All restorative materials have wear properties. We need to understand both how they wear and survive in the oral environment and how they impact opposing natural teeth.  

The wear of enamel is the basis for comparison.

Despite what we sometimes see clinically, enamel is highly resistant to wear (attrition and abrasion), with average annual wear rates of 30-40 microns. The range is from as low as 15 microns to as high as 100+ microns, and there is variability depending on the tooth position in the arch.  

Unlike enamel, which basically all has the same structure and properties, composites come in many different formulas. The chemical and physical properties of the material have a direct impact on its wear resistance and impact on other teeth. Some examples of this include: 

• Size, shape, and hardness of filler particles 
• Quality of the bond between filler particles and polymer matrix 
• Polymerization dynamics of the polymer 

These same properties affect the other physical and handling properties of the material and have to be balanced to create a composite that works clinically.  

Creating improvements in the physical properties of composites has eliminated the high degree of wear in non-contact areas we witnessed years ago. The loss of restorative material gave the appearance of fillings losing their shape and contour. Today our primary concern is in areas of direct occlusal contact.  

One approach might be to avoid using composite that has direct occlusal contact.

I would say this is not only not practical but not necessary. We have a variety of materials available today, with a range of handling and physical properties, and wear rates that are between 30-200 microns a year.  

We need to choose a composite based on things like wear versus polish–ability, anterior versus posterior, and the properties of the particular material we are using. In addition, we can manage the occlusion to maximize the success of the natural teeth as well as the composite. 

According to Markus Zusak, author of The Book Thief, he had to rewrite his book 150-200 times until he was happy with it. And he began by imagining the end of the story, then the beginning, then the chapter headings, then the writing…over and over again. In the end, Markus had a New York Times Best Seller, with 8,000,000 million copies sold and a movie deal. 

One might be tempted to view Markus Zusak as an overnight success but knowing what I have just told you allows you to understand that’s not the truth.

So too is the case with relationship-based/health-centered dentistry. The creation of the practice takes years, starting much like Zusak’s book—beginning with the end in mind. From there, each aspect is assembled from finding and forming the right care team, to developing them, and to finding better and better ways to connect with patients: truly hearing them, understanding their struggles, and sensing their desire to feel better about themselves. 

Along the way, you will make mistakes, have misunderstandings, and outright fail. This will prompt you to rethink, revise, and redo. This is the true nature of success. We learn and move upward with better understanding. 

It has been said that the main difference between a vision and a dream is the work involved.

The later requires none. The former’s work never ends. A true vision is a principle-centered thought capsule aching to be validated by reality. It has an inherent truth built into it which must be realized. And as with Zusak, if it takes 200 revisions to make it happen, then it takes 200 revisions. So be it! 

The simple secret to success is the willingness to be flexible and to accommodate new understandings combined with a sheer force of will and perseverance that only a few are willing to make. 

After my presentation on High Engagement Leadership at the September 2019 Pankey Annual Meeting, a few people asked me about a term that I used in the presentation, VUCA. The acronym VUCA stands for volatility, uncertainty, complexity, and ambiguity—the challenges that we face in today’s world. The term originated in the late 1980s from a thought leader named Warren Bennis. Bennis was known for shaping the concept of authentic leadership, which at its center is the value of being true to one’s self.  

VUCA = Volatility, Uncertainty, Complexity, and Ambiguity 

Complexity in our culture and rapid change are our challenges as leaders. How shall we use all our creative gifts and talents to develop as leaders and influencers in a world that thrives on VUCA? 

The answer might be to start by deepening the trust we have in ourselves. Our ability to navigate through the noise and distractions of today requires high trust in self and a willingness to believe that others will follow us. 

In his recent book ‘Deep Work‘, Cal Newport describes the value of quiet focus in a formula defined by Adam Grant:  

High-Quality Work Produced = (Time Spent) X (Intensity of Focus) 

Slowing things down and eliminating the distractions around us can increase our productivity exponentially. As with exercising, when we commit to uninterrupted focus time, we tend to develop a resilience muscle that is strong when times are complex and distracting. When we are more focused and stay calm in our role as leaders, others appreciate this gift we bring to them—and there is likely to be another ripple effect, development of trust in ourselves.  

Many years ago, when I was first trying to create a successful dental practice, I fell in love with the word “production.” I believed that production was the key to success, so I read everything I could to become more productive.  

I took courses.

In the early years, there were so many courses that centered around how to efficiently double and triple book, how to bring in more “warm bodies,” how to sell more dentistry, and how to utilize more staff to get more done. I never felt like these strategies were the answer to my production issues. I barely became more efficient, and I never became more effective as I just ran myself down. 

In my books, I have written about my issues with stress, which I believe eventually initiated adult-onset diabetes. Through it all, I continued my quest to be productive. In those years I truly learned to become more effective rather than more efficient. Reading Stephen Covey’s First Things First was extremely helpful to prioritize my work and life. But I found that was only part of the solution. The real problem for me was not managing my time. It was managing my energy.  

Diabetes became my blessing and my curse.

In my quest to control high blood sugar and the fatigue that comes with it, I found more energy. I found more mental and emotional clarity as well. A fog was lifted. My diabetes forced me to eat better and to exercise.  

I remember listening to some of Anthony Robbin’s tapes in which he tells the story of living in a small apartment in southern California, being extremely overweight and feeling like a loser. The first thing he did was to exercise. I did too. Slowly at first, I began to run. I built up my time and distance. Now, twenty-five years later, my routine includes six hours per week in the gym, running and lifting and six hours per week doing hot Yoga. The results have been nothing short of amazing. My diabetes is under control, I lost weight, I multiplied my energy level and mental clarity went way beyond what I expected. 

My moods improved, I enjoyed my work more, patient behaviors didn’t get to me as much, my work improved, I learned new techniques and took more continuing education, and most importantly, I had the energy to have a life outside of work.