Can you apply the Dahl technique to localised POSTERIOR wear?

Spoiler alert: hell yeah!

How can the Dahl Technique help when there is posterior wear and NO space to restore?

How predictable is building up posterior teeth (rather than the usual worn anteriors)?

In this episode, Jaz dives into the ‘Reverse Dahl Technique’, a twist on the classic method typically used for localized anterior wear. Dr. Hans Kristian Ognedal from Norway shares his insights, explaining how building up posterior teeth with composite can lead to occlusion magic! 

If you’re curious about this technique and want to see a real-life case study, this episode breaks it all down, with a special visual breakdown for those watching on YouTube or Protrusive Guidance.

Protrusive Dental Pearl: Jaz shares insights from Hold On to Your Kids by Dr. Gordon Neufeld & Dr. Gabor Maté, emphasizing how modern children lose parental attachment too soon, turning to peers for guidance. This shift can lead to anxiety and emotional disconnection. 

Takeaway: Kids thrive when their primary attachment remains with parents, not peers. Strengthening this bond is crucial for healthy development. 

Need to Read it? Check out the Full Episode Transcript below!

Key Takeaways

Highlights of this episode:

If you want to learn more about Dahl Technique, be sure to listen/watch:

This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.

This episode meets GDC Outcomes B and C.

AGD Subject Code: 180 OCCLUSION (Occlusal functional concepts)

Aim: To explore and understand the Reverse Dahl Technique, focusing on its application for patients with localized posterior tooth wear. This technique provides a solution when posterior teeth are worn, and there is insufficient space for proper restoration.

Dentists will be able to –

1. Understand the principles behind the Reverse Dahl Technique and how it differs from the traditional Dahl Technique.

2. Identify the clinical scenarios where the Reverse Dahl Technique can be applied.

3. Comprehend the role of composite build-up in restoring posterior wear and its impact on occlusal reestablishment.

Teaser:
I don’t wear my back teeth. I think I am not able to generate a type of forces that wears my teeth. But I think most patients who wear their teeth, they’re usually in full occlusion. I think having posterior where it’s more a function of consequence of how they function, how they chew, how they eat, how they swallow, how they process food when they take food into the mouth.

Jaz’s Introduction:
So whether you use it or not, I’m sure we’ve all heard about the DAHL technique, right? This is when you have localized anterior tooth wear, and what you’re doing in this case is you are building up the anterior teeth even though you don’t have space. And so because you’re building these teeth up, when the patient bites together, now they’re prematurely hitting their front teeth, the back teeth all open.

There are like bilateral posterior open bites, and what happens over time is intrusion of the anteriors and you know, over eruption or Dento alveolar compensation of the posterior and the occlusion. Like magic reestablishes. So if you wanna go deep dive into that, check out our previous episodes on the  DAHL technique.

Like these are some of the ones we did five years ago with Tiff Qureshi, and they are literally like Protrusive Wall of Fame. So do check out those and I’ll link them at the bottom. But today’s episode, my friends is on something quite different. It is same, same but different as they say in Asia, right?

It is the reverse  DAHL technique. Now instead of having localized anterior tooth wear, we have localized. Posterior tooth wear. Think of that patient who when they bite together, their posterior teeth are just shot, right? There is exposed dentine, there is lots of erosion, and so you’ve got plenty of localized posterior wear.

And then the premolars, canines and anteriors are maybe a little bit worn, but not that worn. And the problem we have is that yes, the posteriors are worn, but when the patient bites together, the back teeth are all contacting, meaning you don’t have space.

So with the reverse  DAHL technique or modified  DAHL technique, what you do then is you build up the posteriors in composite, you leave the anteriors out of the bite, and then like magic, the posteriors will intrude and everything else over ups, if you like, and the context will reestablish.

Now, our guest today, Dr. Hans Kristian Ognedal from Norway, does a wonderful job of discussing this technique and his experiences, and at the end, he shares a case. So for those of you who are listening, while you’re jogging on a train, while you’re driving, don’t worry, I describe the caseand the exact scenario.

For those of you who are watching on Protrusive Guidance or on YouTube, you’ll actually get to see the images as well if you listen all the way to the end. I was quite excited to record this episode because it’s a, a new one, right? It’s a, it’s a new thing for me. I haven’t seen much published on the interweb about this technique, so hopefully you’ll learn something new.

Dental Pearl
Talking of learning something new, every PDP episode I give you a Protrusive Dental Pearl. Now, as you know, I’m a family man, and for those of you on our community Protrusive Guidance, I’m always talking about the books that I’m reading, or actually I’m listening to on Audible. The current one, I just feel compelled to talk about it.

It’s called Hold on to your Kids. Like I’ve got two boys, a 6-year-old and almost 2-year-old, and I think a lot about being a dad and being hopefully a good dad. I actually always wanted to be a parent. I actually love my role as a dad it’s my favorite title in the whole wide world. Quite often I’ll pick like, you know, parenthood books or relationship books because just like I’m interested in dentistry and I read their dental literature.

I’m interested in parenting and being the best parent I can be. So I kind of am attracted to these kind of titles. Now, the book, again is called Hold Onto Your Kid, it’s by Dr. Gordon Neufeld and Dr. Gabor Matè. And it essentially talks about how in modern society, children lose the attachment to their parents too soon.

And so what it talks about is that what children of modern society do is when they lose that attachment to their parent, they then gain the attachment from their peers. And then it’s like, you know, the blind following the blind and there’s a major cause of anxiety and disconnection from family. I’m actually now just getting into the really good parts of the book where it’s actually telling me solutions, right.

You know, the whole several first few hours are talking about the problem, right? The problem of losing attachment to a children and how you cannot serve two masters so they can’t be attached to their peers. And attached to you as their parent. At the same time, they have to pick one. And the way that we have the schooling system, the way that we have social media and phones, that they’re constantly now messaging each other and they’re gaining their attachment from their peers no longer from their parents.

Now we need that parent attachment for them to have a healthy emotional development and emotional security. So I’m listening in now to all the strategies we can use as parents to literally hold onto your kids and hopefully watch them grow into kind and courteous, and emotionally healthy adults. So I just wanna talk about this book and I want to share it with you, right?

That’s my pearl for today. I know it’s not very clinical, but I like to talk about what’s important to me. And right now what’s important to me is parenthood, and I know so many of you are in the same boat as me, so check it out, hold onto your kids. It is quite heavy. It’s like one of those books, like, you know that book, why We Sleep?

Like you can just summarize that entire book in one sentence, which is like, sleep is really important, right? So the vibe here is that parent attachment is very important, way more important than peer attachment. And so hold onto your kids, but really it’s the strategies that it gives you. So I’m just getting to good bits.

Now. And if you’re interested in this, do check it out. I’ll put the link in the show notes now, let’s now join Hans for the full episode. I’ll catch you in the outro.

