Ultra High End Cosmetic Dentistry with Brandon Mack – PDP231

Teaser:
Number one, why people don’t want to take more creative risk. It boils down to fear. And this idea as dentists we’re so type A that we feel like everything is a Super Bowl. We have to get it right on the first attempt. When you are in the process of doing this, you have to understand the level of anxiety that comes with it on the patient’s part, because everything that we’re doing is semi-permanent, right? Nothing lasts forever, but this isn’t a hair dyeing or a haircut.

When a patient says, I want really white teeth, but I want it to look natural. That is a horse with stripes. It’s not a zebra. It is a horse with stripes. I think that for the young dentists embracing every failure, no matter how big or how small, and understanding that every one of those lessons are an opportunity to put you in a better position to treat the next person better, it’s going to make the next person’s case better, every single failure.

So there’s always five checkpoints for patient expectation. Patients are demanding certain things, and so how much do we balance patient expectation and autonomy, what a person wants for themselves? I think it all boils down to one thing. 

Jaz’s Introduction:
Cosmetic dentistry is tough. Think about it when you’re removing caries, is there a way to make that objective? Like some of caries removal is obviously subjective because how much I would remove is different to how much you might remove. But with something like caries detector dye, we know that we can turn this procedure and add a degree of objectivity to it, and we have some guidelines that we all work to.

Now, in the world of cosmetic dentistry, there is the lens that the dentist wears, and then there’s a perception of the patient. And as they say, beauty is in the eye of the beholder. Now, add to that the ultra high expectations that patients can carry today and the very nature of cosmetics and beauty being subjective. This is tough. This is what makes cosmetic dentistry tough. So I’m absolutely honored toast today, Dr. Brandon Mack from Florida.

He is one of the biggest names in cosmetic dentistry and we have a really geeky session today. I asked him how he manages those ultra high expectations patients, so big level stuff. And I also ask him little details like what’s his favorite veneer cement? What is Brandon’s occlusal philosophy? And one thing I really love is I ask him to tell us about his failures. And I always appreciate colleagues that share their failures and what they’ve learned along the way.

Hello, Protruserati. I’m Jaz Gulati and welcome back to your favorite dental podcast. If you’re returning to the podcast, maybe you’re watching this on the Protrusive Guidance app. Thank you so much for coming back.

If you are new to the podcast, you picked a really awesome one to join us. I said on the podcast, I actually really enjoyed Brandon’s flamboyant vocabulary. He’s full of energy, and these are the kind of episodes that really get you feeling good before a day of work.

Dental Pearl
Now, every PDP episode, I give you a Protrusive Dental Pearl. Today’s Pearl is actually inspired from this episode. It was actually something a patient taught me that I’d like to teach you that very much goes in tandem with a theme of this episode about ultra high-end cosmetics and meeting expectations. And something I talked to Brandon on the show so you’ll hear it later, but I had this situation where I’d done some ortho and bonding and I was really loving the result.

Okay? I was actually genuinely happy that I had delivered a nice aesthetic result, but my patient was hung up on one lateral incisor, and yes, it was not symmetrical to the other lateral, but laterals aren’t usually symmetrical, and so this is what you should say, right? You should remind your patients right at the beginning, at the consultation when you’re gauging expectations, is that central incisors are like twins.

They should be pretty symmetrical as much as possible, and they should be the dominant part of the smile, right? Having that central dominance. Now, lateral incisors should be like sisters or siblings. They should not be identical twins and canines are like first cousins or something like that.

Now, when I said this, my patient finally got it. And yes, I just did some adjustment and I tweaked it and I think it did look better. But when I described it this way, my patient says, ah, it’s like eyebrows. She said that when you get your eyebrows done, something I know nothing about obviously, apparently you are told that eyebrows are like sisters.

They’re not twins. They’re like sisters. And I was like, yes. It’s just like eyebrows. And so happy patient in the end. And a nice little way to communicate with your patients and to get across the correct expectations. So feel free to use this eyebrow comparison analogy. Call it what you want. And hey guys, enjoy this episode.

It’s really good. And look, be sure to hit that like button, hit that subscribe button. If you’re on Protrusive Guidance, do drop a comment. Catch you again the outro. Enjoy the episode.

Main Episode:
Dr. Brandon Mack. I wish this wasn’t your first time on the podcast. I wish it was your second time so I can play Return of the Mac Song, but it’s the first time for Brandon Mack. Welcome back my friend. Welcome to the show. All right. It’s so, so cool to have you. I’ve recently discovered your presence online world, thanks to Barraj and oh my God, I’m blown away by the standard of your work. The episode, I called it provisionally Ultra high-end Cosmetics. And my goodness, what you deliver on a day in day out basis is very inspiring.

So I’m very excited to learn from you. So for our guests all around the world, Brandon, please tell us about yourself. 

[Brandon]
So my name is Dr. Brandon Mack. I practice here in Tampa, Florida. We also travel to New York a couple times throughout the year to do cases. And one of our focus is on understanding cosmetic dentistry and its impact, I guess, a world with an egregious appetite for instantaneous gratification.

And we are trying to carve out a particular niche where we’re guiding patients to optimizing aesthetic outcomes while looking through a scope of comprehensive dentistry. I love what I do. I’m having a good time doing it, and I’m really just trying to change the narrative for tapping into a sense of authenticity and really tapping into a passion for what we do.

[Jaz]
Nowadays, so many clinics offer cosmetic dentistry. What do you think when the nature of the clientele, you see, they hand pick you, they carefully seek you out. What is it that they see from what you put out there that think that, okay, for all the dentists I could choose, I’m gonna travel all the way to see Brand Mack. What is it that you think that they’re expecting, why do you think they’ve picked you? What is the promise that you try to deliver? What is your USP? 

