Podcasts about Heller

Gdyby zrobić sondę uliczną i zapytać, czym zajmują się filozofowie, pewnie większość powiedziałaby: myśleniem. Gdyby dopytać, o czym konkretnie myślą, odpowiedzi już by się różniły, ale pewnie obracałyby się wokół wielkich pojęć: byt, moralność, poznanie. Gośćmi dzisiejszego odcinka są naukowcy, którzy w swojej refleksji wzięli na cel coś, co rzadko kiedy bywa obiektem filozoficznego namysłu. Przed Wami autorzy książki „Cokolwiek”: ks. prof. Michał Heller, prof. Jerzy Stelmach i prof. Bartosz Brożek.Książkę znajdziecie tutaj: https://ccpress.pl/cokolwiek/3-26-852Skąd pomysł na taką książkę? – Jest pojęcie ogólniejsze od pojęcia bytu, mianowicie pojęcie cokolwiek. Dlatego że niebyt jest też czymkolwiek, skutkiem tego dyskutowanie o niczym też jest o czymkolwiek – wyjaśnia ks. prof. Heller, filozof, kosmolog i teolog. Ale to nie wszystko. W skład pojęcia „cokolwiek” wchodzi pełna skala czegoś, również coś drobnego czy niedoskonałego, jak byle co. Lubimy się skupiać na tym, co wielkie, kluczowe, a przecież w codziennym życiu obcujemy głównie z tym, co drobne, albo wręcz z byle czym. – Mam wrażenie, że w naszej refleksji nad światem brakuje właśnie refleksji nad byle czym – mówi prof. Brożek, filozof i kognitywista. – A przecież to, co średnie, decyduje o tym, jaki jest świat – ocenia. Nieco inną perspektywę proponuje prof. Stelmach, prawnik i filozof. Wskazuje, że w porę podjęta refleksja nad tym, co w naszym życiu małe, byle jakie, „zamulające” może przynieść dużo dobrego. Można coś takiego dokładnie wskazać i wyeliminować z życia. – Wszystkie błędy, które w życiu popełniamy, to dlatego, że mylimy rzeczy, które są istotne, z byle czym. I że my temu byle czemu poświęcamy Bóg wie jak długo czasu – mówi. Uwaga: nie chodzi tu jednak o to, że powinniśmy w życiu robić tylko rzeczy wielkie i znaczące. Kluczowa jest tu świadomość. Jeśli świadomie decyduję, że poświęcę czas na coś, co innym osobom może wydawać się banalne, to wtedy nie jest już zwykłe cokolwiek, ale konkretne coś. Najgorzej robić byle co automatycznie, siłą rozpędu.W odcinku spieramy się też o lenistwo (żyjemy w cywilizacji lenistwa czy wręcz przeciwnie?), rozmawiamy o prawie Dunsa Szkota, według którego z fałszu wynika cokolwiek, a ks. prof. Heller wyjaśnia, dlaczego prawa przyrody są ograniczeniami i co mają spodnie do filozofii. Odcinek to potoczysty, konwersacyjny i zaskakująco zabawny.

Andre Heller zu Gast im Barbara Karlich Buchklub

In this week’s episode, we break down Ashland QB Nathan Bernhard’s sudden flip from Appalachian State to Maryland and what Ohio’s new NIL ruling could mean for high school athletes moving forward. Then we welcome Hillsdale’s Brady Heller into the studio to recap the Falcons’ hard-fought win over Danville, the importance of depth as injuries stack up and how he’s stepped in on both sides of the ball. Brady reflects on last year’s state title run, the expectations they carry now and previews Hillsdale’s state semifinal matchup with McDonald, including what bringing home a championship would mean to him and the community. Related stories: Hillsdale tops Danville in another instant classic Tradition awaits: Hillsdale meets McDonald & its 100 years of football history Great Expectations: Added pressure hasn’t bothered Hillsdale, Shelby in pursuit of state titles This episode is brought to you by Graham Auto Mall. Intro and outro music is "Story of the Sunflower Samurai" by local artist Vaundoom. Support the show: https://richlandsource.com/membersSee omnystudio.com/listener for privacy information.

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

Ce n'est pas le dernier des lieux communs, nous sommes envahis par les pubs temu et les marchandises, par des objets qui polluent les sols et les esprits, dont pour la plupart, nous sont complètement inutiles, ou alors nous deviennent inintéressant au bout de trois jours. Mais si on creuse un peu le problème, la question de quoi nous avons réellement besoin s'avère plus complexe qu'on le pense. Elle est une véritable question philosophique et politique. Et c'est celle sur laquelle on va se pencher aujourd'hui, à l'aide de Marx, d'Agnès Heller, de Razmig Keucheyan, parmi d'autres. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