Main Episode
Dr. Hans Kristian Ognedal, welcome to the Protrusive Dental Podcast. It was so nice, , just a few, a few months ago now, I think, to spend some, , time together in Bergen.

And I was really amazed by this presentation that you gave, talking about this technique that we’re gonna talk about today. You know, Hans, I didn’t tell you this right, but this podcast right now, it almost didn’t happen. If you asked me 20 minutes ago if this podcast happening, I would’ve said to you no. Okay. Because we were having a Lego incident. We couldn’t find a Lego.

[Hans]
You couldn’t find a Lego. Oh yeah. The kids were going to bed and, , the Lego was missing, 

[Jaz]
I needed new Batman robot lego that we built yesterday and the issue that we turned the house upside down and obviously I was getting the blame that the Mrs. was blaming me.

And then, anyway, she had tidy it away somewhere and she won’t admit it, but she found it and I’m so glad that we get to talk about, and this episode gets to happen tonight because you’re such a busy guy, man, and so I’m glad. I’m really appreciative of the fact you made time for this today. Of course, please, of course. Can you tell us about yourself, Hans?

[Hans]
My name is Hans easy way. I really enjoyed dentistry. I’m not a specialist, but I’m specially interested in dentistry. It’s my hobby, it’s my work. I enjoy every part of dentistry, I enjoy talking with colleagues, I enjoy treating different cases of all kinds. I love composites.

I love ceramics, I love surgeries, and , the lecture you heard was about treating worn teeth. And lately that’s what I’m talking quite a bit about. And, and it’s also a problem that’s rising and you see more and more of tooth wear and yeah. So it’s definitely a challenge that has come into modern dentistry.

[Jaz]
Tell the listeners where in the world you are speaking from today, just so I want them get a better context.

[Hans]
I’m speaking from Stravanger Norway. It’s in the southwestern part of Norway right now. We are in March and we. Don’t have snow at the moment, but it’s just turned cold again, so who knows what’s going to happen. It’s generally a lot of weather on this side of the Northern Sea, more mellow.

[Jaz]
You showed me some images, family images of the weekend going skiing and stuff and I mean, that was really cool to see. And you’re a family man, but you’re a really great dentist, very well-rounded, and you know the amount of where you’re treating.

I think we have so much to learn and unpick with you today, Hans. Yeah. I think want to start with just, just a quick review. I know I have episodes on this already, but for our younger colleagues just recap the original  DAHL principle that we kind of used today when we’re doing the anterior teeth. ‘Cause we’re talking about the opposite today. Yes. But just recap the anteriors.

[Hans]
To recap, the original  DAHL’s concept was about creating occlusal space for anterior crowns. And so they made from cobalt steel plate tooth that they either cemented or just attached to the front teeth and then the patient walked around, chewing on those and over time would create occlusal space for making anterior crowns.

But  DAHL has evolved over time. And now that we have direct composites, most  DAHL cases are made with anterior composites. You build them up politically, and then teeth intrude or erupt and into full occlusion over time. So that’s the original  DAHL’ concept with a modern take on it. 

[Jaz]
And in Scandinavia and in the UK we’ve really embraced it.

I feel like we are the pioneers when you obviously Scandinavia, but then UK is very popular treatment, here, whereas my dear friends in the States, they’re almost very skeptical about this. And what is your take on this? Did you know international friction to adopt it?

[Hans]
I think there are quite a few myths concerning occlusion.

They’re kind of scary, so when I was a young dentist, we didn’t learn very much about occlusion, which is perhaps why I do what I do, because I don’t know, didn’t know enough occlusion or didn’t. Believe enough in occlusion we left. That hinder me. I think it’s a problem with breaking myths. It takes a long time to adjust to new information and or new information trickling down and especially on the  DAHL concept, which was a thing in the 60’s and 70’s, there hasn’t been much research on it after that. 

And it’s also a fairly cheap technique. There’s no one willing to invest in it and invest in doing the research on it, because if you do it right, it’s really, really cheap and you can’t make money of it as a company. So that’s, I think it’s somewhat forgotten and somewhat lost in strong opinions on occlusion that confined around the world, if that’s fair to say. 

[Jaz]
That’s a really, really good point about a lack of interest from companies and the trade in this technique. ’cause it’s the way it is, right?

And therefore that could be a fuel and the fact that it’s not been pushed about as much as it could. Now, what we’re talking about today is a different way of doing  DAHL. Now, I like to call this the reverse  DAHL technique, but what’s the difference between the reverse  DAHL and the modified  DAHL. When you say that, do you mean the same thing or what do you mean?

[Hans]
Yeah, I think we mean the same thing. I was able to have a conversation with Reyes recently on the  DAHL technique and what he’s doing, and I told him what I was doing and yeah, I think it’s the same thing. It’s just, I chose to use the word modified because I don’t think it’s really reverse. I like the name.

[Jaz]
I think it’s cool, like Opposite  DAHL technique, Reverse  DAHL technique. But yeah, I see it okay so guys, when we say modified or reverse, we, we mean the same thing. 

[Hans]
Because a reverse start to me would mean that you grind teeth down to let them over the rough. That would be the opposite of doing good. Well, the opposite of want to what you want to achieve. 

[Jaz]
Exactly. Now we know there’s the direct composite splint technique, which I did have the authors of that paper on the show two years ago. We know when you have a cracked molar and you actually bond composite. To make it in supra occlusion and then the composite will stop the cusp from flexing at the same time because that’s the only tooth and occlusion that’s going to intrude.

Then when you take off the composite, you now have occlusal space. Is this something that you did first or you entered into, or I guess share your journey about how you first got into this? Was it from anterior  DAHL to in posterior a modified way? How, tell us more about that. 

[Hans]
Well, I started like everyone else doing the Anterior  DAHL, and then I started to struggle with what you do when you wear your molars. And in the beginning I did what I was taught. I was taught to do gold on lace you can make them really thin so you don’t grind away too much tooth, or if the tooth was damaged in other ways, you could do a crown. So that’s without touching the vertical dimension. So that’s where I started.

And then I thought, okay, this is going to be really expensive for the patient, or some patient couldn’t afford doing treatment that way. 

[Jaz]
So when in those scenarios we have, posterior only wear the way you would manage it traditionally at the beginning was gold posteriorly to rebuild the structure or or protect the integrity of those posterior teeth, right? Now, when you were doing that, you were still conforming or were you opening the vertical dimension on the gold? 

[Hans]
No, I was still conforming, trying not to open the video. If I was, I would combine that with doing something interiorly because I was really afraid of opening the vertical dimension and- 

[Jaz] Despite doing the anterior DAHL stuff. ‘Cause for me, early on in my career when I started to do dial, that was a massive help in losing that fear, right? When you start doing  DAHL and you do a lot of it, you’re like, hang on a minute, my patients aren’t dying, their condyles aren’t popping out. Maybe we’re okay. 

