Protrusive Dental Podcast

Why does dentistry on social media look so perfect?

Are those flawless before-and-after cases the reality of everyday practice—or just the highlight reel?

And why aren’t we talking more openly about the failures, frustrations, and imperfect outcomes that every dentist experiences?

In this episode, Dr Artem Mkrtichyan joins Jaz for a refreshingly honest conversation about the realities of modern dentistry. Known for his candid and relatable social media posts, Dr. Artem has built a following by sharing what many dentists think—but rarely say out loud: dentistry is hard, results aren’t always perfect, and social media often paints an unrealistic picture of the profession.

https://youtu.be/uTKaeewgrgE

Watch IC074 on YouTube
Key Takeaways

Social media has become a powerful tool for dentists to connect and share experiences.

Mistakes in clinical practice are common and should be openly discussed.

Rural practice may not always lead to higher income as expected.

Success in dentistry is subjective and varies for each individual.

Continuous learning and skill development are crucial for career growth.

Financial freedom in dentistry is not guaranteed and varies widely.

Networking and mentorship can significantly impact career progression.

Social media can be leveraged to attract patients and build a personal brand.

Highlights of this episode:

00:00 Teaser

00:18 Introduction

02:24 Meet Dr Artem Mkrtichyan

05:27 Rejections And Resilience

09:03 Why Honesty Wins

10:58 Rural Dentistry Reality

14:58 Handling Online Criticism

16:01 Associate Vs Owner Myth

18:05 Midroll: Protrusive App

22:48 Dentistry Money Reality

26:57 Design Your Career Path

28:00 Standing Out In Saturated Markets

29:27 Content Marketing Strategy

31:46 Veneer Minimum Ethics

33:48 Final Advice And Community

If this episode resonated with you, don’t miss “I Committed Fraud – Learn from My Mistakes” – PDP248

#InterferenceCast #BeyondDentistry

This episode is not eligible for CPD/CE points, but never fear, there are hundreds of hours of CPD waiting for you on the Ultimate Education Plan.

Why does occlusion feel so confusing at dental school?

What if the problem is not that occlusion is too complex, but that it was taught in the wrong order?

How do you make sense of worn teeth, bite scans, shimstock, leaf gauges, provisionals and T-Scan without getting overwhelmed?

And which small ideas can genuinely change the way you diagnose, plan and restore?

In this episode, Jaz is joined by Dr. Mahmoud Ibrahim for a brilliant occlusion-focused conversation. They each bring five clinical “pearls” that helped occlusion finally click for them — from facially generated treatment planning to checking the contralateral side, muscle palpation, provisionals and digital occlusal data.

https://youtu.be/REQ_L5NNEF4

Watch PDP267 on YouTube
Protrusive Dental Pearl

Create a PowerPoint or Keynote library of your clinical photos so you can quickly show patients relevant examples during consultations.

⚠️ Avoid hunting through random folders chairside — it feels clunky and breaks the flow of the conversation.

✅ Build a scrollable visual library of cracks, before-and-afters, complications, direct restorations, overlays, crowns and consent examples to support clearer patient communication.

Key Takeaways

Occlusion becomes easier when it is placed inside the treatment planning sequence, not treated as a separate subject.

Facially generated treatment planning starts with where the upper teeth need to be for aesthetics.

Once the central incisors are planned, the rest of the occlusion becomes easier to organise.

Worn teeth that are still in occlusion are often in the wrong position.

Anterior wear may be caused by tooth position, contact time, contact force, or a combination of all three.

Gingival levels can reveal whether worn lower incisors have over-erupted.

Digital bite scans are useful, but they are not always a perfect representation of the patient’s bite.

Shimstock remains one of the most valuable and inexpensive tools for checking true occlusal contacts.

After fitting a restoration, checking the contralateral side first can reveal whether the new restoration is high.

Anterior guidance should be steep enough to separate the back teeth, but shallow enough to allow the lower incisors room to move.

Muscle palpation should assess the quality and symmetry of contraction, not just whether the muscles exist.

Always assess the opposing tooth before placing composite, ceramic or an indirect restoration.

A leaf gauge can help create a more repeatable jaw position when planning more complex occlusal cases.

Provisionals are essential for testing aesthetics, function, vertical dimension and occlusion before committing to final restorations.

