Payman Langroudi: This podcast has been brought to you by Mini Smile Makeover Mini Smile Makeovers, a two day anterior [00:00:05] composite course led by the extraordinary talented doctor Depeche Palmer. Two [00:00:10] days of full on, hands on composite training, purely focussed [00:00:15] on anterior work. Composite veneers, polishing, finishing, shade matching. You also [00:00:20] get a free enlightened kit. Plus, we have a great time and a party in the middle to find out the [00:00:25] dates. Mini smile makeover. Now let’s get back to the podcast.

[VOICE]: This [00:00:30] is dental Leaders. [00:00:35] The podcast where you get to go one on one [00:00:40] with emerging leaders in dentistry. Your [00:00:45] hosts Payman Langroudi and Prav Solanki.

Payman Langroudi: It [00:00:50] gives me great pleasure to welcome Mahmoud Ibrahim onto the podcast. I’ve been [00:00:55] looking forward to this podcast for a long, long time and people will know Mahmud mood as the [00:01:00] Occlusion Ninja from our friends [00:01:05] on the dental podcast. Mahmud’s been probably, uh, [00:01:10] the sort of, uh, occlusion guy behind the OB [00:01:15] course and a bunch of other courses that Jazz Gulati runs. Um, [00:01:20] super kind, nice guy. The kind of guy that every single person who meets you, Mahmood, has [00:01:25] such lovely things to say about you. Yeah. So really happy to have you. Well done for coming in finally. [00:01:30]

Mahmoud Ibrahim: Yeah, it’s been a it’s been on the cards for a while. Thanks so much for inviting me [00:01:35] and for the, the water and coffee.

Payman Langroudi: And let’s hope your buddy jazz is listening, because I’m [00:01:40] going to ask for a bunch of pearls, pearls, pearls.

Mahmoud Ibrahim: Make it tangible.

Payman Langroudi: In [00:01:45] fact, I’ve decided they’re going to be called diamonds because they’re Dental Leaders diamonds. Take it up and it’s [00:01:50] going to be a d gonna be a pearl. Right. Um, around occlusion. [00:01:55] Um, because certainly that’s an area most of us struggle with. Um, but [00:02:00] man would give me the straight away. I know, I know, I know, it’s a bit unfair, [00:02:05] a bit unfair. What’s the one thing about occlusion? One thing that most dentists [00:02:10] don’t know that they really should. And then we’ll go into the specific parts. But [00:02:15] what comes to mind when I say that?

Mahmoud Ibrahim: Um, okay. So, uh, you know, I, [00:02:20] I tend to say this to people who who, uh, are wondering whether they should come out on a collision [00:02:25] course or like, well, what does the collision really going to do for me? Mhm. Um, and it’s the [00:02:30] fact that inclusion plays a part in almost any type of dentistry you’re going to do.

Payman Langroudi: Yeah.

Mahmoud Ibrahim: And [00:02:35] more often than not, if you know a little bit about inclusion, you can make your work last a lot [00:02:40] longer because all inclusion is it’s about force management. Right. Um, the [00:02:45] mouth, the mathematics system, whatever you want to call articulatory system. There’s [00:02:50] there’s muscles working and therefore they are exerting some sort of force. [00:02:55] That force has to go somewhere, right? And you know, you got your joints sometimes can [00:03:00] get affected. The muscles can sometimes affect it get affected. Sometimes it’s the teeth. Sometimes it’s whatever you put on [00:03:05] or in the teeth. If you happen to have just done ten veneers on somebody, guess [00:03:10] what? Occlusion is going to be important. Making sure that those things last as long as possible. So, you [00:03:15] know, uh, occlusion is kind of like getting punched in the face in a way. There’s [00:03:20] only a few things you can do if you’re about to get punched in the face. You can either move out of the way. Uh, [00:03:25] so in occlusion terms, for me, that’s, you know, you keep your restorations out of harm’s way, and you can only really [00:03:30] do that if you’re dealing with 1 or 2 teeth. Um, but the other thing you can do is try and [00:03:35] roll with the punches. And a lot of learning occlusion principles is [00:03:40] essentially learning how to roll with the punches, roll with whatever the patient’s going to do with their [00:03:45] teeth, uh, because.

Payman Langroudi: Rather than kind of reorganising everything, is that what you. [00:03:50]

Mahmoud Ibrahim: Still reorganise it?

Payman Langroudi: What do you mean by roll with the punches?

Mahmoud Ibrahim: So, you know, there used to be a belief [00:03:55] that if you perfected someone’s occlusion.

Payman Langroudi: Oh, it’s like a textbook perfect. [00:04:00] Yeah.

Mahmoud Ibrahim: They will no longer grind their teeth. They will no longer do damage to your restorations. We now know that that’s [00:04:05] not fact. Okay? And that never really sat well with me anyway because I always thought, [00:04:10] well, you know, if if it’s the fact that you’ve got interferences that’s causing you to grind, [00:04:15] well, we know that 95% of people out there have interferences of some [00:04:20] kind, but not 95% of us grind our teeth. And the other thing is, if it’s the interference [00:04:25] is making you grind and you’re grinding the interferences away, shouldn’t [00:04:30] there get a point where you’ve ground the interference? Yeah, exactly. You’re gonna stop, right? If it doesn’t happen. [00:04:35] So we need to forget the idea of if you perfect the occlusion, the patient’s going to stop doing whatever it [00:04:40] is they’re doing. So what I mean when I say roll with the punches is you have to assume the patient’s going [00:04:45] to carry on the same behaviour. So how do you. Yeah. How do you plan your restorations, [00:04:50] the shapes of the restorations how they’re going to touch and for how long, [00:04:55] so that they can survive what the patient is going to do to it.

Mahmoud Ibrahim: And I think [00:05:00] part of the reason occlusion became so complicated [00:05:05] or dogmatic is a lot of the time. So we, you know, let’s say [00:05:10] we’re still in the era where it was, you know, if you get the occlusion perfect, [00:05:15] that patient will stop grinding their teeth. Right. What happened was a lot of people learned how to get the occlusion perfect. [00:05:20] Their patients didn’t break restorations as often as the people that didn’t do that. [00:05:25] And therefore you get confirmation bias. You get the fact that, oh, I perfected their occlusion. Yeah. Nothing broke. Therefore, [00:05:30] they have stopped grinding. In fact, what’s happened is the principles [00:05:35] that we apply to get a perfect occlusion also happen to be [00:05:40] very good at mitigating the effects of the forces that are still being applied. Okay. [00:05:45] So they still so the end product is the same. It’s just the reason you’re doing it is [00:05:50] different, right? I’m not doing it. So I stopped the patient grinding. I’m doing it because that design [00:05:55] creates the least amount of stress on my restorations, even though the patient [00:06:00] is still grinding.

Payman Langroudi: That was nature’s design to minimise things.

Mahmoud Ibrahim: So [00:06:05] so here’s here’s where we start, like getting [00:06:10] into. I love biomimetic [00:06:15] dentistry. I love adhesive dentistry. I love all that. However, sometimes [00:06:20] we have to admit that our materials are not quite as good as what nature? [00:06:25] God, evolution, whatever you want to believe in gave us, [00:06:30] right? So I tend to build in certain, uh, [00:06:35] what’s the word like? Um, margins of [00:06:40] error or margins of safety within my restorative design so [00:06:45] that it’s not just, you know, I’m not taking a tooth and creating.

Payman Langroudi: The same thing again. [00:06:50]

Mahmoud Ibrahim: The same thing again? Yeah, because I know I’m using inferior materials. Yeah. Um, so [00:06:55] I’m going to create certain designs that maybe have a little bit of.

Payman Langroudi: Weaknesses [00:07:00] or whatever. Right.

Mahmoud Ibrahim: Thicknesses, wiggle room. Maybe. I’m not as precise as I would like to pretend I am. So [00:07:05] building a little bit of margin for error. So that’s something, you know, we call it also frameworks [00:07:10] a margin of safety occlusion. So essentially it’s taking, uh, you know, inspiration from [00:07:15] like if you look at the building industry, you know, engineering, when they build a beam that [00:07:20] is supposed to withstand ten tons, they give you a beam [00:07:25] that can withstand, withstand 20 tons, right? But they just tell you to put ten tons on it. And that [00:07:30] difference is the margin of safety. So for me, I sort of apply the same [00:07:35] thought process to when it comes to occlusion. You know, I don’t want it so that if I am too tense [00:07:40] out, it will fail. I want to have a little bit of wiggle room.

Payman Langroudi: Mhm.

Mahmoud Ibrahim: Um, [00:07:45] so once you understand that really it truly is about force management. And [00:07:50] then your, you know, you learn some, uh, physics principles, [00:07:55] you know, and again, people say, oh, we’re not machines and yes, we’re not [00:08:00] machines. And I understand that we’re biological beings. You know, I’m not trying to simplify it and [00:08:05] say that we’re mechanistic, but when there [00:08:10] is a force being applied by muscle and that force is being applied onto a surface, [00:08:15] then the rules of physics are going to apply. And I think that’s partly why I gravitated [00:08:20] towards occlusions, because physics has always been a really.

Payman Langroudi: Your favourite.

Mahmoud Ibrahim: Subject. Yeah. Me too. Yeah.

Payman Langroudi: It [00:08:25] was all the sciences for me.

Mahmoud Ibrahim: That makes sense, right? Like, you can make deductions based on common [00:08:30] sense logic.

Payman Langroudi: While we’re there. What were there? Is there any way to stop people grinding?

Mahmoud Ibrahim: It [00:08:35] depends on whether there is a trigger that we can alter. [00:08:40] So there are some people who could be instance [00:08:45] could be airway issues. So if they’re having trouble breathing, there is [00:08:50] some theories that say that, you know, the mandible moves to try and open the airway. So if that is the case [00:08:55] and you sort out their airway issues then yeah, they might stop there. Uh, stop. Stop there [00:09:00] grinding. The problem is, though, you can’t guarantee it. [00:09:05] So I’m not going to rely on it. So even though I think okay, you know, go have a sleep study [00:09:10] comes back yet he’s got some, you know, sleep disordered breathing. We’ll put you on [00:09:15] whatever, you know, the CPAp or whatever it may be. I’m not then going to just assume, [00:09:20] okay, you’re not going to grind your teeth. So I’m going to put pretty thick, really thin edges, all that sort of stuff [00:09:25] everywhere. No I’m just I’m still going to try and minimise my risk as much as possible.

Payman Langroudi: But is there not [00:09:30] like a Botox injection or something.

Mahmoud Ibrahim: So again, you know, it [00:09:35] can help. You’re going to try and decrease the amount of force the muscles can produce. Um, [00:09:40] Botox tends to be something obviously they need to do fairly regularly. [00:09:45] And then again, depending on that patient’s compliance, making sure, you know, if you do the Botox yourself, fine. [00:09:50] Great. Get them back in. Keep doing it. I don’t do it myself. Um, but yeah, you know, it’s it’s [00:09:55] again a great adjunct. Um, but kind of like, you [00:10:00] know, people say, well, you know, I’ll just do what I want. I’ll just give them a night guard. Mhm. Yeah. [00:10:05] But the problem is most people don’t wear that night guard and they don’t want to wear the night guard. Uh, people [00:10:10] who are in pain and they’re night guard helps the pain. They [00:10:15] will wear your night guard. They will wear every single night. Mhm. Um, but patients [00:10:20] aren’t in pain. It’s hard to get them to wear it. So again I [00:10:25] don’t want to rely on it purely. I’ll still give them one. Don’t get me wrong. Um, but [00:10:30] I’ll still build in certain design features that will help minimise [00:10:35] my time.

Payman Langroudi: Is there a night guard that itself reduces bruxism? Or is [00:10:40] it? Or is it just like a protective thing? Is there any evidence of that?

Mahmoud Ibrahim: Um, [00:10:45] so. The the evidence at the moment [00:10:50] doesn’t necessarily favour one over the other. So you’ll [00:10:55] hear about, for example, an anterior mid stop appliance or essentially it’s a, it’s a guard [00:11:00] that has contact on the anterior teeth only here. Uh, you know, you get the sigh, you get the NTI [00:11:05] in the States. Whatever. Yeah. And the idea is that that knocks down the force of [00:11:10] the muscles. Okay. Through a sort of neurological feedback loop. But people still can’t grind [00:11:15] on it. Some people still can. And, you know, there’s a there’s a paper [00:11:20] I quote in, uh, in the course. I can’t remember the reference right now, but it showed [00:11:25] that even with anterior only contact, some, uh, [00:11:30] test subjects, you know, their muscle force decrease was only [00:11:35] down to 55% versus someone else that went down to 5%. So down [00:11:40] to 5% maximum someone else down to 55% [00:11:45] of maximum. Yeah, it’s a huge again discrepancy. So you can say, okay, I’m going to give you this [00:11:50] and your only appliance and it’s going to help take the muscle down, the muscle [00:11:55] force down. Fine. Uh, but on that person where it only takes it down by half, [00:12:00] I mean, if they started with massive chunky muscles, really [00:12:05] high muscle force, you’ve taken that down by half. It might still be strong enough to fracture [00:12:10] restorations. Right. Or someone else? Same muscle mass. The same muscle strength went [00:12:15] down to 5%. Yeah. Now, it might not be strong enough to fracture restorations. They’re very hard to [00:12:20] tell that before you’ve stuck your 10% veneers on. Yeah. So again.

Payman Langroudi: And [00:12:25] how long does that last that reduction. Again very.

Mahmoud Ibrahim: Great point. You know. So again [00:12:30] we there is uh the research I’ve seen at least again [00:12:35] this is it’s relatively old now, but you’ll find that within about sort [00:12:40] of for three months or so on a I think [00:12:45] this one was on a full coverage appliance worn 24 over seven. So full coverage [00:12:50] appliance equilibrated into centre relation given to the patient. They wore it for three [00:12:55] months and they put them on the MGS every couple of weeks, then, you know, every month, etc.. And they found that the muscle force [00:13:00] went down to start with and it stayed down until you get to about [00:13:05] the three month mark and everything just adapts and the muscle force goes back up to where it [00:13:10] was, where it was. So that’s, you know, some people ask me like, how long do you put your patients into [00:13:15] provisionals for if you’re reorganising a case? Yeah, I’ll try and put them in for [00:13:20] 2 to 3 months. Why? Well, this seems as [00:13:25] good a reason as any, right? Uh, it seems, uh, it’s a good amount of time to [00:13:30] test things, but also, if there is a period of adaptation, um, then [00:13:35] I want it to happen while the patient is in provisionals and then see what they do afterwards.

Payman Langroudi: As far [00:13:40] as the epidemiology of it. Do we know what percentage of the population has [00:13:45] severe proxies at some point? What percentage? Brooks. Sometimes, [00:13:50] I mean, are we are we coming like? For instance, the question that constantly flexes [00:13:55] my mind. Does 100% of the population brooks something.

Mahmoud Ibrahim: At some.

Payman Langroudi: Point? [00:14:00]

Mahmoud Ibrahim: I think so. Or maybe not 100. Yeah, but I think it’s pretty high because, [00:14:05] you know, you’re it a lot of the [00:14:10] epidemiology. How do you say that word epidemiology. Yeah that one. Um [00:14:15] research is is based on self-reporting as well. Right. [00:14:20] So how many patients do we get in the chair that I can [00:14:25] clearly see the weather sets matching up in some weird, you know, positions and stuff. You clearly [00:14:30] do something. Well, they have no idea, right? That doesn’t mean they don’t do it. It just means [00:14:35] they don’t know. So again, how [00:14:40] many of those get missed in those in those bits of research? And the other thing is, it seems [00:14:45] that the older we get, the more likely we are to actually Brooks [00:14:50] during the day. So daytime Brooks.

Payman Langroudi: Is that.

Mahmoud Ibrahim: Right? So then your night guard isn’t going [00:14:55] to help, right. Because they’re doing it, you know, while they’re watching TV or driving [00:15:00] to work or whatever it may be. So again, for me, it’s like [00:15:05] I look at the evidence that I can trust. And what is that that’s [00:15:10] on the teeth. So if I see a patient has ground their teeth down because [00:15:15] I can see where sets that match up, then I will assume [00:15:20] that they will continue to do so.

Payman Langroudi: Yeah, but you don’t know. That could have happened 20 years ago. [00:15:25]

Mahmoud Ibrahim: And it could happen again in five years time.