[Hans]
Yeah. Like I said, this is really early, so this is maybe 17, 18, 20 years ago, so because I’m not a young man anymore, but then it kind of progressed. I started covering exposed dentine, I thought, well, at least I’m going to buy this patient maybe a year or two. 

And it’s really easy to do just flowable composites and when a referred patient to orthodontists to have work done, not particularly wear patients, but they were putting on, oh, we need to elevate the bite we’ll put on like three millimeters on this tooth and the patients didn’t seem to complain about it, and I thought, well, maybe I should try putting on a little bit more. And then I knew that if you want composites to last, you need millimeter and half. I thought, well, well, let’s try that one. Let’s try putting on a millimeter and a half. 

[Jaz]
So kind of like you applied the bite turbos in the orthodontic world to this setting. It’s interesting though, Kushal Gadhia, a restorative consultant once taught me years and years ago, and I love it because sometimes patients tolerate big changes in occlusion better than the tiny changes. And that was like a really funny thing to learn actually. And I think it holds true. 

[Hans] Yeah, I think there’s some truth to that. If you’re off by a 10th of a millimeter, that might be quite painful for the patient. But if you build it up two millimeters that doesn’t seem to pose a problem. Patients usually tell me about, it feels a bit weird the first, first week or so, and then it feels fine, they’re not bothered by it. There might not be an occlusion at that time, but they’re not bothered by it anymore. 

And some people just forget that they’ve had it done at, or they just function normally. Through the day, and when you see them next time, they’re almost in full occlusion. So I have done that on single teeth. I have done that on just a few teeth, but usually when I do posterior buildups are that high. It’s part of a full case where you do multiple buildups. 

[Jaz]
Okay, well let’s move on to that then. Let’s imagine a case of localized posterior wear, right? So we’ve got anteriors that typically look pristine, right?

And maybe they have their mamelons got the incisal halo. They usually have good looking anteriors, but the posteriors are worn into dentine. I think it’s important to discuss the etiology aware in these patients. What have you found was, was the cause to factor in these patients that pattern aware?

[Hans]
The pattern aware. I’m not sure if I have a part in my lecture where I talk about the pattern aware and usually I divide the cause of wear. It’s, well, I’ll have to go back to what’s erosion, what’s attrition, what’s abrasion, and I find that in most cases there are some assets involved there’s some erosive component involved in where, and if you want to see that, okay, there’s no most likely an erosive component. Where’s that acid coming from? Is it internally or is it externally? So having a chat with your patient, having the patient make a chart of their diet for a week, for instance. And then you can go through that with your patient and try to pick out stuff.

And you can see, because you can’t really tell if the assets from the external or internal. From the pattern of wear, because I think the pattern of wear is probably due to the way the patient chews, how the tongue covers the teeth, how the cheek covers the teeth. So you can’t really say, is this internal, is this external?

So if I can’t find anything in the diet that can cause that type of erosive wear, of course we’ll have to look at, do you have some type of reflux? Is it, you might not have symptoms on reflux, but you might still have reflux. I’m not sure if you think know the term silent reflux and I, I apologize for my English.

[Jaz]
It’s oh, dude. You should hear my Norwegian. It’s not very good. No, dude. Honestly, you’re doing great. But they’re silent reflux, quite classically. People say that you have like this, like, like this, like a little cough that’s called kind of is pathognomonic of this. 

[Hans]
Yeah. But you have to kind of tease it out in the conversation because they haven’t really thought about it and they say, well, I haven’t really thought about it. And then you see them in a couple of weeks or a month later and they come back and say, well, yeah, actually I feel some of the things that you’re talking about.

[Jaz]
So at that stage from you, is it before you do the treatment, is it referral to the GP or how do you make sure that before you start treatment you fix it?

[Hans]
Referral to the GP, sometimes referral to gastro. There are some new guidelines and gastro in Norway. So now they start treating on suspicion. Instead, if you’re un under 50 years old and they suspect that you have some gastric reflux problems, they start just treating with Antiacid right away.

So because they think that swallowing a camera and doing pH measurements is, is way too invasive and takes too long and costs the society too much money, so much easier to get a packet of tablets and try it out. 

[Jaz]
It’s like, you may not be treating the root cause, you’re just kind of medicating the issue. But that’s a, a whole different topic as long as the acid is not destroying the teeth, I guess. But ideally in a utopian society, it’d be different. 

[Hans]
If you are discussing the root cause, I think the diet, not the modern diet, is an underlying cause of most of these ailments. So diet is underlying gastric reflux, obesity, and also tooth wear. Because we live in a world where all food is you can get hyper palatable food that is really scrumptious to eat, sometimes very high in calories, sometimes no calories, high in acids, and zero nutrition. And I think it’s a tooth where it’s probably a modern disease of our own course. Whereas in the past, like if you see there, I went to the London Museum and saw the old Egyptians in there and had took pictures of their teeth, and they were eating drains with sand in it, and of course they’d bought their teeth, but now we know better. But now we’ve caused our own problems by having the food industry working. 

[Jaz]
So to add to that, professor Bartlett, when I was his DCT trainee, probably the worst train he’d ever had, but he, he taught me one thing, which was when you have the purely Attritive patient, the patient who’s like, you know, a severe grinder and you can imagine the tooth contact time for that individual, you know, during the day and night could be high in an imagined scenario, but even that patient will not wear away their teeth that much because ultimately enamel and enamel is like two similar AKA identical materials rubbing on each other. The wear is not that extreme compared to, let’s say, rough porcelain against enamel.

The enamel will take a hammer, right. So actually when you put a one drop of lemon in the equation, you see serious escalation. So I’m glad you started with that, that actually acid erosion’s a huge, huge player. And when we see these worn teeth, don’t ever just think, oh, this grinding is, you know, 99.99% time, there will be acid erosion and that’ll probably be the primary player. 

[Hans]
I completely agree. I have some bruxist in my practice, there’s some psychiatry involved in bruxism, at least with a patient I see. They have maybe a tick, like they’re tapping their teeth or grinding their teeth and those cases are of course, really, really problematic to solve.

And of course it’s also psychiatry, which means there’s less income. There’s yeah, all sorts of problems regarding those patients. And of course my composite doesn’t last as long, but you can redo ’em. That’s the beauty of this technique that we’re going to talk about is that you could just redo it, you can sandblast it and you can put on some extra. 

[Jaz]
As Tiff Qureshi who, who does so much for  DAHL and making  DAHL accessible to dentists around the world, and what a absolute legend he is. I love his term, you know, recycling the  DAHL, you know. Five years, 10 years later, recycle my patient’s on, on her second recycling of the  DAHL right. And it’s just amazing what you can do exactly how you explained. 

