Because just because they've come in asking for an upper central incisor
rotated, doesn't excuse the fact they might have quite bad wear in their teeth.
Their canines have worn down, their gums aren't in the best condition. You know,
we've got a duty of care for the patients. And,
and the way I do treatment very much is that we give ideal a chance and we work
back from there. So it might involve a lot of work.
It might involve doing orthodontics.
Welcome to the Protrusive Dental podcast,
the Forward Thinking Podcast for dental professionals.
Join us as we discuss hot topics in dentistry, clinical tips,
continuing education,
and adding value to your life and career with your host. Jazz Gulati.
The first rule of planning aesthetic dentistry is so key that everything about
the smile just falls into place from this very first rule. I've got Dr.
Josh Valley today to share the four rules of planning aesthetic dentistry.
Hello, Producer Ra.
I'm Jazz Lati and welcome back to Your Favorite Dental podcast is been a crazy
few weeks for Team Protrusive.
Just a few weeks ago we hosted Lincoln Harris live in London for his famous
de-stress dental lecture. And let me tell you,
this was a masterclass in theatrics, comedy, dental,
comedy and public speaking. It was just a phenomenal lecture. Uh,
and I've actually got a slides, uh,
on my desktop and for eight hours when he spoke for seven hours, right?
And he only had like 38 slides. This is a sign of a phenomenal speaker.
Like he barely looked at his slides and he has so much conviction in his
message. And the lessons he shared were so real world,
a lot of big bigger picture communication type stuff to reduce our stress and
dentistry and a few slides here and there,
and then delving deeper into it was just such an engaging lecture.
There's very few people,
I think can hold and captivate an audience for six hours during the day,
and you learn so much at the same time. It's just absolutely brilliant.
So hats off to you link for, for that.
And I met so many of you for the first time.
It was great to connect with the producer. R uh,
fin came all the way from Northern Island. She's a dental student.
It was great that you made that trip. She's part of our telegram group.
So fin a personal thank you for,
for coming all that way on a day where there was so many train strikes from
around the uk. So thank you so much. And a shout out, I mean, I don't wanna,
I can't shout out all of you.
There's like so many I met for the first time was to privilege,
but when I shout out Saga Patel, uh,
Saga is someone who told me a story when he met me.
He said that the influence that Protrusive had on him was so big and the
Protrusive Dental community Facebook group helped him to connect with his now
principal. And he's in a good place and happy environment.
And that just made me feel so warm and fuzzy and happy. And in fact, we've been,
uh, connecting and this exchanging message on Facebook. And, uh,
we had this photo that we took together and he said, Mate,
I owe my whole inspiration of dentistry back to you became very demotivated
during Covid and dt, but your passion kept me going to where I am now.
So this was just a, a an amazing thing to hear from a producer Tru like him.
And these messages really keep me going and so many of you came with love and
kindness. So thank you to all the people who came to my event. Uh,
and it was just lovely to see you all.
The Protrusive General Pearl is actually a,
a snippet from that lecture that I'm gonna share with you.
I'm gonna paraphrase for you. So Lincoln,
if you haven't heard of Lincoln's episodes, go back,
find anything by Lincoln Harris.
Talk about retraction chords recently and also an episode Forden students just
absolutely phenomenal. Also, if you go back many episodes,
there was five rules that I've learned from Lincoln Harris,
which are just so fundamental.
So r are really key episodes that you should go back and listen to when you get
a chance. But the pearl I wanna share for you is from that lecture.
And basically it's when you've presented some complex or comprehensive density
to a patient and they are not quite sure, yeah,
sometimes even if it's just like the one main option to treat them and they're
not sure, or maybe they're deciding between, you know,
composites or ceramics and they're not sure,
or just any hint of them being uncertain. Anyway,
then the advice that Link gave,
which I just love and I really wanna just share this with you all. Now,
for those who weren't there at the lecture, if you have such a patient,
you should say to them,
I won't let you make a decision yet because you're not sure or not motivated.
Obviously they might not be motivated. Like for example,
dentistry is a stress purchase.
It's like sometimes when I have to get my tires replaced,
I don't have to do that. Patients come in, they don't wanna have crowns,
they we're recommending crowns cuz their teeth are in a bad state. So we,
they need crowns on the posterior teeth, for example,
for this is a distressing purchase for many patients.
So they don't want to have the crowns.
So naturally they don't want to do anything about it,
but they're kind of forced to do something about it.
So what I would say to you and what what Lincoln really echoed is that if your
patient really isn't motivated for dental treatment, then you shouldn't do that.
And I think holds really true for elective work and comprehensive work.
If your patient is not sure or they're not motivated for dental treatment,
you should not continue to treat them. It just makes sense.
Don't do complex treatment on someone who is not sure or not
motivated. And it's totally okay to say that to your patient that, Look,
I don't think you are a hundred percent motivated when you are motivated and
you, you're feeling ready. We can continue with this.
And then they can get their ass in gear and then be motivated for the treatment
or justify that treatment themselves and understand that there is a,
an end goal that you're trying to reach.
And then that's a much better scenario for you and the patient working together
because dentistry is a marriage to your patient,
especially with elective and and comprehensive work.
So if your patient is unsure how to proceed, then help them,
but don't let them proceed until they are sure and they are motivated.
Before we join the main episode,
I shout out to three people who not only join Protrusive Premium by downloading
the app and subscribing, uh,
they're the first ones to actually comment on the community tab within the app.
So if you haven't already downloaded the protrusive app on IRS or Android,
it's a free app to download.
You can even download all the episodes offline so you can listen to them later
on the app. If you go premium, then you get some extra benefits.
But e even if you just joined as a free member,
I would love to have you on the app and for,
so the first three ones that joined where? April, Sunny and Nni,
thank you so much for joining, uh, and,
and commenting on the community section and introducing yourselves.
It's so great to have you and, and so thank you so much for,
for supporting protrusive. It really means a lot.
And thank you to everyone who's downloaded the app.
I hope to grow it and add very regular exclusive content on there.
So like I said, if you haven't already downloaded the app on your device,
go to iOS, go to Android, just type in Protrusive and download the app.
Now let's join the four rules of Planning Aesthetic Dentistry with Dr.
Josh Rowley. Josh Rowley, welcome to the Protrusive Dental podcast my friend.
How are you?
I'm very well, thank you Jess. Thanks for having me on.
It's a absolute privilege and a pleasure to have you on. Uh, Josh, you,
I've seen you grow and grow as a clinician.
