Everybody, and thank you for joining me on this Tuesday evening. It is a little sad that it's June, and I'm sat here in a jumper.

But, hopefully, we'll get some sun eventually, and the weather will start to feel like we've got summer. Anyway, if we're not out enjoying the sunshine, then we may as well be learning. So tonight, we're going to look at how we AI AI technology to help with our diagnostics and our treatment outcomes.

So, we're going to specifically be looking at clear aligners and how we use clear aligners orthodontic treatment, but we do our diagnostics, and but how we do our diagnostics and how those diagnostics can be helped and driven by Pearls AI looking at the X rays, and the diagnostics there. So just to introduce myself, my name is doctor Minnie, and I have been using clear aligners since two thousand sixteen, and it's really all I do now. So I just do a lot more restorative, and now I don't do any restorative.

Really, I spend my most of my time just going around different practices doing clear aligner therapy for adults and kids.

I'm currently doing my masters, in that in in clear aligner therapies, which has been fascinating.

And I'm currently doing another diploma, in in kids orthodontics as well. So there's lots and lots of learning out there. And I find it the whole subject fascinating.

And I think when you find something that you're truly passionate about, you spend a lot of time learning about it or wanting to learn about it because you really want to push yourself to be the very best that you can be. And it takes you on this journey. It takes you on this learning pathway.

And at several points throughout this pathway, there have been key moments.

And the key moments are sort of, you know, I actually decided I wanted to do more clear AI therapy. It wasn't something I fell into. And then, I more recently launched my own mentorship program, and this all came down to believing that it was possible and want you know, believing that we could do it and there was something more to offer the world. So, a slight mindset change there in those the particularly those two years where things took a massive leap forward.

But other than that, I have been pretty much in education around glioclear and AI therapy for the last eight years solidly. And I look forward to another eight more years of solid, learning and growth and development with clear aligner therapy, and what we can give our patients and how we can get those outcomes. So we're gonna think today, yes, about creating smiles because, obviously, smiles are important, but also think about how we can use clear aligners to enhance oral health, aesthetics, and the long term stability of our patients' teeth, and thinking about how we mix those with the ortho restorative.

So we are gonna look at ortho restorative cases today, and we're going to think about how we can drive these outcomes, drive these diagnostics, these conversations, these outcomes for our patients by building great rapport with them right from the start, lots of trust, but also to enable us to diagnose and then treatment plan better as well.

Many of you will know that I'm a I'm a big believer in general practitioners, and I love the fact that general practitioners, we look at everything as a whole from many different disciplines. And, actually, our ability to combine multiple multidisciplinary dentistry is really our superpower.

And, you know, you may find that you go off in one direction more than the other. So for me, I definitely left Endo behind pretty quickly, but I still keep up to date with Endo. I still understand it, and I still, so I can still refer. I can still talk to patients about it. AI think this is what makes general practitioners so special, in the dental work workplace because we can look at everything as a whole. And when we can look at everything as a whole, we can do optimal plans and optimal planning.

Tonight, we're really gonna focus focus on ortho and restorative, although we're going to see a little bit of perio come in in the first case as well.

And, really, you know, previously, patients would go down the road of orthodontic treatment, or they would go down the road of restorative treatment. And they can be two lonely roads, and they'll get you to an end goal. But it doesn't necessarily mean it's the best end goal for the patient because, actually, you know, we can do a lot with ortho. We can do a lot of restorative, but we can do so much more when we're able to mix the two together. And some people might do all of that themselves. Other people may, you know, give out the author or get give out the restorative. But, actually, when we can look at the case and understand everything from a whole, we can go down this beautiful sunny road and get to a wonderful outcome for the patient, normally with less compromises.

So I'm a big believer that, yes, I know we focus on teeth, but we don't really look after teeth. We look after people. And we need to think about the the set of teeth, yes, but we need to think about the human that's attached to those set of teeth that walks through our door because often, you know, especially with our adult patients, it's not a simple solution. Often, there is more that we need to think about because they are dragging around a whole load of dental baggage. Their teeth may not be in the most ideal position or situation, and we need to think about them as a whole holistically, including, you know, their compliance, their temperament, their budget, their their time frame to get them the most ideal solution.

And when I think about, what we can do for patients, Basra is one of the first people that comes to mind. And Basra came to see me because she was unhappy with the aesthetics of her anterior teeth.

She's a teacher, and she was embarrassed standing in front of her class because she felt that the teeth were all people could see, and I can completely understand where she's coming from.

Those upper anterior teeth and the lower anterior teeth are completely proclined. We'll have a look at the moment, but they're almost at, you know, ninety degree ninety degrees, or really, you know, pretty close to there.

And they're completely in the wrong position, and they're sticking out, and she's struggling.

Now, obviously, we can see a few more issues.

So we can see inflammation.

We can see you might be able to see that there's some apical pathology around the upper right four. If we look here, you can probably see some caries, starting off. And Basra may not be fully aware that there are these issues. So how do we start off this conversation?

How do we start by talking to her about what we can do and what we may not be able to do yet? Because, actually, I really want to help Basra achieve her goal of a smile that she can be proud of, as well as the fact that, actually, a lot of this is caused by occlusal trauma. But first, I need to talk to her about the health of her teeth, and I need to get her to understand my why, so where I'm coming from. So I can understand her AI, and it's my job to try and help her get there to achieve her AI.