Just find up on the etiology so why do patients present with localized posterior wear acid erosion a huge player. I, and please, like, correct me if I’m wrong, because I feel as though you have a lot more experience in looking into these localized wear cases. I feel as though these patients may have started with an anterior open bite type of occlusion whereby, they already had a heavier posterior occlusion, and then when you put the acid to compound on that, it’s like the opposite to the deep bite patient.

Think of the deep anterior deep bite patient where they, they destroy the anteriors more and the posterior are sped it’s like the reverse situation. Where you’ve got the class three or the A OB, the posteriors are just get more chewing time, more contact time. And then when you throw acid into that, by the time the posteriors have then worn down, the anteriors now are getting in contact. This is just my theory and this is what, what do you think about this?

[Hans]
I think I disagree on that one. I think the patients that wear their teeth, they’re able to load their teeth quite hard, much harder than I’m able to do. I have an anterior open bite and the class 3, I’ve never been able to touch my front teeth, I don’t wear my back teeth. I think I am not able to generate a type of forces that wears my teeth. I do have jaw pain though. 

On the opposite side, you have the patients who never have jaw pain in in the muscles, and they. Are usually in full occlusion. They have a really heavy bite on and they load all their teeth because they need all their teeth to support that amount of force.

I have this one patient who he managed to intrude his teeth. He had a full arch bridge on 11 teeth, and he managed to intrude that bridge into his gums. So that’s an outlier of course, but I think, most patients who wear their teeth, they’re usually in full occlusion. I think having posterior wear, is more a function of consequence of how they function, how they chew, how they eat, how they swallow, how they process food when they take food into the mouth.

I think that’s probably more important because I don’t think none of these patient, I think it cry to having a anterior open bite that usually means patient with anterior open bite, usually have a large maxillo mandibular angle. They have usually like a long face like I do, usually more crowding. If you have a tongue thrust, you’re biting on your tongue which kind of stops you from biting too fast. 

So the interior open bite cases, those are actually the cases where I don’t recommend doing a modified  DAHL reverse style. If they wear their teeth, they usually, they wear their cusp, the molar cusp, they wear them flack because they, that’s the way they function horizontally.

But when they’re worn flack it stops. If you don’t put acid in there, or significant amounts of acid, even with exposed dentine, that where just stops when the cusp are ground down and the patient functions in laterotrusion, then it stops in those patients. 

[Jaz]
No, no. Definitely. Where when I observe that you find that, yeah, the molars are very flatten, but they stay like that. When you see them year after year, and you could do a time lapse and, see how, how they progress and they stay very stable. 

[Hans]
Yeah, I definitely do recommend taking photographs, following your patient with wear. It’s always beneficial to have a long-term relationship with your patients, so usually if you could at least observe them for a year or so, that would be nice.

If they’re in pain, if you have to do something. Yeah. You don’t have to shy away from that rule and, and treat them of course, but if you can spend some time with them, have a checkup or, or two, take some photographs and sometimes information pops up. That’s really interesting to know. 

[Jaz]
It is important to have those conversations and plant those seeds.

[Hans]
Oh boy. But I place a lot of blame on, on diet, but of course, there’s some environmental courses as well. So if you work in industries like smelting, there’s sulfuric acid in the air. If you work in swimming hall, the chlorinated water. Chlorinated it with highly chlorinated water that also may cause erosive wear. 

If you’re a farmer, you’re using methyl acid you use it to preserve grass in dairy. Okay. That will also be in the air while you’re working with it so I’ve seen a few farmers having worn their teeth, and I think it’s probably due to that because couldn’t find anything in the diet, couldn’t find anything on reflux, so possibly environmental for them. So it’s a good thing to know your patient and have a conversation that you’ll learn. Surprising stuff once in a while. 

[Jaz]
So that’s where the occupation history and the social history definitely comes into play in these erosive cases. That’s a hundred percent for sure. In these cases, Hans, have you noticed a pattern of types of occlusion? So do you find that you’re seeing more class 2 people, class 1, class 3 people? Like any traits that you see people with shorter faces, stronger muscles, traits that you see? 

[Hans]
Yes, definitely. So in the literature it is called Brachy facial Patients, the square faced patients. Those are definitely on the wear list of patient who wears their teeth. You can also see that kind of in the middle, the miso facial patients, and then you’ve got long face patients where you don’t see much wear, but usually you see more TMJ issues. So definitely it’s the Meso facial or the squareish face patient. I usually take pictures of my patient’s face from the front and from the side, and that’s quite informative sometimes. 

[Jaz]
I think that’s so important for anyone who perhaps doesn’t do that. Sometimes when I was younger, I was only taking photos of the teeth and I was missing that information. And I think the more you appreciate the face and the role of that and the muscles is definitely a great, great idea to start taking that facial photo as well.

Let’s imagine that example case that we’ve imagined there are posterior localized wear, and we’ve said that “okay this patient has probably a brachy facial, strong muscles, silent reflux, and they’ve managed to see their GP, and let’s say they’ve controlled it, and now you’re looking to treat and plan this case because this patient’s young.

The primary reason to treat here is not aesthetics, it’s far from it, is to preserve their teeth to make sure that they will keep their teeth for as long as possible, right? 

[Hans]
Preserve the teeth, but ultimately also to preserve aesthetics and functioning. Because if you lose your modus it will inevitably hurt your front teeth over time.

[Jaz]
Do your patients complain of sensitivity? 

[Hans]
Yeah. Then usually I do an impression just to have a model so I can have a look at the model and the way I do the reverse or modified  DAHL, it’s a direct technique so after I’ve assessed the models and I’ve checked the curve of speed and check if are there any interferences for the teeth to either erupt or intrude, and we’ll have to have a chat about eruption and intrusion after this one, then I build up to, usually when you worn down to the dentine, you’ve worn about two millimeters off the molar cusps because young molars and young healthy molars, they have about two millimeters of enamel on top of the cusps. 

So, if you add back anatomy and use anatomy as your guide, you will add about approximately the right amount of composite to the top of that tooth for the composite to be fairly aware assistant to not break. 

[Jaz]
The first question I have there, Hans, is it makes sense to use anatomical norms ’cause that will give you not only the right form and function, but also actually gives you the right amount of thickness for your composite anyway, which, like what you said right in the beginning, but just to go back one step, we gotta talk about it, right?

Joint position. Right. In these cases, are you using centric relation as your guide or not? How are you recording the joint position before you wax it up on the articulator. 

[Hans]
Like I said, my occlusal education was very poor, so I usually start from MIP from full maximum inter cuspation. And since after I build this up, the patient rarely hits more than maybe one point on each tooth, maybe on the seventh so I try to kind of divide the forces between 3/ 7 and 4/ 7, for instance, and you’re hitting just two points. It’s really, really, really easy just to make sure the patient hit those two points about the same time just for comfort. But otherwise the occlusion will evolve from there.

