Podcasts about Occlusion

Pediatric dentist and entrepreneur Dr. Ashley Lerman joins little teeth, BIG Smiles to chat with Dr. Berg about her company First Grin and how its unique approach to teaching families about oral health care. Dr. Lerman shares how First Grin was born out of her experience right out of residency, working in a clinic, seeing dozens of high-risk patients a day who often had little-to-no prevention knowledge. She explains the original First Grin kit designed for expectant parents to set families up for success with the tools and knowledge needed for at-home preventive care. Dr. Lerman also delves into how First Grin is finding success partnering with payers and hospital networks to flag early oral health care as a priority issue amongst medical professionals outside of dentistry. Guest Bio: Dr. Ashley Lerman is a board-certified pediatric dentist, public health advocate, and founder of First Grin, a digital prevention platform that brings oral health into everyday family life. Through First Grin's app and educational kits, she helps families, payers and health systems connect dental care with overall wellness, starting in pregnancy and continuing through childhood and beyond for adults. Dr. Lerman works with major payers, employers, and baby registry partners to make preventive oral health education more accessible at-scale. Her work focuses on building sustainable tech – enabled models that improve engagement, reduce stress, reduce disease, and make oral care easier for families to start early and stick with over time. She's also the voice behind @pediatricdentistmom, a popular social media platform reaching millions of parents for its relatable evidence-based guidance on children's oral health. Her approach blends clinical expertise with empathy, helping parents build healthy habits without guilt or overwhelming them. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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

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Dr. Sean Aiken returns with a bigger family, bigger practice, and more wisdom. He shares how he refined his practice, how he achieves balance and happiness with both family and dentistry, and when he's learned to say "no" as a dentist. Ladies & Gentlemen, you're listening to "Confessions From A Dental Lab" and we're happy you're here. Subscribe today and tell a friend so we can all get 1% better :)Connect with Dr. Aiken on instagram at @saaiken15 and email him at draiken@stmatthewsdentistry.comFollow KJ & NuArt on Instagram at @lifeatnuartdental.com, you can also reach us via email: kj@nuartdental.comLearn more about the lab and request information via our website: https://nuartdental.com/contact

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

Please visit answersincme.com/UPU860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, an expert in managing patients with retinal vein occlusion (RVO) discusses the use of longer-acting anti-VEGF treatments for treating RVO. Upon completion of this activity, participants should be better able to: Explain the rationale for exploring longer-acting anti-VEGF treatment for patients with retinal vein occlusion (RVO); Differentiate the clinical profiles of available and emerging anti-VEGF treatments for macular edema following RVO, based on the latest evidence; and Propose optimized, patient-centered treatment plans for the multidisciplinary management of patients with RVO.

Join Elevated GP: www.theelevatedgp.com Net32.com  Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram His interdisciplinary approach to dentistry is founded in both empirical research and clinical experience. He attended the University of Washington for both his undergraduate and graduate studies where he received his D.D.S. degree in 1995 and an M.S.D. and certificate in Prosthodontics in 1998. For his entire career, Dr. Kinzer has been committed to furthering the art and science of dental education. His unique ability to impart complex clinical processes in a logical, systematic and clear methodology differentiates him from other Prosthodontists and makes him a highly regarded educator nationally and internationally. He is a full-time teaching faculty at Spear Education in Scottsdale, AZ. where he is also resides as the Faculty Chairman and Director of Curriculum and Campus Education. Dr. Kinzer is an Affiliate Assistant Professor in the Graduate Prosthodontics Department at the University of Washington School of Dentistry and an Adjunct Faculty at Arizona School of Dentistry and Oral Health. Dr. Kinzer is a member of many professional organizations including the American Academy of Restorative Dentistry and the American Academy of Esthetic Dentistry, of which he is currently the sitting President. He serves on the editorial review board for several recognized dental publications and has written numerous articles and chapters for dental publication. He has been honored with the American College of Prosthodontics Achievement Award and in 2018, he received the Saul Schluger Memorial Award for Excellence in Diagnosis and Treatment Planning from the Seattle Study Club. In 2022 he was inducted into the World's Top 100 Doctors as part of the Interdisciplinary Cohort. In his free time, Gregg cherishes spending time his wife Jill and their 6 children. He enjoys anything that he can do outside: golfing, hiking, running, skiing, and biking, in addition to a nice glass of wine.

Contributor: Aaron Lessen MD Educational Pearls:  Recent prospective randomized clinical trial assessed optimal head-of-bed positioning in patients with LVO 0º vs. 30º elevation Objective was to determine superiority of the two angles in stability prior to thrombectomy for LVO patients 45 patients randomized to the group with 0° head positioning and 47 patients randomized to the group with 30° head positioning Patients in the 30º group experienced worsening of NIHSS by 2 points or more Patients with head position at 0° showed score stability Hazard ratio 34.40; 95% CI, 4.65-254.37; P 

Please visit answersincme.com/SYV860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, two experts in retinal vein occlusion (RVO) discuss diagnosis and anti-VEGF treatment of the condition. Upon completion of this activity, participants should be better able to: Explain the rationale for exploring longer-acting anti-VEGF treatment for patients with RVO; Recognize the importance of early diagnosis to address the burden of RVO; and Propose optimized, patient-centered treatment plans for the multidisciplinary management of patients with RVO.

Please visit answersincme.com/SYV860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, two experts in retinal vein occlusion (RVO) discuss diagnosis and anti-VEGF treatment of the condition. Upon completion of this activity, participants should be better able to: Explain the rationale for exploring longer-acting anti-VEGF treatment for patients with RVO; Recognize the importance of early diagnosis to address the burden of RVO; and Propose optimized, patient-centered treatment plans for the multidisciplinary management of patients with RVO.

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

Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses Outcomes of Left Atrial Appendage Occlusion in Patients With and Without Gastrointestinal Bleeds.

Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses Prevalence of peri-device leak in Watchman patients with versus without electrically isolated left atrial appendage.

Host Dr. Joel Berg is joined by American Dental Association (ADA) President Dr. Richard Rosato. In this conversation, Dr. Rosato shares his journey from shifting gears from pediatric medicine to pediatric dentistry as a student and how his relationships have affected his participation in organized dentistry. Dr. Rosato shares his experience as a private practitioner and business owner, and how that mentality and passion influence the impact he hopes to have during his time as ADA President. In particular, Dr. Rosato speaks about the importance of practitioner and patient mental wellbeing. Guest Bio: Dr. Rosato is a native New Englander. He was born in Revere, MA, and raised in Danvers, MA. He moved to NH in 1986 to attend Saint Anselm College. After college, he attended Tufts University School of Dental Medicine and graduated in 1994. Then he was off to Chicago to the University of Illinois Medical Center, Cook County Hospital, Michael Reese Hospital, Mercy Hospital, and the West Side VA for his residency in oral and maxillofacial surgery which was completed in 1998. He then moved back to New England and practiced initially in Rhode Island before finding a home back in NH in 2000. He quickly enjoyed being a part of shaping the profession of dentistry and advocating for patients through leadership. Initially, he served the NH Dental Society as the Council on Government Affairs Chair for 5 years before ascending through the leadership ladder from 2006-10 culminating with becoming president of the NH Dental Society in 2010. Following his year as president he was appointed to the American Dental Society Council on Ethics, Bylaws, and Judicial Affairs and served as chair in his final and fourth year on the Council in 2015. During his national leadership time, he also continued to serve the NH Dental Society as Long Term Delegate for 8 years 2011-2019. He was then appointed to serve from 2015 to 2019 as caucus chair of the ADA First District representing all 6 New England States. Following this he ran and was elected to the ADA board of trustees to serve from 2019-2023. While on the ADA BOT, he also served as compensation chair, ADA Business Enterprise Inc. as a board member, and a board member of the Innovation Advisory Committee. He has a tremendous calling to be at the tip of the profession fighting for oral healthcare so that everyone can have a dental home. He resides in Concord with his wife, Dr. Laurie Rosato, and three children, Richard Jr, Colin, and Madison. He cherishes family time and enjoys golf, the Boston Bruins, and car rides with his labradoodle Roma.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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