[Brandon]
You know, in a world where there are so many options. I feel like what speaks to a patient the most is gonna be a multitude of things. When it comes to social media, most of our patients are gonna find us from other people talking about what it is that we’ve been able to do for them. And social media has also been a huge marketplace for people to discover us and discover the body of work and what we put out to the world essentially is focusing on a sense of transparency on how we craft the product and how we put passion into what it is that we do.

So patients that are selecting us, while there are so many good cosmetic dentists across the world. I have my list of favorites, but I think more importantly, what they are coming here for is an alignment of energy and an alignment of who we are as people and what we’re putting out to the world.

Not necessarily just the work, but I do think that our work speaks to a particular population of people who are seeking someone who focuses on the micro details. I always have this saying that, a patient or a person can never have higher expectations than we have for ourselves. So people who are aligned with that concept or that principle, or they want someone who is gonna deliver energy and love in the work that they do, and have that translate into something that they can enjoy, I think those are the people that are selecting us and what separates us from the pack.

[Jaz]
I mean, making it relatable to general dentist. Some advice I’ve always received, Brandon, is people never buy treatment. People never buy the dentistry they buy you. I see that very much in when the kind of stuff you put out there and what I’ve seen of you.

But your rise to the top of cosmetic dentistry from what I’ve seen, I’ve been very impressed. Can you just describe your journey? Have there been any blips along the way? Has it been very linear or have there been a few curve balls along your journey? 

[Brandon]
You know what? All started out when I had a friend, we were hanging out in my building and this kid was from Abu Dhabi. He was like, hey, my dad has a finance company. We’re looking for dentists to come over. And that was my initial push to seek out CE at a high rate of acquisition.

I wanted to just do as much see as possible because there were certain requirements from the Ministry of Health that they required for dentists to come over. You either needed two years previous experience or you needed to have a certain certificate or specialty, and I had neither one of those ’cause I was just starting out my journey.

And so I went on this quest to consume as much continuing education as possible. And I ran into a couple of people that changed my life forever. And one in particular, this guy named Miguel Ortiz from Argentina. He was a Harvard trained prosthodontist. I went to take a photography course with him and this lab named Midwest Dental Arts with Justin McCroy down in Sarasota.

And when I saw these guys and what they were doing in dentistry, it completely blew my mind and opened my mind up to a whole nother world of possibilities. There was this guy, Eduardo De Agüiar from Venezuela. I saw he had this picture. It was a needle and thread, and the name of the picture is when the pictures really matter.

And that sat with me because I had never seen dentistry photographed at such a high level, at such an artistic way. I had never seen it in dental school. None of my friends were doing it, and it intrigued me. And you get on a journey where passionate people are passionate about everything that they do.

But I was lucky enough to also discover my passion through this journey or quest to seek out continuing education to try new opportunities. Now, my career, it kind of went in a different way, but it really came down to being very passionate and being compelling, which is a quote from Joe Plumeri, this guy who comes to aesthetic advantage to speak on occasion.

But he always says there’s two things about people who are gonna be successful, is that you have to be compelling and you have to be passionate. You have to be obsessed. And so those things, I would say catapult to the next level. 

[Jaz]
You don’t fancy going to Abu Dhabi anymore? 

[Brandon]
Man, you know, I still wanna go. Abu Dhabi, it seems so incredible. Are you kidding me? Everybody wants to go down Abu Dhabi. 

[Jaz]
Well, you know what? This really cool thing that we’ve set up, I haven’t advertised or anything, or put it on social, it’s just through our email list, but we’re setting up this, we call it the Dubai excursion, right?

The deluxe occlusion. We’re doing an inclusion course in Dubai, but it’s like I’ve seen it in US. A lot of educators, they do this, their courses at Disney World, right. And then they encourage everyone to bring their family along, right? And so we’re kind of making this thing happen in Dubai. We’re encourage at the Atlantis who’s got the waterpark and stuff, and a mixing family and passion. So if you wanna come and join us next year at April, man, come to Dubai with us. You can- 

[Brandon]
I would love to. 

[Jaz]
You have the whole seminar day yourself. 

[Brandon]
I’d love to. 

[Jaz]
I digress. You already mentioned some mentors. You already mentioned the role of being inspired by someone, so that’s great. The next thing we wanna tackle with you, Brandon, ’cause there’s so much we could talk about.

I just wanna really understand the mindset of someone operating in the way that you do. Some of the cases you do, some of the themes of meeting patient expectations, right? This thing really keeps up dentists at nighttime like that, sleepless nights over it. This is a source of anxiety for dentists and when I look at your kind of work you do, like your patients must have high expectations.

They’re coming hundreds of miles, they’re coming see you. Exactly. So my question to you is, what systems or techniques do you employ to help with that? For example, some dentists might have a very strict selection criteria, so they’ll actually dismiss a lot of patients and they pick the home runs other one, the most classic one. Since day one of dental school, we are taught undersell over deliver. Okay, so I wanna know, how do you manage the crazy high expectations that you must get? 

[Brandon]
Man, you hit a lot of points. Make sure that I come back to that undersell over deliver concept. Expectation management, I think is the key of cosmetic dentistry. And if you really think about it, what is cosmetic dentistry? It’s not really a specialty. The way that I look at cosmetic dentistry is essentially a philosophical approach to dentistry and that’s it. Like a lens that we look at everything, how can we be comprehensive? And at the center of that lens, there’s two things that need to be balanced.

Number one, patient autonomy, and also doing the right thing, right? We took a Hippocratic oath in order to become doctors, and so there’s a certain balance, as we know in the world of social media, and now people are taking a accountability for guiding their own oral health and their total health in general.

People want to be in the car seat and drive the car. Patients are demanding certain things, and so how much do we balance patient expectation and autonomy, what a person wants for themselves? I think it all boils down to one thing, having a very clear and dry practice philosophy that governs every decision that you make.

