watching these instructional videos is almost like watching a cooking show or a home renovation show. it's just so relaxing. quite a nice result all the way around. i learn a lot from watching your videos.
I really appreciate it, thankyou very much, corona pandemic push me learn form home and I almost got nothing, because your video I learn better, I hope I can be a good dentist like you 🙏🏻🙏🏻
Truly the best Dental procedures channel up till now ! Thank you, for all the value your creating among us who are following you! The presentations are very professional and incredibly informative.Please keep adding,for all that you put out; it shall be returned to you in a greater sum! Thank you
Hello Dr. Stevenson, I greatly appreciate all your didactic videos. It really inspires in achieving daily clinical excellence ! I have few questions ! Under what circumstances would you prefer to restore a tooth with composite materials over conventional crowns such as (L.D or Zirconia) for this onlay prepped tooth? What are some relative contraindications or conditions for composite restoration for such heavily prepped tooth?
Hi - sorry I missed this question and took so long to respond! I use this technique whenever a patient is short on funds and really needs an onlay, like a cracked tooth, or wear, or even after an RCT. It will provide them with a decent service which may later be treated with a stronger material. Surprisingly though, these hold up very well if they may be maintained and the patient is not a bruxer. When I can't achieve good isolation, these are contraindicated and this often occurs on second molars.
@@StevensonDentalSolutions That is beautiful work doc. I have used this in my own practice a couple of times in the past when there was someone traveling from out of town who needed something fixed on the fly but would not be able to come back for a crown from a lab some time later. However, now that I have a chairside milling machine I am very happy to use the Camoflauge blocks to mill these so I don't have to spend a whole lot of time creating something like that.
Great video as usual. My school only allows circumferential matrix. Can you please advise on how to do buccal cusp replacement of upper premolars in composite?
Incrementally. Divide and conquer the void. Add from the gingival and work up. Overbuild the buccal cusp and finish it back based on the anatomy of the quadrant.
Hi Doc, this is one of my planned series: Fiber post build-up, Steel post build-up, core build-up (no post), and Pin build-up. Thank you for reinforcing my decision! Should be released early next year...
Hello ur videos are amazing, Iam in Dental school but I still learn alot from you... Btw can u maybe post a video for when u want to do a aesthetic restoration like u explain for this one but for a second molar where u have to use a rubber dam with the hook on the second molar too (last tooth).
I don't advocate feather edge margin designs as used in the Vertical Crown prep technique - they don't respect the material properties of ceramics and although they are easier to perform for the dentist, we (as a lab owner) have significantly more trouble milling or pressing these cases. One of the biggest contraindications for zirconia is a marginal thickness of less than 0.5 mm. They may work for gold, but only with an excellent technician. Sorry!
Good day Dr stevenson I am just hoping that if you can make a video for temporary crown fabrication as iam still struggling with that and my exam is due next month I truly appreciate your help
I believe it can be done, at least as a very good temporary. The endodontic community in the US recommends "cuspal protection" on all posterior teeth, however, even this minimum requirement is being challenged. Perhaps an intracoronal bonded restoration will suffice in certain cases, where enough tooth structure remains and the occlusal function is favorable. More research will show us the best choices. Thank you Doctor - great question!!!
Yes, the issue isn't retention, it's durability under occlusal loads, which is less than gold or ceramics. These are reasonable long term temporary restorations.
Hey Dr. Stevenson. I can't thank you enough for all these great videos you have on your channel. Enjoying every single one of them. I have a couple of questions if you don't mind me asking 1st I'd like to know if at some point in the future patient wants to opt for ceramic, do we have to remove all the composite and take an impression from the original cavity for ceramic onlay or we can just do a sort of new onlay preparation on the composite? 2nd If we keep the composite and prep. on top of it for ceramic onlay, should the margins of the ceramic ends on tooth structure or just on composite would be fine? If it should be placed past the composite, how many millimeters should it go beyond the composite margins on facial, lingual and boxes? 3rd From your point of view, how good of an option is to restore a vital tooth with thin walls with composite first and then prepare it for ceramic onlay instead of reducing the cusp's height to a point where there's enough dentin support and then place the ceramic onlay direct on tooth? Would the tooth and ceramic's resistance to fracture be effected if we placed the ceramic restoration on top of the composite rather than on tooth directly? Forgive me for asking so many questions here. I understand if you couldn't answer them. Many thanks Cheers!