In this episode of Five Minute Friday, I get fired up about something that far too many orthodontists overlook: occlusion fundamentals. Not just cuspid rise vs. group function, but how to recognize when a case needs to be treated in CR, how to make a full-coverage splint, and why even a simple occlusal equilibration can radically improve a patient's quality of life. I share what I learned from my three-year gnathological residency at the University of Washington, and why I believe every orthodontist should have this level of working knowledge — especially if you're restoring full arch cases with aligners or fixed appliances.I also float an idea I've been on the fence about: a day-and-a-half live course on occlusion — practical, clinical, and built for orthodontists who want to elevate their diagnosis, treatment planning, and outcomes. If you've ever seen a post on group function and wondered, “Is this OK?” — this episode is your wake-up call. It's time we stop treating occlusion as an afterthought and start embracing it as foundational to our profession.QUOTES"For many of you out there, you're burning the candle on both ends… That's not a consulting problem. That's a coaching problem."– Dr. Glenn Krieger"Will it be cheap? Absolutely not. Will I guarantee you'll make 5x what you spend in your first year? Absolutely."– Dr. Glenn KriegerKey TakeawaysIntro & coaching vs. consulting preview (00:00)The 4 types of growth support: peer groups, mentors, consultants, coaches (01:30)Why peer support (like Orthopreneurs RD) matters — but isn't enough (02:50)The limits of consultants: they fix problems, not whole practices (04:10)Coaching = curriculum + accountability + transformation (05:30)The Schuster Center story & how it changed Dr. Krieger's life (07:15)What the 2026 Orthopreneurs Coaching Program will include (09:30)Call to action: Reach out if you're ready to scale with less stress (11:30)Additional ResourcesIf you're tired of feeling unsure about what to do when a patient's bite “just doesn't feel right,” I'm putting together a potential one-day or day-and-a-half Occlusion Fundamentals for Orthodontists course. We'll cover CR manipulation, splint design, equilibration, and more. DM me if you're interested — if there's enough demand, we'll make it happen. It'll be practical, hands-on, and something you'll use every week in practice.Register for Ortho Vanguard: https://www.opvanguard.com - For more information, visit: https://orthopreneurs.com/- Join our FREE Facebook group here: https://www.facebook.com/groups/

Today's episode is all about expanding your expertise and setting yourself apart in the ever-evolving world of dentistry. As a general dentist, you have the opportunity to transform your practice by sub-specializing in airway and TMJ conditions—two critical areas that are often overlooked but deeply impact patient health. Our guest today is Dr Stephanie Vondrak. She owns and operates a private practice in Elkhorn, Nebraska. Dr. Vondrak is a prime example of how expanding a practice with specialized services in airway and TMJ disorders can elevate the standard of care across all phases of restorative dentistry. In doing so, she has not only enhanced patient outcomes but also found immense fulfillment in her career. Thanks to our episode sponsors: NSK America - https://www.nskdental.com/ Shining 3D- https://www.shining3ddental.com/ GUM - https://www.sunstargum.com/us-en/

Host Dr. Joel Berg is joined by Dr. Tim Wright on this episode of little teeth, BIG Smiles for a discussion of hot topics in dentistry and how those topics make it into the profession's academic publications. Dr. Wright also delves into his experience as Editor of JADA, the Journal of the American Dental Association. Now in his fourth year, he explains the manuscript submission and review process, as well as the topics he anticipates being the next big “cover stories” and emerging topics. Guest Bio: Tim Wright received his DDS degree from West Virginia University and completed his Pediatric Dentistry training and Master of Science Degree at the University of Alabama at Birmingham. He currently is a Professor in the Division of Pediatric Dentistry and Public Health at The Adams School of Dentistry at the University of North Carolina, Chapel Hill, where he has served as Pediatric Dentistry Department Chair and Department of Endodontics Interim Chair. He is a Diplomate of the American Board of Pediatric Dentistry, a Fellow of the American Academy for the Advancement of Science, and a Past President of the American Association of Dental Research. He has Chaired the Counsel of Scientific Affairs for the American Dental Association and American Academy of Pediatric Dentistry. He has published over 200 peer reviewed scientific manuscripts, edited three textbooks and authored 27 text chapters. Dr. Wright is the Editor in Chief of the Journal of the American Dental Association and Chair of the AAPD Evidence Based Dentistry Committee.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Mirza Umair Khalid, MD, social media editor of JACC: Cardiovascular Interventions, and Niccolò Ciardetti, MD discuss a recently published study examining use of Drug Coated Balloons for CTO PCI in the large ERCTO registry.

Early airway health can shape your child's long-term development more than you think. In this episode, myofunctional therapist and dental hygienist Caity Hart joins me to break down what parents need to know about expanders, guided growth appliances and how the mouth and airway are connected. We explore how structural oral issues like crowded teeth, mouth breathing and tongue posture can influence sleep, behavior and even facial development. Caity explains the difference between fixed and removable expanders, how to know if your child is a candidate and the importance of early assessment. We also talk about what to expect during treatment, how bodywork supports the process and why nasal breathing is a key to lifelong health. This conversation is packed with empowering insights for parents who want to be proactive, not reactive, when it comes to their child's oral and airway development. Whether you're concerned about snoring, teeth grinding or just want to get ahead of orthodontic issues, this episode will guide you with clarity, confidence and compassion. Topics Covered In This Episode: Myofunctional therapy and oral development Signs your child may need an expander Skeletal expansion and nasal breathing Early airway assessment for children How to choose the right dental appliance Show Notes: Follow Caity @mindfulmyo/ on Instagram Visit Mindful Myo Read Management of the Developing Dentition and Occlusion in Pediatric Dentistry article Read The Role of Myofunctional Therapy in Pediatric Dentistry article Click here to learn more about Dr. Elana Roumell's Doctor Mom Membership, a membership designed for moms who want to be their child's number one health advocate! Click here to learn more about Steph Greunke, RD's online nutrition program and community, Postpartum Reset, an intimate private community and online roadmap for any mama (or mama-to-be) who feels stuck, alone, and depleted and wants to learn how to thrive in motherhood. Listen to today's episode on our website Caitlyn earned her degree in Dental Hygiene in 2016 from West Los Angeles College after almost a decade in the dental field as a dental assistant in Southern California. In 2020, Caitlyn and her family moved to the Treasure Valley in the beautiful state of Idaho. She has years of experience working in Conventional, Integrative and Airway focused dentistry. Caitlyn is passionate about early identification of craniofacial growth and jaw development deficiencies in children. These negative growth patterns can have profound effects on sleep, breathing and the TMJ into adulthood. Caitlyn believes that Myofunctional therapy is one of the most underutilized treatment modalities in dentistry. Her goal as a therapist is to bridge the gap between oral and systemic health with a focus on nasal breathing, tongue posture, correct swallow and lip seal. She is passionate about encouraging proper craniofacial growth in children and supporting breathing and sleep optimization in all ages. This Episode's Sponsors  Enjoy the health benefits of PaleoValley's products such as their supplements, superfood bars and meat sticks.  Receive 15% off your purchase by heading to paleovalley.com/doctormom  Discover for yourself why Needed is trusted by women's health practitioners and mamas alike to support optimal pregnancy outcomes. Try their 4 Part Complete Nutrition plan which includes a Prenatal Multi, Omega-3, Collagen Protein, and Pre/Probiotic. To get started, head to thisisneeded.com, and use code DOCTORMOM20 for 20% off Needed's Complete Plan! Active Skin Repair is a must-have for everyone to keep themselves and their families healthy and clean.  Keep a bottle in the car to spray your face after removing your mask, a bottle in your medicine cabinet to replace your toxic first aid products, and one in your outdoor pack for whatever life throws at you.  Use code DOCTORMOM to receive 20% off your order + free shipping (with $35 minimum purchase). Visit BLDGActive.com to order. INTRODUCE YOURSELF to Steph and Dr. Elana on Instagram. They can't wait to meet you! @stephgreunke @drelanaroumell Please remember that the views and ideas presented on this podcast are for informational purposes only.  All information presented on this podcast is for informational purposes and not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a healthcare provider. Consult with your healthcare provider before starting any diet, supplement regimen, or to determine the appropriateness of the information shared on this podcast, or if you have any questions regarding your treatment plan.