In this episode, I'm joined by world-renowned trauma expert Dr. Diane Poole Heller for a profound conversation on attachment wounds, healing relational trauma, and the path back to secure connection. Diane shares insights from decades of work in Somatic Experiencing and her DARe™ model, helping us understand why so many of us feel unsafe in intimacy—and what we can do about it.We explore the origins of avoidant, ambivalent, and disorganized attachment patterns, how early ruptures shape adult relationships, and why nervous system regulation is key to healing. Diane brings a grounded, compassionate perspective to the messy, tender process of becoming securely attached, whether you're in a relationship or not.This conversation is full of lightbulb moments, practical takeaways, and gentle reminders that secure connection is not just possible—it's our birthright.Connect with Diane:www.traumasolutions.comhttps://www.instagram.com/traumaattachmenttraining/❥Softening into self- 3 month 1:1 with Whats App Support:https://marina-yt.mykajabi.com/offers/PAWQhZHu❥❥1:1 Coaching with me: https://docs.google.com/forms/d/e/1FAIpQLSfWcZM5s9c2OjOLwoGMI5jE6rh_JAzjN2d_vCtuVe7e3pVGxw/viewform❥❥❥Stay or Go Course: ⁠https://marinayt.com/stay-or-go⁠ ❥❥❥❥ FREE RESOURCE: a step-by-step process of working with your triggersTRIGGERED TO ROOTED: A ROADMAP TO CREATE TREASURES FROM YOUR TRIGGERSThis powerful step by step process will walk you through how to somatically move through a trigger, ground yourself, allow the emotions to come up and experience massive growth in your lifeDownload here:⁠ ⁠https://marinayt.com/trigger-2-rooted⁠⁠Follow me on Instagram:⁠ ⁠www.instagram.com/marina.y.t⁠⁠ Subscribe to YouTube: http://www.youtube.com/@marinatriner Top Episode Quotes:“Connection is a biological imperative—we're wired to attach, even when it hurts.”“You don't have to wait for a perfect childhood to have a great adulthood.”“Healing attachment wounds isn't about fixing—you're not broken. It's about reconnecting.”“Our patterns were brilliant survival strategies. But they're not always the best relationship strategies.”“Secure attachment can be earned, at any stage of life.”attachment healing, trauma recovery, somatic experiencing, secure attachment, avoidant attachment, anxious attachment, nervous system healing, childhood trauma, relationship wounds, emotional safety, trauma-informed relationships, intimacy healing, healing attachment styles

Welcome to "Thriving in Midlife Redefining Aging with Wellness" the podcast where we discuss how to live an extraordinary life in every aspect. I'm your host, Kellie Lupsha, a high-performance health coach, who is delighted to be your guide to vitality.In today's episode, I'm diving into one of the most misunderstood parts of midlife health: the obsession with quick fixes. Everywhere we look, someone is telling us to try a new peptide, a new hormone, or a new supplement. But before we reach for the “next best thing,” it's time to reconnect with the foundations our bodies have always relied on. If you're ready to feel empowered, clear, and confident in your health again, this episode is for you.Key Highlights:The real foundations of wellness: sleep, hydration, movement, and nurturing yourself.How supplement overload can actually hold you back, and how to simplify your routine.Gene activation and GLP-1 explained: how to naturally turn your body's switches back on.Why exhaustion isn't just about sleep, decision fatigue, and constant notifications are draining your brain.The difference between treating symptoms and supporting your body at its root.Practical ways to nurture yourself daily, even in small five- to ten-minute routines.Key Takeaways:“10 years from now 70% of us will be on some GLP one. It's not for weight loss. It's because the GLP one hormone that we all have inside of us... helps regulate our metabolic health.”-Kellie Lupsha“We have to get back to basics... our bodies as human beings were designed to operate beautifully if we give it the sleep and the rest for restore.” -Kellie Lupsha*TAKE THE FREE ~ DISCOVER YOUR MIDLIFE HEALTH BLUEPRINT*****>>> Click Here

Show notes: (0:00) Intro (0:43) The accidental discovery that launched it all (2:18) Why the palm, not the arm, is key to heat transfer (5:00) Pull-up performance nearly triples using hand cooling (7:56) How the CoolMitt works and why it matters (15:39) Why cold plunges aren't the same as cooling during workouts (21:31) Circadian rhythms and peak performance timing (25:21) Tips to reduce jet lag and adjust your internal clock (29:42) The link between sleep, memory, and weight gain (31:29) Natural fixes for sleep apnea and insomnia (39:02) Why eating earlier helps your metabolism (43:08) Why ice water is too cold and what temp actually works (45:15) Outro Who is H. Craig Heller?   Dr. H. Craig Heller is the Lorry I. Lokey/Business Wire Professor of Biology at Stanford University. He earned his Ph.D. in Biology from Yale University in 1970 and has spent his career studying sleep, circadian rhythms, and human temperature regulation. His work explores how body temperature impacts performance, fatigue, and recovery, as well as how sleep and circadian biology influence learning, memory, and developmental conditions like Down syndrome.   Dr. Heller has held leadership roles across various departments and programs at Stanford and is widely recognized for both his research and teaching. His discoveries have led to real-world innovations, including technologies that help athletes train more effectively by managing heat stress.   Connect with Dr. Heller: Website: https://coolmitt.myshopify.com/ Links and Resources: Peak Performance Life Peak Performance on Facebook Peak Performance on Instagram  