And she needs to understand my why, the clinical side of things, so that we can marry that together and we can come up with the perfect plan. Well, one of my favourite things is photos. So I really do believe that seeing is believing.

And so I love to show patients their photos. And I will put patients' photos up on screen, and we will have a look at them together. And every patient says the same thing. They go, oh gosh. I don't wanna see that. And so I say, no one wants to look at these, but, you know, ultimately, these are your teeth. We need to have a look at them together so we can see what's going on.

But photos only show part of the story. They don't show the full story.

We take radiographs or x rays for a reason and that's so we can see a little bit deeper, a little bit further where we can't see with our naked eyes. And this is where Pearl AI comes in so wonderfully because we take the X rays, we look at the X rays, and we will make some AI.

We will make some judgments. And then a lot of the time, we show the patient the X-ray, and we sort of wave our pen maybe over it, and we try and show them or maybe our finger or the mouse, try and show them what we mean. But, actually, it just looks like gray and white or gray and slightly grayer areas to the patient because they haven't been trained to see what we can see.

And so when we think about how to break down that barrier, how to describe to patients what's going on in their mouth in more detail, show them the extent of the damage when perhaps you can't always see it on the on the photos, This is where Pearl AI and you can see it really shines up the different problems, the different parts of the dentition. So we can see caries being very highlighted there. The patient you don't have to so say, you know, can you see this area? Here's the patient. You can say, AI. The pink areas, that's AI we've got holes that we're going to need to go in and do something there. The place fillings or onlays depending on, you know, your diagnostics and the the the degree of tooth surface loss.

And by communicating with patients in this way, again, it's that seeing is believing. They they understand it because they can see it.

And it builds that report, builds that communication, it builds that trust. Because ultimately and AI know we don't like to believe it, but ultimately dentists aren't well trusted within, within the population, within the general population.

And patients often say, well, I can't feel a problem.

And they might not be able to feel a problem, so now we can show them a problem. And they don't have to rely on us by ourselves. They can see what's going on in their mouth. Because often and again, you'll go to you know, you all heard the saying, go to eleven dentists. You get twenty treatment plans.

Because we all have slightly differing, views of what we're looking at. And I think this is the other beautiful thing about AI, about the AI and about Pearl AI is it takes away that that that need for the patient to sort of blindly trust us because they can see it.

But the flip side of that is that, actually, we as dentists can trust more in our diagnostic skills and maybe even improve our diagnostic skills and tweak our treatment plans. So for instance, how many of you have looked at an x-ray and gone, oh gosh. Is that cavitated into dentine? Do I need to address that now, or is that something that I can I can leave for a little while?

Or perhaps we can, you know, try AI put some some fluoride on it. Maybe we can reverse, the decalcification.

Is it cavitated? Is it not cavitated? Is it indented? Is it non to dentine? If it isn't to dentine, how far is it indented?

You know, and all these questions come in, you know, come in. We can second guess ourselves, and it can make our job a lot more stressful. And I'm a big believer that dentistry is stressful enough. We don't need to make it any more stressful for us.

And so whilst it's great at communicating with patients, the other side of the AI and the diagnostics is it can confirm and back up what we believe that we're seeing. So my protocol is AI will take the x rays. I will look at the x rays. I will look at the bone levels. I AI look at the caries. I will look at the restorative margins, and then I will turn on the AI technology.

And I will look at it and use it to confirm and possibly AI even spot things that maybe I hadn't picked up when I was looking at the X rays with a naked with a naked eye because the AI technology is so sensitive.

And as we as we know, when you've got eleven dentists, you can get twenty treatment plans. This takes out that sort of ambiguity there, which is which is just a nice reassurance to have within the surgery. So we can be really confident with our treatment planning and our diagnostics as well. So you can see on the left the the caries, and then on the AI, you can see, you know, eighty seven percent in enamel, thirteen percent in dentine.

And we can see, we have a figure then to put against whether we're going to intervene with, you know, filling, so drilling out the decay, or if we're going to see if we can remineralize the area with fluoride or other, technologies. So you've got AI, etcetera. So depending on how invasive and non invasive we're going to try and be. And what's really nice is that it took used to take me a long time to measure bone levels, but the bone levels get measured almost instantly.

Well, there is instantly.

So there's no, you know, messing around with little rulers to try and see how high or how low the bones are. It comes up and you can get a pretty quick overview and talk to your patient about it very quickly.

So from a diagnostic point of view, from a communication point of view, this is very powerful. And this is what we used for Basra because we used the photos, we used the AI, on the x rays, And, ultimately, the answer that I gave her wasn't no.

It was not yet. I was like, yes. We can. And I actually believe we should align your teeth because of the traumatic occlusion, but not yet.

We need to address these situation the other situations first. The primary disease, we need to get the periodontal disease under control. We need to address the apical infection around the upright four. We need to address the caries, get everything stabilized, and then we can look at, the next phase, which will be aligning the teeth.

And so Basra went off, and she was very motivated. And here, you know, I we I love to use specialists, when we need to.

So she went to see my periodontal specialist. She has some wonderful treatment for about a year, a year and a half. Got everything stabilized.

She I didn't do the root canal. Someone else did the root canal, and then I did the direct restorations as stabilisation restorations because ultimately, I'm gonna come in and put onlays in later on due to the destruction on the upper right four and the upper left six. So we're gonna do some, little bit of cuspal coverage there.