So the occlusion will evolve from there to what I’m thinking is that, Joint position in these cases doesn’t really matter because you’re working in a system where everything changes. I think we as dentists now, and I think this is part of why occlusion has become such a difficulty, is that we’re thinking of our mouth and our teeth are static because they are firm there’s no cells that change the surface and not like the rest of the body. 

But the truth is teeth are living, teeth are moving and they are in place because of all the functional forces that are on them. They’re tongue, lips, cheek, chewing forces, habitual forces are keeping teeth in their place. And so we’re working in a system that that changes all the time.

I don’t think really think it matters. What I do think matters if that when you cover that sensitive dentine, the patient will be happy for it and we’ll be able to chew off of that and we’ll be able to have a glass of wine and some shrimps and a shrimp salad sandwich without being in pain, which is from day one after doing that treatment.

[Jaz]
Okay. Well, in this case, I love the idea of the second molars in equal intensity contacts, but in a typical case that you’ve treated, is it just the second molars that are getting the composite or are you having to do the second molars? The first molars and the second premolars, but actually because you’ve built them up to anatomical form, it’s actually only the second molars because the way the jaw closes that are taking the contact, that will then intrude and then, then the second, the first molars and the premolars will eventually come into contact. Just explain that. 

[Hans]
That is completely correct way to put it. Just because the function of the jaw, how the jaw functions, you will only be hitting your most poster posterior teeth when you’re doing those buildups. But of course, I take the. Opportunity to build up the rest of the teeth that are worn, but the patient will, of course, only hit on the most posterior teeth.

[Jaz]
And in this case, would you typically just do, like, obviously I’m sure you’re looking the anatomy of the teeth and you’re thinking, well, both the upper and the lower are destroyed. So let me add in wax on both, or like split the difference or do you tend to have a strategy to preferentially wax up one arch more than the other? Or what have you found? Or is one arch more affected than the other usually? 

[Hans]
I usually don’t do wax up. To me, this is a direct technique for different reasons, but I’ve been practicing my anatomy for a long time it feels really easy for me.

[Jaz]
So it’s a free hand technique?

[Hans]
It’s a free hand technique.

[Jaz]
That’s so cool. 

[Hans]
So you don’t need to use technicians or use wax-ups. Those techniques are for the really, really difficult cases where you don’t have. Much anatomy to guide you. So if the teeth are completely destroyed, maybe you lost a third of the occlusal height, completely exposed dentine, then it becomes a lot more difficult to do those buildups because you don’t have any reference points.

I find that my technique, I was lucky to be able to see one of Didier Dietschi lectures on interceptive dentistry, and he does that directly in the mouth. And this technique resembles a lot his technique, but he’s of course much more fluent in occlusion than I am. So he takes that into concern but he says the problem is how to get enough space for the most posterior teeth, and this technique, the reverse  DAHL, the modified  DAHL.

That’s the answer to that question. You let the teeth move so you build up. So yes, you build up all the teeth that needs to build up. 

[Jaz]
Yeah. So upper as well as lower, basically 

[Hans]
If there’s words on the upper. Yes, I treat those as well, perhaps not at the same time. Perhaps we’ll do the lower first and then we’ll wait a few months before we do the uppers, just to make the patient a bit, a little bit more comfortable.

But I have treated patient who wanted to have it all done in one go, and of course, they ended up maybe with a 6 millimeter anterior opening afterwards. Yeah, it worked out. But usually I have patients that are close by so we can stage the treatment a little bit more and perhaps make it a little bit more comfortable. Although I haven’t had any patients really complain about discomfort. 

[Jaz]
Well, we’re gonna unpack about, when you monitor these patients, how long it takes and whatnot. We’re gonna get to that. But just one little thing, which I find amusing is that if I was doing this treatment, like if I’m building up the lowers, I would be looking at the upper and if I’m seeing like a really sharp cusp, I’d be smoothing it down. Do you adapt to that as well? To, to try and get nicer forces?

[Hans]
If you have a really sharp cup, I, I know about your contracept of Robinhood dentistry, but in this case, we can do more Oprah Winfrey dentistry so you can get a filling and so if you have a really plunging cusp in the upper and you have composites or amalgams, uppers and lowers and you need to, and they kind of born u-shaped. Yeah. 

Then I would probably just build up old teeth during a short period and then you’ll be able to lower the Cuspal planes. So that you get the Cuspal plane won’t be as steep anymore. And you can build the cuspal planes so that they’re less steep than the canine planes, and that takes away a lot of those problems. So the patient get more freedom and attrition in and horizontal movements, and you transfer guidance to the anterior or the canines. 

[Jaz]
Okay. So let’s talk about that. You’ve just done, let’s say the, the lower second molars and the first molar and the second pre-molar. When you deliver this, the contacts equal intensity only on the second molars ’cause the way the jaw closes. Yeah. But at that moment in time, do they still have some canine guidance?

[Hans]
Well, it depends on how deep your bite is. So if patients with really deep bite, when you open them a millimeter and a half posteriorly, they still can touch with their front teeth.

They can still bite off food with their front teeth. So some patients are like that. Some patients have less where you open them up. They don’t have any contact on the front teeth. Doesn’t seem to matter much. Both groups of patients, in my experience, doesn’t really experience much discomfort. 

[Jaz]
Are you having to adjust the excursions in any way to make sure they’re to a particular liking?

[Hans]
So that’s what you do on the follow-ups because after doing a full jaw buildups, at least I’m really tied. So I’ll just make sure that they’re hitting those two points. And you’ve made cusps a cost. We’ll have some planes to them. So you can have, sometimes you have to adjust for excursions on the cusp, and sometimes you can use cusps to kind of guide teeth into the right position if you have a pronounced curve of spee for instance, in an older patient, you get most of the tooth movement, I believe, is in the lower jaw you get intrusion in the lower jaw. And that can open contacts and then you can use the cuspal planes to kind of guide those teeth and close those contacts over time. 

[Jaz]
But the day they leave you, when you fit them, obviously with Tide and stuff, but when they grind left and right, it’s not only the dots on the second molars, but they’re also grinding on these second molars. Right. And, but that’s okay. That’s how you leave them.

[Hans]
Yeah, I’ll just leave them like that and, but sometimes, of course it’s composite you can adjust it. And like I said, you’re also in a working environment where everything changes. So what might be completely fine on the day you leave them. Might not be fine when they come back after usually I have, I see them after a month to do some adjustments. Hopefully we’ll get to talk about how we do that. I do that, but yes, you can be mindful of excursions. Not too mindful though. Because now you just built up those teeth and everything’s changed for the patient. Nothing works the way it used to.

The neurology isn’t there. Reaction patterns aren’t there. So that just needs to settle. Patient just needs a bit of time. 