HUGE NEWS: Pipe and Slipmats – the radio show – will be broadcasting live on Loose FM on Thursday November 20, from 11am-1pm (UK time). Listen live here: https://www.loose.fm Message the station during the show to give us encouragement (or ask for shout outs) on their Insta: https://www.instagram.com/loose.fm/ It's been a minute but we're back once again (yes, like the renegade master) with some brilliant clubland memories and big tunes from the nightlife archives. Will Tunde like any of the music this time? Will James be able to hold back from turning fond clubland memories into academic-style discussions about youth subcultures – and will Scott be able to go through an entire episode without mentioning DJ Sasha? Discover the answers to these questions – together with top tracks from Steve Hurley, Farley & Heller, T-Coy and many more – in the latest episode of Pipe and Slipmats. Note to listeners: we'd really intended to get this one released prior to our summer 2025 Ibiza trip. Sadly we didn't, so please ignore our well-intentioned invite to come party with us on the White Isle. We'll be back there in 2026 though, so watch this space for details.

Lena har lenge ønsket seg denne spesielle gjesten i studio. Svigerfaren hennes, Paul Røthe, fyller 90 år om få uker.Han er også et inspirerende forbilde for Lena, alltid nysgjerrig og åpen for nye perspektiver.Hvordan får du det til, lurer Lena? Det gjelder å lære seg resignasjonens kunst. Stikke fingeren i jorda og akseptere ting som de er. Jo eldre jeg blir, jo viktigere blir det å delta aktivt i livet rundt seg. Ikke tenke på alt man ikke lenger kan gjøre, gi opp og finne den raske veien til TV og godstolen, svarer Paul.For det er trist å møte gamle, forstokkede mennesker som har ment én ting hele livet, uten evne til refleksjon og nye perspektiver.Det prøver jeg å kjempe aktivt imot, ved å holde topplokket i sving, sier han.Paul er med i flere diskusjonsfora. Noen av dem har et bredt aldersspenn, men på tenketanken på Bogstad er det flest eldre mennesker, forteller han.-Der har vi klare regler for at vi ikke skal holde på å klage over alt mulig. Heller spørre seg selv, hva kan jeg gjøre ut av alderdommen. Hvordan kan jeg finne løsninger, være kreativ og konstruktiv i eget liv.Paul forteller også om en fin og aktiv barndom på gård og om faren som ble tatt i fangenskap og sendt til Tyskland under krigen. -Barndommen skulle ikke være risikofri, slik jeg har inntrykk av at mange foreldre tenker i dag at den skal være. Vi regnet med litt skrubbsår og småskader, det var en del av den frie leken. Hosted on Acast. See acast.com/privacy for more information.

Lori Larson Heller is a writer, speaker, fierce ALS advocate, and a widow. She is also the President of the Jim Heller 'End ALS' Memorial Fund. Lori was a previous guest on the podcast (EP 6) and since then has written a book called "Buckle Up" about her life, loss and the power of moving forward. Lori doesn't tell you to "move on" or offer cliches that don't help. She encourages you to emerge stronger, roll down the windows, listen to some tunes and begin to enjoy life again. I hope you are encouraged by her story, humor and faith.

Mickey Heller wasn't eager to open up about his Second World War military service. But his grandson, Aron Heller, a journalist and contributor to The CJN, was curious about his zayde's wartime past—and so, over the span of a decade, he asked questions durings phone calls, visits and emails. As Heller discovered his grandfather's fascinating untold stories, he decided to expand his scope of inquiry to include his grandfather's circle of Jewish veterans who fought in the Second World War, and also Israel's War of Independence as overseas volunteer fighters called mahal. In one story, Heller discovers previously unpublished details about a long-unsolved plane crash in southern Israel that cost the lives of three Canadian military volunteers in 1948. Heller combined these stories into a new nonfiction book, Zaidy's Band, to be released Nov. 11, 2025, for Remembrance Day. Heller joins North Star host Ellin Bessner to share stories about his late grandfather and the parallels between that elder generation and those who are defending Israel today. Related links Learn more about Aron Heller's new book [Zaidy's Band ](https://aronheller.com/)and see where he's holding book talks across Canada from Nov. 11-19. Read Aron Heller's tribute to his late grandfather Mickey Heller, in [The CJN archives](https://thecjn.ca/opinion/even-as-he-turns-100-rcaf-veteran-mickey-heller-goes-back-to-memories-of-the-second-world-war/). Read Aron Heller's coverage from Israel of Oct. 7 in [[The CJN](https://thecjn.ca/opinion/canadian-dispatches-from-israel-at-wartime-like-father-like-daughter/)] Credits Host and writer: Ellin Bessner (@ebessner) Production team: Zachary Kauffman (senior producer), Andrea Varsany (producer), Michael Fraiman (executive producer) Music: Bret Higgins Support our show Subscribe to The CJN newsletter Donate to The CJN Subscribe to North StarClick here

Halloween: celebration or desecration? The Mass, where "God gives joy to my youth." Fr. Matteo's Mass of Saint John? Why does God bless sinful unions with children? The bold declaration of the Transalpine Redemptorists! Dr Heller 's interview on Thuc. Stephen Kokx interviews Julius Smetona of "What Catholics Believe." Christ is King ! Transalpine Redemptorists Open Letter https://papastronsay.com/resources/do... This episode was recorded on 10/28/2025. Our Links: http://linkwcb.com/ Please consider making a monetary donation to What Catholics Believe. Father Jenkins remembers all of our benefactors in general during his daily Mass, and he also offers one Mass on the first Sunday of every month specially for all supporters of What Catholics Believe. May God bless you for your generosity! https://www.wcbohio.com/donate Subscribe to our other YouTube channels: @WCBHighlights @WCBHolyMassLivestream May God bless you all!

