Class II Composite Preparation for ADEX Caries #30 MO

[@nmda9578]

You're a good man, Dr. Stevenson. Thank you for helping out all of us students and recent graduates with your excellent videos.

[@StevensonDentalSolutions]

Hopefully some seasoned dentists will dare to learn as well!

[@StevensonDentalSolutions]

My pleasure!

[@rodrigocartens7563]

So much control, hundreds if not thousands of preps will give us this kind of ability. Thank you for sharing all this priceless information!

[@StevensonDentalSolutions]

Thank you Rodrigo!

[@georgewhitehead8185]

Thank you Dr. Richard Stevenson for this great video. I studied it several times, along with some of your other videos, and I just passed the ADEX examination about 2 weeks ago. Doctor George Whitehead D.D.S. (October 2023). P.S. I had purchased your "Composite Instruments (7) Kit" and it was an additional asset in me passing this board.

[@StevensonDentalSolutions]

Thank you for this! Wishing you the best! Rich Stevenson

[@alexfretli9267]

Dr. Stevenson please make a video on dental materials (etch, prime, bond, etc)! We would greatly appreciate it

[@StevensonDentalSolutions]

Will do!

[@dinojubalsalvanera7997]

Nothing like watching a Sturdevant Chip to start off my morning. Excellent video, as always.

[@StevensonDentalSolutions]

Thank you😂

[@shadybishai7662]

Thank you Dr. Stevenson! You are wonderful. I liked that in this video, you kept the sound of the handpiece on so we can see how fast the bur revolves while you are preping the cavity! Would you please make a video on how to prepare rest seats (mainly Occ & cingulum) for RPD. Thank you so much :)

[@StevensonDentalSolutions]

Ooh that's a cool topic - I'll put this in the queue!

[@mydentalkey]

Amazing video, Dr. Stevenson. We at MDK really look up to you and your videos!

[@StevensonDentalSolutions]

Cool - thank you!

[@jewel3337]

Amazing video as always!! I had an exam two days ago, I got this case and my results came out today I'm so happy! Can't wait for the part 2 restoration video :)

[@StevensonDentalSolutions]

👏🏻

[@ayshahazla2619]

Thank you for the demo sir. As always impeccable😊

[@StevensonDentalSolutions]

Thank you Doc

[@RADIUMGLASS]

I had an interproximal cavity and I think the dentist ripped me off by selling me a crown. All visible areas of the tooth were in perfect shape and he ground down such a good tooth to put that thing on.

[@StevensonDentalSolutions]

Sad. Spread the word - crowns are a last resort!

[@avantik6499]

Thank you so much for your help, question how far gingivally ideally must we go? Before asking for a modification?

[@StevensonDentalSolutions]

ADEX allows for up to 1 mm of clearance for an ACCEPTABLE SCORE. Over 1.0 mm but less than 2.5 mm of clearance would Grade SUB (Marginally Substandard). I would shoot for 0.75 mm and then ask for a modification if you must extend further.

[@xiaoxiaoyanzi]

Hi Dr. Stevenson! At 10:25 you mentioned that to extend the gingival floor more gingivally we would need permission from the floor examiners, but I also noticed that the gingival clearance at that point still seems to be less than 1mm. Do we still need permission to extend the proximal box more gingivally (to almost 4.5mm measured from the occlusal) if the gingival clearance is still less than 1mm? I've noticed that due to the anatomy of the teeth that I've been using to practice (DTX ones) the gingival clearance seems to be always less than 1mm no matter how gingivally I extend the box. Thank you so much for your help!

[@StevensonDentalSolutions]

You are correct - you may extend to 1.0 mm gingivally without approval. The rules have changed since I first made the video

[@xiaoxiaoyanzi]

@@StevensonDentalSolutions Thanks Dr. Stevenson! Do you know if we are required to remove all of the white dust that sometimes gets stuck at the DEJ? Would the examiners consider that as caries/decalcification? Thanks!!

[@ammoula2974]

Thank you so much for the amazing demo doc! In the ADEX manual they describe the acceptable proximal contact clearance as “CLOSED OR VISIBLY OPEN”. I can’t wrap my head around that honestly. Can you plz clarify how could it be closed or visibly open at the same time? Thank you!!

