Bonding of indirect ceramic restorations with warm composite using a vibrating tool to apply pressure against the tooth results in a very superior bond strength and increases success rates for their longevity. Fantastic video Doctor! ❤❤
God bless u sir. Your videos have helped so many people u have no idea. I'm so thankful that I found your channel. I watch and rewatch ur videos, they're gold!!! I sure can't wait for ur future video / series in occlusion.
To my shame , a recent dental graduate from a UK dental school and this is the first time I have come across composite resin cementation. We were only ever taught about GIC cements and universal self curing cements. Interesting how much you learn about dentistry once you actually graduate. Great video as always , keep up the good work !
Hi Dr Stevenson, I want to thank you for your great videos you generously share with others. You are a very good instructor. I passed my exam and learned a lot from your tips and you have golden hands.keep up good job and god bless you.
Thank you so much for your videos, Dr. Stevenson I have a couple of questions, if I may ask: 1. How do you prepare natural teeth for use for training purposes? And how do you mount them on a Typodont? 2. Which cement would be comparable to preheated composite in such cases; in order to achieve optimum enamel peripheral seal?
1. The natural teeth are cleaned and the roots are shaped to mimic the plastic teeth in length and diameter and then fixed to the typodont with PMMA. It's best to use a lubricant before "gluing them in" so they may be retrieved. You can even place a screw in the bottom and create threads for the attachment to the natural tooth. 2. Any dual cure cement - like Panavia, DuoLink, ParaCore, etc., works great. THANK YOU for the question.
I have a question about classification of ceramics because I get a little bit confused.. Can you suggest any good readings on that topic.? Can't wait for your occlusion series.. Greetings from Egypt 🇪🇬👏
Let me put out a video on ceramic classification - should be a help to many - it is confusing. In the meantime, check out this article by McLaren:thinkblue.me/Pubs/PDFs/cer_class_compendium_2015.pdf
Hi Dr Stevenson . I would like to know if you have to Light Cure the tooth after application of the bonding agent ? Also would a flowable composite or core build up dual cure composite be suitable for cementation as well . Thank you
When you use a dual cure activator (for ex. ScotchBond Universal + RelyX Ultimate Cement has them incorporated) you do not need to light cure the bonding material. Also, through many years of collective clinical experience, as long as the restoration is somewhat translucent and not more that 3 mm thick, you may light cure the bonding and the cement through the restoration after cementation.
@@mustafaaburass9650 I use either, but usually a resin cement - not a SARC. When the tooth has the need for more esthetic blending due to a special shade - warm composite.
Hi Dr. Stevenson. Before I get to my question, I’d like to sincerely thank you for your tremendous generosity and passion for teaching! Your videos have significantly changed the way I practice and ultimately elevated the level of care to my patients. Since last watching this video, I’ve done more cementations and one of the issues I’ve faced is voids or ditching at the margin while removing excess cement/composite. Have you experienced this? What would you do when you notice this? Do you add flowable resin prior to final curing? Thank you so much!
WOW, thank you! I perform" bullnose etching" (around the edge onto the outer surface by 0.5 mm), silanate this edge too, and clean the cement completely - no tack curing - then finish and polish with wet Dialites - always spinning from ceramic to tooth. Seems to help seal the margin. Dr. S
@@StevensonDentalSolutions thank you Dr. S. What kind of cement do you use? I use ParaCore but it seems to set very quickly, especially when I use ParaBond with it.
Hi doctor! Tnx for your videos! They are life savinggg❤my questions is, is your bonding system( scotchbond) self cure?? And if not, why u didn’t cure the bonding prior to placing composite??
Hello. I am about to consider an emax ceramic inlay but I wonder if the day I have to remove it will not be a nightmare if the dentist struggles to remove it or is forced to damage what remains natural of my tooth. Not to make too much noise with the tools and hurt my hearing. Thank you for your opinion.
Your question is quite appropriate. Removing failed ceramic restorations that have been bonded adhesively to the tooth will result in some collateral damage to healthy tooth structure IF using drills. We do have lasers that may be quite promising in removing bonded failed restorations without any damage to the underlying tooth. I would not worry too much about the removal as we will have the laser option and likely to have other options in the next 10-15 years when replacement may be necessary. Dr. Stevenson
Which the actual way to remove today ? Only drilling ? How to remove only the inlay when it's soo tiny ? Using a laser on a such tiny surface, I don't see how the dentist cannot be too close to the tooth. What about the contact noise to drill a ceramic vs composite ? Because it's harder and maybe a long time work. is there any hear damage for the patien that ears directly the drill trough the bones contact ? I don't see a single video about it on youtube. @@StevensonDentalSolutions
Yes doc ..thanks for sharing these techniques..without payment and conferences we r achieving these knowledges. CAN we use veneer cement for cementing emax crowns or inlays...?
May I ask some quistions about bonding an emax restoration. 1- Should i put the bond (clearfill liner bond f ) on top 2 bottle silane from bisco on an emax restoration or the silane is enough when using heated composite? If so, the 2 bottle system clearfill liner bond f has a primer should i apply the primer on an emax after silane application? 2- should i put silane on an existing composite on the tooth when bonding to emax restoration then place the bond 2 bottle system primer and bond?