AI course, anyone?

The Supreme Court's interpretation of the Second Amendment has changed significantly over the last 20 years. Rulings in cases like DC v. Heller in 2008 and New York State Rifle & Pistol Association, Inc. v. Bruen in 2022 recast the "right to bear arms" in a new legal framework that makes it more challenging to create effective firearm regulations. On this episode of Policy Outsider, we speak with a New York State legislator and a political science scholar about constitutional originalism—the theory underlying aspects of these rulings—and the practical considerations of legislating in the complex legal environment created by the Court's decisions. GuestsHonorable Charles D. Lavine, New York State Assemblymember, Assembly District 13Robert J. Spitzer, Member, Regional Gun Violence Research Consortium; Distinguished Service Professor Emeritus, Political Science Department, SUNY Cortland

Thanks for joining Jill Baughan today on Finding Joy ...No Matter What.   Make a Joy Box for Someone You Care About: https://jillbaughan.com/joy-box/   Baughan, Jill. No Matter What: 90 Devotions for Experiencing Unexpected Joy in Tough Times. Our Daily Bread Publishers, 2025. https://www.amazon.com/Matter-What-Devotions-Experiencing-Unexpected/dp/1640703969/ref=sr_1_fkmr0_2?crid=2P84MZ9ZHR8GP&dib=eyJ2IjoiMSJ9.tntQJ9EM7blGaZoioVbqX6I_0yYOKo8tdykCW8iK-uAvkXQk9Ry0lpqv5B5AbILG2ukb9dFrb2IXoEgQqylefy1nbqk0864loTgd-KtpMP4.n3_3ScZp85susbWQjitYEXe9t2G22Lh_kSGcJ0-dWF8&dib_tag=se&keywords=jill+baughan+book&qid=1740769177&sprefix=jill+baughan%2Caps%2C119&sr=8-2-fkmr0   Bowler, Kate. Have a Beautiful, Terrible Day. Convergent Books, 2024. Everything Happens Podcast.  "Catherine Price: Serious About Fun," 11/07/23. https://katebowler.com/podcasts/serious-about-fun/ Heller, Karen. "Fun Is Dead." The Washington Post, December 23, 2023. Price, Catherine. The Power of Fun: How to Feel Alive Again. Random House, 2023. The Fun Girls from The Andy Griffith Show.  https://en.wikipedia.org/wiki/The_Fun_Girls   Connect with Jill: Facebook ~ Instagram ~ Twitter ~  Website

Hedda ist Seiltänzerin im Alkazar auf der Reeperbahn. Als die Nazis die Macht im Staate übernehmen, verändert sich der Kiez gravierend. Kampmann verbindet die Not ihrer Figuren eng mit den politischen Verhältnissen.

In this week's episode, joined by 2024 New Orleans-Matsue Sister City Exchange Program participants Katherine Heller & Wade Trosclair, the Krewe looks back & celebrates 30 years of friendship between Matsue, Japan & New Orleans, Louisiana... a sister city relationship built on cultural exchange, mutual curiosity, &shared spirit. Together, they reflect on their time in Matsue during the exchange program, their experiences with host families, and the deep connections that form when two communities separated by an ocean come together.------ About the Krewe ------The Krewe of Japan Podcast is a weekly episodic podcast sponsored by the Japan Society of New Orleans. Check them out every Friday afternoon around noon CST on Apple, Google, Spotify, Amazon, Stitcher, or wherever you get your podcasts.  Want to share your experiences with the Krewe? Or perhaps you have ideas for episodes, feedback, comments, or questions? Let the Krewe know by e-mail at kreweofjapanpodcast@gmail.com or on social media (Twitter: @kreweofjapan, Instagram: @kreweofjapanpodcast, Facebook: Krewe of Japan Podcast Page, TikTok: @kreweofjapanpodcast, LinkedIn: Krewe of Japan LinkedIn Page, Blue Sky Social: @kreweofjapan.bsky.social, & the Krewe of Japan Youtube Channel). Until next time, enjoy!------ Support the Krewe! Offer Links for Affiliates ------Use the referral links below & our promo code from the episode (timestamps [hh:mm:ss] where you can find the code)!Support your favorite NFL Team AND podcast! Shop NFLShop to gear up for football season!Zencastr Offer Link - Use my special link to save 30% off your 1st month of any Zencastr paid plan!  (00:53:00)------ Past Matsue/Sister City Episodes ------Lafcadio Hearn: 2024 King of Carnival (S5Bonus)Explore Matsue ft. Nicholas McCullough (S4E19)Jokichi Takamine: The Earliest Bridge Between New Orleans & Japan ft. Stephen Lyman (S4E13)The Life & Legacy of Lafcadio Hearn ft. Bon & Shoko Koizumi (S1E9)Matsue & New Orleans: Sister Cities ft. Dr. Samantha Perez (S1E2)------ Links about the Exchange ------2024 Exchange Program Info/PicturesShogun Martial Arts Dojo (Katie's family's dojo)------ JSNO Upcoming Events ------JSNO Event CalendarJoin JSNO Today!

