Join Elevated GP: www.theelevatedgp.com

Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit

Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf

In part two of this in-depth conversation, Dr. John Kois moves beyond theory and into clinical application, tackling the questions every restorative dentist eventually faces:
Who is actually a high-risk occlusal patient?
How do we distinguish past adaptation from active breakdown?
And why do so many "standard solutions" fail to prevent restorative complications?

Building on the foundational concepts from part one, this episode focuses on how occlusion shows up in day-to-day practice—and how dentists can make more informed decisions before committing to complex restorative or implant treatment. Dr. Kois explains why visual wear alone is an unreliable predictor of risk, how to identify whether wear is active versus inactive, and why patient symptoms often tell a more important story than what we see on models or scans.

A major theme of this conversation is closing the gap between chairside evaluation and real-world function. Dr. Kois challenges common habits—such as adjusting restorations with patients fully reclined, relying solely on articulating paper marks, or reflexively prescribing nightguards—and explains why these approaches often miss the true etiology of failure. Instead, he emphasizes evaluating occlusion in positions and movements that reflect how patients actually chew, speak, and function throughout the day.

In this episode, you'll learn:

• How to identify true high-risk occlusal cases before restorative treatment begins

• Why active wear and patient-reported change matter more than historical attrition

• How muscle symptoms, mobility, and joint loading influence predictability

• When nightguards and Botox may mask symptoms rather than solve the problem

• Why larger restorative and implant cases demand a deeper understanding of jaw position, tooth fit, and functional pathways

Dr. Kois also shares candid insights on emerging technologies such as jaw tracking—where they add value, where they fall short, and why they are most impactful in comprehensive and full-arch cases rather than routine dentistry. The discussion highlights an important truth: many restorative failures are not material failures, but diagnostic failures rooted in incomplete occlusal assessment.

The episode closes with a powerful reflection on learning, clinical growth, and professional development—distinguishing information from knowledge, and knowledge from wisdom. Dr. Kois outlines the progression from skepticism to commitment, underscoring why true clinical mastery requires not just understanding concepts, but applying them consistently over time.

Together, parts one and two form a cohesive framework for thinking differently about occlusion—one grounded in physiology, adaptation, and long-term predictability. If you're aiming to move beyond bread-and-butter dentistry and into more complex, fulfilling clinical work, this conversation provides essential perspective on how to do so more thoughtfully and successfully.

Join Elevated GP: www.theelevatedgp.com

Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit

Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf

Occlusion is one of the most talked-about—and most misunderstood—topics in restorative dentistry. In this first installment of a two-part conversation, Dr. John Kois challenges many of the static, mechanical definitions of occlusion that most dentists were taught in dental school and offers a fundamentally different way of thinking about how the masticatory system actually works in real patients.

Drawing from decades of clinical practice, specialty training in both periodontics and prosthodontics, and his experience educating restorative dentists around the world, Dr. Kois reframes occlusion as a dynamic, adaptive system rather than a fixed set of contacts to be checked off with articulating paper. He explains why relying solely on traditional concepts like MIP, right and left working movements, and morphological classifications often fails to predict long-term outcomes—and why this gap is at the root of many restorative failures, postoperative sensitivity, mobility, muscle pain, and patient dissatisfaction.

This episode lays the foundation for understanding occlusion through the lens of function, adaptation, and risk, rather than dogma. Dr. Kois introduces key concepts such as pathway wear, jaw position relative to the head, and the body's adaptive responses to occlusal disharmony—highlighting why so many problems are misattributed to bruxism, airway issues, or "parafunction," when the true etiology lies elsewhere.

You'll hear why:

• MIP should be viewed as a terminal position, not the starting point of occlusal analysis

• Static bite relationships often tell us very little about whether an occlusion is actually working

• Pathway wear is one of the most critical—and commonly missed—risk factors in restorative cases

• Many restorative "failures" are actually adaptive responses by the body trying to protect itself

• Dentists often succeed not because occlusion is ideal, but because patients adapt—sometimes at a long-term biological cost

This conversation is especially relevant for dentists who want to move beyond single-tooth dentistry and into more comprehensive care—full-mouth cases, complex restorative planning, implant rehabilitation, and interdisciplinary treatment. If you've ever had a case that looked perfect on the articulator but unraveled clinically, this episode will help you understand why.

Part one sets the conceptual framework. In part two, the discussion continues into how these principles influence diagnosis, restorative decision-making, and long-term predictability.

If occlusion has ever felt confusing, frustrating, or inconsistent in your hands, this episode will help you start seeing the system differently—and more clearly.

In Part 2 of this two-part conversation, we move from theory into the real-world details that quietly put dentists at risk every single day.

My guest, Evan Sampson, is a healthcare attorney who has served as general counsel to one of the largest dental support organizations in the country. He brings a rare and invaluable perspective at the intersection of dentistry, law, payer audits, and regulatory enforcement — and in this episode, we get very specific.

We unpack what actually makes certain procedures, CDT codes, and clinical scenarios high-risk from a fraud, waste, and abuse standpoint, even when there is no malicious intent. Evan explains how dentists inadvertently get flagged as outliers, why payer audits are often data-driven rather than complaint-driven, and how documentation gaps — not clinical skill — are what ultimately create exposure.

This conversation goes deep into:

• Why up-coding, unbundling, and weak surgical extraction documentation are some of the most common (and expensive) pitfalls

• How payer audits are triggered, what auditors look for, and why Medicaid claims carry disproportionate risk

• Why dentists should write progress notes as if a regulator, payer, or board investigator will read them later — because one day, they might

• The legal realities of fee-for-service, out-of-network billing, professional courtesy, discounts, and when "good intentions" can still create compliance problems

We also spend significant time on a topic every dentist encounters but few are trained to manage: difficult and high-risk patients.

Evan shares how to identify red flags that may not be obvious at first, when it is appropriate to terminate the doctor-patient relationship, and how to do so without exposing yourself to allegations of abandonment. We discuss unruly patients, non-payment, mid-treatment dismissals, refunds, releases, and why protecting your license sometimes means making uncomfortable — but strategic — decisions.

This episode is ultimately about risk reduction, professionalism, and self-preservation. Not practicing defensively, but practicing deliberately. Tightening the details. Building a culture of compliance. And understanding that most dentists who get into serious trouble never thought they were doing anything wrong.

If you care about protecting your license, your livelihood, and your future — this is an episode you don't want to skip.