Unsurprising low number of views of this fantastic video. But thank you for your honest evaluation and millions of people should and will eventually have this option MENTIONED by a dentist.
Awesome video. Thank you. You've basically validated my thinking, in regard as to exactly why my new dentist (after doing all the initial x-rays), has informed me that I have infection "pockets" at the top of the roots, under two upper rear molar crowns, done by my last dentist. Now they are recommending implants as the solution for this. He says both of those crowns fit very well, but were poorly sealed during the procedure. Fml
My dentine tubules are ******* agony thanks to silent GERD thru lockdown. Had 20 caries, now all fixed. Left with a Dr's appt mid next month and duraphat toothpaste offering relief for 5-10 minutes. Longing for a dentist like you. Here in UK, they don't want to take on new patients. Mine is 70 and getting clumsy. So painful and depressing.
An important part of IDS that most dentists don't get is that it's ONLY on the dentin. You're not supposed to apply bond onto the enamel margins. In fact, you're supposed to lightly prep away any bond that gets onto the enamel margins. Another point is that IDS and Core-build up with either flowable or packable composite are very similar techniques depending on remaining tooth structure. It's just that insurances won't cover IDS 😂.
very useful information sir..thank you so much for teaching fluently..i have a question... what to do in case of crown cementation using GIC ? should i do immediate dental sealing after tooth prep aration and if yes then should i apply second layer of bonding agent during crown cementation or should i do etching and then place a crown using GIC ?
jay gohil If you are using a gic, immediate Dentin sealing is not necessary. The benefits of immediate Dentin sealing are for resin bonded restorations.
If you're not doing same-day CAD/CAM restorations and remove the oxygen inhibited layer prior to temporization, do you get a lower bond strength at the time of delivery? The dentin hybrid layer would be sealed on the prep day so are you getting any useful bonding to the IDS surface that has the oxygen inhibited layer removed? Does re-etching and bonding the IDS layer at delivery pretty much give you the same bond as it would have to dentin with no IDS? Thanks for the info.
Great video. I have to review some literature about this. I very sure that this technique is great at the dentin side because you r using self etch and you are working with the smear layer and smear plugs in dentin. (Selective etch for sure) I m very courious about the adhesion prosses between that adhesive or resin that is acually polimerized and now you want to add more resin (the resin cement) need a very clear protocol.
Cristian Izquierdo hey good thoughts. Prior to cementing with resin cement you need to re-etch the tooth and, depending on the bonding agent, re-apply your bonding agent. You can join our website for free and you will find some handouts that may be useful. www.comprehensivedentist.com
@@TheComprehensiveDentist thanks.. I going to make my research about that. Because you know the masterpiece of adhesion is using the inhivited layer of the adhesive or last layer of resin and in this case this inhivited layer is lost, maybe the acid etch make new pores and clean the resin or adhesive but its limitate the adhesion to a micromechanical retention only, loosing the advantage of the chemical adhesion. Maybe usin a silane over the resin layer after the acid etch improve the adhesion of the resin cement to that "old" adhesive layer or resin layer without oxigen inhivited layer.
Great video, but one concern I have is accidentally getting excessive thickness of bond on enamel or dentin crown margins, then taking the impression and ending up with a crown sitting on bond and not tooth structure. Can u speak to this?
Dr. David Wood DDS Good thought. So after you do the immediate dentin seal, it will most likely result in some of the bonding agent getting on your enamel margins and near the finish line. Extreme precision with this technique is not always possible. To combat this concern, go back around your margins with a fine diamond and “re-fresh” your enamel margin to re-expose any enamel that was covered. This is a gentle, low rpm refreshing of the enamel. Then take your impression. Hope that helps.
If you do a cementation with conventional cements like GI and ZnPh, you do it, because it is easy. If you do a cementation with adhesion, you do it because you want it to be as perfect as possible. So there is no point in doing IDS for cenvetional cementation, because it is too complicated (rubberdam, using bonding agent, curing) Second point: ZnPh is working on friction, IDS might not improve friction (because friction is not needed in adhesive dentistry - so no one knows if its better with IDS) and non resin-GIC has a good chemical bond to tooth tissues itself. + If you use both adhesion and GIC - the weekest part of the scheme is GIC cohesion (it means that failiure will most probably occure inside GIC) So you improve nothing. I hope I helped.
