Episodes

  • Rotary vs Reciprocating Files – The Endo Showdown with Samuel Johnson Part 1 – PDP270

    Rotary vs Reciprocating Files – The Endo Showdown with Samuel Johnson Part 1 – PDP270
    Jun 3 2026
    Rotary or reciprocating files — which should you actually be using? Is one safer than the other? Does reciprocation really reduce file separation? Are you choosing your system because it suits the canal anatomy, or because it is simply the one you were taught? Endodontic file systems can feel like a maze of brands, tapers, alloys, motions and marketing claims. But beneath all that noise, the real question is much more practical: what is your file doing inside the canal, and what compromise are you accepting? In this episode, Dr Samuel Johnson returns to unpack the Endo Showdown: rotary versus reciprocating files. We cover file motion, glide paths, shaping philosophy, NiTi metallurgy, cyclic fatigue, torsional fatigue, and why no system is perfect. https://youtu.be/HfWDBbNgjsA Watch PDP270 on YouTube Protrusive Dental Pearl A palliative root canal can be useful for an unrestorable tooth if disinfecting the canal allows infection to heal and natural bone to recover before extraction and future implant planning. ⚠️ Do not dismiss root canal treatment purely because the tooth is not a long-term functional restoration. ✅ Where appropriate, consider whether endodontic disinfection could improve the future implant site by allowing natural bone healing. Key Takeaways The purpose of shaping is not simply to scrape canal walls; it is to create space for irrigant flow.Irrigation is the most important part of root canal disinfection.Rotary files move in a continuous 360-degree rotation.Reciprocating files cut in one direction and reverse before excessive stress builds up.Modern reciprocation is designed to cut, release and gradually progress apically.File choice is not just about motion; metallurgy, taper, design and operator experience all matter.NiTi hand files with strong shape memory may be problematic in curved canals because they want to straighten.Martensitic heat-treated files are more flexible and can better follow canal curvature.Unwinding flutes are a warning sign that a file may be close to separation.Inspect files regularly during treatment, especially in curved, calcified or difficult canals.A glide path is essential before introducing larger rotary or reciprocating files.Without a glide path, a shaping file may create its own path, risking ledging, transportation or perforation.“Grabby” files pull themselves into the canal; this can be useful in experienced hands but risky if forced.Reciprocating systems can feel simpler and safer, but they are not foolproof.Cyclic fatigue happens when a file repeatedly bends around a curve until microcracks form.Torsional fatigue happens when part of the file binds while the motor continues to turn. Highlights of the episode: 00:00 Teaser00:47 Introduction02:13 Protrusive Dental Pearl: Palliative Root Canal Treatment05:30 Main Question: Rotary vs Reciprocating Files06:31 Hybrid File Motions08:19 File Choice Is More Than Motion10:26 Purpose of Shaping in Endodontics11:10 Chemo-Mechanical Preparation11:34 Rotary Motion in Root Canal Treatment11:45 Origins of Reciprocation12:21 Balanced Force Technique18:00 NiTi K-Files vs Stainless Steel K-Files22:37 Practical Advice: Inspect the File23:40 Rotary Can Also Be a One File System24:24 Reciprocation and Sense of Safety24:47 “Grabby” Files24:53 Midroll33:54 Choosing Between Rotary and Reciprocating35:20 Cyclic Fatigue37:41 Endo Radar Pro Ads40:20 Torque and RPM in Endodontics41:41 Why Reciprocation Advances42:56 Debris Extrusion in RCT43:34 Benefits of Rotary Systems44:13 Tactile Feedback in Root Canal Treatment45:21 Outro Want more? Check out previous episode with Dr. Samuel Johnson: Working Lengths and Troubleshooting Apex Locators – PDP216 🦷 Looking for an endomotor? Upgrade your endodontic workflow with the Woodpecker Endo Radar Pro. Head to protrusive.co.uk/endomotor and use coupon code PROTRUSIVE at checkout to claim an exclusive discount and your choice of complimentary file system. #PDPMainEpisodes #EndoRestorative This episode is eligible for 0.5 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes CAGD Subject Code: 070 Endodontics Aim: To improve dentists’ understanding of rotary and reciprocating endodontic file systems, including file motion, glide path creation, file metallurgy, fatigue mechanisms, irrigation principles, and practical steps to reduce procedural risks. Dentists will be able to – Understand the clinical differences between rotary and reciprocating file motions and how these may influence endodontic workflowRecognise key risk factors for file separation, including cyclic fatigue, torsional fatigue, file distortion and inappropriate file useApply practical principles around glide path creation, irrigation, file inspection and system selection in endodontic treatment
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    45 mins
  • A Practical Guide to Modern Caries Management Part 2 – Peptides, SDF, Hydroxyapatite and Xeristomia! – PDP269

