Protrusive Dental Podcast

If you showed the same bitewing to 10 dentists, would they all agree on whether to pick up the drill? Why does the word monitoring mean nothing to a patient — and how does swapping it for active surveillance change everything from your notes to your indemnity to your government policy meetings? Is it overtreatment to act on an E2 lesion — or is “watch and wait” actually the lazy answer dressed up as minimally invasive? And what should you actually do with AI caries detection that flags shadows your eye doesn't see? In this episode, Professor Avijit Banerjee — Professor of Cariology & Operative Dentistry at King's College London, Honorary Consultant at Guy's & St Thomas', and First Dean of the Faculty of Dentistry at the College of General Dentistry — sits down with Jaz for what is genuinely one of the most important caries conversations on the podcast. Part one of two. Avijit doesn't do soft answers. The drill-fill-bill model is broken. “Monitoring” needs to go. “Treatment planning” is antiquated terminology medics dropped twenty-five years ago. And AI in caries diagnosis? Useful — but the moment it gets things wrong, you are the one with indemnity, not the software. What you walk away with is a framework (MIOC), a decision filter (three factors that decide whether to pick up a bur), and a vocabulary shift you can implement tomorrow. Part two covers peptides, SDF, hydroxyapatite, stepwise excavation, and managing caries in xerostomia. https://youtu.be/YriLo8_hXNw Watch PDP268 on YouTube Protrusive Dental Pearl: Delete the Word “Monitor” from Your Vocabulary Stop saying monitor. Start saying active surveillance. ⚠️ Active surveillance must not mean passive delay — document your reasoning, risk assessment, and what would trigger intervention. ✅ Explain it to patients as structured, proactive care: clinical checks, radiographs, risk review, behaviour support, and timely action if things change. Key Takeaways Minimum intervention oral care is bigger than minimally invasive dentistry. MIOC is prevention-based, person-focused, susceptibility-related, and delivered by the whole oral healthcare team. MID is only one part of MIOC: operative dentistry when a tooth actually needs intervention. The four MIOC domains are: identify the problem, prevent lesions and control disease, provide minimally invasive operative care, then reassess. A care plan is more useful than a treatment plan because it includes justification, prevention, behaviour change, and review. Ask patients what matters to you, not just what's the matter with you. Cavitation, cleansability, and lesion activity should guide whether to intervene operatively. A cavitated lesion that cannot be cleaned is much more likely to remain active. Smooth surface lesions may sometimes be made cleansable without conventional drilling. Restorations are not just about filling holes; they help recreate a cleansable tooth surface. There is no single perfect caries detection technology — clinical examination and good radiographs remain fundamental. If using NIRI, fluorescence, scanners, or AI, understand how the technology works and where it fails. AI should support diagnosis, not replace clinical judgement. For uncertain early lesions, triangulate: clinical findings, radiographs, risk, technology, and patient factors. Proximal resin infiltration has a role in the right patient and situation, especially as part of a wider prevention-led strategy. Highlights of This Episode 00:00 Teaser 02:17 Protrusive Dental Pearl: Active Surveillance, Not Monitoring 09:14 Minimum Intervention Oral Care vs Minimally Invasive Dentistry 11:28 Core Principles of MIOC 11:48 Domain 1: Identify the Problem 12:46 Domain 2: Prevention of Lesions and Control of Disease 13:18 Microinvasive Care Options 14:41 Domain 3: Minimally Invasive Operative Dentistry 16:38 Why “Active Surveillance” Matters 18:24 MIOC as a Practical Framework 19:43 Applying MIOC in Patient Communication 22:38 Sustainability & Salutogenesis 29:05 When to Pick Up a Drill 30:23 Biofilm as the Engine of Caries 31:33 Purpose of a Restoration in Caries Management 36:13 Caries Detection Technologies 42:44 Watch and Wait vs Detect and Manage 01:02:52 Outro Professor Avijit Banerjee's recommended reading and ongoing work: New textbook: A Clinical Guide to Advanced Minimum Intervention Restorative Dentistry (Banerjee A., Elsevier, 2024) — the most comprehensive single reference for modern MIOC and MID.

Why does dentistry on social media look so perfect? Are those flawless before-and-after cases the reality of everyday practice—or just the highlight reel? And why aren't we talking more openly about the failures, frustrations, and imperfect outcomes that every dentist experiences? In this episode, Dr Artem Mkrtichyan joins Jaz for a refreshingly honest conversation about the realities of modern dentistry. Known for his candid and relatable social media posts, Dr. Artem has built a following by sharing what many dentists think—but rarely say out loud: dentistry is hard, results aren't always perfect, and social media often paints an unrealistic picture of the profession. https://youtu.be/uTKaeewgrgE Watch IC074 on YouTube Key Takeaways Social media has become a powerful tool for dentists to connect and share experiences. Mistakes in clinical practice are common and should be openly discussed. Rural practice may not always lead to higher income as expected. Success in dentistry is subjective and varies for each individual. Continuous learning and skill development are crucial for career growth. Financial freedom in dentistry is not guaranteed and varies widely. Networking and mentorship can significantly impact career progression. Social media can be leveraged to attract patients and build a personal brand. Highlights of this episode: 00:00 Teaser 00:18 Introduction 02:24 Meet Dr Artem Mkrtichyan 05:27 Rejections And Resilience 09:03 Why Honesty Wins 10:58 Rural Dentistry Reality 14:58 Handling Online Criticism 16:01 Associate Vs Owner Myth 18:05 Midroll: Protrusive App 22:48 Dentistry Money Reality 26:57 Design Your Career Path 28:00 Standing Out In Saturated Markets 29:27 Content Marketing Strategy 31:46 Veneer Minimum Ethics 33:48 Final Advice And Community If this episode resonated with you, don't miss “I Committed Fraud – Learn from My Mistakes” – PDP248 #InterferenceCast #BeyondDentistry 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.

Why does occlusion feel so confusing at dental school? What if the problem is not that occlusion is too complex, but that it was taught in the wrong order? How do you make sense of worn teeth, bite scans, shimstock, leaf gauges, provisionals and T-Scan without getting overwhelmed? And which small ideas can genuinely change the way you diagnose, plan and restore? In this episode, Jaz is joined by Dr. Mahmoud Ibrahim for a brilliant occlusion-focused conversation. They each bring five clinical “pearls” that helped occlusion finally click for them — from facially generated treatment planning to checking the contralateral side, muscle palpation, provisionals and digital occlusal data. https://youtu.be/REQ_L5NNEF4 Watch PDP267 on YouTube Protrusive Dental Pearl Create a PowerPoint or Keynote library of your clinical photos so you can quickly show patients relevant examples during consultations. ⚠️ Avoid hunting through random folders chairside — it feels clunky and breaks the flow of the conversation. ✅ Build a scrollable visual library of cracks, before-and-afters, complications, direct restorations, overlays, crowns and consent examples to support clearer patient communication. Key Takeaways Occlusion becomes easier when it is placed inside the treatment planning sequence, not treated as a separate subject. Facially generated treatment planning starts with where the upper teeth need to be for aesthetics. Once the central incisors are planned, the rest of the occlusion becomes easier to organise. Worn teeth that are still in occlusion are often in the wrong position. Anterior wear may be caused by tooth position, contact time, contact force, or a combination of all three. Gingival levels can reveal whether worn lower incisors have over-erupted. Digital bite scans are useful, but they are not always a perfect representation of the patient's bite. Shimstock remains one of the most valuable and inexpensive tools for checking true occlusal contacts. After fitting a restoration, checking the contralateral side first can reveal whether the new restoration is high. Anterior guidance should be steep enough to separate the back teeth, but shallow enough to allow the lower incisors room to move. Muscle palpation should assess the quality and symmetry of contraction, not just whether the muscles exist. Always assess the opposing tooth before placing composite, ceramic or an indirect restoration. A leaf gauge can help create a more repeatable jaw position when planning more complex occlusal cases. Provisionals are essential for testing aesthetics, function, vertical dimension and occlusion before committing to final restorations. Highlights of the Episode: 00:00 Teaser 00:56 Introduction 03:36 Pearl: Build a Clinical Photo PowerPoint 12:48 Pearl 1: Facially Generated Treatment Planning 15:56 Pearl 2: Worn Teeth in Occlusion Are in the Wrong Position 18:05 Why Tooth Position Matters 18:22 Three Causes of Wear to Consider 19:34 Pearl 3: Digital Bite Scans Are Not Always Accurate 20:24 Why Shimstock Still Matters in Digital Dentistry 24:18 Pearl 4: Check the Contralateral Side After a Restoration 26:27 Pearl 5: The First Movement of Opening Is Not Pure Rotation 28:27 Midroll 33:10 Pearl 6: Healthy Occlusion Should Have Coordinated Muscle Contraction 35:22 Why Muscle Palpation Is a Useful Data Point 38:18 Practical Muscle Assessment Tip 38:58 Pearl 7: Always Look at the Opposing Tooth 39:33 What to Check Before an Indirect Restoration 39:44 Why the Opposing Tooth Matters 41:13 Pearl 8: Leaf Gauge for Finding a Repeatable Jaw Position 42:43 What a Leaf Gauge Is 44:33 Pearl 9: Provisionals Reduce the Fear of Complex Cases 47:49 Pearl 10: T-Scan Adds Objective Occlusal Data 53:16 Course Options and Learning Pathway 55:59 Outro ✨Connect with Dr. Mahmoud on Instagram

Are we overcomplicating posterior composites? Are those beautiful fissures and stains actually helping the patient… or just us? Why does that “perfect” restoration suddenly need 20 minutes of occlusal adjustment after rubber dam removal? And how can we make functional, predictable composites without burning time or stress? In this episode, Dr. Vishaal Shah shares a refreshingly practical approach to posterior composites. From understanding the basics, to simplifying anatomy and improving efficiency, this is a grounded, clinically focused conversation on how to deliver restorations that actually serve the patient. https://youtu.be/tdkTxzcloN0 Watch PDP266 on YouTube Protrusive Dental PearlMatch your composite anatomy to the patient's dental age and opposing dentition before you start building. ⚠️ Overbuilding cusps in a worn dentition will create occlusal interferences and wasted adjustment time✅ Assess space, wear, and occlusion first—then design the restoration accordingly Key Takeaways Function, efficiency, and occlusal compatibility should guide every restoration Dental age (wear) is more important than chronological age when planning anatomy Always assess the opposing tooth before designing cusps and fissures Use the whole arch—not just the contralateral tooth—as your anatomical guide Follow the central fissure line across the quadrant to orient your restoration Avoid textbook anatomy in worn dentitions—adapt to what's present Large MOD composites often act as interim restorations before crowns Build proximal walls first to establish contact and control final contour Use composite slump (with a microbrush) to naturally form proximal curvature Base layer height should match the deepest fissure level of adjacent teeth Map out fissures and cusps before building to improve accuracy and speed Start with the most difficult cusp first to reduce fatigue-related errors Proper planning before drilling reduces occlusal errors and remakes Highlights of the Episode: 00:00 Teaser 01:08 Introduction 01:50 Pearl: Matching Anatomy to Dental Age 05:32 Posterior Composite: Start with Basics, Not Complexity 10:42 Efficient Approach to Large Restorations 14:22 Efficiency vs Ideal Posterior Restorations 19:25 Building Proximal Walls First 20:55 Using Putty Stents for Missing Cusps 23:54 Midroll 27:15 Using Putty Stents for Missing Cusps 27:25 Matrix System Selection 28:06 No Pre-Wedging Philosophy 29:06 Managing Composite Overhangs 30:46 Matrix Ring Differences 32:45 Interjection 37:03 Matrix Ring Differences 37:43 Proximal Wall Technique for Posterior Composite 41:03 Base Layer Strategy in Posterior Restorations 42:23 Mapping Anatomy Before Composite Build-Up 43:13 Cusp Build-Up Approach 45:03 Minimal Adjustment Philosophy 46:43 Final Philosophy: Keep It Simple 48:00 Learning Opportunities 49:54 Outro

When is it appropriate to consider an MRI for your TMD patient? What's actually involved in MRI of the TMJ? Can you use any MRI machine, or is the choice of imaging center crucial? And who should be reporting on these scans — does it really matter? (Hint: yes, it does!) Dr. Kevin Lotzof, a straight-talking radiologist, joins Jaz for a controversial deep dive into the role of MRI in Temporomandibular Disorders. While many experts downplay its importance, Kevin argues that TMJs are under-imaged and under-diagnosed — and that we may be missing critical pathology. They explore the practicalities of imaging, how to set expectations with your patients, and why strong but differing views in TMD care can ultimately help you refine your own clinical approach. https://youtu.be/-yo_Qx4Zg5Q Watch PDP265 on YouTube  Protrusive Dental Pearl: Adopt the mindset of “Find the cancer today.”When carrying out examinations—whether soft tissue or extraoral—approach it with the intention of detecting oral or skin cancers early. This mindset helps clinicians look beyond just teeth, catch unusual or suspicious lesions, and potentially save lives. Key Takeaways TMJ is often overlooked but is crucial for overall health. MRI is essential for accurate TMJ diagnosis. Cone beam CT cannot replace MRI for TMD assessment. Patients with headaches may have undiagnosed TMD. Education on TMJ imaging is lacking among dental professionals. Asymptomatic patients should still be scanned for TMJ issues. The quality of imaging directly impacts diagnosis accuracy. Patients often feel anxious about MRI procedures. Understanding patient perspectives can improve care. There is a need for better collaboration between dentists and radiologists. Highlight of the episode: 00:00 Teaser 00:55 Intro 05:20 Protrusive dental pearl 06:36 Interview with Dr. Kevin Lotzof 09:38 Under-Imaging and Differing Perspectives 13:27 Access and MRI Centers in the UK 17:51 TMJ MRI: Patient Expectations 22:17 Midroll 25:53 Open MRI Machines 27:26 Ideal Candidates for MRI Imaging 29:55 Cone Beam CT vs. MRI 31:53 Screening and Asymptomatic Patients 38:43 Centers with Reliable TMJ Imaging 41:27 Encouragement for General Dentists 46:33 Outro Where to Get Reliable TMJ Imaging ⭐ Top Pick: Orion, Wimpole Street, London(Full contact details available via the Protrusive Guidance App)

Is titanium still the gold standard for implants? Are zirconia implants just hype from biological dentistry… or something more? Do ceramic implants really integrate as well as titanium? And should we already be offering patients a choice? Zirconia implants are no longer a fringe concept—they're entering mainstream conversations. In this episode, Dr. Pav Khaira returns to break down the science, clinical decision-making, and real-world application of zirconia vs titanium implants. From corrosion and osteoimmunology to occlusion and case selection, this is a practical, evidence-led discussion for clinicians navigating modern implant options. https://youtu.be/-RCvf2KOdSc Watch PDP264 on YouTube Protrusive Dental Pearl: Thriving in Challenging Times

Is burnout inevitable in dentistry? Why do so many high-achieving dentists still feel unfulfilled? Are we too harsh on ourselves without even realising it? And what if the way we speak to ourselves is the real problem? In this episode, Jaz sits down with Dr Aditi Bhalla—a Prosthodontist and Integrative Psychotherapist, with over 15 years in dentistry and extensive training in mental health, mindfulness, and movement—to explore compassion-focused dentistry. They unpack burnout, perfectionism, fear-driven practice, and how understanding your mind could be the key to a sustainable, fulfilling career. https://youtu.be/pNsW6AiWsWQ Watch IC073 on Youtube Key Takeaways Burnout often stems from perfectionism, shame, and constant self-criticism Many dentists tie their self-worth entirely to clinical performance Childhood experiences can shape how we respond to stress and pressure High-functioning anxiety is common but often goes unnoticed NHS-style time pressure and fear of complaints drive chronic stress Decision fatigue in dentistry significantly impacts performance and wellbeing Social media amplifies comparison and feelings of inadequacy There is a growing gap between expectations and real-world dentistry Compassion requires courage, wisdom, and commitment—not weakness Dentists are good at caring for patients but neglect self-care Accepting positive feedback is as important as improving weaknesses Emotional awareness is the first step to managing stress effectively A “compassion toolkit” helps regulate emotions in real-time clinical scenarios Sustainable dentistry requires prevention of burnout, not just coping strategies Team culture improves when you recognise the human behind the role Compassionate leadership still requires clear boundaries and accountability Highlights of this episode: 00:00 Teaser 00:51 Introduction 07:50 What “Therapy” Means 11:43 Role of Childhood & Trauma 13:10 Therapists Need Therapy Too 14:40 Breakdown & Burnout in Dentistry 16:50 Causes of Burnout in Dentistry 19:50 Clinical Stress Factors 20:50 Decision Fatigue in Dentistry 23:35 Burnout in Modern Dentistry – Why More Now? 27:38 Midroll 30:59 Burnout in Modern Dentistry – Why More Now? 31:11 What is Compassion? 32:11 Lack of Self-Compassion in Dentistry 33:11 Three Directions of Compassion in Dentistry 35:11 Compassion Focused Dentistry (CFD) 39:11 Nervous System Awareness 41:31 Applying Compassion in DailyDental Practice 43:01 Compassion = Emotional Intelligence + Mindfulness 43:41 Compassion “Kit Bag” 45:11 Compassion in the Team 46:41 Creating a Compassionate Practice 51:51 Getting Started with Compassion 54:12 Outro