Okay? And so when I think about meeting a patient’s expectation, I wanna first sit and be a very good diagnostician. I wanna be able to understand exactly what I’m dealing with so that I can communicate with a patient in a way that’s very digestible so that they can understand. But we put it in the framework of their expectations and it starts with just listening and understanding how can we become a translator?

And that is the biggest challenge. And I think we are equipped with certain tools that allows us to communicate effectively. Not just with the patient, but once the patient does accept treatment with the labs and creators that we collaborate with. And one of these things are tools that are the center of everything that we do is being able to handcraft temporaries that tell a particular story because now the patient has an opportunity to test drive what it is that you did for them, but they also have an idea for direct feedback.

Did you translate the vision that I have for myself? One of the things that we have in place is that 24 hours after doing a case, I bring a patient back. I sent them down in a new environment. We take photos, videos, same records we do in the beginning, and we analyze ’em. We give the patients an opportunity to give feedback, so there’s always five checkpoints for patient expectation.

When a patient comes in and fills out the paperwork and tells you their chief concern, the patient isn’t usually involved in a mockup or digital design. That’s more for inter-office communication to verify, hey, are we on the right path? Is everybody on the creative team on board with this? The temporaries day one, when you’re doing the preparation, this is an opportunity for us to deliver the vision that we’ve aligned ourselves on, that the patient has told you, this is what I expect from a functional and aesthetic standpoint.

After that, the fourth checkpoint is when the patient is gonna give feedback, did we deliver? And if we did deliver, fantastic. Now you have to manage that expectation again because it is very difficult, as you know, even with the tools and technological advancements in dentistry to copy a set of teeth, one-to-one.

And so over the years, I have changed my language. I don’t say that we’re gonna copy the temps. What we’re doing is we are creating a framework for aesthetic and functional interpretation from the partners that we work with. And so we have a lot of different labs. And one of the difficult things is when you’re working with different creators, different ceramics from Romania, Brazil, Los Angeles, New York, London.

If you’re working with those team of people, how do you have a unifying body or a certain aesthetic voice that communicates to the patients? That consistency is going to give you trust from the patients. And that is going to help manage the patient’s expectation. Their expectations are being managed before they even meet you.

Are you consistent? Do you have a consistent aesthetic voice? And what is your philosophical approach? Are you a doctor that I do what the patient wants? Or are you a doctor that says, hey, let me hear what it is that you expect and let me translate that into something actionable within a framework of what I’m comfortable doing.

And so there’s so many different approaches that you can take, but I think managing the expectation starts with listening, communicating and being aligned on an agreed upon vision. 

[Jaz]
Let’s just talk with the lab, ’cause you said it’s a very difficult thing to do an exact replica, which is why creating a framework, it makes sense. Do you choose the technician based on who’s a good match for the patient or like some other clinic, what they do is they kind of give the patient a brochure. It’s like, here are the five labs I work with. You pick the menu of the day. You pick the signature dish, you pick the ceramics that you like the most, and their work. Like how do you become that decision? 

[Brandon]
First of all, I love your energy, brother. You got me fired up this morning at 8.45. It is a delicate dance when it comes to choosing the technician, and I heard this thing on social media the other day, and it was about being magical, right?

And so when you have talent, and you do something and it just comes out great, those people who have talent that they’re just born with and they’ve fostered over the years, they’re able to be magical. But when you can take that and apply science or an algorithm to it, now you have something that is just undeniably exceptional.

And so when it comes to selecting a technician, we’ve boiled it down to, alright, this particular technician, he does color very well. He works on preps with homogenous prep shades very well. His interpretations of shapes tend to have more sharp line angles as opposed to another interpretation of the temporaries tend to be a little bit more soft or rounded.

And when you have a certain vision for a patient, the final result, the beginning, you have a ceramics in mind. Who is going to maximize their skillset to deliver that kind of interpretation of the product. And so I’m always thinking from the beginning consult from first meeting a patient. It’s like, oh wow, this is a great case for Chris.

Oh, this is a great case for Rico. Oh, this is a good case for Calvin. Danny. Boom. And so we selected based on which ceramist has the skillset to deliver on that particular case type? Some of my ceramics are very, very good at mixing different material selections. Feldspathic, mixed with layer zirconia, or some are really good at using lithium disilicate.

Some are very good. When we start talking about changing vertical dimension, which we’re gonna talk about later on the pod, I believe. It really depends. All of my ceramics have a particular thing that they do very, very well, and I like to connect with them so that we can exchange energy. I believe in having two sets of creatives on a case versus me being the only person there and they work for me, so I like to have feedback, and we’re gonna talk about that in the future. 

[Jaz]
And when you were discovering these technicians to have that flow, who aligns with you? I mean, you’ve named about four or five different locations. You must have been through at least 20 different technicians until you settle on the five of your A team or whatever. Tell us about the journey of working with many technicians or going about to discover who best aligns with your practice or your values of aesthetic dentistry? 

[Brandon]
Investing energy and risk, and building genuine, authentic relationships. That’s what it’s all about. The first thing that I do when I reach out to a ceramic or they reach out to me, I tell ’em about my approach and how I like to work, and I ask them, is this something that you would be interested in?

And what is your vision for yourself? How do you like to work? Some people, they want to be the artist. They wanna have a lot more creative control of contours. When you’re early in your career, it’s nice to have ceramics that can guide you through the process and kind of, be the training wheels for the case to make sure that it goes as you plan, as you progress in your skills and your aesthetic vision and your functional capabilities to deliver, you start to wanna have more creative control over the case and then you wanna match that energy with someone who can deliver what it is that you see.

And so the conversation changes over time. The cost change over time. And as you vet different ceramics, it’s more about who is the most willing to communicate in a way that I like to communicate. The minimum standard is, is the work good? Do they do good model work, and are they passionate? If they have those three things, they can come to the table to work.

