Dental Digest Podcast with Dr. Melissa Seibert

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  In Part 2 of this two-part conversation on Dental Digest, Dr. Melissa Seibert continues her discussion with digital dentistry educator and CAD/CAM expert Dr. Michael Skramstad. While Part 1 focused on the foundations of digital workflows, this episode explores the clinical nuances where digital dentistry either enhances precision or quietly introduces risk. The conversation begins with one of the most under-recognized challenges in restorative dentistry: the accuracy of digital bite registrations and full-arch scanning. Dr. Skramstad explains that while intraoral scanners are highly capable, their accuracy is heavily dependent on clinician awareness and workflow management. In cases where patients struggle to find a repeatable bite position, digital or analog records may both become unreliable. In these scenarios, techniques such as deprogramming with a leaf gauge and capturing an open CR bite digitally can improve reproducibility and clinical outcomes. DDP SkramstadP2 First Edit Dr. Skramstad then discusses one of the most important factors affecting digital impressions: margin management. While scanner technology has improved dramatically, the accuracy of digital impressions still depends primarily on the quality of the tooth preparation and effective hemostasis. He emphasizes that meticulous preparation design remains the single most important determinant of restorative fit, regardless of the digital system used. DDP SkramstadP2 First Edit The discussion also explores practical strategies for managing subgingival margins. Techniques such as ViscoStat Clear for hemostasis, selective use of retraction cord, and careful isolation protocols can significantly improve scan accuracy and margin visualization. Importantly, workflow decisions may differ depending on whether restorations are fabricated in-house or sent to a laboratory, since file formats such as STL lack color information and can make margin identification more difficult for technicians. DDP SkramstadP2 First Edit The episode then shifts to material selection in contemporary restorative dentistry, particularly the evolving role of zirconia. Early zirconia restorations were often criticized for poor esthetics, but recent material innovations have dramatically improved translucency and optical properties. Dr. Skramstad explains why modern zirconia systems—such as multi-layered zirconia materials—are increasingly used in both posterior and selected anterior applications, while still maintaining the exceptional strength that originally drove zirconia's adoption. DDP SkramstadP2 First Edit The conversation also addresses: • The clinical differences between bonding vs. cementing zirconia restorations • How preparation design influences retention and restorative longevity • The impact of speed sintering on zirconia optical and mechanical properties • When digital workflows simplify restorative dentistry—and when they introduce hidden complexity One of the most important themes reinforced throughout the discussion is that digital dentistry does not replace clinical fundamentals—it magnifies them. Technology can improve efficiency and accuracy, but it cannot compensate for poor preparation design, inadequate isolation, or imprecise clinical technique. For dentists exploring or expanding digital workflows, this episode provides a grounded perspective on how to integrate digital tools responsibly while maintaining the biological and mechanical principles that underpin successful restorative dentistry. Topics discussed include: • Digital bite registration and centric relation records • Margin management in digital impressions • Hemostasis techniques for intraoral scanning • STL vs PLY file formats in digital workflows • Zirconia vs lithium disilicate restorations • Speed sintering and modern zirconia materials Whether you're already practicing chairside CAD/CAM dentistry or simply evaluating digital systems for your practice, this conversation offers a thoughtful look at how technology intersects with clinical judgment in modern restorative dentistry.

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf    Digital dentistry has transformed restorative workflows over the past decade—but many clinicians still struggle to understand where digital tools truly improve accuracy and where limitations remain. In this episode of Dental Digest, Dr. Melissa Seibert sits down with digital dentistry educator and CAD/CAM expert Dr. Michael Skramstad to explore how intraoral scanners, digital bite registration, and AI-assisted articulation are actually performing in modern restorative practice. Dr. Skramstad has spent decades working at the intersection of clinical dentistry and digital innovation. As a longtime CAD/CAM educator, CEREC trainer, and product consultant for major dental manufacturers, he has stress-tested many of the technologies shaping today's digital workflows. In this conversation, he shares practical insights into how scanners perform in real-world restorative dentistry—not just under ideal conditions. The discussion begins with one of the most persistent challenges in digital workflows: occlusion accuracy. While intraoral scanners can capture highly detailed digital impressions, digital bite registrations can still introduce discrepancies. Dr. Skramstad explains the multiple factors that influence digital occlusal accuracy—including scanner technology, scan strategy, tooth mobility, the number of teeth captured, and even how firmly a patient bites during the scan. He notes that while single-unit restorations tend to be forgiving, larger cases such as full-arch restorations demand far greater precision. The conversation then explores emerging tools designed to address these limitations, including AI-based articulation software such as BiteFinder, which analyzes tooth morphology and wear patterns to algorithmically re-articulate digital models and improve occlusal alignment.   Dr. Skramstad walks through how clinicians can integrate these tools into their workflows when sending cases to the lab or designing restorations with Exocad. Dr. Seibert and Dr. Skramstad also compare leading intraoral scanners and discuss how different systems perform depending on the clinical application. Some scanners excel at capturing tooth structure, others capture soft tissue more effectively, and certain systems may provide advantages when scanning full-arch cases. The discussion highlights why scanner field of view, scan stitching algorithms, and scan path protocols all influence the final digital model accuracy. Beyond technology itself, the episode also touches on clinical workflow and team integration. Dr. Skramstad shares how responsibilities such as scanning, designing restorations, and fabricating surgical guides can be delegated within the dental team. He discusses why some aspects of digital dentistry benefit from delegation while others require direct dentist oversight—especially when precision and aesthetics are critical. Finally, the conversation broadens into leadership and practice management. Dr. Skramstad shares lessons from running a large dental team and explains why hiring for character and adaptability often matters more than prior experience. These insights offer a valuable perspective for clinicians building teams in modern digital practices.