    A Practical Guide to Modern Caries Management Part 2 – Peptides, SDF, Hydroxyapatite and Xeristomia! – PDP269
    May 27 2026
    Should we still be drilling early caries lesions? Where do peptides, resin infiltration, fluoride varnish and SDF actually fit in modern practice? Is hydroxyapatite toothpaste a genuine alternative to fluoride, or just another dental trend? And when you see that suspicious grey occlusal shadow, do you seal it, explore it, or actively surveil it? In part two of this modern caries management episode, Jaz continues the conversation with Prof. Avijit Banerjee on minimal intervention dentistry. This episode moves beyond diagnosis and communication into the practical management of early and progressing caries lesions, including peptides, SDF, hydroxyapatite toothpaste, fissure sealing, xerostomia, root caries and selective caries removal. https://youtu.be/dGt7FW7C4N0 Watch PDP269 on YouTube Protrusive Dental Pearl Use the Contemporary Caries Management Implementation Pack as a chairside aid to turn the episode into daily clinical action. ⚠️ Learning the evidence is not enough if it never makes it into your patient conversations, risk assessment or treatment planning. ✅ Print it, laminate it, and use it to support communication, diagnosis, active surveillance and minimally invasive decision-making. Disclaimer: This is an educational resource produced by Team Protrusive, derived from the two-part Protrusive Dental Podcast episode featuring Prof. Avijit Banerjee. Its contents were not written, reviewed, or endorsed by Prof. Banerjee; they represent Team Protrusive’s own interpretation of the material discussed. It is intended as a practical summary and is not a substitute for primary sources. We strongly encourage all clinicians to consult the latest Clinical Practice Guidelines before making treatment decisions. Key Takeaways: Peptides are designed to infiltrate early enamel lesions and create a scaffold for mineral deposition.Peptide technologies still need minerals from saliva, toothpaste, mouthwash or other sources to work.Fluoride supports remineralisation; it acts more like the “mortar” than the “bricks”.Early E1 lesions are usually managed with prevention, fluoride, oral hygiene, diet control and biofilm control.Deeper enamel lesions, such as progressing E1 or E2 lesions, may be suitable for resin infiltration or peptide infiltration.SDF is better suited to cavitated lesions where arrest and stabilisation are needed.In the UK, SDF is licensed for dentine sensitivity, so caries arrest is an off-label use.SDF can be very useful for children, older adults, medically compromised patients and care-home patients.The main downside of conventional SDF is black staining, especially on anterior teeth.Hydroxyapatite toothpaste has more science behind it than charcoal-style fad toothpastes.Fluoride toothpaste remains the preferred baseline recommendation when patients are happy to use fluoride.A suspicious grey occlusal lesion should be assessed in the context of the patient’s overall caries risk.In selected cases, a tiny exploratory opening can act like a diagnostic biopsy.Sealing fissures on the same tooth being restored can be sensible when the fissure pattern is deep.For severe xerostomia and root caries risk, consider high-fluoride regimes, close recalls, trays or dentures as carriers for remineralising agents. YouTube Highlights: 00:00 Teaser01:17 Introduction02:17 Pearl: Caries Management Implementation Pack05:54 What are Peptides?14:42 SDF: Silver Diamine Fluoride14:55 Early Enamel Lesion Pathway15:11 When to Consider Resin or Peptide Infiltration15:51 Best Use Case for SDF20:14 Hydroxyapatite Toothpaste21:18 Fluoride Safety and Evidence27:00 Midroll40:53 Preventive vs Therapeutic Sealants42:09 Severe Xerostomia and Root Caries44:40 Using Trays or Dentures as Carriers45:48 Tooth Mousse and CPP-ACP47:11 Artificial Saliva47:46 Why the Patient Has Dry Mouth Matters49:35 Current Position on Stepwise Excavation50:09 Selective Caries Removal51:15 Deep Caries Guidelines53:01 Materials Are Not Everything in Caries Management55:59 Further Learning Resource 56:44 Outro Want more? Check out part one of this modern caries management series for communication, diagnostics, triangulating data and deciding which caries detection tools are actually worth using. 🦷 Download the Contemporary Caries Management Implementation PackHead to protrusive.co.uk/MID to access the free implementation pack, including key communication points, diagnosis guidance, management flowcharts and evidence links. Professor Avijit Banerjee’s recommended reading and ongoing work: New textbook: A Clinical Guide to Advanced Minimum Intervention Restorative Dentistry (Banerjee A., Elsevier, 2024) — the most comprehensive single reference for modern MIOC and MID. 👉 uk.elsevierhealth.com (ISBN 978-0-443-10971-3) Resources mentioned in this episode: S3 Guidelines: https://pmc.ncbi.nlm.nih.gov/articles/PMC13099699/ 🦷 Interested in Proximal Resin Infiltration? Explore The Iconic Method with Cat Edney: a free 1-hour ...
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    57 mins
  • A Practical Guide to Modern Caries Management – MIOC and MID Part 1 – PDP268

