Class II Composite Restoration | Stevenson Dental Solutions
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- čas přidán 2. 05. 2018
- In this video, Dr. Stevenson demonstrates the Wall and Lobe technique for developing ideal anatomy and contours.
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Thanks for watching! - Krátké a kreslené filmy
Do you know that your amazing technique makes life as a dental assistant exciting? To watch you work with meticulous perfection .... you take the time to make it anatomically correct. Not many providers do such a beautiful job. Thank you, it's awesome.
Very kind of you - Thank you.
Wow, this is amazing, my school never taught me anything like this!
Hi Doc, thank you. I’ve learned exponentially more since graduating dental school as well.
😳
You r a doctor but your CZcams channel is full of exercise video.why??
@@md.abdullahal-araf3369 he is a university teacher
+1🥲
Thank you Doc, that's awesome I learnt some new techniques keep uploading such videos
Love your videos Dr. Stevenson! Really amazing, thank you very much for sharing your knowledge with us.
Thank you Dr. C! More coming... Dr. S
Amazing! Thank you so much for your videos.
Doc i really appreciated. I got a lot of tips from this video you're amazing.
Hocalar anlatmayınca ta buralarda buluşuyoruz
Thank you Dr. Stevenson for the video🙏🙏
You are very welcome
perfect .. like your work and patience
Thank you Doctor!
Thank you so much for sharing this video. The result is amazing!
Thank you!
This is not what we’re taught at school but looks wonderful and efficient
I take it back, 1 hour is crazy. Looks great though.
That is incredible! I will try this technique starting today.
Doctor your videos are so helpful. Thank you so much.
My pleasure!
Learnt so much! Thank you for sharing your knowledge!
Thank you!
Excellent instruction and Demo. Thank you Dr. Stevenson!!
An inspiring video. A "simple" procedure yet so difficult to master.
So true!
Your videos are the best. I mainly use them for dental school. :)
Awesome - thank you.
I’ve learned so much from this video !! It’s perfect. Your technique made it so simple and allowed me to improve my restorations in sim lab 😊 thank youuuuu
Awesome! Best, Dr. Stevenson
Thanks, doc
Wow, that is beautifully amazing work!
Good review of sectional matrix systems. I have been using them since 1992. The original Bityne sectional matrix was developed by a dentist in California. He intended his system, to be used to place anatomically correct class 2 amalgam restorations. His instructions advocated the use of Brown dental compound to support and stabilize the stainless matrix. I have used many different systems since. There is not a system that can be used easily and effectively for all situations. One thing I have experienced is that attempting to place an MOD using two springs is not predictable. Discovering an open contact after removal of the springs and matrices is not a time saver.
Thanks for the insights and info!
These videos are great! thank you
Thak you AI!
It was artistic....inspiring indeed,thank you sir
Thank you.
As a dental student, I have so much admiration for your meticulous attention to detail and scientific approach.
I am sure you're well aware of what tremendous impact these videos have, a valuable educational tool for dentist and dental students across the world.
Thank you. I try my best and deeply appreciate your kind words. Dr. S
you are really great doctor , thank you from egypt
Thank you Doc!
so good.
Beautiful work. I tried this but it isn’t as easy as you make it out to be. Hopefully with patience and time :) thanks for sharing
Thanks! Keep at it and stay tuned for more.
Thanx v much for the wonderful video.
Thank you! I appreciate your support.
I love this technique , start the mesial /distal wall, transforming the Class II TO Class I, simpler to complete restoration
Yes, I agree!
Great👏
Thank you 🙏. Very much
Thank you for watching!
Great work thank you
Thank you too!
Thanks Doc...I practice in Dubai.. shall find out if available here.
Could you do Cl V composite prep and rest on a canine or other tooth?
This is so beautiful..
Thanks
Beautiful restoration! Great techniques. Thank you for sharing this video
Thank you Doctor.
Hello Dr Stevenson, I am a dentist in the UK. I tried to do this technique with a patient the other day and I had a few issues and wondering what your thoughts were. I used the palodent matrix system, but with a rubber dam in place, are they too soft? becuase by the time I got it into the contact it was all bent. Also, another issue I had was bleeding when removing the wedge which was very stressful.
Have you got any tips?
Thanks
In case you doing MOD cavity which side you do first ? Can we use 2 palodent ring together in same time!
Thank you so much your video Dr. Stevenson ! I have a quick question.
If you do not have a modeling resin to deep into microbrush, what other materials could be possibly used to fill the resin interfaces where anatomy is sculptured? Is it okay to use wetting resin?
