1
00:00:00,000 --> 00:00:03,120
Because just because they've come in
asking for an upper central incisor

2
00:00:03,120 --> 00:00:06,360
rotated, doesn't excuse the fact they
might have quite bad wear in their teeth.

3
00:00:06,360 --> 00:00:09,400
Their canines have worn down, their gums
aren't in the best condition. You know,

4
00:00:09,400 --> 00:00:11,200
we've got a duty of care
for the patients. And,

5
00:00:11,500 --> 00:00:14,960
and the way I do treatment very much is
that we give ideal a chance and we work

6
00:00:14,960 --> 00:00:17,880
back from there. So it
might involve a lot of work.

7
00:00:17,880 --> 00:00:19,920
It might involve doing orthodontics.

8
00:00:20,690 --> 00:00:23,240
Welcome to the Protrusive Dental podcast,

9
00:00:23,700 --> 00:00:26,680
the Forward Thinking Podcast
for dental professionals.

10
00:00:27,030 --> 00:00:30,840
Join us as we discuss hot topics
in dentistry, clinical tips,

11
00:00:30,870 --> 00:00:32,240
continuing education,

12
00:00:32,340 --> 00:00:37,240
and adding value to your life and
career with your host. Jazz Gulati.

13
00:00:41,060 --> 00:00:45,880
The first rule of planning aesthetic
dentistry is so key that everything about

14
00:00:45,880 --> 00:00:50,240
the smile just falls into place from
this very first rule. I've got Dr.

15
00:00:50,240 --> 00:00:54,000
Josh Valley today to share the four
rules of planning aesthetic dentistry.

16
00:00:54,040 --> 00:00:55,160
Hello, Producer Ra.

17
00:00:55,180 --> 00:00:59,640
I'm Jazz Lati and welcome back to Your
Favorite Dental podcast is been a crazy

18
00:00:59,820 --> 00:01:01,760
few weeks for Team Protrusive.

19
00:01:01,760 --> 00:01:05,680
Just a few weeks ago we hosted Lincoln
Harris live in London for his famous

20
00:01:05,760 --> 00:01:08,200
de-stress dental lecture.
And let me tell you,

21
00:01:08,230 --> 00:01:12,200
this was a masterclass in
theatrics, comedy, dental,

22
00:01:12,200 --> 00:01:16,240
comedy and public speaking. It
was just a phenomenal lecture. Uh,

23
00:01:16,240 --> 00:01:17,600
and I've actually got a slides, uh,

24
00:01:17,600 --> 00:01:21,320
on my desktop and for eight hours
when he spoke for seven hours, right?

25
00:01:21,380 --> 00:01:26,120
And he only had like 38 slides. This
is a sign of a phenomenal speaker.

26
00:01:26,120 --> 00:01:28,720
Like he barely looked at his slides
and he has so much conviction in his

27
00:01:28,720 --> 00:01:31,680
message. And the lessons he
shared were so real world,

28
00:01:31,750 --> 00:01:36,000
a lot of big bigger picture communication
type stuff to reduce our stress and

29
00:01:36,000 --> 00:01:37,520
dentistry and a few slides here and there,

30
00:01:37,520 --> 00:01:40,000
and then delving deeper into it
was just such an engaging lecture.

31
00:01:40,000 --> 00:01:40,840
There's very few people,

32
00:01:40,840 --> 00:01:45,400
I think can hold and captivate an
audience for six hours during the day,

33
00:01:45,400 --> 00:01:48,720
and you learn so much at the same
time. It's just absolutely brilliant.

34
00:01:48,720 --> 00:01:50,360
So hats off to you link for, for that.

35
00:01:50,360 --> 00:01:52,720
And I met so many of
you for the first time.

36
00:01:52,720 --> 00:01:55,280
It was great to connect
with the producer. R uh,

37
00:01:55,520 --> 00:01:58,000
fin came all the way from Northern
Island. She's a dental student.

38
00:01:58,000 --> 00:02:01,080
It was great that you made that trip.
She's part of our telegram group.

39
00:02:01,080 --> 00:02:02,880
So fin a personal thank you for,

40
00:02:02,880 --> 00:02:06,080
for coming all that way on a day where
there was so many train strikes from

41
00:02:06,080 --> 00:02:09,160
around the uk. So thank you so much.
And a shout out, I mean, I don't wanna,

42
00:02:09,160 --> 00:02:10,360
I can't shout out all of you.

43
00:02:10,360 --> 00:02:12,960
There's like so many I met for
the first time was to privilege,

44
00:02:12,960 --> 00:02:15,360
but when I shout out Saga Patel, uh,

45
00:02:15,480 --> 00:02:17,640
Saga is someone who told
me a story when he met me.

46
00:02:17,640 --> 00:02:21,160
He said that the influence that
Protrusive had on him was so big and the

47
00:02:21,160 --> 00:02:25,480
Protrusive Dental community Facebook
group helped him to connect with his now

48
00:02:25,480 --> 00:02:27,880
principal. And he's in a good
place and happy environment.

49
00:02:27,880 --> 00:02:31,560
And that just made me feel so warm and
fuzzy and happy. And in fact, we've been,

50
00:02:31,560 --> 00:02:34,200
uh, connecting and this exchanging
message on Facebook. And, uh,

51
00:02:34,200 --> 00:02:36,440
we had this photo that we took
together and he said, Mate,

52
00:02:36,440 --> 00:02:41,000
I owe my whole inspiration of dentistry
back to you became very demotivated

53
00:02:41,000 --> 00:02:44,920
during Covid and dt, but your passion
kept me going to where I am now.

54
00:02:45,250 --> 00:02:49,240
So this was just a, a an amazing thing
to hear from a producer Tru like him.

55
00:02:49,240 --> 00:02:52,800
And these messages really keep me going
and so many of you came with love and

56
00:02:52,800 --> 00:02:55,960
kindness. So thank you to all the
people who came to my event. Uh,

57
00:02:55,960 --> 00:02:57,680
and it was just lovely to see you all.

58
00:02:57,680 --> 00:02:59,600
The Protrusive General
Pearl is actually a,

59
00:02:59,600 --> 00:03:01,640
a snippet from that lecture
that I'm gonna share with you.

60
00:03:01,640 --> 00:03:03,200
I'm gonna paraphrase for you. So Lincoln,

61
00:03:03,200 --> 00:03:05,440
if you haven't heard of
Lincoln's episodes, go back,

62
00:03:05,440 --> 00:03:06,600
find anything by Lincoln Harris.

63
00:03:06,600 --> 00:03:10,000
Talk about retraction chords recently
and also an episode Forden students just

64
00:03:10,000 --> 00:03:12,840
absolutely phenomenal. Also,
if you go back many episodes,

65
00:03:12,840 --> 00:03:15,680
there was five rules that I've
learned from Lincoln Harris,

66
00:03:15,680 --> 00:03:17,040
which are just so fundamental.

67
00:03:17,040 --> 00:03:20,640
So r are really key episodes that you
should go back and listen to when you get

68
00:03:20,640 --> 00:03:23,240
a chance. But the pearl I wanna
share for you is from that lecture.

69
00:03:23,240 --> 00:03:27,160
And basically it's when you've presented
some complex or comprehensive density

70
00:03:27,160 --> 00:03:31,080
to a patient and they
are not quite sure, yeah,

71
00:03:31,080 --> 00:03:34,760
sometimes even if it's just like the one
main option to treat them and they're

72
00:03:34,760 --> 00:03:37,560
not sure, or maybe they're
deciding between, you know,

73
00:03:37,880 --> 00:03:39,800
composites or ceramics
and they're not sure,

74
00:03:39,800 --> 00:03:43,280
or just any hint of them
being uncertain. Anyway,

75
00:03:43,510 --> 00:03:45,080
then the advice that Link gave,

76
00:03:45,080 --> 00:03:47,640
which I just love and I really wanna
just share this with you all. Now,

77
00:03:47,640 --> 00:03:49,880
for those who weren't there at the
lecture, if you have such a patient,

78
00:03:49,980 --> 00:03:51,000
you should say to them,

79
00:03:51,190 --> 00:03:54,880
I won't let you make a decision yet
because you're not sure or not motivated.

80
00:03:54,880 --> 00:03:57,000
Obviously they might not be
motivated. Like for example,

81
00:03:57,000 --> 00:03:59,200
dentistry is a stress purchase.

82
00:03:59,200 --> 00:04:01,480
It's like sometimes when I
have to get my tires replaced,

83
00:04:01,480 --> 00:04:04,200
I don't have to do that. Patients
come in, they don't wanna have crowns,

84
00:04:04,200 --> 00:04:07,720
they we're recommending crowns cuz
their teeth are in a bad state. So we,

85
00:04:07,720 --> 00:04:09,560
they need crowns on the
posterior teeth, for example,

86
00:04:09,700 --> 00:04:13,000
for this is a distressing
purchase for many patients.

87
00:04:13,050 --> 00:04:14,680
So they don't want to have the crowns.

88
00:04:14,680 --> 00:04:16,720
So naturally they don't want
to do anything about it,

89
00:04:16,720 --> 00:04:18,240
but they're kind of forced
to do something about it.

90
00:04:18,530 --> 00:04:22,960
So what I would say to you and what what
Lincoln really echoed is that if your

91
00:04:22,960 --> 00:04:26,400
patient really isn't motivated for dental
treatment, then you shouldn't do that.

92
00:04:26,400 --> 00:04:30,200
And I think holds really true for
elective work and comprehensive work.

93
00:04:30,290 --> 00:04:34,360
If your patient is not sure or they're
not motivated for dental treatment,

94
00:04:34,380 --> 00:04:37,120
you should not continue to
treat them. It just makes sense.

95
00:04:37,120 --> 00:04:41,800
Don't do complex treatment on
someone who is not sure or not

96
00:04:41,800 --> 00:04:44,640
motivated. And it's totally okay to
say that to your patient that, Look,

97
00:04:44,640 --> 00:04:47,480
I don't think you are a hundred percent
motivated when you are motivated and

98
00:04:47,480 --> 00:04:49,520
you, you're feeling ready.
We can continue with this.

99
00:04:49,520 --> 00:04:53,120
And then they can get their ass in gear
and then be motivated for the treatment

100
00:04:53,290 --> 00:04:56,200
or justify that treatment themselves
and understand that there is a,

101
00:04:56,200 --> 00:04:57,600
an end goal that you're trying to reach.

102
00:04:57,780 --> 00:05:02,600
And then that's a much better scenario
for you and the patient working together

103
00:05:02,600 --> 00:05:04,600
because dentistry is a
marriage to your patient,

104
00:05:04,600 --> 00:05:06,840
especially with elective
and and comprehensive work.

105
00:05:06,890 --> 00:05:09,720
So if your patient is unsure
how to proceed, then help them,

106
00:05:09,740 --> 00:05:13,560
but don't let them proceed until
they are sure and they are motivated.

107
00:05:13,560 --> 00:05:14,960
Before we join the main episode,

108
00:05:14,960 --> 00:05:18,800
I shout out to three people who not only
join Protrusive Premium by downloading

109
00:05:18,800 --> 00:05:20,440
the app and subscribing, uh,

110
00:05:20,440 --> 00:05:24,040
they're the first ones to actually comment
on the community tab within the app.

111
00:05:24,040 --> 00:05:27,120
So if you haven't already downloaded
the protrusive app on IRS or Android,

112
00:05:27,120 --> 00:05:27,960
it's a free app to download.

113
00:05:27,960 --> 00:05:31,400
You can even download all the episodes
offline so you can listen to them later

114
00:05:31,730 --> 00:05:34,400
on the app. If you go premium,
then you get some extra benefits.

115
00:05:34,400 --> 00:05:36,360
But e even if you just
joined as a free member,

116
00:05:36,360 --> 00:05:38,560
I would love to have
you on the app and for,

117
00:05:38,560 --> 00:05:42,320
so the first three ones that
joined where? April, Sunny and Nni,

118
00:05:42,320 --> 00:05:44,040
thank you so much for joining, uh, and,

119
00:05:44,040 --> 00:05:46,360
and commenting on the community
section and introducing yourselves.

120
00:05:46,360 --> 00:05:48,760
It's so great to have you and,
and so thank you so much for,

121
00:05:48,760 --> 00:05:50,400
for supporting protrusive.
It really means a lot.

122
00:05:50,400 --> 00:05:52,360
And thank you to everyone
who's downloaded the app.

123
00:05:52,360 --> 00:05:55,360
I hope to grow it and add very
regular exclusive content on there.

124
00:05:55,360 --> 00:05:58,120
So like I said, if you haven't already
downloaded the app on your device,

125
00:05:58,120 --> 00:06:01,520
go to iOS, go to Android, just type
in Protrusive and download the app.

126
00:06:01,520 --> 00:06:05,480
Now let's join the four rules of
Planning Aesthetic Dentistry with Dr.

127
00:06:05,480 --> 00:06:09,600
Josh Rowley. Josh Rowley, welcome to
the Protrusive Dental podcast my friend.

128
00:06:09,600 --> 00:06:10,260
How are you?

129
00:06:10,260 --> 00:06:12,480
I'm very well, thank you
Jess. Thanks for having me on.

130
00:06:12,590 --> 00:06:15,600
It's a absolute privilege and a
pleasure to have you on. Uh, Josh, you,

131
00:06:15,600 --> 00:06:17,640
I've seen you grow and
grow as a clinician.

