Protrusive Dental Podcast

Does ‘elective’ or ‘pre-emptive’ endodontics have a role in Restorative Dentistry? It almost feels dirty to me as I try my best to PRESERVE pulp vitality! But sometimes this bites you, and you wish you had carried out root canal treatment before cementing that crown. At what point can pre-emptive root canal be justified in a world where MTA and biodentine exist? https://youtu.be/9Gc_yik9fDU Watch PDP202 on Youtube In this episode, Jaz sits down with renowned endodontist Dr. Brett Gilbert to delve into the intriguing world of elective or pre-emptive endodontics. Together, they explore challenging cases where teeth with uncertain pulpal health may require root canal treatment, whether due to caries or crown prep. Dr. Gilbert sheds light on patient communication strategies, the role of bioactive materials like biodentine and bioceramic sealers, and how to make crucial decisions about preserving pulp vitality. Protrusive Dental Pearl: Dr. Pav Khaira suggests using Alvogyl, commonly used for dry sockets, to treat pericoronitis! After cleaning and disinfecting the area, place a small amount under the operculum for immediate relief and to soothe inflammation. Need to Read it? Check out the Full Episode Transcript below! Highlights of this Episode: 3:01 Protrusive Dental Pearl 03:55 Dr. Brett Gilbert's Journey and Philosophy 07:17 Elective or Pre-emptive Endodontics 11:06 Radiographic Measurement 11:40 Real-Life Encounters  15:29 Discussing Treatment Options and Patient Communication 20:28 Can Biodentine Prevent Root Canal? 22:45 Materials and Techniques in Endodontics 26:16 Death of Gutta-percha? This episode is eligible for 0.5 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes B and C. AGD Subject code: 070 Endodontics (Endodontic infections, microbiology and treatment) Dentists will be able to:  1. Learn what elective or preemptive endodontics entails and recognize scenarios where root canal treatment may be required due to caries or crown preparation, and how to approach them.2. Discover effective strategies for explaining treatment options to patients, improving trust and decision-making.3. Gain insights into the use of bioactive materials like biodentine and bioceramic sealers, and their benefits in preserving pulp vitality. If you liked this episode, you’ll love Post Operative Pain after Endodontics – Prevention and Management – GF017 Click below for full episode transcript: Teaser: I do believe in these instances, you are justified to recommend the treatment. You're not demanding it. You're not saying it's dogma, but you're having a conversation so the patient understands. Because what happens if you don't is you do your work, you're doing it in best faith. Patient winds up in pain, and they become very angry. Teaser:They become agitated, and they want to blame the dentist. And without a conversation, without a dialogue, they're clueless, and all of a sudden, they just think you did something wrong. You are a human, and you are the doctor. Speak to yourself. Let the words flow out so that you can explain all the different possibilities in a way that the patient feels heard, understood, but also nurtured, and at the same time you realize this is biology. We are not in control. Jaz's Introduction:In a world where we want to do everything to preserve pulp vitality, is it ever appropriate to carry out elective endodontics? Another terminology that our guest today, Dr. Brett Gilbert shared with me is preemptive endodontics. For example, you have a tooth with dubious pulpal prognosis. And you know that by prepping it for a crown or by removing the caries, this tooth may need root canal treatment. Is it okay to just go ahead and do the root canal so it doesn't bite you in the behind in the future? You see, I was always taught to do everything possible to preserve pulp vitality.

