Digital Dentures for Every Dentist – The Death of Impressions? – PDP195

Jaz’s Introduction:
Is this the end of impressions for dentures? Have we finally reached a time whereby we can scan the tissues and we don’t need any of that mucocompressive nonsense. Is digital dentistry there yet when it comes to dentures? For our clinical steps, the design and the manufacture of our dentures.

Our guest today, Dr. Rupert Monkhouse, back again on the podcast, does a wonderful job of giving us an overview of how digital denture is employed within dentures, not only by us clinicians, but also the lab side and the manufacturer side. But I asked him to truly dive deep and focus onto what we do clinically.

How much of what we do clinically can we now do entirely digitally? And the two workflows we discussed today in really good depth are the complete denture workflow and the Cobalt Chrome partial denture workflows. Get your onions ready because this is a really deep and really awesome episode. I think Rupert does a wonderful job.

You will find out which scenarios we should be actually scanning and ditching the impressions and whether there are any game changing benefits of moving to a digital workflow for dentures. This episode is our highlight episode for removable prosthodontics month. And next month, i. e. September, will be occlusion month.

Hello, Protruserati. I’m Jaz Gulati and welcome back to your favorite dental podcast. I feel like I haven’t connected with you guys for so long. I know you’ve been having an episode every week, but a lot of those episodes actually recorded a while ago. I knew that when the summer would come and my son would be off school, that we would get really busy.

And also we’ve moved from Reading to West London. Not too far from Heathrow actually. Moving is not fun, but we’re finally settled now in my new office space and it’s so great to get in front of the camera again and make protrusive episodes because I learned so much. I had a minimal understanding of digital dentures and I gained from this episode and I know that you will too.

Here at our new family home in West London we celebrated my son’s fifth birthday and I was thinking, oh my goodness, where did those years go? And I actually remember when my son was born and I announced it on the podcast all those years ago. And many ways we have grown. We as a Protrusive community have grown around the world.

Whether you’re watching this on the Protrusive app, YouTube, or listening on Spotify on your commute, however you consume Protrusive, it really means a lot that you tune in. If you aren’t already on our community for the geekiest and nicest dentists in the world, do check out protrusive. app. You can actually access it on your laptop or your web browser or the native iOS or Android app.

If you’re going to download the Android app, by the way, make sure you actually make an account on the website first, which once again is protrusive. app. The big change with all this I want to announce is that we are finally PACE approved for those doctors in North America. When you answer our quizzes for CE, you can actually enter your AGD number and we will take care of the CE for you. The American doctors have been asking me for years about this approval and I’m so pleased that we can now contribute to your CE tally.

Dental Pearl
Every PDP episode I give you a Protrusive Dental Pearl. Today’s pearl is related to the field of prosthodontics, whether it’s removable prosth or fixed prosth. There’s often lots of stages when indirect work is involved.

And the pearl is that it’s so, so, so important to understand each and every stage of what you do and why you do it. What benefit is the technician gaining? What challenges are you presenting to the technician? For example, when I was learning complete dentures for many years, I followed the whole checklist in the recipe book for all the things that you check for, for a wax jaw registration.

But sometimes I was guilty of not knowing why we are recording certain. Sometimes I was guilty of not knowing why we were recording that piece of information. What benefit will it actually have to the patient or the technician in recording this extra piece of information? And it’s only when you understand the reason for which you are recording something that you can actually be more judicious about your work and actually understand, actually, I don’t need to record this because the technician doesn’t need it in this scenario.

I’ll give you another example. I remember taking one of my impressions many years ago to my consultant. I was a trainee and I showed him my impression and I thought, hmm, I think I’ve screwed up because there’s an air bubble. I didn’t notice it before, but I see an air bubble in the impression. Does this mean that we can’t proceed with the crown anymore?

And that I need to bring my patient back? But he pointed out to me that yes, there is an air bubble. But where is the location of this air bubble? Is it in a critical location, i. e. at the margin where your seal will be disrupted? Or is it a little bit away from the margin? And actually visualizing what the model, what the cast model will look like.

And what this actually means for your crown. Is it critical or is it not? In that case, my air bubble wasn’t critical. I didn’t have to bring my patient back. And so when you really think what the technician is getting from you and what compromises that you may accept, it can really help you advance your prosthodontics.

Another example is should you do a half mouth scan or a full mouth scan? Imagine you’re doing a single crown in what kind of scenarios is a half mouth scan acceptable? And what kind of scenarios do you actually need to scan the entire dentition? So Protruserati, make it your mission. If there’s any aspect of prosthodontics that’s always confused you in terms of data collection, what you send to the lab, then please post it on our app.

The philosophies and values of protrusive guidance is that we don’t want to be judgmental. There’s no such thing as a silly question and we can all learn and grow together. Hope you enjoyed this episode, I know you will, and I’ll catch you in the outro.

Main Episode:
Dr. Rupert Monkhouse, welcome back to the Protrusive Dental Podcast once again, we’ve talked about your journey before, which we absolutely loved because if anyone hasn’t heard it, it’s a wonderful story about how you landed your associate position that you’re in that you’re still there now, actually.

It was just wonderful. I won’t do the spoiler now because I want everyone to go back and listen to that because it was so good. And then you also talk about complete lower dentures, which we all hate, and then you covered that really well. And then now with so much of the digital stuff around, I was like, okay, who better than our own resident denture geek, Dr. Rupert Monkhouse, to talk to us about digital dentures.

Now we were catching up before we hit record, and some people may not have heard of you, very few people, right? You are like the guy associated with hashtag Impression Club. But I would like to know, By the end of this episode, is that in jeopardy? Are you going to start calling it hashtag scan club now?

Are impressions dead? That’s one of the questions I have. So Rupert, take it away. Please introduce yourself to those who may not have heard of you and say hello to the Protruserati who already know and love you.

[Rupert]
Hi guys, thanks for having me back on mate. It’s been a long time actually, virtually or otherwise since I’ve seen you. It’s been probably was that last chat even. But now I’m Rupert. I’m a general dentist based in Reading. I’m just, well, village down the road from you. And as you just alluded to that, I’ve restarted, I’ve gone back to school. I’ve just finishing off the first year of the MClinDent in Fixed and Removable Prosth at King’s.

And yeah, I do general dentistry. We’re fortunate to have lots of specialists in the practice, so I don’t do endo, I don’t do perio, I don’t do that much cosmetic stuff. I work with people like Celine Higdon and things. So I do quadrants, crown and bridge, and most of the dentures in the practice as well. And I do a little bit of teaching and speaking on some removable too, including on digital dentures, which we’re going to chat about today. But spoiler alert, we’re still going to do impressions.

[Jaz]
We’re still doing impressions. Okay. There we are. Now we know, and then we can talk about the indications. Cause my only experience of digital dentures, probably around I don’t know, 2017, 2018, we had the TRIOS scanner and this patient needed like an immediate denture.

So we thought, okay, why don’t we just scan and see what comes back? And out came this acrylic immediate denture and it fit pretty good, right? I haven’t been brave enough yet to replace impressions for Chrome work, but I’m feeling that maybe you’re going to convince me that maybe we can, and I just like to know, and I think we’d all like to know those who aren’t using digital techniques for dentures.