    A Practical Guide to Modern Caries Management – MIOC and MID Part 1 – PDP268
    May 20 2026
    If you showed the same bitewing to 10 dentists, would they all agree on whether to pick up the drill? Why does the word monitoring mean nothing to a patient — and how does swapping it for active surveillance change everything from your notes to your indemnity to your government policy meetings? Is it overtreatment to act on an E2 lesion — or is “watch and wait” actually the lazy answer dressed up as minimally invasive? And what should you actually do with AI caries detection that flags shadows your eye doesn’t see? In this episode, Professor Avijit Banerjee — Professor of Cariology & Operative Dentistry at King’s College London, Honorary Consultant at Guy’s & St Thomas’, and First Dean of the Faculty of Dentistry at the College of General Dentistry — sits down with Jaz for what is genuinely one of the most important caries conversations on the podcast. Part one of two. Avijit doesn’t do soft answers. The drill-fill-bill model is broken. “Monitoring” needs to go. “Treatment planning” is antiquated terminology medics dropped twenty-five years ago. And AI in caries diagnosis? Useful — but the moment it gets things wrong, you are the one with indemnity, not the software. What you walk away with is a framework (MIOC), a decision filter (three factors that decide whether to pick up a bur), and a vocabulary shift you can implement tomorrow. Part two covers peptides, SDF, hydroxyapatite, stepwise excavation, and managing caries in xerostomia. https://youtu.be/YriLo8_hXNw Watch PDP268 on YouTube Protrusive Dental Pearl: Delete the Word “Monitor” from Your Vocabulary Stop saying monitor. Start saying active surveillance. ⚠️ Active surveillance must not mean passive delay — document your reasoning, risk assessment, and what would trigger intervention. ✅ Explain it to patients as structured, proactive care: clinical checks, radiographs, risk review, behaviour support, and timely action if things change. Key Takeaways Minimum intervention oral care is bigger than minimally invasive dentistry.MIOC is prevention-based, person-focused, susceptibility-related, and delivered by the whole oral healthcare team.MID is only one part of MIOC: operative dentistry when a tooth actually needs intervention.The four MIOC domains are: identify the problem, prevent lesions and control disease, provide minimally invasive operative care, then reassess.A care plan is more useful than a treatment plan because it includes justification, prevention, behaviour change, and review.Ask patients what matters to you, not just what’s the matter with you.Cavitation, cleansability, and lesion activity should guide whether to intervene operatively.A cavitated lesion that cannot be cleaned is much more likely to remain active.Smooth surface lesions may sometimes be made cleansable without conventional drilling.Restorations are not just about filling holes; they help recreate a cleansable tooth surface.There is no single perfect caries detection technology — clinical examination and good radiographs remain fundamental.If using NIRI, fluorescence, scanners, or AI, understand how the technology works and where it fails.AI should support diagnosis, not replace clinical judgement.For uncertain early lesions, triangulate: clinical findings, radiographs, risk, technology, and patient factors.Proximal resin infiltration has a role in the right patient and situation, especially as part of a wider prevention-led strategy. Highlights of This Episode 00:00 Teaser 02:17 Protrusive Dental Pearl: Active Surveillance, Not Monitoring 09:14 Minimum Intervention Oral Care vs Minimally Invasive Dentistry 11:28 Core Principles of MIOC 11:48 Domain 1: Identify the Problem 12:46 Domain 2: Prevention of Lesions and Control of Disease 13:18 Microinvasive Care Options 14:41 Domain 3: Minimally Invasive Operative Dentistry 16:38 Why “Active Surveillance” Matters 18:24 MIOC as a Practical Framework 19:43 Applying MIOC in Patient Communication 22:38 Sustainability & Salutogenesis 29:05 When to Pick Up a Drill 30:23 Biofilm as the Engine of Caries 31:33 Purpose of a Restoration in Caries Management 36:13 Caries Detection Technologies 42:44 Watch and Wait vs Detect and Manage 01:02:52 Outro Professor Avijit Banerjee’s recommended reading and ongoing work: New textbook: A Clinical Guide to Advanced Minimum Intervention Restorative Dentistry (Banerjee A., Elsevier, 2024) — the most comprehensive single reference for modern MIOC and MID. 👉 uk.elsevierhealth.com (ISBN 978-0-443-10971-3) 🦷 Interested in Proximal Resin Infiltration? Don’t miss out! DMG Icon Proximal discount for dental professionals at protrusive.co.uk/dmgExplore The Iconic Method with Cat Edney: a free 1-hour webinar on 24 June 2026, followed by a hands-on 1-day Birmingham course on 4 July 2026 covering Icon resin infiltration, tooth whitening and NIRI-guided enamel management, with verifiable CPD available. Loved This Episode? Try this next: Is ...
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    1 hr and 3 mins
  • Realism, Mistakes and Radical Honesty in Dentistry – IC074

