Cleaning up cement may very well be the most stressful thing that I do. Someone needs to build a better mousetrap, but it just isn't happening. Sure, there are instruments of all kinds to address the problem, but do any really work well? They are mostly reactive instruments. Saws to open contacts after the contact is already bonded closed, scalers to pry rock like masses of material from subgingival crevasses and reciprocating handpieces to sand down the craggy remnants that just won't give up their grip.

Most definitely the cements themselves have changed. They have extended gel stages and easier cleanup, but when I am struggling with the mesial contact the distal contact welds itself shut. It's great that the major manufacturers are giving it the old college try, but little real progress has been made.

Using a separating agent, like BlueSep from Parkell, seems to work well, but get just a tiny bit of it on the intaglio of the restoration and it will turn you into an insomniac. Face it, do you really think you can go to bed at night and actually sleep while millions of bacteria are traveling on the superhighway you built for them under your restoration?

If you were hoping that this paragraph was going to provide the answer to this conundrum, well sorry, I just don't have a perfect answer. I have, however, gone back to something that I hate to do; I have been packing the dreaded cord. It allows me to pull out gelled cement faster, and prevents it from getting subgingival in the first place.

So, in addition to my extensive isolation and rigorous bonding protocol, I pack cord at some point in the procedure depending upon the situation. If I need it for imaging I pack two cords and pull one before powdering. If it's not necessary for imaging, I pack it sometime before cementation. Then at just the right moment, I pull it and it helps to clean out the interproximals very well.

One more thing - something that I also have found helpful is just before cementation, I pop in an occlusal guard. No, not in the patient's mouth. In my own mouth. As I said, cleaning up cement is the most stressful part of my day. Limiting my clenching is really helping me out.

I was just joking about the guard, but I wasn't joking about the cord. It does help. It's not the cure-all end-all; we are all still looking for that. But right now, it helps me a great deal.