Protrusive Dental Podcast

Check out the TOC IPR Kit with the Intensiv Swingle - Protruserati Discount! Email TOC Dental for the discount IPR can be a tough gig - from the feeling of 'making it up as you go along', to the genuine threat of repetitive strain injury from using strips. Let me help you take guesswork out of it! By the end of this episode, you'll know exactly what instruments to use and have a step-by-step process in place. Why? Because I didn't learn this the easy way. I learned it the hard way, but now I'm going to share with you these different techniques to use that will definitely give you confidence and help you get high quality, efficient and SAFE IPR for your ortho cases. https://youtu.be/x6K2o9tS0GU Check out this full episode on YouTube Need to Read it? Check out the Full Episode Transcript below! Protrusive Dental Pearl: No matter how much IPR you think you have done, do some more. You probably haven't done enough. Don't believe me? Check out this paper below by Dr. Tony Weir. "You can avoid the random learning experience I had, and you'll be able to provide better IPR than I first did for my patients." Dr. Jaz Gulati In this audio-only episode (IPR Video on YouTube) I discussed: How I learned IPR 00:50IPR Strips 12:52IPR Burs 20:17IPR Perforated Discs 24:25Intensiv Swingle Review 28:12IPR Planning 35:21 Check out this paper as mentioned by Dr. Jaz Gulati: IPR-as-part-of-Invisalign®-treatment-in-10-orthodontic-practicesDownload Quantitative-comparison-of-3-enamel-stripping-devices-in-vitroDownload Thank you TOC Dental for the instruments I used. Show them your warmth and support, Protruserati! Email TOC Dental for the Discount! If you enjoyed this orthodontic episode, you may also enjoy my episode with Dr. Devaki Patel all about IPR for Dummies. Click below for full episode transcript: Opening Snippet: Five years ago, I went on a one-day short-term orthodontic course. And another course they talked about IPR. But very briefly, it wasn't covered in much detail at all. In fact, I remember them talking about, call it tooth slenderizeation, don't call it IPR call it to slenderization because it's more patient-friendly. So that was the main thing I remembered. And there we are, you know, they said, go ahead, and you can start doing orthodontic cases now and IPR is totally safe, don't worry. And by the way, use these strips... So that was my first experience about learning about IPR. I then did my first ortho case, which was my wife. Quite commonly, I think as dentist, we tend to treat a family member or our spouses first when we're learning a technique like orthodontics. I also find by the way that splints when people start doing anterior occlusal splints or whatnot, they also find somewhere to practice with their spouse, but it's a similar theme. Now, I actually remember being in Singapore, and my wife was in the chair, I was doing some IPR with strips and I was thinking, wow, this is really slow. What does the orthodontist in the practice use? Because we had an orthodontist at work there. And my nurse said, oh, yeah, he just use these discs. He makes it look really easy. I'm sure it'll be fine, Jaz. And so I started using this disc. And boy, that was an interesting experience, because I was using it and I was like, I was asking the nurse, I was asking LC. LC, am I doing this right? Is this correct? She said, No, no, no, he doesn't like this, like that, this kind of a stroke. And how about now? Am I doing it right? And say, yes, yes, you're doing it right now. So it's quite a laughable experience. When I think about it now. It's quite a dangerous way to learn IPR. But this is our reality. I find that so many dentists that start orthodontics, IPR is like learning from YouTube, winging it or from mentors. So for me, it was winging it. But then also, when I came back to the UK, I did the Invisalign course, which, by the way, again, didn't teach me much about IPR.

