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PFM Premolar Using T-PREP Technique - Acadental Tooth #4
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- čas přidán 12. 02. 2019
- Crowns made of metal and ceramic are also referred to as "Porcelain Fused to Metal" (PFM) crowns. Additional reduction is required where porcelain is required to provide room for both metal and ceramic. The permanent teeth between your canine teeth, or cuspids, in the front of your mouth and your molars in the back of your mouth are called premolars, also known as bicuspids. In this video, Dr. Richard Stevenson demonstrates about PFM Premolar T-PREP - a different way to approach reduction. Works well, even without prep guides or stents.
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Thanks for watching!
So you know something valueable and you dont keep it to yourself but instead you share it with others , this is priceless , this is the definition of a true teacher ! god bless
Thank you doc.
fantastic as usual, i hope you remain active on this platform you have no idea how helpful you have been worldwide :)
Great! Thank you - one vid per week - that's the plan!
These videos would have been so nice to have when I began as a dentist in 1995. Great resource for our profession. Thanks Rich!
Thanks Eric!
Thank you so much Dr Richard. I really appreciate that you uploaded this video upon my comment on another great video of yours. Great video, thanks Sir.
A very interesting technique! Just when you think you may have see it all, someone thinks of a new way to perform a procedure in a new and innovative way. Can't wait to try this!
Thank you - it works really well clinically too. All the best Doc!
Thank you so much for this wonderful video. After seeing your videos my knowledge and confidence to do operative dentistry has increased tremendously. Thank you once again !!
Oh wow can you please tell me who to do good finshing and polshing i have been sufring with that
Excellent video sir as all of your other videos. They are extremely helpful. Thank you so much for your efforts.
Thanks a lot professor..for that great effort ...greeting from Egypt
Thank you sooooooo much ... I usually do a perp and get low marks .. but last time at my mid-exam I did your tech I got almost full mark ... 👌🏻👌🏻
AWESOME!!!
Thank you so much Dr. Stevenson !! I watch all your videos and apply them in my dental simulation labs and have really improved so much with your help! I hope my residency lands in California hahah
Wonderful!
Thank you so much! I love how you explain each step you do!
Thank you Asmaa!
Coming back to your videos before my crown prep tomorrow. thank you so much, your videos always give me that extra reassurance. 🙏🙏🙏
Great! My Pleasure.
@@StevensonDentalSolutions I did it! Using the method and reducing in diff planes. It worked so well, thank you again!☺️
@@michelle02798 AWESOME!!!
So helpful! My prosthodontic professor struggles to explain these concepts to our class and will not give us a demonstration of a single crown preparation. His description of the difference between a shoulder and chamfer was “A shoulder is a shoulder and a chamfer is a chamfer.” You are a lifesaver for me through my journey in dental school.
So glad to read this comment! Wishing you the best.
Thanks dr Stevenson , it is the best tech for prep I had seen ever , it is simple and easy , thanks again ❤️
Thank you Ahmed! It works well clinically too!
how to apply same tech in molars?
That’s a great technique Dr. Stevenson 😊
Thank you - it's been working consistently on patients without fail!
God bless you for sharing your knowledge. Amazing tips and techniques as usual. Miss your videos, I hope you are doing great Doctor.
Thank you - more coming soon - been so busy with courses and patient care.
Really interesting technique. Will definitely try this in my preclinic!
Awesome! The T Prep Rocks!
This is such a small video with one simple preparation of a tooth, but make no mistake, this is truly a pillar for dentistry. It's free, very effective in its teaching, all high-yield information and shows every step you need to take and why.
If you are a university teacher reading this please, PLEASE look into this video and remember yourself why you teach. If you refuse to simplify or show all the steps and why we do it, it's not only the students that pay the price, it's also the patients they have in the future. People teach to make the world better. It shocks me how bad some professors were in my dental school. Bad teachers shouldn't teach. Dental schools are full of them.
Thank you!
Great work
Amazing, thank you Dr
Great video, as always!
Maybe some time in the future you can do some tips and tricks videos on clinical scenarios we often face that stray from clinically ideal.
Some potential examples...
Deep sub gingival decay in the proximal box that makes getting a good seal with your matrix band very difficult.
Adjacent class 2 restorations - the best way to restore to get good contours and contacts.
Working on the distal most tooth in the arch when you have a rubber dam on, and the clamp is in the way of your matrix or operative field.
I’ll try to think of more!
Microscope ready - planning on several this year. Thanks
It really amazing explanations
Awesome! You are a mad genius!