Highlights of the Episode:

00:00 Teaser

00:56 Introduction

03:36 Pearl: Build a Clinical Photo PowerPoint

12:48 Pearl 1: Facially Generated Treatment Planning

15:56 Pearl 2: Worn Teeth in Occlusion Are in the Wrong Position

18:05 Why Tooth Position Matters

18:22 Three Causes of Wear to Consider

19:34 Pearl 3: Digital Bite Scans Are Not Always Accurate

20:24 Why Shimstock Still Matters in Digital Dentistry

24:18 Pearl 4: Check the Contralateral Side After a Restoration

26:27 Pearl 5: The First Movement of Opening Is Not Pure Rotation

28:27 Midroll

33:10 Pearl 6: Healthy Occlusion Should Have Coordinated Muscle Contraction

35:22 Why Muscle Palpation Is a Useful Data Point

38:18 Practical Muscle Assessment Tip

38:58 Pearl 7: Always Look at the Opposing Tooth

39:33 What to Check Before an Indirect Restoration

39:44 Why the Opposing Tooth Matters

41:13 Pearl 8: Leaf Gauge for Finding a Repeatable Jaw Position

42:43 What a Leaf Gauge Is

44:33 Pearl 9: Provisionals Reduce the Fear of Complex Cases

47:49 Pearl 10: T-Scan Adds Objective Occlusal Data

53:16 Course Options and Learning Pathway

55:59 Outro

✨Connect with Dr. Mahmoud on Instagram

📍 Want to make occlusion more practical?

Bulletproof is designed to take occlusion from abstract theory to real-world clinical application — covering posterior crowns, quadrant dentistry, PROPER conformative dentistry, occlusal risk assessment, shimstock, leaf gauges and daily protocols you can use straight away.

The next Bulletproof course takes place on 26th–27th June at London Heathrow (Radisson Blu Hotel)

Don’t miss it — find out more at bulletproofdentistry.com

➡️Check out more episodes on occlusion: Indirect Restorations For Guiding Teeth – PDP196

#PDPMainEpisodes  #OcclusionTMDandSplints

This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance.

This episode meets GDC Outcomes C

AGD Subject Code: 180 Occlusion

Aim: To help dentists improve their understanding and clinical application of occlusion by recognising key diagnostic signs, using practical occlusal assessment tools, and applying occlusal principles to restorative treatment planning.

Dentists will be able to –

Apply facially generated treatment planning principles when assessing occlusal and restorative cases.

Identify how tooth position, contact time and contact force contribute to tooth wear and restoration risk.

Use practical occlusal assessment methods such as shimstock, contralateral checking, muscle palpation, leaf gauges, provisionals and T-Scan data.

Are we overcomplicating posterior composites?

Are those beautiful fissures and stains actually helping the patient… or just us?

Why does that “perfect” restoration suddenly need 20 minutes of occlusal adjustment after rubber dam removal?

And how can we make functional, predictable composites without burning time or stress?

In this episode, Dr. Vishaal Shah shares a refreshingly practical approach to posterior composites. From understanding the basics, to simplifying anatomy and improving efficiency, this is a grounded, clinically focused conversation on how to deliver restorations that actually serve the patient.

https://youtu.be/tdkTxzcloN0

Watch PDP266 on YouTube
Protrusive Dental Pearl
Match your composite anatomy to the patient’s dental age and opposing dentition before you start building.

⚠️ Overbuilding cusps in a worn dentition will create occlusal interferences and wasted adjustment time
✅ Assess space, wear, and occlusion first—then design the restoration accordingly

Key Takeaways

Function, efficiency, and occlusal compatibility should guide every restoration

Dental age (wear) is more important than chronological age when planning anatomy

Always assess the opposing tooth before designing cusps and fissures

Use the whole arch—not just the contralateral tooth—as your anatomical guide

Follow the central fissure line across the quadrant to orient your restoration

Avoid textbook anatomy in worn dentitions—adapt to what’s present

Large MOD composites often act as interim restorations before crowns

Build proximal walls first to establish contact and control final contour

Use composite slump (with a microbrush) to naturally form proximal curvature

Base layer height should match the deepest fissure level of adjacent teeth

Map out fissures and cusps before building to improve accuracy and speed

Start with the most difficult cusp first to reduce fatigue-related errors

Proper planning before drilling reduces occlusal errors and remakes

Highlights of the Episode:

00:00 Teaser

01:08 Introduction

01:50 Pearl: Matching Anatomy to Dental Age

05:32 Posterior Composite: Start with Basics, Not Complexity

10:42 Efficient Approach to Large Restorations

14:22 Efficiency vs Ideal Posterior Restorations

19:25 Building Proximal Walls First

20:55 Using Putty Stents for Missing Cusps

23:54 Midroll

27:15 Using Putty Stents for Missing Cusps

27:25 Matrix System Selection

28:06 No Pre-Wedging Philosophy

29:06 Managing Composite Overhangs

30:46 Matrix Ring Differences

32:45 Interjection

37:03 Matrix Ring Differences

37:43 Proximal Wall Technique for Posterior Composite

41:03 Base Layer Strategy in Posterior Restorations

42:23 Mapping Anatomy Before Composite Build-Up

43:13 Cusp Build-Up Approach

45:03 Minimal Adjustment Philosophy

46:43 Final Philosophy: Keep It Simple

48:00 Learning Opportunities

49:54 Outro

🔥 Want to level up your posterior composites?
Dr. Vishaal Shah runs hands-on courses focused on simplifying and mastering everyday restorations.
👉 Visit www.levelupdentistry.com to explore courses and upcoming training opportunities.