    Realism, Mistakes and Radical Honesty in Dentistry – IC074
    May 13 2026

    Why does dentistry on social media look so perfect?

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

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

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

    https://youtu.be/uTKaeewgrgE Watch IC074 on YouTube

    Key Takeaways

    • Social media has become a powerful tool for dentists to connect and share experiences.
    • Mistakes in clinical practice are common and should be openly discussed.
    • Rural practice may not always lead to higher income as expected.
    • Success in dentistry is subjective and varies for each individual.
    • Continuous learning and skill development are crucial for career growth.
    • Financial freedom in dentistry is not guaranteed and varies widely.
    • Networking and mentorship can significantly impact career progression.
    • Social media can be leveraged to attract patients and build a personal brand.

    Highlights of this episode:

    • 00:00 Teaser
    • 00:18 Introduction
    • 02:24 Meet Dr Artem Mkrtichyan
    • 05:27 Rejections And Resilience
    • 09:03 Why Honesty Wins
    • 10:58 Rural Dentistry Reality
    • 14:58 Handling Online Criticism
    • 16:01 Associate Vs Owner Myth
    • 18:05 Midroll: Protrusive App
    • 22:48 Dentistry Money Reality
    • 26:57 Design Your Career Path
    • 28:00 Standing Out In Saturated Markets
    • 29:27 Content Marketing Strategy
    • 31:46 Veneer Minimum Ethics
    • 33:48 Final Advice And Community

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

    #InterferenceCast #BeyondDentistry

    This episode is not eligible for CPD/CE points, but never fear, there are hundreds of hours of CPD waiting for you on the Ultimate Education Plan.
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    34 mins
  • 10 Occlusion Pearls That Will Blow Your Mind – PDP267

    10 Occlusion Pearls That Will Blow Your Mind – PDP267
    May 11 2026
    Why does occlusion feel so confusing at dental school? What if the problem is not that occlusion is too complex, but that it was taught in the wrong order? How do you make sense of worn teeth, bite scans, shimstock, leaf gauges, provisionals and T-Scan without getting overwhelmed? And which small ideas can genuinely change the way you diagnose, plan and restore? In this episode, Jaz is joined by Dr. Mahmoud Ibrahim for a brilliant occlusion-focused conversation. They each bring five clinical “pearls” that helped occlusion finally click for them — from facially generated treatment planning to checking the contralateral side, muscle palpation, provisionals and digital occlusal data. https://youtu.be/REQ_L5NNEF4 Watch PDP267 on YouTube Protrusive Dental Pearl Create a PowerPoint or Keynote library of your clinical photos so you can quickly show patients relevant examples during consultations. ⚠️ Avoid hunting through random folders chairside — it feels clunky and breaks the flow of the conversation. ✅ Build a scrollable visual library of cracks, before-and-afters, complications, direct restorations, overlays, crowns and consent examples to support clearer patient communication. Key Takeaways Occlusion becomes easier when it is placed inside the treatment planning sequence, not treated as a separate subject.Facially generated treatment planning starts with where the upper teeth need to be for aesthetics.Once the central incisors are planned, the rest of the occlusion becomes