Amazing Doctor
Woww
Very nice of you, thank you for watching.
You're videos are amazing! I'm a dental student in Australia and these videos are invaluable.!They definitely top any videos we've received from our school!
With that said, I was hoping you could answer a quick question.
When placing my first bit of composite into my prep (using the composite gun), I find that the little bit of composite I do try and place into my prep often pulls away from the tooth, or comes out of my prep entirely when I pull my composite gun away and out of the mouth. Any suggestions on how I might be able to prevent this from happening?
Thank you, Dr. Stevenson!
Thank you Alex! Try removing a small increment of composite and rolling it in a small shape about the size of a sesame seed and use the plastic instrument to place it.
sir how can we use a composite restoration in a deep caries management?...
Did you burnish the contact ?
wow wow wow. why dont they teach it like this in every dental school.
Dental school just teaches you to be minimally competent. The very tip of an enormous iceberg.
Had this done
today I was sweating
What if we get hight points?
Hello Dr. Stevenson! Thank you for the great video! What type of resin did you use at the end? Is it a flowable?
Modeling resin - Bisco
What do u use to remove excess interproximal?
You can use the disc system he showed to trim off excess on the Buccal/Lingual aspects but if you need to lighten and shape the contact try wedging it and lightly use an interproximal finishing strip (be careful not to remove contact though)
very elaborated and solved all my doubts about matrices in cl-2 composite..
can we fill the proximal box in one go ??
Yes, with a bulk fill that is capable of being cured all the way through, but best to fill with a wall or with increments with standard composite for maximal physical properties.
@@StevensonDentalSolutions Thank you so much for reply..
yes sticking to the wall is an ideal technique as it does reduce the chances of shrinkage and then micro leakage .
please elaborate on composite materials you use
The thing I don’t get is my composite gets sticky and doesn’t have this viscosity when I’m working with it. Idk what I’m doing wrong
Try using "Modeling Resin" by Bisco. You dip the instrument in it and it allows for a stick-free application and does not weaken the composite - very very cool! Here is the LINK: www.bisco.com/modeling-resin/
Why i feel there is open contact on the disto lingual side of the 2nd molar?
Amazing Doc! I always watch your videos before my practical exams. Your techniques give me confidence that I will do excellent on my test. Do you still teach at UCLA?
Thank you - I left UCLA last June to practice in the real world, run my teaching center and operate my dental lab. I'm deeply enjoying my new professional activities.
Excellent. My goal is to attend a class at your teaching center.
Hey Doc, I am in dental school working on this technique and I was wondering if you have an tips for if the isthmus of the preparation is more narrow, making it more difficult to create the lobes? Thank you!
Good question - the lobes will be very small, and the thin IPC (interproximal carver) is ideal. Even though it is narrow it is important to build the lobes, as you are aware. High magnification also helps. It can be quite fiddly!
Hello dr I have a question can I use a microbrush with bonding agent to blend the composite restoration before curing or it will affect the physical properties of composite .. thanks in advance
Yes you can
Do you think the Palodent system would be good for amalgam restorations also? Thank you again for the amazing videos
Thanks - no it separates the teeth too much and it becomes impossible to remove the matrix without breaking the freshly placed amalgam.
Best
Thank you!
That is one gorgeous restoration! When you use the extra bond to help make the composite flow better and not stick to your instruments, how do you get it off the tooth? Do you scrape it off before you cure or does it just come off after curing when you polish?
I usually try to use Modeling Resin (by Bisco) - just didn't haver it that day...But whatever remains on the tooth is easily polished off. Thank you!
thanks a lot Dr. Can u please share class3
Prep and restoration - it's in the queue!
Hi Dr. Stevenson. Do you have a favorite section matrix system? I need to purchase new separating rings, and would like to find ones that are less likely to "pop" off or be interfered with by the dam clamp. Thanks for any incite you may have.
Garrison Fusion. $$$$ but great.
@@StevensonDentalSolutions I have this, doc! Its also my favorite!
Does using bond on the uncured composite weaken/lower the integrity of the composite material?
Composite Modeling Resin is a light-curable, low viscosity microfilled resin (30% by weight), designed for use as a composite sculpting resin.
By wetting your instrument with Composite Modeling Resin, you can facilitate the placement and sculpting of all direct composite restorations without the worries of having the composite stick to the instrument.
Unlike adhesives, Composite Modeling Resin contains no solvent and is HEMA-free, so it will enhance composite placement without weakening the restoration.