Great questions! 1. There is no need to place the liner bond on the restoration after silane, but if you do, make sure you allow the solvent to volatilize to ensure good adhesion to the silaneated surface. 2. It looks like silane is not helping bond to the composite as well as it had been hoped. No clinical data supports this approach - so there is no need. All the best, Dr. S
Hi doctor thank you for the video. In case of a composite onlay/inlay, do we have to etch it with HF prior of silane, bond and cement? Or with orthophosphoric 35%?
Not required. With composite, treat the surface with a light sand blastoff Aluminum Oxide to increase surface energy and use adhesives as with your direct composites. Some dentists do use HF and silane in an attempt to link and bond to the glass filler particles, but this hasn't been shown to improve clinical performance. Simply making the surface microscopically irregular provides ample retention.
@@StevensonDentalSolutions So for prep of the composite restoration you modify texture with air abrasion, you clean with Ivoclean, use primer for instance Monobond Plus and then you are ready to lute with a resin cement. And in between of primer and luting cement do you use any bonding agent like in ceramics? Thank you doctor for your instant reply. I appreciate it!
Thank you, Sir! Great videos! Why did you use the bisco bond after silanizing the ceramic Emax? I read some study that recommend to only use silane after etching with HF, please Sir? Thank you a lot!
You can't, hence the limitation of this technique to translucent, and less thick restorations. I typically use a dual sure cement, and only use warm composite when I need the extra strength and shade variability with a thin and translucent restoration.
Greetings Dr. Stevenson. I would like to take a moment to appreciate how in-depth are your video tutorials. Coming to my query could you please tell me whether the bonding agent needs to be cured before seating of the prostheses? I use tetric N Bond
Thank you - the manufacturers will usually recommend that you thin and then light cured the adhesive before cementation, however, this may render the restoration less likely to fully seat due to adhesive "pooling". A way around this is to simply light cure simultaneously with the cement, however, this has the potential of not curing the adhesive adequately, particularly if the restoration is thick or opaque. Perhaps the best choice is to use a dual cure adhesive, like Scotchbond Universal + RelyX Ultimate cement - as they work together to cure the adhesive. Also, many light cure adhesives have a DCA (dual cure activator)_ which isn't highly publicized by the manufacturer but available,
thx for the good video. I am a dental school student and have a question. why did you etch only th margin of restoration? I think you just say the reason in the video, but I couldn't understand cause of my english problem... TT
The dentin was sealed during the preparation step (IDS), and then it was cleaned with Aluminum Oxide - therefore, no need to etch, as it is covered with resin.
Could you please tell me what kind of composite do you use and prewarm them to which temperature？cause I know not all composite can be used to cement ceramic restoration.thank you
54-60 C with most composites (check with the manufacturer for your specific composite). Film thickness tests have been published for traditional resin cements and the best bond strength were found when the cements were between 50-100 microns - when very thin, like 20 microns [doi.org/10.1016/S0109-5641(96)80030-3], the bond strengths dropped significantly. For the warm composite technique, one lab study [doi.org/10.1016/j.jds.2014.03.006] published show that the Tetric Evo Ceram Bulk Fill (Ivoclar) was thinned to about 75 microns when warmed to 60C, and in general nanohybrids were thinned better than hybrids and microhybrids, using a 15 Kg. static load with glass slabs. I believe that with vibration using a chopstick and mallet, we may reduce this even more. The worst performers were the packable types. like Filtek P60. All composites when warmed to 54-60 C will reduce in film thickness significantly - about 30%. Hope I've helped!
Really enjoying the videos, have you done one on Indirect composite onlays/crowns. What reduction would you do for these? I have a case coming up fairly soon :) thanks again for all the help!
This is a huge mistake - it will prevent the complete seating of the indirect restoration due to the film thickness...even if it's reported to be as little as 10 microns, it will pool in the corners of the preparation and prevent complete seating...
@@StevensonDentalSolutions Thanks, so both the adhesive on the tooth and on intaglio surface of the restoration should be cured together once the restoration is seated.
The usual choice is resin cement, however, warm composite works well if the restoration is not too thick. There are unlimited shades and the composite is stronger than the resin cement. NOTE: the composite must be warmed to soften it.
Doctor Steven do you recommend using Self-adhesive resin cements for cementation of all ceramic restorations and zirconia in case of inlay / onlay / crown and bridges ?
thank you Sir fro your fantastic videos , I would like to understand the step of etching the fitting surface of the ceramic restoration , why we should etch only the periphery not all the internal surface ??
Thanks Dr for your amazing videos, and i would like to ask you if you used immediate dentine sealing before the impression taking or no? otherwise, what do you recommend to protect the dentine after preparation? Thanks so much
I etch the ceramic beyond the edge and bond around the restoration margin slightly, hence I want to secure this area fully before finishing. Tack curing leaves the composite cement soft (enough to remove easily, hence it's popularity) and it then may be torn from under the marginal seal area. Marginal staining then becomes a problem...
thank you dr stevenson for your effort, Isn`t it better to use a resin cement for cementation of the ceramic here? and in case of using a composite isn`t it better to use a flowable type of composite for a cementation? you know it will flow better and it will occupy a smaller area for cementation?
