Protrusive Dental Podcast

You’re doing a routine exam when you spot it – a stained hairline crack snaking across the marginal ridge of a molar. Your patient hasn’t mentioned any symptoms… Yet. Should you sound the alarm? Monitor and wait? Jump straight to treatment? Cracked teeth are one of dentistry’s most misunderstood diagnoses. Colleagues debate whether to crown or monitor. And that crack you’re staring at? It could stay dormant for years—or spiral into an extraction by next month. So what separates the teeth that crack catastrophically from those that quietly hold together? In this episode, I am joined by final-year dental student Emma to crack the code (pun intended) on cracked tooth syndrome.  We break down the easy-to-remember “position, force, time” framework to help you spot risk factors before disaster strikes, and share a real-world case of a 19-year-old bruxist whose molar was saved by smart occlusal thinking. If you’ve ever felt uncertain about diagnosing, explaining, or managing cracked teeth, this episode will change how you think about every suspicious line you see. https://youtu.be/mU8mM8ZNIVU Watch PS019 on YouTube Key Takeaways Risk factors include large restorations and bruxism. Occlusion plays a significant role in tooth health. Diet can impact the integrity of teeth. Every patient presents unique challenges in treatment. Communication about dental issues is key for patient care. Certain teeth are more prone to fractures due to their anatomy. The weakest link theory explains why some patients experience more dental issues. Patient history is crucial in predicting future dental problems. The age and dental history of a patient influence treatment decisions. Understanding occlusion is essential for diagnosing and treating cracked teeth. The location of a tooth affects the force it experiences during chewing. Bruxism increases the risk of tooth fractures. Tooth contacts and forces play a critical role in diagnosing issues. Opposing teeth can provide valuable insights into tooth health. Effective communication is essential in managing cracked teeth. Stains on teeth can indicate deeper issues with cracks. Monitoring and documenting cracks over time is crucial for patient care. Highlights of this episode: 00:00 Teaser 00:49 Intro 03:25 Emma's Dental School Updates 07:18 What is Cracked Tooth Syndrome (CTS)? 10:02 Crack Progression and Severity 12:45 Risk Factors 14:54 Position–Force–Time Framework 21:53 Which Teeth Fracture Most Often? 25:32 Midroll 28:53 Which Teeth Fracture Most Often? 30:37 The Weakest Link Theory 34:05 Diagnostic Tools 37:56 Treatment Planning 39:42 Case Study – High Force Patient 47:27 Communication and Patient Management 51:03 Key Clinician Takeaways 53:03 Conclusion and Next Episode Preview 53:42 Outro Check out the AAE cracked teeth and root fracture guide for excellent visuals and classification details. Literature review on cracked teeth – examines evidence around risk factors, prevention, diagnosis, and treatment of cracked teeth. Want to learn more about cracked teeth? Have a listen to PDP028 and PDP098 – both packed with practical tips and case-based insights. #BreadAndButterDentistry #PDPMainEpisodes #OcclusionTMDandSplints This episode is eligible for 0.75 CE credits via the quiz on Protrusive Guidance. This episode contributes to the following GDC development outcomes: Outcome C AGD Subject Code: 250 – Operative (Restorative) Dentistry Aim: To help dental professionals understand the causes, diagnosis, and management of cracked teeth through a practical, evidence-based approach. It focuses on identifying risk factors using the Position–Force–Time framework and improving patient outcomes through informed communication and tailored treatment planning. Dentists will be able to: Explain the aetiology and progression of cracked tooth syndrome Identify high-risk teeth and patient factors—such as restoration design, occlusal contacts, and parafunctional habits—that predispose to cracks Communicate effectively with patients about the significance of cracks, prognosis, and monitoring options, improving patient understanding and consent

Are you confident in spotting a child at risk of neglect? Do you know what to do if you witness abuse in your practice? How can you raise concerns safely while protecting both the child and your team? This episode with Dr. Christine Park provides tangible actions, practical scripts, and clear guidance for managing challenging scenarios—like seeing an adult hit a child in the waiting room or recognizing neglect in the dental chair. These are situations dental school rarely prepares us for. Every practice needs clear protocols for safeguarding. This episode acts as a North Star, helping you stay compliant while ethically doing the right thing. If you treat children, you must listen to this episode and share it with every colleague who treats children. https://youtu.be/-kYs23Xa4Ls Watch PDP251 on YouTube Protrusive Dental Pearl: Find the phone number of your local child safeguarding board / social services. Verify it, then display it where you and your team can quickly access it. Key Takeaways Dentists are trained observers of family dynamics. Recognizing normal behavior is key in dental care. Unconscious observations can guide professionals. Feeling uncomfortable about a situation is a valid signal. Empowerment comes from trusting your instincts. Dental care professionals see many aspects of families. It’s important to act on uncomfortable feelings. Observation skills are crucial for effective care. Children’s interactions reveal much about family health. Awareness of discomfort can lead to better outcomes. Highlights of this episode: 00:00 Teaser 00:59 Intro 02:40 Pearl – Child Protection Hotline 05:23 Dr. Christine Park’s Background and Expertise 08:37 The Role of Dentists in Safeguarding Children 11:19 Practical Scenarios and Guidelines for Safeguarding 15:35 Recognizing Silent Cases of Neglect 17:29 Team Collaboration and Support in Safeguarding 21:58 Guidelines and Policies for Effective Safeguarding 22:03 Midroll 25:24 Guidelines and Policies for Effective Safeguarding 28:32 Handling a Tough Safeguarding Scenario 32:18 Dealing with Poor Oral Hygiene and Neglect 39:12 Managing Parental Reactions and Consent 43:08 The Importance of Safeguarding in Dentistry 45:34 Further Guidance and Resources 46:10 Outro