What’s actually involved? What are the nuances? What are the differences? What are the compromises and what are the benefits? So I guess the first place to start will be what kind of dentures can you actually do digitally, right? Is it partial? Is it complete? Is it Chromes? Is it the world’s your oyster? And what are the sort of boundaries?

[Rupert]
I mean, if we’re going to talk digital dentures as a whole, yes, you can do it for all of those things. Immediates, partials, completes, chromes, everything. The key thing to break down is, I was like, when I talk about it, I put up a little Venn diagram of three overlapping circles, okay, so there’s three things we can digitize.

That’s the data input, so the impression of some sort, and the jaw edge, etc., etc. So we can digitally do that. We can digitally design dentures, whether that’s chromes, completes, partials, and we can digitally manufacture dentures again, mostly at the moment for complete dentures, chromes are getting there, partials are a little bit iffy.

So there are those three areas and with a Venn, it’s not a perfect Venn diagram, but they almost work interchangeably. And I’m sure we’ll talk about, you can sort of jump in and out as it suits you. So there’s, as you say, indications and pros and cons. And there’s certain cases where I think this is going to be great for digital, certain where we say let’s do this all analog, some where we’re doing it hybridly.

I’m sure it’s something we’re going to cover, but there’s no really yet purely digital workflow. The closest would be Chrome’s. But I’m not sold on the digital manufacturer of Chromes yet, but we’ll get to Chromes later.

[Jaz]
Well, I guess when we were brainstorming this, Rupert, in my mind, yes, you’re totally right that the whole designing is done by technicians that say digitally, and then there’s digital techniques to actually produce the denture. Is that like printing, for example, right?

[Rupert]
Absolutely. Yes. I mean, in terms of manufacture, if you’re talking acrylics, you essentially are looking at milling or printing.

[Jaz]
And can you, for dental students, can you just explain, it’s useful to know what’s the difference in milling and printing, just the bare foundation, which is useful knowledge, even for how zirconia crowns are milled. What does that actually mean?

[Rupert]
Sure. So in terms of the milling, you’re going to have done a digital design, and then you have a solid block of material. So your crown, you’re going to have like your little solid ingot of zirconia, or Emax or whatever it is. And in terms of the complete dentures you’re going to have the acrylic.

Now I do a lot of work with Ivoclar and full disclosure I’m a key opinion leader for them now but they don’t pay me to say anything. And they have a system called Ivotion for instance which is incredibly clever, which is actually a puck of pink and white fused together already that you mill a denture out of in one piece.

Other systems you mill the pink so it cuts away, drills it away inside this milling machine like a Cerec machine for instance. Drills it away, and you bond together, then you’re pink and white, and you have a perfectly formed denture.

[Jaz]
So it’s a reductive technique. Milling is reductive. You get a big block, you make it into a shape that you want.

[Rupert]
Yeah, so that takes time, which is the downside to that. And there’s obviously wastage as well, because there’s a lot of stuff that you’re not using, essentially. And you can try and be clever with a full set of veneers or something. You can sort of mill them out of one puck if you line them all up correctly inside it.

But for dentures, and that’s something I’ll probably talk about later in pros and cons, a full service lab isn’t necessarily going to want to mill one arch of a denture when they can mill 20 zirconia units. So that’s where things get a bit tricky. Printing is an additive thing, so it starts from the ground up essentially, and it is a lot less wastage, it’s faster. But the material science isn’t quite there yet, I don’t think. Dentsply-

[Jaz]
It’s been limited to resin, right? I mean, the traditional acrylics we use, they’d be different to what we can print?

[Rupert]
Yeah, so there’s a material called Lucitone from Dentsply, which seems to be the one that’s sort of leading the charge at the moment. We’ve had a play with it. It’s not quite there yet in our hands, but we’ve only done it for partials. It seems to work better for completes. In general with this, complete dentures is the easiest way to get into the digital beyond what you said with immediates and again, well, I’m sure we’ll get to that in a bit.

But essentially the printing process there again is in two stages. It prints the pink, it prints the whites and you bond them together. And that’s where the partials is quite difficult. If you’ve got like the single tooth, how do you know you bonded it exactly right? Whereas the completes, when it’s like a horseshoe of teeth, it’s a lot easier to get that into the correct place.

But printing’s going to be the future. It’s the same as anything. Additive manufacturers always going to be the future because it’s faster, there’s less waste involved in and so forth. So that’s a manufacturer side of it. I said, it’s just one caveat. It’s a lot more accurate and a lot well, we’ll touch on some cases that I’ve been doing perhaps, but it’s a lot faster, more efficient for the technicians as well.

[Jaz]
So printing is more efficient. Yeah?

[Rupert]
Absolutely. Yeah.

[Jaz]
Okay. So the reason I asked that is because I want to touch on it but really the the main focus I want to do today if it’s okay with you Rupert is the actual dentist, the clinician side of it, right whereby it’s the data input stuff but it’s great that you reminded us that actually digital dentures encompasses so much more than what we do chair side. But if we perhaps focus on a chair side, what stages because we’re talking about so the difficulty in this episode, Rupert, unlike other episodes that usually we’ve honed in on just Chrome’s or just completes and partials.

We’re kind of talking about dentures in general, right? So huge scope, but let’s try our best. What stages or what types of work do we still need impressions for? For example, you might say that the secondary impression of this type of denture, where do we still rely on impressions?

[Rupert]
Fine. So for me personally, in the workflows complete dentures still needs an impression.

[Jaz]
Both primary and secondary?

[Rupert]
So in terms of primary and secondary, yes, you can do that. Okay, so let’s just talk completes for a second because it will get sort of, there’s loads. So as I say, I mentioned, we sort of, we teach this and we did a course on this last, I don’t know, when was it, June or something. And even within the course, we worked out like four different workflows because there’s just so many areas that you can use. Okay.

[Jaz]
So I think what’d be good and useful, Rupert, then is like, I mean, I’m going to want you to continue and explain this, but I think for the purposes of making high quality education here. But not doing injustice to, like, you don’t want to scrape all four, right? If we just discuss one workflow, which you think is the most real world applicable workflow. We’ll talk in detail about that.

And then the other three workflows, I want them to go on your course. I want them to learn from you. But there’s no point skimming four workflows, right? There’s no point skimming four workflows. So briefly describe them. But it’ll be nice to example patient, talk about that. It’ll really make it tangible. But yes, complete dentures, you were saying.

[Rupert]
Yeah, so complete dentures. So for your general dentist or whoever’s listening who hasn’t done anything. You can do everything your side, in the chair, completely analog. Okay, so you can do primary impressions, you can do secondary impressions, jaw edge, etc. And you can scan all of those things. Okay, so you can take a primary impression, you can scan it. TRIOS is fantastic at that and it has a setting for it. So does Medit.

[Jaz]
I’ve never actually done this. So actually scanning the impression, because I’ve seen people scanning the models, but actually scanning the impression. Okay, cool.

[Rupert]
Scanning the impression. So you can scan your impression and that will send off to the lab. The lab inverts it and that becomes a cast. Okay, so it’s very cool. The benefits of doing that. My technician Dean is up in Oldham, I’m not posting it overnight. It’s not in this hot weather being left on top of a radiator or something. The bag opens, the alginate dries out. Whatever comes out of the mouth is being replicated by the scan.