Warm composite shrinks about 1.5% compared to 4% or more for flowable composite. The warm composite technique provides a very strong resin luting space. It is very technique sensitive though. I would only use this technique when the restoration is not more than 2 mm thick. Thicker and more opaque ceramics should be bonded with dual cure resin cements. Resin cements which are dual cured and have a built in dual cure activator to work in concert with the bonding agent are the gold standard.
@@StevensonDentalSolutionswhen using the dual cure cement, when do you start flossing interprox and do the rest of the cement clean up if you don’t tack cure?
Hi, I love your video. May you do video for primary/deciduous molar class ll amalgam preparation too ? I know you did a video for permanent molar class ll amalgam already, but I read a references said that the preparation for primary molar class ll amalgam is way more conservative and have a slightly differences?! Look forward for your guides and videos. Xo
It usually takes about 3-5 minutes to heat up with the Calset (by AdDent). I also use a Phasor from Vista (really hard to locate these days) which uses an induction coil and takes less than 1 minute.
Thank you for the awesome question! I clean these over a sink with air/water spray and then take it to my steamer, in the lab and give it a good shower. The red color of the Ivoclar HF let's you know if any material is left behind.
Nice video Dr.Stevenson. do you remove the glaze layer from the outer 0.5 mm periphery of the restoration before you etch it with HF? Or your lab does it beforehand?
Usually I just etch the outer rim for 90 seconds, for the feldspathic glaze etching, then the intaglio for 20-30 seconds. I've had limited success getting the lab to leave glaze off this area.
Why you didnt etch totally the preparation before cementation as you have etched only the enamel?? Did you use selective etching this time? As you have used total etching approach in the IDS
The tooth was etched totally during the PREP for IDS, then the enamel was cleaned with the bur before the impression. For the cementation, the dentin simply needs to be cleaned as it has already been sealed with DBA. The enamel however requires etching because the etched surface was removed at the pre-impression stage. I will total etch the prep whenever I see that the bonded layer has been removed by over cleaning with Aluminum Oxide.
Why did you use an adhesive on the tooth if you already IDS? I guess you still needed it at the enamel but why on the already sealed dentin? Also, would you do the same with an auto adhesive cement?
You've sealed it during the prep, but you need to bond it during the seat, especially after air abrading the contaminated surface during the cementation step. The same steps regardless of the resin cement used. Thank you, Doc!
Hi Dr Stevenson , love the vids . What are your indications for choosing a warm composite technique as opposed to a resin cement to cement the restorations ? Thank you.
Typically when shade is critical - I have more choices, and whenever I have a margin that isn't ideal and a remake isn't in the best interest of the patient - this way, the defect may be sealed.
Stevenson Dental Solutions great , thanks for clarifying . Please do come to Thailand and do some workshops and lectures , I am sure the dental community would love to have you ! Thanks again
at 11.44 in the video u jumped from HF etching the margins of your inlay to silane treatment ..??? u cleaned the HF off and then phosphoric etched to remove the residues ?? or as the video suggested you applied the silane directly to the still etching surface ?? Confusing
Thank you for the Questions. Tooth: Phosphoric acid, etch, rinse and suction excess, then apply bonding agent and lightly dry. Restoration: HF intaglio and edges, rinse, dry, then mix and apply Silane, then air dry, then apply boding resin, air dry. After this, apply warm composite and cement. Sorry for the confusion doctor and thank you for pointing this out. Dr. S
Best to only use this technique when you have relatively thin and translucent inlays and onlays. Best technique is Dual cured composite. I made this video because people requested this technique. I use it only when shade is critical with thin restorations.
Final curing only. As long as the restoration is translucent. Alternatively, you may use a dual cured primer/adhesive which is made to polymerize with the cement, like RelyX Ultimate and ScotchBond Universal. The issue with pre-cementation curing is that the adhesive is thick enough to interfere with complete seating.
Usually you can use a spoon and uplift it. Rarely, the use of a carbide carefully positioned away from the margins may be used to create a slit with which a large spoon is used.
Zirconia Will be safer if it is a stronger material But ceramic Cad CAM constructions Will last forever at once with no chemicals and protect the inner connection and also Help as antivirus & bacteria to save Humanity from all diagnoses via dentistry.
Amazing, it was a great series of videos to follow and learn from. One question doc, after cimentation if there is any need for oclusion adjustment, what do you recommend?
Great video! Wondering why glycerine gel was not used during the cementation with composite to prevent oxygen inhibited layer? assuming there could still be marginal ditching/discoloration even with the peripheral etching? Thanks!
