Articulating paper has been around for over a hundred years, and it’s still the most common way we evaluate the way our patients’ teeth touch or occlude. But there’s so much we cannot tell by looking at those marks! We cannot tell which ones are higher force or low force, and we definitely cannot tell anything about the timing of contacts. In this episode with Dr. Robert Kerstein will enlighten you about the T-Scan!
Protrusive Dental Pearl: Classically on glazed ceramic, articulating paper marks will be difficult to show up. A little hack to overcome this is to get a tiny smear of vaseline on a micro-brush, paint the articulating paper and get the patient to bite together because the Vaseline has an effect on the articulating paper which allows it to stain or ink the teeth more effectively.
In this episode Dr. Rob and I discussed:
- Traditional way of using articulating paper and its disadvantages 14:55
- T-scan in terms of occlusal adjustment 19:34
- T-scan in terms of differences in adaptive capacity 24:53
- Importance of patient’s feedback 28:58
- Treating patients with TMD through occlusal equilibration 35:45
- Dentists’ concern about the thickness of the T-scan 41:20
- Level of precision in diagnosing patients 46:50
- Why does T-scan seldom meantion on occlusal courses 54:18
All of the Protruserati clan get £200 OFF the T-Scan™ from Clark Dental with the code ‘protrusive‘!
As promised in the episode, if you would like to read some studies/evidence base for the T Scan click here.
Click here to email Dr. Rob Kerstein
If you enjoyed this episode, check out Philosophy of Functional Occlusion with Riaz Yar
Click below for full episode transcript:Opening Snippet: Articulating paper marks are lying to you. Now just think about it for a second, right? When you stick some articulating paper in, and you get the patient to bite together, you often get false positives. So you get these red or blue marks in areas where the teeth aren't actually touching. And you also get false negatives, areas of teeth which actually touching and you don't see a mark and I'll tell you in my Protrusive Pearl later on how to overcome that when it comes to ceramic, glazed ceramic sometimes doesn't pick up the articulating paper ink, and therefore I'll share with you a little tip on how to make it appear...
I just want to just elaborate on this point a little bit. When we see articulating paper marks, we see small dots we see big dots. We kind of have different beliefs if you ask different dentists some will say oh, it’s the bigger marks that mean that there’s more force, whereas other people think No no smaller marks because pressure is force over area therefore, a smaller mark often means higher pressure. The reality of it is, is that this has been studied, and we cannot tell by looking at articulating paper marks, which ones are higher force or low force, and we definitely cannot tell which teeth are hitting first before they eventually, more or less come together. We don’t know anything about the timing of those contacts, which is what this episode is all about. Hello, Protruserati I’m Jaz Gulati. Now, let me elaborate on that a little bit more still. When we’re dealing with single tooth dentistry, this really isn’t so important because you’re just working on one tooth. And how important is that one tooth-like to be in the grand scheme of the entire occlusion of the patient. In most patients, you can get away with a lot, you know, our patients are great at adapting. But when you have an arch of temporaries, or multiple units, let’s say five or six units, and you want to be able to make sure that the patient’s occlusion is comfortable, and that no one restoration is taking too much load. We’re relying on this articulating paper ink, but you don’t know where to adjust. And eventually what could happen is that you end up just adjusting away all the blue dots until you don’t have any contact anymore.
So this is why I think there’s a huge benefit of something called a Tek-scan, or a T scan. And I was, well I had huge reservations about this. And when I met Dr. Robert Kerstein, who’s the guest on today. He’s from the USA. He’s done so much research. He is the go-to guy when it comes to anything to do with the Tek-scan. We shared a very intimate study club together. It was three delegates and Dr. Rob Kerstein. For a whole day, we were talking in geeking out about occlusion so you can tell I was emceeing my elements. And you know what I was heckling, Dr. Rob Kerstein a lot. We’ll talk about that a bit. I was disagreeing with him. I was arguing with him. In good nature, we were debating, okay? And I think it’s important to debate, you know, you shouldn’t take everything that you hear at face value, you should argue and debate. And so we did that, and I had a great time. And I went away thinking that okay, to be able to measure the force and time has some value in many situations. When it comes to bigger cases, it is for me now that I have a T scan. And the reason why this episode is coming out so late since I recorded it is because I was waiting for my T scan to be delivered. And now I’ve used it on some patients, and I am really loving it. So talk all about that journey. In fact, I’m going to do a whole occlusal adjustment episode just to elaborate on my experiences as a beginner using the T scan, and what cool and fascinating anatomical things I found by using it. But I don’t want to distract from the meat of the episode today, which is Rob Kerstein, all about how articulating paper marks aligned to us, and the role of being able to measure the force and time and the benefit that gives to us and our patients. Before I met Dr. Rob Kerstein in Brighton, I had heard of a Tek-scan, but I’ve never actually seen it in the flesh. And I got to see it. And if you haven’t seen it before, it’s like articulating paper, it’s like a horseshoe shape. But it’s completely digital, it looks like a little paper version of a circuit board. And what the basic benefit of it is that when you put in the patient’s mouth, and get the bite together, it transmits all this data to the computer. And you can see which tooth hits first, what is the sequence of the tooth contacts and which teeth are hitting early and which the teeth are hitting late, how much force is being distributed across the arch. Now, think of it already like with implants, right? For example, when we’re working with traditional articulating paper, we’re trying to make sure that we can get some degree of clearance on single implants, right? We don’t want our implants to hold shimstock foil. We want a little bit of clearance now ask different dentists they’ll tell you different microns of amount. But now you can actually quantify that and verify that digitally using something like a T-scan so many numerous benefits and we’ll talk all about them but the thing that took me by surprise is that there’s actually so much evidence when it comes to CT scan. Like we know that in the field of occlusion General, the long term studies, follow-ups, conclusions are poor quality overall. But then Dr. Rob Kerstein opened my eyes to all this evidence basis. To share this Google Drive folder with me with so many PDFs looking at the different trials and studies have happened with the different evolutions of T-scan. And some of it was just really eye opening. So if you want to geek out with that, he’s given permission for me to share these PDFs with you all. All you have to do is go to protrusive.co.uk/evidence. That’s protrusive.co.uk/evidence, and I’ll give you access to every one of these PDFs. So if you want to just geek out or learn further, or critique the evidence, we should always critique the evidence when it’s available. Check that out. [Jaz]
My experiences so far, T-scan has kind of been pretty cool. I can’t wait to share that with you in the extra episode, like I said, but I take great comfort in knowing that great dentists like Dr. Bobby Supple from the US and Dr. Riaz Yar, UK, his very own doctor, Professor, Riaz Yar is also using it. In fact, he’s sharing on his Instagram story pretty much every day, different T scan cases, just great to know that I’m in good company when it comes to that. Actually acquiring a T scan was a tough thing to do as an associate, right? I’m not the owner of the clinic, I’m just an associate. Therefore, it was something that I had to have a real in depth conversation, my principals because ultimately I was going to be the only one there’s gonna be using it. So I felt bad that my principals were gonna have to pull out their credit card and buy something that’s just for me. So I sort of struck a deal with my principals, as an associate up I’ll pay for it. But let’s work out a little business deals. So if you don’t hear about my business deal, I’ll talk about that in the outro. I don’t want distract from the main episode any further. So if you listen to the outro, I’ll tell you about the conversations I have with my principlas, and how the T scan has some degree of an ROI, has a return on investment. Now in episode four, all the way back when in episode four, I did discuss with Dr. Neel Jaiswal about microscopes and how microscopes something that you buy, because you want to improve your dentistry, it doesn’t really have an ROI that you can’t charge X amount for your root canal treatment. And then you can’t charge an extra subsidy for the microscope, it just doesn’t work. But with a T scan, I’m able to actually do that. And patients do realize a wow factor when it comes to this. So I’ll talk about how the business arrangement works. If you listen in the outro. [Jaz]
