Very Dental Student: Year One with Dr. Kevin Harland

[00:00:01] [SPEAKER_02]: This is a production of the Very Dental Podcast Network.

[00:00:09] [SPEAKER_02]: It's time for a Very Dental Podcast just for students and new dentists. Welcome to the Very Dental Student Podcast. And now here's your host, Mohamed Aboubasha.

[00:00:20] [SPEAKER_03]: Hello everybody. Welcome to another episode of the Very Dental Student Podcast. I'm your host, Mohamed Aboubasha.

[00:00:26] [SPEAKER_03]: I'm coming at you with a repeat guest. I believe this is the third time we've had him on the podcast.

[00:00:32] [SPEAKER_03]: We've got Dr. Kevin Harland. Dr. Harland, how are you doing today?

[00:00:37] [SPEAKER_03]: I'm doing great. Excited to be here.

[00:00:40] [SPEAKER_03]: Awesome. So for those of the listeners who may not have heard the first couple episodes we recorded together,

[00:00:48] [SPEAKER_03]: can you just give them a brief introduction to yourself and what you've been up to for the last year?

[00:00:54] [SPEAKER_00]: Sure. Yeah. So I graduated back in 2023 from OU College of Dentistry.

[00:01:06] [SPEAKER_00]: Started working. I was at an office that didn't technically start working until September of 2023, but I work in a restorative practice and do a lot of

[00:01:20] [SPEAKER_00]: so much of the students fillings and Sarek is a big part of what we do. So that's really exciting. I kind of came to this office because I really loved that.

[00:01:29] [SPEAKER_00]: And outside of dentistry, I am a semi new dad. My baby's about to turn a year old in July. So a husband and a dad, and those are super important things to me as well.

[00:01:45] [SPEAKER_03]: Awesome. Yeah. So can you, can you kind of talk to us about just reflect on like the last year, you know, from starting your job up until now, like kind of what are the, what are the, what are the highlights or what are the things that really stand out?

[00:02:04] [SPEAKER_03]: Um, just, and you can kind of go wherever you want to with that.

[00:02:09] [SPEAKER_00]: Yeah. I would say, you know, just seeing the, I think the highlight is like seeing the progression in myself, um, from going from what feels like somebody who has no idea what they're doing, you know, for the most part, not hurting people, but walking into a room with confidence and, uh, sitting down with a patient with some ounce of confidence, you know, going from.

[00:02:33] [SPEAKER_00]: Kind of that zero level to now I feel like I can walk in the room and it's easy to make conversation with people. Um, I kind of have a routine of what I say. Uh, I pretty much say the same stuff every time now, uh, but just more comfortable talking to people. Um, I think that's one thing that I didn't necessarily realize this whole, I knew that being a dentist, I would be.

[00:02:59] [SPEAKER_00]: With, with, with people all day long, but I didn't know how much I was going to talk. And my wife says I talked too much and that's probably true, but there's a lot of, there's a lot of time to fill space and try and make patients feel comfortable and get to know people.

[00:03:14] [SPEAKER_00]: And it requires you to kind of your, your, uh, social, social bucket has to be pretty full at the beginning of the day. By the end of the day, you're kind of, I get a little talked out sometimes.

[00:03:28] [SPEAKER_03]: Yeah, for sure. That's actually great. Cause I remember during one of our interviews, uh, you mentioned like speaking to patients and kind of like getting used to having like some sort of workflow was like one of your pain points early on in practice.

[00:03:45] [SPEAKER_03]: So it's good to hear that at this point, you feel like that you've kind of gotten that down and it's more of just a routine for you.

[00:03:52] [SPEAKER_00]: Yeah, I definitely feel like, cause everything from walking in and greeting a patient and making them feel welcomed and, um, getting to know them a little bit, you know, talking about new patient exam, getting to know them a little bit, getting to know, you know, what brings them in and, um, you know, what's going on inside their mouth.

[00:04:11] [SPEAKER_00]: And, um, I just feel like I'm a lot more confident walking in that room.

[00:04:17] [SPEAKER_00]: And the second part of that is treatment planning, you know, looking in someone's mouth and being able to come up with a comprehensive treatment plan.

[00:04:26] [SPEAKER_00]: Um, it's definitely something that I haven't mastered.

[00:04:29] [SPEAKER_00]: I feel like every, every day, you know, we occasionally do some case reviews.

[00:04:33] [SPEAKER_00]: We take a lot of photos in our office, so it's really easy to go over cases and, um, just look at stuff with other doctors in our practice and say, Hey,

[00:04:41] [SPEAKER_00]: what would you have done here?

[00:04:42] [SPEAKER_00]: You know, why did you treatment plan this?

[00:04:45] [SPEAKER_00]: Why did you treatment plan this?

[00:04:47] [SPEAKER_00]: Um, just getting to have that conversation and kind of a little review process, um, at times can make you feel, you know, feel bad about yourself, but also can also it helps, helps to just kind of do a self review of your, of your work.

[00:05:01] [SPEAKER_03]: And yeah, I just took my first set of DSLR photos today, uh, on a workup I had, and that was a very rough experience.

[00:05:13] [SPEAKER_03]: How long did it take you to get, you know, good and efficient at taking those, uh, like full mouth series of photos with the DSLR?

[00:05:20] [SPEAKER_03]: Yeah.

[00:05:22] [SPEAKER_00]: Yeah.

[00:05:22] [SPEAKER_00]: So I'll, a while, um, the biggest game changer for me, you know, cause it's just macro photography.

[00:05:29] [SPEAKER_00]: Um, the biggest thing that helped all of the photos in our practice was getting a high quality flash, something that actually puts out some light.

[00:05:38] [SPEAKER_00]: We had a really, a really, uh, cheap janky flash on our camera for a while that just basically gave out no light.

[00:05:47] [SPEAKER_00]: And that really influences the settings parameters that you can have on your camera that can allow you to get a good photo.

[00:05:53] [SPEAKER_00]: You know, if you don't have enough light, your F stop has to be pretty low or, um, your shutter has to be open really a long time.

[00:06:01] [SPEAKER_00]: So if you can get that F stop up, I'm shooting at like, um, F 22.

[00:06:07] [SPEAKER_00]: And I think my, um, whatever the length of time the shutters opens like a hundred and that gives you a better,

[00:06:16] [SPEAKER_00]: you know, how your loops, you know, they're in focus for like a certain distance.

[00:06:20] [SPEAKER_00]: Yeah.

[00:06:22] [SPEAKER_00]: That higher F number, from my understanding, I could be totally wrong in botching this, but from my understanding that having that higher F number gives you more of like a, a length.

[00:06:31] [SPEAKER_00]: That things are in focus.

[00:06:33] [SPEAKER_00]: Yeah.

[00:06:34] [SPEAKER_00]: Like the focal distance or whatever the range.

[00:06:37] [SPEAKER_00]: Yeah.

[00:06:38] [SPEAKER_00]: The range that you can, everything can be clear is larger.

[00:06:41] [SPEAKER_00]: And so at the beginning you had trying to shoot those photos, you had to be, if you weren't exactly in this, it's a really small range where the photo is clear.

[00:06:51] [SPEAKER_00]: Um, now that we have a really nice flash and our settings are correct, I can snap 12 photos and, you know, one, two, three, for the most part with a hygienist who knows what, knows what we're taking pictures of and helping you blow off teeth.

[00:07:07] [SPEAKER_00]: And the hygienist, it can get a lot easier, but the biggest game changer was, yeah.

[00:07:12] [SPEAKER_00]: Getting that really high quality flash was really helped me out.

[00:07:18] [SPEAKER_00]: Well, it's a challenge, it's a challenge, but it's, man, it does.

[00:07:21] [SPEAKER_00]: It doesn't reveal to you a little bit what you can't see.

[00:07:25] [SPEAKER_00]: That is.

[00:07:26] [SPEAKER_03]: Yeah, that is very true.

[00:07:27] [SPEAKER_03]: I mean, the photos I took today, um, I don't know.

[00:07:30] [SPEAKER_03]: I feel like we're kind of limited at the school with the mirrors and retractors.

[00:07:34] [SPEAKER_03]: They really weren't like ideal.