Tack curing is a great way to clean up resin cement, no doubt. However, when you are trying to create a continuous ceramic-resin-tooth seal, tack curing is counterproductive. In the techniques presented, we use HF etch 500 microns beyond the typical bondable interface of the ceramic margin, not just the intaglio, and bond to the entire meniscus of the ceramic margin, not just the inner surface. The resin cement will thus fill this micro-concavity and prevent staining in the future. Tack curing will disrupt the creation of this, and because the resin is not permitted to fully cure and gain strength - it will be ripped off the ceramic leaving the surface rougher. Dr. Ed McLaren (DDS, Prosthodontist and Master Technician) taught me this about 20 years ago. Since then, no more stained margins. Thank you for the great question. Dr. Stevenson
@@StevensonDentalSolutions Dr. Stevenson Thank you for this thorough reply. Can we use this technique for anterior ceramic veneers when we are using resin cement? or is it beneficial only for Onlays/Inlays using composite resin types of cement. And when you say "resin cement will thus fill this micro-concavity and prevent staining in the future" do you mean we blend the excess cement on previously HF etched outer edges of the ceramic or do you mean applying an unfilled/filled adhesive resin on these surfaces to avoid getting future discoloration? Many thanks
Bonding of indirect ceramic restorations with warm composite using a vibrating tool to apply pressure against the tooth results in a very superior bond strength and increases success rates for their longevity. Fantastic video Doctor! ❤❤
God bless u sir. Your videos have helped so many people u have no idea. I'm so thankful that I found your channel. I watch and rewatch ur videos, they're gold!!! I sure can't wait for ur future video / series in occlusion.
Thank you Doc!
To my shame , a recent dental graduate from a UK dental school and this is the first time I have come across composite resin cementation. We were only ever taught about GIC cements and universal self curing cements. Interesting how much you learn about dentistry once you actually graduate. Great video as always , keep up the good work !
Great - thank you for your support!
Doc, you are a hero for posting these videos. Thank you so much!
Glad you like them!
Thanks for sharing . A lot of clarity over this subject . Your talk is so clear en effective .
Thank you!
That was great! I have ever seen good fine clear tutorial like this
Very nice of you - thank you.
Good to see that you are using IDS, and resin coating. That means you get the strongest bond not to enamel, but dentin.
Always packed with so much valuable info.. Thank you.
My pleasure - thannk you.
New Subscriber. Great information. Nice to see a perfectionist Dentist at work, plus you are a great teacher.
Thank you - spread the word - dentistry rocks!
Hi Dr Stevenson,
I want to thank you for your great videos you generously share with others. You are a very good instructor. I passed my exam and learned a lot from your tips and you have golden hands.keep up good job and god bless you.
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Best video ever on cementation! Thank you♥️
Thank you!!!
Thank you so much Sir.
Your videos are amazing. I have learnt alot. Every details are discussed very nicely.
Thank you, Doc.
Very great series there 👏👏👏
Thank you Doc!
this is a work of art!
Thank you
great info doc that we can use everyday
Great - thank you for watching!
Thanks much for your videos. Helps a lot. 🙏🙏
My pleasure!
Perfect tips and tricks 💥
Thanks for your effort 🌟
My pleasure 😊
Very beautiful video thank you very much doctor 👏🙏
My pleasure - thank you for watching!
Ohhh thanks a lottt 🤍
Thank you doc your video really helpfull
Great - thank you for watching.
Thank you so much for your videos, Dr. Stevenson
I have a couple of questions, if I may ask:
1. How do you prepare natural teeth for use for training purposes? And how do you mount them on a Typodont?
2. Which cement would be comparable to preheated composite in such cases; in order to achieve optimum enamel peripheral seal?
1. The natural teeth are cleaned and the roots are shaped to mimic the plastic teeth in length and diameter and then fixed to the typodont with PMMA. It's best to use a lubricant before "gluing them in" so they may be retrieved. You can even place a screw in the bottom and create threads for the attachment to the natural tooth.
2. Any dual cure cement - like Panavia, DuoLink, ParaCore, etc., works great. THANK YOU for the question.
Stevenson Dental Solutions Thank you so much, Dr Stevenson
Anytime Doc!
I have a question about classification of ceramics because I get a little bit confused.. Can you suggest any good readings on that topic.?
Can't wait for your occlusion series.. Greetings from Egypt 🇪🇬👏
An article from Ed McLaren and Russ Giordano - classification of modern ceramics - it's also available from Ed McLaren's website - oral arts...
Let me put out a video on ceramic classification - should be a help to many - it is confusing. In the meantime, check out this article by McLaren:thinkblue.me/Pubs/PDFs/cer_class_compendium_2015.pdf
Hi Dr Stevenson . I would like to know if you have to Light Cure the tooth after application of the bonding agent ? Also would a flowable composite or core build up dual cure composite be suitable for cementation as well . Thank you
When you use a dual cure activator (for ex. ScotchBond Universal + RelyX Ultimate Cement has them incorporated) you do not need to light cure the bonding material. Also, through many years of collective clinical experience, as long as the restoration is somewhat translucent and not more that 3 mm thick, you may light cure the bonding and the cement through the restoration after cementation.
Thank you so much doctor ..
Thank you!
Stevenson Dental Solutions doctor ..just I am asking why you use worm composite technique instead of self adhesive cement..thanks alot
@@mustafaaburass9650 I use either, but usually a resin cement - not a SARC. When the tooth has the need for more esthetic blending due to a special shade - warm composite.
thanks for sharing!
My pleasure!