Thank you Doc
Awesome. Thanks so much for sharing
Thank you!
was one of your students in UCLA, every week i check for new videos...you are awesome Dr.RGS...thx for your efforts ...any video for crown prep critique or about retention of short height crowns any tips? thank you
Thank you so much Sir. It was helpful, you are the best
Thank you, Doc!
Simplified excellence!!
Very kind of you, Doctor.
AWESOME!!!!!
Thank u great video as usual💐
Thank you Doc - will try to make the videos you have requested. Dr. S
Great helpful video!
Thank you! Dr. S
thank you so much
My pleasure - thank you for watching.
Verry helpful thank you doctor
Thanks, Doc!
thank you very much 🙏
My pleasure!
nice techq. hoping to complete rubber dam series
Thank you so much for this sir! I’ll be doing my first tooth preparation on 25 tomorrow and I’m excited to try this out!
Awesome! Best wishes to you.
My friend after you use these reduction on mandibular incisors, what is going to be left of the tooth?
Thank you Dr. Stevenson, a beautiful preparation. I would like to use your videos in my video presentations.
Feel free! Thank you for the mention in your lectures
Thanks you 💜
My pleasure!
Thank You Dr S. Requesting you to please make a video of Class 4 composite free hand.
Okee!
Thanks for the great demos you always provide on your CZcams channel. Can you please do a PFM prep on lower left canine
Thanks
Will do!
@@StevensonDentalSolutions appreciate that thanks
Nice
I'll use this technique on my exam tomorrow :) I hope it will work
It works great! Best wishes on the test.
Thanks dr
Thank you!
Thanks
My pleasure!
Doctor can u please write all the measurment from all aspect please
Amazing!!! Thank you so much!
I’d like to know can the T-prep be used in other teeth? (Incisors and molars)
Yes it can. For molars it requires two Ts
One center on each of the cusps
@@StevensonDentalSolutions awesome doc! What about the incisors please?
Thank you kind sir for the amazing video! I do have a question not regarding it. When I prepare the premolars on the mesial and distal, I tend to over reduce because I'm afraid of hitting the adjacent teeth. Any tips ?
Use a needle bur to pass through the interproximal leaving a slice of tooth as a protective barrier. I like the 859-010 for this - check it out on your website.
hi, Dr what the name for the instrumental that are you using for measure?this technic works for the bench test? in my bench test I need to prepare a porcelain-fused-to-metal crown as a part of a bridge on tooth #5, a cast gold crown as a part of the same bridge on #3 and a class II amalgama on tooth #29 MO. have no idea for where to start. could you help me, please. thank you
Thanks for a video🙏and i want to know name of the instruement which you measure prepared area
RGS 1-2 stevensondentalsolutions.com/product/rgs-1-2/ Thank you!
Thank you for sharing this technique doctor. If we are doing a PFM on tooth number 5, do we still make 1.5-2 mm occlusal reduction because there is some pre-existing clearance before we attempt occlusal reduction especially in Columbia typodont. I end up with lot of clearance . Please try to make a video on it doctor. That would help us immensely. Thanks..
Good question. If the final restoration will be identical in contour and occlusion to the pre-op, then perform the procedure with the T-prep design, and you'll be in good shape. However, if the graders are looking for the amount of clearance from the prep to the opposing, you'll need to prep more conservatively and then adjust after closing the typodont. If you make a provisional stent from the pre-op tooth and use just clearance as your goal, your temp will be thin in some areas. Hopefully, the graders understand that this is a flawed approach. Always base your prep design on the desired final restoration.
Stevenson Dental Solutions Thank you for your response doc!!
Hiiiiii. Amazing video! Do you have a similar technique for anteriors too using this same method please?
I have a lower canine for now - check the library - more coming thank you!
@@StevensonDentalSolutions thanks!
@@Dr_Awua My pleasure!
Does this T-prep share the similar concepts with the depth plane you showed in the other videos?
Which is better for the starters? Is it better than the guiding grooving method taught in my school?
I think it's best to use guiding grooves at first and then move to this technique after you are comfortable with your school technique. THe T prep requires a bit more experience to get right... THANK YOU!
IF YOU COULD DO A VIDEO ABOUT VERTIPREP WITH A BAT BUR THAT WOULD BE GREAT
Not a prep I use but I will probably make a video since so many subs have asked. Thank you
This tech is amazing !! my canines and premolar preparation are incredible neat and clear... I am trying to apply in a lower 1st molar and I am struggling a bit, I was wondering if you can help me with some tips
Try using two T's on the molar - one along the Mesial cusps and one along the distal cusps - it works well here too. Thank you
Stevenson Dental Solutions Thank you Dr !!!