There’s infection control stuff, you’re not worried about, did the nurse completely, perfectly disinfect that thing that my technician’s going to open. But also things like, we’ve done those lower, as you mentioned, we talked lower completes two episodes ago. We’ve all done it where we’ve got that super scraggly bit of lingual sort of extension that’s super flappy and moving around. When your technician cast that that’s going to distort and your impression is not going to be realistic because you can just scan that it’s going to be perfectly replicated. So you get more accuracy there and of course the scan is that your technician in 45 seconds. It’s not taking a day and a half to get there. So you can do that and get the benefit of that and then they can make a tray for you conventionally, and you can take a secondary impression, and you can do the same thing again and scan it. And you know exactly what you’ve taken has been replicated, and there’s no room for the distortion there.

[Jaz]
Is there a specific mode on TRIOS for this, for scanning impressions, and also, I don’t know, I don’t trust my iTero. I just, I don’t know, for me, iTero, because I’ve used so many different scanners, I use iTero, yes, we do Invisalign, yes, I do it for my crown prep stuff, but I just have this, and correct me if I’m wrong, I just have this feeling that I’m using this slightly inferior scanner when it comes to restorative, so will it have the fidelity and the quality to do that?

[Rupert]
Disclosure number two, I’m a Beta Tester for 3Shape. So, you can do this with an iTero. It’s very challenging at the moment. They are bringing out a denture mode on iTero. But the previous stuff that I’ve done with it, it starts scanning briefly, turn it off, turn off the cleanup, and then it will sort of work like a desktop scanner.

But there’s no algorithm there for it to work out what’s going on. Things like PrimeScan, Medit, Trios, 3DISC, they do have specific denture settings. And for instance, within Trios, when you say I’m doing a denture, it gives you five different options of how you’re going to do the denture. So again, we’ve got other workflows.

But one of them is impressions. And it has a specific scanning path, so it knows you’re going to start at the tuberosity, and you’re going to scan around the arch, etc. So it knows roughly what to expect, so it stitched it together much quicker. So with the TRIOS you can scan an impression in 30 seconds, where in iTero it can take me 30 minutes in my lunch break kind of thing, because you’re literally going back to eating and things like that. So, I’m sure iTero will get there because they’re bringing the system in but at the moment those companies are are ahead of it. But you can say you can scan with all of those.

[Jaz]
Good because I think people are wondering oh will my scanner be good enough? I think you’ve answered that and I think the future is exciting for that. What about when you get to the wax jaw registration? Can you digitize that? Can we scan that?

[Rupert]
Absolutely. So again, you can do your wax rims as normal. Do all of your markers and so forth and then take a bite reg and then what you can then do is scan that outside of the mouth. So you can then essentially on the TRIOS you’d call it the reference denture, which again is another one of these five workflows where essentially you’d scan your lower rim 360. So you scan the fitting surface, which is already based off your secondary model. So it should be your working base essentially. You then scan the wax rim all the way around and you have a exact replica of your rim. You do the same for the upper and then you put your bite reg material in between click it all together and you just scan a bite as if it’s an iTero scan like you do on your restorative and then the technician has a virtually mounted set of models, essentially, they can then just invert the wax rims again. They’ve got their models in the correct position and they can design you a denture.

[Jaz]
Brilliant. And how successful is this? Is this something that there’s no evidence for in terms of accuracy because it’s so new? Or have the papers already been done in terms of, yeah, this is acceptable. But, more importantly, I also want to know your experiences in doing this because you’ve done, you do a lot of this kind of work. So when you have done it, the traditional impression workflow, and now using this kind of workflow. Are you noticing that they’re the same, superior, inferior?

[Rupert]
So, there’s evidence coming for it, more and more. Yeah, there’s loads of papers on accuracy of scanners, but it is more for crown and bridge and things like that. I mean, anecdotally, from my own, sort of, Dean and I have been experimenting, so I think we’ve done, across various different workflows, we’ve done, I think, eight cases now, where we’ve actually given the patient two sets of dentures. So, for instance, we’ve done cases where all the way through we’ve done the primary impression, I’ve scanned it, and I’ve sent the impression off, we’ve cast it up.

We’ve done a secondary impression, scanned it, and cast it up. We’ve done a wax rim, we’ve scanned it, and we’ve mounted it. We’ve done a 3D printed try in, and we’ve done a wax try in. We’ve processed and we’ve milled, and then I’ve given the patient two sets of dentures. said where this one for week one, this one for week two.

[Jaz]
And did you blind the patient as to which one was which?

[Rupert]
Blind patient? Didn’t know which all I did was put a dot on, I put a dot on one set of them. So they knew which pair goes together and for the workflows where we scan the lab work, or we did the reference denture, eight out of eight preferred digital.

[Jaz]
Wow. I mean, that is categorically a preference there. That is awesome.

[Rupert]
I’m not sure what the power number needs to be for this study, but from mine-

[Jaz]
That is pretty good. It’s not like you’ve done two, done eight, right. And they’re all preferred. It’s not like, Oh, it was six and two. It was eight. That’s pretty awesome. Now when you actually look at the denture, can you tell just by looking at it, which is the digital workflow, which is the impression workflow?

[Rupert]
Just about. So Dean’s getting very good at disguising them. So, all of those cases we’ve done were milled complete dentures, and we’ve done the various two different options where you mill the pink, mill the white, glue it together, and you mill the monoblock, the Ivotion.

So of course, what it means is, either way, the teeth are all one solid piece. So you don’t get that really nice sort of separation like you do with the conventional mounting teeth inside the wax. So, there’s a lot more sort of work dressing it up to make it look pretty, to sort of disc in between, put a bit of tinting in.

Yeah, because I’ve done it, you can look at them and you can work it out. But from extraoral smile photo, things like that, you can’t really tell the difference. The quality of the teeth at the moment isn’t quite as nice. You’ve got those very high-end denture teeth with the layering and the translucency and things like that.

That’s coming. That’s coming within these blocks. They’re getting very, very clever with the blocks. But, the average patient on average person on the street is not going to tell the difference when they’re done really, really nicely. And Dean’s got very, very skilled at doing that.

[Jaz]
What kind of metrics were you assessing for in terms of patient feedback on, and also your feedback? Like, for example, yes, the patient preferred them, but did you notice a difference in the retention and stability, or is that roughly the same as just the patient preferred the comfort? What was it superior and was there anything that was inferior about the digital compared to the traditional?

[Rupert]
So, the only inferiority is when you’re really, really, really macroing in, and I take my big photos and whatever, and I sit there polishing off all the dark spaces on Photoshop, all of that, when I’ve got the macro flash on it, and my 40 megapixel camera, yeah, I can see the difference, minorly, aesthetically, in the teeth and things, beyond that, there’s no real downsides from my perspective.

So clinically for me, much fewer adjustments to the fitting surface. Usually none. The bites, again, very rarely do we even need to adjust the occlusion at all. It’s as sort of, as long as your try in was fine, your fit is going to be fine because it’s a perfect replication. So you’re not doing the whole investing of the wax, melting it away, the teeth might shift a fraction, you put the acrylic in, that distorts, you’ve not got any of that. So there’s no real tweaking of the position of the teeth from the patient’s perspective.

[Jaz]
Well, can I just check for here now? Because we didn’t talk about this. So the wax try in, is that the digitally produced wax try in when they send it to you, that’s actually still in wax, right?