Let's be honest – the occlusion after Aligner cases can be a little ‘off' (even after fixed appliances!) How do you know if your patient's occlusion after aligner treatment is acceptable or risky? What practical guidelines can general dentists follow to manage occlusion when orthodontic results aren't textbook-perfect? Jaz and Dr. Jesper Hatt explore the most common challenges dentists face, from ClinCheck errors and digital setup pitfalls to balancing aesthetics with functional occlusion. They also discuss key strategies to help you evaluate, guide, and optimize occlusion in your patients, because understanding what is acceptable and what needs intervention can make all the difference in long-term treatment stability and patient satisfaction. https://youtu.be/e74lUbyTCaA Watch PDP250 on YouTube Protrusive Dental Pearl: Harmony and Occlusal Compatibility Always ensure restorative anatomy suits the patient's natural occlusal scheme and age-related wear. If opposing teeth are flat and amalgam-filled, polished cuspal anatomy will be incompatible — flatten as needed to conform. Need to Read it? Check out the Full Episode Transcript below! Key Takeaways Common mistakes in ClinCheck planning often stem from occlusion issues. Effective communication and documentation are crucial in clinical support. Occlusion must be set correctly to ensure successful treatment outcomes. Understanding the patient’s profile is essential for effective orthodontics. Collaboration between GPs and orthodontists can enhance patient care. Retention of orthodontic results is a lifelong commitment. Aesthetic goals must align with functional occlusion in treatment planning. Informed consent is critical when discussing potential surgical interventions. The tongue plays a crucial role in orthodontic outcomes. Spacing cases should often be approached as restorative cases. Aligners can achieve precise spacing more effectively than fixed appliances. Enamel adjustments may be necessary for optimal occlusion post-treatment. Retention strategies must be tailored to individual patient needs. Case assessment is vital for determining treatment complexity. Highlights of this episode: 00:00 Teaser 00:59 Intro 02:53  Pearl – Harmony and Occlusal Compatibility 05:57 Dr. Jesper Hatt Introduction 07:34 Clinical Support Systems 10:18 Occlusion and Aligner Therapy 20:41 Bite Recording Considerations 25:32 Collaborative Approach in Orthodontics 30:31 Occlusal Goals vs. Aesthetic Goals 31:42 Midroll 35:03 Occlusal Goals vs. Aesthetic Goals 35:25 Challenges with Spacing Cases 42:19 Occlusion Checkpoints After Aligners 50:17 Considerations for Retention 54:55 Case Assessment and Treatment Planning 58:14 Key Lessons and Final Thoughts 01:00:19 Interconnectedness of Body and Teeth 01:02:48 Resources for Dentists and Case Support 01:04:40 Outro Free Aligner Case Support!Send your patient's case number and get a full assessment in 24 hours—easy, moderate, complex, or referral. Plus, access our 52-point planning protocol and 2-min photo course. No uploads, no cost. [Get Free Access Now] Learn more at alignerservice.com If you enjoyed this episode, don't miss: Do's and Don'ts of Aligners [STRAIGHTPRIL] – PDP071 #PDPMainEpisodes #OcclusionTMDandSplints #OrthoRestorative This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes A and C. AGD Subject Code: 370 ORTHODONTICS (Functional orthodontic therapy) Aim: To provide general dentists with practical guidance for managing occlusion in aligner therapy, from bite capture to retention, including common pitfalls, functional considerations, and case selection. Dentists will be able to – Identify common errors in digital bite capture and occlusion setup. Understand the impact of anterior inclination and mandibular movement patterns on occlusal stability. Plan retention strategies appropriate for aligner and restorative cases. Click below for full episode transcript: Teaser: The one thing that we always check initially is the occlusion set correct by the aligner company. Because if the occlusion is not set correctly, everything else just doesn't matter because the teeth will move, but into a wrong position because the occlusion is off from the beginning. I don't know about you, but if half the orthodontists are afraid of controlling the root movements in extraction cases, as a GP, I would be terrified. Teaser:I don’t care if you just move from premolar to premolar or all the teeth. Orthodontics is orthodontics, so you will affect all the teeth during the treatment. The question’s just how much. Imagine going to a football stadium. The orthodontist will be able to find the football stadium.  If it’s a reasonable orthodontist, he’ll be able to find the section you’re going to sit in, and if he’s really, really, really good, he will be able to find the row that you’re going to sit in, but the exact spot where you are going to sit… he will never, ever be able to find that with orthodontics. Jaz’s Introduction: Hello, Protruserati. I’m Jaz Gulati. Welcome back to your favorite dental podcast. I’m joined today by our guest, Dr. Jesper Hatt. All this dentist does is help other dentists with their treatment plans for aligners. From speaking to him, I gather that he’s no longer practicing clinically and is full-time clinical support for colleagues for their aligner cases. So there’s a lot we can learn from someone who day in day out has to do so much treatment planning and speaking to GDPs about their cases, how they’re tracking, how they’re not tracking, complications, and then years of seeing again, okay, how well did that first set of aligners actually perform? What is predictable and what isn’t? And as well as asking what are the most common errors we make on our ClinChecks or treatment plan softwares. I really wanted to probe in further. I really want to ask him about clinical guidelines for occlusion after ortho. Sometimes we treat a case and whilst the aesthetics of that aligner case is beautiful, the occlusion is sometimes not as good. So let’s talk about what that actually means. What is a not-good occlusion? What is a good occlusion? And just to offer some guidelines for practitioners to follow because guess what? No orthodontist in the world is gonna ever get the occlusion correct through ortho. Therefore, we as GPs are never gonna get a perfect textbook occlusion, but we need to understand what is acceptable and what is a good guideline to follow. That’s exactly what we’ll present to you in this episode today. Dental PearlNow, this is a CE slash CPD eligible episode and as our main PDP episode, I’ll give you a Protrusive Dental Pearl. Today’s pearl is very much relevant to the theme of orthodontics and occlusion we’re discussing today, and it’s probably a pearl I’ve given to you already in the past somewhere down the line, but it’s so important and so key. I really want to just emphasize on it again. In fact, a colleague messaged me recently and it reminded me of this concept I’m about to explain. She sent me an image of a resin bonded bridge she did, which had failed. It was a lower incisor, and just a few days after bonding, it failed. And so this dentist is feeling a bit embarrassed and wanted my advice. Now, by the way, guys, if you message me for advice on Instagram, on Facebook, or something like that, it’s very hit and miss. Like my priorities in life are family, health, and everything that happens on Protrusive Guidance. Our network. If you message me outside that network, I may not see it. The team might, but I may not see it. It’s the only way that I can really maintain control and calm in my life. The reason for saying this, I don’t want anyone to be offended. I’m not ignoring anyone. It’s just the volume of messages I get year on year, they’re astronomical. And I don’t mind if you nudge me. If you messaged me something weeks or months ago and I haven’t replied, I probably haven’t seen it. Please do nudge me. And the best place to catch me on is Protrusive Guidance. If you DM me on Protrusive Guidance, home of the nicest and geekiest dentists in the world, that’s the only platform I will log in daily. That’s our baby, our community. Anyway, so I caught this Facebook message and it was up to me to help this colleague. And one observation I made is that the lower teeth were all worn. The upper teeth were really worn, but this resin bonded bridge pontic, it just looked like a perfect tooth. The patient was something like 77 or 80. So it really made me think that, okay, why are we putting something that looks like a 25-year-old’s tooth in a 77-year-old? But even forgetting age and stuff, you have to look at the adjacent teeth in the arch. Is your restoration harmonious with the other teeth in the arch, and of course is the restoration harmonious with what’s opposing it? Because it’s just not compatible. So part one of this pearl is make sure any restoration you do, whether it’s direct or indirect, is harmonious with the patient’s arch and with the opposing teeth and with their occlusal scheme. Because otherwise, if you get rubber dam on and you give your 75-year-old patient beautiful composite resin, it’s got all that cuspal fissure pattern and anatomy, and you take that rubber dam off and you notice that all the other teeth are flat and the opposing teeth are flat amalgams, guess what? You’re gonna be making your composite flat, whether you like it or not. You created a restoration that’s proud, right? That’s why you did not conform to the patient’s own arch or existing anatomical scheme. So the part B of this is the thing that I get very excited to talk about, right? So sometimes you have a worn dentition, but then you have one tooth that’s not worn at all. It’s like that in-standing lateral incisor, right? Think of an upper lateral incisor that’s a bit in-standing, and you see some wear on all the incisors, but that lateral incisor does not have any wear in it because it was never in the firing line. It was never in function. It was never in parafunction. Now, if you give this patient aligners or fixed appliances, you’re doing ortho and you’re now going to align this lateral incisor. So it’s now gonna eventually get into occlusion and it will be in the functional and parafunctional pathways of this patient. Do you really think you can just leave that incisor be? No. It’s not gonna be compatible with the adjacent teeth. It’s not going to be compatible with the opposing tooth and the occlusal scheme. So guess what? You have to get your bur out or your Sof-Lex disc out, and you have to bake in some years into that tooth. Or you have to build up all the other teeth if appropriate for that patient. You’ve just gotta think about it. And I hope that makes sense so you can stay out of trouble. You’re not gonna get chipping and you can consent your patient appropriately for enamel adjustment, which is something that we do talk about in this episode. I think you’re in for an absolute cracker. I hope you enjoy. I’ll catch you in the outro. Main Episode: Doctor Jesper Hatt, thank you so much for coming to Protrusive Dental Podcast. We met in Scandinavia, in Copenhagen. You delivered this wonderful lecture and it was so nice to connect with you then and to finally have you on the show. Tell us, how are you, where in the world are you, and tell us about yourself. [Jesper] Well, thank you for the invitation, first of all. Well, I’m a dentist. I used to practice in Denmark since I originally come from Denmark. My mother’s from Germany, and now I live in Switzerland and have stopped practicing dentistry since 2018. Now I only do consulting work and I help doctors around the world with making their aligner business successful. [Jaz] And this is like probably clinical advice, but also like strategic advice and positioning and that kinda stuff. Probably the whole shebang, right? [Jesper] Yeah. I mean, I have a team around me, so my wife’s a dentist as well, and I would say she’s the expert in Europe on clear aligners. She’s been working for, first of all, our practice. She’s a dentist too. She worked with me in the practice. We practiced together for 10 years. Then she became a clinical advisor for Allion Tech with responsibility for clinical support of Scandinavia. She was headhunted to ClearCorrect, worked in Basel while I was doing more and more consulting stuff in Denmark. So she was traveling back and forth, and I considered this to be a little bit challenging for our family. So I asked her, well, why don’t we just relocate to Switzerland since ClearCorrect is located there? And sure we did. And after two years she told me, I think clinical support, it’s okay. And I like to train the teams, but I’d really like to do more than that because she found out that doctors, they were able to book a spot sometime in the future, let’s say two weeks out in the future at a time that suited the doctors… no, not the doctors, ClearCorrect. Or Invisalign or whatever clear aligner company you use. So as a doctor, you’re able to block the spot and at that time you can have your 30 minutes one-on-one online with a clinical expert. And she said it’s always between the patients or administrative stuff. So they’re not really focused on their ClearCorrect or clear aligner patient. And so they forget half of what I tell them. I can see it in the setups they do. They end up having to call me again. It doesn’t work like that. I would like to help them. [Jaz] It’s a clunky pathway of mentorship. [Jesper] Yes. And so she wanted to change the way clinical support was built up. So we do it differently. We do it only in writing so people can remember what we are telling them. They can always go back in the note and see what’s been going on, what was the advice we gave them, and we offer this co-creation support where we take over most of the treatment planning of the ClearCorrect or Clear Aligner or Spark or Invisalign or Angel Aligner treatment planning. So we do all the digital planning for the doctor, deliver what we think would be right for the patient based on the feedback we initially got from the doctor. And then the doctor can come back and say, well, I’d like a little more space for some crowns in the front, or I would like the canines to be in a better position in order to achieve immediate post disclusion. And so we can go into this discussion back and forth and adjust the digital setup in a way that is more realistic and predictable and do it all for the doctors. So they, on an average, they spend four to six hours less chair time when they use that kind of service compared to if they do everything themselves. And on top of that, you can put your planning time. She was responsible for that and it works quite well. I still remember when we initially got on all these online calls and we would see fireworks in the background and confetti coming down from the top and all of that. [Jaz] Exactly. So excuse that little bit, but okay. So essentially what you’re doing is, for an aligner user myself, for example, you’re doing the ClinChecks, you are helping, supporting with the ClinChecks, the planning. And I’ve got a lot of questions about that. The first question I’ll start with, which is off the script, but there’s probably a hundred different mistakes that could happen in a ClinCheck, right? But what is the most repeatable, predictable, common mistake that you’ll see when a new user sends a case to you to help them with their planning? What’s the most common mistake that you will see in a setup? [Jesper] Two things, actually. The one thing that we always check initially is the occlusion set correct by the aligner company. Because if the occlusion is not set correctly, everything else just doesn’t matter because the teeth will move but into a wrong position because the occlusion is off from the beginning. And so we always check that as the first part. How does this— [Jaz] So let’s talk about that ’cause that might be confusing for a younger colleague because they’re like, hey, hang on a minute. I scanned the bite left and right. What do you mean the occlusion is wrong? Because surely that gets carried through into what I see on the ClinCheck. So what do you think is the mechanism for this to happen? [Jesper] Two different reasons. I’m from a time when I graduated in 2003, so that was before digital dentistry. So when I went to the Pankey Institute and learned everything about functional occlusion and all of that stuff, I also found out that most of my patients, when I put silicone impression material between the teeth and asked the patients to bite together, they would always protrude a little bit unless I instructed them to bite hard on the posterior teeth. And when we got the scanners, when we put a scanner into the cheek and pull the cheek, most patients, when we asked them to bite together to do the intraoral scan of the bite, they also protruded a little bit, not much, but enough to set the bite wrong. So that is the one challenge when the technicians of the aligner companies put the models together. The other challenge is that some of the aligner companies, they let the technicians set the models. We always, as the first thing when we see a case, we always look at the photos, the clinical photos. And that’s why the clinical photos have to be of great quality. So we look at the clinical photos of the patient— [Jaz] And also in those clinical photos, Jesper, you have to coach them correctly to bite. You have to notice if they’re biting wrong even in the photos ’cause then it just duplicates the error. And that’s why good photography and actually being able to coach the patient is so imperative. [Jesper] Yes, that’s correct. But we compare the two and usually if we see a difference, we ask the doctor, is what we see in the photo correct, or is what we see on the digital models correct? And because we don’t like differences. So that would be the first step to look for. And what’s the second? The second thing is that when you look at the setup, the anterior teeth are usually—I’m trying to show you—the anterior teeth are very, very steep. Typically with aligners it’s a lot easier to tip the crowns. So when you have a class II patient, deviation one, where the anteriors are in a forward position, proclined, and you have a lot of space between the anteriors of the maxilla and the mandible, then the easiest thing on a digital setup is to just retrocline the anteriors of the upper to make them fit the lowers, which you could then procline a little bit, but usually you have very steep relationships between the two and this— [Jaz] So you’re more likely to restrict the envelope of function, functional interference anteriorly. You are obviously reducing the overjet, but you may end up reducing like a wall contact rather than an elegant, more open gate. [Jesper] Yes. And there’s another dimension to this because when we work with orthodontics, one of the most important things to look for is actually the profile of the patient. Because let’s say I’m trying to illustrate this now, so I hope you get a 90— [Jaz] So describe it for our audio listeners as well. So we’re looking at a profile view of Jesper. [Jesper] Yes. So I’m turning the side to the camera. I hope you can see my profile here. So let’s say I had flared anterior maxillary teeth and I wanted to retrocline them. It would have an effect on my upper lip, so the lip would fall backwards if I just retrocline everything. And every millimeter we move the anteriors in the maxilla in a posterior direction, we will have a potential lip drop of three millimeters. In addition, if we don’t get the nasolabial angulation correct, we risk the lower face will simply disappear in the face of the patient. So soft tissue plays a role here, so we cannot just retrocline the teeth. It looks great on the computer screen, but when it comes to reality, we’ll have a functional challenge. We’ll have a soft tissue support challenge, and in addition we’ll have long-term retention challenges as well. Because when you have a steep inclination, the anterior teeth in the mandible, they don’t have any kind of support. They will not be stopped by anything in the maxillary teeth, which you would if you had the right inclination between the teeth, which would be about 120 degrees. So why do aligner companies always set the teeth straight up and down in the anterior part? We wondered about this for years. We don’t have a strict answer. We don’t know exactly why it’s like this, but I have a hunch. I think there are two things to it. First of all, the easiest thing to do with aligners is to move the crown, so we can just tip the teeth. You take them back, you make a lot of IPR, and then you just tip them so they’re retroclined. Secondly, all aligner companies, they come from the United States. And in the United States there is a higher representation of class III patients. Now why is that important? All our patients can be put into two different categories in regards to how they move their mandible. They are the crocodiles that only open and close, like move up and down, and then we have the cows. And then we have the cows that move the mandible around, or the camels. I mean, every camel, if you’ve seen a camel chew, it’s just moving from side to side. [Jaz] Horses as well. Horses as well. [Jesper] They kind of do that. [Jaz] But I’m glad you didn’t say rats ’cause it’s more elegant to be a crocodile than a rat. [Jesper] Exactly. And I usually say we only tell the crocodiles. So why is this a challenge and why isn’t it a challenge with class III patients? Well, all real class III patients act like crocodiles, so they don’t move them side to side. From a functional perspective, it’s really not a problem having steep anterior inclination or steep relationships as long as you have a stable stop where the anteriors—so the anteriors will not elongate and create the red effect. So they just elongate until they hit the palate. If you can make a stop in the anterior part of the occlusion, then you’ll have some kind of stability with the class III patients. But with class II patients, we see a lot more cows. So they move the mandible from side to side and anterior and back and forth and all… they have the mandible going all kinds of places. And when they do that, we need some kind of anterior guidance to guide the mandible. I usually say the upper jaw creates the framework in which the mandible will move. So if the framework is too small, we fight the muscles. And whenever we fight the muscles, we lose because muscles always win. It doesn’t matter if it’s teeth, if it’s bone, if it’s joints, they all lose if they fight the muscles— [Jaz] As Peter Dawson would say, in the war between teeth and muscles or any system and muscles, the muscles always win. Absolutely. And the other analogy you remind me of is the maxilla being like a garage or “garage” from UK, like a garage. And the mandible being like the car, and if you’re really constrained, you’re gonna crash in and you’re gonna… everything will be in tatters. So that’s another great way to think about it. Okay. That’s very, very helpful. I’m gonna—’cause there’s so much I wanna cover. And I think you’ve really summed up nicely. But one thing just to finish on this aspect of that common mistake being that the upper anteriors are retroclined, really what you’re trying to say is we need to be looking at other modalities, other movements. So I’m thinking you’re saying extraction, if it’s suitable for the face, or distalisation. Are you thinking like that rather than the easier thing for the aligners, which is the retrocline. Am I going about it the right way? [Jesper] Depends on the patient. [Jaz] Of course. [Jesper] Rule of thumb: if you’re a GP, don’t ever touch extraction cases. Rule of thumb. Why? Because it is extremely challenging to move teeth parallel. So you will most—especially with aligners—I mean, I talk with a very respected orthodontist once and I asked him, well, what do you think about GPs treating extraction cases where they extract, you know, two premolars in the maxilla? And he said, well, I don’t know how to answer this. Let me just explain to you: half of my orthodontist colleagues, they are afraid of extraction cases. And I asked them why. Because it’s so hard to control the root movement. Now, I don’t know about you— [Jaz] With aligners. We’re specifically talking about aligners here, right? [Jesper] With all kinds of orthodontic appliances. [Jaz] Thank you. [Jesper] So now, I don’t know about you, but if half the orthodontists are afraid of controlling the root movements in extraction cases, as a GP, I would be terrified. And I am a GP. So I usually say, yeah, sometimes you will have so much crowding and so little space in the mandible, so there’s an incisor that is almost popped out by itself. In those cases, yes. Then you can do an extraction case. But when we’re talking about premolars that are going to be extracted, or if you want to close the space in the posterior part by translating a tooth into that open space, don’t. It’s just the easiest way to end up in a disaster because the only thing you’ll see is just teeth that tip into that space, and you’ll have a really hard time controlling the root movements, getting them corrected again. [Jaz] Well, thank you for offering that guideline. I think that’s very sage advice for those GPs doing aligners, to stay in your lane and just be… the best thing about being a GP, Jesper, is you get to cherry pick, right? There’s so many bad things about being a GP. Like you literally have to be kinda like a micro-specialist in everything in a way. And so sometimes it’s good to be like, you know what, I’ll keep this and I’ll send this out. And being selective and case selection is the crux of everything. So I’m really glad you mentioned that. I mean, we talked and touched already on so much occlusion. The next question I’m gonna ask you then is, like you said, a common error is the bite and how the bite appears on the ClinCheck or whichever software a dentist is using. Now, related to bite, vast majority of orthodontic cases are treated in the patient’s existing habitual occlusion, their maximum intercuspal position. Early on in my aligner journey, I had a patient who had an anterior crossbite. And because of that anterior crossbite, their jaw deviated. It was a displaced—the lower jaw displaced. And then I learned from that, that actually for that instance, perhaps I should not have used an MIP scan. I should have used more like centric relation or first point of contact scan before the displacement of the jaw happens. So that was like always in my mind. Sometimes we can and should be using an alternative TMJ position or a bite reference other than MIP. Firstly, what do you think about that kind of scenario and are there any other scenarios which you would suggest that we should not be using the patient’s habitual occlusion for their bite scan for planning orthodontics? [Jesper] Well, I mentioned that I was trained at the Pankey Institute, and when you start out right after—I mean, I spent 400 hours over there. Initially, I thought I was a little bit brainwashed by that because I thought every single patient should be in centric relation. Now, after having put more than 600 patients on the bite appliance first before I did anything, I started to see some patterns. And so today, I would say it’s not all patients that I would get into centric relation before I start treating the teeth. But when we talk about aligner therapy and orthodontic treatment, I think it’s beneficial if you can see the signs for those patients where you would say, hmm, something in the occlusion here could be a little bit risky. So let’s say there are wear facets on the molars. That will always trigger a red flag in my head. Let’s say there are crossbites or bite positions that kind of lock in the teeth. We talked about class III patients before, and I said if it’s a real skeletal-deviation class III patient, it’s a crocodile. But sometimes patients are not real class III skeletal deviation patients. They’re simply being forced into a class III due to the occlusion. That’s where the teeth fit together. So once you put aligners between the teeth and plastic covers the surfaces, suddenly the patients are able to move the jaws more freely and then they start to seat into centric. That may be okay. Usually it is okay. The challenge is consequences. So when you’re a GP and you suddenly see a patient moving to centric relation and you find out, whoa, on a horizontal level there’s a four- to six-millimeter difference between the initial starting point and where we are now, and maybe we create an eight-millimeter open bite in the anterior as well because they simply seat that much. And I mean, we have seen it. So is this a disaster? Well, it depends. If you have informed the patient well enough initially and said, well, you might have a lower jaw that moves into a different position when we start out, and if this new position is really, really off compared to where you are right now, you might end up needing maxillofacial surgery, then the patient’s prepared. But if they’re not prepared and you suddenly have to tell them, you know, I think we might need maxillofacial surgery… I can come up with a lot of patients in my head that would say, hey doctor, that was not part of my plan. And they will be really disappointed. And at that point there’s no turning back, so you can’t reverse. So I think if you are unsure, then you are sure. Then you should use some kind of deprogramming device or figure out where is centric relation on this patient. If there isn’t that much of a difference between maximum intercuspation and centric— [Jesper] Relation, I don’t care. Because once you start moving the teeth, I don’t care if you just move from premolar to premolar or all the teeth. Orthodontics is orthodontics, so you will affect all the teeth during the treatment. The question’s just how much. And sometimes it’s just by putting plastic between the teeth that you will see a change, not in the tooth position, but in the mandibular position. And I just think it’s nicer to know a little bit where this is going before you start. And the more you see of this—I mean, as I mentioned, after 600 bite appliances in the mouths of my patients, I started to see patterns. And sometimes in the end, after 20 years of practicing, I started to say, let’s just start, see where this ends. But I would always inform the patients: if it goes totally out of control, we might end up needing surgery, and there’s no way to avoid it if that happens. And if the patients were okay with that, we’d just start out. Because I mean, is it bad? No. I just start the orthodontic treatment and I set the teeth as they should be in the right framework. Sometimes the upper and the lower jaw don’t fit together. Well, send them to the surgeon and they will move either the upper or the lower jaw into the right position, and then we have it. No harm is done because we have done the initial work that the orthodontist would do. But I will say when I had these surgical patients—let’s say we just started out with aligners and we figured, I can’t control this enough. I need a surgeon to look at this—then I would send them off to an orthodontist, and the orthodontist and the surgeon would take over. Because then—I mean, surgical patients and kids—that’s the second group of patients besides the extraction cases that I would not treat as a GP. ‘Cause we simply don’t know enough about how to affect growth on kids. And when it comes to surgery, there’s so much that is… so much knowledge that we need to know and the collaboration with the surgeons that we’re not trained to handle. So I think that should be handled by the orthodontists as well. [Jaz] I think collaborative cases like that are definitely specialist in nature, and I think that’s a really good point. I think the point there was informed consent. The mistake is you don’t warn the patient or you do not do the correct screening. So again, I always encourage my guests—so Jesper, you included—that we may disagree, and that’s okay. That’s the beauty of dentistry. So something that I look for is: if the patient has a stable and repeatable maximum intercuspal position, things lock very well, and there’s a minimal slide—like I use my leaf gauge and the CR-CP is like a small number of leaves and the jaw hardly moves a little bit—then there’s no point of uncoupling them, removing that nice posterior coupling that they have just to chase this elusive joint position. Then you have to do so many more teeth. But when we have a breakdown in the system, which you kind of said, if there’s wear as one aspect, or we think that, okay, this patient’s occlusion is not really working for them, then we have an opportunity to do full-mouth rehabilitation in enamel. Because that’s what orthodontics is. And so that’s a point to consider. So I would encourage our GP colleagues to look at the case, look at the patient in front of you, and decide: is this a stable, repeatable occlusion that you would like to use as a baseline, or is there something wrong? Then consider referring out or considering—if you’re more advanced in occlusion studies—using an alternative position, not the patient’s own bite as a reference. So anything you wanna add to that or disagree with in that monologue I just said there? [Jesper] No, I think there’s one thing I’d like the listeners to consider. I see a lot of fighting between orthodontists and GPs, and I think it should be a collaboration instead. There’s a lot of orthodontists that are afraid of GPs taking over more and more aligner treatments, and they see a huge increase in the amount of cases that go wrong. Well, there’s a huge increase of patients being treated, so there will be more patients, just statistically, that will get into problems. Now, if the orthodontist is smart—in my opinion, that’s my opinion—they reach out to all their referring doctors and they tell them, look, come in. I will teach you which cases you can start with and which you should refer. Let’s start there. Start your aligner treatments. Start out, try stuff. I will be there to help you if you run into problems. So whenever you see a challenge, whenever there’s a problem, send the patient over to me and I’ll take over. But I will be there to help you if anything goes wrong. Now, the reason this is really, really a great business advice for the orthodontists is because once you teach the GPs around you to look for deviations from the normal, which would be the indication for orthodontics, the doctors start to diagnose and see a lot more patients needing orthodontics and prescribe it to the patients, or at least propose it to the patients. Which would initially not do much more than just increase the amount of aligner treatments. But over time, I tell you, all the orthodontists doing this, they are drowning in work. So I mean, they will literally be overflown by patients being referred by all the doctors, because suddenly all the other doctors around them start to diagnose orthodontically. They see the patients which they haven’t seen before. So I think this is—from a business perspective—a really, really great thing for the orthodontists to have a collaboration with this. And it’ll also help the GPs to feel more secure when they start treating their patients. And in the end, that will lead to more patients getting the right treatment they deserve. And I think that is the core. That is what’s so important for us to remember. That’s what we’re here for. I mean, yes, it’s nice to make money. We have to live. It’s nice with a great business, but what all dentists I know of are really striving for is to treat their patients to the best of their ability. And this helps them to do that. [Jaz] Ultimate benefactor of this collaborative approach is the patient. And I love that you said that. I think I want all orthodontists to listen to that soundbite and take it on board and be willing to help. Most of them I know are lovely orthodontists and they’re helping to teach their GPs and help them and in return they get lots of referrals. And I think that’s the best way to go. Let’s talk a little bit about occlusal goals we look for at the end of orthodontics. This is an interesting topic. I’m gonna start by saying that just two days ago I got a DM from one of the Protruserati, his name is Keith Curry—shout out to him on Instagram—and he just sent me a little message: “Jaz, do you sometimes find that when you’re doing alignment as a GP that it’s conflicting the orthodontic, the occlusal goal you’re trying to get?” And I knew what I was getting to. It’s that scenario whereby you have the kind of class II division 2, right? But they have anterior guidance. Now you align everything, okay, and now you completely lost anterior guidance. And so the way I told him is that, you know what, yes, this is happening all the time. Are we potentially at war between an aesthetic smile and a functional occlusion? And sometimes there’s a compromise. Sometimes you can have both. But that—to achieve both—needs either a specialist set of eyes or lots of auxiliary techniques or a lot more time than what GPs usually give for their cases. So first let’s touch on that. Do you also agree that sometimes there is a war between what will be aesthetic and what will be a nice functional occlusion? And then we’ll actually talk about, okay, what are some of the guidelines that we look for at the end of completing an aligner case? [Jesper] Great question and great observation. I would say I don’t think there’s a conflict because what I’ve learned is form follows function. So if you get the function right, aesthetics will always be great. Almost always. I mean, we have those crazy-shaped faces sometimes, but… so form follows function. The challenge here is that in adult patients, we cannot manipulate growth. So a skeletal deviation is a skeletal deviation, which means if we have a class II patient, it’s most likely that that patient has a skeletal deviation. I rarely see a dental deviation. It happens, but it’s really, really rare. So that means that in principle, all our class II and chronic class III patients are surgical patients. However, does that mean that we should treat all our class II and class III patients surgically? No, I don’t think so. But we have to consider that they are all compromise cases. So we need to figure a compromise. So initially, when I started out with my occlusal knowledge, I have to admit, I didn’t do the orthodontic treatment planning. I did it with Heller, and she would give me feedback and tell me, I think this is doable and this is probably a little bit challenging. If we do this instead, we can keep the teeth within the bony frame. We can keep them in a good occlusion. Then I would say, well, you have a flat curve of Spee. I’d like to have a little bit of curve. It’s called a curve of Spee and not the orthodontic flat curve of Spee. And then we would have a discussion back and forth about that. Then initially I would always want anterior coupling where the anterior teeth would touch each other. I have actually changed that concept in my mind and accepted the orthodontic way of thinking because most orthodontists will leave a little space in the anterior. So when you end the orthodontic treatment, you almost always have a little bit of space between the anterior teeth so they don’t touch each other. Why? Because no matter what, no matter how you retain the patient after treatment, there will still be some sort of relapse. And we don’t know where it’ll come or how, but it will come. Because the teeth will always be positioned in a balance between the push from the tongue and from the cheeks and the muscles surrounding the teeth. And that’s a dynamic that changes over the years. So I don’t see retention as a one- or two-year thing. It’s a lifelong thing. And the surrounding tissues will change the pressure and thereby the balance between the tongue and the cheeks and where the teeth would naturally settle into position. Now, that said, as I mentioned initially, if we fight the muscles, we’ll lose. So let’s say we have an anterior open bite. That will always create a tongue habit where the patient positions the tongue in the anterior teeth when they swallow because if they don’t, food and drink will just be splashed out between the teeth. They can’t swallow. It will just be pushed out of the mouth. [Jaz] So is that not like a secondary thing? Like that tongue habit is secondary to the AOB? So in those cases, if you correct the anterior open bite, theoretically should that tongue posture not self-correct? [Jesper] Well, we would like to think so, but it’s not always the case. And there’s several reasons to it. Because why are the teeth in the position? Is it because of the tongue or because of the tooth position? Now, spacing cases is one of those cases where you can really illustrate it really well. It looks really easy to treat these patients. If we take away all the soft tissue considerations on the profile photo, I mean, you can just retract the teeth and you close all the spaces—super easy. Tipping movements. It’s super easy orthodontically to move quickly. Very easy as well. However, you restrict the tongue and now we have a retention problem. So there are three things that can happen. You can bond a retainer on the lingual side or the palatal side of the teeth, upper, lower—just bond everything together—and after three months, you will have a diastema distal to the bonded retainer because the tongue simply pushes all the teeth in an anterior direction. [Jaz] I’ve also seen—and you’ve probably seen this as well—the patient’s tongue being so strong in these exact scenarios where the multiple spacing has been closed, which probably should have been a restorative plan rather than orthodontic plan, and the retainer wire snaps in half. [Jesper] Yes, from the tongue. [Jaz] That always fascinated me. [Jesper] Well, you’ll see debonding all the time, even though you sandblast and you follow all the bonding protocol. And debonding, breaking wires, diastemas in places where you think, how is that even possible? Or—and this is the worst part—or you induce sleep apnea on these patients because you simply restrict the space for the tongue. So they start snoring, and then they have a total different set of health issues afterwards. So spacing—I mean, this just illustrates the power of the tongue and why we should always be careful with spacing cases. I mean, spacing cases, in my opinion, are always to be considered ortho-restorative cases. Or you can consider, do you want to leave some space distal to the canines? Because there you can create an optical illusion with composites. Or do you want to distribute space equally between the teeth and place veneers or crowns or whatever. And this is one of those cases where I’d say aligners are just fabulous compared to fixed appliances. Because if you go to an orthodontist only using fixed appliances and you tell that orthodontist, please redistribute space in the anterior part of the maxilla and I want exactly 1.2 millimeters between every single tooth in the anterior segment, six years later he’s still not reached that goal because it just moves back and forth. Put aligners on: three months later, you have exactly—and I mean exactly—1.2 millimeters of space between each and every single tooth. When it comes to intrusion and extrusion, I would probably consider using fixed appliances rather than aligners if it’s more than three millimeters. So every orthodontic system—and aligners are just an orthodontic system—each system has its pros and cons, and we just have to consider which system is right for this patient that I have in my chair. But back to the tongue issue. What should we do? I mean, yes, there are two different schools. So if you have, let’s say, a tongue habit that needs to be treated, there are those that say we need to get rid of the tongue habit before we start to correct the teeth. And then there are those that say that doesn’t really work because there’s no room for the tongue. So we need to create room for the tongue first and then train the patient to stop the habit. Both schools and both philosophies are being followed out there. I have my preferred philosophy, but I will let the listener start to think about what they believe and follow their philosophy. Because there is nothing here that is right or wrong. And that is— [Jaz] I think the right answer, Jesper, is probably speak to that local orthodontist who’s gonna be helping you out and whatever they recommend—their religion—follow that one. Because then at least you have something to defend yourself. Like okay, I followed the way you said. Let’s fix it together now. [Jesper] That’s a great one. Yeah, exactly. [Jaz] Okay, well just touching up on the occlusion then, sometimes we do get left with like suboptimal occlusions. But to be able to define a suboptimal occlusion… let’s wrap this occlusion element up. When we are completing an orthodontic case—let’s talk aligners specifically—when the aligners come off and the fixed retainers come on, for example, and the patient’s now in retention, what are some of the occlusal checkpoints or guidelines that you advise checking for to make sure that, okay, now we have a reasonably okay occlusion and let things settle from here? For example, it would be, for me, a failure if the patient finishes their aligners and they’re only holding articulating paper on one side and not the other side. That’s for me a failure. Or if they’ve got a posterior open bite bilaterally. Okay, then we need to go refinement. We need to get things sorted. But then where do you draw the line? How extreme do you need to be? Do you need every single tooth in shim-stock foil contact? Because then we are getting really beyond that. We have to give the adaptation some wiggle room to happen. So I would love to know from your learning at Pankey, from your experience, what would you recommend is a good way for a GP to follow about, okay, it may not be perfect and you’ll probably never get perfect. And one of the orthodontists that taught me said he’s never, ever done a case that’s finished with a perfect occlusion ever. And he said that to me. [Jesper] So—and that’s exactly the point with orthodontics. I learned that imagine going to a football stadium. The orthodontist will be able to find the football stadium. If it’s a reasonable orthodontist, he’ll be able to find the section you’re going to sit in. And if he’s really, really, really good, he will be able to find the row that you’re going to sit in. But the exact spot where you are going to sit, he will never, ever be able to find that with orthodontics. And this is where settling comes in and a little bit of enamel adjustments. [Jaz] I’m so glad you said that. I’m so glad you mentioned enamel adjustment. That’s a very dirty word, but I agree with that. And here’s what I teach on my occlusion courses: what we do with aligners essentially is we’re tampering with the lock. Let’s say the upper jaw is the lock. It’s the still one. We’re tampering with the key, which is the lower jaw—the one that moves—we tamper with the key and the lock, and we expect them both to fit together at the end without having to shave the key and to modify the lock. So for years I was doing aligners without enamel adjustment ’cause my eyes were not open. My mind was not open to this. And as I learned, and now I use digital measuring of occlusion stuff and I seldom can finish a case to get a decent—for my criteria, which is higher than it used to be, and my own stat—is part of my own growth that’s happened over time is that I just think it’s an important skill that GPs are not taught and they should be. It’s all about finishing that case. And I think, I agree with you that some adjustment goes a long way. We’re not massacring enamel. It’s little tweaks to get that. [Jesper] Exactly. I like the sound there because sometimes you hear that “ahh,” it doesn’t really sound right, but “tsst,” that’s better. [Jaz] That’s the one. You know, it reminds me of that lecture you did in Copenhagen. You did this cool thing—which I’ve never seen anyone do before. You sat with one leg over the other and you said, okay guys, bite together. Everyone bit together. And then you swapped the legs so the other leg was over the other and bite together. And then you said, okay, whose occlusion felt different? And about a third of the audience put their hand up, I think. Tell us about that for a second. [Jesper] Well, just promise me we go back to the final part because there are some things we should consider. [Jaz] Let’s save this as a secret thing at the end for incentive for everyone to listen to the end—how the leg position changes your occlusion. Let’s talk about the more important thing. I digressed. [Jesper] Let’s talk about the occlusal goals because I think it’s important. I mean, if you do enamel adjustments in the end—so when we finish the treatment, when we come to the last aligner in the treatment plan—I think we should start by breaking things down to the simplest way possible. Start by asking the patient: are you satisfied with the way the teeth look? Yes or no? If she’s satisfied, great. How do you feel about the occlusion? “Well, it fits okay.” Great. Now the patient is happy. There’s nothing she wants to—or he wants to—change. Then you look at the occlusion. Now, it is important to remember that what we see on the computer screen, on the aligner planning tools, will never, ever correspond 100% to what we see in the mouth of the patient. And there are several reasons for that. But one of the things that we have found to be really interesting is that if you take that last step and you say, okay, the occlusion doesn’t fit exactly as on the screen, but it’s kind of there… if you use that last step and you don’t do a re-scan for a retainer, but you use the last step of the aligner treatment as your reference for your aligner retainer… We sometimes see that over six months, if the patient wears that aligner 22 hours a day for another three to six months, the teeth will settle more and more into the aligner and create an occlusion that looks more and more like what you see on the screen. Which to me just tells me that the biology doesn’t necessarily follow the plan everywhere in the tempo that we set throughout the aligner plan. But over time, at the last step, if it’s just minor adjustments, the teeth will actually move into that position if we use the last stage as a reference for the retainer. Now, if we do a scan at that point and use that as a reference for creating an aligner retainer, then we just keep the teeth in that position. Now, if the teeth are a little bit more off— [Jaz] I’m just gonna recap that, Jesper, ’cause I understood what you said there, but I want you to just make sure I fully understood it. When we request, for example, Align, the Vivera retainer, it gives you an option: “I will submit a new scan” or “use the last step.” And actually I seldom use that, but now I realize you’re right. It makes sense. But then on the one hand, if the occlusion is—if the aesthetics are good and the patient’s occlusion feels good, what is your own judgment to decide whether we’re still going to allow for some more settling and occlusal changes to happen over a year using the Vivera retainers based on the ClinCheck last-aligner profile, rather than, okay, let’s just retain to this position? What is making you do the extra work, extra monitoring? [Jesper] To me, it’s not extra monitoring. It’s just basic. I mean, it’s just part of my protocol. I follow the patients. And honestly, to me, it’s just time-saving to just use the last step in the aligner. Because I mean, if the plan is right and if the teeth have been tracking well, they should be in that position. Why do I then need to re-scan for Vivera retainers or for other kinds of retainers? Now, if the occlusion is a little bit more off—and in a minute you’ll probably ask me when do I see which is which, and I can’t really tell you; it’s about experience—but that’s the beauty of this. If I see there’s a little bit more deviation and I like some teeth, the occlusion isn’t really good on one side compared to the other side, I would rather have a bonded retainer from first premolar to first premolar in the mandible, combined with a Hawley or Begg or something like that retainer for the upper. And you can order them with an acrylic plate covering some of the anterior teeth so they keep that position, but that allows the teeth to settle. And over three months you should see some kind of improvement. If you don’t see enough improvement and let’s say you still have a tendency for a kind of an open bite on one side, you can always add some cross elastics, put some buttons on the upper, on the lower, instruct the patient to use these, and then in three months you will have the occlusion you want. Now, once that is established—you have that kind of occlusion—you need to keep the teeth there for at least six months before you do some kind of equilibration or enamel adjustment. Because if you do the enamel adjustment right after you have reached your final destination for the teeth, the teeth will still settle and move. So you do the equilibration, two weeks later everything looks off again. You do the equilibration, two weeks later things have changed again. So I prefer to wait six months before I do the final equilibration. Now, in this equation what we’ve been talking about here, it goes from very simple to more and more complex. And then we have to consider, well, did I expand the mandible posterior segment? If so, I can’t just use a bonded retainer on the lower and I need to add something to keep the teeth out there in combination with whatever I want in the upper. Do I want to keep the Begg retainer or the Hawley, or do I want to change to something differently? So these kinds of considerations have to be there from the beginning of the treatment because, I mean, it costs additional money to order a Begg retainer compared to just an aligner. [Jaz] A Begg retainer is the same as Hawley? [Jesper] Well, no. It has a little different design. [Jaz] Oh, a Begg as in B-E-G-G? [Jesper] Yes. [Jaz] Yeah, got it. Got it. Okay. [Jesper] And then in Denmark we use the Jensen retainer, which is a Danish invention, which goes from canine to canine or from first premolar to first premolar but with a different type of wire which keeps the teeth more in place compared to a round wire. So there are different variations. The most important part here is it allows the posterior teeth to settle so they can move, which they can’t in an aligner to the same degree at least. Now, this is all really nice in teeth that only need to be moved into the right position, but most of our patients are adult patients, or they should at least be adult patients. Most of my patients were more than 30 years old. So if you have a patient with anterior crowding and you move the teeth into the right position where the teeth should be, the teeth are in the right position, but they still look ugly because they have been worn anteriorly by the position they were in when they were crooked. So when we position them, we still need to do some restorative work. Then what? We still need to retain those teeth. The patient wants to be finished now as fast as possible, so we can’t wait the six months to make the final touches. So we have to figure out: what do we do? And then we have to think of some kind of retention strategy to keep the teeth in place during that restorative procedure. And I mean, at the end of an aligner treatment or any orthodontic treatment, two days is enough to have relapse in some patients. Some patients it’s not a problem. The teeth are just there to stay in the same position for three months, and then they start to move a little bit around. But other patients—I mean, you just have to look away and then go back to the teeth and they’re in a different position. You can’t know what kind of patient you have in your chair right now. So you have to consider the way you plan your restorative procedure in regards to how you retain the teeth during that phase. So if you want to do anterior composites or veneers, do it all at once. Put in a bonded retainer, scan, and get your aligner retainer as fast as possible. Or use a Begg or a Hawley or something like that that’s a little bit more flexible. If you want to do crowns, then we have a whole different challenge and then we have to consider how do we then retain the teeth. [Jaz] Okay. Well I think that was lovely. I think that gives us some thoughts and ideas of planning sequence of retention, which is the ultimate thing to consider when it comes to occlusion. Okay, yeah, you get the occlusion, but how do you retain it? But in many cases, as the patient’s wearing aligners, the occlusion is embedding in and is fine. And you take off the aligners, the patient’s happy with how it looks. They bite together. It feels good. You are happy that yes, both sides of the mouth are biting together. Now, it might not be that every single contact is shim-hold, but you got, let’s say, within 20 microns, 40 microns, okay? Then some bedding happens. In that kind of scenario, would you be happy to say, okay, I’m gonna scan your teeth as they are because I’m happy with the occlusion, the occlusal goals are good, and they’re near enough the ClinCheck, and go for the retainers to that position? Or is your default preference as a clinician to go for the Vivera or equivalent based on the last aligner, on the ClinCheck projection? [Jesper] I would still go for the last aligner because I think the planning I’ve done is probably a little bit more precise than what I see clinically. However, I still expect that I will have to do a little bit of enamel reshaping at the end after six months, but that’s okay. I mean, the changes are so small, so you can still use the last aligner or the Vivera retainer that you already have ordered. So it’s not that much of a problem. [Jaz] Which goes back to your previous point: if it’s a big deviation, then you’ve gotta look at the alternative ways, whether you’re gonna go for refinement or you’re gonna allow some occlusal settling with a Hawley and a lower fixed-retainer combination, or the elastics like you said. Okay. Just so we’re coming to the end of the podcast—and I really enjoyed our time—I would like to delve deep into just a final thing, which is a little checklist, a helpful checklist for case assessment that you have for GDPs. [Jesper] Yeah, thank you. First of all, one of the big challenges in a GP practice is being able to take a full series of clinical photos in two minutes without assistance. I think most dentists struggle with that, but that is a foundational prerequisite to any aligner treatment. Once you have the photos, I would sit down with the photos and I would consider six different steps. One: is this a patient that I could treat restoratively only? Because that would be the simplest for me to do. Next, moving up in complexity: would be, do I need periodontal crown lengthening? Or next step would be: do I need to change the vertical dimension, or is there something about centric relation that I should consider? Moving up a little bit on the complexity: are there missing teeth? Do I need to replace teeth with implants? Next step would be orthodontics. So this is step five. The next most complex case we can treat is actually an aligner case—orthodontics in general. And the last part would be: are the teeth actually in the right position in the face of the patient, or do I need surgery to correct the jaw position? So these six steps, I think they’re helpful to follow to just think, how can I break this case down into more easy, digestible bits and pieces to figure out what kind of patient I have in front of me? Now, if you consider it to be an orthodontic case or ortho-restorative case, here comes the challenge: case selection. How do you figure out is this an easy, moderate, complex, or referral case? And here’s the trick: do 500 to 1000 treatment plans or treatments with clear aligners. And then you know. But until then, you really don’t. This is where you should rely on someone you can trust who can help you do the initial case selection. Because you can have two identical patients—one is easy and one is super complex—but they look the same. So it’s really nice if you have done less than 500 cases to have someone who can help you with the case selection. And I don’t say this to sell anything, because we don’t charge for that. Because it’s so essential that we don’t do something that is wrong or gives us a lot of challenges and headaches in the practice. I mean, the practice runs really fast and lean-oriented, so we need to make things digestible, easy to work with. And I think that’s really important. [Jaz] It goes full circle to what we said before about having that referral network, staying in your lane, knowing when to refer out, cherry-picking—it all goes back full circle with that. And not even orthodontics, but restorative dentistry—case selection is just imperative in everything we do. [Jesper] Yes. And there is—we always get the question when we do courses and we do consulting—can’t you just show me a couple of cases that are easy to start with? And it works with implants, kind of. But with orthodontics where we move—I mean, we affect all the teeth—it’s just not possible. I know the aligner companies want to show you some where you say, you can only just do these kinds of cases and they are really easy. The fact is they’re not. But they want to sell their aligners. [Jaz] I get it. They are until they’re not. It’s like that famous thing, right? Everyone’s got a plan until they get punched in the face. So yeah, it can seemingly be easy, but then a complication happens and it’s really about understanding what complications to expect, screening for them, and how you handle that. But thanks so much. Tell us—yeah, go on, sorry. [Jesper] There are three things I’d like to end on here. So, first of all, we’ve been talking together for about an hour about a topic that, if you want to take postgraduate education, it takes three years to become an orthodontist. And there is a reason it takes three to four years. However, I want to encourage the listener to think about this: Mercedes has never, ever excused last year’s model. Meaning that they always strive for perfection. So if we go into the practice and we do the very best we can every single day, there is no way we can go back and excuse what we

