Dear Dr Stevenson, I love the idea of having enamel hatchets for clearing contact points and cleaning up the proximal box. But here in Scotland we don’t use them and instead clear them using burs which to me is just asking for iatrogenic damage. I was wondering if you could do one prep video where you do it using a handpiece and particularly that stage of the prep so I can see a way of helping to minimise damage.
Composite has more rounded internal line angles, may have flared exit angles and is typically smaller in width and depth, however, not always, as the prep outline is determined by caries.
Its really a beautiful and informative demonstration of class 2 composite. Thanks a lot Dr Stevenson, but I would like to ask one question. Some school asks for bevel on facial and lingual walls of proximal box. Can you please tell me whats the best method to do same please? Thanks and regards.
Thank you Doctor for this tutorial. In reality, when caries is shallow but includes proximal area, do we prepare box for composite restoration or only extend enough to remove carious area? Why do we need proximal box and gingival clearance when composite provides micro mechanical retention and preserve tooth structure? Thank you in advance
You need to break contact in order to: 1. visualize caries removal at the enamel margins, 2. facilitate matrix placement, 3. confirm adaptation and seal of the composite, 4. allow for finishing of the composite and inspection for voids. Small lesions (E1 and E2) without cavitation don't require surgical intervention. The philosophy is this: if it's small and uncavitated, it requires a pharmacological approach, not surgical, however if it is cavitated, and you must drill, then do it thoroughly.
Hello Dr. Stevenson, all of these bur uses are amazing, but I've started to noticed that small diamond high speed burs are quite common among restorative dentistry community to remove caries. I was wondering if maybe you could do a Class I/II restoration of premolars or molars of your choice? I've used them in clinic and I find that more review with this bur usage will help others. It's quite unique in that because it's a round bur, you can actually angle the bur so that it's not "perpendicular" to the occlusal plane when using say a 330 carbide bur. This would potentially increase vision when approaching occlusal surfaces of the upper arch and help with suctioning in real patients!!!
It really may not matter much, but traditional convergent walls will add to the retention of the composite and might be of importance when minimal enamel remains.
@@StevensonDentalSolutions thank you, Do you have any videos on chair position? I've been having a difficult time seeing into the box on MO preparations
Thank you so much for the wonderful prep. Doc, can you please make a video of #20 DO for amalgam. While I am trying to make the facial exit angle, it's flaring up and I am ending up with obtuse exit angle. If I am trying to avoid that, I could barely get any facial clearance and having an acute exit angle.Appreciate if you can help.
If you are my professor I'd never miss your class. The lecturer we have in my college is too busy and don't teach us properly. What a waste of years, money and time.
Thanks for the high quality videos doc. Is there any alternative to the 330RGS for smoothing the pulpal wall in composite preps? What did you use before it was developed?
With all due respect, are we not supposed to bevel the cavo-surface line angels for composite restorations? I have been taught in my dental school in India to do so and I have been following it all my life. The rationale, to prevent micro leakage caused by the eventual disintegration of bonding agent. Please correct me if I'm wrong.
Hi, bevelling composites serve two main purposes: they increase the bond strength/retention of the final restoration due to the enamel rod configuration which results after beveling, and they help blend the composite more seamlessly for esthetic cases (large facial class III and IV, and Vs on the enamel wall only) Using bevels for other classes, like class II's is a double edge sword - the bevel may increase the seal, but flowing the composite into the proximal acute area created by the bevel is unpredictable, and often results in voids. Bonding to enamel will not disintegrate - it is the strongest bond we have so the rationale isn't quite correct. We never bevel any areas that will be in function, as the thin composite will be subject to fracture over time. With most class I, II and III preparations, retention is not an issue and bevels are usually avoided to facilitate better filling of the cavity. Thank you for the question!
