Margin Elevation Technique Demystified with Dr Matt Nejad

[@klksplsor]

Dr. Nejad, as a final year dental student, I thank you for this highly informative and brief video.

[@BiomimeticDentistry]

thank you!

[@ysk249]

This is a great example of a one-stop learning solution for busy dentists and dental students. Thanks for posting the best medley video on Margin Elevation Technique.

[@GarrisonDental]

Thank you! We're glad you enjoy it. Dr. Nejad was amazing to work with in creating these videos and we hope there will be more in the future!

[@choochd]

Awesome tutorial, Dr. Nejad. Love all the details and reasoning of why you make certain choices over others.

[@ZACY1234]

Best DME Video on KZbin!!

[@ZACY1234]

Great video Dr. Nejad. Thanks for the very good tips 👍👍

[@busenazuysal292]

Thank you very much sir

[@hindajabbar4163]

Very informative video

[@2kidsnosleep]

Nice stuff, going to try that matrix 👍🏻

[@BiomimeticDentistry]

awesome!

[@dongdongdong8413]

Thank you

[@rubasarkez9917]

That was awesome. Thank you for your effort 👌🏻

[@vette003]

I went to your course a few years ago. I could not get this technique to work in practice because when the caries is apical to the PDL of the rest of the tooth the bottom of the band either cuts into the gums causing bleeding or the surrounding gum does not let the band seat apically enough to reach the bottom of the prep. This technique only seems to work on a typodont with no PDL. Why can't a band be made with the bottom of the band extending apically to the rest of the band like the old molar bands?

[@GarrisonDental]

I am sorry you are having difficulty. This is an extremely difficult procedure the deeper you go subgingival, but I assure you the band works on more than the typodont. I use it exclusively and like anything else, practice and experience make the difference. Sometimes I do place another sectional matrix band between the reel-matrix DME band and the tooth so that the reel-matrix DME band acts essentially as a retainer to hold the other sectional matrix band tightly against the tooth. We have tested the design you mention and it was less effective than placing another sectional matrix band in place for a few reasons. - Dr. Matt Nejad

[@gregwarrior]

practitioner here, i also have this problem , it’s due to big mesial and distal height difference，this causes instability when tightening the band. I solve this by detaching the bad from the reel and customizing it a bit. But the biggest trick that makes a difference is to simply do gingivectomy. it’s just impossible to get a reliable seal when soft tissue is present. I’ve tried multiple products from multiple companies , Torr VM , garrison, polydentia, dentsply, bioclear. Non will give you a reliable seal unless you do soft tissue management!

[@ronyeahright9536]

usually when seating any matrix band, if you have one side that has very deep decay and can't get that side of the band fully down there, take the band out, and use some crown and bridge scissors to cut out a "U" shape on the OPPOSITE side of the problematic deeper side; this will allow the band to go deeper and hopefully reach the bottom of the prep.

[@mukeshadwani4695]

Fantastic

[@acash93]

Also, how do you account for bonding to cementum? Would you use GI cement for marginal elevation, or do you stick to composite resin?

[@taylorshank9443]

Using a 4th generation bonding system (kerr optibond fl) can achieve a bond strength of around 40mpa, similar to that found at the natural DEJ. I use composite, not GI or RMGI. “Open sandwich” techniques are not recommended anymore as the GI has poor resistance to wear and degradation over time

[@DOUGOUTY]

Thanks a lot for this case I sometimes use other technics to fill The margin it was very difficult and took a lot Times. I'm very satisfy

[@ApokinAleksandr]

Why Dr Matt Nejad use plastic model wiout applying rubberdam isolation for demonstration?

[@GarrisonDental]

Thanks for the question. For demonstration purposes, rubber dams are not placed on the typodonts (unless it's a video on how to place rubber dam). Also, depending on how deep the margin goes subgingivally, you may not be able to place a rubber dam until you've built up your margin to be supragingival.

[@williamwebley6964]

Why not just geristore?

[@williamwebley6964]

To raise the margin

[@BiomimeticDentistry]

@@williamwebley6964 - becuase geristore has a low bond strength, poor mechanical properties, if you are terminating an adhesive restoration on geristore or glass ionomer margins, it will not last because stress will magnify at that interface and geristore or GI will crack.

[@magdaebsheir5089]

Thank you so much

[@pavithrakannan6499]

Great video, thanks for posting it. Is there a particular all ceramic material you recommend for the inlays and inlays with this technique?

[@BiomimeticDentistry]

Thank you- I like LiSi from GC (Lithium Discilicate).

[@TonySongDMD]

Thank you for sharing amazing technique doc! What type of codes can you use for (1) deep margin elevation and (2) immediate dentin sealing procedures?

[@samhyatt2427]

Thank you But I can’t understand why you do this procedure. If you can place any type of matrix specifically isolating with rubber dam so you can just save all this time and take an impression for the ceramic.

