Podcast: Play in new window | Download (Duration: 1:08:31 — 94.1MB)
Subscribe: RSS
In this mammoth episode (boy, it’s a long one but I hope you like it!) we have the legend that is Dr Jason Smithson.
If you are a Dentist and have not heard of Jason Smithson, you have been living under a rock!
The calibre of cases that Jason posts on Social media and lectures is always unbelievable and we as a profession learn a lot from from him, as well as the courses he runs. I went on his Onlays and Veneers course about 4 years ago and I was really engaged throughout the entire 2 days.
Need to Read it? Check out the Full Episode Transcript below!
We will be talking all thinks eMax onlays and vertical preparations.
Protrusive Dental Pearl: for all my listeners, a group just for you where we can share content, knowledge and files for each other: Protrusive Dental Community
First half we discuss all about lithium disilicate onlays including:
- Indications and contraindications
- When an onlay really should be a crown
- Thickness of eMax
- Why flat top onlays are not recommended
- How thin can we go if on virgin enamel? (Think of OVD increase cases)
- IDS (Immediate Dentine Sealing) and and DME (Deep Margin Elevation
We also discussed Vertipreps in great detail!
- What is “vertiptrep “or “vertical crowns”?
- Why have they ‘suddenly’ become fashionable?
- Tips for temporising for Vertis (see eggshell technique reference)
- What to tell your technician
- Trouble shooting Vertical crowns (overcoming friction!)
And we also discuss a gem right at the end about how I help to improve the longevity of my anterior work by a simple trick that takes 4 or 5 minutes with only with a disc….and Smithson agreed it is a good thing to do!
Resources shared with this episode on the Protrusive Dental Community Facebook group:
- Eggshell temporary technique
- Loi’s paper on BOPT
- Bur codes for the Vertical prep burs we discuss
Lots of news to share with you all:
Those of you who follow me on Instagram (@jazzygulati) or like the Protrusive Dental Podcast Facebook page (I’m pretty active) will have seen the news that starting from the next episode (which by the way is with none other than Kushal Gadhia) you can get enhanced CPD!
My guest and I will produce A&Os and have some questions for you to answer. The only caveat is you have to be a Dentinal Tubules member – if you listen to my ramblings, you either LOVE dentistry or you WANT TO TRY to love dentistry or you want to reignite your passion, and that’s exactly what Tubules is about and I am provide for them to quality assure and issue my CPD.
This Podcast on Youtube:
For information about Jason Smithson’s next courses, visit:
Click below for full episode transcript:
Opening Snippet: Too many people start a wear case by slapping some composite on the teeth. And really what you need to do is take a step back and work out why they've got a problem...Jaz’s Introduction: Hello everyone, and welcome to Protrusive Dental podcast. This is Episode 19 with Dr. Jason Smithson. Jason Smithson is an internationally acclaimed dentist, and he’s a fantastic educator. If you don’t know who he is, you’re probably living under a rock or something because he is one of those well known dentists in the world. I went to his course around about four years ago now on onlays and veneers, and it’s one of the best courses I’ve been on. He is such an inspirational dentist in the sense that he shares so much of his knowledge. So if you go on Facebook, and you check out some of his cases, they are fantastic. Like I said, he is famous around the world raised it to Latin America and Asia. And when he has time he tries to the UK as well. So I was really excited to have Jason on the podcast today. We will be discussing all things Emaxs, lithium disilicate and particularly in respect to onlays. Cuz you know, we could talk about all sorts of veneers, I suppose we touched on that a little bit, but mostly it’s about Emaxs or lithium disilicate onlays posteriorly. And also, we’re talking about verti preps, which are very much in fashion, I think it’s it’s very poorly uncertain. And a lot of the teaching seems to be on Facebook only. Jason is the only person I know who’s running course on vertical in the UK. Usually, a lot of the dentists I know are running in Italy. So it’s great to have Jason run the flag for UK. And we’ll be talking all about the vertical preparation. So if you’re completely, you’ve never heard of verti preps, or if you’ve seen them, you’ve heard about them and you want to know more than this episode is for you. It’s packed with loads of gems, as always, especially because we’ve got Jason, he’s such a giver of knowledge. Before we join Jason in the main podcast, there’s actually a lot of news I have to discuss with you. Those of you follow me on Facebook and on Instagram. So Instagram is @jazzygulati. And on Facebook is the Protrusive Dental podcast Facebook page. But I’m pretty active on there and posting almost daily and hopefully is used usually quite useful stuff for people, I hope. And so you will have seen my post about my announcement if you like about the fact that my podcast starting from the next guest, which by the way will be Kushal Gadhia. And yes, it’s occlusion again, I promise you is going to be engaging even if you’re not into your occlusion because I think we’re going to make it quite relevant for everyone. And it’s gonna be a funny title. I’m actually excited to share that with you. But I’m not going to tell you what the title is. I’m going to keep it a surprise. But from starting on Kushal Gadhia’s episode, it’s going to be CPD, verifiable CPD or enhanced CPD. So the way it’s going to happen is there’ll be aims objectives, there’ll be some questions that you have to answer on Dentinal Tubules. And then you can actually get CPD for your commute. You know, while you commute and you listen to podcasts, you can now be getting CPD, which is amazing. And it’s all thanks to Dhru Shah and Dentinal Tubules. And to be fair, if you’re listening to my podcast, then you’re probably a dentist who’s really engaged, you’re really passionate about dentistry, or if you’re none of those two, then you probably want to be engaged or you want to be in a position where you love dentistry. And that’s why Listen to me, and that’s, that’s amazing. I love to have you on and I love you know, I love the feedback I’m getting the people are liking the content, which is the means the world to me, but I want you to know that everything that I’m about with my dentistry and my passion for it, and our podcast, is the exact same thing that Dentinal Tubules is about. So if it’s one more thing that you need to join Dentinal Tubules, to fair, you know, I’m probably certain that 60-70% of my listeners are already Tubulites, just because like I said, you know, the kind of people who invest themselves and who want to listen to my ramblings, kind of people who are really passionate and therefore you’re probably already part of Dentinal Tubules. So for you guys, there’ll be some CPD. From two episodes ago with Tif Qureshi, the pearl I shared with you is about the budget composite heater which is 30 pounds and looks like a lot of you are enjoying using it which is great. So now you can access all the benefits of heated composite, heated LA. And also my now friend and listener, fellow listener, Alan Burgin, who on Instagram is @the.cornish.dentist. Fantastic profile with lots of great cases, please follow Alan. He messaged me say that actually, you can also use it to heat your mirrors on there. So while the mirror is still in your pouch, you keep it on the heater or about you know, 60 degrees 55-60 degrees. And then once you’re ready to take your occlusal photographs or your buccal photographs, the mirror is not going to steam anymore, which is great because usually what I used to do before Alan gave me this tip was I’d be warming up the mirror in hot water and it’s wet you have to dry it or my nurse will be blowing air while I’m taking the photos. And this worked a charm. So Alan, thanks so much for that tip. And guys, you can start doing that now just keep it as pouch, you don’t need remove the pouch, and the temperatures, not an issue as it doesn’t get