LIVE from Chicago AES 2024 + Midwinter!

Fresh off our thrilling journey to the American Equilibration Society (AES) Conference in Chicago, alongside the Midwinter event, this episode is your ‘access all areas’ to relive the highlights of our long-awaited expedition.

Previously focused solely on equilibration, AES now embraces a broader spectrum, encompassing occlusion, comprehensive dentistry and the TMJs. Join me and Dr Mahmoud Ibrahim as we unpack the highlights of this dynamic event.

https://youtu.be/3lQohxbKSig Watch this on YoutubeNeed to Read it? Check out the Full Episode Transcript below!

Highlights of this episode:

1:05 The Journey to AES

3:20 AES Opening Ceremony 2024

3:52 Global View of Diagnosis and Treatment Planning

5:29 Diagnostic Records in the Digital Practice

6:19 Dr. Chuck Fischer 

7:57 Dr. Glenn Kidder

12:41 TM Joint Imaging from an Orthopedic Perspective

14:15 Adopting a Top-Down Security and Privacy Strategy

14:45 Lip Esthetics and Maxillary-Mandibular Advancement Surgery

16:30 Indications of TMJ Replacement in Ortho-Surgical Case 

17:04 Face First Treatment of the TMJoint

18:11 AES Day 2

19:32 Occlusion – TMD from the Orthodontist’s Perspective

20:53 Occlusion – TMD from the Periodontist’s Perspective

21:39 Catch up with the Protruserati

31:02 Case Study: TMD Panel

32:41 Digital Occlusion: What Works and What Doesn’t Work

33:48 Occlusion – TMD from Prosthodontist’s Perspective

38:54 Insights and Reflections from Dental Giants: Kois, Spear, and More

40:38 ‘Composite Challenge’

42:44 Interview with Dr Alan Mead

45:28 Reflections and Takeaways from the Conference

53:11 Connecting with the Dental Community and Looking Ahead

If you loved this episode, be sure to check out BACD Experience With Pascal Magne

Discover more podcast episodes like this one and earn CPD or CE credits. Join our community to access exclusive content such as ‘Verti Preps for Plonkers’, Sectioning School tutorials, over 30 rubber dam demonstration videos, webinar replays, and clinical videos showcasing various dental procedures. Upgrade to our Ultimate Education Plan for comprehensive learning resources. 

Click below for full episode transcript: Jaz's Introduction: A, E, S. It's in the joint. Sorry, had to get that out of my chest, but we're back. We're back from AES TMJ conference in Chicago. I also went to Midwinter, and this episode will summarize mine and Mahmoud's trip to somewhere where we had longed to go for so long, the American Equilibration Society. Now, This society likes to be called AES because we've kind of moved away from the whole equilibration thing.

Jaz’s Introduction:

It’s way more than equilibration. It is occlusion. It is TMJ is the definitive conference sense that brings together all these occlusal camps. And I tell you guys, I was in heaven. I was in education heaven, and I was also in food coma heaven. So join me in Mahmoud on this, like on the field kind of different podcast, gain a sense of the magic of AES 2024 conference.

You’ll kind of feel like your presence was there. And of course I’ll share at least one key lesson per lecture. As well as some interviews from the amazing Protruserati and mentors that I met. Like, I shook hands with John Kois and Frank Spear within an hour, and I didn’t even wash my hands. So how did this trip begin?

Well, it began with what we call level one permission. Now I joke about this level one permission whenever we organize a trip like last year, a few years ago Porto, this year we’re going Sicily in June for Vertipreps and of course for Chicago, I needed level one permission. So people ask me on Facebook, what is level one permission?

Okay, level one permission is when you have to ask your spouse if you can go. I know that sounds really weak, but it’s a reality when you’re a father of two boys, young boys, I had to absolutely beg Sim to let me go to Chicago. I’m so thankful, me and Mahmoud were both thankful to our wives for letting us go.

So Mahmoud’s got three kids, I’ve got two kids, both young families. And we had to beg our families to let us go so that we can follow our passion and attend our first AES conference. I mean, the lineup was just amazing. Like John Kois, Frank Spear on the same day. Are you kidding me? It was absolutely insane to just be in their presence.

And obviously, the president this year was Dr. Jim McKee, who’s been a previous guest on the podcast. And I also got to see Bobby Supple. Now, if you remember from that episode with Bobby Supple, I kind of promised him that I would come to AES and I didn’t know when it would be, but I did promise him that I would come.

I’ve been wanting to come to AES every year and I’ve got a small child, but 2025 is a really cool date that I can earmark to my wife and really just build this, what’s 2021 now I’m going to keep whispering every few nights, every few weeks, okay, 2025 AES so there we are. It finally happened. And also it was really nice to to see an old friend and mentor, Dr. Michael Melkers.

That guy has taught me so much about occlusion and splints. So it was just great to catch up with Michael again. We’ll be hearing a little bit later how Michael made our trip very special when it comes to hot dogs and oysters. I actually had oysters for the first time and they weren’t just any oysters.

They were very fancy oysters. And so thanks so much, Dr. Michael Melkers for allowing me to have oysters for the first time ever and experience the traditional Chicago hot dog. So we arrived to Chicago from London Heathrow and we were just amazed at the architectural beauty of Chicago. It also seemed like a melting pot of different cultures.

So as a city, we loved it. I mean, it was mostly the conference that we attended and we didn’t get to explore as much as we’d like, but from what we saw of Chicago, it was a pretty awesome place. So the theme of the conference this year, AES 2024 was Clinical Excellence through Interdisciplinary Care.

And this was the 69th meeting that they had. So the way the AES actually started was A, with a prayer, which is pretty cool. And then secondly, there was some flag bearers and I got to bear the flag of Mexico, which is pretty cool. And as we’re bearing these flags to represent all of Mexico where all the delegates who’ve attended AES are from.

So loads of different countries attended. I’ve got Mexico flag. We’re walking in and we’ve got bagpipers. So these bagpipers are marching in and way behind with the flags, and everyone’s like standing and clapping as is happening. And this is very different. I’ve never seen a conference start like that. We then had the first lecture.

The first lecture was a global view of diagnosis and treatment planning. This is by Dr. J William Robbins and James F. Otten, this was a fantastic lecture. Now I’m not going to be here and say that every single lecture was fantastic. I’m not going to do that to you. I’ll give you the learning points. And I’ll be honest that some lectures as always in a conference out of the, I don’t know, 12 lectures or how many there were, were sensational and others were maybe not my cup of tea, right?