Payman Langroudi: Yeah yeah yeah yeah.

Mahmoud Ibrahim: So I [00:15:30] will assume.

Payman Langroudi: That, for instance, this first is very important in bleaching the current severe [00:15:35] bruxism. Is, for me, the number one most important [00:15:40] thing you need to look out for in a patient. Yeah, for tray whitening because it’s just ruined. [00:15:45] Straight whitening. Yeah, but current severe bruxism. What’s the best way is that. Is that a muscle examination. Because [00:15:50] a tooth examination you know, you’ve got some 21 year old who’s [00:15:55] grinding like hell, but there hasn’t ground for enough years to cause where [00:16:00] to happen. I mean, and then you say 21 year old amazing. Everything’s going to [00:16:05] go really well and then it’s a terrible case. Yeah.

Mahmoud Ibrahim: What about if they’re clenching? [00:16:10] Is that equally bad for the whitening?

Payman Langroudi: I don’t know, I guess.

Mahmoud Ibrahim: I.

Payman Langroudi: Guess it’s difficult to know for sure, but. [00:16:15] Yeah, probably.

Mahmoud Ibrahim: Have you looked into Brookes checker?

Payman Langroudi: No.

Mahmoud Ibrahim: So Brock’s checker is. It’s [00:16:20] like a it’s nearly like an Essex blank, but it’s thinner and it’s got this like dye, [00:16:25] this red dye on it. So you create a suck down right. And you give it to the patient in there where at night. [00:16:30] And essentially if they rub on it they’re going to rub away where the, you know, the red. And it’s [00:16:35] actually quite good at matching sort of their wear patterns and stuff. So it’s again [00:16:40] could be add it to your little package, you know, get that first see.

Payman Langroudi: Is it [00:16:45] custom made.

Mahmoud Ibrahim: Or is it custom made. Yeah yeah yeah. But they’re cheap. They’re not expensive. They’re not [00:16:50] expensive. You get the blanks. Any lab can make it from scan. Very interesting though.

Payman Langroudi: Yeah, but a muscle examination [00:16:55] like that’s.

Mahmoud Ibrahim: What we.

Payman Langroudi: Teach. We we teach strong muscles, severe [00:17:00] current bruxism.

Mahmoud Ibrahim: Yeah. Yeah.

Payman Langroudi: So or tongue examination. You know, a soft tissue examination for me. [00:17:05]

Mahmoud Ibrahim: Yeah. So traditionally speaking tongue scalloping cheek ridging could be signs [00:17:10] of limiting. Yeah. Yeah. Again that could be muscle spasm. [00:17:15] It could be. But I mean it’s possible. It’s possible. So if [00:17:20] we had a way of definitely telling you know trust [00:17:25] me everybody would know about it by now because that’s like is probably the biggest, uh, factor [00:17:30] you want to consider when you’re, you know, doing treatment, like doing a rehab or doing some aesthetic [00:17:35] treatment. If you can get a 100% guaranteed answer to that question. Like [00:17:40] a lot of things would change. Um, but all of the I think you need to take all of [00:17:45] those things together. So look at the muscles. Yeah, look at the soft tissues. You know, is [00:17:50] there a sensitivity?

Payman Langroudi: Um, crack teeth, wear facets, all of that?

Mahmoud Ibrahim: Yeah. Yeah. But [00:17:55] if if I’m going to commit to doing ten, 20 [00:18:00] units on a patient, and I see that there is where I will design [00:18:05] my restorations to try and mitigate for whatever is they do. Because [00:18:10] it doesn’t it doesn’t automatically mean my restorations are going to be [00:18:15] ten times uglier, right? Like the.

Payman Langroudi: Think of a couple of examples when you say what they do. So [00:18:20] you’re talking about different patterns of bruxism lead you to design your your restorations [00:18:25] differently. Right. Is that what you mean?

Mahmoud Ibrahim: Yeah. In a nutshell.

Payman Langroudi: So to give me a couple of examples of the difference, [00:18:30] what do you do differently in different situations?

Mahmoud Ibrahim: So if you see someone, for example, that has [00:18:35] wear just on the edges of their teeth, right. But they’re not a class three, they have a normal class [00:18:40] one incisor relationship they have over, yet they have a they have an overbite. But [00:18:45] the where is purely on their edges. Now there is again, [00:18:50] you’ll probably I don’t know, we might get a lot of pushback on this. You know, some people will say, okay, well [00:18:55] what’s going on is they’ve got an interference at the back and that is making them posture forward and [00:19:00] say on their front teeth, maybe, um, maybe it’s an airway issue. They’re [00:19:05] coming forward to open their airway. Um, maybe, uh, they have joint problems. [00:19:10] So they’re getting off the desk and or getting, you know, getting onto the desk by by moving forward. [00:19:15] Maybe, maybe, maybe, maybe.

Payman Langroudi: But for whatever reason, they’re coming.

Mahmoud Ibrahim: For the reason they’re doing it. Yeah, right. Unless [00:19:20] you’re in a fix. The reason. So you’re going to take every single patient who’s got some [00:19:25] wear on the edge of their teeth and either equilibrate them or put them through a sleep study. [00:19:30] Or, you know, get the TMJ sorted. Which if [00:19:35] you can. Great. Um, but what you need to accept is the chancellor. They’re still going [00:19:40] to do it. Right. And with some patients, I think it’s just a habit. You know, especially when I see it on just maybe [00:19:45] two teeth. Right. That’s something they’re doing and.

Payman Langroudi: You know, concentrating or something, you know. [00:19:50]

Mahmoud Ibrahim: And and this is, again, just my theory, I think, you know, when you see that, just [00:19:55] check the inside of their lip.

Payman Langroudi: Mhm.

Mahmoud Ibrahim: Honestly, 90% of the time I find that the lip is like all [00:20:00] chewed up and they’re just.

Payman Langroudi: Habitually they’re.

Mahmoud Ibrahim: Literally sitting there. And [00:20:05] to chew your lip you need to bring your inside ledges together. Yeah. Guess what. Doing that for you [00:20:10] know exactly. It’s going to wear the teeth down. So now you see that where right [00:20:15] now you’re going to restore it, right? You’re going to use your Palmer. [00:20:20]

Payman Langroudi: Which.

Mahmoud Ibrahim: Material.

Payman Langroudi: Which thickness and so on. Right.

Mahmoud Ibrahim: Yeah. Thickness is probably [00:20:25] in terms of especially composite is a big factor. Yeah. Um, you know what am I going to put on [00:20:30] that incisal edge? It’s not going to be my microfilm. It might not place [00:20:35] little melons. I might not place all my pictures and tints and stuff, you know, and [00:20:40] I’ll make it thick enough. But also look at the lower teeth. What you don’t want to do is make all the top [00:20:45] teeth pretty. And I see a lot of these cases where they’ve made the top teeth pretty. But look at the lower teeth. No, like jagged and [00:20:50] really sharp bits sticking up. Yeah, I guess what that sharp bit is going to be like a nail. And as soon as that [00:20:55] patient goes to chew their lip again, they’re gonna, you know, and it might not be straight away. Right. [00:21:00] The like well, I did it last week and it’s fine. You know, those sharp edges don’t create the crack immediately. [00:21:05] Right. They can create like a micro crack. And then as they do it more and more, or [00:21:10] they bite into a fork or or a carrot or whatever, right. Those cracks will propagate. And [00:21:15] then over time, that will chip. So, you know, we are very good at saying to [00:21:20] patients now, you know, uh, make sure you budget for [00:21:25] repairs and replacements. Um, you know, we’ll be repairing [00:21:30] 1 to 2 edges every 1 to 2 years. Budget this much money, whatever. And. Great. [00:21:35] And you, you want you want to consent the patient for what’s going to be involved 100%. But [00:21:40] I think a lot of the time, a little bit of money curing of those lower edges [00:21:45] makes a big difference.

Payman Langroudi: Yeah. And I think, you know, the minimally invasive [00:21:50] kind of revolution has meant that the likes of anyone who [00:21:55] qualified in the last ten years will not drill enamel like [00:22:00] they will not like in that situation. That would be like some sort of sacrilege. Like like like [00:22:05] and it’s so weird, you know, because like you say, we’re talking about tiny amounts to save [00:22:10] a lot of hassle for everyone. Um, but yeah, that’s what the younger dentists particularly [00:22:15] like.

Mahmoud Ibrahim: Yeah, we make a big joke about it. Like when we when we know when we’re talking about this [00:22:20] sort of on the courses and stuff and we’re like, okay, like, guys, just be ready, okay? This [00:22:25] is gonna be like, you know, sacrilege. This is enamel sacrifice [00:22:30] going on. But what I do tell them is, you know, that peak that’s sticking up. [00:22:35] Guess what’s going to happen when that breaks? Because it’s not going to stay there forever, [00:22:40] right? Yeah, that’s gonna break. And it’s not going to break cleanly. It’s gonna break. It’s gonna take a little bit more off [00:22:45] of the the bit of the tooth next to it. So in [00:22:50] fact, you are saving enamel.

Payman Langroudi: Yeah.

Mahmoud Ibrahim: But you know, like trying to [00:22:55] appeal to their, uh, their.

Payman Langroudi: Minimally invasive side. Right?

Mahmoud Ibrahim: Yeah, exactly. So [00:23:00] I have, you know, and I also worried it to the patient in a way, you [00:23:05] know, I don’t, you know, you don’t say to them, could I please drill away some [00:23:10] of your enamel? I mean, obviously they know, uh, so I’ll just say, look, to make this work, [00:23:15] I need to just smooth off some of the rough edges on those lower teeth. It’ll be like just doing a [00:23:20] manicure, right? Everybody loves a manicure. And you know, you do it so that you can run your gloved [00:23:25] finger over it and not feel anything sharp. It’s it’s tiny, tiny amounts, but [00:23:30] they can make a mess difference.

Payman Langroudi: So there we go. There’s one common error that people make with [00:23:35] occlusion. And we come across this all the time, right? That that question of these teeth have been shortened for [00:23:40] a reason. Yeah. And then we just go in and lengthen them and expect [00:23:45] the composites, which are nowhere near as strong as the original teeth to manage that common error. [00:23:50] Yeah. For anterior composites. Yeah. See it all the time. Yeah. What’s the other common [00:23:55] errors? Now I’d suspect. I mean, do bear with me. Yeah. It’s been 14 years since [00:24:00] I was a dentist. Like anything on the seven. Any item on the seven [00:24:05] is is much more dangerous than on any other tooth. Am I right about that? That’s right. And again, [00:24:10] just talk us through those and the common things that people do wrong there.

Mahmoud Ibrahim: Well, so yeah, again, [00:24:15] you know, when you, you can either think about it in terms of biology [00:24:20] okay. So you’ve got your, uh, people [00:24:25] hate this word, but mechanoreceptors and stuff like that. So generally forces when you’re [00:24:30] when you’ve got contact on posterior teeth, the elevator muscles, the muscles of mastication, they can exert [00:24:35] more force. Right. You get more of the fibres actually recruited. That’s one thing. [00:24:40] But also very simply put the seven is closer to the hinge. Yeah. [00:24:45] And the muscles. So you’re just going to have higher forces on the seven than you do on your central standard. [00:24:50] Now what other problems do you have with sevens. They tend to be clinically [00:24:55] shorter crowds. Right.

Payman Langroudi: So let’s play less to play.

Mahmoud Ibrahim: With, less to play with. Right. You can’t prep as [00:25:00] much to give yourself enough thickness. Um, sometimes the upper seven tends to be [00:25:05] tilted. So to the side with the palatal cusp hanging down, you can you might want to call it like a plunger [00:25:10] cusp or something. So there’s a lot of things that, uh, work against you sometimes. [00:25:15] Right. So a step one is be aware of all these things. [00:25:20] Right. So, you know, will the patient let you put gold on a seven if [00:25:25] they do? I mean, you know, again, this is a you’re you’re an aesthetic [00:25:30] course. Uh.

Payman Langroudi: Let me give me the words you use to persuade them, because [00:25:35] I could, I could, I could yeah, I mean, I just talk about how long it’s going to last. Right.

Mahmoud Ibrahim: Yeah. I just say, look, [00:25:40] your tooth’s very short. Um, and if you want it to last as long as [00:25:45] possible, I want to put a material on there that can be. So I’ll say, like, a [00:25:50] really strong and thin section. Although actually it’s not. It’s strength. It’s it’s malleability [00:25:55] and it’s ability to adapt. But you don’t have to go into that patient. Right. But but yeah that’s the [00:26:00] key there. Um, and it’s not going to uh, we can get into this in [00:26:05] a second, but I think you need to understand what the definition of failure is in a lot [00:26:10] of these things as well. Right. So even going back to the anterior teeth, these [00:26:15] patients are not going to stop doing what they’re doing. They’re still going to wear their the teeth down, they’re still [00:26:20] going to wear your composite down. So again consenting. But for me [00:26:25] one light bulb moment was when I understood what is or what isn’t failure. I’m not trying to [00:26:30] stop my composite wearing. I’m trying to stop catastrophic failure. So I’m trying to stop them [00:26:35] ringing me on a Sunday night going. My front tooth just broke. Or your composite chipped. Right. [00:26:40] If it’s where it happened, slowly enough, nobody notices, right? You get to do the same [00:26:45] procedure again in ten years time. But it’s those chips, those fractures. That’s what you want to avoid. And [00:26:50] the same thing on a seven, right? Slowly they might wear through it. But again that is [00:26:55] less of a catastrophic failure than the crown fracturing um, or uh, [00:27:00] deep bonding coming off completely.

Payman Langroudi: Um, sometimes, I mean, [00:27:05] this must have a name like, you prep the seven and you destroy the whole stability [00:27:10] of the occlusion.

Mahmoud Ibrahim: Yeah, it’s called the last tooth in the arch syndrome.

Payman Langroudi: Right. And then you can’t get clearance [00:27:15] anymore because how much you prep, it just keeps on going or whatever. Yeah. Is it possible [00:27:20] to predict that might happen? Yes it is.

Mahmoud Ibrahim: So we again [00:27:25] we go through this. We actually have the, um, I talk about this for a whole hour [00:27:30] on a podcast, but I’ll give you.

Payman Langroudi: The break it down to one minute. One minute.

Mahmoud Ibrahim: Essentially, [00:27:35] what’s happening with those patients is that tooth happens to be their initial point of contact, [00:27:40] or the first point of contact in central correlation. Yeah, right. So their joints are seated [00:27:45] as they’re closing one tooth hits and then they slide into their normal bite. That’s their central contact [00:27:50] point. And it happens to be the tooth you’re about to prep. So now you prep it. And [00:27:55] what happens is that the joint seats upwards a little bit right.

Payman Langroudi: The joint is not used to that. [00:28:00] So it just.

Mahmoud Ibrahim: Yeah. Well the joint has no reason to now sit [00:28:05] further down. Right. Because it was that interference that was stopping its eating. So [00:28:10] now that’s gone. Now it seats. And now you just lost some or [00:28:15] all of the space you’ve created. So what you don’t want to do is you don’t want to be [00:28:20] in that situation having not told the patient and having no [00:28:25] out. So the simplest thing you can do is screen for it. Okay. And the way we teach is [00:28:30] leaf gauge. You get a leaf gauge essentially just a bunch of plastic leaves. You put it in the patient’s mouth [00:28:35] and using the, the, you know, technique of forward, back and squeeze, you’re trying to get the condyles [00:28:40] to seat and you’re going to find which tooth is this patient’s first point of contact. [00:28:45] If it’s a tooth you’re about to work on. There may be a risk. If it’s not great, [00:28:50] carry on. So what do we do if it is the tooth we’re about to work on? In [00:28:55] a nutshell, you need to figure out how much space might you lose? [00:29:00] Okay. Simplest way is look at the next tooth along [00:29:05] that looks like it might touch sort of next if you like. Right. If [00:29:10] that space is a quarter of a millimetre or half a millimetre. [00:29:15] Chances are that’s the most you can lose, right? Because everything’s good. You keep moving up until that two [00:29:20] thirds. If it’s half a millimetre, I’m not bothered. I’ll just prep an extra half. If [00:29:25] it’s a plunger cusp at the top. I’ll smooth it down a little bit. Tell the patient. Yeah. Now, [00:29:30] if it’s two millimetres of space, then I’m like, [00:29:35] okay, this could be a problem, right? But whose problem is it?

