Everything Veneers – PDP021

Main Interview: [Jaz] Marina, thank you so much for coming on the Protrusive Dental Podcast. It’s great to have you on. How are you?

[Manrina]
Yeah, really good. Thanks, Jaz.

[Jaz]
You’re always smiling. You’re always always always smiling and you got your most beautiful whitest teeth ever.

[Manrina]
I’m like promoting my own work.

[Jaz]
You have to, right? Because that’s exactly what you’re doing. You’re doing veneers. You’re doing cosmetic dentistry, and you know, you talk the talk, you walk the walk, right?

[Manrina]
Right. That’s exactly. It makes my job easy. Cuz my patients will come in and they’ll be like, Can you give me a smile like yours? I’m like, you know what I can. And that’s half the job done.

[Jaz]
Perfect. So tell to my listeners a little bit about yourself, about your journey and how you got into cosmetic dentistry and veneers in particular.

[Manrina]
So I have a really interesting career pathway. A really unusual one, I think. When I graduated from university, and at the time, it was VT. So I graduated in 2002. From Guys hospital, which is now Kings. And there was a job opening that came up for Harvey Nichols, first dentist. And they were asking, yeah, so they were asking for someone that was two years graduated, and someone that was five years graduated, like as a minimum requirement. And obviously, I just graduated, so I didn’t fulfill either of those. But in my VT group, everyone was like, Manrina, you have to apply for this like you are JHarvey Nichols’ dentist. It sounds like, Right, I’m gonna do it.

[Jaz]
So what made your group like affiliate you with that? I mean, it’s really flattering that everyone said that you’re the girl for this job. So that what is it about? Was it the sort of stuff that you were already interested in?

[Manrina]
So I think I’m quite fashion-y, like, I quite like my clothes and my fashion and, you know, interested in the way things look. And so that’s what people have always known me for at university, and then I guess, by the VT group as well. People always assume I’m wearing designer stuff, which I’m not necessarily but you know, I like to put things together in a certain way. And think about what I’m wearing, and maybe not repeat outfits too much. And certainly more so when I was younger, and maybe I’ve relaxed a little bit about it now. But I’m the same still now. Now when I go out, like I really enjoy dressing up and putting things together. And that comes from my mother. My mother’s exactly the same at her age. You know, she made sure that we were always coordinated, that you know, to like, you know, when we have had these long plaid, and our hair bands at the bottom bar plot would match our top boy shoes. So that’s just the way we were brought out.

[Jaz]
You know, Manrina, there is this certain questions. You never ask women, but I don’t think this is. I think I can ask you this, but please tell me if I’m wrong. How many?

[Manrina]
How many shoes?

[Jaz]
How many pairs of shoes do you own?

[Manrina]
Oh, yeah, I do. I couldn’t even count. I have shoe cupboards and shoe cupboards and shoe cupboards in my house. So yeah, there’s a lot of shoes, a lot of boots, and a lot of sandals. And yeah, a lot of heels every type in every color, and every brand.

[Jaz]
I messaged you a few weeks ago, and I said, Look, when I told my wife, she’s also a dentist. When I told my wife Manrina’s agreed to come on the podcast. She was like, “Oh, I might start listening to the podcast now.” [Manrina] Oh I loved it! Women power! [Jaz] So I’m gonna have to cut that bit out by the shoes, though. So cuz I don’t want her to get an ideas. So I’m so sorry. You were telling about your story about Harvey Nicks. So how did you get the job?

[Manrina]
Yeah, so that was Yeah. So just to go back. I also really love the way the amount of support I’ve got from women l through this journey. So that’s a classic example that was so beautiful of your wife to say that. And there’s been, I’ve been inundated with messages from women on social media since I released my course saying that, “Oh, great. So great to see a female educator.” And I think that’s really lovely as well. But anyway, so yeah, well, I’m sure we’ll come back to that. Let’s go back to my career pathway. So yeah, I fight this job that I was very unqualified, well, I had a dental degree, but that’s about it. And it was a bit of a process. So it was weird that I learned Ostler, which some of you may know or may not know, but it was really the first practice of its kind back in the day, the first Dental Spa in the UK. And the interview process, so I was shortlisted for this interview, and the interview process was an interview with the owner and the manager and written exam and we were given a recommended reading list of like five to seven cosmetic textbooks and then patient exam as well and they would then mark us on how the patient felt about being examined by us.

[Jaz]
That is like a high level interview. I mean, I haven’t you heard of an interview process quite like that? It’s pretty cool.

[Manrina]
But, you know, it was an opportunity of a lifetime like, you know, getting that job completely changed my life. I you know, it’s been such an amazing journey from there on in and I’m so grateful to Surinder for giving me the opportunity back then. So yeah, I think rightly so. That it was such a process because they were looking for the right person for it. And so, yeah, we did, I did the interview and Surinder and Surinder had known the manager at the time, like my personality, so they were like, Okay, so what one thing was to get shortlisted, and you know, and then do that interview. And then there was the written exam. And because I just come out of university, I was really used to reading textbooks and absorbing knowledge. So I went, you know, read all those textbooks, took it all in, took the exam and did really well in that. And then, with a new patient exam, you know, again, which I just come out of university. So we’ve been taught the gold standard way to do an exam and everything needed to be checked. So that’s the way that I did my exams. I hadn’t been sort of ruined by

[Jaz]
I haven’t like started taking shortcuts just yet. You haven’t cut corners. You’re doing things by the book.

[Manrina]
Yeah, exactly. So we did all that. And anyway, so yeah. And it was amazing. When I walked in all the shortlist of dentists, it was this beautiful clinic with this waiting room with all these beautiful dentists. I think, you know, you chosen a bunch of good looking people who had a dental degree, and then he chose from them to take the job according to those three stages that we went through. So it was really fortunate to get that job. And at the time, I told him, I was like, you know, I don’t have the qualifications, the experience that you asked for. And he was like, Well, you know, you’ve got the right load and the right personality. And as long as you’re keen to learn, I’ll teach you, I’ll teach you the dentistry. And that was it.

[Jaz]
It’s like a mentor to you.

[Manrina]
Such a mentor. And I think I really like the way that he was, I think it’s correct. I think, you know, if I ever open my own clinic, I’ll do the same thing. I’ll take on dentist, you have the right attitude, they don’t necessarily need to have all the skills yet. They just need to be willing to learn, you know, without ego, and I put the hard work in and I was fully there. I was like, yeah, I’ll work any hours. I’ll do anything. You know, you tell me to do work wise, I just want to learn. And it was never about money. It was always about just getting the experience and absorbing the knowledge. Cuz I wanted this so bad and I wanted to make him proud. And feel like he made the right decision.

[Jaz]
Perfect. And then from there, your cosmetic dentistry experience and your exposure through the mentorship grew and grew, I imagine.

