Protrusive Dental Podcast

I’m so excited to bring you another one of my favorite people today: Prav Solanki. I’ve said it before and I’ll say it again, “for every CLINICAL course you do, do a NON-clinical one”. This is super important. We talk health, relationships, business growth – and if you listen all the way to the end, you’ll learn a BRILLIANT way to build social proof in to a consultation that is elegant. https://youtu.be/zmQsC99_MoU “The definition of success for me: To be able to do what you want, when you want, with whom you want; without any financial constraints.” Dr. Prav Solanki Need to Read it? Check out the Full Episode Transcript below! The highlights of this episode: 8:46 How Prav became a Dentrepreneur 17:28 Work Life Balance in Dentistry 31:50 Importance of Pitching 43:57 Importance of Social Proof on a Consultation Appointment All of the Protruserati clan get 10% OFF the Business and Mindset Mastery with the code ‘protrusive‘! Check out this blog with Dr. Prav and his 21-day fast experience If you enjoyed this episode, you will also like Being Unstoppable with Ferhan Ahmed Click below for full episode transcript: Jaz's Introduction: Do you remember how I say how important it is to do a NON-CLINICAL COURSE for every clinical course you do? I think that's super important because we are dealing with humans, we are dealing with emotions, we are COMMUNICATORS when we're in the practice. So I've brought on someone today who's gonna blow your mind. Jaz’s Introduction: The lessons we share, and I need you to, guys, I needed to listen all the way to the end of this one because the main takeaway, my favorite thing that Prav Solanki shares with you today is gonna absolutely change the way of how you do social proof at your consultations. Now what I mean by that is this awkward moment in the consultation potentially a bigger case where you’re like, well, let me show you some examples of my work, kind of thing. Right? That’s what the sales gurus teach, right? it’s funny because we need some sort of social proof because usually proud of the work you did and sometimes patients wanna see what other patients have had done, because it’s inspiration for them. But it’s always very awkward to sort of pull up a PowerPoint or whatever and show them what technique Prav teaches us is just fantastic. It’s gonna change the way how you introduce that to your consultations in such an elegant manner. So that’s around about the 15 minute mark where they’re about, so towards the end, but there’s so much value built in before then we talk about that old thing, work-life balance, right? What is a balanced life look like? How we can actually live life more purposefully that’s the kind of themes that we cover with that. We also talk about the importance of PITCHING. Whether you like it or not, we are constantly pitching to our patients, to our reception team, to our nurse, to our family. We are pitching all the time. So have you ever done exercise where you’ve looked at your pitch? We kind of do that with you. So we’re gonna go through that as well. And finally, the importance of being a good storyteller or introducing stories into your consultations. And that’s kind of like the main thing I wanna take away. And the one word, the one magic word. This begins with M that Prav taught me. And it’s just an elegant way to build social proof, like I said. So I know you’re gonna gain so much. So I’m not gonna talk on for too long. I want you to gain so much from this. Main Episode:So here we are, over to you Prav. Prav Solanki. Welcome to the Protrusive Dental Podcast, my friend. How are you? [Prav]Really well, buddy. I’m in London today. I’m in enlightens offices, but I’ve got a couple of meetings in London, so, I’ve just caught up with payment and I’ve stolen his meeting room for this podcast. But I’m well, I was up at four o’clock this morning, did a mini workout, fasting. So, two days, I’ll be two days in towards the end of this day, but I may just break it and go out with some food for Pay. [Jaz]Very good. For those who are familiar with the recent 72 hour fast I did. I would not have been able to do it. It was a charity. I would not have been able to do it if it wasn’t for Pay. Pay has been a mentor in many ways actually. You know, it’s a recurring theme mentorship is podcast, but Prav even, didn’t even know that he was Prav, Pay as well, you know, loved to Pay. But Prav didn’t even know that the impact he had on me on the last couple of years, cause I’ve just been following his social media for I think just about Covid time. In fact, the very first post of yours I saw Prav, which tells me a lot about you as a person and your philosophy and your quirks is you posted a photo of your car and you had to take a train somewhere and you couldn’t find a parking spot. And so you had to decide, okay, what am I doing now? Do I miss the train? It was like, it wasn’t a cheap train, right? Or do I get a parking fine? And then you said, okay, here’s my, and you posted the photo of your car looking I seen better days, but it’s like, you know what, there’s a lesson to be learned here. And I was like, I like this guy. I like how he thinks. And that’s when I first really connected. And I think the algorithm must have picked up that I like that post. And then your [beep] just kept coming up, which is great. I love your sort monologues in the camera, in the car and stuff. So I obviously really, really enjoyed all the content you post out. Any reflections based on that event a few years ago? [Prav]Do you know what? It’s like anything in life, buddy, that you’ve gotta make that decision there and then, right. And it’s one way or the other. And for me, I just evaluate things really quickly. Yeah. With the car parking situation, it was really clear to me it wasn’t about the price. It wasn’t about the cost, right? Even though there’s evaluation. The train was 150 quid. The car parking fine might have been 50 quid. So if you’re just making a quick financial decision, boom, it’s really easy, right? But more importantly, I was going to meet somebody, and if I was late for that person, then it would’ve thrown the whole value situation out of the window, right? [Jaz]Mm-hmm. [Prav]But yeah, I’m not really a massive rule breaker either, usually, but in that situation, it just had to be done. But funnily enough, this morning, I’ve done something similar. I’ve broken a rule. I’ll show you here. So my daughter loves UGLies. Yeah. [Jaz]I’ve never heard of him. Does that make me weird? [Prav]No, it doesn’t. It just means you don’t get on the first class train, but neither do I anymore, right? So, back in the day, I used to get first class train everywhere. And the reason being, is you can go to the lounge beforehand, right? So buying a first class ticket gets you access to a lounge, which is my office, pre-trained. Then I get off at the other side in London. Let’s say I arrive in London at eight o’clock and I’ve got till one o’clock before my meeting. I’ve got from eight to one, I’ve got a desk, I’ve got food, got coffee on tap, right? I can apply value to that and then I get a desk on the train where I can sit and work. I can justify that, right? I’m not taking a first class train cause I’m a snob. I just take that first class train because it makes sense. Post covid, I took this first class train to London, the first train took back and I’m walking into the first class carriage and I see what the [beep] there’s premium standard, what the hell’s premium standard, right? So, I walk through premium standards, empty. So I make a mental note of that, go and sit down on the train. And because I’m fasting most of the time, A) I can’t benefit from the food, the free food anymore, right? B) The screwed up the lounge. So now you can only go into the lounge at Houston if you’re departing and you can only go in there one hour before you go nuts for a full day. Right? So that’s all messed up at my end in Crew. The lounge opens at half past seven in the morning, far too late for me. Right. So there’s no benefit. Premium standard is like first class, but you don’t get the food and you don’t get the lounge. Well, I can’t take advantage of that anyway. Right. But the other downside is, every time I used to get into first class, I’d pick up these UGLies for my daughter. Yeah. And these are little chocolate treats. Now my daughter absolutely adores, and this is my 19-year-old daughter by the way. Right. So yesterday evening I’m speaking to her and she goes, ‘ Pick some UGLies up for me.’ I said, ‘I can’t, I’m in premium standard. I can’t get uglies for you.’ She’s like, ‘Give him a sub story. Tell him your daughter wants some uglies, right?’ I said, ‘I don’t even get the opportunity to tell a sub story because no one comes and serves you in premium standard, right?’ So I get into Houston, I know we’re going off topic here, but I get into Houston, up the escalator, walk into first class lounge, right? The lady goes, ‘Can I see your ticket?’ I bolt past and say, ‘I’m gonna piss my pants if I don’t go to the toilet.’ So I leg it straight into the toilet. The first part of that story was actually true. I did need the toilet, right? But on my way out, I grab a handful of UGLies, stick them in my pocket and just walk out and give a note to the lady, right? I’ve got UGLies for my daughter, man. I’ve achieved my goal for today, right? And so I sent her a little photograph and she said, ‘How?’ So I’m gonna tell her that story later on and we’re gonna talk about storytelling later. Right? [Jaz]I was just gonna say because what you did there is, you shared some a lesson. You shared a story. And that’s one of the themes I’m gonna cover today. Like, I’m a big fan of everything that you put out and a lot of what you put out is story based. And I’ve noticed that a lot we put out is stories based and I think that’s really powerful and I wanna be able to help the dentist, the Protruserati, who listen and watch with that. Because it’s a theme I’ve covered before that, and something that Zak Kara, my friend, said that, ‘ Facts tell, Stories sell.’ And it’s not about selling, but it is about growth. It is about business. I am very, very clear on my podcast that in an ideal world, for every clinical course you do, we should do a non-clinical course. And what I want you to bring you on for is give everyone a bit of a taster of what kind of lessons we can learn, nonclinical. I do a lot of those now because there’s an interference cast arm of the podcast, which is growing, growing and getting lots more, engagement on that sometimes more than the clinical stuff nowadays because people read, resonate with the non-clinical realities of being a dentist. So why don’t we go before we just talk about stories, maybe because it just weaves nicely. Then we’ll talk about, in fact, let’s save stories because I wanna do a little full circle. So you wanna learn more about stories? We’ll come round. You have to stay to the end to come stories. Just before we start talking about the POWER of a PITCH, perhaps just tell us a little bit about yourself. I mean, you and Pay are the fantastic hosts of Dental Leaders, but your stories just give us a little bit of story about, your university, interesting university experience and how you came to be the marketing, dentrepreneur as you are today. [Prav]So, Jaz, I’ll give you the quick sort of route around this. So, you know, I was destined to be either a medical researcher or a doctor, right? You know, growing up in a traditional Indian family, right? Doctor, dentist, accountant, you know, and make your parents proud and all the rest of it as a young Asian kid. I think you sold a story, right? A story about success. And my parents or my father’s idea of success is completely different to mine. And his thinking has now changed anyway. Right? And for me, success really revolves around being able to do what you want, when you want, with whoever you want, without any financial constraints. Right. That’s success for me. Not putting a badge on you saying you’re a doctor, you’re a dentist, or whatever. Right. And if you get there, wonderful. Cut a long story short. You know, I went down that traditional route, it was a university for the best part of ten years, studying medicine, doing a PhD in pharmacology and to- [Jaz]This was at Oxford? [Prav]At Oxford University. Yeah. Towards the end of that, and the backstory behind my PhD, it was fully funded. I’d won a Welcome Trust scholarship. But the beauty of that is not to sort of say, ‘Hey, I won this scholarship.’ It was actually, it was a fully funded gig, right? So it was four years funded. I’d finished my PhD in three years, but I had to stretch this bad boy out to make the most of the funding, right? So, the last year was plain sailing, right? Because my thesis was written up. I was ready for my Viva but had 12 months of happy days. So it was at that point my brother was launching. He first launched Kiss Dental right back in 2005. He was sat there having long lunch breaks. The practice wasn’t really doing much, but he’d come up with an amazing name and brand, Kiss Dental, right? So he said, ‘Hey, bro, fancy given us a hand with this marketing stuff.’ I knew nothing about marketing right at that point, but Jaz, I knew this, right? If I could learn, the names of every single blood vessel from head to toe and the innovation of every nerve from head to toe and the bloody kreb cycle and all the biochemistry and the pharmacology and all the rest of it. I reckon I could figure out this marketing luck, right? So that was a challenge I took. I had a lot of spare time on my hands, so I learned things like Google Ads. Made a lot of mistakes, did some video, some TV ads, some radio ads, some newspaper ads, you name it. Cut a long story short, in a short space of time, Kiss Dental became a success. My brother at the time was on the Paul Tipton like course that was the course back in the day to do, right? So he was on that and all his colleagues on that course were asking him questions. ‘Hey, who does your marketing mate? What happened? How did you do this?’ My brother said, ‘Speak to this guy called Prav. Don’t tell anyone.’ Didn’t tell anyone we were brothers. Right? And I guess there in his mind, the reason behind that was he didn’t want the affiliation and the association, right. He just wanted to say, I’ll let you make your own way so to speak. Right. Don’t pedal off the back. Whatever his reason was that came and bit me on the ass a little bit later. Right. Because we didn’t, I wasn’t transparent about that and it’s not the way I operate now. Right. But anyway, cut a long story short. By the time I’d vid for my PhD, I had about 10, 12 customers. Okay. I was charging buttons mate, absolutely buttons. The first website I built for a client, I coded myself and I charged 250 quid for it. And I reckon I put in about 400 hours into that website. Right. [Jaz]Wow. [Prav]I knew nothing. And I was learning the ropes and all the rest of it. And I knew nothing about value or respecting my own value. And then a client of mine and I’ll shout him out. It’s Dr. Riten Patel. He’s got a practice in Walton-on-Thames. He picked up the phone and he goes, ‘Do you know what Prav, what you’ve done for my practice has completely turned it around and I’m gonna ask you to increase your fees. Fivefold. Well, I’ll only agree to pay you fivefold if you write to all your customers and do the same.’ Yeah, I didn’t have the balls to do. [Jaz]Wow. What a legend. [Prav]What a hero man. [Jaz]What an absolute legend. We need more of that. I’ve heard something similar in terms of, you know, look, what you did was great value and someone appreciated it. And sometimes I don’t wanna, you know, blow the trumpet or whatever. But with this podcast and some of the little mini course that I have, it’s so damn. Like they’ve got a $90 course on Resin Bonded Bridges, which is, I charge 900 pounds for resin bonded bridge. I know it’s incredible value and I love it when dentist message me saying, ‘ Jaz, can I pay you 400 pounds for this?’ I’m like, no. So there are these dentists, you know, there’s this perception that dentists were greedy and whatnot, but I think when the mindset is correct and people want to reciprocate, they understand that, okay, what has value and what doesn’t? So really hats off that dentist for giving you what you needed at that time, I think. [Prav]And this was way back in the day, right? Where he could have carried on just rinsing that for what it was. Right. And I’d say he gave me that kickstart in my career to really teach me the value of value, you know? And so I didn’t do as he said, and I carried on, and then he picked up the phone and goes, ‘Prav, you do what I’ve told you, 80% of your customers say you are too expensive. So they go. Now you’re doing 20% of the work and earning the same money. Well, the [beep] is wrong with you?’ And it was that conversation that really made that switch. And I lost one customer after writing that email, mate. Yeah. Lost one customer. That was it. [Jaz]Impressive. [Prav]And you know what, Jaz, from that moment onwards, things changed. I started I guess providing more value, being able to afford to hire people. And I went from a point of hiring people based on cheap, okay. Hiring people who I could afford at the time. To then saying, I want the best, I want the best copywriter, I want the best software developer. I want the best. This, that and the other, and I’m gonna charge a premium for you. Right. And I’m gonna offer a premium service. And things just change when you do that buddy, everyone knows in their dental practices as well in their clinics, right? When you hire good quality, you know, emotionally intelligent team members, they change your entire patient experience. Right? And for me- [Jaz]The culture of the practice. [Prav]Everything, mate. Yeah. Whether it’s the culture of the practice, the culture of a marketing team, your business, whatever it is, it all changes. But if you are hiring based on an hourly rate, you’re just exchanging money for time. [Jaz]Pay peanut to get monkeys. [Prav]Yeah, absolutely. Anyway, where was I going to digress. So we take that story full circle, right? And I’m just gonna fast forward to where I am today rather than just going through the whole story. Right? So since then, I launched my marketing agency, which is what, 15, 16 years ago now. Right. Since then, I’ve become a practice owner. I’ve sold practices, so then I became a co-owner of the IAS Academy. And then I’ve got into developing bits of software to help dental practices grow, so on and so forth. And I’m always interested in opportunities, but during that whole journey, Jaz, doesn’t come easy, right? You gotta sacrifice a few things, right? Whether it be work-life balance, whether it be kids, whether it be your other half, right? And your relationship with them. Or your relationship with health or food or whatever that may be. Right? And we all do that to different extents. It’s like a sliding scale, right? So, Prav may get fat and let his health go. Right? Someone else may start neglecting their wife or their partner or whatever, right? And someone else may just shut off from the kids. And I’ve got business partners in all of these businesses who’ve done all of that to a different degree, right? We all know that running a business is- [Jaz]The perfect thing I wanna say now is just, it leads so well to one of the questions I wanna ask about work-life balance. And I know how you’ve done that so well done you weaved that in perfectly. But actually, one thing I didn’t send you is the backstory of this is when I was 17, again, a story, I’m showing a story now. When I was 17, I was doing drama. No. When I was 16, I was doing drama gcse. So this may come as no surprise that I did a GCSE drama. I almost took it to a level, like I almost like had this aspiration at the time of going into acting. Actually, I was very much interested in that. So when I look at now that who’s living my best life, I think the singing dentist is living my best life, right? It’s just creative. It’s so good. It’s so fun. But anyway, so I kind of like, it makes sense how I’m in this podcast and I’m in this, you know, crazy things that I do. So it all sort of makes sense when you look at your history and your background. But anyway, my drama teacher at the time, Ms. Wyndham, she came up to me and the group that were doing drama. And I don’t know why she said she must have seen something that maybe we were burning the candles at both ends. I think that’s how the saying goes. And said, guys, I’m gonna tell you a lesson. And she was Australian, so I’m not gonna do the Australian accent. But she said to us, ‘Guys, just remember for the rest of your life and career, that of these three things-‘ This was her philosophy and I’m betting that your philosophy is different. I’m betting. But her philosophy was there three things you have to pick two. Okay. So WORK, SOCIAL LIFE, AND HEALTH. Right? Okay. So work, social life, health, pick two. Because the third one, you won’t be able to achieve. You could only have two. Which two will you go for? So that was her mantra. That was her mindset that she was sharing with us. So my question to you is, A) what do you think about Ms. Wyndham? Do you think she’s right or can we have our cake and eat it? Can we do a fully balanced life? What does that even look like? What is balanced? Because you know, you are so well connected. Dentists and family dentists like, you know, IAS and so many clients, you’d know more dentist and I do probably, and you know their stories. What does balance look like? Is Ms. Wyndham, right? [Prav]Do you know what? Balance is different for everyone, Jaz. And you know, based on my philosophy, Ms. Wyndham’s wrong. Yeah, there’s the short answer to your question. But in her mind, she’s right. Okay. Because she can’t see past being able to focus on two things at once. Okay. She can’t see past that. And there’ll be people who say, well, I can’t multitask, or I can’t do this, that, and the other. Right? I think balance looks several aspects of your life, Jaz. And I’ll give you my take on it, but this doesn’t mean that, this is not necessarily an endorsement of follow Prav’s Way, right? We all have our own ideas of what balance is, right? But for me, balance revolves around that definition of success that I gave earlier, right? Being able to do what I want with who I want, when I want, wherever I want, without any financial constraints, right? And that’s my definition of success. But to be able to do that, you need to have all the different areas of your life in check. And, you know, where I take inspiration from is, you may or may not have heard of the Wheel of Life, right? Or the different incarnations of it. [Jaz]You told me about it recently in one of our Zoom chats. But now I want you to share it with everyone. [Prav]Yeah. And the way I look at it is that, let me give you an example. Jaz, maybe you don’t have bust ups with your misses, right? But I have them. Okay? And if I’ve had a bust up with my misses that morning, and then I’ve got to go to work and do a good piece of work, I guarantee you’ll be [beep] Maybe not a [beep], but I guarantee you it will not be optimal. Why? Because I love that lady to bits and she means the world to me, right? And the anxiety that’s gonna be burning in here is gonna distract me from my mission. And the same can apply to anything else, right? There’s nothing quite like a health scare to reset your work life balance. And so when you look at all different aspects of your life, your physical health, your career and professional development, finance, relationships with your other half, right? Whether it comes down to just being happy with that person, being present in the moment, having an amazing sex life, whatever it is, revolves around that relationship. Sometimes we’re too scared to talk about that stuff. But it’s important. And then friends, like I look at my uni like my best, best friends in the whole world. I can count them on my fingers. And those best friends, I may not see them for three, four years because they’re all over the place. But I can pick up the phone to Jason and say, ‘Hey buddy, how’s it going? I need you here in Manchester.’ He’ll drop everything. He’ll come to Manchester. But the moment me and Jason connect, even if we haven’t connected for three years, buddy, it’s like taking a step back in time. And we’re best mates. Okay. And having that time with just mates friends, not your partner, not your relationships. And I know, okay, we marry our best friends and all the rest of it. But then you have your boys or your girls or your buddies or whatever. There’s that time. And that’s important for our own inner sort of wellbeing. [Jaz]I’m a big fan of that, and Simon Sinek talks about that all the oxytocin and the group and the community and having social interactions, tribal interactions are so important to your overall wellbeing, just like you said. And I’m a big fan of that philosophy as well. [Prav]So important. And then, this may sound a little bit woowoo. But sort of mental and spiritual wellbeing as well. And spirituality or whatever, it can mean different things to different people once again. To someday anchor it to religion. To some, it might just be five minutes of meditation. It might be going for a walk in the woods, with a cup of coffee or whatever. But that place where you are at peace with yourself, and you are comfortable being lonely. That’s my thing, right? And whether I’m doing my breathing exercises in the morning, or I just go for a walk in the garden when the birds are tweeting and I’ve got a cup of coffee in my hand, whatever that is. It’s having all lows in balance. And that’s where I think a balanced life is. And we talk about this wheel of life and there’s an exercise that you can do, which you say, okay, well, on a scale of one to 10, how good do you think your physical health? Where do you think your physical health is? Where do you think your relationship with your partner is? Where do you think your relationship with your dad, your mom, your brother, your sister, your top five friends, how much selfish time do you get for just you, just Prav time, how much Prav time do you get where you can do whatever the hell you wanna do, when you wanna do it. Okay. And what about spiritual? Mentally?? How do you feel about your career progression and where that’s going right now? I challenge anyone to score that, one to 10 and score 10 in every area. It just doesn’t happen. I repeat that exercise all the time and my numbers are all over the flipping place. And I tried myself. [Jaz]Prav, can I just give a shout out to someone based on what you said? I wanna give a shout out to my now ex principal Hap Gil in Richmond, who maybe we as a team didn’t see the value or the purpose of it at the time, because it was like, I’m already so busy, I’ve gotta do this now. Is he’d give us this sheet with all these it’s like two side sheet with all these questions. And it was pretty much based on all that, like right out of 10, do you feel you make enough money? Do you feel you have enough time with your children? Like all those various things. So many different metrics. Kind of like the wheel, but not in a wheel representation. And then, so then he’d actually block out time. It’s a busy principal here, high end work. He’d block out at a half an hour with you, sit down with you and go through it. No principal has to do that with his associate. And I just really look back and I think, and then he keeps his old ones, keeps your old ones compare. And it’s such a wonderful thing. And I respect the fact that you do it and it’s something that you condone. And I think we should all have this as a regular thing. Maybe you should have something in your diary, I don’t know how often you recommend Prav, but maybe every six months, every year. When is a good time to check in with yourself? [Prav]So I’m a big believer in and look, we can all set goals at different stages and stuff. I check in with myself like once a quarter, right? Every 90 days or so, every 90 days I’ll go through my wheel of life, sit down, I actually sit down with my wife and we make a list of things that the piss each other off about each other. [Jaz]I love this. [Prav]And then we talk to each other about how we can fix that for each other rather than fixing it for ourselves. [Jaz]I’m so gonna do this, mate. [Prav]Yeah. I do my wheel, I do a full panel of blood tests. And look, people say to me, why the hell did you get your bloods done every three months? You fricking dentist are telling me to get my teeth cleaned every six months. And to not check your cholesterol or your liver function or your diabetic risk score or whatever. It’s mental. And it’s so affordable today, right. There’s services that come to your home, the phlebotomist comes to your house and you get it on a dashboard. Like there’s no excuse now not to do that. So yeah, I tend to check in and do that, right? And the important part of, let’s say, growing a business or growing your life or trying to achieve success or whatever happiness is. Is taking that time out to think and reflect on yourself and on your life because if we’re busy in that rat race all the time. Always say that, especially in business. When do your best ideas or your best thoughts come to you? When you ain’t got nothing to do. For me, I’m taking a walk in the park, I’m with the kids or whatever, or I’m taking a [beep], but those best ideas- [Jaz]Toilet university. [Prav]Toilet University mate. But those moments of inspiration, those best, they don’t come to you when you are deep in work, right? When you’re putting processes together, when you’re delegating to your team, they come to you when you’re away from all the noise. [Jaz]Well, I think the take home there is, cuz you’ve got a few more areas to cover, is have a check in with yourself, take a look at Ziglar’s W heel of Life, have a way to check in with yourself to see how you’re doing. And I personally think, yes, Ms. Wyndham was wrong. However, when I look back at my last nine years at Dentist before my son came along, I was very much into the gym. I had to sacrifice that for my son. And I’m totally happy I did, but I’m always thinking, okay, how can I tweak my life to make more time for my health? So it’s a constant reflection, not just going on autopilots. So now every Tuesday and Thursday, me and my principal we do a little workout even it’s just something just to feel like we get some social time to have a chat and we get some exercise in. But like at various points in life, depending on where you are, In which phase of life you’re in balance will be the best you can achieve in that phase. Like you mentioned fat Prav, right? When you were fat Prav, you had other things going on that was at the time had to be done and that had you couldn’t have done it any other way, but you’ve learnt, you sort of adapted your lifestyle based on that. [Prav]But let me just pick up on that Jaz. You know, we are talking about balance here and not having time. And I mentioned earlier, there’s nothing quite like a health scare to reasses to reset that work life balance. You can’t do this thing. When we talk about those, the wheel of life or the different things, we can prioritize. Whether it’s segmenting time, you’ve said on the two days a week, you do the exercise with your principal, right? Why is it not more than two days a week? Is that because your health only prioritizes for two days a week? You don’t have- [Jaz]It must be at the moment. That’s how much value I’m giving to my health, which is a shame, but yeah. [Prav]That’s how much value you’re giving to your health, right? And for me at the moment, people talk about non-negotiables given whatever buzzwords you want. But for me, there’s a bit of sacred time in the morning. There’ll be an intense workout. There’ll be a little bit of the equivalent of whatever you want to consider, meditation to be, breathing exercises, whatever, right? And then I start my day. The harder the workout, the easier the day. It really, is that for me, Jaz. And so depending on those different areas of life, we can prioritize it. I don’t buy any bullshit that you tell me. If you tell me you haven’t got seven minutes every morning to work out. [Jaz]Agreed. Do a quick HITT worker. I absolutely agree. It’s the lies you tell yourselves. And I’m a hundred percent with you, buddy. A hundred percent with you. [Prav]And but we tell ourself this story, right? Fat Prav was telling him himself this story that he was a hundred percent tunnel vision. It was work. He didn’t have time to cook. [Jaz]You don’t mind that. Right? You don’t mind that I went there, right? You call, right. [Prav]No, no, buddy. I don’t. And not at all. And the whole thing was what was fat Prav doing? He was getting a subway on his way into work. And he’d stack up on the cookies to have throughout the day. And then on his way back from work, it’d be Domino’s. And honestly, I’m disgusted at myself now. You know who my passenger was on the way home from work? It was a cardboard box, with a hot Domino’s in there. And I’d have peppers all down. Do you know what I mean? Didn’t have time to stop and eat because it was so bloody busy. I was telling myself some bullshit story. [Jaz]Guys, this is the same Prav who blogged about his 21 day fast experience. Just, just liquids, just water and black coffee only. I’m gonna share that link in the blog post because you need to read about how much mental strength you need and based on what you’re telling us about fat Prav. And to go to the extreme, obviously don’t try this at home, get ’em, seek medical care. Try a 24 hour thing first. But, you know, this is a separate conversation. But the reason I mentioned that is just to so much I learned from reading that and inspired me. And also it just talks a lot about your humor because it was like a day by day, poo by poo account. I just love that so much. You know, I think that we have very similar toilet humor. Prav, can I ask you about, can we just switch gears now and talk about the importance of having a pitch. So we just covered a bounce life. We touched a little bit on stories, and we’re gonna finish on stories, but having a pitch, I first realized that I need to have a pitch when I went to a talk by a chap called Daniel Priestley. And he says that whether you realize it or not, you’re always pitching, whether that’s pitching to your patients, to your nurse, to your reception team, to your other half. You are pitching something always that you are oozing something from your social media, from your real life. And that messaging, what you stand for, needs to be clear. And it really got a driven home for me, Prav recently. When I went to one of the Riaz Yar’s course, good buddy of mine. And we were talking a little bit about how he presents treatment plans, and then he said, he took a step back and said, ‘You know what, when my patients go through a treatment process with me, they don’t buy the treatment, they buy me.’ And then, so how can we bridge that gap? And you are pointing to yourself. You’re absolutely agree with that. Here’s just me adding my piece for the real expert ie you tells us about the importance of pitching and how to do it. But why I took away from that is. And then something that Riaz does is how I implemented that. So knowledge is nothing without implementation. How I implemented that into my daily, uh, work is now when I have a new patient consultation, it isn’t Invisalign or click correct or whatever, you name it, I am going to introduce myself, pitch for 30 seconds. I’m Jaz. I’m about minimally invasive dentistry, healthy smiles. I’m a bit of a geek. I love it. I’m a family man. Here’s a photo. My family, this is me. And I care deeply about my patients and I’m so glad you’re here, kind of thing. So now they just know about me and then we talk about the teeth and stuff. So I like to set the scene like that, and that’s where I took that message further in terms of pitching. So Prav, over to you as the sort of someone who teaches dentists how to pitch. How important is pitching? [Prav]So before I get into that, I’m just gonna very briefly touch on something called imposter syndrome, right? Because the majority of dentists I speak to about pitching their U S P or their story or whatever, right? There’s always someone who’s got more experience in place in implants. There’s always someone who’s done more aligner cases. There’s always someone who’s better at sculpting composite on front of teeth. There always this, right? So this imposter syndrome kicks in. How can I say something amazing about myself when all my competitors are out there doing amazing things or whatever. So there’s that whole thing about imposter syndrome and my one rebuttal to that Jaz is I am the world expert at being Prav Solanki and there ain’t no human being better than me at being Prav Solanki. I knew the world expert being Jaz Gulati, and we can take that message on, right? Okay. The way another dentist may deliver dentistry may be in a more caring way. They may be better with phobic patients, more gentle. You may be the dentist who goes out to the waiting room and gets down at their level, bends down and says, hi, Prav. Put your hand on them, I know you’re really nervous. I’ve got your notes in there. And, but there’s nothing to worry about, right? That patient’s not gonna give a shit about the flipping translucency on their composites. Or whatever you want to call it, right. I’m not should but . But, we’ve all got our own U S P, right? And call it a USP or inner ways of working. We’re all individual and world experts of being ourselves. So like set the stage with that first. Okay. And then your pitch really the way I speak to dentists about how they should get their- Sorry, Jaz, go on. [Jaz]I just wanna say something before you then come to the pitch bit, cuz you mentioned about impostor syndrome. Something that I know we’ve had talks about this, you suffer from it at times. I suffer it and I’m a big believer that actually we need the Impostor syndrome to do the work, to actually do our amazing things that we do. Basically, it is something that we need and then it’s deeply seated in our profession and everyone suffered is a good thing to have actually. And, you know, you need to see as a positive. I’m gonna just share a lesson from Gary V, who’s so big on social media and that kind of stuff. The leaf I’ve taken from him is that, with putting myself out there so much on social media, it was a big step for me. Like I’m just going gung-ho, I’m repurposing, I’m like in everyone’s faces now on social media and that, it took a lot of courage to put my stick in my head above the parapet to do that. But I’ve come to a stage now where I am, I back myself, you know, cricket, they say you back yourself. I bat myself in up that, you know what I have stories to share. I have dentists I can help through getting on great, great guests like yourself and whatnot on the show and sharing my own nuggets. So I own the fact that yes, I am Jaz Gulati and I can give the quirks that only I can give, but I’m also self-aware enough to know that I’m nothing. Right? There are so many people that know more than me, and I want to actually bring them on and share their stuff, right? And I’m always happy to say that, you know what? I don’t know this and I don’t know that. And then it’s respecting. You don’t know what you don’t know. So the combination of that is what keeps me going, basically. So I just wanted to add that in because some people may need to hear that from Gary v’s perspective. And I really like that actually. [Prav]I think, you’ve got a really valid point there, Jaz, which is the whole, when it comes to imposter syndrome, right? Certainly for me, it drives me to do my very best because when you suffer from imposter syndrome, you know what you don’t know, right? That’s the whole premise of it. You know what you don’t know. And so you make sure that you try and fill those knowledge gaps. You make your slides perfect, your presentation and whatever, right? And we, you know, the total opposite of that, right? The Dunning Kruger effect, you know, unskilled and unaware of it. It’s that person, we are bags of confidence, right? But they don’t know their limitations. I think that’s far worse than imposter syndrome, right? Fake it till you make it syndrome or whatever you want to call it. I’d rather be that guy who’s got imposter syndrome. And be aware of what my limitations are, what I don’t know, maybe as a dentist that’s even more important where, you know which case is not to treat. How far you can take things. [Jaz]Painful lessons learned. [Prav]When I speak to my clients about getting their pitch right. The first thing you’ve gotta do is go on like a self-discovery process of like, what is it about me that my patients love? How’d you find that out? A really good way to find out and how I discover about my clients. I go and read their Google reviews. Because it’s what patients have written in their own words about those clinicians, and you get those little nuggets. If you’ve got a lot of reviews, right? If you just spent a little bit of time reading those Google reviews, you’ll figure out what that dentists or clinicians or practices, USPS are very quickly. Okay. I’m gonna give you another tip that’ll really help you figure that out in a second. So you’ve got that, you figure out what you are all about, right? And then your pitch, I usually come up with two. So there’s my pitch in the first person that I would give to you as my patient. Before I’ve even had the opportunity to do that. There’s a team member who’s speaking to potential patients on the phone about Prav, about Jaz, about whoever the clinician is, right? That’s the first pitch that you need to nail. And you need, so I always get, sit down with the dentist, sit down with the team and say, okay, if you are booking an appointment with Dr. Chohan in my practice, what are they going to leave with? What’s the minimum amount of information they’re gonna leave with? And how are you gonna make that phone call memorable? What’s really important is memorable phone calls, because we’d have to be deluded to think, especially when patients are making a large investment that they’re only ringing my practice. It’s their money, it’s their choice. They can ring half a dozen practices and go back and say, do you know what Carrie said to me about Dr. Johan? That’s really resonated with me. So let’s say you go through your whole discovery, learning the patient’s pain points and all the rest of it, and then Carrie turns around to that patient and says, look, I know you’re really nervous about dentistry, right? I know you’re nervous and you haven’t been to the dentist in about 10 years. But rest assured, Dr. Chohan is incredibly gentle. He’ll come out to reception and meet you, and you can just have a chat in the lounge if you want. You don’t need to step out in the surgery when it comes to implant dentistry. He works with a sedation dentist who can put you into a relaxed dream-like state so that you won’t have much awareness of really what’s happening at the time. You won’t feel any pain, but before you get to that step, just to let you know, he’s placed in excess of 5,000 implants in his career. Everything from really simple stuff to the complex stuff. And other dentists from the local area send all their complex work to Suresh when they can’t do it. I’d love to invite you just to come in and have a meeting with Suresh and learn if he’s the right person you’d like to trust with your teeth. And then that lady gets on the phone and speaks to another clinic and says, I’m interested in dental implants. Yeah, no problem. Add implants stat from three and a half thousand pounds if you’d like to book a free consultation is a 35 pound with fully refundable deposit. Can I get you booked in for that? Nothing wrong with what she said, right? But my phone calls more memorable. Do you understand where I’m coming from in terms of- [Jaz]A hundred percent. And so the takeaway here guys, is check out your Google reviews, come up with your own personal pitch, can idea of it, and then such a amazing gem. Make sure the receptionist, like the people who pick up the phone are so important to your business beyond belief. And so do they have a pitch for you? And that’s what Prav means in terms of having a first person one and will it be a second or third person? I don’t know how it works. Yeah. And so that is key. Anything else on pitching? Because I want to get to the stories before we can wrap up this very, wow, jam packed episode so far. Anything else on pitching? Because I know you got a course on this and I wanna tell people how to get onto it because only gonna cover in depth. This podcast is more about the breadth and getting people to think, ‘Oh, do I have a pitch, do I not?’ Basically. So, anything else on pitching prep? [Prav]Just a very quick tip. We spend a lot of time with our patients in consultations. We asked the right questions on a scale of one to 10, wave your magic wand, blah, blah, blah. All of this sort of stuff to get the gold out of the patients. And then we resonate with them. And you know, like we said earlier, we’re not selling porcelain, right? We’re selling human beings here. We’re selling us. The one, the times where we’ve learned more about our patients, learned the most about our patients has been when we’ve sat down with them post-treatment, spent a lot of time with them and talked to them about the things that they wouldn’t share with us in the consultation. Now, in my clinic, Jaz, we are very privileged in the fact that these patients invite us to come and spend that time with them in their own homes. And we sit down with them when we talk to them about what was lifelike before. Can you just take me back to your car journey when you’re on the way to the consultation? What were you feeling? Was your heart racing? What were you thinking? Can you take me back to the car journey when you’d left the consultation? How did that feel? You know, they’ll talk about hope and things like that, right? Then we sit down and talk to their husbands, wives, children, et cetera, et cetera, and take things from there. And that is such a cool way of finding out about your patients, really, truly what they experienced. [Jaz]So I love how you go in someone’s home, and you collect those stories, and I’ve seen, I’ve been lucky enough to see some of those videos you shared me, at one of your presentations. Really great stuff. How much emotional, joy, life changing stuff, you know, obviously your clinic’s called Changing Faces, right? So, it’s amazing what you do. I want you to tell the Protruserati, how you then take that video or take that sort of content that you make, turn it into a story, which it is automatically a story. It’s from some someone’s perspective about how they fell and whatnot and what changes are made. I think a lot of dentists struggle. So at the consultation appointment, we’re taught, you know, by the gurus that okay, you know, share a testimonial show before and after. Tell how awesome you are for through social proof. It can get very awkward. Oh, let me show you three examples of people I treated just like you. Bang, bang, bang. But you told me something the other week and I was like, okay, I need to get you on the podcast to share this with every single person. Do you remember what it was firstly, right? [Prav]I know, I know exactly what you’re talking about. [Jaz]Please. Do it. [Prav]Jaz, the reason I know this is because later on this week, I’m gonna be speaking at a Anoop’s memorial event. In memory of him at the B A C D. And I’ve spent a lot of time with Anoop. He’s been down to my offices. I’ve trained his team. I’ve trained his team at his place. And his favorite thing is this, what I’m about to share with you. [Jaz]It’s mine as well. Please, please. I mean, learning this from you was one my favorite thing that I’ve learned from you so far. [Prav]This was his favorite thing. Invite your testimonials into the consultation room. Invite your patients into the consultation room, and how’d you do that? It’s really simple. You just say to the patient, ‘Joanne, I’d like you to meet Sean. Sean’s not in the room at this point.’ But it’s a really nice way of introducing somebody that you’ve already treated and that somebody could be in the form of a Google review. It could be in the form of a before and after, or it could be in the form of a video testimony you’re about to play. And if you say to that patient, ‘Joanne, I’d love you to meet Sean. But before I play his video, let me just tell you a little something about him. He came in here after avoiding the dentist for 20 years. When he came in here, he was a mere fraction of the man he is today. He’d never leave home without his denture glue. He used to take his dentures out to eat his food. His diet was incredibly restricted, and he thought that there’s no way he’s gonna be able to afford the dentistry that he needed. But don’t take my word for it. Let’s just listen to what Sean had to say about his journey.’ You press play and Sean deals with every single objection that patient could possibly come up with, whether it’s financial, this, that, and the other. I can even at that point, believe it or not, you know, when we talk about finance options for patients, right? Can you afford it? Can you take dental finance out? Many of our patients remortgage their homes for their dentistry. You’ve never heard anyone teach the concept of asking a patient to remortgage their homes for teeth, right? Because it sounds completely unethical, right? Sounds freaking crazy, right? But Sean remortgaged this home. Neil remortgaged his home. Ellie remortgaged her home. But a really neat way of me explaining that to a patient is to say, ‘Do you know what, Sean thought he had no options to afford his treatment. But you know what he ended up doing? Remortgaging his house, because that’s how important his smile was to him. And that’s what Ellie did. And that’s what these people did.’ And I feel that the power of storytelling, , we talk about having memorable phone calls. It’s about the memorable consultations. Well, that guy said that the rear implant goes in at 45 degrees and it’s made out a titanium. And the front ones go in at 90 degrees, and then there’s this metal bar, and then they convert this denture and it’s so many millimeters thick. And then they’re gonna put a temporary on. And then after the temporary, three months later, they’re gonna put a fixed final prosthesis on and all the rest of it. And the other patient goes and goes, Sean was buzzing his tits off after that he could eat the food he wanted, he was living his best life. He was smiling in front of the camera and he remortgaged his house to make it affordable. What are you going to remember? So, my biggest tip when it comes to consultations, I can’t teach you the clinical stuff. I can’t teach you how to write treatment plans, but I think invite your patients to join you in the consultation with the other patient. But the other thing is when you invite that patient in, pick the right patient to invite into the room. Yeah. Sean is a 48-year-old bald, Birmingham lad, ex-boxer. Okay. I am not gonna invite Sean into the room when there’s a 75-year-old deer there. [Jaz]Shirley [Prav]Sat with her husband. But I’ll bring Ellie into the room whose husband was a builder and talked about the estimate that we gave them his version of what a treatment plan was. And how he finally saw the sparkle in Ellie’s eyes after she’d had the treatment. You know, and her husband goes to talk about, actually the biggest difference I saw was in my wife’s eyes. Now, if he’s saying that about his wife and you got husband and wife in there, I’m inviting Ellie into the consultation, pick the right patient to invite into the consultation. [Jaz]Extra value added that. I mean, th this is brilliant guys. If you are multitasking, I want you to just rewind five minutes and listen to this again, because it’s just an elegant way to make a story, which is so, so important. Stories are so, so incredibly important. We touched on it in the beginning, but it’s a much better way than, I’m gonna show you an example case. Like, it is so much better to personalize. Put a human behind it. It just, you know, cuz we connect with other humans, it’s just a better way of giving social proof. So thank you so much, Prav. We’re very selflessly sharing that. And obviously this podcast is covering breadth. I wish I was joining you on the 15th of July. I’m on a Perio-Prostho course. You know how annoyed I was about that. So when you run the second one, I wanna be there. But please tell us about how we can get a little bit more depth on your course about growth and growing as a person, past development business. What’s the title? Tell us some more details about that. Please. [Prav]Sort of quickly summarize this. This has been a course in the making for probably the last eight to 10 years, right? And the reason why I didn’t launch this course, number one, imposter syndrome. Number two, how could I deliver value in a one day, two day event or whatever, right? How could I possibly deliver that value? And the most important thing to me when someone attends a course or a piece of education is execution. Because if you turned up to my course and you walked away absolutely inspired thinking, ‘Fucking hell, that was amazing. I’ve learned this, this, this, and I’ve got all these notes, and it’s great.’ And then you go home and then two months later you look at the notes and you can’t even read your own handwriting and you’re in the same position you was before you attending the course. I’ve failed. Failed miserably, right? And so for me it was about creating something that delivered execution because as we all know, I know through the IAS Academy, I’m close friends with Payman and Dipesh, who run the Mini Smile Makeover course. And many educators who tell me that implementation and execution is the hardest thing to achieve in all of this, right? We can all pass knowledge on, that’s easy. We can inspire people with our content. But what about getting them to implement and execute? So, the IAS Academy have been asking me to run this course for a long time. But I had to just wrap my head around how am I gonna get people to implement and execute. So we’re gonna be starting off with, we call it goal setting, right? And we’re gonna plan the next 90 days. I’m gonna be sharing with you some of the concepts that have been taught to me by my business coaches that I’ve adapted myself in terms of goal setting, how I do it, how frequently I look at my goals, how I deal with accountability and all of that, right? And then as part and parcel of the course, the one thing that I wanted to do is, you know, you turn and put the course on day one in the morning. Nobody knows each other. You’re saying you are hellos, you’re getting to know each other. I’m getting to know the delegate. And before you know it, you’re two, three hours into the course and you’ve just started warming up. So prior to the course, we’re gonna have a group zoom session where we get to know each other, where I get to understand what you guys are about. Prior to that, you will have filled out a questionnaire, really deep questionnaire, the sort of questionnaire that I share with my one-to-one coaching clients. The purpose of that questionnaire really is to really make you reflect and think about certain aspects of your life. You may not take that questionnaire any further than that, and no one else will have access to those answers other than myself, and I won’t share them with anyone else. But it’s there to make you reflect. During that zoom call, you can voluntarily share whatever your aha moments were from completing that question, or if you wanna share anything else, there’ll be a small coaching session on that zoom. But the purpose of that zoom is to leave you with two pieces of homework to deliver on the morning of the course. Number one is prepare your pitch for your receptionist. And number two, prepare your pitch for your patients. The first thing that will happen in the morning is I will coach you through that process so we perfect your pitches first thing in the morning. We’ll go through some goal setting exercises and then moving on into the day. I will go through the Wheel of life exercise with you and we’ll look at balance, right? I think balance is really important. For all the reasons we discussed earlier. Jaz, I think the balance in health, finance, relationships, friends, selfish, fun, mental and spiritual. All that’s really important as a moment of realization. Later on, we’re gonna be talking about SOPs or Standard Operating Procedures and as a self-employed- [Jaz]Not the covid kind yet. [Prav]No, no. Definitely. [Jaz]My goodness. [Prav]Definitely not. So, you know, I’ve got a unique way in which you give me a business process. I’ll map it out in 10 to 15 minutes very quickly, and anyone who’s worked with me knows I can do that. But it’s not because that’s my unique abilities, because I use a certain process to map out processes, and I’ve tried it all, writing operations manuals, doing videos for team members, all the rest of it. I’m going to, I’m just gonna share that with you, and you are gonna map out a process, a business process or some kind of process during that day. I’ll share the tools with you that I use for that. and then we’re gonna talk about taking time out and taking time out of business or work or life or whatever it is, gives you those eureka moments where you can have your best ideas, right? And it’s not just whilst you’re on the toilet, right? We need scheduled time out, away from work so that we can reflect and we can get those eureka moments, right? In order for you to take time out, you need to be able to delegate effectively. And whether you are delegating to a nurse, a receptionist, a practice manager, whoever that is, you need a good delegation strategy. And I’ll just leave you with this note, just as a carrot really is that have you ever delegated to somebody thinking to yourself, okay, that’s sorted. Now I’ve packed it, it’s outta my life. You come back a week later and you think, why has he or she not done that? Why haven’t they done this? I asked that person to do this. It’s not their fault. Nine times outta 10. It’s not their fault. [Jaz]Garbage in, garbage out. [Prav]It’s your delegation strategy. Yeah. And it’s garbage in, garbage out. Absolutely. So I’m gonna teach you how I delegate, which allows me to have that freedom to, to have those moments, those eureka moments. Naturally I’m gonna be talking about and sharing marketing strategy with you. It’s a big part of what I do in my life. So I’m gonna be sharing some actionable marketing strategies with you during the day and lots, lots more during that days. [Jaz]I’m gutted, I can’t make that date, but for the future renditions, but for those who can, it’s in London, 15th of July. I’ll put the link on so everyone can click onto it very easily. I’ll put it, below here as, as well. Anything else that anyone should know, either about the podcast or about the upcoming course? [Prav]I think ultimately, I think what you said earlier, Jaz really resonates, which is, you know, for every clinical course do a non-clinical course, right? [Jaz]Hundred percent. [Prav]I’m not, and look, I’m not here just trying to pitch my cell [beep] right? It really isn’t about that because the time and the effort and the energy that’s gone into producing this, I don’t want it to be a failure. And I want everyone to execute, right? And I’m gonna make damn sure that everyone executes. After the course, I’m gonna make sure there’s some accountability calls thrown into the mix. And that was actually an idea from Jaz when I ran the course by him. He’s a great sounding board, Jaz. And when I designed the course and put it together, obviously wanted to get your feedback on it, Jaz. And the one thing that you said is love Prav. If you want execution, get some accountability calls in with them. And then I wanna know where every single one of you are in 90 days time. So we’re gonna all come together. It will be virtually. And I hope, I really do hope that you are in a different place to where you are today. and I’ll end with this Jaz. My most successful one-to-one client who I’ve been working with for the last 18 months, his name’s Ash. Father of two, six year old twin boys and he came to me working five days a week. If I was to compare my clients on a financial basis, he’s right at the bottom. He’s not earning big money, he’s not driving fast cars, he’s not wearing expensive watches and he doesn’t wear Gucci or Prada either, right? [Jaz]My kind of guy. [Prav]Yeah. But let me tell you something. Ash came to me and he said, ‘Prav, I want to cash in on that time with my twin boys and I don’t wanna miss those moments. So I wanna drop my working days from five to somewhere between two and three, I want my income in the practice to remain stable. And if we can get there, that’s my definition of success, okay?’ And that’s where he is today. And I would say, you know, we’ve, I’ve had clients who I’ve worked with and we’ve exited their business for multimillion figures. Ash is my biggest success story because he’s grounded, he’s achieved, and do you know what he’s doing? He’s cashing in on that investment with his children and when he’s older. Yeah. And when he needs his kids. I truly believe they’ll be there for him. [Jaz]I love that. But you messed up the story Prav. You messed it up. [Prav]Go on. [Jaz]You didn’t say, ‘Meet Ash.’ Said Jaz, I want you to meet Ash. [Prav]Oh, thanks for that. Jaz’s Outro:That was brilliant. Thank you. Thank you so much. There we have it guys. Thanks for listening all the way to the end. So that M word is Meet. You know, meet Sean. I just love that so much. I want, before you commit to treatment, I want you to meet Sean and it’s just a great way to then show their Google review or show the photos and stuff. It just personalizes things so much. Look, if you resonated with Prav today, I twisted his arm after he stopped recording. I said, listen, can you please sweeten the deal for the Protruserati? You can get 10% off the course with Prav on 15th of July in London and the code. Of course, what else would it be? It’s Protrusive. The code is Protrusive and you get 10% off on the 15th of July. So you need to head, and I made it easy for you. If you go to protrusive.co.uk/prav, that’s P-R-A-V. That’s four letters, P-R-A-V. It’ll take you straight to the page for his course. And then just remember to put the coupon code Protrusive, put 10% off. I think this would be great. I mean, think about how much money we spend on clinical courses. If there was one non-clinical course, I want to do at the top of my list is this one, so I can’t wait to join you. Maybe in the next one. I can’t be done on the 15th of July. I’m already actually booked on a clinical course. But I’m, I know is gonna’ build so much value for you. I’m proud. Thanks so much for sweetening the deal for everyone. I really appreciate that. Guys, I hope you gained so much value from that. I catch you in the next one.

