Thank you Dr Stevenson for all the tips. My question: I tend to line my dentine with vitrebond or Gc Liner regardless whether it is deep or shadow prep. In fact I will do a close sandwich technique with deep filling n have fuji 9 as a base. Can you pls offer your opinion as most colleagues find that my technique has weak bond strength. Should I just keep lining to deep dentine? I personally find that my fillings have less sensitivity comparatively. And, IDS is only indicated for prep with indirect restorations right? Thank you
I would check with your Komet rep - they can convert the Brasseler numbers to the European numbering system. Our website does have these available in kits but it might be less costly to obtain from a local dealer.
The IDS show great bond between the adhesives to the dentin in studies by pascal magne. But this technique requires bonding of "new" resin, to "old" resin if you have a period of time for the technician to manufacture the restoration. In our clinic its usually 14 days. How well is the bond between the warm composites to the resin the the filled adhesives that were put in IDS?
IDS is not exactly showing better results (longevity) according to recent clinical trials and systematic reviews. I still use this technique but many are abandoning it...Lab studies always show IDS to be better but it's a different matter in the clinical arena. I believe that our best help in assuring longevity comes from prep design (with more traditional retention and resistance forms) and also substantial quantities of enamel.
What is the name of filled bonding agent ( trade name ) and what is advantage of using of filled bonding agent . And who or which company sells glycerine while doing IDS. Please advise . Thanks
OptiBond FL (Kerr). Filled adhesives are stronger and secure the hybrid layer with less degradation. You may purchase glycerine through Ivoclar - the product name is Liquid Strip. www.net32.com/ec/liquid-strip-glycerin-gel-applicator-syringe-single-d-23382?adpos=&scid=scplp23382&sc_intid=23382&gad_source=1&gclid=Cj0KCQiAyeWrBhDDARIsAGP1mWRbhsSmL-Q4iKRDAOkLUzdbcNpXKxHGQXy3TmxBaNJf9hkx2gfRGVQaAvKWEALw_wcB
The shoulder may be anywhere it needs to be based on the quality of the remaining structure. Usually in the most conservative situations, it resides at the base of the A plane (Functional Cusp Bevel), or approximately level with the pulpal wall.
Hi Dr. Stevenson, hope you’re staying well during this time. I have a few questions that I would greatly appreciate your response to. What is the opaque white material on the preps (beautiful BTW) at 11:48? Is that core build up material, e.g. ParaCore? Is the build up completed after IDS? I tried the DME technique with the modified tofflemire band but had a lot of trouble getting the band through the unprepared contact (for example, distal contact on a MO onlay). Also, the band constantly tears as I’m tightening it. Perhaps, I’m over tightening? Have you experienced these issues and if so, any advice? Thank you!
ParaCore white, placed over glass ionomer before IDS. For the DME technique, place a spoon excavator in the gingival embrasure of the unprepared side and twist or lever to lessen the contact intensity and the bands will slip through. Use 0.0015” matrix material - it will not break when tightened. Thank you for the excellent questions !
good morning Dr stevenson, i'm very thankful for your video, however i have some question, do we have to air blown the bonding, before putting the glycerin gel and light cured it? thank you
Not at all - onlays remove about 1/2 the tooth structure of a crown. Less than 5% of dentists have the skills to perform these. And even fewer use rubber dam and magnification. Select carefully!
@@preetleo09 I did my first margin elevation in 1988 and though that I would be sued! It works great. I kept this quiet for nearly 30 years...now it's widely used.
Hi Dr Stevenson thank you for the excellent video! I have one question, normally I've seen curing of the adhesive and then application of glycerine + plus further curing. You placed the bond, then glycerine and then cured. Will glycerine interfere with the bond when done this way? Thank you
The glycerin is to eliminate the air inhibited layer. If you add the glycerin after curing, the composite polymers have already bonded to oxygen, hence they can’t be inhibited. The glycerin and the bonding agents will not mix together as they have different polarities (hydrophilic and hydrophobic) Thank you fir the very thoughtful question!