After the success of PDP103 Adhesive Full Mouth Rehabs in 11 Appointments, we’re here again to discuss how to plan the Wax Up, Mock up and temporaries using bis-acryl with Dr Devang Patel. https://youtu.be/GuqSkCvFWNk Check out this full episode on YouTube Need to Read it? Check out the Full Episode Transcript below! Protrusive Dental Pearl: How I communicate a high RCT risk: For ordinary patients, I would always say “YOUR tooth decay (in YOUR tooth)/ YOUR filling was very deep.” But for some patients who you feel would make trouble, I would continue to add “...if we do nothing, then your tooth will eventually be in a worse situation. And you may lose your tooth. This could be a painful process as well. If I do something, then that involves drilling your tooth decay, drilling the soft bits of your tooth away and drilling away the old filling that's leaking. Drilling is not a nice thing. So by drilling, the drill is damaging your nerve. Your nerve may die and need a Root Canal." Highlights from this episode: Appointment 2: Patients’ Records (Impressions) 11:35Patients’ Vibe as part of Assessment before planning treatment 18:29Load Testing as part of Assessment 24:22Type of toothwear to consider the type of arch reconstruction 31:48Curve of Spee as part of Assessment 36:25Guidelines regarding Re-RCT before restoring 40:40Comprehensive Evaluation among Patients 45:32Appointment 3: Mock-up and Temporaries 51:58 Check out this occlusion one-day course, hands-on and theory for the Kana Dental Academy. With amazing Speakers line-up (some of them are Protrusive Dental Podcast Alumni) If you enjoyed this episode, be sure to check out the first part Adhesive Full Mouth Rehabs in 11 Appointments and the third part Adhesive Full Mouth Rehabs Part 3  Click below for full episode transcript: Opening Snippet: It's very important for you and technician to know what type of palatal shape you want to create when they're doing wax up. And most of the technician gets it wrong, okay? Because they're trying to create natural palatal shape which we're not trying to achieve... Jaz's Introduction: Hello, Protruserati. I'm Jaz Gulati. Welcome back to another episode of Protrusive Dental Podcast. In this episode, we're going to go through how to plan your full mouth adhesive rehabilitation, including the wax up stage and actually putting the wax up into the mouth using a bis-acryl mock up and how to even send the patient home with that mock up so they can test esthetics, phonetics and function. If you're new to the podcast. Welcome, it's great to have you. This is a part 2 of 3, so you need to rewind to Episode 103. For the part one of adhesive full mouth rehab. The concept here with Dr. Devang Patel, is we're going to cover the 11 appointments, the traditionally 11 appointments from the very first time you see the patient for a comprehensive examination, all the way to reviewing them with an occlusal appliance at the end, and all the stages in between of how to get a full mouth rehab done using adhesive approach. This has been one of the most anticipated episodes ever, like the amount of DMS I get saying, Jaz when is the part two out? I really enjoyed part one. So here it is, guys, I'm so excited to share with you. And Dev. I mean, shout out to Dev for getting so much value, giving so much away to the Protruserati, it is really, really great to have educators like you who are all giving, right? That's what we want, we want to share with each other, share knowledge and improve our daily workflows. [Jaz] Now, before we get on to today's Protrusive Dental Pearl, I want to talk about emails, right? Yesterday, I sent an email and the subject was like 'Why you need to start charging more for your dentistry?' And this email has absolutely exploded. I've had huge open rates. And it was like an essay type email, but I just jam packed it with some reflections that had. So basically one of the delegates on the Splint C...

Learn how dental associates can secure their dream positions using a 4-minute technique. Find out why it's challenging for both associates and principals to connect. Discover the power of thinking outside the box in the dental industry.

You HAVE to check out the music video to catch the REAL vibes! Watch Fresh Prince of Appliances on YouTube https://www.youtube.com/watch?v=pJ_Czt6TDWA Singing Dentist - you ready for the collab? ;) Next cohort of SplintCourse will be open for enrolment in March. Sign up for the launch email by clicking here!