And that’s how conferences work, right? But this one was right up there. This system that these two lecturers have developed is actually well known. There’s actually a book. It’s called global diagnosis, a new vision of dental diagnosis and treatment plannings by J. William Robbins and Jeff Rouse. And if anyone wants a good resource for treatment planning and having like a global view, then I think this will really fit the bill.

I think the main. takeaway that I could share with you was the following. You know how when we plan a case, we like to start from the incisal edges, like the upper central incisors, where they sit in the face will really determine the rest of the upper aesthetics. And once you determine that you can determine the opposing.

But Dr. Robbins argued, actually, perhaps we give too much emphasis to the incisal edge and we need to give more emphasis to the upper incisor gingival margins. So the gingival margins of the upper incisors. Because this then gives you a periodontal diagnosis. So for example, gummy smile, vertical maxillary excess, or something called altered passive eruption, whereby the gums didn’t mature and they didn’t recede to the CEJ.

So that’s why another cause of a gummy smile. And they had a whole system that they shared about how to diagnose and what are the different options to treat. And I think it’s a really great one for anyone early in their career to really get a landscape of treatment planning and diagnosis. The second lecture was called diagnostic records in the digital practice. This was by Dr. Seth Atkins.

What a clever, clever man. Like at the moment I’m scanning, but that’s as far as digital as I’ve gone. I’d like to do more like, you know, printing and designing, but I haven’t quite gotten to that, but what Dr. Atkins was showing was absolutely brilliant.

At the. cutting edge of digital dentistry. My biggest thing that I enjoy the most from this lecture was just seeing the 3d printed mock up as an overlay that goes in the teeth and how they really can look fantastic and how far the printing has come to allow us to do that. So next time you have a situation where you want to do like a mock up, it can be 3d printed.

So speak to your lab and work alongside your lab to work on the digital design to be able to create some sort of a mock up that you can give your patient like this instant smile to assess. Like traditionally we’d use like LuxaTemp or ProTemp in a putty, but with digital dentistry and printing, there’s a neater and quicker way.

Then it was the break and every break I was able to catch up with colleagues who attended the conference and I went into like interview mode. I just wanted to ask questions and just be a sponge and gain from their wisdom and knowledge. And also hear about the experiences of attending AES all these years.

For example, Dr. Chuck Fisher has been attending AES for 40 years. Let’s hear it from him. Can these conferences perhaps be a bit different dogmatic? That’s what I asked him.

[Chuck] Chuck Fisher, I’m from outside of Denver, Colorado. I’ve been coming to AES for probably 40 plus years, and I find it one of the best meetings I can go to, not only the information that we get, but the experience with colleagues from all over the world. It’s just an amazing time. Thanks.

[Jaz] Why do you think there is perhaps this perception that inclusion conferences can be very dogmatic? What would you say to someone who perhaps has that view?

[Chuck] I’d say you have to come and watch the dialogues that occur with opposing views. And that’s the way we learn is we’re challenged by other people that think I see a different perspective and it makes us stronger on ours or we have to change-

[Jaz] What I’m looking forward to today is the debate that’s going to be happening later, which I think we need more. We need more debate and dialogue about different ways of managing a condition.

[Chuck] You bet. That’s we learn from each other and we have to have dialogue. We have to have confrontation.

[Jaz] It’s very much the case here, in a nice way, and it’s very collaborative, so I’m very stoked to be here, actually.

[Chuck] Me too. We’re on the same boat.

[Jaz] The next person I got to meet was an oral facial pain specialist, Dr. Glenn Kidder. Now, I actually have his photo in some of my slides, with a quote that he says. And I’ll explain what the quote is in a moment, but it was so nice to meet this genuine man. And what I liked the way our discussion went is, when you speak to oral facial pain specialists, they’ll argue that actually, the occlusion isn’t so important, you know?

In terms of pain and TMD, we know that the link between occlusion and TMD isn’t established. And I know that’s going to offend some people. Like one of my mentors, Robert Kirstein, he’s the other way and I respect him. Whereas others will be like, nope, there’s no evidence at all that occlusion and TMD are linked.

Now you’ll see from my discussion, very brief discussion with Dr. Glenn Kidder that he likes to see both sides of the coin. So let’s hear what he has to say.

I just want to say thank you so much for inspiring me. You don’t know this, but I do some talks on occlusion, and one of the slides I put up has your photo on it. And I put the following quote, okay? It’s the way teeth come together, occlusion is important. The way they function is more important. But the most important is for how long, how they function. And I love that quote. So just do you mind spending a minute just explaining just for the younger colleagues out there, just a little bit more about that.

And is that something that you picked up or is that something that you sort of sat down and philosophized over? Where’d that come from?

[Glenn] Oh, I don’t know. I have over 5, 000 hours of CE, so I’m not sure where that came from, but I have an occlusion background through Pankey and Dawson, but on the other hand, I’m a board certified in oral facial pain, so I respect the science and so most people in that field would say occlusion is not particularly important.

And I like to see both sides of that equation. So sometimes I think the side that doesn’t think occlusion is important, thinks more of exactly how the teeth fit. But you can have a perfect occlusion and still have a lot of symptoms if you’re clenching and grinding a lot. On the other hand, you can have a terrible occlusion if you don’t clench and grind a lot, it may not be an issue.

So every case is different. So we have to do individualized treatment plans and we need to come up with a diagnosis, but I think occlusion is important and I do respect that. I think you need to fit right, look right and fit right to work right. However, if you clench and grind, it’s a major factor.

[Jaz] Brilliant. And I saw you earlier with your grand grandchild.

[Glenn] That’s my grandson.

[Jaz] Adorable. And that was real. That was really nice to see that at a dental conference for you to have that. So do you bring family often to the conference?

[Glenn] No, my oldest son and her mother are both dentists. And Michelle Lee, they asked her to come to this meeting and they’ve been here a couple of times before. But, I’m happy that they’re here and they enjoying the course.

[Jaz] Great. I’d like to encourage the listeners and watchers to consider coming to AES one day. And I have been waiting for years for this moment. So to be here, I had to beg my wife to let me, we’ve got two young boys. I had to beg my wife to be here. So Sim, thanks so much.

[Glenn] I’ve been here about 40 times.

[Jaz] And this is the theme.