[@StevensonDentalSolutions]

Break the contact no matter what they say - this is the only way to go...

[@ammoula2974]

@@StevensonDentalSolutions Thanks!!

[@drannemathews1]

THEY SAY "OR" !!!

[@stefanczechorskidds5536]

Thank you, will adapt this technique / information in my teaching at MUSoD. Thanks again.

[@StevensonDentalSolutions]

Excellent! Best wishes to you.

[@ffayash]

Great demo. Thanks a lot professor.

[@StevensonDentalSolutions]

My pleasure!

[@toothferrin]

Thanks for the video. Im a current d3 dental student at ucla. I noticed that your axial wall is concave. My faculty has always really pushed for the axial wall to be convex like the natural tooth structure. I was wondering what your opinion is on this? Again i appreciate the videos. Its nice to see the touch that somebody else has up close.

[@StevensonDentalSolutions]

This is a caries removal tooth, not an ideal tooth. For ideal preps, the axial wall must follow the outer gingival margin.

[@drannemathews1]

TO START OFF THIS A CARIES TOOTH!!!!

[@saroshsalim9719]

Thanks for making this video! When we have to “diagnose the lesion” what are the correct words to use? Should we write “MO #30” or “mesial caries #30?” Thanks 🙏

[@StevensonDentalSolutions]

#30 MO caries

[@saroshsalim9719]

@@StevensonDentalSolutions thanks 🙏

[@melissa-iq9cf]

doc upload more video about PFM and class II amalgam preparation please 🙏🙏🙏

[@StevensonDentalSolutions]

I will try my best

[@tamzidashawkat8394]

Hey Dr. Stevenson can you make videos about access cavity preparation for root Canal treatment for molar, premolars, and anterior teeth, please ?

[@StevensonDentalSolutions]

I have one for molars already - will give this some serious thought!

[@bimosrex7590]

Great sir👌👏👏.

[@StevensonDentalSolutions]

Thank you!

[@Sara-ur4mp]

Hi Dr. Stevenson, Thanks a million for this video. I have a question. What would be the height of the axial wall when preparing the tooth to acceptable dimensions before requesting modification? Thank you again

[@StevensonDentalSolutions]

There is no height requirement. The key is the gingival clearance, which can't exceed 1.0 mm to be considered Acceptable. Best wishes!

[@dongdongdong8413]

thank you teacher

[@StevensonDentalSolutions]

My pleasure!

[@basentsaleh2551]

Thank you for your video Dr. Stevenson! How do you make sure that your axial wall depth extends beyond the DEJ, but less than 1.5 mm when you are prepping the ideal on these caries simulated teeth?

[@StevensonDentalSolutions]

I use the RGS instruments and measure as I go deeper. I also use the burs, which are of known widths to gauge the depth at all times.

[@olivermarchand1852]

Great video as usual. Although I would have made video quality of at least 720 px. Would be nice to work with you and make a similar video series in China.

[@StevensonDentalSolutions]

Was shot in 4K, KZbin...reach me via our website

[@olivermarchand1852]

@@StevensonDentalSolutions Hi Dr. Stevenson, I have visited your website, I did not see any email, only an phone number to text to.

[@IYT231]

Hey Doc wonderful work. I requested you a demonstration of mandibular amalgam restoration MODL a while ago. Can you please spare some time to make that video. Thanks 😊

[@StevensonDentalSolutions]

With the DL cusp capped?

[@IYT231]

Stevenson Dental Solutions with DL . Thanks

[@duniagarcia6879]

Thanks Dr Stevenson for all your help with this wonderful videos, May I ask how far deep can I go gingivally on the proximal box without having to request a modification for the adex exam ? Thanks.

[@StevensonDentalSolutions]

After you reach 1.0 mm clearance with the adjacent tooth, further mods should be requested.

[@irynamelnykovych5807]

Hello Dr.! Thank you for your video. Just can you tell me if prep premolar class 2 composite is it need convergine one wall and orthogonal another (depending upper/lower)?

[@StevensonDentalSolutions]

Not necessary - the walls may be parallel or converging like the amalgam.