Dental Acupuncture made tangible thanks to our guest Dr David Johnson. We cover the basics of trigger points relevant to Dentistry and Temporomandibular Joint Pain, as well as the two main applications of acupuncture in for Dentists. https://youtu.be/sHGJcsIAses Check out this full episode on YouTube Need to Read it? Check out the Full Episode Transcript below! Protrusive Dental Pearl: How I communicate an Oro-Antral Communication:  I will pull up the radiograph and show it to the patient and warn them that the root of THEIR tooth is so close to the sinus. "If your roots live in your sinus then there is a chance that you will have a new party trick: when you drink water through your mouth, it could come out through your nose via the sinus", and that creates a memorable warning/consent. In this episode I asked Dr. David: What is a Trigger Point?What is the pathophysiology of a trigger point?What causes the trigger points to turn on? What are the uses of acupuncture in dentistry in terms of a gag reflex?What is the success rate of acupuncture?How does acupressure work?Implementation of acupuncture in general dental practice Please do check out Dr David Johnson's Course and Implement Acupuncture on your practice Monday morning. If you would like me to organise another course with Dr Johnson, DM me on Instagram @protrusivedental If you loved this episode, please do check out Hypnotize Your Patients with 3 Quick Techniques with Dr Jane Lelean Click below for full episode transcript: Opening Snippet: Patients with a prominent gag reflex, patients with temporomandibular joint pain of muscular origin, in relation to that is headaches, migraines, and especially headaches, we know this one yet 60% of patients who have temporomandibular joint pain are getting regular headaches, we need to start coming away from it and moving as your stunts do down onto the neck because we know that most headaches are coming from muscles of the head and the neck.. Jaz's Introduction: Hello, Protruserati. I'm Jaz Gulati, welcome back to another Protrusive Dental Podcast episode. I feel like it's been a long time since I had a PDP episode, we've had a couple of group functions, which I hope you really enjoy with Pav. Like I told Pav before I recorded those episodes, speak to me like I'm five years old, because like I said, in a recent Instagram post, I don't know very much about implants. So that's why I really enjoyed learning those basic principles from Pav and sharing them with you. And we had some great comments on YouTube asking for more of this kind of stuff, because it's a confusing gray area, which Pav made very clear. Anyway, this episode is about acupuncture, and trigger points, and two really key uses of acupuncture in dentistry, even if you don't proceed with actually implementing acupuncture into your care, then I think you're still getting a lot of value from David Johnson, Dr. David Johnson did a fantastic job to explain the benefits of acupuncture but also how you can use something called acupressure to actually suppress the gag reflex on children and adults. So do stick around for that absolute gem of advice that he gives. And I think you're able to gain even just from that. This area, you know, trigger points and acupuncture is yet another area, which is not really talked about much in dental school, especially trigger points, like the more I learned about trigger points, the more I'm like how do they not explain this in dental school? I can actually think back to patients at dental school, which were having issues around trigger points and referred pain. And we and the dental tutor and I as a student, we couldn't figure out what was going on. But now I look back and I think yes, it must have been referred pain. And it makes so much more sense to me and you find it, once you know what you're looking for, you can find it a lot more. I think on a monthly basis, I find patients who'd benefit from this.

Today we pick up where we left off on the 1st part of Group Function Episode 13 “Can I Probe This Implant?” In this episode I asked Dr Pav Khaira about bone loss around implants - what is normal and when should I worry? Another very interesting and controversial issue we tackled is how to manage implant screw loosening as a GDP? https://youtu.be/C1Y_AdDhLzU Check out this full episode on YouTube Need to Read it? Check out the Full Episode Transcript below! “If every single year you're losing one millimeter (of bone) that's obviously an issue and we need to intervene and do something,” Dr Pav Khaira In this episode we discussed: Normal bone loss for average implants 1:53Guidelines for GDPs managing loose implant screws 5:03Universal Implant Drivers? 10:45 If you liked this episode, be sure to check out the first part of this series Can I Probe This Implant? Click below for full episode transcript: Opening Snippet: Because screws become stressed and they become strained. That may be one of the reasons why it's come loose. And if you retighten a strange screw you can you can cause it to break, then you're in trouble because you may not be able to retrieve it from the implant head... Jaz' Introduction:Hello, Protruserati. I'm Jaz Gulati and welcome back to this second part of the group function. So we split it into two. On the first group function, if you haven't listened to it already, it was "Can I probe that implant?" Is it cool to probe around implants? Because there was a myth that you may scratch the implant? So is there any truth to that? Should we be concerned? That's all covered in part one. In this part two, we've got Dr. Pav Khaira, we're talking about What is the normal amount of bone loss around implant? So when I am reviewing patients who had implants placed elsewhere, potentially, and I take a peri-apical radiograph, it's been five years since they had the implant and my expecting bone loss. At what point do I