Zirconia Veneers!? eMax vs LiSi? Which type of Zirconia should I use (and yes, there are 3 main types of Zirconia!) and is there still a place for Feldspathic veneers? These burning questions is why I brought on the OG: Ed McLaren. What Dr Ed McLaren does not know about dental ceramics is not worth knowing, and he gives it all away on this cracker of an episode which is sure to go down in Protrusive Hall of Fame! https://youtu.be/ZR-V-ekhMv0 Protrusive Dental Pearl: How to mask a metal post? For me, a post-core is just a space-filler, it’s a way to retain some sort of foundation/core restoration. I do not mind cutting it back a little bit – below I share a video of how to mask a metal core using Paracore White Opaque, to help my ceramist. You can also use an opaquer resin such as Ivoclar Direct Opaque – it’s like Dental Tipex! Want to download the 1 page summary of all the indications for free? Click here to access the download. https://www.instagram.com/reel/Cd0P2mJqNUn/?utm_source=ig_web_copy_link Enlighten Smiles sponsor this episode. I know some of you feel that we can’t make composite look as good as ceramic. Well, you need to check out the work by Dipesh Parmar. His course is called Mini Smile Makeover where he teaches his techniques using Renamel Composite and other brands to give you some amazing results working with composite resin.  Need to Read it? Check out the Full Episode Transcript below! Highlights of this episode: 11:07 Feldspathic Ceramic in terms of Patient demand and Dentist skill set 18:26 Shortage of skill set from Technicians in the future 20:41 Composite vs Ceramic Veneers 23:11 APC Protocol in Zirconia for Veneers 29:10 Posterior Zirconia Onlays 31:42 Decision Making regarding Biomechanical status of the patient 37:29 Ivoclar eMax vs GC LiSi 39:57 Different types of Zirconia 50:00 Restorative protocol for wear cases Check out these studies as mentioned by Dr. Ed McLaren – if they are not showing up on your usual podcast player, be sure to visit the show notes on the protrusive website. Influence of Enamel Preservation on Failure Rates of Porcelain LaminateVeneersDownload Check out the Hands-On Courses by Dr. Ed McLaren If you like this episode, you’ll also like Dr. Chris Orr’s Composite vs Ceramic Click below for full episode transcript: Jaz's Introduction: Is it just me or can dental ceramics get really confusing sometimes? It seems like every other year, new types of ceramics are coming out, new protocols are being recommended. And it's difficult to sometimes keep up. So, that's why I brought on the Ed McLaren. Jaz’s Introduction:None other than Ed McLaren who’s like this most AMAZING RESTORATIVE DENTIST EVER. You may also know him from making these epic like movie trailers, dental movie trailers, a prolific speaker, a master ceramist himself, as well as, being a dentist. He has so much knowledge about ceramics. Where he doesn’t know is probably not even worth knowing. Hello, Protruserati. I’m Jaz Gulati. And welcome back to your favorite dental podcast for your hit of knowledge and clinical tips. The kinds of things I asked Dr. Ed McLaren are like, what are the LATEST UPDATES when it comes to CERAMICS? What are the different TYPES of ZIRCONIA? Let’s take a step back for a moment there, you know. These Zirconias have been there for a while, but there’s different generations. When do we know when to use each generation? Zirconia bonding has come so far. Can we now start doing ZIRCONIA VENEER? I know some clinicians are. Is that okay, is that kosher? We asked Dr. Ed McClaren. And finally, what is the difference between Emax and LiSi and which is better? Protruserati we’re in for a treat. Now, before we joined the main episode, let’s have today’s Protrusive Dental Pearl. I posted this on social media recently about how to MASK A METAL POST. So, let’s say you’re treating a tooth like an upper central or lower central incisor, in my case, with a existing post core and crown. So, you resection the old crown, and whoa, you have this ugly metal post. And with teeth like lower incisors, for example. Well, crowns are always compromised, right, because it’s such tiny teeth. That’s why, I think vertical crowns are absolutely amazing for this, right. So, in this situation, which I shared with you, and I’ll describe it for my audio listeners, you have a metal post. For me, a post core is just a space filler, it’s a way to actually have some sort of foundation restoration. So, I sacrifice a little bit of the metal core, i.e, I use a tungsten carbide bur, I drill into the core labelly to create a space. And I use Paracore white opaque shade to completely mask that metal. So, now when my technician is working on it. He’ll have a much easier time to mask the metal. The other way that I’ve seen some colleagues do it is, by using like white opaque tint that you can get. I know Ivocalar do one I think it’s called direct opaque. So, it’s just like a paint on a resin, very thin low film thickness. And it’s like super opaque, super white. And you can just paint that over if you don’t want to remove so much. But in this case, I sacrifice a metal and I use a bright white opaque core material like paracord, which I’m a big fan of. But you could also use the resin like I said. So, now we have masked that metal post and you get a better chance of getting a good shade match. Now, if you’re thinking, are you concerned? Are you worried about drilling into a metal post? Just think about it. The last time you had to remove a metal post that was bonded in was it difficult? Or is it easy? It was super difficult, right? Like you’re there for a long time with your ultrasonics and your burs and whatnot. I did not worry at all about the post somehow coming loose, it was very secure. So, you have to make that sort of judgment call and case by case but usually these posts are in pretty well. This episode is very kindly sponsored by Enlighten Smiles. Now, I know episode about ceramics. But a lot of times for our younger patients, composite is sometimes the most appropriate material. And if you think you can’t make composite look as good as ceramic. You just check out the work by Dipesh Parmar. This guy is a master dentists. He teaches his techniques using renamel composite and other brands to give you some amazing results working with composite resin. His course called Mini Smile Makeover. It’s fantastic. I’ve been on it twice now.  The beautiful thing is that you can go again and again and again. It doesn’t cost you. So, you pay once and if you need to go again, as a refresher, you can go for free, which is just amazing. Which other course offers that? You could check out the course on minismilemakeover.com. Once again that’s minismilemakeover.com. Main Episode:Ed McLaren, welcome to the Protrusive Dental Podcast. How are you my friend? [Ed] I’m doing well. Thank you! How are you? [Jaz] No one’s ever asked me. Wow! No guests have asked me how I am. Thank you so much. I’m doing great. I’m all the better to have one of my people I respect so much in the dental education space. But the other thing I really love about you, Ed is not only the clarity in which you educate. You are the finest dental educators out there in my opinion, but your movies that you make are just so brilliant that I want the world to see them. So, tell us a little bit about you for those listeners, very few listeners who haven’t heard of you. And then eventually, tell us about how you got into making these dental, essentially, spoof movies which is just phenomenal. [Ed] Thank you! Yeah, in fact, I just finished one in Egypt that we’re in post right now. Post-production means that it’s been edited at this point, called Ceramist Never Die. It’s a twist on bond, a James Bond movie. My name is Ed Bonded in the movie. So anyway, let’s say I’ve been a dentist for like 38 years, as a general dentist for five years, and then got a little bored with General Dentistry and decided I wanted to be a prosthodontist. Yeah, actually, kind of the real reason I went in that direction. I originally wanted to be a periodontist. But in those days, in late 80s, there was such a fear of getting AIDS from a patient, right? In those days, I actually thought I just go as far away from blood as possible, and work on, essentially, older people that need a denture. So, that’s how it all started. And actually, that wasn’t all that much fun for me to tell you the truth. So, I searched around and thought, well, what is it I like about what I do, and I really enjoyed the aesthetic aspect. I enjoyed doing veneers, were just starting to hit then. I enjoyed doing veneers. I enjoyed doing more aesthetic work. I still enjoy doing dentures, but it was like sort of gravitated toward people that liked aesthetics, too. That wasn’t just function only. So, that’s how that all started. And then, I realized when I went to PROSPERO, like I said, my director made us do all the lab work. Everybody thought it was a punishment, except me. I mean, I was loving doing it till three, four or five in the morning, which I still do now, making all the ceramics. So, that’s basically how it all started. And then, it just gravitated more toward, you know, current concepts, minimalistic dentistry. When you start to understand what things work and why, and what things don’t work and why. So, the movie thing started was, you know, as computers evolved, and we all started moving to computers around 2000. I just started learning programs, how to edit video. And it just started with very simple stuff around 2000 to just take my images of my work or my travel images and animate them in some way, which you see mostly what people do today, right? So, I did that for about nine years, till 2008, 2009. And I started to get bored doing that. I mean, that was boring for me. And I thought, well, what’s the next level? Create a movie with people in it, right? Keep something. So, I thought, okay, if I’m going to do that, the few other people that I saw doing it, I thought, ‘God, if they don’t relate it to dentistry, they don’t keep it short.’ They don’t keep it interesting it’s going to be a big flop. So, I thought, ‘Okay, I got to do something that’s current, something that’s related to everybody knows, like Star Wars, and come up with some dental thing.’ So, that’s how it started. So, I came up with the first one called Ceramic Wars. What was it called The Return of the Ceramist. And then, I did a couple more of that. And then, the last one I did on Ceramic Wars was called, The Last Crusade. And actually, since now Star Wars seems to be cycling in various formats, MANDALORIA, or NB1 or not, NB1. Anyway, you’ve seen there’s so many variations of that. So I just wrote- [Jaz] For those who haven’t it, they must appreciate that this is not just some like little, like guy on an iPhone. This is really professionally produced and these are just the finest quality enjoyment in terms of entertainment that you find in dentistry. I find- [Ed] Thank you! And that’s why I don’t have a Ferrari or McLaren or you know, because all it costs a lot. I mean, it’s a lot of my time, it’s movies about 1000 hours of my time, but it’s also, you know, I’m spending 30,40, 50 thousand dollars. Normally would have had to spend three, four, or 500 if I didn’t do the work, so it just evolved into doing that. And then I just ideas start to happen. And just like you get creative with something, and I get very creative. And I look for scripts or movies that I think that I can do something that’s kind of cool and short. And so, I’ve done like four now Star Wars movies, there’s a fifth one, I’m writing a return of it. We won a Raiders of the Lost Ark, a spoof on the matrix, a serious spoof called a source a Down and Out in Beverly Hills movie, where I’m a bum on the street and something like that, and then the James Bond movie, and then just a couple of other fun things. And I’m working on a movie called Cambo for cyber, but I’m not in good enough shape. And I don’t know if I’ve ever had a Rambo character, and then, three or four like that. So, that’s how it all started. [Jaz] Where is the home for all these movies? Is there is it on YouTube or? [Ed] Well, okay, so that’s an interesting question. Yeah, you can go to edmclaren.com. and you can see five or six of them. I’ve made eight, nine now. Okay, that ninth ones in post, and kind of what I decided to do was not put them, the current ones on YouTube because actually, it’s a draw for my lectures. It’s an interesting vibe of stuff. It’s, you know, 20-30% of the people are in the room not to watch the lecture. They’re just there to watch the movie. Which is okay, for me, at least. So, the movie I made just before COVID called Raiders of the Lost Art, I haven’t even had a chance to play it except at one or two venues. And then I’ve got a movie called The Source, I haven’t played anywhere, which is a spoof on the matrix. I’m just waiting as the lecture circuit opens back up, so I can get it out there a little bit and get people to the lectures. And, you know, so go from there. So- [Jaz] It was great that tubules. Well, I’ll put the link to edmclaren.com so people can check out the quality and the caliber of those movies. And that’s something I aspire to that at the moment, I make a few spoof videos, I made the Fresh Prince of Appliances. And that was like a two-minute thing. But what you know what you do? That’s like my goal for the future. So, something to aim at. Ed, I love everything. What’s that? Sorry? [Ed] It’s a full time job. Almost. [Jaz] It sounds like it. All the hours, and then the cost and stuff. But oh, my god, the quality you produce is just epic. So, please continue. We need that kind of stuff. Now, you are well known for many things. But yeah, I mean, the whole play on ceramics in the movies and stuff. So, you are my go-to guy with anything ceramics. What you don’t know about ceramics, in my opinion, it’s probably what not worth knowing about. So, I’m going to hit you with the first question that I have, which is, is there still a place for feldspathic ceramic? Both in terms of patient demand, dentist skill set, I guess. Are we still being taught it at dental schools? And then thereafter, are there technicians who are still happy to make these beautiful feldspathic restorations? And if you don’t mind Ed, for the younger listeners that we have, just also explained what is feldspathic ceramic and how it evolved within the last 20-30 years? [Ed] Well, given the literal definition of feldspathic or the scientific and that would kind of screw people up a little bit. But just think of feldspathic ceramic as porcelain. The stuff that we layer on the surface. Whether it be layered it on metal, whether we layered it on Emax, whether we layer it on zirconia, or any other version of core. That we also make porcelain veneers out of it. And so the porcelain veneer, basically, is bonded to the tooth instead of being bonded to the metal. It’s bonded to the tooth. Okay. And so, there were several questions in that one question. The first interesting question was the demand from patients. The interesting thing that demand kind of went down for a while from patients. And because of social media being such an interesting phenomena, it’s actually come back significantly because of people that have gotten famous doing it like the Michael apple’s, as you might know, my gap of my Peppa. He’s becoming very famous, especially in the, maybe more patient world than the dentist world, but also in the dentist world too. Bill Dorfman, who started Discus Dental. He’s basically was in my class, we’re the same age, both a few minutes over 60. And Bill’s known for that too. Bill is probably was probably one of the top guys known for a number of years. And now the interesting thing is, because they’re all posting daily on this, and then you got a few other people starting to do this. There’s a dentist in Dubai called Duvall Lelouche, who I had the opportunity to meet. And I gotta tell you out there, he’s probably one of the most best dentist I’ve seen for a combination of, if he’s watching and not have your head grown, but for a combination of treatment planning, because sometimes we see maybe good veneers, but we’re questioning the treatment plan, right? It’s not a process of why they did something in the first place. Because first we’re doctors, right? So, from treatment planning from ceramist, he’s got four or five ceramist in his office. So, he’s been posting a lot. And so, what’s happened the last four or five years, from very little requests from patients that I’ve seen, I don’t say for me, but at the school when I was at UCLA and stuff like that, all of a sudden people are coming in now, because they’re so savvy on the internet, they know where to go, they’re seeing this, ‘Hey, whats this porcelain veneer?’ And more than that they even know what it is now and they go, ‘That’s really what I want for my tooth.’ So, I think the market is there. I really believe the market is there. Then the second question about the aesthetics you know, most of us have all done Emax or Empress or GC LISI monolithic and it’s good. You know, it looks good, but it doesn’t look great. Okay, so the place for feldspathic veneers is where you got a patient that really wants a very natural looking tooth just like you’d layer composite, you wouldn’t use one shade of a monolithic material. So, now the challenge then becomes, where does it work clinically? So, without getting too deep into material science, it works when we have mostly enamel on the tooth. And it’s not the bond, we all think okay, we get a better bond to enamel then dentin. That’s actually not true. If we have fresh clean dentin, it’s not contaminated. Your bond strength to dentin is actually higher than enamel. But it still fails more on dentin and the reason why dentin is eight times more flexible than enamel. So, when you load an enamel ceramics, when it’s on enamel, the stress passes through the porcelain and is absorbed by the enamel underneath just like on a PFM. Why a PFM works is because the high strength stiffness of the metal. So, that’s really the key for long term success. It doesn’t work on a bonded the dentin surer. But you’re going to see maybe 5, 6, 7, 8% failure rate per year. If you’re bonding the dentin with ceramic just because the dentin bends, the stresses absorbed in the ceramic. Where you’re going to see probably less than a half a percent per year, when you’re bonding to mostly enamel. So, that’s really the key for me. Now, I also did a study that we published because people said, well what if I have a little bit that exposed? What if it’s just 5%, 10%, or 15%. We heard, this was purely speculation, that you could have 50% of the enamel gone from the tooth or 50% dents and exposed and your bond Porcelain is going to pave like 100% porcelain. We tested that. We published it in the JPD and you know nobody- [Jaz] It’s going to have 100% enamel or 100% dentin? [Ed] So, we looked at 100% dentin and 100% enamel bonding too. 50% dentin, 50% enamel and 100% dentin and then we fatigued it and fractured them. So, here was the results, 50% dentin exposed, and 50% enamel basically behaved like 100% dentin. So, that was fascinating to us. In fact, a three-tenths of a millimeter veneer bonded to 100% enamel, was stronger than a 1.2-millimeter-thick veneer bonded to half dentin, half enamel. So, enamel really is keen because it absorbs stress. It’s a stress absorption phenomenon. Okay, so where does that leave us if you can’t do it with 50%? So, we also tested if we’re missing 10% enamel, 20% enamel or 10% dentin exposed, 20%-30%, so, it’s about 30%. Where there’s about 30% enamel missing and dentin expose your bonding to is where that dynamic changes where the stress starts absorbing more in the porcelain. But I’ll give you another good article. The best article I found clinically, that’s obviously a laboratory article, Glebe Grill. Many of you know in Turkey that published an article just last couple of years. He’s published several things over the years, where he followed literally about 1000 veneers and bonded to enamel, bonded to dentin, margins and enamel. And here’s what he found with clinical data, good clinical data, well documented clinical data, that as long as you have at least a periphery in enamel but dentin exposed, it does pretty well. Your failure it maybe percent and a half per year, okay. But when you have full dentin at your margin, that’s when you go to an eMax, that’s when you go to maybe an empress. Empress still works, but non-layer. Don’t layer your Empress. If you feel like you have to layer for whatever reason that’s now in Emax or as Zirconia [Jaz] Amazing! I love those guidelines that you gave in terms of 30% and dentin and 70% enamel and all those studies that you referenced. I’ll make sure I get them in the show notes. But that’s a very helpful answer. But with the labs, now massively uptaking and going into CAD CAM and in a way I do find they’re encouraging them to say, ‘Oh you know what, let me just mill this for you’, kind of thing. So, did you think there was going to be a shortage of skill set from dental technicians in the future who can hand layer beautiful porcelain? [Ed] Yeah, let me distill down one maybe into one or two sentences my clinical thought process, okay. Obviously, if I have 100% enamel to bond to an anterior teeth, I’m doing feldspathic. When I get close to 50% dentin to bond, then I go to a glass ceramic and make a decision, is it an Empress or Emax? I still like Empress. It looks a little better. It’s a feldspathic material that you machine. Then when I can’t bond, so the time to go to zirconia is when I can’t bond and, you know, basically, it’s going to be sort of a conventional crime. So, that’s the clinical thought process. So, your last question about the laboratory. That’s been the biggest problem. And as you know, I ran a laboratory school at UCLA, unfortunately, we had a bad fire that closed it. I have to tell you, I get called literally daily now, and several emails a week for, ‘Hey, I need to find a ceramics that can do veneers. I need to find a ceramics that can micro layers zirconia.’ So, we as a dental professional organized dentistry, we’re really dropping the ball on teaching people how to do that. So yes, that is a challenge. That’s a challenge to find a somebody that can do a feldspathic veneer, well. I can tell you, one of the laboratories tell me that one of their biggest concerns about doing this is the time involved, it’s a three, four or five times more than machining something and finishing it because the model work is so different. And so, actually, my partner in crime and digital as Jed Archibald, who works with Gordon and Rella Christensen. Actually, we’re working on, we’re trying to come up with a full digital workflow to get the model work done. So, the model work and then a machinable refractory die, and we’re really close. So, that it’s easy and easy for the technician, all they got to do is layer a little bit like they were layering zirconia crown. So hopefully, that’s done in the next few months. But yes, we got to train technicians, you gotta find a decent technician who can do this. And it’s harder and harder. Yeah. [Jaz] On the other side of things, when you look at the dentists, especially the younger dentists, I’m pretty sure this is also happening in the States as well. But definitely the UK, composite veneers have been really taking off, where do you think that there’s gonna end up in the future? You know, 10 years down the line, are we expecting some sort of a great boom in these composite veneer failures? And then, perhaps a rising of them being converted to ceramic? [Ed] Yeah, I mean, I’m all for that. Okay. I think it’s great because you can be a little bit more conservative with your composite prep. Now, I can do almost a no prep. I’m back to the phase where I’m just prepping just a little bit. Because I find if I do no prep, I can make the veneers but the margins aren’t what I’d like to have, you know. So, it’s very difficult to make perfect margins of blend in the tooth. So, even if I think I don’t need a prep, I’m still putting the latest chamfer on. So yeah, that’s the biggest mistake that most dentists make that are doing veneers. They grossly over prep for a veneer. So yeah, I think developing the composite skills is a great thing and composites done well. You know, they can last 7, 10 or 15 years if you buff them up a little bit. But I gotta tell you, I see so many veneer cases coming over, composite bonding cases come in. And I would say if I see 20 cases, I might like one or 30 cases, might like one. Usually, when I see a veneer case from a decent ceramics, I like more than a half, let’s say. I’m going to hard on myself in art and other people. So, you got to get the skill set. It’s a skill set. Now, one thing of truth in advertising, because I used to do a lot of bonding and I was pretty good at it actually. And I know how to layer composites. I don’t do it much anymore. Unless I teach a course just for fun. I know all of these guys professional friends the Newton Fahl’s, the Didier Dietschi’s’s and all this. And when you get them off the record, you say, ‘Come on! that stuff that you’re showing with all the little effects and the mamelons and the perfect surface texture. It looks like God made it you know and stuff like that. How long did you really, how long did that work?’ And they said, ‘An average of 2-2 and a half hours of tooth.’ And I said in one appointment, Your 10 teeth are spending 20 hours?’ No, we never got it done in one appointment, two, maybe three appointments. So, we’re building it up, shaping it, sending the patient home, they come back little tweak here, little addition there, little subtraction there. And then the third visit is to polish and surface texture. So, that type of composite that you see in the articles is not a simple thing. Okay, it’s a wonderful thing done well, but it’s not a simple thing. [Jaz] A little industry secret share there by Ed. Thank you very much. Very good to know. Next question then is, some docs are anecdotally using zirconia for veneers. Okay, now this seems a little bit absurd to me. And then on that vein, and we can probably venture out and digress into zirconia for partial coverage posteriorities. But let’s just stick on this veneers topic. Are we yet at a stage using the Markus Blatz APC protocol, for example, that we can predictably bond zirconia? And, is this something that you condone? [Ed] Yeah, okay. So, let’s maybe step back in our space for just a second because I was just talking, doing this to Egypt yesterday, exactly what we’re doing here. And because I’m gonna go there and teach a course on there, they said, ‘Hey, listen, we want to learn how to match zirconia next to eMax. So, we can do an eMax veneers and zirconia or something like that. I said, ‘Why don’t you just use eMax?’ So, one of the first tricks that I tell people, when you’re matching restorations next to central lateral whatever, you use the same veneering material on both materials. So if I got to do his zirconia crown, on one, two, okay, one, one, excuse me and I got to do a veneer on two-one. I’m going to use the same porcelain for the veneer on two-one that I did on one-one. And that’s also a problem right there. It’s a very simple technique, but more specific to your question. Okay. So, I’ve been sandblasting zirconia for years. I’ve been using MDP primer for years, both back on alumina, when we were going to look concerned about sandblasting some things could potentially weaken it, okay. But when I bonded, it didn’t fracture when I used conventional cements I had more fractures, because there may be you start some cracks. But it’s an interesting thing. It was a very good paper and you might want to look it up. I believe it was in dental materials by Matthias Kern. He did looked up all the cohort studies and did a meta-analysis of several different studies and 2015 and hasn’t changed that much was sandblast- [Jaz] That was for resin bonded bridges, right? That was for resin bonded bridges, right? I think that- [Ed] Right. But still for resin bonded bridges, okay. Even if we had a phenomenal bond, it shouldn’t come off. Several studies had very low clinical success. Alright, so yes, I could demonstrate and I did some work with John Burgess and Nate Lawson. I was part of their team or they were part of my team; we’re all part of a team for a couple years. Had an opportunity to look at it. You can get phenomenal bond strengths on day one, when you sandblast Zirconia, put an MDP primer on, it looks good. But when you sheer it off, okay, even though the bond strength is very high, it’s an adhesive failure. It’s always an adhesive failure, and it’s not ripping out the ceramic on one side. And Burgess also did a study where he looked at sandblasting and no sandblasting. So, super smooth zirconia. T hen when he sandblasted, which is gonna give you a little bit of roughness. Nothing like sandblasting the glass and give you a little bit of roughness. All right, then, he used an MDP primer on both. And basically, what he found was about 70% of the bond strength. So more than half, let’s say for sure, more than half was because of the chemistry of the MDP primer. All of these primers can dehydrolyze in the mouth; they can break down in the mouth. So, if we see some leakage, which sometimes happens, okay, that’s the reason for failure. And by the way, about roughly about 10 to 12 years after sandblasting my Procera crowns and using that original MDP primer, which is still the main one everybody uses. I had a few crowns start falling off, just because the cement hydrolyzed broke down. So, I’m giving you a little scientific perspective. I worry about the long-term clinical bond strength for Zirconia until we can effectively etch it and effectively get a really good micro mechanical bond. So, I gotta agree with you. I don’t see the rationale of doing Zirconia veneers when we already have somebody else, something else that works that doesn’t break. So, eMax, Lithium disilicate, GC LiSi, Vita has Supremity. They have Ambria. There’s one out of Korea that looks really nice. There’s 6, 7, 8, 9 products on the market; the monolithic look better than zirconia that won’t break that we can etch. So, that’s what I would recommend today. Now, having said that, there’s a company in Korea that makes a product, and you may want to make a note of this and look this up for your viewers, called ZIRCOS Etch for etching zirconia. It’s a very caustic acid. In fact, you have to have a special vent in your lab to etch the zirconia and it will etch a five line material; it will etch the cubic form of zirconia. It won’t etch the 3y, the pure to trigonal, but we’re only going to use five line, right. We’re gonna use the more translucent cubic material. So, you may want to look into that, and it’s a very caustic acid. You could not put your hand in it without severely burning yourself. So it’s called ZIRCOS Etch. And I happen to know it works, because my colleagues tested at UCLA. So, if I was going to do a veneer, for whatever reason, and here’s the one reason I might do a zirconia veneer, I’m going to do zirconia monolithic everywhere else. And I got one or two teeth, that I just feel, ‘Oh, I don’t want to prep it. I mean, the inner proximal is good; the lingual is good, but I want to have the same material, then I would do it.’ [Jaz] Amazing! That is really useful. And I never heard of this Zircos Etch. I’ll look it up. That’s very fascinating. So, the future potentially, is looking good, but I like how you answered that. Okay, maybe at the moment where we are in the long-term, sort of follow-up isn’t there yet. And so, you’re a little bit hesitant to make that recommendation. [Ed] Let me just add, so if you feel compelled to do that, for whatever reason, maybe your lab does it. I would think a little bit more with adding a little retention and resistance form back to GV Black, meaning a few may be a little bit of a retention groove, mesial distal, something like that. Just to give it a little bit more resistance form. So, that’s if you’re gonna do it, okay? [Jaz] Well, that lends itself next to the second part of the question where I have some colleagues who are doing posterior zirconia onlays. Now again, once again, I’m very much like, okay, if it’s an onlay, I need to have an enamel. If I have an enamel, I’m going to be using lithium disilicate. So, do you have similar thoughts about zirconia monolithic onlays that are bonded posteriorly? [Ed] Well, I mean, it’s the same thought process. We were one of the beta test sites at UCLA for eMax and we started using it in 2004-ish, I think. So, we are graduate students because it was an aesthetic program. We had multiple chairs going and 2-3 year graduate students. So, we did a ton of posterior eMax, and we did roughly three thousand. And I had a deal with the patient because, at UCLA is very protective of their IRB, Institutional Review Board.  And I wanted data, and I didn’t want to go through all of that. So, I just figured I’d present all the data, okay. So, after over 10 years of doing three thousand restorations onlays with graduate students, not me, graduates. So, we had a whole bunch of graduate students. So, my poll, I probably did two 300. And they did fail 2700 or so. We had one known fracture in 10 years, one known fracture of bonded, bonded, bonded, bonded eMax. And the average thickness we measured them were right around a millimeter. So, I don’t believe we need a millimeter and a half. I think a millimeter is fine. Maybe even eight-tenths because that stuff is so strong. Of course, this was non-layered, and it was all well-bonded. And it was all, I believed early on and sealing dentin I learned from Pascal Magne and John Sorensen, by the way. To give him a little credit, my mentor believed in sealing dentin back in the 80s. But he never published anything about it. And obviously, everybody knows Pascal, who’s done the most work on it over the years. So, we were sealing dentin back in the 80s when I was in my process program. And for lots of reasons sensitivity, we had a good idea that it increased bond strength. But Pascal shows that roughly doubles maybe even Quinn topples bond strength if you feel dentin at the preparation appointment. So, when you factor all those things in, we had one restoration fail that we know of. Somebody could have moved to China and fell out of the study. But we offered them a free renewal if it came back, if it failed in less than five years, which we never had one. So, I can tell you, since that works so well, and it looks so good in the mouth. Why do something that you’re not sure about? [Jaz] That’s so true. And I agree totally with that. Just interesting question for you. I also asked this to Chris Orr, many, many episodes ago, just to understand your philosophy. That, let’s say you’re gonna go to eight-tenths of a millimeter or a millimeter monolithic eMax, for example, is your decision-making tree anyway, influence by the biomechanical risk or the biomechanical status of the patient, i.e, large masseters, known bruxist, would you then, perhaps sink your burr in a little bit deeper? Does that deserve an active aggressive bruxist influence your material thickness or not? [Ed] So, the first thing I’m looking at is kind of the amount of remaining enamel. So, let’s say you got that eight-tenths, whatever you’re at, whether you’re building up the teeth, right, you’re gonna open the vertical, restore the vertical, whatever you want to say that is, okay. And you get that eight-tenths. If there’s some enamel there, I’m not worried about that, okay. There was a study done by Gordon Christensen, and a couple of others followed up over the years that they went into laboratories, measured the average thickness of porcelain, on a PFM. The average thickness was a half a millimeter thick. And we didn’t see a fracture that much. Maybe a marginal ridge somewhere, but the occlusal didn’t pop off. Why? Because the metal absorbs the stress, the stress passes through the system into the metal. So, the first thought process is an enamel. So if I’ve got an enamel, great, I’m not worried about being eight-tenths. If I’m completely indented, I’ll probably go for that millimeter. I think it’s a little thin. I might just take an extra millimeter or two off of that tenth of a millimeter or two off the dentin. Okay. Now, having said that, that’s an interesting concept that comes up about biomimetics. I love that concept. Just in medicine, whether in dentistry, yes, we want to mimic structures as much as we possibly can. Okay, and that’s whether it’s aesthetically or functionally or biologically. But we truly need to be able to do that too, right. So, we have not been able to reproduce the dental enamel junction as it forms; it sends fibers into the enamel and it sends fibers into the dentin. So, when you look at a tooth, you see all these little fracture lines; those pieces of enamel that are being held on by things that we haven’t created yet. Okay, we haven’t been able to create that. And enamel is a very different material in ceramics. It fails in a very different way than our ceramics. When enamel fails, it starts on the occlusal surface or facial and goes right to the dentin and stops. When our ceramics fracture, it fails like a spiderweb called Hertzian cone fracture. So, we do have to think about thicknesses. And one of the things that’s bothered me that I’ve seen that’s come out, when people are carrying anything too far, whether it’s aesthetics or whether it’s biomimetics. I see, you know, you’re looking at it tooth. So, imagine you’re looking at tooth, if you remove all of this tooth structure, okay. So, you got three millimeters of dentin. Maybe you’re missing a millimeter and a half of enamel, typical thickness of an enamel and the thought process is okay composite has about the same thickness or thing physical properties as dentin. So, let’s build up a dentin the core, the shape of the dent, save for the missing dentin. And then we’re going to bond some ceramic on that because that’s perfect biomimetics that composite the same as dentin, the ceramic basically the same as enamel. I can tell you that will be a disaster clinically. Okay, that sounds actually been done over time. Dominique of  came up with what he called the Encore Crown, or something like that where he made crowns. So, missing dentin, missing enamel, he made copings out of composite. Then put ceramic on top, goes in the mouth, sounded like a good idea, bonded the composite bends, bends, bends, bends, bends, bends like the dentin would then bend, and the ceramic peeled away. Alright, so I understand the thought process, you want to minimize or mitigate the stress to the tooth by putting composite on there. Okay, that’s kind of the goal. Okay, the next question is great, but do you need the four millimeters for a composite? So, I talked to some engineers and understood, ‘No, no, no.’ If you’re missing some help to even stress out, about a half-millimeter composite is all you need, you don’t need four millimeters to even the stress out on the surface underneath. So, the light bulb goes on. We fractured a couple of teeth. Pasquale, I think he published something on this. So, let’s imagine you’re missing four millimeters, or three millimeters of dentin. Just a little thin layer of composite to even out the pulpal surface or whatever. Then fill in the rest of the space with three or four millimeters of ceramic and you’ll get the best of both worlds. The thicker the ceramic is, the less likely it is to fracture. You only need about a half a millimeter of composite to dampen the stress on the tooth. There’s no difference in stress to the tooth if the composite’s a half millimeter, 1, 3, 4 or 5. You’ll only need about a half millimeter and so that it makes it easier- [Jaz] I’ve been doing it that way since Mahul Patel, who you may even know in the UK, a very good prosthodontist. He actually told me he learned that from you and was influenced by you, and then he passed it on to me. And so yes, I don’t build the sort of foundation or core composite. I just add the thickness to my lithium disilicate restoration. And that’s a good thing to do, I think. [Ed] You do want to add about maybe about half of it. If your goal is to dampen the stress on the tooth. If the thought process, well, I don’t want to wedge the tooth or I want to even out the stress on the tooth, then either a structural flawable, will mean a strong flowable, okay, that has high flexural strength. [Jaz] I use g-aenial flow like g-aenial injectable, highly filled. But even then I do my IDS. I do my immediate dentin sealing with it, and that for me, kills two birds with one stone. Is that reasonable? [Ed] Oh, that’s great, that’s exactly how I think, now too since we now have very good flowables that have high compressive strength that aren’t like rubber. Okay, that’s exactly a great technique that saves your time, too. [Jaz] Amazing! Brilliant. I’m loving the pace of this week. We’re covering a lot of ground here. I’ve got two more questions here of general themes of this valuable time that I have with you. Okay, so now let’s think about the topic of posterior ceramic onlays, lithium disilicate onlays. I want to know your opinion, your clinical opinion, or any expertise or studies that you’ve seen comparing an Ivoclar product, eMax, versus I believe, is LiSi, GC? Is that right? [Ed] GC LiSi [Jaz] Yeah, GC LiSi, so. [Ed] I have not seen it. That somebody has compared it directly. And I’ve done a few GC LiSi, but not enough to say that hey, like the 3000 eMax. I can tell you; I have friends that I trust that would tell me the truth. Okay, that had been working with the product since it was launched. And they’re having very similar success rates as long as it’s not a layer. If it’s just a monolithic, well bond at GC LiSi, they’re not seeing any particular issues, with failures coming back and things like that. When they start to run into failures. Here’s where people start to see failures, where they’re doing conventional cementation, it’s a little thinner. And, you know, because then the ceramic absorbs all the stress and or incorrect preparations for this type of material, which would be very soft and round on the inside, just pretty much following the anatomy of the tooth the best you can, with no sharp internal line angles. You don’t need any retention resistance form if you have a periphery of an enamel and both seem to be equally successful to me. [Jaz] Is there any anecdotal aesthetic advantage of either? [Ed] I think where people run into problem with Emax and you hear some people say they love it, they say it’s gray. Emax is an interesting material and GC seemed to have solved the problem and I don’t know, they won’t tell me what they did. In Emax, you can’t fire more than about two or three times when you fire a third and the fourth time- [Jaz] It goes gray. [Ed] It goes gray and I think what’s happening is the pigments burning out. The pigment, whatever pigment was in there, it’s like table glass. If your table in your living room and you look at it as a greenish gray look, so it’s just burning out the pigments. So, I think if you can keep it to one or two firings, essentially a glaze, right, if monolithic little pain glaze, I think you’re fine. [Jaz] Hey guys, I know Dr. Ed McLaren has covered a lot here but if you want a simple one page summary of this podcast episode, so you got like a different which ceramic, when kind of thing, when would you do what, then we’ve made a one page infographic. You could download it on protrusive.co.uk forward slash ceramics. That’s protrusive.co.uk forward slash ceramics. Back to the main episode. Okay, fascinating. And so the last question is to just discuss zirconia. I know, you could probably speak for like five days in a row, a full day’s couple of movies of yours in between, to keep everyone occupied on this topic. But I love how you were able to grasp this big mammoth topic, and how well-read you are into just a couple of guidelines at general dentists can apply. And I love how you did that with the first question. So, I don’t want to really put this complex question for you because it’s oversimplifying it. But if we had to, suggest a guideline for the selection of the different types zirconia, you mentioned earlier, 3Y, 5Y, if you don’t mind a bit of revision, firstly, on what is the difference and then, when to use? Which zirconia? Essentially, the question, and when should you lay in, when should you use monolithic form? [Ed] So 3Y means 3% of the molecules are Yitria oxide. Okay, and then 97% are zirconia. And the original materials like Lava, most of you remember that name were very opaque materials to trigonal zone. When you have 3% Yitria, you have mostly 100% to trigonal shape crystals zirconium. It’s very opaque, but very strong. Okay. Ceramic engineers have known for years, and they started to apply it to dentistry 5, 6, 7 years ago that you increase the Yitria content, you had three oxide added more Yitria, a little bit less zirconia. The final material had a phase shift, the crystal shifted to a cubic form of crystal, okay. Because there’s actually about four or five but three main ones, three shapes of zirconia, which actually kind of behave like three different materials to tell you the truth. So, this material has been people been calling it five mole or 5Y’s. So, what they mean is 5% of the molecules when you hear a 5Y are Yitria. Which creates a material, it’s about 50% cubic zirconia and 50% trigonal zirconia. A fake diamond is 100% cubic zirconia. You have to put about 8% of the molecules in there at Yitria. There’s one thing that comes up because people have asked me they said, ‘Well, I open up this little thing that I get from the manufacturer, and I don’t see three or four or five Y, I don’t understand. I see 8%, 7%, that’s by weight. Okay, according to the FDA, they have to report the different amounts by weight. So, volume is different. That same thing with our composites, right. We got a 70% weight filler, but by volume, it’s 30%. It’s just a different each molecule has a little different weight and that’s what that means. So, the newer seven years will be put on the market roughly. Cubic containing 5Y materials are much more translucent, we’ve all seen that. And they’re very temperamental, because you’ll get from one lab a little opaque-ish. And one lab, it’ll be beautiful. So, it’s part material and part firing. These materials are very, very sensitive to fire and actually more than porcelain. So, if you fire them wrong, they can look like a marble or they could turn gray to like eMax example. So, where would I use those today? Those materials are strong enough for single crowns anywhere in the mouth. There are about 750 Mega Pascals when you’re done centering them. Now, here’s an interesting thing about a 5Y material. We were the first one publishing on this, when you sandblast the inside of a 5Y material, okay. The cubic crystal, it does not strengthen, like a 3Y, you probably heard that you can sandblast a 3Y material, it does not weaken at all.  Because it’s a little micro crack phenomenon. There’s a phase transformation and blah, blah, blah. Okay, so the functional strength of a 5Y material is not 750 MegaPascals. When you’re done processing the inside, it’s about five or 550. Perfect! That’s plenty for a crown. 550 Mega Pascals is plenty for crown but not for a bridge. Okay, so the 3Y materials were originally for layering. There’s a material it’s in between called a 4Y material. It means 4% of the molecules or Yitria, 96% of the molecules are tetragonal. That 4Y material forms a material that’s roughly 30% cubic, and 70% to tetragonal. Two good things about that, it’s almost as translucent as the 5Y, not quite, but almost. Here’s the nice thing about that material, the flexural strength is still up very high around 1000 MegaPascals but you can still sandblast it so when you sandblast it, it’s still 1000. When you sandblast a 5Y material, it goes from 750 to 500 because you weaken it, just like glass, okay. So, where do you use that? So, anywhere in the mouth that I wanted a monolithic restoration, single tooth, I’m going to use a 5Y material. Okay, STML from Noritake, most people know, or the super the high translucent, but you need to ask those questions if they’re 5Y materials. The lab will know, or they should know that anyway. Okay. So, I’m using the single restorations, anywhere in the mouth. Maybe for a small three unit monolithic bridge and the anterior part of the mouth 500 Mega Pascal’s probably okay. Okay, the ADA says we need six, maybe 800 for mega Pascal’s for longspan bridge. So, for any bridgework, I use a 4Y material. That’s the material, it’s 30% cubic face. Here’s the nice thing about that, it’s translucent enough that it looks decent, monolithic. I wouldn’t say great, but decent. And the reality is most of our patients are fine with decent aesthetics, right. Especially, if they’ve got such bad teeth, they’ve walked around with that, we’re doing an all on four and all in six or none on one or something. Okay, so for any bridge work, I would use a 4Y material. Here’s also the nice thing about it, it’s strong enough to layer if you want to. You can cut it back and layer like a 3Y material. I don’t know that I would layer a 5Y material. Maybe a little bit on the facial, but I would not cut it back to a thin coping and layer. You’re probably gonna see some fractures down the road. So, simple 5Y monolithic, okay, 4Y monolithic for bridges, and micro layering. [Jaz] Got it. So, instead of 5Y for any monolithic crown anywhere in the mouth, including anterior, probably don’t layer it unless you have to build in the facial, 4Y bridges. Maybe for a crown, it’s overkill, because you got the 5Y anyway, and then you can layer that with a bit more predictability and less risk? [Ed] Yeah, so let’s maybe look at it from a different perspective. A lot of times, you know, a lot of smaller labs or dentists don’t want to have 5 million materials in the drawer because you got to pay for all that stuff. Can you distill it down even more? So, here’s what I would do, you could do easily use 4Y material for your crowns, okay, for posterior crowns monolithic or something like prime, which is 3Y, 4Y and 5Y from either car. They’ve made a gradient of Yitria and thus a gradient of cubic face in it, which is a nice material. Use that for your single crowns, use it for your bridges, and then do Emax or GC LISI or Suprenity or Ambria, any of the high strength glass ceramics you like on anterior teeth. And then for the right case of feldspathic veneer, the right case. [Jaz] That’s such a brilliant real world application. Keeping in mind that we don’t want to be stocking all these different types of ceramics and materials. So, I like that real world recommendation, I think we will all gain a lot from that. Those are the main questions I want to cover and you covered them so wonderfully. So, thank you so much. Are there any other things that based on the questions that you’re thinking, and you know what, it’d be really good on this topic to get these nuggets to these dentists all over the world. A lot in UK dentists listen to this one. And also US and Australia. Anything while you have the microphone before I want to know about, how we can learn further from you? [Ed] I think I’ve covered it all. I mean, you’ve got the you know the simplistic idea of how I do a case and basically feldspathic veneer anterior, usually Emax in the posterior, okay, that’s usually what I do. If you came walking in, and I knew you were a patient of mine, unless I can’t bond. If for whatever reason, maybe sub gingival margins, or maybe I can’t isolate, they’ve got a tongue the size of a horse or something like that. Then I’m going to use zirconia and then for bridges I’ll use zirconia, okay. So, that would be the basic thought process there. [Jaz] So, no more PFM for you? [Ed] Now I haven’t done a PFM in ages. I don’t have a problem with it if you want to do a PFM. But, you know, conservative prep with this zirconia crown, take advantage of the substrate a color to bleed through, you know, the only time I might consider a PFM is where I’d maybe I had a completely black tooth. And I wanted to just make a thimble as thin as possible mental framework that I could go and coat so I could get a little warmness to it. So, that I had as much room for porcelain because I had a completely opaque the two that might be the one reason for it. Okay. [Jaz] How about gold, and are you using much gold? [Ed] Personally is, I used to love doing gold work. I did a lot of gold and I made it myself. I, my own, I do all my ceramics today and I still I have for a number of years. I don’t have a problem with it. But I gotta tell you that once you start getting known for doing, you know, nice looking aesthetics, I find people won’t even go like this if I used to make a gold occlusal, like that. You know, they hated the label. So no, I think it’s a fabulous restoration. Absolutely. If patient doesn’t care about aesthetics, and you like doing it. Absolutely, especially with some of your older patients that are bruxers. Oh here I was gonna go to an interesting place. Thankfully mentioned that. So, pop back in my head. So then, one of the questions related to this, what do you do on a significant wear case? Like you said, for your bruxers and you got to restore them, right? Now, let’s start historically for what people would do, is they somebody come in with a lot of wear and a little short teeth and they want to have new looking teeth. Typically, what do we do, we cut all the rest of the tooth structure down, and we make crowns and maybe we open the bite depending on your belief system. I’ve been doing this long enough to know that I completely disagree with the Dawson philosophy. That vertical dimension is stable through life and teeth are supra-erupt at the same point. I completely disagree. They treated enough patients over the years, that there wear exceeded their super eruption. Then I was able to restore their vertical and they did fine. And obviously some didn’t. But think about that for a second, the concept for patients 50 years old. Over 50 years, they’ve worn off 50% of their tooth structure. So, you’re going to treat a wear case. They walk in the door and your mindset is, you’re going to take off the 30 or 40% more of their tooth structure. You’re going to destroy 30% more in the next couple of hours and that’s a treatment? Okay, so you know that early on, in fact, right when Emax came out, that popped into my head. This is the material to use for wear cases. So, if I can restore vertical, great. It open as much as I can, I feel functionally, of course, you’re gonna test it out with your temporaries, your aesthetic prototypes and mock ups, whatever you want to call it. See if they re-establish some closest speaking base, vertical dimension of rest. See if their muscles are fine here. You test that first then you go to the final and then basically I just go for one millimeter thick Emax. So, I prep through my mock-up when I get a millimeter great, if I already have a more and more than a millimeter of composite acrylic and they’re wonderful. It’s even thicker then. Okay, so that’s how I would restore a wear case. And of course, I’m not going to do porcelain veneers in wear case. I’m going to do bonded Emax on those those types of cases. But I never liked how that looks, to tell you the truth. It just looks different to me. [Jaz] Amazing. Thanks for covering that guideline for wear cases I’m sure we gain so much from today’s episode at your place is called is it Art Oral America? [Ed]Yeah, so you can find my courses on AOA, it’s ArtOral America and I kind of partnered with DTG, dental technicians guild, aoadtg.com And then I have my own website called Edmclaren.com. And then I got all keep all my articles and crap on there. Actually, it was interesting you bring that up. Some marketing people said, you’ve created so much confusion in the marketplace because you’ve got names everywhere. Names for think blue, you’ve got names for black back and black now, you’ve got Art Oral America, got this. So, this you need to settle on one name. So, I actually just hired an IT guy and about a month or two, it’s everything’s just going to be in Ed McLaren’s. You can find everything under aoadtg.com. But next month, it’ll be just my name, so you can find it. [Jaz] And the courses that you run. Are they catered for dentists or technicians or both? Who are you mostly teaching nowadays? [Ed] D. All of the above. So, I’m a dentist and a prosthodontist. So, I have courses for dentists. I have courses for technicians. And I have courses for teams and I just restarted a course. You’ve probably seen this course called Full Digital Workflow for Milos Li culpa, I did that in 2008-2009. And then same period, I did it in 2013-2014. And it stopped for various reasons. And we just started again a month ago with John Archibald. So take a patient, start to finish. We do everything digital, but I had to call the digital dental team because I don’t believe purely digital restorations look that good. I believe that we have to add a little human touch; we change a line angle, we paint a little bit; we put a little surface texture, we do a little something to bring that good to great. And so, that’s basically the course that’s called the Digital Dental Team, where we treat a live patient. I actually let the participants machine some veneers. The dentists get to try theirs in and play this texture and stuff like that. So, that’s a fun course. [Jaz] And that’s all in LA? [Ed] Well, it’s all in my facility here in Park City, Utah. Okay, and because if I’m going to treat a live patient, I gotta have a good facility. I gotta feel comfortable because we got to start and finished in three days. But yeah, I mean, I do courses all over, you can just check my website or my social media and usually I post where I’m going to be if I’m going to be in Egypt, or I’m going to be in England or something like that. And so- [Jaz] Well, I’d love to catch you in us one then I’ll put the links on the website so everyone can check out and it guys if anything, right I’m going to try and summarize this in the notes in a PDF format, or the list of guidelines recommendations. But do check out Ed McLaren’s website as content and do check out the movies. I’m telling you the movies, you know, keep me saying it, they are something else. And thanks so much for everything you do for the profession and really appreciate one of my heroes give me some time today. I really appreciate it. [Ed] Thank you. Yeah, in the videos, five of the videos are on YouTube on Ed McLaren. Okay. Jaz’s Outro:Perfect! There we have it guys, the epic, the one and only, Ed McLaren. Wasn’t he just awesome? He’s a top guy. I’d love to go to the states and learn more and spend some more time with him. It makes me feel really great when these amazing clinicians give up their time to come on this show. So, thanks for listening all the way to the end. I know you’ve gained so much from that as it I once again. If you want to download the infographic, it’s protrusive.co.uk/ceramics. That’ll take you straight to the page where you can download the infographic PDF and it was just like a helpful aide memoire to summarize the findings from this episode. So anyway, thanks so much for joining me. If you found this useful, or if you know the dentist, your colleague who’s also struggling with ceramic decision making, please send them a link to this podcast. Share the love. Thanks so much. I’ll catch you in the next episode.

