[Occlusion Month] Indirect Restorations For Guiding Teeth – PDP196

Plant it low and watch it grow? Is that serving our patients? Should we keep our crowns flat to avoid ‘interferences’? How about guiding teeth - how can we recreate and build in guidance and the correct cuspal inclination in our indirect work? https://youtu.be/b2KA84dXhnI Watch PDP196 on Youtube As part of Occlusion month I am joined by my dental technician Graham Entwistle and Occlusion geek Dr Mahmoud Ibrahim. We discuss foundational occlusal concepts relevant to our daily indirect restorations. Protrusive Dental Pearl: Bleeding papilla? Use the HOW technique to QUICKLY stop bleeding - insert a Wedge obliquely (Haemostasis with Oblique Wedge technique) as taught by Dr Sunny Sadana from Drecomposite.com Treatment Planning Symposium 16th November HYBRID EVENT Basics of Occlusion Live 2 Day Hands-On Course with Jaz and Mahmoud Need to Read it? Check out the Full Episode Transcript below! Highlights of this Episode: 0:00 Introduction 03:31 Protrusive Dental Pearl 05:16 Introduction - Graham Entwistle + Mahmoud Ibrahim 08:25 Guiding Teeth 11:40 Why is Guidance important? 16:35 What information should we provide our technicians? 20:00 Excursions and Patient Case 28:00 Complex crown creation 33:33 To Facebow or not to Facebow? 34:40 A Technician’s POV 49:50 What is the Technician aiming for? 51:06 Perfect Contacts - technician perspective 53:23 Final Thoughts This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes B and C. AGD Subject code: 180 Occlusion (Occlusal functional concepts) Dentists will be able to: 1. Understand the importance of guidance and occlusion in crown design, ensuring restorations contribute positively to occlusal function and patient well-being. 2. Improve communication strategies with dental technicians, including providing crucial details such as shim holds and occlusal plane guidance, to ensure optimal restorations. 3. Make informed decisions about the distribution of occlusal forces to prevent damage and maintain functional integrity in prosthetic designs. If you liked this episode, you’ll love PDP137 - Q&A with a Dental Technician Click below for full episode transcript: Teaser: If there's one thing people take away from this podcast, it's this point right here, which can easily be missed, okay? When we send a bite to our technician, whether it's a physical bite or a digital bite, more often than not, okay, it's wrong. Jaz's Introduction:Welcome to Occlusion Month on Protrusive Dental Podcast 2024. I've just been a little bit excited for this theme. It's one of my favorite themes to discuss because it was Occlusion, learning Occlusion. It's what allowed my dentistry to become more fun. Allow me to move away from single tooth dentistry and through a series of episodes this month, we're going to help you do the same. Ultimately occlusion is just really good restorative dentistry. It's part of the package, but It's perceived as it's like this dark art, this incredibly confusing thing. I think sometimes it's pitched that way to sell more courses, etc. But me and Mahmoud want to convince you that occlusion is easy. It can be simplified. Have faith, stick with us this month, and we hope to demystify some elements of occlusion. In today's episode, we're covering a theme whereby when you have a guiding tooth. Now, when I said guiding tooth, what did you think of? You probably thought of a canine, canine guidance. So let's talk about that scenario, okay? Let's say you're replacing a canine either with direct restorative material or a crown. Crown's easier to discuss. If you're replacing a canine with a crown or even an implant, how do you design the occlusion on that tooth? How do you ensure that you get the correct guidance from that tooth. Now, actually the real world scenario is not canine guidance because very few of our patients are actually canine guided. Most of our patients are in some sort of group function. And so let's say the next time you're replacing a molar or a premolar, you check the occlusion beforehand, you get the patient to grind left and right, recreate their power functional movements. You see these wear facets lining up and you realize that this MOD amalgam that you're about to replace with an overlay or a crown is actually serving that patient in their occlusion. That tooth is being used as a guiding tooth. So you're probably thinking, okay, so Jaz, where are you going with this? The theme of today is how do we ensure that that is replicated in the final crown? Do we want it replicated in the final crown? Because let's agree on one thing, right? If a molar is a guiding tooth, it's involved in group function, and now you're going to put a crown on it, do you want that tooth just to be completely flat? Of course you don't, that's not adding anything to function, it's not serving the patient anyway. So really what it boils down to is how do