132
00:06:17,660 --> 00:06:19,880
The stuff you're doing in
Author restorative is amazing.

133
00:06:19,990 --> 00:06:22,760
I dunno if you remember a few years ago
I asked you some help with a case and

134
00:06:22,760 --> 00:06:25,520
you helped me nail it. Do you, do
you remember that? I, yeah, so.

135
00:06:25,520 --> 00:06:28,040
There we're, Do you remember
that? Yeah, <laugh>. Try my best.

136
00:06:28,070 --> 00:06:30,680
I can Joshua, when I
asked you for help on, on,

137
00:06:30,680 --> 00:06:32,960
on that case in Facebook all those
years ago. So thank you again.

138
00:06:33,270 --> 00:06:35,960
I feel like you've switched
a line companies, uh, you,

139
00:06:35,960 --> 00:06:38,600
you batting for the other
team now. So what, what, what,

140
00:06:38,600 --> 00:06:42,160
what led you to to change,
uh, a liner sort of, uh,

141
00:06:42,160 --> 00:06:44,240
modality from one company
to another company?

142
00:06:44,240 --> 00:06:46,320
Cause I see you doing a lot
of work with, with Schal now.

143
00:06:46,320 --> 00:06:47,920
Yeah, absolutely. Yeah. I,

144
00:06:47,920 --> 00:06:51,680
I teach and I mentor anyone who needs
help with any aligner brands that are out

145
00:06:51,680 --> 00:06:53,640
there. But the main reason for me why I,

146
00:06:53,640 --> 00:06:58,080
I made the switch a few years ago now
to sure smell was because of patient

147
00:06:58,080 --> 00:07:00,840
preference. You know, patients
want a discreet nature treatment,

148
00:07:01,060 --> 00:07:04,280
one that maybe their friends
even relatives might not
even know that they're,

149
00:07:04,280 --> 00:07:07,320
they're even doing. And yeah,
it really comes down to the,

150
00:07:07,320 --> 00:07:09,240
the material that they're
made from actually. Um,

151
00:07:09,240 --> 00:07:12,000
I had a friend actually who I'm doing
his treatment for who just finished his,

152
00:07:12,000 --> 00:07:16,080
his braces treatment and there's a couple
of little tweaks to do and we have now

153
00:07:16,080 --> 00:07:20,360
just made him a couple of sure SMILE
aligners just to finish his case. Uh,

154
00:07:20,360 --> 00:07:23,360
I suppose just to do the fine tuning.
And he was like, Wow, why didn't,

155
00:07:23,360 --> 00:07:26,400
why didn't I start with these
aligners in the first place? He's,

156
00:07:26,400 --> 00:07:27,400
and he's a dentist as well.

157
00:07:27,400 --> 00:07:31,080
He's a dentist and a colleague of mine
and he's honestly converted. And I'm,

158
00:07:31,080 --> 00:07:34,760
I'm gradually getting one by one people
turning over thinking why are people not

159
00:07:34,760 --> 00:07:38,520
using these? Um, but yeah, the,
the clarity is one that the,

160
00:07:38,520 --> 00:07:41,280
the ability to be able to give the
patients what they've asked for,

161
00:07:41,280 --> 00:07:42,840
which is a discreet nature of treatment,

162
00:07:42,840 --> 00:07:44,640
something that fits in
with their lifestyle,

163
00:07:44,640 --> 00:07:47,720
something that they can eat and
chew what they want, you know,

164
00:07:47,720 --> 00:07:50,200
it maintains its clarity throughout
the treatment as well. You know,

165
00:07:50,200 --> 00:07:53,320
one of the things which was a bit of a
bug bear for me was after some aligners

166
00:07:53,320 --> 00:07:57,400
have been worn for a few days or a week
or so, um, they do tend to tarnish. Uh,

167
00:07:57,400 --> 00:08:00,920
and then it makes it a
little bit difficult if you
have to go back a couple of

168
00:08:00,920 --> 00:08:04,080
aligners to kind of pick teeth up and
then go forward again. And so it's,

169
00:08:04,080 --> 00:08:04,560
it's again,

170
00:08:04,560 --> 00:08:07,360
opened up a whole new arm of aligner
treatment for me where I can ask the

171
00:08:07,360 --> 00:08:10,240
patients to go back in time, be
as well as go forward. So, um,

172
00:08:10,240 --> 00:08:12,560
because they're happy to go back and
wear them cuz they maintain their

173
00:08:12,560 --> 00:08:13,480
integrity. Well.

174
00:08:13,480 --> 00:08:15,520
I, I I think, uh, we're
gonna talk about, uh,

175
00:08:15,520 --> 00:08:17,200
I mean I'd like to know
a bit more about the,

176
00:08:17,200 --> 00:08:20,320
that system cuz there's something about
trim heights and stuff, which, uh,

177
00:08:20,360 --> 00:08:23,560
seems really like voodoo science, but
it seems really clever. But I wanna,

178
00:08:23,630 --> 00:08:26,760
I wanna say that towards the end, uh,
let's talk more about the, the, these,

179
00:08:26,820 --> 00:08:30,560
the four principles that make the
four rules of aesthetic, uh, planning,

180
00:08:30,560 --> 00:08:32,920
which obviously with your
background in Author Restorative,

181
00:08:32,920 --> 00:08:35,440
I think you'd be perfect for just
to set the scene and the context.

182
00:08:35,440 --> 00:08:40,160
The first time we met was a part of
the dental tub's trip to lun to to see,

183
00:08:40,410 --> 00:08:44,480
to see the GC group. We learned about
junior concerts. Uh, and from then I knew,

184
00:08:44,480 --> 00:08:46,720
okay, this guy's a really switched
on guy. He knows what he wants.

185
00:08:46,820 --> 00:08:50,680
And to see the dent you've made and
the author Restorative world has been

186
00:08:50,680 --> 00:08:53,440
absolutely amazing. So, uh, it
is great to have you on. Josh,

187
00:08:53,620 --> 00:08:57,280
for those that don't know you, you Josh,
please tell us little bit about you,

188
00:08:57,280 --> 00:09:00,240
your journey, how you
fell into orthodontics.

189
00:09:00,240 --> 00:09:03,040
And I actually wanna know for
myself, are you limited to orthotics?

190
00:09:03,040 --> 00:09:03,840
Cause I just feel like that's,

191
00:09:03,840 --> 00:09:06,320
that'd be a real shame if you're not
doing a story of dentistry as well.

192
00:09:06,420 --> 00:09:08,480
How long have we got <laugh>? My story?

193
00:09:09,180 --> 00:09:11,760
You got 60 seconds for
this intro, <laugh>, 60.

194
00:09:11,760 --> 00:09:14,640
Seconds. Well, my name's
Dr. Josh Ruly, um,

195
00:09:14,640 --> 00:09:17,200
a specialist orthodontist
in Edinburgh in Scotland.

196
00:09:17,510 --> 00:09:22,280
I work in two dental practices, one which
is purely focused at the orthodontics.

197
00:09:22,280 --> 00:09:25,560
I do a combination of NHS
and private orthodontics.

198
00:09:26,100 --> 00:09:28,720
And the other practice is
very much a general practice.

199
00:09:28,950 --> 00:09:33,320
I I see patients for checkups.
I do restorative work,
limited restorative work.

200
00:09:33,470 --> 00:09:38,160
I tend to not do that many endodontic
treatments or nothing with too much blood

201
00:09:38,160 --> 00:09:40,120
and guts, no surgery kind of things. It's.

202
00:09:40,120 --> 00:09:40,953
A typical orthodontist.

203
00:09:41,030 --> 00:09:44,920
Yeah, absolutely. Um, I've been
doing a lot of teaching as well,

204
00:09:44,920 --> 00:09:49,440
just pretty much since lockdown actually.
I mean, quite enjoying that. Uh,

205
00:09:49,440 --> 00:09:53,120
just kind of sharing the past experiences,
sharing the knowledge that I can,

206
00:09:53,270 --> 00:09:57,360
trying to help younger
dentists and dentists that
want to get into orthodontics

207
00:09:57,360 --> 00:10:01,520
later on in their career just to try not
make the mistakes that I made as such,

208
00:10:01,520 --> 00:10:06,160
trying to get them the, the quicker
path <laugh>, I suppose. Um, but yeah,

209
00:10:06,160 --> 00:10:10,480
no thoroughly enjoying when I do, can
imagine myself doing anything else. Well.

210
00:10:10,480 --> 00:10:13,880
I I I would've thought when I saw you all
those years ago that you were gonna be

211
00:10:14,040 --> 00:10:16,080
fully down the restorative path. What,

212
00:10:16,080 --> 00:10:19,120
what made you pivot into
specializing in orthodontics? Right.

213
00:10:19,430 --> 00:10:22,240
Yeah, absolutely. So I, I kind
of went a little bit of a,

214
00:10:22,240 --> 00:10:26,520
a niche way into orthodontics whereby
I was working in a quite a high end

215
00:10:26,720 --> 00:10:30,200
practice in Edinburgh at the time. Um,
had very good mentors around me. Um,

216
00:10:30,200 --> 00:10:34,200
and as a general practitioner I was
doing a lot of aligner treatments and I

217
00:10:34,200 --> 00:10:35,040
really enjoyed doing it,

218
00:10:35,040 --> 00:10:38,840
but I definitely found that there was
that little black box of knowledge that I

219
00:10:38,840 --> 00:10:39,673
just didn't know.

220
00:10:40,100 --> 00:10:43,520
And I thought about doing
post-graduate courses privately funded.

221
00:10:43,790 --> 00:10:47,480
I then looked into maybe going back
and doing specialty training and it was

222
00:10:47,480 --> 00:10:51,000
because I then, you know, went into the
hospital and just inquired about it,

223
00:10:51,470 --> 00:10:56,200
that actually it was just a complete
chance that at the time the consultant

224
00:10:56,320 --> 00:10:59,600
in charge actually offered me
a position the following year,

225
00:10:59,600 --> 00:11:03,040
in fact starting in about
two months. And so, uh, yeah,

226
00:11:03,040 --> 00:11:05,120
it was really quite a
curve ball. Uh, and it,

227
00:11:05,120 --> 00:11:07,360
it wasn't a specialist
training rate, I have to say.

228
00:11:07,360 --> 00:11:11,240
It was a privately funded
doctorate whereby, um,

229
00:11:11,240 --> 00:11:15,200
I entered into, uh, the world of
orthodontics just wanting to know more.

230
00:11:15,510 --> 00:11:18,280
I didn't have any interest
really becoming a specialist.

231
00:11:18,280 --> 00:11:20,880
I just knew that if I wanna
know what's inside this box,

232
00:11:21,070 --> 00:11:24,920
I've gotta go and do this. Gotta treat
the patients bit of over the shoulder,

233
00:11:24,970 --> 00:11:28,920
uh, mentoring and, and yeah. And it
kind of went on from there, really.

234
00:11:29,060 --> 00:11:30,400
And like I said, it's,

235
00:11:31,030 --> 00:11:34,400
I've got an engineering kind of brain
and orthotic is all about the kind of the

236
00:11:34,600 --> 00:11:35,960
engineering and, and the
planning and the cases,

237
00:11:35,960 --> 00:11:37,560
which I'm sure we'll
talk a lot about today.

238
00:11:38,000 --> 00:11:40,760
<Laugh>. Well, I, you know, the
education that you do and I,

239
00:11:40,760 --> 00:11:41,680
and I watch your staff,

240
00:11:41,680 --> 00:11:46,120
so I know that you are
involved in planning smiles
and you don't work with D S D

241
00:11:46,140 --> 00:11:48,760
and you, you, you, you do all that
kind of stuff, which is great.

242
00:11:48,760 --> 00:11:50,000
So do you still do like, um,

243
00:11:50,000 --> 00:11:53,600
composite bonding beers as an
adjunct to your author or what,

244
00:11:53,600 --> 00:11:54,960
gimme a percentage breakdown, like, okay,

245
00:11:54,960 --> 00:11:56,840
I would like to know what
Josh Rowdy is doing today.

246
00:11:56,840 --> 00:11:59,400
So in terms of your
percentage of aligners,

247
00:11:59,400 --> 00:12:02,920
your percentage of fixed appliances for
also. So tell me about that and then,

248
00:12:02,920 --> 00:12:06,000
then also tell me author in general
versus your restorative. I I would just,

249
00:12:06,000 --> 00:12:06,960
just, I'm being nosy.

250
00:12:07,090 --> 00:12:08,560
No, that's absolutely fine. Um,

251
00:12:08,560 --> 00:12:12,160
so I would say in both practices now I'm,

252
00:12:12,160 --> 00:12:15,120
I'm 50 50 with braces and aligners,

253
00:12:15,540 --> 00:12:18,400
and the reason why that number might be
higher than you might think with braces

254
00:12:18,400 --> 00:12:21,000
is because I do NHS orthodontics and, and,

255
00:12:21,340 --> 00:12:25,520
and NHS orthodontics is really the bread
and butter of an orthodontist work.