How much money is enough? Let’s face it, General Dentist is one of the most challenging jobs in the world – what level of income is worth the stress and health risks? This is a very personal question and will vary according to each Dentist’s money mindset and personal values. Dr. James Martin joins us again to discuss personal finances for Dentists. https://youtu.be/QwtQ43cU2uY Check out this full episode on YouTube “Your rich life is determined by your little network, your family, your friends, your nearest and dearest – THAT is worth more than any amount of money.” Dr. Jaz Gulati Need to Read it? Check out the Full Episode Transcript below! The Highlights of this Episode: 4:28 How much money is enough for Dentists?11:42 How does one decide how much money is enough for them?15:16 When do you envision Retirement?18:57 Financial Independence23:23 Importance of Saving36:40 Should associates look towards practice ownership?41:41 Summary Points Check out this book recommended by Dr. Jaz: I Will Teach You To Be Rich By Ramit Sethi If you enjoyed this episode, do check out Money – 5 reflections to help you get started with Investing Click below for full episode transcript: Jaz's Introduction: Let's face it guys. If dentistry didn't pay what it did, would you actually go into work? I think we have one of the most TOUGHEST JOBS there is. I mean, obviously I'll be biased when I say that, and so would you, but really think about it. We don't have a pleasant job at times. It's highly rewarding, but we take a lot of risks. [Jaz]We risk our health to do what we do. So if we didn’t pay what it does, would you still do it? Probably not. I know I’ve spoken to a lot of you about this and we all seem to say, you know what? You know it should pay more if anything, but if it paid any less, then you definitely wouldn’t do this job. Now it got me thinking how much money is enough because we’re in danger of doing this horrible thing where we look at other people’s lives and they say, oh yeah, he’s gone to Maldives on holiday and how many cars this person have, and you start to look over the fence and the grass is greener on the other side, we start buying things. We don’t need to impress people, we don’t like, you’ve heard this all before, obviously, but the topic of today is something very sensitive. HOW MUCH MONEY IS ENOUGH? It’s a funny one, isn’t it? Right? What are your goals? We talk about retirement, we talk about how much money is your rich life, and I talk about the origin of that in the main podcast episode. Just give some context. I went to the podcast show in London today, which was a nice, fun day out, and I went to be able to serve you guys better because it is become a big part of my life, the podcast. I love doing it. I’m so appreciative that I have an audience. You guys, you listen to me. Thank you so much for listening to me. It means everything to me and I want to serve you more. So that’s why I went to the podcast show, pick up few tips and tricks. I invited my buddy James Martin from Dentist who invest come along. He of course did episode 44, if you remember. So if you’re beginning into investing, like if you’re a beginner in investing, then you should to totally listen to that episode. We cover a lot of personal finances in that episode, but today we’re covering this, you know, it’s like a group function almost. Right? This episode we’re going to cover this one topic where how much money is enough, and I also cover this theme towards the end of as an associate, should you be looking to become a principal. Because principals earn way more according to the figures that I quote, which are the NASDAL figures, which are like a bunch of averages. So we’ll share all of that and hope this episode doesn’t offend anyone. It’s sold very much based on averages and whatnot. And of course, finance is such a personal thing, right? Main Episode:So let’s join the interview with James, which was featured live on Facebook. So if you hear some shoutouts, that’s what’s happening. I was live. Hello guys. We are live. I’m just going to be checking the stream. I’ve got none other than James Martin. James, you can only talk when I give you the microphone. [James]Okay, I see in that case, well, I’ll just hold my horses until Jaz passed the microphone with me. What’s up everybody? Absolutely buzzed to be here today with- Oh, hello. [Jaz]Hello live indeed. You should now go on your phone and share to ‘The Dentist Who Invest’ guys can catch us in the goal because very interesting topic we’re going to cover today. By the way, let me build some context where we are right now. Yeah, we are at the London Podcast show, which is so cool. It’s kind of weird to be at a trade event that’s not dentistry. And it’s just great. And I came here to be inspired and we both came here to do good things. Hopefully catching you in your lunch hour. I know we’re a little bit early for that, but maybe we aren’t be able to have a little chat on some questions. Interesting topic. But anyway, just building some context. We’re here at the London Podcast Show, so when I met him today, I was like, Hey, how’s it going? I was pretty chilled about it. He was like, oh, it’s the first time we. I’m like, no way. Because I feel like, you know, from the on online world, the presence, I feel as though I know you already, right? [James]Yeah. Yeah. [Jaz] So that was strange. So now we are officially IRL Friends. Do you know what that means? IRL? [James]In real life. [Jaz]We are in real life friends now. So anyway, we were sat at, there’s like all the big brands here, Amazon Music, Spotify, Sony, et cetera, et cetera. YouTube is here, et cetera. So, we sat down to record, find a nice quiet place to record, and we really struggled. We got kicked out of Spotify and got kicked out of Amazon Music. I’m sure you’ll agree that the Amazon music were much kinder in kicking us out than Spotify. Spotify were very venomous in kicking us out, which is an interesting story. But anyway, let’s cut to chase because we’ve got limited time. Let’s talk about a really, really important question. I’m sure we can write a whole book, like you said on this, which is how much income is enough for dentist? And the reason I’m asking you this, James, and we can exchange our sort of thoughts and values on this, is something I notice on your dentist invest very often an anonymous poster will say, ‘I earn 2k a day or I earn 120K, a hundred k.’ Whatever, insert number, 70K, whatever. And then eventually you get the idea or you suss out that they’re trying to ask, how am I doing? What is everyone else earning kind of thing. Should I go limited? That’s a very common question. Again, should I go limited? So this, you know, if you take a step back, how much money is enough for dentist, I’m going to leave it very open. And obviously you’ll get a niche into that. But how do you begin to answer that. [James] I love that question. And just like you said, Jaz, it pops up on the grip all the time. And here’s the thing, I think we have to caveat everything with what we’re about to say. That even the average dentist earns close to two and a half times the national average wage. You know what I mean? And the thing about it is what you’ll find is that most books which dictate or determine or discuss how people can invest or from the perspective of Joe Bloggs, you know, someone who’s on a wage, which is conventionally more aligned with the mean average wage in the UK. So for us dentists, we have to look at everything, if every single one of those books says that actually you can make something, you can make a meaningful retirement from that level of salary, then surely to goodness. There must be a way for somebody who’s on much higher than that. [Jaz]Should I just jump in with the NASDAL figures? [James]Yeah, yeah, absolutely. [Jaz]I asked such an open-ended question there, if I just jump in with the NASDAL figures. So if you guys aren’t familiar, it’s the National Association of Specialist Dental Accountants and Lawyers. These guys published a report every year and this report, the most recent one they published, they published in March, 2022. It was just two months ago. And it was for the year. It was the year of pandemic. So income from 2020 to 2021. Tough year, right? That the one of the toughest financial years we go ahead. And this is going to blow your guys’ mind if you are not already familiar with this. Right. Overall dental practices see an increase in average net profit per principal from 130K to 150K. All right. NHS practices, increase in net profit from per principal from 116 to 145k. Private practices see an increase in average profit from 133 to 143K in the most toughest of climates ever. Right. And lastly, us poor associates. Okay. Listen to this. Average ratio went down from 70K to 63K. [James]Yeah. Wow. Still a very good salary. However, even though that’s a down grade, there’s still a good salary compared to everybody else. But this is the thing. This is why it’s such an important question because I feel like for dentists and for lots of people, it’s almost like you’ll sacrifice your health and your wellbeing to pursue even more money and even more wealth. And the question is, at what point do you stop doing that? At what point do you have enough? But that’s the question really. That’s the burning question. Here’s the thing, here’s a perspective from looking at investing. When you retire you can either have enough, you can have too much, or you can have too little. Alright? Really, really, really simple. Yeah. But the thing of what it is, in that simplicity, there’s a few things that we have to break down, okay. To actually get that sweet spot. Alright? Requires some significant planning. Or significant foresight, or at least having a sit down with an FA, an IFA, CFA, whatever, or giving it some thought yourself. Because the thing about it is it’s very easy to just go OTT and- [Jaz]Break it down FA like someone might not be familiar with that. [James]Oh yeah. Well, they’re all just terms for financial advisor. So somebody who can plan your wealth journey, someone who can plan when it’s a good idea for you to retire. [Jaz]Have you got one? [James]I don’t have an FA, no. But you see, the thing about it is for someone who’s young-ish, I’m just turned 30, getting close to 31, investing for someone who’s young-ish is actually way, way, way simpler than someone who is closer to retirement. So for me personally, some of the FAs that I know, the ones that are, they look at the longer term picture, let’s say that, yeah. They will actually say to people who are my age, they’ll say, ‘Listen, you don’t need me. This is what you have to do. Go do this, this, and this. And it’s so simple.’ What they’ll normally do is charge you a fee to set it up and then let you go from there. And then really where the skill comes in is when someone’s a little bit closer to retirement and they’re thinking, okay, when do I move my stocks portfolio into bonds? At what rate do I do it at? When do I keep some cash on the side? Which part do I siphon out and live on? There’s all these other questions that come into play, and that’s when the skill hits in Be with me. So some FAs will say, listen, don’t bother when you’re so young, your goal is capital appreciation. Okay? Not preservation in any way. And that’s why for me personally, it’s really simple, but that advice doesn’t go for everybody. And the Reddit knowledge, the Reddit logic, I suppose is to just go and buy the S&P p 500, but that kinda works for some people. Well, sorry, it does work for some people, but maybe not necessarily for everybody because it becomes a more complex conversation the further down the line you go. Jaz, do you want to say something? [Jaz]Yeah. So firstly, so S&P 500 for those who aren’t familiar with financial terms is, the US Index is so basically standard and important index of the 500 top companies in the US right? Is that fair to say? [James]Something like that. [Jaz]And therefore a lot of people believe that the greatest economy in the world is USA and therefore if you put all your money in that index, as it grows, you obviously gain wealth. So that’s a very well-known and common strategy. But I’m just going to just go back to the point you made at the beginning whereby you either have too little enough or too much. [James]Yeah. [Jaz]But it takes a very special type of person to say, you know what, I bought too much because you got to draw the line in the sand somewhere saying this is enough. So I think the first challenge to answer this question about how much money is enough to earn per year, is first having that sit down with your family, with your spouse, with your partner, whoever, and deciding what is our end goal? What is enough? Because interesting, I just remembered now there’s a guy called Ramit Sethi. Have you heard of Ramit Sethi? [James]I’ve heard the name. I’m not sure who he is. [Jaz]He’s an American chap and he wrote the book, I Will Teach You to Be Rich. And essentially, he works with people of all different incomes. And as you said, before, even that 63K is still two and a bit times more than the average in the UK. Right. And will come by the way that 63K is a mean. Not a median. So, it is a false representation. It is also including like part-time workers, people on maternity DF1s. People who for some reason have taken sabbatical, et cetera, et cetera. Therefore, a better figure would be a median. And I’ve emailed NASDAL two or three times over the last five years to find that out. They don’t have that, those figures. So a median would be a better figure, and I suspect that would be higher than the 63K, a median, right? So median is that and that middle person, how much they are they earning, but it doesn’t matter what the other person’s earning, we need to decide in ourselves how much is enough. So, this is now very much your domain. How does one decide how much money is enough for them? I’m jumping points now, Ramit Sethi, he wrote that book, I Will Teach You To Be Rich, and he works for people with all different income backgrounds. And what I love about this guy is that he teaches everyone that you need to decide what is it like, imagine you had not unlimited funds, but you had good number of funds. What would your life look like? Would you have a Starbucks every day? Some people was like, if I can have a Starbucks every day, eat out twice a week, have ’em at the best gym membership in town. I’d be happy. And that is then your rich life. So what Ramit really good at saying, you write down what is your rich life. And every single person can attain their own rich life. [James]Well, here’s the thing. Here’s the thing about money. Here’s another way to flashlight or illustrate what you’ve just said. There’s only three things you can do with money, okay? You can either have fun, you can give it away, okay? Or you can invest it. Here’s the thing, but do you notice what’s not in there? Not in those three things, hoarding it. Which is what we’re all guilty of to a degree, because it looks pretty, it’s a nice vanity metric to have a huge amount of cash in a bank account, but actually past a certain point, past a certain buffer zone that you need to sustain yourself. In the worst-case scenario, it doesn’t really make much sense to have too much of that, and actually the money needs a better home. Okay? Because at that stage, you’re losing your wealth because of something called inflation, which many will have heard of. Maybe they don’t know what the term means. Inflation is where your cash loses its value, uses its ability to be exchanged for stuff. For stuff, for lack of a better term. The things that you can buy from the shop every day, and effectively what’s happening is, oh, hello. We’ve got some questions in. Do you both visit yourself retiring, then? [Jaz]Hi Narni, just say hello to Narni first. [James]Hello, Narni. Nice to meet you, Narni. But yeah, back to what we were saying. You know, past a certain point, those hours which you exchanged for that cash, effectively, the record of those hours is being eroded. Does that make sense? Right. So imagine if I said it to you, Jaz, you came and worked for me for seven days, or seven hours in a day, right? And I paid you a hundred pounds, okay? And I give you 700 credits at the end of the day. And I said, done and dusted, we share hands on it. Good days work. Imagine if I came to you two weeks later and I said, actually, Jaz, I’ve just double checked my records. You only work six and a half hours that day. I’ll be having 50 pounds back. Okay. How insulted would you feel? You’d be like, no. No way in heck. I worked those seven hours. That’s the concept of inflation right there. It’s just another way of thinking about it. [Jaz] That’s the best way of heard inflation. I like that. [James]It’s cool, isn’t it? It’s someone reaching into your pocket and taking back that money. Now, obviously the analogy breaks down slightly because the bank balance doesn’t go down, but it’s just the value. How much that 700 pounds is worth, how much you can obtain in exchange for that. Because if you think about it, that’s the record off your work. See what I mean? So, but the record is faulty. That’s the problem. [Jaz]Yeah, absolutely. I mean, that’s a great way to describe it, inflation. So we’re all subject to that. So, before we get to the point of, okay, how do we hedge against that investing or whatever against the effects of inflation, which is always in the media nowadays, what is our best strategy? Is it also involving a high savings rate? Cause we must discuss, I think we discussed in our previous episodes or savings rate now, how much of our money are we actually saving? All that money that we earn, how much are we saving? How much are we investing? Okay. And how much of that, how much of our energy should we put into that? Or should we instead put energy into trying to look at strategies to increase our income? What’s going to get us to our retirement amount of money, which again, we should all have aligned the sand somewhere. So let’s answer Narni’s question. Okay. So, James, when do you envisage yourself retiring? [James]Do you know what? Right. Thanks for that question, Narni. Okay. Here’s the thing about retirement. Retirement is the day that you stop exchanging present unhappiness for a future promise of being unhappy. Okay? Not to get too deep and philosophical, but does that make sense? So here’s the thing, what about if you love what you do every day, aren’t you in a way retired? You know what I mean? Because you do it for free anyway, not to get, you were probably just expecting an answer. Maybe like, I don’t know, 50, 60, 70, you know, some sort of something really tangible there. [Jaz]Do you have a number? Do you have an a that you thought, you know, cause I know you love what you do, but do you have an a number? [James]Do you know what? I think we get to, again, not to be slippery, but you know, I think that when we look at retirement, there’s actually two terms that constitutes. One is financial freedom, one is financial independence. So financial in- [Jaz]Define both. [James]Absolutely. Financial independence is the point where your assets sustain your expenditures. Okay. But you have nothing left over because then at that point, if you think about it, you could continuously live and not work anymore. Financial freedom is when you have a little bit more on top. You know what I mean? But within those two, within those two ranges, there’s a little bit of scope. You know what I mean? So for me personally, when do I want to retire? I don’t think it’s unreasonable that anybody might say they want to retire. You know, sub 40, and for me personally, by the time I’d be very pleased if that was me, and I think a lot of people would say the same. But my goal is to get there to that point of financial independence as soon as possible. Not necessarily freedom. Because if you think about it, where’s the sky’s the limit on freedom. How much freedom do you want? How much fun can you have? Just to go back to what we were saying earlier, the three things that you can do with your money, that’s a little bit of a different conversation. When I reach financial independence, I’ll let you know Narni.. Okay. Because my perspective might have changed by that point, but it’s an interesting way of looking at it, the concept of financial independence and financial freedom. For most people, when they say retirement, they mean financial independence plus a little bit of freedom on top, but how much scope is there that’s different based on the individual Financial independence is the first aim for me. [Jaz]If you want to ask mine, I’m happy to reveal this to you guys. Me and my wife talk, and I’d said to my wife, said to Sim so many times. I like the number 55. I like it. Okay. And as much as it’d be nice to retire at 38, whatever. Going back to what you said, I love what I do. I love my clinical dentistry, and I just feel as though I don’t want to spend, you know, up till age 70 doing it is backbreaking. It’s tough stuff. But if I can be financially independent by 55 and so that I don’t need that income anymore to sustain the lifestyle I have, I’d be happy. I’d love to go traveling the world. You know, I’ve had a taste of that. I lived in work in Singapore. One of our goals in life is to travel further and, you know, live in Dubai for six months, live in Peru for six months. I’d love to do that kind of stuff. But you need to be independent enough to be able to fulfill your dreams. So I think it’s really important to have some dreams, but even more fundamentally important, I’ll repeat it again, is we need to sit down with our significant others as a family and decide what is your rich life look like? How much money is enough money so that you’re not chasing numbers. If you just constantly like, I want more, I want more, I want more. You’ll never be satisfied. So with that, with our incomes and with our average incomes and whatnot, how much money is enough money? And the fact that associates are, if you look at the NASDAL figures, we’re earning way less than principals. But principals arguably take on more stress. Like, stress is inevitable. We wouldn’t do the jobs that we do if it earned half of what we get, we just wouldn’t do it. It’s just too stressful. Right. A lot of people, even at this income level, it’s like, no, it’s not worth it. I’d rather, earn less and not do clinical dentistry, for example. So the question I’m getting is, how do we protect against the losing value of money at the same time? How do we form a strategy so that we’re able to look towards financial independence, and I don’t know if you want to bring in your janitor story that you were telling about as well. [James]Yeah. That story does work, but actually there’s probably something else that I could say that’s probably more relevant at this point. So the second thing you said was- [Jaz]Honestly, I was going for it and I lost track, so I just gave you like five different questions. Pick anyone you want. [James]Basically what you said, the second thing you said. Give us a ballpark way, the way that we can use to calculate, at which point we might viably be able to live off our assets, right? So you have to drive some sticks in the ground. And here’s the thing, whatever that number is, it can’t be too specific for each individual. And the reason is things change with time. Nobody knows how much inflation is going to be. Nobody knows how much stocks are going to go up in value, are going to go up in price, but there’s a really good rule of thumb that everybody can use and it’s the rule of 25. Have you heard this? [Jaz]Uh, no. [James]The rule of 25 says- [Jaz]Oh, yes, 4%. Okay. [James]4%. Yeah. [Jaz]Please. [James]So for anybody who doesn’t know, it’s commonly accepted that within the financial industry, that if your assets, whatever 4% of your assets is the value of your assets in terms of pounds is how much you can live off. How much you can safely withdraw from that balance, that balance of your stocks and shares asset, your bank account, your stock portfolio effectively. [Jaz]I’m just going to jump in. So let’s say you had a million pounds at an ISR. So you’re an ISR millionaire, you have a million pounds in isr, 4% is 40 grand. Therefore, what we’re looking at here is 4% of that is, is 40 grand. So, yeah, based on that. [James]Yeah, well, exactly. Well, actually it gets more technical again, because, originally, the original study refers to a portfolio 50% stocks and 50% bonds. But it’s still a good rule of thumb no matter what your portfolio constitutes effectively, because it only ever is that it’s only ever a rule of thumb. So because of that, what that means is if the safe withdrawal limit, the safe amount that you can take value out of your portfolio is 4%. [Jaz]Every year. [James]Every year. Important thing to mention. Then, by extrapolation, if we take however much we want to live on and multiply it by 25, then that is a good thing to aim for. But like I say, the key thing to understand is it’s only over a rule of thumb and it’s only ever something that we can aim for because the conversation becomes more in depth. Because it’s said that the first few years after you retire your portfolio’s performance in those first few years totally determines what that safe withdrawal with will be. So this is, again, this is, now, you can see where the complexity comes in a little bit, but that’s why it’s a good rule of thumb. But the thing about it is we can get as complex as we like, but we can never predict the future anyway. So that’s the best way to drive a stick in the grind. So here’s a way that you can calculate that. Okay. Now, you can get into spending and budgeting and things like that and try to reduce how much money goes out of your bank account every week, every month based on budgeting practice or just having an awareness of what you’re spending looking at your bank account and saying, do I need to spend this? Do I need to spend that? There’s an all direct debit that I forgot about whatever. Okay. Now, without going into that as a subject, because that has massive depth, which will actually give you a better figure of how much you’re likely to spend or how much you are spending because you spent some time thinking about it and thinking about how you can reduce it without doing any of that. Go to your bank, figure out what was the balance at the start of the year, figure out what was the balance at the end of the year. Okay. That will be the net increase. Subtract that from how much you brought home last year, how much you were paid. There’s a rough figure for your net expenditure. Multiply that by 25. There’s your stake in the grind. There’s the thing that you’re aiming for, are you with me? But remember, it only is ever something that you’re aiming for. But then it comes, begs the next question, how do you actually get there? And that’s probably something we could spend a whole podcast talking about in itself. But it’s a nice rule. I like that. The rule of 25 and the story that you’re referring to about Ronald Reed, I’ll delve into that in just a minute. But first of all, did that make sense? Did you like that? Was that- [Jaz]It totally makes sense, and it depends on which stage of life you’re in. So yes, calculate how much you spent in one year, multiply by 25. If you want a snapshot of what kind of money you need to have in a pot somewhere as assets or whatnot so that you can use this rule 25. And that’s a good way to go. But how important is saving the money that we earn now and that’s where the story of the janitor comes in. [James]Yeah, absolutely. So again, only ever a rule of thumb as there is with lots of things in fans, save just enough to be uncomfortable because then you know you’re working for it, you know. But the thing about it is people always say, how much do I need to save? And the question is, you can only save as much as you can, you know? But the point is, it’s about enjoying life to a certain extent as well. The one thing you don’t want to do, and the one thing that is actually most common with dentists, most people have an issue with getting the money in the first place. Dentists often have a problem with the opposite issue. They have too much money, but they’re spending too much and they’re working too hard for it. And life support, enjoying the journey a little bit as well. And at least if you have something that you can aim for, you might think to yourself, actually, I’m working too much because I’m earning too much. Because then what that would mean is, and actually I’m earning too much. My, the date that I’m aiming to retire for, even if it is very soon, it’s might be- It’s not possible to save anymore past a certain point because you can only put so much in your savings account. Are you with me? Yeah. But it’s horses for courses and you know, do you want to save that extra money and put it in a business? Really, it just becomes this huge conversation. But the thing that I said earlier is a nice rule of thumb and just be careful because the most common problem is probably dentist because of the sheer fact that we’re there in the first place. That we are dentists, we work hard. It’s in our DNA. It’s what we do, and we’re probably overdoing it. That’s the mindset flip. That’s the perspective that- [Jaz]What do you think is driving that? Why are we doing that? Is there a degree of looking on social media and seeing some dentists with their watches and cars and thinking that, you know what, I want that, is it a lifestyle thing? What’s driving this behavior? [James]I think it’s, first of all, by qualification. We’re there because we do work hard. So I think it’s going to be our DNA, I think it’s going to be the fact that we’ve got we’ve been doing it for a while. We’re probably creatures of habit to get through university, to get through education. We had to do that. You know, it’s always, it’s part of our identity effectively. I do think a second component to that is competitiveness. 100% of anybody who, what’s that restaurant? It opened in London and it’s got a thousand Pine Tomahawk stick. [Jaz]Must. [James]Yeah. There we go. Yes. I could never pronounce it properly, but anyway, so when that opened, some of my friends caught me up and they were like, oh, have you heard about this place? It’s got a tomahawk stick for a thousand pounds. And I was like, oh. Nate, I suppose. Then they were like, when are we going? And I’m like, no. I’m not going there. I don’t want to go there. I think that’s way too much. So, for me, it’s an like, where does that come from? Where did that sentiment come from? Part of it is for the gram, you know, let’s be real. You know, people wanted to take a snapshot with a thousand-pound tomahawks stick. It’s not going to be me. That’s never going to be me. You know what I mean? But with that level of spend, thriftness, you’ll always find a way to blow your cash. If you want to keep up with the Smiths next door, you’ll get a nice car, you’ll get a nice Beamer. Like the Smiths have. Guess what? You’ll eventually buy a nice house. You move to the next neighborhood with the Jones. The Jones are going to have a mansion. You might find that you beat crutch up with the Jones eventually. Yeah. You move to the next neighborhood, and it’s got the bezos. Can never forget, remember how to pronounce his name and the giz, right? And then guess what? You have to keep up with them and they’re billionaires. So it’s a non-ending game that you might never win. And what do you sacrifice in the process? That’s all I wanted to say. [Jaz]Very good. And on that note, very relevant is when we are getting a mortgage, are you a homeowner? [James]No. [Jaz]So when we are looking for mortgages, there’s a trend among dentists that I’ve seen that they against all people psychologically is they really max out, like my wife told me, I don’t know anything much about this. My wife told me that you can borrow four times, your combined income, whatever, right? So dentists will, the year that they’re going to get a mortgage, they’re going to declare the least amount of expenses to bump up their income. So now they can borrow the highest amount from the bank so that they can live in the biggest freaking house. Yeah, with five bedrooms and three en suites for their husband, wife, couple. Why are we doing this to ourselves? I am so glad that me and my wife bought a small little two bedroom, in the outskirts of Reading, which didn’t cost that much. And I look at my colleagues and it’s not a bad thing though. My colleagues have bought huge houses, if that’s part of your rich life, then great. But let’s be considerate about the kind of debt you’re getting. I mean, I know properties property mortgage is a good kind of debt, but we’re really, you know, we’re stretch. Stretching that. So we’re stretching that. We’ve got high mortgage payments and then private school, first kid comes along, you think, oh, you know what I’m a professional. I want to give my child the best private school you have the second kid, now you’ve gotta send that kid to private school. You can’t bloody send the first kid and not send the second kid to private school. And now suddenly you need to work. You can’t retire 55 and you to work until 68 to make sure that you got enough money to give your kids when they go to uni as well. So this is the kind of issue that I think dentists get trapped into. I know some high earning dentists, you know, implant dentists and they’re still working at 63, and I’m like, you know, why? And they’re like, oh man, yeah, private school, this, that and the other. They got high monthly expenditure. So you have to commit to these kind of things with caution. Is that the life you want? If it is, then fine. But if you wanted to drive 55, why don’t we plan our expenditure in the same way when it comes to property and the school that you send your child to. [James]But yeah, you’ve just touched upon something huge there. You can spend as much as you like. There’s no upper limit. You know there’s always going to be, you can buy a Lambo, then you can buy a solid gold Lambo, but then you can buy 10 solid gold Lambos. There’s always going to be a way to spend. So at which point do we say, actually, this is my cutoff point. And for some people that threshold is lower, and for some it’s higher. But there has to be an upper limit. So that brings me onto to what we were going to talk about two seconds ago, which was the story that Jaz referred to earlier of a gentleman called Ronald Reed. And this is super interesting. And within this story, there’s a lesson for how much is too much, how much is enough, how much is too little. Alright. Story of Ronald Reed. Really personal story. Read it a while ago. Ronald Reed. Ronald Reed was a janitor. He was born in 1925. Okay. Ronald Reed, great topic. It is a great topic. It’s interesting, isn’t it? Thank you for that comment. Reed was a janitor born in 1925, and he was born in the Midwest in America. Now, Ronald Reed grew up very modest background, and when I say modest, I mean modest, you know, barely living, handover, fist, parents barely putting food on the table. Okay? This guy did not come from wealth. Alright. Ronald Reed grew up. He was conscripted in World War ii. He went to fight in the US nearby. He survived the war. He had a fairly unremarkable war career. There was nothing really much to say. He was straight down the road playing, mediocre and self-professed as well. That was not a discredit to the guy. He just wanted an average life. He was totally happy to have that existence. Went back to his Midwest. Life went back to his family in the Midwest in America, and then around about that time, he got a job as a janitor in a school, and that’s where he worked for the rest of his life. Okay. When he was 30, he met a lovely lady. He settled on, she had two kids from a previous relationship. He never had any kids himself. Both of those kids were dependents. There were still about 10 at this point, but Ronald took them under his wing. Ronald looked after them. He made sure they had a nice childhood. You know, they never scrimped on anything. Okay. Now Ronald, amongst his friends, he was a bit of a but of a joke because he was known for his not his, how can I say? Not his complete and utter, thriftiness, but he’s- [Jaz]Frugality. [James]Frugality is a good word. He was known not, he wasn’t totally tight with his money. Like he would ensure that his friends had a good time. You know, he would always get runden in if he was at the pub, this, that and the other. [Jaz]His surname was Patel. [James]Is there’s a reference there that I’m not getting yet? [Jaz]A cultural reference. Don’t worry. I’ll come to it. [James]Okay. Okay. Slightly lost on me, but, okay. Anyway. Yeah, so Ronald Reed wasn’t the most thrifty person in the whole world when it came to his friends, but it was, when it came to his personal life, he Had clothes that he wore for about 20 years. There was holes in them, had the dungarees, the American style dungarees. There was a little linchpin in them to hold them together. He did not spend any money on himself. He drove this Toyota for about 30 years. Okay, now, from the outside looking in, Ronald did not look like he had any money whatsoever, and certainly he worked as a janitor in the school, and whilst he worked hard, his wage was never above average. It was slightly below average. Now, Ronald had a habit. Every single day after he worked in the school, nine to five, he went to the local library. And there he would spend an hour, alright, now we got to remember this is in 1940s, 1950s, you know, so activities aside from, there wasn’t that many things to grab our attention as there was an nowadays. So, he used to go and read. This is what he used to do because he used to enjoy that. And what he did was he got really into reading of investing and stocks. Alright. But he never really talked about it to his friends. Okay. This only became clear later for reasons that I’ll go into in just a moment. And what he did was he realized with time that actually that if he is very disciplined with his money and he tucks a little bit away every month, even though he is not earning that much. So, I believe he was tucking away about a hundred dollars every month and his wage was maybe a thousand dollars, so a 10th of what he earned, but not a great deal. But he was doing this consistently and he picked very particular stocks to buy in because this was before the day of funds. This was before the day of ETFs, which are things, assets that we can purchase, which diversify us automatically across the whole market. He picked particular ones, but he spread himself across about 10 or 20, and he realized, that this principle of diversification was so important through his own reading. Now, Ronald was a creature of habit. He worked in this school for about 40 years, but he always tucked away a little bit every month. It came up in passing conversation between him and his friends, but he never really talked about it. A huge great deal, and certainly as I say, from the outside looking in, he was good to his friends. He was good to his adopted kids. He was good to his wife, but the one person he wasn’t good to wasn’t south. Yeah. And he certainly had a modest house, modest car, all of those things. Ronald lived to a grand old age. Ronald lived to about 90, 90 or so when Ronald died. On his deathbed, he said that he bequeathed part of his wealth to his stepdaughters, to his surviving wife, some to the library and some to the school that he used to work in. And when he said this, no one looked at his will, but he just mentioned on his deathbed that he’d done this. And everybody thought, okay, well that’s very generous of Ronald. But I suppose at the same time they thought, We can’t expect too much given what we know about Ronald. Okay? Ronald passed away. Very sad day. A lot of people knew him in the time. Very popular. Ronald was buried. They looked at, they got his will, they looked at his will, his family looked at his will. They had no idea what to expect. They saw that his net wealth was 8 million dollars. [Jaz]Wow. [James]8 million dollars. Okay. This was from someone who never earned more than I suppose today’s equivalent of maybe $20,000 his whole life. Yeah. But what he’d done is he’d saved consistently; he’d bought certain stocks that were very generous in their remuneration. They pay high dividends and he’d reinvested every single thing. Okay. Yeah. So, you know when we have people who are high earners and they’re saying, how can we put enough? How much is enough to put away? What that tells us is that actually part of it is how much we are, but actually not as part, you know, big a part as we might think, and it’s more about discipline, understanding the principles of investing. And understanding how you can use that consistently to generate wealth over time. But there has to be that upper limit on how much we’re spending Now, if Ronald can do it, and Ronald’s salary is here, and we’ve got dentists who are doing extremely well. I’ve seen some dentists who turn, you know, their gross is 400K a year. 500K, things like that. I know one guy his is 750,000 a year. Now that’s the most extreme I’ve ever heard. Very good dentist. [Jaz]They’re the outliers. [James]They are the outliers. Well, yeah. Let’s put the outliers to one side. [Jaz]You know, let’s talk about, let’s talk about the NASDAL. Let’s talk about 63k dentists. [James]And that’s the best point, right? That’s even better than what I was about to say, because that’s the average wage. Yeah. And surely there’s some scope in there somewhere that if we have the right mindset, we have the right discipline, and we have the understanding that there’s enough to tuck away. Yeah. To give ourselves a healthy retirement. How we do that is another question. That’s, again, probably a subject for another podcast because you could flash that out in a lot of detail. But in that story, there is a massive lesson in itself that those are the eyes that we should be looking at looking at this width. How interesting is that? [Jaz]I love that story about Ronald Patel. Now , before we summarize it, main points of this episode, I just want to just ask that one big question because in the blue we see here are associates losing out. What do you think James? With what I’ve told you about how much more principals earn than associates, do you think associates should be looking towards practice ownership for the reason that the profits may be greater? [James]Okay. I love this question. So, to answer this question, here’s what we have to look at. We have to look at how much you’re really earning. Your actual hourly pay, have you heard of this concept? Yeah. Alright, I’ll flesh it out in more detail for those who haven’t heard of this. But basically, if you go to work and you work nine to five, you might look at your gross pay, your gross pay as an associate, and that’ll be after your practice deduction. So, say like you’re on 50% and let’s say that’s 60, 70,000 pounds a year, whatever it is. Yeah. Now, if you, it’s very. To look at the nine to five, and you know, let’s say you’ve got a lunch hour in between there, so you’ve got eight hours, it’s between nine to five minus your lunch hour, so that’s seven hours a day, right? So, let’s say you’re doing that five times a week. 35 times, 35 hours a in a week. [Jaz]I just want to add the community that, James, that the Protruserati, unfortunately yeah, we might be working nine to five, but we’re doing clin checks in the morning. [James]But dude, this is where I’m going. This is exactly where I’m going. Exactly. Okay. Because it’s very easy to look at that metric, you know, and divide however much you’re getting in a year by however many hours, 35 times 52, whatever that is off the top of my head, you know, somebody will be able to work that out off the top of the head. Maybe we can use a calculator on that one. And it’s very easy to look at that and think that’s my hourly rate. Okay, but what’s your actual hourly rate? How long does it take you to get to work every day? Watch your commute. Remember, you have to times your commute by two. Okay? Then you have to minus travel and expenses. Then you have to minus the lunch. Or maybe you might have a nicer lunch because you’re at work. Then you have to minus how many hours you spend thinking about work, okay? When you come home, because that’s actually time that you wouldn’t be spending other. So we’ve got- [Jaz]63,000 pounds, right? Divided by 1825, which is an amount of hours. [James]That’s 35 times 52. Yes. 1820 [Jaz] So the answer is that’s a 34 pound an hour. [James]Okay. Interesting to know. So, if we go off the numbers that I just said, you’re on, how much was it a year? [Jaz]63,000. Just take that NASDAL figure. [James]Brilliant. Yeah. And you’re working 35 times, 52 hours a year, and you are on just over 30 pounds. That’s what you said. [Jaz]Just about 35 pounds. [James]35 pounds. That’s your rear real hourly rate. But remember, that’s going to be much less than what meets the eye because of all the things that I’ve said. The. How much you’re spending to get to work. These are just some examples, how much you’re spending on your car, for example. [Jaz]The treatment planning. You’re sat treatment, planning, emailing patients. That’s most of my day. [James]Treatment planning, learning, communicating with patients, courses, those patients that need an extra phone call after work. What is your real hourly rate? Okay, now we are just talking about an associate at this point. What happens when you become a principal? Okay. What happens when you become a principal? Yeah, your weight just go up on paper by 20%, but how much are you- [Jaz]Way more, you know, they go up by a hundred percent based on the NASDAL figures. \ [James]Yeah. Okay. Fair enough. So they double, but are you working twice as much? Or even if it does go up, does it go up from 35 pounds an hour to 45 pounds an hour, is it actually worth it at that point? Or are you spending so many hours working that actually it’s like a flipping pair of hands or on your neck because remember, there’s only 168 hours in a week. If you think about it. You can’t get more hours. You can always get more money, but you can’t get more hours. Yeah. Now, the thing about it is, even though on paper that looks like an upgrade in terms of how much you’re earning, I’m just calling into question, how much more are you actually earning? Given your true hourly rate, and also how many things are you simultaneously cutting yourself off from holding yourself back from, like, for example, educating yourself on finance, educating yourself on investing, which by the way, can pay you six and seven figures over the course of a lifetime, okay? Because you’re sacrificing that short term extra, however much a week. Yeah. But like I say, you’re cutting yourself off from opportunities in the long term because of the fact that you’re not a principal. I’m not saying that’s the case for everybody, but what I am saying is it’s worth having a think about it, and it isn’t always the case. There’s more to it than meets the eye effectively. See what I mean? [Jaz]Absolutely. I think, are we losing out as associates? It doesn’t matter. Don’t think of it like that. If money is your primary driver for becoming a principal, you’ll be miserable, right. Be a principal. Because you want autonomy and you want control and you want to be the captain of your ship and you want to just not have to answer to anyone. Right. And then, yeah, there might be some financial rewards. You might have to work harder for it. You know when your nurse message on the WhatsApp group at 7:00 AM that she can’t come in today, that’s your headache. Yeah. That’s on you. But don’t be looking at this NASDAL report thinking, oh, I’m going to be a pro that makes so much more money, right? There’s other issues. So look beyond the money. So let’s now take in turns. One summary point each, now that everyone’s reach to end this episode, thanks to the 20 guys or so live at this moment in time. Let’s go for four or five summary points. We’ll do one each. Okay. So one for me, summary point is, find out what is your rich life read Ramit Sethi’s book. Okay. So, I Can Teach You To Be Rich is his book and essentially it’s about finding what your rich life is. So, for me, as long as I can, gosh, I’m trying to think. For me, my rich life is having good Wi-Fi, right? That’s one of the fundamentals. Being close to work. Being able to go to cost and have a coffee and not have to think, look, check my bank balance going out family to eat out and not having to open a man at. That’s for me is my rich life. And to fair, I’m very much already my little rich life because I don’t have desires of a Rolex. I don’t have desires for a fancy car. So, I feel like I’m scaled low. But my rich life now is also thinking about private school for Ishaan. So as long as I can do those things, that’s my rich life. So I know how much is enough for me. So that’s point number one. Point number two, James. [James]Yeah, I love the thing about how much is your rich life, because it’s totally a thing. You can have too much. [Jaz]Just a shout out to Abzu was a restorative registrar when I was a Sheffield doing my DCT, well, a lovely guy. His story, 11 years in general practice. He then went to do his re restorative registrar training. So if anyone’s thinking I’m too late, you know, look at abs. Awesome guy. Abs, thanks for joining in mate. We appreciate that. [James]Awesome. Thanks. So, yeah, biggest thing for me is it’s a trap that I nearly fell into the trap of thinking that more is always better especially when you look at it purely from the lens of finance and you think to yourself, how can I get more money? Because actually the very basic logic on that one would be, the more money I can get, the easier my life becomes in the long term, and it’s not always the case. Okay. There’s actually more factors to it, and the real hourly rate that we were just talking about a minute ago is so flipp and powerful and so flipping useful and more money doesn’t always equal more happiness, and that’s the older dash really. But we’ve given you some real tangible reasons as to why on this and actually fleshed out that statement and its meaning. [Jaz]And if, once you do figure out your hourly rate, let’s say, you know, let’s go take that 35 pound an hour average figure, a very, very crude figure just to keep things simple. And then you were going to, actually, my hourly rate is really 25 pounds an hour because of all the time I’m spending. But then if a cleaner is going to cost you 15 pound an hour. You get the cleaner in, you don’t clean it yourself, basically. That’s a huge, huge lesson there. Basically, you just work an hour extra, for example. I’m just giving you an idea, basically. So, uh, that’s that, but that’s a side thing from you. So the other summary of this episode and James, thanks so much for just being so fluid and good in me here today. The other lesson I want to just finish off couple more points to summary is think about your savings rate. Okay. And that’s what it’s called. How much money are you actually saving, if you look at your annual income, what percentage of that is being saved and the higher the percentage, the better. So if you go by Reddit standards and the people who are into final for personal finance on there, if you are saving like above 40%, if you’re at the 50% savings rate, you are doing amazing. All right? And this is based on people who are earning like 20K-30K a year and they’re able to achieve a frugal life and save 50%. I know dentists who earn six figures and they struggle to save 10%. So we need to really evaluate a life and really consider powering through and working deliberately on getting a higher savings rate, investing more, saving more. Be like Ronald Patel. [James]Absolutely. Well, here’s a start just to put that one into something tangible and actionable. If you have, whoops, we’ve just lost a little boom for the microphone. Let me grab that. Hello. We’re back again. There we’re, if you save of 20,000 pounds and you put that in an ISR so an ISR individual savings of kind. Something that’s accessible to every single individual whose UK based stocks and shares, specifically, which you can use as a tax-free wrapper to invest in the stock market or bonds or other assets effectively. So if we take 20,000 pounds and we maxi our savings of account every year, maxi the limit, which each one of us have. Every single tax year and we attain a 10% accrual rate, a 10% rate at which that appreciates every year, which is what is typical-ish for the stock market on the high side of typical. There’s more factors to it than that. But let’s just leave that for the superficial level for the moment, 10% is something that’s achievable and if you do that, put that 20,000 pounds in that ISR coin, and you do that for 20 years and every single rate, every single year that is appreciating by 10% and it’s compounding. Yeah. Then by the end of those 20 years, you should, in theory, have 1.3 million. Now, if we go back, to the rule of 4%, 25 times your expenditure. Then actually what that gives us is just over 40,000. 45,000 ish. Yeah. 45 thousandish, which is a handsome salary and it’s something that you can live on reasonably. Most people- [Jaz]52K [James]52K even better. There we go. [Jaz]Tax free is a nicer, it’s a nicer. [James]Tax free if it’s in a nicer as well, and that’s what we have to remember because you pay tax on the way in, but not on the way out which is interesting. So yeah, that’s a really important thing to remember. That’s also tax free. So what that tells us is the theory is that over after 20 years of being able to tuck away that someone in iso, which is within reach of a lot of dentists, but not always the general population, then that gives us a nice stake in the grind and a nice perspective through which we can view things. And it just shows us how really in theory that with that knowledge and with that logic, it’s achievable for anybody within 20 years. How cool is that. [Jaz]That is amazing. Real lesson there guys. I’m going to wrap up one last message. I said it in a few episodes ago, but it’s really, really since I had that episode or that sit down with, George Andre Cardozo in that restaurant in Porto, and he said this wonderful thing is that life is not about the destination. It’s not even about the journey. Do you know what life is about James. [James]Love? [Jaz]It’s about that love, but it’s about, it’s not about the journey. I love that. It’s not about the journey. It’s not about the destination, it’s about the company, right? So your rich life is being determined by your little network, your family, your friends, your nearest and dearest. That is worse worth more than any amount of money. So stop looking at how much other associates earning. Stop looking at how much your principal’s earning, right? Find out how much is enough for you. Have that conversation. If you haven’t had that conversation, your family have it. All right? Give you a significant other and extra squeeze tonight. Give your children an extra kiss on the forehead tonight, okay? Because that’s what it’s all about. Screw money. Right. It’s all about the big important things. It’s about time. Time is such a great one that you mentioned on. So thanks for joining on this episode. Check out dentists who invests will be obviously on both the groups. James is doing some wonderful things and teaching dentists about personal finance. And if you’re looking at me and how I’m dressed, I’m dressed like the NASDAL figures dentist. If you want to go into to crypto then you can dress like James. [James]You know what, this is the one suit that I have. Crypto is not doing so well these days. Yeah. So, I spared out my crypto winnings on this one suit. But yeah, thanks for having me. Jaz, absolute pleasure to talk to all of your members and for anybody who’s watching this on ‘The Dentist Who Invest’ if you don’t know about Jaz Gulati, check out Protrusive Dental Podcast. Guys, it’s been a thrill to talk money, finance, and also how much money us dentists needs. Such a pertinent question today with my good friend Jaz. Hope everybody is having an absolutely smashing Wednesday and we will catch up super soon. Jaz’s Outro:There we have it guys. Thank you for listening. All the way to the end as always. It’s very, very good of you. You are so loyal listening to the end always. I really appreciate it. Just one favor, if you don’t mind when I go on my Apple Podcast page, and I used to have over a hundred ratings and now I’ve only got seven. I don’t know what’s reset or why that’s happened, but if you are listening on Apple, and if you gained from this episode or my podcast, I would love for you to help me get discovered by other dentists by giving it a five-star review. If you believe that’s how much this podcast is worth to you, please do consider leaving a review. It really means a lot. If you listen on Spotify, then please do as well. But Apple, I don’t know what’s happening with Apple. So please help me out. And I catch you in the next one. Oh my God, the next one’s going to be amazing. It’s about update on ceramics. So what’s changed in ceramics in 2022 with an absolute rockstar in the industry? I’m not going to spoil who it is. E is an absolute rockstar, so I cannot wait to bring him on the show. Oh, and one more thing guys, for obvious reasons, this episode will not be going publicly on YouTube. It’ll be an unlisted link. So you have to go to protrusive.co.uk to go on the relevant episode and then click onto the YouTube video from the website. You can’t actually go on find it on YouTube like you usually would do because we’re talking very sensitive topic, obviously, right? Money, right? So we don’t want this to be out in the public to a non-dentist. Which is why I think the Protrusive app, when I fully launch it publicly to all dentists, will be useful because it’ll help to filter out a non-dentist and then I can get the right people listening and watching the episodes because the other day I had someone actually from Bangladesh, a regular Joe Blogg’s public member, a patient if you like, email me photos of his wisdom teeth with a bit of bone in between ie a minor tuberosity fracture, saying that I’ve been searching the internet for hours and I came across your episode about broken tuberosity and I’m want you to take a look at these wisdom teeth. By photo when you think, is this okay? Because I don’t trusts my dentist bloody ba I’m like, what on earth is going on? Right? So I don’t want the wrong eyes seeing our stuff. So our stuff is our stuff. Therefore, do consider that maybe in the future this kind of content will be exclusively available on the app. So I catch you next week.