get concerned? And what point should I refer? So we're gonna find that out. And another very interesting controversial issue is, how do you as a GDP manage a screw loosening? So if the implant crown is loose, is it cool for us to be going in and tightening it? What about if you don't have the right equipment? Or how to even identify which system it is. You have to stop every single driver there is? The very real world question there and I think Pav does great justice. So let's hear it from Pav, and I'll catch you in the outro. Main Interview:[Jaz] When you see a radiograph of an implant, let's say a peri-apical. And I don't know when this implant was on, I can ask the patient, the patient like a long time ago, five years ago, 10 years ago, they give me a vague answer. But anyway, am I expecting ever, is it acceptable to have threads exposed supracrestal, ie, all the threads are not in the bone, some of the threads are outside the bone, Is this acceptable? And be what amount of bone loss is normal? Because I understand that after you place an implant, after about a year, you expect to lose "some", you're probably gonna say yes, by do all this crazy voodoo magic that they don't lose any bone. But for the average implant, what is normal in terms of bone loss. [Pav]So historically, what's been considered acceptable is as a rule of thumb, bone loss down to the first thread, then about 0.2 millimeters per year, as you quite rightly said that these is, the modern techniques, the modern concepts, were really shouldn't be seeing anything at all. But you know, I see loads of patients where they come in to see me where they've had implants placed 20 years ago, okay? And I think the issue is in the absence, in the absence of any inflammatory responses, like what we've discussed about before, there's no bleeding, there's no suppuration, the implants been there 20 years, if you've got a 15-18 millimeter long implant, you've got three millimeters of thread exposed,

"Don't probe implants with a metal probe or you'll scratch it!" - and so for years I was afraid to check the gingival health around implants. Crazy right? Dr Pav Khaira is here to bust that myth - but like with everything, it's not a simple answer - it has some interesting anatomical considerations. His answer is so eloquent, check it out! https://youtu.be/pLDfqe8liLE Check out this full episode on YouTube Need to Read it? Check out the Full Episode Transcript below! “If you can get to the neck of the implant, you SHOULD be probing to the neck of the implant...but you don't want to do it too aggressively, it should just be very gentle pressure.” Dr Pav Khaira In this group function we discussed: Can you probe implants? 5:33Screening Periodontal Health of Implants 11:14Referring patients with Peri-implantitis 16:22 Check out The Dental Implant Podcast! If you liked this episode, you will love revisiting Implant Assessment for GDPs: from Space Requirement to Ridge Preservation Click below for full episode transcript: Opening Snippet: You just got into the cuff just sweeping it backwards and forwards and you seeing whether that triggers any bleeding because that's a sign of inflammation... Jaz' Introduction:Hello, Protruserati. I'm Jaz Gulati and welcome to this group function. Now if you're new to the podcast, welcome, great to have you. A group function is where we work together as a team to find out a solution to a common problem. And the problem I'm presenting today and I'm hoping to get a good answer from Pav today is 'Can you probe around implants?' And what I mean by that is, I was fed a lie or a semi lie at dental school, like someone told me, I don't know who it was. But if you use a metal probe, to do a periodontal probing chart of an implant, you will scratch that implant and therefore that will harbor bacteria. And therefore you should not be probing around implants. So for the longest time, I didn't check the periodontal health of implants and it sounds really bad. But as a GDP who doesn't place implants, not much to do with implants. I thought that was the right thing to do. I thought I was doing less harm by not inserting my Williams or WHO or CPITN probe in the sulcus to check for the periodontal health because I didn't want to scratch the implant. I was scared of scratching the implant if you like. So I was expecting this to be a really quick group function. And I thought Pav was saying Yeah, you totally can. It's all good. But Pav of being Pav, an amazing guy he is. The only does he give us a really good definitive answer at the end, where he talks about the rationale of what the concerns are maybe and how each actually look a little bit deeper than Can you probe? Can you not? Because there's some anatomical variation, so I'm not going to spoil it for you. Let's join this group function with Dr. Pav Khaira. That man again. Pav Khaira. Main Interview:[Jaz] Dr. Pav Khaira, welcome back to the podcast, my friend. How are you? [Pav]I'm very good right now. How you doing? [Jaz]Yeah, great. So it is Pav Khaira from The Dental Implant Podcast. And I'm gonna just pick your brains. You need to teach us something today. You need to speak to me like I'm five years old. Because this, the following questions I'm gonna ask you on this group function today is very much basic things that you're probably gonna laugh at me like Jaz, why you asked me these basic questions? But I'm sure with the referring dentist that you've met and your colleagues, like when it comes to implants we come out in dental school, like a lot of other topics. And we're like, where do we even begin? So just before we dive into that, just reminder on people who perhaps didn't listen to our episode on finding your niche. I think it was episode 76 from memory. Do listen to finding your niche, it's a cool one where we discover what is like your calling in dentistry. So do check that one out.