[00:07:36] [SPEAKER_03]: So, but they were still a lot better than, like, I could see stuff way better than I could just with a, with a hand mirror going in.

[00:07:44] [SPEAKER_03]: Anyway, that's, I hate to get too sidetracked with that, but, um, maybe that could be a whole podcast in and of itself, just dental photography.

[00:07:51] [SPEAKER_03]: Yeah, so, um, so in terms of your clinical experience, we've talked about, um, or we've talked about like getting more comfortable walking in treatment planning, building the rapport with the patients.

[00:08:02] [SPEAKER_03]: What do you feel like is the, is the biggest thing you've, you've improved on clinically in your first year out?

[00:08:09] [SPEAKER_00]: Um, probably just workflow with, um, workflow inside the patient's mouth.

[00:08:18] [SPEAKER_00]: Um, what from everything from knowing exactly what I'm knowing is all the steps, you know, you think, you know, all the steps and you, you do know all the steps, but having it becomes like a nature where you're not having to think, all right, I have this next.

[00:08:33] [SPEAKER_00]: What am I going to do next?

[00:08:34] [SPEAKER_00]: Knowing, all right, I've done this a hundred times.

[00:08:37] [SPEAKER_00]: I know what's going to happen next.

[00:08:38] [SPEAKER_00]: I know what I need next.

[00:08:39] [SPEAKER_00]: I know what I need out.

[00:08:41] [SPEAKER_00]: Me and the assistant know what we need out.

[00:08:43] [SPEAKER_00]: We need floss.

[00:08:44] [SPEAKER_00]: Yeah.

[00:08:45] [SPEAKER_00]: Yeah.

[00:08:46] [SPEAKER_00]: We need floss.

[00:08:47] [SPEAKER_00]: That's been a pain point.

[00:08:49] [SPEAKER_00]: Sometimes I'm like, Hey, can I get a piece of floss?

[00:08:52] [SPEAKER_00]: Like at a really critical time, like when the cement setting up and there's no floss out.

[00:08:55] [SPEAKER_00]: I'm like, what is going on?

[00:08:58] [SPEAKER_00]: We're at a dental office.

[00:08:59] [SPEAKER_00]: Yeah.

[00:08:59] [SPEAKER_00]: Floss out.

[00:09:01] [SPEAKER_00]: Um, but yeah, just little things like that.

[00:09:06] [SPEAKER_00]: And then just, you know, overall, I would say just speed, speed.

[00:09:11] [SPEAKER_00]: And with, with that increased workflow and knowing all the things and working well with an assistant, I would say the overall improvement has been just speed of my ability to get things done.

[00:09:22] [SPEAKER_00]: And, um, you know, doing a great job at the same time.

[00:09:27] [SPEAKER_00]: I think that's, it's a, it's a, it's a balance of, all right, I want to, I want to get this done.

[00:09:32] [SPEAKER_00]: And, but I also need to do it, make it sure it looks great.

[00:09:37] [SPEAKER_00]: And there's times that I have plenty of time in the schedule and I don't feel rushed and I can spend a little extra time polishing that prep.

[00:09:45] [SPEAKER_00]: Um, but there are also times when it's patient isn't having a great time and we kind of need to get things moving along and I still have a great looking prep, but it might not be as finely polished.

[00:09:57] [SPEAKER_00]: Um, that definitely, definitely happens sometimes.

[00:10:00] [SPEAKER_03]: Yeah.

[00:10:01] [SPEAKER_03]: Uh, what would you say, this is a question I asked you, um, before, but what would you say your average, like just a day in, in the office looks like in terms of, uh, how many patients you see and what kind of stuff you're doing?

[00:10:16] [SPEAKER_03]: What kind of cases you're doing?

[00:10:18] [SPEAKER_00]: Yeah.

[00:10:18] [SPEAKER_00]: So, um, say today I did a little case of some sealants and fillings in the morning for about an hour or so, saw some hygiene patients.

[00:10:31] [SPEAKER_00]: So I think it's all a couple hygiene patients.

[00:10:35] [SPEAKER_00]: Um, and then I did a scan for a implant.

[00:10:40] [SPEAKER_00]: So an implant that had been placed and then I'm going to fabricate a crown for it in house in our, with our CEREC system.

[00:10:47] [SPEAKER_00]: And sometimes we can do that same days.

[00:10:49] [SPEAKER_00]: This particular case, we're going to give it a couple of days in between.

[00:10:54] [SPEAKER_00]: So we got all the scan information, put the scan post in there, did the scans, that whole thing.

[00:11:00] [SPEAKER_00]: So, um, then did two more sets of kind of set, just some basic fillings on husband and wife, um, one after the other.

[00:11:11] [SPEAKER_00]: And then just intermixed with some exams.

[00:11:13] [SPEAKER_00]: That was all before lunch, after lunch.

[00:11:17] [SPEAKER_00]: Um, another kind of larger restorative, like fillings and sealant case.

[00:11:21] [SPEAKER_00]: And then end of the day with little three little fillings, nice and easy.

[00:11:25] [SPEAKER_00]: Um, yeah, I would say that's, that's pretty, pretty chill.

[00:11:30] [SPEAKER_00]: So one, two, three, four, five, six patients that day or today.

[00:11:35] [SPEAKER_00]: And I would say that's, that's an ideal day.

[00:11:37] [SPEAKER_00]: I like, I like that, that, and then seeing hygiene interspersed through there, um, probably

[00:11:43] [SPEAKER_00]: one to maybe two times an hour while we're working.

[00:11:47] [SPEAKER_00]: So that would be, that's what an ideal day for me looks like.

[00:11:51] [SPEAKER_00]: Keeps the schedule relatively full.

[00:11:52] [SPEAKER_00]: I'm not sitting around on my hands too much.

[00:11:55] [SPEAKER_03]: Um, and are you seeing, yeah, that sounds, that sounds pretty good.

[00:12:00] [SPEAKER_03]: And are you seeing patients primarily in one column?

[00:12:03] [SPEAKER_03]: Yeah.

[00:12:04] [SPEAKER_03]: One column in your office.

[00:12:05] [SPEAKER_00]: Sometimes, I mean, one column, one chair.

[00:12:08] [SPEAKER_00]: Sometimes we switch over if it's like today.

[00:12:10] [SPEAKER_00]: I had one little, one case that ran a little long.

[00:12:12] [SPEAKER_00]: So they just seat my patient right next to me in the chair next to me.

[00:12:14] [SPEAKER_00]: And we have easy to improvise.

[00:12:19] [SPEAKER_00]: So sometimes we're one and a half chairs, maybe.

[00:12:21] [SPEAKER_00]: I don't know.

[00:12:22] [SPEAKER_03]: Yeah.

[00:12:22] [SPEAKER_03]: Very good.

[00:12:24] [SPEAKER_03]: And then after you, so what is your favorite type of case to do?

[00:12:29] [SPEAKER_03]: Um, you know, you've obviously, you're restorative heavy practice, but like, are you the type of,

[00:12:36] [SPEAKER_03]: are you, is your favorite case like a fixed case?

[00:12:39] [SPEAKER_03]: Uh, like, or is your favorite case more operative?

[00:12:42] [SPEAKER_03]: What would, would you like really enjoy?

[00:12:45] [SPEAKER_00]: I really enjoy something.

[00:12:50] [SPEAKER_00]: So not having to go subgingival because we're scanning.

[00:12:53] [SPEAKER_00]: Um, so any, anytime I can keep something above the gum line, um, just cause it's easier to scan.

[00:12:59] [SPEAKER_00]: I would say just an easy, easy, either an easy crown or an easy onlay, um, where you're not packing cord for, to save your life or, um, yeah, everything's high and dry.

[00:13:13] [SPEAKER_00]: For the most part.

[00:13:15] [SPEAKER_00]: I would say that's, that's my favorite kind of case.

[00:13:18] [SPEAKER_00]: A crown, some people call them crown lays or, uh, you know, some type of onlay that not having to go super, um, far on the mesial or distal.

[00:13:27] [SPEAKER_00]: I think the harder cases are when you're doing a crown prep and the decay is super deep on the mesial and distal that can get, uh, frustrating at times.

[00:13:37] [SPEAKER_00]: No, I don't, I don't look forward to those cases.