Today, we will share with you some of the lessons that Dr. Avi Patel and I learned at the very beginning of delivering clear aligner treatment. If you’re just starting out, this is an excellent episode for you because it’ll help you avoid some of the pitfalls that we encountered. For example, best protocol for attachments or accurately estimating what level/complexity of aligner treatment is needed by a patient. https://youtu.be/4831y3g4MOI Check out this full episode on YouTube Need to Read it? Check out the Full Episode Transcript below! Protrusive Dental Pearl: Correct a rotated tooth by means of HYPERCORRECTION. This means adding a few extra clicks of rotation so that on the clincheck it looks like you have done a little bit too much. This works because orthodontic movements are NOT 100% predictable. This episode is brought to you by Enlighten Smiles which is a premium brand of teeth whitening that guarantees B1 in your Viveras. If you want to know more about teeth whitening and get better results for your patients, do check out their webinar, Enlighten Online Training. The Highlights of this episode:  11:39 Invisalign does not teach you Orthodontics 16:49 Basic rule in Orthodontics 21:49 Patient Communication regarding fees 26:59 Comprehensive Orthodontic Treatment 34:06 Refinement and Additional Aligners 38:02 Patient Communication in terms of treatment duration 41:23 Planning IPR – Best practices 43:53 Best Composite for Invisalign Attachments? 45:33 Protocol for Bonding Invisalign Attachments If you’re finding a mentor to implement clear aligners at your practice, be sure to check out Clear Aligner Advisor also Dr. Avi’s YouTube Channel for some career advice. If you liked this episode, you should check out Do’s and Don’ts of Aligners with Dr. Farooq Ahmed  Click below for full episode transcript: Opening Snippet: When you will have an adult and you're trying to move their teeth with plastic, that does not mean that you cannot improve their situation, right? You can. So if you are coming from a place of function, health and improving, the clear aligners will check all those boxes. It's as dentists we get hung up, I think on perfection. And I'm not saying to not strive for perfection, always strive for it, but we also have to be realistic. These are humans. Jaz’s Introduction:Hello, Protruserati. I’m Jaz Gulati and welcome back to your favorite dental podcast. This one is really for the new dentists, new grads, or maybe you’ve been qualified for some while but you’re new to the world of clear aligners, and I know the title of this episode, and we discuss Invisalign a lot, it’s actually applicable to any clear aligner system, clear correct or any, you name it. It’s not specific to the Invisalign brand. But the lessons that me and Avi are going to share with you today can be applied to all of those different aligner systems. Essentially, it’s about the challenges that we had at the very beginning. For example, I didn’t know what to quote the patient in terms of which comprehensive or light or express like which level of aligner therapy the patient needed ie how many aligners the patient needed, how long the treatment would be little tips for IPR, all these things I just didn’t know, I didn’t appreciate how to do your attachments. We’re gonna discuss all of that in this episode. So essentially, this episode is the episode I wish I had, when I was new to clear aligners or new to Invisalign. By the time you listen to this, the app, the Protrusive app is actually out. And it’s being used by around about 185 beta testers, these are people who signed up to a Splint Course, as a bonus, like early, you know, fast action bonus, if you sign up for Splint course, in this time, you get the protrusive premium. So these people qualified for first access to the app, and they can now get CPD or CPE certificates for all episodes. As in when they listen, they can now answer some questions and get certificates emailed to them by my team, as well as lots of other perks on the app. But when I release the output general sale, I will let you know. So those of you who have been asking me about Hey, when’s the app coming out? Well, it’s out it’s just being used by a very exclusive bunch as we get it fine tuned and perfected, ready for general sale coming to you soon. The podcast is free and will always free. Some concerns I have is that some of the things that I discuss with my guests, I don’t want patients to see it or hear it. This is like dentist talk, right? There are some things we just want to keep between us dentists, like we’re talking about fee setting, and complexity planning that kind of stuff. It’s probably best that it’s not on a public forum like YouTube. So that position or the role that the apps can have in the future is again, you can access it for free. If you want to get certificates, yeah, you got to pay for it. But if you want to actually watch the videos that won’t be made public, the app will be the best place to do that. So more information to follow soon. Before we join the main episode, let me give you the Protrusive Pearl for you today because we’re talking about clear aligners, let’s talk about planning your clear aligner movements, or for all intents purposes, the ClinCheck for those who use Invisalign. When you’re planning your movements, there’s something called hyper-correction. So for example, let’s say you have a rotated upper lateral incisor, very common. And let’s even back up a little bit and talk about how you describe a rotation, you know something I didn’t appreciate when I was starting out. How do you actually describe a rotated tooth? So imagine you have a rotated lateral incisor, the easiest way to describe it is distal out or distal in or mesial in or mesial out and it’s kind of self explanatory what that means just visualize it. Okay, if a lateral incisor is mesial out, you know that the medial side of it is going buccally, it’s like flaring outwards. Now saying a mesial out is the same as saying distal in. It’s a quick and easy way to describe a rotation. The other way to do it would be if a tooth is rotated mesio-buccally, you know that the mesial portion of that lateral incisor is rotated more towards the buccal, but it’s easier to say mesial out than mesio-buccal, so I like mesial in, medial out, distal in, distal out. And that’s how you describe rotations very easily. Now, why is that relevant? So, rotations are pesky movements, they are difficult moments when you’re rotating teeth. That’s when tracking can get lost and especially on lateral incisors, smaller teeth, this is where you’re gonna slip up a little bit. So one way you can kind of improve the predictability or get a better outcome is hypercorrect. What that means is that if a lateral incisor for example, as the example tooth can be any rotated tooth, or any movement for any tooth, let me explain. If a lateral incisor is mesial out, and you want to bring it mesial in and correct rotation. In your ClinCheck, if you finish with a tooth perfectly well aligned, then maybe by the end of treatment because the rotation movement is not 100% predictable, you will finish the aligners with it being not quite perfect, it’s still going to be a tiny bit mesial out. Now, if you hyper correct, it means that you go from a scenario where you start off medial out because that’s the malocclusion and then on the clincheck you’re going to correct it, but actually you’re not going to correct it until it’s perfect, you’re going to correct it until it’s actually gone the other way it’s going to go distal out or mesial in and You’ve overdone it, you’ve overcorrected the rotation or hyper corrected it. So don’t worry doesn’t mean that your patient is going to end up with a tooth that’s rotated the other way now that’s very unlikely. By doing that hyper correction and making the ClinCheck look worse off in the other direction means that you’re more likely to finish with perfect alignment. So this called hyper correction. So for example, if you know that your lateral incisor needs 10 degrees of rotation. Why don’t you just add in 13 degrees rotation so hyper correct that movement, make it look slightly worse at the end, and you’re more likely to correct that rotation. So this is called hyper correction. It’s also really good to use in deep bite cases. So a lot of your deep bite clinchecks, they may finish with anterior open bites at the end. And of course, the patient with a deep bite will never finish with an anterior open bite at the end. But if you show that on the ClinCheck it’s kind of like showing you the forces that you’re placing on the teeth. Now if you need more inspiration or knowledge regarding that area, do check out episode 71 with Dr. Farooq Ahmed, we geek out about this, we talked about all the do’s and don’ts of aligners and what movements are predictable and which movements are not predictable. So once you’ve listened to this episode, and you’re hungry for actual orthodontic knowledge when it comes to biomechanics of aligners, I would definitely check out episode 71 Because Farooq covers that so well. In this episode, we’re going to start from the basics like you know, you’re brand new Invisalign provider. And the reason I’m making this is I kind of wish I had this when I was starting out so I’m hoping this helps you. I’ll catch you in the outro. This episode is brought to you by enlightened smiles which is the premium brand of teeth whitening. There’s loads of reasons I use and like enlighten. One of them is that they guarantee B1 in your Viveras. So going on with the theme of this podcast episode, you know, invisalign, clear aligner therapy, if you’re using Viveras already, Enlighten offer the guarantee with their own whitening trays which are super sealed, but they offer it with Viveras because Viveras are tightly sealed. So if you’re already in lots of Viveras and you want to give the patient a guaranteed result, you should definitely consider using enlighten. Now if you want to learn more about the system, or just generally you want to geek out and learn about teeth whitening in general, the science teeth whitening and getting better results to your patients, do check out their webinar ran by Payman Langroudi is on protrusive.co.uk/enlighten Main Interview: [Jaz] Dr. Avi Patel, welcome to the protrusive dental podcast. How are you my friend? [Avi]I’m doing great. How are you? [Jaz]I’m very good. It was nice to connect with you on Instagram. We were talking about Invisalign primarily, but let’s call it clear aligner therapy. Okay, you can obviously we’re going to talk about Invisalign. But you know, when we say Invisalign, we’re talking about clear aligners. And what I liked about you was that you over the last few years, we were having a little chat before I hit the record button, you’ve done a high volume of cases, you’ve got gone into the nitty gritty of creating your patients, and seeing all the sort of issues that can come along the way and power through them. But also, you’re fresh enough that you can remember the challenges of that when you’re starting out. So you’ve got you get the best of both worlds. But for those who don’t know your story, just to tell us a little bit about you how you got involved with doing high volume of a line of work and the kind of dentistry that excites you. [Avi]Yeah. So I graduated Dental School in 2018, I went to NYU. And when I graduated, I was living in the city, but commuting out to Connecticut. So they have a rule in New York where if you want to practice there, you have to either do a one year residency, or you have to have two years of working experience in a different state. So I just wanted to kind of get out there start working. Honestly, I just was tired of school. And I felt like I could learn more in the real world. So I did I dove in. And it had its challenges. But it was, I think, a good learning experience because I was able to be in multiple practices. And it just looking back now It exposed me to many different ways of dentistry, I think, you know, when we’re in school, you tend to assume the practice owners kind of know everything and have everything together. But every practice owner has their own challenges, right. So for me to get that, you know, I call that my real world residency where it’s, you know, these are different offices operating differently. And each one I learned something from them right at the end of the day, you know, not every associate ship lasted that long just because of different challenges fit stuff like that. But yeah, I don’t I just tried to keep a positive a positive mindset for as long as I could. And then two years go by and I’m finally kind of levelled out in a couple practices I was working with to at the time, and then the pandemic hits. So pandemic hits, and, you know, everyone kind of pauses you’re reflecting, you’re going through all the, all the stages of what lockdown does to you as a human. And, you know, part of it for me, I dove into CEE, right. I was like, You know what, let me just use this time and just learn because I was starting to get a little, I guess, bored of this is the bread and butter, and I was looking for a little bit more dentistry to do because at that point, I felt like if I can do more, I can offer more. Maybe that’ll excite me and, and, yes, I took an implant course and then I dove into Invisalign. NYU certifies us. That’s why I didn’t pick a different, you know, brand to go with. So I was already [Jaz]saying so you qualify from NYU with your Is it okay. If you major in said DDS, right. Correct. DDS, and then with your DDs, you just get thrown? Hey, you can do Invisalign now. So right, [Avi]yeah, so so so in the curriculum, it was always a joke. It was like modules and like we had a class to go to, but it was the click through modules. There was no like, hey, let’s teach you when you got into clinic in dental school, you could actually do a case, but it was the most difficult thing. It was so complex, you had to schedule specific time with one faculty member. And you had to align their schedule with the patients. And they did the whole like paper, full facial analysis bite, like just overcomplicated it and it was just I mean, the only benefit is that I didn’t have to pay the $3,000 When I got out of school to get certified. [Jaz]That’s all I want to know. Do you save three? You said this is amazing. Well, [Avi]my, my tuition, my tuition was through the roof. So I’m sure I paid for it. Yeah, [Jaz]so I mean, on that note, I mean, it’s worth addressing this, which is, and you kind of touched on it a little bit now, whereby when you have Invisalign accreditation, or you go on the course to learn Invisalign, a lot of dentists when I was at my accreditation, I think it was like 2017. But a lot of dentists came there expecting to learn orthodontics at the same time as learning Invisalign as a system. And they went away hugely disappointed, because actually, Invisalign never has it said they’ll teach you orthodontics, then they don’t promise that they don’t never will. They are someone who’s gonna give you the tools. And they assume that you have prior orthodontic knowledge or you’re gonna get some mentorship. So I think that’s really important that the new dentists who who are considering dabbling are learning about aligners that they need to get some sort of education regarding orthodontics. So where did you learn your orthodontics from is one trying to ask and and what would you advise young dentists? [Avi]Yeah, so you know, I, I basically, basically took the module, I mean, I’ll be like brutally honest, I did the modules online, I did all like the videos. And then basically, I was just like, I all I want to know, I didn’t necessarily understand all of the orthodontics behind it. But I was determined to make it work. And I just basically I was like, I want to know what is predictable, right? What are cases that I can do? What are cases that I should not do? And then essentially right, giving me like the guardrails to kind of stick to. And then I reached out and I made sure I had support in terms of getting help with clean checks and stuff like that. So that’s it. Again, I know that doesn’t sit well with a lot of people, because you know that it can be scary. But again, I was the real [Jaz]world. What you said was is a real world GDP general dentist issue whereby we qualify, we have some basic screening and assessment, knowledge and orthodontics. And then suddenly, we’re on this $3,000 course, Invisalign. And now we can, we’re armed with this power to give aligners to patients. And then we need to recognize the A, okay, we perhaps need more education, mentorship, but be you also need to make sure that you put food on the plate. And so you need to actually pay the bills and actually do some orthodontics as well. So it’s a fine balance. But I think the main message is Yeah, find the mentorship, find the education, don’t expect yourself just from having gone to the Invisalign accreditation course to actually give you any superior knowledge on diagnosis, assessment and treatment planning when it comes to orthodontics [Avi]correct and that’s the thing in this space right now with clear aligners is you hit it on the nail or they are expecting you right to have that that knowledge before you use their systems. But I also just think as a general dentists if you know your I call it your lane, if you know your lane, and you know what you can tackle and what you can treat and it’s sitting in all of our practices, right? It’s the simple crowding, spacing, right, like the basic stuff, but you can still make a huge difference. If you focus on that you’re gonna get comprehensive care to your patients, right, you’re gonna be able to pay the bills because your production is going to go through the roof and it’s just a very, it’s a great service. I feel like in today’s day and age, a lot of patients here in America, at least I know the UK has their stigmas for people not caring about their oral health, but you know, people here like begging for Invisalign. Like you have doctors that are doing too With three cases a month, and I know that they’re only doing two to three cases a month, because they’re I just I always ask them, like, Are you actively talking about it? Or are your patients asking you for it? And they all say, Oh, my patients asked for it. I’m like, exactly. So that’s a whole nother subset that we can kind of get into later. But um, yeah, I think it’s, it’s huge. And it’s critically important for general dentists to know that you, you can’t just take one course you can’t just get certified. You have to dive into this. And that’s what I did. You know, [Jaz]and that’s in Austin, Texas. I mean, you didn’t get that bit where you went to Texas a&m and many corporate you said that, that that allowed you to fuel this passion and discover your your space in aligners and how you enjoy doing that. But one thing I want to know is that you did the implant course first. Are you still placing implants? are you placing implants now or not? So [Avi]yeah, I guess we go back to the story. I finished up Connecticut moved to Austin joined the mini corporate spot. And then they basically gave me free rein, they were like, Hey, do whatever you want, we’ll support you. Here’s an iTero. You know, we have a Nobel implant, you know, extra hands on course you can take so I just, I did it all. I started placing implants. Sticking to the basics, right? You’re 90, lower molars, upper pre molars, nothing really too complex. And it was a lot more of a steady growth. I still do place implants, but honestly, not as many. I think I feel like my my growth skyrocketed with Invisalign faster than with implants. So I haven’t abandoned it. But that’s just kind of where my practice is at right now. [Jaz]Is your patient demographic, younger, older or give us a painted picture of that? [Avi]Service demographic is like state employees. 50s 60s, I’d say my average patient is like in their 50s or 60s. So it’s not even like, in my opinion, the sweet spot, which is like your 30 year olds, right. So this is like a tough spine like the office I’m at, but it’s like, it’s old. It’s like I think the office is older than me, honestly. But if you go about in a certain way, and I think if you embody the mindset of, hey, this isn’t just an added service. This is part of what I do, right? Being definitive. When you see a cavity that goes to the nerve that needs a root canal and a crown, there’s no question when you see crowded teeth spacing, any issues like that, you know, malocclusion, hey, you have misaligned teeth, you need clear aligners. This is what we’re doing. That is how you ramp up everything. But again, that comes you have to have confidence. You can’t you just start saying that now you gotta treat it right. And it’s like, okay, what what can I treat? What can I not treat? [Jaz]Well, we can definitely cover a little bit about that today. And one thing I will ask you later is, can you remember a time in your eagerness or early stages of doing ms line where you treated a case? And you didn’t anticipate how difficult it might be? Or how or why perhaps you shouldn’t have treated that specific type of malocclusion. On Me personally, I can tell you straight away, I treated treated a posterior crossbite once where I just shouldn’t have touched it. There was no reason for me to touch it was not aligned with the patient goals. Can you think of a time where you tweeted someone and then you perhaps broke a basic rule? [Avi]Yeah. I would say I took on a deep bite case that I probably shouldn’t have taken. I didn’t understand. I didn’t realize you know, the I mean, intrusion is the most difficult movement to do with clear aligners period, especially in adults, right. So, yeah, I just didn’t know. But I set the patient’s expectations accordingly, right, the thing that we all have to this my philosophy you have to get used to, when you have an adult and you’re trying to move their teeth with plastic, that does not mean that you cannot improve their situation, right? You can. So if you are coming from a place of function, health, and improving the clear aligners will check all those boxes, it’s as dentists we get hung up, I think on perfection. And I’m not saying to not strive for perfection, always strive for it, but we also have to be realistic. These are humans, these are you know, these are teeth that you know, you can control a certain amount like you don’t know if a tooth is enclosed and stuff like that before, there’s so many variables. So you can’t let these challenges stop you from actually, you know, offering the services. What I’m getting at with this is I realized with my patients, I’m not selling them on a perfect, perfect a perfect smile. I’m not selling them on cosmetics, I am educating them about the oral health implications, and how we can improve that like my patients come out of clear aligners able to floss and they’re like, Doc, I can floss like this is actually not that bad. Like before I used to shred my floss, I stopped doing it, and now they’re like I do it. And you can tell so it’s, that’s it’s a mental shift, which is, you know, a message that I’m trying to kind of get out there. Because I think everybody wins, right? It’s, you can improve someone’s life by 90%. Yes, it’s not 100% But don’t beat yourself up for that 2% that you missed out on because of all the other growth that you had. [Jaz]Well said and on the topic of a deep bite case. I had seen a few My colleagues struggle with that because they they go in and what they do, they show the patient, the ClinCheck, and the ClinCheck. It finishes up as like, you know, beautiful two millimeters over Overbite overjet. And then what they don’t realize that the ClinCheck, and we’ll come on to this later is a representation of the forces that have been applied to the tooth, not an actual, this is how it’s gonna end up in the ClinCheck is essentially called cartoon don’t take, as I heard someone say once, so that’s gonna, that’s gonna be a big issue. So I know one of my colleagues Farooq, what he taught me was that if you’re going to hyper correct the the deep by IE, make it look like an finish with an anterior open by in your ClinCheck in a way to help the predictability of getting some further degree of and deep bite correction. But you show the patient not the final outcome, you show the patient like you know, halfway through and say, Look, this is roughly what we’re gonna end up with a deep bite. And if we do that, rather than sending the patient the animation and the way they’re gonna, you know, beautifully correct the deep bite, then you’re asking for trouble? [Avi]Oh, yeah, absolutely. That’s a huge thing. I didn’t even know that when I first started. So but that’s that’s great advice to hyper correct, honestly, kind of my protocol is, if it’s a deep bite greater than four millimeters, I don’t even touch it that goes to the Orthodox like, I’m an advocate to referring to orthodontics I’d like, you know, we’re saying earlier, I kind of know how to stay in my lane, and I figured out what is treatable, what’s not. And then there’s that gray area where if the patient is super wanting to do it’s like, okay, I guess we’ll we’ll give it a shot. But you set the expectations accordingly, right? Hey, this is something we can improve, it’s going to be challenging, if you’re willing to you know, comply wear the aligners, this may take longer than the six to eight months that my case is usually take. But if you want to do it, we can do it. And if you’re upfront with the patient, right, it takes that pressure off for you. And they also are able to comprehend that they’ll know so they’re not going to be upset if it takes a year. But yeah, [Jaz]well two great points that one is Yeah, patient communication, don’t undersell over deliver kind of thing, which is very important, but also staying in your lane again. And knowing that okay, this is beyond my comfort zone. And there’s plenty more cases out there for you, as a beginner dentist Invisalign, for those listening maybe, and you don’t have to treat everything that comes your way and definitely use that referral. And I think I always say the best thing about being a GDP, and the specialist may want to just shut their ears here with their listen to this is the best thing about being in GDP is cherry picking, right? We can just cherry pick the cases, let’s GPS, we have the most difficult job in the world as well in the world of dentistry, and maybe even the world. Okay, let’s go with that. We have the most difficult job in the world. And therefore let’s let’s enjoy the benefit of cherry picking. But the main thing is for four main things I want to go on, I want you to four lessons I want to pass on in terms of when we’re starting out with Invisalign or clear aligners, I remember my journey, it comes to a point where your patient is interested, you’ve done your diagnosis and whatnot, you’ve had that conversation patients excited. And now the patient wants to know how much it’s gonna cost. And so, in your mind as a new Invisalign provider, you’re like, Okay, I’m not quite sure if there’s going to be a light within 14 liners or comprehensive, like unlimited liners, and you’re not quite sure, but to the patient on the other end of that to difference that you quote in terms of comprehensive and like, not for all, but for some, it may be the make or break in terms of whether they can afford it or go ahead with it. So before they invest in the ClinCheck, they need to be given a ballpark figure. So the question essentially, I’m asking is, as young dentists who haven’t treated enough cases to know exactly which level of aligners you know, light or comprehensive the patient’s going to need, how do you communicate that to the patient? What do you always quote, the highest fee? And then if it’s a lower, it’s a bonus, what do you advise? [Avi]So we’ll get into little sales tips here. But basically, I like to keep it simple, right? The whole thing about being a provider’s you have to be confident from the start, right, your patient will see when you are not confident this was ah, this is actually one of the hurdles that before I even moved to Austin and I was still practice practicing my first two years out of school. This is one of the reasons why I didn’t even start, I didn’t start cases because I was like, I don’t know, is this a go? Is this a light is this comprehensive? So it’s very common. So but then once I got the advice of hey, every case is comprehensive, right? That my part people’s ears up. And I’m going to explain why but that’s that’s kind of the that’s the way I do it. Right. So to answer the question, every case is comprehensive, but how do you get there Well, when you when you start, again come from a place of providing value, right? How are clear aligners going to impact the patient’s oral health, right? You start listing the issues you show them if you have an iTero show them the crowded teeth, show them the information, show them the where all that stuff dentists like to think that we can like I mean, which we are we are great at speaking to patients and talking about stuff but what we don’t what sometimes you forget is a patient has no idea what some of the stuff we’re saying, oh, crowding, where that’s like, that’s why I love the itera. You put that sucker up there, you show them and you got the colors, you got everything. And then it’s very obvious, right? Any person understands at that point what you’re saying. So if you have an iTero, start doing those scans, because that is going to build your value, right? You don’t have to say as much as showing. And so I come from that place. So already, it is now okay, I’m listening, because the dentist is talking to me about my oral health. Right? They are not talking to me about cosmetics, they’re not talking to me about the way I look. And it’s this might, you know, dentist may not agree, but my opinion is most people don’t really care how their teeth look, okay? It’s not something that they’re willing to spend, not everyone is willing to spend $5,000, you know, to improve the looks, [Jaz]but you start to think in our demographic, Avi because you said your patients are you know, 5060s. Same here. In fact, the last two clinics I did last week, patient 72 and patient 68, my actual clincheck and my last two, okay, so I have a way older demographic, and I agree with you, most of them when we have that conversation, it’s usually because the teeth are quite worn at the front end. So it’s and it’s envelope, a function issue that they’re now coming around to freezing or lower incisor crowding and calculus and easy to clean, and we’re coming from that angle there. Look, I’m gonna make things look nice when I’m there. But I know that your prime motivation is to sort this out or sort that out, and how that relates to function and health. And so I agree with an older demographic, maybe with the younger one with the marketing and stuff and the world of tick tock and stuff. Maybe there is obviously a cosmetic and people coming in for vintage cosmetic and composite veneers. And Invisalign is a huge market in the UK for that kind of stuff. So yeah, I think in every demographic, you have a different focus. I guess you’re right. [Avi]No, definitely. But I do think even if you’re so it’s even easier when it’s a younger demographic, because now they’re already thinking cosmetics, and you give them a valid health reason why they’re like, done. I’m doing it, right. Because dentists and physicians, the biggest difference is like, you know, people go dentists, or they’re just car salesmen. They’re just car salesmen just trying to upsell me. And it’s like, no, like, the stuff we’re doing is fear oral health, like it’s for your health, right? And that impacts the rest of your body. People don’t question physicians when they say stuff, because it’s a Association of Health, right and improving it. So when we come from that same standpoint, these more expensive cases that more expensive procedures, you have to build that value otherwise to then be like, Oh, my insurance doesn’t cover it, I’m not doing it, this or that, right. So start from there, you build it out. So you have that box checked, they understand the value of it, right? So now, they don’t really know how much it’s gonna cost, but they understand why they need it and why it’s important. That’s huge. And if you don’t do that, then you’re not going to be able to even get to the next step. So let’s assume you’ve communicated that now. Is it going to be a light go or comprehensive reason why I say everything should be a comprehensive is because one, when you have comprehensive, you have more control of the case, right? So I know when you’re starting out, you may not understand why you would need all that controller all that power, but you want it because the texts when you use like the go or the light, the text that you’re talking to don’t really actually know, like, you think that the person on the other side is like has your best interests in mind and like is able to, like construct this perfect. ClinCheck No, you have to be the provider and you have to actually dictate the movement. And I’m sure when you had Dr. Bethel on here, he said the same thing, where you know, you have to you have to communicate it as the doctor. So with go, [Jaz]I just wanted to interject there because literally today aren’t we have a telegram group for the producer auntie and identities a message about a dubious prognosis, second, lower secondary molar? I’m saying it in this way, because American Numbering and British numbering is different for teeth. Let’s say we both understand lower secondary molar. Yeah, so lower secondary molar of dubious prognosis. And then she was suggesting that, let me send him this scan and oppression to Invisalign. And then, instead of doing lots of IPR I, maybe Invisalign will suggest to me to extract this tooth. And I said, Well, we’ll we’ll hold up, and then you decide whether you extract the tooth or not, you know, Invisalign Will not they will, if you want them to light it, they will just align everything, they’ll expand everything, they align it, the extraction choice and decision is made by you as a clinician, so just very much as to make it very tangible. Yes, agreed. The technician is there just to follow some protocols, you are the captain of the ship, and you must steer exactly how you want it. And a lot these, you know, as much as we hate to think about it, the technician Invisalign technician at the end there, and we may think, oh, yeah, they know what they’re doing. And they do. But essentially, when you actually see these guys, what they’re doing is they’re literally they’re selecting the teeth, tooth by tooth, and then they’re making them look straight. Okay, they’re straight now. They look nice now next. And that’s it. No consideration of the there’s no condition of biotype occlusion. Yes, they have their basic guidances and stuff, but they really need the direction from us. Absolutely [Avi]correct. And so again, you know, earlier dentists right? No, don’t let this scare you. This is not meant to be scary. It’s just letting you know how to look at this. You can go about it in the right way. Right? So you go comprehensive, you have that ability. Now, the difference between go and comprehensive is Invisalign go does not move the molars, right? It doesn’t move the molars and you’re limited to 20 trays, and then one set of refinement. Now, that’s ideal, like most of my cases are 20 trays or less. You know, I’ve taken Dr. course, he’s he’s teaches reengage, and its philosophy of not moving the molars, you know, focusing on a little bit more IPR. But the reason is, because when you move molars, you increase the chances of a posterior open bite, right. So I know there’s a bunch of different philosophies out there. That’s the way that I’ve kind of committed to and works. And it’s in this realm of like a six to eight month kind of treatment time you get in you treat the patient, and then you know, everyone goes on to retainers. But with comprehensive, you can do the same thing, you can mark the molars, and you can just say don’t move these teeth. Right? You have that ability in the prescription to now. So now that automatically eliminates go in that regard. And the advantage is with comprehensive, you get unlimited trays for five years. Okay. Now, why is that important? When you have a patient that just finished and even if it only takes six to eight months, it doesn’t matter. 20 Let’s say they took 20 trays, they’re done. They’re in the retainers. Two years later, they lose their retainers their teeth shift, right? This happens, right? People get lazy with retainers, this has called relapse, we all know it. They come in in two years. And then now they’re like, Hey, Doc, my teeth moves. What do we do? So would you at that point, feel more comfortable telling the patient? Yes, let’s do go again. Because you ran out, right? And you don’t have let’s do Gogan? Give me another 3000 or whatever it is you’re charging for? Would you just like to be like, Hey, no problem, we’ll just do a scan, we’ll get your new retainers. And you’re just back in the trace, right? So it’s that added value. And then I even sometimes will mention to patients that are a little weary of pricing. I say, Hey, listen, this is like almost like a warranty for you. Right? It’s an insurance built into the cost. And patients get more comfortable. Whereas the go, it can get, you know, hairy, and then no one likes having those conversations where, you know, they’re like, Oh, well, my teeth moved, like, Yeah, but you just did it. This only happened two years ago, right? And they’re just like, oh, well, you got to pay again. And then it’s just it’s not, it’s not good. So that’s kind of where and I’ve been in that situation where not even the length wise, but I thought it was gonna take 20 trays, but they needed, you know, two sets of refinement. And then now we’re talking about money again, hey, I need another $1,000 Because you know, your teeth didn’t move the way they’re supposed to. So just eliminate those headaches go to comprehensive you know, and it’ll just make your life easier. [Jaz]I think that’s great advice. And I at the beginning, I actually for my first clinchecks, I use this like ClinCheck advisory service, I think it was invisible TX. And IT guy helped me with my visit and my ClinCheck to the beginning, because I was I was learning I want to make sure I was doing it right and whatnot. And then I email them one saying, Hey, I don’t know whether I should do this patient in within the confines of like, it was like 14 liners or comprehensive. And he actually said, depends how fussy your patient is. I was like, wow, I never I never thought about it that way. But I like the advice you give that. Okay. I think the advice to echo here for those listening and watching is, if you are on the fence, don’t even think about it go comprehensive. If you’re on the fence, if it’s like a really obvious clear, like mine a really minor crowding, it’s gonna be sorted well within 10 aligners, and you get up to 14, then fine. But if you get a really fussy patient for a reason, or you’re on the fence, I think that’s great. Not only because of the warranty thing that you said about you know, relapse happened and stuff. But the thing I love most about it is the thing that you said right at the beginning, is that you need to be confident when you’re communicating to the patient. I know that I’ve disservice my patients in the past at the consultation, where I’ve looked in other made that face and I thought you know what, I’m basically 5000 4000 I don’t know, and then the patient’s like, Okay, this guy doesn’t know he’s doing. Yeah, I knew I was doing but I was just like, I was trying to find out what’s your quote them? So I think for that reason, I think it’s wonderful advice. I think just just go comprehensive. And I think you can’t go wrong with that. So if you’re on the fence, definitely go comprehensive. That is a very, very good way to answer that question. I think a lot of people would have gained value from that. I wish I knew that earlier in my career. Anything you want to add to that before I go to next question. [Avi]I was just gonna say I like how you said that were you know, I think in the beginning, you start comprehensive and then as you get more comfortable, you know what’s predictable, because you do the more cases you see, you see how the teeth move, okay, and then you get that confidence, hey, we just did this and that, you just know that it’s about 14 That’ll take about 20. So then you can start scaling it back. But to your point. I like that unless you know, stick to the comprehensive [Jaz]very good and you mentioned refinement earlier. It’d be really good for one of my colleagues, my boss is actually when He started Invisalign. He didn’t know about refinement, he literally was like, okay, they either get that out in their first round. And then he realized that patients weren’t quite happy and what’s going on here? Or there’s something called refinement. And because that he wasn’t told that at the course. So he tells me, and so when I told him that, hey, a lot of my cases go to refinement. And that’s kind of normal, you know, and he’s always that is that, you know, he didn’t know that. So I’d love to learn from you. What percentage of cases go to refinement? And would you like to suggest to those listening, there’s a newbie dentists starting out Invisalign that that is Yeah. Is that a normal thing? Is it expected? And how can we gauge that? [Avi]Yeah, that’s a great question. I think when I first started out, so first of all, I don’t even know what the word refinement meant. Like, [Jaz]additional aligners. Now, obviously, they call it additional liners, but yeah, I mean, five minute addition liners, we’re talking about the same thing. [Avi]Yeah, definitely. And it’s yeah, I still call it refinement. But it’s when I first started, I was like, I don’t even know what this word means. But yeah, so it’s a mental hurdle to get over. But I think, again, all of this is mentality based to boost confidence. So I felt bad that they weren’t finishing and getting to where they needed to be in 20. Trays. Right. In the beginning, I felt bad. I was like, damn, like, Doc, God, we got to we got to do more aligners. Right. Like it’s a failure. Meanwhile, we’ve just corrected the severe crowding, and like we’re just tweaking the end. Right. So I think once you understand that, that it’s expected. You know, again, some clinicians they take pride in is a very minimal refinement percentage, I’m going to be honest, a lot of my cases do go to refinement. But it’s okay. Because I have already communicated that ahead of time. I don’t tell the patients Hey, you’re going to be done in 20? No, you say at the consultation, this will be about six to eight months, right? Depends on and then if you want to go further, because they have questions, they look, there’s a bunch of factors, you have to wear the trays 22 hours a day, otherwise, the treatment will take longer, right? And you have to come to your appointments, all this and all that, right. So you build that into the bidding. So that way they’re aware, because most patients, the really good ones wear it for 22 hours a day. And this stuff works, right? It’s the ones that are a little lazy, and they’re not that you’ll see. And it’s like a well at we’re at the end, and this could be better. So don’t take the onus off of it. It’s not your fault. It’s it’s it could be that the patient wasn’t wearing the trays, and that’s okay, right. They know, they have to wear more trays, or they’re gonna say, Hey, I’m done. Put me in the retainers I’ve done with this stuff. I’ve had patients do that too. And I’m like, Well, we could still improve this. And they’re like, is it better functionally or not? And I’m like, yeah, it’s definitely better functionally, but, and then they’re like, Okay, well, I don’t want to wear the trays anymore. Okay, fine. Because at that point, you know, it’s, it’s their choice to right. So, yeah, we [Jaz]definitely don’t say for those watching, listening, definitely don’t say the patient, okay. It’s gonna be, you know, 25 liners as you can see the ClinCheck. And then we’ll be done and then be disappointed at the end, and refinements are expected, I said they expected and then sometimes you get lucky. And I said, the expected because we know that orthodontic movements are not 100%, predictable, you know, tipping is, you know, 70 80%, predictable, or there abouts. Everything has, you know, rotations and 50% predictable ability. You know, after this episode, we’re Farukh, again to memorize the figures. But we know it’s not predictable. So we can’t say that within one round, even if you hyper correct and stuff. So I always say to my patients, we do it in different rounds. Or sometimes say it’s like playing golf, you know, sometimes get home one, but most time you get a bit closer to home. And there’s little minor changes at the end little tweaks, we’ll get those right. And I say to my patients, sometimes I’m gonna be the one pestering, you say, can I please do this, and I’ll beg you to let me align. And sometimes you’ll be like, you know, that little movement. And this is what we’re here for. We want to get both of us happy. So So that’s the kind of arrangement I say at the consultation. So they know that the first 20 aligners, fine is there, but they know that they’re gonna have more and then back to your point about the timeline. Yes, it’s more about the timeline, rather than, you know, additional aligners and whatnot. So my next question. So you answered very well, that if you’re unsure about which band they’re going to be in, just say, comprehensive. But what about the newbie dentist who doesn’t know how long movements take yet? How do you then give the patient a range, oh, I can just get six to eight months, six to eight months to 12 months, any guide that you have to actually tell the patient how long the treatment duration might be. [Avi]So that all comes down to the type of cases you’re working on. Right? It’s all case selection. So going back to what I was saying, staying in your lane, knowing what you can treat, right, you’re crowding, spacing, anterior open bite, stuff like that, if you’re only treating those, you’re only going to be in a six, it’s going to be six to eight months. That’s just how it works, right? Because you’re not moving these massive molars and doing all like this like posterior double, like you shouldn’t be doing double posterior cross, but you can do singular, but don’t do double and even singular, like, if they’re functional and they’re fine. You don’t have to necessarily improve it right. [Jaz]I learned that the hard way. Yes. Yeah. So [Avi]you kind of set yourself up but That’s the other thing. It’s my case selection then trickles down to like, Okay, since we’re only doing this, it’ll be six to eight months. And then that’s kind of how I do it. Has there been patients that have gone a little bit past eight months? Yes. But again, it’s because, you know, they admitted they weren’t wearing the trays or, you know, they said there was a tooth that was really tough to move. And when you see them at the checks, you kind of give them updates. And they are they are okay with it. It’s not as scary as you’d think. I think we forget, when you ask patients in braces that are seeing an orthodontist, they say, Oh, it might be two years a year or whatever, like they don’t know the orthodontist keep moving the teeth until they get it to where they one. There’s no like dentists. I think we just like, oh, we ever prep the crown. Today we deliver in two weeks. Like it’s it’s very, you know, but that’s not how ortho is it’s, it’s there’s a lot more variables so you gotta be [Jaz]agreed. And I think I want to add to that say that you know, if you think it’s going to be six to eight months, just say nine months, you know, the patient will be happy when there’s no harm undersell, oh, no one’s ever said, what, nine months, dentists down the road said eight months, you know, but no one’s ever said that. Right? They said, Okay, fine, nine months, I can deal with that. It’s not gonna make a huge difference in terms of how it is and just gives you a little bit of breathing space. And I think two times, a few times I’ve regretted taking cases on was a Bridezilla where she’s, you know, she’s getting married. And like, you know, just be very careful with those ones. And then also when the patient’s like, Oh, I’m going to I’m moving to New Zealand in six, six months, do you think we can get this right? Don’t do that. It’s just not worth it. Don’t have your treatment done in New Zealand. It just puts too much pressure on you and and try and fit them around when you’re busy and stuff. So I think would you agree that those two kinds of cases, just be careful tread carefully? [Avi]Correct? Absolutely. And that’s the thing is you have to do this information gathering in the beginning, right gonna get their expectation, see what they want to do. Tell them what you see. Because this stuff comes out. Yeah. Don’t Don’t take the brunt like, and I’ve had that conversation. And I’ve told them like, hey, to get the result. Because if you start it, and then it comes up, and it’s not perfect, then you’re taking off attachments, like the week before the wedding, and then, oh, I’ve been doing all this extra coaching for no reason. It’s like, hey, let’s just maybe do some whitening, right? Get everything nice and wait for you for the wedding and the pictures and then we’ll straighten everything after. Yeah, very true. [Jaz]Now, last few questions, either sort of very common themes from the community. One is IPR. Like I’ve done so many live videos now for IPR because this is something that people do when you’re starting out. It’s a stressful thing. IPR is so stressful. The first time I did IPR was like, you know, as a restorative dentist, I felt dirty, you know, it felt like it feels so wrong. And then also the technique and you doubt yourself and you’re you see these horrible radiographs online about IPR gone wrong, and you don’t want to be that dentists. So I’ve covered IPR a lot already. But any advice that you have for planning IPR, for efficiency that you want to pass on to the community? [Avi]Yeah, so whenever you see IPR, this is a huge tip. I got this from Dr. Blocker. Basically, if you have IPR, from canine to canine on the mandible, and it’s point two, right point two all the way across, what you can do is you can actually go into the like the 3d controls and where you can manipulate where you want to get put IPR. Again, this is what you can do in comprehensive you can’t do this in Invisalign go. But if you already have a case, what you basically do is you eliminate the IPR, and you can just add point five to the Museum of the canines. And then that gets you that millimeter of space that you need. Right, so that hack is crazy good, because now instead of IPR in so many teeth and trying to be very precise, you just can literally take like the mosquito diamond bird go to the museum of the canine underneath the contact, feather swipe up on both of those, there’s plenty of enamel on the canines, you don’t have to worry about that. And then you get the space that you need, and the teeth move. That’s and then if you need more space, you can just do distal of the canine as well. I like to try to preserve the interiors as much as I can. I try not to do any IPR on the maxillary if I can avoid it. But that is very key, just to minimize that, I think is redistributing where the IPR goes, gives you a lot more freedom. [Jaz]Yeah, a lot of people might not realize that you can do that. And that’s a really, really great tip. And especially like, you know, you’ve got like naught point three here, naught point three, they’re not paying for that, then group it up into an open forum and open five and leave the other one alone. And then definitely, you can do that as long as the space that you end up with is similar or the same. So that’s a great tip there. And then also, yes, canines in general, have such a meaty enamel, and they are great candidates for IPR. The only thing the only caveat here is that if you have a tendency for black triangles, that perhaps then still keep the IPR for those lower and sizes which will help the black triangles is one thing to note there, but that’s a really good top tip there in terms of planning for IPR. And the final question of it is before we just have a little chat is which is and I get this all the time, which is the best composite for attachments. So what do you use for attachments at the moment? [Avi]So I use tetric Evo flow tetric Evo flow I was using like a bulk fill, but my assistant actually request because my system does my attachments. She Questions, we go to the flobo version of it. So it’s tetric Evo flow, and then the flow bubble. And then I actually did try it out. And it is, it’s very nice. It’s not too like soupy liquidy. It’s not too, you know, meaty to where you can’t put it into the tray. But yeah, it’s we do the full version of it. And that’s great, because it’s translucent as well, so you really can’t see it. So the patients like that. And then kind of a little bit more composite tips, I can dive in here. [Jaz]I mean, it’d be good to learn about your protocol, people ask me, What’s the best way to do my attachment to talk with us? Yeah, you could share each other’s protocols. But one thing I shouldn’t add is, I’m at the moment using a genial injectable for it, I just love how it holds a shape, like you can literally do anything you want to the template, and it just holds its shape so nicely, and I’ve had no issues with that as well. And that’s got you know, it’s a it’s a restorative composite, paste and composite in a fillable form, if you’d like so that I have no worries about it wearing Well, you know, people say that oh, yeah. What if the continual aligner removal insertion is wearing away the attachments? I don’t worry about that with genial, but I think that you’re one that you’d recommend the tetric EBA. Flow is, I think, is one of the official ones that that Invisalign recommend, I believe. [Avi]Yeah, it probably is. Because I learned that from a course that I took, yeah, yeah. But yeah, it works. It works. [Jaz]Yep, tell us your protocol for attachments. [Avi]So protocol for attachments, it all starts I attach. So I’ll attach. And it all starts with controlling your act, right. Because when you do attachments, the biggest thing is you want to minimize the amount of flash that you get the amount of excess composite that’s there. Because if you have that, that will not allow the aligners to seek correctly. And then that is going to obviously cause issues with movements, right. So it starts from the beginning, control your edge only edge in the area where the attachment is gonna go. Right. So you etch their normal protocol that you use for etching, when you do restorative, I’m treating this essentially like a you know, like a filling, right? So that you go to that spot, that’s exactly where you need to be very precise, rinse it off, air dry, and then I’ll take whereas [Jaz]for restorative, you know, we want to etch beyond, because you want to go and get a seamless margin. For Invisalign wondered the opposite, you want to literally contain it within that square or whatever I completely agree. [Avi]Right, so you start there and then bond with bond I use like a micro brush to apply it. I believe the bond that it uses Excite, any bonding is fine. It’s just, if you’re filling, put it this way, if your fillings are staying intact, it’s that’s a good etch and bond system to use. Obviously, composites would be a little different, but stick to what you have, you don’t have to go by all different products, but control that bond as well. Right. And I like to apply it. At first I was just using it was like a pen. And so it had that tip on the edge of it. I don’t know exactly what it is. But it was like [Jaz]I think it’s a brand that one I think is black with the green [Avi]color. But I was using that at first when my attachments kept falling off. And the reason was, is that’s like an etching bond. And one, it wasn’t because of that it was because of the contamination. So if you take that, and you apply it on different teeth, right saliva can kind of get involved with it, by the time you’re on your second or third quadrant of applying. That has it’s not clean anymore, right. So I made a change. And I actually just used Micro