Now, from there, how do we communicate? What’s the energy? What’s the alignment? Do we enjoy working with one another? Are we on the same wavelength? What is it that you see? Am I learning from you and are you learning from me? All those things are very, very important.

But yeah, we’ve gone through at least 20 ceramists and some really good ones too, and you kind of settle in the people that you actually enjoy working with, not just because the work is good, because you enjoy the energy exchange that happens there in creating something special, and there’s a certain power that comes with that. I love that part of it. 

[Jaz]
That’s brilliant. Now, when I talk to many dentists, younger colleagues, they always ask me, oh, how do I choose a lab technician? Or which technician do you use Jaz? And the mistake they’re making there is that, we’re very sheepish in dentistry.

Like, for example, you start working in practice and whichever lab that practice has been using for the last 15 years, he just said, oh, this is who we use for dentures, and this is who we use for crowns and you just go with that. But to go through that uncomfortable period of actually having a conversation with a new technician and actually seeing that A, they are communicative.

And they are responsive, which is what we need in this world. And then eventually you will find someone who is similar to you, really great denture removal process specialist Dr. Finlay Sutton in the UK. He recommended once in a podcast to find a technician who’s kind of like a similar age to you.

And that you wanna like bounce off each other and then you grow like together over the years. And that always really resonated with me. And it’s really nice to have those open communication channels. Like sometimes my wife will look through my phone and the WhatsApp messages and exchanges and or voice notes between me and the technician. She’s thinking like, what’s going on here? You speak to him more than you speak to me, kind of thing. 

[Brandon]
Yeah, I know that. Listen, I’m up at like four in the morning sometimes talking to the ceramists because we’re at different locations. I think that you said something there, and I think it really boils down to the fear why people don’t want to take more creative risk.

It boils down to fear and this idea as dentists we’re so type A that we feel like everything is a Super Bowl, we have to get it right on the first attempt. What many people don’t understand is that even when I’ve identified someone that I would know as being the best in the world, it takes a minimum.

And I don’t even think this is an overstatement. I think it’s an understatement, a minimum of 15 to 20 cases to dial in a particular language until there is a certain homeostasis that’s happening there where you are just in the zone oscillating back and forth. And a lot of people have to be okay with taking that risk.

They have the fear that we’re not gonna get it right this first time. It’s like there’s certain indicators. How do they fit, how is the communication? Are they open to feedback? Do they give you feedback? Because if you have that type of relationship, exactly, like your mentor told you, that the prosthodontic technician, it is about getting with someone that you can grow with. And I think it takes 15 to 20 cases to build a body of work. And now you can reference those cases when it comes to color and texture and design. That’s really important. 

[Jaz]
Brandon, you have a very flamboyant vocabulary. I love it. I just wanted to put that in there. Now we mentioned undersell over deliver and I wanna hear what you say on that, but before I let you go off on that, another thing it reminded me of eight, nine years ago I was, there was lecture.

And this dentist, he was teaching us that when you try in a crown, let’s say you try and crown on upper premolar, okay? And then you show the patient in the mirror to check the crown. And then he was saying never say, what do you think? Because his thing was, you’re just inviting feedback. They say, oh, it’s a bit fat.

Or is the color okay? Then he was like, you’re setting up yourself up for failure and revisions and that kind of stuff. Now that was, you have to understand the context where that was coming from, Brandon. That was coming from someone who’s head of a corporate and he wants the fits to go in the first time and therefore less remakes.

Therefore, profitability is highest in his corporate chain practice kind of thing. Whereas what you described was like multiple checkpoints, multiple times of checking for alignment and accepting feedback and hearing feedback and trying to get there. And so going back then to what the opposite of that, but also going to undersell and over deliver, which is what we’re taught as, what we’re taught in dental school is undersell over deliver. What is your philosophy on that approach? 

[Brandon]
I think confidence comes through humility. And what I mean by that is that you have to have the humility to analyze your work and know that there’s space to get better. And by getting better consistently, you become confident through time. And that confidence comes off in the consultations.

And so with me, my approach is being very aware, self-aware about one’s own’s ability is very, very important, and it’s okay to communicate that and be honest about that with the patient, whether it’s good or bad. I think that it is a tricky thing. I talk to my team about this all the time. When you are in the process of doing this, you have to understand the level of anxiety that comes with it on the patient’s part, because everything that we’re doing is semi-permanent, right?

Nothing lasts forever, but this isn’t a hair dyeing or a haircut, what we’re doing, we intend for it to last a very long for time. And just about everything that we do in dentistry, even if it’s a zero prep veneers irreversible, the surface of that tooth will never be the same again. And so what I talk to my team about and everybody in the process is that our job is to control. What are we controlling? Their trust in the process and everything that we do, it is geared towards that.

Number one, did we give them the space to talk in the consultation, did we listen? Thoroughly? That way the body of work is gonna procedure you. They’ve seen the work already and so I don’t like to get into the weeds about what they want things to look like in the beginning because now you’re introducing the opportunity for the wheels to fall off of the thing.

Their feedback comes from that post-op, and I don’t like to just give them a mirror when they sit up because that is a very intimate thing when they look at themselves for the first time. I don’t wanna be involved in that process. I don’t wanna be involved and I don’t want my team involved. I want that to be something intimate that they experience.

Over the course of 24 to 48 hours themselves where they don’t feel judged and now they can have honest feedback with themselves and come the next day or the next two days and give that feedback. And so what I’m doing is I’m taking the photos and I’m studying the case so that once we come to post-op, I want them to speak first, to make sure that we’re aligned.

We’re seeing the same things. If they see what I see, this is a home run if you can execute. Right? But if they’re seeing something different, it’s like, let’s take a step back. Let me understand where you’re at. And then now you go in there and you deliver. Oh, that answers the question. It is a very tricky thing.