Are single-use diamond burs more efficient at cutting? When should we throw away a bur and pick up a fresh one? How long are they supposed to last? (it's measured in minutes!) Are expensive brands a con? Tiny, but one of the most important tools of our trade…BURS! In a world full of different identifying numbers and names, it can get confusing and even overwhelming.  https://youtu.be/Ol0_XcIbSD8 Watch PDP201 on Youtube That’s why on today’s episode, we welcome Günter and Marcela from Intensiv, a globally recognised manufacturer of dental burs, where they take great pride in bringing the latest tech to help make our dental procedures that much easier and effective. In this episode, we cover how diamonds are sourced, what the differences are in colours of burs and how the grain size of diamonds can change our results. There’s lots of amazing tips and tricks here given by the team at Intensiv, so you’ll definitely walk away from this one with something new up your sleeve. Need to Read it? Check out the Full Episode Transcript below! HIGHLIGHTS of this Episode: 01:24 Protrusive Dental Pearl 02:03 Introduction to Team Intensiv 05:40 Understanding Bur Codes 10:49 Bur Colours 15:10 When to Use Different Grit Diamonds 18:40 Single Use Burs vs Reusable Burs 24:59 Sourcing Diamonds 29:18 Fixing the Diamonds to the Metal Shank 32:40 Is my bur fit for purpose? 37:30 Drilling Zirconia 39:30 Final Tips 41:20 Contact Intensiv This episode is eligible for 0.75 CE credit via the quiz below. AGD Code: 250 Operative (restorative) Dentistry (Preparation Technology) GDC Learning Outcome:  C Learning Outcomes Identify the appropriate dental burs for different procedures, considering grit size and material composition, to ensure efficient and safe treatment. Evaluate the impact of bur selection on patient comfort and procedural outcomes, minimising trauma and maximising efficiency during dental treatments. Implement best practices for the maintenance and replacement of burs to ensure optimal performance and longevity, thereby improving clinical results and patient satisfaction. If you liked this episode, you will aslso like: PDP117 - Dental Ceramics in 2022 – Which Ceramic Should I Use Click below for full episode transcript: Teaser: Are single use burs better or really more cost effective than our traditional multi use burs? I think the answer is actually going to surprise you. And my biggest pet peeve, the thing I hate the most, is using a bur and it has like zero cutting efficiency. I work in a clinic where we share our burs and we have like different bur kits made up. Jaz's Introduction:And so sometimes I use a bur and I hadn't inspected it and I find that, oh my goodness, this is taking way longer than it should. And of course I have to ask my nurse to go to the stock room to get a brand new bur. But this is frustrating. Like when you are using a bur with less cutting efficiency. It is annoying and it's actually downright dangerous for the tooth. So how can you tell? Is there an objective way to tell and subjectively, how can you tell exactly the moment when you should bin a bur? So you avoid that horrible scenario. Hello, Protruserati. I'm Jaz Gulati and welcome back to your favorite dental podcast. I'm joined today by Günter Smailus and Marcella Roba who represent Intensiv. Intensiv is a Swiss based company which specializes in diamonds, so who better to find out more about the use of diamond burs and everything to do with diamonds. It's a very geeky episode, but I feel diamond burs and diamonds in dentistry, we use them so much, we rely on them so much. I think it's worth an episode, it's worth discussing about different diamonds in dentistry. I have no financial interest with Intensiv, this is not a sponsored episode. But this is very much for the pursuit of knowledge and disseminating information to Protruserati, i. e. you guys,

Last Live Occlusion Course of 2024 - Book Now: https://courses.iasortho.com/courses/gb/occlusion POV: You spend a fortune on a composite anatomy course and are excited to implement on Monday morning. However, every time you apply those concepts, you end up drilling it away because it’s proud in the occlusion! It essentially now looks like a tooth coloured version of the amalgam you just removed! Your nurse’s eyes are like pools of fire - that’s half her lunch break gone. This happens a few more times until you realise that you’re missing a trick… Enter this podcast to save your career! ;) https://youtu.be/5MVvknCNV-8 Watch PDP200 on Youtube Dr Jaz Gulati and Dr Mahmoud Ibrahim will teach you how to radically minimize adjustments on your daily restorations. Key Takeaways: Always check the patient's occlusion before starting any restoration. Utilize shim stock to ensure accurate occlusal contacts post-restoration. Pre-op visual checks are crucial for successful composite placement. Don't compromise on the anatomy of the restoration for aesthetics. Use thinner articulating paper for more precise occlusal markings. Communicate effectively with your dental nurse about new protocols. Involve your senses to assess the quality of your restorations. Document occlusal marks pre and post-restoration for reference. Adjustments should be minimal if pre-op checks are thorough. Educate patients about their occlusion to manage expectations. Need to Read it? Check out the Full Episode Transcript below! Highlights of this Episode:05:24 Introduction - Dr Mahmoud Ibrahim08:42 Posterior Composite14:15 Shim Stock Foil16:35 Effects of Numbing on Occlusion18:23 Lower First Molar Example22:06 Shim Stock revisited26:22 Lateral Excursions30:32 Fissure Staining?31:56 Old Restoration as a Guide35:33 Restoration Techniques and Adjustments38:03 Tips and Tricks43:28 Event Discussion45:09 The Importance of