Brush and applied a new Micro Brush in each quadrant. So that way, there’s no chance of saliva really touching it ever since I made that change, attachments don’t come off. So that was keys control that contamination. So you put that on, you know, air dry cure, then now what I do is I cut the trays in half. Okay, so you go to your incisors, cut them in half for the maxillary and mandibular. So now you have your four separate trays, this allows you to really ensure that you have a clean working space if you you know, if you try to do a whole arch at a time, like that’s a lot of isolation that you have to achieve and if you can achieve a great for me that just it’s very difficult to do so and I would just liked the fact that I can pop it on, you know, once I have it on then I use like the little I guess we call it college pliers here to something that you can use to kind of pinch the trays and you can just pinch the trays buccal lingual and what that does is that pushes the composite onto the tooth and then you cure that when you do that. I guess we can go back to where how much you feel. I feel right. I don’t underfill it I don’t overfill it. I tried to keep it very level with the trays. It’s okay if you’re gonna go one way overfill it. Okay, if you’re gonna go in with overfill it because that’ll ensure that you capture everything and you don’t have to worry because if you did if you control your edge and you control your bond that composite that’s excess will actually just it should flick right off with a scalar right or whatever you may use to polish at the end so you do that you cure it and then they’re pretty much on then the other thing that we use is a black light so you can just get a black light when you shine black [Jaz]UV torch it’s something that we’re yeah I’m advocate before UV torch and that it shows up the flash so well, isn’t it? [Avi]Correct? Yeah, composite lights up. Then you just go in, remove the floor. Wash them. And that’s pretty much it. [Jaz]And for that just a tip, I don’t think genial is as fluorescent, I think the Tetrick one that you recommended is like it goes bright purple, right when you put the black ports on it. Yeah. So if you’re going to be if you like the idea of doing this, then I probably would use the, the company that you recommended that just don’t say the name, say the name of it again, Tetrick evil flow, that’s the one. So if you feel like the idea of them shining purple with the black torch or the UV torch, then definitely go for that one. Genial GC products have lower fluorescence, and they don’t show as well. So you may be left disappointed, do use obligate for your isolation. [Avi]I tried it, but it was a little tricky getting in, we’ll use like an ISO dry, right. So it has basically, prop up your one side of the mouth keeps the tongue and everything out of the way. So that’s nice. And that adds in the whole work in quadrants and halves of the mouth. So that’s what we use. [Jaz]Okay, now, I’m quite a big fan of the obligate or works well, on my hands. The real big issue I had, when I started working in this new practice two months, or two years ago, is that the this is huge, like, $5,000 light above us, right? It’s like, by evidence, like really bright, and I didn’t realize the power of this light. And so when I be delivering my attachments, by time actually just inserted the template, the composite or cured, and it and actually complained to Invisalign saying, hey, all the last five patients, the the templates you’re sending, they don’t fit the teeth. This is This is terrible. This is rubbish. You guys, you guys suck. But but it was actually it was actually my fault and the light and I figured out and I actually posted on this on Facebook as well, like what’s going on? Is everyone else’s tashman templates not fitting. So it’s basically the light was prematurely prematurely curing it. So be careful if you find is though, that when you put your template in, it’s not seating that well, it’s probably because of competence just cured. And that’s a very simple thing, just control your light environment. That is one thing that’s going to definitely save someone I think eventually we’ll all will remember this tip and figure it out. Any last words on templates, or attachments, even [Avi]I’d say that’s pretty much it, I think you stick to that and ensure they’re on, you know, emphasize to the patient, hey, if this if you feel like anything pops off, let us know get them in. Because if you don’t, if they go too long, without an attachment, that tooth isn’t going to track and it’s not going to move. So you got to stress that. But [Jaz]I mean, I remember early on right when I was starting Invisalign, I do something really stupid and funny, right? So because I didn’t have faith in my attachment, because I didn’t because I was starting out. I didn’t know whether they work. Now I didn’t. Obviously I was stupid, because I believe in compensate, wanting to know, why wouldn’t I believe it on the facial the enamel is just a stupid thing. But as soon as the patient left off the attachments, I go on the doctor website, and I preempt the next visit, I’d ordered a template for appointment five, stage five, I just order a template. So by the time the patient comes back, I would have the template ready just in case. And he realized don’t don’t miss. But yeah, it doesn’t cost anything to get to order a template. So I thought let me template anyway. But yeah, I realized I didn’t need it. And those templates, those attachments that are going to come away, they usually come away within like two days, basically. And if they come away, in the first couple days, they’ll stay the long haul, they’ll go, you know, multiple refinements and whatnot, we can talk about that another time. But I think you’ve provided great value to everyone listen, there, you’ve given those faith who are starting out Invisalign. And obviously, you’ve got a bit more experienced now you’ve done more, you know, a bit you’ve been through all the mistakes and challenges. So it’s great to have your sort of lessons there. Please tell us how we can connect with you what services you offer, I think you’ve done some coaching. And I think a lot of people would appreciate that, please tell us about that [Avi]pretty much this whole conversation sit everything on the nail, in terms of challenges, especially for starting off. So again, I am not like a diamond provider, I am not doing you know, 1000s and 1000s of cases I am very much, you know, I wouldn’t say brand new, but I’m pretty well versed in these initial challenges. And I realized right with with cases that the hardest thing is to start, right. It’s the fear of all the things that we just talked about, hopefully people listening, you know, we’ve given you some confidence to kind of push forward, you know, but again, the biggest a big key is having that one on one support, right? So I created a coaching kind of coaching consulting business, where I’ll work with dentists and help them get started. Right, get them going on the right foot teaching, you know how to pick your cases, how to set up your clean checks, how to keep everything predictable, to where you’re able to really get your feet wet and get comfortable. And get you to a place where you’re doing like 10 cases a month, consistently and no sweat. And I mean that we’re kind of automating you to where it’s like you don’t have to really stress it. Then after that, it’s like you kind of make it what you want, right? And if dentists are comfortable with that they’re great. If they want to further educate themselves, then that’s when the courses are incredible, because you can and this is what I really think a lot of dentists see too is like you can take a course and it’s a phenomenal course. But if you don’t even know how to start. That’s that information just becomes overwhelming, right? And you and you and you get lost in that. So I’ve kind of created this and it’s helped. It’s helped some dentists. They’re pretty Should it and then I’m also looking to start to build like a community to to where people can kind of share and stuff. They’re here in America, we have the ACA, American Academy of clear aligners. So that’s a nice community that I’m a part of. But it does have all ranges of expertise. So it’s, it’s good. And it can be a little overwhelming sometimes, where if you’re brand new, you don’t really know what we can ask. So let’s say [Jaz]your mission is to help those starting out to get started on the right foot. Right? Absolutely. So how do we connect with you if someone you know would like like to learn more? Yeah, [Avi]so I have I mean, multiple ways Instagram is one my instagram handle is Dr. Spelled out dot Avi. I have a website for the coaching business. It’s called clear aligner advisor.co. So on there, it has my email, phone number, all that kind of stuff. But yeah, Instagram or on the website, or the easiest. For any newbie dentists that are listening. I did start a YouTube channel as well. Just kind of sharing career advice. Now. It’s not just Invisalign. It’s everything. Like I said, I was in 10 different offices, my first two years out, saw dentistry done a bunch of different ways, the good, the bad, the ugly, and just kind of sharing my insight. So I have a YouTube channel as well. It’s the same thing Dr. Avi spelled out. But yeah, it’s a I look [Jaz]forward to subscribing and connecting further. I think it’s been nice to remind ourselves of the challenges when you’re starting out. And yeah, definitely the I think the demand for just starting out your first few cases is huge. Like I said, I paid for my first 10 Clinchecks to get help with those. Because I was so lacking in confidence in terms of what I was doing, it actually spurred me on to do a whole diploma in orthodontics, because the thought of not knowing enough was was was haunting me. And so when you arm yourself with knowledge and get some mentorship in many forms, and now online like like you offer is just one of the beautiful things about how we’re advancing in dentistry that we can reach out and get mentorship from anywhere in the world is amazing. So I’ll be sure to put your channel link in the show notes. And if you listen all the way to the end remember that the app is out the protrusive app is out so check it out this video will be on there so for you to enjoy and then you get to see are these cool glasses and it’s cool shirt. I’ll be thanks so much for coming on and sharing your nuggets they may really appreciate it. [Avi]I really appreciate it thank you for having me. Jaz’s Outro:Well there we have it guys hope you found that valuable you obviously probably only listen if you actually are starting out with liners chances are you probably know it didn’t reach all the way to the end if you’re already quite experienced in providing aligner therapy but if you have for some reason amazing. Thanks so much for listening all the way to the end. Catch you in the next episode. Listen if you could do me a favor. If you found this useful, and you know someone else who’s starting off with Linus send them this episode and introduce them to the podcast. That’s how this podcast grows. And I really appreciate your listenership as always. Thank you

This was the most difficult interview I ever recorded for Protrusive Dental Podcast. I was approached by a representative from Smile Direct Club to appear on the podcast. I had mixed feelings but knew this was an opportunity to ask some good questions and gain an insight into how this active and significant stakeholder in clear aligner therapy (whether we like it or not) operates. https://youtu.be/6Sjwr52_EkM Video to this episode has not been made public and only those with a link can watch it – OR on the Protrusive APP releasing for general sale next week Need to Read it? Check out the Full Episode Transcript below! Protrusive Dental Pearl: In terms of efficiency in doing your IPR, be sure to plan your IPR and your ClinCheck so that a lot of the IPR happens in one go when the contact is more aligned.  https://youtu.be/x6K2o9tS0GU The highlight of this episode: 10:13 Current market trends for clear aligners 12:59 Animosity Between Smile Direct Club and Dentists 17:19 Patients that are suitable for Smile Direct Club 19:33 Smile Direct Club’s Workflow/Patient Concern 30:32 Patient Education about Direct Smile Club 33:44 SDC’s ‘Lifetime’ Aligners? 37:11 SDC’s Night Time Aligners?! 43:20 SDC’s pop up shop within Dental Practice 46:55 Dental Boards vs Smile Direct Club 53:16 Patient Support Network? If you enjoyed this episode, you will also like GDP Alignment vs Specialist Orthodontics Click below for full episode transcript: Opening Snippet: Carrying out orthodontics is radiographs, temporomandibular joint assessment, Periodontal probing, periodontal diagnosis. Where is that in the workflow? So essentially what I'm asking Dr. Ataii is if someone doesn't see you and goes to perhaps to one, the pop up shops in the street, what is the workflow? And do you think there's something that should be improved in the workflow and let's learn about the workflow first I think before we can then as dentist be critique that. Jaz’s Introduction:Hello, Protruserati. I’m Jaz Gulati and welcome back to the most difficult interview I’ve ever had to do. When the opportunity first came to discuss with a representative from Smile Direct Club, you can imagine my initial thought I was like no way, I’m not giving them any airtime, right? That was the initial thought. And then I just pause and I thought okay, this is an opportunity. So I posted this about this invitation to our group on Facebook Protrusive Dental Community and oh my god, you guys are hilarious. The amount of stuff you guys came out with saying do this, do that, ask him this some real tough questions or whatnot. And then Jonathan Doron, one of my buddies, one of the Protruserati, he made an awesome comment, right? And he got me thinking, okay, so amongst all of them on there, read his comment out it says, “If you think Smile Direct Club are doing something wrong, as most dentists do, then why not have them on and debate it. They’re already here and providing the treatment whether you do or not. It would be an interesting break from the usual format, which you know, I love already. And it would genuinely like to see them come on and have a discussion in good faith.” And that was the most beautiful thing. So Jonathan, thank you so much, because that really helped me and it was a guiding comment for me in terms of how I’m going to approach this interview. Because look, I’m gonna be straight up with you all. A) I don’t want to get sued. Okay, I want this podcast and I want to be able to feed my family in the future as a dentist, so I don’t want to get sued by anyone for any kind of thing, defamation, right? So I came and approached this podcast in a sensitive way. And I feel as though would I have asked certain questions in a different way. Had I seen Dr. Ataii, Dr. Payam Ataii, our guests and he was lovely. So thanks so much for being so lovely, Dr. Payam Ataii. So had, I would have asked him in a different way? Had I known him a bit better? And also, in a private situation, not in a publicly aired podcast. Yes, I would have asked in a completely different way, but to preserve the good faith and good nature of a debate, and because at the end of the day, yes, he’s a representative of Smile Direct Club. But he’s a human and you know, he’s smiling back at me. I didn’t feel like making him feel bad. So that’s the angle I came up with. Now, we do discuss concerns about patient safety, because for me, the way I’m approaching it is very much same as Jonathan, Smile Direct Club are here to stay. Whether we like it or not, they’re here. In fact, when I watch her cricket, I watch her videos, but the only thing I watch on TV is cricket. And on Sky Sports. Every fifth commercial was Smile Direct Club. So they are everywhere. They’re on tik tok. They’re on TV adverts, all our patients by the time they’ve come to see me for an Invisalign consultation. They’ve seen the adverts, they know about Smile Direct Club. So my agenda is how can we raise the patient safety? Because what I don’t want to see is people patients, because people are, our people are our patients, right? Them having suffering or having problems because they have problems even with my treatment and your treatment. Let’s face it, right? Orthodontic treatment doesn’t always go even by a specialist, you know, there’s always some complications. But as long as treatments are done with the patient safety being number one concern then that is the most important thing. So I do challenge Dr. Ataii on patient safety. And so this episode is here for you to listen to and enjoy. And for you to make up your own conclusions about what you feel. And you need to kind of read between the lines. And I encourage you to be open minded and learn because I think at the very least let’s learn about the workflow of Smile Direct Club, so we know where they’re coming from, and how it may actually suit certain patients. But why there is this friction animosity between Smile Direct Club and dentists and what the future may hold. The Protrusive Dental Pearl I have for you is related to orthodontics and one of the things that we discuss it that those patients who go on to have Small Direct Club aligners or retainers, they do it without attachments, and they do it without IPR. So this is interesting and really crazy, they have something called nighttime aligners. Blew my mind, right? So I discussed about that. And I probe about that and I challenged about that. And I request about that, that we need research thereafter. So if this is gonna be working, if nighttime aligners for less than 12 hours is an option, and it’s working and it’s out there, then I want to know when As in the interests of science and the progression of dentistry, I want to know what cases it works for, what the success rate is, etc. So as an opportunity for research, but just backing up a little bit now, the tip for IPR, very basic, but if you’re an experienced aligner practitioner, then you know this already, but some of the dentists listen there might be new to aligners, new to Invisalign, new to *insert brand of aligners. When you are told that you need to do some IPR. And I’ve said this, like four or five times on a podcast before I’m sure I have, but I think I’m gonna say it because I met a dentist the other day, and he was Oh, my God, I had the longest appointment ever. I do so much IPR, do you know, how difficult is to 0.5 millimeter IPR, between every tooth between 6 to 6 and it took me like an hour and a half and the patient was in agony. And so the problem is, my friend, my colleague here approached a situation that he thought when on the ClinCheck, because he was using Invisalign, when it went yellow 0.5 He thought, Okay, today, I need to make 0.5 Okay, this is not true, guys, okay? All that yellow means is that there’s a collision that’s about to happen. And so you need to create some space. So you need to do you know, 0.1 or 0.2, get some space, okay? And then a few weeks later, you can do another 0.1, 0.2. In terms of efficiency, then there is so much more efficient, if you actually clever in your planning of your IPR and your ClinCheck to actually plan it so that a lot of the IPR happens in one go when the contact is more aligned. And then you can get a better quality of IPR as well, rather than doing it sequentially at different times, so you can be clever in the planning. So there’s so much more I can go into an IPR. And if you haven’t already checked out the ultimate IPR episode. Please do, something I’m really proud of, the work spent loads of time to make and it covers the main different ways of doing IPR in one episode, and clinical videos, etc. And I discuss more about planning, orthodontics and IPR. So do check that one out. And now let’s join our much anticipated episode with Dr. Payam Ataii, a representative of Smile Direct Club aligners. Can you believe it is happening? Here you go. Main Interview: [Jaz] Dr. Payam Ataii, welcome to the Protrusive Dental Podcast. How are you? [Payam]I’m fantastic. Thank you for having me. [Jaz]It’s great. And this is a real opportunity here for dentists to learn more about the current trends in aligners, about the, you know, the Smile Direct Club, let’s just talk about the elephant in the room. Smile Direct Club has come along, and a lot of dentists have got scared and worried. And it’s a great opportunity to have a bridge, a discussion here today, which will be the main meat of what we’re discussing. So I’m very excited to get into that. When I told my community that someone who works very closely with SDC, we will astray, they got very excited. Yes, we had some comments of concern and whatnot. I said, Listen, you know, one of Stephen Covey’s habits, for success was seek first to understand and then to be understood, so I’m really looking forward to having our discussion now, please just describe your role, and also what it where it is that you do and where you’re based. And just a little bit about yourself, Dr. Ataii? [Payam]Sure. Yeah, so I’m based in Orange County Southern California, United States. And I’ve been treating patients with clear aligners, a little over 19 years, I was one of the early adopters, when if you remember clear aligners were born and with Invisalign, and kind of mass produced in a way. So I was one of the early adopters, I became faculty at aligner, kind of had a teaching position for 14 years with aligner. And as you kind of grow in the aligner space, and your patients kind of grow with you, I noticed that there’s other options coming in the market, you know, being, you know, Smile Direct Club being one of them and these options and opportunities, instead of me kind of shying away from the mic wanting to find out what it’s all about. So for the past year, year and a half now, a couple years now I’ve been offering Smile Direct Club as one of additional aligner services that I also offer to my patients with, you know, Invisalign and other strommen now has ClearCorrect. So there’s multiple aligners that fit different modalities of patient treatments. [Jaz]And do you exclusively do orthodontics aligners? Or do you, are you a generalist? Because I just saw recently a video on YouTube, you talking about I think, sleep apnea, which is a very good video, by the way, you present yourself really well. Tell us about you know, is that all you do? Is it more to it? [Payam]Yeah, so I’m a general practitioner, so I do practice general dentistry, drilling, filling crowns just few minutes ago, I just got done doing a class two that I thought was going to be simple and it turned in to be a big deep decay. So I still do general dentistry, I do crown and bridge and yes, Sleep Apnea is one of the things that I got and start treating patients about 14 years ago, because when you start to do aligners, you’re going to notice that these removable type of appliances like clear aligners or anti snoring if you will, kind of open the other avenues of not just drill and fill but patients you start to see airway, you start to see better oral care so now you start to going whole health and full body. [Jaz]Absolutely agree. When I did my Orthodontic diploma, the first thing I started to notice in people was beyond the teeth. I started to notice people’s faces more. You know, who’s long faces, short face and all these things that was the most biggest revelation when I started to learn more about orthodontics, so I completely agree with you there. So first question, generic question Dr Ataii is, what are the current market trends for clear aligners? Like, we’ve seen a boom right, like, and I don’t know how far back this goes, you’ve been in the game way longer than I have and are we gonna expect this boom to continue? What is the current state of play in that rod? [Payam]Yeah, absolutely. Look, when I first started talking about aligners, and this is back in 2003, talking to dentists and just general practitioners and some orthodontist that look, there’s this plastic appliance that you can kind of put in an upright teeth and kind of move them around. And these minor at that time, minor movements can create volumes of beautiful smiles. And, you know, it wasn’t really accepted until about maybe 2010. When all of a sudden you saw aligners being pitched on the media. You know, obviously social media wasn’t as big but still had its growth in marketing. So patients started to kind of look at their smiles as instead of veneering. Because remember, 2008 2009 2010 it was all about veneers. You know what kind of, how thin is the veneers, how DaVinci veneers. Emaxs that was starting to give abroad. And I remember, at one point, we talked about those ceramic crowns. Ceramic crowns, I mean, no gold? How’s that possible? How you gonna cement it? So, you know, when you start to see that rise of patient education. And you start to notice that, you know, the aligners are really in demand now, I mean, they’re discreet, they’re easy, and I see it on the rise. And I you know, when you start to look at the math, and when even Invisaligns numbers that they say we’ve only treated 10% of the population, you know, 10% is all that they’ve really penetrated that’s 90% left to be treated that have malocclusions absorbed. So I think it’s on the rise. I think that clear aligners are going to be the right, right there with white fillings. I mean, they’re just kind of escalating to a point where a lot of companies now are delivering this even now you see what Smile Direct Club remote, and having those tele dentistry kind of on the rise as well. [Jaz]Well, I’ve seen the obviously trends increase in general practice, but also amongst specialist I know, plenty of specialists who, initially are specialist community perhaps was a bit resistant to accept clear aligners. And then what I found is speaking some colleagues that actually they’ve moved to no longer doing fixed appliances. They’re a specialist, but they’re no longer doing fixed appliances. And they just choose to niche themselves into being just the best time there is including monotherapy. I think that that talks that speaks a lot of volume actually [Payam]Add that because advances in actual technology, we think about the treatment plan software, I mean, look at the advancements where we’re at in 3d. So I’m glad that they’re considering themselves removables. I think removables is the way to go honestly, but go on sorry, didn’t mean to interrupt. [Jaz]No, please. That’s a, I’m very welcome interjections like that. That’s good. So dentists are concerned about Smile Direct Club as competition. So the competition being that okay, look, I’m a general dentist, and orthodontist. And now, there’s a feeling of animosity because the dentist feel like we’re being undercut. And that now, you know, on social media, dentists say, Oh, DIY aligners or mailorder aligners to try and make it seem or just try and just refer to SDC aligners as inferior if you like. So they try and use different terms, what not, we got to have to go through all of them. But why do you think that? And where do you think animosity comes from? Is it just because dentists feel like financially, they’re now getting a smaller slice of the pie? [Payam]So let’s go back to about year and a half, two years ago, when I had the same feeling. So the main reason why I wanted to look under the hood and see what it is that Smile Direct does. Because you only see the cheapest price or the you know, the reality is that patients tend to go towards something inexpensive, rather than us being the expensive route. And then you start to demographically look at these patients. Well, when I first had engagements with Smile Direct Club, I realized, look, it’s not justified for us to be worried because if anything, the amount of marketing and dollar that they spend in educating patients, not every patient is a candidate for Smile Direct Club. So here’s the fact, the fact is that Smile Direct Club only treats those minor movements, you’re talking, you know, the social six, they’re not correcting crossbites, they’re not doing full class twos or class three type orthodontics. And a lot of times those patients actually get rejected and guess what they go back to? Us. So the patient already knows they don’t qualify for $2,000 deal. And now they know that they tried every avenue not to pay that 2000 And guess what? Now they’ve been kind of I like to say now they’re a warm lead, right? So for us when you start to look at the overall patient IQ, look they’re starting to get smarter. I mean, this idea of social media has really gotten to a point where my 14 year old says, Hey, Dad, are you giving me Smile Direct Club? Are you give me Invisalign? What are you giving me? Your 14, how the heck do you know? I mean, he might have heard things. But his social media folks are talking this, 14 year old friends are talking. So I don’t think they’re undercutting if anything, I think they’re helping increase that patient IQ with the amount of marketing dollars they spent. And out 10 patients, how many of them are really a candidate? Probably about three, guess what happens to the rest, that’s like seven of them that are going to come back to our laps, we as practitioners have to be prepared to have the conversation. Look, it’s a great tool. It may not be for you. But it serves a purpose for those underserved minor social six tooth movements that patients are looking for, they’re not looking for perfection, if good is good enough, that they’re happy with that, there’s the $2,000, but be prepared for you to pick up the difference of patients that are coming to your practice, rather than cutting them off and say, you know, as a matter of fact, I joined what’s called a Partner Network in their group where they actually send the patients over to me, I get to have a crack at them for fillings, crowns, because they’ve been advertising this $2,000 deal, patients are coming in to get a scan or an impression. And guess what they walk out with? An idea of their cavity, their tooth, and maybe or maybe not, there’ll be a candidate, but they hope that they will be and guess what happens when they’re not a candidate? They come back to my practice for full price fee. I think that’s where we’re missing the boat, we’re missing those. I cannot spend millions of dollars advertising my practice, but I can join a company that does [Jaz]I just want to agree straight away, because there might be some things in this podcast that we disagree with. And let’s do that in a winning good camaraderie and good spirit to have a good educational discussion today. But I have to agree that the presence and marketing that Smile Direct Club have brought like, you know, that awareness. And I do think that is fueled over the past few years, how many conversations we’re having with our patients regarding orthodontics, and straight teeth. So I would definitely give that as a as a bonus thing. And that’s it, you know, lots of dentists are worried and concerned and stuff, but for sure, a lot of dentists may not have considered that the free marketing that kind of getting is there. Okay, so let’s Yeah, I completely wholeheartedly agree with that. You mentioned about some cases being rejected, and maybe three out of 10. So that’s really interesting to know, because one question further down as a spin off was, Do you know what percentage of applicants it turns down? Because they’re not suitable for treatment? [Payam]Yeah, so, I know that I can give you based on my experience. So patients are going online, my office happens to land in their zip code, they come in to get a scan or an impression. And I said, I mean, I see some of them that there’s no way in heck that they’re going to kind of, you know, qualify, because young and three or four millimeters of movements, that Smile Direct, really accommodates. And I don’t want to burst their bubbles, because I don’t want them to think I’m trying to sell them my office. So I can tell you out of 10 I’ve literally have seen about three to four get accepted with Smile Direct Club and the rest is every [Jaz]10 that come to you as the sort of middleman between you and Smile Direct Club and then getting it, three out of that, three to four out of those 10 will actually be eligible based on their malocclusion to have the treatment? [Payam]Right. Absolutely. [Jaz]That’s really fascinating. That’s fascinating. [Payam]Keep in mind, they have state licensed doctors that look over these patients, right? So they have their own treatment planning software that their state licensed doctors are looking at. And if their doctors don’t feel comfortable if they want an x ray, they want some other information, again the patient comes back to me and at that point if the patient hasn’t been accepted they get, I think like three rounds of doctors that look at them you know that these, Smile Direct doesn’t want to say no to money, let’s just be honest here, they’re gonna say yes, but they’re doctors those seven that did not get treatment is probably because their doctors didn’t feel comfortable. So when you say do it yourself or do it your self type of a scenario it’s really I’d like to market that as a telemedicine, the doctors still behind the wheel. Now the phone calls and all that little attachments and IPR Okay, that’s all out of the way. So in my mind, if you look at a patient in your practice out of 10 of them how many of them have minor movements that fits right in that smile direct club category that for, you know, three to four patients? [Jaz]Well that I think is well and good patients coming to see you, you’ve got so much experience and you know general dentists and getting get a feel for what you’re about and stuff that’s good. But what about the patients that go to a pop up shop in the mall or High Street wherever and they never get to see a dentist face to face. So let’s talk about this. There is a concern because when someone things that I would check before carrying out orthodontics is radiographs, temporomandibular joint assessment, Periodontal probing, periodontal diagnosis. Where is that in the workflow? So essentially what I’m asking you Dr. Ataii is if someone doesn’t see you and goes to perhaps the one that popped up shops in the street. What is the workflow? And do you think there’s something that should be improved in the workflow? And let’s learn about the workflow first, I think before we can then as dentist be critiqued. [Payam]So what I want to tell you is I’m basically a pop up shop. Right? I’m bait, when I when we talk about the Partner Network that’s given the way that the olive branch has been extended from Smile Direct Club to the general practitioners and orthodontists say, Look, we’re more than happy to refer these patients to your office. These are our consumer patients, you scan them, you send them, but if there’s cavities, or fillings or cleanings, go ahead and do it, let us and our doctors make the decision. So here’s the way it works. The workflow, the patient, either they send the impression that a pop up shop in my office or at home, they send it in and that 3d software, the doctor gets to look at. As scenario where the movements are beyond what Smile Direct Club has within their own system. They then reject the patient or tell the patient I’ve seen this, it’s an email that goes we’re not 100% confident that your smile can be reached. And here’s the best you got to get some patients like that’s fine with me. They went from here to here. They’re OK with it. But some patients say no, I want something more. So they’re given that opportunity, because the doctors behind the wheel are the ones that say yes or no. From there, these pop up shops or at home or my office. They’re just the center to scan just like how, as an orthodontist, you go somewhere to do a ceph, right? The reality is there’s software and the doctors are who’s behind the wheel. Now, I can tell you, I’ve had some cases that patients have come in, they’re like in the middle of treatment. And I look at that patient I go, this was an ideal patient, why? The two teeth are banging against each other. There’s some mobility going on, as you know, time space and pressure, that pressure is needs to get maybe into approximated. And I look and I say all it needs is an IPR. But the patient hasn’t been told IPR, the patient accepted. And I look at their video. And I’m like, wait, the video shows that the tooth still has an overlap. And the patient says, Yeah, I know. But I thought they would fix that. Meaning that the patients saw the movement, but still wanted to override that movement. That’s the main problem. The main problem is how do we get the patients to understand and I know smile, direct club is doing a good job in educating the patients. I just don’t feel that the patients understand what they’re really getting. Because the movement they show, clearly, you’re going from here to here, is that good enough. Patient says that is good. But maybe I can push a little bit more. Maybe I can get you know, I’m gonna be okay with this. But maybe because they say like, remember, Smile Direct Club says lifetime aligners. So what happens is, the reality is not the pop up shop, not the doctor, but the patient education part of it. And that’s what I see smiledirectclub really doing now. I see them now saying, Hey, here’s, I see before I used to see this big fat spaces, and they’re closing them. Now I see these minor spaces, I see these minor movements. I think they’re starting to now catch on to show Hey, patients, these are the cases that will be ideal for you to kind of come over for us to help treat. And I don’t know if that helps you any. [Jaz]Now that that does an annual evaluation of that case that you described, where perhaps it could have benefited from IPR. It might make sense. But again, when they come and see you, that’s great. But let’s say they go to a mall, and they have a scan. At what point does the doctor do they get to see A) they get to clinical images? Do they get radiographs? Do they get paid on the probings? Do they get a joint assessment? Do they get to see the biotype of the gingiva? At what point does that happen? Did that happen to someone who doesn’t come through you because you can’t blind yourself, you’re going to look at that. Right? So where does that happen when they do the impression themselves? At what point does the doctor have input on that? [Payam]Yeah. So if you’re doing minor movements, for me, if the tooth and scan show a healthy tooth structure, then I’m going to maybe just simple closure through two or three millimeters, I’m fine with no X rays because I have a 3d or a scan of that patient. But there’s times when they ask X rays, there’s times when they ask for the patient’s to go be seen, for instance, an open bite or a there are certain cases that these patients have to now go outside the mall and get those additional radiographs or films. How many of those cases are like that? Again, I go back to that my experience that, you know, we I can tell you one or two times they requested X rays on cases that have been really simple. I’m like, wait a minute. I don’t need X rays for that even in my own practice. But the doctor wanted it for some reason. Maybe it was a uprighting of a molar they were doing or maybe bicuspid movements, but because it’s the sixth anterior teeth typically radiographs and those TMDS I mean, think about it if you’re just moving as an orthodontist. If you’re just bringing teeth back, you’re not moving bicuspids or molar and you just reclining back a few millimeters, I don’t know if X ray or stuff is needed, we’re talking what 16 aligners at most, maybe 10 aligners at most, less than three months. These are the type of treatments we’re talking about. Beyond that, I’ve seen them request X rays and Perio probing and additional information. Now, does the patient follow up with it? No, I’ve seen patients come to my practice saying, You know what, just tell me how much your cost is, again, they educated the patient. Now the patient got burned out, and is finally coming to do the work through a potential practitioner. So I see it in both realms. I have not seen pop up shops necessarily take X rays, but then again, it’s up to the doctor, the clinician to request it if should they wish [Jaz]My only concern is like you from a scan, you can’t tell who has got periodontal bone loss because sometimes you get pocketing six millimeters and you think that gingiva was fine. So what about those patients that could be because we don’t want to be doing orthodontic movements on teeth that, obviously are involved in active periodontal disease. And the other scenario to discuss as dentists here because it’s a dental podcast, you know, it’s not for patients is trauma, history of trauma. So one of the things I will check for, amongst other things is Okay, have you ever had trauma before, because then you’re significantly at risk of root resorption. If you’ve had a trauma as far as orthodontic treatment, we know that so is that part of the screening within Smile Direct Club? And it’s great. If not, then perhaps that needs to be a discussion that we should have as clinicians who want to at the end of the day, it’s all about patient safety at the end of the day. [Payam]So let’s talk about Smile Direct Club, what they provide, they provide a portal, they provide a process for clinicians, state licensed clinicians, they have a few 100 of them, but for them to look at the photos, look at those 3d scans. Look it from all different angles of the patient’s really gum tissue, if they want and want to request the perio probe or an x ray, they can. Remember Smile Direct Club, what they’ve done really well is they’ve kind of created this process and software and an app where the patient 24/7 has access to a doctor or to a call center. Think about even in my office, I’m working Monday to Wednesdays, Thursdays half days, they only have access to me at that time, right? So Smile Direct Club provides this basic portal, if you will, in process, what the doctor does with it is like in your case, you look for trauma. In your case, you look for periodontal issues. And if the scan is not enough, then they do request for that. I think that’s the misconception that doctors don’t know and I didn’t know. I didn’t know that there’s actually a doctor behind every case, there is. Now some doctors have dedicated their entire practice to this. Some doctors are actually practicing orthodontist, few of them I actually met that there was a meeting that I got to meet a few what they call ELPs. And these are doctors within the smile direct network. And they’ve been kind of like really proactive about fine tuning. What case are we going to ask for x rays, what case do we know if it’s just simply closing? Do we really need because that the scan images is a really good image you can see gum tissue, you can see puffy gums. But if you see red puffy gums, and on the photos, red puffy gums are there even at the Pop up shop, you’re taking photos, then they’re going to request that and that’s what the portal allows them to do. [Jaz]Some dentists will say that, well what kind of system is this because aligners don’t work without IPR and attachments? What would you say for that? [Payam]So, here’s been my experience. For rotations, 20 degrees or more, you’re going to need an attachment. For extrusions, you’re going to need an attachment for short clinical crowns, you’re going to need an attachment, IPR if you’ve got teeth that are overlapping. And even if you have greater than four millimeters of overlap, you know, I am just for your doctors listening, I just use the dummy version of a perio probe, you know, I just show it to my patients. Look, here’s a perio probe here’s what three millimeters looks like. I put that horizontally over their teeth. And if I could show them, this has got two or three millimeters of overlap. This is going to be an area where it’s going to be a problem. We may need attachment, we may need to put your teeth on a diet, IPR. You know, I kind of say that to them. Smile Direct Club, if you notice a lot of their cases are spacing cases. A lot of their cases that go through the treatment are this minor overlap. There’s no extrusions, very limited posterior movements, very little rotations. So when you look at the type of patients and you look at the before and afters on their social media posts, you’re going to notice out, these are like four or five month type six less than six month treatments. But the image that the dentist has is they’re treating everybody. Well. That’s not true because you have at least what 70% of patients out there that have class one bite with minor crowding less than four millimeters. That was one of the aligners statistics they used to teach all the time. So that’s who they’ve tapped into, they’ve tapped into that market, those aligner cases that you do that are three to six month cases. You know, I don’t think these patients even want attachments, or they even want to have that, you know, they’re looking for the cosmetics, literally, [Jaz]It’s a really simple case. And if I can do it without attachments, in the old time, I would it makes sense. So it kind of paints a picture of the ideal avatar ideal case forSmile Direct Club And why it can work without attachments and IPR. So I get that. But then it’s also like, I guess the danger is patients doing something and then not being happy with the end result, but then not really realizing that actually it took to get the desired result, they should have had IPR and they should have had attachments. So how do we educate? The problem is how do we educate the patients so they can make a better informed choice whether they do go ahead with a limited outcomes with Smile Direct Club? Or they get the whole cake with by going to a dentist, just like you said, how can we educate those patients so that they can make better decisions for themselves? [Payam]I think this is where Smile Direct Club is really making headway with their Partner Network, right? So the doctor partner network is really their way of saying, Guys, look, we’re here to help you, we’re going to get these patients regardless, we have our doctors, we’re going to reject, you know, these potential six or seven patients potentially, it’s going to land maybe on your lap. So if we can at least agree that give us a crack at those simple case like myself, I had a patient who had wore aligners 10 years ago, okay. She didn’t wear her retainer. She came to my office, and she had started getting diastema between her anterior incisors, and a little bit of rotation on the lower anterior crowding, right? So I asked her, I says, Have you been wearing your trainer? Oh, no, I lost it. I’m so sorry. All right, well, you know, what am I going to quote her? It’s going to be another 5000. It’s going to be another 2000. It’s going to be you know, 10 aligners, 15. And she felt as if I owed her aligners because she paid me already. Now remember, she did this 10 years ago, and I’m looking at it. I’m like, You know what, I have a perfect solution to your problem. She says, What is it, I said, you’re going to need retainers, retainers are at least 500 bucks, you’re going to need at least some sort of an office interject which it’s got to be at least 1000 bucks on my end. I’m going to give you this opportunity of using Smile Direct Club, you get your retainers, you get your and you have the treating doctor, I’m still your doctor for your everything else. But because you weren’t a good patient and didn’t wear your retainer. I don’t feel comfortable charging you another fee. But guess what, all of this is built in for you and they get lifetime aligners. That was a perfect candidate because she had a small diastema, little rotation that would have worked less than three, four months changing her aligners and she wanted to only wear it at night, they have this nighttime aligner that works perfectly for her, this is where Smile Direct Club has really done well in my practice, because now I know that there are certain patients A) it’s affordable B) It’s a remote, the patient is a rep. It’s funny, the patient’s dental rep, by the way, should have known better to where the typical, she’s always traveling. And so this remote version, and the telemedicine really helps her, there’s an app 24/7 she can reach someone because she told me Oh, I tried calling your office and 10 years ago, I gave you aligner to try calling my office like when, right? So I think there’s room for growth if this partner network is a tool to help educate these patients, in my opinion. [Jaz]Well please educate me because what does it mean by lifetime aligners, what does that mean? [Payam]So SDC, smile direct club gives lifetime aligners. So let’s say they lose their aligners. They don’t wear the retainer T shifts, they’ll do it again for them at no charge. [Jaz]Wow. So this is essentially [Payam]Things could change, but that’s as of today. [Jaz]Okay, so let’s say that a patient has correction, and they wear their retainers for like six months, and let’s say it was a rotation and typically a rotation will relapse. And it was the patient’s own bad life choice not to wear their retainer that they can just pick up the phone be like, Hey, I have a Give me some more aligners. Okay. Is that essentially the way? [Payam]That’s what happens. And I think it’s, they might do a $90 charge for additional retainers, but for aligner tooth movements. Currently, they’re not charging the patients. I can’t do [Jaz]Yeah, we can’t. We can’t do that. But this is splitting me how I feel about this because A) I feel like wow, this is amazing for patients who are just, you know, because patients have relapsed all the time. So firstly is as a consumer Wow. But as a doctor as a dentist, my concern is it’s almost encouraging a bad behavior. It’s encouraging repeat orthodontics which is obviously associated with risks, gingival risks, resorption risks. So I don’t I’m not quite sure how I feel as a consumer, I feel great. As a doctor who’s paramount importance is patient safety, lifetime aligners, I can see why they do it. But the that is almost like an encouraging behavior. How do you feel about that? [Payam]Well, so look, I am sure that they put some parentheses in that I’m sure that not every patient is going to go through. But from a clinical standpoint, I know aligners are the safest, right? So we talked about root resorption, there hasn’t been a single indication of the tooth just stops tracking, right, the aligner pops up. So there’s no real bone hitting the apex of the root and the root getting resorb. Periodontal issues, Let’s say the patient had to have a crown done, or had to have, like you said some other dental treatments, Is it really fair to the patient to pay something, you know, when you say lifetimes, you got to think about what the patient’s necessities work, because during the life of the patient, they’re gonna go through some dental treatments, right? They’re gonna go through some sort of filling maybe some sort of crown, maybe a bridge. So the reality is, you’ve got to kind of look at it in a general sense, and not look at it from a, I am always a positive person. I’m always like, hey, you know what, that’s great. That actually helps. I’m sure there’s boundaries, because I’ve heard one of my patients pay 99 bucks again for a retainer. So I’m sure there’s some fees associated to it. But the word lifetime, to me, what that tells me is not necessarily encouraging bad behavior, but rather that patients are going to be caring more about their teeth. So think about it. And this statistic, I can give you, four out of 10 patients, okay, they just did a poll, they said that they brush their teeth, they take better care of their teeth after Smile Direct Club treatment, right? Because now they want to protect their investment. So I think it’s actually encouraging better oral health rather than encouraging bad behavior, because there’s a whole parameter that they have to read as to what lifetime aligner means, right? New crown, new this, new that. So we have to kind of be a little bit more the complexities of, I guess patients mindset is different than us as clinicians, right? [Jaz]No, and that helps. And I appreciate that answer. Thank you. Next thing as a someone who does orthodontics, if my patients were wearing their aligners for nighttime only, that doesn’t sit well with me. I trained them, have to wear it 22 hours and stuff. So how does the science within orthodontics? How does that work in terms of nighttime aligners, what’s different about these nighttime aligners that allows it to even work at a, you know, as a biomechanical, biological level? How does tooth movement have that happen? For less than 16 hours of movement, or at least 12 hours? If it’s just nighttime? If it’s eight hours, Please enlighten me, [Payam]Right. So much slower pace. That’s how it happened. So we need three things that I mentioned time, space and pressure, right? You put enough pressure, you put enough time, something’s gonna move, right? The problem is osteoblastic and osteoclastic activity happen when there’s some sort of trauma introduced, they move much faster, right? So if we create some sort of traumatic event, now you get that cellular activity, if we don’t, what happens you put the pressure, the tooth kind of moves, and hopefully the next aligner creates that momentum going and going. So the nighttime aligner torque has been altered. It’s their own secret sauce that they’ve put together, I can tell you that I had a patient. Again, diastemas are perfect. And you know, small spacings are perfect. I had a patient who wore his aligners. Instead of taking literally three, four months, he took a little longer took, I think, nine months for him. But his teeth were closed, and it looked fantastic. And it was in retention next time I saw him because I see patients once every six months when they’re doing these types of treatments for their cleanings. And I think that the torque and the tooth movements, instead of being that traditional 0.25, or the 0.3 millimeters changes. In my mindset, look, as long as they’re wearing the aligners and lifting a little over 10 hours, you’re gonna get some sort of movement. Now how much torque? Believe me there’s pressure built in, right? And there’s your trauma as long as they wear it. So in my mind, I can tell you, I’ve seen all types of patients, the most compliant ones are the ones that you kind of fit their schedule into your schedule and create a treatment plan based on them. If you tell them this is the way it is. I’ve always done it at they’ve had a few that fallen off and they just don’t comply. So I think this is a good option for patients that are willing to wear it, they’re an attorney in the morning but at night they get home they can pop it on, right? Let’s try that and I think time, space, pressure with their torque it’s I mean they have results as a, was a 1.6 million cases that Smile direct club has treated and a fair good share of my when my time [Jaz]What I would love for to happen is an opportunity for research. I mean because because because lot of studies like imagine you’re designing a study and you’re like okay, we’re gonna give these patients like what Invisalign aligners from dentists. And we’re going to compare 18 hours wear versus nighttime only wear. Now, with my limited knowledge of ethics and evidence base, with my limited knowledge. I feel as though that that would not pass the ethics committee because they’re like, Well, are they potentially getting a substantive treatment because from the from what we know about biomechanics, it might not work. But because the SDC are able to offer this option, it’s a great opportunity to collect data, and then that could then in the future, help to inform us in terms of okay, which malocclusions, which movements, which kind of patients benefited from the nighttime aligners, and that could really be a massive paradigm shift. Because to me that makes like, Whoa, how is that possible? But you’ve obviously told me that our patients are happily wearing retention now after having teeth straightening. So I’ve got to change the way I think this and I think it’s I really do hope there is some documented research that happens from this and presented and I think this is how, this is the bridge between Smile Direct Club and dentists becoming stronger, which would be an opportunity to advance orthodontics. And, you know, having shorter time orthodontics is an advancement of in our