In 2014, Narendra Modi became India's Prime Minister, marking the beginning of what many experts and international watchgroups identify as a period of democratic erosion in the country. Since then, a number of other democracies around the world have followed India on this path — including, by many measures, the United States. On this episode, Dan Richards talks with two experts on Indian politics and society about Modi's rise in India: its causes and effects, how it compares to other instances of democratic erosion around the world, and what it can teach us about democracy's weaknesses and strengths. Guests on this episode:Poulami Roychowdhury is an associate professor of sociology and international and public affairs at the Watson School of International and Public Affairs.Patrick Heller is a professor of sociology and international and public affairs and director of the Watson School's Saxena Center for Contemporary South Asia. Read Roychowdhury's and Heller's recent work exploring democracy and democratic erosion in India.

Der Birsigparkplatz hinter der Steinenvorstadt soll heller und freundlicher werden. Der Kanton Baselstadt plant eine Zwischennutzung. Es soll Bäume in Töpfen, Sitzbänke und eine Spielkiste geben. Ein Teil der Parkplätze wird aufgehoben. Ausserdem Thema: · Euroairport mit weniger Spätstarts · Velofahrer stirbt bei Unfall auf dem Dreispitz · Stan Wawrinka gewinnt an den Swiss Indoors

Ideologie ist der Wissenschaft fremd, sollte man meinen. Doch jetzt äußern politische Kräfte den Vorwurf immer lauter – und treffen die Wissenschaft damit ins Mark. Wo greift der Vorwurf und wo fängt das politische Gemetzel an? Heller, Lydia www.deutschlandfunk.de, Wissenschaft im Brennpunkt

Heller ikke Hødd ble noen målestokk for LSK, som feide gutta fra Ulsteinvik av Åråsen-matta med 4-0. Trym holder seg innendørs på grunn av ekstremværet Amy, så i denne episoden stiller Sören Döpker opp som vikar. Han benytter anledningen til å fortelle sin versjon av Sandnes-turen, før han må opp i duell mot Patrick i en Tyskland-relatert nøtt.Podkasten produseres av Mottaket Media og inneholder annonsering.

On this week's episode of TheFallenState TV, host Jesse Lee Peterson is joined by Kim Heller—She is an author, political commentator, and social advocate. Kim shares insights from her writing and work, discussing the legacy of apartheid, the challenges facing the country’s democracy, and her unfiltered take on issues of identity and power. Jesse presses with his signature bold questions, sparking moments of both tension and humor as they explore faith, leadership, and truth in a divided society. It’s a powerful exchange you won’t want to miss, as Kim opens up about her personal journey and convictions. The discussion also sheds light on the broader struggles facing not just South Africa, but the world at large.

With his team seemingly getting better with each passing game, Linganore High girls soccer coach Mike Heller is this week's guest on The Final Score podcast. Heller reflects with host Greg Swatek on the Lancers' big showdown with Oakdale over the past week. Linganore did not get the result it wanted, falling to the Bears 3-2 in overtime. But the Lancers did push the Bears more than any team had so far this season. They not only scored the first goals of the season against Oakdale this season, they held a one-goal lead on two different occasions. The coach talks about what that result might do for his team going forward and why it has improved so much since the start of the season. Heller also talks about his background in soccer and how he got his start in coaching. He talks about what it means to him to be coaching at Linganore and why he enjoys coaching this group so much. Prior to that conversation, FNP sports writer Alexander Dacy joins Greg to review Week 4 of the high school football season in Frederick County and look ahead to Week 5.

Today #TradeCrew, we're joined by Justin Heller, an HVAC Install Lead with six years in the trenches and a passion for all things mechanical. From motorcycles to mini splits, Justin brings the same energy and intensity—and he's not afraid to share his perspective on where the HVAC trade is headed. Here's what you'll hear in this episode: Segment 1 – Life Catch-Up, Hobbies & Family Justin talks about balancing installs with motorcycles, mountain biking, and family life. We hear how his passion for mechanics first sparked, his favorite past HVAC R&D episodes, and what his dream downtime weekend looks like. Segment 2 – From Wrenching to Leading: The HVAC Journey At 25, Justin jumped into HVAC without a trade background. He shares how wrenching on bikes translated to installs, the humbling and rewarding moments of his career, standout mentors, and what it takes to lead an install crew. Segment 3 – HVAC Hot Takes & Trade Talk We dig into Justin's take on the A2L transition, where the trade is winning and missing, and how he keeps it real on HVAC social media. He shares daily habits that set his installs apart, his dream truck setup, and his perspective on evolving tech like inverters and press fittings—before closing the segment with his Crawlspace Confession. Segment 4 – Community, Business Mindset & Giving Back Justin reflects on how he channels his energy into mentoring, supporting fellow techs, and building a culture of giving back through training, education, and collaboration. Enjoy the episode?