Dear Dr. Stevenson,
Thank you so much this incredibly informative video. I have a question.. Some universities don't provide appropriate burs for interproximal reduction. Mostly it's 016 or 018. In that case, is it possible to do a crown prep without over reducing the MD axially?
Also, do you have any recommendation for using the fine burs towards the end in dry cutting? I struggle with getting mesiocclusal and distocclusal surface being somewhat sharp.
Thank you in advance. 🙏
It's unfortunate that some Universities don't re-exam their bur sequences. You are 100% correct, the 106 and 108 burs will not fit between the IP areas without causing over-reduction. You'll need to find a thinner bur - even a carbide, like a 169L or 699...Dry cutting is a secret of master clinicians and has been known to be the best mode for refinement for many decades. Unfortunately, a poorly executed study over 50 years ago scared the dental world into the over-use of water to "protect" the pulp. The over-use of water coolant leads to over-prepping! A light touch, new burs and air coolant have been very safely used with no pulpal consequences by thousands of experts. Use the side of the tip to round off the mesial and distoocclusal line angles, or even use an abrasive point (something that you might use for polishing composite).
@@StevensonDentalSolutions
Wow! I can't believe there was history to it! Thank you so much for taking the time to get back to my query. Really appreciate it! I have a couple more questions.
1) Sometimes when trying to get clearance going from the occlusal to gingival I get like a heap of material and it wastes a lot of time to cut down and then make a margin there. Any suggestions on how I can avoid this step?
2) If the typodont can be brought to occlusion, what is a good reference point during exams to check if there's adequate occlusal clearance? Constraints - There's neither putty nor RGS to measure.
Dear Dr. Stevenson,
Is there any way to judge the buccal and lingual taper of #5 PFM? Also, instead of chamfer bur like the one in the video, is it alright to use a 856016 for the lingual chamfer? I have noticed that controlling the bur 887709 is a little challenging and makes the margin pointy and scratchy for me. Could you also please share about the transition zone for shoulder and chamfer interproximally for #5 ?
Thank you.
Best regards,
Adi
Look at the prep from the facial view and each wall should be leaning inward at about 1 second on a clock - this would give 12 degrees of total occlusal convergence. The 856-016 would be fine, although the margin will not technically be a chamfer, it will be a fillet, which is designed for ceramics and not metal. The majority of dental schools don't understand this...so using it and calling it a chamfer won't cause any issues.
Hello Dr,
In this video for facial reduction you used 847-KR 016 while in another video of pfm prep on tooth #30 you used 878k-012 for facial reduction followed by 8847KR-016..both approaches produce the same result?
Yes - I always like to show different ways to accomplish a good result.
Realy amazing job.... My qustionis is that why u made shoulder on facial and chamfer on lingual ?
For the standard PFM in the US, we use a porcelain butt joint on the facial and a lingual collar in metal. This requires a shoulder for the ceramic and chamfer for the metal. Thank you!
Standard for PFM. I have been practicing many years and would go for .75mm-1mm rounded shoulder for entire margin for monolithic zirconia or .5mm chamfer all around for bonded emax.
Can i use this tprep technique on the molars for pfm prep? Can you pls do a tutorial of it plsss. Badly need it for my practicals. Nice videos by the way. I learned a lot! 😊
Yes, you sure can - you prep it like 2 premolars with a tenon running faciolingually across the Mesial cusps and another running across the Distal cusps. I'll try to add another video!
Thank you so much! 😍 Ill wait for it dr stevenson. 😍
Hey Dr. Stevenson, how do you position yourself/hand when you're doing the B plane reduction? It feels like I have to tilt my wrist in an uncomfortable and unstable position when I'm working on it
Yes, it's the toughest plane - inverting your wrist works well - also try cutting this plane from the 12 o'clock position.
@@StevensonDentalSolutions Thanks!
My pleasure!
Thank you sir its good way , because today i have done my first prep of this tooth ,and i coudlnt do so well cause i cant find any way for saving cuspes ,and not reduce them , but i think it is also good way for saving height of cusps is it?
Yes, it works well - try to keep the bur parallel to the triangular ridge inclination.
This is a smart technique and i'm gonna try it,
Can you please make a video for the amount of preparation required for each type of restoration, Every source i find seems to recommend a different amount of preparation, i hope you can clear this up for me, Thanks.
All Metallic.
Full veneer PFM.
All Ceramic.
The answers are within my videos aggregately.
Sir pls can U describe skirts coves and slots
Coming soon!
