Molar Ceramo-Metal Preparation | How to Prepare a PFM On a Maxillary Molar
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- čas přidán 26. 07. 2024
- Dr. Stevenson takes you through the steps for preparing a PFM on a maxillary molar on Kilgore (Nissan) tooth #3.
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Molar Ceramo-Metal Preparation | How to Prepare a PFM On a Maxillary Molar
#stevensondentalsolutions #pfm #pfmpreparation
Thanks for watching! - Krátké a kreslené filmy
Thank you very much for sharing with us your vast knowledge, Dr. Stevenson! All your videos are as good as gold! You excel at everything you do. Thanks again!
A true pleasure to be able to help!
Thank you so much Dr. for the videos. I find them very informative and helpful for students and dentists! Thanks again for your time and sharing your knowledge and wonderful skills.
You are an amazing teacher! Thank you for your help!!
I apreciate your work and creativity ... you are my proffesor who I have never met but the most I have learnt from him .. God bless you
Thank you
Thank you very much Dr for this video
The best doc,and the best preparation
Thank you very much ,and waiting another videos❤
Thank you Doctor!
thankyou Dr. Richad Stevenson
Great presentation Dr Stevenson. I graduated from dental school in 1980 . The clinical requirements were extensive for both operative dentistry and crown and bridge. I personally think both departments should have been lumped together into one department called fixed restorative. As students we were required to successfully complete 40 "units" of crowns and bridges. Almost all the associated lab processes were required to be completed by the student. The school had its own lab and we were allowed to to use the lab to fabricate 6 units of PFM restorations, The remaining 34 units were waxed up and cast by the students and porcelain stacked and oven fired if the crown or bridge was a PFM.. In the operative dentistry section we were required to wax up, cast, and cement 140 surfaces of indirect gold inlays and onlays.restorations. Additionally there were additional requirements for cast gold restorations with wax patterns obtained and sprued using Kerr pattern wax when "group function was the objective and the centric and excursive contacts were obtained using Kerr pattern wax directly from the tooth being treated, Rarely a shortage of patients needing treatment and always a shortage of time to get things done. I often used a hybrid technique where I would transfer the wax pattern to a stone cast made from an impression to refine the proximal contacts and counters, I left dental school a strong advocate of a shoulder.bevel prep design. Interesting I have not prepared a tooth with a margin design like this in more than 15 years for many reasons,, The cervical portion of a tooth is where the pulp is closest to the surface, Preparing a shoulder in this cervical zone has no benefit when using gold or monolithic Zirconia, Rounded junctures between axial and gingival portions of a tooth preparation seem to be our best option. Minimal taper of the prepared tooth s very important I use either a 1.2, a 1.4, or a 1.6 round end cylinder fine grit diamond to finish the margins for crown preparations being very careful not to engage the crest/mid point of the round end that would create "J" shaped margin.Many labs set the milling tolerance with way too much allowance fo cement space and the crowns they fabricate fit like socks on a rooster, One think that baffled me as a dental student was how little attention was given to cleaning the tooth prior to cementation and keeping to both well isolated, Over the past 42 years manufacturers of cements seem to focus on attracting dentists that are looking for an easier way
impressive. your teaching skills are incredible
Thank you - happy to help!
whether it’s a pfm pep or not, it’s still incredibly informative regarding preparations in general. Thank you!
Thank you!
Really nicely done.
What a fantastic preparation ❤️
Thank you, Doc!
my best choice for all preparations 👏👏👏👍👍😊
Dear Dr. Stevenson,
Thank you so much for always replying to my doubts..Today, I'm writing to share with you that I got acceptance from an advanced standing program and I owe my success to you. Even though I wasn't your direct apprentice, you still took time to guide me here. I'd like to share a small story from the epic Mahabharata in India where a student named Eklavya is denied formal education by his Guru but through his determination and just by observing his Guru perform tasks for otherstudents, Eklavya gets better and better until he becomes the best student the guru had ever seen. I'm far from being the best but in context of learning from a distance, I'm the Eklavya to you and have learned so much from you and you are my Guru. 🙏
I look forward to learning from you, in-person as I progress in my career.
Thank you so much.