Are you sacrificing your health for your patients? Are your neck and back quietly dictating how long you can practise? Do you skip workouts because you “don't have time”? And what if your career ended—not by choice, but because your body gave up first? In this episode, Jaz is joined by Fraser Smith, a sports scientist and nutrition expert, to break down what dentists actually need to do to stay healthy, pain-free, and practising for longer. From EMS training and realistic exercise routines to nutrition and injury prevention, this is a practical guide to protecting your most important asset—your health. https://youtu.be/kQu7rDlzT8k Watch IC072 on Youtube Key Takeaways Health is a key pillar of career longevity in dentistry Many dentists sacrifice exercise and sleep during high-stress periods Short, consistent workouts are more sustainable than long, infrequent sessions EMS can be a useful time-efficient adjunct but should not replace a full training programme Strength, endurance, and mobility are all essential components of fitness Most dentists should start with small, manageable exercise habits and build gradually Deadlifts are beneficial but require proper technique and guidance Reformer Pilates is a practical option for improving posture and mobility Stretching provides short-term relief but must be combined with strengthening Most musculoskeletal pain in dentists is due to repetitive strain and weakness Movement and gradual strengthening are key to managing and preventing pain Ignoring early pain increases the risk of chronic, persistent symptoms Nutrition should be balanced and sustainable rather than extreme Protein intake is often insufficient in active individuals Supplements can support performance but should not replace a good diet Long-term success depends on prioritising health as part of professional responsibility Highlights of this episode: 00:00 Teaser 00:53 Introduction 05:40 What is EMS Training? 07:45 Get to know Fraser Smith 09:35 What's the ideal health routine for Dentists? 11:56 Deadlifts for Dentists 15:01 Stretching & Posture Tips for Dentists 18:35 Midroll 21:56 Stretching & Posture Tips for Dentists 25:41 Balanced Nutrition 28:23 Protein Intake Suggestions 30:51 Back Pain Management 39:09 Outro

Why does dentistry have such high levels of stress and burnout? Why do so many clinicians feel isolated despite working in busy practices? What are the early warning signs that a colleague might be struggling? And what can you actually do — practically — if someone is in crisis? In this powerful and deeply important episode, Professor John Gibson shares his personal story and the mission behind the Canmore Trust. The conversation explores suicide prevention in dentistry, how to recognise warning signs, and the simple but life-saving actions every clinician should know. https://youtu.be/BftumzpytJI Watch IC071 on YouTube Key Takeaways Dentistry has a well-recognised issue with stress, burnout, and suicide risk Suicide is always multifactorial — never caused by a single event Toxic culture, including harassment and unrealistic expectations, contributes to distress Social media comparison can amplify feelings of inadequacy and isolation Dentistry is uniquely demanding — both intellectually and technically Mental health stigma prevents open conversations within the profession Neurodivergence is increasingly relevant and often underdiagnosed Perfectionism is a key risk trait linked to suicidal thinking Working below your moral standards creates significant psychological stress Warning signs include changes in temperament, withdrawal, and isolation Asking directly about suicide does not increase risk — it can save lives Use the “double bounce” approach: ask the question twice if needed If someone says yes, act immediately — hospital or emergency services You are not responsible for managing the crisis alone Early support includes sharing concerns and involving a trusted person GP support can be transformative and should not be delayed Highlight of this episode: 00:00 Teaser 00:51 Intro 04:16 John Gibson Introduction 07:15 Understanding the Scale of Suicide in Dentistry 09:59 Why Suicide Happens in Dentistry 11:13 Key Risk Factors of Suicide in Dentistry 12:09 Social Media and Comparison 12:52 Isolation 13:04 Difficulty of Dentistry 14:03 Mental Health Stigma 15:22 Neurodiversity 18:18 Perfectionism and Moral Conflict in Dentistry 21:44 Recognising Warning Signs of Suicide 21:46 Midroll 25:07 Recognising Warning Signs of Suicide 26:21 How to Approach a Suicidal Colleague 28:49 Double Bounce Technique 30:44 If the Answer is YES 33:36 Support and Resources for Dentists 34:12 Key Suicide Prevention Steps 37:40 Creating a Supportive Workplace 39:18 Reflective Space 40:00 Daily Positivity Practice 42:46 Canmore Trust Podcast 42:59 Outro Learn more about mental health in Dentistry: Check out more episodes on mental health, burnout, and wellbeing in dentistry. PDP185 – Mental Health in Dentistry IC040 – Overcoming Adversities

You've spotted the signs—wear, scalloping, fragmentation, maybe even a low AHI—but what does that really mean? When the data doesn't match the symptoms, how do you move forward? And how do you integrate airway into full mouth rehab without compromising function, stability, or predictability? In this episode, Jaz is joined by Dr. Aston Parmar to explore the real-world application of airway dentistry. They discuss how to help patients own their problem, why sleep testing matters, and how airway influences diagnosis, treatment planning, and long-term outcomes. https://youtu.be/-zVV1FAT0NI Watch PDP263 on YouTube Protrusive Dental Pearl Nasal Breathing and Simple Screening Nasal airflow can be a major limiting factor in sleep quality. Simple test: flare nostrils → if breathing improves, nasal resistance may be present. Nasal dilators can be a cheap, low-risk intervention for selected patients. Not all patients need mandibular advancement — sometimes the issue is nasal. Second pearl: test snoring improvement by advancing the mandible. If forward positioning reduces snoring sound → mandibular advancement may help. Key Takeaways Patients must own their problem before accepting treatment Airway dentistry is about risk reduction, not cure Apnea-Hypopnea Index (AHI) has limitations—context and patterns matter more than raw scores Upper Airway Resistance Syndrome (UARS) is common but underdiagnosed Sleep fragmentation can exist even with low AHI scores Myofunctional therapy improves compliance and outcomes Multi-night sleep testing provides more accurate insights Collaboration with ENT specialists improves diagnostic accuracy Airway is the bookend of full mouth rehab (start and end) Dentistry should be airway-sympathetic, not just tooth-focused Mandibular advancement devices are effective but require careful titration Morning occlusal guides help reduce bite changes from appliances Not all patients need the same pathway—risk stratification is key Predictability in dentistry depends on understanding the whole system The environment (airway, function, biology) matters more than the teeth Highlights of this episode: 00:00 – Introduction to Upper Airway Resistance Syndrome 02:08 – Pearl: Nasal Breathing and Simple Screening 07:43 – Recap: Myofunctional Therapy and Indications 08:30 – Role of Myofunctional Therapy in Treatment Planning 09:40 – Patient Communication and Case Acceptance 23:20 – Sleep-Disordered Breathing Spectrum 23:50 – Apnea vs Hypopnea and Apnea-Hypopnea Index (AHI) Limitations 30:00 – Upper Airway Resistance Syndrome (UARS) 35:43 – Management of UARS 37:00 – Mandibular Advancement Devices (MAD) 39:00 – Maxillary Expansion and Surgical Options 41:00 – Treatment Pathway and ENT Involvement 44:00 – Risk Assessment in Full Mouth Rehab 59:30 – Airway-Sympathetic Dentistry 01:02:00 – Treatment Philosophy and Case Selection 01:07:00 – Airway as Bookends of Treatment 01:09:00 – Managing Side Effects of MAD 01:12:00 – Career Insight and Final Reflections Want to learn more? Watch part 1 of this episode: PDP262 – Implementing Sleep, Airway and Myo to Restorative Dentistry Part 1 Also, check out Stop Blaming Bruxism with Dr. Sandra Hulac – PDP142

What do you actually do once you've screened a patient for airway or sleep-disordered breathing? You suspect sleep apnea—but since we can't diagnose it as dentists, how does that influence the care you provide? What do you do with that information, and who should you be working with to help your patient? And what if you want to implement airway into your practice—but you're not in the right environment to do so? In this episode, Dr. Aston Parmar joins Jaz to break down how to implement airway in everyday dentistry. Together, they explore what happens after screening, how it influences treatment planning, and how dentists can work with other professionals to deliver better care. https://youtu.be/wGbgbW8muUI Watch PDP262 on YouTube  Protrusive Dental Pearl Use the Mallampati Score as a quick chairside airway screen: have the patient open wide and stick out their tongue. Grade 1 = low risk; higher grades indicate greater Sleep-Disordered Breathing risk.  ⚠️ In TMD patients, limited opening can give falsely high scores.  ✅ Always interpret alongside history and full exam. Key Takeaways Airway management is often overlooked in dental education. Sleep testing can significantly improve patient outcomes. Dentists should focus on airway health to enhance sleep quality. Collaboration with orthodontists can benefit patient care. Myofunctional therapy is crucial for both children and adults. Early intervention before age six is vital for nasal breathing. Tongue function plays a significant role in dental health. Breathing patterns can affect orthodontic stability. The Malampati score is a key indicator of sleep disorder risk. Upper airway resistance syndrome can be difficult to diagnose. Collaboration with myofunctional therapists enhances patient outcomes. Understanding airway health is essential for total body health. Inspiring the next generation of dental professionals is important. Highlights of this episode: 00:00 Teaser 00:51 Introduction 04:03 Protrusive Dental Pearl: Mallampati Score 05:37 Meet Dr. Aston Parmar 09:51 Journey into Dentistry 17:10 Implementing Training in Practice 22:41 First Exposure to Airway Concept 30:18 South Wales Dental Sleep Clinic Model 30:21 Midroll 33:42 South Wales Dental Sleep Clinic Model 41:17 Myofunctional Therapy Explained 48: 51 Orthodontic Stability and Neutral Zone 54:52 Quickfire Screening Red Flags 01:02:55 Sleep Apnea Basics 01:04:23  Upper Area Resistance Syndrome (UARS) 01:08:53 Outro Want more? Check out Airway Dentistry with Jeff Rouse – PDP229

Are AI receptionists here to take over your practice? How do they actually work, and what can they do—or not do—for your team? Could they make life easier for staff without replacing humans, or are they just a gimmick? In this episode, award-winning dentist and marketing expert Dr. Grant McAree joins Jaz to break down AI receptionists. Together, they explore what an AI receptionist really is, how it integrates with your practice, and the compliance and legal considerations every dentist should know. They also dive into the bigger picture—who these systems are really for, how patient interactions are managed, and a live demonstration of an AI receptionist in action that shows exactly what it can—and can't—do for your practice. https://youtu.be/Jx-0jOZG3lE Watch IC070 on YouTube Key Takeaways: AI receptionists are evolving to provide better patient interactions. Data insights reveal significant gaps in patient communication. The technology is designed to assist, not replace human receptionists. AI can help streamline appointment bookings and patient inquiries. Understanding patient needs is crucial for effective AI responses. Customization of AI responses is essential for different practices. The future of AI in dentistry looks promising but requires careful implementation. AI should not be seen as a replacement but as a tool for efficiency. Compliance and data storage are critical in patient interactions. The integration of AI can lead to improved patient experiences. YouTube Highlights: 00:00 Teaser 05:06 Meet Dr. Grant McAree 07:32 Grant's Journey to AI 11:03 AI Gold Rush and Inequality 11:56 Interjection 14:01 AI Gold Rush and Inequality 15:59 Compliance and Legal Risks 18:42 What an AI Receptionist Does 20:54 Midroll 24:16 What an AI Receptionist Does 26:51 Comparing AI to Human Receptionists 32:47 Leads Data and Compliance 36:38 Future Adoption and Risks 42:46 Additional Features and Learning More 43:30 Jaz Call to AI Receptionist 46:01 Outro Unlock the future of patient consultations!

Can you claim parking expenses as a dentist? What about a coffee machine for your practice—could that really be deductible? Or investing in a MSc in Implantology—does that count as a tax write-off? In this episode, chartered accountant Sebastian Stracey joins Jaz to answer all those “am I naughty if I claim this?” questions that dentists and associates always wonder about. Together, they cover what's truly deductible, what isn't, and some surprising exceptions you might not expect. They also dive into the bigger picture—how principals and associates really compare in terms of income, stress, and responsibility—and Seb shares insights that might change the way you view your career path. https://youtu.be/BW_TZ5iZ-B8 Watch PDP261 on YouTube Protrusive Dental Pearl Check out our free Financial Resilience Webinar Replay on Protrusive Guidance, where Dr. Sunny Sadana and I discuss associate contracts, case acceptance, investing, and fee setting. Key Takeaways: Dentists often forget to claim mobile phone bills as expenses. Home office usage can be claimed, especially for associates. Keeping detailed mileage logs is crucial for claiming travel expenses. Laundry and cleaning expenses for scrubs can be claimed. Communication with your accountant is key to maximizing claims. Continuing education expenses can be gray areas but may be allowable. Gathering evidence for claims is essential to justify them to HMRC. Specialization programs can be claimed if they build on existing knowledge. Fixed fee services for accountants are beneficial for associates. Always discuss your situation with your accountant to ensure compliance. Many new dentists struggle financially during their training. Understanding tax obligations is crucial for financial stability. VAT regulations can be complex, especially for cosmetic treatments. It’s important to save for tax throughout the year, not just at the end. Common misconceptions about tax deductions can lead to financial pitfalls. Dentists should engage in financial education early in their careers. Expense claims can be tricky, especially for gifts and personal items. The distinction between personal and business expenses is vital for tax purposes. Associates and principals have different financial realities in dentistry. Communication and education about finances are essential for dental professionals. Highlight of this episode: 00:00 Teaser 00:42 Introduction 02:06 Pearl: Free Financial Resilience Webinar Replay 04:45 Meet Sebastian Stracey 06:56 Common Missed Expenses 13:57 Home Internet Claims 16:49 Asking Accountants Questions 19:07 Claiming Masters Courses 26:31 Specialist Training Costs 27:30 Midroll 30:41 Specialist Training Costs 33:28 Saving for Tax Bills 36:36 VAT on Cosmetic Work 40:06 “Am I Naughty If?” Questions 49:10 Wild Expense Attempts 50:11 Ways Dentists Can Learn More About Tax and Finance 51:56 Associate vs Principal Numbers 53:39 Outro Get expert financial guidance for individuals and businesses with Humphrey & Co—your trusted partners in taxes, planning, and business success Learn strategies for career security, smart investing, and building wealth—watch Personal Finances for Dentists (IC068) #PDPMainEpisodes #BeyondDentistry This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes B. AGD Subject Code: 550 – Practice Management and Human Resources Aim: To outline common allowable and non-allowable expense claims for dentists and highlight the importance of documentation, communication with accountants, and financial planning. Dentists will be able to – Identify commonly missed claimable expenses in dental practice. Recognize expenses that are not allowable under tax rules. Understand the importance of documentation and communication with accountants when claiming expenses.

Can AI really help you communicate better with patients? What if you could audit your own consultations and discover which words, pauses, and stories increase treatment acceptance? Dr. David Amador joins Jaz for a fascinating episode exploring how AI can transform the way we interact with patients. From auditing conversations to radiographic interpretation, they break down practical applications that improve both communication and patient care. They also discuss how storytelling, patient trust, and ethical use of AI all come together to boost treatment acceptance — showing that AI isn't here to replace us, but to make us better. https://youtu.be/L38Hhu855Ro Watch IC069 on YouTube Key Takeaways AI is transforming the way dental practices operate. Storytelling is crucial for effective patient communication. Building a strong team culture enhances practice success. Data security is paramount when using AI tools. Continuous training is essential for team development. Patient engagement strategies can improve treatment acceptance. AI tools can streamline administrative tasks and improve efficiency. Understanding patient needs leads to better care outcomes. Effective marketing requires a solid online presence and SEO. Networking with other professionals can provide valuable insights. Highlight of the episode 00:00 Teaser 00:34 Intro 02:23 Dr. Amador’s Background and Practice 08:14 Using AI for Decision Support 10:26 Leveraging AI for Communication and Training 15:57 Using AI for Patient Care and Diagnosis 21:37 Midroll 1 24:58 Using AI for Patient Care and Diagnosis 26:11 Leveraging AI for Dental Practice Efficiency 27:35 Midroll 2 30:20 Leveraging AI for Dental Practice Efficiency 32:44 Training and Scaling with AI Tools 33:45 Creating SOPs and Playbooks 36:53 Enhancing Patient Communication with Personalized Videos 40:36 Training and Data-Driven Growth 44:52 Outro AI isn't the future — it's your next teammate. Imagine: while you focus on patient care, AI records your consults, summarizes them, audits your communication, and helps interpret radiographs. Plaud.ai makes note-taking automatic. Overjet makes diagnostics and patient communication crystal clear. Check out Midtown Dental Studio — where cutting-edge technology meets genuine care.  If you found this episode valuable, don't miss PS015: Communicating Fees, Treatment Plans, and More #InterferenceCast #CareerDevelopment #Communication This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes A and B AGD Subject Code: 550 – Practice Management and Human Relations Aim: To explore how artificial intelligence (AI) can be used to audit communication, enhance storytelling, and improve patient conversion while maintaining patient-centered care. Dentists will be able to – Explain how AI tools can support communication, diagnosis, and patient understanding in dentistry. Demonstrate how storytelling and patient-centered communication influence treatment acceptance. Evaluate the ethical, professional, and practical considerations of integrating AI into dental practice.

What is a prompt, and how do AI models actually work? Which AI tools should you be using in dentistry? Is it safe to put patient details into AI—and how can it help you save time and reduce stress? In this episode, Dr. Daz Kasperek joins to make AI in dentistry tangible, even if you've never used it before. Together, we cover the basics: from getting started with prompts and AI models to understanding ethical considerations and practical ways AI can streamline your workflow. They also explore the bigger picture—how AI can improve efficiency, enhance patient communication, and give clinicians more time to enjoy life outside the clinic. https://youtu.be/cmin0h7GNyE Watch PDP260 on YouTube  Protrusive Dental Pearl: A free AI tool called Dental Disrupt Smile Simulator lets you upload a smile photo and instantly generate a realistic smile makeover simulation for patient discussions. It runs as a custom GPT inside ChatGPT, created by Dr. Jason Lipscomb Key Takeaways: AI is revolutionizing the field of dentistry, particularly in diagnosis. Prompt engineering is crucial for effective AI interactions. Personalization of AI tools can significantly improve their utility. AI can automate administrative tasks, potentially reducing the need for receptionists. AI can enhance communication between dentists and patients. The integration of AI in dentistry is still in its early stages. AI can provide personalized recommendations for patient care. Voice transcription is a more efficient way to interact with AI. The future of dentistry will heavily rely on AI technologies. AI is revolutionizing image creation in dentistry. Choosing the right AI model is crucial for effective use. Patient confidentiality must be prioritized when using AI. AI can transform administrative roles in dentistry. AI can assist in personalized education and training. The human connection in healthcare cannot be replaced by AI. Job roles will evolve rather than disappear due to AI. AI’s limitations highlight the importance of clinician expertise. Episode Highlights: 00:00 Teaser 01:08 Introduction 03:05  Protrusive Dental Pearl – Smile Simulator 06:39 Meet Dr Daz Kasperek 07:16 AI Adoption and Inequality 16:58 Better Prompting with RCT (Role, Context, Task) 21:56 AI and Administrative Work in Dentistry 30:42 AI Notes in Practice 35:05 Midroll 38:26 AI Notes in Practice 38:49 Smile Simulator Demo 41:57 Choosing Your AI Stack 49:01 Patient Confidentiality and Data Safety 54:38 AI in Dentistry – What It Will Replace 01:01:56 What AI Cannot Replace 01:04:53 Endo AI Research and Thesis 01:07:10 Contact and Resources 01:08:17 Outro If you enjoyed this episode, don't miss “NEVER Write Notes Again! How I Use AI for Awesome and Efficient Dental Records – PDP181.” #PDPMainEpisodes #CareerDevelopment  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: 550 PRACTICE MANAGEMENT AND HUMAN RELATIONS Aim: To provide dental professionals with a foundational understanding of artificial intelligence (AI) in dentistry, including its practical applications, limitations, and ethical considerations, to improve efficiency, patient communication, and clinical workflow. Dentists will be able to: Explain what AI is and the difference between an AI model and a prompt. Identify key AI platforms and tools relevant to dentistry and personal use. Apply AI safely in clinical practice while maintaining patient confidentiality.

Are you struggling to get your resin work looking flawless? Wondering how to polish your composites so they shine like a pro? Curious about practical tips you can implement immediately to level up your smile makeovers? In this episode, Dr. Charles Brandon shares three game-changing secrets for mastering composite resin. From practical techniques you can apply right away to a conceptual tip that will completely transform the way you polish, Charles leaves no stone unturned. Get ready for an episode packed with actionable advice, insider knowledge, and inspiration from a dentist whose resin work is truly next-level. Whether you're refining your layering skills or aiming for that perfect finish, this episode is a must-listen. https://youtu.be/dBlN_rbHnTI Watch PDP259 on YouTube Protrusive Dental Pearl: Level up your resin veneers with the Perio Bur (code and more info here)— a long diamond bur for the slow-speed 1:1 handpiece that gives unmatched control, crisp shaping, and beautiful texture. If you use only one bur for finishing composite, make it this one. Check out this  video of Perio bur in Action on a Real Resin Veneer Case → protrusive.co.uk/periobur Key Takeaways The significance of patient communication and understanding their needs is highlighted. Mistakes are seen as learning opportunities that contribute to growth in practice. The role of mentorship in navigating challenges in aesthetic dentistry is discussed. Aesthetic communication is crucial for patient satisfaction. Patients are visually aided, not verbally aided. Effective layering techniques can enhance composite work. Practice on typodont models to build skills. The polish is secondary to proper placement and finishing. Understanding composite materials is key to success. Start with two shades for layering to minimize complexity. Courses should cover the entire process, not just techniques. Self-teaching is a valuable way to improve skills. Investing in oneself is essential for growth in dentistry. YouTube Highlights: 00:00 Teaser 01:10 Introduction 02:05 Protrusive Dental Pearl – Using a Perio Bur 05:56 Dr. Charles Brandon's Journey in Dentistry 11:42 Challenges and Reflections in Aesthetic Dentistry 19:08 Perfect Smile Secret #1: Build from the Bottom Up 26:08 Managing Temporaries During a Trial Smile 26:48 Midroll 30:09 Managing Temporaries During a Trial Smile 35:17 Freehand vs. Stent-Based Systems 39:19 Perfect Smile Secret #2: More Than Polish 44:23 Perfect Smile Secret #3: It's Not the Composite 48:19 Practice and Continuous Learning 53:20 Course Offerings and Final Thoughts 56:00 Outro Level Up Your Skills Practice at home with a simple AliExpress setup (~$200) including a 1:5 & 1:1 handpiece plus micromotor. Take it further with Dr. Charles Brandon's composite veneer Masterclass and master the full process from design to finish. If you enjoyed this episode, check out Minimal Preparation Veneers – PDP219. #PDPMainEpisodes #AdhesiveDentistry #CareerDevelopment This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes  C. AGD Subject Code: 780 ESTHETICS/COSMETIC DENTISTRY Aim: To equip dentists with practical techniques, workflows, and mindset strategies for delivering high-quality aesthetic dentistry using composite veneers, from patient communication and trial smiles to layering, polishing, and continuous skill development. Dentists will be able to – Explain the importance of patient communication, trial smiles, and expectation management in aesthetic dentistry. Demonstrate a stepwise workflow for additive composite veneers, including mock-ups, trial duration, and handling of temporaries. Apply layering, finishing, and polishing techniques effectively using minimal composite shades to achieve predictable aesthetic outcomes. Cost:Access to this CE activity is included with an active Protrusive Guidance membership. Current membership pricing is available at www.protrusive.app. Cancellation & Refund Policy:Memberships may be cancelled at any time. Access to CE activities remains active until the end of the current billing cycle. Subscription charges are non-refundable once processed. Full details are available at www.protrusive.app.

Are you a high-earning dentist… living paycheck to paycheck? Do you ever feel financially stretched – despite earning well? Are you trapped in dentistry's “golden handcuffs”? And what would your life look like if you worked because you wanted to… not because you had to? In this rare solo episode, Jaz steps away from occlusion and restorative dentistry to talk about something just as important: personal finances and career security for dentists. After going deep down the money rabbit hole — reading books like Rich Dad Poor Dad, The Simple Path to Wealth, and I Will Teach You To Be Rich — Jaz shares how his upbringing, early career decisions, and financial education shaped his beliefs about wealth, freedom, and dentistry. This isn't financial advice.It's a mindset shift. And for many dentists, it might be the most important episode you hear this year. https://youtu.be/4OXruGIdb_g Watch IC068 on YouTube Your day list reflects your earning power. The work you do each day quietly sets the limits of what you can earn. Exams and single-surface composites create one kind of ceiling; comprehensive cases, ortho, rehab, sedation, and complex restorative work create another. Upskilling changes that ceiling and gives you far more control over your financial future. Want more mindset shifts like this?AskJaz — your on-demand dental brain — is built into the Protrusive App. Key Takeaways High income does not guarantee financial security. Dentistry can become “golden handcuffs” without asset building. Invest in yourself early — skill drives earning power. Lifestyle creep quietly erodes freedom. Financial independence means practicing because you want to. Define your rich life and align spending accordingly. Highlights of This Episode: 00:00 Why talk about money on a dental podcast?04:12 Perspective and gratitude as dentists10:45 The 45% paycheck-to-paycheck poll16:20 Associates vs principals — the reality22:34 Lifestyle creep explained27:18 Golden handcuffs in dentistry31:10 Growing up with financial scarcity40:02 Investing in yourself early in your career47:55 Index funds and financial resilience55:20 The 20% happiness illusion01:02:18 Defining your rich life01:08:42 Action steps and reflection #PersonalFinances  This episode isnot eligible for CPD/CE points, but never fear, there are hundreds of hours of CPD waiting for you on the Ultimate Education Plan. If you enjoyed this episode, check out IC022 – Income for Dentists and Jaz’s Top 10 Financial Literacy books inside Protrusive Guidance.

Have you ever wondered how hypnotherapy can help your dental patients? Can it really reduce anxiety, manage chronic pain, or even stop habits like cheek biting? How can dentists integrate hypnotherapy into their care without stepping outside their scope of practice? In this episode, Jaz and Dr. Rita Pais break down how hypnotherapy works, who can benefit, and practical ways dentists can incorporate it into patient care. They also discuss real patient examples, from dental phobia to awake bruxism, showing how a minimally invasive talking therapy can make a real difference in improving habits, reducing stress, and enhancing overall patient outcomes. https://youtu.be/ONnC_nP0iBQ Watch PDP258 on YouTube Protrusive Dental Pearl: How to Get Patients to Happily Accept a Mouth Prop – Use confident, directive communication paired with a simple analogy and a swallowing expectation to dramatically improve patient acceptance of mouth props. Key Takeaways Hypnotherapy combines hypnosis with therapeutic techniques for health outcomes. Cognitive Behavioral Hypnotherapy (CBH) enhances treatment effectiveness. Patients must be willing to try hypnotherapy for it to work. Chronic pain management can benefit from relaxation techniques in hypnotherapy. Hypnotherapy can address dental phobias and habits like nail-biting. Awareness of habits is crucial for effective hypnotherapy. Finding a qualified hypnotherapist is essential for successful treatment. Science-based approaches in hypnotherapy are preferred by practitioners. Success stories in hypnotherapy can be very rewarding for practitioners. Hypnotherapy can be delivered online or in person, making it accessible. Youtube Highlights 00:00 Teaser 00:59 Introduction 02:13 Protrusive dental pearl: How to Get Patients to Happily Accept a Mouth Prop 05:35 Dr. Rita Pais: Journey into Hypnotherapy 06:32 Hypnotherapy and Its Applications 08:39 Understanding Hypnotherapy and Pain 11:59 How Cognitive Behavioural Hypnotherapy Works 15:35 Midroll 18:56 How Cognitive Behavioural Hypnotherapy Works 20:41 Dental Indications for Hypnotherapy 24:41 Finding a Trusted Hypnotherapist 26:50 Mock Hypnotherapy Session: Patient Journey 30:51 Final Thoughts and Resources 32:28 Outro For dentists looking to refer patients, The Hypnotherapy Directory is one available resource, though it lists all types of hypnotherapy. For patients or colleagues interested in hypnotherapy referrals or collaboration, check out: Rita Pais Hypnotherapy If you loved this episode, make sure to watch Hypnotize Your Patients with 3 Quick Techniques – IC015 This episode is eligible for 0.5 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes A and C. AGD Subject Code: 340 ANESTHESIA AND PAIN MANAGEMENT (Anxiolysis) Aim: To provide dentists with a practical overview of hypnotherapy applications in dentistry, including cognitive behavioural hypnotherapy (CBH), patient selection, and habit/pain management. Dentists will be able to – Distinguish between hypnosis and hypnotherapy. Explain how cognitive behavioural hypnotherapy integrates CBT and hypnosis. Identify dental indications for hypnotherapy, including phobias, pain, and habits. Cost:Access to this CE activity is included with an active Protrusive Guidance membership. Current membership pricing is available at www.protrusive.app. Cancellation & Refund Policy:Memberships may be cancelled at any time. Access to CE activities remains active until the end of the current billing cycle. Subscription charges are non-refundable once processed. Full details are available at www.protrusive.app.

After watching this episode, you’ll understand exactly why owning your website matters. And here’s the good news: as a Protrusive community member, you can get 50% off your professional dental website – built specifically for associates who want to stand out.

Did Triman ever buy his own camera setup? Has he figured out which niche or specialty he wants to pursue? Are molar endodontics and surgical extractions still his fear procedures? And how's he getting on with those tricky fee discussions and private patient conversations? Dr Triman Ahluwalia returns for another catch-up — one year after stepping into his first associate position. In this episode, Jaz follows Triman's journey from new graduate to confident young clinician, exploring what's changed and what lessons he's learned along the way. From building confidence in complex procedures to improving communication and investing in the right tools, this episode is packed with insights every fresh grad and early-career dentist can relate to. https://youtu.be/gJNUM6JSLfE Watch IC066 on YouTube Takeaways Investing in photography can enhance documentation and patient engagement. Confidence in discussing costs with patients improves with experience. Mentorship is vital for growth and learning in dentistry. Building a strong portfolio is essential for career development. Choosing the right educational path depends on personal learning styles. Communication with patients should focus on care rather than costs. Dentistry offers diverse pathways for specialization and growth. Highlights: 00:00 Teaser 00:30 Introduction 03:18 Patient Demographics and Practice Insights 06:04 Investing in Photography Equipment 10:13  Handling Complex Procedures and Referrals 13:20 Choosing the Right Courses for Career Growth 17:21 Communicating Costs and Building Confidence 18:32 Midroll 21:53 Communicating Costs and Building Confidence 27:31 Learning from Senior Colleagues and Mentorship 31:50 Building and Improving Your Dental Portfolio 33:56 Final Reflections and Advice for Young Dentists 38:41 Outro

What if you finally reach the peak of your career—only to have your body shut it down? Why are so many dentists forced to cancel clinics, not because of burnout or skill, but because of crippling back pain? And what if this “expected hazard of dentistry” didn't actually have to be inevitable? In this episode, Dr. Aniko Ball joins Jaz to challenge the long-held belief that chronic pain is just part of being a dentist. As an expert in dental ergonomics and the Alexander Technique, she reveals why so many clinicians are unknowingly damaging their bodies every single day—and how simple, overlooked changes can completely transform career longevity. The mission for this episode was simple: deliver five genuinely life-changing, immediately actionable tips to protect your neck, back, and future. No fluff. No theory for theory's sake. Just practical changes you can implement straight away—starting from your very next clinic session. If your health matters to you as much as your dentistry, this is an unmissable episode. https://youtu.be/u7hEOPpEsGA Watch PDP27 on Youtube Protrusive Dental Pearl: Cut toxic noise, protect time for your health, and optimize the small habits you repeat daily. You only rotate ~10–13 meals—upgrade those, move a little more, sleep a little better. Small, consistent upgrades compound into an unrecognisable year. Key Takeaways: Back pain in dentistry is not inevitable—it is largely the result of cumulative postural habits. Most dental pain comes from holding positions the body was never designed to hold, not from single traumatic events. Lifting the elbow or shoulder for prolonged periods activates movement muscles, guaranteeing shoulder and upper back pain. A finger rest must be used on the non-dominant hand holding the mirror, not just the dominant hand. Hovering the mirror is equivalent to holding the arm raised against gravity. The spine is not designed for sustained bending or twisting, even slightly. Staying vertical is critical—move the patient and the chair, not your spine. Traditional loupes often force neck flexion; refractive loupes or microscopes allow upright posture and straight-ahead vision. Stool height matters: hips slightly higher than knees, feet flat, heels fully released into the floor. If leg weight isn't given to the floor, the lower back absorbs the load instead. Habits outside the clinic—especially looking down at a mobile phone—train the same harmful postural patterns used in dentistry. Postural change feels strange at first because bad habits feel comfortable, even when they are damaging. Real change requires habit interruption, repetition, and support over several weeks. Your body is your most important instrument—protecting it protects your career. Highlights: 00:00 Teaser 00:52 Introduction 03:36 Pearl – Optimizing Small Habits 07:06 Interview with Dr. Aniko Ball: Her Journey on Ergonomics and Dentistry 10:00 Challenging Misconceptions in Dentistry 17:42 Common Mistakes and Practical Tips for Better Posture 28:29 Importance of Refractive Loupes and Microscopes 29:53 Midroll 33:14 Importance of Refractive Loupes and Microscopes 34:18 Communicating with Patients for Better Ergonomics 38:06 The Science of Habit Change and Neuromuscular Training 42:40 Optimizing Dental Stool Height for Better Ergonomics 47:14 The Impact of Mobile Phone Usage on Posture 50:53 Key Posture and Ergonomic Takeaways 53:35 Full-Day Ergonomics Workshop 59:13 Outro

When should you attempt to save the root filled molar that everyone else thinks is doomed? What are the key steps to safely remove, treat, and replant a tooth without causing fractures or resorption? And how do you manage patient expectations and post-op care to maximize success? In this episode, Dr. Samuel Kratchman and Dr. Shivakar join Jaz to explore intentional tooth replantation—a procedure that rarely gets the spotlight but can completely change treatment options for challenging cases. They cover everything from case selection and imaging, to managing crowns and fragile teeth, to simple tools and techniques that make this procedure predictable and accessible. They also dive into patient communication, consent, and how to include this procedure as part of your everyday dental armamentarium, giving you the confidence to consider it when the right case comes along. https://youtu.be/SjJTzbJ_AXs Watch PDP256 on YouTube Key Takeaways: Intentional replantation is a viable alternative to extraction. The success rate of intentional replantation is documented at 88-89%. Patient education is crucial for successful treatment outcomes. The periodontal ligament must be kept moist during the procedure. Imaging is essential for understanding tooth anatomy before replantation. The procedure can be performed atraumatically with proper technique. Replantation can be a last chance for teeth that are difficult to replace with implants. A mindset shift is needed in dentistry to prioritize saving natural teeth. Apical infections are often linked to the root tip and surrounding tissue. A good coronal seal is essential before any restorative work. Common complications include ankylosis and resorption. Inflammation can aid in the extraction process by serving the ligament. Post-operative care is vital for successful recovery. Highlights: 00:00 Teaser 00:48 Introduction 03:27 Pearl: PDL is everything  04:54 Interview with Dr. Shivakar Mehrotra 07:03 Interview with Dr. Samuel Kratchman 11:01 Terminologies and Success Rates of Replantation 16:03 Indications of Replantation 22:29 Evaluating Radiographs and Clinical Factors 28:48 Case Studies and Practical Applications 30:51 Midroll 34:12 Case Studies and Practical Applications 38:08 Management of Apical Infection 40:35 Curveball Scenario: Combined Endodontic and Restorative Challenge 45:57 Replantation Success Rates and Complications 51:06 Radiographic Signs and Extraction Techniques 56:03 Postoperative Care and Instructions 59:49 Final Thoughts and Resources 01:02:14 Outro

Are posterior tooth contacts really harmless? Could group function and non-working side interferences be driving muscular TMD, headaches, and facial pain? And can digital occlusal data change how we approach bite adjustment? Dr. Jeremy Bliss joins the podcast to tackle one of the most controversial topics in dentistry: Selective Grinding/Equilibration for TMD but specifically Disclusion Time Reduction (DTR). With a strong focus on restorative technology, lasers, and T-Scan analysis, Jeremy brings a practical and experience-driven perspective to occlusion and bite therapy. This episode breaks DTR down from the very beginning—what it is, how it differs from traditional equilibration, and why reducing posterior tooth contact during excursive movements may help certain susceptible patients. The conversation also explores canine guidance vs group function, macro vs micro occlusion, and where DTR fits within evidence-based dentistry when conservative care has failed. https://youtu.be/TMa11nh7VIU Watch PDP255 on YouTube Protrusive Dental Pearl: Don't buy advanced occlusal or motion-tracking tech unless your type of dentistry, training, lab support, and local backup can fully use the data—otherwise it's just a Ferrari stuck in traffic. Key Takeaways: Disclusion Time Reduction (DTR) & T-Scan T-Scan: Provides objective data on tooth contact timing and force—impossible to see with the eye or articulating paper. EMG: Tracks temporalis and masseter activity to show how muscles respond to occlusion. Goal of DTR: Reduce posterior tooth contact during excursions, shifting contact to canines to relax muscles. Patient Selection: Best for symptomatic muscular TMD; requires sufficient canine/incisal overlap. Clinical Benefits: Reduces headaches, migraines, muscle tension, parafunctional damage, and progressive tooth wear. Procedure: Conservative enamel adjustments (0.5–0.75 mm), guided by T-Scan; posterior teeth should disclude in

When are antibiotics truly indicated in dentistry? How do you manage the patient who's begging for a prescription? And what impact are we having on the gut every time we prescribe unnecessarily? In this episode, Dr. Jeremy Lenaerts joins Jaz to explore the world of antibiotics in dentistry. Together, they cover when to prescribe, when not to, and why analgesics or local measures are often the better option. They also dive into the bigger picture—antibiotic resistance, gut health, and how to navigate those tricky conversations when patients demand antibiotics for the wrong reasons. https://youtu.be/-Q4hvl-8vpU Watch PDP254 on Youtube Protrusive Dental Pearl? Save time and avoid confusion with a ready-made Antibiotics Cheat Sheet that combines the best guidelines into one resource. It covers: True indications and contraindications Drug interactions First, second, and third-line choices Doses and duration

Can adults really expand their maxilla? Is treating sleep apnea with a CPAP or mandibular advancement device only MASKING the problem? How does craniofacial anatomy influence airway health, and what should dentists look for? Dr. Dave Singh joins us to dive into CranioFacial Sleep Medicine. He breaks down how structural issues—like a narrow maxilla, high-arched palate, or limited tongue space—can be root causes of sleep-disordered breathing, rather than just treating symptoms.  The episode also touches on controversies in orthodontics and presents evidence supporting interventions once thought impossible in adults. https://youtu.be/WUyeOjKquJU Watch PDP253 on Youtube Protrusive Dental Pearl: Obstructive Sleep Apnea is NOT just a “fat old man disease.” If you're not screening every patient for sleep and airway issues, you're missing a huge piece of their overall health. Snoring, bruxism, and craniofacial anatomy are all connected, and understanding these links can transform the way you approach patient care. Key Takeaways: Mandibular advancement appliances are not a universal solution. While effective for some patients, they often fail to address the underlying causes of airway collapse. Craniofacial sleep medicine focuses on airway etiology, not just symptom control, by identifying why the mandible, tongue, and airway behave as they do during sleep. The cranial base plays a foundational role in facial growth, jaw position, and airway size, directly influencing sleep apnea risk. A retruded mandible is frequently due to developmental and epigenetic factors, rather than being an isolated mandibular issue. Sleep apnea has multiple endotypes—including craniofacial, neurologic, metabolic, and myopathic—requiring individualized treatment planning. Bruxism is not a reliable airway-opening mechanism and may be a primitive physiological response to hypoxia rather than a protective behavior. Tooth wear can be an early indicator of sleep-disordered breathing, and should prompt clinicians to screen beyond restorative concerns. Upper Airway Resistance Syndrome (UARS) can occur even when the apnea-hypopnea index (AHI) is low, particularly in non-obese patients with fatigue, pain, and poor sleep quality. Palatal expansion should be understood as a 3D craniofacial intervention, aimed at improving nasal airflow and airway function—not merely widening the dental arch. Effective care depends on an integrated, multidisciplinary approach, involving dentists, orthodontists, sleep physicians, ENTs, and myofunctional therapists. Youtube Highlights: 00:00 Teaser 01:01 Introduction 02:56 Pearl: Debunking Myths About Sleep Apnea 04:27 Interview with Professor Dave Singh: Journey and Insights 13:23 Craniofacial Development 18:53 Epigenetics and Orthodontic Controversies 25:52 Diagnosis and Treatment of Sleep Apnea 32:49 Understanding Upper Airway Resistance Syndrome 34:17 Midroll 37:38 Understanding Upper Airway Resistance Syndrome 39:45 Diagnosing Sleep Disorders and Treatment Modalities 43:58 Exploring Bruxism and Its Hypotheses 45:19 CPAP and Alternative Treatments for Sleep Apnea 48:12 Managing Upper Airway Resistance Syndrome 55:11 Integrative Approach to Sleep Disorder Management 57:17 Diagnostic Protocols and Imaging Techniques 01:02:25 The Importance of Proper Device Fit and Function 01:07:16 Upcoming Events and Further Learning Opportunities 01:09:56 Outro ✨ Don't Miss Out: Practical, anatomy-based approaches to sleep and airway management for dentists and specialists