It is tricky, especially when you are asking a patient, what do you think? One of my mentors, he always said he would do one side of the temps one way, the other side of the temps another way. It’s like, what side do you like best? So the answer is always positive. No, I’m just kidding. But he did say that. That’s one of my mentors. This is Dr. Larry Rosenthal. He’s a funny guy. 

[Jaz]
Okay, that’s interesting actually. I like that. But I mean, I think the undersell over deliver concept, therefore, in your practice you don’t really practice that ’cause you are prototyping everything and you are, you are checking every change and so they’re gain to get what you see is what you get to a large degree because you’ve tried everything in the prototype. Is that fair to say? 

[Brandon]
Well, I have a question for you. This is why that resonated with me. How do you feel about this concept of conservatism for the sake of being conservative? Undersell over deliver. I know where you’re going with it, but this is why it struck a chord with me. And it goes back to kind of understanding occlusion also and functionality.

I think a lot of the problem in cosmetic dentistry is that we’re not given the patients the opportunity to explore what is possible. A lot of times we undersell a patient by under diagnosing because we don’t want to hear no, we’re afraid they may say, no, maybe this is too invasive, but what is really invasive?

Think about a patient who has wear from, let’s call it bulimia, and they wanna explore the concept of cosmetic dentistry, and a new dentist recommends doing 10 teeth on the top and then 10 lower veneers on the bottom. How invasive does that have to be? How much tooth structure do you have to cut if they already have acid wear and now the occlusal surface have the little acid dimples on the cusp tips.

Now, if we were to consider opening the vertical dimension or the bite by mounting the case in CR for prosthetic convenience, how much more conservative could we be by treating a few more teeth in terms of saving the total amount of enamel that’s being cut for this case? And the amount of time that we can preserve the entire system, you know?

And so I think about that a lot. I know you were going a different place with that question, but that’s what popped into my mind when you talked about, I guess the under promise, over deliver. 

[Jaz]
No, but I like it. That gives it a very good perspective. We are afraid of rejection. 

[Brandon]
Oh, very much so.

[Jaz]
No, that sits perfectly with me. When you were going to like, through process of setting everything up in your systems, obviously everything that you’ve been doing over the years. It informs your system and you’re gonna make this tweak and you’re gonna do it like that, and eventually it takes years to build these systems and therefore, managing expectations over the years.

Are you happy to share a couple of hairy scenarios where expectations work difficult to meet for whatever reason? Or some failures along the way that you can pass on some lessons to us. Seeing you where you are now, it’s nice for the little guys to say that, hey, you know what? We can still all mistakes and learn and grow together. 

[Brandon]
This plays in the why it’s great to have amazing mentors and be very open to helping your community. Because I remember a particular case was referred to me from a periodontist. This sweet lady came in and she was in the process of doing some other cosmetic surgery, facial enhancements and such, and we were gonna do her teeth.

And at the time I thought that I understood the nature of where we were from a cultural standpoint with aesthetics. Meaning when we talk about natural teeth, what does that mean for people? What does that mean for dentists when it came to color, what white teeth meant to patients versus what it meant to dentists?

And we did this case where a patient, we thought we hit a home run. The case was like an 0M1–0M3 at the time we showed it. We didn’t show the shade tabs because that’s what was taught to me. That is what I learned is that, oh, we don’t show a patient a shade tab, but we have them select a color based on the temporaries.

It’s this good. Is it too white or is it too dark? That was what I learned. And so in this particular case, it was one of the best cases that I thought that I had treated, and she came back to me and we mismanaged the case so poorly. When she asked, she said, hey, do you think these teeth are white enough?

And I remember looking at the centrals thinking, it’s like they do look a little warm, and we tried to convince her. I wanted to convince her because I was so attached to the amount of work that was put into delivering the case. And that was one of my best lessons for me to remove myself. If you put in so much work and you hit 99% of patient expectation, you know that you put in the 99%, but that 1% is what it took to meet that expectation.

You have to be in a position where you can stomach that level of failure. And be okay with saying, hey, you know what? I see what it is that you’re saying. I’m gonna go back and we’re gonna replace this case. Now, when you’re getting into a game of elective dentistry, it can get a little hairy. You have to be okay with understanding that everyone’s opinion about what is beautiful or what meets their expectation is gonna be different.

And if you don’t manage the patient well throughout the entirety of the process, their expectations can shift at any point. And you can be upside down on a case, meaning it doesn’t matter what you do technically. If you mismanage the patient and meeting their expectation, it can go sideways, and you have to have systems in place to predict when that’s going to happen.

Understanding personality types and patient psychology when you meet somebody and really respecting your decision, am I going to take on this patient? Can I help them get closer to what it is they want to access? Or am I not the provider to guide this patient to meeting their expectations? Should I recommend that they have a second opinion?

I think those are things that I learned early on in my career. I also remember there were cases when I used to think that OM3 was the whitest that I would wanna go because there was this, certain dentists were regarded in a way if they made the teeth too white and too opaque, and patients were asking for it.

Early on I was a little bit fearful of going wider and wider. I didn’t want to take those type of risks from thinking that I wouldn’t like it. And so as you go through your career, you start to understand who you are. It’s like, is it about me pleasing myself and feeling like, oh, I did a great job and I love it.

Or is it about pleasing the patient? Where is the balance? And I felt like that was the, at the center of a lot of my early failures as well. And that’s something that’s very difficult to talk about- 

[Jaz]
That the patients wanted to go whiter? 

[Brandon]
Correct. You know, you have some dentists that say, hey, the patient wanted this, so I did it and I think we leaned, I used to look at dentists who said that as like, hey, that’s just an excuse for accepting a low standard of what should be done. Patient standards are so incredibly low, you could do just about anything and make them happy. But if you don’t have a high level of standard for yourself, then at least that’s what I used to think. Right? And that was the excuse that I would make.