256
00:12:25,520 --> 00:12:29,920
It's the growing individuals. It's
where you can really, you know, do your,

257
00:12:30,350 --> 00:12:33,480
I see, see the biggest changes
sometimes I suppose with, with, uh,

258
00:12:33,480 --> 00:12:37,760
with functional appliances, even
surgery, um, as well. Um, but yes,

259
00:12:38,580 --> 00:12:41,600
NHS side leads into the private side in
the sense that you'll get a lot of kids

260
00:12:41,600 --> 00:12:46,440
whose, whose parents, uh, might ask,
Oh, you know, I, I see, uh, you know,

261
00:12:46,440 --> 00:12:49,360
the results I've seen with, with my son
or daughter are fantastic. You know,

262
00:12:49,360 --> 00:12:52,040
what do you think, uh, you could do with
me? And they're sitting in the chair,

263
00:12:52,040 --> 00:12:55,040
you know, just beside the dental chair
and they just go like this, you know,

264
00:12:55,040 --> 00:12:55,960
what can he do with this? You know,

265
00:12:55,960 --> 00:12:58,880
I'm sure you get the same <laugh>
I know and one leads to the other.

266
00:12:59,340 --> 00:13:02,800
I'm doing more and more treatments with
aligners now because I'm becoming more

267
00:13:02,800 --> 00:13:03,920
confident in what they can do.

268
00:13:03,940 --> 00:13:07,040
But I'm very aware the limitations
that aligners have as well. And so,

269
00:13:07,290 --> 00:13:09,800
as I'll probably talk a
little bit about later, um,

270
00:13:09,800 --> 00:13:14,080
aligners are really a tool for the
job, just like braces are a tool. Uh,

271
00:13:14,080 --> 00:13:17,240
and really it's about
knowing that limitations and
knowing what is is best for

272
00:13:17,240 --> 00:13:21,520
the job really. But in terms of, or
restorative, you're absolutely right. Uh,

273
00:13:21,520 --> 00:13:25,880
I tend to focus my restorative work on
the post orthodontic kind of treatments,

274
00:13:25,880 --> 00:13:29,880
like in size, alleged bonding, could
even be veneers. I'm putting together a,

275
00:13:29,880 --> 00:13:34,640
a lecture for a, a course I'm doing
next week where, uh, you know, I'm,

276
00:13:34,640 --> 00:13:36,240
you know what it's like when
you're writing lectures,

277
00:13:36,240 --> 00:13:37,760
you're trifling through your, your cases.

278
00:13:37,760 --> 00:13:40,920
And I'm thinking I do a lot more porcelain
than I maybe think <laugh> actually.

279
00:13:41,180 --> 00:13:43,560
But a lot of it is just the,
the tweaking at the end,

280
00:13:43,560 --> 00:13:46,800
reshaping the teeth in
sizely. Um, so turn a,

281
00:13:46,800 --> 00:13:48,520
a good case into a great one really. So.

282
00:13:48,520 --> 00:13:49,720
This episode, what I wanna, um,

283
00:13:49,720 --> 00:13:53,440
extra from your mind onto a producer
r is where do you even begin?

284
00:13:53,440 --> 00:13:57,280
So the rules of aesthetic planning and
who better than you? Someone who is,

285
00:13:57,280 --> 00:14:00,240
you know, has done all your training
and ortho formal training, ortho,

286
00:14:00,240 --> 00:14:02,280
but I know your heart is
as a restorative dentist.

287
00:14:02,280 --> 00:14:06,320
So I think someone like you is perfectly
suited Now before we cover the main

288
00:14:06,320 --> 00:14:09,320
thing. You know what I'm like when
it comes to occlusion? I, I can't,

289
00:14:09,320 --> 00:14:13,600
I can't possibly continue without
asking you a very interesting curve wall

290
00:14:13,840 --> 00:14:16,200
question. This is completely
unscripted for everyone.

291
00:14:16,390 --> 00:14:19,920
I was at a lecture yesterday
by Coran and Muong, uh,

292
00:14:19,920 --> 00:14:24,000
and they're talking about the orthodontic
restorative interface in terms of the

293
00:14:24,000 --> 00:14:25,200
joint position. Uh,

294
00:14:25,200 --> 00:14:30,000
what I mean by that is the starting
point for most rehabs in traditional

295
00:14:30,000 --> 00:14:34,000
sort of school thinking,
not neuromuscular, but
uh, ation. But then, um,

296
00:14:34,430 --> 00:14:37,880
Cora asked the audience, Okay, now
orthodontist, where do they start?

297
00:14:37,880 --> 00:14:41,040
Which joint position do they start
in? And everyone sort of said, Well,

298
00:14:41,040 --> 00:14:44,040
they just kind of just work around MIP
usually, cuz that's the way I'm taught.

299
00:14:44,040 --> 00:14:47,960
Now, for you as someone who is trained
in as a restorative dentist, I would,

300
00:14:47,960 --> 00:14:51,440
I'm just being nosy again. Do you screen
for the first point of contact in,

301
00:14:51,440 --> 00:14:53,000
in your, your young kids or your,

302
00:14:53,000 --> 00:14:56,680
or your adults and then plan from that
joint position for your orthotics?

303
00:14:56,680 --> 00:14:57,760
Yeah, absolutely. You know,

304
00:14:57,760 --> 00:15:01,040
leaf gauge is one of the most useful
tools in the armory of a dentist in my

305
00:15:01,040 --> 00:15:03,120
opinion. So you wanna make sure that the,

306
00:15:03,120 --> 00:15:07,080
the patient's comfortable in reaching
a CR position and really, you know,

307
00:15:07,080 --> 00:15:09,040
that leaf gauge should
be a, a diagnostic tool.

308
00:15:09,190 --> 00:15:13,600
It's a way of us deciding is this joint
healthy enough to be able to kind of

309
00:15:13,600 --> 00:15:16,440
like Humpty Dumpty participation off
the wall to then put them back together

310
00:15:16,440 --> 00:15:18,840
again with orthodontics or, you know,

311
00:15:19,050 --> 00:15:22,800
is the joint maybe in a position that's
gonna cause problems or cause potential

312
00:15:22,800 --> 00:15:25,560
pain when you're doing this as well?
So for a lot of adult patients,

313
00:15:25,560 --> 00:15:28,160
certainly if there are symptoms of tmd,

314
00:15:28,160 --> 00:15:31,360
whether that be muscular
or intercapal problems.

315
00:15:31,450 --> 00:15:32,920
So it was good to diagnose those first.

316
00:15:32,920 --> 00:15:36,920
And it can be as simple as making a blin
or a little to see a jig just to get

317
00:15:37,000 --> 00:15:39,960
'em to wear for the interim time before
they get their braces on or aligners

318
00:15:39,960 --> 00:15:42,360
started and, and is a
general thumb for me.

319
00:15:42,490 --> 00:15:45,600
If that pain or problems they've
been having go away with that, uh,

320
00:15:45,600 --> 00:15:48,040
anterior bite or deprogrammer,
then you're good to go.

321
00:15:48,130 --> 00:15:51,440
Whereas if they sometimes make the problem
worse or they really can't wear it,

322
00:15:51,450 --> 00:15:54,320
it might be an indication for
further diagnostic records.

323
00:15:54,330 --> 00:15:58,480
It could even be you would refer them
to or medicine clinic just to see for a

324
00:15:58,480 --> 00:16:02,320
second opinion as well. I have to say
it's not an area that I'm, you know,

325
00:16:02,350 --> 00:16:05,560
a specialist in, not like
yourself, but certainly I know the,

326
00:16:05,560 --> 00:16:07,920
the boxes to tick to know when
I'm being safe and not <laugh>.

327
00:16:08,270 --> 00:16:09,920
Good man. Good man. I, it,

328
00:16:09,920 --> 00:16:13,800
it is good to hear about Orantes as
yourself looking at the joint position in

329
00:16:13,800 --> 00:16:15,920
terms of their final
orthotic outcome. But anyway,

330
00:16:15,920 --> 00:16:19,800
that's digressing into occlusion. Where
do you start, Josh? Okay, <laugh>,

331
00:16:19,860 --> 00:16:22,440
you got a patient in the
chair and they want, uh,

332
00:16:22,440 --> 00:16:27,240
a lovely smile and with your eyes,
how do you begin planning aesthetics?

333
00:16:27,240 --> 00:16:29,880
So if you were to boil it down to four
rules, which I highly ask you to do,

334
00:16:30,070 --> 00:16:32,880
what is the first rule
of of, of making this,

335
00:16:32,880 --> 00:16:34,760
helping this patient to
achieve a beautiful smile?

336
00:16:34,760 --> 00:16:35,200
Cool.

337
00:16:35,200 --> 00:16:40,120
Well we're off the four rules of
planning aesthetic dentistry in I opinion

338
00:16:40,120 --> 00:16:43,800
the first, really it all starts with the
face because you gotta know, you know,

339
00:16:43,800 --> 00:16:46,240
where what's gonna look good
for the patient or where,

340
00:16:46,240 --> 00:16:49,720
what is the face asking of the
teeth is, is what we normally see.

341
00:16:49,720 --> 00:16:53,800
So first of it all starts with a, a
facial photograph. And then we start,

342
00:16:53,800 --> 00:16:56,280
what we would do is a
small design. And so the,

343
00:16:56,280 --> 00:17:01,080
the real starting position of a smile
is really the incisal edge of the upward

344
00:17:01,080 --> 00:17:03,560
central incisors. So we're
taking our photograph,

345
00:17:03,700 --> 00:17:06,880
the first bit that you do when you're
doing a small design is you orientate that

346
00:17:06,880 --> 00:17:08,440
photograph to the horizontal.

347
00:17:08,440 --> 00:17:12,720
So you're making sure that patient's
face is perfectly in line. And then we,

348
00:17:12,880 --> 00:17:13,520
we draw do.

349
00:17:13,520 --> 00:17:15,320
You use any tools for
this? Like, like, you know,

350
00:17:15,320 --> 00:17:19,000
so sometimes people do like
go a bit lopsided, so, uh,

351
00:17:19,000 --> 00:17:22,480
do you use like blinds behind you?
Exactly. So how do you gauge that as a,

352
00:17:22,480 --> 00:17:25,200
as a young dentist try and take
photos, portrait photographs,

353
00:17:25,200 --> 00:17:26,680
how can you be sure to help.

354
00:17:26,680 --> 00:17:29,760
You? So usually natural head position,
just asking the patient just to relax,

355
00:17:29,760 --> 00:17:32,160
show their shoulders, usually just
before they take the photographs,

356
00:17:32,700 --> 00:17:35,920
try and get the patient to look directly
into the camera and just being aware

357
00:17:35,920 --> 00:17:38,440
and the patient might kind of just
move their head left to right.

358
00:17:38,440 --> 00:17:41,240
So we're getting a really nice parallel
picture with the patient's face.

359
00:17:41,300 --> 00:17:44,320
The software that I I would use is
just keynote. You can use keynote,

360
00:17:44,320 --> 00:17:46,800
you can use PowerPoint, you
can use paint, you know, any,

361
00:17:46,800 --> 00:17:48,880
any software that allowed
you to draw lines on a page.

362
00:17:48,880 --> 00:17:49,880
It's really not that simple.

363
00:17:49,880 --> 00:17:52,600
You could even print off a
picture of the patient's face, uh,

364
00:17:52,600 --> 00:17:56,040
full smiling picture for example, and,
and literally draw with pen and paper.

365
00:17:56,780 --> 00:18:00,040
And really you're looking at drawing
that midline. Where's the facial midline?

366
00:18:00,380 --> 00:18:03,360
And then we're looking at two
photographs that I take, uh,

367
00:18:03,360 --> 00:18:06,480
for every single patient that walks
on the door and it is an m position

368
00:18:06,480 --> 00:18:08,600
photograph and an e position photograph,

369
00:18:09,190 --> 00:18:12,960
e position being the maximum smile that
that patient can give you, you know,

370
00:18:12,960 --> 00:18:14,520
really exaggerating the lip movements.

371
00:18:14,520 --> 00:18:18,240
You wanna see how high that lip
moves up or the top lip moves up.

372
00:18:18,240 --> 00:18:20,760
I should say end position a
bit more difficult actually.

373
00:18:20,760 --> 00:18:24,280
But that is generally our relaxed position
where there is no muscle activity in

374
00:18:24,280 --> 00:18:24,980
the upper lip.

375
00:18:24,980 --> 00:18:28,520
And what we're really looking for with
between these two photographs is where

376
00:18:28,520 --> 00:18:30,000
does the inci lead sit?

377
00:18:30,650 --> 00:18:35,600
So the end position you were looking
at maybe two to three millimeters of

378
00:18:35,600 --> 00:18:37,920
incisal display in maybe
a slightly older patient,

379
00:18:38,050 --> 00:18:42,280
whereas that number will usually increase
to maybe six or even seven millimeters

380
00:18:42,280 --> 00:18:45,480
for someone who's very young. And
so really that's our starting point.

381
00:18:45,490 --> 00:18:46,760
So the end position, just.

382
00:18:46,760 --> 00:18:50,240
Just so I can make it, I think you're
gonna come to it now, exactly what the,

383
00:18:50,240 --> 00:18:54,000
the dentist should say to the
patient to get them to make those um,

384
00:18:54,000 --> 00:18:55,040
smiles that we want. Well.

385
00:18:55,040 --> 00:18:56,800
To be honest, I just get the
patient to lick their lips.

386
00:18:56,810 --> 00:18:59,720
So for the end position I say lick your
lips and just let your lips just rest.