More about posterior restorations:
Check out more episodes on occlusion and restorative dentistry: How to Place Posterior Composites without Destroying Your Anatomy – PDP200

#PDPMainEpisodes  #BreadandButterDentistry 

This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance.

This episode meets GDC Outcomes C

AGD Subject Code: 250 Operative Dentistry

Aim: To enhance clinicians’ understanding of efficient, functional posterior composite techniques with a focus on anatomy, occlusion, and practical workflow.

Dentists will be able to –

Assess dental age and occlusal compatibility when planning posterior composites

Apply simplified, efficient techniques to build functional posterior restorations

Select appropriate materials and matrix systems to optimise contact, contour, and outcomes

When is it appropriate to consider an MRI for your TMD patient?

What’s actually involved in MRI of the TMJ?

Can you use any MRI machine, or is the choice of imaging center crucial?

And who should be reporting on these scans — does it really matter? (Hint: yes, it does!)

Dr. Kevin Lotzof, a straight-talking radiologist, joins Jaz for a controversial deep dive into the role of MRI in Temporomandibular Disorders. While many experts downplay its importance, Kevin argues that TMJs are under-imaged and under-diagnosed — and that we may be missing critical pathology.

They explore the practicalities of imaging, how to set expectations with your patients, and why strong but differing views in TMD care can ultimately help you refine your own clinical approach.

https://youtu.be/-yo_Qx4Zg5Q

Watch PDP265 on YouTube
 Protrusive Dental Pearl: Adopt the mindset of “Find the cancer today.”
When carrying out examinations—whether soft tissue or extraoral—approach it with the intention of detecting oral or skin cancers early. This mindset helps clinicians look beyond just teeth, catch unusual or suspicious lesions, and potentially save lives.

Key Takeaways

TMJ is often overlooked but is crucial for overall health.

MRI is essential for accurate TMJ diagnosis.

Cone beam CT cannot replace MRI for TMD assessment.

Patients with headaches may have undiagnosed TMD.

Education on TMJ imaging is lacking among dental professionals.

Asymptomatic patients should still be scanned for TMJ issues.

The quality of imaging directly impacts diagnosis accuracy.

Patients often feel anxious about MRI procedures.

Understanding patient perspectives can improve care.

There is a need for better collaboration between dentists and radiologists.

Highlight of the episode:

00:00 Teaser

00:55 Intro

05:20 Protrusive dental pearl

06:36 Interview with Dr. Kevin Lotzof

09:38 Under-Imaging and Differing Perspectives

13:27 Access and MRI Centers in the UK

17:51 TMJ MRI: Patient Expectations

22:17 Midroll

25:53 Open MRI Machines

27:26 Ideal Candidates for MRI Imaging

29:55 Cone Beam CT vs. MRI

31:53 Screening and Asymptomatic Patients

38:43 Centers with Reliable TMJ Imaging

41:27 Encouragement for General Dentists

46:33 Outro

Where to Get Reliable TMJ Imaging

⭐ Top Pick:

Orion, Wimpole Street, London
(Full contact details available via the Protrusive Guidance App)

🏙️ Other London Options:

Spire Bushey, Circle Hendon, Cavell, Kings Oak, Circle Healthcare Center 

Learn more about TMJ radiographic imaging in PDP223: Understanding TMD Radiographic Imaging – Pano vs CBCT vs MRI

#PDPMainEpisodes #OcclusionTMDandSplints #CareerDevelopment

This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance. 

This episode meets GDC Outcomes A and C.

AGD Subject Code: 730 ORAL MEDICINE, ORAL DIAGNOSIS, ORAL PATHOLOGY (Imaging techniques)

Aim: To highlight the importance of MRI in the diagnosis and management of temporomandibular joint (TMJ) disorders, ensuring safe and effective orthodontic and restorative treatment planning.

Dentists will be able to:

Explain why MRI is superior to clinical examination and CBCT in diagnosing TMJ pathology.