too hot. So thanks so much Alan for contributing. I’m also getting a lot of good vibes about the custom screen that shared Episode 18. So a lot of you guys have downloaded that and start using the custom screen and getting some feedback for it, which is great. Now, one of my listeners, and it’s a great thing about this podcast, because in a way, it’s self selecting. And what I mean by that is, you know, that phrase that you deserve the patients that you get, and sort of the patients that you attract over your working career as a dentist, they’re sort of reflective of you. So I feel the kind of people that are bothering to sort of log on to listen to my ramblings during their commute or in you know, at home or whenever you look, wherever you listen to my podcast, you guys are some of the most passionate and sort of crazy geeky people there are, which is totally cool. And through my podcast. I’ve made so many new friends and I met so many cool people. And I’ve been speaking on either Facebook or WhatsApp with all these lovely and Instagram and all the people who I never really had met before. And it’s just been fantastic. So one of those people is Richard McIndoe. And so what Richard did, he downloaded the custom screen. And he added the bit I told you that was lacking, the goals bit. So thanks so much, Richard, for doing that. It’s really, really kind of you. And he’s happy for you to share that with everyone. So I’ll be sticking that on. So which leads me very nicely to my Protrusive Dental Pearl for this episode. The pearl for this episode is that I am going to set up a Facebook group. And already the first thing you’re thinking is Oh my God, not another Dental Group, okay, just hear me out in a second. Hear me out. I’m going to make another group within my podcast page. So be like the protrusive Dental community if you’d like, right? And the reason I’m doing that is because in some of the bigger groups would like you know, 10-15,000 people, we get all sorts of people, right, you know, anyone, any dentist can join that. The idea of starting this sort of group is I’m only going to be telling the people who listen to my podcast or on my Instagram about this group, I’m not gonna invite anyone at all, you guys have to do the hard work to find it on facebook and join it itself. I’ll put the link on my Instagram, I suppose, or on my blog, but otherwise, I’m not going to be so broadcasting on the Dental Group. So the reason that’s important is because the group itself is self selecting. Now I know some dentists, some young dentists particularly who’ve been shut down before for posting something that, you know, that mean, there’s no such thing as a stupid question. And that’s the way it should be. But sometimes, people in the past have posted something in good nature than they’ve been shot down and had nasty comments, and they’re sort of afraid to post in these dental groups anymore. So the reason I’m starting this Protrusive Dental community is basically so I can share all these files with you. So not to keep going on Google Drive and stuff. So I’m gonna make it like a group where we can, you know people Richard, who very kindly shared the modified version of the custom screen can now put it on the group and I can put some files on the group says easy for everyone to sort of download things. And we can anyone can totally post cases they want. And I’m going to try and get some good people that I know as mentors on the facebook group, if they want to be particularly people who’ve been on the podcast before. So that’s what I’m, that’s the reason I’m doing it. So even if only 10 people join is totally worth it for me. It’s an area where I’m gonna be just sticking on the files that I may mention on here, any templates, PDF downloads, you know, things like that. So it’s more of a group, a community so that anyone else can post on the pages, usually me who can post but with a group, it can get all of my listeners involved. So like I said, it’s self selecting and making it look a safe environment where you’ll be posting or you’ll be reading content of people who are listeners to the podcast just like you are so that I’m hoping it’s gonna be like a non toxic if it can be non threatening sort of environment. So that’s why I’m doing that. And that’s my pearl. Please, if you like the sort of stuff I’m sharing, join the Protrusive Dental community Facebook group, you’ll probably find it within my page. And then that way you can download all things I always talk about, and then things that other my listeners sort of improve for me or share back with me and they’re happy for me to stick it on the group. And a lot of times people are sending me really helpful PDFs and then oh, Jaz, I listened to that bit. And here’s why think and here’s this paper I’m sending you that will help you. And that’s been amazing. So I want to share that with everyone. So my pearl is please join that group. And I’m hoping that through there I can be posting a lot more valuable stuff that you can download. Right enough of my ramblings. Let’s join Jason Smithson, Emaxs, onlays, verti prep. Let’s go.
Main Interview:
[Jaz] Thank you so much for coming on Protrusive Dental podcast. I’ve been meaning to have you on as a guest for ages. So thanks for coming on. [Jason] Thank you very much. [Jaz] Do you have had such a huge influence on my clinical philosophies, my protocols. All of the things I’ve learned about resin, you know stem from your teachings, for example, daily composite flow, I’m still using a probe and a micro brush as you told me [overlapping conversation [Jaz] I went on to your course. I’m being deadly serious what you offer on not just on social media, but through your teaching, of course. But if you just hone in on your Facebook posts that you do with all your lovely cases, I think every one of them have such great learning points. So I know loads of dentists who gained so much value from your posts. I’ve learned heaps and heaps and heaps from from you. And also you’ve got the time to comment and reply to people and answer a question. So that’s amazing, my laptop almost feel there. [Jason]That would not be good [Jaz]
Would not be good at all. So that’s why I’m so happy to have you on because I think you have so much to offer and share. In terms of previously how I’ve done it, I usually introduce the guests a little bit. I do like a crappy introduction about myself, but I let I let you add in. But you know, if you don’t know Jason Smithson, then you’ve been living under a rock is gonna make you blush a bit more. Obviously, he’s one of the rock stars of density in the world. He’s famous for lots of things. He’s famous for lots of things, including the photo every time he goes into international course or something he’s got his shoes, fancy shoes always, up in a train station, legs up. So that’s one of the things he’s famous for. So Jason Smithson is a massive inspiration to me, Jason, anything want to add to that? [Jason]
Not really. That sounds good. [Jaz]
Let’s just go in. I want to get, I’m gonna give the listeners a lot of value because we have a limited time with you. I was taught Emaxs onlays by you. I hadn’t placed a single Emaxs onlay. Into fair, I was doing NSH style non precious onlays back so many years ago, but when I came on your course, a few years ago, I think it was in. Was it? Was it Wakefield or? [Jason]
Wakefield. Yeah, with Prem. [Jaz]
That’s it. With Prem. [Jason] Lunch, if you remember? [Jaz]
That was the first thing I always think of lunch when I think of Prem. [Jason]Yeah, [Jaz] amongst other things. So also Jägerbomb, I think of when I think Prem, that’s when I learned about Emaxs onlays from you. And honestly, your protocols, I use them daily. So that’s great. So let’s just talk about do you think Emaxs onlays are an over utilized restoration? [Jason]
I think I was thinking about this earlier, actually, I think it’s over utilized and underutilized. And it really depends where you’re coming from. We see, when we look on social media, particularly because that’s nowadays, where we look at them Stream Map, most of us don’t look at journals anymore, you tend to see quite a lot of onlays done, where perhaps, maybe you ought to be thinking of doing crowns. And that comes from the new minimally invasive concept. And perhaps sometimes we’re a little bit too minimally invasive. And then you also see direct resins done where really, they should have onlays. And I think the main reason for that is really money and perhaps to some degree, a little bit inexperience. So my answer to your question is yes and no. [Jaz]