Dr. Adam Power, co-founder and Chief Medical Officer at Front Line Medical Technologies, shares his fascinating journey from a background in vascular surgery to developing COBRA-OS, a groundbreaking device for hemorrhage control. He discusses the challenges and milestones in bringing this life-saving technology to market, the impact of the device in trauma and emergency care, and innovative future applications, including its unexpected use in non-traumatic cardiac arrest.    Guest links: https://frontlinemedtech.com/ Charity supported: Canadian Cancer Society Interested in being a guest on the show or have feedback to share? Email us at theleadingdifference@velentium.com.  PRODUCTION CREDITS Host & Editor: Lindsey Dinneen Producer: Velentium Medical   EPISODE TRANSCRIPT Episode 064 - Dr. Adam Power [00:00:00] Lindsey Dinneen: Hi, I'm Lindsey and I'm talking with MedTech industry leaders on how they change lives for a better world. [00:00:09] Diane Bouis: The inventions and technologies are fascinating and so are the people who work with them. [00:00:15] Frank Jaskulke: There was a period of time where I realized, fundamentally, my job was to go hang out with really smart people that are saving lives and then do work that would help them save more lives. [00:00:28] Diane Bouis: I got into the business to save lives and it is incredibly motivating to work with people who are in that same business, saving or improving lives. [00:00:38] Duane Mancini: What better industry than where I get to wake up every day and just save people's lives. [00:00:42] Lindsey Dinneen: These are extraordinary people doing extraordinary work, and this is The Leading Difference. Hello, and welcome back to another episode of The Leading Difference podcast. I'm your host, Lindsey, and today I'm excited to introduce you to my guest, Dr. Adam Power. Dr. Power is a leader in innovative medical devices for trauma and emergency care that is committed to lowering the barriers and bleeding control and resuscitation. Dr. Power was instrumental in the development of COBRA-OS, drawing on his unique clinical viewpoint and expertise to ensure utmost patient safety and assist with the company's global expansion. In addition to his current role as co-founder and Chief Medical Officer at Front Line Medical Technologies Incorporated, Dr. Adam Power is a vascular surgeon in the division of vascular surgery at Western University, which he joined in the fall of 2012, and he is involved in all aspects of academics and clinical care. Also, Front Line was just named the 2025 Medical Device Technology Company of the Year, so I definitely wanted to highlight that too. All right. Well, thank you so much for being here today, Adam. I'm so delighted to speak with you. [00:01:55] Dr. Adam Power: Yes, it's a pleasure to be here. Thank you. [00:01:57] Lindsey Dinneen: Of course. Well, I'd love if you would start by sharing a little bit about yourself, your background, and what led you to what you're doing today. [00:02:05] Dr. Adam Power: Sure, I'd love to. So I'm a Canadian. I grew up on the east coast of Canada and was always interested in science and math and those types of things. I think, importantly, I grew up with an identical twin brother as well. So we really didn't know what we wanted to do with our lives, and ultimately we're good in science and math and ended up in medicine. And then both of us, when we got into medicine, we weren't sure exactly what we wanted to do in medicine, and ultimately both of us became surgeons. He became a urology surgeon, and I became a vascular surgeon, where we joke that we're both plumbers. I deal with the red stuff and he's the yellow stuff. But I did my initial medical school out on the east coast of Canada and then I did my general surgery training, which also involved trauma training, and then did a Master's of Bioscience Enterprise, which was basically biotech business from the University of Cambridge in the UK. When I finished my general surgery training, I continued on and did vascular surgery training at Mayo Clinic down in the US, and since that time after graduating from there, I've been at Western University in London, Ontario, Canada, for the past 13 years practicing as a vascular surgeon and an academic vascular surgeon. But when I was here at Western, I was always interested in innovation. I filed my first patent as a resident way back when, and have filed many over the years. But ultimately, if I was ever gonna see anything that came outta my head and was actually used in a patient or I could actually use in a patient, I figured I'd have to do it. I knew that I couldn't do it by myself. And so, I was very fortunate to meet my co-founder Dr. Asha Parekh. She's a PhD, biomedical engineer, extremely smart jack of all trades, and we teamed up now about eight years ago. We met here at Western, teamed up and really took an idea right out of our heads and patented it and raised money for it, prototyped it, brought it all through the regulatory steps to approvals, built a quality system and ultimately got it out onto the market in Canada, US, Europe, now Australia, and more to come. So the commercialization piece is what we've been focusing on over the past three years. And it's been really fun, but very exhausting but very rewarding as well. I think I'll stop there because I've been blathering on, but... [00:04:39] Lindsey Dinneen: No, it's fantastic. I really appreciate it. Plus, it's really fun to hear about your trajectory and so, okay, so you've teased us a little bit about this company of yours and this innovation of yours. Can you now share a little bit more about that and the development of it over time? [00:04:55] Dr. Adam Power: Yes, of course. Well, I mean, thing that we recognized early on is, and I'll just explain how I normally explain it, is if you have bleeding, it's a hemorrhage control device. And so if you have bleeding in your extremities, then you can often either put pressure on it or you can put a tourniquet on it. The problem when you have internal bleeding in the torso is that you can't actually put direct pressure on it, and there's no tourniquet that necessarily works for intraabdominal, intrathoracic bleeding. And when people bleed to death before coming to hospital, I mean, they're bleeding in these areas. You can empty almost your entire blood volume into your chest or into your abdomen. And this does account for a significant number of fatalities in all environments, basically in the trauma environment. That's military, that's pre-hospital, that's any time that that people are bleeding from internal organs. And so, because this is such a problem, the old fashioned way to fix it is to open up someone's chest and put a clamp on the aorta. So what does that do? Is it basically above the clamp, keeps blood flowing. The remaining blood in the body keeps blood flowing to the brain and the heart, keep you alive. And then below the clamp, it stops sort of the hemorrhaging from the spleen or the liver or whatever. So there's two things going on. One above the clamp and two below the clamp. But opening up somebody's chest in, you know, side of the road or in the emergency department really is impossible. You need highly skilled people like vascular surgeons like myself to be able to do this. And even if we were at the side of the road, we don't have the resources available to keep a patient alive. So there is this idea that we could do this minimally invasively, sort of accomplish this through minimally invasive means. And this, the idea of doing REBOA, which is an acronym-- Resuscitative Endovascular Balloon Occlusion of the Aorta-- came into being. This was probably 15, 20 years ago now. It wasn't necessarily a new idea. It had been done since the Korean War. There was somebody actually put a balloon up into someone's aorta to stop bleeding, but it came back again and was starting to be used a little bit more because. And so really the idea is to, through the femoral artery in your groin where you can feel a pulse, you introduce initially a sheath, which is your access point, and then you place the device up through the sheath, up into the aorta and inflate a balloon in the aorta. So instead of an external clamp, it's an internal balloon clamp that keeps blood flowing above the balloon and stops the blood flowing from below the balloon. Initially these devices were as big as my baby finger, like they were massive. And so if you put them in and you took it out, there was a big hole in the artery, had to cut down on the artery and repair the artery. But as it got more and more advanced and technology advanced, they become smaller and smaller. So that's really where we came in. The initial devices were 12 French, about the size of my baby finger. And then it advanced to Seven French and all of a sudden Seven French-- and these are diameter, French sizes are basically diameter-- and so when it went from 12 to seven French, now we could start doing it through the skin without actually cutting down on the artery. But that Seven French size was still very large and you're putting this in the hands of people that don't do this all the time. And so, we had the idea to bring it down even further now to Four French. And so this is essentially the size of an IV. And so you put a tiny little IV in somebody's femoral artery. And lots of different people can do that. And then you advance the device up in, inflate the balloon and you can magically occlude the aorta. In our first study that we did, the first inhuman study, we averaged about just over a minute to occlude someone's aorta, which was really fast to be able to get that amount of control that quickly. So that, that was really been the advancement is to decrease the access size, make this whole procedure simpler so that so that we can essentially save more lives. [00:09:08] Lindsey Dinneen: Okay, so thank you so much for sharing a little bit about that. Can you tell me about the beginnings of this innovation and how you brought it to market? Because it's really wonderful to hear all the success, and I'm so excited to hear that it's spreading, you have presence all over the place now. But you know, that's not an easy pathway. And I'm curious if you could walk us through a little bit about that decision to go, "You know what? We have a solution to a known problem, we can make this happen." And then how did you actually go about doing that? [00:09:42] Dr. Adam Power: Yeah. I think, I mean, I make it sound fairly straightforward, like a nice story, but it certainly was not that. I mean, we were very lucky I would say, that we had a lot of great advisors and mentors that we figured that we try not to fail early, fail fast. We wanted to make this one as successful as possible. So before we made any decision, we often would consult our mentors. And I'm a surgeon. I like to shoot first, ask questions later. My partner is not. And so I think we, we strike an excellent balance between not just the engineering and clinical side of things, but also from driving a business forward, getting all the information, but helping to get decisions made and moving forward. You know, starting out, we really had to choose the right sort of fit for what we wanted to pursue. We like to say it checked all the boxes. It checked all the boxes as far as even where we are. We're in Canada, we're not in a tech triangle where there's tons of funding opportunities. We knew we would be limited from a funding perspective, so we couldn't choose something that necessarily required a hundred million dollars to start up. So, you know, we had this device that we knew that we could fundraise for it. And then once it was fundraised, it was simple enough that we could get it manufactured. We chose to go the OEM route for the original equipment manufacturer, so we didn't have to build a manufacturing facilities ourselves. And then really from there, and building a quality system in the regulatory, we did work with a lot of consultants, that was both positive and negative experience. We had great consultants. We had not so great consultants. But really what our our goal was, is to learn the process ourselves. And so there's always manuals for things, even from the FDA perspective. They give out great documentation about what is supposed to go into an FDA application. And we dug into that. We really tried to understand. We did not trust anyone. That's one of my rules in surgery is, "don't trust anyone, not even myself." So we really didn't trust our consultants, and we tried to double check and triple check everything so that we didn't make mistakes. And of course, we did make mistakes and had to go back to the drawing board a few times. But as much as we wanted to get this out there, we really did wanna learn the process and know the process because ultimately we're the ones that are responsible to the patients in the end, and we needed to make sure that we had a handle on each and every step of the way. We, of course, because of that, were maybe not as quick as we could have been but in other places we became more efficient because, as we learned the process, getting feedback back and doing it right the first time, it really made a difference. So. [00:12:39] Lindsey Dinneen: Yeah, absolutely. Of course. Yeah, and I appreciate you going into a little bit more of the nitty gritty details 'cause it is so fun to hear the success stories, but of course, as you go along, there's that pathway to success. And it's helpful to understand that yeah, it's gonna be potentially a long road, sometimes windy, sometimes weird, but at the same time that it is possible. So as you look to the future with your company, what are you thinking of in terms of the future? Are you going to continue down this pathway and continue with iterations of this device? Are you thinking of new devices to introduce as well? Or, what are your thoughts for the future? [00:13:18] Dr. Adam Power: Yeah. And I have to be very careful what I say here, obviously. I can share generically what our thoughts are. We love this. Ultimately there was no better feeling than to use-- I mean, I've used my device to save a patient. And, you know, I would say that Asha, who's my co-founder, she cares. I'm a physician, but she cares about the patients just as much as I do, as does everyone in our company, which is really quite rewarding. But the future, what does the future hold? We really want this to get to everywhere. Yes, we're in lots of different countries ,have commercialized really all around the globe, but we really wanna go deeper into a lot of these geographies and really help as many people as possible. We realize that we can't do it on our own and are gonna need help. And so that's, we're in a growth phase right now of our company and we're looking for strategic collaboration. We're looking for those opportunities to deepen our ties and in all the different geographies. That being said, we are inventors and of course we have an idea every day about what we could improve on. But as far as the pipeline goes for our company, we are focusing on some very specific up and coming applications that we hope to have in the next couple of years. And I also wanna say that, I talked about trauma and bleeding, but the more exciting side of aortic occlusion has really been the applications. And you'd think, okay, it makes sense for trauma to be able to stop blood flow and stop bleeding. But some of our recent successes have been through postpartum hemorrhage. And there is this really, terrible condition called placenta accreta, where the placenta grows into the uterus and when you deliver the baby either by C-section or by delivery, and then the placenta attempts to be delivered, it tears, and you can have torrential bleeding. And, and so our device is being used in these women who are pregnant when inflicted with this condition and helping to decrease blood transfusions, helping to save a mother's life. So that's been really amazing. And then next on the horizon is strangely there's, it's not even a bleeding application. We've done some research and there's research going on globally about using aortic, minimally invasive aortic occlusion for non-traumatic cardiac arrest. And so if, which is really, again, it's like, "Oh my gosh, does this thing do everything? It might make your supper tonight if you're not careful." So it, so what happens there is that if somebody drops dead basically in front of you, and you start CPR, if you start pushing on their chest and pushing on their heart, you're pushing blood to the whole body. And the way you get someone back to life is if you can get the heart muscle oxygenated again. So if you put an aortic occlusion balloon up close to the heart, every time you push, you're directing blood right into the coronary arteries and right into the brain as well. And so what we're seeing is that there's increased return of spontaneous circulation rates when you do this with CPR. And there are different trials around the world that if this shows that there's an increase in survival or in better neurological survival, this will be the first time that we've really changed the script on cardiac arrest since advanced cardiac life support came out many years ago. So this, again, is very exciting for a simple device to be able to make that much impact in all these different areas. So, you know, we have a lot to focus on right now, even growing into the future because some of these, like cardiac arrest, are quite early on. So we don't wanna lose sight of this great original product, but we do think all the time about different pipeline ideas that could help other patients. [00:17:18] Lindsey Dinneen: Yeah, but, and to your point, even the amazing other use cases for this incredible device, like you said-- maybe it's gonna make us dinner next-- but the idea being that, who knows? I mean, there's so much more to discover even now, which makes me excited just to think about how many more use cases you could have for it and how many more people you could save. So, speaking of that, are there any stories that kind of stand out to you, moments that you've had where, you know, either through your day job, so to speak, being a vascular surgeon, but also being the co-founder of this company that really sort of affirmed to you that, "You know what? I am in the right place at the right time, in the right industry." Just those moments that really stick with you. [00:18:05] Dr. Adam Power: Yeah, I mean, it obviously all stems back to the patient and what patients are impacted. And I remember, the first time that the device was used at our hospital, one of the radiologists called me in and said, " We need to use one of these balloon occlusion devices for a patient that's been in an accident." And so I went in and I said, "I actually have the device that my partner and I created. We can use this for the patient." And so we started using it for the lady that was involved in a very serious accident, had a pelvic fracture, and she was a Jane Doe at that particular time. She was anonymous. And anyway, we noticed that she had actually had some vascular surgery done based on her angiograms, and I leaned over and I-- so she was sedated, but she was awake-- I said, "Have you had vascular surgery? Who's your vascular surgeon?" And she said, "It's Dr. Power. He's such a nice man." And so I was actually helping one of my patients. That was pretty crazy. [00:19:04] Lindsey Dinneen: Oh. [00:19:05] Dr. Adam Power: Also from my hospital, when I heard one of my junior residents was able to save someone's life. So, you know, junior residents are often good, but they're not trained surgeons. And so to have a simplistic device that one of my residents could actually place and help someone, that's pretty amazing too. There's also been times where like even the postpartum hemorrhage, we hear the first cases in the States of saving mother and baby. That's pretty incredible. Or that we donated some devices to the Ukraine conflict as well, and we heard that it saved some soldiers' lives as well. And there's different military groups that, that use our device and save soldiers. So it's all back to the patient. And hearing those success stories and hearing about somebody alive because of this particular device, because of all this effort that we've put in. I mean, it's really makes it worthwhile. It sounds kind of corny, but as a surgeon, I can help one person at a time, but as somebody involved in industry and medical device industry, I don't even have to be there. You know, this device can help long after I'm gone. The tricky part of it, being the Chief Medical Officer is, I usually only have to worry about my patients. Now I have to worry about everybody worldwide and the device being used. That was a little hard to wrap my head around initially, but yeah. [00:20:28] Lindsey Dinneen: Yeah, of course. But the ripple, the ripples, the impact that you get to have because of this device and because of your diligence getting it to market, because it isn't an easy path, and that's incredible. So thank you for doing the work that you're doing. That's not easy and it's very appreciated. This is incredible. So, yeah. So, okay. When you were growing up, let's say 8-year-old, Adam-- you know, you're having a good time doing whatever you like to do-- could you possibly have pictured yourself where you are now? [00:21:08] Dr. Adam Power: No, I don't think so. I mean, I, I. I came from a very small, like, small upbringing and, you know, in my family I had absolutely lovely family members, but they really, apart from my aunt, they weren't overly educated. And so I really didn't know what it took to be successful in life, really. I had work ethic from my parents, that's for sure. And so that's what they bred into me. And all I knew is that I was gonna work as hard as I could, and I figured that as long as I keep working-- and I was lucky to have some brains as well-- then I figured things would fall into place. They honestly haven't fallen into place exactly how I pictured them as I grew older and what it would look like. But I'm certainly thankful for where I am right now, and what is the next five years or 10 years gonna look like? I have no idea. And I guess I just don't even picture it. I have goals, but I also know that those goals change depending on circumstances. And you need, as I'm growing into middle age-- I think I'm beyond middle age now-- I'm thinking about midlife crisis and things like that. I get into philosophy and there's like telic and atelic things and so, it's sounds, again, it's about the path and the journey. It's not about the ultimate goal because, having reached a lot of these successes, that good feeling lasts for maybe a day or half a day. And you think you know, I spent all these years coming with the, with our device, getting our device to market and getting FDA approval and like, oh my gosh, like, you'd think, I'd feel so great about that. And it did. It felt great, but you wake up the next day and you gotta keep going. So you have to enjoy the journey and that's really what it's the wisdom that comes with age is trying to enjoy the journey as much as possible and not focus too much beyond that. [00:23:09] Lindsey Dinneen: Yeah. Yeah, and I think that's really good advice too, in that it is because the daily life isn't usually all the celebration and successes. I mean, that does happen and those are good moments, but because the vast majority of our life is spent on the journey component of it, and going through those peaks and valleys, it is important to find something you love and feel that you can make an impact in. So I'm so thankful that this is what you've chosen to do. So pivoting the conversation a little bit just for fun, imagine that you're to be offered a million dollars to teach a masterclass on anything you want. Could be within your industry, but it doesn't have to be. What would you choose to teach? [00:23:55] Dr. Adam Power: And would that mean that I was an expert in it? [00:23:58] Lindsey Dinneen: Well, certainly if you're getting paid a million dollars, somebody has decided you aren't an expert at it. How about that? [00:24:05] Dr. Adam Power: Okay. Well. Can I pretend like I'm an expert in it? There's something that I really love, but I'm not I'm probably not an expert in it. It would be, I would teach a masterclass in DJing. Isn't that strange? I know it's so random. [00:24:21] Lindsey Dinneen: Oh my goodness! Tell me more! [00:24:23] Dr. Adam Power: Well, I mean, I love music. I've, I grew up playing lots of sports and never was involved in music. And, and I've always appreciated music and art, but I was never able to do it. And, you know, growing up I did love sort of all types of music and then even electronic music and it just somehow talked to me. So I started DJing electronic music basically when I was around med school and have always loved it now, and when I was over in England, I DJ'ed on the campus radio and also DJ'd in a club. It was really fun and it sounds pretty silly to be talking about this when I have these other things that are on the go. But honestly, being able to share space with other human beings these days, and actually having a good time and having it not be stressful and having it be only, you know, everybody's wishing others to have a good time. There's not many people that go out sort of dancing into electronic music that are thinking bad things about other people. Really they're just out for a good time. And so being able to steer that whole music and scene is pretty awesome. And I do love it. And I don't DJ as much as I used to, but I still do different events, usually Christmas parties for the operating room. I'll do the typically wedding sort of DJ, but then they always, 'cause they know me, they let me do an hour long electronic set, which is like hardcore electronic. But then I go back to the regular stuff. But I would want to teach a masterclass in DJing. [00:25:56] Lindsey Dinneen: That is awesome. How exciting. Oh my gosh, I love that. And I think you're right. Music brings us together and it's a wonderful way to, to share a little bit of joy. [00:26:07] Dr. Adam Power: Yeah. [00:26:08] Lindsey Dinneen: Yeah. Okay. And then how do you wish to be remembered after you leave this world? [00:26:15] Dr. Adam Power: I, so number one is I don't, again, with my midlife crisis, I've actually been trying to eliminate my ego as much as possible. And so when people talk about legacy, it actually gives me the hives these days to be quite honest, because I don't like that because I think you're focused a lot on yourself. In my opinion, a lot of legacy is all about you. The way that I would wanna be remembered, though, is truly that I was kind and compassionate to everyone that I met, and that I stood for something, and that I left the world a better place. [00:26:57] Lindsey Dinneen: Yeah, those are wonderful things to want to be remembered for, absolutely. And then final question, what is one thing that makes you smile every time you see or think about it? [00:27:09] Dr. Adam Power: My kids. My son Kai and my daughter Saoirse. They are the light of my life. And I, you would think that with how busy I am ,you know, those things would deprioritize, but they truly are the one thing in my life that makes me smile when I get up in the morning. [00:27:30] Lindsey Dinneen: Oh, that's wonderful. Well, that is absolutely incredible. I loved getting to meet you and speak with you a little bit today. Thank you so much for sharing about your journey. Thank you for sharing about your incredible device and your bits of wisdom along the way. The idea of we've gotta enjoy the experience, the path, the journey. And I just really appreciate you spending some time with us. So thank you for everything you're doing to change lives for a better world. [00:27:59] Dr. Adam Power: Oh, well, thank you for giving me the opportunity to speak with you. It was absolutely lovely chatting with you today. [00:28:05] Lindsey Dinneen: Wonderful. Well, thank you again so much. Thank you also to listeners who are tuning in, and if you're as inspired as I am, I would love it if you would share this episode with a colleague or two and we'll catch you next time. [00:28:20] Ben Trombold: The Leading Difference is brought to you by Velentium. Velentium is a full-service CDMO with 100% in-house capability to design, develop, and manufacture medical devices from class two wearables to class three active implantable medical devices. Velentium specializes in active implantables, leads, programmers, and accessories across a wide range of indications, such as neuromodulation, deep brain stimulation, cardiac management, and diabetes management. Velentium's core competencies include electrical, firmware, and mechanical design, mobile apps, embedded cybersecurity, human factors and usability, automated test systems, systems engineering, and contract manufacturing. Velentium works with clients worldwide, from startups seeking funding to established Fortune 100 companies. Visit velentium.com to explore your next step in medical device development.