[Glenn] It’s a great meeting. And I always leave here with a little bit of a knot in my stomach feeling as there’s just so much more to learn. I got to keep learning. So it’s a great meeting to come to.

[Jaz] Just quickly then. Some young colleagues may be concerned, some colleagues may be concerned that perhaps occlusion conferences could be dogmatic. What would you have to say to them about the AES regards to that?

[Glenn] I think we keep a very open mind. I didn’t see any dogma here this morning. In fact, just the opposite. I think we keep very open minds. We look at the whole patient and we look from airway to aesthetics, the occlusion to so many factors that are involved. I think we do a pretty good job of looking at the whole patient.

[Jaz] And you get a great representation from all the big occlusion bodies, you got Kois, Dawson, Pankey, they’re all coming together to discuss such a topic that’s so close to our hearts. Final thing then, what’s your top advice for a new graduate, a young dentist in anything in dentistry? It could be patient relationship. It could be a clinical tip. Anything you think.

[Glenn] Just to keep learning, never feel like, you know it all, again, the more I learned, the more I realized I don’t know, personally, I have a little bias toward the Pankey Institute because I think they teach things in a cool way, a lot of hands on stuff.

[Jaz] The human stuff that you guys cover, which I’ll be just famous there-

[Glenn] To learn more about the technical end up learning more about how to be a better person.

[Jaz] About themselves as well.

[Glenn] And so that’s an important thing as you develop, you’re not just your practice, but your family and your community. So that’s the cool place.

[Jaz] My first exposure to occlusion through my old principal, Hap Gil, who’s a proud Pankey alumni, was a Pankey and some of the things that he passed on to me. So, shout out to the Pankey Institute there. Thanks so much, Dr. Kidder. It was honestly an absolute pleasure to meet you.

[Glenn] Enjoyed.

[Jaz] So after the break, there was a lecture on TM joint imaging from an orthopedic perspective. This was radiologist, Dr. Tom Predey and Dr. Jim McKee presenting together. The main takeaways here was they were going over the Piper classification system and actually had an episode with Dr. Jim McKee, all about the Piper classification. Funny story. I was standing next to Dr. Mark Piper, who had an epic mustache and it was just amazing to be in his presence. This is the magic of conferences just like this.

I was very excited to be standing next to one of the most Eminent TMJ surgeons in the world. Anyway, the main takeaway that I could pass on to you from this TMJ imaging lecture is twofold. One is that maybe centric relation isn’t a thing anymore. Maybe centric relation isn’t the preferred term that we are now preferring FSCP.

Can you think of what FSCP stands for? Okay, full marks if you said fully seated condyla position. Listen, I don’t make the rules, but I’m happy to play along. It makes sense. Let’s go with it. Okay. So FSCP is in, centric relation is out. And the other main overarching theme of this was that we need to be wary of the occlusion that develops because of a change at the joint level.

So as Dr. Jim McKee said in our episode, actually think not about how the occlusion influences the joints. Think how the joints influence the occlusion. So for example, the loss of the disc over the joint may mean that you develop an anterior open bite. So as the condyles potentially seat further and they go superior and posterior maybe, this would manifest as a change in the dental occlusion.

And so to keep in mind when you experience a change in the occlusion, that perhaps the joint imaging will help to validate your diagnosis. The lecture after that was adopting a top down security and privacy strategy. So basically this was by someone called Rex Lee. And the long and short of it is that we’re all royally screwed.

Whether you’re on iOS, Android, they’re all selling our data all the time. And we’re constantly at risk of being hacked. And if you have a smartphone, like we all do, then we’re in a pretty crap situation. And to be honest with you, I got a little bit depressed and I didn’t know what the conclusions were.

So, I think the guy was doing a great job in raising awareness, but it was very, very sad to know that we’re all screwed. So after a lunch break, we had a phenomenal lecture by Dr. Michael Gunson, who’s a California based oral surgeon. Now in the UK, we have a speciality called oral surgery. And we have a separate speciality called oral and maxillofacial surgery.

For the latter, you need to do dentistry and medicine. Now, I learned that in the States, they just have oral surgeon and oral surgeons, like they are like max, max, they’re all encompassing. And so this chap was a very charismatic oral surgeon. I loved his lecture. And basically the top takeaway here is the importance of a lip seal.

Now, firstly, he started his lecture by saying that it’s absolutely that occlusion is not linked to TMD. He strongly believes that there is a link. And then he went on to say about assessing the inter labial gap, i. e. the gap between your upper lip and lower lip, i. e. it just shouldn’t exist. When we close our mouth together, our lips should come together first and then our teeth should come together.

And he really emphasized that lips being apart is very pathological, and if we think about breathing, eating, and communicating, these are all vital for survival, and all need to achieve some sort of a lip seal at certain points. And what he said was that the brain will sacrifice all other things to achieve this.

So as long as the brain can continue to breathe, eat, and communicate, then everything else is relevant. So sometimes if you think about how much effort the patient who’s got incompetent lips is doing, how much extra work the facial musculature must be putting in to allow the lips to form a seal could be a significant player in temporomandibular disorder.

So that was a fantastic lecture about the lips, which are the way our smiles are framed. And it really gave me a heightened importance when I’m assessing smiles and taking that lip in repose photo to really make sure that this is not overlooked. Now, following Dr. Michael Gunson, oral surgeon, it was followed by two more oral surgeons.

So remember, the interdisciplinary element of the conference is now in full force. Now, we had Dr. Reza Movahed and also Dr. Brian Shah, also, very talented surgeons. Now, a lot of the stuff they were saying was surgery based, and it was like, wow, this is really fascinating, and you guys are amazing for the surgery that you do.

But it wasn’t applicable on Monday morning for me, but it was really, really interesting. It was interesting, especially some of the like general takeaways. Well, I look at this guy, Dr. Reza Movahed, and this guy is like a phenomenal artist. He’s a musician, he’s an oral surgeon. So really, if you want it all, you can have it all.

And then we had Dr. Brian Shah talk about all these algorithms of when to do a total joint replacement versus discectomy. But the most tangible thing I can pass on to you from these lectures is who is the most susceptible, which patient is most susceptible to perhaps needing surgery in the future? And it’s that patient with the small condyles.

It was a common theme amongst surgeons that if you’ve got small condyles, that automatically puts you at further risk of having a breakdown and potentially needing surgery in the future for a TMD issue. And they all had these scenarios they were describing the patient with a bag of nine different splints and eventually they come and see the surgeon and they need the total joint replacement.