And I totally agree. And I remember a few years ago, I went through space, maybe I was, you know, when you go into courses, and you just want to do that techniques. Of course, I may have gone through a period of over utilizing Emaxs onlays, somethings I should have been a full crowns. I think I was doing Emaxs onlays. So I mean, another way of saying is that in too many situations, I was having to do deep margin elevation. And when that sort of sentence comes along, then you know, you may be over utilizing it. So before we come on to teach our listeners or educate them about what deep margin elevation is, and you’ll do much more, much better job of that. And I will do, we’ll just talk about just the indications in your books. What percentage of your posterior indirect work is lithium die silicate onlays as a as a sweeping statement, I guess? And what are your, what’s the ideal tooth to require an Emaxs onlays in your books versus At what point does that switch to a different type of restoration, crown? full veneer crown? Yeah. [Jason]
So I mean, we al learn at university the restorative cascade, so obviously, we’ve got direct resin, amalgam maybe. And then we’ve got an onlay and then we’ve got a crown. When you switch from doing a direct resin to a ceramic onlay, well, really when you’ve lost maybe a couple of marginal ridges, because the marginal ridges hold the tooth together a little bit like the rings on a barrel. We call that the peripheral rim theory. Basically the enamel around the periphery of the tooth, it can be used on still marginal ridge at other rings on a barrel and it stops the cusps from spreading out. When you load it when you buy time. When you lose that, the cusp could be more and you’re more likely to fracture it. The other thing to take on board is the amount of dentine underneath the cusps. So what we do is We measure the thickness of the cups. In other words, we take out the existing restoration, remove the caries. And then we use some calipers something like an Iwanson gauge would be good. So thing you might measure crown thicknesses with and just measure at the base of the cavity to the outside of the tooth. And what we’re looking for is a thickness of three millimeters or more. So is there’s a bit more to it. But there’s a basic for two slots to marginal ridges. And the cusp bases are three millimeters or less than you should if you’re doing an onlay [Jaz]
Just on that point, Jason because I’ve seen some photos on social media where Dentists have removed the restoration, remove the caries and then they get in there once engage out and they’re measuring the the cusp thickness but they might they might be measuring the wrong part of the tooth. So you’ve made it measured a good point, then, you know, you’re measuring the base of the cavity where if someone’s gonna, some people are measuring, you know, the higher, you know, the actual coronal part where it might be one and a half millimeters, but that’s supported by that three millimeters base. So is that a point worth exploring? [Jason]
It is. really the base of the cavity. But it is only really important when you go beyond the kind of half the depth of the crown of the tooth. Do you follow me? Because if you’ve got if you’ve got a quite a shallow cavity, maybe a millimeter and a half depth, you just reached maybe one two millimeters deep and you’re barely reaching into dentine and you’ve got thing cusps, you may not need to do an onlay in that case, because of the height of the height of their residual cusp comes into action as well. So it’s basically a whole day lecture on biomechanics cover or [Jaz]
Absolutely. Fine. So you decided, Okay, so if you’ve got like an MOD situation and your cusp is looking a bit thin, and you’ve measured it, at that point, you’re looking to go for the onlay, but then what makes an onlay into the crown is what I like to [Jason]
Yes, so, an onlay is retained, conventionally with a gold onlay, we have our retention form, which is parallel walls, near parallel or 6-20 degree taper. Potholes, maybe grooves, something like [inaudible] made show, one you may have seen on Facebook this are very, very obvious retentive features. And that’s because those restorations don’t adhesive. Nowadays, with adhesive restoration ceramic onlays, we use extra enamel as a retentive feature. So what we’re looking for is to have a decent amount of good quality enamel to bond to. So what we don’t want to do and what I see quite commonly on Facebook, for example, is people doing an onlay when they have a mesial cavity that’s on dentine, distal cavity that’s on dentine, and then a class five, so perhaps about 270 degrees on the margin is dentine that’s probably not a very good risk for an onlay. What we’re looking for is a decent thickness. There’s no research to tell us what the decent thickness is, but a decent thickness of good quality enamel. And if you don’t have that, then maybe you should think about being a crown and using standard potential resistance form parallel walls and taper to retain that. So that’s your decision making process, really. When I was younger, as you kind of alluded to maybe about, oh, about 10 years ago, I was doing onlays on everything and saving everything. And what it found was if you don’t have a reasonable amount of enamel, there’s no data on that, but perhaps about 270 degrees of the tooth is enamel. They come off at about three or four year down the line. So for that reason, we do crowns with those, because it’s a crown. [Jaz]
Fine. And I’ve got two questions based on that then what I mean is deep margin elevation, something that you’re doing a lot of nowadays in terms of your posterior restorations, or is that something that you really are doing on rare occasions, but it’s good to have like a trick up your sleeve. And then you can also explain about DMV to our listeners as well. [Jason]
Okay, so DME is well, it’s kind of heresy really. I mean, when I trained we which was late 80s, early 90s. We were sort of taught to finish on sound dentine or sound enamel and if you didn’t finish on sound enamel is a problem. So nowadays with an adhesive restoration, what you can do is particularly in the mesial distal box, you can fill the mesial distal box and in a conventional way with direct resin and then you finish your ceramic margin on that correct resin. And that’s called gingival margin elevation or nowadays deep margin elevation. I do it quite a lot, but I do quite a lot onlays so but as a percentage of the onlay as I do I, I wouldn’t say I do it a massive amount, because often if you lost a lot of enamel for the reasons I discussed earlier, you’ve probably got to do crown. Yeah, I think again, it’s probably over utilized. The other problem with it is, the idea of deep margin elevation is to elevate the margin out of the sulcus. So what you’re doing is you’re dealing with a tooth that has usually mesial, or distal caries in the mesial distal box within the sulcus, but it isn’t breaching the epithelium and it isn’t breaching the connective tissue. So you do the margin elevation to raise your margins supragingivally. And the reason why you do that is because when you come back to the patient’s cementation, a couple of weeks later, I don’t know, 2-3 weeks later, you can isolate more easily with rubberdam. Because the margin is supragingival. That’s the advantage of doing the gingival margin our deep margin elevation. However, nowadays, quite a lot of people are using the margin elevation to deal with biological width invasion. In other words, you’ve got caries which is breached [inaudible] in the connective tissue. And that’s good medicine really. Really those cases need to have surgery or something like that for extraction. [Jaz]