Merriam-Webster's Word of the Day for September 22, 2025 is: catch-22 • KATCH-twen-tee-TOO • noun Catch-22 typically refers to a difficult situation for which there is no easy or possible solution. In the narrowest use of the term, it refers to a problematic situation for which the only solution is denied by a circumstance inherent in the problem or by a rule. // I'm in a catch-22: to get the job I need experience, but how do I get experience if I can't get the job? See the entry > Examples: “… Liverpool is famed for its nightlife, but I'm getting the impression it could do with some help. … In December 2023, the ECHO spoke to people in Liverpool's late-night economy, and the prevailing view was it had become a struggle. … Prices don't help—drinks and tickets are more expensive than they've ever been, but venues are stuck in a Catch-22 situation, caught between having to cover huge operating costs and wanting to get people through the doors.” — Dan Haygarth, The Liverpool Echo (Liverpool, England), 23 Aug. 2025 Did you know? Catch-22 originated as the title of a 1961 novel by Joseph Heller. (Heller had originally planned to title his novel Catch-18, but the publication of Leon Uris's Mila 18 persuaded him to change the number.) The catch-22 in Catch-22 involves a mysterious Army Air Forces regulation which asserts that a man is considered mentally unsound if he willingly continues to fly dangerous combat missions but that if he makes the necessary formal request to be relieved of such missions, the very act of making the request proves that he is sane and therefore ineligible to be relieved. Catch-22 soon entered the language as a label for any irrational, circular, and impossible situation.

Ever feel stuck in the gap between a great idea and actually getting it done? Licensed psychologist and executive function coach Dr. Carey Heller joins us to reveal how to master your workflow by spotting executive dysfunction and installing the right systems.  Dr. Heller shares unique, actionable strategies, from using AI to break down overwhelming projects to leveraging physical movement for better focus and why the phrase "action precedes motivation" is the ultimate mindset shift. We also explore the importance of active recovery over passive rest and how to create lasting boundaries between your work and personal life.  This episode is a practical guide for turning your intentions into repeatable, lasting habits.ℹ️ About the GuestDr. Carey Heller is a licensed psychologist and co-founder of Heller Psychology Group, based in Bethesda, Maryland, specializing in ADHD and executive function challenges in children, adolescents, and adults. Dr. Heller also runs an executive functioning boot camp program and can see clients virtually in 42 states. Dr Heller really focuses on helping people to be more efficient, better organized, productive, and happier as well as less stressed. In addition to Dr. Heller's work with his practice, he volunteers his time in a variety of ways. Specifically, he serves as the Montgomery County, MD CHADD chapter coordinator and is on the National CHADD board. He also supervises graduate students conducting testing at The George Washington University. Furthermore, Dr. Heller loves to write, has published a few books, and numerous articles, especially in Attention Magazine and Washington Parent Magazine.Websites:Heller Psychology Group  Dr. Carey Heller's personal site   Instagram:@hellerpsych  @CareyHellerPsyD  

GUARDIAN AT THE GATEFOLD—Today's guest has become almost synonymous with graphic design and editorial publishing. His career began in the defiant New York “sex press” of the late 1960s, where not-actually-that-surprisingly, as a teenager he was already art-directing magazines like Screw and The New York Review of Sex. That unlikely starting point gave him a rare education in the power of design to command attention and shape meaning.We're talking about designer, author, editor, educator, and true legend, Steven Heller.Heller went on to spend more than three decades at The New York Times, most memorably as art director of The New York Times Book Review. There, he transformed the visual life of the section, commissioning bold, original illustration and making the case—over and over again—that design is not ornamental but integral to editorial voice. Through his advocacy, he helped elevate the status of designers in publishing offices, giving visual thinkers a seat at the table alongside editors and writers.Beyond the newsroom, Heller has been prolific almost to the point of obsession. He has written, edited, or co-authored more than two hundred books on design, creating an extraordinary record of the field's history, ideas, and influences. And most recently, he turned that critical eye inward with his memoir, Growing Up Underground, a candid account of his early years in New York's counterculture publishing scene.Steve is a practitioner, a chronicler, and an advocate for design—and he's also part of the team here at Magazeum. We are thrilled to turn the mic on him for this special conversation.—This episode is made possible by our friends at Commercial Type and Freeport Press. A production of Magazeum LLC ©2021–2025

This week's guest is Dr. Craig Heller, a Stanford biology professor who has spent decades studying thermoregulation, circadian rhythms, and human performance. Dr. Heller explains his groundbreaking discovery that cooling specific hairless surfaces of the body (the palms, soles, and face) can dramatically extend endurance, strength, and recovery. From enabling athletes to push past muscle failure to offering practical solutions for both heat exhaustion and hypothermia, his research has profound implications for training, competition, and even medical recovery. It's a fascinating conversation about how the body manages heat, why performance often fails when it does, and how simple interventions might redefine human limits. Hope you enjoy.