[Rupert]
3D printed. No, so we normally 3D print it, so it’s a solid block 3D printed or milled, you can mill it, but that’s more, more costly. So you can print it, mill it. Yeah, in theory, you could dip out of the workflow at that point and do it in wax, but then you’re missing out on the benefit of the digital planning side of it, which I know it says the technician side, but I’ll just briefly touch on that. So as we said, you’ve if you scan your watch rims, you’ve got these articulated digital models. What the technician then does on the software is essentially they can analyze the models like they do they mark certain landmarks papillas, tuberosities, the rugae, the arch form, etc. And then the software automatically puts the occlusal plane and the software will automatically put the teeth on the upper where it needs to be.

The technician can then tweak it with their own eye and experience. And then the software automatically makes the lowers go into the best possible position to match the upper. So, Dean’s done this where a full, full setup he can do in two minutes and then tweak it a little bit. I’m only just starting my technical journey in the laboratory bit.

It’ll take me half a day to set up a complete and even then it’s one tooth at a time and the chance of getting everything interlocking beautifully is so low. Whereas that you just literally click a few buttons and it’s done for you. So that’s where the accuracy of the occlusion and that’s what I think patients perceive. is they just say it feels tighter, feels better in the bite, and feels softer for the milled surface, feels softer in their mouth for some reason.

[Jaz]
Okay, and that 3D printed try in, what if you like on a traditional wax trine, if you want to maybe just tweak a tooth, maybe make it a little bit more imbricated, you want to maybe adjust it, obviously you said the occlusion doesn’t need much adjustment, but melt the wax, you intrude a tooth a little bit.

You don’t have that luxury anymore in the 3d printed, right? You’ve got to really give the technician enough information and maybe even WhatsApp communicate. Are you happy with this? Are you happy with this before they actually send it over? And that’s what I’m thinking.

[Rupert]
Absolutely. So yeah, that’s one of the areas where in the workflow, it’s a little bit more challenging because as I say, again, like through though the MClinDent I’m sat there a lot more with the wax, I’m a lot more comfortable with moving the teeth around and things like that.

So generally the byte’s pretty spot on already because it’s been worked out by AI and all that kind of stuff. But you can always still tweak and polish as if it’s almost as set denture. Because it’s on this full printed monoblock base, it’s rock solid. So you can sit there and you can adjust it, it’s not, you know, the teeth aren’t going to move and they’re not going to break off and things like that.

So you can tweak and adjust them. And then the technician or yourself can even scan that back in and just copy that. A bit like how you do your mock up in the mouth for a veneer case and then you scan it and replicate that for your finals, you can do that again. So it’s a little tricky when you’ve got macro changes to make, like you’ve got the incisal length too long and you need to lop off two millimeters.

[Jaz]
You could just drill it off, right? And then draw on there.

[Rupert]
You could just drill it off. Exactly. So that’s what I’ve done. I’ve done it on one of the cases we show where like, just got a sharpie out, sort of scribbled on the incisal edge until the patient was happy. Drilled off one side so the technician can measure it. But then when they go back in, they just chain the teeth together, link them together and just go, right, move up two mil, job done. And they’re not sat there for 45 minutes moving all the teeth up and then dialing the occlusion back in. It does it for them.

So it’s a little bit trickier chair side, but actually for the technician doing those changes, it’s easier. And as you say, full face photos always, this is usually an element that we come to a lot. You can’t get away from your classical pros. Digital isn’t going to save you. If you don’t put a retraction cord around your crown prep, your scan isn’t going to be any good.

Just because it’s a scanner, it’s not going to save you, yeah? So you’ve still got to do all of that brilliant analogue work, which includes, for me, my workflow doesn’t change. When it’s a wax try in, I’m taking full face portraits, full set, side on, relaxed, smiling, etc, etc. So Dean can sit there as he normally does and says, you’ve got the midline wrong again, yep.

Idiot. Yeah, I’m going to do that. Do that. Tweak it across. So all of that and he can still tweak all of those things. But it’s just a little bit, you’ve got to sort of work on, think on your feet a little bit more compared to, as you say, just tweaking teeth a fraction.

[Jaz]
Well, on that theme about learning and thinking differently, I think Peter Dawson said that, digital was great. But it’s a way to get, maybe it was Frank Spears who said this, it gets you into trouble faster. Like you can like, now you’ve got like a Ferrari and you can actually just crash it much quicker basically. So you’ve got to kind of know the nuances, how to drive it. So my next question really is, now that you did this little experiment, which I highly respect, and we found that actually all this digital stuff we’re doing, it’s actually improving patient outcomes.

So that’s already one reason why we should, because, because for me, I’m thinking, look, you’ve done the impressions to scan is actually an added step for the clinician at a time and step for the clinician, right? And the quality of scan was something goes wrong, et cetera, et cetera. So we’re actually adding time in some ways when the clinician to produce this digital result, but we’re getting a potentially a better result.

Is it also cheaper? Is it also faster, better in other respects? And do you think that we should be? Moving this workflow, this exact workflow described whereby you take an impression and scan it, should that become the standard?

[Rupert]
Yes, I think in terms of the laboratory costs at the moment, it’s more or less the same because it can be a little bit more expensive because there’s more time taken in finessing them at the end with the artistry and stuff to make them look good.

I mean, in terms of your clinical time, yes, the scanning is going to take a little bit of time, but at the same time, whilst you’re taking the opposing alginate, your nurse could be scanning the impression for you.

[Jaz]
So the whole no postage thing is also winner.

[Rupert]
Yeah, exactly. And that’s it. You could say, well, I couldn’t shrink my turnaround time by two days because it’s not going to take two days to get there. And the other models already cast up. They haven’t got to sit there and wait for the stone to set and then trim it and do you know, so there is a lot more efficiency from there. I think the interesting thing for the future is going to be, are you going to end up with these digital labs where you have a master technician and a bunch of CAD guys and the CAD guys set everything up and then the technician comes in and goes move that move that right next print that move that move that right next do that and actually you’ve then got this much more effective efficient laboratory rather than one person there mixing 400 kilos of gypsum every day and that kind of stuff.

In terms of the patient outcomes, my patients are preferring it. We are moving more and more towards just doing that. We’re still doing a lot of the comparisons just for our own sort of research, but we’re moving towards that being our main workflow for particularly the complete dentures. And the Chrome dentures and immediates as well.

So personally we’re getting there, but even for yourself, if you don’t want to scan it, you can send it to your lab and most labs now have a lab scanner so they can scan it for you. So you don’t even need to own a scanner, but you could still do digital dentures as well. So, yeah, there’s a million different ways that-

[Jaz]
The scope is so vast, the scope is so vast. So on this topic of you just mentioned immediate dentures is a really easy win to someone who’s never done anything. It’s just really new to digital is to scan someone’s like, imagine you’re doing immediate denture to replace, two upper laterals or something right in the upper left lateral, upper right lateral. And then they’ve got these like dodgy restorations and then about to be extracted.

If you scan the arch as standard, you’ve got enough teeth to get your retention. The acrylic can actually engage into the undercuts. Is that a really easy impression free win for immediate dentures? Or am I missing something here in terms of some nuances that we should consider before considering scanning over impressions?

