#AskJaz – Inlays, Stable Income vs Risk, Injection Moulding Mistake – AJ001

Hi Protruserati! Welcome to the first episode of #AskJaz. This segment is all about sharing some gems I have learned from my mentors – I will address a combination of the questions YOU have sent in over the last few weeks.

Check out this full episode on YouTube

Need to Read it? Check out the Full Episode Transcript below!

In this episode, I answered some of these questions:

  • Inlay that kept coming out 3:15
  • Stable Income vs Risks 5:18
  • Mentorship 6:36
  • Injection Moulding Mistake 7:38

Step by Step PDF Infographic. Click here

If you loved this episode, be sure to check out the first episode of the ‘Occlusal Adjustment’ How To Plan Your CPD/CE to Maximise Learning 

Click below for full episode transcript:

Opening Snippet: Welcome to the first-ever AskJaz, I'm doing it live, okay, Because I am literally so strapped for time right now, tomorrow is my holiday, I'm going to Dubai on a family holiday...

Jaz’s Introduction: Man, I have never needed a holiday so badly. So for those of you who know me, you’ll know what I’m like, for those of you who don’t know me so well, I only really switch off when I’m abroad. It’s just a funny thing about me. So if I’m not playing my son, or if I’m not chopping onions, or if I’m not writing a treatment plan letter, or doing some admin or doing the podcast stuff, or the courses stuff, I literally don’t switch off. So this pandemic has been very difficult for me in a way that I’ve been desperate for an opportunity to switch off. So that’s coming next week. But I want to explore this concept of AskJaz, because I’m no like, you know that I’m No expert. There are so many people who know so much more and do great work and I admire what they do. For me, it’s just sharing. And the reason why I think that’s important is because when I started to share some years ago, so the specific example is when I worked in Singapore, and then I came back to the UK. And then what we found is that, like, I was on the phone to a different dentist every single day on my commute, to from Oxford and to back to London. And I was telling them the same story. They’re asking me the same questions. Hey, what’s it like in Singapore? How much do you earn? What’s the language like? Are there any exams that you have to pass to be able to practice in Singapore and that kind of stuff? So I decided to share and I made a podcast called Protrusive Dental Podcast, you may have heard of it. And I thought it was just a great thing to be able to do to free up time for me that was amazing, It was a selfish reason why I created the podcast, okay, if I can now just make this and the next episode was like, USA, one of my friends was going to USA she’s studying there. Okay, how can we now help people who might be considering the USA and then Episode 4 (I meant Ep 5, my bad!) was Australia. So the way it developed initially was like, I was kind of like this immigration agent for dentists, right? But then I started to be myself, I started to share my geeky things. I’m a massive geek when it comes to dentistry, as you guys know, so I think it’s so important to share.

And one of the questions instantly I had in was about a dentist who was so nervous to share and post his cases on social media. And I said, Listen, if you can post your cases on social media, you will develop so fast, so quick, and so much that it’s going to be, it’s going to bring about great, great vibes, great energy when someone shares. So part of the Ask Jaz is although I felt like a massive imposter syndrome, so you know, ask me, I’m the expert, nothing like that at all. I’m just literally here to share. So let me share with you some questions that we’ve had over the past few weeks, obviously, on YouTube, we had that question about the bonding protocol. He said, Saline but he meant Silane. And so I shared that to the Protrusive Dental Community Facebook group, if you’re not part of it, do join it. And on that group, there were some great comments, I tagged some people who I really admire why no have really studied in depth all about the bonding protocol. And what’s the best way to get highest bond strengths? So they chipped in so German shout out to you, my friend. There’s some great content. So if you’re looking for some bonding tips, and optimizing your bond strength to ceramic, that’s already covered on the Protrusive Dental Community, just go straight there.

So the next question I had was from a buddy I’m not gonna I’m trying not to name people without asking their permission first and at the time when people ask this I didn’t think of asked, so I’m not going to name people but you know who you are. So one of my buddies whom I actually went to Dental school with, he told me about an inlay that kept coming out. So an inlay I think, as a premolar that kept coming out maybe three times. And so he said, Okay, what do I do now? How do I manage this inlay that’s coming up? So funny thing about inlay is that when I was at a really great lecture in Singapore, I can’t for the life of me, I cannot remember the name of the speaker. He was a Swiss speaker in Singapore at the Singapore Dental Conference and I have to find his name. And he shared this hilarious thing about inlays. He described inlays as RobinHood dentistry. You are stealing from the rich and you’re giving to yourself, you’re stealing from the rich and you’re giving to the dentist so it’s RobinHood dentistry. Because inlays, he kind of saw as an obsolete thing. So he did not practice inlays and he thought that it was kind of very few niche scenarios where it’s appropriate.

Actually, the episode we did with Chris Orr 30 something, I actually asked him about, okay, well, is there a place for inlays in dentistry? And he literally said, So Chris Orr, someone we all love and respect so much in dentistry, Chris Orr literally said that the only time you do an inlay is if he’s kind of running out of time and he’s prepping a whole quadrant. And instead of doing an MO composite, he’ll just impress the entire quadrant of indirects. And then he was asked for an inlay in that area basically. So there’s no major reason of doing an inlay usually. So what I said to my buddy, was that okay, the patient doesn’t care about the inlay. The patient doesn’t want an inlay. The patient wants a tooth. Do your composites for that, you know, my composites don’t fall out, okay? So then why don’t you just clean up the tooth and place a composite? Is said Yeah, you’re right, actually that the patient doesn’t care, the patient just wants their tooth. So that was how we dealt with that. I thought that that’s something worth sharing about where inlays stand in dentistry. And the advice I gave.