Best regards,
Adi
Hi Adi - that is great! I am so happy for you. Your thoughtful message uplifted my day! Wishing you the best, hope to meet someday...Dr. S
Hello dr, can you please please please post a video of upper canine PFM preparation ??? Would be highly appreciated ..thanks again
outstanding demonstration.
Thank you!
Thanks doctor very useful video
Thank you doctor, I received your message. I already did the order through Ebay, but, I am going to contact your web page. Thanks again
Excellent, Very perfect preparation
Thank you so much
Thank you! Dr. Stevenson
Great video dr.stevenson.. thank u..
Thank you Doc
the best ever . thank you Dr.
Thank you for watching and for your kindness. Dr. S
Nice video and explaination of tooth preparation!
Thank you.
thank you so Much sir,very informative
Glad to share!
amazing Preparation .thnx from Germany!
Thank you!
Mükkemel bir kesim🧿👏💐
great resource
Thank you, Doc!
Brilliant ❤
Great video Dr. Stevenson! This is the first time I've heard someone describe a technique where the transverse ridge is maintained in their preparation. It makes perfect sense as more tooth structure is maintained, resulting in a biological prep with greater resistance form. I was wondering, with regards to interproximal clearance is there a shorter but that you might use? I usually find that most my patients struggle to open wide enough for the needle but to be held upright. I also find I end up with the prep looking overtapered on the dist, especially when the contact point is quite far gingival. What do you look for in when preparing these area? Maybe a video on your positioning for tooth preparation would be useful to others as well? Thanks again for your wonderful content and time out into these videos!
Hi Doc - thank you. I use a 169L carbide for limited access situations to break proximal contact - works great. Obtaining up to 20 degrees of taper on one wall is perfectly fine as long as you have good circumference (the tooth determines this) and long enough walls (4mm). You may always place an axial groove to deal with the overtaper, and keep the other walls closer to 6 degrees. Often this is unavoidable when the distal has a long contact occlusogingivally.
Thank u sir for making such videos
U have excellent teaching skills
Videos r incredible
Pls make videos of crown preparation for pfm for lower incisors
Cool idea - I will!
great job
Nice of you to say - thank you.
Dear Dr. Stevenson; Can you please make a video on PFM on lower premolars? Mine becomes really small...Don’t see where the problem is... I would very much appreciate it.
Impeccable
Thank you David. All the best.
Замечательно удачи док )
Thanks!
Can you please make a video for lower molar PFM as well 🙏. Very helpful videos
For sure, thank you
Thank u
Cool - thank you for watching!
Thank you so much for sharing your teachings. Would like to ask, in clinical settings, how long will it take you to prep a tooth?
Usually about 10-15 minutes.
Super work Dr Stevenson!! Do you mind we share? (All credits and links back to you and your channel of course!!)
Of course - thank you!
خیلی عالی
Thank you Dr S. when you used 878K-012 for axial reduction and then 8847 for shoulder, was there any internal undercut created.??Can we use 847 bur directly for both shoulder and axial reduction.?
Undercuts are often created while prepping. The key is to recognize them and make corrections- you may use the 847 from the start and then the 878k to create the chamfer and transition. Either way works.
I like kind of fun awesome .
Hi Doctor, great video!! Would you prepare the occlusal the same way for a cast metal crown?
I know it would be less reduction.
Exactly - you are correct!
Stevenson Dental Solutions , aww thanks Doctor, you take care of your viewers!!!
hello dr. thank you very much for the video and the time you[re giving un answering our questions. I'm a dentist but I'm preparing to get my approbation in another country and I found it always difficult to do the preparation on this tooth. I mean it's really ok if it's with a good view like this but it's so difficult to do it when it's the real (upper jaw) and my real Problem is the transition from distal to palatinal surface. Do you have any advice. I appreciate you answer.
I actually find it easier to work in the mouth - funny me. For the DL area, it just takes time and practice - try different mirror positions and also different head positions of your patient - towards you, away from you, etc.
Do you employ this technique when working with natural dentition? I have been practicing this technique for my #3 full cast gold and #5 PFM fixed partial denture practical exam.
Yes I do this the same way with patients.
Hi Dr how do you tackle the difficulty of prepping the distal of teeth especially with the finish line? I find it very challenging and can get all my other surfaces looking nice but my distal is rarely acceptable due to challenging visibility. Any tips? Greetings from Scotland!