Yeah, absolutely. I’m glad you mentioned that. Because the next question I was going to ask you is in order to do deep margin elevation, what tissue management do you do, but I think what you’ve alluded to in that sentence is that actually, if you’re having to do a lot of gingivectomy then in that case, probably that’s not the right case, would you agree with that? [Jason]
Well, I usually end up using, I’m the old school I still use electrosurgery. But you usually have to do a tiny bit of electrosurgery just to get the bound on. And usually if the patients have caries within the sulcus, that usually got some degree of gingivitis in that area anyway, so often, there’s a little bit bleeding. So we do a little bit of electrosurgery usually just taking spaces. But if you finding your cutting with your like, you know, when you cut with electrosurgery and so going black and just something finding the bone, that’s probably a tooth that needs to go in a bucket or be crown lengthening, one or the other. [Jaz]
Right, let’s hold that thought for when we talk about verti preps later. Come on. So the next thing I want to ask you is about immediate dentals dentin sealing. If you can describe that for listeners, what IDS is. And do you still I mean, I know you’re taught it on your course I went a few years ago [Jason] Yeah. [Jaz]
Has there been any advancements in the literature suggests that actually, it’s not so much well worth doing or what are your thoughts on this? [Jason]
Well, IDS for Immediate Dentin Sealing basically classically, when you do ceramic prep to prep the tooth and then impress the tooth and then send the impression away for lab work, then the lab work would come back you would hybridize the dentin. So, you would etch, prime and bond the dentin then you would cement the onlay or crown with a veneer cement or heated composite, one or the other. Immediate Dentin Sealing is slightly different what you do is prep the tooth and then you etch, prime and bond the tooth prior to take an impression. And then you take the impression of the practice which has been etched, primed and bonded, get the onlay fabricated or crowd and then the crown onlay comes back and you’re cemented that. It does offer some advantages, higher bond strengths, sealing of the dentinal tubules so you get less sensitivity etc. So yes, it’s kind of funny because I do it all the time when I do my onlays because commonly when I do my onlays, I block out all the undercuts anyway. So I have to etch, prime and bond so I kind of do it. When I do my crowns, most of my crowns are vertical. So I cement them conventionally with resin modified glass ionomer so I don’t bother with immediate dentin sealing. And I also don’t bother with them anymore with veneers because most of my veneers are now mainly in enamel. So there’s no point because by definition immediate dentin sealing is no guarantee so [Jaz]
Okay, so an Emax onlays you are obviously because it makes sense because you’re when you’re blocking the undercuts with resin, it just makes sense when most of them [Jason] but you’re going to do it anyway. [Jaz] Yeah, that makes absolute sense. What I think you’ve touched on is ready. But are there any common mistakes that you see dentists make either with immediate dentin sealing or with Emaxs onlays in terms of case selection or execution. [Jason]
In case selection we’ve talked about quite a bit. I’m not a massive fan of the flat onlay preparation. I like to see I used to do those again a while ago. But there is a concept called [forms first the band], which means that if you give a little bit of a resistance form, if you cut into box form a little bit of a different height in the preparation, you get more resistance format. And when you bite on the tooth, it stops the onlay from twisting on the tooth. And it reduces the amount of stress the bond is under, therefore the onlay tends to stay on better. [Jaz]
Yep, that’s certainly what you taught me at your course. And that’s why I’ve been doing another thing. It’s just more for the benefit of the listeners. But when I place the onlay on, it’s nice to have that resistance form that is not going to be twisting around, it’s got that positive seat. Yeah, might not have some retention, because it’s gonna be getting the retention from the resin cement. But it’s nice to have that resistance form. So I’m a believer in that. And in terms of thickness, what you taught me at the course was two millimeters thickness of lithium silicate. Are you still following that? And how about in cases where you may, for example, if you are increasing the vertical dimension, and you are able to add, additively posteriorly, can you go down to a millimeter? If you’re let’s say bonding to virgin or near virgin enamel? [Jason]
Yes, is the answer. I think the guidelines are somewhere about 1.8. We do 2 because 2 is enough. Basically, if you’ve got a tooth that is pretty much intact, in other words, it hasn’t got an MOD cavity. The enamel covering the two thirds remaining, which you might get, in quite rare cases usually wear cases or erosive wear cases would be quite common. So the patient has a virgin tooth, which may have some enamel wear but the majority of the enamel is left. The enamel covering the tooth gives the tooth some rigidity. Because enamel is a rigid material. So when you bite on that tooth, it doesn’t bend and flex so much. In comparison, if you have a tooth that has an MOD cavity when you bite on it because it’s lost that peripheral rim which I talked about right at the beginning the tooth bends or flexes more. Now because with a tooth that has all the enamel remaining isn’t bending and flexing so much you can put onto that a thinner onlay because the onlay is better supported. It’s a little bit like laying paving slabs on to hardcore rather than on to sand. If you lay on too hardcore, which is a firmer base, that are much less likely to crack if you put it on sound that’s more likely to crack. So if those, if you have in those unusual cases or the enamel remaining, you can actually go down to a millimeter on the cusps at 0.7 in the fissures that the researchers by Matthias Kern in Germany. [Jaz] All right. [Jason] So there you go. So you can open the vertical with less distance. Some people now get down to 0.3 and I think it’s possible but it’s hazardous. I think if you stick around one it’s for the average GPS [Jaz]
and anteriorly we’ll see that’s completely different to Emaxs onlays and whatnot anteriorly for veneers is that where you can go contact lens thin quite thin anteriorly or is that, are we still using lithium disilicate in those cases if we’re going ultra thin? [Jason]
To be honest, if we go ultra thin I go stacked feldspathic veneers because there’s no substructure in it so you get a better aesthetic. But if you go below 0.3 you tend to get fractures. My findings were I got quite a few fractures in the box when they’ve been sent to me. And then quite a few fractures on the seating and then quite a few fractures after sitting out for 24-48 hour period. I think if you can push them up to 0.5 it’s a lot safer and you just make your life much easier. I mean, 0.3, 0.5 is a huge difference. But there’s a massive difference in predictability, just by jumping that 0.2 millimeters. [Jaz]
Brilliant. One more thing that you taught me, which I think a lot of dentists may not appreciate or know about was and something I started to request on my lab docket was exactly which [Jason] which ingot? [Jaz] Yeah, which ingot of lithium disilicate to use. So, you know, you taught me about HO, MO, MT, LT. So no low translucency, medium translucency. So, did you mind just doing a quick recommendation for mostly on posterior onlays, which ingot would you recommend in which scenarios? [Jason]