If I had said to Basra no, or if I hadn't spent time describing and showing Basra what was going on in her mouth, she may have heard the word not yet and tell her and actually heard no. And she may not have been as motivated to actually get herself to a point where she was healthy. And so that's why I'm such a big believer in spending time showing patients what you're seeing, how you're seeing it, how you think it should be addressed, and marrying up their why to your why.

Because even with, you know, fantastic oral hygiene from her, you can see that we're still struggling around the upper anterior palatal aspects there. There's a little bit of inflammation, and, ultimately, that's because there's occlusal trauma. So no matter how well she's brushing her teeth, no matter how well, she's motivated, that occlusal trauma is going to have some level of instability there. And this isn't nighttime parafunction.

This is functional occlusal trauma. It's happening while she's eating, talking, swallowing, etcetera. So we do need to sort it out. A AI NAT mouth guard is not going to do anything.

So we decide that we're going to align the teeth. And the whole purpose here from the alignment pointed through point of view is to remove the crowding and AI, so to bring back those upper anterior teeth. And you can see just how proclined they were in the beginning. And then we're aiming. They'll still look be slightly proclined compared to normal.

But for, her facial aesthetics, and for the position and including how much crowding we have in the lower arch, this is the end result that we're going to go for.

If we had tried to tip the teeth further back, so so if we'd AI the teeth any further back, we'd have had to do more IPR in the lower arch, and we'd already taken out a tooth. We took we took out, the lower right two actually because it had ninety percent bone loss. And on balance, we were like, well, we'll take that tooth out rather than doing even more IPR to create space, because I had a relatively poor prognosis anyway.

And you can see that everything's tucked in nicely there. And here is where we ended.

This is about twelve months worth of AI.

AI really quite happy with this result. She is thrilled because she has got a straight smile that doesn't look like it is sticking out. AI thrilled because I've got good occlusal contacts. I've got good stability.

No fremitis. No occlusal trauma like we had before.

And she's maintaining that good level of oral hygiene. You can just see the couple of oenlase I popped on at the back on the upper right four and the upper left six, just due to the tooth tissue that was lost, sort of pre op with those large caries lesions.

So it took us a while to go from the pre op to the post op. This wasn't a quick few months case.

It was challenging. And halfway through the aligner treatment, we had to pause because we had a little bit of a wobble with our periodontal stability, so which is fine. We just keep the patient in the same aligner whilst they go back to the specialist, get everything tidied up, and then they can come back again.

But this, I feel, is the power of the power of communication, the power of diagnostics, and the power of the technology we have today because I would far prefer to do this with, a removable appliance and fixed because I can manage the force levels quite quite predictably as well as we use very small forces on the teeth at each stage to really protect and respect the periodontal tissue there.

And you can just see. I AI we all are drawn to the to look at the the mouth, but look at the eyes. I find that it's beautiful. You look at the eyes, AI the eyes are much brighter.

Not only that, but from a comfort point of view, she's she can actually close her mouth. She can create an an oral seal with her lips rather than having to pull up her chin more and stick her tongue out. So this is, you know, transformed, Basra. And it all started off with that consultation, the diagnostics because I wasn't the first page person that Basra saw.

And, thankfully, we were able to work together to get her to this to get her to this position.

And one of the most beautiful things I find about the type of work that we do, yes, we are we do look at the smile, but actually, we can really instigate this health related behavioral change. And not only is it is it easier for Basra to keep her teeth cleaned when they're straight and there's no spacing, but something changes mentally, and she perceives that she has a better ability to keep her teeth clean and to have a better diet.

And that mental change to be able to to give someone more belief in themselves, I think is absolutely just fantastic.

And, when we think about sort of cosmetic and aesthetic dentistry, what we can give back to patient, it does really go far beyond this model. We're gonna go around that, topic a little, a little further, this this evening.

But first of all, let's move on to Tim. And Tim came to see me because he wanted to get his upper right one or his upper anterior teeth sorted, I would say, actually.

The upper right one had been knocked out by his wife on their first date with her handbag, and then it was subsequently knocked out again, I think, a couple of weeks before their wedding.

And then he hadn't done anything about it.

It was always on the to do list.

And I inherited inherited Tim from a colleague who had left the practice, and he was very good at coming in for his six month checkups, but he never went ahead with treatment. He He was, oh, I'll do it later. I'm he's busy. He's got two daughters. He runs a company. He's busy, busy, busy.

And that's fine. You know? We give patients the information, and they they they decide what to do with it.

But this upper right one truly, truly is failing. And even though it's failing, it is a real testament to our bond ability that we have at them have, you know, in this day and age because that is a temporary post, and that is a whole load of composite that has been placed there. And it is holding and it's holding well. It's it's I think it's five years. So it is failing, but it's sort of failing slowly.

And, that, you know, that can give patients this confidence that they don't need to do anything about it.

So, of course, we use the Pearl AI.

We're having a look at the bone levels.

You can see that it's highlighting where perhaps the restorative margin isn't AI, flush with the tooth. So that gets highlighted. We're looking at the bone levels. But what's also really nice is that we can turn on the tooth, tissue. So we can see exactly where the root is, where the pulp is, root canals, dentine, enamel, and restorations. And look at that tooth.