Marginal Ridges46:25 Anatomy or aNOTomy?48:17 Post-Op Checklist: Final Adjustmentsand Polishing Tips54:19 Wrapping Up: Using Your Senses in Dentistry56:43 Outro This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance App. This episode meets GDC Outcomes A and C. AGD Code: 250 Operative (Restorative) Dentistry (Direct restorations) Dentists will be able to: Evaluate and manage occlusion during posterior composite restorations, ensuring that patient bite and interdigitation are maintained post-procedure. Effectively use shim stock foil and articulating paper to achieve precise contact points and occlusal balance, minimizing the need for post-restoration adjustments. Apply practical techniques, such as using occlusal stamps and soft flex discs, to streamline posterior composite restorations while improving the durability and aesthetics of the final result. If you liked this episode, check out: IC046 - 4 Ways and 6 Great Reasons to Document Your Dentistry Click below for full episode transcript: Teaser: The cuspal inclines and using visual references that I take before I prep the tooth. So I'll look at where the marginal ridge is compared to the base of the cavity. Where's the bottom of the fissure pattern on the adjacent tooth, for example. Use those visual references and then the angle of the cusp. The angle of the cusp is probably, for me at least, one of the most important ones. Teaser:Some patients are like princess and the pea, whereas other patients are like everything feels amazing. And the very last thing you check is how does that feel? That's like the last. Why are we getting patients to feel their bite? They shouldn't like become obsessed about their bite. We're kind of edging them closer every time we say, how does it feel? How does it feel? They're feeling their bite. Something that really should be not really present for them, if you like. Once you get quicker and slicker,

Follow THESE protocols to eliminate teeth whitening sensitivity in your practice - your patients will love you. Have you ever had a patient who had to stop whitening due to severe sensitivity? Should we be whitening when there are active carious lesions? (the answer might surprise you) https://youtu.be/IC3wMpfLo30 Watch PDP199 on Youtube In this episode, Dr. Linda Greenwall is back with another phenomenal episode as we dive into this common concern. Together, we discuss practical tips and effective strategies and protocols to help patients achieve radiant smiles without pain. Protrusive Dental Pearl: We’ve made an infographic to summarise this awesome episode. This one is available freely under the episode in our Protrusive Guidance App. Need to Read it? Check out the Full Episode Transcript below! Highlights of the episode: 03:06 Dr. Linda Greenwald's Background and Experience 07:09 Teeth Whitening: A Global Perspective 08:31 Diagnosing Teeth Sensitivity 14:28 Managing Non-Carious Cervical Lesions (NCCLs) 22:30 Using Sensodyne for Sensitivity Management 24:36 Exploring Different Sensodyne Products 26:26 Bruxism and Occlusal Forces: Mechanisms of Sensitivity 29:39 Role of Hydration and Tray Design 32:57 Whitening Limitations: Cervical Whitening and Medication Impact 36:41 Dehydration and Discoloration 42:03 Therapeutic Uses of Whitening Trays 48:53 Upcoming Events and Final Thoughts Dr. Linda Greenwald invites the Protruseratis to the "Future Dentistry" conference on November 1st at the BDA, featuring dental AI, restorative, orthodontics, and implant innovations. This episode is eligible for 1 CE credit via the quiz on the Protrusive Guidance App. This episode meets GDC Outcomes A and C. AGD code 780 ESTHETICS/COSMETIC DENTISTRY (Tooth whitening/bleaching) Dentists will be able to: 1. Understand the causes of teeth sensitivity during whitening treatments and conduct thorough diagnostics. 2. Implement pre-whitening protocols such as treating non-carious cervical lesions and recommending desensitizing toothpastes. 3. Gain insights into preventative measures for managing sensitivity in whitening treatments. If you love this, be sure to check out Dr. Linda’s other Protrusive Episodes: Finally, Some Clarity on Teeth Whitening for Under-18s with Linda Greenwall – PDP096 and ICON Resin Infiltration – Step by Step FULL PROTOCOL – PDP140 Click below for full episode transcript: Teaser: Any discolored tooth needs a periapical radiograph, really, really important, because you are looking for undiagnosed periapical lesions. And most dentists don't know, if there is an undiagnosed periapical lesion and you put whitening gel into, so you take oxygen, and you shove it into an anaerobic area, you are going to have max of sensitivity- Teaser:Because I think a lot of dentists are afraid of doing that because they're afraid of not being able to adequately bleach the cervical area. So here's another point. You can't adequately bleach the cervical area. It's never going to be the same shade. And that's a myth- The last two millimeters of the bleaching tray. So that actually tray is not rubbing on the cervical area. And they found it improved sensitivity and made no difference to the whitening effect whatsoever. So you can do that. Jaz's Introduction:Protruserati, this just might be the most actionable and impactful piece of content you'll ever consume on the topic of teeth whitening sensitivity to really help our patients to whiten better without having the horrible side effect of teeth sensitivity. I don't know about you, but for some patients it can be so bad that after about three days they don't whiten ever again. And you have to have that awkward conversation with the patient. But now, following Dr. Linda Greenwald's protocols, We can eliminate teeth sensitivity. Like, we could have spoken for like hours and hours and hours.