The Protrusive Dental Pearl I have is about articulating paper. Now you’re thinking Jaz, you’re talking about the T scan, which is supposed to replace your articulating paper because it’s like the new age thing. And now you’re going to give us a tip about articularly paper? How does that work? Well, actually, when you use a T scan, you interpret the data, but you still need the ink from the articulating paper because that’s all the articulating paper does, it transfers ink from the contacts, it doesn’t tell you the true contacts always, and doesn’t tell you about force and time so but you want to know about the ink points. So when you’re interpreting that T scan data, you’re marrying it up with the articulating paper mark so they’re still important and they’re still role of the article in paper ink. Now sometimes you might realize that no matter how much you get the patient to occlude together the ink is not rubbing off on the teeth and quite classically glaze ceramic will be difficult to actually have the articulating paper mark show up. So the little hack for you is to get a tiny smear of Vaseline please please please put a sparing amount of Vaseline, like a microbrush for example. And then you paint that Micro Brush on the articulating paper. Now, obviously articulate papers are different this works on Accufilm which is the one I use, and then you paint both sides of it, and you get the patient to bite together. And there we are, before you could not see the ink mark and now you will be able to because the Vaseline has an effect on the articulating paper which allows it to stain or ink the teeth more effectively. So that if this really works and helps you know scenarios, we just want to see where exactly the contact is on your ceramic restoration. So hope you enjoy this main podcast, you know, open your mind guys open your mind. I know we’ve been taught a specific way and like I said I was the biggest heckler Rob Kerstein ever had. But I think there’s a beauty and listening to different people’s opinions. And let’s give our, you know, warm Protrusive Welcome to Dr. Rob Kerstein and listen to what he has to say. Because I definitely have found so much value from it and I hope you will too. I’ll see you in the outro where I talk about my business deal with my principlas.
Robert Kerstein, Welcome to the Protrusive Dental Podcast. How are you sir? [Rob]
I’m good. Thank you for asking. How are you doing? [Jaz]
Yeah, great obviously was great to see you at the Tubules Congress. I was one of the guys that your lectures and I when I email you say I said hey, I was the annoying guy who kept asking silly questions and stuff and we were having you know, it was good fun. It wasn’t many of us but that made for a very intimate discussion. And I got to have a lot of one to one with you. And we exchanged philosophies and debate and I felt as though with occlusion it was really good and important that we kept it was still with mutual respect because we see all the time, different occlusal camps, right? They’re at each other’s throats. But my mindset is very much like okay, I want to hear your perspective. Now, I might not agree with everything you had say Rob and definitely you wouldn’t agree with some things that I believe but I think what this podcast is about, what protrusive is about, is bringing these different occlusal philosophies together and just sharing with one another. So that’s why I’m so grateful for you to join me today. You obviously had your UK tour. Now for those of you who don’t know you are, Rob, please tell us a little bit about yourself, where you practice, obviously you’re a prosthodontist, how you got involved with the objective measurement of occlusion and how that’s evolved over time? [Rob]
Well, first, thank you for having me on the Protrusive podcast, and I’m honored to be here. I’m a prosthodontist, as you said, and I began my training at Tufts in 1984. When I graduated dental school, I was a dental student and went on to prosthodontics. And in my program was built the first T scan, T scan one, we’re now on T scan 10. And I began using it without really any knowledge other than you know, it was something that you can measure time and force and although it had a manual, it wasn’t really understood how you would use its data. And what Heitler for example, how would you make a better denture with it? How would you deliver a crown and bridge case with it? You know, how could you diagnose someone’s occlusion with it, but it had some very interesting features, mostly the timing aspect, you could measure timing, and you could measure force levels. And when you use that information to make intelligent choices about what to adjust or to treat, patients responded much faster than when it wasn’t used. And as a personal resident, I was delivering different size temporaries, I was delivering different crown and bridge cases we were at the beginning of implants. So that wasn’t really part of my program other than the introduction to implant dentistry. 1983 was when Brandon Mark wrote his important paper about how to do osseointegration. So I was 1984. And the T scan was built then and it was transferred to 16 Dental institutions in the United States, all prominent prosthodontic programs. And I was the only person who really took to it in a sort of studying it scientific way. And I saw things weather that you couldn’t see without it. And certainly you couldn’t see with traditional occlusal indicators, like carbon paper, for example or silicone imprints or mounted models, because it was dynamic, you have this time element. So I began studying it with my professor who built it. My Professor Bill Manus, William Manus, he built the program, T-scan 1 with five engineers from Massachusetts Institute of Technology. And I was the first real researcher with it. Which was led to me becoming more and more involved with it over time, and I’ve been part of every iteration in some way from T-scan one, all the way up to today’s version of T-scan 10. And I should say in full disclosure, I am a consultant for the Tekscan Corporation. But I do not receive compensation for sales of any Tekscan product. I’m strictly education, research and training. And I’ve been an advocate, of course, because I’ve seen how powerful it is compared to what traditional occlusion offers and the T-scan has found solutions for many problems that dentists face routinely that traditional occlusion has not found answers for. So that’s really how I got into it. Now 38 years later, I’ve published hundreds of articles about it, most of it research and hard science, some commentary, but most of it is hard science and research on timing, and excursive function and how that influences the neurophysiology of the human somatic ethics system. I’ve been fortunate enough to collaborate with many experts around the world to publish five volumes on digital measured occlusion. That really is an incredible compilation of all that we’ve discovered with using digital occlusion compared to using traditional occlusion and it’s a major advance for the patient to have digital occlusion be performed on them. So you know, I my whole role, my whole life has really been tied up in the T scan. Although I didn’t start out that way I started out, I was going to be a prosthodontist who crowns lots of teeth and made beautiful smiles and I did that, but I use the T scan to help me do that. And that was a huge advantage through my years of clinical practice. And now I don’t practice anymore other than to do live demonstrations and to treat patients in seminars. But I collaborate with many researchers throughout the world and continue to publish lecture and trained dentist and how to properly use the technology. [Jaz]
Well, I think the best place to start would be some people who are listening who may have heard about the Tekscan or the T-scan and maybe even just roll it back a little bit. You know, what is the alternative that we’ve been trained to use it in dental school and we use all the time and I think you made a great point of the fallacies or the fall backs or the problems when using articulating foil or articulating paper. So if you just explain to dentist, what is the traditional way. And what are the disadvantages of relying on articulating paper marks in terms of the “the way to measure the occlusion?” And what does the teeth can offer, above and beyond these paper marks? [Rob]