[@jameshastings7252]

This procedure is used to raise the root surface/restorative margin to the level of the gingiva or slightly above. Although it's possible to "just...take an impression" your restoration margin will be subgingival and is likely to create chronic inflammation, bone loss and eventual failure of your restoration. This is an alternative to invasive crown lengthening and subsequent creation of a food trap and inability to cleanse the area properly. Once you have mastered the Deep Margin Elevation procedure it's not time comsuming and it creates value. And you must charge for it.

[@sorinher1]

This technique seems to be very unpredictable and unsafe.Bonding strength of the composite to dentin is very weak and because of the future leakeage after the composite contraction you can expect secondary carries.The elevated margin can also fracture as a result of pression from the crown or onlay margin.I prefer to crown al the cavities margins and even CLP.Maybe reinforced glass ionomer cement would be a better choice for this sensitive technique.

[@BiomimeticDentistry]

@@sorinher1 Hi Sorin. Thank you. Interestingly, the scientific publications are in complete contrast to what you are saying. Of course adequate isolation is essential but doing good dentistry is a prerequisite to anything lasting. If you are being honest, every dental procedure is technique sensitive, from a simple amalgam to a gold crown. I think its time to stop using the excuse of technique sensitivity and focus on doing good work. Using glass ionomer would be a terrible idea for this but it is a difficult procedure that many have mastered and it has been published and used for over 10 years now.

[@BiomimeticDentistry]

Also, it is much more manageable to maintain optimal isolation with the band in place and rubber dam while you elevate the margin, than it is to cement and remove excess cement and polymerize without contamination. The matrix forms a seal and a wall, but even the best rubber dam would be very difficult to maintain an optimal enviornment during cementation when you are 2-3 mm subgingival.

[@mariamfarroukh1977]

Wow! a quick question, can we do this then continue with regular composite filling right? just change the matrix band and use tofflemire or sectional right? thank you!

[@GarrisonDental]

Yes! That's exactly right. You use the margin elevation band to build up the margin on teeth where the margin is subgingival. Then, you are able to switch to your regular matrix or tofflemire system to complete the restoration.

[@tayloranderson456]

Just nuts 99% of dentists might crown that tooth, meanwhile this is an option.

[@Whitetea94]

May I ask how do you manage the bleeding aftter taking out the form?

[@joseabitbol6962]

Great presentation! Thank for sharing. Is the Reel Matrix tensioning instrument easy to tight and untight the reel matrix? It looks bulky to be used to tight the reel matrix in areas of Upper first or second molars? Thanks

[@GarrisonDental]

It is fairly simple to tighten the bands down and not too difficult to loosen it. Normally you would loosen it up enough after restoring until you can get leverage to pull the band off the tooth, so you aren't tightening and loosening the band repeatedly. As far as being bulky, once the band is placed, you no longer have the tensioning instrument in your way, unlike a tofflemire retainer. The "neck" of the instrument is long enough to reach in areas that may be difficult otherwise.

[@jstimmel1]

I really liked the video and your approach to these types of cases! I understand why you like to use heated, packable composite, but are you ever concerned about being able to cure adequately? In the typodont case the lingual cusps are missing so I don't think getting the curing light close to the composite would be too hard, but what if the lingual cusps were intact and you couldn't place the curing light very close to the composite? Would you consider some type of auto-polymerizing material?

[@BiomimeticDentistry]

Thank you! No, it's really not a concern to cure in a deep box. Simply cure from the buccal and lingual sides. If necessary, you can use an extension on your curing light (Ultradent makes one for the Valo which I recommend) but I hardly use that. I prefer to use light-cured only so I have full control of the contour and also you need to be quick to avoid moisture, heme, or any other contamination so light-cure is ideal for this. When you cure from the buccal and lingual, its unlikely that any portion of the composite is more than 4 mm away from the light and that will do the trick. All the Best, MN

[@WJLTHY]

If you can get an isolated distal margin for the elevated margin for this procedure, why don't you just do an inlay instead?

[@GarrisonDental]

Thanks for the question! The margin elevation technique is often used to bring a margin supergingival to allow proper scanning for digital impressions to create CAD inlays.

[@WJLTHY]

@@GarrisonDental Thanks!

[@fatimagilani8028]

The entire matrix/metal strip can actually enter the margin and disappear? How so?

[@snuppy01]

Very informative video, Dr. Nejad! Could I get your thoughts on doing DME with GI?

[@GarrisonDental]

Hello! Sorry for the wait on this question. We had to wait for Dr. Nejad to send us his reply. "Glass ionomer is not recommended. The material properties and bond strength are not comparable to composite if you do the composite with good isolation, incremental layers, and strong dentin bonding agents." - Dr. Nejad.

[@paulchahal7545]

@@GarrisonDental what about compomers? Such as Bioactive?