I’m doing my first crown prep on a patient next week! Scary!
Hi Matin - no worries - you'll do great because you CARE! You are exactly the kind of student all faculty enjoy teaching - motivated and concerned. The best combo. Take your time and realize that it is the trick part - even if it takes two visits - your patient will understand. Stabilize your body and get a good clean view and work without water to refine. Practice your stroke before you activate the pedal. Best wishes!
Hello Dr.
Do you place the gingival cord when you form a buccal shoulder margin?
If not, the gingiva will be damaged and bleeding.
Hi again Doctor - yes, I do when the finish line will approximate the tissue - in other words when the finish line will be equal-gingival or sub-gingival. I use an Alum cord, braided (not knitted), size 0 (Gingibraid).
@@StevensonDentalSolutions Thank you..! Have a nice weekend...
Hello Dr
Do you place 1cord or 2cord ?
Dear Dr. Stevenson thank you for your time and help and appreciate your great work and support. I have a question, when we say 4mm of the walls would be left after occlusal reduction it’s only about the buccolingual side right? Proximal walls are shorter like 3mm? Is it not too short for molar all ceramic prep?
Correct! Thank you.
Great effort Doctor thanks alot
I have a question please, how the tooth doesn’t burn even though you aren’t using water ?
And can you give me tips on how to work inside phantom head without feeling pain in my neck as the phantom is not flexible that much and what is the best position for working on upper left quadrant
Light touch - new burs.
Check out the ergonomics videos I have =- they help.
@@StevensonDentalSolutions i will thanks Doctor
hello doc, why shoulder finish line is not recommendation for pfm/all metal crown?
metal requires a chamfer or shoulder bevel. It better seals and it is less destructive to the tooth.
Good work Dr. stevenson! I would really like to see this done on a patient with the proper ergonomics. I always struggle working on the upper molar and end up having to bend my whole head just to look directly at it. Whenever I work with a mirror, the water blurs the view.
Any advice?
Thank you!
please check out my ergonomics videos (2 of them). I also will cut the bulk of the prep with water and then refine dry - helps tremendously and a secret that master clinicians have taught me.
Hallo Dr. Stevensons
Could you please make a video about temporary crown? Wenn I do the Prep. for pfm it always fraktures lingually. I'm sure I don't have undercuts but maybe 0.7 lingually is just not enough?
Thank you very much for all the videos. I'm learning so much from your channel. 🌺
Thank you - I will!
Amazing I wish how fortunate i would be if I had a chance To learn ur prosthetic skills. Another doubt is the chamfer and shoulder is equi gingival or supra gingival?
Always best to be supra-gingival for perio health when possible.
Stevenson Dental Solutions sir esthetics would'nt be a concern on the buccal aspect ???
I can be at times - need to discuss with patient: conservative and healthy vs esthetic
Dr.Stevenson we won't be given an RGS during the bench exam..so can the bur be used to measure the thickness of the reduction we did?
Yes - you just have to know the bur diameter. The last three numbers on the bur is the diameter of the widest portion of the bur. 856 - 016 = 1.6 mm wide. Not at the tip! At the widest area.
Dr.Stevenson,
While practicing crown preps, do you recommend filling the bottle connected to the dental turbine with water? I have been using the handpiece without water flow and the diamond burs just burn/wear off after single use. What can be done?
Do not fill the water bottle, but lower the speed of the rotation by lowering the pressure out of the tank to 80 psi and lowering the turbine output to 2.5 bar. Use lighter pressure with intermittent strokes. If you notice burning, you are going too fast or with too much pressure.
@@StevensonDentalSolutions thanks alot!
Can u please write all the measurment of all aspect please
Hi, doc!
I cannot prepare a thick margin with 878k-012 bur.
How should I move 878k-012 bur to prepare a thick margin?
FOR THE METAL MARGIN AREAS: It's best to use a wider diamond, like an 878k-016 if you desire more bulk of metal. Best bur for true chamfer is: 877-010...
Hi Dr.Stevenson,I am confused regarding the axial wall prep.Do we have to first reduce all the 4 walls with 878k-012 and then later use 8847KR-016 on the buccal wall only or can we reduce first the buccal wall directly with 8847KR-016 and reduce lingual wall separately with 878k-012?
