Fixed Retainers Demystified – PDP108

Jaz’ Introduction: Welcome back Protruserati to this episode on fixed retainers. We’re continuing with our Ortho theme. Like I really hope you enjoy and gained so much value from that IPR techniques video like we and the team. And I say we, it was a team effort to put this video together. And it’s been so great to see your comments and your feedback on Instagram, on YouTube comments, so please keep them coming if you found that video useful. In this one, I’m going to make another bold promise, okay? The video that will be part of this podcast. So if you’re one of my loyal listeners, I appreciate you. If you’re new to the podcast listening, thanks so much for joining from wherever you are in the world. This podcast will speak to Raj Jabbal about the different ways, the different fixed retainer types available. Is there a superior one? Is it a case that Raj Jabbal, the specialist orthodontist we speak to does he always place a fixed retainer? Or is there a place for removable retainers only. So we’ll talk about the sort of daily conundrums that we have when we’re deciding on the recipe for retention, which is unique to every patient, let’s not forget that retention should be a unique thing based on the patient, based on the initial situation. Because initial situation, the crowded state is the most stable state. So if you’re watching on YouTube, great, I will have a video step by step made by cephtactics, which is just the most beautiful video you’ll ever see of someone applying a fixed retainer. It really helps make it tangible. And what I’ll be doing is I’ll be jumping in and out of that video and just giving you my sort of little pointers here and there. Okay, why I might disagree with some parts that video and how certain parts are just so mind blowing, and so much better than the way I used to do it. But again, if you’re listening, then don’t worry, I’ll make sure that you’ll have an easy place to click on tool. So wherever you listen, that you can jump straight to a video and watch it but you’ll still gain so much more from the conversation with Dr. Raj Jabbal today.

[Jaz]
Before he joined the main episode, let me give you the Protrusive Dental Pearl. So you know that thing where if you only had one wish, what would that wish be? We all know that one wish should always be ‘The I want unlimited wishes.’ So if I had to give you just one pearl right now, it would be that I want to give you access to unlimited pearls. So how I’m going to do that? We’ll you need to check out my email newsletter. So what are you gonna do is you’re going to head to protrusive.co.uk/emails, that’s protrusive.co.uk/emails because on there, you get a sample of some of the emails I’ve sent out and the goodies are in those emails. But you’re also then got the opportunity to sign up to my email list. Why is that important? Because the app is coming soon, like we are so ready that has taken us months of hard work to put together the protrusive app, and I hope they’re just as much value as the episodes give you, the app will make you go so much further like has this section called centric relationships. We will have different offers and courses that you can enroll on with a discount code. They will also be sections where you can actually get certificates for all the videos that you watch. So you can now learn but also get the certificate that showed that okay, this is account towards a credit as for your CPD to sign up to all that. Go toprotrusive.co.uk/emails and I look forward to have you on my email list and I will probably email you at about every two to four weeks. Let’s join the main podcast and the end of this video will be the fixed retainer video step by step, the one that I’m hyping up so much, it truly is fantastic. I’m also going to upload it on YouTube as a standalone, I want to make sure that it’s really 100% confident with them. But after watching this video, and after this podcast episode where we discuss the rationale behind the exact wire that has been used to make this video and how to get the little bends perfectly placed using the Tucker that’s all sort of described in the conversation with Raj Jabbal. Let’s kick that off right now.

Main Interview:

[Jaz] Raj Jabbal, specialist orthodontist, welcome to the Protrusive Dental Podcast. How are you?

[Raj]
Thanks for having me. Very well. Thanks

[Jaz]
You and Rohit. Rohit have an episode. I’ve been so excited to get both of you on at some stage. You’ve taught me so much already. It’s been great to be part of the cephtactics team teaching. So the bit I do guys is I teach about how patients can stop from chewing up and breaking their retainers and screening for TMD. And when to treat and when not to treat, or looking at joint issues. So thank you for having me on the team to do that. Raj, just for those who may have never heard of you or seen you before. Give us a little bit a brief background of what your interests are, where you work and how cephtactics came to be?

