A lower molar with a new crown, a growing periapical radiolucency, and furcation bone loss can feel like a coin flip: saveable infection or a hidden vertical root fracture? We talk through a real case and the exact decision-making that turns uncertainty into a plan, starting with access design that lets us inspect the pulpal floor and internal walls where fractures often show themselves.

From there, we get practical about root canal disinfection. We break down an irrigation protocol built around sodium hypochlorite, EDTA, and ultrasonic irrigation activation with EndoUltra, including why ultrasonic energy behaves differently than sonic systems and why you can still transmit cleaning energy to the apex even when the tip is a few millimeters short. We also explain the “pressure washer vs garden hose” analogy and why activation time, fresh irrigant replenishment, and tip movement matter for cleaning isthmuses, fins, and apical microanatomy.

Then we add the missing piece: measurement. We walk through ATP-based indicator scoring (EndoScore), how the swab and tube workflow fits into the final rinse, and how we use the number to decide whether to obturate, re-irrigate and reactivate, or place calcium hydroxide for a second visit. We also tackle sealer puffs and extrusion near the inferior alveolar nerve, how bioactive sealer like Regen changes the risk conversation, and what one-year radiographic healing can look like when the canal system is genuinely clean.

If you’re looking to improve root canal outcomes with a repeatable, evidence-based endodontic irrigation and verification workflow, hit subscribe, share this with a colleague, and leave us a review with your go-to activation time and your target EndoScore.

Recurrent decay is the silent killer of a lot of “good” composite work, especially at the gingival floor of a Class II box where patients simply cannot keep things clean. Dr. Michael Miyasaki lays out a practical, repeatable bioactive dentistry workflow designed to boost restoration longevity by improving isolation, controlling bleeding, and building a stronger seal where failures usually start. If you’ve been looking for a clearer clinical playbook for deep direct restorations, this is a step-by-step listen.

We start with field control that actually holds up under real conditions: rubber dam isolation, then predictable hemostasis using Quickstat-Free, a clear aluminum chloride solution that helps stop bleeding without discoloring esthetic areas. From there, we move into the exact sequence for cleaning and etching with Clean and Boost, plus how and when we add Desensimax in deeper preparations to support comfort, antimicrobial protection, fluoride delivery, and long-term bond durability.

The core of the technique is bioactive restorative materials built around bioglass, including Regen Universal Adhesive and a Regen flowable composite liner used as a reservoir. We talk through why this “universal” adhesive is not self-etching, how the liner supports adaptation and margin sealing, and how deep curing with the PinkWave curing light fits into polymerization confidence. You’ll also hear practical handling tips like warming composite (including Exquisite) for better adaptation and using a wetting resin like Seam-Free for cleaner sculpting and contour.

Finally, we get into the decision-making that matters chairside: open sandwich vs closed sandwich, and the remin open sandwich technique that intentionally brings bioactive flowable up to demineralized contact areas to help prevent the next cavity. If this helps you think differently about margins, deep dentin, and adjacent tooth risk, subscribe, share the episode with a colleague, and leave a review so more clinicians can find the workflow.

A root canal can look flawless on a radiograph and still hurt like crazy. We dig into a real retreatment case where the “good” root canal is the one failing, and the only way forward is to stop guessing and start measuring what might still be living inside the canal system.

Dr. Ryan Walsh joins me to break down how he approaches access through an existing crown, gutta percha removal, patency confirmation with an apex locator, and why a quick ATP-based indicator test can change the plan. We talk through EndoScore basics, what the 1 to 100 scale is actually reflecting, and the practical thresholds that guide decision-making before obturation. When the first reading comes back high, we use calcium hydroxide and reassess, expecting the score to fall if the canal system is truly disinfected.

Then the twist: the score stays higher than it should, which pushes a deeper look at anatomy. By troughing the mesial groove, we uncover a mid-mesial canal, a common enough variation to matter and a sneaky enough space to keep bacteria protected. Once that canal is shaped and cleaned, the score drops dramatically, giving both clinical confidence and a clear, simple story to share with the patient.

If you want more predictable endodontics, better ways to explain persistent symptoms, and a practical framework for using objective data in root canal retreatment, listen through to the end. Subscribe, share this with a colleague, and leave a review with your biggest takeaway.

If you’ve ever placed a deep composite and wondered why one tooth stays comfortable while another turns sensitive, the answer is usually not the brand name on the syringe. It’s the technique stack: how clean the tooth really is, how you manage deep dentin, and how you place and cure composite so it seals instead of shrinking away.

We break down a practical, clinic-tested workflow for bioactive dentistry using bioglass-based materials, starting with contamination control. Handpiece turbine oil and other residues can land on the prep, so we talk through when a gentler cleanser-etchant approach like Clean and Boost makes sense near the pulp, and why it can support bond strength while being kinder to deep dentin. From there we move into composite warming, including the science behind lower viscosity, better adaptation, fewer voids, improved microleakage outcomes, and research pointing to higher conversion and deeper cure with less curing time.

Next, we get hands-on with placement details that save real chair time: using a composite wetting resin to stop sticking and pullback while sculpting, and how small step-down delivery tips help you place warmed composite precisely in tight areas. Finally, we walk through two deep decay cases, including a conservative direct restoration and a larger molar case that becomes an onlay, all with the goal of preserving tooth structure, reducing postoperative sensitivity, and lowering the risk of recurrent decay.

If you want more predictable adhesive dentistry and longer-lasting restorations, subscribe, share this with a colleague, and leave a review with your go-to deep margin protocol.