[@talalsoailehaljoaid9188]

Can you make video about burs and uses 💓💞

[@StevensonDentalSolutions]

Okay, will try my best.

[@faizachaudary3076]

Thank you for another great video! Do you know what the approximate dmensions of the box are on an ideal composite prep?

[@StevensonDentalSolutions]

Tough to say as it is determined by the contact area with the adjacent tooth.

[@kristenhoglund1149]

Is it acceptable to extend the Occlusal part of the prep the way you demonstrated if there is no caries in the occlusal groove? To extend this way if no caries is present would I have to request a modification and use the logic that I am attempting to improve retention? Thanks again for the video, its AMAZING!

[@StevensonDentalSolutions]

The conventional outline as shown will always be accepted. There is no way for the plastic tooth to having carious fissures anyway. Alternatively, you may certainly prep a slot with grooves and spare the occlusal. It's up to you.

[@ahmedmohamedmohamed8323]

Many thanks for you Dr. Stevenson . I have just a little question , How about the depth of the box ? Does it depend on extension of caries in this area . THANK YOU for your effort

[@StevensonDentalSolutions]

The gingival extension will be 0.5 minimum but always beyond the caries.

[@yarahaj1583]

Thank you for the great tips! Is it mandatory to prep the occlusion for Class II PREP for the CDCA or a mesial box would be enough?

[@StevensonDentalSolutions]

They will accept a box only form however you will need to make sure you have enough retention. Binding to enamel on class 2 composites simply isn’t enough.

[@sunsalmaghray8059]

Thank you Dr. fir your great videos! I would like to ask where can I find the teeth with build in caries?

[@StevensonDentalSolutions]

stevensondentalsolutions.com

[@silvn1212]

please what’s the measurement from the pupal floor to the cavosurface ideally?

[@StevensonDentalSolutions]

1.5 mm, but ADEX will allow less.

[@3456kingkhan]

Awesome 👏 🤩👍👌🙌🏽

[@StevensonDentalSolutions]

Thank you Doc

[@lostcause486]

Hi Dr. Stevenson, do we have to prep the occlusal for the exam or are slot preps acceptable?

[@StevensonDentalSolutions]

The entire occlusal.

[@reynaldogomez6131]

Dr. What if there is a pulp exposure. How can I proceed? My friend failed because of that. Thank you

[@StevensonDentalSolutions]

The decay should not get that close in most cases. It's common to ask for more extensions than actually indicated, hence pulp exposures.

[@revanth3508]

I just visited your store at your site . Do you ship out the materials and Burs to the U.K. ?

[@StevensonDentalSolutions]

It's tough - we've had so many issues with shipping to the UK, however, if you email us a list of items and are okay with FedEx, we'll do it! [e-mail]

[@glitterlicious01]

How do you know when you are about to have a pulpal exposure on these ADEX teeth?

[@StevensonDentalSolutions]

It's very tough to know by appearance or feel, but I have sectioned them and the carious exposure on molars is 3 mm from the outer surface. For the anterior teeth is about 2 mm.

[@choochd]

I noticed you left your axial wall concave what is your opinion on those who teach that the axial wall must be convex?

[@StevensonDentalSolutions]

in an ideal prep with no caries, convex axial walls is appropriate. When removing caries, the axial wall will become concave, due to a caries focused modification. Creating a convex axial wall after caries removal is contra-indicated as it removes perfectly health tooth structure for no apparent benefit. Placing a liner and base in order to build the wall back to convexity may seem appealing but the "minimum basing concept" has clearly shown that this practice affords no advantage, except perhaps pulpal protection...however, with typical D1 caries, (out 1/3 of dentin) placing a base is not considered necessary.

[@rachelbrown3665]

hey, needing advice! I am retaking and had the 29 DO and I did not leave any caries but I over-prepared my procimal wall, axial, and isthmus. i was confused because i thought they wanted us to go to the max of each of these dimensions ie near 1 mm proximal clearance, 1 mm from the DEJ etc. but also, there was mesial occlusal caries that you could not find unless you went 2mm deep and some people faield because of left caries in that area. is it typical to have the caries not connected for this exam? any adivce on going to the max i would appreciate!