The stuff you're doing in Author restorative is amazing.
I dunno if you remember a few years ago I asked you some help with a case and
you helped me nail it. Do you, do you remember that? I, yeah, so.
There we're, Do you remember that? Yeah, . Try my best.
I can Joshua, when I asked you for help on, on,
on that case in Facebook all those years ago. So thank you again.
I feel like you've switched a line companies, uh, you,
you batting for the other team now. So what, what, what,
what led you to to change, uh, a liner sort of, uh,
modality from one company to another company?
Cause I see you doing a lot of work with, with Schal now.
Yeah, absolutely. Yeah. I,
I teach and I mentor anyone who needs help with any aligner brands that are out
there. But the main reason for me why I,
I made the switch a few years ago now to sure smell was because of patient
preference. You know, patients want a discreet nature treatment,
one that maybe their friends even relatives might not even know that they're,
they're even doing. And yeah, it really comes down to the,
the material that they're made from actually. Um,
I had a friend actually who I'm doing his treatment for who just finished his,
his braces treatment and there's a couple of little tweaks to do and we have now
just made him a couple of sure SMILE aligners just to finish his case. Uh,
I suppose just to do the fine tuning. And he was like, Wow, why didn't,
why didn't I start with these aligners in the first place? He's,
and he's a dentist as well.
He's a dentist and a colleague of mine and he's honestly converted. And I'm,
I'm gradually getting one by one people turning over thinking why are people not
using these? Um, but yeah, the, the clarity is one that the,
the ability to be able to give the patients what they've asked for,
which is a discreet nature of treatment,
something that fits in with their lifestyle,
something that they can eat and chew what they want, you know,
it maintains its clarity throughout the treatment as well. You know,
one of the things which was a bit of a bug bear for me was after some aligners
have been worn for a few days or a week or so, um, they do tend to tarnish. Uh,
and then it makes it a little bit difficult if you have to go back a couple of
aligners to kind of pick teeth up and then go forward again. And so it's,
it's again,
opened up a whole new arm of aligner treatment for me where I can ask the
patients to go back in time, be as well as go forward. So, um,
because they're happy to go back and wear them cuz they maintain their
integrity. Well.
I, I I think, uh, we're gonna talk about, uh,
I mean I'd like to know a bit more about the,
that system cuz there's something about trim heights and stuff, which, uh,
seems really like voodoo science, but it seems really clever. But I wanna,
I wanna say that towards the end, uh, let's talk more about the, the, these,
the four principles that make the four rules of aesthetic, uh, planning,
which obviously with your background in Author Restorative,
I think you'd be perfect for just to set the scene and the context.
The first time we met was a part of the dental tub's trip to lun to to see,
to see the GC group. We learned about junior concerts. Uh, and from then I knew,
okay, this guy's a really switched on guy. He knows what he wants.
And to see the dent you've made and the author Restorative world has been
absolutely amazing. So, uh, it is great to have you on. Josh,
for those that don't know you, you Josh, please tell us little bit about you,
your journey, how you fell into orthodontics.
And I actually wanna know for myself, are you limited to orthotics?
Cause I just feel like that's,
that'd be a real shame if you're not doing a story of dentistry as well.
How long have we got ? My story?
You got 60 seconds for this intro, , 60.
Seconds. Well, my name's Dr. Josh Ruly, um,
a specialist orthodontist in Edinburgh in Scotland.
I work in two dental practices, one which is purely focused at the orthodontics.
I do a combination of NHS and private orthodontics.
And the other practice is very much a general practice.
I I see patients for checkups. I do restorative work, limited restorative work.
I tend to not do that many endodontic treatments or nothing with too much blood
and guts, no surgery kind of things. It's.
A typical orthodontist.
Yeah, absolutely. Um, I've been doing a lot of teaching as well,
just pretty much since lockdown actually. I mean, quite enjoying that. Uh,
just kind of sharing the past experiences, sharing the knowledge that I can,
trying to help younger dentists and dentists that want to get into orthodontics
later on in their career just to try not make the mistakes that I made as such,
trying to get them the, the quicker path , I suppose. Um, but yeah,
no thoroughly enjoying when I do, can imagine myself doing anything else. Well.
I I I would've thought when I saw you all those years ago that you were gonna be
fully down the restorative path. What,
what made you pivot into specializing in orthodontics? Right.
Yeah, absolutely. So I, I kind of went a little bit of a,
a niche way into orthodontics whereby I was working in a quite a high end
practice in Edinburgh at the time. Um, had very good mentors around me. Um,
and as a general practitioner I was doing a lot of aligner treatments and I
really enjoyed doing it,
but I definitely found that there was that little black box of knowledge that I
just didn't know.
And I thought about doing post-graduate courses privately funded.
I then looked into maybe going back and doing specialty training and it was
because I then, you know, went into the hospital and just inquired about it,
that actually it was just a complete chance that at the time the consultant
in charge actually offered me a position the following year,
in fact starting in about two months. And so, uh, yeah,
it was really quite a curve ball. Uh, and it,
it wasn't a specialist training rate, I have to say.
It was a privately funded doctorate whereby, um,
I entered into, uh, the world of orthodontics just wanting to know more.
I didn't have any interest really becoming a specialist.
I just knew that if I wanna know what's inside this box,
I've gotta go and do this. Gotta treat the patients bit of over the shoulder,
uh, mentoring and, and yeah. And it kind of went on from there, really.
And like I said, it's,
I've got an engineering kind of brain and orthotic is all about the kind of the
engineering and, and the planning and the cases,
which I'm sure we'll talk a lot about today.
. Well, I, you know, the education that you do and I,
and I watch your staff,
so I know that you are involved in planning smiles and you don't work with D S D
and you, you, you, you do all that kind of stuff, which is great.
So do you still do like, um,
composite bonding beers as an adjunct to your author or what,
gimme a percentage breakdown, like, okay,
I would like to know what Josh Rowdy is doing today.
So in terms of your percentage of aligners,
your percentage of fixed appliances for also. So tell me about that and then,
then also tell me author in general versus your restorative. I I would just,
just, I'm being nosy.
No, that's absolutely fine. Um,
so I would say in both practices now I'm,
I'm 50 50 with braces and aligners,
and the reason why that number might be higher than you might think with braces
is because I do NHS orthodontics and, and,
and NHS orthodontics is really the bread and butter of an orthodontist work.
