This is my video on ferrule effect and biologic width, concepts that come up often in operative dentistry and prosthodontics. Let me know what you want to see next!
Mental Dental, could you add a video of "determine restorability"? As a dental student I am sometimes still confused of when or not we can crown a tooth. Thanks.
Mental Dental, could you add a video of "determine restorability"? As a dental student I am sometimes still confused of when or not we can crown a tooth. Thanks.
Thank you very much, this is a very well explained concept that i was struggling to understand. I liked the way you introduced each concept and used a clinical case to wrap it together!
Very good video on explaoning the ferrule effect and biological width. However I don't understand why you would need such a large crown placed over that last restoration. Why not remove the amalgam, reassess the tooth structure after caries removal. Then consider a composite core and prepare the tooth for an onlay or even an overlay. That would be a lot more conservative and you could place it on sound tooth structure with retentive features incorporated. Also if the tooth were to flare-up or become symptomatic and require endodontic treatment, it would be easier to carry this out through an onlay than a crown for obvious reasons.
That was very helpful! I appreciated that you were drawing lines and reiterating the concepts in relation to what you were talking about (e.g. drawing arrows to indicate the consequences of lateral pressure just on the core instead of tooth + core, ferrule is specifically 1.5mm of natural tooth, etc). It's a much more active form of learning and I wish more professors taught like this because concepts get confusing when we don't know their reference points and powerpoints are just full of images. Thanks again!
Its nice explanation, however if we do crown lengthening on that tooth, bifurcation will be exposed which is one of contraindications for crown lengthening and ortho extrusion. Always have to look at bifurcation when you started thinking about crown lengthening.
i suggest you go to Ray Bertolotti adhesion website ..this is over treatment here on the last molar example ...the biologic width needn't be invaded if the amalgam is removed and a Bonded resin core placed and then the restoration may finally be placed as an occlusal overlay and all the margins are in composite and supra gingival..that would be clinically the best choice here and in most posterior deep margin situations
thanks for sharing your thoughts .. to my knowledge there is a principle that goes the finish line of a prep should be placed on sound tooth structure regarding crowns so i doubt if what u are suggesting violates that .. what do you think? i'm gonna check the website u mentioned, just wanted to discuss
when the margins are so deep and the best crowns have a fit gap of say 30 to 100 micrometers ..you are asking for gingival irritation this deep ..by sealing a resin core with say a SE system like Liner Bond SE or Prelude SE or Premio bond with a DC Light cure core material you know you will have a stable margin deep with no GAP too be filled by a cement with a crown at the same margin...you then place a crown preparation or occlusal overlay as the definitive restoration..I feel this is the way dentistry is now being taught ...and attempting to move away from crowns totally and using modern adhesive dentistry at its best ...theonly crowns we should be placing are replacing crowns ...occlusla overlays like veneers for occlusion on the posteriors is whats being advised in most Biomimetic principles ...Pascal Magne...
yes i agree with you regarding your treatment plan occlusal veneers or onlays or full coverage it is up to you .. i also agree with your choice of composite core and sealing the indirect restoration with light cure resin cement.. what i wanted to comment about is placing ur prep margins on composite itself u are saying "all margins are in composite" if the case is so deep i still want to place my margins on sound tooth structure and that's whats going to determine if the tooth is restorable, because preparing on composite gives weak margins and very low thickness of composite at the finish line, going against resistance principle .. on the other hand if my margins were to be put on sound tooth structure it will have better resistance to occlusal forces because of the remaining root structure. force distribution is hence better whereas in composite margins,okay forces will be transmitted to tooth structure but passing by composite interphase first makes composite vulnerable to fracture at margins
Pascal Magne and his philosophy of Biomimeticdentistry will have a lot to say to u about resistance and retention form when sandblasting and bonded restorations are your primary motivating philosophy...height and width of the core etc had a lot more input as to restorability in the days of Zn phosphate cements in the days of sandblasting then etch wash bonding ...am / dentistry is entering a paradigm shift in thinking ....biologic widths needn't be invaded as per your molar example is my whole point and margins can and must be made in composite resonant placed supragingivally ...regard sJames
in the above case, what about partial ferrule? if you had ferrule everywhere else except the distal box area, would that be considered low risk enough to not have ferrule in that location and proceed with the crown?
If a tooth has an inadequate ferrule, which of the following is an effective strategy to increase tooth structure available for crown preparation? A. Cementation of the restoration with a glass ionomer cement. B. Sub-gingival preparation and prolonged temporization. C. Orthodontic eruption. D. Elective endodontic treatment and a post core. Hey dr. Ryan what might be the answer for this question?
After crown lengthening procedure, if the bone level is at the furcation and crown root ratio is not enough. Is it worth going thru all these procedures, or will u do extraction n implant??
kezia varghese Excellent question! And your reasoning is exactly right. If the furcation were to be exposed or if there would be an inadequate crown root ratio after crown lengthening then the tooth is generally planned for extraction, and considering all other patient factors, may or may not be replaced with something like an implant, bridge, or removable prosthesis.