[Manrina]
So that was 18 years ago. Yeah, that he took me on and then from there, obviously, you know, yeah, we were the first sort of Dental Spa in the country. And then we’re going to clinic in Harrods as well. So then he moved me from Harvey Nichols to Harrods, and then I was their first dentist. And then we got the TV show, 10 years younger. So at the time, there was no sky TV. And that used to air on channel four, eight o’clock every Thursday night. And it was only me and Surinder doing smile makeovers in the clinic. So it would be 200 new patients that would contact us every Friday morning, trying to book in to win those slot. And then between the two of us, we had to do all these smile makeovers. So I spent my 20s doing veneers, prepping veneers like, every day, and I would work till midnight, I would work weekends, you know, we had to get them in and I didn’t mind doing it. This was my protein it was where I was happy. And actually the way that clinic was, we were like family. So I felt like I was with family. We were all working together anyway, we had this aim to be the best and

[Jaz]
I totally get that vibe, Manrina, I get that vibe from your Instagram stories and the way you manage your patients and the way that you get you know, friendly in the right in a professional way. But you really, I can tell that you go the extra effort to make them feel comfortable. Definitely get that vibe. And the cases, the volume of cases you produce. Excellent veneer cases. The reason that when I thought okay, my listeners asked for a podcast episode about veneers I thought of you straight away. And of course you’re telling me your story about how many veneers you got to place so early on. And just reminds me of the 10,000 hour rule. You know, Malcolm Gladwell made it famous and you had such a lot of exposure to veneers. So that’s why I’m excited to the next half an hour or so to download as much knowledge as possible, that’s reasonable within half an hour through this podcast [Manrina] Lets’ do it! [Jaz] about veneers. So I obviously got a few, list a few questions for you. So let me start with question number one, which is probably the most common question I’ve come across with my fellow listeners is ceramic versus composite. We’ve seen composite veneers boom in the last maybe three years. I don’t know what it is. But suddenly everyone’s doing composite veneers now. You tend to from what I’ve seen on Instagram, you tend to place more porcelain veneers. What’s the conversation that you have with your patients? What’s your experience with ceramic versus composite veneers? And what would you advise?

[Manrina]
Yeah, so without a doubt, there’s been a massive boom. And there’s been a really big boom, actually, in younger patients, I feel like the older patients are still coming in and asking and happy to have porcelain. But the younger patients, there’s been a lot of scare tactics around porcelain. And people are really worried about their teeth being cut. And so they’re like, Can we do composite? Does that mean you don’t have to cut my teeth? And I think it’s a matter of a conversation, I think some people are suitable for composite bonding. And that’s fine. And I will do that in those cases. But if it’s a case that needs full labial coverage, then I would prefer to place porcelain, I think where there isn’t advantage to composite is a lot of people aren’t very confident with porcelain veneers. And so perhaps they’re over prepping them, or they’re worried that their porcelain veneers will fall off. And so they’re prepping tooth for crowns, as opposed to veneers. And so there’s some quite heavy preps going on with them. And so I understand, you know, what, why patients would want it and the risks associated with that. However, if a small modification is done correctly, and you know, the lab I’ve been working with them for 18 years, they now make me these beautiful Emaxs, I use Emaxs veneers. And they can be 0.3 of a millimeter thick. So they’re very, very thin, and they’re very strong and very beautiful. So where you’re broadening the smile quite often on the on the premolars, on the side of the smile, there’s, no prep, I just prep a margin and stick these veneers on. So there’s no risk associated with that, or very low risk associated with that. And in areas that I maybe do need to prep, then I’ll encourage my patients to have pre alignment first. So I’ll align the teeth accordingly. So again, there’s very little prep needed. And because ortho has also evolved massively, it’s very quick and easy now to move to it’s not like the old age, you know, asking patients to wear brackets. And so there’s a really big take up with that. I don’t mind doing

[Jaz]
What percentage of your patients, would you say, have both an ortho-restorative treatment from you rather than purely restorative driven?

[Manrina]
Yeah, so percentage wise, most, I would say more than not, will have some sort of ortho first, even if it’s just a few clear aligners. So maybe I’d say 60-40 some patients come to me with already straight teeth, they’ve had ortho as a child, they may even still have retainers on. And then that they’re having that they you know, they’ve worn, they take teeth away because of grinding heavy. I mean, that’s a massive issue everywhere, but certainly in London. And so then the teeth are already straight. And then it’s not, really an issue

[Jaz]
I completely agree with. And that’s why I went on to study an ortho diploma because I figured out in while I like doing is tooth wear cases and big cases. And what I see is that I think yes, 60-70% of patients who need a rehabilitation would benefit from orthodontics, because it means you can do a more minimally invasive job. So you mentioned, obviously that, you know, if you’re only doing zero, in some cases doing 0.3 millimeters, and that’s going to be quite invasive, but what technique would you use? Because some you know, I’m assuming use the Gürel technique or whatever other, what techniques can you do to teach my listeners about how to be more minimal, because what you don’t want to do, as some Dentists have done and I know this is that they look they open up [schellenberg], and they see that Oh, and then you see prep 0.8 millimeters. And no matter what the position of teeth is, you’ll just prep 0.8 millimeters everywhere, which we know is not the right way to do but for those who are less experienced of veneers. Can you please explain your protocol?

[Manrina]
Yeah. [Jaz] that makes sense. [Manrina] So that’s Yeah, so I think it’s really important before you try and do something like this for your patient, it’s a cosmetic treatment that they don’t necessarily need to have, but they want to have, and it’s not something that you’re taught how to do at university. So it’s very important to go on some sort, of course, and learn how to do this properly, learn about wax ups, and how to set up a case and make sure that your work is going to last. And I know Michael’s again, the way that I taught it was that we do a wax up, stick impressions of the smile, design the new smile, get a wax up made of that, and then get a putty index made of wax up that can be placed in the mouth, over the teeth. So if the putty index just on the incisal edges of the teeth, and you place that in the mouth, and then from there, you can see which bits need to be removed, so that the veneer won’t, won’t stick out. And so that’s what we do with the delegates as you say and you look at it, and then you mark those areas. So you’re gonna something?

[Jaz]
No, no, no. So as you were saying that, I mean, I do that a lot, by the way. So hope doesn’t put you off. But so you’ve got the putty and I want to make it very tangible. So lots of learning points, lots of learning points in there. So you’ve got the putty index on, what is the typical labial reduction, which are the 0.3 millimeter cases and which are the 0.7 millimeter cases, how would you differentiate?

[Manrina]
You look at your putty index, and then you have a look at how much space you have labially and then you see if you have that sort of point. In a standard case, you have 0.3 millimeters and any way you don’t, or you would just remove the extra bit of soft tissues. So I mark it, and then you can remove it. And then you put the index in again, so that you can see that. So you can see you’ve taken off the excess. Now, also, there’s the bur. And actually, I’ve even got the number of the burs, so we’re just making a list,

[Jaz]
That’d be great. I mean, if you can read it out, and then I always put it in the blog post as well. That’d be great. My listeners love burcodes.

[Manrina]
I need to take you for walk though. So I would thake you for walk.

[Jaz]
Let’s go. Let’s go for a tour. Share Road. [Manrina] Yeah, there you go. Exactly. [Jaz] So obviously the bur aid you to prep the correct amount. So it’s like a guide, right?

[Manrina]
Yes, exactly. So we’ve got the 0.3 reduction. So the bur that I use, to prep with, so to actually prep my margins, I use the 6. So this is from, Komet. So the 6844.314.014 and also the .016 you’ll have to write that down. Because that’s

[Jaz]
So what I’ll do is at the exact moment that I play this bit, and people are watching this, magically, in my hand, the bur will appear over here. So but I’ll put that on. So when people need to contact Komet to buy it. So obviously, you know, I was explaining to my listeners, in my last episode, actually, or two episodes ago about how to interpret burcode. So the last four digits would mean how thick it is at the tip. So what you’re suggesting there is the 1.4 and the 1.6. But only part of that is the is it is yeah, is the diamond that’s cutting and then while using that bur, is it the one that’s like the Christmas tree shaped like it’s got little bits on, right? Like, it’s got a gap?

