Protrusive Dental Podcast

Stop taking OPGs/Panoral radiographs for TMD…they have limited benefit! In this episode I discuss the Piper Classification of TMJ with Dr Jim McKee from the Spear faculty. We also cover exactly when and why imaging of the TMJ may be beneficial (MRIs and CBCTs). I have found the Piper classification easy to implement and I hope this episode helps you understand it. https://youtu.be/n4lRWAQeA5A Check out full episode on YouTube Protrusive Dental Pearl: Observe the patient’s path of opening. If someone’s jaw opening makes a ‘V’ shape, that’s a DEVIATION. If someone’s jaw opens, and then it goes all the way to one side, and it doesn’t go back to the middle, that’s a DEFLECTION. If you want to Download the PDF version of the Piper Classification of TMJ Infographic we made, click here! Piper Classification PDF Dr Jim McKee is part of Spear Education – a platform that has taught me so much of my occlusion. In this episode I asked Dr. Jim McKee: What is the Piper Classification of TMJ? What are the risks of having to rehabilitate someone where you haven’t the health of the TMJ? (19:22) Are there any other useful TMD classifications? (21:01) Is there any benefit of taking a Panoral radiograph? (24:48) What is the difference between an MRI and CBCT for someone with a TMJ pathology? (26:51) What type of imaging is best for TMD? (28:58) What additional information can a CBCT provide above an MRI? (33:59) How do we decide the most appropriate imaging technique? (35:22) Dr McKee’s thoughts on idiopathic condylar resorption in adult patients? (32:58) Should we be taking routine MRI/CBCT for TMJ health diagnosis? Or only for patients who have a joint based history? (36:62) Is there a clinical way to determine which classifications patients are in (Piper III vs Piper IV)? (39:23) Is TMJ disorder always a progressive disorder? (40:51) How to manage asymptomatic clicks? (42:17) Deviation or Deflection as part of full workup and imaging of the way to get the exact diagnosis? (44:07) How does the Piper classification influence Restorative management? (47:12) If you enjoyed this episode, check out TMJ Physiotherapy – When to Refer and How They can Help  Check out SPEAR EDUCATION, a two-day seminar, where Dr. Jim McKee teaches 25% of the course!

Does Biological Width, apparently now known as ‘Supra-crestal tissue attachment’ confuse you? Or would you like an introduction or a refresher on the clinical stages of Crown Lengthening? Fear not, I twisted specialist Periodontist Reena Wadia’s arm and finally got her on the show to teach us! https://youtu.be/No-8hjFsWNs Check out this full episode on YouTube Protrusive Dental Pearl: How to find out what kind of biotype you’re dealing with: Use a ball ended Perio probe and use the ball-end/tip (sometimes it’s coloured) and probe in to the sulcus – if you can see the tip of the probe shining through the gingiva then that’s a THIN biotype. and if you can’t see the tip of the probe then that is a THICK biotype. “Don’t complicate things, if something works in your hands and you’re doing it well, keep things simple, don’t have too many variations because then it just starts getting unpredictable. So test everything out, go on courses, and then see what works in your hand and then stick with that.” – Dr. Reena Wadia In this episode, we discussed: Bone sounding (10:35) Aesthetic crown lengthening (13:06) and Functional crown lengthening (18:02) Altered passive eruption and active eruption (14:21) Fundamental difference between the two types of crown lengthening (20:06) Biology of keratinised tissue (24:13) Steps involved in crown lengthening surgery (26:32) Using dental stents as a guide (29:44) Post-op management for flaps (30:35) Pre- and Post-operative care (33:05) Ideal case for beginner Dentists (35:19) Placement of sutures (36:28) Check out Dr.Reeda Wadia’s Perio School Check out Reena’s Crown Lengthening Live course on a Sunday in London! If you liked this episode, you might also enjoy How to Save ‘Hopeless’ Teeth with the Surgical Extrusion Technique 

Are you enjoying a fulfilling career? Is this how you imagined life would be in Dentistry? If not, are you going to do anything about it? My guest, Laura Bailey did! Growth and improvement is not linear. Taking MASSIVE action is the answer! https://youtu.be/nDloghDpYsE Check out this full video episode on YouTube! Protrusive Dental Pearl:  Write something down that you’re going to change in your life or your work, and then COMMIT to it until you get the desired result. I’ll say it again, commit until you get the desired result! Here with me is someone who commits to take a massive action, Laura Bailey, whom I work with on Fridays (we are both a little crazy and we love cricket – dream team!) “But you can’t expect to know everything and be able to do everything.” – Laura Bailey In this episode, we discussed: Principals taking risk with their young associates – business side, implementing treatment? Building healthy relationships with colleagues Signs to look in a clinic for young dentists/therapists to work in Taking a leap of faith Having a nurse support system Check out Laura Bailey on Instagram! If you liked this episode, you might also enjoy How to Win at Life and Succeed in Dentistry – Emotional Intelligence

