Protrusive Dental Podcast

Get ready for the best summary of bridges you ever heard, including diving deep in to this mystical design of bridgework called ‘fixed-movable’ bridge. You cannot search about Bridge Design on Google without landing on the great content that Prof Paul Tipton has released. https://youtu.be/h9mmRiFtHmU Protrusive Dental Pearl: where to place your grooves for crowns and bridges?Crowns: place grooves mesial or distal, or mesial AND distal. Ideally in tooth and not in core material (we elaborate in the episode). Why mesial and distal for crowns and bridges? The forces will be transmitted bucco-lingually on a crown – therefore grooves perpendicular to this force vector to resist it would be mesial/distal. How about for bridges then? For conventional bridges the grooves are placed buccal or lingual, or buccal AND lingual. This is because the forces are now acting antero-posteriorly on the bridge via forces on the pontic(s). The buccal/lingual grooves will resist antero-posterior forces. Prof Tipton and I discuss: The benefits of fixed-movable bridges (such as negating the need for parallel preps of abutments) The contraindications of Fixed-Moveable bridges (such mobility of abutments) Why fixed-moveable bridges should be the default design Myth-busting Ante’s law What is the maximum span of fixed-moveable bridgework? What are the rules that govern cantilever bridges? what about mesial cantilever vs distal cantilever? Why is Distal cantilever worse, and is there any evidence to back this up? The steps in planning for Bridges: 1. Design anterior bridgework first 2. Choose your abutment teeth 3. What Design? (F-F, F-M, Cantilever?) and 4. Type of retainers for the abutments (Adhesive retainer, conventional crown, onlay etc) We discuss an actual case and live planning for a Fixed-Movable bridge Where is the fixed-movable attachment housed? Anterior or posterior? Inside the abutment or outside of it? The one thing you must do when placing Fixed-moveable bridges or you would have wasted the time and effort:Remove a small portion of the male component – about 0.25mm on average If you enjoyed this episode, you will like the complete denture tips given by Dr Mark Bishop – check it out! To learn more about Tipton Training, check out their website for courses.

One night when Dr Rajiv Ruwala was up all night as his daughter would not sleep…he came up with a very inspired list… He was interviewing Dentists for associate positions and asked himself, ‘What are the habits of the most successful and valued Dentists?’ He came up with this awesome list which we discuss point-by-point in this episode of the podcast: https://www.youtube.com/watch?v=NJeMUF05T18 Here are the 10 habits below: They can listen to the patients story and find a treatment to become a solution for the patient. I asked Rajiv if he has any tips in encouraging patients to tell their story or their goal? They often do not offer this info up front. They are proactive in recommending treatment, not reactive. I asked Rajiv to give a tangible example of being proactive. I also asked how to handle the situation when a proactive Dentist inherits the list of a reactive Dentist. They don’t get validation from how much patients pay them, but from how much the patient values what they have to say. If the patients value what the dentist has to say, they naturally accept the treatment. How do we serve patients who do not value Dentistry? They work with their nurses to make sure everything is ready and set up before the patient enters the room. The value of a great nurse is monumental – are you a checklist kinda guy? You may be surprised by the answer he gives… They do not moan about their working environment, the “system” or their staff, they help find solutions to problems and improve the situation. I like this because I always like to approach people or managers with solutions not problems. Rajiv has lots of solutions to work effectively in the NHS. They are happy to refer out and develop a skill/niche that allows people to refer to them. I have my views on this but how do you think one should find their niche? Rajiv gives his ideas. They don’t ask for something for nothing. Instead they build value before investing/ asking for investment. This is massive. How can you build value in to the care you provide? They look to improve in three key areas; clinically, financially, and personal growth, and aren’t afraid to ask for help to do this. Tell us how you, Rajiv, have looked to improve in those 3 domains for inspiration? They are not adversaries, they want to associate/collaborate. I find most successful dentists are so willing to share and help! They take adequate time off to be fully charged/energised. How much time off do you recommend, or is it personal?How about 10,000 rule when you are newly qualified? Rajiv talked about courses for communication which also features making the NHS system work, rather than moaning about it! You can find out more about that here: Course for Associates – PYP course Course for Principals – KYN course If you would like to pre-register for the Splint Course (limited delegates to allow mentoring and support), please subscribe for updates and surprises if you are looking for a comprehensive, step-by-step, clinical splint course.

