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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

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.

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

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

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

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

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

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

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

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

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

The Northern Mental Health Nursing Qualitative Research Forum meets three times a year to connect Mental Health Nurse researchers interested in, and conducting, qualitative research, methodologies and innovations. If you wish to be added to the mailing list, please contact james.turner@shu.ac.uk. The following session was recorded at their fifth event on Friday 3 May 2024. With thanks to Prof Karen Wright and Dr James Turner for organising the event and the invitation to support with recording the sessions. Author: Dr Gary Lamph Title: A World Café Approach that explored perspectives of people with lived experience and occupational experience Background - The diagnosis personality disorder is one which continues to split opinions. Negative connotations, stigma and negativity surrounds the diagnostic category. In recent years a movement to challenge the label and terminology of personality disorder has emerged. Aim – To explore the perspectives of the diagnostic label personality disorder with people with lived and occupational experience in a live conference world café based format. Methods – Adopting a World café participatory method provided a flexible and effective approach to capturing the qualitative views of people in a large group format. Table discussions were hosted using a co-facilitated model to capture the table discussions. Each table had different discussion points pertaining to the diagnostic label. The event ensured that necessary dialogue is developed, delivered and analysed in co-production. The unique methods and delivery will be discussed. Results - This study identified contrasting opinions towards the label of Personality Disorder and provides insight into the concerns described for both keeping and losing the label. Although many felt the words ‘‘personality'' and ‘‘disorder'' are not in themselves helpful, certain positive views were also revealed. Perspectives towards the label were influenced by the way in which diagnosis was explained and understood by patients and practitioners, alongside the extent to which service provision and evidence-based interventions were offered. X Links: VG - https://x.com/VanessaRNMH NL - https://x.com/niadla​​​​​​​​ DM - https://x.com/davidamunday GL - https://x.com/gazlamph

Aim- To bless God for His anointing of us - keeping us in Christ. --I. Doctrine- God's Anointing of His Churchmen is Invincible - A. Real Threats Really Do Come Our Way- B. But None of Them Can De-Christianize Us--II. Exegesis- The Teaching Ministry of God's Anointing of Us, His Children- A. It Anticipates Liars and Their Treacheries -v. 26-- B. It is the Special Grace of the Holy Spirit -v. 27a-- C. Its Main Function is to Keep Us United to the Godhead -v. 27b---III. Application- Why God's Anointing of Us is Our Unconquerable Secret Weapon- A. Because the World Can Do Nothing About the Fact that We Possess This -- B. The Impregnable Blocker Of All Serious Theological Error

Aim- To glory in our risen Christ - as God's resurrected church

Aim: To glory in our risen Christ - as God's resurrected church

Welcome to episode 119 [originally broadcast on Wednesday 15 March 2023] of #mhTV​​​​​​​​. Between 13 and 14 March the 2023 Horatio Congress happened in Malta. Dr Neil Murphy and Dave Munday attended on behalf of Unite/MHNA. In this episode, Neil and Dave provide a brief reflection on some of the highlights from the two day event. Following this you can see a recording of the congress session that Dave gave, joined by Nicky Lambert via Zoom: ‘#mhTV – how to build an online digital community'. We were also lucky to have the excellent volunteer, Shuna Vanner take up the ask to join in the conference session. Shuna is a clinical nurse specialist in Heiloo, Netherlands. Background: Mental ill health is still seen as frightening or mysterious, although it's part of everyday human experience. The community of people who live with mental distress, who care for and about them, who work to make things easier through research, practice and education have move in common than divides them and there is much to be understood and celebrated. During the pandemic and in their own time, the #mhTV team created an online television and podcast series to support colleagues, celebrate nursing and discuss mental health issues. We began by live streaming their conversations about COVID-19 on Facebook and covered mor- al injury, bereavement, loss and social inequality and have gone on to produce a 100 episodes about all aspects of mental health practice. Aim: To share our experience of coproducing a learning network and collaborating to produce educational and professional content Method: This is a shared and coproduced endeavour - we meet guests and engage in helping conversations to make complex ideas or intimidating topics accessible and interesting - we share links to work, articles, im- ages and support independent learning during the show and can respond to real time questions. We want to share our love of mental health communities and believe that you don't need permission to educate yourself or explore subjects you find interesting. For example the team also hosted the mental health nursing research conference enabling it to go ahead free of charge and expanding its reach to be seen by more than 2,000 people compared to its usual 200 attendees. Results and Discussion: In this workshop we will describe what we did and why. We will look at the successes and lessons learned and offer practical suggestions and guidance for anyone wishing to try something similar. We will also describe the technology used and how to get the most out of social media from a professional perspective. Some useful links: - Horatio: European Psychiatric Nurses website: https://www.horatio-eu.com - The Horatio Congress website: https://www.horatiocongress2023.com - An Unite/MHNA Twitter thread from #HoratioCongress2023: https://twitter.com/Unite_MHNA/status/1635192459310530560?s=20 Some Twitter links to follow are: VG - www.twitter.com/VanessaRNMH NL - www.twitter.com/niadla​​​​​​​​ DM - www.twitter.com/davidamunday Horatio: https://twitter.com/Horatio_eu Credits: #mhTV Presenters: Vanessa Gilmartin, Nicky Lambert & David Munday Guests: Dr Neil Murphy & Shauna Vanner Theme music: Tony Gillam Production & Editing: David Munday