It is a retained root with a lot of composite placed in there. And, actually, showing Tim this meant that he all of a sudden AI just how little of his tooth was actually left, and perhaps we should do something about it proactively rather than reactively a little later on down the line.

Because, you know, what's the consequence of not doing treatment? Probably that at some point, that composite's going to fail at some point, and then it's going to be an emergency situation where we're gonna be trying to build it up again, like a couple of weeks before his wedding in comp in composite so he can go about his day and he's not missing a tooth. If we're doing it proactively, then we can control that situation and make sure that he's never without a tooth without a front tooth. And that little leakage that we can see that's been highlighted by the by the AI technology on that distal margin, again, it's another way of communicating and say, look. That is what you know, this is just going to get worse and worse.

So we did decide to go ahead, finally, and we were looking at the DSD.

Okay?

The digital smile design, roughly the teeth are in an okay position.

AI. They're not in a terrible position.

The teeth on the left are a little narrow. The teeth on the right are a little little AI.

You know? But generally speaking, that's already restorative anyway.

We don't really have to do any ortho treatment here. We can probably get away with this with just restorative. But and there is a but here.

We have quite a tight anterior occlusion.

Can you see that sort of, how how close the upper anterior teeth and the lower anterior teeth are?

It looks like he's almost stuck, and, actually, he was sort of very constricted or restricted in his envelope function. And this can, present his tooth wear on the platelet of the upper, label of the lower. AI can present as muscular plane, TMJ, gravitas.

So you might have some mobility. And we had a little bit of lower crowding as well.

And so what we said is we said, look. We could do this purely restoratively, but if we could align the teeth if we could align the teeth, it would just allow us to redistribute the space slightly differently in the anteriors. That's gonna give us better harmony, and it will look better in the end. And also what we can do is we can just move those lower teeth a little bit further, further back. That way, we are we can just remove those hard anterior contacts, and that means the restorative, that we're going to put in is gonna last a lot longer as well because we're not gonna have sort of those, hard anterior contacts.

Because one thing we don't want to do in these situations, we don't want to pull the upper anterior teeth back to close the space. So that's not what we do. We actually left space everywhere in the upper arch. We just redistributed it so it was in a better position, and then it was just we touched back the lower anterior teeth slightly. So we had less we had more space between those upper and lower teeth. So that's creating a better overjet, unrestricting that envelope of function, so we've got better, movement of the jaw without crashing into those upper anterior teeth there.

So here we are post AI, and you can see minor changes. This was this was as opposed to Basra, this was nice quick, ortho. And just to show you how predictable, you know, the technology is when we set it up correctly. So this was our initial DSD.

That's where we wanted the teeth to finish, and that's where the teeth finished. Okay? So you can see they're pretty perfectly moved. What that means is that we're really set up now for a restorative.

Upper right one comes out. We use a temporary resin bonded bridge AI the, implant, the the screw is is integrating. Then we transition to a temporary crown, so we could sculpt the soft tissue. And then AI, our final crown, and you can see the minor really just the polishing disc, the prep on the upper left one, upper left two.

On the upper right two, I just removed the composite. And to be honest with you, that was what was underneath. So it was slightly discoloured. You can see that slight discoloration there, but, it was fairly, you know, barely touched even though it had quite a lot of composite on before.

We got lucky with what we were finding underneath.

So the day of fit, we placed the implant and then the rest of the veneers. We can see the gums don't look like AI fully settled. We've got little black triangles and that's quite normal. We want to give everything time to mature, which it will do as long as there's not stuff stuck underneath.

And then a few, you know, a few I think this is a couple of a few weeks later, things are looking like they're maturing nicely and that will continue to get better and better, as time goes on. And you can see that nice posterior occlusion on the left and the right. You've got an overjet now. We've untrapped that, functional occlusion, and Tim's happy.

AI like to take post the post ops so we can see that. Just check everything again. Look at the look at the, bone levels, make sure we're happy with all the restorative margins, and we've got rid of the cement, if there is any. So, you know, I like to take X rays after I've fitted so that I can, see if there's any cement left over.

And if there is, then I know exactly where I need to go in and clear it up. So you can see there's a little bit left on the mesial of the upper left one. Well now I can go in, with a scalpel and I can just really make sure that I I can I can get that off for Tim? So nothing's gonna be underneath there irritating the soft tissues.

So we can everything can heal nicely.

And you know his wife was very happy. Ended up treating his wife afterwards as well. So again we've got come back to these benefits. These these benefits that we can give our patients.

Yes health related behavioural change but also oral health. We can improve the aesthetics, the function and ultimately mean that actually the patient can clean around those teeth better. So round crowding there'll be less plaque traps, and around spacing. Again, you know, food not getting stuck within spacing, making sure that everything's nice, nicely contoured so that no bacteria plaque, etcetera is being is getting stuck around our restorative margins as well.

So that improved aesthetics, that improved function. And I have to say one of the biggest things I'm finding at the moment is function. Patients are very functionally motivated at the moment.

So when you can show them that tooth wear or they're coming in with jaw pain, muscular pain, actually being able to help them with through proper diagnostics, means that you can, you know, change their life. You get people who have been in agony for months, and they've been told over and over again that they're just grinding at night. But, actually, if we do our true diagnostics, we find out that, it is a functional, occlusal trauma or occlusal problem, And we can step in and we can really fix that for them because we can get put put the teeth where they should be rather than where they've been forced to be.

