Why and how you need to Improve your Tooth Morphology – PDP046

Jaz’s Introduction: What makes your restorations look amazing? Well, the more natural they look, the better they will look. And I think to mimic nature, we need a really good understanding of anatomy. Now, this is something that we think we know when we qualify at dental school that we know our tooth looks like right? But actually, it comes with a lot of practice and determination and actually knowing in your mind’s eye what a tooth should look like. And that can be easier said than done that we all know what a central incisor looks like. But until you appreciate that the gingival zenith, that’s the highest point of the gum, for example, is usually around about a millimeter distal, or that the mesial line angle is straighter and the distal line angle is curved, these little subtle pieces of information that will be the difference between getting a flat and lifeless looking central incisor with something that looks really natural and reputable. And that’s exactly why we have Jurgita on the podcast today. She is anatomy queen. We’ll be talking about all things anatomy, how to make our restorations look better, starting from tomorrow, what is the work that you need to do now to get to a stage that you’re improving your anatomy. The Protrusive Dental podcast I have for you is something I’ve posted on my Instagram recently I posted a case of deep caries. Now it was a lower second molar and the patient had a wisdom tooth. So lower second molar distal very deep caries, the kind of thing that would ruin a Thursday afternoon, right? And it’s basically very subgingival caries. You may even need a root canal in the future but the tooth is still restorable the tooth, you can still save the tooth. So what is my way to manage these sorts of situations? Well, something I picked up from lots of Facebook groups [ ? ]. Tomorrow tooth, Maciek, who’s going to be a guest on a podcast sometime soon is that to get the best result. And to allow the rubber dam to actually be sealing the base of the cavity. And to allow your matrix to actually create the seal is you need to get rid of that inflamed excessive gum tissue, right? And the best way I found from learning from these people, is to use a thermal cut bur. Now, a thermal cut bur is a bur without any diamonds. And I believe that and don’t quote me on this is dentsply produced this. And they initially made it because they have this thermafill root canal system, obturation system, right? And the way that you would remove the plastic and the gutta percha will be to use this diamondless bur, right? It’s like this naked ball bur. But we found that actually, if you use it on full rev without any water, it just cauterizes and burns and just destroys the gum completely out of the way and just rid the papilla, you get rid of the papilla. And now you can actually get the rubber dam to seat and create a seal. And now you can get that all important seal with the matrix band. Because it’s not constantly battling the papilla, you can actually get better wedging as well. So that’s my Protrusive Dental pearl, consider using the set of the thermal cut burs. At now, if I was getting a set, I’d get the assorted set. So you get like a really small one, slightly bigger one, like the big one and a massive one, because interdental spaces all varied in different sizes. So the smaller one opens smaller gaps, the bigger one for the larger sort of molars that are sort of tilted away from each other. And with that, after you anethetize a patient, you can just remove the gingiva, you place the restoration. And don’t worry the gingiva in as long as a bone is there, it will grow back. Okay, the bone sets the tone, remember? So that’s my top pearl for you today. The other thing I would say before we just jump into the episode is really a thank you to guys. The last month or so, the podcast has really exploded, a lot of new people discovering I’m getting lots of messages saying ‘hey, I’m just found your podcast.’ People are bingeing it, which is like wow, the most flattering thing ever. And want to shout out Dr. Lincoln Hearst, whom I don’t think I’ve ever met before, but this guy has been so so kind, alight you name it. He went on this a couple of Facebook groups and just without me asking him shared my Michigan splints overrated episode and he just said so many little lovely things. So, Lincoln, thanks so much for sharing and getting so much exposure for this podcast. I really appreciate it. So thank you to everyone who’s continuing to support the podcast. I’ve got some great content lined up for you. Hope you enjoy this episode with Jurgita and I’ll catch you in the outro.

Main Interview:

[Jaz]
How’s your day?

[Jurgita]
Been all right. I’ve been off been waxing the teeth so amazing.

[Jaz]
Okay, cuz you do I’m great thank you. You do your own wax ups?

[Jurgita]
Well no not often. I did the wax up from my own teeth so yeah, that I do myself but

[Jaz]
Why? Why are you waxing up your own teeth? I don’t get it.

[Jurgita]
Even dentist made some dentistry sometimes

[Jaz]
Are you get to make a stent for yourself and like you know put heated composite and do your own dentistry?

[Jurgita]
No. I won’t take it that far. I just waxed up.