387
00:19:00,100 --> 00:19:02,480
And a lot of the time for
adult patients, you know,

388
00:19:02,480 --> 00:19:03,640
they might not show any inside.

389
00:19:03,640 --> 00:19:05,640
I'll just play a rest and
don't worry if that's the case.

390
00:19:05,640 --> 00:19:09,720
Cuz that means you've probably got an
additive case where you want to move the

391
00:19:09,720 --> 00:19:12,000
teeth down or maybe add length the teeth.

392
00:19:12,000 --> 00:19:14,800
So they then have display
of incisor display at rest.

393
00:19:15,180 --> 00:19:16,560
And then with the e position,

394
00:19:16,560 --> 00:19:20,040
it is literally just imagine I've told
you the funniest joke and you've got this

395
00:19:20,040 --> 00:19:20,780
belly laugh,

396
00:19:20,780 --> 00:19:23,560
how high can you get your upper lip
to go up when you're smiling at your

397
00:19:23,560 --> 00:19:25,960
maximum? Mm-hmm <affirmative>.
And that's really what I say. And,

398
00:19:25,960 --> 00:19:30,240
and and it's important to
get the diagnosis right
cuz I do get, you know, uh,

399
00:19:30,240 --> 00:19:33,280
shy individuals that come in and
they're, they're guarded, you know,

400
00:19:33,280 --> 00:19:36,400
you wanna try and get this e m position
out of them and you gotta try and make

401
00:19:36,400 --> 00:19:40,200
them laugh anything you can because you
can get your diagnosis wrong if you get

402
00:19:40,200 --> 00:19:41,000
these photographs wrong.

403
00:19:41,000 --> 00:19:43,760
And it's important that you kind of are
aware that that is as much as the look

404
00:19:43,760 --> 00:19:44,390
can move.

405
00:19:44,390 --> 00:19:48,640
When I used to Josh get my patients
through the, the Emma, so say Emma. Yeah.

406
00:19:48,640 --> 00:19:51,560
But I found out that people for some
reason found it funny and say Emma,

407
00:19:51,580 --> 00:19:55,200
and then, and then Shannon smiles, I
take it they start smiling and so I got,

408
00:19:55,230 --> 00:19:58,120
I kind of got a little bit of a rest
one, but then I got a smile and then,

409
00:19:58,120 --> 00:20:00,480
then my usual question means, do
you have an Emma in your life?

410
00:20:00,480 --> 00:20:03,880
And then they really smile. Okay,
they, they they they stop um,

411
00:20:03,880 --> 00:20:06,080
getting really awkward if their
partners also in the room <laugh>.

412
00:20:06,330 --> 00:20:09,800
So I stopped doing that one. So
I like your one licking lips.

413
00:20:10,160 --> 00:20:10,960
<Laugh>. Yeah.

414
00:20:10,960 --> 00:20:11,760
That's it. Exactly.

415
00:20:11,760 --> 00:20:14,640
Exactly. Very good. And yeah,
and then from there, you know,

416
00:20:14,640 --> 00:20:16,080
you've got your vertical reference point,

417
00:20:16,080 --> 00:20:18,840
you've also got your horizontal reference
point cause you know where the facial

418
00:20:18,840 --> 00:20:23,040
midline is and that is where you build
your smile from that kind of middot all

419
00:20:23,040 --> 00:20:24,200
the way around to the
back. Mm-hmm <affirmative>.

420
00:20:24,200 --> 00:20:27,720
And I suppose going back a
little bit to, to the main title,

421
00:20:27,720 --> 00:20:29,960
which was the four Rules
of Planning, you know,

422
00:20:29,960 --> 00:20:33,160
the next one for me is really getting
the diagnosis right. You know,

423
00:20:33,160 --> 00:20:36,600
without the diagnosis being correct,
you're off to a bad start it, you know,

424
00:20:36,600 --> 00:20:39,080
you might not be able to deliver
the best for that patient.

425
00:20:39,420 --> 00:20:43,280
And so really just understanding where
the patient has come from. I, I, when I,

426
00:20:43,280 --> 00:20:46,200
when I teach certainly, you
know, younger dentists, you know,

427
00:20:46,200 --> 00:20:48,720
you know what questions they
should be asking of the patient.

428
00:20:48,750 --> 00:20:53,400
I always start with the, the five Ws and
and n h. So it's kind of like the what,

429
00:20:53,400 --> 00:20:57,160
where, when, why, and how
or who sometimes as well.

430
00:20:57,380 --> 00:21:00,000
And it's really asking, you know,
where is the patient come from,

431
00:21:00,000 --> 00:21:03,040
why is there where seen here asking
yourself all these questions,

432
00:21:03,040 --> 00:21:05,080
like if you were in like a job interview
or something like that, you know?

433
00:21:05,540 --> 00:21:08,800
And it's kind of really just getting a
detailed background of why the patient is

434
00:21:08,800 --> 00:21:12,520
presenting in this way. Cuz it's only
under, once you understand, you know,

435
00:21:12,520 --> 00:21:15,040
why their teeth and dentition
or malocclusion is like this,

436
00:21:15,040 --> 00:21:16,440
you can then start to treat it.

437
00:21:16,930 --> 00:21:19,280
So really important that
we get the diagnosis right.

438
00:21:19,280 --> 00:21:23,840
And that just covers all dentistry, not
necessarily just aesthetic dentistry.

439
00:21:23,840 --> 00:21:27,920
Cuz aesthetic dentistry really is an
umbrella term for all the specialties

440
00:21:27,920 --> 00:21:28,200
really.

441
00:21:28,200 --> 00:21:32,320
Okay. I guess the best example of
that, Josh, I'm sure you agree, is um,

442
00:21:32,320 --> 00:21:36,040
when deciding whether to
lengthen the teeth mm-hmm.

443
00:21:36,080 --> 00:21:38,760
<affirmative> like downwards
or push the gum go, go upwards,

444
00:21:38,760 --> 00:21:40,760
I you crown lengthening. And
that's as a young dentist,

445
00:21:40,760 --> 00:21:44,440
I I I struggle okay in this case. But
it's all, it comes down to diagnosis and,

446
00:21:44,440 --> 00:21:45,480
and then again your photos,

447
00:21:45,630 --> 00:21:49,760
just like the ones you described become
so powerful in helping you decide should

448
00:21:49,760 --> 00:21:52,880
you lengthen or actually this is one for
the periodontist or yourself with some

449
00:21:52,880 --> 00:21:55,640
experience to actually make the
gums go higher up a gum lift.

450
00:21:55,910 --> 00:21:59,400
That's it. Yeah, you can, I
mean what a smell design is,

451
00:21:59,400 --> 00:22:02,360
it's basically a blueprint. It's
like if you're building a house,

452
00:22:02,360 --> 00:22:05,400
you don't just start laying bricks and
that's where dentists go wrong sometimes.

453
00:22:05,740 --> 00:22:08,560
You gotta know where you're going.
And so therefore what do you do?

454
00:22:08,560 --> 00:22:13,040
Well you bring in an architect, you
work out what shape, what room size,

455
00:22:13,040 --> 00:22:15,320
where's the garages
going. And then, you know,

456
00:22:15,320 --> 00:22:18,360
after that then you ask the engineer,
you know, is this actually gonna work?

457
00:22:18,460 --> 00:22:21,960
And what I mean by the engineer in
dentistry is you do trial smiles. You,

458
00:22:21,960 --> 00:22:25,120
you might simulate the orthodontic
tooth movement with orthodontic, uh,

459
00:22:25,120 --> 00:22:28,840
simulations. And only once you've actually
got that you've got your blueprint,

460
00:22:28,840 --> 00:22:31,160
you've asked the engineer,
they're pretty happy with it,

461
00:22:31,190 --> 00:22:32,760
then you start building the bricks.

462
00:22:33,180 --> 00:22:37,000
And I always say that smile design
should really be part of every special

463
00:22:37,000 --> 00:22:40,760
diagnosis, just like taking your
x-rays or taking, uh, photographs. Um,

464
00:22:40,760 --> 00:22:42,960
you know, it should form part of
your special investigation, Sorry,

465
00:22:42,960 --> 00:22:46,360
is what I meant to say. And then I suppose
going on to, to the third, kind of.

466
00:22:46,510 --> 00:22:48,360
Before we get the third
one, Josh, you know,

467
00:22:48,360 --> 00:22:51,720
you maybe think of this question now
is, you know, you're someone who I,

468
00:22:51,720 --> 00:22:54,520
I respect as a restorative dentist
and then you went this formal orthotic

469
00:22:54,600 --> 00:22:58,360
training, which is awesome. But when
you did that orthotic training, uh,

470
00:22:58,640 --> 00:23:01,080
compared to perhaps some of
the other trainees, orthotics,

471
00:23:01,080 --> 00:23:03,280
you were probably a bit more
experienced in the restorative side.

472
00:23:03,660 --> 00:23:08,640
Did you find that the orthotic
program covered these aspects of smile

473
00:23:08,640 --> 00:23:12,000
design mm-hmm <affirmative> in the same
or different or better or worse way than

474
00:23:12,000 --> 00:23:14,280
what the restorative dentists
teach restorative dentists?

475
00:23:14,280 --> 00:23:15,640
That's a very good question actually.

476
00:23:15,640 --> 00:23:16,880
It's not one I've actually
thought of before,

477
00:23:16,880 --> 00:23:19,320
but I have to say that a lot of the,

478
00:23:19,320 --> 00:23:22,160
the post-graduate orthodontic
programs out there,

479
00:23:22,710 --> 00:23:25,560
I suppose they're maybe more traditional
in the way that they would approach

480
00:23:25,560 --> 00:23:29,360
the, the planning of cases where it's
very much study models on a bench <laugh>,

481
00:23:29,360 --> 00:23:32,480
if I'm perfectly honest. And
it's, it's not difficult. Well,

482
00:23:32,480 --> 00:23:33,360
it might be difficult for some,

483
00:23:33,360 --> 00:23:36,680
but for some cases it can be
quite difficult to get the,

484
00:23:36,680 --> 00:23:39,480
the smile to the good with in the face
you can get the models lovely in class

485
00:23:39,480 --> 00:23:42,040
one, that's not a problem. You're
taking teeth out, moving teeth around.

486
00:23:42,040 --> 00:23:45,040
It's just a big boys me can really,
you know, it's just, it is just, uh,

487
00:23:45,280 --> 00:23:46,880
pulling teeth here, there and everywhere,

488
00:23:47,140 --> 00:23:49,120
but it's actually getting it
to look good within the face.

489
00:23:49,120 --> 00:23:52,320
And that can depend on the, the
canting, the strategies can't,

490
00:23:52,320 --> 00:23:56,120
if there's a transverse can't, how much
inside display they have, you know,

491
00:23:56,120 --> 00:23:56,560
things like that.

492
00:23:56,560 --> 00:24:00,760
You're looking at all the plains of space
to fit those models in that nice class

493
00:24:00,760 --> 00:24:02,400
one inclusion, ideally <laugh>.

494
00:24:03,010 --> 00:24:06,400
So it's safe to say that whilst people
were doing their study models planning,

495
00:24:06,460 --> 00:24:10,000
you were keeping that for the to pass
exams, but you were looking at the,

496
00:24:10,000 --> 00:24:11,000
the photos more than anything.

497
00:24:11,000 --> 00:24:14,320
Always, always having that facial picture
there and always really just having

498
00:24:14,320 --> 00:24:17,280
references. You don't always
have to do a full small design,

499
00:24:17,280 --> 00:24:19,720
but as long as you know your
references, you're starting points,

500
00:24:19,720 --> 00:24:23,520
you kind of work from there. But I like
to, to work in a way that I've, I'm try,

501
00:24:23,520 --> 00:24:26,840
I'm gathering all the diagnostic
information I can and,

502
00:24:26,840 --> 00:24:29,320
and then kind of using that
when I'm formulating a plan.

503
00:24:29,580 --> 00:24:34,000
And I suppose that then leads very well,
I was gonna say into the third rule,

504
00:24:34,000 --> 00:24:34,640
which is.

505
00:24:34,640 --> 00:24:36,920
But I just wanna summarize
this thing so far. So,

506
00:24:36,920 --> 00:24:39,640
so I just wanna summarize rule
one was, uh, begin with the, uh,

507
00:24:39,640 --> 00:24:41,600
upper incid ledges and
plan from there. Uh,

508
00:24:41,600 --> 00:24:44,080
and then rule two is nail your diagnosis.

509
00:24:44,350 --> 00:24:47,160
Absolutely all the W's and H's to,

510
00:24:47,160 --> 00:24:49,200
to figure out the story and
then to help you forward.

511
00:24:49,200 --> 00:24:51,840
So that's why we're up to her so far.
So hit us with rule three of my friend.

512
00:24:52,250 --> 00:24:53,360
So rule three really,

513
00:24:53,360 --> 00:24:56,560
and it's one that I kind of follow
every single day and it's, uh,

514
00:24:56,560 --> 00:24:59,920
gonna talk to me about a dentist
called Dr. Miguel Stanley, um,

515
00:24:59,920 --> 00:25:01,720
I'm sure you've heard of
before over in America. Yes.

516
00:25:01,720 --> 00:25:03,000
Christiana, Ronaldo, dentist.