TIME SENSITIVE – 50% off Maciek’s Online Contact Point Ambassador Course! Click here Let’s face it, Class IIs may be our bread and butter Restorative Dentistry but they are ANYTHING but simple. In some scenarios, achieving a perfect contact on a class II restoration seems impossible.You have likely been in a scenario where everything is going to plan and your matrix is looking like it will achieve a lovely contact area – however, as soon as you insert the wedge or tighten the band (circumferential matrices) the matrix leans away from the adjacent tooth, revealing a ghastly looking open contact. How can we overcome this? Is soft tissue removal an option? In this Group Function, I’m again joined by my boy Dr Maciek Czerwinski who answers this emphatically! https://www.youtube.com/watch?v=V6pu7FLb9Kw The full episode! Minor video issues with Maciek https://www.youtube.com/watch?v=cvX-oaEaqUI How to do Teflon Floss Technique – the Main Interview Podcast Video has some syncing issues, please bare with us! “If you use the stiff wedge, if the wedge is too big it will just move the matrix (and you lose your contact), but if you’ve got something soft, it will go under the curvature of the matrix, and then it will just self adapt.” – Dr Maciek Czerwinski In this group function we also discuss: Is it necessary to remove soft tissue? – Why? How? What to use?  How to improve the contact area Why and when to place an orthodontic separator to help your future restoration Tired of spending hours just to customise your stiff wedges and matrices? Check this gem shared by Dr Maciek – FINALLy the video on how to do the Teflon Floss technique (as promised in the episode): Also, Dr Maciek is giving 50% off to all Protruserati up until June 30. Click here to check it out! I have done his online course and it was very comprehensive and is guaranteed to improve your contact points no matter how tricky the situation. It is an all-encompassing direct restorations online course – with play by play explanation of matricing, wedging, ring selection and isolation! Click on the image to check out Maciek’s course! If you have any other questions that would make a good group function, please do message me on @protrusivedental Instagram page or the Facebook Page If you enjoyed this, you might also like my other episode with Dr Maciek Czerwinski on Which is the Best Matrix System for Class II Restorations 

A fun little comparison episode discussing the differences between Dentistry in the States and in the UK – in this episode I am joined by the host of Dentistry Rising podcast, Dr Bette Robin! https://youtu.be/N_u8LkD8EnY Dr. Bette Robin, who desired to make a massive change in her life and left clinical Dentistry some years ago and went in to Law and practice sales – she never looked back!  Join us in this light hearted discussion where we chat about: Cultural differences in USA vs UK Dentistry – dental school, earnings, biggest barriers, treatment plans How the national health systems compare Finding different paths out of Dentistry How to become a better communicator  SplintCourse update: Enrolment ends on Monday 21st June! Enroll now by clicking here to join a community of Dentists around the world who want to End Splint Confusion!  If you enjoyed this episode, then do check out Dr. Bette Robin on her Dental Rising Podcast You might also enjoy The American Dental Dream – PDP002 with Dr. Kristina Gauchan!

How to do Deep Margin Elevation? What are the most important factors in achieving high bond strengths for our restorations? I sometimes look at modern onlay preps and think, ‘God MUST exist’, because I think it’s a miracle how these flat, table-top onlays stay on! I am joined by a world-famous educator in Biomimetic and Adhesive Dentistry: Dr David Gerdolle David Gerdolle, based in Switzerland, introduced me to contemporary ceramic onlays 8 years ago. It took me 3 years to convince myself the techniques would work in my hands! In this episode I want to fast-forward your progress so you can gain more perspective on adhesive restorations and DME (Deep Margin Elevation). https://youtu.be/cOkEAaawgdI Super pragmatic and scientific bonding principles! Protrusive Dental Pearl: How can you show patients what shorter anterior teeth might look like to them discing them down? Use a black Sharpie marker, colour in the part of the edge (maybe 0.5-1mm) that you’re considering removing. Take photograph and show it to them! It helps if their mouth is open for the photo so we see the dark backdrop of the oral cavity. With the knowledge of Dr. David Gerdolle and biomimetic dentistry, we discussed how it is possible to bond a material to the tooth structure in those ‘table-top’ style, flat onlays.  It doesn’t happen magically. It’s about the nitty gritty detail, the micro steps and respecting certain criterias. “If you don’t remember anything of your bonding protocol, just remember that, it has to be clean and rough” – Dr. David Gerdolle Clean and Rough, that’s it right there! In this episode, we also talked about: Failures in using biomimetic dentistry and what we can learn from that How these restorations have resistance form Bonding protocol step-by-step for adhesive dentistry Deep Margin Elevation – how to do it As promised, DM me on Instagram @protrusivedental for the PDF copy of the steps of deep margin elevation.  If you enjoyed this episode, then do check out Dr. David Gerdolle for more courses. You might also enjoy Ceramic Onlays from Preps, Temporisation and Bonding Protocols by Nik Sethi!