Payman Langroudi: Patience. [00:29:40]

Mahmoud Ibrahim: Patience problem? Yeah, right. My duty is to inform. [00:29:45] We could crown on this tooth. I would need to do this. That might happen. Okay, [00:29:50] so, uh, what do we do? Right. Um, I’m like, okay, if it’s something [00:29:55] you still want to do, I need to get more information. So for me, let’s get some models mounted. Right. [00:30:00] You can do the prep on the model and then see what happens. Right. And [00:30:05] you can then use that information to relay back to the patient. Well it could change your bite. It could do this could do [00:30:10] that. Whatever. You know, there’s a [00:30:15] lot of time in what we do. There’s a difference between what’s in the textbook and what you [00:30:20] get to do, or what the patients allow you to do in real life. Yeah. Um, but by the way, let’s [00:30:25] say the patient says, oh, absolutely not. I’m not doing that. What I have done before, where, [00:30:30] you know, the tooth is still restored with the direct, uh, restoration. [00:30:35] You know, I’ve just maintained that the rest of the tooth and just restored [00:30:40] it direct. You know, after making this. So discovery. Now, does that [00:30:45] increase the risk of this tooth fracturing? Yeah, possibly, if that tooth is getting [00:30:50] pounded.

Mahmoud Ibrahim: Right. If it is something that the patient does go on and maybe grind [00:30:55] or clench on it or does it in slides, some people do, some people don’t. Right. There is an [00:31:00] increased risk to that tooth. But again whose risk is it. Patients. Patients. Right. So again you inform [00:31:05] you tell them this might happen. What else can we do. Right. Maybe a protective appliance [00:31:10] might help if it’s something that they do at night, right? But again, you [00:31:15] know, there’s you can’t always fix everything. But I think [00:31:20] the last thing you want to do is be in a situation where you’ve prepped the truth, and now you’re about [00:31:25] to pop it because there’s just no space and you haven’t told the patient and you’re [00:31:30] not stuck. So just screen for it with practice takes two minutes. So if I’m prepping your last [00:31:35] tooth of any sort, I will definitely do it. If I’m doing like [00:31:40] a six and they still have the seven, I’ll do it on a good day. And if I’m being lazy, I might [00:31:45] not.

Payman Langroudi: Not so. Not so crucial. Right. Yeah.

Mahmoud Ibrahim: So I don’t see a lot of wear that sort of stuff.

Payman Langroudi: So there we go. The [00:31:50] first one, the anterior I mean the lateral right. The distal side of the lateral. This [00:31:55] this one. This one that you just mentioned. What else.

Mahmoud Ibrahim: What [00:32:00] else in terms of.

Payman Langroudi: The general dentist is out there. Might not know [00:32:05] about something in occlusion. Some simple thing like the two that you just mentioned. [00:32:10] That will make a massive difference to their, you know, screen for [00:32:15] what? Like I’d say, I don’t know what I’d say. The communication with the lab [00:32:20] aspect of it. And what’s the point of you knowing everything about occlusion if you can’t communicate that to the lab? [00:32:25] Like, why are you doing what you’re doing? You know, cusp angles. [00:32:30] Angles.

Mahmoud Ibrahim: Yeah. So and you have to kind of take a step back [00:32:35] from that, because if you don’t know what is in the patient’s mouth, you can’t communicate it [00:32:40] to the lab. So, you know, again, it seems so basic [00:32:45] when you think about it. And yet, you know, if I line up a hundred [00:32:50] people that have just left dental school and asked them, okay, you know, you check [00:32:55] the occlusion, right? They’re like, yeah, we check the occlusion. I’m like, okay, do you check it after you’ve done the filling? Yes, we check [00:33:00] it after we’ve done the filling. Okay. Did you check it before you did the filling?

Payman Langroudi: Very rare. Yeah.

Mahmoud Ibrahim: No.

Payman Langroudi: So what are [00:33:05] you checking? It’s great advice, isn’t it?

Mahmoud Ibrahim: So what, are you checking it again?

Payman Langroudi: Just that one piece of it.

Mahmoud Ibrahim: And, [00:33:10] you know, again on when we’re talking about this on the course. Sometimes it it [00:33:15] does tend to be like, okay, that you’ve just finished explaining the basic occlusal exam [00:33:20] and then you’re going to like, oh my God, it’s a lot. It really isn’t on like a day [00:33:25] to day dentistry basis. So you know when, when, when the patient’s in you [00:33:30] can either you can even do this while they’re getting numb. Right. So I put topical [00:33:35] on. Yeah. Doesn’t work blah blah whatever. It’s just part of.

Payman Langroudi: I think [00:33:40] it works. Try the area, put it on, leave it for a long time.

Mahmoud Ibrahim: And even if it is placebo, [00:33:45] fine. Even it just makes it patient. Feel better, fine. Whatever. It’s just part of my routine. [00:33:50] Put that on and then I use troll foil. There is a reason [00:33:55] it is more expensive, but for me, I don’t even have to really dry the teeth out [00:34:00] for it to mark it just marks. So I’ll do that and use shim stock.

Payman Langroudi: Because [00:34:05] it’s thinner.

Mahmoud Ibrahim: It’s thinner. And the number of times [00:34:10] you think teeth touch when they don’t, you know, is quite, is quite high. And [00:34:15] what I really do think I know this this [00:34:20] is people are going to switch off now. Um, but shim stock is a bit of a game changer because [00:34:25] it gives you so much confidence in knowing that you’ve nailed the occlusion in [00:34:30] terms of I’ve given you back exactly what you had before. Right. You might feel like it’s weird, [00:34:35] but trust me on this. It’s just your numb. It will be fine. Right. Instead [00:34:40] of going back and just adjusting and then going, um, I know it’s still.

Payman Langroudi: You’re saying [00:34:45] you’re you can say it with authority. Much more confidence.

Mahmoud Ibrahim: Yeah. And when you do that [00:34:50] with the patient, they’re like, oh okay. Cool. Right. And honestly, 1 [00:34:55] in 1000 cases will be, uh, come back. I’ve got an issue. [00:35:00] Yeah. Um, because it is so, so precise. Um, [00:35:05] but you need to check the occlusion before you start, so you have something to compare [00:35:10] it to at the end. But equally, then you have something to give to the lab. Right. So if I’m doing an [00:35:15] indirect restoration, I have the very least will tell the lab which teeth hold stock and which [00:35:20] don’t. Not even the whole mouth, just the tooth. I’m working on one [00:35:25] behind it, one in front of it and maybe one on the other side. If I’m taking a full arch scan, a lot of the time I’m [00:35:30] taking like a quadrant. Quadrant scan, right? Um, and [00:35:35] with regards to your question about possible angles and stuff, again, you know, [00:35:40] technicians love making pretty things just like we do. Yeah. So they don’t want to pick the [00:35:45] tooth with the prettiest anatomy big, you know? Yeah, [00:35:50] exactly. Like 16 different values and stuff. Yeah. Uh, and that might not be appropriate. [00:35:55] Right. So, you know, we say only goes like, why sometimes you have [00:36:00] to think like, why do you want to give a 70 year old patient A ten year old’s tooth. That [00:36:05] makes no sense. Yeah. So I will always give them guidance in terms [00:36:10] of saying don’t make the cusps any steeper than.

Payman Langroudi: The adjacent.

Mahmoud Ibrahim: Tooth. [00:36:15] Yeah. The seven if I’m doing the six, for example. Um, and [00:36:20] the fact that you are telling them that the fact that you are giving them the shim stock holds, [00:36:25] the fact that you are dictating what you want, that’s [00:36:30] not the case. They’re going to pass on to the most junior, [00:36:35] least experienced.

Payman Langroudi: That’s interesting.

Mahmoud Ibrahim: Right. That’s they’re going to pay attention to [00:36:40] that and they will send you back what you want. And if they don’t you send it back once. Trust [00:36:45] me after that, every time it will come back they would. It’s not going to be perfect every time. It’s not what I’m saying. [00:36:50] What I’m saying is extra attention. Yeah, yeah. They’ll they’ll they’ll know. Okay. [00:36:55] This guy’s serious. This guy’s serious. They’re gonna check. They’re going to pay attention. [00:37:00] Now, do you know, is the equation perfect on every single one of my iterations? No. Do [00:37:05] I sometimes cement things in that are a little bit shy? Yes I do. Um, [00:37:10] yeah. Not not half a millimetre out of the way. Not a millimetre out of the bite. That’s, you [00:37:15] know, that’s that’s leaving too much to chance for me. Yeah. But [00:37:20] you know, if, uh, if if I double up that articulating paper and [00:37:25] it starts grabbing and it’s like, that’s like 40 microns. Yeah. It’s fine. [00:37:30] Um, and, yeah, a lot of people might be thinking, well, that’s [00:37:35] still, like, ridiculous. Who cares? It’s just one tooth. Well, [00:37:40] if you want to keep doing just one tooth every single time, fine. For [00:37:45] me, I enjoy doing more involved stuff. [00:37:50] So doing quadrant, doing a full arch, doing a full mouth, and you can’t leave a full arch out of the bite. So [00:37:55] you learn on the single. Mondays and Tuesdays. Right. And then it’s like you extrapolate.

Payman Langroudi: Yeah. [00:38:00] Like you learn a composite on a single central, but that’s what you extrapolate into [00:38:05] a full smile or whatever. Yeah. Yeah. And what about the patient’s ability to sort of, [00:38:10] um, adapt?

Mahmoud Ibrahim: I mean, we would be screwed.

Payman Langroudi: Without.

Mahmoud Ibrahim: Without [00:38:15] that massively.

Payman Langroudi: With Invisalign or whatever. Right. The teeth are nowhere near each other, and [00:38:20] then they jiggle themselves in. Does that not mean that if we make little mistakes and occlusion doesn’t matter because things will [00:38:25] adapt? Or is it like sometimes they will, sometimes they won’t, and then you’re in trouble? Yeah, exactly. [00:38:30]

Mahmoud Ibrahim: Well, sometimes they do, sometimes they don’t. Yeah. And also you got to remember when you’ve just finished Invisalign all [00:38:35] these periodontal ligaments are really wide. Yeah that’s true. So there is, there is um.

Payman Langroudi: A [00:38:40] very moving around anyway. Yeah.

Mahmoud Ibrahim: Yeah. There’s a good point. There’s a, there’s a very sort of well-known, [00:38:45] um, someone that speaks a lot about [00:38:50] whether CRPS is, is is real or not. And, [00:38:55] you know, I agree with 99% of the stuff that they say in terms of [00:39:00] and let’s not be dogmatic about things. However, when you [00:39:05] when you’re able to put brackets and braces on a [00:39:10] lot of the complex cases, I think the ability of the teeth [00:39:15] and the ligament and stuff to adapt becomes much higher because you’ve just loosened everything.

Payman Langroudi: Essentially, [00:39:20] the very good point. Right. Never thought.

Mahmoud Ibrahim: About it. Yeah. And then [00:39:25] it does make you think like, okay, well, if, if everything can just jiggle around and and fit [00:39:30] after a while then yeah, much easier. But yeah, we rely heavily on the patient’s ability [00:39:35] to adapt. Um, without that, you honestly, you’d be you’d be [00:39:40] you’d never do more than one tooth at a time.

Payman Langroudi: That would be the difference between a machine and a and a [00:39:45] and a and a human right. Yeah.

Mahmoud Ibrahim: Essentially. Yeah, yeah. Because there’s a lot [00:39:50] of moving parts and there’s a lot of squishy parts as well. You know, so again, there are certain things you learn growing [00:39:55] up, not growing up, but growing up in this industry or in this career, and you start thinking, I don’t [00:40:00] know, man, that doesn’t really make sense. So, you know, you you go and you learn about central [00:40:05] relation, for example, and you get told this, you can identify this with [00:40:10] pinpoint accuracy. Yeah. I was thinking [00:40:15] the amount of like squishy bits involved. You got the [00:40:20] disc the the muscles, the, you know, your mandible flexes.

Payman Langroudi: Is that.

Mahmoud Ibrahim: Right? Yeah. [00:40:25] And and it’s, it’s to a point where there can actually be a difference in. [00:40:30] So when this all this becomes much more important when you’re dealing with implants and stuff because you don’t have [00:40:35] the flexibility of the periodontal ligament. But yeah, that can have an impact. [00:40:40] The fact that the mandible flexibility your stone models or your printed models don’t know.

[TRANSITION]: Interesting.

Mahmoud Ibrahim: So imagine [00:40:45] then you’re trying to tell me that central relation is a point. Yeah. Whereas [00:40:50] if I, you know, was out last night and I’m super dehydrated, [00:40:55] it might be that my disc is actually slightly thinner today than it was yesterday.

[TRANSITION]: I [00:41:00] just see. Yeah.

Mahmoud Ibrahim: So again, that false, um, [00:41:05] belief that we might be more accurate than we really are. And [00:41:10] then extrapolating to that to hey, if you don’t learn how [00:41:15] to be super accurate by coming and [00:41:20] letting me teach you this very precise method [00:41:25] that only I can teach you, yeah, you will fail. Yeah. [00:41:30] That kind of initially sat not so comfortable with me. I was like that. I [00:41:35] don’t know. I just don’t see it being that precise. And hence why? Margin of safety. [00:41:40] Just building a little bit of room for error. You know, if you assume that centre correlation is a small [00:41:45] area, right, you make your where the teeth contact maybe [00:41:50] just a little bit bigger. Then you’re just like less likely to have to have issues. [00:41:55]

Payman Langroudi: When did you like it? [00:42:00] Not suddenly, but when did you decide? I’m gonna check out occlusion. And, like, were [00:42:05] you always that cat? Like like it curious cat. But [00:42:10] but, you know, it’s a kind of big thing to say. I’m going to figure out as much as I can about occlusion [00:42:15] almost on your own. You decided to do that, right? It wasn’t like you were on a course or something. [00:42:20] You just decided to do that.

Mahmoud Ibrahim: Yeah. So. Okay.

Payman Langroudi: Um, what’s the story of that? [00:42:25] Well, you taught it very well at Manchester, number one.

Mahmoud Ibrahim: No, not at all. Not at all. It’s [00:42:30] poorly taught in general. Yeah. Especially undergrad. Not [00:42:35] necessarily. I’m not saying that to say that dental schools do a bad job. I just think [00:42:40] they have a hell of a job already making us. Mildly [00:42:45] competent, you know? Yeah, yeah. You know, safe [00:42:50] enough not to kill patients. You know, that’s tough enough.

Payman Langroudi: Do you trace it back to a particular [00:42:55] case, for instance, like a particular fracture that you were like, why the hell did that happen? I need to know everything about this [00:43:00] thing.

Mahmoud Ibrahim: Well, so honestly, like, during uni, I [00:43:05] was just, hey, what do I need to just pass? I’ll [00:43:10] do that and let’s just go have fun, right? That was it. Graduating [00:43:15] was probably one of the biggest sort of anticlimactic things. [00:43:20] Not because I was expecting it. That’s what I’m saying. What I’m saying is.

[TRANSITION]: Like.

Payman Langroudi: Everything was working towards. [00:43:25]

[TRANSITION]: That. Yeah, well, it was like.

Mahmoud Ibrahim: Well, now, um, the [00:43:30] hard part begins sort of thing, you know? And I [00:43:35] was like, I’ve seen two patients a day, max, up until this [00:43:40] point, and now I’m expected to see 20. Um, you don’t learn [00:43:45] how to speak to patients. Literally everything is scary. Everything scares the shit out of you, [00:43:50] and then you’re expected to do it. Do it well, [00:43:55] um, and get better. Which I was like, oh my God, you know. So [00:44:00] I spent the first five years trying to do anything to get out [00:44:05] of that story.

Payman Langroudi: Oh, really?

Mahmoud Ibrahim: Yeah, I read what I didn’t enjoy at all. I really [00:44:10] did enjoy it whatsoever.

Payman Langroudi: Well, I didn’t know this.

Mahmoud Ibrahim: No. Um, [00:44:15] you know, I tried to I learned I learned how to sort of build websites. I had an [00:44:20] idea to create a Dental buying group. Believe it or not, you’re not [00:44:25] the first guy I know, right? This was the first season.

Payman Langroudi: And you won’t be the.

Mahmoud Ibrahim: Last. 2006. Um, [00:44:30] and anyway, clearly I wasn’t any good at any of that either. [00:44:35]

Payman Langroudi: So did you actually take any of those little ideas, any distance or so?