I have a video on All-Ceramic Crowns (ruclips.net/video/SfCj6FLCGPM/видео.html) but not one on the different types of ceramics specifically. Sounds like a good topic for a future video!
So I understand the concept of biological width. But what is the consequence of violating it. Maybe we have a patient that cannot pay for ortho/crown lengthening but still wants a crown. Can it still be done? What is the consequence of only leave 1mm of biological wide? Mobility? Thanks for the video.
Great question. There is some debate about this, but the potential consequences of violating biological width are gingival inflammation around the restoration, bleeding on probing, gingival recession, pocket formation, clinical attachment loss, and alveolar bone loss. All of these can contribute to an unpredictable effect on the gingival levels leading to a potentially unesthetic restorative outcome if performed in the anterior.
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This is my video on ferrule effect and biologic width, concepts that come up often in operative dentistry and prosthodontics. Let me know what you want to see next!
Do you have videos on fixed partial dentures?
By the way, all your videos are very helpful! Thank you so much for that 😊
What is the difference between core ferrule and crown ferrule
Mental Dental, could you add a video of "determine restorability"? As a dental student I am sometimes still confused of when or not we can crown a tooth. Thanks.
‘Natural attachment that shouldn’t be interrupted’- that was well worded, now I know how to tell it to my patients. Thank you
Hands down the best explanation I’ve ever seen. God bless you.
Wow, thank you! God bless you as well! 🙏🏼
Very useful video, you simplify concepts which are otherwise hard to grasp, thank you very much! :)
Mental Dental, could you add a video of "determine restorability"? As a dental student I am sometimes still confused of when or not we can crown a tooth. Thanks.
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Wish you were one of my teachers .. you have a special way to explain things so clearly, thanks .. keep it up
Mental dental never fails to deliver! Amazing video, thank you!
Thanks for this amazing video. Finally understood these terms
Thank you very much, this is a very well explained concept that i was struggling to understand. I liked the way you introduced each concept and used a clinical case to wrap it together!
Thanks for the positive feedback, glad to hear you found the video helpful!
Very good video on explaoning the ferrule effect and biological width. However I don't understand why you would need such a large crown placed over that last restoration. Why not remove the amalgam, reassess the tooth structure after caries removal. Then consider a composite core and prepare the tooth for an onlay or even an overlay. That would be a lot more conservative and you could place it on sound tooth structure with retentive features incorporated. Also if the tooth were to flare-up or become symptomatic and require endodontic treatment, it would be easier to carry this out through an onlay than a crown for obvious reasons.
I'm very thankful for having you in youtube dental community! you made it very easy for me, thanks again!
I appreciate you watching my videos! You’re welcome! 💯
Thank you very much! Your video is so helpful
That was very helpful! I appreciated that you were drawing lines and reiterating the concepts in relation to what you were talking about (e.g. drawing arrows to indicate the consequences of lateral pressure just on the core instead of tooth + core, ferrule is specifically 1.5mm of natural tooth, etc). It's a much more active form of learning and I wish more professors taught like this because concepts get confusing when we don't know their reference points and powerpoints are just full of images. Thanks again!
Thank you for that excellent feedback. I really appreciate it!
Oh thank you! I finally understood what the ferrule effect means!
You're welcome, that's awesome! :)
Thank you, this was very helpful, could you do some videos about how to make a crown step by step(metal-ceramic, zirconia etc)?
That was really really great THANK YOU
It’s amazing, thank you bro for your help
this is so well explained and easy to understand! thank you so much for your effort!!!
Thank you for the great feedback! 😄
Thank you so much for your work !
You're very welcome! Thank you for watching!
Great video✨
Thank you🙏🏼
Thx, finally I understant it 👏👏
Super helpful!!
Thank you so much! you saved my dental school lyf
Thank you so much
Your video so helpful
ty sooo much for this video it helped me alot
Thank you it was very helpful
Thank you. Great video
Thank you very helpful😌
Thank you very much
That was so helpful. Thank you so much :)
Glad it was helpful! ☺️
Great video
... excellent explanation doc 👍🤠
Glad it was helpful! 🙌🏼😄
Thank you❤❤
Thanks !
Thank you
Thank you so much .
You're very welcome!
Its nice explanation, however if we do crown lengthening on that tooth, bifurcation will be exposed which is one of contraindications for crown lengthening and ortho extrusion. Always have to look at bifurcation when you started thinking about crown lengthening.