But I know one thing that was perhaps missing was some key guidelines for us dentists, some key guidelines of at what point should we stop bothering with occlusal appliances and conservative care, and perhaps where early intervention, early surgery may have benefited the patient.

So I think that element maybe could have been discussed, but I was in awe of the amazing surgeries they were doing and what is possible out there. Always important to get exposure of this kind of stuff. So that marked the end of day one. And so day two, I interviewed Mahmoud in the morning. We were super, super excited. Today was a big day.

Mahmoud, it is the big day. John Kois, Frank Spear. What are you thinking, man?

[Mahmoud] So let me tell you a little story. When I was younger, Planet Hollywood opened in Dubai in the early 90s. Do you know, you’ve heard of Planet Hollywood, right? So it’s like a restaurant.

It’s sponsored by a lot of A list celebrities, usually, and they come to the opening. We were standing there outside and one of my friends managed to grab and hug Sylvester Stallone. Like he was giggling like a little girl when that happened. And I just looked at him. I was like, calm down, dude.

You’re going to have to control me today and stop me doing that. When I see one of those two, I’m going to fanboy so hard. I’m really, really, really excited.

[Jaz] Tough question. Team Spear or Team Kois?

[Mahmoud] I think I’ve probably had a lot more influence on me by Spear’s teachings? So I’ll have to go team Spear.

[Jaz] Shame on you.

[Mahmoud] I know, I know. Well, you weren’t going to let me get away with that giving you an answer, were you?

[Jaz] So day two of AES. Absolute superstars today, John Kois, Frank Spear to name a few. But one thing I’m actually really excited for today is the panel discussion. The theme is like, how would you treat this on Monday morning?

And they’re talking about disc displacement. It’s something we see all the time. We can all diagnose it in a way, but actually the management of it, TMD is like the Wild West, right? And So yesterday we saw some surgery and stuff, but today is real applicable stuff. Let’s go check some people out.

So the 8. 15am lecture was by Dr. Domingo Martin. I think he’s part of the face group, this is from memory, which is like this group of orthodontists who are very knowledgeable on occlusion. I know what you’re thinking, what, orthodontists? Occlusion? It can’t be, it can’t be true. Well, these guys are actually working in the fully seated condylar position, which is a great point.

Right? Like if you’re doing a full mouth rehab in enamel, which is essentially what orthodontics is, perhaps we should be choosing to work to a fully seated condylar position. And this was exactly what this lecture was about. And he showed some cases and in a high percentage of cases, Dr. Martin would actually give these patients a splint, an orthotic to wear 24/7 for some time to completely deprogram them and find their first point of contact in the fully seated condylar position.

And they can repeatedly bite that and then do the orthodontics in that position. So really now what you’ve done is you’ve built the teeth around where the joints are the most stable. So that was really cool to see. I’d heard a lot about Domingo Martin, but it’s first time to see his lecture and he was hilarious.

There’s one thing he said, right? He was talking about relapse and he was saying about the importance of the interincisal angle and actually getting the joints in the right place, getting the teeth in the right place that relapse may be mitigated. And what he says to his patient is, look, relapse will happen.

Now, one to two millimeters, just be grateful that you’re still alive. And honestly, that got the biggest laugh for the conference and it just really put everything into perspective, I guess. We then had a periodontist lecturing. So the occlusion was a occlusion TMD from the periodontist perspective.

This was Dr. George Mandelaris. And the key takeaway, the key notes I have from his lecture is a takeaway, no recession, no problem. This theory needs to change, right? So just because you don’t have recession doesn’t mean there isn’t a problem. If you’ve got a thin biotype and thin bone and the teeth are being pushed orthodontically out of the bony envelope, just because you don’t see recession doesn’t mean there’s a big problem.

The teeth are essentially walking off a cliff and so in the susceptible individual before orthodontics, it’s important to liaise with your periodontist. And he was showing some really advanced perio things, which I am not familiar with, but he seemed very intelligent and it was really cool surgery, what he was doing. So more power to you.

God bless you, sir. And he also echoed a saying, he said, small condyles, big problems. Then at the break, I was able to catch up with some more Protruserati. I was able to catch up with committee member, Dr. Matt Standridge, and I presented a hoodie to Dr. Colleen Scheive. Now she’s on the Protrusive Guidance app.

It’s great to have her there. And funny story about Colleen, right? She found me because she basically went on YouTube and she typed in occlusion and she found me, right? And then she found the episode I did with Dr. Koray Feran on equilibration. And then she came to London to do Koray’s course.

Obviously it was brilliant. And so she went back and I saw a message saying, Hey, Colleen, you live in Chicago. Are you coming to the AES? And bless her. She was so honest with me. She said, she was like, I had to go away and Google what AES was. And it was great that actually that led to her coming to AES.

And it was great to meet Colleen there. I wanted to give her a hoodie. And also, she was just a lovely, lovely person. She really embodies everything, Protrusive is about. She’s nice and geeky. And actually she gave me some great parenting tips. And so you’ll hear how I give her a hoodie to celebrate her.

So Matt, we just met. It’s great to meet you. Do you come every year to your committee? Okay, your committee. Okay, amazing. Okay. So how long have you been involved with AES for?

[Matt] For AES, my first meeting was about eight years ago. And I’ve made most of them since. It’s been a great organization to get involved with. And then just this year they asked me to get involved as industry relations chair. And so this is my first year doing that.

[Jaz] And so you’re responsible for all this?

[Matt] Well, I will be next year.

[Jaz] Okay. Okay. Yeah. Okay. Yeah. The vibe is brilliant. I’m absolutely loving it so far.

[Matt] Thank you.

[Jaz] What message could you give to Protruserati and then those who are always maybe considering it but haven’t never made the plunge?

[Matt] If I had to give an elevator pitch, I would say it’s the best two day clinical comprehensive meeting in the world. I mean, you have all of these thought leaders from all of the great occlusion camps and world leader worldwide, and they bring them together and they may have some disagreements, but we have a central philosophy around function and stability. And I think that’s just something that’s not talked about enough. So you won’t find another two day meeting like this.

[Jaz] Do you think there’s an element of dogma involved?