In this powerful episode of the Less Insurance Dependence Podcast, we sit down with Dr. Robert Kerstein, a global pioneer in digital occlusion and Disclusion Time Reduction (DTR) therapy. He explains how TS Scan technology is revolutionizing diagnostics, improving patient outcomes, and eliminating the guesswork of traditional occlusal methods. Dr. Kerstein explains how DTR therapy not only relieves TMD pain, headaches, and bruxism but also enhances airway function and overall wellbeing.This episode dives into the clinical, operational, and patient-experience benefits of embracing data-driven dentistry. With real-life patient stories, proven research, and actionable strategies, listeners will gain insights on how to improve efficiency, elevate care, and move towards greater independence from insurance reliance. Book your free marketing strategy meeting with Ekwa at your convenience. Plus, at the end of the session, get a free analysis report to find out where your practice stands online. It's our gift to you! https://www.lessinsurancedependence.com/marketing-strategy-meeting/  If you're looking to boost your case acceptance rates and enhance patient communication, you can schedule a Coaching Strategy Meeting with Gary Takacs. With his experience in helping practices thrive, Gary will work with you on personalized coaching, ensuring you and your team are prepared to present treatment plans confidently, offer financing options, and communicate the value of essential dental services. https://www.lessinsurancedependence.com/csm/ 