517
00:25:03,800 --> 00:25:08,160
<Laugh>. I think so, yeah, you're right.
And he, he really kind of hit home,

518
00:25:08,160 --> 00:25:09,840
to me it was about giving idea a chance.

519
00:25:10,020 --> 00:25:13,000
And what that means is that every
patient that comes in the front door,

520
00:25:13,460 --> 00:25:16,360
you know, they have come
to you for a diagnosis,

521
00:25:16,360 --> 00:25:19,920
they've come to you for a
way of presenting to them
what is the best thing for

522
00:25:19,920 --> 00:25:23,640
them. They might come in saying, Josh,
my upper right central incisors rotated,

523
00:25:23,640 --> 00:25:27,120
that's all I want to treat. But I I, I
don't ignore that, don't get me wrong,

524
00:25:27,120 --> 00:25:27,480
but I,

525
00:25:27,480 --> 00:25:31,480
I kind of put that to one side because
I would still take the same records,

526
00:25:31,620 --> 00:25:35,480
photographs, scans, X-rays, maybe
even a com beam CT if it needed it.

527
00:25:35,700 --> 00:25:39,200
And I would treat that patient, you
know, as if they've asked me, Josh,

528
00:25:39,200 --> 00:25:42,160
what can I do here, time and money or
no object, what would you love to do?

529
00:25:42,380 --> 00:25:45,720
Cuz just because they've come in asking
for an upper central incisor rotated,

530
00:25:45,960 --> 00:25:48,720
doesn't excuse the fact they might
have quite bad wear in their teeth.

531
00:25:48,720 --> 00:25:51,760
Their canines have worn down, their gums
aren't in the best condition. You know,

532
00:25:51,760 --> 00:25:53,560
we've got a duty of care
for the patients and,

533
00:25:53,860 --> 00:25:57,440
and the way I do treatment very much is
that we give ideal a chance and we work

534
00:25:57,440 --> 00:26:00,360
back from there. So it
might involve a lot of work,

535
00:26:00,360 --> 00:26:02,200
it might involve doing orthodontics,

536
00:26:02,280 --> 00:26:04,440
might involve some porcelain
work or composite work.

537
00:26:04,440 --> 00:26:08,040
It might involve very heavy work with the
periodontal specialists if there's any

538
00:26:08,040 --> 00:26:09,200
problems. Um,

539
00:26:09,200 --> 00:26:13,320
it might even involve orthotic surgery
because they have a underlying skeletal

540
00:26:13,320 --> 00:26:17,320
problem. But it's important that the, the
patient is aware of all that could be.

541
00:26:17,420 --> 00:26:19,680
And then working back from
there, you know, it's,

542
00:26:19,680 --> 00:26:22,120
there's absolutely no harm
in doing compromising, uh,

543
00:26:22,120 --> 00:26:25,480
for your treatment as long as the patient
is aware that, you know, that is the,

544
00:26:25,480 --> 00:26:29,800
the gold standard of what we could have
in ideal world and we can work back from

545
00:26:29,800 --> 00:26:32,640
there. So for me, rule three
is giving idea a chance.

546
00:26:33,230 --> 00:26:34,680
I I love that rule, Josh. I mean,

547
00:26:34,680 --> 00:26:37,880
rule one is so fundamental and when
I started to actually look at smiles,

548
00:26:37,880 --> 00:26:40,680
rule two is great in terms of making
sure we get the bigger picture,

549
00:26:40,820 --> 00:26:42,600
but rule three in terms of a,

550
00:26:42,600 --> 00:26:46,680
a real communication skill to have with
your patients. Because put it this way,

551
00:26:46,690 --> 00:26:50,600
if you never present the ideal,
you never get to do the ideal.

552
00:26:50,600 --> 00:26:52,160
If you never present
comprehensive, guess what?

553
00:26:52,160 --> 00:26:55,720
You never get to do comprehensive. So
that's such a a, a key one. And uh,

554
00:26:55,960 --> 00:26:57,920
recently I was at a lecture,
uh, by Lincoln Harris who,

555
00:26:57,920 --> 00:27:02,600
who came over to London and did a amazing
like performance. It was a, an actual,

556
00:27:02,690 --> 00:27:05,560
uh, performance. He was a, one
of the best performances of his,

557
00:27:05,560 --> 00:27:09,480
cause I've seen him live before, but he
was just on fire and it reminded me of,

558
00:27:09,480 --> 00:27:13,200
of a great thing he taught that day is
that he'll he says to patients, and,

559
00:27:13,200 --> 00:27:14,240
and I'm definitely, you know,

560
00:27:14,240 --> 00:27:18,400
gonna use this patience is I'm gonna
present to you the ideal plan mm-hmm.

561
00:27:18,440 --> 00:27:20,120
<affirmative> if if it's
too expensive and you can,

562
00:27:20,120 --> 00:27:22,640
and he says you can use the
word expensive, it's okay,
don't be don't shy. Yeah.

563
00:27:22,640 --> 00:27:26,040
If it's too expensive, let me know. We
can make some compromises and find a,

564
00:27:26,110 --> 00:27:28,080
a solution that best suits you a rule.

565
00:27:28,080 --> 00:27:31,680
But I'm gonna still plan ideally
because everyone deserves ideal.

566
00:27:31,690 --> 00:27:34,400
So I'm gonna plan ideally, but if
it's too expensive, let me know.

567
00:27:34,400 --> 00:27:36,400
I have other options. And
that gives you the license.

568
00:27:36,710 --> 00:27:40,720
Yeah, it really does. And I suppose
compromises can be in materials,

569
00:27:40,810 --> 00:27:45,120
it can be an accepting certain things
of a male occlusion, for instance,

570
00:27:45,120 --> 00:27:45,640
an over jet.

571
00:27:45,640 --> 00:27:47,560
Like a slightly increase, I was
just gonna say over jet Yeah.

572
00:27:47,560 --> 00:27:50,840
Like that. Or a crossbite that you
might not want to try and uh, treat.

573
00:27:50,840 --> 00:27:54,400
And there might be limitations and it
might be that surgery is the only option.

574
00:27:54,700 --> 00:27:55,920
I'm sure we've seen, uh,

575
00:27:55,920 --> 00:27:58,440
I think I saw in your stories
recently that I think it was your,

576
00:27:58,440 --> 00:28:01,960
was your oldest son had his adenoids
taken out recently, Is that right? Yeah.

577
00:28:01,960 --> 00:28:02,690
Mm-hmm. <affirmative>.
Mm-hmm <affirmative>.

578
00:28:02,690 --> 00:28:06,080
We get patients that unfortunately
don't get that done. And then they have,

579
00:28:06,080 --> 00:28:06,400
you know,

580
00:28:06,400 --> 00:28:10,480
skilly to problems that
manifest throughout their
adult life and narrowing over

581
00:28:10,480 --> 00:28:12,440
the upper jaw, for example. And they want,

582
00:28:12,440 --> 00:28:16,480
they come in asking for a wider smile
and it's something that's orthotic alone,

583
00:28:16,480 --> 00:28:19,000
it's something that we can't give them
because we'd be moving those teeth out

584
00:28:19,000 --> 00:28:21,680
the bone. And so really
their options are, you know,

585
00:28:21,680 --> 00:28:23,480
accepting that fact that orthodontically,

586
00:28:23,480 --> 00:28:27,280
that's where the teeth have to be or
restoratively, it can be a bit wider,

587
00:28:27,280 --> 00:28:29,880
you know, it can add veneers,
composite to widen the teeth, uh,

588
00:28:29,880 --> 00:28:33,560
artificially as such. Or they're moving
the bones, you know, they're moving the,

589
00:28:33,560 --> 00:28:35,400
their surgical expansion. I wouldn't,

590
00:28:35,400 --> 00:28:37,760
I wouldn't dream anyone
or wish anyone to have it,

591
00:28:37,760 --> 00:28:40,240
but certainly it is an option
and these are the things that,

592
00:28:40,240 --> 00:28:43,800
that it's important that anyone who's
providing orthodontics really in my

593
00:28:43,800 --> 00:28:46,480
opinion knows about, you know,
always plan towards their deal.

594
00:28:46,540 --> 00:28:49,400
And you can always compromise from there
as long as the patient is aware of what

595
00:28:49,400 --> 00:28:50,680
these compromises mean long term.

596
00:28:50,680 --> 00:28:51,400
Mm-hmm. <affirmative> mm-hmm.

597
00:28:51,400 --> 00:28:54,080
<affirmative> and medically legally that
it just makes sense to write notes in

598
00:28:54,080 --> 00:28:56,840
that way as well so that they know,
uh, exactly what the ideal was.

599
00:28:56,840 --> 00:29:00,000
And sometimes, you know, as I say,
treat children idealistically,

600
00:29:00,000 --> 00:29:03,000
treat adults realistically. That's
a, a mantra drilled into me,

601
00:29:03,000 --> 00:29:06,200
but it doesn't mean that we can't
present the ideal plan to adults.

602
00:29:06,230 --> 00:29:09,760
Absolutely. Yeah. The good
thing is, you know, in a lot,

603
00:29:09,760 --> 00:29:13,320
a lot of the patients I treat are kind
of younger teenagers and I guess they

604
00:29:13,320 --> 00:29:16,000
come with a little bit less baggage in
the sense that they normally have really

605
00:29:16,000 --> 00:29:20,880
nice shapes of teeth on war and, you
know, good, good oral hygiene ideally. Uh,

606
00:29:20,880 --> 00:29:23,560
and, and really it's a case of really
just moving the teeth, you know, to,

607
00:29:23,560 --> 00:29:26,520
to where their face faces asking.
But adults as, as you know,

608
00:29:26,520 --> 00:29:30,040
they come with some more problems,
gum problems, wear, uh, missing teeth,

609
00:29:30,040 --> 00:29:34,040
things like that. So there's a lot more
to plan. And I have to say that I, I,

610
00:29:34,040 --> 00:29:38,440
I have no problems with saying to my
patients, I don't know because in reality,

611
00:29:38,500 --> 00:29:39,333
you know,

612
00:29:39,500 --> 00:29:44,080
you were thrown with so much information
in a first consultation situation that

613
00:29:44,080 --> 00:29:47,600
you can certainly let the patients know,
you know, what a rough idea could be.

614
00:29:47,600 --> 00:29:48,920
I think your teeth are outta position.

615
00:29:48,920 --> 00:29:50,880
Maybe we can think about
some orthodontics here.

616
00:29:50,990 --> 00:29:52,960
I think the shape of your
teeth could be adjusted,

617
00:29:52,960 --> 00:29:55,840
maybe even the color adjusted here.
So you've got a couple of ideas,

618
00:29:55,840 --> 00:29:56,720
you're planting the seed,

619
00:29:56,940 --> 00:30:00,600
but I'm not always telling the patient
at day one that we need to do this, this,

620
00:30:00,600 --> 00:30:02,760
and this. You know, you say, I don't
know yet. The honest answer is,

621
00:30:02,760 --> 00:30:05,920
I'm gonna invite you back when I'm gonna
gather some more information and I'm

622
00:30:05,920 --> 00:30:09,080
gonna get you back in and we're gonna
present a couple of options for you.

623
00:30:09,080 --> 00:30:11,280
You know, and if one of
those options fits your,

624
00:30:11,310 --> 00:30:13,600
your budget and fits what
you're wanting, then great,

625
00:30:13,600 --> 00:30:17,040
we can go ahead And I suppose
the, the fourth kind of rule,

626
00:30:17,200 --> 00:30:19,000
bring me right into that really nicely.

627
00:30:19,000 --> 00:30:23,000
There is simulations cuz during a
second consultation appointment,

628
00:30:23,350 --> 00:30:25,000
simulating the treatment, uh,

629
00:30:25,000 --> 00:30:28,440
plan for the patient and really allowing
them to visualize it before they begin

630
00:30:28,610 --> 00:30:30,040
is crucial in my opinion.

631
00:30:30,060 --> 00:30:34,920
And that can be as simple as doing an
orthodontic setup such as an aligner setup

632
00:30:34,920 --> 00:30:38,400
to show the patient the beginning and
end result of what orthotics can mean.

633
00:30:38,400 --> 00:30:42,240
Different aligner companies have
got different softwares and stuff.

634
00:30:42,240 --> 00:30:44,200
So that's what you mean
by the simulation, right?

635
00:30:44,200 --> 00:30:47,200
Absolutely. Yeah. So the Sure
Smile aligners, which is the,

636
00:30:47,220 --> 00:30:51,400
the company that I have been working with
for a very long time and I've really,

637
00:30:51,420 --> 00:30:51,920
you know,

638
00:30:51,920 --> 00:30:55,240
enjoying using the software and really
enjoying using the aligners as I'm sure

639
00:30:55,240 --> 00:30:58,400
we'll talk about it later on as well. I
can even share my screen and show you,

640
00:30:58,490 --> 00:31:02,720
um, you know, what the software word
looks like. So we got example here.

641
00:31:02,940 --> 00:31:05,600
And just describe for those listening
in the car, driving on the train,

642
00:31:05,600 --> 00:31:08,840
chopping onions, et cetera, just also
describe, uh, what we're seeing here.

643
00:31:08,840 --> 00:31:11,200
As well. So what we're seeing
here is an orthotic simulation.