[Matt] I would say a lot less than probably it used to be now. I’m fairly a young blood with this so I’m sure it was a lot more dogmatic before but I would say things have been opened up a lot more within the last 10 years, I would say and incorporating multiple different thought processes and from different camps and stuff and it’s amalgamated a lot more than probably what it used to be.

[Jaz] Amazing. Well, thanks for for being part of this. I look forward to seeing you next year. Hopefully. Last question and this may not make the podcast because I’m debating whether this is kosher or not. Team Spear or team Kois?

[Matt] What’s that?

[Jaz] Team Spear or team Kois?

[Matt] Oh, I love both. I’ve been through a lot of Spear and I’m currently going through Kois.

[Jaz] Okay, I love that. I love that answer.

[Matt] So yeah, yeah, I love both, but yeah.

[Jaz] If you had to pick one.

[Matt] So right now, what I will say this, I will say Kois’ treatment planning way of doing things and how structured it is, and almost like systematic how it is, I would say that really put some light bulbs off in my head. Like it really connected some things.

[Jaz] I love it. I feel, I agree. His stuff is amazing. so much. I’m going to hand the mic over to Colleen now. Okay, Colleen.

[Colleen] Yeah, it’s been so make me look more professional. If you’re sitting next to me, it’s been so nice.

[Jaz] As a Protruserati, it was great to have you here, right? And so I wanted to just give you this hoodie. I wanted to make sure you have a protrusive hoodie basically. So while you open the hoodie, I’m going to tell the Protruserati a little bit about you. Colleen, just having met you and stuff and on the podcast. And I asked you on the old app on the forum, are you coming? And you had to look into it. It’s actually, it was just down the road from me.

[Colleen] So I’m going to come really easy.

[Jaz] I love how you’re getting stuck in. I love you getting stuck in. Amazing. Okay, good. It’s been so nice to meet you here. And I had a really nice conversation yesterday. And I’m just inspired by you as a learner. But also, you got three kids, three kids. And then we discussed about how there’s a season of learning and season of life.

And sometimes there are other priorities and learning is not number one priority. And then now your kids are ageable, perhaps, but you can go back into it and stuff. You look great. So amazing. So good. Okay. I love my discuss. Okay. You do us at 12. Do us 12 now. Okay. But, it was just great to learn about you as a business owner, a practice owner, dentist, a parent. What advice would you give to women in dentistry who are mums who are aspiring practice owners. How, and those who aspire to go to CE classes and stuff, what advice would you give to them?

[Colleen] I think, what I am learning and coming to grips with is that there is no balance. So stop searching for it, right? Their life is always a lot. And so, you try to find the good parts in each part that you are. And what I am coming back to is finding Colleen. I had lost Colleen for a while, right? So, your doctor, and your boss, and your wife, and your mom, and your daughter, and I had lost a sense of self.

So, it was a very purposeful kind of chat in your own head of like, who you are, and what things make you happy, and then you bring that part of you into all of those other relationships, and I don’t, I mean, I feel better all the time, so I’m going to call that successful, right?

And so I think we all have a different sense of what success is, certainly in the U. S., right? Monetary is usually at the top of that list, but that’s not necessarily true, right? I have a lot of friends who are incredibly successful. financially successful. But then they’ll talk about these simple things like, oh, I played catch with my kids and this is the beauty of life.

And I’m thinking, oh, okay. Well, I like my kids and they don’t drive me insane. And I like my patients and I like my team. So to that, so that’s successful for me.

[Jaz] Amazing. I was really nice to get some parenting tips from you last night. Well, the story you told me last night, I will never forget that. So I thank you for making me a better parent after the essay.

[Colleen] So it’s by far my favorite job. It is. I mean, just, yeah, raising tiny people is amazing. They teach me as well.

[Jaz] So anything you want to say while you’re on the podcast to the Protruserati?

[Colleen] Oh my gosh, keep watching, learn about the joint and how to create everything into that proper function. But yeah, I mean, I will definitely keep watching.

[Jaz] Where has your occlusion journey taken you? Cause you’ve done a bit training with Lukas Lassman, you’ve done Pankey. You’re here now. Do you ever feel, because you’ve been exposed to a few different teachings, that perhaps it’s got confusing for you, and it says you made the topic less tangible?

Unknown Speaker: Occlusion’s kind of a mystique of its own, isn’t it? And it’s like it’s perceived to be a dark art. Particularly, I think, the main reason because it gets confused in dental schools between departments. And we always think in a very departmentalized way, don’t we? So you have surgeons who are talking about anatomy and they typically within their department will tell you about the physiology of how the joint works and all the rest of it.

But truthfully, do they know how the dysfunction of the joint works when it relates to the occlusion and the teeth when they meet in the middle? Well, usually because of their training, less than you might imagine. And you remember back in university as an undergrad in Sheffield, we have the restorative tutors teaching us about occlusion. Did they know anything about joints? Probably not realistically.

[Jaz] I mean, yesterday was a testament to that. We had a whole lecture about joint based occlusion. So the occlusion as a consequence of the joint. So the disc lip and then that changes the occlusion.

Unknown Speaker: Yeah.

[Jaz] And actually what we see is a class two, but actually they were a class one. 12-year-old. But it’s because of the disc injury.

Unknown Speaker: And as a result of that journey of just discovery of all of these pieces of the puzzle fitting together. I don’t think you can ever know enough. And so my journey of why I bolted on the things that I did at the time was almost by accident.

Pankey became a kind of an extension of the work that I did when I lived out in Australia and worked out there for a couple of years and the dentists out there were comprehensively minded dentists and that was the work they were doing and they went well you can’t go anywhere without having the bedrock of occlusion underneath you. So go to Pankey or go to Spear or go to Dawson or something and to be honest with you a lot of it was to do with I was just exploring and following the world and following my nose and seeing where life took me and then it can get confusing when you then bolt other things onto it but when you really like people like Lukas Lassman for example.

You listen to his stuff and he’s brilliant at formulating his patchwork quote and explaining why he ascribes is quite a strong word, but kind of like why he’s taught, he’s tied these aspects of Dawson ology into it. And why he uses up a Kois deprogrammer, as opposed to a Pankey deprogrammer and things like that.

When you go, okay, fair play. I kind of get where he’s coming from.

[Jaz] Just a quick one, Team Spear or Team Kois?

Unknown Speaker: Should we make this like a big old, I think on one side of the audience there’s going to be half and then on the other side of it’s still be half. And then I think they’ll split down the middle and they’ll me, I’m hoping there’s going to be a fight at some point today, so I’ll probably sit right on the fences.

