The Semi-Indirect Technique for Toothwear Cases – PDP187

Check out the ‘semi-indirect’ technique to restore toothwear cases - including palatal backings made chairside and bonded at the same time. Join Jaz as he geeks out with Dr Zohaib Khwaja to extract the nuances of this clever technique. We also deep dive into the Dahl technique. https://youtu.be/tIRfmJL1qpw Watch PDP187 on Youtube Protrusive Guidance members with access to the Protrusive Vault can check our Semi-Indirect Composite infographic with a step by step visual protocol for semi-indirect palatal backings. Protrusive Dental Pearl: Practice finding centric relation on your general patients, even if they are just attending for a routine examination. It is a great way to get practice! Check out Dr Khwaja’s Instagram page Need to Read it? Check out the Full Episode Transcript below! Highlights of this Episode:02:48 - Protrusive Dental Pearl - Finding CR05:15 - Dr. Zohaib Khwaja Introduction11:14 - What is the Dahl Technique? 17:41 - Restoring Worn Posterior Teeth 28:37 - Restoring Anterior Teeth39:23 - Dr. Zohaib - The Teacher Access the CPD quiz through our app on https://www.protrusive.app, either on your browser or by downloading our mobile app. For the full educational experience, our Ultimate Education Plan gives you access to all our courses, webinars, and exclusive monthly content. Join us on Protrusive Guidance, our own platform for dental professionals. No need for Facebook anymore! 😉 If you liked this episode, you will also like Why do some Dentists find Dahl Distasteful? – PDP016 Click below for full episode transcript: Jaz's Introduction: In this episode, we're going to discuss something called the Semi Indirect Technique that can be so helpful when you're managing tooth wear cases. So because we're talking about tooth wear cases and the actual treatment of them, i. e. usually increasing the vertical dimension, aka opening the bite and how you fill in that space. Jaz’s Introduction:So if you are earlier in your dental and occlusion journey, or maybe you're not yet comfortable going beyond single tooth dentistry, then this episode may be difficult to grasp, but you should use these experiences as motivation and inspiration. It's a bit like when you go to a conference and some of the stuff that's being presented is so far beyond and above you at that moment in time in your journey where you are, but it's still really important to pay respect and listen because that can be the spark that you need in your career sometimes. But of course, if you're into occlusion and tooth wear. And you love restorative dentistry, then this could be a really geeky discussion that you're going to be able to apply on Monday morning if you've never used this technique before. Like, to give you a flavor of it, it's essentially using the wax up to create your own composite restoration. So you're using the wax up to create your own, like, direct composite onlays, for example, right? Direct composite onlays that you're making. So not indirect, it's direct because you're making them using the wax up and using the putty. And you'll see later, our guest, Zohaib Khwaja. He's going to explain why this has certain benefits and perhaps when he wouldn't use this technique and go indirect. And from speaking to him, I do think that it's a really nice trick to have up your sleeve, especially if you're interested in the adhesive management of tooth wear. Hello, Protruserati, I'm Jaz Gulati, and welcome back to the Protrusive Dental Podcast. If you're new to the podcast, welcome, it's great to have you. And of course, if you're a veteran on Protrusive, then it'll be good to see you on Protrusive Guidance, our app, our platform, where we connect, where we share, where we learn and grow together. Before I bring on Zohaib to share the Protrusive Dental Pearl, the team have also made an infographic. So everything that we explain, Zohaib has kindly given his photos and we've made a little infographic so you can follow along to this episode and keep as a reference in the future for when you have that kind of case coming through. To download this infographic, simply head over to Protrusive Guidance. Most of you listening and watching already have your login, but if you don't, head over to protrusive. app. And make a free account. I'll make it freely available to everyone. It's kinda like a perk of being in the network. Of course, if you're paying subscriber, you've got access to Protrusive Vault. It'll be there alongside all the papers and infographics that are a fingertip away just for you. The Protrusive Dental Pearl today, which Zohaib will explain, is all about finding centric relation, but actually what I love about what you said is the practice of it. Now whether you use a leaf gauge or you've been taught how to use bimanual manipulation and that's what you choose to do, it is a