It's the growing individuals. It's where you can really, you know, do your,
I see, see the biggest changes sometimes I suppose with, with, uh,
with functional appliances, even surgery, um, as well. Um, but yes,
NHS side leads into the private side in the sense that you'll get a lot of kids
whose, whose parents, uh, might ask, Oh, you know, I, I see, uh, you know,
the results I've seen with, with my son or daughter are fantastic. You know,
what do you think, uh, you could do with me? And they're sitting in the chair,
you know, just beside the dental chair and they just go like this, you know,
what can he do with this? You know,
I'm sure you get the same I know and one leads to the other.
I'm doing more and more treatments with aligners now because I'm becoming more
confident in what they can do.
But I'm very aware the limitations that aligners have as well. And so,
as I'll probably talk a little bit about later, um,
aligners are really a tool for the job, just like braces are a tool. Uh,
and really it's about knowing that limitations and knowing what is is best for
the job really. But in terms of, or restorative, you're absolutely right. Uh,
I tend to focus my restorative work on the post orthodontic kind of treatments,
like in size, alleged bonding, could even be veneers. I'm putting together a,
a lecture for a, a course I'm doing next week where, uh, you know, I'm,
you know what it's like when you're writing lectures,
you're trifling through your, your cases.
And I'm thinking I do a lot more porcelain than I maybe think actually.
But a lot of it is just the, the tweaking at the end,
reshaping the teeth in sizely. Um, so turn a,
a good case into a great one really. So.
This episode, what I wanna, um,
extra from your mind onto a producer r is where do you even begin?
So the rules of aesthetic planning and who better than you? Someone who is,
you know, has done all your training and ortho formal training, ortho,
but I know your heart is as a restorative dentist.
So I think someone like you is perfectly suited Now before we cover the main
thing. You know what I'm like when it comes to occlusion? I, I can't,
I can't possibly continue without asking you a very interesting curve wall
question. This is completely unscripted for everyone.
I was at a lecture yesterday by Coran and Muong, uh,
and they're talking about the orthodontic restorative interface in terms of the
joint position. Uh,
what I mean by that is the starting point for most rehabs in traditional
sort of school thinking, not neuromuscular, but uh, ation. But then, um,
Cora asked the audience, Okay, now orthodontist, where do they start?
Which joint position do they start in? And everyone sort of said, Well,
they just kind of just work around MIP usually, cuz that's the way I'm taught.
Now, for you as someone who is trained in as a restorative dentist, I would,
I'm just being nosy again. Do you screen for the first point of contact in,
in your, your young kids or your,
or your adults and then plan from that joint position for your orthotics?
Yeah, absolutely. You know,
leaf gauge is one of the most useful tools in the armory of a dentist in my
opinion. So you wanna make sure that the,
the patient's comfortable in reaching a CR position and really, you know,
that leaf gauge should be a, a diagnostic tool.
It's a way of us deciding is this joint healthy enough to be able to kind of
like Humpty Dumpty participation off the wall to then put them back together
again with orthodontics or, you know,
is the joint maybe in a position that's gonna cause problems or cause potential
pain when you're doing this as well? So for a lot of adult patients,
certainly if there are symptoms of tmd,
whether that be muscular or intercapal problems.
So it was good to diagnose those first.
And it can be as simple as making a blin or a little to see a jig just to get
'em to wear for the interim time before they get their braces on or aligners
started and, and is a general thumb for me.
If that pain or problems they've been having go away with that, uh,
anterior bite or deprogrammer, then you're good to go.
Whereas if they sometimes make the problem worse or they really can't wear it,
it might be an indication for further diagnostic records.
It could even be you would refer them to or medicine clinic just to see for a
second opinion as well. I have to say it's not an area that I'm, you know,
a specialist in, not like yourself, but certainly I know the,
the boxes to tick to know when I'm being safe and not .
Good man. Good man. I, it,
it is good to hear about Orantes as yourself looking at the joint position in
terms of their final orthotic outcome. But anyway,
that's digressing into occlusion. Where do you start, Josh? Okay, ,
you got a patient in the chair and they want, uh,
a lovely smile and with your eyes, how do you begin planning aesthetics?
So if you were to boil it down to four rules, which I highly ask you to do,
what is the first rule of of, of making this,
helping this patient to achieve a beautiful smile?
Cool.
Well we're off the four rules of planning aesthetic dentistry in I opinion
the first, really it all starts with the face because you gotta know, you know,
where what's gonna look good for the patient or where,
what is the face asking of the teeth is, is what we normally see.
So first of it all starts with a, a facial photograph. And then we start,
what we would do is a small design. And so the,
the real starting position of a smile is really the incisal edge of the upward
central incisors. So we're taking our photograph,
the first bit that you do when you're doing a small design is you orientate that
photograph to the horizontal.
So you're making sure that patient's face is perfectly in line. And then we,
we draw do.
You use any tools for this? Like, like, you know,
so sometimes people do like go a bit lopsided, so, uh,
do you use like blinds behind you? Exactly. So how do you gauge that as a,
as a young dentist try and take photos, portrait photographs,
how can you be sure to help.
You? So usually natural head position, just asking the patient just to relax,
show their shoulders, usually just before they take the photographs,
try and get the patient to look directly into the camera and just being aware
and the patient might kind of just move their head left to right.
So we're getting a really nice parallel picture with the patient's face.
The software that I I would use is just keynote. You can use keynote,
you can use PowerPoint, you can use paint, you know, any,
any software that allowed you to draw lines on a page.
It's really not that simple.
You could even print off a picture of the patient's face, uh,
full smiling picture for example, and, and literally draw with pen and paper.
And really you're looking at drawing that midline. Where's the facial midline?
And then we're looking at two photographs that I take, uh,
for every single patient that walks on the door and it is an m position
photograph and an e position photograph,
e position being the maximum smile that that patient can give you, you know,
really exaggerating the lip movements.
You wanna see how high that lip moves up or the top lip moves up.
I should say end position a bit more difficult actually.
But that is generally our relaxed position where there is no muscle activity in
the upper lip.
And what we're really looking for with between these two photographs is where
does the inci lead sit?
So the end position you were looking at maybe two to three millimeters of
incisal display in maybe a slightly older patient,
whereas that number will usually increase to maybe six or even seven millimeters
for someone who's very young. And so really that's our starting point.
So the end position, just.
Just so I can make it, I think you're gonna come to it now, exactly what the,
the dentist should say to the patient to get them to make those um,
smiles that we want. Well.