Most clinicians blame “sensitive composites” on bonding steps or patient factors, but we keep coming back to a simpler culprit: the cure. Dr. Michael Miyasaki walks us through how incomplete polymerization and polymerization shrinkage can create stress, gaps, and long-term restorative problems, even when the restoration looks fine on top. If you’ve ever wondered why a Class I or Class II composite feels great chairside and then comes back with postoperative sensitivity, this conversation gets specific about what to change.

We talk about the two big ways curing goes wrong: not delivering enough energy to fully cure the material, and shadowing that blocks light from reaching key walls and the gingival floor. We explain why keeping the curing light close matters, how light guide shape affects access to posterior teeth, and why beam collimation can be the difference between a confident cure and a guess. We also dig into modern photoinitiators and quad-wave wavelength technology, and how improved curing can reduce shrinkage, strengthen margins, cut marginal staining, and lower the risk of secondary decay.

Then we get hands-on with tools and techniques you can use right away: a transillumination diagnostic tip to help visualize cracks, a tight contact curing ball approach to reduce open contacts and food impaction in Class II restorations, and a small tacking tip workflow for crown cementation and veneers that stabilizes the restoration so cleanup and flossing are faster before the final cure. If you want restorations you can trust, start by upgrading your curing fundamentals.

Subscribe, share this with a colleague who fights sensitivity and open contacts, and leave a review with the curing light and curing time you’re using so we can compare notes.

Most restorations don’t fail because we “did a bad filling” they fail because biology keeps working at the margins. I’m Dr. Michael Miyosaki, and I’m sharing a practical, research-backed way to extend the life of direct composite restorations by making the tooth restoration interface more than a mechanical seal. When recurrent decay sneaks in at the gingival floor, it starts a familiar chain reaction: replacement fillings, larger preps, indirect restorations, endo, and eventually tooth loss. We can do better when we plan for biofilm and design for bioactivity.

We break down a predictable restorative workflow for large, deep Class II and cervical-type situations: margin control, smarter etching, sensitivity reduction, dependable curing, better composite adaptation, and a placement approach that protects the most vulnerable zones. Then we dig into the “secret sauce” behind mineral-enriched systems that use 45S5 bioglass, including why getting bioactive chemistry into dentin tubules before sealing can matter for long-term outcomes.

You’ll also hear why a nitric-acid cleanser and etchant can be gentler on dentin and soft tissue than phosphoric acid, how it can support stronger bonding, and what clinical research suggests about reduced postoperative sensitivity over time. We close with margin-protection evidence from lab cycling models and a real-world reminder of what happens when older, non-bioactive materials hit the 10 to 11 year mark. If you care about bioactive dentistry, recurrent decay prevention, postoperative sensitivity, and longer-lasting composites, this one’s for you.

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Cutting less can be the most advanced dentistry we do. Dr. Michael Miyasaki sits down with biomimetic pioneer Dr. David Alleman to challenge the привычный reflex of “big cavity equals crown” and to map a more conservative path that protects the pulp, preserves critical tooth structure, and keeps teeth functioning like teeth. If you’ve ever felt stuck in the restoration cycle, this conversation offers a framework to think differently and work more predictably.

We dig into the foundations of biomimetic restorative dentistry and adhesive dentistry: why the bottom half of the tooth below the height of contour is so important for stress distribution, how full crown preparations can remove the architecture that helps teeth flex, and why the first mission is often preventing endodontics rather than planning around it. Dr. Alleman also explains why materials alone don’t save cases. The results come from isolation, magnification, caries and crack management, immediate dentin sealing, and a disciplined protocol that doesn’t skip the steps that protect the seal.

Then we get practical with fiber reinforcement and Ribbond. We talk about moving beyond routine posts, how bonded fiber and composite can reduce catastrophic root fractures, where anterior fiber bridges can shine in real-world emergencies, and why posterior bridges face occlusal forces that can make them a bad bet. You’ll also hear a clear walkthrough for a heavily restored molar with an old amalgam and visible cracks, including the patient questions that guide risk assessment and timing.

If you care about minimally invasive dentistry, predictable bonding, and restorations built for longevity, hit play. Subscribe, share this with a colleague who’s tired of redo dentistry, and leave a review with the most conservative change you want to make next.

You can place a perfect filling and still lose the tooth later. That’s the uncomfortable truth Dr. Michael Miyasaki wrestles with after nearly 40 years in dentistry, and it’s why he’s built a practical framework he calls Dentistry 2.0: care that starts before the hole, not after it shows up on an X-ray.

We talk through the real problem behind so many repeat procedures: the disease environment doesn’t change just because a restoration looks good. Mature biofilm at the gum line and between teeth can quietly push inflammation, bone loss, halitosis, and recurrent decay. Dr. Miyasaki explains how modern intraoral imaging with biofluorescence makes that risk visible so patients can finally see what we mean and participate in the fix. From there, the focus shifts to ongoing biofilm management using targeted home care like Perioprotect trays with a low-concentration hydrogen peroxide gel, plus strengthening vulnerable enamel with remineralization support in high-risk areas.

When restoration is truly needed, Dentistry 2.0 doesn’t stop at “fill the space.” We dig into protective restorative dentistry, including bioactive materials designed to neutralize acidity at restoration margins, why complete curing and polymerization matter for longevity, and how reinforcement strategies can sometimes help preserve tooth structure before automatically escalating to crowns. The throughline is simple: detect earlier, educate better, modify the cause, and help teeth last longer as lifespans increase.

If you’re a clinician looking to differentiate your dental practice beyond price, or a patient who wants fewer surprises, press play. Subscribe, share this with a friend who cares about preventive dentistry, and leave a review with your biggest question about keeping teeth healthy long term.