Dr Stevenson I really likes the way you explain . Really appreciate. The burs you mentioned and Instrument that you used in this video who sells those . Pleased advise . Thanks
Hi Doc, it's for a long term seal. All of the caries research, particularly from Maltz, Mertz-Fairhurst and others recommend a GI or RMGI liner to seal the caries - not a resin. In deeper carious lesions, where the pulp is perhaps involved or nearly involved, MTA is used, then secured in place with an RMGI (check out the study by Hilton et. al. a Prospective Clinical Trial on MTA vs Dycal). For shallow lesions, I go straight to resin. So, to summarize: 1. Shallow preps: DBA, 2. Deeper preps: RMGI, then DBA, and 3. Very deep preps/Indirect pulp caps: MTA, RMGI then DBA. Best to you Doc.
@@StevensonDentalSolutions I was taught in Dental school that in deep cavities we can leave some Caries and directly apply composite over it without the use of any liner, the reason was that well-done composite will achieve complete peripheral seal that suffocate the remaining bacteria and hence arrest the Caries process .?
Seal is achieved if the composite is exquisitely placed under optimal conditions, however, but the pulp won't be happy - composite releases HEMA and other molecules proven to be harmful to undifferentiated fibroblasts. The evidence from prospective clinical trials is very strong to advocate MTA with near or actual pulp exposures followed by RMGI.
Many times I struggle with healthy DEJ, mainly because after removing caries it looks hard and healthy with the explorer, but then I use caries detector and colours it. Could you please give any advice when to trust caries detector and when it lies?
Caries detectors are poor with respective to the tendency for high false positives as they stain for more than just bacteria (decay) and yet are great for almost always staining caries when it exists. If you rely only on the caries detector, you will find the actual caries but will also get a positive stain for areas that shouldn't be excavated at all. Caries Detectors 's are good to teach us where caries tend to hide (under cusps and along the dej), but might be overkill and lead to excessive removal of tooth structure. The KEY to successful caries removal is tactile feedback. Essentially, remove all stains along the D.E.J. and then carefully test the entire periphery with a sharp explorer. NOTE: The WREB examiners are well calibrated on this and use the tactile test on exams. Best to you!
I want to ask u about deep margins. 1) Can I cut gingiva using slow speed round bur? 2) Do I need to add composite to elevate the margin for onlay or can it be placed directly there?
Typically I use rubber dam and retract the tissue with the dam, however, surgery is sometimes required. I would not typically place a margin on dentin for a bonded inlay or onlay because access is compromised - so in these cases a Margin Elevation Procedure makes sense. In the MEP, since a small area is being treated you may focus on this area only and achieve isolation with a matrix band. I use GI for this, but several others use composite. Neither is ideal, but at least the margin will be in a more accessible area.
@@StevensonDentalSolutions Excellent, very clear. One thing more: If some of my margin is composite as we said, how will i treat this area before bonding the onlay?
Thank you so much por sharing that information doctor! as a bachelor I find this very helpful :3 Btw I have a question about the LOW SPEED part, is that with a special handpiece? because I don't know how to input 500 to 1000 rpm in my low speed handpiece 😢, thank you for your time! and best wishes from Latin America, Perú 🇵🇪!
Hello doc , if an adult patient permanent molar tooth was treated with silver diamine fluoride before, and now the tooth looks stained. Will an indirect inlay/onlay ceramic still be a good treatment option? Will there be bonding issues? Or not indicated? Thank you
Yes, gold may be used as well with less enamel removal. To me, the premature loss of enamel that is most upsetting is from the patient’s untreated erosion and wear that necessitated this treatment.
Hi, very good question!. Although the "biomimetic" technique you mention is popular, there are very few long term (over 10 years) prospective clinical trials to support it. The use a RMGI provides for a well-documented (numerous decade-plus long clinical trials) approach to support its use as a liner. I believe that innovation is critical, but clinical dentistry should evolve based on evidence and support in order to make changes to proven protocols. However, I have concluded long ago that it is the enamel peripheral seal that makes everything work so well in the final analysis, so just about any technique will work in this regard. Thank you for your comment!