So moving on to Ben then. So Ben came to see me because he wanted well, actually, he really didn't like his upper canines. And you can see his upper canines are in the position of the upper laterals, and he's got retained c's.

Other than that, generally, things aren't looking too bad. Yeah. A little bit of oil AI and improvement around the general margins. Yes.

Art forms are pretty okay. Thank goodness the c's have stayed there because that's maintained the space for us. Okay. We didn't wouldn't wouldn't want that space to be lost because then Ben is going to be turning in more and more into a class three, whereas we still got that positive overjet here, which makes our job a lot easier in general.

We've actually even got a little bit of spacing in the lower arch.

And so when we were thinking about the different options, again, it comes down to the diagnostics and that conversation with Ben. So we've got two big options here. The textbook option would be to take out the seas, AI the canines, and then replace the canines with, re restore the lateral positions with with laterals, with bridge or with implants.

The other option is to maintain, the canines where they are, take out the c's, and replace the c's with, bridge or implant to make it look like canines.

And both are good options. Both are reasonable options. And then it comes down to a conversation because AI those canines, if we look at the roots, the roots are actually very upright already. So if we're going to distillise them, we want to make sure those roots stay really perfectly upright because that means that we don't take out, the the opportunity for Ben to have an implant later on or implants later on down the line because there is a risk, however, that instead of the root oops. Sorry. Instead of the roots translating, that they tip.

Okay?

So that would be the risk of trying to distalize those canines is that they tip instead of translate. And if that happens, then one, it's difficult to correct. But two, if it was left like this and not seen, then if Ben ever wanted implants in the future where those laterals should be, They're not going to be able to get in because the roots of the canine are gonna be in the way.

So what does that mean? It means that if we want to AI the canines into the position of the c's, it is going to be more difficult. Now we shouldn't not do things just because it's difficult, but what comes with more complexity?

Increased time, increased cost, maybe increased disciplines because we might want to use tabs or mini screws.

And ultimately, that's going to impact what the patient can or can't do at the moment or is willing to do or isn't willing to do. And so therefore, I always think it's very reasonable to offer them both options and see what see what they prefer. And, ultimately, Ben wasn't up for a hugely long treatment plan. He wanted a good result, a functional result, but something that, wasn't going to take a year and a half to two years, something that we're more looking at sort of, under a year.

And so that's what we decided to do. And do you know what? If Ben changes his mind in ten years' time and he decides actually he does want to AI his canines, he can still do that. We haven't taken out that option for him.

So we've left all options open for the future.

But it comes again to our AI and our digital setups because the first thing that we want to do is we want to see, do we need to move the teeth? Is there a need to move the teeth to get a better outcome here?

I don't really want to retract the upper anterior teeth, but do I need to or can I align them in such a way that I'm not retracting?

I'm just getting the teeth into a better position.

And so here, we go onto a digital smile design. This truly is digital because we're looking at, a digital implementation of it. So the blue is where I want the teeth to finish. That's where I want the restorations to finish roughly.

What we can see on the left is that those canines, the whole buccal surface of the canines is point is out of the blue. And if we put on the heat map, what we can see is that where the yellow, orange, and red is on those canines and a little bit on those distal corners of the upper centrals, we're going to need to prepare the teeth. Now Ben is in his early twenties.

I really don't want to prepare the teeth if I can help, but I really want to avoid preparing the teeth. I want to get him something that's functional, that's gonna last a long time. But ultimately, if he did change his mind later on down the line on what he wants, that he I haven't removed any options for him because he's young and things change. So we say, right. Okay.

We will move the teeth. We'll do a little bit of ortho, and it's gonna be a few weeks. Nothing crazy.

I'm really just moving the front four upper anterior teeth and the lower six, anterior teeth in order to adjust the position of the canines.

And, actually, instead of retracting the canines, it was more a proclination of the upper centrals so that I could get a slightly more buccal, finish. And that means that I don't need to do any preparation. So notice now on the right hand side how there is no yellow, orange, red on the heat map, it's all blue. This shows me that this is all additive dentistry now. None of it is reduction.

A few weeks of ortho changes the prognosis, the restorative cycle for these teeth and keeps the options open for Ben going forward. Again, this is communication. This is where we're talking to our patients. We're showing them the benefit of what we're doing because for us it can be difficult to visualise AI. For patients it can be almost impossible for them to visualise it. So therefore, show it seeing really is believing.

So we get here after the post alignment.

We take out the c's, do composite on the upper, two to two. So we disguise the canines as laterals.

Take out the c's, and here, for budget reasons, we went for resin bonded bridges.

But I don't go straight to the final bridges. Here we've got the temporary bridges, and you can see they're not the best looking, but I'm only using them to sculpt the soft tissue. And I the reason why I want a metal wing, even though you can see that shine through, is that I can get the metal on and off as I need. So I can change the shape of the pontic to sculpt the gum in you know, differently or I can I can alter it basically? I'm not stuck.

So that's why I like the metal so I can sort of get it on and off and alter things to really sculpt the tissue.

After a few weeks, that's what we look AI. You can see just by removing the metal wings, the anterior composite looks much better, much brighter because you've got that metal shine through.

But look at how the gingival margins have been sculpted, utilising those temporary resin bonded bridges.