Oh, for sure - either way works well with practice. I've taught this numerous ways. I think that it's always a good idea to try on method several times before moving on to another.
@@StevensonDentalSolutions so 8847KR-016 gives a shoulder margin and 878k-012 a chamfer margin???
Hi Dr,
For PFM crown prep do we have to reduce occlusally 2mm which should be overall occlusal reduction or do we have to reduce the functional cusps which in upper molars are palatal cusps by 1.5mm where there is only coverage by metal and buccal cusps by 2mm where coverage is both by metal and porcelain?
Today, we seldom use Metal occlusal coverage with PFMs and this is not expected in dental schools. Consider the entire occlusal surface the same and obtain 2 mm clearance.
@@StevensonDentalSolutions thanks a ton!
Hello Dr,
When placing bevels at the very end, should the tips of cusps be slightly flattened?
softened would be the word I'd use, but yes, not as sharp.
@@StevensonDentalSolutions thanks
Beautiful prep! How do you check the reduction of the B plane? It's pretty difficult to measure with the burr tip from what I gather from the video as there are very few original occlusal surface landmarks. There's a high risk of over prepping or underprepping. Thanks
You check the reduction as you are prepping. You may also compare the marginal ridge height of the prep and the adjacent teeth. Please watch the entire video - don't skip ahead and listen to the narrative.
Hello Dr.
When tip of the bur can fit into the margin created is that the amount of axial reduction that is required?
For the shoulder, yes, but not so for the chamfer on the lingual. The shape of the chamfer requires, half to fit. I think this might have been what you were asking.
@@StevensonDentalSolutions so can 877-009 bur be used lingually for both lingual axial reduction and placing the chamfer?And 877-009 tip should fit half it's way?
Thanks for these information. I would like if you can do pfm on upper canine.
Coming soon! Thank you for the suggestion. Dr. S
Dear Dr Steven , how can we buy the burs? for me it's easy to buy over eBay , is it possible to buy these bur kit on eBay ? please comment , thanks
Hi
The bur blocks are on eBay. Search SDS Bur Block. Make an offer for $150, and we will accept.
Hi Dr.
Can 877-009 bur be used for lingual reduction and placing the chamfer at the same time?and the amount of lingual reduction be equal to the tip of 877-009 fitting half way?
Yes, but, probably best to use the 877-010 to 878K-014 got this - they both have a 1.0 mm tip width.
@@StevensonDentalSolutions thankyou very much
Hello Dr.Stevenson,
Is there any video of pfm crown prep for mandibular premolars?
It's part of the FDP video
@@StevensonDentalSolutions found it..thankyou!
Thanks for videos. Very helpful. Can you please post PFM preparation for lower 1st molars also?
Will do - it's in the queue
Hi Dr. just a quick question, can I use a flat end for occlusal reduction?thank you
Like an 837-012 or a 847-016, yes! They work great
@@StevensonDentalSolutions Thank you so much. More power to you!
@@vatech844 Thanks!
Hi Dr. Stevenson...I hope you are doing great! I have a question...I am really struggling to keep my buccal reduction for premolars and molars under 1.5 mm and to prepare buccal margin to 1.2 mm for PFM...Can you please guide me how to maintain bucco-lingual taper without ruining measurements? Also, If I keep my bur parallel to intact tooth structure to prepare shoulder margin, this would create undercut and make my bucco-lingual convergence wrong...Can you please guide me?
Watch every crown prep video I have in the library first and get back to me - I explain this in detail - DON'T SKIP AHEAD.
@@StevensonDentalSolutions I will...Thanks a lot for your reply and advice...
@@harinderpalsingh5744 my pleasure
im struggling with tooth preps so much, it's like I can't implement what's in my mind on the tooth using the bur, something's wrong with my technique that I can't quite pinpoint. My preps always end up with shaky over-reduced finish lines and an obvious lack of uniformity/control during reductionn.
it takes hundreds of teeth to make significant improvement. Hang tough!
Thanks doctor.. Plz tell me the amount of reduction of occlusal aspect of posterior teeth for PMF crown in the functional cusp and non functional cusp
1.5 on the non-esthetic cusp and 2,.0 on the facial cusp (both maxillary and mandibular)
@@StevensonDentalSolutions thanks doctor you are amazing ... what the amount of axial reduction ?