As Dentists we do not treat headaches – however, we can manage the parafunctional forces and you will be amazed at how many patients will reduce their use of analgesics after these appliances. This is the big one….we finally delve deeper in to Anterior appliances as part of Splintember! https://www.youtube.com/watch?v=0jX7mB_jDKc Lets talk about these really evil devices [/sarcasm] – the anterior only or segmental appliances, the ones dental school told me to stay away from… There are lots of names/derivatives/ and brands for these such as: B splint or Dawson B splint NTI /SCi/Mci Bitesoft FOS E-splint named after Jimmy Eubank DAASA or the umbrella term for this splint family which is called AMPSA I have decided the only way to make this work for those that listen to the podcast on your commutes and while you garden is that I will urge you to go on to the Protrusive Dental Community where I will post example photos and videos of the various appliances. If you have not listened to Episode 8 with one of my mentors Barry Glassman – I really urge you to, we talk about these appliances and whether or not they cause an anterior open bites. In a nutshell – many dentists condemn this appliance. They believe that by having a splint only on the front teeth, that the back teeth will over-erupt or dentoalveolar compensation will take place. Does that happen? – NO, they do not tend to cause a Dahl effect for the following reasons: AMPSAs are only worn during sleep Dahl effect you need bone deposition – its not going to happen from 8 hours a night! I was careful with my words, I specifically said they do not cause an AOBs due to the Dahl effect. Technically, ANY appliance can cause an AOB due to muscle deprogramming and condylar repositioning +/- postural changes depending on which camp you believe in. You can actually predict which are the patients this might happen to – once again, from any appliance, but because the anterior ones are more efficient at relaxing the lateral pterygoids, this is why they are implicated for it. How does it work and which records do you need? The way it works is similar to the concepts or rationale of anterior guidance which I discussed in the previous episode. By not involving the back teeth – you are furthest away from that powerful nutcracker AKA the TMJ, and also due to the proprioception from anteriors, you are able to switch off the anterior temporalis muscles. What does this mean? What records do you need? Why do I like leaf gauges? Find out all in this episode of the podcast – I will go even deeper with Part 2 – watch this space! If you would like to join us for Occlusion2020 Virtual 2 day intensive program on 27th and 28th November, there are a few tickets left! Join me in Part 2 where we will talk about: Deciding upper arch or lower arch, or sometimes both arches What is the difference between these various anterior appliances and is one better than the other? Why even an AMPSA can be an overkill and which patients may actually benefit from simpler devices How many of my patients have developed AOBs, which splints caused them, and how to manage such a scenario

Michigan Splints AKA Stabilization Splints are the ‘gold standard’ occlusal splint according to many occlusal camps. https://www.youtube.com/watch?v=DIfqn2Zkjp0 Check out the Youtube channel for video versions of the podcast. At 10 minute mark there is an error – I showed a Facebow being used whilst talking about Leaf Gauges. Dental School told me that this Splint is the only one I will need to know and it will cure all. If this does not work…maybe the patient has ‘atypical facial pain’ 😉 Now before you all attack me…. I have to confess. It is actually a great all-rounder splint – but there are some key reasons why Michigan appliances (or Tanner for the lower) is massively overrated! Listen to this episode as I cover: What is a Michigan splint? How does this splint work? What records do you need for a Michigan splint? Do you need a Facebow? What are the limitations of Michigan occlusal splints? Why might other splints be better for many scenarios? Why you should be careful prescribing Michigan splints to primary clenchers Protrusive Dental Pearls were sent in by fellow listeners regarding patient care and rubber dam hole spacing. Have you checked out the rest of the episodes from Splintember? Here is a rough transcript: Lets face it – Dental school barely scratched the surface in a lot of areas, including Occlusion and splints – so it should come as no surprise to you that Michigans splints are not as great as you were taught they were. Michigan splints are actually a really good all rounder splint for all the main diagnoses within ‘TMD’ – quite often when I find a tricky case and I am unsure if the issue is more muscle or joint, I will recommend a Michigan – but still, it is a massively overrated appliance and is totally overkill for most of our patients. Lets start the basics – what is a Michigan splint? It is classically a hard upper splint.The lower is called a Tanner. Aka Stabilisation splint. It’s a centric relation appliance. What does this mean? I explain in the podcast (so listen up!). I go in to this appliance in a lot more detail and all the shortcomings. Fellow geeks, to conclude: It’s a great all rounders splint. And if ever you’re unsure of joint vs muscle diagnosis and you can convince your patient to spend hours in the chair, spend that money and you think they’ll comply, then go for it. It’s a great splint. But if you’re more concerned that your diagnosis is muscular, or the asymptomatic patient, and perhaps as an appliance to deprogram your patient….there are definitely more efficient ways to deprogram your patient. And that’s exactly what we’ll talk about at the next episode….stay tuned for the rest of Splintember!