644
00:31:11,200 --> 00:31:15,240
It's showing us the plan from the start
to the finish of where the teeth need to

645
00:31:15,240 --> 00:31:17,400
move to start and then the finish.

646
00:31:17,740 --> 00:31:19,960
And what we're also getting
here is the staging here.

647
00:31:19,960 --> 00:31:24,800
So the stage models of going from day
one or aligner one all the way up to,

648
00:31:24,800 --> 00:31:26,520
in this case aligner number 28.

649
00:31:26,750 --> 00:31:30,920
It's showing us where the attachments
need to go to provide that extra grip to

650
00:31:30,920 --> 00:31:31,760
the teeth that need it,

651
00:31:31,930 --> 00:31:36,720
as well as any space creation by the form
of any i p or into proximal reduction.

652
00:31:36,790 --> 00:31:40,040
It's between the teeth. It allows us
to get the room to align the teeth.

653
00:31:40,270 --> 00:31:43,440
It's showing us when that's being
performed and at what stage it's being

654
00:31:43,440 --> 00:31:46,720
performed. And so this is
something which I use a lot to,

655
00:31:46,720 --> 00:31:50,400
to just demonstrate to patients just
how their treatment will play out from

656
00:31:50,400 --> 00:31:54,320
start to finish. And so they get
that kind of crystal ball moment of,

657
00:31:54,320 --> 00:31:56,520
of what their treatment will
look like once they're done.

658
00:31:56,520 --> 00:31:58,160
Mean. This is, this is
brilliant, but the Josh,

659
00:31:58,210 --> 00:32:03,040
there's a another Lana company that
I use at the moment, uh, and uh,

660
00:32:03,040 --> 00:32:06,240
they are very well known, uh, and they
have their own version of software. Uh,

661
00:32:06,240 --> 00:32:09,560
and I wanna, I wanna know from you
someone who's used both systems, uh,

662
00:32:09,560 --> 00:32:14,040
is there anything different or,
or, um, interesting about, uh,

663
00:32:14,040 --> 00:32:14,960
the Shore Smile software?

664
00:32:14,960 --> 00:32:18,600
Because I heard yesterday at the Congress
that something about the envelope of

665
00:32:18,720 --> 00:32:20,800
function, uh, outlines is they,

666
00:32:20,800 --> 00:32:23,080
they will show you the cross
section of the envelope.

667
00:32:23,280 --> 00:32:26,240
Function. It does indeed.
So this software is,

668
00:32:26,240 --> 00:32:30,040
is really the most powerful software
I've ever seen <laugh>. It's,

669
00:32:30,040 --> 00:32:31,480
it's got so much in it and the, the,

670
00:32:31,480 --> 00:32:34,080
one of the biggest things for me
are the quality control tools.

671
00:32:34,570 --> 00:32:38,160
So these are the tools that allow you
to see the contact points, tooth widths,

672
00:32:38,460 --> 00:32:41,960
the, the marginal ridges,
tooth axis and things as well.

673
00:32:42,210 --> 00:32:45,920
As well as being able to actually
kind of see and measure, uh, you know,

674
00:32:45,920 --> 00:32:49,680
between the teeth. Uh, let me get
the kinda measuring tool here.

675
00:32:49,940 --> 00:32:51,720
You can kind of clip the frame as well.

676
00:32:51,720 --> 00:32:53,800
So you can see the envelope
of function right there.

677
00:32:54,020 --> 00:32:55,960
You can then move but
between the teeth Yeah.

678
00:32:55,960 --> 00:32:57,400
To see where the contact points are.

679
00:32:57,930 --> 00:33:01,920
It is really quite sometimes
daunting, I'm not gonna lie,

680
00:33:02,100 --> 00:33:05,800
the amount of buttons. Yeah, <laugh>. But
to be honest with you, you know, it's,

681
00:33:05,800 --> 00:33:09,160
you can use it for as much or
as little as you want really.

682
00:33:09,220 --> 00:33:10,720
You get out what you
want, what you put in.

683
00:33:10,720 --> 00:33:14,040
So if you wanna see all that extra
detail, you can reveal it if you want to,

684
00:33:14,040 --> 00:33:16,160
but if you want to do the usual
stuff, you can do that as well. I can,

685
00:33:16,160 --> 00:33:17,480
I can see that. I mean the.

686
00:33:17,640 --> 00:33:21,400
Software really came from traditional
orthodontic planning with brackets and

687
00:33:21,400 --> 00:33:25,800
wires and it's really kind of developed
from there. And so there is so much, uh,

688
00:33:25,800 --> 00:33:29,240
diagnostic information that can be,
you know, at your fingertips here, uh,

689
00:33:29,240 --> 00:33:32,040
as well, really looking really
closely into your cases to,

690
00:33:32,040 --> 00:33:35,800
to look at where they come from and
where you want to get to. Um, and that's,

691
00:33:35,800 --> 00:33:36,120
you know,

692
00:33:36,120 --> 00:33:39,080
that's just the software that's not
even talking about the actual aligners

693
00:33:39,080 --> 00:33:41,920
themselves. So yeah, you can see
I'm passionate about it cuz uh,

694
00:33:41,920 --> 00:33:46,160
I honestly don't know why more people
aren't using it because it's like wow.

695
00:33:46,180 --> 00:33:46,600
But.

696
00:33:46,600 --> 00:33:49,600
So okay, let, let's, let's talk about
that Josh. We, so, you know, rule,

697
00:33:49,600 --> 00:33:52,880
rule one was in size,
alleged rule two was ask, uh,

698
00:33:52,880 --> 00:33:56,200
the questions to get the diagnoses
all the Ws and h uh, rule three,

699
00:33:56,200 --> 00:33:57,400
which I love was, uh,

700
00:33:57,400 --> 00:34:01,080
give ideal a chance mm-hmm
<affirmative> and rule four was, um, uh,

701
00:34:01,080 --> 00:34:03,800
the rule of aesthetic
planning is use simulation,

702
00:34:03,800 --> 00:34:05,240
which just makes so much sense to,

703
00:34:05,240 --> 00:34:07,960
to your patient and also to you as
you're planning the case. Oh my God,

704
00:34:07,960 --> 00:34:11,160
you just overlaid the face over it. This
is awesome. <laugh>. Okay, so, so this,

705
00:34:11,160 --> 00:34:13,320
this is cool. So, um, that
makes for complete sense now.

706
00:34:13,320 --> 00:34:15,560
I'll let you just tell me any other
things you wanna tell me about Rule four

707
00:34:15,560 --> 00:34:16,960
before we then talk about, uh,

708
00:34:16,960 --> 00:34:20,480
Short Smile and why perhaps we're using
Short Smile and not some of the other

709
00:34:20,480 --> 00:34:21,800
competitor aligners out there.

710
00:34:21,870 --> 00:34:25,880
Yeah, I mean for, for me really as
I told you in rule one, you know,

711
00:34:25,880 --> 00:34:28,520
it starts with the face, it
starts with a small design and,

712
00:34:28,520 --> 00:34:31,680
and really with the software
you can overlay the exact teeth,

713
00:34:31,950 --> 00:34:35,600
both the starting model and the end
model, you know, into the patient's face.

714
00:34:35,600 --> 00:34:38,240
You can see kind of what it's
gonna look like in the end.

715
00:34:38,240 --> 00:34:39,560
Like a try before you buy.

716
00:34:39,780 --> 00:34:42,280
You wouldn't buy a car without
taking it for a test drive first.

717
00:34:42,280 --> 00:34:45,080
And that's exactly the
same. So this is really the,

718
00:34:45,080 --> 00:34:48,680
the simplest version of the simulation
where you can just show the patient what

719
00:34:48,680 --> 00:34:49,960
it would look like. You know,

720
00:34:49,960 --> 00:34:53,600
it's a little bit of a cartoon here cuz
obviously the teeth are your scans that

721
00:34:53,600 --> 00:34:54,560
you've taken in, in the mouth,

722
00:34:54,860 --> 00:34:57,440
but it really does give the
patient a really nice idea of.

723
00:34:57,440 --> 00:35:00,920
What it, And sorry to stop you Josh.
You said scans, I have to ask you this,

724
00:35:00,920 --> 00:35:04,960
right. So with certain aligner companies,
you have to get a certain scanner to,

725
00:35:04,960 --> 00:35:07,680
to send. So would I need a
dense splice? So I would have,

726
00:35:07,680 --> 00:35:11,000
I would have to have a prime scan
to send to get short smile aligners.

727
00:35:11,050 --> 00:35:12,560
No, you don't actually the,

728
00:35:12,560 --> 00:35:16,920
the Sure Smile aligner system is very
much an open access platform except scans

729
00:35:16,920 --> 00:35:20,400
from any brand of scanner
that's out there. Um,

730
00:35:21,040 --> 00:35:24,600
and that's part of the reason why I really
like working with Den Supply is that

731
00:35:24,600 --> 00:35:26,800
they have always been
and always will be, uh,

732
00:35:26,800 --> 00:35:30,800
an open access software where you're not
limited by a brand as well as that you

733
00:35:30,800 --> 00:35:35,440
can also export things. So without
jumping too far ahead here, you know,

734
00:35:35,440 --> 00:35:37,400
it really does give
you, you know, know the,

735
00:35:37,400 --> 00:35:42,040
the freedom and the versatility to ask
for all of your aligners to be made.

736
00:35:42,410 --> 00:35:44,880
Um, and that's by Sure smile itself. Um,

737
00:35:44,880 --> 00:35:47,720
which comes in a very nice kind of
branded packaging just like you would with

738
00:35:47,720 --> 00:35:50,040
other aligner brands as well.
The patients will recognize,

739
00:35:50,260 --> 00:35:52,280
but it does also allow you to export.

740
00:35:52,330 --> 00:35:55,080
So if you have a local dental
lab or you have a lab in house,

741
00:35:55,080 --> 00:35:58,440
you can ask for them to print the models
for you, for you to make your aligners.

742
00:35:58,440 --> 00:36:01,360
Or even if you wanna do
everything you know yourself,

743
00:36:01,360 --> 00:36:06,280
you could export each SDL file
or each scan file of every stage

744
00:36:06,280 --> 00:36:09,280
or every aligner in that treatment
and you can make them yourself.

745
00:36:09,650 --> 00:36:13,280
So it's a bit like, describe this in
the past, but going into a restaurant,

746
00:36:13,280 --> 00:36:16,400
you know, you can go in and you
can order from the set menu,

747
00:36:16,400 --> 00:36:19,240
which is like what you would do with
other aligner brands where you're limited

748
00:36:19,240 --> 00:36:22,600
to maybe 12 or four, you
know, 24 aligners, you know,

749
00:36:22,600 --> 00:36:24,040
or you can have as many
aligners as you want.

750
00:36:24,040 --> 00:36:27,080
You can eat as much as you want
in the buffet <laugh> or you know,

751
00:36:27,080 --> 00:36:28,560
you can choose from the ala carte menu.

752
00:36:28,560 --> 00:36:30,280
You can decide you don't
wanna starter today,

753
00:36:30,280 --> 00:36:32,080
but you won't want a man in
a dessert and that's fine.

754
00:36:32,080 --> 00:36:34,520
So you can export the SDL
fouls and make that yourself.

755
00:36:34,570 --> 00:36:37,120
Or if you really wanna go to town,

756
00:36:37,260 --> 00:36:41,040
you can even go walk into the kitchen
and you can make your own food <laugh>,

757
00:36:41,040 --> 00:36:43,200
you know, you can actually go in there.

758
00:36:43,200 --> 00:36:45,640
You're not relying on a
technician if you really want to.

759
00:36:45,640 --> 00:36:49,880
And I would say and stress that I keep
this myself for more milder cases where I

760
00:36:49,880 --> 00:36:53,200
can take control and be my own technician
where I can actually move the teeth

761
00:36:53,200 --> 00:36:56,080
myself, plan the movements
which the software allows,

762
00:36:56,080 --> 00:37:01,000
and then actually explore or ask Smail
to make my aligners for me. So there is.

763
00:37:01,000 --> 00:37:03,720
What would be the benefit to
you, Josh? Why would you, uh,

764
00:37:03,720 --> 00:37:06,480
do that step of making it in
house? Is it ultimately a,

765
00:37:06,550 --> 00:37:09,920
a financial benefit of you cooking
in house compared to eating out?

766
00:37:09,930 --> 00:37:12,920
It is really the financial benefit,
but also for the patient. Yeah,

767
00:37:12,920 --> 00:37:15,480
I mean at the end of the day I'm not
having to pay for the chef <laugh>,

768
00:37:15,690 --> 00:37:16,240
so Yeah.

769
00:37:16,240 --> 00:37:18,000
Yeah. But but that's really good that,

770
00:37:18,000 --> 00:37:19,800
that the dead supply
and short allow you to,

771
00:37:19,800 --> 00:37:23,240
I'm kind of surprised in a way and and
shocked and it's pretty impressive that

772
00:37:23,240 --> 00:37:26,680
they it is, they're pretty open with
that. That's, that's to be admired I.

773
00:37:26,680 --> 00:37:29,560
Guess. I I guess you can use it for
as much or as little as you wish.