[00:13:39] [SPEAKER_00]: Just especially like with scanning it.

[00:13:42] [SPEAKER_00]: Yeah.

[00:13:42] [SPEAKER_00]: Yeah.

[00:13:42] [SPEAKER_00]: Just cause yeah, we're, cause we're scanning and, um, making sure everything is nice and dry and clean.

[00:13:49] [SPEAKER_00]: You can get a good scan so you can make a good restoration that fits well.

[00:13:52] [SPEAKER_00]: Um, that's more of a challenge when patients bleeding or, um, the prep is super deep and the cameras having to, having to look really far down.

[00:14:02] [SPEAKER_00]: Um, that can, I would say the days that I have the most fun is when I can scan it in like 30 seconds.

[00:14:09] [SPEAKER_03]: Yeah.

[00:14:09] [SPEAKER_03]: No, that makes perfect sense.

[00:14:11] [SPEAKER_03]: Um, so I know that you are pretty, you, the, the practice that you work in, uh, uses a lot, CEREC a lot.

[00:14:19] [SPEAKER_03]: So I thought one thing that would be very cool would be, uh, especially for the students out there who have definitely heard of CEREC, but don't really understand what the workflow is like.

[00:14:28] [SPEAKER_03]: Um, is if we could go to like a, through a step-by-step of, let's say like you have an onlay appointment.

[00:14:34] [SPEAKER_03]: Um, just like after you get the patient numb, talk, talk me through each step, um, from prep till final bonding of the onlay.

[00:14:45] [SPEAKER_03]: Yeah.

[00:14:48] [SPEAKER_00]: So patients numb doing an onlay.

[00:14:51] [SPEAKER_00]: So, um, some capacity we've had to lose a cusp somewhere on the tooth.

[00:14:56] [SPEAKER_00]: Um, so initially go through in our, um, scanning software, you know, in the CEREC software, we have a prime scan at our office.

[00:15:05] [SPEAKER_00]: Um, you just tell the computer, you have to input into the computer, everything that you want.

[00:15:09] [SPEAKER_00]: So I'm telling the tooth, Hey, I'm working on tooth number 14.

[00:15:13] [SPEAKER_00]: I'm doing this type of restoration.

[00:15:16] [SPEAKER_00]: I'm going to use this type of material.

[00:15:18] [SPEAKER_00]: You know, let's say we're going to use Emacs.

[00:15:20] [SPEAKER_00]: Um, and then tell it, you just kind of have to give the computer little information.

[00:15:24] [SPEAKER_00]: Where am I going to mail it?

[00:15:24] [SPEAKER_00]: I'm going to mail it.

[00:15:26] [SPEAKER_00]: You know, we have several mills at the office, so we just have to tell it where it's going to go.

[00:15:30] [SPEAKER_00]: Um, from there, a lot of times I, while I'm getting the patient numb, so let's say I'm getting number 14 numb, I'll give our injection.

[00:15:39] [SPEAKER_00]: And while that's kind of setting in, you know, I try to not waste that time.

[00:15:44] [SPEAKER_00]: If I can get up and do a check during that time, I would love to do that while the patient's getting numb.

[00:15:47] [SPEAKER_00]: Um, I say, I say that in air quotes because it doesn't really take that long on a maxilla.

[00:15:52] [SPEAKER_00]: Um, and, um, I use that time to scan the opposing arch.

[00:16:04] [SPEAKER_00]: Um, and I think you could technically get a buckle scan there too.

[00:16:08] [SPEAKER_00]: So you have to, you know, we're getting an upper, let's say you're working on tooth number 14.

[00:16:11] [SPEAKER_00]: So can't take the upper scan yet because we have prepped the tooth.

[00:16:16] [SPEAKER_00]: We'd just have to delete.

[00:16:18] [SPEAKER_00]: Um, but we can take the lower and we could possibly take the bite.

[00:16:22] [SPEAKER_00]: I don't typically take the bite till I'm totally done, but just to get that out of the way.

[00:16:27] [SPEAKER_00]: Um, after that's done, you know, we start drilling, get the old, you know, big DO restoration or MOD restoration out and get the tooth prepped.

[00:16:39] [SPEAKER_00]: This is where I spend probably a large majority of my time.

[00:16:42] [SPEAKER_00]: And this is where, you know, this is where you're going to kind of gain speed over time is being confident and using that handpiece to get the old restoration out, get the decay out, knowing what's decay.

[00:16:55] [SPEAKER_00]: Um, I use a lot of carries indicator die just cause it makes me feel good and makes me feel good to know where everything's at.

[00:17:05] [SPEAKER_00]: And, um, once the tooth is prepped, so that could take me anywhere from, uh, 15 minutes to sometimes on these, I've done some more complex, um, designs, which I don't necessarily recommend.

[00:17:22] [SPEAKER_00]: And those can sometimes take a long time because you've got to get all your walls to be, um, divergent open so that everything can see passively.

[00:17:34] [SPEAKER_00]: Um, so just make sure that all your walls are going the right way, um, have nice clean margins.

[00:17:41] [SPEAKER_00]: At some point you need to get your cord in there because we're scanning.

[00:17:44] [SPEAKER_00]: So we have to be able to see the scanner has to be able to see everything that you're doing.

[00:17:48] [SPEAKER_00]: So if your gum tissue is in the way, you need to push it out of the way.

[00:17:54] [SPEAKER_00]: So getting that cord packed in there, we've set our cord.

[00:17:57] [SPEAKER_00]: We use epi cord, um, a little double O epi cord.

[00:18:02] [SPEAKER_00]: And we hope we soak it in hemident as well, just to kind of help control some of the bleeding.

[00:18:09] [SPEAKER_00]: And that typically does a pretty good job.

[00:18:11] [SPEAKER_00]: I'm a one cord, maybe two cord if it's getting, um, kind of deep person.

[00:18:15] [SPEAKER_00]: And then in cases where, you know, patients bleeding a lot, let's say they had a, a restoration that had a big overhang and they've been catching debris in there.

[00:18:24] [SPEAKER_00]: And the guns are all upset.

[00:18:27] [SPEAKER_00]: Um, we have a, a retraction paste by 3M.

[00:18:31] [SPEAKER_00]: I don't know exactly what it's called, but it's basically like aluminum chloride that you would scrub on, but it's in a paste form.

[00:18:37] [SPEAKER_00]: And that does a really great job.

[00:18:38] [SPEAKER_00]: You know, that's a great point when you get frustrated because you're trying to get your cord through, but you can't see anything because there's blood everywhere.

[00:18:44] [SPEAKER_00]: And this one, I would love to have a little electrocautery thing to go down there and just, we don't have one of those in our office, but I've been looking into it.

[00:18:55] [SPEAKER_00]: But just throw some retraction paste in there, set the patient up and say, Hey, I'm gonna put some medicine on your gums for a second so that we can get a really good picture of your teeth.

[00:19:03] [SPEAKER_00]: I said, that's exactly what I say.

[00:19:05] [SPEAKER_00]: And it gives their jaw a rest, gives your back a rest and you can go do a check or whatever you need to do.

[00:19:12] [SPEAKER_03]: So, so I do have one quick follow up question.

[00:19:15] [SPEAKER_03]: So when you're doing an online, how often are you like close to the gym?

[00:19:21] [SPEAKER_03]: Cause I honestly have no idea.

[00:19:24] [SPEAKER_03]: Um, yeah, I've never seen, seen a clinical scenario where we've opted to do an online on a live patient.

[00:19:31] [SPEAKER_03]: So I don't know like where the finish line usually is, um, or anything like that.

[00:19:36] [SPEAKER_00]: Yeah.

[00:19:36] [SPEAKER_00]: Yeah.

[00:19:37] [SPEAKER_00]: So I'm thinking about, um, somebody had a really large MO or DO or MOD restoration.

[00:19:44] [SPEAKER_00]: So on that mesial and distal, depending on how far, you know, the initial prep was taken.

[00:19:50] [SPEAKER_00]: So it was cut to put the initial composite in there and then the recurrent decay that's underneath it, you know, that can go pretty, pretty far.

[00:20:00] [SPEAKER_00]: And hopefully not too far, you know, we want to stay, stay away from the bone as much as we can, but that can, that's typically where we're getting under the gum line.