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  In Part 2 of this series, Dr. Melissa Seibert and Professor Bart Van Meerbeek transition from foundational adhesive science into the nuanced clinical decisions that shape long-term outcomes. If Part 1 established the biological and material principles behind durable bonding, this episode addresses the gray zones clinicians navigate daily: contamination, enzymatic degradation, substrate variability, polymerization stress, and postoperative sensitivity. The discussion confronts several widely accepted assumptions and asks a more rigorous question: what does the evidence actually support? Professor Van Meerbeek offers data-driven clarity on topics that are often ritualized rather than critically examined. From the debated role of chlorhexidine and MMP inhibition to the thermal effects of curing lights, air particle abrasion, C-factor management, and the true value of flowable composites, this conversation reframes bonding as a system rather than a single step. The message is consistent: simplification may be attractive, but substrate awareness, technique sensitivity, and respect for hydrophobic layering remain central to predictable outcomes. The episode concludes with a forward-looking reflection on where adhesive dentistry stands today. According to Van Meerbeek, modern multi-step systems may already be operating above 90% of their theoretical potential. The future, therefore, is not merely about bonding harder but bonding smarter—possibly integrating bioactivity without compromising performance. For clinicians committed to practicing with intellectual precision rather than procedural habit, this episode provides both reassurance and recalibration.  

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  In Part 1 of this two-part series, Dr. Melissa Seibert sits down with Professor Bart Van Meerbeek, one of the most influential figures in adhesive dentistry worldwide. From dentin permeability to hybrid layer degradation, Professor Van Meerbeek's research has fundamentally shaped how clinicians understand the biological and mechanical realities of bonding. This conversation moves beyond product marketing and into the core science: what we truly know, what remains uncertain, and why durability in adhesion continues to require deliberate clinical judgment. Together, they unpack the "adhesion degradation paradox," the hydrophilicity trade-off inherent in universal systems, and the persistent performance gap between simplified one-step adhesives and multi-step gold standards. The discussion explores film thickness, hydrophobic layering, stress distribution, and the biomechanical role of flowable composites as stress-relieving buffers. They also examine why 10-MDP concentration matters, why not all universal adhesives perform equivalently, and how bonding strategy should be tailored to substrate conditions—from young permeable dentin to sclerotic or amalgam-affected substrates. This is not a discussion about shortcuts. It is a rigorous, clinically grounded examination of what evidence-based adhesive dentistry actually demands. If you are striving to practice with greater clarity, confidence, and scientific defensibility, this episode will recalibrate how you think about bonding protocols in everyday practice. Part 2 will continue the conversation, moving deeper into contamination management, clinical troubleshooting, and long-term durability.

JOIN ELEVATED GP Follow @dr.melissa_seibert on Instagram   Dr. Dichter brings nearly 20 years of clinical, research and teaching experience — as a general practitioner and prosthodontist — to his position with Spear. He serves as an instructor in the Treating the Terminal Dentition and Fully Edentulous Patient seminar, in addition to multiple Spear Workshops. Dr. Dichter has served as a guest lecturer and clinical instructor at Oregon Health and Science University School of Dentistry, teaching occlusion and esthetics. He has been a Spear faculty member since the company's inception, as well as a contributing author for Spear Digest. He is passionate about education and is involved with multiple study groups in the U.S. and Canada. After earning his D.M.D. from OHSU in 1995, Dr. Dichter practiced general dentistry and eventually joined a startup practice in his hometown in coastal Oregon before moving to a practice in Portland. He brought 16 years of restorative dental experience into UCLA's world-renowned, full-time advanced prosthodontics residency, which he completed in 2014.

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  Episode Description In part two of this two-part conversation, Dr. Brian Vence moves from philosophy into execution, offering a clear, ethical, and highly practical framework for how comprehensive dentistry is diagnosed, discussed, and ultimately chosen by patients in a successful fee-for-service practice. This episode is a deep dive into how dentists can guide patients through complex decisions without pressure, persuasion, or procedural selling. Dr. Vence outlines his structured yet flexible approach to patient intake, record gathering, diagnosis, and treatment planning—centered around what he calls the Pathway to Essential and Meaningful Treatment. Rather than dictating solutions, he emphasizes co-discovery: helping patients see, understand, and articulate their own problems before ever discussing procedures. A central theme is risk reduction over procedures. Dr. Vence explains how he frames treatment options not as products to purchase, but as graduated ways to lower biological, structural, functional, and aesthetic risk over time. From stabilizing compromised teeth to sequencing orthodontics, restorative care, and provisional solutions, the focus remains on sustainability—not urgency. You'll hear practical insight on: How to structure patient intake from the first phone call through diagnosis and case presentation Why allowing patients to ask for solutions is more powerful than proposing them How to use analogies and visual co-discovery to explain complex problems without overwhelm The difference between short-term stabilization and long-term structural correction Why timelines, pacing, and emotional safety matter more than closing treatment plans Dr. Vence also addresses real-world concerns around fees, financing, and practice sustainability. He discusses why fee structures should reflect time, complexity, and overhead—not insurance schedules—and how this approach supports both clinical integrity and business stability. Importantly, he underscores that dentists cannot want treatment more than the patient does—a mindset shift that allows for clarity, calm, and long-term success. The episode closes with a candid reflection on leadership, emotional resilience, and the inner work required to sustain a fee-for-service practice over decades. Dr. Vence shares why confidence doesn't come from certainty or volume, but from having a clear vision, strong values, and the ability to remain grounded as conditions change. Together, parts one and two provide a comprehensive roadmap for dentists who want to practice at a higher level—clinically, ethically, and relationally—while building a practice that is both financially stable and deeply fulfilling. This is not about faster dentistry. It's about better decisions, made well, over time.

