Dr. John Kois's Clinical Decision-Making Regarding Wear Patients

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Episode Description

In part two of this in-depth conversation, Dr. John Kois moves beyond theory and into clinical application, tackling the questions every restorative dentist eventually faces: Who is actually a high-risk occlusal patient? How do we distinguish past adaptation from active breakdown? And why do so many "standard solutions" fail to prevent restorative complications?

Building on the foundational concepts from part one, this episode focuses on how occlusion shows up in day-to-day practice—and how dentists can make more informed decisions before committing to complex restorative or implant treatment. Dr. Kois explains why visual wear alone is an unreliable predictor of risk, how to identify whether wear is active versus inactive, and why patient symptoms often tell a more important story than what we see on models or scans.

A major theme of this conversation is closing the gap between chairside evaluation and real-world function. Dr. Kois challenges common habits—such as adjusting restorations with patients fully reclined, relying solely on articulating paper marks, or reflexively prescribing nightguards—and explains why these approaches often miss the true etiology of failure. Instead, he emphasizes evaluating occlusion in positions and movements that reflect how patients actually chew, speak, and function throughout the day.

In this episode, you'll learn:

• How to identify true high-risk occlusal cases before restorative treatment begins

• Why active wear and patient-reported change matter more than historical attrition

• How muscle symptoms, mobility, and joint loading influence predictability

• When nightguards and Botox may mask symptoms rather than solve the problem

• Why larger restorative and implant cases demand a deeper understanding of jaw position, tooth fit, and functional pathways

Dr. Kois also shares candid insights on emerging technologies such as jaw tracking—where they add value, where they fall short, and why they are most impactful in comprehensive and full-arch cases rather than routine dentistry. The discussion highlights an important truth: many restorative failures are not material failures, but diagnostic failures rooted in incomplete occlusal assessment.

The episode closes with a powerful reflection on learning, clinical growth, and professional development—distinguishing information from knowledge, and knowledge from wisdom. Dr. Kois outlines the progression from skepticism to commitment, underscoring why true clinical mastery requires not just understanding concepts, but applying them consistently over time.

Together, parts one and two form a cohesive framework for thinking differently about occlusion—one grounded in physiology, adaptation, and long-term predictability. If you're aiming to move beyond bread-and-butter dentistry and into more complex, fulfilling clinical work, this conversation provides essential perspective on how to do so more thoughtfully and successfully.