[Rupert]
100 percent so for me, they’ve pretty much, I’d say 90 percent of my immediate dentures I scan for. The only times I don’t scan for would be if I’ve got a big free end saddle already, because the scan isn’t great at getting the soft tissue that things like the TRIOS and the PrimeScan and things are much better.

Obviously things like you mentioned Invisalign again earlier or iTero earlier, that’s Prime before Invisalign. So it wants to see teeth everywhere. It’s not that great at picking up pink. But even if it can pick it up, you don’t have the functionality. So that’s the line-

[Jaz]
Then you’re taking the impression, you’re scanning that then. That’s why you made that distinction, right?

[Rupert]
Well, if you’re doing that. So if it’s a free-end saddle and it’s perio teeth or something like that, I’ll still maybe do an impression and maybe we’ll make that analogue, still. But for perio clearances, partial clearances or whatever, for me the scanning is far better, because like you mentioned there, like the acrylic and the undercuts and things.

When you’ve got those long receded teeth, black triangles. Alginate is just going to tear. So the technician actually isn’t going to be able to get that colletting really nice. The digital ones where you scan like that, they get such a better fit in that initial stage. It’s just where you have a flange is not going to be accurate.

It’s not going to be functional because you’ve not done any border molding. So that’s the area where, again, it comes back to that you need to know your analog, where if I do a digital immediate, when I fit the denture, I will still do inside the denture. After the teeth have come out, I’ll do a light body wash inside, fit the denture in.

Patient will then board a mould, and that will show up at the flanges, it will push away the light body where it’s overextended or it’s too tight. And that will show up as just plain acrylic within an island of acrylic within the light body. You get your handpiece out and you adjust that and you’re going to sculpt or carve back a functional sulcus at that point. So, that’s the step you need to bear in mind is that you might need to then do-

[Jaz]
But then are you sending it to the lab to get that processed then?

[Rupert]
No. So it’s already processed. So I do the scan. The lab prints off the models and they usually just make it analog on those models. They might duplicate them. But they make it analog on those models. I take out the teeth. I do the denture. I fit the denture in. I do the light body. And I use that as a fit checker to see where it’s overextended. So where that silicon gets pushed away on the flanges is where it’s overextended. The lips have pushed the silicon out of the way.

So that acrylic would be too far up into the sulcus. So you just mark that little island of acrylic with pencil or sharpie or whatever. Peel it all off and then you just polish these little hot spots where it’s too tight or too extended and then you’ve now made it functional, but you still need to know how to do that in the first place. But for me those are media digitally 100%, all the way. Periopatient’s amazing.

[Jaz]
Brilliant. And could you just use pressure spot indicator paste in those scenarios?

[Rupert]
You can. I find it a little more messy. You can get specific silicons as well as specific fit checker silicons that set faster than your standard light body as well. So you could use PIP. I find PIP is more useful at review when there’s an ulcer and you dry it, put it on the ulcer and see where it transfers.

[Jaz]
So maybe we’re talking about different brands. I really like the Coltene one. Have you used that one? The greenish one?

[Rupert]
Yeah.

[Jaz]
Okay. Cause that’s fairly fast setting. I mean, that’s kind of like a FitChecker quite fast set, but so there’s another one that’s white, almost like toothpaste, that’s horrible. That works well for the dental ulcer, I find.

[Rupert]
Yeah, but that’s for the ulcer. There’s different ways to do it. I just get regular silicons and just pop it in and then.

[Jaz]
Which is good because everyone listening to this who doesn’t have PIP, they’ve got silicons they can use, right? So that’s the good thing you mentioned there, because we’ve all got it in our drawers, we can use that.

Now you’ve said about finding out where it’s overextended. What about if it’s underextended somewhere? We can just get our chair side acrylic and just add some and then just mold them, do the border molding chair side, right?

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[Rupert]
Yeah, absolutely. So you could add to them exactly the same. No problem at all. Whenever I do an immediate, I’ve always got something like Visco-Gel ready to go, which isn’t as a soft sort of temporary liner that it’s quite clever. It’s sort of fixed tropic. So it’s keeps drifting around where it needs to go and things. So you can still add so that you could use chest type acrylic, you could use soft GC reline, silicon, material, whatever you want to use, you could extend it again correctly.

And I mean, that’s the interesting sort of one that under extension with a scan as well. And that’s where, that’s the misconceptions that you go, oh, I’m doing a complete digital data. I’m going to scan soft tissues. By the way, that’s the ninth case we’ve done side by side. And that’s the only one where they preferred the analog when we scanned the soft tissue.

[Jaz]
Okay. So what you’re trying to say is, you actually tried to bypass impressions completely and did it all from scanning any kind of, I imagine you’re like kind of holding the cheek in a certain way to like mimic where you imagine their boulder molding would be, right? Is that what you’re trying to do?

[Rupert]
We just scanned it and Dean just sort of guessed as much as he could. But yeah, so you can get a bit of under extension, but if we’re talking immediates yeah, you’re relining them at three months. You’re remaking them. So it’s not the end of the world-

[Jaz]
So even immediate complete is what you described. Immediate complete. Is that what you just described that you did it completely digital?

[Rupert]
No, that was a standard complete. I mean, we did one recently where this case I’ve just shared on Instagram. Actually, I don’t know when this is going out-

[Jaz]
But soon it’s removal pros month.

[Rupert]
Is it? Amazing. Fantastic. Well, it’s called Staged Immediate Dentures on my page. And basically the chap had a load of missing teeth, perio. Had never worn dentures, so I scanned him in the consultation anyway. We made a partial to replace the missing teeth that were already there and a couple of teeth were extracting.

See how he tolerated it. And then the same, Dean kept the model on record and said right to take off all the upper teeth and make it complete off the same scan. Again, that’s quite nice. It’s just sat there on the, on the cloud. You can just bring it back, print it off. You’ve not thrown away the model.

And that was all over the place, but I just got the GC Soft Reline. It’s a nice silicon material and filled it up basically, and all the board is a silicon, but it fits like a glove still at three months. So, it’s an immediate, that’s the reality of it. It works beautifully for scanning.

[Jaz]
Excellent. Well, I’m very excited to delve further into this. Cobalt chromes. Can we talk about Chromes? We’ve got time to talk about Chromes and then we can wrap up then. And this would be a nice meaty segment. You suggested that with Chromes, we can actually do a lot more digitally. And in terms of the data input, we might be able to get away with a lot more.

Cause remember chromes are tooth-borne in the sense that they’re relying on retention of their teeth more than the mucosa. So can you maybe describe that because you described that complete denture protocol so wonderfully with the impression you scan the impression I think a lot of people that’s really helped it to click in people’s minds. Can you can we do the same for a partial chrome denture that’s probably not free end saddle? That’s a bounded maybe three or four teeth make it a bit easier. Can we talk about that scenario?

[Rupert]
Sure. So, I mean if you’re looking at a bounded chrome, upper bounded chrome something like that then-

[Jaz]
Let’s say it’s replacing upper lateral to upper lateral and then a mold on one side.

[Rupert]
Cool. Fine. So I would look at, for that I’d be scanning as a primary. So scan, usually for me, that’d be in the consultation. I do that anyway from a consultation. Great for communication, either with a patient or with deans a lot of the time. It’s another beauty of it. In that consultation, non invasive thing, take a quick scan.