Okay, so, here we’re talking about Emaxs, which is an Ivoclar product, which is what most people do whether they use, whether they realize it or not. And it comes in varying translucency, HT, high translucency being the most translucent, and HO, high opacity being the most least translucent. So you would tend to use the HT when you’re replacing enamel. So that would be a good solution for a very thin veneer. There are some other ingots, which may be a good option for that as well. Most people, whether they realize it or not, tend to get the LT which is a next one up, low translucency. The reason is because it’s easier to use in the lab. So the lab technician, if the dentist doesn’t ask for a certain ingot that’s probably the one they’re going to get. The HO is used where you need a really high opacity situation where you’ve got maybe a discolored core, maybe a metal post, or maybe an implant to block out discoloration. But I don’t tend to use that very much because I tend to do full crowns, when I do full crowns I used [inaudible] So I don’t tend to use Emaxs in that situation. The other ingot, the medium opacity, which is kind of in the middle. We use when we’re doing Emaxs crowns. And this might be a situation where you’re doing crowns on the teeth that you can bond them. In other words, there’s an enamel margin. So we may do Emaxs crowns and bond them. But some people may have noticed Emaxs can look good in the mouth. And then when you photograph it looks great. You’ve been noticed that? [Jaz] Yeah, I have [Jason] Occasionally. And that’s not a problem with the material. It’s actually a problem with materials selection. So if you use the LT ingot, it’s a little bit more translucent. So if you make the whole crown with an LT ingot, it tends to look gray. Whereas if you make the whole part of the crown with the MO ingot, which is less transfers and more opaque, and then layer over it, you don’t have the frame. So that’s just a little tip if you do full crown, not always for veneers, although sometimes we do veneers with MO as well. If you got somebody who has got discoloration, tetracycline maybe or one discolored [inaudible] teeth, or they want a particularly bright kind of Hollywood smile, that might be a good indication to the CMA. [Jaz]
That’s important because when I do speak to dentists, and it you know, we’re discussing about which prescription of, you know, lithium disilicate ingot for, they don’t really appreciate. And that’s something that was unique about your course that you went through in good detail about that. So [Jason]
On the Ivoclar website if you have a look, [Jaz]
Jason, we all know no one has time to read nowadays. This is why we need you. [Jason]
It’s not on Facebook, though. I think it’s on. [Jaz]
It’s not on Facebook, it’s not going to get absorbed. Awesome. We’ve covered Emaxs onlays. Now to get to the sort of the main fashion trend over the last couple of years, which is vertical preparations, verti preps and I love that title of your course. I think I saw it was vertical preparation. It was old tricks for new dogs? [Jason]
Yeah. Because it’s not new. [Jaz]
Yeah, absolutely. And when I read in to it Holy crap, you know, this has been like from the 70s right? [Jason]
Earlier. way. You know, it’s all very fashionable now. But guys, particularly in Italy have been doing it since the 70s. Definitely, and maybe the 60s. So really nothing new. [Jaz]
Yeah, when I saw it first on Facebook, and let’s be honest, that’s where I saw it first. And then I went on to read the paper by Loi, which, you know, a lot of people who will see on Facebook, they won’t then actually go search for lithium. I thought, No, no, I gotta read up more about this. I went to read the Loi paper, is a brilliant paper. And in fact, I’ll put the link on my blog page for the Loi paper for those who want to read it. So that’d be a good thing to do. All right, a reminder. So you mentioned that most of the crowns that you’re placing nowadays are vertical. Was that, were you also doing that 10 years ago, five years ago? Is this a shift that you’ve made as well? And why have you made that shift? And now let’s talk about, can you educate because you know, a lot of people every time you see vertical preparations, or vertical crowns being post on Facebook, it’s still something new that we don’t get taught at dental school so people like, what is this doctor? Is it going to work? Is it going to fracture? Question mark, question mark, what the hell is a verti prep. So let’s get into that. [Jason]
Well, it’s nothing. It’s nothing new, really, it’s just a knife edge margin, really. So it’s actually the oldest form of margin because historically, we didn’t have very good handpieces we didn’t have very good burs. So we cut knife edges. Because we’re dentist, we’re lazy, it was easier. And then when the turbine came around in the 70s, and we put quality down on burs, we started cut chamfer margins because it’s easier to cut a chamfer margins, get a good aesthetic. And so the knife edge died out because you couldn’t get a good aesthetic with a ceramic margin on a knife edge. However, nowadays, we’ve got a Zirconia so you can finish Zirconia down to a very thin margin 0.3 millimeters. And it still has the attentional strength to cope with that. So nowadays, we can do a good quality durable margin with Zirconia. And actually, there’s quite a bit of research that shows you can do it with Emaxs as well, although I personally wouldn’t do with Emaxs because Zirconia is a little bit stronger. And I’m going to cement it anyway. I’m not going to bond this [Jaz]
subgingival, yeah. [Jason]
Yeah, exactly. So, you know, it’s kind of just been reinvented. But the thing that people are getting involved in now that’s slightly different is historically we used to spin a bur and round the tooth, there’s a paper by Ingraham, which you may know on “gingitage”, so you tape around the tooth and the tip of the bur would trough the sulcus as well. And then you impress that day. Whereas Loi’s paper, that you’ve read talks about how to condition the tissues, over usually a 40 day period. So you can take an impression at 40 days with really decent quality tissues. So I do quite a lot of vertical in my practices, really, because my patient base is quite old. And those patients in their 70s 80s have got crowns that were placed maybe in the 1980s 1990s, quite deep subgingival, quite broken down teeth. So I do the vertical because it helps me recover the margin. And also it’s more conservative. [Jaz]
Brilliant. Can you talk a bit about how you recover? So you’ve got an old crown that you’re dismantling which had a shoulder? How do you, What’s your protocol and converting that, now, old crown prep into a verti prep? [Jason]
Yes, so what we do is, it’s not always possible because if it’s really deep into the sulcus and it’s quite heavy shamfer or heavy shoulder, you can’t do this. But rather, when I first trained we start off with a crown with a prep margin and just made the margin a bit bigger, basically a bit deeper and it’s quite destructive. So nowadays, we do the exact opposite. What we do is take your crown off, clean it off, maybe air abraded and then etch, prime, bond, place regular composite, and then just prep on to the composite with vertical I will finish the margin on dentine. Often there’s quite a bit of core in the tooth and that’s not really a problem [Jaz]
Brilliant. The biggest issue I’ve had with the verti prep when I’m doing it is initially as a learning curve and I made this one want to get to is training your technician because a lot of technicians are uncomfortable so and then the technician I now work with an Oxford I’ve sort of had to encourage him and send him the Loi’s paper and you know some health diagrams and what we’re trying to achieve here and he’s done really well but the initial issue I had was that there was friction in seating these crowns, right? So then Jason I read this on Facebook look I’m so sorry. But then I read the actually the space that should be placed cervically. Is that the best way to do it? I mean, because I think that’s against the principles of what we’re taught, right? You know, you want a less base cervically, nice tight seal. So how do you train your technician to overcome the issue of sort of friction so that would prevent your crown from fully seating? And what is the role in dye spacer in this, if any? [Jason]