Mahmoud Ibrahim: Uh, yeah. I mean, [00:44:40] uh, you know, I had, uh, bespoke software written for the, the, the buying [00:44:45] thing. Oh, really? Yeah, yeah. Uh, and then. Yeah, [00:44:50] ultimately it.

Payman Langroudi: Was changed.

Payman Langroudi: What changed?

Mahmoud Ibrahim: So [00:44:55] funnily enough, one day I did. I remember this very, very [00:45:00] clearly. I did a class for composite. And it looked like an I swear. Sure, [00:45:05] saying look like shit. Like it was so bad. And I was [00:45:10] kind of disgusted with myself. Honestly, I.

[TRANSITION]: Was a little bit [00:45:15] disgusted.

Mahmoud Ibrahim: With myself. And I was like, okay, well, if I’m kind of stuck doing this. [00:45:20]

Payman Langroudi: Then let’s figure out how to do it.

Mahmoud Ibrahim: Well, try and do it well. Yeah. [00:45:25] And it was just the start of where you [00:45:30] can find stuff on YouTube that wasn’t garbage. You know, it was okay when someone’s actually [00:45:35] showing a procedure. You know, the first time I saw someone use, like, a little putty stent, I was like, mind [00:45:40] blown. This is amazing. They don’t teach you that at uni? No. You know, not back when I was there anyway. [00:45:45]

Payman Langroudi: No, they saw that.

Mahmoud Ibrahim: Yeah. So I was like.

[TRANSITION]: Oh, there’s.

Mahmoud Ibrahim: Actually more than one way to do this. Great. Okay. [00:45:50]

Payman Langroudi: And that literally flicked a switch and you went then all in like, [00:45:55] are you that cat like you?

Mahmoud Ibrahim: Extremes.

Payman Langroudi: Extremes.

Mahmoud Ibrahim: Yeah yeah yeah yeah. And [00:46:00] also, um, like slightly, slightly obsessive. So [00:46:05] I went through periods where I would [00:46:10] pick like say endo. So my endo as well, [00:46:15] I was like, okay, let’s learn how to do endo. And I’d have a folder. Right. And I’d [00:46:20] spend three, four months and literally every day all I would look at is endo [00:46:25] stuff. Right. And just write the protocols down, learn them, practice them, find out what [00:46:30] the evidence is and just try and get better. Once I felt like, okay, reasonable, [00:46:35] right, I’ll move on to the next thing. So I couldn’t even do more than one thing at once, right? [00:46:40] Like I wasn’t.

Payman Langroudi: Hyperfocus.

Mahmoud Ibrahim: Yeah, I couldn’t just say, okay, I’ll do endo perio [00:46:45] and inlays or lasers. I’m like, no one thing. Um, [00:46:50] and it’s not necessarily healthy. And it wasn’t. It wasn’t [00:46:55] always in a good way. Uh, but anyway, that’s how I did it. Um, [00:47:00] the occlusion thing came about again. Because, you know. [00:47:05]

Payman Langroudi: Before you go ahead. What do you mean? Wasn’t always in a good way.

Mahmoud Ibrahim: Having [00:47:10] a slightly, like one. Uh, [00:47:15] single. Single? Yeah. Single minded? [00:47:20] Yeah. Yeah. We all have.

Payman Langroudi: That single minded determination.

Mahmoud Ibrahim: Yeah. Can be. Can be [00:47:25] unhealthy. You know.

Payman Langroudi: As in relationships with others. Whatever you just to.

Mahmoud Ibrahim: Complete [00:47:30] can be.

Payman Langroudi: You only see that you don’t see anything.

Mahmoud Ibrahim: Yeah.

Payman Langroudi: Yeah. Okay. So occlusion.

Mahmoud Ibrahim: So [00:47:35] that again came about because of, you know, I think I’m [00:47:40] a fairly logical person who’s able to make logical deductions fairly well. [00:47:45] You know, that’s probably one my one strength. So when [00:47:50] I was starting to enjoy dentistry a little bit more. I was like, okay, [00:47:55] well, I like the idea of making teeth look nice, treating debilitated [00:48:00] dentition that look messed up and the patients can’t chew or whatever. [00:48:05] But why would my stuff last [00:48:10] when they’ve destroyed their enamel? Like, what’s the [00:48:15] secret here? Yeah. So that’s that was the trigger, right? And that was me. Okay. Well, what do I [00:48:20] need to learn? So I start asking questions and God bless him, there’s two of my [00:48:25] sort of long term, uh, mentors, uh, you know, shout out to, uh, Doctor Michael [00:48:30] Marcus. You know, they I wouldn’t be where I am [00:48:35] now if it wasn’t for those two. Who are they? So teachers. So. No. So, Eleanor, she’s a dentist [00:48:40] out in California.

Payman Langroudi: Oh, okay.

Mahmoud Ibrahim: And Michael Marcus. He’s in New Hampshire at the moment [00:48:45] again. He they’ve both, you know, been teaching occlusion [00:48:50] treatment, planning, communication at a high level for decades. You [00:48:55] know, and they were always so generous with their time [00:49:00] and so sharing their knowledge. And the beautiful thing [00:49:05] is like when, um, you know, when I get a chance to, to say that to them, you know, and thank [00:49:10] them. Uh, you know, my especially was like, you know, you know, just just make sure you pass it on [00:49:15] sort of thing, which is really cool, really nice.

Payman Langroudi: Um, what did you do? Dm them or. Go on. [00:49:20]

Mahmoud Ibrahim: Yeah. So essentially essentially it was initially stalking and asking questions, following cases, [00:49:25] asking for advice. Um, and then you go from there.

Payman Langroudi: Literally.

Payman Langroudi: What did you [00:49:30] do here? What can I do here?

Mahmoud Ibrahim: Yeah. And their teaching style really suited me as [00:49:35] well because they ask questions. They they don’t give you the answer. They’ll show you and [00:49:40] they’ll say, what’s the problem? You know, Why would this not work? And then you have to make [00:49:45] that leap yourself. And once you do that, you never forget it. That’s right. And [00:49:50] I think that translated into how I teach as well. Um, [00:49:55] but then once you’ve once you now know [00:50:00] what the holes in your knowledge are, then you [00:50:05] try and fill them. Right. So that’s when it starts becoming. Okay. Let’s you know, you can either go out to the [00:50:10] US and join one of these big continuum. You know back in my time is like buy DVDs, right? Buy all the Frank [00:50:15] Speer DVDs. Buy buy these buy the books. Dawson oxen. Did you? Yeah. Yeah. Yeah. [00:50:20] Yeah, yeah. Um, you know, there’s a collusion design. Um, [00:50:25] it’s called the the program by Stephen Phelan. You know, here there was Raja Ahluwalia, [00:50:30] who ran a great sort of, um, uh, I think [00:50:35] it’s over for weekends, of course. And he has got sort of a very heavy, punky Influence [00:50:40] Steven Davis on on my Masters. Um, reading [00:50:45] the papers, you know. So again, this was even. Even so how [00:50:50] old is my son now? 11. So yeah, he was he was one. I still remember, [00:50:55] you know, they go to bed early at that age. And after that, after he’d go to bed, he’d [00:51:00] be like four hours of just reading papers, you know, any, any stuff [00:51:05] that I’m between me and like, laying or Mike is like documented.

Mahmoud Ibrahim: So I’d create a [00:51:10] word document, put everything together, put the similar cases together and start figuring [00:51:15] out the commonalities they have. Because, again, another thing I noticed was, you know, you’ve [00:51:20] got like all these different occlusal camps, you know, you and there’s [00:51:25] maybe 3 or 4 of them that have fairly major differences [00:51:30] in terms of how they approach occlusion or treatment planning. And [00:51:35] the problem is that they all work right, Because if one of them didn’t. [00:51:40] It clearly wouldn’t be here 20, 30, or 40 years later. So they must [00:51:45] work. So again, logically to me, what that what that told me [00:51:50] was that the secret sauce wasn’t in what they did differently. It’s when it’s what [00:51:55] they do that is the same. And all that is just force management, you know. And I think [00:52:00] a similar sort of thing, you know, where we talked earlier about the belief [00:52:05] was that we would correct someone’s occlusion and they would stop grinding. And we now know that’s [00:52:10] false. And yet the practices are still the same. Why? [00:52:15] Because they happen to be the same practices you would do to try and survive that patient’s [00:52:20] occlusion. Right. Make your restorations work in that patient’s mouth. Now I see the same sort of [00:52:25] thing happening with parrot function. Or, you know, if you want to narrow [00:52:30] it down to bruxism versus function. So you listen to some amazing people [00:52:35] speak and it’s all about function, functional conflicts, you know, constricted envelopes [00:52:40] of function.

Mahmoud Ibrahim: And I agree, I believe all of [00:52:45] that does exist. You listen to someone else. And it’s all about power functions. It’s all about grinding. It’s all [00:52:50] our books. And yes, I believe all that exists as well. But again, the cool thing is the [00:52:55] same stuff you do for one works for the other. Right. So if [00:53:00] I’m hyper focussed on function and I do some stuff, design my illustration in a particular [00:53:05] way, the contacts in a particular way, guess what? It’s gonna [00:53:10] also help mitigate the effects of power function. But now because I’m hyper focussed on function, I think, [00:53:15] oh, I’ve sorted out the function, that’s why nothing’s breaking, whereas actually you’ve done both. So again, I think [00:53:20] to me at least that’s becoming more obvious. I used to be a [00:53:25] lot more power function focussed in terms of like I’m just going to mitigate for grinding and clenching. That [00:53:30] sort of stuff didn’t pay quite as much attention to [00:53:35] Functional conflicts up until probably about five years ago, where [00:53:40] I started reading more. Looking more at my own patients. You know, I take videos of people chewing, [00:53:45] speaking and just look at it. And then you start to come to your own conclusions. [00:53:50] Um, and you can see that actually the same thing I do for one, I do for the other anyway. Um, [00:53:55] so it was I can’t remember where we got to, you know, occlusion.

Payman Langroudi: Why did you get into [00:54:00] it and then how far you went into it. And, you know, you’re telling me that.

Mahmoud Ibrahim: Yeah. Yeah. So, you know, you’re [00:54:05] you’re reading everything. You’re learning the things that taught me the most. And I think [00:54:10] that allow me to feel, um, [00:54:15] that it’s okay for me to stand there and teach people.

Payman Langroudi: Yeah.

Mahmoud Ibrahim: Is [00:54:20] I went through a phase of I will plan and I [00:54:25] will wax up and I will carry out all my own cases. Oh, really? Yeah. [00:54:30] So once you’ve done 20 wax wakes. Ups on [00:54:35] tooth wear cases ranging from this patient just wants to treat their upper front teeth [00:54:40] to more extensive cases. You learn so much [00:54:45] because every time you pick up that waxer and you put some wax on the teeth, you are making [00:54:50] a micro decision and you are then seeing what the effect of that decision is on [00:54:55] the occlusion, but also maybe on aesthetics, right on function. You’re [00:55:00] you’re making these decisions and then you’re going back, oh, I need to you know, you need to remove [00:55:05] some from here. I need to shorten this. I need to lengthen that. And that doing [00:55:10] that over and over again makes you understand why the principles [00:55:15] are the way they are. Right. So that for me was a huge teaching point. And [00:55:20] lots and lots of people ask me like, oh, you know, how do I what, you [00:55:25] know, what’s the number one thing I should try and do if I want to learn to model, just wax up your own cases. Really? [00:55:30] Yeah. Even if it’s just a Central. Just do the front teeth. Whatever [00:55:35] it is, just wax it up. It doesn’t have to be pretty, you know, sometimes I’ll do the wax up. It’s not that pretty, but [00:55:40] it works. I’ll send it to the lab and they can make it pretty. Uh, even with [00:55:45] composite. Just do more. Mock it up. Just with composite. Do it in the patient’s [00:55:50] mouth. If it’s simple, you can do a mock optimisation and work it out that way. But just on a set of models allows [00:55:55] you to add take away, you know, see what happens.

Payman Langroudi: Understand what’s going on. A bit like [00:56:00] intimately, right? Yeah.

Mahmoud Ibrahim: So for me that was that [00:56:05] was a lot of hours but I unlock. Yeah, [00:56:10] yeah yeah I really did. And it made me again [00:56:15] you know uh, sometimes you say things that maybe [00:56:20] go against the grain a little bit, and you always wonder whether people are like, the hell you know, shut the [00:56:25] hell up. But I truly think sometimes these smaller [00:56:30] changes that you can make. Like making the edge a little bit thicker. Securing [00:56:35] the lower incisors. Building in these margins of safety. The angles, all that sort of stuff. [00:56:40] Might. And a lot of patients make more of a difference to the survivability [00:56:45] of your restorations than making sure central collation is with pinpoint accuracy, [00:56:50] right.

Payman Langroudi: I think you know what? I think it’s a it’s a funny thing that sometimes [00:56:55] with deep understanding comes simple, simple, [00:57:00] simple like like, I don’t know, like e equals MC squared. Sounds [00:57:05] pretty simple. Yeah. But that took a deep understanding to get to that point. [00:57:10] And, and the simplicity with which I mean teaching in the end is simplifying [00:57:15] the complicated in a way. Right. The simplicity with which you look [00:57:20] at a subject often is a reflection of your deep understanding [00:57:25] of that subject. Like you brought it down to one thing like force management. Yeah. [00:57:30] And you know, the amount of reading you’ve done over the years. And here we’ve brought it down to that. Yeah. [00:57:35] You could, you could, I could be some professor somewhere and say, who was this kid? They were saying, force [00:57:40] majeure. But sometimes keeping it simple comes from understanding it deeply. [00:57:45] And and the opposite. People complicate things because [00:57:50] they don’t fully understand them.

Mahmoud Ibrahim: Yeah. And I think there definitely is a risk of oversimplification, [00:57:55] you know. Sure. You know, we look at, uh, you know, you’ll say, okay, well, you [00:58:00] talked about the angles and stuff or why don’t you just make them all really shallow? Because the patients need to chew, [00:58:05] right? Yeah. But at the same time, there [00:58:10] are. You need to weigh up. So. So [00:58:15] learning occlusion is kind of like learning how to use, uh, you know, build puzzles. [00:58:20] Right. I can tell you very simply, if you want to do [00:58:25] the puzzle, take a piece that has an outer bit, Put it into the bit with the indie bit. That’s it. [00:58:30] Right. That’s.

Payman Langroudi: That’s it. It’s a bit over simple, but.

Mahmoud Ibrahim: It’s not the same as let me giving [00:58:35] you a thousand piece puzzle and saying, okay, work this out. Right. You need strategies. At that point you just start thinking, [00:58:40] okay, build the borders, look at the corners, blah blah, blah. Put all the colours together. It’s the same thing [00:58:45] with the clues. You need to figure out how complex is this case. And then what you’ll find is a lot [00:58:50] of the time there is a bit of a tug of war between, especially in tooth wear cases, between aesthetics and [00:58:55] between managing the risk. Yeah. [00:59:00] So and whether that’s a hand function. Definitely. I’ve put it in [00:59:05] there with aesthetics and function together on one side. And maybe power function or [00:59:10] mitigating for power function on the other side, whereas you want to make things as safe as possible, but that might [00:59:15] influence the aesthetics of the case, or it might affect the chewing [00:59:20] efficiency. But how much? You know, if I take your chewing efficiency [00:59:25] from a random number, I pull out of my backside of, I don’t know, 70%. [00:59:30] I take you down to 60%. It’s not going [00:59:35] to make a difference. What if you’ve got just flat amalgams everywhere, broken teeth and your chewing efficiency is actually [00:59:40] 15% and I only take you up to 40? Is [00:59:45] that good or bad?

Payman Langroudi: That’s good.

Mahmoud Ibrahim: Right. So this is what I mean by [00:59:50] it’s a it’s it’s a set of thought frameworks [00:59:55] if you like, or ways of thinking. And then you have to take each case [01:00:00] on its, on its merits. Yeah. You know and patient goals come [01:00:05] into it as well. Right. Do I have a patient in the chair who wants ultimate aesthetics. Yeah. [01:00:10] They want all the translucency they want. Fine. But whose problem is it? It’s a patient’s [01:00:15] problem. Right. Explain. Yeah, I can make it look like that, but you’re just more likely to chip it. What [01:00:20] do you want to do? It’s funny. We run a webinar. [01:00:25] Um, and, um, I put up this photo of a case I’d done. [01:00:30] I’d finished it with a tooth white case, and I was like, okay, guys, just, [01:00:35] you know, um, give me some feedback on how you think this looks, especially the proportions [01:00:40] of the teeth. The amount of people are savage when you let them, like, give them the green light. [01:00:45]

Payman Langroudi: Did you just show the after?