[Manrina]
Oh, yeah. So this is a prepper. So this is for doing the actual margins. So it’s just a straight bur. It’s just a straight bur. Right? Cool with a red o rgreen margin. But yeah, I was just looking at the list. And then it looks like, you know what I haven’t got. Haven’t got it written next to it. But I can

[Jaz]
Just send it to me. And I’ll put it on. So Manrina’s burs that she recommends. We’ll put that on post.

[Manrina]
Yeah, I know, I’m going to contact them and get this made as a bur kit. The problem is, it’s from dental directory and Komet from two different places. So I don’t know, I don’t know who’s going to make this bur kit for me.

[Jaz]
They’ll be fighting, they’ll be fighting to make a bur kit, Manrina.

[Manrina]
Fighting. Yeah, there you go. And so yeah, one of these two will be the depth reduction bur. But yeah, I’ll double check which one is and make sure I’m giving you the right number.

[Jaz]
Technique where once you’ve sort of made a temporary or once you’ve done a trial smile, then you prep and then you color it in, I see that being as a technique like you coloring with a pencil where it hasn’t been reduced enough. Is that something that you use?

[Manrina]
Yeah, so we use a pencil a lot. So first of all, when you put the putty index on, use a pencil to remove the bits that are jutting out, that stopped the index from sitting comfortably. And then you go ahead with this depth reduction bur and over, you know, on the areas. So on the premolars is where you can see there’s all, say that you’re broadening and you can see there’s already enough space, don’t even bother doing this before the cheat where you can see that you’re just at the margin at the putty margin. This is quite difficult to explain. Without having a visual

[Jaz]
Audio only have Yeah, I know. I mean, but try it. Try your best.

[Manrina]
Yeah. If it doesn’t make much sense, then yeah, I don’t know. Yeah.

[Jaz]
We’ll do some videos.

[Manrina]
Oh, yeah, we have to do a video. So, then you use the depth reduction bur you put it parallel to the tooth, you go across the labial surface. And then you take a pencil, and you mark the depth. And then you can make sure you prep until you remove the pencil and then you know, you’ve removed enough. But actually, again, on my course we do this two ways. So first of all, I showed them the Galip Gürel technique. So we’ll go through that as well. Should go through that now?

[Jaz]
What is Galip Gürel technique? And then what is the Manrina technique?

[Manrina]
Yeah, exactly. So in the Manrina technique is the one that I just told you. That’s how typically, I will do it, I will use the putty index. So I will take my putty index, I’ll cut it to the incisal I place it over the teeth, I’ll mark where I need to reduce. And then I’ll just go through eyeballing and reducing where I need to. But Originally, I used to do it Galip’s way. The reason why I stopped doing that is because I think it’s really good aid initially, but sometimes it can mean that when you put the actual temporaries on they’re not as smooth as they are when you’re using the stent for the first time. Because I think you need a bit of resin stays on this stent And so yeah, just for the sake of that but but as a learning aid. It’s really good, really good technique. So the way that works is when you do your setup, so you have your wax up done, you design your wax up, you have it created, you have this incisal index made, and you also get a temporary stent made so that you can place your temporaries. So at the beginning of the appointment, actually, I think there might still be some benefit here to putting the incisal index on and still removing the extra bits that you can see, obviously jot out, if there are those bits, hopefully you’ve done your pre alignment and there aren’t issues, then you fill the stent with temporary materials. So that would be ProTemp or Luxatemp, or whatever brand you decide to use. And then you pop that in the mouth, and those stents can be in any color. And then you take this depth reduction bur, you hold it flat against the tooth, and you put your your depth marks through the temporary, then you take your pencil, you mark the depth marks, just as we talked about doing this now on the tooth, and then you peel off the temporary. And you see whether any of those pencil marks actually mark your teeth. And actually, I think when we did that just when I did it just now on my course for the patient we were doing there, I’ve made, we may have got one little pencil mark, like most of the teeth that need any prep, which is really interesting, because then suddenly, you’re like, Oh, I would have gone ahead with the depth bur and cut all of these away. And actually there was no need to get to the final result that we’re wanting.

[Jaz]
So a lot of these areas are going to be additive and through the wax up. And a lot of these are therefore very minimal. So that’s the way to do it. Rather than just going around prepping an arbitrary number. You got to begin with the end in mind, like you said, with the wax up control process, the only question that comes to my mind is, how do you factor in a tooth that might be slightly more discolored? So let’s say a darker central incisor or let’s say the scenario where they’re all dark teeth, or the other scenario, which is very annoying is when actually one tooth is darker. Can you talk, tell us about how you would treat a veneer case any differently in your hands?

[Manrina]
Yeah. Oh, no, of course. Yeah. So you’d have to prep, you’d have to prep much deeper. And actually, within the depth reduction burs, we have a 0.3 millimeter and a 0.5 millimeter depth reduction bur, so that we can prep a little bit further. And you may even want to prep a little further than that, to be honest. And it depends how you decide you want to tackle the case, you may decide that if it’s a full tetracycline case, for example, it’s all quite dark, your prep is all a little bit heavier. So you’re looking at least 0.5 millimeter reduction, maybe even a little bit more than that, to be honest. Looking at I mean, I can’t give you an exact amount, but I would you put 0.5 and let go a little bit further with it. So that the lab have got space to place the layers to mask out the depth of color. But if it’s a single tooth, or if it’s just isolated areas that are quite dark for some reason, then I’ll prep just that area deeper. And I’ll mask the darkness with a composite so with a quite a opaque.

[Jaz]
Okay, like something like the pink opaque, like that sort of stuff? Or like resin?

[Manrina]
Yeah, it’s just an opaque composite. So within my set of my Venus Pearl composites, which is what I’m using at the moment. Yeah, there’s some a opaque, pacifiers or opaquers? So I take quite an opaque shade, and just stick that on. So that I’ve done the job for the lab, and then they’re not masking any

[Jaz]
But more importantly, what the lab get is a cast. Right? So tell us about your documentation, which then aids the color and which percentage of patients are you actually sending to the lab to actually get some, you know, custom shade match? Or is it all mostly through photography and your relationship with your laboratories?

[Manrina]
Yeah, so for a smile makeover, so anything actually usually even just for four units, or, and more than that, so 4, 6, 8, 10 whatever, 20, 24 whatever, it will be through my own. I’ll take the records myself, and I’ll let the lab know what it is that I want. But for majority, if not all, 99% of single centrals I’ll send them to the lab.

[Jaz]
Okay, perfect. But then the photos you’re sending tells the laboratory the starting shade, or the dye shade, as you wanna call it stumps, shades used to be called so that the lab know exactly what color they started with. Right? [Manrina] So they have all the information. [Jaz] What’s the most popular shade that patients and yourself in the patient select in your clinic? [Manrina] BL3 three [Jaz] Is that the whitest or BL4 or what?

[Manrina]
BL1 is the whitest. So I always tell my, you know, my patients quite often will come in and then I’ll be like, we’re gonna do these in BL3 because BL3 is my favorite. And they’ll be like, okay, let’s have a look. And then you know, they’ll always pick up BL1 and be like, ‘Can we do this color?’ And I always tell them the story that you know, I done over 10,000 ceramics in my, 10,000 veneer in my career, and within that I’ve already done two cases in BL1. And one of them, she came, had the teeth done pay be 15 grand, insisted on having the done on BL1. I was like, ‘Don’t do it. Don’t do it don’t do it.’ And she was like, ‘No, no, no, this is what I want to do.’ So at the end fine, we did them the BL1. And she came back the following year, as say ‘You were right, they’re too light’ Had been redone in A2. And that’s been another 15 grand to do it

[Jaz]
It’s like to go from BL1 to A2 is a significant jump

[Manrina]
Yeah, like she knew that they were too white. She hated them so much that she was like, just give me, then there was another argument, right? Because I’m like, at least let’s do B1. An A2 and I showed pictures of that case, again on my course because it’s just an intersting one.