Identify the key indications for TMJ MRI, including both dental and non-dental symptoms.

Recognize the limitations of poor imaging technique and reporting in TMJ diagnosis

Is titanium still the gold standard for implants?

Are zirconia implants just hype from biological dentistry… or something more?

Do ceramic implants really integrate as well as titanium?

And should we already be offering patients a choice?

Zirconia implants are no longer a fringe concept—they’re entering mainstream conversations. In this episode, Dr. Pav Khaira returns to break down the science, clinical decision-making, and real-world application of zirconia vs titanium implants. From corrosion and osteoimmunology to occlusion and case selection, this is a practical, evidence-led discussion for clinicians navigating modern implant options.

https://youtu.be/-RCvf2KOdSc

Watch PDP264 on YouTube
Protrusive Dental Pearl: Thriving in Challenging Times

💡 Prioritize quality sleep—it sharpens decision-making, improves mood, and reduces irritability (6–7 solid hours beats longer, disrupted sleep).

➡️ Remember, stress comes from how we respond, not the situation itself—focus on what you can control and let go of the rest.

📢 Lean on your support system and make time for reflection and gratitude—they help reframe pressure and build resilience.

Key Takeaways

Zirconia implants integrate just as well as titanium, with comparable clinical outcomes

Early healing may be slightly faster around zirconia, but long-term results are similar

Titanium can corrode over time, releasing particles linked to peri-implantitis

Zirconia does not corrode, removing this biological risk factor

Modern implant thinking focuses on osteoimmunology, not just osseointegration

Zirconia implants are often one-piece → no microgap and improved crestal bone stability

Surgical placement must be highly precise—zirconia is less forgiving than titanium

Guided osteotomy is strongly recommended for ceramic implants

Fracture risk in modern zirconia implants is low when manufactured correctly

Hot isostatic pressing significantly increases zirconia strength and reduces defects

Case selection is critical—limited bone or complex angulation may favour titanium

Zirconia implants are typically cement-retained only

Excess cement remains a risk factor for peri-implant disease → manage carefully

Zinc phosphate cement is useful due to radiopacity and bacteriostatic properties

Angled screw correction (titanium) is predictable only up to ~15 degrees

Patient preference for metal-free dentistry is a growing driver of zirconia demand

Episode Highlights

00:00 Teaser

00:49 Introduction

02:32 Protrusive Dental Pearl: Advice for Dentists during challenging times

05:14 Basics: What Are Implants Made Of?

07:13 Osseointegration: Zirconia vs Titanium

08:28 Why Zirconia? Biological Rationale

11:13 Clinical Advantages of Zirconia Implant

14:09 Zirconia Implants Limitations in Clinical Use

17:45  Case Selection: When to Use Zirconia Implant

19:16 Fracture Risk: Myth vs Reality

21:30 Midroll

24:51 Fracture Risk: Myth vs Reality

25:29 Importance of Manufacturing Zirconia Implants

27:49 Weaknesses & Clinical Considerations of Zirconia Implants

30:49 Occlusal Programming for Implants

32:24 Screw vs Cement Retention in Implants

34:07 Angle Screw Correction (titanium Context)

36:20 Cement Choices for Zirconia Implants

38:27 Market Share & Future Trends of Zirconia Implants

40:25 Learning Resources for Zirconia Implants

41:51 Medico-Legal Considerations of Zirconia Implants

47:37 Training & Education Pathways for Zirconia Implants 

48:25 Outro

Want to go deeper into implants?

Explore Dr. Pav Khaira’s Academy of Implant Excellence— training designed to help you truly understand the why behind implant dentistry, not just follow protocols. Hands-on options, mentorship, and advanced training available.

✨Follow Academy of Implant Excellence on Instagram: https://www.instagram.com/academyofimplantexcellence

Mentioned resources from this Episode

Book: Zirconia: Material Properties and Surgical Principles for Dental Implants and Restorations

Want more?

📢 Check out more episodes on implant complications and treatment planning

Implant Occlusion that Makes Sense – PDP 204

Implant Assessment for GDPs: from Space Requirement to Ridge Preservation – PDP052

#PDPMainEpisodes

This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance.

This episode meets GDC Outcomes C

AGD Subject Code: 690 Implants

Aim: To improve understanding of zirconia implants, including biological considerations, clinical indications, limitations, occlusal principles, consent, and material-related decision-making.

Dentists will be able to –

Describe the clinical and biological considerations when comparing zirconia and titanium implants

Identify key case selection factors and limitations for zirconia implant treatment

Apply practical principles for occlusion, cementation, consent, and risk reduction in implant dentistry