easier to organise.Worn teeth that are still in occlusion are often in the wrong position.Anterior wear may be caused by tooth position, contact time, contact force, or a combination of all three.Gingival levels can reveal whether worn lower incisors have over-erupted.Digital bite scans are useful, but they are not always a perfect representation of the patient’s bite.Shimstock remains one of the most valuable and inexpensive tools for checking true occlusal contacts.After fitting a restoration, checking the contralateral side first can reveal whether the new restoration is high.Anterior guidance should be steep enough to separate the back teeth, but shallow enough to allow the lower incisors room to move.Muscle palpation should assess the quality and symmetry of contraction, not just whether the muscles exist.Always assess the opposing tooth before placing composite, ceramic or an indirect restoration.A leaf gauge can help create a more repeatable jaw position when planning more complex occlusal cases.Provisionals are essential for testing aesthetics, function, vertical dimension and occlusion before committing to final restorations. Highlights of the Episode: 00:00 Teaser00:56 Introduction03:36 Pearl: Build a Clinical Photo PowerPoint12:48 Pearl 1: Facially Generated Treatment Planning15:56 Pearl 2: Worn Teeth in Occlusion Are in the Wrong Position18:05 Why Tooth Position Matters18:22 Three Causes of Wear to Consider19:34 Pearl 3: Digital Bite Scans Are Not Always Accurate20:24 Why Shimstock Still Matters in Digital Dentistry24:18 Pearl 4: Check the Contralateral Side After a Restoration26:27 Pearl 5: The First Movement of Opening Is Not Pure Rotation28:27 Midroll33:10 Pearl 6: Healthy Occlusion Should Have Coordinated Muscle Contraction35:22 Why Muscle Palpation Is a Useful Data Point38:18 Practical Muscle Assessment Tip38:58 Pearl 7: Always Look at the Opposing Tooth39:33 What to Check Before an Indirect Restoration39:44 Why the Opposing Tooth Matters41:13 Pearl 8: Leaf Gauge for Finding a Repeatable Jaw Position42:43 What a Leaf Gauge Is44:33 Pearl 9: Provisionals Reduce the Fear of Complex Cases47:49 Pearl 10: T-Scan Adds Objective Occlusal Data53:16 Course Options and Learning Pathway55:59 Outro ✨Connect with Dr. Mahmoud on Instagram 📍 Want to make occlusion more practical? Bulletproof is designed to take occlusion from abstract theory to real-world clinical application — covering posterior crowns, quadrant dentistry, PROPER conformative dentistry, occlusal risk assessment, shimstock, leaf gauges and daily protocols you can use straight away.The next Bulletproof course takes place on 26th–27th June at London Heathrow (Radisson Blu Hotel)Don’t miss it — find out more at bulletproofdentistry.com ➡️Check out more episodes on occlusion: Indirect Restorations For Guiding Teeth – PDP196 #PDPMainEpisodes #OcclusionTMDandSplints This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes C AGD Subject Code: 180 Occlusion Aim: To help dentists improve their understanding and clinical application of occlusion by recognising key diagnostic signs, using practical occlusal assessment tools, and applying occlusal principles to restorative treatment planning. Dentists will be able to – Apply facially generated treatment planning principles when assessing occlusal and restorative cases.Identify how tooth position, contact time and contact force ...
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    58 mins
  • Posterior Composites Done Right – PDP266