[Jaz]
Okay. And the patient then goes away. What’s your review schedule like for these patients? Like how often do you see them and then more importantly, what have you observed, Hans, when you’re seeing them they come back at week one. They’re like this, they come back at week five, and I, I’d love to know. What is an average of what you’ve what you’re seeing and when do they fully establish contact? 

[Hans]
Yes. I think we have to stop talking about the Curve of Spee in this case, because teeth have a constant width.

They don’t change the width unless you, you grind on them or on them. So the curve, it works like a bridge, like the keystone in a bridge. So if you try to compress the curve, compress the teeth into the curve, for instance, for uppers, if you want to intrude uppers, that’s really difficult because. You’re trying to put teeth, trying to compress those teeth into a curve, that means you have, might have to release, do some IPR between those teeth to have them intrude and the same with the lowest, the curve of speed.

Usually if you have intrusion, then intrusion is easy, but if, if you want them in a younger patient, if you want them to erupt. That means you might have to release little bit in between the teeth to give the teeth an opportunity to erupt into the curve. 

Other than that, you might, sometimes you need the help of an orthodontist if you really don’t want to grind on teeth or there’s no opportunity to grind on fillings or things, and sometimes you can just leave it like that and just be aware of that. It just takes a lot longer when the teeth have to move a little bit horizontally to adjust for that curve of speed. 

So when the patient comes back in after a month, they usually see them after one month. They’ve been well informed about this being a bit little bit awkward in the beginning and after a month, they’re well on the way. Usually they’ve closed more than half the way down after a month.

[Jaz]
Do you think there’s any condylar repositioning happening there? Do you think that very quick change? Like in the anterior  DAHL we say that if you see a lot of change happen very quickly, that’s not necessarily intrusion and dento alveolar compensation, that could be the condyles repositioning. Have you suspected the same in your cases? 

[Hans]
Why not? Why shouldn’t that happen? Everything else changes. I do think I think in terms of how fast the patient comes back in a rule of thumb is that a tooth can move about a millimeter per month.

So to me it seems like that’s approximately the rule that I follow. So that’s why my take is that it’s probably mostly intrusion for those patients. I check with my foil, I check with my contact paper, and also I use a floss. So I check the contacts with the floss. If they’re really hard, that tells me something about how the teeth move.

So if you have a really hard contact and it didn’t use to be really hard, that means that, okay, if it’s in the upper jaw, yes this tooth is probably intruding. If it’s in the lower jaw, then yes, this tooth is probably erupting and you have to decide if you want to give, make some space for that. So that’s what I do on normal checkups. But most of the time patient is completely fine. Yeah, it was a bit awkward in the beginning. Feels better and better. Then we do an evaluation. When should I see you again? Perhaps I see you in another month. Perhaps I see you in a couple of months and sometimes patient close the occlusion really fast then, is that, no, I can’t be bothered by coming back. We’ll see you at the next checkup. So, and then they do, and it’s, it’s fine. 

[Jaz]
Well, a bit like the question I have my mind now is a bit like orthodontics. Like I am imagining at that first review that there will be some increased physiological mobility of those second molars, which is part of the process, a bit like ortho patients, aligner patients, when you take off the aligners, there’s some mobility and for a younger dentist who’s never seen this before, that can be quite worrying, but just it confirmed. Have you observed that? And just to reassure everyone. 

[Hans]
That definitely happens. And in one case, I built the posterior cuffs, I built them too steep. I was into a pronounced anatomy at the time, and I, of course, had to adjust for excursions on those teeth and they firmed up. And for the next checkup, they were fixed again. 

So, yes. Be aware of teeth moving. Sometimes it’s a good thing, so sometimes it’s a bad thing and I’m not sure if me adjusting the occlusion on those teeth helped or contributed to do the case or was irrelevant to the case. It might have just solved by itself without me intervening. 

[Jaz]
Good point. And in these cases, when you see them again and you follow them up, what percentage, fully established contact, and then how long on average does that take? Does that take like a, a year, two years, you know, quicker on younger patients? Longer and older patients kind of thing? 

[Hans]
No, I think it depends on how much force the patient is able to put on a teeth. Most people I treat for posterior wear are not young guys. They’re, they’re older people. They’re 35, 40, sometimes 50’s and deruptive potential of the teeth is not, is not really high.

In  DAHL study, he said that his patient, his selection of patients, and that’s one of the myth myths of  DAHL, is that it’s about 60% eruption and 40% intrusion, but that’s the average of the selection of the cases that Dahl investigated. But he says in his article that it seems that eruption is more pronounced in younger patients.

And intrusion is more pronounced in older patient and he related that to facial growth and facial changes as you age. So it kind of depends on the age of the patients. If you have an old patient, you, most of the changes will probably intrusion and if you have a very young patient , most of it will probably eruption.

[Jaz] And at the end, once a teeth established contact. Are there any adjustments you need to do at that point, or do you find that this everything just falls into place nicely and you don’t need to do any adjustments? 

[Hans] Yeah, usually I don’t need to do any adjustments. But I do think about occlusion when I do the buildups.

Like I said earlier, I prefer to make the cuspal planes less steep than the canine plane, so the patient usually ends up in anterior or canine disclusion canine guidance. Do you need canine guidance to function for most patients, probably not, but it’s a way to possibly save my restorations a little bit longer just to make them it last a little bit longer, to not place them under tensile forces and try to make all the forces on the composite compressor.

[Jaz]
Very true. And that’s a huge tip right there, guys. You know, Hans said to try and keep your restorations under compression ’cause our materials can handle that much better. And so you mentioned the word longevity to make it all last longer. What do you tell your patients and you know, sometimes we, what we tell our patients is not what actually happens.

You know, we actually hopefully undersell it and over deliver. So how long does it take until Hans is gonna recycle a posterior dial case? 

[Hans]
I’ve haven’t had to recycle many of them so far. I’ve recycled a couple of them and that was like 10 years and 12 years. So last quite a long time. Then I have a couple of patient who crushed their composites. So the composite looks like gravel on top of their tooth. And we had, and then I said, okay, this is, we need ceramics here. 

So sometimes that happens, but then you’ve created a space for the ceramics so you can do the ceramics much more minimal and invasive. But I do think that ceramics does have a, apart from being quite expensive doing ceramics, I think they do have a place in the posterior  DAHL, modified  DAHL technique as well. And if you’re really brave and know, think you know what you’re doing, you might go directly to ceramics. 

[Jaz]
That was just what was I was gonna ask, basically, I mean, I’d only trust you to do that because you know, I think you need a bit of experience when you’re doing these kind of cases I guess.

But have you done that then? How many cases you’ve done? Yeah. We’ve just gone to ceramics, especially nowadays with the, I’m recording soon with Pascal Manet on occlusal veneers, right. And you know, 0.4 millimeters zirconia, occlusal veneers, or maybe some thicker lithium di silicate ones, so minimal prep, ’cause you already have the thickness, ’cause you open the bite. There could be some benefit here. 