[00:20:11] [SPEAKER_00]: And then, you know, thinking about where you're going to bring your shoulder out on the buckle or lingual.

[00:20:19] [SPEAKER_00]: Um, you know, sometimes those depending on where, again, depending on where the decay is or, um, typically the buckle and lingual, I try to keep as much as I can.

[00:20:28] [SPEAKER_00]: There's, it's not as common place to have decay unless it's like class five decay.

[00:20:33] [SPEAKER_00]: Um, not as I can typically keep those pretty high, um, which is what I prefer to do because it's easier to scan and, you know, taking away less to structure, you know, we're, we're going to be bonding these in anyway.

[00:20:45] [SPEAKER_00]: So there's not a lot of thought put into retention form.

[00:20:50] [SPEAKER_00]: Um, but yeah, typically on the mesial and distal, mesial and distal can get pretty, depending on, you know, some people have you open that box up and there's like no papilla in there.

[00:21:00] [SPEAKER_00]: And then another person you open up and like the papilla is like falling over into your prep.

[00:21:06] [SPEAKER_00]: So a little, you know, um, a little, uh, what do we call it?

[00:21:14] [SPEAKER_00]: Diamond curatage, taking your, taking your diamond really fast and cutting away some of that papilla.

[00:21:19] [SPEAKER_00]: Sometimes that's necessary to get it off your prep because you gotta be able to see it.

[00:21:25] [SPEAKER_00]: Yeah, that makes perfect sense.

[00:21:26] [SPEAKER_00]: So that's one of the disadvantages of, of scanning is that you have to be able to see stuff.

[00:21:31] [SPEAKER_00]: If the camera can't see it, then, or if you can't see it, the camera can't see it.

[00:21:35] [SPEAKER_00]: The camera can't see it.

[00:21:37] [SPEAKER_00]: It's going to have a tough time making a restoration there.

[00:21:39] [SPEAKER_03]: Yeah.

[00:21:40] [SPEAKER_03]: Have you ever, have you ever, uh, seen videos or like, um, done yourself like deep margin elevation on a case like that?

[00:21:48] [SPEAKER_00]: Um, I've definitely seen videos of it and I've, I've actually looked into it pretty extensively.

[00:21:54] [SPEAKER_00]: Um, there's a guy, David, David Alleman, Davey Alleman.

[00:21:58] [SPEAKER_00]: They have an Instagram that I walk, seen a lot of their stuff.

[00:22:03] [SPEAKER_00]: And I'm a big, uh, biomimetic guy.

[00:22:06] [SPEAKER_00]: Yeah.

[00:22:06] [SPEAKER_00]: Big biomimetic guy.

[00:22:07] [SPEAKER_00]: Um, so, but that's, it's in school, we're taught that that's pretty taboo to put a rest, put a restoration on a margin down there.

[00:22:20] [SPEAKER_00]: Yeah.

[00:22:20] [SPEAKER_00]: I think that there's definitely times when it, it could definitely make your life a lot easier.

[00:22:25] [SPEAKER_00]: Um, but then you have your, I think that old kind of old school thought in what I was taught in dental school was, well, why would you put a restoration on, you know, you're putting this thing that you're hoping is going to last a long time on a piece of composite, you know, that they think basically isn't going to last as long.

[00:22:44] [SPEAKER_00]: Long, but I think you have to have a really, really great technique if you're going to do that, you know, as far as isolation of that really deep, um, deep margin.

[00:22:55] [SPEAKER_00]: But yeah, that absolutely makes it a lot easier.

[00:22:57] [SPEAKER_00]: There's a lot of examples out there on, if you go to like Davey Alleman on Instagram, you can see some of the stuff that he does.

[00:23:04] [SPEAKER_00]: He does a lot of those types of restorations and just knowing they're all about bonding.

[00:23:09] [SPEAKER_00]: So you just have to know how to handle that.

[00:23:11] [SPEAKER_00]: Also afterwards, there are a lot of time they're aerating their preps and putting on those with usually a heated composite.

[00:23:18] [SPEAKER_00]: We don't do that.

[00:23:20] [SPEAKER_00]: Um, I don't do that.

[00:23:22] [SPEAKER_00]: So, but someday maybe I can see, but I definitely looked into it.

[00:23:26] [SPEAKER_00]: It's looks pretty labor intensive to do versus just trying to get your margin down there.

[00:23:32] [SPEAKER_00]: And, you know, the idea is having, you know, really strong ceramic down there versus having your composite that maybe could fail.

[00:23:41] [SPEAKER_00]: But I don't think there's a right or wrong answer there.

[00:23:44] [SPEAKER_00]: Yeah.

[00:23:45] [SPEAKER_00]: You're going to get a lot of opinions on whether that's right or wrong.

[00:23:49] [SPEAKER_00]: Yeah.

[00:23:49] [SPEAKER_00]: I just want, just was curious.

[00:23:51] [SPEAKER_03]: So I thought I'd ask.

[00:23:52] [SPEAKER_00]: No, I had the same question in dental school.

[00:23:54] [SPEAKER_00]: I remember asking.

[00:23:57] [SPEAKER_03]: Yeah.

[00:23:57] [SPEAKER_03]: Sweet.

[00:23:58] [SPEAKER_03]: So sorry, I derailed you a little bit.

[00:24:00] [SPEAKER_03]: So if we go back to kind of the sequence, the appointment sequence.

[00:24:04] [SPEAKER_03]: And so you just finished prepping.

[00:24:07] [SPEAKER_03]: And then where do you go from there?

[00:24:09] [SPEAKER_00]: You pack cord, make sure everything's nice and good.

[00:24:13] [SPEAKER_00]: You know, looking over my prep, making sure if there's any places I could refine, it'd be a great, great time to take kind of an initial scan.

[00:24:20] [SPEAKER_00]: And just look at your prep overall.

[00:24:22] [SPEAKER_00]: You're going to be able to blow that prep up a lot bigger on that screen than you can see through your loops.

[00:24:27] [SPEAKER_00]: And you can kind of, I mean, you can turn it every which way and make sure all your walls are aligned the way you want them to.

[00:24:34] [SPEAKER_00]: Make sure everything's smooth.

[00:24:38] [SPEAKER_00]: And yeah, that's so taking an initial kind of scan.

[00:24:44] [SPEAKER_00]: Maybe you make some edits after that.

[00:24:46] [SPEAKER_00]: I really like to take mine to final.

[00:24:49] [SPEAKER_00]: I try to get, I think I probably tend to not do a kind of check step.

[00:24:56] [SPEAKER_00]: I try to get everything nice and perfect.

[00:24:59] [SPEAKER_00]: And if I start taking a scan and it doesn't look good, then I go back.

[00:25:03] [SPEAKER_00]: But yeah, and once everything, you're pretty confident with everything's, everything's pretty good.

[00:25:10] [SPEAKER_00]: Then you take your final kind of your final scan of that upper arch, which would be number two, number 14.

[00:25:17] [SPEAKER_00]: And make sure that your margins all look nice and clear.

[00:25:19] [SPEAKER_00]: You can delineate where the, where the margin would, would go, you know, having a good, you know, cross, cross arch.

[00:25:27] [SPEAKER_00]: So if I'm doing number 14, I'm going to probably try to get all the way over to the other molar in my scan, just so that our occlusion can be as spot on as possible.

[00:25:37] [SPEAKER_00]: You got to be careful.

[00:25:37] [SPEAKER_00]: Sometimes the software can get confused, especially if you just have a really small portion of the scan.

[00:25:45] [SPEAKER_00]: And I've had cases where they include, you know, you do the buckle scan.

[00:25:49] [SPEAKER_00]: So the buckle scan basically is the jaw relationship.

[00:25:51] [SPEAKER_00]: So you have the patient bite down.

[00:25:55] [SPEAKER_00]: I have, I say top, top, top your teeth together a couple of times and squeeze nice and tight.

[00:25:59] [SPEAKER_00]: And there's people out there that say that sets the PDL kind of compresses the PDL a little bit.

[00:26:04] [SPEAKER_00]: Um, so I have my patients do that.

[00:26:06] [SPEAKER_00]: And while they're kind of squeezing nice and tight, I take the scan and it kind of brings the upper scan and lower scan together and shows you where the jaw relationship is.