    Posterior Composites Done Right – PDP266
    May 8 2026
    Are we overcomplicating posterior composites? Are those beautiful fissures and stains actually helping the patient… or just us? Why does that “perfect” restoration suddenly need 20 minutes of occlusal adjustment after rubber dam removal? And how can we make functional, predictable composites without burning time or stress? In this episode, Dr. Vishaal Shah shares a refreshingly practical approach to posterior composites. From understanding the basics, to simplifying anatomy and improving efficiency, this is a grounded, clinically focused conversation on how to deliver restorations that actually serve the patient. https://youtu.be/tdkTxzcloN0 Watch PDP266 on YouTube Protrusive Dental PearlMatch your composite anatomy to the patient’s dental age and opposing dentition before you start building. ⚠️ Overbuilding cusps in a worn dentition will create occlusal interferences and wasted adjustment time✅ Assess space, wear, and occlusion first—then design the restoration accordingly Key Takeaways Function, efficiency, and occlusal compatibility should guide every restorationDental age (wear) is more important than chronological age when planning anatomyAlways assess the opposing tooth before designing cusps and fissuresUse the whole arch—not just the contralateral tooth—as your anatomical guideFollow the central fissure line across the quadrant to orient your restorationAvoid textbook anatomy in worn dentitions—adapt to what’s presentLarge MOD composites often act as interim restorations before crownsBuild proximal walls first to establish contact and control final contourUse composite slump (with a microbrush) to naturally form proximal curvatureBase layer height should match the deepest fissure level of adjacent teethMap out fissures and cusps before building to improve accuracy and speedStart with the most difficult cusp first to reduce fatigue-related errorsProper planning before drilling reduces occlusal errors and remakes Highlights of the Episode: 00:00 Teaser01:08 Introduction01:50 Pearl: Matching Anatomy to Dental Age05:32 Posterior Composite: Start with Basics, Not Complexity10:42 Efficient Approach to Large Restorations14:22 Efficiency vs Ideal Posterior Restorations19:25 Building Proximal Walls First20:55 Using Putty Stents for Missing Cusps23:54 Midroll27:15 Using Putty Stents for Missing Cusps27:25 Matrix System Selection28:06 No Pre-Wedging Philosophy29:06 Managing Composite Overhangs30:46 Matrix Ring Differences32:45 Interjection37:03 Matrix Ring Differences37:43 Proximal Wall Technique for Posterior Composite41:03 Base Layer Strategy in Posterior Restorations42:23 Mapping Anatomy Before Composite Build-Up43:13 Cusp Build-Up Approach45:03 Minimal Adjustment Philosophy46:43 Final Philosophy: Keep It Simple48:00 Learning Opportunities49:54 Outro 🔥 Want to level up your posterior composites?Dr. Vishaal Shah runs hands-on courses focused on simplifying and mastering everyday restorations.👉 Visit www.levelupdentistry.com to explore courses and upcoming training opportunities. More about posterior restorations:Check out more episodes on occlusion and restorative dentistry: How to Place Posterior Composites without Destroying Your Anatomy – PDP200 #PDPMainEpisodes #BreadandButterDentistry This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes C AGD Subject Code: 250 Operative Dentistry Aim: To enhance clinicians’ understanding of efficient, functional posterior composite techniques with a focus on anatomy, occlusion, and practical workflow. Dentists will be able to – Assess dental age and occlusal compatibility when planning posterior compositesApply simplified, efficient techniques to build functional posterior restorationsSelect appropriate materials and matrix systems to optimise contact, contour, and outcomes
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    52 mins
  • Why We Need to Take MRIs for TMJs! – PDP265