Thank you for watching - best wishers, Dr. Stevenson
Hi Dr. Stevenson. Before I get to my question, I’d like to sincerely thank you for your tremendous generosity and passion for teaching! Your videos have significantly changed the way I practice and ultimately elevated the level of care to my patients. Since last watching this video, I’ve done more cementations and one of the issues I’ve faced is voids or ditching at the margin while removing excess cement/composite. Have you experienced this? What would you do when you notice this? Do you add flowable resin prior to final curing? Thank you so much!
WOW, thank you! I perform" bullnose etching" (around the edge onto the outer surface by 0.5 mm), silanate this edge too, and clean the cement completely - no tack curing - then finish and polish with wet Dialites - always spinning from ceramic to tooth. Seems to help seal the margin. Dr. S
@@StevensonDentalSolutions thank you Dr. S. What kind of cement do you use? I use ParaCore but it seems to set very quickly, especially when I use ParaBond with it.
@@snuppy01 I use RelyX Ultimate with ScotchBond Universal. Gives good working time.
@@StevensonDentalSolutions Thank you Dr. S!!
@@snuppy01 MY PLEASURE!
Great stuff!
Thank you for watching!
Hi doctor! Tnx for your videos! They are life savinggg❤my questions is, is your bonding system( scotchbond) self cure?? And if not, why u didn’t cure the bonding prior to placing composite??
Simultaneous curing due to translucent inlays
Hola Dr., una pregunta, con qué material cementó las incrustaciones?, gracias y hermoso trabajo.
Resin Cement or Warm Composite. Gracias
@@StevensonDentalSolutions Gracias Dr.
keep going you promised "one per week"
Okay - I will try!
@@StevensonDentalSolutions
what a great mentor .. I would like to have the budget to join your courses ... :)
Hello.
I am about to consider an emax ceramic inlay but I wonder if the day I have to remove it will not be a nightmare if the dentist struggles to remove it or is forced to damage what remains natural of my tooth. Not to make too much noise with the tools and hurt my hearing.
Thank you for your opinion.
Your question is quite appropriate. Removing failed ceramic restorations that have been bonded adhesively to the tooth will result in some collateral damage to healthy tooth structure IF using drills. We do have lasers that may be quite promising in removing bonded failed restorations without any damage to the underlying tooth. I would not worry too much about the removal as we will have the laser option and likely to have other options in the next 10-15 years when replacement may be necessary. Dr. Stevenson
Which the actual way to remove today ? Only drilling ? How to remove only the inlay when it's soo tiny ?
Using a laser on a such tiny surface, I don't see how the dentist cannot be too close to the tooth.
What about the contact noise to drill a ceramic vs composite ? Because it's harder and maybe a long time work. is there any hear damage for the patien that ears directly the drill trough the bones contact ?
I don't see a single video about it on youtube.
@@StevensonDentalSolutions
Yes doc ..thanks for sharing these techniques..without payment and conferences we r achieving these knowledges. CAN we use veneer cement for cementing emax crowns or inlays...?
Thanks doc. Yes, you can as ling as the ceramic is not too thick (blocking the light)
Yes doc thanks again for ur prompt reply ..really appreciate
May I ask some quistions about bonding an emax restoration.
1- Should i put the bond (clearfill liner bond f ) on top 2 bottle silane from bisco on an emax restoration or the silane is enough when using heated composite? If so, the 2 bottle system clearfill liner bond f has a primer should i apply the primer on an emax after silane application?
2- should i put silane on an existing composite on the tooth when bonding to emax restoration then place the bond 2 bottle system primer and bond?
Great questions! 1. There is no need to place the liner bond on the restoration after silane, but if you do, make sure you allow the solvent to volatilize to ensure good adhesion to the silaneated surface.
2. It looks like silane is not helping bond to the composite as well as it had been hoped. No clinical data supports this approach - so there is no need. All the best, Dr. S
Hi doctor thank you for the video. In case of a composite onlay/inlay, do we have to etch it with HF prior of silane, bond and cement? Or with orthophosphoric 35%?
Not required. With composite, treat the surface with a light sand blastoff Aluminum Oxide to increase surface energy and use adhesives as with your direct composites. Some dentists do use HF and silane in an attempt to link and bond to the glass filler particles, but this hasn't been shown to improve clinical performance. Simply making the surface microscopically irregular provides ample retention.
@@StevensonDentalSolutions So for prep of the composite restoration you modify texture with air abrasion, you clean with Ivoclean, use primer for instance Monobond Plus and then you are ready to lute with a resin cement. And in between of primer and luting cement do you use any bonding agent like in ceramics? Thank you doctor for your instant reply. I appreciate it!
Thank you, Sir! Great videos!
Why did you use the bisco bond after silanizing the ceramic Emax? I read some study that recommend to only use silane after etching with HF, please Sir?
Thank you a lot!
Just to promote better flow of the composite cement - thank you!
You are fabulous💪🤩
Thanks for watching and for this!
How can you be sure that the composite for cementation is fully cured underneath the porcelain?
Thanks
You can't, hence the limitation of this technique to translucent, and less thick restorations. I typically use a dual sure cement, and only use warm composite when I need the extra strength and shade variability with a thin and translucent restoration.