774
00:37:29,560 --> 00:37:30,720
Just like the,

775
00:37:30,720 --> 00:37:34,600
the quality control tools and the
diagnostic tools in the sense that uh,

776
00:37:34,600 --> 00:37:37,880
if you do have a more mild
case, perhaps just a, a relapse,

777
00:37:37,880 --> 00:37:40,720
that patient has lost the retainer
for a few weeks and they said, ah,

778
00:37:40,720 --> 00:37:43,640
my tooth has moved a little bit. You
know, you could literally take a,

779
00:37:43,640 --> 00:37:46,720
a scan of the mouth, upload
it, move that tooth back,

780
00:37:46,720 --> 00:37:50,200
it'll tell you just how many stages
you might need and then, you know,

781
00:37:50,200 --> 00:37:52,320
you make those aligners and
it saves the cost for you,

782
00:37:52,320 --> 00:37:54,280
saves the cost for the
patient. Everyone wins.

783
00:37:54,450 --> 00:37:57,200
Is that something that um,
you get taught by Sure. Smile.

784
00:37:57,200 --> 00:38:00,280
Cause I guess there are lots of courses
teaching how to do your own liners

785
00:38:00,280 --> 00:38:01,010
orthodontic base.

786
00:38:01,010 --> 00:38:05,120
So does Shore Smile actually teach
you the methods involved that hey,

787
00:38:05,120 --> 00:38:07,720
if you wanna come to the kitchen, cook
itself, you know, here's your utensils,

788
00:38:07,720 --> 00:38:08,553
Like how's it work?

789
00:38:08,660 --> 00:38:12,880
The main focus for sure smile, you
know, as a mentor and as a tutor myself,

790
00:38:12,880 --> 00:38:17,240
really it is using the software and it
is about kind of using the technicians is

791
00:38:17,240 --> 00:38:21,200
communicating with the technicians for
more complex cases or cases that you want

792
00:38:21,200 --> 00:38:23,440
the help basically. But it, it,

793
00:38:23,440 --> 00:38:26,160
it allows you to open the
doors to do that yourself.

794
00:38:26,160 --> 00:38:29,320
And that is something that over the
years I have, I have learnt myself,

795
00:38:29,320 --> 00:38:32,920
you know, I haven't had much guidance
other than some of my peers. But, and,

796
00:38:32,920 --> 00:38:35,640
and in a sense there is an element of
trial and error error here as well.

797
00:38:35,640 --> 00:38:38,520
You know, you are moving the
tooth. My, my old movements,

798
00:38:38,520 --> 00:38:42,440
I would say I wouldn't tackle anything
above say, uh, eight or 10 aligners.

799
00:38:42,440 --> 00:38:45,200
Mm-hmm. <affirmative> myself.
But certainly the more, but.

800
00:38:45,200 --> 00:38:47,400
With their full package. But
with, with their full package,

801
00:38:47,400 --> 00:38:50,240
you can do elastic tads
like the, the full whack.

802
00:38:50,240 --> 00:38:52,440
Absolutely. Yeah. There
is no limitation. Again,

803
00:38:52,440 --> 00:38:56,080
you can add elastics if you need to.
In fact, I've just listened to your,

804
00:38:56,080 --> 00:38:57,600
your one of the podcasts from uh,

805
00:38:57,720 --> 00:39:00,960
Straight Pro actually about elastics
and I was a bit kind of like, Oh wow,

806
00:39:00,960 --> 00:39:04,560
don't use them <laugh>. I do, I do,
I do. And I don't, I have to say,

807
00:39:04,560 --> 00:39:06,760
and I'm glad I listened to
that lecture cuz it kind of,

808
00:39:06,810 --> 00:39:09,560
or the podcaster cause it
really did uh, kind of, uh,

809
00:39:09,560 --> 00:39:11,440
confirm that I'm doing things
okay <laugh>, you know,

810
00:39:11,500 --> 00:39:12,760
I'm not doing it for the sake of it,

811
00:39:12,760 --> 00:39:15,360
I'm doing it cause I'm moving
individual teeth and yeah, you know,

812
00:39:15,650 --> 00:39:18,240
if you want and allowed
you to be creative,

813
00:39:18,240 --> 00:39:21,240
you can add bite ramps if
you want to yourself. Um,

814
00:39:21,240 --> 00:39:23,560
you can actually ask for
a variable trim height.

815
00:39:23,560 --> 00:39:27,080
And this is one of the most underrated
things in aligners at the moment is

816
00:39:27,080 --> 00:39:29,280
asking for a variable trim height, what.

817
00:39:29,280 --> 00:39:31,440
It means first. Explain what that actually
yeah, what you were just about to do.

818
00:39:31,440 --> 00:39:33,040
I'm sorry, but also like why,

819
00:39:33,040 --> 00:39:36,600
Well I wanna know when you would
ask for a lower trim height high.

820
00:39:36,600 --> 00:39:39,400
Cause I've seen Tiff talk about
this and I'm like, first, okay,

821
00:39:39,400 --> 00:39:40,840
it's pretty cool how you
can customize something,

822
00:39:40,840 --> 00:39:42,720
but at the moment with
my lack of knowledge,

823
00:39:42,720 --> 00:39:46,040
I wouldn't know when to prescribe which
one and what benefits would you get.

824
00:39:46,130 --> 00:39:47,880
So tell us teachers enlighten.

825
00:39:47,880 --> 00:39:49,240
Us. So yeah, as you said,

826
00:39:49,240 --> 00:39:51,600
I actually again just listened
to a podcast that TIF did,

827
00:39:51,600 --> 00:39:54,240
I think it was the Teeth
and Teals podcast, um, that,

828
00:39:54,240 --> 00:39:57,400
that's just gone on recently actually.
And he described this perfectly actually.

829
00:39:57,400 --> 00:39:59,360
So I'm probably gonna repeat a little
bit what you said if I'm honest.

830
00:39:59,620 --> 00:40:02,440
And that is that with,
uh, scallops trimline,

831
00:40:02,440 --> 00:40:06,720
like you might be more accustomed to using
some other brand of aligners that has

832
00:40:06,720 --> 00:40:10,160
a degree of flexibility. Okay. For
correcting rotated teeth, for example,

833
00:40:10,160 --> 00:40:13,720
where you want the plastic to be able to
bend an almost stretch into an Embraer

834
00:40:13,720 --> 00:40:15,640
or into an area where it's the,

835
00:40:15,640 --> 00:40:18,680
the plastic is quite difficult
to reach because with a liners,

836
00:40:18,680 --> 00:40:19,560
you gotta think like the plastic,

837
00:40:19,560 --> 00:40:24,080
how does that tooth or a liner grip that
tooth? You know, I think I I also, uh,

838
00:40:24,080 --> 00:40:27,560
like the analogy on one of the podcasts
I listened to recently where it's like a

839
00:40:27,560 --> 00:40:29,560
slippery watermelon seed
<laugh>, I love that.

840
00:40:29,670 --> 00:40:34,000
Like I laughter on sizes like slippery
watermelon seeds, that's it. And uh,

841
00:40:34,020 --> 00:40:37,840
and yeah, you know, uh, more
flexible aligner, uh, trim height,

842
00:40:37,840 --> 00:40:39,520
like the skeletal mic four rotations.

843
00:40:39,860 --> 00:40:44,720
But also being aware that the higher
up or the, the more rigid the tray is.

844
00:40:44,810 --> 00:40:48,800
So if you're asking for a straight trim
line more associated with something like

845
00:40:48,800 --> 00:40:51,560
a retainer for example, that
becomes a lot more rigid.

846
00:40:52,060 --> 00:40:56,920
And so if the patient is needing a
lot of attachments because of control,

847
00:40:57,160 --> 00:40:59,560
you want to keep more control
over a certain tooth movements,

848
00:41:00,030 --> 00:41:03,560
then again you might choose a scallop
trim line because you want that

849
00:41:03,560 --> 00:41:06,520
flexibility so the patient can
comfortably get it in and out.

850
00:41:06,880 --> 00:41:09,360
<laugh> and I have been caught out
in the past where I thought, yeah,

851
00:41:09,360 --> 00:41:12,560
all the attachments really high trim line
and the patient goes and you're like,

852
00:41:12,560 --> 00:41:16,200
Oh wow, that ain't coming out easy.
So yeah, is a degree, you know,

853
00:41:16,250 --> 00:41:19,920
is a bit of a learning curve as well
when you start with this other option

854
00:41:19,920 --> 00:41:22,920
essentially you maybe haven't
had the chance to use before.

855
00:41:23,210 --> 00:41:26,800
So, so, so if you go for a higher
trim line, ie. Um, straight,

856
00:41:26,800 --> 00:41:30,160
so not scallop straight, that means
that you need to use less attachments.

857
00:41:30,160 --> 00:41:30,840
Did I get that.

858
00:41:30,840 --> 00:41:35,640
Right? Yeah, you're spot on. So where
the more rigid tray, because this the,

859
00:41:35,690 --> 00:41:38,080
um, aligner is trimmed a bit higher, it,

860
00:41:38,080 --> 00:41:41,560
you can apply I suppose slightly
heavier forces to the teeth just ever so

861
00:41:41,720 --> 00:41:45,520
slightly. Um, and it does mean you
get more control, you know, so, um,

862
00:41:45,520 --> 00:41:46,760
it will mean less attachments,

863
00:41:46,760 --> 00:41:50,920
which is amazing cuz patients generally
request a aligner treatment for the

864
00:41:50,920 --> 00:41:52,520
discrete nature of the treatment.

865
00:41:52,660 --> 00:41:55,280
And so when you can offer the
patient a higher trim line,

866
00:41:55,280 --> 00:41:57,840
which keeps the plastic
above the smile line,

867
00:41:57,840 --> 00:42:00,280
so they don't actually see
any of the plastic at all, uh,

868
00:42:00,280 --> 00:42:01,480
or the edge of the plastic I should say,

869
00:42:01,480 --> 00:42:04,480
which is something very visible and
you're having less attachments because

870
00:42:04,480 --> 00:42:05,480
attachments are,

871
00:42:05,480 --> 00:42:08,880
they reflect the light at different
angles and they can be very visible. And,

872
00:42:08,880 --> 00:42:10,240
and one of the things which, uh,

873
00:42:10,240 --> 00:42:13,120
it was one of the main reasons why I
moved away from other aligner brands and

874
00:42:13,120 --> 00:42:13,440
then, you know,

875
00:42:13,440 --> 00:42:17,880
years and years ago was because actually
during that fitting appointment where

876
00:42:17,880 --> 00:42:21,120
you, you hand the patient the mirror
and say, Here is your first aligner,

877
00:42:21,140 --> 00:42:24,800
you know, I used to dread that because
the honest truth was it didn't look, it,

878
00:42:25,020 --> 00:42:28,720
you know, the, the aligners weren't maybe
as clear as they were hoping for. Uh,

879
00:42:28,720 --> 00:42:31,960
and also there was a lot of attachments
which just drew away from that discreet

880
00:42:31,960 --> 00:42:36,800
nature. And so now it is a complete
cha rev reversal whereby, you know,

881
00:42:36,800 --> 00:42:40,160
I, I I, I'm looking forward to giving
the patient the, the mirror and saying,

882
00:42:40,160 --> 00:42:43,800
Look how clear these are the
actual line of material themselves,

883
00:42:44,620 --> 00:42:48,200
and look how, you know, discreet this
can be for you. So, you know, there's,

884
00:42:48,200 --> 00:42:52,600
this is a topic I speak a lot on and,
and it's fantastic. I'm hoping I'm, um,

885
00:42:52,600 --> 00:42:55,160
bringing forward my, uh,
my enthusiasm for it.

886
00:42:55,440 --> 00:42:58,720
<Laugh> absolutely. No, it, it shines
through. Now, do I need to, to spend, uh,

887
00:42:58,790 --> 00:43:01,680
a best part of, uh,
4,000 pounds to, to, to,

888
00:43:01,680 --> 00:43:03,560
to learn how to give
<laugh> these aligners?

889
00:43:04,250 --> 00:43:07,760
No, not at all. No, it's, well,
maybe not my, uh, my hair to say,

890
00:43:07,760 --> 00:43:11,440
but certainly if you were keen to get
involved with another aligner brand as

891
00:43:11,440 --> 00:43:15,160
such, you know, I'd always say don't put
all your eggs in one basket. You know,

892
00:43:15,270 --> 00:43:18,320
look around and see what other
options are available. And sure.

893
00:43:18,320 --> 00:43:21,560
Us now being one of the major competitors
in the aligner market at the moment,

894
00:43:22,220 --> 00:43:24,280
and if you wanted to start using Sure.

895
00:43:24,280 --> 00:43:27,560
Smile is a case of reaching out
to one of the representatives, uh,

896
00:43:27,560 --> 00:43:31,440
going in on the website and expressing
your interest. Um, there isn't so much a,

897
00:43:31,440 --> 00:43:35,240
a course that you would pay to go
on as such that you're almost, uh,

898
00:43:35,240 --> 00:43:38,160
paying to have access to the software
cuz it is such a powerful software.

899
00:43:38,340 --> 00:43:41,760
And with that access then
comes the case for you to do,

900
00:43:41,760 --> 00:43:45,720
for your first case for free. So really,
uh, there's an investment to make to,

901
00:43:45,720 --> 00:43:49,520
to start using She Smile. But if you
do your first case, it balances out.

902
00:43:49,570 --> 00:43:52,200
So that's really the best way
I can describe it. Brilliant.