To be honest, I just get the patient to lick their lips.
So for the end position I say lick your lips and just let your lips just rest.
And a lot of the time for adult patients, you know,
they might not show any inside.
I'll just play a rest and don't worry if that's the case.
Cuz that means you've probably got an additive case where you want to move the
teeth down or maybe add length the teeth.
So they then have display of incisor display at rest.
And then with the e position,
it is literally just imagine I've told you the funniest joke and you've got this
belly laugh,
how high can you get your upper lip to go up when you're smiling at your
maximum? Mm-hmm . And that's really what I say. And,
and and it's important to get the diagnosis right cuz I do get, you know, uh,
shy individuals that come in and they're, they're guarded, you know,
you wanna try and get this e m position out of them and you gotta try and make
them laugh anything you can because you can get your diagnosis wrong if you get
these photographs wrong.
And it's important that you kind of are aware that that is as much as the look
can move.
When I used to Josh get my patients through the, the Emma, so say Emma. Yeah.
But I found out that people for some reason found it funny and say Emma,
and then, and then Shannon smiles, I take it they start smiling and so I got,
I kind of got a little bit of a rest one, but then I got a smile and then,
then my usual question means, do you have an Emma in your life?
And then they really smile. Okay, they, they they they stop um,
getting really awkward if their partners also in the room .
So I stopped doing that one. So I like your one licking lips.
. Yeah.
That's it. Exactly.
Exactly. Very good. And yeah, and then from there, you know,
you've got your vertical reference point,
you've also got your horizontal reference point cause you know where the facial
midline is and that is where you build your smile from that kind of middot all
the way around to the back. Mm-hmm .
And I suppose going back a little bit to, to the main title,
which was the four Rules of Planning, you know,
the next one for me is really getting the diagnosis right. You know,
without the diagnosis being correct, you're off to a bad start it, you know,
you might not be able to deliver the best for that patient.
And so really just understanding where the patient has come from. I, I, when I,
when I teach certainly, you know, younger dentists, you know,
you know what questions they should be asking of the patient.
I always start with the, the five Ws and and n h. So it's kind of like the what,
where, when, why, and how or who sometimes as well.
And it's really asking, you know, where is the patient come from,
why is there where seen here asking yourself all these questions,
like if you were in like a job interview or something like that, you know?
And it's kind of really just getting a detailed background of why the patient is
presenting in this way. Cuz it's only under, once you understand, you know,
why their teeth and dentition or malocclusion is like this,
you can then start to treat it.
So really important that we get the diagnosis right.
And that just covers all dentistry, not necessarily just aesthetic dentistry.
Cuz aesthetic dentistry really is an umbrella term for all the specialties
really.
Okay. I guess the best example of that, Josh, I'm sure you agree, is um,
when deciding whether to lengthen the teeth mm-hmm.
like downwards or push the gum go, go upwards,
I you crown lengthening. And that's as a young dentist,
I I I struggle okay in this case. But it's all, it comes down to diagnosis and,
and then again your photos,
just like the ones you described become so powerful in helping you decide should
you lengthen or actually this is one for the periodontist or yourself with some
experience to actually make the gums go higher up a gum lift.
That's it. Yeah, you can, I mean what a smell design is,
it's basically a blueprint. It's like if you're building a house,
you don't just start laying bricks and that's where dentists go wrong sometimes.
You gotta know where you're going. And so therefore what do you do?
Well you bring in an architect, you work out what shape, what room size,
where's the garages going. And then, you know,
after that then you ask the engineer, you know, is this actually gonna work?
And what I mean by the engineer in dentistry is you do trial smiles. You,
you might simulate the orthodontic tooth movement with orthodontic, uh,
simulations. And only once you've actually got that you've got your blueprint,
you've asked the engineer, they're pretty happy with it,
then you start building the bricks.
And I always say that smile design should really be part of every special
diagnosis, just like taking your x-rays or taking, uh, photographs. Um,
you know, it should form part of your special investigation, Sorry,
is what I meant to say. And then I suppose going on to, to the third, kind of.
Before we get the third one, Josh, you know,
you maybe think of this question now is, you know, you're someone who I,
I respect as a restorative dentist and then you went this formal orthotic
training, which is awesome. But when you did that orthotic training, uh,
compared to perhaps some of the other trainees, orthotics,
you were probably a bit more experienced in the restorative side.
Did you find that the orthotic program covered these aspects of smile
design mm-hmm in the same or different or better or worse way than
what the restorative dentists teach restorative dentists?
That's a very good question actually.
It's not one I've actually thought of before,
but I have to say that a lot of the,
the post-graduate orthodontic programs out there,
I suppose they're maybe more traditional in the way that they would approach
the, the planning of cases where it's very much study models on a bench ,
if I'm perfectly honest. And it's, it's not difficult. Well,
it might be difficult for some,
but for some cases it can be quite difficult to get the,
the smile to the good with in the face you can get the models lovely in class
one, that's not a problem. You're taking teeth out, moving teeth around.
It's just a big boys me can really, you know, it's just, it is just, uh,
pulling teeth here, there and everywhere,
but it's actually getting it to look good within the face.
And that can depend on the, the canting, the strategies can't,
if there's a transverse can't, how much inside display they have, you know,
things like that.
You're looking at all the plains of space to fit those models in that nice class
one inclusion, ideally .
So it's safe to say that whilst people were doing their study models planning,
you were keeping that for the to pass exams, but you were looking at the,
the photos more than anything.
Always, always having that facial picture there and always really just having
references. You don't always have to do a full small design,
but as long as you know your references, you're starting points,
you kind of work from there. But I like to, to work in a way that I've, I'm try,
I'm gathering all the diagnostic information I can and,
and then kind of using that when I'm formulating a plan.
And I suppose that then leads very well, I was gonna say into the third rule,
which is.
But I just wanna summarize this thing so far. So,
so I just wanna summarize rule one was, uh, begin with the, uh,
upper incid ledges and plan from there. Uh,
and then rule two is nail your diagnosis.
Absolutely all the W's and H's to,
to figure out the story and then to help you forward.
So that's why we're up to her so far. So hit us with rule three of my friend.
So rule three really,
and it's one that I kind of follow every single day and it's, uh,
gonna talk to me about a dentist called Dr. Miguel Stanley, um,
I'm sure you've heard of before over in America. Yes.
Christiana, Ronaldo, dentist.