No problem - happy to reply: 1. If the composite was place fairly recently and you find no leakage, leaving it as a block out would be ideal. I would attempt to prepare the new cavity with none of the composite covering enamel - in other words, using the initial composite as a dentin replacement. 2. I typically prepare these on enamel margins except when performing a GEME procedure. With the Gingivally Extensive Margin Elevation, however, I would use RMGI in lieu of composite for reasons I have highlighted in the GEME video. 3. It's great question, because in small unpublished studies I performed at UCLA, we found that the bonded composite can work well to support undermined cusps... but little or no good published evidence supports this. It occlusion is favorable and forces are no stressing these areas, good clinical judgement would say, yes. it's a reasonable approach.
Thanks for this beautifuly presented tutorial. I have one question, do you advocate doing the same on a prepped model made from an impression of a patient and then later on cementing that with a resin cement back on to the tooth. Regards
Yes, this works really well - the indirect direct technique...But I'd recommend Mach II by Parkell and not stone for the model, as Mach II is flexible and releases the restoration after curing easier. If you can't locate Mach II, use a stiff bite reg material - simply pour up the alginate (not PVS) impression with the bite reg
Doctor such a nice work. May I ask you what type of polishing kit being used. Can you provide us the brand of the cup, point, and the spiral polisher. thanks
Dr stevenson good day Sometimes specially on typodont teeth when we finish the composite and dry it with triplex while polishing the filling ,incremental lines appear on the actual composite how can we prevent that? Thanks so much
Dr Stevenson Thank you so much for your great video. They inspire me!!!! One question: If you decide to make an onlay restoration on a tooth that has one intact marginal ridge how would you deal with it. Should we break the contact intentionally or not? If not, should we use a rigid matrix like tofflemire and a wedge?
Great question: I'd suggest always breaking the contact when a box is indicated. - when we don't, the lab must carefully separate the connected stone dies and this easily leads to marginal defects. If you scan it, you have other issues, like delineating the exact margin location. When there is no need to drop a box, you may completely spare the marginal ridge and perform an Inlay/Onlay. Best, Dr. S
@@StevensonDentalSolutions Thank you so much Dr S. Yet,, my question was about direct restoration with composite, in cases where there is a (thin) remaining marginal ridge and we decide to cover it with composite in the same visit. Should we prepare 2mm or more? If we prepare just 2mm, the contact won't be totally broken. In this scenario which matrix would you recommend to use. Thanks a lot doc.
I would not touch the marginal ridge in this case and perform an MO or DO direct composite onlay - it’s a cool prep design which I’ll share in a vid soon. If you must include the MR I’d break contact.
Watching this over and over again and how awesome it is
Cool - thank you!
watching these instructional videos is almost like watching a cooking show or a home renovation show. it's just so relaxing.
quite a nice result all the way around. i learn a lot from watching your videos.
Great - good thing to relax...
Excellent result looks so real and natural. Outstanding not just ok!!
thank you, Dr. S
great two video experience! very nice result. i woud have liked to have seen the finishing of the cervical margins. thank you SO much!
Thank you doc...sorry about that. I do use #12 blade, then 3M or EpiTex finishing strips - never bur at the cervical.
No words to describe the beauty of your work
Thank you Ali, Dr. S
I wish my dentist was such an artist.
Oh, thank you.
Great job, Dr. Stevenson from Mexico, I'm your fan too.
And proud to see you, great teacher. Grateful of you.
Thank you Doctor!