Mahmoud Ibrahim: Just the after? Yeah. Yeah, yeah. And they’re like really [01:00:50] boxy, really square. What you know, and I was like, okay, calm down. Um, [01:00:55] and then I showed them before. Right. And I said, okay, look at the amount [01:01:00] of wear and look at what this patient’s done to their teeth. Right. The every extra [01:01:05] millimetre add in terms of length increases my risk of fracture. And actually, when you look [01:01:10] at the smile, you look at it in the patient’s face. It looks fine. Okay. It’s not you know, I wouldn’t, [01:01:15] you know, enter you.

Mahmoud Ibrahim: Know.

Mahmoud Ibrahim: Like some prize [01:01:20] giving thing with it. But the patient was over the moon And now I [01:01:25] know that the risk of fracture is much, much, much lower. Right. So again, I will do my [01:01:30] mock-up. I will do all that sort of stuff. And maybe I’ll give this patient [01:01:35] a nine millimetre central, whereas we know, you know, ten and a half, 11.5 if you’re an American, 12.5 [01:01:40] is what you want.

Payman Langroudi: Yeah. Yeah.

Mahmoud Ibrahim: Give give him give him nine. Give him nine and a [01:01:45] half. See what he says. Right. If they’re like, yeah, this looks amazing because it’s twice the size of the tooth they have. Then [01:01:50] you’re all good. So yeah. Each patient.

Payman Langroudi: When [01:01:55] did you first meet Chaz Galati?

Mahmoud Ibrahim: Oh, uh, so [01:02:00] I heard his podcast. So this was.

Payman Langroudi: Uh, after you heard this podcast? [01:02:05]

Mahmoud Ibrahim: Yeah, but it was like his second episode.

Payman Langroudi: From some, like, somewhere else. No, no, [01:02:10] no.

Mahmoud Ibrahim: So, like, I think two episodes in, um, and at that point, I was, you [01:02:15] know, I still am, but, you know, I still will try and consume as much dental [01:02:20] knowledge from anybody and anywhere as I can.

Payman Langroudi: Um, dental vacuum cleaner? [01:02:25]

Mahmoud Ibrahim: Yeah. Pretty much. Yeah. Um, so I saw his one come [01:02:30] up, and I was, like, obtrusive. Okay, maybe. Maybe there’s an occlusion slant here, because I was. I was obsessed with the occlusion. Like, [01:02:35] you know, 12 years into my rabbit hole at that point. And I listened to the episode, [01:02:40] and. And so I emailed him. You know, I’ve never emailed anyone on a podcast before. I [01:02:45] emailed him saying, dude, look, you know, massive respect. Really love what you’re doing. Um, [01:02:50] and, uh, you know, I’m so glad someone here in the UK is finally talking [01:02:55] about this, you know, and jokingly and I finally, I had no [01:03:00] idea about his relationship with either of these two people. But the two people I just mentioned to you, Lenard and Michael [01:03:05] Melchers, um, you know, I and I still have the email because I showed it to him, like again, [01:03:10] like six months ago. So maybe one day you and I will be the Leonard and Michael Marcus of the [01:03:15] UK. And, um, and he was like, oh, you know, that’d be awesome. Like, we just had a little bit of back and forth, [01:03:20] on email. And then he created his telegram group. So [01:03:25] I joined the telegram group. And as it grew, people joined. [01:03:30] People started asking questions, you know, help with cases, things like that.

Mahmoud Ibrahim: And if [01:03:35] I thought I could help, um, you know, I’d give my $0.02. And [01:03:40] usually it was either occlusion related or composite related. Those are the two kinds of things that I enjoy [01:03:45] the most. Um, so that [01:03:50] carried on for a while. And then I think it was after [01:03:55] it was after Covid, it was after Covid because there was a there was a [01:04:00] I think there was a course on occlusion that a lot of the society at the time [01:04:05] went to. And, um, a lot of them came out of it thinking, you know, it’s really good, [01:04:10] but we’re still confused. Um, and that’s when jazz and I thought, [01:04:15] actually. Most of the occlusion courses [01:04:20] assume a basic level of knowledge that [01:04:25] isn’t always there, right? So then he was like, do you wanna do something? I [01:04:30] was like, okay, what? Let’s make a. Essentially what became oh, [01:04:35] Bob and God. I mean, if I knew how much time and effort it would take to make, I mean, [01:04:40] I’d still do it because it’s probably one of the most rewarding things I’ve ever done. But that took over our [01:04:45] lives for, like, a year and a half or two. Two years.

Payman Langroudi: Yeah, I remember at that time. [01:04:50]

Mahmoud Ibrahim: But yeah, no, it was great because, you know, we’re obviously both very passionate about [01:04:55] the subject matter, about teaching, about [01:05:00] just, you know, we both enjoy interacting with people, being, uh, [01:05:05] being out there. And, um, but we’re also very good friends. He’s probably going to [01:05:10] deny it, but we’re good friends. Or at least at least [01:05:15] from my side. Yeah. No, we again, Luckily, we haven’t done really, really well. So, um, [01:05:20] yeah, it’s, you know.

Payman Langroudi: You and as a as a partnership. What who brings [01:05:25] what? Um.

Mahmoud Ibrahim: You know, I think undeniably, [01:05:30] you know, jazz is, uh, is a he’s a, he’s, you know, [01:05:35] he’s incredible on the, on the mic in front of people. He’s, um.

Payman Langroudi: He’s one of [01:05:40] my heroes, man.

Mahmoud Ibrahim: Yeah. I love the guy.

Payman Langroudi: He’s one of my heroes. But outside of, like, the guy, [01:05:45] I just want my heroes in terms of just almost turned education upside down. [01:05:50] Yeah, I said this kid who’s. I mean, I still call him a kid, but. But back then, when he started, [01:05:55] it was, what, six years out of dental school or something? You know, five years out of dental school, maybe [01:06:00] this kid who’s five years out of dental school is providing much more valuable [01:06:05] knowledge than everyone else. Yeah, it’s such an amazing thing. And then when I, you [01:06:10] know, got close to him a bit more. What? An executor man. Yeah. What [01:06:15] an executor. So? So he brings, like, a communication and, uh, that. [01:06:20] What do you.

Mahmoud Ibrahim: Use? Huge amounts of knowledge as well.

Payman Langroudi: Collusion itself.

Mahmoud Ibrahim: I mean, he’s [01:06:25] he’s he’s he’s also got you know, he’s he’s done a lot of training. He’s also got, uh, plenty [01:06:30] of his own sort of ideas. Um, but yeah, for me as well, [01:06:35] it’s, it’s, I’m obsessed with. The [01:06:40] content, the, you know, jazz [01:06:45] always so gets, gets a bit of a headache for me because I, I, I want flow. [01:06:50] I know that doesn’t necessarily make sense, but I’ve been on so many occlusion [01:06:55] courses where you start the day somewhere an [01:07:00] hour later, you’re talking about something, and there’s no clear [01:07:05] path as to how you got from there to here. Like, what is the story? Right. [01:07:10] So you’re you’re finding it very difficult to pay attention. Follow along. You’ve [01:07:15] just been told. Okay. Palpate the masters. It’s like. Why? [01:07:20] Yeah, because, I mean, I know the patient has them. So what am I doing? [01:07:25] But it’s never. Then taken back to. What [01:07:30] does this tell me? How does it affect my clinical management? Right. So I [01:07:35] didn’t I 100% did not want to replicate that. You know, because I can throw [01:07:40] out easily five topics occlusion related that I can cover [01:07:45] in a day. Right. And they could all be relevant. But [01:07:50] if the day doesn’t flow in a way that makes sense. I find [01:07:55] people get lost. Right. And it’s far easier to remember the thing we spoke [01:08:00] about an hour ago. If it clearly has led to what we’re talking about now. [01:08:05] So that became like my mission of the [01:08:10] problem with with occlusion and the real reason we made orb online first [01:08:15] was. It’s hard sometimes [01:08:20] to explain a concept or the beginning [01:08:25] of a concept. Without explaining something more basic. [01:08:30] But even that basic thing kind of has [01:08:35] has something related to it that at the end I’m not explaining this very well, but this [01:08:40] is why I always say to people, you know, don’t make this. Don’t let [01:08:45] this be the last collision course you do, because something you learn at the end of [01:08:50] this course.

Payman Langroudi: Is the beginning of something else.

Mahmoud Ibrahim: Be the beginning. We’ll we’ll make something [01:08:55] at the beginning of another course. Make sense? Even though it’s more basic. Yeah. Um, and so we wanted [01:09:00] the ability for people to watch it and then watch it again because you start talking definitions, you know, at [01:09:05] the beginning and you’re talking about centre correlation. Centralisation doesn’t make sense when you’re [01:09:10] just talking about it on its own. Centre correlation really starts to make sense when you’re [01:09:15] talking about why you need it, which a lot of the time is you’re reorganising inclusion, which a [01:09:20] lot of the time is for math rehabs, really complex stuff, which you don’t cover at [01:09:25] the beginning of an inclusion course. You cover it at.

Payman Langroudi: The end context.

Mahmoud Ibrahim: Right? Just telling them what it is, but then waiting five modules to [01:09:30] tell them when you can use it. It doesn’t make sense. But once you got there, if you go back and [01:09:35] now read that repetition.

Payman Langroudi: Massive thing.

Mahmoud Ibrahim: Huge.

Payman Langroudi: It’s under under-recognized. [01:09:40] You know, I still learn stuff. Every MSM I go to, I learn something. Yeah, yeah. And [01:09:45] it’s not only being told it again. So it goes. It’s not that. It’s your frame [01:09:50] of mind. Like you said, your frame of mind at the end is totally different, and my frame of mind on July [01:09:55] the 12th is different to my frame of mind on December 1st. You know, like even things like that, [01:10:00] um, you know, little clicks that happen. I used to have a CD stuck [01:10:05] in my CD changer.

Mahmoud Ibrahim: Oh, we’re going back now.

Payman Langroudi: The whole thing.

Mahmoud Ibrahim: Is.

Payman Langroudi: It? Yeah, it was. The six [01:10:10] CDs only had those CDs. One of them was Nancy Robbins. One of 20 [01:10:15] CD thing I bought. And guess what? The only one I remember, [01:10:20] of course, is that so how to manage when, when when you’re overwhelmed. What [01:10:25] five questions to ask yourself. Yeah. And it was there was 19 other CDs. I don’t remember anything about [01:10:30] the why because I listened to that one so many times.

Mahmoud Ibrahim: Because it’s a fine balance though, especially [01:10:35] in courses. I feel like most people don’t come on the same course twice.

Payman Langroudi: Um, we really, really, really [01:10:40] encourage it on MSM, you know, like, I want to treat those people as VIPs as well. [01:10:45] Yeah. Because, you know.

Mahmoud Ibrahim: If.

Payman Langroudi: You’ve been on MSM.

Mahmoud Ibrahim: Like.

Payman Langroudi: Ten years ago, you can come as much as you are. [01:10:50] You can go one person’s come seven times. Oh wow. Yeah, I think she was she was enjoying [01:10:55] the socials. Yeah. But but my point.

Mahmoud Ibrahim: Is.

Payman Langroudi: My point is my point is yeah that that [01:11:00] when when you come a second time to MSM, I feel like me. You gave me one [01:11:05] whole weekend and now you’re giving me another whole weekend of your time. Yeah. [01:11:10]

Mahmoud Ibrahim: That’s incredible.

Payman Langroudi: That’s incredible. Yeah, that’s an incredible thing. Yeah. So for me, they are the VIPs [01:11:15] in the room. The ones that come again, you know.

Mahmoud Ibrahim: Yeah, yeah. If they’re willing to like, we’ve, we’ve had, [01:11:20] you know, people do over and then come on the live course as well. And again you know I’ll shake [01:11:25] every single one of their hands and say like, you know, that’s that’s awesome. You know, the fact that the [01:11:30] way maybe we’re conveying information or whatever it is seems to to work [01:11:35] for you. Um, I couldn’t ask for a higher compliment.

Payman Langroudi: What [01:11:40] degree of hero worship do you come across about you? Does it? Does it happen? Do you have, like, fan [01:11:45] boys and girls? No, I bet you do. I think you do. I bet you do. It’s one [01:11:50] of those subjects, like, I don’t know, like, if you. There must be. You must see. Do you ever see yourself in this [01:11:55] younger person? Like someone who’s dying, like diving in and wants to know everything? Yeah.

Mahmoud Ibrahim: Must do. [01:12:00] Yes, 100%. 100%. And there’s, you know, there comes a point where you start thinking, hmm. You know, [01:12:05] I need to, uh. I need to try and, like, help them grow. Because [01:12:10] one day they’re going to be, you know, a massive [01:12:15] source of of knowledge and innovation and just new thoughts. Yeah. You know, like, [01:12:20] um, so you do see that in some people? I think, you know, I said this before [01:12:25] we started recording, but there are some incredibly hungry people out there. Like, it’s amazing [01:12:30] to see people who are one, two, three, five years out and the stuff they’re [01:12:35] doing or getting involved in. I’m like, you know, when I was your age, I didn’t give a [01:12:40] crap.

[TRANSITION]: About this career ready? Man? I was like.

Payman Langroudi: You know, Lewis McKenzie used to say [01:12:45] that the thing that drove him the most in teaching was when one of his [01:12:50] students would teach him. Yeah. You know, and and he used to talk about Depeche and [01:12:55] Millie or whoever it was. Uh, Richard Lee was one of his students. Mhm.

[TRANSITION]: Um, wow.

Payman Langroudi: And, [01:13:00] and and it’s very it’s a very interesting thing because it, it’s a massive thing. [01:13:05] This person who. Who knew less than you now knows more than you. Kind of [01:13:10] idea. And in my world, it happens to me all the time. It’s a bit painful to tell the truth, because I [01:13:15] get some. Some fourth year dental student says, hi, how are you doing? What should I do? [01:13:20] And then I see that same fourth identity and becomes like a one year past PhD. Phd [01:13:25] plus one. And I still feel like I know more about what’s going on than him. And then I see that. And then suddenly [01:13:30] within like three, four years, I see this cat now knows way more about many [01:13:35] things than I know about. And it’s painful. And yet it’s it’s a lovely thing to see, you know, [01:13:40] it’s.

Mahmoud Ibrahim: Well, you know, I have a little bit of experience of it from the other end as well, which [01:13:45] was, um, was really cool. So we attended a live lecture by Layne and, and [01:13:50] Mike, who obviously had a massive influence on me. And then, um, during the lecture, [01:13:55] I’m obviously paying attention. And then all of a sudden, like one of my illustrations comes up and I’m like, [01:14:00] that looks familiar. The hell.

Payman Langroudi: Bastard. Yeah.

Mahmoud Ibrahim: Um, but then he, you know, [01:14:05] and then he made a joke about exactly what he said, but it was. And then he [01:14:10] said it was me. You know, as in, like acknowledging the fact that, look, you know.

Payman Langroudi: Same movement for.

Mahmoud Ibrahim: The [01:14:15] original. Yeah, exactly. He’s like, you know, an original thought coming out of someone I helped, you [01:14:20] know, come a long way. And and to me, I was like, that was probably again, you know, I’ll [01:14:25] I’ll never get over that in terms of how hot I felt. You know, like, immediate [01:14:30] sweat pouring off you. You’re like, people are looking at you. And I’m like, oh my God. There’s probably like, you know, [01:14:35] one of the coolest things that has ever happened. Um, and so [01:14:40] it’s good to show those people that you have, [01:14:45] you know, paid attention and that you are proud of what they’ve [01:14:50] done. So, you know, seeing it from the other end.

Payman Langroudi: Tell me about your week. Like, [01:14:55] how many days are you full on dentist? How many days you sort of work on [01:15:00] teaching?

Mahmoud Ibrahim: Um, so at the moment, because we opened so [01:15:05] I opened the practice with, uh, two partners, three partners two [01:15:10] years ago now, two and a half years ago.

Payman Langroudi: Oh, so you’re a principal now.