Coward. Make coward. Do I have to wear any of their like devices? Is that what we have to do today? I have to wear a Kois programmer all day.

[Jaz] You can arrange that.

Unknown Speaker: To be fair. I do have a little take Kois.

[Jaz] Okay, there we go. So after the break, having spoken to Matt and given the hoodie to Colleen, there’s really cool panel, like it was a case study, three perspectives on a patient who had basically a disc displacement. It was Dr. Lynn Lipskis, Dr. Lee Ann Brady, who I adore. Absolutely adore. What a wonderful woman, I’ve been following her blog for years, fantastic educator.

And Dr. Peter Lemieux. I probably said that really wrong, I’m so sorry Dr. Peter Lemieux. [trying to pronounce ‘Lemieux’ correctly]. God damn, I wish I was listening to when they pronounce his surname. Anyway, really cool guy. Very cool headed. Anyway, fantastic panel discussion. I wish we went more into treatment. I wish, I mean, that thing could have been a whole, that panel discussion could have been a whole day.

I would have loved to delve deeper into treatment strategies, but it was basically about how they assess and diagnose such a patient. My biggest takeaway I want to give you from that lecture is of course, DrLee Ann Brady, right? Her saying is, Talk your think. Just a wonderful thing. I’m a big fan of showing your working out.

Like when I’ve got a tough case, I’m very happy to show my working out and my patient. I’m saying, hmm, you know what? So here’s where it could be because X, Y, and Z, but also we must also consider A, B, and C. And obviously stay away from jargon. I make it in patient friendly terms, but just talking your think and, saying what you see and just having that open and honest relationship with your patient is fantastic.

And so that was a real communication gem to highlight. So after this lecture, Dr. Michael Melkers surprised us with the Chicago style hot dogs, which are amazing. I almost said donuts there, Chicago style hot dogs, which are absolutely fantastic, better than five guys. And I just want to say, thank you again, Michael, for being here.

Oysters, the hot dogs, everything. It was a real culinary experience. So now, what you’ve been waiting for, right? So it was next up was John Kois and Frank Spear. Not together, separately, okay? So first was Dr. John Kois with his colleague, Dr. Marta Revilla-Leon. Now, this lady. Gosh, she’s so clever. So she is like the authority on like face scanning and digital dentistry and how precise these digital articulator systems and motion trackers are basically.

And so she’s the authority on that. So basically what they were talking about is the old facebow, traditional facebow and articulator and how in John Coyce’s own words, the days of the articulator are numbered. Why? Because now with the advent of face scanning and digital articulators and different ways to transfer that information digitally now is so good.

And the way it’s heading is that articulators are going to be dead. Right. I mean, of course there’ll always be niche uses of them, but a bit like the digital scanners that we have today, your TRIOS, your iteros, et cetera, your medits, year by year, the number of impressions being taken are less and less.

And it’s going to be the same with articulators and facebows. And so that was the main taker of that. Their articulators are going to get phased down. He didn’t say exactly when, but me and Mahmoud are having a chat and he had some cool things to say. In fact, let’s listen to what Mahmoud had to say about that lecture.

So before I share Mahmoud’s reflections on this, I’m going to just tell you about Frank Spears lecture. Again, if It was so great to see these two giants one after the other, and I was just starstruck. I was in awe. These guys have taught me so much. And so just like from John’s lecture about articulators being phased out, the takeaway from Frank Spear’s lecture, which was basically about TMD and the prosthodontist perspective.

A good reflection to share from Frank Spear’s lecture is that most patients are not in centric relation. We know this already. Most patients have some degree of slide. And so maybe it’s not the presence of the slide. That’s an issue. It’s perhaps the degree of the slide. So if someone’s got a severe slide, we know in the literature that that is correlated with TMD and facial pain.

Now we don’t know whether that’s because perhaps the joints change and that’s what caused a slide, and that could be like a confining factor here, but essentially I like his common sense approach and the quote he said was having a patient know where to close is more important than the pin point CR position.

Let me say that again. Having a patient know where to close is more important than a pinpoint centric relation position. So I like the fact that Frank Spear is not so bogged down like some clinicians are, but it has to be fully seated condylar position. And we had some of that at the conference and that there’s a degree of a biological variability or a bit of fudge in the system.

Okay, we are in Chicago. Midwinter, waiting for the midwinter shuttle. How awesome was yesterday?

[Mahmoud] Absolutely incredible.

[Jaz] John Kois, Frank Spear, at the same place.

[Mahmoud] Yeah, it was so eye opening. I also loved the contrast between the two.

[Jaz] Go on, tell us more. Firstly, we totally fangirled them both. Haven’t washed my hands since.

[Mahmoud] Yeah.

[Jaz] We got to take both our hands, which is pretty special.

[Mahmoud] Yeah, selfies.

[Jaz] And we got the selfies. And we squirted chilli in, you squirted chilli in Mike’s face.

[Mahmoud] Mike’s face.

[Jaz] Yeah. Michael Melkers massive shout out to him. He’s looked after us so well. He helped us through and through. So it’s all these superstars that we’re just, so a huge shout out to someone who’s taught us so much and inspired us, actually.

[Mahmoud] Yeah, you made this really, really unforgettable. So thanks so much.

[Jaz] Entire committee, actually, we were in this meeting room with all the AES members and the amount of hard work that goes into it was super obvious. So for next year, guys, AES 2025, please do show your support to help a society like this that really, it’s like the main one for comprehensive care.

[Mahmoud] Yeah. I mean, it’s doing all the right things. Isn’t it? It puts you in an environment where you can really meet people from all sorts. They’re all interested in the same thing of doing like absolutely amazing high quality dentistry. And I mean, the quality of the content was mind blowing.

[Jaz] So tell us about some of the younger colleagues, this thing, sometimes I get this question, like Jaz. What do you mean? What is comprehensive care? What does that mean? What does that mean to you?

[Mahmoud] Comprehensive care really, kind of means you’ve got to look at the patient as a whole. So, a patient might present to you complaining that they’ve got a broken tooth or some pain, but you’ve got to step back and to take a look at the bigger picture because things aren’t always obvious. And the best way to serve that patient isn’t always necessarily just fix that one tooth and off they go.