[00:26:20] [SPEAKER_00]: Um, and after that, pretty much done.

[00:26:23] [SPEAKER_00]: Then you got to push the, push the scan forward to the, so that was all in what's called the acquisition phase.

[00:26:28] [SPEAKER_00]: Cause we're acquiring all the information, the upper scan, the lower scan, the buckle scan, requiring all that information.

[00:26:34] [SPEAKER_00]: Then we're moving to the model phase.

[00:26:36] [SPEAKER_00]: So up on the top, we'll say model.

[00:26:39] [SPEAKER_00]: And there you can, this is a critical step for me.

[00:26:43] [SPEAKER_00]: So I, I make sure I stay in the room, make sure the patient, I always tell the patient, Hey, I'm going to make sure everything looks really great before we, before we start making this.

[00:26:53] [SPEAKER_00]: Because really I want to check, can I draw my margin really well?

[00:26:57] [SPEAKER_00]: Um, and do I have enough occlusal clearance?

[00:27:00] [SPEAKER_00]: So that's the big thing is I feel the thing that I struggled with the most at the beginning was, do I have enough clearance?

[00:27:07] [SPEAKER_00]: You know, am I making this crown thick enough that we can mill it?

[00:27:11] [SPEAKER_00]: Um, but also thick enough that it's not going to break.

[00:27:13] [SPEAKER_00]: Cause that's really the important thing.

[00:27:15] [SPEAKER_00]: I don't want to make something too thin.

[00:27:17] [SPEAKER_00]: And then the patient goes and bites down something and breaks because, because it was too thin.

[00:27:22] [SPEAKER_00]: Certainly you can make one adequate thickness and then it breaks anyways.

[00:27:25] [SPEAKER_00]: But, um, yeah, so I'm doing a, um, you get a distance is called distance to antagonist.

[00:27:34] [SPEAKER_00]: So measuring that, making sure it all shows up in like green or red, just make sure I don't have any red spots.

[00:27:42] [SPEAKER_00]: Um, and then, and it's different for different materials.

[00:27:45] [SPEAKER_00]: So we use, uh, you know, with zirconia, our, our zirconia, we use IvoClar's prime zirconia.

[00:27:51] [SPEAKER_00]: The minimum is 0.8, um, versus Emacs is one, but we really like 1.5.

[00:27:58] [SPEAKER_00]: Um, and then we use also Tetric CAD, which is like a composite, um, ceramic mix that, um, minimum thickness is 1.5.

[00:28:09] [SPEAKER_00]: But minimum thickness is 1.5, but really you need a little bit more because otherwise you're just gonna release flat restoration.

[00:28:18] [SPEAKER_00]: Um, you really need a lot of, unfortunately you need some, if you want the crown crown to look really pretty, um, you've got to kind of have enough room to make the, make the anatomy there kind of show up in the design process.

[00:28:35] [SPEAKER_03]: Yeah, that makes sense.

[00:28:36] [SPEAKER_03]: So this was a good time.

[00:28:38] [SPEAKER_03]: We talked about, you talked about the three different materials that you guys use in your mill.

[00:28:42] [SPEAKER_03]: Um, talk to me about material selection and what type of cases you would choose which material.

[00:28:50] [SPEAKER_00]: Yeah.

[00:28:50] [SPEAKER_00]: So this is, um, just my opinion, I guess.

[00:28:55] [SPEAKER_00]: Um, I really have liked using the zirconia, millable zirconia because with this prime zirconia, we can mill it in about.

[00:29:05] [SPEAKER_00]: Uh, the manufacturers state that you could mill it five minutes, but that's on super fast and you have to have a special set of burrs in there.

[00:29:13] [SPEAKER_00]: It's lit on super fast and it doesn't have as fine of anatomy.

[00:29:16] [SPEAKER_00]: So I grind mine on extra fine because I'm a nerd because I have to do less work, um, in the post milling stage.

[00:29:28] [SPEAKER_00]: Really just have to polish it up and put it in the oven.

[00:29:32] [SPEAKER_00]: It's just an easy.

[00:29:33] [SPEAKER_00]: And so that's 15 minutes in the mill and it takes another couple of minutes to polish it.

[00:29:38] [SPEAKER_00]: And then 15 minutes in the, um, in the oven.

[00:29:43] [SPEAKER_00]: So you're looking at a little over 30 minutes for something like that.

[00:29:48] [SPEAKER_00]: Um, and that, that I really liked that workflow and because they're typically a little easier to cement, I'm not bonding my zirconia restorations in.

[00:29:56] [SPEAKER_00]: Um, so I really, I really liked that because it's kind of less stress.

[00:30:02] [SPEAKER_00]: You need bonding restorations and can, you know, you have to have really great isolation.

[00:30:08] [SPEAKER_00]: I want great isolation anyways, but it's more on the top of your mind.

[00:30:12] [SPEAKER_00]: Um, it's more, but more technique sensitive and a challenge.

[00:30:15] [SPEAKER_00]: So in cases with that, so you're asking when would I use what, um, molar, second molar, deep, um, deep margins.

[00:30:24] [SPEAKER_00]: Not sure I'm going to get, you know, perfect isolation.

[00:30:27] [SPEAKER_00]: I'd love to use zirconia just cause the ease of use, you know, our preps can be a little less aggressive.

[00:30:32] [SPEAKER_00]: Um, just cause the materials that will handle thinner parameters.

[00:30:37] [SPEAKER_00]: Um, but Emacs, a lot of people use Emacs in the posterior a lot, you know, some people that's all that they use.

[00:30:44] [SPEAKER_00]: Um, they don't, they don't do zirconia cause they don't see a need for it.

[00:30:47] [SPEAKER_00]: And I've done a lot of molars and Emacs, um, just make sure you got enough thickness and, um, you know, that process is going to look a little different, you know, into the technicalities of why I would want to use zirconia.

[00:31:02] [SPEAKER_00]: So zirconia, you can just take it right out of the mill, polish it and put it directly into the oven with Emacs.

[00:31:08] [SPEAKER_00]: You can take it out of the mill.

[00:31:10] [SPEAKER_00]: You can try actually try it in the mouth.

[00:31:13] [SPEAKER_00]: You cut the sprue off.

[00:31:14] [SPEAKER_00]: That's part of the process, but you can place it in the mouth and kind of check my margins look good.

[00:31:20] [SPEAKER_00]: Does everything.

[00:31:21] [SPEAKER_00]: It's kind of your final check before you kind of waste your time staining and glazing it and putting it in the oven.

[00:31:28] [SPEAKER_00]: Um, if there's a problem, you can kind of know with zirconia, you're going straight to finish.

[00:31:32] [SPEAKER_00]: There's no check step in there.

[00:31:34] [SPEAKER_00]: Um, so I have only a couple of times I've had to go and remake something.

[00:31:41] [SPEAKER_00]: And typically it was because it was my fault.

[00:31:43] [SPEAKER_00]: There was one time that I forgot to put back on the minimal thickness.

[00:31:47] [SPEAKER_00]: So basically the computer telling you, Hey, there's a minimal thickness error here.

[00:31:50] [SPEAKER_00]: I forgot to check that box.

[00:31:52] [SPEAKER_00]: So I got a restoration out and I'm looking at it.

[00:31:54] [SPEAKER_00]: It's super thin.

[00:31:55] [SPEAKER_00]: I'm like, man, did I, I must've screwed something up here.

[00:31:59] [SPEAKER_00]: So I had to remill something for that.

[00:32:02] [SPEAKER_00]: But I would say my zirconia restorations have fit really well.

[00:32:05] [SPEAKER_00]: Um, I really liked the way they fit.

[00:32:09] [SPEAKER_00]: Um, but then other, so Emacs, um, in the anterior, I'm going to use Emacs probably pre molar forward.

[00:32:17] [SPEAKER_00]: And any, probably most pre molars I want to use Emacs just cause it's prettier.

[00:32:23] [SPEAKER_00]: Um, but this prime zirconia that they have out right now is pretty nice.

[00:32:27] [SPEAKER_00]: I mean, it looks really well.

[00:32:30] [SPEAKER_00]: If I had, if I got a restoration on a posterior tooth, I'd probably get zirconia.