Mahmoud Ibrahim: Or at the time? Yes. [01:15:15] So I’m an associate three days a week. Okay. And I work in my practice. It will be [01:15:20] two, two days a week starting June. Where’s that? Uh, Birmingham. [01:15:25] So it’s, um, you know, Boston, sort of civic centre.

Payman Langroudi: Mhm.

Mahmoud Ibrahim: Um, so [01:15:30] right now, because of that setup, I’m clinical five days a week.

Payman Langroudi: Um. [01:15:35]

Mahmoud Ibrahim: So in terms of trying to [01:15:40] create content, trying to, uh, you know, I was doing it on the train [01:15:45] here. Uh, when I got here, I had half an hour or so, I went into sushi place, sat down, get a laptop out. [01:15:50] You know, in the evenings, you get the laptop out, at lunchtime, you get the laptop out. Uh, especially on the run [01:15:55] up to a course like we got Bullet-proof is out. Uh, we’re doing that in two weeks, and then the first [01:16:00] on triple bill is in June. It’s flat out, you know, blessed. And my wife is amazing. [01:16:05] You know, during the weekend, uh, she’ll take the kids and I’ll get, [01:16:10] you know, laptop time, which is what it is. So that’s that’s why I’ll so dedicate to to [01:16:15] to course content. Um, that I’ll go in on the weekend to record [01:16:20] video of um.

Payman Langroudi: So you’re very, very, very busy.

Mahmoud Ibrahim: Yeah. Right now, you [01:16:25] know, when we.

Payman Langroudi: Five days a week. It’s a lot. It’s a dentist. Full stop. Even if [01:16:30] you did nothing else. Yeah. So the fact that you’re doing all this stuff as well. [01:16:35] Yeah. And how often are you doing live courses?

Mahmoud Ibrahim: So [01:16:40] this year I think we have overall 8 [01:16:45] or 9 dates, which are weekends.

Payman Langroudi: Two days.

Mahmoud Ibrahim: Yeah. [01:16:50] Yeah, I think so.

Payman Langroudi: And what is bullet-proof and what’s not unshakeable.

Mahmoud Ibrahim: So [01:16:55] Bullet-proof used to be called our basics of occlusion course, Right? And [01:17:00] the reason for the name change was that we realised that it wasn’t really [01:17:05] cool name. Well, that number one.

Payman Langroudi: Used it to a much cooler name.

Mahmoud Ibrahim: Number one. Yeah. [01:17:10] But also at least what we found from the feedback was that people were leaving the course with a lot [01:17:15] more than just understanding some definitions and understanding, you know, Ontario guidances. [01:17:20] Um, because it’s real life, you know, daily [01:17:25] scenarios. And we do lots of hands on. And like I said before, you [01:17:30] need to be able to relate what you’re learning to, how it’s going to affect your daily [01:17:35] density. So heavy emphasis on that. So bullet-proof is more general [01:17:40] occlusal principles applied to your daily what we call informative dentistry. [01:17:45] So when you’re not changing people’s bites, which is 99% of what we do, you know, your crowns at the [01:17:50] front, your class fours and the sorry crowns at the back, etc.. Yeah, [01:17:55] yeah. Um. Well, [01:18:00] whereas untouchable was, um. It was born [01:18:05] out of again doing, uh, doing a webinar of the same title that just went crazy. [01:18:10] Um, because again, lots of people do amazing [01:18:15] courses like MSM, and then they do a lot of anterior composite [01:18:20] work. And then maybe for some of them they have issues with things chipping, things cracking, [01:18:25] etc.. So I really enjoy anterior composite work, like it’s [01:18:30] probably my favourite thing to do really. Yeah.

Payman Langroudi: Not for mouth rehab or [01:18:35] something.

Mahmoud Ibrahim: It’s too stressful. Mm, I do them. But [01:18:40] my sweet spot is having two on the go, Max. [01:18:45] Any more than that, it’s just. Yeah, it’s really stressful.

Payman Langroudi: Worrisome? [01:18:50]

Mahmoud Ibrahim: Yeah. Again, beauty of being a general dentist, right? Um, [01:18:55] I get to cherry pick. So, um. But, yeah, doing your composite work is [01:19:00] the most fun I have in the industry. Um, but [01:19:05] if I was seeing chipping a lot and having constant issues, it wouldn’t be fun. So, [01:19:10] you know, having treated cases with anterior bonding that maybe some [01:19:15] others would have looked at and thought, hmm. You know, I don’t know that this would work. I’m [01:19:20] doing it for the last ten years. Um, I then decided [01:19:25] to sort of distil, sort of go back and distil the things [01:19:30] that maybe I consider in, in risk, assessing those patients [01:19:35] and deciding, okay, yeah, I’ll do it or not. Because sometimes you make these decisions [01:19:40] of intuitively, um, but it’s only when you decide to teach it that you [01:19:45] then have to go back and think critically as to, okay, why did I do it on this patient and not on this patient? Why did I say to [01:19:50] this patient, you need we need to open the vertical or we need to do Dol or we need to do ortho. Whereas [01:19:55] with this patient we were like, okay, yeah, I think I can make it work. And, you know, five, six, ten years later, it’s [01:20:00] still working. Um, so yeah, that was that was really cool to, uh, going back and deciphering [01:20:05] what it is exactly.

Payman Langroudi: How long was it between [01:20:10] the time that you decided we’re going to do this course and you wrote [01:20:15] the content for any. [01:20:20] But let’s let’s talk on cheaper because that’s the one you were discussing.

Mahmoud Ibrahim: Yeah.

Payman Langroudi: Yeah. [01:20:25] It’s not finished yet. Yeah.

Mahmoud Ibrahim: Because it’s never finished. Yeah. That’s the thing. It’s it’s never perfect. [01:20:30] Let’s put it that way.

Payman Langroudi: Are you more Google or are you more Apple? Do you know what I mean? Like like Google will [01:20:35] put out a product almost like it’s unfinished. It’s not a it’s not a, it’s an experimental. [01:20:40] It’s in a way, in a way. And then and then they it’s, [01:20:45] it’s, it’s right as it’s out based on the feedback and make it a better product. [01:20:50] Whereas Apple will only put out a product when they feel like it’s fully ready for market, you know?

Mahmoud Ibrahim: Yeah. Well, [01:20:55] okay. If you’re on a simple answer, definitely more Apple. Purely because [01:21:00] again, you know, there’s there’s probably two things that I drive jazz crazy about. [01:21:05] It’s flow. There’s one. And the other one is I do [01:21:10] not want any delegate that takes a course to [01:21:15] come out and not be safe or keep themselves safe, [01:21:20] or I don’t want to give them a false sense of security, allowing them to take risks [01:21:25] that might get them into trouble. Right. So my primary focus is [01:21:30] I will teach you what to look out for [01:21:35] in order not to get yourself in hot water. Right. And then we’ll we’ll talk about [01:21:40] the cases you can do. But I will always err on the side of caution. And in that, [01:21:45] in that respect, I’ll say it has to be ready. [01:21:50] You know, it has to be ready, so I won’t put it out there. That’s [01:21:55] the minute. Yeah, but, you know, it has to be. Again. [01:22:00] But not to sound. But it has to be good. [01:22:05] Like.

Payman Langroudi: Yeah, but there are, there are degrees like I’m thinking about. She’s been writing a porcelain [01:22:10] course for four years now. Yeah. Four years.

Mahmoud Ibrahim: Yeah. I mean.

Payman Langroudi: Like, because [01:22:15] he is a perfectionist. Right. He and that. That’s kind of gets in the way. Yeah. [01:22:20] Like 100%. Now, when it’s ready, it’s gonna be amazing. I’m sure it’s [01:22:25] a beautiful thing. Yeah.

Mahmoud Ibrahim: So the thing is, though, the way you got to look at it is, you [01:22:30] know, let’s let’s say that perfection is 99% [01:22:35] right after year one. He was probably at 97. Yeah, exactly. [01:22:40] Yeah. Right. Let’s let’s call it 90. Yeah, yeah. After year 295. And [01:22:45] it’s tiny incremental gains after that. Yeah, yeah. But I think it’s important.

Payman Langroudi: But it’s a mindset. [01:22:50] It’s a mindset thing. Yeah. Like, some people are built one way. Some people have built another way.

Mahmoud Ibrahim: 100%.

Payman Langroudi: I mean, [01:22:55] I remember he was just a kid, man. The conversation we had about, um, the [01:23:00] his course. I said, look, do whatever you want, but I don’t want a single [01:23:05] slide that is a filler. Mhm. Yeah. And it’s my pet hate. Yeah. [01:23:10] And of course that you can tell the guy, this guy just put that slide in just, just to fill it up. You know just. [01:23:15]

Mahmoud Ibrahim: Like wish I had that problem.

Payman Langroudi: Yeah exactly. And then the other thing about of course, [01:23:20] is that really pissed me off, right. I’ll ask you the same question. What grinds your gears about courses [01:23:25] or about dentistry? But what pisses me off, right, is the slide where it’s [01:23:30] just like four bullet points and the guy reads the first one and reads the second one and [01:23:35] reads the third one, which makes me go crazy. I just love him. Just almost like it’s almost like for me [01:23:40] sitting in a GP waiting room. Um, and he’s 40 minutes late and I’m just sitting there [01:23:45] and thinking, oh, my time is being wasted, obviously. Like, I think. What about you? What grinds your gears?

Mahmoud Ibrahim: I [01:23:50] mean, that one definitely does, because I’m like, I can read it. Yeah. So just move on. Um, [01:23:55] so we talked about repetition and it being important. [01:24:00] Too much repetition does annoy me. Okay. If it’s it’s like I get. [01:24:05]

Payman Langroudi: It, I get it.

Mahmoud Ibrahim: I get it. That’s. Yeah. It’s. I had you I remember we had, um. [01:24:10] God bless him. I’m not gonna say his name. We had a tutor at Manchester, [01:24:15] and, um, I mean, the topic itself was a bit boring [01:24:20] anyway.

Payman Langroudi: Oh, what was the topic?

Mahmoud Ibrahim: It was the dental materials.

Payman Langroudi: Oh.

Mahmoud Ibrahim: But [01:24:25] you know, when you’re trying to explain that maybe something is is [01:24:30] is is a is a ring shape, don’t you understand? [01:24:35] Right. Yeah. But I can then go on to tell you that shaped like a doughnut [01:24:40] or, you know, polos. Do you remember polos like that? Yeah. Or like, um, you know, it [01:24:45] could be like a hula hoop. I get it. Joey. [01:24:50] One of those. So there’s definitely, uh, repetition to reinforce, and [01:24:55] then there’s redundancy after that.

Payman Langroudi: I thought I’d move on button. Yeah, the [01:25:00] whole audience gets a button. If more than 50% press the button, the slide just moves forward by itself. [01:25:05]

Mahmoud Ibrahim: That’d be so.

Payman Langroudi: Cool. You know, like, whatever. Like, say, this is a 75% move on [01:25:10] course. Yeah, yeah, 75%. Push the button. It’s moving on. Yeah. And no one should feel [01:25:15] bad about, like, even the speakers shouldn’t feel bad. It’s just the way it is. Yeah. You know.

[BOTH]: I think it’ll be a lot of fun.

Mahmoud Ibrahim: Very [01:25:20] interesting.

[BOTH]: Content.

Payman Langroudi: Yeah.

Mahmoud Ibrahim: But now.

Payman Langroudi: What else? What else? What [01:25:25] about but around, like, fashion and dentistry? Instagram. Like what [01:25:30] pisses you off? Because I know what makes you happy, right? We all get a lot of value [01:25:35] from it. Right. You wouldn’t have met Michael as these people if it wasn’t for social media. [01:25:40] Yeah, but what pisses you off about what people do? Like. Like, let me give you an example. I [01:25:45] don’t like it when people do composite veneers and.

Mahmoud Ibrahim: They give it a.

Payman Langroudi: Name. No, [01:25:50] no. Definitely that. But I’ve been guilty of it myself too. Yeah. You know, in [01:25:55] business, you end up giving things a name that already exists. Yeah. Yeah. Um, if [01:26:00] you talk about Nano. That one. Um, yeah. They did. They trademarked it, actually. But the [01:26:05] question of no when someone does composite is actually does actual harm. Mhm. [01:26:10] Yeah. And I’m not talking staining I’m like sometimes you see like ledges and things like you know where the, where [01:26:15] the uh, line angles are clearly not going in getting [01:26:20] straight up because the material’s spread laterally.

Mahmoud Ibrahim: I literally had.

Payman Langroudi: To I mean, [01:26:25] you see that sometimes.

Mahmoud Ibrahim: Right? Yeah, I just removed. Um, some [01:26:30] some terribly done so of composite. Upper eight units. [01:26:35] Lower eight units. I mean, the lawyers didn’t need it at all to the extent that we just removed it. I’m just gonna wait in the teeth. That’s [01:26:40] it. Boom. They’re straight. They’re perfect teeth. Um. The [01:26:45] uppers. Uh, unfortunately, uh, you know, the patient feels too self-conscious [01:26:50] to have them completely removed. So, again, I just removed all the ledges, reshaped everything. Then [01:26:55] we’re going to go through a phase of oral hygiene, get the gums sorted. Um, really? [01:27:00] She could benefit some ortho first, but she’s absolutely. No. Um, and [01:27:05] then we’re just gonna redo them. Um, but, you know.

Payman Langroudi: It’s [01:27:10] upsetting.

Mahmoud Ibrahim: It is. And the thing is, like, I, I personally [01:27:15] do tread carefully in terms of trying not to throw people under the [01:27:20] bus.

Payman Langroudi: And it’s so important. Also important.

Mahmoud Ibrahim: But that was probably the [01:27:25] hardest time in terms of how I, uh, [01:27:30] chose my words. Right. Um, unfortunately, the, you know, [01:27:35] I, I thought, you know, at this point with this level that [01:27:40] that shouldn’t be done, that you’re doing harm to a patient. But the problem is that the dentists [01:27:45] are not there anymore. You know that practice, whatever it is, is not there anymore.

Payman Langroudi: Um, [01:27:50] do you see a lot of turkey patients?

Mahmoud Ibrahim: Some are not. Not a ton. [01:27:55] I see some.

[TRANSITION]: You get referred.

Payman Langroudi: Patients for, like, difficult occlusal [01:28:00] situations from all of your disciples.

Mahmoud Ibrahim: Yeah. I mean surrounding [01:28:05] clinicians and stuff that. No. Yeah. Yeah, yeah.

Payman Langroudi: So what amount of your [01:28:10] work is referral based?

Mahmoud Ibrahim: No, not a massive amount. I still [01:28:15] probably get a lot more off of social media than Instagram and stuff.

[TRANSITION]: Oh, really?

Mahmoud Ibrahim: Yeah. Yeah.

[TRANSITION]: Um, [01:28:20] patients. Mhm.

Mahmoud Ibrahim: Yeah, yeah. Referrals are probably I’d say in the last [01:28:25] month probably 2 or 3.

[TRANSITION]: Um still. [01:28:30]

Mahmoud Ibrahim: Yes. Yeah. But again not all of it is a look. Treat this patient. [01:28:35] Some of it is you know this patient’s got like joy ache and stuff and I don’t [01:28:40] know what to do. Uh, or, um, you know, the patient has what [01:28:45] we do get a lot of is they get referred in for endo because they’re a specialist end on the practice, and [01:28:50] then the patient goes back to their dentist, and then their dentist says, oh, I can’t restore [01:28:55] this. So now they’re pissed off. They ring around the dentist and they go see Mahmud, [01:29:00] and they come to me. And then, you know, we look at sorting it that way.

Payman Langroudi: So there’s five days you’re [01:29:05] doing quite intense kind of work.

Mahmoud Ibrahim: I you know, I wouldn’t say all of it. I [01:29:10] wouldn’t say all of it is is is is intense. Um, and [01:29:15] that’s kind of why I like having two bigger cases on the go at [01:29:20] any one point, like my max. Like, I, I do like to have, you know, half [01:29:25] my time spent doing something that’s, you know, bonding in and only, you know, you I book my book [01:29:30] 50 minutes for me bonding in a single only. Oh, really? Um.

Payman Langroudi: The whole thing.

Mahmoud Ibrahim: Yeah, [01:29:35] yeah, yeah. So it’s it’s nice. Relaxing. You know, you’ve done it a billion times before. [01:29:40] Um, you can be proud of it at the end. And it’s.