Why do some patients have painful joints, whereas others get headaches? And why do MOST of our parafunctional patients not get any symptoms at all? Why do some peoples teeth wear away, whilst others teeth are riddled in cracks? https://www.youtube.com/watch?v=amdss07uN9s In this episode, I talk about the pros and cons of devoting your career in Dentistry to treating Temporomandibular disorders. Treating ‘TMD’ can be a complex field because it deals with all the complexities of chronic pain. However, it can be a very rewarding area. I also discussed why the umbrella term of ‘TMD’ is not really specific enough. We can do better as a profession to understand the diagnoses within ‘TMD’ a little better. Protrusive Dental Pearl: check out the Otter app for transcribing your voice, lectures or any audio/video! This is great for anyone who wants to convert audio in to notes, for students, and for content creators. I have uploaded the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) PDF file on to the Protrusive Dental Community group as promised to the listeners. If you enjoyed this episode, check out Myth Busting Occlusion and TMD with Dr Barry Glassman.

2021 UPDATE: This blew up! I was inspired to create a flowchart to help with Splint Decision Making – download the flowchart by clicking here Which is the BEST Dental Splint? https://www.youtube.com/watch?v=BsXjNkmQf9s Best splint on YouTube – or listen on the usual podcast channels It is finally SPLINTEMBER and we kick it off with an all time important question – which is the best splint for your parafunctional/bruxist/TMD patient? Surely it’s a Michigan…right? Or maybe it’s a Gelb appliance? Or the humble soft splint…? Did I just say that?SURELY it’s a A- Splint, B-Splint or a C-Splint?! Well, I have an answer for you…it’s called the G-Splint! The G-Splint* is the best dental splint there is. There are so many factors that will determine this. In this episode, Dr Jaz Gulati explores many of the factors to consider for appliance therapy in the form of dental splints: What are you trying to achieve? Is the patient symptomatic? What is the ‘purpose’ of the splint? (Hat tip to Dr Michael Melkers) What is the goal? What about access, cost, airway, orthodontics and compliance with splints? Protrusive Dental Pearl: A quick way to remove temporary crowns and onlays using a haemostat! Tune in for the rest of Splintember where I will go deep in to different splints! *The G-Splint is just a metaphor for splint provision based on the history, exam and diagnosis for your patient! Remember to hit subscribe for updates and join the newsletter on www.protrusive.co.uk

It is the one you have been patiently waiting for since I announced it on Instagram….Personal Branding with Shaz Memon who wrote the BOOK ‘Instagram for Dentists’. https://youtu.be/R9tU-lLlLlY What Shaz, from Digimax Dental, does not know about branding as a Dentist is not worth knowing. Protrusive Dental Pearl: Are you Google-able? Are you one page 1 of Google when patients and potential patients search for you? This is so important and is the reason companies pay MILLIONS for ‘Search Engine Optimisation’ or ‘SEO’ (not to be confused with SOE Exact!). A great way for Dentists to harness the power of being found in Google is to collect verified patient reviews using Doctify Collect verified reviews and add a widget to your clinician website Join our interview where I probe Shaz about all things personal branding: Should you have a logo as a Dentist? Learn about the hilarious error I made with an old, secret, stashed-away and destroyed logo that I am embarrassed about now! Is a Dentist website page, independent to the practice website, appropriate? What does Shaz think about doing it on the cheap via Fiverr or Canva? What makes a good dental website – BONUS: Shaz critiques my website (completely unexpected!) What are they keys to success for branding yourself online? The funny thing is that all the advice Shaz gave me on my Dentist website …I have still not updated/improved it based on his advice. That is one of the pitfalls of doing everything yourself. Getting the advice, unscripted and ‘live’ during the show was the highlight of the episode! If you enjoyed this episode, please support the podcast by subscribing so I can continue to make this type of content!