you get the lab to give you the right anatomy to give you the right occlusion? Both in static and in dynamic, i. e. moving the jaw around. Which is why I'm joined by not only Dr. Mahmoud Ibrahim, but also one of the technicians I work with, Graham Entwistle. He does all my overlays and vertiprep crowns, and he does a wonderful job, and he has his own ideas and philosophies around occlusion. And so I'm so grateful that he joined us today. Some of those episodes in the past where we've had a technician, including him when he came on an episode we did, Five Things Your Technician Wished You Knew. They've been received really well. We need to do more collaborative episodes with technicians. Hello, Protruserati, I'm Jaz Gulati, and welcome back to your favorite dental podcast. This episode is eligible for CE or CPD. We are officially PACE approved, so all the docs in the states and around the world can also have that validation, and we submit it to the AGD on your behalf as well. The way you get CE or CPD for listening or watching these episodes, It's through our app, Protrusive Guidance. If you're on Android, make sure you make an account on protrusive. app first, probably the best way. Go on that website, make an account, and then you can use that login on your app that you download from the Play Store or from the App Store. Dental PearlEvery PDP episode, I give you a Protrusive Dental Pearl. Today's one is really cool. I think you're going to really love it. It's very, very applicable. When you have that gingiva that just does not stop bleeding and it's really annoying you and it's ruining your day, it's ruining your plans. What are you going to do? You could use some astringent, you can maybe get a cotton pellet, soak it in ViscoStat™ Clear and apply some pressure for three minutes, or you can get your laser or something fancy, but a really easy thing that you could do that every dentist in the world has access to is use a wooden wedge, but not in the way that you think. You see, this is called the HOW technique. H O W. It stands for Haemostasis Oblique Wedge, as taught to me by Dr. Sunny Sadana. So a little turban tip to Sunny. So what you do is if you have a papilla that's bleeding a lot, instead of inserting the wooden wedge, it has to be a nice meaty wooden wedge, instead of inserting it in like the normal way, right, when you go completely through, from the buccal to the palatal, for example, this time you're going to angle it so the tip is angled towards the gingiva. Can you imagine it being angled down towards the gingiva? Now, you're going to get your tweezers, the back of the tweezers, and push. What you've essentially done is you've kind of stabbed the gingiva. Can you imagine just the gingiva being stabbed? I jokingly call this in a WhatsApp group, I call it stab-o-dontics. But you know what? How is probably a nicer way to frame it. And what you'll find after about a minute is that the bleeding just stops. The vessels are essentially temporarily occluded or the pressure just stops the bleeding and it can get you out of jail. If that's not tangible enough, the second part of this pearl is that I will be adding a video. The video will first go on Protrusive Guidance. Because that's where everything always goes first, to our community, the community of the geekiest and nicest dentists in the world. And then I'll add it on YouTube as well, so do check that one out. If next time you're stuck with a bleeding papilla, use the how technique with the wedge in an oblique fashion. Hope you enjoy this episode, I'll catch you in the outro. Main Episode:Graham Entwistle and Mahmoud Ibrahim. Welcome back Protrusive Dental Podcast. Today's a special one. We don't usually do like a, well, I don't want to call it a three way, but let's call it a threesome. threesome, a dental threesome. Good to see you guys again. It is a special because very rarely do we get to have a technician input. So it's great, Graham, we're always privileged to have you speak. Mahmoud, always a pleasure. And it's a great topic because it's something that we don't talk about enough, right? Guiding teeth. Okay. And we'll talk about what guiding tooth is and basic crowns. Now, before we hit the record button, there was a few things that we discussed, right? Between us three, we have 10 kids, right? With most of the heavy lifting being done by Graham with five, 10 is good. It's probably the most number of children, most number of offspring on this podcast ever in one show. So Graham, how on earth do you still have a pulse? How are you still sane? How do you still produce wonderful crowns that you send me. How does this work? [Graham]I'm very lucky. I'm graced with a wonderful team at home and within the laboratory now. And without the support I wouldn't be able to do it. So, I've only got those people really to thank for my sanity [Jaz]And Mahmoud, what do you do to keep sane, my friend,