Ep. 4: Experience Matters: What You Learn From 6,000 Arches

Part 10:00

This is Podpopuli, podcast for the people. Hello and welcome to Beyond the Arches. I'm Daniel Noorthoek and with me today we have Nicholas Glick. Hey, Doc. How are you? I'm doing all right. How about yourself? Doing well. Today we're going to talk about experience matters. Absolutely. ▶What I've learned and some stuff that I've learned in doing 5,000, 6,000 arches plus. Plus. And, you know, we've spanned a lot of different ways. We've cut the apple a lot of different ways. And so we've learned some lessons.

Yeah. Hopefully today in this podcast, you know, as a listener, as a potential patient, you're going to be able to maybe hear a little bit of the background of what Dr. Noorthoek has seen over his, you know, 5,000 arches, some of the failures he's seen, some of the positives, how he started with starting with six implants and maybe going to five and then going to four. And the reasonings behind that, because as a consumer, you're going to see a plethora of different kinds of marketing materials and it all sounds really cool. But Dr. Noorthoek, you have experience doing all that. So you can actually kind of lead a little credence on why your protocol is the way it is and how you kind of got there.

Yeah. The number one thing I've learned, is that you do lose hair and your hair does turn gray under stress. Yeah. I'm pretty young, but working for another one. I have a couple of gray hairs on the side. I remember when you grew your first one. ▶I was proud of it too. I think this episode could easily be a 10 year podcast, right? Just follow it for 10 years. Um, but I'd like to, to this, this won't be long enough to kind of cover so much stuff. We're going to go through some of the stuff you talked about, but, um, I'd like to make this like, sort of like a mini segment that we do sort of occasionally along the way. Um, because it is part of what we really work off of, right? It's, it's what I've learned from, from, um, doing these cases and what you've learned in working in the lab. What we all do at work is kind of impart and build and grow that whole thing. And it becomes sort of your identity, right? You, you become what, what your past experience is. And so it's a very, very big topic and very, very broad.

There are a couple of things that I was going to, you know, kind of highlight. So, um, and that was, it was another, but yet again, I kind of think about these a little bit ahead of time, not, not terribly. So, but I think a lot on a little bit. And one thing I was thinking about today is that the number one thing, this is Dr. Dan's number one thing that I see, uh, or have learned with experience of, of thousands of arches is generally speaking, a patient that goes in hyper nervous of some certain thing happening will generally speak that into existence where they are more likely to have that happen.

If, if a patient is really nervous about, uh, an implant or let's say, uh, the tooth color being wrong, uh, then they're more likely to have that happen. And so I think that's a really, really, really strong, somehow, some way that will end up happening. It really does kind of speak into existence. Now, the way you use that experience is you say to yourself, this person's really concerned about an implant failure. I'm going to make sure that I overbuild this or make it so that it's really locked tight. So that reduces what they've already spoken into existence.

But that's really honestly like the number one sort of just take home the, what is the number one little nugget that's sort of shocking or something different. That's probably like number one, like the person that is the most concerned about getting an infection there, they might, they're probably going to get one more so than the average person, the person that is hyper nervous about the sedation. Um, they're the harder ones to calm down, right? That things, um, affect them in that way that they've sort of spoken into existence.

which is interesting to me. Yeah. And as a clinician, that's your number one job now is,

Part 24:31

okay, well, this patient just put up their walls, their concerns. Now, at least you know how to try to overcome it and do your best, like you said, for implants or making sure that that patient's comfortable and numb. The lights are off in the room when they're getting the sedated process, but you wouldn't be able to overcome any of that if this was your first arch. ▶So I'm sure you have taken different tactics from arch 100 to 500 to a thousand and continue to learn and kind of be a little bit more creative in your ways of calming a patient or listening to them and understanding their concerns compared to when you first did your first full arch case.

Yeah. It's a little bit like when you see the mouse through a maze experiment and they run them through, you know how they were like, have you ever seen the ones where they run it through a maze like four or five, six times and the times get faster and faster and the solves get faster and faster. Same thing if like, we'll say it's a puzzle, right? Every patient's a puzzle. If you're actually doing a jigsaw puzzle and it's our first time doing a 25 piece jigsaw puzzle, you and I doing it together, let's say it takes a minute. I don't know how long it takes to do a 25 piece, but it's going to take us longer than if you then immediately dump it over, set it back out and you and I do the same thing.