I think the first thing that will happen when you send the impression to the technician and [inaudible] for it, they’ll immediately call you and say, I can’t see a margin. That’s for somebody. And your answer should be Well, no. And that’s the whole point. And then you say to them, the technician will say to you, so where should I put the margin, and you say to them, you decide. And that’s like a whole different ballgame for technician because historically, with a linear margin, or, for example, margin, we’ve, as dentists of practice chamfer, or shoulder or shoulder with a chamfer, or whatever, we’ve defined where the margin wants to go. And the technician that has followed our direction, whereas the vertical, within limits, the technician can choose exactly where they want to put it to get the optimal aesthetic outcome. And that’s a bit of a game changer for a lot of technicians. Because commonly, particularly with things like for example, a diastema closure, or a discolored tooth, perhaps the technician with a standard chamfer the technician may call you and say actually, the margin is not really deep enough, I can’t get a good emergence profile, I can’t mask this discoloration. Whereas with vertical, they can just make it a bit deeper if they want. Obviously, you haven’t got to make it so deep that you get a biologic width invasion. But it gives the technician a lot of flexibility. So often, the interesting thing is you would imagine most technicians will be thrilled with that to be given the choice of where to put the margin, but actually quite a lot of them aren’t, they find it quite challenging, because you’re just throwing the ball into their court. And they’re not used to that. So you kind of have to, we, the technicians I work with, we choose to tweeners, where we’re going to put the budget. And it’s to give us the optimal aesthetics but without invading the tissues, usually about a maximum of 0.5 millimeters into the sulcus. But maybe palatally, it might be equigingival, just because it’s better for the tissues. So we didn’t touch on, which is a common error and a common mistake is technicians will then finish the margin down to a knife edge, or the ceramic and that’s when they break. I had a my mother I did one of my first vertical crowns on about seven, eight years ago. And it was an upper right first molar. And she had an endo problem. And the guy who builds those seven upper chest filled is good endodontist did her endo and Okay, I think he spent about three or four visits during the endo made a really nice job with the endo and all settle down. And then I decided I was going to do a vertical crown on it of the crown prep. I didn’t really know what I was doing to be honest. And I got my technician to finish the margin down to a knife edge. And she came in and tried it and look good, fitted well, good contacts. Nice occlusal scheme. I then fitted it because I didn’t space it well, hydrostatic pressure give a big halfmoon fracture on the palatal [Jaz]
Immediately? Then and there? [Jason]
Immediately. So I seated in with my thumb. I immediately hear that [breaking sound]. And I was like, Whoa shit, I’m going to get this out. So I’m trying to get this out with juicy crowns forceps not going anywhere. So there it was. But the reality is, what you should do is have about a 45 degree angle emergence profile on the crown a little bit like you might see on an implant and that technicians find, a lot of dentists actually have quite uncomfortable with that. And certainly a lot of technicians are you know, when I first started doing it, the technician would be saying “what we, shall just finish it right down? So it’s really nice and flush,” the answer’s no, the tissue reacts quite well to a 0.3 millimeter margin. With a 45 degree emergence profile, that’s a maximum of 0.5 millimeters into the sulcus just not a problem with that. And because he’s at 45 degree emergence profile, you get a degree of stress. So that’s something you need to teach your technicians. [Jaz]
That’s something I definitely take my teach my technician, you made me both very happy to learn that but also very, very nervous. [Jason]
Well, that’s just life happens on your mother or guaranteed relative [Jaz]
Yeah, absolutely. That’s a fantastic tip to get a train your technician to have that 45 degree bevel. So what about the overcoming the friction because obviously, by the nature of this verti preparations they’re going to be very tall and the taper is to your control. So they’re very vertical in nature. So there’s lots of friction. How can I overcome that? [Jason]
I think that a lot of the preps we see are under tapered. I think that’s a problem. I also think, actually, it’s not so much the fit, because to be honest, we talk a lot about dice facing, but let’s be honest, most of them is a Zirconia, and they’re milled, so they’re not going to fit perfectly anyway, a lot of the problem that you see, and I see this on cases, people show up when they show the model work, because they take the margin into the undercut, in the sulcus, and not many people discuss this, but if you’re not careful, you can scan into the undercut and you can work even if you impress the technicians gonna make a model scanner and then you’re gonna mill into the undercut. And then when you sit it, [Jaz] it’s not gonna sit, yeah. [Jason] It’s not going to sit and that’s a common problem. And not many people will take the time, what we do is, before we trim the die, either digitally or analog, we mark a line at a level of the tissue. And then we trim the dye. And then we mark another line at the maximum apical extent of the impression, bottom of the sulcus, give or take. And obviously, if we go above the line, above the gingival margin, there’s going to be, you’re going to have a visible margin. So you want to go below that. And obviously, if you go below the line to the bottom of the sulcus, you’re going to have a biologic width invasion. So you want to be above that. So you’ve got this kind of sweet spot between the two lines. But unless you’ve marked those lines before you trim the die, you’re gonna have a problem. There’s also a problem. It’s very difficult actually to prepare something particularly pre molars, upper fours and upper sixes into the furcation on the mesial of the upper four. And often on the distal of the upper six, it’s quite difficult to prep it to there without getting some degree of undercut. So sometimes you have to accept you’re going to be slightly supragingival there or going to destroy a lot of tooth. And that’s, I think, a lot of the time you need retention or try to tuck it in to try and get a better aesthetic. And that’s when they don’t sit. I don’t think [overlapping conversation] dice faces a bit of a red herring sometimes. Because they’re milled and whatever people tell you the milling process is quite accurate, but not, it’s not as accurate as the PFMs as we used to do. So I think it’s more margin position than dice facing to be quite honest. [Jaz]
Okay, so margin position and taper is the main take home point on that [Jason]
Taper. Yeah, if you look at, Well, there’s a lot of research on taper, I mean, Goodacre, the classic research on paper and they talk about somewhere between 6 and 20 degree taper, I would suggest a 20 degree taper for zirconia crowns, probably a good idea. Because if you don’t have a reasonable amount of taper on top TLC, you can’t see too because of the hydrostatic pressure. Of the cement. So for that reason, we, I would tend to taper as a Zirconia crown, vertical or a little bit more than I would taper for example, a PFM crown. I would tend towards that maybe 6 to 10 degree taper for PFM, personally, but maybe more like 20 for the Zirconia or vertical? [Jaz]
Okay, that makes perfect sense. And Yep, I am also thankfully following that as well, which is good. It’s always whenever you say something, I’m doing it. I’m like, so happy inside. So that’s good. Can you give us some tips on temporarization of vertical preparation. So the issue is that, yes, it’s so thin, you know, at the margin area that, you know, sometimes when I’m making a temporary, it can fracture. So what I’m doing actually is before I’m prepping sometimes I’m adding a bit of flowable to tooth to beef it up. And then in my index, I’ve got a thicker sort of temporary crown coming. Is that a good way? Is there a better way? [Jason]