For direct restorations and IDS I use OptiBond FL (Kerr) (4th gen) and for indirect I use ScotchBond Universal (3M) (8th gen) with RelyX Ultimate Reson Cememt for posteriors and RelyX Veneer for anteriors.
We often having dentists from all over the world attend, however, it is very expensive, considering travel costs. I do have webinars coming up that are free - check this out: Univet Optical is sponsoring me for a 5 part series on Ceramics, starting December 8 at 6:00 pm Pacific Time - check out there website for the link.
@@StevensonDentalSolutions thank you sir🙏your videos are lifesaving, you are helping our dental community in number of ways we are so thankful to you u r doing a great job keep it up sir🙏
For everything if you wish. I use a filled adhesive for every bonding procedure - numerous prospective clinical trials show it to be superior to infilled products.
Great video! but we did use a RMGIC as a liner earlier so won't that interfere with IDS? because there doesn't seem to be any exposed dentin in tooth 1.7
True - very little exposed dentin in 17. It's a judgement call - some use no RMGI others use lots of it. In this video I used a lot, but it can be done with much less, thereby taking advantage of IDS. I usually place an RMGI in the deepest areas only and this provides for a long term albeit weak bond to dentin, with the IDS being of benefit with the more shallow dentin.
Stevenson Dental Solutions that makes a lot of sense :) Thank you so much for posting. I’m a new grad and you’re videos have been tremendously helpful!
May I also ask you, if polishing is enough for removal of the air inhibited layer, or glycerin use is a must?? (and if polishing may remove the bonded hybrid layer, if used solo without flowable composite)
@@StevensonDentalSolutions Thank you so much for your reply, but may I ask you, the oxygen inhibited layer is a must to bond composite layers to each other. when we remove it, won't the bond to the resin cement be weaker, hence the oxygen inhibited layer responsible for adhesion is removed, as it will be similar to bonding or repairing an old composite with the conventional methods. Or is sandblasting a crucial step to compensate for the oxygen inhibited layer that we removed, like when bonding to an old composite, you have to sandblast it and others even apply MDP to achieve a proper bond
At the time of the finished preparation. The theory is that the dentin is best sealed when it is freshly cut, with the hope that it is better preserved as a hybrid layer and less likely to degrade over time. Also, it is assumed that it will be more resistant to moisture contamination and subsequent micro leakage. Patients do report slightly lower post prep sensitivity with IDS. HOWEVER! Recent systematic reviews of IDS show that it is of little help in longevity of the restoration. It looks like the IDS approach may not be worth the effort, but more clinical trials will expose the best evidence.
OptiBond FL is filled. Most other 4th gens are filled but OptiBond FL is the most filled. If you have a doubt, use flowable on top of the adhesive for the biomimetic seal.
Great effort as usual, may I ask you if scotch bond adhesive from 3m is considered as a filled adhesive?? so can I use it solo for IDS or does it need flowable composite on top??
With a normal occlusal scheme for cases requiring onlays: 1. I always cap functional cusps, 2. Shoe Non-functional cusps, 3. Cap non-functional cusps when required due to structural compromise or existing defects/caries/etc. that would merit capping. Thank you for the question!
Great video with great input! I am wondering how the composite during cementation process bonds to the sealing layer. Maybe you could give an answer to this =)
The surface is air-abraded and then re-etched at the delivery appointment, then this surface is treated again with primer and adhesive, allowing ample double methacrylate bonds to copolymerize with the resin cement. Thank you, Doc!
Hi Dr Stevenson, do you know if porcelain fillings can be easily removed without damaging them in order to replace the adhesive cement used to attach them?
Dr. Stevenson, do you normally etch with the polycarboxylic acid before placing GI/RMGI liner? Would this enhance the bone strength in a clinically significant way? Thank you in advance!
No I do not - the bond strength doesn't need to be enhanced much and the PAA is potentially injurious to the pulp in a deep cavity. I do use PAA for GI restorations, which rely on adhesion for better seal with the oral environment.