It's going to be easier and easier. And so it is that sort of same thing over and over. And so that part got in the middle of this, you know, let's say in arch three to 5,000. It was really, really fun to see that efficiency of doing so many puzzles work out. But there's another thing that's sort of intangible as well. It's decision making, right? It's how, how much time do I need? To make a decision or address a problem or fix something? And how much information do I need as well? Right? Because you start to learn, well, I didn't really, I don't really need to see that piece of information because it's this, this same thing every time, right? So your flow charts changing all, all throughout your career. And the funnest was really when it was starting to get really efficient. And because it was efficient, because you see those, those things work out, you can do a little bit more of a minimal surgery. You're not hurting the patient as much.

So your, your results get improved over time. That's where it gets really fun is when you start to see really, really low complications that you could address if you ran into, because you have the experience, but you're running into less of them because of the decision-making that you're made that you've had to make hundreds of times, right? Not to keep going back to football and Superbowl kind of stuff, but it's the same thing. And so it's really, really fun to see how same thing as, you know, Tom Brady or Patrick Mahomes making a decision, just a simple decision, just what to eat on Superbowl day. They're going to be a whole lot more prepared because they made a mistake and bought, you know, ate too many pieces of sausage or bacon on their first one.

And it made them sick, right? Does that really affect the game? Maybe not, but probably could, you know? So that person that's been in the Superbowl five, six times is going to be, you're sort of good. They may not always win, right? We're still in the human body. We're still doing surgery, but the person that's been there the most is going to be the one that's sort of the most reliable to make the decision. And so experientially or experience wise, when you're starting your career, you see big, bigger complications, right? Or more, you see more probably because you don't have the experience to really make the decisions in the, in the move.

Part 38:16

And then you start to see less. And you don't ever really attribute it to, uh, your technique or you, you're just like, Oh, these implants must be better. But in reality, it's you improving the efficiency and the speed and the postoperative fallout and things like that. So that's, that's been really fun. If I look back and I start to think about things like, Oh, well, you know, that patient, I got more infections because I was making decisions while they were open, or I was trying to figure out how to fit this guide in.

▶And so when I talk to a person that's just starting, right, a clinician, that's just beginning this and they're on the first, their path to their first 50 arches, we'll say, I always tell them your, your fallout rate, let's say your complication rate is 10%. So five of those cases might have a problem, right? I say, uh, sure. No problem. Makes sense. Five of them. Well, you're, and I tell them like specifically, you are going to have at least 10 of them have big problems, right? And they look at you like, yeah, but I care about my patients and I, you know, do all this stuff. I know you do, but that's just the way the numbers work because you're trying to figure things out and you're trying to make it work and it's different parts and pieces. It's not a workflow that you're used to. And you're just naturally going to draw out more, a higher complication rate than you want. And that is a little bit of the cool part to observe too, with, with, it's a little bit of a safeguard.

Right. So we as Dun & One that have sort of, um, made it as an established brand, we're a little bit insulated, uh, where we've made it over that hurdle, right? And that hurdle could be different things, but it could be 50, it could be a hundred, it could be 150. And when I say insulated, I'm saying protected from every single person doing this, because mostly what you'll see is people that maybe don't really have a whole lot, right. To do this, or they don't understand really what kind of game they're getting into and they'll do their first 50 cases and see all those big problems.

And then they kind of lie down and say, well, I don't want to touch those. Those don't work. It's not them. It's always, those don't work. And that kind of protects us from, from competition in a way, because, and, and rightfully so, because if you don't have the hoods, but to make it over the 50 or the a hundred or whatever you want to draw the mark at, then maybe you shouldn't be doing it. Cause as sexy and fun as they want to make this in dental shows and as sexy as fun as they want to make it in training and as sexy and as fun as they want to make it with marketing to, to you as the patient, that's, um, it comes with, it doesn't, it's not for the faint of heart. Things happen and it's a high dollar, we'll say high risk, high dollar, high stakes game. And you have to have the