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  Episode Description In part one of this two-part conversation, Dr. Brian Vence shares a deeply thoughtful and experience-driven perspective on what it actually takes to build a successful fee-for-service practice—one rooted not in persuasion or sales tactics, but in trust, diagnosis, and meaningful human connection. With more than three decades of clinical experience and a career dedicated to interdisciplinary, comprehensive care, Dr. Vence reframes treatment planning as a behavioral and relational process, not a transactional one. He challenges the idea that comprehensive dentistry is something that must be "sold," and instead positions it as a process of helping patients clarify their own values, goals, and tolerance for risk—at their pace, not ours. This episode explores how dentists can meet patients where they are without abandoning ideal diagnosis. Dr. Vence explains why patients often fixate on a single tooth or isolated concern, and how honoring that starting point—when done thoughtfully—can open the door to deeper, more comprehensive care over time. Rather than overwhelming patients with full-mouth solutions on day one, he advocates for sequencing conversations, building psychological safety, and creating space for patients to envision what's possible. A major theme of the discussion is the concept of "Pathways to Essential and Meaningful Treatment." Dr. Vence walks through how environment, language, and timing directly influence patient decision-making—and why treatment planning conversations are often better held outside the operatory, away from the fight-or-flight associations many patients carry with dentistry. In this episode, you'll hear: Why fee-for-service dentistry begins with mindset and culture—not insurance policies How to stop "convincing" patients and instead become a clear, unbiased sounding board Why comprehensive treatment planning is fundamentally about behavior, not procedures How environment and language influence whether patients feel safe enough to future-focus The importance of honoring patient autonomy while still holding space for ideal diagnosis Dr. Vence also shares practical insights into new patient workflows, from the first phone call to in-office consultations, emphasizing the value of curiosity, listening, and slowing down. He highlights why efficiency often crowds out effectiveness—and why the most productive clinical days are rarely about volume, but about depth of connection. This conversation is especially relevant for dentists who feel tension between practicing the dentistry they know is right and navigating patient hesitancy, financial concerns, or insurance-driven expectations. If you've ever felt frustrated trying to align comprehensive care with patient readiness, this episode offers a grounded, humane, and sustainable way forward. Part one sets the philosophical and relational foundation. In part two, the conversation continues into diagnosis, case presentation, and how to guide patients through complex decisions without coercion. This is not an episode about selling dentistry. It's about helping patients—and clinicians—make clearer, more meaningful choices.  

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf     Episode Description In part two of this in-depth conversation, Dr. John Kois moves beyond theory and into clinical application, tackling the questions every restorative dentist eventually faces: Who is actually a high-risk occlusal patient? How do we distinguish past adaptation from active breakdown? And why do so many "standard solutions" fail to prevent restorative complications? Building on the foundational concepts from part one, this episode focuses on how occlusion shows up in day-to-day practice—and how dentists can make more informed decisions before committing to complex restorative or implant treatment. Dr. Kois explains why visual wear alone is an unreliable predictor of risk, how to identify whether wear is active versus inactive, and why patient symptoms often tell a more important story than what we see on models or scans. A major theme of this conversation is closing the gap between chairside evaluation and real-world function. Dr. Kois challenges common habits—such as adjusting restorations with patients fully reclined, relying solely on articulating paper marks, or reflexively prescribing nightguards—and explains why these approaches often miss the true etiology of failure. Instead, he emphasizes evaluating occlusion in positions and movements that reflect how patients actually chew, speak, and function throughout the day. In this episode, you'll learn: How to identify true high-risk occlusal cases before restorative treatment begins Why active wear and patient-reported change matter more than historical attrition How muscle symptoms, mobility, and joint loading influence predictability When nightguards and Botox may mask symptoms rather than solve the problem Why larger restorative and implant cases demand a deeper understanding of jaw position, tooth fit, and functional pathways Dr. Kois also shares candid insights on emerging technologies such as jaw tracking—where they add value, where they fall short, and why they are most impactful in comprehensive and full-arch cases rather than routine dentistry. The discussion highlights an important truth: many restorative failures are not material failures, but diagnostic failures rooted in incomplete occlusal assessment. The episode closes with a powerful reflection on learning, clinical growth, and professional development—distinguishing information from knowledge, and knowledge from wisdom. Dr. Kois outlines the progression from skepticism to commitment, underscoring why true clinical mastery requires not just understanding concepts, but applying them consistently over time. Together, parts one and two form a cohesive framework for thinking differently about occlusion—one grounded in physiology, adaptation, and long-term predictability. If you're aiming to move beyond bread-and-butter dentistry and into more complex, fulfilling clinical work, this conversation provides essential perspective on how to do so more thoughtfully and successfully.