[Jaz]
Awesome. That is a great learning point, you know, about communication. Really good.

[Manrina]
Most of them do. To be honest. Most of they start saying they’ll be on BL1. And by the end of the conversation, they’re like, okay, I’ll trust you on this. Let’s do BL3. And BL3 is a great color.

[Jaz]
Before but some levels they’ll say what shade Are you but then I was also gonna ask you what shader Simon Cowell? [Manira] Yeah, probably a BL1. [Jaz] Okay, did you use that example? No one wants to have teeth like Simon Cowell.

[Manrina]
Some do. Yeah, they’ll say, Oh, don’t make me look like Simon Cowell. And then they’ll like pick up a piece of paper and be like, Oh, can we do in this color? I want to look like him. Also has to do with the anatomy. And so you could get away with like a much whiter color. If you put the correct anatomy in. And that’s something really important to understand with the patient. You know, some people will say, don’t ask your patients Oh, it’s so annoying when patients, send in pictures of celebrities. Because how are you going to make them look like a celebrity. Whereas I always ask my patients to do that. I send you pictures of smiles that you like, because it gives me an idea about their vibe, whether sometimes what they say and what they actually want doesn’t correlate. So once they send pictures. I’m like, okay, that’s a good one

[Jaz]
Interesting. Okay, I see what you mean there. Very good. The next thing I want to ask then is, do you follow an occlusion camp like some people are like following like Pankey or Dawson? People know what I think and whatnot. But what Well, how do you manage the cases where you have got tooth wear people are parafunctioning or bruxing, so you need to be a little bit smarter about the way you design the occlusion. Particularly if you’re placing lower veneers, because that’s taken the sort of including, you know, the whole guidance involved in the fact that the sort of the forces going on a lower veneer is quite different to what goes on upper veneer. So how do you manage just a few points about occlusion management with your veneer cases?

[Manrina]
Yeah, so I’m really big on occlusion. I teach occlusion to the DFTs every year in the VT scheme. And that’s always scary, scary how little they know. But yeah, I did the Dawson courses over three years in Florida, back in the day, like 2004 to 2007. And

[Jaz]
That’s so much more glamorous, you went to Florida and I have to go to the Wirral

[Manrina]
I love that though, Ian Buckle. So I studied aesthetic advantage with Larry Rosen style. And, you know, Ian was studying at the same time as me, so I got to know him back then in 2004. And then, you know, at the time, we were both learning all these things, and yeah, he was learning it at Dawson and I was learning about Dawson and then obviously, he went on to teach it. And I always recommend people who ask me about please go to the Wirral and learn with him because I think that’s a really good course.

[Jaz]
A great story. I never knew that you and Ian sort of went to the same place to learn. That is so cool. Honestly. You need to send Ian some of the cream that you use though. You need to send Ian some of the moisturizers. Sorry, Ian, I love you really, mate I’m gonna see you in March. I’m seeing you like I’m doing the Dawson Academy at the moment the Wirral at the moment. So I’m seeing Ian in March and he’s probably gonna kick my ass for if he listen to this, so hopefully he won’t. But anyway, so you did the Dawson in Florida. Is that with Pete Dawson himself?

[Manrina]
Yeah, exactly. So Karina was teaching us and Pete Dawson was around by 10 he gave me He gave me odd lecture. And actually, oh my God, I’ve got this book. Like, right here. As I was referring to it, yeah, for some slides that I was waiting for my course. So yeah, so that’s my thought. That’s where my learning is from. And occlusions must be important because I can’t have my my veneers fail. And so I’m not worried about my veneers debonding, they’re not going to debond and the technique that I use, they show recent studies have shown that you can hang a man off the veneer and it won’t debond. So that’s not my concern. My concern is patience breaking their veneers and anything that can break. Exactly. Anything that will break a tooth will break your veneers. That’s what I tell them. So I’m like You know, you’re grinding habit, the reason your teeth already worn is because of this habit that we need to control. And we need to reset your bite as it should be. And also obviously biting fingernails and eating peanuts, opening packets with teeth, opening bottles with teeth, and all these other things, that’s a conversation that we always have. But my patients always restored in canine guidance. And we look so we check that it’s the canines that are taking the load on their lateral excursions, and we have a look at protrusive and we check that the bite is set up correctly, but also, if they’re grinding on their back, so Okay, 85% of my patients grind their teeth. And that’s because people in London grind their teeth like [Jaz] 100% agreed [Manrina] stressful, right? Crossing the road is stressful, getting on the tube is stressful. These people, everyone’s stressed, I grind my teeth. You know what I’m working, I love my job but when I prep [Jaz] I do big time. [Manrina] Yeah, I clench release, so my nurse will see me doing it. And actually, I Botox my masseters because I had this really quite square face from my grinding habit. And so yeah, I stopped some Botox in there

[Jaz]
So tell me, just on that point, do you feel like a reduction in your bite force?

[Manrina]
Yeah, of course, it’s massive, massively reduced. So I can eat and drink as normal. But I used to eat packs of nuts. Like I would just empty out a whole pack of nut which was too many nuts, right? So it wasn’t, this is what I tell my patients and that you can’t eat a pack of nuts, after I Botox your masseters. But you can eat a few nuts, which is all you should be eating anyway. So now when I tried to do that, my masseter gets tired. And I stopped, I have a few and I stopped

[Jaz]
Interested, so the feeling is that after a few nuts, you get tired.

[Manrina]
Yeah. And that’s why I’m not grinding as well. So I go to grind, and then I’m tired, and then I stop. So I feel like I’m going off course. So good to go. Yeah, so the reason, we look at patients, and they either grind on their back teeth, or they grind on their front teeth, you know, they have all of these strange habits, some just grind of one side. And you want to have a look at what that habit is and look at the wear pattern and try and work out what it is that they’re doing. And then you want to try and manage that habit for them. So if they are not just clenching really nicely, and it’s not really nice, it’s really bad on their molars and cracking all of them, then it will be because there’s a prematurity back there. So there’s something that’s uncomfortable for them to bite on at the back. And so in that case, I know that I want to equilibrate them, so that if they are going to continue with this grinding habit, and they’re not going to follow protocol and wear their night guard or put Botox, their masseters or the other things that we’ll discuss, then at least they’re grinding on their back teeth. So there’s bigger teeth to take the force, rather than them trying to break the porcelain work that I put in their mouth. So yeah, a lot of my patients get equilibrated

[Jaz]
So you’re taking the loads in your case, you’re taking the loads away from the anteriors from for your veneers. But then all of your veneer patients are given a splint or a retainer or you know, or not really or it depends

[Manrina]
Yes, so the majority, the vast majority of them all, and some of them will refuse it because they say I’m not going to use it. And in those cases, I’ll usually give them one anyway. And then I might just give it free of charge and just say, at least I felt like I’ve given it to you, but then I’m aware that they’re not going to use it. And then we have a further conversation about what we’re going to do about that. So yeah, potentially, it’s very toxic the masseters, which is really appealing to women, and so a lot of them, you know, will do that as part of their treatment plan. But for some of the men, because it’s slimming for your face, you know, they want their big jaw. And so they you know, they didn’t want to do that. And so then add to check where those loads are going. And what I also want to do for a lot of them, is show the pictures of really horrible wear cases and tell them, you know, this is the sort of thing that I see every day. That’s why I’m paranoid about eating my enamel. It never grows back. And so I wear my night guard every night doesn’t matter what time I go to bed, or you know what I’ve been doing, I will go and I’ll put that in, because I’m paranoid about it. So I would like you to be paranoid about it, too. And show them why. And equally for this ironic work is that you’ve got this beautiful smile now. You haven’t loved your smile, you haven’t looked off it brilliantly. But now you love it. And it’s very expensive. So if you love it, look after it. And you’re gonna have to wear this to sleep. And to be fair, the majority of the will give in, ‘Okay, Manrina’ Yeah!