. I think so, yeah, you're right. And he, he really kind of hit home,
to me it was about giving idea a chance.
And what that means is that every patient that comes in the front door,
you know, they have come to you for a diagnosis,
they've come to you for a way of presenting to them what is the best thing for
them. They might come in saying, Josh, my upper right central incisors rotated,
that's all I want to treat. But I I, I don't ignore that, don't get me wrong,
but I,
I kind of put that to one side because I would still take the same records,
photographs, scans, X-rays, maybe even a com beam CT if it needed it.
And I would treat that patient, you know, as if they've asked me, Josh,
what can I do here, time and money or no object, what would you love to do?
Cuz just because they've come in asking for an upper central incisor rotated,
doesn't excuse the fact they might have quite bad wear in their teeth.
Their canines have worn down, their gums aren't in the best condition. You know,
we've got a duty of care for the patients and,
and the way I do treatment very much is that we give ideal a chance and we work
back from there. So it might involve a lot of work,
it might involve doing orthodontics,
might involve some porcelain work or composite work.
It might involve very heavy work with the periodontal specialists if there's any
problems. Um,
it might even involve orthotic surgery because they have a underlying skeletal
problem. But it's important that the, the patient is aware of all that could be.
And then working back from there, you know, it's,
there's absolutely no harm in doing compromising, uh,
for your treatment as long as the patient is aware that, you know, that is the,
the gold standard of what we could have in ideal world and we can work back from
there. So for me, rule three is giving idea a chance.
I I love that rule, Josh. I mean,
rule one is so fundamental and when I started to actually look at smiles,
rule two is great in terms of making sure we get the bigger picture,
but rule three in terms of a,
a real communication skill to have with your patients. Because put it this way,
if you never present the ideal, you never get to do the ideal.
If you never present comprehensive, guess what?
You never get to do comprehensive. So that's such a a, a key one. And uh,
recently I was at a lecture, uh, by Lincoln Harris who,
who came over to London and did a amazing like performance. It was a, an actual,
uh, performance. He was a, one of the best performances of his,
cause I've seen him live before, but he was just on fire and it reminded me of,
of a great thing he taught that day is that he'll he says to patients, and,
and I'm definitely, you know,
gonna use this patience is I'm gonna present to you the ideal plan mm-hmm.
if if it's too expensive and you can,
and he says you can use the word expensive, it's okay, don't be don't shy. Yeah.
If it's too expensive, let me know. We can make some compromises and find a,
a solution that best suits you a rule.
But I'm gonna still plan ideally because everyone deserves ideal.
So I'm gonna plan ideally, but if it's too expensive, let me know.
I have other options. And that gives you the license.
Yeah, it really does. And I suppose compromises can be in materials,
it can be an accepting certain things of a male occlusion, for instance,
an over jet.
Like a slightly increase, I was just gonna say over jet Yeah.
Like that. Or a crossbite that you might not want to try and uh, treat.
And there might be limitations and it might be that surgery is the only option.
I'm sure we've seen, uh,
I think I saw in your stories recently that I think it was your,
was your oldest son had his adenoids taken out recently, Is that right? Yeah.
Mm-hmm. . Mm-hmm .
We get patients that unfortunately don't get that done. And then they have,
you know,
skilly to problems that manifest throughout their adult life and narrowing over
the upper jaw, for example. And they want,
they come in asking for a wider smile and it's something that's orthotic alone,
it's something that we can't give them because we'd be moving those teeth out
the bone. And so really their options are, you know,
accepting that fact that orthodontically,
that's where the teeth have to be or restoratively, it can be a bit wider,
you know, it can add veneers, composite to widen the teeth, uh,
artificially as such. Or they're moving the bones, you know, they're moving the,
their surgical expansion. I wouldn't,
I wouldn't dream anyone or wish anyone to have it,
but certainly it is an option and these are the things that,
that it's important that anyone who's providing orthodontics really in my
opinion knows about, you know, always plan towards their deal.
And you can always compromise from there as long as the patient is aware of what
these compromises mean long term.
Mm-hmm. mm-hmm.
and medically legally that it just makes sense to write notes in
that way as well so that they know, uh, exactly what the ideal was.
And sometimes, you know, as I say, treat children idealistically,
treat adults realistically. That's a, a mantra drilled into me,
but it doesn't mean that we can't present the ideal plan to adults.
Absolutely. Yeah. The good thing is, you know, in a lot,
a lot of the patients I treat are kind of younger teenagers and I guess they
come with a little bit less baggage in the sense that they normally have really
nice shapes of teeth on war and, you know, good, good oral hygiene ideally. Uh,
and, and really it's a case of really just moving the teeth, you know, to,
to where their face faces asking. But adults as, as you know,
they come with some more problems, gum problems, wear, uh, missing teeth,
things like that. So there's a lot more to plan. And I have to say that I, I,
I have no problems with saying to my patients, I don't know because in reality,
you know,
you were thrown with so much information in a first consultation situation that
you can certainly let the patients know, you know, what a rough idea could be.
I think your teeth are outta position.
Maybe we can think about some orthodontics here.
I think the shape of your teeth could be adjusted,
maybe even the color adjusted here. So you've got a couple of ideas,
you're planting the seed,
but I'm not always telling the patient at day one that we need to do this, this,
and this. You know, you say, I don't know yet. The honest answer is,
I'm gonna invite you back when I'm gonna gather some more information and I'm
gonna get you back in and we're gonna present a couple of options for you.
You know, and if one of those options fits your,
your budget and fits what you're wanting, then great,
we can go ahead And I suppose the, the fourth kind of rule,
bring me right into that really nicely.
There is simulations cuz during a second consultation appointment,
simulating the treatment, uh,
plan for the patient and really allowing them to visualize it before they begin
is crucial in my opinion.
And that can be as simple as doing an orthodontic setup such as an aligner setup
to show the patient the beginning and end result of what orthotics can mean.
Different aligner companies have got different softwares and stuff.
So that's what you mean by the simulation, right?
Absolutely. Yeah. So the Sure Smile aligners, which is the,
the company that I have been working with for a very long time and I've really,
you know,
enjoying using the software and really enjoying using the aligners as I'm sure
we'll talk about it later on as well. I can even share my screen and show you,
um, you know, what the software word looks like. So we got example here.
And just describe for those listening in the car, driving on the train,
chopping onions, et cetera, just also describe, uh, what we're seeing here.