It’s a really good way. No, no, if you just use some flowable I don’t like to mention brand or something like GC universal flow would be good because it’s the thing, heavier flowable. If you will just go around the margin and then when you take your PVS putty wash, for if you attempt that will work better. So I think we also use is upper four to four particularly I use those 3M Ion Crowns, which are the preformed plastic [inaudible]. Like shell crowns and you know, you’ve got the cost involved in buying those, but actually, it’s a lot faster. Anyway, it’s a faster procedure with one of those, you’ve got a lot less work to do and finishing them and mocking around with it. So we do that. Another thing we do is, if I’m doing multiple units, I just get lab temps. We get shell temps me so there’s a paper by a guy called Gregg Kinzer from experience shoot [inaudible] called the egg shell temporary technique. So what we do is we take about an impression of the patient’s teeth beforehand, we get a diagnostic wax up that’s processed, this is done to she now. Then we take the stent to that, putty stent to that and then a teeth prep. And then we fill that stent with some acrylic. And we see seated over the cracked teeth on the model. To do this, you need to be minimally prepped and we take it off and then thin out the inside of the egg as a crown till that eggshell thing, hence egg shell crown. And then we take out to the patient prep their teeth, and you can just fill that with snap or trim or something like that. [Jaz]
But not bis-acryl. It has to be acrylic, not bis-acryl? [Jason]
It could be bis-acryl but the problem with bis-acryl is snap set. So when you fill it with, and sometimes if you’re not on your toes, you have trouble getting it out. The other problem is it doesn’t trim so well. So when you trim the margin, it’s quite tricky to do the margin, I guess. So yeah, not bis-acryl. Generally, I just use snap for trimming something quite old fashioned drill. You get a those seated from pop it on and off. Particularly with multiple units, six or eight units, you want to be able to pop them on and off. So you get a good fit, but they don’t lock in place. [Jaz]
Is it true that the vertical crowns that come back, the reason that they’re not chipping in the margin where they’re so thin is because you need to have an adequate thickness occlusal thickness that may impart the strength to the crown? Is it? Am I making sense there? [Jason] No. [Jaz] Okay. So [Jason]
It’s the 45 degree angle, margin, that’s what makes them not break. If you see them right down. And again, this is a Facebook problem when you look at a lot of cases on Facebook and a lot of cases done by gurus on Facebook, the margins are correct. It’s usually that sinned right now. [Jaz]
Absolutely. I mean yeah [Jason]
Which is a problem. Yeah, you need, if you look at Loi’s paper this really nice pictures to show the emergence profiles, like a 45 degree angle, give or take 30-40 degree angle, and it’s quite a fit. So it’s almost an overhang. But it’s a thickness of tissue will tolerate. [Jaz]
Fine. And then speaking of gurus now, this can be controversial a bit. So. It’s gotta be done, Jason. Come on. You can’t mention much. And you know, this is, let’s have a respectful conversation. There’s a whole backbar, philosophies so if anyone who’s not familiar with this, there are you know, there’s the battbar is like an endo Z bur, if you like, diamond with a non cutting edge, and that can supposedly do your gingitage at the same time as prepping your feather edge if you like, whereas in Loi’s paper they use the is flame shaped burns, right? The thin flame shaped bur? [Jason]
862 or 863 for years [Jaz]
So tell us about, obviously, I know you like the 862s and 863s, but do you see any issues with using that bur? [Jason]Yes [Jaz] please tell us [Jason]
Well, first of all, I use the 862 or 863, undercut problems with using that, right? So I my hands off [Jaz] the wrong hands [Jason] in the wrong hands. And the problems are is basically a flame. And if you don’t hold it at the right angle or modify the angle, you can end up gouging the root. So when again, when I first started doing this, I was just picking up spinning around around looked like a great prep. And then on some of the cases, I’d end up being Perio surgery on them. So I prep them, put them on temps, and then I do perio surgery, either receptive or grafting. And when I raise the flap, all those roots look terrible, you know, the loads of dents in the roots. And that’s really due to poor bur angulation. Now, there’s a group called Tomorrow Tooth on Facebook. And I’m very friendly with Pasquale, who is the founder of it, he’s very good friend of mine in fact. He wants to give me some olive oil from his olive oil farm. Very, very good, very good. And they recognize that was and the other problem with the 863 or 862 is it’s quite tricky to prep a margin without getting an undercut just goes back to what we were saying before with seating issues or fracturing issues. So 862 and 863 are not without their difficulties. So they came up with batt, B-A-T-T to counteract this and it’s so much chunkier bur that I would agree in inexperienced, you’re much less likely to gouge your root. And you’re also much less likely to get an undercut, the problem is quite a fat bur. So you do a little bit more than gingitage to make a massive, whacking great trough all the way around the tooth. And if you look at the cases, there’s typically quite a lot of bleeding. So as soon as, if you just remove epithelium from the sulcus, you get tissue healing within about 7 to 14 days. And it’s pretty predictable. If you trough away a lot of connective tissue. Let’s be honest here, we’re all going to remove a bit of connective tissue, irrespective of how careful or how good and great we are. But if you remove a lot, the patients get more pain afterwards for sure, and healing is going to be a lot less predictable. So for that reason, I’m not a big fan of the battbur. However, the battbur has an advantage in such as it has a safe tip. In other words, the tip of it isn’t Diamond Coated. But you can and again, I’ll mention brands here from Meisinger, you can get an 863 with a safe tip. So I actually use a Meisinger 863 or 862 safe tip. So I get I’ve just actually putting the slides together for next year’s lectures. But that I’ve been using that for about 10 months now and I’m really sloughing off first time i’ve admitted it publicly. But that is kind of the best of both worlds. You’ve got a safe tip that doesn’t gouge, it’s a much finer bur. So in answer to your question, I think both techniques are have their disadvantages. [Jaz] Yep [Jason] Let’s say that [Jaz]
Which is why the sort of flame shaped with a non cutting edge makes so much sense. So that’s [Jason]
Because it’s a very slim bur, particularly if you use a 012, which is what I use is that’s 1.2 millimeter diameter rather than 016. Lot less tissue damage. It’s just a bit more sophisticated way of doing it. It’s a very well publicized bur, not many, I mean, I’ve been involved in writing the book, and I didn’t know anything about it. And I just kind of fell upon it when I was dealing with Meisinger. But it’s a nice book. [Jaz]
Brilliant. Now it’s a great tip. And I started using the 862, 863 like you advise. And then because I didn’t trust myself, I moved in the battbur. So the way I the way I prevent the way I sort of learned, prevent really destroying the gingiva is just packing lots of ptfe in the sulcus. And then that way I’m not destroying the sulcus and it can give, it makes a little stock for me. [Jason]
Yeah, but then that’s fine, but it takes time to prep the ptfe. So it’s time consuming, very time consuming, actually. And you’re not getting any gingitage which is the whole point of the procedure. [Jaz]
Yeah, I see it means so it essentially it all almost makes it a supragingival or equigingival technique by doing that, I appreciate that. [Jason]
And that’s probably very good for lower molar, you know, you have a knife edge finish is slightly equi or supragingival. On a lower molar, that’s fine. That’s gonna give you reasonable outcome. Look at the X ray, because you’ve got a notch and then you margin but on an upper central incisors, it’s gonna look like grey. I don’t think [Jaz]