Thank you for all the informations. Really appreciate your time and effort. My question: we use clearfill se prime and bond in our clinic. Often my preps are quite conservative. What is the disadvantage / problem if I dont put on the thin layer of flowable after IDS but I am doing same day cementation? 2) Can you please guide me if I can do pre etching on clearfill se prime and bond . Thanks in advance.
thank you so much i've been going through my textbooks for residency exam n came across this n had no idea what it was so your video was really helpful. what i wanted to ask was ,you said at the beginning of the vid that IDS is primarily used in indirect restorative techniques , so veneers , crowns ..etc my question is can it also be used in endodontic treatment ? say i have a molar n i did the canal preparation but need a second appointment to finish , can i use IDS before the first appointment is over ? would it have the same benefits ? thank you .
Hello! That is a great question. I personally have seen no articles that discuss IDS on endo treated teeth. I haven't looked for any either! That would be a good lit review. In theory, I think it could still be advantageous to some degree but my question would be...is it clinically significant? Especially, if the tooth will receive a crown or full coverage restoration at a future appointment? I am not convinced I would necessarily do that prior to finishing the root canal. Although, after the root canal, you could do your bonding and allow about 5 minutes for the bond to "mature" prior to doing a core restoration. That may not be a bad idea. Long story short, I am not 100% positive what the correct answer is!! Good luck on your exam!
Great video!! Could you elaborate on how you might do IDS using Scotchbond Universal please as I could not see this on the video. Pascal Magne uses Optibond FL because the 2nd layer is a 50% filled resin and so protects the bond. However, I like Scotchbond Universal which is unfilled. Pascal talks about possibly using flowable resin as a 2nd layer to protect the bond if using unfilled bonding agent. Any views? I also wondered if a good topic for a video might be how to apply rubber dam when cementing these dentine bonded crowns etc. I really struggle especially if the margins are not supra-gingival. Many thanks.
CHRISTOPHER TOWNSHEND hey Christopher! Very good points! I would recommend using flowable composite over the scotchbond universal, especially if you are not doing same day crowns. We do a fair amount of CAD/CAM so I will sometimes not use flowable. In that case I apply scotchbond after prep, scan, and reapply scotchbond right before cementation. The rubber dam idea is good. Currently, I use the Isodry for cementations. Hope that helps.
CHRISTOPHER TOWNSHEND Hey Chris, I messaged you from my personal UA-cam account and didn’t realize it until now. Send me your email and I will forward you a handout that goes over the process.
The Comprehensive Dentist Thanks Jason. Isodry is a great idea, thanks. I will pm you my email if I can work out how to do it. Many thanks! How do you temporary your onlays etc if not doing same day crowns do the temp stays on but also does not bind to the IDS layer? What are you using for cementation out of interest. Pascal Magne uses heated composite which I have not tried. Keep the videos coming. I think they are great.
CHRISTOPHER TOWNSHEND Good question. So if doing temps or taking a PVS impression, it is recommended that you remove the oxygen inhibition layer. You can do this with a glycerin gel or by scrubbing prep with 70% ethyl alcohol for 10 seconds. Use the temp cement of your choice. For final cementation, I have been using more rely-x ultimate than any thing else lately. Our clinic uses that for the time being and it is compatible with scotchbond universal.
What is the concept of bond maturation? Surely this shouldn’t apply to light cure only bonding agents? Also, how does the re-exposure of the bonding agent and the preparation process for cementation (cleansing of tooth from debris from temp and temp cement, exposure to saliva and blood) affect the bond strength? When my ploymerized bond gets contaminated, I always feel uneasy about re-etching and rinsing off the cured bond.
kareemmeng The polymerization stresses of curing are relieved some over time. Especially if you allow the bonding agent to sit for a few minutes after curing. When doing immediate dentin sealing, you need to use a thicker adhesive bonding agent or place a low modulus flowable over the bond. This will protect the bond if contaminated.