As well. So what we're seeing here is an orthotic simulation.
It's showing us the plan from the start to the finish of where the teeth need to
move to start and then the finish.
And what we're also getting here is the staging here.
So the stage models of going from day one or aligner one all the way up to,
in this case aligner number 28.
It's showing us where the attachments need to go to provide that extra grip to
the teeth that need it,
as well as any space creation by the form of any i p or into proximal reduction.
It's between the teeth. It allows us to get the room to align the teeth.
It's showing us when that's being performed and at what stage it's being
performed. And so this is something which I use a lot to,
to just demonstrate to patients just how their treatment will play out from
start to finish. And so they get that kind of crystal ball moment of,
of what their treatment will look like once they're done.
Mean. This is, this is brilliant, but the Josh,
there's a another Lana company that I use at the moment, uh, and uh,
they are very well known, uh, and they have their own version of software. Uh,
and I wanna, I wanna know from you someone who's used both systems, uh,
is there anything different or, or, um, interesting about, uh,
the Shore Smile software?
Because I heard yesterday at the Congress that something about the envelope of
function, uh, outlines is they,
they will show you the cross section of the envelope.
Function. It does indeed. So this software is,
is really the most powerful software I've ever seen . It's,
it's got so much in it and the, the,
one of the biggest things for me are the quality control tools.
So these are the tools that allow you to see the contact points, tooth widths,
the, the marginal ridges, tooth axis and things as well.
As well as being able to actually kind of see and measure, uh, you know,
between the teeth. Uh, let me get the kinda measuring tool here.
You can kind of clip the frame as well.
So you can see the envelope of function right there.
You can then move but between the teeth Yeah.
To see where the contact points are.
It is really quite sometimes daunting, I'm not gonna lie,
the amount of buttons. Yeah, . But to be honest with you, you know, it's,
you can use it for as much or as little as you want really.
You get out what you want, what you put in.
So if you wanna see all that extra detail, you can reveal it if you want to,
but if you want to do the usual stuff, you can do that as well. I can,
I can see that. I mean the.
Software really came from traditional orthodontic planning with brackets and
wires and it's really kind of developed from there. And so there is so much, uh,
diagnostic information that can be, you know, at your fingertips here, uh,
as well, really looking really closely into your cases to,
to look at where they come from and where you want to get to. Um, and that's,
you know,
that's just the software that's not even talking about the actual aligners
themselves. So yeah, you can see I'm passionate about it cuz uh,
I honestly don't know why more people aren't using it because it's like wow.
But.
So okay, let, let's, let's talk about that Josh. We, so, you know, rule,
rule one was in size, alleged rule two was ask, uh,
the questions to get the diagnoses all the Ws and h uh, rule three,
which I love was, uh,
give ideal a chance mm-hmm and rule four was, um, uh,
the rule of aesthetic planning is use simulation,
which just makes so much sense to,
to your patient and also to you as you're planning the case. Oh my God,
you just overlaid the face over it. This is awesome. . Okay, so, so this,
this is cool. So, um, that makes for complete sense now.
I'll let you just tell me any other things you wanna tell me about Rule four
before we then talk about, uh,
Short Smile and why perhaps we're using Short Smile and not some of the other
competitor aligners out there.
Yeah, I mean for, for me really as I told you in rule one, you know,
it starts with the face, it starts with a small design and,
and really with the software you can overlay the exact teeth,
both the starting model and the end model, you know, into the patient's face.
You can see kind of what it's gonna look like in the end.
Like a try before you buy.
You wouldn't buy a car without taking it for a test drive first.
And that's exactly the same. So this is really the,
the simplest version of the simulation where you can just show the patient what
it would look like. You know,
it's a little bit of a cartoon here cuz obviously the teeth are your scans that
you've taken in, in the mouth,
but it really does give the patient a really nice idea of.
What it, And sorry to stop you Josh. You said scans, I have to ask you this,
right. So with certain aligner companies, you have to get a certain scanner to,
to send. So would I need a dense splice? So I would have,
I would have to have a prime scan to send to get short smile aligners.
No, you don't actually the,
the Sure Smile aligner system is very much an open access platform except scans
from any brand of scanner that's out there. Um,
and that's part of the reason why I really like working with Den Supply is that
they have always been and always will be, uh,
an open access software where you're not limited by a brand as well as that you
can also export things. So without jumping too far ahead here, you know,
it really does give you, you know, know the,
the freedom and the versatility to ask for all of your aligners to be made.
Um, and that's by Sure smile itself. Um,
which comes in a very nice kind of branded packaging just like you would with
other aligner brands as well. The patients will recognize,
but it does also allow you to export.
So if you have a local dental lab or you have a lab in house,
you can ask for them to print the models for you, for you to make your aligners.
Or even if you wanna do everything you know yourself,
you could export each SDL file or each scan file of every stage
or every aligner in that treatment and you can make them yourself.
So it's a bit like, describe this in the past, but going into a restaurant,
you know, you can go in and you can order from the set menu,
which is like what you would do with other aligner brands where you're limited
to maybe 12 or four, you know, 24 aligners, you know,
or you can have as many aligners as you want.
You can eat as much as you want in the buffet or you know,
you can choose from the ala carte menu.
You can decide you don't wanna starter today,
but you won't want a man in a dessert and that's fine.
So you can export the SDL fouls and make that yourself.
Or if you really wanna go to town,
you can even go walk into the kitchen and you can make your own food ,
you know, you can actually go in there.
You're not relying on a technician if you really want to.
And I would say and stress that I keep this myself for more milder cases where I
can take control and be my own technician where I can actually move the teeth
myself, plan the movements which the software allows,
and then actually explore or ask Smail to make my aligners for me. So there is.
What would be the benefit to you, Josh? Why would you, uh,
do that step of making it in house? Is it ultimately a,
a financial benefit of you cooking in house compared to eating out?
It is really the financial benefit, but also for the patient. Yeah,
I mean at the end of the day I'm not having to pay for the chef ,
so Yeah.
Yeah. But but that's really good that,
that the dead supply and short allow you to,
I'm kind of surprised in a way and and shocked and it's pretty impressive that
they it is, they're pretty open with that. That's, that's to be admired I.
Guess. I I guess you can use it for as much or as little as you wish.