And now it is a little bit different. I’m more open to taking more risk and understanding how can I achieve what it is that they want by doing what I’m comfortable with. And I’m talking purely aesthetics. Now, is it possible to give an unrealistic level of whiteness or value to a set of teeth and still have it have elements of believability?

And because of all of those failures early in my career for color, that’s where the concept of believability came from. It’s not natural when a patient says, I want really white teeth, but I want it to look natural. That is a horse with stripes. It’s not a zebra. It is a horse with stripes. These are two conflicting things that I felt like, it didn’t exist.

And so it forced me to have more open lines of communications with my lab partners to ask them how can we press the boundaries of giving something that could be believed as being real, but also have elements of wow factor? And so over the course of like two to three years, I was able to develop that concept, and it came directly from failures to communicate expectations around color, opacity, fluorescence, reflectivity, absorbing teeth, and all of these concepts you learn along the way.

And it modulates how you prep a tooth based on prep, shade, material, thickness, material choice, all of that stuff. And so I think that for the young dentist, embracing every failure. No matter how big or how small, and understanding that every one of those lessons are an opportunity to put you in a better position to treat the next person better, it’s going to make the next person’s case better. Every single failure. 

[Jaz]
In this case, it’s all about just doing right for the patient, but the two words that, I’m just screaming in my head based on everything you said there. And the whole mention of the psychological status of the patient and everything is some clinics, they may employ a initial screening form for I know, psychometric analysis or something like that.

You know, the two words I’m thinking of, right? Body dysmorphia. Have you had body dysmorphia patients? ‘Cause I can imagine, that can drive you up the wall, right? Because you want to do your best. But they keep changing their mind. They don’t know what they want themselves. And then you end up in this perpetual cycle and that’s very toxic for everyone involved.

So do you have a way of screening for that so that they can get the correct medical help potentially before you do the other element of it? Or has your experience been otherwise? 

[Brandon]
You saw how hesitant I was to say the words body dysmorphia or tooth dysmorphia because that is a very real thing. And we have to ask ourselves as dentists, are we contributing to it or are we making it better? So I think that also boils down to that personal practice philosophy. In my office, I think about that when every time I sit down and do a consultation, does this person have body dysmorphia? Can I meet their expectations and are their expectations realistic?

Yesterday I had a patient come in, she says, hey, my friend treated me with orthodontics. And this lateral won’t move. It won’t turn. And they did Invisalign go on me. And then they told me, oh, we should have done Invisalign comprehensive care. And now they’re telling me I need 32 more trays. And I sat down with the patient and I told her, I said, listen, you’re gonna walk into 10 offices.

Out of 10 offices, and every one of us is gonna tell you, wow, your dentist did a phenomenal job. I see what you are saying about the lateral being tucked behind the central. But these teeth are gorgeous. They look absolutely phenomenal, and they were stunned. She had a stunning smile, very natural, had very nice depth, central dominant lateral setback.

But she was looking for this perfection that it doesn’t even exist in nature. And I heard something once that there are no straight lines in nature and I’ve been very pressed to find one. And so I was trying to explain to her this concept of balance and embracing asymetry and embracing the characterization of the teeth because I think she was suffering from body dysmorphia or tooth dysmorphia where she was looking for a level of perfection that does not exist.

And if we were to introduce perfection into her smile, it’s going to introduce a certain level of aesthetic stress because her face is asymmetrical. And now with that perfect smile, it’s gonna have us focus on, look, the interpupillary line is off. This eye is a little bit low. This side of the jaw is a little bit longer and more prominent.

So I think it’s something that’s very difficult to deal with. And I don’t think we talk about it enough in dentistry because I think a lot of the world profits on body dysmorphia, and it’s something that we should be talking about a lot more to help pick populations of people, and I think social media has a lot to do with it.

We are more self-aware of how we look. Filters has a lot to do with it. Us being able to change and modulate the way that we look, and then if we see ourself through filters over and over and over again. And then we have to juxtapose that to what we see in real life. It can create body dysmorphia and then who has to deal with it.

[Jaz]
I loved your use of the word aesthetic stress, the whole concept of facial flow and aesthetic stress. And I really like that, it reminded me of an interaction with a patient a few weeks ago. Similar issue, like I did her Invisalign, I did her a bonding, and I was in love with it. It’s very important for the operator to be in love with it because though if you are like fitting something right?

And you’re like, you are not in love with it. Then the two years later they come back and they say, I don’t love it. You’re like, yeah, okay. Yeah, I see what you mean. Now you can’t, you have to fall, you have to be in love with it yourself. And so I was in love with it first year, so it ticked the first box.

But she was saying this lateral and that lateral and the thing that saved me, I guess, or but got her to understand, okay, because I was really liking this, right, is something that apparently is used eyebrows, women’s eyebrows, right? They say eyebrows, they’re not twins. They’re like sisters. Okay.

They’re slightly different, which I really liked because I always explain to the patient, look, the centrals should be like twins, right? The laterals should be like siblings, and then the canine should be like cousins, first cousins. And she was like, oh, so it’s like eyebrows. Eyebrows should be like siblings. I’m like, there we are. 

[Brandon]
I love that. I’ve never heard that about eyebrows, but I do. I see it. I use something very similar, except I say the essentials are like fraternal twins. They don’t have to be boy and boy, but man, I love it, man. I love it. Yes. I bet you bring a high octane energy to your patients brother and I know they love you for it.

[Jaz]
I appreciate that very much. Means a lot, coming from you. Okay, cool. We’re now into the occlusal philosophy. So, Brandon look. You do all these cases. You mentioned already about raising the vertical dimension and that bulimia case. It’s a tough question to ask someone, and so good luck. What is your, in a nutshell, what is your occlusal philosophy?