Host Dr. Joel Berg speaks with Dr. Chelsea Fosse, Vice President of the AAPD Research and Policy Center (RPC) on the current hot topics in public health and how the RPC is working to make an impact. They delve into how pediatric dentistry can continue to lead the way among the other dental specialties and with our medical peers on care for those children and adults with disabilities and other special healthcare needs. Dr. Fosse also shares how AAPD members and other healthcare professionals can turn to the RPC for support with state-specific questions relating to Medicaid or other legislation. Guest Bio: Chelsea Fosse, DMD, MPH is the Vice President, Research & Policy Center at the American Academy of Pediatric Dentistry (AAPD). She is boarded in dental public health. Before shifting her career to work in oral health policy research, she worked as a general dentist treating adults with disabilities. At AAPD, Chelsea leads a team focused on Medicaid policy and program administration, evidence-based dental care, access to high quality and safe dental care, the pediatric dental workforce, and other contemporary issues in oral health, public health, and health policy. She was previously at the American Dental Association (ADA) Health Policy Institute (HPI) where she led policy analysis for issues related to Medicaid and studied the oral health workforce and the industry's response to the COVID-19 pandemic. Before dental school, she worked in the Division of Children with Special Needs at the American Academy of Pediatrics. She currently serves as President of the Board of Directors at Well Child Center, a community-based organization offering WIC, dental, and other social and health services in Elgin, IL. Chelsea received her bachelor's from The University of Texas in 2009, DMD from Rutgers in 2017, and MPH from Columbia University in 2019. She completed a general practice residency at Helen Hayes Hospital in 2018 and a dental public health residency at Jacobi Medical Center in 2020. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Join Chris Wolfe on EyeCode Media as he unpacks the intricacies of punctal occlusion, focusing on billing and documentation strategies. Discover how to navigate the challenges of providing top-notch patient care while ensuring proper compensation. This episode covers the use of modifiers, the importance of detailed documentation, and practical solutions to common billing issues. Tune in for expert insights that will empower eye care professionals to enhance their practice. ---------------------- For our listeners, use the code 'EYECODEMEDIA22' for 10% off at check out for our Premiere Billing & Coding bundle or our EyeCode Billing & Coding course. Sharpen your billing and coding skills today and leave no money on the table! questions@eyecode-education.com https://coopervision.com/our-company/news-center/press-release/coopervision-and-aoa-join-forces-launch-myopia-collective Go to MacuHealth.com and use the coupon code PODCAST2024 at checkout for special discounts  Show Sponsors: CooperVision MacuHealth EssilorLuxottica