[Jaz]
Okay, there we are someone who is truly dedicated to dental morphology doing your own wax ups and stuff and that’s exactly what we will be talking about today, Jurgita. Is it Jorgita or Jurgita? Like how do you say your name?

[Jurgita]
Jurgita with a silent j?

[Jaz]
So you are Hungarian?

[Jurgita]
No, I’m not.

[Jurgita]
Oh my god.

[Jurgita]
Try again. Try all the European countries that you know.

[Jaz]
guys might know it. Let’s not go. Long Night and very embarrassing to me and you. I just I don’t know why I thought you’re Hungarian. I’m sorry.

[Jurgita]
Yeah, no, I’m Lithuanian.

[Jaz]
Okay, fine. Fine. I know a very good Lithuanian dentist. [ name ] [Jurgita]
[Gudalif.] Yeah.

[Jaz]
He’s a really cool guy.

[Jurgita]
He’s my dentist as well, by the way.

[Jaz]
No way. He’s your dentist?

[Jurgita]
Yeah.

[Jaz]
Okay, that is pretty cool. So are you from Vilnius?

[Jurgita]
Yeah, I used to live there. Yes. And I worked there for quite a while. But funny enough I only met him after I left Lithuania.

[Jaz]
That’s cool. And he’s also someone who’s like you’re like you also someone who’s really good at the whole morphology. He obviously doesn’t teaching on posterior morphology nowadays. And I’ve seen a lot of your work as well, which is why I wanted to have you on the show today. And you know, let’s just kick right in. Tell the listeners a little bit about yourself, Jurgita.

[Jurgita]
Yes. So I am Jurgita with a silent J. I am Lithuanian as we found out already. I am a restorative dentist graduated from Eastman. I did my masters in restorative dentistry. I work in two lovely private practices in London. I’m very lucky to have amazing places to work. One of my places is with Basil Mizrahi. He in Harley Street in London. Another one is in Holborn with an amazing team. And yeah, so I do enjoy I truly am passionate about tooth morphology, not necessarily per se as tooth morphology I just find that it is very, very helpful for me. And it improves my dentistry.

[Jaz]
Well, anyone listening to that, and you know, Basil Mizrahi is an internationally renowned dentist. And the fact that you get to work with him and that you have access to his brain like so much so much. It makes me incredibly jealous and envious. So with that is an amazing feat and that you pretty much have him as a mentor, right?

[Jurgita]
I do. Yes. I think I’m very lucky to have him. I’m very lucky to have him as my mentor. He’s my friend and I think we make an amazing team. He teaches me the whole new world of Dentistry of traditional mechanical dentistry, like almost like a bit of an old school and I bring in a bit of a new well vog dentistry, a composite bonding, digital dentistry. So I think Yeah, I’m very lucky to have him. I’m very lucky that we are such a great match. Yeah.

[Jaz]
So I’m just trying to understand the dynamic and workflow with you and Basil Mizrahi like, in my head I this is what I’m imagining. Because I know the kind of Dentistry he does. He does like these massive rehabilitations that patients spend years in orthodontics and years in temporaries. I’m joking, obviously. And finally,

[Jurgita]
You are not that far off.

[Jaz]
I know but I have to say that I guess but yeah, he really you know that the step ladder of success that he’s known for, you know, one thing at a time, and the beautiful precision dentistry, but I’m just trying to think of like, do you see your own patients from beginning to end? Or is your relationship, working relationship in a way that he will send, refer the patients to you for some aspects, and then he will do some aspects like, Can you just tell me about your working dynamic?

[Jurgita]
Yeah, it’s really a bit of a mix and match. I have my own patients that come to see me through my Instagram from, I don’t know from Eastman, from the courses and I follow them through from the beginning to the end. There are certain things that I don’t do so inevitably I will be referring those patients either to Basil or other specialties, Endodontics, Periodontics So I really tried to focus on restorative dentistry and only do this field so yes, of course I will be referring my patients out for certain things. As it comes, when it comes for Basil and how we work, so yes, there will be certain things he doesn’t do. So obviously he would refer those patients to me. Patients that prefer for one or another reason to see me they would come to see me. But it really depends other cases, again, I would do myself from start to finish. Again, I asked him as a mentor, so I tried to, you know, to use him as much as I can like, I asked for his help. He asked for my help. So I think we thought of developing our and refining our relationship as we go. But it really is a mix of everything.

[Jaz]
Well, that’s amazing as one young dentist to another, I think it’s amazing where you’re at the moment and I’m excited to see your development, how you grow and grow and your work on Instagram. The sort of the documentation that you produce is phenomenal. And I just want to say like, women in dentistry, you know, we want more of a presence and to have role models like you for all women in dentistry is just absolutely amazing. And let’s just go back to the first time I got exposed to you, was I think it was 2018, it was the Dentinal Tubules Congress. I may have the year on but it was it 2018?

[Jurgita]
I believe so. Yeah.

[Jaz]
Time flies. Well, you You came on stage and you just blew us away with your lecture. I actually remember the opening part because I’m part of Toastmasters. And we practice public speaking and stuff. And the bold start you made was something so awesome that do you practice public speaking on the side? Do you do Toastmasters?

[Jurgita]
No, absolutely not. It’s a very strange thing that you’ve mentioned the Dentinal Tubule. So that was my first ever public speaking.

[Jaz]
No, get out of here. Get out of it. I know buy it, you’re lying.

[Jurgita]
I swear to God, it was our first ever public speaking exercise that I did. It was on that stage over there. I did ask around, you know, okay, I have no idea how to do that. Would you tell me now, you know, what do people say on the stage. So I did kind of look at, you know, Apple presentations and very famous talks, and I just tried to kind of take the best out of which, refine my own recipe, you know, you can’t really blindly follow the recipe that is given there for ToastMaster. So you have to adapt it to your own personality, which you’re comfortable with. And I think I just did what I thought I wanted to do and I talked about something that I’m passionate about, and I’m really glad that you liked it and that people loved it.

[Jaz]
You came across so well such that I remember when you made that initial you asked you started your lecture with a question. I’m sorry, I forgot what the question was. I remember the elegant way that you asked this question like, like you just asked a beautiful question. And then you captivates everyone’s attention. And then someone next to me was like, she’s obviously had some professional training and I’m not lying. That’s what’s he said

[Jurgita]
Really?

[Jaz]
Yeah, so his name is Dave. He actually won some of the Toastmasters in Ealing, I believe in the local area. So he’s a very high level Russian speaker and he sort of had said, Yeah, she’s obviously our training. So that’s amazing what you told me there. And you were talking about tooth morphology that day. And I guess it was you who changed my mind about it in a way that I used to think drawing teeth was a complete waste of time. And then you you showed me this amazing like how to make my crappy drawings amazing and how I can then translate that clinically and the importance of it, which is what we’re gonna talk about today. So tell me why are you so passionate about tooth morphology, dental morphology?

[Jurgita]
Well, Jaz, I must be a very boring person. And I have nothing better to do with my life just to be interested in tooth morphology. But jokes aside, I think that passion for it, it really comes from my personal experience with the tooth morphology, with the knowledge and what it did to my dentistry, how it elevated my dentistry and subsequently, how the satisfaction from my own job really grew exponentially as I started looking into that topic, because I think we dentist we all find ourselves at that point in our careers, no matter whether you’re a newly graduate, or we’re far away into the dentistry, we find ourselves at the point where no matter how many courses you go to, no matter how many articles you read, and you try and you try to gain that experience, you kind of hit the ceiling a little bit where you know what suppose what is the poster look like but it doesn’t really come out like that in your own work. And this is how I felt I think early in my beginning of my career, you know, I used to try really hard and it doesn’t look the way I want to do. So what I used to think that, okay, must be my materials that I’m using, I’m going to change all materials. So you’ve changed the materials, you change the instruments, you even change the technician and it still looks crap. So I think it’s the realization about tooth morphology, that it is actually important it came when I was doing my masters at Eastman and you know, we have a lot of modules, different topics, different fields of dentistry. So, I used to go to the occlusion topic module, right, it’s very extensive, and then it would briefly mention, ‘you need to know the morphology, if you want to achieve good occlusion,’ then I go to crown and bridge module and then they briefly mentioned that ‘Alright, you know, if you want to prep the tooth, really well, then you need to know tooth morphology.’ All right, then we start talking about treatment planning, and then they again emphasize how important is morphologies. And I was thinking, Wait a second, why do they really mean that tooth morphology? What does it even mean? You know, to know the tooth morphology? I know a tooth morphology I’m a dentist, I know the tooth morphology. And then I realized that do I really? What kind of training did I get about the tooth morphology in my undergrad? This is where we get it, right? And I was thinking yeah, okay, I remember when we were playing with a plasticine that was way early in dentistry training, the early days and as far as I was concerned, at the time, my priority was to be able to distinguish between the upper and lower premolar,right? And that’s, I think that’s how I came out. And then slowly, gradually started looking into that topic, reading different kinds of books, playing with plasticine, again, going to the courses and I was amazed myself, how it transformed everything, all my direct restorations, the treatment planning, the prep, the indirect restoration, everything it transformed, and I think, Oh my god, this is such a gap in dentistry. It’s not actually being taught that well, and we do underestimated and I think that’s how I grew it. And I wanted to spread the word and started to come up with the maybe courses and integrate that into our teaching with Basil into in our academy. So yeah, that’s the story.

[Jaz]
Well, Jurgita, you get you raise a great point, because I think you mentioned it like as dentist as we qualify, we feel like we know it, because we should know it, something we should fundamentally know and we feel we know it but it you know, all dentists listening to this right now, the next unless you work with Basil Mizrahi, the next five patients you see in their mouths that you look at, just look at the morphology of the restorations. And then think to yourself, can we as a profession and should we as a profession be upping our game? Right? And I think yes, and I’m sure you definitely say yes to that. Where do you think we need to start? Like, where can we start if you want to up our game with morphology, because I think you’re totally right. If we improve our apology, we improve so much more than just how good things look. So just tell us a bit about how to get started and what else can benefit from better morphology.

[Jurgita]
I probably will make a detour to answer that question is I think what you mentioned it’s exactly what it is we dentists we are a bit clueless if I be if I may be so daring about morphology and we are sort of are ashamed to admit that, you know, after having done dentistry for like 15, 20 years, how can you not know the tooth morphology? And everyone, I believe that everyone really can benefit from it. It doesn’t really matter what kind of dentistry you do, whether you’re a single tooth dentist guy or a full mouth rehabilitation guy. Here’s a couple of factors, Jaz. So we all like to do all this dentistry to the best ability, right? We try to improve every single time in everything what we do, okay? And here is another fact, we’re really crappy at morphology. And with dentists, we try to recreate a tooth form day in and day out. But we don’t know what we are trying to recreate. So I think this is the big gap. And you know, for the sake of the argument, you know, if you are that guy who says that, well, you know what, I do my single crown, I don’t really care about the aesthetics, about the pathology, how is going to come out? Why do I need to bother? And so I think, okay, if you’re a single, you know, tooth guy and you’re trying to do that crown you’re interested in I suppose the longevity, but how you’re going to achieve that if you’re not going to have the right anatomy, the right contact points? How are you going to be sure that is not going to fail? Or even more so than nowadays, cosmetic dentistry. Composite veneers are so big nowadays, right?

[Jaz]
Everywhere. Can we just say that it’s just a bit too much? I think I personally I see so many beautiful teeth that just need some whitening and that’s it. And I’m seeing composite being plastered all over. I guess if you’re that dentist placing all these composite veneers and of course, your anatomy needs to be good, but what about the, and I’m sure It comes is what about the non cosmetic dentist? What about the humble general dentist just working on posterior teeth? Is it as important for them to be really awesome with their morphology as long as things fit together?

[Jurgita]
I think what you are, what you mentioned now is and I’m really glad you brought this up, everyone thinks that morphology is only referred like concerns only cosmetic dentist or aesthetic dentist, which is very far from the truth. Now just think about that, teeth they look ver,y they have very specific shape this is how nature made it and they do have that shape for the very particular reason, for the very particular function which dentistry we call the occlusion, okay? And I think the morphology and occlusion it is not really possible one without the other. So you can’t have good function, good longevity without having good morphology and vice versa. But what happens interestingly, when you get that good morphology, cosmetic, and aesthetics is the natural byproduct. So if you will restore the form Yes, you will be concerned on a posterior teeth thrive here you’re one you know, you have good occlusion for the teeth, not too chip, not to break, quite stable, have enough room for your porcelain restorations, whatnot, you will restore it to the good shape and form. It will look aesthetic. It cannot not look aesthetic. It’s just the natural byproduct. I think it’s very important.

[Jaz]
Okay, so Jurgita, I get your point. But okay, nowadays, everything is going digital, right? Like you send something to your technician and he or she is like digitally waxing it up. And maybe your, the whole workflow is getting digital. And even to the extent that if you’re doing your composites nowadays, there’s so many different companies like smilefast, for example, where you get your stent, the anatomy is pretty much built into it. So should you therefore be investing, if you’ve got a finite amount of time, which we all do? And it’s like a budget, for example, in terms of what we how much time we invest in learning? Should we instead of learning about morphology, invest that time and learning how to work the different software’s how to do a digital wax up? I’m playing devil’s advocate, I appreciate that.

[Jurgita]
Yeah, that’s a really, really good point. And don’t get me wrong. I love digital dentistry. And I have to admit I’m quite early on. And I’m quite on a steep learning curve, I’m trying to really catch the wave and ride it. And I think it’s an absolutely amazing tool, especially when you plan your cases, especially when you have the patient in your chair and you try to visualize both for the patient, for him or her to be able to see and for yourself, when you’re doing the treatment planning, right? You need to start with the end result at the end of the day. And you know that you know, the basics of the treatment planning is that you start with the end result. And then slowly you try to work your way backwards, to see what you need to do in order to get to that result. And I think they’re the digital dentistry is absolutely amazing. It’s very, very quick. But also there are a couple of issues with digital dentistry. I think people take it that as it digital dentistry is artificial intelligence, as if you upload everything to the software, and it will do everything for you. Well, at the moment, at this point in time, it’s not artificial intelligence, it’s still being used by human intelligence, which means that there is an actual person, whether it’s going to be you or dentist or the technician is an actual person who’s going to sit behind that software and pull out this tooth libraries, tooth morphology libraries, he’s going to upload that and select the form that fits to that patient will adjust that form in order for the occlusion to be well and functional, etc. So you still need the human power, and you still need to have that knowledge. So let’s say you can solve that just by exporting everything to the lab and the digital technician will send you back the models you can do your mock ups, etc. Now imagine what happens if you know technologies don’t get everything right there is an actual human being in your chair. Now the tooth morphology on its own without other smile components such as the face, the lips, the gingival components, the skeletal pattern means nothing right? So you’re going to try everything that digital software produced for you. And you’ll see that you know what? It doesn’t look right. So if you don’t know the morphology, how are you going to tell the software change this or change that? It’s not the artificial intelligence, you need to have the power for you know, in order to use the digital technology. And I love how [Paolo Khanna] once said and [Paolo Khanna] if you know he’s a brilliant dentist from Brazil, who wrote a beautiful book about tooth morphology and he is now very big on digital workflows from start to finish using everything and he does those cases absolutely beautifully. So I really loved how he once said that digital dentistry and all those softwares and tooth libraries, they are not going to let you to jump and skip the morphology completely. But they will allow you, those software’s will allow you to achieve that end result quicker. And me personally, what I have, what issue I have with digital dentistry at the moment is it’s bloody expensive. You know, if you want to have, if you want to have a full access to all the libraries to use all the tools that they have, it’s enormous money at the moment, obviously, that is going to change at some point. But at the moment as it is now. It’s quite expensive. So I probably use it at the beginning for the treatment planning. But then I ended up using quite a lot the analog stages, and I am in control still. It’s not the software that’s in control. I am in control. And I know what fits, what whether it was selected, right. So yeah, digital dentistry is great. It’s got the huge potential, you’ll still have the human being in your chair. And you’ll need to know how to apply that knowledge and digital dentistry also, is everything to do with the indirect restorations. What about the direct one? Who’s going to tell you you know how to sculpt the tooth when when you do everything directly? So yeah, it’s useful. It has its place, definitely, but it can’t replace human brain.

[Jaz]
So two things I want to add to that. One is, for example, if you’re using some of these, like stent systems, like smilefast, for example, what if they come in with a chipped tooth one day, you don’t have a stent, you need to know the line angles, need to know all that sort of stuff, you need to have those skills with you. So that’s the whole direct thing. And the other one I guess and a comparison to what you said about if a technician is selecting from like a skin or a template of an occlusal morphology, he still needs to know his morphology to choose, which is the best one for that scenario and I guess the best comparison would be for those of us who do Invisalign, the outcome simulator is an outcome simulator. It’s not the human. And how many errors do we see from the outcome simulator doing these ridiculous movements, which are just not possible in biology? So we have to respect that AI, like, just like you said, it’s AI and you still need that human expertise. So this leads nicely to the next question, which is if I want to improve my morphology, what’s the first thing I should do? What are some practical, tangible tips you can give to listeners about improving their morphology today?

[Jurgita]
Right. So there’s no easy way to do that I can show you that I can take this disclaimer. Now, there is no easy way to learn the morphology, it requires a lot of effort, it’s quite time consuming. And I know I’m a dentist and I know how we love you know, you go to the course on a Saturday, you come back on a Monday and you want to apply all everything that you’ve learned you want to charge for this. So here’s the thing with a morphology, it’s not going to happen. Instead, it’s the knowledge that you’re going to be able to apply to every field of the dentistry that will massively improve the quality of your dentistry. Obviously, better quality of the dentistry the happier patients are, the happier you are yourself. The happier the patient, the more patients you get, the more patients we get, then you start earning a little bit more. So it’s quite a slow process. However, I’m a firm believer that everyone is capable to learn that if you give them a recipe, so I the way I teach the morphology is it’s not that I you know, I’ll explain you how the upper left teeth is. And then you’re going to go back to the practice and repeat it. I think there is a protocol that needs to be followed. But it’s better to follow in order to be more efficient. So the way I teach it, it consists of three steps. First, stupid simple actually, First, you need to have the knowledge meaning that you need to visualize the morphology. When you look at the particular tooth, you need to understand what is it exactly that you’re looking at? How to understand one thing that our eyes are only going to recognize those features of the morphology that our brain taught us to see. As if you know, well imagine very simply, if I know Brad Pitt, and I bump into him on the street, I’m going to oh my god I bumped into. Yeah. And then if I don’t know, but I’ve never heard of him before I can bump into him three times a day, it will not make difference for me. Right? So it’s the same with the morphology, you look at the tooth, you have to understand what is it about the tooth that makes it right? or wrong? What are these features that you’re looking at? What are these cusps? Why are they there? What are they? Where the tips are etc. So I think the knowledge and that visualization is a very important step. And this is what you do first, you get the books, you look at the pictures, you look at any courses that you know, you may find online. You can read about it. But then you need to take an action from that. Now imagine, Jaz, what would happen if I show you the same Very beautiful, cute upper left six, I can explain everything in detail about that six for you. And I tell you now go and do that in the mouth. Would you be able to do replicate that straightaway?

[Jaz]
No, of course not. I mean, surely one needs to practice, practice and you know, close your eyes, visualize it and keep practicing. Now, that’s my guess.

[Jurgita]
Exactly. So I think, you know, practicing that on our patients, we do that inevitably, we practice that on our patients, but it’s very difficult to be predictable and quick. So therefore, I think the step number two, that is very useful and is very controversial, and is very hated by a dentist is when you start drawing the tooth. And I don’t necessarily mean a very fancy drawing with shadings and colorings, it might be a very simplistic, very, very simple drawing, where you repeat the same tooth over and over again, it allows you to make mistakes, correct them quickly produce numerous amounts of the same drawing or different drawings on the same tooth, and learn how the human form is supposed to look like. So if you make a mistake, you can correct it. And what I mean by that is that you know, when you draw again, and again, you teach your brain to recall everything that you what you call that, because knowledge when you were reading about it, it just trains your brain to recall, to reproduce all these features that is somewhere there in the brain. And finally, the third,

[Jaz]
What if you can’t draw? What if, like me, you can’t draw? And that’s a common objection you might get. Yes, number one, you said, you know, what the tooth looks like, and the case so i can completely learn the anatomy of an upper first molar, the transverse ridge, visualize it, but then like, when I’m drawing it, I look like I drew like a banana or something, you know, like, [overlapping conversation] [Jurgita]
You know, I mean it’s a very common question that I get, or the remark that I get from the courses. And oh, trust me, the eye rolling that I’ve seen on the corner, like, what are you trying to become Picassos here or what? Well, if you don’t want to be an artist, well, don’t be, you’re a dentist, you don’t need to draw the tooth, you know, for it to look very three dimensional. Drawing, there’s a difference between the artistic drawing when you try to produce the piece of art and there is a drawing as an exercise to learn the tooth morphology. And that is two completely different things. So me, for example, I can draw you a very realistic tooth, very three dimensional tooth, does that mean that I’m an artist? Jaz, you should look at my drawings. I mean, they are complete rubbish. I mean, you asked me to draw a horse, it will be a disaster. But I can draw a tooth because, to me drawing is very methodological, it’s very logical, I follow a very precise sequence, thinking about the features of the morphology, and training my brain. So you know, if you don’t want to do very complicated drawing, draw me like or try to draw me the shapes and the symmetry of six interior teeth, for example, right? If you can do that, I know that somebody who can draw six anterior teeth to the symmetry to correct proportions to correct alignment, will, is likely to be able to reproduce that on maybe composite veneers the next day. Whereas the other way around, it’s not very common. Don’t be an artist.

[Jaz]
So, visualize, draw, but it doesn’t have to be fancy 3d, it could just be getting the sort of the basics right, so you can take them step one even further and basically be able to train your hands. What about number three?

[Jurgita]
So the number three is the three dimensional sculpting of the tooth. So this is when you literally, whatever you’ve learned, whatever you visualized, whatever you’ve drawn, you’ll surprisingly, how quickly you’re going to be able to reproduce that three dimensionally with any material on any tooth. I think what we very often believe is that oh, we need to have a very light hand and be so artistic in order to be reproducing a really nice shapes of the teeth which is not true. Our hands, they are not you know, organs with the brain themselves, our hands, they’re merely following what our brains tell them to do. So the better you’ve trained your brain, the better you can recall it from your memory, the easier your hand will be able to follow with any material.

[Jaz]
So what’s the best material so if someone’s listening to something, okay, I’m going to do number one, I’m going to learn my anatomy. Number two, I’m going to start drawing I’m gonna start following on Instagram, I’m gonna start copying what you do. And then number three, I’m going to start sculpting. When it comes to actually sculpting and getting that practice. I see some technicians and they’d like carved soap for example, is that the best way that you recommend dentists who want to get to number three or stage three In practice, is that a good way to do it? Or is there a different product or material way to practice number three?

[Jurgita]
So I’ll tell you this, a soap was really good during the lockdown. Because we didn’t have an access to our dental materials. And the soap was probably the cheapest or the easiest one, and accessible to everyone. Any material is really good. Whether it is the bar of soap or amalgam, or the composite, or the plasticine, or the wax, any material that you can achieve the three dimensional form. Now, me personally, I do quite like wax. And I did that a lot, actually, when I was learning morphology myself, but I know that dentists hate two things, drawing and wax up. Because the argument is that, you know, I don’t do my own wax, my technician does that for me. And so why would I waste my time? And I get the point, but I always have like a question at the back of my mind, why wouldn’t you learn the wax up? Okay, yes, you would rely on the technicians and Jaz you probably know, you know, you probably have your, the technicians that you love. And they are damn good. I love my technicians, I learn a lot from them. But are they always getting the result 100%? They don’t. Of course they don’t they’re not gods, they don’t have the patient in the chair. They don’t see the patient’s face, they don’t see the mimics and the dynamics of the face. They can’t get it right. So imagine you’ve got the full mouth wax up, you see the patient for the mock up, the trial, and you realize that doesn’t really look right. So what you’re going to do? You can bring the technician and say, Well, I’m sending it back, can you give it another go with it, and then send the wax up again, you try again, you can take photos, or in my opinion, what I typically do is I take the wax I adjust what needs to be adjusted, be the shape, be the length, or the proportion, or embrasures, what not. And I adjusted myself, I send it back to the lab and I say okay, I’ve done the adjustments, just make it a bit neater, clean it up and we can proceed. So it’s a really good material to actually, it’s very useful material to know how to use. But I think what people really do love is to use the composite to try sculpting, because that’s a material that we’re very familiar with. We use it a lot every day. And it you can use it in small increments, you can trim it, you can add, you can subtract. It’s a really versatile material. I think this is the reason why I came up with this kind of idea to organize a course where I teach morphology and composites on the same course. And I teach the composite, everything you need to know about composition, like layering, etc. But I also teach the morphology and morphology through composites and I think it marries so well everyone is so used to that. Results are great and you learn a lot about composites, you can apply that straightaway in the practice. And it’s easy. Honestly, in my personal opinion, I think that our composites, especially when it comes to the anteriors, anterior teeth, they look as good as your morphology. It’s you can be layering left and right. But if you’re not going to finish it right, so the morphology, it’s not going to be right.

[Jaz]
I’m just visualizing, practicing that stage three. And I agree with you, I think composite makes somewhat sense. And I’m glad that’s how you teach it. It’s just hands on something we’re very familiar with compared to the wax, but I’m just thinking, as a dentist, we’re always usually doing additive stuff, right? We’re adding increments of composite. So for me, I mean, if I’m going to be practicing my composites, the bar of soap doesn’t appeal to me as much because the soap is reductive. Do you think if you completely miss the reductive techniques, and you only focus on additive, is that okay? Or do you think to train the mind you need to be able to practice the third element with both additive and reductive to be as good as you?

[Jurgita]
You’re quite right additive and subtractive techniques, they are quite different. And I think when it comes to the bar of soap, it doesn’t really matter. The purpose of the bar of soap is to train the morphology meaning is that you are going to try to sculpt the shape, the cusps, the fissures depth, marginal ridges in the right place, is going to take time it’s going to be time consuming. Now subtractive in the mouth, it’s way more difficult. And what is the next material that is subtractive in the mouth that we use clinically? It’s the amalgam. Now have you tried to sculpt the morphology from the amalgam? It’s really, really difficult because what you do you overbuild the tooth first and then you use very flat instruments to sculpt at Very delicate rounded morphology. So, it’s extremely difficult to produce naturally looking convex surfaces with an amalgam. So, therefore, the additive techniques, such as composites, there are way more probably easier for us dentist. Now, having said that, when I say additive techniques is the composite always purely additive material, most of the time it is yes, but then you need to do the occlusal adjustment, then you need to do the finishing where you really try to flow through you know, the primary morphology, the secondary morphology, the tertiary morphology, you still end up subtracting. So, in my view, if you are training and learning, it doesn’t really make much difference which technique you are going to be using when it comes using that in the mouth, additive is easier, but you will use the subtractive methods as well.

[Jaz]
I’m just so I was just reflecting how it’s been four years since I’ve placed an amalgam stick to additive as well. Jurgita, thank you so much for a really insightful three steps that you shared with us there. I think people can go away and be able to retrain their minds and try and pay attention a bit more about learning this sort of what makes a tooth, that tooth you know, what are the key occlusal features or morphological features of anteriors and then do the whole drawing it and then eventually sculpting it and obviously they can reach out to you for help with that. Your Instagram handle if you want to share your Instagram handle?

[Jurgita]
Yes, it’s drjurgitasybaite, you probably need to put that out I think just because it’s unpronounceable also unsellable.

[Jaz]
No worries.

[Jurgita]
I am on Instagram, I have the website which is called toothmorphology.com. So have a look around in there. I am also on Facebook with my own name and as toothmorphology.com. So if you have any questions, need any advice of what books to read, or even if you want to take a shot of what you’ve been doing, you know, at your free time with the morphology, I’m always open to having a look and maybe giving you an advise to it.

[Jaz]
That’s amazing. And I just remembered a really cool video you posted recently, whereby you had, I think you had some models, and then you were doing some anterior equilibration adjustments. And then you had all the red dots and then maybe one tooth is missing. And you go step by step about how to adjust the palatals of the upper incisors to get even contacts. I mean, if you guys are on Instagram, you definitely need to check out the profile, just to watch that video alone, as well as all that beautiful content that you have in clinical and non clinical. It’s really great. And as well as you one last question, Jurgita is you’ve done the Masters at Eastman. And Eastman is like known as this hardcore Institute, right? Tell us about one tip you can give us about work life balance.

[Jurgita]
Oh my god, I am a really bad person to give that tip because I have no work-life balance. And I think when I did it, my personal life was a bit on hold. And I’m very grateful for all the family and all the friends and the ones who still remember that I exist. But yeah, I think always remember the people that try to support you in everything you do. Our lives would be absolutely meaningless without them. And try to enjoy everything you do yourself, both in career and in your personal life.

[Jaz]
Amazing. Jurgita, thank you so much for coming on Protrusive Dental podcast and sharing your insights. It’s been great having you on today.

[Jurgita]
Thank you very much for inviting and I look forward to upcoming Protrusive Dental podcasts. Thank you, Jaz.

[Jaz]
Thanks so much.

Jaz’s Outro: So there we have it. Thank you so much for listening all the way to the end, it’s probably time we started to draw some more teeth, starting to carve some more soap, wax up your own teeth like she’s you know, Jurgita’s so dedicated with all our wax ups and whatnot. So that’s amazing, and I really appreciate the chat that we had with her. If you found value from that please let someone know who may be struggling with their anatomy. Or if you’d like to leave a review if you listen on Apple. So anyone who listens on Apple, please subscribe, and please consider leaving a review. That’s how the podcast grows. So I’ll catch you in the next one. Thanks so much for listening all the way to the end.