The Comprehensive Dentist so how much does the stress become relieved? I’ve tried to find some literature on that but it’s scanty. I’ve especially been interested in how much of the polymerization shrinkage on composite occurs once the curing light hits the composite. Does most of it happen in the first 2 seconds, 5 seconds, etc?
Do you still re-do your adhesive protocol on the delivery appoinment or you just clean the preparation and then cement it? P.S What about the protocol of 2 times adhesive appliance (1st light cured, 2nd not light cured)?
How do I get my dentist to listen to me and apply a dentin filler. They told me nothinh was wrong except that I grind my teeth. He told me to wear. Night guard and if that didn't work to come back so he could show me some jaw exercises. It's been a year, my tooth hurts everyday ALL day. Why don't dentists tell you the dangers of grinding your teeth and how you can grind them down to the nerve!?
L. C. I am not visualizing the full extent of your current problem based on your description. You can always try another dentist if you are concerned. I would also perhaps encourage you to be screened for sleep apnea. Tooth wear and jaw pain is linked to sleep apnea and other sleep disorders. If there is a sleep issue present, often the treatment of the sleep issue helps with the dental issues. You can talk to your primary care physician about a sleep study.
Great video! How do you clean the temporary cement or crown.. wouldn't it affect the bonding? Do you apply adhesive bonding again during cementation or the IDS is enough?.
arkhe de leon Thanks! You clean off the temp cement with a diamond at low speeds (stay away from margin!!) or micro-sandblasting. I prefer the latter. And yes, you do want to re-apply your bonding prior to cementation.
Mohamed Fattah It depends on what bonding agent you use! For example, in my clinic we are using multilink automix. That system has a bonding agent and you do not cure it prior to cementation. It sets as the cement sets. Others, like rely-x ultimate, recommend using scotchbond universal with a dual cure activator to ensure proper curing of bonding agent. 4th and 5th gen bonding agents don’t typically have the option for a dual cure activator and historically have to be cured prior to cementation or could be cured through very thin restorations (ex. Veneers). It is important to read the ifu for your bonding agent and cement to ensure you fully understand what the manufacturer requires.
Nikhil Patel I do! Immediate Dentin seal is great for establishing a good hybrid layer but it does very little for our enamel. That second application just before bonding the restoration is mainly for refreshing the Dentin seal and for the enamel bond!
@@alaa.shible2743 directly application is required on dentin, but acid etching works for enamel. Besides air-borne particle abrasion may be more effective and reliable
A .S first, it is not immediate Denton sealing if you are in the enamel. Second, with veneers, because so thin, you typically cure the bonding agent and cement at same time. If you placed a layer of bonding agent and cured it, your veneers could be overcontoured or too thick.
Unsurprising low number of views of this fantastic video. But thank you for your honest evaluation and millions of people should and will eventually have this option MENTIONED by a dentist.
Manny Tuzman thank you for the kind words. I am glad to contribute to the profession and to share what I have learned.
Awesome video. Thank you. You've basically validated my thinking, in regard as to exactly why my new dentist (after doing all the initial x-rays), has informed me that I have infection "pockets" at the top of the roots, under two upper rear molar crowns, done by my last dentist. Now they are recommending implants as the solution for this. He says both of those crowns fit very well, but were poorly sealed during the procedure. Fml
My dentine tubules are ******* agony thanks to silent GERD thru lockdown. Had 20 caries, now all fixed. Left with a Dr's appt mid next month and duraphat toothpaste offering relief for 5-10 minutes. Longing for a dentist like you. Here in UK, they don't want to take on new patients. Mine is 70 and getting clumsy. So painful and depressing.
Very useful i was hoping more details about how to apply and how is it going to effect cementation protocols
Very good educational program.
Great video doc! 👍
An important part of IDS that most dentists don't get is that it's ONLY on the dentin. You're not supposed to apply bond onto the enamel margins. In fact, you're supposed to lightly prep away any bond that gets onto the enamel margins.