For the adex exam, how far mesiodistally do you extend the box before asking for a mod? The manual says 1.5mm past the DEJ bht that would be 2.5mm (really big) before asking for a mod. Are we better off asking for a mod at 1.5mm (0.5mm into dentin) or will we be docked for asking for a mod before meeting the maximums
Great question. THe best approach is the following: 1. Prep to ideal in all respects. 2. Extend only those areas that need to be extended to remove caries (first outline, then internal with slow speed and round burs). Make these extensions close to the max but not quite...and 3. Ask for further mods in 0.5 mm increments. If you do 1 and 2 properly, you'll have little to ask for in step 3. Sometimes nothing. Yes, it is entirely possible to ace this prep with no interaction at all with the floor examiner. The team at CDCA understands that these teeth are tricky. They want you to leave stain and only remove that which has explorer "tug back".
why you made a conventional old design for class 2 composite ? I mean this design is indicated for amalgam ... thanks in advance to your amazing videos .. I learned alot from it
The WREB exam demands this - it's not a true class II amalgam either - the extensions are less, line angles are not sharp, the depth is less and there are no retention grooves. Thank you!
Dr. Stevenson, can you let me know what was the cavity depth of proximal box both facially and lingually? Because the mandibular premolar has a lingually inclined occlusal table, should the gingival seat follow the same or if it should be flat what is the minimum depth at proximal box(lingually) in this case? Thank you
The box dimensions are not absolute. They are determined by the contact size and the need to remove caries and break contact. The gingival seat (better nomenclature = gingival wall) has no relation to the pulpal wall or the plane of the occlusal table, but is determined by the need to break the gingival contact in a uniform fashion. The pulpal wall is always (ALWAYS) parallel to the occlusal table for all teeth.
The same as amalgam prep but with more conservation and rounded line angles but with occlusal divergance Not occlusal convergence . Is that correct ? Or there is also occlusal convergence ?
First of all, the enamel and DEJ must be pristine, then soft to the explorer peripheral dentin caries is best to be removed. From this point on, it's a much harder call but essentially, remove what won't expose the pulp, and leave hard stained dentin. Thank you Doc!
Either - the issue with too slow is the need to use more pressure - the issue with too fast is the speed at which tooth structure us removed. The speed may be modulated with the foot pedal to a certain extent.
Thank you. While doing DO Class2 on mandibular 1st molar, i avoid extending into distobuccal groove as it increases my isthmus width. Is it ok to not extend into distobuccal groove(between distobuccal and distal cusp).?
@@afsanashaikh5571 Break contact on the buccal and lingual and use an obtuse angle with a thin bur - almost a saucer shape - this will expose a lot of enamel for bonding.
@@StevensonDentalSolutions thank u so much sir for replying and clearing my doubts ...and which matrix system do we need to use...as IAM in rural area I use the old tofflemier and straight matrix band
@@afsanashaikh5571 It would be best to use a sectional matrix, biting ring and wedge system - there are many available online - some are quite affordable.
The "S" curve is simply a smoothing of the outline from the occlusal to the box - it increases the resistance form of the restoration. It occurs anywhere that a sharp edge needs refinement.
Dr. Stevenson, you are the Bob Ross of dentists! Your videos are always super informative, clear, and relaxing. Thank you for making this video!
Wow - thank you!
I passed my WREBS but really wished I saw this video beforehand... Great video doc.
Love it! Your videos are extremely helpful. Would love to see a video on occlusal adjustments on porcelain restorations.
Yes - will do! Thank you Jennifer.
Dear Dr Stevenson, I love the idea of having enamel hatchets for clearing contact points and cleaning up the proximal box. But here in Scotland we don’t use them and instead clear them using burs which to me is just asking for iatrogenic damage. I was wondering if you could do one prep video where you do it using a handpiece and particularly that stage of the prep so I can see a way of helping to minimise damage.
Will do!
Such a great professor with amazing videos
So nice of you, thank you!
Gosh i hope my teachers were just like you.
So nice of you!
Great videos Dr Stevenson ,we would like to see videos about posts (fiber posts)
Will do!
Stevenson Dental Solutions yes . Please sir !!
Another awesome video! Thank you so much.
What is the main difference between class 2 in composite and amalgam?
Any videos on the tunnel prepration?
Composite has more rounded internal line angles, may have flared exit angles and is typically smaller in width and depth, however, not always, as the prep outline is determined by caries.
@@StevensonDentalSolutions many thanks!!
Its really a beautiful and informative demonstration of class 2 composite. Thanks a lot Dr Stevenson, but I would like to ask one question. Some school asks for bevel on facial and lingual walls of proximal box. Can you please tell me whats the best method to do same please?
Thanks and regards.
I run up the margins with a 7901 to create a bevel when necessary
@@StevensonDentalSolutions Thanks fro the info. Any videos that show the process of doing the bevel and the final result? Thank you
@@ionitfeinzaig-yehoshua9294 Not yet -
What would be the difference if this was an amalgam prep besides the walls being convergent?
