12 Key Lessons – New Year Special Episode – PDP209

Jaz Gulati:
Things that I took away that I’ll be changing in my practice or sometimes things that were validated, lessons and ideas and protocols that were validated. Validation is a really beautiful thing. As you gain more experience in your career, the more courses you go on, you realize that you get to a point where you’re not learning as many new things anymore.

And sometimes you go to a course and it’s just one little thing you picked up. And it was all worth it. And so much of it is actually validation. It’s really lovely sometimes to know that there are other people doing it the same way that you’re doing it, or the advice that you were taught a few years ago is still current and best practice according to someone that you really respect.

Hello Protruserati, I’m Jaz Gulati and welcome back to your favorite dental podcast. Now as this is a PDP episode, before I start, I will give you your protrusive Dental Pearl. And as it is January 1st, it’s 6am as I’m recording this before the kids wake up. And I’ll tell you something really sad, right?

Last night was the first time in my living memory, like literally since I was like six years old, I’ve always seen the new year end. I’ve always seen the clock strike midnight. And to wish those around me a happy new year. Last night, me, the kids, everyone were asleep by 10 p. m. And I guess it’s a sign of maturity, it’s a sign of growing up.

It’s a sign of a season of life I’m in. You know, life is all about family and the two young boys that we have. And by 10 p. m. we were absolutely exhausted. Which is why I was able to be up at like 4 something this morning to get the studio ready to record this. And the reason I’m telling you this is because it’s very relevant to the pearl I’m going to give you.

See, this time of year is really important to me because it was around about this time, six years ago, that I started the Protrusive Dental Podcast. At that time, I had every reason in my mind not to do this, to not start a podcast. Who’s going to listen? I hate the sound of my voice. I don’t have the budget for a studio and I can’t even buy a green screen.

What do I do? I don’t even know how to get started. But then I came across a book all those years ago. It was called Start Now, Get Perfect Later by Rob Moore. And that book really motivated me to just get started. Even if one person listens, that I will get something started. Fast forward so many years and we’ve crossed 1. 1 million audio listens, over 2 million views on YouTube in total, and thousands of Protruserati just like you all over the world that me and Team Protrusive are absolutely indebted to. Thank you so much for supporting the show by watching, by subscribing, by commenting and liking. It really means so much.

Dental Pearl
But, I’m still not at the pearl yet. The pearl is this, that as Protrusive grew and I knew that I have this role to play in the universe. This small little role to play in the universe that means a lot to a lot of dentists actually. Now, we as a team are privileged to receive messages of reigniting dentists passion for dentistry.

Helping dentists get out of a bad mindset and to be the best clinician possible. Those messages absolutely gets the team pumped and those are the highs, but we also experienced lows. Sometimes the workload gets a lot. It’s very tricky sometimes being a clinical dentist, family man, looking after the body and the mind and all those things.

So number one question I get is Jaz, how do you fit it all in? Now there’s a whole webinar I did on this. It’s called My Productivity Secrets Revealed. I think I did it around almost like two years ago now. Still, 100 relevant including how I hired a team. The daily mantras that I follow that’s all there in the webinar and that’s available on Protrusive Guidance. It’s in the webinar replay section. But the thing I want to share with you and echo with you now as we stride into 2025 is what are you willing to sacrifice?

Like, you may have some things that you want to achieve this year, and that’s great. Write them down. Believe in yourself. If you want to own your own practice, if you want to open up a chicken shop, if you want to write a book, or if you want to start doing implants in your practice, or maybe you want to serve your family in a special way.

Me personally, I want to do more cooking this year. Whatever it is that you want to do, it’s likely going to require sometime. So where are you going to get this time from? And so I want you to write your goal down, the thing that you want to achieve in 2025. But it’s not enough to just write it down. I want you to write down what you are willing to sacrifice to achieve that thing, to achieve that goal, to reach that summit.

And so to give you a flavor of the things that I had to give up to make sure that Protrusive is running and alive and thriving is that me, I don’t watch Netflix. I don’t watch TV basically at all. I stopped watching my football matches. I used to watch Manchester United every single football match the whole 90 minutes, two hours I used to watch it and I knew if I’m going to be serious in my career, I had to stop doing that.

So I became a, what we call a fair weather fan. I just watched the odd highlights here and there. And unfortunately my team is not doing so well at the moment, which is sad, but you get the idea. I gave up these luxuries or these pleasures so that I can devote the time. I was absolutely unwilling to give up time with my children and my wife.

I was unwilling to sacrifice on time away vacations and holiday. And I also made sure that I leverage my time while I commute to work from London to Reading now, that I am listening to something, be it a podcast, be it audiobooks. Gosh, I’m a massive fan of Audible and audiobooks. Well, I also have a YouTube premium subscription so I can actually play a video on YouTube but then close the screen and the audio of the video is still playing in the background.

So I can just consume as I drive and reflect and leverage that time. Now, I did just recently start watching Squid Game Season 2, right? We’re like two episodes in. It’s absolutely brilliant. And my wife is really happy that we’re watching it. It’s our little thing to watch together. But by and large, I try and eliminate the non productive things which don’t bring me so much joy.

What brings me joy is the gym. And so I absolutely did not want to give up the gym. So about three, four times a week, I go to the gym and make it happen. Even if it’s just a half an hour workout, which it usually 99% of the time it is. So hope that gives you some perspective, some ideas about writing down what are the things that you will sacrifice that do not give you enough joy.