Modelling Resin is a light-cured, low viscosity microfilled resin for use as a composite sculpting resin. The properties of composite naturally lend itself to stick to your instrument. Modelling Resin overcomes this aggravating tackiness and was developed to aid in the placement and shaping of your composites. By wetting your instrument, Modelling Resin can be used to place and sculpt all of your direct composite restorations.
Sir plz do some cusp build up videos
I did one - the MOD direct composite onlay - will do more though...Thank you!
Could you please explain MOD restoration with palodent? Some tips thank you
Yes - sure will!
Wow,great work!! I would like to ask you 2 questions. Is it possible to do this technique for primary molars ?because the cavities are too small.Also,what do you think about c-factor , in the first proximal layer?are we feel safe or we can do that in 2 steps?
I suppose you could do it in Primary first molars, but wear strong loupes! As for the C-factor, here is the mathematical breakdown for a 2 mm deep x 3 mm wide x4 mm tall box: 1. Bulk Fill = 1.55; 2. Flowable Increment = 1.44; 3. Incremental banked layer (corner) 1.21; and 4. Wall technique = 0.41 Who knew! The centripetal wall technique is significantly better - gotta love math.
@@StevensonDentalSolutions thank you very much !!
@@arety9180 My pleasure
just failed this resto exam by indirect vision. For some reason it was first few times I got open contact n would like to know if using Vring w wedge helps. I used tofflemere and couldnt wedge properly
Sorry to learn of this! The Tofflemire approach just won't create a nice contact with composite.
When I use the disk it usually takes away structure from the plastic tooth... idk what im doing wrong I try to do it the way you are showing
Try using a little water and angle the disk so it touches the composite for the most part. Also, try starting with a less coarse disk. Keep at it!
You wouldn't put another wedge from the buccal to close that little opening in the buccal box area?
Three options: leave it and clean it up when you are removing proximal flash, place a modified wedge from the facial to close it (small so the ring easily seats) or use a thin instrument like a cord packer to push the bad against the box. Thank you for your catch!
Doctor
Can you show us Amalgam and Composite filling in Conservative MOD class 2 ?
Thats alot challenging as we have limited area. I shall be really grateful.
Thanks
I will put this in the queue! Good idea...
@@StevensonDentalSolutions Thank you so much dear Doctor
Glass Ionomers such as Equia Forte, Fuji Triae, IX... etc... require the use of a polyacrylic acid and not sulfuric. Fuji Cavity Conditioner is indicated for use as etchant. Cheers and great job on being conservative.
Fuji Triage. I don't know of anyone using Sulfuric acid in dentistry...PAA has been used for GIs since 1972 and its purpose is to remove the smear layer to allow for better chemical adhesion of the pendant silicate groups of the ALS particles in the powder to the available Phosphate and Calcium ions (on both the enamel and dentin interface) via relatively weak (2-6 MPa) covalent bonding. An RMGI liner may be effectively used without PAA by bonding to the smear layer - similar to self-etching adhesives.
You can use phosphoric acid too, says so on the packaging
I guess for dental students just to practice the final lobes is it possible to place one large bulk to make the base and then on top of that we can place the enamel lobe to create the anatomy?
Yes, this is great. If you do lay done the first areas in lobes, with a dentin shade, the results could be better, shade wise, but this is optional.
Thank you so much for the amazing video. Is there any way to remove the excess proximal composite (overhang) other than using the discs and the knife? As I often end up injuring the neighboring tooth.
Yes, the #12 scalpel and a very sharp posterior gold knife. All the best!
@@StevensonDentalSolutions I appreciate a lot your fast and prompt reply. Thank you!
What is the liquid that you use with micro blush?
Modeling resin (Bisco)
Feliz día de la odontología
Gracias!
This is amazing work. However, I sometimes find myself spending much time creating accurate anatomy only to grind it away to adjust occlusion 😂
Me too! I've improved by using the adjacent marginal ridge as a guide and checking it before I start with articulating paper and then trying to replicate the contour...
@@StevensonDentalSolutions That's a very valuable tip doctor. Thank you so much for all your work!
That seems to be a lot of adhesive you are using, wouldn’t it affect the longevity of the restoration?
Modeling resin not adhesive
Dr.stevenson, when you used the micro brush, what was on it? I saw a yellow coloured liquid.
It was bonding resin, but I typically use Modeling Resin (Bisco) for this.
@@StevensonDentalSolutions hello Dr. Stevenson, compared to the modeling resin, does the bonding resin compromise the composite at all (should we be more judicious with bonding resin compared to modeling resin)? What is the main purpose of using the bonding resin? For a glossier finish after curing or does it change the composition of the composite?