[@StevensonDentalSolutions]

I would prep to ideal then only extend those walls required to move due to caries, slightly less than the ADEX max allowed, then involve the FE for permission to extend. If you prep 1.5 mm pulpally, you can see the decay. Stick to a traditional style prep, and not a slot or box.

[@dejiamoo]

Hey Dr. Stevenson! Great video as always. Do you think the ADA will opt for mannequin boards given the pandemic?

[@StevensonDentalSolutions]

Well both the WREB and the ADEX (the two largest exam agencies) went to mannequins and plastic teeth this year. Almost every state has now approved plastic teeth for licensure exams. The new RTX teeth by Acadental with hidden caries seem to be the future. It's probably a good thing!

[@dejiamoo]

@@StevensonDentalSolutions That's awesome. The hassle of recruiting patients is a stress I'm glad has been eliminated from the curriculum.

[@StevensonDentalSolutions]

Agreed! And these new teeth are really cool.

[@ayushmathur7622]

Excellent demonstration Dr. Stevenson! Do you know where we can find Acadental RTX teeth to practice on? Will they be available on your web store?

[@StevensonDentalSolutions]

Coming within one week to our store!

[@metrogru]

so the good prep should eventually have tug back or shouldn't have tug back?

[@StevensonDentalSolutions]

Should not have tugback.

[@rezarazi720]

thank you Dr. Stevensn. I was wondering on CDCA do we always do a MO extrnded to distal on a manikin test or we might do a slot prep??

[@StevensonDentalSolutions]

Slot prep is fine - just make sure you have enough retention - bonding alone is not enough.

[@rezarazi720]

Thank you Dr. Stevenson

[@StevensonDentalSolutions]

@@rezarazi720 You bet! Best wishes on the exam.

[@JuanBot]

What speed are you using the handpiece at?

[@StevensonDentalSolutions]

less than full - using the rheostat to control the speed - slow for smoothing and faster for bulk removal. Always slow for caries removal.

[@niteshdaswani9432]

do we need divergent wall for proximal box

[@StevensonDentalSolutions]

Flared for composite or 90 degrees as viewed from the occlusal. From the proximal view, the walls are typically convergent.

[@pavneettak4964]

Hi Dr. Stevenson, if am to ask for modification for this particular prep., what would be the ideal extention of axial wall gingivally to request...0.25 to 0.50 mm??

[@StevensonDentalSolutions]

0.5 mm per request

[@pavneettak184]

Got it. Thank you!

[@gaurivelankiwar3239]

Hello Dr S. What is the difference between RTX and DTX teeth?

[@StevensonDentalSolutions]

The RTX teeth are made specifically for WREB Exam practice, while the DTX teeth are made exclusively for ADEX Exam practice. The artificial caries in the RTX teeth behaves differently than the DTX teeth. Caries in the DTX teeth penetrates the DEJ in a more realistic manner. Having said all of this, neither type are actually used on the exams. The WREB and ADEX use special exam teeth which are similar but not the same...

[@gaurivelankiwar3239]

@@StevensonDentalSolutions Thank you so much for the reply!

[@skdenter2169]

Good your life video

[@StevensonDentalSolutions]

Thank you

[@pavneettak4964]

Hi Dr. Stevenson, is there any other way to check for residual caries in the cdca exam on the typodont tooth other than the tactile sensation with the explorer?

[@StevensonDentalSolutions]

That's it - dyes won't help. The examiners have the same challenge that you have. Beat at their own game!

[@shmulikroth7574]

When you start your punch cut, how close are you to the marginal ridge?

[@StevensonDentalSolutions]

Within 1 mm

[@drseemabhandari2698]

Really narrow prepn ...great

[@StevensonDentalSolutions]

Glad you like it!

[@metinkaraca3171]

Class ||| |V and V we we want please

[@StevensonDentalSolutions]

Coming soon!

[@mgossett34]

Hello Dr. Stevenson since you are out of the RGS 330 burs which but could I use to replace the 330 RGS when refining the pupal 😊floor area

[@StevensonDentalSolutions]

or the 245.