Step back, have a look at, they’re always talking about, I mean, the heavy focus was on. So looking at the joints because there might be a bit of a I don’t want to say paradigm shift, but we are starting to learn and really appreciate the effect the joint has on the rest of the occlusion, how things come together.

[Jaz] As Jim McKee said on the podcast, when he came on my podcast, it was just great to see him. He hosted so well. He said that we used to think how the occlusion affects a TMJ. But really what we should be thinking is how is a TMJ and the mal health of it, the maladaptation of it affect the occlusion, which is really my eye opening once you think of it that way.

Now, back to the thing about comprehensive care, I just want to say, the way I see comprehensive care very simply is there used to be a time where dentists would just treat caries only, right? Hundreds of years ago, caries, take teeth out. That was it. Then it was like, okay, we need to now look at caries and perio.

Then I was like, okay, caries, perio, mouth cancer. And now really the next level is okay. Look at their diet, look at their joint health, look at their masticatory system, their breathing. That is a comprehensive dentist and that doesn’t happen like a shortcut overnight because dental school doesn’t prepare us for that. So this is where societies like the AES really come into play.

[Mahmoud] They open your eyes and then they help you, guide you through the process of acquiring the knowledge you need to be able to implement it and honestly implement it. I mean, they’re always there to help you figure out a way to put it into your own working environment, we know that everybody can dedicate 90 minutes to their first patient exam or whatever it is.

[Jaz] Especially when you’re younger, maybe don’t own your own clinic, but if you just tweak one thing at a time, like, for example, like if you’re at the moment, if you don’t palpate the masseters, but I know we bang on about this, right?

Yeah, just one thing that you do, for example, at the moment, if you don’t make a diagnosis list. A simple thing, like how many dentists you know who just don’t make a list of diagnoses? Right? Just make a diagnosis list and go for it and keep adding to your sort of comprehensive exam. Eventually you get comfortable in your shoes to be able to make better diagnoses, better diagnoses and better care.

[Mahmoud] And every time you add something, you get good at it. It frees up a little bit more of your mind to add the next thing. And then it all becomes routine.

[Jaz] It can’t just be done in one day. So, it’s a beautiful thing. Now, just before the shuttle comes, what was your top takeaway from John Kois? I can’t pronounce that lady’s name. She was brilliant, Spanish lady. John Kois’.

[Mahmoud] Marta?

[Jaz] Marta. Well, her surname, I forgot, but yeah, Marta, she was brilliant. John Kois, the way you introduced her, she’s a force of nature, I think that’s what she said. How much she’s done in this field of digital dentistry already is fantastic. What was your main, just describe to those who weren’t there, what it was about and what your main takeaway was.

[Mahmoud] So it was about where digital was going, or where it is, really, and-

[Jaz] articulators are dead. Of course, make that clear.

[Mahmoud] Anyone who’s heard me speak knows how much I love the traditional articulators, face bows, etc. And the reason I love them is because they were there to do a job, right? They were making our work more predictable. I think they’ll still have a place in certain areas, but the way to get more accurate records and do this in a more predictable way is certainly digital. And that’s here. And she’s doing all the hard work behind the scenes of testing.

[Jaz] Okay. So the rest of this show today is basically me and Mahmoud at the Chicago midwinter conference, which was cool. Like it was a downer compared to the magic of the AES. Like how could something compete with what we just seen. Yeah. But it was nice. It was nice to be in Chicago and good vibes and good food.

And some of the cool things I’m going to highlight you in this podcast is the coolest thing that I saw at midwinter, which is called a halo. This is a mirror that I think is releasing next month. No financial interest here, but apparently it’s like a mirror, a mouth mirror and an intraoral camera at the same time.

I mean, this is genius and apparently it heats up so it doesn’t steam up. So take my money kind of thing, right? It sounds amazing. So I kind of interviewed those guys as the most innovative thing I saw at the conference. We also caught up with Dr. Alan Mead. And finally, Mahmoud set me a challenge. He set me a challenge, say composite as the Americans do.

He sent me a chance to say composite at 10 times. So let’s count if I was able to achieve this challenge. Thanks to our good friends at Cosmodent.

[Mahmoud] Okay. So, we’re setting a challenge for Jaz. He has to interview the guys at Cosmodent. And he has to say the word composite at least five times. You ready?

[Jaz] All right. Wish me luck. Okay. So, we’re talking about your composite range. What makes your composite really exceptional compared to the other composite brands out there?

[Cosmodent] First of all, we’re the only company that makes a microfilm. Better polishability. Better. There’s one company where there’s one other company that makes a microfilm. They don’t sell a lot of it, but we’re basically, we’re the only company Fizzly has it and shows renamable microfilter. Best polishability-

[Jaz] This composite, I’ve used it before. Really fantastic shine. I mean, I go on a Dipesh Parmar course in the UK, but their payment, they distribute it to good friends of payment. So I’ve tried this composite firsthand, really lovely sheen and shine.

[Cosmodent] Gives you better, possibly better trans, better reflexibility for class fives. Give you better wearability, Give you better depth of color. It matches the Vita Shade Guide exactly on the button once it’s cured. So it doesn’t go darker or lighter.

Our hybrids are stronger than anything else on the market. A little bit more opacious. So they block out underlying color better. They also match-

[Jaz] Do you guys make pink opaque composite as well?

[Cosmodent] Pink opaque is designed, it’s a microfill based composite. It’s designed to block out dark grey, dark brown metal. And it brings the value up on, like, white, which brings the value up. It brings the, it makes things brighter, but brings the value down. The pink keeps the value up. So when you put your composite over the top, it gives you the-

[Jaz] Keeps the chroma gives some warmth as well.

[Cosmodent] Gives it warmth. We also have our pink composite called Gingafill, which is three different colors, light, medium, and dark. It’s the only microfilm based composite there is, so it has better flex again, so you don’t lose it when you’re putting it in margins. It holds its polish so it looks wet, like gingival tissue, unlike the other ones that actually lose their polish and become opaque. Same thing with our microfilter, we’re talking about re enamel microfilter, better flex so you don’t lose your margins. It doesn’t lose its polish like a hybrid or nanofilter, so it doesn’t become opaque, that’s why you can’t see where the composite stops and the dew starts.

[Jaz] I’m a fan of this composite, so if you haven’t used a re enamel composite before, please do give it a go. Nice to meet you.

[Cosmodent] Nice to meet you as well.

[Jaz] I’ve been on podcasting, okay, Alan Mead, how was your day?