‘The Riches are in the Niches’, apparently. In the last episode we already touched on the topic of finding your niche but this time we were able to dive deep in to this. Will your career sky rocket when you find your niche? Or are you better off being the jack of all trades?  What are the benefits of finding a niche, how to go about it? And what does it ACTUALLY mean? https://youtu.be/aGniihvrNpg Protrusive Dental Pearl: a Challenge for you – grab a pen and paper and write down ALL the clinical procedures that you LIKE to do, and then also what procedures you would like to do MORE OF. Figure out where your niche could lie. And don’t forget, it’s not a race! It helps helps to make a list of procedures that don’t excite you (for me, I have no affinity to facial aesthetics!) My guest, Dr Pav Khaira is a MASSIVE geek and I loved that he quite openly admitted to failure in the past and helped us learn some lessons. I also enjoyed hearing that it is TOTALLY FINE to change your niche as you mature as a clinician. In this episode, we talked about: Being a super GDP vs niching down? Young dentists rushing to find their niche Is it okay to niche too soon or is too late to find your niche? The opportunities of learning Becoming a ‘go to dentist’ The downside of niching  If you enjoyed this episode, then do check out the Dental Implant Podcast by Dr. Pav Khaira. You might also enjoy 6 Signs You are a Comprehensive Dentist!

George Cheetham, known as George The Dentist, is a restorative dentistry expert and social media educator. In their discussion, he shares insights on the growing trend of composite veneers versus simpler alternatives like teeth whitening. George emphasizes effective patient communication and the significance of documentation in practice. He also delves into the pressures faced by young dentists today, offering tips on enhancing online presence. Plus, he shares thoughts on the importance of humility and collaboration in delivering quality dental care.

‘An average Dentist working with an excellent Technician can go very far’, was the message my old training program director gave me. Technicians are often the unsung heroes whilst the Dentists collect all the praise and accolades. Who do we blame when things go wrong? Our technician, of course! Not fair at all – this is why I welcomed RDT Graham Entwhistle of Trueform Dental Laboratory to air his frustrations at Dentists – you will pick up some great tips here to improve your working relationship with your dental technician! https://youtu.be/NRDdRCg-9QI How to work better with your dental technician Protrusive Dental Pearl: Use websites like Loom or even Whatsapp to communicate with video and voice with your technician. Great, clear communication will ensure expectations are met for both parties. SPOILER – the 5 things that Technicians wished we Dentists knew: Dentists need to improve their communication! Back to basics – if you want better work, you have to fill a better prescription form. Even just the lack of basic info drives technicians mad! We also discussed about Ivoclar Ingots for your ceramic Make sure your tooth preparation is appropriate for your material selection! Decide the material BEFORE you prep the tooth! Your impressions need to be clearer please! Do you always check for distortions, drags or voids? Could you consider trying Impregum? Shade guides – they can vary and can discolour over time. It’s important to ensure the shade guide matches your technician’s and the materials they use. Acrylic shade guides will discolour over time! We share some shade taking advice for Dentists Do you etch your own ceramic? If not, why not? Take control of your bonding, consider etching yourself to prevent ceramic over-etching. You can’t hold your technician accountable for your bond strength! Check our Graham’s work on Instagram! If you liked this episode, you will also enjoy the classic with Jason Smithson on eMax Onlays and Vertical preps!

Lower Complete Dentures are the bane of Removable Prosthodontics. I know many Dentists who ‘hate making lower full Dentures’, likely because they are difficult to master. So difficult that I got Dr Rupert Monkhouse to give the Protruserati a podcast masterclass on how to improve in this frustrating area of Dentistry! https://youtu.be/cW41CHiLgGI Why won’t you stop floating, damn you! Protrusive Dental Pearl: The power of silence! When you present your patients a solution or treatment plan, or tell them the fee, there may be a silence. Embrace it. Expect it. Don’t panic. This is normal! DO NOT but in with a ‘why don’t you just think about it…’ In this episode we discussed: How can you predict if a suction lower denture is anatomically possible? What materials Rupert likes to use What and how to adjust at the Try in stages of complete dentures How to get the wax try-in to stay in the mouth! Communication pearls surrounding lower complete Dentures If you enjoyed this topic, why not also check out the Master himself, Dr Finlay Sutton on Troubleshooting Chrome Dentures! For details on Rupert’s Denture course, DM him on Instagram! https://www.instagram.com/dentistrupert/