Emma Hutchison, a dental student, shares valuable insights on navigating the complexities of occlusion and centric relation. She discusses the dilemma of whether to cement a crown that feels off-bite but looks good. The conversation also dives into the GABS occlusal philosophy, and practical techniques for checking occlusion effectively. Emma highlights the importance of mastering dental terminology and emphasizes the need for personalized maintenance plans in long-term care, making it essential listening for dental students aiming to enhance their clinical skills.

“Defensive Dentistry and the fear culture is the number 1 cause of anxiety amongst Dentists” How can we instead foster a culture where we can focus on growth and supporting each other? Does Dentistry have a social media problem? https://youtu.be/wsiENbuIXcE Watch IC053 on Youtube Join us on this episode with Dr Mehy Lo-Presti as we navigate dentistry and social media, the pros and cons of using the online world as part of our portfolio and how we can remove anxiety through effective communication. 2 Events to Attend: DentoRama 18th October Treatment Planning Symposium (Hybrid Event) 16th Nov Need to Read it? Check out the Full Episode Transcript below! Highlights of this Episode:02:05 Introduction - Dr Mehy Lo-Presti06:42 Mehy Early On12:04 Dento-Rama15:30 Social Media in Dentistry20:35 Life Before Social Media21:25 Social Media is a Business 23:40 What Causes Anxiety for Dentists?29:45 Overcoming the Fear Factor34:45 Fast Tracking to Success41:20 Wrapping Up47:14 Booking the Event and Getting in Touch This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance. GDC LEARNING OUTCOMES: A AGD Code 770 (Self Improvement) Dentists will be able to: Gain insights into how social media affects clinical practice, patient perceptions, and professional image, learning how to use these platforms responsibly. Manage the pressures of online validation, minimising the impact on their mental health and maintaining a healthy work-life balance. Develop stronger communication methods both online and offline, ensuring clearer patient education, reducing complaints, and fostering better relationships within the dental team. For the full educational experience, our Ultimate Education Plan gives you access to all our courses, webinars, and exclusive monthly content. This includes videos on Overlay preps and the famous 'Vertipreps for Plonkers' series. If you liked this episode, check out IC035 - Best Practices in Social Media for Dentists Click below for full episode transcript: Teaser: It depends again, what you want to show, who you want to be in social media. I always have this debate. I asked this many times in my events. Is it okay to share your personal life and your professional life at the same time? And some people will say yes. And, but there are consequences of that. And the consequences is that- Teaser:I don't believe in fast tracks. I don't believe in that things can go very quick because you're going to miss a lot of learning in the process. So I think exploring and making mistakes and allowing yourself to fail. It's something that. It will make you grow way faster. People are happy in their jobs when they feel that they are treated as adults. And this is something I learned from the employees from Google and Netflix and all these super fancy offices. They understood that people don't care if you give them free food, they have a gym, you have cinema, you have all this super cool things in their office. So if you don't treat them as adults and you don't give them this freedom, they won't be happy. Jaz's Introduction:What's the number one thing holding you back as a clinician? What's holding you back from growing as a dentist and actually sleeping well at night time? It is an F word. Me and my guest today, Dr. Mehy Lo-Presti, we believe that fear is holding us back. When all of our decision making and all of our judgments and our communications are processed through this filter of fear and our dentistry is fear driven and therefore defensive. This is what may thought was the number one contributor of anxiety for dentists. Hello, Protruserati, I'm Jaz Gulati, and welcome back to the Protrusive Dental Podcast. This is an interference cast, where we discuss more of the non clinical themes, which are super important, because we touch on communication, we touch on fulfillment, and we also touch on social media, because we can't avoid it.