Do you have a “hopeless” retained root you're ready to extract? Think implants, dentures, or bridges are the only way forward? What if there's a way to save that tooth — predictably and biologically? In this episode, Dr. Vala Seif shares his experience with the Surgical Extrusion Technique — a game-changing approach that lets you reposition the root coronally to regain ferrule and restore teeth once thought impossible to save. Jaz and Dr. Seif dive into case selection, atraumatic technique, stabilization, and timing, all guided by Dr. Seif's own SAFE/SEIF Protocol, developed from over 200 successful cases. https://youtu.be/2TyodqgAP9w Watch PDP249 on YouTube Protrusive Dental Pearl: When checking a ferrule, consider height, thickness, and location of functional load. Upper teeth: prioritize palatal ferrule. Lower teeth: prioritize buccal. Tip: do a partial surgical extrusion, rotate the tooth 180°, then stabilize. Key Takeaways Surgical extrusion is a technique-sensitive procedure that requires careful planning. Case selection is crucial for the success of surgical extrusion. A crown-root ratio of 1:1 is ideal for surgical extrusion. Patients are often more cooperative when they see surgical extrusion as their last chance to save a tooth. Surgical extrusion can be more efficient than orthodontic extrusion in certain cases. The importance of ferrule in dental restorations cannot be overstated. Proper case selection is crucial for successful outcomes. Atraumatic techniques are essential for preserving tooth structure. The 'Safe Protocol' offers a structured approach to surgical extrusion. Patient communication is key to managing expectations. Flowable composite is preferred for tooth fixation post-extraction. Understanding root morphology is important for successful extractions. Highlights of this episode: 00:00 Surgical Extrusion Podcast Teaser 01:07 Introduction 02:38 Protrusive Dental Pearl 05:53 Interview with Dr. Vala Seif 08:57 Definition and Philosophy of Surgical Extrusion 15:30 Indications, Case Selection, and Root Morphology 21:37 Comparing Surgical and Orthodontic Extrusion 25:54 Crown Lengthening Drawbacks 28:39 Occlusal Considerations 33:53 Midroll 37:16 Definition and Importance of the Ferrule 43:07 Clinical Protocols and Fixation Methods 01:00:01 Post-Extrusion Care and Final Restoration 01:05:04 Learning More and Final Thoughts 01:09:29 Outro Further Learning: Instagram: @extrusionmaster — case examples, papers, and protocol updates. Online and in-person courses in development (Europe + global access). Loved this episode? Don't miss “How to Save ‘Hopeless' Teeth with the Surgical Extrusion Technique” – PDP061 #PDPMainEpisodes #OralSurgeryandOralMedicine #OrthoRestorative This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes C. AGD Subject Code: 310 ORAL AND MAXILLOFACIAL SURGERY Aim: To understand the biological and clinical principles of surgical extrusion as a conservative alternative to orthodontic extrusion or crown lengthening for managing structurally compromised teeth. Dentists will be able to - Identify suitable clinical cases for surgical extrusion, including correct root morphology and crown–root ratios. Describe the step-by-step SAFE Protocol for atraumatic surgical extrusion, fixation, and timing of endodontic treatment. Evaluate the advantages, limitations, and biomechanical considerations of surgical extrusion compared with orthodontic extrusion and crown lengthening.

Are you confident in replacing a single missing central incisor? When is a denture the right option — and when should you consider a bridge or implant instead? Why is the single central incisor one of the hardest teeth to replace to a patient's satisfaction? In this Back to Basics episode, Jaz and Protrusive Student Emma Hutchison explore the unique challenges of replacing a single central incisor. They break down when each option — denture, resin-bonded bridge, conventional bridge, or implant — is appropriate, and the biological and aesthetic factors that influence that decision. They also share key communication strategies to help you manage expectations, guide patients through realistic treatment choices, and avoid disappointment when dealing with this most visible and demanding tooth. https://youtu.be/czjPQxKpwPw Watch PS018 on YouTube Key Takeaways:  Replacing a single central incisor isn't just about technical skill — it's about communication and case selection.  Success comes from helping patients understand that a restoration replaces a tooth's function and appearance, not nature itself.  Clear conversations about expectations, limitations, and maintenance are what turn a difficult aesthetic case into a satisfying long-term result. Highlights of this episode: 00:00 Teaser 00:28 Intro 01:56 From Dental Nurse to Final-Year Student 07:38 Challenges and Considerations in Replacing Central Incisors 12:51 Patient Communication and Treatment Planning 18:33 Discussing Treatment Options and Enamel Considerations 21:16 Communicating Options and Guiding Patient Decisions 25:51 Choosing Between Fixed and Removable Options 27:10 Midroll 30:31 Choosing Between Fixed and Removable Options 31:05 Handling Old Crowns and Patient Communication 34:17 Conventional vs. Resin-Bonded Bridges 37:57 Occlusal Load, Function, and Implant Considerations 43:40 Digital Workflow in Dentistry 45:54 Managing Aesthetic Expectations 48:34 Final Thoughts and Recommendations 52:59 Outro

What if one bad decision completely changed the course of your career? In this exclusive, members-only episode, Jaz sits down with a fellow dentist from our community who shares his raw, honest story about a moment of misjudgment — committing fraud — and the painful lessons that followed. This isn't about blame. It's about insight, accountability, and redemption. From the shock of investigation and court hearings, to the struggle of rebuilding trust and identity, this conversation shines a light on what really happens behind closed doors when things go wrong. The aim of this podcast was to hopefully deter colleagues from temptation which can affect anyone at any time. https://youtu.be/QF-UNrlYjcw Watch PDP248 on YouTube How to Watch the Full Episode This is a members-only podcast episode due to its sensitive nature. You can access it by creating a free Community account at: https://www.protrusive.app Highlights of this episode: 00:00 Teaser 00:49 Introduction 05:49 End Screen Love this episode? Don't miss Divorce, Alcohol and Rough Patches - Overcoming Adversities (IC040) #PDPMainEpisodes #BeyondDentistry This episode is eligible for 0.5 CE credits via the Quiz on Protrusive Guidance.  This episode meets GDC Outcomes A and D AGD Subject Code: 555 Ethics in Dentistry Aim: To reflect on the ethical, professional, and emotional lessons learned from a real-life case of dental fraud, highlighting accountability, insight, and rehabilitation while identifying practical steps to prevent similar incidents. Dentists will be able to - Recognise how workplace pressures, lack of mentorship, and poor oversight can lead to ethical lapses. Understand the legal, professional, and emotional consequences of dishonesty and poor record keeping. Identify support systems, coping strategies, and self-reflective tools to prevent burnout and maintain integrity.

Ever had a patient swear their bite feels “off” - even though the articulating paper marks look perfect and you've adjusted everything twice over? Or maybe you've placed a beautiful quadrant of onlays, only to have them return saying, “these three teeth still feel proud.” If that sounds familiar, you're not alone. In this episode, I'm joined (in my car, no less!) by Dr. Robert Kerstein, who was back in the UK to teach about digital occlusion and the power of the T-Scan and ‘disclusion time reduction therapy'. We dig into why a patient's bite can still feel “off” even when everything looks right, how timing is just as important as force, and why splints and Botox don't always solve TMD. Robert explains why micro-occlusion is the real game-changer, how scanners could mislead you, and why dentistry still clings to articulating paper. So if you've ever wondered why “perfect” cases still come back with bite complaints, or whether timing data can actually prevent fractures and headaches, this episode will give you plenty to chew on - pun intended. https://youtu.be/0lCAsjFhsXI Watch PDP247 on YouTube Key Takeaways: Micro-occlusion, not just “dots and lines,” is the real driver of patient comfort and long-term tooth health. T-Scan measures both force and timing, which scanners and articulating paper cannot capture. Many patients show signs of occlusal damage without symptoms. Disclusion Time Reduction (DTR) treats TMD neurologically without splints, Botox, or TENS. Relying on occlusograms alone for guiding reduction is risky. Dentists can reduce post-treatment complaints by balancing micro-occlusion with T-Scan. Adopting T-Scan requires proper training. CR can be a convenient reference point, but MIP works well in most cases if micro-occlusion is managed. Objective, repeatable data builds patient trust and provides medico-legal reassurance. Highlights of this episode: 00:00 Teaser 01:13 Intro 4:41 Protrusive Dental Pearl -  Removing a Temporarily Cemented Crown 06:39 Introduction 08:48 Global Training Footprint 09:32 What Robert Teaches (DTR & T-Scan) 09:55 Occlusion as Neurologic 10:33 Macro vs Micro-Occlusion 11:33 Neural Pathway 15:00 MIP vs CR Framing 16:48 Signs Without Symptoms 19:16 Silent Majority 20:08 Why Treat Asymptomatic Signs 20:50 Disclusion and MIP 22:28 Occlusogram Caveats 24:53 Midroll 28:14 Occlusogram Caveats 28:29 Why Occlusograms Mislead 29:21 Don't Adjust From Color Alone 31:47 What Pressure/Timing Enable Clinically 33:02 Prosthetic Reality Check 34:46 Patient-Perceived Comfort 35:29 Why Isn't T-Scan Everywhere? 36:29 Political Resistance 37:42 CR as Utility 38:18 MIP and Vertical Dimension. 39:48 Macro ≠ Micro 41:00 Material Longevity Benefits 41:57 T-Scan Training 42:58 Three Competencies to Master 44:20 Micro-Occlusion Rules 44:46 Outro If you want to get more clued up on TMD, tune into this episode for the latest insights and guidelines! PDP213 - TMD New Guidelines -  however be warned that the guidelines are contradictory to what Dr. Kerstein advises….ah the wonderful world of TMD!  #OcclusionTMDandSplints #OrthoRestorative This episode is eligible for 0.5 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes A, C. AGD Subject Code: 250 – Clinical Dentistry (Occlusion/Restorative) Aim: to explore the role of micro-occlusion and timing in TMD and restorative success, highlighting how tools like T-Scan provide data that other tools cannot. This episode seeks to give dentists practical insights into diagnosing, preventing, and treating occlusal problems with greater accuracy. Dentists will be able to: Describe the role of micro-occlusion and disclusion time in TMD symptoms and tooth wear. Recognising the limitations of traditional methods of occlusion adjustment.

Is social media killing professionalism in dentistry? Are young dentists really “clowns” online—or is lightheartedness perfectly fine? Is social media a disease? Where's the line between humor, banter, and outright disrespect? In this episode, Jaz is joined by Joseph Lucido from the States to tackle these tough questions head-on. Sparked by a fiery Facebook rant, they dive into whether social media is harming our profession, how dentists should present themselves online, and if there's still room for fun without crossing the line. Whether you love or hate dental content on social media, this conversation will make you rethink how we represent our profession to the world. Shout-out to two US doctors creating excellent, entertaining content on social media Dr Brady Smith Dr. Nicholas J Ciardiello Check out the 3-Step Modern Dental Marketing Plan from Clear to Launch Dental — designed to help you simplify your marketing and grow your practice without the overwhelm. https://youtu.be/W7Uh-ML9dZg Watch IC063 on YouTube Takeaways Social media etiquette is crucial for healthcare professionals. Avoid controversial topics to maintain professionalism. A social media presence is essential for modern dental practices. Patients often check social media to verify a practice's credibility. Content should reflect the personality of the dentist and practice. Highlight satisfied patients to build social proof. Consistency in posting is key to maintaining engagement. Separate personal and professional social media accounts. Batch content creation to save time and effort. Engaging content can lead to more patient inquiries. Highlights of this episode: 00:00 Teaser 00:31 Intro 01:47 Introducing Joseph Lucido: Social Media Expert 03:21 Social Media Etiquette for Dentists 06:14 The Importance of Social Media Presence 12:04 Balancing Professionalism and Humor Online 17:39 Authenticity in Social Media 19:51 Balancing Personal and Professional Content 21:51 Effective Social Media Strategies 25:27 Time Management for Social Media 27:26 Do's and Don'ts of Social Media 29:43 The Power of Social Proof 30:49 Conclusion and Resources 32:47 Outro Love this episode? Don't miss Best Practices in Social Media for Dentists – How to Stay Out of Trouble Yet Be Impactful (IC035) #InterferenceCast #Communication #BreadandButterDentistry This episode is not eligible for CPD/CE points, but never fear, there are hundreds of hours of CPD waiting for you on the Ultimate Education Plan, including Premium clinical walkthroughs and Masterclasses.

Cracked teeth — the diagnosis we all hate as Dentists! How do you decide when to monitor and when to intervene? What is the recommended intervention at different scenarios of cracks? Should we be chasing cracks and reinforcing with fibers; is there actually enough long-term data to support that approach? Over the years, we've had some epic episodes on this topic — from Kreena Patel's “I Hate Cracked Teeth” (PDP028) to Dr. Lane Ochi's Masterclass on Diagnosis and Management (PDP175). But in this brand-new episode, Jaz is joined by Dr. Masoud Hassanzadeh to bring it all together — not just the diagnosis of cracks, but their management. They explore when to intervene, the role of fibers in preventing propagation, and even the fascinating possibility that cracks in teeth may have some ability to heal, just like bone! This one's a deep dive that will change how you talk to patients — and how you approach cracked teeth in your own practice. https://youtu.be/VHYRBnfJS3I Watch PDP246 on YouTube  Protrusive Dental Pearl Your patient's history predicts the future! Ask if past extractions were difficult → clues you into anatomical challenges. Ask how they lost other teeth → if cracks, be proactive with today's cracks. History isn't just background—it's a clinical tool. Key Takeaways Cracks in teeth can be diagnosed using magnification and high-quality imaging. Patient factors such as age and muscle strength play a significant role in crack prognosis. Symptomatic cracks should be treated to prevent further propagation. Understanding the anatomy of the tooth is crucial for effective treatment. The healing mechanism of cracks in teeth is possible but varies between enamel and dentin. Fibers can be used to strengthen restorations and manage cracks effectively. Long-term studies are needed to assess the effectiveness of current crack management protocols. The use of fluorescence filters can help identify bacteria in cracks. Chasing cracks should be done cautiously to avoid pulp exposure. A comprehensive understanding of crack mechanics can improve treatment outcomes. Highlights of this episode: 00:00 Teaser 00:47 Intro 03:08 Protrusive Dental Pearl - The Importance of Dental History 07:18 Interview with Masoud Hassanzadeh 08:22 Diagnosing and Managing Cracks 21:13 When to Intervene on Cracks 25:50 Restoration Techniques and Materials 28:30 Chasing Cracks: Guidelines and Techniques 36:50 Mechanisms of Crack Healing in Teeth 45:11 Exploring the Use of Fibers in Dentistry 52:43 Introducing the Book on Cracked Teeth 54:57 Percussion-Based Diagnostics (QPD) 56:44 Key Takeaways 57:21 Conclusion and Final Thoughts 01:00:07 Outro As promised, here are the studies mentioned during the discussion: Why cracks do not propagate as quickly in root dentin: Study 1a & 1b Root dentin has significantly higher fracture toughness compared to coronal dentin—nearly twice as tough, as demonstrated in multiple studies. The key difference lies in their structure and toughness. Root dentin's unique collagen orientation adds strength, while its fewer lumens and thinner peritubular cuffs make it less brittle. In contrast, coronal dentin has thicker cuffs, which increase brittleness. Unlike coronal dentin, which fractures uniformly, radicular dentin is anisotropic—its fracture behavior varies depending on direction. These structural features give root dentin greater resistance to cracking, making it more durable under stress. Studies on decreasing crack length due to crack repair in enamel. Study 2 The importance of the modulus of elasticity of the final restoration in arresting crack propagation. Study 3 The role of fiber in restoring cracked teeth and how it can increase fracture strength—even surpassing that of natural teeth. Study 4 Decision Making for Retention of Endodontically Treated Posterior Cracked Te...

With the final places remaining for our Occlusion Getaway, we present the official FAQ Podcast! Dreaming of combining occlusion learning with a luxury getaway? Want to earn 56 hours of CPD while soaking up the Dubai sunshine? Looking for a course where you can master PRACTICAL occlusion in Restorative Dentristry and make it a family-friendly, tax-deductible trip? Easter 2026 is set to be unforgettable. Join Dr. Jaz Gulati and Dr. Mahmoud Ibrahim for an extraordinary Occlusion Excursion in Dubai — a blend of serious CPD and sunshine that redefines what “continuing education” can be. We've always believed in mixing work and pleasure, and this time, we're taking it to the next level. Think luxury, learning, and laughter — all under the warm Dubai sun. Watch IC062 on Youtube

Do all whitening gels work the same, or is the brand actually important? Are lights and in-office “power whitening” just marketing hype? And what's the deal with the infamous white diet - do your patients really need to give up coffee and red wine? In this episode, I sit down with Dr. Wyman Chan, the man who literally hung up his drills in 2002 to dedicate his career to whitening alone. With over 20,000 cases under his belt (and a PhD in the science behind it), Wyman shares his three golden rules for whitening success: trays, communication, and conscious bleaching. We're also joined by Dr. Niki Shah, who brings his own insights into whitening and patient care, making this a conversation packed with both science and clinical experience. Wyman introduces his latest invention—Magic 3, a fizzing gel that reveals and removes plaque while calming gums. Plus, Wyman busts some of the biggest whitening myths (sorry, “white diet”) and explains why he no longer bothers with internal bleaching. If you've ever wondered how to make whitening safer, more predictable, and less stressful for you and your patients—this is the episode you'll want to tune in for. Protrusive Dental Pearl Innovation in Hygiene with Magic 3 - What is Magic 3? A colorless plaque indicator gel developed by Wyman Chan. Fizzes on contact with plaque. Cleans teeth, removes superficial stains, and softens soft calculus. Clinical Application Alternative to scaling/polishing for routine patients. Nervous patients who dislike ultrasonic scalers. Children (6+) – safe as a Class I medical device. Orthodontic patients – helps prevent white spot lesions. Learn more at https://protrusive.co.uk/magic3 https://youtu.be/ImpHJP3Wxec Watch PDP245 on YouTube Key Takeaways: Teeth whitening success depends on tray design, formulation, technique, and compliance. Conscious bleaching helps minimise sensitivity. Sensitivity is due to peroxide reaching the pulp. Patients should adjust wear time gradually, starting short and increasing if comfortable. Communication and treatment planning are crucial to match whitening regimes with lifestyles. The “white diet” is not scientifically necessary - normal eating and drinking can resume within minutes. External bleaching alone can be effective, even for single dark teeth. Tetracycline-stained teeth can respond to whitening with the right protocols. The brand is less important than protocol consistency and clinician experience. In-office light-assisted whitening adds risk, cost, and chairside time without proven benefit. Allergic reactions are more likely caused by gel additives, not peroxide itself. Emerging products, such as peroxide-based gels for plaque disruption and gingival health, may complement whitening in the future. Highlights of this episode: 00:00 TEASER 1:00 INTRO 3:13 PROTRUSIVE DENTAL PEARL 07:05 Dr. Wyman Chan Introduction 13:32 Niki's Journey in Dentistry 17:03 Whitening Products and Techniques 23:09 Three Keys to Whitening Success 30:03 Addressing Sensitivity in Teeth Whitening 37:43 MIDROLL 41:04 Addressing Sensitivity in Teeth Whitening 46:15 Whitening as Treatment Planning 49:10 Myths and Misconceptions 01:00:27 Lights and In-Office Whitening 01:03:13 Introducing Magic3: A Revolutionary Dental Product 01:16:10 OUTRO Discover Magic3 and Dr. Wyman Chan's inventions If this episode piqued your interest, continue the whitening theme by listening to PDP199 “How To Eliminate Sensitivity During Teeth Whitening”. And don't miss the upcoming visual follow-up to this episode! #PDPMainEpisodes #BreadandButterDentistry This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes A, C, and D. AGD Subject Code: 780 – Esthetics/Cosmetic Dentistry Aim: To deepen dentists' understanding of teeth whitening by exploring evidenc...

Why should Dentists be talking about screen time with parents? Are smartphones even safe for children? What is the right age to give a child their first phone? Laura Spells and Arabella Skinner join Jaz in this thought-provoking episode to tackle one of today's biggest parenting challenges: smartphones and social media in young hands. Together they explore the impact of early phone use on children's health, development, and mental wellbeing—and why healthcare professionals should be paying close attention. https://youtu.be/7RUJZqtEr18 Watch IC061 on YouTube  Protrusive Dental Pearl: Live by your values—not your profession, spouse, or children. Don't sacrifice for them; choose what aligns with you, so love never turns into resentment. Need to Read it? Check out the Full Episode Transcript below! Key Takeaways Screen time is a significant public health concern. Mental health issues are rising due to social media exposure. Early childhood screen time has long-term effects. Parents need clear guidance on screen time limits. Community support is essential for children's well-being. Health professionals must ask about screen time in assessments. Regulatory changes are needed for safer screen use. The impact of social media on self-esteem is profound. Misinformation about health trends can lead to dangerous practices among youth. Dentists play a crucial role in educating patients about safe health practices. Parents should engage in conversations about social media with their children. Creating a family digital plan can help manage screen time effectively. Collaboration among health professionals needs to raise awareness about the dangers of unregulated products. Empowering parents with knowledge is essential for effective parenting in the digital age. Role modeling healthy behaviors is important for parents. Highlights of this episode: 00:00  TEASER 01:18  INTRO 03:13 PROTRUSIVE DENTAL PEARL 04:54 Introducing Our Guests: Arabella and Laura Spells 09:24 Statistics and Scale of the Problem 18:09 Early Years and Screen Time 22:27 Safer Alternatives and Regulation 27:08 MIDROLL 30:29 Safer Alternatives and Regulation 30:53 Ideal Guidelines for Screen Usage 34:01 The Role of Dentists in Addressing Social Media Issues 44:59 Parental Guidance and Digital Plans 53:53 Final Thoughts and Resources 56:06 OUTRO ✅ Action Steps

How can you tell if a root canal treatment is truly successful? Do you always need cuspal coverage after a root canal? Are hand files still relevant, or has rotary completely taken over? And does GP pumping really improve the effectiveness of irrigants like hypochlorite? Emma returns for another Protrusive Student Series episode as she heads into her final year of dental school. Together, we explore the fundamentals of endodontics - covering restoration choices, success criteria, instrumentation, and irrigation protocols. This episode breaks down the basics every student and young dentist should understand, while also tackling the common debates and real-world challenges of endo. https://youtu.be/DK1ZAEPE_E4 Watch PS017 on YouTube Key Takeaways Understanding the 'why' behind dental procedures is crucial for effective practice. Both hand files and rotary files have their place in endodontics, especially for beginners. Good irrigation techniques are essential for effective endodontic treatment. Rubber dam isolation is critical for safe and effective endodontic procedures. Learning to determine the master apical file size is a key skill in endodontics. The use of EDTA helps in removing the smear layer during root canal treatment. Endodontic specialists often use advanced techniques and tools for more efficient treatments. Success in endodontics is not just about radiographs, it is sometimes defined by patient comfort and healing. Cuspal coverage is often necessary after root canal treatment. Patient communication is key to managing expectations. Consent forms should be tailored to individual cases. Understanding proprioception is important for tooth preservation. Highlights of this episode: 00:00 Teaser 00:51 Intro 02:50 Emma's Final Year Reflections 04:34 Exploring Specialties 07:02 Endodontics: A Student's Perspective 08:15 Rotary vs Hand Files 11:45 Step-by-Step Notes for Students 14:24 Patency and Recapitulation 14:55 Determining Master Apical File Size 16:58 Irrigation Protocols and Techniques 21:22 Typical Irrigation Protocol 23:51 Rubber Dam Importance 27:25 Rubber Dam Importance 28:21 Role of 17% EDTA 28:59 Success Factors in Endodontics 29:46 Success Factors in Endodontics 30:46 Real-World Endodontic Practices and Challenges 32:11 Understanding Success and Survival in Root Canal 34:26 Successful Outcomes 36:24 Success vs Survival 38:12 The Debate on Cuspal Coverage and Timing 40:48 Proprioception 41:54 Pre-Endodontic Build-Up 42:29 Direct Cuspal Coverage 44:03 Consent and Communication in Endodontic 47:25 Conclusion and Future Topics 49:02 Outro Resources mentioned: Outcome of primary root canal treatment: systematic review of the literature – Part 1  Outcome of primary root canal treatment: systematic review of the literature – Part 2. Influence of clinical factors  Radiographic Assessment of the Quality of Root Canal Fillings Check out Simple Re-RCT Cases – ‘How To' Guide – PDP233 for more Endodontic insights #BreadandButterDentistry #EndoRestorative This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcome C. AGD Subject Code: 070 – Endodontics (Endodontic infections, microbiology, and treatment) Aim: To provide dental students and early-career dentists with a structured understanding of endodontic fundamentals, including instrumentation, irrigation protocols, success factors, and restorative considerations. Dentists will be able to: Differentiate between hand and rotary file systems and identify their advantages and risks. Evaluate the factors influencing the success and survival of root canal treatment. Recognize when cuspal coverage or pre-endodontic build-ups are required.

How should you  gain consent for ELECTIVE treatments? Is selling in dentistry something to avoid, or an essential part of patient care? How much does emotional intelligence really matter for your success and happiness? Dr. Colin Campbell joins for a powerful episode that dives into consent, sales, and the balance between profit and ethics in dentistry. He also unpacks the huge role of emotional intelligence—not just in clinical practice, but in life. Expect real talk, strong opinions, and communication gems that can reshape the way you connect with patients and approach your career. https://youtu.be/Wtugp1t-IrM Watch PDP244 on Youtube Protrusive Dental Pearl: Read (or listen to) the book Let Them by Mel Robbins — a powerful reminder to take control of your own life and emotions instead of letting outside events dictate them. Takeaways Building trust with patients is crucial for effective consent. Consent should be a relationship management exercise, not just a legal formality. Understanding the patient's perspective is key to effective communication. Elective treatments should be approached with caution and ethical considerations. Sales in dentistry is not a dirty word; it's about providing solutions to patients. Emotional intelligence is a vital skill for dentists to develop. Good dentistry is about doing what is best for the patient, not just for profit. Continuous education and self-improvement are essential for success in dentistry. HIghlights of this episode: 00:00 Teaser 00:44 INTRO 01:44  Protrusive Dental Pearl 02:58 Welcoming Dr. Colin Campbell 04:55 Colin's Background and Philosophy 05:36 The Importance of General Dentistry 08:40 Finding a Niche vs. Being a Generalist 11:14 Understanding Consent in Dentistry 17:42 Fear of Losing the “Sale” 18:50 Building Trust with Patients 22:09 Consent Process Overview 22:49 Patient Consultation Process – Building the Bridge to Trust 29:00 Developing Emotional Intelligence (EQ) 30:00 Patient Consultation Process – The Mechanics 30:58 Patient Consultation Process – Exploring Options 31:13 Join Protrusive Guidance 34:34 Patient Consultation Process – Exploring Options 34:36 Patient Consultation Process – Follow-Up and Consent Pathway 35:54 Patient Pathways After Consultation 36:48 Treatment Plan Letters & Legal Angle 38:45 Approach to Consent Letters 40:21 Personality Types in Consultations 42:21 Systematizing Your Process 43:37 Ethics in Elective Treatments 53:15 Guidance for New Dentists on Elective Treatments 56:33 Interjection 57:48 Guidance for New Dentists on Elective Treatments 57:56 Sales in Dentistry  01:03:05 Conclusion and Final Thoughts 01:05:20 OUTRO ✨ Transform Your Dentistry ✨

Can and should Dentists carry out home sleep testing? It's actually super easy and I have been doing it for 18 months! What happens after you screen them—do you know what to do next? This episode will teach you! Dr. Jaz Gulati shares his personal journey into incorporating sleep testing in practice—after 1.5 years of doing it, the impact has been nothing short of game-changing. https://youtu.be/H4rTkIuOHWI Watch PDP243 on Youtube Joined by clinical sleep scientist Max Thomas in this jam-packed episode, they deep dive into what it really means to go beyond awareness of sleep-disordered breathing. He breaks down the practical steps for dentists who want to do more than just refer—and start making a difference in their patients' lives. You'll learn how to bridge the gap between theory and action, how to screen effectively, and why you play a pivotal role in the patient's journey to better sleep, more energy, and a healthier life. Protrusive Dental Pearl: If a patient has been seen gasping, choking, or stopping breathing during sleep — that's pathognomonic for sleep-disordered breathing.

Imagine your patient is choking on a rubber dam clamp...what's the safest way to manage choking when the patient is lying flat? Your patient's hands are shaking and they're drenched in sweat - is it low blood sugar, anxiety, or a cardiac event? ​​Do you know exactly what to do if your patient has a seizure in the chair? This second part of the Medical Emergencies series with  Rachel King Harris dives even deeper into real-life scenarios that dental teams may face. From seizures and how (and when) to give buccal midazolam, to managing choking in a dental chair, this episode is packed with practical, clear guidance. We also explore key steps in treating diabetic hypoglycaemia, understanding glucagon vs glucose, and how to confidently manage patients with angina or previous heart attacks—when to use GTN, when to give aspirin, and when to simply wait for the ambulance. It's all about staying calm, being prepared, and delivering safe, effective care when it matters most. https://youtu.be/fyIIsT0dlIc Watch PDP242 on Youtube Protrusive Dental Pearl: Assign a clear lead to regularly check the expiry dates and supplies of emergency medications and equipment. This isn't just about ticking regulatory boxes — it's about saving lives. Little checks like this can make a big difference in a true emergency. Need to Read it? Check out the Full Episode Transcript below! Highlights of this episode: 00:00 Teaser 00:44 Intro 03:09 Protrusive dental pearl 04:14 Recap from Part 1 06:58 Seizures: Personal Experiences and Practical Tips 13:45 Seizure Emergency Kit: Buccal Midazolam 21:29 Emergency Drug Kit Overview 22:10 Choking: Techniques and Guidelines 29:19 Midroll 32:40 Choking: Techniques and Guidelines 34:05 Handling Infant Choking Emergencies 36:11 Recognizing and Managing Hypoglycemia 41:11 Emergency Protocols for Hypoglycemia 47:35 Managing Cardiac Emergencies in Dental Practice 58:59 Final Thoughts and Training Recommendations 01:00:39 Outro Stay up to date by reviewing the latest guidelines from the Resuscitation Council UK. Grab your Anaphylaxis Summary + Medical Emergency Cheatsheets from https://protrusive.co.uk/me. And make sure you've listened to Part 1 of Medical Emergencies so you don't miss any crucial information. #PDPMainEpisodes #CareerDevelopment #BeyondDentistry ​​This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes C and D. AGD Subject Code: 142 Medical emergency training and CPR Aim: To equip dental professionals with the knowledge, confidence, and practical skills to recognize and effectively manage common medical emergencies in the dental setting, ensuring patient safety and optimal outcomes. Dentists will be able to: Identify signs and symptoms of common medical emergencies in dental practice, including anaphylaxis, asthma attacks, seizures, angina, hypoglycemia, and stroke. Describe the immediate management protocols for each emergency, including correct drug doses, routes, and timings. Demonstrate appropriate use of emergency equipment and drugs available in the dental setting. Click below for full episode transcript: Teaser: And you're saying that you deal with one hole only and it's the mouth and not anywhere else. Teaser:When you're becoming a dentist and you have to choose between medical and dental school, you either look up one and you look down the other, and so I said, let me look down, not up. So here we are. That made me realize, and the advice on that Facebook post was, anyone age five or under choke on grapes. And so you totally agree with that? I do. I do. I just think it's not worth it. Sweaty. Sweaty. Very, very clammy. You know, there's pools of sweat that I mentioned with hypose. You can get exactly the same with an MI. Yeah. Nausea, vomiting, sweaty, clammy, impending doom. So again,

HIGHLY RECOMMENDED CPD for all Dental professionals - without getting bored! Do you know exactly what to do if a patient faints in your chair? Could you spot the early signs of anaphylaxis—before it's too late? How quickly could you find and deliver adrenaline if it really mattered? https://youtu.be/7b2oG4g12q0 Watch PDP241 on Youtube After six years of podcasting and creating CPD, we're finally tackling medical emergencies the Protrusive way. In this two-part series, Jaz is joined by lead nurse and medical emergencies educator Rachel King Harris, who breaks down the real-life scenarios every dental team needs to prepare for—without the fluff or generic lecture feel. From vasovagal syncope to adrenaline protocols, you'll learn how to stay calm, think clearly, and take action when it matters most. By the end of this episode (and the next), you'll not only tick the box for your GDC-required CPD—you'll actually feel ready. Because when emergencies happen in the chair, panic isn't a plan. Let's get you prepared. Protrusive Dental Pearl: Be emergency-ready! Download a free medical emergencies cheat sheet — a quick guide for symptoms, drugs, and actions during a crisis. You can download this ready-made cheat sheet for free at protrusive.co.uk/me. Print it, laminate it, and pop it into your medical kit. Your whole team will thank you! Key Takeaways: Medical emergencies in dentistry are rare but high-stakes — being prepared is essential. Guidelines change often — regular refreshers are vital. You don't need to memorise everything — use validated resources and calm judgment. Vasovagal Syncope is the most common emergency in dental settings. If unconsciousness persists → consider other causes: meds, blood sugar, cardiac issues. Anaphylaxis can occur even without rash — don't wait for it. Key signs: stridor, lip/tongue swelling, wheeze, “impending doom,” difficulty breathing. Keep emergency drug guides visible and updated (e.g., BDA laminated sheets). Ampules = longer shelf life, more doses than EpiPens, and more cost-effective. Don't wait for the rash — airway signs matter most in anaphylaxis. Always carry two adrenaline auto-injectors — even for mild allergy patients. Highlights of this episode: 00:00 TEASER 00:53 INTRO 04:50  Protrusive Dental Pearl 06:01 Meet Rachel King Harris: Expert in Medical emergencies 09:42 Practical Tips for Emergencies 12:05 Understanding Vasavagal Syncope 17:01 GTN Spray 20:09 Recognizing and managing Anaphylaxis 30:05 Midroll 33:26 Recognizing and managing Anaphylaxis 34:41 Allergic Reaction to Chlorhexidine Gel 37:27 What's Inside Emergency Bag? 41:51 Adrenaline Ampules vs Auto-Injectors 52:04 Oxygen Administration In Dental Practices 57:13 Oxygen and Emergency tools 59:05 Oxygen Contraindication 1:06:37 Outro Stay up to date by reviewing the latest guidelines from the Resuscitation Council UK. Check out this Anaphylaxis Summary Document Enjoyed this one? Make sure to check out PDP159 – How to Manage Children in Dental Pain, where we dive into real-life paediatric emergencies in dentistry. ​​This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes C and D. AGD Subject Code: 142 Medical emergency training and CPR Aim:To improve the preparedness and confidence of dental professionals in recognising and managing common medical emergencies in the dental setting, with an emphasis on vasovagal syncope, anaphylaxis, and appropriate use of emergency medications and equipment. Dentists will be able to - Identify early signs and symptoms of vasovagal syncope and anaphylaxis in a dental setting. Apply appropriate first-aid management protocols, including patient positioning, airway support, and oxygen delivery. Understand the updated guidelines for prioritising adrenaline over antihistamines or steroids in ana...