Scalia's Heller ruling — and the decisions that followed — didn't just reshape gun laws; they transformed political disagreements into open-season assassinations…See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode, we sit down with James Heller to explore his unexpected journey from physics to real estate wholesaling. James opens up about his early career in the semiconductor industry, how the pandemic shifted his path, and the role a close friend played in introducing him to the world of real estate in Boise. What began as cold calls and trial-and-error quickly turned into a career built on persistence and adaptability.We dive into the early challenges James faced without formal training, his first breakthrough deal in Longmont, and the lessons that reshaped his approach to valuing properties and closing deals. James shares how his leadership experience from the corporate world gave him an edge in team building, KPI tracking, and managing business operations remotely.He also unpacks his strategies for hiring, scaling with virtual assistants, and identifying bottlenecks in business growth. With a clear focus on the Colorado market, James reveals why staying local has been key to his success and how he plans to continue scaling through people and processes.From physics labs to phone calls, James's story is packed with insights on resilience, leadership, and the practical side of building a real estate business from scratch.Key Topics:-James Heller's transition from physics to wholesaling real estate-Early challenges and first deal in Longmont-Leadership skills and applying KPIs to business growth-Expanding the team with virtual assistants and new hires-Lessons from flipping and managing disposition strategies-Introduction of Acre Fi and future plans===

This week's Summer Series is a multi-family office twofer, with Stan Miranda, co-founder and Chairman Emeritus of Partners Capital and Jenny Heller from Brandywine. Both firms started as multi-family offices that have evolved in different ways. Partners Capital has grown and scaled as a leading OCIO, while Brandywine has remained a boutique with a fixed set of family clients. Please enjoy my conversations with Stan Miranda from 2023 and Jenny Heller from episode 7 back in 2017 and a follow-up in 2021. Jenny Heller EP. 7 – May 17, 2017 Jenny Heller EP. 211 – August 29, 2021 Stan Miranda EP. 334 – August 21, 2023 Learn More Follow Ted on Twitter at @tseides or LinkedIn Subscribe to the mailing list Access Transcript with Premium Membership

This week's Summer Series is a multi-family office twofer, with Stan Miranda, co-founder and Chairman Emeritus of Partners Capital and Jenny Heller from Brandywine. Both firms started as multi-family offices that have evolved in different ways. Partners Capital has grown and scaled as a leading OCIO, while Brandywine has remained a boutique with a fixed set of family clients. Please enjoy my conversations with Stan Miranda from 2023 and Jenny Heller from episode 7 back in 2017 and a follow-up in 2021. Jenny Heller EP. 7 – May 17, 2017 Jenny Heller EP. 211 – August 29, 2021 Stan Miranda EP. 334 – August 21, 2023 Learn More Follow Ted on Twitter at @tseides or LinkedIn Subscribe to the mailing list Access Transcript with Premium Membership

In this Huberman Lab Essentials episode, my guest is Dr. Craig Heller, PhD, a professor of biology at Stanford University and a world expert on the science of temperature regulation. We discuss how the body and brain regulate temperature in different conditions and why conventional cooling methods, such as placing ice packs on the neck, do not effectively reduce core body temperature. Dr. Heller explains why cooling glabrous skin areas—the palms, soles and upper face—efficiently releases body heat and can significantly enhance physical performance and endurance. We discuss how targeted palmar cooling improves both short-term performance and long-term training adaptation in aerobic and anaerobic exercise. Read the episode show notes at hubermanlab.com. Thank you to our sponsors AG1: https://drinkag1.com/huberman Carbon: https://joincarbon.com/huberman Function: https://functionhealth.com/huberman Timestamps (00:00) Craig Heller (00:26) Deliberate Cold Exposure, Cold Showers, Ice Baths; Vasoconstriction (02:26) Cold Shower vs Cold Immersion, Boundary Layer, Tool: Improve Aerobic Exercise Performance (04:54) Anaerobic Exercise & Overheating, Muscle Failure, Muscle Fatigue (07:19) Sponsor: Carbon (09:06) Anaerobic Exercise, Cool Down with Ice Water or Cold Towel? (11:28) Should You Cool Body/Head to Lower Body Temperature?, Hyperthermia, Heat Stroke (15:17) Body Sites for Quick Cooling: Palms, Soles & Upper Face, Glabrous Surfaces (17:48) Tool: Loosen Grip & Performance; Gloves & Socks (19:21) Cooling Brain via Upper Face (20:41) Sponsor: AG1 (22:05) Cooling Brain to Offset Concussion? (23:01) Enhance Anaerobic Performance & Cooling Palms, Heat Loss (26:17) Improve Aerobic Endurance & Cooling Palms (27:11) CoolMitt; Ice Cold Is Too Cold (30:11) Sponsor: Function (31:44) Tool: Use Palmer Cooling to Enhance Performance; Cooling Palms, Soles & Face (35:28) Acknowledgments Disclaimer & Disclosures Learn more about your ad choices. Visit megaphone.fm/adchoices