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  Episode Description Occlusion is one of the most talked-about—and most misunderstood—topics in restorative dentistry. In this first installment of a two-part conversation, Dr. John Kois challenges many of the static, mechanical definitions of occlusion that most dentists were taught in dental school and offers a fundamentally different way of thinking about how the masticatory system actually works in real patients. Drawing from decades of clinical practice, specialty training in both periodontics and prosthodontics, and his experience educating restorative dentists around the world, Dr. Kois reframes occlusion as a dynamic, adaptive system rather than a fixed set of contacts to be checked off with articulating paper. He explains why relying solely on traditional concepts like MIP, right and left working movements, and morphological classifications often fails to predict long-term outcomes—and why this gap is at the root of many restorative failures, postoperative sensitivity, mobility, muscle pain, and patient dissatisfaction. This episode lays the foundation for understanding occlusion through the lens of function, adaptation, and risk, rather than dogma. Dr. Kois introduces key concepts such as pathway wear, jaw position relative to the head, and the body's adaptive responses to occlusal disharmony—highlighting why so many problems are misattributed to bruxism, airway issues, or "parafunction," when the true etiology lies elsewhere. You'll hear why: MIP should be viewed as a terminal position, not the starting point of occlusal analysis Static bite relationships often tell us very little about whether an occlusion is actually working Pathway wear is one of the most critical—and commonly missed—risk factors in restorative cases Many restorative "failures" are actually adaptive responses by the body trying to protect itself Dentists often succeed not because occlusion is ideal, but because patients adapt—sometimes at a long-term biological cost This conversation is especially relevant for dentists who want to move beyond single-tooth dentistry and into more comprehensive care—full-mouth cases, complex restorative planning, implant rehabilitation, and interdisciplinary treatment. If you've ever had a case that looked perfect on the articulator but unraveled clinically, this episode will help you understand why. Part one sets the conceptual framework. In part two, the discussion continues into how these principles influence diagnosis, restorative decision-making, and long-term predictability. If occlusion has ever felt confusing, frustrating, or inconsistent in your hands, this episode will help you start seeing the system differently—and more clearly.

Episode Description In Part 2 of this two-part conversation, we move from theory into the real-world details that quietly put dentists at risk every single day. My guest, Evan Sampson, is a healthcare attorney who has served as general counsel to one of the largest dental support organizations in the country. He brings a rare and invaluable perspective at the intersection of dentistry, law, payer audits, and regulatory enforcement — and in this episode, we get very specific. We unpack what actually makes certain procedures, CDT codes, and clinical scenarios high-risk from a fraud, waste, and abuse standpoint, even when there is no malicious intent. Evan explains how dentists inadvertently get flagged as outliers, why payer audits are often data-driven rather than complaint-driven, and how documentation gaps — not clinical skill — are what ultimately create exposure. This conversation goes deep into: Why up-coding, unbundling, and weak surgical extraction documentation are some of the most common (and expensive) pitfalls How payer audits are triggered, what auditors look for, and why Medicaid claims carry disproportionate risk Why dentists should write progress notes as if a regulator, payer, or board investigator will read them later — because one day, they might The legal realities of fee-for-service, out-of-network billing, professional courtesy, discounts, and when "good intentions" can still create compliance problems We also spend significant time on a topic every dentist encounters but few are trained to manage: difficult and high-risk patients. Evan shares how to identify red flags that may not be obvious at first, when it is appropriate to terminate the doctor-patient relationship, and how to do so without exposing yourself to allegations of abandonment. We discuss unruly patients, non-payment, mid-treatment dismissals, refunds, releases, and why protecting your license sometimes means making uncomfortable — but strategic — decisions. This episode is ultimately about risk reduction, professionalism, and self-preservation. Not practicing defensively, but practicing deliberately. Tightening the details. Building a culture of compliance. And understanding that most dentists who get into serious trouble never thought they were doing anything wrong. If you care about protecting your license, your livelihood, and your future — this is an episode you don't want to skip.

Episode Description Most dentists think of compliance as a background concern—something administrative, abstract, or handled by "the office." In reality, it's one of the highest-risk, most overlooked areas of modern dental practice. In Part 1 of this two-part series, Dr. Melissa Seibert sits down with Evan Sampson, a healthcare attorney with over a decade of experience advising dentists and healthcare organizations on fraud, waste, abuse, regulatory compliance, and risk mitigation. Evan has served as General Counsel to a major dental support organization and held senior compliance leadership roles within the largest municipal hospital system in the United States. In this episode, he pulls back the curtain on what compliance actually looks like in day-to-day dentistry—and why well-intentioned clinicians often put themselves at risk without realizing it. This conversation reframes clinical notes as legal evidence, not just charting formalities. Together, Dr. Seibert and Evan explore how common documentation habits—templated notes, vague progress entries, auto-populated language, and inconsistent coding—can quietly become liabilities during audits, payer disputes, or board complaints. You'll hear a candid breakdown of: What fraud, waste, and abuse actually look like in everyday dental practice (and why most of it is inadvertent) Why documentation and coding errors are among the most common sources of exposure for dentists The legal risks of upcoding, unbundling, and inaccurate procedure representation Why surgical vs. simple extraction coding is so frequently audited How "write it once and forget it" charting can come back years later—with real consequences The mindset shift dentists need: writing notes as if they will be read aloud in a courtroom Why the cover-up—or "fixing" notes improperly—is often worse than the original mistake How compliance, when done well, can actually reveal missed revenue and operational inefficiencies This episode isn't about fear-mongering. It's about clarity, ownership, and professional maturity. If you're a dentist who cares deeply about doing the right thing—clinically and ethically—this conversation will fundamentally change how you think about notes, coding, and responsibility. And this is just the foundation. Part 2 will go even deeper into consent, adverse events, and proactive strategies to protect yourself, your license, and your future. If you've ever thought: "I didn't know that could be a problem." "That's how we've always charted." "The front desk handles the coding." This episode is required listening.