How on earth can a neck injection eliminate teeth sensitivity? Can a patient's tooth sensitivity really be linked to their occlusion? Is occlusal adjustment ever indicated for sensitivity? And what's the actual mechanism behind those cases where everything looks fine — no cracks, no significant wear, no exposed dentine — yet the patient still complains their teeth are sensitive? In this episode, Dr. Nick Yiannios shares the concept of Sympathetic Dentin Hypersensitivity (SDH), a groundbreaking way of understanding sensitivity that goes beyond the usual suspects like caries, erosion, or leakage. We dive into how the sympathetic nervous system in the pulp can drive unexplained pain, why traditional approaches often fail, and how objective tools like T-Scan and EMG can reveal what articulating paper misses. This could completely change the way you diagnose and manage those “mystery” sensitivity cases that just don't add up. https://youtu.be/a2Mg72Y_zkw Watch PDP240 on Youtube Protrusive Dental Pearl: When fitting a resin-bonded bridge (RBB), if you're unsure about the fit and cement gap, use light-bodied PVS on the intaglio surface of the wing. After setting and peeling it away, the thickness of the PVS shows you the expected cement layer. Ideally, it should be thin and even; a thicker area highlights where your gap is excessive. Key Takeaways: The T-scan technology revolutionizes occlusal analysis. Sensitive teeth can be linked to occlusion and bite adjustments. Frictional dental hypersensitivity (FDH) is a key concept in understanding sensitivity. Sympathetic responses may contribute to dental hypersensitivity. Innovative treatments include laser therapy and ozone application. Addressing root causes is essential for long-term solutions. Dentists should explore literature for new insights and techniques. Critical thinking is vital in dental practice. Advanced technology can enhance patient care and outcomes. Objective data is essential for effective occlusal adjustments. Understanding joint function is crucial for dental health. Differentiating between types of dental hypersensitivity is important. The sympathetic nervous system plays a significant role in dental pain. Educating patients about their conditions fosters better outcomes. The beaker of pain concept helps in understanding patient symptoms. Continuous learning is vital for dental professionals. Objective metrics are necessary for accurate diagnosis and treatment. Highlights of this episode: 00:00 Teaser 00:39 Intro 03:51 Protrusive Dental Pearl 05:42: Dr. Nick Yiannios' Journey and Innovations 07:46 T-Scan and Digital Occlusal Analysis 08:29 FIRST INTERJECTION 13:46 T-Scan and Digital Occlusal Analysis 14:07 Discovery of Occlusion–Sensitivity Link 20:44 Second interjection 24:25 Student Case – Sensitivity from a Bridge 26:04  Dentine Hypersensitivity 28:39 Cervical Dentine Hypersensitivity 30:44 The Role of Lasers and Ozone in Dental Treatment 35:24 Alternatives for Dentists Without Lasers 43:12 Alternatives for Dentists Without Lasers 44:00 Frictional Dental Hypersensitivity Explained 47:15 The Importance of T-Scan in Dentistry 50:57 Neck Blocks and Sympathetic Responses. 58:24 Third interjection 01:00:01 Neck Block Mechanism 01:12:34 The Beaker of Pain Concept 01:14:38 Fourth interjection 01:16:23 The Beaker of Pain Concept 01:16:59 Community and Collaboration 1:20:57 Outro Curious to dive deeper?You can explore more of Dr. Nick's work and insights through these resources: Upcoming course: CNO6 – Sympathetics in Dentistry: The Missing Link in General & Specialty Practice AES (American Equilibration Society) – check out their upcoming conference for world-class learning in occlusion and TMD. CNO – Center for Neural Occlusion Facebook community: Neural Occlusion YouTube channel: Dr.

Is it time to say goodbye to your DSLR? Are mirrorless cameras really the future of dental photography? If your DSLR is still working perfectly, should you upgrade now or wait for the right time? Jaz is joined by Dr. Ashish Soneji in this game-changing episode to discuss the death of the DSLR and why the shift to mirrorless cameras is inevitable. They break down whether you should proactively switch or strategically hold off, plus what this means for your existing lenses. You'll also learn the rules of mix and match—can you use your current DSLR lens on a mirrorless body? And most importantly, which mirrorless lenses are worth buying and which ones to avoid (hint: if they don't have markings, you might be in trouble!). If you care about consistent, high-quality dental photography, this episode is a must-listen! https://youtu.be/Y29Mnz26ZIU Watch PDP239 on Youtube Protrusive Dental Pearl: Jaz introduces the 21-Day Photography Challenge for beginners, featuring 21 short videos to help dentists take clear, well-framed photos. In just three weeks, participants will master essential shots, including tricky occlusal views, at their own pace. Key Takeaways: Investing in quality equipment pays off in the long run. Mirrorless cameras offer significant advantages over DSLRs. Lighting is crucial for capturing quality images. Standardized images require barrel markings on lenses. Second-hand DSLRs can be a cost-effective option for beginners. The evolution of camera technology impacts photography practices. Choosing the right lens is essential for dental photography. Flash consistency is vital for accurate representation in images. Upgrading to mirrorless is a smart move for future-proofing photography. Upgrading your camera setup should align with your clinical progression. Mirrorless cameras are lighter and offer better image quality. Consider the size and transportability of your camera kit. Timing for upgrades can be linked to job changes or equipment failures. Image quality is influenced by megapixels, especially for presentations and printing. Using the right tools, like smaller mirrors and retractors, can improve photography outcomes. Testing second-hand cameras before purchase is crucial to avoid issues. Mobile photography is improving, but may not match the quality of dedicated cameras. Investing in good photographic equipment is essential for quality results. Highlights of this episode: 00:00 Teaser 00:47 Intro 01:41 Protrusive Dental Pearl 03:30 Ashish's Journey into Photography 09:06 The Shift from DSLR to Mirrorless Cameras 13:33 Choosing the Right Camera Setup 15:32 Upgrading to Mirrorless Cameras 19:22 Camera Recommendations for Beginners 27:23 Investing in Reliable Flash Equipment 32:20 Investing in Reliable Flash Equipment 33:48 When to Upgrade Your Camera Setup 38:08 Getting HQ Images: Mirrorless vs DSLR 42:03 Avoiding Newer Lenses 43:23 Posterior Quadrant Photography 47:50 Tips for Buying Second-Hand Cameras 49:54 Mobile Dental Photography: Are We There Yet? 53:20 Getting Your First Mirrorless Camera 55:40 Course Information 57:53 Outro

Should we be doing more to save questionable teeth? What if you could buy more time — without compromising patient care? Dr. Omar Ikram returns for a powerful episode diving into the real-world decision-making between endodontics and implants. Together with Jaz, they explore tough scenarios — like teeth with nasty cracks or minimal remaining structure — and ask the critical question: when is it truly time to extract? They break down concepts like retained roots, root burial, amputation, and a new term Jaz introduces — palliative endodontics. Because sometimes the best outcome isn't immediate replacement, but smart, strategic delay. https://youtu.be/5msP908JvuI Watch PDP238 on Youtube Protrusive Dental Pearl: When discussing treatment longevity with older patients, tailor your language to be more relatable. Instead of saying, “I plan my dentistry to age 100,” say, “I want this to last well into your eighties or nineties.” This makes the conversation more personal and realistic, helping patients better connect with the concept of long-term outcomes. Key Takeaways Understanding the limitations of implants compared to natural teeth is vital. Medical history significantly impacts dental treatment decisions. Managing patient expectations is crucial for satisfaction. Palliative endodontics can provide temporary relief and management. Reading and interpreting CBCT scans requires skill and experience. If it's not that five millimeter defect, it's up to you. The second molar is a good one because often second molars can't be replaced with an implant. Retaining roots is definitely a good way to go. You need to risk assess the patient before extraction. Palliative endo is technically always an option. Success in endo can be often difficult to achieve. Asymptomatic and functional is a good criteria. If endo is on the table, it's feasible. Highlights of this episode: 00:00 Teaser 00:35 Introduction 01:48 Protrusive Dental Pearl 04:15 Interview with Dr. Omar Ikram: Philosophy and Growth 10:17 Endodontics vs. Implants: Treatment Planning 16:35 Antidepressants and Dental Implant Failure 19:37 Managing External Cervical Resorption (ECR) 22:30 Patient Communication 24:16 Cracks and Complications in Endodontics 29:12 Endodontic Protocol 30:50 Challenges with CBCT and Cracks 32:07 Second Molars: Retain or Extract? 35:05 Retaining Roots for Future Implants 36:21 Root Burial and Special Cases 40:08 Root Amputation: A Niche Solution 40:57 Key Signs to Rethink Root Canal Treatment 43:17 Cracked Teeth: Poor Prognosis 47:08 Stained Crack Tooth 50:19 Success vs. Survival in Endodontics 56:02 Final Thoughts and Upcoming Events Want to sharpen your endo game even further? Watch Stop Being Slow at Root Canals! Efficient RCTs with Dr Omar Ikram – PDP163 Check out Specialist Endo Crows Nest — led by Dr. Omar Ikram, offering expert care, hands-on courses, and practical tips for real-world endodontics. This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes A and C. AGD Subject Code: 070 ENDODONTICS (Endodontic diagnosis) Aim: To help clinicians develop a deeper understanding of when to preserve a tooth through endodontic treatment versus when to consider extraction and implant placement. Dentists will be able to - Identify key red flags that may contraindicate definitive root canal treatment. Understand the concept of palliative endodontics and how it can be used to delay or defer implant placement responsibly. Recognize the value of retained roots in maintaining alveolar bone, particularly in medically compromised or high-risk patients. #PDPMainEpisodes #EndoRestorative #BreadandButterDentistry

Is Practice Ownership worth the stress?  What's the most difficult thing you have to do as a practice owner?  Thinking about starting your own squat practice? How long does it really take before you see profit, and what sacrifices do you need to make along the way? In this episode, Jaz is joined by Dr. Shabnam Zai to unpack the real highs and lows of running a dental practice. From the loss of control as an associate, to the resilience needed during COVID, to the challenges of leadership and managing a team—nothing is sugar-coated here. They also tackle the big money question: when does a squat practice finally become profitable, and is it worth the grind in those first few years? If you've ever wondered whether practice ownership is for you—or why it might not be—this episode will give you the clarity (and reality check) you need. https://youtu.be/Tf1bgOWMA2A Watch PDP237 on Youtube Protrusive Dental Pearl: “DO NOT COMPARE YOUR WORK TO WHAT YOU SEE ON SOCIAL MEDIA” Most cases shown online are the very best results, done under perfect conditions by clinicians with thousands of hours of experience.  Instead of letting that trigger self-doubt or imposter syndrome, use it as inspiration: respect it, aspire toward it, and occasionally achieve it — but remember that real-world dentistry is different. Key Takeaways Engagement in work is crucial for job satisfaction. Time management is essential for balancing work and family. Marketing and patient relationships are vital for practice growth. Quality time with family is more important than quantity. Coaching can help surface potential and provide accountability. Delegation is essential for effective practice management. Vulnerability can arise unexpectedly in practice ownership. Managing people requires empathy and clear communication. Being an associate can be fulfilling and offers flexibility. It's important to have projects outside of dentistry. Balancing family life with practice ownership is challenging but possible. Financial planning is crucial before starting a practice. Understanding your priorities helps in making career decisions. Documenting staff performance is key to effective management. Continuous learning and self-improvement are vital for success. Highlights of this episode: 0000 Teaser 00:25 Intro 06:10: Guest Introduction – Dr. Shabnam Zai 08:38 Journey into Dentistry and Practice Ownership 15:08 Practice Philosophy and Security 16:33 Decision Making and Growth 19:10 Hardest Part of Being a Practice Owner 24:30 Balancing Parenthood and Dentistry 26:10 Coaching and Supporting Others 30:44 Compliance and Personality Types 34:15 Compliance and Personality Types 35:55 Navigating Career Vulnerability During COVID-19 37:06 The Importance of Self-Awareness and Managing People 40:07 The Forever Associate Trend 43:01 Projects vs Goals 48:33 Balancing Parenthood and Professional Growth 50:47 Financial Considerations for Starting a Practice 59:05 Final Thoughts and Mentorship Opportunities 59:42 Outro Enjoyed this episode? You might also like Treatment Co-Ordinators – Are They Right For Your Practice? – IC043 #PDPMainEpisodes #CareerDevelopment #BeyondDentistry Connect with Dr. Shabnam:Website → shabnamzai.comInstagram → @drshabnamzai This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes: B: Effective management of self and working with others in the dental team. AGD Subject Code: 550 PRACTICE MANAGEMENT AND HUMAN RELATIONS Aim: To provide dentists with an honest, practical insight into practice ownership—particularly squat practices—covering the challenges, rewards, financial realities, and mindset shifts needed for success. Dentists will be able to - Explain the main motivations for becoming a practice owner versus remaining an associate. 2.

Are you living your career by design—or just letting it happen to you? Do you know what your ideal day as a dentist looks like? What about your ideal week? In this episode, Jaz is joined by Dr. Andrea Ogden to explore how you can design a career—and a life—in dentistry that feels purposeful and fulfilling. They dive into why many of us get stuck on autopilot, chasing goals we've never truly chosen, and how to break free by aligning work with your values.  Andrea also shares practical techniques to help you fall back in love with dentistry, so you can build a career that energises you—inside and outside the surgery. https://youtu.be/XDxlUFeEpbw Watch IC060 on Youtube Need to Read it? Check out the Full Episode Transcript below! Highlights of this episode: 00:00 Teaser 00:21 Introduction 04:49 Guest Introduction – Dr. Andrea Ogden 06:05  Andrea's Journey in Dentistry 08:51 Pivotal Moments in Dentistry 14:51 Trial and Error in Career Development 15:51 Current Role 16:59 Identifying Strengths vs. Enjoyment in Dentistry 18:18 Challenges for Young Dentists 21:51 The Importance of Career Awareness 24:05 Impact of Social Media 26:57 Understanding the Decline in Dentist Morale 31:51 External Factors Contributing to Stress 35:09 Internal Factors and Cognitive Dissonance 41:17 Practical Steps to Reignite Passion for Dentistry 47:32 Resilience Through Adaptation 48:59 Community and Support Networks 51:46 Enjoying the Journey 56:30 Outro Key Takeaways:  Dentistry is more than fillings and crown preps—it's a career you can shape to truly excite you. Choose Variety & Joy – Build a mix of roles that energise you, not just ones you're good at. Ditch the Comparison Game – Your journey is unique; stop measuring it against 15-year veterans on Instagram. Guard Your Values – Burnout often comes from a mismatch between what you believe in and where you work. Align the two. Create Space to Reflect – Slow down, think, and use SMART goals to plan your next step.  Find Your Tribe – Mentors, colleagues, and community will keep you inspired and resilient. Celebrate the Wins – Small or big, they're proof you're moving forward. Loved this conversation? You'll also enjoy Passion and Values in Dentistry – PDP014 #CareerDevelopment #InterferenceCast #BreadandButterDentistry This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes  B: Effective management of self and working with others in the dental team. C: Maintenance and development of knowledge and skills within your field of practice. D: Maintenance of skills, behaviours and attitudes which maintain patient confidence in you and the dental profession, and put patients' interests first.  AGD Subject Code: 770 – Practice Management and Human Relations Aim: To provide dentists with strategies, insights, and practical steps to rekindle passion for dentistry, align their work with personal values, and develop sustainable career satisfaction. Dentists will be able to - 1. Identify personal values and career drivers that contribute to long-term job satisfaction. 2. Recognise common stressors affecting dental morale and their underlying causes. 3. Apply structured decision-making frameworks (e.g., SMART goals) to career planning. Click below for full episode transcript: Teaser: There's a definite difference between doing more of something or because you are good at it and doing more of something because you enjoy it. You know your values are a compass. As to, you know, where you are gonna go in, in, in life. I think if you are listening to this conversation and you are really struggling, is that the first thing you need to do is you, Jaz's Introduction:Hello Protruserati. I'm Jaz Gulati and welcome back to your favorite Dental podcast. This is the interference cast, like the nonclinical arm,

Is gold really dead or making a comeback 2025? Are zirconia and biomimetic dentistry sounding the final bell for precious metal restorations? Is there still a place for gold in modern practice—and when is it actually the best option? Dr. Lane Ochi joins Jaz for a rare live podcast episode to unpack the current and future role of gold restorations. From skyrocketing costs and lost lab skills, to emerging alternatives like milled cobalt chrome, this episode covers everything you wish dental school taught about gold. They even dive into clever tricks for temporizing gold and discuss the surprising lab workaround that may save your patient money—without compromising function. https://youtu.be/QWhY2_Oghd0 Watch PDP236 on Youtube Protrusive Dental Pearl: You can achieve profound anesthesia for lower molars—including cracked, heavily worn ones—using Articaine buccal infiltrations instead of an ID block, even in dense bone cases.

Can you apply the Dahl technique to localised POSTERIOR wear? Spoiler alert: hell yeah! How can the Dahl Technique help when there is posterior wear and NO space to restore? How predictable is building up posterior teeth (rather than the usual worn anteriors)? In this episode, Jaz dives into the ‘Reverse Dahl Technique', a twist on the classic method typically used for localized anterior wear. Dr. Hans Kristian Ognedal from Norway shares his insights, explaining how building up posterior teeth with composite can lead to occlusion magic!  If you're curious about this technique and want to see a real-life case study, this episode breaks it all down, with a special visual breakdown for those watching on YouTube or Protrusive Guidance. https://youtu.be/V8MTFfXmdlw Watch PDP235 on Youtube Protrusive Dental Pearl: Jaz shares insights from Hold On to Your Kids by Dr. Gordon Neufeld & Dr. Gabor Maté, emphasizing how modern children lose parental attachment too soon, turning to peers for guidance. This shift can lead to anxiety and emotional disconnection.  Takeaway: Kids thrive when their primary attachment remains with parents, not peers. Strengthening this bond is crucial for healthy development.  Key Takeaways The traditional Dahl principle focuses on creating occlusal space for anterior crowns. The reverse Dahl technique is a direct method for treating worn POSTERIOR teeth. Diet plays a significant role in tooth wear and dental health. Taking photographs of patients' teeth can help track wear over time. Understanding the etiology of tooth wear is crucial for effective treatment. Building up dental anatomy is essential for successful restorations. Occlusion should be viewed as a dynamic system rather than a static one.  Patients can adapt well to this treatment modality “Patients that wear their teeth, they don't usually have TMJ problems.” Highlights of this episode: 02:22  Protrusive Dental Pearl 04:50 Guest Introduction: Dr. Hans Kristian Ognedal 07:06 Understanding the Original Dahl Concept 09:31 Exploring Reverse Dahl Technique 13:30 Etiology and Patterns of Tooth Wear 23:46 Facial Patterns and Occlusal Traits Linked to Wear 24:44 Clinical Approach to Posterior Wear 30:26 Patient Comfort and Staging Treatments 32:11 Cuspal Planes and Guidance 34:21 Review Schedule and Observations 38:44 Longevity of Treatments 44:04 Contraindications and Patient Selection  45:24 Case Studies and Practical Tips 49:30 Night Guard Use 53:06 Final Thoughts and Education Opportunities If you want to learn more about Dahl Technique, be sure to listen/watch: Why do some Dentists find Dahl Distasteful? – PDP016 Dahl Part 2 (The Spicy Bit) – PDP017 Dahl Technique and ‘Maryland Bridges' – GF001 This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes B and C. AGD Subject Code: 180 OCCLUSION (Occlusal functional concepts) Aim: To explore and understand the Reverse Dahl Technique, focusing on its application for patients with localized posterior tooth wear. This technique provides a solution when posterior teeth are worn, and there is insufficient space for proper restoration. Dentists will be able to - 1. Understand the principles behind the Reverse Dahl Technique and how it differs from the traditional Dahl Technique. 2. Identify the clinical scenarios where the Reverse Dahl Technique can be applied. 3. Comprehend the role of composite build-up in restoring posterior wear and its impact on occlusal reestablishment.

Do you feel confident managing patients with TMD or oro-facial pain? Are you clear on when to treat conservatively—and when to escalate? What's the best SEQUENCE of care for TMD patients? Emma returns to Protrusive Students fresh from her finals, joining Jaz for an insightful episode on the basics of TMD management. Together, they explore the foundational steps of TMD care, from proper diagnosis to the logic behind a structured treatment hierarchy. They break down conservative versus aggressive approaches, share clinical tips for muscle and joint assessment, and highlight common mistakes to avoid—especially during palpation and history taking. Whether you're a student, a dentist returning to practice, or just want a refresher on TMD, this episode will help solidify your approach and boost your clinical confidence. https://youtu.be/p5VJzwSka94 Watch PS016 on Youtube Key Takeaways TMD is a complex topic with various treatment approaches. Patient education is crucial in managing TMD effectively. Physiotherapy can significantly aid in TMD treatment. Different splints serve different purposes in TMD management. Bruxism can be a silent issue that affects many patients. Identifying the source of pain is essential for effective treatment. Stress can exacerbate TMD symptoms in patient cohorts Continuous learning and resources are vital for dental professionals. Highlights of this episode: 02:35 Emma's Finals Experience and Advice 05:16 Deep Dive into TMD: Clinical Insights 09:59 Common TMD Disorders and Their Presentation 18:31 TMD Treatment Options 28:00 Medications and Appliance Therapy 34:25 Practical Tips for Managing TMD 37:19 Addressing Bruxism and Patient Communication 41:00 Protrusive Pathways and Future Plans 43:46 Protrusive Students S2

Have you heard of Photobiomodulation (PBM)? Or are you thinking... ‘photo-what?!' Is red light therapy just voodoo science—or is it already part of mainstream healthcare? Can PBM really help with wound healing, pain relief, and even reduce the risk of dementia? In this episode, Professor Praveen Arany joins Jaz Gulati to break down the science and clinical relevance of PBM in dentistry. They explore how this light-based therapy works, its applications in managing oral lesions, and why it's already standard care for cancer patients undergoing chemotherapy. They also discuss real-world cases, practical protocols, and how PBM could shape the future of dental care. Whether you're a skeptic or just curious, this episode will open your eyes to an emerging and evidence-based treatment modality. https://youtu.be/lQrawr3-YQA Watch PDP234 on YouTube Protrusive Dental Pearl: SHEEP Scoring as a practical tool to assess the prognosis and restorability of compromised teeth.

Should you be re-treating that root canal—or referring it out? What are the red flags that scream “specialist only”? How do you confidently remove GP without compromising disinfection? Dr. Ayman Al-Sibassi joins Jaz in this endo-packed episode to help you navigate the tricky world of root canal re-treatments. From solvent selection and GP removal techniques to assessing case difficulty, they break down everything a GDP needs to know to make smart, confident decisions. You'll learn how to spot the cases you should be tackling, which ones to send to your endodontist, and what tools and techniques will make the re-treatment process smoother and safer. Because not all re-treatments are created equal—and some are surprisingly simple once you know what to look for. https://www.youtube.com/watch?v=apMtcuNTLqI Watch PDP233 on YouTube Protrusive Dental Pearl: A crack in a bonded ceramic restoration isn't necessarily a failure! Just like we accept cracks in natural enamel, we can also accept cracks in ceramics—as long as it's been properly bonded. Shoutout to Dr. Pascal Magne for this powerful mindset shift! Need to Read it? Check out the Full Episode Transcript below! Key Takeaways Specialist training in endodontics includes a variety of surgical skills. The complexity of root canal retreatments varies significantly. General dentists can perform some retreatments, but should assess complexity carefully. Patient consent is essential, especially regarding potential unrestorability. Communication about fees should be clear and upfront with patients. Red flags for retreatment include poor coronal seal and previous treatment quality. CBCT imaging is becoming increasingly important in endodontic practice. Collaboration between general dentists and specialists enhances patient outcomes. Many referrals stem from straightforward cases that are poorly managed. Using solvents can aid in GP removal but should be approached cautiously. Single visit treatments are often preferred for patient convenience. Adequate disinfection is crucial, sometimes necessitating a second visit. The survival rate of root canal-treated teeth is comparable to implants. Patient age and overall health should guide treatment decisions. Understanding the difference between success and survival in endodontics is essential. Highlights of this episode: 00:00 Introduction 05:02 — Protrusive Dental Pearl: Cracks in enamel vs. dentine  06:34 — Guest Introduction: Dr. Ayman Al-Sibassi and his journey into Endo  11:03 Assessing the complexity of re-treatments and when to refer 15:21 The role of CBCT in diagnosis and treatment planning 17:47 Ethical and financial dilemmas: charging for unrestorable teeth 22:05 Red flags in root canal re-treatments 34:55 Techniques for GP removal and file selection 47:07 Cost vs. predictability: re-treatment vs. implants and long-term outcomes Take a look at this Endodontic Complexity Assessment Tool to help you evaluate how challenging a root canal case really is. If you enjoyed this episode, you'll definitely want to check out: Stop Being Slow at Root Canals! Efficient RCTs with Dr. Omar Ikram – PDP163 This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes B and C. AGD Subject Code: 070 ENDODONTICS (Non-surgical treatment)  #PDPMainEpisodes #EndoRestorative Aim: To provide clinicians with a structured approach to diagnosing, planning, and executing simple Re-Root Canal Treatments (Re-RCTs), while recognizing case limitations and improving treatment outcomes. Dentists will be able to: Identify clinical situations where Re-RCT is appropriate and distinguish them from cases requiring referral or alternative treatment. Describe the potential challenges such as canal blockages, separated instruments, or apical complications, and know when to refer.

Are you confident when increasing the vertical dimension? How do you plan, stage, and sequence a full-mouth case safely? What's the right deprogramming method—leaf gauge, Kois appliance, or something else? Dr. David Bloom joins Jaz in this powerhouse episode to demystify the real-world process of increasing vertical dimension. With decades of experience in comprehensive dentistry, David shares how he approaches diagnosis, bite records, temporization, and final restorations—with predictability and confidence. https://youtu.be/gAaP0VYP84s Watch PDP232 on YouTube Protrusive Dental Pearl: Pick one occlusal philosophy and stick with it until you understand it well through real cases. Once you're confident, stay open to other approaches—hearing different views will make you smarter, more flexible, and a better dentist. If you are looking to get started with the foundations of Occlusion, check out our comprehensive Online Occlusion Course. Highlights of this episode: 00:00 Trailer 00:55 Introduction 04:43 Guest Introduction: Dr. David Bloom 10:25 Equilibration Techniques Explained 11:18  Interjection #1 15:50  Opening Vertical Dimension vs. Orthodontics 18:06 Interjection #2 23:05 Whitening and Restorative Solutions 25:27 Guidelines for Raising Vertical Dimension 25:52 Interjection #3 29:28 Midroll 32:49 Guidelines for Raising Vertical Dimension 36:06 Visual Try-In and Adapting Vertical Dimension 40:16 Case Planning and Execution 41:16 Interjection #4 43:42 Case Planning and Execution 50:23 Material Preference for Provisionals 52:00 Bite Registration and Final Adjustments 55:06 Do's and Don'ts for Clinicians 57:15 Conclusion and Resources 58:59 Outro Key Takeaways Vertical Dimension and Adaptation: Opening the vertical dimension in dentistry can be challenging, especially for edentulous patients who lack proprioception. However, with proper planning and understanding of occlusion, the human body can adapt remarkably well. Occlusal Philosophy: It's important to learn one occlusal philosophy well, whether it's Kois, Dawson, or another. Understanding different approaches can make you a more rounded clinician, as different patients may benefit from different methods. Equilibration and Deprogramming: Equilibration is crucial for idealizing occlusion by eliminating interferences. Deprogramming helps in achieving centric relation, a stable and repeatable position for the condyles, which is essential for successful equilibration. Orthodontics vs. Vertical Dimension: Deciding between orthodontics and opening the vertical dimension depends on the specific case. For example, pre-aligning patients with orthodontics might be necessary to address a restricted envelope of function. Testing and Adaptation: Testing the vertical dimension with transitional materials like composite can help patients adapt before moving to definitive restorations. Experienced clinicians may sometimes proceed directly to final restorations based on their judgment and diagnostic steps. Get CE/CPD for this episode only on the Protrusive Guidance App.

How do you manage patients that have ultra high expectations? What's the best way to communicate cosmetic outcomes before the final result? How do you balance your aesthetic vision with what they see? Dr. Brandon Mack joins Jaz for a deep dive into the realities of cosmetic dentistry—from subjective perceptions of beauty to practical tips that make or break a case. They discuss how to navigate aesthetic stress, manage patient expectations, and even go into Brandon's favorite veneer cement and occlusal philosophy. Plus, Brandon shares key failures that shaped his journey—and how you can avoid the same pitfalls. https://youtu.be/s7puDNP3d7U Watch PDP231 on YouTube Protrusive Dental Pearl: When discussing smile design with patients, especially in high-end cosmetic cases, set the right expectations early by using this memorable “Eyebrow Analogy”: Central incisors = Twins (they should be as symmetrical as possible) Lateral incisors = Sisters (not identical, but related) Canines = Cousins (more individual) This helps patients understand that perfect symmetry isn't always natural or necessary — especially for lateral incisors! Key Takeaways Cosmetic dentistry as a lens through which all treatment should be approached—balancing patient autonomy with ethical care. Managing expectations begins before the patient sits in the chair. It continues through structured checkpoints: from initial consultation to provisional feedback and final delivery. Temps aren't just placeholders—they are test drives. They align expectations between the dentist, patient, and lab, reducing surprises and improving satisfaction. Some dentists may under-diagnose due to fear of rejection—not out of true minimalism. Thoughtful planning can make “more treatment” actually less invasive. Patients often want teeth that are both ultra-white and natural-looking. Brandon developed the concept of believability—a visual balance that delivers a wow-factor while still appearing real. Creating a mathematically perfect smile can make natural facial asymmetries more obvious. Dentists must weigh beauty against harmony. Social media and filters have distorted patient self-perception. Dentists must learn to identify signs of body or tooth dysmorphia and respond ethically—not just clinically. Building relationships with ceramists over time—expecting 15–20 cases before finding synergy. Each technician has unique strengths and should be matched accordingly. Composite veneers are accessible and beautiful—but extremely technique-sensitive. You become the ceramist. Brandon admires them but uses them selectively due to long-term maintenance concerns. Panavia Veneer Cement – Translucent for its predictable handling, strength, and minimal risk to thin ceramic restorations. Highlights of this episode: 01:35  Protrusive Dental Pearl 03:11 Dr. Brandon Mack's Journey and Philosophy 09:19 Managing Patient Expectations in Cosmetic Dentistry 14:23 Choosing the Right Technician 21:13 “Undersell and Overdeliver” Philosophy 25:12 Conservatism in Cosmetic Dentistry 26:48 Overcoming Failures 33:15 Body Dysmorphia in Dentistry 37:28 Occlusal Philosophy and Techniques 38:30 Fake It Till You Make It? 40:38 Veneer Cement  42:07 Composite Veneers 44:17 Upcoming London Event and Final Thoughts

We use articulators to help ‘mimic' our patient's jaw movements, to ultimately do less adjustments/revisions in the future. But are digital articulators there yet? Or is analog king? Or is digital dentistry just flashy tech with no real-world benefits? Can a virtual articulator truly match the movements of your patient's jaw? Is a CBCT really better than a facebow—and WHEN should you use which? In this cutting-edge episode with Dr. Seth Atkins, we dive into the world of digital articulation—exploring how tools like virtual articulators, CBCT alignment, and 3D-printed provisionals are transforming clinical workflows. You'll learn how to combine analog wisdom with digital precision, improve lab communication, and make full-mouth rehabs more predictable and efficient than ever. From mounting accuracy to motion capture, this episode is your ultimate guide to articulating smarter in the digital age. https://www.youtube.com/watch?v=fT31Ecf_kDo Watch PDP230 on YouTube Protrusive Dental Pearl: Always send your lab the color version of your digital scan — the PLY file — not just the STL. STL shows shape, but PLY shows color — like markings and tissue detail. Ask your lab: "Are you seeing color, or do you need the PLY?" Better scans = better results Need to Read it? Check out the Full Episode Transcript below! Key Takeaways: Digital methods can enhance accuracy and patient outcomes → but only when used intentionally. Understanding both analog and digital techniques is crucial → they complement each other, not compete. Mentorship plays a significant role in advancing dental education → experience accelerates clinical confidence. Digital workflows can significantly reduce chair time → and improve patient comfort in the process. The integration of CBCT with digital workflows enhances diagnostics → giving clearer insight into static and functional relationships. Digital provisionals offer a cost-effective and efficient solution → saving time, money, and frustration for both dentist and patient. Axiography is essential for capturing patient motion accurately → because real movement matters more than assumptions. Highlights of the Episode: 00:00 Introduction 04:00  Protrusive Dental Pearl 05:32 Interview with Dr. Seth Atkins and his Journey into Digital Dentistry 08:06 The Evolution of Digital Articulation 13:38 Digital Workflow and Mentorship 20:01 Accuracy and Efficiency in Digital Dentistry 22:32 Static and Dynamic Relations in Digital Dentistry 31:01 Interjection 1 36:05 Practical Guidelines on Integrating CBCT 37:15 Interjection 2  40:59 Clinical Observations in Dental Rehabilitation 42:29 Interjection 3  45:21 Introduction to Axiography 46:40 Advancements in Digital Dentistry 49:33 3D Printing in Dental Practice 53:31 Motion Tracking on Digital Articulators 57:30 Cost Efficiency of Digital Tools 01:01:10 Alternatives to CBCT 01:05:52 Involvement with AES and Future Plans Check out the study mentioned: "Comparison of the accuracy of a cone beam computed tomography-based virtual mounting technique with that of the conventional mounting technique using facebow"

Are you considering the airway in your treatment planning? Could centric relation (CR) be compromising your patient's breathing? When you open the vertical dimension, are you making the airway better—or worse? Welcome to another AES 2026 series episode, this time with LEGEND Dr. Jeff Rouse as he joins Jaz in this eye-opening episode to explore how airway, aesthetics, and function are deeply interconnected—especially in prosthodontics. They discuss key clinical scenarios like vertical dimension changes, examining how your choices may impact the airway—sometimes in ways you didn't expect. With practical insights and examples, this episode will help you make smarter, airway-conscious decisions that elevate both your functional and aesthetic outcomes. https://youtu.be/-Ut-qme7Vcg Watch PDP229 on Youtube Protrusive Dental Pearl: Plan your breaks 12 months in advance to avoid burnout and ensure quality time with your loved ones. Prioritize rest and connection before reaching exhaustion—your body, mind, and heart will thank you. Key Takeaways Airway health is crucial in dentistry, impacting aesthetics and function. Understanding airway issues can lead to better treatment outcomes for patients. Breastfeeding plays a significant role in childhood development and airway health. Interdisciplinary approaches are essential for effective adult treatment. Aesthetics and function are key factors in airway prosthodontics. Most patients are unaware of their airway issues until they are addressed. Early intervention in childhood can prevent future airway problems. Combining orthodontics and prosthodontics can enhance patient care. Airway management is crucial for overall patient health. A great bite is not just about teeth alignment. Pathway wear can indicate deeper dental issues. Vertical dimension changes can negatively impact airway. Understanding joint positions is essential in treatment planning. Continuous education is vital for modern dental practices. Highlights of this patient: 02:22  Protrusive Dental Pearl 04:34 Interview with Dr. Jeff Rouse Begins 09:05 Understanding Airway Prosthodontics 15:58 The Role of Cone Beam CT Scans 17:58 Treating Children and Early Interventions 24:50 Addressing Adult Airway Issues 29:43 Multidisciplinary Approach in Dentistry 31:46 Patient Transformations and Airway Focus 34:42 Understanding Pathway Wear 41:32 Impact of Vertical Dimension on Airway 48:55 Exploring Different Occlusion Philosophies 51:34 A Sneak Peek at AES 2026: Dental Wear Patterns Of The Airway Patient 55:25 Upcoming Events and Resources Explore the world of sleep disordered breathing with Prof. Ama Johal in PDP033: "Airway – Dentistry's Elephant in the Room."

Have you actually looked back at your long-term cases to see how layering compares to injection moulding? Is traditional freehand layering still your go-to for anterior composite aesthetics? Are you using it because it gives the best result — or just because that's how you were trained? In this episode, Dr. Marco Maiolino joins Jaz Gulati for a meaty discussion about injection moulding—a technique that's changing the game in anterior composites (and posterior!) This isn't about trends. It's about clinical outcomes. We've all admired the beauty of layered composites—translucency, halo, the “natural” look. But after 5, 7, or even 10 years... do they hold up? Dr. Maiolino brings over a decade of follow-up data—and the results might surprise you. https://youtu.be/wHs8QQkgPhU Watch PDP228 on Youtube Protrusive Dental Pearl When in doubt between two shades (e.g., A1 vs. A2), always choose the lighter shade. Higher-value shades blend better and result in higher patient satisfaction. Techniques: Use the composite button method and black-and-white photography to objectively evaluate shade blending. Outcome: Lighter shades minimize the risk of patient dissatisfaction and rework.

Should we really restore primary molars without local anaesthetic or injections? When should we start taking radiographs for child patients? Is it time to say goodbye to traditional anterior strip crowns and embrace preformed zirconia crowns? And seriously - how do you get a wiggly, fidgety child to sit still long enough for a solid restoration?! The secret lies in choosing a technique that's both quick and effective! In this episode, Dr. Tim Keys unpacks the real challenges of restoring primary teeth, breaking down the pros and cons of popular approaches like the Hall Crown technique, Pediatric Zirconia crowns, and conventional stainless steel crowns (SSCs). Tune in for practical insights to make pediatric crown work less stressful and more successful - helping you find the best fit for your little patients. https://youtu.be/VJm4TFKLXEA Dr. Keys is also involved in dental education and offers courses through his platform, Kids Dental Tips. One of his upcoming courses is titled "Restorative Paediatric Dentistry," a two-day event scheduled to be held in Brisbane. Protrusive Dental Pearl: One of our best ever Protrusive Infographics! This week's Pearl is a handy downloadable PDF infographic summarising the key points from this episode on Children's Crowns Techniques. Grab your copy here! Need to Read it? Check out the Full Episode Transcript below! Key Takeaways: The Hall crown technique is a non-invasive approach to treating pediatric teeth. Radiographs are essential for accurate diagnosis and treatment planning in children. Case selection is crucial for the success of pediatric dental treatments. Zirconia crowns have superior aesthetics over stainless steel crowns. The success rate of intra-coronal fillings in primary molars is lower compared to crowns. Zirconia crowns rarely fracture compared to strip crowns. Mild supra-occlusion is acceptable in pediatric dentistry. Hands-on experience is crucial for mastering crown techniques. Highlights of this episode: 00:00 Introduction 01:32 The Protrusive Dental Pearl 04:19 Dr. Tim Keys 06:26 Work-life balance & parenting 12:05 Hall crowns Vs Zirconia crowns 13:12 Pediatric crowns and caries management 15:40 Failure rates and clinical implications 17:51 Stainless steel crowns: conventional vs Hall technique 21:03 Case selection and radiographs 25:31 Radiographic criteria 27:04 The Hall Technique 29:59 Technique tips 38:00 Zirconia crowns vs strip crowns 46:55 Education, resources, and further learning 51:02 Outro Key Article mentioned in this episode: Effectiveness, Costs and Patient Acceptance of a Conventional and a Biological Treatment Approach for Carious Primary Teeth in Children | Caries Research | Karger Publishers #PDPMainEpisodes #BreadandButterDentistry If you enjoyed this episode, you should check out PDP159 - How to Manage Children in Dental Pain. This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes A and C. AGD Subject Code: 430 Pediatric Dentistry. In this episode, Jaz and Dr. Tim Keys explore practical approaches to restoring pediatric teeth, focusing on the selection, preparation, and placement of direct restorations. They discuss material choices, clinical tips, and how to tailor techniques to improve outcomes and cooperation in young patients. Dentists will be able to: Understand the clinical indications and benefits of various crown techniques used in the restoration of pediatric teeth Recognise the importance of selecting appropriate cementation materials and techniques for different types of direct restorations in children Appreciate the key clinical considerations involved in the preparation and placement of a range of direct restorative techniques in pediatric dentistry https://media.blubrry.com/protrusive/content.blubrry.com/protrusive/PDP227.mp3

How can dentists help kids breathe, sleep, and grow better—even if the problem isn't the teeth? When should you refer, and what tools can you use right now in your practice? In this AES special episode, Jaz Gulati is joined by Dr. Liz Turner and Dr. Meggie Graham—general dentists who have evolved their practice with a deep passion for airway and whole-child health. They walk us through five real patients, including Jaz's own son, to show what airway dentistry looks like in the real world. From growth appliances and myofunctional therapy to inflammation control and ENT collaboration, this episode connects the dots between breathing and behavior, development, and even dental crowding. https://youtu.be/Y6EfufPd98E Watch PDP226 on Youtube Protrusive Dental Pearl: "Don't stay stagnant—keep learning, keep growing, and reinvent yourself every 5–10 years." Think of your dental career in seasons—explore new areas, refine your interests, and let go of what no longer brings you joy. This keeps your passion for dentistry alive and evolving. Need to Read it? Check out the Full Episode Transcript below! Key Takeaways Airway dentistry is a growing field that emphasizes prevention. Understanding airway issues can lead to better health outcomes. Dentists can play a crucial role in optimizing health through airway management. Health optimization is a key focus in modern dentistry. Interdisciplinary collaboration is essential for effective patient care. Functional dentistry addresses the root causes of dental issues. Children's airway health can significantly impact their development. Dentists should feel empowered to make positive changes in their patients' lives. Facial aesthetics can significantly impact self-esteem and health. Nasal breathing is crucial for overall health and well-being. Quality of life can be improved through better patient care. Breastfeeding plays a vital role in a child's development. Addressing sleep issues in children is essential for their growth. Understanding the connection between breathing and systemic health is vital. Highlights of this episode: 02:04  Protrusive Dental Pearl 04:08 Interview with Dr. Liz Turner 06:18 Interview with Dr. Meggie Graham 07:43 Personal Journeys into Airway Dentistry 16:26 ENT Referrals 21:55 Understanding Airway Symptoms and Treatment 26:10 Patient Case Studies and Treatment Approaches 36:46 The Importance of Nasal Breathing 45:30 Pediatric Airway Concerns and Solutions 55:09 Educational Resources and Final Thoughts