Thank you Eric! I'm currently using OptiBond FL (KavoKerr), but I'm leaning towards a universal like Scotchbond Universal - the clinical trials are steadily being published and are very encouraging.
For OptiBond FL (and other 4th gens) no curing is required after primer application, just air thining, followed by the adhesive. Different products have different protocols, so it's best to follow the manufacturer's recommendation. For cementation, if the onlay or inlay is reasonably translucent, and I'm using a total-etch multiple step system like OptiBond FL, I will not cure until the restoration is cemented. Alternately, you could use a Dual Cure Activator (DCA)with a universal system or even a universal system without a DCA (Scotch Bond Universal) with cement which has the DCA in the cement itself, like RelyX Ultimate Cement. The latter technique is preferred when the ceramic is thick and will not allow for adequate curing through the restoration.
Hi Dr Stevenson..I've been following ur videos since many years...thank you for the great info in every video u share... for IDS i have two questions.. first: in this video you air dry the primer but NOT the filled resin...is that deliberately done and should the same be done whenever we use a filled adhesive? second: I always see dentin sensitivity at cementation appointment even when I have followed the proper steps under rubber dam? Is that because I air dry the filled resin to a thin layer? Best Regards...
Incredible video, best I have seen on IDS thus far. Truly world class work thanks Dr. Stevenson!
Thank you Chris - will keep at it...
Thanks so much Dr. STEVENSON 👍👍
My pleasure!
Thanks Doc. 😘
Thanks
Thanks for the big effort, cannot wait for the impression + video
Thank you Yazan!
Greetings from egypt.. Great Channel.. Great effort.. Great mentor 👏
Greetings - thank you!
Thank you Doc - all the best, Dr. S
I'm thinking from where you take the ceramic
Thank you Dr Stevenson for all the tips. My question: I tend to line my dentine with vitrebond or Gc Liner regardless whether it is deep or shadow prep. In fact I will do a close sandwich technique with deep filling n have fuji 9 as a base. Can you pls offer your opinion as most colleagues find that my technique has weak bond strength. Should I just keep lining to deep dentine? I personally find that my fillings have less sensitivity comparatively.
And, IDS is only indicated for prep with indirect restorations right? Thank you
Dr. Are these burrs and other instruments for measurements used for these video series available in a kit for purchase?
I would check with your Komet rep - they can convert the Brasseler numbers to the European numbering system. Our website does have these available in kits but it might be less costly to obtain from a local dealer.
The IDS show great bond between the adhesives to the dentin in studies by pascal magne. But this technique requires bonding of "new" resin, to "old" resin if you have a period of time for the technician to manufacture the restoration. In our clinic its usually 14 days. How well is the bond between the warm composites to the resin the the filled adhesives that were put in IDS?
IDS is not exactly showing better results (longevity) according to recent clinical trials and systematic reviews. I still use this technique but many are abandoning it...Lab studies always show IDS to be better but it's a different matter in the clinical arena. I believe that our best help in assuring longevity comes from prep design (with more traditional retention and resistance forms) and also substantial quantities of enamel.
Great videos, thank you doctor. I appreciate your work.
My pleasure - thank you for watching!
greaaat videoooooo waiting for video 4 :D thanksss all the way from méxico
Muchas Gracias!
Greeting from Middle East IRAQ
THANKS TO SHARING YOUR KNOWLEDGE
REGARD
Thank you for watching and sharing!