What if I told you that not understanding occlusion is quietly sabotaging your treatment outcomes—and your confidence?In this week's 5 Minute Friday, I'm revisiting a topic that too many orthodontists dismiss: occlusion. After a recent conversation with Bruce McFarlane (and reflections on chats with legends like Tom Pitts and Ron Roncone), I felt compelled to spotlight how deeply impactful understanding occlusion truly is. If you think it's just for restorative docs—or you "get enough of it" through aligners—think again.I share insights from my own training under some of the best in the field, including three years studying at the University of Washington. I break down real-world ortho challenges like posterior open bites, centric relation issues, and how the NTI appliance is causing more chaos than most realize. This episode isn't a lecture—it's a wake-up call. If you're not fluent in occlusion, you're not fully equipped to protect your patients… or your practice.QUOTES“Once you understand occlusion, your life is going to change.”  - Dr. Glenn Krieger“If you haven't taken a Roth course or been to Coyce or Spear, don't tell me you know occlusion.” - Dr. Glenn KriegerKey TakeawaysIntro (00:00)How orthodontists have dismissed occlusion over time (01:10)Jerry Schultz, PK Thomas, and foundational lessons in occlusion (02:30)Clinical consequences of posterior open bites (03:50)Why understanding TMJ and facial types still matters (04:40)The NTI appliance: a silent saboteur? (06:00)Final challenge: If you really knew occlusion… would your treatment change? (07:00)Additional ResourcesIf you want this kind of transformation for your own team, join me at the final Orthopreneurs Summit in Vegas this September. Go to opSummit2025.com and grab your seat today. Payment plans are almost gone and passes are disappearing fast. This will be the most impactful event you'll ever attend—don't miss it.- For more information, visit: https://orthopreneurs.com/- Join our FREE Facebook group here: https://www.facebook.com/groups/OrthoPreneurs

Hap Gill takes us on a fascinating journey from his early days "bashing the Nash" to becoming a pioneer in comprehensive dentistry and communication. With characteristic honesty, he shares how a transformative experience at the Pankey Institute opened his eyes to occlusion and patient care, whilst his unexpected background as a dating coach revolutionised his approach to patient communication.From team management crises to clinical breakthroughs, Hap reveals the mindset shifts that transformed both his practice and his patients' lives, proving that being brave enough to step outside your comfort zone can lead to extraordinary results.In This Episode00:01:45 - Early career struggles and "bashing the Nash"00:05:00 - Discovery of the Pankey Institute00:07:00 - First day revelation: "Design your ideal day"00:08:40 - Born brave or shaped by upbringing?00:09:20 - Growing up in Hounslow with teacher father00:11:45 - Privilege and parenting perspectives00:17:40 - Career advice: Communication trumps clinical skills00:23:25 - Dating coach secrets applied to dentistry00:34:35 - Team management crisis: Three resignations in one week00:40:30 - Blackbox thinking00:49:45 - Clinical stories and treatment philosophy00:57:20 - Occlusion aha moments: Anterior guidance revelation01:06:25 - Biggest case: RTA patient reconstruction01:11:05 - Best lecture ever01:16:25 - Fantasy dinner party01:21:40 - Last days and legacyAbout Hap GillHap Gill qualified as a dentist in 1991 and spent his early years working in NHS practice before discovering comprehensive dentistry through the Pankey Institute. Based in Richmond, he runs a private practice focused on restorative dentistry, occlusion, and exceptional patient communication. Known for his innovative approach to treatment planning and team management, Hap combines clinical excellence with business acumen, drawing from diverse experiences including an unexpected stint as a dating coach.

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

Dr. David Carsten joins little teeth, BIG Smiles host Dr. Joel Berg for a conversation on waterline safety. A previous Chair of Infection Control for the Washington State Dental Commission, Dr. Carsten shares information on how waterlines can be compromised and what practitioners can do to maintain waterline safety to protect their patients and themselves. Guest Bio: David Carsten, DDS, is a dentist anesthesiologist. He has a BS in Biochemistry from Washington State University, with a background in Medical Bacteriology and virology. His DDS is from the University of Washington. He has 5 publications in the scientific literature. He received the Award of Distinction in Continuing Education from the Academy of Dentistry International in 2005. He lectures often, internally and externally, on many topics. For example, Dave did more than 30 lectures regarding the COVID-19 pandemic from 10 January 2020 to the present and has consulted dentists and entities regarding mitigation. He is an Assistant Professor in Hospital Dentistry at Oregon Health Sciences University, General Practice Residency program. That program focuses on patients that fall within the broad definition of special needs and are thirteen years old or older. He was on the ADA Steering Committee for the DLOSCE. He mentors the interdisciplinary lecture group at OHSU, the Tilikum Crossing Seminar Series. He is a Chair for the Department of Health, Washington State Dental Commission, also chairing the Infection Control Committee. Dave lives in Vancouver with his wife, Sharon, his son, Davin, and their dog, Kiki. He has been a member of the Spiritual Care Team at Salmon Creek Legacy Hospital since 2012.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Episode 307 hosts Hayley Anderson (Registered Nurse from Perth, Australia) This is the 4th chapter in our mini-series called ‘Disasters & Solutions'. Here we look at some of the unusual, difficult or outright disasterous outcomes for patients caused by injectables. We speak to the injectors who managed the case and go through what happened, step by step. We'll learn about what might have been done to prevent the problem and what injectors can do in their own practice to be safer practitioners.     In Chapter 4, we discuss Hayley's experience (on the other side of the needle as a patient) when she had a temple treatment with a hybrid blend of Radiesse, Belotero Revive and saline. She suffered a significant vascular occlusion and we hear about what happened, how it was managed and the lessons learned from the incident.  00:00 Introduction to Inside Aesthetics 00:46 Welcome to Chapter Four: Disasters and Solutions 01:03 Exciting News and Competitions 02:14 Introducing Today's Guest: Hayley Anderson 03:56 Hayley's Background and Journey in Aesthetics 05:11 The Vascular Occlusion 06:36 Managing the Complication: Initial Steps 08:40 In-Depth Discussion on Injection Techniques 24:58 Seeking Expert Help and Hospital Visit 29:50 Continuing Treatment and Hyperbaric Therapy 30:34 Understanding Aspirin and Viagra in Medical Treatments 30:51 Hyperbaric Oxygen Therapy: Benefits and Applications 31:25 Dosage and Administration of Aspirin 32:01 Viagra in Vascular Occlusions 33:09 Hyperbaric Chamber Experience 34:59 Managing Occlusions: A Case Study 37:52 The Role of Ultrasound in Treatment 41:50 Post-Treatment Recovery and Reflections 43:38 Collaborative Care and Telehealth 44:48 Lessons Learned and Future Practices 52:59 The Importance of Informed Consent 54:56 Treating Friends and Family: Ethical Considerations 57:06 Final Thoughts and Recommendations   APPLY TO OUR NEW IA COMPETITION & WIN A TICKET TO ICCE IN CAIRO, EGYPT!   CLICK HERE TO JOIN OUR PATREON FOR ON DEMAND EDUCATION & SUPPORT CLICK HERE TO BROWSE OUR IA OFFERS FOR DISCOUNTS & SPECIALS CLICK HERE IF YOU'RE A BRAND OR COMPANY & WANT TO WORK WITH US CLICK HERE TO APPLY TO BE A GUEST ON OUR PODCAST JOIN OUR LISTENER WHATSAPP GROUP & SEND US YOUR COMMENTS, SUGGESTIONS OR JUST SAY HI! CONTACT US