Are you still using long-term provisionals just to test OVD? Is an occlusal splint really the best way to assess vertical dimension? Could raising the OVD actually harm your patient? Dr. Lukasz Lassmann joins Jaz and Mahmoud Ibrahim  this AES special episode to challenge conventional thinking around occlusion, vertical dimension, and full mouth rehab. Lukasz shares his unique perspective as a clinician, educator, and researcher, bringing clarity to a topic that often feels murky and divided. They explore real-world questions like managing asymptomatic clicks before ortho, why occlusion alone won't “cure” bruxism, and the number one reason not to raise the vertical without proper understanding. Plus, Lukasz drops an incredible airway assessment tip at the end of the episode! Protrusive Dental Pearl: Use a comprehensive TMD history-taking form to effectively triage patients into urgent (red), moderate (amber), or low-risk (green) categories—this allows you to prioritize care appropriately and build rapport by focusing on examination rather than data collection during the appointment. https://youtu.be/ZhIoUxdMMsg Watch PDP225 on Youtube Download the form: protrusive.co.uk/tmdhistory Download the Patient History Evaluation Form Need to Read it? Check out the Full Episode Transcript below! Takeaways Understanding red flags in TMD patients is essential. Patient history is vital for effective treatment. Phonetics can be unpredictable in dental rehabilitation. Diet and sleep significantly affect TMD management. Gut health is linked to chronic pain conditions. Communication with patients is key to successful outcomes. Bruxism may not be solely caused by occlusion issues. Palpating the lateral pterygoid is often ineffective and painful. Equilibration and centric relation are controversial topics in dentistry. Increasing vertical dimension can exacerbate sleep apnea. Holistic approaches are essential in diagnosing and treating TMD. Not all patients with TMD have malocclusion or attrition. Sleep apnea is increasingly common in younger, slimmer patients. Polygraphy is a useful diagnostic tool for sleep apnea. DISE (drug-induced sleep endoscopy) is a valuable diagnostic procedure. Highlights of this episode: 02:48  Protrusive Dental Pearl 04:37 Lukasz Lassman's Journey and Philosophy 08:11 Debunking Myths About Vertical Dimension 12:10 Patients in the Red Zone 23:15 The Role of Diet and Lifestyle in Facial Pain 31:38 Adapting to New Restorative Methods 34:41 Phonetic Challenges in Dentistry 39:02 The Role of Occlusion in Bruxism 41:18 Palpating Lateral Pterygoid Muscle 43:27 Centric Relation vs. Equilibration Debate 50:07 OVD Red Flag: Airway 01:03:27 Conclusion and Future Events Studies Mentioned:Gut Bless Your Pain—Roles of the Gut Microbiota, Sleep, and Melatonin in Chronic Orofacial Pain and Depression Randomised controlled trial on testing an increased vertical dimension of occlusion prior to restorative treatment of tooth wear

Should You Invest in Chairside Milling or 3D Printing? How do milling and printing compare in durability and cost? Which option provides the best long-term ROI for your workflow? In this deep dive, Dr. Rustom Moopen shares his experience with CEREC, ExoCAD, and in-house fabrication, breaking down the real benefits and limitations of both technologies. From restoration strength to efficiency and investment costs, this episode unpacks what every dentist needs to know before taking the leap into milling, printing, and CAD/CAM workflows. https://youtu.be/fgQnrDfXnqI Watch PDP224 on Youtube Protrusive Dental Pearl: Achieving the same effect (of the ‘Soft Clamp' by Kerr) with a metal clamp without requiring a potentially painful palatal injection - Dr. Jo Cape (Protruserati) suggests using a cotton bud to apply topical anesthetic to the gingiva where the clamp will be placed, leaving it for a minute, improving patient comfort! Key TakeAway: Investing in technology like milling can lead to a measurable ROI. Time management is crucial in dental procedures for efficiency. Milling is a subtractive process, while printing is additive. Mentorship is often more valuable than formal courses. The dental industry is evolving with new technologies. Understanding the nuances of dental procedures can enhance practice. Early adoption of technology can set a practice apart. Milling and printing serve different purposes in dental work. Mock-ups can save time and improve patient satisfaction. Milling offers more reliability than printing for dental applications. The choice between milling and printing depends on personal preference and practice needs. Milled composites have a proven track record of durability. Printed splints may not hold up under heavy use. Investing in milling technology can enhance practice efficiency. Design software plays a crucial role in modern dentistry. Understanding the strengths and weaknesses of each method is essential for success. Investing in dental software can be costly but worthwhile. Learning design software is crucial for modern dentistry. Milling is generally superior to printing for final restorations. Regulatory considerations are important for in-house lab work. Choosing the right milling equipment depends on practice needs. Training and mentorship are essential for mastering dental technology. Highlights of this episode: 03:29 Protrusive Dental Pearl 04:59 Meet Dr. Rustom Moopen: Journey of Learning and Mentorship 09:21 Early Adoption of CAD/CAM Technology 11:54 The Practicalities of Chairside Milling 19:01 Emax Chairside Workflow 23:10 Printing vs. Milling: Understanding the Basics 26:48 Printed Mock-Ups and Workflow Integration 29:43 Comparing Milled and Printed Composites 32:07 The Future of Splints: Milling vs. Printing 35:50 Choices After Scanning a Tooth 37:16 Milling vs. Printing: Pros and Cons 41:11 Design Software and Training 49:28 Practical Applications of 3D Printing 53:42 Investing in Digital Dentistry 55:35 Printed Restorations vs Direct Composite 56:45 Regulatory Concerns 58:31 Investing in Milling Units 01:00:53 Ideal Candidates for Milling 01:03:49 Training and Resources  If you enjoyed this episode, don't miss PDP137 – Q&A with a Dental Technician! #PDPMainEpisodes #BreadandButterDentistry This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes B and C. AGD Subject Code: 130 ELECTIVES (Product/technology training) This episode aimed to provide an in-depth understanding of the fundamentals of 3D printing, milling, and digital dentistry, enabling clinicians to integrate these technologies efficiently into their workflow for improved precision, cost-effectiveness, and patient outcomes. Dentists will be able to - 1. Differentiate between 3D printing and milling,

“Jaz, I don't know which course to take?” “Should I do Aspire Academy, Kois, Chris Orr or Paul Tipton?” (all great courses and legends by the way!) Of course its confusing - there are now more ‘Level 7 Diplomas' than Dentists! There are also lots of biased testimonials - surely they can't ALL be the ‘best course I ever did?', right? So just HOW do you choose the right postgraduate program to elevate your skills?  What mindset helps new grads thrive, especially when they're feeling stuck? This episode shares Lakshmi's decision making as she opted for the RipeGlobal Fellowship. Lakshmi's journey is a perfect example of how the right mindset and a strategic approach to education can transform your dental career. Jaz and Lakshmi discuss her experience of choosing the right course, enrolling in the Ripe Global Restorative Fellowship, and the challenges she faced along the way.   They also talk through the importance of ongoing learning, the impact of mentorship, and how Lakshmi's mindset shift helped her grow as a dentist. Whether you're a new grad or seasoned dentist looking to upskill, Lakshmi's story will inspire you to take control of your career growth and make the most of every opportunity. https://youtu.be/waC_kQJhcio Watch IC059 on Youtube Book a free video consultation with the RipeGlobal Team to see if this course is right for you: protrusive.co.uk/RGdiscount This is an affiliate link that gets you 20% OFF if you enrol - but you first need to discover if it's the right course for you (it involves treating a manikin in your own clinic!) Key Takeaways: Hands-on experience is crucial for building confidence in clinical skills. Finding the right practice is important for professional growth. Investing in continuing education is vital for skill enhancement. Mentorship plays a vital role in navigating early career challenges. A supportive team can significantly impact a dentist's experience. Understanding one's learning style is key to effective training. Practical learning enhances engagement and application in real scenarios. Balancing time commitments is essential for managing a demanding course load. Choosing a course that aligns with one's career goals is vital for success. Maintaining a passion for one's work contributes to success. It's important to reflect on personal growth and set achievable goals. The journey in dentistry is not linear; expect ups and downs. Highlights for this episode: 02:29 Lakshmi's Journey and Dental School Experience 06:45 First Year as a Dentist 12:01 Finding the Right Practice 19:49 Considering Advanced Courses 25:36 Choosing RIPE Global Fellowship 29:21 Lakshmi's Hands-On Experience with Ripe Global 37:40 Challenges and Growth in the Fellowship 42:37 Balancing Life and Professional Growth 52:57 Mentorship and Personal Development 54:41  Future Aspirations and Final Reflections This is a non-clinical episode without CPD. For CPD or CE credits, visit the Protrusive Guidance app—hundreds of hours and mini-courses await! Stay up-to-date with Dr. Lakshmi's valuable content and expert advice! Follow her on Instagram! If you loved this episode, be sure to check out another epic episode - Non-Clinical Growth for the Busy Dentist (Your Health, Relationships, and Business) – IC023 #InterferenceCast #CareerDevelopment #BreadandButterDentistry

Which imaging techniques should you prioritize for TMD patients? Does a panoramic radiograph hold any value?  When should you consider taking a CBCT of the joints instead? How about an MRI scan for the TMJ? Dr. Dania Tamimi joins Jaz for the first AES 2026 Takeover episode, diving deep into the complexities of TMD diagnosis and TMJ Imaging. They break down the key imaging techniques, how to use them effectively, and the importance of accurate reports in patient care. They also discuss key strategies for making sense of MRIs and CBCTs, highlighting how the quality of reports can significantly impact patient care and diagnosis. Understanding these concepts early can make all the difference in effectively managing TMD cases. https://youtu.be/NBCdqhs5oNY Watch PDP223 on Youtube Protrusive Dental Pearl: Don't lose touch with the magic of in-person learning — balance online education with attending live conferences to connect with peers, meet mentors, and experience the true essence of dentistry! Join us in Chicago AES 2026 where Jaz and Mahmoud will also be speaking among superstars such as Jeff Rouse and Lukasz Lassmann! Need to Read it? Check out the Full Episode Transcript below! Key Takeaways: Imaging should follow clinical diagnosis → not replace it. Every imaging modality answers different questions; choose wisely. TMJ disorders affect more than the jaw → they influence face, airway, growth, posture. Think beyond replacing teeth → treatment should serve function, not just fill space. Avoid “satisfaction of search error” → finding one problem shouldn't stop broader evaluation. Highlights of this episode: 02:52  Protrusive Dental Pearl 06:01 Meet Dr. Dania Tamimi 09:04 Understanding TMJ Imaging 16:00 TMJ Soft Tissue Anatomy  21:04 The Miracle Joint: TMJ Self-Repair 24:26 The Role of Imaging in TMJ Diagnosis 28:15 Acquiring Panoramic Images 39:35 Guidelines for Using Different Imaging Techniques 41:26 Case Study: Misdiagnosis and Its Consequences 45:46 Balancing Clinical Diagnosis and Imaging 50:17 Role of Imaging in Orthodontics 53:18 The Importance of Accurate MRI Reporting 58:27 Final Thoughts on Imaging and Diagnosis 01:00:54 Upcoming Events and Learning Opportunities

Why do some patients struggle with anesthesia, requiring multiple cartridges just to get numb? Could your TMD patients have an underlying systemic condition that's been missed? Are you overlooking the signs of a connective tissue disorder? https://youtu.be/gaoJKPTV_Z0 Watch PDP222 on Youtube ”When you can't connect the issue, think connective tissue!” Dr. Audrey Kershaw joins Jaz for a fascinating deep dive into the world of connective tissue disorders and their hidden impact on dentistry. Together, they explore how hypermobility, unexplained joint issues, and even a history of spontaneous injuries could be key indicators of an underlying disorder. They also break down why dentists play a crucial role in screening and identifying these conditions, ensuring better patient outcomes and a more holistic approach to care. Because sometimes, when things don't seem connected… they actually are. Protrusive Dental Pearl: Don't just take a "relevant" medical history—take a comprehensive one! Encourage patients to share all health issues, even those they don't think relate to dentistry. You might uncover important clues about conditions like connective tissue disorders or sleep-disordered breathing, leading to better care and stronger patient trust. Key Take-aways Ehlers-Danlos Syndrome is often misunderstood and underdiagnosed. Patients with connective tissue disorders often face skepticism from healthcare providers. POTS is a common condition associated with EDS that affects blood pressure regulation. Many TMD patients may have undiagnosed connective tissue disorders. Awareness and education about EDS are crucial for better patient outcomes. The healthcare system can be challenging for patients seeking diagnoses. Research on local anesthetic effectiveness in EDS patients is lacking. Personal experiences can help in understanding and diagnosing connective tissue disorders. Collaboration between healthcare professionals is essential for patient care. Genetic testing is crucial for diagnosing rare types of Ehlers-Danlos. Dental professionals should be aware of the signs of connective tissue disorders. Diagnosis can empower patients to understand their health better. Holistic care is vital in managing symptoms associated with EDS and TMD. Medical histories should be seen as relevant in dental practice. Highlights of this episode: 02:17 Protrusive Dental Pearl 04:21  Dr. Audrey Kershaw's Journey and Insights 09:45 Personal Experiences and Professional Observations 11:55 Diagnosis and Management of Connective Tissue Disorders 13:31 POTS (Postural Orthostatic Tachycardia Syndrome) 15:30 Understanding Ehlers-Danlos Syndrome (EDS) 24:55 Hypermobile EDS and the Need for Awareness 27:53 International Consortium of EDS GP Checklist 28:34 Genetic Testing and Red Flags 31:44 The Role of Dentists in Identifying EDS 40:32 Journey to Diagnosis 43:47 The Value of a Diagnosis 48:43 Dental Implications of EDS 55:00 Final Thoughts and Resources "If you know one case of EDS, you only know one. Every case is different. Many are severely debilitated, unable to work or carry out daily tasks, often denying their struggles after years of being dismissed." - Dr. Audrey Kershaw Promised Resources Podcast Recommendation: Linda Blustein's Podcast (about POTS and connective tissue disorders) Specialists & Research: Dr. Alan Hakim – A specialist in Ehlers-Danlos Syndrome (EDS) research based in London. Norris Lab (U.S.) – Researching genetic markers for hEDS Local Anesthesia Information Resources for Screening & Diagnosis:  Diagnostic Criteria for Hypermobile Ehlers-Danlos SyndromeDownload 5-part-questionnaire-for-hypermobilityDownload Symptomatic Joint-Hypermobility GuideDownload Red Flag PatientsDownload Educational Conferences & Talks: Scottish Dental Show – Audrey is involved in raising awaren...

Can composite really outperform ceramic in the right case? Do you know when to choose an inlay over an onlay? What makes occlusal veneers so effective — even at just 0.6 mm thickness? After years of anticipation, Dr. Pascal Magne finally joins Jaz Gulati on the podcast for an episode packed with adhesive dentistry gold. They dive deep into occlusal veneers, material selection, and why indirect composite may be the best-kept secret for worn, root-filled molars. They also unpack the full bonding protocol step-by-step—from air abrasion and IDS to silane application and cementation with preheated composite. Whether you're doing full rehabs or composite repairs, this episode is your go-to guide for smarter biomimetic dentistry. https://youtu.be/WTsF1mD-nTo Watch PDP221 on Youtube Protrusive Dental Pearl: After applying silane, don't just let it evaporate—let it react for 30 seconds, then air dry, and crucially, use a heat source (like a hairdryer) for 60 seconds to activate it properly and achieve optimal bond strength. This enhances the effectiveness of silane and significantly improves the bond strength of indirect restorations like composite or lithium disilicate. Key Takeaways: Occlusal veneers can be as thin as 0.6 mm. Indirect composite is often a superior choice for restorations. Proper bonding protocols are crucial for successful restorations. Focusing on strengths rather than weaknesses is key in dentistry. Conservative approaches in dentistry can preserve tooth structure. The vital tooth is always preferable to a non-vital tooth. Composite resin has wear properties similar to enamel. Occlusal veneers provide excellent protection for compromised teeth. Porcelain veneers have long-term durability compared to composites. The evolution of composite materials has led to better options for restorations. Zirconia is strong but difficult to adjust and bond effectively. Immediate dentin sealing is crucial for successful bonding and patient comfort. The Dahl principle allows for minimal preparation in certain cases. Composites can be as effective as ceramics when used correctly. Understanding the properties of materials is essential for successful restorations. Thin occlusal veneers can be successfully bonded with proper techniques. Highlights of this episode: 0:00 Introduction 02:52 Protrusive Dental Pearl 04:42 Dr. Pascal Magne on His Current Focus 10:16 Understanding Cusp Coverage and Material Choices 15:48 Conservative Approaches in Dentistry 23:16 Unsupported Enamel: Can it Still be Reinforced? 28:05 Occlusal Veneers Indications 37:00 Material Selection: Composite vs Ceramic 01:24:42 Outro Referenced Studies - all below are available to download on Protrusive Vault in Protrusive Guidance Effect of immediate dentine sealing on the aging and fracture strength of lithium disilicate inlays and overlays  Short-fiber Reinforced MOD Restorations of Molars with Severely Undermined Cusps  Ultrathin CAD-CAM glass ceramic and composite resin occlusal veneers for the treatment of severe dental erosion  Strains in the marginal ridge during occlusal loading  Antagonist Enamel Wears More Than Ceramic Inlays  Outcomes of resin-bonded attachments for removable dental prostheses Performance of ceramic laminate veneers with immediate dentine sealing  Keep the learning going with Magne Education If you enjoyed this episode, don't miss A Geeky Discussion on Adhesive Onlays – that's PDP161! This episode is eligible for 1.25 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes B and C. AGD Subject Code: 250 OPERATIVE (RESTORATIVE)DENTISTRY (Indirect restorations) Aim: To provide clinicians with evidence-based guidance on occlusal veneer indications, material selection, and conservative restorative protocols—emphasizing the role of adhesive techniques and biomimetic prin...

What is the number 1 communication advice for Dentists? Are you confident in discussing treatment fees with your patients? Do you struggle with communicating your worth without feeling awkward? How do you shift your mindset to charge what you're truly worth without feeling guilty (a money mindset issue)? https://youtu.be/vapDrnVqHRw In this enlightening conversation, Jaz opens up about his own struggles with money mindset and how he overcame them to confidently charge for his dental services. Joined by dental student Naveed Bhatti, they explore the challenges of pricing treatments, offering empathetic solutions to patients, and using the power of visualization to boost confidence in fee discussions. They also dive into the importance of being transparent with fees, managing discounts, and recognizing your true value as a dental professional. Whether you're new to the field or have years of experience, these strategies will help you navigate the financial side of dentistry with ease and confidence. Key Takeaways Communication is crucial in dentistry, often more than clinical skills. Active listening is essential; avoid interrupting patients. Nervous patients may talk excessively; guide the conversation gently. Patients may withhold information due to fear or anxiety. It's important to make treatment recommendations based on patient needs. Asking open-ended questions can help gather more information. Experience builds confidence in patient interactions. Being authentic while adapting to patients is key. Patients can sense when a dentist is confident or insincere. Building rapport leads to better patient relationships. Kindness is essential in patient interactions. Patients often reflect the values of their dentists. Effective communication can bridge the gap between jargon and patient understanding. Long-term relationships with patients enhance trust and satisfaction. Discussing fees requires confidence and transparency. Visualization techniques can improve communication skills. Empathy is important, but it should not compromise business integrity. Highlights of this episode: 01:46 Introducing Naveed Bhatti and His Journey 02:53 The Importance of Communication in Dentistry (Do's and Don'ts) 08:13 Handling Nervous and Quiet Patients 10:51 Dealing with Patients Who Don't Tell the Whole Truth 14:35 Making Treatment Recommendations 17:56 Asking the Right Questions 21:36 Balancing Professionalism and Personal Connection 25:49 Handling Difficult Patients  31:38 Effective Communication with Patients 35:05 Discussing Treatment Fees with Confidence 40:25 The Power of Visualization in Dentistry 48:56 Concluding Thoughts and Future Plans Support Nav's YouTube channel, The StuDent If you enjoyed this episode, don't miss out on Think Comprehensive – Communication Gems with Zak Kara – PDP010! This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcome B. AGD Subject Code: 550 PRACTICE MANAGEMENT AND HUMAN RELATIONS Aim: To enhance dental professionals' communication skills by exploring effective strategies for patient interaction, treatment planning, and fee discussions—ultimately building trust, improving patient outcomes, and boosting confidence in everyday clinical practice. Dentists will be able to - 1. Recognize the importance of active listening and body language in patient communication. 2. Explain treatment options using patient-centered language and analogies that promote understanding and buy-in. 3. Discuss treatment fees with clarity and conviction, addressing money mindset barriers and building perceived value.