excellent
Thank you so much, you are greeaat!! 😀
You're welcome! Thank you for the kind words :)
i suggest you go to Ray Bertolotti adhesion website ..this is over treatment here on the last molar example ...the biologic width needn't be invaded if the amalgam is removed and a Bonded resin core placed and then the restoration may finally be placed as an occlusal overlay and all the margins are in composite and supra gingival..that would be clinically the best choice here and in most posterior deep margin situations
thanks for sharing your thoughts .. to my knowledge there is a principle that goes the finish line of a prep should be placed on sound tooth structure regarding crowns so i doubt if what u are suggesting violates that .. what do you think? i'm gonna check the website u mentioned, just wanted to discuss
when the margins are so deep and the best crowns have a fit gap of say 30 to 100 micrometers ..you are asking for gingival irritation this deep ..by sealing a resin core with say a SE system like Liner Bond SE or Prelude SE or Premio bond with a DC Light cure core material you know you will have a stable margin deep with no GAP too be filled by a cement with a crown at the same margin...you then place a crown preparation or occlusal overlay as the definitive restoration..I feel this is the way dentistry is now being taught ...and attempting to move away from crowns totally and using modern adhesive dentistry at its best ...theonly crowns we should be placing are replacing crowns ...occlusla overlays like veneers for occlusion on the posteriors is whats being advised in most Biomimetic principles ...Pascal Magne...
yes i agree with you regarding your treatment plan occlusal veneers or onlays or full coverage it is up to you .. i also agree with your choice of composite core and sealing the indirect restoration with light cure resin cement.. what i wanted to comment about is placing ur prep margins on composite itself u are saying "all margins are in composite" if the case is so deep i still want to place my margins on sound tooth structure and that's whats going to determine if the tooth is restorable, because preparing on composite gives weak margins and very low thickness of composite at the finish line, going against resistance principle .. on the other hand if my margins were to be put on sound tooth structure it will have better resistance to occlusal forces because of the remaining root structure. force distribution is hence better whereas in composite margins,okay forces will be transmitted to tooth structure but passing by composite interphase first makes composite vulnerable to fracture at margins
Pascal Magne and his philosophy of Biomimeticdentistry will have a lot to say to u about resistance and retention form when sandblasting and bonded restorations are your primary motivating philosophy...height and width of the core etc had a lot more input as to restorability in the days of Zn phosphate cements in the days of sandblasting then etch wash bonding ...am / dentistry is entering a paradigm shift in thinking ....biologic widths needn't be invaded as per your molar example is my whole point and margins can and must be made in composite resonant placed supragingivally ...regard sJames
ahh..i got you and i'd love to hear about prognosis studies that back up this approach .. it would make life much easier.
thanks for the discussion
Great!!!
You also have to consider the biotype, whether it's thick or thin for gingival recession
in the above case, what about partial ferrule? if you had ferrule everywhere else except the distal box area, would that be considered low risk enough to not have ferrule in that location and proceed with the crown?
thank you thankyouuuu
You're welcome!
Lovely
Sir how can we give it in a case where we have just root stumps and no crown structure
If a tooth has an inadequate ferrule, which of the
following is an effective strategy to increase tooth
structure available for crown preparation?
A. Cementation of the restoration with a glass
ionomer cement.
B. Sub-gingival preparation and prolonged
temporization.
C. Orthodontic eruption.
D. Elective endodontic treatment and a post core.
Hey dr. Ryan what might be the answer for this question?
Surgical crown lengthening or orthodontic extrusion (answer C) would be the best ways to increase ferrule.
After crown lengthening procedure, if the bone level is at the furcation and crown root ratio is not enough. Is it worth going thru all these procedures, or will u do extraction n implant??
kezia varghese Excellent question! And your reasoning is exactly right. If the furcation were to be exposed or if there would be an inadequate crown root ratio after crown lengthening then the tooth is generally planned for extraction, and considering all other patient factors, may or may not be replaced with something like an implant, bridge, or removable prosthesis.
do you have a video about different types of ceramics and their classifications
I have a video on All-Ceramic Crowns (ruclips.net/video/SfCj6FLCGPM/видео.html) but not one on the different types of ceramics specifically. Sounds like a good topic for a future video!
@@mentaldental yeah i'm looking forward for it, quite a complicated one.
how much long tooth without ferrule comparatively with tooth with it ?
I really loved this video
I’m glad you enjoyed it!
So what’s the scientific limit to stay away from biological width when prepping a tooth for a crown in mm?
So I understand the concept of biological width. But what is the consequence of violating it. Maybe we have a patient that cannot pay for ortho/crown lengthening but still wants a crown. Can it still be done? What is the consequence of only leave 1mm of biological wide? Mobility? Thanks for the video.
Great question. There is some debate about this, but the potential consequences of violating biological width are gingival inflammation around the restoration, bleeding on probing, gingival recession, pocket formation, clinical attachment loss, and alveolar bone loss. All of these can contribute to an unpredictable effect on the gingival levels leading to a potentially unesthetic restorative outcome if performed in the anterior.
All of this bone you’ll loose through violating biological width is bone support you won’t have for a later implant.
👌👌
which playlist is this video in???? plz help
This video is not in a playlist! It is a standalone video to describe a difficult dental concept.
Mental Dental thank u dr, glad to be one of the patreons as well m thanks for your continuous output & help
i love you
What about BW IF I REMOVE THE BONE IT WILL BE VOLATILE?
Why doesn't the right one say "crown"?
welcome to implantology
Thanks!
You're welcome! Hope you found the video helpful.