I can send that to Dean, he can then print it off, we can have models together, and we can chat about the case, etc, and plan it, so. We’ll do those scans, it then goes over to Chris, our Chrome technician, he’s going to look at path of insertions, and guide planes, and rest seats, and undercuts, and da da and he can say, ideally rest seats.

How are these teeth for rest seats? We need to add, if we’re going to use this as an undercut, etc. And then you can make all those adjustments, do all your preparations, and I would just scan again, try and get as much scan extensions as possible. So my secondary is a scan.

[Jaz]
So this is after you’ve done your guide planes, your rest seats, all adjusted, right?

[Rupert]
Yeah. My secondary impressions appointment is preps and scan.

[Jaz]
And scan again. Okay, great. Now just to talk more nuances of this bit. I quite like nowadays, if I’m doing the guide planes, I get my technician to make me these acrylic copings that just guide me exactly where to drill. I quite like doing that. Do you eyeball it? Do you ask for copings? How do you get the guide planes perfect?

[Rupert]
Bit of both. Yeah. Eyeballing it usually, but if it’s particularly tricky, like if you’ve got like a, you can have some crazy ones where you’ve got like a lateral and a seven and that’s your sort of bounded area, that’s quite hard to line up.

It’s almost like if you’ve got five missing and you’ve got four and a six, it’s like a bridge prep is it’s quite easy to line those up. But yeah, copings are great. Either just making it out sort of an acrylic or you can get some printed, obviously. Now those are really handy just to make things more efficient for you and more accurate because if you’ve got the data and at the moment with, especially the things like the printed, it can take seconds to actually get it made and cost pennies. So why not do it? I think that they’re really, really useful. We had a case last year where we had to reduce the sold abutment. And we did exactly that. It was right. How much space do you need? I want an extra 1. 7 mil, please. So the coping went down. I’ve trimmed off to there. How much buccal space you need prep, like a prep guide. So yeah, those can be really useful to make in the sense of chat to your technician about for sure.

[Jaz]
And it’s great to use. Also in the fixed prosthodontic world where I remember doing this crown and then the contact with the future implant in the future wasn’t going to be very good. And so he wanted me to prep the mesial some more. So he sent me this digitally printed coping, put it on and just for the few seconds, precisely managed to remove that piece through structure to allow the crown to fit and then now had a better contact area for the future implants. So, it’s great.

And to be able to do this so efficiently is absolutely fantastic. So I’m glad we touched on that. I’m thinking some people haven’t seen that before, but, oh, yeah, this is clever. Let me speak to my technician because everything we’re saying that today, guys, it’s going to be wasted if you don’t start a conversation with your technician.

I think at the end, I’ll ask you about how to find a technician. I think I’ve asked you that before, but it’s a nice thing to be reminded of. So you’ve done your secondary appointment, secondary Impression, in quotation marks is a scan, obviously, and then what happens next in terms of everything’s being digitally designed by your clever lab?

[Rupert]
So nine times out of 10, our jaw reg is done with the scan as well, of course. So as long as we’ve got an MIP case, you know, the jaw reg is done as part of the scan, if need, if it’s not an MIP, then, we’ll just do a conventional wax rim, because actually, my lab at the moment still with Chris, with Chris Hesketh is it’s all analog still from him.

So he gets his printed model and he just uses that. So we still haven’t dived into the digital chromes just yet. You can do them again. You can do them, you can set aside and mill them or you can print them. It’s not printing. It’s your SLM or SLS, laser sintering and that Selective Laser Sintering, Selective Laser Melting. So again, you’ve got those two options. You can mill them out of chrome, mill them out of titanium, or you can print them out of, again, usually it’s a sort of metal base. The issues with that potentially.

[Jaz]
I’ve heard of a PEEK.

[Rupert]
Yeah, so you can use PEEK as well.

[Jaz]
What is it? Is it a resin?

[Rupert]
It’s a high impact sort of resin material essentially with a bit more sort of flexural. So you can use that. We’ve looked at it. Space usually tends to be a problem with peak. You need sort of connectors and things need to be quite sort of chunky and it can be quite challenging. We had a case where the patient didn’t want metal.

But didn’t want a full palette, acrylic, etc. So we had to do a chrome, essentially, but they didn’t want metal. We didn’t go through with anything, because we said there’s not enough space. You can’t do it. It’s metal or nothing, I’m afraid. But yeah, but peak can be done as well. I’m not sure about printing on peak style materials yet.

But the issues for us is that, well, at the moment, we don’t feel it better yet. So if you’re milling, say, usually it’s titanium they do, it’s very, very common in America. America ahead of us on this. If you’re milling it, you can’t use different clasps without not milling the clasps. You mill a framework and then you’ve got to go back in and do clasps conventionally onto the framework.

So it’s not that much more sort of efficient. And for the sort of high end chromes we’re doing with Chris, he’s absolutely fantastic. So until it’s better for us, we’re not going to switch. But for health service chromes, for instance, when you get your arm twisted into one of those, it might be a really great option, actually, that’s going to fit really well. But for our workflow, Chris is then making it conventionally analog again. And this is what I said earlier, you can dip in and out. However you like-

[Jaz]
But the clinician you as a clinician so far, you’ve been fully digital, what you get back, as a clinician and like, okay, it’s good to know that, but I can now crack on. So as far as a dentist concerned it, this has been fully digital. Do you see what I mean? In terms of what you have to do?

[Rupert]
Yeah, absolutely. From our perspective, chair side fully digital. And I find you’ve got a nicer accuracy with the fit, then we always do a verifier. So either Mill or print a sort of copy of the denture out of an acrylic material so that we can check that our scan is accurate because our chromes are pretty pricey. So I don’t want to have to make those twice. So then we check that’s accurate. Great. So that’s our appointment three. And then you can do a try in tooth trying on top of that as well.

If you like, you sort of mill this little framework and it clicks in with some teeth on it. So, the shades rise in the bites, right? And then the chrome gets made and then you fit. So that would be our sort of five appointment protocol there.

[Jaz]
Do you like to do a tooth try in with the chrome or are you going straight to the chrome with the teeth on because you’ve done a separate tooth try in and a separate chrome verification? Are you going straight to fit?

[Rupert]
So once we’ve then done the Chrome try we’re then going to fit because ideally with Chrome again, it’s the sort of classic pros ideally you’re doing some sort of tooth trying before you commit to your Chrome framework.

[Jaz]
Yes.

[Rupert]
Because you don’t know where exactly your teeth are going to be and where the framework needs to be to accommodate those. Do you need to do backings in type by cases, et cetera. So that’s where, when we’ve done our verifier, we do, usually we’ll just do a verifier that clicks in on its own so I can see everything nicely. And then we have just a separate wax try in that goes in. You can combine them together, but you’re sort of doing neither job at the same time.

I’d rather have my verifier. And I can see a bit like an implant guide with windows. You can see that that’s seating fully. So you’ve done that. Then you do your current try-in and just on its own as a framework. And then you’ve already verified the bites, et cetera. So you can go straight to fit.

[Jaz]
Great. So the main pissing piece is that we all need a Dean and we all need a Chris in our lives. So how’d you go about finding these great people to work with? And what advice you want to give to Petrucciati around the world in terms of finding a technician? Cause so much of what we do hinges on that.