@@mohamedshandy4680 for the facial is is about 1-1.2 mm at the margin area and gradually more as you climb towards the occlusal surface - up to 1.5 mm or so. For the lingual, with a metal collar, the reduction may be less, about 0.75 mm, but also increasing as you move occlusally.
@@StevensonDentalSolutions thanks for all things with my respect .. Can you write all this steps with the amount of reduction or depth in filling or endo in the next vedioes because my friends dentist and me follow you but the the first language is not the english ... you have many vedioes that write all the steps and this help us ... we respect you and see you the amazing dentist!!
Hi how much is tge degree of taper of the PFm you did?
It ranges - the key is that it provides for adequate draw with the adjacent surfaces and maintains adequate retention.
Dr, how much axial reduction is required bucally,lingually and proximally?
PFM
Facial = 1.0 - 1.5 mm measures at the margin.
Lingual 0.5 - 1.0 mm measured at the margin.(metal)
Proximal: transition from lingual to facial evenly - no wings required.
@@StevensonDentalSolutions the dimension measured at the margin would be the same above the margin too right?for example for pfm facial reduction is 1 to 1.5mm at the margin then it is the same above the margin that is the entire facial surface of the tooth right?
the problem is that we rarely prepare complete tooth like this ..... usually pt ask to crown teeth is highly fractured and filled and sometimes tilted
So true! Good to know the ideal nonetheless...
🧡🧡🧡🧡🧡
As the tool is called 3min?
RGS 3-4. stevensondentalsolutions.com/product/rgs-3-4/
My dentist growned my teeth down to nothing and at gum and below, iam screwed. No shoulder visable. One day he burned & recessed my gums with with hot iron thing.
So sorry
I have one more question.
Should PFM crown margin be formed with shoulder margin?
Should not it be formed with a deep chamfer margin?
The answer is both. You simply need to satisfy three things for a porcelain margin for a PFM: 1. Depth must be at least 1 mm measured at the finish line to the axial wall. This allows for Metal (as little as 0.3 mm), Opaque (as little as 0.2 mm), and Porcelain (as little as 0.5 mm) => [0.3+0.2+0.5=1.0 mm]
2. The angle formed between the margin and the unprepared tooth should be as close to 90 degrees as possible, and 3. The finish line form must be incredibly smooth. These requirements may be accomplished with a shoulder or a "Deep Modified Chamfer" - which really is not a TRUE chamfer, as chamfers form an obtuse angle (at least 135 degrees) with the unprepared tooth surface, in other words they should decline at least 45 degrees from the horizontal plane. Probably a better term for this deep modified chamfer would be Modified Shoulder, since condition 2 must be achieved and the only difference between the two designs is that the Deep Modified Chamfer (aka Modified Shoulder) has a rounded line angle internally (a larger radius), compared to the True Shoulder.
@@StevensonDentalSolutions Do I need to use the deep chamfer bur so that it lies 90 degrees to the unprepared tootth?
yes exactly, for the porcelain but joint margin.
@@StevensonDentalSolutions thank u..
I learn a lot from your video.
Why not undermine the interproximal enamel like you do on your filling videos? You don't even need to drop a box, you can just move from in a bucco-lingual direction through the contact and leave some enamel that will flake off later anyway.
Yes, this is often how I teach this - so many ways...Thank you Doc
thanks doctor please translate into türkish
Let me look into this
👌🇺🇦
God
Thanks but just trying to do it right...
This is fine on typodont teeth. In the real world this is a joke. The occlusal reduction isn't the most important thing. A great margin and corresponding impression is. This is timely slow. Most crown preparation have caries that are challenging thus a difficult impression. Lab techs love me because I create a crisp margin with flashing past the margin. That's how you get an excellent fitting crown. This is ok for a dental student but on a real patient with deep subgingival caries this is not helpful. Again you have to capture the margin deep sub gingival in the real world. Get a soft tissue laser and get an excellent impression every time. Anyone can prep a typodont tooth. Try it in the real world with real cavities. That's what dentist struggle with. I see it all the time. Crowns with poor margins because the dentist failed to use a quality lab and get an accurate impression.
Thank you Doctor - your comments are appreciated. Best wishes to you!