[Raj]
Yeah, I mean, I’m a specialist orthodontist, and I’ve been working in private care mainly for the last round about 10 years old. And specifically, my interests have always been around growth and development, maybe genetics, stability, relapse almost came into that, and fit really well into that specific idea. And the enigma of all of this is that we don’t really understand it very well. And that’s what really made me more excited about it. Because in orthodontics, you can make things very mathematical and succinct, an A plus B equals C. And then suddenly growth comes around, and it’s like the demon in the back. And you only start to understand more about growth, the more and more you see cases of yours going, let’s say topsy turvy, you know, and that’s when you start to question it more and more, especially when it starts to look at things like genetic factors as well. And you ask around to the parents and How tall are you? And How tall is your your dad? And where are you from originally? And all these little aspects which come and knit together in orthodontics, I think this is a really big, really interesting thing, which I would love to walk around more.

[Jaz]
Raj talks a lot about genetics, and the bigger picture kind of stuff, phenotypes and whatnot. He’s the only guy who I’ve sat through a lecture and he starts talking about how Columbian teeth are different from Japanese teeth, are different from Estonian teeth, etc, etc. It’s quite special medicine. So his knowledge is limitless, obviously, the amount of stuff and metaphysics that you know about genetics is crazy. So at the moment, you’re teaching dentists how to implement orthodontic practice safely. And you do a whole like 10-Day prototype class programs on

[Raj]
A 10-day program with lots of assistance on the side, we do some zoom sessions as well and all these other bits of this but the 10 day meet in the bone. That’s what we want. We want the guys to come in and you know, whenever we look at a lecture, we want to have enough meat on the bone that you actually go back famished, okay for more

[Jaz]
Amazing. I love that philosophy. Now, today, this episode is very much about fixed retention. It’s a big bugbear. Maybe in this, I know in this fascist community because I’m part of your Facebook groups, loads of specialist orthodontists on it. And it’s a it’s a real annoying thing that orthodontist find and also GDPs. I find it super super fiddly. And in preparation for this episode, Raj, you saw the Facebook post I made to the Protrusive Dental Community I said, Look, we find fixed retainers really annoying, really fiddly. How can we make it easier for GDPs? And just yesterday, I placed them lower fixed retainer went fine. And I had a challenge on the upper one. And I want to pick your brain about that. But before you get to that, I’m going to go to structured order. And you’re about to be doing a lecture now just on fixed retention and hands on models. You get your delegates to place fixed retainers, which I think is amazing to be able to do that on the models. So if anything that I’m going to asked you is covered in that lecture, then don’t answer it now because I rather just extracted from there to be understand. So firstly, I’m going to ask you, do you routinely use fixed retention IE, as part of your specialist plans that you do that may be more elaborate, more pushing the boundaries compared to GDP perhaps? Do all your patients get a fixed retainer and a removable? Or is it customized for each individually?

[Raj]
Yeah, I mean, before what I used to do is it was a blanket statement. And I used to have fixed retention in the top and bottom arches and removable retainers for everyone. And and now slowly but surely it’s becoming more and more of a situation where your, the fixed retainer in the lower arch is by far more important than the one in the top. And, you know, lots of patients will report, they wanted they say no. The idea is that a lot of these situations are customized. And I work with a clinician in Escrow back. And she is a specialist orthodontist, trained in New York. And she has right now she’s on the face program n Spain and Italy. And you know, the most important aspect of their treatment has always been, did you get the occlusion right? Did you get the bite right. And that’s more important than both the retainers put together. And that’s

[Jaz]
Because stability, right?

[Raj]
Yeah Stability.

[Jaz]
It contributes stability.

[Raj]
So I mean, I still probably most of my patients will get though the kitchen sink sent to them. But you know, when I’m

[Jaz]
Suppose we’ll get fixed and removable as a blanket. Top and bottom? or?

[Raj]
Top and Bottom. But the upper arch, I don’t usually extend it to the canines as much unless I brought a canine down from the heavens or something as such, you know, that sort of thing. You know, but most of the time, I think most of the time you’re looking at that, but I’m dipping my toes into being a little bit more brave. And I think I would be okay, because I had a patient yesterday on and he said, Raj, I want this fixed retainer off and I said, Look, I love your teeth. They look fantastic. I don’t want to take it off. He said No, Raj, you know that they’re not going to move and I’m like, okay, Christmas present this year, I’m going to take off your fixed retainers and Lea, my receptionist said, Are you serious? I said, Yes. He’s our experiment. To make sure that the bite is right

[Jaz]
Okay. Yeah. So what the angle you were coming from is that there is a belief that If you get the bite right, and you get the correct incisors in the right angulation with each other, you know, incisal edge to the cingulum. And you have your setup correct that maybe that is a huge player in stability in orthodontics. Obviously, we have soft tissue factors as well to consider, we can get into the time and whatnot. But the answer I guess the main answer is yes, you are on the hole. Most patients will get fixed and removal. Yeah. So what is the best type of fixed retainer? Is there a best type? So the ones I used in the past, the GDPs out there listening dentists, chain. So this is the one that was taught my diploma but I know Raj feels very strongly negatively towards retainer and I’m sure he will add that. And actually Mandeep Gosal on the Facebook group, he actually mentioned that he only use it for the lower because he’s concerned about relapse on the upper in his experience. So I’ve used the chain, I find it really easy, so easy to place a chain. Almost too easy. Okay. Yeah. And then that’s when it was also taught to me my diploma, I started doing it. The other ones is the braided. And then there’s the flat. So it’s like a rectangular, you know, not rectangular, but like 2D rectangular

[Raj]
Like a ribbon type

[Jaz]
Like a ribbon. Are there any others I’ve missed out? I’m sure there are ways and one of the most wanted for GDPs

[Raj]
Those are the main ones. I mean, of course, you get the cast ones that have been used all throughout the older days, you know, I mean, the first fixed retainers are actually matrix band, you know, with lots of holes in them, you know, remember the tofflemire and all that. So people are not using them. And they used to just shape to make lots the holes, but when you look at them, like the coaxial types, you got the twist flex, you got like the ribbon version, which is multi stranded as well, but flattened in a way. The thing is, I’m always very careful with the round, twist flex, yeah, because these are really, really important wires to know the metals behind it, because they can actually unravel and if they unravel, you start getting this warpage and you convert your retainer into an orthodontic appliance.

[Jaz]
Just disheartening. Yeah, I’ve seen it post on community I’ve seen in my own patients that I review, not the patients I placed on because I don’t actually tend to use that retainer but I’ve seen the consequence of it. And I’m sure you guys have as well. And one of the questions you’re asked about, okay, how do we prevent that? For is it for that reason that you’ll avoid braided?bhv

[Raj]
I generally try to avoid them. Yeah, I generally try and avoid them. But you can anneal the wire, that means we can put it under some heat, and then put it on

[Jaz]
But let’s make it really tangible because people actually want to know that right? So the way the way I’ve done in the past when I had to use it before is I will get lighter. And once I’ve got my right length, and it’s ready to place. I will just burn it until it just goes I think it glows. It glows. And then I wash it. It turns a horrible black color. But now it’s no longer going to be able to impart force.

[Raj]
Yes, and you’re not, what you’re basically doing is you’re converting a specific phase of the metal. So you’re moving from martensitic phase to austenitic when you put that heat. The only issue I have with it is that has that word has is it enough. Now on every year I’ll see about four or five patients in the situation where you start seeing weird torquing movements, etc. I haven’t seen it in any of my patients. Touchwood. Yeah, because I did use it quite a bit when I was just out of university and stuff like this. But the other issue I have with this is that retainer doesn’t sit really nicely onto the onto the tooth surface. So you gather almost a bulky appearance of the composite. And so..

[Jaz]
When placing directly

[Raj]
When you place directly. When you place it indirectly, you tend to get a thinner version, you know, and you might get it a little bit better. But the best benefit I’m getting, I mean the best retainer I will say is going to be the flat ribbon type of multi stranded retailer. And look, I don’t know if we should be promoting one or the other and all that sort of thing but be very careful with anything too flimsy as well. Because if it’s really flimsy

[Jaz]
Like a chain

[Raj]
Like the chain because the reasons why the cast retainers will the best retainer ever was because they attached to one canine and the other canine and kept the IC width, the intercanine width, which is the first thing which collapses into relapse. It’s the first thing that starts to go down. Because what happened with the Bishara studies was that they said it’s remained stable. But the beauty of the Bishara studies, they made lots and lots of models of people over long periods of time. And you could start to see that the intercanine width starts to reduce. And if you look at any of your Invisalign cases, you know, when they send you the clincheck, if you ask for no IPR in the lower labial segment, you will see they’ll start to operate intercanine width. And that’s exactly what you want. And as you operate the intercanine width and if you keep it that way, the upper doesn’t collapse. And so that’s why the perfect retainer would be trying to keep the retains, the two teeth apart, the two canines in the lower arch apart. Okay?

[Jaz]
So what we’re going for here is that the one that you are using and one that you will teach your delegates

[Raj]
We were going to be looking at the flat twisted

[Jaz] And I’ll show you the video of that probably something on your screen now as we’re talking. So as we’ll put that in. So fine. So we know about we wanted, you all answer your question as well, how to prevent that from happening, avoid twiflex is the most logical way to do that? And we’re going to show you step by step on how to place a fixed retainer. So Raj are going to go through that. How do you bend it neatly, so it adapts to the embrasure spaces. So usually, when I’m, I’m still wanting to prove like whether this is your first retainer in place, or 100 like me, I’m still not perfecting it. And sometimes I’m biased towards an indirect laminate one, because they look so much better than my own. I want to be able to level where I can make beautifully well adapted. Are you going to show that?

[Raj]
I’ll show you how that is. But there’s another aspect of this, which I think is really important, we must understand the more bends we put in the retainer, the more points of failure there will be. So I love retainers which going on the margins, and etc, etc, all that sort of thing, you want to keep it in the contact point. If you keep it in the contact point, there should be the least number of bends possible. Now, when we use the twist flex, I mean, the one that I’m going to be showing you

[Jaz]
Not the twistflex, the ribbon

[Raj]
The ribbon type of retainer, you’re going to see that it actually is extremely easy to bend. And now there’s a really important aspect of this as well. Because I use the least number of flosses involved. You can use eight flosses if you wish I don’t mind looking and all those sort of things. But if you use the least number of flosses, what you can do is test whether the wire is passive or not, you can release it and see where it’s going. And you can bend it into positions a little by little as it goes around the edge. If needed.

[Jaz]
If it’s not passive and you release that floss. If you’re thinking Wait, where’s floss coming in this time, don’t worry I’m going to show you the technique and how we use floss to stabilize it. But if you pull the floss and then let go and it moves, if you were to pull again and just bonded to that position, that is creating a force.

[Raj]
That’s exactly what’s happening. And that’s why whenever you use this, I use the back end of Tucker, and you’re going to be, it’s literally just polishing the retainer onto it. And you can release the floss and see how well that it actually does adapt because it’s the material is amazing because it’s it’s really, really bendable. So the austenitic phase is really high in this material. And the beauty of this is solid, it doesn’t cause any of this sort of movements, which is the most dangerous ones, okay? It doesn’t have that twist ability.

[Jaz]
I mean, so we’re gonna see how to adapt it. So we’ll add that in. I had an issue yesterday, I was using that exact wire on the upper, and I had the correct length all laid out. I was going to go from canine to canine, because I did some movements of the canine. And when it was on the middle of, let’s say the right canine, by the time I brought across the bridge, there was enough vertical discrepancy. It was either gonna go gingival or beyond the canine tip. Yeah. So is the answer for that is that in those cases, you have to go indirect? I can’t bend it.

[Raj]
So the thing is this, the idea would be you start bonding from Centrals, and you work your way upwards. So the stress distribution goes that way. There’s another way that you can do it from one side, but there’s a chance that you start canting the retainer. So the idea is to start in the Central, and then move to the next Central and just release the floss and see, you will see that things are actually okay.

[Jaz]
It’s heading towards the gingiva you can’t get in that type of ribbon. Why you can’t bend or can you? Bend that level and describe it?

[Raj]
Because as it comes closer and closer to the canine, sometimes what people do is they do this yeah, they merge it around. So if you start doing this, you stop putting strain on this point here. You might fracture some of the strings, okay, on the wire, but the main thing is this, it’ll allow a little bit of a drift, but if you drink too much, then maybe okay, but now if you want to do anything lab, I would say you want something which is cast and maybe machined. Okay, so like I think if I’m not mistaken, there’s some labs, which are actually machine cutting retainers into position. These are cast sounding very expensive as well. Those, especially anatomy, like we were talking about the different types of anatomy. South American, spine of South America specifically, you will see this almost peg spade shaped arrangements of the incisors. That’s when you’re like you’re not going to win, you got into this lab, and that’s a you know, it’s a one off, but the thing is, yeah, that’s where prices start to become a little bit more.

[Jaz]
Yeah, that that helps me enough, right. I know that I probably wouldn’t have had been able to do it direct that one. So we’re gonna see it step by step. We’ve talked about why is becoming active and unraveling. So Raj, last question before we actually get to more hands on clinical stuff, which I’ll be, we will be filming for you guys to get advantage of, is those clinicians who are part of the Protrusive Dental Community, so shout out to Richard and Zach, two good friends of mine. They found that over time, they’re all of their fixed retainer problems went away when they stopped using them. And now they give Viveras or equivalent three sets of really high quality, clear pressure formed retainers, and the old is now on the Patient. As far as the evidence goes, I believe that fixed versus removable. If someone, if a patient is really religious with their removable, as long as the retainer that the rural retainer doesn’t get damaged or warped or put in the hot water, as long as the patient wearing it, there’s no chance of relapse? Is that a fair statement?

[Raj]
I don’t think we can go down that path that simply because the fact is the fixed retainer and the removable retainer are two completely different jobs. Now the removable, like if you talk to Romania, and he talks a lot about orthodontics being a crucial rehabilitation. And if you’re doing any sort of denture or anything like this, what are we doing? We’re impinging on this space, which is near the sulcus and you got to cheeks in all these different areas, you know, where we modulus, we know all about the modulus activity in orthodontics ever. And the more and more we looked down this path, and we realize that the arch form itself is critical, right? And now I have, I have all been praised for the Viveras except one thing, the one thing I have an issue with is them giving three. Now there’s a reason for this, what I’ve realized is that rather when you start looking at growth and development, it is wrong to sit in perpetuity, and think that there’s going to be some sort of static nature in your whole career, in life and that’s it. You need to be perfect until you’re in the box, and you got to say, see, it’s a Peter and say hello, and you’d like well done, ain’t never going to happen, okay, it’s always going to be some sort of flux and change, which happens. Now there’s some change, which is acceptable. And there’s some which isn’t. Now wear of course, dental wear happens throughout life. And we always have that, that’s not taken into account at all, whenever we use retainers and people tend to use retainers less and less and less and less and less, until then they end they’re gone. And that sort of thing. And then it’s so important to, rather in orthodontics, to say that you’re thinking in the finite game theory, which is that’s it I want and that’s my teeth, and that’s what they going to be for the rest of my life. It’s a dance, it’s always gonna be here and there and here and there, you will lose sometimes, you’re going to gain sometimes, patients gonna worry

[Jaz]
There will be Periodontal changes.

[Raj]
Yes, exactly. And that’s why I say I need both, fixed and removable have a place to play. Now, if I’ve got a patient who’s so good, and he’s wearing Viveras by the way, he’s wearing Viveras. And he says, Listen, I’m wearing Viveras every night and I’ll be like, the chance of his teeth moving are extremely low, extremely low.

[Jaz]
And even if they did a little bit will say, Well, you know, right, it will not be, it will be the case will still be a success.

[Raj]
Exactly if he wears it once or twice a week at night on like Vivera? Yep. A normal Essix? No, no, no, no. Now we started to go into a dodgy zone. The beauty of Viveras, of course, accuracy, robustness, you know, and all that. So if the patient is wearing them, I’m happy. My biggest failures with fixed retainers are not bond issues. Their wire breakages. Now why a breakage is happened when there’s a force on the wire all the time.

[Jaz]
The  tongue

[Raj]
The tongue is the book you know, why don’t they just, do we really need it? But you listen, the tongue is the biggest issue it keeps hurting the area and if you keep pressing on it and not only chewing chewing chewing that’s why those the cost retainers are only attached to two units usually go through less stress than the ones which are attached to mulitple points of failure can occur. And that’s the problem. So if someone says no to the fixed, I’m like, okay, Viveras? And you better behave, you know, and I’m like, I’m actually okay. But till unlike you know, just don’t give them three, change is every three years or something you know, change it again, get a new one, it’s the accuracy is the key. Not when it has undergone plastic deformation. You know, the most plastic deformation the second one will not fit as well. So they’ll always be a little bit of something there. And so that’s why even when my patients come and ask me, I’ve had my mold, can you make the new retainer to this? I’m like

[Jaz]
To exist, my old model from three years ago

[Raj]
From 3 years ago or some even some like four or five years ago and I’m like, No, it’s not going to fit as well because it’s always changed.

[Jaz]
Hi, guys, it’s Jaz Gulati here and I’ll be just coming in various moments really important moments in this epic video, just to give you a few hints. Now when it comes to air particle abrasion. I’m not aware of any evidence that when it comes to fixed retainers, what’s better? 27 microns or 50 microns? Traditionally, for intraoral bonding, we use a 27 microns but you can use 50 microns. Now you have to think, What are you trying to achieve by using air particle abrasion. For me the main benefits for when it comes to placing a fixed retainer is twofold. Number one is you’re removing the biofilm, okay? So so important to remove the biofilm before you do any bonding and number two is that you help to remove the aprismatic layer of enamel, which may also cause an inferior bonding basically, so you get higher bond strengths to enamel that’s just below the aprismatic layer. Whoa, whoa, now you’re thinking Ah, but Jaz, I don’t have an air abrasion unit. What do I do? Well, let’s think how can we remove the aprismatic layer and how can we remove the biofilm. Now for the biofilm, I would use a bristle brush and some pumice slurry and that will really help to remove the biofilm. And to remove the aprismatic layer of enamel, I would actually use like a fine rugby ball Diamond Bur and I will just lightly scratch the enamel. You only tried to move like 30 to 50 microns of enamel here so not very much. And for those of you getting very nervous about removing enamel, you’ve probably just done a whole lot of IPR so calm down yeah.

[Jaz]
So when we see this image here, in that still, the amount of etch that’s applied? It’s not enough for me, I want a little bit more surface area of etch you should always be etching a little bit more than where you think your composite will be placed.

[Jaz]
So when the floss was introduced here, and it was being placed, you probably closed watching really closely. Okay, what’s going on here, I don’t understand. But now that is in this position, ie, you’ve literally just gone between the canine and lateral incisor on each side. And that’s it. That’s all that’s happened so far. This is really easy. This is the beauty of this technique. Because what I’m used to doing is I’m putting these little loops in multiple different areas, multiple different contacts between the teeth. And just overcomplicating it, I love this technique of just putting it putting one piece of floss, not even two pieces of floss, one long piece of floss, okay, carrying it over making two loops, which you’re about to see. And this is just genius, rather than faffing around with multiple different flosses.

[Jaz]
Remember that placing a fixed retainer is a four-handed job, okay? While you’re feeding the fixed retainer through, it should be your nurse who should be helping you by pulling this floss. And you should obviously have this conversation with the nurse before you do it for the first time. So show them this video, okay? Let’s train your nurse together before you actually do the procedure. So your nurse not looking funny like what do I do I pull? How hard do I pull? When do I pull? Okay, all those things should be known to a nurse before you do this.

[Jaz]
Guys, this is the most beautiful part in the sense that you’re using the Tucker and you’re pressing into the embrasure areas, in the interproximal areas where the contact is to create that little bend. Now you don’t want too many bends and you don’t want too extreme of bend. And so how can you ensure that the amount of a bend that you have is not excessive? Well, if you make sure that your fixed retainer is along the contact points so it’s not too apical or too incisal to the contact area, you want to keep it at the contact area, therefore it doesn’t have to bend into the tooth very much, okay? And the other thing you could do is just lightly pre-bend your wire to the rough shape that’s going to help you and then you’re using that Tucker and you’re putting that a fair bit of force here to just press it against a tooth and kind of bend it in each contact area at the contact point. And that’s what’s gonna give you that lovely shape that we all desire.

[Jaz]
Now, before you actually placed the composite flowable here, here’s what you got to do, okay? You just get the nurse or yourself or whoever’s holding the floss to just let go a little bit and observe. When the floss is let go on one side, does the fixed retainer does it sort of bend away from the tooth? If it does, then that is not passive. Okay? You need to do a bit more bending there to make sure it’s passive so an ideal retainer here is that when you let go of the floss it holds its shape and it’s not moving away too much just like we discussed in the main podcast Episode.

[Jaz]
Well there we have it guys hope you gained a lot of value from that. Now, this episode happened because you guys voted for it. So sometimes I give you an option okay, like do you want this episode or that episode? So it was a toss-up between fixed retainers and force and timing data when it comes to occlusion and why articulating paper marks are lying to you. And that’s exactly what the next episode is about. It’s about the T scan and how that gives us so much more data that we can’t get from traditional articulating paper. So do join that episode and one after that just to really whet your appetite will be the one with Devang Patel part three of three of full mouth rehabilitation. So listen if you gain value from these episodes, if you’re enjoying them, please do consider leaving a rating on Spotify, Apple, or wherever you listen to it, and I look forward to join you in the next one.