    Why We Need to Take MRIs for TMJs! – PDP265
    May 6 2026

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

    What’s actually involved in MRI of the TMJ?

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

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

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

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

    https://youtu.be/-yo_Qx4Zg5Q Watch PDP265 on YouTube

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

    Key Takeaways

    • TMJ is often overlooked but is crucial for overall health.
    • MRI is essential for accurate TMJ diagnosis.
    • Cone beam CT cannot replace MRI for TMD assessment.
    • Patients with headaches may have undiagnosed TMD.
    • Education on TMJ imaging is lacking among dental professionals.
    • Asymptomatic patients should still be scanned for TMJ issues.
    • The quality of imaging directly impacts diagnosis accuracy.
    • Patients often feel anxious about MRI procedures.
    • Understanding patient perspectives can improve care.
    • There is a need for better collaboration between dentists and radiologists.

    Highlight of the episode:

    • 00:00 Teaser
    • 00:55 Intro
    • 05:20 Protrusive dental pearl
    • 06:36 Interview with Dr. Kevin Lotzof
    • 09:38 Under-Imaging and Differing Perspectives
    • 13:27 Access and MRI Centers in the UK
    • 17:51 TMJ MRI: Patient Expectations
    • 22:17 Midroll
    • 25:53 Open MRI Machines
    • 27:26 Ideal Candidates for MRI Imaging
    • 29:55 Cone Beam CT vs. MRI
    • 31:53 Screening and Asymptomatic Patients
    • 38:43 Centers with Reliable TMJ Imaging
    • 41:27 Encouragement for General Dentists
    • 46:33 Outro

    Where to Get Reliable TMJ Imaging

    ⭐ Top Pick:

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

    🏙️ Other London Options:

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

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

    #PDPMainEpisodes #OcclusionTMDandSplints #CareerDevelopment

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

    This episode meets GDC Outcomes A and C.

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

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

    Dentists will be able to:

    1. Explain why MRI is superior to clinical examination and CBCT in diagnosing TMJ pathology.
    2. Identify the key indications for TMJ MRI, including both dental and non-dental symptoms.
    3. Recognize the limitations of poor imaging technique and reporting in TMJ diagnosis
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    50 mins
  • Zirconia vs. Titanium: The Implant Debate – PDP264