Learn the challenges dentists face with back to back Class II restorations and the value of pre-wedging. Dr Chris O'Connor shares his restoration protocol and troubleshooting tips. Discover the use of sectional bands for tooth separation and the importance of pre-wedging for successful restorations. Also, explore the educational benefits of Instagram for dentists.

Happy New Year, Protruserati! In this episode we geek out with Dr Dev and Jaz as they discuss the initial stages of a Full Mouth Rehabilitation. In this 3-part series we will go on to describe the step-by-step stages for an Adhesive Full Mouth Rehab . Before we dive into the meaty part of this series later on, Dr Devang Patel will take us to the journey  of the clinician’s mindset who's doing full mouth rehab and how to communicate effectively with patients. https://youtu.be/Dnj0PDe0ulc Check out this full episode on YouTube Need to Read it? Check out the Full Episode Transcript below! Protrusive Dental Pearl: Write down one good thing that happened each day of 2022 on a post-it note, fold it and put it in a jar. By the end of the year, you're gonna have 365 post notes of all the good things that happened that year. Check out the RipeGlobal Facebook Group that inspired this pearl! “However, learning is nothing without action. So you can learn and learn and learn and learn...but if you don't take any action, then you're not going to get anywhere.” Dr Devang Patel In this episode we talked about: The mindset of the dentist doing a full mouth rehab 12:19The three step technique 25:32Appointment 1: Diagnosis and Treatment Plan 26:00Communication with Patients 37:57Reorganizing versus Conforming Occlusion 40:30 If you enjoyed this episode, be sure to check out the second part Adhesive Full Mouth Rehabs Part 2 – Wax Up and Temporaries and the third part Adhesive Full Mouth Rehabs Part 3  Click below for full episode transcript: Opening Snippet: Were you looking at step one is your diagnosis and treatment plan. That's the biggest step ever. The second step would be your anterior reconstruction and third step is posterior reconstruction... Jaz' Introduction:Happy New Year 2022. Protruserati, welcome back to your favorite dental podcast. I really appreciate you coming back. And if you're a new listener, welcome to this podcast. Hope you get lots of value from it. And today's episode is part of a three series. So this first part is about full mouth rehabilitation, adhesive dentistry, so an adhesive rehab, ie using some sort of composite resin, either direct or indirect, and how to transfer that from the wax up to the mouth. So we're gonna break it up into three different episodes with Dr. Dev Patel, who came on before, and he talked about private dentistry versus public dentistry and how we can be comprehensive in public dentistry. So in today's episode, we're looking at the mindset of the clinician who's doing full mouth rehab, because we can't just dive in talking about how to do these beautiful wax ups, and how to do all the big composites and indirect work as well, which we mentioned, that comes in episode three, actually. But we need to first start off on the right foot. And we need to know why you want to get involved with full mouth dentistry. What the mindset of the clinician is, how to diagnose, how to communicate, what to say, and how to say it at your treatment plan presentation appointment, to be able to then lead you with the correct patient, with the correct diagnosis to treat that patient in a full mouth manner. This series is titled 11 steps have a decent format rehabs and so really, this episode looks at appointment zero, ie your mindset, you as a dentist, and appointment one. And also when you bring the patient back and you speak to them. So those are the first couple appointments. The second part of the series coming probably in about four weeks time when we record is going to be appointments two to five, this is when you actually do, your mounting, your wax up, your transferring of the wax up to the mouth and you're assessing the phonetics and the aesthetics and you send them home to test drive. And then the final part getting to there are really meaty bits. Okay, but I think it's good for you to listen to these foundational parts one and two, before you come to that one,