Join Elevated GP: www.theelevatedgp.com Net32.com  Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram His interdisciplinary approach to dentistry is founded in both empirical research and clinical experience. He attended the University of Washington for both his undergraduate and graduate studies where he received his D.D.S. degree in 1995 and an M.S.D. and certificate in Prosthodontics in 1998. For his entire career, Dr. Kinzer has been committed to furthering the art and science of dental education. His unique ability to impart complex clinical processes in a logical, systematic and clear methodology differentiates him from other Prosthodontists and makes him a highly regarded educator nationally and internationally. He is a full-time teaching faculty at Spear Education in Scottsdale, AZ. where he is also resides as the Faculty Chairman and Director of Curriculum and Campus Education. Dr. Kinzer is an Affiliate Assistant Professor in the Graduate Prosthodontics Department at the University of Washington School of Dentistry and an Adjunct Faculty at Arizona School of Dentistry and Oral Health. Dr. Kinzer is a member of many professional organizations including the American Academy of Restorative Dentistry and the American Academy of Esthetic Dentistry, of which he is currently the sitting President. He serves on the editorial review board for several recognized dental publications and has written numerous articles and chapters for dental publication. He has been honored with the American College of Prosthodontics Achievement Award and in 2018, he received the Saul Schluger Memorial Award for Excellence in Diagnosis and Treatment Planning from the Seattle Study Club. In 2022 he was inducted into the World's Top 100 Doctors as part of the Interdisciplinary Cohort. In his free time, Gregg cherishes spending time his wife Jill and their 6 children. He enjoys anything that he can do outside: golfing, hiking, running, skiing, and biking, in addition to a nice glass of wine.

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

Dr. Dan Ackerman and Drs. Luuk Dekker and Jasper D. Daems discuss the analysis of various aLVO stroke detection scales to determine which one is the most useful for prehospital triage. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000213570 

Dr. Jeanette MacLean, a trailblazer in minimally invasive SDF practices, joins Dr. Joel Berg to discuss how observations and a willingness to try a different approach can positively benefit both providers and patients. Dr. MacLean shares how her own learning experiences seeing the same patients year after year in private practice led to her desire to consider less aggressive treatment options. She also delves into how the collaborative pediatric dental community was imperative in guiding her path. Guest Bio: Dr. Jeanette MacLean has been in private practice as an Owner for 20 years. As an appointee to the American Academy of Pediatric Dentistry's Speakers Bureau and has provided lectures across the United States, Canada, and Mexico, as well as webinars viewed in over 40 countries. Dr. MacLean graduated summa cum laude with a Bachelor of Science in Chemistry from Northern Arizona University in 1999. She received her dental degree, with honors, from the University of Southern California in 2003 and completed her specialty training in pediatric dentistry in 2005 at the Sunrise Children's Hospital through the University of Nevada School of Medicine. Dr. MacLean is a Fellow of the American Academy of Pediatric Dentistry, Fellow of the American College of Dentists, Fellow of the Pierre Fauchard Academy, and Diplomate of the American Board of Pediatric Dentistry. Her research has been published in the journals Pediatric Dentistry, the Journal of Clinical Pediatric Dentistry, the British Dental Journal, and Compendium. She has been featured twice in the New York Times: She is also an active member of the Central Arizona Dental Society, the Arizona Dental Association, the American Dental Association, the Arizona Academy of Pediatric Dentistry and the American Academy of Pediatric Dentistry. She is married to Timothy Budd, an attorney, and they have a son, Charlie, and a daughter, Sabrina. She has donated her time to underprivileged children both locally and in Mexico, Belize, and Costa Rica, and has been honored for her volunteer work and humanitarian achievements. She speaks conversational Spanish, and her interests include party planning, crafts, Jazzercise and all things Disney. She is also active in Local First Arizona, the Arizona Dental Associations' AHCCCS Subcommittee and Women in Dentistry group. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Dr. Dan Ackerman talks with Drs. Luuk Dekker and Jasper D. Daems about analyzing various anterior-circulation large-vessel occlusion (aLVO) stroke detection scales to determine which one is the most useful for prehospital triage. Read the related article in Neurology®.  Disclosures can be found at Neurology.org.   

Vertebral artery occlusion survivor Joel shares how recovery reshaped his life, inspired empathy, and renewed his purpose. The post Vertebral Artery Occlusion Nearly Took Him Down – How Joel Fought Back appeared first on Recovery After Stroke.

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

Chronic Total Occlusion in 2025   Guest: Gregory Barsness, M.D. Host: Malcolm Bell, M.D.   Chronic (>3 months) complete epicardial coronary obstructive lesions, often referred to as CTOs, are recognized in a large minority of those referred for coronary angiography yet historically represent

Join Mark, Henry, and Gary (we are Kate-less unfortunately this week) for discussion of epidural steroid injections for adults with radicular back pain, post a fib ablation management, and oral semaglutide for high-risk patients with Type 2 DM

LTBS host Dr. Joel Berg sits down with incoming American Academy of Pediatric Dentistry President Dr. Tom Ison to talk about his leadership journey. Dr. Ison shares how he felt the pull to specialize in pediatrics after practicing as a general dentist, and how that choice impacted him as a rural practitioner. He also delves into his agenda for the 25-26 Academy year, including honoring the legacy of the leaders who came before him. Recorded in front of a live audience at AAPD 2025, the conversation is a testament to the importance of professional organizations and the role they play in sharing expert information. Guest Bio: Dr. Thomas G. Ison is in private practice in Newburgh, Ind. He received his dental degree and certificate in pediatric dentistry from the University of Kentucky College of Dentistry and Chandler Medical Center in Lexington, Ky., and completed a Fellowship in Pediatric Dentistry at Indiana University School of Dentistry. He previously held appointments as an assistant professor at the University of Kentucky College of Dentistry and Chief of Dentistry at Norton Children's Hospital, in Louisville. He is a Fellow of the American Academy of Pediatric Dentistry and American College of Dentists, as well as a Diplomate of the American Board of Pediatric Dentistry. He has completed the AAPD Leadership Institute at Kellogg and the Advanced Leadership at Wharton. He served as a consultant to the AAPD Council of Clinical Affairs, District III (now Southeastern) Trustee and is a Past President of the Southeastern Society of Pediatric Dentistry and Kentucky Academy of Pediatric Dentistry. Dr. Ison has been an examiner for the ABPD Oral Clinical Exam as well as committee member and part leader for the Renewal of Certification Examination. He resides in Evansville, Ind., with his wife, Connie, and daughter, Maggie.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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