Happy New Year, Protruserati ✨ As 2025 comes to a close, we wanted to pause and reflect by revisiting the moments that genuinely shaped how we practise, think, and show up in the clinic. This Best of 2025 episode starts with restorative and aesthetics, moves through digital workflows, endo, paediatrics, surgery, communication, and finishes with what sustains us over a long career. These are the clips that made me pause, rethink, and quietly adjust how I work – and I hope they do the same for you. Some of the ideas you'll hear in this episode include: Predictable ways to manage wear and space without over-treating Small restorative and material choices that have a big impact long-term Practical digital workflows that genuinely improve accuracy and efficiency Endo fundamentals that reduce stress and increase consistency Clear clinical judgement for paediatrics, surgery, and medical emergencies Communication habits that build trust without using jargon Simple, sustainable ways to protect your body, health, and curiosity https://youtu.be/rsOxnzlYUkc Watch the Best of 2025 on YouTube Also, AskJaz is here!

Do your patients really have two bites? Does their bite change when they lie down? When they sleep? And how can you explain centric relation, posture, and deprogramming in a way that patients actually understand? Dr. Bobby Supple joins Jaz for a powerful episode unpacking one of the most misunderstood topics in occlusion: the daytime chewing bite versus the nighttime airway bite. After spending days with Bobby in his New Mexico clinic, Jaz saw firsthand how simply and elegantly Bobby communicates concepts that usually leave patients — and dentists — confused. Together, they explore why bite discrepancies exist, what happens when the condyles fully seat, and how aligning Bite One and Bite Two over time can transform patient comfort and restorative outcomes. https://youtu.be/EC_qxUF7GxI Watch PDP252 on YouTube Protrusive Dental Pearl When assessing abfractions, always check the patient's bite in two positions: seated upright and lying back. Posture subtly shifts the condylar position and can change how forces load the tooth. Want more gems like this? AskJaz — your on-demand dental brain, will be soon baked right into the Protrusive App. Key Takeaways: Every patient has two bites — their upright chewing bite and their horizontal airway bite. Posture changes the condylar position more than we realise. Clear communication can make complex occlusion concepts instantly understandable. Aligning Bite One and Bite Two over time leads to healthier joints and more predictable dentistry. Highlights of this episode: 03:36  Pearl – Assessing Abfractions 06:47 Dr. Bobby Supple’s Journey to Dentistry 10:46 Confusion Around Centric Relation 13:22 Exploring T-Scan Technology 21:40 The Evolution of Digital Occlusion 27:05 Effect of Sitting vs. Reclined Position 32:03 Airway and Skeletal Asymmetry 37:19 Bite Philosophy and Treatment 42:10 Orthotics and Long-term Care 52:13 Preventive Dental Care 58:18 Ask Jaz AI (Beta Launch)

How do you balance a high-performance dental career with being an effective parent? What strategies help you stay sane amidst the organized chaos of family life? How can showing up as your best self benefit both your patients and your children? Dr. Shandy Vijayan and Dr. Raabiha Maan join Jaz in this nonclinical episode to share their experiences of parenthood in dentistry. From the unique perspectives of two dentist-moms and the dad viewpoint, they discuss the real-life challenges of raising children while maintaining personal well-being. They also share practical tips, book recommendations, and actionable strategies for self-care and emotional regulation—helping you create a balanced family life while thriving in your career. During the episode, Jaz also mentions KARRI — a fun, screen-free voice messenger that helps kids stay safely connected with parents and friends, without social media or internet access. Loved by kids. Trusted by parents. Get 50% off via: www.protrusive.co.uk/karri https://youtu.be/F-Tp83_tuco Watch IC065 on Youtube Key Takeaways Life comes in “seasons”; early parenting (~0–8 yrs) is intense but temporary. Reduce clinical load early to focus on children; career focus increases after ~12 yrs. Prioritize time with kids over tasks; coordinated parenting schedules help. House help significantly reduces stress, frees energy for quality interactions. Support networks (family, in-laws, professional communities) are essential. Grandparents: allow flexibility; avoid micromanaging childcare. Returning to work: stress, costs (GDC, indemnity, childcare), skill gaps, guilt. Dentistry = high-performance + emotional labor; manage energy carefully. Quick mental reset between work/home recommended; part-time can boost longevity. Parent happiness + strong parental relationship = major factor in kids' emotional regulation. Run family like a small business: systems, schedules, clear roles. Self-regulation, EQ, and self-care benefit family, patients, and professional life. Highlights of this episode: 00:00 Teaser 01:00 Intro 02:50 Shandy’s Story: Juggling Multiple Clinics 08:11 Raabiha’s Story: Managing a Practice and Family 08:58 Interjection 16:03 Raabiha’s Story: Managing a Practice and Family 18:17 Life Seasons and Reducing Clinical Commitment 21:05 The Value of Help and Support Networks 27:00 Financial and Emotional Challenges in Dentistry 33:03 Midroll 36:22 Financial and Emotional Challenges in Dentistry 36:24 Balancing Work and Home Life 42:26 Time Management and Setting Boundaries 46:51 Self-Care and Emotional Regulation 53:53 Upcoming Wellness Event 59:01 Final Thoughts and Future Ideas 59:49 Outro Ready to take the next step? Check out this great resource for new dentists and trainees: Dentistry in a Nutshell Join the community at the Dental Mums Network to connect with dentist‑parents balancing clinical work and family life. Revive 2026 – A Wellness Event Like No Other (6 hours CPD)

Thinking of moving to the USA as a dentist? Wondering what exams, applications, and documents you'll need to practice or specialize there? Curious about how much it costs — and what life as a dentist in the States is really like? Dr. Hazel Kerr and Dr. Dorrin Reyhani join Jaz for a deep dive into everything you need to know about moving to America as a dentist. Both UK-trained and now faculty at UPenn, they share their personal journeys and break down the full pathway — from exams like the INBDE and TOEFL, to transcripts, personal statements, and application timelines. They also discuss what it's like working in the US compared to the UK, including earning potential, patient culture, and training opportunities. Whether you want to complete an advanced standing program, pursue a specialty, or bring your skills back home, this episode gives you a clear roadmap to make it happen. https://youtu.be/Ro9dljETKpc Watch IC065 on YouTube Key Takeaways The journey to becoming a dentist varies significantly by country. Specializing in dentistry can open more opportunities than general practice. Board certification enhances professional status and may offer insurance benefits. International dentists have specific routes to practice in the US. Scholarships can significantly reduce the financial burden of dental education. Teaching positions can provide pathways to practice without additional costs. Faculty primarily teach and supervise dental students in clinics. Early preparation for the INBD exam is crucial for success. Clinical experience and a strong portfolio are essential for applications. Networking and externships can enhance application prospects. Understanding the application process can alleviate stress for international students. Cultural differences impact how dental care is valued and perceived. Highlights of this episode: 00:00 Teaser 00:55 Introduction 04:15 Journey to Specialization 12:49 Understanding the Certification and Board Process 15:35 Exploring Different Routes for International Dentists 18:17 Financial Considerations and Scholarships 25:48 US Difficulty and Competitiveness 29:35 Choosing Between General and Specialty Routes 31:11 Navigating State-Specific Licensing 33:28 Teaching and Clinical Responsibilities 35:03 Midroll 38:24 Teaching and Clinical Responsibilities 43:01 Application Process and Exams 52:07 Residency and Career Pathways 57:39 Application Portals 01:00:35 Work Experience Before Specialization 01:03:22 Why Dentists Choose to Work in the US 01:09:36 Finishing the Program and Looking Ahead 01:12:01 Outro If you enjoyed this episode, you'll definitely be inspired by The American Dental Dream – PDP002. #InterferenceCast #CareerDevelopmentThis 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.

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,