I really appreciate it, thankyou very much, corona pandemic push me learn form home and I almost got nothing, because your video I learn better, I hope I can be a good dentist like you 🙏🏻🙏🏻
Great! I wish you the best.
One of the best Dental videos ever to have sought after !!! extremely satisfying and useful !!!
Great! Thank you for watching doctor.
"The final result turned out ok" alright Mr Humble.
another series of excellent composite videos Dr Stevenson, thank you so much! we learn so much with every video, keep up the great work!
Thank you Just Peace - really appreciate your support and comments!
Appreciate that Dr stevenson it's so helpful thank u just need to follow your videos in step by step
Wish you always all the best
Great - thank you!
Outstanding 😍
Thank you!
Excellent esthetics. Very well done.
Thank you!
Beautifully placed.. i love all your videos....tremendously helpful.
Thank you!
Great work👏🏽 Thank you!
Thank you Doctor! Will keep at it.
Hey! Just found your channel. Im a dental student from austria. Just am amazed by your videos! Really appreciate your work! Thanks a lot
Great! Thank you for watching!
Truly the best Dental procedures channel up till now ! Thank you, for all the value your creating among us who are following you! The presentations are very professional and incredibly informative.Please keep adding,for all that you put out; it shall be returned to you in a greater sum! Thank you
You are a gift
Bless you
Amazing and thank you very much
exelent vedios that help me in my clinic on daily basis exept how you sculpt composite needs lots of skills that i personaly dont have !!
Thank you Doctor
I wish some day I do something like this , I should practice more and more
Thank you for your inspirational work
Thank you Doctor
Awesome content as usual! Killing the TH-cam game Dr. Stevenson - Sami UCLA 16’
Hi Sami - thank you and it''s great to have a former Bruin on board!
dr stevenson that's lovely amazing work that one can learn a lot from it
thank you so much for your great videos
Thank you Doc - appreciate the support.
Beautiful work
Thank you Doctor.
Turned out ok ??? Its beyond amazzzzingg
Too nice.
Amazing Doc....beautiful..!!
Thank you!
Thank you dr Stevenson , you are a great help
Thank you Doc!
You are the best merci beaucoup 💎
Thank you for watching!
wonderful work and explanation!
Thank you Doc!
Excellent video
Thank you Doctor!
Thank you dr for the amazing video. I’ve learned a lot🙏🏻I love your channel and your content🌸
Thank you! I appreciate your support. Dr. S
U r amazing sir ... Learn lots things from u....
Thank you Doctor!
amazing thank you Dr.S
Thank you!
Hello Dr. Stevenson, I greatly appreciate all your didactic videos. It really inspires in achieving daily clinical excellence !
I have few questions ! Under what circumstances would you prefer to restore a tooth with composite materials over conventional crowns such as (L.D or Zirconia) for this onlay prepped tooth?
What are some relative contraindications or conditions for composite restoration for such heavily prepped tooth?
Hi - sorry I missed this question and took so long to respond! I use this technique whenever a patient is short on funds and really needs an onlay, like a cracked tooth, or wear, or even after an RCT. It will provide them with a decent service which may later be treated with a stronger material. Surprisingly though, these hold up very well if they may be maintained and the patient is not a bruxer. When I can't achieve good isolation, these are contraindicated and this often occurs on second molars.
@@StevensonDentalSolutions That is beautiful work doc. I have used this in my own practice a couple of times in the past when there was someone traveling from out of town who needed something fixed on the fly but would not be able to come back for a crown from a lab some time later. However, now that I have a chairside milling machine I am very happy to use the Camoflauge blocks to mill these so I don't have to spend a whole lot of time creating something like that.
excellent video! please keep up the great work!
Appreciate your support doc! Thank you.
Very helpful content, thank you!!
Great, thank you!
Really, Perfect job 👍🏻
Thank you Doc
U R most welcome Doc
@@saeedal-gadhaan3526 Nice
Great video as usual. My school only allows circumferential matrix. Can you please advise on how to do buccal cusp replacement of upper premolars in composite?