Few can do this well, but there are masters out there if one knows where to look - like the American Academy of Restorative Dentistry - they are an elite group of clinicians. The American Academy of Esthetic Dentistry is another. Many of the Biomimetic dentists have good training and can help. The first question I would ask a prospective dentist is:" Do you use a rubber dam for nearly all of your restorative procedures? " If the answer is "absolutely!", then you have a good idea that you are dealing with an excellence-oriented clinician.
doctor stevenson good day i am really having troubles preparing the proximal box , specially due to no face to face classes , i have atypodont mount and i am practicing my dental ergonomics but my problem is we are only using slow speed handpieces . is there a specific bur that we can use on slowspeed that can help us in imitating the results that a hispeed handpiece burs can create on proximal box preparations? thanks in advance
Absolutely! Far more biocompatible than (pulpally toxic) composites, and have a true chemical bond to tooth structure. May I suggest some clinically relevant literature for you to educate yourself with? Happy to help those who don't know what they don't know. Thank you for expressing your confusion!
I know I didn't ask the original question, but would appreciate if you would point me towards the clinically relevant articles. Always looking to learn more about dental materials. Thank you
Thanks a million for exerting this great effort to educate us . I learned a lot from your videos.
Thank you .
It is my pleasure!
Merry Christmas Dr stevenson and thank u so much for your effort
My pleasure! Happy Holidays.
Wishing you a Merry christmas and Happy new year!! Thank you once again for your teaching and knowledge ☺
Happy Holidays to you as well!
you are just an honest artist...
Thank you - appreciate your comment! Dr. S
Wishing you a merry Christmas and a happy New year ❤❤❤
You are the best ever
Thank you Mohammed! Happy Holidays. Dr. S
Sir, so much benifitted from your vidios. Love from Bangladesh
Happy holidays, Dr. Stevenson!
Thank you Doc - all the best.
Keep going we're waiting for the next step 😍👍👍
I'm happy to keep it going Doc!
Dr Stevenson I really likes the way you explain . Really appreciate. The burs you mentioned and Instrument that you used in this video who sells those . Pleased advise . Thanks
Thanks - everything is available from our website: stevensondentalsolutions.com/product-category/dental-burs/
Lovely as always doc .. One question please , what is the purpose of liner ?
Hi Doc, it's for a long term seal. All of the caries research, particularly from Maltz, Mertz-Fairhurst and others recommend a GI or RMGI liner to seal the caries - not a resin. In deeper carious lesions, where the pulp is perhaps involved or nearly involved, MTA is used, then secured in place with an RMGI (check out the study by Hilton et. al. a Prospective Clinical Trial on MTA vs Dycal). For shallow lesions, I go straight to resin. So, to summarize: 1. Shallow preps: DBA, 2. Deeper preps: RMGI, then DBA, and 3. Very deep preps/Indirect pulp caps: MTA, RMGI then DBA. Best to you Doc.
@@StevensonDentalSolutions I was taught in Dental school that in deep cavities we can leave some Caries and directly apply composite over it without the use of any liner, the reason was that well-done composite will achieve complete peripheral seal that suffocate the remaining bacteria and hence arrest the Caries process .?
Seal is achieved if the composite is exquisitely placed under optimal conditions, however, but the pulp won't be happy - composite releases HEMA and other molecules proven to be harmful to undifferentiated fibroblasts. The evidence from prospective clinical trials is very strong to advocate MTA with near or actual pulp exposures followed by RMGI.
Stevenson Dental Solutions Great info, thanks for the effort Dr Stevenson.
Thank you Omar!
I love your work 😍❤️
Thank you Doc - wishing you the best, Dr. S
Great
Many times I struggle with healthy DEJ, mainly because after removing caries it looks hard and healthy with the explorer, but then I use caries detector and colours it. Could you please give any advice when to trust caries detector and when it lies?
Caries detectors are poor with respective to the tendency for high false positives as they stain for more than just bacteria (decay) and yet are great for almost always staining caries when it exists. If you rely only on the caries detector, you will find the actual caries but will also get a positive stain for areas that shouldn't be excavated at all. Caries Detectors 's are good to teach us where caries tend to hide (under cusps and along the dej), but might be overkill and lead to excessive removal of tooth structure. The KEY to successful caries removal is tactile feedback. Essentially, remove all stains along the D.E.J. and then carefully test the entire periphery with a sharp explorer. NOTE: The WREB examiners are well calibrated on this and use the tactile test on exams. Best to you!
Gettin this done Monday. Any pain or any drugs being issued besides the shot to numb?