field. Okay. So I hope and if it’s not, I would love you to feed that back to them. Because we want data we want something to feed and change our paradigms. [Payam]Yeah. So to that, yes, there’s actually a few opportunities there. They’re, number one, let me just back up, 19 years ago, when I was doing clear aligners, nobody wanted to participate in a research. It was Invisalign. Invisalign, even the Dental Board didn’t accept it, I actually was, I call got a call from California Dental Board about billing a non orthodontic appliance to an insurance called MetLife. That it’s not considered and what is this Invisalign? What is this thing you build? Right? So, until that has actually been accepted until we as clinicians really start to take in and do what you said it accepting this, you won’t see much research, however,Smile Direct Club on their own. There’s research going on, there’s one in South Africa, there’s had researched r&d that’s running it. I mean, I’m aware that there’s a huge study going on with the whole nighttime aligner versus the actual PDL, ligament movements. You know, there’s a couple of schools that they’ve gotten involved with kind of running these types of different cases, yes, you’re gonna see things coming out soon. But it could have been even faster if us as dental community would accept it, and say, Hey, I’d like to be participant in this r&d. I like to be fair, because, you know, for the first few years, I remember I myself, did I rejected the mess of $2,000. Are you kidding me? $2,500, for you’re undercutting me, but now that I know what cases they do, how they do it, who their doctors are, I kind of get it. I’m like, Yeah, this is actually this could actually work for us for those minor tooth movements. And eventually, it could actually be scaled as a good partner for other treatments that I want to give my patients with a clear aligner treatments. I mean, again, I’m agnostic of who I treat [Jaz]What’s in it for you? And like, for example, if a dentist in the UK or US whatever, decides to become a partner, like essentially like a pop up shop within a dental practice, what’s in it for you? [Payam]Yeah, so we get paid for our time with the scan and taking those impressions. So we actually get paid for that timeline that we’re spending with the patient, just like you would send the patient to a scan, like a CT or some type of a scan, same thing. And financially, it’s actually pretty rewarding, because what they’re paying us is our actual time. And at the same time, we get to have these patients come to our practice, they get to see our office, they get to experience our staff, some of them have their own dentist, and they say, My dentist doesn’t agree with me being here. I said, I’m sorry to hear that if you want to ever change or we’re here for you, otherwise, I send them back to their dentist. We’ve actually been very successful in gaming, I can tell you easily we gain, we get about 15-20 patients per week that come in for a scan. And we gain over 50% of them as patients literally that we know for cleanings, for fillings and you know, I have to do an exam, I bring them on a different day to do the exam. We just get the scan done. We don’t want them to feel we’re upselling them dentistry, but we tell them, hey, if you like and you need a checkup, we’d be loved to be your patient, be your dentist for you and keep you as a patient. So I think that’s also an opportunity other than getting paid for our time. [Jaz]One thing I really want to do in this interview is come in a mindset of open mindedness and when I’m when I pitch this to my communities that okay, I’m going to speaking to a representative SDC. You can imagine that like what Okay say this, say that. And I was like, no, no, I’m gonna come in with an open mind. And you know, let’s be positive. And so far, I think we have have gained some positives. And I hope you felt that I’ve challenged you as well, equally. That is it. Okay. Is that kosher? And I think that’s a good debate to have. Now, yeah, I see that as a benefit for the doctor. Because automatically, I think that most patients who have orthodontics from me will benefit from some edge bonding, some composite here and there. And that gives a, you know, an opportunity to get some work done. That is another avenue of gaining patients, like you said, so I can get it from your perspective, how that’s happening. So that does clear a few things up for me. How is this model being done worldwide? Or is in the US only in terms of partner dentists? [Payam]Yeah, so the Partner Network gives these patients the opportunity to come to the dental offices in the US that I know of, I’m not quite sure internationally or globally, what they’re doing, I do know that they’re planning on rolling it out. But for us, it’s only a year and a half or so old. I mean, when I came on board, that was the main reason,what’s in it for me, you know, Why would I do this? And you know, there’s patients that come in now, sometimes what’s called a, they’re middle of their treatment. And, you know, we still gain them, because the reality is, some of them say, look, I kind of feel like I need to do more, I like what they did, but I need to do more. And right away smile direct can either continue as a patient, or they can now fast forward to us and we can kind of address maybe they need an implant, maybe they need to do veneers, maybe they need more aligners, and I can now go at a discounted fee for them because they’ve already paid 2000. So again, it gives them an opportunity for us, I don’t know, globally or world wide if they’ve rolled it out yet. I hope they have. It’s a great opportunity. [Jaz]It’s an important question to ask. And so how it works and stuff so people getting a fair insight into what’s happening. So I think in October 2019, maybe 2019 and 2020. Apparently, California’s governor signed the legislation requiring dentists to review recent X rays before prescribing orthodontic treatment. So as you know, I would always take PAs or an OPG for that, as my you know, I was taught, and I feel that’s a good because I want to see the roots and you know, you want to, you don’t know which patient is gonna get root resorption and stuff. And then Smile Direct Club sued California Dental Board accusing or trying to squash the competitive threat. So the board has filed a motion to dismiss the suit now. And that’s what happened. So where is this sort of friction happening between the dental boards And Smile Direct Club? And where is it because that was a few years aga, here is that movement to now? And are the dental boards a little bit sort of together with Smile Direct Club in terms of okay, if you’re going to be treating patients, let us make it a safer experience now. So where are we in that regard? [Payam]Right. So based on my knowledge, right now, that’s the case has been settled. And there is a little bit of kumbaya happening. So the doctors now can ask and the patient can upload images or X rays of their own, if they already have it from their existing or the partner network has been really a big one in California that they’ve kind of scaled this out. So that opportunity is now where smile direct has made some adjustments that the patient can get those x rays to the treating doctor. And more importantly, other boards are starting to kind of understand this is access to care. This is a remote type dentistry. It’s tele-dentistry. So maybe the doctor can get behind the computer, see the patient and request either a visual or a potential radiograph from the patient. So it’s working out a little more positive. I know that back in 2019. And I’m very well aware of that, because that’s around the timeline when I started investigating SDC. But they’ve settled and again, there was another case in another dental board in other states want to say New York or somewhere that’s also been so now there’s the boards are kind of I don’t want to say working together with SDC, but they’re not as they kind of understand the model that there is a doctor behind the wheel. And that doctor is responsible, so that treating doctor better get the things he needs or she needs to get to treat this patient. Versus the misconception was, SDC is doing it and as he’s like, look, we’re providing this platform for doctors and patients that come together. This telemedicine is what really been doing since 2014. But unfortunately, you know, the boards viewed it that SDC is the one that’s treating these patients. And finally, I think now there’s been light shed of how the workflow is and those treating doctors licensed doctors are now responsive and they can request it. So I see it as a positive. But look, it needed to happen. I mean, it happened with a line. It happened with aligners too. You know, these are class two medical devices, they are made for regulations, and you have to know what’s going in patient’s mouth. So I’m not against that, I just want to make sure that other doctors understand the process and the opportunities given with an open mind, just like I now have become, because look, there could be another aligner company that comes up and says, you know, we have this version of doing aligners now, or we have this, and you have to give an opportunity to see exactly what it is that these companies offer. And to me, it’s education to this public. It’s treatment to the public. And I like to be on the, I always say, the cutting edge, not the bleeding edge. So I’m asking [Jaz]That was a tough question. That was a tough question. I think you did. Just so well done for taking that tough question. Where do you think is gonna go in the future in terms of bridging and getting rid of this, if that’s the aim, I’m sure it is animosity that many dentists and orthodontists have towards Smile Direct Club. Like, for example, like on that note, did you feel like you were like entering the dark side? Initially, when you and you sort of said, Okay, I’m gonna be fine, or did you feel like oh, my god, what am I doing? [Payam]Oh yeah, my other aligner rep, my Invisalign rep, my quick rep, every one I said look at do you see all the logos on my I have Spark, I have Invisalign, I have ClearCorrect, I’m agnostic, because not every patient is going to accept the type of treatment that I have in mind. Remember, it’s when you look at it, I have multiple composite fillings that I feel the patients with, there’s one that’s two millimeter of cure, there’s one that’s four millimeter cure, I use some proposed. Same thing with aligners. I think Smile Direct Club is perfect for this minor tooth movement, remote type of treatment. And it’s ideal for the I like to say access to care, but at the same time, I believe the dark side is going to go away slowly, as new doctors come to the market, like the older doctors, it’s very even, it’s hard to even convince them about Invisalign. Let’s just be straight here. I mean, you get those 30 to 40 year old age doctors, they’re kind of okay with Invisalign. They may not quite understand Smile Direct Club yet, but you get those younger new grads, and they’ve seen social media, they’ve seen how it works, these doctors are going to change the dental market, I will tell you, my son, I see him if he becomes a dentist, which I hope, I see him being more behind the computer and setting up, you know, even remote type of treatments, than just the way we do it where we have to have tactile feeling, you know, I mean, you have caries detection that are just simply with a little scanner, you can see caries, you can see you know, Periodontal that’s coming out, you have AI happening, you know, Smile Direct Club is actually working on that AI technology right now as we speak. I don’t know if I’m overstepping my bounds, I’m telling you, but reality is, they’re really advancing. What I feel is the future of dentistry, Invisalign is doing it. You know, I see 3M kind of slowed down a bit, I’m hoping them catching up again. But the reality is, that’s the future so I’ve kind of done away with the older generation of dentists, including myself with the white hair. I think the newer generation gonna have a much easier time accepting and not calling it the dark side. [Jaz]Very good. And would you be willing Dr. Ataii take one more tricky question but I have sugar coated it, so it’s not like the question that the dentist, the dentist want me to ask a specific in a specific way, which involves like, waiver forms and that kind of stuff. I’m not gonna go there. The way I’m going to ask you, the way, I’m not gonna go there, because I think that’d be unfair to you come and give me a good time as a representative of Smile Direct Club. So I want to be it, puts you in a fair way. So there are some avenues I could take, which will be I think, unfair, let me ask you in a fairway, which is even when I do aligners, things sometimes go wrong. Okay? Sometimes my patient ends up with an AOB when I didn’t intend for it to happen, or sometimes a posterior open bite, and then I do some corrections. Or I find that a patient develops, or my colleagues come to me when patients develop TMD, because that’s kind of thing I’m interested in, and then I’m there to help the patient where the most important thing patient safety, so when things go wrong with any aligner treatment, okay, and let’s say yeah, let’s assume let’s make them a number that 5% of all cases, okay, hopefully not 5%, 1% Of all the treatment that I do with the aligners, there’ll be a complication. And let’s say that we apply that same 1% to Smile Direct Club or any brand of aligners. And then sometimes you need a doctor on board to help out. How can the patients, the people public who get Smile Direct Club with remote doctors get the help they need? Because sometimes you need just a special eye cast on it. So is there a dedicated support network and how does it work? [Payam]So that is actually one of the key questions that I looked at the very first because like I mentioned to you before, my office is Monday through Wednesday, half day Thursdays they only have access to me three and a half days. That’s it. Smile direct club has created not just the app, but the portal that 24/7 At any time, they can call customer service, customer service where triage either goes to a hygienist or to the treating provider. So that portal if the patient and I can tell you out of 1,000,005 or million six cases, there’s going to be a few cases that didn’t go the right way. Right away. I was actually involved in a just doing some consulting with one of the docs and says hey, there’s a smile direct patient and she’s getting recession because the teeth are proclining forward. And I said well what did they do? They said nothing customer service go went to the treating doctor, treating doctor did a visual like a face to our What is it like a zoom type? And you need to get to a periodontist. You need to stop the aligners, stop where you’re at, go to a periodontist. They sent the patient to the periodontist, periodontist said yes it’s procline, you had recession, there were some abstractions, you know, you just don’t go any more forward anymore and start the intrusion. And they brought came back and she started with some intrusion and they stopped so she wasn’t going to really go forward anymore for procline the teeth anymore. And I thought that was a great example of how this 24/7 access to care helps. Because right away the treating provider the stabilized treat I was actually contacted. That particular doctor has his own practice as the patient that comes to practice. She’s like, I’m like 600 miles away, I can’t get to you then I gotta get you a periodontist. Smile Direct Club aided the patient in finding a local perio. It’s the same way if the patient comes to my practice and I get a posterior open bite, how am I going to triage that? Either I have to cut the aligners. I have to do some IPR and bring it back. So in my mind, hopefully those cases don’t happen. But out of a million I’m sure it has. But that’s the one story I can tell you that I saw that they took care of it right away. Now, there are patients who don’t wear the aligners at all, right? And now you’ve got a whole different problem, right? They got, now you got to go back and start them all over again. They didn’t wear the aligner, they have a cavity now you gotta go get clearance. So but the ones that are active treatment and something goes sideways, they stopped right away by contacting Smile Direct Club and they guide the patient which way to go. [Jaz]Who’s checking there? Because when I see and this just me just being curious that we’re not you know, I see my patients every I know some people are way more remote but I see our patient every four to eight weeks, you know, depending I’m just seeing how is tracking going, any issues and stuff. Do they get like check ins with a doctor they have a zoom every six weeks? How does it work? [Payam]So the work that the way it works is that they have a little self check that they have these little cheek retractors and their own camera. So every 90 days, I think it’s like it used to be 90 now I think it’s 60, they do little photo they take the front side side with aligners and with aligners off, upper and lower. They send that in Smile Direct Club at that point has their own between treating doctors and their own back end because I’ve seen hygienist, I’ve seen treatment coordinators that are kind of like watching these patients from there. If there’s a problem they don’t fit the you know, they don’t check box, all the bite is okay and all those things it goes to now the treating doctor. the treating doctor then scheduled a zoom call or some sort of a communication with the patient to either continue or go to a small shop get rescanned. We got to read retool it. So they do have self check ins done through the app. Again, it used to be 90 days, but I think they changed that to 60 days now. [Jaz]Okay, brilliant. I really appreciate your time, Dr. Ataii. And I think it’s, you know, difficult to stick your head up and say okay, I’m you know, you’re brave, I think, and I thank you for coming to speak about a difficult, and I think it’s a very sensitive topic. But I think you represented yourself very well. And like, I’m not here, and I’m assuming somebody out there. I’m not here to promote Smile Direct Club, I’m also not here to just put you guys down because I wanted a environment like, this is a forward thinking podcast, that’s what Protrusive is about. And I want it that is not SDC, whether we like it or not. We’re out there. You’re aligning. So my perspective I was coming from as okay, what’s the safety like, let the dentists understand the workflow. And so I go away now from this chant, thinking, Okay, I’m glad that of all the cases that you see, seven, or six to seven are rejected, and that makes you feel better. And then those cases that don’t get attachments and IPR, I get it, I still have some concerns. And that’s normal as a dentist to internalize some of the stuff. But I feel as though we’ve what we’ve covered today gives the dentists an insight and they can make up their own mind where they stand, but I do think the other end is conversation now. I do feel that you have helped the reputation of Smile Direct Club amongst dentists for sure. And I think you’ve held up really well. So I really appreciate those tough questions that you that you answered. Thank you. Are there any points that you would like to finish with while you have the microphone to dentists all over the world? [Payam]Yes. So first and foremost, never judge, you have to always, again, I’m a practicing dentist, and my patients come first, right? And always, always, we have to have the standard of care and financial means balance. So I need to make money in order to keep my doors open at the same time without standard of care to make sure I treat patients. And that’s what I think smile direct is doing. I think what they’re doing is now Smile Direct Club is kind of balancing with this partner network with this, educating, with the kind of pushing to the dental community that look, we’re not here against you, we’re here to actually help you. Because you’re not planning on picking up a car and driving 2000 miles in some remote area to treat these patients. We’re going to bring these patients to you. And I think that marketing itself again, patient education, has really helped, I would say the dental industry, we just have to now see how we can create those guidelines to make it fit for us. Jaz’s Outro:So there we have it, guys a perspective from Smile Direct Club. Thank you Dr Ataii. And like I told you the intro, I could have approached it in a different way. Like, there are so many things I could say but okay, I don’t want to land myself in legal trouble. I told you that guys already. And also I wanted to respect the human, the human that was with me, and I think he took all the questions in good faith. He was smiling back. And if you listen to this, you didn’t see a smile. He was very good. He was a good sport. So let’s commend that. And I think there is a lot more to be discussed in a super private episode. Maybe one day who knows. But I think for a public, this podcast has gone Spotify and everything. So I hope this scratches an itch and gives us some insight into, you know, I learned a lot in terms of how Smile Direct Club aligners works, okay? Has it changed my opinion? It has a little bit in a way because I like the fact that it rejects a lot of cases and it should and I think it allows for us to have these conversations because like I said, whether we like it or not Smile Direct Club are here to stay. So let’s have those conversations to bridge the gap between them and us and hopefully, we can ultimately work up to patient safety, the highest level of patient safety. So hope you enjoyed that and I’ll catch you in the next one

Is every dental CPD/CE really awesome? I think the best investment I ever made was in postgraduate courses, but with escalating costs and ever-expanding choices for courses, how does the confused Dentist pick a course? Is there a toxic culture whereby Dentists are afraid to give less than perfect reviews for a course? https://youtu.be/Idgy1YfXaTY Need to Read it? Check out the Full Episode Transcript below! The highlights of this episode: 7:07 Importance of Feedback on Dental Courses 23:17 Too Many Positive Reviews! 27:22 What kind of learner are you? 30:11 How to Choose the Courses you should take Check out the book recommended by Druh Shah called The Long Game: How to Be a Long-Term Thinker in a Short-Term World by Dorie Clark If you enjoyed this episode, you will also like Being Unstoppable with Ferhan Ahmed Click below for full episode transcript: Opening Snippet: Are you six months later still using stuff from that course, right? Are you still, have you changed your practice because of that course? How was the after support, how's everything like that? Jaz’s Introduction:You know how we always moan that dental education at dental school is kind of letting us down and we come out qualified. And we feel underprepared. This episode is kind of moaning not about undergraduate dental education, which I’m actually, I’m not moaning I want to say but we’re debating okay, because I’ve got Dhru Shah and Niall Hutchinson, we’re debating about the current state of art when it comes to dental CPD or dental CE, so that’s continuing education, continuing professional development, all the courses that we go on, after dental school, there is kind of like a toxic culture. And I spoke about this, in the previous episode #AskJaz. And this is what sort of stimulated or created this debate because in that episode, I kind of answered a key question where people are saying, Should I do this course or should I do that course, this course because it’s a significant investment. And all the reviews are really confusing. I don’t know which one to pick. And I kind of said, well, it kinda doesn’t matter. Because from all these reviews, you’re probably very unlikely to go wrong. But then after the episode, I’ve had two of the Protruserati who I really respect and really loved, they messaged me, and they said, Jaz, I’m really regretting, they said, Thanks for tackling that topic it’s not really spoken about enough. But they said, I’m doing this course, one is a restorative course very well known UK. And the other one is a very well known orthodontic course in the UK. And these two guys, these are like course junkies, that course connoisseurs, they’re no like spring chickens that are just doing their first course they’ve done several courses. And they reached out say, You know what Jaz, you had a point because I kind of went by the hype of this course and the reviews. And I’m extremely disappointed after investing, probably in five figure course here we’re talking about, so not a cheap course. And education is worth every penny, I think. And we can go on and on talk about value and the importance of implementation to gain the most out of courses. But essentially, these two guys who are really great dentists, they were left disappointed. And I think that stems from the fact that whenever we search about reviews of courses, we always hear that this course is amazing. That course amazing. This course is life changing. So how do you know which one to pick? Well, the way I think about it, everything in life, everything in life, okay, that’s the quality of dental care that we give, or the quality of the lawyers or teachers or the quality of food that’s out there in the world. Like it’s everything follows a bell curve. There’s most of it, which is average and maybe above average. And then there’s a 5% outliers on either side, which are just abysmal and absolutely awesome. But when he read the reviews for courses, apparently, every single course is damn awesome. And so it becomes very difficult to pick. So I you know, where are the the course reviews that say this was a solid 7 out of 10. Well, there’s a reason those course reviews don’t exist because of the culture that exists that people are afraid to give reviews, which are less than 10 out of 10 because it’s a small world in dentistry, and we are afraid to be ostracized. We are afraid to get backlash from educators. Maybe the real reviews are exchanged at 2am at the bar in confidence, looking over your shoulder. Is anyone listening? Yeah, that course. Yeah. It wasn’t as good as said on Instagram, right? So this is the kind of debate we’re having a little bit controversial. It’s funny how this episode came to be. This was actually a random impromptu Friday Night Live episode recording that we did. And one of my guests Niall, he is actually in the car driving. So for those of you watching, you won’t actually get to see much you’ll see a pitch black. But for those listening, you’ll gain a lot of value from this. It’s quite a stimulating debate. It’s quite different from what I usually put out, I guess. But this is an interference cast as like a kind of like a non clinical interruption. Ultimately, this is completely unscripted and straight from the heart. If you do for some reason, wanted a video of this episode, I put it as unlisted on YouTube, which means that you can’t actually searched for it, you have to go on the protrusive.co.uk website to access the video. Why? Because this is the kind of themes that we discuss are not relevant for patients. And I don’t want patients to come across this and one of the best things that to come from this chat from this episode is the birth of a Facebook group which I shall not name and I’ll explain why in a moment. But this Facebook group was created by Niall, one of my guests, based on conversations that we had literally the next morning Niall set this up as a safe place for dentists and colleagues to post their mistakes, because we learned so much from our mistakes. So it’s all about creating a safe environment where we can learn from each other’s mistakes. It’s completely different and unique type of learning. The reason I’m not giving you a ‘Hey, join our group. Here’s a link’ kind of thing is because I want to create friction. I want to make it difficult for you to join this group. So only the right eyes and the right hearts join this group. What I mean by that is I don’t want people to join this group because they want to see all the perforations that I’ve done, all the interproximal elbows that I never prepped for veneers and I share those on the group so far. And it’s not a place for us to come and laugh at our colleagues even though you can anonymously post and that’s fine you know, you can share your story, you can share your communication errors, you can share clinical mistakes and whatnot in a safe environment. But part of the way that this is a safe environment is that not anyone can just join willy nilly. So if you join the Protrusive Dental Community Facebook group first and find that then you can find a link to join this group. And even then, you know, like direct link, you have to comment and then one of my colleagues, Krissel, she will fact check, you she will like do an ID check on you, she will stalk you online to make sure you are who you say you are, you’re actually a dental colleague, and then you’ll get accepted. What this does is it creates a very safe environment for us to share our mistakes. So it’s a great wonderful, beautiful thing that formed as a result of this episode. So hope enjoy this episode eye opening, fascinating, controversial maybe. And I’ll catch you in the outro Main Interview: [Jaz]Welcome to the first ever Friday Night Live Protrusive Dental podcast with another first ever guest Niall Hutchinson is, not with his red wine. I’m the one with the red wine, we switch roles. He’s driving, my first ever driving guest and of course a veteran to the podcast, Dhru. How are you both? First, I’ll start with Niall. Now, how are you mate? [Niall]I’m very well thank you very well, it’s been a busy week but yeah, fantastic. Thank you. [Jaz]I’m so again like I said, before we started recording, I’m really glad that you didn’t have your red wine with you. But you said you’re recording at Payman and you can do that podcast with red wine. So we’re very much looking forward to that. [Niall]Yep, absolutely. That’s coming up. [Jaz]He might cut in and out so we’ll have to just as it comes in. Dhru, how are you mate? [Dhru]Great. I’m great. How are you? Welcome I think it’s nice to be back actually [Jaz]Mate, you always fun guest and obviously I’ve got your juices flowing says it’s gonna set some context because some people, Niall, your connection dropped for a bit but now you’re back so great to have you back. Guys, he’s actually driving so those listening in the future, I have a driving guest. It’s pretty cool. It’s pretty funny fit, funny for me, actually. So let me just set some context guys, before we just start picking your brains. The context is earlier today or yesterday, I’ve lost track of time. Last night I published an episode #AskJaz number two. And the first question on that one was, Should I do, I’m confused young dentists, Should I do the Paul Tipton course? Should I do with Chris Orr course? Should I do the Richard Porter Aspire course? This is like up there? And the question like the most common question we get along with which indemnity provider and which composite heater etc, etc., right? So really common question. And these are mini episodes that I make they’re completely unscripted. So I just went off on a ramble and I said, You know what, there is a toxic culture, that you’re always going to be flooded with positive reviews. And because we’re all nice to each other. Well, I believe that, I want to believe that there’s a niceness in us. There’s a fuzzy niceness in us. And that’s why we don’t post negative shit about each other. Because it’s a good thing. We don’t want to be, you know, negative and defaming people. However, there’s a fine line about bad experiences and people making decisions based on social media hype when it comes to courses. And so I posted that on Facebook and you guys jumped in. So I’ll go first with you Dhru, you’ve been you’ve had a number of hours now to reflect on this very controversial post. Where do you think we’re at just just summarize situation, the landscape in your words? [Dhru]What’s the filter? Listen, I, I personally think that we’ve seen an explosion of courses in the last few years, when I pretty much started Tubules signing of 10, well, 13 years ago, but when we probably went into the education side away from the forums, it would have been about 10 or 12 years. And at that point, the real problem was the lack of information and the lack of you know, the education being out there, and I’ve been seeing it for the last few years, we no longer have a lack of information and education anymore, we now have a lack of attention and focus to doing what’s specific. And where we are now is that Yeah, there’s just, there’s more courses than we can, you know, I mean, I see the amount of courses going up and actually there’s a lot to think about there. [Jaz]Niall, what about you, my friend? What’s the landscape in terms of your thoughts on that post? [Niall]Yeah, I agree with you entirely. I, in fact, that made me think why hasn’t somebody produced the independent review site where you can anomalously, the problem is with you know, you get these feedback forms at the end of the course or you get the video in the middle of the course or the course hasn’t even finished and you’re sort of they no come up and say a few words to the video. And you know, you’ve got no choice but to be nice, you know, really haven’t and I can tell you there’s two or three courses I’ve been on not over the last few years where they have been frankly shit and they expensive courses as well. And I filled in the feedback form saying basically this is, you don’t want to put this as shit. But you go in the other totally ignored. And [Jaz]What it is, right? Is if it was a good, okay course, you give it a five. If it was shit, you give it a four. [Dhru]Yeah. Because we’ve had a couple of, you know, even Congress we’ve had feedback where we’ve had to take things on board and take it on the chin. And I’m quite happy to say this. But actually, you know, one of the congresses, we had someone go, this is the worst course I’ve ever been on in 30 Plus careers. My thought, wow. And actually, our team broke down in tears. But the truth of the matter is, we appreciate honest feedback. And we personally went to this person, and found out what exactly are the things that didn’t work out for them. We’ve had this a handful of times, but I think the feedback forms have got to be honest reviews, but you can only give honest reviews as a delegate on the feedback form if you trust the course provider. That’s why we can get the honest feedback that we get, because they trust us to follow it up to action on it to change it. I mean, every person who’s come back with any kind of feedback, have actually said, I’m coming back to the next Congress, and that one person has turned up three times after the first negative review, and seen those changes. And that’s the power of reviews if you do them properly. But there’s no reviews, those are feedback, understandably [Niall]Probably is, you pointed out, there’s this FOMO herd mentality at the moment, you know, wherever he goes, Oh, I’ve got to go on. So and so of course, it goes through this course, go through that. Now, it may be that just it’s, you know, not a great course. But everybody just seems to want to do that at the moment. You know, I can think of a few course providers are a bit like that at the moment that everybody wants to do it. But equally well, the thing is, I know people trust you Dhru but you had one negative feedback, it’s a bit like getting one patient ringing up and complain about you how many have left quietly, you know, because they didn’t quite trust you or didn’t fit felt awkward to actually give you what they were really thinking. I personally think there’s more of a scope for it more of an anonymous field, which, you know, where the feedback could be given in an anonymous way away from the course, maybe just after the course or whatever. And then I think people would actually probably be more honest about what they thought in the course about the course. [Dhru]I think that’s, I agree with that. But I’m not a fan of anonymous, because anonymous means you’re hiding behind a wall and doing things and the truth of the matter is that both parties have to build enough trust with each other, to be able to do that. I would want a patient come in the same way that I’m in dentistry, I don’t want a patient complaining anonymously. And my patients trust me enough to know that they’ve got a problem, they’ve got a concern, they’ve got anything, I am approachable enough for them to tell me what I need to. So maybe there’s an issue here about how we operate with our communication in dentistry, generally, you know, and most course providers or dental providers, and communication and trust building is one of the most powerful psychological tools. Now that puts a question out there straightaway, away from reviews, how many course providers think about come on and learn about communication, psychology, human, you know, thought processes, behavior processes to create the conditions that allow that honest communication to happen. Yes. Another interesting question to put out there. [Niall]Yeah. The problem is, I think that dentistry is a small community. All right. And there are a few, let’s not get into the dentistry top 50 again, but there are a few people who have strong, let’s say strong opinions of themselves, you know, that they really do. And as a result, and don’t forget that courses bring in an awful lot of money. They are much more profitable than any dentistry would ever be. All right. On a daily or an hourly basis, or whatever would you call it. So they are very keen to keep these courses going and people coming in. And I think people go, well, A) it’s a bit like the emperor’s new clothes. For some of them. It’s like, Oh, everybody else thinks they’re, Look, everybody else is saying they’re brilliant. And you’re the one that’s scared to come and go oh, no, they’re actually a bit shit. You know, and I thought it was a pretty well, they can be very strong egos these people who run these courses, I just did run the course not no disrespect, Druh, but I mean, I even though I’ve got quite strongly opinion, I wouldn’t run a course. I didn’t think I’m good enough to run the course. Yeah. But there are a lot of big egos out there. So people get sort of bullied into sort of saying, Oh, I don’t want to say anything bad because they might block me or they might not, you know, I might be a part of the gang anymore. Oh, you know what I mean? So that’s why we’re come back to anonymous. I don’t, I agree with you. I don’t think Anonymous is not useful. But there’s there could be some way of feeding in that it wasn’t anonymous to a central party, but the central party fed the stuff on [Jaz]Independent adjudicator. [Niall]Yes. [Dhru]Yeah. [Niall]So basically says, Yes, this is genuine feedback from a genuine person, right? But it gets fed on anonymously. [Jaz]But I want that feedback to be presented in a balanced way on that. So let’s say you go to a course provider page, and then that feedback should be like, Okay, so from the reviews that we’ve seen on social media and what we’ve collected, we find that overall, most people have a, you know, a good positive experience, a few negative we had a focus around the catering. Now, someone can read that and think, okay, know what the catering is amount me, and therefore, I’m gonna go on this course, because this course is good. But for those people who, you know, who go to courses for the catering, then they will know that, okay, this course, I’m just making this up, obviously, just give an example, and how this could be used. But that is one way to consider it. [Dhru]I think this but there’s two things to think here, Jaz, and that level as well for course reviews. And I think the important first thing, the important bit is that whoever gives a review, good or bad is giving their meaning of it. Now, as you’re aware, many of the courses we do at to build some of the lectures, we do film them, because the lectures allow us to do it. And then I distinctly remember, there was one, where the, when we looked at the feedback, the person left some really heavy feedback that the lecture was not polite to me, or was obnoxious, whatever it was, I reached out to this person had a very good chat, I then reviewed the video because the conversation and everything was there just for my feedback to say what’s happened here. And there was a total loss of meaning, locked on both ends. And it was almost like someone had misinterpreted it in a different way. And so whether it’s anonymous or not, or whether it’s a negative or positive review, you have to remember that it’s not the most direct interpretation of things that happened on the course it is the meaning derived for that single person. So that’s one of the first thing [Jaz]It’s like restaurant reviews, like restaurant reviews. Yeah, they can, I do think is a bit. It’s a bit personal taste involved here. There’s a palette involved here [Dhru]That’s right. [Jaz]There’s a palette for educational work [Dhru]There’s a palette involved, and there’s a there’s an art form, but then then you bring the second point where you talked about catering. And so one of the biggest strengths in trying to arrange reviews or workout reviews, is we’ve got to have some criteria. And since Niall didn’t want to bring out the top 50, it’s the same argument I say. What’s the criteria, right? It’s but the question being if you build some parameters around which you can make the judgment, now it’s a level playing field within that area, [Dhru]So like objective data with many parameters collected for all the educators? [Dhru]Yes, correct, then you get a trend, you’re never gonna get obvious. It’s right, you get 90 positives, 10 negatives. You get 85 positives, I don’t know, 15, negatives, whatever. But then it’s not just one course. The other thing to then note is you look at reviews across courses. I’m making this very complicated I think.But you look at reviews across courses, now you see a trend appearing. And in that trend, in that objective criteria, you get a better long term judgment of what’s being derived. There’s a third factor here. And I think now it’s pointed this as well, you go to a course and somebody says, Listen, I’m going to, I want a video at the end of this course, can you give me a testimonial? Yes, that’s got value at that point. But the biggest value is the biggest impact of that course is when I go into practice, and the changes I make in practice and the results I see of those changes. So one of those criteria is about so you do another review and feedback six months, nine months later, and that impact factor. Now it makes sense when you add all of these things, what’s the trend of things happening here? That’s what the key should be. Not ‘I went on this course last Monday. Here’s my five star review’, which is brilliant. Because you’re writing on the emotions of that course, you will write something positive, it takes a long time for the emotion [Dhru]The after support as well for cases and mentorship thereafter, which is also really crucial for courses. [Niall]Absolutely correct. All of these things bring into the review system that we need to think about. Sorry, I’ve rambled on [Jaz]Any points because I’d point wants to hear you out. [Niall]But the problem is with giving, the thing about giving feedback on the day is there is this sort of Fear Factor or bullying factor or whatever you want to call it or even just put it in a positive way, and exuberance factor. You know that you’re going Oh, fantastic, brilliant, loved it, you know, really nice. They really enjoyed it. So I’m gonna give it brilliant review. You’re absolutely bang on right, are you six months later still using stuff from that course, right? Are you still, have you changed your practice because of that course? How was the after support? How was everything like that? I must have had this interesting Just hearing you say Dhru that when you give negative feedback, you chest up. The two times to tell you, either I’ve given negative feedback and horses never contact us or not interested. Now, of course, stop making the the opinion of them even worse. But I think the problem is, it’s far too easy. We see quite often on social media, people were photos of their feedback forms, going, Oh, look at all this brilliant feedback I got on my course you know, and you go, yeah, but that’s not really mean that much does that you sort of semi bullied them into that. Then they but [Dhru]There’s another point here as well, Niall that it’s this showing the feedback, but actually, I want, you almost want to know, not from the course provider, but you want to know it from the person itself about how that course met their learning needs. That’s slightly different isn’t about who’s actually showing that feedback, because the course provider will show you the feedback. And same with us, the Tubules. I mean, you know, course providers showing that feedback, look how amazing we are. Yeah, clap for me, please. But actually, the real bit has to be the real impact of a course is when the person who went on that course tells you how to change their practice. [Niall]Yeah, absolutely. 100%, it’s made it better for you, it’s either work easier and more profitable, whatever way, whatever quality you got out of it, you know? Is it still there in three months? Six months? I mean, you know, there are courses I have done. Yes, that has totally changed in my practice. There are courses I have done more when, you know what, it was the CPD hours and ultimately hasn’t changed anything at all. And the thing also, I find that the moment, you know, think courses have got ridiculously expensive? [Dhru]No. [Niall]No? [Dhru]I’ll tell you why. Well, because we run courses all the time. And, you know, the genuine cost of elements has gone up. Now we, we run courses at such a way that we try and limit the amount the companies have to just give as equipment or materials. Tubules, we buy as much as we can simply because we don’t want to think that there’s influence of companies or anything like that. Companies do come and support it, but we buy as much as materials, but the cost whether it’s Brexit, inflation, I don’t know what it is. But the cost is generally high. By time you include speaker fee, the venue fee, okay, we’ve probably, I mean Jaz, you’ve probably come to some of the courses you know, the hot food we like to give or whatever, we almost make it personally yours perhaps because the numbers we keep small, it might be all of these, but actually the genuine costs of just event management have shot off massively [Jaz]And the VAT. I just want to have in there. Exists, just because it doesn’t for dentists it does flip and flip way round. [Dhru]Ladies and gentlemen, this episode is just been dedicated to Pav Khaira. So yes, you’re right, [Niall]The VAT including course you have to charge VAT and in looking in the course VAT is it? [Dhru]We put it in the course fee as a veteran, just company, we’ve just put it in the course fee. It’s included. But you’re right, they’ve got I mean, Jaz you’ve had the same experience, I suppose the cost of just shot through the roof. [Jaz]It’s a little bit different in the way that a lot of stuff I do is online as well, which helps keeps costs lower, right? But ultimately, what it costs, the educator especially for community based learning why I run is mentorship thereafter and being there for everyone and dedicating time. And that’s something that’s really important for courses. But the main reason to get a go have you guys on tonight is to see if we can come up with some sort of a solution. Druh, you’ve offered some ideas now you’ve offered some ideas. Probably the best one that I saw in on the Facebook group was someone who suggested, I’m so sorry, I have my phones over there. And I can’t go find exactly who it was who suggested this, but some sort of a website or a group where you get to see the course name, a little bit about the course. But you don’t get to see the reviews or whatever. But you get to see who has attended that course. And the people who have attended they get permission that can you know, you can see that I’ve been on this course. And then you might say, oh, you know, well, I went to dental school with this person, like, you know, 15 years ago, I trust this person, they’re similar to me, let me message them and get their sort of advice on how it was and they can independently without the course organized knowing what they exchange give their okay know what it was good. I found this useful, but the support hasn’t been as good but is definitely better than the other course I did. Like they can give some real good advice, which when you ask on a big public forum, like on Facebook, you just gonna get flooded with positive feedback and the negative feedback will probably be private message. [Niall]Yeah. You know that I thought that was an excellent idea. And I do think that some of the there does need to be some sort of independent, you know, forum where people can find out more by courses because it is just too bad, towards nothing but positive reviews. And we’ve all been I mean, Jaz, you must have been on some courses that you thought God, this was bit shit. I mean, have you been on courses? [Jaz]Yes. It’s only because I critique the education very seriously. And I always think of it as, okay, the learning points. How can I apply this on Monday morning? That’s a mindset I come from so when I find that when I’ve been on some, you know, five figure courses, and I feel as though the support wasn’t there thereafter, or a regret, you know, you get like, Yeah, I know there’s buyer’s remorse when you’re buying material things but when it comes to to knowledge, I don’t think you can ever regret it. Because knowledge is knowledge, it’s always a good thing. But when the fact on Dhru’s point, if you don’t get to implement it, because of whatever reason, I either mentorship, the support wasn’t there, or the way that the course was delivered to you. In on this point in the way the course is delivered to you was it was teachable. And people always educated say, You know what, I designed this course to be teachable. That doesn’t mean anything to me, as a learner, I want the course to be learnable. It should be about learnability, not teachability. That’s why I’m coming from [Niall]Yeah, I think [Dhru]I think you’re spot on. Yeah, [Niall]I think you’re spot on. Dhru said earlier about communication. I think what you mean is almost people need to be taught how to teach course, people, anybody can throw on a course at the moment. I mean, I can throw in the course and be awful, but [Jaz]That would be brilliant. Maybe it’s nice red wine, and we love all the different rights you actually do. And I would definitely go to yours [Niall]Would be fantastic journey on my course. Now the catering would be amazing. It would begin us on top. But No, but seriously, but anybody gets through on the course it doesn’t mean they can bloody teach. Yeah. And then. And that’s a big issue. I mean, how many I mean, I don’t know if you’ve got any, your kids aren’t old enough, probably guys, but my kids have been through university, they’ve both been to Durham, and then. So good universities, what was their main complaint? Half the lecturers couldn’t teach. I’m sorry, half of them can’t teach. So they’re charging, sometimes 800-900 quid for a day course. But they can’t actually teach [Jaz]100% my wife is doing a master’s, I’m not going to say which one or where. And I get to sit in on some of these webinars that she goes to. And I’m like, this is death by PowerPoint. These are specialist teaching. This is death by PowerPoint. This is not acceptable. And I completely agree with you. [Dhru]I mean, we don’t agree with bullets, knocking people out. And people try and do this with bullet points. It just doesn’t work really I think we have to. But there’s something big here. And again, I take it step back, because we introduced a really strict QA form on Tubules. For every course now to approve it. Well, we’ve added for a couple, three years now. The QA form is 13 pages long. So anybody wants to run a course with us has to go through this QA form. And in that Niall, we actually, you know, ask questions like, does your course actually identify the learners need before they arrive on your course? We ask things like, does this course, you know, what’s the teaching experience of the educators? But also, what is the presentation experience? Or what is the experience of the educator in terms of having delivered this kind of teaching, the surprising the variability you get? And one of the biggest things is you say, if you can do dentistry, and you want to translate that knowledge doesn’t mean you can teach, you can share facts, but sharing your experience so that somebody can take that experience and you know, supercharge what they’ve done, that takes some serious skill. [Niall]Yeah, and there are some very good, don’t get me wrong, there are some very good educators out there, some very good teachers, but they tend to be the ones who’ve gone, maybe done more advanced degrees, they’re not just a simple BDS. They’ve gone through maybe a level of hospital or university, you know, the so they learned how to lecture through that. You know, there have been some courses, the education has been absolutely brilliant, the teaching has been absolutely brilliant. I’ve just been on far too many where you’re going. Yeah, you’re just flicking slides up, basically. And that’s all you’re doing. Yeah, it’s a bit [Dhru]And this speaks another bit. It’s about how you interact and engage the speaker. So do to answer your question Jaz about how can you make this really usable? I think, look, factor one has to be, you know, you can talk to somebody who you know, trust to give you the information. [Jaz]Because you mentioned something earlier on Facebook, which I think is really worth mentioning now, is that the only person who can really give you the best opinion is the guy who’s been on both Aspire and Tipton and Richard, you know, and Chris Orr, the guy who’s been on all three is in the best position, but that guy’s a unicorn, right? The only there’s only two people in the whole world that come close is Muhammad Sharjeel, if you know him, he’s been on every single course in the world and course connoisseur, Anya Sienska these two people if they said things good or bad, believe them, okay? Everyone else word depends. Have they have the experience? Have they tasted the other educators? Just bear that in mind, based on a point you just said [Dhru]Yeah, I think that’s that’s really important because nobody can compare it. And then people will say this the best course I’ve ever been on I go, compared to what? And this look, we’ve got to flip the game, I’m going to play this differently to say the flip the game in the sense that millions of courses out there, somebody turns up and goes, I want to go on a, I’m going to use an example. I’m going to go on a prep course. And you see the same, this course is excellent and the same name popping up. Now the first cynic in me says, Say names popping up in this thread. Is it being happened are a genuine will? Or is there a back end private group pushing this and that’s the cynic in me saying this. But but that’s because of course has been going what we have to do is that the learner themselves have to realize not just improving crown preps actually figure out what specific part of the preps they want to improve, and how are they going to learn best? What’s the best learning for them? Is it interactive workshops, group lectures, and find a course that fits that, right? That’s a level of intelligence you need because forget course reviews, you will always get good review when these factors connect in life. If my if you know what I want to learn from a course and what you want to learn from a course Jaz and what you learn to learn from a course Niall, it’s completely different. Our experiences our concept of [Jaz]But the really tangible here, I want to learn crown preps. Okay. I go on Facebook, I go on fourth with this bio dentist, I type in Crown prep course. Okay, and every thread I go on, it will have the same names over and over again, I’m still none the wiser, I don’t know who to