Payman Langroudi: Not. What do you book for the for the prep [01:29:45] visit? 90 minutes. So 90 plus 50, 140 [01:29:50] minutes, which is two hours and 20. And then what do [01:29:55] you charge for that?

Mahmoud Ibrahim: Uh, 9.95.

Payman Langroudi: That’s in context with the amount [01:30:00] of time you’re spending. That 9.95 is not as expensive as it sounds.

Mahmoud Ibrahim: It’s not.

Payman Langroudi: It’s [01:30:05] not.

Mahmoud Ibrahim: It’s not.

Payman Langroudi: But Birmingham is, well, quite difficult town to to to [01:30:10] sell expensive stuff. No.

Mahmoud Ibrahim: So where I work in Telford.

Payman Langroudi: Telford. [01:30:15]

Mahmoud Ibrahim: Is, is, is the practice. I’m an associate at the practice is Birmingham but the one in Telford. [01:30:20] Uh, people are okay paying for quality.

Payman Langroudi: And each [01:30:25] person must be the same, right? Isn’t that the move. [01:30:30]

Mahmoud Ibrahim: You.

Payman Langroudi: Attract? Isn’t that the Mayfair of Birmingham?

Mahmoud Ibrahim: Uh.

[BOTH]: Sort of. Yeah.

Mahmoud Ibrahim: But. [01:30:35] Yeah.

Payman Langroudi: So. Telford. Northern better than Edgbaston.

Mahmoud Ibrahim: They’re very [01:30:40] they’re very different clientele. So the Telford patients I get are probably [01:30:45] a bit more mature, a bit more, uh, established. Um, [01:30:50] there is wealth around the area, but not, you know, not everywhere, not in little pockets. [01:30:55] Um, but this practice has been there for 50 years, so it’s got a reputation [01:31:00] for quality. Um, so people come in and they’re happy [01:31:05] to pay a reasonable amount. You know, I’m not going to extort them, but [01:31:10] for good quality stuff. But they’re not the type of patient that’s going to be [01:31:15] like, oh, this onley that you put on my Severn is half a shade out, you [01:31:20] know. Exactly. So that’s. Yeah.

Payman Langroudi: Older patients. [01:31:25] Yeah. Yeah. Older patients are the best man.

Mahmoud Ibrahim: They’re great. They’re great. You know I love doing, you [01:31:30] know, my composite veneers, my composite work. And you know that stuff. You need [01:31:35] to get it right. But I think if I did it all day, every [01:31:40] day, doing five days a week, I’d be really stressed out. So I think the [01:31:45] fact that, yeah, I do five days a week is a lot, but a lot of it is [01:31:50] on a well-established list that I do. Uh, [01:31:55] I’ve looked after for ten years. So good.

Payman Langroudi: So good. You know, respectful. [01:32:00] Yeah. Uh, they somehow stuff works on them. They don’t have, like, hypersensitivity and stuff. Yeah. [01:32:05] You know, like, they’ve got very small pops, you know, the secondary dentine.

Mahmoud Ibrahim: Yeah. Pops are in their knees. [01:32:10]

Payman Langroudi: Yeah. If, if even something I remember, like a temporary would fall off. Wouldn’t even bother [01:32:15] telling me I fell a week ago. Yeah, I loved working [01:32:20] with those. They’ve got money. Let’s not forget that in the current economy. Right? It’s the younger [01:32:25] ones in trouble. Yeah. Let’s get to the darker part of the pod. [01:32:30] We like to talk about clinical mistakes. What [01:32:35] comes to mind when I say clinical error? Something we can all learn from.

Mahmoud Ibrahim: Um, [01:32:40] okay. I mean, I thought about this, obviously. I’ve [01:32:45] made a few. A couple of them are more severe than others, so probably the first one that [01:32:50] I remember this was probably like, I don’t know, 3 or 4 years out. And, um, I was trying [01:32:55] to take, uh, an upper. There was an upper lateral doing extraction, and I had an immediate [01:33:00] denture, single tooth, immediate denture to go. And, um, I was struggling. And, [01:33:05] you know, when you struggle, you start getting frustrated, and then you start just. I’m just gonna [01:33:10] shove this luxation in and wherever and just. Yeah. [01:33:15] That face.

Payman Langroudi: I’ve been there. I’ve been.

[BOTH]: There. Yeah.

Mahmoud Ibrahim: And then off [01:33:20] goes the central. Broken off [01:33:25] the right gum line.

Payman Langroudi: What did you say?

Mahmoud Ibrahim: Uh, [01:33:30] I said I’m sorry.

Payman Langroudi: And how did the patient take?

Mahmoud Ibrahim: So [01:33:35] luckily, I know this is probably why you’re not gonna let him get away with it, but the patient was [01:33:40] fantastic.

Payman Langroudi: He was long term patient.

Mahmoud Ibrahim: Viewers know I’d only been graduated [01:33:45] a few years. Oh, well, so I think that’s what he. Like, [01:33:50] used as a reason within himself not to get angry. [01:33:55] He’s like, look, you know, you’re you’re young.

Payman Langroudi: Listen, man. Some people, some people, some people handle shit [01:34:00] in one way and other people handle it in others. So you lucked out. I’m not. I’m [01:34:05] not.

[BOTH]: Gonna.

Mahmoud Ibrahim: Yeah, I knew you wouldn’t.

[BOTH]: That’s what I’ll tell you anyway, because it was a goodie.

Payman Langroudi: Its a.

[BOTH]: Goodie. It [01:34:10] was like, you.

Mahmoud Ibrahim: Know, heart in my balls for, you know, like a good [01:34:15] 30 minutes trying to explain to this patient what I’ve done.

Payman Langroudi: I mean, it’s an interesting thing. Like [01:34:20] when you extract a tooth. Now, I bet.

[BOTH]: You’re so.

Payman Langroudi: Careful paying.

[BOTH]: Attention. [01:34:25]

Mahmoud Ibrahim: To that. Oh my God. Yeah. Ever since, that’s the best way to learn something is to [01:34:30] go for one time. Yeah. You never forget that lesson.

Payman Langroudi: What about another one? The one I am going to accept. [01:34:35] You seemed like you know this part of the show quite well.

Mahmoud Ibrahim: Um. I mean, maybe you’ll accept this [01:34:40] one. So I will normally do my preps under rubber dam.

Payman Langroudi: Preps [01:34:45] of all sorts. Yeah, yeah.

Mahmoud Ibrahim: Usually split down. And not because I’m some [01:34:50] sort of high, mighty biomimetic adhesive. Blah. No, it’s just easier.

Payman Langroudi: You’re comfortable [01:34:55] with.

Mahmoud Ibrahim: It? Yeah. It’s just easier to not have to worry about the tongue, the cheek, blah, blah, blah. Okay. Anyway, on this [01:35:00] one patient, I didn’t. I don’t know why I can’t remember. And I was prepping a lower six [01:35:05] and I was trying to like keep this tongue out of the way, etc., etc. I nick [01:35:10] the floor of the mouth with my bur, and honestly, it looked like his intestines [01:35:15] had spilled out just blood.

Payman Langroudi: You know.

Mahmoud Ibrahim: There was blood, but it was [01:35:20] like, you know, all the veins, like you see all the veins in it all like just spilled out from his gap [01:35:25] and it just looked just disgusting as his veins and blood and [01:35:30] and I’m, like, trying to, like, poke it back in with my mirror and I’m just panicking. Obviously [01:35:35] the patients had an ID block, so I have no idea what’s going on.

Payman Langroudi: Yeah.

Mahmoud Ibrahim: So [01:35:40] I’m like, okay, look, I just. Yeah, I had to. So I was like, sorry I [01:35:45] caught your tongue. I’m gonna try and get to stop the bleeding. So, uh, you know, we do it with [01:35:50] cotton for a while. Stop the bleeding. I’ll put a suture in. Put the suture in. [01:35:55] I still have to finish. Like putting a temporary on and stuff. So put the suture in, and, [01:36:00] um. And the patient’s, he’s already like. He’s a he’s a lovely guy, but he’s already, like, very [01:36:05] nervous. He’s not you know, he doesn’t take dentistry easily. So, um, [01:36:10] so then he’s, uh, he’s he’s [01:36:15] not entirely sure what’s happened. Okay. But he’s he’s obviously I’m I’m warning him about the post-op pain, [01:36:20] the bleeding, blah, blah. And then the the next, the next day, uh, I ring [01:36:25] him, so I give him my personal phone number, like. Like I’m gonna ring you tomorrow. I’ll ring him. And, um. [01:36:30] And he was like, yeah, you know. It feels a bit weird, but it’s it’s [01:36:35] not that bad. So anyway, I keep reviewing him and stuff and it heals in the end. But [01:36:40] his, like, I can tell that that really [01:36:45] knocked his confidence in me. And that then by osmosis, [01:36:50] knocked my confidence in myself. Right. Um, it took [01:36:55] me a while to, to get over that, especially since I had something similar happen on [01:37:00] a different patient. But this was after I fitted a crown and I was trying to get some, uh, some excess [01:37:05] cement out and use one of those serrated strips. And again, you know, you get frustrated. You can’t get over there. [01:37:10] Overdid it.

Payman Langroudi: Oh, yeah.

Mahmoud Ibrahim: Yeah, yeah. But that was pretty bad. Like, [01:37:15] it was pretty deep. And the the the one.

Payman Langroudi: What [01:37:20] do you say while, like, how long did it take you to get over there.

Mahmoud Ibrahim: Oh good. Like looking six [01:37:25] months a year. Oh, really? Yeah. Yeah. Yeah. Yeah. Yeah.

Payman Langroudi: Yeah.

[TRANSITION]: How [01:37:30] interesting. Mhm.

Mahmoud Ibrahim: And then with this guy that that cut here. So I did again the same thing [01:37:35] with sutured up gave him a ring and uh on the phone he’s fine. And [01:37:40] then the next day he writes a complaint letter to my practice manager. So [01:37:45] then I go speak to my manager. And I was like so odd because I spoke to him on the phone and he was fine, like, it was [01:37:50] really nice. And, um, so anyway, we go through the [01:37:55] whole complaint procedure, blah, blah, blah. Um, I give him, um, the crime for free, [01:38:00] etc. but the one thing that stuck with me was he he spoke to my practice manager and he said, [01:38:05] and he asked her, you know, when Mahmud rang me the next day, was that genuine?

[TRANSITION]: Mhm. [01:38:10] I was like.

Payman Langroudi: That hurts huh? Yeah it did. [01:38:15]

Mahmoud Ibrahim: It did. But at the same time it made me think okay. [01:38:20] Was it genuine? Like if I had to assign a proportion, you know, if you put yourself in my [01:38:25] position and you have to assign a proportion to how much of it was pure [01:38:30] offensive. Yeah, how much it was purely caring about this other human being, being hurt [01:38:35] by something I did versus okay, well, I need to check on him. [01:38:40] You know, it’ll it’ll work better. It’ll [01:38:45] look better if if I do that versus if I don’t do that, you know, can [01:38:50] I sit here and say that none of it was.

Payman Langroudi: Do you not routinely call patients? [01:38:55]

Mahmoud Ibrahim: We do. If it’s a like if I’ve done like a big procedure or something. Oh yeah.

Payman Langroudi: So it’s [01:39:00] one of those.

Mahmoud Ibrahim: A lot of the time I’ll get someone to call them. Yeah. Or. Because, [01:39:05] you know, I’ll do it. But obviously in this case it was it was more it [01:39:10] was not just how are you doing? It’s a you know, how is it? How was the pain? You know, I’m really [01:39:15] sorry this happened. You know, I was just reiterating the same stuff I’ve said already, but [01:39:20] can I hand on heart say that none of it was self-preservation. No, I don’t [01:39:25] think anyone can. Really?

Payman Langroudi: So what?

Mahmoud Ibrahim: So. Yeah. Yeah, it doesn’t matter. [01:39:30] But, you know, the fact that he thought that.

Payman Langroudi: Well, there’s your ethical sort of sort [01:39:35] of, uh, basis of your ethical sort of behaviour. Where does it [01:39:40] come from? Are you religious?

Mahmoud Ibrahim: I am again, not like, [01:39:45] uh, I’m not super strict, but I follow like I’m a muslim. I [01:39:50] follow, uh, uh, Islam now do I do [01:39:55] I feel that’s the the basis for my.

Payman Langroudi: Not necessarily. Right. [01:40:00]

Mahmoud Ibrahim: You know, it’s a good question, isn’t it? It’s like if you take a bunch of people, [01:40:05] new newborns and and not give them any guidance, would ethics [01:40:10] and morality represent what we have?

Payman Langroudi: You know, what I’m saying is this notion [01:40:15] of if, let’s say, if there was no ethics on morality at [01:40:20] all, like you give, You give zero. And then what would happen? And [01:40:25] almost we have this weird understanding that if there was none, we’d all go kill each other. [01:40:30] Yeah. Whereas the elephants are walking all across. They’re not killing each other. [01:40:35] Yeah. The snakes and the fish are in the in the river. They’re not killing each other. [01:40:40] Yeah, they might be killing other animals. Yeah. And what I’m saying is that there is a species related [01:40:45] cooperation that species have with each other. And you don’t [01:40:50] need to be taught ethics and morality for a species to get on with each other. Doesn’t [01:40:55] need teaching in a in a in a book. And it’s important. Yeah. Because we almost default into this [01:41:00] idea of if there was no ethics, we’d fuck each other up. But that’s [01:41:05] not how species behave.

Mahmoud Ibrahim: Well, I mean.

Payman Langroudi: And by the way, I think when.

Mahmoud Ibrahim: You when the [01:41:10] species.

Payman Langroudi: When there is ethics, we fuck each other up. Let’s not forget that too.

Mahmoud Ibrahim: But I don’t know that [01:41:15] it’s species wide, because, I mean, just look at the history of.

Payman Langroudi: You [01:41:20] know, wars and things.

Mahmoud Ibrahim: Yeah. People, you know, basically just going and invading [01:41:25] another country to take all its resources.

Payman Langroudi: I know, but.

Mahmoud Ibrahim: Off.

Payman Langroudi: Of often based on religions [01:41:30] and things as well. Yeah. Like it’s almost like it’s almost like God is on my side, that thing.

Mahmoud Ibrahim: Well, [01:41:35] that that may be used as an excuse a lot of the time, but I think a [01:41:40] lot of it is it’s wealth power, it’s resources. It’s what’s [01:41:45] going to make me richer, you know. And, um, those people have something that can [01:41:50] make me richer. And I have bigger guns, so.

Payman Langroudi: That’s always going to.

Mahmoud Ibrahim: Work. Yeah. Uh, [01:41:55] so, yeah, maybe it’s not species wide. Maybe it’s more, I don’t [01:42:00] know. Oh, yeah. Interesting. You said it’s [01:42:05] a dark part of the deep part.

Payman Langroudi: But what’s a [01:42:10] the best lecture you’ve ever been to? What comes to mind? Who [01:42:15] gave the best lecture?

Mahmoud Ibrahim: Um, for me, I [01:42:20] think Frank Speer probably comes to mind when I think about someone [01:42:25] who has talked some of the most sense [01:42:30] I have heard.

Payman Langroudi: Consistently for a long time. Right.

Mahmoud Ibrahim: Yeah, yeah, yeah. [01:42:35] And his his pragmatic approach to things just [01:42:40] always worked for me and has always made sense in my head.

Payman Langroudi: You’ve not done [01:42:45] the continuum. You’ve just had the CDs and things.

Mahmoud Ibrahim: I’ve not visited Scottsdale, but [01:42:50] yeah, CDs. And then, you know, I’m part of their online stuff. Up until now. [01:42:55]

Payman Langroudi: Such.

Mahmoud Ibrahim: A great deal on most of it. But, you know, you feel sometimes like you want to just give back. Yeah, yeah yeah, yeah. [01:43:00] In a way, yeah. But it’s such great stuff. Um. And yeah, he’s always [01:43:05] just talked sense I found.

Payman Langroudi: And what [01:43:10] is a course that if, if, if you had no time and money constraints at all. [01:43:15]

[TRANSITION]: Mhm.

Mahmoud Ibrahim: That would go.

Payman Langroudi: On, of course. Would you jump to first?

Mahmoud Ibrahim: Could [01:43:20] I pick more than one?

[TRANSITION]: Sure.