[Hans]
But I’m thinking also that you’ve negated the problem so you don’t have to make really thin occlusal veneers. Yes, I’ve read about it and read the some research on it.

And it’s quite a favorable prognosis, but you don’t have to make 0.4 millimeter occlusal veneer. You can probably make them for a decent thickness that really make them last because teeth will move and perhaps you can do this, do a temporary in composite, just a quick and dirty one. And then wait for occlusion to settle, and then you can do it in, ceramics to give a very long lasting restoration. 

So in a few cases you’ve had to do that because they’re trying to destroy the composites. But in a lot of these cases, you’re seeing ’em last and you’re probably saying, you’re probably just observing and monitoring. Yeah. I think it depends on how much of the damage is caused by the patient’s by attrition, how much of the damage is caused by erosion. So how much just physical and how much is chemical? So I do, I’ve seen patients that have followed up for a long time and which they have mostly erosive wear. 

And then you see they undermine the restorations that I’ve done. So the restorations are still there. The enamel around it just kind of disappear and then you have to go back. But then it’s composite so you can go back in and you can put the rubber dam on and you can do some air abrasion and you can, I love my aqua care for that. Do some air abrasion and then you can just bond may highly filled flowable or maybe normal paste composite and just repair those damages and then you can go on for a long time. 

[Jaz]
Brilliant. And just ’cause we’re wrapping up now, I’d, I’d love to see Hans, if you are able to on the app or on YouTube, have you got maybe a, a before and after when the occlusion was established, just an example case to help the visuals?

[Hans]
Yeah. Let’s do that. 

[Jaz]
Okay, so while you are doing that, and, you’ll see the share button at the bottom. I’m gonna ask you, I’m gonna be very naughty and while you are focusing on get finding in case I’m still gonna ask you some questions. Okay. So you have to multitask big time.

Okay. Yeah. Contraindications. Are there any contraindications to this technique that you can present to, a very keen young colleague who might say, oh. I’m gonna try this tomorrow. Can you put some shackles on them and suggest some contraindication? 

[Hans]
Anterior open bites, do not do this in anterior open bites. The diagnosis is the selection, worn posterior teeth. Those patients, when you give them that diagnosis that you have posterior tooth wear, that’s when you can do this type of treatment. 

[Jaz]
Kind of those tough cases where you’re scratching your head thinking, how do I fix this? Because there’s so much more wear posterior than there is anteriorly, and you’re kind of like scratching your head and then you think, ah, yes, this technique exists. 

[Hans]
Yeah. So you already selected your patient by having a patient having wear. So, it’s important that there is wear, and also if you can stop the wear by getting the patient to change their habits. Even exposed dentine will last a really, really, really long time without wear. So you might not need to do buildups. And that’s why I said you have to have a proper diagnosis. You have to know why the damage, why is the patient looking like the patient does right now, before you start doing any treatment.

So that’s my take on it. And also patients with TMJ, then again, you normally don’t have occlusal wear. Avoid opening the bite on the posterior, it might be quite painful. So let’s see if I can share an image with you from a case of done. This is the posterior doll case, so I’m just gonna describe it for those audio listeners.

[Jaz]
Right. So those on Spotify and Apple, some beautiful rubber dam dentistry going on here with the beautiful Teflon ligature as well. And it’s a classic erosive case with the wear. You see the cupping, I see some attrition as well on the second molar. So yeah, the kind of like the scenario we described.

[Hans]
Yeah. So we abrade that, clean it up well, put in some separation between the teeth and then start building up. I usually start a little bit on the marginal ridge then cusp by cusp. Your comms are beautiful man. Yeah, thanks. Thanks, lovely, Nancy. These sessions are quite enjoyable for me. I love building that up.

And this patient, you see, that’s him right after, he has quite a deep bite, so it’s a deep bite patient, but with those crowns on the centrals, but rest of the teeth unrestricted. Yeah. So probably a trauma case. Yeah, a trauma case when he was quite young. Those crowns are made by a dentist in London, not by me. He was working there at the time. Really nice crowns in, in my opinion. So that’s right. Straight up, right after I’ve built those teeth up, you can see there’s a little bit of marks on top of the cuffs there that’s not really context, just an abrasive mark from the occlusal paper. And these are pictures. 

[Jaz]
So lovely shot here. Clearly showing the posterior separation. Yeah. In the premolar region. Right? So obviously anterior we can’t appreciate it ’cause you have someone with like a complete a hundred percent deep bite and now they have like a. 90% deep bite. Whereas on the premolars, you can see how they’re outta the occlusion now because you’ve only treated here second molar, and first molar, and lower only. 

[Hans]
Yeah, lower only on this guy because well, we’re staging the treatment on, on him, and like you said, he has bit of a plunging cusp on the upper, so perhaps I should have done the upper at the same time, but. I know, well, he’s local here, so I know I’ll have to treat him several times during his lifetime, at least my professional career if he decide to stay with me. And this is about, let’s, I have to check my notes on this one. Sorry.

[Jaz]
Hey, this makes you so happy. This, this, this is the money shot right here. This makes us happy. So guys, we are seeing the photo right, of the established occlusion and it’s just a thing of beauty. Yeah. Right. Those premolar spaces have been filled in just in a marvelous way.

And the intercuspation here on the left especially is really beautiful. Yeah. It’s he’s really back to where he was before we began and he’s got the a hundred percent deep bite again, or maybe the 99% deep bite again. 

[Hans]
Yeah. It’s back to having a deep bite. He will, think should you really do orthodontics to fix that deep bite perhaps? I don’t know. He seems to work well. 

[Jaz]
It’s another option, right? You fix the deep bite and you create some space posteriorly. But then that’s, that’s a very tricky case in terms of Anchorage stuff, right? Because you’re trying to intrude the anteriors and intrude the posteriors. And so that’s a very tricky overall case I think.

[Hans]
I’m really happy to refer orthodontics to an orthodontist, so I’m not doing much of that myself, but that’s two months after on this guy. 

[Jaz]
Two months. That’s very impressive. 

[Hans]
Yeah, so like I said, it depends on how much force the patient is putting on on their teeth and how fast they can move them. And I think the case that took the longest, took about three years. I built her up, then she got cancer, got really, really sick, hospitalized for a long time, and of course teeth didn’t move but when I saw her a year ago, she was back to being healthy and then in full occlusion.

So something is happening. There are some muscles involved I think. But she was comfortable all the time, even though her bite had hadn’t closed all the way, it just closed partially. She was comfortable, I said, okay, now that you are ill should we just grind away some composite to make you more comfortable?

And she goes, no, it doesn’t bother me at all. And when I saw a year ago, she was back in full occlusion. So changing the occlusion doesn’t really matter. And as you said on the lecture, I saw you on you shouldn’t really be touching your teeth. Too much anyway during the day, during the 24 hours of the daytime.