choose. Alright? So help me. [Dhru]God. Of course, one, your question has to be a lot smarter. It has to be not just crown prep course, it has to be, I wouldn’t go on a course that improves these aspects. Because you’ve got to have, as a learner, you’ve got to have that much insight to know what you want to improve, and how you want to improve it. And two learn like this. Now you put those questions out there, and then say, Does this course actually give these specific details of the way I learn and what I want to learn? So that’s not just this course is excellent. How does this course deliver these things that helps you make a better informed decision. When we talked about informed consent for too long, but the informed decision becomes very important here, because that is powerful. The second thing I’ve also learned, [Jaz]From Niall, in terms of that point. Niall, any insight onto choosing that crown prep course as an example? Or [Niall]What’s interesting about that, though, the problem is, you’ve got you pick out a learner, who has got some insight to what’s wrong with them. But quite often, the learners don’t know what they don’t know. So what they’re doing is they’re going I want to get better at crowns. I really don’t know what I don’t know, it’s not the tough times until you go on the course, example I did, I’m driving home from during the Botox clinic. That’s why I’m sort of driving home. And I did Botox started during the 12 years ago, I went through the general course, I didn’t know anything about it. I then went back into the very specific course, because I worked out what I didn’t know. The problem is coming out of dental school when they’re young. They don’t know what they don’t know that dumb luck are old nowadays in dental school. So for them to at the very start, that they don’t know what they don’t know. So therefore, you know, it is still difficult for them to choose. And I think, you know, you put your second point there, Dhru what you’re going to say? [Dhru]No, I was only on that point, what you were gonna say I say one of the biggest things that learners need to do is develop that art. Now I will talk about the four P’s of growth. And one of those Ps is people. And what I say is you don’t know what you don’t know, because you interact with people on what course I should choose. Instead, maybe you should take a step back and interact with trusted people to put your stuff you’ve done out there and say, here’s a crown prep I have done, what do you think? Get objective, useful feedback from people who you trust and who you know can give it to you. The right people, the right process, the right way to give you the feedback to you for you to understand what you don’t know. And that’s, you know, I mean, I say it’s about study clubs. That’s where study clubs are reported or whatever [Niall]It should we have, instead of having, showcasing I know, this is sad, again, you go on to showcase, all the brilliant work that’s done, especially all the composites have been touched up with Photoshop afterwards. No that doesn’t happen. They know but seriously, should we really have a shit dentistry Facebook page, you know, this is a, you know, this is my cock up of the day, you know, experienced dentists going look at one wrong hair, you know, or Mike, you know, whatever. The problem is, people get put off you say, well, they should put out what they’ve done. I mean, Even I as I’m 35 years Dentist, even I am scared to put photos up of my crown preps or of my this or of my that, because I’m looking at some of the stuff on there and going God no Jesus Christ, I’ll just get ripped shreds over this, you know, then they, you know, it is scary to put that out there. Do we need to get some more comfortable environments where people can put them out there and it will be soft? Like the mathlete. [Jaz]That environment is not Instagram firstly, that’s not the right environment but let’s create that environment because I love what you said there. We should have a shit dentistry page where we can is no humblebrag so you just post your cock up and that will make everyone feel like you know what? We’re on the level playing we all make mistakes and I think we need to have that and it reminded me five days ago someone posted on one the dental groups, I don’t know if you must have seen this both of you, some IPR that was done that was on lower incisor and it went in pretty much went into lower incisor probably millimeter half, two millimeter shy of the pulp. Okay. And what I love about this dentist who posted this is that A) that takes balls to post that firstly B) they said look, I already, they said in the post, they said I already feel really bad about what I’ve done. So please, you know, just leave me alone like help me don’t, you know, don’t ridicule me, help me. And I just love that because it was so real like, you know what I cocked up, I admit it. I just want to fix this. What do I have to do? And even more than that I loved everyone’s replies, there was no animosity, there was no one like What the hell were you thinking? It was okay, don’t worry, get the aligner, fill it with composite, you know, let’s fix this and well done to posting and well done for sharing. And we need more of that. [Dhru]Well, we need more of that. And that was those brave of him to come out on him or her I saw the post on a public forum. But we really need and this is why I keep saying we need peer review groups. Trusted groups of small groups of people who really can talk to each other. Today, I feel shit, I can pick the phone up to somebody and say, Listen, I need help. That trusted group actually then understands you at a deeper enough level to recommend the right course to you. If that makes sense? Because they know not just where you cock up or where you’ve needed help. They know who the person you are. And in fact, there’s a good chance that perhaps a Jaz here, the whole group will end up on the same course because they share the same concerns and troubles. Now you’re getting more powerful delivery, of course is possibly [Niall]Thanks. I’ll see you. Thank you for inviting me. [Jaz]The best thing that’s happened from this conversation guys, I really enjoy talking to you. I’ll go wrap up. It’s a school night with the best thing has happened. Now I love your suggestion. Let’s do it. Let’s make it, let’s all three be admins and whatnot. Let’s make a group. We can call it something other than Shit Dentistry, or Oops Dentistry or whatever, like some sort of a page where, you know what you post your cock ups, it’s cool. You can do it anonymously, you can do it as yourself. It doesn’t matter. Let’s just love and respect that we all make mistakes. And I thank you now for coming up idea. [Jaz]See you. Take care, my friend. Take care. Thanks for joining us, Druh. Thanks again. It’s a school night for me. I’m at work. We’re gonna call it a day. But Dhru, any final points my friend before we say good night, everyone, and everyone has a lovely weekend, hopefully. Any final points mate? [Dhru]I think we’ve looked at most of these things. But for the younger graduates, my main point is suppose one last thing to add here is I read and I use an example of a book. I’ve read this book. And if anyone’s name, it’s called The Long Game by Dorie Clark. And I read this book a year ago, and just straight after I’d read Simon cynics infinite thinking, the infinite game, interestingly, both of the books were brilliant last year, since then, I’ve fired through loads of books. And I went back to these two books. And by the way, when I read books, I’ve read the same book about three times before I move on. But I went to those two books last week and finished them. And the biggest thing that came out of me was, have I read these books before? It’s so it’s almost think about, I’ve been on a course. And then I’ve done other dentistry, and I’ve done everything. And then I’ve been on a course again, and suddenly thought really was this the same course I was on? And so the biggest thing is what you’ve done in between, and how you’ve applied a lot of that stuff and how you change your thinking, how your concept changed. Now, I think anything that you do, whichever course you choose, however you do reviews, end of the day, you the person, the biggest learning is the application of how you do it, and how you change concepts. So you’ve got to apply, think and reflect until you don’t do that yourself. No matter what number of reviews and websites and crap turns out there. That’s not going to change your growth. To me that’s the important part. Yeah. [Jaz]Well said Druh and that reminded me of sort of stories are real quick. One chap called Asif Saeed, very charismatic, bloke, good public speaker, runs his private little courses doesn’t really advertise so much. But I went on one of his evening lectures, and he told me about a story about how he reads the same book every year. The one book for the last, I don’t know 10-15 years he has been reading that same book every year. And every year he reads that same book. The book is always the same, He has changed every year. And when he gets that book and it’s almost just like you said, it’s almost as if he’s read a different book, and how can we apply that to what we’re talking that you have to think about where you are in your journey, what is going to get you, what is gonna propel you forward. And it might not be the same course as what your friend or your colleagues thinking of doing your, what your principals thinking and doing. So you will maybe gain from a course in a completely different way to someone else. So I guess I’m trying to say is, trust in the process doesn’t mean you give up courses, but maybe ask your colleagues what they found. Find someone similar to you, the similar learning needs to get the best idea I guess, and again, that’s where that idea of have some sort of a website or directory now just to give a plug to everyone. Chris Waith had a fantastic comment on the Facebook group, please read it. Malvina Chandu, has already got a I think a company name or a website name, which is called Which Dental, to help people figure this kind of thing out, there was also dental careers guide. So lots of people message me and even privately messaged me saying, You know what, I’ve a lot of people have had this thought before. It wasn’t just me rambling today, it wasn’t for a lot of people have had this thought before, that wouldn’t be nice to have a website where we can collect data that truly reflects the course provider. But not only that, because not about the course provider. It’s about navigating that confused dentist who still doesn’t know whether he should do Chris Orr, Richard Porter, or Tipton or whatever, okay? So I don’t know if that’s gonna help them navigate the right person towards where they need to be. And maybe it doesn’t even matter. I don’t know, in these big courses, I don’t know. But it is a shame and I had a message today based on yesterday’s episode from a dentist who spent five figures on a orthodontic related course I cannot say his name, because if I do, then people figure out which course he’s on and he was like, You know what, I really regret this because when they were talking about topic A there were no visuals. And I’m a very visual learner. This is a real thing. And they were really gutted about the learning experience, despite the hype on social media about this course. So how do we protect people from falling into a course [Dhru]Like I said earlier? What’s your need? How do you learn? [Jaz]That’s it [Dhru]Someone asked that question said, I’m a visual learner. How do I do this? [Jaz]That’s fine. But how do you suss out which course is better for visual learners? Which course is better for that? We don’t have that because when you go on Facebook, of course, we need objective feedback. That is repeatable and I guess calibrated. That’s what we need. This could be an absolute pipe dream. I don’t know if it’s gonna happen. But hey, some reflections on a Friday night. Dhru, thanks so much. Niall, have a safe journey home, my friend. Thanks so much. Look forward to seeing you, Niall. I think next month or the month after we look forward to seeing soon. [Naill]Precision dental. Alright. Lovely. Thank you very much. [Jaz]Thank you guys. Good night, [Dhru]Have a great evening, guys. Safe journey. Jaz’s Outro:Protruserati, I’m Jaz Gulati. Thanks for listening all the way to the end. I kind of said that now. Because I forgot to say my usual intro at the beginning. Super, super, super busy man. There’s a lot of lecturing I’m doing. I’m doing my first ever full day on occlusion. I mean, the amount of hard work I’ve done early mornings, late nights to put this all together tell stories to build in lots of cases and stuff. So I’m doing this with Mahmoud Abraham from KANA Dental Academy in Milton Keynes. So life has been quite a whirlwind at the moment. So I’m so sorry, if I haven’t replied to any Instagram messages, Facebook messages, emails and whatnot. It’s been super hectic, but it’s all fun and games. And it’s the kind of thing I love to do. So thanks for bearing with me, the episodes will be coming thick and fast once I finish this little educational interruption, if you’d like. And then we’ll get back to the more heavy clinical episodes, which I know you truly love. Thanks again for listening all the way to the end. And thank you also to all those guys who tuned into live and then reached out and said, Hey, I want to help you to set up this sort of which of dental education, this trustpilot of dental education. And I think the way I’m gonna leave it is, well I had to think about it and super difficult to actually set this up. And to make it truly fair to educators and also valuable for potential delegates. So I’m having a meeting with Niall face to face meeting, I think end of this month to have a chat about how we can truly make this work. But watch this space. And I’ll keep you guys posted. The app is coming soon. I just somehow need to find a spare five hours where I can just finalize everything and release the app for you guys to enjoy. So good things coming very soon. But just bear with me. Thanks so much, and I’ll catch you in the next one

Virtual Hands-On Suturing Masterclass enrolment ends 2nd May 2022 – click here to get your hands-on kit + video instructions Your suture is the signature you leave on your surgery. I actually suck at suturing, and so does my handwriting, so I’m really not winning at signatures! This was a really selfish episode because I really wanted to improve my suturing skills – I enrolled on the Suturing Masterclass with Dr Cajee and brought him on to level up our sutures! In this episode, Dr. Nabeel Cajee will help you break down the basics of different suture techniques and share some tips for use in practice.  https://youtu.be/37rY0q6v2cg Check out this full episode on YouTube Need to Read it? Check out the Full Episode Transcript below! Protrusive Dental Pearl: Use the power of video messages to communicate with patients (think post-op instructions) or your lab technician (they love the detail). Currently I am using LOOM which allows me to seamlessly record my screen and my voice/video and creates a sharable link. “Excelling at suturing does three things, it helps patients heal better, less complications, eliminate dry socket. With good suturing, it allows you to grow as a clinician and take on more surgery cases” Dr. Nabeel Cajee In this episode we discussed: Dr. Cajee’s pathway to Implant Dentistry 4:03 Types of suturing materials 11:03 Types of Sutures for specific cases 17:33 Different Techniques of Suturing 19:04 Vertical vs Horizontal Mattress Suture and when to use them 24:05 Guidelines in tying the knot 26:21 How to Improve Suturing skills 30:00 Best type of Suture for a Functional Crown Lengthening 33:00 Check out the SUTURING MASTERCLASS (scroll all the way down the page) to gain confidence in your overall surgical skills with a hands-on kit to get stuck in! $70 OFF with code ‘Protrusive’ All of the Protruserati clan get $70 OFF the SUTURING MASTERCLASS with the code ‘PROTRUSIVE‘! Click below for full episode transcript: Opening Snippet: What was your first experience of suturing like? If you're like, my guest, Nabeel Cajee, then it was probably like, you know what, I got this, he had a background in embroidery Jaz’s Introduction:But for me, I was absolutely hopeless. And to be fair, I’ve improved a lot since the first days in dental school, but there’s so much I still need to improve on, which is why I found you one of the best people to teach on sutures. This guy is brilliant. He’s got a whole online portfolio of videos to watch. And it is something that’s really helped me and I’m continuing through his course. And I want to bring him on to share with you some nuggets of inspiration to improve your suturing come Monday morning. We covered this episode. But no, there are two types of courses, there are courses that you do, which will ultimately, it may not be the main goal, but ultimately it will improve your return on investment, or it will give you a return on investment. So I know that if I start placing implants, and I got an implant year long course, it might cost me a lot of money on this one year long course. But I know that there’ll be a return on investment, I can offer my patients implants. And that should reflect my bottom line. That shouldn’t be the reason I do the course, ideally, but it will have an ROI. There are other courses that you do, and other things that we’ve purchased like microscopes for example, or suturing, for example that you do because you know that you can give the highest quality of your care to that patient. One of the things that Nabeel says that when you place a suture, that is your signature of the surgery. I love that saying, right? And to be fair, from my experiences with suturing, I can definitely do with a helping hand hence why I’ve come to this sort of episode, I think I can share this with everyone to help you all. In this episode, we’re going to cover what are the types of sutures available. If there was one suture, you had to stock in the practice, which one would it be and why you might need to venture into different types of knots and different types of sutures. Protrusive Dental Pearl:The Protrusive Dental Pearl I have for you is something that we practice where I work in Reading. And every time we do an extraction, as well as giving the VERBAL post operative instructions, we’ll also give WRITTEN post op instructions. But one thing we did around about 18 months ago is we recorded a video, it was one of my colleagues, Susie in the practice, she has just explained to the camera, what you need to do exactly the same kind of stuff that we were giving verbally. But now through a video format. And after analyzing the stats after about a year, a lot of our patients are clicking on this. So even though they’ve been told verbally, even though they have the sheet, a lot of our patients end up clicking on this YouTube link. So essentially, after the extraction, the nurse knows to just go in the templates automatically send this email because they’ve had an extraction. And that’s got like all the reminders for them. And a lot of our patients benefit from this. So the pearl here is consider any procedure for which you give a post operative instruction, and you want to go really a level beyond then I think if you can record a video, whether it’s on YouTube, or one of my favorite programs now loom, you can visit loom.dental to learn how that works. So you make a loom video of you just speaking to the camera, it will be you in the corner, or you can make some big as well. And you just explaining the instructions, you can communicate whatever you want through a video message to a patient, I think it really adds to the level of care that you’re giving. I think it’s something that’s quite innovative. And this is 2022. So this is the future, I think this future is video communication, and being able to reinforce what you’re saying in the surgery through video. And I think that there’s an opportunity here for marketing when the patients, watch your video. And if you make it public, then anyone on the internet can gain some advice after extractions. And that can help you with search engine optimization. Or your patients once they watch the video that you know what my dentist is awesome. I’m going to share this link with anyone who needs it. Or the next time they need to give a dentist recommendation. They will, Oh you know what I’m going to recommend Jaz or Susie or whatever. Because after I had my extraction, they even sent me a video of them explaining everything I felt really well looked after. So Pearl is to think about, could you implement a video letter to your patient as part of post operative advice or any message that you want to send to them after the appointment? Let’s improve your sutures with Nabeel Cajee. I’ll catch you in the outro. [Jaz]What’s the pathway into implant dentistry in the US? I’m sure there’s many pathways, but what was your pathway? [Nabeel]Yeah, my pathway was really the year after I graduated at dental school. In dental school, I didn’t place a single implant or restore single implant. It was really right after I finished dental school, I found myself as a resident in a trauma center. And I was an advanced general resident and part of our charge was to restore all of the implants that the Oral Surgery residents placed and those were just tons of trauma cases. So my very first case, the day after dental school or mean starting in my residency was an all on four quad zygomatic. Honestly, that was my very first case. [Jaz]That’s the craziest first case I’ve ever heard of. [Nabeel] 5:45Yeah, it was like Welcome to Dentistry Quad Zygomatic and I just loved it. I just loved everything about like the implant prosth side. And then part of that year, I got to spend about four months just on oral surgery service. And I picked up a lot of like the base surgery skills that way. And at the end of that year, I said, it wouldn’t take too much more for me to be at the point where I could take my patients just start to finish, I want to place the implants right where I want them. I want to restore the cases as I want to. And that really got my journey started. [Jaz]It’s fascinating, I mean, as Steve Jobs said something I mentioned in the podcast and I’m speaking to a guest like to understand the journey. And since we have already hit the record button, you mentioned something really cool about your journey. Dr. Nabeel Cajee, welcome to the Protrusive Dental Podcast. It’s great to have you it’s late night in California. It’s early morning in Reading and I really appreciate you making time you’re a father of an eight month old girl, I love your Instagram, I love you sharing everything. And it just makes sense. So on that point of connecting the dots, it makes sense, your journey, your evolution, where it started in your residency. And there’s always in everyone’s journey, an element of luck and timing involved, like had you been in a residency where the direction and the mentorship and the cases and your first case was in a quad zygomatic, right? You may have been into a different niche within dentistry. But it’s amazing how that blossomed. And then now it makes sense with the suturing masterclass. We’ll talk about that later. But it kind of when you look back, does it make sense now how you have evolved in this direction in your career? [Nabeel]Well, honestly, and if I were to even dig further back, as a child, my mom would embroider. And she didn’t have any daughters. So she’d actually asked me to help her. So I think those base skills as a child, embroidering with my mom, later on, when given the opportunity and residency, it was just fun. It was just fun to jump into those surgery cases, and then build from there. [Jaz]And well, you’d like good at suturing straightaway, because of the hand skills that you had from embroidery? [Nabeel]I think that may have played a role just feeling very comfortable with needle and thread. But honestly, like starting right out of dental school, I didn’t know a lot of surgery techniques, I mean, suturing techniques, I think very few people leave dental school with this whole arsenal of suturing techniques ready to apply in various clinical scenarios. So I think I was inclined toward it. And then given the mentorship specifically of a doctor, Dr. Gaffapour for me, he really built my suturing skills as a resident and gave me a foundation to springboard from and that’s where then I was able to build from there and just grow, grow, grow. And I just love sharing it at this point. [Jaz]It’s interesting to know that because when I think back to my learning of sutures, I remember being I think it’s like, second or third year dental school. And it’s a five week course in the UK. And we get to like, it’s like foam, we’re practicing on foam. And I mean, this one guy, says a group of eight, I mean, this one guy will just completely hopeless, right? And the reason what prompted me to reach out with the suturing masterclass and speak to Rex and doing the course and I’ve got the models here, and I’m going to show them in a moment. So I love it. But the reason I got into it is because I had this incident where I was suturing and things weren’t going so great. And at the end, my nurse, the way nurses communicate to us, or DA’s for you guys, where they communicate to us in a very subtle and beautiful way that maybe you should do some see. And this is ‘Oh, you know, the implantologist? He does it differently.’ When they say he does it differently, that’s when you know that, okay, I think I need to revisit my suturing. [Nabeel]And I think that’s it, you seem like many GPs, at some point you don’t stay a basic restorative GP. At some point, interest grows. Some people it might be orthodontics, but some people are surgically inclined, and they want to build in that direction. So I think if you want to build in that direction, all of a sudden, you’re going to start doing more surgical extractions, get into implants, get into these surgical scenarios where you’re looking at tissue that you want to bring together. And you say, ‘Wait, if I want to bring that tissue more coronal, how would I do? If I want to bring it down, how would I do? If I want to close with tension? Reading those scenarios, how would I do it?’ And that’s all of a sudden where you’re like, ‘Okay, I know that single interrupted, but dropping the single interrupt is just art. It’s just not getting you where I want to go. So what could I do to actually get there?’ You’re out there to do that. [Jaz]You’re so right. With that question that how would I do that? And that’s the question I asked all the time. So in my three years, obviously, you’re in the implant field and you’re niching and your surgical background has influenced you further to go deeper into that field. For me, I’m very much a general dentist. I like treating all sorts of cases and I’m ortho restorative, but in the last three years, I mean, in the last few years I did my first like, full canine to canine palatal functional Crown Lengthening case, that was my first thing that I did in a way, that was a big feat for me. So then I remember revising, like, okay, and then one of the question was, okay, my sequencing writing everything down my protocol, you know what I’m doing something for the first time a bigger case like that, which is a step beyond for me, a step above for me. And one of the question was, how am I going to switch this? Is my single interrupted going to be enough kind of thing, right? So I lost the end. Okay, how would you close suture case? And we’ll talk about what type of sutures will be interesting to know from you. But that was one and then doing more wisdom teeth, from my experiences in Singapore and being influenced by someone called Nekky Jamal in Canada and his course and stuff. So yeah, definitely, I’ve seen the evolution of surgery. And that’s why I think I recognize that okay, I need to up my skills here with suturing and you’re the man to help me Nabeel, I can see that already. So let’s dive in with the first question, man. I was taught Vicryl, and Vicryl is a brand, right? Vicryl is a brand, it’s a PGA, polyglycolic acid. Right? So that was the first suture that was taught to us as students, and the sizes, which I think will really go down back to basics, just explain a moment about sizes and what it actually means for the newbie dentist listening. And that’s the first sort of suture that we learned, is that the universal suture? Is that a, if you only had one, would it be that one? [Nabeel]Great question. I’ll go back to what are the sizes of sutures. So there’s something called the US Pharmacopoeia system, and that’s what designates the sizes. So it goes, it starts off as 00. And that’s actually the biggest suture you can get. We will not be using that in dentistry that will be to like, pull muscles and big structures in the body together. And then it just goes further and further up. So, then so then it goes 1-0, 2-0 It’s all these O’s. But, generally in dentistry, we use between 3-0, and about 5-0, 6-0. If you get into more micro surgery techniques, and that’s say periodontist, that are now using ophthalmic grade sutures for really like Target papilla gently together, they’ll go even further to like 7-0, 8-0 using microscopes and all of that, but let’s keep it basic, right? For the surgically minded GP, I would say stick to a range between 4-0 and 6-0 right? 3-0 is a good one, a 3-0 Vicryl but what you’ll see is the larger the suture is the thread you tear the tissue more, you actually want a smaller suture. So 3-0 Vicryl is a good one. My one of my personal favorites is the 4-0 PGA, I won’t use the brand name because you can get any of them. That is a favorite of mine. However, when we look at sutures, we look at different categories so that you’ll see absorbability would be one, knot retention would be another, how long does it hold under tension, let’s see here. A price, the economy of sutures. And unfortunately, when you take all of those different categories, and you stack it against sutures, there isn’t one suture that has it all. There’s some that come close, [Jaz]I wouldn’t think so just like in restorative dentist. And there’s no one matrix system is best for Class II restorations and I was definitely expecting you to say that. Can you give us like a one minute guideline as to the Nabeel’s recipe book in terms of the single interupted in a normal case, would you use 4-0 vicryl? And then in for surgical cases, have you heard you or is every case so unique, depending on the tissues that you actually might change even between certain type of surgeries? [Nabeel]Yeah. So I would say this is with a caveat that in the right clinicians hand, the suture choice doesn’t actually matter. [Jaz]Okay. [Nabeel]However, there are sutures that are better for certain clinical scenarios than others. So to close some grafts, there are some periodontist that will use Chromic Gut. [Jaz]Yeah, what does that with that name like Chromic Gut? It just sounds like the, what was that name derived from just sounds horrible. [Nabeel]Yeah, it’s just in the gut being like the cat gut intestines, in chromic formulation to make it last longer. [Jaz]So it’s actually made from the intestines of a cat? [Nabeel]Maybe originally, but I think now there might be a little bit more synthetic material use in them. But those materials are more natural materials. And for me, I wouldn’t think about using a chromic gut in a grafted site because you do have more of an inflammatory response from the breakdown of the suture, but that’s me. I want something that’s like inert to the tissue. I would probably use a monofilament synthetic, which won’t trap bacteria, which won’t trap the plaque on the threads as well as wick bacteria onto the threads, things like that. But in the right clinicians hand it works, right? However, when we’re looking at cases, say, as a surgical GP, as a GP, you can do all the surgery cases, you want to as long as you’re doing them to a high level of care. And I think that’s where the suturing choice then does make a difference. Where if you were to be in a scenario, and you have to explain your work, and someone’s like, why are you using this sutures, that the best suture for the job, I don’t want to be the scenario I’m saying. It’s a great suture, it works in some people’s hands, but- [Jaz]I just use the same one for everything. It works. [Nabeel]I just use the same one for everything, I want to be in a position saying I use the best material for the job. And in that case, you have the different categories, which would be braided sutures, non-braided sutures, which is kind of like a twined rope, or fishing line, the difference in how the threads are laid out. The synthetic and natural sutures, and then the variances between them. So vicryl is a braided, synthetic, it has the advantage of not having a strong of like an immune response or inflammatory response as it breaks down. But it does wick stuff into it. It does wick debris into the suture. [Jaz]Oh, it’s covered in plaque usually in my hands. [Nabeel]Yeah, it wouldn’t. I mean, sometimes when I’ve used it, patients look back and they say I have something growing and infection, you’re like, no, no, no, you don’t. Just run the course. [Jaz]But the difference between your sutures and my sutures that when they come back to see you, you’ve actually got a suture to cut, but by time they come and see me after about a week, the patient may think, thankfully that oh, this tissue absorbed but from doing your course already I know that actually absorbability can take up to 60 days, I was like, what? Okay. So obviously my sutures are falling out and not absorbing. So that’s the difference between your sutures and my sutures, you’ve probably seen a lot of yours come back, or as mine has just gone ingestive. [Nabeel]Well, we could change that. I think some of that might come into a knot time. [Jaz]Yeah, exactly that. If I was to break down exactly the stage, I think my choices stuff is okay. It’s when it comes down to the knot. I’m sure we can explore a few tips there. Anything else that any sort obviously, it’s a podcast episode down day, it’s to entertain, it’s to educate the people driving and stuff. Any key point you want to call for we got the next question in terms of the wide sort of range of different sutures, even in terms of stalking them as a practice. But how crazy do you want to go like having different types? Is there a more economical way to do it? [Nabeel]Yeah. And I think you don’t need to have tons of types. I think vicryl 4-0, or PG 4-0 is a great one for like, your everyday extraction, things like that. And then having one like one other or two other synthetic monofilament say for more delicate positioning of soft tissue, a nylon 5-0 or polypropylene 5-0, those two sutures, a nylon or polypropylene 5-0, and a 4-0 vicryl that can carry you. [Jaz]I mean, if you speak to a dentist to let’s say works in an emergency clinic, and all they do is extractions. And that’s it. They don’t do any fine soft tissue work and they just get people out of pain, then the only one they probably need to stock to keep, in terms of law and economics would probably be a 4-0 vicryl, is that fair to say? [Nabeel]Yeah, I’d say a 4-0 vicryl. It’s a great suture for extractions. I’m not a big fan of the gut sutures for extractions, especially sometimes in wisdom teeth, especially if there was muscle pull, it just breaks them apart. So the vicryl can actually have some strength and fall out if the patient doesn’t come back for a follow up. [Jaz]Yes, I can vouch for that one. Nabeel, what are the most essential types of sutures now? What I mean is you know I can do a single interrupted, I can do a horizontal mattress and for coming to your course. That’s all I know. Okay? So what are, sort of like as a young dentist newly qualified, which ones do you absolutely need to know and then as you evolve your interest, what are the kind of sutures that you think that we should know as a clinician? [Nabeel]Good question. I think everything starts with the single interrupted, but and I think it’s good to practice anytime you get a chance to suture just drop that single interrupted, but at some point, you realize that doesn’t carry you far enough. So a suture that I think every dentist should know. And one that I want you to place tomorrow is the laurell suture, okay? Once, it combined, it’s a twist of the horizontal mattress that you know, and it’s one step above that. Right? Once you place the Laurell suture, you’re gonna get hooked on suturing. Because you’re going to look at your flaps come together beautifully. And you’re gonna say this one simple variation of something I was doing all of a sudden lead to a big difference. And so that’s going to be the next step. And then from there, there’s all the continuous ones. And I think it’s just gonna instill a fire in you to learn more and more. [Jaz]I think the continuous ones is something I’m looking forward to learn from the course. Because at the moment, I’m on like decision making, the kit and stuff. The kit just arrived two days ago, which I’m just showing this now. [Nabeel]It just cleared customs. [Jaz]Yes, so it cleared customs. So this is cool. Because speaking to Rex, I was like, Look, I wanna do this course. But I don’t want to do just the lectures only I want to experience the hands on like, Well, we haven’t really shipped out before. And I was like, listen, make it happen. Let’s see if we can make this international now. And I can, these blades made it through Man, these blades made it through.. [Nabeel]Amazing [Jaz]Yeah, I know, right? So you got all the different types in here. But these models are something else. And they’re the same ones. What I love is that the same ones that you use in the videos that you show, and the different angles that you show is going to be make it really good and amenable for me to practice those. So I’ll practice laurell, and the continuous. I think I know what to do, but I can see in the video, and then the pace that you go out was just perfect. But also there’s the ability to pause, and watch again and once again, which for me when I was previously looking at textbooks, and even online, looking at diagrams, or drawings and stuff, illustrations, I just can’t learn that like that I actually see someone to do it. And I think your point is great that you must implement, like you said, do the Laurell and do it straight away and when you do it tomorrow. When you I’ve learned sutures in the past, I’ve learned some way of on the extraction course and maybe just a little bit thrown in there, I do the suture, if I don’t do an extraction soon, I don’t practice that specific type of knot technique, you forget, you forget exactly that, oh, is it this way? Is it that way? And then in the, I’m already running late, and the pressure is on and my nurses looking at me like Hurry up. At that point, you’re like, Okay, single interrupted, the one that will pull out in a week. So I think it’s great to have that kind of resource to look back on. So I mean, amazing. So with those different techniques that you show, I’m looking forward to practice them on the models. One other suture that I uses the horizontal mattress and whatnot. So it’s particularly after an extraction like a purse string, grow everything together. And a variant of that which I learned when I was in Singapore is the cross stitch. So instead of going like as a square, you’re just going diagonally one across, it just makes like an X sign. And that’s something that I uses, a similar variant. Is that the main indication for a horizontal? And when would you actually use a vertical mattress suture? [Nabeel]Good question. So what you’re talking about is what we call the ‘figure of eight suture’ where you form an X across. And that suture is actually ideally used during socket grafting, because you can play something in the socket, and it’ll form an X or almost like a net on top of it. It’s a great suture. One of the issues I think you may have with those sutures, is when you tie your knot, it bounces up. Do you find it hard to get the knot flat against the tissue? [Jaz]Yes, yes, I know what you mean. [Nabeel]Okay, so that’s a tricky thing. And in the course, there’s something I called the ‘modified surgeon’s knot.’ It’s where you do three forward throws, two reverse, one forward. And that’ll help you get those knot tighter, just a little tidbit. But that’s a great suture to close an extraction site. But I want you to try the Laurell. The Laurell is going to change how you see extractions, completely change. [Jaz]I love doing so much more sectioning and elevating. So the need to suture here and obviously, with my evolution, I wanna be able to help I’m referring more to implantologist and I like to help him with the grafting. So I think that’s where it’s gonna come in. And yes, excited to learn the Laurell technique. When would you use a vertical? I’ve never had to use, probably because of lack of knowledge or experience. But what is the indication for vertical? [Nabeel]What’s the difference between the vertical and the horizontal mattress? [Jaz]And when would you use the it? [Nabeel]So the difference between the two and when you think about it, the horizontal mattress has two entry points which are basic, same mesial and distal, right? When you close and say you’re trying to bring together the tissues with a little tension, if you pull too tight on the knot, you choke the tissue, because it’s the knot is horizontal across. So the horizontal mattress can actually be used. I’m just going to give a clinical example. Say if you’re biopsied something, you can actually place a horizontal mattress at the base of it and cut your leash and out and it holds hemostasis, right? Think about that. But is that necessarily what you want when you’re grafting a site to choke the blood supply, that’s what you do [Jaz]I love the way of saying it choking, it just, it’s a perfect term to use. [Nabeel]So the vertical mattress takes the horizontal mattress and because now you’re looking at a more apical and coronal entry point, it does the same thing but doesn’t choke the blood supply. And so you’re trying to be really delicate and bring a papilla up together. The last thing you want to do is choke the blood supply. You could use a vertical mattress to bring the papilla up. [Jaz]Got it. Very good. I think as a GP doing more and more surgery, do you think a vertical is something that is a natural evolution sort of technique to learn beyond horizontal mattresses? Do you think it’s essential in surgery? [Nabeel]I think it’ll have its advantages, say bringing tissue up and not choking the blood supply very delicately like say bringing a papilla up, it does, however, for closing it, then you may want to look into, there’s suture techniques named after different surgeons for different scenarios. So we go over a lot of them, the the Laurell, the Biddle stone, the Ford, a lot of these ones meant for the scenarios of grafting and others. [Jaz]Very good. And when we come to tying the knot, I mean, you mentioned already make sure that we don’t choke it, tension free. Is there a description or a guideline in terms of tomorrow morning, when we maybe the suturing, how tight do you want to go? Is there a guideline? Is there a test and have you if you’ve choked it? How do you know you choked it? How do you know you’re too loose, like a lot of mine, guilty of being too loose, and I justify it in my head like yeah, you know what, I’m not choking the tissues, I’m not choking, but is there a guideline as to how tight they should be? [Nabeel]Blanched after you’ve tied down, what you want to see. And when you throw your knots down there, there’s various types of surgery knots. And so there’s the most common surgical knot is two forward throws, one reverse throw, right? So two times clockwise, counterclockwise, then you reverse it. And then there’s what we do that the modified surgeon’s knot, which is three throws, and it has its advantages and disadvantages, but what you want to see is when you do your first throw, you want to see those threads lay down nice and flat against the tissue, not with a lot of tension, because you don’t need a lot of tension. But you want to see that that first throw lay down flat. And then when the second throw comes down, you want to see it lay neatly on top of the first throw, that just locks it in. And then you add on a couple extra just to secure the knot. But it doesn’t have to close with a lot of tension. The knot doesn’t, it just has to lay down flat against the tissues. [Jaz]So lay it flat, but no blanching. And previously, we’re not we know now that we’re talking numbers and throws and stuff. From a background I come from the way I was taught was two in one direction, one in the other direction, and then one again, in the opposite direction, is that acceptable? Because I know there’s so many variations. Is that okay? [Nabeel]Yeah, that’s fine. Sometimes- [Jaz]But is that the Nabeel Cajee way? It wasn’t it? [Nabeel]You saw by it was like, Yeah, you can do that, part of my training was seeing special needs, individuals with special needs in the operating room. And one of our rules was that not better not come loose. Because if those stitches came loose, that patient has to go back to the operating room because you can’t see them otherwise. So and these aren’t patients that are compliant, they’re going to intervene, and they’re gonna want to play with their sutures. [Jaz]So this is under general anesthetic or sedation? [Nabeel]Yeah, under general anesthesia. So, if those sutures weren’t tight, we had to cut them and tie them again, if they weren’t secure. So we would do two forward, one reverse, two forward, one reverse, two forward, one reverse. Six throws [Jaz]Is that many times? Okay. [Nabeel]Whacking it that many times. I think that, in a general practice, you don’t have to do it that many times. But at this stage, I generally go 2-1-2-1. And the reason for it is if you see when you look at your knot, the two forward throws, it’s like 2-1-2-1, the knot just locks on itself, and there’s something called the square knot, which is generally one forward throw, one reverse throw, but when you look at it two single throws can actually unravel on itself a bit, but technically we’re stacking the actual surgeon’s knot. And that’s just so much more secure. [Jaz]Amazing. Well, you’ve answered my main questions I want to know about suturing and I think there’s a lot of nuggets there for everyone to go away with and when they place in the next suture to realize about okay, putting too much tension, the different ones available, but I think maybe inspired people for those who are thinking okay, I need to improve my suturing skills. What’s the next step? I think your course is the answer for that. Tell us about the making of this course. What is the mission statement, and how you think that this is changing the sort of way that we can learn sutures? [Nabeel]Who I had in mind when we made this course is essentially the surgically minded GP, someone who has been wanting to get into implants, or have been placing them for some time. And now see some of the challenges. Someone who sees, wants to jump into some soft tissue grafting, someone who wants to do some wisdom teeth, but there’s essentially a rule that I live by, which is only open what you can close. And so you’re seeing these scenarios, and you want to close them right. And essentially, it’s three things, you want to close these right, because suturing, excelling at suturing does three things, it helps patients heal better, less complications, eliminate dry socket from your practice with good suturing essentially. It allows you to grow as a clinician and take on more surgery cases. Because if you find that fun, well, why not have fun every day. And the other part to it is, I really believe suturing is the signature you leave on your surgery cases. [Jaz]Wow, I love that. [Nabeel]I really believe that. I love it. And I take great pride in this work. When I’ve done with a wisdom tooth case, I had my patient a mouth mirror and I say look inside, I want them to see the suturing work. And when they’re like wow, I’m not even bleeding, it’s clean, it’s just it helps everything. Suturing is not one of those skills you leave dental school and you have all of them. And my goal is just to give that dentist who really wants to get into these cases and do that type of work, as much as I can give them from my experiences, my training and understanding to be able to read scenarios on a clinical side and then apply if we want to move tissue in, up down, as well as a good understanding of the fundamentals, which would be what types of threads are out there? What are their pros and cons though these are the lectures of their own. [Jaz]That’s why videos are just so clear in demonstrating in terms of clarity of the lessons, the pace and the ability to rewatch again and again and again, because my evolution and it just came at a perfect time for me as I’m venturing more into Perio-Prostho, I’m actually going on in 15th July I’m going on, there’s a chap at dental school, Billy Asha’s in the UK. He’s a fantastic clinician and he’s doing a Perio-Prostho course. And I could see myself getting more into more Crown Lengthening case in the future, so I going on myself so get back on that question I was asked you, Crown Lengthening, functional Crown Lengthening on the palatal side of the upper canine to canine and you’ve removed some bone and then now you’re and obviously cut some gum away. And now you’re approximating the tissues back. Obviously, cases vary, but what is the kind of suture that you would use for that kind of case? If you were to visualize that case now? [Nabeel]So you straight across canine to canine? [Jaz]Yes I scalloped I removed about two millimeters of gingiva, scalloped palatal side, I did not raise any flap labially just palatally. And then just approximate the tissue. So why did I just did because it was what I knew I did between each papilla. I did a single interrupted. Okay. Is that okay? And then is there something else that could be a bit better than I probably use 4-0 vicryl? So again, the result healed fine. He’s now in full mouth rehab, he’s now into crowns. And I managed to gain the ferrule that I wanted. But that signature that I leave on my patients at the moment, I feel as though it’s going to be better now that I found you. But it’s something I’m working on. So is there any way that you would approach this kind of scenario? [Nabeel]Generally, whenever I’m laying flat tissue back against the teeth and you want to especially moving the papilla exactly where you want them to go. And that type of approximation. I look to the sling suture or the continuous sling. It’s just you have so much control over how the papilla get laid down. It’s amazing. [Jaz]And you covered on the course right? [Nabeel]It’s yeah, it’s definitely in the course. I had, it’s a great suture. It is a little tricky. I mean, I love that you jump straight into, like I’m not even going labial, I’m going palatal you know I admire your- [Jaz]I had a good mentorship, Nabeel, there’s a periodontist, Amit Patel, really sat with me and said okay, this is the game plan and he drew the diagram to me, and I had a little bit of experience, and I was doing more surgery in the last three years more than I ever had before, so and the case went brilliantly. I was really proud and really hard on patients. It was at the right time for me, but I know I’ll be doing more this next three to five years. So it was, your course came at the right time for me in terms of my learning needs. [Nabeel]Yeah. I mean, for a lot of those, for me, it’s the as I said, the continuous sling, I would probably have gone for a 5-0 polypropylene suture, or a 5-0 PTFE suture. I think for these cases, that the vicryl is a great suture. But when you see how, when you jumped to the 5-0 suture, the needle also changes, you probably have, what was used an FS2 needle, which is a little bigger, and the ability just to slide through these tissues and control them. And you’ll just see how gentle these sutures are then to the actual tissue. You know, you fell in love when you got married. And when you had your child you’re gonna fall in love again. [Jaz]Absolutely, absolutely. I love that. Buddy, thank you so much for giving up your time. And there’s a little discount code that implant ninja team have given us. I’ll share that in the outro with everyone so that they can check out your course, I’m excited to learn the Laurell. I’m excited to go back and see what I should have done with that crown lengthening case. But one thing I wasn’t saying in the intro as well is there are two types of courses, maybe right there, these courses which do have some degree of return on investment, like if you go on a certain type of, if you’ve got an implant course learn how to place implants, then you hope that in five years’ time, you’re going to make a return on investment on the implant course. With suturing, I agree with that may reduce dry socket. It may reduce post operative complications, but it’s difficult to assign a bottom line to better suturing. But there’s nothing better than having the confidence that, you know what my suture is going to stay. This is my signature, just like you said, I love that and having the knowledge and the feeling that you’re giving the best surgical care to a patient, you combo price on that, right? There’s no ROI needed. That is the ROI right there. So that’s the category that your course comes in, in how I feel. So I’m excited to really practice, practice, practice. And we’ll all. In crown lengthening in case I do. I will DM you on Instagram, share your Instagram in the moment, my suturing obviously and I cannot wait to do that, my friend. Tell us your Instagram handle, my friend. [Nabeel]It’s @drcajee [Jaz]@drcajee. Amazing. Everyone check out Nabeel and his work and his journey as a new parent, relatively new parent and all the implant stuff that he does. Any final words while you have the microphone to the world of dentists, mostly UK, Europe and now US, Canada, Australia and New Zealand. What do you want to say to everyone on this topic? [Nabeel]Well, first of all, Jaz, I just want to thank you for having me tonight or this morning on your side. And to the world of dentists, I think dentistry is just such a beautiful field, that we have the opportunity to grow, to grow on a daily basis, to grow on a yearly a career path, where your skills are today, and where you’ll be in a year or two years, may be completely different. And I really want to see our generation of dentists really defining something new for the field, bringing new technology, new techniques to the forefront, I really want to see us practicing like we’re in 2022 later on, like we’re in the future. And I just really hope that what you experienced with us during this podcast was valuable. And if you choose to take the course that it really benefits you. Jaz’s Outro: It certainly will, my friend. Thanks so much for giving up your time. Well, there we have it guys some great inspiration there for suturing. If you’re on that journey, like I am sometimes little things that we take for granted like suturing is exactly the kind of thing that you need to do to feel more confident about your overall surgical skills. So you’ve got to level up your suturing, head to protrusive.co.uk/suture. And it will take you straight to where you want to be to enroll in the class. And as part of the Protruserati, Protrusive discount that famous ‘PROTRUSIVE’ discount code. If you use it on there, you will get $70 off. Now, if you’re international people i.e. if you’re outside the US, you will get $70 off and that will be reflected on the shipping because shipping is quite dear. It’s about $100. So if we can knock off $70 shipping, that makes it a bit more palatable. Then it makes sense why the shipping is so much because it’s the medical equipment being sent to you and the models and stuff which you get to keep obviously so that will take care of the most of the shipping for you. But if you’re in the US, then you can knock off $70 off the overall price of the course. So check out protrusive.co.uk/suture and we’ll take you straight to the implant ninja school where you can enroll to level up your game in suturing. Thanks so much for joining me and I’ll catch you in the next one.