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  In Part 2 of this powerful series, Dr. Melissa Seibert continues her in-depth conversation with cosmetic dentist and AACD leader Dr. David Eshom, exploring the deeper psychological, business, and interpersonal frameworks that underpin a thriving fee-for-service practice. Together, they unpack the realities of transitioning away from insurance dependence, the emotional traps dentists fall into, and the communication strategies that safeguard both the patient relationship and the dentist's peace of mind. Dr. Eshom offers decades of wisdom on how to recognize patient readiness, how to present comprehensive treatment without triggering defensiveness, and how to gracefully identify patients who may not be ideal candidates for complex care. He shares the subtle behavioral cues that differentiate collaborative patients from those who may become litigious, overly exacting, or misaligned with your practice philosophy—and how to exit these relationships ethically and respectfully when needed. The episode also tackles some of the profession's most pressing realities: Why the insurance model forces dentists into ethical and financial corners How to communicate a fee-for-service structure without alienating patients The psychology behind presenting conditions and consequences—not pressure and sales Why slowing down for deeper exams ultimately accelerates practice growth How to block your schedule, restructure hygiene exams, and build time for meaningful conversations The importance of discernment: knowing when a patient is truly a "yes," when they're a "not now," and when they're a "no" Dr. Eshom also walks through his workflow for large aesthetic cases—from shade decisions to motivational mock-ups and trial smiles—while highlighting how these tools improve clarity, set expectations, and reduce risk for both patient and provider. The conversation concludes with a reflective discussion about building a freedom-based business, attracting aligned patients, and creating a practice model that delivers exceptional dentistry without compromising your wellbeing, your values, or your clinical standards. If you've ever wondered how to elevate your practice beyond the constraints of insurance, identify ideal patients, or cultivate a career defined by autonomy and fulfillment, this episode is a masterclass in sustainable, relationship-driven dentistry.

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  n Part 1 of this two-part series, Dr. Melissa Seibert sits down with cosmetic dentist and AACD residency preceptor Dr. David Eshom for a powerful conversation that reframes how dentists think about photography, diagnosis, communication, and case acceptance. Drawing from more than 20 years of comprehensive cosmetic dentistry, Dr. Eshom reveals why extraoral photography—not intraoral cameras, not radiographs—is the single most effective tool for building trust and helping patients clearly see the value of comprehensive care. Together, they break down a step-by-step new patient workflow that seamlessly blends diagnostics with psychology, showing how simple point-and-shoot photography placed at the beginning of the exam can elevate patient engagement, differentiate your practice, and eliminate the pressure-based communication styles that leave patients feeling skeptical or overwhelmed. Dr. Eshom explains how co-diagnosis—rooted in permission-based dialogue and visual storytelling—helps patients recognize their own conditions, understand consequences, and ask for solutions rather than being sold to. This episode dives into: The most overlooked use of photography in dentistry: real-time conversation with the patient How to structure a new patient visit that fosters trust, clarity, and long-term case acceptance Why facially generated treatment planning is so effective—especially for patients who "never knew" what their smile looked like Communication strategies that shift patients from an "insurance model" to a value-driven mindset How simplifying photography (yes, even with an iPhone or point-and-shoot) makes comprehensive exams dramatically more effective What to say—and not say—when presenting conditions to avoid making patients feel judged or pressured How this method empowered Dr. Eshom to build a fully fee-for-service practice and drop every insurance plan This conversation is practical, strategic, and deeply grounded in human psychology. If you want a proven communication system that elevates your new patient experience, improves case acceptance, and builds lifelong patient trust—all without feeling salesy—this episode will reshape how you practice.