Key verse. v. 4 Little children, you are from God and have overcome them, for he who is in you is greater than he who is in the world. --Aim- To be transformed in our thinking, through Jesus', triumph on our behalf.

Key verse. v. 4 Little children, you are from God and have overcome them, for he who is in you is greater than he who is in the world. --Aim- To be transformed in our thinking, through Jesus', triumph on our behalf.

Key verse. v. 4 Little children, you are from God and have overcome them, for he who is in you is greater than he who is in the world. Aim: To be transformed in our thinking, through Jesus', triumph on our behalf.

Aim: To understand the true meaning of Advent love (Isaiah 43:1-3; 54:10; Matthew 1:18-21)

Aim: To examine what our Christian response should be to Halloween (1 Corinthians 8)

Aim: To ask ourselves if we have lost sight of what church is meant to be (Acts 2:42-47)

Aim: To bless God for His anointing of us - keeping us in Christ. I. Doctrine: God's Anointing of His Churchmen is Invincible A. Real Threats Really Do Come Our Way B. But None of Them Can De-Christianize UsII. Exegesis: The Teaching Ministry of God's Anointing of Us, His Children A. It Anticipates Liars and Their Treacheries (v. 26) B. It is the Special Grace of the Holy Spirit (v. 27a) C. Its Main Function is to Keep Us United to the Godhead (v. 27b)III. Application: Why God's Anointing of Us is Our Unconquerable Secret Weapon A. Because the World Can Do Nothing About the Fact that We Possess This — B. The Impregnable Blocker Of All Serious Theological Error

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.09.07.506981v1?rss=1 Authors: Parks, S. Z., Rutter, G. A., Leclerc, I. Abstract: Background: Soluble Resistance Related Calcium Binding Protein (sorcin) is a calcium (Ca2+) binding protein which has been shown to play a role in maintaining intracellular endoplasmic reticulum (ER) Ca2+ stores and lowering ER stress. Recently, our lab has demonstrated that sorcin expression was downregulated in the islets of Langerhans of mice fed a high-fat diet or in human islets incubated with the saturated fatty acid palmitate. We also showed that overexpression of sorcin under control of the rat insulin promoter (RIP7) in C57BL/6J mice, or whole body sorcin deletion in 129S1/SvImJ mice, improves or impairs insulin secretion and pancreatic {beta}-cell function respectively. The mechanisms behind this beneficial role of sorcin in the pancreatic {beta}-cell might depend on protection against lipotoxic endoplasmic reticulum (ER) stress through improved ER Ca2+ dynamics and activation of the Activating Transcription Factor 6 (ATF6) branch of the unfolded protein response (UPR). Whether sorcin is also implicated in hypothalamic ER stress during the progression of obesity is unknown. This could potentially contribute to the diminished satiety typically observed in overweight individuals. Aim: To investigate a potential role of sorcin in hypothalamic ER stress, leptin resistance, hyperphagia and obesity. Methods: Whole-body sorcin null mice, backcrossed onto the C57BL/6J genetic background, were used. Body weight, food intake and EchoMRI body composition were measured in vivo whereas qRT-PCR analysis of sorcin and ER stress markers expression were performed on the arcuate nucleus of the hypothalamus. Leptin signalling through STAT3 phosphorylation was measured by Western blots on sorcin-null HEK293 cells, engineered by CRISPR/Cas9, and transfected with leptin receptor (LepRb). Results: Sorcin expression was not influenced in the arcuate nucleus (ARC) of the hypothalamus by diet-induced obesity. Whole-body sorcin ablation did not cause ARC ER stress nor changes in body weight, body composition or food intake in C57BL/6 male mice exposed to a high-fat, high-sugar diet. STAT3 phosphorylation (Y705) in response to leptin was not impaired in sorcin-null HEK293 cells. Conclusion: In our model, whole body sorcin ablation did not increase hypothalamic ER stress nor influenced food intake or body weight. Copy rights belong to original authors. Visit the link for more info Podcast created by PaperPlayer