Mahmoud Ibrahim: I go on, uh, [01:43:25] the panky and the choice continuance. Because. [01:43:30] Obviously, they’ve been [01:43:35] around a long time. Uh, panky. Specifically, they there’s a lot [01:43:40] more than just teeth. Yeah. Then they talk about.

Payman Langroudi: Personal [01:43:45] control and finances. Lots of stuff. Lots and lots of nice stuff.

Mahmoud Ibrahim: And and and ultimately, [01:43:50] you become part of something quite, quite big, quite well established. [01:43:55] Quite, you know, the network uniform. Uh, but also the ideas that you’d get, I [01:44:00] think would be amazing, you know. Um, so, so those two and being [01:44:05] in that space in terms of, you know, being an educator, being that sort of stuff is [01:44:10] in no way for me has ever has ever signalled that I should. [01:44:15] Okay, well, don’t go on courses anymore. No, no, because.

Payman Langroudi: Quite.

Mahmoud Ibrahim: The opposite. You know, what are people going to [01:44:20] think you’re going to learn? Why should I learn from you know that doesn’t work like that. You know.

Payman Langroudi: I [01:44:25] was to an illustrator came on MSM, but I have not seen [01:44:30] anyone take as many notes. You know, we’ve we’ve we’ve trained 1750 [01:44:35] dentists. I just found out. Yeah. Out of those 1100 dentists. Yeah. And [01:44:40] your sister took the most notes. He was just busy. Busy. No no no [01:44:45] no no no. Says and you realise, you know that that that cat doesn’t need to take notes. He’s doing [01:44:50] full mouth rehab every day. He’s not doing much composite. Yeah. Like he he was there for the [01:44:55] curiosity. Yeah. You know and I think I think teachers [01:45:00] should go on as many courses as possible.

Mahmoud Ibrahim: Yeah I mean I do I, I aim to go on, [01:45:05] uh, you know, a few a year at least. And, you know, I’ve always got a composite one on there [01:45:10] and I’ll always, you know, someone will be like, aren’t you gonna. Because I’m [01:45:15] hopefully at some point I’m gonna teach you myself. Aren’t you gonna teach you? I was like, so I’m [01:45:20] not gonna do with it. No. On the contrary. Um, well, the one thing I do try and do, though, is like, if I am [01:45:25] gonna go on one, I always let the person know in terms of like, hey, uh, [01:45:30] are you.

Payman Langroudi: This is who.

Mahmoud Ibrahim: I am because I’m. No, not. This is who I am.

Payman Langroudi: No, this is this is what I plan to do.

Mahmoud Ibrahim: Yeah, [01:45:35] I plan on some, you know, like entrepreneurs coming out. There’s going to be some competent teaching there. You [01:45:40] know, just so you know, I’m not intending on stealing stuff.

Payman Langroudi: That’s good.

[TRANSITION]: Man.

Mahmoud Ibrahim: But. [01:45:45] Yeah, exactly. I thought, you know, if I don’t say anything, they might think, oh, I came and, you know, that’s like, [01:45:50] that’s mine. Yeah. Uh, whereas, you know, if I say.

Payman Langroudi: What about which book or paper was [01:45:55] like a stand up.

Mahmoud Ibrahim: Um, I [01:46:00] can’t quote you the reference for the paper. Um, but I can tell you [01:46:05] what happened. And, uh, this is one that really did change my mind. Um, and it was, [01:46:10] um, you know, I was looking at We’re going to seclusion. Right? So, uh, looking [01:46:15] at group function versus canine guidance in people, right. And they found and they the way they looked at it was [01:46:20] they, they they took 15 people and it’s not massive sample size, but they took 15 people that have naturally [01:46:25] occurring canine guidance. So when they grind left and right, they’re just on their canines. And they took another 15 people [01:46:30] who have naturally occurring group function. Right. Um, and what [01:46:35] they did was they, uh, checked their EMG levels for the, the muscles and how [01:46:40] hard they’re firing or whatever. And surprisingly, they found that there [01:46:45] was really no difference. Right. So we are traditionally [01:46:50] taught, right. If you give people canine guidance, [01:46:55] you will shut the muscles down and therefore they won’t grind as hard and therefore your restorations [01:47:00] will be protected. Whereas if you give them group function, you know the muscles are going to go [01:47:05] crazy and stuff’s going to break. But the evidence doesn’t necessarily support [01:47:10] that. And on the flip side, you’ve got where you do have group function. Remember [01:47:15] there’s more than one tooth taking that load. So if there’s two teeth taking the load, [01:47:20] you have half the load on each tooth there or thereabouts. Right. Um, so [01:47:25] I stopped being scared of group function. And now I use it as [01:47:30] a tool when I need to. Right. So if I’ve got a [01:47:35] compromised canine or, you know, or if I think this patient [01:47:40] really grinds their teeth quite hard, I want to spread the load as much as possible. You know.

Payman Langroudi: Canine is an amazing [01:47:45] thing, though. Yeah. I feel like there’s mysteries in the canine. Yeah. Because it’s.

[TRANSITION]: It’s not a mystery. [01:47:50]

Payman Langroudi: Though. Well, what I mean is, like the PDL of the canine is different to the PDL [01:47:55] of every other tooth because the number of times you see only canines left. Yeah, that like, [01:48:00] it’s a stronger tooth than the rest in every way. Yeah.

Mahmoud Ibrahim: So there’s lots [01:48:05] to it. So there’s the bone around it. Okay. It’s buttressed, so there’s more bone around it. Um, [01:48:10] look at the shape of the palatal surface [01:48:15] of a central versus a canine. The central is much more concave, [01:48:20] right? Whereas a canine can actually have a convexity in it, which is going to again, be [01:48:25] more resistant. Right. Um, it’s in the corner of the mouth. Now [01:48:30] that means it’s furthest away from the TMJ. But also it means that [01:48:35] when the patient grinds side to side. And the reason grinding [01:48:40] is mostly side to side is because not to get too deep into it. But you’re again, [01:48:45] there’s no proof of this. This is my logical thinking is if you go [01:48:50] purely forwards, both of your condyles are out of their socket. So [01:48:55] you have basically two of the joints sitting on slippery slopes. [01:49:00] Right. It’s hard to exert any force without having the kernels [01:49:05] just slip back. Whereas when you go one side, there’s one condyle that is still braced in the socket, so [01:49:10] it gives you a point to push against.

Payman Langroudi: Throughout this conversation I’ve been moving my jaws around. Yeah.

Mahmoud Ibrahim: So [01:49:15] you see actually that most grinding is left and right. Very little of it is purely forward. And [01:49:20] the other thing is to do a purely forward motion. You need both lateral pterygoid to contract nearly at the same time, which [01:49:25] is not which is a coordinated movement, because bruxism is an uncoordinated movement anyway. [01:49:30] So again, if you’re going to go mostly side to side, and our materials handle [01:49:35] stress best when they are compressed, you want the load to go on the tooth that’s on [01:49:40] the side, because then the material is being squeezed rather than being flexed. So [01:49:45] again, it’s one of those where we stumbled on canine guidance and we [01:49:50] made it into this, like panacea, but for the wrong reasons, [01:49:55] or at least the wrong thinking. But there is, you know, I have a slide. And of course I was [01:50:00] like, why is canine still a thing? You know, because the guy who, you know, came up with [01:50:05] the idea, Mikko, Amico basically just looked at the skulls of a bunch of dead people, and he found the ones that have [01:50:10] canine guidance. Didn’t have worn canines, but did they have canine guns [01:50:15] because they didn’t have worn canines, or did they have unworn canines because they had canine guidance? [01:50:20] Mhm. Right. Chicken or egg? Um, but it just so happens [01:50:25] that actually there is a good reason for why the canine is useful in those situations. But [01:50:30] it’s not magical. It’s logical.

Payman Langroudi: Have you ever looked at animal teeth like [01:50:35] it’s really interesting right.

Mahmoud Ibrahim: Like, yeah, it’s designed to stick it in flesh [01:50:40] and then pull. Yeah. So obviously it’s designed to take that lateral load.

Payman Langroudi: But which is if you [01:50:45] look at like a dog’s teeth or whatever. Wolf’s teeth. Yeah. It’s a whole other [01:50:50] like it’s, it’s.

Mahmoud Ibrahim: It’s, it’s compared.

Payman Langroudi: To everything. Times the size of every other. Interesting. Yeah. Yeah. [01:50:55] We come to the end of our time, man. But I could keep talking forever.

Mahmoud Ibrahim: Yeah. Me too. Man, this was fun. [01:51:00]

Payman Langroudi: The final question is, are the same every time? Yeah. Fancy [01:51:05] dinner party, fantasy, fantasy dinner party. Three [01:51:10] guests, dead or alive. Who do you have?

Mahmoud Ibrahim: Um, yeah, you might remember that. Obviously, we had this [01:51:15] planned, uh, for late last year. Mhm. And then, um, [01:51:20] uh, I had to cancel the first one that was set up, uh, because we lost my dad. [01:51:25] Yeah. Suddenly sort of passed away. Um, so, you know, I [01:51:30] changed the list I had from back then to include him, uh, so [01:51:35] that I can, you know, catch him up on what I’ve been up to and stuff. And. And I don’t think [01:51:40] any of us, uh, live our lives without sort of any regrets and stuff. So, [01:51:45] you know, whether it’s something you should have said or something you should have done, or something you shouldn’t have said or shouldn’t have [01:51:50] done and given the chance to either, you know, rectify [01:51:55] some of that. I don’t I don’t think I’d let let that go. So I’d have him. [01:52:00] Um, and it’s even the second [01:52:05] person. I was on the original list anyway, but it has even more meaning now and I’ll explain [01:52:10] why. But it would be David Attenborough. So again, growing up, it was one of those things that my [01:52:15] dad and I bonded on. You know, I was talking about my son and how me and him always loved to talk about basketball. It was just something we bond over [01:52:20] again, like nature shows and stuff like that and Top Gear, everything else was just two things of me and my dad always [01:52:25] watched together, so that’d be cool, because also, I mean, imagine the stories the guy like David [01:52:30] Attenborough was just unbelievable.

Payman Langroudi: It could be Prime Minister tomorrow if you want.

Mahmoud Ibrahim: To easily.

Payman Langroudi: Vote for everyone [01:52:35] easily.

Mahmoud Ibrahim: Um, and then the last one was a little bit more tricky. But [01:52:40] again, um, I think, I think I, [01:52:45] you know, take it back to my family in a way, something I could then speak to with about [01:52:50] my, uh, with my son about would be I’d have Michael Jordan.

Payman Langroudi: So, uh. [01:52:55]

Mahmoud Ibrahim: You know, the guy was an is, uh, a legend, uh, in every [01:53:00] sense of the word. But also he wasn’t universally [01:53:05] loved. You know, in terms of his team-mates, it was a hard person [01:53:10] to, to, to be with in terms of being being his team-mate being, um, [01:53:15] uh, being someone he relied on. You know, he held [01:53:20] himself to such a high degree that it’s very hard to keep up with that. [01:53:25]

Payman Langroudi: Obsession comes with sacrifice, man. You know, like, you know, it’s just you know it. You [01:53:30] know it. Yeah. It’s.

Mahmoud Ibrahim: Yeah, I’m sure there’s plenty of people [01:53:35] out there that are both very successful and very good people [01:53:40] and good with the relationships and stuff. But I do see a bit of a trend [01:53:45] where the people who are exceptional.

Payman Langroudi: You know, become the best in [01:53:50] the world by acting like everyone else. You have to act very differently to anyone else. Right. And [01:53:55] that causes problems.

Mahmoud Ibrahim: Yeah. And the amount of self-belief, I think, is where [01:54:00] I would like, want to maybe like pick his brain a little bit because, you [01:54:05] know, I’ve I’ve again it’s one of those where it’s almost a superpower. [01:54:10] Like having that much belief in yourself is amazing, you know. And [01:54:15] uh, it can it can allow you to do things other people wouldn’t even try. So, [01:54:20] um, yeah, I don’t know how much fun the guests will have with each other, but I’ll have [01:54:25] a great time with it.

Payman Langroudi: Who was the fourth that got kicked out? Do you remember?

Mahmoud Ibrahim: Um. [01:54:30]

Payman Langroudi: Never mind.

Mahmoud Ibrahim: I don’t remember. No.

[BOTH]: I wasn’t that [01:54:35] good. Clarity.

Payman Langroudi: Final question. On your deathbed, [01:54:40] surrounded by your loved ones. Three pieces [01:54:45] of advice. And people take this differently. Like it could be I did [01:54:50] this. You do it, too. Or it could be, I wish I did this. You [01:54:55] do it.

Mahmoud Ibrahim: That’s a mix of both, I think the [01:55:00] one it would be the you [01:55:05] know, the pursuit of excellence in anything can be its own reward. But [01:55:10] at the same time, it might open doors for you don’t even know exist at this point. [01:55:15] You know, so I look back at my own experience where, you know, when I was [01:55:20] studying, you know, going down these deep rabbit holes and becoming obsessed with [01:55:25] occlusion dentistry and just getting better at it. I didn’t know that I was someday going to [01:55:30] teach. Like, if you told me ten years ago you were going to maybe start teaching, I would have laughed in [01:55:35] your face, you know, like, nah. Um, so you just never know. [01:55:40] Second piece of advice is one I am giving them because [01:55:45] maybe I’m not very good at it. Uh, but that is. Don’t [01:55:50] wait for. Life [01:55:55] to be perfect, or are there [01:56:00] to be no more challenges for you to enjoy your life? Because [01:56:05] life isn’t the stuff you do between these challenges. It is the challenges, right? So [01:56:10] try and find time. I’m really not good at that.

Payman Langroudi: So it’s so easy to say when [01:56:15] I sell the business I will be this happy guy or whatever. Yeah, like so [01:56:20] easy to say that.

Mahmoud Ibrahim: And even on smaller things, you know, when we’re done with this house, one of the kitchen when [01:56:25] I’ve, when this practice is set up, when I’ve written this course, once I’ve done this and it’s always something else, [01:56:30] you know, and, uh, so very true. Don’t wait. Um, the last one [01:56:35] again, I think is, is is really important. I think I’m reasonably good at this, but it’s [01:56:40] take your work seriously, but don’t take yourself too seriously. You know, [01:56:45] like, try and be the best that you can be, but [01:56:50] do it humbly, you know, don’t don’t think you’re all that, Um, [01:56:55] you know, strive, try and be the one who wins the prize. But if you, you [01:57:00] know, you trip up, getting, uh, onto that stage to try to accept it, you [01:57:05] trip, just own it, you know? Laugh along with everybody else because [01:57:10] there’s no point in taking it too seriously. You’re not. Not [01:57:15] all that.

Payman Langroudi: You’re not all that. The lovely way to [01:57:20] end it. Do you know Gary Vee? He talks about that, that idea of, [01:57:25] hey, if someone if something fails and someone attacks you, don’t worry about [01:57:30] it. But at the same time, as people are pumping you up that don’t get high on that supply [01:57:35] either. Yeah, it’s very true. Very, very true. It’s a massive pleasure, man. Really, really [01:57:40] enjoyed it.

Mahmoud Ibrahim: Yeah. Me too man.

Payman Langroudi: Really good. I hope we do it again. Yeah. And good luck with the, [01:57:45] uh, on breakable. Unachievable. It sounds a bit like [01:57:50] that Nicholas Taleb. Antifragile.

Mahmoud Ibrahim: But that’s Oh, yeah.

Payman Langroudi: It’s [01:57:55] a nice word.

Mahmoud Ibrahim: Yeah.

[BOTH]: What’s your [01:58:00] name?

Mahmoud Ibrahim: Names? Uh, probably not the best thing [01:58:05] about it, but it’s.

Payman Langroudi: Thanks so much.

[BOTH]: For doing this.

Mahmoud Ibrahim: No. Thanks, man.

[VOICE]: This [01:58:10] is Dental Leaders, the podcast where you get to go [01:58:15] one on one with emerging leaders in dentistry. Your [01:58:20] hosts, Payman Langroudi and Prav Solanki. [01:58:25]

Prav Solanki: Thanks for listening, guys. If you got this far, you must have listened to the whole [01:58:30] thing. And just a huge thank you both from me and pay for actually sticking through and listening to [01:58:35] what we had to say and what our guests had to say, because I’m assuming you got some value out [01:58:40] of it.

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