Part 411:16

wherewithal to fix and address. And keep your calm and understand that the person that's dealing with that complication that was positive, it wasn't going to be them is now that person that's facing that. And they're human. They have emotions. They're disappointed by that. They're of course going to be disappointed in you, maybe not directly, but you have to have that understanding. And that takes time, right? They, um, I'm thinking of something where, where in the movies, they, I've, I've seen a movie where they say, uh, you can't understand love at a young age. You can understand the feeling, but not true love because you haven't gone through the hurt and the letdown and the breakups and the things. And, and once you finally get to a maturity and you can understand what forgiveness means, then you can understand what love means. Right. And that's a very weird abstract way to kind of relate it, but it's the same thing. If you don't understand where a patient's coming from more than you can understand what forgiveness means, then you can understand where those emotions are coming from. You really can't understand how to treat that patient because at the end of the day, we're all human. We all have those emotions. We understand being let down. And, and that's the sign of a true tenured clinician in whatever it may be. It could be a single implant or whatnot, but that's when you see a person give true empathy, they probably have a lot behind them. And that understanding goes a long ways in terms of the relationship, fixing the case, those kinds of things. And I didn't mean to get all like emotional and deep in terms of experience. You were probably expecting like use this implant and do this. Uh, but that, that really is to me, that's the take home of, of experience. Yeah. And for, you know, the experience from a clinician also translates to the rest of the staff. So your staff is going to start understanding. I mean, I remember when I first started working for you eight years ago, if a patient came in with a failed implant, it was almost like, you know, it was like, I don't know, I don't know. I don't know. I don't know. I don't know. Like alarm started ringing. Your eyes got big or not yours, but a staff member treating the patient was like, Oh my goodness. Like you have a failed implant. Like you didn't even want to say it. And it was like the patient's like holding down the chair. Like what is about to happen to me? Am I going to lose all my teeth? Well, now you've done so many arches, the, you know, there is a failure rate, like we've discussed in past episodes, but having a systematic approach to it because now if a patient came in the clinic and for whatever reason, maybe an infection, they lost an implant and they need to have it replaced. It's a simple pat on the shoulder. You're in good hands. No big deal. We're just going to remove it, put a new implant in. We'll get you a temporary or even maybe alter your final zirconia. And before you even know it, you'll be back on the road. Like nothing ever happened. And the patient just mad to come in with a stress level 10. Well, now they're leaving with a stress level three or four.

▶You're not going to ever get it to zero, but they're going to go, wow, I'm in great care. And that only is possible through the repetition of the clinician doing all these arches. Because again, if you were within that first 50, you're going to might throw your hands up and say, man, full arch isn't for me. There is failures coming in. My staff can't handle it. This is just a total nightmare because it derailed my entire day. Whereas if it happened today at 2 PM, 2 30, the office is seeing the next patient. There's no big deal. Life is going on. And the overall vibe for the patient and the entire staff is, well, you're going to be all right. We're going to continue this train. Yeah. It's become more of a, more of a speed bump. Yeah. Another thing that I've learned a lot is when you're doing, when I was trained, I was sort of trained.

This was the devil, right? The, the snap indentures was the King because hybrids don't work. Right. And that's probably a result of just not great materials and techniques and they're not having a consensus and accuracy of data, et cetera. But in my experience, I've really learned to see things for myself and make the decision for myself because this procedure, as much as we've mentioned complications in this and a couple other episodes, this procedure is so straightforward. It's so resolute.

It identifies so many comp, so many different backgrounds and patient base, right? I mean, our patients can range in age from 30 all the way to 97 and the need for it may be all the way from aesthetic with some missing teeth all the way to absolutely no teeth or really bad decay and really bad periodontal disease. Doesn't really matter. Doesn't necessarily matter the background as long as we can get them into something. It's affordable, but the procedure itself with all of the things that it addresses, the procedure itself is resolute, successful, and very predictable. And that predictability gives me confidence and ability to sit and say, in my experience, very well, right?

If my experience was different and the case wasn't in the procedure, wasn't that way, then my experience would be that I don't own Dun & One and I don't have this procedure. ▶But my experience has taught me that this is a really great service. It fits a really big need. It helps a lot of people. It addresses a lot of problems. And it's not always what the talking

Part 517:10

heads say that is correct. It's not even necessarily what the research says. And I follow research pretty well. But what you can use to guide you is good, solid-rooted fundamentals, good, solid surgical technique, good sterile technique, good employee hiring, good machinery, all of those things. If you follow those basics, the rules of the traditional what can be done can be bent a little bit, which is interesting because it reminds me, it's probably, a faux pas to mention Tesla these days, but it reminds me of Tesla. I think you and I were talking about it. One of their little secret sauces is when they started this company, since they weren't one of the big ones, they sort of got disbarred from simple things like latches, vent covers, you name it, rear view mirrors. And they had to start from the ground up, sourcing vendors, designing.