Well, it’s a very good question. First, the traditional method is very important because it marks the teeth if you’re going to specifically talk about articulating paper. But that’s its true use, it’s not really designed to measure the occlusion and although Dentistry has given it those attributes, by sort of describing size as a way to choose force, or color depth, or distribution, lots of marks that look like they’re everywhere means you have a balanced by and actually, research shows, none of that is actually true. For example, large paper marks are only forceful 14 to 21% of the time. So if someone always picks the largest mark as the highest force, they’re going to be incorrect 86% of the time, and studies actually bear that information out. So the research on both articulating paper as a medium to detect force actually is very, very strong in that it can’t be done at all, right? And if you asked an engineer, it’s very simple. Actually, if you asked an engineer, can you measure by force with carbon paper, any marks and they would say, No, it doesn’t measure anything, it’s just ink, because of a lack of measurement tools prior to the computer era used these analog materials like wax and silicone imprints, and articulating paper markings to try to determine what was going on with the occlusion. But all the mediums really do is detect size of contact, not the type of contact quality, not the timing of it, not the force. And research again, bears this all out this, there was recently a published systematic review, I looked at all the literature on valid studies that show whether articulating paper for example, can measure force. And there are only 20 papers in the entire continuum of dental literature on articulating papers capabilities, and none of them show it can measure anything at all occlusal. So, as I said, Dentistry has given it this credibility that it should be used to detect force and it can’t do it at all. Alternatively, the T scan does measure force, time and pressure by capturing the electronic displacement of applied pressure to the teeth as it spreads out over the teeth. You know, when you bang your teeth, hands together, it’s like banging teeth together, the force spreads out, you know, across your hand, depending on how you impact and what angle of attack you have. That’s what the T scan measures. So as the teeth approximate each other, grind over each other clench together, gnash together, the T scan can capture those interactions of the result in force across a time continuum. And that allows one to make very intelligent decisions about what aspects of the occlusion there’s too much force in, there’s too little force in which side hits too early, which side it’s too late. You may remember in our seminar, our patient demonstration, the dentist that we measured his right side always hit the floor and.. [Jaz]
Shout out to Ian, top guy, funny guy. So yeah, we did with the Congress is we used Ian as an example, we use the T scan on him. And yeah, you’re right. It was always the right side in terms of timing that was shooting up to his maximum pressure. Now, just to continue this theme, the reason why I am on board and reason I purchase and the reason why I brought you on stage, because, you know, I think there’s a huge role in terms of spreading the knowledge about the benefits of measuring occlusion, which this podcast will evolve. But a lot of people listening right now or watching will be thinking, Well, I’ve been using articulating paper all these years. And I also I’m using sound some just like (blop sound) that you know, which is fine. Okay, you’re getting some of that using your fingers to check for PDL movement. But what did it for me, what the benefit I find is that it’s a tool that’s going to make me at other things more efficient, more accurate, and especially in the era of implants, and we’re trying to be careful to move forces away from implants, I see as a huge tool that will ultimately save me time in terms of justments Like, just today I was, I did some resin build ups, upper 3-3, lower 3-3, and I was relying on carbon paper markings. And if I just had the Tekscan I’m all avoided. I’m waiting for it now. It’ll just give me a quick reference to adjust it. However, some dentists are concerned about the Tekscan that Hey, why are we even adjusting these occlusions in the first place? Like why? Why are these timing issues even a problem? Because what most Dentist will argue is that the literature supports that occlusal adjustment doesn’t help TMD now the real issue is poor. And I think you’ll agree with that Robert, the literature that’s done that cuckoos occlusal equilibration and stuff and we’ll come to that isn’t great literature in the first place. But a lot of dentists have this concern that T scan is this tool doesn’t encourage Dentist to start grinding away contacts, or has actually had they continued their life without that occlusal adjustment. They may have been just fine. So how can we speak to that cohort of dentists? [Rob]
Well, those dentists that don’t measure the occlusion, use a lot of subjectivity to make occlusal assessments, like you mentioned, sound and feel, none of that quantifies the actual occlusion in any, you know, measurable way that allows you to make again, intelligent decisions about what to treat. And this is not necessarily related to solely making occlusal adjustments on natural teeth, it’s you just said you did six composite build up, so three and three against each other, delivering that it can become a real problem for an office if they choose the wrong contacts, because they chose the paper marks that they thought were the ones they should treat. But actually, they left a lot of bad contacts in place, or they removed good ones, thinking they’re removing bad ones. And so the value of measuring for any clinician is their choice to use the T scan to treat occlusally, but certainly in the restorative realm, in the implant realm, in the prosthodontic realm, not guessing at paper marks, we still measure forces a huge advantage for any treating practitioner and just what you mentioned that it would speed up your end result, yes, it would actually guide your end result, it would allow you to make again, intelligent choices as to what to remove after you did your buildups. And that principle applies to whether you’re delivering a denture, whether you’re delivering a fancy implant prosthesis, whether you’re adjusting in natural dentition, because the patient has TMD symptoms, whether you have you know, occlusal issues that keep showing up after you’ve done a quadrant of fillings, and the patient keeps coming back saying it doesn’t feel right. These are all things that plague a dental practice. You know, I’ve given seminars, courses and live demonstrations all over the world. And I always 100% of the time receive patients in these demonstrations that have had dentistry done, that they aren’t comfortable with. And they’re not able to get comfortable with sometimes months or years of follow up of traditional occlusion attempts to manage their case. And what’s fascinating is, the patients are amazed that I can actually measure their bite and fix what’s wrong in front of a group of people, not ever knowing them, I didn’t have any pre-determination of what their situation was. In other words, I didn’t choose them, they were chosen for me. And I was able to many times in just that short appointment that was in a live demonstration, resolve their problem for them because I was able to measure. So that translates into if you have a T scan at delivery, you measure the outcome, you improve the outcome with intelligence and knowledge as to what contacts to treat as opposed to subjectively trying to decide which ones to treat. And the patient saying I think it’s high over here, I think it’s high over there. All of that is eliminated by having the T scan to give you the incorrect forces where they’re located on the teeth to show you where there’s too much pressure and your new restoration. And then you adjust accordingly. And that speeds up the treatment for both you and the patient. And, you know, just to follow on that thought not to overplay this, but the idea of having complications after dentistry, that’s something that came to see me in my office to my 37, 36 years of practice, all more than any other thing that sought me out were patients who were uncomfortable with the dentistry they received, patients came from all over the world to have a T scan evaluation. And again, many of them left in one or two visits with a markedly improved situation that really the only difference between me and the treating practitioner was I had the information about force time and pressure, that the dentist who made the teeth, the fillings, the crowns, whatever it was it had set this patient off and it wasn’t full mouth rehabilitation. It was quadrants of fillings, a few crowns together, orthodontic end result, a tooth was extracted in there by change. These things were all manageable at the moment they occurred if you have knowledge of force, time and pressure so the dentists who who say, you know, well the T scan is encouraging us to adjust this. There’s so much adjusting going on in dentistry, every dentist adjust things every day. And imagine if you could control you know, so many more of your outcomes that you know, you didn’t have the guesswork of subjectivity that traditional occlusion brings to your day to day practice. It would save you so much time. [Jaz]
But moreover, these patients that were finding their way to you on these courses, which were you didn’t pick them they just came in they had a problem and you were solving it. Do you think there could be an element of the fact that the same dentist who treated that patient initially who now had a bite that wasn’t happy for whatever reason, that same dentist who’s also treating many other patients, those other patients maybe had a wider scope of adaptation or a adaptive capacity. And then there are certain group of patients, everyone’s adaptive capacity might be different. And some people’s bites just may be more sensitive than others. And because that difference, this cohort of patients treated by that same dentist didn’t feel the comfort that the other patients usually do it. Do you think there’s any merit in that? Is there any research behind that? [Rob]