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  In Part 2 of this powerful two-part series, Dr. Melissa Seibert sits back down with renowned oral and maxillofacial surgeon Dr. Scott Bolding, whose orthopedic-driven approach to TMJ diagnostics and surgery is reshaping how dentistry understands joint disease. If you've ever wondered why TMJ patients get "punted" from provider to provider, why MRI-based diagnosis never became mainstream, or how degenerative joint pathology silently derails orthodontic and restorative outcomes, this episode will fundamentally change the way you think. Dr. Bolding unpacks the historical missteps that led to dentistry's decades-long avoidance of TMJ surgery—from disastrous 1980s implant materials to insurance fallout and a profession-wide retreat from joint management. He explains how this cultural shift created clinical blind spots that we still see today, and why the message of "TMJ will get better if you leave it alone" has harmed diagnostic rigor for an entire generation of dentists. Together, Dr. Seibert and Dr. Bolding explore: How ligament injury leads to disc displacement—and when that displacement becomes surgically relevant Why MRI and CBCT are indispensable tools for modern diagnosis (and what specific radiographic findings clinicians should never overlook) How unaddressed joint pathology contributes to tooth wear, occlusal collapse, postoperative symptoms, and even failed orthognathic cases The truth about total joint prostheses today—far removed from the failed biomaterials of the past—and why custom joints offer dramatic predictability for patients with severe degeneration The critical need for comprehensive dentists to reclaim TMJ literacy and function as quarterbacks—not bystanders—in interdisciplinary care Dr. Bolding also describes the orthopedic model for surgical decision-making, clarifying when joints can be repaired, when they cannot, and how airway considerations should influence mandibular advancement in joint reconstruction. The conversation closes with a call to action for dentists everywhere: joint-aware dentistry isn't optional—it's foundational to predictable outcomes in restorative, orthodontic, and airway-driven treatment planning. This is a masterclass in the contemporary philosophy of TMJ management—equal parts clinical insight, historical context, and future-forward thinking.

Join Elevated GP: www.theelevatedgp.com Net32.com  Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram   Description: In this episode, Dr. Scott Bolding — leading oral and maxillofacial surgeon and airway reconstruction expert — dismantles the outdated belief that sleep apnea is primarily a soft-tissue problem. He explains why the bone dictates the obstruction, why skeletal repositioning is the true driver of airway patency, and how maxillary advancement, mandibular rotation, and hyoid biomechanics can radically transform patient physiology. You'll also hear how CBCT, DICE, and joint-first diagnostics reshape treatment planning for sleep apnea and complex cases. A must-listen for clinicians who want to move beyond superficial airway conversations and into evidence-based surgical frameworks.

Join Elevated GP: www.theelevatedgp.com Net32.com  Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram His interdisciplinary approach to dentistry is founded in both empirical research and clinical experience. He attended the University of Washington for both his undergraduate and graduate studies where he received his D.D.S. degree in 1995 and an M.S.D. and certificate in Prosthodontics in 1998. For his entire career, Dr. Kinzer has been committed to furthering the art and science of dental education. His unique ability to impart complex clinical processes in a logical, systematic and clear methodology differentiates him from other Prosthodontists and makes him a highly regarded educator nationally and internationally. He is a full-time teaching faculty at Spear Education in Scottsdale, AZ. where he is also resides as the Faculty Chairman and Director of Curriculum and Campus Education. Dr. Kinzer is an Affiliate Assistant Professor in the Graduate Prosthodontics Department at the University of Washington School of Dentistry and an Adjunct Faculty at Arizona School of Dentistry and Oral Health. Dr. Kinzer is a member of many professional organizations including the American Academy of Restorative Dentistry and the American Academy of Esthetic Dentistry, of which he is currently the sitting President. He serves on the editorial review board for several recognized dental publications and has written numerous articles and chapters for dental publication. He has been honored with the American College of Prosthodontics Achievement Award and in 2018, he received the Saul Schluger Memorial Award for Excellence in Diagnosis and Treatment Planning from the Seattle Study Club. In 2022 he was inducted into the World's Top 100 Doctors as part of the Interdisciplinary Cohort. In his free time, Gregg cherishes spending time his wife Jill and their 6 children. He enjoys anything that he can do outside: golfing, hiking, running, skiing, and biking, in addition to a nice glass of wine.