Then we place our final zirconia bridges in the end. We've got zirconia cantilever bridges coming off the AI.

Nice big surface area on the on the canines.

Nice area to bond to.

AI when I get lots of questions about this and about how we didn't go mesial off the four, But if we play that through, if I went measially off the four, I'm still not going to be able to be canine guided at this stage because the the whatever I'm gonna put in the canine position is going to be a pontic. We don't want it to be canine guided. So no matter what we're gonna do here, we're going to be group function.

So if I had gone measly forward of the fours, to get the best bond or best long term prognosis of those bridges, I'm going to need to do some wrap around preparations.

It's likely going to be metal.

So from a preparation point of view and from an aesthetic point of view, that's, you know, both ticks and the negative on a con list. By doing it this way, again, it's just additive. I've done no drilling.

We haven't done big a big amount of retraction of oh, sorry. Retraction of the upper anterior teeth. We've left space to allow for the for the pontic wings to fit in.

We've really just mesialized the mesialized the centrals and proclined them slightly.

And a little bit of retraction in the lower arch because we have that space distal to the lower left three. So it's given us the overjet. We need to fit that in and to fit that in nicely. And then we've got a good group function on both sides, and you can see he's pretty much unrestored.

So, that a good group function working working well will be absolutely fine here.

And so we go from here to there in a few months, and Ben is thrilled.

And as I said, he has every option still open to him. It's completely additive. I did no drilling apart from, apart from to remove the, temporary the the resin cement from the temporary bridges. It's the only time I picked up a burr.

Everything else was completely additive. It's the kind of dentistry I absolutely love. And when we can do that and we can give back so much confidence. Because whilst we focus and we tend to focus on the physical benefits that we can give patients, actually, the psychosocial, I believe, are far more important.

We can change self esteem, self confidence.

People will go on that first date or go for that job interview or maybe go to university.

We can transform their lives by giving them the confidence to put themselves in situations that they may never have put themselves in before.

And that to me, you know, when you when patients come back and I always see patients after a year once we finished treatment.

When they come back and they tell you these stories, yes. I'm really happy that this you know, we've reduced the risk of perio or tooth wear or caries, etcetera. But those emotional stories are what really gets you and really makes you get out of bed in the morning.

So our last case tonight is Tom. And Tom had a little bit of everything. And, over the last year, we've really been adding to Tom's case, and I've been showing a little bit more because he's always a work in progress. And we're we're close to the end now.

So Tom. Tom came to see me, and he came to see me because his lower left, one and lower left two veneer kept popping off. And he had had it fixed multiple AI, but the dentist placed it. And he was going away to America for a big meeting, and he needed it fixed.

So I said, okay.

I can stick it on. I've got no guarantee it will stay.

I thought it was lithium disilicate, but I couldn't be sure.

So prepped the teeth, prepped the veneers, stuck them on as an emergency. Off he went. AI I actually really didn't expect to hear from him again because it was an emergency appointment, you know, in a rush because he was going off for this meeting into America. And then I did hear from him again, and he booked in for a full assessment and full consultation, because he wanted to sort his mouth out.

Now what transpired over that appointment is that, actually, Tom was in the process of suing, his previous dentist. There was a disagreement, in in terms of finances, actually, more than anything else.

And that made me made me a little bit nervous because it would make all of us nervous or does make all of us nervous.

However, Tom was just he was a really lovely person, and I really did feel that we could help him.

We can see there's so much going on here. We have class three incisal relationship.

We have occlusal trauma anteriorly.

We have significant tooth wear. There's not this is not just attrition. This there's there's erosion here going on as well.

We have caries.

We've got cracks. We've got this interesting bridge that's been put in, so he's got five incisors rather than four.

And, ultimately, there was, you know, something pretty much wrong with every single tooth.

And apart from the upper sixes, which always makes me laugh because they're one of the teeth that have been been in there the longest.

But you can see there is extensive problems on all the dentition.

And so we really need you know, he really does need help. This isn't a purely aesthetic case. We can't look at this tooth by tooth because if we look at this tooth by tooth, we're not going to solve the overall issue. And so we start to look at things as a whole and move away from this single tooth dentistry Because single tooth dentistry is what has got Tom here in the first place, and now we need a different solution to get him to a position of stability.

So OPG, and again, we're using pearl. I don't need to tell Tom, you know, your idea with this because I I like it. It actually really helps my thinking as well. It's very visual. So I do this from the scan.

You know, the newest scanners now can detect caries, which is fantastic. So you've got another way of showing patients. But I can take the OPG AI I can show show, AI, I can look look at everything that's flaring up here. There's a lot going on posteriorly.

We've got primary disease, but we've got tooth wear. We've got cracks. And bringing it all together, Tom can start to see that actually this isn't going to be a simple case of replacing those lower anterior veneers. There's a lot more going on here.

And, again, we can show him show him the bone levels. So thinking about where the bone is, and we had some periodontal disease, especially around this bridge on the lower AI, replacing that well, the second lower right too because it's a fifth incisor, where he was struggling to clean around, and there was decay around the back of it, around all the lingual surface.

But I don't I don't have to prove anything. AI it's there. It's written. It's it's showing up on the screen for me, and it may means that the conversation is very different because instead of me having to persuade Tom that these things are going on in his mouth, I can show him that these things are going on in his mouth. And I can say, look. This is what's being flagged up.