Also, I was curious, considering the dentin shade composite is almost entirely exposed in the central fossa, would you recommend using a darker dentin shade than the enamel shade?
Thank you for these videos, your technique is incredible.
Bonding resin which contains HEMA may discolor over time and does weaken the compute slightly, but this won't be the reason for failure. The main reason to use a resin is to keep the composite from sticking to the instrument and to smooth our the composite. Both of these issues have been helped with the titanium nitride coated interments and manufacturing improvements over the years. I like a Body or Dentin Shade in the deepest areas followed by enamel and then a milky white enamel on top. Tokuyama Estetlite Omega is really nice.
The results look amazing... I wonder how cripplingly expensive this is
Not too bad - 300-500 for these is typical
What is the main advantage of sectional matrix?? Occlusogingivally or mesiodistally
mainly occlusogingivally. Develops a better and more natural physiologic contact and contour.
Doctor the tooth preparation for composite is very aggressive, don’t you agree?
I though it was for amalgam.
Yes, this is a pre-prepped tooth from Kilgore used by some US Dental Schools to teach filling large cavities. I used it in the demo to show the technique for filling a large cavity with composite. For example, when removing a large failing amalgam and restoring with direct composite. Thank you!
Wouldn’t the extra bond that was added toward the end be counted as flash?
Let’s say we don’t use bond as you used in the video, what ways can we utilize to fix the issues the presented in the composite ?
Thank you! It was a great video
This is modeling resin, but it's not really required and I usually don't need it. I use a very nicecomposite that will not stick (Tokuyama Esteelite Omega) and a Titanium Nitride plasma coated instrument.
I would imagine in between the polishing steps , adjustments in the occlusion have to be done with articulating paper. I wonder If you had ever a perfect sculpture of a patients tooth anatomy, to which you never needed to go the step of articulating paper. Now that would be like a hole in one or a double eagle on the golf course. Just curious if you have a favorite but affordable combination of matched materials that would get great results for compression, zero micro seepage, and anatomy of occlussal. Bonding agent, glass ionimer, composites, etc. I have seen these steps in person by my hand all change on a live patient with DA suction, dental dam, cheek retractors and rubber bite blocks. I know in this profession if the patient has a BIG MOUTH, all the better.....lol ! Great video !
You are so right! Dentistry is so much more challenging in the oral environment! Never done anything close to perfect - but I keep trying...I use the following steps: 1. RMGI liner in deep areas, 2. ACID etch with Phosphoric acid w/BAC, Rinse, "Moist Dry" 3. CHX 2% for 30 sec, then blot dry, 4. 4th gen bonding system (OptiBond FL), then centripetal wall and anatomical build-up. All the best! Dr. S
Thank you very much for the information. Great video !
Anytime Doc!
It's a very nice technique and beautiful result. No disrespect, but could you not use the instrument in the direction from throat? it's not something that can do clinically.
Sure check out my video library for this.
Nice 😂😂
Can this technique be done with a tofflemire matrix band?
It can but the result will be a point contact rather than a nice well-contoured physiologic one.
@@StevensonDentalSolutions thanks for your response. I never see any tofflemire videos on class2 composites and I'm just wondering if this works for those who still find comfort in them. What burs do you recommend for finishing, for those who may not create as good anatomy as you?
@@Raynieday6969 The best burs are the 7404-014, the 7102-014, and the 274- most of these are also available tin diamond as well. After using these, the Dialite System from Brasseler or the Cosmedent System work really well.
Thanks a bunch doc
Dr what composite did you use
G-ænial Sculpt®
Light-Cured, Universal Nano Hybrid Compactable Composite
there is no need for a gingival floor for a composite restoration just an open contact would suffice ideally, unless I'm not aware of something.
not according to US Licensure requirements.
Thanks doctor but what about the color
For this video, color was not considered. I will make another soon which features the shade requirements, opacities, and stains required to maximize natural color.
thanks a lot , waiting the video
Is this a MO?
Yes an MO, Mesioocclusal.
@@StevensonDentalSolutions amazing! Could you please make a composite restoration class 1 video? Preferably tooth number 26! First molar
@@glowingxlights9652 I will! Thank you for the suggestion - upper left first molar occlusal. Got it.
Thank you for the great video. But you are a little bit slow and you are god damn talkative
Very rude and uncalled for
Dr.S is also a teacher, trying to explain his work to you and me, no need for your words. Personally, I have been using this technique for years, yet I watched it till the end, trying to learn anything I can, and in awe of his talent to explain and make things easy
If you don't appreciate, please don't watch.