Injection Molding PDF Email me: dr.melissaseibert@gmail.com Join Elevated GP: www.theelevatedgp.com Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram In this second installment of Dental Digest's conversation with Dr. Jonathan Esquivel, host Dr. Melissa Seibert and her guest push deeper into the artistry, biology, and discipline required to restore anterior implants that are as functional as they are beautiful. While Part 1 introduced Esquivel's framework of space, volume, and time, this episode focuses on the next frontier—provisionalization, emergence-profile design, and the E-B-C concept that defines the biologic foundations of aesthetic implant therapy. Dr. Esquivel begins by demystifying the provisionalization workflow for anterior implants—whether immediate or delayed. He walks listeners step by step through decision-making factors such as ridge healing, tissue phenotype, and the importance of minimizing the number of disconnections to protect the fragile mucosal seal. He stresses that efficiency in implant dentistry isn't about finishing fast—it's about achieving predictability in the fewest biologically respectful appointments. The discussion then turns to the team-based dynamics between the restorative dentist and the surgeon. Dr. Esquivel details how he coordinates cases digitally, sending STL files and mock-ups for joint planning before the first incision. His six-phase system—Acquisition, Blueprint, Confirmation, Design, Execution, and Follow-up—illustrates how restorative-driven implant dentistry must begin with facial and prosthetic design, not with a drill guide. From there, the episode dives into the chairside artistry of immediate provisionalization. Using a pre-milled shell and temporary cylinder, Dr. Esquivel describes how to "pick up" a provisional and sculpt the subgingival contours in real time. But as he emphasizes, the true challenge lies not in fabrication—but in understanding how material additions and reductions influence soft-tissue behavior. This insight leads to one of the most clinically valuable segments of the episode: Dr. Esquivel's E-B-C concept, an evolution of the classic critical- and subcritical-contour framework. The E-Zone (Esthetic Zone), roughly the first millimeter below the gingival zenith, governs margin stability and the visible pink–white transition. The B-Zone (Biologic or Boundary Zone) supports the mucosal seal and should remain concave to create space for healthy soft tissue. The C-Zone (Crestal Zone), the most apical 1–2 mm, must be slim and biologically quiet to preserve the crestal bone. Dr. Esquivel explains how even subtle over-contouring in these zones can trigger recession or bone loss, while proper shaping promotes long-term harmony between implant and tissue. Using tactile language, he describes his preference for pear-shaped acrylic burs to sculpt the concavity of the B-zone, and how digital workflows now allow clinicians to model these micro-contours virtually before any material is placed. The conversation culminates in a reflection on philosophy as much as technique. Dr. Esquivel urges clinicians to focus on mastering the basics—aesthetic symmetry, biologic respect, and patience—rather than chasing novelty. "An implant is not a tooth," he reminds us. "Our goal is to protect the bone, guide the tissue, and understand what we can't see." Listeners will leave this episode with a detailed understanding of: How to design, print, or fabricate custom provisionals that shape the soft tissue biologically The dimensional logic behind the E-B-C zones and how each governs tissue stability Why limiting abutment disconnections preserves the mucosal seal How digital and analog workflows can be integrated seamlessly And the mindset shift required to see implants not as prosthetic devices, but as biologic restorations Part 2 is both a masterclass in subgingival design and a meditation on restraint. Dr. Esquivel reminds us that excellence in implant aesthetics doesn't come from doing more—it comes from doing less, but with absolute intention.

Injection Molding PDF Email me dr.melissaseibert@gmail.com  Join Elevated GP: www.theelevatedgp.com Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram In this episode of Dental Digest, Dr. Melissa Seibert sits down with prosthodontist and educator Dr. Jonathan Esquivel for part one of an enlightening two-part series that explores the biologic and aesthetic complexities of implant restoration. Known for his meticulous approach and his evidence-based framework of space, volume, and time, Dr. Esquivel brings clarity to one of dentistry's most challenging frontiers: the anterior aesthetic zone. They begin by examining why restoring a single anterior implant is often considered the ultimate test of restorative mastery. Dr. Esquivel explains that implants behave fundamentally differently from natural roots—they lack the periodontal ligament and its vascular support—making soft tissue far less forgiving. Even slight changes in tissue contour or bone volume can compromise long-term success. He introduces his four cornerstones for implant predictability: luck (biologic variability), three-dimensional positioning, emergence-profile design, and patient maintenance, emphasizing that precision and patient education are inseparable. The conversation then turns to three-dimensional implant positioning and the role of reverse-engineered planning. Dr. Esquivel insists that every implant must begin with the end in mind—by first visualizing where the tooth should be. He details how ideal placement, roughly 4 mm apical to the planned incisal edge and aligned toward the cingulum, forms the foundation for natural emergence and long-term stability. But true success, he notes, depends equally on interdisciplinary collaboration—sometimes requiring orthodontic repositioning or periodontal modification before an implant is ever placed. Dr. Esquivel and Dr. Seibert next tackle the aesthetic challenge of adjacent implants and the pursuit of symmetry. Perfect papillae between centrals are notoriously difficult to maintain, and Dr. Esquivel discusses techniques—from soft-tissue grafting to orthodontic extrusion—to preserve harmony between the pink and the white. He stresses that treatment planning is as much about patient selection and expectation management as it is about surgical technique: "The hardest part isn't the implant—it's finding a patient willing to go through the process." The discussion deepens into the critical role of soft tissue in achieving lasting aesthetics. Dr. Esquivel explains his distinction between margin-preservation therapies (maintaining existing tissue contours) and margin-re-establishment therapies (rebuilding lost dimensions). He makes a compelling case that most anterior implants benefit from connective-tissue grafting, since thicker tissue phenotypes promote margin stability, mask restorative materials, and protect against recession. From there, the episode explores ridge dimensional changes after extraction—why bone and soft-tissue collapse are inevitable without intervention, and how provisional restorations can slow this process. Dr. Esquivel cautions against relying on removable flippers, which may accelerate resorption, and instead advocates for properly designed Essix retainers or fixed provisionals that maintain space without transmitting occlusal pressure. His guiding principle: space, volume, and time—allowing tissue to heal in an environment that supports both biological integrity and aesthetic form. The conversation culminates with an in-depth reflection on the biological and prosthetic purpose of provisionalization. Drawing on insights from Dr. Todd Schoenbaum, Dr. Esquivel reframes the provisional phase not as optional, but as biologically mandatory. The provisional guides tissue healing, allows for gradual adaptation, and provides essential information for the ceramist—ensuring that the final crown replicates the ideal emergence contours established chairside. As Dr. Esquivel puts it, "Dentists should take credit not for the white, but for the pink—the transition zone we've designed and stabilized." By the end of this episode, listeners will gain a detailed understanding of: How to apply Dr. Esquivel's space–volume–time model to aesthetic implant planning The biologic reasoning behind connective-tissue grafting and margin-preservation therapies Why provisionalization is central to both soft-tissue stability and prosthetic accuracy How to communicate healing timelines and realistic expectations to patients Part one of this series is both technically rigorous and refreshingly human—an exploration of how aesthetic implant success lies not in speed or convenience, but in respecting biology, sequencing, and time.