[Jaz]
Very true. And the only question I have now, ’cause I know someone’s gonna mention the comments, right, is they’re gonna say, I think I know what you’re gonna say as well, and they’re gonna ask you, do you give the patient a guard after they’ve established their occlusion? 

[Hans]
Yes. Sometimes I’ve tried that. Generally guards are not used for a long time, perhaps maybe a month or two in the beginning. If the patient is still thinking about it and then they forget the guard when they go to their cabin or to on holiday. 

[Jaz]
To my cabin-

[Hans] To my cab. Yeah. Reminds me, yeah, that one was really good.

[Jaz]
Reminds the performance 

[Hans]
Maybe to know what the f— says. So I think compliance on night guards to stop where is poor and I’m not always sure that it’s the nighttime where that is the problem. Perhaps it’s the daytime wear and then I’m not wearing a guard anyway, so I usually, I don’t do guards right now.

[Jaz]
I just still want to see what you are practicing. 

[Hans]
I don’t do guards. I thought I should tell this will wear and next time we’ll add some composite again. And you’ll wear that away again. I think that is more comfortable for the patient. But of course you have some patients who are really, really conscientious and, and are able to wear a guard during nighttime every night and do that consistently over the years.

[Jaz]
Hans, you would’ve seen in Didier Dietschi cases that he shows, right? He shows he’s like ridiculously brilliant 30 year follow ups, of anterior resins. The thing he says, which is the same thing that Tony Rotondo said last year when I saw him speak and show his like 22-year-old re recall is. The only reason this patient’s composites look so good is not because I am a master, it’s because she wore her night guard every night, and that literally, that’s what he said in his words.

So sometimes when you get that patient who really wants to keep things. Things pristine. Yeah. And if the nocturnal brox has been an ecological factor Yeah. Then that can help longevity. But I completely take your view that it takes a special kind of person to be able to comply as good as those patients.

[Hans]
Yeah. Like I said, it has to be nocturnal where, and it has to be a really conscientious patient. They do exist, but how many patients, how many night guards do you need to make? To treat that one patient who will actually use it. 

[Jaz]
Asymptomatic patients ha have got the poorest. If you’ve got symptoms, you’ve got TMD and you’re symptomatic, and then you are, you are willing to wear even the most wackiest of spin. Yeah. But when you give an asymptomatic individual an appliance, then you will definitely get have to accept reduced compliance race. We’ve across the hour you are approaching midnight, but yes, so I wanna make sure that you get to bed, 

[Hans]
I’m fine. I’m happy, talking with you. I just wanted to make one last point. 

[Jaz]
Yes, please. 

[Hans]
Patients that wear their teeth, they don’t have TMJ problems, so they’re asymptomatic in the first place. So that’s a point to you that giving asymptomatic patients splints doesn’t really work well and sometimes if they’re dentists, they might. If they’re dentists, I do treat some dentists as well. 

[Jaz]
That’s very true actually. And, what, what you mentioned there was just on last point, what you mentioned there was is very true that the patients who have wear on their teeth, they often don’t have stresses on their masticatory system.

With those patients whose periodontium. Has taken all the stress. Yeah. They often don’t have the wear the opposite in a way. Right. So, sometimes patients have lots of wear but no jaw issues. Sometimes patients have mobility in their teeth, but no wear. 

And so this is all part, like the weakest link theory that is really good paper attached to this episode and it’s like trying to put patients into boxes, just like a stupid little thing to do, but it kind of explains what we see in the real world. Hans, thank you so much for this. Please do tell us about any education you run. I know you’re on the lecture circuit. If you’ve got any education coming up that you’d like our audience to tune into. I’d love for you to talk about that, my friend. 

[Hans]
Usually I lecture in Norwegian mostly, at least for now. Perhaps this will change after this podcast. You have a, you have a very widespread audience around the world at the moment. I do not have anything coming up.

I’m very involved with building a new clinic. So that’s mostly what’s on my mind and we’ll see what opportunities comes later on. Other than that, if you want to see me, I do run the continuing education with the four fellows of mine here in Stavanger in this part of the country. So you, you can come see some of our courses if you like. We have some quite interesting ones- 

[Jaz]
And your Instagram handle so they can see your lovely photography and– 

[Hans]
It’s tannlegognedal it’s in Norwegian, my last name, and Tan Legg, which is dentist in Norwegian. So that’s my Instagram handle and you’re free to share that of course, on your video if you like.

[Jaz]
Amazing. No, I always tag our guests in, in the description. So Hans, thank you so much. 

[Hans]
Yeah, thanks. If anyone has a question, I’m really happy to answer them. Send me a message on Instagram. I think that’s easiest. No worries. 

[Jaz]
And send Hans a message on Insta or comment below. And I’ll tell Hans now and again check it and to hopefully see lots and lots of thank yous and honestly, Hans, thank you for covering a topic that is not widely talked about and it’s a really good minimally invasive solution when we’re scratching our head running out of ideas ’cause yeah, classically, yes, gold on Lays or these ways of doing it, but to raise the vertical dimension on posteriors only can be a very scary thing to do. 

When you are, you know, let alone doing anterior  DAHL for the first time to do this Reversal  DAHL. And I think you’ve just covered it really well in a really pragmatic way. I like that you’re not using wax up, you’re not using funky stuff, you’re just building them up to anatomical form and you’re letting nature do the rest. 

[Hans]
And of course scanning has worked wonders. You ask about injection molding at one point, why not? But then you all already has involved some very heavy technology so you can manage the occlusion in a whole another way. This technique, the reverse  DAHL really started as a, as a really hands-on, direct composite way to do it, just to minimize the expenses of having models, having wax ups, doing difficult occlusal stuff. 

[Jaz]
Hans, appreciate your time and thanks so much for everyone for listening to the end.

Jaz’s Outro:
Well, there we have it guys. Thanks so much for listening all the way to the end. Now you know about the reverse  DAHL technique. If you’re inspired by this and you wanna learn more about the normal  DAHL technique, then again, I’ve linked it all in the show notes. This episode is eligible for an hour of CPD or CE Credit Suite are a PACE approved provider.

Now that you’ve done the hard work of listening to someone talk about teeth for a whole hour, just answer the questions, get 80%, and you get your CE certificate. Our CPD Queen Marie will look after you and just like this, you can gain so many hours. Throughout the year making this one of the most valuable subscriptions that you have.

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I wanna thank you again for listening. I wanna thank the team of Erica, Gian, Krissel, Julia, Nav, Emma, who at this moment in time is doing her finals, so wishing her all the best. And with that, my friends, thank you so much. I’ll catch you same time, same place next week. Bye for now. Oh, and don’t forget to give this a thumbs up.