Another point is that IDS and Core-build up with either flowable or packable composite are very similar techniques depending on remaining tooth structure. It's just that insurances won't cover IDS 😂.
very useful information sir..thank you so much for teaching fluently..i have a question... what to do in case of crown cementation using GIC ? should i do immediate dental sealing after tooth prep aration and if yes then should i apply second layer of bonding agent during crown cementation or should i do etching and then place a crown using GIC ?
jay gohil If you are using a gic, immediate Dentin sealing is not necessary. The benefits of immediate Dentin sealing are for resin bonded restorations.
@@TheComprehensiveDentist thank you so much sir..
If you're not doing same-day CAD/CAM restorations and remove the oxygen inhibited layer prior to temporization, do you get a lower bond strength at the time of delivery? The dentin hybrid layer would be sealed on the prep day so are you getting any useful bonding to the IDS surface that has the oxygen inhibited layer removed? Does re-etching and bonding the IDS layer at delivery pretty much give you the same bond as it would have to dentin with no IDS? Thanks for the info.
Thanks for the video. How do you stop temporaries from no bonding?
Remove the oxygen inhibition layer with glycerin gel or rub IDS with alcohol.
Great video. I have to review some literature about this. I very sure that this technique is great at the dentin side because you r using self etch and you are working with the smear layer and smear plugs in dentin. (Selective etch for sure)
I m very courious about the adhesion prosses between that adhesive or resin that is acually polimerized and now you want to add more resin (the resin cement) need a very clear protocol.
Cristian Izquierdo hey good thoughts. Prior to cementing with resin cement you need to re-etch the tooth and, depending on the bonding agent, re-apply your bonding agent. You can join our website for free and you will find some handouts that may be useful. www.comprehensivedentist.com
@@TheComprehensiveDentist thanks.. I going to make my research about that. Because you know the masterpiece of adhesion is using the inhivited layer of the adhesive or last layer of resin and in this case this inhivited layer is lost, maybe the acid etch make new pores and clean the resin or adhesive but its limitate the adhesion to a micromechanical retention only, loosing the advantage of the chemical adhesion. Maybe usin a silane over the resin layer after the acid etch improve the adhesion of the resin cement to that "old" adhesive layer or resin layer without oxigen inhivited layer.
@@cristianizquierdo6530 agree
Great video, but one concern I have is accidentally getting excessive thickness of bond on enamel or dentin crown margins, then taking the impression and ending up with a crown sitting on bond and not tooth structure. Can u speak to this?
Dr. David Wood DDS Good thought. So after you do the immediate dentin seal, it will most likely result in some of the bonding agent getting on your enamel margins and near the finish line. Extreme precision with this technique is not always possible. To combat this concern, go back around your margins with a fine diamond and “re-fresh” your enamel margin to re-expose any enamel that was covered. This is a gentle, low rpm refreshing of the enamel. Then take your impression. Hope that helps.
The Comprehensive Dentist I would use a new bond tip to remove the excessive bond before airing and light cure.
@@hoanikki1 agree
very useful. thank you.
Priyankita Kar Good to hear. Thank you!
Great video. Even if you weren't doing bonded restorations, it would still work with GI and zinc phosphate based cementation wouldn't it?
If you do a cementation with conventional cements like GI and ZnPh, you do it, because it is easy.
If you do a cementation with adhesion, you do it because you want it to be as perfect as possible.
So there is no point in doing IDS for cenvetional cementation, because it is too complicated (rubberdam, using bonding agent, curing)
Second point: ZnPh is working on friction, IDS might not improve friction (because friction is not needed in adhesive dentistry - so no one knows if its better with IDS) and non resin-GIC has a good chemical bond to tooth tissues itself. + If you use both adhesion and GIC - the weekest part of the scheme is GIC cohesion (it means that failiure will most probably occure inside GIC) So you improve nothing. I hope I helped.
It will probably work in terms of diminishing postoperative sensitivity. But will have no effect on increased adhesion.
Thank you for all the informations. Really appreciate your time and effort.