[Jaz]
That was amazing. That whole minute, that’s gonna be my opening snippet of the podcast. I really like that. I’m gonna, like memorize exactly word for word and say to my patients, just like that. That was that. I really like that. Thank you for sharing that.

[Manrina]
I feel like I should like record and press play because I have so many like me record,

[Jaz]
You know, it’s patient communication. That’s the crux of it. So you know, you said to the patient that you know, I want you to be paranoid like I am. I really like that. So tell me about let’s talk about some Patient Management. Moving away from the tooth slightly might come back to it but patients who come and ask for veneers, okay, they can be character sometimes. Let’s call it, right? Some of them may even have body dysmorphia, which is a real problem nowadays. Do you ever encounter difficult characters? The kind that, you know, the expectations are so high that it’s not even real, like no matter what job you do, what they’re after is is just never gonna happen. And it’s difficult to make it tangible, because every case is different. But do you see what I mean? I mean, some people call them crazies, or whatever. But there is a group of people that, you know, I would get nervous to treat. So do you get patients like that? Not because you don’t feel that you have the right skills because obviously, you place so many units, but it’s just that their expectations are just something else.

[Manrina]
Yeah, so you know, again, I talk about this on my course, I don’t have that issue very often. And I think it’s because I’ve been in high end, cosmetic dental treatments, my whole career. You know, that’s all I’ve known since I graduated. So at [London] where started, it was known for being the most expensive clinic in the country. And the reason that people came to us were because we were the most expensive, and they showed off about it over dinner. And so that in itself attracts a certain type of patient that’s looking for the most expensive clinic. And so I started off with that type of patient, right? the really demanding patients us really, really need everything to be perfect. And so there’s a lot of things that I put in place throughout the smile makeover process, to make sure that I don’t end up with an unhappy patient. The first thing is that at the initial consultation, we use Photoshop, and I’ll put the patient’s face up and on Photoshop, I’ll start showing them what the smile that we’re designing will look like, if they’ve got, say, a mid line . And I’ll show you some examples of closing doen the diastema, leaving the diastema. But because we’re using Photoshop, and not just using a perfect smile stuck on to the patient’s face, it’s showing them what actually realistically achievable for them. I do a lot of gum surgery

[Jaz]
Do to teach that on your course? To how to manipulate images on Photoshop?

[Manrina]
Yeah, so there’s a really small part of the introduction to it. But actually, [Tim Locksmith] who owns the clinic, where I work now is planning on doing a full course about that. So he’s just in the process of setting that up. So it’s like an introduction

[Jaz]
You do this, Manrina? You do this yourself, like on Photoshop, you’re doing the Photoshop.

[Manrina]
For my patients, and it takes a while to learn it, which is why I can’t teach the full, basic version of it on my course. But then say go on a four day course if you want to learn about it properly. And do the same thing with photography, I show a really basic version, but do recommend that you go into a four day course to learn about

[Jaz]
I like the idea of manipulating the patient’s own teeth, rather than putting on the teeth. So what you said there I really like, okay, so you’re manipulating on Photoshop. So that’s one part of communication, what else would you do?

[Manrina]
But also within that, quite often, I would say, more than half at least half of my patients, I moved their gums as well. So I do my own gum surgery. And so the photoshops really useful for that, because they’ll be like, Oh, no, my gums are fine. But then once you start moving things, they can see that for symmetry, they’re not fine. And then even though that seems like an added expense, and a procedure, they don’t necessarily want they see that, that visual benefit of it. And so that’s why they’re often they’ll go for the gum surgery, and they’ll see how short their teeth are compared to the length they should be. So they also become aware of how much damage they’ve done. And then they’re more likely to take their grinding habit more seriously. Because usually at that stage, they’re not even aware of their grinding habit. So the first stage is convincing them that they’ve even got it. So yeah, first things like Photoshop, and then we do the wax up. And then obviously, I showed them the wax up, and they put it in their mouth. And then after the prep appointment, they’ve got their temporaries on, and then I do a review appointment two days later. And so at that stage, we look at the temporaries. And we talk about the color and we talk about shape. And if they don’t walk in that room and say to me, “Oh, Manrina I love them,” Then we’re not leaving that appointment, or we’re not leaving that stage. Until that’s their reaction to their temporaries. So, I mean, most of the time we achieve that in that one appointment. But if we don’t, I’m happy to leave them in temporaries for a month, and just keep seeing them every few days, until we have something that they’re like, ‘Oh, these were amazing. And this is exactly what I want.’ So I think that

[Jaz]
So what kind would you have to do in typical case to get them happy? Would you have to completely put a new set of the temporaries that are different shape usually or color or what?

[Manrina]
Yeah, so no, we never, I can’t remember the last time I changed the temporaries completely, but you change them yourself. So I take flowable composite, and I can make them shorter. Or I’ll take a soft flex desk and I’ll make them so some like even shorter, flowable composite make them longer. If they feel they feel too wide, I’ll change the line angles. Sometimes myself, I want to change the, you know, we have this whole conversation about midlines the human eye will see the midline can be up to four millimeters to either side and the human eye won’t see it. So you know at that initial consultation, we go through mid lines and I’ll say to them, you know your midline is not quite in the middle. But if I want to move it for you, I will have to prep the teeth more. So it’s less than four millimeters. Should we accept it where it is. And you know there’ll be like “Yeah, that’s fine.” But then once everything else is perfect, maybe it’s not fine. And so that gives them an opportunity as well at that stage to look at that. The other thing I do is I make and you may have seen this video on my Instagram recently, when I when I was showing showing you a patient I did this with the lab will make both the laterals asymmetrical. So something that I’ll often do in my smile makeover visits, you know, the centrals need to be very symmetrical, I want everything to be very symmetrical. But if you wanted to add some asymmetry, so that it wasn’t too perfect to smile, then I would add it within the lateral. So anyway, in the wax up, we make the lateral tooth different shapes. And then at this conversation, we say, “Okay, Which one do you like better?” And sometimes they’ll say, “Oh, I really like that they different, or they’ll say, Oh, I like the round one. I like the square one.” Sometimes it can feel too square and then we’ll open up embrasures and they can feel too wide, and then we’ll change line angles to make them look more narrow, you know, they can feel too long, they can feel too short. They can feel too white. And then I’ll put a glaze on to darken them.

[Jaz]
There’s so much you could do using their own temporaries.

[Manrina]
Oh, yeah. And I don’t have them saying they want them whiter, because I always put them on the same or whiter than I think they would want. So if anything, they’ll go darker. So I don’t have that problem. Because that’s how it

[Jaz]
What’s your record for the longest time you’ve kept something temporary is because there’s so many modifications.