Thank you Doctor for this tutorial.
In reality, when caries is shallow but includes proximal area, do we prepare box for composite restoration or only extend enough to remove carious area? Why do we need proximal box and gingival clearance when composite provides micro mechanical retention and preserve tooth structure? Thank you in advance
You need to break contact in order to: 1. visualize caries removal at the enamel margins, 2. facilitate matrix placement, 3. confirm adaptation and seal of the composite, 4. allow for finishing of the composite and inspection for voids. Small lesions (E1 and E2) without cavitation don't require surgical intervention. The philosophy is this: if it's small and uncavitated, it requires a pharmacological approach, not surgical, however if it is cavitated, and you must drill, then do it thoroughly.
Is this the same preparation for cdca on the adex tooth
Thank you
Hello Dr. Could you tell me where I could order the RGS 3 and 4 hand instruments?
stevensondentalsolutions.com
Hello Dr. Stevenson, all of these bur uses are amazing, but I've started to noticed that small diamond high speed burs are quite common among restorative dentistry community to remove caries. I was wondering if maybe you could do a Class I/II restoration of premolars or molars of your choice? I've used them in clinic and I find that more review with this bur usage will help others. It's quite unique in that because it's a round bur, you can actually angle the bur so that it's not "perpendicular" to the occlusal plane when using say a 330 carbide bur. This would potentially increase vision when approaching occlusal surfaces of the upper arch and help with suctioning in real patients!!!
I hope this wasn't too confusing
Okay good. Keep it up.
The Bob Ross of dentistry
I've heard that before!
I would love to restore this with composite ❤❤
Thank you Doc!
For a composite prep, should the walls be divergent or convergent?
It really may not matter much, but traditional convergent walls will add to the retention of the composite and might be of importance when minimal enamel remains.
What in particular are you unhappy with in your preparation? I'm trying to develop an aesthetic eye and I would like to be able to see what you see.
Just 0.1 mm errors in extension, and minor irregularities...
@@StevensonDentalSolutions thank you, Do you have any videos on chair position? I've been having a difficult time seeing into the box on MO preparations
@@user-sr3tj5gn8y Yes - check out my channel library - I have two on Chair position (ergonomics)
Thank you so much for the wonderful prep. Doc, can you please make a video of #20 DO for amalgam. While I am trying to make the facial exit angle, it's flaring up and I am ending up with obtuse exit angle. If I am trying to avoid that, I could barely get any facial clearance and having an acute exit angle.Appreciate if you can help.
Try prepping the box first with ideal extensions and exit angles, THEN, add the occlusal area - you'll see a huge difference.
Stevenson Dental Solutions Sure Doc, will try. Thank you so much for your response!
@@jemimachatla7911 Let me know how it goes...
Stevenson Dental Solutions It helped a lot. As you said, I noticed a big difference. Thank you so much Doc.
Awesome!
If you are my professor I'd never miss your class. The lecturer we have in my college is too busy and don't teach us properly. What a waste of years, money and time.
Sorry to hear this - dental education is in trouble...
Thanks for the high quality videos doc. Is there any alternative to the 330RGS for smoothing the pulpal wall in composite preps? What did you use before it was developed?
I did the best I could with a 330 or 55
U r the best
Thank you - wishing you much success!
With all due respect, are we not supposed to bevel the cavo-surface line angels for composite restorations? I have been taught in my dental school in India to do so and I have been following it all my life. The rationale, to prevent micro leakage caused by the eventual disintegration of bonding agent. Please correct me if I'm wrong.
Hi, bevelling composites serve two main purposes: they increase the bond strength/retention of the final restoration due to the enamel rod configuration which results after beveling, and they help blend the composite more seamlessly for esthetic cases (large facial class III and IV, and Vs on the enamel wall only) Using bevels for other classes, like class II's is a double edge sword - the bevel may increase the seal, but flowing the composite into the proximal acute area created by the bevel is unpredictable, and often results in voids. Bonding to enamel will not disintegrate - it is the strongest bond we have so the rationale isn't quite correct. We never bevel any areas that will be in function, as the thin composite will be subject to fracture over time. With most class I, II and III preparations, retention is not an issue and bevels are usually avoided to facilitate better filling of the cavity. Thank you for the question!