Well, I can’t speak to if there’s research behind that, but what you’re talking about is called, you know, is really the central nervous systems ability to modulate the occlusal neurologic output that comes from the teeth. And the challenge for any dentist is, we don’t know the adaptive capacity of each person, even though they might sound nice in the chair before we started working with them. 10 visits later, after they’re still complaining about their bite, we didn’t know that that person was, let’s say, more sensitive than someone else. So the reality of using the T scan, it allows you to get high precision outcomes with every patient, and therefore you aren’t, you know, you’re really in a way controlling, I shouldn’t say controlling, but you’re optimizing their adaptive response to the installed occlusion and to the other patients that you’re discussing, the ones that may not have felt their bite was off, or their bite was problematic, their ability to describe what’s going on occlusally, although accepting, it doesn’t mean that the case is good. You know, I, here’s an example of that I recently trained a dentist in a state near mine, you know, two hours away. And he had a patient come in who had a fancy, upper implant case done, like a fixed hybrid against natural teeth on the bottom. And he said, Yeah, it feels really great. And you know, I’m having no trouble with it, we put them on the T scan, he was 70% right 30% left with all the force concentrated on two or three implants. So he wasn’t able to describe the real problem. And so even though his adaptive capacity might have been high, his ability to discern quality occlusal district force distribution was very poor. And then the interesting thing is when we rearranged it to be much more balanced and much less concentrated in one corner of the prosthesis, which if you put that out now, five years, seven years, with that corners receiving 70% of the bite, it’s going to break things, it’s going to loosen implants, it’s going to cause screws to come undone. You know, it’s hard to say what would happen, but there’s no question with that overload that it was going to have some sequelae. So after we finished rearranging, he goes, you know, that really is a lot better. I didn’t realize how much pressure I was putting in the front corner of my mouth until after I had this pressure relieved, right? So the response of the patient is obviously, a critical factor in, let’s say, how fast they adapt to what we do. But it doesn’t mean that the person who doesn’t feel their bite or is aware of their bite isn’t suffering occlusal overload in certain parts of their mouth, or isn’t having gum recession on a few teeth, or isn’t having wear on a few teeth, because they’ve still tolerated their bite, it doesn’t mean that they’re not having occlusal problem. [Jaz]
I just want to add to that Rob and I agree that just because a patient says it feels fine, doesn’t mean it’s fine. Because so many times my career, I’ve just done my restoration, I’ve taken rubberdam off, I get an underbite together and say, I just stupidly asked prematurely, how’s that appeal, and they say it feels great. But when you had a look, here’s a huge discrepancy, you know, which I would never accept, you know, and I would never want to leave that patient without huge. I’m talking like, you know, a whole millimeter on the other side. And then only after I adjusted, oh, yeah, it still feels great. But now at least I’ve got everything in contact and conformed to the previous. So patients subjectivity is something that we shouldn’t rely wholly on, which I agree with. Now, an interesting thing that you mentioned, this is deviating a little bit, but I thought it would make for an interesting discussion point. Just to learn a little bit about this from you, cuz this was really fascinating. You mentioned about if by equilibrating someone’s MIP, so that the you got a better balance. And I may be using the wrong terms here, Rob, so please correct me, you improve the patient’s a gait and I think you may use that word or another word, but just to tell you I actually had, I was posting about the Tekscan on Instagram. And someone reached out to me on Instagram, who was a patient who actually received a T scan treatment, and this is what he had to say, This is from Peters Health Journal. And he said, I had my bite adjusted through T scan. The effects were stunning after alterations not visible to the eye, such weird sensations went through my body from head to toe, and it says occlusion, this guy he’s not a dentist said occlusion has a big influence on the whole body. And this was after you’d mentioned about some similar things that you’re on the Congress now, Dentist naturally We as a collective group dentist, we think that this is a lot of hocus pocus. But what patients tell us what is important, what they tell us the feedback they give us is important. How could you, How many times have your patients described such an effect to you? And what do you think is behind that? [Rob]
Well, the first part, many patients have described, peripheral improvements that they did not expect to receive from having their bite refined with the T scan in specific ways. And it isn’t only balancing the bite, it’s treating the excursions and treating the excursive function that’s actually one of the most critical components to obtaining high-quality outcomes. But the response that you’re talking about the peripheral postural response like this person had is due to the fact that the posterior pulpal fibers and the posterior PDO, periodontal ligament mechanical receptors, they input noxious stimuli into the brain directly because fibers from them go directly into the center of the brain into the reticular formation, which is a huge brain center. So Morpheus, middle of your cerebellum that controls breathing, respiration, digestion, posture, and balance and sexual function. And the teeth are hooked up to digestion through the swallowing mechanism and chewing and masticating. So the center of the brain receives this output from the teeth every time teeth are rubbed together, compressed, flexed, chewed upon, ground over cleansed against every time, it’s not something that human can control. And the person who’s susceptible to it has poor modulation of it in the central nervous system, which may be termed as per our last discussion as adaptation. But the nature of it is it’s an ongoing, electrical, toxic influx that teeth put out that unless the human has a resistance to it, it takes its toll in many different ways. And again, this is because of the neurology, which is not well taught and not well understood by dentistry. Occlusion is taught biomechanically, you know, it’s not taught neurologically. And yet, it’s an extremely, the occlusion is an amazing neurologic trigger, it’s the biggest trigger point in the head and neck, that’s not ever been considered a trigger point. And, but it constantly is throwing out electrical stimuli in order to modulate swallowing, and digestion and chewing at the brain level. And so why someone would have, let’s say, improve posture from having their bite adjusted with the T scan, which is actually a very nice study that just came out on 90 patients who have dramatically improved posture, after having their bite adjusted with the T scan is because of this pathway into the center of the brain that the posterior pulps and PDL fibres make, and it’s not a synaptic entrance, it’s a direct, no switch right into the center of the brain. And so then the electrical stimulus that comes from the teeth, if it’s a lot, which is, again, what is the individual humans modulation of it, if it’s a lot of electrical activity, which we can measure some of that with the EMG in service muscles, but the same negative energy goes out to the center of the brain, it will influence other structures. And so people have told me that they had brain fog go away, after they had their bite adjusted, they always felt like weird and unclear and they couldn’t find anything wrong with them. And they had to, you know, MRIs of their brain and scans done to their head and when their bite was adjusted, they their brain fog lifted, right? Well, that’s a similar component as to someone saying that my shoulders aligned after I had my bite adjusted or I stopped having throat tension, like, very interesting thing that happens to singers is singers can sing better after they have their bite adjusted. I’ve treated opera singers, who would say I can’t get the range I used to get in, and my muscles tighten up. And you know, and it just feels like I can’t be free with my singing. And then we free them of their noxious stimulus that comes from their pulse, and they PDLs with the posterior teeth, and they can sing better, longer, wider, taller, deeper, higher, with less muscle strain that’s very noticeable. And it’s in a short period of time, it doesn’t take months to kick in, it happens within a few short weeks of improving this noxious output that the teeth make [Jaz]