skill. Finding the fully seated condylar position is a skill and so Zohaib's tip is really good because it encourages you to practice it. So let's hear it from Zohaib. Today's Protrusive Pearl is by our guest Zohaib. We're talking about it a little bit and I'll get him to say it, but I love what he's going to say. I'm going to prime you guys now because it's an idea of putting things into practice, even perhaps when it's not necessary, but it's building up those muscle skills. So when it comes necessary, it's so much easier. It's really like a, considered like a dark art, this part. So Zohaib, take it away. [Zohaib]So, I think if I've got a tip, it would be something that I found useful when I started first going on courses, learning about CR and kind of bimanual manipulation and things like that. I didn't have any cases to do this on, but I would have regular patients for checkups. And if they were comfortable, I would maybe manipulate and try and find CR, find the first point of contact, make a note of it. I really just practice some of the things before I needed to use them. And you kind of constantly thinking when you're seeing a patient for a checkup. They're not interested in kind of managing their tooth with it, but you're having a look, where's that weird facet, is that the first point of contact, is the mandible sliding, and you're kind of, a bit of detective work, even when you don't need to, and I found that kind of spurred my interest, because if a tooth fractured, I thought, why is that fractured, they're already happy to have an onlay or a crown, but I want to kind of know a little bit more, and so you might look at their guidance pattern, and there might be a kind of non working side interference, And it was that kind of detective work that made me more interested in tooth wear and other bits and pieces. So, I think if there's one tip, it would be kind of be interested in some weird dental things and you might find a bit of a passion that leads from that. [Jaz]I think you're right, and especially with what we're going to be talking about today. Tooth wear, tooth surface loss. When you're treating these cases, you're often raising the vertical dimension and often the joint position of choice that you may prescribe rather than just being arbitrary is central relation or fully seated condylar position or stable condylar position, call it what you want. And it's a skill to be able to find it, which is what you described. No matter how is that you've learned to find it. And we've got a webinar on YouTube all about this kind of stuff as well. I'm sure you guys teach it as well in your courses. But use that technique every so often, even when you don't need to, to refine those skills. So when you need it, you nail it. Thank you, Zohaib. Hope you enjoyed that Pearl. Like some of our younger colleagues may be like, ah, I don't know anything about centric relation. In which case, check out the webinar that we've done. It's called Finding Centric. And this webinar replay is available on Protrusive Guidance. There's a whole section for webinar replays. You can check it out. Let's now join Zohaib in the main episode. Dr. Zohaib Khwaja, again, another fellow of Protruserati. It's been great to interview Protruseratis recently. How are you, my friend? [Zohaib]Really good, Jaz. Thanks for having me on. I've watched the podcast and listened over the last few years. You've definitely kept me company on many of commutes, so really happy to be contributing today and really looking forward to our conversation. [Jaz]I'm very much looking forward to your contribution. It's a great topic and I'm very excited to dive into it. We'll be talking about managing vertical dimension, when to do DAHL technique versus when to go ahead and restore the posteriors and a little bit more about some of the things that you shared with me on social media, like the palatal backing. So lots of geeky goodness to come tooth wear related, which I know is difficult to find good content on that. So I think we're going to make it today. So let's make it happen. I'm very excited to dive into that and extract as much as I can from you for the Protruserati and true protrusive style. But we were just talking before we hit the record button about your journey. It's always nice to learn the journey. And so just to just summarize, you've got so many masters. I've lost track now. Just maybe you tell us what's your journey been like? [Zohaib]So I graduated 2011 from King's. I spent a year doing a MaxFax job. And then pretty much I've been in general practice since then. But kind of a few things happened to me early on in my career that were quite seminal I remember probably being about a couple of years post qualification and one of the professors at King sat me down. Prof Dunn who some of your your listeners will definitely know and he kind of sat me down.