Aim: To see that the Purim feast is a foretaste of our eternal future (Esther 9:20-10:3)

Aim: To understand that our faith is based on “being certain of what we do not see” (Esther 9:1-19)

Aim: To understand that God's justice and love are inseparable (Esther 8)

Aim: To understand what it means to identify as one of God's people (Esther 5)

Aim: To see that God's presence is often seen most in the actions of His people (Esther 4)

Aim: To see that God can use us as an instrument of hope (Esther 2:19-3:15)

Aim: To see that God is working and wants to use us in EVERY situation that we find ourselves in (Esther 2:8-18)

Aim: To see that pride comes before a fall (Esther 1:10-22)

Aim: To understand what it means to be a humble Christian (John 13:1-11; Matthew 6:1-3)

Aim: To understand that we should be like King Jesus, not King Xerxes (Esther 1:1-9)

Aim- To be good stewards in Christ of life and death -earth and heaven---Key Verses-vv. 23-24- -I am hard pressed between the two. My desire is to depart and be with Christ, for that is far better. But to remain in the flesh is more necessary on your account.- -ESV-

Aim- To be good stewards in Christ of life and death -earth and heaven---Key Verses-vv. 23-24- -I am hard pressed between the two. My desire is to depart and be with Christ, for that is far better. But to remain in the flesh is more necessary on your account.- -ESV-

Aim- To be Faithful to God in Christ-as His redeemed people--Key Verse-v. 3- -Then this Daniel became distinguished above all the other high officials and satraps, because an excellent spirit was in him. And the king planned to set him over the whole kingdom.- -ESV-

Aim- To be Faithful to God in Christ-as His redeemed people--Key Verse-v. 3- -Then this Daniel became distinguished above all the other high officials and satraps, because an excellent spirit was in him. And the king planned to set him over the whole kingdom.- -ESV-

Aim- To both Love and Fear The God of Glory-in our Lord Jesus Christ-Key Verse-v. 28- -PERES, your kingdom is divided and given to the Medes and Persians.- -ESV-

Aim- To both Love and Fear The God of Glory-in our Lord Jesus Christ-Key Verse-v. 28- -PERES, your kingdom is divided and given to the Medes and Persians.- -ESV-

Aim- To be Humble and Loving Listeners -to Jesus--Key Phrase-v. 23c- - . . . but the God in whose hand is your breath, and whose are all your ways, you have not honored.- -ESV-

Aim- To be Humble and Loving Listeners -to Jesus--Key Phrase-v. 23c- - . . . but the God in whose hand is your breath, and whose are all your ways, you have not honored.- -ESV-

Aim: To understand the context and background of the Jewish people in the lead up to the book of Esther (Esther 1:1-9)

Aim: To understand the six key characteristics that confirm scripture as the only word of God (Psalm 19:7-14)

Aim- To be Humble, God-Loving Christian churchmen--Key Verse-v. 17- -Then Daniel answered and said before the king, 'Let your gifts be for your-self, and give your rewards to another. Nevertheless, I will read the writing to the king and make known to him the interpretation.' - -ESV-

Aim- To be Humble, God-Loving Christian churchmen--Key Verse-v. 17- -Then Daniel answered and said before the king, 'Let your gifts be for your-self, and give your rewards to another. Nevertheless, I will read the writing to the king and make known to him the interpretation.' - -ESV-

Aim- To remain Faithful to Christ-Not Straying from Him--Key Verses-vv. 19-20a- -The LORD has said to you, O remnant of Judah, 'Do not go to Egypt.' Know for a certainty that I have warned you this day that you have gone astray at the cost of your lives.- -ESV-

Aim- To remain Faithful to Christ-Not Straying from Him--Key Verses-vv. 19-20a- -The LORD has said to you, O remnant of Judah, 'Do not go to Egypt.' Know for a certainty that I have warned you this day that you have gone astray at the cost of your lives.- -ESV-

Aim: To understand that we must trust in the Lord with all our hearts (Proverbs 3:5-6)