[00:32:34] [SPEAKER_00]: Um, and then the other one that we use, we use Vita Enamic sometimes.

[00:32:40] [SPEAKER_00]: It's like a, one of those composite, uh, ceramic mix mixtures.

[00:32:47] [SPEAKER_00]: Um, and then Tetra Cat is another one we use.

[00:32:50] [SPEAKER_00]: And those are typically used for onlays because those don't have to go through the oven.

[00:32:56] [SPEAKER_00]: So those are really fun to do because you're not, they can kind of be done quick.

[00:33:01] [SPEAKER_00]: Um, and I, that's kind of nice cause it pays well and you can get done quickly.

[00:33:07] [SPEAKER_00]: Um, that's, that's a win in my book.

[00:33:09] [SPEAKER_00]: You don't have to mess around with it going into the oven and doing all this stuff.

[00:33:13] [SPEAKER_00]: Um, you can just go right out of the mill, polish it up right in the patient's mouth and

[00:33:17] [SPEAKER_00]: you're done.

[00:33:17] [SPEAKER_00]: Yeah.

[00:33:18] [SPEAKER_00]: Those are the three different types of materials that we use.

[00:33:24] [SPEAKER_00]: Um, then, so that's, that can answer your question there.

[00:33:28] [SPEAKER_03]: Yeah.

[00:33:28] [SPEAKER_03]: So I do have a follow up question.

[00:33:30] [SPEAKER_03]: So when you mentioned like, uh, using the zirconia and the emacs, um, and you mentioned

[00:33:37] [SPEAKER_03]: also that you're cementing zirconia.

[00:33:40] [SPEAKER_03]: So is that keeping in mind, are you using those just for like conventional crown preps or are

[00:33:46] [SPEAKER_03]: you also using that on onlay or like overlay type preps?

[00:33:50] [SPEAKER_03]: Yeah.

[00:33:51] [SPEAKER_00]: So using emacs more for on lays and overlays, non-retentive, something that's super non-retentive.

[00:34:03] [SPEAKER_00]: Um, I would use emacs just because you're able to bond to it a little more securely.

[00:34:09] [SPEAKER_00]: There's a lot of people out there that say you can bond zirconia really well.

[00:34:12] [SPEAKER_00]: Um, I would be a little more cautious to put like, let's say like a table.

[00:34:17] [SPEAKER_00]: I think you have something called the tabletop prep or there's no, there's hardly any shoulder

[00:34:21] [SPEAKER_00]: or anything.

[00:34:23] [SPEAKER_00]: I would be cautious about using zirconia just because I don't know for a long time they said,

[00:34:29] [SPEAKER_00]: Hey, you can't do that.

[00:34:30] [SPEAKER_00]: But now there's people out there saying, maybe you can, um, you have to particle abrade the

[00:34:35] [SPEAKER_00]: zirconia and then apply a, some type of silenation to it.

[00:34:41] [SPEAKER_00]: Um, it's kind of a process to bond zirconia.

[00:34:44] [SPEAKER_00]: I think it's definitely possible though.

[00:34:45] [SPEAKER_00]: And there's times that I've wanted to do it just because, you know, the big question

[00:34:50] [SPEAKER_00]: that I ask myself all the time is like, man, it'd be nice to not have to reduce so much

[00:34:54] [SPEAKER_00]: tooth just because, just for the, not because the tooth is necessarily bad, but because our

[00:35:00] [SPEAKER_00]: materials aren't, can't withstand being that thin.

[00:35:04] [SPEAKER_00]: Um, so there's times that I wanted to do some zirconia on lays, but I haven't done it yet

[00:35:10] [SPEAKER_00]: just because I don't honestly don't know how well it would work.

[00:35:13] [SPEAKER_00]: And I don't have predictability of it, of bonding those restorations in, but people used to bond

[00:35:18] [SPEAKER_00]: in, they used to cement in gold on lays, you know, and they stay in people's mouth.

[00:35:23] [SPEAKER_00]: So you can't see why it wouldn't work.

[00:35:26] [SPEAKER_00]: Yeah.

[00:35:26] [SPEAKER_00]: That makes sense.

[00:35:28] [SPEAKER_03]: Yeah.

[00:35:28] [SPEAKER_03]: I mean, I've definitely heard of zirconia bonding, um, and like different, yeah, different

[00:35:33] [SPEAKER_03]: protocols for it.

[00:35:35] [SPEAKER_03]: Um, but I, I also definitely have no idea cause you know, I haven't even bonded in a single

[00:35:41] [SPEAKER_03]: restoration yet other than, other than composite fillings.

[00:35:44] [SPEAKER_03]: So, so definitely have no clue, but, um, from what we've gone over in our fixed courses

[00:35:50] [SPEAKER_03]: and stuff, definitely they harp on really, if you, if you need something bonded, you go

[00:35:56] [SPEAKER_03]: with Emax, that's like the gold standard.

[00:35:58] [SPEAKER_00]: Yeah.

[00:35:59] [SPEAKER_00]: Emax.

[00:35:59] [SPEAKER_00]: And then our, those composite, um, you know, those blocks that have, you know, some portion

[00:36:05] [SPEAKER_00]: of composite or some portion of, um, ceramic those bond really well too, you know?

[00:36:11] [SPEAKER_00]: So those are super, uh, super great.

[00:36:16] [SPEAKER_00]: Um, but again, more technique sensitive cause you're, you're bonding something in and that's

[00:36:21] [SPEAKER_00]: why I like, I like stuff that's easy.

[00:36:23] [SPEAKER_00]: Um, that's why sometimes it's easier to grab some RMGI cement and stick a zirconia restoration

[00:36:32] [SPEAKER_00]: on.

[00:36:33] [SPEAKER_03]: Yep.

[00:36:34] [SPEAKER_00]: Fair enough.

[00:36:34] [SPEAKER_03]: Um, would you say that there's, so I want to go back to kind of.

[00:36:40] [SPEAKER_03]: Treatment planning.

[00:36:41] [SPEAKER_03]: We've talked, you talked a little bit about how it's been easier to kind of been able

[00:36:46] [SPEAKER_03]: to present a treatment plan with, with more confidence.

[00:36:50] [SPEAKER_03]: Um, what do you think has been like, uh, the most difficult thing when it comes to treatment

[00:36:56] [SPEAKER_03]: planning?

[00:36:56] [SPEAKER_03]: Like, um, is it knowing when or when or when not to save a tooth or is it like just being

[00:37:04] [SPEAKER_03]: able to really identify kind of bigger picture stuff?

[00:37:07] [SPEAKER_03]: Like what's the stuff that, um, that you've kind of developed that treatment planning muscle?

[00:37:13] Um.

[00:37:14] [SPEAKER_00]: I would say that it's still the biggest challenge is knowing when to intervene and when not to

[00:37:19] [SPEAKER_00]: intervene.

[00:37:20] [SPEAKER_00]: You know, somebody has a, you know, a large amalgam restoration that they've had for 30

[00:37:25] [SPEAKER_00]: years and the margins look okay, but the tooth is super gray, but radiographically you don't

[00:37:32] [SPEAKER_00]: see anything.

[00:37:33] [SPEAKER_00]: Yeah.

[00:37:34] [SPEAKER_00]: You know, is there micro leakage happening under that amalgam?

[00:37:37] [SPEAKER_00]: Um, I don't know, I don't really know what's underneath it until you take it out, but no,

[00:37:42] [SPEAKER_00]: kind of making that decision.

[00:37:43] [SPEAKER_00]: Okay.

[00:37:43] [SPEAKER_00]: Well then do we just explore and do that?

[00:37:45] [SPEAKER_00]: Like, I think I asked myself that question a lot, especially with amalgam restorations,

[00:37:49] [SPEAKER_00]: like a positive restorations.

[00:37:50] [SPEAKER_00]: It's like, you know, is there a current decay on the x-ray?

[00:37:53] [SPEAKER_00]: Is there margins?

[00:37:55] [SPEAKER_00]: Are they breaking down?

[00:37:56] [SPEAKER_00]: Is there obvious recurrent decay around it?