Welcome back to the second episode of #AskJaz where I answered questions from the Protruserati – from communication to caries management, I will try my best to help. When I don’t know the answer (far too often!) I usually know someone who does! https://youtu.be/Pvt-czUEZ3Q Click Here to watch on YouTube In this #AskJaz I tackled: Picking Courses – Which Year Long Restorative Course? 4:45  Which Facebow should I buy? 10:16  When giving the patient some options goes too far 12:02  Reduce Root Resorption Risk for relapse cases 17:50  Do join our Protrusive Dental Community Facebook Group. It has so many great gems and pearls shared in our little community! Click below for full episode transcript: Opening Snippet: Hello Protruserati, I'm Jaz Gulati and welcome back to the second ever AskJaz Jaz’s Introduction: I’ve just come back from Porto in Portugal. And it was an amazing trip. Let me tell you about it because it’s very relevant to the podcast. The way this trip came to be is that in Episode 89, I had Dr. George Andre Cardoso on the podcasts and we were discussing Digital VertiPreps IE, how to scan when you do the BOPT, or the shoulder less technique, they’re slightly different, right? So one’s shoulder, this one’s edgeless. We can talk about that another time. But essentially, this crown preparation or bridge preparation technique, which is pretty much all the rage at the moment, and for good reason. You know, I’m a big believer in vertical preps, they are much more conservative, they help you to gain ferulle, they help you help you to preserve the horizontal ferulle, and their soft tissues. Love it. So I’m a big fan of this prep. I’ve been doing it for some years now. But I knew that so many dentists in the UK wanted to learn. And so in that episode, Episode 89, Andre says, Hey, why don’t you guys come on over and we can do something, we were just chatting. And I was like, Yeah, that sounds great, you know, maybe if anyone’s interested if you want to go on his website and register your interest. [Jaz]Fast forward, maybe six to eight months later, and we had enough people interested that I’m actually organized 16 dentists. They happen to be all from the UK. And we flew over to Porto in Portugal, and George Andre Cardoso and his team. Thank you, Catia. Thank you, Joanna. Thank you, Gustavo. They treated us to a fantastic course on vertical preparation hands on. So morning was theory, afternoon hands on. All the dentists that came walked away with their own bur kits. But the best thing about it all was the people, the company because it reminds me very much of being at Andre’s dad’s restaurant, his dad seafood restaurant in Porto, which is part of a package, you know, you come. We do a course. We include lunch. We include dinner at Andre’s Dad’s seafood restaurant in Espinho. It was phenomenal. And we’re there at dinner. And George Andre Cardoso, he shares some life philosophy, we’re talking philosophy. And he says Jaz, you know, I came to realize that life is not about the destination. And I said, Yeah, of course not. We all know it’s about the journey. He goes, No, life is not about the destination. Life is not even about the journey. Life is about the company. And at that moment, with this packed restaurant full of all these colleagues, which are some of them I’ve never met before. They are Protruserati, which I met for the first time, which was amazing. It made me realize, Wow, this is special. You know, when you go away for trips, it reminded me of being at Uni. We just got these ski trips at dental schools and that they were the best. And so the vibe here was just amazing. It was just so much fun. It was a great city tour of Porto. We had great food, Francesinha, if you guys don’t know Francesinha is I mean, I’ll just wrap this up really quickly because you probably want to get to the AskJaz questions. Francesinha, you can’t call it a toasty because Portuguese people will get very upset if you call a Francesinha a toasty, but it is a toasty. Okay, so toasties has two slices of bread. It’s a toasty, inside the Toasty is steak, bacon, sausage. I’m sorry if I’m getting anything my Portuguese people. And then on top of this toasty is a fried egg, okay? So awesome meaty, toasty, fried egg on top, wrapped, covered, smothered in melted cheese. Wow. Okay, now the whole thing is served swimming in a tomato broth. It was just phenomenal. They call it heart attack on a plate. And oh my god, I had far too many on this trip. It was just amazing. It was the first time I went to Portugal. And it was a bit selfish of me to choose Portugal because I like to go new places. And I realized that dentists were hungry to travel abroad. Now obviously, because of pandemic’s hopefully coming to an end and travels opening up. And I think there’s a real hunger from everyone to travel abroad to learn from great clinicians, but also to get tax deductible holiday. [Jaz]So if you feel like you want to join us in the next Protrusive tour, or whatever it may be, haven’t got anything in mind just yet. But I think the demand is there. I mean, the same group, I’m speaking to them on WhatsApp daily, and they’re keen, let’s go again somewhere, right? So I think the scope is there to organize more trips in the future, to have fun, to learn, to experience new culture to learn from new dentists from around the world. And to just have a community of dentists which are like minded, having a good time, all that is tax deductible. So if you like the idea of that go to protrusive.co.uk/excursions, and that will take you to a page where you can keep up to date in any future trips and planning because this one went so well so amazing that I definitely want to help facilitate and organize something like this again. So if you’re wondering why my voice is hoarse, it’s because I’ve had a very crazy few days in Porto with some lovely people. Anyway, let’s hit the questions, right? Main Podcast:So first question from Instagram, I’m gonna block out the names you know, but when I get the questions and I help someone out, it then to go back in time and to ask permission to use their name or whatnot. So you can see the screenshots but I’m gonna blur out the name because I haven’t got permission to share the name to the podcast just yet. So it’s question is ‘Hi Jaz, hope you’re well, long time listener of your podcast. (Amazing, loved to hear that). I wanted to ask your opinion on further postgraduate training. I’m getting a bit bored and comfortable with simple nhs work. I want to do a year long course, is there any that you recommend either through first hand experience or from people you know. I’ve looked at the tipton courses, Chris Orr’s course, and Dr Banerji’s masters through Portsmouth Uni. Any advice would be welcome.’ This is such a common question such a big question, a question that ran through my own mind when I was a relatively young dentist, and I was considering Okay, what am I going to do? Now, the reason I did not do a paid private year long course, is because I did 18 months in total of restorative DCT. So those of you abroad, it’s Dental Core Training like a residency in hospital and I got really good exposure when I was at Sheffield. For that one year in Sheffield, I got really great hands on exposure, thinking full mouth, thinking facebows, articulators, lots of dahl cases, one full mouth rehab, which is pretty crazy when you think about it. Re-root treatment on the microscope, so I got great experience, it was a fantastic post. I loved it. And because I had that sort of experience under my belt, I didn’t think it would be necessary for me to splash out on a year long course. As much as I was tempted by the Aspire Academy Richard Porter, and Tipton and Chris Orr, all these great names Dr. Banerji, everyone that, this gentleman name, this dentists name. So there are so many great educators I mean, I’m not gonna name them all but just add a few more Dominic Hassell, Monik Vasant, if you’re in the States or Australia, there’s even more to consider Singapore, wherever you are. There are great dentists near you who run year long courses, which are going to really upskill you. But how do you pick? How do you pick which is the right one? I think that cost is pretty much similar for all of them, right? So cost is not really, it’s a factor but it’s not the factor. I mean, let’s be honest, you what you’d rather go to someone who’s the best, like who’s the most renowned for whom your friend has been through their training and your friend has something good to say, you’re probably going to trust your friend over just a perception that you have. But how good someone will train you out. There’s a big problem in dentistry, it’s a huge, huge, huge toxic culture in courses when it comes to dentistry, which is we see all the time positive reviews about courses, but where are the negative reviews? And I guess it’s a nice thing, I guess that there aren’t negative reviews defaming people, which is a good thing. Yeah, that’s a nice, sensible thing. But at the same time, if everyone’s always saying that, Oh, this course is awesome. This course is awesome. This course is awesome. Now we know that every course is not awesome. So how do you read between the lines and figure out, Okay, which course is more likely to help me more than other one, and which course is not going to sit well with me. Now put it this way. I know a fantastic educator, for whom many people keep raving on about, I had one of my close friends. And he said, Oh, he runs on it. And he thought it was a waste of money. It was terrible. And, you know, like and trust my friend here. [Jaz]So it was mixed opinions I was getting about this course, I guess the lesson there is that for some people’s values and who you are as a person and what you’re, what kind of lens you were and their perception lenses or your as you want to call them. The way you see the world will be different to someone else. So when you go on Facebook, and you say Oh, I would recommend this course, I would highly recommend Tipton, I would highly recommend Chris Orr or whichever course you’re thinking of. More than likely you’ll be happy as well. But remember that, that person’s experiences, training requirements, learning needs will be different to yours. So I guess the long winded way of me saying is A) it’s almost impossible to choose the right course for you the perfect course for you. Because there’s no Trustpilot, right? In dentistry courses, there’s no place where you can write good and bad reviews. And if you write bad reviews, you will not get ostracized or judged because imagine, you go out in the open and you write something bad about a course that you went on, or dentistry is a really small world. That’s why people are afraid to write Oh, you know what, this course is average. No one says that. No, this course, no one says on social media, Oh, this course is very average. Because they know that the educators probably on that forum, they’re going to read it and educators maybe a nice guy or girl and they don’t want to offend them. So the really now give you the final answer is it doesn’t matter. All right? These are all respected clinicians. They’ve got an army of fans on social media, raving about how awesome their courses are. Chances are if one course is going to be 98% satisfaction, the other one might be 94% satisfaction. Do you see? It’s very unlikely that these tried and tested courses that have been running for so many years, with such great reviews, which are really out in the open, it’s unlikely that you’re going to be one of the very few people who are unhappy with it. But the best way to do is find someone who’s similar to you. Similar learning needs, similar position when they did that course and ask them and sometimes you know, if you’re in Mancheste, find a course that’s in Manchester. If you’re in London find the course that’s in London, you know, you got to think about cost of travel time away from family, because really how much of a big difference will it make if you choose one educator over another? I don’t know. Because they all seem pretty awesome to me. So don’t read into it too much. Figure out which days suit you best, what’s your budget suits you best, which location suits you best, and just trust in the process and go into the course with a willingness to learn and willingness to implement that knowledge. That’s far more important than if you do educator A or educator B. [Jaz]Now I know lots of people may disagree with me that no no no, this educator is the best. I don’t see it that way. I think that these are all brilliant clinicians. Yes, a few percentage points difference but how are you going to find out? Until you do every single course you’re not going to find out. So do what feels right to you my friend and just run with it, go with it, trust the process. [Jaz]Okay, next question is from my buddy Pri and he asked me, which is the facebow that I should buy? So most common ones use in the UK, particularly, the Denar. Denar is probably the most common one use. There’s also Artex which is the one I have. Although nowadays I’m doing more and more techniques to avoid having to use Articulator and stuff I’m using digital techniques. Over here the right bite registrations at the correct desired OVD, lots of photos, a stick bite, using the TMJ as the best articulator and being very comfortable to adjust the temporaries to refine the occlusion how I want it before then moving to definitive. So that’s a good way to bypass all of that, but I still think, it’s so important to, for the restorative dentists be familiar with Facebows and articulators. So the question is, which Facebow, like I said, there’s Denar there’s Artex, there’s SAM® 3, there’s a few other brands out there, I think the best way to decide is to speak to your technician ceramist or your lab who you think is going to be there for you for the comprehensive cases. So you find out which articulator your lab is using, because guess what the lab that I use, they prefer not to use Denar, believe it or not. And I use another lab, which actually prefers the Denar system and they don’t have. So if I send them my artex Facebow transfer jig, they can’t use it. They prefer me to use a Denar. So the lab I use now is the one that I can send them my Artex Facebow to and they have the Artex articulators. Do you understand what I’m trying to say? The best person to advise you on this is a person who’s going to be mounting. Yes, you may be mounting yourself, fair enough, but you want to be working in tandem with your laboratory, with your technician, with your ceramist. So the best Facebow is for the articulator or the system that your technician prefers. Simple as that. And that will be my go to. Pick up the phone, call your technician and find out which Facebow they want you to buy. [Jaz]Okay, next one is from one of my Splint Course delegates, we were just talking on our secret group, and there was a case posted where there was some deviation on mouth opening. And this patient was a potential for orthodontics. So we were doing joint health screening prior to orthodontics, which is really, really important, right? So I talked through the process and we decided that okay, this patient should be consented appropriately on the risks and whatnot. But it’s probably safe to have orthodontics, knowing what we know the lack of locking, and generally no certain no pain symptoms, and the signs which are manageable, we decided that okay, this patient is suitable for orthodontics but with appropriate consent that okay, there is potentially a weakness in your jaw joint. And then we looked at, I helped her to look at the ClinCheck together on Zoom. And we looked at the ClinCheck, this patient had a crossbite. Now, I think this was a posterior crossbite in one area. And I suggested that okay, it’s interesting, the crossbite isn’t that one side and this may have something to do with the reason why the jaw deviates on opening actually is trying to get back to a centric position, but the crossbite forces the jaw to move to another position. But I suggested Hey, why don’t you do the bite registration for the ClinCheck in the centric relation contact position. So one things that taught me on my orthodontic diploma is it’s not enough. When you’re presenting your orthodontic plan to a supervisor. It’s not enough to say okay, the patient has a cross bite, you should never just say the patient is crossed bite, you should say the patient has a cross bite with or without displacement. Because this is very important. So if someone has a cross bite, we know what cross bite is, if they have a cross bite with displacement, it usually means that in their centric relation contact position, they are hitting onto that cross bite tooth or cross bite teeth. And then the jaw is deviating or deflecting in to another area to move around the cross bite, so cross bite with or without a displacement. So if the jaw moves it’s displaced, but if the jaw is not affected by the cross bite tooth or teeth in any way, and it’s nothing to do with the centric relation contact position, then is without displacement. [Jaz]So this is important because when we’re planning for orthodontics, sometimes or always you should check whether the crossbite has a displacement or no displacement. And if it does have a displacement, we then must consider, should we treat from that position. So for the either optimum joint health or to improve the prognosis of being able to move the teeth so for example, in their MIP, it may look like whoa, this crossbite is really extreme, but in their centric relation contact position, the crossbite doesn’t look so scary anymore. So that is so important. Now, the crux of it is this, when I suggested to this dentist that Hey, you know, you should scan the bite in the centric relation contact position, because you found out that there was a cross bite with displacement, run a ortho simulation or ClinCheck from there, and then decide which is the best plan for the patient in terms of their joint health and the tooth movements, and then present that plan to the patient. Now, here’s the interesting thing that the dentist said to me. She said, Okay, I will give the patient an option, whether I should treat her in this bite or in that bite, I was like, no, no, no, you can’t do that. It’s like an orthopedic surgeon saying to you, Okay, should I, You want me to treat your hip in this position? Or that position? Right? Like, how would the patient know whether, how the orthopedic surgeon should place the hip in a different position, right? So just like that, can you imagine a patient having to make a decision where, What the hell is MIP? What’s the central relation contact point? Some of the dentists listening to this may have heard of all these things for the first time if you’re a new graduate, right? So how do you expect the patient to understand the pathophysiology, the mechanics of orthodontic movements, kinesthetics of temporomandibular jaw body movements, etc, etc, etc, right? How can you say that to a patient that, Okay, you want me to treat your position A or your position B? That is a clinician lead decision, you need to decide what compromises you will be made if you treat position A or position B. And you should recommend and present the plan that, Okay to treat your issue, we need to fix you in this bite. You don’t give the patient the option of, can I treat you in this joint position or that joint position. I guess in some cases with ClinCheck what it is that you can do because you can simulate different bites and different scenarios. Usually, yeah, we can say okay, if I treat you this way, it’s going to cost you, not cost you. It’s cost you time and cost you twice amount of time by treating you this way. But when it comes to joint health, I feel as though we decide okay, is that joint important or not? And if it is, can you improve anything by planning your orthodontics in a better way, even though some orthodontist listening to this right now. Saying Jaz, you’re on shaky grounds here, you know, you cannot improve or deteriorate the joint health from orthodontics, etc, etc. But come on, guys, if there’s an option to treat the patient in centric relation contact position, and that improves your tooth movement mechanics. And that’s a better position for the jaw joint, and there’s a better position for the TMJ, we should explore that. So sorry if that got a little bit complicated, but I guess the crux for those younger dentists here is sometimes you need to pick and choose the way that you communicate to a patient and what you actually, it’s a bit like asking the patient, you have a cracked tooth, when I treat this tooth, do you want me to chase the crack? Or do want me to not chase the crack? I mean, can you understand that? Like, why would a patient know whether to chase a crack or not? It’s the same way you can’t tell a patient, Oh, do you want me to treat in position A or position B. So remember some things, you are the dentist you need to use your best knowledge and experience and mentorship to present the plan that is appropriate for the patient. You cannot give this kind of control to a patient ie chase the crack or not chase the crack or treat you in this position or treat in that position. So just be careful how you present things to patients. Sorry if that one got a bit confusing. [Jaz]Your last question guys. This was from our Protrusive Dental community. It’s from my buddy Kjartan in Scandinavia, and he posted a case of a lateral incisor which had a little bit of resorption because this patient had prior orthodontics. Now this patient had relapse and was interested in more orthodontics. And so Kjartan asked, you know, what do I do? Like, what kind of consent do I have to give the patient? What are the risks here? Is it safe to do another round of orthodontics, which is what the patient wants? So, our buddy Farooq Ahmed, if you haven’t listened to Episode 71, please listen. It’s a great one. It’s called the Do’s and Don’ts of aligners. That’s the do’s and don’ts of aligners episode 71. So protrusive.co.uk/071 will take you straight to that. He did such a great job of summarizing which movements with aligners are predictable, which aren’t. And so Farooq came to the rescue on our Facebook group. And he gave a fantastic reply, which was that we don’t know exactly which factors increase root resorption but we know how much of an effect certain features have or certain movements have. So he shared a study by Currell 2019 and Sondeijker 2020. And this little table. So essentially the advice that Farooq gave, and this is what you should apply to any patient who has evidence of root resorption and you are considering to do orthodontics, and you’re consenting the patient, you should stick to light forces. So actually, with aligners, we know that we are giving lighter forces with aligners than fix appliances. And the top pearl that Farooq gave was that you can reduce the velocity of tooth movements with your aligners. So imagine it takes 20 aligners to get the desired result. For that same patient, you would do it in 40 aligners, it’s still the same result. But you’re each aligners doing half the movements, you’re going a much slower pace, which is lighter forces. This is interesting because it’s lighter forces which is really important. But at the same time, one of the factors in the little table he put up and I’ll share that with you now for those watching is duration was one factor which was associated with higher risk of root resorption, so many years of treatment is obviously much worse for resorption risk than just a year or some months of treatment. So the longer the treatment duration, the more likely a patient would have root resorption. The other really important in fact, the greatest thing is intrusion. Intrusion was associated with 11 times greater root resorption than controls in the study. So the other thing to learn is that if you’re going to treat this patient, treat them with aligners, treat them slow, but hopefully not too long duration, I guess, hopefully, maybe manage relapse cases only anything more complex than that send it to an orthodontist. It’s not worth your time as a GDP, the risk is too great I’d say and therefore to additionally reduce your risk, you would prevent intrusive movements, you would prevent intrusive movements and you actually would, if possible, prevent extrusive movements because extrusion was associated with a 4.5 times greater root resorption than control. So avoid long treatment. Avoid heavy forces, avoid intrusion, avoid extrusion. [Jaz]So if you want to check that out, get joined the Protrusive Dental Community has so many great gems and pearls shared by the community there. That’s all the questions I had time for today. The next episode is on suturing. I’m very excited to share that. And I’ve got so much other great content. I literally just recorded with Ed McLaren the other day, and I’m so excited to share ceramic selection with you guys so you know how to choose your ceramic in 2022. That’s upcoming as well. So thanks for catching this AJ002. Thank you for putting up with my very hoarse voice. Appreciate you listening all the way to the end. I’ll catch you in the next one

Consent. It’s one of the most important parts of your practice—and it’s somehow turned in to a tick-box/paperwork exercise. Is it truly possible to automate the consent process for an individual? Dr. Shaun Sellars and Zak Kara are here to break it down for you, so you can get your patient on board with the treatment they need while keeping yourself out of legal trouble. We’ve covered some of the laws that govern consent in Dentistry, as well as how to level-up your patient communication skills. https://youtu.be/_8O5CqoYIS4 Need to Read it? Check out the Full Episode Transcript below! Protrusive Dental Pearl: Be sure to subscribe to my email newsletter for the PDF Flowchart for Consent made by Dr. Shaun Sellars  This episode is sponsored by Enlighten Whitening – thanks for your support Dr. Payman Langroudi and team! Please do check out their online training. Within their Live online training, they cover so many points related to consenting our patients for teeth whitening – from the onset of white patches to predicting and managing expectations of different whitening cases. Highlights of this episode: PDF Flowchart for Consent by Dr. Shaun Sellars 5:53 Ramifications of Montgomery 7:43 Consent forms – are they worth it? 10:00 Stages of Consent Process 17:38 ‘Protocolization’ 22:05 Process of getting Consent 26:25 Getting Consent with the help of Technology 33:42 If you loved this episode, check out the first part of this episode Record Keeping and Emotional Intelligence Click below for full episode transcript: Opening Snippet:Replacing missing teeth, do nothing denture bridge implant, this is classic, okay? How to replace missing teeth writing consent. Do nothing is always an option. So you must must must must must always say you doing nothing is not even if your pain the patient comes in massive amounts of pain. Do nothing is an option, you can say it's not a good option and you should be able to recommend the treatment option. Jaz’s Introduction:Consent is like an onion. What does that even mean? Well, you have to listen towards the end of the episode to find out what I meant by consent is like an onion. Now this episode is going to go in the Protrusive Hall of Fame like think of episode 10. I always refer back to Episode 10 with Zak Kara because I know how much you guys loved it because the stats always show me that people are listening to that one again and again and again. That’s probably the most repeat listen-to episode there is and I’ve got a funny feeling that this episode is going to actually surpass that as the most listened-to and repeat-listened-to. And I even I can’t wait to listen to it again. Because there are so many great non clinical communication gems, which I know we all crave. Protruserati, Welcome back to the Protrusive Dental Podcast. I’m your host, Jaz Gulati. I’ve got Shaun Sellars and Zak Kara on today. And this is gonna blow your mind. Some of the laws that we discussed in terms of consenting are specific to the UK. But if you’re in the US, Australia or around the world, we all consent our patients and you will definitely take away some very tangible points on how to be an effective communicator and consent your patients properly and that does not mean you tell them every single damn option. You’ll find out why when Listen. This episode is brought to you by enlightened smiles. This is the premium brand of teeth whitening. They guarantee a B1 shade and it’s just a slick system. The branding is on point, the passing on point, patients love it very low sensitivity from my experiences. And so the reason this is relevant to consent is I did their online training some years ago with Payman Langroudi and it’s brilliant. It covers so many points related to consenting our patients probably for teeth whitening from the white patches that can arise, from the expectations of result for the treatment durations, for different cases, for example, tetracycline staining, they have the whole protocol. So do check out their online training. The link for that is protrusive.co.uk/enlighten. And that will take you straight to the page to book onto the online training. I want to thank Enlighten smiles and Payman Langroudi for supporting this podcast. The Protrusive Dental Pearl for you is a gift. It’s a PDF gift to you which Sean Sellars actually made. It’s the flowchart for consent which we discuss in this episode. So if you want to access that make sure you are subscribed to my email newsletter. You can do that by going to protrusive.co.uk/emails and if you’re listening to this episode in the future, you will find that email because I’ll make it public and you’ll be able to download that PDF. Now just before we join Sean and Zak for a fun chat let’s take a moment to reflect and also say Thank you. Okay, so I’m gonna start with thanks first. Yesterday it was announced that I’ve been voted amongst from all you guys, all the peers as a top 50 dentist. Now what that means is like the top 50 Most Influential dentists in the country I guess because it’s a UK thing, dentistry.co.uk. So firstly, thank you for voting for me. I mean, I really appreciate it I never asked anyone to vote for me I kind of have kept quite low key about this. So it’s very sweet of you guys to get up your time and vote Wow. I mean, thank you really from the buttom of my heart for doing that. But if I was to go a bit reflective for the reason I did and promote it as much as perhaps the people who make these things wanted me to is one main reason I’m gonna read you a quote. Okay, let me read you a quote. It’s a quote from Adam Grant. Okay? It says this, he says this. “Beware of confusing attention with admiration. Being noticed (ie through a platform such as a top 50 voting popularity contest) Being noticed, isn’t a substitute for being respected. Don’t mistake recognition for appreciation. Knowing who you are, doesn’t mean people will value what you do. The point of sharing isn’t to gain followers. It’s to make a contribution” And say again, it’s to make a contribution. And the reason I reflected in this way is that whilst I’m so thankful for you guys voting for me, I mean, that’s really kind. And thankfully, when I look at that list of top 50 There’s so many dentists, there’s one of my mentors, Riaz Yar, he contributed so much to occlusion. He’s doing studies with dahl and it’s just amazing. There’s too many to name from Tif Qureshi, and I’m not gonna name any more because I’ll get in trouble for missing people that there’s so many great dentists, Raj Ratan and another one that comes to mind in terms of great contributions in dentistry, but remember that there are the unsung heroes in dentistry who makes so much of a contribution that aren’t recognized in this somewhat of a popularity contest, I’m sorry if that offends anyone. So let’s take a moment to think not about the top 50. Let’s think about all the people in your life, you as a dentist, think of the person who has made a contribution to you in the last year, and I want to message or email, this dentist or colleague, or coach or whoever it is, and say, Listen, you might not be in a top 50 list this year. But that doesn’t mean anything to me, because you have made a huge contribution to my professional development. And I think it’s a great thing to be able to thank the people around us who helped us so much. Anyway, I am so pumped for you to listen to this, check it out. And I’ll catch you in the outro. Main Interview: [Zak]I will try to consent that person. But actually you can come across as you’ve kind of not quite planned ahead. So careful. [Jaz]Yeah. But I think the crux of it is sometimes to ask questions to validate their understanding, I think is a good way to do it in certain procedures. Which leads me nicely to consenting patients. And, Shaun, there’s something that I know you’re quite hot on, you’ve got this PDF that you sent me, is that something that you’re hoping to share with us? [Shaun]Yeah, absolutely. So for one of my assignments, in my master’s, I came up with this workflow on consent. So everyone gets worked up about consent. And with some of the changes in the law fairly recently, the way that we have to present complex consent to patients is confusing to a lot of people, I think. So my little workflow, which there’s a copy here [Jaz]I just forwarded it to you, Zak. So I mean, essentially what you’ve made, just describe to listeners, what you’ve made here, we’ve got workflow. [Shaun]So we’ve got the number of sections on the process of gaining consent, most of it’s where we’re quite good at but one of the difficulties that dentists find and healthcare workers find is this idea of balancing risks and benefits of treatment to patients, how do we do that in a way where we can ensure that we are getting pretty solid consent at the end of the day. And that changed to a certain extent in the Montgomery ruling, which some of you may have heard of. Although if we’re being technical, all Montgomery did was change the law to match the guidance from the GDC and the GMC. So we should have been doing this for a number of years already, theoretically. [Jaz]Can you show for those young dentists who may have not attended the law and ethics lectures at dental school, just briefly explain the ramifications of Montgomery. And if you were to do like a one paragraph summary of what we need to do in our practice now to make sure that we are consenting effectively, what would that be? [Shaun]Okay, so before Montgomery, the amount of information you needed to disclose to patients on the risks and benefits of a treatment was governed by what an average dentist would give to patients. And that sort of ruling was based on the Bolin case in the 50s. So we were consenting to a level that was acceptable in the 1950s, which probably isn’t right. Admittedly, the sidaway Casio came from his 80s. But still, we’ve changed a lot. Our laws are based on our ethical backgrounds and the way that society accepts things, okay? So Montgomery has changed that. So what Montgomery says is that the information that you need to give to patients on the risks and benefits of treatment should be based on what that patient in your chair considers to be important and relevance, as well as what dentists think is important and relevant. So it’s a different level of information disclosure, what it doesn’t mean is you have to tell patients about every single thing that could possibly go wrong with your treatment. It doesn’t mean that… [Jaz]Which is what some consent forms do. [Shaun]Absolutely. And to be perfectly honest, most consent forms aren’t worth the paper they’re written on. [Jaz]Thank goodness, because I don’t do but I should, in the next year or so one of my things in my clinical workflow is to add them because as Lincoln Harris taught me in one episode is that people consume information differently. Some people are good listeners, some people retain more when they’re reading things. So it’s good to cater for all types of people. But do you use consent forms? Both of you, Shaun, Zak, do you have consent forms? If so, how do you implement them before we then go deeper into the topic of consent? [Shaun]So very briefly, yes, we get people to sign on a clear path and give them a paper copy if they want it. [Zak]We do a similar sort of thing. We sign off an estimate for certain types of treatments. The main thing that I’ve been involved in, I think I’m gonna pause this, I’m gonna pause mine and I’m going to tell you, I’m going to ask you when I present you with an ‘Am I naughty if’ later [Jaz]Okay, fine, awesome, awesome, we will do that fine. So fine, you’re still using Form stuff. So you mentioned that really well, you describe Montgomery perfectly. So going back to your workflow, you’ve understood the patient, and you’ve given them the reasonable risks that you feel they need to know. And then therefore, as part of your very top of your flowchart, reasonable treatment options, and then you split that into three. So I’ll let you take over again, you’ll do a much better job than I [Shaun]So the first and most basic thing is to understand what your patient wants out of the treatment. Okay, so there’s, if you’re patient has come to you, and has constantly for years and years and years said, the last thing I ever want in my mouth is a denture, okay, and they’ve got a couple of edentulous spaces, say they need to replace a couple of premolars, you might want to mention a denture in passing, but you don’t want to spend a lot of time on it necessarily, because they don’t want it. But when you’re presenting your treatment options to patients, so replacing missing teeth, do nothing denture bridge implant, this is classic, okay, how to replace a missing tooth writing consent. Do nothing is always an option. So you must, must, must, must, must always say you doing nothing is not, even if your pain the patient comes in massive amounts of pain, do nothing is an option. You can say it’s not a good option. And you should be able to recommend a treatment option. If you look at the law, if you look at all the guidelines [Jaz]Which is something people forget, you know, there are people Yeah, we can, should recommend something people often just splattering out eight different options getting, you know, getting patients to pick like some sort of like a gamble, recommended because [Shaun]He’s the expert in that room. [Zak]And they’ll get what would you do? And they’ll go Oh, no, I can’t tell you that. [Shaun]So the way that I get around that is I would choose this, but I am not you so you kind of get the best of both worlds. You can say, look, it’s your decision, you do what you like, but I would do this, and this is why I would do this. So you give you get again, you’ve got that story to give. [Jaz]Because X, Y and Z is important to me. That’s I mean, yeah, the whole thing in medicine, okay, I’ll like you to take on that because I like where this is going. [Shaun]So then legally and according to the guidelines, you then have to present the risks and benefits of those treatment options equally. So in, so say, okay, she’s having treatment routine is gonna get out of pain, but it may fail, you know, 80% success rate in practice, 90% success rate in practice, or you could go see a specialist, and you go through your treatment options. Even handedly given these these risks and benefits of the treatment, then you enter this sort of dialogue phase. So you have to sort of have a bit of chat with your patient. And this is where, again, understanding your patient really comes into its own because some patients will not want to know a great deal about the treatment, they just say, What would you do, I’m going to get on and do that. Fine. Some patients will want to go that I really don’t know, I need to go and think about this, I need to go and talk to my other half about this, I need to consider this, this this and the cost nor the NS it. And if you look at all the guidelines, one of the things that is really, really clear is that patients need to be given time to consider their choices. So I had a patient, when I was working in Lincoln, he went down to a large practice in the south of England. I don’t know where. But he had a completely failing dentition. He was considering implants. I wanted to refer him to Collin but he didn’t want to pay Collin’s prices, fine. No problem at all. Went down, found a practice that would do it. He came back to me and said I went to that practice and they they did an assessment for me and said, Well, we can do it this afternoon. We can do your. And that he just went no, I’m not I’m not doing it. But the consent process of that practice must have been awful, because how can you consent to a procedure that is so invasive, expensive and potentially unpredictable? Because I knew that the chap’s history, in a couple of hours, you just can’t do it. So your patient has to be given time, and then they’ll come back. And you can say right. So that is a problem in practice, actually giving patients that time to think about things is an issue because you want to be booking that patient into the treatment. So the way that I do it is I can paste in my card. I say that this is these are the pros and cons. we’ve chatted about that. Here’s my card. There’s the practice phone number on there. There’s my work email address on that. If you’ve got any questions, give us a ring, drop us an email. What I will do is I will follow up with an email with some information on, so then I will, either sit down and write them an email, which you can do in your own time, which is quite nice or, again, plug for pro has lesser letters to write to patients and what are called reports. So they can, you can essentially template a load of treatments that you’ve done, or you’ve got to do say you want to do an implant for a patient, you can say, what these what implants are these the benefits and risks of implants, and you can email that to the patient, you get read reports. FlyNotes something very similar. This is very good, actually. And you know, they’ve digested it, and they get the chance to reply to the things that have been brought up there. So you’ve got this idea that the patient can sit and think and then contact you to make the appointments as appropriate, I think we get hung up about patients making the appointment there and then because they don’t need to, at the end of the day, do they as long as they book in and get the treatment they need. [Jaz]That’s fascinating, Shaun because and I totally agree with you, because that is so valid. But I’ve been on few ethical selling courses, let’s call them, communication courses. And you know what they say? It’s like the number one rule of sales, like they can’t leave the practice without booking something, they have to book something in. And you think that is this mad, you know, hack, but this is what they’re, the gurus are teaching young dentists who, [Zak]From practice efficiency for creating workflows, it can be one of the simplest things because then you know that person’s in your diary. But you shouldn’t be putting them in your diary just for funsies. Just because you it’s in your benefit and not there benefit. That the thing you should have. And this is one thing I learned through failure, as a young associate in a practice with not very many systems is that you need to have backburner banks of people that you need to follow up, you need to have people that on the other end of the spectrum who actually want to see you sooner, you need to have a list of those people. And so you need to be able to dig into that when you’ve got a short notice last minute cancellation for an emergency tomorrow. So something happened and you’ve now got a two hour empty space in the diary. That’s why those ethical selling type people will say it’s necessary because they want to fill the diary space. But that’s not a bad thing as long as you’re doing it in the right way. Is that fair to say? [Shaun]So I’ve got so many points on that. For a start, there is no such thing as ethical selling. There’s no such thing. Does not exist. Does not exist 100% [Zak]Can we quote this, because this is the guy [Shaun]In absolutely. There are three stages to the consent process, there’s capacity, your patient has to have capacity to consent. There’s the knowledge and information, which is what we’ve just been talking about. But one of the most important stages of the consent process is that it must be done voluntarily without coercion from anyone. And that includes us, ethical selling does not exist. That doesn’t mean we don’t sell. I don’t think we sell treatments. I don’t think we sell treatment at all. We sell ideas. But most importantly, we sell ourselves. We are the products, okay? And the way that we sell ourselves is by making the people in our chairs and the people around us confident that we can carry out that treatment. But ethical selling is bullshit. Now, if you like. And there are people that have made very, very good money out there repeating.. [Zak]Mantras. [Shaun]Yeah, exactly. Do not be taken in by that because people can read through it. If people are saying, Oh, you’ve got to do this, NLP this. It’s utter utter rubbish [Jaz]Zak, I know you want to add to that. Because you’re, I mean, I don’t know if you want to reveal this. And you know, you don’t have to, Zak, reveal this if you don’t want to but you sent me a really cool thing that you sent your patients who are thinking of sending your patients as a way of checking the understanding and checking consent. Is that something they want you? [Zak]So am I naught if? Sure. Am I naughty if I have completely turned what used to be my consent process upside down by using technology, right? My method with this now is something called a TypeForm. You might have heard of typeforms, which integrates video, audio, pictures, that kind of stuff like animation, you type stuff, and words. And what I did is I told myself, okay, if this is a 21st century, right? If I haven’t already got compacity and voluntariness, by virtue of the fact that this person in front of me is let’s say, consenting for a dental implant or something more complex like orthodontic treatment, something significant then I don’t have a paper based form anymore. I have an online type form. And it’s a method of gathering that person’s understanding progressively through this. But also checking, they’ve actually done that thing and watched it because they’re required fields. And you can, by virtue of having done it several times, I now know that it takes at least 15 minutes. So you can’t possibly get through that process if it comes up and says for type form was completed in two minutes. Cut Yeah, I need to reconsent that person because it didn’t happen. Am I naughty? Is that naughty? [Shaun]I think I quite like that. There’s a couple of points I would say about that. In my patient cohort, it wouldn’t necessarily work because I have a load and load of old ideas that have real issues with any kind of technology. Okay. But I really like the idea, I think, for that tech savvy cohort of patients. That’s brilliant. That’s really, really good. [Jaz]I’ve seen it, Shaun. And this is like, I loved it, I thought it was so so detailed, but not overly detailed. It was very visual, it was so easy to follow. And so I’m a big fan of it. [Zak]There are also elements where you know, when sometimes you’re trying to consent somebody for something, but because of stuff that’s happened in your day, this goes back to earlier in the conversation, you may not on top form, and you didn’t explain it in the when you look back and you go, Oh, I was alright, but it wasn’t me on my A-game. Well, if I’ve kind of scripted most of this, and I have a short one minute video for this is what root resorption is and how, why you need to know about it, or what the relevance in your case is. But I’ve also then embellished and customized that particular thing for that particular patient. Then my sort of understanding of, see, one of the things I struggle with in dentistry is that there’s no rulebook, we’re all trying to evolve ourselves as human beings every day, and there is no recipe but actually, if you stick to the core values and principles behind why you’re doing it, which is truly because my heart is in trying to make the process better, not because I’m trying to skimp on it, then actually, I don’t know. What is your other point? You’re gonna make it How am I naughty? Trying to justify it here, [Shaun]Just from what you’ve said, I also have this real issue. I used to be, I’m beginning to put what I call protocolization that I can’t really sell, it’s having having checklists for things. So the way that, I’m, this is off topic. So the way I look at things, if you’re going on a plane, you are reassured this flying piece of tin is going to stay in the air. Because the pilot and co pilot have walked round on their walk round, they’ve ticked everything off, and everything is safe. We don’t do that in dentistry so much. Because well, I think it’s partly an ego driven thing in that, well, I don’t need a list of things to tick off because it’s all in my head. But heads go wrong all the time you miss things out the amount of times that you’ve forgotten to pick up the bond, but when you’re doing a composite, and this just gives you a nudge and I don’t want that bond. You know, that kind of thing. So I [Jaz]Or your nurse skips the etch or forgets the etch you have to write that down [Shaun]Yeah, exactly. So yeah, it works both ways. So I was a few years ago, I was really into right, we need to put protocols into everything, everything, everything, everything, everything. I think there’s still a real place for that getting protocols for checkups, getting examinations, getting protocols for doing composites, getting protocols for doing this and then actually documenting that well in your notes. So you can change the protocols all the time. Because just because you’ve got a way of doing things, doesn’t mean that’s the set where you’re going to do things forever. It has to constantly be reviewed and changed if needed. I’ve completely forgotten where I was going. [Zak]Can I just? I was gonna jump in and ask another naughty Am I naughty? Because this is the other thing that I do we have a perio protocol in our practice. Am I naughty if I simply quote the protocol in my notes? Treatment recommended protocol for periodontal treatment grades. [Shaun]I think you’re okay as long as you’ve got these. Yeah, as long as this [Zak]so that the end, one for that. [Shaun]So what you need to do as long as your protocol is dated. So if it changes, it’s been updated. So if you’ve got a, say for example, in at the moment, with COVID that’s going on. We have we’ve got our SOP that was a specific practice sop it currently runs to about 50 pages, because I helped put it together therefore it’s quite intense. And being the tech nerd that I am it’s now on version 5.1 [Zak]I love you, and I’m disgusted with you all at once. [Shaun]So in my notes, when we first came back, it was version three, I think 3.0. So in the notes, and I’ve got all of those different updates to the SOP, on my Dropbox in my harddrive. So I referenced the version of the SOP in the notes [Jaz]That is so clever. [Shaun]So you could theoretically Yeah, as long as you’ve got a store of all the protocols and how they’ve updated over time, I can’t see why you shouldn’t be able to refer to those protocols, as long as you’ve got some reference to the exact protocol that you were referring to. So if it if it’s then changed, you can justify that. So yes, we’ve changed the way that we’re doing things because we’ve got an updated protocol to do things [Jaz]That I do the same thing sometimes. I’m naughty if I’m naughty, but for adhesive protocols, sometimes the right standard as adhesive protocol followed, because I’m sick of writing or copying, pasting because if could see a check on my notes, the same protocol we have done. But then I’ve got a protocol somewhere. But I what I’m really going to take away from what you said, Shaun there is if I update it have different versions. So if you go back in my notes, you will see that two years ago, it might have been V1 and a now it could be like V5.1 like surround sound. So yes, that sounds good. I like that. I’m gonna take that. I’m gonna definitely pinch that. [Shaun]What else are we talking about? Oh, yes, patients. So patients, so my old dears probably wouldn’t be so hot on the type form, but there’s definitely a subset of patients that would be brilliant for. The other thing that is really important is to remember that consent isn’t a one time issue. Consent is a process, okay? So that chat that I’m having with my patient before they get into the nitty gritty of the appointment. That’s my consent process for that appointment. So you’ve, so they understand the risks and the benefits of the treatment because we’ve talked about that, or we’ve sent them an email or they’ve gone through your your Wizzy videos or whatnot. But you check that on the day as well. Because if there’s anything that they haven’t quite grasped, or you need to clarify, you need to clarify them before you’re halfway taking your tooth out, don’t you really? And remember, patients can withdraw that consent at any time. Although, yeah, there’s going to be times where that’s a bit tricky when you’ve got enough rate that’s half out or you’ve got this tooth that sections or whatnot. So is it naughty? Absolutely not as brilliant, but it just needs a little bit of [Zak]care [Shaun]like everything else. Yeah, a bit of care and attention. Don’t we all? [Jaz]Okay, have you got any more Zak? [Zak]Oh no, not on the tip of my tongue. [Jaz]Okay, am I naughty if? If for my clear aligner patients in, let’s just call them Invisalign patients because that’s what I use. Let’s be out there. For my Invisalign patients. [Zak]Sponsorship [Jaz]I will email them each one individually say that their unique thing that’s unique about them their risks, like hey, by the way, Miss Smith, you are at very big risk of black triangles, in particular, and then everyone will get the same video of me talking through the 16 point-thing that you should know before you start Invisalign. So YouTube video, that’s a private link that only my patients can see. And I’ll email them and it goes through generically 16 But in my email, I’d say you should watch this video please watch the video reply back to me. But pay particular attention to points three and point eight because they are most relevant to you. Am I naughty if I do it that way? [Shaun]I quite like that [Zak]How can you prove they’ve watched it? How can you prove they’ve understood it? [Jaz]The reply. Yeah, they understood bit you know, that’s where you’re Typeform, it works better because it has a bit more responsiveness so but here’s my rationale is like me speaking at them for those eight minutes vs me speaking at them at the leisure time while they’re having coffee with me speaking. What they’re Yeah, they’re listening to me [Zak]I only been using mine for the last two weeks. And for the using that method, the feedback I’ve had so far was That was awesome. I got to watch it in my own time. I got to share it with share with my partner. We saw the video of my tooth movements before I started, we kind of understood this was the right decision for me. Awesome. [Shaun]Yeah, the guy that comes and does implants in our practice, he does a lot of video consults now, but you’ll also record a specific video for the patient and often for me as well, just to say he said like [Jaz]LOOM? Using loom? [Shaun]Oh, no, I’m using them for some other bits. I’m not sure what he uses actually. Yeah, but he’ll sit down and just go through treatments for patients. Obviously, he’s done. How many of these so he’s just picking these stock phrases to a certain extent but because you’re picking those stock phrases in the specific order and specific need for that patient. It becomes very tailor made and it’s a really good service. So yeah, using that kind of technology is really good. It’s really good. [Jaz]Brilliant. Have you heard? Have you guys heard this thing about consent being like an onion? [Zak]Why is it always onion to give? Were chopping onions, we’re gardening we’re doing many things. Listen to the podcast and now Jaz is gonna call consent, an onion. Fantastic. [Jaz]I like what Shaun, he said it makes you cry. Okay, let me show this one. This is actually from we was winding up here, but because I want one more thing I want to ask you is how use FlyNotes because you mentioned it in briefing, but I want to know more about more about flying notes. But just the last thing about consent. There’s so much more when talking about the but we, Zak, have another podcast recording about equilibration in 11 minutes. [Zak]Were talking about consenting stuff. [Jaz]Equilibration. Onions, onion, sorry, onions. The way consent is like an onion. This is from Raj Ratan, right? Consent is like an onion because it has many layers, right? So your patient, turning up at the appointment is the initial layer, then your patient having a seat and opening their mouth is another a layer, your patient having signed a consent form is another layer. And then your patient, you telling your patient and reminding them of the risk is yet another layer. So it’s not just one thing. And I really like this onion analogy, because it’s a multi layer. And it’s not just one signature on a piece of paper. It’s not just one type form that you do. It’s those number of things that go together. [Shaun]Yeah, I really like that. And I think so. So just to answer that. With, I don’t get particularly concerned about consent, because at the end of the day, if you’ve got the patient on your side, and they know what you’re doing, and you know what you’re doing, it’s very, very rarely going to be a problem. The only time it’s a problem is if you’ve got a disgruntled patient, or you’ve got a vexatious patience, you are never ever going to be able to stop a patient who is deliberately going to complain about you from complaining, that is impossible. You can laminate, [Jaz]Veneer patients are crazy. [Shaun]But for the vast majority of the patients who sit in your chair, as long as you have a good relationship with them, consent isn’t going to be a huge issue. The other thing is that the reason that we gain consent for patients or we go through the consent process, I should say, is because we are messing around with patients bodies, and patients have a right to know and understand what is going to go on with their bodies that someone else is going to do. That’s the basis of consent. And that’s why consent really has changed over the years because back in the 80s, back in the 50s. It was this very paternalistic view, doctor knows best dentist knows best, open your mouth, get on with it. Society has changed and society has changed for the better, we are much more in control of our own healthcare and our own the treatment that we have. So we should know more about our treatment. If we were in that position, if we’re in the position of a patient, if I was sat in your dental chair, there’ll be a certain amount of information that I would want to know from the dentist carrying out my treatment. So why shouldn’t it be like that for the patient that sat in my chair? [Zak]Damn right. It’s all about mutual trust and mutual relationships. It’s all about people. And this is why I love the times that you’ve invited me on your podcast Jaz because communication is everything and everything is communication. That’s just how every aspect of dentistry works, right? [Jaz]Which is just at the beginning as Shaun said, you know, this is , it doesn’t matter how good you are with your hand skills, it’s all about, like we said we can how you make people feel and the communication aspect, the non clinical is everything. Shaun, I’m gonna ask you two things now. FlyNotes, just what is FlyNotes, you mentioned it before. I don’t know what flynotes is. [Shaun]Flynotes is a digital tool, specifically to gain, can help and gain consent with patients. It’s brilliant. It’s really, really good. Again, it’s a template based system. So you choose the procedure or procedures that you’re doing, you can select the specific risks and benefits of that treatment, edit the text to go along with that, then package it together, email over to the patients, patients can read it. And then you get a link back saying that your patients have received it, a link back saying that your patients have read it and they get the opportunity to sign their consent forms digitally and ask any questions. It’s really good [Zak]A fair counterbalance, I really looked into Flynotes. And I didn’t like one aspect of it, which is that, it’s very wordy. It’s all about my words, and there’s no picture element. There’s no video element. There’s no interactive elements. So it’s so difficult for visual learners and for the wordy people. [Shaun]So that’s why I tend to use karoku Pro a little bit more where you can add pictures and that kind of thing. I also know that Brian’s dental are about to launch some kinds of similar system I haven’t seen anything about that. But if Connor or any of the Brian people want to hit me up more than welcome to send me a link to have a look at that, that’d be good. [Jaz]I’m sure they will. Chaps, it’s has been an absolute pleasure to speak with you both. Shaun, thanks for giving up your time and sharing some of the gems that you learned from your masters also just conversational gems and a little bit about how you speak with your patients which are the real details that are the Protruserati love and they want to know about what are the things that we say which is why Zak is so popular and we always love having you back on Zak and the return of “Am I naughty if?” was very special. Gentlemen, thanks so much. And I look forward to catching you both again soon. [Zak]Jaz, one last thing. Shaun needs a plug. [Jaz]Of course. Absolutely. Shaun, what are we plugging? Are you have you got of course [Zak]No. Podcast. Only so many commutes to work and back. But obviously, the Protruserati know and well that they listen to the Protrusive Dental Podcast but there is also one. [Jaz]Incisive Decisive, and it’s great to have you Shaun on our little telegram group as well. And I’m more than happy for you to post your post your episodes on there, man, you know that [Shaun]So Incisive Decisive is the original and best dental product on ethics and philosophy. Myself and Colin Campbell, we were on long term hiatus, partly due to COVID. Partly due to me moving but we’ve recorded some. We have recorded some new episodes. We are sporadic at best and trying to get those edited. That’s a long story. Yeah, it’s incisivedecisive.com [Zak]I really enjoy it. So jump on that for sure. And the banter that you guys have Colin and you agree [Shaun]It’s significantly more swearing. [Zak]Scotsman involved, of course. [Jaz]Well said, Well, I’ll definitely add the link for those who haven’t listened to Incisive Decisive into new episodes coming. I’ll put that link in the show notes as well. So thank you so much for that. And thank you, Shaun. Appreciate it. [Shaun]Thank you very much. Thanks, guys. Jaz’s Outro:There we have it guys. Wow, what an episode so many gems, I think you’re gonna have to come back and listen to it again, right? I think it’s one of those where you just kind of like you know, curl up one day in bed and just listen again. And then you listen to again, and this time, you can take notes. And by the way, the transcripts of all the episodes are on the website, so if you ever miss anything, or you want to see exactly what they’re saying, they’re about 99% accurate Okay, so bear with me. I try and do what I can. So don’t hold me accountable for it slight inaccuracies in terms of spellings and stuff. Anyway, hope you enjoy that episode. Thanks so much for listening all the way to the end as you always do. If you found this of value, please share it with a dentist and your practice feature. Please share it with your colleagues. Please share it on social media. Shout about it from the top of the tree tops. I’d say that carefully. And if you’re watching on YouTube, please hit subscribe. And if you’re listening, please consider leaving me a rating. Thanks so much and I’ll catch you in the next episode

Protrusive Colonel Dr. Zak Kara and Dr. Shaun Sellars discuss record keeping and emotional intelligence. Topics include building rapport with patients through personalized note-taking, the role of showmanship in dentistry, the importance of self-awareness, using Loom.dental for communication and consent, and the shift towards electronic record keeping.