Incrementally. Divide and conquer the void. Add from the gingival and work up. Overbuild the buccal cusp and finish it back based on the anatomy of the quadrant.
Speechless Amazing 👏🏾👏🏾👏🏾😍😍
Thank you Doc! I'll keep at it...
you are amazing , thanks for sharing wish all the best
Thank you for your encouragement - happy to share.
very nice and amazing
You are very nice - thank you, Doc.
Thanks for your magnificent work, doctor.
Can you please upload videos on post & core preps?!
Thanks in advance...
Hi Doc, this is one of my planned series: Fiber post build-up, Steel post build-up, core build-up (no post), and Pin build-up. Thank you for reinforcing my decision! Should be released early next year...
Hello ur videos are amazing, Iam in Dental school but I still learn alot from you... Btw can u maybe post a video for when u want to do a aesthetic restoration like u explain for this one but for a second molar where u have to use a rubber dam with the hook on the second molar too (last tooth).
Sounds like one of my soon to be made projects! Good suggestion.
Thanks a lot for the fabulous video Sir! Absolutely great content! Dr. Stevenson, could you please upload videos on Verti crown preps? Thanks
I don't advocate feather edge margin designs as used in the Vertical Crown prep technique - they don't respect the material properties of ceramics and although they are easier to perform for the dentist, we (as a lab owner) have significantly more trouble milling or pressing these cases. One of the biggest contraindications for zirconia is a marginal thickness of less than 0.5 mm. They may work for gold, but only with an excellent technician. Sorry!
Thanks a lot for the info Dr. Stevenson
Good day Dr stevenson I am just hoping that if you can make a video for temporary crown fabrication as iam still struggling with that and my exam is due next month
I truly appreciate your help
I have this in the queue
Is it possible to do this kind of restoration on a tooth thats has a root canal treatment done?
I believe it can be done, at least as a very good temporary. The endodontic community in the US recommends "cuspal protection" on all posterior teeth, however, even this minimum requirement is being challenged. Perhaps an intracoronal bonded restoration will suffice in certain cases, where enough tooth structure remains and the occlusal function is favorable. More research will show us the best choices. Thank you Doctor - great question!!!
Magic,and marvellous ,...❤️🙏
Sir how do u polish interdentally and at gingival seal???
I do, usually with a series of 4 progressively finer grits on finishing strips. Thank you!
Will there be retention of the composite
Yes, the issue isn't retention, it's durability under occlusal loads, which is less than gold or ceramics. These are reasonable long term temporary restorations.
Hey Dr. Stevenson.
I can't thank you enough for all these great videos you have on your channel. Enjoying every single one of them.
I have a couple of questions if you don't mind me asking
1st I'd like to know if at some point in the future patient wants to opt for ceramic, do we have to remove all the composite and take an impression from the original cavity for ceramic onlay or we can just do a sort of new onlay preparation on the composite?
2nd If we keep the composite and prep. on top of it for ceramic onlay, should the margins of the ceramic ends on tooth structure or just on composite would be fine? If it should be placed past the composite, how many millimeters should it go beyond the composite margins on facial, lingual and boxes?
3rd From your point of view, how good of an option is to restore a vital tooth with thin walls with composite first and then prepare it for ceramic onlay instead of reducing the cusp's height to a point where there's enough dentin support and then place the ceramic onlay direct on tooth?
Would the tooth and ceramic's resistance to fracture be effected if we placed the ceramic restoration on top of the composite rather than on tooth directly?
Forgive me for asking so many questions here. I understand if you couldn't answer them.
Many thanks
Cheers!
No problem - happy to reply:
1. If the composite was place fairly recently and you find no leakage, leaving it as a block out would be ideal. I would attempt to prepare the new cavity with none of the composite covering enamel - in other words, using the initial composite as a dentin replacement.