[00:37:58] [SPEAKER_00]: It's a little easier to see, but on those amalgams, you know, that there's that corrosion

[00:38:03] [SPEAKER_00]: product that's, that's formed and you know, you see some teeth that are pretty discolored.

[00:38:08] [SPEAKER_00]: And I think there's times that I'm like, it looks ugly.

[00:38:14] [SPEAKER_00]: So should we replace it?

[00:38:15] [SPEAKER_00]: I think sometimes I have to ask myself that question and try to make a, you know, an informed

[00:38:21] [SPEAKER_00]: decision about what to do.

[00:38:23] [SPEAKER_00]: You, a lot of times you blow those pictures up on the x-ray on the, on the, you know,

[00:38:29] [SPEAKER_00]: the screen for the patient and they go, what the heck is that?

[00:38:31] [SPEAKER_00]: That looks awful.

[00:38:33] [SPEAKER_00]: And you're like, yeah, it does look awful.

[00:38:35] [SPEAKER_00]: It's brown and black.

[00:38:36] [SPEAKER_00]: And, you know, I would say that's still a little bit of a challenge and, you know, patients,

[00:38:43] [SPEAKER_00]: they have all kinds of questions, you know, that you have to be kind of ready to answer

[00:38:47] [SPEAKER_00]: and kind of have now that I've done this more times, it's like, okay, I have my thing

[00:38:52] [SPEAKER_00]: that I say, well, well doc, that I've had that feeling forever.

[00:38:55] [SPEAKER_00]: It's never hurt me.

[00:38:56] [SPEAKER_00]: It doesn't hurt, but you know, a whole portion of the tooth's broken off or, you know, there's

[00:39:00] [SPEAKER_00]: a huge crack down one of the cusps and, you know, you kind of have to inform them, Hey,

[00:39:07] [SPEAKER_00]: this is what I see.

[00:39:08] [SPEAKER_00]: You know, these are the things that could happen.

[00:39:10] [SPEAKER_00]: These are the risks, you know, kind of that informed consent.

[00:39:14] [SPEAKER_00]: So, um, cause really I heard somebody say this one time, um, and kind of diagnosing is like,

[00:39:22] [SPEAKER_00]: you really, you're, you're just, you're just calling the plays.

[00:39:24] [SPEAKER_00]: Like you're referring a game.

[00:39:26] [SPEAKER_00]: Like you're just calling what you see.

[00:39:28] [SPEAKER_00]: And I think sometimes I have to just call what I see.

[00:39:31] [SPEAKER_00]: And if this restoration looks bad, it looks bad.

[00:39:34] [SPEAKER_00]: You know, Hey, there's recurrent decay around your teeth.

[00:39:37] [SPEAKER_00]: We should fix that.

[00:39:39] [SPEAKER_00]: Um, and sometimes it doesn't have to be this super complex thing.

[00:39:44] [SPEAKER_00]: Um, but I would say there's still even times that you feel like you're missing something

[00:39:48] [SPEAKER_00]: on stuff on x-rays or you're looking at an x-ray and you're like, man, is that, is that

[00:39:53] [SPEAKER_00]: into the dent?

[00:39:53] [SPEAKER_00]: And how far is it into the dent?

[00:39:54] [SPEAKER_00]: And do I really want to go in and disrupt this tooth?

[00:39:58] [SPEAKER_00]: Cause I think I asked myself that question a lot is, and sometimes I think that I overthink,

[00:40:03] [SPEAKER_00]: like if I go in and treat, am I doing this tooth harm or am I doing something

[00:40:08] [SPEAKER_00]: good for the tooth?

[00:40:09] [SPEAKER_00]: Uh, cause sometimes you have these like smaller lesions that, and especially on new patients,

[00:40:15] [SPEAKER_00]: I think I, I tend to want to like see another x-ray.

[00:40:19] [SPEAKER_00]: Like, is it getting worse or has it been like this for five years?

[00:40:24] [SPEAKER_00]: Uh, I think I have, I ask myself those questions a lot.

[00:40:28] [SPEAKER_00]: So, and I think it's definitely like you're saying, it's a muscle that you have to, you

[00:40:31] [SPEAKER_00]: have to exercise and you have to look at.

[00:40:33] [SPEAKER_00]: And every time you go in and go in and do a restoration and, you know, you open up and

[00:40:38] [SPEAKER_00]: the decay wasn't as big as you thought it was, or you open it up and you're like, holy

[00:40:42] [SPEAKER_00]: crap, I missed this on an x-ray.

[00:40:44] [SPEAKER_00]: How did I, you know, I think that on some second molars, um, opening up some cavities

[00:40:51] [SPEAKER_00]: on back there and then going back and looking at the X, you know, typically I have the x-ray

[00:40:55] [SPEAKER_00]: pulled up so I can see it as I'm working on it, but I'll open it up and be like, holy

[00:40:58] [SPEAKER_00]: crap.

[00:40:59] [SPEAKER_00]: I can't believe all this decay was in here.

[00:41:01] [SPEAKER_00]: I didn't, I had no idea.

[00:41:02] [SPEAKER_00]: And then I looked back at the x-ray and I'm kind of like squinting at it, trying to see,

[00:41:07] [SPEAKER_00]: man, how did I miss that?

[00:41:08] [SPEAKER_00]: You know?

[00:41:09] [SPEAKER_00]: And then when you see that and then you, I'm the type of person I'm like, oh my gosh, how

[00:41:13] [SPEAKER_00]: many people have come through?

[00:41:14] [SPEAKER_00]: And I didn't see that.

[00:41:15] [SPEAKER_00]: Yeah.

[00:41:16] [SPEAKER_03]: You know, it's funny you mentioned that literally on a second molar on number two, I was working

[00:41:21] [SPEAKER_03]: and we were, we had treatment planned like a PRR or something.

[00:41:25] [SPEAKER_03]: It was like, yeah, it's probably not even really curious, but, um, it's just has deep

[00:41:31] [SPEAKER_03]: grooves and stuff.

[00:41:32] [SPEAKER_03]: So a little bit of staining.

[00:41:34] [SPEAKER_03]: So we treated and planned a PRR and then it ended up like going in the whole distal marginal

[00:41:40] [SPEAKER_03]: ridge was completely undermined and it turned into a DO.

[00:41:43] [SPEAKER_03]: And I literally, I pulled up the x-ray and I was like, yeah, I guess I see it.

[00:41:48] [SPEAKER_03]: But I mean, not really like if that's why I feel like one thing I really want to have

[00:41:55] [SPEAKER_03]: whenever I'm a first graduate is like something like the Pearl AI or something like any of

[00:42:01] [SPEAKER_03]: those AI kind of second opinion type softwares, just cause I feel like inherently there's going

[00:42:06] [SPEAKER_03]: to be so much stuff that I miss.

[00:42:08] [SPEAKER_03]: Yeah.

[00:42:08] [SPEAKER_00]: We we've used a portion of the AI.

[00:42:12] [SPEAKER_00]: Um, I think it was on our computers for a while.

[00:42:14] [SPEAKER_00]: We did like a little trial with a company and I'll be honest.

[00:42:18] [SPEAKER_00]: I didn't use it that I didn't use it that much because I, there was part of me that was

[00:42:22] [SPEAKER_00]: like, ah, what does this thing know?

[00:42:24] [SPEAKER_00]: You know, I went to all the school to learn all this.

[00:42:26] [SPEAKER_00]: What is this AI really going to know?

[00:42:27] [SPEAKER_00]: And I felt like it, like it really, it felt like it was over diagnosing a little bit, not

[00:42:34] [SPEAKER_00]: because it doesn't diagnose.

[00:42:35] [SPEAKER_00]: It just shows you stuff, but it's like showing a lot of stuff.

[00:42:38] [SPEAKER_00]: And I'm like, holy crap, is that really something there?

[00:42:41] [SPEAKER_00]: You know, once it like draws your eye to it, then you're like, oh, I should do that.

[00:42:45] [SPEAKER_00]: But then I like want to turn all of it off and, you know, is that, am I going to use that

[00:42:48] [SPEAKER_00]: as evidence to go in and do something sometimes?

[00:42:53] [SPEAKER_00]: Yeah.

[00:42:53] [SPEAKER_00]: And sometimes not, but I, I, I, I wish I would have looked at it more, um, while we had it.