Greetings Dr. Stevenson. I would like to take a moment to appreciate how in-depth are your video tutorials. Coming to my query could you please tell me whether the bonding agent needs to be cured before seating of the prostheses? I use tetric N Bond
Thank you - the manufacturers will usually recommend that you thin and then light cured the adhesive before cementation, however, this may render the restoration less likely to fully seat due to adhesive "pooling". A way around this is to simply light cure simultaneously with the cement, however, this has the potential of not curing the adhesive adequately, particularly if the restoration is thick or opaque. Perhaps the best choice is to use a dual cure adhesive, like Scotchbond Universal + RelyX Ultimate cement - as they work together to cure the adhesive. Also, many light cure adhesives have a DCA (dual cure activator)_ which isn't highly publicized by the manufacturer but available,
Understood sir. Thank you very much for clearing it up for me. Much obliged
Thankyou for the amazing video, did you manage to do a video assessing occlusion before/after cementation?
I shall - great idea!
thx for the good video. I am a dental school student and have a question. why did you etch only th margin of restoration? I think you just say the reason in the video, but I couldn't understand cause of my english problem... TT
The dentin was sealed during the preparation step (IDS), and then it was cleaned with Aluminum Oxide - therefore, no need to etch, as it is covered with resin.
Could you please tell me what kind of composite do you use and prewarm them to which temperature？cause I know not all composite can be used to cement ceramic restoration.thank you
54-60 C with most composites (check with the manufacturer for your specific composite). Film thickness tests have been published for traditional resin cements and the best bond strength were found when the cements were between 50-100 microns - when very thin, like 20 microns [doi.org/10.1016/S0109-5641(96)80030-3], the bond strengths dropped significantly. For the warm composite technique, one lab study [doi.org/10.1016/j.jds.2014.03.006] published show that the Tetric Evo Ceram Bulk Fill (Ivoclar) was thinned to about 75 microns when warmed to 60C, and in general nanohybrids were thinned better than hybrids and microhybrids, using a 15 Kg. static load with glass slabs. I believe that with vibration using a chopstick and mallet, we may reduce this even more. The worst performers were the packable types. like Filtek P60. All composites when warmed to 54-60 C will reduce in film thickness significantly - about 30%. Hope I've helped!
@@StevensonDentalSolutions perfect🌹👌whats the benefit of heated composites to resin cements??
Really enjoying the videos, have you done one on Indirect composite onlays/crowns. What reduction would you do for these? I have a case coming up fairly soon :) thanks again for all the help!
1.5 mm for emax, thank you!
Hey doctor, i have a question. Why didn't you cure the bonding that you applied to the tooth surface?
This is a huge mistake - it will prevent the complete seating of the indirect restoration due to the film thickness...even if it's reported to be as little as 10 microns, it will pool in the corners of the preparation and prevent complete seating...
@@StevensonDentalSolutions Thanks, so both the adhesive on the tooth and on intaglio surface of the restoration should be cured together once the restoration is seated.
Hi Dr. I have question
Why u use composite when fixing the restoration
The usual choice is resin cement, however, warm composite works well if the restoration is not too thick. There are unlimited shades and the composite is stronger than the resin cement. NOTE: the composite must be warmed to soften it.
Doctor Steven do you recommend using Self-adhesive resin cements for cementation of all ceramic restorations and zirconia in case of inlay / onlay / crown and bridges ?
No. The traditional resin cements are the best choice for these. SARCs lack the high bond strength and durability required.
Hi Dr can doing good cementation without use Sandblasting?
Yes, with a clean surface and etching and bonding.
Hello. Do you cement the composite onlay the same way or do you have any other protocol for that?
Sam method - thank you!
Thanks Dr
Thank you!
thank you Sir fro your fantastic videos , I would like to understand the step of etching the fitting surface of the ceramic restoration , why we should etch only the periphery not all the internal surface ??
Etch both, but always include the periphery as well.
Thanks Dr for your amazing videos, and i would like to ask you if you used immediate dentine sealing before the impression taking or no? otherwise, what do you recommend to protect the dentine after preparation?
Thanks so much
Yes, I do, then I clean the margins with a fine diamond to reduce the residue from excess adhesive materials at the marginal interface.
Hi doc! Thank you for your videos. I find them enjoyable. I'd like to ask. Why is it that you don't like tack curing when cementing?
I etch the ceramic beyond the edge and bond around the restoration margin slightly, hence I want to secure this area fully before finishing. Tack curing leaves the composite cement soft (enough to remove easily, hence it's popularity) and it then may be torn from under the marginal seal area. Marginal staining then becomes a problem...
Thank you for such an amazing explanation !
Thank you for watching!
thank you dr stevenson for your effort, Isn`t it better to use a resin cement for cementation of the ceramic here? and in case of using a composite isn`t it better to use a flowable type of composite for a cementation? you know it will flow better and it will occupy a smaller area for cementation?
