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Lower Complete Dentures are the bane of Removable Prosthodontics. I know many Dentists who ‘hate making lower full Dentures’, likely because they are difficult to master. So difficult that I got Dr Rupert Monkhouse to give the Protruserati a podcast masterclass on how to improve in this frustrating area of Dentistry!
Need to Read it? Check out the Full Episode Transcript below!
Protrusive Dental Pearl: The power of silence! When you present your patients a solution or treatment plan, or tell them the fee, there may be a silence. Embrace it. Expect it. Don’t panic. This is normal! DO NOT but in with a ‘why don’t you just think about it…’
In this episode we discussed:
- How can you predict if a suction lower denture is anatomically possible?
- What materials Rupert likes to use
- What and how to adjust at the Try in stages of complete dentures
- How to get the wax try-in to stay in the mouth!
- Communication pearls surrounding lower complete Dentures
If you enjoyed this topic, why not also check out the Master himself, Dr Finlay Sutton on Troubleshooting Chrome Dentures!
For details on Rupert’s Denture course, DM him on Instagram!
Click here for Full Episode Transcription:
Opening Snippet: I think pros actually is quite not easy but it's it has a few basic concepts if you master those and then sort of extrapolate them you can work out more difficult cases you know.Jazโs introduction:ย
Now we all know how annoying lower complete dentures can be. I could probably think about four dentists in the entire world who liked doing complete dentures. And the secret is because theyโre good at it, right. And one of those dentists that I can think of is Rupert Monkhouse, who is doing some sensational things with his patients, with his photography. Itโs just absolute art. And Iโve got him because heโs so good at removal prostho. So today weโre talking about exclusively the bane of our existence in removal prostho, which is a lower complete dentures.
In this episode with Rupert, weโre going to ask about how to get more predictability, if thatโs even possible with the lower complete dentures. What are the signs that actually you may be onto a winner and that you may be able to get a suction lower denture, that elusive suction from a lower denture, which you see flaunting on Instagram, I probably achieve this twice in my career so far. Weโre able to get the lower denture suction, and both times you pull the camera out, you record it because itโs such a proud moment, right? To get suction on a lower complete denture.
So Iโm going to ask Rupert, is there a formula? Or is it all luck? As well as that we talked about all the different stages that Rupert utilizes to help him get a really stable, lower complete denture.
Protrusive Dental Pearl
The Protrusive Dental Pearl I have for you is a communication one. Itโs something that I think as a profession on the whole, weโre not very good at and something that we were never taught. And now when I learned this technique, I guess itโs a technique in communication, it really made a huge difference. And I remember one time in Reading, we were doing an Invisalign open day, and I had two other dentists in the room while I was doing a consultation. So we were taking turns, one person was right in the notes, the other person was filling like the radiograph requests, that kind of stuff. So weโre working as a team for this Invisalign open day.
And I went through my entire spiel, I showed the before and afterโs I listened to the patientโs wants and needs and how we can help this patient to have a better smile. Now, when it came to the close, i.e., itโs going to cost this much and this much time, is this something you want to proceed with? Right, so thatโs called a close when you close a treatment plan. When it came to a close, there was a silence, i.e. I finished speaking. And now there was an awkward silence.
Now what happens? Imagine youโre going to a patient, youโre going to say to a patient, you need an implant and three restorations and the cost will be 6000 pounds. Okay. And then once you said that, what happens next? Well, usually there might be paused for like, a couple of seconds before what happens usually after that pause? Usually the dentist might say, okay, you can think about it if you want, or the dentist might say, does that not make sense? Because for some reason that pause is something that we canโt fathom, is something that we canโt tolerate, is something that we kind of panic from that pause. Right?
So the lesson here, and what I did that day, was that I just let the pause happen. Okay, I zip my mouth shut. I said, itโs going to cost this much. Itโs going to take this much time. Is this something you want to do? I just paused. And it was around about a 20-second pause, right? Imagine three dentists in the room and the patient, and there was a 20 seconds pause, that 20-second pause, seemed like probably like five minutes.
It was it seemed like an eternity, right? And the patient said, โOkay, fine, I can do it.โ And then sheโs now having Invisalign with one of the dentist at the practice. So the lesson we can learn here is A) respect the pause, he or she who speaks first loses, so donโt speak first, letโs give that patient the time. And the way I learned is that patient needs that time to just figure out โOh, which day can I come in? How much money do I have? How can I afford this? Is this the right thing for me?โ
In the patientโs head, theyโre probably thinking theyโre taking about three or five seconds to respond. But theyโre in like a trance. Theyโre really just thinking about a few things. And once theyโve made up their mind, they will then answer. If you rush the patient, or if you interrupt the patient itโs so easy to say to them. Think about it. And what happens is they go home and they think about it, and the rational brain takes over, because why? Cosmetic dentistry Invisalign is an emotional purchase. Okay? And when they say, you know what, I rather go on holiday, and thatโs it, they wonโt be having the treatment anymore, which is a shame because who loses out?
I think you lose out but the patient also lose out because how many patients do you know whoโve had cosmetic treatment from you? And regretted it? Very few, probably none, because they all want to have a better smile are so grateful. And quite often you hear this time and time again. They always say I wish Iโd done this treatment sooner. So thatโs my elaborate communication Protrusive Dental Pearl for you. Start respecting the pause. Donโt panic. Give the patient the time to breathe and the time to think. Hope you enjoyed that one and I hope you enjoy the session with Rupert Monkhouse. Iโll catch you in the outro.
Main Episode:
Rupert Monkhouse, Welcome to the Protrusive Dental podcast. How are you my friend?
[Rupert]
Iโm good, man. Thanks for having me on. Iโm really excited to be on having a chat with you,
[Jaz]
Man, I am so stoked to have you on mine. The level of dentistry, level of just removal prosth that you do like itโs similar to what I said about Finlay because I know you listened to it, the Finlay episode is like the same thing I said to him, I say to you, you are making removable prosth sexy, right? Because sometimes I wonder and we were just having a chat before we started recording, I actually thought you limited your practice to removal prosth, but then I found out you did extirpation today, you did some fillings or whatnot. And just itโs amazing that the level that youโre doing this and the way youโre documenting. So the first thing to know is for the listeners, test a little about yourself and how you got into removal prosth. And why not composite veneers? Why not facial aesthetics? Why this seemingly specialized rule of prosth, which youโve made sexy, which is great.