My question: we use clearfill se prime and bond in our clinic. Often my preps are quite conservative. What is the disadvantage / problem if I dont put on the thin layer of flowable after IDS but I am doing same day cementation?
2) Can you please guide me if I can do pre etching on clearfill se prime and bond .
Thanks in advance.
Ping C I wouldn’t worry about pre-etching with Clearfil SE. A thin layer of flowable is ideal but likely not a deal breaker with same day cemenatation
@@TheComprehensiveDentist thank you for your reply. Appreciate it.
thank you so much i've been going through my textbooks for residency exam n came across this n had no idea what it was so your video was really helpful. what i wanted to ask was ,you said at the beginning of the vid that IDS is primarily used in indirect restorative techniques , so veneers , crowns ..etc my question is can it also be used in endodontic treatment ? say i have a molar n i did the canal preparation but need a second appointment to finish , can i use IDS before the first appointment is over ? would it have the same benefits ? thank you .
Hello! That is a great question. I personally have seen no articles that discuss IDS on endo treated teeth. I haven't looked for any either! That would be a good lit review. In theory, I think it could still be advantageous to some degree but my question would be...is it clinically significant? Especially, if the tooth will receive a crown or full coverage restoration at a future appointment? I am not convinced I would necessarily do that prior to finishing the root canal. Although, after the root canal, you could do your bonding and allow about 5 minutes for the bond to "mature" prior to doing a core restoration. That may not be a bad idea. Long story short, I am not 100% positive what the correct answer is!! Good luck on your exam!
Great video!! Could you elaborate on how you might do IDS using Scotchbond Universal please as I could not see this on the video. Pascal Magne uses Optibond FL because the 2nd layer is a 50% filled resin and so protects the bond. However, I like Scotchbond Universal which is unfilled. Pascal talks about possibly using flowable resin as a 2nd layer to protect the bond if using unfilled bonding agent. Any views? I also wondered if a good topic for a video might be how to apply rubber dam when cementing these dentine bonded crowns etc. I really struggle especially if the margins are not supra-gingival. Many thanks.
CHRISTOPHER TOWNSHEND hey Christopher! Very good points! I would recommend using flowable composite over the scotchbond universal, especially if you are not doing same day crowns. We do a fair amount of CAD/CAM so I will sometimes not use flowable. In that case I apply scotchbond after prep, scan, and reapply scotchbond right before cementation. The rubber dam idea is good. Currently, I use the Isodry for cementations. Hope that helps.
CHRISTOPHER TOWNSHEND Hey Chris, I messaged you from my personal UA-cam account and didn’t realize it until now. Send me your email and I will forward you a handout that goes over the process.
The Comprehensive Dentist Thanks Jason. Isodry is a great idea, thanks. I will pm you my email if I can work out how to do it. Many thanks! How do you temporary your onlays etc if not doing same day crowns do the temp stays on but also does not bind to the IDS layer? What are you using for cementation out of interest. Pascal Magne uses heated composite which I have not tried. Keep the videos coming. I think they are great.
CHRISTOPHER TOWNSHEND Good question. So if doing temps or taking a PVS impression, it is recommended that you remove the oxygen inhibition layer. You can do this with a glycerin gel or by scrubbing prep with 70% ethyl alcohol for 10 seconds. Use the temp cement of your choice. For final cementation, I have been using more rely-x ultimate than any thing else lately. Our clinic uses that for the time being and it is compatible with scotchbond universal.
@@jasonbullock5239 agree
What is the concept of bond maturation? Surely this shouldn’t apply to light cure only bonding agents? Also, how does the re-exposure of the bonding agent and the preparation process for cementation (cleansing of tooth from debris from temp and temp cement, exposure to saliva and blood) affect the bond strength? When my ploymerized bond gets contaminated, I always feel uneasy about re-etching and rinsing off the cured bond.
kareemmeng The polymerization stresses of curing are relieved some over time. Especially if you allow the bonding agent to sit for a few minutes after curing. When doing immediate dentin sealing, you need to use a thicker adhesive bonding agent or place a low modulus flowable over the bond. This will protect the bond if contaminated.