Warm composite shrinks about 1.5% compared to 4% or more for flowable composite. The warm composite technique provides a very strong resin luting space. It is very technique sensitive though. I would only use this technique when the restoration is not more than 2 mm thick. Thicker and more opaque ceramics should be bonded with dual cure resin cements. Resin cements which are dual cured and have a built in dual cure activator to work in concert with the bonding agent are the gold standard.
@@StevensonDentalSolutions would you recommend a certain type of resin cement
@@ahmadmohi659 I like the 3M ScotchBond Universal + RelyX Ultimate, shade A1 Bonding for most cementations...
@@StevensonDentalSolutionswhen using the dual cure cement, when do you start flossing interprox and do the rest of the cement clean up if you don’t tack cure?
How do you remove the provisional acrylic temp? Do you drill it out?
Hi, I love your video. May you do video for primary/deciduous molar class ll amalgam preparation too ?
I know you did a video for permanent molar class ll amalgam already, but I read a references said that the preparation for primary molar class ll amalgam is way more conservative and have a slightly differences?! Look forward for your guides and videos. Xo
I will add this to the queue - thank you!
Perfect🌹how long do you put the compule in the heater ?? Tim?
It usually takes about 3-5 minutes to heat up with the Calset (by AdDent). I also use a Phasor from Vista (really hard to locate these days) which uses an induction coil and takes less than 1 minute.
Could we use here self adhesive resin cement(dual cured) ?
Even though we did etch and bond to the tooth ?
Like RelyX Unicem II, yes, as long as the tooth has been etched and primed. You just don't have as many shade choices...
@@StevensonDentalSolutions Thanks doctor appreciate it
How do you clean the HF acid etch. It is simply wash and dry or do you use any particular cleaning agent.
Thank you for the awesome question!
I clean these over a sink with air/water spray and then take it to my steamer, in the lab and give it a good shower. The red color of the Ivoclar HF let's you know if any material is left behind.
Nice video Dr.Stevenson. do you remove the glaze layer from the outer 0.5 mm periphery of the restoration before you etch it with HF? Or your lab does it beforehand?
Usually I just etch the outer rim for 90 seconds, for the feldspathic glaze etching, then the intaglio for 20-30 seconds. I've had limited success getting the lab to leave glaze off this area.
@@StevensonDentalSolutions Thank you very much for your valuable guidance.
@@riteshgadhia3870 My pleasure!
@@StevensonDentalSolutions one more question sir, at which air pressure do you work with the air abrasion unit?
@@riteshgadhia3870 I use the CrystalMark system at 2-3 Bar.
Why you didnt etch totally the preparation before cementation as you have etched only the enamel?? Did you use selective etching this time? As you have used total etching approach in the IDS
The tooth was etched totally during the PREP for IDS, then the enamel was cleaned with the bur before the impression. For the cementation, the dentin simply needs to be cleaned as it has already been sealed with DBA. The enamel however requires etching because the etched surface was removed at the pre-impression stage. I will total etch the prep whenever I see that the bonded layer has been removed by over cleaning with Aluminum Oxide.
Why did you use an adhesive on the tooth if you already IDS? I guess you still needed it at the enamel but why on the already sealed dentin? Also, would you do the same with an auto adhesive cement?
You've sealed it during the prep, but you need to bond it during the seat, especially after air abrading the contaminated surface during the cementation step. The same steps regardless of the resin cement used. Thank you, Doc!
Hi Dr Stevenson , love the vids . What are your indications for choosing a warm composite technique as opposed to a resin cement to cement the restorations ? Thank you.
Typically when shade is critical - I have more choices, and whenever I have a margin that isn't ideal and a remake isn't in the best interest of the patient - this way, the defect may be sealed.
Stevenson Dental Solutions great , thanks for clarifying . Please do come to Thailand and do some workshops and lectures , I am sure the dental community would love to have you ! Thanks again
@@dr.avinashksajnani7930 I'd enjoy the opportunity!
at 11.44 in the video u jumped from HF etching the margins of your inlay to silane treatment ..??? u cleaned the HF off and then phosphoric etched to remove the residues ?? or as the video suggested you applied the silane directly to the still etching surface ?? Confusing
Thank you for the Questions. Tooth: Phosphoric acid, etch, rinse and suction excess, then apply bonding agent and lightly dry. Restoration: HF intaglio and edges, rinse, dry, then mix and apply Silane, then air dry, then apply boding resin, air dry. After this, apply warm composite and cement. Sorry for the confusion doctor and thank you for pointing this out. Dr. S
Sir what is your way of removing these provisional?is it with the tip of explorer
Typically I use a very strong spoon excavator - explorers are a bit too week and tend to bend,
Hi Doctor, how can you be sure you have cured the composite completely?
Best to only use this technique when you have relatively thin and translucent inlays and onlays. Best technique is Dual cured composite. I made this video because people requested this technique. I use it only when shade is critical with thin restorations.
@@StevensonDentalSolutions Thank you Dr. Stevenson!
شكرا
why use warmed up composite when we can use flowable? reply would be extremely appreciated
Warm composite only shrinks 1.5%, flowable shrinks 4% or more. Warm composite has a higher rate of conversion as well.
Prof plz can we cement composite or zirconia onlay with resin modified glass ionomer ?