You’re right. So everything I’ve been saying to fair, I haven’t done this technique anteriorly just because I mostly use it for premolar is fractured, maximizing ferrule posteriorly. Whereas I think you’re right to have the sort of tissue control and thing to wrap up on verti preps is, yeah, well, that was one of the main questions I wanted about verti prep. Is there anything else that you want to tell the listeners about vertical crowns? [Jason]
No. Well, I would suggest, and this is not advertising myself, I would suggest that you don’t learn off Facebook. [Jaz]
That’s a great advice. But I was gonna ask you actually just now, can you? You know, you want to do anything on vertical preparation? Can you please tell us about that? [Jason]
Yeah, we do. For various courses, we have a website. And I think the thing with the vertical is bur angulation, it’s really all about bur angulation whether you use batt bur, whether you use 863. You can’t really learn about bur angulation from pictures on Facebook. So you actually physically need to see it done, demonstrated, whether it be by me or whoever, you just make sure you actually see it done. And then actually do a course where you physically get some hands on component because actually, it’s quite tricky to do. It’s much better to learn on the plastic model, there’s no GDC involved in that. Nor is there’s bleeding, before you test out on a patient. So that would be my take, that message out that the fact that’s slightly in my lecture, download this technique on Facebook, because it’s something that’s tactile, and you really have to learn it by seeing really. [Jaz]
And if you don’t mind, I’ll put the website for your course on my blog along with all the other sort of things that you mentioned, I’ll put Loi’s paper, the egg shell technique, your website for your courses. When’s your next main course coming along? [Jason]
The course in Russia next week in Moscow [Jaz]
No for UK. So my listeners are UK based if they’re looking to come in Smithson [Jason]
I don’t even know. I think we got work coming up in about march in Glasgow. I think it’s my first few [Jaz]
Jason, thanks so much for coming on Protrusive Dental podcast. I know my podcast is quite clinically focused. So I’m going to try and put some supporting sort of information for our listeners. But if anything went above anyone’s head, please send in some questions if you’d like. In fact, that reminds me, someone did actually send in a question for you. I posted on Facebook, and you gonna come on the podcast. Are there any questions for you? The problem is it’s questions like you know, this question you could probably give lecture and I know you do lecture about this, like five days in a row about this one thing and he wants you to know about composites for free rehabilitations, and managing the occlusion, and I just don’t think you can satisfy. But if there was one tip that you could give to someone, just any random tip, I’ve got one tip in my head, I’ll give them as well. But is that, what would you say is the one tip, any sort of scope domain of have that sort of question? [Jason]
For wear, Steven begin with the end in mind. Too many people start wear case by slapping some opposite on her teeth. And really, what you need to do is take a step back and work out why they’ve got a problem. Work out where you want them to end up. And that usually involves having some deprogramming, and usually it’s some articulated models and usually the wax up. So actually, the composite is the least important, is the most important part is actually diagnostics and deciding where you’re going to go. So that’s the main message there otherwise, you’re gonna get really burned. [Jaz]
Brilliant, and one thing that Jason I’d like your opinion on this is something I do quite a bit it’s fun restoring a chipped or worn upper anterior region. And if I noticed that the lower anteriors are sharp and chipped and broken and I smooth the opposing sharp bits of enamel to get nice, flatter, rounded, opposing contacts to distribute the force better. Is that a valid approach? [Jason]
We call it incisal edge grooming. [overlappin conversation] Incisal edge manicure, it was called by David, oh gosh, there’s a guy I saw on dental town maybe 15, 20 years ago. [Jaz]
I love it. Incisal manicure. That’s fantastic [Jason]
Incisal manicure. It’s a soft flex disc about two or three minutes. But it makes a hell of a difference. [Jaz]
Yeah. So yeah, I mean, I’m doing this, but you’re happy that I’m doing this. And it’s a good thing too. I think it makes a difference in terms of education. [Jason]
And patients, you know, I say to patients, you know, because I think of basically touching my lower teeth, at the top is fix and say, Look, why don’t we just level these out and make them a lot prettier and a lot smoother on your tongue? It’s less of a soaring effect on your upper teeth. [Jaz] That’s a great way to put it. [Jason] Yeah. Because, you know, if I was having some upper centrals fixed in composite, and somebody starts banging away at my lower teeth, I’d be like, What’s he doing? So you’ve kind of got to some degree sell it, but it’s a positive thing. Most people sit up and go, Whoa, that feels better, you know, they don’t feel so sharp. But they didn’t realize it was sharp because it accommodates? So yeah. That’s good. [Jaz]
Brilliant. Thank you so much, Jason, really, really appreciate you having on. [Jason]
No, Jaz. Thank you very much.
Jaz’s Outro: So thank you, again, for listening all the way to the end. I’m sorry, if it was a bit echoey. Jason was recording it in a large room. So I’m hoping my editor managed to get rid of that echo, magically. But if it was still above echo there, I apologize. Not the usual crisp quality that people told me about. So next episode is with Kushal Gadhia, I’m not going to tell you the title, it’s going to be a funny one, it’s gonna be a good one, a very relevant for daily practice, but it is on the theme of occlusion. And it may or may not involve a certain joint. A lot of you’ve also been recommending guests to me that you think will be good. And I’m starting to contact them and everyone said yes, so far. So I’ve got a great lineup coming up. One thing I’m also very sort of forward thinking about, I suppose is, or rather I’m mindful of is that a lot of the speakers I’m having on, you know the beginning had lots of female speakers, which is awesome. Then I had lots of male and now it’s getting a bit male dominated. And I think there’s such great women in dentistry. So I’ve already contacted some really, really inspiring female dentists. Is that political correct? Female dentist? Women dentist? Women in dentistry. I think they have so much to offer. So that’s gonna be happening in my podcast future episodes as well. So please tune in. And I’m sorry, if there was any confusion about the sort of splint course I’m doing in Patcham. It’s actually two dates. So you can either come on the 1st of February, or the 29th of February. They’re both Saturdays so it’s not a two day course or a one day course. But if you want to come along, you can do just give me a DM, message me and I’ll send you the link that you need. And lastly, if you liked what you heard, and you want to go to one of Jason’s courses, I’m gonna put the link up in my blog post which will be on www.jaz.dental underneath this podcast episode, so you can go and went on this video prep course which I’ve been dying to get to. I can’t make the April dates, it’s my sister’s birthday, but hopefully we’ll do another one the UK if not I’m on heavy travel because you know I love mixing travel and dentistry, it’s tax deductible, holidays to me at the end of the day. So yeah, you could check that out and thank you so much for listening.
[…] If you enjoyed this episode, the do check out eMax Onlays and Vertipreps with Jason Smithson! […]
[…] you enjoyed this episode, you will love Emax Onlays and Vertipreps with Jason […]
[…] If you liked this episode, you will also enjoy the classic with Jason Smithson on eMax Onlays and Vertical preps! […]
[…] If you enjoyed this episode, check out eMax Onlays and Vertipreps […]
[…] If you want to learn more about vertical preparations check out eMax Onlays and Vertipreps with Dr Jason Smithson […]
[…] If you enjoyed this episode, you will love Myth Busting Occlusion and TMJ […]