[Brandon]
My occlusal philosophy is I look at a patient, is the bite stable or is it not? Is it a destructive bite or is it stable? If the bite is stable, then we should consider restoring them in their comfortable bite or MIP. We leave the vertical dimension the same, and we’re gonna shoot for canine guidance on a case so that the back teeth disclude when they go in the lateral excursive movements.

If the bite is destructive, we have to decide a starting point and mounting the case and CR, and then understanding how do we alter the vertical dimension based on prosthetic convenience and occlusion. And so it really boils down to that. 

[Jaz]
I love it. And let’s just keep it back. ‘Cause I love the simplicity. Occlusion is this thing that’s over complicated. Just having a few, ’cause we can talk for like seven hours on one topic of vertical dimension stuff, but I’m happy with that. So Brandon, I appreciate that very much. I always want to ask a cosmetic dentist this, right? To what extent do you agree or disagree with the following statement? Fake it till you make it.

[Brandon]
Next question. No, I’m kidding. I disagree because I did my career in reverse. I tried to put in the work first and then I wanted to make it. Now you see a lot of the young dentists, they come out celebrities, and they’re very, very popular. But there’s a lot of pontification that happens, and I, I don’t think it’s pontification because they want, I think it’s pontification because they don’t know that they don’t know.

Some of the things, and I don’t believe that we should fake it till you make it, because there’s a lot of harm that could be introduced in this industry to patients, and we are dealing with something that is very powerful. And I always say this, if you have a product or service that is so powerful as hope, love, and something is addiction, right?

Those are magnetic forces. And the power that we have to change a person’s life or the idea that we can change their life, it is a magnetic force that must be approached with responsibility. And I think that the fake it till you make it is something that’s very prevalent in our industry, and I think people should focus more on getting the proper training and building up a certain skillset before we try to jump out and have that type of approach because it is very dangerous.

Patients, they don’t know better in some instances, and they want a product because it is powerful. We are unlocking a level of freedom for people. They wanna explore, experience, empower, and express. And the teeth is the cornerstone of facial beauty, or it can be. And it’s also connected to how we look at ourself, our self worth, our value.

And so if you have the power to deliver that to somebody, or they think that you can. Faking it till you make it can be a very dangerous concept in my personal opinion. That’s why I said, hey, next question. This may have to be edited out because hey, I’m the dentist. Dentist and I’m here for us. 

[Jaz]
Last couple of questions. Very like technical geeky kind of stuff, right? Because obviously we’ll talk about your London visit. Very exciting next year, and we’ll talk about the kind of things that we’d be talking then, but everyone will probably want to know like such a stupid little thing, like what’s Brandon’s favorite veneer cement? 

[Brandon]
Panavia veneer cement, translucent. And it is something about when you do a wet trying with a veneer and you have a very nice prep shade, all right? If you are doing ultra thin veneers, we all know that both the ceramic, the substrate and the cement are gonna contribute to the final color. If you have a veneer that’s thicker, it’s really the material and a little bit of the substrate that contributes and the cement has a little bit less of an effect.

But with these ultra thin veneers that we’re doing, the cement has a certain effect on the final result. And I love using the Panavia veneer, translucent cement, and I tell all of my labs, this is a cement that we use so that they can do these little custom prep tabs. And then they can do a veneer, and now they’re gonna know how the cement influences the ceramic and have like a little bit of a standard.

And so I love that. I really like using the same cement for a case so that I don’t have to modulate the final color with the cement, that translucent cement from Panavia, it handles well, cleans well, and it has a really good viscosity that doesn’t fracture thin veneers when you overly pressure to it. Sometimes with something like a RelyX veneer cement, it’s a little too thick, and so if you have too much pressure on a ultra thin veneer, it can be susceptible to fracture before curing. So that is my ultimate favorite of all time. 

[Jaz]
As a Panavia fanboy myself, I’m very happy to hear that. What are your thoughts on composite veneers? Because they’re all the craze, right? And I know a lot of American dentists, they say compo-sh*t and so they don’t believe in it and stuff. Whereas other people are really, that’s all they do right?

Day in, day out. They’re doing resin veneers. What’s your stance on that? You are looking at all this happening. What’s your philosophy on this? 

[Brandon]
Everybody wants to be a bodybuilder, but no one wants to lift the heavy weights. The best cosmetic dentists in the world either start on or they know how to manipulate composite extremely well.

You have to be talented. An extreme level of talent to use composite, well, composite veneers, in my personal opinion are one of the best things that has hit dentistry because it offers a very nice solution at a little bit lower of a price point. The challenge is, and why a lot of Americans don’t do it is because it is technically demanding.

For most, it requires that you have a high level of skill. There’s no one to save you. There is no lab or designer to save you, even though we have digital design and you can do the suck down method where you do every other two TEFLON it off. But they have some very talented dentists that are working with composite veneers, and I’m a huge fan of it.

Now, in my hands. I don’t like to use it just because from for long-term maintenance. And being the level of you gotta be really good. And I love working with composites. I feel like my experience with doing composite veneers or class four restorations early on, learning from Dr. Adamo and Dr. Amanda Seay out in Charleston, that is what gave me my initial boost and getting fired up about cosmetic dentistry because you are essentially the ceramics now.

It’s up to you texture, the layering, looking how colors interact, understanding the achromatics and how teeth look when they hydrate or dehydrate. I mean, composite is amazing. I think it’s a wonderful material. One of my closest friends, Jeff Trembley outta Nashville, he plays with the composite veneers.

Dr. Marshall Hanson in Utah’s good. Felipe Verde. I don’t know how to pronounce his name properly, please forgive me. Huge fan kidding monsters in a good way. Rhodri Thomas, Australian, I believe. 

[Jaz]
Rhodri Thomas? 

[Brandon]
Yes. 

[Jaz]
He’s Welsh. He’s from the UK. 