The Comprehensive Dentist so how much does the stress become relieved? I’ve tried to find some literature on that but it’s scanty. I’ve especially been interested in how much of the polymerization shrinkage on composite occurs once the curing light hits the composite. Does most of it happen in the first 2 seconds, 5 seconds, etc?
You do this for both vital and non vital teeth??
true
Do you still re-do your adhesive protocol on the delivery appoinment or you just clean the preparation and then cement it?
P.S What about the protocol of 2 times adhesive appliance (1st light cured, 2nd not light cured)?
It all depends on your resin cement that you are using. I would defer to your cementation protocols for your product of choice.
Love your amzing work Doctor ! I cant seem to find the endocrown video in your channel , can u provide me the link please? Thank you
Teoh Wen Chen It is on www.comprehensivedentist.com. It is on the free library.
The Comprehensive Dentist thank you for the fast reply 👌
Teoh Wen Chen no problem. Let me know if you need anything else!
The Comprehensive Dentist thank you very much ! Keep up the good work Dr !
How do I get my dentist to listen to me and apply a dentin filler. They told me nothinh was wrong except that I grind my teeth. He told me to wear. Night guard and if that didn't work to come back so he could show me some jaw exercises. It's been a year, my tooth hurts everyday ALL day. Why don't dentists tell you the dangers of grinding your teeth and how you can grind them down to the nerve!?
L. C. I am not visualizing the full extent of your current problem based on your description. You can always try another dentist if you are concerned. I would also perhaps encourage you to be screened for sleep apnea. Tooth wear and jaw pain is linked to sleep apnea and other sleep disorders. If there is a sleep issue present, often the treatment of the sleep issue helps with the dental issues. You can talk to your primary care physician about a sleep study.
Great video! How do you clean the temporary cement or crown.. wouldn't it affect the bonding? Do you apply adhesive bonding again during cementation or the IDS is enough?.
arkhe de leon Thanks! You clean off the temp cement with a diamond at low speeds (stay away from margin!!) or micro-sandblasting. I prefer the latter. And yes, you do want to re-apply your bonding prior to cementation.
Do we need curing for the 2nd coat of the bonding agent?
Mohamed Fattah It depends on what bonding agent you use! For example, in my clinic we are using multilink automix. That system has a bonding agent and you do not cure it prior to cementation. It sets as the cement sets. Others, like rely-x ultimate, recommend using scotchbond universal with a dual cure activator to ensure proper curing of bonding agent. 4th and 5th gen bonding agents don’t typically have the option for a dual cure activator and historically have to be cured prior to cementation or could be cured through very thin restorations (ex. Veneers). It is important to read the ifu for your bonding agent and cement to ensure you fully understand what the manufacturer requires.
@@mohamedfattah411 depends on the coverage type of the restoration and the viscosity of the adhesive
Hi awesome vid! I was just wondering if at the second appt if you apply another layer of bond if you have done immediate dentin sealing prior?
Nikhil Patel I do! Immediate Dentin seal is great for establishing a good hybrid layer but it does very little for our enamel. That second application just before bonding the restoration is mainly for refreshing the Dentin seal and for the enamel bond!
did you applied directly on previous bond or do acid-etch first !
@@alaa.shible2743 directly application is required on dentin, but acid etching works for enamel. Besides air-borne particle abrasion may be more effective and reliable
directly application is required on dentin, but acid etching works for enamel. Besides air-borne particle abrasion may be more effective and reliable
Why do you mention veneer as contra-indication example while preparation of veneer require only 0.5 so we still in Eamel !
A .S first, it is not immediate Denton sealing if you are in the enamel. Second, with veneers, because so thin, you typically cure the bonding agent and cement at same time. If you placed a layer of bonding agent and cured it, your veneers could be overcontoured or too thick.
no IDS required on enamel
ok whats ur point, 3m has the option others dont. Couldnt you wrap it up in 15 sec? A lot of literature suggest yet no reference youtube dentists age
Adrian Sances Do you have a question? I don’t understand anything you have said...