So k, that's what it looks like in real money. So that's what we can see. This is what it looks like underneath the surface, and here is what's going on underneath the surface in more detail around specific parts of the mouth. And then we can move on to, okay.

Great. What are our options? What is our treatment plan here? What are we going to do?

It's not often in life that we're given gifts.

Okay?

And here we were given a gift with this extra little incisor. But if we think about this, these class threes, edge to edge, he's got look at that occlusal trauma on the veneer on the upper left one.

The reason why that lower left two, that lower left one is pinging off all the time is because the occlusion.

It's not because of pure poor bonding.

It's just being smashed off in in in as he's functioning.

So we want to create a better overjet. Again, we want to create a better overjet. I don't want to do any retraction of these upper anterior teeth. I want to keep those the way they are. Let me use this to restore, but I do want to create a little bit of space so that the mandible has space to function, has space to move.

We sorted out all the primary disease first. Okay? So, posteriorly, we were placing onlays.

We were, you know, doing addressing the decay. We're addressing the periodontal disease as much as we could around this lower right two, lower right three area.

And then we move on to getting the teeth into the right position.

And here, what we're trying to do is we're trying to create a better overjet.

Okay? Level the incisal edge level the gingival margin slightly so that we can come in and restore.

And we did a little bit of expansion on those canines. So you can see the canines, they're almost edge to edge in the pre op on the left hand side, and then on the right hand side, they come out.

Use of class three elastics, and this is what we're aiming for. We're aiming to create space. Now don't forget, Tom has quite significant tooth around the palatal of his upper anterior teeth. So we're trying to create space, yes, for where the teeth are now, but also I want to add palatally. I need to add material palatally.

So we start moving and we go from here. Notice how the lower right tooth is quite tipped.

And we want the teeth lower incisors to be upright. That's what we're aiming for. Okay?

Now with periodontal disease, you know, the less bone you have, the less stability you have, and the more mobile the teeth can feel, and it can be a little bit daunting sometimes when you're looking at the teeth and they are quite mobile. They should be mobile if they're moving. But it did get to a point where me and Tom were like, oh, gosh. Actually, you know, AI let's let's just check.

So let's take the X rays. We took the X-ray. AI was actually quite happy with how upright that lower right one was looking. If you look at the roots, they're much more AI.

They're in a much better position. They're not tipped.

And then we were also just double checking bone levels, making sure that we were happy and that we had sort of stability there. We weren't seeing anything any drastic changes.

But, ultimately, what we decided here is even though we were quite reassured by the figures that we were seeing and by what we were seeing on the screen and the x-ray, we did decide that we were going to stop treatment because we said, well, we've got the crown and the roots upright. That is what we really, really want. And if there's a little bit of space, left over, then I can close that with a bit more composite mesial to the cape to the lower right three, rather than trying to push that lower right two even further, to the right. So we AI, driven by the AI, driven by the technology that we were seeing, that this actually was a good place for us to finish.

We had our positive overjet. We had the space we needed, and then we go into our diagnostic wax up. So this I love that this can come back and forth from the lab so easily. We can make tweaks, make sure we're happy, make sure AI then send it to the lab, make sure the patient makes sure he's happy.

And, again, we're looking at that additiveness. So if we can see anything that's coming through, we can say, actually, no. Let's maybe add a quarter of a millimeter buccally, so that we don't need to do any more preparations. Ultimately, we've had a lot of tooth tissue loss here already.

So we do a smile trial, make sure we're generally happy with how things are gonna look, and then we do our preparations. I like to prep through the temporary. I like to do the smile AI, sorry, and then I prep through.

You can see the upper anterior teeth, pure the buccal surface is beautiful enamel. I really haven't touched anything. And given that those upper central incisors, the veneers were on, I think, for about twenty years, Right? What wonderful preparations to find underneath.

The lower incisors had had a little bit more of a heavy prep when they'd had the veneers done. So, really, we just took those off, smoothed it out as best we could.

But, you know, we're bonding to dentine there.

Not always the ideal situation, but it will it will work. It will be okay.

So preparations, I really didn't touch the palatal because the palatal had that tooth wear. So Tom had almost done that treatment for me.

And we so I just polish around the path of insertion. They are gonna be wrap around crowns, full crowns in the upper anteriors because of that loss we had, previously. On the lowers, we're gonna stick to veneers.

So we review the temporaries, and I'm checking to make sure I'm happy with the phonetics, the function, the shape, the aesthetics, make sure Tom's happy. He normally comes back a week later. So he wears these for a week at home, looks at them in different situations, make sure he doesn't come back with everything chipped and broken, and he didn't.

So then we put in our final crowns and our final veneers.

And me and Tom, you know, the good thing about being able to have that communication, that rapport right at the start with your patients is that if things aren't perfect, then you can have a conversation about it. So for instance, if we look here, the lower AI, three, the lower right, two, you'll see the gun looks really inflamed. It looks quite angry.

And I've left a space, meso of the lower right three. And we were really struggling here with the periodontal. We're really struggling here with the stability of that lower right two. It was mobile. And so it was a very good decision that we decided to abandon, you know, abandon, but to stop the ortho side of things a little earlier. Once we got everything upright, that was that was the right decision.

And then it was a decision, do we place a fixed retainer or do we not place a fixed retainer?