[Alan] It was good, it was long. Exhausting because we were doing it in here.

[Jaz] How many guests did you end up speaking to today?

[Alan] Seven or eight. And that’s a lot considering I didn’t really have any, I only had two of them scheduled when I got here and I had to turn some away. I feel bad about it. So that’s great. It was good.

[Jaz] Two months worth of content right there.

[Alan] It kind of is. Yeah. Like it’s every podcaster that does this goes, Ooh, this is good. I gotta, I can put my feet up in a little while, but not that that ever really happens. But yeah. So that was good.

[Jaz] Highlight of the day, what was one thing that you learned today from speaking to a guest that you want to pass on to the people of Protrusive, who I’m hoping will also tune in to a Very Dental Podcast as well?

[Alan] It’s a good question.

[Jaz] What was my resounding thing?

[Alan] Well, I talked with a hygienist about prevention and how I think some dentists, a lot of dentists have kind of given up on prevention. And by saying that going, I think we’ve given up on a lot of people, maybe dentists care more than people do. Hygienists are more into prevention than dentists. It was an interesting conversation. I think. Maybe dentists put prevention off to the hygienist so we can do it. And when in reality it needs to be the whole team, it really does.

And that was a real, I talked to a couple of people about that. Honestly, that was one good thing. Also, I got to sit down with David Hornbrook, which I mean, I’ve podcasted with him before, but it’s so in person, he’s just the best. I could talk to him for hours. So yeah, it was very good.

[Jaz] Well, we look forward to checking that one out. It’s just great to see you in the person. Really good to see you, it was really cool. But hopefully not the last time.

[Alan] How have you liked this meeting? Is this your first midwinter?

[Jaz] Yeah. The first midwinter. I mean, the main reason I came was for AES. Frank Spear, John Kois, Gunson.

[Alan] So they didn’t speak together. They spoke at the same meeting. How about that?

[Jaz] I know. I know. We never thought it would happen. But me and Mahmoud thought if we don’t come this year. With that lineup. So hoping to encourage lots of younger blood all around the world. To consider coming to meetings like that basically, is AES one that you ever been to?

[Alan] Man, I’ve been AES adjacent for a long time. I should probably go. Cause I know, I mean, I know a lot of the Spear guys that go there and I mean, Jason, the new president is, I’ve been friends with him since dental for 20 years.

[Jaz] He seems like a really cool guy, and so we’re excited he’s the new president.

[Alan] He’s a good leader. He’ll be great.

[Jaz] Do you know what he did for his acceptance speech?

[Alan] I don’t. I don’t. What is it?

[Jaz] It was a rap. It was a rap. He basically rapped for five minutes.

[Alan] Of course, of course he did. I’m not surprised by that at all.

[Jaz] So hopefully, again, I’ll come again next year for AES, but it was nice to experience Midwinter. It’s much, just like everything in America, it’s much bigger than everything we have in the UK. Yeah.

[Alan] Well, and the weather has been pretty mild considering. Midwinter is one of those things where it could be 70 and sunny or 20 below. So you hit a pretty good time, I think.

[Jaz] Yeah. Very lucky. John Kois, Frank Spear, the weather. And then now we got to meet you as well.

[Alan] Nice to meet you.

[Jaz] Thank you so much. Thank you. Okay, guys, we’ve just arrived at Heathrow from a fantastic trip. I’ve lost my voice still, major jet lag once again. But just want to sign off with a couple of things. Firstly about John Kois’s lecture. We didn’t get to reflect on that because I posted on Instagram about the death of articulators.

I was at the WIPMIC stand at the Chicago Midwinter. I posted a story and you guys were like, whoa, what the hell? Like, what’s going on? Our articulator is really dead. And I don’t care the fact that I’m in a tunnel and you can’t see me. You guys can hear me, right? So that’s the most important thing.

Our articulator is dead. Then I also want to just sign off by just the experience that we’ve had in Chicago. So firstly, Mahmoud, you were paying more attention in that lecture than I was. This is your bag, right? Like I was mesmerized by John Kois. But as soon as they were talking about all the mud jaw and the face scanning, I’ll apply this Monday morning because you love your articulator.

You stroke your articulator to bed. So for you, this was like a big deal. So, what were the main summaries or takeaways from that lesson that led me to say on Instagram? This could be, I mean, as John Kois says, the days of the articulator are numbered.

[Mahmoud] So, I mean, hi everybody, so we’ve just got off of like an hour of flight, so excuse me if I’m a little bit incoherent, but I would like to, first of all, say that I slightly disagree with John Kois, which is a big statement for me, because I still think analogue will always, at least for me, have a slight advantage, and that is the feel. Now, once, some of you may have heard me.

[Jaz] I told you guys he strokes his articulator.

[Mahmoud] I do. So, we can talk about that another time. However, what they were talking about essentially with digital, right? We can all scan arches, right? You can get the arches scanned and digitized and then you can put them into a digital articulator on whatever software you want.

The problem’s always been how do you orient or orientate the arches on the articulator so they best represent how they are in the patient.

[Jaz] Essentially the problem just for the younger colleagues is how can we replicate the patient and their movements, whichever way we do it, whether it’s traditional or digital, how can we make the patient’s head on a plate?

[Mahmoud] When you do an analog, a facebow is a good way to do it, right? It relates to the upper arch to the condyles. But the problem is there was no digital facebow. Getting the digital scans onto the digital articulator usually is just random, but then some people started using photographs, right? You take a digital photograph, make sure you can see the entire so approach where they’re, you know, use retractors or not.

And then you rely on the technician’s ability to orientate a 3d digital scan using a 2d photo and trying to get AP position, the anterior position, anterior posterior position, the lateral, line everything up. So the beautiful, the beautiful thing was that the Kois group, they did a lot of research and they compared using a photo versus using a 3D face scan.

And what they found was overall using the face scan was more accurate, although it depended a lot on the quality of your scan. So if you had a crappy face scanner, you’re going to get crappy results at a good face scanner. You’ll get better results than using just a photo and the results could vary in terms of error between like half a millimeter to up to six millimeters, which is insane. But obviously what she kept on sort of getting back to is the gold standard seems to be the the jaw trackers. The jaw trackers are going to be the gold standard like the MODJAW and there’s a few other ones out there and competition will always breed better results and bring the hopefully the prices down eventually for people like us to be able to use them.

However,