In this episode we listen to Alan’s story. His name is Alan Burgin and he’s also known as The Cornish Dentist on Instagram. https://youtu.be/oF-yyrwPfm4 His story involves themes of mentorship, challenges, overcoming adversity, gaining a work life balance, (so actually going abroad to Australia for six months)….I don’t give too much of the story away, but it involves so many real-world themes. And actually, it also involves a bit of luck and something that we touched on in Episode 34 with Richard Porter on emotional intelligence was the element of luck in your career trajectory is actually very important. The Protrusive Dental Pearl is about how to make cementing crowns less messy using Vaseline! I hope you enjoy listening to our reflective chat! NEXT MONTH will be Splintember! I will cover all things dental splints to simplify this confusing area of Dentistry. Listen to the FULL episode via direct download or via the following platforms: Spotify Apple Google Podcast Subscribe on Android

Case Acceptance – sounds dirty doesn’t it? Well its kind of important. We can make a huge difference to the lives of our patients and do more of the Dentistry we love to do. But only if your patient sees value in your treatment plan and believes you are the right Dentist with the right solutions. I spoke with Dr Gurs Sehmi who shared all his secrets! (I kind of forced it out of him!) The protrusive dental pearl for the episode is a video I shared on Protrusive Dental Community (FB page) using a Endodontic tool to squirt peroxide gel deep in to the access cavity to treat an internal bleaching case (see images below!): Before internal bleaching. UR1 sustained trauma – it was root filled with an MTA plug and GP by my Endodontist, Dr Cesar Munoz After internal bleaching. What a difference! Unfortunately no Video podcast for this episode (technical error on my part!) but for anyone inspired by Dr Gurs Sehmi’s protocols, do check out what he has to share: Here is the link to register for the mentoring program: https://accelerator.dentalnotebox.com/ This is a link where people can sign up for live cases https://dr-gurs-sehmi.lpages.co/live-case-stream The Dental Notebox Instagram/ FB link is: https://www.instagram.com/dentalnotebox/ https://www.facebook.com/DentalNoteBox/ If you like this episode, you will love Communication gems with Dr Zak Kara!

If there is one piece of content I produce in my LIFE which I think MAY have a massive impact on your life – it might not get much bigger than this one right here! I will put the video up shortly, but you can catch it on Facebook premiere tonight at 8pm on Protrusive Dental Podcast Facebook Page. Video: https://www.youtube.com/watch?v=HZ8yKV0MTr4 Do your grades at dental school influence your success as a Dentist?Is your IQ important? I would be surprised if any of you answered ‘yes’ for these questions. So what do Richard Porter and I believe is the most important predictor of success in your life, relationships and work? Two words: Emotional Intelligence. Find a quiet place, close your eyes* and take a dive in to the world of Emotional Intelligence as applied to Dentistry: *not while driving!! We discuss: How important is luck in your life and career What is emotional intelligence and what tangible examples can Richard provide relevant to Dentistry? Why does high emotional intelligence mean more ‘successful’ and even higher earning Dentists? Are you born with Emotional Intelligence, or can you improve your EQ? Why is Emotional Intelligence important for Dentists, Dental Therapists and the entire dental team? How can you find out your level of EI? Richard suggested The Big 5 Ocean Assessment – such as understandmyself.com Resources as promised: Harvard Happiness StudyDunedin study Learn with Richard Porter and Aspire If you liked this episode, you will love 12 Rules for Dentistry