    Zirconia vs. Titanium: The Implant Debate – PDP264
    Apr 29 2026
    Is titanium still the gold standard for implants? Are zirconia implants just hype from biological dentistry… or something more? Do ceramic implants really integrate as well as titanium? And should we already be offering patients a choice? Zirconia implants are no longer a fringe concept—they’re entering mainstream conversations. In this episode, Dr. Pav Khaira returns to break down the science, clinical decision-making, and real-world application of zirconia vs titanium implants. From corrosion and osteoimmunology to occlusion and case selection, this is a practical, evidence-led discussion for clinicians navigating modern implant options. https://youtu.be/-RCvf2KOdSc Watch PDP264 on YouTube Protrusive Dental Pearl: Thriving in Challenging Times 💡 Prioritize quality sleep—it sharpens decision-making, improves mood, and reduces irritability (6–7 solid hours beats longer, disrupted sleep). ➡️ Remember, stress comes from how we respond, not the situation itself—focus on what you can control and let go of the rest. 📢 Lean on your support system and make time for reflection and gratitude—they help reframe pressure and build resilience. Key Takeaways Zirconia implants integrate just as well as titanium, with comparable clinical outcomesEarly healing may be slightly faster around zirconia, but long-term results are similarTitanium can corrode over time, releasing particles linked to peri-implantitisZirconia does not corrode, removing this biological risk factorModern implant thinking focuses on osteoimmunology, not just osseointegrationZirconia implants are often one-piece → no microgap and improved crestal bone stabilitySurgical placement must be highly precise—zirconia is less forgiving than titaniumGuided osteotomy is strongly recommended for ceramic implantsFracture risk in modern zirconia implants is low when manufactured correctlyHot isostatic pressing significantly increases zirconia strength and reduces defectsCase selection is critical—limited bone or complex angulation may favour titaniumZirconia implants are typically cement-retained onlyExcess cement remains a risk factor for peri-implant disease → manage carefullyZinc phosphate cement is useful due to radiopacity and bacteriostatic propertiesAngled screw correction (titanium) is predictable only up to ~15 degreesPatient preference for metal-free dentistry is a growing driver of zirconia demand Episode Highlights 00:00 Teaser00:49 Introduction02:32 Protrusive Dental Pearl: Advice for Dentists during challenging times05:14 Basics: What Are Implants Made Of?07:13 Osseointegration: Zirconia vs Titanium08:28 Why Zirconia? Biological Rationale11:13 Clinical Advantages of Zirconia Implant14:09 Zirconia Implants Limitations in Clinical Use17:45 Case Selection: When to Use Zirconia Implant19:16 Fracture Risk: Myth vs Reality21:30 Midroll24:51 Fracture Risk: Myth vs Reality25:29 Importance of Manufacturing Zirconia Implants27:49 Weaknesses & Clinical Considerations of Zirconia Implants30:49 Occlusal Programming for Implants32:24 Screw vs Cement Retention in Implants34:07 Angle Screw Correction (titanium Context)36:20 Cement Choices for Zirconia Implants38:27 Market Share & Future Trends of Zirconia Implants40:25 Learning Resources for Zirconia Implants41:51 Medico-Legal Considerations of Zirconia Implants47:37 Training & Education Pathways for Zirconia Implants 48:25 Outro Want to go deeper into implants? Explore Dr. Pav Khaira’s Academy of Implant Excellence— training designed to help you truly understand the why behind implant dentistry, not just follow protocols. Hands-on options, mentorship, and advanced training available. ✨Follow Academy of Implant Excellence on Instagram: https://www.instagram.com/academyofimplantexcellence Mentioned resources from this Episode Book: Zirconia: Material Properties and Surgical Principles for Dental Implants and Restorations Want more? 📢 Check out more episodes on implant complications and treatment planning Implant Occlusion that Makes Sense – PDP 204Implant Assessment for GDPs: from Space Requirement to Ridge Preservation – PDP052 #PDPMainEpisodes This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes C AGD Subject Code: 690 Implants Aim: To improve understanding of zirconia implants, including biological considerations, clinical indications, limitations, occlusal principles, consent, and material-related decision-making. Dentists will be able to – Describe the clinical and biological considerations when comparing zirconia and titanium implantsIdentify key case selection factors and limitations for zirconia implant treatmentApply practical principles for occlusion, cementation, consent, and risk reduction in implant dentistry
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    50 mins