They might give you joy, but not enough to sacrifice that dream or that desire that you have. And if you’re on Protrusive Guidance, I would love if you could DM me what that is. Open up the app, find me and direct message me what that one thing is that you want to achieve. I would just love to know. I need only a few of you will do this. They’ll be really nice. Okay. So hope that was a inspiring and helpful to someone and let’s get the show on the road.

Main Episode:
Let’s now look at January, 2024’s top lesson. So one of the podcasts I had the most listens and views in January 2024 was Value Your Skills, How to Stop Underselling Yourself. It was an AskJaz006, and I’m quite proud of it, right?

Please do check out that video. And really, it’s about how I struggled at the beginning of my career trying to talk fees to patients. I think so many of us experienced this theme. And that’s normal when you don’t have much experience. You haven’t seen your work and how long your dentistry can work.

When you lack experience, you constantly doubt yourself. And that often gets reflected in your fees, which I understand. I totally understand. But as you gain more experience and skill and you go on more courses. You have every right to command a fair fee and to stop underselling yourself. So please do listen to that podcast.

If you need that kind of a boost, but I’m going to kill two birds in one stone here. Dr. Amit actually commented on that video. And I just realized I didn’t reply to that. Okay. Almost a year ago. I’m sorry, Amit, you are a subscriber. You are someone who comments regularly on the YouTube. I love you so much.

Thank you so much. I’m sorry. I didn’t reply to that one. I just noticed. So why don’t we tackle that one? Cause the lesson is here. Okay. So Amit said, bloody amazing video. Thanks Amit. He asked, what’s best way to convince patients of your value? And do you ever think you run the risk of overvaluing yourself, that patients decline treatment plans and go elsewhere is such a hard balance of sticking to your principles and understanding the realities of patients budgets and market competition.

What a wonderful question, right? So how can we present our fair fee, but not scare too many patients away. So actually you don’t get through the dentistry because everyone’s going elsewhere. I mean, we could have a whole episode just discussing this, but I’m going to give you one quote from one of my mentors, Dr. Michael Melkers. He’s been on the podcast a few times before and he will come again in the future. Please do check out everything by Dr. Michael Melkers.

The quote that was shared to him by a mentor is what I’m passing on to you guys. It’s so relevant to Amit’s question. And the quote is this, “A fair fee is paid with gratitude and accepted without resentment.” So if you just quickly break that down, when a patient pays you a fee and they’re so thankful, like, I remember a landmark moment in my career whereby I was seeing patients under a public healthcare system and they were paying either nothing or next to nothing.

Some of the patients, not all, but some of these patients just didn’t value dentistry. And I was doing all this work. I was working really hard and getting paid peanuts not matching the effort and the time I was putting in my work. And I noticed that the gratitude from these patients, some patients was lacking.

Whereas when I moved to the private sector, I noticed that patients were paying a much higher fee and rightfully so. ‘Cause to deliver good dentistry is not cheap. So patients were paying a lot more, but I was getting thank you cards and so much more gratitude. How does that work? You see, when patients value good quality care, longevity, and how someone can solve their problems, money becomes A factor but not The factor.

And what you’ll notice that when you present yourself to the universe in that way, that patients will pay your fee with gratitude. Now obviously we need to be sensitive of budgets and we can’t just charge a million dollars a crown because that’s just stupid. It’s got to be a fair fee in the way that you are meeting your overheads, you’re making a fair profit, and you’re reflecting your skills, quality, and training.

And when you present that to patients, patients can smell the confidence. They can see that, yes, this dentist, he might be charging a little bit more than these other dentists, but I can tell from the social proof, all these cases that you’ve done before, or the way that you made the patient feel, or the way you explain the plan to them that, yes, this is a dentist for me.

And they will pay your fee with gratitude. But it must be a fee that’s received by you without resentment. The classic one is this, right? You see a patient, you make some complete dentures, and then you see the same patient for 45 adjustments, and you don’t charge every time for those adjustments. So your hourly fee was probably like $2 an hour by the end of it.

And you resent that. You hate that. It’s a bit like when you are lacking experience and you do this silly thing whereby you know something’s not going to work. You know something’s really pushing the boundaries, like trying to crown a lateral incisor. Which has no ferrule at all. But the patient really wants you to save it.

So you save this lateral incisor, stick a fiber post in it, you put a crown on it, and three months later, it breaks away. Because it didn’t have any ferrule. Sound familiar? Hopefully not. But, for me it’s familiar, and for many of you it may be familiar. You know you shouldn’t have done it, but the patient really wanted it.

But now, because it’s failed too soon, all that warning that you do, patients seem to forget. When you say, yeah, but it might just last one day kind of thing, patients are very good at forgetting, because once there’s a fee exchange, things become a little bit different. And so some people end up working for free, and then they do a bridge for this patient as a gesture of goodwill, that, okay, I’m sorry it failed early kind of thing, and you take it on yourself.

So really the lesson is that try and do predictable dentistry, and don’t be in a situation whereby You’re doing dentistry for free and therefore you get that feeling of resent. Or if you really are, are cheap and you’re not charging enough, when a small complication happens, the patient needs to come back.

You want to feel like, hey, I charge a fair fee and I like this patient, the patient likes me and I’m going to go to the ends of the universe to help my patient. That’s great. What you don’t want to feel is that you gave a patient a massive discount, and then you’re seeing the patient again and again to sort these little minor issues out, and you’re constantly resenting the fact that, oh man, I wish I didn’t sell myself so cheap.

There’s so much extra work here, so much effort and time being placed into it, and you’re not being remunerated fairly. So once again, paid with gratitude, received without resentment. Thank you, Dr. Michael Melkers. And thank you Amit for commenting on Protrusive Podcasts and being a Protruserati.

Now let’s move on to February. The biggest episode in February 2024 was with Dr. Lane Ochi, one of my heroes. It’s funny because Dr. Michael Melkers and Lane Ochi, they’re kind of like two peas in a pod. They go together, they go fishing, they lecture together, they’re top blokes. And a great win for Protrusive was having Dr. Lane Ochi, on our app, Protrusive Guidance, in our community, and he’s so regularly posting, helping.

Just one of the nicest people in the world. Forget dentists, just nicest humans in the world. And so the reason I’m on my phone here is I’m looking at the premium notes. So all these episodes, they have these premium notes. And to jog my memory, I’m looking through my phone basically and seeing the PDF that was generated.

So if you want access to like the cliff notes or the summary notes of every single podcast episode, that’s available on Protrusive Guidance. So download that on Play Store and on iOS. And one of the biggest takeaways from that episode with Dr. Lane Ochi is like, we’re already, most of us are taking photos, right?

Either on our DSLR or intraoral camera, but a really quick win is you get the patient to get their phone out. And get the patient to take a photo of that thing you’re showing them. Now, this episode was about crack teeth, should you chase cracks, the decision making process, the patient discussions, really fantastic episode, do listen to it.

And all these episodes we’re referencing, we’ll put them in the show notes. But essentially, when you take a photo of a crack, and you need to have a discussion with your patient, you need to involve them. Yeah, I mean, it’s great to show the patient the photo. It’s amazing. And if you ever have a crack, air abrade that and then the crack will look even more obvious because sometimes in photos you can’t pick it up.

But when you aerobraid it, it’s a little tip that you can actually see the crack a little clearer. Now what you then do is get the patient take a photo on their phone of their crack because then they take it home with them and they reflect and they think about it and they show their significant other because a lot of times when things are important, but asymptomatic when they’re not having pain It’s like when they leave the office like okay, they’re forgotten about it. But it’s actually something they need to learn live with.

They need to own the fact that there’s a crack there and they need to decide with our guidance and discussion of different options available, whether they want to be proactive or reactive, they need to own whichever decision they make. There was a great little tip that I think we can all implement. I’m trying to pick tips here that we can all implement on a day to day basis and that’s the one for February.

Now February 2024 was very special because that’s when we launched Protrusive Guidance. We moved away from the Protrusive Education app, which is a great start. Like I’m a big believer in start now, get perfect later. Like I said, so that first iteration of the app we had was great to get us going. But then now we have really the Rolls Royce of an app.

The Protrusive Guidance app now is a significant investment and time went into it, but I’m so proud of it. It’s a really lovely community. It’s 3000 strong community of you guys, Protruserati, all around the world and that was launched in Feb 2024. So thanks to all of you who jumped on and are supporting the show and our team. I really appreciate that.

Now moving on to March 2024, the top tip from this month’s episode, which had the most views and listens was How to Never Write Notes Again. So the really cool thing happened is I was on a flight to Chicago for the AES, which was absolutely amazing. I would highly encourage everyone to go to the AES in Chicago.

It’s a great meeting of all the occlusal minds. And it was just so inspiring. And while I was on the flight, I was looking at different ways to optimize my notes. Cause as you know, I hate two things in life. I hate washing dishes and guess what? Now we have a dishwasher. And I hate writing my notes, but now I use AI and AI has absolutely changed the game for me.

Now you must still check the notes that are produced from AI. Make sure it’s accurate. Make sure the microphone that picked up your words that it picked it up correctly. So it’s still our duty to check it, but my notes are so much more thorough, so much more accurate. And I get to save the audio recording, all this with my patient’s consent.

So two softwares I’m using at the moment are Digital TCO and Dental Audio Notes. I use both of them. Because I’m so reliant on audio for my notes that I would hate it if one of them crashed and I lost the audio that I refuse to have it. And they’re so fairly priced that saving four to five hours a week for me so I can do more of this stuff is so important that that’s why I subscribe to both.

So check out Dental Audio Notes and check out Digital TCO. Digital TCO is the main one I use for my notes. And DAN is what I use a moment for just the high quality audio recording, but it also has fantastic features, AI features, always growing. And again, I’ll put those links in the show notes. If you want special Protrusive pricing on Digital TCO, then head to digitaltco.co.uk/protrusive so you get that top plan at their lowest fee. So it is something like that. 30, 40% off at the moment. And that is an affiliate link, by the way, but absolutely transform my practice. So the main lesson there is, are you using AI in your note taking yet? And if not, why not?

My nurse is so much happier. Like God bless her. She’s slow at typing. Okay. Zoe, I’m sorry to say, you know it. I know it. Well, you’re slow at typing. But it’s okay because now you love the fact that I use AI and you just supplement it with little things here and there and we check it together. So it’s absolutely great.

Now, moving on to April, we had Dr. Celine Higton, we had so many great guests, but the one that had the most views and listens was Dr. Celine Higton, Isolating the Last Tooth. So it’s all about rubber dam usage, and she’s such a brilliant advocate of adhesive dentistry and rubber dam isolation, which I’m a huge fan of, as you know.

On the app, we have the Quick and Slick Rubber Dam masterclass webinar, plus 30 videos showing you how I isolate in real time through loop mounted camera, how I isolate all these cases. Some are two minutes, some are 15 minutes, really tricky cases that I’ve isolated, and that’s available on the app.

But the main takeaway I want to give you, or the lesson I want to highlight from that episode, is if you are frustrated with rubber dam usage, you’re probably using the wrong gear because when you use the right type of rubber dam and the correct clamps i. e wingless clamps and use the correct technique i. e is four handed, right? Your nurse should be using the floss and actually I don’t like it when the nurse uses floss. We use flossettes those little harp shaped things Those are like y shaped things with like a little floss going through it like a line of floss. If your nurse uses that they get so much better access.

And now you can just hold the dam in place and the nurse can use the flossette. So I know a good trades person never blames their tools, but probably you’re struggling with rubber dam because you’re using the wrong tools. If you use the right tools and the right technique, honestly, it becomes so much easier.

And obviously getting those reps in, getting those reps in to become better and better, and even how you communicate rubber dam to your patients. That’s really important. So check out that episode as I now talk about a kind of an opposite episode, right?

Cause in May, the most popular episode was Class Two Composites Without a Wedge. Okay. The contact opening technique. That’s PDP188 with Dr. Sunny Sadana. He’s the guy who’s famous for bringing the greater curve matrix and making accessible in the UK and other parts of the world. So the greater curve matrix. Speak to the Americans, they know about this matrix band, it’s pretty slick, it’s pretty good.

And I come from a background where everything needs a sectional matrix, and if it can’t be, if it’s too complex for a sectional matrix, it’s got to be indirect, right? And therefore, using rubber dam, and as you know, I love using dam, but since using the greater curve matrix now for a year and a half now, I’m using less dam, okay?

Now, I am sinning, if you think that, if you’re probably right to think that I might be sinning here, but look, I’m actually a former head of the rubber dam police. I’m a former inspector of the rubber dam police. Everything was rubber dam before, but now the seal that I get with a great curve matrix means that my gingival seal is perfect.

And therefore, if I’m treating an upper premolar, first molar and I’ve got a really great seal and the patient’s not a mouth breather and I can keep it well isolated, then maybe in that patient I’m not going to use rubber dam. Whereas if it’s a lower arch I’m pretty much always going to use rubber dam, Do you see what I mean?

I’ve kind of become a little more flexible and that’s down to the fantastic gingival seal that I get from the great curved matrix band. There’s a live webinar I did with Sunny on Protrusive Guidance recently all about my tough composite cases. So I showed everyone videos, me doing a peg lateral with the greater curve band and a couple of class twos whereby I got a good contact and one where I didn’t get a good contact and we kind of critiqued it together.

So that’s on Protrusive guidance. The main lesson I can give you from this is that there is a beauty in being able to change your protocols when something more clever or more efficient comes your way. Sometimes you get set in our ways. That something always has to be done in a certain way, and that is dangerous.

So it’s important about doing things that work in your hands and not changing your protocols too often. But now, and again, to review emerging technologies or a different mindset, because the contact opening technique is just like, it’s absolutely crazy. I was really against it when I first learned about it.

Think about it. You put your matrix band on your circumferential matrix band, you put it on. And now you don’t use a wedge instead to get the contact with a tooth next door. You get a bur and you drill a hole through the matrix to contact the adjacent tooth. It just sounds barbaric. It sounds wrong. Let me tell you, it works.

Okay, and now because you get a really good seal and you don’t get that wedge that opens up the contact and distorts your matrix band. There is a place for this. I still use sectional matrix bands I still use other systems but using the contact opening technique It’s totally something we need to have in our armamentarium.

Especially for me, my patient base is age 60 plus primarily. I work in like a little village in Reading and therefore my patients have like subgingival caries, root caries, big restorations to do. So this is why I’m a huge fan of this matrix plan. And we’ll just highlight you to be open to different ways of doing it and really try it, critique it before you poo poo something.

Okay. That brings us on to May and May had the best performing episode. You guys absolutely loved Onlays Versus Full Crowns with Dr. Alan Burgin. It was the most listened to episode on Spotify, on Apple, on YouTube, you name it. It absolutely outperformed all metrics.

And it’s a testament to Dr. Alan Burgin and the wonderful work he does. And it was just a lovely discussion, real world discussion. We look at it too. We think, hmm, how are we going to restore it? You’ve got to begin with the end in mind. So are you doing an overlay, something in ceramic adhesive dentistry, or you can do a full crown, which we’re of course doing less and less of.

The exception to that is I’m doing a lot of vertical crowns and vertical crowns is like basically a vertiprep and you’re like minimally preparing and therefore you get to conserve so much tooth structure. And it’s amazing a stat that Alan shared on that podcast is that when you design it, well, a vertical preparation can actually be even more conservative than an overlay in terms of how much tooth preparation you have to do, how much tooth tissue was sacrificed. So we’re at a situation now that we can use zirconia vertical crowns in a very minimalistic way. Now, that doesn’t mean I’m going to be crowning everything because when I have enamel, I believe in adhesive dentistry and I will be doing my overlays.

I love doing my overlays. Get the rubber dam on and fall in love with little minute details of bonding and being biomimetic and being adhesive and that’s great. But when you have a dubious tooth that you don’t have that high quality enamel all the way around, I’m totally gonna vertical prep that. I see how much ferrule I gain or how much tooth structure I preserve and it just makes me smile.

So if you’re not already doing vertical preparations or overlays, then maybe this is the year that you start learning about these two modes of treatment, which is pretty much how I do my indirect restoration. It’s either going to be an adhesive overlay. Or if I’m doing a crown, it’s going to be a vertical preparation.

There’s so many courses out there. Do check them out. I would encourage you to go on a hands on one. But if you want to do something online, then I have that on Protrusive Guidance. So in the premium clinical videos, I have full walkthroughs of doing adhesive procedures. So adhesive overlays and the veneer being bonded.

So you can check that out. Or, I’ve got a whole series, VertiPrep for Plonkers, which I’m going to probably rename to the VertiPrep Challenge. Your first premolar vertical crown. These are some of your guys favorite piece of content that we have on Protrusive. Your favorite course that you’ve done is VertiPrep for Plonkers, so do check that one out. It’s on the Ultimate Education Plan on Protrusive Guidance.

So guys, if you’re still doing shoulders, I would like you to reconsider. Could you be doing more overlays? Could you be doing vertical prep? Could you be more conservative? By using these two indirect modalities.

Okay. So we’ve done half the review so far and it’s almost 7 a. m. in the UK and that’s my wife’s alarm. She’s doing the New Year’s shift today. So it’s New Year’s Day. She’s doing the New Year’s shift. God bless her. Healthcare worker helping out emergency patients on New Year’s Day, and I’ve got the boys. So I’m going to go now and you can join the rest of it on part two.

So I’ll come back later. I’ll record part two for you guys. Hope you’re enjoying it so far. And I’ll catch you in part two. And of course, for newcomers, thank you so much for joining the podcast. Please do hit the subscribe button for those who are returning. So many of you have not hit that subscribe button.

What’s wrong? Are you allergic to it? Hit that subscribe button, show your support to Team Protrusive, and I promise you, we will support you back with the content we make this year. So thanks so much for listening to this one. Slightly different episode, but I just wanted to do like a year recap. And I’ll also in part two, we’ll finish off the recap and the key lessons. But then also look ahead at what we’ve got planned for 2025. All right. Bye for now. Before my wife wakes up, catch you in a bit.

Hello and welcome back to part two of this new year special. It’s funny because. I told you I was up really early 4 a. m. And I had to wrap up part one because it was almost 7 a. m. My wife was gonna be up. I had to look after the kids. I gave you a little glimpse of my life there and now it’s 11 58 p. m. So it’s almost midnight. I was working the evening shift. So remember I work morning shift one week and an evening shift the other week. And this way I get to do a school pickup or a drop off.

It actually is pretty good for work life balance in that regard. Yeah, came home this evening, quite late, caught up with the missus. And there we are, we’re recording now. And echoing back to that same theme that we talked about in part one, which is how do I fill it in? I gave you some of my advice about productivity in part one.

So if you didn’t check out part one, then do check out part one. It was a nice overview of the first half of the year. Okay. And now we’re going to continue with part two, but the whole productivity thing means that, how bad do you want to achieve something? How bad do you want to do something?

And like I said, in part one, there are some things that you’re willing to sacrifice and some things that you weren’t. And once you’ve made peace with that, you can do a lot. They always say that you overestimate what you can do in a year and underestimate what you can do in 10 years. By the way can we make that the pearl for this episode?

I realize this is not actually a proper PDP. It’s like a off the cuff part 1 part 2 New Year special. But yeah, I do like that one you overestimate what you can do in a year and you underestimate what you do in 10 years.

So where we left off last time was the month of July and in July the most popular episode was which generation bonding agent is the best. Now, this is really popular. You guys love adhesive topics and the main takeaway I want to give you from this episode with Dr. Sam Sherif, and it’s so simple and it’s so foundational and you’ve probably heard me say it before. For any adhesive system that you start using, please, please, please read the directions for use.

In fact, read the directions for use for every product you’re using, but especially for the adhesive stuff. These things are so specific and so technique sensitive that you need to make sure every stage is right. In fact, we had a question in the community recently, and the question was, can you use, like, the primer of one system and the bond of a different brand, and will it work?

And some of the community members on Protrusive Guidance chipped in and said, actually, I’ve been accidentally doing this for years. And I haven’t had any issues. So you know what? If it’s the same generation of bonding agent, then maybe it’s going to be fine. If you use like a GC primer and an Ivoclar bond, maybe it’s okay, but I would never ever advocate it.

I would not sleep well at night if I did this. And I’m a big believer in that, whichever system you use try and use the same brand stuff. Don’t do mixing and matching. Cause just, it’s just anxiety central for me. So on this theme of reading, when you’re using an adhesive system, especially if it’s new to you, maybe you joined a new clinic, read everything you can about that adhesive system.

What does the manufacturer say about how it should be used? Are there any clinical papers discussing the sort of deviations in the protocol? What about experiences from your colleagues that use a cement? Sometimes it’d be like, Oh, you know what? With this specific system, make sure you do this or you wait 20 seconds.

There’s so much we can learn. from our colleagues. In fact, I remember reading about OptiBond FL. You know that fourth generation bond, OptiBond FL? It’s like the grandfather of all the bonds, right? People love it still, although nowadays the newer generations have pretty much caught up. Okay, let’s face it.

But, some of the purists still like to use OptiBond FL and ideally use the primer on the dentine and the bond on the dentine and enamel. And so, correct me if I’m wrong, but the protocol I read was that if you’re bonding to enamel only, you don’t need to use a primer. You go straight to the bond. So you do etch and the bond, you don’t need to prime if you’re working on the enamel.

But then if you read the papers, they did these studies whereby they actually did use the primer on enamel and they found that it didn’t work. Did actually improve the bond strengths. So there’s those little nuances and additional evidence that comes out, companies will manufacture and test their products and they’re always gonna be a little bit biased.

So any independent research you can read about your adhesive system, that’s like the best way to geek out. So I would definitely encourage you all to do that. Okay, now let’s continue the theme of 12 tips across the 12 months, right? So just to remind you from part one, we’re going to just go over 2024 episodes and like the key things that you can validate your learning or just remember what was shared that month if you’ve been on this Protrusive journey.

If this happens to be the first episode you’ve clicked onto, then wow, everything you’re hearing is like, oh, that’s a gem. That’s a gem. But to many of you, Protruserati, this is all familiar. I’m just reminding you of these knowledge bombs that were dropped some time ago.

So August. Okay. So August, the top episode was the one with Dr. Rupert Monkhouse. Do you remember the digital dentures? Is this the death of impressions? And what I don’t want to do is like summarize the entire episode. You really need to listen to that one. It’s just so great. The scope for digital dentistry and how patients actually preferring them with a little test that Rupert did.

So that was fantastic. But the main thing I want to give you, because it may not be relevant to all of you around the world. Many clinics have not yet embraced digital dentistry. And I think that will change in time. And scanners become ever prevalent. In fact, on the Protrusive Guidance community, some of you invested in these own brand Chinese makes of scanners and you guys are having good success and you guys are liking them.

So look, they’re becoming a really affordable, like for two and a half thousand pounds, I think Terence Ong bought one, which is amazing. And he’s been very happy with it. He posted this on the community. But the pearl I want to give you from that episode is something that we spoke before with Rupert as well, and it’s something that’s applicable to everyone, which is finding a great technician.

Do you know your technician’s name? Okay, so many colleagues, they don’t actually know who their technician is. Why? Because they’re sending their work to a big lab, which is cool, which is fine. They’re sending it to a big lab. And someone different touches their work all the time. Now, if you feel compelled due to geographical convenience, or your big corporate is making you do it, to send it to a quote unquote big lab, that’s fine.

But how about you visit that big lab, look a technician in the eye, and form a relationship with one technician, or maybe two technicians in that lab. And start being on WhatsApp terms with them. Try to understand and develop each other’s philosophies. That would be a wonderful thing to do. In fact, something that Dr. Finlay Sutton himself a few years ago on the podcast, he said is try and find a technician, similar age to you, then you can just develop together over the years.

And the other thing here is that as dentists sometimes, me especially when I was younger, I was scared to teach quote unquote teach something to the technician because I was thinking wait I’m just a young dentist what can I teach a technician well actually when I spoke to technicians they felt the same they thought oh what can I teach the dentist the dentist is the king is the guru I need to adapt to them and be guided by them whereas the dentist is like hey the technician is my guru the technician knows so much more than me about this.

But actually there’s something that you can both offer the technician and the dentist working together and teaching each other and growing together. So that’s the top tip I want to give you on the theme of dentures and generally with all types of lab work, find yourself a good technician to grow with.

Okay, moving on to September 2024. It’s that man, Mahmoud Ibrahim. It was a joint episode we did on Vertical Dimension. This was probably like the second most listened to episode in the entire year after the one about full crowns versus overlays. So if you want a really good summary, if you haven’t listened to this one yet, check it out.

It’s PDP197, Vertical Dimension, Don’t Be Scared. And the lesson is, don’t be scared. It is actually quite predictable, especially up to five millimeters. And the thing I want to highlight or the thing I want to give away to you is a really wonderful paper. It’s the review by J. Abduo. It’s been cited by 527, right?

And it’s like the first one on Google. So it’s called clinical considerations for increasing occlusal vertical dimension, a review. It is a brilliant review. So I’ll make sure I put in the show notes, but this paper is just such a great thing to read. Me and Mahmoud go over some points and we do some extra bits around it.

But if you’re the kind of guy or gal who likes to get it in their hands and read every detail, then this review, look no further. It is truly a fantastic review. So I wanted to include a reference that you can check out and just geek out with. Okay, so I’m on to the next one. I’m smiling. All right, okay, because the one for October literally posted like an exact calendar month after the previous one is again with Mahmoud Ibrahim.

So you guys loved our episodes. I appreciate you guys so much. Thank you. And this one was a big one, right? It was how to place posterior composites without destroying your anatomy, right? That the most foundational thing, we’ve all been there, you place that restoration and you make it look beautiful.

Cause he went on that course that showed us how to make teeth look beautiful. And then we take off the rubber dam. Patient bites together and you know where it’s going, right? You have to drill it all away and it just looks flat. It looks like a white amalgam and you’re thinking, why did I even bother?

What a waste of time. You’re already running late. So this is like a really familiar site. So main takeaway from that episode and there’s all these different strategies that we discussed in terms of how to make sure that you can do the least amount of adjustment as possible. And I think if I was to give you the top tip from that one is the following, right?

If you answer this question whereby should the anatomy that you give to your patient in your restoration, should it follow the textbook? Like we all know what a virgin six year old tooth looks like. We all know what a first molar looks like, right? And we look at the textbook, the molar that they show in the textbook, what age is that patient?

Like six years old, eight years old. Those anatomical norms that we see in the textbook, they are like pristine teeth. They don’t have any of the natural wear baked in. You don’t even see any evidence of an opposing tooth in that image. So if we give that to your patient who’s 65 and a severe bruxist and you give that kind of anatomy, well guess what?

You’re going to be drilling it all away. So we must take inspiration from the textbook, but what we must deliver must be appropriate to the opposing tooth, to the actual arch, and to the entire chewing system of that patient. So the thing I always say is, why are we giving a six year old a 14 year old’s tooth.

When you start really thinking about it, and then how you actually place your composites will change for the better. Because now we’ll be doing a lot less adjustment. Because you know that there are certain bits of anatomy that get deleted, that get worn away by the time you get to age 60 or 70. So our restorations, even posterior, must be age appropriate, but more important than age, you actually have to look at your patient.

Look, study the occlusion preoperatively really well. So many of us don’t do this, by the way, right? We just dive in, remove the caries, and we check the occlusion at the end. Always, always, always. We emphasize it. Check the occlusion before you start, so you know what you’re conforming to. Okay, almost coming to the end guys.

Looking at November, the top podcast was Dr. Mike Gregory on making awesome dentures. I mean, what a, inspirational guy. You know, stuff that he shares on Instagram is just absolutely fantastic. And he’s so giving and visual. And the top takeaway I had from that was when you’re creating undercuts, like sometimes when you’re doing dentures and some of your teeth, like premodels, they’re really flat.

They don’t have enough anatomy. And so he teaches to use flowable composite to create buccal and or lingual undercuts. And the best analogy uses is a fried egg, right? So what you don’t want to do when you’re creating undercuts, right? Is you don’t want to make a hard boiled egg cut in half.

So basically you don’t want like a pimple coming out of the tooth, because how is that clasp going to engage that? And then how are you going to remove that denture, right? The clasp needs to like slip on and slip off. Right? So you need to imagine a fried egg. A really good way that we didn’t discuss is there, but you know how sometimes you see invisalign attachments or clear aligner attachments, right?

And when they’re done by someone who’s not using magnification, and they’re really messy attachments, a bit like that. Sometimes they look like fried eggs, right? So fried egg flowable composite is you basically make it look like a fried egg. So it’s got this like a wide base. And then as you get to the middle, you get to the yolk.

It’s got a little gentle raise, right? It’s like a gentle raise and that’s so much better for your class to actually come onto the undercut and then come back off. So that was the top takeaway from that episode.

I just wanted to remind you of, and now lastly, December, just last month, the top episode was the one I did with Emma, right? You know, Emma, the Protrusive Student. I hope you guys have been enjoying our back to basics, the Protrusive Student series. There’s more of that to come in 2025 and something really cool happened during this episode whereby she asked me about application points and something that I’ve always had inside me in my head, but I never had the opportunity to discuss was how extractions are like avocados in the way that when you cut an avocado in half and you remove the avocado nut.

There’s a special technique of doing so and if you mess it up, then it can take out the flesh of the avocado with it, blah, blah. And so I use that analogy of removing a nut and I compared it to removing a tooth and how you know when you’ve got that application point, what happens if you put too much force?

So it actually turned out to be a really cool episode, really well received. I’m glad I managed to get this avocado analogy out to me. So if you know someone early in their career, and I think early in their career, everyone would benefit from an extraction, like a basics of extraction episode, please do send them that as a gift.

It would really mean a lot to me if you would just send them that episode, because the younger colleagues absolutely love that one. And now every time I reach for an avocado and I’m removing the nut, I always think of that episode with Emma. So if you haven’t listened to it, do check it out. But remember the way that you remove the nut from avocado, there’s so much we can learn about extraction.

So if you haven’t heard the analogy, do check out that episode from last month. So now that brings us very nicely to just looking forward at 2025. And I’m always led by you guys. I would love to know from you guys in the comments, what topics do you want me to cover with a guest? And if you can name a guest, I will do my best to get them on as well.

You know, we’ve done over 300 episodes of Protrusive. Can you believe it? Now, can you believe we’ve actually done over 300 episodes of Protrusive? And I think we’ve barely scratch the surface. There’s so much to learn. It reminds me of one of my favorite quotes by Mahatma Gandhi, which is live as though it is your last day.

I’m gonna have to get this quote now. It’s from the top of my head but it’s like live as though you’re going to die tomorrow and learn as though you’ll live forever. So I think that the true joy of dentistry for me comes from learning. I’m always learning. I’m learning every day. And that’s a beautiful thing.

Like, imagine being in a profession where you didn’t learn something new. And what dentistry presents us is always, there’s new research, new technologies, and every patient comes with unique challenges. That’s what keeps this repetitive thing of dentistry interesting because there are so many nuances in every patient and the more you become comprehensive. Looking at the bigger picture the more exciting it becomes as well. Now before we sign off here this new year special episode is not eligible for CPD or CE. But that’s okay because most of the others are on Protrusive Guidance as you know. And so the ultimate way to subscribe to Protrusive is by signing up for the Ultimate Education Plan.

This is what helps to support the podcast and help it to grow so that Team Protrusive can continue to do what we’re doing, which is Making Dentistry tangible. If you’d like to sign up to our masterclasses, and join the nicest and geekiest dentists in the world. Check out protrusive.co.uk/ultimate and check out our best plan.

Do not forget to comment below though, and tell me what you’d like to cover next. Now, if you’re not going to be joining us for Protrusive Guidance, then can you at least subscribe on YouTube? For the last few years, our YouTube listeners and watchers has actually exceeded Spotify and Apple podcasts.

So I would really appreciate whichever platform, if you’re listening on Spotify or Apple or Amazon, or if you’re watching on YouTube, we’d really severe bruxist and you give that kind of anatomy, well guess what?

You’re going to be drilling it all away. So we must take inspiration from the textbook, but what we must deliver must be appropriate to the opposing tooth, to the actual arch, and to the entire chewing system of that patient. So the thing I always say is, why are we giving a six year old a tooth, a 14 year old’s tooth?

When you start really thinking about it, and then how you actually place your composites will change for the better. Because now we’ll be doing a lot less adjustment. Because you know that there are certain bits of anatomy that get deleted, that get worn away by the time you get to age 60 or 70. So our restorations, even posterior, must be age appropriate, but more important than age, you actually have to look at your patient.

Look Study the occlusion preoperatively really well. So many of us don’t do this, by the way, right? We just dive in, remove the caries and we check the occlusion at the end. Always, always, always. We emphasize it. Check the occlusion before you start, so you know what you’re conforming to. Okay, almost coming to the end guys.

Looking at November, the top podcast was Dr. Mike Gregory on making awesome dentures. I mean, what a, inspirational guy. You know, stuff that he shares on Instagram is just absolutely fantastic. And he’s so giving and visual. And the top takeaway I had from that was when you’re creating undercuts, like sometimes when you’re doing dentures and some of your teeth, like premodels, they’re really flat.

They don’t have enough anatomy. And so he teaches to use flowable composite to create undercuts. To create buccal and or lingual undercuts. And the best analogy uses is a fried egg, right? So what you don’t want to do when you’re creating undercuts, right? Is you don’t want to make a hard boiled egg cut in half.

So basically you don’t want like a pimple coming out of the tooth, because how is that clasp going to engage that? And then how are you going to remove that denture, right? The clasp needs to like slip on and slip off. Right? So you need to imagine a. fried egg You know, a really good way that we didn’t discuss is there, but you know how sometimes you see invisalign attachments or clear aligner attachments, right?

And when they’re done by someone who’s not using magnification, and they’re really messy attachments, a bit like that. Sometimes they look like fried eggs, right? So fried egg flowable composite is you basically make it look like a fried egg. So it’s got this like a wide base. And then as you get to the middle, you get to the yolk.

It’s got a little gentle raise, right? It’s like a gentle raise and that’s so much better for your class to actually come onto the undercut and then come back off. So that was the top takeaway from that episode. I just wanted to remind you of, and now lastly, December, just last month, The top episode was the one I did with Emma, right?

You know, Emma, the protrusive student. I hope you guys have been enjoying our, you know, back to basics, the protrusive student series. There’s more of that to come in 2025 and something really cool happened during this episode whereby she asked me about application points and something that I’ve always had inside me in my head, but I never had the opportunity to discuss was how extractions are like avocados in the way that when you cut an avocado in half and you remove the avocado nut.

There’s a special technique of doing so and if you mess it up, then it can, you know, take out the flesh of the avocado with it, blah, blah. And so I use that analogy of removing a nut and I compared it to removing a tooth and how, you know, when you’ve got that application point, what happens if you put too much force?

So it actually turned out to be a really cool episode, really well received. I’m glad I managed to. Get this avocado analogy out to me. So if you know someone early in their career, and I think early in their career, everyone would benefit from an extraction, like a basics of extraction episode, please do send them that as a gift.

It would really mean a lot to me if you would just send them that episode, because the younger colleagues absolutely love that one. And now every time I reach for an avocado and I’m removing the nut, I always think of that episode with Emma. So if you haven’t listened to it, do check it out. But remember the way that you remove the nut from avocado, there’s so much we can learn about extraction.

So if you haven’t heard the analogy, Do check out that episode from last month. So now that brings us very nicely to just looking forward at 2025. And I’m always led by you guys. I would love to know from you guys in the comments, what topics do you want me to cover with a guest? And if you can name a guest, I will do my best to get them on as well.

You know, we’ve done over 300 episodes of protrusive. Can you believe it? Now, can you believe we’ve actually done over 300 episodes of protrusive? And I think we’ve barely missed it. Scratch the surface. There’s so much to learn. It reminds me of one of my favorite quotes by Mahatma Gandhi, which is live as though It is your last day.

I’m gonna have to get this quote now. It’s from the top of my head But it’s like live as though you’re going to die tomorrow and learn as though you’ll live forever So I think that the true joy of dentistry for me comes from learning. I’m always learning. I’m learning every day Every day. And that’s a beautiful thing.

Like, imagine being in a profession where you didn’t learn something new. And what Dentistry presents us is always, there’s new research, new technologies, and every patient comes with unique challenges. That’s what Dentistry is. Keeps this repetitive thing of dentistry interesting because there are so many nuances in every patient and the more you become comprehensive Looking at the bigger picture the more exciting it becomes as well Now before we sign off here this uh new year special episode is not eligible for cpd or ce But that’s okay because most of the others are on protrusive guidance as you know And so the ultimate way to subscribe to Protrusive is by signing up for the Ultimate Education Plan.

This is what helps to support the podcast and help it to grow so that Team Protrusive can continue to do what we’re doing, which is making Dentistry tangible. If you’d like to sign up to our masterclasses, And join the nicest and geekiest dentists in the world. Check out protrusive.co.uk/ultimate and check out our best plan.

Do not forget to comment below though, and tell me what you’d like to cover next. Now, if you’re not going to be joining us for Protrusive Guidance, then can you at least subscribe on YouTube? For the last few years, our YouTube listeners and watchers has actually exceeded, you know, Spotify and Apple podcasts.

So I would really appreciate whichever platform, if you’re listening on Spotify or Apple or Amazon, or if you’re watching on YouTube, we’d really appreciate it. Appreciate it if you hit that subscribe button. Thanks so much for making it to the end once again. I’ll catch you same time, same place next week.

Bye for now.