[Rupert]
Yes. I mean, so my previous technician now works for Ivoclar, Ricardo and Dean. We’re through Instagram. We met online chatting about cases. Ricardo said, let’s work together. Ricardo moved over to Ivoclar. So I said, let’s work with Dean for this case, first case. And now we’ve been working together for sort of three years. Chris is Viadene, Chris only works with a few technicians. A lot of it’s very sort of gate kept and all this kind of stuff.

But for me, the main one is Instagram. There’s loads of amazing technicians out on Instagram. So just get out there, find them. And I think the biggest thing with removable is everyone obsesses over locality. Because you’re used to doing relines, additions, repairs. I have a local lab. He’s great.

He’s awesome. I send him these absolutely mental additions where we turn like a three tooth partial into a complete denture and stuff like that and he nails it.

[Jaz]
He loves you for that.

[Rupert]
Well he loves it because all I send him is relines, repairs and additions. So I pick up the phone and he’s like, what? But I use him for that. And then I use a guy, 200 miles away for the rest of my work. You don’t need to be tied into someone who can do pick up and drop off within the 30 mile radius kind of thing. So there’s loads and loads of great technicians out there. And I mean, this is where the digital gets really cool.

You know, we did a case where I did all my stuff in Reading and actually it was a case with Ivoclar and we sent it to a guy in Canada, who’s like the best guy in the world, a guy called Eric Kukucka sent it over to Canada. He designed it. He sent it back to Ivoclar to mill it and then I fitted it, so I didn’t even use a technician in this country, really.

Yes, someone in Ivoclar, Ricardo, dressed it all up to make it look pretty. But in theory, you could use anyone with the digital because it’s going to get to Canada in a minute. It’s not going to have to get on a flight. So, as we get more and more into these digital workflows, actually. The world is quite literally our oyster in terms of what technicians we can use.

But when you’re looking for one, it’s just about who you can build a relationship with. And, you mentioned earlier, like, WhatsApp and stuff, like, Dean and I spend way too much time on WhatsApp. Probably a good hour, or at least an hour a week, just catching up. Where are we with this case? Where are we with that?

Because my, I think I mentioned it before, my lab dockets are horrendously bad. It’s like, try an A2, next time, cheers. See what’s that voice note and there’ll be a two minute voice note about like, Hey man, So I think we need to move this and duh, duh, duh, duh. But we just find that’s a better way for us to communicate because again, you’re busy in practice or whatever just say I’m going to send you a voice note on this day, obviously, and just, and do it there. And I think if technicians-

[Jaz]
Mind you, there’s a two word prescription, See Email. See Email.. Yeah. And in the email, I’ve got all my stuff, my photos, and my Loom videos saying, Oh, you know, Graham, have a look at this. Can you replicate this? I think I’ll need a guide plan here. What do you think? So yeah, I mean, the world is evolving, even how we communicate is more digital and therefore it’s a mindset shift we need to appreciate because a lot of dentists are like in this fixed mentality that, Oh, I need my technician literally next door building next to me kind of thing. Right.

And so it’s good to have that technician, but if you’re not able to do the kind of work you want to, because you think your technician needs to be literally right next to you, then we need to move away from that kind of thinking like you said.

[Rupert]
A hundred percent. And if the technician doesn’t want to sit there and chat to you about stuff, then we’ll just find another technician. Like, that’s the one we get asked a lot on our impression courses or whatever. It’s how do I find the technician? It’s always the number one question. No one actually cares about taking impressions or doing digital dentures. It’s just literally the way to meet technicians. But if they don’t want to have the relationship that you want to have to do the best work, find someone else.

There’s plenty of technicians out there and there’s plenty of other clinicians to work with that technician. Like, we’ve all got enough work, it’ll be fine. But just don’t spend time working on something that isn’t working for you, really.

[Jaz]
I think what we need to do is we need to create the tinder for technician and dentist, right? Create that, find out what kind of hours we like to work, what kind of a communication methods we like and match them up and stuff. This is a great idea. But if a technician is listening to this, and obviously you’ve listened this far and you’re interested and you are enthusiastic and you like the geeky side of it.

If you’ve managed to listen to this far into our chat. Please reach out to Rupert. So he can identify you as, Oh, this is someone who’s interested in help match you up with dentists similarly here. Please message me, join the Protrusive Community, check out the impression club website, which he’s doing great things.

It’s about working. I know technicians think, Oh, I’m competing with that technician or whatever. And the same with dentists, but it’s not the case at all. There’s plenty of work to go around and there’s a huge demand for technicians that are just keen beans that we’d like to work with. That are great communicators.

And there’s treasure trove of dentists ready to work with you. Should you just put yourself out there? Say, you know what? I’m willing to have these WhatsApp conversations and look at these photos and work closely with dentists. I think they get a better kick out of it, right?

They get a lot of enjoyment from knowing who their dentist is, seeing that work on Instagram later, it doesn’t have to be on social media. I’m just giving your example, but you can just have a beautiful relationship with the technician whereby they’re seeing the work that’s being done and fitted because you ask technicians how much of the time this crown that you’re making. Will you ever see it again? No, once a ship is gone, they’ll never ever see. The sad truth is they’ll never see what it looks like in the patient’s mouth.

[Rupert]
Yeah, and some of the times with our bigger cases, I’ve actually asked the patient, like, is it all right if we give Dean a call? When we’ve done the fit or something and we’ll just sit there on facetime with Dean and he’ll have a chat with the patient because then every time it’s like that absolutely made my day because I document stuff a lot and he’ll see the pictures. And we’ll talk about the lecture about them, etc, etc. But like to actually sit there and have a chat with the patient and Dean’s a main character within my surgery. Yes, it’s me and my nurse and whatever be going right Dean’s going to work on this and he’s got this. They know Dean, they feel like they know him. So then actually at the end they get to have a chat with him a lot of the time.

[Jaz]
And it adds value as well because the patient’s like, okay, look, you have every right to charge what you charge Rupert, because you take her time, you take use the best materials, you do what you do. But it’s also great for patients to know that it’s not just you. There is a whole team approach behind this. There are really technically skilled people behind the scenes and the technologies that they’re using, which I’m sure you talk about. That’s how you build values. Oh, this gets people, patients are really interested in technology behind the scenes that goes through to make the prostheses that we fit.

And if you just engage in that conversation, you’d be amazed how many patients are genuinely interested in what’s happening. And suddenly their perception of what they’re having done is vastly improved for the right reasons.

[Rupert]
100%, I mean, the number of the patients with these milled completes or whatever that we’re doing, I say this is, I go, Oh, that one’s the computer denture, by the way. And it blows their mind that this thing’s been designed on a computer and a robot has made it. And we’re doing a case at the moment, which I’m really excited about where it’s a upper complete over natural teeth. And patient came in with a lot of expectations, very, very, very high expectations mentioned a certain dentist in the Northwest.

And it was going to go up to see him. So, you’re already like sweating at that point where I was like, was it Finley? Yes, yes. Finley. I was going to go up and sit in here. She’s traveling from Oxfordshire to Manchester. I’m going, right. Okay. Pressure’s on. But all I did was another, well, another workflow we haven’t talked about the reference denture, but in the consultation, relined a denture with silicone, scanned it.