[Rupert]
Yeah, I mean, I graduated in 2017 from Kings. And thatโs really where it sort of came from. Mainly as my third year tutor we did removeable started that in third year. And I just had one of those tutors thatโs just so passionate and such an incredible teacher.
[Jaz]
Whatโs the name of the tutor?
[Rupert]
Andreas Antonopoulos. Heโs out in Cyprus now. But he was running [maxbox] prosthodontics as well. I think he still pops over to guys to do that. And so yeah, he was my third year tutor and just got me sort of sucked in with it. I went and did my FD up in hole and they had the sedation contract for the area. So weโd have once a month loads patients coming in for sedation. If they didnโt have complete or immediate dentures, they got sent to the FDA to make up a pair pretty [sharpish], I got loads of experience there. And we had an in house lab there as well. So I was always popping in with a technician and we had a CDT there. So yeah, itโs just sort of really thrown into it. And I just like the amount of change you can get especially like completes I think I said on a post the other days, itโs a blank canvas, youโve got a lot of control on what you can do. And yeah, I just find it enjoyable. I do all general dentistry, but my practice on Instagram is limited, removeable is at least.
[Jaz]
Man, your passion just shines through. And I love hearing peopleโs origin story. Because a lot of people, a lot of dentist ask how do I know what my niche is? How do I know what kind dentistry I want to sort of niche down into it? And I love your story that hey, you had an influential tutor in dental school. And then you were in, you happen to fall into a practice whereby there had this contract with sedation, and you were seeing tons and tons of removal prosth, which obviously just fueled your passion more and more.
And now youโre in a situation where youโre really taking wonderful photographs and these brilliant cases. And listen, today is all about suction lower dentures, right? Because lower dentures are the bane of all dentists. And it all came about because recently on my Instagram, I posted one of my few cases I have where I managed to achieve suction on a lower full or lower complete denture. And in the comments on someone there and said, bring Rupert on I think thatโs how it went. I was like yes, totally this this sounds amazing. So Iโm happy to have you on and I had Mark Bishop on, we talked about all things complete dentures. Then I had Fin about Chrome dentures. So Iโm being a bit harsh to you. Iโm giving you the most difficult thing to discuss in removal prosth, but letโs go with it.
So the first question I have is, how do you know which case you have a chance? Right? When do you know Okay, you know what, Iโve got a chance, or do you always have a chance? Or are there some situations where maybe you want to throw in the outward classification something that you think you know what it is impossible to get a suction lower denture. Give us a flavor of that.
[Rupert]
I wouldnโt want to ruin the episode straight at the start and everyone logs off. But I donโt think you can know, as you say, like outright, this oneโs going to be great. This one isnโt. Because Iโve seen like the full range Iโve got a couple of videos on my page was probably ones that youโve seen or people have asked to see. And the one chap heโs got the most beautiful ridges, big wide awesome ridges, great upper no suction and then Iโve got a ladyโs got these non-existent inverted and itโs got suction as well. And so youโve got the two extremes and you get it but I donโt think you can ever know for certain. But as you say, I think you can achieve it with any ridge you just got to sort of back yourself and go through with it.
[Jaz]
So, Rupert, what percentages do you think is luck? And what percentage do you think? Itโs because I put it down to luck when I get it. I was lucky. I just got lucky. Right? But how much a skill on a different patient that might not work but on this patient, it did? Is that a fair question? I donโt know. You tell me.
[Rupert]
I think itโs 50-50 to get it [where you donโt isnโt it?] So now I think youโve got to do everything the same all the way, that each time you do it. And then itโs sort of itโs going to even itself out over the course of it. But Iโve had patients where theyโve come in and thought oh this is going to be an awesome good chances suction here and Iโve text my technician with the primary instance they are they made this going to be a good one. And we havenโt quite been able to get it. But I think actually though it comes down to is suction actually important to what is going to make it a successful treatment for the patient as Iโve never had a patient come and say I really want a suction lower denture, please. Theyโre gone. My lower denture is not that great. I want to make a new one. So itโs great to have but I donโt think itโs not the be all and end all. I think a supportive denture is probably better, because then youโre more likely to get that stability, which is what they really need.
[Jaz]
Brilliant. And by supported you mean, like some implants. So Implant Supported dentures, you mean?
[Rupert]
Just supportive in terms of that would be if you go right back to my third year tutor, and youโre saying he had the stability triangle. So your stability is your balance of your support and your retention, resistance away from the tissue support, resistance towards the tissues. So particularly for the lower gravity is helping you I think issues that patients have is when theyโre biting and there isnโt that much support, and it brux it displaces youโve lost the stability. And no matter how much suction or retention you have, if youโve got rubbish support, youโre going to lose your retention anyway. Because itโs not going to be able to overpower that see soaring or whatever it is. So I think actually, I personally, I donโt focus on getting retention, I focus on getting support, because I think I know 9 times out of 10. If I make a really nice supportive denture, itโs going to be better than what they walked in with to see me at the consultation.
[Jaz]
Make that really tangible, Rupert, like what do you mean, how can I make a- Because I test for retention, I test for stability. But thereโs a poor concept to me is yes, we read about and stuff, but itโs not something I looked at denture. I thought, okay, how well is it supported? What do you mean by support? You mean, how well the lips and soft tissues rest over it? Or how well it just sits? Give me a bit more about the support and how we can improve the support of our dentures.
[Rupert]
Sure, I think your support in terms of finger resting on the side on the fives and sixes regions pressing down, is it resisting against it? Is it feel like itโs rocking? So let you see those little mini complete dentures where the flanges essentially like the width of the teeth, when you know theyโve got buccal shelves, theyโve got a lingual extension, because we all have that even when thereโs that full resorption you might lose the height, but youโre still going to have the width of the mandible bone thatโs not going to go anywhere, itโs going to shrink downwards, but not necessarily inwards. So I always look at seeing how far I can get it out towards the cheeks. Yeah, thatโs then going to play into your support of the cheeks and the lips. Because weโre not just replacing the teeth, weโre replacing the bone, the hard tissue thatโs been lost as well. So if youโve got those kind of nice, extended flanges, posteriorly, youโre going to have a much better support and itโs not going to move around. And thatโs going to improve that stability, which is actually what the patient means when I donโt have a tight fitting denture or at least thatโs what I think.
[Jaz]
Brilliant. That really helps. There have been some times in the past especially the DCT. I made loads complete dentures back then. And sometimes I had overextended and if thatโs the right word so basically in the lower molar region of my complete denture, I had gone too far buccal or too far towards the cheek. So how can we how can I minimize that problem? And how do you know where your special tray should end in a buccal direction in terms of how far does the periphery go in terms of the buccally if that makes sense towards the cheek is that only landmarks are used to draw that out.
[Rupert]
I wouldnโt definitely say [Lamaze], I think your frenal attachments are going to help you because obviously thereโs not going to be a massive extension beyond the frenal attachment. So you can be a little bit realistic there. I think I always deliberately try and overextend the primary impression, one to make sure I get all the landmarks that are going to help me so if you want to get support all or even retention, if youโre looking at retention, you want compressible tissues, posteriorly your retromolar pads, you want to get the buccal shelves, you want to get a lingual extension. So you want to make sure you get all that in your primary impression anyway, so I do try and overextend it, and then I look at trying in my tray, making sure actually there is a free bit of sulcus around it that we can work into. So when we do a functional border molding impression, weโre going to have the suitable thickness of material there. And weโre not overextending it so if youโve tried to try-in and itโs absolutely cutting into the cheeks and yet the patients have wrapped the lips around and itโs knocking your you can feel it moving around you know youโve overextended that.
[Jaz]
Awesome that helps. So I think next is find out step by step. Okay, just talk us through, obviously, you can you can go on three, four days teaching about this. Thereโs not some you can learn a podcast episode, letโs just give a flavor. Just give us some step by step some things that you think have been instrumental in helping you to get better supported, better retentive, better stability from your dentures. Lower dentures.
[Rupert]
Just stick to the lowers and yeah, so I think first off, like assess the patient fully. I think Mark covered it really well in his episode, itโs like itโs not just a treatment plan about lower complete denture. Have a good look at the patient. Have a look at what do your ridges look like? Is it really flat? Is it nice and wide and thick? Is there a bony undercut? Does the patient have a large tongue? Have they not had a lower denture and the tongues and floor the mouth has expanded in and things like that, look at those landmarks that youโre going to get. I was looking at what the patient has already what their denture is, like, if theyโve got one of those little tiny dentures or thing, happy days, Iโm probably going to be able to improve this if theyโve got one with really nice looking flanges or start to get a little bit worried. And assess other things, whatโs their saliva like? Because if theyโve got bone dry mouth, youโre not going to get anything there. You need that from [filmer] saliva. And I think you need to assess how good the patient is at wearing dentures as well. Now, I had a lady recently, just when we came back from lockdown, and she came in and she was a full denture wearer and sheโd been wearing for 40 years, and she just went, โI just want something that looks nicer.โ And I thought happy days because Ricardo will sort that for me. And she had no bone at all. And her lower denture when I was asserting, it was absolutely swimming around all over the place. And I was like, โhow are you with that?โ And she was absolutely fine. Sheโs one of those. I like to use that analogy, like riding a bike, when youโre riding a bike, youโre super stable, but one legs going out one legs going down. But youโre super balanced, and youโre fine with it. And she was riding the bike, this denture is moving everywhere, but she was absolutely fine. So if youโve got a patient like that, happy days, you might improve it, but itโs not really the end of the world to them.
[Jaz]
I mean, that patient has a superior neuromuscular adaptation, right? That patient is a good denture wearer itโs like you said, so these patients are kind of sometimes, donโt never get complacent, but they kind of home runs where theyโve got this crappy denture and they are wearing it. And those are ones that I like to take on. And when itโs not that criteria, I like to refer them to you.
[Rupert]
Iโm only down the roads, you know where to find me if you want to.
[Jaz]
Absolutely.
[Rupert]
Yeah. So I think those I think those ones are as you say they can be the homerun, I think the toughest ones are patients that are transitioning like perio patients transitioning maybe from a partial to a complete or like [add a chat,] the ones that Iโve been sharing recently, the fancy signature ones where heโd actually never been wearing a denture yet a really bad gag reflex. Heโd never worn dentures, but heโs been edentulous for 10 years. And thatโs like, youโre saying, youโve really youโve got to learn this, like itโs a skill. And I use that riding a bike analogy. And I think they sort of get that. Those are the tough cases. And especially in a media when theyโre not everywhere, and their lips are pushing it all out already, because they canโt move them. I think those are the challenges. Weโre the ones where theyโve happily worn for 45 years and the expert denture wearers, happy days.
[Jaz]
Sweet. So you talked about the patient profile, like what you just said, you talk about your primary impressions where youโre trying to get overextended on purpose. Letโs move on to maybe some pearls in the special tray, because thatโs really such a key appointment to get your final impression. You mentioned greenstick. And I didnโt think that you mentioned border molding. But my question now is, can you describe your technique for border molding? Do you use green stick?
[Rupert]
Yeah, so one little thing that I didnโt mention earlier on the on the primaries as well, I think just use putty. Donโt just stick alginate in there, because youโre not going to get that retraction of the tissues. You mentioned green sticks and stuff there as well for your secondaries. You want to make sure youโre attracting those tissues, because youโre not going to get the buccal shelves, youโre not going to get it back to the retromolar pad and youโre going to end up with that, that tooth wide denture again. And the secondaries, I donโt use green stick, I just donโt like using it. Itโs just really fiddly. I prefer using putty, but actually do my secondaries in a three stage impression. So I do the first stage might be a little bit different to what sort of people do so Iโve deliberately overextended not massively, but overextended. So I know where the frenal attachments are so recorded and cut them back. And then what Iโm doing is Iโm placing that tray in and checking it, seeing that I can see that Iโve got my two to three millimeters of free sulcus. And then what I do is I take a little bit of putty, and for a lower, Iโm going to do three balls of putty in the tray. So Iโll do one each side in that sort of buccal shelf retromolar pad area and Iโll do one in the incisal. Place the tray in, get just patient relax, place the tray and check that I can see all the way around my three millimeters of buccal sulcus and just leave it there for it to set. Once that sort of half set or mostly set you can take that out because itโs just as a guide. But what it means then is every time I place it back in, I know I can push down and Iโm not going to push it too far in and overextend it. And also it means that every time I put it in for the other two impressions, itโs locating in the same spot every time.
[Jaz]
That is awesome. And that is a fantastic pearl. Iโve never thought through that for so Iโve definitely learned something there. Iโm going to write that down. That is a beauty right there. So what next, so you got your putty balls, youโve got like a triangle, something thatโs quite stable, like you said, and you can visualize that three millimeters which is genius. What next?
[Rupert]
So next Iโll do my border molding, Iโll do the main body of it again in putty. So you could do green stick. If you want to do green stick, like Happy Days go for it. I just prefer the sort of the feel and use of putty. So Iโll do putty around the edges, get my good border molding. So then I know that when I placed this in, and the puttyโs got that thickness of three millimeters, placed it in, get a functional impression going, and I personally do it completely patient driven. I donโt like doing lip pulling or anything like that. I think that distorts your sulcus shape. If you pull a lip, youโre going to have the muscle being long and thin, whereas a muscle in function actually is shortening and fattening. So it will make itโs probably only a marginal gains thing that your sulcus shape is going to be slightly different. So Iโll place that in my receipts or my soft tissue stops or stopping it from overextending, then wrapping the lips around the ooze, the eeze opening wide, obviously for a lower moving the tongue around left and right forwards and backwards, and then theyโre compressing and pushing that back up. So then hopefully weโve got exactly the functional depth of the sulcus rather than just the static depth of the sulcus. And I think itโs really important with if youโre doing that kind of patient driven border molding that youโre really I really get into it, me and my nurse end up probably doing it under our masks as well. But you sort of really hype them up and explain how important is and you say, well, you know, if you donโt do this properly for me, every time we try and say all look at that your denture is going to pop out because your lips are pushing it up. So and really getting to exaggerate it and you can have a bit of fun with it really and patients quite end up laughing half the time which is quite good because most people hate impressions and things.
[Jaz]
That is great. And I think itโs so important to know these things that you say so ooze, the ease to get that sort of functional movement of the muscles. My favorite thing learning as a DCT from Professor Mike Phelan, are you familiar with the Professor Phelan?
[Rupert]
Hm-mm.
[Jaz]
So he is fantastic Irish accent I donโt know if Iโve said this episode before, but heโd say to patients smile like a politician, pout like a supermodel and all these things are just patients love that and itโs a great thing to make them laugh and stuff. So I think you definitely got the right idea. Theyโre brilliant. So youโve done that with more putty now. You mentioned my green stick I donโt like using it. Have you used pink stick before?
[Rupert]
I havenโt. Talk to me about pink stick.
[Jaz]
Pink stick is like green sticks like sexier cousin like itโs so good. Like I used it at Guyโs are still ones because my consultant then [sarutobi a poor] our little hack was green stick is rubbish. Donโt use it use pink stick. It was so much better to handle and I never I donโt know what to order from I never order it again. I donโt do enough dentures. But check out pink stick. Let me know what you think might be cool to see what you think of pink stick but pink stick was- Please do let me know what you think, man. But cool. So youโre using putty in that way. Youโve now done your initial three balls, youโve done your function, the ooze and ease, you made the patient laugh, youโve made something out of it. Whatโs the whatโs the secret sauce?
[Rupert]
And then the third stage, either Iโll use a light body and medium body, you can use an alginate. Again, if you like itโs just getting that fine detail. But I prefer using a silicon. So because what I think is if you use in the silicon, place that over wash impression style, and then exactly the same border molding again, hopefully youโll get lice little sort of strips of light body around the frenal attachments, youโll see it just about wrapping around. But again, yes, I placed it in mainly for lower, itโs going to be get the tongue up first so that youโre not trapping that and youโre sitting it down nicely. And I think if you have the tongue up and out of the way, first, youโre not going to, if youโre dragging that impression down against the tongue, you might be pressing material away and you wonโt get the full depth lingually that you might be able to. So again to roll the tongue right back, push it forwards, left and right as far as they can get into press into the tray as well activate the anterior sort of floor of the mouth. And then youโre squeezing the lips doing your palate as you say, say in ooze, cheesy grins and Eโs opening while wiggling the jaw left and right. Thatโs more for the other really get the coronoid processes and things like that. But then, light bodies like that, and the way the reason I like the silicon is actually I can take it out, put it back in, and I can assess almost straightaway. How reliable that suction is because I think you can do an impression if you put a load of alginate in there and thereโs loads of saliva trapped and it comes out and it makes a lovely substance only thing happy days. But actually it might have been that it was just stuck in an undercut or whatever it is. But if youโve you can repeatedly put that tray in two or three times. And you know thatโs a reliable repeatable suction.
[Jaz]
Any concerns about any bony undercuts, is there anything we should be doing with the significant bony undercuts?
[Rupert]
Yeah, I think undercuts, Iโve not actually made a complete yet with sort of big mandibular tori or anything like that, that you obviously want to avoid them because theyโre going to be sore particularly tori [but] the gingiva is so thin there anyway. So again, that sort of try and capture them in that primary impression. Make sure your technicians aware that you want to avoid those and get the tray if youโve almost got to sort of do deliberately get it a bit wrong in the primary to be able to get it right in the secondary that you want to be avoiding that. Really because itโs going to just cause you a nightmare in terms of where youโre going to end up with extending it and youโre going to end up cutting about loads when itโs rubbing and itโs all like that they have not actually had thatโs probably like the one sort of thing that I havenโt had yet for a load of I need to get so if you see one send it send it to me.
[Jaz]
Youโre going to hate me, man. This is cool. I like what is going so you really described quite beautifully the impression stage I think loads of people are driving right now chopping onions running, and then next lower denture theyโre going to be like impressions days that yes, Iโm going to do exactly how Rupert described it. Because I think you described it really clearly. What are the other in regards to go exhaustively into other appointments, but just a few pertinent points in terms of what you think is important to getting a good lower complete denture?
[Rupert]
Yeah, so obviously, like youโve done some good [imps] youโre going to do your read your appointment, gold standard, you want to do on an acrylic base, rarely one, if youโre doing that off your secondary impression, then youโre going to know pretty well how good your secondary impression is. And if you want to, you can always then rely on that if you concern light body so a whenever you want to do but also obviously having an acrylic base, itโs going to make it more stable, youโre going to get a more accurate registration. I think the best thing if you want to talk about the reg and stuff is go and listen to the other complete denture Episode [promarkers.] I think you nailed that. really well. Look at previous photos. Iโm not sure if Finlay mentioned it in his episode, because it wasnโt really on a clip but heโs a big advocate obviously of photos from before. The classic class two patient palatal class two you may come class one for a complete and their lower denture keep pinging out because their lip is pushing it backwards because youโve massively invaded the neutral zone. Check those kinds of things, if you can, thatโs where like the photos are really, really good. If you see someone is a bond or palatal class two make sure that youโve adjusted your rooms suitably and appropriately. And wax try in, thereโs not really I wouldnโt say thereโs much special stuff there. I think what I try, I try and avoid if the patient thinks itโs overextended in wax, I will say just bear with me and let me process it because Iโd rather polish off in acrylic than accidentally lump off a massive bit of wax. I donโt know if heโs sort of agree with that. But I think sort of Iโd rather have the control of a straight bur rather than sitting there with a wax knife and accidentally take off half the flange that Iโve worked so hard raising the tongue and doing an Rm 4.
[Jaz]
100%. I donโt want to see my wax work. I think that was my stressful moments. As always with a wax knife in hand, a Bunsen burner, and just a mess of wax on my nerves just looking at me like what the hell is he doing? So definitely share that sentiment. I think itโs good to tell the patient in that way. So really the wax try-in for you is more aesthetics and phonetics?
[Rupert]
Yeah, 100% I think, especially with sort of more of the cases that Iโm doing sharing now is obviously thereโs quite a high aesthetic component in them, or at least for me and my technician, weโre pushing the aesthetic side and patients donโt always appreciate their lovely for [an iris to] teeth and things but we do and but yeah, weโve had a few cases recently with old photos and things like that, which are really fun to do. So itโs more checking that and, and yet again, you can get an acrylic base inside your wax try-in if you want to again, assess that stability, support, retention, whichever you want to sort of worry about the other one,[the orchestra] in Germany is my favorite appointment. Youโre really anxious about it first, because you think it could all go terribly wrong. But generally, itโs like the easiest appointment there. Yeah, and if youโre a little bit worried again, just like if youโre feeling like your wax try-in particular, if you havenโt got an acrylic base, if youโre thinking itโs not feeling that stable, Iโll always just again, just put in a bit of light body seated in reborder mold, and at least then itโs going to be even if itโs just the fact that itโs in wax, and itโs not retentive, because itโs wax rather than acrylic. Thatโs just going to make it stable gives the patient confidence. If you send it back in and your technician looks at and goes, No, itโs fine. It fits fine. Itโs not a problem. They can just peel it off. If they think oh actually that might be quite good. Iโll recast that and, and use it almost like a reline impression, then youโve not lost anything. So I think thatโs a little thing that I sometimes do at the wax try-in.
[Jaz]
Thatโs not a little thing thatโs a massive thing, that is a huge gem. So usually I just maybe put some fixative in or something but the light body itโs just a genius idea because not only are you improving the situation then and there but then your technician might find that information useful. So that is a huge pearl. Really appreciate that. So use light body, that is wicked. Do I was just I was thinking the story. I remembered a patient I saw a guyโs hostel. And heโd had, heโs not a great denture wearer. Heโs about 85. And heโs on his fifth complete denture in last six years, so you know where itโs going. The ridges looked okay. And it fell upon me as a DCT to inherit this case. So I started making these complete dentures and I got to the wax try-in stage on that day, my assistant just wasnโt around. So I was by myself, right And the patient goes to me, I wish there was a way that I can test if thereโs going to be good. I know I want to eat something. And I thought to myself, is this [kosher?] I mean, can the patient try and eat something now? And you know, lo and behold, his [Kara] and him they had a peanut butter sandwich. So on his wax try-in upper lower wax try-in complete dentures, he started to eat this peanut butter sandwich. Do you know this is a good way of assessing anything? Or thatโs an absolute waste of time, because I felt was a massive waste of time. And it probably just went back with like peanut butter residue back to the lab. But at the time, letโs give it a go. Why not?
[Rupert]
Yeah, I think I mean, Ricardo gets a bit touchy, if I let the patient bite down a little bit too hard, and the teeth have moved a fraction. So I think heโd kill me if I did that. I think the problem is with wax, unless youโve got it like a processed acrylic base, the fits never going to be as you and I always say that before. Before Iโve even taken out the box for the workshops, I look, this is wax, itโs not going to be great. Itโs not isnโt going to fit way, way tighter when itโs plastic, the saliva doesnโt work the same. And so I think if theyโre worried and it could be a stability thing, I get a do a little cotton roll, pop it in one side, give a little bit of a bite, a little bit of a bite. Because then theyโre not going to be really crunching through. Itโs more just again, just testing that sort of support and stability. And I think if I sent Ricardo a peanut butter covered completely, heโd probably not work with me ever again. I need a new technician.
[Jaz]
Okay, I remember had flashbacks. But yeah, nothing I donโt advise. But for sure. I thought youโd agree with me in that sense, as well as a stupid thing to do. But hey, itโs something I did back when it could become the story at the wax try-in stage. What if you? Are you really thoroughly checking the occlusion? Because, like, are you checking for any interferences to centric relation, because at that stage, in the past, I have sort of just heated up my wax knife made some of the teeth, or the wax underneath the teeth a bit loose and get them to bite again, sort of intrude that tooth? Is that something youโre doing? Or do you do tend not to also mess with the occlusion until you get to? Unless is way off? Or how do you manage that?
[Rupert]
Yeah, I think the main thing I do try and do with wax try-in is I pop them in and just try and instantly start talking to the patient about something else and just let them sit with them in for four or five, six minutes. annoying, Iโve got a really big mirror in my main surgery that I work in. And I try and deliberately stand in front of it. So they canโt spend any time looking at it. Yeah, and just literally let this sit there and let them wear them for three or four minutes. And then see what they think obviously, if theyโre falling straight out and you need to that little, light body, reline on them do that. But I try not ask too many questions or think about it too much. Iโve got the luxury of [ABS] Iโm doing it all privately. So Iโve got loads and loads of time for my wax try-in and things Iโm not squeezing in a 15 minute wax try but I think just let it sit and settle there for a little while. And then just ask them how does it feel? Is it comfortable? As you know, do you got the OBD right and I think have a good look at it. And yeah, if thereโs an obvious point then absolutely, Iโd do exactly the same as you hate the wax knife but sort of get it underneath allow them to then intruded themselves into a position that feels more comfortable. I think the main thing though, is photos and full face photos for wax try and even things itโs like a slight midline shift. But we had a case that we did and I needed like a nose to chin one. And Ricardo was fuming because he wanted some eyes in there to be able to because we felt the midline was slightly off and he managed to fix it because heโs that good but take photos of your wax try. Take photos of your wax rim with your midline because again I had as a window impression as you post about it as a window impression case I did and I drawn the line and youโre not going to like mount the patient and sit exactly in the middle of them I do I do it from the left or the patientโs right and align round and Iโd done the midline and a slight angle probably five degrees or something when I looked at the photo when all thatโs obviously wrong and center to recall we have everything in a Dropbox and things like that and weโve got a full face photo and you can see that the top of the line is exactly right where the nose is and then it comes off to the side like that and he was able to just to adjust it and then itโs absolutely fine. So I think thatโs the thing as well that take photos of everything. Wax rim, take photos of that in the mouth, and you can check your smile line you can check your interpapillary you can share your ala-tragal if you want to confirm the photos, I think even if you did a Iโm doing a presentation. Middle of February for some undergraduates and I realized I donโt actually have any I didnโt have at the time anyway, any bite plane pictures of the patients. I just took them on a nurse and she was a little bit sort of class three. And at the time I took this side on for ala-tragal and it looked great. And then I put it in Keynote to do the slides and I drew the line ala-tragal, duplicated the line for the angle and dragged it down and she was off by 10 degrees and I was like oh I would probably would have thought that looked fine, actually. And I might have I done that with some cases. So that was a big thing for me is that Iโm going to start taking the side on photos and confirming these things on keynote with no, either with Ricardo later, or I might even start doing in surgery. But yeah, I think lots of photos, because you can rescue a lot of things. But I try not to change too much or wax try-in. Going back to the original question.
[Jaz]
No, and thatโs great. And to two main takeaways is take the full face photos because theyโre so valuable. And also find your Ricardo. Everyone should have a Ricardo. It sounds great, man. He sounds like he in a banter way. But he pushes you and he gets you to do things in a certain way. Thank you, you guys be used to feed off each other. And you guys are both very passionate. So find your Ricardo. And at the end, you can tell us how you can find someone like that. But yeah,
[Rupert]
Yeah, weโre both as [sad] as each other. Really. I think thatโs the thing. And he makes me look good. So definitely find yourself a Ricardo, but not mine, because heโll get too busy.
[Jaz]
Shoutout to Ricardo but please donโt use Ricardo, or we might not see as many.
[Rupert]
Shoutout to the VRdentstudio.
[Jaz]
Due to the shattered population.
[Rupert]
I tagged him in everything. So VRdentstudio, I tagged him in every single post. So yeah.
[Jaz]
well, thatโs very good of you. Because thereโs some dentists there who post these beautiful veneers and stuff. And they donโt credit the technician where theyโve taken a monoblock patient to these beautiful tranluscencies, but itโs actually the ceramist, whoโs on all the work or the or the complete denture cases. So itโs very good of you to shout out your technician, every case that you do, thatโs amazing.
[Rupert]
100% I mean, we built up a really good relationship, and our cases wouldnโt be as good if it wasnโt with his work, as we sort of push each other, we understand each other. And itโs just about building that relationship. I think thatโs the kind of thing with these kinds of cases is about consistency. Itโs like consistency with how you take your impressions consistently, how you assess the case, what you ask for, with your lab work, and not with your technician. And itโs difficult when maybe youโre in NHS or in a mixed practice, and you send it to that lab. And itโs, you know, itโs a corporate lab with 20 technicians in it and you donโt know whoโs getting it and you get one thing back from one person or one thing back from another and they never read the doc here, that person, itโs coming back from them because theyโve done the wrong thing or, and so I think even if youโre doing it, sending it to a lab like that, try and get to know someone there and because there will be one technician there that wants it. And it might be that, all the all the great technicians will probably work in a place like that at some point. So chances are, thereโs probably a great technician in the making there and find them and go along for the ride with them. Rather than Iโve just sort of piggybacked on Ricardo when heโs already been smashing it, thereโs always a chance you might find that person and work together and grow the I think Finlay covered that, didnโt he with sort of what he was doing.
[Jaz]
Thatโs it, he said, find someone roughly the same age as you and grow together. And I think youโve given a good tip there. But even if youโre sending it to a corporate lab, like visit that lab, if you can and find that one guy who might be that dark horse that you know youโve never met before you seen their name on the on the sheet before now you get say hello to them and say would you like to buddy up with me, we can do cases together and in only if you see that fire in their belly, and a twinkle in their eye that you can start saying, you send it to a corporate lab, but 123 but FAO, whatever their name is, and then you sort of you know, or that case will always go to them and build that relationship which is awesome. Someday weโll cover that as well. So now on to the fit appointment, my friend, onto fit appointment, talk us through your workflow, like I know some dentists will try it in and see how it goes. Some dentists will straight away put on whatโs that green stuff by coating the pressure spot indicator that straight away before they actually get the patient try and whatโs your whatโs your protocol?
[Rupert]
Yeah, I just similar to the wax trying-in, just pop them in. And again, try and instantly start talking about something else or not even thinking about it, like make it really matter of fact thing, weโre going to pop these dentures in happy days. See how they feel? I mean, I try and even not adjust them at all on the day if I can. Unless and this is an obvious sore spot. Itโs definitely digging in somewhere or thereโs an undercut that weโve slightly gone into or something like that, then then obviously Iโll adjust that. But I think with these cases and we said keep saying about the little tiny denture with the non-existent flange realistically, Iโm probably making something a lot bigger. And Iโve already said that to them appointment one, I think itโs really really important in that assessment appointment that you manage those expectations straight up. Itโs going to be bigger, itโs going to take you some time to get used to youโve got to retrain the muscles itโs going to rub, I use this like fit appointments all about like a shoe analogy. Yeah, even if Iโm doing these super fancy signature characterized dentures, you say well, no matter how expensive pair of shoes Theyโve always given me a blister, itโs going to take time to break in my 300 pound pair of churches or my 10 pound prime up pumps, you know, theyโre going to rub either way. So give them a little bit of a chance. And itโs a new set of trainers, youโre not going to run a marathon on day one, youโre going to go for a walk around the block first aware around the house, youโre not going to head out and do a 42k straight off the bat, youโve got to give them a little bit of time. And yeah, for those ones, where theyโve had a teeny tiny denture before, I sort of say, well, let me make it gold standard, or let me make it as textbook as I can give it a week, give it two weeks. And if we have to compromise, thatโs absolutely fine. We can adjust it then. But then itโs a bit like the wax trying thing, I can trim it off, itโs a whole lot harder to make a flange longer after Iโve made it, Iโd rather cut it back then, try and add it on again, thatโs because thatโs just not going to happen. So yeah, just try and get it in as best as I can. And if thereโs an obvious, you know, source for Sundayโs polishing, then then fine, but I try not to touch it too much. Because you can sort of say, well, weโve made it as, as potentially as good as itโs going to be textbook or whatever that is, and you sort of, itโs all about feeding that in throughout the entire process. And thatโs where, again, having a technician that you know that they have accountability. Ricardo is mentioned in my first appointment, I mentioned by name because weโre going to do photos of everything, the pre op, full face photos at the first appointment, and you sort of you build in how much work youโre doing. And I think the way that I do them probably like your chat with five dentures, I doubt the other five dentures were made in the same way. So they sort of go Oh, there is a process here. Like, get behind that letโs do what he says letโs give it letโs give it a week. Two week review. And they believe in it more I think site like psychology is really really important in, in denture wearers.
[Jaz]
What percentage of your patients when they come back to you a week or two weeks afterwards will have an ulcer at the flange area?
[Rupert]
Probably about 20-30%. Usually lingually because I tend to really, really go for it lingually because thatโs like, thatโs a gimme, thereโs loads and loads of sulcus steps there. And mostly that never ever had a denture there before. She said, itโs, he say the shoes again, you say itโs not only your new set of shoes, but youโve never had a shoe that long before itโs going to rub. Itโs going to rub in a different place. You know? Iโd say probably about the 30%. Maybe.
[Jaz]
Thatโs remarkable. I mean, how many dentures? I mean, do you have you ever done a denture and maybe Iโm sounding stupid here but were you have given the final dentures, theyโve gone away and they come back, everythingโs fine. And you donโt need to adjust anything. For me. I just canโt imagine that ever happening. But maybe youโre going to prove me wrong.
[Rupert]
I mean, Iโve had two in the last three months that havenโt seen for review, because they just cancelled it and never came back. Iโm hoping thatโs a good thing. Because theyโre happy. Yeah, weโve been like in touch with one guy was work, work related COVID at work and things like that. So heโs been in touch. Heโs like, No, Iโm fine. I donโt need to come back. And yeah, a lot of the time theyโll will come back for a chat anyway. And Iโll say that I want to see them or do some more photos. Maybe particularly, itโs like an immediate.
[Jaz]
The review aka the photoshoot.
[Rupert]
Yeah, that more or less, thatโs what the review is most of the time. Yeah. So quite often, actually. It might just be that itโs a slight Polish or they found at one specific movement. Maybe thereโs a slight interference somewhere. And itโs just a little occlusal adjustment or something. But Iโd say generally, probably about 30% need something doing but most of the time, theyโre quite happy.
[Jaz]
That sounds crazy. Thatโs like witchcraft to me. So wow, thatโs very impressive. Totally. That is wow, just remarkable. Tell us about when you have been able to achieve a suction lower denture? Is it obvious at that appointment? Or have they sometimes gone away with? You havenโt got that suction when they come back for review but they now have that section after review. Well, how does it happen usually?
[Rupert]
I mean that the I think the two videos that Iโve got on they are day of fit videos are literally just pop in here, the squelch say sit there for two minutes, give them a little squeeze together for me. And I think thatโs really important. They donโt just pop it in and expect it to be suctioned straightaway. Youโve got to let it bed a little bit. So yeah, both of those they were straight in. But yeah, Iโve had a couple where one of the chaps that the guy who had the COVID cases work and didnโt come back that oh, the bottom one feels so much better. Now itโs fitting really nicely. And this is the child whoโd never worn any dentures at all before. Then he had a massive tongue to be fair, which probably helps sort of keep it support it and balance it. Yeah, I think you can definitely learn to adapt the muscles because itโs more again about that stability and not displacing it. Learning to ride that bike not displacing or knocking it out which is going to interfere with having a continuous maintain suction but generally If you pop it down you and you hear a squelch, then happy days youโre probably going to be alright.
[Jaz]
Now for us normal dentist not at your level, Rupert, with complete dentures. One tip I want to give to the more average dentist at removable prosth. Is that one of the piece of advice that was given to me by [Linden Cabo] I think as a professor or doctor, Dr. Linden Cabo, he told me that sometimes as dentists when we give complete dentures, just have patients, we attempt to, weโre so tempted to do something, pick up the handpiece, do some adjustments, whatever, just let them go home with itโs like you do. And then sometimes they just need more time until the situation improves, and improves, improves and you havenโt done a thing and then suddenly, theyโre able to keep it in. So sometimes they just need some more time. Is that a fair thing to say?
[Rupert]
Absolutely, that we said it before that muscular control thatโs really, really important, especially for lower, that the upper, youโre going to, you can get that suction cup effect, and then youโll be fine. But the lower you need some element of skill to maintain it, and even [seeds] and that youโve got this, you heard the [swells,] right? And they go, yeah, and you say, well, itโs going to be lost because your tongues flapping around all over the place. And youโre constantly pressing it and moving it, youโve got to learn that youโre sort of subconsciously realize that seal is wearing off, and oh, I just need to bite it down, or I need to press rest my tongue over the top of it. And actually, itโs that rather than thinking that youโre going to pop it down, itโs going to sit there quite happily forever not move is a no, no, youโve got to keep updating that seal that suction, youโve got to keep pressing it back down with the teeth. But youโll get used to that you wonโt have to think about that in a week, two weeks. And thatโs where you get the improvement over time is that theyโve just been learning subconsciously. Theyโre not thinking about the fact that itโs got, itโs losing the seal, and itโs getting loose. Theyโre just biting it down. And thatโs it. No, thatโs definitely right. As long as theyโre just trying send them off. Unless thereโs a glaringly [obvious fit], thatโs occlusally wrong, or definitely you got a flange wrong, and you havenโt got the extension right, adjust that. But if it feels pretty comfortable, and theyโre good to go, Iโll just try and send them out the doors as well as you can.
[Jaz]
Amazing. Well, before we go, I want to ask about some of the educational stuff that youโre putting on. But before we get to that last question, because we canโt do an episode on protrusive, without talking about the occlusion. Just tell us about the fit appointment, and maybe the review, whatโs the most common thing that you might do for the occlusion? I mean, do you actively look this BULL rule, buccal on the upper and lingual of the lower do try and do that, give us a bit of a minute or so on the recipe for success with occlusion. With dentures.
[Rupert]
Obviously, youโve taken that from your reg appointment, make sure youโre getting your simple things, right, youโre ala-tragal plane, youโve got it, getting a nice lower lip line and the things that that so that everything is where it should be and youโre not making the patient work harder than they should, in terms of the fact that the angles off and theyโre getting contact too early, or youโve got this odd shape lower, thatโs having to work with the sort of wrong occlusal plane of your upper, I think really, itโs about making sure theyโre comfortable and get them in a protruded or position that feels comfortable for them. Make sure that theyโre happy with it. And then make sure theyโre not a blatant class two, or class three that youโve missed. And just set them up. And I think as well, maybe itโs a NHS mindset of, for appointments, get it done, but I donโt mind doing three wax try-ins, four waxed try-ins to make sure Iโve got it 100%. And you say that to the patient, you say weโre going to do the first try-in, and even the fit appointment half the time, I might say, weโre going to try it in the plastic, or we might still want to make some changes. And a bit like, you can sort of set for crowns as well, weโll try it in and we might need to, alter this little bit and send it back and like you would with maybe an implant crown. But I think yeah, like donโt be afraid to do another try-in, and make sure the patients are 100% happy as well. But I think you can sort of tell quite quickly occlusion wise, the worst is when you pop it in and youโve suddenly got like a two unit midline shift. And theyโve got a complete [scissor] by on one side of saying you think what have I done here, but itโs just because suddenly they feel like theyโve got a denture in rather than a wax block is that they suddenly bite in a completely different place. And Iโve had that a couple of times, not like not quite that drastically, but where it is just a little bit off. I think, see, if youโre happy with the upper. Get set, make sure the upper set, right, I think Mark said in his the upper is the beauty, the lower is for the function, and, you know, I do a lot of taking the posteriors off the lower. If Iโm happy with the effort the posterior is are 4, 5, 6 donโt put sevens on, donโt put sevens on completes because theyโre just going to give you more problems. Take the 4, 5, 6 off, leave the incisors if you can, and potentially just rearrange them at that point because theyโve got an incisal. Hopefully the incisors then might go into the correct place. You can reg them then and just get them get your technician to reset it up there. If you completely off. Dig out your wax room. Hello waxaa and hopefully they havenโt destroyed it. But yeah, I think itโs Donโt be afraid of doing multiple waxed try-ins and build it into cost of private treatment or, yeah, and just again, be upfront about the whole thing, you know, be super upfront early on, because if you start making, if you start saying things are difficult at the white shrine, itโs an excuse, if you told them three appointments ago, or they go, Oh, you did say that, we might have to try in a few times. Itโs all about just not being negative or pessimistic, but just being reasonable. and managing those expectations.
[Jaz]
Brilliant, because the communication is half the battle. Now, Rupert, as you know, with protrusive, Iโm a massive promoter of education, and with people like you who just do so much for our dental Instagram community, and you post these beautiful cases, and Iโm sure we get DMS all the time that hey, you know what, can you help me with this case? or How can I get photography like yours? or How can I get dentures like yours? I saw that you promoted a course recently. Please tell us about that. Because I know a load of the Protruserati, it will be interesting that so give us a flavor, man.
[Rupert]
Yeah. So we announced it was a couple of weeks ago. Now itโs Ricardo and myself. And weโve teamed up with [Roger Thomas] Iโm sure everyone will know who Roger is. Because actually, Roger was a big inspiration for me and how I do the secondary impressions I do. So Iโll see in some of the pictures that he was putting on. I know heโs got that name, sort of known for it on Instagram. But heโs got he takes some incredible impressions and made some amazing dentures. And I sort of looked at what he was doing and tried to reverse engineer it and experiment. And so we did his art of resin course, which is awesome. And we started talking about dentures there. And yeah, so weโre looking at running a course itโs called the art of completes. And the plan is that so itโs a two day course take you through start to finish with a live patient with Ricardo in the technical stuff in between as well, which try to cover that start to finish on how to get hopefully, a reliable suction things. Iโm hoping I didnโt give too much away in the secondary impressions, chat that we did, otherwise, I might get it.
[Rupert]
But honestly, we really appreciate that. I think we really appreciate I think anyone listening should really appreciate that the level of detail that youโre going to give us so much there. But there are so many, many steps in gems, that itโs impossible to give out in a podcast episode, but you gave massive value there. So guys, if you like Rupertโs content support him in the course I have no doubt in the world would with yourself involved and Ricardo thatโs going to be a highly educational really supportive course on something that just doesnโt get taught well enough. At dental school because of a lack of cases, we just donโt do enough cases. And before we start getting fancy, itโs about getting those foundations right, would you get are so good at covering.
[Rupert]
Yeah, no, I think I actually had someone write to me today saying that are there a recent graduate and they you know, theyโre worried about x, y, and z and reorganizing the OBD into it, and I was just like, just like wind it, wind it back a sec. And just, I think prosth actually is quite not easy. But itโs, itโs has a few basic concepts. If you master those, and then sort of extrapolate them, you can work out more difficult cases, you know, think about balancing your support. Just think about those three basic things. And then you can do more challenging cases like big fibrous rich upper, weโre talking low as well, you know, big fibrous Ridge, thatโs just that you got across your cross your Ridge, youโve got an imbalance in the support. And if you just put one uniform piece of plastic there, itโs going to rock in rotate. So how can you get around that and thatโs why I like his eyes problem solving. And itโs just yeah, working through things like that. But I think Yeah, work on the basics, and then that will open doors for yourself in doing more challenging things and talk to your technician as well. If youโve had any cell saying about the occlusion and things like that, I want to do my normal copper answer on Instagram, which is my technician actually sorts most of it. So I asked him and heโll be able to point you better because yeah, I think thatโs probably asked their opinion and because itโs a team thing at the end of the day.
[Jaz]
Amazing. Rupert, thanks so much for bringing so much value on suction complete lower dentures. I hope everyone listening got a lot of value from that. I know I did. I picked up a few gems I wrote down so excited on my next lower denture, which might be a year away. As you can see, I donโt do that many. The next really crazy one I get is definitely coming your way. So thank you so much.
[Rupert]
Cheers, man. Thanks for having me on.
Jazโs Outro:
Thank you Protruserati for listening all the way to the end. I hope that helped you to be more confident on lower complete dentures. Do check out Rupertโs work on Instagram itโs absolutely amazing. His Instagram handle his dentist Rupert do also follow at protrusive Dental if youโre not already, and just check out the quality of his photography, the quality of the treatments he does. He takes these fantastic portrait photos of before and after. And these dentures I tell you, they make these patients look about 20 years younger. So Rupert, keep up the amazing work youโre doing and I hope youโll catch me in the next episode, which is Five things your technician wished you knew.
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