Another question I had was, some advice I gave to one of my colleagues on telegram about how there’s a job position. So he’s looking for an associate position, by the way, that app is coming out soon, it’s going to have like a jobs board. But he’s looking for an associate position. And I sent him a link to an associate position, which was advertising for someone to build their own list, and it had all the bells and whistles and toys. But the downside is there’s no initial stable income, you have to do the hard work to build your list. So he said to me, I need a stable income, though, this is the issue. And I said, Look, sometimes you have to take a pay cut, sometimes you have to take a pay cut to, in the pursuit of something much bigger. So for example, when people are starting a brand new practice, okay, from what I read, it’s very unlikely that that practice will be highly profitable until about year two, this is from reading, I’ve zero experience of owning a practice or zero desire to own a practice. But this one I read, it takes some time to get the level where you’re making profit. So when you’re making, when starting to practice, or when you’re doing a master’s program, okay? You’re not only are you paying the fees for the master’s program, you’re also taking a hit in terms of loss of earnings. So that’s another consideration there. So sometimes you have to take a pay cut, to be able to grow. So that’s the advice I gave there.

Someone asked about, where do you find a mentor for implants, and I kind of gave a couple of suggestions that I knew of in London. But I think whenever you are considering, okay, I need a mentor. There’s no harm in just literally reaching out whether it’s by email, facebook, instagram for you, like you’ve all heard of this thing that there’s six degrees of separation between you and anyone else in the world. When it comes to dentistry, it’s probably like two degrees of separation between you and any other dentists in the world. And nowadays, you can message pretty much any dentist like if I were to message Marcus, Professor Marcus Black, who I admire so much on the work he’s done with the Zirconia and Ceramics, like he replies to me, I message him on Instagram, I get some advice for him. So you can reach anyone, and then you can build that relationship of mentorship. So I always say, there’s never been a better time to be a dentist than right now. So mentors are everywhere, you just got to keep an eye out.

Next one was, which is the best way to prevent contact sticking tooth to each other. I forgot the context of this one. So Uzman I’ll get back to you on that. Okay, last one, then. My buddy was doing an injection molding case. And he was absolutely horrified, because he managed to stick loads of teeth together. So injection molding, obviously, you get like the clear stent like exaclear or Memosil, I think people prefer exaclear, because it’s a bit clearer. So exaclear’s a GC product, super clear. And one top tip is to make sure it’s got enough thickness, and therefore it have enough rigidity. So when you’re using that kind of stuff, make sure it’s it’s thick enough so that it doesn’t flex as you’re placing it back on the teeth. So when it comes to injection molding, one of my buddies, he went on, like two courses, not on injection molding, but on treating tooth wear. So he found this tooth wear case and decided that okay, I’m going to use the injection molding technique, which was briefly described on the course. And he found that he had an absolute nightmare. Despite using PTFE, he found that the composite went everywhere, and it stuck to everywhere. So I delve deeper with this dentist. I said, Okay, can you just describe your protocol to me, and I was kind of shocked that although he’d been on this couple of courses, no one had mentioned to him that nowadays, there’s only one really sensible way to do injection molding, in my opinion, okay? I’m no expert in injection molding, but in my opinion, there’s only one the sensible way to approach it. And that’s by using an every other tooth model.

So what does that mean? So imagine you have the pre op, upper model, or someone with worn teeth. So imagine these worn teeth of a model. And then you get the technician to digitally wax it up, okay? And print that model. So now you have the pre op model and the post op model. And you can do that the trial and the mock up to get the patient’s approval and check the cant and the aesthetics and phonetics and that’s all fine. But on the day of the injection molding, the clever thing is that you can tell the technician on the digital plan to Okay, let’s say we’re doing upper canine to upper canine, every second tooth, right click, Remove, so remove the digital wax up. So let’s say you have an upper right canine which is digitally waxed up and the upper right lateral which is original tooth, it’s not waxed up, then the upper Central is digitally waxed up then the other Central is not waxed up. So this causes every other tooth scan and when you print that lesson every other tooth model. So the first thing you will do for injection molding is create a memosil or exaclear stent for that every other tooth model now can you see where I’m going here? When you put that exaclear stent on the worn teeth, it’s going to hug the every other worn teeth so nicely that you’re going to really minimize how much excess you get. Because if you use just the exaclear of the final model, that composite’s just going to go everywhere, it’s going to stick everything together. So by using this every other tooth model, the first sort of stent you put on, will be waxing up every second tooth. And then the other alternative tooth, the exaclear will be hugging the teeth so nicely, so tightly, that it’s really going to minimize the excess. This makes it really quick, really easy. It’s definitely worth the extra expense of having a second model, you know, that cost minimal in terms of how much you can be charging for a patient. Then once you’ve done that, and you’ve tidied it up, and there’s just a little bit of excess to clean, now you can use the final sort of every tooth being waxed up. And essentially, you have another stop now, whereby you’re going to really minimize how much excess you have because you already have composite on the adjacent teeth. And yes, of course you have to use your PTFE and make sure that you’re not overzealous with your injection molding, you’re not placing too much of the resin. So it was a real shock that this dentist had about how much he had to sort of clean up. So he had to put the patient back in, start again, do a lot of it freehand. So a real waste but a real valuable lesson learned.

Jaz’s Outro: Anyway guys, thanks so much for joining me. If you follow me on social media, you probably hopefully see some nice holiday snaps. I’ll catch you next week, same time, same place. appreciate you listening so much. Thank you

Hosted by
Jaz Gulati

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