Great 🎉🎉🎉 what was wrong with previous rct?
Not sure...
Would you do a video of PFM lower premolar #21 and FGC lower molar #19. This is the exact prep I have for an exam lol
Hi - will try - tons on the list! Thank you for the suggestion!
@@StevensonDentalSolutions thank you for the consideration and fast reply!
Dear Dr. Stevenson,
I have a couple of questions.
1) Sometimes when trying to get Interproximal clearance going from the occlusal to gingival I get like a heap of material and it wastes a lot of time to cut down and then make a margin there. Any suggestions on how I can avoid this step?
2) If the typodont can be brought to occlusion, what is a good reference point during exams to check if there's adequate occlusal clearance? Constraints - There's neither putty nor RGS to measure.
Thank you.
Best,
Adi
Reduce the facial and lingual axial walls first, then the IP clearance will be a smaller job, and faster. 2. Use the shank of a friction grip bur and insert between at a 30 degree angle (parallel to the reduction planes on the facial) - all shanks for friction grip measure 1.6 mm. Also, you can use the 330 bur vertically at the marginal ridge areas of the prep - the bur can provide you with valuable reduction information (1.5 mm long bur)
Should we check the occlusal clearance with opposing occlusion?
And should it be 1.5mm everywhere?Thank you dear Doctor.
Yes, and it should be 1.5-2.0 mm. You may use a pvs bite registration material to check - slice the registration and measure the thickness...
if i were to prep number 29 for a metal crown are these the same steps you would take? how much reduction do you want on the buccal or lingual side? is it 1.5mm on the buccal and 1.0mm on the lingual like you would do for a molar such as 30? how does this prep differ from doing it on a premolar? THANK YOIU
Premolars and molars are the same with respect to dimensions for cast gold: 0.5 mm chamfer 360 degrees and 1.5 occlusal clearance. The axial wall reduction will simply result naturally as you follow the taper desired and the secondary planes. For PFM, it's usually best to reduce about 1.0 mm on the lingual finish line - this allows a minimal collar. The facial finish line is 1-1-5 - ideal is 1.2 or so.
Hey doc can you reply by in which sequence you have used bur?
847KR-016 Occlusal reduction and Facial reduction, 878K-012 for axial reduction on lingual and proximal, then 8877-009 for refining the chamfer, and KS0f for refining the occlusal.
@@StevensonDentalSolutions thanks doc quick reply
When you have a proximal resto subgingival, how do you approach the interproximal area to crown prep on sound tooth. I place a thick retraction cord, yet it bleeds and get a notch on the margin. It becomes extremely time consuming. Is there a better and a faster way especially in upper premolars.
rubber dam
What's the type of bur that you used in occlusal reduction, doctor?
837-012 or ks1
How do you spell “tennen” correctly? The mid portion that you left for reduction reference.
Tenon as in Mortise and Tenon
Hi doctor, nice video could you summary the dimentions of the preparation. Occlusal: 1.5 to 2mm ; Facial 1.5mm; palatal:1 mm ; facial shoulder 1 to 1.2 mm ; Palatal shoulder 0.5 to 1mm; Finish line chamfer
Perfect. You got it.
Verry Nice verry
Thank you!
Can I use a probe to measure ??
Yes, for sure
What is your position when preparing Upper left premolar ? The water splashes over the mirror and makes indirect vision challenging, can you elaborate about how to handle this problem?
Thanks
Keep water flow to a reasonable level. Use the "cut a little, look a little" approach, and finally, turn the water off completely for the final. refinement.
@@StevensonDentalSolutions Thank you so much
I need help with these undercuts ... how do I improve any techniques
Look at the prep from the facial and hold the tapered diamond along the long access of the prep - use the adjacent contact areas as a guide, then move the bur to the mesial and see that it should not touch any area above the internal of the axial-finish line - if it does, th=is is your under cut area - use the bur as positioned to remove it, then repeat øn the distal. For buccal lingual undercuts, look at the tooth from the occlusal with one eye closed - make sure that you can visualize the entire chamfer/shoulder without any of the axial wall restricting the view. IF you find a tight spot, remove the upper portion of the axial wall in this area first and re-evaluate. If it's still undercut, take the bur all the way to the finish line and lean the bur towards the center of the tooth (perpendicular to the undercut) - this should help...
Stevenson Dental Solutions thank u I never thought you would reply thanks ❤️
Stevenson Dental Solutions could you do a video plz .. like do a tooth with undercuts and show how to correct them .. thanks doctor
Use a coarse finishing disc on the walls to eradicate undercuts. More conservative than using a bur.