My Britt and I shared this with you when we met my British dental brain is very much like what is this Hocus Pocus, like and that might be a response that you may get. So but I know that you said you’ve got you know, this T scan data that shows this but when you look at the mainstream evidence on the works of Manfredini et al, who really is a whole opposite camp, whereas you know, there’s a camp where says you know, there’s so high importance in terms of the correct bite, whereas there’s other camps that that suggest that for example, TMD hasn’t nothing to do with occlusion. These are bold things, even the systematic reviews which again, the studies aren’t that great are against it. So, therefore, as a defensive dentist practicing in the UK, I would find it a very bold claim to make to a patient that we can improve X, Y, and Z by adjusting your bite by know that you have got lots of patients that you told me that you’ve been able to for example, treat that TMD through occlusal adjustment which as a profession as a whole in the UK, especially then was talking to us but UK that is frowned upon treatment as especially first-line Okay, so first line will be various other things physiotherapy explains whatever. And then potentially there could be some occlusal adjustment that is, but a dentist in the UK would have to think twice before doing that. So tell us about your experiences in treating patients with TMD through occlusal equilibration, which has been guided by the T scan. And why do you think occlusal camps, different occlusal camps, different dental schools on taking this technology and using it in the way that you’ve seen benefit many patients? [Rob]
Well, it’s a two-part question. So the first part with respect to treating TMD, equilibration is not actually what we do. That’s the first thing and most, but it’s important because most of the studies that looked at TMD response to occlusal adjustment actually had a form of occlusal equilibration done. And that’s actually not what the T-scan-guided treatment is all about. So equilibration is making CR and CO equal. And if you do that, you will lessen the CR, CO discrepancy. But you won’t treat any symptoms with any predictability, because positional improvements aren’t a solution to TMD. They’re there. That’s why the schools have a hard time not the dental schools, but the schools of philosophical fog, they believe that they find this ideal position, the symptoms will go away. And that’s true with the appliance between the teeth. But once the teeth come back together again, no matter what position you’re in, the neurologist goes back to work and often people that are re occluded, let’s say after a month in splints, their symptoms come right back when their ortho puts their teeth together or their prosthodontics puts the teeth together in this new so-called position. So it’s actually the teeth themselves that create the symptoms through neurologic output into the brain, as I described before. And this is a component of occlusal adjustment that hasn’t been addressed by the outdated studies that used occlusal equilibration. And they also know studies and this is important to also those studies, only treated CR CO discrepancy and balancing inclines but not treat working. So group function contacts in those studies that people like. Let’s say the biopsychosocial camp would say that there’s no relationship between occlusion and TMD. They asked in treatment, they actually didn’t treat the most important component. We’ve discovered through many papers now, research papers that we using EMG that working so good function contacts cause most of the problems that dentists face when it comes to symptoms. And so those studies that a lot of people use as evidence that bite adjustment or the bite has nothing to do with TMD actually didn’t treat the correct thing. And so of course, they got no resolution. Now we’ve been treating working side group function in a procedure called disclusion time reduction, which is an exclusively based occlusal adjustment that’s done in MIP, maximum intercuspation, and it’s not done in CR there’s no position in the patient in CR and there’s no appliance phase needed before you do it in correct patients, which are patients that have high muscle firing reasonably good occlusal relationships both skeletally and dentally and have no significant joint breakdown, they can call pop and click and they can have mild displacements, but they can’t have a bone to bone contact and they can’t be have condylar damage and they can’t have fully displays discs. And so that actually makes up a wide range of TMJ patients who have mostly muscular problems that’s actually 80% of the TMJ fee population. So, you know, we’ve proved over and over and over again in studies not again my word in research environments, treating many different groups of patients at different places in the world, with different practitioners using the T scan in these specific ways to treat the dissolution time. And the results are comparable study to study that the occlusion is the number one cause of TMD, especially muscular TMD. Well, it’s because of this neurology. So the last thing I want to say is you quoted some, you didn’t quote them, but you pointed to some systematic reviews. All the systematic reviews about [Jaz]
Luther 2010 is a classic one the orthodontic community [Rob]
You won’t find any t scan studies in any of the systematic reviews. They’ve been purposely left out and I’ve been dealing with that since 1984. There have been Many years that important T scan studies were done about the disclusion time reduction about treating TMD symptoms, controlled occlusal adjustment studies, treating timing force and pressure. And the none of them have made it into the systematic reviews until recently, until recently, there’s a 2021 systematic review that looked at all the different occlusal indicators and how useful they are for measuring occlusion and for treating patients. And, of course, that one actually included about 90 T scan papers. And that’s that’s the first systematic, [Jaz]
I will check that one out. And I’ll share that with the community you know, because one of the things about this podcast is just to share as much knowledge as we can in there, especially in the realm of occlusion. So it’s great to share these concepts. Now. One objection people might have is what the sensor is 100 microns thick. Now what Rayne told me when she came up to practice those 100 meters, but when a patient bites together, it becomes 60 microns. Some dentists might suggest that okay, because there’s 60 microns between the teeth. How is it really recording what you think we’re recording? Is one objection that dentist might have been in equally in the carbon paper world, we know that we get false marks all the time, we get false-positive marks all the time. So that’s one thing for that. But what do you have to say to a dentist who may be concerned about trying the Tekscan on their patients because they are worried about the thickness of the actual T scan itself? [Rob]
Well, the thickness has been an issue for a long time with the naysayers of the T scan, because instead of recognizing that the sensor is a sophisticated printed electronic circuit that measures incredibly detailed occlusal dynamics that can’t be measured in any other way. The fact that it’s 100 microns thick, and gets reduced to 67 microns is actually inconsequential because of what it does, right? It measures things you can’t see in any other way for spread over teeth. Like I said, if I go like this, the force spreads out of my hand, I can’t measure it by looking, right? But if I put a T scan sensor in there, I would be able to see the full spread where it went, which parts of my hand, which parts got overloaded, which parts didn’t get any force, right? So the sophisticated printed electronic circuit is an incredible device. It’s actually used all over the world, in many applications that people don’t question its thickness, because it works in such unique ways and give such unique information. And it’s used in hundreds of industries, it’s just that Dentistry has thought that it should be thinner. But unfortunately, the gold standard of measuring time and force is the T scan sensor, right? Marking teeth might be carbon paper at 30 microns or 20 microns. But marking paper doesn’t give force time and pressure information. And it doesn’t allow the dentist to know any of the information that the T scan sensor knows. So the sensor itself has to work well under compressive, load repetitive pressure loads and clenching and grinding actions and not get destroyed. And actually one study that was done on all the different occlusal indicators showed that the T scan was the only occlusal indicator that could reproduce the test environment 18 out of 19 times, all other occlusal indicators, carbon paper wax, silk ribbon silicone, they all got destroyed after they got through 4, 5, 6, 7 uses. And of course, that’s not the case with the T scan sensor. So the thickness is a positive attribute to being able to gather this very unique and highly precise information that can’t be gathered in any other way. And I think that’s really just sort of like an argument that’s gone by the wayside. You know, if you want the information that the T scan gives you, the sensor thickness is not really a concern, right? And having said that, it’s well within the range of many occlusal indicators that dentists use routinely. For example, this carbon paper that’s 200 microns thick that no one complains about using, right? No one ever says it’s too thick to use. Well, it’s the same. [Jaz]