Hello Doctor, thanks for the presentation..please make a presentation about occlussion and bite rigestration..wish u luck
I will - great suggestions! I do have this: th-cam.com/video/n0dsvF_Zlwc/w-d-xo.html
What is the name of filled bonding agent ( trade name ) and what is advantage of using of filled bonding agent . And who or which company sells glycerine while doing IDS. Please advise . Thanks
OptiBond FL (Kerr). Filled adhesives are stronger and secure the hybrid layer with less degradation. You may purchase glycerine through Ivoclar - the product name is Liquid Strip. www.net32.com/ec/liquid-strip-glycerin-gel-applicator-syringe-single-d-23382?adpos=&scid=scplp23382&sc_intid=23382&gad_source=1&gclid=Cj0KCQiAyeWrBhDDARIsAGP1mWRbhsSmL-Q4iKRDAOkLUzdbcNpXKxHGQXy3TmxBaNJf9hkx2gfRGVQaAvKWEALw_wcB
If l am going to use a layer of flowable composite, should I add glycerine to uncured flowable then cure it through the glycerin
Yes - this would be the alternative IDS technique from a 4th gen, like OptiBond FL.
Dr. How far(millimeter) from the occlusal surface do you place that palatal shelf for onlays? Thanx!
The shoulder may be anywhere it needs to be based on the quality of the remaining structure. Usually in the most conservative situations, it resides at the base of the A plane (Functional Cusp Bevel), or approximately level with the pulpal wall.
Hi Dr. Stevenson, hope you’re staying well during this time. I have a few questions that I would greatly appreciate your response to.
What is the opaque white material on the preps (beautiful BTW) at 11:48? Is that core build up material, e.g. ParaCore? Is the build up completed after IDS?
I tried the DME technique with the modified tofflemire band but had a lot of trouble getting the band through the unprepared contact (for example, distal contact on a MO onlay). Also, the band constantly tears as I’m tightening it. Perhaps, I’m over tightening? Have you experienced these issues and if so, any advice? Thank you!
ParaCore white, placed over glass ionomer before IDS. For the DME technique, place a spoon excavator in the gingival embrasure of the unprepared side and twist or lever to lessen the contact intensity and the bands will slip through. Use 0.0015” matrix material - it will not break when tightened. Thank you for
the excellent questions !
Stevenson Dental Solutions I’ll give it a try! Thank you very much!
wich adhasives are filled adhesive?
Many are - it's always changing - it's best to inquire directly to the manufacturer.
good morning Dr stevenson, i'm very thankful for your video, however i have some question, do we have to air blown the bonding, before putting the glycerin gel and light cured it? thank you
Thank you for your question. We must evaporate the solvent and cure for a few seconds, then apply glycerine and cure fully.
So these teeth didn’t necessarily need root canal’s?
Not at all - onlays remove about 1/2 the tooth structure of a crown. Less than 5% of dentists have the skills to perform these. And even fewer use rubber dam and magnification. Select carefully!
Beautiful... Thanks a lot Dr. Stevenson.
My pleasure!
Do we have to smoothen the pulpul floor in the same level?
Not necessary - just make it relatively flat with rounded internal line angles and adequate depth. Thank you
@@StevensonDentalSolutions Thank you Sir.
My pleasure.
In case of a subgingival proximal box....can the margin of the inlay rest on the composite/ RMGIC?
Yes, this is a margin elevation technique - the research is minimal but it seems to work well.
@@StevensonDentalSolutions Thank you sir...i have been practicing it for more than 5yrs now but have always been sceptical about the result
@@preetleo09 I did my first margin elevation in 1988 and though that I would be sued! It works great. I kept this quiet for nearly 30 years...now it's widely used.
Dr When you say ceramic do you mean e_max?
glass-ceramic, lithium disilicate, IPS e.max, yes
Hi Dr Stevenson thank you for the excellent video! I have one question, normally I've seen curing of the adhesive and then application of glycerine + plus further curing. You placed the bond, then glycerine and then cured. Will glycerine interfere with the bond when done this way? Thank you
The glycerin is to eliminate the air inhibited layer. If you add the glycerin after curing, the composite polymers have already bonded to oxygen, hence they can’t be inhibited. The glycerin and the bonding agents will not mix together as they have different polarities (hydrophilic and hydrophobic)
Thank you fir the very thoughtful question!
Sir, you are great♥️
Thank you for watching!
Can you suggest a filled adhesive brand that you use?
For direct restorations and IDS I use OptiBond FL (Kerr) (4th gen) and for indirect I use ScotchBond Universal (3M) (8th gen) with RelyX Ultimate Reson Cememt for posteriors and RelyX Veneer for anteriors.