For the adex exam, how far mesiodistally do you extend the box before asking for a mod? The manual says 1.5mm past the DEJ bht that would be 2.5mm (really big) before asking for a mod. Are we better off asking for a mod at 1.5mm (0.5mm into dentin) or will we be docked for asking for a mod before meeting the maximums
Great question. THe best approach is the following: 1. Prep to ideal in all respects. 2. Extend only those areas that need to be extended to remove caries (first outline, then internal with slow speed and round burs). Make these extensions close to the max but not quite...and 3. Ask for further mods in 0.5 mm increments. If you do 1 and 2 properly, you'll have little to ask for in step 3. Sometimes nothing. Yes, it is entirely possible to ace this prep with no interaction at all with the floor examiner. The team at CDCA understands that these teeth are tricky. They want you to leave stain and only remove that which has explorer "tug back".
why you made a conventional old design for class 2 composite ? I mean this design is indicated for amalgam ... thanks in advance to your amazing videos .. I learned alot from it
The WREB exam demands this - it's not a true class II amalgam either - the extensions are less, line angles are not sharp, the depth is less and there are no retention grooves. Thank you!
Hi Dr do we need to put S curve even for composite?
Not necessarily, unless you wish to smooth the outline.
Dr. Stevenson, can you let me know what was the cavity depth of proximal box both facially and lingually? Because the mandibular premolar has a lingually inclined occlusal table, should the gingival seat follow the same or if it should be flat what is the minimum depth at proximal box(lingually) in this case? Thank you
The box dimensions are not absolute. They are determined by the contact size and the need to remove caries and break contact. The gingival seat (better nomenclature = gingival wall) has no relation to the pulpal wall or the plane of the occlusal table, but is determined by the need to break the gingival contact in a uniform fashion. The pulpal wall is always (ALWAYS) parallel to the occlusal table for all teeth.
If i need to take that’s information to my reassure , which reference I should write plz
Summit - contemporary operative dentistry, 4th ed.
Stevenson Dental Solutions thank you 🙏🏻
can i use spoon shaped excavator instead of enamel hatchet?
It may work is very sharp.
The same as amalgam prep but with more conservation and rounded line angles but with occlusal divergance Not occlusal convergence . Is that correct ? Or there is also occlusal convergence ?
Occlusal convergence is helpful but not absolutely required
#Q: sometimes facing difficulty in recognize between infected dentin &affected.. Dr Do you have any advice help?
First of all, the enamel and DEJ must be pristine, then soft to the explorer peripheral dentin caries is best to be removed. From this point on, it's a much harder call but essentially, remove what won't expose the pulp, and leave hard stained dentin. Thank you Doc!
@stevensondentalsolutions What should be the hand piece speed on a electric hand piece for beginners 200K or 100K?
Either - the issue with too slow is the need to use more pressure - the issue with too fast is the speed at which tooth structure us removed. The speed may be modulated with the foot pedal to a certain extent.
Thank you. While doing DO Class2 on mandibular 1st molar, i avoid extending into distobuccal groove as it increases my isthmus width. Is it ok to not extend into distobuccal groove(between distobuccal and distal cusp).?
Yes - only extend if caries dictates it. Thank you
On a typodont, try to create a fishtail like the videos on this topic...preserving the distal cusp
Sir ..when I do box preparation where caries is very little ... I go for composite but get fractured in few months ..why is it?
You need a lot of retention and enamel bevels interproximally. Always use rubber dam, and a total etch technique
@@StevensonDentalSolutions so need to enlarge the cavity more even if caries is little and the caries was lingually so the buccolingual width was more
@@afsanashaikh5571 Break contact on the buccal and lingual and use an obtuse angle with a thin bur - almost a saucer shape - this will expose a lot of enamel for bonding.
@@StevensonDentalSolutions thank u so much sir for replying and clearing my doubts ...and which matrix system do we need to use...as IAM in rural area I use the old tofflemier and straight matrix band
@@afsanashaikh5571 It would be best to use a sectional matrix, biting ring and wedge system - there are many available online - some are quite affordable.
Is the S curve just on the buccal side or both sides?and what's the aim of it?
The "S" curve is simply a smoothing of the outline from the occlusal to the box - it increases the resistance form of the restoration. It occurs anywhere that a sharp edge needs refinement.