[@iBiebercookie3]

But arent we gonna have to remove that Mesial bit anyway when doing preparation for say a full crown, i know this is indicated for onlay, but say it was indicated for a fill crown.. isnt the margin gonna go anyway because the crown has to be seated on tooth surfaces all around? And never on composite?

[@Rosa-sw8qp]

Genius

[@franny5295]

Have you ever tried this with a kid using Activa BioActive Base/Liner and either their BioActive Restoration or Kids formula for filling a tooth?

[@acash93]

It still is very time consuming because of the small increments. Financially, how do you charge for marginal elevation?

[@danymanchster1759]

build up?!

[@goksuozalp52]

Thank you. Would we do IDS on an endodontic treated tooth?

[@GarrisonDental]

@BiomimeticDentistry would you be able to assist by answering this question, Dr. Nejad?

[@despinan5782]

Very useful video Dr. Nejad! I would like to ask if it is possible to use the slick bands with the traditional tofflemire retainer or are they compatible with the garrison kit only? Thank you in advance.

[@GarrisonDental]

Hello! Thanks for the question. I can answer this one for Dr. Nejad. The ReelMatrix reels that Dr. Nejad uses with the tensioning instrument are only compatible with that system, however, the Slickbands you mentioned (without a reel) can be bought and used with any Tofflemire retainer of your choice.

[@SamiGB1994]

Sir, are we going to use the flowable or generally the composite in deep margin relocation. Is this not going to affect the bonding between tooth and composite. Would suggest resin modified glass ionomer in such cases or no worries of use the new bonds and composite these days.

[@GarrisonDental]

We happened to film a follow up video to this one over the weekend, so stay tuned for an answer in that video. I'm hoping to have it available in the next couple of weeks.

[@claywills9015]

What are your techniques to get inverted rubber dam on the deep margins to complete the DME process? Maybe your next video ;)

[@GarrisonDental]

That sounds like a great idea for another video. When doing the DME process my goal is to keep the rubber dam displaced laterally away from the tooth while I place the matrix band in. I have my assistant help me move the dam out of the way by stretching it while the band is placed, then once the DME band is in position, the dam applies pressure against the band and helps maintain the isolation. I am not super concerned with inverting the dam. If the DME band is placed directly above an inverted dam, then it will usually interfere with the band functioning as intended and the dam will often will push the band out of the sulcus. - Dr. Matt Nejad

[@marieashkarian4683]

Can this method be used instead of a crown lengthening surgery after a root canal on a severely decayed tooth so that a crown can then be placed? I'm faced with this situation right now, and I don't want to do the crown lengthening if I can avoid it. Any thoughts?

[@GarrisonDental]

The short answer is yes. You should be able to use this technique the way you described. To get Dr. Nejad's official answer, you can contact him on Instagram at dr_mattnejad.

[@revanth3508]

GarrisonDental will it not be a problem if the margin of the crown will then be on composite rather than natural tooth structure ?

[@radujko]

@@revanth3508 this is the question that needed to be asked. I am always making sure my margins are finished on tooth structure, not core buildup, this procedure is doing the exact opposite. In fact, I remember in school we were scolded if the margins were not on tooth. I'd like to see the difference in success between enamel/dentin on composite vs. tooth structure relating to margin leakage.

[@GarrisonDental]

@@radujko Here's the follow up video we filmed with Dr. Nejad where he addresses this question and others that came up after this original video was posted: kzbin.info/www/bejne/Zn-zqqCbhpZsbNk

[@NaeemAhmad-yb9no]

Hi, thanks for sharing! Can we use the same band for anterior teeth DME?

[@GarrisonDental]

If you can get that band to adapt low enough in the sulcus on anterior preps, there shouldn't be a reason not to use it. We have a video being published this Friday that shows the new Fusion Anterior System placement for deep restorations. Be sure to check that out when it's available!

[@flavoureslam]

I want to know the name of the matrix please

[@GarrisonDental]

Hello Dr. Soliman, Dr. Nejad is discussing the Margin Elevation Band in this video. It's available in a Reel with the ReelMatrix system from Garrison, or as a standalone band for a Tofflemire-Style system. You can find out more about the ReelMatrix System here: www.garrisondental.com/en/matrix-systems/retainerless-tofflemire-style/reelmatrix-kit or the Margin Elevation Bands in a Tofflemire-Style system here: www.garrisondental.com/en/matrix-systems/traditional-tofflemire-style/slick-bands-tofflemire-matrices

[@arnellprato1176]

Do you charge extra for this?

[@BiomimeticDentistry]

I charge this as a restorative foundation code.

[@maverick-6356]

Trust me, its not that easy 😌

[@BiomimeticDentistry]

Nothing in dentistry is easy. Trust me =)

[@dyotov]

Can I do it with Equia HT GIC?

[@GarrisonDental]

Thanks for the question! For the best answer, we have another video for you to watch (it's under 2 minutes): kzbin.info/www/bejne/d3eXZ4OEl5Wrppo