Injection Molding PDF Email me: Dr.melissaseibert@gmail.com Join Elevated GP: www.theelevatedgp.com Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram Episode Summary In this powerful continuation of their two-part conversation, Dr. Melissa Seibert and Dr. David Attia dive beyond digital workflows to confront the deeper philosophical questions shaping modern implant dentistry. Building on last week's discussion of data stacking, SmileCloud integration, and biologically driven design, this episode explores the nuanced realities of aesthetic-zone decision-making, ethical treatment planning, and the human side of high-level clinical care. Dr. Attia opens with an unflinching look at when—and why—implants may not be the ideal solution. Using examples from his collaboration with renowned prosthodontist Dr. Tony Rotondo, he explains why lateral incisors often perform better with resin-bonded fixed partial dentures (FDPs) rather than implants, especially in cases with limited mesiodistal space or compromised interproximal bone. He and Dr. Seibert examine the synergy between partial extraction therapy and resin-bonded FDPs, illustrating how biologic preservation can achieve long-term aesthetic stability with less surgical intervention. From there, the conversation transitions to Attia's mastery of provisionalization strategies in the aesthetic zone. He details how he designs custom healing abutments and Maryland-style bridges that provide patients with fixed provisionals—even when primary stability is limited. Listeners gain an inside look at his precision-driven process for contouring the subcritical zone, controlling soft-tissue architecture, and creating minimal yet functional clearance between the pontic and abutment. His philosophy is simple but profound: every anterior patient should leave the chair with something fixed—even if it isn't load-bearing. The discussion then widens to tackle the moral tension between commercial dentistry and biologic integrity. Dr. Seibert asks the hard question: How do clinicians reconcile high-quality, time-intensive dentistry with the economic pressures of high-volume practice? Dr. Attia's answer is unequivocal—ethical dentistry may take longer and require greater effort, but the money follows the mastery. He critiques the growing trend of overtreatment in both restorative and surgical spheres, warning of a coming wave of revision cases born from expedience and over-commercialization. Attia advocates for a "longevity-first" mindset—prioritizing preservation over replacement, patient education over production, and sustainable outcomes over speed. Drawing from his own follow-ups across fourteen practices, he reflects on the humility and evolution that come with long-term case review: what he did six months ago wasn't wrong—but it can always be better. The episode concludes with a candid meditation on values alignment in practice. Both clinicians emphasize the importance of knowing one's philosophy, communicating it transparently, and being comfortable acknowledging that "you're not everyone's dentist." Attia urges younger practitioners to resist the social-media allure of aggressive full-arch cases, reminding them that truly exceptional dentistry begins with sound biologic principles, refined communication, and disciplined restraint. Listeners will leave this episode with: A framework for choosing between implants and resin-bonded FDPs in the aesthetic zone Strategies for designing custom provisionals that maintain soft-tissue integrity Guidance on educating patients about biologic and financial "costs" of treatment Insight into navigating the ethical crossroads of modern dentistry This conversation is both technical and deeply human—a masterclass on how to balance innovation with integrity and how to practice dentistry that endures not just biologically, but ethically.

Injection Molding PDF Join Elevated GP: www.theelevatedgp.com Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram   In this first of a two-part series, Dr. Melissa Seibert sits down with Dr. David Attia—an international educator leading the charge in digital and implant dentistry—to explore how advanced technologies are revolutionizing multidisciplinary care. Together, they unpack how tools like SmileCloud, CBCT segmentation, and 3D facial scanning are allowing clinicians to "stack" digital data for unparalleled treatment precision. Dr. Attia shares how virtual patient workflows have streamlined his implant and aesthetic planning, transforming coordination between surgical, restorative, and laboratory teams. The discussion also dives into biologically driven implant concepts, the evolution of partial extraction therapy, and the philosophy that "preservation is the ultimate form of regeneration." This episode will reshape how you think about digital integration and tissue preservation in the aesthetic zone.   Dr. David Attia completed his undergraduate training at Griffith University, Queensland. Following graduation, Dr. Attia completed a Post Graduate Diploma in Orthodontics and Dentofacial Orthopedics through the City of London Dental School. David's passion for surgery led him to complete a Master's in Oral Implantology through Goethe University in Frankfurt, Germany. His Master's thesis focused on a novel approach in full-arch implant rehabilitations and he presented his research at the 6th Annual Congress of Innovation Jumps in Oral Implantology. Dr. Attia now holds a teaching appointment with Goethe University as a surgical mentor for Australian students completing the program. He has also presented on the implementation of photography into clinical practice, as well as the importance of soft tissue management around implants both locally and abroad. Dr. Attia is a core faculty instructor for the Australasian College of Dental Practitioners Graduate Diploma in Oral Implants and is also involved in live surgical training of dentists looking to begin or advance their journey in dental implantology. David thoroughly enjoys the multi-disciplinary approach to dentistry. His unique combination of education and training allows him to implement cutting-edge treatment, offering patients comprehensive, predictable and long-term treatment solutions. He is passionate about sharing knowledge and is regularly involved in training and mentoring recent graduates.