[Manrina]
It wasn’t modifications, but one guy just disappeared for six months. He loved this temp so much. And we kept calling him saying come into your finals, come in for your finals. He was like, No, I’m fine. I’m good. If you don’t understand. My face is not there. And so they don’t typically want to come.

[Jaz]
So this guy’s temporary survived the whole six months?

[Manrina]
Yeah. And they can, you know

[Jaz]
Well done. So. today, I put my Instagram story today, right? I asked everyone. Have you got any questions for Manrina? So one of the questions I got was tell us about multi unit veneer temporarisation. So can you tell us about how you make temporaries?

[Manrina]
Yeah, of course, yeah. So we use that stent that we talked about earlier. So the lab, it’s a lab made, copy of the wax up. And so when you’re ready for your temps, I spot etch the teeth that you want to temporized, so just a little drop of etch, and then a little drop of bond and cure that and then you take the stent, and you fill that up as a single unit with the Protemp, Luxatemp whichever one you’ve decided to use. And then you pop that in the mouth. And you also squeeze a little bit on your gloves, and you can check when it’s set. And then my stent is typically two layers, so like almost like a special tray with a stent inside. So then I’ll take off the special tray and have a look how it’s looking. And then peel off the stent for the temporaries are left in the mouth. And then remove all the access and cleanup. And then I use a mosquito Bur, which I have a number for that hair as well. 582 mosquitoes in Dental Directory or Komet, maybe? I have to give you a list of these. And as I go through and clean up interproximally. So even though they’re all stuck together, they look like separate units.

[Jaz]
Brilliant. So they’re linked together and you’re using the shrink fit then right there. You’re not using any, they shrink fit. Cool. And it’s been

[Manrina]
I spot etch-bond on every tooth.

[Jaz]
Yep. And then the bis-acryl just wrapped over.

[Manrina]
Yeah, you don’t want, you want them to be stuck to every tooth. So even if something was to break, they would still stay on the individual teeth. But you don’t want them to be so well stuck. You can’t flick them off when it comes to removing them. And because the temporary material so sort of stiff. It doesn’t, It’s all sort of stuck together and stay solid in there anyway. So it’s not easy to take off anyway, when it comes to taking off.

[Jaz]
Perfect. That’s answered your question, Jamie. I think you asked that today. So thanks so much for answering that. So I want to now ask you about your bonding protocol. So now your veneers are there, the patient’s approved the temporaries, tell us about your bonding protocol. Rubber dam? No rubber dam? Which cement? Are using heated composite? Are you using Panavia? I mean, there’s so many ways to do it. What is your usual protocol?

[Manrina]
Okay, so I used to use rubber dam and I use to used to split down. But I like to see the whole face when I’m bonding to see what’s going on and see how these teeth look because I always tell my patients that 9 out of 10 times I will fit this case at fit appointment, but 1 out of 10 times I won’t and if I go to fit and something doesn’t look perfect to me, I’m not going to fit it. So I’ll just put their temporaries back on and I’ll send them back in and get them changed so I kind of need to see the face, the position of the nose and the eyes and everything else what I’m bonding. So I moved from rubber dam to using an OptraGate. So I use an OptraGate just to keep the lips out of the way. I had like really nice suction for my nurse, keep things dry or I put some gauze on the tongue just in case I dropped any veneers so it doesn’t go down the throat. And then so first of all, we removed the temps and then I take my veneers, they’ve already on the model so they’re already set up, I know which tooth is going to go where in the mouth. And my nurse does the same thing on her side, she draws a chart so she can put the relevant veneer on the relevant tooth. Because I’ve had problems in the past where the nurse gives you or you know, you asked for the wrong veneer, you asked for the upper left tooth, you meant for the upper right tooth or the nurse gives you the wrong veneer and then you go to stick it out, it’s a mess. And you really because you’re sticking 10 veneers on at the same time, you really need the process to be smooth and easy. So I take the OptraGate, gauze, take the tooth off model, dip it in water, so the water gives me, gives it a little bit of sort of sticking power to the tooth. [Jaz] I was gonna ask you that how you do that. So yeah, you do it with water. Cool. [Manrina] with water, yeah, and try in paste if need be. But first of all do with water and see. And then and then I placed the mold in the mouth and check that I look at everything in check if I’m happy with it. If I’m not, if I feel like ‘Oh, they look a bit wide or a bit dark or something compared to the lowers’ So you’re not renewing all the teeth, or say you’re just doing for and you want to match it to the other teeth. And then I use a try in paste. So it’s from from Ivoclar. And it’s called Variolink, the kit that I use. And so they have all these try ins, they have white and opaque, I normally go for translucent. Because most of you don’t have to make a change. But sometimes you’ll use bleach, I think, and then you also have yellow and you have brown. So there’s lots of different shades that you can use. And I’ll pop the trials in. And usually at that stage, I’ll show the patient as well. And be like, “Okay, this is what I decided, this is what they look like.” And they’ll be like, “Oh my god, amazing. Like, yeah, let’s do this great.” Then I take off each veneer one at a time, as I take them off, I wash off, Iwash them. So wash and dry with my three in one, the nurse holds a plastic cup for me to wash and dry them with. And then she goes and puts them on their relevant chart. So as I give them to her, I say upper left one. And then whatever I say she has to repeat. And that’s always awkward for new nurses that come to work with me because they said, you know, it feels so extra. But it’s

[Jaz]
Like it’s a system, it’s a system.

[Manrina]
Yeah I got all these little systems in place, just because of as a problem has occurred in my career over the years, I put a system in place to make sure that never happens again. So there’s lots of them. But that’s and that’s one of them, that we always do. So I say and then she repeats and same thing when she passes to me. She has them all. And then on her end, she etches them. And then she places monobond, which is the silane. And then she and then I use an OptiBond™ FL as my bonding. And so she places OptiBond™ FL bonds like the OptiBond™ FL 2 on the veneers, on the fit surface. And then she covers them over so that that doesn’t set. And in the meantime in the mouth, I etc all the dentine and enamel, I just do it as one big block. And then I go through and then I wash all my etch off. And then I have a little dappen dish full of primer, and they still OptiBond™ FL number one, and then I soak each tooth in primer, I just keep soaking it and watching the tooth absorb all the liquid. And then just keep going. And then once I’ve done all that, then sometimes I’ll take if, I feel like there’s still excess around like it’s soak and I put some more on. And now it’s not soaking it up anymore. Then I’ll take the large suction and just suction around the any excess. And then I do the same thing with one. So I have a dappen dish then I go and I soak it, which is the bond, and then I’ll take the suction, just make sure it’s a nice thin layer. And then whichever order I tried the veneer on in, I cement in that same order. So again, that’s another little veneer hack that you can get caught out. If you don’t do it in the same order, then that may be the only order they fit. So if you change your order, they may or may not sit next to each other as nicely or be really difficult. And you don’t want that stress when you’re about to cement. So in that same order upper right one, typically it’s upper right one, upper left one, upper right two, upper left two, and so on and so forth. I take the veneer, I could take my Variolink, and normally it’s trans. For just a veneer. I’ll use a trans just base and for something bigger, an inlay, onlay, a veneer onlay, I’ll use base plus catalyst. So it’s got a drill formula the Variolink, squeeze that onto the fit surface and then put it on the tooth. And as I placed it on the tooth, I want to see cement squeezed out. And again, the amount of cement you put is really important, because you want to put enough that you see it squeeze out. You don’t want to put so much that it’s fixed squeeze on because these veneers are very thin, and you don’t want to risk breaking them. You don’t want to put, you don’t want to use force when you’re placing them