Just like the,
the quality control tools and the diagnostic tools in the sense that uh,
if you do have a more mild case, perhaps just a, a relapse,
that patient has lost the retainer for a few weeks and they said, ah,
my tooth has moved a little bit. You know, you could literally take a,
a scan of the mouth, upload it, move that tooth back,
it'll tell you just how many stages you might need and then, you know,
you make those aligners and it saves the cost for you,
saves the cost for the patient. Everyone wins.
Is that something that um, you get taught by Sure. Smile.
Cause I guess there are lots of courses teaching how to do your own liners
orthodontic base.
So does Shore Smile actually teach you the methods involved that hey,
if you wanna come to the kitchen, cook itself, you know, here's your utensils,
Like how's it work?
The main focus for sure smile, you know, as a mentor and as a tutor myself,
really it is using the software and it is about kind of using the technicians is
communicating with the technicians for more complex cases or cases that you want
the help basically. But it, it,
it allows you to open the doors to do that yourself.
And that is something that over the years I have, I have learnt myself,
you know, I haven't had much guidance other than some of my peers. But, and,
and in a sense there is an element of trial and error error here as well.
You know, you are moving the tooth. My, my old movements,
I would say I wouldn't tackle anything above say, uh, eight or 10 aligners.
Mm-hmm. myself. But certainly the more, but.
With their full package. But with, with their full package,
you can do elastic tads like the, the full whack.
Absolutely. Yeah. There is no limitation. Again,
you can add elastics if you need to. In fact, I've just listened to your,
your one of the podcasts from uh,
Straight Pro actually about elastics and I was a bit kind of like, Oh wow,
don't use them . I do, I do, I do. And I don't, I have to say,
and I'm glad I listened to that lecture cuz it kind of,
or the podcaster cause it really did uh, kind of, uh,
confirm that I'm doing things okay , you know,
I'm not doing it for the sake of it,
I'm doing it cause I'm moving individual teeth and yeah, you know,
if you want and allowed you to be creative,
you can add bite ramps if you want to yourself. Um,
you can actually ask for a variable trim height.
And this is one of the most underrated things in aligners at the moment is
asking for a variable trim height, what.
It means first. Explain what that actually yeah, what you were just about to do.
I'm sorry, but also like why,
Well I wanna know when you would ask for a lower trim height high.
Cause I've seen Tiff talk about this and I'm like, first, okay,
it's pretty cool how you can customize something,
but at the moment with my lack of knowledge,
I wouldn't know when to prescribe which one and what benefits would you get.
So tell us teachers enlighten.
Us. So yeah, as you said,
I actually again just listened to a podcast that TIF did,
I think it was the Teeth and Teals podcast, um, that,
that's just gone on recently actually. And he described this perfectly actually.
So I'm probably gonna repeat a little bit what you said if I'm honest.
And that is that with, uh, scallops trimline,
like you might be more accustomed to using some other brand of aligners that has
a degree of flexibility. Okay. For correcting rotated teeth, for example,
where you want the plastic to be able to bend an almost stretch into an Embraer
or into an area where it's the,
the plastic is quite difficult to reach because with a liners,
you gotta think like the plastic,
how does that tooth or a liner grip that tooth? You know, I think I I also, uh,
like the analogy on one of the podcasts I listened to recently where it's like a
slippery watermelon seed , I love that.
Like I laughter on sizes like slippery watermelon seeds, that's it. And uh,
and yeah, you know, uh, more flexible aligner, uh, trim height,
like the skeletal mic four rotations.
But also being aware that the higher up or the, the more rigid the tray is.
So if you're asking for a straight trim line more associated with something like
a retainer for example, that becomes a lot more rigid.
And so if the patient is needing a lot of attachments because of control,
you want to keep more control over a certain tooth movements,
then again you might choose a scallop trim line because you want that
flexibility so the patient can comfortably get it in and out.
and I have been caught out in the past where I thought, yeah,
all the attachments really high trim line and the patient goes and you're like,
Oh wow, that ain't coming out easy. So yeah, is a degree, you know,
is a bit of a learning curve as well when you start with this other option
essentially you maybe haven't had the chance to use before.
So, so, so if you go for a higher trim line, ie. Um, straight,
so not scallop straight, that means that you need to use less attachments.
Did I get that.
Right? Yeah, you're spot on. So where the more rigid tray, because this the,
um, aligner is trimmed a bit higher, it,
you can apply I suppose slightly heavier forces to the teeth just ever so
slightly. Um, and it does mean you get more control, you know, so, um,
it will mean less attachments,
which is amazing cuz patients generally request a aligner treatment for the
discrete nature of the treatment.
And so when you can offer the patient a higher trim line,
which keeps the plastic above the smile line,
so they don't actually see any of the plastic at all, uh,
or the edge of the plastic I should say,
which is something very visible and you're having less attachments because
attachments are,
they reflect the light at different angles and they can be very visible. And,
and one of the things which, uh,
it was one of the main reasons why I moved away from other aligner brands and
then, you know,
years and years ago was because actually during that fitting appointment where
you, you hand the patient the mirror and say, Here is your first aligner,
you know, I used to dread that because the honest truth was it didn't look, it,
you know, the, the aligners weren't maybe as clear as they were hoping for. Uh,
and also there was a lot of attachments which just drew away from that discreet
nature. And so now it is a complete cha rev reversal whereby, you know,
I, I I, I'm looking forward to giving the patient the, the mirror and saying,
Look how clear these are the actual line of material themselves,
and look how, you know, discreet this can be for you. So, you know, there's,
this is a topic I speak a lot on and, and it's fantastic. I'm hoping I'm, um,
bringing forward my, uh, my enthusiasm for it.
absolutely. No, it, it shines through. Now, do I need to, to spend, uh,
a best part of, uh, 4,000 pounds to, to, to,
to learn how to give these aligners?
No, not at all. No, it's, well, maybe not my, uh, my hair to say,
but certainly if you were keen to get involved with another aligner brand as
such, you know, I'd always say don't put all your eggs in one basket. You know,
look around and see what other options are available. And sure.
Us now being one of the major competitors in the aligner market at the moment,
and if you wanted to start using Sure.
Smile is a case of reaching out to one of the representatives, uh,
going in on the website and expressing your interest. Um, there isn't so much a,
a course that you would pay to go on as such that you're almost, uh,
paying to have access to the software cuz it is such a powerful software.
And with that access then comes the case for you to do,
for your first case for free. So really, uh, there's an investment to make to,
to start using She Smile. But if you do your first case, it balances out.
So that's really the best way I can describe it. Brilliant.