Dive into the intriguing debate of bridges versus dentures for tooth replacement! Discover why implants aren't always the best choice and what factors influence decision-making. Learn about the risks and rewards of using a root-filled tooth as a bridge abutment. Explore the art of communicating treatment options with patients and hear wild case stories like roundhouse bridges. Plus, understand the balance of ideal treatments versus patients' budgets and preferences to enhance your dental practice.

Treatment Planning Symposium 16th November Hybrid event: https://www.protrusive.co.uk/rx Are you still afraid of raising the Vertical Dimension? You cannot break free from the shackles of single tooth Dentistry if you don’t get comfortable with vertical dimensions changes in Restorative Dentistry. https://youtu.be/Nb-LTyzRKuU Watch PDP197 on Youtube In this episode, Dr. Jaz Gulati and Dr. Mahmoud Ibrahim  simplify the complex topic of increasing vertical dimension.  What is a safe limit of increasing the vertical dimension? They cover the essentials of joint health, muscle stability, and the importance of centric relation (does it actually matter?) Protrusive Dental Pearl: Use Duralay copings for guide planes to ensure stable dentures with a single path of insertion. While eyeballing the prep can be challenging, he suggests requesting acrylic copings from the lab for precise preparation. He explains that technicians survey models to identify undercuts and determine the path of insertion, and instead of manual prepping, he advises using lab-created reduction copings and acrylic jigs to simplify and accurately guide the preparation process.  Need to Read it? Check out the Full Episode Transcript below! Highlights of this episode:  02:05 Protrusive Dental Pearl  Acyrlic Copings for Guide Planes 03:57 Dr. Mahmoud Ibrahim’s Introduction 06:05 Personal Experiences with Vertical Dimension 08:45 Challenges and Techniques in Vertical Dimension 14:17 Clinical Considerations (Restorative Dentistry) and Research 21:15 How to Assess OVD Loss? 24:35 Factors to Consider in Increasing the Vertical Dimension 28:41 Treatment Planning: Orthodontics vs. Restorative Management 32:21 Assessing Cases for Vertical Dimension 34:39 Joint Position and Vertical Dimension 39:47 Occlusal Appliances Prior to Increasing Vertical Dimension  45:26 Joint Relationship 50:49 Reproducibility and Stability in Occlusal Planning 53:00 Summary and Final Thoughts on Vertical Dimension This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. AGD code: 180 Occlusion  (Occlusal therapy) This episode meets GDC Outcomes A and C. Dentists will be able to: 1. Explore key clinical considerations and current research in restorative dentistry related to vertical dimension, enhancing your ability to make informed decisions. 2. Understand the relationship between joint position and vertical dimension, and how to assess and manage this relationship effectively. 3. Recall the guidelines for assessing the vertical dimension and the safe limit for this in dentate patients. If you liked this, you will also like Functionally Generated Path Technique – Conforming to Funky Occlusions – PDP168 Click below for full episode transcript: Teaser: But it can also help you stage treatments, right? It's a great technique to learn because it allows you then to stage those more comprehensive cases. So one of the most useful things about opening vertical dimension is gaining space for your material without having to prep teeth that they're usually already quite worn. Now that is a huge benefit for anterior teeth, but also can come into play on back teeth. Jaz's Introduction:I used to be petrified of opening the bite, i.e any kind of treatment that would increase the patient's vertical dimension would be way out of my comfort zone and it really made me worried like, is the patient going to adapt? Are they going to get joint pain? Am I perhaps increasing the vertical dimension too much? And so for the first 18 months of my career, I was focusing on conformative dentistry. Not having to change the vertical dimension, just accepting the patient's bite for what it is and working with it. You know, a filling here or a crown there. And back then it mostly was small and large composites. I was still finding my feet, I wasn't confident with indirect dentistry,

