Dentist2Dentist

Dr. Micheal Miyasaki

Join Dr. Mike Miyasaki as he talks dentist to dentist about the trends, products, and clinical applications in dentistry today. 

  1. 2d ago

    Root Canal Through Zirconia: Using ATP Testing to Verify Before Obturation

    A root canal can look finished on a radiograph and still be biologically “dirty” enough to cause problems later, especially when you’re treating through a zirconia crown or zirconia bridge you’re trying to preserve. Dr. Michael Miyasaki breaks down how he uses ATP testing as a final reality check before obturation, so the decision to fill is based on measurable cleanliness rather than gut feel. We start with the real-world challenge: gaining access through zirconia safely with the right bur and copious water, then building a predictable endodontic workflow from diagnosis and isolation through working length, glide path, shaping, and finishing. From there, we zoom in on what actually disinfects the canal system: irrigation. You’ll hear the “why” behind sodium hypochlorite, EDTA smear layer removal, and the difference ultrasonic activation makes when you’re trying to clean lateral anatomy you’ll never touch with files. Then we get practical with the ATP sampling method and EndoScore thresholds, including what to do when the score comes back high. We talk troubleshooting isolation, missed canals, bleeding from working length errors, insufficient shaping, and when calcium hydroxide plus a second visit is the smarter move. Finally, we share a step-by-step recipe for sealing the access through zirconia using zirconia cleanser and primer, a universal adhesive, proper curing depth, and composite layering that can blend cleanly with the restoration. If you want more clinical workflows like this, subscribe, share this episode with a colleague, and leave a review with your go-to EndoScore target.

  2. Oct 28

    Leadership of You, End 2026 Strong

    The economy feels shaky, costs are up, and insurance reimbursements are not getting any kinder. That’s exactly when most dental practices get tempted to play defense and cut their way to safety. I take the opposite view. If you want to lead your practice through uncertainty, you cannot save yourself out of a downturn, you have to build your way through it with smarter systems, stronger skills, and clearer marketing. I walk through a simple year-end framework: pick three things to finish 2026 strong, then map the steps, the deadline, and the person responsible so it actually happens. From there, we get tactical about ethical dental practice growth with “skill stacking” by adding services patients are actively seeking such as dental implants, clear aligners, endodontics, aesthetics, airway and TMD care, and minimally invasive preventive dentistry. The goal is to raise patient value by offering real solutions, not by drifting into gray areas just to hit production. We also dig into the operational side that makes growth sustainable: SOPs, team training, and delegation that reduces bottlenecks and improves the patient experience. I share how we think about first visits, photos and radiographs, educating patients on options, and using reviews, referrals, and consistent content marketing to keep new patient flow steady. If you want a more resilient dental practice heading into 2027, listen through, take notes, and choose one change you’ll implement this month. Subscribe, share this with a colleague, and leave a review with your biggest takeaway.

  3. Oct 14

    Getting A Clean Root Canal With EndoUltra And Endocator Scoring

    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.

  4. Sep 30

    How to up your Bioactivity Game with the Correct Techniquem Part II

    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.

    How to up your Bioactivity Game with the Correct Techniquem Part II
  5. Sep 23

    Finding the Missed Root Canal: An Endocator® Case Review with Dr. Ryan Walsh and Dr. Mike Miyasaki

    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.

    Finding the Missed Root Canal: An Endocator® Case Review with Dr. Ryan Walsh and Dr. Mike Miyasaki
  6. Sep 16

    How to up your Bioactivity Game with the Correct Technique

    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.

    How to up your Bioactivity Game with the Correct Technique
  7. Sep 9

    Up Your Bioactivity With Proper Curing Tools

    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.

    Up Your Bioactivity With Proper Curing Tools
  8. Sep 8

    Boost Bioactivity to Prevent Recurrent Decay

    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.  Subscribe for the next techniques, share this with a colleague, and leave a review so more clinicians can find the protocol.

    Boost Bioactivity to Prevent Recurrent Decay

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Join Dr. Mike Miyasaki as he talks dentist to dentist about the trends, products, and clinical applications in dentistry today.