None of my listeners use that one. None of my listeners use that one. But yeah, please don’t use 200 microns [Rob]
The point being that wafers are much thicker than these guys, right? And certain common papers are thinner. But the thinness doesn’t mean that the information that the T scan offers a clinician is negated because of the sensor has a certain thickness to work well under many compressive load situations and report highly sophisticated data, right? It’s like you need that thickness so it doesn’t get destroyed while it’s being chewed on, right? And so it works extremely well. One of the most interesting things about that argument is there are no papers written about the T scan, where the sense of perforation is a problem, right? In other words, people Don’t write things that say, yeah, the sense of breaks, you know, you can only use it three times, you know breaks very often. And when you, when that happened, you get corrupted data, you don’t get a hole in, that doesn’t mark ink, you get a corrupted electronic entity. So the thickness is really an important attribute to be able to withstand the stresses of occlusion. And as I said, it’s well within the range of many occlusal indicators that people don’t question its thickness. [Jaz]
I mean, yeah, for me, it’s the whole additional information that that thickness gives us in terms of timing and pressure, which was for me, the lightbulb moment and why I’m excited to use this technology to help my patients. Like we debated about this already Rob and you know, I’m not convinced yet, I’m not convinced yet. And I’m still young dentist, I’ve so much to learn. The thing with me is I’m open to the fact that in five years’ time, I might change my mind. And as long as that’s led by some degree of evidence or good clinical sound experiences, so if for example, if my patients after my T scanner adjustments in the future, do come back and they start bruxing, which is what something that we spoke about, you said that okay, there is a belief that once we get the everything adjusted 50-50 or near abouts and we get a reduced the excursion disclusion time that patients may start bruxing, I’d like to find that out for myself through sophisticated methods and whatnot. And I was speaking to Ian, we want to hit up East Grinstead hostel, want to do some sleep studies, it’s what we do with EMG. That’s the pinnacle, so to prove some of that, but you know, I’m open to it. And I want to work with the technology to grow dentistry in the glow, the measuring of occlusion. So I think that’s important. And I just think it’s a fantastic tool the way you describe it. So there’s definitely a place in it. Why only and I have to ask this because I know my listeners know, my thoughts on this is that we have these people who are 20-minute chewers a day like people who just don’t spend much time in MIP. So I know you wanted this very well when we left the Congress, but I think everyone else is here as well, is that if we have people who are just chewing their teeth 20 minutes a day, and they’re not that parafunctional, for example, this group of patients, then do we really need the to go to that level of precision, especially in an asymptomatic patient who may have an anterior open bite, and they’ve had it for many years and have no issues and stuff. And they’re only 20-minute chewers and not having any signs of occlusal disease. Is it overkill to have this level of precision? Is it really necessary? [Rob]
Well, it’s a very good question. It’s certainly not overkilled to be able to adequately diagnose anyone’s occlusion to a high level of precision, it’s more beneficial to both the patient and to the clinician. But what you’re asking about is, why is it that you know, if the teeth are only used for 20 minutes, is this occlusion such an important issue, and it’s because people swallow 1000 times a day, and in order to swallow, you have to put your teeth together and swallowing is what actually creates the hyperfunction of the musculature, because it has to go on, it’s a central nervous system-mediated response that we have no control over it, to lubricate your throat, to protect your airway from swallowing food, to ensure that you’re able to eat and chew and digest and fuel your body. So swallowing makes up a huge amount of time that people put their teeth together unknowingly. And just to point out above the 20 Minute study, most people don’t know about that study, that study was done with a three-unit bridge, which is only three teeth in the mouth, right? That’s not all 32 teeth being used, right. So that’s a.. [Jaz]
I thought it was done by complete dentures. Graf 1969, I think but I may, yeah, it’s a difficult study to get hold on. I’ll tell you that. [Rob]
Right. And that’s and again, doing it with complete dentures if it’s a different study than the 3 unit Bridge study, which was an 18-minute study, meaning that that bridge has functioned for 18 minutes, you’re not able to do with a denture even in any way replicate the human function, so it’s not going to comparable. It’s not going to comparable environment to be able to test how many times a day someone put their teeth together. But the overriding element to answer the question as I did in the seminar that you were at with me, is that the swallowing mechanism puts teeth together 1000s of times a day and that those compressions inflections of the pulp stimulate muscle activity that tire out the patient. And that’s what TMJ comes from. It’s when the swallow mechanism is actually backfiring. And then the person can’t chew well because their muscles have been contracted too many times to swallow for years. And now their jaw doesn’t chew well or they get headaches because they’ve been contracted. The temples have been contracting to swallow 1000s of times a day and they build up lactic acid and that’s been person goes and uses their teeth and then they get a migraine, right? It’s all tied into the central nervous system and the Swallow mechanism of the person can’t control so these timing of teeth studies are just, they’re not comparable to what really goes on in the human condition. And as a result, it’s not an environment that can really test out how someone might respond to their occlusion. So the second part of the question is, you know, do we need this kind of precision, the challenge for any dentist is that you don’t know, we don’t know how well the patient will adapt to what we give them. And so there’s that element. And then there’s the breakage fracture and dislodgement element, we make them something nice. And then six months later, there’s a chunk of it missing, that shouldn’t be missing, because it’s brand new, but it’s missing because the occlusal forces were managed. So everyone needs this kind of precision for their patients to get predictable outcomes, measuring the bite with the T scan and optimizing it with the T scan data, enclosure and excursions. And that’s important that people understand that it’s not balancing the bite. Balancing the bite, people can live with a five to 10% imbalance in their bite much more comfortably than they can with poor excursive function. Because balancing the bite is really not a generator of high muscle firing. It’s chewing, eating and moving around that causes high muscle firing. And so excursive control, excursive treatment with the T scan is very, very important more so than balancing the bite in the natural tooth patient. But in the prosthetic patient balancing the bite is very important to preserve the dental materials and to make sure that that one side isn’t taking 70% Like that patient I described, right? so that the implant doesn’t get overloaded. So the answer to your question is Who needs the precision, every dentist needs the precision, they’re fighting against the occlusal forces in their practice every day, whether they believe they are or not, the occlusal forces are at work every day in your practice, you may not be treating them but they’re they’re breaking teeth on the patient. They’re causing gum recession, they’re causing headaches and jaw pain. They’re breaking you new ceramic inlay that was just put in or they’re not allowing the person to adapt to the new ceramic inlay that was put in. So the nature of measuring only improves the outcomes for the dentist and the patient. And so there is no you know, answer that. Yeah, it’s okay for some you don’t really need it for everyone. You only need it for the top 10% who can’t get used to what we make them. No, that’s not true at all. Every dentist needs control over the occlusion. It’ll save so much time if they measure that, you know, the problems dentists face tied to occlusion more than any other aspect of their practice. There’s no question about that. [Jaz]