And that's sort of been one of their key. When you sit in a Tesla, I drive a Tesla that has not been vandalized yet. I drive a Tesla. And when I sit in it, it's a very different experience than anything else. And it drives great. And it works wonderfully. ▶So sometimes having that little tweak and not having to go the way of the big corporate or the way that the guru of the industry, the titan of the industry says, has been something that's been a little bit of a challenge for me. And I think that's a good thing.

It's like a secret sauce. You still have to make a car. You still have to put side view mirrors and rear view mirrors and safety alerts. We're not saying reinvent it and make a steel cage or whatnot. But we're saying when you have those fundamentals, when you know the parts and pieces that go into it and you know that you have a good team, thinking outside the box can sometimes be really beneficial. Yeah. And making that comparison to Tesla again, the Tesla, when they first unveiled their first...

Roadster to today's Model Y that was just launched, it's a totally different vehicle. The safety is five stars. You're having all these different full driving techniques, the same way with implant dentistry. I mean, we'll see clinicians sometimes post on Instagram that they did an all on 10 or all on eight or all on six. And does it look cool? Sure. I mean, it might have a shiny red paint of code on it, but that doesn't mean the bones there are good.

And, you know, doing 10 implants, well, that's really only going to benefit the implant company that's selling those implants. So it really does take a clinician to be able to have the time in the chair to be able to see, diagnose and understand what that best workflow truly is, not only for themselves, but also for the patient's long-term care. Because you as a listener, that's the number one thing in the game. Yeah. You want to make sure that your clinician is using a good reputable implant. But at the end of the day, all the trust in them. So you want to make sure that they've gone through the trials and tribulations to make sure they are going to give you the best possible result. So I find that, you know, interesting a little bit about how your career has taken off and you've devoted pretty much your entire life to this full arch dentistry side of things. And that's the only procedure you do. You're not out here doing, you know, crown and bridge cases. You're not doing individual root canals or something of that nature, which you're more than capable of doing. You're not capable of doing, but having it be an implant dentistry focused bit has really allowed you to tailor your protocol to what Done In One is today. And it's something that I think that patients really adapt well to once they start to understand why you do these things, because ▶I'm sure they come in on consults and say, well, Mr., you know, this different clinician has said, well, I need eight implants or I need six implants. And you're going to come in and say, well, maybe your case does need five, or maybe you do need four.

But this is what my protocol is. And they might look at you like, oh, well, you're the same price point as them. Am I going to get ripped off for this? Like, am I not getting a backup camera or anything of that nature? When in reality you are and you're getting the, you know, the appropriate care, it's just, there's different avenues of getting there sometimes. Yeah. If you're getting a car with a back view camera, just it's not, you don't need six implants. You don't need a spoiler in the way, right?

Sometimes the back view camera is of no use if you have a spoiler in the way, and that's what you get to when you get a lot of implants and sometimes they need it, right? The, my, my career has been lucky in the fact that where I've headed and what I, what I have gone to being full arch is truly just been a road or a river or however you want to, you know, a hill of following, following.

Something that's predictable and following something that feels good for the patients and, and feels great to, to be a providing an offering. I didn't just say, oh, I want to make X, Y, Z. ▶Therefore I want to do this, or this is new and shiny. And I hear a lot of people like this. It was this very organic, just sort of accidentally fell into it. And then that turned into more and wow, this really works. And, and it was this very like organic, natural, like, following the river, you know, down, down, uh, on the path. I mean, same for you, right? So

Part 622:51

you've, you've been around for three or 4,000 of those, uh, 6,000 arches. So, you know, in your experience, I'm sure you didn't expect as a little 10 year old kid in whatever grade you'd be fifth grade. I'm sure you didn't expect to work for a dental company and be as passionate as you are about it, but your experience told you and dictated and you followed your, heart or the, the signs enough to say, wow, this is really cool. Like I want to be a part of this.