[Jaz]
Has that ever happened to you as you’re placing it and it’s like, broken

[Manrina]
Oh yeah, of course that’s

[Jaz]
Exactly. And hence why the systems and hence why we

[Manrina]
Of course it’d be ridiculous to think that everything is in place because of things that have gone wrong over the years initially. And that’s what I think young dentist or dentist starting out need to know that Yeah, it’s scary. And definitely don’t do this sort of treatment without having some sort of education behind it, even when you do. I mean, I was really fortunate when I was learning because I was taught, it was like university, I would prep my case and then Surinder would check it before we take the impression then I would take the impression and then Surinder would check it before I could send to do the temp, you know, so every stage was checked. And that’s what how until I was good enough, didn’t need to check anymore. And so I understand that not everyone has that, a little things will go wrong along the way, or the impression won’t be good enough. So you know, nowadays, I’ll take one impression before I always took two. So there was something a margin or something there that lab can’t see. And it’s so many units, at least they’ve got two impressions to that they can look up. Anyway, back to cementing. And then you place all the veneers on, make sure that they’re all nicely seated, and then I clean up. So I take a brush and I clean up all the excess. And then I want to floss. And sometimes what mostly I’ll feel nervous about flossing without some sort of cure. So this is a dangerous part. And your nurse needs to be very good. And so again, I’m very strict with this, that I hold, I thought on one side, I hold the veneer in place. I hold it in place with maybe like a scalar or I use something to hold it. And then I’ll use my finger to cover the tooth next door. And then I’ll tell them to spot cure, so if you have a spot cure light that’s fine. Anyway, regardless, whatever light cure you’re using, she goes on to the gingival margin. And she goes one two, and moves away. And that’s how she has to do it. She moves in and she says out loud, one, two, and then she physically moves away so that I can see what’s going on. And I do the same thing, place the next one, make sure it’s perfect. And then she and then so then they’re cured. But they’re only cured for like a second or so. And so and then I can floss. So then I go through and I floss them all

[Jaz]
So only once you tack cure them all then you start flossing? And are you still quite gentle as you’re flossing.

[Manrina]
Vvery gentle because it’s still soft. There’s cement you needed to be stopping you need to be gentle. Now you also need perfect oral hygiene because you cannot cement a blood and again, I’ve done this in the past, even if they look good, but there’s a little bit of blood, blood’s going on to the veneer and then they’ve got a black veneer because that blood stays there and it stains. So now my patients I will not touch them until their oral hygiene is perfect. And they know that, they have to keep seeing the hygienist. They have to change the way they clean at home. They have to be flossing. They have to be brushing twice a day with electric toothbrush. And then yeah,

[Jaz]
That’s so foundational but I’m so glad you said it because you know you have such a beautiful Instagram profile you have so many great cases but we don’t appreciate that what you’re doing, you’ve got the foundation set first from good mentorship. [Manrina] Everything’s set. [Jaz] The really good gingival health which is so imperative to bonding veneers I’m so glad you mentioned that it’s all about the glitz and glam at the end. It’s about having proper dentistry with good respecting the biology. And so I’m really pleased you mentioned that.

[Manrina]
Well there’s this other Instagram veneers guy that’s got like, I don’t know, 250,000 followers, and one of his patients came to see me and she was like, Oh, you know, he’s flying into London, and he worked between LA and London. And I’m having my veneers done with him tomorrow. And he’s charging me like 50 grand and I suddenly panicked and someone told me that I should be seeing you and say Can you have a look at my teeth? And I hadn’t looked at she had raging gingivitis. And because he hadn’t done a consultation at all, she just messaged saying she wanted to have veneers, he said he’s flying in on this day, I’ll do them for you. I don’t know how he was planning on doing them with her bleeding gums, but

[Jaz]
I’m glad you’re advocating the correct way. So you’re now flossed

[Manrina]
For me, it makes my life easy, the less I prep, the less sensitivity they’re gonna have, the less likely they’re going to need a root canal. The less problems I have. My biggest practice builder is referrals, right? Every patient that comes to me, I want them to replace themselves with another patient. And the only way I’m going to do that is if they love my work, they enjoy coming to see me and they don’t have any problems. So that’s the way my practice has had to evolve to beat you. I’ve been doing this for so many years, and my patients be coming back to me 10 years later when it was time 15 years later to replace their veneers and coming finding me to do it. It’s because you know you have you practice like that.

[Jaz]
So just to finish off the bonding protocol, you’re now gently floss, you now pick up your light cure to

[Manrina]
Clean up. My nurses light curing so at least 40 seconds on each tooth individually. But then the other probably end up getting 60 I know some dentists doing it at the margins too. I don’t. I did learn with Pascal Magne and probably did it for a while and then stopped. And so I don’t put Listerine but they do get a really good cure. And then once they’ve all been cured, I take a polishing bur and that is 856EF.314.012 and I remove all the excess composite at the margin that’s really really important to do that while they’re numb because you don’t want any cement there because that will cause gingival inflammation. If you get recession and that’s a disaster. And then I take it, I’ll floss. And if there is a little bit of cement stuck there, then I’ll take a serrated strip, clean in between the teeth, then I’ll take a yellow metal strip and still clean in between the teeth. And so I need, and then I take a yellow rugby ball, and I clean the back the margin between the porcelain and the tooth, removing cement beds. So

[Jaz]
How many hours would have typical fit of, let’s say, eight units, for example, take you?

[Manrina]
So I will book two hours, but it will take an hour. And the reason I always work longer is because I want my patients to feel like they have a lot of time. Like if they want to stop and they want to talk and or they want to, you know, wherever they want to do will do. And I don’t want them to ever feel like I’m rushing to see another patient. So yeah.

[Jaz]
Brilliant. So now you’ve [Manrina] Then we’ve take the occlusion? [Jaz] Yes. Perfect.

[Manrina]
Yeah, check occlusion, check everything looks good. I warn them before they come that their lips going to be swollen, so they won’t be able to tell what they look like. And I say don’t even worry about it. Go ahead and go home, go relax, book a review appointment which always booked two days later. And they come in. And that’s when we look at them. And then if we want to, we can make some small changes with shape if I want to make them look more round or more square. But to be fair, 95% of the time, there’s no change, because we’ve already done all that in the temporaries. So if there are they’re minor changes, and we make them

[Jaz]
Has it ever happened to you? Because that is something that I speak to dentists and a lot of dentist are going to describe this scenario is, you do some veneers I mean, I think it probably doesn’t happen to you because your temporarization process sounds really good. But they do some venners, and then they go back to their partner or husband or family. And then someone makes a comment. And they come back and they’re upset that oh, this person didn’t like them or someone said this and then they’re suddenly debating Have I made the wrong decision? Is that, have you encountered that scenario? Did they come for you for advice like that? Has that happen to you?

[Manrina]
Yeah. So some of my patients, I would say all my patients say, I wish I’d done this sooner. So they all love it in the end. But definitely, they can come back at the temporary stage and have opinions and I asked them to ask for opinions. I was like, you’ve got two days between your prep appointment and your annual review appointment. So go and ask opinions, make sure you show your husband or wife, show your friends and come back to me. And then whatever comments they come back with, we manage them. So it’s all managed at the temporary stage. So by the time you get to fit they love them. And even at the temporary stage, we don’t leave that until they love them. I know you said before, how long have I gone through the temporary stage, which is modifications, I think I told you about the six months ago and that wasn’t one of the modifications he just didn’t want to come back. I wouldn’t leave them in temps intentionally for longer than a month. And actually 95% the time, it the modifications are made and they’re happy within that review appointment. And it’s rare that I need to get them back. But there certainly has been cases where I got them back. But I wouldn’t leave them for longer than a month. But within a month we have to get there.