Are ergonomic loupes and fancy chairs really worth the investment? Is back pain an inevitable part of being a dentist—or can it be prevented? Are you setting yourself up for a long, pain-free career in dentistry? What's the number one thing you should be doing right now to protect your body for the long haul? Dr. Sam Cope is back, and he's not just any dentist—he started as a physiotherapist before training in dentistry. That means when it comes to musculoskeletal health, posture, and career longevity, Sam knows his stuff. In this episode, Jaz and Sam revisit the crucial topic of back pain in dentistry and dive even deeper into what actually works to keep you practicing pain-free. So, if you clicked on this because you're worried about back pain, take this as your sign—your future self will thank you. https://youtu.be/lUC45aLXZKk Watch PDP220 on Youtube Protrusive Dental Pearl:  Motion is lotion. Staying active prevents back pain and keeps your career strong. If you're not making time for exercise, it's time to rethink your habits. Knowing isn't enough—action is what matters. Prioritize your health now. Key Take-Away: Posture and back pain have no direct correlation. Apprenticeships provide invaluable experience and learning opportunities. Investing time in learning and shadowing can accelerate career growth. Ergonomic tools can enhance comfort but should be tailored to individual needs. Mental health is crucial for dentists, and seeking help is a sign of strength. The human body can adapt to various postures with training. Choosing a specialization should align with personal interests and strengths. Preventative measures in ergonomics can improve career longevity. Continuous learning and adaptation are essential in the dental field. Choosing the right dental chair is crucial for comfort. Preventative strategies for back pain include regular exercise. Need to Read it? Check out the Full Episode Transcript below! Highlights of this episode: 02:05  Protrusive Dental Pearl 04:26 Sam's Journey from Physio to Dentist 10:33 The Value of Apprenticeships and Mentorship 16:24 Niching in Dentistry 22:30 Ergonomics in Dentistry: Loupes and Chairs 27:03 Choosing the Right Chair for Your Comfort 29:54 Top Tips for Dentists to Prevent Back Pain  This episode is eligible for 1 CE credit via the quiz below.  This episode meets GDC Outcomes A and C. AGD Subject Code: 130 ELECTIVES (149 Multi-disciplinary topics) Aim: To highlight the importance of ergonomics and physical well-being in dentistry. To share strategies for preventing occupational strain and burnout. Dentists will be able to - 1. Assess the role of ergonomic loupes, chairs, and posture in reducing strain and improving long-term musculoskeletal health. 2. Understand the significance of muscle conditioning over posture correction. 3. Incorporate exercise routines to manage physical strain during long procedures. If you enjoyed this episode, you won't want to miss Got Your Back – Physios and Dentists – PDP025! #PDPMainEpisodes #BeyondDentistry #CareerDevelopment Click below for full episode transcript: Jaz's Introduction: Over 270 episodes ago, I had on Dr. Sam Cope when he was a a baby dentist, and he's unique because he's a physio who trained to then become a dentist. Back then, we discussed about back pain and dentistry and how to prevent it, and we talk a bit more about those themes today. Are ergo loops worth it? Jaz's Introduction:Are those posh Bambach kind of chairs. Are they worth it? What's the number one advice to have a career with longevity and good health from a back pain perspective and as a physio come dentist, what does Sam do? What are the things that he practices? Because he's a bit like when Christiano Ronaldo rejoined Manchester United. He was like a, he was a big deal, right? He is the goat. He's the greatest of all time.

Are “contact lens veneers” just fake news? Why is the traditional 0.7mm prep approach outdated? Are you truly preserving enamel in your veneer preparations? Should you ever bond veneers to root dentin or cementum after crown lengthening? Why is the Galip Gürel technique the gold standard for minimal prep veneers? https://youtu.be/5BEFD1XaZtE Watch PDP219 on Youtube Dr. David Bloom joins Jaz for an insightful episode, sharing his 36 years of experience in cosmetic and restorative dentistry. With over two decades in the same practice, he's seen what works—and what leads to failure—when it comes to veneers. We also cover the key steps in mock-ups, planning, and veneer preparation. Protrusive Dental Pearl:  Always Wax Up for 10: When planning veneers, start with a 10-unit wax-up (even if the patient initially wants 4 or 6). This allows them to visualize their full smile with a mock-up, compare different options, and make an informed decision. It's not about upselling - most patients will appreciate the fuller look. Key Take-aways: Health and diagnosis are foundational in cosmetic dentistry. Visual try-ins are crucial for patient engagement and satisfaction. Minimally invasive techniques are preferred for cosmetic procedures. Communication with patients about their options is essential. Bonding to enamel is more reliable than bonding to dentin. Permission statements help in guiding patient expectations. The transition from veneers to crowns should be carefully considered. Staining is not the primary concern when bonding to dentin. A change in surface texture is key in modern dental preparations. Visual aids are crucial in helping patients understand their treatment options. The Gurel technique emphasizes minimal preparation for veneers. Effective communication with patients can enhance their treatment experience. Understanding occlusion is fundamental in aesthetic dentistry. Veneer thickness should be as minimal as possible for aesthetic results. Patient involvement in the design process is essential. Cementation techniques can vary based on gingival health. Maintaining a facial path of insertion is important for aesthetic outcomes. Building a good relationship with lab technicians is key to successful restorations. Need to Read it? Check out the Full Episode Transcript below! Highlights of this episode: 02:56  Protrusive Dental Pearl 04:15 Interview with Dr. David Bloom: Journey and Expertise 11:54 The Importance of Enamel in Veneer Longevity 13:46 Prepless Cases and Visual Try-Ins 18:54  Permission Statement 22:24 Visual Try-Ins Protocol 25:13 Decision-Making: Veneers vs. Crowns 28:35 Bonding to Root Dentine and Long-Term Outcomes 33:34 Opening Embrasures: Techniques and Tips 35:19 Visual Try-Ins and Patient Communication 38:50 Wax-up in Occlusion 41:25 The Gurel Technique Explained 47:09 Black Triangles  49:40 Guidelines for First Veneer Case 54:10 Contact Lens Veneers 56:18 Cementation Preferences and Techniques 01:00:15 Final Thoughts and Educational Resources Need expert guidance on veneers and smile design? Join Intaglio Mentoring and connect with top mentors for real-time case support and level up your Dentistry. Dr David Bloom is also a mentor on Intaglio. Watch this space for David's new educational website coming soon - he teaches Veneers hands-on too. If you loved this episode, make sure to watch How to Temporise Veneers Step by Step FULL GUIDE – PDP214 This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes B and C. AGD Subject Code: 780 ESTHETICS/COSMETICDENTISTRY (Tooth colored restorations) #PDPMainEpisodes #AdhesiveDentistry Aim: To provide an in-depth understanding of minimal preparation veneers, focusing on enamel preservation, diagnostic workflows, patient communication,

CORE CPD ALERT!

Is Work-Life Balance a Myth? How do you find the right balance between your professional responsibilities and personal life? Can you truly have it all…without sacrificing your health or family time? https://youtu.be/wkAv3noFXNk Watch PS014 on Youtube In this episode, Jaz and Emma Hutchison, ‘the Protrusive Student', dive into the real challenges of balancing parenthood, clinical dentistry, and LIFE! Jaz shares his strategies for managing these demands, revealing that while perfect balance might not exist, navigating life's seasons with intention can make all the difference. If you've ever struggled with finding your own balance, this episode is packed with key takeaways for dentists at every stage of their careers. Highlights of this episode: 03:34 Emma's New Year Reflections and Study Habits 12:20 Balancing Family, Work, and Personal Time 19:50 The Importance of Planning and Support Systems 23:16 Recognizing Opportunities and Setting Boundaries 28:15 Understanding Circle of Concern and Influence 30:24 Eat That Frog: Tackling Difficult Tasks First 31:02 Burnout in Dentistry: Real Experiences 39:51 The Importance of Mentorship 41:07 Just in Time Learning 44:03 Decision Making and Confidence 49:15 Effective Time Management Strategies 51:16 Final Thoughts and Takeaways Key Takeaways: Preparation and good mental health are crucial for success during exam periods. Internalizing knowledge helps in better understanding and retention. Finding time for hobbies and self-care is essential for well-being. Planning and prioritizing tasks can lead to more effective study habits. Support systems play a vital role in managing stress. You can achieve a lot by focusing on your big priorities. Eat That Frog: tackle difficult tasks first. Burnout is a real risk for dentists. Finding a mentor is extremely beneficial for career growth. Just-in-time learning is more effective than just-in-case learning. This episode is not eligible for CPD/CE points, but never fear, there are hundreds of hours of CPD waiting for you on the Ultimate Education Plan, including Premium clinical workthroughs and Masterclasses. If you enjoyed this episode, be sure to watch Stress in Dentistry 2024 – Life Changing Decisions – IC048

When Your Size 10 File is not going to length, what is happening? Your apex locator isn't giving you a zero reading. Your file is stuck. You're wondering—have you ledged? Or could something else be at play? In this must-listen follow-up episode, Dr. Samuel Johnson returns to tackle the biggest endodontic dilemmas left unanswered from part one. If you haven't checked that out yet, go back and listen—it's packed with insights on working lengths, apex locators, and even the role of consent in endodontics. https://youtu.be/1E6pK2iOPjY Watch PDP217 on Youtube Now, in part two, we go deeper. We're talking blockages, ledges, portals of exit, and the mysterious phenomenon of file gripping. Plus, Dr. Johnson takes on your burning questions from the Protrusive community—like how he responds to biological dentists claiming root canals should be avoided entirely. (Yep, we're addressing that controversy head-on!) Protrusive Dental Pearl: For a more visual learning experience, dive into the Pre-Endo Build-Up on Protrusive Guidance and see Jaz and Samuel's insights in action. Sonic Pro Ultrasonic Bath - 15% OFF before 30th April with coupon code ‘protrusive' Improve your Bond Strengths - purchase while stocks last: Sonic Pro Discount Key Takeaway: General dentists often overlook the importance of taper. Removing too much dentin can weaken the tooth. GP cones can be unstable and affect the procedure. Reshaping GP cones can often resolve length issues. Pre-bending GP cones can help navigate tight curves. Biological dentists have controversial views on root canals. It's essential to prioritize the patient's best interest. Using endo frost can aid in manipulating GP cones. Consent should be informed and comprehensive. Communication between referring dentists and specialists is vital. Continuous learning is essential for dental professionals. Ultrasonic activation improves endodontic outcomes. Pulpotomy and root canal treatments have distinct indications. Building a supportive community can alleviate feelings of isolation in dentistry. Dentists should charge for their time and expertise. Highlight of this Episode: 01:03 Protrusive Dental Pearl 01:49 Common Scenarios and Tips for Young Dentists 05:30 File Gripping and Canal Anatomy 08:30 Master Apical File: The Common Dilemma 11:18 GP Cone Issues and Solutions 17:03 Addressing Root Canal Myths  23:35 Cracks in Teeth: Prognosis and Treatment 25:44 Ninja Access Cavities: Pros and Cons 28:21 Common Mistakes in Emergency Endodontic Treatments 33:51 Obturation: Overextended vs Short 34:41 UltraSonic vs Sonic Irrigants 36:15 Pulpotomy and General Dentistry 39:25 Building a Dental Community As promised, here are the ESE Guidelines on managing cracked teeth. Watch and learn from Dr. Samuel Johnson on Instagram and YouTube! Don't miss the first part of this series: PDP216 – Working Lengths and Troubleshooting Apex Locators #PDPMainEpisodes #EndoRestorative #BreadandButterDentistry This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes B and C. AGD Subject Code: 070 ENDODONTICS (Emerging concepts, techniques, therapies and technology) This episode aimed to provide deeper insights into troubleshooting endodontic challenges, particularly when files fail to reach working length. It explores common pitfalls, advanced techniques, and expert strategies to improve clinical outcomes in root canal treatments. Dentists will be able to - 1. Recognize common endodontic challenges and strategies to navigate them effectively. 2. Evaluate the role of master apical files and resolve common dilemmas in achieving optimal shaping. 3. Identify frequent errors in urgent cases and improve treatment approaches.

‘Mentorship is more important than courses' - said lots of wise Dentists, and I think they're right! Do you have a mentor guiding you in your dental career? How do you know if you're making the right clinical decisions? https://youtu.be/5N0kj2YuFtA Watch IC058 on Youtube In this episode, Jaz is joined by Damian Panchal and Shivani Sadani to discuss the power of mentorship in dentistry. They explore why having a mentor can accelerate your growth, boost your confidence, and help you navigate complex cases with ease. They also introduce Intaglio, a brand-new platform designed to connect dentists with experienced mentors—so you can get real-time guidance, solve cases faster, and elevate your practice like never before. Listen in to learn why mentorship might be the best investment you make in your career. Key Takeaways: Mentorship is essential for professional growth in dentistry. Post-course support is increasingly important for new dentists. Real-world experience is crucial for applying theoretical knowledge. Investing in mentorship can lead to long-term benefits in practice. Effective mentorship can significantly improve clinical confidence and skills.  Mentorship is accessible and affordable for all levels. The value of mentorship lies in its application of knowledge. Mentors can help navigate career challenges beyond clinical skills. Relatable mentors can provide the best guidance. Learning from others' mistakes can save time and effort. Highlights of this episode: 00:00 Introduction 00:48 Introducing Intaglio: A New Mentorship Platform 01:45 Damian Panchala and Shivani Sedani - Personal Journeys 04:46 Mentorship Crisis in Dentistry 11:51 The Role of Social Media and Forums in Mentorship 17:41 The Value of Paid Mentorship 21:03 Exploring the Intaglio Platform 23:44 The Role of Mentors Beyond Clinical Help 31:05 Intaglio's Vision and Future Plans This episode is not eligible for CPD/CE points, but never fear, there are hundreds of hours of CPD waiting for you on the Ultimate Education Plan, including Premium clinical workthroughs and Masterclasses.

What makes apex locators reliable—or completely misleading? How do you determine the true working length of a root canal? Why is relying solely on radiographs for endo success a risky move? Dr. Samuel Johnson joins Jaz for a game-changing episode that will make you rethink everything you know about endodontics. In this first part of a two-part special, they dive into the nuances of apex locators, the difference between the radiographic apex and apical constriction, and why our radiographs might be lying to us. They also explore the power of glide path files, how to improve your endodontics workflow, and an incredible way to consent patients—something that extends beyond just root canals. Because mastering endodontics isn't just about technique—it's about communication, precision, and making the right calls for long-term success. Stay tuned for Part 2, where we go even deeper into endo essentials! https://youtu.be/M2z8Dl_g4XY Watch PDP216 on Youtube Protrusive Dental Pearl:  Buy a small whiteboard and marker for patient communication. Draw details, highlight the treatment plans, and list pros, cons, and fees. This builds trust, improves consent, and makes treatment clearer. Snap a photo and upload it to the patient's records. https://amzn.to/3DzUJfn Key Takeaway: Understanding the difference between radiographic and anatomical apex is crucial. Apex locators are essential tools for accurate working length measurements. The anatomy of the root canal system is complex and requires careful navigation. A well-informed patient is more likely to have realistic expectations about treatment. Glide path files can significantly reduce treatment time. Avoid forcing files into hard stops to prevent damage. Complicated anatomy can lead to unexpected challenges during treatment. Taking radiographs can help clarify uncertain situations. Highlights of this Episode: 01:40 Protrusive Dental Pearl: Patient Communication 02:39 Welcoming Dr. Samuel Johnson 04:36 Samuel's Passion for Endodontics 07:07 Reliability of Radiographic Measurements vs. Apex Locators 11:15 Canal Anatomy 14:30 Overextension vs Overfilling 16:23 Combining Apex Locators and Radiographs 20:52 Apex Locators and Hypochlorite: The Perfect Combination? 24:00 Efficiency in NHS Dentistry 26:10 Transitioning from NHS to Private Practice 27:42 Understanding Radiographic vs Anatomical Apex 29:26 The Importance of Consent in Endodontics 33:07 Mastering Apex Locators: Tips and Tricks 37:07 The Role of Glide Path Files in Endodontics 39:19 Troubleshooting Endodontic Challenges Watch and learn from Dr. Samuel Johnson on Instagram and YouTube! If you loved this episode, be sure to watch Elective Endodontics? It's all about Communication – PDP202 #PDPMainEpisodes #EndoRestorative #BreadandButterDentistry This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes B and C. AGD Subject Code: 070 ENDODONTICS (Emerging concepts, techniques, therapies and technology) This episode aimed to enhance clinicians' understanding of endodontic diagnostics and workflow, focusing on apex locators, working length determination, and effective patient communication. By refining these skills, practitioners can improve treatment accuracy, efficiency, and patient outcomes. Dentists will be able to - 1. Differentiate between the radiographic apex and the apical constriction and understand why radiographs alone can be misleading. 2. Evaluate the reliability of apex locators and recognize factors that affect their accuracy. 3. Apply the use of glide path files to improve efficiency and reduce treatment time in root canal procedures. Want More Clinical Gems? Join the Protrusive Guidance App to get access to masterclasses, premium videos, and exclusive Q&As with experts. Head over to protrusive.co.

Are you confident in managing patients on bisphosphonates or biologics? Which medications increase the risk of medication-related osteonecrosis of the jaw (MRONJ)? How do you decide when to extract a tooth and when to refer to a specialist? In this episode, Jaz is joined by oral surgery consultant Dr. Pippa Cullingham to explore the complexities of MRONJ. They break down the key risk factors, share expert advice on when to proceed with extractions, and discuss the latest guidelines for managing patients at risk. They also discuss the importance of early assessment - by identifying at-risk teeth early, you can help prevent serious complications and ensure the best outcome for your patients. https://youtu.be/KnQoI8Z-FhM Watch PDP215 on Youtube Protrusive Dental Pearl: it is so important to assess patients before they start taking high-risk medications like bisphosphonates or biologics, using radiographs to identify potential issues. Extractions should ideally be done before medication starts to avoid complications, as MRONJ risk increases once treatment begins. Key Takeaways: Medication-related osteonecrosis of the jaw concerns medications other than bisphosphonates. Risk assessment is crucial when considering dental extractions for patients on certain medications. Guidelines from the Scottish Dental Clinical Effectiveness Partnership are valuable resources for dentists. Higher-risk patients require careful management and communication with their medical teams. Denosumab has a different risk profile compared to bisphosphonates. Patients on long-term bisphosphonates may still have risks even after stopping the medication. Dentists should feel empowered to manage certain extractions in primary care with proper guidance. The decision to extract a tooth should weigh the risks and benefits for the patient. Always assess the patient's risk before extraction. Eight weeks is a critical time for assessing healing. Antibiotics are not recommended for preventing MRONJ in the UK. Radiotherapy history significantly impacts extraction risk. Referral to specialists may be necessary for high-risk patients. Highlights of this episode: 02:15 Protrusive Dental Pearl 03:52  Interview with Dr. Pippa Cullingham: Insights and Experiences 06:40 Medications and Their Risks 10:02 MRONJ: Incidence and Prevalence 13:13 Biologics and other medications 14:19 Guidelines and Best Practices 17:22 Managing High-Risk Patients 25:03 Prophylactic Antibiotics  26:55 Risk Assessment 28:47 Radiotherapy & ORN Risk 31:49 Tips and Key Takeaways 33:32 New Medications & Prevention Strategies For the best approach to managing MRONJ, check the SDCEP Guidelines and the American White Paper. This episode is eligible for 0.5 CE credits via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes B and C. AGD Subject Code: 730 ORAL MEDICINE, ORAL DIAGNOSIS, ORAL PATHOLOGY (Diagnosis, management and treatment of oral pathologies) Dentists will be able to - 1. Be aware of the medications that increase the risk of MRONJ. 2. Learn how to assess the risk of MRONJ in patients, particularly before starting high-risk medications. 3. Understand when to proceed with extractions and when to refer patients to specialists for management. If you liked this episode, check out PDP206 - White Patches

Not quite happy or set with being a GDP? Have you just started as a GDP and want to streamline your learnings for a brighter future? Is an MSc the right plan of action for you? How important are mentors in all of this? In this episode we discuss Dr Kiran Shakla's journey from University to Australia to working as a Dentist at a Specialist Practice. She shares with us her top tips on how Dentists can make the most of their weekly schedules and reduce stress while dealing with different cases. https://youtu.be/IiecXSpsJmc Watch IC057 on Youtube Key Takeaways: Hard work and determination are key to success in dentistry. Work-life balance is crucial for long-term satisfaction in dentistry. The first ten years post-graduation are vital for career development. General dentistry can be fulfilling without the need for specialization. It's important to recognize when to refer patients to specialists. Kiran emphasizes the value of personal growth and continuous learning.. Finding joy in everyday practice is essential for a sustainable career. Australia taught me valuable skills in private practice. Private dentistry focuses more on patient care than money. Communication is crucial for patient satisfaction. Finding mentorship can be challenging but essential. Shadowing experienced professionals enhances learning. Balancing work and education requires sacrifices. Highlight of this episode: 02:34 Introduction to Dr Kiran Shankla 06:18 Correlation between Uni and the Real World 07:29 Selling a Dream 10:13 Going Hard Early 12:43 Taking Work Home 14:55 General Dentistry 20:48 Kiran's Journey  24:23 What did the experience teach Kiran? 31:33 Mentoring 34:38 Work Schedule 37:38 Bone to pick with Master's 43:33 Orthodontic Position 48:53 Working with Nurses 54:33 Networking 56:33 Wrapping Up Connect with Dr. Kiran on Instagram! This is a non-clinical episode without CPD. For CPD or CE credits, visit the Protrusive Guidance app—hundreds of hours and mini-courses await! If you liked this episode, check out: Stress in Dentistry 2024 – Life Changing Decisions – IC048

How do we decide whether speciality training is right for us? Is the best time to specialise straight after Dental School? Or should we gain some experience in practice first? Dr Beant Thandi joins us today to share his journey into specialising and shares some key experiences that will surely help guide you along the way. We discuss the different specialities within Dentistry as well as what personality types may suit them. This episode will really help you understand what it takes to specialise and how to get there. https://youtu.be/f8ZM8EkjSQY Watch IC056 on Youtube Key Takeaways:- Beant is starting his specialization in periodontics.- His journey began during COVID, leading to a desire to specialize.- Proactive learning and mentorship played a crucial role in hisdevelopment.- Financial planning is essential when considering specialization.- Choosing a specialty should align with personal interests and strengths.- Periodontics offers a breadth of practice that appeals to Beant.- The importance of community support in dental education cannot be overstated.- Reflection and documentation of cases can enhance learning and confidence.- Understanding the financial implications of specialization is vital.- It's important to stay grounded and not rush into specialization.  Highlights of this Episode:00:00 Teaser02:38 Intro to Dr Beant Thandi04:03 Dental Journey06:10 What Influenced You?12:56 Too Young to Specialise17:50 Judgement by Jaz21:00 Never too Young26:05 Cost of Specialising28:23 Why not the USA?31:30 Roasting Prostho34:45 Roasting Endo37:42 Roasting Ortho39:49 Roasting Oral Surgery45:00 Shoutout to Lucy45:30 Final Thoughts47:28 End Outro If you liked this episode, check out a classic: Should You Specialise? PDP006 This episode is not eligible for CPD/CE points, but never fear, there are hundreds of hours of CPD waiting for you on the Ultimate Education Plan, including Premium clinical workthroughs and Masterclasses.