Brilliant. So you obviously, uh, teach, uh, for sure Smile. Uh,
are you also like a mentor like on the end of a phone, Uh,
if someone needs advice in planning case, or how does it,
I guess my next question is how, how does support lend itself to the.
System? So at the moment, um, Sure. Smile and Is Academy, uh,
myself and Tiff and Ross Hobson and, and many other mentors that are out there,
I can't name them all. Um, we've, we actually have a,
a kinda a handshake agreement, I suppose, with, uh, dense supply and,
and Sure smile to provide a lot of the teaching and also the mentoring.
So if there are cases that you would like to ask questions, upload photographs,
get any, um, help with,
then there are many mentors all over the world to help with that.
There is also the,
the communication kind of customer support line as well for simple more software
related things as well. So there will be an answer to your question.
Somewhere. Is this on like a IAS website where you got like the forum and stuff?
Oh, that's brilliant. So I mean, having used that in the past, um, I,
I can definitely vouch for that. Uh, you know, I have so much faith in ias. Tif,
yeah, Prof, uh, so some, some great people there. So, uh,
IAS is very trustworthy. So that that, that, that's a really good thing to,
to have. So that, that's, that's amazing. And you.
And you can again, use as much or little of the, the, um,
support network that's there as you wish. You know,
even things like WhatsApp group chats,
if you just wanna quick answer to a question as well, you know,
we're trying to keep it in the 21st century and keep everyone kind of in contact
with one another.
. Very cool. Well, Josh, uh,
you've answered my main thing about the four key rules in planning aesthetic
dentistry and it's great coming from you, so passionate about ortho,
restorative and, uh,
I'm sure you'll agree that the best orthotics might be done with,
from someone who's got a restorative eye, uh, as you do. And I,
and I truly believe that.
So it's great to learn these pearls from you and thanks for sharing some extra
bits about why other aligner companies might do things differently and what
benefits that may present. So, um, you know, shout out to, to shore smile for,
for that.
So it's great to learn about that and I trust people like you and Tiff,
Tiff is a, is a huge inspiration in, in my career and, and I know yours as well.
So, uh, uh, hat tip to Tiff as well, uh, Josh,
tell us how we can follow you and find out more from you on,
on social media and also any courses that you run, that kind of stuff. Yeah.
I, I wish I was better with social media, if I'm honest with you. I just,
it's a matter of time. It really is. How much time can you afford? I,
I'm a busy man, what can I say? You know, treating, treating the patients,
doing what I enjoy doing the most,
which is actually achieving these smiles that, that we do. But yeah,
happy for anyone to contact me via social media, things like that.
If you want to, I'm on Instagram and Facebook. I would strongly encourage,
you know, anyone who's listening today to, if you have any questions,
just to reach out to me and yeah. You know, see what's out there.
I would say to any,
any young dentist or dentist who really wanting to get into this kind of work,
whether it's with orthodontics or or smile design, you know, do,
do your research, you know, see what courses might be out there.
I don't particularly run any courses myself. I,
I do a lot of the teaching through Sure Smile and Through Is Academy. So again,
you know, seek these courses out if you want to learn more.
There is so much with aligners, you know, it's,
it's not something that can be taught in a day. You know,
like when you go in a course, uh, you know, in a hotel room for one day, yes,
they can teach you how to do the fundamentals,
which is your i p your polishing machine, your teeth.
You can teach you how to put attachments on, but there is, it's,
it's that black box I was talking about before that really, you know,
separates the, you know, how to do it, but how to really can understand it.
Really, it's like passion driving test.
You don't really know how to drive and you passion driving test , do you?
Absolutely no, you, you always learn afterwards.
And I said the same thing about, about bds and, uh,
it's great to have mentorship, which is a recurring theme of the podcast,
hence why, uh, you know, I was able to, to lean on your knowledge as a mentor,
uh, a few years back on a case. So thank you again, Josh, for,
for helping me out that time and again, helping me out this time to, to,
to help these dentists, uh, better plan their aesthetics and just, you know,
that rule one is just so key in knowing where to begin.
And I really love that rule three, you know, that, that communication one.
So those are my two of the, my favorite of the four.
But I think you gave great value there. So Josh, thank you so much for,
for spending time with us today. No.
Thanks very much Chaz. Thanks for everyone who was listening and yeah,
everyone enjoyed the rest of your weekend .
So there we have it guys. Is a summary.
Rule number one that I said right at the beginning is to start with the upper in
size ledges.
Once you plan where the upper incisal edge will go in the face and your or the
proposed future position of that central incisor and everything else falls into
place. Uh, that rule two was to find out what the diagnosis is diagnosed,
diagnosed diagnosis, the why, the what, the how,
where do you want the different teeth to be?
So the example I gave was whether you should lengthen the teeth or in that
specific patient,
would you get a better result in the face by crown lengthening?
Another example would be if someone's with proportions of their teeth that got
re small lateral in sizes. That's really important as partly your diagnosis.
So diagnose in every way possible so you can get a better treatment plan,
cuz the diagnosis always informs your treatment plan.
Rule number three was my personal favorite. Give ideal a chance,
give the ideal treatment plan a chance, communicate it with your patient. Yes,
you can make compromises. It is not a sin, it is not dirty to compromise,
but if you are compromising,
the patient should know there's a compromise being made.
It really helps with your consent. And number four, simulations.
So if you aren't using a line of therapy,
then you can use the software of your line of company yet. Sure. Smile,
look very, very snazzy. So thanks to Josh for sharing a screen share,
but those who are listening,
were able to follow along in terms of what makes this software unique.
And if you've watched or if you've listened on the protrusive premium app,
you can now answer the simple questions to claim your c p D for this episode,
which is really quick and easy. Within 72 hours,
we send you a certificate with your reflective log inside as well.
One of the example questions for this episode, uh,
is what are the two main photos used for deciding the central inci position?
Is it A, the d and n smile? Is it B, the e and n Smile?
Is it C the e and m smile, or is it D? The d and m smiles.
So if you know the answer to that one and the other ones,
why don't you join Protrusive Premium,
answer a few questions and get rewarded for your c p D hour for listening to the
entire way and also validate your learning and reflect on it.
This is gonna be really good at the end of the year to have all your reflections
and the lessons you learn from protrusive in one place.
So if you've got a few minutes,
get on the app and just answer those questions and you are well on your way to
getting c p D. Anyway, I'll catch you in the next episode. Same time,
same place. Thank you for listening all the way to the end.