Class II Composites WITHOUT a Wedge + Contact Opening Technique – PDP188

Jaz’s Introduction:
The other benefit, of course, is that it gives you some separation. And this helps to accommodate for the actual width of the matrix span, so that once you finish your restoration, you remove the wedge and hopefully the teeth will rebound and you’ll have a contact.

Another benefit of wedges is actually suppressing or depressing that papilla. It allows you to manage those deeper cavities with much more ease. So as you can see, I’m a fan of wedging and I even invest in all sorts of different types of wedges and those low profile diamond wedges for those trickier and deeper scenarios. So why is this episode on doing your class two restorations without a wedge? Isn’t that a little bit crazy?

Hello Protruserati, I’m Jaz Gulati and welcome back to your favorite dental podcast. So let me tell you, it was like a paradigm shift. It was a big shift in my thinking when I started to use this technique without a wedge because the wedge has so many benefits, but how many times have you introduced the wedge and seen that your matrix band has completely now moved away from your contact?

You have an open contact now. And sometimes a bit like the ring, the wedge can distort your matrix. So if there is a way to do good quality class three restorations and get a contact and get a seal without needing to use a wedge, then that is worth exploring. And that’s exactly what we’re doing today.

My guest, Dr. Sunny Sadana is a major fan of the greater curve matrix band. He’s a distributor in the UK. Now, many of you in the States watching, listening to this. are already very familiar with the greater curve matrix band. It’s something that I discovered probably about 18 months ago through Sunny, and now about 70 percent of the cases I do are with a greater curve matrix band.

I still use sectionals, and we’ll come on to that in the meat of the podcast, because Sunny doesn’t use any sectionals at all. Whereas I think there’s still a place for sectionals. For your smaller cavities, the nice contour that you get is great. But for those big behemoth amalgam replacements, those MODs, those subgingival areas, I went through a phase of trying to make a sectional work.

Like, the sectional just wasn’t going to work, but I was trying to make, I was desperate to make the sectional work. So in my aging population of patients, I see the greater curve has been absolutely brilliant. And so two shocking things you must know about the greater curve. Maybe should I give it a spoiler? Should I not? I’ll do a little bit of a spoiler.

So if you follow the protocols, you don’t need to use a wedge. So I think that is well worth a listen. So hang with us to find out how that actually works. How can you use a matrix without a wedge? Don’t you lose the benefits of the seal and the separation, all that kind of stuff.

And secondly, something called the contact opening technique, which I think will blow your mind. It’ll feel like dirty. It’ll feel like the first time you’re learning IPR. I don’t want to do this. This feels wrong. But actually this contact opening technique has been absolutely brilliant in the clever way to support a wedgeless technique.

Dental Pearl
The Protrusive Dental Pearl I have for you today is actually about wedging in a way. It’s probably a recycled one from one of the older episodes, but the value of pre wedging, like here I am saying that wedges are important, and then I told you that now I’m not even using a wedge in many scenarios because I’m using the greater curve protocols, but I’m still doing pre wedging.

Pre wedging is like, for example, you get a wooden wedge and after you’ve numbed up the patient, you’re going to put the wedge through and you want to get it really through. You want to build some pressure, right? And sometimes when I’m breaking contact, I like to use like a FenderWedge or one of those plastic wedges with that metal shield, right?

To make sure you don’t damage the adjacent tooth. So we don’t want the atrogenic damage either way. I’ve got some sort of wedge in there and the benefits of pre wedging are brilliant. They really help you out in making your restoration, your class II, which are tricky things. It makes it easier. For those of you who already pre wedge, you know the benefits too well, and you can’t imagine doing a restoration without pre wedging first.

But if you’re not yet converted to pre wedging, give it a go. Get that wedge in before you start to remove the caries or the old amalgam, and you’ll see that it gives you access, better access to sub gingival areas. Perhaps it’s just slightly sub gingival, but because you introduced a wedge and it’s been there for a while already, by the time you take out the wedge to do your matricing, the papilla has now already been suppressed.

You don’t need to remove the papilla, you don’t need a papillectomy because the wedge just suppressed your papilla. So whilst we do talk about not using a wedge, I’m still a big believer and a fan of pre wedging. Hope you enjoyed this episode and just to let you know, some aspects of this episode are exclusively on Protrusive Guidance.

Why? Because this is a public forum and some of the things we discuss when it came to communication, fee setting, what is a fair price to charge patients, if the patients kind of come across stuff, it’s not really the right platform for them. It’s like strictly dentist talk. So the best way to consume this episode would be on Protrusive Guidance.

It’s our free app. There are also paid plans for CPD and my masterclasses, but essentially the community is free and you can access it. The behind the scenes, the hidden talk that I’m telling you about fully on Protrusive Guidance. But I hope you enjoy this talk about the wedgeless technique and something called the concept opening technique. And I’ll catch you in the outro.

Main episode:

Dr. Sunny Sadana, welcome again to the Protrusive Guidance podcast. This time, actually on the podcast before we went so visual, we had this beautiful visuals. And if anyone hasn’t seen this episode I did with Sunny, just walking through like, all the mainstream matrices.

There are the pros and cons lovely little table you made. That is an absolute peach of content that’s on YouTube, but I want to make something that’s widespread spread this knowledge across the world through Spotify, Apple, and other means. How you doing, buddy?

[Sunny]
I’m good. Jaz. Nice to see you as always.

[Jaz]
It’s been great to see your journey over the years. I briefly I met you when Pay organized this thing with Enlighten, like briefly across the room. And Pay said to me, you know what, you need to meet Sunny, right? And then when you spoke, I was like, wait, who’s speaking? And I saw Sunny, you, you have like the most cockney, he’s the most cockney, the most cockney person I know, right?

So that was quite pleasant. It’s been great to know you, your ethos and everything. So Sunny, I know you, the community knows you. For those listening, watching, haven’t come across your work before, tell us about you.

[Sunny]
So I am a practicing dentist. I mainly do restorative. So, and that’s mainly on a referral basis. I’m also the head trainer at DRE Composite. So the DRE Composite course, which stands for Direct Restorative Excellence, not Dr. Dre and yeah, composite is my thing and yeah, live and breathe it. And particularly using this matrix system called a greater curve, the greater curve matrix system, which absolutely changed the game for me and for many other delegates now. That’s pretty much me in a nutshell, clinically at least.

[Jaz]
Let’s talk about that because you influenced me a lot with this matrix as well. So the greater curve matrix has always been on my radar. I’ve been on dental town before. I have American friends and therefore, we know about the greater curve matrix. And then essentially you. We’ve got the license. Is that how it works? You’ve got the license to distribute it and teach on it in the UK. Is that how it works?

[Sunny]
Yeah, pretty much that. But I mean, the way that actually all came about was after sort of a eight years of trial and error, should I say, I didn’t have the smoothest of dental journeys, became quite depressed for the whole thing.

I found dentistry quite difficult, NHS practice to NHS practice. Then I went to a squat private practice and realized I wasn’t that actually private dentistry wasn’t the saving grace. It was actually, it comes down to your skills and your abilities with patients and how you communicate with them and being able to adjust with them and all the rest of it.

And so I did what everybody does, right? Taking your advice. I did a bunch of courses, right? All the big names, did spend a lot of time trying to learn from some greats. Hopefully, some of their magic will rub off on me. But sadly, it just didn’t transpire that way. So after spending quite a lot of money, having a young family as well, moving into this squat private practice with very few patients, you can imagine the pressure was on.

And so the fact that it wasn’t really materializing in, I don’t want to tarnish it by talking about the money, but I mean that we’ve got to live. And it just didn’t really turn up. Yeah, I was kind of at my wits end. Tried to actually leave dentistry for a while. If anyone’s on the dentist who invests Facebook group, they’ll probably see my Bitcoin analysis.

And let’s just say that didn’t really work out as well as I hoped, but I’ve been given a third chance this time, so we’ll see how this cycle goes, but nonetheless.

[Jaz]
#WhenLambo. [overlapping conversation]

[Sunny]
Lambo’s a bit cheesy, but I do love the Lamborghini Urus. The truck is actually quite cool. Nonetheless, returned to sort of dentistry, really determined to make a good go of it. And so I just really doubled down and everything. And I spent a lot of time listening to American podcasts, Howard Farran’s podcast in particular. So really influenced by him and just the pragmatic way that Americans thought.

And in my mind, I thought that NHS really bogs people down and the conversations are about UDAs and this. And I just felt like shackled by that mindset. So I really went into the American side of education and doing some, and that’s when I came across dental town. And then I came across, I was always into composite.

And then I came across the greater curve system and at the time there was like 17, 000 posts about this matrix. And I’m looking at it thinking, hold on, there’s no wedge here. There’s no ring. Yeah, this guy was getting a great contact. It just looked ridiculously simple that how-

[Jaz]
It’s like voodoo. When you first come across it, like, I’m glad we’re talking about it already because I was going to ask you about the whole journey of getting Greatest Curve to the UK because previously, lots of dentists, as they’re now, obviously they buy from you, but previously they’d go straight to America and try and bypass customs, et cetera, to get this kind of stuff over here.

And so it’s great that you did that. And it’s nice to know that, okay, that was your journey to getting it, but you’re right. The biggest shock factor for me, cause this episode, I want to talk about all the different types of matrices, I guess, but the biggest shock factor for me, which I was skeptical about was the whole thing about wedgeless, right?