[Brandon]
Yeah, he is stellar. 

[Jaz]
Look, you’ve answered all these questions brilliantly. The time has really flown with you, my friend, but we need you to tell us about your trip to London. Baraj connected me with you. He says, you know, Jaz you gotta check out Brandon’s work. And I’m so glad he introduced me. I know it’s a two day, it’s quite intense two day thing. He showed me the images of like the cinema type thing.

I dunno if I’m allowed to say the venue and that kinda stuff, but the photos look amazing, but more importantly, you are putting on an educational package. You’re doing a live demo. What is that the dentist gonna gain from this experience with you over two days in February, 2026? 

[Brandon]
I think the biggest thing that I want to communicate is changing the way that they approach cosmetic dentistry. Changing and unlocking their mind and what they think about how they communicate with the patient and with the lab, and equipping them with tools to focus on understanding the impact of provisionalization and what it means to use that as your primary tool between A to B and B to C, meaning between me and the patient.

And then me in the lab and the patient in the lab so that the flow of information is consistent. And then taking those concepts and figuring out how do we actually execute on it? Taking the information that we know, how do I do what you do? How do I create the transition zones? How do I communicate the stroke of a line angle?

What does texture and modulation of surface anatomy do to how it interacts with light? I think using these tools, I think is gonna be one of the biggest takeaways from the course. Changing and unlocking the way that we think about how we approach dentistry and then giving them actionable items to actually execute on the biggest communication tool that we have.

[Jaz]
At what level are you pitching this in terms of are you gonna be able to serve dentists who are like, brand new, or people who’ve been in the game and doing some aesthetic dentistry for the last five, 10 years? Like, who’s the ideal dentist? 

[Brandon]
For the new dentist, it’s going to unlock what is possible. And for a dentist that has dabbled, either in some cases or a lot of cases, especially someone who’s dabbled, in some cases, in a lot of cases, there are going to be certain takeaways or AHA moments that every time that I go to a lecture, I can go to the same lecture three times and there’s always a new takeaway because my level of work that I’ve seen is increased, and there’s always nuggets or pearls that are like, wow, this is massive.

And now I can put that connection together. I think it’s gonna serve both populations, especially the younger dentists. And people who have already dabbled in doing aesthetic cases and aesthetic dentistry. 

[Jaz]
It’s like reading a good book, right? And then when you read it again the next year, like it hits you completely differently. Now, the book didn’t change, but you changed, right? And so some people will come into a course like yours and if their practice is built around cosmetic dentistry, right, they’re gonna be like seeking validation, but also, oh wow, Brandon does it this cool way that I hadn’t considered and introduced these technicians that you might use or workflows.

And then sometimes it’s about those tiny nuggets that make a big difference to your practice, whereas a new grad might come and just be like, wow, how do I make sure that in the next five years I can make a treatment plan and trajectory to get to some way towards what you’ve achieved? And so I’m very excited for this.

I’m gonna put all the links. Now that you’ve been on the podcast. The link will be protrusive.co.uk/returnofthemack. So I can remember it and that will take him to the website to do the booking. So we will do that ’cause that’s fun to do.

Brandon, thank you so much for spending some time with me. I know you’re a mega busy guy and I’m so glad our calendars could align in this way. You brought a lot of value. You’re very real. It’s been an absolute pleasure to talk to you. Any last words for all the audience out there? 

[Brandon]
Jaz, I appreciate you guys. I appreciate the love. I’m an energy guy. I felt the energy here was great. I’m looking forward to seeing everybody in London in February, 2026 and the world is yours and everything in it, brother. I hope that you guys are well and it’s been a pleasure having this conversation with you. Thanks so much for having me, and it means, it means a lot to us. 

[Jaz]
Thank you, buddy. Catch you soon.

Jaz’s Outro:
Well, there we have it guys. Thanks so much for listening all the way to the end. Yes, indeed. Dr. Brandon Mack is coming to London. I think it’s Feb, sixth and seventh, 2026. It’s in a central London location. Some of my friends such as Bal Sohal are flying Brandon into London to deliver a two day experience.

They have given the Protruserati a discount code. As always, it’s protrusive and it’s gotta be with capital letters. I’ll just make it very clear that I do not have a financial interest in this at all. But having spoken to Brandon today, I’m sure you enjoyed his appeal and his energy. I think there’s a lot we can learn from him.

So if you’re interested in this event in February, head over to protrusive.co.uk/returnofthemack. That’s protrusive.co.uk/returnofthemack. Mac we’re spelling MACK ’cause that’s his name. I’ll put that in the show notes of course. And this episode was eligible for CE or CPD. We are a PACE approved education provider.

Answer the questions, get 80%. Look, you’ve done all the hard work. You’ve listened to an hour of dentistry, you deserve a CE credit and the only place to get that is on the Protrusive Guidance app. If you haven’t got an account yet, head over to your web browser. Go to protrusive app. And you get to choose a paid plan that suits you best.

If all you ever do is listen to the podcast, you’re gonna rack up 40, 50 hours of CE every year just from listening to our weekly podcasts. And we have a plan for you. If you want a bit more than that, and actually watch all our clinical walkthroughs and premium clinical videos and masterclasses and the live monthly webinar that we do, that you get CPD for.

Then we have a package for you as well. It’s all tax deductible, of course. And as far as education’s concerned, it’s one of the best value dental education subscriptions out there. So if you want the full fat experience, head over to protrusive.co.uk/ultimate and join the nicest and geekiest community of dentists in the world.

As always, I wanna thank Team Protrusive for all their hard work behind the scenes. Some of the recent infographics we’ve been making are absolutely killer. We share them in our email list, we share them on Instagram, but the number one place to check them out are on the Protrusive Vault. And again, that’s on the app.

And so with that, I’ll catch you same time, same place next week. Bye for now.