Heated confrontations with patients are never fun. Nobody likes to argue, and no Dentist likes being pressured or micro-managed by patients! In this episode we cover a lot of communication gems with Dr Vy Phan that will definitely allow you to remain calm and be effective the next time you face a 'difficult' patient (you know who I mean!) https://youtu.be/vDP5wIaK3Ok Check out this full episode on YouTube Need to Read it? Check out the Full Episode Transcript below! The Protrusive Dental Pearl: Never to say 'No' to patients. Instead, be tactful by pitching it and phrasing it in a different way - you are still saying 'No' but in a much less harsh and patient-friendly way. I give some concrete examples in this episode. “One of the ways of gaining patient trust is education - there's a breakdown of communication often when the patients don't trust you and they're not educated enough” Dr Vy Phan This is the IntraOral Camera I was telling you about - inexpensive, high quality and a modern day necessity in my opinion. Available on Amazon In this episode we discussed: Big Challenges young Dentists might face in terms of patient interactions and communications 10:30When to consider dismissing a 'difficult patient' 20:20Advice to young dentists when a patient questions the level of experience based on age/appearance/sex 31:08The ‘My Way or The Highway Approach’ 38:04Communication gems with Difficult Patients 46:16How to Write a dismissal letter to difficult patients 49:54Handling Patients who continually ask for discounts 59:41 Check out Dr. Vy Phan on Instagram! If you enjoyed this, you will of course love Think Comprehensive – Communication Gems with Zak Kara  Click below for full episode transcript: Opening Snippet: (Vy) I think my way or the highway approach is really appropriate when it didn't the best interest of the patient, you know, you know that it would be different, it will be risky, you know, there'd be more long term (Jaz) Inappropriate, risky, just not the, it will land you in legal issues. (Vy) Exactly... Jaz' Introduction:Hello, Protruserati, I'm Jaz Gulati and welcome to this or can I say it's an awesome episode? Oh, my God Vy Phan will blow your mind. This is a real world topic. There are so many communication gems shared in this episode. And really, when it comes to communication skills, when do they really matter? I mean, yes, it's good to get case acceptance and building value through user communication. But what really matters is so tough patients, those confrontations, those arguments that you might have with patients, you know the ones where your heart is racing? Words can really powerful. And I think communication skills are really tested in those tough scenarios. And we're talking all about those in this episode. When it comes to the word difficult in difficult patients, I was really debating whether to use it or not. Because really difficult patients are just difficult people and yet difficult people in every walk of life. Like if you take an arbitrary figure, like 1 in 20 people, well, I don't want to use the 'A' word. So 1 in 20 people are not nice people, right? And so 1 in 20 teachers will be not nice. 1 in 20 doctors will be not nice. 1 in 20 dentist were not nice, for example, right? So 1 in 20 of all your patients may not be the nicest people in the world. And so to deal with these patients, it can be tough. And these patients, we classify them as maybe difficult. But the funny thing about classing patients difficult is that what you might perceive as a difficult patient, your colleague, your associate, may find that they get along with a patient really well. And they think yeah, what do you mean, Mr. Smith is completely fine. What are you talking about? So it actually varies dentists to dentist and so our perceptions are equally important. When we decide who is "difficult". There are lots of themes that we cover in this episode, like for example,