And then I’m not going to say the next point because it’s too early in the podcast to give two shockers to everyone. Let’s just start with one. Okay, you don’t need a wedge when using this matrices, which was like, we could totally discuss that and then how that works out. Why that can be advantageous in a moment, but please carry on. You were also blown away like I was eventually about the whole no wedge technique. What else did you find compelling?

[Sunny]
I mean, there’s lots of, I suppose, rubber dams, like a big massive topic, right? Whether people will die on that hill, right? But there are downsides to rubber dam as well. Sometimes it doesn’t work as well. It’s technique sensitive, some patients don’t tolerate it nonetheless. So, it’s almost like you use rubber dam, you get a good bonded restoration. If you don’t, you don’t. But we’ve all got restorations where we didn’t use rubber dam and it worked out quite well.

And actually the pivotal thing was the moisture control, right? It’s the isolation. And the thing that was really compelling to me was the seal from this matrix alone, you can actually get standalone isolation. So, instead of just not using rubber dam, you could use a split dam and put greater curve on, and yeah, pretty much you’ve tackled all the problems right at the local level, as well as controlling for humidity and all the other benefits that we have from rubber dam, including protecting the airway and all that good stuff.

So anyway, did you see lots of shots like that? I was like, I’m not sure I could post that on a UK Facebook group without getting shut down, but here we are, with lots of dentists.

[Jaz]
Not by the rubber dam police.

[Sunny]
Exactly, exactly, exactly. But my point is that use rubber dam, I’ve got nothing against it, right? But there are times where you can’t and example being, and I know we’ll get onto that as well, DME, right? The funniest part about rubber dam is at the deep margins when you really need it to work, it just doesn’t. We have to split it. And so, that’s where Greater Curve shines and we’ll talk about that, the whole sub gingival, how I’m pretty much, I’m not a specialist, I don’t have a diploma, but I’m able to tackle pretty much. Anything that comes across my table, anything that’s referred to me, I can deal with it. And so for me, that’s magical, the ability to serve patients to that level is magical. So back to, yeah, go on.

[Jaz]
With the seal that you mentioned, just for any of the younger colleague students, the seal we mean is that gingival seal, i.e., the very deepest, darkest bit of your cavity, right? The bit that the seal is the deal in that area. And you’re right, I was quite impressed with the divergence that you get from the greater curve, hence the name, greater curve, I guess. And then, the way it tightens at that base and the ability to get the seal where sometimes you wash a cavity out with three in one, there’s the spray, right?

And then you dry it, but then there’s still liquid residue. There’s still water residue, fluid, at the bit, at the base, a lot of time, not every time, right. But a lot of times I’m blowing air and it’s like super dry. I’d never been, ever have been able to achieve that with any circumferential matrix, but I guess let’s just start with that then.

2024 you are unique. And I know you are unique, but you’re spreading this methodology and this way of thinking whereby you are looking for a pragmatic solution. And obviously, let’s admit it, you’re going to be biased as your sister is your baby in the UK now, right? You’ll be biased because this is your matrix.

And recently, I know I did some episodes about BioClear matrices and stuff. So I’m not here to say that any one matrix is the best. Cause in my hands, I’m using your matrix, the greater curve, not your, but you know what I mean, the greater curve one. 70%. That’s a lot. I mean, you asked me two years ago, I didn’t own a greater curve matrix man.

So obviously it was zero. So from zero to 70 percent of all my restorations, okay, are now greater curve. Number one reason being is my patient base is 60 plus, and I’m most of the time replacing behemoth amalgams which is subgingival. And they’re pretty much, okay. you know what? We can probably go indirect here and go ceramic.

Which I do a lot of as well, or we can go a large restoration. And therefore, my matrix band of choice is the greater curve. I still use sectionals because I just find that and this is a real important point is because I went through a phase, Sunny, of using sectionals, like for everything, like no matter what the cavity ended up looking like in my mind, I was like, if I’m not using a sectional, I am a deficient dentist.

I am cutting too many corners. I am not being anatomical, whatever that means, right? So therefore I fell into this trap of Emax trap as well. But at one stage, I know Zak went through as well. Everything was an emax onlay at one stage, right? Like I went through this phase. So everything was an Emax onlay once upon a time.

And I know people listening and watching are going to resonate with this. Everything was a sectional matrix once upon a time. And then you realize, you know what? You got to use the best tools at your disposal and you got to adapt it for what you have in front of you and sectionals when it got too big.

When it got to medium to large, yes, it can be done, but it’s a lot of effort for the reward, which can be unpredictable. That’s what I found. What was your experience with sectionals, as you developed into your enjoyment and fulfillment of composites?

[Sunny]
Well, I mean, my experience with sectionals was never that good, in fact, learning from some really great dentists who are doing this magical stuff, and then I’m getting back to the surgery after doing 10 hands on days, and then I still can’t get a sectional to work, right?

And then I thought, is this just me? Or are there other people that feel this way? And that’s obviously what spurred me to go and have a look on these American forums. And also just for the American approach in terms of just the business of dentistry, right? So again, really influenced by Howard Fran’s book, Uncomplicate Business, Uncomplicate Dentistry, I believe it’s called.

But it’s a business book about dentistry. And it’s one of those books I listen to every year just to really center myself when it comes to all things business and dentistry. Nonetheless, on that forum, I found the system, I ordered it 2018, I started using it for two years. I just gave up on sectionals because it made that much of a difference to me.

Immediately, I just didn’t need them anymore. However, I didn’t know a single soul that was using greater curves. So here I was trialing and erroring away for two years by myself. And yeah, of course-

[Jaz]
You had the forum though, right? You were on the forum, I guess, picking up tips and sharing.

[Sunny]
And I was a lurker 90% of the people are, right? Social media is quite a new thing to me, right? It wouldn’t look that way when people look at my social media, but it’s quite a new thing to me. And so prior to that, just a lurker really, I was more into playing football really than being too much online. And so that was a bit of a shift. So I didn’t really ask any questions there either.

And then the stars really aligned in 2021. I actually heard Dr. Brown, the inventor of the greater curve system, right. And this is a dentist in his seventies, four years of experience talking absolute truth with Howard Farran. And I was just immediately drawn to this guy. I thought, wow, this guy’s pragmatic, super pragmatic.

In fact, he says something super outlandish. He says on the podcast, I do most of my dentistry without a rubber dam and nobody can say that and it’s almost like contentious. He’s like, Oh my God, what about a person? But this guy’s got amazing recalls, 10 years plus of ridiculous things, built up an apple core style incisor or lateral.

I can’t remember the one that, and then he used that with rebond the tooth replace the direct reboond bridge to replace the central. And the last he saw it was five years strong. And so it just mind boggled me what was possible. And I knew things were possible, that I didn’t think was beforehand.

For example, training with Sabir Banerjee, you’d see his recalls 20 years old when the composite was rubbish and there was no air abrasion. And so I just knew there was a world of possibility and I just never had it. And then I got to taste it with this system. And then anyway, once I heard Denny on that podcast, I emailed him and he said to me, let’s jump on a zoom.

So we did. We hit it off, we had some real stuff in common. He was interesting thing about him is he was a Vietnam War veteran before he became a dentist. So I actually served in a war. It’s pretty gnarly stuff, right? But very, very down to earth, humble guy. And nowhere near that level of service, but I was an army reserve for five years.

So we just had this kind of common ground and understanding. And for both of us, it’s pretty much like what’s the most effective way to do anything with the least amount of steps, right? You want to be the most direct, most effective. You don’t want to go around the long, windy route for no reason, unless it had a strategic benefit.

So we just kind of really aligned in that way. So then he said to me, stop giving me your cases. So I did. And then with that, that was pretty much the beginning of this sort of mentorship from 4, 000 miles away. And so we would do these calls very routinely. I bring my cases. He basically retired after COVID as well.

So yeah, it was just really a kind of like a natural fit for us to kind of, we became friends from this point. And so I continued in that capacity for probably about nine months and my dentistry got so strong.

[Jaz]
Do you mind me asking, Sunny, was it a paid arrangement or was this this guy from across the Atlantic just being super nice to you and just like teaching you the ropes and giving you his time?

[Sunny]
Exactly that. So, what a top.

[Jaz]
That’s rare.

[Sunny]
Yeah, what a top guy, right? What a top guy. So, I’d like to think it was something to do with my charming self too, but no, I mean, he’s a great guy, right? So, I’d love to be thankful for, in that regard, giving me the time. And so, people sometimes look at it and go, it’s just a matrix, why do I need to look, there’s so much nuance to this thing.

You name any restorative problem, you think of something that is tedious, difficult. Once you’ve been trained, this thing just solves it, right? Black triangle, diastema, extreme subgingival class fives, direct composite onlays, with the way that we’re doing it, it’s just so slick that the time it takes is just minimal, right?

And no patient wants to be in your chair longer than necessary anyway. So patients love it. You’re giving them a great result. And we’ll get into how the market values these kinds of treatments because sometimes, composites are kind of seen like a bit of a tedious thing that we have to do, but actually very rewarding for patient and dentists for many reasons.

Anyway, nonetheless, from that mentorship, my dentistry just really improved so much so that nine months after that, quite bold move. I left Associate Dentistry to set up a private referral service. And so, the beginning arrangement was pretty much I was visiting people’s surgeries and doing cases that they were going to extract these teeth pretty much. And so they’d send them to me, I’d do it, and then that was how that started.

[Jaz]
How do you even begin to create a service like that? I mean, how do you even, I imagine you just have to contact all your colleagues that you know, be like, listen, this is the kind of dentistry that I think I’ve got an interest in that I really enjoy. And these are the problems that you guys probably don’t want to solve. And I’m here to solve them and take them off your hand. Was it just that, and just letting them know that you were out there and ready?

[Sunny]
You know, life is like serendipitous sometimes, isn’t it? It’s just so funny how these things unfold. The initial arrangement, funnily enough, wasn’t a restorative service. It was me and a friend and we set up an endo referral service. As a non endodontist, which is crazy now when I think about it. ‘Cause I did a few courses.

[Jaz]
What?

[Sunny]
Yeah, I know. Don’t even start on that. In fact, I remember the first clinic was so, so crazy now. Really nice married couple that owned the surgery once, a dentist one up really lovely people. I got all the time in the world for them and that’s how it unfolded. It was so crazy that my friend’s mom was seeing the lady dentist as a patient and then she had said, oh, we’d start this practice.

We’re looking for dentists. She said, my son’s a dentist. And so that’s how we got in touch. And so I went for this interview at the time, right? Wanting to move on from where I was and it just turned out that it wasn’t going to work out for me to be an associate in that respect.

Like I wasn’t doing NHS at the time and all the rest of it. And then it just struck me that actually they were like referring some stuff out of their surgery. And I just said to him, look, why don’t you send those endos to me? I’ll do them in house. My friend will come and assist. And then, you keep the patient, you do the crown, we’ll split the income.

And I remember the first session we did, I think we started like one o’clock in the afternoon and we finished like 11.30 at night. And I found an MB2 at that point. And it was just awful. And the practice owner, my non dentist friend comes into the room and he looks at me and he goes, oh, we had a cracking day, didn’t we lads?

And I was like, yeah, cracking, absolutely cracking, you know? And now he’s just like, what have I done? So that was the birth of the service. And then because actually the thing I was best at was these really gnarly teeth that needed endo. I can fix them up really quickly though. I could do a pre endo build up so quickly and they’re just a really slick little clinical tidbit of how that works.

You’ve got these really broken tooth guys, got irreversible pulpitis or something, and you need to be able to get a clamp on. And actually sometimes you can’t get a clamp on a really broken tooth like that. So you can put greater curve on there. You can add just a little bit of EDTA, right?

So no hyperchlorite and you can do your coronal flare. Yeah, you just do your coronal flare, make that space, put your GP in there, and then etch and bond around it and build up your wall. And so you’re maintaining that straight line axis, nothing’s going down the canal, and actually it’s pretty easy to do the endo from there and then fill the centre, right?

And a lot of these guys are going to go for indirect. But I know I’ve done that DME or the wall or the actual core, whatever you want to call it, I know I’ve done that really, really well.

[Jaz]
Perimetrial buildup is something that Pasquale Venuti says, you know what, I was actually thinking of Pasquale earlier when he was talking about it because one of the issues that Pasquale is very good at pointing out is when we are doing, for example, class fives and you see some dentists. They’ve got rubber dam on, they’re doing these class fives, right? And you can imagine now you’ve got like the most distal molar clamp. You’ve got the most mesial clamp because why not and then for the class fives you’ve got like two brinkers B4 and so in 2017 I was in Sydney or Melbourne right and I was there Pasquale was lecturing with Lincoln and he described it as the sulcus. So he was, it’s a sulcus, right?

And he was like, I love this. He’s right. This is the sulcus, right? Because he just said, sod all this. Just whack some PTFE in the circus. You can be fine. And that for me was like, paradigm shift. Like, yeah, he’s right. Why are we juggling this? And everything’s like falling out and collapsing. And you can’t do it on stoke, in stoke and Tuesday night.

You can’t do it in your practice. Only the elite can do it. So that was the first taste of that. And everything you’re saying is very much echoing that thing about making things easier, breaking things down. Why not just, cause it’s not sexy doesn’t mean you can’t just use one clamp, which is actually superior in many ways to get that seal in the trickiest of cases.

[Sunny]
I mean, interestingly too. I mean, we were talking about that, but I mean, for me. Hands down. I am biased. Everybody knows it. But I mean, when it comes to class fives, you can give me some really, really difficult ones. And I’m going to get that done with a greater curve. That it is so, so straightforward. And then any worries that you have.

[Jaz]
Dude, you do everything with a greater curve. I just want to emphasize that.

[Sunny]
That’s right. That’s right.

[Jaz]
Sunny will do a class one with a greater curve. No, I’m just kidding.

[Sunny]
Well, you laugh at that. But like if I’ve got an upper eight and it’s like really difficult to keep it dry, I put the greater curve on and I do it. So, yeah.

[Jaz]
That’s true. Okay, fine. But that’s actually true. So there we are. You name a class, you name any restorative scenario and you’ve got your trusty greater curve, which, it’s a learning curve, and that’s why you run course on and stuff. It’s a learning curve, but having used it now for 15 months now to 18 months, when you introduced me to it, I have to say, like I said, 70 percent is big deal.

I think if I had a younger population, I’d probably use it less. However, having said that, if I had a younger population of patients, then perhaps post orthodontic, black triangles might be more of an issue. And I’ve seen you and your colleagues do so many great black triangle closure cases as well, especially using that brass one, for example, or the U band.

You’ve got different matrix designs, but fundamentally, let’s talk about the two most shocking things about this system. So just to recap, guys, matrices. Nowadays, I’m using greater curve, 70 percent time, circumferential matrix, which I never thought I’d be saying, like, if you asked me three years ago, I would never have said that I’d be using a circumferential, but it is what it is.

I’m mad enough to say that if something good comes along, I’m just going to accept it. I’m going to be like, you know what? Fine. What I was doing before, and this is better. I accept it. Let’s move on. And so that’s the situation. Now I’m using a Palodent. I’m using Tor VM in those smaller cases.

I’m still using rings in those smaller cases, but that’s about 30 percent of my work. Anteriorly, class threes, massive bugbear for me. Honestly, I hate class threes, especially through and through class threes, right? Through and through class threes. I find very fiddly. I’ve done the whole thing about the Mylar strip and the wedge, and it gets very fiddly.

And then when you told me to use the greater curve for the class three, I was very, again, skeptical. But it went really well, the seal. And so I’ve enjoyed a few cases doing it that way as well. But like I said, you use it for everything. And so you can find your perfect ground. And if you like using sectionals, still use sectionals.

But when you have that case that is super subjunctival and is tricky, don’t try and put a square into a round peg, right? Don’t do that. Just use a system that’s actually built for that purpose. Because part of the beauty is wedge less. So tell us, why is a wedge less scenario advantageous in those deep sub gingival cases.

[Sunny]
Maybe not just for sub gingival, just in general, well, actually let’s address that point head on. First of all, when it’s super sub gingival, to get that seal, you need to put a wedge really sub gingivally, and often that is tricky, right? Then you can sometimes actually dentists who’ve got all these different types of wedges and they’re still struggling. And then the trade will have five wedges, four sectionals that they’ve gone through, trying, playing to see, you know, to see which one fits

[Jaz]
Customizing the wedge yourself with the bur, the wooden one. And then the diamond wedges are great. Diamond wedges are great, but sometimes even then you’re not going to be able to get that low profile.

[Sunny]
Totally. And there’s variability in the patient, right? Some people have these thick, soft tissue, that’s really hard to put anything down there. So nonetheless, we’ve just got all these variables to deal with. Whereas, not having to worry about which just takes out variable way.

So, I do offer like a free CPD sessions on our website, right? People can just book it, one on one for their practice, whoever, just so they can actually see these scenarios. And the first few subgingival scenarios I’ll show are just plug and play solution. It pretty much is you see the greater curve, you tie it in place and it seals there, and then there are more extreme examples where I’m talking like, almost Crestal, really, really sub gingival.

We’re able to do that, but of course there’s a bit of a technique. We call it a cervical relief technique. You’ve posted it in Protrusive Guidance where you adjust the bottom of the band. But those are, I don’t commonly do that. But there’s a nice clear sort of progressive framework that if this, then that, so then when it comes to sub gingivals, there are like only four things that we do.

And we just go in that order until you get to get the seal. And if you can’t get a silver greater curve, it’s quite unlikely, that it’s going to involve crown lengthening at that stage. It’s going to need something beyond direct resto

back to your question as well with wedges. So yeah, number one with subgingivals, quite difficult to even just get a wedge to do its job. That’s number one. Number two is getting a contact when it’s really, well just in general, getting a contact can be difficult sometimes. And then when you’ve got wide spaces, the more subgingival it goes, the wider this space becomes as well, just by nature of the lesion. And so again, having to try to wedge there to get some separation to compensate for the thickness of the matrix in hopes that it comes back, touches, and gives you a contact, can sometimes be very hit and miss.

That can be hit and miss for people when they’re doing quadrants, right? I love a good quadrant. I think it’s one of the most underrated things in dentistry, right? You don’t need to market for it. You know, there’s no lab bill, it’s not Invisalign, there’s no implant complications, your indemnity doesn’t go up, but patients all need composite, right?

And so when you can do a quadrant really well, it’s pretty staggering. Like, just delegates, forget me, people see my cases, they see my efficiency. That’s cool. But then a delegate can come and do six weeks with us, and then they can turn around and say, I’m doing these quadrants in one and a half hours and charging average costs.

[Jaz]
Well, I want to talk about this specifically, because I told you on the phone that, a lot of patients have started to watch you on this YouTube channel. If you’re a patient listening to me on Spotify, God help you. If you’re a patient on YouTube right now, get out of here. It’s not for you, it’s for dentists, okay?

Like, just leave. Okay. And so some of this parts of this conversation, which are super cool, super important communication kind of stuff, I’m going to reserve for Protrusive Guidance. So if you guys are not on Protrusive Guidance yet, protrusive app, come on there. There’s a space there for, to discuss greater curve cases and that kind of stuff as well, which is pretty cool.

But I want you to come to there to come to this extra bit that Sunny’s going to talk about where it comes to efficiency and workflow and make sure you’re cost effective for your clinic as well. But we’ll come to that. But yeah, the whole wedge thing, like you said, you put the wedge in and then the contact opens up. You’ve lost your contact.

[Sunny]
Yeah, exactly. And two situations really come to mind as well is that sometimes where you got like first of all, I’ve just got two really distinct things that I know we address quite well as well in my mind. One is when you have like a complex cavity, where it’s just not perfectly spherical anymore, and you put on let’s say a pro matrix, this thing collapses in and you get gap in one side, it just kind of contorts, right?

And so that’s one very common issue. Then the other one is in a similar way, where you have a wide space, you put this matrix on, you’ve already got space, and now you’ve got a wedge, and it makes the space worse. And so now you’re playing gymnastics, trying to do stuff with this matrix, trying to hold it over and all the rest of it.

And it’s just super difficult, and that is, again, I show that example from our episode, and then I show the next example, and then I show the exact same scenario with the greater curve on and you’ve got this fantastic seal, even though it is an irregular shaped tooth. And it lies up right where the contacts need to go. So just from the design alone, even if you didn’t train with me, that is a big difference to a lot of people’s work immediately, just from a design perspective. But of course there are.

[Jaz]
Well, objection number one would be then if you’re not using a wedge, then how is it able to achieve the seal? Just to recap that, how is it able to achieve a seal? Because lots of matrix systems, they rely on the wedge to get the seal.

[Sunny]
Sure. So, I mean, the best analogy, I think is like a tourniquet. You know how a tourniquet works? Maybe that’s too mainstream. Maybe, like, it’s a bit gruesome, but like an a noose. You know how an a noose works? Right? You know. Oh my god. Yeah, I know, it’s gruesome. But, I mean, it probably makes it very clear how it works. So, imagine, the tooth is the poor soul. And then the noose is the matrix, right? And it just literally tightens around the next super tongue.

[Jaz]
I got one for you that’s a little bit more PG, yeah? How about we call it the floss ligature? How floss ligature works? It’s dental as well, right? And that’s a great example, right? You know how it goes more apical when you pull it?

[Sunny]
Sure, sure, exactly that. It’s exactly like a floss tie, right? It’s just made out of steel or brass. So that’s how it works in regards to the seal, yeah? So we’re not relying on a wedge for that purpose. And so, in getting the contact without a wedge, then, we do a technique called contact opening, right? Which basically-

[Jaz]
Which is the first time you’re blown away is, What? No wedge? And then the second time, you almost collapse. Contact opening, what did he say? So you got to explain this. Everyone just like, if you’re chopping onions, stop. This is important. This is going to shock you. All right. Go for it.

[Sunny]
I mean, I’m just going to like me. They love the steps. I’ll just paint the picture. You’ve got this matrix in place. You’ve got the seal. Lovely. It’s lying up against the adjacent marginal ridges. You take your burnisher just under a rounded marginal ridge in the upper third of the crown, you’re going to burnish really firmly for 10, 20 seconds, like a lot of people do. And then the difference is you would take a fine rugby bur.

Yeah. Fast hand piece, no water. And with the belly of the bur, the max convexity. You’re going to gently rub left and right on that spot where you just burnished. You rub it left and right, you take it off, you have a look again. You rub left and right, you take it off.

[Jaz]
Water or no water?

[Sunny]
No water because we need to see, right? And you continue to do that check in until you remove that final layer of matrix. And there you have it. You have this contact opening. A literal space in the matrix where you do not need the matrix if you want to get a contact. And when you do the technique correctly, the actual edges, the peripheries actually got a quite a nice bevel just from that side to side motion.

As a result, if you see any of my videos, when we’re introducing floss in and out, it’s super smooth. Doesn’t fray, but it’s pretty cool. Nonetheless, from that point, we want to make sure that that contact open is super smooth. So when we run a probe from the greater curve metal, the brass or the steel, and then it goes onto the tooth and then goes onto the metal again, we want to make sure that that’s seamless.

We want a really nice seamless transition. And for obvious reasons, we want to remove this by band. And then when it comes to removal, let’s just keep it easy now, we’ve just done an MO, and people are probably thinking this because I was, like, oh, hold on, aren’t these teeth glued together?

Actually, it’s a super weak bond between this very small space, right, it’s roughly a millimetre, or two millimetres, if it’s a largitude in diameter, roughly. Take a flat plastic, twist, you separate that weakly bonded composite, and because it’s so weakly bonded, it doesn’t splint or fray, some of those objections may come to mind, they did for me. But yeah, I’ve been doing this since 2018. It doesn’t splint or fray. In fact, it’s a super smooth transition from that point we take four four steps.

[Jaz]
I mean if you do this wrong though, like no I’m just going to point out if someone does it wrong whereby they haven’t done the burnishing. The burnishing steps really important with the instrument because If you don’t do that and see where you need to actually do the removal of the metal and you don’t appreciate it then you might be actually too apical And you might be actually poking a hole in the gingival embrasure space and not against the contact.

And if you do that, then the composite, it makes a mess. So you got to be a bit judicious, but you’re right. Like the whole thing, like firstly, you got to convince yourself that what you’re doing is correct. It’s like when you do IPR the first time, it feels dirty. It feels wrong. Like how dare you do IPR right now, when you come to terms with, okay, I’m going to remove the metal and see the contact or the restoration next door.

And bond directly to that, except you’re not actually adding etch or bond there obviously, but like the composite is touching right against it, right? So that’s like a paradigm shift. But when you’re doing that, it is a great way to get a contact and I can vouch for the fact that, yeah, it works, but you just got to just train your mind.

And also the second person you need to convince other than yourself is your nurse. Literally Zoe thought I lost my marbles the first time she saw me do it. It’s like, wait, what’s he doing? So you’ve got to actually just give your nurse a pep talk.

[Sunny]
Sure, sure. 100%. And look, there’s two kinds of dentists I really encounter, right? There’s going to be the dentist who says, give me the kit, I’m just going to figure it out, right? And that’s cool. They can do it. In fact, for them, I’d say, look, don’t start off with the contacts opening immediately. Instead, just get used to how the system works, how it all seats and do all that.

And instead, just burnish and wedge as usual. Yeah, just at the beginning. I just use it as a regular matrix. No drama. Then there are other people who say, look, this makes a bunch of sense to me. There’s many benefits I see to this. I really want to position myself as to be the guy who’s really good at composites.

And we could talk about why I think composites, my largest thesis at play here is actually I think composites the future, really bigger picture for patients and dentists. And then those guys are the type of people who say, well, show me what you got, let me spend six weeks and let me just take the whole framework.

Let me go from beginning to end. Theoretical to technique. I mean, for example, the way we break this down, we call it the BOSS method. So B is regarding band on, and then O is for opening, whether you’re doing a contact opening or an access window, S is for seal. And then the next S is for snowplow.

And so people are probably familiar with some of those things, but we spend time on each of those things so that you nail it and you don’t waste time in practice making mistakes, right? You make mistakes with us on your hands on day, and then you just get into the surgery and get going. Because nothing worse than faffing around with your patient looking at you, because they do detect it when something’s not going smoothly.

[Jaz]
Well, I just want to make the contact opening technique a bit more tangible, because in case people are thinking, wait, is that what they said? Because they might have misunderstood. So, you’ve got the matrix band on, you’ve got no wedge, you’ve got a lovely tight seal. Literally, it’s so, so nice and tight, and it’s good, there’s no moisture, okay?

The metal band is up against the adjacent tooth, right? So, let’s say if you’re doing an MO on a first molar, you’re up against a premolar. You’re now going to get the rugby ball. Now, I do it a different way. I’ll talk about it in a moment. Mahmoud taught me this way. So, you said it was rugby ball. You remove, use like a yellow or red, a microfine one, right?

And just gently sway around until you just perforate through the metal. And now you can see the restoration or the tooth adjacent. Obviously, before you’ve done this, you’ve burnished with a metal instrument like a ball burnisher to make sure you know where you’re going. Now, Mahmoud taught me, what’s this technique called? We use the rose head and use it in reverse.

[Sunny]
I actually got that name from him.

[Jaz]
I love this.

[Sunny]
I actually got that name from him. So credit.

[Jaz]
It’s amazing. So shout out to Mahmoud. I love it. So put the rose head, I think I put it about 15, 20, 000 quite fast, but in reverse. So the cutting is very minimal. And I just see that thinning of the metal.

This is now my preferred way right now of doing the contact opening. So you do that, and then when I’ve posted this on social media before, people message me saying, Jaz, won’t your composite stick to the next door? And what about the etching? Do you do the etching and bonding before you do this?

Well, actually, no. Correct me if I’m doing it wrong as part of the protocols, but I do the washing. I do my etching and bonding after the contact opening. I’m just careful not to get the edge of the bond. For the window, because the window is where the contact point is. And the apical cavity is way down there. So there’s enough of a margin for you not to be cat candid enough to get it in that window.

[Sunny]
Totally, totally. But my point is there’s tons of options, right? You can go the full hog and do the contact opening. You can just use it as a normal matrix and wedge as usual. Or you can go halfway house and do super burnishing. Which you can just thin the matrix out quite a lot without even doing the contact opening. I still recommend a wedge with that though, just so you get the same predictability. But the benefit of the contact opening is the predictability is just there. I can’t remember either in a context.

[Jaz]
Wait, you’re saying use a wedge with the contact opening?

[Sunny]
No, no, sorry, I’m saying if you’re going to do the rose head technique, yeah, what you just mentioned. The super burnish, yeah, inverted commas. If you’re going to do that, then I recommend still using the wedge just to apply some separating pressure. If you’re not going to make a contact opening with the rose head. So some will just thin it.

[Jaz]
Oh, no, no. So yeah, fine. So I understand. So if you’re not going to be brave enough to contact the adjacent tooth in your early stages, then to get a bit more separation from the wedge, not necessarily the seal, because you already have the seal, but just get more separation. Can you use a ring? Do people ever use a ring with a greater curve?

[Sunny]
I’ve not really seen it. I don’t. Denny never taught me to do that. So I’ve never really seen it. And then I think actually might interfere with the flare of the-

[Jaz]
Just imagine it. Yeah, it might mess up the flare. And then it might get like a convex concave kind of thing going on around the edges. So, yeah, I had never done it either. It was just a wonder.

[Sunny]
What we’re trying to teach as well is we’re trying to teach an approach for any dentist, anywhere with whatever they have, so the common tools that dentists will have, we’ve give everybody what they need, but these are basic tools that everybody has, and they’ll be able to do this, good dentistry.

The example of where that would probably get in the way is like, say you’re doing like an MOD and a class five and you’re using a U band, right? This guy’s my favorite, by the way. And you can actually do this class five and the MOD all in one go, but then putting a ring in a way. Another variable, and then we’re going to have to teach when to use a ring, when not to use a ring, just by not using a ring, it’s not going to interfere with that setup. Does that make sense? So actually just, I just wouldn’t recommend just even needing rings. It defeats the point, the whole point of this is simplicity, you know?

[Jaz]
You don’t own a ring, yeah, you don’t have a ring, you don’t have a ring in your server.

[Sunny]
There’s no ring on it, no, there’s no ring. In fact, what I’m going to do is actually, because I travel to different surgeries, I’m going to take a video of what’s in my trolley, right? People always curious to know what I work with, but it’s pretty simple.

[Jaz]
Just like a billion greater curve matrices.

[Sunny]
Yeah. Hundreds, hundreds. But then just so that we’ve completely made it tangible. Then you’ve twisted this bonded contact, inverted commas again, with this flat plastic is separated nice and cleanly.

No problem. You take forceps, close to the tooth as possible, yeah? Parallel to the long axis of the tooth. You grab the band nice and close, and you rotate. You’re not going to pull it out, you’re going to rotate. And by rotating, you’ll feel how tight that contact is. And it will just move, dislodge, and then it just comes out, right?

And so, when you’ve got a great contact because that’s what happens. But here’s another top tip for people who aren’t using greater curve. Because I’ve been in this horrible situation. When I was using Palodent Sectionals, I remember this patient like it was yesterday, and I was doing a lower six and seven, and very particular patient, knew about dentistry, which is always a red flag sometimes.

When the patient knows more about dentistry than I did, but came in, said about the problem, all the rest of it, I started doing it, and then when I finished this restoration, I was trying to remove this Palodent Foil, and the three little holes, the top tab, the little hole, and then on the sides, and I used the Palodent for something, and it ripped the hole, because this contact was so tight, I had really, maybe I just over condensed it, or whatever else, or the matrix was really thin, and-

[Jaz]
All that army strength.

[Sunny]
Yeah, maybe, maybe, let me not flex my biceps right now, Jaz, I’ve been training, I promise. But nonetheless, I pulled it, ripped it, ripped the other side, ripped the top. I was like, what am I going to do here? And I literally had to drill the composite out to get the rest of that matrix out. So yeah, awful. So here’s the top tip for any, especially the young guys as well.

Yeah. Young guys and gals, you may have this problem. Don’t stress, always take a breather. They say these kind of adages in the army as well. That, calm is contagious. I stay calm, right? If you’re not calm, the whole team gets infected. Your assistant does, the patient’s looking at you going, why is there sweat dripping off his head?

So always, always good to take a breather, stay calm. Try and take your flat plastic and really get in between the sectional foil and the composite as much as you can. Yes, he’s just trying to separate whatever bond there is and then same deal, take a flat plastic twist the tooth in between just try and relieve whatever tight pressure that is in there and then get that forcep nice and close. And again, rotate it out rather than trying to pull it and shred it into pieces. And that works really quite well as well.

[Jaz]
So just to make it tangible, this is a bit like the sausage technique, not to do with implants, soft tissues or anything. The sausage technique was introduced to me by Lincoln Harris. It’s when you’re doing lower incisors and you’re restoring wear on lower incisors.

So let’s say you want to do like 1. 5 millimeters of composite on the lower incisal edge, and you want to do all four lower incisors at once. Maybe they already have a contact, right? But you’re going to put this big sausage of composite from lower incisor. So all four lower incisors, right? Then you just shape it and you get like your thin instrument, your IPCL or whatever.

And you get like the embrasures going. And then you’re going to get the shape right. And then you’re going to cure it. So it’s all connected together. But because you thinned it out with the embrasure, you can go into your flat plastic. And just twist, twist, twist, and cleave, and break the composite apart. So I do like a good sausage technique. Yeah. Let’s clarify. Have you heard of have you heard of Bud Mopper?

[Sunny]
No, I haven’t.

[Jaz]
Okay, this guy, I hope I’m saying his name right. We met him, me and Mahmoud met him in Chicago recently. He’s like, a guru of Composite in the States. Cosmedent. He teaches Composite. Cosmedent, right? And so, he had this, he called this technique The Mopper Popper.

[Sunny]
Oh, I have heard of this. Yeah, yeah.

[Jaz]
The Mopper Popper. So, I shook this guy’s hand. Walk away. And Mahmoud goes, Jaz, you know who that was, right? And I’m like, who are you? It was Bud Mopper. He goes, he’s the inventor of the Mopper Popper.

So the Mopper Popper is basically, just like you said, you get your flat plastic in and you just twist and it just breaks those bonds. The Mopper Popper is what you should be using, kind of, when you’re using the greater curve as well before you remove the matrix. Just so, to links back in again.

The next few things I want to talk about in the interest of time is before we do the whole communication bit, which is going to be off YouTube. One thing that I think is really important to get out there is the amalgam ban. 2025, you probably know more about this than I do. And I think if you’re looking for a solution, that’s going to be applicable to dentists working in a system where, we’re all time constrained, but sometimes we live in a service of getting our patients as healthy as possible, as quick as possible.

Then that’s where the matrix does shine in a way. And I think with the amalgam ban, I think what your matrix offers is a solution that’s like an alternative to amalgam that’s not GIC, like you can still use composite, but you just now made it in a way that’s very efficient, but you’re going to do a better job of explaining than I just did.

[Sunny]
Yeah, I mean, so if somebody’s just been doing the amalgams for a whole bunch of time, and then they’re faced with this uncertainty of maybe I can’t use this material I’m really good at, that can cause a lot of anxiety, right? And then what’s the closest thing to that is GIC, just pack it in a similar way, right?

And for any of your patients listening to this, I say there’s a massive difference between a filling, a metal filling and a composite restoration, you know what I mean? Jaz, we’ve talked about this a lot of times. But a filling is a hole and you’re filling a pothole with the metal, you can really do that.

And I’m not saying I’m very skillful dentist that can replaced many, many cusps. They can certainly do that, but the skill and technique required to place composite is actually, I think is quite different. The technical demands are there. There are prerequisites that are required in order for us to get a good bond and all the rest of it.

Whereas amalgam is very forgiving. So GIC isn’t an amalgam replacement. So for those people who aren’t saying, okay, cool. There’s a bunch of uncertainty. I do want to position myself to be able to do composites. Learning how to use a credit card system. You’re learning the techniques that we teach and talk about and talk with the whole efficiency aspect.

And we’ve got delegates out doing similar timeframes to our algorithms. You can get very quick and very effective at working this way. It’s very simple. It’s very effective. As mentioned, it’s the minimum number of steps to do a really good job. So, hopefully that addressed your points on that.

[Jaz]
No, no, I think it’s important to mention. I mean, whilst the number is shrinking year by year, it is something that gives some people a lot of anxiety, the fact that amalgam won’t be around, right? Because they’re so dependent on it. And so sometimes to have a way to be efficient in a world that’s free of amalgam is important to consider and will serve a group of dentists out there.

We’re now going to move this conversation. If you’re on Spotify, carry on listening. Apple, yes, carry on listening. But if you’re on YouTube, you might want to go to Protrusive Guidance website. It’s protrusive. app because then we’ll talk about communication. We’re going to talk about communicating fees.

Very important. Cause we need to charge you at worth. And I’m a big believer in that. And I think I want to just highlight a really good thing that you’re doing with your movement and what you’re teaching dentists, which is to value themselves. So let’s just hit it straight in the head. We’ve talked about this before.

A filling is what you put in a sandwich, right? And so, to give you an example, Starbucks. Have you heard of how Starbucks is able to charge what it charges? Like, the origin of it.

[Sunny]
The origin? Is it the comparison to Dunkin Donuts? Is it that one?

[Jaz]
Maybe. I mean, it might be to Dunkin Donuts, but essentially, like, every other cafe you ever went in had the same look, right? And they were charging the same amount. You go to the first Starbucks, like, whoa, am I in a coffee shop? It just feels different. And they’re suddenly charging twice as much as what anyone’s charging, right? And at the time, it was like, what, this much for a coffee kind of thing? But the whole experience was different.

They made a whole experience out of it. And so in a way, if we market ourselves, oh yeah, you need a filling. A filling is what goes in a sandwich. Just like you said, a composite, especially when you’re doing customer placement, you’re subgingival, the class twos are tricky. Class twos are definitely tricky, especially the bigger they get, the more tricky they get.

Sometimes even the claustrophobic ones are bloody tricky as well. So either way, it’s technique sensitive. It’s tricky. We need to position ourselves that it’s not a filling, it’s a reconstruction. It’s really important that we tell our patients that this is reconstruction. This is kind of like the Starbucks effect.

And I’m not saying this to be manipulative or persuasive or anything like that. It’s doing justice to what we are doing. We are doing a reconstruction. So please stop calling it a filling, guys. It’s a reconstruction of your tooth. And my mind was blown by our mutual friend, Payman. Payman Langroudi.

Many years ago, someone posted it on a group where he was just talking about fees and he was suggesting that how our composites should be charging at least half what our crowns do. And I was like, whoa, what? He and I had to read that again. Is that, you know, and I see what you meant because again, the time and the care and the longevity of these things is bloody good.

These things will last in their mouth, so we need to value it. And therefore, these reconstructions, okay, and essentially, same day teeth. What you’re giving this patient is not different to a CEREC in a way. I know people say, CEREC doctors are shouting at the screen now, it’s like, what the hell you say?

How dare you compare composite CEREC? But the care and the attention and the longevity is there, right? If it’s thick enough, it’s going to last. So any reflections on what I’ve just said here, basically on the whole same day teeth kind of thing, which is what we need to, that mindset we need to adopt.

[Sunny]
So many points and so many things there. I’m going to lose myself now. What I like to say, as I like to say, for just restorations, what we would say as a white filling, that’s a restoration. And then as you say, when this sort of hospital coverage, then it’s a reconstruction, it’s a big goal. So I just think I frame it slightly different than that regarding, there’s so many parts to unpack there Jaz. Where should we start? Sorry. No, there’s so much in there.

[Jaz]
I should have chunked it. I should have. But I just wanted to get it out.

[Sunny]
I should have bullet pointed that. But I think often when we talk about that, see, Payman said you should charge half the fee as a crown. That’s cool. I kind of get it. At least that’s a step in the right direction. But actually, I think actually we should be looking at, I’m-

[Jaz]
No, it was at least but basically the point he was making, the lesson was like, don’t think that, oh, a filling should be like a fifth of a crown. It’s like suboptimal, that’s the wrong way. Think about it.

[Sunny]
So I’m much more a proponent of, we should be charging for the time that we spend on the thing. So, in an ideal world, if your target hourly rate, let’s just pretend it’s 300 pounds per hour. Then everything you did should collect 300 pounds per hour, whether it was perio or extraction, whatever, you would adjust the time to reflect the rate.

So for me and my patients, I see some when it comes to that discussion, whether they’re going to have a direct or indirect, I say, look, the good news is they’re both the same fee. What we’re going to decide is not what’s cheaper. We’re going to decide what’s better for you. And then again, back to your point in your episode regarding not to sell yourself short, you stress and what I stressed at delegates as well, the GDC does recommend, it will just say that you should make a recommendation.

And so at that point, I’d interject and say, look, this is why I think this would be a much more suitable restoration for you, and here’s the reasons why. Now, where do those reasons come from? Not me, right? They come from the patient. If the patient’s saying at the beginning of the exam, and it’s super important to listen to them, I mean, look, many a great dentist will tell you this and does it.

If the patient’s saying to you during the exam, I’m super nervous as a dentist, I don’t like treatment, all of these things that they, the patient factors are super relevant. Then perhaps, doing restoration in one go rather than doing it over multiple visits would be more comfortable for them.

And so I really listen to those patients needs and some patients can’t stay in the chair too long. They just they don’t like the sound of the drill for example. So going for a crown prep may be the worst thing for them. So I really do like to listen to the patients and meet them where they are. But from my perspective also when it comes to like like the confidence to charge and all that kind of stuff I think confidence comes from competence.

When you’re doing this stuff for a while, and you see that it works, and you get a seal, and as you said on your recommendation regarding courses, that you go and learn from these guys, these people who have been there, done that, and they’re saying to you, look, here’s a great protocol to follow, and then you do that.

At the beginning of your career, that’s the best you can do, right? You haven’t got the longevity and the experience to see what it’s going to look like, but at least, taking those steps is a great positive step to do that. And if you are following protocol, protocol gives us consistency across the board, right? And I think from there, the confidence comes and then you start to really value yourself. But one of those things that really-

[Jaz]
I think a way to value yourself is when you get to that level where you have that confidence and that which gives you the confidence when you get asked to do something that is like way less than what you would do or like, maybe you fall into old habits.

It feels wrong to you. Feels like, wait, you actually feel it yourself. Like, I’m not doing it for that much. I’m worth way much, much more. I’m not saying that’s a bad thing. I think that’s a good thing. I think you too, everyone needs to aspire to that level where they feel like, okay, well, this is my rate. I’m worth this rate and I’ve earned this rate. So it’s not to say that we should all have these like egos and stuff. No, I’m beyond that. But actually it’s to match your level of expertise and care.

[Sunny]
Totally, totally. I think, there’s like a real different sort of difference in cultures across different professions as well. Dentistry is a bit difficult because we are in the health profession and then we don’t want to conflate that with profiteering. But we have businesses to run and if that is something that worries you then I think having a rate, a metric that you are working towards can just keep any feelings that you are taking advantage of people or anything away.

But to give an example of a friend of mine who’s in construction, this really hit me. I remember him saying to me one day, he had this job on and he said, yeah, it’s not worth my time. I was like, that’s 500 pounds. He’s like, yeah, I’m not going to pay for that. And I was like, wow, this is a guy who actually respects his worth.

Cause he knows this guy’s got just to paint the picture too, right? The guy takes this stuff seriously. He’s got a master’s in real estate. So it’s not like he doesn’t invest in it, but we do too. We invest in it. So, we’re here on a evening. Listening about the best ways and new ways and innovative ways to streamline things for our patients.

Now, that’s dedication, right? And so that story, I don’t know if you’ve heard this story about Picasso. So, it really rings true. Picasso is sitting in a cafe and he’s doing a doodle on a napkin and it takes him five minutes, he does his beautiful drawing and then this lady walks over and she goes, excuse me, can I buy that?

And he goes, well certainly madam, it’s 20, 000. She goes but it took you five minutes. He goes no madam. It took me a lifetime. And there’s those other Costs and you say, you should charge for your reviews because you got the building cost you got that you got all these other things.

I think principals will probably be really mindful, they’ll be cognizant of hourly rate and things that are not making sense and la la la and at what point does doing free exams not make sense anymore and they’re really cognizant of all that stuff. But associates sometimes we can be in our own la la land of I just want to do dentistry I don’t want to think about anything. And so when I started doing these referral things and renting chair space and doing the whole inverted commas freelance stuff, I’m looking at this stuff just as much as a principal.

Cause I’m like, oh, that didn’t make money. I actually lost on that. And yeah, I’ve got kids to feed. So it’s not about profiteering. It is just good business sense, right? You want to serve your patients to the highest, but you also for me, I want to maximize my return for my time. Time is the ultimate unit. I’m never going to get that back.

[Jaz]
Well, I’m surprised then, Sunny, that you mentioned this hourly rate. I feel like you’re going to break the shackles there and then talk about the next level, because maybe you planted this for me to say this, but the problem with the hourly rate is that it puts a ceiling.

It puts a ceiling that, if you’re doing one complex restoration or three complex restorations. You just took an hour or an hour and 45, and now you’re just multiplying the fee. Whereas actually, sometimes, it’s better to do 3x the fee, not 1. 5 the fee. Do you see what I mean? Because if you’re going purely by time, the patient’s getting a better deal at a certain stage.

The level of expertise you’re showing, managing the occlusion of more restorations, surely that needs to be a high level of expertise, and that needs to be rewarded, rather than just multiplying by time. I think there needs to be a factor of actually, per tooth, which is what I thought you were going to say. So just tell us more about that.

[Sunny]
No, so I’d still price it per tooth. So interestingly, this is what I do. And again, so we have the tray composite, of course, we go over the fundamentals, but then people who want more of this sort of stuff and who are trying to go and do rent surgery space or whatever else will work for me.

I’d be saying to him, look, what we need to do is set your menu. Let’s just keep it simple for composites right now. And this is a guide, right? I said, you’re going to have, no, a composite that takes 30 minutes, right? And you call it simple restoration or whatever you want to call it, right? And then you’d have for 45 minutes and then you’ll have for 60 minutes.

I’m not selling the time. I’m selling the time I think that restoration will take. So that restoration is priced at 45-minute restoration. This restoration is charged at a 75-minute restoration. So sometimes, yeah, you are going to win. So there is no sealing. There’s going to be times where you’re really efficient.

Everything’s gone to plan. And yeah, you have made more than your expected hourly rate, but there are other times where it does go against you. So I hate that NHS terms, swings and roundabouts, but yeah, again, I don’t want to cap anyone anywhere. But then the other point to that is what’s wrong with being a dreamer and setting a really outrageous hourly rate?

If you really respect your work and you’re going to deliver for the patient and you’ve got plumbers that won’t come to your house without paying 250, you paying them 250 pounds to come to your house. I just think there’s a bit of a mind block sometimes with what is fair. But to me, what is fair is dictated by the patient once more.

Patients pay for what they want. If they’re not paying, your prices are probably too high. If the patients are paying, it’s probably fair. It’s up to them, not your colleague who says, Oh, but there’s no lab bill. The patient doesn’t care that there’s not a lab bill. The patient is paying for convenience.

Comfort, service, longevity, they’re paying for a whole host of things. And some of those are more important to some patients and they’re less important to others. So that’s just kind of my stance on that.

[Jaz]
Well, just to add to that, I just want to just make sure that, look, you said it, it’s not about profiteering, but it’s about making sure that you are respecting your time. So that’s the most important thing. And sometimes you said it exactly right. Sometimes you’re winning. And sometimes you’re losing and what Lincoln Harris taught me again, I always pretty much every second episode I mentioned Linc and how much he’s taught me in my career, but remember being in Singapore.

This is like 2017 his lecture in Singapore, maybe 2016 actually and I’m there, he was doing his RETP Rapid Efficient Treatment Planning course at that time, which I don’t think he does anymore live but he was doing it and then he made this really great point that sometimes you’re winning and sometimes you’re losing.

And sometimes you’re losing to the extent that denture that you gave to Mrs Smith, she’s on her eighth review and you’re there half an hour every time adjusting it and I’m charged a penny extra, right? Or that implant complication that you’re just dealing with, right? And time’s taken and then you order some new laboratory things and sometimes you’re losing.

So sometimes you’re losing and losing big. And so sometimes it’s okay to win big. And for me, that was like, Oh my God, he’s right. Like, why can’t we win big? So he said to me, When I win, I want to win big. He said that to me. He’s like, quite often I’m losing. And it’s not nice. So when I win, I want to ensure that I’m winning.

And for me at the time, maybe it hit me in an uncomfortable way. Maybe that was my money mindset issue at the time. So I’m just being real with you. Maybe that didn’t set well me at the time. I was like, hmm, is that really fair, though? And I had my own like, money mindset issues and barriers and whatnot.

But I think it’s really important for everyone to hear this and know that, okay, it might not make sense to you the first time around, but the more experience you get and the more skill that you employ and the more worth it that you feel, like it’s important to realize that it’s completely okay to win big and that our profession and what you’re training for, it really deserves the credit.

[Sunny]
Holy, I want to talk to that. And then I want to talk about that patient that you said that came back 25 times but talk to that. I mean, I wasn’t always this way, right? I remember when I was an NHS dentist at the beginning, and this maybe about 2014, 15, I’d go for a drink with a friend afterwards, dentist, and I’d say to him, have you ever thought about going private?

And I get all the reasons as to why private was a bad idea, right? So I was kind of surrounded by that mindset for some time. And humans, we’re just the number one rationalizers in the world, right? We’re just experts. We’re professionals when it comes to rationalizing our decisions after the fact, right?

So there I was really convincing myself. Of course, I think many people, when they come out of university, are really left leaning, right? And so I really believed I was helping the community and that, I was doing my bit and I was serving these people in need and all the rest of it, and sometimes I was valuing the dentistry more than they were, and it’s just the reality of it.

And so I did have that mindset where like, I shouldn’t make too much money, charging beyond a hundred pounds for a composite is bad. And all of these self limiting beliefs, and that’s so cliche, like, every wannabe internet coach says that, like self limiting beliefs, but some of them are real, right?

There are some truths to some of this stuff, but I definitely had it and it was a shift and a transition. And I got really interested in topics outside of dentistry that really helped me kind of understand that there is a life outside of just people that you speak to and what they see, because it’s a bit of an echo chamber sometimes.

Yeah. So when I was first talking to Dr. Brown, explaining the NHS to him, and that you may have to do 10 restorations for 65 pounds, or whatever it was at the time, I can’t hear. I really think he thought I was pulling his leg. He thought I was joking. I was like, Denny, I’m not joking.

And then my mind started to expand a little bit more. When you hear about this American dentist called Bruce Baird, yeah, really quite well known, this guy was doing two million dollars a year on two days a week. So I started to break that down.

[Jaz]
Wow.

[Sunny]
I said, what does that look like hourly? What does it look like per restoration? And I started moving in that direction, and I didn’t look back. And so with the confidence, being able to deliver, being able to solve problems, being kind to patients, not always thinking that you have to get a patient to say yes. It’s their opportunity to also say no during a consultation.

If they want to say no, I want to know now. I don’t want to know later. It’s patients come to you with problems. And some of us have general skill sets, and some of us have skill sets that could be monetized more. You should take advantage. There’s nothing wrong with that.

And the patients who are going to want your help and attention will take it, and the ones that don’t, won’t. And it’s just one little adage to that, one little addition to that. It’s often another thing I see when talking to dentists, particularly about sales and stuff, and I’ve got a sales background. Hopefully, maybe it shows. But I was a number one salesman in PC world, like, three years in a row when I was a young guy.

[Jaz]
So you’re from the ad! You’re from the ad!

[Sunny]
I’m not from the ad, Jaz.

[Jaz]
I always wanted to do that.

[Sunny]
But yeah, I mean, like, for example, you learn something when you deal with these feet, you learn with you’re dealing with people. And so one of the things I was taught, very early on in my career is that some of the people who could be the best at sales, the best at getting inverted commas, advancement, whatever you want to call it. Some people just get hang ups about the language, but whatever you want to call it. For me, I see sales as helping guide somebody to a decision.

You want to help guide somebody towards action. That’s our responsibility, right? They got problems. We need to get them to take action so we can help them. If you talk and get to the point where the patient is like, yeah, okay, cool. One of the most common things I’ve seen in sales and just in general with dentists is that they just have the need to fill that silence.

Yeah. And they’ll talk more and they would and they say that, you make the sale and then you take it back. And so that’s like quite a common thing I often see. An interesting real life example of, an example of this where I was a dentist’s biggest fan. So, my six year old daughter at the time had MIH, right?

And so I got caries in her lower sixes and I was devastated. I was like, oh my god, what a bad dad I am, giving her too much sugar and all the rest of it. We saw a pediatric dentist because I didn’t want to treat her, right? She was very young and you got this emotional attachment to her, you know, if she flinches I’m going to feel it and all the rest of it.

So, paid to see the specialist pediatric dentist and she said yep, she’s got MIH, we need to do XYZ And I said cool and then on the day of the appointment, that dentist was ill and there was another dentist there, GDP and I said look, this is a good practice I’m confident, and the lady was very nice. She treats my daughter better than I could have.

Better than I could have, right? LA, the whole shebang, super caring, hand on her hand, it’s okay darling, do really well, like just care that I couldn’t have given her, right? And she does these restorations, everything’s gone well, and I knew one of them was deep because it looked like on the rad, it looked deep.

She sits the patient up, now I’m chuffed, I’m this dentist’s number one fan, right? I’m ready to go write a five star Google review, that’s how happy I was, right? This is done, my kid’s happy. She didn’t cry. It’s great, great. I then say to her, very simply, she knows I’m a dentist, right? I say to her, very simply, I say, Doc, that lower left, how deep was it?

Because you saw it, I didn’t see it. And for the next 90 seconds, she fills it with excuses as to this, as to that. I saw her do some things that maybe you shouldn’t do. Maybe you shouldn’t dip your microbrush in bond to smooth the composite off after, right? But listen, I wasn’t going to get into the nitty gritty, right?

She got it done and I was happy. And look, if this dentist is listening, I’m still your number one fan, right? I’m just sharing this from a learning perspective, right? And I’m not naming them any names. But it got to, and she was telling me about how this molars innovated differently from an adult, and just all this stuff that I knew just wasn’t true.

And I was just like, I was your biggest fan, and I’ve just left, like, just want to get out of this room now. And my point is just, it’s really common sometimes, we want to feel that silence, but sometimes people just need that silence just to think. Some people are those thinkers, some people aren’t.

Their silence is not a no, and even if it is, So what? Right. Even if it, people ask me all the time, how do you deal with objections? It’s not a formula, it’s not a script. Dealing with objections, what kind of objection? What is it? So if the patient says, as an example, I need to think about it.

There could be 1,000,001 reasons other than you. It may not be personal. Maybe nothing to do with your skillset. Maybe the fee was actually beyond their budget. Maybe it was, they’re not comfortable with you. There could be so many things, right? Maybe the procedure that you’ve told them that they need.

They just can’t face it because they’ve got problems with their spouse right now. Who knows. What I like to do at that point is say, look, totally understand that, this is a big decision. I need to think about it too, right? Totally normal. What I’d like to do though, however, if it’s okay with you, I’d like to get back in touch with you next week.

I saw you speaking to Kerry at the desk. You really got on with her. She’ll give you a shout next week and just see where you are with things. Is that okay? And you’re just now, instead of this being the patient’s kind of ended the dialogue, you’re saying, okay, cool. I totally respect that, but let me meet you where you are and can let me get in touch with you again. And now you’ve got that follow up. And guess what? I love a follow up. Yeah. I love a follow up. There’s some provider they’ve listed by.

[Jaz]
Follow ups are the best kind of FUs.

[Sunny]
Yeah. They’re the best FUs. I’ve got a big one. I mean, this is, there’s this website and they listed our course, right? And I didn’t ask for it or anything like that, yeah? And they emailed me a couple times saying, oh, you’re not using this and da da da. And I just ignored it every time. And then this guy followed up and said, look, I’d love to have a chat with you. You can like, you can just book a call with me and then I can tell you how we can maybe help you.

And because there was this continuity of this conversation, I actually, I booked the call and it’s booked for Monday and I’m going to see what the guy has to say. But people are busy, life is busy and we forget about things and follow up isn’t like, you’re not pestering people.

Yeah, unless they said you don’t contact me. Cool, no problem. If you’ve agreed, and that’s why I like to get permission from said person, whatever it is, if it’s okay with you. Same deal, if somebody books a free CBD session with me, I let them know we’re going to cover, what a greater curve matrix is and what it can do.

I’m going to just talk very lightly about who I am, why I’m qualified to talk. I’m now going to dig deep into techniques so you can really get a grips, get to grips with this stuff. And there’ll be techniques that you can use in practice. And if it’s okay with you at the end, I’ll tell you a little bit about the course and what’s included.

So I’m getting their permission too, because the last thing I want to do is present what the course is and what it can do for them. If they’re not interested. If they’re just here for the technique, no problem. But I don’t want to waste their time, and so I think getting permission is quite a respectful thing to do.

Interjection:
Hey guys, just a quick message to say thank you so much. Because you’re watching this bit, you’re obviously on Protrusive Guidance, and I just want to say, really, really thank you so much. If you haven’t seen already, there’s some helpful videos we’ve added, like how to download an infographic, how to download an mp3. How do you get your CPD certificates? All those common questions you’ve been asking me, how to add a case to Protrusive Guidance.

So if you’re new or you want to familiarize yourself with how best to use Protrusive Guidance, do check out the new how to videos.

[Jaz]
So I know you teach about this stuff as well as part of the network of things that you teach. So more power to you, my friend. I’ll put this back in the YouTube for those dentists watching though. Tell us about the courses. Tell us about where they are. What format they are and how we can learn more from you.

[Sunny]
Okay, cool. So, I mean, easy next steps for a lot of people, if they want to learn more, they could go on to drecomposite. com. So that’s drecomposite. com. And on there you can click the free CPD tab and you can literally book a zoom with me, so you can put that with your team or you can put that one on one. I just love sharing this stuff. So as mentioned, we go deep into techniques as well, and stuff that you can use immediately.

So I want to give you some immediate wins. And then from there, you really get the full gist of what this is and if it can help you, and if we’re a right fit for you, But what I do know from doing this for two years, it’s not for everybody, but the people it is for, I mean, it’s a super good fit.

So, hopefully you’ll be able to see that from like our reviews and testimonials and the people that we have helped so far. Secondly to that, to the dentists who just love gizmos and love gadgets and just want to get stuck in, they can also visit that same website and they can click shop greater curve.

And they can actually buy a kit, or certain bands that they want, or the retainer. They can buy what they want. And then we’ve got a resources tab, and it just shows you how to set the matrix up and start using it. We’re going to be uploading a whole bunch of interesting stuff for just people to get started, who maybe don’t want to do the course, which is perfectly fine too.

Now, for those who do want to do the course, you can book it there. Mainly at the moment, we’re doing them from London. So it is a blended program in that it’s over six weeks, 20 hours CPD. So you do the online theory course first, in your own time, by size lectures. Then you turn up for the hands on day and when I say hands on you could just see a joke and I say today I’m going to be your drill sergeant because it’s lots and lots of reps.

Anyone who knows me, I’m all about repetitions it’s just all hands on, right? And so now from the really good feedback from our delegates that we’ve really remodeled this to really max it out. Every time a delegate tells me and if we really just implement that no questions. So as an example, like we have breaks, but if you don’t want to take breaks, you can just stay at a station and keep, and keep working away and there will be trainers there to coach you through the day, so we will meet your energy completely.

Then after that we carry on for six weeks, we’ve got a private community group. We’ve got a knowledge base. We’ve got five webinars over that series. We begin with the sort of Dre’s subgingival methodology, just that step by step, how do we approach it? Troubleshooting common errors, just all the stuff you’re really going to need to know after that phase.

The one after that is a sales communication and consent. I’m a big fan of using tools like ChairSyde and Pearl. And so I actually show the exact workflows that I use. Like this is how I do it. This is how I present it. PDF cheat sheets, you name it. Like I really want people to win. So we do that and then the webinars carry on as you can see and then the final one is like really advanced applications.

And at that point there’ll be many delegates who are like, cool, man. This guy’s giving me some lifelong skills. I’m back into the wilderness. I’ll go. And there will be others at that point who say, look, I want to do more training with you. And then we’ve got our anterior program, posterior. We have shadowing options.

We have mentoring options. We have a longer term sort of coaching type of deal, so we’ve got two of our trainers, they were delegates turned trainers, and they’ve been doing that program ever since they did the first course. So they’ve done all the courses plus this long term coaching. And I’m not going to start talking to numbers now, cause I know it’s a public again, but some of the numbers that these guys are doing is eye watering, and if anyone wants to know, just message me, say, what was this guy doing before and what’s he doing now, as real life case studies from just the power of just being able to accelerate, you’re learning from other people’s mistakes. I trialed and errored for a long time to find my feet. So we just packaged that really neatly into other offerings, including a sales program as well. So sales communication for the dentist. Yeah. Hopefully that was a not too much of a shield.

[Jaz]
No, no. It’s brilliant because I’m not just saying this. I think when we have so many courses out there and choice, I think the reason why the Dre Composite course is good. Having been at myself is if you are literally like a fresh graduate, right? I think you owe yourself a course like yours because it covers basically things like caries removal, right? Caries removal, subgingival, daily stressful scenarios that we have, and how to use this wonderful tool that you’ve imported from the US and now sharing throughout Europe and stuff.

So that’s great. But it’s also in there for the experienced dentist who’s had a go, tried all these matrices and is now maybe their interest has peaked. And they want to go to the next level. They want to start doing black triangles with this kind of stuff as well. And they’ve seen some of the stuff you put out there. So I think there’s something in it for everyone, but I would say as a foundational thing, like if you haven’t been to a good quality restorative course that covers these tricky scenarios, not the perfectly sized MO cavity that you never seem to get, the actual behemoth sized ones I’m getting with day in and day out.

Then I think do yourself a favor, check out, everything they’re doing at drecomposite. com and I’ll be sure to put that link in the show notes. So Sunny, my friend, thanks for talking wedge lists, amalgam bans, communication tips and pearls, talking fees, all that kind of stuff. Appreciate your time, bro.

[Sunny]
I appreciate it as well. Thanks for having me and a big shout out to you as well, man. I really appreciate you. At the beginning when nobody knew who I was, he was one of the first to say, Look, jump on the pod, man. It’s all good. I believe in what you’re doing. So I appreciate that as well, man. Heartfelt.

[Jaz]
Battle of the Matrix Bands. If you haven’t seen that video, check it out.

[Sunny]
Totally, man. Totally, totally, totally.

Jaz’s Outro:
Well, there we have it, guys. Maybe you’re going to consider now changing the way you use a matrix. Maybe you’ll consider trying the greater curve. Or maybe you found another gem in there that you can apply on Monday morning. Either way, I hope you gained something from this podcast.

This episode is eligible for CPD, so if you’re on Protrusive Guidance, scroll down, click on the quiz, answer a few questions, and if you get enough right, Mari, the CPD Queen, will send you a certificate. I mean, you’ve come this way, all this way to the outro, you deserve some CPD points.

If you found this episode helpful or you want to show a colleague about a different way of thinking and maybe shock them about the whole wedge list and the contact opening, please consider sending it to a colleague to see how the podcast grows after all. Thank you again for joining me and to our guest, Dr. Sunny Sedana from DREcomposite. com.

Oh, and of course I want to thank my team, Erika, Krissel, Gian, Mari, Nav, Emma, and Rakesh. You guys always ask me, Jaz, how do you juggle everything? How do you get all these episodes out? How do you make so much content? Well, it’s thanks to the team. If you want to support what we do, please do consider joining a paid plan on Protrusive Guidance so we can continue to make all these videos for you.

The website for that once again is protrusive. app and I’ll catch you same time, same place next week. Bye for now.