Hello sir , is there a way for Indian dentists to do a course in your institute 🙏🙏
We often having dentists from all over the world attend, however, it is very expensive, considering travel costs. I do have webinars coming up that are free - check this out: Univet Optical is sponsoring me for a 5 part series on Ceramics, starting December 8 at 6:00 pm Pacific Time - check out there website for the link.
@@StevensonDentalSolutions thank you sir🙏your videos are lifesaving, you are helping our dental community in number of ways we are so thankful to you u r doing a great job keep it up sir🙏
Must you remove the contacts?
It allows for easier access to margins for refinement, and cement removal, etc., so yes, always break contact or don't enter it at all.
Excuse my ignorance , can you please name commercially available filled and non filled adhesive .
Filled: OptiBond FL, unfilled: OptiBond Solo, but currently most all adhesives are filled to some degree. For example OptiBond Solo PLUS is filled.
@@StevensonDentalSolutions thank you :)
Sir where do we use filled adhesive apart from IDs?
For everything if you wish. I use a filled adhesive for every bonding procedure - numerous prospective clinical trials show it to be superior to infilled products.
@@StevensonDentalSolutions can we use filled adhesive for Dentin hypersensitivity
Is this process successful for lifetime.. Plz reply
Usually, a well-made ceramic inlay/onlay will last 15 years. A gold restoration would typically last 30 years or more.
Hello,What's the durability of tooth coloured inlay?..can they last easily a decade?
Oh yes, most likely. Research varies on longevity but if well made and normal patient risk factors 12-15 years would be expected.
Great video! but we did use a RMGIC as a liner earlier so won't that interfere with IDS? because there doesn't seem to be any exposed dentin in tooth 1.7
True - very little exposed dentin in 17. It's a judgement call - some use no RMGI others use lots of it. In this video I used a lot, but it can be done with much less, thereby taking advantage of IDS. I usually place an RMGI in the deepest areas only and this provides for a long term albeit weak bond to dentin, with the IDS being of benefit with the more shallow dentin.
Stevenson Dental Solutions that makes a lot of sense :)
Thank you so much for posting. I’m a new grad and you’re videos have been tremendously helpful!
Great - thank you for your thoughtful comments/questions!
May I also ask you, if polishing is enough for removal of the air inhibited layer, or glycerin use is a must?? (and if polishing may remove the bonded hybrid layer, if used solo without flowable composite)
Unnecessary to use glycerine if you scrub before provisionals.
@@StevensonDentalSolutions Thank you so much for your reply, but may I ask you, the oxygen inhibited layer is a must to bond composite layers to each other. when we remove it, won't the bond to the resin cement be weaker, hence the oxygen inhibited layer responsible for adhesion is removed, as it will be similar to bonding or repairing an old composite with the conventional methods.
Or is sandblasting a crucial step to compensate for the oxygen inhibited layer that we removed, like when bonding to an old composite, you have to sandblast it and others even apply MDP to achieve a proper bond
@@Omran-g9o When you delivery the restoration, the IDS layer is sandblasted lightly and rebonded so all is well.
What do you temporize inlays with Dr Stevenson?
DuraSeal with Dental Stopping in the box areas.
What is the purpose of dentine sealing and when is it done?
At the time of the finished preparation. The theory is that the dentin is best sealed when it is freshly cut, with the hope that it is better preserved as a hybrid layer and less likely to degrade over time. Also, it is assumed that it will be more resistant to moisture contamination and subsequent micro leakage. Patients do report slightly lower post prep sensitivity with IDS.
HOWEVER! Recent systematic reviews of IDS show that it is of little help in longevity of the restoration. It looks like the IDS approach may not be worth the effort, but more clinical trials will expose the best evidence.
Thnx Dr. Why did u prep again after doing the IDS? And you mentioned to use one type of bonding only?
The difficult part is that i don't know which adhesive is filled or unfilled resin. How could we recognize that, prof?