Plant it low and watch it grow? Is that serving our patients? Should we keep our crowns flat to avoid ‘interferences’? How about guiding teeth - how can we recreate and build in guidance and the correct cuspal inclination in our indirect work? https://youtu.be/b2KA84dXhnI Watch PDP196 on Youtube As part of Occlusion month I am joined by my dental technician Graham Entwistle and Occlusion geek Dr Mahmoud Ibrahim. We discuss foundational occlusal concepts relevant to our daily indirect restorations. Protrusive Dental Pearl: Bleeding papilla? Use the HOW technique to QUICKLY stop bleeding - insert a Wedge obliquely (Haemostasis with Oblique Wedge technique) as taught by Dr Sunny Sadana from Drecomposite.com Treatment Planning Symposium 16th November HYBRID EVENT Basics of Occlusion Live 2 Day Hands-On Course with Jaz and Mahmoud Need to Read it? Check out the Full Episode Transcript below! Highlights of this Episode: 0:00 Introduction 03:31 Protrusive Dental Pearl 05:16 Introduction - Graham Entwistle + Mahmoud Ibrahim 08:25 Guiding Teeth 11:40 Why is Guidance important? 16:35 What information should we provide our technicians? 20:00 Excursions and Patient Case 28:00 Complex crown creation 33:33 To Facebow or not to Facebow? 34:40 A Technician’s POV 49:50 What is the Technician aiming for? 51:06 Perfect Contacts - technician perspective 53:23 Final Thoughts This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes B and C. AGD Subject code: 180 Occlusion (Occlusal functional concepts) Dentists will be able to: 1. Understand the importance of guidance and occlusion in crown design, ensuring restorations contribute positively to occlusal function and patient well-being. 2. Improve communication strategies with dental technicians, including providing crucial details such as shim holds and occlusal plane guidance, to ensure optimal restorations. 3. Make informed decisions about the distribution of occlusal forces to prevent damage and maintain functional integrity in prosthetic designs. If you liked this episode, you’ll love PDP137 - Q&A with a Dental Technician Click below for full episode transcript: Teaser: If there's one thing people take away from this podcast, it's this point right here, which can easily be missed, okay? When we send a bite to our technician, whether it's a physical bite or a digital bite, more often than not, okay, it's wrong. Jaz's Introduction:Welcome to Occlusion Month on Protrusive Dental Podcast 2024. I've just been a little bit excited for this theme. It's one of my favorite themes to discuss because it was Occlusion, learning Occlusion. It's what allowed my dentistry to become more fun. Allow me to move away from single tooth dentistry and through a series of episodes this month, we're going to help you do the same. Ultimately occlusion is just really good restorative dentistry. It's part of the package, but It's perceived as it's like this dark art, this incredibly confusing thing. I think sometimes it's pitched that way to sell more courses, etc. But me and Mahmoud want to convince you that occlusion is easy. It can be simplified. Have faith, stick with us this month, and we hope to demystify some elements of occlusion. In today's episode, we're covering a theme whereby when you have a guiding tooth. Now, when I said guiding tooth, what did you think of? You probably thought of a canine, canine guidance. So let's talk about that scenario, okay? Let's say you're replacing a canine either with direct restorative material or a crown. Crown's easier to discuss. If you're replacing a canine with a crown or even an implant, how do you design the occlusion on that tooth? How do you ensure that you get the correct guidance from that tooth. Now, actually the real world scenario is not canine guidance because very few of our patients are actually canine guided.

Emma Hutchison, a dental student with expertise in removable prosthetics, joins to simplify the complexities of dentures. They discuss the vital joint positions for fitting dentures and how to accurately calculate freeway space. The conversation dives into the nuances of Wax Jaw Registration, shedding light on what is genuinely recorded in the process. Additionally, Emma shares valuable exam revision tips and emphasizes the importance of continuous learning in mastering removable prosthodontics. It's a must-listen for students eager to enhance their denture skills!