903
00:43:52,200 --> 00:43:56,040
Brilliant. So you obviously, uh,
teach, uh, for sure Smile. Uh,

904
00:43:56,040 --> 00:43:58,960
are you also like a mentor
like on the end of a phone, Uh,

905
00:43:58,960 --> 00:44:01,560
if someone needs advice in
planning case, or how does it,

906
00:44:01,560 --> 00:44:05,080
I guess my next question is how,
how does support lend itself to the.

907
00:44:05,080 --> 00:44:09,440
System? So at the moment, um,
Sure. Smile and Is Academy, uh,

908
00:44:09,440 --> 00:44:12,920
myself and Tiff and Ross Hobson and, and
many other mentors that are out there,

909
00:44:12,920 --> 00:44:16,040
I can't name them all. Um,
we've, we actually have a,

910
00:44:16,040 --> 00:44:19,360
a kinda a handshake agreement, I
suppose, with, uh, dense supply and,

911
00:44:19,360 --> 00:44:22,120
and Sure smile to provide a lot of
the teaching and also the mentoring.

912
00:44:22,330 --> 00:44:26,520
So if there are cases that you would like
to ask questions, upload photographs,

913
00:44:26,580 --> 00:44:28,160
get any, um, help with,

914
00:44:28,270 --> 00:44:31,720
then there are many mentors all
over the world to help with that.

915
00:44:31,800 --> 00:44:33,160
There is also the,

916
00:44:33,340 --> 00:44:36,760
the communication kind of customer support
line as well for simple more software

917
00:44:36,760 --> 00:44:39,440
related things as well. So there
will be an answer to your question.

918
00:44:39,440 --> 00:44:43,040
Somewhere. Is this on like a IAS website
where you got like the forum and stuff?

919
00:44:43,040 --> 00:44:45,800
Oh, that's brilliant. So I mean,
having used that in the past, um, I,

920
00:44:45,800 --> 00:44:49,040
I can definitely vouch for that. Uh, you
know, I have so much faith in ias. Tif,

921
00:44:49,800 --> 00:44:52,760
yeah, Prof, uh, so some, some
great people there. So, uh,

922
00:44:52,760 --> 00:44:55,680
IAS is very trustworthy. So that that,
that, that's a really good thing to,

923
00:44:55,680 --> 00:44:57,440
to have. So that, that's,
that's amazing. And you.

924
00:44:57,440 --> 00:45:01,000
And you can again, use as much
or little of the, the, um,

925
00:45:01,000 --> 00:45:03,320
support network that's
there as you wish. You know,

926
00:45:03,320 --> 00:45:04,880
even things like WhatsApp group chats,

927
00:45:04,880 --> 00:45:06,720
if you just wanna quick answer
to a question as well, you know,

928
00:45:06,720 --> 00:45:09,640
we're trying to keep it in
the 21st century and keep
everyone kind of in contact

929
00:45:09,840 --> 00:45:10,673
with one another.

930
00:45:10,880 --> 00:45:12,680
<Laugh>. Very cool. Well, Josh, uh,

931
00:45:12,680 --> 00:45:16,560
you've answered my main thing about the
four key rules in planning aesthetic

932
00:45:16,560 --> 00:45:19,160
dentistry and it's great coming
from you, so passionate about ortho,

933
00:45:19,160 --> 00:45:20,200
restorative and, uh,

934
00:45:20,200 --> 00:45:22,520
I'm sure you'll agree that the
best orthotics might be done with,

935
00:45:22,520 --> 00:45:25,760
from someone who's got a restorative
eye, uh, as you do. And I,

936
00:45:25,760 --> 00:45:26,600
and I truly believe that.

937
00:45:26,690 --> 00:45:30,160
So it's great to learn these pearls from
you and thanks for sharing some extra

938
00:45:30,320 --> 00:45:33,680
bits about why other aligner companies
might do things differently and what

939
00:45:33,680 --> 00:45:36,960
benefits that may present. So, um, you
know, shout out to, to shore smile for,

940
00:45:36,960 --> 00:45:37,530
for that.

941
00:45:37,530 --> 00:45:40,760
So it's great to learn about that
and I trust people like you and Tiff,

942
00:45:40,920 --> 00:45:44,320
Tiff is a, is a huge inspiration in, in
my career and, and I know yours as well.

943
00:45:44,450 --> 00:45:46,960
So, uh, uh, hat tip to
Tiff as well, uh, Josh,

944
00:45:46,960 --> 00:45:49,480
tell us how we can follow you
and find out more from you on,

945
00:45:49,480 --> 00:45:52,800
on social media and also any courses
that you run, that kind of stuff. Yeah.

946
00:45:53,270 --> 00:45:56,160
I, I wish I was better with social
media, if I'm honest with you. I just,

947
00:45:56,160 --> 00:46:00,040
it's a matter of time. It really
is. How much time can you afford? I,

948
00:46:00,100 --> 00:46:03,120
I'm a busy man, what can I say? You
know, treating, treating the patients,

949
00:46:03,120 --> 00:46:04,280
doing what I enjoy doing the most,

950
00:46:04,280 --> 00:46:07,200
which is actually achieving these
smiles that, that we do. But yeah,

951
00:46:07,280 --> 00:46:11,120
happy for anyone to contact me via
social media, things like that.

952
00:46:11,120 --> 00:46:14,160
If you want to, I'm on Instagram and
Facebook. I would strongly encourage,

953
00:46:14,160 --> 00:46:16,800
you know, anyone who's listening
today to, if you have any questions,

954
00:46:16,800 --> 00:46:19,800
just to reach out to me and yeah.
You know, see what's out there.

955
00:46:20,150 --> 00:46:21,000
I would say to any,

956
00:46:21,000 --> 00:46:24,880
any young dentist or dentist who really
wanting to get into this kind of work,

957
00:46:24,880 --> 00:46:28,040
whether it's with orthodontics
or or smile design, you know, do,

958
00:46:28,040 --> 00:46:30,360
do your research, you know, see
what courses might be out there.

959
00:46:30,360 --> 00:46:33,600
I don't particularly run
any courses myself. I,

960
00:46:33,600 --> 00:46:37,640
I do a lot of the teaching through Sure
Smile and Through Is Academy. So again,

961
00:46:37,640 --> 00:46:40,200
you know, seek these courses
out if you want to learn more.

962
00:46:40,280 --> 00:46:43,280
There is so much with
aligners, you know, it's,

963
00:46:43,280 --> 00:46:45,520
it's not something that can
be taught in a day. You know,

964
00:46:45,520 --> 00:46:49,480
like when you go in a course, uh, you
know, in a hotel room for one day, yes,

965
00:46:49,480 --> 00:46:51,320
they can teach you how
to do the fundamentals,

966
00:46:51,320 --> 00:46:53,880
which is your i p your
polishing machine, your teeth.

967
00:46:54,300 --> 00:46:57,320
You can teach you how to put
attachments on, but there is, it's,

968
00:46:57,320 --> 00:47:00,480
it's that black box I was talking
about before that really, you know,

969
00:47:00,720 --> 00:47:04,560
separates the, you know, how to do it,
but how to really can understand it.

970
00:47:04,560 --> 00:47:06,200
Really, it's like passion driving test.

971
00:47:06,200 --> 00:47:09,240
You don't really know how to drive and
you passion driving test <laugh>, do you?

972
00:47:09,240 --> 00:47:11,160
Absolutely no, you, you
always learn afterwards.

973
00:47:11,160 --> 00:47:13,040
And I said the same thing
about, about bds and, uh,

974
00:47:13,320 --> 00:47:15,760
it's great to have mentorship, which
is a recurring theme of the podcast,

975
00:47:15,760 --> 00:47:19,360
hence why, uh, you know, I was able to,
to lean on your knowledge as a mentor,

976
00:47:19,610 --> 00:47:23,120
uh, a few years back on a case.
So thank you again, Josh, for,

977
00:47:23,120 --> 00:47:26,120
for helping me out that time and
again, helping me out this time to, to,

978
00:47:26,120 --> 00:47:29,720
to help these dentists, uh, better plan
their aesthetics and just, you know,

979
00:47:29,720 --> 00:47:32,280
that rule one is just so key
in knowing where to begin.

980
00:47:32,280 --> 00:47:35,600
And I really love that rule three, you
know, that, that communication one.

981
00:47:35,600 --> 00:47:37,720
So those are my two of the,
my favorite of the four.

982
00:47:37,720 --> 00:47:40,440
But I think you gave great value
there. So Josh, thank you so much for,

983
00:47:40,440 --> 00:47:41,800
for spending time with us today. No.

984
00:47:41,800 --> 00:47:44,600
Thanks very much Chaz. Thanks for
everyone who was listening and yeah,

985
00:47:44,920 --> 00:47:46,600
everyone enjoyed the rest
of your weekend <laugh>.

986
00:47:46,970 --> 00:47:48,840
So there we have it guys. Is a summary.

987
00:47:48,870 --> 00:47:53,520
Rule number one that I said right at the
beginning is to start with the upper in

988
00:47:53,520 --> 00:47:54,040
size ledges.

989
00:47:54,040 --> 00:47:58,560
Once you plan where the upper incisal
edge will go in the face and your or the

990
00:47:58,720 --> 00:48:02,480
proposed future position of that central
incisor and everything else falls into

991
00:48:02,480 --> 00:48:06,880
place. Uh, that rule two was to find
out what the diagnosis is diagnosed,

992
00:48:06,880 --> 00:48:09,600
diagnosed diagnosis, the
why, the what, the how,

993
00:48:09,640 --> 00:48:11,400
where do you want the
different teeth to be?

994
00:48:11,400 --> 00:48:15,200
So the example I gave was whether you
should lengthen the teeth or in that

995
00:48:15,480 --> 00:48:15,840
specific patient,

996
00:48:15,840 --> 00:48:18,760
would you get a better result in
the face by crown lengthening?

997
00:48:18,760 --> 00:48:22,600
Another example would be if someone's
with proportions of their teeth that got

998
00:48:22,600 --> 00:48:26,280
re small lateral in sizes. That's really
important as partly your diagnosis.

999
00:48:26,280 --> 00:48:30,720
So diagnose in every way possible so
you can get a better treatment plan,

1000
00:48:30,720 --> 00:48:33,480
cuz the diagnosis always
informs your treatment plan.

1001
00:48:33,480 --> 00:48:37,640
Rule number three was my personal
favorite. Give ideal a chance,

1002
00:48:37,640 --> 00:48:41,400
give the ideal treatment plan a chance,
communicate it with your patient. Yes,

1003
00:48:41,400 --> 00:48:45,240
you can make compromises. It is not
a sin, it is not dirty to compromise,

1004
00:48:45,240 --> 00:48:46,560
but if you are compromising,

1005
00:48:46,560 --> 00:48:48,240
the patient should know there's
a compromise being made.

1006
00:48:48,240 --> 00:48:51,840
It really helps with your consent.
And number four, simulations.

1007
00:48:51,840 --> 00:48:53,480
So if you aren't using a line of therapy,

1008
00:48:53,550 --> 00:48:56,680
then you can use the software of your
line of company yet. Sure. Smile,

1009
00:48:56,680 --> 00:48:59,920
look very, very snazzy. So thanks
to Josh for sharing a screen share,

1010
00:48:59,920 --> 00:49:01,000
but those who are listening,

1011
00:49:01,000 --> 00:49:04,160
were able to follow along in terms
of what makes this software unique.

1012
00:49:04,160 --> 00:49:07,880
And if you've watched or if you've
listened on the protrusive premium app,

1013
00:49:07,880 --> 00:49:11,760
you can now answer the simple questions
to claim your c p D for this episode,

1014
00:49:11,760 --> 00:49:13,960
which is really quick and
easy. Within 72 hours,

1015
00:49:13,960 --> 00:49:17,320
we send you a certificate with
your reflective log inside as well.

1016
00:49:17,420 --> 00:49:19,960
One of the example questions
for this episode, uh,

1017
00:49:19,960 --> 00:49:24,280
is what are the two main photos used
for deciding the central inci position?

1018
00:49:24,450 --> 00:49:28,880
Is it A, the d and n smile?
Is it B, the e and n Smile?

1019
00:49:29,010 --> 00:49:33,400
Is it C the e and m smile, or
is it D? The d and m smiles.

1020
00:49:33,400 --> 00:49:35,280
So if you know the answer to
that one and the other ones,

1021
00:49:35,280 --> 00:49:36,480
why don't you join Protrusive Premium,

1022
00:49:36,480 --> 00:49:41,200
answer a few questions and get rewarded
for your c p D hour for listening to the

1023
00:49:41,200 --> 00:49:44,280
entire way and also validate
your learning and reflect on it.

1024
00:49:44,280 --> 00:49:47,280
This is gonna be really good at the end
of the year to have all your reflections

1025
00:49:47,300 --> 00:49:50,480
and the lessons you learn
from protrusive in one place.

1026
00:49:50,490 --> 00:49:51,720
So if you've got a few minutes,

1027
00:49:51,780 --> 00:49:55,200
get on the app and just answer those
questions and you are well on your way to

1028
00:49:55,200 --> 00:49:58,240
getting c p D. Anyway, I'll catch
you in the next episode. Same time,

1029
00:49:58,240 --> 00:50:01,800
same place. Thank you for
listening all the way to the end.