[00:43:01] [SPEAKER_00]: Um, but definitely something interesting.

[00:43:03] [SPEAKER_03]: Yeah.

[00:43:04] [SPEAKER_03]: I mean, it'll only get better in the years ago, I'm sure.

[00:43:06] [SPEAKER_03]: So I feel like that's one thing I've heard somebody, I don't remember who it was, but

[00:43:11] [SPEAKER_03]: it actually might've been this podcast.

[00:43:13] [SPEAKER_03]: Um, it might've been Kevin and Zach, um, saying that it's basically something similar

[00:43:19] [SPEAKER_03]: to just digital x-rays.

[00:43:20] [SPEAKER_03]: Like it's going to meet resistance.

[00:43:22] [SPEAKER_03]: It's going to be slow to adopt, but then eventually it'll just be standard of practice

[00:43:27] [SPEAKER_03]: most likely.

[00:43:28] [SPEAKER_03]: Um, just cause like, why would you not use something?

[00:43:31] [SPEAKER_03]: I mean, once it gets really, once they really improve it to where it's super accurate, like,

[00:43:36] [SPEAKER_03]: why would you not use it at that point?

[00:43:38] [SPEAKER_03]: Exactly.

[00:43:40] [SPEAKER_03]: All right.

[00:43:40] [SPEAKER_03]: Well, we've talked about a lot and I think there's definitely some, um, some good information

[00:43:45] [SPEAKER_03]: in this episode.

[00:43:46] [SPEAKER_03]: Is there any more just kind of, uh, pieces of advice or, uh, big nuggets you want to just,

[00:43:53] [SPEAKER_03]: uh, uh, give to the listeners before we close out?

[00:44:00] [SPEAKER_00]: Um, I feel like if I could say something that I feel like I want to say to myself a lot is

[00:44:04] [SPEAKER_00]: just try not to be too hard on yourself, but also holding yourself to high standards.

[00:44:09] [SPEAKER_00]: I think there's a lot of times that I, you know, make a, you make a small mistake here,

[00:44:14] [SPEAKER_00]: you make a small mistake there.

[00:44:15] [SPEAKER_00]: You have to, you know, I had to redo a case, um, a couple of weeks ago and, you know, try

[00:44:22] [SPEAKER_00]: not to beat yourself up too much.

[00:44:24] [SPEAKER_00]: I think sometimes I have to remember, like, it's only been a year.

[00:44:27] [SPEAKER_00]: I don't know everything, but I think there's this like desire to be the best at everything

[00:44:35] [SPEAKER_00]: and knowing that kind of, this is a practice and you, you aren't going to be a hundred percent

[00:44:43] [SPEAKER_00]: the first time you do it or the second or the third or the fourth or the hundredth.

[00:44:48] [SPEAKER_00]: Um, I think that is something that is, I have to remind myself of a lot.

[00:44:54] [SPEAKER_00]: Um, and that there's days that, you know, stuff's, stuff's hard.

[00:44:59] [SPEAKER_00]: Um, you go into it, you know, in school, I definitely remember feeling like this sucks.

[00:45:04] [SPEAKER_00]: I don't want to go to school anymore.

[00:45:05] [SPEAKER_00]: I've been doing this for so many years, but there's days sometimes I'm like, man,

[00:45:11] [SPEAKER_00]: it was kind of nice to not have to like worry.

[00:45:13] [SPEAKER_00]: You know, your worries just, they don't go away.

[00:45:15] [SPEAKER_00]: They just move to a different area and it's definitely more fun being out of school.

[00:45:20] [SPEAKER_00]: I mean, there's so much more freedom.

[00:45:22] [SPEAKER_00]: Um, there's so much, you know, you get to be you, um, you get to practice how you want

[00:45:28] [SPEAKER_00]: to, how you want to practice and what you believe in.

[00:45:30] [SPEAKER_00]: Um, and I think that's, that's really awesome.

[00:45:33] [SPEAKER_00]: And it's fun to be in this process, but it's frustrating at times to figure out what, what

[00:45:38] [SPEAKER_00]: you believe and what, you know, when am I going to do this?

[00:45:41] [SPEAKER_00]: When am I going to intervene?

[00:45:43] [SPEAKER_00]: You know, kind of like what we were talking earlier, um, trying to figure that out for

[00:45:46] [SPEAKER_00]: yourself.

[00:45:47] [SPEAKER_00]: Um, it's really, I think there's, what I've learned is there's, there's lessons that

[00:45:52] [SPEAKER_00]: people, you know, a lot of times people want to give you advice and, um, help you along

[00:45:57] [SPEAKER_00]: a lot, but there's time, there's certain lessons that it's, you have to learn for yourself.

[00:46:02] [SPEAKER_00]: And there's certain failures that you have to go through yourself.

[00:46:06] [SPEAKER_00]: Um, for me, I know mine is like, I want to make these super small, tiny restorations

[00:46:11] [SPEAKER_00]: and try to fit them in.

[00:46:13] [SPEAKER_00]: And man, it's, it's a challenge and it doesn't typically work out well.

[00:46:17] [SPEAKER_00]: That was one of the things that I kept trying to make is these really tiny onlays or these

[00:46:22] [SPEAKER_00]: really intricate little designs.

[00:46:26] [SPEAKER_00]: And that was a lesson that as many times as kind of my mentor and other doctors in the

[00:46:30] [SPEAKER_00]: office told me, Hey, it's, it's really, really tough.

[00:46:34] [SPEAKER_00]: You're going to wish you didn't do that.

[00:46:36] [SPEAKER_00]: Um, I had to do it a couple of times and kind of learn because I believe in myself and

[00:46:40] [SPEAKER_00]: I'm like, man, just cause you can't do it doesn't mean I can't do it.

[00:46:44] [SPEAKER_00]: Um, and kind of, uh, kind of believing in yourself, but also giving yourself the, you

[00:46:49] [SPEAKER_00]: know, leeway to fail sometimes, um, so that you can learn for yourself.

[00:46:54] [SPEAKER_00]: I think that's pretty valuable.

[00:46:55] [SPEAKER_03]: Yeah, I think that's a really good tip or really good advice.

[00:46:59] [SPEAKER_03]: Um, I can already think of like just one, one faculty that I work with, um, in operative

[00:47:06] [SPEAKER_03]: a lot.

[00:47:06] [SPEAKER_03]: He's always told me like, every time you do something and you see it with your own eyes,

[00:47:11] [SPEAKER_03]: it's different than somebody just telling you, because like, I don't know, like you can almost

[00:47:16] [SPEAKER_03]: put it into your, your map of experiences that you've had.

[00:47:21] [SPEAKER_03]: You, you have like a, like a web or like a, you can link it to the x-ray that you saw.

[00:47:26] [SPEAKER_03]: You can remember the bonding protocol you used or whatever, what, whatever instrument

[00:47:31] [SPEAKER_03]: you used or what you saw, and you can associate it with the outcomes.

[00:47:35] [SPEAKER_03]: And it's really something you have to do yourself because it's like, you have to be able to tell

[00:47:40] [SPEAKER_03]: yourself that story whenever you're remembering why something failed.

[00:47:45] [SPEAKER_03]: And I think that makes perfect sense.

[00:47:46] [SPEAKER_03]: So even though somebody might tell you, you, you still probably need to make those failures

[00:47:50] [SPEAKER_03]: yourself so that you can actually learn from it.

[00:47:53] [SPEAKER_03]: Yeah.

[00:47:54] [SPEAKER_03]: Yeah.

[00:47:54] [SPEAKER_03]: Awesome.

[00:47:55] [SPEAKER_03]: Well, Dr. Harland, uh, it's been a pleasure, um, uh, having you on, I'm sure we'll be having

[00:48:00] [SPEAKER_03]: you back on in the future.

[00:48:02] [SPEAKER_03]: Um, if there's any guests that have any questions or sorry, if there's any listeners that have

[00:48:07] [SPEAKER_03]: any questions for my guest, Dr. Harland, you can, uh, message me on Facebook and I can forward

[00:48:13] [SPEAKER_03]: your questions over to him.

[00:48:15] [SPEAKER_03]: Um, but for Dr. Harland and for myself, Muhammad, thank you guys for listening.