I am very impressed with your attention to detail. The idea of placing a separate composite restoration gingival to the final one would have never have occurred to me.
I love watching these videos so thorough and this type of dentistry is so intentional I’m fascinated.I’ll have to become a dentist to afford all the work in need done in bone in biomimetic dentistry but doesn’t stop me from enjoying this level of work 😂
Thanks for sharing Dr Nejad. This is a very interesting concept. If you DME for onlay, aren’t you worried about onlay bonding to composite margin? Traditionally we were taught to bond indirects to natural tooth only..
Not at all. That is an outdated paradigm. This has been a common practice since I was in dental school in 2010. If you are interested, check out my Level I course. The link is in the description and I cover this in detail! Thank you
What if the seal is good enough for isolation but not absolutely micrometer-perfect, so you still have to finish the margins with a bur or disc? I find that it is difficult to polish the margin with the rubber dam on (low visibility) and if I manage to do it, the rubber dam gets damaged and needs to be replaced before I can continue (which is annoying). How do you do it?
I am sure that is what happens when you do it but that’s not the universal truth. I have cases at 9 and 10 years now and there are hundreds of thousands of restorations like this which have not washed out.
Thanks for this great educational content! How can crown lengthening be eliminated as a treatment when the preparation violated the biological width? How can DME stop the bone resorption from that violation?
Thank you. The biologic width seems to re-establish over several years in most cases but I have seen some instances where things stay as restored. My opinion is that isolated deep margins are well tolerated when there is optimal adhesion and marginal seal. If these conditions are met, a natural remodeling process can occur with good conditions for success. Remember that biologic width is an average and can vary from person to person.
@@BiomimeticDentistry You are my HERO and I hope to emulate your clinical excellence and minimally invasive approach one day. Thanks for your response. While optimal seal and adhesion are critical, if there is an invasion of the biologic width component, the bone will resorb to accommodate that space necessary space. Biologic width is an average, and while we cannot measure it clinically, in the presented case in our video, that was a clear invasion of the BW. Please see this recent article : PMID: 35323250- "For the time being, DME should be applied with caution respecting three criteria: capability of field isolation, the perfect seal of the cervical margin provided by the matrix, and no invasion of the connective compartment of biological width."
Thank you. However, after 5-10 years of follow up on my own cases. I have observed the following: no biologic width reaction, healthy pocket depths, healthy tissue, and a successfull, asymptomatic result. That leaves the question: "What is the problem?" and "Why is a more invasive approach recommended?"
Thanks doctor Matt ! , I think that deep margins of upper molars are almost always concave ! is the band in band that you mentioned is enough to manage that ? (with Teflon in between) ...in this case the elevated margin will also become concave , right ? how to manage that and smoothly transition into a convex proximal wall
Is there any way to use glass ionomer or amalgam for deep margin elevation if you are worried that you cant keep the tooth isolated? Also is this technique indicated for a zirconia crown or is it exclusively for a ceramic that can be bonded? thank you
This is all of highly bonded adhesive restorations. Definitely not amalgam or GI as a base. That would definitely lead to problems. The whole concept of not terminating margins on existing restorations applies to GI and Amalgam, but not adhesively bonded restorations placed with optimal conditions/materials/ and technique. Best- MN
Hello. I think the cases I showed demonstrate that but the thing is that the technique, materials, isolation are all very important. How well the procedure is performed determines how well it is tolerated and that is the hardest thing for people to grasp. Best- MN
I am very impressed with your attention to detail. The idea of placing a separate composite restoration gingival to the final one would have never have occurred to me.
Thank you very much!
Thank’s for effort and educational content
I love watching these videos so thorough and this type of dentistry is so intentional I’m fascinated.I’ll have to become a dentist to afford all the work in need done in bone in biomimetic dentistry but doesn’t stop me from enjoying this level of work 😂
Thank you 🙏🏼 ❤️
Superb technique, but wondering why not use laser to take away the soft tissue and try margin elevation.
Good job doctor Thanks
The music were kind of loud other than that its all good
Extremely nice and informative presentation.
Thank you 🙌
Thank you for your work!!!