Hi guys, it’s Jaz again just interfering with this helpful nugget, which for some of you will save you a lot of money. If you are in the market for a T scan, then either twisted the arm of Clark Dental to give you a discount. So if you use the protrusive, that famous protrusive code, you will get 200 pounds off a T scan unit use it contact clock Dental, this is an exclusive offer for the Protruserati only because you guys are ones that are geeky and love occlusion. That’s why you listen to podcasts. So if you head to clarkdentalsales.co.uk. That’s Clark without an E, that’s clarkdentalsales. I’ll put it in the description on the show notes. So you can check it out. And you can get a 200-pound discount by using the code ‘protrusive’. So hope that helps. [Jaz]
It brings true whenever I’ve got a patient in temporaries, right? And I’ve inserted some temporaries. And I just liked the idea of being guided by technology that measures the time, the pressure to be able to adjust that and to guide that adjustment. So that I’m being led by technology so at the end of that procedure. I can I have proof from that video that CCMP does that. Okay, things are balanced. And I feel better about that when someone’s in temporaries and moving that on to definitives. I’d love to maybe see you again five years, maybe over a beer, and say, You know what, I’ve been using it and this is some other findings that I found. So I’m excited to try this technology. But you know, I think there’s no doubt about it. Precision, which one of our patients doesn’t deserve our precision. I think they all do and deserve our best hands. And nowadays, with everything going digital, there’s obviously been around for 37 years takes care. It’s not like it’s new technology. But I think there’s a huge is a time now definitely more than ever, where we to use all the tools we can to level up our game. And I think that’s what T scan offers in terms of the occlusion realms. So my last question is, why are some of these? I mean, I’ve been you were there when I told you I’ve been on so many occlusion causes, like so many like I’m a massive junkie. Why didn’t anyone else rave on about the importance of getting it right and being you’ll just be or just being able to measure with using a Tekscan? It was seldom mentioned [Rob]
Well, that’s a good question, and I’m not sure I have the correct answer for or a single answer. But I think that the answer that I tend to believe is at the core of it is that fortunately, or unfortunately depending on your perspective, the T scan has disproved all the Principles of the different philosophies over and over and over again in science validated science. And so their lack of adoption by some of the dentist throughout the world has been that it’s challenged what they’ve been learning and teaching for some time now an example would be, you know that you need to be in the right position to control the patient symptoms. And of course, we treat people in MIP, we don’t have to move them, we don’t need appliance therapy for many of them, we can treat them right in their MIP. That’s disproving a positional belief system, right? And then there are many of those, there are at least three major positional belief systems. And, you know, for many people, the positions don’t solve their solution, don’t solve their problem, just fixing their MIP solves the problem. And again, this is something that’s been studied. Another example of what the T scan is this proved many, many times over is the common paper marks, they don’t measure anything and the choosing them. Another thing that the T scan is disproved, is that dentists can’t choose the right marks with any accuracy, three separate studies on 600 to 700 dentists so that dentists will choose the wrong paper marks 85 to 95% of the time. And so there’s a lot of things that T scan has challenged and disruptive technologies are often, you know, held back from adoption, because they make people uncomfortable to face the realities of what they’ve learned may not actually be correct. And again, we have research, many, many, many studies to back up these philosophical, let’s say challenges that the T scan offers dentistry, and all of it is betterment for the patient. Right? It’s not that, you know, if you can treat someone’s, let’s say, taking positions as an entity, that, you know, is typically how TMJ is treated in some new position with some appliance-based location. Well, for the patient, imagine if you can not make an appliance. And you don’t need to change their position. And you treat their occlusion in precise specific ways that you have to learn how to do to be a T scan user, which I think I’ll talk about in a second before we sign off, and the symptoms go away. Most of them go away in 7 to 90 days, which matches up to 30 or 40 studies which show that same thing over and over and over again in different populations and different classes of individuals and different practitioners doing the same kind of treatment sort of replicating each other’s findings. And you’re a patient who can get rid of most of their symptoms in two to three months, versus wearing an appliance for 18 months to two years, then maybe getting rid of their symptoms, maybe not getting rid of their symptoms, and then having to go through orthodontics to put their teeth together in the new position. And they’re all prosthodontics to put their teeth together in the new position, which is very costly and time-consuming. When the T scan could treat that same patient, possibly or a dentist using the T scan in specific ways could possibly treat that patient in their MIP in 30 to 90 days, right, the value to the public is huge. And the value to the dentist is predictable outcomes that have been validated in many research studies. So the last thing I wanted to say was, you know, you said What if I’m five years, we’re having a beer, and we are telling me you know, you have had great experiences and you find some new things? Well, I would certainly encourage that. Because, for example, you mentioned doing sleep studies, I’ve hoped to do a sleep study, because we have many studies which show that people stop grinding their teeth. So it’s sleep study would be a perfect, you know, the extension of that. But the secret to being able to be effective with the T scan is not only one, it’s being trained to use it well. And so one of the challenges of T scan has people, you know, take it out of the box and they try to use it and even though they might get some introductory training, there are actually many skills one has to develop to be an effective T scan user. And they all start out with recording in specific ways and setting up recording parameters to capture useful data. And that then translates into data analysis that allows one to intelligently assess the occlusion and the excursive function and the balance and the timing and the things that matter to the patient’s neurophysiology. And the third level of training is to actually take that information to the patient’s mouth and make intelligent adjustments that control many of these problems that traditional occlusion has no answers for. So without the training, just only one won’t do it. So if you can train intensely meaning you or a dentist who chooses to become involved with the T scan, they have to train intensely to get good at it. It doesn’t work by itself, the user makes it work well, and that skill development that we teach you that you have to then practice and evolve. And once you do that, and it becomes second nature, your patients will greatly Thank you. Because you’ll speed up many procedures, you’ll control end results, you’ll have longer-lasting dental restorations, you’ll be able to, predictably treat patient after patient. And it isn’t to say that just because you have a T scan, there aren’t people that come back and need touch-up bite adjustment visits. But the fascinating thing about that is as a prosthodontist, I’ve delivered many, many, many cases, all different types of things, from implant cases to crown and bridge cases, to denture cases, combinations of all of them partial denture cases, the numbers of people that came back for problematic occlusal adjustments in my practice, from work that I did with the T scan was so little compared to those that sought me out from all over the world who had routine dentistry done that they couldn’t live with sometimes for years, I got an email from one woman just to show you how impactful this problem is. A woman said I had my bio adjusted, you know, after some fillings, and I got TMJ, this is to paraphrase. And I was 25 at the time. Since that time, many procedures have been done trying to help me and I’m not sure if the T scan can help me but I’m reaching out to you to find out. I’m now 67 years old, the woman went back 40 years with a post-operative dental scenario, that was a routine procedure that translated into over 40 years of jaw problems, right? So any dentist can have a problem like that arise. And so the nature of the T scan, it allows you to once you learn how to use it well to predictably obtained outcomes case after case. And that, of course, is a benefit to your patients. And it’s certainly a benefit to them in practice. [Jaz]