Tylenol or Advil usually for the soreness - no pain would be expected.
I want to ask u about deep margins.
1) Can I cut gingiva using slow speed round bur?
2) Do I need to add composite to elevate the margin for onlay or can it be placed directly there?
Typically I use rubber dam and retract the tissue with the dam, however, surgery is sometimes required. I would not typically place a margin on dentin for a bonded inlay or onlay because access is compromised - so in these cases a Margin Elevation Procedure makes sense. In the MEP, since a small area is being treated you may focus on this area only and achieve isolation with a matrix band. I use GI for this, but several others use composite. Neither is ideal, but at least the margin will be in a more accessible area.
@@StevensonDentalSolutions Excellent, very clear. One thing more: If some of my margin is composite as we said, how will i treat this area before bonding the onlay?
Thank you so much por sharing that information doctor! as a bachelor I find this very helpful :3
Btw I have a question about the LOW SPEED part, is that with a special handpiece? because I don't know how to input 500 to 1000 rpm in my low speed handpiece 😢, thank you for your time! and best wishes from Latin America, Perú 🇵🇪!
Hi Doc, the special handpiece is the low speed motor with the friction grip attachment - simply use your pedal control for the lower speeds.
Hello doc , if an adult patient permanent molar tooth was treated with silver diamine fluoride before, and now the tooth looks stained. Will an indirect inlay/onlay ceramic still be a good treatment option? Will there be bonding issues? Or not indicated? Thank you
I won't be an issue - clean the area with air-abrasion or cover with RMGI, then build up to ideal contour and prep ideally.
Very sad to see this enamel going...is this the best treatment?
Yes, gold may be used as well with less enamel removal. To me, the premature loss of enamel that is most upsetting is from the patient’s untreated erosion and wear that necessitated this treatment.
Can we use dycal instead of rmcis?
I would travel to you to get all gold inlay and onlays I’m over getting fillings I want permenane solution
We are happy to have you travel to us!
Thanks to sharing
But why do IDS with flowable Composite instead of GIC ... all recents protocols used composite for block out step
Regard
Hi, very good question!. Although the "biomimetic" technique you mention is popular, there are very few long term (over 10 years) prospective clinical trials to support it. The use a RMGI provides for a well-documented (numerous decade-plus long clinical trials) approach to support its use as a liner. I believe that innovation is critical, but clinical dentistry should evolve based on evidence and support in order to make changes to proven protocols. However, I have concluded long ago that it is the enamel peripheral seal that makes everything work so well in the final analysis, so just about any technique will work in this regard. Thank you for your comment!
Stevenson Dental Solutions thanks dr to sharing your knowledge
Best regard
Thank you Doctor - appreciate your support and comments.
I wonder how many dentist can do this properly, I’m sorry but I bet not many. Have anyone had and onlay with success? Comfortable and lasting success?
Few can do this well, but there are masters out there if one knows where to look - like the American Academy of Restorative Dentistry - they are an elite group of clinicians. The American Academy of Esthetic Dentistry is another. Many of the Biomimetic dentists have good training and can help. The first question I would ask a prospective dentist is:" Do you use a rubber dam for nearly all of your restorative procedures? " If the answer is "absolutely!", then you have a good idea that you are dealing with an excellence-oriented clinician.
doctor stevenson good day i am really having troubles preparing the proximal box , specially due to no face to face classes , i have atypodont mount and i am practicing my dental ergonomics but my problem is we are only using slow speed handpieces . is there a specific bur that we can use on slowspeed that can help us in imitating the results that a hispeed handpiece burs can create on proximal box preparations? thanks in advance
Use a 555D (a diamond shaped like a 55 bur.
@@StevensonDentalSolutions Thankyou doctor Stevenson
como se llama la palanquita que utilizan para romper paredes proximales?
10-6-14 enamel hatchet.
damn you still use gic liners?
Absolutely! Far more biocompatible than (pulpally toxic) composites, and have a true chemical bond to tooth structure. May I suggest some clinically relevant literature for you to educate yourself with? Happy to help those who don't know what they don't know. Thank you for expressing your confusion!
I know I didn't ask the original question, but would appreciate if you would point me towards the clinically relevant articles. Always looking to learn more about dental materials. Thank you
А чего без воды?
It is an extracted tooth. I turn off water to make it easier to see the details.
Gh