OptiBond FL is filled. Most other 4th gens are filled but OptiBond FL is the most filled. If you have a doubt, use flowable on top of the adhesive for the biomimetic seal.
@@StevensonDentalSolutions thanks alot, professor!
Great effort as usual, may I ask you if scotch bond adhesive from 3m is considered as a filled adhesive?? so can I use it solo for IDS or does it need flowable composite on top??
Good questions. You'll need to use flowable with SBU.
Thank you again Dr.S, I have a question about your criteria for when you decide to cover a cusp vs shoeing? Hope this finds you well :)
With a normal occlusal scheme for cases requiring onlays: 1. I always cap functional cusps, 2. Shoe Non-functional cusps, 3. Cap non-functional cusps when required due to structural compromise or existing defects/caries/etc. that would merit capping. Thank you for the question!
Great video with great input! I am wondering how the composite during cementation process bonds to the sealing layer. Maybe you could give an answer to this =)
The surface is air-abraded and then re-etched at the delivery appointment, then this surface is treated again with primer and adhesive, allowing ample double methacrylate bonds to copolymerize with the resin cement. Thank you, Doc!
Hi Dr Stevenson, do you know if porcelain fillings can be easily removed without damaging them in order to replace the adhesive cement used to attach them?
This can't be done successfully. They will be destroyed during the removal process.
@@StevensonDentalSolutions thank you
Dr. Stevenson, do you normally etch with the polycarboxylic acid before placing GI/RMGI liner? Would this enhance the bone strength in a clinically significant way? Thank you in advance!
No I do not - the bond strength doesn't need to be enhanced much and the PAA is potentially injurious to the pulp in a deep cavity. I do use PAA for GI restorations, which rely on adhesion for better seal with the oral environment.
I want to see a video from the provenance of it
Pressed lithium disilicate (IPS e.max)
Great informative videos! What Bonding agent do you use for IDS?
Thank you Eric! I'm currently using OptiBond FL (KavoKerr), but I'm leaning towards a universal like Scotchbond Universal - the clinical trials are steadily being published and are very encouraging.
@@StevensonDentalSolutions Is it need to put a thin layer of flowable composite over Scotchbond Universal ? Thank you Doc
According to 3M's data it is not necessary to add a layer of flowable to the surface while performing IDS.
Five years out.. and I realized how little prep knowledge for modern day ceramics schools teach .....
Amen!
Dr. Stevenson,
Do you light cure after the primer application i.e. before the adhesive? Thank you!
David
For OptiBond FL (and other 4th gens) no curing is required after primer application, just air thining, followed by the adhesive. Different products have different protocols, so it's best to follow the manufacturer's recommendation. For cementation, if the onlay or inlay is reasonably translucent, and I'm using a total-etch multiple step system like OptiBond FL, I will not cure until the restoration is cemented. Alternately, you could use a Dual Cure Activator (DCA)with a universal system or even a universal system without a DCA (Scotch Bond Universal) with cement which has the DCA in the cement itself, like RelyX Ultimate Cement. The latter technique is preferred when the ceramic is thick and will not allow for adequate curing through the restoration.
Thank you very much Dr! Hoping to catch you at one of your courses!
Great!
no
Hi Dr Stevenson..I've been following ur videos since many years...thank you for the great info in every video u share... for IDS i have two questions.. first: in this video you air dry the primer but NOT the filled resin...is that deliberately done and should the same be done whenever we use a filled adhesive? second: I always see dentin sensitivity at cementation appointment even when I have followed the proper steps under rubber dam? Is that because I air dry the filled resin to a thin layer? Best Regards...
Good questions!
I usually air dry both layers 3 seconds each.
Perhaps more agitation and time could be spent to insure adhesive penetration.
Stevenson Dental Solutions Thank you Dr Stevenson :)
Dr. Stevenson it's a great video and effort. Thank you. I'd like to contact you for a possible business collaboration. Best regards
Thank you - email: dr.s@rgsdds.com
❤