My pleasure!
Thanks for sharing Dr Nejad. This is a very interesting concept. If you DME for onlay, aren’t you worried about onlay bonding to composite margin? Traditionally we were taught to bond indirects to natural tooth only..
Not at all. That is an outdated paradigm. This has been a common practice since I was in dental school in 2010. If you are interested, check out my Level I course. The link is in the description and I cover this in detail! Thank you
❤❤excellent lecture 👌
What if the seal is good enough for isolation but not absolutely micrometer-perfect, so you still have to finish the margins with a bur or disc? I find that it is difficult to polish the margin with the rubber dam on (low visibility) and if I manage to do it, the rubber dam gets damaged and needs to be replaced before I can continue (which is annoying). How do you do it?
Great video, but I have a question. How you can control bleeding when you remove the first matrix after DME?
Thank you
Thank you very much
Place your indirect restoration on top of a subgingival composite and watch it wash out.
I am sure that is what happens when you do it but that’s not the universal truth. I have cases at 9 and 10 years now and there are hundreds of thousands of restorations like this which have not washed out.
Here:
instagram.com/p/C2kheVYBEmd/?igsh=ZWMyNDBlOTQyNg==
instagram.com/p/C1uekJ5IY4n/?igsh=ZWMyNDBlOTQyNg==
instagram.com/p/C1UpYy6NabX/?igsh=ZWMyNDBlOTQyNg==
Thanks for this great educational content!
How can crown lengthening be eliminated as a treatment when the preparation violated the biological width? How can DME stop the bone resorption from that violation?
Thank you. The biologic width seems to re-establish over several years in most cases but I have seen some instances where things stay as restored. My opinion is that isolated deep margins are well tolerated when there is optimal adhesion and marginal seal. If these conditions are met, a natural remodeling process can occur with good conditions for success. Remember that biologic width is an average and can vary from person to person.
@@BiomimeticDentistry You are my HERO and I hope to emulate your clinical excellence and minimally invasive approach one day.
Thanks for your response. While optimal seal and adhesion are critical, if there is an invasion of the biologic width component, the bone will resorb to accommodate that space necessary space. Biologic width is an average, and while we cannot measure it clinically, in the presented case in our video, that was a clear invasion of the BW. Please see this recent article : PMID: 35323250- "For the time being, DME should be applied with caution respecting three criteria: capability of field isolation, the perfect seal of the cervical margin provided by the matrix, and no invasion of the connective compartment of biological width."
Thank you. However, after 5-10 years of follow up on my own cases. I have observed the following: no biologic width reaction, healthy pocket depths, healthy tissue, and a successfull, asymptomatic result. That leaves the question: "What is the problem?" and "Why is a more invasive approach recommended?"
Thanks doctor Matt ! , I think that deep margins of upper molars are almost always concave ! is the band in band that you mentioned is enough to manage that ? (with Teflon in between) ...in this case the elevated margin will also become concave , right ? how to manage that and smoothly transition into a convex proximal wall
With good judgement and practice, that is very achievable but it does time to get comfortable with that.
Is there any way to use glass ionomer or amalgam for deep margin elevation if you are worried that you cant keep the tooth isolated? Also is this technique indicated for a zirconia crown or is it exclusively for a ceramic that can be bonded? thank you
This is all of highly bonded adhesive restorations. Definitely not amalgam or GI as a base. That would definitely lead to problems. The whole concept of not terminating margins on existing restorations applies to GI and Amalgam, but not adhesively bonded restorations placed with optimal conditions/materials/ and technique. Best- MN
Great, thank you for the response!
Where can i find a biomimetic dentist in Florida
The Music is distracting. It makes it difficult to concentrate on the techniques and information.
Hello Sir, if the carious lesion is deep and violates the biological width, then can we go for deep margin elevation?
Hello. I think the cases I showed demonstrate that but the thing is that the technique, materials, isolation are all very important. How well the procedure is performed determines how well it is tolerated and that is the hardest thing for people to grasp. Best- MN
❤❤❤
This is silly....can be everything but not deep margin.....shallow margin it os