No research on this has been performed clinically. I would use a resin cement for ceramic onlays.
@@StevensonDentalSolutions do you mean no research use zirconia or composite onlay itself?
Hi Dr, fastantic video. a question.
Is not it better to use a wheel core-build up such as ParaCore or Core Lite DC?
Yes these are great options and I use ParaCore when I believe that there is structural compromise. For minimal block-outs, I use RMGI.
We need remediation therapy now from attack of cements too.
thank you so much
your videos are really informative
at 8:45 when you said that the dentin is sealed ?
many thanks from me before hand
Yes, in the IDS technique, the dentin is sealed at the prep and then simply cleaned with air abrasion at delivery.
Is there any alternative to using air abrasion to reactivate the bonding surface?
Scrub with flour pumice and re-etch
Is tehere is any curing of bond in between or just the final curing ?
Final curing only. As long as the restoration is translucent. Alternatively, you may use a dual cured primer/adhesive which is made to polymerize with the cement, like RelyX Ultimate and ScotchBond Universal. The issue with pre-cementation curing is that the adhesive is thick enough to interfere with complete seating.
@@StevensonDentalSolutions amazing
Is there any dual cure adhesive other than scotchBond universal doctor ?
How do u remove the temporary acrylic restoration? Do u drill it?
Usually you can use a spoon and uplift it. Rarely, the use of a carbide carefully positioned away from the margins may be used to create a slit with which a large spoon is used.
Beautiful 😍
Thank you Doc!
Thank you so much
You are amazing
Can you please make video about endodontic acces on upper simulated molar
Than u again 👏👏
I'm partnering with two endodontists to do just that! Thank you!
Incredible work and extremely informative! Do you mind if we share? (With all credit and copyright to you ofcourse)
Thank you. Yes, please share - no restrictions!
Cementation procedure very complicatedand there is a lot of steps 😫😫😩 could I do it like a veneer with resin cement ?
Yes for sure!
Zirconia Will be safer if it is a stronger material
But ceramic Cad CAM constructions Will last forever at once with no chemicals and protect the inner connection and also Help as antivirus & bacteria to save Humanity from all diagnoses via dentistry.
What else can we use for temporary till final cementation?
polycarboxylate cement
❤❤❤❤
Amazing, it was a great series of videos to follow and learn from. One question doc, after cimentation if there is any need for oclusion adjustment, what do you recommend?
Fine diamond, slow speed (10k-15k in electric) followed by Brasseler Dialite LD system. Thank you!
Thank you
can I ask what is the name of the dental technician or technologist he or she mad these restorations?
Mr. Levon Vardumyan of Master Milling Center in Burbank, CA, USA -www.master-milling.com - my friend and business partner. Thank you!
Great video! Wondering why glycerine gel was not used during the cementation with composite to prevent oxygen inhibited layer? assuming there could still be marginal ditching/discoloration even with the peripheral etching? Thanks!
Yes, I make these videos from home and forgot to bring my liquid strip with me for this procedure. You are 100% correct.
To what degree of celcius should we heat the composite to be used for cementation??
55 degrees
@@StevensonDentalSolutions thanks , and all composite could be used ??
How much is this procedure?
Depends on your region in the US and the experience/expertise of the dentist - could be as little as $1000 up to $4000 per tooth.
Lovely..
Thank you Omar - all the best!
How long does such a tooth work?
See previous anser
You are working hard to affect all cells with chemicals as cement.
nice tricks but why didn't you floss before complete curing?
I did - just edited out - thank you
Echa Will save Humanity via rules.
Why dont you like to tack cure?
Tack curing is a great way to clean up resin cement, no doubt. However, when you are trying to create a continuous ceramic-resin-tooth seal, tack curing is counterproductive. In the techniques presented, we use HF etch 500 microns beyond the typical bondable interface of the ceramic margin, not just the intaglio, and bond to the entire meniscus of the ceramic margin, not just the inner surface. The resin cement will thus fill this micro-concavity and prevent staining in the future. Tack curing will disrupt the creation of this, and because the resin is not permitted to fully cure and gain strength - it will be ripped off the ceramic leaving the surface rougher. Dr. Ed McLaren (DDS, Prosthodontist and Master Technician) taught me this about 20 years ago. Since then, no more stained margins. Thank you for the great question. Dr. Stevenson
@@StevensonDentalSolutions Dr. Stevenson Thank you for this thorough reply.
Can we use this technique for anterior ceramic veneers when we are using resin cement? or is it beneficial only for Onlays/Inlays using composite resin types of cement.
And when you say "resin cement will thus fill this micro-concavity and prevent staining in the future" do you mean we blend the excess cement on previously HF etched outer edges of the ceramic or do you mean applying an unfilled/filled adhesive resin on these surfaces to avoid getting future discoloration?
Many thanks
@@amirmo6615 Yes and yes. It is a technique that is applicable to veneers as well and will prevent staining. Best, Dr. S
couldnt find part 4
ruclips.net/video/uHqzsZeblCk/видео.html
AMAZING VIDEOS! Thank you very much for sharing!! Do you have an instagram account?
Richard Stevenson thanks
It is not simple to handle toxicity at all.