Dean made a quick mock up. At the next appointment, I said, we can give you this. I’m going to charge you for it. But this is going to gauge both of our expectations. This is 90 percent of what we can achieve. And she went away with it, came back two weeks later and went, this is already 10 times better than my denture.

She’s been wearing this printed try in around the house and whatever, and said, let’s go, let’s do this. So, this is incredible technology and it took me five minutes in the consultation and it turned this potentially very stressful case into one of my favorite cases, I’m super excited.

[Jaz]
Absolutely genius. I love that. This is like the equivalent of doing a really good, not trying, like a temporary veneers that are really good, gives a patient, they know what they’re expecting and they come back and say, yes, this is what I want. There’s no confusion about shade in the future. There’s no friction and communication errors. That is really nifty.

[Rupert]
Yeah, and that’s the big, I’ve never done it before. So take away the printed try in because it’s always been like, yeah, it’s great. Awesome. Go for it. But for this case, we did. And you know, it’s the old thing of like, they go, oh, can I take the wax try in home? And you go, yeah.

So you’re showing my husband, or my wife, or, my daughter, whatever. And you go, well, okay, but like, don’t have a cup of tea, and don’t wear it for too long because it will start to melt and then the teeth are going to move and then we’ve got to start again whereas this is rock solid. If we verified it already.

It makes no difference if that thing never returns, if it snaps in half, because they’ve got the file, they just mill it, or print it, or whatever again. So, for those kind of cases, you can say, and I’m going to do it, we’re at the definitive wax try now, we’ve still done our conventional impressions, we’ve done wax, we haven’t done wax rims, because we’ve done reference denture.

But we’re going to get the definitive try now, and again, I’m going to say, hmm, we’re not committing yet, you go away for two weeks and wear this at home. And then you tell me you’re happy and then you’ve got consent, right? You can just say you told me you’re happy with this. You can wear this you can eat with this. You can try it all out proper. So that’s a really really cool aspect. And that reference denture, that for me is the gold standard.

[Jaz]
Well, thanks so much for this whistle-stop tour on digital dentures. I thought you covered a lot. I think a lot of people have gone away thinking, Wow, how am I going to use these acrylic copings to, I can actually scan my impressions to, okay, I can now actually, be more confident when I’m scanning and finding the right technician to communicate with all these factors that we discussed.

Rupert, I want them to learn more from you as a guest and a friend. I want them to know about your stuff. Tell us about impression club. Tell us about your next course where people can learn more. Like my job here is whilst I’m not as crazy about dentures as you but when someone, when it comes to learning, I want them to learn from people who as crazy as you are. So tell us about where, what kind of courses you’re running at the moment.

[Rupert]
So, you mentioned impression club, the impression of podcasts can’t be quiet. Sorry. I’m a bit busy guys, but essentially if you head over to impressionclub.co.Uk, currently we have two courses that are actively running, which is the primary impressions course covering all things, primary impressions with Mike Gregory who- Has Mike been on the podcast yet?

[Jaz]
Not yet, we had a chat on Instagram and we kind of said yeah we’re going to come on and we never actually got the date. Coming soon. I’d love to have him on. Can you just twist his elbow and just as long.

[Rupert]
He’ll be there, he’ll be there. So I’ve run it with Mike down in Bath and a dancer called Steph has me up in Manchester who are both awesome and that’s been running for quite a while now. There’s a couple of dates out actually for February if you want to check that out. And then we do a digital denture course as well, which we’re hoping to get launched in again in November.

We’re just trying to make sure 3Shape are available, and that is run with both Dean and Ricardo. So it’s quite a unique course where actually we have half the delegates are technicians, half of them are clinicians. So if you want to bring your tech to come along with your technician, then awesome. That’s fantastic. You’re both on the same page. If you want to meet a technician, there’s going to be seven of them there. So, come along. If you want to meet some dentists that want to do it, come along.

[Jaz]
This is the real world Tinder of a technician and dentist working together.

[Rupert]
We’re there. So that’s cool. So, in that we cover a lot of these workflows. We go for the clinicians. We do hands on of scanning the imps, doing altered cast technique for free end saddle digital chromes. I’ve got a post about that, I know we didn’t touch on it, I’ve got a post on that on my page if you want to find that. And the technicians do a full full set up on the computers, they do a whole afternoon of working with Dean on characterizing, they get a milled venture in their own hands and get to dress them all up.

And it’s just really cool to have both sides together. And then we’re working on a few others in the background, immediate dentures, implant dentures, complete dentures, coming soon. All of those are on the website, available to join mailing lists and things like that. It’s just trying to find the time to put content together, but I know you’re no stranger to that dilemma either.

[Jaz]
Absolutely, and we appreciate everything you do, including just like hats off again, guys, if you missed it earlier. I’m sure it was at the highlight of the episode where Rupert talked about this experiment they did with his patient. That takes a lot of organization and planning. And so kudos for that.

Honestly, I’m so glad you did that. And you were able to share that with us. I’ll put all the links in the show notes. All my followers are already your followers, but I’ll put that in the link as well. So they can, they can follow Rupert’s work is stunning. It is making dentures sexy.

So Rupert, thank you so much for coming on the podcast again. You’re always a welcome guest. Thanks for sharing all the wonderful things you do and just making it geeky, sexy, fun. Thank you so much, my friend.

[Rupert]
And thank you for having me and thanks everyone for listening. And Jaz, a big cheers for getting Andreas on because that was such an epic episode.

Jaz’s Outro:
It was great. I still get, I was in Valencia on the European aligner, supposing this lady from Cyprus comes in, Hey, you, your Jaz, you interviewed Andreas. That was so good. I was like, Oh wow, this, that’s cool. So thank you for that introduction and the recommendation. Shout out to Andreas. I’m hoping we’ll be listening to this. Absolutely amazing. Just such an impactful hour that you covered on dentures really, really good. So thanks for geeking out with us as well.

Well, there we have it guys. Thank you so much for listening all the way to the end. Impressions are not quite dead, but there is a compelling argument to go digital.

And I’m so grateful that Rupert covered those two workflows really well. If you want to learn more about digital inclusion, check out Rupert’s courses. I’ll put the links below wherever you’re watching this. I know he’s got an additional date in November with 3Shape.

Now this wonderful episode he did for us is worth one hour of enhanced CPD or one CE credit now that we are PACE approved. All you have to do is answer the quiz on the Protrusive Guidance app. We have three plans available on Protrusive Guidance. One is the free community access. Join in our chat, our discussions, ask questions, grow together, be nice and be geeky together. But you don’t get the CE. If you want to get the CE from the podcast episodes, join the premium podcast CE plan.

If you want that and you want the access to our webinar replays, masterclasses, mini courses, including VertiPrep for Plonkers and Sectioning School and RBB Masterclass, then you want the Ultimate Education Plan. I think the annual plan is incredible value for what you get, both in terms of the hours and the quality of the education. So do head over to protrusive app to choose the plan that’s best for you.

I want to thank Team Protrusive, many of which would stuck with Protrusive for so many years. Thank you, Erika, for the production. Thank you, Mari, our CE Queen. Thank you Nav for the notes on this one, including the PDF transcript and the premium notes that always follow our episodes available for our paying users.

With your support, protrusive has been able to grow, so thank you so much. Once again, I’ll catch you same time, same place next week. Bye for now.