What does RGS stand for? English is not my native language and i'm trying to find a sinonim or a translation so i can explain to my teacher what it is. Ps. Your videos are golden,especialy now that we are learning preps from home, your chanel saved my life, and my grades :))
Restorative Guide System
So happy the videos have helped!
I'm beginer and in my school, we only have 10 practice of 2hours in one semester. We already did 4 practices and i'm very bad. We dont have free access to lab so i can't train. How am i supposed to validate the semester with this few training ?
I hear you! You may consider setting up a home turbine system - you will have unlimited practice hours this way...stevensondentalsolutions.com/shop/turbine-with-quickconnector/
What RPM are you using?
100K electric, and sometimes stall out speeds on air high speed.
Please define all planes?
C plane = the non-functional cusp reduction. B plane = the central facing reduction and A plane = the functional cusp bevel.
Excuse me my inglish is verry bad. How do you push the finish line to inder gingival ? Do you excercise a strenght for préparation teeth ? Pouvez vous me montrer une photo d' une latérale préparée (j'ai l'habitude d'avoir une latérale très petite).
insérez d'abord la corde de rétraction dans le sulcus, puis préparez doucement la ligne d'arrivée. Utilisez une fraise de coupe pour affiner la marge.
what's C plane? and B plane??
This video and others in my library explain the concept: czcams.com/video/xFQRfM6Wibs/video.html
It's really helpful,but it would be more helpful by performing on the patient and upload the video😊
Yes - coming soon. Thank you!
@@StevensonDentalSolutions I'll be waiting sir
I live 7 minutes from your San Dimas location. Do you see patients there at all? I need a good dentist for an upper denture or partial. I doubt I can afford implants. Blue shield 65÷ Dental plan.
We will have an operatory finished there in 2 months - we have numerous options - give us a call in March. Best, Dr. S
@@StevensonDentalSolutions an operatory?
A fully functional dental chair within our center.
@@StevensonDentalSolutions ok great.
Excellent technique for dental students who start learning principles of crown prep. In a real world teeth that need crowns are usually
Broken down , are not wholesome and you cannot measure your reduction. Many teeth are smaller than ideal in size and form and in respect
To gingiva.
If a practicing dentist does not know how to do a prep by now, he should quit dentistry and sell watermelon for a living .
Also the question is what type of crown this prep is for. I mean what material. Crown prep is the function of material the crown is made of.
PFM. Unfortunately the vast majority of dentists prep teeth very substandardly, and take even worse scans and impressions. Where do they learn to be better after dental school? CE courses, sitting in a lecture room? Not possible! You need many years of mentoring by a master clinician to become an excellent clinician. I recommend to dentists, many of whom have many years of experience or are faculty or prosthodontists (in my study club for example) to engage themselves in learning more, opening their minds and eyes. and joining me in Chicago each year at the American Academy of Restorative Dentistry for example - such a great group to be a member of - they are the best of the best, and no-one even knows their names for the most part. I ask my mentees to try to be humble, for they don't know what they don't know. All dentists can become better if they have a passion for it. Preparations in the mouth can be glorious and even more ideal than this demo. Thank you for being so honest about your attitudes towards our profession - it is quite revealing. Sincerely, Rich Stevenson
Sweet prep, i assume dislikes are people missing the like button.
Can't make everyone happy - but it would be good to hear other opinions!
Fab! How long should it take us to do it? Thanks.
lupet mo boss
salamat po
hanep
I can't see why a student could not close the typodont bite in order to check prep clearance. This sounds like the typical university bullshit and another unnecessary stress for the student.
BTW with the materials we have these days PFM's seem redundant. I have not done one in over 10 years.
These types of preps are really just testing dexterity and bur control.
No argument from me on any of your points.
Excuse me my inglish is verry bad. How do you push the finish line to inder gingival ? Do you excercise a strenght for préparation teeth ? Pouvez vous me montrer une photo d' une latérale préparée (j'ai l'habitude d'avoir une latérale très petite).
insérez d'abord la corde de rétraction dans le sulcus, puis préparez doucement la ligne d'arrivée. Utilisez une fraise de coupe pour affiner la marge.
@@StevensonDentalSolutions Merci beaucoup.
@@amirarasha4318 Mon plaisir!
@@StevensonDentalSolutions quand le Collet de la dent est petit. (dent conique) la dent préparée sera petite alors qu'elle votre solution svp ?
@@amirarasha4318
essayez d'effectuer une onlay si possible, sinon la dent deviendra très fine