And there are pros and cons for both. So placing a fixed retainer, the pros, yes. We've got reduced alveolar support, so that would be quite helpful from a stability point of view.

We have mobility. Have increased mobility because of the reduced alveolar support. So, actually, that will help with the stabilization as well.

But negatives.

There's periodontal disease that already is going to make the situation more difficult to clean, and Tom struggled when he had a bridge there initially.

Not only that but if we look at the plate or surface of that lower right two, the lower right one, there's been root canal treatment. There's been heavy veneer preps. So actually, there's very little tooth left for us to bond onto.

So how stable is that fixed retainer going to be? So me and Tom had a conversation. I said, look. I don't know what the best answer is here, but I think what we should do is we should wait and see. We'll make some temporary s six retainers, and let's see if everything AI in six months. If it doesn't, I will place a fixed retainer, and I'm gonna add some composite mesial to that lower right three. But I wanted to place the composite at when I placed the fixed retainer, not diff separately because I want I wanted to get the best bond strength that I absolutely could.

I didn't want to bond. AI we can bond composite to composite, but I didn't want to do that if I can help it. So we said, right. We'll leave it six months.

And this is what I mean about that open and honest conversation, all driven from that earlier, you know, open and honest visualization conversation.

And waited six months, it hadn't stabilised. Okay? Actually, what Tom had found is because it was it because the tooth was mobile, he didn't really want to clean around it as well as he should be even though he was going to, therapy appointments, because it was making him a little anxious. So we said, AI.

No. Okay. Let's take the lower right through. We're gonna put a composite. We're gonna put a fixed retainer, and then we're going to see.

So he's back with the periodontist at the moment, back AI to get that nice stability, and he will get there. He's very motivated.

I have no doubt he'll get there. And AI get I reckon in a month or two, I'll have new photos of him showing, all that gingiva AI and healed. So the right, the lower right side will look like the lower left side.

But he's thrilled at the moment. He's so happy at the moment. We've achieved better stability.

We've got rid of the tooth wear, better aesthetics. He's much more confident.

And he's absolutely thrilled that we looked at everything as a whole, and he's thrilled with the results.

So that's really putting everything together, and it really, I find, shows the importance or that the the the necessity of making sure that we really understand our patients. And I truly believe it's all built out of finding out their why. What has driven them to come and see you in this moment, in this time?

And then showing them our AI. Showing them visually showing them what we can see in their mouth through photos, through scans, through AI on the X rays. Because the more that we can show them, the more that we can marry up their AI and our why together, the more likely they are to go ahead with the treatment that they need and the more likely they are to get the result that they want. Because we're coming from a place of understanding from both places.

So for me, I use the digital tools, the AI technology for every single patient. I think it's absolutely critical, not just from, well, from diagnostics, from treatment planning, from monitoring, all the way through, to get patients the results that they want.

I like to leave lectures on this. So you are the hero of your own story. So you go out there. You make those decisions, and you create the life that you want to create. So for me, that came through doing clear aligner therapy and really making sure that that was the cornerstone of my, cornerstone of what I was offering to patients because it drives me. I I just get so excited when I think about biomechanics, which is sad, but I do. I really, really enjoy it.

And you could be the hero of your own story as well. The flip side of this is that we also have to allow patients to be the hero of their own story. We're there to support them, and to help them get to where they want to be. And the more we can show them, the more that they can see, the more that they can almost feel, with the use of AI technology and these tools, the digital tools we have today, you know, the more likely they are to harness that power and go forward.

So thank you very much.

It's been an absolute pleasure. I hope that you that that's been helpful.

If anyone would like more information about Pearl, if you look up Pearl AI, it is an absolute fantastic software, and I use it daily with my patients.

I love it. They love it. It gives me more confidence. It gives me better communications. It gives the patient more confidence.

So there's tons of benefits. And if anyone wants to, contact me, then you can do so through the, website, where I run a program, twelve month mentorship program about clear aligners or through Instagram. And I can't wait to connect with you. So I'm gonna stop the webinar now. I'm gonna take down the webinar, and then I'm going to answer some questions.

So stop sharing so I can see, and then let's go and have a look at questions.

So, the zirconia bridges, how are they bonded? So you can bond zirconia.

You just have to, follow, certain principles. So air abrasion, and MDP a bond which has MDP or MDP primer, and then, just resin cement. So nothing crazy fancy, but just following those steps, making sure, you know, as always, there's no, water or, or contamination.

And then I say, well, I love zirconia bridges. I find they work really, really nicely.

So for Ben's case of composite bonding on the AI to make them look like lactose being oxygen is less invasive. That's that is what we did. So we moved the teeth, into a slightly different position. It was all additive. There was no they didn't pick up a drill once, and touch enamel on his, so we did composite.

If he wants to later on, he can use ceramics, and there'll probably need to be a little bit of preparation just on the, towards the bulbosity of the canine gingival. But other than that, everything everything was, additive. There was no, no no drilling of those canines at all.

Perfect. So they're the only two questions I can see. So I'm not sure if I'm missing any, but hopefully AI not.

Nope. We're all good, doctor Milley. Brilliant. Okay. Well, thank you so much, everyone.

Have a wonderful rest of your evening. Have a wonderful rest of the week, and hopefully we see some sunshine this evening this weekend. Sorry.

And thank you very much for having me and for hosting. Bye bye.

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