2. I typically prepare these on enamel margins except when performing a GEME procedure. With the Gingivally Extensive Margin Elevation, however, I would use RMGI in lieu of composite for reasons I have highlighted in the GEME video.
3. It's great question, because in small unpublished studies I performed at UCLA, we found that the bonded composite can work well to support undermined cusps... but little or no good published evidence supports this. It occlusion is favorable and forces are no stressing these areas, good clinical judgement would say, yes. it's a reasonable approach.
@@StevensonDentalSolutions Thank you Doctor for taking the time and reply
Appreciate your works, videos , and your replies
Best
Very nice restoration ! Would you do a composite onlay like this on a root canal treated tooth as well?
Wow!💙💙
Sick!
Thanks for this beautifuly presented tutorial. I have one question, do you advocate doing the same on a prepped model made from an impression of a patient and then later on cementing that with a resin cement back on to the tooth.
Regards
Yes, this works really well - the indirect direct technique...But I'd recommend Mach II by Parkell and not stone for the model, as Mach II is flexible and releases the restoration after curing easier. If you can't locate Mach II, use a stiff bite reg material - simply pour up the alginate (not PVS) impression with the bite reg
Doctor such a nice work. May I ask you what type of polishing kit being used. Can you provide us the brand of the cup, point, and the spiral polisher. thanks
Brasseler Diacomp system (Cup, Point and FeatherLite) - available from stevensondentalsolutions.com Thank you for watching!
while correction of facial embrasure why we need to etch the old composite ?bond only is enough or what ??
Just a little etch to clean the surface.
Dr. Steven do you recommend direct composite onlay for badly destructed endodontically treated lower molars as well?
Not as the longest lasting solutions, no, but as an alternative to nothing, yes.
Dr stevenson good day
Sometimes specially on typodont teeth when we finish the composite and dry it with triplex while polishing the filling ,incremental lines appear on the actual composite how can we prevent that?
Thanks so much
Use water, spin from composite to tooth, use a light touch.
Thanks Dr
May i ask for the selective etching approach do we need to use flowable composite?
No - a paste compote will have equal bond.
@@StevensonDentalSolutions what do you prefer the total etch or the selective one ? Clinically is ther any differece
hello dr do u ficus on the second plane palatally, whe i do the occlusal table reduces
Not sure I understand...sorry
@@StevensonDentalSolutions The 15 has a slight second plane? Please correct me.Thank you
@@someonesomeday1 yes it does to support the enamel and increase bond strength.
My choice thanks *****
Thanks!
Beautiful work
Thank you Dr. Lim - appreciate your comment!
thank you so much for your video , love your work
Thank you Doc!
Dr Stevenson Thank you so much for your great video. They inspire me!!!! One question: If you decide to make an onlay restoration on a tooth that has one intact marginal ridge how would you deal with it. Should we break the contact intentionally or not? If not, should we use a rigid matrix like tofflemire and a wedge?
Great question: I'd suggest always breaking the contact when a box is indicated. - when we don't, the lab must carefully separate the connected stone dies and this easily leads to marginal defects. If you scan it, you have other issues, like delineating the exact margin location. When there is no need to drop a box, you may completely spare the marginal ridge and perform an Inlay/Onlay. Best, Dr. S
@@StevensonDentalSolutions Thank you so much Dr S. Yet,, my question was about direct restoration with composite, in cases where there is a (thin) remaining marginal ridge and we decide to cover it with composite in the same visit. Should we prepare 2mm or more? If we prepare just 2mm, the contact won't be totally broken. In this scenario which matrix would you recommend to use.
Thanks a lot doc.
I would not touch the marginal ridge in this case and perform an MO or DO direct composite onlay - it’s a cool prep design which I’ll share in a vid soon. If you must include the MR I’d break contact.
So beautiful 😍
Thank you - I appreciate you watching.
At 6:55 are you applying bond to the composite?
modeling resin
@@StevensonDentalSolutions what's the purpose of modelling resin?