[Jaz]
Other temporaries like a tepe-able, Is that what you advocate them to like religiously tepe them?

[Manrina]
Yes, they have to clean it and then gingival health has to be optimal for the fit appointment. Because I can’t have any bleeding. So I give them tepes, pink tepes and Corsodyl gel. And so they they need to brush twice a day with their electric toothbrush, then they rinse with peroxyl. I get them to rinse peroxyl and then I get them to dip their tepe brushes in Corsodyl gel. And then I use my little mosquito bur. I think I gave you the code for earlier, 582 and you go and make sure there’s these, Oh I got these codes, I love that. I’ve just got these handy. [Jaz] Cheat Sheet. [Manrina] And then yeah, open up and make sure that it’s not a visible hole. But to make sure they can get in there. Put the gel in and leave it there. So they don’t rinse it off. And they do that twice a day. So yeah, the gums are beautiful when they come in for fit in

[Jaz]
Beautiful. So now I’ve got my final three questions, because we’ll have to wrap up, we could speak forever about this. So these final three questions. So they are and I’ll list them together and you can answer them. One is when does a veneer become a crown for you? So when do you think actually now I’m not gonna veneer this I’m gonna go for traditional retention resistance form. So when does the veneer become a crown? The next question I will ask you then after that will be just your final tips for success to young dentists. And the last one, you know, please tell us about you know, I think you’re obviously doing some veneer courses. Tell us about what that involves and what dates because I think this episode will probably be coming out in late Feb. I think so tell us about what dates are available. So those three questions when is a veneer a crown, tips for young dentists and tell us about your course. Sounds like

[Manrina]
So, first of all, I don’t crown very often at all. And also I don’t differentiate between veneers, three quarter veneers and crowns, price wise, I tell my patients that I’m going to prep however I need to prep whatever I need to remove to get the best result for you. The only thing reasons I would crown is maybe I’ve got a patient recently that came into over two actually last week that had really a lot of labial wear from Bolivia. Besides, I mean, think they were both bilinear as a child as children. And even for those cases, I would rather put composite veneers on the palatal. And then porcelain veneers on the labial. Just with the, you know, there’s a quite normally, there’s a grinding habit there as well. I don’t want them grinding on porcelain. And so it’s still nice to do two veneers. But yeah, you could do sometimes you need to do a three quarter, or you may just do a full coverage. And then it’s a crown. So yeah, veneer crown. No, I don’t like to differentiate, it’s just wherever it is the minimum amount of tooth tissue that needs to be removed, to get the result of [Jaz] to get the job done. [Manrina] Get the job done. And then for dentist wanting it. My advice to young dentists is learning. And I think I talk about this a lot on my Instagram page. I spent a lot of money on my education, all through my career even now even you know in 2019. And people always like question the amount that I spent saying, wow, you spend so much on your education, I was flying around the world and getting my education and you don’t need to do that anymore, but you did back then. Because there’s really good UK courses now. And don’t be scared of that. Like if you want, if you’re interested in something and you want to learn about it, then learn about it properly, go on a course and learn about it. And don’t be scared about the expense of it. Because you will only earn more from what you’ve learned. [Jaz] 100% [Manrina] And so yeah, I always say to dentists, so they don’t get bored and so they’re building off what they could do, you know, keep going on a simple ortho course then about that, put that into practice, you know, go on and whitening course learn about that. Definitely go on an occlusion course. If you’re interested in smile design, they come on a smile design course. And that leads on to question number three. Well, there are smile design courses in the UK. And they maybe there wasn’t one that everyone was knew about. Oh, there wasn’t I don’t know, maybe there wasn’t the best one. I think, yeah, probably all good ones. I did my studies in America, I did the aesthetic advantage in New York over three years with Larry Rosenthal and APA. And you know, I had to fly to New York, and it cost me 7000 pounds to do each level. It’s $7,000. And I did it. I get to fly my patient out there. And it was amazing. And that was great. But

[Jaz]
Cool. So you flew your patient, your patient flew with a sat next to you on the airplane?

[Manrina]
No. I think Yeah, yeah. Because we go for lectures as well. And then they can’t we do the preps, they fly back. And it was the same thing. Two weeks later, they come and they fly again. So I’m very much. I’m not emulating that for what my course what I’m doing here. But I’m offering a similar service here because it really wasn’t something like that. And that education is what I needed. And that’s what kick started my career for me. And I’m offering that same thing. There were far too many dentists that are trying to do these cases and don’t know how to do them. So they were failing. And then their patients are coming to see me and I’m having to redo it. And there are too many dentists prepping crowns rather than veneers, you know, my friends are doing it when I talk to them, because they’re scared that veneers will fall off. So I don’t want people to do that anymore. So I’m offering a course that gives you a really nice outline. And the people on my course this time, you have had a range of skills, and someone who’s only been graduated two years. Certainly when I went into the course it started the course in New York, I’d only been graduated two years to another guy who’s been graduated 20 years and done a restorative MSC, but really not done any smile makeovers. So it’s one thing to do an MSc and another thing to actually learn about how it works in practice with something that I’ve been doing every day for the last 18 years because you know even now, I work in a cosmetic practice all we do is cosmetic work. We don’t do general dentistry. So this is my everyday job. And there’s a lot of lot of tips and tricks that I can give you about how to make this predictable make it minimally invasive make it you don’t have any problems and go through the things that weren’t wrong me and make sure they don’t go wrong for you and also support you then moving forward because I had a lot of support and you need that. So at least a major support network they’re moving forward. So we have the course states that are running now but the next ones are in June

[Jaz]
I’ll just put the dates and the link on the blog post

[Manrina]
Yeah. Come down.

[Jaz]
You owe me some website, you owe me some dates. Yeah, and you owe me some bur codes.

[Manrina]
Yes. I will send them all.

[Jaz]
Where is it? It’s a central London

[Manrina]
Yes it’s being held at the clinic by work the London smile clinic, it’s Rovio. So really easy to get to. I can give you hotel details for people who are flying in, this time we had someone flying from Sweden, someone flying from Dubai and then obviously the number from the UK Yeah, and

[Jaz]
Flying the flag for UK dentist and flying the flag for women dentist. So that’s just really good. And that’s it like you said the beginning right. And my wife was happy that I’m bringing a very successful and very good woman dentist. So you know, I echo all the people’s thoughts and views that have been reaching out to you with positivity and I think that’s exactly with you know, on behalf of me and my listeners. I wish you all the best within, I wish all the women in dentistry the best but I’m just so pleased that I had you on as a role model for the women in dentistry. And the three really nice stories I got from this episode from you as your the role of mentorship that was, yeah, your career and I was always banging on about. I’m always banging on about that mentorship, how you’ve invested so much time and money to spend time in the dirt. What I mean by that is you actually work your socks off courses.

[Manrina]
Yeah. There’s no space for ego. You can’t. Yeah,

[Jaz]
Absolutely. And then just now your attitude to give back through all the posts that you put on Instagram and also now the course is running. So you’ve been a brilliant guest to interview, Manrina. Thank you so much for coming on the show.

[Manrina]
Thank you for inviting me.