Today's throwback episode features an in person interview with Dr. Brian Baliwas...the one and only @sfdentalnerd!  Zach and Kevin were asking about dental myths and Brian delivered! The discussion navigated through occlusion myths and explores contemporary approaches to occlusion. Brian shares insights from his education at the Kois Center, advocating for an 'outside in' approach to checking occlusion. The conversation further delves into the importance of orthodontics in setting up a stable bite for long-term restorative success. Brian also touches upon practical tips to avoid issues with veneers and crowns, emphasizing the significance of clearing the pathway for a more functional bite. Some links from the show: Brian's Instagram handle Kois Center Join the Very Dental Facebook group using the password "Timmerman," Hornbrook" or "McWethy," "Papa Randy" or "Lipscomb!" Very Clinical is brought to you by Zirc Dental Products, Inc., your trusted partner in dental efficiency and organization. The Very Clinical Corner segment features Kate Reinert, LDA, an experienced dental professional passionate about helping practices achieve clinical excellence.  Connect with Kate Reinert on LinkedIn: Kate Reinert, LDA  Book a call with Kate: Reserve a Call  Ready to upscale your team? Explore Zirc's solutions today: zirc.com  

Join Elevated GP: www.theelevatedgp.com Free Class II Masterclass - Click Here to Join Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram Dr. Drew McDonald, DDS, MS Dr. Drew McDonald is a board-certified orthodontic specialist based in St. Petersburg, Florida. He is renowned for his expertise in airway and temporomandibular joint-focused treatment planning, surgically facilitated orthodontic therapy, and complex interdisciplinary care. Dr. McDonald lectures internationally and has contributed to literature and textbooks in these areas.  Born and raised in Tucson, Arizona, Dr. McDonald's passion for baseball led him to the University of New Mexico, where he played as a catcher for the Lobos and earned a Bachelor of Science in Biology with a minor in Chemistry. He pursued dental education at Creighton University, graduating cum laude and receiving honors including induction into Omicron Kappa Upsilon and Alpha Sigma Nu. He then completed a rigorous orthodontic residency at the University of Missouri-Kansas City, earning both his certificate in orthodontics and a master's degree in Oral and Craniofacial Sciences.  Outside the clinic, Dr. McDonald enjoys spending time with his wife and two daughters, grilling, and playing golf.

Dr. Carolyn Strom joins host Dr. Joel Berg to discuss the impact of literacy on how the brain continues to learn and process information. Dr. Strom shares her experience as a first-grade teacher in an area with high rates of intergenerational illiteracy and how her interactions with parents and students led her to dive deeper into the neurosciences of learning and comprehension, particularly in relation to dyslexia. She speaks to how implementing the science of learning matters as the brain learns new skills – and how this thinking can also be utilized in the dental sphere. Guest Bio: Carolyn Strom is a clinical professor, reading specialist, and former first grade teacher. She collaborates widely with school districts, families, educators, and ed tech companies to bridge the disconnect between neuroscientific research and educational practice. Dr. Strom is a recent recipient of NYU Steinhardt's Teaching Excellence Award and has published her work in The Reading Teacher, The Reading League Journal, and The Handbook of Learning Disabilities. She maintains a clinical practice in New York working with children who have dyslexia. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Dr. Rhonda Kalasho is a one-of-a-kind dentist with contagious energy and a plethora of applicable tips to maximize success in dentistry. We talk occlusion, dental membership strategies, mindset, and so much more. Don't miss this episode! Ladies & Gentlemen, you're listening to "Confessions From A Dental Lab" and we're happy you're here. Subscribe today and tell a friend so we can all get 1% better :)Connect with Dr. Kalasho on instagram at @dr.rhondakalasho and email her at rhondakalasho@glomoderndental.comFollow KJ & NuArt on Instagram at @lifeatnuartdental, you can also reach us via email: kj@nuartdental.comLearn more about the lab and request information via our website: https://www.nuartdental.com/new-dentist-contact-form/

In this thought-provoking clinical roundtable, Dr. Chris Wolfe is joined by Dr. Shane Kannarr and Dr. Aaron Werner to unpack the real-world implications of Lacrifill, a novel hyaluronic acid-based punctal occlusion device that's changing the conversation around dry eye management. What starts as a lighthearted discussion about plumbing and practice life quickly turns into a deep dive into how Lacrifill may reshape our protocols, especially in a landscape where traditional plugs have fallen out of favor. From staining outcomes and HA elution to procedural technique and patient selection strategies, this episode is packed with critical thinking, clinical transparency, and honest questions. Topics Covered: How Lacrifill differs from traditional punctal plugs Why inflammation changed the game—and may be causing underuse of occlusion The value of fluorescein and lissamine staining, lid wiper epitheliopathy, and neurotrophic keratopathy Real-world feedback: injection technique, cannula size, managing patient discomfort Strategic use in seasonal dry eye, post-cataract care, and diagnostic dry eye pathways How to build consistent, team-based dry eye protocols that evolve with innovation Whether you're just beginning to explore dry eye treatment or looking to refine your advanced protocol, this episode provides a candid, collaborative look at how Lacrifill might become more than just the “new plug”—and instead, a pillar in your dry eye strategy. Plus: Tips for integrating procedures more confidently and systematizing care so your entire team delivers better outcomes. Resources: Lacrifill clinical trial and product data (https://lacrifill.com/clinical-trial-and-product-data/) Disposable Blunt Tip Dispensing Needle (https://a.co/d/63bXrPS)   --------------------- For our listeners, use the code 'EYECODEMEDIA22' for 10% off at check out for our Premiere Billing & Coding bundle or our EyeCode Billing & Coding course. Sharpen your billing and coding skills today and leave no money on the table! questions@eyecode-education.com https://coopervision.com/our-company/news-center/press-release/coopervision-and-aoa-join-forces-launch-myopia-collective Go to MacuHealth.com and use the coupon code PODCAST2024 at checkout for special discounts  Show Sponsors: CooperVision MacuHealth

Niacinamide does not cause MACE -Follicular keratosis is a thing -Clear cell papulosis -Clobetasol under occlusion for severe AA -Dupi raises eos... temporarily -Join Luke's CME experience on Jak inhibitors! rushu.gathered.com/invite/ELe31Enb69Register for the U of U Practical Derm course!medicine.utah.edu/dermatology/educ…nities/practicalLearn more about the U of U Dermatology ECHO model!physicians.utah.edu/echo/dermatology-primarycareWant to donate to the cause? Do so here!
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Muscle Minds Podcast with Dr Scott Stevenson & Scott McNally 00:00 Introduction to Muscle Minds and Training Philosophy 01:00 Understanding Stretching in Fortitude Training 03:17 The Role of Occlusion and Extreme Stretching 10:39 Exploring Sarcomerogenesis and Muscle Growth 17:14 Practical Applications of Lengthened Position Training 25:48 Understanding Blood Flow and Muscle Activation 33:20 Incorporating Occlusion Training in Workouts 35:41 Adjusting Training Cycles: On and Off Cycle Strategies 46:04 Maintaining Strength During Diet Phases ✅ Signed Copy of Be Your Own Bodybuilding Coach (15% goes to ASPCA) https://www.ebay.com/itm/205121965946

This week, Kevin and Zach are joined again by Alan and "Dr." Mo, host of the Very Dental Student podcast, to answer more listener questions. They cover a range of topics, including: Mastering Occlusion: Tips and tools for achieving optimal occlusion in restorative procedures, with a focus on fillings and crowns. Managing Patients with a Strong Gag Reflex: Practical strategies for minimizing gagging during procedures, including the use of acupuncture, rubber dams, and patient communication techniques. Diagnosing and Treating Crack Tooth Syndrome: Identifying and addressing cracked teeth, with insights on the use of transilluminators, tooth sleuths, and provisional crowns. Staying Current with Dental Technology: Balancing the desire to keep up with the latest advancements without overspending, with a discussion on return on investment and the importance of contentment. It's important to remember that Al is obviously a Gryffindor and Kevin is most likely a Hufflepuff. Join the Very Dental Facebook group using the password "Timmerman," Hornbrook" or "McWethy," "Papa Randy" or "Lipscomb!" Very Clinical is brought to you by Zirc Dental Products, Inc., your trusted partner in dental efficiency and organization. The Very Clinical Corner segment features Kate Reinert, LDA, an experienced dental professional passionate about helping practices achieve clinical excellence. Today's episode featured Isolation Devices!  Connect with Kate Reinert on LinkedIn: Kate Reinert, LDA  Book a call with Kate: Reserve a Call  Ready to upscale your team? Explore Zirc's solutions today: zirc.com