Absolutely. I had my own dental conditions where I was missing two T's. So I hated the dentist and, uh, still kind of did when you first hired me, I still, I still had a little bit of issues with the dentist. Um, but yeah, absolutely. And it's been incredible to see how your protocol has changed and how that's related to the labs protocol changing and then also directing the treatment coordinators and the assistants. What their protocol is. And it all roots from experience because again, if you're just trying to kind of fly by night and wing it on every single one, well, it comes very apparent and then you don't have the buy-in from your staff members. I mean, I've been with you for eight years now and that's mostly because you've treated me well and you have a protocol and a systematic approach to things that makes me feel at home and says, okay, well I know what Monday, Tuesday, Wednesday, Thursday, and Friday are all going to look like this week. Comparatively, to a lot of clinics, if you don't have a, a, a way of going about this, every single case is going to be a different procedure. And then at that point, it's, it's a crapshoot. Maybe you get lucky in this patient, love their smile, but then you have another patient that's going to come in five days a week and every single day it's going to be a drag and, and it's gonna just eat the morale of the entire office away. Yeah. It's, it's, we all have passions and things that we can look.

That we can look to and say, well, that makes sense what they're saying. You know, you and I both kind of share a passion or an enjoyment for cooking. And I can tell you the pictures that I showed you of things that I was making when, when I first met you and pictures of things you were making when you first met me weren't that great. Right. And, and it's not like we have a totally different kitchen and you have a totally different utensils. It's still pretty much the same oven.

It's pretty much the same. ▶Knives. It's the same dishware, cookware, all of that stuff. And so, but you improve over time because it's a thing of enjoyment because it didn't make you sick because it did taste good. And you thought you could make it better. And that passion and that drive allows you to attain that experience. And the real thing with the experience is you look back and go that, that as that was worth it. I didn't even, I didn't even realize this was happening because I was just kind of following.

My palate, right. For cooking. Yeah. And, and yet I'm here. And now you're looking forward to the next time you get to do it and you can't wait to invite friends and family over to show them what you've created and keep expanding upon it, which kind of, again, and not to continue to relate it back to Done In One, but it relates back to Done In One where yes, if a family member needs this, please come in. I want to show you how awesome this

Part 726:09

company is. I work for and how we're going to be able to get you a brand new set of teeth within, you know, seven, 10 days. Whatever's really up to the patients, you know, kind of liking in their, their acceptance of the case. So it does just continue to compound on wins and you have to start with that first win and then continue to go. And same with full arch. You got to start with that first case to then to get to 50 to a hundred to 2000. And it's, it's incredible. So, I mean, I think over the life of this podcast, you're going to be able to really, not only for other clinicians, but also for patients out there as well to kind of get a, you know, get a, you know, get a, you know, get a understanding of how you've gotten to this point in your career that you can sit at a podcast for 50 episodes and try to explain the, the, you know, trials and tribulations and the wins of full arch, but also just be a real human through the process and say, Hey, this is where we started. These are the issues that we've had. And this is how you can see, you know, great results in your case or in your practice or, or whatever kind of brings you to listen to this podcast. Absolutely. I think, you know, like I said, we're going to go, we're going to experience will be a big part of, of this message and things that we've learned. And so very unrealistic to capture it all in one episode, but I think those are sort of like the starting points of, you know, the passion and the repetition and looking back and sort of the efficiencies, uh, things that we've discussed here are all sort of the high level versions. Right. And then now, now, as we get further and further and deeper into the information, like, you know, you could even relate a portion of experience to what zirconia we use in the lab and all of those things, which we will talk about. So I think it was a good starting point. I appreciate you coming in and, you know, um, I think, uh, I think we've had a good starting point. Yeah. I think it's going to be great. I mean, a wise man once told me that sometimes you have to identify inefficiencies and move away from them. And, um, you know, I think that we're going to really be able to get patients a lot of information here. So I'm, I'm pretty, pumped on that. So that what Nick just alluded to there was, uh, a little inside joke that, um, he came up with when he started. So yeah, I had to give myself credit for that one.

It was a wise man, a wise man. Now, maybe not so wise then. Not then I didn't have gray hairs then, but which is another tale of experience. Yes, sir. So we appreciate you listening like subscribe and submit any questions. If you do have any, we'd like this to be conversational and personal. So, um, that relies, on you asking us for what content you are telling us what content you would like asking us questions, interacting with us. And, uh, so we appreciate your listening and, uh, look forward to seeing you next time. Yep. Have a great one. Thanks Nick.