Today, we're diving into a condition that's as fascinating as it is complex: Achalasia—where the esophagus stops playing nice, and swallowing becomes a daily challenge. We're breaking down the latest evidence, comparing POEM, pneumatic dilation, and Heller myotomy, and digging into what actually matters when deciding how to treat each achalasia subtype. Join show hosts Drs. Jake Greenberg, Dana Portenier, Zach Weitzner, and Joey Lew as they discuss the past, present, and future of Achalasia management. Whether you're a medical student or a seasoned attending, this episode will arm you with the tools to think critically about diagnosis, tailor your treatment strategy, and stay ahead of the curve on the future of achalasia care. Hosts:  ·      Jacob Greenberg, MD, EdM, MIS Division Chief and Vice Chair for Education, Duke University ·      Dana Portenier, MD, MIS Fellowship Director, Duke University ·      Zachary Weitzner, MD, Minimally Invasive and Bariatric Surgery Fellow, Duke University, @ZachWeitznerMD ·      Joey Lew, MD, MFA, Surgical resident PGY-3, Duke University, @lew__actually Learning Goals:  By the end of this episode, listeners will be able to: ·      Describe the pathophysiology and key diagnostic criteria for achalasia, including the role of manometry, EGD, and esophagram. ·      Differentiate between the three subtypes of achalasia based on the Chicago Classification and understand the clinical significance of each. ·      Compare treatment options for achalasia—pneumatic dilation, Lap Heller myotomy, and POEM—including indications, efficacy, and long-term outcomes. ·      Interpret landmark studies (e.g., European Achalasia Trial, JAMA POEM trial) and their impact on treatment decision-making. ·      Recognize patient-specific factors (age, comorbidities, achalasia subtype) that influence the choice of therapy. ·      Discuss evolving technologies and future directions in achalasia management, including endoluminal robotics, ARMS, and combined anti-reflux strategies. ·      Outline a basic treatment algorithm for newly diagnosed achalasia, incorporating diagnostic steps and tailored interventions. ·      Appreciate the multidisciplinary approach to achalasia care, including the roles of MIS surgeons, gastroenterologists, and emerging procedural skillsets. References: ·      Boeckxstaens G, Elsen S, Belmans A, Annese V, Bredenoord AJ, Busch OR, Costantini M, Fumagalli U, Smout AJPM, Tack J, Vanuytsel T, Zaninotto G, Salvador R; European Achalasia Trial Investigators. 10‑year follow-up results of the European Achalasia Trial: a multicentre randomised controlled trial comparing pneumatic dilation with laparoscopic Heller myotomy. Gut. 2024 Mar;73(4):582‑589. doi: 10.1136/gutjnl‑2023‑331374. PMID: 38050085 https://pubmed.ncbi.nlm.nih.gov/38050085/ ·      He J, Yin Y, Tang W, Jiang J, Gu L, Yi J, Yan L, Chen S, Wu Y, Liu X. Objective Outcomes of an Extended Anti‑reflux Mucosectomy in the Treatment of PPI‑Dependent Gastroesophageal Reflux Disease (with Video). J Gastrointest Surg. 2022 Aug;26(8):1566–1574. doi:10.1007/s11605‑022‑05396‑9. PMID: 35776296 https://pubmed.ncbi.nlm.nih.gov/35776296/ ·      Modayil RJ, Zhang X, Rothberg B, et al. Peroral endoscopic myotomy: 10-year outcomes from a large, single-center U.S. series with high follow-up completion and comprehensive analysis of long-term efficacy, safety, objective GERD, and endoscopic functional luminal assessment. Gastrointest Endosc. 2021;94(5):930-942. doi:10.1016/j.gie.2021.05.014. PMID: 33989646. https://pubmed.ncbi.nlm.nih.gov/33989646/ ·      Ponds FA, Fockens P, Lei A, Neuhaus H, Beyna T, Kandler J, Frieling T, Chiu PWY, Wu JCY, Wong VWY, Costamagna G, Familiari P, Kahrilas PJ, Pandolfino JE, Smout AJPM, Bredenoord AJ. Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment-naive patients with achalasia: a randomized clinical trial. JAMA. 2019 Jul 9;322(2):134–144. doi:10.1001/jama.2019.8859. PMID: 31287522. https://pubmed.ncbi.nlm.nih.gov/31287522/ ·      Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT; ACG Clinical Guidelines Committee. ACG clinical guidelines: Diagnosis and management of achalasia. Am J Gastroenterol. 2020 Sep;115(9):1393–1411. doi:10.14309/ajg.0000000000000731. PMID: 32773454; PMCID: PMC9896940 https://pubmed.ncbi.nlm.nih.gov/32773454/ ·      West RL, Hirsch DP, Bartelsman JF, de Borst J, Ferwerda G, Tytgat GN, Boeckxstaens GE. Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol. 2002;97(6):1346-1351. doi:10.1111/j.1572-0241.2002.05771.x. PMID:12094848. https://pubmed.ncbi.nlm.nih.gov/12094848/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen