Back-to-Back Class IIs with Dr. Matt Burton

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  Dr. Matt Burton, DDS is a clinician, educator, and internationally recognized speaker whose work centers on elevating the clinical precision and decision-making of the modern general dentist. Known for his articulate teaching style and clinically grounded philosophy, Dr. Burton has developed a reputation for translating complex restorative and prosthodontic principles into practical, reproducible workflows that can be implemented immediately in everyday practice. Clinical Philosophy and Focus Dr. Burton's approach to dentistry is rooted in a comprehensive, systems-based model of care, where diagnosis precedes intervention and treatment planning is guided by long-term biologic and mechanical stability rather than short-term procedural convenience. His clinical interests primarily include: Restorative dentistry and prosthodontics Occlusion and functional diagnosis Treatment planning for worn dentition Adhesive dentistry and material selection Interdisciplinary case management He emphasizes that predictable outcomes are less about isolated technical execution and more about correct sequencing, risk assessment, and biomechanical understanding. This perspective resonates strongly with dentists seeking to transition from "bread-and-butter" dentistry to more comprehensive, high-level care. Education and Teaching Impact Dr. Burton is widely respected for his ability to deconstruct complex topics—such as occlusion, vertical dimension, and full-mouth rehabilitation—into clear, structured frameworks. His teaching is characterized by: A strong emphasis on first principles Clear visual and conceptual models for diagnosis and planning Case-based learning grounded in real-world scenarios A focus on clinical decision-making, not just technique

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  In Part 2 of this two-part conversation on Dental Digest, Dr. Melissa Seibert continues her discussion with digital dentistry educator and CAD/CAM expert Dr. Michael Skramstad. While Part 1 focused on the foundations of digital workflows, this episode explores the clinical nuances where digital dentistry either enhances precision or quietly introduces risk. The conversation begins with one of the most under-recognized challenges in restorative dentistry: the accuracy of digital bite registrations and full-arch scanning. Dr. Skramstad explains that while intraoral scanners are highly capable, their accuracy is heavily dependent on clinician awareness and workflow management. In cases where patients struggle to find a repeatable bite position, digital or analog records may both become unreliable. In these scenarios, techniques such as deprogramming with a leaf gauge and capturing an open CR bite digitally can improve reproducibility and clinical outcomes. DDP SkramstadP2 First Edit Dr. Skramstad then discusses one of the most important factors affecting digital impressions: margin management. While scanner technology has improved dramatically, the accuracy of digital impressions still depends primarily on the quality of the tooth preparation and effective hemostasis. He emphasizes that meticulous preparation design remains the single most important determinant of restorative fit, regardless of the digital system used. DDP SkramstadP2 First Edit The discussion also explores practical strategies for managing subgingival margins. Techniques such as ViscoStat Clear for hemostasis, selective use of retraction cord, and careful isolation protocols can significantly improve scan accuracy and margin visualization. Importantly, workflow decisions may differ depending on whether restorations are fabricated in-house or sent to a laboratory, since file formats such as STL lack color information and can make margin identification more difficult for technicians. DDP SkramstadP2 First Edit The episode then shifts to material selection in contemporary restorative dentistry, particularly the evolving role of zirconia. Early zirconia restorations were often criticized for poor esthetics, but recent material innovations have dramatically improved translucency and optical properties. Dr. Skramstad explains why modern zirconia systems—such as multi-layered zirconia materials—are increasingly used in both posterior and selected anterior applications, while still maintaining the exceptional strength that originally drove zirconia's adoption. DDP SkramstadP2 First Edit The conversation also addresses: • The clinical differences between bonding vs. cementing zirconia restorations • How preparation design influences retention and restorative longevity • The impact of speed sintering on zirconia optical and mechanical properties • When digital workflows simplify restorative dentistry—and when they introduce hidden complexity One of the most important themes reinforced throughout the discussion is that digital dentistry does not replace clinical fundamentals—it magnifies them. Technology can improve efficiency and accuracy, but it cannot compensate for poor preparation design, inadequate isolation, or imprecise clinical technique. For dentists exploring or expanding digital workflows, this episode provides a grounded perspective on how to integrate digital tools responsibly while maintaining the biological and mechanical principles that underpin successful restorative dentistry. Topics discussed include: • Digital bite registration and centric relation records • Margin management in digital impressions • Hemostasis techniques for intraoral scanning • STL vs PLY file formats in digital workflows • Zirconia vs lithium disilicate restorations • Speed sintering and modern zirconia materials Whether you're already practicing chairside CAD/CAM dentistry or simply evaluating digital systems for your practice, this conversation offers a thoughtful look at how technology intersects with clinical judgment in modern restorative dentistry.

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf    Digital dentistry has transformed restorative workflows over the past decade—but many clinicians still struggle to understand where digital tools truly improve accuracy and where limitations remain. In this episode of Dental Digest, Dr. Melissa Seibert sits down with digital dentistry educator and CAD/CAM expert Dr. Michael Skramstad to explore how intraoral scanners, digital bite registration, and AI-assisted articulation are actually performing in modern restorative practice. Dr. Skramstad has spent decades working at the intersection of clinical dentistry and digital innovation. As a longtime CAD/CAM educator, CEREC trainer, and product consultant for major dental manufacturers, he has stress-tested many of the technologies shaping today's digital workflows. In this conversation, he shares practical insights into how scanners perform in real-world restorative dentistry—not just under ideal conditions. The discussion begins with one of the most persistent challenges in digital workflows: occlusion accuracy. While intraoral scanners can capture highly detailed digital impressions, digital bite registrations can still introduce discrepancies. Dr. Skramstad explains the multiple factors that influence digital occlusal accuracy—including scanner technology, scan strategy, tooth mobility, the number of teeth captured, and even how firmly a patient bites during the scan. He notes that while single-unit restorations tend to be forgiving, larger cases such as full-arch restorations demand far greater precision. The conversation then explores emerging tools designed to address these limitations, including AI-based articulation software such as BiteFinder, which analyzes tooth morphology and wear patterns to algorithmically re-articulate digital models and improve occlusal alignment.   Dr. Skramstad walks through how clinicians can integrate these tools into their workflows when sending cases to the lab or designing restorations with Exocad. Dr. Seibert and Dr. Skramstad also compare leading intraoral scanners and discuss how different systems perform depending on the clinical application. Some scanners excel at capturing tooth structure, others capture soft tissue more effectively, and certain systems may provide advantages when scanning full-arch cases. The discussion highlights why scanner field of view, scan stitching algorithms, and scan path protocols all influence the final digital model accuracy. Beyond technology itself, the episode also touches on clinical workflow and team integration. Dr. Skramstad shares how responsibilities such as scanning, designing restorations, and fabricating surgical guides can be delegated within the dental team. He discusses why some aspects of digital dentistry benefit from delegation while others require direct dentist oversight—especially when precision and aesthetics are critical. Finally, the conversation broadens into leadership and practice management. Dr. Skramstad shares lessons from running a large dental team and explains why hiring for character and adaptability often matters more than prior experience. These insights offer a valuable perspective for clinicians building teams in modern digital practices.

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  In Part 2 of this series, Dr. Melissa Seibert and Professor Bart Van Meerbeek transition from foundational adhesive science into the nuanced clinical decisions that shape long-term outcomes. If Part 1 established the biological and material principles behind durable bonding, this episode addresses the gray zones clinicians navigate daily: contamination, enzymatic degradation, substrate variability, polymerization stress, and postoperative sensitivity. The discussion confronts several widely accepted assumptions and asks a more rigorous question: what does the evidence actually support? Professor Van Meerbeek offers data-driven clarity on topics that are often ritualized rather than critically examined. From the debated role of chlorhexidine and MMP inhibition to the thermal effects of curing lights, air particle abrasion, C-factor management, and the true value of flowable composites, this conversation reframes bonding as a system rather than a single step. The message is consistent: simplification may be attractive, but substrate awareness, technique sensitivity, and respect for hydrophobic layering remain central to predictable outcomes. The episode concludes with a forward-looking reflection on where adhesive dentistry stands today. According to Van Meerbeek, modern multi-step systems may already be operating above 90% of their theoretical potential. The future, therefore, is not merely about bonding harder but bonding smarter—possibly integrating bioactivity without compromising performance. For clinicians committed to practicing with intellectual precision rather than procedural habit, this episode provides both reassurance and recalibration.  

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  In Part 1 of this two-part series, Dr. Melissa Seibert sits down with Professor Bart Van Meerbeek, one of the most influential figures in adhesive dentistry worldwide. From dentin permeability to hybrid layer degradation, Professor Van Meerbeek's research has fundamentally shaped how clinicians understand the biological and mechanical realities of bonding. This conversation moves beyond product marketing and into the core science: what we truly know, what remains uncertain, and why durability in adhesion continues to require deliberate clinical judgment. Together, they unpack the "adhesion degradation paradox," the hydrophilicity trade-off inherent in universal systems, and the persistent performance gap between simplified one-step adhesives and multi-step gold standards. The discussion explores film thickness, hydrophobic layering, stress distribution, and the biomechanical role of flowable composites as stress-relieving buffers. They also examine why 10-MDP concentration matters, why not all universal adhesives perform equivalently, and how bonding strategy should be tailored to substrate conditions—from young permeable dentin to sclerotic or amalgam-affected substrates. This is not a discussion about shortcuts. It is a rigorous, clinically grounded examination of what evidence-based adhesive dentistry actually demands. If you are striving to practice with greater clarity, confidence, and scientific defensibility, this episode will recalibrate how you think about bonding protocols in everyday practice. Part 2 will continue the conversation, moving deeper into contamination management, clinical troubleshooting, and long-term durability.

JOIN ELEVATED GP Follow @dr.melissa_seibert on Instagram   Dr. Dichter brings nearly 20 years of clinical, research and teaching experience — as a general practitioner and prosthodontist — to his position with Spear. He serves as an instructor in the Treating the Terminal Dentition and Fully Edentulous Patient seminar, in addition to multiple Spear Workshops. Dr. Dichter has served as a guest lecturer and clinical instructor at Oregon Health and Science University School of Dentistry, teaching occlusion and esthetics. He has been a Spear faculty member since the company's inception, as well as a contributing author for Spear Digest. He is passionate about education and is involved with multiple study groups in the U.S. and Canada. After earning his D.M.D. from OHSU in 1995, Dr. Dichter practiced general dentistry and eventually joined a startup practice in his hometown in coastal Oregon before moving to a practice in Portland. He brought 16 years of restorative dental experience into UCLA's world-renowned, full-time advanced prosthodontics residency, which he completed in 2014.

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  Episode Description In part two of this two-part conversation, Dr. Brian Vence moves from philosophy into execution, offering a clear, ethical, and highly practical framework for how comprehensive dentistry is diagnosed, discussed, and ultimately chosen by patients in a successful fee-for-service practice. This episode is a deep dive into how dentists can guide patients through complex decisions without pressure, persuasion, or procedural selling. Dr. Vence outlines his structured yet flexible approach to patient intake, record gathering, diagnosis, and treatment planning—centered around what he calls the Pathway to Essential and Meaningful Treatment. Rather than dictating solutions, he emphasizes co-discovery: helping patients see, understand, and articulate their own problems before ever discussing procedures. A central theme is risk reduction over procedures. Dr. Vence explains how he frames treatment options not as products to purchase, but as graduated ways to lower biological, structural, functional, and aesthetic risk over time. From stabilizing compromised teeth to sequencing orthodontics, restorative care, and provisional solutions, the focus remains on sustainability—not urgency. You'll hear practical insight on: How to structure patient intake from the first phone call through diagnosis and case presentation Why allowing patients to ask for solutions is more powerful than proposing them How to use analogies and visual co-discovery to explain complex problems without overwhelm The difference between short-term stabilization and long-term structural correction Why timelines, pacing, and emotional safety matter more than closing treatment plans Dr. Vence also addresses real-world concerns around fees, financing, and practice sustainability. He discusses why fee structures should reflect time, complexity, and overhead—not insurance schedules—and how this approach supports both clinical integrity and business stability. Importantly, he underscores that dentists cannot want treatment more than the patient does—a mindset shift that allows for clarity, calm, and long-term success. The episode closes with a candid reflection on leadership, emotional resilience, and the inner work required to sustain a fee-for-service practice over decades. Dr. Vence shares why confidence doesn't come from certainty or volume, but from having a clear vision, strong values, and the ability to remain grounded as conditions change. Together, parts one and two provide a comprehensive roadmap for dentists who want to practice at a higher level—clinically, ethically, and relationally—while building a practice that is both financially stable and deeply fulfilling. This is not about faster dentistry. It's about better decisions, made well, over time.

*]:pointer-events-auto scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" tabindex="-1" data-turn-id= "request-695fd1b8-25fc-8328-8327-03cc041aa4d0-5" data-testid= "conversation-turn-10" data-scroll-anchor="false" data-turn= "assistant"> Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  Episode Description In part one of this two-part conversation, Dr. Brian Vence shares a deeply thoughtful and experience-driven perspective on what it actually takes to build a successful fee-for-service practice—one rooted not in persuasion or sales tactics, but in trust, diagnosis, and meaningful human connection. With more than three decades of clinical experience and a career dedicated to interdisciplinary, comprehensive care, Dr. Vence reframes treatment planning as a behavioral and relational process, not a transactional one. He challenges the idea that comprehensive dentistry is something that must be "sold," and instead positions it as a process of helping patients clarify their own values, goals, and tolerance for risk—at their pace, not ours. This episode explores how dentists can meet patients where they are without abandoning ideal diagnosis. Dr. Vence explains why patients often fixate on a single tooth or isolated concern, and how honoring that starting point—when done thoughtfully—can open the door to deeper, more comprehensive care over time. Rather than overwhelming patients with full-mouth solutions on day one, he advocates for sequencing conversations, building psychological safety, and creating space for patients to envision what's possible. A major theme of the discussion is the concept of "Pathways to Essential and Meaningful Treatment." Dr. Vence walks through how environment, language, and timing directly influence patient decision-making—and why treatment planning conversations are often better held outside the operatory, away from the fight-or-flight associations many patients carry with dentistry. In this episode, you'll hear: Why fee-for-service dentistry begins with mindset and culture—not insurance policies How to stop "convincing" patients and instead become a clear, unbiased sounding board Why comprehensive treatment planning is fundamentally about behavior, not procedures How environment and language influence whether patients feel safe enough to future-focus The importance of honoring patient autonomy while still holding space for ideal diagnosis Dr. Vence also shares practical insights into new patient workflows, from the first phone call to in-office consultations, emphasizing the value of curiosity, listening, and slowing down. He highlights why efficiency often crowds out effectiveness—and why the most productive clinical days are rarely about volume, but about depth of connection. This conversation is especially relevant for dentists who feel tension between practicing the dentistry they know is right and navigating patient hesitancy, financial concerns, or insurance-driven expectations. If you've ever felt frustrated trying to align comprehensive care with patient readiness, this episode offers a grounded, humane, and sustainable way forward. Part one sets the philosophical and relational foundation. In part two, the conversation continues into diagnosis, case presentation, and how to guide patients through complex decisions without coercion. This is not an episode about selling dentistry. It's about helping patients—and clinicians—make clearer, more meaningful choices.  

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf     Episode Description In part two of this in-depth conversation, Dr. John Kois moves beyond theory and into clinical application, tackling the questions every restorative dentist eventually faces: Who is actually a high-risk occlusal patient? How do we distinguish past adaptation from active breakdown? And why do so many "standard solutions" fail to prevent restorative complications? Building on the foundational concepts from part one, this episode focuses on how occlusion shows up in day-to-day practice—and how dentists can make more informed decisions before committing to complex restorative or implant treatment. Dr. Kois explains why visual wear alone is an unreliable predictor of risk, how to identify whether wear is active versus inactive, and why patient symptoms often tell a more important story than what we see on models or scans. A major theme of this conversation is closing the gap between chairside evaluation and real-world function. Dr. Kois challenges common habits—such as adjusting restorations with patients fully reclined, relying solely on articulating paper marks, or reflexively prescribing nightguards—and explains why these approaches often miss the true etiology of failure. Instead, he emphasizes evaluating occlusion in positions and movements that reflect how patients actually chew, speak, and function throughout the day. In this episode, you'll learn: How to identify true high-risk occlusal cases before restorative treatment begins Why active wear and patient-reported change matter more than historical attrition How muscle symptoms, mobility, and joint loading influence predictability When nightguards and Botox may mask symptoms rather than solve the problem Why larger restorative and implant cases demand a deeper understanding of jaw position, tooth fit, and functional pathways Dr. Kois also shares candid insights on emerging technologies such as jaw tracking—where they add value, where they fall short, and why they are most impactful in comprehensive and full-arch cases rather than routine dentistry. The discussion highlights an important truth: many restorative failures are not material failures, but diagnostic failures rooted in incomplete occlusal assessment. The episode closes with a powerful reflection on learning, clinical growth, and professional development—distinguishing information from knowledge, and knowledge from wisdom. Dr. Kois outlines the progression from skepticism to commitment, underscoring why true clinical mastery requires not just understanding concepts, but applying them consistently over time. Together, parts one and two form a cohesive framework for thinking differently about occlusion—one grounded in physiology, adaptation, and long-term predictability. If you're aiming to move beyond bread-and-butter dentistry and into more complex, fulfilling clinical work, this conversation provides essential perspective on how to do so more thoughtfully and successfully.

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  Episode Description Occlusion is one of the most talked-about—and most misunderstood—topics in restorative dentistry. In this first installment of a two-part conversation, Dr. John Kois challenges many of the static, mechanical definitions of occlusion that most dentists were taught in dental school and offers a fundamentally different way of thinking about how the masticatory system actually works in real patients. Drawing from decades of clinical practice, specialty training in both periodontics and prosthodontics, and his experience educating restorative dentists around the world, Dr. Kois reframes occlusion as a dynamic, adaptive system rather than a fixed set of contacts to be checked off with articulating paper. He explains why relying solely on traditional concepts like MIP, right and left working movements, and morphological classifications often fails to predict long-term outcomes—and why this gap is at the root of many restorative failures, postoperative sensitivity, mobility, muscle pain, and patient dissatisfaction. This episode lays the foundation for understanding occlusion through the lens of function, adaptation, and risk, rather than dogma. Dr. Kois introduces key concepts such as pathway wear, jaw position relative to the head, and the body's adaptive responses to occlusal disharmony—highlighting why so many problems are misattributed to bruxism, airway issues, or "parafunction," when the true etiology lies elsewhere. You'll hear why: MIP should be viewed as a terminal position, not the starting point of occlusal analysis Static bite relationships often tell us very little about whether an occlusion is actually working Pathway wear is one of the most critical—and commonly missed—risk factors in restorative cases Many restorative "failures" are actually adaptive responses by the body trying to protect itself Dentists often succeed not because occlusion is ideal, but because patients adapt—sometimes at a long-term biological cost This conversation is especially relevant for dentists who want to move beyond single-tooth dentistry and into more comprehensive care—full-mouth cases, complex restorative planning, implant rehabilitation, and interdisciplinary treatment. If you've ever had a case that looked perfect on the articulator but unraveled clinically, this episode will help you understand why. Part one sets the conceptual framework. In part two, the discussion continues into how these principles influence diagnosis, restorative decision-making, and long-term predictability. If occlusion has ever felt confusing, frustrating, or inconsistent in your hands, this episode will help you start seeing the system differently—and more clearly.