Well, Rob, I appreciate you giving your time to share about all your experience that you’ve had and the good work you’re doing in the teaching side of it. And I’m excited to use it technology to benefit my patients. Ultimately, everything I do is about my patients. And also you know, because I’m a big geek and I like my toys. So having an occlusion toy was like, really important to me. So I’m really excited to use it. If you don’t mind, of course, I’ll email you to get your advice. And I’d love to share some cases with you so I can get some mentorship and grow. Because I appreciate the fact that you know, I’ve got Riaz in the UK, who’s obviously learning as well and using it, I’ve got other great clinicians, but you know, it’s to be able to stand on the shoulders of giants to be able to accelerate how fast I can learn will be so important, rather than just guessing. So I appreciate you so much for sharing what you have with the listeners today. And let’s see where this journey takes me. And I think it’s been it’s very, I’m sure it’s been very fascinating to a lot of people to hear about some of the benefits they talked about. A lot of people will be like, well, this is all Hocus Pocus, whatever. And it’s you know, we there are some dentists who will think that but my philosophy is, you know, listen to everyone, give your ears to everyone, all those camps, and then be a student forever, and be willing to appreciate others perspective. So thanks for sharing your perspective today and giving up your time. [Rob]
Well, thank you very much for having me. And I just want to state that the opinions that I expressed mine and not those of Tekscan the corporation. And you’re going to have great health in the UK from people like Riaz and Clark Cental and Ash Palmer, they’re, you know, really taken to the T scan. But I think the fact that you mentioned that you’re open to many camps, you open to many you want to blend it all together. Just for everyone who’s listening to understand the T scan crosses all camps, you can use the T scan no matter what your philosophy is if you want to do neuromuscular dentistry in and open the mandible and advance the mandible and crown all the teeth and you know, put it all together, you can use a T scan on the orthotic phase, you can use the T scan on the crown or bridge phase, you can use the T scan on the temporary phase, the T scan is universal in that way. It’s not filosofi. [Jaz]
And also you can use the T scan on the splints and as well I’ll be, well next year I’ll be getting the EMG data for my splints as well to use it alongside the T scan. So I’m quite excited to do that as well. So yeah, it can be used as a tool for those phases as well. [Rob]
Yes, well, a splint is a really good example of something that you know, you can make a splint where the balance on the splint on the occlusal contact pattern is again 70% Right 30% Left, that 70% side is not going to be tolerated well by the TM joint of that side. And so the effectiveness of the splint is then compromised. But with the articulating paper marks or the silicone imprints or whatever people are using to assess the splint quality, occlusal quality, there’s no assessing. It’s just Ink Spots. It’s just holes in wax. It’s not quantifiable information. So the T scan will help you in anything that you make it If you learn how to use it well, and that’s really the important thing, your training will make all the difference to Jaz. And so I look forward to helping you. And I’m certainly a resource for any T scan user, you can email me, you can send me cases. And I often, [Jaz]
Please do share your website, so I can put it on the show notes. So for those who want to learn more, especially if you know, how do you have a lot of listeners in the US as well, who may be just want, you know, for you to come back to the office, as you suggested that at the Congress or in around the world who wants your help and guidance, as someone who’s extremely experienced that, you know, the, you know, like, I wouldn’t say founding member, but you know, I mean, you were there with the chap who made it, and you’ve been using it along, it’s more than anyone I guess. So to have your expertise, I’d love to share your website and email. So people can grow and learn from [Rob]
you. Well, I can certainly give you that information. And, you know, if you want any research papers that we’ve done, I can certainly provide those to you as well. So, and we share with the podcast if you have requests for certain, [Jaz]
Oh, we love papers, or I say, my group listens we all we do is before we sleep, we read papers. If you can send anything over, I think it’d be a great help to a lot of, I mean, it’s good to be a skeptic is good to reason is good to go by evidence. So as you know, as soon as someone mentioned new technology, there are people who, willy nilly will go for it. So but it’s always good. Like I questioned you a lot, obviously, it’s good to question things, but it’s also good to do your due diligence and read the papers and read the studies and not turn a blind eye to what’s out there. So yeah, good send, I’ll be able to share with everyone and again, thank you so much for sharing your knowledge with us. [Rob]
Thank you for having me. I hope you enjoyed interviewing me. [Jaz]
I certainly did. Thanks so much.
Jaz’s Outro: Oh, there we have it, guys, thank you for listening all the way to the end, if you want to check out the evidence base. Once again, it’s protrusive.co.uk/evidence to download all the papers that Rob Kerstein kindly shared with us all. So you can get an idea of the evidence base, I’m really enjoying my experience with T scan so far, I think for multiple units, and I’ve got patient in temporaries, it gives you the confidence that things are balanced, I can even check something called the disclusion time. So when the patient is an MIP, and the excursing left and right, yes, we can talk about canine guidance and group function, etc. But one really important thing is that it should, they should not be in that excursive motion for too long of a duration, you want it to be quick and smooth. And using the objective data of the T Scan allows me to do that.[Jaz]
Now I promised you in the intro that I’ll talk to you in this outro about how I struck a business deal with my principals. So I think it was fair of me to say to our principals that okay, I appreciate that. I don’t want you to get it to me, because it’s a big investment if you get it, and then if I’m the only one using it, is that really going to help you guys? So I said, Okay, let me buy but then let me also get a bigger slice of the pie when I use it. So the way it works is that I knew that some dentists like Ash Palmer, I heard would charge a subsidy. So here’s your plan is x 1000s of pounds dollars, and you’re gonna do veneers and crowns or whatever. So I’m using it more and more to my bigger cases. And also for evaluation. So I have two set fee prices. If I know that for a case, I want to do a T scan bite analysis, I will charge X amount, okay? So 150 pounds, okay, so I’ll charge X amount for a bite analysis, if I was going to use the sensor, and I’m going to use it in a patient and I’m going to get some data gathering, then patients are happy, you know, as part of the, you know, when they pay for wax-up or when they pay for planning stages. patients understand, Okay, before we proceed any further at with these tests, and once they see the technology, they’re like, Wow, okay, that’s pretty cool. It’s a great visual thing to show patients and patients actually, you know, really understand that the bite should be balanced, you know, patients often get that in a bite, there should be some degree of balance. Now, obviously, the background that I come from is occlusion versus occluding, very much inspired by Barry Glassman, and we can definitely talk about that in the occlusal adjustment that I’ll be doing following this. But essentially, I have a price for bite analysis. But then the bite, the price I have for a bite, a T scan lead bite adjustment. So basically, if I’m doing a bigger case, let’s say I’m doing like recently, I had four crowns, anteriorly and a chrome denture. And therefore at the end of that plan, I’m going to put in a T scan sort of bite adjustment, and I will charge 2x or 300 pounds as an extra, but that anything I charged based on a T scan, it would come to me as the Associate 100%, basically. So I still respect the time, the surgery time, and I still Bill according to the surgery time. But as an addition, I will charge this sort of a subsidy for the T scan. And that comes to me. And therefore it’s like a return on investment for this investment of T scan. And it also doesn’t take anything away from the clinic. If anything, it adds like a USP, add something unique to the clinic. And I do see myself getting more referrals in the future for this kind of stuff. So that’s how I do it. That’s how I agree. So kudos to my principals for agreeing to that. Thanks so much, John and Chris. I appreciate that. And I think it’s a win-win for us both. I get to get a return on investment for the investment that I made is 100%. But we also get more patients hopefully, and I get to do the kind of dentistry that I love. Okay, I think all principals want a happy associate and I’m very happy with my T scan mounted on the wall. So I think this is a win-win. hope you gained value from that and I’ll catch you in the occlusal adjustment, and so many awesome episodes yet to come with great guests. So I look forward to sharing that with you all. I’ll catch you in the next episode, same time, same place