorative materials. It blends 2 active monomers—MDP, a phosphate monomer, and BPDM, a carboxylate monomer—to enhance bond strengths to zirconia, alumina, and metal substrates.

“I love having the additional confidence that Z-Prime Plus provides in improving adhesion,” said Albuquerque clinician Dr. Marisol King, who places zirconia crowns about 2 to 3 times a week, primarily on first and second molars. “While Z-Prime Plus is an extra step, I have more confidence that there will be sufficient adhesion,” she added.

Challenge #4: Long Working & Setting Times

It used to be the case that protecting the pulp and minimizing inflammation came at a cost: long working and setting times. But times have changed, both literally and figuratively, thanks to the creation of materials like TheraBase, a self-adhesive base and liner that pairs continuous calcium and fluoride release* with convenient syringe delivery and minimal waste.

“TheraBase has great retention and my patients have benefited from much less postop sensitivity,” noted Dr. Aliisha Choucair. “I like how it dispenses and how it performs.”

With a working time of 1 minute, including mixing, and a maximum setting time of 5 minutes, TheraBase is stronger and more durable than other base materials, glass ionomers, and resin-modified glass ionomers. It contains the MDP monomer for a reliable bond to dentin, and generates an alkaline pH to promote pulp vitality.1Best of all, it will cure even in deep restorations where light cannot reach.

“TheraBase has helped me restore very deep cavities where the patient was otherwise at risk of needing root canal therapy,” added Dr. Choucair. “Root canal therapy is a great treatment, but I think most people would agree that if we can avoid needing one, that is a positive outcome.”

A firm believer of using bases and liners under just about all his restorations, Daniel Ward, DDS, says TheraBase is one of the key reasons his patients tell him their fillings never hurt. “I like to use TheraBase because it can be used in varying thicknesses, releases calcium and fluoride, is dual-cured, and adheres well to dentin without using phosphoric acid,” shared Dr. Ward. “It has good working and setting times, and the automix dual syringe with small, disposable cannula tips allows for easy placement.” 

Challenge #5: Undercured Material

Inadequate polymerization presents a real challenge to a successful restoration, leading to a weak, wear-prone, or unesthetic result. And the culprit isn’t always the curing light. Luckily, BISCO’s Core-Flo DC and Core-Flo DC Lite offer reliable dual-cure chemistry that performs equally well in light- and self-cure modes. So, regardless of how deep the prep is, the materials will fully polymerize to ensure a long-lasting restoration.

“I appreciate the lower viscosity of Core-Flo DC Lite, and I use it primarily when I’m building against a matrix band in deep-margin elevation cases, or when I’m sealing deep canals in endodontically treated teeth,” said Devin McClintock, DDS. “I also like that it’s a dual-core material—if I'm dealing with endodontically treated teeth, I want a light and a chemical cure to ensure the material will be fully polymerized and set to achieve maximum strength.

”Another problem with some core materials? Microleakage of fluids, bacteria, or debris between the restoration and the tooth. “Because Core-Flo DC Lite is less viscous, I know it will level against the matrix and reduce air bubbles,” affirmed Dr. McClintock. “When I finalize the crown prep and lift up the margin, that transition from buildup material to the tooth has a nice, contoured anatomy. I don’t have to worry about food getting caught down there or bacteria causing a problem.”

Backed by Science

Whether it's lining, bonding, cementing, or applying a healthy dose of fluoride, BISCO has products that are backed by science, created by experts, and used by dentists everywhere to achieve predictable and durable results for their patients.

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_{1. Okabe T, Sakamoto M, Takeuchi H, Matsushima K. Effects of pH on mineralization ability of human dental pulp cells. J Endod. 2006;32(3):198–201.}